We are on week four of saving time through simple black and white strategies. Unless each of us embraces change and learns to be more productive in a shorter amount of time with better results than you are currently getting, we will fall victim of the PPO virus: Decreased reimbursements with few if any adjustments in fee schedule. Like it or not, we are in a small consumer driven business where convenience and price will always play a part. Here is a new list of easy action steps that can, cumulatively, save you hours a day.
1. Most of us use PVS impression materials for crown and bridge. Great stuff but it has a few limitations that can cause some horrendous problems in our final crown and bridge. You cannot use latex gloves with PVS due to inhibition of set from Sulfur. No retraction cords with ferric salts or aluminum salts due to inhibition of set. Great care to completely scrub the tooth after making a temp or build-up due to acrylates left on the smear level will ruin your impression. Finally, you should never use PVS for more than 2-3 crown prep impressions at one time. PVS begins to set the minute it is mixed and if you do a large number of tooth impressions at one time, the first tooth that you squirt low viscosity syringe material around will have almost set before you finish the last tooth. When you go to seat the tray with heavy body PVS it will have the tendency to alter the partially set PVS to cause slight errors in the final impression. Two or three teeth are fine, but any more and you should use Polyether impression material. This material gives you a fluid consistency for the entire time and at the very end, it snap sets. Much better impressions for 4 or more teeth.
2. Composites are interesting. I would always use a composite warmer when using any brand of composite filling material: Calcet by AdDent.com. It increases the flowability, cure depth, and conversion during setting. It should be the standard of care for composite fillings. Better fillings done faster is the word for the day.
3. Contact paper: Don’t use anything but Accufilm from Parkell or Madame Butterfly from Almore International. Anything else is too thick and will cause you to lose time by over adjusting teeth.
4. Posts: I wouldn’t use anything but Flexi-post by www.edsdental.com: 37% more retentive than a cast post, I have never had one break or come lose, will not create internal stress on the root of the tooth, and takes less than 5 minutes to place. There’s some time saved with a better result. Never, ever use Para-posts.
5. Root canals: Make sure that you are not irrigating with just sodium hypochlorite. Such a mistake. It will not kill Enterococcus Faecalis which is in over 33% of all necrotic teeth. Irritrol: For irrigation. (Also from edsdental.com) Better than EDTA and Sodium Hypochlorite alone which can damage root canal dentin. Has EDTA + Chlorhexidine + surfactants and Chelators to do a better job. NOTE: Sodium Hypochlorite will not kill Enterococcus Faecalis (in 33% of all necrotic teeth) but the Chlorohexidine that is in Irritrol kills everything. This is why you should always scrub filling and crown preps with Chlorohexidine before placing Gluma: It kills everything. Savings of reputation and hours to redo a root canal.
6. Root canals: Go buy Pro-Root MTA. This will save teeth and it is a miracle worker in iatrogenic or decay perforation of roots. Amazing at how well it works.
7. Root canals: Never use a rotary endo handpiece. Who in their right mind ever thought that having a system that is basically a tiny screw turning in a tiny canal and thinking that that was a good idea? Go to reciprocating handpieces and never ever lodge a broken file in a tooth again. Time savings: lawsuits, redoing endo, and loss of reputation. Great reason to do it right the first time.
8. Bleeding: I am talking out of control, sucking chest wound type bleeders that will ruin your impression or your day. Buy some Cuttrol: 2 seconds and it is done. (www.ichthysenterprises.com)
9. Insurance: Always mis-figure the amount that insurance will pay in your favor by 5%-7%. In this way you will be closer to what they will actually pay and look like a hero when you call and tell them that that they have a credit balance. The savings of time and reputation comes when there is no money to chase down after the service is delivered.
10. Dry Sockets: Purchase some Polymyxin B which is Bacitracin Zinc + Polymyxin B Sulfate by Pfizer. Just take the tooth out and take a small spoon or 9A periosteal elevator and dump some in the socket and have them bite on a moistened 2X2 gauze. It works every time.
I know that every reader can probably add some more but this should give you an idea of how every minute matters and speed means profit. This is the secret to becoming a Tarzan in a managed care jungle. If you have a couple of ideas please send them in and I will type them up along with where they came from in an additional article. Have a better year than the last one. This is how you Summit.
Michael Abernathy, DDS
PS. The Revised and Expanded 2nd Edition of The Super General Dental Practice book is now available. If you liked the original, you’ll really love this one. If you missed the original, you don’t want to miss this one. Order yours today by clicking on this link.