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Beyond the Bite

The Official Blog of the Florida Dental Association

Tag: members

Latex Precautions in the Dental Setting

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By Rosanne Cain, BSN, LHRM, Patient Safety/Risk Manager II, The Doctors Company


Recognizing latex allergies is an important patient safety precaution.

A 43-year-old registered nurse presented to his dentist for a regular teeth cleaning procedure. After several years of daily use of latex gloves and medical supplies, he developed a severe sensitivity to latex that ultimately resulted in anaphylactic reactions to most latex exposures.

Prior to his scheduled appointment, he contacted the dental office and informed the staff about his severe latex allergy. The dental staff made a note in his dental record and prepared the exam room with nitrile gloves. When he arrived, the dental hygienist recommended protective eyewear. The patient asked the hygienist if the foam cushioning around the eyepieces was latex-free. The hygienist could not confirm. The hygienist also failed to note that she placed small rubber bands, which also contain latex, around the handles of her dental instruments.

The hygienist began the procedure. The patient began to itch, which was quickly followed by wheezing. The procedure was stopped, and the patient immediately administered his medication. The patient’s action avoided a severe anaphylactic reaction.

Discussion
During the past 30 years, latex allergies have been recognized as a significant problem for both specific patient and provider populations. The incidence of latex allergy in the general population has been estimated to be between 1 and 6 percent. Some adolescents experience incidences as high as 73 percent (notably those individuals with spina bifida and related pathologies). Women account for approximately 70 percent of latex-related anaphylactic reactions (most commonly during ob/gyn procedures).1 Adults with spinal cord trauma, neurogenic bladder or documented history of unexplained intraoperative anaphylaxis also can be affected by frequent exposure to latex supplies. Health care workers maintain an incidence of allergic response that ranges from 8 to 17 percent.2 Other at-risk populations with repeated exposure to latex gloves include lifeguards, emergency responders, law enforcement professionals and cosmetologists.

In addition, glove powder has been shown to aerosolize latex proteins and increases the risks of a reaction in latex-sensitized patients or staff. The U.S. Food and Drug Administration recently announced a ban of the use of powdered gloves in surgery, powdered patient examination gloves and absorbable powder used on surgical gloves. The ban was issued after an investigation determined that the powdered products present an “unreasonable and substantial risk of illness or injury, and that the risk cannot be corrected or eliminated by labeling or a change in labeling.”3

Although most dentists are familiar with latex allergies, the infrequency of a severe reaction during a dental procedure can cause inadequate precautionary measures in a dental practice. Implement the following risk management strategies to reduce latex-related risks.

Risk Management Strategies

  1. Know your patient’s latex allergy status, and note it prominently in the patient’s medical records. Allergy status should be updated on each patient visit.
  2. Remove toys that contain latex from your practice’s common areas and play zones.
  3. Practice latex avoidance precautions. Create a patient area that is latex-free and educate staff about all dental-related products that are restricted from the room.
  4. Identify dental products that contain latex, including gingival stimulators, irrigation tips, dental dams, bulb syringes, cushioned eye protection goggles, tourniquets, rubber stoppers on medicine vials, adhesive tapes and bandages, water tubing, prophy cups, and rubber toothbrush heads and grips.
  5. Use latex-free carts, bandages, reservoir bags, airways, endotracheal tubes, laryngeal mask airways and ventilator bellows.
  6. Maintain a list of latex-free dental devices and office products and ensure that it is readily available for staff reference.
  7. Remember that touching any latex object can cause transmission of the allergen by hand to the patient.
  8. Ensure that your supplies include emergency medications with non-latex syringes and medicine stoppers.
  9. Perform practice drills with your staff so they are prepared for latex-related medical emergencies.

For a free brochure on latex allergy, contact the American College of Allergy, Asthma and Immunology (ACAAI) by calling toll-free 800.842.7777. Additional information is available on the ACAAI website at http://acaai.org/allergies/types/skin-allergies/latex-allergy.

 

References:
1. Allergic reactions during labour analgesia and caesarean section anaesthesia. Adriaensens, I., Vercauteren, M., Janssen, L., Leysen, J., Ebo, D. International Journal of Obstetric Anesthesia 2013 Jul; 22(3): 231-242.

2. American Latex Allergy Association, http://latexallergyresources.org/statistics

3. FDA Rule, Banned Devices; Powdered Surgeon’s Gloves, Powdered Patient Examination Gloves, and Absorbable Powder for Lubricating a Surgeon’s Glove, 81 FR 91722, December 19, 2016, https://www.federalregister.gov/documents/2016/12/19/2016-30382/banned-devices-powdered-surgeons-gloves-powdered-patient-examination-gloves-and-absorbable-powder

 

Reprinted with permission. ©2017 The Doctors Company. For more patient safety articles and practice tips, visit www.thedoctors.com/patientsafety.

The guidelines suggested here are not rules, do not constitute legal advice and do not ensure a successful outcome. The ultimate decision regarding the appropriateness of any treatment must be made by each health care provider in light of all circumstances prevailing in the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered.

Why Electronic Documentation Can be Such a Pain

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By Juanita Benedict, DPT, CEAS II

I get it. I understand why electronic medical records are necessary. Documenting in this format is supposed to decrease medical errors and improve coordination of health care. I even prefer electronic documentation in most circumstances. Honestly, who wants to sit and hand write 30 detailed notes at the end of the day? It’s a great concept, except … don’t we already spend too much time in front of a screen? Even before the implementation of the electronic record requirements, a study from the Council for Research Excellence in 2009 reported in the New York Times claimed that the average American spends more than eight hours per day in front of a screen! With more of our personal and business interactions being performed in front of the computer or mobile device, how much has that time increased almost seven years later?

Despite the benefits of electronic documenting for overall improved coordination of health and documentation compliance, the fact is that extended screen time is simply not healthy. Here are three reasons why:

1. More prolonged sitting. After sitting all or most of the day, the last thing your body needs is more sitting. However, it is unlikely that you have equipped your office with one of those cool treadmill desks. Sedentary activities promote cardiovascular disease, increase the risk of obesity and consequential health problems associated with it, decrease aerobic capacity and much more. Of course, there is a higher incidence of musculoskeletal pain in those who are more sedentary because the body is simply getting weaker.

2. More poor posturing. Proper posturing is just as important while using a computer as it is when working on patients to decrease risk of developing musculoskeletal dysfunction. Just as proper sitting postures often are lacking when delivering dental care, computer operating postures often leave much to be desired. If you are already experiencing neck/shoulder/back/wrist pain, your computer positioning may be a contributing factor that you have not considered. This is another area where those pesky muscle imbalances wreak havoc.

3. More visual stress. Eye strain is a problem for dental professionals. According to the American Optometric Association, extended time on computers can lead to a collection of symptoms that has been named “computer vision syndrome.” Symptoms include headaches, blurred vision, and even neck and shoulder pain. Since eye strain is already common in dentistry due to the demands of accommodation and such, adding more activities that promote poor eye health is not ideal.

As it becomes more necessary to increase your screen time at work, it becomes even more necessary to change your lifestyle habits. Here are just a few tips on how to counteract some of the consequences of extended computer use:

Unplug: Spend time away from computers, phones, tablets and TV screens! You may be amazed at how difficult this may be at first. However, after a while, this will seem like a refreshing oasis of time. Reconnect with those things you once loved.

Move: Any way you want. Dance. Walk. Swim. Bike. Go to the gym. Play with your kids. Help a neighbor move. Clean the house! It doesn’t matter what you do — just get going. This act alone has tremendous emotional and physical health benefits.

Eat well: With an increase of sedentary activities, there is a decrease in calories burned and increase in fat deposited throughout the body. If you are not training to run a marathon, make sure you are not eating as though you are. Stick to a healthy diet with a lot of fiber and water. Peristalsis tends to slow as we become more sedentary as well, which can lead to bloating and other very uncomfortable things!

Educate yourself: Knowing your risk factors for developing pain and compromising your health is necessary so that you can learn how to overcome them. Use quality and reputable resources to make changes in your daily practice. OSHA has provided a free guide to setting up a proper workstation environment to improve posturing. Other resources provide information on how to assess your computer stations and help you to configure a station that makes long hours of documentation, business transactions, emailing, and even reading blogs more comfortable and safe for you.

It appears electronic documentation is here to stay. So, it is of utmost importance that you learn how to protect your health from the devastating consequences that will result from hours of screen time.

As always: Be healthy and practice safely!


Juanita Benedict is a physical therapist in Florida who works specifically with dental professionals to reduce their pain while practicing as well as extend their careers. For more information, go to www.healthydentistrysolutions.com or contact her at 407.801.3324.

 

Not as Busy as You Would Like? Try Looking Around the Dental “Neighborhood”

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By Dr. Rick Huot

According to the ADA Health Policy Institute’s recent research brief, statistics show that dental offices have been lagging behind other business entities to recover from the Great Recession that started in 2008. Except in rural and urban areas that have a numerical shortage of dentists, most dental practices are reporting flat earnings and are just keeping up with the increasing costs of running an efficient practice.

The measure of growth in a practice due to internally referred patients and patients obtained by external marketing is called organic growth, since it is “home grown” from the efforts that the present office has done all along.

Another “fast track” of achieving growth is to purchase an existing practice in your practice neighborhood, by either merging into the larger office, or purchasing the existing patient base and obtaining the services of the present dentist, and many, if not all, of the doctor’s staff members.

This is the first year that millennial dentists will outnumber baby boomer dentists, and many of the boomers are approaching their 70s, which is past the traditional retirement age of 65 for the majority of America’s workforce for the last generation. However, people (and dentists!) are living longer, and quite possibly need to work longer, as they are financially short of their retirement goals.

For a young dentist (Dr. Millennial), buying an existing practice from a nearby colleague (Dr. Boomer) is a win-win situation, and some of the immediate benefits include:

  1. Purchasing an existing patient base is a more efficient way of securing new patients. The patients that belong to Dr. Boomer are existing “vetted” patients with a track record of seeking care, and a desire to keep their doctor-patient relationship with a young dentist, knowing it won’t be long before they have to choose a new dentist. Retaining upwards of 90 percent of the patient base is not unusual in this type of practice purchase, especially if Dr. Boomer occasionally practices in the new office.
  2. Every dental practice has a core of outstanding staff members, and the ability to retain those staff members will give Dr. Boomer’s patients a “familiar face” to see when they come in for dental treatment.
  3. The small equipment and additional supplies purchased with Dr. Boomer’s practice will increase efficiency in terms of instrument turnaround, such as extra handpieces and instrument setups, and reduce the future need of high-cost items, such as extra digital sensors and computer workstations.
  4. Dr. Millennial has a ready-made “temp service” in Dr. Boomer, which keeps the practice open for longer periods of time during vacation times and in the case of a female dentist, maternity leave. Having the practice open for more days and longer times increases the profitability of a business, as fixed costs are already accounted for and variable costs are less.

For Dr. Boomer, this also is a win-win situation, as some of the benefits include:

  1. The ability to take time off without the worry of provider coverage, and paying the costs of running a practice at a time in life when we physically slow down.
  2. If Dr. Boomer becomes a solo independent contractor to Dr. Millennial, the pension laws for someone reaching 50 years of age dramatically allows the older doctor to get a direct tax deduction for a considerable amount of retirement funds ($215,000 for a defined benefit plan, and $54,000 employee contribution to a defined contribution plan not including the matching provision), while taking a reduced amount to live on, since the practice sale would have provided funds for living expenses.
  3. Since Dr. Boomer is now a self-employed solo dentist, a Subchapter S corporation would allow practice profits to “flow through” their normal tax return (1040), and could provide tax bracket benefits.

As with any financial and business transaction, all of these practice purchase sales should be done with competent financial and legal advice, and might include a transition specialist who could facilitate the merger.

So, Dr. Millennial, it is time to look “around the neighborhood” and find someone compatible to your practice and business philosophy. The decision you make may prove to be the most financially astute one you will make in your entire practice career!

 

Dr. Huot is a general dentist in Vero Beach and the founder of Beachside Dental Consultants Inc., a dental practice management consulting business. He is on the FDA Board of Trustees and can be reached at rhuot@bot.floridadental.org. 

The Dental Practice Sales Funnel

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By Sarah Woods, Dental Marketing Consultant

The sales funnel is alive and well within every dental practice. The success of marketing efforts is directly related to the sales effectiveness of the dental team within the dental practice. Each team member has a role to play in the success of the patient experience and how well it translates into increased treatment acceptance. The problem with this reality is that many dental practices fail to accept and understand the uniquely important role each person plays in the patient experience. The specific sales role of each team member is necessary and cannot be eliminated from the process due to cutting corners by under-staffing.

Based on the size of the practice, there should be at least one person in the following positions:

Marketing Coordinator/New Patient Concierge: handles internal and external marketing, takes photos for social media and digital platforms, acts as brand ambassador within the community, coordinates special events/seminars, implements and manages promotions and specials within the office.

Front Desk/Concierge: answers incoming calls with an upbeat attitude, schedules appointments, greets patients with a cheerful disposition and a warm smile.

Insurance Coordinator: handles all insurance companies, generates all insurance claims, coordinates payments, updates patient accounts.

Dental Assistant: assists dentist in providing treatment to patients, develops trusting relationship with each patient and follows up with the patient after treatment performed.

Hygienist: provides excellent dental cleanings, performs periodontal treatments, develops and nurtures relationships with the patient, and schedules future hygiene appointments for patients.

Treatment Coordinator: presents treatment plans to patients in an educated and confident way, and schedules necessary appointments.

Check Out: checks out patients and schedules all future appointments.

The key responsibility of each of these roles is to interact with the patient in a positive, thoughtful way while maintaining confidence. If just one of these roles isn’t filled, treatment acceptance and patient retention will suffer, affecting the bottom line of the practice.

 

Sarah is a dental marketing consultant with extensive experience working with dental practices to maximize their patient potential. With in-depth experience in various levels of a dental practice, she has a unique perspective that allows her to be effective at implementing strategies throughout the office that can be executed easily.

Please connect with Sarah on LinkedIn at linkedin.com/in/sarahcwoods or email her at Scwoods79@gmail.com