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Getting What You Need: What to Do If Your Practice Is Not Providing What You Need to Do Your Job. Image courtesy of kues1/stock.adobe.com. 


There are things that you want for your practice and things that you need to do your job. Some hygienists would argue that these are 2 ways of saying the same thing. However, your dental practice isn't always of the same mind.

So, which things do you need, how do you get them, and what do you do if you hit a brick wall? We found out from a few experts in the dental hygiene field.

Katrina Sanders, RDH, BSDH, M.Ed, RF, a practicing dental hygienist, dental hygiene educator, and international speaker, says hygienists' needs have changed since she began her career. The hygiene field has experienced a paradigm shift regarding how to treat patients and the technology used to do it.

For example, Sanders says hygienists examine more tethered oral tissues and screen for more pathologies in the mouth than before, as well as discussing sleep, airway, and TMJ complications. Also, aging patients require complete dentition maintenance as the older population lives longer and hangs on to all their teeth. Hygienists also have infection control and sterilization to consider. Furthermore, patients present with advanced disease from conditions that worsened from delayed treatment during the pandemic and now need care.

Hygienists are constantly adapting to those changes and demands, taking on additional duties while still handling the old ones, Sanders explains. Hygienists are catching up and seeing new layers of disease, new lesions, and new inflammation in their patients, trying to reframe the patient experience based on what they see. What they need is another set of hands.

Sanders has an assistant in her clinical practice that works alongside her, allowing her to deliver the standards of excellence expected from hygienists today. Her assistant is:

Preparing and auditing charts for future appointments, noting who needs imaging or advanced imaging

Taking medical histories and inputting them into the electronic health record (EHR)

Handling tasks like perio charting, intraoral and extraoral photos

Scribing clinical notes during the patient appointment

Managing patient correspondence for the hygienists

Retrieving equipment so Sanders doesn't have to change personal protective equipment (PPE)

Priming Sanders regarding patient care triggers, like queries regarding applying fluoride varnish or locally delivered antibiotics in specific areas of disease

Communicating with the dentist about initial findings or exams needed

"To provide that level of care needed by the community of patients, hygienists need an assistant," Sanders says.

A Safe and Supportive Working Environment

Speaker and presenter Caitlin Parsons, RDH, C-IAYT, wellness and ergonomic professional says hygienists need a safe working environment for practitioners and patients, from infection control protocols to the cords and equipment in the operatory, making their work safe physically, to feeling safe to express themselves regarding concerns about operations at the practice.

"If you don't feel safe to go to your doctor or manager and bring up challenges, then that practitioner is unhappy, doesn't feel supported, and probably can't do her job properly," Parsons says.

In addition, Parsons thinks good ergonomics and equipment are essential. For example, is there a protocol and budget at the practice for replacing equipment? She also feels that hygienists also need to feel there is a trusting relationship there, autonomy to do their job, and support from the practice stakeholders.

"That goes for everyone in the office," Parsons says. "The hygienists want to feel supported by the front office person, but also, it goes the other way."

Brandi Hooker Evans, RDH-ER, MHE, speaker and consultant with Stellar Outcomes, says hygienists need the courage to challenge the status quo before addressing any product, training, or adjunct they want for their practice. In addition, hygienists should feel confident about their performance in the past so they can plan for their future possibilities.

However, the future also requires good ergonomics. So, Hooker Evans thinks operatory equipment that keeps hygienists' bodies feeling good is essential, which includes magnified vision.

"A lot of hygienists still are not using loupes, and we know that can be huge," Hooker Evans says. "Even more so, the ergonomic loupes that have taken the world by storm where we don't have to lean our head forward is an incredible investment in our body."

However, investing in the future doesn't always mean buying something. Hooker Evans suggests hygienists alternate between seated and standing positions when delivering patient care. She thinks this free option is an excellent way to improve ergonomics and challenge the status quo of how they provide treatment.

"A third thing is to pick a new topic that applies to their patients. It doesn't have to be their teeth, but anything that has to do with their patients or their day at the dental office that is new and exciting that they can geek out on through the internet," Hooker Evans says. "Follow a new Instagram account about sleep apnea, take nutrition or a movement course, or learn about myofunctional therapy. One of the reasons we bet so burnt out is because we never expand our horizons."

Moreover, hygienists can help the patient take responsibility and accountability for their health. By giving patients the tools and changing the conversation, hygienists allow patients to diagnose their gum disease and own the behavior changes needed to treat it.

"Hygienists need the courage to empower their patients to be in charge of their own health," Hooker Evans says.

Tim Quirt, DDS, Senior Vice President of Clinical Operations at Heartland Dental focused on hygiene operations and development, says hygienists need work-life balance. The repetitive nature of clinical hygiene requires a good environment that supports work-life balance to be successful.

Also, viewing dental hygiene as a career and not a job is essential. Dr Quirt recommends plotting a path for career growth on the work side of that balance, so hygienists don't get bored doing the same procedures all the time.

"There are other ones out there that you should learn and should be a part of your developmental opportunities," Dr Quirt says.

These opportunities also require a robust hygienist-doctor partnership. Therefore, hygienists should find a doctor with whom their clinical philosophies mesh so that the doctor can support the hygienist in their career growth and work-life balance.

"Self-care is a big thing, too, because it's not going to be easy, and you will be doing it for quite a long time," Dr Quirt says.

Getting what you want or need requires some strategy. Sanders thinks the first step is recognizing an appropriate time to discuss getting things done, which isn't when the dentist just finished a complicated treatment.

In addition, she thinks having an ownership mindset is essential. The hygienist should research and present what they want and be prepared to defend why it is critical to the practice goals.

For example, suppose the hygienist is looking for a supportive hygiene assistant. In that case, they should be prepared to report the going rate, have a working start to the job description, and be able to clarify where the new assistant could help not only financially but also in elevating patient care.

"So, it should be things like, 'Doctor, I see that there are opportunities to do more perio. My hands are currently tied; I'm struggling to gather the correct assessments and educate patients in one sitting. But, with the use of an assistant, I believe I would have the ability to gather all of these pieces and educate the patient while empowering my assistant to get that person scheduled for treatment,'" Sanders says. "Then, the doctor, or practice owner, can see that the dental assistant becomes an extension of the hygiene team, helping to support the patients."

Parsons agrees that emotional asks are not as successful as good communication skills and research why this ask is necessary.

For example, Parsons describes herself as a people pleaser early in her career that didn't want to make waves at the practice. However, she couldn't express herself about not having what she needed, and she regretted how these frustrations ended up coming out later. Therefore, she learned to process emotions and discuss her concerns with the practice stakeholders conversationally.

Also, hygienists need to have realistic expectations about what the doctor provides. Parsons says that getting what they need might require hygienists to invest in themselves. Seeing that commitment to their career and the practice through self-investment could enhance the doctor-hygienist relationship, making the dentist more amenable to supporting the hygienists' requests.

"That collaboration allows for more freedom and less stress and confrontation," Parsons says.

In addition, Parsons thinks hygienists should research and connect with other professionals through networking groups or social media. By discovering how other hygienists manage their work environment, hygienists can advocate for themselves.

"It can feel lonely when we feel like we have no other options. But, often, there are other options that we don't think about," Parsons says. "Sometimes it's a matter of being patient and putting in the time for getting what you need. We build that trust and put in the work for them to do that for us."

For new hygienists, Dr Quirt says hygienists should know how they want to spend their clinical days and their practice philosophy. For example, is it working in a busy practice that emphasizes the prevention and treatment of periodontal disease or one that works with many kids? Or all of the above? Once hygienists know these details, finding a situation and physician that supports that philosophy of care is more straightforward.

By contrast, seasoned hygienists will want to build that physician-hygienist relationship and leverage that to get a work environment that meshes with the hygienist's philosophy. When hygienists know what stresses them out and what feels healthy, they can communicate that to the practice stakeholders.

"Especially now when it's an employee environment. You can shop around and make sure that the practice is a great fit for you," Dr Quirt says.

Hooker Evans says that hygienists first need to roll up their sleeves; none of this change is coming to your email inbox.

"When I want to change my life, my go-to step is to decide what it is I want and then, second, see if someone else has it. Then, if they do, I figure out how they got it," Hooker Evans says.

She also recommends combining the power of virtual and real-world communities. For example, use the web to find a book, blog, or article or search for an online community about your areas of interest. Also, visit with the team to find like-minded team members. When you have 3 or 4 people excited about something at the office, it gets momentum, Hooker Evans says.

"It snowballs if you allow your team to get on board with you, which is also how you're going to get it to come to fruition," Hooker Evans says.

When It Isn't Going to Happen, What's Next?

The demand for hygienists is still high after the pandemic. Dr Quirt says that hygienists are in an empowered situation right now, which isn't bad. If a practice is not meeting hygienists' needs, they can find one that does, Dr Quirt says.

"If it's not a fun office or not busy enough, or you don't feel like you are achieving the next level in your career, then it's time to consider a career move," Dr. Quirt says. "It might require finding something that's a better fit. It could be private practice, a small group, a dental support organization practice, or it could even be teaching and training. So, there's a lot out there. But, first, you've got to go back to your philosophy and determine what is making you unhappy with where you are right now."

Moreover, Dr Quirt thinks hygienists have more opportunities today than ever. There are more resources available and more types of practices to join. Hygienists could also consider getting their degrees and becoming a dentist.

"The world is your oyster right now," Dr Quirt says.

In addition, Heartland Dental has locations in more than 38 states, making it easy to migrate elsewhere in the country. Heartland has built-in support, education, and different ways of compensating employees, including bonuses. There are also career growth opportunities as regional hygiene mentors or as operations and education professionals. Dr Quirt says they have many options at Heartland that are not necessarily patient facing.

"We try to target whatever a hygienist wants, even on the work-life balance side. So, if you're looking for part-time or temporary, we are open to any and all options for hygienists," Dr Quirt says. "And you have freedom of movement. So, if you don't like one office for any particular reason, you can move within the family of practices. So, it just makes it easier."

Sanders also thinks hygienists should be open to investing in the equipment they need to do their jobs if a practice is unable or unwilling to provide it for them. While not a popular option, Sanders thinks taking control of the situation can be beneficial. However, she also thinks hygienists should seek clarity on what is needed to get what they want.

"This insight gives you a lot of information about some of the challenges or pain points for the practice," Sanders says.

Moreover, having these conversations has the added benefit of communicating to the practice stakeholders how invested the hygienist is in the practice and its vision. It also shows them what is important to you, she says.

"It shows that you're a 'partner' in the practice and that you're emotionally and mentally invested in excellence within the practice," Sanders says.

If a practice consistently doesn't give a hygienist what they need, Sanders says it could mean that the core values and philosophies are not in alignment. After careful consideration, Sanders would encourage hygienists in that position to find another opportunity.

"My hope is that a practice owner who has been afforded the opportunity to give you the things you need but chose not to would acknowledge that this is a decision that you made to preserve the longevity of your career and your joy and passion for it," Sanders says.

Parsons agrees that if it isn't happening, standing up for what you believe and deserve is essential, no matter how difficult that might be. Moreover, it is critical to leave a toxic work environment.

"People have bills, though, so if you can't jump out of a job, start looking and putting feelers out there," Parsons says, adding that the networking groups can be an excellent place to find new opportunities. "Temping is a great way to see different offices, what you like and what you don't, or how other people are doing things. Then, try the new office and see what works. You never know if you can get a permanent position from temping, especially these days.

"Parsons also likes Cloud Dentistry, a dental staffing platform that connects practices with dental professionals for permanent, part-time, or temporary positions.

"You can put in your specific preferences, whether it's hours or type of office or how far it is from you, so many different things, which is nice," Parsons says.

Sometimes, it requires introspection, too. Hooker Evans thinks that hygienists that are not getting what they need should reflect on their role in the failure. For example, have they been clear in their intent, expressed what they are hoping for, and delivered it with kindness? If not, maybe modifications in these areas could change the outcome.

"See if there's something you can do from inside of you to benefit and support the team and elevate everyone as a whole," Hooker Evans says.

However, she says it might be time to leave when you have done all that and still don't have what you need. Trying a new office as a temp might be a path to new possibilities. Hooker Evans likes TempStars for connecting offices and dental professionals.

Some hygienists decide to leave clinical hygiene. Hooker Evans works with hygienists that are now yoga instructors, myofunctional therapists, marketing business owners, and sleep specialists. Some move into nutrition or life coaching. In all of these cases, their background in dental hygiene has been foundational to their success. Hooker Evans believes that there is a place everyone is supposed to be, and while it's scary to move on, it might be the best thing for the hygienist's career.

"What's on the other side of staying stagnant," Hooker Evans says, "is often exhilarating and beautiful."

Articles

There are things you want and need, and some would argue they are the same thing. So, we explore what to do if your practice is not providing what you need to do your job. 

Getting What You Need: What to Do If Your Practice Is Not Providing What You Need to Do Your Job

Companies market these materials as universal. Touted as one-size-fits-most materials addressing numerous indications, universal materials provide the reliable outcomes clinicians depend on in their fast-paced daily work.

We discuss universal materials options you can rely on, how small a material set you can keep on hand in your armamentarium, and how to sort through the options to find the universal solution that works best for most patients.

One significant category for these materials is universal cement. Jennifer Sanders, DMD, a private practice dentist in Frenchtown, Montana, is a user. After its performance, the most crucial reason she uses it is to reduce her inventory, which is essential to her practice management philosophy.

“I don’t want thousands of dollars worth of stuff sitting in my lab. The more stuff I have, the more it gets lost, or my assistants don’t know where it is or what to do with it. So if I can simplify, that makes everybody’s life a little bit easier,” Dr Sanders says.

Although she doesn’t use a one-shade universal composite, she does use a brand where the shades transition very well. The universal composite she uses isn’t as streamlined as the one-shade composite, but it gives her more control, a critical feature to many dentists.

Ease of use is essential to Dr Sanders too. Different systems have different workflows, which the dental team needs to remember. This process can leave a lot more room for user error when you aren’t as familiar with the workflow, she says. Therefore, using a universal cement often makes it easier to remember the manufacturer’s directions and simplifies the assistants’ setup.

International speaker and presenter Troy A. Schmedding, DDS, AAACD, says he likes Kuraray’s CLEARFIL Majesty™ ES-2 Universal in terms of a universal composite material that can handle most situations. He estimates that he uses it in 80% of his restorative cases in the posterior.

“I don’t think there’s a material out there today that covers 100% of your restorations,” Dr Schmedding says. “Materials that cover the broad spectrum of cases you do daily help you minimize your inventory because they are very reliable products.”

However, Dr Schmedding likes having more materials for anterior work, where he wants to do more mimicking. When working in the anterior, you must have a product line with opacities and translucency, he says. These materials allow clinicians to mimic nature and blend more consistently than they could with a universal.

“But overall, the universal composite is a great outlet for most of your cases,” he adds.

Todd Snyder, DDS, FAACD, FIADFE, ASDA, ABAD, uses BISCO’s All-Bond Universal bonding agent. He says he uses it for every case where a bonding agent is necessary and appreciates how he can use 1 bottle everywhere without sacrificing anything for convenience.

“To me, universal is 1 bottle that I can use without making sacrifices to the patient outcome,” Dr Snyder says. “I can use All-Bond for my direct restorations. I can use it for my indirect restorations. I can use it for my light-cured or my dual-cured. I don’t need any additional bottles ever. And it works with every manufacturer’s product and gets high bond strength."

Speaker and trainer Tim Bizga, DDS, FAGD, practices general dentistry in Cleveland, Ohio. He likes how universal products are great for inventory streamlining and how they provide efficiency and simplicity to the workflow. Like Dr Snyder, he uses BISCO’s All-Bond, and he also likes Prime&Bond elect® Universal Dental Adhesive from Dentsply Sirona. Universal primers have been efficient in his practice because he can use 1 primer with all the substrates, he says.

“Now you don’t have to stock 5 different bottles that expire fast because of their chemistry,” Dr Bizga says. “When they went universal, you got more shelf life and streamlined your inventory.”

Dentists can go relatively small with inventory in some product types, depending on their preferences, Dr Sanders says. For example, she feels some clinicians might only need 1 cement, with the caveat that what clinicians do will drive those decisions.

Dr Sanders is not on board with using 1 composite everywhere in the mouth. However, she believes a composite with fewer shades that can be more versatile allows dentists to simplify their inventory significantly, reducing waste.

“I used to have all these different shades of composite, and they used to expire. I don’t have those anymore. So I’ve pared it down,” Dr Sanders says. “Some of that is me learning and growing in my practice and learning about inventory management, and some of it is the currently available materials.”

Advancements in composite technology for fillers contribute to streamlining materials, Dr Schmedding says. In addition, the spherical shape enables a better balance between light and tooth structure.

“It allows the material to absorb and scatter light better than any materials we’ve had in the past,” he says. “So we’ve all noticed a smaller product line, meaning we have more shades crossing over in composite dentistry than we ever have had before. What that’s done for us is take that 32-shade guide that they used to have and minimized it down to 4 to 6 shades that seems to cover a broad range of what we’re doing in dentistry."

Having 4 to 6 shades from a universal composite is a vast improvement over buying 32 shades, using 4, and throwing away 28, Dr Schmedding adds.

“In that sense, the advancement across the lines has been great,” he says.

Critical Considerations With Universal Materials

According to Dr Snyder, the first question clinicians should ask when using universal materials should be about its limitations. Next, dentists should consider what they are giving up to enjoy a universal application. Although universal can work in some products, in others it can be too much of a sacrifice in performance that leads to inferior patient outcomes.

“As a dentist, you have to think for yourself,” Dr Snyder says. “If something sounds too good to be true, it usually is…not always, but usually.”

The material that will do the job best based on the restoration prep is the driving force behind every product he uses, Dr Snyder says. So if that’s universal, he will choose that. However, if it isn’t, he picks the material that will work best for the treatment in front of him.

For example, glass ionomer cement, cermet, calcium aluminate, or calcium silicates are universal because clinicians can use them for many indications. However, Dr Snyder says it would be unwise for clinicians to use them in every situation. The same goes for many of the modern dual-barrel cements. They can do a lot, he notes, but not everything.

“If there’s going to be some saliva moisture, I need to jump to a calcium aluminate or glass ionomer, something that is made partially of water, that likes water, and creates hydroxyapatite in the presence of phosphate and sulcular fluids or saliva,” Dr Snyder explains. “So there’s a time when one should be used over the other.”

As universals are not one-size-fits-all, Dr Snyder cautions against making the automatic choice to use one based on convenience and expediency. For example, relying on quick and easy materials because they finish the job faster and increase the profitability of an inadequate insurance reimbursement does not lead to the best choices for the patient. Instead, he encourages clinicians to consider the trade-offs for ease of use and what that might mean for the long-term outcome.

“It’s all about the patient integrity,” Dr Snyder says.

Dentists should also ask why they need the product to be universal, according to Dr Bizga. Is it storage, inventory, efficiency, or all of the above? In his practice, Dr Bizga needs a primer with versatility. His practice performs a variety of procedures, from endodontics to implants and orthodontics, crowns, and fillings. With this variety, he wants universals that work with the different materials he chooses based on the patient and given situation.

“You have to look at the problem you’re trying to solve and whether you even have a problem,” Dr Bizga says, adding that sometimes people chase the newer product just because it’s new. “You’ve got to ask yourself, ‘Is this something I need?’ And for me, bonding and primers are areas where universals simplify things and make it much easier.”

Dr Sanders encourages clinicians to try a material before rethinking their inventory. If clinicians like the workability of the material or the way it polishes, they will have more success with their one-size-fits-most strategy for inventory management. Dr Snyder thinks talking to clinicians that use the product can help, too.

In addition, she thinks looking at the studies about the material for how it will hold up in the long term and buying from reputable companies is essential, too. Plus, the cost should be in line with a clinician’s expectations.

“If it’s way more expensive to have this 1 composite rather than having 5 composites, it’s not worth it,” Dr Sanders says. “It still needs to be worth it.”

Perhaps most importantly, Dr Schmedding believes clinicians should choose a universal material from a reputable manufacturer. Part of his attraction to Kuraray’s product lines is their performance over the years in the dental industry. Also, he encourages understanding the research behind the materials and the track records before jumping into new product lines and new manufacturers.

“You need to go with someone that’s been around the block for several years [and] has product lines that stand the test of time over and over, especially when dealing with adhesion-based composite dentistry,” Dr Schmedding says. “Make sure you are dealing with a good manufacturer.”

How many universal material options can you rely on and how small a material set you can use today?

Universal Materials: One Size Fits Most

Product development in materials has many goals, including the overarching goal of developing the material of choice for every clinician using it. When it comes to earning business for dentists, how important is the material’s ease of use?

Rolando Nunez, DDS, MSc, manager of clinical research at BISCO, Inc, believes it is essential for a product to be easy to use. Moreover, a product’s user interface should not differ significantly from what individuals are doing now or require a lot of specific equipment, which can be a turnoff for clinical teams. If a material requires any of those things, its performance must be worthwhile to manage the aggravation resulting from adjustments in the dental practice

For example, when dentistry introduced intraoral scanners, the scanners presented an enormous opportunity for dental practices to incorporate digital dentistry. Dr Nunez says dental practices thought digital scanners were worth the disruption, expense, and training required to incorporate them into the practice.

Few materials deliver game-changing results the way intraoral scanners did. Therefore, Dr Nunez thinks most restorative materials tend to be plug and play, meaning they are approximately the same user interface with neither significant nuance nor steep learning curve. “For instance, one cement will be very similar to another when it comes to how to use and dispense it. It might have nuances like viscosity and shade but nothing that will be a deal breaker,” Dr Nunez says.

Jason Goodchild, DMD, vice president of clinical affairs for Premier Dental Products Company, agrees that ease of use is essential but not at the expense of optimal results. Premier is always thinking about how to make something better, safer, faster, less expensive, and easier to use to achieve a desired outcome.

However, clinicians should consider the disruption to the regular workflow as well, Dr Goodchild says. For example, if a product changes how a dental team works, the launch will require a lot of marketing and client education, which may or may not work. Therefore, staying within the confines of the existing workflow is often one of the features required for ease of use. As a result, many products grow incrementally rather than by making giant leaps. “When you do that, the constraints of product development become difficult,” Dr Goodchild says.

Regarding the benefits of a new product, Dr Goodchild says Premier’s voice of the customer exercises reveal clients need the material to be efficient from a price standpoint and the confidence that it will do what the company claims. However, ease of use also tops the list of what clients want. “For the [individuals] who are using it, they’ve got to be able to put it in their hand and know exactly what to do,” Dr Goodchild says.

The need for efficiency in the dental office drives this mentality. However, because every clinician already has their own way of doing things, disruptions to that method can be a tough sell for many dental practices, “especially when the existing system was working just fine,” Dr Goodchild says.

For example, Premier’s Traxodent® Hemodent® Paste Retraction System tops the product category of tissue management. It’s easy to use and works well. However, Dr Goodchild says the team is hesitant to research improvements to the product for fear of inadvertently changing something that was working well. “We are mindful of how to improve an already successful product without screwing it up,” Dr Goodchild says.

The behavioral sciences, which study how psychology affects individuals’ decision-making, assert that our need for things to be easy comes from our ancestors. In the past, conserving energy was connected to survival. Saving our strength was essential when competing against others and hunting for and gathering food.

We don’t have the same living conditions as our ancestors, but we still have their minds. Even when food is abundant and refueling requires far less effort, our brain still favors expending less energy when given a choice. Therefore, we are hardwired to appreciate things that are easy.1

From a dental practice perspective, Troy Schmedding, DDS, AAACD, says adhesive dentistry contributes to why dentists want things to be easy. When the primary restorative material was amalgam, the technique wasn’t as crucial to obtain an excellent outcome. However, when adhesive dentistry became the restorative approach of choice, the technique developed many more steps. Unfortunately, with each step, there is an additional opportunity for a mistake that affects the patient outcome.

“As a clinician, a product’s ease of use is critical because of the communication factor that goes into a lot of adhesive-based dentistry, meaning you’re relying on an assistant or someone to help you apply these materials. So having fewer steps means fewer opportunities for something to get messed up,” Dr Schmedding says.

Dr Schmedding likes PANAVIA™ SA Cement Universal because it contains 10-methacryloyloxydecyl dihydrogen phosphate and a silane-based monomer, which he describes as a game changer in self-adhesive resin cement products. He appreciates that he still has the option to use it with a bonding agent. He finds it is a material he uses a lot in his practice. “That would be my Swiss Army knife in terms of cement,” Dr Schmedding says.

However, ease of use has many definitions, Dr Nunez says. For example, composites have different elements that make them easy to use. So although one clinician might equate ease of use with convenience, another might think ease of use refers to a multipurpose material. Others might call a material easy to use because it has a simple user interface.

“When you talk about a composite, ‘easy to use’ might be related to handling, matching a shade, or the ability to polish, which are related to the user interface, not clinical performance. But those things are crucial because you want the learning curve for the material to be quick,” Dr Nunez says. “You want to be able to use things fairly quickly and hassle-free.”

One characteristic Dr Goodchild thinks makes products easy to use is robustness. This term describes a product one may use in different environments, including less than ideal conditions, that still works. Clinicians consider that easy, he says.

Dr Goodchild also says products should fit client expectations of the product category, meaning ease of use is product specific. For example, an easy-to-use cement might be easy to apply and clean up. In contrast, an easy-to-use bonding agent will not produce postoperative sensitivity but will be easy to spread around and have a suitable viscosity.

Also, Dr Goodchild thinks ease of use should include a 360° view of a product. For example, how does it interact with other products? How does it interact with the dental team? How well does it perform for the patient? He sees these questions as part of the idea of what makes things easy. “I don’t think you can separate ease of use from clinical success,” he says. “I can make things that are easy to use, but if they don’t work, they are not worth it.”

Dr Schmedding also thinks reducing the number of steps is essential for easy-to-use products. For adhesive dentistry, he thinks clear directions and 2-bottle bonding agent systems that help with “minimizing the chemistry set” are essential. Even though it cuts out a few steps, using single-bottle bonding agents increases the dynamic for potential issues, Dr Schmedding says.

For example, drying times or application times are different depending on the substrate, which can complicate things for the dentist. In addition, paying extra attention to details like shaking the bottle, making sure the adhesive is agitated when applying it, and adequately air-thinning to allow time for the solvents to evaporate and achieve good bond strength doesn’t make things easy.

“The simplification of adhesion-based dentistry usually means we’re combining things into 1 bottle, which is very convenient for us,” Dr Schmedding explains. “But within that 1-bottle system is a lot of chemistry and a lot of opportunity for error if not used properly. It’s counterintuitive. Two bottles with 2 steps might be a little more complicated, but it’s easier because you separate chemistry.”

There are almost always trade-offs when you increase the convenience of something. For example, Dr Nunez’s watch delivers his text messages, but the text is too small for him to read. So he would rather read them on his phone.

Similar trade-offs exist when increasing the convenience of dental materials that clinicians use for many indications, Dr Nunez says. Although research supports the use of dental materials for many indications, he says it also shows that multipurpose systems are not always the optimal options.

There are other sacrifices that a clinician makes for ease of use. For example, most cement comes in an automix syringe, which is easy to use and convenient because clinicians don’t need to mix the cement by hand. Dr Nunez says the drawback here is not performance but waste. “So, it all depends,” Dr Nunez says. “Ease of use has its drawbacks.”

Clinicians should also remember that when something changes about a product, it will likely affect something else. Dr Goodchild says it’s never a zero-sum game. For example, if manufacturers change the viscosity of a composite to make it flow into tight preps, it might be harder to control.

However, the best products find a way to answer the clinician’s pain points while working well and remaining cost-efficient for the dental practice’s margins. “If you look at market-leading products across the board, you could make the case they all check that box: They all are easy to use. Plus, they’re all well-established brands and very good at what they do,” Dr Goodchild says. “When you get all those things, you’ve got a home run.”

1. Ratner P. How evolution made our brains lazy. Big Think. September 26, 2018. Accessed February 2, 2023.https://bigthink.com/neuropsych/evolution-made-our-brains-lazy

Can a material's usability earn dentists more business?

How Important Is a Material’s Ease of Use?

Can't Someone Else Do It? Outsourcing Can Help Dental Labs Adapt to Changing Market Conditions. Photo courtesy of Vitalii Vodolazskyi/stock.adobe.com. 


Dental labs have many challenges today. There is a shortage of labor in dental labs and fewer programs that train new ones. Also, a commoditization mindset prevails in many lab owners' pricing strategies, which decreases profit margins. Further pressing profit margins are the rising costs of business in an inflationary market.

During times like these, dental labs could try to produce as many cases as they can in-house to stay in the black. However, some outsource work to trusted partners that can help carry the load.

We explore why dental labs need outsource partners today, what is possible for labs to outsource, from digital design to fabrication and more, and what they can do to avoid problems with their customers—and the government—from outsourcing.

Travis Zick, Co-Founder and Director of Finance & Acquisitions for Apex Dental Laboratory Group and former President of the National Association of Dental Laboratories (NADL), says having an outsourcing partner is essential in today's lab environment. Several factors might inspire a lab to leverage outsourcing options rather than producing it themselves. For example, if the type of product the doctor needs isn't something the lab has the staff for or if there is not enough business with those products to justify additional staffing, having an outsourcing partner is essential.

"We're doing more things than we've done in the past, as far as types of products and treatment plans, so that's a significant reason to outsource," Zick says. "Another major factor that drives outsourcing is the labor shortage, which could mean you don't have enough technicians to do the work you are getting. The employee shortage has been real for everybody, but especially for the dental lab industry."

Tim Torbenson, President of evo820, LLC, an FDA compliance consultancy for dental labs, agrees that staffing issues are hitting labs hard. Many of his clients have staffing issues, which leads to increased labor costs through wages for overtime and more remakes because of pressure to do more at the same time with fewer people. Outsourcing provides a great way to manage workloads and reduce these costs when a lab's digital production is at capacity.

"Outsourcing provides that release valve," Torbenson says.

Jack Marrano, CDT, Director of Signature Prosthetics, Absolute Dental Services, says that smaller labs with limited staff feel the labor shortage felt even more keenly. For example, if a designer is on vacation, that smaller lab might not have a designer that week. However, he says larger labs also feel the sting of this labor shortage. Labs of all sizes get in a production bind when technicians get sick. Moreover, the uncertain future of the dental laboratory labor pool means labs will continue to use outsourcing partners.

Marrano says another part of the problem is that the easy-to-fill positions requiring technicians with less skill and experience are not what a lab needs. Instead, dental labs need technicians with higher degrees of skill, knowledge, and expertise. Unfortunately, the dental lab industry lacks personnel in those areas.

"We're staring down the barrel of a massive vacuum of experienced labor in dental technology. Plus, if you look at the demographics and the breakdown, we currently do not have any new blood coming in," Marrano says. "Therefore, it helps to lean heavily on the outsourcing available to laboratories today."

Marrano says tactics like outsourcing provide ways for labs to adapt to the market conditions they face today. Dental labs must think of different ways to continue providing quality products while also having the ability to scale. Otherwise, the lab won't be around much longer.

"If you don't grow, you die," Marrano says. "We are all looking for ways to grow without sacrificing quality."

Having Someone Else Handle the United States Food and Drug Administration (FDA)

Zick says another good reason to outsource is the changing FDA regulations and compliance requirements for dental labs that produce some dental restorations. While most core products a dental lab makes are exempt from FDA oversight, some products, like abutments or sleep appliances, are not. Producing these products opens the dental lab up to FDA audits and inspections, which can carry steep consequences if the FDA cites the lab for non-compliance. Zick says an excellent solution is for the lab to outsource these products to an FDA-compliant partner.

For example, Zick says implant services have recently been a high-growth area for dental lab services. However, many parts of the implant fall under FDA oversight. So, if a dental lab wants to offer implants produced in-house to meet this rising demand, it will require committing resources to comply with FDA regulations.

Another less complicated option is for the dental lab to work with implant companies, like Dentsply Sirona, Straumann, and Nobel, that are FDA-registered and compliant. Dental labs can buy the implant parts from the manufacturers and then produce the final crown, which falls outside of FDA oversight in-house.

"That's what we do because it's just not worth the headache," Zick says.

Torbenson agrees with this strategy, adding that using an FDA-compliant outsourcing partner means labs can bring to market any devices that have FDA requirements, such as Titanium custom abutments, screw-retained crowns and bridges, surgical guides, sleep appliances, and orthodontic aligners.

"It's a tremendous benefit to offer those devices under someone else's 510(k) or FDA compliance," Torbenson says.

However, Torbenson emphasizes that any dental laboratory offering these devices must use an outsource partner that is FDA-registered and should be able to prove the partner is compliant during an FDA audit. Otherwise, the FDA could shut down the lab's use of the outsourcing partner, which could end up leaving the lab's clients that want those appliances hanging. Torbenson recommends labs get a confirmation that the outsource partner is FDA compliant in writing every year to protect against that scenario.

"You should request a copy of their recent FDA Establishment Registration and repeat that exercise every February," Torbenson says. "Be sure you protect your company from a surprise shutdown of your source because of FDA-compliance issues."

Moreover, if the outsourced partner is offshore, Torbenson reminds the United States labs they need to be FDA-registered as an 

. Many labs are unaware of this FDA requirement. Historically, Torbenson says labs have not experienced shipment interruptions regarding this regulation. However, he says United States Customs is increasing their intensity on shipment inspection from offshore suppliers and holding many more shipments until customs officers can confirm the supplier's FDA compliance.

"If you have been receiving shipments from any foreign outsource, best to get FDA-registered and eliminate the potential having cases held for an extended period," Torbenson says.

Other Cautions for Working with Outsourcing Partners

Disclosure is another area that Zick would caution labs to bear in mind about outsourcing. Per the NADL, 12 states have either administrative or statutory laws that regulate dental labs and their technicians. These laws usually require dental labs to register with the state and disclose materials and point of origin for the delivered restorations to their clients. However, Zick says that many labs in these states don't comply with these laws, nor are dentists aware of the regulations. Nevertheless, Zick says up-front communication about where the restoration is produced and disclosing this information with delivery is crucial for the lab.

"A key factor to keep in mind if you want to utilize an outsource partner for some of these things is to be honest and tell your client that you're not making it and who is," Zick says.

Many dentists will not care who produces the restoration, Zick says. Instead, the clients call because the dentist likes working with the lab, and they have a relationship. The dentist trusts the lab to handle those details as long as the lab can vouch for the outsourced partner's work. To live up to that trust, Zick advises labs to know their outsource partners and to have consistent quality control (QC) reviews for the delivered cases.

"We all care about our relationship with our client and the end-of-the-line patient care," Zick says. "So, you need to know who you partner with and know they have the proper compliance in place."

Marrano agrees that it is essential to have a QC check when the cases come back to ensure the restorations meet the lab's standards. Also, the lab should track the outsourced cases to ensure the appliances come back on time.

Moreover, a lab should also have a QC check on their data entry. If the lab has something specific that they want for their cases, it should put those details in the case notes for the outsourcing partners. Outsourcing partners will do what you tell them to do, Marrano says.

"If you don't pay attention to your data entry, there is a good chance you will get a restoration that you aren't happy with," Marrano says.

Also, Marrano cautions lab technicians to measure success differently on outsourced cases. Differences exist between a restoration that meets the industry standards for shape, contour, occlusion, and margins and a restoration with all those things 

 the technician's signature touches. Besides, technicians can always add those final touches after the case returns. Marrano sees putting those final artistic touches on the case as a far more efficient use of that technician's time than handling it end-to-end.

"When you look at the benefit of an outsource partner, you have to look at the benefit of having a restoration that meets the standards apart from the artistry element," Marrano says. "When you use that metric, overwhelmingly, labs will say that outsourcing has great value and that their partners are an indispensable part of the way labs do business today."

The Benefits of Using an Outsource Partner

Some labs want to outsource as part of a digitalization strategy. Torbenson tells smaller labs that want to digitalize to start by investing in a quality scanner, giving the lab access to outsourcing opportunities.

When a client is considering adding another digital manufacturing process, Torbenson suggests starting with the CAD capability and leveraging an outsource manufacturer to build the lab's client base. Then, a lab can confirm they have the business to justify the equipment investment.

"Too many of our clients invested in the CAD and the equipment in manufacturing that did not meet their expectations. So, when you build the caseload, then purchase the equipment and bring the manufacturing in-house, it is a solid plan that will get you an ROI," Torbenson says.

Zick agrees using outsourcing partners to manage equipment investment timing is a sound strategy for dental labs in today's business environment. He says that a new mill or 3D printer costs tens of thousands of dollars, and to get a predictable ROI, a lab needs consistent work for that equipment. Zick thinks offering products that require that equipment and then outsourcing those projects until the lab builds enough business to bring those cases in-house makes good business sense for a dental lab today.

"If it's something new where only a certain printer can produce a specific product that your doctors are asking for, then use an outsourcing partner at first," Zick says.

Zick likes this outsourcing strategy for labs that want to offer digital dentures. Many doctors like the idea of digital dentures, especially when they hear about 3D-printed dentures, Zick says. However, unless the dental lab has technicians that can design dentures digitally and printers to make them, this product is difficult and expensive to introduce in-house.

"But you can immediately start offering them if you use a third party," Zick says. "Then, once you build up a little demand, you can run the ROIs for doing them yourself, comparing the benefit of bringing it in-house versus continuing to utilize an outside partner."

Absolute Dental Services has several outsourcing partners for their lab. For example, they order all of their milled gold crowns from Argen. They also use Bertram Dental Lab for their cobalt chrome frameworks.

Like many of the complicated restorative lab processes, waxing and casting a traditional partial is a skill that requires knowledge and experience. However, experienced technicians didn't pass on those skills to the next generation, Marrano says, and then many of them retired. Therefore, Bertram is a resource Absolute can lean on for those cases rather than scrambling to train someone on staff.

In addition to cast-partial frames, Zick says another area that is increasing in popularity for outsourcing is design. He says the shortage of trained designers drives this trend, with design centers filling that technician void. For example, FullContour by 3Shape and Evident CAD designs allow labs to send scan files and get completed case designs back in 6 to 24 hours.

"And they cost us less than it would to have a trained staff designer sitting around hoping there's work for them to do," Zick says. "These design centers can do some complex designs or different types of cases that you aren't used to. For example, they can do your denture design or partial design. They can even do surgical planning for you. So, it opens a new line of products for labs that may not be able to offer those in-house."

Torbenson also encourages labs to outsource design to 3Shape Automate, the artificial intelligence (AI) design service for posterior crowns and mouth guards, which he describes as an incredible advantage for dental labs.

"It is a very efficient, affordable, reliable, and precise service available with the bonus of not falling under FDA regulatory oversight," Torbenson says. "This is a tremendous advancement in our industry in its infancy that will reshape CAD and outsourcing."

Marrano agrees, adding that Absolute Dental Services is the most extensive user of 3Shape Automate for AI design of nightguards and single crown posteriors. He appreciates the efficiency of uploading the case to the cloud, getting the design back in seven to eight minutes, and then sending it to their 3D printers. Plus, he thinks the designs are fantastic.

"AI eliminates the grunt work," Marrano says. "It frees up a technician with a lot of skill and experience to do the other jobs in the lab where those skills are needed."

We explore what is possible for labs to outsource, from digital design to fabrication, why dental labs should use them, and what they can do to avoid problems with their customers. 

Can't Someone Else Do It? Outsourcing Can Help Dental Labs Adapt to Changing Market Conditions

Hype vs. Reality: Is New Dental Technology Changing the Game. Image courtesy of Who is Danny/stock.adobe.com. 


Marketers like to throw around the phrase "game changer" in conversations about new dental technology. They need your attention, so they do their best to get it by creating attention-grabbing content and splashy advertising campaigns. 

But does the reality of dental technology live up to the hype? We look at dental technology today, including materials science, laser dentistry, 3D printing, artificial intelligence (AI), and robotics.

"Game changer" gets thrown around a lot regarding new dental technology. We look at the reality of dental technology. 