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California and Washington Both Require a Face Mask When in Public


A growing number of US states have mandated the use of masks and face coverings while in public.
With many states starting to lift coronavirus restrictions, more people are venturing out in public, but the number of cases is still rising in nearly half of them.
That's where masks come in. A recent study found that the use of masks and face coverings has been the most effective way to reduce person-to-person spread of coronavirus.
Here are the states that require the use of masks or face coverings in public settings.

California- As of June 18

California Gov. Gavin Newsom issued a statewide order on Thursday requiring the use of face coverings in public indoor spaces, including while shopping, riding on public transportation or seeking medical care.
Newsom's order also mandated the use of masks or face coverings in public outdoor spaces when social distancing is not an option. There was no guidance on how the order will be enforced or if violators will face any penalties or citations.

Connecticut- As of April 20

Connecticut's mask requirement applies to any resident over the age of 2 in a public space where social distancing isn't possible. The rules also apply to individuals using public transportation, taxis or rideshare services.
The state's Department of Economic and Community Development also released mask guidelines for essential workers:
Employees at essential businesses must wear masks or any other material covering their mouth and nose at all times while at work. Employers must provide masks or the materials to make them. All customers under age 2 must wear them, too.
People who refuse to wear masks aren't required to provide proof that they're medically exempt.

Delaware- As of April 28

Delaware Gov. John Carney ordered residents to wear face masks while in public, including at grocery and convenience stores, pharmacies, doctor's offices and on public transportation.
Children under the age of 12 are not required to wear face coverings, and those age 2 and under must not wear face masks due to the risk of suffocation.

District of Columbia- As of May 16

District of Columbia Mayor Muriel Bowser ordered the use of masks or face coverings when conducting essential business or travel and social distancing isn't possible.
Masks or other face coverings are required in grocery stores, pharmacies and takeout restaurants. On public transportation, face coverings are required if individuals are unable to be six feet apart.
Children between the ages of 2 and 9 are advised to wear masks.

Hawaii- As of April 20

Both customers and employees at essential businesses are required to wear cloth face coverings. Establishments must limit the number of customers allowed in and keep them six feet apart. Anyone who violates those rules could face a fine of up to $5,000, or up to a year in prison if found guilty, according to Hawaii Gov. David Ige's order.

Illinois- As of May 1

Illinois Gov. JB Pritzker ordered the use of face masks for anyone stepping outside their house.
Face coverings are required while shopping at essential businesses, traveling on public transportation, picking up food, or visiting the doctor and it's impossible to stay six feet apart.

Kentucky- As of May 11

Kentucky Gov. Andy Beshear ordered all state residents to wear face masks in public.
Gov. Beshear has said that people will not be fined or arrested for not wearing a mask in public, but the order gives businesses the right to turn away any customer not wearing a face covering.

Maine- As of May 1

Maine Gov. Janet Mills issued an order requiring face coverings or masks for anyone over the age of 2 in indoor public spaces such as supermarkets, retail stores, pharmacies and doctor's offices.

Maryland- As of April 18

Commuters must wear face coverings while using Maryland's public transit, according to Gov. Larry Hogan's order.
Employees of essential businesses and customers over the age 9 must wear face coverings. Adults accompanying young children should make an effort to get them to wear a mask.

Massachusetts- As of May 6

Massachusetts Gov. Charlie Baker issued an order requiring the use of face coverings or masks in both indoor and outdoor spaces where social distancing isn't possible.
Children under the age of 2 do not have to adhere to this order.

Michigan- As of June 18

Michigan requires all residents to wear face coverings or masks in all public settings.
Businesses are allowed to deny entry to individuals not wearing face coverings.

New Jersey- As of April 8

New Jersey was the first state to require customers and employees to wear face coverings at essential businesses and construction sites. Businesses must provide them to employees and deny entry to any customer who refuse to wear them (though customers can still pick up food or medicines in other contact-free ways).
Commuters on New Jersey's trains, buses and light rails must wear face coverings. If they refuse, they may be denied entry.

New Mexico- As of May 16

Adults are required to wear masks in all public settings, except while eating, drinking, exercising or for medical reasons. Masks are recommended for children 3 and older, and children 5 and under must have adult supervision.

New York- As of April 17

New York Gov. Andrew Cuomo's executive order mandated state residents to wear masks in public.
All residents over age 2 must wear masks or face coverings when in public and social distancing is impossible.

Pennsylvania- As of April 19

Essential businesses must provide and require their employees to wear masks, according to the order from Pennsylvania's Department of Health. Customers at these businesses must wear masks while on the premises or be denied entry.

Rhode Island- As of May 8

Gov. Gina Raimondo issued an order requiring all residents over the age of 2 to wear face coverings or masks while in public settings, whether indoors or outdoors.


A Guide to Reopening Your BusinessAfter the CoronaVirus


A guide to helping businesses of all types and in all regions navigate the complex process of reopening and evolving post-coronavirus pandemic.

Reopening and adjusting to the "new normal" will involve several steps for businesses to take, from researching, communicating, and executing PPE Safety plans to pivoting strategically

In the early months of 2020, the COVID-19 pandemic prompted wide-sweeping shutdowns and shelter-in-place orders across the United States. Now, as parts of the country look to start relaxing these strict measures, small business owners need to think about what's next and how they will adapt and move forward safely and sustainably.

COVID-19 has impacted every business differently. Some were able to shift to a remote work model, while others adjusted operations or closed their doors entirely. Factors that have impacted businesses' timelines and their abilities to resume "normal" operations include:

  • The status of any existing stay-at-home orders in their state(s) of operation. See the U.S. Chamber of Commerce's State-by-State Reopening Guide for details on reopening plans in your state.
  • The severity and volume of COVID-19 cases within their locale.
  • Whether the business has a physical location And needs PPE or Disposable Surgical Face Masks.
  • The ability to enforce proper social distancing (at least six feet between individuals) within the business location.
  • The level of contact with customers and other employees (e.g., beauty salons and gyms with direct physical contact vs. retail stores and restaurants with indirect contact).

One thing is true across the board, though: Every business will face tremendous challenges as our nation begins the path to recovery, while still facing the public health threat of the virus.

When brick-and-mortar businesses are able to reopen their doors, consumers may be wary about being in an enclosed space with other individuals, regardless of the health and safety protocols in place. Even digital businesses that have remained fully operational may find it difficult to boost sales with so many customers facing lost or limited income.

The businesses that will survive and thrive are the ones that can be flexible and adaptable to consumers' new and evolving needs. You'll need to plan carefully and understand not only what may need to change about your business, but what new growth opportunities may exist for you in a post-pandemic world.

In this guide, we'll walk you through the steps your business will need to take to reopen as restrictions are lifted across the country from the CoronaVirus. While your exact reopening strategy will depend on your home state and business type, you can use this playbook as a starting point to help you plan and prepare for the "new normal."

Learn

There's a lot of information out there about COVID-19, so you'll need to focus on the most reputable, reliable sources to find the right guidance for your business.

Government agencies and public health organizations are best places to find accurate, updated information for businesses that are looking to reopen. We've compiled a few key resources to help you get started.

Federal guideline resources

  • Centers for Disease Control and Prevention (CDC). The CDC has become one of the most widely referenced resources on COVID-19. Aside from general public health guidelines for reducing the spread of the virus, the CDC has also created several dedicated landing pages providing coronavirus guidance for businesses and workplaces and how to prepare your small business for the effects of the pandemic.
  • Guidelines for Opening Up America Again. While President Trump has left reopening plans up to individual state governors, he has unveiled a three-phase set of guidelines for states to follow, based on the advice of public health experts. Understanding each phase may give you a better understanding of where your state currently stands and what the requirements are for moving on to future phases.
  • Coronavirus.gov. The White House's official coronavirus website is a hub for all official government resources on coronavirus for the American public and its businesses.
  • OSHA has also issued guidance for returning to work.

State-level resources

  • U.S. Chamber of Commerce State-by-State Business Reopening Guidance. The Chamber has created a comprehensive map compiling the latest guidance, timelines and other reopening information for employers. This map will be updated as new state plans take effect and new information becomes available.
  • Your state's official government website. State governments have been working hard to keep their websites up to date with the latest coronavirus-related guidance and regulations. There are several places to find the appropriate links to your state government’s homepage and departments, including usa.gov and irs.gov.
  • Your state or governor's official social media accounts. Many states and their governors operate official accounts on Facebook, Twitter and other social media platforms. In recent months, these accounts have been largely dedicated to real-time updates on coronavirus statistics and executive orders. Be sure to look for the blue "Verified" checkmark next to the account name to ensure it's a legitimate page.


Local-level resources


Within some states, individual counties and cities have set further restrictions or different guidelines from the overall state. This is especially true in major metropolitan areas with dense populations. If your business operates in a major city or highly populated county, you'll want to check your city or county's official government website to see if there are specific guidelines to which you need to adhere.

Industry-specific resources

  • CDC. The CDC has created individual guideline documents for numerous industries that are uniquely impacted by COVID-19, including educational institutions, public health/healthcare professionals, veterinary clinics, retirement communities and more. You can view and search all CDC guidance documents here.
  • American Industrial Hygiene Association (AIHA). The AIHA has also created detailed industry guidelines for sectors like at-home service providers, construction workers, gyms, salons, retailers, restaurants and others as they plan their return to work. As a professional association for occupational health and safety science professionals, the AIHA has developed all guidelines for its Back to Work Safely initiative with special industrial health considerations in mind.

The Plan
Creating your reopening plan will require a lot of internal and external assessment of multiple factors that could impact your success moving forward. Here are a few important things you'll need to consider:

Regulations
Throughout the Covid-19 pandemic, individual states and regions have been tasked with determining their own guidelines for stay-at-home orders and business closures. Some states have even delegated certain decisions to the county or city levels, which may make it difficult for businesses with multiple locations to create a company-wide reopening plan.

Depending on the type of establishment you operate, your state may develop industry-specific policies, based on best practices and recommendations from public health officials and the federal guidelines for reopening America. For instance, your state may mandate strict physical distancing and sanitation protocols, as well as require employees and customers to wear face coverings or Disposable Surgical face Masks in your location and also in your industry. We all know that as a business you will be required to Disinfect more. Thats why Lions Dental Supply has supplied only Hospital Level Disinfactant that is listed by the CDC to Kill the CoronaVirus. 

By understanding your obligations under your state's regulations, as well as the generally accepted guidelines for your industry, you will be able to craft a reopening plan that instills trust and confidence among the individuals who interact with your company.

Safety
As a business owner, your primary concern should be the health and safety of your employees and customers. All places of business, including shops, restaurants, construction sites and offices, must take precautions to reduce the risk of spreading COVID-19 on-premises. Such as Providing PPE and Disinfecting the work space more often.

Here are some considerations as you develop your new safety policies in the post-coronavirus workplace:

General hygiene practices

  • Think about how you can best reiterate and enforce the CDC's guidelines for proper, frequent handwashing and coughing/sneezing into a tissue or elbow when employees return to work.
  • Assess your business's current cleaning and sanitation practices against the CDC's recently released recommendations. What procedures can you implement or upgrade to reduce the spread of the virus, and how can your staff help maintain those practices? This may include sourcing and stocking up on cleaning products and sanitizers for employee use during work hours.

Personal Protective Equipment (PPE)

  • If your business was subject to the Occupational Health and Safety Administration's general requirements for employee PPE use, make sure you continue to adhere to those guidelines when you reopen.
  • If your state has issued requirements for your employees and/or customers to use Disposable Surgical face masks and Nitrile gloves on-premises, have a plan in place to enforce that regulation and provide PPE to employees if at all possible. Otherwise, you may wish to encourage employees to wear a washable cloth face coverings in the workplace, per the CDC's official recommendation.


Social distancing

  • Consider how your current workspace can be reconfigured to encourage social distancing if telework is not possible. The CDC recommends installing physical barriers, changing layouts to put at least six feet of distance between work stations, closing communal spaces, staggering shifts and breaks and refraining from large events.
  • According to LifeLabs, you may wish to consider limiting the number of employees in the workplace and alternating teams to further encourage social distancing.


Employee Health Monitoring

  • Develop a plan for monitoring your employees' health, with a particular focus on COVID-19 symptoms.
  • Decide how you will handle a positive case of COVID-19 in your workplace after you reopen. OSHA’s guidelines give specific steps on how to manage and isolate employees displaying COVID-19 symptoms.
  • Reiterate your sick time and paid time off policies to employees and discourage them from coming to work if they feel ill.

Security

If your business has been able to operate remotely during the crisis and plans to continue this arrangement long-term, cybersecurity will need to be a top priority. Coronavirus scams are rampant, and your employees are the first line of defense against hackers.

You may have put ad-hoc security solutions in place like Virtual Private Network (VPN) access, but if employees will be working from home on a more permanent basis, consider the technical infrastructure you might need to ensure the security of your sensitive business and customer data. This may include banning personal device use for business purposes, limiting company-wide file access, making password managers mandatory, implementing multi-factor authentication and training (or re-training) employees on cybersecurity best practices.

As part of your post-COVID-19 communications, you'll need to set clear and accurate expectations with those who interact withyour business.

Assess your business needs

Once you've determined the new precautions and protocols your business will need to follow, it's time to consider your operational needs. From limited funding to supply chain disruptions, you may encounter a few challenges as you seek to ramp up your core business activities.

Ask yourself the following questions to help you get a better picture of what you might need to get things moving again:

What does my business need right now to survive?

The biggest obstacle most businesses are facing as they plan to reopen is financing and PPE Such as Disposable Face Masks, Gloves, and Hand Sanitizer. Even businesses that have remained partially open during the crisis have likely seen a hit to their revenue, and many now need help covering basic expenses like rent and utilities before they can ramp back up.

Look at your numbers and figure out the bare minimum you need to get things going again. Then, consider federal and state financial aid resources like the Paycheck Protection Program (PPP), disaster assistance loans from the U.S. Small Business Administration and the employee retention tax credit available under the CARES Act.

What will my initial staffing requirements be when I reopen?
If you're one of the many businesses that had to lay off or furlough employees during the crisis, you may not be able to bring them all back at their full capacity right away. Consider whether you can offer limited hours to the majority of your pre-pandemic staff, or whether it makes more sense to have a few key individuals on for their regular hours, while slowly re-expanding your employee base as business picks up again.

What employee concerns about workplace health and safety will I need to address?
As a small business, your staff will be a critical part of your recovery, so it's important to let them know you will take their safety seriously when you reopen. Clearly communicate all plans and policies you develop regarding PPE and employee health monitoring and take the time to answer any questions and concerns from your staff. Enforce the Disposable Face Masks policy.

What will my customers’ needs and demands look like now and in the foreseeable future?
Your customers' lives have all been impacted by COVID-19, and they may need different things from your business right now. Their disposable income is likely limited right now, so get creative and think of how you can help solve the challenges they're facing at this point in time. This may be as simple as changing your marketing messaging, but some businesses may need to reposition or update their core offerings to fill the needs of their market. Either way, Salesforce recommends rapidly innovating your products and services to better meet immediate customer needs.

 
What's possible for my business?
The reality is that most businesses will not simply be able to "pick up where they left off" when they reopen their doors. Based on your current available resources and potential funding sources through coronavirus aid programs, make a thorough, honest assessment of what might be feasible for your business in the following areas:

  • Your budget. How much capital can you access, and how can you best put that money to use?
  • Your space/location. Can your physical space be adapted to encourage social distancing? Face Mask, PPE, Disinfectant.
  • Your supply chain. What do your supply chain vendor relationships look like right now? Would it make sense to look for any new vendors to help you meet short-term needs as you reopen? you will likely need new vendors for PPE and Face Masks, Hand Sanitizer, no contact infrared thermometers, Disinfectant that will Kill the CoronaVirus, and Gloves.
  • Your products/services. How can you pivot your offerings to be relevant to your customers' needs right now?
  • Your revenue impact. What is the scope of your coronavirus-related losses right now, and how much do you expect to recoup once you're fully operational again?

Communicate

Your business will likely need to communicate plans to several different audiences, and each one requires a tailored approach to ensure the right message is received.

As part of your post-COVID-19 communications, you'll need to set clear and accurate expectations with those who interact with your business. Your employees, customers and vendors will need to know what to expect from you as you execute your reopening plan.

Follow these tips to communicate with your business's various stakeholders throughout the process:

Employees
As the people who help you serve your customers, your employees need to be kept in the loop about your business's reopening plan. According to Cushman & Wakefield, your employee communication plan should provide thorough, accurate information about physical workplace changes and safety measures, as well as set appropriate expectations for following new procedures. Use multiple communication channels (email, chat, video, social media, physical displays in the workplace, etc.) and invite any questions they may have after you share your plan.

A few important things to address:

  • Details of the changes, including any actions taken in their absence to sanitize and Disinfact or prepare the workspace.
  • New work practices and guidelines for health and safety.
  • How you will transition policies such as remote work, time off and flexible schedules if they had been adjusted during the pandemic.
  • Resources available to employees if they have questions or concerns.
     
    Customers
    During these difficult times, customers understand and expect that your business will be operating differently. However, they still expect transparency and timely updates as you establish a path forward. EY advised companies to follow these best practices when communicating with customers:
  • Use multiple channels to ensure your message is widely received and reinforced.
  • Demonstrate that customer interests are a priority and address their concerns directly.
  • Create and share an FAQ document outlining specific questions around your supply chain, your health and safety practices and potential risks to your customers if they continue to patronize your business.
  • Reach out to affected customers and offer assistance where appropriate.
     
    Vendors/partners
    Take time to meet with each of your vendors and partners to review your agreements and contracts. If you plan to continue working together as your business reopens, let them know what (if anything) might need to change about your working relationship, and whether it's possible to adjust your arrangement. Salesforce recommends co-creating business continuity plans with your partners and suppliers to help both of you streamline operations.

Regardless of your audience, make sure your message to each is consistent and clear across every touchpoint and channel.

Execute
With your planning and preparation complete, it's time to put your reopening strategy into motion. Follow these steps to set yourself on the right track for getting back to business.

Develop a time frame
Because states are rolling out their reopening plans in phases, it may be difficult to nail down a precise timeline for your reopening. According to the CDC, businesses should only consider reopening if they meet the following conditions:

  • You are in a community that no longer requires significant mitigation.
  • Reopening would be in compliance with your state and local orders.
  • You are ready to protect employees at higher risk for severe illness With PPE such as Disposable Surgical Masks and Gloves. or just Disinfecting more.

As you develop your time frame for reopening, here are a few steps you can take to make a smoother transition:

  • Get input from your team. If your business is customer-facing, ask your staff for their thoughts and concerns about interacting with customers in the near term, given the current circumstances in your state. Some staff may be eager to get back to work, while others may feel more comfortable waiting a week or two for an additional drop in COVID-19 cases.
  • Plan out an anticipated schedule of pre-opening tasks. From deep-cleaning and Using Hospital Level Disinfectant like Cetylcide II Concentrate Hard-Surface High-Level Hospital Disinfectant, Virucide, Fungicide, Germicidal to rearranging furniture to encourage social distancing, A Disposable Surgical Face Mask Policy, make a list of everything you'll need to do to get your business customer-ready.
  • Coordinate with your vendors. If you've been shut down, start reaching out to vendors re-establish your supply chain and administrative support. If you've been operating in a limited capacity, plan ahead for how your inventory needs may increase as business picks up.
  • Give your customers a heads up. Even if you don't have an exact date for reopening yet, stay in touch with your customers and let them know to stay tuned for an upcoming announcement.

Lay out your marketing strategy

  • Assess your competitors and how they're handling marketing. Study both local competitors and ones in other regions where the COVID-19 situation may be different. It's important to get a broad range of marketing and communications examples and gauge whether customers are reacting positively or negatively.
  • Create an updated marketing strategy that reflects your customers' current needs. Successful marketing in the COVID-19 era means shying away from overly promotional messaging and speaking to the current reality and experiences your customers are facing.
  • Use your marketing channels to communicate important reopening announcements, changes and information your customers will need to know. Stay on top of your website, blog, email lists, social media channels and other platforms to deliver a consistent message about your business's plans.

Be ready to adapt to any obstacles

  • Anticipate and prepare for challenges. No matter how prepared you are, you may find that some elements of reopening your business are more difficult than you expected. You may need to change directions quickly and make swift decisions to overcome obstacles.
  • Check in with your employees. During your first few weeks of operating "normally" again, frequently chat with your staff and see how they're feeling. See if there's anything you can do to make their jobs easier or give them greater peace of mind about their health and safety.
  • Know that you won't get it perfect on day one. Mistakes may happen as you execute your reopening plan, and that's OK. If something goes wrong, quickly acknowledge the situation and let employees and customers know how you're making it right.
  • Create formal and informal processes for getting feedback. Listening to your employees, customers, vendors and partners during this time is critical for your future success. Have one-on-one conversations, share polls on social media and send out anonymous surveys via email to encourage your stakeholders to share their thoughts.
  • Analyze your sales data, customer behavior and ROI. Your numbers likely won't bounce back right away, especially if you've changed your product or service offering. Keep an eye on your business analytics to understand what's working and what's not.
  • Gauge the overall community response. Pay attention to what customers are saying about you (and your competitors) as everyone adjusts to your industry's operational changes. Take customer suggestions seriously and always acknowledge anyone who mentions your business directly.

Respond and pivot your strategy accordingly

  • Make adjustments based on the feedback you receive. Your employees and customers may be feeling apprehensive and nervous right now, so it's more important than ever to meet their needs. Do what you can to adjust your operations in response to stakeholder feedback.
  • Communicate evolving changes in a timely, transparent manner. Let people know what's happening and why. If appropriate, give credit to the employee or customer who inspired the change so your audience knows you're listening to them.
  • Continue mapping out your road back to normal. Normalcy is not going to happen overnight. In fact, "normal" for you moving forward may look very different from what it looked like pre-pandemic. More PPE, Everyone wearing a Surgical face Mask. Your journey back to the volume of customers you had before may take time, but all your business can do is keep learning, growing and evolving as new information becomes available.

For more resources from the U.S. Chamber of Commerce:

  • All of our coronavirus content in one place.
  • Reopening Guide and Resources
  • Main Street Lending Program Guide
  • Social Media Toolkit for Reopening for Reopening
  • State-by-State Business Reopening Guide, with interactive map
  • Paycheck Protection Loan Guide
  • Economic Injury Disaster Loan Guide
  • Guide to PPP Loan Forgiveness
  • Employee Retention Tax Credit Guide
  • Coronavirus Response Toolkit for Businesses
  • Customizable flyer for businesses to communicate with customers
  • Find your local Chamber of Commerce
  • The U.S. Chamber of Commerce Foundation's list of small business resources for coronavirus assistance
  • CARES Act Guide for Independent Contractors and 1099 Workers

COVID-19 back-to-work checklists you can customize for your business


One of the most important parts of your business’ reopening strategy will be consumer confidence.

Make a set of “no personal contact” rules
Limit handshaking, closed meeting spaces, hugging, or any other physical contact.

Questions to ask: 

Where is contact made between people in a normal situation?
Is contact necessary?
Is there any personal protection equipment (PPE) that my staff could use to reduce the transmission of infection for essential contact?
How and where can I post new no-contact rules to ensure my staff has read and understood our updated policy?

Encourage “no item sharing” when possible
This includes things like pens, staplers, notebooks, dry erase markers, desk space, file folders, computers, and anything else that can be assigned to individual workers and not shared. We recognize not all businesses will be able to afford a zero-tolerance policy of shared work tools, but where, within reason, a limiting of exposure to shared objects, caution should be made.

Questions to ask: 

What are the essential tools of my business? And who uses them?
Are there any high-risk staff whose job may increase their risk of infection?
Are there any PPEs that can help protect my workers?
What are the items my business can afford to supply all workers with?
How and where can I post new no item sharing rules to ensure my staff has read and understood our updated policy?

Reorganize your floor plan
What can you do to your work space that will maximize 6-foot distance between workers, customers, and visitors? Can you stagger workspaces? Adjust desks to point towards walls or office partitions?

Questions to ask: 

What are the essential needs for space for my business?
What are areas that are underutilized today?
Are there any superfluous areas now that folks need 6-feet barriers, and how can I reimagine those spaces to make room for today’s needs?
What are we using ____, ____, ____ space for?

Get rid of common “gathering” areas
In accordance with the step above, reconfigure your water cooler hang out spots, too. Can you reallocate these communal gathering places for open-air conferences space or more roomy desk arrangements? Before COVID-19 workers liked to share kitchenettes, breakrooms, and staff lounges, but we might not be able to afford such on-the-job luxury spaces. Where can you minimize hang-out spaces and maximize 6-foot distances?

Questions to ask: 

Do you have common gathering areas?
How do your employees naturally hang out? And where?
While not eliminating employee camaraderie, what’s the best approach to minimize staff exposure to one another?

Close breakroom hangouts
Workers will need breaks, legally and mentally. But how will you handle them? Previously, restaurant and retail breakrooms could be found with several staffers relaxing on worn out couches, quickly eating snacks or cracking jokes before returning to the floor.

Now, these breaks need to be monitored. Is your staff 6 feet apart? Does your breakroom have enough room to accommodate the amount of workers who would be taking a break at once? What about smoke breaks and lunch breaks? Are there signs posted to wash hands before re-entering the workfloor after breaks, just as there were in restrooms?

Questions to ask: 

What breaks or time off standards are required in your line of work, and how does your physical space address these needs?
Are there any easy ways to improve those spaces to make them less partial to contagion?
What are you doing to clean these spaces? Is there any way to improve?
Do you have signs posted for staff workers to ensure they are washing their hands with soap and water for 20 seconds before returning to work?

Create prominent hand sanitizing stations, complete with cleaning supplies
Hand sanitizer might be your newest line item on your profit and loss statement (P&L). Businesses are going to need to invest in safety equipment of both their workers and patrons to keep the confidence of consumers coming back. If your shop feels risky, shoppers might not return. So make a point to buy 60% or more alcohol per volume hand sanitizers and make them freely available across your business or office space.

Questions to ask: 

Are you able to afford hand sanitizer stations?
Where would be the best place(s) to put hand sanitizer stations?
What signage would you need to create?
Are there hand sanitizer dispensers available for guests, visitors, mailmen, clients, friends, neighbors, customers?

Post communal equipment cleaning rules
If your office has gym equipment or common-use equipment (such as copy machines, metal machinery, and industry-specific tools) consider posting clear directions about how to clean the equipment between uses to keep multi-users safe.

Questions to ask: 

What are the most common communal equipment uses in your line of work?
Are these shared?
What are the equipment cleaning considerations you deem reasonably required to keep clean of COVID-19 or other germs?
Are there any training sessions needed to ensure the safety of staff while increasing their cleaning responsibilities?
How much time would you expect this to take?
Does that impact the expectations of each individual contributor’s workloads?

Create appropriate face mask rules
States and companies are able to make individual requirements regarding face mask requirements. For instance, Ohio Governor Mike DeWine is requiring face coverings for employees and clients/customers at all times. And JetBlue, the airline company, was the first to require both staff and passengers to wear face masks at all times during travel. While heeding federal and local regulations, create face mask rules that you deem are the most appropriate for your line of business. Then, update your employee handbook with your new policies, and make sure employees are clear with your expectations of both them and the customers you serve.

Questions to ask:

How close are my employees to customers?
How much do you think wearing face masks would increase the confidence of your employees and clients?
What is your budget for PPE?
Is it reasonable to expect face mask policies? For how long?
What all would go in your policy, and what are the consequences for employees who break conduct?

Limit the number of people in a closed room
If you must have a “closed-room” discussion after opening your office, assess the options to either:

Host the discussion in a large enough room to give each attendee a 6-foot space between one another, or
Host the meeting virtually, wherein each participant may be under the same roof, but the meeting still takes place via a web conferencing tool online, to minimize direct exposure.wear a disposable face Mask.
As a general rule, post the number of people each room can accommodate, and make sure to update room booking software accordingly. For instance, if your conference rooms were bookable for 10 people before coronavirus, and now it is deemed that the space can actually only host 3 to 4 people, update the preferences so that employees aren’t making inadvertent errors in booking meetings.

Questions to ask: 

How many conference rooms do you have / do you need?
Are there any ways to conduct business virtually?
How many people can safely fit in your conference rooms now?
Are there adequate Disinfecting supplies and ventilation systems to prevent the transmission of COVID in these spaces?
Do you feel comfortable with your workers using these spaces for group discussions?

Break the 9-5
The 9am to 5pm workday might be under societal scrutiny as group dynamics wane in favor for distanced interactions between people. And, it’s not just the 9-5ers who need to consider this, but how can your business adjust its hours of operation all together to make room for something new.

Questions to ask: 

What are other ways your business could reduce the likelihood of infection? PPE, Disposable Face Masks, Gloves, Hand Sanitizer, and Cetylcide II Concentrate Hard-Surface High-Level Hospital Disinfectant.
Could you stagger workdays into shifts where employees come at non 9-5 hours based on team or function?
What are the parts of your business’ products of services that can remain remote? As an example, consultancies often set up in-person “discovery meetings” with new clients. Could this remain virtual moving forward?
Would employees consider working weekends for two days off during the weekday?
Then, after you’ve made your new policies …
After you’ve formulated your new policies, it’s critical that you document those policies for employees to access and review. The best way to do this is to update a digital employee handbook. The employee handbook, if you don’t already have one, is a singular place for your company to publish policies, expectations, recourse for misconduct, and more. A digital copy makes it easy for a company to update and disseminate information as it changes.

A digital employee handbook is going to be particularly important during COVID-19 and its aftermath. If you need help with employee handbooks, try these templates.


Dental Air Polishing: HAVE I BEEN DOING IT WRONG?


As a hygienist, do you avoid using air polishing in your practice?  You may have preconceived notions about how it works and what it can and cannot do. Like most hygienists, your initial introduction to air polishing, likely in school, left you feeling more disappointed than impressed. The early-to-market products were too messy and too harsh, giving you no reason to use air polishing over traditional scaling and rubber cup polishing methods.

AIRFLOW® Therapy changes all that. This system is more advanced than any air polishing product you’ve tried in the past. Incorporating AIRFLOW Therapy into your practice will improve how you handle biofilm management, saving you time and leading to healthier, happier patients. With AIRFLOW Therapy, there are no worries about messy procedures or patient discomfort. This system actually reduces the amount of time it takes to remove biofilm, making your practice more efficient and profitable while also allowing you to provide your patients with optimal care.

Air polishing technology has changed, and with proper training and manufacturer support, you can easily incorporate this biofilm management method into your workflow. Hu-Friedy offers the support you need to make it happen, along with an advanced air polishing solution that’s unlike any other system on the market.

Still not convinced you should incorporate air polishing into your practice? Here are the top concerns hygienists have about air polishing, and how AIRFLOW Therapy addresses each one. You’ll find air polishing technology deserves a second look, and that it’s come a long way from what you remember.  

Concern 1: Powder is a problem

The older polishing systems were messy, gritty and uncomfortable for patients, and only designed for enamel surfaces.  AIRFLOW’s powders are different. Designed for comfort, the system’s low-abrasive powders feel just like water and are safe for restorations, root surfaces, and dental implants. 

What makes AIRFLOW’s powders so much better than other options on the market? They’re made with smaller microns and are efficient and effective.  AIRFLOW’s PLUS Powder, for example, is made with erythritol, a sugar alcohol with a grain size of just 14 microns. It’s unique particle shape and strength are great for biofilm removal and light to moderate stain removal. Another low abrasive option is PERIO Powder, made with glycine, an amino acid with proven effectiveness for biofilm and light stain removal.  Finally, for patients with heavier stain, AIRFLOW Classic powder is a more comfortable sodium bicarbonate option with a grain size of 40 microns. 

Concern 2: Patient comfort

Another concern about air polishing is patient discomfort. The devices are optimized for low abrasive powders to deliver a gentle spray that can be directed toward the gingiva, minimizing the messiness for the patient. Using AIRFLOW for biofilm removal reduces the amount of instrumentation overall, leaving hand and ultrasonic scalers for hard deposits. Biofilm removal in periodontal pockets is made easier with the PERIOFLOW® nozzle – a flexible plastic nozzle that inserts into the pocket to disrupt the biofilm.  Compared to metal subgingival tips, the PERIOFlOW nozzle is easier to fit around crown contours, particularly implant prosthetics. 

AIRFLOW therapy improves biofilm management within your hygiene appointments. Patients will notice the comfort and efficiency, leaving your office with that “just cleaned” feeling everyone loves.

Concern 3: It doesn’t fit my workflow

Are you wondering how to fit AIRFLOW into your workflow? You may think another process will take extra time. Not so. AIRFLOW actually saves time, especially when implemented in the beginning of the prophylaxis clinical routine, which should follow these four steps:

Screening/exam diagnosis
AIRFLOW Therapy for biofilm removal
Scaling for calculus removal
Patient education and extra services
Why does AIRFLOW Therapy come before scaling? Finishing biofilm removal before calculus removal reduces instrumentation time and clears the surfaces to better detect hard deposits. The time consuming “stroke by stroke” biofilm removal you’ve gotten used to isn’t necessary anymore. This gives you extra time to focus on other tasks that bring value to your practice, such as talking to patients about the various services you provide and how those services can help them meet their oral health goals.

AIRFLOW systems come in different options, from a versatile tabletop unit to a basic device that connects to the handpiece hose. They are designed with ergonomics in mind, making them easy to incorporate into any practice.

Original Story from Hu-Friedy


Ensure Oral Health During Pregnancy


Pregnant women experience an increase in progesterone and estrogen, which exacerbates the inflammatory response to gingival irritants, such as plaque biofilm. Simultaneously, changes in the oral microflora favor the pathogens associated with gingivitis. As a result, pregnant women are more susceptible to gingivitis, pregnancy granuloma, periodontal diseases, and dental caries.

Gingivitis is a common oral condition that affects up to 75% of pregnant women. Increased levels of estrogen and progesterone, changes in the oral flora, and a weakened immune system affect gingival tissue and cause inflammation. Poor oral hygiene and increased biofilm can exaggerate the gingival response. Pregnant women may experience gingivitis beginning in the second month and continuing throughout pregnancy. Although the severity may improve post-partum, most women who experience gingivitis during pregnancy will likely have some form of the disease after pregnancy.

A pregnancy granuloma, sometimes called a pregnancy tumor, may form as the result of local irritants, such as plaque biofilm due to poor oral hygiene or forming on overhanging restorations. It is most commonly seen along the maxillary anterior labial aspect of the interdental papilla. The color ranges from dark red to bluish purple. It is usually no larger then 2 cm and bleeds easily. Pregnancy granulomas will often self-resolve. If surgical excision is required, it is best-performed post pregnancy, as recurrence during pregnancy is possible. The hormonal changes that occur during pregnancy increase a women’s susceptibility to periodontal pathogens and reduce the body’s ability to repair oral soft tissues. Periodontal diseases have been associated with adverse pregnancy outcomes.

Changes in the oral environment during pregnancy can increase the risk for caries. Pregnant women tend to crave a diet high in sugar and fermentable carbohydrates, increasing the risk for caries. In addition, many pregnant women experience nausea and vomiting, which can compromise oral hygiene efforts. Vomiting also increases acidity in the oral cavity. At later stages of pregnancy, the upward pressure from an expanding uterus may cause acid reflux. This type of acidic environment favors cariogenic bacteria and can also cause erosion. Additionally, cariogenic Streptococcus mutans passes from mother to infant through vertical transmission. The bacterium is transferred by sharing utensils or toothbrushes, kissing on the lips, cleaning a dropped pacifier by mouth, or the prechewing of food. Pregnant women with untreated caries have high levels of S. mutans in their saliva and are thus likely to pass the bacteria onto their offspring. Children who acquire the bacterium at an early age have a greater risk of developing early childhood caries.

Although the most common reason cited for not seeking care is lack of perceived need, research shows access to care also plays a role. The likelihood of low-income and uninsured women receiving such care is even lower. Oral health coverage for pregnant women varies by state, although states must cover pregnancy-related services. This means Medicaid-eligible pregnant women must receive oral health services if the oral condition is exacerbated by the pregnancy or could negatively impact the pregnancy. Access to care may also be hindered by low oral health literacy and language barriers. All health professionals should ensure patients understand the information presented and are given the opportunity to ask questions.

The Oral Health Care During Pregnancy: A National Consensus Statement declares that comprehensive oral care—including necessary radiographs and use of approved local anesthesia—are beneficial during pregnancy and pose no fetal or maternal risk. Furthermore, treatment can be safely rendered any time during pregnancy, although pregnant women may be most comfortable being treated in the second trimester. Pregnant women may experience nausea and vomiting in the first trimester and any manipulation of oral tissues may worsen the symptoms.

From Dimension of Dental Hygiene


Vista Dental introduces CanalClean, an endodontic irrigation kit


Endodontic retreatment rates are up over 35%, partially due to improper irrigation techniques and protocol. Vista Dental Products’ two-step irrigation protocol features Vista engineered chemistries for maximum canal disinfection.

The redesigned CanalClean irrigation procedure kit contains pharmacy fresh solutions, irrigating tips, and a micro-aspirator in a “peel and use” kit. Lions Dental Supply Will carry the CanalClean Endodontic Irragation System.

SmearOFF 2-in-1, which is included in the kit, eliminates the need for ethylenediaminetetraacetic acid (EDTA), chlorhexidine, and a rinsing agent. Chlor-XTRA and SmearOFF are 100% compatible and will not form a precipitate when mixed.

Chlor-XTRA is three times thinner than standard sodium hypochlorite compounds, and offers two times greater digestion capability. SmearOFF is a combination EDTA and chlorhexidine solution that will not form as a precipitate when mixed with sodium hypochlorite.


Cheaper handpiece repairs aren’t always better—they’re actually worse


When you walk into your practice, you want things to run smoothly—no glitches, unexpected cancellations, staff conflicts, or equipment failures. Unfortunately, these things happen more often than we’d like because, to some extent, many are out of our control. That’s when we modify, adapt, and make the most out of the situation. But maybe we have more control than we think. Curious? Keep reading.

Steve Frost, DDS, who runs a successful endodontic office in Arizona, was looking to purchase new handpieces. He made the investment with KaVo and purchased the lubricating and maintenance accessories per the manufacturer’s recommendations, as it is well documented that daily handpiece maintenance is essential. The demand he put on his handpieces was high. Over time the torque, stress, and strain from cutting through zirconia, metal, and porcelain crowns took its toll.

After about a year and a half of heavy and intense use, as normal wear and tear would have it, the handpieces needed to be sent in for service and replacement parts. The fixes would be simple . . . or so he thought. He sent them out to a local repair provider and didn’t think anything of it when they came back.

However, after about five or six months, much to his dismay, he noticed the turbines grinding in several handpieces, which subsequently led to vibrating and overheating. Not good. He sent them back to the repair provider a second time, and the same thing happened. Only this time, he noticed that the color on the head was different (albeit slightly) than the rest of the handpiece, so he called his KaVo sales representative. Dr. Frost was slightly frustrated as his investment up to this point was costly and getting a little out of hand.

“Counterfeit parts,” the sales rep told him. Those two words summed it up. “Original equipment manufacturer, or OEM, parts comply with the highest standards and are manufactured to meet rigorous quality and regulatory requirements, whereas counterfeit parts may not be,” he explained. Unbeknownst to him, Dr. Frost’s handpiece was repaired with counterfeit parts. As a result, the turbines were more or less shot and the entire handpiece needed a complete overhaul. This was not the kind of news he wanted to hear, especially after he had already spent enough on repairs to have paid for a new handpiece.

If this story sounds familiar, there’s a good reason. I interviewed the repair managers of the top five dental handpiece repair companies that came up from a quick Google search. When asked about their service and parts protocol, four out of the five companies said that, unless the customer stated otherwise, after-market parts are used over OEM parts. Why? Because they’re cheaper.

Your first thought may be, “I don’t want to pay a big bill, and if the parts are just as good, then I don’t have a problem with it.” That’s part of the dilemma. We are made to believe they are just as good, but are they? You know the old saying, “If it’s too good to be true, it probably is”? In the case of handpiece repair, it really is.

Handpieces are one of the most heavily used pieces of equipment in a dental office, yet most practices don’t have contingency plans for repairs. Or if a repaired handpiece breaks, dentists often default to thinking the issue is with the handpiece, instead of the inferior parts used in an earlier repair.

To get better insight into why counterfeit parts are such a problem, I talked with Nichole Hansen who is the manager of the handpiece repair department at KaVo. The first thing she told me is that repairs arrive at her facility daily because they were fixed without OEM parts. It gets even more interesting:

Counterfeit parts can significantly increase the risk of damaging genuine internal parts—yes, the parts may “fit,” but that doesn’t mean they will last or maximize the anticipated lifetime use of the handpiece.
Handpieces that come in with counterfeit parts will typically last less than six months The most common complaints include gear grinding, loud noises, inadequate or inefficient cutting, and overheating.
While cheaper repairs are initially more appealing, dentists might end up spending two to three times more using generic parts than they would if they had repaired it properly with OEM parts in the first place.
This one is worth repeating: OEM parts comply with the highest standards and are manufactured to meet rigorous quality and regulatory requirements. Counterfeit parts may not be.
With counterfeit parts, the likelihood of the handpiece malfunctioning increases, which raises extreme safety concerns for your patients.
Not all after-market parts are considered counterfeit, but KaVo always recommends using only genuine parts to ensure the maximum performance and lifespan of the handpiece.
Both after-market and counterfeit parts could potentially void any manufacturer warranties on the handpiece.
When repaired at an authorized facility by a certified technician, notes, test outcomes, and the technician ID will accompany the return.
We always look for ways to save money and be more efficient with what we do. That’s prudent and good business sense. So let me ask you this: Do you want to spend your money twice when it comes to your equipment?

Let’s put this into perspective. A patient comes in with a broken tooth needing a crown. The patient wants a cheap fix, and you say the best investment is a crown because it returns the tooth to full form and function. A large filling, on the other hand, is a temporary fix, and the patient can ultimately lose the tooth. The key question is this: Is it worth it in the long run to save a few bucks now, in exchange for increasing the risk of losing a tooth? I don’t know about you, but I’d get the crown done. The same goes with our handpieces. Don’t take a risk because it’s cheaper. Insist on getting the best parts for a maximized return on your investment.

Greg Gillespie, DDS, a general dentist in Washington state, has had his own share of negative experiences with faulty parts and nonauthorized repairs. He now insists on only OEM parts and recommends the following:

Use only repair providers who have been authorized by your device’s manufacturer.
Look for a guarantee. Many unauthorized repair providers do not guarantee that their repair will last.
Insist on only OEM parts. For example, KaVo uses OEM parts 100% of the time for all repairs, which allows them to return the handpiece back to its original performance.
Choose a repair provider who offers knowledgeable customer service to provide full support and answer questions about your instrument.
Ask for a report on your handpiece repair. Most authorized repair teams perform tests on handpieces with every repair. They include the test results and detailed notes with each repair, giving you invaluable information for the life of your handpiece.
Mishaps will happen within every practice. While many are out of your control, handpiece repair isn’t. The next time your handpiece starts to grind or overheat, make the wise decision to get it fixed correctly. Although the less expensive alternative may be enticing, you should insist on an authorized repair facility that only uses OEM parts. This will save you time and money as you properly maintain one of the most important tools in your practice. Dentistry is your livelihood, and this is definitely worth the investment.

Originally From dentistryiq.com


Soft tissue grafting


This month Lions Dental Supply focus on billing for soft tissue grafting. This includes dental practices whose dentists are performing the tunneling technique and/or the Chao Pinhole Surgical Technique.
 

D4270—Pedicle soft tissue graft
Purpose: A pedicle tissue graft is performed to "fix" gum recession. This procedure code can be used to report the tunneling procedure technique or the Chao Pinhole Surgical Technique. It involves augmenting the gingiva to obtain adequate root coverage.

There are many variables involved when it comes to dental insurance coverage and reimbursement for this procedure.

• Dental insurance companies usually cover only if the correct information is reported.

• Submitting the claim with x-rays and periodontal charting is not enough to facilitate coverage and payment.

• A clear written narrative that explains the need for the procedure must be submitted.

• Gingival recession must be noted in the narrative at 5 mm or greater in order for insurance companies to approve coverage.

• Gingival inflammation should be noted in the narrative: mild, moderate, or severe.

• The amount of keratinized/non-keratinized gingiva must be noted in the narrative in order for insurance companies to approve coverage.

• The amount of attached and unattached gingiva must be noted in order for insurance companies to approve coverage.

• Root sensitivity must be noted in the narrative at moderate sensitivity in order for insurance companies to approve coverage.

• If root caries exists, it must be noted in the narrative.

• Mobility must be noted. If mobility exists, the procedure may be denied.

• A 24- to 36-month exclusion applies. This means the same insurance will cover only the procedure in the same teeth reported every 24 to 36 months.

Lions Dental Supply has all the Dental Equipment needed to do any Dental surgery.

From dentistryiq.com


How to safely and effectively care for dental restorations.


Dental hygienists routinely deal with prophylaxis of not only teeth, but a vast array of restorative materials. These restorations involve metallic, ceramic, polymeric, and composite materials that are part of the huge armamentarium representing old and new products employed over the past 50 years. More than 1,000 restorative products may be encountered, most of which are not specifically identified in a patient’s record. A dental hygienist needs to be able to recognize various restorative materials and employ the correct treatment protocol. The goals of this review are to summarize the key principles for safe finishing and polishing operations, consider the structure and properties of restorative materials that put them at risk, and identify precautions for dental hygiene procedures.

Metals, ceramics, polymers, and composites are synthetic restorative materials. Metals include amalgam, removable partial denture frameworks, implants, gold, and other casting alloys. Ceramics may be porcelain, porcelain fused-to-metal, porcelain veneers, and high-strength ceramics. Polymers involve infiltrants and polymethyl methacrylate (PMMA) denture base materials. Composites encompass dental composites, glass ionomers, and temporaries. Management of these materials during a dental hygiene appointment requires some understanding of a material’s structure (arrangement, bonding, composition, defects) and properties (physical, chemical, mechanical, biological).1 Clean and smooth surfaces are essential for esthetics, biological health, and long-term resistance to restorative material degradation. This article will focus on identifying unintended effects of cleaning and prevention methods on surfaces.

The microstructure of all restorative materials is based on the chemical phases that exist within a material. A simplified view of microstructures is as a continuous and dispersed phase (Figure 1).2 For example, a dental composite with a dispersed phase of silica filler reinforces a continuous phase, which is based on crosslinked polymer and difunctional monomers. Another example is a dental amalgam with dispersed phases of residual crystalline amalgam alloy particles within a continuous phase of crystalline reaction products.

During a routine prophylaxis (plaque, calculus, and stain removal; surface smoothening) or prevention procedures (topical fluoride applications), a restorative material’s surface may be altered. Softer phases may be inadvertently or selectively removed. The dispersed phase is often chemically different and provides reinforcement properties. It may react differently to finishing and polishing. The best results are achieved by using polishing materials that are softer than both the dispersed and continuous phases of the restorative material.

For a variety of reasons, surfaces also may require gentle smoothening (finishing) by leveling of irregularities after setting, reactions after setting, or intraoral wear. Polishing is intended to remove plaque, stain, or corrosion. These abrasion processes are two-body (ie, surface and abrader) or three-body (ie, surface; lubricant, such as saliva or water; and abrader). The most commonly used, the three-body process is the preferred protocol. Cleaning is desired without substantial surface abrasion. Polishing agents must contain materials that are hard enough to remove plaque or stain, but soft enough to not damage surfaces.

Risks from wear or abrasion are relatively easy to rank in terms of a Mohs Hardness Scale (Table 1).2 Hardness of any material is its mechanical resistance to plastic deformation. Mohs scale comparisons involve two materials being rubbed together to see which one is scratched by the other. This scale spans all material hardness, from the softest (talc = 1) to the hardest (diamond = 10). Hardness is 5–6 for enamel, 3–4 for dentin, and 2–3 for cementum. Polishing agents should be softer than enamel or any of the soft phases in a restorative material.

While the primary consideration in polishing involves the hardness of materials, there are other factors, such as type of wear, duration of wear, applied pressure, and size of polishing particles. Larger particles produce greater wear. Smaller particles may erode softer phases. Dentifrices are designed to accomplish the same result as polishing procedures and are subject to the same conditions. Hardness ratios are typically used to summarize the relative likelihood of a potentially abrasive material to produce surface wear (Figure 2).2

Wear of composites intraorally occurs due to small silica particles (eg, 0.1 µm) within food that abrade the surface by removing softer continuous phases. For restorative composites, this risk is dramatically reduced by high filler particle loading, combining two or three particle sizes for better particle packing, and minimizing average interparticle spaces to less than 0.1 µm.3 Composites wear, but the process is very slow. Longevity for posterior composites equal those of dental amalgams.4,5 Particles in prophylaxis materials must be soft, and have little tendency to abrade the polymer phase.

SPECIAL PRECAUTIONS FOR DENTAL HYGIENE
While most smoothening and polishing procedures are straightforward, there are special precautions worthy to note.

Tooth-colored materials (composites, glass ionomers, temporary, or provisional restorations). Without prior knowledge, it is generally difficult to identify a composite vs a glass ionomer restoration. Both are esthetic and have a continuous polymer phase with a dispersed silicate phase. Dental hygienists should be careful not to apply too much pressure during the polishing stage of the prophylaxis or the continuous polymer phase could slowly become abraded. Surface stains are easy to remove. Marginal stains associated with Class I, II, III, and V restorations, as well as veneers, involve discoloration that cannot be removed without damaging the restorative material. Do not aggressively polish at the margins. A variety of composites (macrofill, midifill, minifill, microfill, nanofill, and bi-hybrid or tri-hybrids, and glass ionomer materials) are available, but the various types are sufficiently similar that the same approach should apply.6

Amalgam. Tarnish or electrochemical corrosion products create a darkened or blackened appearance. Removing corrosion products produces a reflective metallic appearance that may be good for cleanliness but does not increase the material’s longevity. Inadvertent dry polishing of an amalgam and/or excessive pressure generates surface heat that easily melts the Ag2Hg3 reaction product (melting point = 127° C)7 within the continual phase—releasing and smearing Hg on the surface. The amalgam looks shiny because of its Hg-rich surface layer, but that smear layer is quickly lost over the next few days, exposing the patient and clinician to some Hg vapor during or post-procedure.

Always polish amalgams while using water to lubricate and cool the surface. Also, utilize high-volume evacuation to ensure that any mercury-rich materials that form vapor are quickly eliminated and not inhaled by the patient or the dental hygienist.

Amalgam restorations do wear, albeit very slowly. They also expand slowly over time. The net change on occlusal surfaces is that there is no visible change. Yet, in sites protected from intraoral food abrasion, such as interproximal surfaces or facial surfaces, amalgams may slowly begin to stand out from the cavity above the surface of adjacent tooth structure.6 This appearance is not the result of bad dentistry, but simply the lack of natural abrasion. Use water cooling when resurfacing an amalgam restoration. Resurfacing an amalgam restoration may release some Hg vapor, so local high-volume evacuation should be utilized as well as a rubber dam to remove any associated liquid or vapor.

Infiltrated interproximal lesions. Interproximal lesions without cavitation can be infused with special low-viscosity resin that is polymerizable to halt lesion progression and reinforce tooth structure. Beware that radiolucencies on intraoral radiographs may not necessarily signify an advancing carious lesion. These infiltrations stop caries.8 The process should be noted carefully in the patient record during placement. Check for those treatments in the patient’s history.

Titanium implant posts and titanium alloys. These materials are protected by a film of titanium dioxide (called a passivating film) that forms rapidly, clings tightly to the surface. It is so thin that it appears transparent and invisible. Scaling or aggressive polishing procedures remove this protective film. It will immediately reform if the surface is clean. Effective but not overly aggressive instrumentation strokes should be used, along with light polishing pressure and pumice and water. The same protective film may be disturbed by acidic reactions associated with some topical fluorides.

Ceramic: all-ceramic and porcelain-fused-to-metal restorations. Ceramic is relatively resistant to degradation but surfaces can be partly dissolved by highly acidic intraoral solutions.9–11 Treatments with certain topical fluorides will also dissolve small bits of the surface. We have found that coating at-risk surfaces with a petroleum jelly film or other nonwater soluble agent is a simple way to provide temporary protection.

As delivered, ceramic materials should have very smooth external surfaces. Any intraoral adjustments produce surface scratches that require smoothening with diamond finishing pastes (particle sizes approaching 0.1 µm). Ceramics have high hardness and therefore require zirconia or diamond polishing agents for smoothening. Ceramics are very susceptible to crack formation from stressed areas containing surface defects. If these defects are recognized, they should be removed with special small particle diamond polishing pastes. They cannot be removed with normal polishing materials during a dental hygiene procedure.

Dental cements. Permanent restorations are attached with traditional acid-based cements, glass ionomer cements, or resin (composite) cements. The thickness of exposed cement at margins is typically 50 microns to 250 microns. These materials generally have lower hardness than restorative materials or tooth structure. Aggressive polishing may force abrasive material into the margin and potentially erode the cement.12 A technique of light pressure with prophy cup and prophy paste while polishing with swiping strokes across the margins is recommended.

Denture base materials. Most denture base polymer is PMMA with a hardness value similar to that of dentin. These materials are routinely cleaned with commercial denture base products and/or a soft toothbrush with soap and water. Abrasives in polishing materials or dentifrices will produce some surface scratching. Denture base material is commonly crosslinked by adding some difunctional monomer with the original methyl methacrylate monomers, which creates a more water-resistant material. Remember that a PMMA denture is prone to absorb water intraorally, and lose water when it is out of the mouth. Its mechanical properties vary as a function of water content. This is why dentures are stored in water when not being worn. Avoid procedures that would dry out the material.

Gold alloys. Alloys based on gold also corrode, but very slowly. Their surfaces are susceptible to electrochemical corrosion and over time may develop some surface pitting due to the presence of plaque. Therefore, gold restorations should be fully polished during recare visits. Rubber cup polishing with fine prophy paste is recommended. Any surface corrosion products that form are water soluble and, therefore, will not accumulate. Areas that are pitted can be polished, but will continue to slowly corrode if not kept clean.

Bonding systems. Bonding agents are extremely thin (< 5 µm) and only exposed at margins. Bonding agents are not at risk during routine prophylaxis and polishing operations. Do not attempt to remove stain that has crept into open margins of composites or veneers because of the possibility of damaging the margins. This situation is an esthetic failure and requires repair of margins.

CONCLUSION
Dental hygienists play a crucial role in the long-term maintenance of dental restorations. Appropriate care of restorations during dental hygiene procedures depends on recognizing restorative materials, understanding specific precautions, and carefully conducting finishing/polishing procedures. Removal of stain and plaque depends on the hardness of the prophylaxis agent, which should always be less than the hardness of the phases involved in the restorative material or tooth structure. The goal is always to remove plaque, calculus, and/or stain without disturbing the structure of underlying restorative materials.

From Dimensions of Dental Hygiene


Technique Tips for Handheld Radiography



Appropriate training and keeping up to date on research are key to ensuring the safe and effective use of a handheld X-ray device.
By Ann M. Bruhn, RDH, BSDH, MS and Kimberly Lintag, RDH, BSDH, MS On Oct 11, 2018
Handheld, portable dental X-ray devices, or handhelds, have gained popularity over the past few years because they enable operators to simultaneously hold the device while exposing radiographic images. In contrast, when using wall-mounted dental X-ray units, the operator must leave the room to make the X-ray exposure, maintaining a safe distance from the source of radiation. Handhelds are ideal for use in situations where wall-mounted dental X-ray devices are not accessible, such as mobile dental clinics and outreach events where midlevel dental hygiene practitioners may provide oral hygiene assessment and treatment.1 In addition, handhelds are useful in emergency situations of mass fatality incidents for disaster victim identification.2

SAFETY
Figure 1. Periapical images require steep increased or
decreased vertical angulation from 0°.
Handhelds are equipped with a backscatter ring shield around the position indicating device (PID) and inherent shielding to keep the operator in the “zone of protection” from resulting backscatter radiation that may be produced during dental X-ray exposures. Current research validates the safety surrounding handheld units cleared by the United States Food and Drug Administration (FDA); no additional radiation risk to the operator has been found when using handheld X-ray equipment when all required safety protocols are followed.3

A 2014 study on handhelds found that devices not cleared by the FDA led to an increased radiation dose to both the patient and operator, as operator shielding and collimation of the primary X-ray beam were not adequate.4 Handheld equipment must have inherent shielding, additional shielding around the PID, and an affixed backscatter ring shield. Handhelds should never be used if the backscatter ring shield is defective, not affixed to the PID, or broken.

Radiographers may also don a lead apron with attached thyroid collar to eliminate any possible scatter radiation exposure from suboptimal positioning of the handheld device and backscatter ring. In addition, some state regulatory boards require operators of handheld radiographic equipment to wear a dosimeter badge to measure the amount of radiation received within a specific preset period, such as weekly or monthly. However, dosimeter badges do not directly protect the operator from ionizing radiation exposure because levels of radiation are found after the badge is assessed. After the dosimeter badge readings are analyzed, the operator may realize that additional protective measures and precautions are necessary.

To further minimize radiation exposure when using handhelds, exposure settings such as milliamperage (mA), exposure time, and kilovoltage (kV) settings should be changed depending on the bone density of the area being imaged, similar to the use of a wall-mounted dental X-ray unit. High density areas within the oral cavity (posterior regions) will require increased exposure settings, while lower density areas will require decreased exposure settings (anterior region).5 Manufacturers of handheld X-ray devices may recommend appropriate exposure settings based on the type of image receptor used (direct digital sensor, phosphor plate, or film); teeth being imaged; location within the oral cavity (maxilla or mandible); and patient size (adult or child). Overall, exposure settings can be set lower for digital sensors and higher for phosphor plates and film, respectively.

Radiographers using handheld radiographic equipment should be knowledgeable on the lowest exposure settings needed to produce an acceptable image and be able to apply safe practices for the operator and patient.

TECHNIQUE
Figure 2. Patients should be instructed to move their head
position upward for mandibular periapical images or
downward for maxillary periapical images.
The operator must follow manufacturer instructions for optimal radiation safety when using handheld X-ray devices. One of the directions for safe use of handhelds is to hold the device at the operator’s mid-torso height for all exposures. However, holding the device at mid-torso height requires a vertical angulation of approximately 0° (with the device parallel to the floor), which is not possible to maintain for all types of dental radiographs. Periapical images require steep increased or decreased vertical angulation from 0°, which would place the operator at risk for radiation exposure to critical organs and out of the “zone of protection” given by the backscatter ring shield of the handheld device (Figure 1).

To follow manufacturer directions and reduce possible operator radiation exposure when using handhelds, the patient should be instructed to move his or her head position upward for mandibular periapical images or downward for maxillary periapical images, instead of keeping the patient’s occlusal plane parallel to the floor and mid-sagittal plane perpendicular to the floor (Figure 2).

The operator must stand directly behind the handheld device during the exposure for optimal protection with the backscatter ring shield, which makes the visualization of accurate angulations necessary to achieve quality images difficult. Also, because the patient’s head will not be in the usual position for exposing radiographs and tilted either higher or lower for operator safety, accurate angulations for effective technique will be more difficult to determine.

The use of image receptor holding devices is beneficial to assist the operator with accurate positioning of the PID; however, the backscatter ring shield interferes with the metal extension arm of the image receptor holding device. Manufacturers of holding devices have shortened the metal positioning arm for use with handheld radiographic equipment; therefore, altered equipment should be used together with handheld devices.

CONCLUSION
With the increased use of handheld X-ray devices, operators need to understand the necessary alterations and safety mechanisms for radiation safety and protection. In order to receive the maximum benefit of handheld devices while minimizing operator scatter radiation, all safety precautions must be followed. Proper technique is vital, as scatter radiation is reduced if the operator is within the backscatter ring shield zone of protection. Operators need to ensure handheld devices are kept at mid-torso height for all exposures to maintain optimal protection with the backscatter ring shield. Training prior to the use of handheld devices and keeping up to date with research and guidelines surrounding handheld radiographic equipment will ensure operator safety and high-quality radiographic images.

from Dimensions of Dental Hygiene


Video Dental Concepts announces MobileX handheld intraoral x-ray system


Video Dental Concepts has expanded its portfolio of imaging solutions with the new MobileX handheld intraoral x-ray system, which is designed to offer dental professionals reliability and efficiency.
The MobileX has a unique, lead-infused acrylic shield that protects the operator from scatter radiation, while an internal proprietary housing encases the x-ray tube to block radiation leakage. When the MobileX is used as directed, these shields create a “safe zone” for the operator throughout the x-ray acquisition process.

MobileX produces sharp, clear radiographic images. The system utilizes the latest in x-ray technology—a 0.4 mm focal spot, plus a 70 kV DC x-ray generator that consistently delivers exacting, repeatable exposures.

This handheld x-ray system provides freedom in workflow that is unattainable with wall-mount units. Portable and easy to use, the MobileX can be moved freely between operatories and lets clinicians remain chairside—creating a more positive radiographic experience for all involved. MobileX also provides an immediate cost savings, compared to equipping multiple operatories with wall-mount units.

The MobileX is ready for use right out of the box. Video Dental Concepts does, however, provide free and complete technical service, along with an operating manual and video. Lions Dental Supply & Equipment Will be carrying the MobileX HandHeld Dental X-Ray Unit.

The MobileX features a cutting-edge battery technology, an intuitive user interface, and ergonomic design, making it easier to use and hold. The MobileX battery technology provides consistently reliable, long-lasting battery longevity. Clinicians can easily select the right dose for a patient’s particular need by choosing from a variety of easy-to-understand graphic settings in the redesigned touch pad interface. The MobileX is lightweight and easy to handle.

from DentistryIQ


The Coronavirus Threat: How Should Dental Offices Be Prepared?


Editor’s Note: Information about COVID-19 is changing on a daily, sometimes hourly, basis. We have made every attempt to ensure this article is up-to-date at the time of publication, but with the rapid changes occurring, some information may have changed since publication. Please visit https://www.coronavirus. gov/ for the latest news and information on COVID-19.

Declared a “public health emergency of international concern” on February 11, by the World Health Organization (WHO), the coronavirus that presented itself in Wuhan, China, is now known as COVID-19.1

In COVID-19, the “CO” stands for corona, the “VI” for virus, and “D” for disease. Formerly, this disease was referred to as “2019 novel coronavirus” or “2019-nCoV.” As the virus breached the borders of Wuhan City, the Hebei Province, and eventually China, it has earned the title bestowed by WHO.

On January 31, 2020, the U.S. Department of Health and Human Services secretary declared it a U.S. public health emergency. The Center for Disease Control (CDC) and the American Dental Association (ADA) have made public statements regarding precautions that dental practices need to take in order to address this “emergency of international concern.”2 The CDC continues to actively monitor this outbreak and update their recommendations at www.cdc.gov.

Hygienists find themselves on the front line of enforcing compliance guidelines in the dental practice and need to be aware of current recommendations. Following the CDC guidelines is a best practice even if the dental practice is located in one of the 22 states that dictate their own OSHA plan that may, or may not, incorporate CDC guidelines into mandatory regulatory requirements. In order to incorporate protocols to protect dental staff and patients, dental teams should review what COVID-19 is, why it is different from the “seasonal flu,” and what the CDC recommended preventative measures are to minimize transmission.

COVID-19
This unique coronavirus, originally reported in Wuhan City, Hebei Province, China, is part of a larger family of viruses that are common in different species of animals. Camels, bats, and cats have been documented originators of the virus, although an intermediary animal host may have allowed the virus to “jump” to humans.

Although rare, coronaviruses do infect people and can spread from person to person. This is the case with COVID-19. It was also the case with SARS, which emerged in 2002. SARS is another well-known coronavirus that originated in southeast China.

As of the date this article was written, SARS has proven to infect fewer people but had a larger mortality rate. According to the National Center for Biotechnology Information (NCBI), SARS is estimated to have infected more than 8,500 people, spreading to 30 countries within six months. The death rate was high, with a crude mortality of 9%, or approximately 765 patients.3 Compare that to COVID-19 data as of February 15, which shows an infection tally of more than 58,000 people in 25 countries in just two months with a crude mortality rate of less than 1% at approximately 1,500 deaths.4

Tracking may be underreported, as patients with mild symptoms may not seek medical care. There is currently no vaccine available for COVID-19. Symptoms are primarily respiratory in nature with fever, cough, and shortness of breath appearing within two to 14 days of exposure.1

COVID-19 vs. The “Seasonal Flu”
As of February 15, COVID-19 has been positively identified in 15 patients in the United States5. The potential for additional cases is high as the cruise ship, Diamond Princess, is reporting nearly 300 confirmed cases on board with a number of U.S. citizens listed as passengers.6  The current protocol, when COVID-19 is suspected or when someone has been in contact with a confirmed COVID-19 case, is to quarantine for 14 days and monitor for symptoms. In serious cases, COVID-19 attacks the lungs and replicates itself with an end result of pneumonia. Medically compromised and elderly patients are more susceptible to this dangerous turn. Compare that to the seasonal flu, which can also attack the lungs leading to pneumonia, a lack of oxygen, and system failure.

According to preliminary estimates from the CDC, 14,000 people have died, and 250,000 people have been hospitalized during the 2019-2020 flu season7. A large difference between the flu and COVID-19 is the availability of vaccines. There is currently no vaccine available for COVID-19. The mortality rate for the seasonal flu is less than 0.1%. Comparing COVID-19 to the flu with the intent of minimizing COVID-19, on the premise that the seasonal flu is worse, may minimize the response and open pathways to further transmission.

The death rate for COVID-19 is 20 times that of the flu, and we are only two months into tracking the spread of this virus. The CDC has posted recommended dental practice protocols to minimize the transference of all infectious diseases, including the seasonal flu and COVID-19.

Coronavirus Impact on Dental Practices
The impact on dental practices is twofold. Practices may find a delay in products and supplies shipped from China due to the quarantine and work stoppage. Practices also find they need to take precautionary steps to protect staff and patients while doing their part to minimize the potential spread of the virus. The CDC recommends the following8:

Take a detailed travel and health history. Do not provide non-emergent or cosmetic treatment to patients within 14 days of travel from China or exposure to others that have traveled from China. Reschedule patients with respiratory symptoms to prevent the spread of infection. This includes patients with any flu-like symptoms.
Wash hands with soap and water for at least 20 seconds after contact with patients or use an alcohol-based hand sanitizer with at least 60% alcohol if soap and water are not available. Avoid touching the eyes, nose, and mouth with unwashed hands.
Stay home when sick; cover coughs and sneezes with a tissue and throw the tissue in the trash; and clean and disinfect frequently touched objects and surfaces.
The ADA urges all practicing dentists, dental auxiliaries and dental laboratories to employ appropriate infection control procedures as described in the 2003 CDC Guidelines, and 2016 CDC Summary and to keep up to date as scientific information leads to improvements in infection control, risk assessment, and disease management in oral health care.
There is currently no FDA-approved post-exposure prophylaxis for people who may have been exposed to 2019-nCoV. Posting a sign at the entrance to the dental practice that instructs patients with symptoms, or those that have traveled from China within 14 days, to reschedule their appointment is a best practice. Asking for travel history when confirming and scheduling patients provides an opportunity to reschedule ahead of the appointment if necessary.

Dental teams are exposed to a number of occupational hazards, including exposure to infections, hepatitis, percutaneous exposures, ionizing radiation, noise, muscle and skeletal challenges, dermatitis, eye injuries, allergic reactions, psychological and stress challenges and more. NCBI considers dentistry an extremely hazardous career.

These challenges are often not within the clinician’s control. However, taking steps to minimize the spread of infectious disease by following the CDC recommendations will reduce exposure and add a layer of protection in an already high exposure career. Stay safe out there.

From Today's RDH


What dental offices are doing to prevent coronavirus infection


Dentists, hygienists and other dental professionals are at high risk for work-related exposure to coronavirus, but they can take steps to protect themselves.


"We have really good ways to prescreen patients: by taking their temperature, asking them questions regarding travel in the last two weeks, asking how they're feeling and if they have flu-like symptoms," said Dr. Fotinos Panagakos, vice dean of administration and research at West Virginia University School of Dentistry in Morgantown.

"But they may still answer 'no' to all of those questions, and their temperature may be normal, but they may still be infected though they're not showing symptoms yet," he said in a university news release.

Patients' coughs and sneezes aren't the only ways dentists can be exposed to the coronavirus.

"In dentistry, many of the procedures that we do require using a handpiece to drill a tooth, or an ultrasonic scaler to clean the teeth," Panagakos said. "The water used can form an aerosol. If you aerosolize something, it's going to end up in the air. You can just imagine what that means if a patient is carrying the virus."

However, standard precautions such as gloves, goggles, gowns and mask can help minimize exposure during treatment. Patients also have a role to play.

On March 16, the American Dental Association called on dentists to suspend elective care for three weeks to lower the risk.

"Call the dental office—if your office hasn't reached out to you already—to determine whether you should come in or not," Panagakos suggested. A cleaning or checkup can be postponed.

"If you're having an actual dental emergency that involves pain, if you have swelling or if you have an apparent infection in your mouth, contact your dental provider right away and find out how they're managing those emergency cases," he said. "Most offices may see you, or they may refer you to another location that's seeing emergencies."

From Medical Press