Tuesday 8 January 2013
Dentists vs. insurers: The road ahead
Dentists vs. insurers: The road ahead
November 5, 2007 -- One evening after attending the ADA's annual session in San Francisco, Karen Gustin was chatting with a dentist on the shuttle bus to her hotel. When he found out Gustin was vice president of marketing for insurer Ameritas Group Dental and Eye Care, he asked the person next to him if he could trade seats. "It was a joke -- sort of," says Gustin.
It shows just how tenuous -- even adversarial -- the relationship between dentists and insurance companies is. But as current healthcare trends show, you can't avoid dealing with insurance companies. Soon, you'll be even more involved with them.
Gustin and other insurance industry panelists described how the dentist/insurer relationship will evolve in "An Inside View of Dental Benefits" presentation at the ADA conference, underwritten by the National Association of Dental Plans (NADP).
All the panelists stressed insurers value good relationships with dentists. Besides having dedicated provider relations staff, insurers have advisory panels composed of dentists. "We take your comments very seriously," says Gene Sherman, a former dentist turned chief operating officer of Starmount Life Insurance Co.
Why should you care?
It's in your best interest to track where dental plans are going, says Jon Seltenheim, senior vice-president of operations at United Concordia Companies. "Dentists should want more people to enroll because coverage overcomes the cost barrier, making people more likely to visit the dentist and more often, and have more dental procedures."
In 2004, $81 billion was spent on dental care, and insurers paid half of that tab. The NADP predicts expenditures will more than double, to $167 billion, by 2015. That's partly due to more Americans getting dental benefits. (In 2006, it was 176 million, 57 percent of the U.S. population.) Half the people with dental benefits belong to a dental Preferred Provider Organization, and 23 percent belong to a dental indemnity plan, but the latter is pricey for both dentist and patient and will keep declining in popularity.
Many dentists wonder why maximum annual benefits have not increased in the past 25 years. That's due to employers, who provide 96 percent of Americans' dental coverage. According to Seltenheim, because medical costs keep going up, employers can only offer so much health insurance coverage. When push comes to shove, dental benefits are often the first to go. "The medical side is what drives their agenda because it's so difficult to control."
New products and target markets
The NADP estimates 41 percent of employers change their dental plan solely because of rates. They're also making more employees contribute more out-of-pocket costs.
Insurers are coming up with new options to keep both groups on board, such as increasing maximums based on a person's overall wellness. One approach: "Rollover maximums," which roll over a portion of an employee's annual maximum to future years as long as the employee visits the dentist at least once a year. Insurers are also expanding coverage to include implants and sealants for more age groups.
With the large-employer market saturated, dental insurers are going after small businesses and individuals, particularly the uninsured, part-timers, and retiring Boomers whose dental costs are not covered by Medicare. Individual-coverage plans have doubled from 12 to 23 in the past three years, and the AARP recently announced its own dental plan, sponsored by Delta Dental. That doesn't mean individual plans won't be less cost-sensitive, says Gustin. "It's like the Burger King slogan ‘Have it your way.' That's what people want, but they'll still be sensitive to costs as more of the premium costs shift to their pocket."
Get your money fast
Insurance companies are also emphasizing electronic claim filing (39 percent of all carriers currently offer it) which pays dentists three times faster than snail mail. And no, insurers are not sitting on claims longer than usual to earn interest. "States require us to pay within 14, 21, or 28 days," says Sherman. "What holds payment up is when we don't get all the necessary documentation."
A dumb reminder -- but one many dental offices don't follow -- is filling out all the required fields on forms and X-rays. Submitting duplicate X-rays is a good idea but don't send Xeroxed copies of radiographs. "They're too hard to read, and that will hold up your claim even longer," says Sherman.
Narratives provide good information -- but use them judiciously, Sherman adds. "They're helpful if there are extenuating circumstances but they can also create delays. They can't be auto-adjudicated, meaning the processing computer will spit out a claim with a narrative for a human to review it."
Insurers have partnered with National Electronic Attachment to create FastLook, a one-stop web site that lets dentists see all insurers' guidelines for claim filing. Go to http://www.nea-fast.com/ for details.
Future plans
The NADP is partnering with the ADA, dental societies, and dental insurers on several initiatives, including a tax break for dentists upgrading their office equipment, the inclusion of dental coverage in Health Savings Accounts, and a national campaign to promote oral health literacy.
The latter is especially important said panel members, as the media discovers that poor oral health is linked to higher risks for heart disease, stroke, and Alzheimer's. "The dentist is usually the first to identify systemic health problems--120 disease symptoms can be detected in the mouth alone," says Doyle Williams, a former dentist and chief dental officer for insurer DentaQuest. "We can rally around this point to increase people's access to dental care."
Insurers are looking to tweak coverage after assessing a person's risk status, says Williams. "It will no longer be one-size-fits all. It will be linked to one's health risks."
To increase oral health, Williams predicts insurers will soon cover the following:
Chlorhexide mouth rinse after scaling and root planning
Prescription-strength fluoride toothpaste for adults after periodontal surgery
Sealants for a greater range of age groups
More treatments for pregnant women and diabetics
Looking down the road a ways, the NADP is sponsoring scientific studies of vaccines and stem-cell research for further oral-based treatments. For now, its biggest push is creating assessment tools to identify people at highest risk, so they can get more frequent prophylaxis, scaling, and root planning.
These efforts can only pay off for dentists, says Williams. If insurers can identify these patients and get them treated earlier, they'll realize they need insurance. That means, says Williams, they'll be in your office more often and be getting the care they need.
Related dental links: Handpiece Dental Burs Micro Motor
Dentists,vs.,insurers:,The,road,ahead
Nonpracticing dentists now eligible for ADA membership
Good bacteria beat periodontal disease
November 1, 2007 -- Can you fight bacteria with bacteria? Apparently so, according to a new animal study in the November issue of the Journal of Dental Research. In the study, a mixture of beneficial bacteria was applied after scaling and root planing (a technique known as Guided Pocket Recolonization or GPR). The results: growth of plaque-causing bacteria was substantially slowed and reduced, as was inflammation. The technique could be a way to sidestep the problem of antibacterial resistance, and be a useful adjunct to traditional periodontal treatments.
In this study of "probiotic" treatment, researchers used bacteria replacement therapy on male beagle dogs after scaling and root planning.The study divided the dogs into four groups: A negative control group that received no treatment, a positive control group that received subgingival scaling and root planning, a group that received a single application of bacterial mixture, and one that received multiple applications. The multiple applications group had the greatest reduction in anaerobic and black-pigmented bacteria, followed by the single application group. The multiple application group also showed maximum reduction in levels of P. gulae.
Wim Teughels, corresponding author and professor in the Department of Periodontology at Catholic University Leuven, noted in a press release that additional studies must be conducted to assess the viability of this treatment in humans. Marc Quirynen, principal investigator and a professor at Catholic University Leuven, and his team are continuing to test non-pathogenic bacteria that are helpful to humans, noting "We hope the current study will inspire other investigators to consider periodontal disease therapy from this novel perspective."
Related dental links: ultrasonic cleaner Compact Cleaner ultrasonic scaler
Good,bacteria,beat,periodontal,disease
Do race and class affect dental care?
Do race and class affect dental care?
November 1, 2007 -- Race and economic stature play a key role in the quality of dental care a patient receives, according to a new study in the November issue of the Journal of Health Care for the Poor and Underserved.
"Drawing from [an] evaluation [of data collected for the Florida Dental Care Study], we conducted research to determine if African Americans or lower-income individuals attend [dental] practices that are typically different from practices attended by their white or higher-income counterparts," said Gregg Gilbert, D.D.S., chair of the Department of Diagnostic Sciences at the University of Alabama at Birmingham School of Dentistry and author of the paper in a press release.
Researchers discovered that dentists who cater mostly to black or lower income patients have busier practices with longer waiting times. These dentists are also less likely to discuss preventative care, certain diagnostic and treatment services, and alternatives to extraction with their patients.
Although the study was based on questionnaires answered by a small group of dentists, the authors feel these results resonate with other findings, and represent a nationwide trend.
Related dental links: Micro Motor ultrasonic cleaner Compact Cleaner
Do,race,and,class,affect,dental,care?
Good bacteria beat periodontal disease
Good bacteria beat periodontal disease
November 1, 2007 -- Can you fight bacteria with bacteria? Apparently so, according to a new animal study in the November issue of the Journal of Dental Research. In the study, a mixture of beneficial bacteria was applied after scaling and root planing (a technique known as Guided Pocket Recolonization or GPR). The results: growth of plaque-causing bacteria was substantially slowed and reduced, as was inflammation. The technique could be a way to sidestep the problem of antibacterial resistance, and be a useful adjunct to traditional periodontal treatments.
In this study of "probiotic" treatment, researchers used bacteria replacement therapy on male beagle dogs after scaling and root planning.The study divided the dogs into four groups: A negative control group that received no treatment, a positive control group that received subgingival scaling and root planning, a group that received a single application of bacterial mixture, and one that received multiple applications. The multiple applications group had the greatest reduction in anaerobic and black-pigmented bacteria, followed by the single application group. The multiple application group also showed maximum reduction in levels of P. gulae.
Wim Teughels, corresponding author and professor in the Department of Periodontology at Catholic University Leuven, noted in a press release that additional studies must be conducted to assess the viability of this treatment in humans. Marc Quirynen, principal investigator and a professor at Catholic University Leuven, and his team are continuing to test non-pathogenic bacteria that are helpful to humans, noting "We hope the current study will inspire other investigators to consider periodontal disease therapy from this novel perspective."
Related dental links: ultrasonic cleaner Compact Cleaner ultrasonic scaler
Good,bacteria,beat,periodontal,disease
Beat the malpractice rap
Beat the malpractice rap
November 1, 2007 -- "Malpractice" was the word at two same-day presentations held at the recent ADA show in San Francisco. Both sessions discussed how dentists could arm themselves against patient lawsuits. The best defense? Take good notes.
A complete patient record should include more than just treatment notes, say Curtis Jensen, a Monterey, California dentist, and David J. Weiss, a Los Angeles medical/dental malpractice attorney, who co-presented the "Risk Management" session. "Your practice hinges on your records. They're legal documents, evidence, and your best defense in a lawsuit."
One sixth of the medical malpractice lawsuits in the U.S. are filed against dentists (it's one third in California), according to Mitchell Gardiner, a dentist in Fair Haven, New Jersey, who reviews malpractice lawsuits as an expert witness and hosted the ADA session on "Malpractice and Documentation." "You think you charge a lot for a crown? Wait till you see the legal fees associated with a case."
A typical lawsuit
To illustrate how bad note taking can come back to haunt dentists, the seminars presented real lawsuits. Consider the California case of Reese v. Mallory. Reese had been a patient of Dr. Mallory since 1980, but continually declined X-rays and periodontal probing due to cost concerns. By 2003, she had only 21 teeth remaining. The following year, Reese complained of pain in tooth #21. Mallory found nine-millimeter pockets and suggested extraction. He also referred Reese to a periodontist, who took radiographs and was shocked to see seven 9-mm. pockets throughout Reese's mouth. Her lower teeth couldn't be saved. The periodontist called Mallory, who was surprised but explained Reese's X-ray refusals.
Meanwhile, a frantic Reese searched the yellow pages for a prosthodontist, who suggested she sue her dentist. Reese sought $150,000 in compensatory damages, alleging Mallory neglected to treat her periodontal disease over a 20-year span.
When the attorneys asked for Mallory's patient record, all he had to show was one page, scrawled in nearly illegible pencil, lacking any detail on appointments spanning over 20 years. He had referred her to a periodontist 14 times, but never noted that on the chart.
"Mallory did very little to prepare himself, despite lots of warning signs," says Weiss. "Patients who consistently refuse X-rays or referrals are the ones who are going to trap you."
The result? Mallory settled the case for a six-figure sum.
Record this
Every patient record should include:
All radiographs, lab forms and models, plus a summary of what you learned from them
A complete description of the dental treatment performed
How that treatment will address problems identified in your diagnosis
If your diagnosis leads to more than one treatment alternative, note them all
Any reasons for choosing an uncommon alternative
Whether all or part of the treatment requires a referral to a specialist, and who you recommended
"The most accurate records are those you take down while seeing the patient," says Gardiner. "Patient complaints and discussions are easy to forget later on."
Even if your patient signs a waiver, you're still at risk, says Weiss. "If you lay an instrument on a patient and you see suspicious signs, you should know better than to do nothing."
Jensen requires his patients to sign an informed refusal form, and educates them on the consequences of rejecting treatment. He also follows up with a separate letter. "When my patient refuses X-rays, I tell him that if he does not get radiographs within two weeks, he must find another dentist. I document it in the record." If the patient leaves, says Jensen, he sends them a letter and notes their exit from his practice. "Good riddance," says Jensen. "The stress is gone."
But a referral doesn't get you off the hook. If that specialist screws up, the patient will often sue both of you. "Know who you are referring to," says Jensen. "Your colleagues are an extension of your practice." The more serious the referral, the more you must follow up on outcomes. Don't just give the patient a verbal referral. To protect yourself, schedule that referral appointment from your office before the patient leaves.
It is acceptable to make changes in your records, says Gardiner, but you must date the new info, relate it to the previous entry, and explain the change. If you made an error, cross it out and label it as "error." Don't make any subjective comments about the patient on the chart – keep a separate diary sheet in the folder so it won't be involved in the lawsuit. Financial records should also be kept separate.
Health histories are vital
It's recommended that you now take patients' vital signs (blood pressure and pulse) at every visit and pay attention to external indicators, such as clammy skin, shortness of breath, and the patient's comments about their well-being. If the signs look bad, consider not treating them and/or referring them to a physician for a checkup.
Failure to do so and the consequences are illustrated in the case of Larson v. Andrew. The 53-year-old obese Larson checked "no" to all health history questions every year. During a tooth extraction, Larson had heavy breathing and clammy skin and despite documenting it, Andrew said nothing and went on with treatment. He requested Larson get a follow-up call after the appointment but the staff forgot. As they all left for the day, they saw Larson slumped over in his car, dead for several hours. His wife sued for $750,000 in compensatory damages and future earnings (Larson earned good money), alleging Andrew's failure to review Larson's health, resulting in his death. The jury found Andrew negligent for not voicing concerns. Although Andrew did not have to pay damages, his reputation took a beating.
Bottom line: Update your patient's health history at every appointment (skip the two weeks for crowns and bridges). Your patient should sign it and you should initial it to show you looked it over. If an answer doesn't jibe with what you've observed in your patient, inquire verbally and note the patient's responses in the record.
Protect yourself
Check your state's Dental Practice Act for dental recordkeeping requirements. All three presenters stressed that you must never throw records away. That's because in most states, the statute of limitations is two years from the time the incident occurs or when the patient discovers it, which could be 20 years after treatment.
Digital records are an ideal way for documenting patient history. You eliminate illegible handwriting and make diagnosis and treatment easier for you and your patient to follow. Electronic records are easier to transfer and take up far less space than their paper kin.
So when your next patient comes in, open your ears, uncap a pen and start taking notes. Minor hand cramps and inky fingers are a minor price to pay for avoiding thousands in legal fees, or worse, a huge judgment. "No matter how much time you spend caring for your patients, if you don't note it in your records, it won't make a difference to a jury of 12 non-dentists," says Gardiner.
Related dental links: Compact Cleaner ultrasonic scaler ultrasonic scaler dental
Beat,the,malpractice,rap
Paperless dental office still a myth
Paperless dental office still a myth
October 31, 2007 -- You can do your taxes, apply to school, and even buy your groceries via computer. One of these days, paper seems sure to follow clay tablets as an outmoded means of record keeping. So why do dentists still track their patients on paper?
The answer, according to a recent study published in the July/August issue of the Journal of the American Medical Informatics Association, is that computerized record keeping systems for dentists are incomplete and difficult to use.
"Transporting a dental practice from paper to computer is not a simple process," co-author, Titus Schleyer, DMD, PhD, told DrBicuspid. "Everyone can write progress notes on paper...but not everyone can use a computer program."
Resistance to tracking dental patients digitally is particularly surprising, since most dentists in the United States use computers for billing and appointments.
Well-designed medical records software should appeal to dentists for all the same reasons that superior accounting programs do. Paper records are bulky; difficult to share or search; awkward to backup; vulnerable to water, fire and mildew; and do not follow a uniform format
Yet according to the study, as of 2000, while 85.1 percent of all dentists in the United States use computers in their office, only 1.8 percent maintain complete computer-based patient records (CPRs).
So what's stopping dentists from going paperless?
The study found that, in fact, CPRs programs aren't all that well designed--they don’t capture all the information that a dentist might want to keep on a patient. These programs also are difficult to navigate. Worse, says Dr. Schleyer, when you switch from one screen to the next to review patient information, you must remember what you saw on the previous screen. Also, data fields that are commonly grouped in paper-based records aren't in some CPRs programs or are completely absent.
The researchers evaluated 10 existing paper record formats--four from practicing dentists, two from dental schools, and four from commercial vendors, and also consulted three textbooks that cover dental records.
They extracted and categorized all data fields from these sources and created a Baseline Dental Record (BDR). The authors eliminated fields that applied to specific populations (such as students or faculty), and those that duplicated the format or content of other fields.
The authors don't consider the BDR to be the gold standard for dental record keeping. "It is simply a good place to start for improving existing CPRs," said co-author Heiko Spallek, DMD, PhD, who, like Schleyer, is on faculty at the University of Pittsburgh Center for Dental Informatics.
The information content of the BDR was then tested against four major CPR programs -- Dentrix V. 10.0.36.0, EagleSoft V. 10.08 and SoftDent V. 10.0.2.94 and PracticeWorks V. 5.0.2.034 -- which collectively have 80 percent of the market share. The study focused only on clinical data fields and did not consider administrative fields such as billing and scheduling. It compared single data fields, as well as categories of data fields.
The BDR had 20 main categories and 363 data fields. On average, the CPRs programs evaluated can only record data in 11 to 16 of the BDR's categories and only 174 data fields. Three categories completely absent in all the reviewed CPRs programs were chief complaint, systemic diagnosis, and problem list.
The CPRs programs were also limited in their ability to chart hard tissue and periodontal findings. Collectively, the four CPRs applications could chart 31 percent to 88 percent of the hard tissue conditions listed in the BDR. Of the 28 conditions listed in the BDR's periodontal section, only six could be charted in all systems. Five could not be charted at all.
The CPRs vendors reviewed the results of the study and their comments are included in the study. One vendor noted that any of the clinical categories or fields that were missing could easily be entered as text in progress notes.
But the authors don't consider this an adequate alternative. "For example," they wrote, "although the numerical reading of a caries test for a single tooth can be recorded in the progress notes, a much better place would be the hard tissue chart, where it can be directly associated with the tooth and related data." Entering information in text fields reduces efficiency and effectiveness.
Kodak complains that the versions of PracticeWorks and SoftDent used in the study were released in 2003, are now out of date, and don't "accurately reflect the capabilities" of the company's offerings. "In the four years since then, we have released several major updates for both products that have both added functionality and expanded clinical data," said Steve Mallot, Director, Dental Development, KODAK Dental Systems in an email to DrBicuspid
Another vendor argued that its program could be customized to accommodate charting. All the tested CPRs could be customized to some degree but were all tested in default mode. "In the medical community customizing creates all kinds of hassles," Dr. Spallek told DrBicuspid. Besides, added Spallek, dentists pay a lot of money for these specialized programs. Why should they have to spend the extra time and/or money customizing them?
The BDR is currently a working project in the ADA's Standards Committee on Dental Informatics (SCDI).The ADA will use the results from the BDR study to create a more complete model. When this phase will be complete--and how CPRs vendors will respond--is unknown.
Related dental links: ultrasonic scaler ultrasonic scaler dental Teeth Whitening
Paperless,dental,office,still,a,myth
Delta Dental expands coverage
Delta Dental expands coverage
October 30, 2007 -- Delta Dental Insurance Company and Delta Dental of Pennsylvania recently announced that they are adding additional cleanings and oral exams for pregnant women, and implant coverage to their standard programs.
"By offering implant coverage as a standard benefit, we give patients more choices when replacing lost teeth," said Marilynn Belek, DMD, Delta Dental’s executive vice president and chief dental officer in a press release. "The efficacy of implants is a proven, viable clinical alternative, and this coverage helps make it more affordable for more people."
And although periodontal disease has not been directly linked to pre-term babies or lower-weight babies, this new coverage feature will nevertheless provide pregnant women the benefits of better oral health according to Dr. Belek.
"Meanwhile, we continue to monitor the results of evidence-based studies to ensure that any benefits we add are cost-effective and beneficial to our enrollees and customers," said Dr. Belek in a press release.
These additional benefits will be offered in Alabama, Delaware, Florida, Georgia, Louisiana, Maryland, Mississippi, Nevada, New York, Pennsylvania, Texas, Utah, West Virginia and the District of Columbia, starting Jan. 1, 2008 or later.
Related dental links: ultrasonic scaler dental Teeth Whitening teeth whitening kit
Delta,Dental,expands,coverage
Kids and candy: Don't be a Halloween Grinch
Kids and candy: Don't be a Halloween Grinch
October 30, 2007 -- Pumpkin patches, a nip in the air, goblins, ghosts, ghouls -- and lots of candy. Yup, it's that time of year again. And around the country, dentists want to know how they can avoid becoming the Grinch of Halloween.
It's a classic dilemma. On the one hand, sugar contributes to the damage that dentists spend their lives fixing. On the other hand, what's Halloween without trick or treating? In coping with this apparently no-win situation, dentists fall into three camps.
First, there's damage control. "Ideally kids should not eat any candy, but it's Halloween," said Emily Wu, D.D.S., a pediatric dentist in San Francisco. She counsels patients and their parents to focus on sugar-free candy, to avoid sticky sweets that linger on the teeth, and to brush, brush, and brush some more.
Irfan Atcha, D.D.S., who practices in Dyer, IN, offers another approach to mitigation that is catching on among dentists nationwide. He invites children to come in between 3:30 p.m. and 6:30 p.m. the day after Halloween with their bulging loot bags. The kids will receive $1 for every pound of candy they turn in. There's only one catch -- no bites.
"It is my campaign against cavities and tooth decay amongst the kids here in Indiana," stated Dr. Atcha in an e-mail to DrBicuspid.com. "The candy that we buy from the kids will be shipped oversees to the troops who are fighting for our security, and it will bring a bit of cheer and sweetness to their day."
The second alternative is to direct the celebration way from the mouth. "A treat does not have to be candy. Give them coloring books, sharpies, temporary tattoos," said Mary Hayes, D.D.S., who practices in Chicago and is a spokesperson for the American Dental Association. "I have children who are high caries risk and get tooth decay at the drop of a hat. This way they don't feel deprived." She also recommends rationing the candy, and giving it to the children as dessert.
And the third approach? Capitulation may be too strong a word. Let's call it .... discretion. "In our culture Halloween is a fun day -- one day out of the year," argued Helaine Smith, D.M.D., from Boston. "Cavities are a complex disease process that does not happen from eating a little bit of Halloween candy."
As for handing out sugar-free treats she has only four words: "It's never gonna happen."
Related dental links: Teeth Whitening teeth whitening kit teeth whitening gel
Kids,and,candy:,Don't,be,a,Halloween,Grinch
Xylitol gum to the rescue
Xylitol gum to the rescue
October 29, 2007 -- SAN FRANCISCO -- Chomping away on gum has never been a charming habit, but now we have a legitimate medical excuse for it. That's according to John W. Shaner D.M.D., M.S., Associate Professor at the Creighton University Medical Center School of Dentistry. He argues that xylitol- and sorbitol-based gums are so effective at fighting caries that dentists should be handing them out like... well, candy.
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"Sugar is the main driver for caries, so we should be promoting sugar-free products," said Dr. Shaner, who spoke at the recent American Dental Association's 148th annual session here, just in time to influence trick or treating.
Sorbitol and xylitol gum lower caries by 40 percent to 80 percent respectively, he said. Chewing any kind of gum stimulates saliva, which neutralizes acid produced by plaque bacteria and helps in remineralization. When the gum is sugar-free, the chewer gets this benefit without giving bacteria a sugar feast.
Sugar-free gum comes with a variety of sweeteners, but most contain sorbitol or xylitol. "Sorbitol tends to be the main sweetener in most sugar-free or sugarless gums due to cost and its ability to blend with flavors and other sweeteners such as mannitol, xylitol, maltitol, tagatose, isomalt, saccharin, and aspartame," said Dr. Shaner in an email interview with DrBicuspid.com. "Each company has a proprietary recipe that makes their gum taste a certain way, [hoping] that it will sell better."
However, some plaque bacteria can metabolize sorbitol if in contact with it for a long period of time. Chewing sorbitol gum for more than 20 minutes increases its careogenic potential.
Xylitol is more effective because it "tricks" plaque bacteria, Dr. Shaner said. When the organisms try to metabolize xylitol, they convert it to xylitol 5 phosphate, which is toxic to them. In expelling this substance, they waste energy they would otherwise use to grow and multiply.
The American Dental Association has recently given its seal of acceptance to three sorbitol-based gums -- Orbit, Extra, and Eclipse. The ADA receives $12,000 for each gum it knights, said Dr. Shaner. But the acceptance has evidence behind it, he argued. "Toothpaste gets a seal of approval. Why shouldn’t gum?"
For its part, the U.S. Food and Drug Administration (FDA) has only approved the statement that xylitol doesn't cause caries -- not that it helps prevent them. But other researchers agree with Dr. Shaner. "The evidence is strong enough to support the regular use of xylitol-sweetened gum as a way to prevent caries, and it can be promoted as a public-health preventive measure," wrote Brian A. Burt B.D.S., M.P.H., Ph.D. in the February 2006 issue of the Journal of the American Dental Association. (In an email interview with DrBicuspid, Dr. Shaner cited a half dozen studies supporting this view.)
Dr. Burt agrees with Dr. Shaner that sorbitol should be considered a low careogenic sweetener instead of noncareogenic."Dentists should advise their patients who chew sorbitol-sweetened gum to do so no more than three times per day," he wrote.
Although xylitol is the more effective sweetener, sorbitol-based gum is more common because it is cheaper. For example, you can buy 144 pieces of Wrigley's Orbit gum on Amazon for $11.73. A 100-piece bottle of Xylichew sold on the same site will run you $19.57. That's probably why the xylitol in some gums is diluted with other sweeteners.
Always check the label to see how much xylitol a gum contains, Dr. Shaner warned -- and how much sugar. (Under FDA regulations, gum can be labeled "sugar-free" or "sugarless" if it contains less than half a gram of sugar per serving. "Less sugar", on the other hand, means at least 25 percent less sugar than a reference product.)
How much to chew
Dr. Shaner recommends chewing six grams of xylitol gum per day, in at least three sessions of five to 20 minutes each. Chew less, and you'll get the benefits from increased saliva flow, but not the antibacterial effect. (Chewing more than 40 grams a day, on the other hand, can cause laxative effects.)
Since some gums contain a gram or less of xylitol per piece, you might have to chew two at a time to get the full six grams. "Chewing a theraputic dose of xylitol gum is about a dollar a day habit," pointed out Marilynn Rothen, R.H.D, B.S. at the University of Washington Seattle, in a DrBicuspid interview.
Dr. Shaner recommends Ice Breakers Ice Cube which is readily available, and Epic, Zapp, XyliChew, Spry, and Peelu brands, which are available in health stores or online. For those patients who don't like chewing gum, Dr. Shaner recommended sucking on xylitol hard candies.
And he urged dentists to encourage the habit. "Do your new patients leave with a toothbrush and toothpaste kit?" he asked the audience. "Do they leave with a piece of xylitol gum?" Scanning the unresponsive faces before him he frowned. "They should!" he said. "Forty percent reduction from sorbitol, 80 percent reduction from xylitol. Why aren’t you giving them gum?"
Related dental links: teeth whitening kit teeth whitening gel Water Filter
Xylitol,gum,to,the,rescue
ADEA plans to diversify dentists
ADEA plans to diversify dentists
October 29, 2007 -- The American Dental Education Association (ADEA) announced this month it had received a $550,457 grant to encourage people from African-American, poor, and other underrepresented groups to become dentists.
ADEA will use the grant, provided by the Josiah Macy, Jr. Foundation, to plan a seven-year combined undergraduate and graduate dental curriculum based on one being used by the Sophie Davis School of Biomedical Education to diversify medical schools.
Students will be recruited from high schools with "dense populations of underrepresented minorities and low income students," says Jeanne Sinkford, D.D.S., Ph.D., director of the ADEA Center for Equity and Diversity "You go where the marbles are."
The students will spend five years in an undergraduate program that provides part of their preclinical training. After two more years at a dental school, they will have all the training required to become dentists.
"Only 5 percent of practicing dentists are African-American," said ADEA President James Q. Swift, D.D.S, in a news release. "And the percentage remains sadly similar for Hispanic dentists and much smaller for American Indians and Alaskan Natives. Given the demographic changes in the United States, it is a priority of ADEA to increase the enrollment of [these groups]."
Four educational institutions will participate: Columbia University College of Dental Medicine, the University of New Mexico, and the Medical College of Georgia School of Dentistry in collaboration with the Atlanta University Center. Each will partner with a nearby undergraduate school. For example, the Georgia School of Dentistry will work with Morehouse College.
Related dental links: teeth whitening gel Water Filter intraoral camera
ADEA,plans,to,diversify,dentists
The end of cavities? Part II
The end of cavities? Part II
October 26, 2007 -- After attending a meeting on plaque in the late 1990s, Albany, California dentist Nathan Kaufman, DDS, began to see just how much dentists could do to prevent caries. The realization gradually led him to transform the way he treats his patients -- and the way he makes his living. "We're changing the paradigm," he says
Dr. Kaufman has joined a new movement in dentistry called caries management by risk assessment (CAMBRA). Adherents use diagnostic tools to estimate each patient's risk of developing cavities, then bring to bear preventative therapies -- frequent cleanings and exams, fluoride varnishes and gels, calcium phosphate, xylitol gum and antibacterial rinses -- to according to the patients' needs.
The movement is gaining steam; the Journal of the California Dental Association is devoting its October and November issues to the topic, along with an endorsement of CAMBRA signed by representatives of most U.S dental schools. "Not only is it scientifically interesting, it's the right way to treat patients," says Dr. Kaufman, who argues that CAMBRA will soon become the legal standard of care.
When the approach works, patients get far fewer cavities. For the dentist, that means less money from restorations. But it also means attracting more patients, Dr. Kaufman says. "If you have twice as many patients but do half as much work on each one, you make the same money."
Not everyone is ready to hop on the CAMBRA wagon. Some dentists operate as if nothing has changed. They encourage brushing and flossing, but don't bother with more aggressive prevention techniques. They may cater to patients who didn't benefit as much from the fluoride revolution and have plenty of restorations that need maintenance.
Other dentists are emphasizing cosmetics, catering to patients with healthy teeth who want to brighten or balance their smiles.
But a cutting edge group of dentists like Dr. Kaufman who embrace CAMBRA claim they make as good or better money than their hide-bound peers. "I have a small number of colleagues around the country who are making a good living doing this," said John Featherstone, M.Sc., Ph.D., dean of the University of California at San Francisco dentistry school and one of the movement's leaders. How is this possible?
Ready or not
The answer isn't obvious. First there's the problem of reimbursement. Few, if any, insurers will cover more than two examinations in a year, much less chewing gum. Patients are often reluctant to pay for anything their insurance won't cover, so it's hard for dentists to reap a profit on these services and prescriptions.
And it's hard to attract patients before they feel any pain. "Prevention just doesn't sell," says Ed O'Keefe, a Chicago dental marketing consultant.
But insurers are beginning to embrace preventive techniques, since they drive down the companies' own costs says Tom Limoli, an Atlanta insurance consultant. Employers are driving the change because they shoulder most of the cost of dental insurance in the United States. As insurance portability laws take effect, argues Limoli, there will be more competition among insurers, forcing them to look for more efficient approaches to dental care -- such as CAMBRA. Already some Delta Dental plans are paying for fluoride varnishes.
Being on top of such trends can make a dentist stand out from competitors, says Dr. Kaufman.
Limoli suggests offering promotional discounts -- such as those through a dental discount plan -- to get patients in the door. Once in the chair, the dentist must deliver a good experience.
Dr. Featherstone insists patients will buy into preventative treatments once they understand the benefits. "People like to know that they won't be coming back with pain, for implants, for bridges. And they are telling their friends. Every [dentist] I know who is doing CAMBRA in private practice is building their practice."
By the time Dr. Kaufman went into semiretirement in 2005, he had built his practice up to 3,600 patients, creating a constant stream through the door. "We had to start early and work through lunch," he says. His only marketing has been word of mouth.
One key to CAMBRA as a business model is relying more on hygienists who can do fluoride treatments and much of the other work. Kaufman booked 13 days of hygienist time per week.
"This is the future," says Dr. Kaufman. "Whether you join now or later."
Related dental links: Water Filter intraoral camera Wired Camera
The,end,of,cavities?,Part,II
Caries prevention: New legal standards?
Caries prevention: New legal standards?
October 26, 2007 -- Where professors tread, lawyers are sure to follow. A new consensus statement that will be published in the November issue of the Journal of the California Dental Association looks likely to increase dentists' liability for preventing cavities.
"Consensus Statement Caries Management by Risk Assessment: Implementation Guidelines to Support Oral Health" briefly describes how dentists should assess their patients' risk of caries and work aggressively -- using counseling, antibacterials, and remineralizing agents -- to prevent the disease from damaging teeth. It includes endorsements by caries experts from most U.S. dental schools, including 18 deans.
"Once this is out there and published, it's going to become the standard of care," said co-author John Featherstone, M.Sc., Ph.D., acting dean of the University of California San Francisco School of Dentistry. The standard of care is the scale juries use to weigh a dentist's guilt or innocence in malpractice lawsuits.
Although the full legal implications of the consensus statement might take some time to work out, Dr. Featherstone argued that the principles in the statement -- known as caries management by risk assessment (CAMBRA) -- have been known for years and that dentists should already be putting them into practice.
But most aren't. "If somebody comes in with frank cavities in their teeth, we know there is bacteria in their mouth," he said. "But what does the dentist typically do? They fill the teeth and say, 'Go home.' The prevention they offer is, 'Brush your teeth and you'll be all right.' "
Attempts to change that attitude are already under way at most dental schools, according to Martin Davis, D.D.S., a professor of pediatric dentistry at Columbia University. "We have to educate the whole profession on this."
He questions whether CAMBRA (which some advocates refer to as "anticipatory guidance") has the force of law. "Nobody is going to come down on anybody yet," he said.
But somebody already has. Dental malpractice attorney Edwin J. Zinman, D.D.S., J.D., argues that most of the consensus statement's ideas are taught in dental schools and were articulated in a similar 2003 statement in the Journal of the California Dental Association and statements by the American Dental Association. "The legal ramification is that it's the standard of care," he said. "It's what all reasonable dentists should be doing."
In fact, Dr. Zinman said, he has already won cases against dentists who aren't taking aggressive enough measures to prevent decay in their patients' teeth. He cited one recent $75,000 settlement won from a dentist who replaced a patient's broken restoration without taking steps to control the patient's caries. "Dentists who are not doing this are putting their patients at medical risk and putting themselves at legal risk."
The guidelines
So what must dentists do to protect themselves and their patients? The consensus statement says they should use factors such as past history of caries to sort their patients into three categories: low, medium, high, and extreme risk.
Moderate-risk patients should get "improved remineralization therapy and reduction of other risk factors, which may include antibacterial therapy." High-risk patients should get all of the above including antibacterial therapy. Extreme risk patients should get all the same treatments as high-risk patients plus, if they have severe salivary dysfunction, "buffering agents and calcium and phosphate supplementation." (The statement gives no advice for low-risk patients.)
The document does detail some specifications of the antibacterial and remineralization products that dentists should use.
Other articles printed in the October and November issues of the Journal of the California Dental Association offer even greater detail on these products, and more specific risk assessment guidelines.
Though the consensus statement captured a wide representation of dentists, not everyone is on board. Domenick Zero, D.D.S., M.S., a caries researcher at Indiana University said he declined to sign. "The article contained endorsements of commercial products," he said. "The [authors] give them all this credence, and I don't think it's right."
For example, he objects to the document's endorsement of xylitol as an antibacterial agent and amorphous calcium phosphate for remineralization. He argues that large, randomized, placebo controlled trials are still needed to prove these agents are effective.
But he agrees with CAMBRA's underlying concept of assessing patients' risk and employing well established preventative strategies, such as fluoride varnish and dietary counseling. The bottom line, as he tells his students: "You either pay attention to me or you pay attention to lawyers."
Related dental links: intraoral camera Wired Camera welding machines
Caries,prevention:,New,legal,standards?
Science journals take on poverty
Science journals take on poverty
October 25, 2007 -- The Council of Science Editors (CSE) organized a Global Theme Issue on poverty and human development on Oct. 22, with 235 science journals from 37 countries simultaneously publishing more than 750 articles on the topic.
"The goal of the CSE Global Theme Issue is to stimulate interest and research in poverty and human development and disseminate the results of this research as widely as possible," according to a press release by the Council of Science Editors.
Several dental journals participated in the effort. A guest editorial in the Journal of Dental Research highlighted the dental problems plaguing the poor.
"Caries in adults and children, acute oral viral infections and noma, oral lesions of HIV/AIDS, periodontal diseases, craniofacial and dental developmental defects, and oropharyngeal/salivary gland neoplasms occur largely unchecked in resource-poor nations," the editorial noted. "It is clear that much of the global burden of oral disease affects the poor and neglected segments of humanity in both rich and poor countries."
Related dental links: Wired Camera welding machines welding machines for sale
Science,journals,take,on,poverty
Study: Cancer treatment causes caries
Study: Cancer treatment causes caries
October 25, 2007 -- Radiation therapy for thyroid cancer can cause long-term dental disease, researchers at the University Hospital in Basel Switzerland report in this month's Journal of Nuclear Medicine.
Previous research showed that zapping thyroids with high doses of radioiodine damages salivary glands, often leading to sialadenitis and xerostomia. So the investigators contacted 176 patients who had undergone this treatment over the previous three decades and asked them and their dentists about the health of their teeth.
This graph shows the dramatic increase in tooth extractions after radiation therapy for thyroid cancer. Copyright ? by the Society of Nuclear Medicine Inc. From "The Dental Safety Profile of High-Dose Radioiodine Therapy for Thyroid Cancer: Long-Term Results of a Longitudinal Cohort Study," by Martin A. Walter, et al., Journal of Nuclear Medicine 48: 1620-1625.
They found that these patients were 98.8 percent more likely to have caries after the radiation than before it. And they were 8.14 percent more likely to have a tooth extracted for every gigabecquerel of radioiodine they had received.
So what can be done? First, the investigators suggest, only those patients who could benefit most from radioiodine therapy should undergo it. Second, patients who have had this therapy should take precautions above and beyond normal hygiene: they should be careful to avoid dehydration; they should try glandular massage to preserve their saliva flow; and they should be cautious with anticholinergic drugs, which can also cause xerostomia.
Related dental links: welding machines welding machines for sale Bunsen Burner
Study:,Cancer,treatment,causes,caries
Cosmetic confidential
Cosmetic confidential
October 23, 2007 -- The dark truth behind those bright smiles
Ah, for the glamorous life of a cosmetic dentist. No more bratty kids or cranky codgers filling up the waiting room. No more extractions, fillings, or root canals. You'll spend your afternoons bleaching Lindsay Lohan's teeth or straightening Ashton Kutcher's smile. Who knows? You could end up with your own "Extreme Makeover"-style reality TV show.
Before you decide enter into the realm of pure aesthetics, though, take heed. We've drilled deep inside the world of cosmetic dentistry, peeled off its thin veneer and revealed the decay beneath.
OK, maybe that's overstating it a bit. But we have talked to some of the top dental professionals in the country and got the inside skinny on the booming world of cosmetics. Bottom line? It's not as easy as it looks or as profitable as it seems (more on that later).
Part I: So you wanna be a cosmetic dentist
You may be a whiz with an explorer and a root canal ace, but the differences between general dentistry and aesthetic dentistry are more than cosmetic. Success demands skills that often reside outside the comfort zone for many general dentists. Here are some keys to success.
Choose your lab carefully. Your work will only be as good as the lab you partner with, so pick a good one -- or more than one. Surveys by the American Academy of Cosmetic Dentists (AACD) show that 8 out of 10 dentists use multiple labs, often a cheaper one for basic treatments and higher-end techs for cosmetic work.
"Dentists really need to shop around for the right lab," said Laura Kelly, who holds the distinction of being both the first woman and the first nondentist to be named president of the AACD. A ceramist by trade, she knows quality cosmetic dentistry requires close collaboration between GDs and techs. "You need to make sure their skill level mirrors where you want to go with your practice, you share the same philosophy, and speak the same language."
And once you've got a lab you like, work hard to maintain a good relationship. When they've done a good job, show them the "after" pictures and send a little sugar their way, Kelly said. "Too often the ceramist only hears when adjustments need to be made," she said. "Smart dentists will call them up and say, 'Hey thanks, you really made me look good.' You can make a technician's month with just one phone call."
Polish your shutter skills. Being good with a handpiece is essential to being a successful cosmetic dentist. But how good are you with a Nikon or an Olympus? No patient will engage you without first checking your portfolio. If your shots are out of focus, over- or underexposed, or simply unattractive, you won't gain their trust -- no matter how good you are. You'll also want to bring your photos when you visit a new lab, so they can understand the standards of work you expect. One step in the right direction: Take a dental photography class (the AACD offers some).
"I see photographs in dental journals and I'm embarrassed for my profession," said Dr. David Landau, an accredited member of the AACD who operates a private practice in San Diego. "The teeth look fake, the gums look red or washed out instead of pink and healthy, and the exposure is so off you can't tell the chroma and value of the porcelain. As a member of the AACD, one of the first things you learn is how to be an excellent clinical photographer."
Beware trouble patients. Some people just can't be pleased -- and they're definitely not the ones you want coming to you for cosmetic work. One leading aesthetic practitioner who asked to remain anonymous tells the story of a woman who came into his office looking for extensive cosmetic work.
"The first thing she tells me is how her plastic surgeon 'butchered' her," he said. "Then she showed me a line over her eye that I couldn't see. The use of the word 'butchered' was a real warning sign that she had expectations no dentist in the world could possibly fulfill." He ultimately declined to take on the case.
"As an aesthetic dentist, you think 'I can do that,' but if you haven't read the patient well, it will cost you a lot of time and money," he added.
Avoid Dumbell U. Cosmetic dentistry isn't an ADA-accredited specialty, but continuing education in cosmetic techniques is a must for any general dentist stepping into this realm. "The technology develops so quickly that if you don't take courses every year you'll fall behind," warned Dr. Dan Nathanson, professor and chairman of the department of restorative sciences and biomaterials at Boston University. Just be careful about what that continuing education course really qualifies you for.
For example, taking a week-long course in occlusion doesn't mean you're able to perform complex prosthodontic procedures. "Some graduates get a false sense of security about their ability to do these things," he said. "If we could teach you to be a prosthodontist in a week, we wouldn't be offering a three-year degree."
General dentists who want to improve their skill set in cosmetic dentistry should look for courses associated with the local chapters of the AACD, American Academy of Esthetic Dentistry (AAED), or a university linked to those organizations. One example is Boston University (Nathanson is a director of the AAED); another is UCLA, where Dr. Brian LeSage, director of its Aesthetic Continuum, is also an AACD fellow.
Beware the malpractice monster. When it comes to patient lawsuits, you're three times as likely to get sued over crown and bridge work than dentures or surgical extractions, according to surveys by the ADA. But focusing on cosmetic dentistry doesn't guarantee you'll get sued less. It could make you a bigger target.
"Whenever you are dealing with the very subjective opinions of patients [getting cosmetic procedures], you risk displeasing them," noted attorney Frank Recker, an attorney and dentist in Marco Island, FL. "And an unhappy patient generally poses a greater risk of suit in my view, whether meritorious or not."
The best way to avoid legal jeopardy is to ensure that your patients understand everything that's involved in the procedure, and that you understand what the patient is expecting you to deliver, Landau said. (See "Beware trouble patients" above.)
Know when to call for backup. As a general dentist, you can perform virtually any procedure a specialist could -- but you probably shouldn't. If you get bitten by the malpractice monster, you'll be held to the standard of care typically provided by a board-certified specialist. Knowing which cases are too complex or exceed your skillset not only saves you money in the long run, it's also better for the patient.
"Different general dentists have different comfort zones," Landau said. "Sometimes to get to the ideal gum position you have to move the gum without moving the bone, which any dentist can do. Sometimes you have to move the gum and the bone, which some GDs wouldn't feel comfortable with. If you have to replace an anterior tooth with an implant, you're probably best referring it out to a specialist who understands the demands of making an implant look like a natural tooth erupting out of the gums."
But understanding the patient's cosmetic needs requires a trained eye, he said. "You need to understand what a natural healthy gum line should look like. A lot of general dentists don't know what they don't know."
"So much of what we do these days is in concert with cosmetic dentists, we're almost like a team," said Dr. Donald Joondeph, a professor emeritus of orthodontics at the University of Washington who operates a private practice in Bellevue. "The GD, orthodontist, periodontist, prosthodontist, oral surgeon -- each of us has his own role to play. We all look at the case and plug in to make the end product the best it can be."
One example, Joondeph said, would be a missing tooth that requires an implant. "Let's say a person had an upper lateral incisor congenitally absent and the adjacent teeth have drifted into the space making the space too small for an implant," he said. "A 'team' would then be required: an orthodontist to align the teeth and open the space where the tooth was missing, making the space the same size as the one on the opposite side; a periodontist or oral and maxillofacial surgeon to place the implant; and the general dentist to place the crown."
Get accredited. If you're serious about aesthetics, the AACD offers an accreditation program, but getting your sheepskin is no trivial task. Dentists must pass a written exam, then submit five patient cases over five years to a board of reviewers who evaluate each case on 50 separate criteria, and then pass an oral exam. Only a very small percentage of the dentists achieve accreditation within the five-year window the AACD allows. To become an accredited fellow (42 worldwide) requires a far more rigorous examination of clinical ability. The Academy of Comprehensive Esthetics (ACE), likewise has a tough certification program.
Just remember that the benefits are largely personal -- cosmetic dentistry is not an ADA board-certified specialty. Getting that sheepskin doesn't mean you'll automatically be able to charge more for your services, either. And many dentists who lack the AACD credential still do excellent work, saidDr. Larry Addleson, an accredited fellow and past president of the AACD who operates a private practice in San Diego. "But you can know for sure that those who become accredited are capable of performing at a high level."
Part II: Where's the money?
OK, here's the part of the story you've been waiting for. Is cosmetic dentistry your road to riches?
On one hand, pay for dentists has never been better. According to surveys conducted by the ADA, average annual salaries for dental practitioners rose from $166,000 in 2000 to nearly $186,000 in 2004. The number of cosmetic procedures rose 12.5% over roughly the same period, according to surveys conducted by the American Academy of Cosmetic Dentistry (AACD).
Ipso facto, cosmetics must good for your bottom line, right?
Not necessarily. While dental incomes are rising -- and cosmetic procedures certainly add to the kitty -- the main reason dentists make more money is that the ratio of dentists to the general population has been dropping since the 1980s, according to Boston University's Nathanson. There are more sick teeth and relatively fewer people to fix them.
Another limiting factor is insurance. Purely cosmetic treatments, such as veneers or teeth whitening, are generally not covered by insurance. That means patients must foot the bill themselves or finance the work through third parties like CareCredit or Dental Fee Plan (a Capital One credit card used to pay for dental work). Nearly 82% of dentists offer third-party financial help, according to the AACD.
The good news for dentists is that instead of getting paid a percentage of your fees by a PPO or insurance plan, you'll usually get paid in full, said Dr. Charles Blair, a practice management consultant in Charlotte, NC, and author of Coding with Confidence: The "Go-To" Guide for CDT-2007/2008.
The bad news: cosmetic dentistry is more sensitive to fluctuations in the market. When the national economy hits a tailspin, everyone has fewer reasons to smile -- or to pay $500 to whiten their teeth.
The inconvenient truth? "If you're doing cosmetic dentistry right, you're probably not making a lot of money," said Dr. Larry Addleson. For one thing, doing it right means using higher quality -- and more expensive -- labs.
"You can get a crown or veneer made in an offshore lab for $100, or you can pay a master ceramist $600," he said. "If the veneer costs you $100 and you charge the patient $800, you can make more money. But you can't charge six times as much for a $600 veneer and expect to remain competitive."
You must also be willing to send things back to the lab for a do-over -- or several do-overs -- until you and the patient are satisfied. Whether dentists can recoup the added costs depends on their relationship with both the lab and their patients, Kelly said, but the same market rules apply.
"You have to be willing to reject things that most dentists would say are beautiful," said Dr. David Landau. "When a cosmetic case comes back from the lab we call it a 'first fitting,' not delivery of the final product. Every time you do a fitting and reject the work, you lose money."
Doing it right means also taking more time to work with patients, especially when dealing with complex cases. It can mean spending more time and money for continuing education, and paying more for qualified staff.
Cosmetic dentists also incur greater advertising costs, according to Blair. "Pure cosmetic dentists typically spend 7% to 10% of their gross on advertising, versus around 1% for most general dentists," he said.
In his 25 years of consulting, Blair said he's seen a handful of GDs give up bread and butter dentistry and focus entirely on cosmetic work, but few end up sticking with it.
"Some people have walked the plank, gotten out of the PPOs and regular insurance plans, and tried to specialize only in cosmetics," he said. "But I've seen some stumbling there. Many have had to run back to general dentistry. I caution dentists to maintain their bread and butter practice and let cosmetics be the gravy."
For dentists like Addleson, money isn't the motivator. It's about raising the overall quality of dental work for his community as a whole -- one reason why he's a director of the San Diego Advanced Study Group and currently mentoring 10 dentists in his area.
"If you're really committed to cosmetic dentistry, you're not going to get rich," he said. "It's an inner passion. Yesterday doesn't matter. You're only as good as what you do today. It's like trying to understand why Van Gogh cut off his own ear. It's hard for people who don't share this passion to understand."
Related dental links: welding machines for sale Bunsen Burner Dental Loupes
Cosmetic,confidential
OPINION: Dear New York Times: The answer isn't more dentists
OPINION: Dear New York Times: The answer isn't more dentists
October 23, 2007 -- In all the heated debate about the New York Times' recent controversial piece, "Boom Times for U.S. Dentists, But Not for Americans' Teeth," some basic history and economic realities have been ignored.
The boom in the number of dentists in the 1970s (my generation) didn't result in more people getting dental care. Back then, the federal government said we didn't have enough dentists. The result was a glut of dentists and less business for dentists all the way around. It took years to work off the oversupply.
Now the government is saying the same thing. But if we've learned anything, increased availability of a service doesn't necessarily increase utilization. If people can't pay for a service, they won't use it. And if people don't want to pay for a service, they won't value it, either.
The real problem is that federal and state medical assistance programs aimed at helping the underprivileged (and even the lower-middle class) don't come close to covering a dentist's overhead. Are dentists expected to provide medical care at a loss, to essentially subsidize dental care for those who can't afford it? I can't help but agree with Dr. Terry D. Dickinson, the executive director of the Virginia Dental Association, when he said, "Charity is not a healthcare system."
If dental care is truly important (and I wouldn't be a dentist if I didn't think it was), then we all need to step up to the plate -- Congress, state legislatures, and yes, taxpayers. Everyone should contribute to making dental healthcare available to the people most in need. Like attorneys, dentists do plenty of pro bono work. But ultimately, they have to make a living, too.
In Wisconsin, where I practice, the Marshfield Clinic is working with the Family Health Center to set up rural dental clinics to provide care to underserved patients.The only downside? The group doesn't cover Medford, where I practice. (More than 9% of the local population lives below the poverty line, including nearly 13% under the age of 18.) What makes this program possible? Federal grants, higher Medicare and Medicaid compensation, state grants, and more. If the government appropriately reimbursed dentists for their services, there'd be plenty of access to dental care for Americans of all economic stripes. There wouldn't be a need for dental "therapists."
Dentists are healers -- compassionate, civic-minded men and women who are dedicated to helping their fellow citizens. But we're not doormats. It's up to our elected representatives -- who, to date, have shown little backbone -- to tackle the inequities in American healthcare, and to come up with the bucks to make it happen.
Kim Gowey, D.D.S., practices in Medford, WI. He is a past president of the American Academy of Implant Dentistry. He was on the continuing education faculty of Howard University School of Dentistry's Implant Maxicourse, and Baylor College of Dentistry.
Related dental links: Bunsen Burner Dental Loupes Vacuum Forming Machine
OPINION:,Dear,New,York,Times:,The,answer,isn't,more,dentists
October 23, 2007 -- In all the heated debate about the New York Times' recent controversial piece, "Boom Times for U.S. Dentists, But Not for Americans' Teeth," some basic history and economic realities have been ignored.
The boom in the number of dentists in the 1970s (my generation) didn't result in more people getting dental care. Back then, the federal government said we didn't have enough dentists. The result was a glut of dentists and less business for dentists all the way around. It took years to work off the oversupply.
Now the government is saying the same thing. But if we've learned anything, increased availability of a service doesn't necessarily increase utilization. If people can't pay for a service, they won't use it. And if people don't want to pay for a service, they won't value it, either.
The real problem is that federal and state medical assistance programs aimed at helping the underprivileged (and even the lower-middle class) don't come close to covering a dentist's overhead. Are dentists expected to provide medical care at a loss, to essentially subsidize dental care for those who can't afford it? I can't help but agree with Dr. Terry D. Dickinson, the executive director of the Virginia Dental Association, when he said, "Charity is not a healthcare system."
If dental care is truly important (and I wouldn't be a dentist if I didn't think it was), then we all need to step up to the plate -- Congress, state legislatures, and yes, taxpayers. Everyone should contribute to making dental healthcare available to the people most in need. Like attorneys, dentists do plenty of pro bono work. But ultimately, they have to make a living, too.
In Wisconsin, where I practice, the Marshfield Clinic is working with the Family Health Center to set up rural dental clinics to provide care to underserved patients.The only downside? The group doesn't cover Medford, where I practice. (More than 9% of the local population lives below the poverty line, including nearly 13% under the age of 18.) What makes this program possible? Federal grants, higher Medicare and Medicaid compensation, state grants, and more. If the government appropriately reimbursed dentists for their services, there'd be plenty of access to dental care for Americans of all economic stripes. There wouldn't be a need for dental "therapists."
Dentists are healers -- compassionate, civic-minded men and women who are dedicated to helping their fellow citizens. But we're not doormats. It's up to our elected representatives -- who, to date, have shown little backbone -- to tackle the inequities in American healthcare, and to come up with the bucks to make it happen.
Kim Gowey, D.D.S., practices in Medford, WI. He is a past president of the American Academy of Implant Dentistry. He was on the continuing education faculty of Howard University School of Dentistry's Implant Maxicourse, and Baylor College of Dentistry.
Related dental links: Bunsen Burner Dental Loupes Vacuum Forming Machine
OPINION:,Dear,New,York,Times:,The,answer,isn't,more,dentists
The battle of the power toothbrushes
The battle of the power toothbrushes
October 22, 2007 -- Ultreo, Inc., makers of Ultreo, a power toothbrush based on ultrasound waveguide technology, filed a counter suit against Procter & Gamble in the United States District Court for the Southern District of New York last week.
P&G, which makes the Oral-B power toothbrush, filed a suit against Ultreo in September for allegedly misleading consumers and dental professionals through false advertising. According to P&G, Ultreo's claim that their product's ultrasound waveguide technology creates bubbles that fight plaque--that bristle action alone leaves behind--is false. P&G further claimed that one of its studies proved the Ultreo toothbrush was more effective at removing plaque with its ultrasound waveguide technology switched off.
"Ultreo has provided no clinical proof that the ultrasound makes any difference in plaque removal in the mouth. We're taking this action to prevent consumers from being misled and to protect our business," said Dr. Paul Warren, Vice President of Global Oral Care Scientific and Professional Relations for P&G in a press release.
Ultreo has denied these claims in full, and in its countersuit says that P&G is misleading consumers and dental professionals by falsely disparaging Ultreo. Ultreo claims considerable scientific evidence proves its product's advantages, notably a 95 percent reduction of plaque within the first minute of brushing.
"Our marketing focuses on the strong scientific evidence behind Ultreo and the proven consumer preference for the incredible feeling of clean Ultreo provides," said Ultreo CEO and President Jack Gallagher in a press release. "It’s obvious that this is the real source of concern for P&G. The fact that a $76 billion market leader is attacking and disparaging a $3 million startup offering a technological innovation simply validates Ultreo’s acceptance by the marketplace."
Related dental links: Dental Loupes Vacuum Forming Machine root canal
The,battle,of,the,power,toothbrushes
Work less, earn more? One dentist explains how
Work less, earn more? One dentist explains how
October 22, 2007 -- William Blatchford, D.D.S., had a successful practice but he wasn't truly happy. He worked five days a week, never had time for vacations, and always felt a cloud of stress hanging over him. One night while eating leftovers from yet another office dinner, his wife and fellow dentist, Carolyn, said, "We're eating the leftovers of the practice's revenues every month." One night, Blatchford had a realization: He needed to change the entire way he ran his business.
Once he did, Blatchford claims he eventually climbed to the top 1 percent of highest-grossing dentists nationwide. Then he founded Blatchford Solutions and became a coach and consultant to 2,500 dental practices. His selling point: Life is too short, so develop a practice that allows you the lifestyle you desire. When he is not flying planes; skiing near his Bend, Oregon home; or sailing in Puget Sound; Blatchford spreads the word about his theory.
Dr. William Blatchford
His "Show Me the Money" session at the recent ADA conference in San Francisco was a few years in coming. "Two years ago, the ADA told me not to talk about profit or use the 'S-word' at the conference." (We're assuming he meant "sell".) "This year, they actually requested I do this program. It shows how far the dental business has come."
One of his seemingly contrary discoveries: Customer service demands that you focus on income. "People want to go to a dentist who is profitable. They don't want a dentist working on their teeth who is preoccupied with paying the rent."
Cut back on overhead
What keeps dentists from boosting profits? They're bad at estimating what to expect to gross every month, says Blatchford. "A dentist has one month that's shockingly big and assumes it will always be like that and spends money on more staff and equipment. The next month, business goes back to normal and he's worrying about paying expenses. What did the dentist do to make that one month so big? Chances are, they don't know.
"Your 'range of predictability' shouldn't go up and down. It should become narrower."
In Blatchford's case, he scrutinized his staffing. He had 16 employees, five solely for hygiene. ("What does one dentist need 16 employees for?") He laid off three hygienists ("The worst day of my career"), then later cut his total staff to eight. A year later, he grossed slightly more than the prior year, even with half his staff.
Blatchford boasts that his clients gross between $2 to $3 million annually, even when working with staffs of five or fewer. More telling? His dentists work 3.5 days a week and take eight to 10 weeks vacation a year. All of them have cut their overhead and reduced their staff to a handful. "It's not about time spent or efforts made, or even how much you work. It's about results."
Getting there means cutting the small stuff, focusing on high-end treatments, and developing specialized niches. One of Blatchford's clients moved his dental practice to Florida and focused on cosmetic dentures and implants for the abundant population of well-heeled seniors. The dentist charges $6,000 to $10,000 a pop. The results: He went from grossing $800,000 a year to $2 million, with half his previous overhead (a team of five employees), and a four-day workweek.
Another client only works three mornings a week, but she focuses on dentures and implant-supported dentures in a Polish neighborhood in Chicago. "She doesn't do fillings or see kids," says Blatchford. "But she earns so much in her specialty that she throws in a spare set of dentures for free." She likewise trimmed staff, cutting overhead from 63 percent to 37 percent, and grosses $1 million annually.
Typically, 30 percent of a dentist's overhead is staff. Blatchford says it should be 12 to 20 percent. But pay those staffers you keep well--double their salaries. "I once hired someone incompetent and then had to hire a trainer to help her. That's stupid." Hire the most competent staff, give them incentives of higher pay and a reduced workweek, and they'll give you hard work and loyalty in return.
Focus on your top clientele
Blatchford is a firm believer that the top 20 percent of patients generate 80 percent of your income--and that the bottom 20 percent can actually be an income drain. "It's ludicrous to treat all patients the same when some are actually costing you money."
He suggests you create a spreadsheet of all your patients and how much they spend, then list them in descending order of expenditures. "When the descending total hits 80 percent of total income, study those people in that range. Look at their age, gender, and treatments needed -- that's your target market. Get rid of the bottom 20 percent."
Raise fees, lower receivables
Don't be afraid to raise fees, either. Blatchford actually recommends doubling them. "People go to my Chicago-based client because her dentures cost twice as much. They perceive it as quality."
If you're hesitant to double, add the bill cost to your current fee. "Then you can send work to the best lab around, because the patient is paying for it directly."
Accounts receivables are poison in his book. Say you have $100,000 in A/R on Jan.1. Over the course of a year, you'll lose $6,000 through inflation, $10,000 from money you could have invested (if you had it), $36,000 in the costs of trying to get patients to pay, and $24,000 in write-off of bad debts. By year's end, you will have lost $76,000.
"That's why my clients do not carry account receivables," says Blatchford. "It's check, cash or credit card upfront at the desk."
Make treatments affordable by offering financing options from outside sources. Why not?, says Blatchford. "That's how they pay for their car and big-screen TV."
Ply them with services
Consultants often tell dentists to focus on getting more hygiene patients, but Blackford says forget that. "You'll only break even. It will never be a profit center."
Instead, focus on doing more Class II and Class III procedures. "If you do two units of a crown or bridge, your net profit per hour triples." He also recommends offering additional services, such as denture implants, cosmetic dentures, and veneers.
How can you get patients to accept these offerings? "McDonald's made millions by asking, 'Do you want fries with your burger?'" says Blatchford. "Say to your patient during a procedure, 'I notice you'll need an additional crown here soon. We can get both done while you're still numb and save you two extra appointments.'"
Instead of trying to educate patients about treatments' benefits, appeal to their emotions. "People don't want dentures or veneers, they want their teeth to look good, feel good and last a long time. Instead of trying to sell the process, you should be selling the results."
Moneymaking aside, Blatchford emphasizes that all dentists should balance business and pleasure, and ensure that they can incorporate both into their practice. "Life is too short. Make a commitment to be happy. You should say, 'Thank God it's Monday!' Focus only on the things you want to do and enjoy them, both in work and life."
Related dental links: Vacuum Forming Machine root canal Wax Pot
Work,less,,earn,more?,One,dentist,explains,how
October 22, 2007 -- William Blatchford, D.D.S., had a successful practice but he wasn't truly happy. He worked five days a week, never had time for vacations, and always felt a cloud of stress hanging over him. One night while eating leftovers from yet another office dinner, his wife and fellow dentist, Carolyn, said, "We're eating the leftovers of the practice's revenues every month." One night, Blatchford had a realization: He needed to change the entire way he ran his business.
Once he did, Blatchford claims he eventually climbed to the top 1 percent of highest-grossing dentists nationwide. Then he founded Blatchford Solutions and became a coach and consultant to 2,500 dental practices. His selling point: Life is too short, so develop a practice that allows you the lifestyle you desire. When he is not flying planes; skiing near his Bend, Oregon home; or sailing in Puget Sound; Blatchford spreads the word about his theory.
Dr. William Blatchford
His "Show Me the Money" session at the recent ADA conference in San Francisco was a few years in coming. "Two years ago, the ADA told me not to talk about profit or use the 'S-word' at the conference." (We're assuming he meant "sell".) "This year, they actually requested I do this program. It shows how far the dental business has come."
One of his seemingly contrary discoveries: Customer service demands that you focus on income. "People want to go to a dentist who is profitable. They don't want a dentist working on their teeth who is preoccupied with paying the rent."
Cut back on overhead
What keeps dentists from boosting profits? They're bad at estimating what to expect to gross every month, says Blatchford. "A dentist has one month that's shockingly big and assumes it will always be like that and spends money on more staff and equipment. The next month, business goes back to normal and he's worrying about paying expenses. What did the dentist do to make that one month so big? Chances are, they don't know.
"Your 'range of predictability' shouldn't go up and down. It should become narrower."
In Blatchford's case, he scrutinized his staffing. He had 16 employees, five solely for hygiene. ("What does one dentist need 16 employees for?") He laid off three hygienists ("The worst day of my career"), then later cut his total staff to eight. A year later, he grossed slightly more than the prior year, even with half his staff.
Blatchford boasts that his clients gross between $2 to $3 million annually, even when working with staffs of five or fewer. More telling? His dentists work 3.5 days a week and take eight to 10 weeks vacation a year. All of them have cut their overhead and reduced their staff to a handful. "It's not about time spent or efforts made, or even how much you work. It's about results."
Getting there means cutting the small stuff, focusing on high-end treatments, and developing specialized niches. One of Blatchford's clients moved his dental practice to Florida and focused on cosmetic dentures and implants for the abundant population of well-heeled seniors. The dentist charges $6,000 to $10,000 a pop. The results: He went from grossing $800,000 a year to $2 million, with half his previous overhead (a team of five employees), and a four-day workweek.
Another client only works three mornings a week, but she focuses on dentures and implant-supported dentures in a Polish neighborhood in Chicago. "She doesn't do fillings or see kids," says Blatchford. "But she earns so much in her specialty that she throws in a spare set of dentures for free." She likewise trimmed staff, cutting overhead from 63 percent to 37 percent, and grosses $1 million annually.
Typically, 30 percent of a dentist's overhead is staff. Blatchford says it should be 12 to 20 percent. But pay those staffers you keep well--double their salaries. "I once hired someone incompetent and then had to hire a trainer to help her. That's stupid." Hire the most competent staff, give them incentives of higher pay and a reduced workweek, and they'll give you hard work and loyalty in return.
Focus on your top clientele
Blatchford is a firm believer that the top 20 percent of patients generate 80 percent of your income--and that the bottom 20 percent can actually be an income drain. "It's ludicrous to treat all patients the same when some are actually costing you money."
He suggests you create a spreadsheet of all your patients and how much they spend, then list them in descending order of expenditures. "When the descending total hits 80 percent of total income, study those people in that range. Look at their age, gender, and treatments needed -- that's your target market. Get rid of the bottom 20 percent."
Raise fees, lower receivables
Don't be afraid to raise fees, either. Blatchford actually recommends doubling them. "People go to my Chicago-based client because her dentures cost twice as much. They perceive it as quality."
If you're hesitant to double, add the bill cost to your current fee. "Then you can send work to the best lab around, because the patient is paying for it directly."
Accounts receivables are poison in his book. Say you have $100,000 in A/R on Jan.1. Over the course of a year, you'll lose $6,000 through inflation, $10,000 from money you could have invested (if you had it), $36,000 in the costs of trying to get patients to pay, and $24,000 in write-off of bad debts. By year's end, you will have lost $76,000.
"That's why my clients do not carry account receivables," says Blatchford. "It's check, cash or credit card upfront at the desk."
Make treatments affordable by offering financing options from outside sources. Why not?, says Blatchford. "That's how they pay for their car and big-screen TV."
Ply them with services
Consultants often tell dentists to focus on getting more hygiene patients, but Blackford says forget that. "You'll only break even. It will never be a profit center."
Instead, focus on doing more Class II and Class III procedures. "If you do two units of a crown or bridge, your net profit per hour triples." He also recommends offering additional services, such as denture implants, cosmetic dentures, and veneers.
How can you get patients to accept these offerings? "McDonald's made millions by asking, 'Do you want fries with your burger?'" says Blatchford. "Say to your patient during a procedure, 'I notice you'll need an additional crown here soon. We can get both done while you're still numb and save you two extra appointments.'"
Instead of trying to educate patients about treatments' benefits, appeal to their emotions. "People don't want dentures or veneers, they want their teeth to look good, feel good and last a long time. Instead of trying to sell the process, you should be selling the results."
Moneymaking aside, Blatchford emphasizes that all dentists should balance business and pleasure, and ensure that they can incorporate both into their practice. "Life is too short. Make a commitment to be happy. You should say, 'Thank God it's Monday!' Focus only on the things you want to do and enjoy them, both in work and life."
Related dental links: Vacuum Forming Machine root canal Wax Pot
Work,less,,earn,more?,One,dentist,explains,how
New drug can 'revolutionize' oral and maxillofacial surgery
New drug can 'revolutionize' oral and maxillofacial surgery
October 22, 2007 -- Infuse Bone Graft -- a drug used in orthopedic procedures that stimulates stem cells to form bone -- has recently been approved by the FDA for dental use.
The drug consists of two parts: a solution containing rhBMP-2 (recombinant human bone morphogenetic protein 2) and the ACS (absorbable collagen sponge). It can be highly useful in oral and maxillofacial procedures. Surgeons at the School of Dentistry, Loma Linda University have successfully used Infuse to do reconstruction surgery on gunshot and trauma victims, as well as patients with cleft palates and oral cancer.
Until recently, surgeons harvested bone needed for reconstruction surgery from the patient's own hip or ribs. "This is painful, and requires a second surgery site [on the patient]," said Philip Boyne, D.M.D., M.S., D.Sc., professor emeritus of oral and maxillofacial surgery at Loma Linda, in a press release. Infuse can eliminate this entire process from oral and maxillofacial reconstruction surgery.
"The cleft palate cases are particularly rewarding," Dr. Boyne said. "This new drug makes a second surgery unnecessary and the bone generated from the patient's own stem cells forms bone that beautifully completes the natural arch. And the sponge doesn't have to be removed -- it is eventually absorbed by the body."
Infuse can be used in many areas of dentistry and will save patients considerable time and money. For example, cleft palate cases can be an outpatient procedure, saving insurers as much as $15,000, according to Dr. Boyne.
Related dental links:root canalWax PotElectric Toothbrush
New,drug,can,'revolutionize',oral,and,maxillofacial,surgery
Something to smile about
Something to smile about
October 22, 2007 -- October is National Domestic Violence Awareness Month and according to the American Academy of Cosmetic Dentistry (AACD) five million people are victims of domestic violence in the U.S. every year.
The American Academy of Cosmetic Dentistry Charitable Foundation's (AACDCF) Give Back A Smile (GBAS) program provides free dental care to victims of domestic abuse. They restore broken and damaged teeth at no cost to the victim. To date the foundation has treated 600 cases at a total cost of nearly $5 million.
"After suffering abuse, it is difficult for survivors to find something to smile about, and it's even harder when they don't have a smile to show. Time after time we have witnessed AACD members assist survivors of domestic violence by treating their dental injuries, restoring their smiles, their self-esteem and their lives," said AACD Foundation Director Erin Roberts in a press release.
If one of your patients is a victim in need of help, have them call GBAS at (800) 773-4227 and complete the application process. The AACD will connect eligible applicants with a local GBAS volunteer for treatment.
Related dental links: Wax Pot Electric Toothbrush oral b electric toothbrush
Something,to,smile,about
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