California’s Oral Health Grade Remains Mediocre

 

Oral Health Report Card Grades
	National	California
Prevention	C	F
Factors: Fluoridation, sealants
Access to care	C-	C
Factors: Availability of dentists, children’s Medicaid dental program, visits to dentists, dental insurance status of adults and elderly
Oral health leadership	B+	D-
Factors: dental director, oral health coalition
Oral health status	C+	B-
Factors: oral health of children, use of spit tobacco, edentulous elderly, oral cancer mortality rates

The United States is a little "down in the mouth" according to the newly issued Oral Health Report Card. The nation earned an uninspiring C on the 2001-2002 report, which is intended to provide a snapshot of dental health in America by compiling data from all 50 states and the District of Columbia.

The country’s overall grade inched up from the C- received on the 2000 report card. The slightly improved grade reflects increased national awareness of oral health issues, but the coast-to-coast assessment also shows that there is much work to be done.

"The 2001-2002 report signifies hope for the future, but also underscores the widespread unmet needs that have not changed in a year’s time," said Elizabeth Rogers, director of communications for Oral Health America, the nonprofit advocacy group that develops the grading project.

In determining the national grade, Oral Health America gathered data from each state and looked at prevention, access to care, oral health leadership, and oral health status. Each state also received an individual grade; and California once again received a C, with low marks in the areas of prevention and oral health leadership dragging down the state’s overall grade.

"California’s C grade and its poor score in prevention is especially disappointing due to its reputation as a trend-setting state concerned about health, fitness, and well-being," said Robert Klaus, president of Oral Health America.

"We cannot underestimate the importance of prevention and preventive services in maintaining a lifetime of good oral health," Klaus said. "Prevention is the area in which dentistry has distinguished itself, and so much can be done for so little money."

However, California received an F in prevention because less than 49 percent of the state’s population receives fluoridated water, and the use of dental sealants on children falls between 12 percent and 22 percent

The report also noted that even though California received an F in the fluoridation category, progress has been made; and approximately 30 percent of the population receives fluoridated water.

Klaus also pointed to California’s D- grade in oral health leadership.

"Gov. Davis has not included oral health in his priorities," Klaus said. "California does not have a state dental director, leadership in fluoridation efforts are lagging, and a statewide oral health coalition is not visible."

Klaus also pointed out that several states -- including Minnesota, Kentucky, Missouri and Michigan -- have taken "oral health issues to heart" and worked to appoint state dental directors, provide more money to Medicaid, and increase access to care for senior citizens.

The other low point in California’s score was a D in access to dental care for low-income individuals. According to Oral Health America, 43 percent to 54 percent of California adults with an annual income of less than $15,000 reported a visit to a dentist or dental clinic in the previous year. California was not alone in receiving low marks in this area: All but nine states earned D’s and F’s.

On the other hand, California received healthy marks in several categories, including visits to dentists by individuals with an income of more than $15,000. The Golden State also earned an overall B- in oral health status, a category that looks at oral health of children, use of spit tobacco, edentulous elderly, and oral cancer mortality rates.

In addition to California, 19 other states received a C grade, 19 states scored C+’s and eight states received C-’s. Four states -- Connecticut, Hawaii, Iowa, and Utah -- scored the highest grade of B-.

Klaus said the purpose of the report is to drive home the message from the Surgeon General’s Report on Oral Health that was released in 2000.

The grades on the Oral Health Report Card reflect statistics brought to light in that report, including:

* More than 108 million U.S. adults and children are without dental insurance.

* Almost 2.5 million days of work are lost each year due to dental problems.

* Tooth decay is the most common chronic childhood disease, affecting 50 percent of first-graders and 80 percent of 17-year-olds.

* The full report available online at www.oralhealthamerica.org.

Staff Changes Can Garner Publicity

By Dell Richards

Many dentists don’t realize that adding new dentists, hygienists, or office managers to a practice can be a source of publicity for a dental office. Sending a simple press release about staff changes to the local business media is all that needs to be done.

Business notices are usually published one day a week in daily newspapers and every issue in weekly business journals. To find out who to send the information to, one need only look at the bottom of the column. If there isn’t a name, the title of the column should be used, i.e., "News and Notes."

When one is writing the press release, a few rules apply:

* The obvious should be stated in short sentences: "(Name) was hired or promoted at (practice name)."

* The person’s full name, including middle initial, should be given.

* The exact name of the practice, including "Inc." if appropriate, should be used.

* The person’s duties should be listed in one sentence. "(Name) will be responsible for (list of duties)."

* The person’s previous position and duties should also be given.

* This information should be printed on letterhead with the words "For immediate release" at the top as well as the name and phone number of a contact at the office for questions. Someone specific should be designated to answer calls and track publication by looking at the issues as they come out. The newspaper should not be called to check if the item has been published.

* If an editor phones, the call should be returned immediately. Reporters work on very fast deadlines. If an editor calls in the morning, and the dentist calls back in the afternoon, it may be too late.

* A business portrait should be included, if possible. A photo sometimes increases the chance the notice will be used.

* The office should not expect the photo to be returned, even if a self-addressed, stamped envelope is included. Photos become the newspaper’s property.

It usually takes at least a month for such an item to be published. Once the item is published, the dentist should send a thank-you note.

The office should not ask the editor for copies. The newspaper receptionist can be asked if the paper gives free copies to people included in the issue. Papers cost less at the time of publication if they are picked up than they will later if they are ordered and mailed.

Although feature stories have more immediate impact, frequent newsworthy items also keep a dental office’s name in the public eye.

Dell Richards is the owner of the Sacramento public relations firm Dell Richards Publicity, which specializes in health care clients across California.

Free Genetic Disease Information Center Launched

The National Human Genome Research Institute and the National Institutes of Health’s Office of Rare Diseases have launched a new information center that delivers free and immediate access to information specialists who can provide accurate, reliable information about genetic and rare diseases to patients and their families.

There are more than 6,000 genetic and rare diseases afflicting more than 25 million Americans, but many of these illnesses affect relatively few individuals. As a result, information about these rare disorders may be limited or difficult to find. The new service, called the Genetic and Rare Diseases Information Center, will help relieve this problem by providing reliable information about individual disorders.

Opened in February 2002, the center provides experienced information specialists to personally answer questions from patients and family members on the phone, as well as by e-mail, fax, and regular mail.

"I am delighted we can provide a resource that should be of great benefit to individuals with genetic and rare diseases, and their families," said Francis Collins, MD, PhD, director of the research institute. "Valid and accessible information about these conditions is hard to find, and having an information center staffed by professionals will fill a critically important need. The National Human Genome Research Institute is delighted to be partnering with the Office of Rare Diseases to establish this center."

"Now people can talk to someone -- personally -- and get information right away," said Henrietta Hyatt-Knorr, the office’s acting director. "There will be a quick turn around. If you just received a diagnosis for yourself, your spouse, or your child, now you won’t have to wait to find useful information."

The Genetic Alliance, an international coalition of more than 300 lay advocacy organizations and health professionals, staffs the center with information specialists. The center provides callers with authoritative information about specific illnesses from existing public domain sources, including reliable Web sites, brochures, articles, and even chapters from books. Experts at the information center ensure that the information sent out is current and accurate. The center, however, does not provide genetic counseling and does not offer diagnostic testing, referrals, medical treatment, or advice.

Contact information for the center is as follows:

* Telephone, answered Monday through Friday, noon to 6 p.m., Eastern time: voice (888) 205-2311; TTY (888) 205-3223

* E-mail: gardinfo@nih.gov

* Fax: (202) 966-5689

* Mail: Genetic and Rare Disease Information Center, P.O. Box 8126, Gaithersburg, MD 20898-8126.

Top Challenges for the New Dentist

Most young dentists face five common challenges, according to Ted C. Schumann, CPA, in the November/December 2001 issue of the Bulletin of the West Michigan District Dental Society.

Finding and negotiating an associateship

Most new dentists do not buy a practice right out of dental school, Schumann says, so choosing their first professional experience is one of the most important decisions. Young dentists often make the mistake of taking the first job offered them, he said.

According to Schumann, young dentists should consider many questions before taking the first job, including:

* What type of dentistry do they want to do?

* Is this the owner’s first associate?

* Will the owner share patients?

* Is the owner financially sound?

* Are there enough patients to support a second dentist?

* How will lab fees be handled?

When and how to become an owner

According to Schumann, the only true way for a young dentist to build wealth is through the ownership of a practice.

He said most young dentists eventually reach a point where they are comfortable owning their own practices. Usually that time comes when the young dentist is comfortable practicing clinically and realizes the owner will never teach much about how to run a practice.

The opportunity to become an owner could come from purchasing a retiring dentist’s practice, buying into a practice, or starting from scratch. Schumann said young dentists should spend a lot of time researching which is best for them.

Leadership and management of people

This is the area in which young dentists are least prepared, Schumann wrote. Schumann advises young dentists to seek out training to develop leadership skills. After gaining these skills, the next challenge is to assemble a team that will follow their vision.

Operation of practice

For many dentists, young and old, the greatest challenge is to understand how to run the business side of a practice. Schumann says it’s important to know how to read and understand financial statements and to know how to track key numbers in the practice.

Financial aspects to know include accounts receivable and collections, scheduling for productivity, labor costs, occupancy costs, marketing and advertising, lab fees, cost of supplies, equipment expenses (repairs and maintenance and depreciation), costs of continuing education, and administrative expenses.

Investing, retiring debt and living within one’s means

Schumann said that in financial planning literature, authors refer to dentists as "celebrity investors." He said this means dentists are the type of investors who want to invest in "what's hot."

According to Schumann, the market loses money about one in four years. People who wish to accumulate wealth do so by consistent and systematic investment. He said by using dollar cost averaging and understanding the portfolio allocation process, an investor with a long-term perspective can achieve financial goals.

Most young dentists graduate with considerable debt and within a few years have even more debt for a home and practice. Schumann said much of this debt is necessary and inevitable; but with proper planning, young dentists can look down the road to becoming debt-free.

Dentist Saves the Day in Kindergartner’s Winning Story

A Georgia dentist received a happy surprise while reading his morning paper recently when he found that one of his young patients had won an essay contest with a story featuring a dentist as the hero.

Dr. Keith Crummey, a general dentist in Waycross, Ga., discovered the story as he perused the Waycross Journal-Herald. Trey Chafin, a first-grade student, was named a state winner in the 2001 Young Georgia Authors’ Writing Competition for his essay "The Crazy Glupaste Day," which he penned as a 5-year-old kindergarten student.

In the story, a little boy named Cococ buys glupaste instead of toothpaste at the store, and glues his teeth together that night. He seeks help from his uncle, a builder, who tries to open his mouth with a hammer; from his mother, who tries a chainsaw; and from his father, who calls 911. But finally, Cococ’s dad calls the dentist who used his "speshul drill ... and carefully and gently opened Cococ’s mouth."

Crummey said, "People seem to enjoy telling stories of traumatic dental visits. They delight in portraying the dentist as a villain or ogre. Seldom are we cast as the hero. It was refreshing and encouraging to read a story written by a child portraying the dentist as competent and kind."

Third-Party Financing for Cosmetic Dentistry an Effective Tool

Offering third-party financing as an option to potential cosmetic dental patients is a highly effective tool for gaining treatment acceptance, wrote Roger P. Levin, DDS, MBA, in the fall 2001 issue of the Journal of Cosmetic Dentistry.

Levin said that although interest in cosmetic dentistry is increasing somewhat, patients often decline care because they need special financial arrangements. He noted that American consumers spend millions of dollars on discretionary beauty products, but cosmetic dentistry is still not one of those priorities.

If dentists can offer convenient low monthly payment plans, they are sure to increase the number of patients who accept treatment, Levin said.

It is important for dentists to understand the current economy. When economic conditions begin to slide in any way, people cut back in discretionary spending areas, including expensive cosmetic-related items.

Levin says it is important to help patients afford cosmetic care. Although factors such as fear, procrastination, and time may enter into a patient’s refusal of treatment, Levin said cost should no longer be a factor when dentists offer third-party financing as an option.

Orderly Practice Transfer an Ethical Obligation

Among the important details to be addressed before closing a practice transfer is a plan for patient retention, wrote Rise and Martin Mattler in the November 2001 issue of the Bulletin of the Ninth District Dental Society (New York).

Dentists have an ethical obligation to make the transfer to a new dentist as orderly and seamless as possible for both patients and staff, according to the Mattlers.

They said that dentists should meet with their staff immediately after the closing to let them know about the transition. If a dentist has a warm, longstanding relationship with employees, the dentist may elect to tell staff before the closing.

Patients should be notified of the transition immediately after the practice sale closing. The Mattlers said that dentists should tell patients before word gets out that the dentist is leaving. They recommend a three-step practice transfer plan for notifying patients.

* First, an introductory letter should be sent to all current patients immediately after the practice transaction closes and ownership has changed. The purpose of the letter is to recommend the new dentist to the patients. The Mattlers recommend that the copy refrain from indicating that the practice has been "sold," since most patients don’t like the idea of their dental records being sold to the "highest bidder."

* The second step is to call any patients who are scheduled for an appointment before they will receive the introductory letter. The authors add that before calling, the selling dentist should discuss this with the buyer, since some new owners prefer that patients be informed the day of their appointment rather than beforehand.

* The last step is geared to the buyer of the practice. The Mattlers said the new owner should send a letter to all patients about a month after taking over the practice. This letter would welcome patients and reiterate professional, personal, and practice-related information of interest to patients.

The Mattlers said many well-intentioned sellers plan to stay longer with the practice than necessary to ease the transition, often creating unintended problems for the new dentist. Two problems that arise are insufficient workload for two dentists and the perception by patients and staff that the incoming dentist is "second string." The Mattlers recommended that a dentist plan to stay up to three months at most to ensure a smooth transition and to protect the cash flow of the practice.

Estrogen Receptor Variations Related to Tooth Loss

Estrogen receptor genotypes may be connected to tooth loss in elderly women, Japanese researchers report in the Nov. 14, 2001 issue of the Journal of the American Medical Association.

Researchers studied the effect of estrogen receptor genotype on tooth loss and alveolar height in 132 Japanese women who visited a clinic from 1996 to 2001. Sixteen subjects had received estrogen replacement therapy for six months or less, and one had received the therapy for four years. None of the patients was taking other medications that affect bone metabolism, and none had a history of tobacco use.

Researchers analyzed the subjects’ estrogen receptor genes in blood samples. They found that one gene variant was linked to having fewer teeth. A second gene variant was associated with great alveolar bone loss. They concluded that these genes might not influence alveolar bone loss but rather alveolar bone fragility. The findings did not change after researchers made adjustments for age and time lapsed since menopause and estrogen replacement therapy.

The results, according to researchers, indicate that the type of estrogen receptor a woman carries could signal her risk of experiencing tooth loss.

Universities Collaborate on $5 Million TMD Study

Researchers from the Universities of Buffalo, Minnesota and Washington will collaborate on a $5 million study to establish valid and reliable criteria for the diagnosis and treatment of temporomandibular joint disorder.

The four-year study is being funded by the National Institute of Dental and Craniofacial Research.

"This research study represents the most comprehensive examination of diagnostic methods and concepts yet conducted for any chronic pain disorder," said Dr. Richard Ohrbach of the Center for the Study of Pain at the University at Buffalo School of Dental Medicine. "TMD is difficult to diagnose because there is no single measure that provides objective independent evidence of this disorder."

To establish universal, definitive standards for diagnosing TMD, study investigators will revalidate existing criteria and assess the validity of potential new indicators through blinded clinical examinations, mental status assessments, computer-aided imaging scans, and fluid and tissue analysis.

Honors

Charles Bertolami, DDS, DMedSc, professor and dean of the University of California at San Francisco School of Dentistry, will become president of the American Association for Dental Research on March 6 at the annual meeting in San Diego. Bertolami is a nationally recognized expert in the field of connective tissue repair and the treatment disorders of the temporomandibular joint.

Upcoming Meetings

2002

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 2-4 British and Irish Dental Associations Annual Conference, Belfast, Northern Ireland, (+44) (0)020-7563-4590, events@bda-dentistry.org.uk

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.