You Can’t Live Without Them, So What’s The Next Best Thing?

While there’s no way around using handpieces during this pandemic, some may be better than others in terms of potentially mitigating risk. If you haven’t taken a close look at handpieces in a while, here’s a refresher on what to look for.

There’s no such thing as a “miracle” handpiece that generates zero aerosols. However, there are many options in terms of choosing the next best thing, which are handpieces that meet your clinical needs while reducing aerosol generation and the possibility for cross contamination as much as practically possible. Let’s quickly review some features and performance characteristics that make the most sense in terms of we know about reducing the risk of Covid-19 transmission.

A One-Two Punch Against Aerosols and Cross Contamination

Even if you know what the terms ‘anti-suck back’ and ‘anti-retraction’ mean, you might not realize how important their implications are in our current environment.

The issue of suck back first came to dentistry’s attention back in the 1990s. It became clear that air-driven handpieces were capable of transferring microbes from one patient to the next. That’s because, when air flow is interrupted for braking bur rotation, negative pressure can be created that can “suck back” fluids and debris into the handpiece’s air lines. This problem has been addressed by incorporating anti-suck back systems into well-engineered handpieces by reputable manufacturers. 

Not all handpieces incorporate anti-suck back technology. In fact, if you count in all of the cheap, no-name handpieces being sold through auction sites and questionable vendors, probably most of the handpieces worldwide don’t have anti-suck back features. The problem, of course, is that aerosols, fluids and debris that are sucked deep into the handpiece are more difficult to reach and properly sanitize. If the handpiece isn’t properly sanitized, the next time it’s used you’re exposing the patient, yourself and team to potentially dangerous aerosol.

Another safeguard is the use of an anti-retraction valve in couplers and micromotors to prevent water from being drawn back into the dental unit’s hose and water block. Since the hose, water block and valves are not sterilized, contamination presents a huge problem—but only if it occurs in the first place. Anti-retraction technology prevents this from happening, but once again, the higher quality the product, the more effective it is likely to be. 

It is important to note that dental units are required to have anti-retraction features, commonly known as duckbill valves, one-way valves, backflow valves and other names. However, handpieces are not required to have these features. Despite that, the very best handpieces do have anti-retraction built into the handpiece or coupler. Why? It acts as a backup. If the valves built into dental units begin to fail before a malfunction is able to be identified, the valve in the handpiece or coupler acts as a backup parachute of sorts.

An Ideal Time To Think About How Performance Also Impacts Your Safety

Clearly, if your handpieces don’t incorporate anti-suck back and anti-retraction features, you’re increasing the risk of cross contamination. That being said, it’s being reported that infectious disease experts now believe the length of exposure to Covid-19 and the amount of exposure are key factors in disease transmission. The risk would therefore appear to increase the longer you’re actually using your handpiece.

A solution would therefore be to use the highest-performance handpieces (and burs) possible. Doing so means completing procedures in the least amount of time, with the least amount of effort, and with the best clinical result which lessens the possibility that retreatment is necessary. Investing in high-quality, high-performance handpieces generally ensures you’re getting the benefits of not only anti-suck back and anti-retraction features, but also the ability to do faster dentistry that reduces the amount of time you could be exposed to Covid-19. Since dentistry is more time-consuming today, completing procedures faster contributes to meeting production goals as well, which is a welcome side benefit.

The Case For Investing In Quality and Safety

Obviously, low-quality handpieces offer none of the safety and performance advantages we’ve described. They don’t safeguard patients and your team, they don’t allow you to complete procedures as efficiently as possible, and they also may harbor microbes deep inside the handpiece that cannot be effectively neutralized through sterilization. Pre-Covid, we’d simply remind you that they cost you more money in the long run than they save you upfront. Now, however, they add a potential danger factor that cannot be ignored. It’s more important than ever to buy known brands from reputable dealers. High-quality handpieces last longer, perform better, can be relied on for peace of mind and are backed by their manufacturers for longer.

What Else You Can Do

As far as we know, aerosols are our biggest threat right now when it comes to Covid-19, and handpieces play an unavoidable part in generating them. However, in addition to choosing handpieces that address Covid concerns, there are other ways you can potentially ramp up your safety, like:

• Screening patients and doing reduced-contact check ins with stress-avoiding technology like OperaDDS

• Having patients rinse with a hydrogen peroxide or povidone-iodine solution before procedures

• Using dental dams to reduce airborne particles

• Considering the use of chairside extraoral suction

• Implementing enhanced air quality technology

Bottom Line

Benco Dental only sells handpieces by brands we know and trust, from our own Sterling line to exceptional names like NSK, Dentsply, KaVo and more. Now is the time to consider replacing your handpieces if they don’t meet the standards for today’s crisis. Look for the features we described as you browse the latest models in this issue of Big Big Deals. If you have any questions, be sure and reach out to your Friendly Benco Rep for help and answers. At a time like this, when it seems like everything is a little more complicated, choosing handpieces doesn’t have to be.

DENTISTING DURING CORONAVIRUS Part 3: Interview with Dr. Betsy Carmack

In our third installment of this new series, we’ll be asking questions and getting first-person perspectives on what it’s like so far to practice amid the pandemic. Every region, every practice, every practitioner has unique stories so we’re chronicling them here to give you an up-close and personal look at challenges, solutions and inspiring moments across the country.

Dr. Betsy Carmack is one half of a husband-wife dental team along with Dr. Tyler Carmack. The dynamic duo from Bennington Dental Center (and three other office locations) in Vermont are also current members of Incisal Edge magazine’s 40 Under 40 spotlighting the best, most innovative, most interesting young dentists in America. She’s also a mother of three, champion bodybuilder, and former International Medical Missions Coordinator for Operation Smile.

Q: When did you reopen your practice?

A: Officially, we opened in June. We did see emergencies throughout the period, but we weren’t officially open until June 1.

Q: What has been the biggest challenge so far?

A: Educating ourselves on the new recommendations and protocols, figuring out how to implement them, and coming up with a new protocol manual was challenging for us. I wrote a whole new, 10-page manual that encompassed the new guidelines. Trying to ascertain and find supplies that were not counterfeit was extremely difficult. It took a lot of strategic networking to order things with the hope they would arrive on time. It almost felt like a game show. It took a lot of resources and reading and things are still changing. One week, a circumstance could be okay and then the next week things could change. It’s like ‘Survivor.’ Some situations would change and you have to adapt to the new situation.

Q: How have the changes in PPE affected your ability to practice?

A: It’s been a learning process and a learning curve with the new material. It’s like training for the army…you have to wear all the gear and the uniform and you start running the race. It’s very heavy and hard to breathe. You have a full headlamp, you have your loupes, you have your shield on top of that. We have air filtration units for each operatory as well so you’re shouting through the mask and the shield and the air filtration unit through the suction to the patients hoping they can hear you. We have started doing virtual consultations as an additive to patient communication. It’s more difficult now to have meaningful conversations when you can’t hear or understand or see the doctor. It can be challenging when you have all the PPE on to convey different options to patients.

Q: How has the experience been with patients? Has it been difficult to encourage patients to come into the office?

A: I have found that most patients are eager to come back to routine care. A lot of patients were hesitant to reach out earlier during Covid in fear that they were not in pain. It wasn’t a dental emergency, but it was still a bother to them. Things are going to ebb and flow, but the majority of patients are happy to be back. I don’t sense a huge fear factor. Being in rural Vermont, the caseload is extremely low, and the patient is very safe in terms of what we’ve put in place as protective for patients and staff.

Q: Have you encountered any challenges with staff members?

A: Honestly, I think there was an underlying anxiety everyone felt from what the news publicized. Going into any new challenge is going to be intimidating when you are not used to something, but our staff has really been fantastic. After the first week, they settled in very well. You get headaches, it’s hard to breathe, your personal comfort is not as high as it was prior to Covid but luckily, all of our staff really like what they do. They miss the patient and personal interaction and they’ve been excited to come back.

Q: Will dentistry ever return to what it was like pre-Covid? Should it? Or are the new precautions justified even in a world with a vaccine?

A: I don’t foresee this ending or the regulations changing in the near future. The standard of care in dentistry has always included advanced infection control regulations and if anything, COVID has given dentistry the opportunity to revisit those guidelines. We all joke “I feel safer at work than going to the grocery store” because we’re screening patients, we do temperature checks, we’re allowed to question them and we have full protective gear on. I think it might be the new normal. Dentists fall into this interesting category where we can’t make any other income. A lot of dentists have reached a certain point and they said, I’ve been building my practice my whole life and rather than lose my home and my whole life I would rather start working again. The risks for young dentists are much lower and we’re not going to lose our livelihoods over that.

Second Time Around For The Families First Act

Now that practices are getting back to work, the Families First Coronavirus Response Act is once again relevant and deserving of a reexamination to find out exactly what it means for your practice. Most dental practices were forced to shut down prior to the FFCRA going into effect, so many have not had to comply with this new rule until now. It’s likely some offices have employees who qualify for paid sick leave under the terms of this act, and Benco Dental’s financial planning partners at Cain Watters & Associates are here to help offer clarity and direction to owners who may find themselves impacted. Let’s start with a refresher.

What It Is, How It Works

Beginning in early March, the Department of Labor’s Wage and Hour Division enacted the new Families First Coronavirus Response Act (FFCRA). Effective through December 31, 2020, the legislation outlines new requirements for paid leave for both employers and employees.

The FFCRA details that employees are entitled to paid sick leave if experiencing issues related to Covid-19. An employee is eligible for up to two weeks (80 hours) of paid leave at the regular rate of pay or the applicable minimum wage (whichever is higher) when quarantining per order of government or health care provider or when seeking a medical diagnosis for Covid-19 symptoms.

If an employee is unable to work out of a need to care for an ill individual that has been quarantined or to care for a child (under 18 years old) whose school is closed or childcare provider is inaccessible due to Covid-19; the employee qualifies for paid sick leave at two-thirds the regular rate of pay. Employees experiencing extended issues related to childcare can receive an additional 10-week paid expanded family and medical leave at two-thirds pay or two-thirds the applicable minimum wage (whichever is higher). However, businesses smaller than 50 employees may be exempt from providing leave due to school closings or childcare if the leave would “jeopardize the viability of the business as a going concern.”

Employer Credit

Aside from paid sick leave, the FFCRA provides a refundable credit to employers who are required to pay out either qualifying sick pay or leave pay.  The credits taken on the federal quarterly payroll tax returns are dollar-for-dollar and correspond with the paid leave requirements.


In most situations, under the leave pay rules (FMLEA), a small business is exempt from certain paid sick leave and expanded family and medical leave requirements if the employer employs fewer than 50 employees. Practices under 50 employees should claim this exemption, as requiring to pay leave pay for 10 weeks would materially impact practice operations and financial health, according to Cain Watters. However, note that some practices under 50 employees would still not likely qualify for the exemption – and that’s when you especially need expert advice.

Webinar: PPPFA and PPCRA Strategies For Business Owners

If this sounds like it’s getting complicated fast, relax. Cain Watters has a free webinar that helps break down all of this to help you navigate the rules and maximize loan forgiveness, including:

• Changes with the Paycheck Protection Program Flexibility Act

• HR issues with doctor or employee Covid-19 diagnosis

• Application of the Family First Coronavirus Response Act with reopening

Watch it here, or visit Cain Watters & Associates for this and even more helpful resources.

DENTISTING DURING CORONAVIRUS Part 2: Interview with Dr. Dave Monokian

In our second installment of this new series, we’ll be asking questions and getting first-person perspectives on what it’s like so far to practice amid the pandemic. Every region, every practice, every practitioner has unique stories so we’re chronicling them here to give you an up-close and personal look at challenges, solutions and inspiring moments across the country.

Dr. Dave Monokian, or “Dr. Dave” to his patients, has been surrounded by dentistry his entire life. In 2005, he became a partner and cosmetic dentist at Monokian Family & Cosmetic Dentistry with locations in Marlton and Haddonfield, New Jersey. Dr. Monokian graduated from New York University College of Dentistry and now serves as the President of the Southern Dental Society of New Jersey.

Q: When did you reopen your practice?

A: We officially closed down Monday, March 16th and we opened Tuesday, June 2nd.

Q: What has been the biggest challenge so far?

A: Prior to closing, we had a full schedule between dentists and hygienists. We had to cancel those appointments for the three months we were closed. When we opened again, there were emergency patients who called and the people who had appointments cancelled from March that wanted to reschedule on top of people who had scheduled six months before June. There just aren’t enough hours in the day or days in the week to see every patient. Making sure we’re staying equipped and have all of the right equipment for all of our employees despite the nationwide PPE shortage has been a huge challenge. And just coordinating the schedule — we can’t see nearly as many patients as we used to because of social distancing, trying to stagger appointment times and extending time for appointments to sterilize and disinfect the rooms. I would say those were some of the more significant challenges

Q: How have the changes in PPE affected your ability to practice?

A: It’s something that’s taking some time to get used to because we have to wear extra things and we’re changing things out more regularly now. It just affects the total number of patients we can see per day. It’s affected the overall production, revenue and number of patients we can treat.

Q: How has the experience been with patients? Has it been difficult to encourage patients to come into the office?

A: Even before the pandemic, we took a lot of pride in our infection control which has earned us a lot of loyal patients over the years. When all of this happened, we started on the process early. The day after we closed, I was on the phone trying to order things to stay ahead of the game. People definitely had questions but when we were closed we stayed in constant communication with our patients, sending emails and different types of correspondences. This was great to let them know the things we were doing and implementing in the practice to prepare them prior to coming into the office. The environment is definitely different with taking temperatures, asking various screening questions, things like that. Most of our patients trust that we’re doing the right thing because they’ve been with us for so long.

Q: Have you encountered any challenges with staff members?

A: They’re very supportive of what we’re doing and trying to lend a helping hand when they can. They had their questions about how we would do things and sometimes it’s a bit of trial and error as to how things go but they’ve been great. Our staff has really stepped up to help get everything reorganized and implement all of the new infection control. Dividing the team up to tackle certain areas helped a lot. We have team members that have been with us for a long time and they take pride in being a part of something special.

Q: Will dentistry ever return to what it was like pre-COVID? Should it? Or are the new precautions justified even in a world with a vaccine?

A: It’s probably always going to be how it is now. I remember when my father first started practicing and the AIDS epidemic hit. Before that, dentists weren’t wearing gloves or masks or much of anything; there was a new normal then. The biggest thing will be when we can finally get full PPE back in place and can get fully stocked with at least a month’s supply. Right now, we’re wearing two masks. Eventually, we’ll probably just go to one N95 mask. Our office put certain things in place that we intend on keeping. It’s all justified because you never know what else is around the corner. I don’t think you can ever be too cautious. You can screen and take medical histories, but there’s still a lot of hidden stuff out there. Vaccines give you more peace of mind but vaccines aren’t the be-all and end-all either. It’s difficult because it’s a complete unknown, but we’re in an industry working very close to people’s mouths with a lot of aerosols being created and a lot of potential to transmit something. The more caution, the better.

ANESTHETIC BUFFERING: the time saver dentists need, now more than ever.

Seat, treat and complete with Onset to reduce PPE usage, the potential for cross contamination and treatment time.

Treating patients amid Covid is more time consuming, but Onset by Onpharma will help increase productivity, reduce PPE use and more. Try the introductory kit at no risk. It’s covered by Benco’s Buy & Try Guarantee, so if you’re not fully satisfied, simply return it for your money back.

Let’s start with the bad news we’re all painfully aware of: gone are the days of numbing a patient, checking on another one, coming back to that same patient, and so on. Today, that would require multiple changes of PPE that nobody’s going to be even contemplating. 

The good news: We can make anesthesia work faster, and that’s a win for doctors as much as patients who, now more than ever, may want to reduce their time spent indoors. 

The Onset Solution: Seat, Treat, Complete

With Onset, you can get to procedures faster in this new world of one patient at a time. Seat the patient, administer anesthetic with much less waiting for the patient to get numb, and get to treatment right away. There’s another benefit too: less time awkwardly hanging out and making small talk to pass the minutes while your regular anesthetic does its job.

A Practice Builder That’s Easy To Use

Buffering with Onset was a smart idea before Covid-19, and it’s an even smarter idea now. The product is a labor of love for Dr. Mic Falkel, Founder and Chief Medical Officer for Onpharma Inc. “I knew as far back as dental school that you could build a practice around more comfortable injections,” he said. “But for years, I wanted to accomplish even more. Onset not only makes the injection more comfortable, it allows doctors to achieve more profound numbness faster.”

It’s simple to use: buffer the anesthetic in the Onset Mixing Pen, remove and load into syringe, and inject within one minute. Onset can be used to buffer four of the five major local anesthetics used in dentistry: Lidocaine, Articane, Prilocaine and Mepevicaine. Plus, its useful life once opened is seven days.

Local anesthetic cartridges have a pH of about 3.5, roughly the same as lemon juice. After injection, the body must raise the pH of the anesthetic towards physiologic (~7.4) before the patient can achieve pulpal anesthesia. The body’s buffering process takes time and keeps both doctor and staff waiting. Onset instantly raises the pH of the anesthetic chairside, taking time and the patient’s physiology out of the process. Buffering with Onset right before injection results in a 6,000-fold improvement in the amount of available active anesthetic. 

It’s Also Cost Effective—Something Everyone’s Looking For Now

Onset couldn’t be more affordable, costing on average around 17¢ per injection. Factor in the time savings and improved patient experience, plus savings in PPE, and adding Onset to your practice is an investment that pays off daily.

Renowned educator and dental anesthesiologist Dr. Stanley F. Malamed literally wrote the book on local anesthesia, and he’s a believer. “I sound like I’m a salesman for Onpharma, but I’m not,” he said. “I’ve simply become enamored with the idea of buffering all local anesthetic injections, and specifically those injections given in the mandible where most problems arise when it comes to pain control. I’ve even come to the point where I conclude all of my lectures with it because it makes injection more comfortable, the onset is much more rapid and post-injection soreness is markedly reduced.”

Anesthetic buffering with Onset is something you can do right now to address the immediate Covid challenges, while enjoying its practice building benefits that will last well beyond the pandemic.

Zirconia Perfection, All In One Product Line

Dental Creations, the Texas-based, family-owned and operated manufacturing business, has released a brand-new line of zirconia products.

Stronger than porcelain, zirconia crowns have a five-year survival rate of 99%. Between the new Zir-Perfect zirconia disc, Z-tray, and Z-Beads, Dental Creations covers dentists with high-quality products that provide patients with long-lasting results.

The unique Z-Tray Vented Sintering Tray comes in two sizes and protects while sintering crowns, bridges, inlays, onlays, and veneers. Holes on the side provide better airflow and transfer of heat while sintering, which keeps restorations at the proper temperature. The dense, round, covered tray prevents unwanted condensation and discoloring of the zirconia by the heating elements. It can withstand high heat rates for zirconia in temperatures up to 1700° C, as well as slower heating rates for long-span bridgework.

Pair the Z-Tray with a jar of Z-Beads Zirconia Sintering Beads for the best results. Because the Z-Tray and the Z-Beads heat at different temperature rates, the beads absorb the heat and provide a controlled temperature to prevent shrinkage. Like the tray, the beads can endure temperatures up to 1700° C. Made of high purity zirconia, the beads produce clean, contamination-free restorations.

The last item needed to complete your zirconia system, the Zir-Perfect High Translucent CAD/CAM Zirconia Disc, uses a three-point flexural strength of 1200 Mpa and a natural translucency of 43%. Offered in nine different shades, including white to use with dip stains, the Zir-Perfect can help you deliver restorations that are natural, long-lasting restoration and functions like a real tooth.

DENTISTING DURING CORONAVIRUS Part 1: Interview with Dr. Robert Lalor

In the first installment of this new series, we’ll be asking questions and getting first-person perspectives on what it’s like so far to practice amid the pandemic. Every region, every practice, every practitioner has unique stories so we’re chronicling them here to give you an up-close and personal look at challenges, solutions and inspiring moments across the country.

“Dr. Bob,” as his patients fondly call him, joined the practice his father founded in 2001 and has expanded throughout the southern tier of New York state. Lalor Family Dental now has four practices including the Lalor Implant Center and Dinosaur Dental, which serves pediatric patients only. Dr. Lalor graduated cum laude from the University of Buffalo with a degree of Doctor of Dental Surgery in 2000.

Q: When did you reopen your practice?

A: We never closed all of our offices and I’m proud of that. We had four practices and we consolidated it down to two that were open five or six days a week just seeing emergencies. In some ways, that was great because we had an opportunity to learn and implement new systems as they were being spat out to us and started to learn more about the virus.

Q: What has been the biggest challenge so far?

A: Lack of clarity, lack of clear guidelines that make common sense, and availability of PPE. Because it’s so difficult to get everything that we need or would like, we’re trying to make things last longer. But then you wonder, “Am I skirting the line here? Is this the best I can do for my team? Is there something I could do better? Are there materials I could get better?” I would rather have everything perfect but that’s a little tricky right now. The mixed bag of information that some people are getting online or through other sources are telling part of the story but maybe not the whole story. I’m definitely over-communicating and trying to look at issues from the perspective of the hygienist as best that I can and try to make sure that we mitigate any sort of risk of mistrust there.

Q: Have the changes in PPE affected your ability to practice?

A: Not in the ability to practice, but in materials. New York’s rules state there need to be 15 minutes after a patient is done before the next one can come into the operatory. That is going to affect our scheduling. We’ll figure out how that goes. We do have larger operatories so that shouldn’t impact us as much as the person who has only one or two operatories. We’ll work around that as best we can and make sure we comply with all regulations and turn over patients as fast as possible.

Q: How has the experience been with patients? Has it been difficult to encourage them to come into the office?

A: The patients who needed to come in were enthusiastic and excited that we were open. We send a ‘How was your visit’ type survey after a typical appointment, but we changed that during COVID to ‘How safe did you feel? How did you feel we did? Did you feel like there is anything we could improve as far as safety protocols?’ We thought that would mean more to people at this time than how we did on their filling. We got a lot of feedback from that, most of it not helpful because it was so positive. It gave us an understanding that the patient thought we were doing a good job. We tried to implement changes early and quickly.

Q: How do you plan on encouraging patients to return and continue their usual care?

A: Luckily, we have high demand, so we continue to use that as a strength, and we’ve kept lists of patients to reach out to get them into the office. Zero pressure on our side, more of ‘if you want to come in great, we will get you in and if you don’t want to come in yet, we can schedule you in a few weeks or whenever you want.’ We’re also extending our hours more than ever to allow for more opportunities for patients to come in. We are now a less busy office, but with more hours.

Q: Have you encountered any challenges with staff members?

A: A few people had some reluctance coming back, and we’ve lost a few who have decided to get out of the dentistry field which is fine. The dentists, the hygienists, they’re committed and still in the field for good. We have a core group of team members that were willing to stick around so my hat goes off to them for being willing to stay and work, putting themselves in harm’s way.

Q: Will dentistry ever return to what it was like pre-COVID? Should it? Or are the new precautions justified, even in a world with a vaccine?

A: My belief is that it will be a lot closer to what it was before. I think there will be some realization as to what studies need to be done to better show who is at risk and what legitimate risks we are exposing ourselves to. There needs to be a universal precaution method that works regardless of the disease. Dentistry has not been a hotbed for cases or the center for a lot of controversy, so I believe that the precautions we have taken and the industry as a whole are probably pretty safe. My assumption is that it’s more difficult than we think to get COVID in a dental environment and following the precautions that have led us to this point are going to be sufficient. Social distancing would be to be the biggest effect—the inability to meet people face to face, maskless, socialize, etc. That is the part that is going to hurt more than what we have to wear while treating patients.



Vaniman, a United States manufacturer with over 30 years of air filtration experience, has designed a brand-new line of air purifiers built around the needs of dentists and patients. The Pure Breeze HEPA system features fast, 99% removal efficiency of particles and dangerous aerosols including viruses, chemical odors, and more. It’s available in portable and fume hood versions depending on your individual needs.


The Pure Breeze HEPA Air Purifier portable scrubs the air of dust, chemicals, and biological hazards. This laboratory grade HEPA air cleaner is extremely quiet and ideal for many different air filtration applications. It uses a four-stage filtration system for maximum effectiveness. This unit is half the price and size of comparable industrial air purifiers, and is made is USA.


This quiet system filters clean air from the top vent forcing airborne contaminants down to the lower vent and does so with three different exchange rate speeds. The mobile system minimizes downtime between patients and maximizes the protection of patients and staff.


Watch it in action here, and contact your Friendly Benco Rep for a personalized consultation or call 1.800.GO.BENCO.