The Power of Isolation: A Game Changer for Dental Teams

If you don't have extra people in your practice to help take the load, again, short staff members, team members, dental assistants, this might be the answer because everybody is looking for a dental assistant right now. Welcome to the Phil Klein Dental Podcast. Imagine this, your assistant is juggling a heavy salivator, a mouthful of water from high-speed drilling, a gagging patient motioning to sit up, all while trying to pass instruments and prep materials. It's stressful. It's messy. and it can impact both efficiency and outcomes. Now imagine there's a device that does the heavy lifting. It removes water, retracts soft tissue, and illuminates the field, all hands-free. That means your assistant can focus on everything else that makes your procedure smoother, faster, and more successful in the long run. Joining me today to talk about this game-changing side of dentistry is Shannon Pace Brinker. an internationally recognized dental assistant and educator who's trained tens of thousands of dental professionals on restorative techniques, digital workflows, impressions, veneer cementation, and of course, isolation. Today, we're going to explore how proper isolation can boost quality, efficiency, and teamwork in your practice. So stay tuned. This is one you won't want to miss. Before we bring in our guest, I do want to say that if you're enjoying these episodes and want to support the show, please follow us on Apple Podcasts or Spotify. You'll be the first to know about our new releases and our entire production team will really appreciate it. Shannon, thanks for joining us. Thank you for having me. I think most of our listeners of this show understand the significance of a dry field and good tissue management. So before we get into the details of some of the isolation techniques and devices that are out there today and the ones that you like to use, tell us from your perspective how improved isolation techniques directly impact the quality and longevity of restorative outcomes. Isolation is one of the single biggest, you know, predecessors of when we talk about restorative dentistry because, you know, adhesive dentistry is so unforgiving. And even a small amount of saliva that we know or moisture can compromise that bond. And leading to sensitivity, we've got staining, early failure. You know, when this field is completely isolated, you know, we're protecting that adhesive interface and, you know, maintaining bond strengths and really ensuring the restoration lasts a really long time. And I think this is where good isolation gives us control for contour, margin clarity, accuracy. At the end of the day, the dentist can see what's going on. And so can we as the dental assistant. So what do you say, Shannon, to a dentist who says, listen, I've been doing dentistry for 15 years. I use the rubber dam when needed. Most of the time I rely on cotton rolls, gauze. I have a great assistant who handles suction. She handles tissue retraction. I have good illumination. I don't really need any. extra devices in the office that i have to worry about or manage and i've had great success with what i've learned in dental school and i'm good to go what do you say to those dentists that say that yeah you know i don't want you to change what you're doing if it's working you know this is when we think about what is not working you know if this has worked for you forever for you to change you know i wouldn't expect you to um i i feel like you know When we look at cotton rolls, they have their place, they're quick, they're inexpensive, and they're great for short procedures. What we're finding is when we talk about isolation devices like the Isolite and the Dry Shield, this is where we've got this expanded function, the raising the level of assistance and what we can do now in various states. It is growing. I mean, it's growing leaps and bounds. And so now we've got assistants who are going to be working by themselves where cotton rolls is just not going to get it anymore. We've got to have better isolation. And again, but it's not something that we're looking for changing if it was already working for you. We're just trying to look at what can we do as assistants for those, again, who have more of a expanded function role, they may be doing restorative or that restorative assistant. We need to have something more than just cotton rolls because The doctor and the assistant work together when we're doing these procedures. But if I'm a restorative assistant, the doctor is going to prep and leave. And now I'm working by myself and I'm going to need help. And I feel like this is where we really got to get the word out and show that this is the type of situation where that isolate, again, or that dry shield is going to work so much better for that restorative assistant and the ones that are really changing the states and the duties of assistants that are coming. Yeah. And I think another point that needs to be made is that sometimes the dentist is stuck in that operation. by herself or himself because the staff person, the team member, was out ill that day. And they're short some people. And then now the dentist is doing this restorative work by him or herself. So the idea is, in your mind, because you have tremendous experience in dental assisting and forehand dentistry and everything else, you think it's important to have an isolation solution that should be hands-free, in your opinion. Absolutely. I mean, let's think about it. Right now, there's so many dental assistants, so many that are not certified too. We've got practices that have high demand for dental assistants and we just don't have them, right? We're looking for that diamond in the rough and we're all short. you know, short staff, I hate to say that, but we are, right? And so here's a way where I can place a device and still be able to work even with a brand new assistant who is not, we haven't got our dance yet. Maybe I'm new to your practice as your assistant. If I have an isolation device like this, where, you know, we can place it in the mouth, we can keep the teeth dry, but I can hand you instruments being new, not really knowing, you know, again, every procedure, it really frees me up. to hold more instruments and really train that assistant to not be scared. We've already taken care of the patient as far as suctioning, keeping things isolated. And now I can really function and focus on passing instruments and really getting my rhythm down from a doctor to a new assistant. It's the first thing I tell doctors who hire new team members, you should invest in and isolate because it's gonna take out that fear of I've gotta hold all these instruments, making sure I understand how the dentist works and keeping things isolated. So, you know, there's so many reasons why if you're having new assistants, and this is a big complaint from doctors is, well, they're not fast enough. They're not efficient. Well, doctor, they're brand new. They haven't even learned the steps and they don't even know how you work yet. It takes time for anybody, any dental assistant and doctor team to learn how each other works. And I think this is the first step because it's going to allow me to not have to worry as much about the isolation so I can focus on the right instruments, passing what the doctor needs and then keeping everything. nice and clean at the same time. Does this obviate the need for a rubber dam using this device? It really does. I'm going to tell you, we know statistically, and we just did a big course on rubber dam, less than 6% use rubber dam. So what's happening to the rest of that population is they're using cotton rolls and they may be using an isolation device of some sort. But when you think about something that would suction out the saliva, give you illumination also, and keep this area. clear debris as much as we possibly can, and I can still hold a lot of instruments at one time, it's going to make a big difference in the efficiency and how much time we're going to cut out on each receipt. Yeah, and we're going to talk about that efficiency in a minute. But when that survey was done, was that done with General Dennis? Because endodontists, as I am, retired, I used a rubber dam on every case. So I don't think that Isolite replaces endodontic use of a rubber dam, right? Absolutely. No, this was basically a sort of restorative procedure. Yes, restorative side. Absolutely. So when we're talking about efficiency and you mentioned, you've implied that there's a lot of efficiency built into using. a device like Isolite. It could be that, or there are probably other devices out there. What does that do for actually reducing chair-side time? What are we talking about here? Oh my gosh. I mean, there are some studies right now where we're showing that, you know, we can save probably 15 minutes, anywhere from eight to 15 minutes on average, which is, that's pretty crazy, you know, to save that much time. When you think about that, four, maybe four large restorative cases or four restorative cases throughout the day, that's a lot of time. And Shannon, what part of the procedure are we getting that reduction in time? I think just with the passing of the instruments, we videoed our team just really passing instruments after placing an Isolite. It was pretty amazing how fast they could just do a really, which would be a longer time span of restorative procedure, not have to hold so many things in their hands at one time and be able to just be very efficient with the next instrument and then the next instrument. And in your experience, Shannon, I know you have a lot of experience with Isolite. How do the patients typically deal with the comfort factor of having this device in their mouth during the procedure? The doctor isn't constantly stopping to ask for suction. That assistant isn't fighting the tongue and the cheeks. And listen, patients really and truly, as long as they know, one of the things that we did a little bit different is we let our patients know that we have devices like this that we really purchased for patient comfort to make sure there are patients. Because the biggest complaint that we hear a lot of times, even in hygiene, is because they feel like, oh my gosh, there's so much water coming out of our devices and they can't breathe. And so I think... This is where having something is constantly suctioning out the patient. And so we have little videos that we've made to showcase this. And this is something that, again, we let them know that it's not cheap. This is an investment that we made for patient comfort. What we find is patients really like to bite down on the bite block. And they can just kind of relax. They don't have to worry about if your tongue is in the wrong place. And a lot of times patients are just worried about us as clinicians. Are you able to see? Is my tongue in the way? And when they're numb, it's very hard. But most importantly, it reduces the stress. I think that is what we have to understand for the patient and the doctor. But the patient sometimes is very stressed out because they want to make sure they're doing a good job for us to be able to see and do our best work. That's what we've got to think about. So you're talking about visibility as one of the big issues here. Now, the Isolite has lighting built into it. Does that affect the curing aspect of composites, having that light be on? No, because they do have, you know, they've got several, first of all, they've got several different light modes. Now we can reduce the light or bring it up. And then also they have a mode where we can actually dim out that light and not have to worry about, you know, any setting times for cements or composites that we're utilizing because you basically just hit a little button and now we've blocked out that light. But we still have illumination, which is amazing. And we can still see and still does all the suction at the same time. But we have more control with the chair now. Now, with the new system, compared to the very first one that I ever had, I can add more light if we need to. I can dim it down. My doctor has lights on his lubes. So sometimes he'll like to illuminate the mouth a little bit more with the light. So I'll turn down my light inside the mouth. And then again, having that where we can turn the light and put a dimmer to where it doesn't set up the bonding resin is a great addition. But having different levels has really been a great change for us. So let's say, Shannon, I have three operatories in my practice. They're all equipped with the standard low-speed saliva ejector system. And I also have the HVE in each of these operatories. And then I order one of these isolates. How difficult is it to install? Do I need someone to come and install it? I can do it myself. How long does it take? I'm a big advocate for instructions because we know in dentistry, we don't read anything. If it doesn't have big photos, being an editor, if we don't have step-by-step photos, we're not going to read the writing. I'm going to tell you, they should win an award just for the instructions alone. And I mean that 100%. There's never been a piece of equipment, any device, any dental material I've ever opened up that has this kind of graphics and step-by-step what to do. So I time myself. And I literally set this up in seven minutes, seven minutes. In my ops, we have two HVEs. So we're kind of blessed with that. So this way I can hook up my isolate to one and still have a high volume suction. And if you don't, I just went on to, you know, Practicon is one of the places I go buy the split hose and I can do that. But seven minutes. And now I can go to every op. And listen, we don't have an isolate for every room, but we actually schedule it almost like a. So we know if we have two in my big office and we have seven restorative ops. So we'll basically move it around where we need it. And now we're contemplating on getting a third, but I can tell you seven minutes to set it up initially. Now that we know, we just unhook the hose really quickly and we can move from room to room. And seven minutes was the initial setup. And now we've got it down to, my gosh, maybe two and a half minutes if we need to move it. Yeah, so installation, you don't need a professional to come and install it. Now, what about sterilization? How do you sterilize this unit between... patients, especially if you're moving them from one up to the next. Absolutely. Well, the hose is just any HVE. Of course, we're going to flush it. You can wipe down everything. The disposable component that goes into the patient's mouth, different sizes for different patients, that's disposable. So you just take that off and throw it away with every patient, which makes it really nice. The downside is you really got to know how to measure patients. When they talk about the instructions of your hands in someone's mouth you got to measure it you know and there are times when patients won't open wide enough so i always go up a size up a little bit but you know just knowing how to measure the patient's mouth but again the more we use it the more we're going to be inclined to know what's going to fit certain patients. And now I don't order all the sizes. I just order two or three based upon our patient load and what we have. But I can tell you that it's pretty easy out of the gate. Once you start using it enough, you kind of can eyeball it and know about the sizes, but it's disposable. So you just take off the end, you trash it, and you would still just run your hoses like you normally do and just wipe that down. But by being disposable, it makes it super easy. We just toss it out after every patient. When it comes to larger particles, fragments of tooth structure, amalgam, restorative material like ceramics that... that are being removed and they chip into bigger pieces. The Isolite is not going to remove all that, right? You're still going to need HVE to get in there and remove the fragments, I assume. If I'm going to use it first, the doctor's using a high-speed handpiece with a lot of water. And so that's really what it's doing for me. Not only is it illuminating the mouth, but it's suctioning all the water at one time. So he can get in there, not heat up the tooth and use a lot more water. But I'm still going to use my HVE as double duty. If you don't have another HVE, attachment like you have two you said in each operatory but let's say you only have one and you hook up the isolate to that one you don't have another one to take out the large particles right right so well you would just get a splitter it has a split hose with it um and just depending on the the type of chair that you have uh it has a splitter so you're getting both so you still can use your hve um you just want to make sure that you and one of the things that you also can do is uh we took off the hose for the slav ejector and we have an adapter that will take that other HVE and it can be either or a Slava ejector or an HVE. And that is something that we did in one of our other rooms. And it cost us about 80 bucks for the adapter, but now we've got a larger hose for the HVE or we can use the HVE with the Slava ejector adapter. So you can get a split hose, a split adapter for each one of those. And that is something that I definitely recommend out of the gate. Again, it cost us 80 bucks, but it was worth it. So you teach a lot of... assistants. You're always teaching assistants, whether it's online or in person, and you draw a huge crowd. And one of the things that you talk about is moving away from being what you call just checked out while the doctor works. The assistant, I guess, you're talking about is typically holding suction, but they're not really engaged. So what does this do for the team as a whole in that operatory when you have a device that's hands-free? and it frees the assistant up to do other things, how does that re-engage the assistant in the whole process of restorative dentistry? I think what I would say is that when you think about utilizing isolation devices, I can focus on making sure that I am giving the doctor everything that they need. Our main concern always is going to be the patient. But for me, I can keep the area clean. I can make sure my doctor can see. I can really pay attention to the materials that we're utilizing, especially when we're doing bonding techniques. I mean, the last thing that you want a lot of times is for the patient to stop right in the middle and say, you know, suction, because everything that we use in dentistry tastes terrible. It does. It tastes terrible. And there's nothing that tastes good. And I'll tell you, I can't even think of how many times we were doing bonding, placing veneers, and the patient, as the doctor is doing the edge, A little bit on the tongue or the bonding agent or God forbid we're packing cord and using hemostasis materials. It tastes terrible. And we're right in the middle of a critical procedure. And the patient is telling me to suction, suction, suction. And I will tell you that this is a way for me to just... spray the patient off, you know, and not have to worry and it's going to suction at the same time, but get rid of that bad taste. And and I think that is something that again helps us with efficiency when we're more focused and again, not checked out. Some people think because we have an isolation device like isolate or or even a dry shield or anything else that we can just check out and go to sleep. I find that actually I'm more alert because I can do other things to make sure that I'm passing the correct instruments we're utilizing the right materials and i can stay on top of what's the next step as a great dental assistant we got to know the next step phil or we're not going to be efficient right no absolutely no let me ask you this about taste you mentioned that everything in dentistry tastes terrible and that's pretty much true there are some companies that brag about their fluoride varnish that tastes great and other things. But basically, you're right. Now, this particular device, though, by retracting the tongue in the way that it does, and given that the tongue is loaded with taste buds, do you think that having that tongue away from the treatment area using this device reduces the chance of the patient tasting something that is unpalatable? Oh, absolutely. Absolutely. But for me, you know, I think it goes back to the procedure itself, you know, not having to worry about the patient who's got to close every second. I mean, listen, there are times when doctors say, oh my God, we just, we need to use more rubber dam so we can get them to, to, to stop telling you to suction. Then we get aggravated. There's all kinds of memes out there of patients just saying suction, suction, suction. It's like, oh my God, really? But there are a lot of people who have a lot of, you know, sinus issues. They're worried they're swatting way too much. And we've got older equipment. We've got practices where they've got equipment that really should be. donated in the Smithsonian. Let's be honest, right? If you've got those old instrumentations, like we have an old Cavitron, I'm going to be honest, and it pours out water and I can hear my older patients just like gurgling, right? Yeah, they're gagging. And they also sit up more often. They have to actually sit up. I mean, that just kills your efficiency and productivity. It eats up a lot of time. And it's unfortunate that the patient is gagging and choking because that's a very bad patient experience. From the patient standpoint, we talked a lot about from the assistant standpoint. From the patient standpoint, you think having an isolation solution like the Isolite, what's another one that's out there like the Isolite? Well, there's a dry shield that got, you know, there's Mr. Thirsty that doesn't have a light. It's disposable from Zerg. I mean, there's a lot of really good ones out there. You know, the Isolite, the Isolite, the Dry Shield, the Isodry, you know, Mr. Thirsty. It doesn't matter to me what you're using. What I'm trying to do is trying to help cut down on the chair time. But for honestly, the main thing for me, why I think this is so important is the younger assistants, the new ones that are already so scared. They're going to make a mistake. They're beat up all day long about why they weren't fast enough. And I got to just right now, he's only had an assistant for three weeks and he is beating her up. And I said, hold up. You had a dental assistant with you prior to her for 15 years. She knew you better than your wife. You can't expect a new assistant out of the gate to know you and how you work. That's going to take six months. Right, except you're using Isolite in your office, right? Yes, absolutely. So that new person, isn't she benefiting? It's a woman you're talking about, the assistant. Absolutely. Yeah, isn't she benefiting from the Isolite where she has that easier, smoother transition into the workflow? Absolutely. This is another dentist who was complaining on Instagram. Oh, okay. So, okay. So that's, okay. That's where I didn't, I didn't hear that part. And everybody was beating him up. Everybody was beating him up. But some people were saying, oh, fire her, let her go, move on. And I was like, wait a minute, that's not fair. You know, you've got to give somebody time, but are you giving her the tools to help make her more efficient? And that was the first question that I asked is what do you use for isolation? Because if you invest in something. Even if it's not the Isolite and it's something disposable, it's better than nothing. So then they can maybe free their hands up to really focus on passing the right instruments and being more efficient. That was his biggest complaint was she wasn't fast enough. It changes the game in what the assistant is responsible for when you have something like that. When you have a hands-free suction and tissue retraction device working that illuminates, you're just making the work area so much more conducive for better dentistry. having to feel responsible to make that happen because the device does. And I'd be remiss if I didn't ask you what it costs to buy one of these units. We've talked a lot about the isolate. What does it actually cost to buy one? And I assume there's no installation fees because you can do it yourself rather quickly. So right now, let's just say Safeco. So the price for the isolate, the core, it's called the 890. It's the lower end. It's about $1,000. Okay. And you could buy it through any dental distributor? You really can. Any distributor carries this. So you can get a whole system for about $1,000 in that range? Yes, absolutely. All right. And then what about the bite blocks that are disposable that you need to replace? What are those costs? They're about $100 a box. But you can get them, like I said, a lot of times when you get the light, you're going to get... a lot of those boxes in the kit right it comes with i think like six or seven different boxes in the kit uh and so you've got a lot um in there um for me i i didn't like i said i wanted to make sure i knew exactly what size is out of the gate you've got to really look at the patient load and who are your patients we don't hardly see any kids so i'm never going to reorder the other ones i'm just going to continuously reorder the the the you know the medium the large size but i will tell you that you can get them as low as 49 You can find them, and sometimes I'll see them for $70 a box, $60 a box. I know Safeco has them sometimes for $45 a box. So you can find great deals. Sometimes they even run specials where you buy five, you get one free. The return on investment on this, tell us what you think that is. I mean, it's hard to tell, but it's a $1,000 investment, but you're saving, you say, on some procedures, 15 minutes chairside time. Right. So an average doctor usually thinks about their chair time is 500 an hour. At least that's what consultants will say. You at least got to make $500 an hour, let's say, you know, in a practice. So, but if you look at, you know, saving 15 minutes, 20 minutes on some of those lengthier procedures and you times that by, you know, how many patients a day would you see? Let's say you only saw six. That's 500 bucks. I mean, really, if you think about it, you know, if you. could just have one hour of time a day, think of how many hours that is a week, it pays for itself. And so I think this is where, you know, if you don't have extra people in your practice to help take the load, again, short staff members, team members, dental assistants, this might be the answer because everybody is looking for a dental assistant right now. There's definitely a shortage of help. Now, Isolite, for instance, you talked about a couple of companies, but Isolite. has been around a long time. I mean, I've been in dentistry forever and I've heard it isolate. Have they changed the model and the design of this device or is it so good that it's just the same old device that they've made? Not that there's anything wrong with it. Oh, no, no, it's changed. How has it changed? Well, the illumination dials are different now. We've got a split off and on so we can have it up on a higher suction. control the suction. Maybe I don't need a lot of suction. And sometimes it can be a little loud. Some people, you know, you want to kind of dim that suction down some. But it's pretty quiet. The light, I mean, having the different modes and the different lights, you know, you can go up several different, you know, degrees of light and then come down. And then also having the switch to change from, you know, not being able to do bonding because we're worried about our first generation. Now we can actually, you know, just hit the button. It's so easy to hit the button and make those changes that absolutely the pro is very different now than what we used to have. So it also now has, which is really great. And a lot of people don't even know this. It has an anterior component. So we used to always only having a posterior component. Now it's got an anterior component. So it fits right into the vestibule and we can do anterior restorations now, which is amazing because my doctor used to do a split dam technique for delivering veneers. And I actually took it to John Cranham. I was like, hey, you know, all these years we did split damn technique. Well, guess what? We don't have to do that anymore. You could just place the anterior. And he goes, she didn't even know they had an anterior. And I was like, I know. It's new and it's added to the Pro. That's why you really want the Pro. If you don't buy one, go to the Pro. What is the Pro cost versus the... Yeah, the Pro is about $2,000. So if you don't buy one, go out and buy the Pro because it's got all the different levels of lighting. It also has, again, you've got a choice of... posterior versus anterior. It's easier for me to connect, easier to clean. And again, just being able to control with something with just a touch of a button, you know, but it's so different than the initial isolate that we had originally. What about dental hygiene? How does this device help a dental hygienist given that dental hygienists work by themselves? Oh, listen, my very best friend is a hygienist, Lynn Atkinson. She actually teaches laser dentistry. She sits on the board of the Academy of Laser Dentistry. She will not work in a practice that doesn't have an isolate because she said, Shannon, we could never see. And she does a lot, again, using lasers. You know, they've got a lot of bleeding going on. You have to have isolation and suction. And she said, oh, my God, you know, blood's going everywhere, especially if you've got patients who we're doing this for, you know, scaling. and root planting. She says, how do we ever see before? She said, I've got loops, but it's the one thing to have loops, but you've got bleeding. You've got all these areas where we're trying to rinse and keep things clean. She will never, ever work. And I said, oh my gosh, I never thought about that with my hygienist until I saw Lynn's videos. And you just don't know until you see somebody videotaping their procedures. And listen, as soon as my hygienist saw that, they were like, can we get one of those? And as the host of this podcast program interviewing a lot of key opinion leaders, I often watch their videos just to get an idea of what they're doing so I can ask more intelligent questions, of course. And I often see the Isolite in their clinical videos, which shows that a lot of the key opinion leaders are using it. One of the things that surprised me, Shannon, in this episode is that you mentioned that only 6% of dentists use the rubber dam. I found that surprisingly low. It's very low. And listen, it's been that same number for years and years. Even just Google, even asking chat GPT, the numbers have not changed. I mean, so do you think Isolite, for instance, replaces the need for a rubber dam when it comes to adhesive dentistry? Here's what I think, you know, if you can start with this, at least getting some type of isolation is better than not. I'm always going to be a rubber dam girl, you know, but it also depends on the doctor and the time. You know, right now we're just cramming so many people on the schedule. There's no way that these practices, no matter how much we train assistants to place rubber dam and to be really efficient at it. no matter how much training i've done on rubber dam they're still not going to implement it it's going to be very few and far between this is the easiest implementation uh to help right now you know and i think that is one of the reasons why this has got to be out there because again no matter how much we train on rubber dam and uh it just still going to be the same number of people because we've got so much so many people we know you can't it's is it either one or the other are they mutually exclusive or can you use them together To me, it's either one or the other. Okay, so it's one or the other. Yeah, I assume that. Because when I did endodontics, we used a rubber dam, of course, but we had low speed suction underneath it. And then we had the assistant using an HVE system as well. When we did use water, it would build up on top of the rubber dam and my assistant would suction that off, including any large particles, of course. So I do want to thank you, Shannon. It's been a great discussion. What I do like about having you on the show is that you... Only talk about things that you truly love and have a passion for. And I know it was a very heavy, isolate-weighted episode, which is not typical where we do these episodes focusing on any one particular product. But I think the listeners get it. They understand what the point of this was, is that there are devices out there that provide hands-free isolation. That makes our assistance and our entire restorative process more efficient, saves us time. And certainly there's a good ROI on this. Hope to have you on future programs. And thank you so much, Shannon, for your time. Well, thank you very much too for having me. And thanks for letting me talk about my favorite subject, dental assistants, right, in isolation.