Cliff's Notes

The Business of Dentistry

When Dental Instruments Break! & Cervitec, An Innovation!

Cliff’s Notes for August 29, 2010
…..Client Exclusive E-Blast…..

Cliff Marsh, Henry Schein ……Cell: 201-321-7494……Fax: 201-262-2210…..E-mail:

“Lack of communication between the dentist, staff, and the patient is the number one reason cited by patients as to why they sue.”
Dr. Mitchell Gardiner

In This Week’s Issue
• When Dental Instruments Break!
• Cliff’s Notes Product Review – Cervitec Plus, The innovative new protective varnish!
• Cliff’s Notes Exclusive Special – Oraqix by Dentsply!

When Dental Instruments Break!……
One of the most interesting parts about having an interactive Blog Site is that you can measure the interest level of your readers. Over the past several months some blog topics seem to be of more interest than others. Instrument management appears to be one. So, this week we will talk a little about broken instruments and the communication needed to prevent litigation. Dr. Mitchell Gardiner, a practicing NJ dentist, wrote about the subject for Inside Dentistry.

The most important thing to remember is to care for your instruments and focus on QUALITY. We don’t think about instruments as a big investment like composite or impression material because we usually buy them in small quantities and are mentally tuned to the “necessity” that has no shelf life. But they are the tools that you use to practice and improve your practice and they do have a shelf life.

Now, think about how many you have. A quality dental instrument is expensive. You’ll pay over $20.00 for a Scaler or $60.00+ for a forceps, how many do you have? Do an inventory and you will realize the value of those tools. However, the better the quality, the better they perform for a longer period of time.

Dental instrument are stressed on a daily basis. Between sterilization, use and cleaning, they are the most abused tool in your office. They’re bunched together, put in an ultrasonic cleaner, rinsed, bagged, sterilized, and back in service on a continued basis. Think about the stress on the metal and the cost of replacement and you can understand why they can fail. Most dentists do not incorporate instrument management systems because of the “up-front” expense, but the long term gain can be substantial. Caring for your instruments is also very time consuming and increases the risk of an O.S.H.A. situation. Proper care and management is essential for increased production & productivity. The most organized dental operation will benefit from using an instrument management system and we’ll discuss that next week.

Remember, even the finest instrument carries a risk of breakage. So what happens next?

What to do when a dental instrument breaks!……
The FDA requires written reports on surgical instruments that break. In the dental industry, top line manufacturers such as Hu-Friedy, Nordent, Miltex, Premier, etc. guaranty their instruments against rusting, breaking or tarnishing for life. However, if one breaks and you want to return it certain questions must be answered. The most important is “did it break in the patient mouth and did all the pieces get removed?” Should there be medical situations that arise, dental instrument manufacturers will defend your use of their product providing it was obtained from one of their authorized distributors. If not, the expenses of any legal defense is your responsibility and that of your malpractice insurance carrier. Also, be advised that all manufactures that distribute their products through Henry Schein are required to produce proof of current product liability insurance. Please refer to the instrument/materials manufacturer’s polices for more and current information.

The following article was written for the Chicago Dental Society….August 5, 2010.. John M. Green, DDS, JD, is a practicing dentist and defense attorney who has been representing dentists and dental specialists for 17 years.

It is a dentist’s worst fear: an instrument breaks inside a patient’s mouth during a procedure. What do you do? Well, don’t panic.

Let’s talk about needle breakage. During a mandibular block, the 27 gauge long needle breaks inside the patient’s mouth. While maintaining your composure, you must inform the patient of what has occurred and try to reassure the patient that everything will be fine. Unless the needle is sticking out of the tissue so that you can remove it with a hemostat, you’re best to contact an oral and maxillofacial surgeon to have the patient seen immediately.

Avoid phrases such as “Oh no, I broke the needle!” or any other comments that would indicate you did something wrong. If the patient is visibly upset, you might even want to drive the individual to the oral surgeon’s office Most oral surgeons are skilled in dealing with this situation and will be able to successfully remove the broken needle. It is also advisable to keep the hub of the needle in case the situation turns into a lawsuit.

Another broken instrument scenario is a root canal file separating during an endodontic procedure. You must always inform the patient and document it in your records. It is also recommended that you take an X-ray of the tooth to verify the location of the file within the root canal. On rare occasions, the file may separate beyond the apex of the tooth which would necessitate an immediate referral. However, most of the time a root canal file will remain within the root canal. Depending on the condition of the tooth and where the file separated, it may be within the standard of care to monitor the tooth. Other times, it may be necessary to attempt to remove the file.

If a general dentist is performing treatment and the file separates, he or she may want to consider referring the patient to an endodontist. Once again, try to reassure the patient that you will make every effort either to try to retrieve the separated file or to refer the patient to a specialist to see if the file can be removed or bypassed. From my experience, most lawsuits result from the dentist or endodontist failing to inform the patient of the separated file and they later learn about it from a subsequent treater.
What happens when a dental bur or an elevator breaks inside the patient’s mouth? Obviously, check the oral cavity and try to retrieve the broken instrument with pliers or suction. If you can’t locate the broken instrument, check the trap of the suction to see if it was suctioned up by the dental assistant. If you still are unable to locate the broken instrument then take an X-ray of the area of the mouth that you were working on to see if it is in the soft tissue. If you suspect that the patient might have aspirated it, send the patient for a chest X-ray.

As with the other broken instrument scenarios, you must always inform the patient of the situation and document it in their records. Staying calm and reassuring the patient will go a long way to keeping the situation from becoming chaotic.

Keep in mind that many malpractice policies have what is called a “Medical Payment Provision” which reimburses the patient for bills for medical or dental treatment to correct the problem. Any payment made to the patient under this provision is typically not reportable to the Data Bank. Furthermore, if you have to send the patient to the hospital for a chest X-ray, for example, I recommend that you talk to the patient about paying the hospital bill (either personally or through your Medical Payment Provision).
Payment of a bill is not an admission of liability. If a patient feels that he or she has to foot the medical or dental bill then it may create an environment for a patient to sue.

Remember, if an instrument breaks, stay calm, inform the patient, document the incident, and, if necessary, refer the patient to another healthcare provider to retrieve the broken instrument.

Cervitec Plus…………………..
The innovative new protective varnish containing chlorhexidine.
CDT D9910 application of a desensitizing medicament.
Based on its predecessor, Cervitec Plus is a new-generation varnish intended to ensure the quality of restorative work (e.g., crown and bridge work and implants), as well as provide protection for high-risk caries patients.

More than a decade of clinical experience and multiple international studies confirm the effectiveness of Cervitec. It has been shown to protect at-risk, exposed and sensitive tooth surfaces. The new generation Cervitec Plus has been developed based on this original success while maintaining and enhancing proven features.

The varnish contains the proven combination of 1% chlorhexidine and 1% thymol and is available in Multi Dose and Single Dose units, each of which prevents the risk of cross-contamination. The dropper tube allows the required amount of varnish to be dispensed hygienically and economically.

Enhanced characteristics of Cervitec Plus include improved adhesion to tooth surfaces and heightened tolerance to moisture during its application. As a result, this innovative varnish wets tooth surfaces more thoroughly and demonstrates excellent penetration.

The clinically proven active ingredients remain where they are needed longer and promote the formation of a coating or barrier, making Cervitec Plus highly effective in very small doses of the active ingredients.
Therefore, the side effects associated with chlorhexidine are prevented. Instead, patients enjoy months of professional protection without the need to follow any special regimen.

For more information, call (800) 533-6825 or log onto Ivoclar Vivadent.

Cliff’s Notes Special Offer – Oraqix by Dentsply……
This special is exclusive for Cliff’s Notes Direct E-Blast Clients. It will not appear on Cliff’s Notes Blog.

Sunday August 29th……
It’s back to school and time to look ahead to autumn, my favorite time of year. Enjoy the day because once it’s gone you can’t get it back. Please remember your family amd stay safe.

Cliff Marsh
Henry Schein Dental
P.O. Box 663, 45 Rt. 46 East, Suite 605
Pine Brook, NJ 07058
tel. 201-321-7494

August 29, 2010 - Posted by | Uncategorized

No comments yet.

Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s

%d bloggers like this: