6 Things Every Office Manager Needs To Do Right Now To Achieve Work-Life Balance

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Oftentimes, our work takes precedence over everything else in our lives. Our desire to succeed professionally can push us to set aside our own well-being. Creating a harmonious work-life balance can be challenging but it is essential to improve our physical, emotional and mental well-being. Here are six things you can start doing right now to achieve a better work-life balance.

1. Set an intention for the day

By setting an intention, you are creating a plan of how you want your day to go. When we lack intention, we often feel overwhelmed and out of control. An intention will help you take back control and set yourself up for success by making time for what really matters.

2. Incorporate exercise into your day

Too often, the first to go when our calendars fill up is exercise. Exercise not only reduces stress but improves our mood and work performance. Fit exercise into your busy weekly schedule in the same manner of the often-used airplane oxygen mask example. We need to prioritize exercise so that we can benefit from the decrease in stress and the increase in self-efficacy it provides. Don’t have an hour to lift weights or attend a workout class? Start with a brisk walk around the block. Every little bit counts!

3. Change your self-talk 

Our patterns of self-talk can all too often be negative. We focus on preconceived ideas that we’re “not good enough,” “always a failure” or “can’t do anything right.” On the other hand, positive self-talk switches our narrative to ideas like “I can do better next time” or “I choose to learn from my mistakes and not be held back by them.” It’s about showing yourself some self-compassion and understanding who you are and what you’ve been through.  

4. Take time to disconnect

When you are available all the time, your workday never ends. You need time to shut off your phone and unplug. Give yourself a chance to separate from work – whether it’s taking a 5-minute breather outside the office, practicing yoga or just learning to say no. Embrace every moment of calm that you can throughout the day.

5. Give yourself some grace

It’s time we redefine what perfection means to us and strive for excellence, not perfection. It’s important to remember that you can’t be everything to everyone. Give yourself the grace to “be enough” and not “perfect.” This small mental shift can be a small change that makes a big difference.

6. Save energy by using the right software

Having the right software can not only save you time throughout the day, but also eliminate unwanted stress. If your current software systems make you feel more stressed and it’s challenging to accomplish daily tasks, it might be time to consider implementing a new software.

Determining the right software for your dental practice can be a big decision. Let us help you chart the best course for your unique practice with a free, 15-minute Revolve Software Suite consultation.

Your work-life balance should make you feel like you are paying enough attention to all the important aspects of your life. When you feel the scale of attention is tipped too far in one direction, that is when changes need to be made. The idea of finding balance is to allow us to find the point in-between our work and personal life that ensures both are flourishing. We hope these tips help you on the path to achieving a better work-life balance.

The Hot Tooth, Psychology, and Oral Conscious Sedation

by Dr. Brian McGue

“Doc, I can still feel my tooth,” she said. 

We hadn’t done anything yet. We had placed a mandibular block 10 minutes earlier. She was on 50% nitrous oxide. My assistant had just pulp tested the tooth with cold and the patient hadn’t been able to feel anything with that tooth or any of the teeth in the lower right mandibular quadrant. The patient needed a badly decayed #30 extracted.  I was still in the middle of putting my gloves on.

“Doc, I can still feel something…” she continued but this time her voice had a hint of panic in her voice. I stopped putting on my gloves, leaned back on a treatment cabinet and looked at the patient. That’s when I noticed all the clues that weren’t there at the emergency exam appointment a few days earlier. When I saw this patient at the emergency appointment she was having some pain with #30 but seemed fairly calm. She knew she needed to have #30 extracted and wanted to get the procedure done before Thanksgiving which was about 10 days away. We had scheduled her for the extraction and placed her on antibiotics.

Today was a different story. The first red flag/clue was when she came back to the operatory with her boyfriend. An adult patient who cannot sit for a dental procedure without a support person is outside the norm. The second red flag was her body language. Her whole body was tense. She was gripping the chair arms. She was sweating even though we keep our treatment rooms somewhat cool.  The final clue was her reaction to her perceived level of numbness. Whether she was completely anesthetized wasn’t the point. Her perception of her level of numbness was causing her to slide into the pain-anxiety loop.

The pain-anxiety loop is well known in psychology. It’s a simple concept. We, as dentists, inherently know this phenomenon. It was first enunciated by a physician, W.W. Schottstraedt, in his 1960 book The Pyschophysiologic Approach to Medical Practice: “Pain is a source of anxiety, anxiety is a factor that increases pain, and increased pain incites further anxiety.” In a nutshell, pain and anxiety are circularly related.

The patient in the chair was following this theory exactly. She was anxious which caused her to have a heightened response to pain and that pain was making her increasingly more anxious. At this point we had a decision to make:  either add more anesthetic, maybe with an intraosseous injection, and hope we achieve profound anesthesia or remove her anxiety by rescheduling her and using oral conscious sedation. Because of her increasingly higher level of anxiety we opted for the later.  We backed the patient off of the nitrous, sat her up and explained that we were going to reschedule her for sedation which we felt would make sure she was numb when we took the tooth out.  The patient was very appreciative. 

We immediately did the pre-operative sedation appointment protocol of hooking the patient up to the monitors for at least five minutes, reviewing her medical history and medications, going over informed consents and pre- and post- operative instructions, and dispensing the sedation medications in child-proof containers. Because the patient was not taking any medications, was young and had high anxiety we used the maximum dosages for our Stay In The Box dosing protocols for the pre-procedure anxiety medications for night before the procedure and the day-of procedure sedation medications.  

Three days later we saw the patient. The patient was well sedated but conscious and able to communicate with us. We easily anesthetized the tooth and the extraction was straightforward. The patient did not react at all to the anesthetic placement or the extraction.

Later that evening I called the patient to see how she was doing and how she felt things went today from her perspective. The patient had no memory of having been in the office or of the extraction and was very happy. 

I feel a lot of times the so-called “hot tooth” can be managed better with sedation. Once the pain-anxiety circular path can be interrupted many of those hard to anesthetize teeth or patients can be managed easily. Without question a sedated patient numbs deeper with less anesthetic. Sometimes it pays to simply not push the procedure but take a step back and reschedule the patient with oral conscious sedation.

Online Patient Reviews – Why They Matter

This post was originally published on the Podium Blog.

Just as consumers look to online reviews to decide where they’ll go for dinner or purchase a new product, they also look to online reviews and ratings to select their healthcare providers.

In a Podium-sponsored virtual session at Becker’s Hospital Review 11th Annual Meeting, Bryan Oram, AVP of Strategic Healthcare Sales at Podium, discussed the influence of online reviews for prospective patients and described what healthcare organizations can do to improve their online ratings.

Here are the four key takeaways from Bryan’s session:

1. Online reviews are influencing how patients search for care.

typing on laptop at desk

“Consumers are looking at what other consumers are saying,” said Bryan. And it’s that third-party validation that influences 88% of consumers’ healthcare provider selection. Over 30% of patients say online reviews play a big role in choosing their care while over 50% say they’re willing to travel farther and pay more in order to patronize a practice with higher reviews.” Online reviews are quickly becoming the first stop for consumers as they search for care.

2. Consumers are looking beyond the five-star rating.

While high average star ratings are still the baseline for consumer trust, patients often look beyond just the five-star rating. The number of reviews, the recency of the reviews, and the location of the business also affect whether a patient considers a healthcare provider, as well as the order in which third-party sites, like Google, display the practice. Higher ranked search results garner more of the clicks, no matter the industry.

3. Responding to online reviews can impact a patient’s perspective.

As prospective patients review online reviews, they also pay attention to service recovery—whether or not a business responds to a negative review and the message that’s conveyed in that response. The how and what of those messages influence consumer opinion. In fact, “56% of patients say that a practice’s response to reviews has changed their perspective on the practice,” said Bryan. If your practice isn’t reviewing and responding to reviews for your business, consumers are taking note.

man working at a desk writing down notes

4. Healthcare organizations need a review collection strategy.

Disgruntled patients are more likely to post reviews online compared to patients that have a positive experience. If your practice is waiting for more patients to write reviews organically, without getting asked, you likely won’t see the results you want.

A review strategy, especially one that uses post-visit text messages to ask patients to leave a review, increases the number of reviews, the recency of those reviews, and the average rating (especially because happy patients are the ones leaving reviews). Include a link to the review site in your text to patients post-visit. It makes it quick and easy for them to visit the review site directly from their mobile device. “When prompted, those who have had a good experience are likely to leave a review, especially if you remove a lot of the barriers,” said Bryan.

To learn more and listen to the entire session, click here.

Get better dental reviews with Podium

Watch a Demo and get started with Podium to see how our cloud-based platform can help your practice take its online reputation to the next level. Podium’s efficient, mobile process can help your practice collect 15x the reviews that traditional platforms produce, which in turn will improve local SEO and ultimately boost revenues.

What You Should’ve Learned In Dental School…But Didn’t

Originally Featured in New Dentist Blog.

Something feels oddly familiar.

Sitting in my neighborhood coffee shop with my laptop open, staring at a course syllabus as it ominously lays out what my life will look like for the next several months. Coffee, flash cards, and wild Friday nights are in my future. And if I’m lucky, I’ll get the pleasure of writing a research paper or two while I’m at it. I can only hope as I start my endo residency.

Dr. Vaughn

I haven’t “studied” in six years. I haven’t even thought about studying. It’s been so long since I’ve studied that I’m not even sure I still know how to do it effectively. But still here I am, a student once more, and residency promises to be very much one of those sink or swim scenarios.

Luckily, I haven’t forgotten everything that I learned in dental school. There’s a few lessons I’m bringing with me this time that I’ve picked up along the way. Maybe you’ve heard these a few times before. Maybe you haven’t. But I think all of us, from brand new dental students to those who’ve been out a while, could use a refresher.  Here’s four important lessons that I learned in dental school and in my years practicing as a general dentist.

1. Get your money’s worth.

Every day you walk into your dental school, it’s like showing up to an 8-hour CE course for which you have paid top dollar. It’s tempting to coast. Many of us are guilty of trying to get through our programs by putting as little effort in as possible.

“D stands for Degree,” right?

But what I’ve learned is that dental school is filled with opportunities to learn more than the bare minimum. Some of the most impressive people in our profession work in dental education. And what I’ve found out is that many of the expensive, top-notch CE courses you take as a practicing dentist are taught by, you guessed it, dental school faculty. Take advantage of your environment. You’ve already paid for it.

2. Listen well

Having been a part-time faculty a few times myself, I’ve found one of the most desirable qualities in a student is the ability to listen well. Are you teachable? Can you take constructive criticism? Are you willing to own that “student” mentality?

Will you agree with all of your attendings? No.

Do you have to agree? Of course not.

But no one ever starts a sentence hoping that you’ll finish it for them. Not every teacher is waiting for your perfectly crafted rebuttal of why you did what you did. Oftentimes, listening is the most powerful tool we have. You will find that this translates well out in practice. Make an effort to actively listen to what your patients have to say, and you’ll have a group of raving fans who trust you wholeheartedly.

3. Hand skills rarely matter

Look through the Google reviews of any dental office in your community and you know what you won’t see? Any mention whatsoever about the occlusal composite staining of the Class I secondary grooves. No 5-Star review on the distoincisal angle of your biomimetically placed resin composite. Not even a single word about that buttery smooth crown margin that you spent an extra 15 minutes polishing for your Instagram photo.

Of course, our hand skills do actually matter (to a degree). But my point is that to the patient, what is often more important (and rarely taught in dental school) are the soft skills required to be a successful practitioner. If I could go back to dental school, I’d spend much more time honing that skill set. Because if you can effectively communicate with your patients, and if you can make a great first impression and win their trust, dentistry becomes a lot easier and a lot more enjoyable.

4. Don’t sleep on business and finance.

From my very first day in dental school, I was told that we wouldn’t learn a single thing about how to run a business, but oddly enough it was essential to our success as a dentist. After hearing that, do you think I made a single effort to learn about business and finance as a dental student? (See lesson #1. Hint: I did not)

Like so many of us, I chose the path of least resistance. I didn’t even look at my student loans until six months after finishing my GPR. I didn’t read a single article on practice management until two years into practice.

What a huge mistake. Such a huge mistake in fact, that now I spend much of my time talking to dental students about how to manage their student debt and avoid common mistakes that are made every single day. Mistakes that can set your career back years, and could ultimately affect the decisions you’re able to make for you and your family.

So don’t do what I did. Don’t do what so many of us in this profession continue to do. Start early. Take control of your student loans. Spend time learning about how they work, how to save and budget, and even how to invest.

Tap into the vast list of resources on practice management and how to run a business. Books, podcasts, blogs, and even YouTube. Ask your part-time faculty how they run their private practices. Take advantage of the ADA Success program and have an experienced dentist come to your school and talk about these topics (I’d be more than happy to visit and tell you everything I know).

Dental school was honestly some of the best years of my life. And although it was very difficult and challenging at times, the memories will last me a lifetime. I want to wish all future dentists the best of luck in this new school year. Cherish these moments and always make an effort to take advantage of the opportunities in front of you. Cheers!

Dr. Joe Vaughn is a general dentist who graduated from the University of Alabama and currently practices in Seattle, Washington. He works both as an associate in a private practice as well as in a public health clinic. Dr. Vaughn currently serves in roles with both the Seattle King County Dental Society and the Washington State Dental Association. He is passionate about organized dentistry, writing, and talking with other dentists about the many issues we are facing in our profession today. He welcomes any and all of your questions/comments and can be reached at jkvaughn44@gmail.com.

(3) Morning Huddle Ideas

 By American Association Of Dental Office Management

Audrey Clements, FAADOM with text, "Real-world insights from AADOM authors"

When your team hears that it’s time to start the morning huddle, do they drag their feet, moan and groan, or come to huddle ready to start the day? Are they on their cell phones or eating breakfast?

Morning huddles are the time for you to shine as a dental office manager.

You bring the energy.

You motivate the team to get excited about the day, discuss ways to boost production, and avoid any potential roadblocks in the schedule.

Make the huddle fun but informative and productive for your team.

As the team leader, you should come in with a positive attitude and set the mood for the day.

Here are three important aspects to having a great morning huddle:

Huddle format

The huddle needs to start at the same time every morning and should last about 15-20 minutes.

The huddle should be brief and on point.

Team members should come to the huddle with a copy of the schedule and a pen so they can take notes.

It’s important to not have any distractions such as cell phones, breakfast, or chatting amongst themselves. Everyone needs to be focused and ready for the day.

The team needs to see this as an important part of their morning so that the day runs smoothly.

Leader of the huddle

There are a few ways to facilitate the huddle.

There can be one team member (usually the office manager) running the meeting every day or the team can take turns running the huddle.

The facilitator needs to start the meeting on time, make sure the discussions pertain to the schedule, and discuss any insurance questions or same-day treatment opportunities.

Give the team an opportunity to talk about how yesterday went and how today looks.

What worked and what didn’t?

Let the team give their input as to how to make the day run smoother. This gives the team an appreciation of how important they are and how their input matters.

Huddle agenda

An agenda helps keep the meeting on track so as not to miss any opportunities for patient care.

It helps if you have an outline for the huddle.

Discuss opportunities for same-day treatment and if there are family members who need recare appointments.

The team needs to come to the meeting prepared by looking at the schedule prior to the start of the meeting. This helps with personal accountability and gives them an opportunity to discuss any concerns they may have.

Be ready to listen to any concerns and recommendations.

By having a morning huddle, you will change how your day goes.

Sure, there will be hiccups in the schedule, but by everyone being on the same page the team will know how to handle them.

The morning huddle takes some practice but by having one every day, you and your team will get better and your production will increase.

When we all work together for the same outcome, our day will run much smoother.


Meet the Author

Audrey Clements in black top

Audrey Clements, FAADOM, is the office manager at Yulee Family Dentistry… This text opens a new tab to the practice’s website… in NE Florida.

She has been in the dental field for over 30 years, beginning her career as a dental assistant and gradually working her way up to the role of office manager.

She is currently the vice president of her local AADOM Chapter… This text opens a new tab to the NE Florida chapter website….

A preparedness model for the provision of oral health care during unfolding threats: the case of the covid-19 pandemic

As of May 1 2021, the COVID-19 pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARSCoV- 2), has spread to more than 200 countries and territories, caused over 3 million deaths, and infected more than 150 million people worldwide [1, 2]. Also by May 1 2021, a third wave of infections was experienced by a number countries, some caused by more infectious genetic SARS-CoV-2 variants [3], even in the wake of mass inoculation efforts made possible by the fastest development of a vaccine ever seen in modern history [4]. Nonetheless, the pandemic continues to lead to social unrest [5] and economic and educational pitfalls [6]. The pandemic has also negatively impacted the provision of health care, and in particular oral health care, due to the close face-to-face proximity of professionals to patients’ face [7]. As the virus that causes COVID-19 can be found in saliva droplets and aerosols, the practice of oral health care is said to be at the highest risk for transmission of the virus [8, 9] even more so in light of a strong evidence for airborne spread as discussed by Greenhalgh and colleagues [10]. 

Use of Toothpaste and Toothbrushing Patterns Among Children and Adolescents — United States

Fluoride use is one of the main factors responsible for the decline in prevalence and severity of dental caries and cavities (tooth decay) in the United States (1). Brushing children’s teeth is recommended when the first tooth erupts, as early as 6 months, and the first dental visit should occur no later than age 1 year (2–4). However, ingestion of too much fluoride while teeth are developing can result in visibly detectable changes in enamel structure such as discoloration and pitting (dental fluorosis) (1). Therefore, CDC recommends that children begin using fluoride toothpaste at age 2 years. Children aged 3 years should use no more than a pea-sized amount (0.25 g) until age 6 years, by which time the swallowing reflex has developed sufficiently to prevent inadvertent ingestion. Questions on toothbrushing practices and toothpaste use among children and adolescents were included in the questionnaire component of the National Health and Nutrition Examination Survey (NHANES) for the first time beginning in the 2013–2014 cycle. This study estimates patterns of toothbrushing and toothpaste use among children and adolescents by analyzing parents’ or caregivers’ responses to questions about when the child started to brush teeth, age the child started to use toothpaste, frequency of toothbrushing each day, and amount of toothpaste currently used or used at time of survey. Analysis of 2013–2016 data found that >38% of children aged 3–6 years used more toothpaste than that recommended by CDC and other professional organizations. In addition, nearly 80% of children aged 3–15 years started brushing later than recommended. Parents and caregivers can play a role in ensuring that children are brushing often enough and using the recommended amount of toothpaste.

Mindful Dentist

Dental anxiety challenges patients and providers alike, creating barriers to care, increasing pain perception, and increasing the time and effort required to complete treatment. While patient-centered dentistry invites us to care for the person attached to the teeth, many dentists feel ill-equipped to handle the many emotions that arise during dental treatment. Mindfulness and the practices that cultivate it are invaluable to the provision of patient-centered care in four respects: 1) it provides balance to the dental professional during stressful times, 2) it cultivates the qualities of a patient-centered health care provider 3) it guides actions necessary to meet a patient’s needs, 4) it provides techniques that patients can themselves use to find balance during stressful times. All of these fruits of mindfulness practices are demonstrated in three true vignettes of fearful patients who were treated by the author. Video footage of the three stories is also provided.

Vaccinations for Dental Professionals

Widespread immunization has dramatically altered the global landscape for the transmission of many diseases, reducing morbidity and mortality.1,2General recommendations for childhood and adult vaccinations are designed to minimize the risk of disease transmission among the general public.1 In addition, immunization is considered an essential component of infection control and prevention in healthcare settings.3 In the United States, national guidelines on immunizations for healthcare personnel (HCP) are provided by the Advisory Committee on Immunization Practices (ACIP) and the Hospital Infection Control Practices Advisory Committee (HICPAC).4 State and federal regulations and recommendations from the Public Health Service and organizations should also be included in policies.3 The emergence of COVID-19 and the ensuing pandemic have also resulted in the rapid development of vaccines against SARS-CoV-2 and additional recommendations.Immunization is considered an essential component of infection control and prevention in healthcare settings.

Laws and Vaccinations for HCP

Under the Bloodborne Pathogens Standard, the Occupational Safety and Health Administration (OSHA) mandates that all workers at potential risk of exposure to blood or other potentially infectious materials (OPIM) be educated on the risk of transmission, the benefits of vaccination and offered Hepatitis B (HBV) vaccination at no cost and at a reasonable time and place.5 Should individuals decline vaccination, they must sign a declination form that must be kept in their personnel file. Following declination, individuals can later request vaccination should they wish to and must then receive this at no cost. State laws for HCP may also mandate vaccinations against some transmissible diseases.6 Mandates vary by State, facility and the role of HCP, making it important to check for your location. In addition, exemptions are granted on medical grounds, and may or may not be permitted on philosophical or religious grounds.7,8 Healthcare facilities may also have policies mandating vaccinations, for example, dental schools can mandate vaccinations for students before they begin their curriculum.9,10 Immunizing students before they are at risk of exposure when treating patients protects students and helps to protect others in the school environment, including patients.Under the Bloodborne Pathogens Standard, all healthcare workers at potential risk of exposure to blood or OPIM must be offered vaccination against HBV.

Recommendations for routine vaccination of dental healthcare personnel (DHCP)

Vaccination is recommended for diseases known to represent a substantial risk for transmission in healthcare settings. For DHCP, this has included immunization against HBV, measles, mumps, rubella, varicella, tetanus, pertussis, diphtheria and influenza unless as noted an individual is already immune to a given disease or the vaccine is contraindicated for that individual.3 (see Table 1 for contraindications for vaccines) Vaccines against COVID-19 have now been added as a new vaccine.

HBV vaccine
Vaccination against HBV is recommended unless there is documented evidence of a completed vaccine series or there is serologic evidence of immunity.11 As noted above, this vaccination must be offered to DHCP at risk of exposure to bloodborne pathogens. The CDC Guidelines for infection control in dental health-care settings — 2003, which were published prior to the development of a 2-dose series, recommend vaccination as a 3-dose series to individuals at potential risk of exposure.3 However, in accordance with the more recent CDC recommendations on vaccinations for HCP, which explicitly includes DHCP and students, HBV vaccination can be given as a 2-dose series with the doses 1 month apart (Heplisav-B) or as a 3-dose series at months 0, 1 and 6 (Engerix-B or Recombivax HB).11

Following completion of a vaccine series, serological testing for Hepatitis B surface antibody (anti-HBs) should be performed 1 to 2 months later.3,11 If the level of anti-HBs is <10 mIU/mL, the individual should receive a second series and repeat serological testing. If testing still indicates an inadequate response, the individual is considered a ‘non-responder.’ Separate testing is then recommended to determine if the individual is positive for HBV antigens. If this test result is positive, advice should be provided on how to prevent transmission to others. If negative, advice should be given on precautions to take to prevent infection, and of the need for post-exposure prophylaxis should a confirmed/probable exposure occur. (Figure 1)

Figure 1.
Pathway for HBV vaccination and testing

Measles, mumps and rubella (MMR) vaccine
The recommendation for MMR immunization is based on age.11 For individuals born in 1957 or later, in the absence of prior MMR vaccination or serological evidence of immunity to measles or mumps, a 2-dose series of MMR vaccine with the doses at least 4 weeks apart is recommended (for rubella, a single dose is sufficient).11 During a mumps outbreak, a third dose of mumps-virus-containing vaccine is recommended for previously vaccinated at-risk individuals.12 Individuals born before 1957 are considered immune, while consideration should be given to vaccination for unvaccinated HCP if there is no laboratory evidence of disease or immunity to rubella (1-dose) or measles and/or mumps (2-dose), and during an outbreak of these diseases the respective 1- or 2-dose vaccination schedule is recommended.11 Women should not receive this vaccine while pregnant and should avoid becoming pregnant for 3 months following vaccination.13

Tetanus/Diphtheria/Pertussis (Td/Tdap) vaccine
Tdap as a single-dose vaccine is recommended if not previously received/unknown, even if Td was previously given.11 In addition, a Td/Tdap booster should be given every 10 years. Revaccination is recommended during each pregnancy.

Varicella vaccine
A 2-dose series (doses at least 4 weeks apart) is recommended for unvaccinated DHCP, those who have not had chickenpox/ no serological evidence of immunity.11 Women should not receive this vaccine while pregnant and should avoid becoming pregnant for 3 months following vaccination.14

Influenza
Annual immunization against influenza is recommended and generally given as inactivated vaccine administered by injection. Live attenuated influenza vaccine (administered nasally) or inactivated vaccine may be given to non-pregnant individuals below the age of 50.11 In addition, while it is unlikely that dental healthcare personnel would come in close contact with severely immunosuppressed patients requiring protective isolation, should this be the case then inactivated vaccine is preferred. 

Table 1. Recommended vaccines for DHCP Contraindications
Hepatitis B2-dose series 1 month apart or 3-dose series at months 0, 1 and 6.A life-threatening allergic reaction to a previous dose of HBV vaccine.A severe allergy to any ingredient.Other contraindications can be found on National Vaccine Information Center (NVIC) website.15
MMR2- dose series with doses at least 4 weeks apart if born 1957 or later. A third dose during an outbreak for at-risk previously vaccinated DHCP. Born prior to 1957 considered immune (see above).A severe allergy to any ingredientPregnancy.Other contraindications can be found on the NVIC website.13
Td/TdapIndividuals who have not previously received Tdap should receive Tdap (even if had Td). Tdap/Td booster every 10 years. Revaccination during each pregnancy.A severe allergic reaction to a previous dose of the vaccine.A severe allergy to any ingredient. Other contraindications can be found on the NVIC website.16
Varicella2-dose series with doses at least 4 weeks apart for unvaccinated individuals or those who have not had chickenpox or without serological evidence of immunity.A severe allergy to any ingredient.PregnancyOther contraindications can be found on the NVIC website.14
InfluenzaAnnual immunizationA life-threatening allergic reaction to any previous flu vaccine.< 6 months of age should not receive the inactivated vaccine.Under age 2 years should not receive the live (nasal) vaccine.Other contraindications for the live (nasal) vaccine can be found on the NVIC website.17
COVID-19All DHCP. 2-dose series for mRNA vaccines (see above). Believed an annual vaccination will be needed, pending information.Individuals with severe allergies/allergies to an ingredient should discuss this with their physician.

COVID-19
SARS-CoV-2 vaccines reviewed by the FDA and granted Emergency Use Authorization (EUA) are now available.18,19 It is critically important that immunization for as many people as possible occurs to combat the ongoing pandemic. The effectiveness of available vaccines based on mRNA technology (Pfizer/BioNTech and Moderna) is ≥90%, substantially higher than that of annual influenza vaccines, and the results of clinical trials showed a good safety profile. A 2-f series is required, with the doses 21 and 28 days apart, respectively, for the Pfizer/BioNTech and Moderna vaccines.

For the initial roll-out, with a limited vaccine supply, the CDC issued guidance in December 2020 on prioritization for immunization based on a report from ACIP which advised that HCP be among those offered the first doses. ACIP also stated that federal, state and local jurisdictions should use this guidance for COVID-19 vaccination program planning and implementation. There was, however, concern that the advisory could be interpreted to exclude some categories of HCP, such as DHCP, based on different infection control guidelines for these groups.20 The CDC recommendations were therefore updated on December 29, 2020 and explicitly include prioritizing DHCP including students, and those other groups in Phase 1.21,22 Each State jurisdiction and county can determine prioritized groups for their vaccination program.

Recommendations and the Role of Dental Professionals 

The CDC recommends that all dental settings develop a written health program that addresses immunizations, screening for tuberculosis, work restrictions and other occupational health needs.23 With respect to diseases for which immunization is recommended, DHCP with active measles/mumps/rubella/varicella or who are susceptible to any of these and were exposed are excluded from duty. For pertussis, DHCP are excluded for duty if they have active disease or were exposed and are symptomatic. Details on duty exclusion and its duration can be found in the CDC guidelines and recommendations, with the exception of COVID-19 for which guidance on quarantining was issued.3,24 In addition, a comprehensive written policy including a list of all recommended and required immunizations is recommended.The CDC recommends that all dental settings develop a written health program for DHCP that addresses immunizations, screening for tuberculosis, work restrictions and other occupational health needs.

Immunization of DHCP against specific communicable diseases as recommended by the CDC and ACIP reduces host susceptibility and also helps to reduce the potential for transmission to co-workers and patients.3 Dental professionals can further play a role in disease prevention by educating patients on the benefits of vaccination and by debunking misinformation25. It is especially important at the current time with respect to COVID-19 vaccines that key information is provided to patients regarding vaccine efficacy and safety to encourage vaccination. In addition, depending on the scope of practice for a given State, dental professionals may be able to administer vaccines.Dental professionals can further a role in disease prevention by educating patients on the benefits of vaccination and by debunking misinformation.

Scope of Practice

State laws dictate whether the scope of practice permits dental professionals to administer vaccines and, if so, which ones. The first State to permit dentists to immunize patients of all ages with many vaccine types was Oregon, after the Oregon House Bill 2220 was signed on May 6, 2019.26 The administration of vaccines by dentists is supported by the American Dental Association (ADA).27 A number of States now allow dentists to administer vaccines against COVID-19 during the current emergency.28 In Nevada, as of January 13, 2021 dentists and dental hygienists may administer COVID-19 vaccines with EUA and the State Board of Dental Examiners passed emergency regulations permitting licensed dental professionals to do so provided they first complete a required certification training program.29 Information on the ADA website can be found on vaccine allocation and administration by dentists for some States and contains links for further information.28 Requirements by State vary and may include, for example, additional training. Restrictions on where the vaccine may be administered must also be followed. It is critical to check with your State and State Board on the regulations for dentists and dental hygienists, and to ensure that all regulations and requirements are followed.It is critical to check with your State and State Board on the regulations for dentists and dental hygienists, and to ensure that all regulations and requirements are followed.

Conclusions

Recent events and the EUA of COVID-19 vaccines highlights the importance of immunization. Dental professionals can play a key role in helping to prevent disease transmission by following the recommendations, and educating patients on the benefits, efficacy and safety of vaccinations (in the absence of contraindications). In addition, where permitted and following regulations and recommendations, dental professionals can assist in the implementation of vaccination against COVID-19. Following the CDC recommendations on vaccinations is a key component of infection control and prevention and in protecting DHCP and patients.

Zircon Lab is America’s leading dental lab. We are partnered with dental offices nationwide and are consistently growing. As America’s highest quality dental lab with the most competitive pricing, the highest caliber of product, expert craftsmanship, and fastest delivery, we set the dental industry standard. After choosing Zircon Lab to be your dental lab of choice, you can trust our dental product will be unmatched by any competitors.

References

  • 1.Andre FE, Booy R, Bock HL, Clemens J, Datta SK, John TJ et al. Vaccination greatly reduces disease, disability, death and inequity worldwide. Bulletin of the World Health Organization 2008;86(2):81-160. Available at: https://www.who.int/bulletin/volumes/86/2/07-040089/en/.
  • 2.CDC. Benefits from Immunization During the Vaccines for Children Program Era — United States, 1994–2013. MMWR April 25, 2014;63(16):352-5.
  • 3.CDC. Guidelines for infection control in dental health-care settings — 2003. MMWR Morb Mortal Wkly Rep. 2003;52(RR17);1–61.
  • 4.CDC. Immunization of Health-Care Personnel: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 2011; 60(RR-7).
  • 5.OSHA Fact Sheet. Hepatitis B Vaccination Protection. Available at: https://www.osha.gov/OshDoc/data_BloodborneFacts/bbfact05.pdf. 
  • 6.CDC. State Healthcare Worker and Patient Vaccination Laws. Available at: https://www.cdc.gov/phlp/publications/topic/vaccinationlaws.html 
  • 7.Phadke VK, Bednarczyk RA, Salmon DA, Omer SB. Association Between Vaccine Refusal and Vaccine-Preventable Diseases in the United States: A Review of Measles and Pertussis. doi: 10.1001/jama.2016.1353.
  • 8.Healthcare Training Leader. Carrot or Stick: Immunization Laws for Healthcare Workers, January 14, 2020. Available at: https://healthcare.trainingleader.com/2020/01/immunization-laws-for-healthcare-workers/. 
  • 9.Tufts School of Dental Medicine. Immunization & Health Insurance. Immunization Requirements. Available at: https://dental.tufts.edu/immunization-health-insurance. 
  • 10.The Ohio State University College of Dentistry. Immunization Requirements. Available at: https://dentistry.osu.edu/dental-hygiene/immunization-requirements. 
  • 11.CDC. Recommended Vaccines for Healthcare Workers. Updated 2016. Available at: https://www.cdc.gov/vaccines/adults/rec-vac/hcw.html. 
  • 12.CDC. Recommendation of the Advisory Committee on Immunization Practices for Use of a Third Dose of Mumps Virus–Containing Vaccine in Persons at Increased Risk for Mumps During an Outbreak. MMWR 2018;67(1);33–38. Available at: https://www.cdc.gov/mmwr/volumes/67/wr/mm6701a7.htm. 
  • 13.National Vaccine Information Center. Who should not get Measles vaccine? Available at: https://www.nvic.org/vaccines-and-diseases/measles/who-should-not-get-measles-vaccine-mmr.aspx.
  • 14.National Vaccine Information Center. Who should not get Chickenpox vaccine? Available at: https://www.nvic.org/vaccines-and-diseases/chickenpox/vaccine-who-should-not-get.aspx. 
  • 15.National Vaccine Information Center. Who should not get Hepatitis B vaccine? Available at: https://www.nvic.org/vaccines-and-diseases/hepatitis-b/vaccine-who-should-not-get.aspx 
  • 16.National Vaccine Information Center. Who should not get Tetanus vaccine? Available at: https://www.nvic.org/vaccines-and-diseases/tetanus/vaccine-who-should-not-get.aspx. 
  • 17.National Vaccine Information Center. Who Should Not Get the Influenza (Flu) Vaccines? Available at: https://www.nvic.org/vaccines-and-diseases/influenza/vaccine-who-should-not-get.aspx.
  • 18.U.S. Food & Drug Administration. FDA Takes Key Action in Fight Against COVID-19 By Issuing Emergency Use Authorization for First COVID-19 Vaccine. December 11, 2020. Available at: https://www.fda.gov/news-events/press-announcements/fda-takes-key-action-fight-against-covid-19-issuing-emergency-use-authorization-first-covid-19. 
  • 19.U.S. Food & Drug Administration. FDA Takes Additional Action in Fight Against COVID-19 By Issuing Emergency Use Authorization for Second COVID-19 Vaccine. Available at: https://www.fda.gov/news-events/press-announcements/fda-takes-additional-action-fight-against-covid-19-issuing-emergency-use-authorization-second-covid. 
  • 20.Coalition Letter, COVID-19 Vaccination Playbook for Jurisdictional Operations. December 16, 2020. Available at: https://www.ada.org/~/media/ADA/Advocacy/Files/201216_cdc_ncird_covid19_coalition.pdf. 
  • 21.CDC. The Importance of COVID-19 Vaccination for Healthcare Personnel. Updated December 28, 2020. Available at: https://www.cdc.gov/coronavirus/2019-ncov/vaccines/recommendations/hcp.html. 
  • 22.https://www.ada.org/en/publications/ada-news/2021-archive/january/cdc-confirms-dentists-in-first-phase-of-covid-19-vaccinations.
  • 23.CDC. Dental Health Care Personnel Safety and Program Evaluation https://www.cdc.gov/oralhealth/infectioncontrol/summary-infection-prevention-practices/personal-safety-program-evaluation.html. 
  • 24.ADA. What to Do if Someone on Your Staff Tests Positive for COVID-19. Available at: https://success.ada.org/~/media/CPS/Files/COVID/A_Positive_COVID-19_Test_Result_On_Your_Staff.pdf?la=en. 
  • 25.Hotez P. America and Europe’s new normal: the return of vaccine-preventable diseases. Pediatr Res 2019;85(7):912-4. doi:10.1038/s41390-019-0354-3.
  • 26.Oregon Health & Science University. Oregon Dental Immunization Resources. Available at: https://www.ohsu.edu/school-of-dentistry/oregon-dental-immunization-resources. 
  • 27.ADA News. ADA supports efforts allowing dentists to administer vaccines, October 23, 2020. Available at: https://www.ada.org/en/publications/ada-news/2020-archive/october/ada-supports-efforts-allowing-dentists-to-administer-vaccines. 
  • 28.ADA. COVID-19 Vaccine Regulations for Dentists Map. https://success.ada.org/en/practice-management/patients/covid-19-vaccine-regulations-for-dentists-map. 
  • 29.Nevada Dental Hygienists’ Association. Not going to miss my shot. Available at: https://nvdha.com/.

Dental Impressions: The Digital Alternative

Dental impressions are defined as “a negative imprint of an oral structure used to produce a positive replica of the structure to be used as a permanent record or in the production of a dental restoration or prosthesis.”1

The concept of taking dental impressions to create dental models was first introduced in the mid-18th century when Phillip Pfaff, dentist to Frederick the Great of Prussia, described the technique of pouring plaster of Paris into a beeswax impression.2

While our materials have certainly evolved over the course of the last 260 years, we continue to follow a similar workflow in our attempt to create an accurate analog representation of the oral environment. This conversion process presents many challenges for practicing clinicians that are related to impression retake cost, time, patient comfort and frustration when errors lead to an ill-fitting final restoration. It is appropriate then to pose the question, why is the most critically important step in what we do in restorative dentistry, which is to transfer the data from the patient (dental impression) to the laboratory (gypsum model), continued to be captured in an analog manner when we have a viable digital alternative?

This analog dental impression workflow also creates complications for our dental laboratory partners that are perhaps best illustrated by a 2015 survey in which 47 percent of the survey respondents ranked dentists’ impression-taking skills as their number one client related challenge.3 The results of this survey are supported by an often cited 2005 article in the Journal of Prosthetic Dentistry which concluded that 89.1 percent of dental impressions sent to a dental laboratory had at least one or more observable, critical errors.4

Regardless of whether one chooses to replicate an oral structure digitally or in a more conventional manner, paying attention to the fundamentals of preparation design, tissue management and appropriate isolation is paramount. However, digital impressions address many of the concerns related to retake cost, time, patient comfort5 and, due to their accuracy,6,7 helps to reduce frustration when delivering the final restoration.

I am so proud to say that we are the first dental school in North America to have secured these recently introduced intraoral scanners for use by our students in the pre-doctoral clinics. I view these units as game changers that offer distinct advantages over conventional impressions, and with many intraoral scanner options available, there is no need to wait to join the early adopters as you can easily find one that meets your individual practice goals. Implementing this contemporary approach in capturing “positive” images of oral structures will certainly afford you the opportunity to improve your clinical outcomes while showcasing your interest and commitment to providing-state-of-the-art dentistry to your patients.

By Gary L. Stafford
Marquette University
Published version.WDA Journal,Vol. 93, No. 1 (January-February 2017): 17-18.

Publisher link. ©2017 Wisconsin Dental Association. Used with permission.

Zircon Lab is America’s leading dental lab. We are partnered with dental offices nationwide and are consistently growing. As America’s highest quality dental lab with the most competitive pricing, the highest caliber of product, expert craftsmanship, and fastest delivery, we set the dental industry standard. After choosing Zircon Lab to be your dental lab of choice, you can trust our dental product will be unmatched by any competitors.

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