Internet Becomes Part of Supplying's New Order

Some technical-savvy California dentists are riding a burgeoning wave of electronic commerce that is changing the way they and their staffs order dental supplies.

The Internet, already a major player in international commerce, is breaking new ground in connecting buyers and sellers of dental supplies. It is saving time and money for people willing to participate in a world of electronic commerce that has become part of big business.

Last year, the United States alone generated $12.5 billion, or 79 percent of total worldwide business-to-business (B2B) e-commerce revenues, according to the recently released "e-Commerce: B2B Report." While the dental and medical supply ordering segment is small by comparison, its use is increasing, according to industry analysts.

"The players, consisting of health care information technology and emerging companies, provide solutions to connect the various health care participants, including providers, payers and suppliers," say industry analysts Stephen M. Fitzgibbons and Richard Lee in their recent report titled Health.net. "E-commerce will generate hundreds of billions of dollars in health and medical supplies and product sales."

Providing counterpoint is a recent study commissioned by the two principle American dental supply industry associations, Dental Manufacturers of America and the American Dental Trade Association. Responses to a survey sent to 3,500 dentists nationwide indicate that despite the advent of computers and the Internet, most offices still place their bi-weekly orders by telephone. However, the Internet is playing an ever-increasing part in helping dental manufacturers sell their products directly to dentists.

"Last year we did in the neighborhood of 10 percent of total sales electronically, both through the Internet and other electronic means," says Bob Lamb, vice president of Information Systems for Henry Schein, Inc., the country's largest provider of Internet dental product ordering. "We've been in the electronic world for the last few years and were the first to get into Internet ordering about 18 months ago. That's been the fastest-growing part of our electronic business."

Some California dentists are logging on to take advantage of Internet ordering. A dentist practicing in Campbell in the heart of Northern California's Silicon Valley started using the Internet to order supplies about two years ago almost by happenstance.

"I started when I knew one of my staff was planning to be on maternity leave. I wanted a system I could use to order real quickly at home, and not have to train the new person we hired temporarily," says Walter G. Weber, DDS, immediate past president of the Santa Clara County Dental Society. "I right away liked the fact I don't have to call at a certain time and I could do it at home or in the office, even on the weekend. And it's kind of fun to order with the computer rather than writing up order slips or placing phone calls and pushing a lot of buttons."

He says that using his computer to order supplies and instruments is convenient because the program keeps track of everything he or his staff orders.

"I just ordered some bleaching supplies today, and I simply went into my previous order area and just clicked on it, and ordered it again," Weber says. "That's a real convenience factor that saves time in ordering. Of course, if you have new staff that comes in, you don't have to reinvent the wheel, because they can easily see what was ordered in the past, so that's another time saver."

Using the Internet to order supplies also saves money.

"Prices are a little less on the Internet than in the catalog," Weber says. "And some companies also give special discounts for ordering online, or put items on special sales available only online."

Weber says that virtually everything available in a regular printed catalog -- from burs to medications -- is available online.

"And if I order by noon I get it the next day," he says. "Delivery charges are the same as we were paying before, so there's no difference there."

While Weber is actively using the Internet to order supplies, another Internet-savvy dentist isn't quite there yet, admitting he's from the old school.

"I'm old-fashioned but want to get more into cyberspace," says Steven Hook, DDS, who practices in Marina Del Rey. Hook contributes to a Los Angeles-area web page that offers answers to web surfers' questions about health care issues.

"For years I was loyal to a full-service dental company. But I believe (Internet shopping) is something we'll have to get into," he says. "We've got 5-year-olds that can go all over the place on this. It's silly to not use the Internet to its multitude of advantages."

The advantages of ordering supplies via the Internet led Weber to prognosticate.

"It's a time saver, and it will also be a way to reduce costs, making it a more efficient and logical way to order supplies, so this is what's going to push this forward," Weber says. "If someone is computer literate, this is the best way for them to go."

Health Care Spending Follows HMOs' Lead

The more people in a given area served by managed care organizations, the lower the average expenditures for the care of patients in traditional Medicare fee-for-service plans, according to an article in the Feb. 3 issue of the Journal of the American Medical Association.

Laurence C. Baker, PhD, of Stanford University studied the association between the increasing market penetration by managed care organizations, specifically HMOs, and the payments made by Medicare for patients who were paying physicians per visit and per service (fee-for-service).

The author found that the percentage of fee-for-service expenditures paid by Medicare Part A (hospital care) and Medicare Part B (ambulatory care procedures and consultation that do not require an overnight stay at the hospital, such as regular doctor's visits and outpatient surgery) decreased as the market share of managed care organizations increased. The data was for the years 1990 to 1994, when the average HMO enrollment increased nationally from 15 percent to 21 percent.

"Lower expenditures in areas with high HMO market shares may indicate that traditional Medicare beneficiaries in areas with high market shares received fewer or less intensive services than traditional Medicare beneficiaries in other areas," according to the author.

Some reasons for the decrease in expenditures may be:

* The number of services used (e.g., the cost of two office visits versus the cost of just one office visit).

* The intensity or type of services used (e.g., the cost of diagnostic tests versus the cost of a simple office visit).

* The actual prices charged.

The author speculates that changes in number and intensity of services used, not necessarily changes in prices, are most likely to have the greatest overall effect on expenditures.

"Because it is relatively easy for managed care to affect expenditures by changing utilization but relatively difficult for managed care to affect expenditures by changing prices, perhaps the most straightforward explanation for the results seen here is that managed care contributed to reductions in the number or intensity of services received by patients covered by traditional Medicare," Baker says. He also notes that if managed care reduces the number or intensity of the services performed, then it is important to assess whether that will compromise the quality and results of the health care received.

Reach Out and Thank Someone

By Dell Richards

Washington wags used to say that former President George Bush got where he did by virtue of one thing and one thing only: thank-you notes.

Bush supposedly wrote 10 thank-you notes every day. While that story may be an exaggeration, in this alienated age a hand-written "thank you" touches people in a way that few other gestures do. It's an act of kindness that sets you apart and keeps you in a person's mind -- a good place to be when his or her tooth suddenly aches.

Dentists usually send notes to new patients, but that practice can be extended. Take time during the day to think of three people who did something for you -- from someone who went above and beyond the call of duty to someone who was just doing the job. It can be anyone from a hygienist or a dental supply representative to the department store salesperson or your dry cleaner.

To come across as genuine thanks, the notes must be hand-written. No matter what the size, use good quality paper or card stock. Postcard-size cards, third-cut cards that fit into No. 10 envelopes, and half sheets of stationery all work well. Always put them in an envelope.
A traditional thank-you note is a 5 -inch wide by 8 1/2-inch long half sheet of stationery, printed with your name and logo at the top. You could also have your name and logo printed on half of one side to create a card. If you use the greeting card format, write only on the inside bottom or right half. You may include "Sincerely" or not, depending on the familiarity of the relationship. Attach your degree after the signature if you feel so inclined or need it for recognition.

Even though it may seem like a lot of work to a busy professional, all you have to write is two or three sentences that mention a specific detail about the product, service or gesture and why it was appreciated. After a few weeks, you'll be amazed at the response.

Dell Richards is the owner of Dell Richards Publicity in Sacramento.

Timing May Change in Children's Orthodontics

A recent study shows that adolescents are reaching dental maturation earlier, reports George L. Nadler, DDS, in The Angle Orthodontist, Vol. 68, No. 6.

From the 1970s to 1990s, the age for dental maturity decreased by 1.21 years for males and 1.52 years for females, with a combined average reduction of 1.40 years. This trend may lead to earlier treatment of these patients.

According to a prior study, anticipating the timing of future growth spurts is essential to ensuring a successful outcome of orthodontic therapy. The calcification of the lower canine as a maturational indicator is especially valid for Caucasians. In this study, patient selection was limited to the following:

* Age range 8.5 years to 14.5 years of age.

* Caucasian children only.

* Middle socioeconomic group.

* Negative past and current medical history.

The focus of the study was to compare the dental ages at which specific tooth calcification occurs in two groups of patients whose treatments were separated by approximately 20 years, using the calcification of teeth as maturational indicators. The indicator for this determination was the lower right canine (tooth 43, FDI system). The percentage of tooth calcification was rated according to a method in which the states of tooth calcification are divided into eight segments, A to H. In this study only stages E to H were used. Maturational stages are defined when the following characteristics are discernible:

* Stage E: Root length remains shorter than crown height.

* Stage F: The walls of the pulp chamber form an isosceles triangle, and root length is equal to or greater than crown height.

* Stage G: The walls of the root canal are now parallel, but the apical end is partially closed.

* Stage H: Root apex is completely closed. The periodontal ligament surrounding the root and apex is uniform in width throughout.

Only the F and G stages were used for comparison data. (The elimination of the E- and H-stage patients reduced the sample size by about 50 percent.) According to the study, the average ages at stages F and G were as follows:

Handbook Offers Lowdown on State Dental Boards

The American Association of Dental Examiners has recently published the 10th edition of Composite, a handbook detailing the structure, licensing and disciplinary activities of all state dental boards.

Completed in 1998, the publication contains more than 25 charts describing state dental board structure and operations, licensee population within each state, 1997 board disciplinary activity and complaint statistics, and state licensing requirements. These charts, the result of surveys completed by the licensing jurisdictions, include general requirements, the use of clinical and didactic examinations, continuing education renewal requirements, and the methods used to conduct application background checks. Also included is a listing of licensure and disciplinary board contacts.

Charts are included on specialty licensure and nonaccredited graduates. Copies are available for $20 to AADE members and $35 for nonmembers (shipping costs included). All orders must be prepaid with check or money order payable to the American Association of Dental Examiners. Please print or type full name and mailing address, specify the number of copies you wish to purchase and send orders to: Composite, American Association of Dental Examiners, 211 East Chicago Avenue No. 760, Chicago, IL 60611.

For more information, contact Molly Nadler, AADE executive director, at (800) 621-8099 or (312) 440-7464.

Facial Plastic Surgery Is 'Archives' Subject

The American Medical Association has debuted a new journal -- the Archives of Facial Plastic Surgery.

The peer-reviewed journal offers original research from an international perspective for the medical specialties performing cosmetic and reconstructive surgery of the face which include: facial plastic surgery, otolaryngology-head and neck surgery, dermatology, and plastic surgery. The Archives of Facial Plastic Surgery is the 10th specialty journal in the AMA's Archive series.

The Archives of Facial Plastic Surgery is a complementary journal to the Archives of Otolaryngology -- Head & Neck Surgery, with the editorial boards working in cooperation. In addition to facial plastic surgeons, the editorial board of the Archives of Facial Plastic Surgery includes dermatologists, oculoplastic surgeons and maxillofacial surgeons. It is the official journal of the American Academy of Facial Plastic and Reconstructive Surgery and the International Federation of Facial Plastic Surgery Societies.

In addition to clinical studies, laboratory research and socioeconomic studies, the journal will also publish the following special sections: The Craft of Facial Plastic Surgery (presents innovative techniques); New on the Market (describes the results of using certain products with photographic illustrations); Beauty (a forum for visual or literary arts of interest to physicians); and Ethics and Public Policy (a section for essays on issues relevant to physicians and patients).

The quarterly journal will be published in February, May, August and November each year.

Upcoming Meetings

1999
April 8-11 CDA Scientific Session, Anaheim (916) 443-3382, Ext. 4470

April 13-17 International Dental Show, Cologne, Germany, http://www.koelnmesse.de/ids

April 15-17 International Congress on Reconstructive Preprosthetic Surgery, San Diego (310) 376-0752

April 23-26 UOP/ADA National Conference on Over-the-Counter Dental Drugs and Products, San Francisco (415) 929-6486

April 27-May 1 The American Academy of Oral Medicine Annual Scientific Session (410) 602-8585

April 29-May 1 British Dental Association National Dental Conference, Torquay, England 0971 935 0875

Sept. 16-18 CDA Scientific Session, San Francisco (916) 443-3382, Ext. 4470

Sept. 17-18 Society for Advanced Dentistry Annual Meeting, New Orleans (317) 290-2613

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.