By Dr. Todd Pickle
Polytetrafluoroethylene is a truly amazing
material used in many industries and has lots of uses in dentistry and everyday
The #1 best use in Dentistry: Closing screw access holes in implant
abutments, crowns and hybrids prostheses!
PTFE is very hydrophobic and does not collect microorganisms like cotton
pellets or retraction cords, or heaven forbid wax! It can be packed and condensed, and then
other restorative materials placed over it and they won’t stick to it. It will protect the implant screw so that
your implant components are retrievable, which is a prime benefit of dental
implants over teeth.
It is important to place the PTFE tape
starting in the deepest portion of the screw access hole directly on top of the
implant screw head. Then continue to
pack the tape (start with a long piece about 2 inches) until you have about
2-3mm remaining of the occlusal portion of the screw access hole. This will allow enough space for adequate
filling materials (interim or permanent) to be placed over the PTFE tape and
not always falling out and needing replaced.
But it also means you don’t have to dig very deep when you need to take
Other dental-related uses include: Using it
in endodontic access holes, blocking out undercuts or adjacent teeth around
composite placements, covering sutures while making impressions (instead of
rubber dams). “Gore-Tex” sutures are PTFE because they are strong, do not
attract microorganisms and do not resorb.
And of course, threading pipes for
plumbing! And best of all it is cheap
and you can get it at Home Depot!
By Dr. Sarah D. Parsons
Dentistry is personal. It’s
personal to us because we put our heart and soul into treating patients and
growing our business. We have dedicated
our life’s work to cultivate our dental practices.
But, there is a patient that
is unhappy. A variety of reasons can make a patient unhappy. There is a
miscommunication with a team member, a disagreement over finances, or a perceived
bad experience by the patient of some type. The patient calls or comes to the
office and they are unhappy, so how should you handle this?
First, it is important to
stay calm. We as clinicians take these situations very personal. But we must
put on our “doctor hat” and try to diffuse the situation in a professional
manner without bringing our personal feelings into the situation. We may feel
the patient does not understand the situation or does not have all the
information. This may be true; however, most unhappy patients just want to be
Invite them into a
consultation room or treatment room away from other patients. Hear them out.
Let them tell you in their own words why they are upset and unhappy. Your job
is to just LISTEN! Many times this diffuses the situation immediately; do not
interrupt or try to correct them. Let them tell their perceptions of the
situation from beginning to end. Let them know that your hear them and you
understand their frustrations. Reassure them that you will be taking the time
to review their grievances and that you will help find a way to make it right.
DOCUMENT, DOCUMENT, DOCUMENT!
Do not wait. Immediately document the situation with the patient and write
their exact words in quotes. Be sure to call Dr. Randy Kluender or Dr. Candace
DeLapp to discuss the situation and the best way to resolve your issue.
We know that your dental
practice is personal. That’s why we make it our mission to take these
situations as personal as you do. We have licensed dentists who have been in
private practice who understand your day to day business. We make it our
mission to always take your practice as personal.
By Dr. Candace DeLapp
Senate Bill 22 (SB18-22): Clinical Practice for Opioid Prescribing was signed in to law May 2018.
Briefly, its impact on the
practice of Dentistry is:
Initial prescription must be limited
to a seven-day supply if the prescriber has not written an opioid prescription
for the patient in the last 12 months.
The limits on initial prescribing do not apply if, in the judgement of the dentist, the patient:
chronic pain that lasts longer than 90 days or past the time of normal healing,
as determined by the dentist, or following transfer of care from another
dentist who prescribed an opioid for the patient;
been diagnosed with cancer and is experiencing cancer-related pain; or
- is experiencing
post-surgical pain that, because of the nature of the procedure, is expected to
last more than fourteen days.
The prescriber may exercise
discretion for a second seven-day prescription.
The prescriber must check the Prescription Drug Monitoring Program (PDMP) database except under specific requirements:
patient is experiencing post-surgical pain which routinely exceeds 14 days;
patient has cancer or cancer-related pain;
prescription is administered by an in-patient facility
- the patient
is in hospice or palliative care
For more information on opioid prescribing contact The Trust:
Dr. Kluender [email protected]
Dr. DeLapp [email protected]
Or read the bill here.
By Dr. Lindsay Compton
Dentists don’t practice alone or in a bubble. That would be boring and I personally feel that I would be missing out on a lot of fun and comradery. I consider my hygienist leader in my dental team and sometimes an appendage of my body. For me and my practice philosophy, I wouldn’t practice without a hygienist.
As an important practitioner in the dental office, does the hygienist need malpractice insurance? The oversimplified answer is no. In most instances, the dentist’s professional liability or malpractice insurance will cover the employed dental hygienist. You’ll notice that I said the words “in most instances,” which means not always. Which means there probably was a time when the hygienist was liable. Which means there exists a situation when the hygienist needs their own malpractice insurance.
Let’s look at an example of this. Let’s say that your hygienist was placing sealants on a patient. Unfortunately the etch tip was not securely placed on the tube. As they were carrying it from the patient tray to the patient, the tip popped off and etch was expressed all over the patient’s face and eye. Did I say they patient was not wearing eye protection as well? To make matters worse, the patient had a horrible reaction between their face cream and the phosphoric etch and their face became scarred. The patient not only needed emergency treatment for their eye, but they also needed cosmetic facial and reconstructive surgery to cover up the scar created from the unsecured etch tip. In this instance, the dentist and the hygienist were both listed on the civil law suit. The legal fees and medical fees were over the required state coverage. Therefore both the dentist and hygienist were responsible for the difference in damages because both were listed on the case.
Could just a hygienist be named in a law suit? Yes they can. It would look something like this next example. An elderly patient gets up from a patient visit and uses the back of the patient chair to steady themselves as they exit the operatory. Unfortunately as they reach for the headrest on the chair, they instead only grab the headrest cover that wasn’t secure enough for the needs of the patient. The patient falls and hits their head on the counter top. They end up needing stitches in their head and sue the hygienist, not the dentist, because it was their responsibility for the upkeep of the operatory. Since only the hygienist was named on the law suit, the dentist’s malpractice insurance will not cover the hygienist.
Outside of the scope of this blog is the hygienist that practices independently. Without the direct supervision of a dentist, the hygienist is the sole care provider and is solely liable and must carry their own professional liability insurance.
If your hygienist is weary of the threat of a lawsuit, he or she may purchase professional liability insurance that would cover them if any of the above examples, or situations like them, become true. A resource in Colorado to find out more would be the Colorado Dental Hygienist Association.
By Dr. Sarah D. Parsons
Many patients report to our
offices with PTSD. These patients have undergone perceived severe mental or
physical abuse that elicits mental, physical, or combined responses. It can be
challenging to treat these patients due to their fear and intolerance of pain
and anxiety. Often times we seek additional sedation measures such as nitrous,
minimal, moderate, or even deep/hospital sedation.
Profound local anesthesia is
the cornerstone to management of any dental case in general but is especially
important to any successful management of PTSD. The more that we as clinicians
can deliver successful and profound anesthesia, the better outcome our cases
achieve. Never as a clinician should we dismiss a patient’s reporting of
discomfort or pain during a procedure. Rather in these instances, we should
consider and evaluate our anesthesia.
Sedation of any form is not a
replacement for profound local anesthetic but rather an adjunct to help ease
the anxiety of the dental patient. Prior to additional doses of sedatives,
profound anesthesia should be confirmed. Many patients tolerate more
complicated procedures and sedation cases are more successful, if profound
anesthesia is achieved.
Adequate interviewing of a
patient with PTSD is helpful prior to any dental procedure performed. This can
also aid us in the decision of what sedation level is appropriate. Many
clinicians believe that only moderate to deep sedation will be useful to treat
a PTSD patient. However, this is not always the case and a comprehensive
examination and treatment plan should be performed prior to any dental
Here are some questions you
may want to consider in your interview with a patient that has PTSD prior to
any dental treatment:
- May I inquire the reason for your PTSD diagnosis
- Are there any specific lights, sounds, or situations which trigger your PTSD?
- During your procedure, there will be clinicians whom will be female/male or both. We will be over you and looking down at you during the procedure. Will this trigger your PTSD? Would you be more comfortable with an all male or all female team?
- What are some calming measures you use during a PTSD episode? If you are triggered during this procedure, what measurements would you like me to use to help you through your episode?
- Do you feel you should be more sedated or more awake for your procedure?
Management and treatment of
PTSD patients can be successful in your dental practice. These patients can
become loyal and long term great patients. If you manage your treatment of
these patients successfully with profound anesthesia and appropriately sedate
to the level they require, they will return and become some of your practice’s
biggest fans and cheerleaders.