As Republicans negotiate what will be included in the American Health Care Act before it goes to a vote, the Children's Dental Health Project (CDHP) is joining 6 other pediatric health organizations in opposing the bill, noting that its drastic changes to Medicaid would have a detrimental effect on children and families.

"This bill ends the Medicaid program as we know it, jeopardizing coverage for the 72 million vulnerable Americans—primarily children, pregnant women, seniors, and people with disabilities—who rely on Medicaid for their healthcare," the groups said in a joint statement.

According to the CDHP, children make up the largest group of people who rely on Medicaid. Nearly 36 million children receive Medicaid coverage, including those with special healthcare needs and those from low-income families. Medicaid's Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefits cover dental screenings in addition to other care.

Yet, the groups believe that the bill's plan to fund Medicaid through per capita caps, allow states to choose a block grant model, and lift EPSDT requirements for children would have a negative impact on care and, ultimately, quality of life. Overall, the groups state, children on Medicaid are more likely to get checkups, miss less school, graduate, and enter the workforce than their uninsured peers.

The CDHP is joined by the American Academy of Pediatrics, the Children's Defense Fund, Family Voices, First Focus Campaign for Children, March of Dimes, and the National Association of Pediatric Nurse Practitioners.  

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Nobody likes sitting in the waiting room. There is good news for patients, though, as the national average waiting time to see a doctor is 18 minutes and 35 seconds, according to Vitals—and that's a decrease of one minute and 16 seconds compared to last year. Dentists lead the pack in seeing their patients quickly, as their 8 minute and 27 second average waiting time leads all doctor specialties.

Vitals studied millions of its online reviews to see how wait times correlate with ratings. Physicians with 5 stars, the highest rating on the Vitals site, had an average wait of 12 minutes and 33 seconds. Physicians with just one star, the lowest rating, had an average wait of 33 minutes and 4 seconds. Vitals concluded that there is a strong correlation between the time that patients wait and the rating they ultimately leave.

"Wait time alone is probably not the cause of the bad rating," said Mitch Rothschild, founder and chairman of Vitals. "More likely, a doctor who can't watch the clock may not be effectively managing other parts of the practice that impact the patient experience."

This year's results reflect an overall trend toward shorter waiting times, which are down 13% since Vitals started reporting on the data in 2009. The company attributes the shorter times to the expansion of urgent care centers, retail clinics, infusion centers, and outpatient surgery centers, which are taking the burden off of primary care physicians. Plus, many doctors are expanding hours to mitigate the weekday crush and compete with these other options. Vitals expects these trends to continue.

"With alternative care facilities, telemedicine, and even at-home diagnostic kits, in the not too distant future, we'll only see our doctor for the most serious conditions," said Rothschild. "For now, though, we're seeing that expanded consumer choice has had a direct impact on wait times over the past 8 years."

Geographically speaking, Milwaukee had the shortest wait at 13 minutes and 22 seconds, followed by Portland, Ore, Minneapolis, Anchorage, and Seattle. El Paso was at the bottom of the list, with a 52-second increase during the last year to a new total of nearly 26 minutes, for the sixth year in a row. Memphis, Las Vegas, Miami, and Detroit also were at the bottom of the list.

While dentists topped the list with the shortest patient wait time, they were followed by child psychologists and radiation oncologists, both at 10 minutes at 59 seconds, plastic surgeons at 12 minutes and 28 seconds, and chiropractors at 12 minutes and 35 seconds.

According to Vitals, dentists may have an advantage over their colleagues in other fields because they perform scheduled services for their patients. For example, dentists can accurately predict how long a cleaning or filling will take. Primary care doctors, however, need time to diagnose their patients' vague symptoms, and that may throw off their schedule. 

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As human beings have evolved during the past 6 million years, our resident microbes also have evolved into different species to adapt to different conditions throughout the body, according to research from Duke University. For example, the researchers found that a group of streptococci bacteria in the oral cavity diverged fairly recently, as the palate, tongue, throat, tonsils, gums, and plaque all house their own species of bacteria. According to the university, these findings could help researchers determine how different genes allow microbes to adapt to one place or another and could lead to new therapies that shape the microbiome.

"Over the last decade, there has been significant interest in developing probiotics and transplants of beneficial bacteria to treat a wide variety of health issues," said Lawrence A. David, PhD, senior author of the study and assistant professor of molecular genetics and microbiology at the Duke University School of Medicine. "Our analysis gives us a window into how different bacteria adapt and evolve so that we can more effectively predict which implanted species will survive to make an impact on disease."

Scientists typically learn about the microbiome by sampling a few million bacteria from an area of the body and sequencing them to count which bacteria belong to each species. Then, they compare these counts and generate values that tell them the relative abundance of each type of bacteria. However, relative abundance data requires statistical methods that account for how shifts in one species might affect another. Justin Silverman, an MD-PhD student in David's laboratory, found a mathematical tool used by geologists, called the PhILR transform, that could be adapted to study the relative amounts of bacteria in the microbiome.

Using data from the Human Microbiome Project, the new technique combines the sequencing counts for each species with information on their position on the bacterial family tree. The resulting statistical framework starts with a common ancestor at the top and subsequent generations suspended underneath, like a mobile over a baby's crib, connected by a series of crossbars. By looking at how these crossbars tilt and sway with the weight of the various species dangling from their tips, the researchers could assess how microbial communities grew and evolved in different body sites.

"This technique unlocks a tremendous toolbox of statistical methods that wouldn't have worked before, but that can now be used to analyze microbiome data," Silverman said.

The study, "A Phylogenetic Transform Enhances Analysis of Compositional Microbiota Data," ( was published by eLife.

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The American Association for Dental Research (AADR) and the Friends of the National Institute for Dental and Craniofacial Research (NIDCR) have released a statement announcing their opposition to President Trump's fiscal year 2018 budget request. In particular, the groups oppose the White House's proposal to cut $5.8 billion of funding from the National Institutes of Health (NIH), which is a 20% reduction from the fiscal year 2016 budget, and urge Congress to do the same. NIDCR is part of the NIH.

In 2016, Congress passed the 21st Century Cures Act with bipartisan support. The act approved $4.8 billion in funding for the NIH for precision medicine and biomedical research as part of $6.3 billion overall. According to the AADR, this act is an example of the broad support the NIH has always appreciated from Congress. Furthermore, the AADR notes that the White House is requesting a major reorganization of the NIH's institutes and centers, such as the NIDCR, and calls such moves a needless exercise that will divert attention from the NIH's core mission of uncovering new knowledge that will lead to better health for everyone.

The federal government founded the NIDCR during World War II to improve the oral health of American soldiers deployed overseas. Noting that the nation's defense is linked to the health of its population, the AADR has expressed its continued support for the NIDCR and the role it plays in funding research into less invasive and more cost-effictive and cost efficient ways to improve oral health and reduce the economic burden that dental, oral, and craniofacial diseases and conditions place on Americans.

The AADR has additionally stated its desire to work with Congress on a bipartisan basis to increase funding for all of NIH's institutes and centers, including NIDCR, and to reject any proposals to cut or reorganize NIH. Furthermore, the organization aims to encourage members of Congress to honor its tradition of allocating resources to the entire biomedical enterprise at NIH, recognizing that a discovery in one area of research may be applied to another.

A new partnership has been announced that will streamline the 3-D printing process for dentistry. Watch now to find out the details. Also, we bring an update from the National Children’s Oral Health Foundation, or America’s Toothfairy, about their annual Smile Drive. This week marks the beginning of the Hinman Dental Meeting in Atlanta – find out what’s in store for the 105th annual gathering of dental professionals.

Did You Miss the Last DNN Broadcast? Watch it Now...

What Really Happens When Teeth Meet Sugary Drinks?

Is the urban legend true—will a tooth dissolve when left in a cup of cola? One dentist used his own extracted teeth to see what actually happens when they were exposed to different kinds of sugary beverages. Find out which drinks did the most harm. Also this week, learn about new research from Japan that links tooth loss to dementia. Our final story is about an electric toothbrush that helps fight plaque for people with sensitive gums. Watch now to get these full stories!

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Dentsply Sirona has opened up its CEREC system so clinicians can export scanned data from digital impressions in STL format. As a result, this data also now can be used in software products from other manufacturers. According to the company, this creates new possibilities for dentists who are gradually digitizing their practices. For example, they can use CEREC Omniscan scans in cooperation with their dental laboratory or other clinical planning software. 

“The provision of single-visit dentistry with CEREC does not need an open file, since CEREC is complete as it is. However, we see in the last few years that many other clinical applications are being used in the practice, and customers are asking to use their CEREC digital impressions in those applications,” said Roddy MacLeod, group vice president of Dentsply Sirona CAD/CAM. 

“It made sense to us, and now the option of exporting the scan data puts our customers in a position of being able to use CEREC with additional solutions in a digital world that is becoming ever larger,” said MacLeod.

Dentists can send the CEREC scans to a laboratory of their choice to order restorations. The STL format guarantees compatibility with all commonly used design programs that are employed in labs. The scan data also can be loaded into implant planning software to support preparations for the implant procedure. Plus, the open format enables practitioners to import the CEREC Omniscan scans into any other clinical or practice management software and to archive it there.

The corresponding software licenses will be available at the same time as CEREC SW 4.5.

Dentsply Sirona has announced a definitive agreement to acquire all of the outstanding shares of Recherche Techniques Dentaires (RTD), a privately owned French company that produces endodontic posts, including fiber-reinforced composite posts. 

“RTD’s unique and innovative offering perfectly complements our new R2C, the Root to Crown Solution. R2C provides state-of-the-art products and procedural guidance from diagnosis and treatment planning to the final coronal restoration,” said Jeffrey T. Slovin, Dentsply Sirona CEO.

“R2C and the RTD acquisition will enable us to provide dental professionals with a more complete end-to-end solution for better, safer, and faster root canals and tooth restoration,” said Slovin.

Dentsply Sirona will continue to support and grow the RTD’s brand and private label businesses. The companies have a long history together, as RTD has been supplying Dentsply Sirona with root canal posts for many years.

According to the companies, RTD pioneered fiber-reinforced composite post technology and is the only firm to integrate the manufacturing of composites, cements, and drills to offer complete solutions to its clients.

RTD’s portfolio comprises several styles and shapes of translucent and tooth-colored posts as well as cements and other accessory products for post-core restoration. The company reports that millions of its posts have been successfully used.

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New dentists joining Aspen Dental practices now can take part in the company’s Best Grad Gift Ever. Through this program, all graduating dental students who accept a job at an Aspen Dental practice by April 30, 2017, can participate in the New Grad Edition of the company’s VIBE Sessions exclusive professional development event. They also can enter into a sweepstakes for a 2017 Ford Mustang Shelby GT350R.

“In partnership with Aspen Dental practice owners who serve as mentors to new dentists, we’re committed to making it easier for dentists to achieve their dreams,” said Arwinder Judge, DDS, chief clinical officer at Aspen Dental Management. “We invest millions of dollars annually to support doctor development and mentorship, and this program is just one more way for us to demonstrate our commitment to supporting dentists at every stage of their career journey.”

To be eligible, fourth-year dental students or dental residents must accept a job at an Aspen Dental practice by the end of April 2017. All who qualify will be invited to participate in the Aspen Dental VIBE Session: New Grad Edition on September 16 and September 17 in Chicago, where one winner will be awarded a 2017 Ford Mustang Shelby GT350R.

During the past 3 years, the Aspen Dental VIBE Sessions have brought together hundreds of managing clinical directors, associates, and dental students for professional development, team building, and panel discussions with practice owners and partners. The New Grad Edition will be geared specifically to new dentists with a focus on long-term career building and networking with their peers and established practice owners.

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The number of people with untreated oral conditions such as dental caries and severe chronic periodontitis around the world rose from 2.5 billion in 1990 to 3.5 billion in 2015 due to demographic changes, including population growth and aging, according to a study by an international team of researchers. Also, the researchers noted, there was a 64% increase in disability-adjusted life years due to oral conditions during the same timeframe.

The study examined the world’s progress toward goals established by the Federation Dental International, World Health Organization, and International Association for Dental Research to reduce the level of oral diseases globally and minimize their impact by 2020. Despite some challenges with current measurement methodologies, these groups agree that specific measurable oral health goals should be developed to advance global public health.

Oral health did not improve during the 25 years that were studied, the researchers concluded, and oral conditions remained a major and growing global public challenge in 2015. In 2010, the direct treatment costs of these oral conditions totaled approximately $298 billion worldwide, or 4.6% of global health expenditures. The indirect costs totaled $144 billion. The researchers called for greater efforts and potentially different approaches to meet 2020’s oral health goals.

“Although numerous scientific discoveries and advancements have been achieved to combat and prevent oral health conditions, as a community we know that further efforts are required toward improving oral health worldwide and reducing the global burden of oral diseases,” said Raul Garcia, DMD, president elect of the American Association for Dental Research.

For example, 48% of the world’s population suffers from an oral condition, with 34.1% or 2.5 billion experiencing untreated caries in their permanent teeth in 2015. Also, untreated caries in deciduous teeth affected 573 million children in 2015. Total tooth loss affected 276 million people, peaking between the ages of 75 and 79 years, and severe periodontal disease affected 538 million people, peaking nearly 20 years earlier than total tooth loss.

The study, “Global, Regional, and National Prevalence, Incidence, and Disability-Adjusted Life Years for Oral Conditions for 195 Countries, 1990-2015: A Systematic Analysis for the Global Burden of Diseases, Injuries, and Risk Factors,” was published by the Journal of Dental Research.

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Dental implants are now standard solutions for replacing teeth that are lost due to caries, gum disease, or injuries. But we’re another step closer to growing new teeth in their absence, as researchers at Okayama University have demonstrated successful functional tooth restoration via regeneration in a postnatal large-animal model.

First, the researchers dissected embryonic tooth germ cells and tissues from a beagle 55 days before birth and reconstructed bioengineered tooth germ by means of the organ germ method, which regenerates ectodermal organs by replicating their developmental process starting from a bioengineered organ germ.

Next, these germs were transplanted into mice. In many cases, the germs resulted in tooth-crown formation, featuring both the hard and soft tissues present in natural teeth after several weeks. The researchers also were able to identify the necessary conditions for achieving this success.

Autologous transplantation experiments, which use an organism’s own stem cells instead of relying on a donor to avoid immunological rejection, were then conducted as researchers extracted deciduous teeth from the jawbone of a beagle that was 30 days old. Tooth germ engineered from the dog’s permanent tooth cell and tissue was transplanted after 2 days of cell culture into the dog’s mandible, resulting in tooth eruption 180 days later.

The developmental process of the bioengineered tooth’s formation was practically identical to a natural tooth’s, according to micro-CT analysis. Also, scanning electron microscopy and energy-disruptive x-ray spectroscopy revealed that the bioengineered tooth had the same structure and chemical composition of a natural tooth. Plus, the regenerated tooth’s response to mechanical force was consistent with the proper physiological functioning of the periodontal ligament.

As for human beings, the researchers noted that immature wisdom tooth germ would be a possible source of stem-cell germs, as it is available in the human postnatal jawbone, though this would only pertain to younger people as wisdom teeth mineralize after the age of 7 years. Elderly patients would need other stem-cell sources. Still, the researchers believe this work highlights the feasibility of fully functional restoration by autologous transplantation of bioengineered tooth germ.

The study, “Practical Whole-Tooth Restoration Utilizing Autologous Bioengineered Tooth Germ Transplantation in a Postnatal Canine Model,” was published by Scientific Reports.

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