Cliff's Notes

The Business of Dentistry

Dental Sterilizers & Risk Management

On December 8, 1991 Kimberly Bergalis died, she was 23 years old. She was the first of 6 patients that contracted the Aides virus at a dental office. Dr. David Acer, a Florida dentist who also died of aids, was accused of purposely infecting all 6 patients. Although there was no clinical proof and the Aides virus has not knowingly been transmitted in any dental setting, the race to dental infection control began. At the June 1992 Atlantic City Dental Convention, 6 months after Kimberly’s death, my company sold 32 sterilizer and sold-out on gloves in the first day. Believe it or not, in 1991 very few dentists wore gloves or had real sterilizers, some used toaster ovens.

Sterilizers … (ster·ile: ADJECTIVE .. “free from bacteria or other living microorganisms; totally clean”). The laws of physics states that sterilization occurs when an item is exposed to a consistent 120C degrees for a specific amount of time. There are several different types of sterilization systems available to dentistry, dry heat, steam heat, chemical vapor and gas.

Chemical Vapor … In my opinion chemical vapor sterilization is the best system available to dentistry. This process will not rust or dull instruments and is faster due to the fact that you use a chemical solution instead of distilled water. In today’s market, this system is not practical for a dental office because of the ventilation required and the cost of the chemical sterilant. For a dental practice the wear and tear on instruments can only be avoided by using a dry heat sterilizer.

Dry Heat Sterilizers … Will be the kindest to instruments but they take much longer, 2 hours @ 120C degrees. Carbon steel cutting instrument will not dull and However, autoclavable plastic will melt. Steam sterilizer are much more versatile.

Steam Sterilizers … There are so many different brands and they all do the job if used correctly. Utilizing a pressurized chamber sterilization occurs very quickly but it takes time for the unit to reach pressure an temperature. Manual machines have mechanical timers that alert you to switch the sterilizer to the vent and dry modes. The drawback to a manual machine is that if it is not working correctly and you are not watching the gauges you will never know if proper temperature and pressure are not achieved, . An automatic machine will fill, heat, pressurize, vent and dry on it’s own. If the unit cannot preform the process it will shut down and alert you to the problem. Automatic sterilizers will reduce your liability and be more reliable protecting your patients, team and family.

Liability … Exposure to litigation is the basis of every risk management program. We all have to protect ourselves from the ambulance chasing lawyers. It doesn’t matter if you are right or wrong, your insurance company will settle the case just to make it go away. The sad part is that it will cost you money to defend yourself. An organized risk management program will minimize your out of pocket expense. Now its time to look at you risk management program and how it relates to your sterilization protocol.

Risk Management … When was the last time you looked at your personal security? We’ll look at that in my next rant. Please feel free to contact me with any questions or concerns.


March 18, 2018 Posted by | Uncategorized | Leave a comment

Dental Instrument Management

Do you know how much you have invested in   hand instruments? I bet you don’t…

Did you ever take inventory of your assets? I can’t recall a dental office ever taking a physical inventory. It is time consuming and expensive but it does give you the real value of your business and a good understanding of how much money is sitting on your shelves and in your draws. Start by reviewing you hand instruments because you may be surprised about how much money you have invested.

Your Investment … I always said that in business you never have expenses, only investments. Hand instruments are the tools of a surgeon and an artist and quality matters. One simple Hygiene setup of good quality instruments runs $150.00 and up. Forceps run over $150.00 each and what about sharp explorers. If you did an inventory of your business, excluding the dental equipment, the hand instruments would be over 15% of your reusable assets. This value deserves attention and maintenance is the key.

Care & Maintenance … How does your team manage your instruments? Most dentists or office managers don’t have a clue. Are they dropping them into a germicidal bath like they’re loading a dishwasher or are they treating them with respect because they are expensive? Quality dentals hand instruments are specially designed for different operative situations. Poorly maintained instrument will loose there shape or sharpness, not preform properly and will need to be replace more often. Understand the instrument management process and the flash points that cause damage like an instrument bath, ultrasonic cleaner and a sterilizer.

The Instrument Bath … When offices ask me about cold sterilization solutions for their instrument baths I explain that there is no such thing. An instrument bath is nothing more than a “holding solution” that prevents cross contamination. The strongest holding solutions are not necessary and may cause lesser quality instrument to degrade but the vapors that leak into the air are still toxic. The instrument bath is a place to store contaminated instruments before the ultrasonic cleaner and it should be covered in a well ventilated area.

The Ultrasonic Cleaner … Rule #1 DO NOT use the machine when a patient with a pacemaker is in the office. Ultrasonic cleaners can protect or damage instruments depending on how they are used. Dumping everything into a basket allows the instruments to bang together causing metal fatigue and dulling. The best way to clean instrument in an ultrasonic is with a cassette system. This is an investment project because most offices do not have the right equipment. If you do not use cassettes, instruments should be rinsed, tied, and placed in the ultrasonic with an enzymatic type solution. After removal they should be rinsed again before placing them in the sterilizer.

The Sterilizer … CDC guide lines are continually changing. The rules for handpieces has change dramatically over the past 2 years but we will discuss that at another time. Instrument guide line now call for the instrument to be completely dry but at the same time they want you to keep the clear part of the pouch up for a better sterilization process. We were always told paper up for better drying. Routinely retrieving wet instrument from a sterilizer signals a problem with your instrument management system and a workflow review should be done.

Workflow Review … The entire clinical team needs to be involved when reviewing instrument management. Please feel free to contact me with any questions or concerns.


March 11, 2018 Posted by | Uncategorized | Leave a comment