Jared Kaltwasser

Volunteering overseas can be a life-changing experience for dentists, but sometimes the hardest part is getting started.

Nearly four decades ago, Francis G. Serio, D.M.D., volunteered to go down to San Jose de Ocoa, a region in the Dominican Republic where many residents don’t have access to regular dental care. He didn’t have grand plans.

“I went the first summer to basically do some extractions and do some fillings,” he said. “And that’s what I did. And I went by myself and I had a terrific time.”

That terrific time turned into a life’s work. What started as a solo trip is now the Dominican Dental Mission Project, an effort responsible for millions of dollars in free dental care. Each summer, Serio and a number of recruits and students head down to the Dominican Republic to provide a wide range of dental care, including full dentures. For the residents of San Jose de Ocoa, it has been life-changing opportunity. But it’s changed Serio’s life, too.

 the American Dental Association’s Humanitarian Award for his work

The work became Serio’s passion, and it’s a passion he’s eager to share with other dentists.

Serio frequently gives talks on the subject of international volunteering. Each time he does, he’s approached by dentists interested in the concept of volunteering overseas, but unsure about how to make it happen.

 to offer tips and answers for dentists interested in taking the leap.

For many dentists, the first major hurdle is simply figuring out where, and how, they could go. When he first started in the early 1980s, Serio went by himself after connecting with a medical mission organization. He chose to go to San Jose de Ocoa for the simple reason that the nuns there were bilingual.

Today, it’s a much different landscape.

“Nowadays there are a bunch of folks from International College of Dentists, the Academy of Dentistry International, and others that go around lecturing on how to get involved in international dental projects,” he said. “In 1982 none of that existed.”

 that can help dentists connect with mission organizations.

Another issue is funding. Serio and his family have chosen to make the Dominican mission the cornerstone of their philanthropy, though he also receives donations, including a grant last year from the International College of Dentists. Serio asks fellow volunteers to pay for their in-country costs, and he said many of the supplies are donated by dental supply companies. Collecting that money and those supplies takes extra time, but Serio said he’s able to fit it into his normal schedule.

“If you added up all the hours it takes, yeah, it takes some time,” he said. “But it’s not like I have to sit down and do everything in two days.”

Furthermore, that work is mostly due to Serio’s entrepreneurial spirit and the fact that he runs the dental mission. For most dental missionaries, such administrative and fundraising work is taken care of by the sending mission organization or foundation. That’s one reason why Serio says it’s best to start out by joining up with an established group.

“I would absolutely recommend somebody doing this for the first time go with an established group,” he said.

How do you choose? Serio said there are many organizations to choose from, some based on affinity groups or religious groups. He said would-be volunteers should talk to previous volunteers and also ask the administrators of the sending organization plenty of questions.

“If the administrators don’t seem that responsive maybe you should find another project,” he said.

Another issue faced by dentists traveling overseas is the regulatory landscape. Different countries have different rules about what licenses or permits -- if any -- a dentist needs in order to provide care.

“It’s very site-specific,” he said.

Dentists also need to think about malpractice insurance. In most cases, Serio said, a dentist’s regular malpractice insurance won’t cover international mission trips. However, a number of organizations offer malpractice insurance specifically geared toward covering foreign missions. Serio said the cost of these policies is very low, making it a reasonable purchase on the off chance that a malpractice complaint arises.

Serio added that dentists will also need to make sure they have medical insurance. In most cases, that means buying a travel health insurance policy.

As a whole, Serio said, dentists tend to be very generous, giving back to their local communities through philanthropy and mission of mercy clinics. He realizes that a trip overseas can be a headache and a financial sacrifice -- particularly for early career dentists. However, Serio said the vast majority of dentists who go overseas enjoy the trip and find it worthwhile. Ultimately, the biggest hurdle for some is simply deciding to take the first step.

“Remember the old Nike slogan, ‘Just do it?’” he said. “You get to that point where you have to just start, just do it.”

Texas Dentist Grateful for What He’s Been Given, and Can Give Back

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Articles

For Francis G. Serio, D.M.D., one volunteer opportunity in the Dominican Republic changed his life forever. Now, he is a leader in dental philanthropy helping to guide the next generation of dentists. 

To Volunteer Overseas, Find an Organization and Take the Plunge

Does your practice have written social media policies? According to the ADA, it should.

Digital communication can be a boon for businesses in a broad variety of sectors, but for dentists, embracing new technology can’t mean forgetting about old regulations.

Arthur W. Curley, managing shareholder and senior trial attorney at the law firm Bradley, Curley, Barrabee, and Kowalski, PC, in California, said HIPAA and other state and local privacy regulations can lead to significant liability for dentists and their practices.

Curley has represented dental practices for more than four decades and speaks regularly about legal issues for dentists, including privacy and digital communications. He’ll lead a presentation on this topic, among others, during October’s American Dental Association Annual Meeting in Hawaii.

“We have defended various claims and cases involving allegations of violations of HIPAA and federal and state confidentiality laws,” Curley told 

“In many cases the dentist or staff members did not know or appreciate their legal obligations as to digital communications.”

Curley said in response to such cases, various groups began seeking training from professional litigators. In his ADA session he will teach dental professionals what they need to know about privacy regulations, and give examples of previous cases and claims and how dentists can learn from them.

One of the most problematic forums for dental practices is social media. Such platforms make it easier than ever to connect with patients and bring in new clients, but it is also fraught with opportunities for missteps.

The American Dental Association recommends dental practices have written social media policies. The ADA notes that the policy should align with privacy and discrimination laws, as social media communication is not exempt from these regulations.

One common issue Curley faces is dentists who post about about their treatment results on social media and refer to specific patients, “without appreciating the definition of ‘protected’ identity and the HIPAA laws as to using any part of a patient encounter for marketing.”

Curley said social media liability is not just about what dentists or their staffs post; it’s also about what patients post. He said another issue he encounters regularly is dentists trying to counter negative online reviews.

He said dentists sometimes try to argue with patients when the patient leaves a negative review about their experience. The problem is that such arguments can become a trap -- in defending his or her work in a particular case, the dentist might accidentally reveal details covered by HIPAA.

“A patient does not waive their HIPAA rights to confidentiality by posting a comment about their dentist or dental hygienist,” Curley said.

Dentists also have limited legal recourse to counter a negative review.

“Online reviews are often protected free speech, particularly if they are opinion,” he said. “‘My dentist was rough with me,’ is an opinion and protected speech. Suing for defamation due to a posting on social media, can be risky to the unaware, due to 

In addition to digital communications, Curley will also lead sessions at ADA on dental ethics, avoiding catastrophic claims from sedation complications, and employment law.

The ADA has published a guide on social media and employment. A link to the guide can be found 

A panel at next month's American Dental Association annual meeting will give dentists the opportunity to learn how to use digital communication without exposing themselves to legal liability.

Before Sharing Online, Dentists Need to Brush Up on Privacy Law

“If your team thinks that you don’t care how they treat people or how they do their job they won’t do it well." - Laci L. Phillips

As a dental business coach, Laci L. Phillips can tell almost as soon as she steps foot in a practice whether the dentist and staff are a high-functioning team, or a stressed-out collection of people barely getting by.

There are many reasons why a staff might not be meeting its potential, but one of the reasons is deceptively simple: a lack of regular recognition for high performance.

In short, Phillips said, dentists need to do a better job of complimenting their staffs.

“I think dentists feel like it’s all monetary and I think a lot of dentists really truly don’t know how to give compliment,” she said.

, said she has studied the personality types of dentists, and more often than not a certain type of personality emerges.

“And that type is someone who doesn’t necessarily need compliments, so they don’t give compliments,” she said. “And they’re certainly not going to give one if someone doesn’t deserve it.”

“I think first and foremost it has to start form a genuine place,” Phillips said.

Phillips said compliments are most valuable when they’re true and when they’re genuine. It’s not a numbers game. “If they just walk through the office and systematically say, ‘Hey thanks for coming to work today,’ it’s not as sincere and it’s not as meaningful,” she said.

The first step to genuine compliments is trying to notice the things your staff is doing well. Notice when the chairside assistant hands you everything without even needing to be asked. Notice when a hygienist gives a particularly amazing handoff. Notice when the business office is able to collect the entire fee up front.

“You have to physically and mentally start noticing things,” she said.

Once a dentist has trained her mind to notice, she’ll be better able to turn those observations into genuine, meaningful compliments.

Another key is to focus on gratitude, she said. This, too, can take practice. Some of Phillips’ clients have opted to put a sticky note on their desk to remind themselves to find three things each day for which they’re thankful. Others put a photo or sentimental object on their desk to remind them of all they are thankful for.

Remembering to be grateful can translate into an easier time remembering to compliment and thank staff.

Phillips also said dentists need to think of themselves not only as “bosses” but also as leaders, people invested in their staff, not just the bottom line.

“A boss is going to tell you what you have to do,” she said. “A leader is going to ask you what you want to accomplish. Who do you want to be? A leader makes you feel like you’re going to be a better person. A boss just dictates, and all they care about is the outcome.”

And when it comes to being a leader, Phillips said, the job is never done. Once a dentist starts focusing on helping his employees grow, he also needs to remember to continue to improve as a leader.

“I think the greatest leaders are the constant learners,” she said. “You’re constantly educating yourself.”

Phillips said regular compliments can make a major difference in the atmosphere of a workplace, something patients will pick up on. And if a dentist fails to signal appreciation for good work, they may find they are unintentionally sending a different signal.

“If your team thinks that you don’t care how they treat people or how they do their job they won’t do it well,” she said.

Dental business coach, Laci L. Phillips, says little compliments can make a major difference in how a practice functions.

For Dentists, Complimenting Staff is a Simple, But Important Skill

"Being in shape isn’t only about personal wellness. It also makes a dentist a more effective ambassador for wellness when speaking with her patients." - Uche Odiatu, DMD

Uche Odiatu, DMD, isn’t the kind of person who sees things in narrow silos. Talk to him about dentistry and he’ll invariably connect it to the latest medical research on brain chemistry. Talk about fitness, and he’ll link it to productivity, even to your practice’s bottom line.

“I get all of these obscure journals,” he said. “I read the science. I digest it, and create these analogies for it.”

Those analogies find their way into the speaking engagements that increasingly fill up his calendar, including the American Dental Association’s annual meeting this October.

A dentist by training, Odiatu is also a personal trainer, writer, consultant and speaker. He came about his commitment to fitness early. Growing up in England in the 1960s, his parents fed him a health-conscious diet including health-nut staples like wheat germ, cod liver oil, and brown sugar. It made an impression.

“I found it intriguing that I could eat by design,” he said, “that there was a function behind it besides just filling your belly.”

As he became a teenager and his friends began signing up for the usual array of team sports, Odiatu preferred individual sports, fitness activities and training where he could challenge himself, and which he could continue participating in for his entire life.

He also read, everything he could get his hands on.

“I think reading trained my brain to absorb information and make deductions,” he said. “I found school very easy. And I loved science.”

It was perhaps natural then, that he would go into the field of medicine. When the time came to apply for graduate school, he had an interview at a medical school and a dental school. He underestimated the importance of the interview, “winging” his medical school interview, and learning too late that the interviewers expected interviewees to be well-rehearsed.

When his dental school interview came up a couple of weeks later, he came well-prepared, and his fate was sealed.

Though Odiatu’s interest in dentistry, medicine, and fitness may seem broad, he sees them as one intricately connected subject. He argues that all dentists should take a holistic approach, and offers a number of reasons why.

First, Odiatu says dental professionals ought to approach exercise not as something extra to fit into their already busy schedule, but rather as an important tool to boost efficiency.

“Exercise doesn’t take time,” he said. “It actually gives back time.”

Exercise boosts alertness and productivity, he said, meaning a person’s working hours can be more focused if they exercise instead of living a sedentary lifestyle.

“One of the biggest advantage of exercise is above the neck,” he said. “It’s a fact that the brain loves oxygen and it loves circulation.”

Odiatu said it’s also not about how much time you spend -- even quick, focused workouts can give a person what they need.

Being in shape isn’t only about personal wellness, Odiatu said. It also makes a dentist a more effective ambassador for wellness when speaking with her patients.

“I say get in shape and get good posture and get a flat stomach,” he said. “It’s amazing how people will resonate or move towards someone who’s in shape because your eyes are alive and bright and your speech is clear.”

One reason that’s important is because Odiatu says dentists have a role to play in helping patients understand how their oral health relates to the rest of their bodies. When a dentist is in shape, it makes patients more likely to see the dentist as an authority figure on nutrition.

After all, the food a person eats affects not only their teeth, but also their gut microbiome, which has an effect on overall health that scientists are only beginning to fully understand. Moreover, Odiatu said, problems in the mouth, such as TMJ, can impact what and how you eat, and therefore affect your overall health.

Odiatu said dentists can and should be an authority on such matters, in part because he said the average dentist receives more training in nutrition than the average general practitioner.

“We increase people’s ability to impact their health by changing the way people eat,” he said.

While Odiatu is well versed at explaining the importance of fitness, the question he gets all the time is how to get started; what to do first.

But Odiatu resists the pressure to prescribe specific workouts or schedules.

“You don’t need, ‘How?’” he said. “I always say let’s go first into ‘Why?’”

In his case, the “Why” is his children. He wants to live long enough to see them grow up, and he wants to be healthy enough to be an active father.

“That’s my why,” he said. “I want to be my 3 F’s: I want to be a fun, flexible, father.”

Once a person finds his “Why?” the how will take care of itself. “It becomes powerful, a magnet that literally drags you out of the door in the morning,” he said.

Uche Odiatu, DMD, believes dentists should focus on nutrition and not just their own, but also their patients.

Dentist and Fitness Expert Takes Holistic Approach

“If [the patient] understands that it’s going to cost me $2,000 but they don’t understand the worth of that $2,000, I haven’t done my job right." - Theresa Narantic

When a patient’s arm is bleeding, he wants to do something about it. Right away. But, as dentists know all too well, many patients don’t have anywhere near that sense of urgency when their gums are bleeding.

Theresa Narantic knows this problem all too well. A longtime dental industry consultant and speaker, she works with practices around the country and hears all the time about patient complacency with regard to treatment recommendations.

“The educational level of our oral healthcare patients is lower than what we would like,” she told 

Luckily, there are strategies dental practices can use to dramatically increase their rates of treatment acceptance. Narantic will share her tips and perspective during one of two talks she’ll present at the 

American Association of Dental Office Managers

’ annual meeting in San Antonio, July 19-21.

Narantic likes to think of the treatment acceptance challenge not as getting a single “yes” but as getting “three yeses.”

When recommending a treatment plan, dentists have to make a clinical case for why it’s necessary, explain the procedure itself and the process the patient will undertake, and then explain how the patient can pay for it. In other words: there’s a lot for a patient to take in.

She gives the example of teaching math. In elementary school, a teacher must cover addition, subtraction, multiplication, and division, four different concepts each with its own set of rules and procedures.

“Would we learn if the teacher taught all of those concepts at the same time?” Narantic asked.

The obvious answer is “no.” And yet, Narantic says, dental practices use this all-at-once approach to patient education all the time.

Instead, Narantic suggests breaking up the conversation into three parts. First, the dentist explains the condition, the treatment, and the consequences of inaction.

If the dentist does a good job of this, they’ll get the first of the three “yeses.”

Next, a hygienist or dental assistant makes the value statement, explains how much time and money the treatment will take, and answers any patient questions. Afterward, they offer their question: If we can make this affordable, will you say yes? If done right, that conversation should lead to the second “Yes.”

“If [the patient] understands that it’s going to cost me $2,000 but they don’t understand the worth of that $2,000, I haven’t done my job right,” Narantic said.

The last stop is with a financial or insurance coordinator who explains the financial breakdown for the patient’s particular situation. The goal of that conversation is to get the third and final “Yes” and to get the patient to pay for the procedure up front.

“It’s not a qualified purchase until there’s money in hand,” she said. “So I coach a team in how to get 100% of the dollars before the appointment is even reserved.”

Narantic also said it’s important that each of the three stations is done by a particular staffer.

The dentist has the expertise and credibility to explain the medical rationale. However, it’s important for an ancillary staffer to explain the value proposition because often patients are more willing to ask questions of a hygienist than they are to ask questions of a dentist. The financial or insurance manager is important because only they understand the ins and outs of insurance and financing.

Part of that coaching is planning ahead. In order to secure the three “yeses,” each member of the team needs to be prepared to answer questions and give personalized responses. She recommends doing these chair previews two days in advance.

That planning can also help a dentist mentally prepare to make their case. Often, she says, dentists don’t like the idea of asking for money. However, she reframes the conversations. It’s not about making a sale, she says, but rather offering the patient a treatment or service that will benefit them. Dental staff shouldn’t act like salespeople, but they also shouldn’t poison the well by assuming the patient will want to say no.

“That’s the biggest thing with the ‘yes’ work that I do,” she said. “It is them getting that breakthrough that says just be objective.”

For more information on Narantic’s work, visit 

Image source: CandyBox Images - stock.adobe.com

Dentists often leave significant revenue on the table when patients fail to accept a treatment plan. Here are tips on how to ensure patients buy in, mentally and financially.

Want to Boost Treatment Acceptance? Focus on These Three Yeses

Dentists in Minnesota are hoping to enlist the help of patients in an effort to sway state lawmakers to boost Medicaid reimbursement rates.

The Minnesota Dental Association has kicked off a public awareness campaign aimed at convincing lawmakers to allocate more money toward the state’s Medicaid dental program. The campaign highlights the wide divergence between Medicaid payment rates from state to state. Minnesota currently ranks next to last in reimbursement rates for pediatric dental care. Carmelo Cinqueonce, MBA, executive director of the Minnesota Dental Association, said the issue is not new.

“This is a concern we’ve had for several years,” he told 

Cinqueonce said the issue came to a head when the American Dental Association’s Health Policy Institute (HPI) released a report showing Minnesota had the lowest reimbursement of any state for pediatric dental care.

A campaign subsequently helped get additional money, but not enough to keep up with other states. As of HPI’s most recent report, Minnesota Medicaid reimbursement equaled just 31.1% of the fees charged by dentists. Only Michigan, at 30.7%, had a lower reimbursement rate.

“The legislature, they do throw in a little bit of money here and there, and we’re very grateful for that,” Cinqueonce said. “But we need more in order to really turn the tide and address the problem that’s lingering for so long.”

The MDA estimates the state would need to invest between $50 million and $60 million per year in the state’s next biennial budget in order to close the funding gap.

Reimbursement rates vary dramatically from state to state. According to the 

, Delaware has the highest reimbursement rate for pediatric dental services, at 82.3%. Among states that use a managed-care model, like Minnesota, the highest reimbursement rate is found in Kentucky, which has a 77.9% reimbursement rate.

More than half of states are somewhere in the middle, between 40% and 65%. Only 8 states have a reimbursement rate of less than 35%.

While the lack of funding is a financial issue for dentists, it’s also a major access issue for patients. Low reimbursement rates have caused some dentists to stop participating in the Medicaid program, and others have capped the number of Medicaid patients they’ll take.

That can make it increasingly difficult for patients to find a dental practice willing to take them on.

The problem in Minnesota is receiving scrutiny from the Centers for Medicare and Medicaid Services.

“A year and a half ago the state was put on notice that they needed to do something to address access to care,” Cinqueonce noted.

The April 2017 letter from CMS noted that, in 2015, only 41% of Medicaid patients in Minnesota between the ages of 1 and 20 received any dental service, compared with the national average of 50%. The letter also pointed to an HPI study finding that, in 2014, 71% of commercially insured children in Minnesota received a dental service, while just 42% of Medicaid children did.

Cinqueonce said many dentists want to see Medicaid patients, but the state’s reimbursement levels make it difficult.

“Unfortunately, the economics of it drive many members and many dentists to make that hard decision of saying I can’t contract with Medicaid, I can’t see these patients because reimbursement is so low,” he said.

Conversely, the HPI report found states that increased reimbursement rates had an increase in dentist participation. 

The Minnesota State Legislature is not in session at the moment, so any action won’t happen for months. However, Cinqueonce said the group is launching its campaign now in order to drum up momentum. In addition to a 

, the organization has also launched a petition drive to give the general public a chance to voice their concern. Cinqueonce said he believes Minnesotans will want to remedy the problem even if they personally are not on Medicaid.

“As a citizen of Minnesota I think we owe it to ourselves to not be at the bottom of the pack,” he said.

Minnesota ranks next to last in Medicaid reimbursement rates for child dentistry. A new public relations effort aims to change that.

Minnesota Dentists Mobilize to Push for Higher Medicaid Rates

"...Tooth wear is a multifactorial condition, and the toothpaste alone cannot treat it," says co-author Thiago Saads Carvalho, DDS, MSc, PhD (pictured above)

Despite aisles full of toothpastes promising to stop dental erosion and protect sensitive teeth, new research suggests toothpaste alone can do neither.

Researchers from the University of São Paolo, in Brazil, and the University of Bern, in Switzerland, teamed up to analyze 9 toothpastes. They wanted to know if the toothpastes succeeded in mitigating enamel surface loss, since enamel loss plays a key role in tooth erosion and hypersensitivity.

In all 9 cases, the toothpastes caused tooth enamel loss, rather than prevented it. The tests were done 

 using human enamel samples and an artificial saliva group. The authors conclude that toothpaste shouldn’t be seen as a standalone treatment for dental erosion or sensitivity, but rather as one piece of the puzzle.

In an email, study authors Samira João-Souza, DDS, MSc, and Thiago Saads Carvalho, DDS, MSc, PhD, told 

 their findings support the need for regular dental check-ups, so that emerging dental problems can be caught and treated early.

“More importantly, patients should maintain their oral hygiene at a good standard, and this is possible by using fluoride toothpastes,” João-Souza and Carvalho said. “In this sense, any marketed toothpaste that contains fluoride can be used, but if they have any questions in this regard, they can ask their dentists.”

That said, when it comes to choosing toothpastes for specific clinical purposes, the co-authors said toothpaste isn’t a panacea.

“In our study, we investigated many characteristics/ingredients of the toothpastes that may influence erosive tooth wear,” they said. “But tooth wear is a multifactorial condition, and the toothpaste alone cannot treat it.”

The researchers analyzed a number of physical and chemical factors in their tests of the toothpastes. Each toothpaste led to some degree of enamel surface loss (SL), though it varied based on a number of factors.

“The results of this experiment indicate that enamel SL occurs independent of whether the toothpastes have a desensitizing or anti-erosive claim, and that lower SL is associated with the presence of tin, higher concentration of calcium and phosphate, higher percentage weight of solid particles, smaller particle size, and lower wettability,” the authors wrote. They added, however, that additional studies in needed in a more clinically relevant setting than the current 

João-Souza and Carvalho said dentists can’t overlook diet as a major causative factor in many cases, with highly acidic food and drink a main culprit. Harsh toothpastes and aggressive brushing can also be a factor.

The issue of diet has become a top-line concern in the dental industry, but the authors noted that it was not always prevalent.

“We have observed a steady increase in the number of publications on this topic: where in 1970 almost 40 studies had been published, in 1980, almost 50, but the number doubled in 2000, and in 

“This is a reflection that dental erosion is an increasingly more important topic in research and in the clinic, and that there is a constant demand for knowledge from both dentists and patients,” they said.

The study is titled, “Chemical and physical factors of desensitizing and/or anti-erosive toothpastes associated with lower erosive tooth wear.” It can be read in full at 

A recent study suggests that toothpastes claiming to stop dental erosion won't work without additional interventions.

Despite Claims, Toothpaste Alone Can't Stop Enamel Loss, Sensitivity

Anyone who works or has worked in a dental office and begins to have unusual difficulty breathing should see their primary care physician 

A peculiar cluster of lung-related disease among dentists is leading to renewed calls for proper respiratory protection at dental clinics.

The US Centers for Disease Control and Prevention (CDC) this month published a report looking at cases of idiopathic pulmonary fibrosis (IPF) among dentists in Virginia. IPF is a chronic lung disease and is often fatal. It’s associated with the inhalation of certain dangerous substances and thus is more common in workplaces where chemicals and certain environmental agents are present.

The new study dates back to April of 2016 when a dentist in Virginia was diagnosed with IPF. The clinic where the dentist sought treatment noted that this dentist wasn’t the first dental professional they treated for IPF. They reached out to the CDC to see if this was a common problem for dentists, but no such data existed.

The CDC, in turn, decided to look more closely at the question. They reviewed the records of 894 patients treated at the Virginia tertiary care center between 1996 and 2017. They found a total of nine dental professionals (eight dentists and one dental technician) who were diagnosed with IPF. Seven of the nine died. Though the number of cases is small, it represents a much higher than average rate of IPF. Dentists make up just 0.038 percent of the population, yet at this, clinic they represented nearly 1 percent of cases.

Lead author Randall J. Nett, MD, MPH, of the Respiratory Health Division of the CDC’s National Institute for Occupational Safety and Health, said dental practices don’t always have strong precautions in place to prevent exposure to inhaled health threats.

“Dental personnel are well-trained in preventing exposures from bloodborne pathogens like HIV by using personal protective equipment like gloves and surgical masks,” Nett told 

. “However, surgical masks do not adequately protect against some inhalational exposures encountered in dental practice, like silica.”

For instance, the dentist at the Virginia clinic who survived IPF reported being exposed to known respiratory hazards like silica without wearing proper protection.

Nett said there isn’t yet solid data on the level of protection at dental practices when it comes to these types of health hazards.

“What we do not know at this time is how many dental clinics have adequate engineering controls (like ventilation) or use adequate respiratory protection (NIOSH-certified respirators) to protect against the inhalational respiratory hazards encountered in dental practice,” he said.

It’s also not yet known whether the Virginia cluster is a fluke, or evidence of a profession-wide threat. Nett said the CDC is currently in the process of putting together additional studies that could help determine if the dental industry as a whole faces a higher risk of IPF.

Unfortunately, there’s no way to know if a worker is developing IPF until symptoms arise. Nett said anyone who works or has worked in a dental office and begins to have unusual difficulty breathing should see their primary care physician to evaluate the breathing difficulty.

In the meantime, the Occupational Safety and Health Administration’s guidelines for respiratory protection can be 

Nett’s study, titled “Dental Personnel Treated for Idiopathic Pulmonary Fibrosis at a Tertiary Care Center — Virginia, 2000—2015,” is 

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A string of cases of lung disease among dentists in Virginia has prompted public health officials to research the respiratory health at dental practices.

Cluster of Serious Lung Disease Found Among Dentists in Virginia

Many dentists felt they didn’t have enough knowledge about the virus, such as its symptoms or progression, to discuss it with patients.

Nearly three-quarters of oropharyngeal cancers are caused by the human papillomavirus (HPV), and yet a new study finds many dentists who might otherwise be vigilant about screening for oral cancers, are lacking the training or knowledge necessary to broach the issue of HPV with patients.

The study is based on four focus groups of 33 dentists.

Ellen M. Daley, PhD, MPH, the study’s lead investigator and a professor at the University of South Florida, said the lack of HPV counseling by dentists doesn’t seem to be an issue of motivation. She said dentists have been talking with patients about the cancer risks associated with tobacco and alcohol for decades, and are generally very “on board” with their role in cancer prevention.

“The issue with HPV, as they’ve described it to me, isn’t that they don’t think that this is a critically important issue — they do – but that they [the dentists] don’t know enough about the virus itself to talk about it comfortably, and that they don’t know how to approach talking about such a sensitive topic,” Daley told 

HPV is a very common sexually transmitted virus that does not cause health problems in most of the 78 million Americans who carry it. However, in some cases, it leads to cancer, such as cervical cancer, and cancers of the throat, tongue and tonsils.

Daley said many dentists felt they didn’t have enough knowledge about the virus, such as its symptoms or progression, to discuss it with patients.

One important topic in the HPV discussion is prevention.There is a vaccine against HPV, but the vaccine is only required in two states (Rhode Island and Virginia) and Washington, DC, according to the National Conference of State Legislatures. As a result, Daley said the HPV vaccination rate in the US is “alarmingly low.”

Daley said absent a mandate, providers, including dentists, need to be proactive about educating parents about the vaccine.

HPV can be a major risk factor for certain types of oral cancers, yet many dentists remain reticent to discuss it.