Monday, March 4, 2019

How to Save Money and Frustration by Preventing Sensitivity

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Every dentist deals with postoperative sensitivity.  While it isn’t incredibly common, it can be frustrating for both doctors and the patients that are dealing with it.  The latest issue of Dental Products Reports deals with the finances of the modern dental practice and I thought this month, I’d use my Technology Evangelist column to explore proper restorative techniques that help to decrease the incidence of sensitivity.
Obviously, first and foremost this subject is of a tremendous benefit to the patients we serve.  No one likes having a filling done and then suffering with sensitivity afterwards.  However, decreasing the incidence of sensitivity can also be a financial benefit to the practice as dealing with sensitivity issues fills appointment slots with non-productive time.  Over the years I’ve been lucky enough to have studied with some really incredible clinicians as well as some really incredible scientists that create dental materials.  They have imparted to me a knowledge base that I’m grateful for and indebted to them for having provided.
Here’s what I came up with in this regard:

For those of you over the age of 45, you may remember a character from “Saturday Night Live.” His name was Father Guido Sarducci and was played by comedian Don Novello. In the guise of a Catholic priest, he would offer life lessons as part of Weekend Update.

One of his best bits was The Five Minute University, where he teaches “everything you’ll remember from college classes five years after you’re out of school.” For economics, he says, “supply and demand.” For business, “Buy something at one price and sell it for more.” It’s a great bit that you can view at will on YouTube. Every time I watch it, I laugh.

If you want to run a successful business, you have to have more money coming in the door than is leaving.

One of the things that happens in dentistry that can severely affect things is remakes/redos. My grandpa Flucke used to tell me, “Son, there’s never time to do it right, but there’s always time to do it over.” That little phrase has stuck with me for my entire life, and it certainly holds true for the practice of dentistry.

Having to do something over can have a tremendous impact on your practice. Financially, your overhead continues and the cost of the procedure is being fed by the gross operating revenue of the office. It also affects your scheduling. You’re eliminating time in your schedule that should be devoted to profits, and this compounds to affect your ability to see a patient who would love to be seen for a revenue-generating procedure. Finally, it affects your actual internal marketing strategy. No matter the reason for a redo, you run the risk of a patient losing faith in you. That loss of faith can affect the patient’s desire to refer you or even result in the patient leaving the practice.

I’ll never fault someone for doing the right thing and sometimes, despite our very best efforts, things don’t go as planned, which necessitates redoing something. Handling these cases the right way can even be a practice booster because the patient understands that your desire to do things perfectly outweighs everything else. The best way to avoid the whole scenario is to do everything possible to avoid the situation in the first place. This month let’s take a look at some ways to head off potential problems and keep our redos to a minimum.

Hemostasis and fluid control

When it comes to adhesive dentistry, one of the biggest negative factors we have in bonding is contamination. Whether it’s blood, saliva, or crevicular fluid, any type of biological contamination can directly affect bond strengths. This can lead to sensitivity, marginal leakage/breakdown and shorter lifespan of the restoration. When sensitivity is the issue, we’re often faced with replacing the restoration.

In order to prevent contamination with blood, there are a couple of handy chemistries available that I use routinely. One is ViscoStat®, which is a 20 percent ferric sulfate solution. It does a great job of quickly controlling bleeding. The only drawback is that, due to the iron content, it stains the tissue and has the possibility of making the margin of the restoration appear dark. In the esthetic zone, my agent of choice is ViscoStat® Clear, which is 25 percent aluminum chloride. It isn’t as strong as VicoStat, but since it’s clear, there’s no concern with staining. I also use ViscoStat Clear on Class V restorations, as the AlCl3absorbs crevicular fluid and prevents contamination at the gingival margin.

Fluid control can also be prevented through proper use of the rubber dam. I know a lot of you just rolled your eyes at that last sentence, but hear me out. I don’t really think the rubber dam is that difficult to use if you use the right one.

There are a few brands on the market that now have a built-in flexible plastic frame, that are an all-in-one piece, pre-assembled and ready to go when you open the box. I truly don’t think it’s the dam we hate dealing with — it’s the dam frame (pun intended). These all-in-one systems allow the assistant to place the clamp and then simply snap the assembled dam over it. The process is simple and can be accomplished in just a few seconds. My current favorite is the Insti-Dam and the Relaxed-Fit Insti-Dam from Zirc. Both are latex-free and very durable. You can find others from Aseptico and Hygienic as well.

To view the entire article, head over to the DPR website.  

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