The Group Dentistry Now Show: The Voice Of The DSO Industry – Episode 27

The production of aerosols and spatter in dentistry is one of the biggest concerns regarding the spread of potentially infectious material among both dental professionals and their patients. Now, more than ever, infection prevention is at the forefront of all our minds! Tina Punton from Zirc Dental Products explains how there are simple ways to provide team members and patients with the reassurance that they can practice safe dentistry by mitigating risks. While no way exists to eliminate 100% of aerosols, studies have shown that use of HVE and HVE with an attached device cuts aerosol production by greater than 90%. A reduction in aerosols means a reduction in potentially infectious materials in the air, making a safer environment for both you and your patients. If you’re looking for a super simple solution to achieve isolation safety for your DSO or dental group, this podcast is for you!

Our podcast series brings you dental support and emerging dental group practice analysis, conversation, trends, news and events. Listen to leaders in the DSO and emerging dental group space talk about their challenges, successes, and the future of group dentistry.

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FULL TRANSCRIPT

Bill Neumann:

I’d like to welcome everyone to the Group Dentistry Now Show, I’m Bill Neumann, and really happy to have our next guest here, Tina Punton from Zirc. And I think you’re going to be really interested to hear what Tina has to say because Tina is an RDH and hygienists right now are very… Well, they’ve always been very important to dental practices, but I think right now, all of a sudden dental practices are realizing that they can’t operate without them. So we’re going to talk a little bit about how COVID has really changed the dynamic how hygienists, and even dental assistants to a degree, have played an important role that maybe wasn’t really thought as much about as it is now. So Tina, welcome to the Group Dentistry Now Show.

Tina Punton:

Thank you, Bill. Thank you for having me this morning.

Bill Neumann:

Sure. So I’ll give you a little background on Tina and then we’ll get into some of the Q&A. Tina is a graduate of Minnesota State University Mankato with a degree in dental hygiene. She has 20 years of experience as an RDH. She began her career working with a specialty practice, delivering care in periodontology, but found that she wanted to explore general dentistry and find out what that had to offer. She initially started out as a temp hygienist, and I think we’ll find out why that’s so important to really her experience and then also how that translates to working for Zirc and some of the products that Zirc has created.

Bill Neumann:

But she transitioned into general dentistry full time after being a temporary hygienist, she’s worked for a lot of different teams and organizations throughout her career, which has given her that insight we talked about. She’s a member of the Zirc team and she is an Account Executive focused on special markets and we can talk a little bit about what special markets means, because DSOs don’t realize that maybe it’s not just the DSOs, but you work beyond the DSO space and that gives you some insight as to what’s going on in dentistry, beyond group practice and DSOs. She really helps with the Zirc team from an organizational standpoint, and then some of the really unique products that Zirc has created from an aerosol management standpoint as well, we’re going to talk quite a bit about those. So again, thanks for being on the show today. And why don’t you tell us a little bit, Tina, about Zirc, the organization you work for now?

Tina Punton:

Yeah. Well, Thank again, bill for having me this morning, it’s definitely our pleasure to be with you. So to give you a little background information about Zirc, so Zirc dental product is actually a family-owned business and we’re located just right in Buffalo, Minnesota. We got our start about 53 years ago. And as a top rated product manufacturer, we actually provide global dental industry with niche and innovative products that help practices really save time. And it just helps dental teams become safe, happy, and more efficient, that is really our mission. So we’re a little bit unique in that we do have our in-house engineering department here that allows our teams to be hands on during the development of our new and our cutting edge dental products. And it also gives us that ability to just manufacture everything here right on site. So we proudly do develop and produce all of our products right here in Minnesota. So we’re very, very proud of that.

Bill Neumann:

Yeah. It’s very unique. It’s a great point. I mean, American-made, all made right there at the factory that you’re sitting in today.

Tina Punton:

Yeah, that’s correct. Yeah. So we recently did an expansion. So with each small business, we tend to grow over time, which has been wonderful. So we just did an additional expansion with our sales and marketing department and we are also doing an expansion within our manufacturing side. So in lieu of COVID, we definitely have been noticed with our large variety of our isolation products that we have to offer to dental teams. So our manufacturing production has significantly increased. We’ve added more machining and tooling and we actually went from operating like four days a week for manufacturing production to seven days a week and we’ve had to add three shifts. So it’s important for us, we pride ourselves on really getting our product to our end users in a very short period of time. So we wanted to be proactive and take the steps that we could to really increase our production so that those team members that were in need, those orders would be fulfilled.

Bill Neumann:

Well, that’s exciting. And I know I’m certainly been challenging for the DSOs, emerging groups, solo practitioners, and a lot of dental manufacturers as well when the practices were shut down. So we’ll get into some more detail about why you’re growing, what products and how they can really help DSOs in a variety of ways from patient safety, to making staff feel more safe and secure, hopefully bringing some staff back more quickly when they might be sitting on the sidelines.

Tina Punton:

Yeah.

Bill Neumann:

So let’s talk a little bit about your career as a hygienist. We went over the fact that you focused on specialty periodontology and then temped for a while, got to work for a bunch of different probably solo practitioners, dental organizations. So tell us a little bit about that?

Tina Punton:

Yeah, I’d be happy to. I actually worked as a dental hygienist for 23 years and I truly loved every aspect of my career, not only did it provide me the flexibility, but really I think when you ask most clinicians, it boils down to the relationships that you build with your colleagues and your patients. And it gave me that fulfillment of really being a part of a team that could deliver optimal oral care for my patients. So I did begin working in periodontology, which is kind of a big step for a new grad just walking out of school. But I think it really helped to launch my clinical skills and it also helped me to understand the challenges that patients encounter with periodontal disease. So I really think I had a lot of advantage by beginning there. But I too wanted to explore kind of what general dentistry had to offer and the different little operational approaches because there’s many out there. And so I did begin working for that temporary agency as well, and it opened the door to working with all these different sectors within the industry.

Bill Neumann:

Yeah, that’s certainly exciting. So you really started out focused on periodontology, which of course carries over into general dentistry. And I think the other thing that hygienists do so well because you spend so much time with the patients, you, in a lot of cases, have a better relationship than dentists do.

Tina Punton:

Exactly.

Bill Neumann:

And then you’re also there to really kind of check things out, find out what’s going on. And then to a degree there may be, I know, it’s a dirty word, but sales, right? So there’s some, “Hey, we see some issues here. We’ll talk to the doctor a little bit or the dentist but I think you may need this or this.” So it’s kind of interesting, I know my personal experience with my dentist is not much because my time is spent with the hygienists.

Tina Punton:

Right. That’s exactly it. Yeah. I mean, there’s a lot of times like those relationships, that’s what I mean, I get Christmas cards from more of my patients sometimes just because it is, you build that trust, that’s what it really boils down to. But, it was a time that I noticed, like when I was temping, just a common component really when I have been in a variety of sectors of dentistry and that offices that kind of have good communication and in some type of an organization, they really are much more fun to work with. There’s this feeling that I can’t explain, for some of the offices, it would feel like the wheels were about to fall off the bus because there was so much chaos or disorganization. So, in that term it was easy for me to decide, “I guess I’m not going to go back there,” or the team just wasn’t working well together.

Bill Neumann:

So, let’s talk a little bit about safety and practicing in the age of COVID and really hygienists are on the front lines, hygienist assistants, dentists, for sure. Let’s talk a little bit about that. What are you hearing? What are some of your peers telling you about practicing right now?

Tina Punton:

Yeah. So, it’s just been a short but long seven months since I’ve transitioned out of the clinical side and so as I’ve talked to my peers and the doctors that I’ve worked with, these teams are feeling overwhelmed. They’re busy navigating through all those new regulations and processes and not to mention all the layers of the PPE. But over and over, what I keep hearing is that their biggest concern really is safety for both themselves and their patients, that’s what it really boils down to. And I think most of us would really agree that dentistry been always prioritizing practicing safe dentistry. That’s always been our goal and we’ve always known that we work in an environment where there is that potential for the spread of disease, but we also follow those mandated guidelines that are set forth for us by CDC and OSHA and we really are able to provide those best practices.

Tina Punton:

So, I honestly can say I understand and have compassion for clinicians that had to really question whether they were ready to go back. But I think this will be similar to what we experienced in the ’80s, we will move beyond this crisis and we’ll reflect back on these changes to understand that, in fact, these additional layers of safety were really needed. And what I do know though is that this is a very resilient industry, really, and so it’s an essential part to our healthcare system and the overall health of our patients. So clients will come back and clinicians will come back and we’ll be even stronger. And the clinical team will be there waiting to provide that care because that’s really what’s in their heart.

Bill Neumann:

That’s great to hear. Do you feel that there are any hygienists, maybe, and assistants that are still waiting for things to get “better?” Is there that fear from maybe a certain percentage of the hygienist population that are compromised or fearful and so on? What is the impact that you’re seeing on dental practices?

Tina Punton:

Absolutely. I mean, it’s a valid concern and everyone has to look at their profession and assess that in a different manner. And I do think it is impacting the industry right now. You’ve heard or watched some of the podcasting and some of the social media sites and doctors and teams are concerned that, “I can’t run a full schedule right now because I don’t have my entire team back do so.” And being able to find the dental hygienists and the assistants that are wanting to come back has been compromised a little bit.

Bill Neumann:

I think initially a lot of people thought it would be the patients that would be the issue coming back and what I’m seeing, whether it’s on social media, is that patients for the most part are coming back, but they don’t have the staff in a lot of cases to handle it. So where they could be open five, six days a week to kind of get some of those patients that were not able to come in for their regular hygiene checkup during those three months or so that they were shut down, they can’t bring them in because they don’t have the staff to handle it. Which is really interesting.

Tina Punton:

Yeah. So, it’ll rebound, like I said, with time. When we had the incident with the HIV and AIDS in the ’80s, I think many clinicians that were practicing back then experienced very similar concerns. Sometimes we say, “We’ve always known there’s been 34 different viruses and bacteria and bloodborne pathogens that we’ve had to worry about and now there’s 35.” So, it’s going to take time. And that’s okay, it’ll happen.

Bill Neumann:

Well, that’s encouraging. That’s good. So you’re also a bit of a writer and you wrote an article for us back in May, and it was really wrapped around this whole conversation about safety. So dental aerosol and spatter, what precautions are you taking? And so you mentioned three products that Zirc has: Mr. Thirsty One-Step, Insta Dam and Pink Pedal in that article. Let’s talk a little bit about that. So isolation safety in dentistry, in general, talk about that, talk about the products that really lend themselves to, again, helping patients feel safe and then also this issue with the hygienists and some other staff.

Tina Punton:

Absolutely. So, I think commitment to safety really for Zirc has been ever enduring in terms of the regulations and the recommendations and we’re always looking for ways to develop a safer environment, really for the teams and their patients. And Zirc does have one of the largest lines of isolation products available. In fact, the three that you had mentioned was a combination of the three that we collaborated together to develop something called the protection pack. And it was something that was easy for clinical staff to have samples up to evaluate and to assess, “We know we need something, let’s do our due diligence and check what’s available.” And I think it’s important to understand too that no matter what your role is in the practice, it’s really difficult working alone and maintaining those optimal working fields, so it’s nice that we do have something for everyone.

Tina Punton:

As a hygienist though, personally, I actually began practicing before all the mandates of the high volume evacuation during aerosol generating procedures were needed and I used my ultrasonic scaler every day on every patient. So when that change came in 2003, to be honest, I despised it. It was really hard as a clinician to juggle all those many tasks at hand and adapt to a device that was really heavy to hold and it just really left me struggling with my ergonomics really. And so longterm, it was just very stressful on my body. So, it wasn’t until a little bit later in my career that I actually turned to one of our dental reps and I asked for their help and their service, if maybe they could get me some samples or direct me to some options, what else is available as far as isolation or hands-free devices? And that’s when I had to go to work and really research the product and looking at the pros and the cons for each device.

Tina Punton:

And it was my primary focus to really evaluate like a few concepts. My doctor wanted to know what’s the initial investment? It was important for me to understand the maintenance that was required on the devices. And then I also needed to make sure that there was the compliancy that met the rules of the CDC for high volume evacuation requirements. So I was thrilled when I discovered Mr. Thirsty One Step, I have to be honest. I used it in the later part of my career. It gave me that third hand that I was always looking for, so I didn’t have to constantly juggle things around. And it was just really easy to implement and I didn’t have to purchase any additional system for the product and it did provide that hands free evacuation isolation. It’s wonderful. The high volume that it has from both the front and the back of the device, I never felt like my patients were, we always say, drowning, so it is amazing. And it was easy, I could just attach it into the HVE line that I had right in my operatory and go. So it was great.

Tina Punton:

I think that most clinicians really they’re focused on their patients, they want their patients to be comfortable and they want their appointment to be pleasant and they want to get that Christmas card from them every year. So, it really allowed me as a hygienist just to be a little bit more efficient with my procedures. I did find that it would just provide a greater comfort for my patients with that little built in bite block that comes with it. And then I no longer had to sound like that broken record, “Can you please open a little bit wider?” And it let them relax a little bit more too. I think, I didn’t realize until I read a research paper that many patients actually have a fear of not being able to open wide enough for their clinician and things like that. So, it had been able to provide that as well.

Tina Punton:

And then for me, it was nice just because it is single use. I didn’t have to worry about added time for the reprocessing and following the manufacturer guidelines. And I did find that Zirc did a great job at making sure that all the guidelines for mitigating aerosols were achieved and I was able to really capture most of that aerosol and spatter before it even left my patient’s mouth. So it kept all of us safer.

Bill Neumann:

So, Mr. Thirsty is really the reason why you’re now operating, did you say seven days a week? Six days a week and three shifts?

Tina Punton:

That is correct. Yes. So just kind of circling back to, as a family-owned business, we pride ourselves on being able to get our products into the hands of the clinicians and provide that safety and the efficiency and overall happiness for them. So yes, we have had to. We’ve had some growing pains lately, but in a good way.

Bill Neumann:

Yeah, well, it’s understandable. And obviously these products were Pre=COVID, these were not born of COVID, but certainly very applicable now, more so than ever. The Insta Dam as well and Pink Pedal, tell us a little bit about those two products.

Tina Punton:

Sure. So Insta Dam is a wonderful product, Dentist’s that like to use isolation perhaps during a crown prep or the prep of a filling. The benefit of the Insta Dam is that it comes on a preformed frame already. So many times if you’ve ever had to have a rubber dam applied, and they’re not always the most comfortable, it’s got a big wire frame to it. So, the ease of placement of Insta Dam is probably one of the biggest benefits in addition to time savings. So most times if a doctor’s needing to isolate something mid procedure, they have to take an X-Ray. And so disassemble all of that, take it out, get an X-Ray in. And so with this, you don’t have to do that, you can simply kind of bend the device like a little taco, and then you can still take an X-Ray while leaving it in. So, it expedites the use of it and really mitigates the release of aerosols.

Bill Neumann:

Yeah. Excellent. And I, in a previous life, had to place dam on frames and it’s certainly something that is an acquired skill. So, if it alleviates that step, then that’s wonderful.

Tina Punton:

Yeah. So true.

Bill Neumann:

Yeah. Very good. So let’s talk a little bit about your experience, let’s go back to the beginning when you were temping. Let’s talk about efficiencies that you saw, some practices were probably a lot more efficient than others. So talk a little bit about your experience.

Tina Punton:

Yeah, absolutely. So, it’s a goal for all dental teams to have efficiency in their practices. It’s what’s what we all strive for and offices that didn’t really have systems in place, I would find were kind of just spinning circles, they were often running behind in their schedules probably less productive overall. And the team members just at the end of the day, you could just physically see their exhaustion and a lot of times their frustrations. So, it was just easy to see offices that had some type of management system and operation in place, it made it easy for someone like me to just hop in. I didn’t know where anything was, but if they used an instrument management system like Cassettes, I could help in sterilization and I was happy to help with the daunting task of reprocessing instruments that stack up throughout the day. So, like I said, the offices that were organized, little did I know they had colored trays and sometimes they’d have the cassettes and different accessories that would all match. And the assistant would be bringing like a tub back and forth into the operatories from sterilization. And what I didn’t know back then is that they were actually using Zirc products. So, it was interesting to learn and reflect back once I came to Zirc, I was like, “Oh, that’s what they used. That’s what they had. That was the solution.”

Bill Neumann:

Do you see more since you’re focused on special markets, and teased it a little bit earlier, but special markets, what does that actually mean?

Tina Punton:

Yeah, it really does encompass everything from multi-practice, so might be two to five practices that are all operating under a group of doctors that have collaborated together and then it can also range anything above that. So, I would say anything from the DSO and the group practice side is what I’m really striving to help. I think for them, it’s really important to understand how efficiency plays a critical, critical role in their overall production.

Bill Neumann:

So, what you see, do you see more groups or DSOs using this color coded Cassette system? Do you see adoption of it more so in a group, a DSO setting than a solo? Just what is your experience with that?

Tina Punton:

I think, to be honest, we’ve seen more adoption earlier in solo practice.

Bill Neumann:

Okay.

Tina Punton:

But I think as things are changing with the industry itself, we’re slowly starting to understand and see the exact same trend that we’re seeing as far as the number of solo practices, perhaps, changing a little bit and we have a bigger growth in this industry with the practices and DSOs. So, that’s what I’m here for, I’m here to help those groups, really.

Bill Neumann:

Yeah. Well, DSOs really like systems, this is a system. I could see it being something where an assistant is trained to use the system in the cassettes, the color coded cassettes, in one location and can easily go to the next location and it’s the same system.

Tina Punton:

Absolutely. Yeah. And that’s what it is, it’s their solution. Practices can obtain that organization efficiency through color and we call it the color method really, and it’s not rocket science, but there are two huge benefits that are provided to those dental teams. And the first really is the savings, the biggest pet peeve for doctors and clinicians is having to stop mid procedure because they have a missing material and get up and go find something. And even though those three minutes away at that point in time might not seem like a lot, over five times in a day you can add in another procedure of bleaching impression or delivery or something that also can add to more productivity.

Tina Punton:

And just as you mentioned too the training of new staff, we will have changes that are going to be coming because of this, new staff members are going to be implemented. So it really saves time. There’s a color coded chart that’s posted in multiple areas of the practice and it’s all very systematic and it does allow for those DSO and group practices to duplicate for multiple locations, so that those clinicians working in multiple sites don’t have the stress of going to the next location, “Where’s this stored? And where’s that material?” Those fine things really add up. And then of course… Oh, sorry.

Bill Neumann:

No, go ahead.

Tina Punton:

There second benefit really is just saving money, who doesn’t want to do that? Right now, we need to be looking at areas, “Where can we save money?” Obviously it’s been allocated and changed into all the additional expenses with PPE and so this is the exact spot, something that they can easily change to save money because there’s no excessive overstock of inventory in the operatories anymore, not to mention all the materials that sometimes get buried in the back of a corner of an operatory that will expire and get wasted. So that’s a lot of overheads. So, they don’t have to really take the time to pay the staff to manage a lot of that when they’re only restocking these procedure tubs once a week. So, it’s just greater efficiency really yields increased productivity, really.

Tina Punton:

We actually had a private study that was done by Aldridge Services. And they did this study because they saw a common factor between not only solo practices, but within group and DSOs that the lack of organization of all of their inventory really led to that greater overhead. So, that’s really an interesting article that they saw the need long before some people started looking into it.

Bill Neumann:

Yeah, back to your first point, I really didn’t think about this before because so I was so focused on talking about hygienists coming back, but as well as the assistant, you’re going to have new assistants coming into the practices that maybe don’t have any experience. And so this is one, to have this type of system in place, this organization just makes it easier for them to ramp up much quicker. And then, again, if they’re moving from location to location, there’s no difference, they have that similarity through the different practices.

Tina Punton:

Yes. And I think most clinical teams that work together will really help you to understand that dental assistants in the practice are like the glue, they are. They know the ins and the outs of working the schedule, working the system, they have to be extremely efficient for things to work well. And when you have an assistant that can manage all of that, you’ve got a win-win situation. So, really that color method, it’s easy for offices to implement, it’s a simple concept. They get to have some fun and pick different colors that depict each procedure that they provide in their clinic and then they look through and figure out how to manage all their instruments. Part of our program is that we do have these high quality resident cassettes and so they provide that efficiency. Everything’s right there, you know exactly which tools the doctor’s going to want for that specific procedure. And that just helps to really save on the instruments also, during that reprocessing to not have them all juggling around in an ultrasonic and it helps to dull things, so you can save money there.

Tina Punton:

And then safety, obviously, protecting the clinical staff from those potential sticks. And not to mention, patients right now are very much more aware, their perception of what’s happening in dental offices is very much been increased. I don’t think many patients could tell you what PPE stood for pre-COVID and now they know. So, it’s a great easy system, all that stuff that we talked about gets stored like kind of a flat B-Lock tray that has a clear cover and it locks. And so that allows that compliancy also for staff members. There’s guidelines from OSHA and CDC that really mandate the transportation of those instruments back and forth. And then the last component of that really was the tubs, which that’s what houses all the materials that are specific to each procedure. So, you kind of think of that is like your portable drawer that you really only have to now check and restock once a week, so that your operatories are now clear of all that clutter and it opens up those areas for storage of just disposable products that you’ll use on patients each day.

Bill Neumann:

Excellent. So, if anybody listening or watching this wants to find out more about how to start, “How do I get organized?” Where do they find the information?

Tina Punton:

Yeah, that’s a great question. So, they can actually go to our website or they can contact me directly as well. But Zirc has this free service and it’s called ZOBE and it stands for Zirc’s Organizational Box of Efficiencies. And it’s actually a complimentary service that we provide that really helps to assist teams with taking that next step towards the organization. And it can be baby steps, it doesn’t have to be jumping in all at once. We do find sometimes teams will start, they’ve had an inspection, they needed to mark compliancy off with locking trays and covers. But ZOBE really is just a box that we would send to offices that contains 30 of our most popular organizational items. I think it’s great because team members then can touch it and they can evaluate it and make sure and find what’s going to really work best for the practice because every practice is different. We don’t have two systems that go out the door that are the same. We really pride ourselves on customizing those for what the needs are for each practice.

Tina Punton:

And then here at Zirc we have what we call efficiency consultants. So, they all have clinical experiences and know really how to find the solutions for organizational problems, which is wonderful. So, not only can they talk the talk, but they can walk it because they’ve been there in their shoes. And then we just make it easy, we even put a return label in the box and once they’re done evaluating the products, they can send it back to us. So, it’s a simple step.

Bill Neumann:

Excellent. So, we’ll put up some information at the end of this on how to gain access to ZOBE.

Tina Punton:

Perfect.

Bill Neumann:

So, it sound sounds interesting and I love the fact that it’s customized for every dental practice. And every DSO, we always hear the, “When you’ve seen one DSO, you’ve seen one DSO.” So procedures are all different, the makeup, the staff is different, so they may want to organize things a little bit differently.

Tina Punton:

Absolutely.

Bill Neumann:

One last question, kind of sum up everything we talked about, what are some of the key takeaways from what we discussed? We talked a little bit about staff coming back or maybe slowly coming back, maybe it’s different staff that doesn’t have much experience coming back. And then we highlighted isolation and then also organizations. So, in closing, what do you want people to take away from this?

Tina Punton:

Yeah. I think really it’s just that safety is going to come first, Bill. And I think that it’s important for offices not to be afraid of change. It is a little bit, you find yourself struggling with, “Where do I start?” And I think your dental sales reps are there for a reason, they’re there to help service you. So, do what I did all those years ago and reach out and do your due diligence and do your research, but try a device like Mr. Thirsty or our Insta Dams because those isolation devices really can provide team members and patients with that reassurance that they can practice safe dentistry by mitigating those risks. And they’re super simple to implement.

Tina Punton:

So, I think also just adding efficiency that would follow. When you can use simple, easy operational systems that are in place, all your team members are motivated to work together towards one common goal and it really doesn’t take much product to get you organized. So, you’ll find that that process just really delivers immediate and quantifiable return on your investment. And I think if I had to sum it up in one last verbiage is I think that dental practices, really, if you think of it as an equation, if you have safety plus efficiency, ultimately you will have happiness and not only from your staff members, but also patients alike. They notice, they’re paying attention.

Bill Neumann:

More so than ever, for sure.

Tina Punton:

Absolutely.

Bill Neumann:

Well, great Tina. Tina Punton, Thank you very much for joining us, some great information on safety and organization and just what’s currently going on with hygienists and assistants and staffing. We’re going to have some contact information at the end of this, so if you want to reach out to Tina directly at TinaP@zirc.com. So again, thanks for joining us. Thanks everybody for listening and watching. I’m Bill Neumann and, until next time, this is the Group Dentistry Now Show.