Joe Hannan

The practice owners among our readership are all too familiar with how a state’s tax climate can affect running a business. And so are the analysts at the 

, a politically independent organization that researches tax policy. They’ve been at it since 1937.

Each year, Tax Foundation provides readers with an index of how favorable tax climates are for businesses on a state-by-state level.

 much is collected in taxes by state governments, the index is designed to show 

 states structure their tax systems, and provides a roadmap for improvement.”

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.

· Not a factor in the Tax Foundation survey, but Oregon also ranks among the worst states for student loan debt.

· Levies all major tax types considered by Tax Foundation.

· Rates are low though, and on a broad tax base.

· Not a factor in the Tax Foundation survey, but at least one expert thinks the state has a glut of dentists.

· However, WalletHub ranks it among the states with the highest property tax burdens.

, according to the Bureau of Labor Statistics.

· Ranks among WalletHub’s seven best states for retirement.

· Ranks among the best states for dental visits in 2014, according to the Centers for Disease Control and Prevention.

· Ranks among the seven best states for retirement, according to WalletHub.

· Ranks among the 10 happiest states, according to WalletHub.

Articles

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 10 Most Tax-Friendly States for Businesses

Derek Pearson is vice president of Business Development at 

, a company dedicated to improving social media performance for dentists. He sat down with 

, held Nov. 24-29, 2016, to discuss the common denominators of success he sees on social media in dentistry.

What sorts of things should dentists be doing on social media in order to set themselves apart

Derek Pearson: It’s about being personal. Everybody knows dentistry is about relationships. To build relationships, you have to be personal. Facebook, Instagram, all of these social media tools are a relationship play.

Pearson: On social media, dentists need to be different. They need to stand out, and the only way to really do that is to engage with what your audience will want. A lot of dentists think, “If I post this before and after photo of an implant that I did, I’ll get a lot of engagement,” but they won’t. What they need to do is they need to post pictures of them with their patients. They need to post pictures of people: their patients, their staff, them. They even need to post pictures of their family and what they do, because our patients want to get to know who you actually are.

What are some of the common mistakes that you see dentists making on social media

Pearson: The most common mistakes I see dentists making on social media is they’ll post manufactured content: a tooth joke or an oral-health fact. That’s OK to post occasionally, but people don’t pay attention to that. It looks fake. It doesn’t help me get to know you as a person. It doesn’t help me get to know you as a dentist. It doesn’t help me trust you or even really like you. It tells me nothing about you.

Which social media platforms tend to be the most effective

Pearson: Ultimately, at the end of the day, Facebook is by far the biggest one. Instagram is going to be number two. Twitter is really hard to do for a dentist but if you do it right, you can be effective with it. It just takes a lot of time and energy, where Facebook and Instagram are going to be a little bit easier and a lot more effective. And YouTube, even though it’s not fully a social media platform, YouTube videos are huge for dentists. They help your SEO — where you rank on Google. But by far, Facebook is the most impactful.

What are some of the content types that have been proven to get readers’ attention

Pearson: There’s really only three types of content in my mind. There’s educational. There’s manufactured: the memes, the jokes. And then there’s real and personal. … Ultimately, you’ll start having success as a practice when your business Facebook page starts looking like a personal Facebook page. … If you have a patient that comes in and had no cavities, take a photo of that. Celebrate those moments. If you have a veteran come in, you have a police officer, you have patients that you just have great relationships with, take those photos and celebrate them online. We live in a culture where we love sharing. Your patients are part of that culture and they love sharing. Why not help them share these experiences?

What are some of the pitfalls with Health Insurance Portability and Accountability Act (HIPAA) compliance

Pearson: The best tip I can give for a practice to stay HIPAA compliant is put a system in place that can be automated. When things are automated, you don’t forget. Put a system in place and make sure that you’re following it consistently, that your team knows it.

We sat down with Derek Pearson, the vice president of Business Development at Banyan, a company dedicated to improving social media performance for dentists, to find out what dentist can do on the web to attract patients to their practices.

Q&A: How to Make Your Practice's Social Media Efforts Pay Off

Why You Should Ask Your Dental Patients if they SCUBA Dive

 A recent pilot study conducted by a dental student at the University of Buffalo found that the rigors of SCUBA diving can lead to oral pain and dental issues. The findings were published in the most recent issue of the British Dental Journal.

Dentist Sentenced for Prescribing Pain Meds to Employee, Then Using Them Himself

 The Keene Sentinel of Keene, N.H., reports that Ayman A. Jacobs, DMD, 54, was convicted on two drug possession charges that stemmed from an incident in 2014. He received a 12-month jail sentence, but the sentence was suspended for four years as long as he takes part in drug treatment.

At the following dental museums around the U.S., sink your teeth into dentistry’s past, chew on various cultural attitudes and enjoy tasty professional tidbits.

Analysis Highlights Need to Reform Dental Care Delivery Model

: “It remains unclear whether twenty-first-century dental science, information technology, interprofessional practice, and population health needs can be mounted onto the current nineteenth-century dental care delivery model,” writes analysis author Elizabeth A. Mertz, an associate professor in the Department of Preventive and Restorative Dental Sciences at the University of California, San Francisco.

New Mercury Ruling: Dental Offices Must Comply with EPA Regulation

The EPA has adopted a new federal regulation that requires all dental offices, clinics, and schools to purchase and use dental amalgam separators in their treatment areas.

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As a dentist, you know that you can learn a lot about somebody from looking at their teeth. As it turns out, the same can be said of archeologists.

According to a recent study published in the journal 

, 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.

It turns out that cooking wasn’t a priority among the people who lived in what is now Sima del Elefante, Atapuerca, Spain about 1.2 million years ago. This portion of Spain is the source of some of the oldest human remains found in Europe, the study notes. Researchers determined by studying the plaque on teeth found in this area that starchy carbs were a primary energy source for ancient man in this region, including two grass species. Meat was also a prominent source of protein. The analysis of the calcified plaque revealed that all of this food was consumed raw.

“Evidence for plant exploitation in the earliest stages of hominin occupation in Europe is extremely limited,” the study notes. “The material emerging from dental calculus provides new insights into hitherto unobtainable evidence for use of plants as food, medicine and raw materials.”

Additionally, and perhaps most interestingly for dentists, researchers found pieces of non-edible wood stuck in grooves on the teeth, “suggesting oral hygiene activities,” the study says. These grooves are typical in species that pick their teeth using pieces of wood, the study notes. In other words, the researchers may have uncovered some of the earliest evidence of man’s toothpick use.

“Interproximal grooves, found on teeth of all 

 have long been linked to tooth picking, while oral hygiene activities using plant materials occur in modern higher primate populations,” the study concludes.

One of the lead researchers of the study, Karen Hardy, offered some insight on the findings to the 

“We all get stuff stuck between our teeth,” Hardy told the 

 “I haven’t done the experiment of eating raw meat, but if you think about all the fibers and the tendons in meat, it would probably be worse with a raw diet.”

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.

Archeologists Reveal How Ancient Man Cared for His Teeth

The current delivery model for dental healthcare needs an overhaul.

That’s the message of a pointed analysis of the dental-medical divide, highlighted in the most recent issue of 

“It remains unclear whether twenty-first-century dental science, information technology, interprofessional practice, and population health needs can be mounted onto the current nineteenth-century dental care delivery model,” writes analysis author Elizabeth A. Mertz, an associate professor in the Department of Preventive and Restorative Dental Sciences at the University of California, San Francisco.

Mertz’s article underscores the inequity of access to dental and general healthcare, and how a decade of research has emphasized the oral-health, whole-body health connection. Though access to general healthcare has improved under the Affordable Care Act (ACA), access to dental care has languished. The question is, why?

As dentists know, the two most prevalent oral health issues — cavities and periodontal disease – can have implications for the entire body. However, the cost of associated complications, Mertz writes, is typically not carried by the dental healthcare system, but rather, the general healthcare system. And so the divide persists.

So, what’s to be done about the problem?

“Integration of oral health within broader health care systems promises to improve patient experiences and outcomes through better screening, referrals, and coordination of care, while decreasing overall costs (both dental and medical) through increased prevention and early treatment,” Mertz writes.

This can be accomplished in several ways. Mertz notes the success of “strategic initiatives” on the federal and state level, as well as community-based efforts. On the local levels, these efforts can include school-based fluoride and sealant, as well as general water fluoridation, and the dental home initiative. Mertz also writes that mimicking integration and reform efforts that have succeeded in the behavioral health field would be beneficial.

Ultimately, however, Mertz concludes that success of integration is reliant on the answers to these three questions.

1. “Will the professional dominance that dentists hold over the delivery system continue to be used to resist reform, or will it be deployed toward innovation in care quality, patient experience, and practice productivity?”

2. “Can the communities of payers, philanthropists, health providers, public health, and consumers muster the political will necessary to reorient policy structures toward improved accountability and value?”

3. “Can the current dental education and delivery model adapt to change quickly, or will old structures simply die as new ones are created?”

It remains unclear whether twenty-first-century dental science, information technology, interprofessional practice, and population health needs can be mounted onto the current nineteenth-century dental care delivery model, writes analysis author Elizabeth A. Mertz, an associate professor in the Department of Preventive and Restorative Dental Sciences at the University of California, San Francisco.

In addition to the usual questions you ask new patients on your intake form, you might want to add a new one: Do you SCUBA dive?

 conducted by a dental student at the University of Buffalo found that the rigors of SCUBA diving can lead to oral pain and dental issues. The findings were published in the most recent issue of the 

The researcher, Vinisha Ranna, BDS, who is herself an active SCUBA diver, circulated a survey through social media platforms pertaining to diving. She then whittled her sample size of survey participants down to a 100 recreational divers. The study looked at “diver demographics, diving characteristics (level of certification, number of dives completed), occurrence of dental problems during a dive, and details of the episode.”

Data indicated that 41 percent of respondents experienced some dental distress during dives. Frequently reported problems, 

according to a news release from the University of Buffalo

, included tooth, jaw and gum pain, loosened crowns, and damage to dental fillings. The most commonly reported issue was 

. The study concluded that — though this is a small sample size and there may be biases at play, due to the study recruiting methods – “a high proportion of recreational divers may experience dental symptoms during a dive.”

The news release adds that the symptoms are likely a result of the changes in atmospheric pressure under water, as well as the jaw clenching required to keep an air regulator in place.

The primary takeaway for dentists is, if you know your patient is an active SCUBA diver, you want to ensure that decay issues and damaged restorations are resolved prior to a dive. It’s also worth asking about the type of SCUBA mouthpiece the diver is using. Some divers complained of temporomandibular pain while SCUBA diving.

“Divers are required to meet a standard of medical fitness before certification, but there are no dental health prerequisites,” Ranna said in the university’s news release. “Considering the air supply regulator is held in the mouth, any disorder in the oral cavity can potentially increase the diver’s risk of injury. A dentist can look and see if diving is affecting a patient’s oral health.”

A recent pilot study conducted by a dental student at the University of Buffalo found that the rigors of SCUBA diving can lead to oral pain and dental issues. The findings were published in the most recent issue of the British Dental Journal. 

A New Hampshire dentist was recently sentenced for prescribing Vicodin, Percocet and Norco to a practice employee so that the practice employee could then give the drugs back to the dentist for personal use.

One-Third of Dentists Know of an Opioid-Addicted Colleague

, N.H., reports that Ayman A. Jacobs, DMD, 54, was convicted on two drug possession charges that stemmed from an incident in 2014. He received a 12-month jail sentence, but the sentence was suspended for four years as long as he takes part in drug treatment.

 reports that Dr. Jacobs faced a disciplinary review before a New Hampshire board. The board’s investigation found that in October of 2014, Dr. Jacobs wrote a prescription for painkillers for an employee who also happened to be a patient. This employee then filled the prescription and returned the drugs to the dentist, according to the report. As a result of its findings, the board suspended Dr. Jacobs’ license, and that suspension remains in effect today.

State Dental Association Creates ‘First Of Its Kind’ Set of Opioid Guidelines

 reports that authorities were tipped off to Dr. Jacobs’ illicit behavior by two Keene pharmacists. The pharmacists’ investigation determined that Dr. Jacobs’ employee had filled prescriptions for painkillers at five different pharmacies.

Opioid addiction in the dental community appears to be a common issue. 

 of 196 dentists conducted in August of 2016 found that nearly one in three dentists said they know of a dentist who has been addicted to prescription opioids. Thirty-two percent of respondents said they personally knew a colleague with a painkiller problem. 

The Keene Sentinel of Keene, N.H., reports that Ayman A. Jacobs, DMD, 54, was convicted on two drug possession charges that stemmed from an incident in 2014. He received a 12-month jail sentence, but the sentence was suspended for four years as long as he takes part in drug treatment.

If music can soothe the savage beast, can it also soothe the anxious dental patient?

Dentists have been piping tunes into their practices for years, and many have incorporated TVs and other more advanced entertainment devices. But one Illinois-based dentist has taken a throwback approach to putting patients at ease with music — vinyl records.

 reports that Dan Rangitsch, DMD, who owns a practice in Marion, Ill., has been putting patients at ease with a turntable attached to speakers and a subwoofer. He’s also allowed patients to peruse his collection of LPs to select the tunes they want to hear while he works. This, he says, beats the whirring of the drill or the gurgling of saliva suction.

“I don’t enjoy having my teeth worked on, and the sounds of it,” the 

 quotes him as saying. “So I try to make it as comfortable as possible.”

The news outlet reports that Dr. Rangitsch had been having mixed results with nitrous oxide, noticing that it affected some patients more than others. This caused him to eschew the sedative and instead gravitate toward music.

Dr. Rangitsch, the article notes, tries to keep a broad selection of records on hand to appeal to popular tastes. Though he grew up in Montana, he says that he prefers gangsta rap to the country and pop songs his patients and staff tend to listen to. But he prioritizes creating the best experience for them as possible.

Dr. Rangitsch’s approach for putting patients at ease appears to have merit. 

 reports that a 2013 study in the journal 

 found that music “improves the body’s immune system function and reduces stress.” The same study also found that music can bring down anxiety levels prior to surgery.

The American Psychological Association notes a second study out of Singapore that found music therapy sessions reduced reported levels of persistent pain among patients. In this case, music therapists were brought in to coach patients in signing, playing instruments, discussing lyrics, and even writing songs. These things might be difficult during a dental exam, but the studies at least provide some food for thought. 

An Illinois dentist has equipped his practice with a turntable and speakers, and allows patients to select the records they want to listen to while he works.

Dentist Uses Vinyl Records to Put Patients at Ease

A new study published in the most recent issue of 

projects an increase in the rate at which Americans will use dental care. Researchers also say that preventive dental care will increase and dental treatment will decline.

Researchers say that by 2026, 47 percent of Americans will visit the dentist. That’s an estimated 334 million visits. The estimate, however, relies on the assumption that parents will take advantage of expanded pediatric dental insurance coverage. The research team, which included two economists and a professor of dentistry, attribute this increase to the passage of the Affordable Care Act (ACA).

The research team relied on data from the Medical Expenditure Panel Survey (MEPS), focusing on the years 1996-2013, to form its projections. That data pool included 557,071 people, about 162,000 of which were children. Within this data set, researchers looked at first, whether an individual saw a dentist at all during a given year, and second, how many subsequent dental visits took place, conditional on that first dental visit.

They then created an additional forecast that took into account expanded access to medical and dental coverage under the ACA, which passed in 2014, a year after the last available year of MEPS data.

“Using the two-part model allowed us to generate a forecast for the percentage of the population with dental care use as well as a forecast for average number of dental visits per person,” the study authors wrote.

The study authors also wrote that a separate forecast was of special importance because “apart from dental coverage, enrollment in private health insurance is a strong predictor of dental care use, possibly because private medical coverage acts as a proxy for health-seeking behavior or results in greater disposable income that individuals allocate to dental care.”

The researchers concluded that dentists can expect to see 42.6 percent of the American population this year. That figure is expected to climb to 44.6 percent by 2026, indicating an annual growth rate of .5 percent. The majority of these visits, the author notes, will be for preventative care.

Adjusting for the ACA boosts the percentage of population to 45.8 percent, and “to 46.6 percent when we assumed that all children would be enrolled in private dental coverage.” Researchers estimate the number of total visits to be 334 million under this projection. Driving these projections, researchers write, is the fact that the future elderly are likely to have better oral health as a result of wider access to fluoride and preventative care in their younger years.

The study concludes that even though an increase in dental care is expected, the findings reflect a “lost opportunity,” in that the ACA didn’t “include a dental benefit in Medicare” or “add adult dental benefits to Medicaid in all states.”

Researchers say that by 2026, 47 percent of Americans will visit the dentist. That's an estimated 334 million visits.

Study Estimates Increased Dental Visits in U.S. through 2026

explores methods of delivering better oral health care to a traditionally underserved portion of the population — senior citizens.

The article, titled “Seeking Dental Care for Older Americans,” explores two options: expanding dental coverage under Medicare and changing how care is delivered via the virtual dental home model.

Advocates for expanding Medicare to include more dental coverage have taken the approach of pointing out the oral health, whole-body health connection, the article says. Traditionally, the government has seen a cavity as simply “a hole in the tooth,” the article notes, but it’s actually a bacterial infection that can have severe health complications in geriatric patients. If that bacterial infection spreads from the mouth to the bloodstream, a cavity can become a serious, potentially antibiotic-resistant infection.

Similarly, the article notes, seniors tend to take multiple medications, such as cancer and rheumatoid arthritis medications. Both can suppress the immune system, meaning a cavity can spiral into a much larger health issue.

Currently, Medicare only offers dental coverage in a few instances, the article says, such as “prior to a kidney transplant to rule out any problems that might complicate the outcome,” or “medically necessary” dental care. This can include “services related to surgery on the jaw or other covered procedure, and tooth extraction in preparation for radiation treatment for cancers of the jaw.”

Medicaid, the article notes, isn’t much more helpful either. Not all Medicare beneficiaries qualify, the article says, and even if seniors do, their state might not offer dental coverage. In 2015, only 18 states offered dental coverage, the article says. These states “provided coverage only for emergency extractions.” Thirty-three states “provided one or more services including preventive, restorative or periodontal care.”

If amending Medicare to include dental coverage isn’t a viable option, the article says, perhaps relying on unconventional methods of delivering dental care is. The article highlights the success of the 

, which is administered by the University of the Pacific in San Francisco.

Using this care model, hygienists will visit senior patients in nursing homes where they’ll use portable diagnostic and telemedicine tools. After conducting an examination, cleanings and some basic interventions, the hygienists will send diagnostic information to a dentist to review.

This method would require states to legislate what services hygienists can provide. In California, they are able to decide on appropriate X rays and “provide interim therapeutic restorations to address small cavities without local anesthesia in consultation with a dentist.”

An article in the most recent issue of Health Affairs explores two options for expanding access to oral health care for senior citizens: expanding coverage under Medicare and the virtual dental home model.