Clinic pays $10 million in fraud settlement

Clinic pays $10 million in fraud settlement

April 23, 2008 -- Medicaid Dental Center (MDC) of North Carolina will pay $10,050,000 to the United States and North Carolina to settle claims that it fraudulently billed Medicaid for dental care on impoverished children.

The government alleges that the chain of clinics and its owners, including Michael A. DeRose, D.D.S., and Letitia L. Ballance, D.D.S., submitted reimbursement claims for unnecessary pulpotomies and stainless steel crowns, and that it failed to obtain informed consent.

"These dentists subjected their child patients to invasive and sometimes painful procedures, often for the sake of obtaining money from the North Carolina Medicaid program," said Jeffrey S. Bucholtz, acting assistant attorney general for the department's Civil Division, in a press release.

MDC's attorney, James Wyatt told DrBicuspid.com that the billings were not "fraudulent." "The disputed billings involved differences of opinion among knowledgeable experts," he said.

The settlement concerns procedures done between 2001 and 2003. Both Dr. DeRose and Dr. Ballance were disciplined by the North Carolina Board of Dental Examiners in 2005.

"Any question about the types of treatments given by M.D.C. were investigated and resolved in 2003," said Wyatt. "The clinics are now providing high quality service to people other dentists will not even see."

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Build your perfect Web site: Part I

Build your perfect Web site: Part I

April 23, 2008 -- If you're not on the Web, do you really exist?

Of course you do. You've got an office with four walls and living, breathing human beings inside. But patients are increasingly turning to the Internet for everything from thumb tacks to houses. Those dentists without Web sites are becoming more and more invisible.

If you don't have a Web site, your name might be on the Internet already -- but in an unfavorable context, such as a review by a disgruntled patient. Your Web site offers you the chance to describe yourself and your practice in the best possible light.

And as the recession reaches dentistry, some practice management consultants say that Web sites may offer the most cost-effective of all marketing vehicles.

But how do you get started? Should you hire a designer or do it yourself? The choices can be daunting, so we talked to some of the leading lights in the field of dental Web site design, as well as many Web savvy dentists to offer this practical guide to launching your online presence.

The good news is that only a third of dentists have Web sites so far, so it's still possible to lead the pack, according to Irvin G. Lubis, D.M.D., a former Boonton, N.J. periodontist who now works as a marketing consultant for dentists.


Louis Woolf hired American Eagle to design this Web site for his practice.
Getting started

Where do you begin? Dental Web sites run the gamut of the exceedingly simple, in essence a business card posted to the Web, to the extremely complex, including hooks into your back-office operations.

So start by figuring out how you want to market your practice and how a Web site fits into that plan. Do you want to draw in new patients, provide services to your existing ones, or perhaps a combination of the two? Are you a specialist with services that other dentists don't offer? Is your education or experience outstanding? Would you like the site to be educational as well, providing important information about dental hygiene?

Next consider how interactive you want the site to be. Would you like patients to be able to contact you via email? Would you like them to be able to schedule or change appointments or make payments online? Many of these features will add expense to the site -- but could save your time and your staff's time.

Louis Woolf, D.D.S., of the Sachem Dental Group, in Suffolk County, N.Y., says that he plans to use his new Web site as a way to solicit feedback from patients, and will include a way for patients to make complaints.

"This is important to us because we have five different offices, six partners, and 20 dentists, with many different specialties," he says. "With offices spread out like that, we want to make sure that we're providing the best services possible to our patients. If they can easily make complaints online, either using their real name or anonymously, it will help us make sure we're giving them exactly what they need."

Once you've made these basic decisions, your real work has begun. Even with a professional designer doing the technical and artistic work, you're going to have to spend a chunk of your time working with your designer, possibly providing content for them, and reviewing the site until you're happy with it. So set aside some days.

Choosing a designer

Today's sophisticated surfer expects state-of-the-art design. That's what prompted Dr. Woolf to upgrade his site. Ten years ago, Dr. Woolf says, he had a friend develop a rudimentary site with very basic information about his group's practice. Now he is thoroughly revamping it.

"Resources like Yellow Pages books are being read less and less, while the Web has increasingly become the de facto way that people find new services."
"I've seen the evolution of information since our fist site was up," he says. "For business to be a success, including a dental practice -- it needs to be well-represented on the Internet."

Everyone we interviewed for this article emphasized that you shouldn't try to do it yourself -- or even hire that computer-savvy high schooler who lives down the block. You need a professional designer.

So who do you pick?

The choice will depend a lot on the features you've decided to include. Costs vary tremendously, from as little as $1,500 for a brochure-style site by a local designer to $10,000 for a more interactive site from a nationally known firm.

No matter how large or small your ambitions, look for someone who has already designed several dental sites. Check out other dental Web sites the firm has designed, get in touch with those sites, and ask the dentists whether they were satisfied.

Quite a few firms specialize in dentistry, but they take different approaches to their design work. TNT Dental (www.tntdental.com) has a staff of writers who interview dentists about what information they want on the site, says co-founder Tim Kelley. The staff writes a draft of what will appear, and rewrites it until the dentist is satisfied.

By contrast, Dental Sesame (www.dentalsesame.com) offers a selection of several design templates, and a great deal of boilerplate dental content about dental hygiene. Dentists can select from these pieces, then add information of their own.

Finally, with some design firms, you create all the content yourself. That's the approach Dr. Woolf took in working with American Eagle design firm (www.americaneagle.com).

There are pros and cons to each approach. Using pre-created content will take the least amount of time and effort. On the downside, that approach can conceivably feel generic to potential patients.

Working with a firm to develop your site's content can eat up the hours. "You'll spend longer on this than you expect," says Dr. Woolf. On the upside you will get the site that best reflects your practice. Original content also helps your site pop up higher when a search engine trolls the Web.

Which approach you choose depends once again on your goal for the site. An online business card doesn't need much original content. But if this is your main approach to marketing your practice, sweating over prose may prove essential.

After you've narrowed down your selection of designers, ask about the contract. Make sure that no matter which designer you use, the site and all its content ultimately belongs to you, not to the designer. You may want to pay a lawyer to read the fine print.

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Henry Schein acquires Minerva Dental

Henry Schein acquires Minerva Dental

April 23, 2008 -- Henry Schein announced Tuesday that it acquired Minerva Dental, a supplier of dental consumables and equipment in the U.K.

Terms of the transaction were not disclosed.

"The acquisition of Minerva strengthens Henry Schein's full-service dental business in the U.K., particularly in the South and Southwest regions," said Stanley M. Bergman, chairman and CEO of Henry Schein.

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AGD maps dental economy

AGD maps dental economy

April 23, 2008 -- In 2006 over 786,000 people were employed in the dental work force earning total wages in excess of $33 billion.

So says a statistical map recently released by the Academy of General Dentistry (AGD). The map, entitled "The Economic Contribution of the Dentistry Profession in 2006," enumerates the dental employees per congressional district and their earnings.

The data was compiled from the 2006 U.S. Bureau of Labor Statistics, Quarterly Census of Employment and Wages, and Occupational Employment Statistics Survey.

"We know that legislators and their staffs are very interested in the demographics of their constituency as they make voting and co-sponsorship decisions," said AGD's Washington lobbyist Janet Kopenhaver in a press release. "These statistics and details on how many of their constituents are employed in the dentistry profession should be taken into consideration as legislators consider supporting and co-sponsoring the AGD legislative priorities for this year."

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Recession-proof your practice

Recession-proof your practice

April 22, 2008 -- When Matthew Comfort, D.D.S., balanced his books this winter, he got a shock: Receipts had dipped 20 percent. Dr. Comfort quickly realized that his Rocklin, Calif. practice was falling with the slide in the U.S. economy, and he had to take action. Moving swiftly, he condensed his appointment schedule to four eight-hour days to spend more time in the local hospital emergency room, where he offers dental trauma services. He cut expenses wherever he could. He even asked suppliers for a discount.

As a result, he's sure he'll survive this recession. He may even come out ahead because the hard times have made him look so closely at how he runs his business. "This is another opportunity to get the office fine-tuned," he says.

Dr. Comfort is not alone. Signs are emerging that the tough times will hit dentistry. Not everyone can benefit from the same solutions that worked for Dr. Comfort. But by looking closely at the way they work, dentists can discover multiple paths to averting disaster. Many may find it more important than ever to treat their practices like businesses -- improving efficiency, advertising strategies, and customer satisfaction. New technologies can also boost the bottom line. Finally dentists can demonstrate to patients that dental care is an essential need rather than a luxury.

Though the long-term economic outlook remains foggy, the Robert W. Baird securities firm concluded this month that "a slowdown is truly underway" in dentistry. "Appointment cancellations are up, patient traffic is down, and patients are increasingly pushing back on higher-end dental treatments," the firm reported, after surveying 245 dental offices in early spring.

So far, the recession seems to have hit specialists the hardest, says Irvin G. Lubis, D.M.D., a former Boonton, N.J. periodontist who now works as a marketing consultant for dentists. That’s because they get fewer referrals from general dentists in tough economic times. Three periodontists in Westchester County, N.Y., recently went out of business, he says.

"When things get slower, you want to advertise more."
But generalists are feeling the pinch as well. Richard Gochman, D.D.S., a general dentist in Flushing, N.Y., says some patients are refusing to finish dental work that’s half done. Other patients won’t even consider payment plans these days, even if they are interest-free for a year, because they want more control over their financial lives, he says. An increasing number of patients, meanwhile, are being denied credit so financing is not even an option, a dentist who participated in Baird’s survey says.

Cut your costs

Despite the grim news, dentists don’t need to panic, practice management experts say. They simply need to apply sound business principles -- principles that will help them weather any financial crises and improve their bottom lines for decades to come.

To start with, most dentists waste time and money, says Bill Blatchford, D.D.S. who heads Blatchford Solutions in Bend, Ore. "Dentistry has never had to be efficient," Dr. Blatchford says. But when the economy slows, inefficiency causes more problems than ever. The typical dentist has an overhead of 75 percent, Dr. Blatchford says. With such a high overhead, a 10 percent drop in gross receipts translates to a 40 decrease in net income. Cut your overhead to 50 percent, and a 10 percent slowdown only becomes a 20 decrease in net.

So, how to cut overhead?

In most offices, dentists’ biggest business mistake is overstaffing, says Dr. Blatchford. If something goes wrong, he says, "dentists throw more people at the problem." Instead, carefully analyze the problem, and look at other possible solutions.

In many cases, technology can replace the need for staff time. For example, dentists should aim for paperless offices, which can eliminate endless hours of filing.

In other cases, hygienists can do some of the work of office managers. Even making smaller changes, like having hygienists collect money from patients after cleanings, can make a huge difference. Not only does that stop the office from wasting time billing the patient, but it gets the patient’s money into the dentist’s bank account faster, increasing the amount of interest on money earned from the appointment.

Hygienists should also encourage patients to book their next visits before leaving the office, says Nathan Kaufman, D.D.S. a dentist in Albany, Calif. That way, follow-up phone calls are perceived as appointment reminders rather than business solicitations. "It’s helpful rather than promotional," he says.

Market your practice

But dentists shouldn't shy away from promoting themselves, consultants warn.

Advertising is especially critical during lean times. "When things get slower, you want to advertise more," says Dr. Lubis, noting that a lot of companies have not figured this out.

Advertising doesn't have to mean an expensive newspaper or television campaign, though. Sometimes inexpensive promotions can be much more cost-effective.

Recession-proof,your,practice
Dr. Gochman, who began marketing online only 16 months ago, says the Web is his only profitable advertising tool these days. After he landed his first $9,000 case from his Web site, “it made me a believer,” he says. It can offer you a competitive advantage, too, since only a third of dentists have a Web site according to Dr. Lubis.

Among the other low-cost marketing techniques:

Recording ads on your phone lines, which patients can hear when they are put on hold.
Giving out treats such as homemade cookies -- or sugarless gum -- at the end of appointments.
Raffles for patients.
Social activities. One Virginia orthodontist organizes ice skating parties during the winter.
An office pet. Nick Duncan, D.D.S., a dentist who practices near Lake Tahoe, Calif., has a dog in his office. "People come in just to see the dog," he says, even when they don’t have appointments.
Sprucing up the office. A coat of paint and a vase of fresh flowers in the waiting room can go a long way.
Sell your services

Getting patients into the office is only the first step of the marketing process. Dentists may have to pitch their treatment plans differently in times of economic stress.

One key is persuading patients that if they let problems fester, they will pay more later. Dr. Blatchford suggests politely questioning patients who decline work because of the economy. Some may be resisting treatment out of fear of hardship rather than actual hardship. "Most people really aren’t affected by the economy," he says. "It’s all perception." For example, only 4 percent of people who have mortgages are in foreclosure, he notes.

New technology can help make the sale, as well, says Richard Geller, a dental marketing expert in McLean, Va. A diagnostic laser can detect hidden decay, he says, while a better intraoral camera might convince patients to get more work done.

"My strategy is to provide more services," Dr. Duncan says. He not only invested in new equipment but in continuing education. After taking dozens of hours of classes, he now places implants and invisible orthodontics in addition to doing his general dental work.

"It keeps the patient in the practice," he says. And it wins their loyalty because patients like having the work done by the dentist they already know.

Dentists should also enlist their staffs to sell procedures, Geller says. After all, hygienists and dental assistants often spend more time with patients than dentists do. In particular, they can make the pitch for soft tissue management. A large percentage of patients suffer from some sort of periodontal disease, which can best be treated with multiple office visits.

Cosmetics will be harder to sell in a down economy, but not impossible, Dr. Blatchford insists, noting that Revlon became a successful cosmetics company during the Depression. "No matter how little money people have, they want to look good."

Dr. Kaufman, on the other hand, thinks dentists should focus on new preventative techniques. "You really want to do your core values as well as you can," he says. "There’s an opportunity to better take care of people with services not provided before." Less than 1 percent of dentists measure salivary bacteria levels and only 34 percent apply in-office fluoride varnishes, according to a survey that Dr. Kaufman and his colleagues will present at the International Association for Dental Research convention in July. Yet these approaches can be good for both the patient and the dentist's bottom line.

A growing number of insurance companies will reimburse new preventative techniques, including more frequent visits for high-risk patients. And dentists can present them as a way to cut the cost (as well as the pain) of infection and decay. "Patients see a dental office completely differently, when all of a sudden they perceive you’re treating them for a disease," Dr. Kaufman says. As a result, they become more loyal and more likely to accept your recommendations.

If dentists want to expand services, "why wouldn’t you treat the disease you’re the expert on?" he asked. "This is our turf."

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Study: Digital x-rays easily altered

Study: Digital x-rays easily altered

April 21, 2008 -- Suppose a patient sues you. In trial, the patient's lawyer produces x-rays showing your mistake -- let's say a periapical lesion caused by coronal leakage. You know you did a good job on the crown, so how did this happen?

Maybe you're not as skilled as you thought. Or maybe it's Photoshop.

As digital x-rays become more common, new concerns are rising about the ability to use photo editing software and other techniques to alter x-rays or even CT scans.

In a review article being published by the Journal of Endodontics (JOE), researchers from the University of Ghent, Belgium, summarize several studies showing how convincingly digital x-rays can be manipulated. The article doesn't cite any actual incidents of fraud, but outlines the potential.

"A few years ago, creating a convincingly altered digital image required the efforts of a specialist using sophisticated equipment," the authors write, "but nowadays it can be easily accomplished by anyone with a personal computer." They note that medical fraud makes up 10 percent of all fraud cases in the United States, and argue that the risk of tampering is a major disadvantage of digital x-rays.

When a radiograph is exported from dental software programs, it may be stored in a format that can be opened by Photoshop or a similar program. Of course, as the authors admit, a scanned image of film x-rays can also fall prey to such manipulation.

In fact, a 1999 study published in the Journal of the American Dental Association showed that insurance companies could be fooled this way. Researchers created the appearance of carious lesions, large restorations, fractures and periapical inflammation and submitted claims for treatment. The insurance companies approved compensation in every single case.

Darkroom techniques -- even as simple as exposing or underexposing -- can alter film enough to change the appearance of a disease. "There's no way of knowing that the image has been touched up, and there never has been," says Allan Farman, B.D.S., M.B.A., Ph.D., D.Sc., a professor at the University of Louisville and president elect of the American Academy of Oral and Maxillofacial Radiology. So he doesn't think tampering is a particular problem of the digital age.

And digital equipment makers are hard at work on anti-fraud technology. Among the most promising are digital watermarks -- code embedded into the image that is invisible to the viewer but can be detected by the equipment which will note any changes from the original.

Some equipment already comes with some security measures, the JOE authors write, but most can be outwitted by sophisticated technicians. And these measures have not yet been standardized so that images can be sent securely among machines made by different manufacturers.

So what does this mean to the dentist? In the normal course of dentistry, no one has incentive to tamper with an x-ray. But, the authors write, "alertness and awareness are recommended when digital radiographs are used in any context such as damage claims, medical evidence material, forensic dentistry, presentations, publications, or insurance cases."

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Medica and Minnesota Delta offer new plan

Medica and Minnesota Delta offer new plan

April 18, 2008 -- Medica and Delta Dental of Minnesota are forming a partnership to offer Minnesota residents a new dental plan -- Medica Direct Dental.

Effective May 1, Medica Direct Dental will be available to current and future Minnesota Medica members ages 18 through 64 with Individual medical coverage (Medica Solo, Medica Direct HSA, Medica Direct Value). Family members covered under the medical plan are also covered by the dental plan.

Members can choose from three different plan options:

A preventive-only plan provides 100 percent coverage for routine exams, X-rays, cleanings, and fluoride treatments with an annual maximum of $500 per person.
One comprehensive plan offers all features of the preventive plan, 50 percent coverage for oral surgery, endodontics, root canal therapy, periodontics, crowns, bridges, dentures, and denture/bridge repair; and 80 percent coverage for fillings and sealants with an annual maximum of $1200 per person.
The other comprehensive plan offers a slightly lower coverage on fillings and sealants, with an annual maximum of $1,000 per person.
"Medica is pleased to provide dental coverage as a complement to our Individual medical plans," said Craig Ashby, Medica director of Individual products. "We recognize that good dental health influences overall health and well-being."

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BioHorizons buys Implant Logic Systems

BioHorizons buys Implant Logic Systems

April 18, 2008 -- BioHorizons Implant Systems, a manufacturer of dental implants, has completed its acquisition of Implant Logic Systems, which provides technology solutions for the dental implants market.

BioHorizons first announced its intention to purchase Implant Logic Systems in January.

"We are excited to expand our product offering to include Virtual Implant Placement (VIP) planning software and CAD/CAM surgical guides. This acquisition is a key milestone for us as we move the field of implant dentistry into the digital age," said Steve Boggan, CEO of BioHorizons in a press release.

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Dentists may get tax cut in underserved Maine

Dentists may get tax cut in underserved Maine

April 16, 2008 -- A new bill in Maine promises dentists a tax credit of up to $15,000 for practicing in underserved areas, according to a news report in Bangor Daily News.

Bill LD 2129 -- "An Act to Increase Access to Dental Care" -- sponsored by Rep. Patricia Sutherland, has already passed the Maine House of Representatives.

The tax benefit would be for dentists who join, open a new practice, or buy an existing practice in an underserved area and serve there for five years. The U.S. Department of Health and Human Services will define what qualifies as an underserved area.

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ADA Foundation funds anesthesia education

ADA Foundation funds anesthesia education

April 16, 2008 -- The ADA foundation is giving the American Dental Society of Anesthesiology Research Foundation a $100,000 grant to develop curriculum materials and advanced training for sedation and anesthesia-related emergencies and complications that can arise during procedures.

"The training will be a combination of electronic-mediated written materials and a laboratory practice component based on the latest scientific knowledge and techniques on the use of sedation and anesthesia, giving special emphasis to airway management and emergencies," explains an ADA press release.

Once a pilot test of the proposed test is carried out the ADA Foundation will partner with the ADA to make it available in 2009. The ADA will also encourage state dental boards to accept this course as an alternative to currently required emergency certification courses.

"At a time when dentists are increasing their use of sedation and anesthesia in the dental office," said ADA Foundation President Arthur Dugoni, D.D.S., M.S., "there is a critical need for an advanced course that focuses on emergency management."

For further information call (312) 440-2694.

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Information offered on Olympus Corporation

Information offered on Olympus Corporation

April 15, 2008 -- Want an updated guide on the functioning of Olympus Corporation? For $927 you can pick up a copy of Research and Market's "Olympus Medical Device Company Intelligence Report."

The report focuses primarily on the company's largest division -- Olympus Medical Systems, which makes biomaterials and devises for procedures like endoscopy and minimally invasive surgery.

Of Olympus Medical Systems' total revenue, 31% is generated from sales of minimally invasive products.

"A new area for the minimally invasive business is dental products. The company began selling color measurement equipment for dental clinics and dental implant manufacturers in November 2006," explains a Research and Markets press release. "Olympus plans to continue to expand its involvement in the dental equipment market by developing new products based on its optical and image processing technologies."

The table of contents includes:

Overview
Strategic focus
Products
Research and development
International activities
Financial indicators
Key corporate events
Mergers and acquisitions
Joint ventures
Minority investments
Agreements
Litigation

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Heartland Dental settles fraud suit for $3 million

Heartland Dental settles fraud suit for $3 million

April 15, 2008 -- Heartland Dental -- a company that manages dental practices in a dozen states -- will pay $3 million to settle allegations by the U.S. Attorney's office that it billed Illinois Medicaid for unnecessary dental work, according to newspaper reports.

The company was further accused of letting dentists write prescriptions without government clearance.

Heartland Dental has not admitted to either allegation.

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Heartland Dental settles fraud suit for $3 million

Heartland Dental settles fraud suit for $3 million

April 15, 2008 -- Heartland Dental -- a company that manages dental practices in a dozen states -- will pay $3 million to settle allegations by the U.S. Attorney's office that it billed Illinois Medicaid for unnecessary dental work, according to newspaper reports.

The company was further accused of letting dentists write prescriptions without government clearance.

Heartland Dental has not admitted to either allegation.

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Ultradent adhesive matches Kuraray's Clearfil in strength tests

Ultradent adhesive matches Kuraray's Clearfil in strength tests

April 15, 2008 -- In the world of self-etch adhesives, Kuraray's Clearfil SE is like Muhammad Ali -- the one to beat. That's why researchers at the recent American Association for Dental Research (AADR) annual meeting in Dallas did a double take when they heard Ultradent's improved Peak SE + Peak LC matched the champion in a test of each product's adhesive power.

Ultradent's Peak SE + Peak LC self-etch adhesive combination fared well in studies presented at the American Association for Dental Research annual meeting.
In a study by researchers at Dalhousie University in Canada, Peak SE + LC actually came out on top. "I predicted Clearfil would do better," said observer Joe Ontiveros, D.D.S., director of esthetic dentistry at the University of Texas in Houston. "For this new adhesive to come in higher is significant."

AADR researchers presented results on some two-dozen studies in which they compared Clearfil SE to other adhesives, and in almost all of them, Clearfil SE beat its competition.

Fewer studies looked at Peak SE + LC, which Ultradent improved in a version released this year. But in those few, it came out looking good.

In the Dalhousie study, researchers compared the shear bond strength of several adhesive systems used to attach resin composites to ground enamel, uncut enamel, and dentin. On ground enamel, Peak SE + LC got a rating of 41.18 megapascals (MPa) versus 34.42 for Clearfil SE, a statistically significant difference.

On dentin, the two products reached a statistical draw: 39.12 MPa for Peak SE + LC to 35.57 for Clearfil SE. Likewise, the two were statically tied, 27.26 MPa versus 26.03, on uncut enamel.

Clearfil SE (megapascals) Peak SE + LC (megapascals)
Dentin 35.57 39.12
Ground enamel 34.42 41.18
Uncut enamel 26.03 27.26

The researchers also compared the two self-etch systems to two Ultradent total-etch systems (phosphoric acid + PQ1 and phosphoric acid + Peak LC). Predictably, the total-etch systems were stronger on both ground and uncut enamel. But on dentin, Peak SE + LC was equally strong.

A third self-etch system, Prompt-L-Pop (3M ESPE) scored at the statistical bottom on all three surfaces.

The study was particularly important because of the relatively high number of samples used. The Dalhousie researchers repeated their test three times with 10 teeth used for each bonding system on each of the three types of surfaces (for a total of 30 teeth per bonding system on each surface).

In addition, they thermal-cycled the specimens 2,000 cycles at 5 C and 55 C to mimic conditions in the mouth.

But lead researcher Melanie McLeod, a dental student at Dalhousie, warned that dentists shouldn't conclude that Peak SE + LC is superior simply on the basis of a single study. "This is just one aspect to consider," she said. "There are other factors, such as microleakage and the hydrolytic stability of the adhesive systems."

Indeed, in a microtensile bond strength study presented at the meeting, researchers from the University of Missouri in Kansas City found that Clearfil was stronger than Peak SE + LC and two other adhesives when water pressure was applied to simulate pulpal pressure. And a study from Creighton University in Omaha, NE, on shear bond strength found no statistical difference among these adhesives or five others.

The Dalhousie study was funded by the Natural Sciences and Engineering Research Council of Canada and a grant from Ultradent which the researchers said was unrestricted.

The Missouri research was funded by the U.S. Public Health Service, and the Creighton study listed no funding source.

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AACR show report: Dentists balk at cancer screenings

AACR show report: Dentists balk at cancer screenings

April 15, 2008 -- SAN DIEGO -- Dentists don't want to spend time screening patients for oral cancer because they're not sure how to do it properly -- or how to make money from it, researchers said at the American Association for Cancer Research annual meeting here.

The researchers, from Simon Fraser University and the British Columbia Oral Cancer Prevention Program in Canada, collected four months of data from pilot cancer screening projects at 10 dental offices in Vancouver, then queried dental staff in focus groups.

"The idea was to raise public awareness, and remind dentists and their staff about how easy an oral cancer exam can be," said study author Denise Laronde, a dental hygienist and doctoral candidate at Simon Fraser University.

Earlier research has suggested that dentists could save lives with oral cancer screenings. In a British Columbia study, 70 percent of oral cancer patients who had regular dental office visits were diagnosed at an early stage (stage I or II), while only 40 percent of those who did not have regular dental visits were diagnosed at an early stage, the researchers said.

Oral cancer screening is a quick and painless procedure, yet fewer than 30 percent of people surveyed report being screened, the researchers added.

In the current study, dental personnel were taught to use a novel screening device that uses loss of autofluorescence to identify potential areas of concern in the oral mucosa. Dentists, dental hygienists, and dental assistants participated in a one-day workshop on the procedure with didactic sessions and hands-on assessments of patients with high grade dysplasia or squamous cell cancer lesions.

For the following four months, the dental offices screened all patients over age 21 for oral cancer, collected risk information, completed extraoral and intraoral exams, and performed autofluorescence visualization of the oral mucosa with a handheld device.

"With the autofluorescence device, the exams took less than two minutes," said Laronde. "Although dentists are taught this skill, many of them had questions about the details of oral cancer screening, including how to talk to patients about screening and how to do biopsies."

Some of the participants themselves suggested a way to communicate with patients: Information sheets for patients in different languages, and prep sheets for dental staff with simple responses to common questions, Laronde said. One dentist put together a one page script about oral cancer screening, including why screenings are important, and included statistics about oral cancer. "This raised patients’ awareness, and they started to ask questions about oral cancer that they hadn’t asked before," the dentist said.

Some participants told the researchers that oral cancer just wasn't at the top of their list. "You tend to forget oral cancer screening because you’re focusing on the crowns and bridges and fillings and implants," one dentist said. "You kind of leave all that (screening) education behind."

Others pointed out that they couldn't make money from cancer screenings. "The dentists felt they needed extra time not only for the exam, but for explaining the screening process to patients,"Laronde said.

In general, patient responses were very positive to the screenings. However many were surprised because they hadn’t been screened before, dental personnel reported.

The dentists and other dental personnel called for mandatory continuing education for all dental personnel to maintain the skills needed for oral cancer screenings. They suggested that a certification course for new technology (including fluorescence visualization) be available at conferences and workshops. They also noted that there was a need for guidelines, protocols and referral pathways, regarding who should be screened, at what intervals, what cases to refer forward, and who to refer patients to for follow-up and possible treatment.

In an editorial in a special issue on oral cancer published by the Journal of the Canadian Dental Association in April 2008, the Canadian researchers noted that dentists can prioritize patients for screening. Dentists should especially screen patients over 40, smokers, and those who use alcohol regularly, since these patients are at higher risk, the researchers said. But they recommended that screenings should be performed at every dental visit. "It’s important for us to integrate these screenings into our daily practice," Laronde said.

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Getting tough on deadbeat clients

Getting tough on deadbeat clients

April 15, 2008 -- Paul Donadio is 6 feet 4 inches tall, 230 pounds and all Italian. "I don’t carry a baseball bat, but I definitely fit the role for this business," he jokes.

As district manager for the collection agency Transworld Systems, Donadio knows as much as anyone about overdue dental bills. He told a recent audience at the Yankee Dental Congress that such debt is a growing problem, but that most dentists could collect more than they do.

As health and dental insurance costs have increased, the portion of these bills paid out of pocket is now 35 percent, three times higher than in 1980, says Donadio.

But out of 20 high-priority bills an average person must pay, the dental bill ranks 17. "People are far more likely to pay their cable, cellular, and legal bills," says Donadio. "But at least they’ll pay your bill over the vet bill."

Unfortunately, Donadio says, the average recovery rate for medical and dental bills is 10.8 percent. "It’s a pretty high failure rate."

Why are dentists so low on the priority list? "They think you’re rich and don’t need the money."

Many dentists don’t threaten to collect unpaid bills for fear of alienating patients, but the more reluctant they are to collect, the more money they leave on the table.

Debt depreciates a half a percent less for each day you don't collect, Donadio says.

And the average cost of handling delinquent payments internally is $31.60 per account due. That's the cost of making phone calls and sending statements and letters every 90, 120, and 150 days.

Some dentists outsource the problem to collection agencies after a few months, but Donadio says they should do it sooner. "Day 180 is too late. You should outsource it after 30 days. Think of self-pay balances as a stolen car," he says. "The quicker you report it, the more likely you’ll recover it."

Warning signs that you’ll never get your money: The account becomes 60 days overdue; the patient's phone has been disconnected or unlisted; or payments become smaller and/or less frequent. "If you’re collecting 50 percent or less of your accounts receivable every month, you’ve got a problem and you need to do something different."

To lower delinquency, dentists need to change their way of getting paid, says Donadio. You need to state your financial expectations as clearly as your clinical expectations. Have a clear, concise patient financial policy set up for staff to hold onto and for patients to sign. Train staff to be confident in customer-service skills that includes being empathetic to patients' situation but firm on payment. Offer different credit options and payment schedules. Even consider sending them to patient financial counselors.

On bills you send out, state that a service charge or interest rate will be added to outstanding amounts. List a due date instead of an aging date showing how long the payment has been late. Contact overdue accounts more frequently, as often as every 10 days. At the extreme, refuse to treat non-compliant patients until they pay up.

Better yet, collect payment upfront after they get out of the dentist chair, says Donadio. "Don’t ask, ‘How much can you pay?’ or ‘When can you pay?’ Instead, say something like, ‘Your treatment cost $125. We accept cash, check, Visa or Mastercard. Which do you prefer?’ They’re more likely to pay on the spot than if they get a statement."

But if money is not coming, dentists have a few options.

You could just write off the account, but that means giving up money that belongs to you.
You could hire an attorney, but the legal fees might be more than you are owed.
You could go to small claims court, "but a ruling is not effective if the defendant doesn’t show up in court," says Donadio.
Not surprisingly, he recommends that dentists go to a collection agency instead, arguing that the "third party impact" makes a big difference. "They’ll put your letters in a pile and screen your calls. But when the first letter from a collection agency comes in, they’ll most likely send a check for fear of damaging their credit report."

So who do you call? There are 5,000 collection agencies in the U.S. To find a reputable collection agency, look for one that complies with the licensing requirements of your state.

Ask prospective agencies whether they comply with the Fair Debt Collection Practices Act (FDCPA). Their answers should indicate they are knowledgeable about this law, which prohibits them from "abusive and deceptive" conduct when collecting debt (like calling them at home in the middle of the night, or at work).

Ask for client references. Pick one that has been around for a while.

Also ask prospective collectors if they charge a flat fee or a percentage of the collection amount.

Once you turn it over to an agency, you’ll lose control of the account - and a patient relationship. But don’t worry: No agency will work them over with baseball bats. "We are the good guys in this industry," says Donadio.

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Removing amalgam cures ills -- but so does healthy living

Removing amalgam cures ills -- but so does healthy living

April 11, 2008 -- Can you cure your patients' nagging headaches, skin diseases, and other maladies by removing their amalgam (mercury) fillings? You might, suggests a new German study in the April issue of the Journal of Dental Research.

But it's not the only way to eliminate what patients consider amalgam-related complaints. You could also relieve their woes simply by prescribing a healthier lifestyle, the authors suggest.

Researchers studied 90 patients whose complaints could not be explained by a medical or psychological disorder. They divided the patients into three groups:

Those who had their amalgam fillings removed (removal group).
Those who had amalgam removed and received biological detoxification in the form of high vitamin doses and trace elements (removal-plus group).
Those who simply participated in a health-promotion program that included good nutrition, exercise, and relaxation techniques (no-removal group). This last group did not have amalgams removed.
Participants were between the ages of 20 to 50 and reported at least 10 symptoms -- with three of strong intensity -- that suggested their health complaints were caused by amalgam.

Researchers gave patients a list of 50 symptoms and asked them to rate severity of symptoms on a scale of 0-3 (0 = not present to 3 = strong intensity), and then asked them to rate their three main complaints on a scale of 0-9 (0 = not present to 9 = extreme) to get a weighted sum score. The procedure was repeated one, two, six, 12, and 18 months from the start of study.

The most common complaints were skin disease, headache, mental complaint (nervousness, sleeplessness), general tiredness/weakness, or an infection/low resistance to infections. Less frequently reported woes included allergies, sensory disturbances, and urological, gastrointestinal, and cardiovascular symptoms.

After 12 months, the main-complaints sum score for the removal and removal-plus groups dropped by an average of 3.5 points. The no-removal group saw a drop of 2.5 points.

"The focus of this controlled trial was to investigate treatment options for so-called 'amalgam patients,'" wrote the study authors. "The improvements observed in all groups were clinically relevant and persisted throughout the follow-up period of 18 months."

Although removing mercury fillings (with or without biological detoxification therapy) reduced patients' health complaints, so did a regular health-promotion program without amalgam removal, the authors noted.

"The strong effects of the health-promotion program on the subjective complaints of 'amalgam patients' were unexpected, especially since we observed only a weak relationship between numbers of treatment sessions and symptom relief," wrote the authors.

The authors suggest that adopting a healthy lifestyle -- which included good nutrition, exercise, and relaxation techniques -- in the no-removal group strengthened the patients' immune system and reduced amalgam anxiety. Then again, it could simply be the placebo effect.

"In our trial, amalgam removal was associated with a marked reduction in the participants' subjective health complaints. However, similar improvements were observed after a health-promotion program without amalgam removal," wrote the authors. Also, "there was a statistically significant improvement in the health of all three groups 18 months later," wrote Dieter Melchart, corresponding author, in an email to DrBicuspid.com.

"Although the reasons for amalgam-related complaints are still unclear, our results suggest that amalgam removal is not the only treatment option, since all treatments were associated with clinically relevant improvements," concluded the authors.

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'Swish and spit' test offers early detection of oral cancer

'Swish and spit' test offers early detection of oral cancer

April 11, 2008 -- A new "swish and spit" method, developed at the University at Buffalo and Roswell Park Cancer Institute in New York, has joined the slew of diagnostic methods that aim to detect oral cancer at an early stage.

Researchers conducted a preliminary study by collecting epithelial cells of the mouth with a "swish and spit" method. Eight subjects with oral cancer or a history of abnormal oral lesions and five healthy subjects brushed and rinsed with saline, and then provided saliva samples.

The samples were studied for a fibrous protein molecule known as cytokeratin 8 (CK8) which is a cancer marker. Study results were presented at the 2008 American Academy of Dental Research session in Dallas.

"Cytokeratin 8 expression is closely related to abnormalities of epithelial cells and shows a positive correlation with the development of head and neck squamous cell carcinoma," said Jennifer Frustino, a predoctoral student at the UB School of Dental Medicine and first author on the study. "These markers are especially useful because they are abundant, stable, and easily stained and detected. epithelial cells line all internal and external body surfaces."

Researchers noted that subjects with oral cancer or a history of oral lesions had a much higher percentage of cells with cytokeratin 8 than healthy patients.

"This is the first study that detects CK8 as a biomarker through an easy collection method and simple analysis," said Frustino. "This marker may someday provide a focused target for early detection through a simple test done routinely in a dental office."

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Survey: Dentistry demand dropping

Survey: Dentistry demand dropping

April 11, 2008 -- The demand for dentistry -- particularly expensive procedures -- may slow down over the next few months, according to a survey that financial advisory company Robert W. Baird released last week. The news caused some dental supply companies' stock to fall.

"Our fear is that if job loss accelerates, dental benefits in the U.S. could get less over the next few months," Robert W. Baird analyst Jeff Johnson told DrBicuspid.com. "Job loss is tied into insurance (so) there would be loss in volume of patients and a trade down to lower-end procedures."

Dentsply, whose stock dipped after Johnson's report, argued that he had exaggerated the importance of the recession. "While this will have some impact on the dental industry it is not a large impact," said Bill Jellison, chief financial officer.

Robert W. Baird surveyed 245 dentists (85 percent general dentist and 15 percent specialists) between March 27 and April 9 this year. In addition, it took into account comments from respondents and feedback from a number of public and private dental industry sources, Johnson said.

"While it is fair to say that neutral comments we collected in this survey outweighed some of the more colorful negative comments," the report reads in part, "... if even a small proportion of dental practitioners are seeing a fall-off in patient traffic to the extent noted by some of our survey respondents, industry-wide growth could slow by a couple percentage points."

Here are some of key findings from the survey:

So far in 2008, 29 percent respondents felt that the patient flow was the same as the previous year, 27 percent found it modestly slower and 11 percent found it significantly slower. On the other hand, 24 percent felt it was modestly busier while 8 percent found it significantly busier than last year.
Looking ahead, 33 percent felt patient flow would be the same as the previous year, 28 percent thought it would be modestly slower and 10 percent felt it would be significantly slower. Twenty-two percent felt they would be modestly busier while 8 percent predict they'll have more patient visits than last year.
When asked about patients' willingness to spend money on expensive procedures 43 percent said a small number of patients were less willing to spend in recent months,16 percent said a large number were less willing, 34 percent saw no change, and 7 percent reported that their patients were more willing to spend in recent months.
Based on these trends there will be a slow down in market trends over the next quarter, Johnson projects. And that is why he has dropped the target price on the stock of a number of dental supply companies:

Dentsply stock price down to $42 from $48.
Henry Schein to $64 from $70.
Patterson to $41 from $38.
Sirona Dental Systems to $32 from $35.
Young Innovations to $21 from $27.
With the exception of Henry Schein which is at "over perform," Johnson has downgraded the stock of all other dental supply companies that he monitors to "neutral."

But Jellison is optimistic and explains that when employers cut medical costs, they sometimes replace them with less expensive dental and vision plans.

Other dental supply companies listed in Johnson's report did not respond to requests for comments.

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Gum disease linked with gestational diabetes risk

Gum disease linked with gestational diabetes risk


April 9, 2008 -- NEW YORK (Reuters) April 8 - Pregnant women with gum disease may be more likely to develop gestational diabetes than those with healthy gums, researchers have found.

Gestational diabetes arises during pregnancy and usually resolves after the baby is born, but it can raise a woman's risk of developing type 2 diabetes later on. It can also contribute to problems during pregnancy and delivery, including maternal high blood pressure and a larger-than-normal baby, which may necessitate a cesarean section.

The new findings, published in the Journal of Dental Research, suggest that gum disease may be a treatable risk factor for gestational diabetes.

Among pregnant women researchers followed, the 8% who developed gestational diabetes had higher levels of gum-disease-causing bacteria and inflammation.

Gum disease can trigger an inflammatory response not only in the gums, but throughout the body. It's possible that such inflammation may exacerbate any pregnancy-related impairment in blood sugar control, contributing to gestational diabetes in some women, the researchers speculate.

Past studies have also linked gum disease to a higher risk of premature birth, with one theory being that systemic inflammation is involved.

Of the 265 women in the study, 83% were Hispanic, a group that is at higher-than-average risk of both gestational diabetes and type 2 diabetes. The women who developed gestational diabetes were also significantly more likely to be heavier before they became pregnant, have had gestational diabetes before, and higher C reactive protein levels, a marker for inflammation and cardiovascular disease.

"In addition to its potential role in preterm delivery, evidence that gum disease may also contribute to gestational diabetes suggests that women should see a dentist if they plan to get pregnant, and after becoming pregnant," Dr. Ananda P. Dasanayake, the lead researcher on the study, said in a statement.

"Treating gum disease during pregnancy has been shown to be safe and effective in improving women's oral health and minimizing potential risks," added Dasanayake, a professor at the New York University College of Dentistry.

Future studies, Dasanayake noted, should investigate the link between gum disease and gestational diabetes in other high-risk groups, such as Asian and Native American women.


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Cone-beam CT findings raise liability questions

Cone-beam CT findings raise liability questions

April 9, 2008 -- So you've just bought a new cone-beam CT (CBCT) machine to plan implants, and you're marveling about its ability to literally see inside your patients' heads. Suddenly something catches your eye. What's that spot on the patient's neck?

If you think that's not your responsibility, think again. The 3D images created by cone-beam CT scans can reveal many medical problems, such as atheromas and spinal degeneration, not visible in traditional X-rays. That's a good thing. Recognizing these signs, known as incidental findings, may allow dentists to save lives by referring imperiled patients to medical doctors.

But with the new power comes new responsibility -- and potentially legal liability.

"Any practitioner who acquires a radiology machine is responsible for all the findings on it," says Hareeti Gill, D.D.S., a New York University resident who presented a paper on the topic at the American Association for Dental Research (AADR) annual meeting last week.

"A carotid atheroma indicates a high risk of a stroke. If you don't refer the patient to an M.D., and this patient has a stroke, you're going to be named in a malpractice lawsuit."

Joan Andersen Phelan, D.D.S., one of Dr. Gill's advisors, adds that you can't avoid liability just because you don't own the cone-beam machine. Many services that provide CBCT scanning specify that they don't take any responsibility for interpreting the images -- that's up to the dentist who commissions them.

In a random review of 170 randomly selected CBCT scans, radiologists participating in Dr. Gill's study identified 75 incidental findings of possible medical problems, including seven carotid calcifications. The scans were done on asymptomatic patients not known to have any related disorders.

Just how much responsibility dentists must take for these findings remains controversial. Allan Farman, B.D.S., M.B.A., Ph.D., D.Sc., a University of Louisville professor and president-elect of the American Academy of Oral and Maxillofacial Radiology (AAOMR), agrees with Dr. Gill. "Yes, indeed a dentist is liable for the full volume exposed," he wrote in an e-mail to DrBicuspid.com. "This is especially likely to be the case in states that recognize oral and maxillofacial radiology as a specialty of dentistry -- where the dentist will be held to the standard of the specialist."

That's not a reason to stay away from cone-beam, he argues. "The obligation to diagnose is not CBCT specific. It has always been around," he says. Carotid atheromas could be spotted with simple panoramic X-rays, for example. In fact, CBCT might help dentists by making it easier to catch these problems.

San Francisco dental malpractice attorney Edwin J. Zinman, D.D.S., J.D., takes a more conservative view. He thinks dentists may run the risk of malpractice suits if they don't use CBCT to plan implants. "There was just a $1.7 million verdict against a periodontist who harpooned the alveolar nerve," he said. "He used a medical CT instead of a cone-beam."

And Dr. Zinman agrees that the added information provided by CBCT might include problems that have nothing to do with the reason the scan was original done. "You can't ignore a lesion, even though it's in an area where there is no implant."

But Dr. Zinman doesn't think dentists are liable for spotting problems outside their training -- in general the jaw, the mouth, the sinus. "If it's beyond the area that dentists usually diagnose, they are not responsible," he says.

Dr. Phelan isn't surprised that experts disagree. "This is a new area," she says.

But it leaves dentists with a quandary -- if you don't feel comfortable diagnosing medical problems but you want to plan implants, how can you avoid liability?

The simple answer is to refer patients with incidental findings to a radiologist. Drs. Zinman, Phelan, and Farman all advised dentists who don't think they can catch medical problems to send the X-rays to oral and maxillofacial or head and neck radiologists.

For as little as $75, radiologists can provide a complete interpretation that protects the patient’s whole head and neck -- and the dentist's hindquarters.

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Humana Dental offers oral cancer screening to patients over 40

Humana Dental offers oral cancer screening to patients over 40

April 1, 2008 -- Here's a way to convince high-risk patients to take an oral cancer screening test. Tell them it's free. HumanaDental Insurance has announced that it will now provide oral-cancer screening to HumanaDental members -- over the age of 40 -- enrolled in the company’s fully insured dental plans.

Starting April 1, the insurance company will cover an annual ViziLite Plus exam. Vizilite uses a chemiluminescent light to identify oral lesions and a toluidine blue-based metachromatic dye to mark them.

"After the patient rinses with a special solution, the dentist examines the mouth with a disposable light stick," explains a HumanaDental press release. "Under the light, abnormal tissue appears bright white."

"One person dies of oral cancer every hour in the United States," said Mark Matzke, chief operating officer of HumanaDental in a press release. "Because early detection is the key to fighting this disease, we’re pleased to offer this coverage as part of our commitment to promoting oral health, which is directly linked to overall health."

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Lantis Laser upgrades OCT system

Lantis Laser upgrades OCT system

April 1, 2008 -- Lantis Laser is partnering with Axsun Technologies to upgrade its optical coherence tomography (OCT) dental system.

Axsun designs integrated microelectromechanical systems (MEMs) OCT engines.

The Lantis system will be upgraded with Axsun's patented swept source technology, which will result in the highest attainable performance for frequency domain optical coherence tomography, according to a Lantis press release.

Lantis' OCT Dental Imaging System consists of a handheld scanner the size of a handpiece that, using coherent light, captures real-time, high-resolution cross-sectional images (tomographic slices) of hard or soft dental tissue. The captured images are sent to the company's proprietary imaging software running on a PC for display and analysis.

This chair-side tool can be used for the early detection of tooth decay (including root surface decay), caries around restorations at an early stage, gum disease, the marginal integrity of restorations, and more. According to the company, the system even lets you measure periodontal pockets without physical probing.

This light-based system boasts a resolution up to 10 times that of X-rays, but doesn’t emit any harmful radiation, according to a Lantis press release.

The system, which was slated to hit the market this year, will now be launched in 2009 because of the upgrade.

"Swept source OCT engines that are high-performance and manufacturable in high volume are something we have sought for many years while developing the dental application of OCT. The technology has now caught up with the application, allowing us to offer a much higher system performance level in terms of scanning speed, resolution and in field reliability," said Stan Baron, president and CEO of Lantis in a press release. "At the same time, the cost effectiveness of the Integrated MEMs OCT Engine enables us to meet the targeted price to the dentist of approximately $25,000."

"The application of our technology into the dental industry is very exciting as there is a very large potential customer base to purchase Lantis' OCT Dental Imaging System, and we are geared up to supply this large market," said Dale Flanders, CEO of Axsun in the same release.

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Report offers microscopy imaging techniques to study biomaterials

Report offers microscopy imaging techniques to study biomaterials

April 1, 2008 -- Research and Market's report -- "Dental Biomaterials: Imaging, Testing, And Modelling" -- is a guide on the use and performance of dental biomaterials.

Several chapters in the report are devoted to optical and electron microscopy imaging techniques for dental biomaterial interfaces. It also contains information about the use of computer models in areas such as shape optimization of dental restorations.

Dental cements, fibre-reinforced composites, metals, and alloys are some of the materials discussed in the report, with an emphasis on analyzing their resistance to stress, fracture, wear, and aging

"With its distinguished editors and team of experienced contributors "Dental biomaterials: Imaging, testing, and modeling" will provide researchers, materials scientists, engineers, and dental practitioners with an essential guide to the use and performance of dental biomaterials," says a company press release.

Among the topics covered are:

Optical imaging techniques for dental biomaterials interfaces.
Electron microscopy for imaging interfaces in dental restorations.
Dental adhesives and adhesive performance.
Testing the performance of dental implants.
Assessing the performance of dental handpieces, crowns, implants, and prostheses.
The report costs $247.

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Dental fillings responsible for methylmercury in environment

Dental fillings responsible for methylmercury in environment

April 1, 2008 -- Amalgam fillings are under fire yet again. This time for possibly polluting water with the potent, ingestible, neurotoxin methylmercury.

When mercury is exposed to sulphate-reducing bacteria, it undergoes a chemical change and becomes methylmercury. Researchers at the University of Illinois at Chicago (UIC) and Urbana-Champaign (UIUC) say that mercury entering drain water from dental offices and clinics is a source of methylmercury in the environment.

Karl Rockne, associate professor of environmental engineering at UIC, and James Drummond, UIC professor of restorative dentistry, studied waste water samples from collection tanks serving a single-chair office and a 12-chair dental clinic in Chicago. The study results appeared in the journal Environmental Science & Technology.

"They [the researchers] measured total mercury and methylmercury in both settled and mixed water samples. They then used quantitative polymerase chain reaction to identify the methylating bacteria," explains an article on the journal site.

Methylmercury appeared to be produced partially, if not fully in the waste water, noted Rockne in a UIC press release. In other words, methymercury was being produced before elemental mercury particles got into sewers where sulphur-reducing bacteria thrive, he added.

"The finding raised the question whether the culprit bacteria were living in the mouths of dental patients. We don't have the answer," said Rockne in the UIC press release.

Follow-up research is necessary to further understand this issue, Rockne said.

"Amalgam separators are a good first step, but maybe something else is necessary downstream to prevent further methylation and prevent further soluble mercury from getting through the system," he said in the UIC release.

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Arizona Dental Association, Delta Dental of Arizona fight 'meth mouth'

Arizona Dental Association, Delta Dental of Arizona fight 'meth mouth'

April 1, 2008 -- The Arizona Dental Association and Delta Dental of Arizona Foundation have each made a $10,000 contribution to the Arizona Meth project (AMP).

AMP is a prevention campaign designed to initiate parent-child conversations, and highlight the detrimental effects of meth use. According to the 2006 Arizona Youth Survey, 4.3% of Arizona teens use meth -- almost twice the national average. The campaign is aimed at junior- and high-school students, and young adults between the ages of 18 and 24.

"Dentists are able to recognize possible signs of 'meth mouth' early on and therefore have an opportunity to help patients seek assistance andtreatment," said Rick Murray, executive director and CEO of the Arizona DentalAssociation, in a press release. "Through our collaboration with the Arizona Meth Project, member dental offices around the state have received informational brochures detailing the meth problem in Arizona and resources for users."

"Dentists are often one of the first healthcare professionals to treat a meth user, so our dentists are aware and very concerned about the devastating effects of this drug on our young people," said Bernard Glossy, president of Delta Dental of Arizona, in the release. "Meth destroys families and communities, and as part of the Arizona community, we feel a need and responsibility to help raise awareness of this highly addictive drug."

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BioCad and Dale Dental form partnership

BioCad and Dale Dental form partnership

April 1, 2008 -- BioCad has announced that Dale Dental will be their exclusive outsource laboratory with rights to manufacture, design, and distribute BioCad products to laboratories within the U.S.

BioCad offers CAD/CAM-designed bars and abutments for most brands of implants.

The companies will manufacture implant bars and abutments through a combination of high-precision scanning, CAD design tools, industrial robotized machining, and zirconia and titanium materials.

"Dale Dental is proud to add this new CAD/CAM solution to our broad range of products," said Dave Lesh, president of Dale Dental in a press release. BioCad's easy to use CAD software and impressive milling capabilities allows us to offer implant bars, custom abutments, and other products of extraordinary quality that meet a true need for our customers focused on precision and esthetics."

"We are very excited about our relationship with Dale Dental," said Jean Robichaud, president of BioCad in the same press release. "Dale’s outstanding expertise in dental esthetics and broad customer base gives every lab, dentist, and patient in the U.S. fast and easy access to this revolutionary new technology."

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Picture perfect x-rays

Picture perfect x-rays

April 1, 2008 -- The x-ray is one of the most potent diagnostic weapons in the dentist's arsenal. But over time, it's easy to take x-rays for granted, to take sloppy shots, to make the same mistakes over and over, and worse, unnecessarily expose patients to more radiation, due to retakes.

That's the hard news delivered by Edwin Parks, D.M.D., M.S. and Gail Williamson, R.D.H., M.S., both of Indiana University, in their "Picture Perfect Quality Radiographs" session given at the Yankee Dental Conference 33 recently held in Boston. (Full disclosure: Dr. Parks is a DrBicuspid.com Advisory Board member.)

The duo's goals in this session? To show you how to minimize patient and operator exposure; identify and correct errors in intraoral and panoramic radiographs (both digital and film); how to manage patients to get better shots; and altogether improve the quality of your radiography.

The surprisingly entertaining session covered everything from selection criteria and using receptors properly, to taking sharper images and avoiding goofs in the darkroom, all illustrated with Professor Williamson's colorful anecdotes and Dr. Parks' droll humor. This first article focuses on intraoral radiography; part II will delve into the panoramic side.


A typical underexposed shot. These images cannot be corrected digitally.
Basic mistakes, basic fixes

So where do dentists and their staffs go wrong? For starters, notes Williamson, the basics are often ignored, from film handling to angulation. "Proper technique is a matter of geometry," says Williamson. "And getting the patient to cooperate -- and getting a better picture -- is a matter of psychology."

Some common errors and the fixes:

Quit relying on default settings. "Every patient is different and requires a unique radiographic assessment," says Williamson. Take a medical and dental history, look for clinical signs and symptoms, and consider the patient's age, size, weight, and various risk factors.

"A lot of practices are still using slow D speed film!" says Williamson, with a hint of exasperation in her voice. "Simply by switching from D to F speed film, you can reduce the patient's radiation dose by 60 percent," she says. Switch from D to digital x-ray, and you'll reduce the exposure by 80 percent.

Pick the right receptor. Use a receptor with a rare earth intensifying screen (using phosphors of lanthanum or gadolinium) and you'll likewise minimize exposure even further. And no, receptor holders aren't "cheating" -- they can help standardize picture taking and reduce the number of errors and retakes.

Place the film as close to the object as possible. The receptor should be parallel to the tooth, and at a 90 degree angle to the x-ray source. To reduce patient exposure and penumbra (shadow), use a collimator. You'll get sharper images.

If you can't get a parallel placement -- say, due to patient discomfort -- use the bisecting angle technique. This allows the clinician to control the length of the tooth structure to avoid elongation or foreshortening. Just remember that there's bound to be some distortion, because the receptor and beam are not aligned in parallel.


A horizontal angulation error can produce an image with interproximal overlap.
Keep the darkroom dark! Especially if you're using faster film. Eliminate light leaks and use proper safe lighting; change the developer frequently; and maintain the equipment. There's nothing more galling than having to retake a series of X-ray images because the processor, "ate the film". "And you know darn well that this will happen with that cranky patient who didn't want x-rays taken in the first place," says Williamson.

Get the lead out. Although there's debate about the need for lead aprons and collars, when in doubt, use 'em. Patients expect to be shielded (with apron and collar). Use the shields and they'll feel reassured, and be more cooperative. A key handling tip: Never fold an apron. This creates creases, which can let radiation through.

Watch your dose! That means taking the MPD (maximum permissible dose) guidelines established foir clinicians seriously, especially if you're pregnant. To minimize your exposure, don't hold the x-ray head or PID, don't hold the receptors in the patient's mouth, and don't hold the patient in position. If something or someone must be held, have a properly-shielded family member do it. You're getting exposed to x-rays every day; they're not.

By the same token, you don't have to hide in a bunker when taking x-ray images, says Williamson. Remember the distance and position rule -- if you're 6 feet from the source and angled 90° to 135° from the primary beam -- you're safe.

Anatomical and other challenges

Sometimes you can't get a parallel placement. Sometimes the patient gags no matter what you do. Others fidget or slump, ruining the shots. Williamson's advice:

Bag the gag reflex. Gagging means the patient can't breathe. The trick, says Williamson, is getting the patient to breathe through their nose. Try classic distraction techniques -- have the patient bend their toes, hum, raise one leg -- so they don't focus on gagging. Try the classic placebo technique -- put salt on their tongue. Still another trick: Put a dab of topical anesthetic on their soft palate or the edge of the film. Don't use a spray, warns Williamson. A topical gel gives you more control. Finally, says Williamson, "wrap the offending edge of the film with tissue sponges. It's like a sock on a bare foot."

Tori tori tori! Place the receptor behind the torus and toward the midline. Likewise place topical anesthetic on the torus and tissue sponges on the film to minimize discomfort. Note: Because tori increase the thickness and density of bone in these areas, you may need to increase the exposure time to get a sharp image.

Classic errors, simple solutions

They're oldies but goodies -- film placement errors, angulation snafus, exposure gaffes, and more. What are the common errors and how can you avoid them?

Where's that receptor? Putting the receptor in the wrong place -- or putting in it backwards -- are all common mistakes, says Williamson. The area you want to shoot isn't covered, crowns are cut off, and worse. The correction? Place the film more toward the midline and check that orientation!

Angulation errors. If the vertical angle is too great, the image may be foreshortened -- like a shadow cast when the sun is overhead. The fix: Decrease the vertical angle. If the vertical angle is too small -- easy if you're using flexible plates -- the image is elongated. The fix: Increase the vertical angle.

Use bitewings? Forced to place receptors diagonal to the teeth? Watch out for horizontal angulation errors, which produce a too-wide image with interproximal overlap. The solution is to shoot the x-rays through interproximal surfaces.

Central ray cone-cut errors. If your film is only partially exposed, it isn't in the right place or the tubehead isn't pointing at the center of the film. Solution: Properly align everything, with the ring centered over the film.

Exposure errors. Once again, says Williamson, don't rely on default settings. "Look at your subject! A big guy needs a longer exposure, a small 80 year old woman, much less," says Williamson. Underexposed shots can't be corrected digitally, she says. Overexposed pictures can be fixed. "But the more you fuss with an image, the worse it gets."

Processing boo-boos. "Darkroom errors are a major cause of retakes," says Williamson. Rinse film thoroughly with fixer or it will turn yellow. Temperature and timing can take their toll. So, too, can feed errors (due to the mechanism advancing the film)choice.ich leave permanent artifacts (akin to bite marks!) on the image.

For more detail on radiographic do's and don'ts, check out these pieces by Professor Williamson and/or Dr.

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NADL's Web site educates consumers on contaminated restorations

NADL's Web site educates consumers on contaminated restorations

March 31, 2008 -- A recent investigative report by WBNS-TV of Columbus, Ohio, found lead contamination in crowns coming into the U.S. from overseas. Following the report, the ADA issued a tip sheet for dentists concerned about contaminated restorations. Now the National Association of Dental Laboratories (NADL) has launched a Web site for consumers.

On the NADL site, you can get information about contaminated dental restorations, and contact NADL officials with questions and comments
Currently, there is limited information on the site. One brief article talks about lead and describes the symptoms of lead poisoning.

Mostly the site provides information about the dental laboratory industry, details about lab certification (and what that means in terms of quality assurance), and the NADL.

Visitors can also send questions and comments to the co-executive directors of NADL.

"Lead Contamination: As patient safety is our #1 concern, the National Association of Dental Laboratories (NADL) recognizes that this is a serious concern for not only dental patients, but for the dental community as a whole," claims the homepage.

The Web site will soon be offering more information.


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NADL's Web site educates consumers on contaminated restorations

NADL's Web site educates consumers on contaminated restorations

NADL's Web site educates consumers on contaminated restorations

March 31, 2008 -- A recent investigative report by WBNS-TV of Columbus, Ohio, found lead contamination in crowns coming into the U.S. from overseas. Following the report, the ADA issued a tip sheet for dentists concerned about contaminated restorations. Now the National Association of Dental Laboratories (NADL) has launched a Web site for consumers.

On the NADL site, you can get information about contaminated dental restorations, and contact NADL officials with questions and comments
Currently, there is limited information on the site. One brief article talks about lead and describes the symptoms of lead poisoning.

Mostly the site provides information about the dental laboratory industry, details about lab certification (and what that means in terms of quality assurance), and the NADL.

Visitors can also send questions and comments to the co-executive directors of NADL.

"Lead Contamination: As patient safety is our #1 concern, the National Association of Dental Laboratories (NADL) recognizes that this is a serious concern for not only dental patients, but for the dental community as a whole," claims the homepage.

The Web site will soon be offering more information.


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NADL's Web site educates consumers on contaminated restorations

Endodontists urge kids to 'watch their mouths

Endodontists urge kids to 'watch their mouths


March 27, 2008 -- NEW YORK (Reuters) March 27 As kids everywhere "spring into sports," the American Association of Endodontists (AAE) is urging all young athletes to "watch their mouths" and wear a mouthguard for every sport, including spring sports typically thought of as "non-contact" sports like soccer, softball, baseball, and even gymnastics.

Traumatic injury to the teeth and knocked out teeth are most often associated with football or hockey, but spring sports, such as soccer and baseball, can present just as big a risk, the AAE notes in a statement issued Thursday.

The association points out that soccer players are roughly eight times more likely than football players to suffer mouth injuries and nearly one in five baseball players will experience a dental injury. Mouthguards prevent an estimated 200,000 injuries a year.

"Mouthguards are not just for kids that play rough contact sports," Shepard S. Goldstein, AAE president and an endodontist from Framingham, Massachusetts said. "It is essential that children's teeth be protected from dental injury when they play any physical sport."

"The AAE wants athletes, coaches and parents to know that mouthguard use is imperative for all sports."

There are three types of mouthguards: The off-the-shelf "one-size-fits-all" mouthguard; the mouth-formed "boil-and-bite" mouthguard; and the dentist-made custom mouthguard.

While custom mouth guards offer the best protection, using any type of mouthguard helps to reduce the chance of injury to the teeth, according to the AAE. If a tooth is knocked out, the association suggests taking the following steps to help boost the odds of saving the tooth:

Pick up the tooth by the chewing surface, not the root.
If the tooth is dirty, gently rinse with water.
Reposition the tooth in the socket, if possible.
Keep the tooth moist.
See an endodontist within 30 minutes.
When using mouthguards, it's important to properly maintain and clean them to prevent any possible infections.

The AAE's mouthguard campaign is part of a larger initiative -- the 2008 Root Canal Awareness Week campaign -- which takes place March 30 to April 5.

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New software lets dentists detect osteoporosis

New software lets dentists detect osteoporosis

April 1, 2008 -- Dentists can now add osteoporosis to the growing list of systemic diseases they might be able to detect. All with the help of a new software application -- Osteodent -- which is designed to detect osteoporosis by reading dental X-rays. The software was developed at the School of Dentistry and the Division of Imaging Sciences at the University of Manchester.

The Osteodent program uses ‘active shape modeling’ technology -- developed by the University of Manchester's Division of Imaging Sciences -- during the X-ray process to automatically detect jaw cortex widths of less than 3mm which is a key indicator of osteoporosis, according to an article on the University of Manchester Web site.

Osteodent was tested in a three-year EU-funded study conducted by the University of Manchester in concert with the Universities of Athens, Leuven, Amsterdam, and Malmo. The findings -- "Automated osteoporosis risk assessment by dentists: a new pathway to diagnosis" -- were published last year in the journal Bone.

"At the start of our study we tested 652 women for osteoporosis using the current ‘gold standard’, a highly expensive, DXA test. This identified 140 sufferers," said Professor Keith Horner, one of the researchers in the University of Manchester article. "Our automated X-ray test immediately flagged-up over half of these. The patients concerned may not otherwise have been tested for osteoporosis, and in a real-life situation would immediately be referred for conclusive DXA testing."

"As well as being virtually no extra work for the dentist, the diagnosis does not depend on patients being aware that they are at risk of the disease. Just by introducing a simple tool and getting healthcare professionals working together, around two in five sufferers undertaking routine dental x-rays could be identified," added Dr. Hugh Devlin another researcher in the same article.

UMIP (The University of Manchester's IP commercialisation company), has recently made a deal with Swedish company Crebone AB giving them the rights to sell the software until 2010.

"We're very excited about this product because we know it has enormous potential," said Dr. Horner in another article on the University of Manchester Web site. "As Osteodent works as part of a routine dental appointment it could have substantial benefits for our NHS financially. In countries with private healthcare systems, Osteodent could also be very lucrative to dentists."

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