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Health Care Reform and Dentistry

As the debate lingers on I wonder what effect all proposed legislation will have on dentistry. Will government fund dental insurance like they propose funding insurance short term? If so, they have tall shoes to fill as I think the system works pretty well as it is. I have heard some argue that dentists would actually get more patients and have to do less "free" dental care. On the flip side, I have heard that dentists would HAVE to see more patients in order to make the same pay they do now, because the insurance payouts would be much less per treatment. This is all very confusing and I have not been following it as closely as I should, which is why I ask, how do you think health care reform will impact dentistry?
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Come fly with me...

A new study looks at the highly sophisticated structure of teeth and how this structure could be applied to aircraft and space vehicles of the future. It's been a mystery: how can our teeth withstand such an enormous amount of pressure, over many years, when tooth enamel is only about as strong as glass? Professor Herzl Chai of Tel Aviv University's School of Mechanical Engineering and his colleagues at the National Institute of Standards and Technology and George Washington University gives the answer. The researchers applied varying degrees of mechanical pressure to hundreds of extracted teeth, and studied what occurred on the surface and deep inside them. The study, published in the May 5, 2009, issue of the Proceedings of the National Academy of Science, shows that it is the highly-sophisticated structure of our teeth that keeps them in one piece — and that structure holds promising clues for aerospace engineers as they build the aircraft and space vehicles of the future. Check it out at Science Daily.

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Scientist and Professor Meital Zilberman of Tel Aviv University's Department of Biomedical Engineering has developed a new biologically active "scaffold" made from soluble fibers, which may help humans replace lost or missing bone. The invention, which does not yet have a name, could be used to restore missing bone in a limb lost in an accident, or repair receded jawbones necessary to secure dental implants, says Prof. Zilberman. The scaffold can be shaped so the bone will grow into the proper form. They're also specially developed to release bioactive drugs and proteins in a controlled manner. After a period of time, the fibers can be programmed to dissolve, leaving no trace. Her technology also has potential uses in cosmetic surgery. Instead of silicon implants to square the chin or raise cheekbones, the technology can be used to "grow your own" cheekbones or puffy lips. But Prof. Zilberman says it's far too early to think of such uses. She first started her work in biomaterials at the UT Southwestern Medical Center at Dallas, Texas, and currently is concentrating on various medical applications. One of them intends to make dental implants more effective. She envisions applying the invention to organ tissue regeneration in the future. This sounds extremely promising for dental implant treatment! Comments? Source: Science Daily
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This evening I had a presentation at my dental laboratory with NobelBiocare. The title of the lecture was Zirconia vs PFM Restorations. The speaker, Dr. Thomas Williams showed several examples of less than ideal soft tissue health that resolved with changing to porcelain fused to zirconia restorations. What is the general observations of others on WebDental regarding this subject? Are all ceramics and even composite restorations more biocompatible thna PFM's? Please understand that as a dental technician I don't have the daily opportunity for intraoral observations of my own. Follow to see full course description.http://dickermandental.com/" target="_blank">
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“White wine rots your teeth… and brushing makes it worse,” claimed the Daily Mail today, a British newspaper. This statement was based on a study published in the Journal of Nutrition Research. According to the study, dental erosion from red wine is not as severe. 'The tradition of enjoying different cheeses for dessert or in combination with drinking wine might have a beneficial effect on preventing dental erosion because cheese contains calcium in a high concentration.' The British National Health Service takes issue with the research and findings. What do you think?

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Low-income kids continue to have difficulty getting proper dental care through Medicaid according to the Government Accountability Office. Some of you may remember the tragic case of a twelve year old boy who died in 2007 because of a brain infection which originated from an untreated dental abscess. Investigators determined that many people, including children, simply do not take advantage of the Medicaid programs in place to help them maintain good dental health. Does this bode well for universal health and/or dental care? photo from Positive Health Online
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The End of Dental Implants?

Researchers in China have hypothesized that third molar tooth buds could be harvested during development and later used to replace missing teeth in the future. Could this mean the end of dental implant treatment? The dental implant manufacturers probably have nothing to worry about anytime soon. Time will tell. Comments?

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Congratulations on 150 Years!

The American Dental Association turned 150 years old this year, and it’s in very good health for its age. With 157,000 members, the ADA represents more than 70 percent of U.S. dentists, making it the world’s largest and oldest national dental association—America’s leading advocate for oral health.

It's hard to believe that the ADA has been in existence for 150 years. Are you satisfied with the benefits of membership, and the role that the ADA has played in organized dentistry, public health and dental awareness?

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Perhaps you have heard about this amazing procedure which recently helped a Miami woman regain her lost eyesight. A prosthetic lens was inserted into a tooth that was removed from the patient, and then implanted into the eye. The surgical technique, modified osteo-odonto keratoprosthesis (MOOKP), has proven effective in cases where severe corneal scarring blocks vision, but the eye remains healthy. Has anyone heard of this before? Thoughts or comments? From CNNhealth.com photo credit: Rich Phillips/CNN
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ADA Combats Fears of Mercury Toxicity

The ADA made an announcement recently that it was urging Congress not to support a resolution that "expressed the need for enhanced public awareness of potential health effects posed by mercury." The resolution made frequent references to mercury in dental amalgam.The primary argument is that most public concern over the mercury content in amalgam is based on shoddy science and internet rumors. The ADA made the case that there is no credible, peer-reviewed science available to show that amalgam is toxic.Where do you stand? Do your patients know the content of what you are putting in their fillings? Do they even care?
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WebDental Job Board Launches

We recently launched a job board where WebDental members can post resumes, view jobs, create alerts and find open positions from resources all over the Web.

So if you are looking, or even if you are just curious to see what else is out there, head over and check it out on the top navigation bar.
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Is Drinking Water Destroying Your Patient's Teeth?

The New York Times just had this eye opening article toxic water supplies and its impact on peoples health. If people have to put on special lotion on their skin aver showering, I can't even imagine the damage that it is doing to their teeth.I have become attached to my Brita water filter over the years, but doubt that it would stand up to all the toxins in the types of water supplies that the article talks about.It makes me wonder what being a dentist is like in areas like this. Have you worked with any patients who had difficulty getting access to clean water? How has it impacted their oral health and what have you been able to do to keep them healthy and safe?Photo Credit:Damon Winter, The New York Times
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"Lip Fillers" and Cosmetic Dentistry

One of the newest treatments on the frontier of cosmetic dentistry is Juvederm and Restylane. These are injectable fillers that can create fullness in the lips,as well as to eliminate "smiles lines". We have all been taught that the lips are the frame for the smile, and the teeth represent the "artwork". An increasing number of restorative dentists have embraced these techniques and are incorporating them into their daily esthetic dentistry practices. What are thoughts about this? Any experience?

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ADA Lobbying for Increased Dental Medicaid Funding

A recent article in the Nation's Journal provided insight into the ADA's lobbying activity around the current proposed heathcare reform legislation. Increasing funding for dental medicaid is a primary focus of the ADA according to the article.The ADA noted that low-income Americans are the ones hit hardest when it comes to access to adequate dental care and they would like to see a larger government role in addressing the problem.The director of the ADA's Washington office noted that having dental Medicaid included to the proposed healthcare legislation and that is a top priority.What do you think. Many are doubtful that the Obama administration will be able to pass any healthcare reform legislation this year. How likely do you think anything that passes will include the kind of dental coverage that the ADA is spending your membership dollars to lobby for?
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The American Academy of Implant Dentistry (AAID) said times have changed and patients should forego prolonged dental heroics to save failing teeth and replace them with long-lasting dental implants.

"There really is no justification for undergoing multiple endodontic or periodontic procedures, and enduring the pain and financial burden, to save a diseased tooth," said John Minichetti, DDS, speaking for the AAID. "The days are over for saving teeth till they fall out. Preserving questionable teeth is not the best option from both oral health and cosmetic perspectives."

This is certainly true in modern dental times. The question for many practitioners is "Where do you draw the line?", or "At what point do you condemn the tooth?" There is definitely a difference in opinion in this regard. Do you typically rely on your own personal judgement, or that of a specialist, or maybe both?

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26% of Dentists Quit ADA

Okay, so I know I've been blogging a lot about survey data lately, but this one really piqued my interest and I wanted to hear what everyone hear thought of it.The data comes from TheWealthyDentist.com and says that more than 1 in 4 dentists has quit the ADA for one reason or another.What is your take on the ADA? Everyone I've heard from seems to have their own opinion. Whether they join for insurance reasons, events, or the magazine, it seems that the ADA is completely different things to different people.Do you think that they are doing enough to advance the profession?
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Problems with Dental Patients Texting In-Chair

A survey from the Chicago Dental Society has some pretty interesting stats on exactly how likely patients are to send text messages or take cell phone calls while in the dentists' chair.The survey was taken from a sample of their Facebook fans. Not exactly a scientific sampling, but interesting nonetheless.It found that 46 percent of dentists say in-chair messaging hampers their ability to provide care.I have to admit, during my last visit to my dentist, I pulled out my iPhone to catch up on work emails while she was looking at my x-rays, but I shut it down and opened the 'ol chompers back up nice and wide once she came back in the room.Being a "digital nomad" to the core and always connected, I can empathize with the desire to be reachable at any moment of the day, but is nothing safe from the impact of our connected lives? It still blows my mind how social norms can change so fast.The article also mentions dentists attempting (ineffectively) to enforce no-texting policies in the office. Is this an issue at your practice?What have you done to try and resolve it? Has it worked?
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CHART AUDITINGRonald F. Arndt, DDS, MBA, MAGD, MCCMary Beth Bajornas, CMT,VAHow much dentistry is sitting on your wall? What financial opportunities are you missing with your patients of record? What are you willing to do to “harvest the diamonds in your own back yard?”Chart auditing is the review of charts to determine the status of idle patients. Chart auditing is done by the front desk staff, and should be done minimally on an annual basis. Although this task can be time consuming it can also result in the reactivation of numerous, otherwise lost, patients.Chart auditing should consist of the following: Review of patient’s last appointment How long has it been since they have been in? What did their last appointment consist of? What was their next recommended appointment? Has any contact with the patient been initiated prior to audit?It’s easiest to work chart by chart. After review a personal phone contact should try to be made with the following sample script: “Hello Mrs. Smith, this is Suzie from Dr. Arndt’s office. I am so glad to have finally contacted you personally! How are you doing? We have noticed that you haven’t been to our office in over 18 months, and realize that you are past due for your cleaning. Is there a good day and time for you that we could schedule you with the hygienist?”If the patient for some reason states they are unhappy with treatment, dentistry, etc. you could say the following “ Mrs. Smith, I hope you can give us the opportunity to take care of this – I am sure Dr. Arndt would want me to schedule an appointment for you with him personally for a consultation. Is there a specific day and time that might work for you to come in and speak with Dr. Arndt?”If no personal contact can be made, a reactivation letter can be sent. A reactivation letter should be short and to the point. It should state the patient’s last appointment, what they had done, any treatment that has been recommended, and what they are now due for. At the bottom of the letter a request should be made of the patient to respond to the following: They have moved and wish their records to be forwarded to their new dentist They will not be returning and if they choose to tell why They didn’t realize they were so far behind and wish to schedule an appointment so please call They do wish to schedule but will call when convenient for themA return envelope should be included for the patient’s convenience, and they are more apt to return the request this way.As each request comes in, the patient’s chart should reflect their response. Forwarding records and contacting patient’s for appointments should be done the day the response is received.If after 14 days there is no response, a follow up phone call should be made with this sample script “Hello Mr. George, this is Suzie from Dr. Arndt’s office. How are you?! We haven’t seen you in a while and recently sent out a reactivation letter to you requesting you to advise us of your patient status. We haven’t heard back from you and are touching base to make sure all is ok! We really miss seeing you on your recall visits. Is there a good day and time for you to come in to see Dr. Arndt?”If after multiple attempts there has been no contact, the patient account can be inactivated, with complete and thorough chart notes being added of “no response from patient”. Copies of the reactivation letters should be kept, and any attempts at communication should be recorded as well.By doing chart audits annually, you an ensuring: The patient base you currently have is active. No patient has “slipped through the cracks”. An increase in production by actively working this system. The opportunity to “right” things that may be “wrong”.How long has it been since your charts have been audited? How much production is just lying around in your office, waiting for someone to act upon it? There has to be a consistent method of patient tracking in place and your practice cannot afford to overlook the obvious.To really make your system effective you will want to establish measurables to determine your progress. Below are some of those expectations that you and the team will want to observe every week.1. Establish a goal of 16 calls per day or two per hour.2. How many patients were called?3. How many patients were actually spoken too or contacted?4. How many patients scheduled and what was the value of the treatment scheduled?5. Establish a specific time to review each week.Are you utilizing external marketing but haven’t audited charts? Your practice has many, many internal resources for filling your schedule and your whole team needs to be on board to renew relationships the patients you already have!Remember, your practice is either growing or dying. There’s pretty much nothing in between.Dr. Ron Arndt, The Dental Coach™, works with dentists who want to be in control of their practice rather than the practice controlling them. What that means for them is that they think, act and behave like an ethical CEO because they want to lead more, manage less and be much more profitable in much less time. He is the first and only dentist in the world to hold the coveted designation Master Certified Coach (MCC) awarded by the ICF. He is the author of RIGHT HIRING for the Dental Team and several ThinBooks. He can be reached at www.DrArndt.com or 440‐748‐6161.Mary Beth Bajornas is a Virtual Assistant to dental and business professionals with over 20 years of management, administrative and dental front office experience. Her technique of staff education for the front office to be in “The Perpetual State of Preparedness” is dead on for streamlining front office and patient service functions. She can be reached at www.SuperiorAssisting.com or 330-324-3865
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