Getting To Know Dental Loupes

When we visit a dental office, we often notice our dentist or hygienist wearing a seemingly weird device on their eyes. It looked like a binocular, making us wonder even more what they are used for. In the first place, we wonder what this instrument is called.

The weird-looking, binocular-like device our dentist or hygienist is wearing is called a dental loupe. Generally, a loupe is a small tool used to magnify or see details more closely. Compared to a magnifying glass, a loupe does not have a handle attached to it.


What features do dental loupes have?

There are varying types and brand of dental loupes. Here’s are some features that can be found in dental loupes:

  • A set of glasses (with prescription, if necessary)
  • Galilean or prism view which allows different field views
  • High magnification
  • A headlight
  • Custom-fitted for the dentist
  • High-resolution
  • Easy-to-operate
  • Lightweight
  • Can be flipped

What are the uses and importance of dental loupes?

Dental loupes are necessary for Dentistry. With the help of dental loupes, dentists can see the mouth and its parts clearly as they are magnified, ensuring that the procedure is done with accuracy and precision.

The inside of the mouth can also be dark, thus a dental loupe, having a flashlight attached to it, can shine a bit of light on the mouth and see the area well.

Cavities and other abnormalities of the oral cavity especially those unseen by the naked eye or are only beginning to develop can be detected with the help of dental loupes. Through this, early detection is a possible and immediate treatment to address the dental problem is done before the issue escalates.

Dental loupes also allow appropriate space between the dentist and the patient’s mouth. Using the device, dentists need not lean too close to see the inside of the mouth. Also, since dental loupes magnify the area, dentists have no choice but to move a bit away from the patient’s mouth, saving both from an uncomfortable encounter due to the proximity.

Dentists often need to bend their neck over to see the patient’s teeth, leading to 60 to 80 percent of dental professionals to suffer neck and back pain. Dental loupes lessen the bending.

With the use mentioned above and importance of dental loupes, the magnifying device benefits both the dentist and the patient.

Specific Tasks Where Dental Loupes Are Great For

  • Detect and fill a cavity-infected tooth
  • Look for tartar or calculus to remove
  • Flossing between the teeth
  • Root canal procedure
  • Checking a cracked tooth
  • Cleaning the gum line
  • Checking problems inside the mouth like areas requiring extra care, early signs of gum disease, discoloration of the teeth, oral sores, or abnormal patched on the gums and cheeks

Although not all dentist or dental professional subscribe to the use of dental loupes in their practice, the magnifying device is recommended to increase precision and avoid mistakes especially since the oral cavity is a sensitive region of the body. With dental loupes, procedures can be done more accurately, and details can be seen more clearly.

What Everybody Ought To Know About Dental Impressions

Dental treatments like crowns, bridges, and orthodontic treatments such as dental braces and Invisalign involve specific procedures to be completed.

A dental check-up and a consultation with your dentist are needed to identify the problem and craft the best treatment plan suitable for your needs and other considerations.

A dental X-ray may also follow depending on your case and the oral-related issue, as well as the needed treatment. And often, the first phase of a dental procedure will include taking dental impressions.


What is a dental impression?

A dental impression is a negative impress of the teeth, gums, surrounding tissues, and other components of the oral cavity.

Using the impression taken, a three-dimensional representation is created which in turn is used for different purposes including orthodontics, prosthodontics, maxillofacial prosthetics, dental crowns, dental bridges, and surgery on the mouth, face, or jaw.

A dental impression is also utilized for identification of oral diseases, mouth protector, trays for teeth whitening, and as a permanent record, or a documentation of a treatment process.


What are the different types of a dental impression?

A dental impression may be classified into three main types — preliminary, final, and bite registration.

Primary impressions are often used to create replicas for the documentation or dental arches, diagnosis, and to aid in dental education. On the one hand, final impressions are used in the creation of dies and casts which are used to construct bridges, crowns, dental prosthesis, and other dental repairs.

Bite registrations record the occlusal connection between dental arches. These registrations are necessary when establishing articulation of the lower and upper jaw.


What is used in making a dental impression?

Alginate, an irreversible hydrocolloid and a naturally-occurring polymer, is often used in creating dental impressions.

Alginate is a biomaterial made of brown seaweed and has been widely used in engineering and biomedical science because of its biocompatibility.


What is an impression tray?

To create an impression, an impression tray is needed to act as a container where the impression liquid is positioned. Once the material is on the tray, it will be set into the mouth.

An impression tray can be made of metal, plastic, or disposable Styrofoam in different sizes and for different areas of the mouth. It can also be drilled with a hole or holes.

How is a dental impression made?

First, the impression material will be poured into the tray which will be inserted into the mouth and placed onto the upper or lower teeth.

When the material has turned into a solid rubber mass, the tray will be taken out of the mouth.

Finally, the impression will be forwarded to a dental laboratory to be processed.


Dental impressions make me gag. Are there other options?

Dental hygienists Margaret Walsh and Michele Leonardi Darby have stipulated some guidelines for dentists and dental hygienists to follow to reduce gagging during dental impression taking in their work Dental Hygiene: Theory and Practice.

The guidelines include:

  • When taking a dental impression, keep the impression matter at a considerable distance from the tongue’s posterior third because this is where the gagging reflex is situated.
  • Direct the material’s flow at a distance from the soft palate.
  • Contain the impression material using a wax dam.
  • Avoid overfilling the impression tray.
  • When inserting the tray, make sure the patient is in a vertical position, head bent frontward with the chin leaning down.
  • Make patients do slow and deep breaths via their noses.

Aside from these guidelines, you can actually skip all the hassle of taking dental impressions that make you gag through digital impression system.

A digital impression system creates dental impressions using digital technology or computer. Several images of the area are taken using an intraoral scanner installed on the system which will then create a three-dimensional reproduction of the teeth or mouth.

The final image is e-mailed to a technician for the preparation of the cast and then sent to a laboratory which will generate the final model.


Aside from saving me from gagging, what are the other pros of a digital impression system?

A digital impression system saves you from extended dental visits and also reduced the error linked to traditional dental impressions.

Through this system, one-day dental procedures have become possible.

Get Your Dental Crown In One Day With CAD/CAM Technology

When you crack or chip your tooth, or wants to improve your discolored and weak tooth, your dentist may recommend treatments such as getting a dental crown.


What is a dental crown?

A type of dental restoration, a dental crown is placed over a tooth to cap or encircle the visible regions of the tooth which lies at and above the gum line.

A dental crown is used to shelter a weak tooth, restore a broken or’ damaged tooth, act as a support for a tooth with a large filling, preserve a dental bridge, cap a misshaped or discolored tooth or a dental implant.

Dental crowns can be produced from stainless steel, gold, porcelain, or resin. Among children, stainless steel crowns are considered the best choice, while gold or platinum-made crowns are more sturdy and can endure the biting and chewing pressure better than other types.


How is a dental crown procedure done?

The procedure usually takes two dental visits to be completed as it is divided into two phases — the check-up and preparation, and placement.

During your first visit, a check-up and X-ray are done. Other treatments may also be conducted depending on the condition of your teeth. If your tooth is extremely decayed, additional treatments may be done to ensure that the tooth is suitable for a dental crown procedure.

After an examination, an impression of the tooth is created. After two to three weeks, the crown will be available. During those weeks, a temporary crown will be placed over your prepared tooth to cover and protect it.

The second visit will be the placement of the crown.


I’m busy. Is there a faster way to get a crown?

Fortunately, Dentistry has improved that treatments and procedures which previously needed several dental visits and waiting periods can now be completed in one day with the help of CAD/CAM system.

CAD/CAM (Computer-Aided Design And Computer-Aided Manufacturing) Dentistry can complete dental procedures like digital impressions, full impressions, surgical guides, dentures, implant abutments, and orthodontic appliances.

The best thing about CAD/CAM system is it allowed same-day crowns, dentures, bridges, veneers, implants, among others because it readies the tooth and creates the restoration right in the dental office.


How does CAD/CAM work?

The system is made up of a computer system, milling unit, and a software. The computer system is composed of hardware for viewing and designing and a monitor, while the milling unit guides the machine involved in shaping the restoration. The software has the data or instructions processed by the computer system to produce the restoration,

When these three are put together, the patient can complete his or her treatment in a single visit and without needing to wear a temporary restoration.


What are the advantages and disadvantages of CAD/CAM system?

CAD/CAM system saves you time by only requiring a day of your time for an appointment. If taking dental impressions used to make you gag, you can finally say goodbye to the discomfort of impression-taking as CAD/CAM dentistry does not involve impression-taking that makes you gag.

There will be no provisional restorations, meaning no teeth sensitivity.

The drawback of this system is its cost, and despite involving only a single-day appointment, the appointment may take hours.

Steam Sterilization Also Be Widely Used In Modern Dentistry

Steam or autoclave sterilization is the most common method of instrument sterilization. Instruments are placed in a pack and exposed to steam under pressure. A sterilization indicator (required) such as autoclave tape or an indicator strip is used to identify which instrument packs have been sterilized.

Sterilization at first was accomplished with surgical instruments by astringents or fire, both of which were effective, yet full sterilization was not complete. Alcohol could kill certain forms of bacteria from essential surgical tools, but other harmful species lived on. Flame would also be detrimental to the tools itself, yet nearly full sterilization was accomplished. There still had to be a better way, a way that guaranteed complete sterilization.

The autoclave, or sterilizer, has been around as long as pressure cookers have. When it was realized that pressurized steam could kill off harmful organisms from items such as canning jars and their contents, the autoclave began to be realized. Pressurized steam can kill off any organism with in a very short time.

One Example: 1.8L Cassette Steam Autoclave Sterilizer Quick Sterilization KT-D-18


  1. Applications: quick sterilization for small type medical appliances used in dental practices, E.N.T and gynecology departments
  2. The shortest sterilization cycle only needs 6-7 minutes. Compared with the autoclave with a longer sterilization cycle, this quick autoclave prolongs the life time of the medical instruments relatively, because the cycle time of the sterilized instruments exposed to the high temperature steam is less.
  3. Three press buttons for different sterilization programs, the time and temperature can be set freely according to the users needs.
  4. Under the circumstances of unqualified water and water shortage, it gives an alarm signal and flashed on the display. It stops the sterilization cycle for the low temperature or low pressure during the sterilization process, displays and even prints the faults.
  5. Small dimension, light weight, wide ambient working condition, easy to operate. The cassette is also a good medical instruments container for temporary deposit and carry.


  1. After sterilization program selected and start key pressure, the steam generator heats to an optimum temperature, then certain volume of distilled waters pumped into the generator and immediately converted into steam.
  2. A wall of steam is injected into the cassette, which is loaded with contaminated instruments.
  3. As the steam courses through the cassette, the unclean and cold air stored in the cassette at the first beginning is wholly removed.


  • Dimensions: 570 x 415 x 170 mm (L x W x H)
  • Cassette external size: 390 x 196 x 40 mm (L x W x H)
  • Cassette internal size: 280 x 180 x 38 mm (L x W x H)
  • Reservoir volume: 3.4 L
  • Chamber volume: 1.8L
  • Max temperature: 138 ℃
  • Working temperature: 121 to 135 ℃ (selectable)
  • Water using: distilled water, pure water or ultra pure water
  • Electrical rating: 220VAC±10%, 50Hz, 6A
  • Net Weight: 29 kg
  • Printer: thermal type
  • Paper roll: width 57 mm, roll diameter 48 mm, approx. 180 cycles per roll
  • Print speed: 5 mm/s

The first autoclaves were stovetop models, affixed with valves and steam controls, along with a measuring system to get the right pressure and temperature. These primitive yet effective devices began the process of stopping infection in surgical procedures altogether. The steam was at 212 degrees Fahrenheit (100 degrees Celsius), and the pressure grew to about three atmospheres, so that organisms such as bacteria would simply burst and die and viruses would disintegrate.

The autoclave then began the process of streamlining. Simple electronics were introduced so regulate and monitor temperatures and pressure. The autoclave items are now wrapped in a temperature-sensitive paper, which changes color when sterilization is successful. Larger autoclaves were being developed in the 1960s, such that you could walk into them with the items needing to be cleaned.

This article was brought to you by Hawaii Family Dental – Hawaii’s premier dental practice. For more information, please visit their website here.

Small, Rural Hospital

Big News for Small and Rural Hospitals – CMS Notice Outlines Requirements to Obtain Increased Medicare

Reimbursement for FY 2013

The Department of Health and Human Services, Centers for Medicare and Medicaid Services  issued a notice on March 7, 2013 regarding its implementation of two provisions of the American Taxpayer Relief Act of 2012 (“ATRA”) that may significantly affect the reimbursement of smaller and rural hospitals for fiscal year 2013. (78 FR 14689) Specifically, this notice addresses actions that facilities qualifying for the low-volume hospitals payment adjustment or the Medicare Dependent Small Rural Hospital Program may have to take to receive increased reimbursement for FY 2013.

The Affordable Care Act provided for increased reimbursement of smaller and rural facilities under these two programs for FY 2011 and 2012.  With the end of FY 2012 on September 30, 2012, the increased reimbursement to these facilities expired.  However, with the enactment of ATRA on January 2, 2013 Congress retroactively funded a one year extension of these programs beginning October 1, 2012.

Low Volume Hospital Payment Adjustment

The low volume hospital payment adjustment may be very significant for smaller providers.  Under this program, a facility may receive a percentage increase of reimbursement based on a sliding scale  ranging from 25% for hospitals with fewer than 200 discharges to zero percent for facilities with greater than 1600 annual discharges.

To qualify for the Low Volume Hospital Payment  Adjustment program, a facility must have fewer than 1,600 discharges of individuals  entitled to or enrolled in benefits under Medicare Part A during the fiscal year, and be located more than 15 miles from another subsection (d) hospital.   A hospital that qualified for the low volume hospital status in FY 2012 may continue to receive the adjusted payment on FY 2013 without reapplying to the program, if it continues to meet the criterion based on the March 2012 update to the FY 2011 MedPAR data.  However, the hospital must verify in writing to its fiscal intermediary or MAC no later than March 22, 2013, that it continues to be more than 15 miles from any other subsection (d) hospital. Furthermore, hospitals that wish to participate in this program must also apply by March 22, 2013.

Medicare Dependent, Small Rural Hospital Program

ATRA also provides a one year extension to the Medicare Dependent Small Rural Hospital program (MDH).  As with the low volume hospital payment adjustment, this program was also set to expire at the end of FY 2012.  Hospitals that previously qualified for MDH status will be automatically reinstated as an MDH retroactively to October 1, 2012. However, since this program was set to expire on September 30, 2012 many facilities elected to apply for alternative programs. If a facility applied for the sole community program by August 31, 2012 and was approved, it will receive a SCH designation effective October 1, 2012, and will not receive an MDH designation unless the facility reapplies for this program. Additionally, if a facility missed the August 31, 2012 and subsequently applied for the SCH status with an effective date after October 1, 2012, the facility must  reapply for their MDH status, and such status will be effective 30 days from the date of approval.

Some facilities also requested to cancel their rural classification after the expiration of the MDH program.  For these facilities to re-qualify for the MDH program, they will be required to again request a rural designation and reapply for the MDH program. Therefore, any provider that that was reclassified as a SCH or canceled its rural designation status effective October 1, 2012 will not have its MDH status retroactively reinstated to October 1, 2012.

If you have any question regarding these Medicare programs or any other healthcare care regulation, please contact Clark Hill’s Health Care Practice Group at the information located on this page.

HIPAA Regulations - Healthcare Industry

Final HIPAA Regulations Issued: Provisions Regarding Business Associates, Penalties, Breach Notification Amended

On January 17, the Office of Civil Rights posted its omnibus Final Breach Notification Rule (the “Final Rule”), which modified many provisions of the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”). The Final Rule, set to be published in the Federal Register on January 25, sets forth new responsibilities for business associates and subcontractors, amends the Breach Notification Rule, adds to the notifications required to be included in the Notice of Privacy Practices, and adopts the tiered penalty provisions of the Interim Final Rule (released on August 24, 2009), among many other provisions.

The Final Rule is effective March 26, 2013 with compliance required by covered entities and business associates by September 23, 2013, unless otherwise provided in the Final Rule.

This blog entry summarizes some pertinent provisions of the Final Rule.

Liability of Business Associates and Subcontractors

Under the Final Rule, subcontractors and business associates may be directly liable for certain Privacy and Security Rule violations.  A “business associate” is a third party that a covered entity may engage to assist it in performing its covered services.  To be considered a business associate, the third party must create, receive, maintain or transmit Protected Health Information (“PHI”).  A “subcontractor” is a person to whom a business associate delegates a function, activity or service, other than in the capacity of a member of the workforce of such business associate, and also creates, receives, maintains or transmits PHI.  Consistent with the previous rule, covered entities must have written business associate agreements with their business associates.  Pursuant to the Final Rule, the definition of “business associate” has been extended to include subcontractors. Therefore, the requirements of business associates has extended to subcontractors.  Business associates must ensure that they have agreements with all subcontractors that comply with the new regulations.

Compliance Date for Revised Business Associate Agreements

The compliance date for revising business associate agreements (“BAAs”) to comply with the Final Rule is September 23, 2013.  However, an opportunity to grandfather in existing BAAs exists if the BAA complied with the HIPAA regulations and is not set to be renewed between January 25 and September 23 of this year.  If a BAA renews after September 23, 2013, the BAA must comply by the earlier of (a) the date of the BAA’s renewal, or (b) September 22, 2014.  Those BAAs renewing between January 25 and September 23, 2013 must be revised to comply with the Final Rule by September 23.

Notice of Privacy Practices

The Final Rule requires certain amendments to Notices of Privacy Practices (the “Notice”) and requires certain statements regarding uses and disclosures that require authorization.  For instance, one of the changes requires a statement indicating that most uses and disclosures of psychotherapy notes (where appropriate), uses and disclosures of PHI for marketing purposes, and disclosure that constitute a sale of PHI require authorization.

Individual’s Access to His/Her Own PHI

Upon an individual’s request to obtain an electronic copy of his/her own PHI, the covered entity must furnish the individual with access to the electronic information in the electronic form and format requested by the individual, if it is readily producible, or in a format as agreed to by the covered entity and the individual.

Breach Notification

The most significant changes in the Final Rule fall appear in the revisions to the Breach Notification Rule.  Most considerable is the revision within the Breach Notification Rule was to the definition of “breach”.  Whereas, prior to the Final Rule, a use or disclosure of PHI was presumed to be a breach if it posed a significant risk of financial, reputation or other harm to the individual, a use or disclosure of PHI is now presumed unless the covered entity or business associate, as applicable, demonstrates that there is a low probability that the PHI has been compromised.  In other words, the Final Rule demonstrates a shift from the subjective risk-of-harm standard to the objective low-probability-of-compromise standard.  The Final Rule sets forth a number of factors that must be considered in determining when performing a risk assessment and determining the probability that PHI has been compromised:

  • The nature and extent of the PHI involved, including the types of identifiers and the likelihood of re-identification of the information;
  • The unauthorized person who impermissibly used the PHI or to whom the disclosure was made;
    Whether the PHI was actually acquired or viewed or, alternatively, if only the opportunity existed for the information to be acquired or viewed; and
  • The Final Rule has also made a number of revisions to the notification obligations which arise upon discovery of the breach.

Tiered Penalties

The Final Rule adopted the tiered and increased civil monetary penalty structure to conform with HITECH.  The new penalty provisions are summarized in the following table:

While the foregoing is merely a summary of some of the major changes and provisions of the Final Rule, it is a reminder to all healthcare industry stakeholders that the healthcare regulatory environment continues to be dynamic and attention must be paid to new developments.  Since its release and during the next six months in which the industry has to comply with the Final Rule, Clark Hill’s healthcare attorneys have been, and will be, at the forefront of any new developments and will be available to assist new and existing clients with ensuring compliance with the new requirements.