Teaching a New Philosophy
By David G. JonesSince the late 19th century, the dental standard of care has been to restore carious lesions by drilling and filling. Although research during the past 40 years has revealed that caries is a bacterially driven disease, dental education has predominately focused on restoration, even as prevention has moved closer to the forefront.
Championing a change in philosophies, the University of California, San Francisco, School of Dentistry is embarking on a new path of dental education. The school is combining the departments of Restorative Dentistry and of Dental Public Health and Hygiene into a new entity. Officials hope the new Department of Preventive and Restorative Dental Sciences will provide a better way to teach students and simultaneously benefit patients.
"I think we’re really ahead of the wave that is coming," says John D.B. Featherstone, MSc, PhD, professor of dentistry and chair of the new department. "It will hit all dental schools in the next few years, and it’s our desire to lead this movement."
Featherstone said that combining the departments was the obvious thing to do, since European countries have embraced this new philosophy for some time.
"There is a big move around the world to treat caries as a medical model, treating it as disease," he says. "This allows us to teach it, put it into practice, and have our dentists move out into the community and be more forward thinking, taking advantage of new diagnostic capabilities and treating caries in a more logical fashion."
Featherstone said the school’s teaching will be changed so that students are prepared in the currently accepted fundamental techniques, but also in new ways of providing dental care.
"We have a unique opportunity to combine our current two departments into one that is underpinned by a preventive philosophy for individuals and communities," he says. "Science is ready to be put into practice by having our faculty and students embrace these new concepts and technologies. For example, managing dental caries will be performed through risk assessment, coupled with antibacterial and chemical therapy, with restoration as a last resort. This is a major paradigm shift."
UCSF Dean Charles N. Bertolami, DDS, DMedSc, says that combining the departments creates an enterprise greater than the sum of its parts.
"The hope is that this is going to be a model that will lead the world in generating new and improved methods for teaching and delivering dental care," he says. "By giving it a new name, it reflects the philosophy of integrating prevention and clinical management. And we’re developing outcome measures for our teaching program to see if we can provide an even better teaching method for the future."
James Crawford, DDS, MPH, executive associate dean of the Loma Linda University School of Dentistry, believes UCSF’s decision is innovative and progressive.
"I’m a firm believer in this," Crawford says. "It’s moving dental education in the right direction."
Crawford says that for too long dentists have been tooth carpenters, and they diagnose oral problems from a superficial point of view rather than a systemic point of view.
"We take an X-ray, and if there’s a problem, we try to stop it by putting in a plug," he says. "We’re constantly behind in the disease process because we’re doing this after the fact, and this new approach to dental treatment is much more of a medical model."
Even though Crawford says that Loma Linda is cautiously moving toward a model of treatment similar to UCSF’s, he sees a possible downside.
"We’ve trained the public to expect to sit in the chair and get worked on," he says. "In a school setting, a problem I predict UCSF will have is getting the public to accept this new treatment. We haven’t trained the public to do that, and I think that’s the biggest stumbling block."
Featherstone says that patients presumably will have less restorative care and less removal of sound tooth structure using the new treatment regimen.
"It’s like when you do routine maintenance on your car, you’re better off than taking your vehicle in later for many repairs," he says. "There will be fewer problems, less pain, and fewer emergency type visits -- all benefits."
He also says that dentists concerned about the effect of the new modality on their incomes should know that some insurance companies are willing to participate because it lowers their risk.
"Insurance companies are preparing to broaden their coverage to permit dentistry to be done in this fashion," Featherstone says. "But this won’t happen overnight."
Steven E. Schonfeld, DDS, PhD, chair of CDA’s Council on Education and Professional Relations, agrees that dentistry's approach to caries as a clinical entity probably hasn't changed as much as it should have.
"However, I would like to point out that dentistry has always been in the lead as far as prevention is concerned," he says. "The change at UCSF apparently increases the integration of prevention with clinical restorative practice, and that’s probably a good thing."
A New Year, A New Plan
By Marios P. Gregoriou
A new year. A new decade. A new century.
We use milestones like these as starting points for personal or professional improvement and for taking care of things we've put off doing.
With so many more immediate things to focus on, estate planning is a good example of something on most individuals' to-do lists that has been put off. For people for whom that is the case, the new millennium could be just the milestone needed to start the process of estate planning or reviewing an existing plan.
An unplanned estate or an outdated estate plan can be costly. The government will eventually create its own plan for people without one, and it won't contain too many tax-saving or wealth preservation strategies for individuals and their families.
The following are some factors to be considered during planning or review of an existing plan.
Growing net worth
Securities and other investments, retirement plan assets, a home, business and life insurance policies generally are all counted as part of an individual's estate. An estate might have enjoyed significant gains in recent years and may therefore be worth more than anticipated. Stock market and real estate increases might have helped propel an estate into federal estate tax territory. (States may levy estate taxes also, and consultation with a personal tax adviser is a good idea.)
Estate taxes
The good news is that the amount one can leave to heirs free of federal estate tax is $675,000 for the year 2000, an increase of $25,000 from 1999. Further, that amount will continue to increase to $1 million in 2006.
The bad news is that if one's net worth is well over $650,000, the increase is nominal and won't help heirs significantly relative to federal estate taxes.
Since federal estate taxes represent one of the highest tax rates applied to individuals by the IRS, planning to protect one's assets from the eroding effect of those taxes is desirable.
New address
Individuals with vacation homes or properties in other states, or who have moved to another state, may be subject to uncertainty about which location is considered their legal domicile. If one domicile has not been clearly established, more than one state jurisdiction could successfully tax the estate. A revised estate plan can be created to protect assets against the possibility of multiple taxation.
Family matters
Changes in one's family often are reasons to examine estate plans. Changes can include marriage, divorce, birth and death. Any changes among family members named as heirs should be reflected in the estate plan.
Disability/special health needs
Language can be incorporated into personal trusts to make special provisions for health concerns and to help prevent temporary or permanent disability from disrupting financial affairs.
Business changes
Reviewing an estate plan can help identify potential disruptions or tax implications involving one's business. Whether the business is a sole proprietorship, partnership or closely held corporation, changes in the form of ownership will significantly affect tax and succession issues. A review also will help determine if the business qualifies for a special small-business estate tax break instituted in 1998.
Philanthropic intentions
Maximizing control and management of one's charitable gifts can provide significant tax savings and can also offer other financial benefits for an individual and one's chosen charities.
Marios Gregoriou is an associate vice president financial adviser with Morgan Stanley Dean Witter in Sacramento. He can be reached at (800) 755-8041.
Radioactive levels Are ’50s throwback
The cancer-causing radioisotope Strontium-90 has been found in the teeth of children born in the 1980s at levels equal to those of the middle 1950s, when the United States and the former Soviet Union were conducting routine aboveground nuclear bomb tests.
Directors of the Radiation and Public Health Project, who released an initial report from an ongoing study of baby teeth, said their findings indicate that Americans continued to absorb radiation for years after all atmospheric nuclear testing ended in 1980.
The scientific paper based on the health project results has been accepted for publication in the International Journal of Health Services.
"The early results are quite alarming," says Ernest Sternglass, PhD, professor emeritus of radiological physics at the University of Pittsburgh School of Medicine and co-director of the study who played a key role in the scientific debate that led to the original banning of bomb tests. "The levels of Stronium-90 should have dropped down to near zero once humankind stopped exploding nuclear weapons in the atmosphere. Instead, the levels stayed essentially the same as during the bomb-test years, or in some areas they even increased."
The health project researchers correlated one increase in Stronium-90 during the 1980s in Suffolk County, N.Y., to a corresponding rise in childhood leukemia and cancer (which also have risen nationally since the early 1980s). Studies linking Strontium-90 to childhood cancer caused widespread health concerns during the Eisenhower and Kennedy administrations, resulting in the historic Nuclear Test Ban Treaty between the United States and the USSR in 1963.
The new higher-than-expected levels of radiation were found in 515 teeth tested, most of them for children born in the states of New York, New Jersey, and Florida. Many of the areas where teeth were collected are near nuclear power plants with a history of unusually large radiation releases. Strontium-90, a man-made element that was first introduced into nature as a byproduct of atomic bomb tests, is also produced by fission in nuclear reactors. It enters the body through drinking water and food, concentrating in bones and teeth.
"It is clear that more investigation is urgently needed," Sternglass says. "It is especially urgent given that Strontium-90 is a known carcinogen and a marker for other shorter-lived fission products and simply should not be present at all in our children’s teeth."
The private foundations supporting the study have agreed to assist in financing the collection and analysis of 5,000 baby teeth over the next two years. At the same time, the health project directors called for the U.S. government to conduct a national-scale study of Strontium-90 in the environment. The U.S. Department of Energy ended a program in 1982 that previously measured the intake of Strontium-90 in adult diets, and the EPA stopped monthly reports of fission products in milk in 1990.
Craniofacial Birth Defects
Targeted by Grant to USC
The National Institute of Dental and Craniofacial Research has awarded $5.5 million to the University of Southern California to develop molecular-based strategies for reducing the incidence of craniofacial birth defects.
"If we can understand the fundamental molecular mechanisms that control craniofacial development, then we will be able to prevent, diagnose, and treat craniofacial anomalies, which constitute 35 percent of all birth defects," says molecular biologist Charles F. Shuler, who will lead the interdisciplinary research effort. "Not only do these birth defects put a devastating burden on individuals and families, but they are associated with significant health care costs for society."
One in 700 American children is born with cleft lip and/or cleft palate, although the incidence is 1 in 300 for native Americans and 1 in 500 for Hispanic and Asian populations.
"Every child born with this condition needs four major surgeries," says Shuler, director of USC’s Center for Craniofacial Molecular Biology. "In California, these multiple surgeries cost the state’s children’s services agency an average of $1.5 million per child."
Data bank gathers more information on health professionals
A new government information source, the Healthcare Integrity and Protection Data Bank, now complements, overlaps and integrates the National Practitioner Data Bank. The integration, "for certain purposes," is through broad-based collection of fraud, abuse, and related information on dentists, physicians, HMOs and other health care providers. Congress established the new data bank as part of the Health Insurance Portability and Accountability Act of 1996.
Beginning in November, computers were to sort adverse action reports from reporting agencies for assignment to the proper data bank or both. Criminal investigators have access to the new bank’s files, and any use of information by authorized investigators will not be disclosed to dentists or physicians who self-query the bank, a bank official says. Investigations by licensing boards or other health care entities would, however, be disclosed to a practitioner making a self-query.
The data collection is broad-based enough that reportable "final adverse reactions" include automatic suspension of a license for failure to pay family support for a child or spouse.
The American Dental Association, among other organizations filing formal comments on proposed rules issued a year ago, objected in part to "the broad interpretation of reportable licensure actions (that) goes well beyond the congressional intent" and argued for more limited access to bank information. The latter argument won some concession from regulation writers, but the Department of Health and Human Services insisted on the necessity of sweeping data collection.
The new data bank regulations are available online at www.npdb-hipdb.com.
Oral care fibs are revealed
Sure, patients stretch the truth a bit when their dentists ask them about their oral care habits. But just how much exaggerating is going on?
Optiva Corp. sponsored a survey of 500 patients and 250 dentists to determine the discrepancy in perceptions of oral health and oral care. Among the findings:
* Gum disease, who me? Forty-one percent of people surveyed believe they will never have periodontal disease. Dentists estimate that 78 percent of their patients will suffer from it at one time or another.
* Brush for two minutes. While 44 percent of people surveyed claim they brush for two minutes, dentists say the figure is more like 16 percent.
* The flossing fib. A total of 44 percent of patients surveyed said they floss every day. Dentists say only 13 percent of their patients do so.
* Who’s kidding whom? Forty percent of surveyed patients admit to cleaning up their act with regard to oral hygiene just prior to a dental visit, but 78 percent of dentists said they can tell when patients try to make up for poor hygiene with last-minute efforts.
Honors
Kent Farnsworth, DDS, president of the California Dental Association, has been named Alumnus of the Year for the School of Dentistry at the University of California at Los Angeles.
Web Watch: Employment
The following pages have information on dental employment opportunities.
http://www.cda.org/cda_member/market/index.html
Click on CDA Classified Ads for an online listing of opportunities as appearing in the latest issue of the Journal of the California Dental Association
http://www.ada.org/prof/ed/careers/Jobbank.asp
Opportunities available as listed classified ads in the Journal of the American Dental Association.
This page lists positions for dental personnel in California.
A page listing dental positions.
A listing here does not constitute endorsement by the California Dental Association. As is the case with all web sites, content is subject to frequent change.
Upcoming Meetings
2000
Jan. 19-22 American Academy of Dental Group Practice, San Antonio, Texas, (602) 381-1185
Jan. 27-29 Miami Winter Meeting & Dental Expo, (800) 344-5660
March 1-4 Academy of Laser Dentistry Conference and Exposition, Panama City Beach, Fla., (954) 346-3776
April 5-9 American Society for Laser Medicine and Surgery annual meeting, Reno, Nev., (715) 845-9283
April 6-8 Dentistry 2000 -- British Dental Association Annual Conference and British Dental Trade Association Dental Showcase Exhibition, Birmingham, England, 01934 844408
April 11-15 American Academy of Oral Medicine Annual Scientific Session, Las Vegas, (410) 602-8585
April 13-16 CDA Scientific Session, Anaheim, Calif., (916) 443-3382, Ext. 4470
May 15-20, World Biomaterials Congress and Exposition, Kamuela, Hawaii, (612) 543-0908
June 12-13 "The Face of a Child" -- Surgeon General’s Conference on Children and Oral Health, Washington, D.C., (301) 588-6000
Sept. 15-17 CDA Scientific Session, San Francisco, (916) 443-3382, Ext. 4470
Sept. 17-20 American Academy of Periodontology Annual Meeting, Honolulu, www.perio.org
Oct. 14-18 ADA Annual Session, Chicago, (312) 440-2500
Nov. 29-Dec. 2 Le Mondial du Dentaire, Paris, http://www.fdi.org.uk/calender/index.htm
2001
May 4-8 Australian Dental Congress, Brisbane, +61 (0) 7 3369 0477
To have a meeting included on this list, please send the information
to Upcoming Meetings, CDA Journal, P.O. Box 13749, Sacramento,
CA 95853 or fax the information to (916) 443-2943.
