Joe Hannan

Massachusetts, the host state of the 2017 Yankee Dental Congress, can be considered one of the many fronts in the war against prescription opioid abuse. David A. Keith (BDS, FDSRCS, DMD) and Monica Bharel (MDP, MPH) provided information to arm dentists in the fight against the opioid crisis in their continuing education session, “The Prescription Opioid Crisis and Dentistry,” at the conference in Boston on Thursday.

The location of the Congress is well-suited for this particular topic. Bharel illustrated that point with statistics. Imagine four jumbo jets full of people ages 44 and under. That’s how many people are dying from opioid overdoses in the state each year, she said. That’s about 5 deaths a day — a 390 percent increase over the last 15 years. What’s worse, she explained, is that 74 percent of the deaths in 2016 involved a presence of 

, a lethal opioid more potent than what is typically prescribed.

Dentists, according to Bharel and Keith, play an important role in reversing this deadly trend.

“I’m not saying dentists are a problem,” Keith said. “But we are a part of the issue, and we need to do something here.”

Keith explained that dentists are the chief opioid prescribers for a particularly vulnerable portion of the population: children and young adults ages 10 to 19. This is troublesome when you consider that 70-80 percent of misused prescription opioids originate from legitimate prescriptions.

Where are these prescriptions coming from in the dental field? Keith said third-molar removal “is a source of quite a large number of opioids in our society.”

He supported that statement with statistics. About 66 million prescriptions for opioids are written after third-molar removal in America. Typically, the number of pills per prescription is about 20, of which, on average, about eight get consumed. That means about 40 percent, or 39 million pills, are not being used, Keith explained, highlighting that unused pills are a source of the problem.

So what can dentists do? Ultimately, Keith and Bharel said, dentists need to identify drug-seeking behavior and be more judicious in prescribing opioids. With regard to the former, Keith said that he has seen chronic oral pain lead to opioid dependence.

“These patients are going to be much more difficult to treat,” Keith said. “They may be more likely to abuse opioids.”

These are patients who present with burning mouth syndrome or who may have experienced nerve damage as the result of a surgical procedure. Keith said that it is critical to consult your state’s prescription drug monitoring program to ensure that the patients aren’t doctor shopping.

“We would be remiss to say that dentists prescribe legitimately, but sometimes are scammed,” he said.

As an example, he presented the case of a 33-year-old health care worker who reported jaw pain who recently moved from a neighboring states. After consulting the prescription drug monitoring system, he discovered that this person had 20 prescriptions in the past 6 months, 16 of which were narcotics. They were issued by 18 prescribers, 15 of which were dentists, and filled at 10 different pharmacies. This patient had a similar profile in a neighboring state, he added.                                                                    

When treating post-operative pain, Keith steered dentists in the direction of NSAIDs. Though not effective for chronic pain, NSAIDs tend to be a safer option following operations, such as third-molar removal. Dentists can also preemptive doses of NSAIDs, or use more or longer-lasting local anesthesia. He did, however, caution against acetaminophen toxicity, particularly since the drug is present in so many other medications.

He referred dentists to the Published Dental Analgesia Guide, which offers the following guidance:

 Typically associated with single extractions or endodontics; ibuprofen or acetaminophen

: Typically associated with implant surgery or soft tissue impaction; ibuprofen, acetaminophen or sometimes codeine

Typically associated with boney impaction or complex implant surgery; oxycodone with acetaminophen and NSAIDs.

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What can dentists do to help combat opioid abuse? Two experts offered solutions in this continuing education session at the Yankee Dental Congress on Thursday, Jan. 26.

Yankee Dental Speakers Arm Dentists in Fight Against Opioid Abuse

 runs from Jan. 25-29 at the Boston Convention and Exhibition Center. The Congress is New England’s largest gathering of dental professionals, including more than 450 exhibitors, more than 30 free continuing education course, and hosting more than 28,000 dental professionals.

 tend to be a bit obsessed with the business side of dentistry. With that in mind, here are five business-centric continuing education sessions that look promising. We’ll be covering them to bring you the highlights, in addition to sitting down with other lecturers for video interviews on their given topics.

1. How Not to Fail Miserably at Private Practice: 

 — We get it. Business training in dental school, if it happened at all, was probably an afterthought. This free course should prepare you if you’re looking to join the approximately 80 percent of dentists who own their own practices, according to the American Dental Association’s Health Policy Institute. Topics in this session will include controlling overhead costs and making more effective use of your schedule.

2. Making the Most of Your Dental Investment: 

 — Maybe you’re thinking of finally buying that cone beam radiography setup. Or maybe you’re thinking about expanding into sleep dentistry. Regardless, you’ll want to make sure that there’s a demand for those services in your market, and you’ll want to know how to effectively market those services to patients. This free session should help with both.

3. Expanding Social Media Reach for Patient Acquisition and Patient Retention: 

 — Marketing your dental practice used to start and end with putting an ad in the Yellow Pages. Those days are long gone. Your patients are on social media now, and that’s where you need to be if you want to stay in touch with them. It’s also where you need to be if you’re looking to bring in new sessions. This $75 session looks to offer social media tactics you can put in play right away.

4. Keeping Your Practice Pulse by Using Key Performance Indicators (KPIs): 

 — This free session looks to promote a by-the-numbers overview of flow of patients and revenue through your dental practice. You might know that what gets measured gets managed, but you might not know what, exactly, to measure. That’s where the Key Performance Indicators will come in.

5. Overcoming Obstacles to Practice Ownership: 

 — You don’t need to be afraid of the challenges of practice ownership. This session looks to equip you with the tools you need to handle the business-centric role of running your own practice. The speakers in this free session will review creating the business plan and team that you need to get where you want to be.

The Yankee Dental Congress is New England's largest gathering of dental professionals, including more than 450 exhibitors, more than 30 free continuing education course, and hosting more than 28,000 dental professionals.

Yankee Dental Congress: 5 Promising Practice Management Classes

Books are the furniture of our lives. They help to support healthy thinking and fuel or inspiration. But we get it: As a dentist, you’re super busy. You want to make sure that you get the most out of the time you invest in reading. With that in mind, here are five approachable books — all of which have nothing to do with dentistry – that will feed your mind.

 Stoic philosophy hasn’t been this prominent since it came into being in ancient Greece about 300 B.C. From Wall Street to NFL locker rooms, this way of thinking is helping professionals and athletes to neatly compartmentalize the world into things that fall under one’s control, and things that fall outside of it. Tim Ferriss, the professional self-experimenter, has called stoicism the perfect “operating system for the modern world.” Aurelius wrote “Meditations,” an essential stoic read, between 161 and 180 AD on the battlefield. It is believed that Aurelius never intended for these reflections to be published, but rather wrote them as reminders to stay true to his “ruling principles.” “Meditations” can be found for free all over the internet.

The Obstacle is the Way: The Timeless Art of Turning Trials into Triumph

 Running a dental practice comes with its own unique set of challenges. As your practice’s CEO, you have to be a clinician and a small business owner. Holiday takes the tenants developed by the stoic philosophers of ancient Greece and adapts it for the modern world. Holiday writes that you can use adversity as a compass to point you toward whatever is most critical to success.

How easily we are distracted from what is important and essential in modern living We’ve surrounded ourselves with dozens of technological devices, all competing for our attention at the given moment. It’s no wonder we’re so anxious and overwhelmed. Kabat-Zinn’s landmark self-help book is now ten years old, but it couldn’t be more relevant. Use it to bring mindfulness into your daily life.

The perfect read after a hard day in the office. If you think you have it bad, you don’t have it artillery-barrage, mud-up-to-your-ankles, and death-everywhere bad. This short book is one German’s soldier’s recollection of the First World War. The accounts are so vivid, you can feel the drumming of the guns and the searing choke of mustard gas. These forces have the power of putting things in their proper perspective.

The author of the infamous 4-Hour series of self-help books, Ferriss’ latest tome is a useful megadose of wisdom distilled from the guests who have appeared on his podcast, the 

. Each chapter is devoted to a different guest and breaks that person’s advice into easily digestible portions. Chapters are devoted to celebrities such as Arnold Schwarzenegger, leaders such as retired Gen. Stanley McChrystal, and athletes such as professional surfer Laird Hamilton.  It’s the perfect book to keep nearby for when you need a quick shot of inspiration, motivation, or perspective.

As a dentist, you're super busy. You want to make sure that you get the most out of the time you invest in reading. With that in mind, here are five approachable books all of which have nothing to do with dentistry that will feed your mind.

5 Essential Books for Modern Living

. The practice owners among our readership have certain advantages in these states, which earned high marks from 

, a politically independent organization that researches tax policy. Tax Foundation has been providing this analysis since 1937.

Tax Foundation comes up with an annual index of the most and least business-friendly states in the country. The top 10 had one thing in common: each has eliminated one or more of the major taxes, which, according to the foundation, are corporate income, individual income or sales tax.

Unfortunately, the practice owners in the states at the bottom of Tax Foundation’s list aren’t so lucky. The 10 least business-friendly states earned their spots for myriad reasons. Among them, “complex, non-neutral taxes with comparatively high rates.” New Jersey, Tax Foundation points out as an example, is one of two states that charges an inheritance tax in in addition to an estate tax.

Click to the next page to see the rankings, starting with number 41.

· Tax Foundation notes that Louisiana recently hiked the state sales tax by a penny, bringing the state rate from 4 to 5 percent.

· Louisiana ranks among the five states with the lowest property tax burden, according to 

· In 2010, Northrup Grumman relocated from Virginia to Maryland, citing the more favorable business tax climate as its reason, according to Tax Foundation.

· Maryland was the second most charitable state in 2015, according to 

· Tax Foundation notes that General Electric and Aetna threatened to leave the state in 2015 if the governor approved a budget that raised corporate taxes. GE made good on its threat.

· Connecticut ranks among WalletHub’s 

· Its tax structure isn’t just unfriendly to business. Rhode Island also made WalletHub’s ranking of 

· Tax Foundation notes that states like Ohio need to be concerned about the tax climate of their immediate neighbors, which can lure businesses away.

12 states with the highest shortages of dentists

· It may leave much to be desired, with regard to its business tax climate, but Minnesota does rank among 

· It’s not hospitable to businesses, Tax Foundation says, and it’s also 

· Intel built chip-making facility in Arizona instead of California in 2005. The reason? The tax climate in Arizona. The state has a more favorable corporate income tax system, Tax Foundation says.

8 states with the highest healthcare costs

· New York has climbed in the rankings over the last two years due to corporate tax reforms, Tax Foundation notes.

12 states with the largest dentist shortages

, and the double whammy of an inheritance tax and an estate tax, New Jersey claims the bottom spot, according to Tax Foundation.

It also made the list of the worst states for retirement

According to Tax Foundation, the 10 least business-friendly states in 2017 have earned this designation because of their complex tax codes and high tax rates.

The 10 Least Tax-Friendly States for Businesses

 Expedia.com commissioned the study, conducted by GfK. The research company interviewed and analyzed the responses of 1,005 U.S. interviewees aged 18-years and older.

: The average dental school graduate in 2016 left school with $261,149 in student loans, according to the American Dental Education Association (ADEA). More than 30 percent of grads reported debt of more than $300,000.

Which Anesthesia Do Dental Patients Prefer? Study Offers Insights

 The study, performed by researchers at the Tokyo Dental College, looked to determine whether dental patients preferred propofol or sevoflurane.

Alzheimer's Drug Could Change How Dentists Treat Large Cavities

Researchers have shown a way to stimulate new dentin growth following infection or trauma involving the use of stem cells contained in a tooth’s pulp.

A Pearl of a Destination: Savor Charleston's Oyster

 A bucket of oysters — or about 36 of the briny treats – will cost you about $12 dollars. If you don’t feel like shucking them yourself, there are plenty of food trucks and restaurants to take care of it for you.

These 5 stories were the most popular on Dentist's Money Digest last week.

The DMD Top 5 for the Week Ending Jan. 20

A new type of dental implant that slowly releases antimicrobial drugs may help prevent the formation of biofilms, new research shows.

A team of researchers has presented their findings on this new implant, which uses a reservoir and a semi-porous implant surface, to deliver the drugs over time. 

According to the study, rough implant surfaces, which foster osseointegration, have become increasingly common for dental implants. The drawback of the rough surfaces is that it provides additional surface area, which consequently leads to increased opportunity for stubborn-to-treat biofilm infections.

The implant developed for the study, which is made of a titanium composite, contains an internal reservoir that can be filled with antimicrobials. The titanium composite material itself is integral to this implant’s success in staving off infection, the study says, because it enables the permeation of antimicrobials from the reservoir at a steady rate. Additionally, the study notes, “by adjusting the concentration of the feed solution, the amount of released compound can be fine-tuned.”

Prior to this study, implants have relied on antimicrobial coatings to stave off infection. These coatings are prone to breakdown and damage, the study says.

In this study, researchers filled the reservoir with chlorhexidine, an antimicrobial commonly found in mouth rinses. They manufactuyred the reservoir to delivier 5 mM of chlorhexidine over 10 days. After the study period, researchers used CFU counting and a scanning electron microscope to look for the presence of 

“The metabolic activity of biofilm cells was significantly decreased (± 99 percent reduction) for all chlorhexidine feed concentrations as compared to blank feed solutions,” the study says.

Researchers point out that the reservoir can also be filled with antibiotics. By eliminating the need for a patient to take antibiotics orally, the reservoir delivery method could lead to more consistent dosing, diminishing the risk of antibiotic resistance. The implant can also be reloaded as needed, researchers say.

“Release of this antimicrobial compound prevents and eradicates microbial biofilm formation on the rough implant surface, decreasing the risk of development of peri-implant diseases,” the study concludes.

A team of researchers has presented their findings on this new implant, which uses a reservoir and a semi-porous implant surface, to deliver the drugs over time.

New Dental Implant That Slowly Releases Antimicrobials Fights Biofilms

 sheds new light on which anesthesia type dental patients prefer.

, looked to determine whether dental patients preferred propofol or sevoflurane. They did so by comparing patients’ recovery satisfaction after sedation by each drug. Researchers used all healthy patients who had never been under anesthesia for prior dental treatment.

The study group included 20 patients whose course of treatment included two procedures under general anesthesia. A different type of anesthesia was used for each procedure. Researchers also excluded the use of opioid analgesics and/or nitrous oxide to maintain sedation in order to eliminate those variables, which were present in previous studies.

When comparing the two drugs, researchers noted no difference in the patients’ recovery time, though patients did “come out of anesthesia more quickly with sevoflurane than from propofol,” 

. Some patients experienced nausea from the sevoflurane, but there were no adverse effects reported after 24 hours.

“All patients were able to eat their first meal and drink fluids at a similar time, and no patients experienced nausea or vomiting once leaving the dentist’s office,” a news release from Anesthesia Progress said.

Patients were called 24 hours after their procedures and given a questionnaire. After their second procedure, the patients were asked to rate which anesthesia they would choose for any future dental work. Of the 20 patients, 16 said they preferred propofol and 4 said that they preferred sevoflurane. These patients said they experienced more discomfort and fatigue from the sevoflurane.

“The researchers concluded that propofol is the anesthetic of choice for dental patients with severe anxiety about surgery, but these patients may continue to need general anesthesia in future surgeries,” the news release said. “When patient satisfaction is the highest priority, the researchers suggest that dentists may want to give propofol during in-office surgery.” 

The study, performed by researchers at the Tokyo Dental College, looked to determine whether dental patients preferred propofol or sevoflurane.

 has announced a product distribution partnership with 

, the largest Dental Support Organization in America.

The partnership, which began with the New Year, was recently announced by Patterson Dental in a 

. Patterson’s preferred-vendor status means that any Heartland Dental dentists will now have to purchase products exclusively through Patterson Dental. Vendors and dental-product companies will need to be vetted and approved by Patterson in order to have contact or a working relationship with dentists.

Explaining the decision, Heartland president and CEO Patrick Bauer said his company selected Patterson “because of their history of market-leading service, which dovetails with our experience in the evolving DSO space. Our partnership will benefit from Patterson’s expertise in logistics, technical service, ecommerce and technology, which enables our commitment to mutual growth.”

Patterson Dental president, chairman, and CEO Scott Anderson also lauded the partnership.

“We are excited to partner with a leader such as Heartland Dental that shares our values and the desire to bring best-in-class products and solutions to the dentists and teams they support,” Anderson said.

Heartland provides practice-management services to more than 750 dental practices in the U.S., spread out over 33 states. In addition to providing dentists with continuing education and leadership training, Heartland also offers non-clinical practice support services, such as HR and marketing. 

Heartland Dental has selected Patterson Dental as its preferred vendor, giving Patterson exclusive access to its network of more than 750 dental practices.

Major Dental Support Organization and Patterson Dental Announce Partnership

Dentist is America's 'Best Job' in New Ranking

: The Bureau of Labor Statistics projects employment in dentistry to grow 18 percent between 2014 and 2024.

Archeologists Reveal How Ancient Man Cared for His Teeth

 According to a recent study published in the journal Science of Nature, a team of researchers were able to determine what some of our ancient ancestors ate, how they prepared their food, and even how they cared for their teeth by examining the calcified plaque found on human teeth.

Significant Growth Predicted for Dental Imaging Market Through 2024

: One report estimates an 8.5 percent compounded annual growth rate for the dental imaging market while another puts the figure at 12 percent.

The 10 Most Tax-Friendly States for Businesses

 According to Tax Foundation, the 10 most business-friendly states in 2017 all have one thing in common: they’ve done away with one or more of the major taxes, which, according to the foundation, include corporate income, individual income or sales tax.

The Costs and Benefits of a Digital Dental Workflow

 How you can make use of technology in your dental practice to work smarter, not harder.

The DMD Top 5 for the Week Ending Jan. 13

 ranks Dentist as its best job for 2017. Orthodontist also claimed the number 5 slot for the second consecutive year. And oral and maxillofacial surgeons rounded out the top 10 by claiming ninth.

According to the news outlet, dentists claimed the top spot for several reasons. Chief among them is that the Bureau of Labor Statistics (BLS) projects employment in the profession to grow 18 percent between 2014 and 2024. That’s 23,300 new jobs. Other factors pushing dentistry to the top include: strong salary, low unemployment, and a good work-life balance. 

 puts the median salary among dentists at $152,700 and the unemployment rate at .1 percent. Dentist also ranked as the 

 also gauged job satisfaction for each profession by looking at three factors: upward mobility, stress level and flexibility. While the former two categories fell into the “average” ranking for dentists, the latter earned an “above average” because of the profession’s “alternative working schedule and work-life balance.”

It was a banner year for many health-care professions in 

“Health care jobs often require a human element, so they can’t be exported or entirely replaced by robots — at least not yet,” said Susannah Snider, personal finance editor at U.S. News in a 

. “Continued growth in the health care sector, low unemployment rates, and high salaries make these jobs especially desirable. Plus, individuals can pursue a range of health care positions that require varying levels of skill and education.”

Orthodontists will also fare well in the eyes of the BLS in 2017. The bureau estimates that the profession will see job growth by 18 percent from 2014 to 2024, creating 1,500 jobs along the way. “The BLS suspects this growth will be driven by an increasing desire for this specialized dental care,” the news organization reports.

puts the median salary for Orthodontists at $187,200, the profession’s unemployment rate at .1 percent, and the number of available jobs at 1,500. Orthodontist took the number 4 slot in the best health care jobs ranking. And good news if you’re an orthodontist working in the metropolitan areas of Memphis, Tenn., Atlanta or Boston. 

 says you’re among the most highly compensated in your profession. On the job satisfaction scale, the news organization says that orthodontists have average upward mobility, a below average stress level and above average flexibility.

Rounding out the top 10 jobs are oral and maxillofacial surgeons, which tied for the rank of ninth alongside obstetrician/gynecologist. Oral and maxillofacial surgeons ranked third among the best paying jobs, and the BLS expects their profession will grow 18 percent between 2014 and 2024. Oral and maxillofacial surgeons bring in a median salary of $187,200, have a .6 percent unemployment rate. There are about 1,200 jobs available in the field.

The Bureau of Labor Statistics projects employment in dentistry to grow 18 percent between 2014 and 2024.