PLASTIC-FREE COVID-19 COMPLIANCE UPDATE

We have received a great deal of interest on how we avoided a landslide of plastics while coping with the pandemic. From within the profession,  we heard from dentists burdened by the cost of  purchasing barriers and then disposing of them.

Some also felt pain from losing ground on the critical single-use plastic file that was just gaining traction when the virus arrived.

Some dentists did not want to impose the Covid-19 protective surcharge on their patients, adding to the already high cost of dental treatment.

Other interest came from patients and environmental groups, all appreciative that we were doing something different.

So here’s a little photo rundown on how we  proceeded. These photos are dated from summer 2020. Sice then we no longer use capes or OR caps.

Here’s a patient in the chair, summer 2020. She is wearing a hairdresser’s cape, a cloth Operating Room hat, and disposable nitrile gloves.These have since have been superceded by white washable cloth gloves.  My assistant sewed the hats from cotton cloth. The capes and gloves were inexpensive from Amazon. My assistant in this photo is wearing a more stylish version of the OR hat, as do I when operating. She also has a face shield and mask, the shield also being an Amazon item, which came with 10 screens for around $35. I also wear one.

The patient garb is discarded into a bin in our waiting room, (in which no-one waits any more). They are all  laundered and dried at the end of each day, sometimes on an outdoor clothesline in our rural clean-air environment. When I cycle-commute home from Denman Island, that makes quite a bundle on the bike!

 

Before entering the clinic, of course we screen patients with the usual questions, and we ask patients to remain masked until seated. The patients sanitize their hands, like most premises, before donning the cloth gloves. We provide wipes saturated with sanitizer initially outside at  the doorway, now inside the entry to the bus.

We  wanted to avoid alcohol-based sanitizer to avoid odors and scents in our small airspace. Instead we used Optim 33-TB, a commercial product based on “accelerated peroxide” for dental/medical/veterinary use. It was developed for the last coronavirus, SARS, and is demonstrated very effective against this virus family. It also meets TB and polio challenge tests, eliminating 10 to the sixth power in one minute. It also is easy on the hands and lungs, an important consideration for our small volume office.

After sanitizing, patients dry their hands on a standard white cotton facecloth; dry hands are more comfortable. You see a pile of OR hats behind them.

We had used this product for years in our clinic, its only drawback being occasional surface corrosion on some aluminum surfaces. Being free of phenols, and having no skull and crossbones on it, it has no environmental hazard. This cannot be said of many intermediate-level surface disinfectants in common use in dentistry. Safety was  confirmed by NAVID OMIDBAKHSH ET AL, Am J Infect Cont June 2006,VOL 34,ISSUE 5,PG 251-2547,See http://HTTP://WWW.AJICJOURNAL.ORG/ARTICLE/S0196-6553%2805%2900575-4/ABSTRACT

Here’s where  we made a surprise finding! Optim 33 TB is routinely sold in tubs loaded with a roll of wipes, which, did you see this coming?- is a woven plastic fabric!.

Not good.

So we substituted a  washable paper towel . This was purchased from Lee Valley Tools. Its claim was 300 washes and a final destiny as a compostable product. We are at about 100 washes so far and most are still good. They initially were too large  and used too much solution,so we cut them in half, making them even more affordable.

After we began using these to disinfect our counters and surfaces, we installed a drop-chute in our countertop, under which resides a mesh laundry bag. At day-end, this is zipped closed and run through our laundry cycle. This keeps the wipes separate from the rest of the load, reducing sorting time for the various items.

 

in light of the science behind the pandemic, we began using Optim 33TB in  a spray bottle, as well as in wipes, getting better surface contact on irregular surfaces. Our reasoning:   we are battling an aerosol/droplet-borne pathogen, and thus an aerosol spray  faces off in the same frontier in which we know the virus is spread.

 

 

 

 

 

 

Finally, we now employ  a very-high volume air evacuator which is connected to our central vac system, (which exhausts outside the bus) , ensuring rapid air changeover when generating aerosols.  When flushing with an air/water syringe, or preparing teeth with an air-driven handpiece,research has shown very high capture- over 90%, with two  1/2″ diameter dental high-vacuums. We use one, and this oversize evacuator in tandem.

It stands to reason that a 2 inch diameter tube moving 125 cubic feet of air a minute- over two cubic feet a second- is much more effective than any HVE half-inch tube.. When using water-spray to keep teeth cool and happy, we can even see the droplet stream turn 90 and go down the mouth of this king-size evacuator.

A funnel keeps the tube from aspirating the patient’s cape, or the bib, or any small objects that might get close to it, or their face!

The tube was stocked from a hardware store, the canning funnel from a   retail  canning supply  outlet. A stainless steel mesh is fitted in the mouth of this funnel  to prevent small objects such as temporary crowns being trimmed, from disappearing down its mouth if inadvertently dropped..

 

     

You can see the naked  tube hanging by a magnet from the light-post when not in use, left photo above.   In the right photo, the funnel is in place and attached to a second magnet located behind it chairside There we use it to capture  acrylic dust during temporary crown trimming or denture adjustments. Also to capture mercury vapors released in the removal of amalgam restorations. We consider this large volume aspirator essential for the respiratory health of the team in daily practice of dentistry.

This has been our routine for years to control abrasive powder when sandblasting teeth or prostheses prior to bonding,and it is a cornerstone of our adhesive-oriented practice, ensuring longevity, maximum adhesion, and stain-free margins based on fresh-cut enamel rod-ends see Enamel axioms on this website.

What is new is using it control aerosols.

OTHER CHANGES:

Some final and more generally followed Covid changes:

  • an acrylic screen was placed between patient and receptionist at the front desk.
  • We changed our booking sequence so that no two patients would be in the waiting room at the same time.
  • We evolved to longer appointments to reduce patient turnover/interaction;
  • we reviewed all our surfaces to minimize opportunities for cross-contamination, reorganizing all operating areas.
  • Once onto the plastics-free front, we were able to change  a number of autoclave-loading systems to eliminate single-use wrap and instead used re-usable stainless steel cassettes.
  • We have installed a new autoclave which operates in the new best practices recommendations of dry-to-dry cycles, reducing  sterilizer exhaust air concerns.

 

In summary, Covid became a way to work better, more safely, and in some ways more cheaply. It took hundreds of hours and months to get smooth.

If only society could embrace other problems as fully as this challenge required, we might find our way through a real, permanent, deeply embedded and far more catastrophic crisis:- our presently un-managed climate crisis. It will have  become  larger and more unstoppable once our single-minded  focus on a  virus passes.

We are losing precious years during this distressing Covid period –  time we urgently need to get on top of a burning and progressively less livable planet.

PLASTIC-FREE COVID COMPLIANCE

Last week we changed the last the protocol in our Covid compliance to plastic-free. Living on an abundant ocean’s edge, as I do,and having seen one too many videos of albatross chicks dying of ingested plastic, as I have, I just couldn’t accept that the only way to manage transmission is through single-use disposable plastic barriers.

All our barriers are now washable. Our wipes are washable, up to 300 times, and ultimately compostable. We know that Covid dies in the dryer at 135 degrees F, so our measures agree with science. As I can I will post pictures and more details so that you can see for yourself. And yes, it is much much cheaper, not only  omitting the cost of purchase, but also for tipping fees for increased bulk in the waste stream. And eliminate another cost to pass on to our employment- stressed patients.

Do we get to forget the environment because we have a human pandemic crisis? Obviously, if you think that,  you have never considered being an albatross.

NEW ARTICLE PUBLISHED IN ORAL HEALTH: “GUIDED ANTERIOR REHABILITATION IN COMPOSITE RESIN”

An article in Oral health Journal written by Dr. Walford  is now posted online. See the online article

The title is “Anterior composite rehabilitation: a minimally invasive approach.”  . It details a method for augmenting worn anterior teeth from articulator-mounted models, using a stent to arrive at a pre-determined clinical outcome.

This article closely follows the content which will be organized in the upcoming Handbook of  Composite Prosthodontics

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JOIN THE BANDBENDER COGNOSCENTI

At the Pacific Dental Conference  in Vancouver on March 8, 2019 , Dr. Walford demonstrated a lower-arch  molar MODL restoration on the Live Stage in the Exhibit hall. The Bandbender™ was an key part of the procedure. A large number of attendees “got it” and placed orders for Bandbenders with Sure Dental Innovations, our dealer for Bandbenders™.

Haven’t heard of the Bandbender? It’s the game-changing matrtix-shaper that makes large composites successful. Without it, don’t pass go, don’t collect $200.When sectionals become useless, bring out the Bandbender™.

You can’t talk about flight if you haven’t got wings. The Bandbender shaping system is a cornerstone to large composite success. It develops properly curved proximals from a flat  typical Tofflemire matrix. No broken contacts, no food traps, no expensive repairs. Win every time. Restore boxes of any size on teeth with any amount of missing tooth structure.

It could bring an enormous improvement in your restorative capability and your practice satisfaction. Stop doing it the hard way.

See THE BANDBENDER™

Other high points of the demonstration:

  • Glass fibers- which are the best, and indications for placement see Glass Fibers
  • Cusp shoe design principles –  bevels and the science behind them
  • Outside-in gingival box preparation– protecting the adjacent tooth from iatrogenic damage
  • Up-scaling gingival margins –  avoiding Class II recurrent gingival decay from improper enamel preparation at the margin
  • Isolate rubber dam- the best in the industry see more at Isolation
  • The Sippressor retromolar saliva ejector- an essential patient comfort and isolation device see The Sippressor
  • Custom wedge trimming- seal the gingival matrix and protect the curvature of the Bandbender™ matrix see Wedging
  • Contact Formers to guarantee proximal contact see Placement
  • Etch- the most effective products see Etching
  • Rinse- the most effective protocol see Etching
  • Double-priming dentin, essential for postoperative comfort see Dentin Priming
  • Caries detector for 100% certainty of caries removal and old composite removal
  • Sandblasting for optimum margin adhesion
  • Managing flash see Occlusal Plasty
  • A sandblasting scavenging system to preserve operatory air quality see Big Bertha
  • Adhesive – a versatile DC MDP -based adhesive with a long success record see Bonding
  • Bulk-eze DC bulk fill, the only good bulk fill on the market with research to prove it see Bulk Fill
  • Flowable first gingival increment  to prevent contraction damage to dentistry’s most  fragile margin see Flowable
  • Wet-pack placement- eliminating bubbles at cusp shoe margins see Wetpack Margins
  • Voco Grandioso, a very tough resin  with parameters to validate it see Resin Choices
  • Curing- deeply and powerfully to rapidly  increment large restorations see Curing
  • Calibrating cure to the resin; joule requirement see Curing
  • Proximal post-curing- to ensure maximum cross-linking at the heart of the restoration
  • Occlusal shaping and polishing – a simplified, rapid  method see Occlusal Finishing
  • Articulation – a rapid and exacting verification method  that meets best occlusal principles and delivers postoperative comfort  see Articulation

Perhaps you know these techniques, but if not, they are part of the Class II restoration method in the Handbook of Composite Technique, an online source book soon to be available from this site. Check back for publication date; it will be announced on this home page.

 

OMNICHROMA – A PROMISING NEW RESIN

After development in offshore markets, Tokuyama launched a new resin at the prestigious Chicago Midwinter Meeting in February 2019. It also hit the Pacific Dental Conference, March 2019 . The resin is Omnichroma

What’s new? Its singular claim is an ability to blend with very wide range of tooth shades using only a single shade. They manufacture a second to mask/opaque where needed.

See Cases restored using Omnichroma 

The Promising aspect of this product: Universal shade match promises to simplify  inventory for both dentists and suppliers. it also might improve cosmetics for the patient. Also, it might solve an unmet clinical problem-shade mismatch between restorations and teeth  if teeth are whitened (bleached) through a peroxide program, office-provided or OTC .

How good is it? Can we buy it, throw away our other shaded resins, and put it everywhere? We can evaluate esthetics because we can see that. Esthetics are not enough. We need to also evaluate any new resin for properties which we cannot see. Unless you feel like being reckless you will have to address the limitations highlighted in black below. take your own look at physical properties, which are housed in this product at Tokuyama’s Omnichroma Technical Bulletin

Check it out. You  will find  graphic comparisons with other well-known resins from several university research labs on:

  • Gloss -pg 18= >90%,  rates very high compared to most resins
  • Wear resistance – pg 20= negligible with negligible opposing tooth wear. Top in its class
  • Polymerization Shrinkage – pg 21 1.5% a beneficially low number
  • Radiopacity – pg 25 = average for posterior resins
  • Contraction Stress – pg 29 =>2.5MPa, higher than most, a negative quality suggesting careful placement of small increments might be needed to avoid white line defects and crazing enamel in the host tooth
  • Flexural Strength —pg 30- 110MP  weak– suitable for light function patients in Class II restorations
  • Elastic Modulus- pg 30= 9.2 GPa- less than dentin, below median for posterior resins, limiting its application to light to light-medium function patients. See Resin Selection Sieve , Light function patients 
  • Compressive strength -pg31- 310MPa = high, but not usually a significant clinical attribute
  • Depth of cure – pg 32 –  consistent to 4 mm, indicating high curabiity, which should deliver on properties in real-life clinical application. Better than most resins
  • Stain resistance -pg 22 = low, on par with best-rated resins
  • Color Matching- repeatedly superior to most shade-matched resins

Want to go further? Have a look at how I evaluate resins?…See RESIN SELECTION

 

 

A New Beginning

Welcome back to Peter Walford Dentistry.

We are in the process of rebuilding this site to the next generation of abilities and features.  All the great content will be back soon, so fear not.

The format and organization will be utterly different from the old pre-2000 Wiki-based format. With this WordPress format we are able to provide much greater connectivity and flexibility and the format chosen is to publish  three Handbooks on Adhesive Dental Procedures which can be purchased as desired. See HANDBOOKS

Thank you,
Dr Peter Walford