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Cutting Edge – Trouble in Paradise

Do you have a fully outfitted “dental go-bag” that can help your practice (and your staff) immediately when disaster strikes?

By Howard Strassler, DMD

THE NEWS THIS past summer and early autumn was dominated by Mother Nature, which is seldom a good thing. The epic triple punch landed by Hurricanes Harvey, Irma and Maria (see “Wake of the Flood” elsewhere in this issue) exacted a colossal toll on the people of Texas, Florida, Puerto Rico and more. Throw in a big earthquake in Mexico and the devastating wildfires in Northern California, and vast swaths of North America and environs have been battered over a period of just months.

Disasters, natural or otherwise, always prompt clarion calls for better preparedness next time. Of course no one can ever be considered truly ready to face events of the scale we’ve been seeing, but the plans you’ve made (or haven’t made) beforehand will help determine how quickly you recover and continue — albeit with an altered sense of normalcy.

The aftermath of events like these is often just as cruel as the initial blow, with blackouts, fires, flooding and more taking a further toll. All of it will have an impact on how you and your practice move forward — which in turn has a profound effect on your patients (who need their dental care) and your staff (who depend on their earnings). What local, state and federal financial resources exist for you and your team in such situations? Can any of you afford significant displacement for even a short time?

More questions abound. Think of the devastation of major resort areas in the Caribbean: How long until tourists return? Will islanders who left to seek other employment ever come back? The loss of property and the pressing need to rebuild underscores just how much a lack of skilled laborers — carpenters, plumbers, electricians — can affect recovery as well.

One important way to ensure preparedness, at least in the short or medium term, is a professional version of the personal emergency kit — what I call a “dental go-bag” for your practice. If you’ve been a dentist for decades, this might be old hat to you. Perhaps you’ve already experienced losses ranging from the relatively minor to the substantial. A friend of mine once had his practice mostly ruined by a burst pipe in the office above that took down his ceiling. He had to work out of a temporary facility for three months while the usual parties — insurance adjusters, contractors — put the pieces back together. (My own practice in Maryland has been mostly spared, knock on some wooden teeth. Minor weather events that don’t affect the office but set my schedule back a few days is about as bad as it’s gotten.)

A major catastrophe — one that turns your practice upside down — is of course a far different animal. Dentists in Texas, Florida and Puerto Rico had to contend with flooding and wind damage, as well as disruption to utility services and supply chains for delivery of essentials such as food and water. The hardest-hit practices are now gone. How quickly can they relocate and reopen? Are their patients still in the area? Did their patient records survive the cataclysm? Few cell towers were immediately functional; a cash-only economy was suddenly the sole option.

Again, no one can ever be fully prepared. But planning ahead with your family and staff can make a big difference. One enormous help: “Emergency Planning & Disaster Recovery in the Dental Office,” a 47-page practice-continuity guide, put together by the American Dental Association, downloadable as a PDF. It’s a comprehensive guide to an array of emergencies you might never even consider: terrorism and bioterrorism, hostage situations, chemical spills, cybercrimes, unsanitary water — the full panoply of horrors. Kudos to the ADA, which has really done its homework here. (Similar publications can be found at ready.gov and fema.gov; all are useful, if not as dentally minded.)

Download the ADA guide, print off enough copies for your entire staff and devote at least one all-hands meeting to discussing it. “In many cases,” the organization observes, “without good planning a survivable disaster that closes down a practice closes too many of them permanently.” Wise words.

One final piece of advice: Paperless offices are well and good, but have a set of hard-copy backup records for your practice. I’m no Luddite, far from it, but there’s a reason the Gutenberg Bible is still around. For minor disruptions, forethought and backup materials will be invaluable. For major events — the sort of chaos caused by one of this summer’s disasters — they might be the difference between closing for good and living to drill another day.

HOWARD STRASSLER, DMD is a professor and the director of operative dentistry at the University of Maryland School of Dentistry. He practices in Pikesville, Maryland.

Hints From Howard

The White Stuff

BLEACHING HAS long been the go-to recommendation for minimally invasive tooth whitening. There are, however, some aesthetic defects that are resistant to bleaching — hypocalcification of the enamel most commonly. In such cases, another treatment might be more suitable to treat the developmental defects that cause unsightly tooth discoloration.

For a patient who complains that his or her teeth are too yellow or too dark, a bit of whitening with a peroxide product — one-hour bleaching, tray bleaching or bleaching strips available over the counter — will typically provide an acceptable result. When teeth have developmental discolorations such as fluorosis or hypoplastic enamel, in which the teeth look brown or mottled, bleaching might not work.

In such instances, a dentist might try a technique called microabrasion, as described by Ted Croll, who (literally) wrote the book on the topic. It involves removing superficially discolored enamel using a weak hydrochloric acid-silica paste. Studies have shown this is minimally invasive, effective and long-lasting.

Another novel method of treating hypomineralizations, Icon (DMG America), uses a hydrochloric acid etch of the enamel in the discolored areas, followed by resin infiltration. This changes the appearance of teeth by permitting light to transmit through enamel, enhancing its opalescence.

Learn more about non-bleach whitening options in my new Hints From Howard presentation. Please visit bit.ly/2y6Rq7A to get started.