Implementing Tools in Your Dental Practice Based on Science





By Lexi Marino August 21, 2020

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. Marc Sclafani, co-owner of One Manhattan Dental. The purpose of this discussion was to understand the power of scientific research in making choices on dental technology for safety and how those choices lead to success in times of industry distress.

Watch this video to learn the following:

  • Intraoral vs. extraoral suction – what does the science say?
  • Introducing new products to your team for their safety
  • Building a new practice during a pandemic
  • Bringing in more clientele in trialing times

 

Transcription

Rolando Mia:

Good day, everyone. This is Dental Voice Season 2 with Zyris. My name is Rolando Mia. This is Dr. Marc Sclafani.  When you look at the purpose of Dental Voice, we’re hearing from clinicians like Dr. Marc about their experience, what’s going on, and then advice and perspective with regard to Covid-19. We know everything to shutting down, opening up, and now that we’re working again, it’s really important to try to figure out from clinicians what’s working and what’s not.

So, Dr. Marc, thank you so much for joining us and really appreciate you taking time in your day.

The Importance of Air Filtration

Dr. Marc Sclafani:

Well, thank you for having me again. So, we’ve been shut down since March 12th, but we really never left the office. Once we knew we were going to shut down, we already started taking precautions and knowing that it’s going to be a challenge once we reopened personally. When I said we never shut down, I meant that we were here for emergencies on a very limited schedule seeing one or two patients a day. However, we realized that we had to make some changes.

The first thing that was important for us was air filters in the office. One of the first things we researched were different types of air filters. There’s one that you may hear running behind me in the corner there – it’s a residential air filter system that we bought after research. We found out this one is more proven, and it works best in our room. We wanted to know that the air is being cleaned several times an hour, because we are at most risk for airborne particles that are released from aerosol procedures.

So, let’s talk about what’s working. I think everything is working. Everything is working well. When we first started out, it was slow. Patients were coming in, but now we’re back to a full busy schedule.

We have four hygienists running full time and four doctors full time. We extended our appointments to give everybody more time to get seated. So, there’s less people gathering in the waiting rooms and the rooms are sitting empty for 15 minutes after each appointment to make sure the air is clean.

I think the biggest challenge was getting the staff onboard and making sure that the staff felt comfortable coming back to work, Rolando. That was the most important thing for us. We really take pride in building a big team here at One Manhattan Dental. We communicated with them at least once a week through Zoom chat, similar to what we’re doing now to make sure that they didn’t have any questions and they felt safe coming back.

There are a lot of dentists that I spoke with and they lost staff due to COVID-19. Some of them moved out of the city. Some of them are just afraid to come back to the work and environment. I really feel that we were working in a safe environment and I’m very proud to say that our office is up to spec. It’s also a brand new office. We got lucky and we did a full renovation prior to COVID-19 – that helped also.

Rolando Mia:

Thank you. I appreciate that. It’s so cool – things like airflow, do you see a big difference with regard to all of the PPE equipment that you put into the office? Is it significant?

Dr. Marc Sclafani:

I don’t notice a change in air quality. It’s always been a clean environment. We have a lot of windows in the room, which I can open if I need to. The air has always been cleaning here. I’ve always had an air filter in our office and in our waiting rooms. This time, we just got a better version. That’s going to sift out these small particles, and do a better job cleaning the rooms. That’s just one part of what we did.

The second phase of what we did was to determine, what we need chairside to help remove airborne particles. More specifically what we’re creating with our high-speed hand pieces in relation to aerosols from our dental drills or from devices like the Cavitron that our hygienists use. We researched both ends and our choice was an extra oral device which is a cone shape unit that sits in front of the patient’s mouth comes up about 6 inches in front of the mouth.

However, I found those leave very little room to fit your drill underneath and then your hand was blocking the suction, and it wouldn’t really have a great effect for that. So, then we looked at different intraoral devices and we ended up with Zyris’ Isolite. This product has been around for a long time and something I probably should have had 10 years ago. It’s not just for removing the aerosols. There’s a lot of great uses that we’ve found. So, every room is using the Zyris’ Isolite. The hygienists are using it in every treatment room and the doctors are using it with the patients.

I’ve tried in my own mouth and what I love about it is, one side is a bite block and allows the patient to bite down instead of forcing them to open. The most difficult part of a dental appointment is to have your mouth staying open for 45 minutes. This device allows them to bite down and the other side of the device is retracting the cheek, the tongue, and the tiny little holes are the high-speed suction devices eliminating most of the aerosol and most of the saliva. So, it’s controlling the splatter and the droplets. The droplets are what’s produced in the patient’s mouth without aerosol.

Rolando Mia:

Well, thank you for that. Really appreciate it.

Dr. Marc Sclafani:

Your system is amazing though. It’s really changed our practice.

Keeping Dental Hygienists Safe

Rolando Mia:

Now, you mentioned that your hygienists are all back and it doesn’t sound like there is any trepidation or there’s minimal fear. How did you get them there?

Dr. Marc Sclafani:

It’s a good question. Just like I said earlier, the Zoom chats has really helped them. The communication that we built with our team took the fear away from them. When we purchased the Isolite and we set it up, we did a live zoom with Zyris, and then went over how to use it with our staff. And we had these weekly meetings with our staff and we explained to them all the PPE equipment that we’re gathering for them.

They knew coming back to work that we had enough gowns, we had enough N95’s or KN95 masks. We had face shields, plenty of disposable equipment, and it’s been coming in on a regular basis to keep up with the demand for it. So, before everybody came to the office, they saw all this equipment before they saw any patients. We did a dry run, we had them all try on the equipment.

We also increased chair time. So, the hygienists who had an hour to clean someone’s mouth now have an hour and a half. They didn’t need the whole hour and a half, but we wanted to make sure they had 15 minutes prior where the room was sitting empty and 15 minutes after for the next patient.

There’s a lot more forms to fill out for patients. So, that took a lot more time for each patient coming into the room. We have COVID-19 forms they’re filling out for new patients and existing patients; we have their temperature taken before the visit and have an oximeter reading to check their oxygen levels. Even if they have to have two visits in a row, if they come in on a Monday and they have a second appointment on a Tuesday, this is still routine. So the only complaint I think I got from the hygienists is it’s hard at the end of the day wearing all the extra equipment. However, now that we’ve been into this for a 6-7 weeks now it’s almost back to normal.

Rolando Mia:

When you look at all of the things that you’re putting in place, you had to do research, I’d like to understand the course of your research, and then what led you to implement these tools. I love the fact that you’re basically synthesizing that information and then you’re applying it. What was research that was validated? What were things that you discovered that seemed to be a big issue at the time, but now are not? Is there anything like that?

Implementing Dental Tools Based on Science

Dr. Marc Sclafani:

Well, my partner Rob really helps out a lot with the research. So, whatever I think we should look into he will look it up three times over and make sure it’s perfect before we go to purchase an item. The the biggest thing we researched was the extra oral devices – there was really nothing proven that they work. So, I was really skeptical of ordering one of those extra oral devices.

The Isolite has been proven for a while. It’s been around for a while and it works. The same thing goes for when we did the research on air filtration system, we ended up with the Molekule unit, which has a HEPA and a UV filter in it. It’s mainly made for residential use. The ones that we researched on the medical end weren’t as proven and tested as to the degree that these molecule units were. Part of our research was speaking with different dental groups and different dentists. Asking them, “So what are you guys doing? What are you ordering at the beginning?”

Everything was sold out. Everybody was just running to go buy products without doing any research and they were making mistakes. They would be buying these big units and it’s in the corner of their room, not being used. I like to say everything we bought was implemented. We’re using these items every day.

Rolando Mia:

That’s awesome that you took the time to research rather than just knee jerk and grab everything. Let me ask you this, there’s a cost to all of this equipment. How has that affected your business and what, what fees, that type of stuff?

Dr. Marc Sclafani:

There is a cost, but I look at it as we had no choice, you know, just like the renovation we did here, we made it perfect to serve our patients. We weren’t cutting any corners because most of this truly comes before the patient. It’s my safety and my team’s safety – that comes first. That’s what most of these devices are doing. They’re cleaning the air. So it’s safe for me and my team. It’s not helping that patient that’s in the chair, currently. Rather, it’s helping the next patient that comes into the room. Right?

So, when a patient sits in the chair, the first thing is they’re rinsing peroxyl by Colgate. I’m not sure the exact percentage, but it’s a hydrogen peroxide and they’ll rinse for 30 seconds which will disrupt the bacteria in the mouth. After that, we’ll start treatment and that’s not helping the patient. It’s helping us. It’s helping the air the next patient.

Rolando Mia:

It looks like it’s working. There are studies, or at least information now coming out that although coronavirus cases are literally going through the roof in a lot of different states, new cases are not really coming out from the dental practices, how does that make you feel?

Dr. Marc Sclafani:

I feel like dentists have always gone above and beyond to protect themselves. Going back to any of the earlier viruses, I don’t know what went on in 1918, but SARS and anything later, and even AIDS originally, when that came out, people were afraid to go to the dentist. They thought they were going to get AIDS. Nothing’s being transmitted from the dental office. I mean, I actually feel on the safer here then I am at home. We still have those patients that aren’t coming in yet, and you’re going to get the nervous patients and they’ll wait until there’s a vaccine. It is the summer now. So a lot of that patients do take time off in the summer and are out of the city anyway. So those patients, aren’t going to rush back. They’re going to wait until September and October to come in.

Just this morning I had an emergency patient who call me and wants to come in but says, “I can come in any day, as long as it’s 8 o’clock in the morning. I want to be the first patient in the office.” So, I wasn’t going to argue with her. I scheduled it and she’ll be the first patient in the office. You’re going to get that certain amount of fear where people are afraid to come here that think they’ll come in contact with the virus by stepping outside the house.

Now, these patients are the same patients that haven’t been to an outdoor cafe yet. They haven’t been to a supermarket and they’re staying at home. So that type of fear, I understand it. It’s a lot with the elderly population. However, it’s really not affecting our business on a whole.

Rolando Mia:

That is cool. I love the fact that you’re working with your patients. You’re making the time for them. You’re doing literally everything you have to do. How is the relationship or what’s the communication with some of your referring dentists? What did you put in place for that and how has that been?

Communicating With Referring Dentists During the Pandemic

Dr. Marc Sclafani:

Well, we did a lot of consulting with our referring dentists and let them know what we’re doing to try to encourage them to take similar measures of what we’re doing for their offices. Most of them have taken the same proper precautions and bought similar equipment that we have. Naturally, if the patients come to me, they’re usually comfortable going to the specialist and I make sure that I kind of vetted specialist and make sure my patients are going to a clean office. That’s really important to me. There’s a lot of dentists that’s shut down because of this, that didn’t bring their office up to par or they’re older, and they’re concerned about getting sick themselves. So, we got a lot of new unattached patients from either previous dentist who retired, or just haven’t opened their offices yet.

Rolando Mia:

Do you find that there’s a lot of apprehension or do they tend to be less scared, most of the referrals?

Dr. Marc Sclafani:

Most of the referrals that I’m working with are on the same page that we are. We’re trying to have meetings with their team and are trying to make sure the team is functioning properly. I think that’s the biggest thing is to make sure your team is on the same page from your office manager to your assistants down to your hygienists. We have weekly meetings with all of them just to check in with them, make sure they’re okay. We just ask simple questions like, “Is there anything we’re doing wrong? Is there anything you’d like to see doing better? Is there anything that making you afraid to come to work?”  It’s just like how you and I are talking right now. Our team watches all this stuff and they love it.

Rolando Mia:

So, I’m curious, there are a lot of clinicians who have apprehension because there’s so much uncertainty. It seems like you’re one step ahead of the game. You were doing your research; you were validating things before you were buying them. Where did that come from? Was that just something that you guys came up with? How did you get into that kind of mindset?

Dr. Marc Sclafani:

I give Rob credit for that. Rob, my partner, has got some great leadership skills and I think that’s where we come together a lot. We’ve both done some business training together. We both have a coach that we share that we have weekly calls with and discuss all aspects of our business. Sometimes, we discuss each other. It really helps to collaborate with someone else and make this work. You know, I’d like to think I could do it myself. A lot of input came from my partner and together we help create this environment to make it safe for our patients and our staff. I keep saying the staff, because if the staff come first and then we create a great environment for our patients.

Rolando Mia:

That is so cool. So wait a minute, you’ve known each other for quite a while but recently you started working together. How’s that going?

Dr. Marc Sclafani:

So, I’ve been in this office practicing for about 12 years now. Rob and I are almost best friends. He’s a few years younger than me but we’re like best friends. We’ve been talking and collaborating for years and there was an opportunity for him to come to this space. We redesigned and we rebuilt the whole space together. We’ve been working on our business plans since then and have been trying to make this a better environment. You could see behind me, we branded ourselves. Once he came here, we called ourselves, One Manhattan Dental, and it’s been the rock show since then. We love it.

Rolando Mia:

Are you the same or different?

Making Decisions As a Dental Team For the Practice

Dr. Marc Sclafani:

There’s part of us that are exactly the same and, in some circumstances, we have differences. We kind of find a happy medium and it seems to always work. I think our coach is a big part of that. We make all the decisions together. So, we function as one practice instead of two different dental offices under one roof. And that’s the best part about this.

Rolando Mia:

Yeah, the dynamic seems so positive and there’s a vibe that’s going on. What do you attribute that to? Is it because the patients are coming back? Is there a feeling that you’re kind of sending? I mean, New York was the epicenter for a lot of cases, and it seems to have settled a bit. What do you attribute that to?

Dr. Marc Sclafani:

We both come love coming to work every day. We love taking care of our patients as best as we can. It’s a fun time when we’re working and the patients are in. We’re excited about it. We’re excited about doing big cases, working with our patients, working with our team. I personally don’t have any fear anymore. I’m protecting myself, wearing all my gear, and using my Isolite. I’m just reassuring my patients. Sometimes, you can’t be too casual cause we get in a comfort zone and the patients coming in are still nervous. However, we have a good way of relaxing from the first second they walk in the door.

Rolando Mia:

What advice that you would give other clinicians for things that you would tell them not to do? What would some of those things be?

Dr. Marc Sclafani:

Obviously, don’t panic and communicate with your team. Don’t separate yourself from your team. Don’t try to figure it all out yourself. You need to all work together and all be on the same page. the patient will sense if there’s any disarray or if you’re not doing things right. So, that’s my take on this is to work together with a team. I have spoken to other dentists, some of them too late, they’ve already closed their offices.

A lot of dentists came to us and had questions on where we were securing our devices. One thing that we bought was, we wear these crazy glasses with our light and googles, and they come out very far. Most of these disposable facial shields are too close, and I wasn’t able to adjust my light or my magnification.

So, we’ve designed these face shields that stick out quite a bit, and they allow us to still work with our light while sitting further away from a face. We had dentists call us about that. We helped this company design these and now are selling them on the internet and it really works. So certain things like that, that really helped.

Also, there were certain things where I got information from other dentists you know, the Isolite I knew about that years ago, and I didn’t realize it was wonderful. I thought it was just someone who didn’t have a dental assistant and they wanted to use that instead. But you need both, you need the dental system with suction, and you need the Isolite with the suction working at the same time.

Rolando Mia:

So, the sentiment or the feeling that I get is, although you’re taking this seriously, there’s a sense of calm that’s coming to the office because I mean, COVID-19 is real, right? You need to be really careful, but I’m not getting a sense of apprehension. I don’t feel the anxiety that, that I’ve heard from other folks.

Dr. Marc Sclafani:

Honestly, it’s not there. We have no anxiety coming to work. I feel that the patients feel the same way. You know, they may have a little anxiety when they enter the office, but by the time they leave and they see what we’ve done here, they’re much more relaxed, much calmer.

Rolando Mia:

Your team also seems to have that, “Ah, okay, this is good”, feeling. I think you mentioned you haven’t lost any of your teammates or the other doctors there?

Dr. Marc Sclafani:

We actually hired three new employees since this started. We’ve hired a new hygienist and we hired two new front desk employees. So yeah, there’s no fear. You know, when I think about it as, when you’re getting ready to put all your gear on, you’re like, “Oh, I forgot my shield, or I forgot this.” So that’s becoming more and more routine. Just like when you leave your house, now you grab your cell phone and you have to grab your face mask. You know, it’s another thing not to forget. So, it’s the same thing when we put our equipment on – you put your gowns on, you put your gloves on, and it’s becoming more routine.

Patient Screening and Communication

Rolando Mia:

Do you ever have any patients that refuse to put on a mask or are kind of resistant to you with regard to some of the screening that you’ve done?

Dr. Marc Sclafani:

Yeah. Some people will come in and say, “Oh, I’m fine. I just had my temperature taken”, and we’re still doing it anyway. However, when they come in the room, it’s actually the opposite, everybody comes in with a mask on. Some people are in the chair and they’re still not taking their mask off. I said, I need to look, I need to take a look at your teeth. But that’s it again, they come in maybe a little apprehensive, but they leave on a better note.

Rolando Mia:

I love the fact that there’s so much consistency and you’re literally going over the top with regard to the things that you’re doing and the way that you’re operating. That’s so cool. What is the message that you’d like to give to dentistry overall and what message would you want to give patients regarding going to the dentist?

Dr. Marc Sclafani:

Again, we have always gone above and beyond to do what’s best for ourselves and the patients. We’ve always had proper gear on, like masks. We’ve always worn a Level 3 mask to begin with. Now we’re wearing N95 masks with another mask on top of that. I want everybody to feel safe. I want everybody to feel like you’re not going to come into the dental office and pick up a disease, infection, or a virus that you didn’t already have.

Personally, I’ve been getting tested once a week and getting results within 12 hours. I like to reassure my patients that I’m clean and assure my staff and my family the same. I don’t think anybody needs to be fearful to come to the dentist. You’re doing more wrong for yourself if you don’t. A lot of people have missed their appointments. People have been almost a year without a cleaning and that’s do more harm for your body.

Rolando Mia:

What message do you give to your team, or what’s your perspective on what you’re doing now and how you want to move forward with this?

Dr. Marc Sclafani:

Yeah, my team knows that I’ve been very clear from since the shutdown with the communication. If they have any questions, we discuss them out in the open. They’ve also feel that it’s gotten a much easier. They’re a little hot at the end of the day and a little tired by wearing the disposable gowns but they’re not afraid of treating patients. They’re not concerned about getting sick. They have plenty of equipment to wear. Each assistant, hygienist, they all have their own N95 masks, several of them that they can rotate cause these masks can be reused. So, usually we let them breathe for a day and we rotate the masks that we’re using. So, my staff has been great since day one, really no questions and no concerns about their health at all.

Rolando Mia:

Cool. From your perspective, COVID-19 is not going to go away and there’s probably going to be something else that may be coming out here. What’s the approach or what’s the perspective that you have and how do you see this playing out over time?

The Future of Dentistry

Dr. Marc Sclafani:

I feel this is not the end of it. I think this is going to be around for a while. Even if we do come up with a vaccine, there will be those who will not want to take the shot or whatever there is for the vaccine. So, I think we’re going to be wearing the PPE equipment that we’re wearing now for a while, there could be something else that comes back in a year or two that could be larger than this. We’ll be prepared for it.

You know, I don’t think there’s anything else we could be doing now to be safer. As soon as things change and another virus comes about, we’ll be doing the exact same thing.

Rolando Mia:

Thank you. First of all, when I speak to you, when I speak to Dr. Rob, when I listened to what you’re doing, I feel reassured. People can sense or feel if you don’t feel comfortable. Everything that I hear, everything that I feel from both of you is confidence. I think that’s important. I mean, you’re the professional, you’re the dentist, you’re the ones I’m going to as a patient. If I’m coming in and you don’t have it down, then I’m going to feel it.

Dr. Marc Sclafani:

You know, a lot of the patients knew also before we opened it, we sent out a lot of emails just to communicate with our patients and let them know what we will implement new things in the office to make them feel safe from taking their temperatures, take into the filters, to the Isolites, to the new gowns, to the masks. The plexiglass that we had installed at the front desk. I had an art gallery make this beautiful plexiglass to separate the front desk from the patients so there’s no contact.

Everybody behind the front desk is wearing masks and the patients already knew all this before coming into the office, they expected it. They came in with less fear and less surprises. Everybody still has some concerns and fears, and there’s probably still people that won’t come back until we have a vaccine, but the majority of our people knew in advance that we created this environment for them. Anything new that comes up, we’ll research it and implement it if needed.

Rolando Mia:

I love it. If somebody had a question for you what would be the best way to contact you?

Dr. Marc Sclafani:

The best way to contact me would be through my Instagram, which is @drsclafani, or you can reach us through One Manhattan Dental. I’m here and we’d love to share anything we’ve done with any doctors or patients who have any questions about any of this.

Rolando Mia:

I would encourage people because it seems like you’ve worked through so many things and things are working for you and things are in place and they’re working. What final words would you like to kind of give to your viewers and the folks that are listening to us today?

Dr. Marc Sclafani:

Thank you for listening. Whoever is there today, please don’t have any fear. Any dentists are out there, you should be taking care of your patients, just like you have throughout your career. Patients don’t, don’t pass on your health. Make sure you take care of your teeth, just like the rest of your body. You’re going to be fine. We’re all going to get through this together.

Rolando Mia:

Well, first of all, thank you so much for joining. I really appreciate it. Take care.

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