The Halloween candy that children collect could play a trick on their teeth due to tooth decay. However, it could be a treat for American military personnel serving overseas. Since 2012, Kool Smiles has collected more than 8 tons of donated candy and sent a thousand care packages to servicemen and servicewomen through Operation Troop Treats. To date, Kool Smiles states, it is the largest candy exchange program run by an American dental provider.
“Operation Troop Treats is our way of encouraging children and parents to maintain healthy dental habits this Halloween while also bringing a little joy to US service members deployed overseas who are not able to celebrate with family here at home,” said Kool Smiles chief dental officer Dale Mayfield, DDS.
All Kool Smiles offices will participate in the program during business hours from Friday, October 28 to Saturday, November 5. Children who bring in 25 pieces of unopened candy in its original intended packaging can receive a free toy in exchange. There is a limit of 3 toys per child, and toys will be distributed on a first-come, first-served basis. The program is open to everyone, and participants do not have to be Kool Smiles patients.
“Good dental health is especially important around Halloween when there’s plenty of sugar-filled sweets floating about,” said Mayfield. “We want to make trick-or-treating fun—just without the cavities!”
Kool Smiles also is donating 200 dental care kits for troops to Operation Gratitude as well as the funds to cover their assembly and shipment. Operation Gratitude is a volunteer nonprofit organization that produces more than 200,000 care packages for American service personnel serving in harm’s way and their children as well as for new recruits, those wounded in service, veterans, and first responders.
“We are thrilled that Kool Smiles is continuing its Operation Troop Treats program for the fifth year,” said Operation Gratitude founder Carolyn Blashek. “It’s wonderful to see so many children giving up their candy to help put smiles on the faces of our servicemen and women deployed overseas. Kool Smiles’ additional donations of dental care kits and funds to Operation Gratitude are deeply appreciated and go a long way in boosting troop morale.”
The ADA has named Joseph P. Crowley, DDS, of Cincinnati as its next president-elect. He will serve under incoming president Gary L. Roberts, DDS, of Shreveport, La. Crowley addressed the House of Delegates on Monday, October 24 in Denver, Colo.
“My charge is not to stay status quo. We are well on our way to moving forward to being a progressive organization,” said Crowley, who will spend the next term as president-elect, followed by a year as president in 2018. “I’m very happy to have 2 years with you to move forward.”
Crowley has been a member of the ADA for 40 years and is the immediate past trustee of its 7th District. He also is a former chair of the ADA Council on Government Affairs, chair of the ADA Audit Committee, and a member of the American Dental Political Action Committee Board of Directors.
In 2013, Crowley earned the Ohio Dental Association Distinguished Dentist Award. In 2007, he won the Ohio Pierre Fauchard Distinguished Dentist Award. And in 2001, he received the Ohio Dental Association Achievement Award. A 1976 graduate of the Ohio State University College of Dentistry, Crowley was president of the Ohio Dental Association in 2005 and 2006 and of the Cincinnati Dental Society in 1996.
The Orange County Health Care Agency (OCHCA) now reports 48 cases of mycobacterial infection—15 confirmed, 33 probable, with all 48 hospitalized at some point—involving children between the ages of 3 and 9 years receiving pulpotomies at the Children’s Dental Group facility in Anaheim between March 1 and August 5, 2016. More cases may await, however, as symptoms have been appearing between 15 and 85 days after the infection.
After the initial reports of infection, OCHCA ordered the practice to stop using water in its procedures. The agency then found mycobacteria in 5 water samples taken from the facility. While mycobacteria are common in the environment and generally pose minimal risk, OCHCA believes that the organism multiplied to dangerous levels in the waterlines of the practice’s dental units. Remediation efforts are now underway.
“Mycobacteria is naturally occurring within water. All water that comes from our treatment plants has a recommended number of colony forming units (CFUs) allowable by the federal Environmental Protection Agency (EPA), and that’s 500 CFUs or less,” said Leann Keefer, RDH, MSM, director of education and professional relations with Crosstex, which is now working with Children’s Dental Group to replace its water system.
“Mycobacerium, Legionella, and Pseudomonas are the 3 most common opportunistic pathogens, and you will find them in low numbers,” Keefer said. “The issue comes into the dental unit waterlines because those lines are so narrow, and the flow is relatively low. The water stagnates, and that’s how the biofilm develops. And they multiply into much higher numbers that have the potential for causing disease.”
When dental unit waterlines haven’t been treated, CFU counts could exceed one million as biofilm develops and sticks to the inside walls of those lines. As water flows over that biofilm, it starts to break away from the inside walls and join the stream entering the patient’s mouth. Or, it may enter any aerosol being used as part of that waterline, which then puts the dental professionals at risk as well.
Not all people who are exposed to these bacteria, even in large quantities, necessarily get sick. Outbreaks such as this one and a similar case in Georgia in 2014 and 2015 may have affected children so significantly because their immune systems are still developing, Keefer said. Even then, only 1% of the pediatric patients who were treated at that Georgia practice came down with the infection. The Children’s Dental Group says that it treated about 500 children with pulpotomies, and only children treated for pulpotomies are at risk in the current outbreak.
“But in my mind, one child is too many. One patient is too many,” said Keefer. “This is something we could easily control.”
OCHCA has approved the Children’s Dental Group’s replacement plan for the infected water system, which will be installed by October 31. The new system will include clean water sources, institutional infection control and water routing devices, and ongoing monitoring of purification levels.
“Some people think that using distilled water in your bottle is treating the water. It’s not. The distilled water is still running through those lines. It could be contaminated,” Keefer said. “So if you’ve not been doing anything, you pretty much know that you’re going to be off the charts with CFUs, so it’s time for you to evaluate which method would be best for your particular practice.”
The ADA says that dental unit water that remains untreated or unfiltered is unlikely to meet the 500-CFU/mL standard, so one or more commercial devices and procedures designed to improve water quality should be employed. Commercially available options include independent water reservoirs, chemical treatment regimens, source water treatment systems, daily draining and air purging regimens, and point of use filters.
The Crosstex DentaPure cartridge, for example, uses a matrix of iodinated resin beads to treat water passing through the dental unit waterline during the course of a year to control bacteria. The isotopic iodine it uses is protein-free, so there is no risk of an allergic reaction. It doesn’t require any tablets or routine shocking, nor does it use any silver or have any special disposal requirements. And, distilled water isn’t required.
“DentaPure is basically a NASA technology that was developed to provide safe water for our astronauts while they are in space, and it’s still being used on the International Space Station today,” said Keefer. “As the water flows into the cartridge and over those iodine beads, the iodine is released at 2 to 4 parts per million, which then actively kills the bacteria that’s found in the dental unit waterlines.”
Also, the ADA recommends strict adherence to maintenance protocols and consultation with dental unit manufacturers before initiating any waterline treatment protocol. Waterline treatment schedules should include water quality monitoring as well via self-contained and easy to use water quality indicators, the ADA says. In-office testing kits are available, and many laboratories provide mail-in testing services.
“Our testing has shown that we not only meet but exceed the EPA recommendations. We can claim 200 CFUs or less with the DentaPure unit for a period of one year after installation,” said Keefer. “That’s another huge advantage because it’s not something that your staff has to do daily, that they have to remember about compliance. Once they put it into the system, it’s there for a year.”
Crosstex will remind users when it’s time to replace their DentaPure unit each year, so practices basically can forget about it until it’s time to swap in a new one. However, the company does provide iodinated test strips for users who want to verify that the cartridge is operating properly and releasing between 2 and 4 parts per million of iodine. Users also can send test samples of water to Crosstex for analysis.
“And that’s a great teaching tool for the staff because when it’s coming back at less than 200 CFUs. That’s positive reinforcement that they’re doing the right thing,” said Keefer.
Furthermore, Keefer urges users to follow all Centers for Disease Control and Prevention guidelines for operation. In between each patient, for instance, dental staff should flush the lines for 20 to 30 seconds. This doesn’t remove the biofilm from the inside of the dental unit waterlines, but it does help remove any free-floating oral bacteria and other contaminants that may have backflowed into the system during dental treatment.
The Organization for Safety, Asepsis, and Prevention offers additional resources on dental unit waterline protection and says that dental healthcare personnel should be trained in water quality, biofilm formation, water treatment methods, and appropriate maintenance protocols. Its online materials also detail self-contained water systems, chemical agents, and filters, sterile water delivery systems, and source water treatments. The most overlooked strategy for preventing infections, though, may be communication.
“We think these incidents are devastating for the patients and their families. But it’s also unfortunate that dental practices are the source of these contaminations because they largely are preventable,” Keefer said. “So we need to get the awareness out there, and patients should be asking ‘What are you doing to treat the dental unit waterlines?’ And the staff should be excited to share, ‘This is what we’re doing to keep the dental unit waterlines safe.’”
Dental benefit coverage offerings have grown during the past few years as the Patient Protection and Affordable Care Act (ACA) has become more ingrained within the healthcare system in the United States, according to A.M. Best.
The insurance rating firm reports that companies that filed an annual health statement with the National Association of Insurance Commissioners increased their dental net premiums written by 76.7% in the past decade, from $9.4 billion in 2005 to $16.7 billion in 2015.
Also, the largest annual growth rate came in 2014, when net premiums written increased 14.4% year over year. Similarly, enrollment grew 53.4% for the same time period, increasing to 71.0 million in 2015 from 46.3 million members in 2005, with a 19% year over year increase in 2014.
Despite geographic and provider network challenges, A.M. Best stated, dental business has given health insurances steady net operating gain profitability throughout the past decade with a fairly substantial improvement in results since 2009. This consistent operating gain profitability has been supported by a tightly range-bound loss ratio between a low of 60.4% in 2008 and a peak of 64.3% in 2013.
Dental writers benefit from the mostly consistent utilization of policyholders and usually don’t experience large one-time shock claims that may be associated with more typical health lines of business, which ultimately keeps the loss ratio at fairly manageable and predictable levels.
As companies expand into individual dental markets where adverse selection is a potential risk, products are modified to include longer waiting periods for major dental services and lower annual maximums.
Market share in the overall market is concentrated, as the top 10 dental writers account for 61.5% of the market, with Metropolitan Life & Affiliated Companies dominating with 17.3%. The individual dental market also is concentrated with the top 10 players holding 66.9% of the market, led by MCNA Insurance Company at 30.2%. Individual benefits are a new phenomenon, with interest emerging and premiums growing rapidly in the past 10 years.
And regardless of some provider network challenges and underserved geographic areas, A.M. Best states that the dental insurance industry is poised for growth as employees continue to value the benefit offering from employers and as more dental insurers participate in the ACA exchanges.
According to A.M. Best, increasing competition including numerous small carriers expanding their exchange offerings may pressure operating results on a company by company basis, but underwriting gains in each of the last 5 years are substantially higher than levels recorded from 2005 to 2009.
Privately billed insurance claims related to oral cancer diagnoses rose 61% from 2011 to 2015, according to data on 21 million privately billed medical and dental claims examined by FAIR Health. The greatest increase involved throat cancer (malignant neoplasm of the nasopharynx, hypopharynx, and oropharynx). The second greatest was in tongue cancer (malignant neoplasm of the tongue).
“Oral cancer is a serious and growing public health problem,” said FAIR Health president Robin Gelburd. “We hope that our data help inform the national conversation on this topic.”
Also, 74% of oral cancer claims were for males while 26% were for females. Tongue and throat cancers in particular were more likely to occur in men than women. However, men and women had similar chances of developing gum cancer (malignant neoplasm of the gums) and an oral tumor that was benign but could become cancerous (neoplasm of uncertain behavior—oral). Tobacco use, excessive alcohol use, and human papillomavirus (HPV) are the chief risk factors.
Oral cancer claims occurred much more frequently among individuals age 46 years and older than in younger individuals, with increases among those age 56 to 65 years and decreases for those age 65 years and older. The American Cancer Society estimates that approximately 48,330 Americans will get cancer of the oral cavity or pharynx in 2016 and about 9,570 will die of the disease.
However, patients who are diagnosed in the early stages of the disease see 5-year survival rates between 80% and 90%. That’s why the ADA recommends oral cancer screenings during routine dental checkups, particularly among patients who use tobacco or consume alcohol heavily. Still, FAIR Health reports, adult males were much less likely than adult females to seek preventive dental examinations and cleanings despite their greater risk for oral cancer.
According to FAIR Health, 2 dental procedures associated with oral cancer screenings have been increasingly performed from 2007 to 2015: CDT codes D0431, an adjunctive prediagnostic test, and D7287, an exfoliative cytological sample collection, or obtaining cells for microscopic study. Approximately 65% of these codes were filed for patients between the ages of 31 and 60 years, with the 41- to 50-year-old segment seeing the most codes at about 24%.
A new regenerative scaffold made of biosafe collagen hydrogel and collagen sponge could retain fibroblastic growth factor-2 (FGF2) and stimulate periodontal tissue regeneration. Developed at the Hokkaido University Graduate School of Dental Medicine, the scaffold would improve the outcome of periodontal regenerative surgery and support to prevent tooth loss compared to exiting scaffold materials, according to the researchers.
In periodontal regenerative therapy, stable periodontal attachments including the cementum and periodontal ligament should be reformed on the instrumented tooth surface and stimulate alveolar bone regeneration. But periodontal attachment is difficult to reform because the rapid growth of the junctional epithelium and gingival connective tissue inhibit the growth of periodontal tissue associated with periodontal attachment.
Predictable periodontal regenerative procedures, then, require the development of compatible biomaterial against the periodontal stem cells, progenitors, and tissues. Collagen hydrogels cross-linked by an ascorbate-copper ion system exhibit high fluidity. To promote its operability, the researchers injected the FGF2-loaded collagen hydrogel into the biocompatible 3-D sponge-form collagen before implantation.
The combination of the collagen hydrogel scaffold and FGF2 exhibited good biodegradability of the scaffold and remarkably promoted periodontal healing, the researchers stated, involving the regeneration of cementum, periodontal ligament, and matured alveolar bone in beagles. Also, the FGF2-loaded hydrogel scaffold facilitated the formation of acellular cementum receiving insertions of Sharpey’s fibers continuous to periodontal membrane fibers (true regeneration).
Regenerated periodontal tissue would be effective for resisting the force of mastication, the researchers concluded. They also believe that this technique could replace the preexisting polymer scaffold and artificial bone graft in periodontal surgical therapy. The study, “Collagen Hydrogel Scaffold and Fibroblast Growth Factor-2 Accelerate Periodontal Healing of Class II Furcation Defects in Dog,” was published by The Open Dentistry Journal.
Children who require both dental and non-dental medical procedures should have them completed during a single general anesthesia session whenever possible, recommends the American Society of Anesthesiologists (ASA) based on research that will be presented at its Anesthesiology 2016 annual meeting this week in Chicago.
“While surgery and anesthesia are safer than they’ve ever been, limiting exposure is preferable, especially in children, because there may be sensitivities or a greater risk of anesthesia-related complications,” said Vidya T. Raman, MD, director of pre-admission testing at Nationwide Children’s Hospital and clinical associate professor at the Ohio State University Wexner Medical Center.
“In addition to improving patient safety, we believe combining procedures decreases costs and improves patient satisfaction,” said Raman, who also was the lead author of the study.
Some children require general anesthesia during restorative dental procedures such as tooth extractions and capping. When possible, the researchers stated, these procedures should be performed with other interventions requiring general anesthesia such as tonsil removal, ear tube insertions, and magnetic resonance imaging (MRI), which requires children to be still.
During the study, 55 children had a dental procedure combined with another non-dental medical procedure under one anesthetic. Only 7 of them (13%) saw complications such as vomiting, pain, fever, and pneumonia. Of those, 4 (7%) required unplanned admission to the hospital. Most of those patients were at increased risk of hospitalization because of severe systemic disease, Raman said.
Additionally, combining procedures saved an average of 30%, leading to a savings of approximately $165,000 for the 55 cases, the researchers said. The joint procedures also enabled these patients to be treated in a single visit instead of during the course of weeks or months.
Physicians can use electronic medical records to identify the recommended procedures that can be performed safely at the same time, Raman said. Everyone involved, including dentists, physicians, and parents, should be aware of all upcoming surgeries the child requires and communicate with all parties, Raman said.
However, she added, procedures that are more urgent and vital should be performed first to ensure safety without being combined, such as surgeries with an increased infection risk, spinal fusion, and heart surgeries.
“It can be logistically complex to schedule several procedures at once,” Raman said, “but combining them can decrease costs and pleases parents because their children don’t have to undergo multiple recoveries and can return to school and activities faster.”
Two research studies published by Lasers in Surgery and Medicine have demonstrated how the 1064-nm wavelength PerioLase MVP-7 dental laser system from Millennial Dental Technologies selectively destroys Porphyromonas gingivalis (Pg). This keystone pathogen directs other gum tissue bacteria to become pathogenically active in the progressive destruction involved in moderate to severe gum disease.
Historically, Pg has been identified as a black pigmented species bacteria based on its visible color in lab cultures. Previous studies have shown that it is destroyed in human treatments following the use of a 1064-nm pulsed Nd:YAG laser. These observations led to conjecture that Pg also was pigmented in the body (in vivo) and that the 1064-nm wavelength kills the bacteria by targeting the visible (black) pigment.
The first study, “The Black Bug Myth, Selective Photodestruction of Pigmented Pathogens,” demonstrated that the PerioLase MVP-7 destroys Pg regardless of the amount of visible pigmentation or complete lack of visible pigmentation in the bacterial. It also suggests that the laser kills Pg by destroying an invisible chromophore. Consequently, periodontal bugs don’t need to be black or even visible to the human eye for the laser to eliminate them.
The second study, “Selective Photoantisepsis,” focused on selectively eliminating pathogens at different depths within a tissue model by analyzing the differences between the absorption of light energy by pathogens and host tissues. It supports selective destruction of Pg and Prevotella intermedia (Pi) at depths of 3 to 4 mm using a 1064-nm pulsed Nd:YAG laser.
Unlike the 1064-nm laser, the 810-nm diode laser requires visible pigment to destroy the bacteria. The 810-nm laser also was lethal to the healthy tissue at an earlier stage. The model indicates no selectivity for the 2940-nm Er:YAG laser.
“These 2 studies add to our understanding of the reasons and mechanisms for the benefits of the PerioLase MVP-7 1064-nm pulsed Nd:YAG laser in reducing the periodontal pathogens associated with gum disease,” said Robert H. Gregg II, DDS, co-inventor of the PerioLase MVP-7 and inventor of the LANAP protocol.