It’s a New Day

In this space in October 2001, Journal Associate Editor Steve Gold commented about change. We were reminded by a professional uprising of sorts late last year, that the profession, like every other segment of the society, had entered into the 21st century some 12 to 24 months ago, but was not entirely ready to respond with enthusiasm to a procedural "change" that was necessitated by a new legislative requirement to distribute a new Dental Materials Fact Sheet developed by the Dental Board.

In our continuing effort to keep the membership well informed, the Jan. 4 letter from President Steven Chan, which provided the history and the facts behind this new requirement, is reprinted here. CDA Update and CDA Online had reported both the Dental Board activity and the legislative activity surrounding this issue, which has been summarized in the letter. It should not have been an end of the year surprise to anyone with access to CDA membership information.

It is particularly important to emphasize the importance of CDA Online. It is a members’ nonstop source of information. From legislation to continuing education, it is the medium of choice for members to stay informed with information of essential value in the fast-paced world of contemporary business. If you misplace your copies of the Update of Journal, or someone in the office or home accidentally tosses them out, you can easily access articles, news items, or scientific manuscripts on CDA Online. Everything that affects us can be found there. CDA’s position on legislative issues, significant Dental Board Regulations, OSHA regulations, registration for CDA Scientific Sessions -- they can all be found on CDA Online. Our point here is that CDA Online is an essential business tool that we must train ourselves to utilize if we are to be well-informed. CDA staff can and will provide membership service assistance, but what can be faster than CDA Online?

As noted in the letter from President Chan, CDA Online has featured both the Fact Sheet, the frequently asked questions, and a sample patient acknowledgement form that can be downloaded and copied for some time. The latter two items were printed for a second time last month in Update. Some component societies (mine included) have provided members with the acknowledgement form for the purpose of making copies. In this day of copy machines, provision of one-time copies can be relatively quick and inexpensive without having to resort to a special printing that would only develop a costly inventory of forms.

We are the trusted source of dental information, or at the very least that is an objective of our professional organization; and it should be a key in our individual relationships with patients. While yours truly doesn’t appreciate the added procedures any more than the average colleague, I believe it is a measure we can live with, at least until a more practical procedure might be developed in the future. And to do our part in making CDA the trusted source, we members can use discussion of the Dental Materials Fact Sheet with patients to help us fulfill our professional responsibility to provide and disclose such information to our patients.

As noted in the letter, keep in mind that safety concerns about the mercury in amalgam and anti-amalgam litigation against CDA and ADA have been hovering over dentistry during this past year. CDA staff, and the legal department in particular, spent many hours on our behalf in 2001 trying to bring resolution to the Proposition 65 issue and to the lawsuits served on CDA and ADA. For the past 12 months, we have experienced an extremely difficult environment, spearheaded by sometimes emotional legal and legislative agendas

Our membership in organized dentistry continues to provide us with valuable resources unavailable to nonmembers in facing these challenges and changes, whether it is through CDA Online or by CDA or component staff effort.

It is a new day. But this practitioner is confident that dentistry will adapt to the mandate of this legislation. Stay informed through publications and CDA Online. They will help create a better understanding of the how and why of mandated initiatives. We should not be surprised by these kinds of changes. Instead, we should be constantly preparing ourselves through study of the educational and informational resources available to all members to positively respond to them.

***

Jan. 4, 2002

Dear Colleague:

Happy New Year! On behalf of the officers and trustees of CDA, I wish you peace and prosperity in the coming year.

This letter is intended to apprise you of issues surrounding the revised Dental Materials Fact Sheet (DMFS) by the Dental Board of California (DBC), and the implementation of SB134 (Figueroa), requiring dentists to provide a copy of the DMFS to patients prior to performing restorative dental treatment. A copy of this fact sheet was recently provided to each California licensee directly from the DBC, though unfortunately no instructions were included. While we have attempted to keep you informed of the specifics of this law, the number of inquiries received indicates that additional information is needed. This letter will explain how the law came about, to whom it applies and how to comply.

This fact sheet is not new. In 1992, the Legislature first required the DBC to develop a Dental Materials Fact Sheet and make it available to every dentist. The law encouraged practitioners to discuss with patients the dental materials used in restorative procedures, including advice on the risks and benefits. It was the passage of SB 134 in 2001 that set forth new requirements (effective January 1, 2002). The new law provides that:

* The fact sheet must be provided once to every new patient and to patients of record prior to the performance of restorative procedures.

* An acknowledgment of receipt of the DMFS must be signed by the patient and placed in the patient's record.

* If the board updates the fact sheet, the revised fact sheet must be given to patients as provided above. A dentist must also provide the fact sheet to any patient upon request.

"How did this requirement come about?" For several years, there has been increased attention on products containing mercury by consumer activists, environmental groups, regulatory officials and dentists. This influenced legislative developments in California and other states. In late 2000, the Legislature began hearings to review the Dental Board’s operations. Committee members expressed concern that the DMFS adopted in 1992 had not been updated, and that the Board had not fulfilled its responsibility. At these hearings, representatives from Consumers for Dental Choice spoke about the hazards of dental materials -- specifically amalgam. They lobbied for a ban on the use of amalgam. Because of information provided by CDA regarding the safety and efficacy of amalgam and the current scientific literature supporting its continued use, the Legislature lost interest in a ban. They focused instead on ensuring that patients were informed about dental materials.

Concerns regarding the overall effectiveness of the Dental Board continued to grow. As part of the Dental Board sunset legislation, the committee, determined to ensure that patients had access to pertinent information, considered statutory requirements of informed consent, posting of the fact sheet in the dental office and broader requirements for distribution. It was through the lobbying efforts of CDA that these requirements were deleted. Providing the DMFS to patients prior to performing restorative dental care then became the focus. The 1992 law encouraged discussion of the DMFS with patients. Legislators were convinced that patients were not getting adequate information, and were sensitive to the increased scrutiny on all mercury-containing products. "Encouraging" discussions was no longer sufficient, and a call for documentation was made. While not a perfect solution, accepting CDA's modifications greatly reduced the requirements on the profession while still meeting the author's goal. All of this was happening while there were rumblings about Proposition 65 warnings for mercury in amalgam, and a bill banning the use of most mercury-containing products was finding its way to the Governor.

This new law encourages dentists to discuss dental materials with patients and requires them to provide a copy of the fact sheet to every new and existing patient prior to performing restorative dental treatment. There is no requirement to engage in a lengthy discussion; the intent is to provide patients with the information necessary to make educated decisions. If you do not perform restorative procedures, it is not necessary to provide the fact sheet.

In the January issue of the CDA Update, a copy of the DMFS, a frequently asked questions sheet and a suggested acknowledgement form will be provided. You may make copies for your patients. You may also download the fact sheet from the board's Web site at www.dbc.ca.gov or via CDA's Web site at www.cda.org. Finally, you may call CDA for additional information or copies. The least expensive method is to simply copy the fact sheet and acknowledgement, using the CDA original. Your component dental society may also have options available.

Failure to comply with this law may subject a licensee to disciplinary action by the DBC. It is unknown at this time, however, exactly what level of discipline the DBC will assign to infractions of this law. First violations could result in a warning, a citation, a fine, or a combination thereof. Repeated violations could result in action being taken against a license. As you begin complying, I also want to assure you that CDA is exploring options to further minimize the impact of this law on your practice, including possible amendment to the requirement during the 2002 legislative session.

It must be noted at this juncture that this will not be the last we hear about mercury in dental amalgam. We are nearing a statewide solution to Proposition 65 notice requirements for mercury, and further communication is likely. In addition, litigation against the ADA and CDA related to mercury is in progress in San Francisco. Those organizations and individuals opposed to its use, including a member of the California congressional delegation, will continue to advocate a ban on amalgam.

We trust this information answers questions regarding the Dental Materials Fact Sheet and the new requirements. Often in cases such as this misinformation abounds. Please be sure to look in the January CDA Update for Frequently Asked Questions, and do not hesitate to contact CDA’s Contact Center directly at (800) 736-7701 should you need additional information.

Sincerely,
Steven D. Chan, DDS
President