This month in Tech Tips we’ve got a video showing how easy it is to install a quick disconnect onto your unit, or into a cabinet using a mounting bracket. A few minutes and a couple quick attachments, and you will have an outlet for that scaler or microetcher you needed to attach.
Can’t see the video? You can also view this video on our blog or Youtube.
A University of Connecticut chemist has devised an improved means of early oral cancer detection.
Prof. James Rusling and colleagues previously developed a method of detecting the protein interlukin-6, this protein can signal the presence of oral cancer. But Prof. Rusling did not feel this single protein was enough to make a case as false positives are far too common using only one protein (“biomarker”).
Prof. Rusling’s team developed a device that will detect multiple proteins by attaching antibodies which produce an electric current. This current can be read by another antibody embedded with a microchip.
“Single biomarkers do not provide enough statistical power, and there is too much biological variability in humans for predictions based on them to be correct more than three-fourths of the time at best,” Prof. Rusling says. “And often prediction reliability is much worse than this.”
Prof. Rusling and his team hope to incorporate their work into a new tool for oral cancer detection.
Eventually, they hope to expand into using multiple biomarkers to aid in the detection of other types of cancer as well.
It’s hard to believe it’s been four years. Way back in issue #1 we stated that the goal of Tech Tips was to help dentists and staff increase their independence, reduce down time, and get the most out of their equipment.
Here we are, four years later, and that is precisely what we’ve done!
Thousands of practitioners have saved time and money by learning how to install basic replacement parts such as toggles, air/water syringes, and quick disconnects. We’ve covered the basics of pneumatics and introduced you to the junction box.
We’ve had several issues devoted to sterilizers including “decoding” the Statim sterilizer errors to help you trouble-shoot even if you don’t perform the repair yourself.
But it’s not just about repairs, we’ve also had many issues devoted to maintenance!
The first step in reducing down time and repair costs is reducing the frequency of break downs. The BEST way to do this is to have a good system of routine maintenance in place. We’ve also created a printable poster showing routine maintenance of your sterilizer- post it in your sterilization room to help staff keep your sterilizer running well. We’ve had issues dedicated to specific equipment as well as more general information to cover everything in the office!
We’ve also increased your knowledge with in-depth discussions of the design and function of equipment. Each issue has been replete with detailed descriptions, photographs, illustrations, and diagrams to convey as much information as possible. For further clarification, we’ve had a number of video issues as well.
Our YouTube channel has had tens of thousands of views! Unlike many “dental corporate” videos, we don’t just post a series of commercials for the latest new product. Our videos feature real information that you can put to use immediately in your office to save time and money.
Many of our videos have been made to compliment previous text-and-photo issues of Tech Tips by showing the things we’ve discussed being done in real time. And, they’ve been made by the hard-working tech support staff who take your calls every day. These guys know what real practitioners need to know and are asking us about every day.
We’d like to take this opportunity to thank each and every one of you that take the time to read Tech Tips every month. Whether you receive it in your inbox, read it in our blog, or read other online postings, THANK YOU for following us. Please share Tech Tips with your colleagues too. Point them to our blog, or have them send an e-mail to techtips@amerdental.com to subscribe for free!
Finally, we would really like to hear from YOU. We are interested in your feedback and we invite your topic suggestions so that we can continue to fulfill our mission of presenting you with useful content. What piece of equipment can we help demystify? Do you need help installing something? Please e-mail your ideas, feedback and suggestions to Techtips@amerdental.com!
In the future we’ll continue to provide you with helpful information, diagrams and videos to help you get the most out of your practice. Send us your ideas so we can incorporate them as well.
Bookmark our archives as a handy reference you can use every day!
Delta Dental has performed a survey that shows amazingly enough, many children engage in “high-risk” sports activities without a mouthguard. You can provide superior protection to your patients by providing custom-formed mouthguards produced in office.
Studies have shown that mouthguards can greatly reduce the risk of injury- not only to the dentition, but also reduce the risk of concussion.
A pressure-formed mouthguard provides superior fit and function to a “boil-and-bite” guard purchased over-the-counter. A custom formed appliance will not only stay in place better, but will allow for better breathing enhancing comfort and performance.
Very soon millions of American children will be starting football practice. By the end of July, most will need to have mouthguards- so now is the time to get involved in this process. A small but prominently placed sign that states something like “ASK US ABOUT MOUTHGUARDS” might be extremely helpful in opening a discussion on this subject. By offering this service to your patients, you are not only growing your practice, but also providing a truly important service to your patients. What parent wouldn’t want the extra protection for their child if they were simply made more aware of the possible risks of injury? Many patients may not be aware of how mouthguards not only protect teeth but can cushion impact and reduce the risk of concussion. Of course, participants in many other sports can benefit from the use of mouthguards too. Once you have the techniques down, you can market year-round for basketball, hockey, volleyball, and a host of other activities.
Dr. Shaun Doherty of Massillon Smiles in Ohio has been making athletic mouthguards for patients for some time now. They’re very popular with the local football team, in fact, the Tigers.
Here we see Dr. Doherty’s step-by-step process for making custom mouthguards in the team colors:
Naturally, he starts with an impression of the maxillary arch.
The fresh impression
From the impression you make and trim a model. Reducing the palate and/or making holes in the palate will improve the adaptation of the material to the model and produce an appliance with superior fit. Although this step is not necessarily required, it can improve the results. You may also wish to spray the model with silicone spray at this time. The silicone spray will make it easier to remove the formed appliance from the model.
Using a vacuum former heat the mouthguard material until you have about 1” of “droop”, drop the material over the model, and turn on the vacuum for about 30 seconds. Turn the vacuum off and let the formed appliance cool completely while on the model to avoid distortion.
Once the mouthguard has cooled, remove it from the model and trim with a scissors.
Trimming the appliance
Fine trimming and smoothing of the edges of the appliance can be performed with a Scotch Brite™ wheel on a lathe.
Carefully finishing the edges on the lathe- removing any flashing
At this point, the mouthguard is finished and usable, but with just a few more steps you can create something that will really stand out and help your practice stand out as well.
Put the appliance back on the model (this helps you handle it).
Now you can apply custom graphic elements. In this case, tiger stripes are drawn on the appliance with a fine marker. Decals of the team name and logo are also applied. Craft and hobby stores (and sometimes dollar stores) can be a good source of decals to match your needs. Although a skilled hand (like that of Dr. Doherty) is good too.
Applying custom graphics to the prepared appliance
Once additional graphics have been applied, an extra layer of thin EVA (0.030”) is applied to “seal” in the graphics. When using thinner materials like this, you should drop the material over the model and begin to form as soon as it starts to droop.
Drop the material down as soon as it starts to droop
As with the original mouthguard, turn the vacuum on once the material is in place and let it run for about 30 seconds to get a good fit. This extra layer will not only seal in your custom graphics, but will also provide an extra layer of protection (literally and figuratively) for your patient.
To laminate this extra layer, a pressure dome will need to be incorporated in addition to the standard vacuum former. The pressure dome is placed on top of the vacuum former immediately after the application of vacuum to introduce positive pressure from above, bonding the layers together. Hold the pressure dome in place for approximately 45 seconds.
Positive pressure is required to laminate the thin layer to the mouthguard
Once again, allow plenty of time for the finished appliance to cool completely. Cut away bulk excess of clear material with a scissors (as done with the original basic mouthguard) trim and polish the edges with a Scotch Brite™ pad (also as before) and then finish trimming with a hot knife or Scotch Brite™ wheel (as shown above).
If using a hot knife, take care to feather the edges as well to help blend the two materials together. If not using a knife to trim, you will still want to feather the edges using a heated spatula.
The technique illustrated above allows further customization of the mouthguard by applying additional graphic elements. Not only team names or logos can be incorporated this way, you can also individualize by adding player names, numbers or other custom graphics for a mouthguard that will appeal to the patient (helping to improve compliance and generate referrals).
Mouthguard materials are also available in a pre-fabricated factory laminate. These laminates can be purchased in multi-color patterns that could mimic your school colors (e.g. 1/2 black & 1/2 red). American Dental Accessories, Inc. carries a full line of Proform™ laminates in many colors and color combinations which could simplify providing a custom look to your patient.
Just a few of the Proform colors & color combinations that are available
One important note- If making for a local school or youth league, one must be mindful of league rules and regulations which will often dictate the color of the mouthguard. Many leagues prohibit solid red mouthguards as these may hide if the player is bleeding. Also, white or clear mouthguards are sometimes disallowed as the referees need to be able to tell at a glance if a player is wearing one (and these may not be readily visible). Be certain to check your local league for the specifics before launching a mouthguard program.
A custom-formed appliance will help protect the smiles you’ve helped create and help you differentiate your practice.
Go Tigers! (or whatever team you may root for)
We would like to thank Dr. Shaun Doherty of Massillon smiles for his invaluable assistance in producing this month’s Tech Tips. His step-by-step photos, assistance in proofing, and refining the technique are greatly appreciated.
Yes.
Water quality is important to proper function of your sterilizer.
Why? You’ll find out why, because this month in Tech Tips, we’ll look at the principles of autoclave sterilization.
The sterilizer is one of the most important pieces of equipment in the office. If you don’t have sterile instruments, you can’t work. But, how do these vital pieces of machinery function?
First, we’ll review a little history.
Most dental offices have what are classified as “table top” sterilizers as they are quite compact and small – small enough to fit on a table top (or counter top, more often).
Table top sterilizers were originally designed as “flash” sterilizers for use in medical operating rooms. They were intended for quick “flash” sterilization of instruments whose sterility was somehow compromised in the operatory (most commonly by being dropped). Their (comparatively) short cycle times and small size makes these sterilizers ideal for the dental office as well.
Now that we know a little background, we can move on to matters of function:
Taken at the most basic level, an autoclave is really just a boiling tank. You have water in a reservoir which is drained (or pumped) into the chamber at the beginning of the cycle. The chamber heats up causing the water to boil. The chamber continues to heat, super-heating the steam which then builds up pressure so that the steam permeates all items in the chamber. According to CDC guidelines, most items require 3-7 minutes of exposure to this superheated pressurized steam to be rendered sterile. The specific time will vary depending on the nature of the item and how it is packaged.
Once sterilization has been achieved, the pressurized steam is vented from the chamber and the heating elements turn off allowing the chamber and contents to cool. The vented steam is sometimes exhausted out a drain, or sometimes vented back into the reservoir where there is a condensation coil to facilitate cooling of the steam returning it to a liquid. Finally, the contents of the chamber are allowed to dry (the specific method of drying will vary widely from one make and model of autoclave to another).
As you can see, water (or steam created from this water) is integral to the function of an autoclave. For this reason, it is very important that you only use distilled water or water that has been treated for use in a sterilizer (typically, de-ionized). Properly treated water will have a very low Total Dissolved Solids (TDS) level- 5ppm or less. Distillation or de-ionization are normally the only way to achieve such low TDS levels. Other methods of water treatment (for example, reverse osmosis) are not normally adequate to achieve such low TDS levels.
The water and steam flows through a variety of small pipes and valves many of which can become clogged from the various minerals and additives that may be in untreated (i.e. tap) water. Poor or low water flow can lead to overheating (damaging expensive instruments), failure to achieve pressure (which is required for sterilization to be achieved), as well as damaging components of your autoclave. Naturally, damage to components of the autoclave can lead to malfunction, costly downtime, and expensive repairs.
As an additional safeguard, autoclaves have filters on the water line to catch any debris before the water enters the chamber. Check your filters regularly as part of your routine maintenance. Two examples of fill line filters are pictured below:
This sintered bronze filter is used on Pelton & Crane Sterilizers:
A mesh filter is used on Tuttnauer and Midmark sterilizers:
Many sterilizers will also have a filter in the reservoir- be sure to check it frequently as well. If you notice debris in the reservoir of your autoclave, be sure to clean it out thoroughly using your suction to remove any debris or dirty water.
Water quality is so important that some autoclaves (e.g. the Statim cassette sterilizers) have a built-in water quality sensor that will prevent function if the water is not of suitable purity. Of course, sometimes the sensor can be damaged or get dirty, so make certain to keep it clean & inspect it as part of your regular maintenance.
The water quality sensor also brings to mind a common problem with self-distilled water. Most counter top water distillers are manufactured and marketed for home use so they include carbon filters. The carbon filter is included to improve the taste of the water for drinking. However, they will actually introduce carbon into the water, so remove the carbon filter if distilling water for your sterilizer. The carbon from these filters will often trigger the water quality sensor of the Statim and could impede the function of this and other sterilizers.
As you can see, water quality can play a significant role in the daily use of your autoclave so make certain to only use appropriately prepared water in yours to keep it working well and maintain the vital sterility of your instruments.
Doctors Tommy Murph and Gayle Fletcher are planning another hands-on course for up to 40 PACE credits – this time in poverty-stricken Guatemala.
They’ll be extending humanitarian aid to impoverished citizens while providing instruction to dentists to refine techniques of exodontia.
Three full days of hands-on instruction and 16 hours of lecture are planned from June 30th through July 4th.
Their comprehensive instruction will cover everything from simple extractions to complex horizontal 3rd molars. Learn techniques for removing teeth with minimal trauma and how to handle complications if and when they arise.
Techniques in delivering anesthesia, suturing, laying flaps, instrument selection and use will all be discussed and demonstrated.
Additionally, those who complete the course will be armed with information on how to handle complications such as bleeding, sinus perforations and swelling.
CE packages are available for the full course (including hands-on work) or for the lecture only.
In addition, they are also offering a course in administering anesthesia to dental hygienists for up to 20 CE credits. Send an e-mail to info@amerdental.com for full details including course fees.
Your handpieces are some of the most important instruments in your office. To have a handpiece fail can seriously damage productivity, or worse, injure a patient. Of course keeping a good number of handpieces on hand is always in order, but to maximize handpiece performance and turbine life, adequate and properly performed maintenance is vital. According to handpiece repair professionals, inadequate or improper maintenance is the #1 cause of premature failure of handpieces. Inadequate maintenance has also been attributed by the FDA to patient burns from electric handpieces.
Can’t see the video? You can also view this video on our blog or Youtube.
This month in Tech Tips we’ve got a video showing diagnosis and repair of a Statim sterilizer with a steam leak. When diagnosing any problems, it’s best to start with a physical inspection of the components to look for obvious signs of trouble as our techs do here. You can see the methodical step-wise approach to take whenever trouble shooting.
As it turns out, the problem was simply a worn, bad, or improperly installed cassette seal. Our techs were unable to make a definitive determination but replacing the seal did correct the problem. The simplest things are often a great starting point if using process of elimination to diagnose (sometimes, all one can do).
This demonstration shows the proper method of replacing a Statim cassette seal as well as the importance of lubricating the seal when installing. It may have simply been lack of lubrication that lead to the failure of the original seal (our techs were never able to make a definitive conclusion- but this is something to keep in mind).
Lubricating the cassette seal or door gasket of your sterilizer (as applicable) should be part of your routine maintenance. See previous issues of Tech Tips for more information on trouble shooting and repairing the Statim or other sterilizers.
Can’t see the video? You can also view this video on our blog or Youtube.
In an effort to promote water savings, the EPA has declared March 12-16 “Fix a Leak Week“.
American Dental supports this initiative and reminds you of the importance of routine maintenance to keep your units working well (and free from leaks).
A common cause of water leaks is a worn water relay valve. In issue #35 of Tech Tips we showed you how to replace this valve.
Air/water syringes are another common source of leaks. Several issues of Tech Tips have been dedicated to repairing and maintaining syringes.
Stop leaks in your dental unit with Tech Tips!
Mouthguards Essential in Youth Sports
A recent article in the University of Alabama at Birmingham News reiterates the importance of mouthguards in youth athletics.
The article stressed the importance of wearing a mouthguard in all sports, not just contact sports (like football), as oralfacial injuries are a prevalent cause of injury in many non-contact sports too. In fact, the National Youth Sports Safety Foundation has estimated that as many as 3 million teeth will be knocked out this year during youth sports activities.
Speak to your patients with children about the importance of proper safety equipment.
Tech Tips #47 provided you with step-by-step instructions for fabricating custom mouthguards in office to meet this growing need. And, of course, American Dental Accessories, Inc. can provide you with a wide range of products to help create these valuable appliances.