Rolando Mia, from Zyris, hosts a video series focused on the latest news, topics, and conversations happening in dentistry featuring dentists across the nation. In Season 2, we’re focusing on, “What’s Working and What’s Not”, where we’ll debunk myths by assessing trial and error since the start of Covid-19 in dentistry.
In this episode, we interviewed Dr. Miguel Ortiz, DMD, owner of Dentlit. The purpose of this discussion was to understand this importance of air purification in dental settings in relation to COVID-19.
Watch this video to learn the following:
- Negative Pressure Rooms – how to build one
- Advice for dental students on the importance of patient relatability
- Having mentors and connections with people you trust to give good advice
Dr. Miguel Ortiz:
So, let’s talk a little bit about what we did with COVID.
Purifying the Air in Your Dental Office
You are one of the only, if not the only dentist who, well before all of this happened, just made the decision to just go with what you felt was most important, purifying the air in your operatory. How did you make that decision? How did you do that without without the guidance from the CDC?
Dr. Miguel Ortiz:
When this whole crisis hit, in February or March, I already knew we were closing, and we were closing for a long time. I have family in Europe.
To me, it was very surprising that many of our colleagues thought in March and April were thinking that they were going to reopen in two weeks. In my mind, I was like, “We’re going to be closed until the summer for sure.”
I remember my last photography course was in Miami on March 14th, I had closed my clinic – that was a Sunday. More than half of my audience in that photography course, it was 40 colleagues were saying that I was crazy and that we were not going to close. I was like, “Guys, what are you talking about?” I even remember doing a little speech at the end. It was kind of like a soft closing to the to the course saying, “I hope we don’t regret meeting here. I hope that these meetings are not a mistake and that we should have should all stay home.”
So, I always knew that this was serious. I think I closed the office on March 15th, even though everybody closed, like the 26th. I always knew that we were going to close for a while and that when we came back it wasn’t going to be the same. That was pretty clear.
How did you get there though? How did that happen?
You look at Europe and it wasn’t too hard to see what was happening three weeks ahead of us. At that point Italy was in flames. Spain was in flames, what are we different? It’s pretty clear. You could see what was happening.
And then, it’s always been a classic virus, aerobic infection. So, the idea of, “Is it in the air? Is it not in the air? Should we wear a mask? Should we not wear a mask?” I remember flying to Chicago midwinter from Boston in late February and I was already wearing a mask. I was the only one wearing the mask on the plane and cleaning everything around me.
I’m not trying to say, “Oh, look at me.” I’ve made a million mistakes in my life, but this was surprising because to me it was pretty clear that being proactive has no harm. I mean, we’re still learning about the masks today. So, I knew that coming back, what’s going to be an issue. And the issue was not going to be know how to clean the offices. Rather, the issue was going to be, how do we clean the air? That was always clear for me.
That is when I made the decision very late March, early April with a friend of mine, Dr. Jason, here Massachusetts in that we were not going to listen to this leadership, rather, we needed to clear the air.
So, we did some research in, we realized, okay, a negative pressure room seems like the way to go. I have 4 operatories. He has 11 or 12 or something like that. So, a negative pressure room is basically like having a kitchen hood inside your operatory. All the air gets sucked up through a vent in the ceiling. You suck up all the air, you filter, and you recycle. Then I asked myself, “Does this mean that I had to have a sealed room?” No. It doesn’t mean that you have to have seal room. You should have to have some kind of court, just like a court in front of a window. You create enough of a closure so that air can just flow in.
So, you create a unidirectional flow of air into the operatory, meaning you’re treating a patient and creating aerosols, those aerosols don’t go out. Rather, the air is always coming in. This is classic in a hospital setting.
Building A Negative Pressure Room
The only thing that didn’t sit well with me was just having a HEPA filter. A HEPA filter alone is not going to do it. I also wanted my rooms to be independent. So, we called some engineers and we said we wanted to make a negative pressure room. We want the air to be filter with the thickest HEPA filter, which is what we have in the air conditioners. But I wanted more. They said they could add that.
So, then the air gets sucked up and it goes through the filter. This is on a HVAC system. Right in the roof, after it filters, it goes to an ionic station stage where the particles, get electrically charged, and then you can scrub them by pulls. Then, at the end, I told the engineers that I want a UV light. They were like, “Where do you want a UV light?”, and I said, “I want a UV light in the system”, they’re like, “That’s impossible.”
I’m said, “Why not? The air is going to make it go through a UV light. That’s the simplest thing ever.” They actually did some research and found that it existed already. So, we did that. Then we did the math. I have 4 rooms. How long will it take to build this? This was in late March and by the first week of April, I already had it done.
I reopened in June, anybody who wants to see the system you can view it on my website for the clinic dentlit.com. There is a video there. It was an eye-opening experience when I tested it. We tested it with a smog machine and put it in the operatory – got the laboratory full of smoke. When you don’t turn the system on this motion lingers, and then it started coming out of the room and you can see it going into the hallway. You’re like man, “That’s what we were doing all the time as we drill.” Now, we turn that system on and the air completely clears.
So, one of the things that we wanted to do was the engineer said, “Okay, we can put this in, and you know, you can cleanse the air a couple of times.” And I said, “No, I want it every 4 minutes. I want all of the air in every single room to cleanse every four minutes.” To get that you need to do the math of the square foot or the cubic feet and the air handling, etc.
So, we found that, you can do it every four minutes. You can triple filter that air. Let’s say you filter the air, it goes through the first filter, then he gets ionized and scrubbed, then it gets UV light, then it gets dumped outside and it comes right back in, right? Let’s say you have a virus in the air and the first time around wasn’t scrubbed. Well, you’re going to have to go through it again in 4 minutes.
When we were closed in April and were thinking, “Are we even going to financially survive this debacle?” I felt like they investment was not going to be the one that broke me. Like either we all go down in flames financially or we double down on this. It was the best decision I ever made in my life.
When I was coming back, I had the chance to go to my old office, to do a couple of cases and I was able to remind myself, see all the friends and the chaos. I’m seeing this in many offices, the hygienists don’t want it to come back, the assistants aren’t feeling good, these big machines making noises, etc. My office is looks almost normal. If you’re a patient, the only difference that you see is that I’m wearing. The only difference. We have this like a quarter that closes the entrance to the operatory and it the patients like it; it gives you privacy. It gave the team and the patients just a piece of mind that I’ve never seen before.
When I saw that video of the air getting cleaned and the mistake if you don’t turn it on, I was like, “Ah, we were working like this before?” I feel like it’s one of those things where they used to work without gloves. Now, that seems unthinkable. So, it is also like, if we don’t purify the air forever, we’re going to feel like, all the mist on our face. How many times have you removed your glasses and you feel your face that you’re like, “Oh.” Well, that’s what totally blew me away.
Effects of Creating Clean Airflow
So, it sounds like, it’s not just negative pressure room. You have that you have the filtration, you have the UV, and then you then in within four minutes it’s about cycling the air through the room multiple times in a period of time and every four minutes or so. So, the potential for anything coming through is virtually nothing. I bet your allergies are fantastic.
One of the assistants mentioned that. She said, since we came back, my allergies have been completely clear. The good thing is we have four operatories. Each of them is independent with this system. They all have negative pressure airflow. So, the air is always flowing from, let’s say the hallway or the waiting area, whatever you want to call it into the operatories. In a way as you’re cleansing that room every four minutes, you’re also cleansing the climate because the entire clinic is probably filtered every 20 minutes or every 30 minutes.
Wow, it sounds like it’s the best decision you ever made. Do you or did you research some of the other systems that are out there?
So yes, I researched everything. I never liked the idea of having this machine that purify the air through just the filter right there. Like if you have virus in the air and this filter in this machine right there, how do we know if the virus goes into in the filter right there. I’m not saying yes or no, that’s just the question that I had in my head.
Okay, so we looked into that as something that sits right next to you, but we didn’t think it was, it was a good thing to go with. They’re expensive too. So now we, we did not think of that way. I mean, I didn’t think of it. I didn’t find it. When we looked at the cost, when we saw that it could be done and how it could bring peace of mind for the team and the peace of mind of the patients, to me, it was a no brainer.
I said, look, if I’m going to spend 30 to $40,000 on a multimillion-dollar clinic, that’s not what’s going to get me under. Like if we’re going down because of COVID-19, we’re going down. Like this, you can take my house, right?
Patient Apprehension and COVID-19
When you think about it too, you hit it right on the nose. You’re going to be practicing for years, 10, 15, 20 years. When you look at that investment over that period of time, when you look at the peace of mind that it just gives you, and then more importantly, just that it’s safe for your patients, for you, that totally makes sense. In retrospect, are you discovering that any of your patients are feeling apprehensive?
When you tell them, “Look, this is what we did. This is why we did it.” To be honest, this is the best that can be done. They understand the intention, they understand how you care for the team. You know, I have three kids, I have hygienists and assistants with kids, and I said, we were thinking of how do we treat you in this room? How do we make it so this air right here, doesn’t go to the next room, and keep the rooms separated? And the solution sounds super complex.
It sounds super tricky and nerdy. It’s like saying let’s install air conditioner when you don’t have it. It’s kind of like that. I don’t have an air conditioner. I’m hotter, I think is great. Well, maybe you should install one. Well, yeah, it takes some money. It takes someone from the HVAC. You can figure it out.
Every office layout is different, but it is doable. It is doable. And I do think that many people are going to start looking into this, realize that is the way to go. And hopefully they do it. I recommend it. I totally recommend to fellow business owners to, to look into this.
The Choice to Become a Dentist
So, have you always wanted to be a dentist?
Well, I know astrophysics. So that’s what I wanted to do.
I mean, how do you end up in dentistry because the stars and dentistry is not the same.
My brother became a dental technician. About 25 years ago, I was in LA following the American dream, the American dream wasn’t happening. I went to LACC and I saw there was a program for technician technology. I jumped into it and eventually realized that I never thought I could do things with my hands. That was a realization – I’m not just joking. I always grew up knowing that I was smart enough to do whatever I wanted. I don’t think I’m the smartest guy in the world, but I always knew that I wasn’t dumb so I could do math, science, I could be an architect, could be an engineer, but there was no way I can do things with my hands – I can’t fix a car or do construction. But then, so it wasn’t a realization, when I became a dental technician and I wasn’t all that bad.
So, then I was a dental technician for about eight years, and I realized, “Okay, I can see behind this desk and make a little money, or I can go for more and interact with people and do dentistry. Hopefully I can make a better living out of it.” And by then, you know, a little bit later, I said, “Let’s go for more. Let’s be a dentist.” And then I graduated, and my mom said, “You’re done, right? You’re gonna be a dentist?” And I said, “I’m going to keep going. I’m going to become a prosthodontist.” So, I kept going and I became a prosthodontist. So, if you asked me in the year 2000, if I was going to be in dentistry, I would say said no but in 2003, I was in it.
Well so, the other thing too is this in order to be an excellent dentist, you have to be an artist. And as I’m looking at the things that you do, you’re also a photographer. You have the artistry.
I am a project, OCD driven person. I find goals and I want to achieve them. So, I mean outside of the online world, for about two and a half months on my project has been my yard. I’ve been trying to grow grass in July and August. I am failing so badly at it. I can do a full mouth reconstruction, very complex one, much better than I can grow grass in July. So, my kudos goes to the landscapers right now. I don’t feel like, “Oh, it’s just a landscape or keeping grass green.” It’s not, okay?
So, I find a project, I find a project and I go for it a hundred percent. Being a dentist, being a prosthodontist, being a great prosthodontist, which I aim for. I’m not saying I am; I aim for it. I just focus. Photography, doing it the best; being an educator, trying to be the best that I can be. Either I do it full or I don’t do it all.
When this hit in the March, I’m like, “Okay, let’s go. Let’s go for it.” I was buying PPE in March, like thousands of masks. I have colleagues that opened in March and they were like, “Ah, where do you guys buy masks?” I mean, are you opening tomorrow? You asking me where to buy mass today, today? Like what did you do in the last three months? I mean, Tiger King was only 10 episodes. I binge watched in two days. What else did you do?
Importance of Mentorships in Dentistry
So, did you or do you have a mentor? Do you have somebody that you look up to?
Yes, I do. Dr. Lee James. He was the previous president of The American College of Prosthodontists. My ex-boss, both of them are great mentors. I look up to a lot of people.
Look, to all young dentists out there, and I’m one of them, dentistry is not hard. We read the field, we know chemistry, we know materials – you can learn it all.
However, how you relate to your patient is not easy. How you learn to talk to them, how learn how to classify them, how to understand that you cannot be the same person with everybody. That, for some people does not come naturally, I’m one of them. I used to think for a long time, “This is me. If you like me, you like me and if you don’t. kay, there’s a 100 people in this room, who cares if 50 don’t like me? If the other 50 do, I’m fine. I don’t need everybody.”
When you become a dentist, if half of your patients don’t like you, that’s not a good sign. That takes a lot of time to learn. Hopefully you have somebody that’s been doing this for a while and kind of sit you down and say, “Hey, look, your dentistry is flawless, but you failed personally,” I was lucky to have that on a previous job. It counts the same way with how you relate with the hygienist or how you relate with the team? How do you relate with your boss or with the patients? All of that is, is difficult to learn. You need mentors.
So, I’ve been lucky so far. I had that in school, and I had that in my previous job. Now that I own my own practice, now I’m a little bit on my own trying to manage the team and the patients. But I try to keep myself in check because it’s not easy to empathize with patients. Sometimes we get too caught up on what we’re doing. We are doing dentistry. Let me tell you about the dentistry that I’m about to do. Let me tell you about the treatment that I’m about to do. And the patient is like, “Can you help me? I’m hurting and I’m hurting physically and mentally…”and something we go, “Can you just listen?” And sometimes I fail at that and mentors are very important for that.
A Message to Young Dentists
Thank you for that. So, if you were to summarize, what message would you like to get out to dentists as we close down? I love the messages you’ve been saying about, you know, “Hey, I may be the best clinician on the planet, but if I’ve lost my patient, I failed.”
It’s so true because many dentists that are graduating, they worry about their dentistry. Don’t worry about your dentistry. Even when you mess up, the patient doesn’t know and that doesn’t mean that you should go and mess up. It means you can have an honest mistake. You can prep, you can misdiagnose, and you can have mistakes because most of what we do is not life or death situation. Most of it. So, it could have serious consequences. You could end up with a root canal with an infection.
We don’t want that but it’s the nature of our business that we are four years in school for. We go to work. Well, doctors take a degree and a diploma after four years of medical school, guess what? They cannot practice. Yeah. They’re not allowed to practice. They have to go to residency. We don’t have that. We’re like, go do it. So, it is okay, don’t worry about your dentistry. Worry about if you don’t care about your dentistry, that’s what you should worry about.
If you come out of school and you think you’re the best and every time you make a mistake you go, “Man. I don’t know what that happened. Why did that crown fail? Why did it break two months later?” Then the next day you just go do the same thing – that’s a problem. You got to dig. You got to dig inside. Sometimes it’s your fault and sometimes its not, but it can be a result of you putting that relearning off. If things are not working, you are doing something wrong. Something breaks, something falls off. One thing doesn’t come out of the way you want it. Okay? When you become systematic that every 10 crowns that you put in one comes off – that’s a problem.
When we become systematic, where every class 2 that you do has caries 3 years down the road- that’s a problem. If every time you’re putting on veneers, you have something coming into the field and you just keep rushing just to cement – that’s a problem. You should care about that because you can only hide things for so long. Eventually it’s going to blow up in your face. Even if we’re not even talking about the patient, which is the one who is suffering, but you can’t hide that it will come down to hurt you and you will feel bad. So, worry when you don’t care. And if you care and you keep, you made a mistake, you’ll try to research. You take courses, you reevaluate your protocols.
You may not always find a solution, but you’re going to learn so much in the process of trying to find a solution. You’re going to try to see why your crowns keep this amount in and you aren’t going to go into the hole. You’re going to learn so much about bonding and materials and that the journey was worth it.
So, that’s what I tell new graduates, which is, don’t worry about how much money are you going to make the first year. Don’t worry about paying your loans. Don’t worry about if your boss will be happy or not. Worry about whether or not you are a good person when I’m on that chair. Am I being honest? Worry about that because we’re in control of what we sell. We have a humongous conflict of interest, humongous. It’s really tough. We get to tell a person what they need and we set the price.
It’s a big conflict of interest, right? So, we need you to control ourselves sometimes and say, “You know what? No, you don’t need a restoration right now. You’re 23 years. I can see that decay there. Here’s why this is happening. Change your diet, blah, blah, blah. Come back in 6 months. Let me think. Let’s watch it for a while.” It takes a lot of self-control to say that, instead of like, “I’ll see you in 3 days for a $300 appointment.” The patients can feel it; they know when you overdo it, they know they might not know the dentistry, but they can feel it.
Discussing Isolite and Amalgam Procedures
Thank you for that. You focus on doing everything perfectly, following the science, all that type of stuff.
You guys have great products. Are you coming out with anything?
So, you use our system?
Yes. I love removing amalgams with it – I’m not going to lie to you. I love removing amalgams with the Isolite. When I am prepping something, I don’t 100% always use a rubber dam. I either use a rubber dam or the Isolite system. When I, when it comes to restoration then I put it in. Many times, you know, I need to clean, I need to remove the amalgam, clean prep, you know, have the patient like swallow and things like that. So, I use the rubber dam, to cement or to finish the restoration 100%. Sometimes, you know, I love working on the upper first molar or lower first molar with the Isolite system, you know, it rubs behind it.
Well, first of all, thank you. Thank you so much. Really appreciate it. And look forward to connecting with you again. I love the progressive view that you have.