California Dental Labs’ set of Diamond Impregnated Separators comprises oversized discs specially designed for the precise separation of zirconia, lithium disilicate, and porcelain restorations. Offered in sizes ranging from 26 mm to 29 mm with thicknesses ranging from 0.18 mm to 0.46 mm, the discs are particularly designed for perfect separation, countering, and finishing of the hardest and most difficult dental implants and bridge restorations.
The set features 3 disc styles: Ultra Thin (0.18 to 0.22 mm), Combo (0.22 to 0.26 mm), and Universal (0.46 mm). Specifically formulated to create minimal dust and smell with maximal cutting power, the discs can be ordered separately in one thickness or in a set of 3 different separators.
For more information, call Continental Dental Laboratories of California at (800) 443-8048 or visit continentaldental.com.
As healthcare models continue to evolve in the United States, George Washington University’s Health Workforce Institute (GWHWI) has issued a report that profiles how health workforce needs are changing—and what needs to be done to adapt to emerging needs in the 21st century. Among other areas, the report notes key adaptations that its authors say will help the dental profession better serve its patients, particularly underserved populations.
“The report will help health policy leaders identify new strategies for increasing access to healthcare, especially in remote or isolated regions of the United States,” said Patricia Pittman, PhD, co-director of the GWHWI. “Telehealth, nurse-led clinics, and Medicaid-financing of graduate medical education are just a few of the ways healthcare leaders can ensure that the US workforce is prepared for the future.”
For example, the report spotlights the need to integrate oral health into primary care teams, citing 8 case studies from the State University of New York (SUNY) Albany that documented the efforts of Federally Qualified Health Centers (FQHCs) to do so. Keys to this integration include integrated electronic health records and inclusion of new patient health information forms that ask patients about their history of dental disease and access to a dental home. Some FQHCs even embed a dental hygienist in offsite primary care practices to provide preventive and educational oral health services.
Next, the report associates less restrictive dental hygienist scopes of practice with better oral health. It says that dental hygienists are in a prime position to contribute to the transformation of oral healthcare due to their training and experience. Noting the significant changes in dental hygienist roles during the past decade, SUNY Albany has updated its matrix for assessing scope of practice laws for dental hygienists, enabling the university to demonstrate that states with less restrictive laws for dental hygienists had better oral health outcomes.
With this expansion in mind, the report cites 3 states—Minnesota, Alaska, and Maine—that license dental therapists to increase access to dental services in underserved communities. These professionals are known as “midlevel” providers because they can substitute for and supplement practice by a dentist in restorative therapy. SUNY Albany profiled an FQHC in Minnesota where the use of a dental therapist allowed greater flexibility for task shifting, such as performing simple restorations when a demanding emergency case was diverted to the dentist.
Dental assistants, meanwhile, face challenges. Typically involving clinical and administrative duties, dental assistant positions require middle to low levels of skill. However, training varies, ranging from on the job preparation to formal accredited education programs culminating in an associate’s degree. Allowable tasks also differ by state and sometimes are decided by the dentists who employ these personnel. Some but not all states recognize expanded function dental assistants, requiring extra training and competency testing for tasks such as applying sealants or performing dental radiography.
Outside of dentistry, SUNY Albany found that appropriate physician assistant training also can improve oral health. Currently, 3 out of 4 physician assistants received didactic and/or clinical instruction in oral health during their training. Also, physician assistants who received education in oral health and disease were nearly 3 times more likely to provide oral health services than those who did not receive any education in oral health competencies.
Meanwhile, technology can play a greater role in reaching underserved communities. Sites approved by the National Health Service Corps in states with more favorable telehealth coverage and reimbursement policies were more likely to use telehealth, including teledentistry, as were providers located in states with telehealth grant funds. SUNY Albany prepared 6 case studies of teledentistry programs that outlined strategies for increasing access to general and specialty dental services using remote technology.
Finally, FQHCs require personnel to operate if they’re going to reach underserved populations. SUNY Albany found that dental student externships and dental residencies can serve as a pipeline for FQHCs to hire new dentists. According to the report’s authors, it appears that participation in these clinical rotations is alleviating some of the difficulties that FQHCs face in recruiting dentists to work in the safety net.
This May, dental professionals from around the world will take part in the 47th Journées Dentaires Internationales du Québec. Presented by the Ordre des Dentistes du Quebec, the 3-day convention will provide a host of seminars and hands-on courses led by top dental experts at the Palais des Congrés de Montréal.
For example, TRAC Research’s Rella Christensen, RDH, PhD, will present “New Data—On Critical Dental Questions 2017” on Friday, May 26. Available for 6 continuing education credits, the day-long lecture will review the latest information from clinical testing about today’s cutting-edge technologies and techniques. Dr. Christensen recently gave us a preview of her presentation.
Q: What are the advantages of translucent zirconia?
A: The main advantage of translucent zirconia is its translucence. This allows a more lifelike appearance of zirconia in the aesthetic zone. A primary question today is if translucent zirconia can and should replace Ivoclar Vivadent’s e.max lithium disilicate. No one has the answer yet. Lithium disilicate has the advantage of historical perspective. Our clinical studies show that e.max can be durable when tooth preparations allow adequate thickness. Right now, our work has one year of clinical data on translucent zirconia.
Q: What are the disadvantages of translucent zirconia?
A: Two big disadvantages are its unknown clinical performance throughout time since it is so new, and its ability to match opposing and adjacent dentition reliably. It turns out that zirconia is difficult to color and it tends to have a bright white opacity that makes it stand out in the oral cavity, regardless of the improvement in translucence. In addition, zirconia finishing is an art rather than a science right now. When polished, the material can quite quickly take on an iridescent and gray cast, and it is difficult to impossible to go backwards and undo this problem once it has occurred during finishing. If the technician decides to glaze, we found that glazes begin to wear off within a few months and can leave a rough surface that patients can feel with their tongue and can wear opposing dentition. Right now there is a scramble to find ways to overcome these problems.
Q: Are there other options to translucent zirconia that dentists should consider, and when would they be indicated?
A: Dentists can also consider lithium disilicate and PFM for durability and aesthetics. Our studies show that the original full-strength full-contour zirconia (BruxZir) and PFM are still indicated in the following clinical situations:
- Molar restorations;
- Posterior multi-unit restorations;
- Patients with abusive occlusion;
- Patients with a high-risk lifestyle, such as athletes;
- Where future endodontic needs are anticipated.
Q: What are current alternatives to “drill and fill”?
A: Today, the most discussed and controversial option to “drill and fill” is silver diamine fluoride (SDF) disinfection. The major objection to the procedure is it causes demineralized tooth structure to darken to a brown or black color. Although it does not discolor healthy tooth structure, the discoloration of demineralized tooth structure is permanent. However, SDF use throughout many years in Japan has been shown to delay, and possibly arrest, dental caries. At this point in time, dentistry does not have any methods or chemicals that stop dental caries and maintain health over the lifetime of the patient without the patient’s control of diet, oral hygiene, and saliva flow. SDF is under intensive study and gaining use by pediatric, geriatric, and humanitarian dentists.
Q: Can teeth be remineralized today using various techniques or products?
A: Although mineralization can be demonstrated in vitro in the laboratory, we have not been able to show a significant and sustained affect in vivo. “Remineralization” is an interesting word because it implies different things to different people. We find that patients think it means that their teeth will be returned to their former perfect condition if they use products dispensed by clinicians such as 5,000 ppm dentifrice, amorphous calcium phosphate, xylitol products, etc. But as clinicians know, this is not possible. At our lab, we use the term mineralization rather than remineralization to indicate that ions can be exchanged, but the tooth does not return to its original chemical and physical state.
Q: How do you expect mineralization to evolve in the years ahead?
A: Based on history, progress will probably be slow and sustained. Everyone would like to be able to truly restore the tooth and/or prevent destruction in the first place. Some of the brightest minds in dentistry have tried to address this question for years, but we still appear to have a lot to learn.
Q: What are the advantages of laser use in general dentistry today?
A: Simple soft-tissue surgeries by general dentists have created a niche for lasers. These include troughing before impressions to control bleeding and gain access to margins, crown lengthening, implant access, operculum tissue removal, biopsies, etc. The ability of lasers to control bleeding during cutting has been a useful characteristic in all of these situations.
Q: What are some of the latest treatments that lasers are being used to provide?
A: Probably the most exciting area for lasers is hard-tissue cutting. Lasers are being developed that are now more precise and more rapid in their ability to cut enamel and dentin. I am thinking of Convergent Dental’s Solea CO2 laser. Another area where progress has been made is the elimination of the CO2 laser articulated arm and very precise cutting tips and smaller handpiece. I am thinking here of the Light Scalpel CO2 laser.
Q: Where do you see laser technology going next?
A: Many dentists would like to use a laser in periodontal treatment to kill microbes. We have not yet found a laser of any wavelength that does a credible job clinically in this area. The killing of certain microbes can be demonstrated in the laboratory, but our work shows clearly that the transition to clinical treatment does not give the same results microbiologically. However, this does not mean that methods will not be found in the future to accomplish this goal.
Q: Are there other exciting treatments or technologies emerging?
A: Certainly the area of digital impressions is a technology on the cusp of bursting into general use. We are seeking imaging technology that will allow the clinician to see through the soft tissue and blood to image margins. New ultrasonic equipment for endodontic canal cleaning has also become available that could greatly improve this procedure. The area of dental implants is also moving forward rapidly with new products and more general dentists performing the surgical procedures as well as the restorative procedures. Control of the oral environment in an attempt to control dental caries is of high interest worldwide and has some interesting ideas under development.
Quacquarelli Symonds (QS) has released its 2017 list of the top 51 dental schools in the world, with the University of Hong Kong Faculty of Dentistry taking the top slot for the second year in a row. The University of Michigan School of Dentistry was the top American school and number 2 overall, also for the second year in a row, followed by Tokyo Medical and Dental University, King’s College London Dental Institute, and Harvard School of Dental Medicine in the top 5.
QS scored each school’s academic reputation, employer reputation, and research citations per paper on a scale of zero to 100 and averaged these totals for each final score. Surveyed academics and employers identified up to 10 domestic and 30 international institutions they considered excellent, while QS used Scopus to determine the citation tallies. QS has been ranking the world’s top dental schools since 2011.
University of Hong Kong
“Last year, I told staff and students that being ranked number one in the world was a once in a lifetime achievement. I was wrong!” said Thomas Flemmig, DMD, MBA, dean of the Faculty of Dentistry at the University of Hong Kong. “The ranking is a wonderful recognition of the outstanding achievements of our staff and students and a testament to the excellence of our research, teaching, and service. It demonstrates what we can achieve together.”
In September 2016, the Faculty of Dentistry increased its bachelor of dental surgery (BDS) program by 40% to address the shortage of dentists in Hong Kong. The school also offers postgraduate programs in community dentistry, endodontics, orthodontics, oral and maxillofacial surgery, pediatric dentistry, periodontology, and prosthodontics.
Plus, the school recently launched its Institute of Advanced Dentistry, designed to be a center of excellence for the management of complex oral conditions. It will provide multispecialty advanced dental care and serve as a referral for practicing dentists. The school also says that it will foster clinical innovation, support translational and clinical research, and provide postgraduate and professional dental education.
University of Michigan
With an emphasis on strong links between clinical teaching and research, the University of Michigan retained its hold on the number 2 slot in the QS survey. More than 2,100 students applied for the 109 seats in 2016’s incoming class. Additionally, its faculty published 223 articles last year in more than 100 scientific journals. National and international awards, grants, fellowships, and appointments all bring in millions of dollars for research, too.
“We’re proud that we’ve consistently been recognized among the leaders in dentistry over our 142-year history,” said Laurie McCauley, DDS, MS, PhD, dean of the school. “We’ve been able to achieve that because we have faculty, students, and staff who strive to continually improve dentistry, teaching, and research. That commitment produces an environment of excellence that we’re always working to improve.”
King’s College London
The Dental Institute at King’s College London is the top dental school in Europe, with a strategy designed to integrate education with research, clinical approaches, and patient care. It serves more than 700 undergraduates, 140 graduate taught students, 300 distance learning students, and 110 graduate research students with more than 85 academic staff members. Plus, it cares for more than 300,000 patients each year.
The school comprises 4 research divisions—craniofacial development and stem cell biology, mucosal and salivary research, tissue engineering and biophotonics, and population and patient health—all established to complement the school’s teaching and clinical service initiatives. Clinical training is provided at Guy’s and St. Thomas’ hospitals.
“Rising to first in Europe in the global rankings reaffirms our position as a world-class institution and reflects the dedication, commitment, and innovation of our academic and professional staff, our students, and our alumni,” said interim executive dean Mark Woolford, BDS, MA, PhD.
Other US Schools
“Harvard School of Dental Medicine is delighted to be ranked among the top 5 dental schools in the world in the recently released QS 2017 rankings. This honor is especially noteworthy as the school is celebrating its 150th anniversary this year,” said R. Bruce Donoff, MD, DMD, dean of the school, which serves more than 25,000 patients during more than 57,000 dental visits each year.
“As the first US dental school affiliated with a university and its medical school, and the first to confer the Dentariae Medicinae Doctor (DMD) degree, we celebrate a proud history along with this significant achievement,” Donoff added. “We would also like to recognize and thank our dental school peers around the world who are united in the mission to advance dental education, research, and clinical care.”
In total, 14 schools from the United States made the list. Other schools included:
- New York University College of Dentistry (11th)
- University of North Carolina, Chapel Hill, School of Dentistry (12th)
- University of Washington School of Dentistry (14th)
- University of California, Los Angeles, School of Dentistry (tie 15th)
- University of Pennsylvania, Penn Dental Medicine (tie 15th)
- University of California, San Francisco, School of Dentistry (21st)
- University of Minnesota School of Dentistry (33rd)
- Boston University Henry M. Goldman School of Dental Medicine (36th)
- University of Southern California Herman Ostrow School of Dentistry (41st)
- Columbia University College of Dental Medicine (44th)
- University of Florida College of Dentistry (47th)
- Tufts University School of Dental Medicine (51st)
The Environmental Protection Agency (EPA) has rejected a petition it received on November 23, 2016, from a coalition of grassroots groups and activists asking it to exercise its authority under section 21 of the Toxic Substances Control Act (TSCA) to “prohibit the purposeful addition of fluoridated chemicals to US water supplies.” The EPA published its denial of the petition in the February 27 edition of the Federal Register.
Specifically, the petition urged the EPA “to protect the public and susceptible subpopulations from the neurotoxic risks of fluoride by banning the addition of fluoridation chemicals to water” and cited various studies to support the coalition’s position. However, the EPA reviewed those studies and found problematic basic data quality issues, such as the presence of antecedent-consequent bias. The EPA also reinforced the benefits of public fluoridation.
“After careful consideration, EPA denied the TSCA section 21 petition, primarily because EPA concluded that the petition has not set forth a scientifically defensible basis to conclude that any persons have suffered neurotoxic harm as a result of exposure to fluoride in the US through the purposeful addition of fluoridation chemicals to drinking water or otherwise from fluoride exposure in the US,” the EPA wrote in the Federal Register.
“As teeth are developing (pre-eruptive), regular ingestion of fluoride protects the tooth surface by depositing fluorides throughout the entire tooth surface,” the EPA further wrote. “Systemic fluorides also provide topical protection as ingested fluoride is present in saliva, which continually bathes the tooth. Water fluoridation provides both systemic and topical exposure, which together provide for maximum reduction in dental decay.”
The ADA has commended the EPA for its decision, noting that public water fluoridation serves approximately 211 million people across the United States to protect them from dental disease. According to the ADA, optimal fluoride levels in water can prevent tooth decay by at least 25% in children and adults. Plus, fluoridation costs range from 50 cents per person in large communities to $3.00 per person in small communities per year.
“It’s always heartening when our government comes down on the side of sound science,” said ADA president Gary Roberts, DDS. “Public health policy recommending community water fluoridation results from years of scientifically rigorous analysis of the amount of fluoride people receive from all sources. Water fluoridation is effective and safe.”
The American Fluoridation Society (AFS) also supports the EPA’s decision, adding that this is the second time in 4 years that officials there have reviewed and rejected petitions by fluoridation opponents. The AFS also noted that fluoridation occurs in more than 20 different countries and that it has been practiced safely for more than 70 years, prompting the Centers for Disease Control to call it one of the 10 greatest public health achievements of the 20th century.
“Once again, fluoridation opponents have been caught misreading or misrepresenting the science,” said Johnny Johnson, DMD, MS, president of the AFS. “We applaud the EPA’s response to this flawed position.”
Governor Jay Inslee of Washington State has signed Senate Bill 5079, which lifts restrictions on tribes from using federal funding for Dental Health Aide Therapists, who work under the direction of a dentist to provide cleanings, place fillings, and educate patients about oral health and disease prevention. The bill is designed to expand access to dental care on state tribal lands to address the disparities in oral healthcare faced by many Native Americans in Washington.
“I remember going to the Yakama Nation to a clinic and seeing dozens of kids with horrific caries trying to get emergency dental care. We want to get ahead of caries. We want our kids to have good dental health. We understand that dental health is as important as physical health,” said Inslee. “Finally, we’re going to have a situation where we use good, high-quality dental care in the state of Washington for our tribal members.”
Washington is now the sixth state to authorize some version of dental therapy. Dental therapists now can practice in Minnesota, Maine, and Vermont. Alaska allows dental therapists to practice on tribal lands, and Oregon has authorized pilot projects with several tribes. Massachusetts is currently considering a bill to allow dental therapists statewide. However, North Dakota’s legislature recently defeated a bill to allow dental therapists there.
“We’re going to unlock the door to dollars for healthcare from the federal government. I love the fact that we’re going to bring federal dollars to our state to provide tribal healthcare. These programs have worked in other states. They’ve made high-quality dental care available. They have not reduced health benefits in other areas. It’s great that this state is now building on success in other states,” said Inslee.
“This is a tremendous day for Indian Country here in Washington state. It just adds to the adage down here that the impossible takes a little bit longer. This took 12 years, but perseverance paid off, and we got it done,” said Senator John McCoy, a sponsor of the bill representing the state’s 38th District. “This will help all tribes in rural Washington, so this does mean jobs for rural Washington.”
In 2016, the Swinomish Indian Tribal Community collaborated with the Northwest Portland Area Indian Health Board to become the first tribe in the lower 48 states to hire a dental therapist. Now, tribal representatives say their next step will be to work with schools in the state to train the dental therapists who will be providing this care.
“That’s our next step, to work with community colleges, universities, to bring that training from Anchorage, Alaska, down here to Washington so our kids will stay here in the state and find a place to send them to be trained in the near future,” said Brian Cladoosby, chairman of the Swinomish tribe and president of the National Congress of American Indians. “All that exciting news will be coming out shortly as our next goal after this is implemented.”
The ADA formally opposes the licensing of dental therapists, noting that there is no available data demonstrating that new practice models have increased access to care at a lower cost. Also, the ADA reports that the current number of dentists will continue to grow through 2035 and outpace population growth, while 27% of dentists can add more patients. Instead of new professionals, the ADA believes efforts should focus on better connecting patients with care.
The dental lobby is currently opposing a separate effort in the state’s House of Representatives, House Bill 1364, that would permit dental therapists to practice statewide. But while the Washington State Dental Association is part of those efforts and had joined the ADA in previously opposing work to introduce dental therapists to tribal lands, it chose not to work against Senate Bill 5079.
“To the Washington State Dental Association, a big thank you to them for standing down on our bill this year,” said Cladoosby. “That really meant a lot to us when they came to visit us in Swinomish before the session started to give us their great news that their board voted 10 to zero to do that. That was huge for the dental association to do that.”
“We know this bill means fewer emergency visits to the ER. We know this bill’s going to mean fewer extractions. We know this bill will mean fewer infections. We know this bill is going to mean people with compromised cardiac conditions are going to have fewer problems associated with oral health, which is a real risk,” said Inslee. “It means people are going to have earlier and more frequent cleaning of their teeth, better x-rays, and easing the demand for affordable care on tribal reservations.”
Fluoride is essential to healthy teeth. However, diet plays a widely varying role in supplying children with beneficial amounts of fluoride. A team of researchers at the Indiana University School of Dentistry, then, recently examined how much fluoride is present in the foods and beverages typically consumed by children in the Midwest who are aged 2 years.
The researchers used total diet study food lists cross-referenced with the National Health and Nutrition Examination Survey—What We Eat in America. They also determined concentrations of fluoride via a modification of the hexamethyldisiloxane microdiffusion technique. Daily dietary fluoride intake was estimated using a simulation analysis.
The study, “Fluoride in the Diet of 2-Years-Old Children,” was published by Community Dentistry and Oral Epidemiology. E. A. Martinez Mier, DDS, PhD, MSD, of the department of cariology at the Indiana University School of Dentistry shared her insights about the study’s results with Dentistry Today.
Q: What are the main sources of fluoride for children?
A: There are different fluoride sources depending on the age of the children. The relative contribution of these sources to the total amount of fluoride ingested in a day also varies according to the children’s age. Our study showed that the daily intake from the diet for 2-year-old children will depend on the foods typically consumed by each child based on his or her choice of foods and beverages.
Q: Specifically, what foods provide the most fluoride?
A: In our study, popsicles, mild cheddar cheese, raisins, saltine crackers, creamy peanut butter, beef cheese tacos, chicken/pork franks, and plain wavy potato chips were the items with the highest fluoride content. Previous reports have included fish, tea, and sardines as items with high fluoride content.
Q: What role does public water fluoridation play in children’s fluoride intake?
A: Water and swallowed toothpaste are the greatest sources of fluoride intake for children younger than 6 years. It is estimated that water and water-based beverages contribute to approximately 75% of the total fluoride consumed though the diet in communities that are optimally fluoridated. This should not place these children at risk for excessive consumption. At the currently recommended levels, community water fluoridation has been proven to be safe and effective.
Q: How can parents tell if their children are getting enough fluoride to prevent dental caries?
A: Children who live in communities where water is fluoridated are already receiving the benefits of fluoride. In addition, parents should ensure their children are brushing their teeth with a toothpaste that contains fluoride. They also should visit their dentist, who may recommend additional fluoride.
Q: What impact does too much fluoride have on developing teeth?
A: Too much fluoride consumed when teeth are developing may result in enamel fluorosis. No other negative health effects have been associated with the consumption of water fluoridated at the recommended levels.
Q: Is there anything parents can or should do to mitigate this impact?
A: Parents should supervise their children while brushing to prevent them from swallowing toothpaste. If they consume well water, they should have it tested to find out if it has too much fluoride.
Q: What role should dentists play in ensuring that children are getting the right amounts of fluoride to ensure oral health?
A: Dentists should continue to support community water fluoridation and assess their patients’ risk of developing caries in order to develop individualized fluoride recommendations.
The residents of southeastern Kentucky, including many people who live in the Appalachian Mountains, lack dental care because of poverty as well as transportation difficulties and a lack of dentists. To better serve them, the University of Louisville (UofL) School of Dentistry will work with the Red Bird Clinic to offer comprehensive general dentistry to the region.
“Our collaboration with the Red Bird Clinic is a significant step for the university as we seek to systematically serve our mission to provide healthcare throughout the Commonwealth and improve the overall well-being of its citizens, said Greg Postel, MD, interim UofL president.
Beginning February 23, dental and dental hygiene students will begin clinical rotations at the Red Bird Clinic. Each week, 6 students will travel to Beverly, Ky, and help staff the dental clinic there, open Thursday through Saturday. The clinic provides a variety of services to about 20 to 25 patients daily, including cleanings, fillings, root canals, crowns, bridges, and extractions.
“This new clinical site enhances the education of our students with enriching cultural and clinical practice experiences that will make them compassionate, exceptional dental healthcare providers,” said Gerard Bradley, DMD, BDS, MS, dean of the UofL School of Dentistry.
The Red Bird Clinic is a nonprofit that grew out of the Red Bird Mission, which started in 1921 with a private school and expanded to include medical and dental services, job training, a clothes closet, a food pantry, adult education, services for senior citizens, and more. Its relationship with the UofL School of Dentistry aims to increase the availability of dental treatment for the underserved.
“It is our hope that some of these students will be drawn to practice in rural areas,” said Kari Collins, executive director of the Red Bird Clinic. “Perhaps someone will return to serve at Red Bird Clinic in the future.”
“Everything is not cut and dry at outreach clinics. High difficulty levels provide challenges for the students and increase their abilities. It’s amazing to watch as they begin to put things together and their eyes and faces become bright with satisfaction,” said Bill Collins, DMD, dental director at the Red Bird Clinic.
“I try to ask students to learn one new thing each day. If they continue this, it will make them good, confident practitioners,” said Collins.
Other UofL School of Dentistry alumni—Greg Bently, DMD, Susan King, DMD, and Bob McGuinn, DMD—will serve on rotation as gratis faculty to oversee the UofL students. Already, some dental students have engaged in clinical dental services at the Red Bird Clinic, including the school’s 4 Outreach Scholars.
“It has been a blessing to pursue a career in dentistry, and it is important for me to use my education to give back to fellow Kentuckians as I gain valuable experience in outreach clinics,” said fourth-year dental student and Outreach Scholar Robbie Troehler, who also has served in 5 other clinics throughout the state as part of the Outreach Scholar program.
The North Dakota House defeated House Bill 1256 on Wednesday, February 8, which would have allowed mid-level oral healthcare providers also known as dental therapists to obtain licenses and treat patients. Under the bill, dentists would have remained responsible for the quality of care that their employees provide, and no dentist would have been required to hire dental therapists.
“The North Dakota House affirmed our position that the dental therapy model does not fit North Dakota at this time and that we should continue to focus on education, prevention, collaboration, and outreach specific to our state—strategies that are showing results,” said Brent L. Holman, DDS, executive director of the North Dakota Dental Association.
“By voting to continue North Dakota’s blockage of dental therapists, House lawmakers deprived dentists of their right to hire and patients of their right to choose qualified providers who would have lowered oral healthcare costs and increased access,” said Michael Hamilton, research fellow of healthcare policy at the Heartland Institute.
The bill would have required dental therapists to graduate from an accredited dental therapy education program and pass exams administered by the state’s dental board. Also, dental therapists would have been required to complete 500 hours of clinical practice under the supervision of a dentist to qualify for licensure.
Also, the bill outlined a series of procedures that dental therapists would have been allowed to perform under supervision of a dentist, including but not limited to application of topical disease prevention agents; preparation and placement of direct restorations; extractions of primary teeth; extractions of some badly diseased permanent teeth; pulpotomies; preparation and placement of some crowns; direct pulp capping; and suturing and suture removal.
In January, the Heartland Institute and the Texas Public Policy Foundation released a joint policy brief titled “The Case for Licensing Dental Therapists in North Dakota.” According to the Heartland Institute, dental therapy is a 95-year-old profession used in more than 50 countries to expand oral care services to underserved patients in rural and low-income regions.
The organizations also report that nearly 10% of the state’s population live in 35 areas with dental health professional shortages. A third of all residents age 65 years and older with teeth needed “early or urgent dental care” in 2016. And, 72% of children on Medicaid in the state in 2015 did not use preventive dental care, even though they were eligible.
“All the House accomplished by banning dental therapists was blowing up a bridge by which innovative dentists might have reached underserved patients,” said Hamilton. “The entrenched interest special interest groups of dentists who opposed this measure may now congratulate themselves for robbing each other of a chance to innovate, grow their practices, and treat needy patients.”
The ADA opposes the authorization of non-dentists to perform surgical procedures. While the organization acknowledges the challenges in providing dental care to everyone, it notes the growing numbers of practicing dentists and believes efforts should focus on better connecting patients with them.
Maine, Minnesota, and Vermont all allow dental therapists, while Washington and Oregon have authorized access to midlevel dental providers for native tribes while considering their use statewide. Alaska native tribes also have authorized dental therapy. Arizona, Hawaii, Kansas, Massachusetts, New Hampshire, New Mexico, and Texas all are now exploring the issue.
“Lawmakers in North Dakota chose to look backward, not forward, by rejecting dental therapy as an option for the people of their state,” said John Davidson, senior fellow with the Texas Public Policy Foundation and a policy advisor with the Heartland Institute. “Liberalizing the dental workforce so that more people have access to basic dental care is the wave of the future.”
This February, dentistrytoday.com celebrates National Children's Dental Health Month with news stories, interviews, and blogs all about safeguarding pediatric oral health. #NCDHM
Henry Schein has announced the finalists for its second annual Henry Schein Cares Medal, an award given to nonprofit organizations that demonstrate excellence in expanding care for the underserved. An independent panel of judges selected 3 finalists among applicants from each of 3 fields: oral health, animal health, and medicine.
The oral health medalists include Community Dental Care (CDC) of Minnesota; Gaston Family Health Services of Gastonia, NC; and Interfaith Dental Clinic of Nashville, Tenn. Each of these medalists will receive a case award, including $15,000 for gold, $10,000 for silver, or $5,000 for bronze, as well as $10,000 worth of products from Henry Schein Cares.
Crystal Yang, development coordinator at CDC, recently discussed the organization’s work and how the award will impact its efforts with Dentistry Today.
Q: What kind of care does CDC provide?
A: CDC is a nonprofit organization and Minnesota Health Care Programs community clinic established to provide quality dental services for low-income and minority patients. CDC served as a for-profit clinic for 22 years before incorporating as a nonprofit in 2004. Today, CDC is one of the largest safety-net clinics in Minnesota and is recognized by the Minnesota Department of Health as one of 6 successful models statewide that provide dental services for underserved communities.
CDC currently has 4 clinics—3 in the Twin Cities and one in Rochester, Minn—with a total of 58 dental operatories. We will open a fifth, 18-operatory clinic in Rochester in the fall of 2017. Our mission is to provide culturally sensitive community oral healthcare, preventive education, and professional training and to advocate for access to all. Our vision is that all people will have access to high-quality, affordable dental care to improve their overall health in a convenient, caring, and respectful environment.
All 4 clinics provide comprehensive dental services, including preventive, restorative, endodontic, oral surgery, pediatric, prosthodontic, and emergency procedures. In 2016, we provided 134,274 patient encounters for 46,868 unduplicated patients. Of these, 91% of patients were enrolled in public programs or uninsured with income at or below 275% of the federal poverty level, 64% were a racial/ethnic minority, and 47% were children. To serve more patients and provide care outside of school and work hours, our clinics offer early morning and evening appointments. All clinics dedicate time daily for emergencies, and in 2016 we treated 14,140 emergency patients.
CDC also provides clinic training for dental professionals (dental hygienists, assistants, and advanced dental therapists), nursing students, and community health workers from 12 universities and colleges in Minnesota. In 2016, we provided clinical training for 308 students.
Q: Does CDC have any programs specifically for children?
CDC also has 2 community programs that improve access to oral health care for low-income families and children. Our Program to Improve Community Oral Health (PICOH) provides in-clinic oral health prevention and education for children and pregnant women, outreach to the general community, and school-based preventive oral health programming, including screenings, dental sealants, prophylaxis, and fluoride varnish for low-income children. This is the key program we described in our Henry Schein Cares Medal application.
This past year, PICOH began a pilot project to test strategies for educating and empowering parents of babies and toddlers, up to the age of 2 years, before their children have experienced dental caries and developed poor oral hygiene habits. Since PICOH’s inception in 2006, it has provided preventive care, risk assessment, education, and oral health kits to more than 83,000 children, pregnant women, and parents.
Q: How does it feel to be recognized for this work?
A: We are incredibly honored to be a finalist, and the entire PICOH team was thrilled to hear we were chosen! Our application for the Henry Schein Cares Medal highlighted PICOH as the program we consider our most cutting edge and best practice in its field. PICOH is grounded in evidence-based strategies that build knowledge and skills to last a lifetime. The model is designed around the belief that children (and their parents) need consistent reinforcement of good oral health practices during their early years to positively affect their health throughout their lives.
The staff promotes this long-term impact through strategies such as one-one-on motivational interview-style instruction and anticipatory guidance, proven-to-impact behaviors that reduce cavities. In addition to teaching oral hygiene, PICOH builds oral health literacy and educates families on the proven links between poor oral health, poor nutrition, and chronic diseases. Our results show that the program is making a sustainable impact in childhood caries (cavities) reduction.
PICOH has also received national recognition by the Robert Wood Johnson Foundation and ICF International as one of 12 promising models nationwide that increase access to oral health access for children. The Henry Schein Cares Medal award will add tremendously to the pride and commitment of our PICOH staff, and our entire CDC staff will also share in this sense of accomplishment. We also anticipate that as we advertise this award to our patients and PICOH participants, it will encourage them even more to reach their oral health goals and be a part of this significant success story!
Q: How do you plan on using the award?
A: The cash award and donated products from the Henry Schein Cares Medal will be used by PICOH to expand access to oral health prevention and education services for underserved children in the Twin Cities and Rochester. In 2016, 94% of the children served by PICOH were on public programs, and 85% were minority. These are children from low-income families with limited access to affordable dental care. Also, a majority of the families we serve in PICOH are recent immigrants or refugees who do not understand the importance of good oral health and preventive services. As evidence continues to show a systemic connection between oral health and overall health, it is important to increase access for these most vulnerable populations.