The Future of Dentistry Report Aims at Helping Dentists and Patients

The recently released Future of Dentistry Report has been categorized by some as a blueprint to help guide the dental profession through the trials and tribulations the next 15 years are expected to hold.

As such, the document focuses on strategies that will help the average practitioner negotiate the future world within which dentistry will operate.

ADA commissioned the report in 1999, but it is not a policy document of the association. It was developed by a 16-member oversight committee led by Leslie W. Seldin, DDS, and contains several hundred pages and 114 recommendations.

The report has a specific vision: "Improved health and quality of life for all though optimal oral health." It describes the current status of the dental profession as "strong and healthy," identifies trends such as an expected increase in preferred provider organizations, and outlines challenges such as the geographic imbalances in the dental work force.

So, what does the report mean to California dentists?

"The Future of Dentistry Report is meant to improve the life of anybody connected to the dental profession -- practitioners and staff, as well as the public we serve," Seldin said in a question-and-answer session with the ADA. "It is a roadmap that gives every practitioner in his or her office more tools to provide the very best care to the public. The ultimate goal of the report is to improve the lot of patients and practitioners."

How can a single report, albeit a sizeable one, do this?

As Seldin said, "Everything in the report relates in some way to the practicing dentist."

Take, for instance, the top concerns of CDA dentists as identified in member surveys: third-party issues, the allied health personnel shortage, and regulatory issues.

The report addresses each of these areas, relates each to the overall profession, and offers specific recommendations, which call for a variety of action through such avenues as education, research, finance, or clinical practice.

In addressing the financing of dental services, Seldin notes that it would be shortsighted to ignore the importance of ensuring adequate financing for needed dental care. The report identifies a trend of increasing enrollment in preferred provider organizations and a decline in dental health maintenance organizations. This trend was documented by the ADA Survey Center, which also anticipates an increase in direct reimbursement and more interest in medical savings accounts.

In his overview of the report, Seldin acknowledges that patients are experiencing limitations, restrictions, exclusions, larger co-payments, and administrative problems that, if continued, will lead to growing dissatisfaction with dental insurance plans. Likewise, dentists’ frustration with dental benefits companies is also clearly expressed in the report.

The recommendations to address these concerns are in two parts: employer-based dental benefits and innovation in dental financing arrangements. Employer-based recommendations include marketing, organizational, and legislative suggestions. The recommendations include the dental profession encouraging "the dental benefits industry to streamline procedures, reduce administrative burden and policy limitations, and provide greater flexibility for covered individuals."

The report also clearly acknowledges that there is a shortage in the number of qualified allied personnel, including dental lab technicians. Recommendations support increased mobility for hygienists through licensure by credential. Further recommendations encourage workforce studies and advocate the goal of standardization of approved duties for allied personnel within the United States.

Addressing another top concern of California dentists, the regulation of the profession, Seldin states that "in recent years, regulatory activity has had a profound effect on the manner in which dentistry is practiced."

While noting that some regulatory activity has been appropriate and welcomed by the dental profession, the report also points out that much regulation has been criticized for not being sufficiently supported by scientific data. Recommendations suggest that "the profession must continue to be vigilant and proactive in identifying and researching potential hazards that might impact the safety of patients, the dental workforce, and the environment." Further recommendations include the dental profession remaining proactive in advocating scientifically valid solutions to identified hazards.

In working to advance the report and the recommendations it makes, the ADA received a plan to distribute information from the report to the profession and all of the allied organizations. It is expected that repeated exposure to the report will lead to action, ultimately on a global scale.

* The full text of the Future of Dentistry Report is available online at www.ada.org in the "Your Practice" content area.

Calcium Crisis Bodes Ill for Bones

Only 13.5 percent of girls and 36.3 percent of boys age 12 to 19 in the United States get the recommended daily amount of calcium, placing them at serious risk for osteoporosis and other bone diseases, according to statistics from the Department of Agriculture. Because nearly 90 percent of adult bone mass is established by the end of this age range, the nation’s youth stand in the midst of a calcium crisis.

"Osteoporosis is a pediatric disease with geriatric consequences," said Duane Alexander, MD, director of the National Institute of Child Health and Human Development. "Preventing this and other bone diseases begins in childhood. With low calcium intake levels during these important bone growth periods, today’s children and teens are certain to face a serious public health problem in the future."

The health risks related to low calcium intake are not just years away, Alexander explained. Children are drinking more soft drinks and more noncitrus drinks than they used to; meanwhile, milk consumption has dropped. The number of fractures among children and young adults has increased, probably due to lower intakes of calcium. Pediatricians are also seeing the re-emergence of rickets, a bone disease that results from low levels of vitamin D. Rickets became almost nonexistent after vitamin D was added to milk in the 1950s, but is now appearing at greater rates around the country.

But the major effects of this crisis are yet to come.

"As these children get older, this calcium crisis will become more serious as the population starts to show its highest rate of osteoporosis and other bone health problems in our nation’s history," Alexander said. "But we need to remember that this is a preventable and correctable public health problem."

Getting children to pay attention to their calcium needs is a challenge for scientists and educators, he added. For this reason, the National Institute of Child Health and Human Development has expanded its Milk Matters calcium education campaign and Web site to speak directly to children and their parents about calcium.

The Milk Matters campaign stresses low-fat or fat-free milk as the preferred source of dietary calcium because:

* Milk has a high calcium content.

* Calcium in milk is easily absorbed by the body.

* Milk contains other nutrients -- including vitamin D, vitamin A, B12, potassium, magnesium, and protein -- that are essential to healthy bone and tooth development.

The Milk Matters Web site is an excellent source for information on calcium for health care professionals. For more information on the Milk Matters campaign, please contact the National Institute of Child Health and Human Development clearinghouse at (800) 370-2943, or visit the Web site at www.nichd.nih.gov/milkmatters.

Scientists Find Hidden Piece of Flu Virus

For nearly 20 years, scientists have labored under the assumption that the influenza virus comprises only 10 protein molecules that form its structure and carry out its activities. However, researchers have reported finding a new, "hidden" influenza virus protein. This protein may kill immune system cells that fight the virus, thereby contributing to the virus’s potency, the researchers say.

"We believe this is a groundbreaking finding, although we’re not yet sure how deep the ground is," said Jonathan Yewdell, MD, PhD, a viral immunologist who led a team of scientists at the National Institute of Allergy and Infectious Diseases. "This might be the ‘grand canyon’ of the flu, in terms of understanding this virus’s virulence, or perhaps only a narrow side ravine."

The scientists turned up this new protein by accident, while sifting through bits and pieces of "junk" peptides, the short protein molecules the virus creates once it infects a cell and begins replicating. They form when the process that translates viral genes into proteins goes awry, Yewdell said. In other words, junk peptides result from genetic mistakes.

"We weren’t looking for new proteins at all. We assumed the 10 known influenza proteins were all there were," Yewdell said.

"Like many scientific discoveries, this one happened serendipitously, and it confirms the importance of supporting basic research on infectious diseases," concludes Anthony S. Fauci, MD, director of the institute. "When you have good researchers exploring interesting questions, they are bound to turn up crucial information."

It Isn’t Supposed to Be Like This

By Jeffrey Galler, DDS
Brooklyn, N.Y.

"Have You Gotten Any Calls for X-rays?"

At continuing education lectures, association programs and dental meetings, that is the first question you now hear dentists asking each other. In the past, we talked about the stock market, our practices, families, dental labs, or insurance programs. Now, we discuss providing copies of radiographs so that patients missing in the World Trade Center disaster might be identified. Many of us volunteered to help in the grim task of identifying the deceased by matching the jaw fragments of unrecognizable corpses with dental X-rays.

It Isn’t Supposed to Be Like This

Compassionate hands that spent decades learning how to minimize any discomfort that patients might experience, now handle separated body parts of patients who will never again feel pain, and wonder what it must have felt like when their bodies exploded into countless pieces.

It Isn’t Supposed to Be Like This

Curious hands that palpated and explored the mastication muscles of dental school cadavers now have the grisly task of wiping charred tissues off mandibles and maxillas so that victims' jaws can be analyzed and identified.

It Isn’t Supposed to Be Like This

Nervous hands that examined extracted teeth during dental school tests, hearing professors demand, "Is this a lower right molar or lower left molar?" while wondering what possible difference it could ever make to their future patients, now try to reassemble a lower jaw, fitting broken bony fragments and severed teeth, like a macabre jigsaw puzzle.

It Isn’t Supposed to Be Like This

Dexterous hands that spent a lifetime perfecting skills that help our patients have beautiful smiles and healthy dentitions so that they can smile, and speak, and eat at joyous family gatherings, now examine and identify porcelain margins and skillfully crafted bridges in crushed skulls of patients who will never again smile or chew or celebrate -- all so that the deceased’s family members can cry and grieve properly.

It Isn't Supposed to be Like This

Dentists who devoted their entire professional lives to enhancing their skills so as to improve the health of a small part of the human body, grapple with difficulty and try to understand the mentality of those who dedicate themselves to burning, exploding and crushing the life out of living, breathing humans.

It Really Isn’t Supposed to Be Like This.

Reprinted with permission, New York State Dental Journal, October 2001

Embezzlement causes more than financial damage

Although embezzlement causes financial damage to a dental practice, psychological damage also occurs to the dentist and staff, wrote Gerald Gelle, DDS, in The Bulletin of the Berkeley Dental Society, October 2001.

Theft by someone in a position of trust is usually hard to detect and quite profitable, Gelle wrote. The average case of embezzlement is about $40,000, he said. If caught early enough, the damage to a practice is kept at a financial minimum.

But more than the financial damage is the psychological damage that interferes with the way the office team works together and delivers care.

Gelle said the first part of diagnosing a practice with a suspected embezzler is subjective and intuitive. It requires that dentists look or listen for early behavior warning signs that may or may not be linked to an actual embezzlement. Gelle says being attentive for these signs must be aimed at the practice’s bookkeeper, receptionist, office manager, or whoever handles the money in the office.

One example, Gelle noted, is a person who openly resents a substantial income and an upper-middle class lifestyle and continually makes snide comments about how a patient, a fellow staff member, or the dentist spends money. Comments to heed would be: "He bought that car only because he wanted to show how much money he earns;" or "I wouldn’t be caught dead wearing that much jewelry;" or "$300 on a handbag? What a waste."

Gelle said that openly hating the way a person spends money creates in the embezzler’s mind reasons embezzlement is OK: "Taking their money won’t hurt them in the least bit. If they had the money, they’d only waste it."

Also suspect, according to Gelle, is the person who regularly carries a lot of cash or acts as the office’s resident "banker," offering others small cash loans and advances, or cashing colleagues’ personal or pay checks. Offering this service "justifies" why the person needs to carry so much cash. Gelle said much of the cash is probably stolen directly from patients’ payments.

Another person to watch, Gelle wrote, is the person who adamantly resists any change in the present accounting system. He said this reaction especially rears itself if the change involves the replacement of an antiquated system with an easier, more efficient modern one.

Gelle said dentists should be suspicious about embezzlement if a new accounting system is implemented and there is a sharp increase in cash flow and profitability. It may be that the money is now going to the practice and not the embezzler.

Baby Teeth Used to Study Nuclear Fallout Effects

About 85,000 primary teeth collected between 1959 and 1970 to study the possible effects of nuclear weapons testing were discovered in spring 2001 in a Washington University, Saint Louis, basement. Researchers said the teeth could be used to correlate the bomb testing with health problems years later.

The teeth were collected by the greater Saint Louis Citizens Committee for Nuclear Information to determine if children were absorbing radioactive fallout from nuclear weapons testing by the United States and the Soviet Union in the 1950s. They were discovered when Washington University officials were cleaning out a school bunker where the teeth had been stored since the 1970s.

Researchers from the New York-based Radiation and Public Health Project have launched a project to find the owners of the teeth to determine if they have experienced health problems such as thyroid cancer that could be connected to fallout.

The Saint Louis Baby Tooth Survey collected teeth in the 1950s and 1960s, mostly within a 150-mile radius of Saint Louis. The Radiation and Public Health Project researchers would like to be contacted by anyone born and living in St. Louis from the late 1940s through the 1960s who may have submitted teeth to the study. If matched with any of the discovered teeth, respondents will be asked to complete a questionnaire about their health history.

* The Radiation and Public Health Project can be reached at http://www.radiation.org/.

Dental Forensics Role in Disaster Response Lauded

Dental teamwork and electronic dental identification triage were essential to the success of Operation Noble Eagle, "one of the most comprehensive forensic investigations in U.S. history," the Armed Forces Institute of Pathology, an agency of the Department of Defense, said in a series of reports.

"All avenues of forensic investigation were explored and deployed with zero defects," said Navy Capt. Glenn N. Wagner, director of the institute. Officials offered new details on the institute’s medicolegal response to the Sept. 11 terrorist attacks, which is code-named Operation Noble Eagle.

Officials credit a multidisciplinary effort in which dentists and dental forensics played important roles in the identification of victims of the terrorist attacks and said they hope to make it easier for dentists and other health professionals to "send digital information to us directly" in future disaster investigations.

Upcoming Meetings

2002

March 13-16 Academy of Laser Dentistry Annual Conference & Exhibition, San Diego, (954) 346-3776, www.laserdentistry.org

April 4-7 CDA Scientific Session, Anaheim, (916) 443-3382, Ext. 4470

April 12-14 International Dental Exhibition and Meeting, Singapore, 212 -974-8835, www.idem2002.com

May 7-12 American Academy of Cosmetic Dentistry Annual Session, Honolulu, (800) 543-9220, www.aacdhawaii.com

May 16-19 Organization for Safety and Asepsis Procedures Symposium, Nashville, (800) 298-OSAP, www.osap.org

Sept. 27-29 CDA Scientific Session, San Francisco, (916) 443-3382, Ext. 4470.

Oct. 11-13 National Association of Filipino Dentists in America Annual Meeting, San Francisco, (818) 988-3910.

Oct. 19-23 ADA Annual Session, New Orleans, (312) 440-2500.

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.