Sarah Handzel, BSN, RN

, the American Dental Association (ADA) has asked that the administration consider several oral healthcare reforms in 2017 that could affect the dental profession nationwide. The letter is a result of the Association’s belief that “in too many cases unnecessary federal regulations contribute to the cost of providing care making it more difficult for our members to deliver oral health care services at an affordable price.”

In the letter, the ADA requested that the administration review several current health care regulations that, they suggest, must be rescinded or amended to lessen the adverse impact and burden on dental professionals and their patients. Several health care regulations were highlighted in the letter, and recommendations for improvement from the ADA were 

 — Dentists that do not participate in Medicare should be exempt from the Medicare Ordering and Referring requirements.

 — Dentists and other health care professionals who do not participate in Medicare should be excluded from Medicare Part D enrollment requirements.

 — The ADA recommends Section 1557 simply be enforced as is by the Office of Civil Rights without the formal publication of regulations. Section 1557 pertains to nondiscrimination in health care environments. If this regulation is not rescinded, the ADA recommends an exemption for small businesses with less than 25 employees.

Requirement for providers participating in Medicare Advantage Programs to enroll in Medicare

 — Recommendations from the ADA include full repeal of this regulation to ensure providers of covered services in Medicare Advantage plans may continue to treat patients who choose to use their services, even if they are out-of-network providers.

Substance Abuse and Mental Health Services Administration

 — In response to a proposed expansion of regulations to cover health care practices providing substance abuse disorder diagnoses, treatments, or referrals, the ADA is asking the incoming administration to exempt dental practices from this requirement if a full repeal of this rule is impossible.

The ADA concluded the letter by saying the organization “is looking forward to working with the Trump Administration on a great many issues affecting oral health care in America.” 

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In too many cases unnecessary federal regulations contribute to the cost of providing care making it more difficult for our members to deliver oral health care services at an affordable price, the American Dental Association wrote in a letter to the Trump administration.

ADA Asks Trump to Consider Reforms in 2017

Three European Union institutions (the European Parliament, European Commission and the Council of the European Union) have agreed to 

 on dental amalgam fillings use in children under 15 years old and in pregnant and breastfeeding women. The ban takes effect on July 1, 2018.

The ban comes after interest groups across Europe called for the discontinuation of the use of mercury-containing amalgams, which have come under increased scrutiny in Europe and the United States. The amalgams have been condemned as a risk for “secondary poisoning” by a European Commission scientific advisory board due to its presence in several fish species many people consume.

Currently, Europe is the largest user of dental amalgam globally. Support for the ban came from input from dentists, consumers, and health and environmental non-government organizations.

While the ban on mercury-containing dental amalgams has been adopted by these institutions, it must also be approved by the European Parliament and Council to take full effect. Each member state in the European Union will also be required to develop a national plan for reducing amalgam use. These actions are part of a larger push to implement a plan set forth by the 

, which recognizes the heavy metal as a danger to human health and the environment.

Representatives from several European interest groups expressed support and enthusiasm for the EU ban on amalgam use. One representative from the Health and Environmental Alliance, Genon Jensen, said, “This partial ban on dental amalgams is excellent news, especially for children’s health. It will not only help protect the health of mothers and children but also contribute to reducing everyone’s environmental exposure to mercury. Several Member States either disallow amalgam use or have already reduced it to less than 10 percent of all dental fillings. We hope each Member State will now take seriously its duty to reduce amalgam use for everyone.”

While support for the EU ban on dental amalgam has taken root in Europe, the United States is also taking steps to limit mercury exposure and reduce the amount of mercury released into the environment. 

As Dentist’s Money Digest previously reported

, the Environmental Protection Agency (EPA) has recently adopted a new federal regulation requiring dental offices, schools, and clinics to use amalgam separators in their treatment areas. This will help prevent mercury from entering sewage treatment plants, and the amalgam can be collected and recycled. 

The ban comes after interest groups across Europe called for the discontinuation of the use of mercury-containing amalgams, which have come under increased scrutiny in Europe and the United States.

EU Bans Dental Amalgam Use in Children, Pregnant and Breastfeeding Women

The American Dental Association (ADA) House of Delegates passed Resolution 64H-2016 last year in October. The new resolution addresses the use of opioids in the treatment of dental pain and 

 has been following the dental community’s response to the growing opioid crisis for some time. In in an effort to reduce rates of opioid abuse in America, the ADA has committed to tackling the problem head-on. The new resolution encourages a dialogue between dentists and their patients if opioids are being considered as a treatment option. Dentists should speak to patients about their responsibility in preventing the “misuse, abuse, storage, and disposal of prescription opioids.” Further, dentists are advised to register with and faithfully use a prescription drug monitoring program.

In addition to a candid conversation about responsible opioid use, the ADA now also recommends that:

· Dentists conduct a thorough medical and dental history with each patient to determine the use of current medications, evaluate for potential drug interactions, and identify a history of substance abuse.

· Dentists should also regularly review and follow Centers for Disease Control and Prevention (CDC) and state licensing board recommendations for prescribing opioids.

· In determining treatment, dentists are advised to find treatment options based on best practices to prevent any worsening or relapse of opioid abuse.

· If appropriate, dentists should consider nonsteroidal anti-inflammatory medications as a first-line therapeutic intervention for acute pain management.

· Dentists should identify and use multimodal pain strategies for acute postoperative pain management instead of prescribing opioid analgesics.

· Dentists should coordinate care with other doctors, including pain management specialists, if appropriate when prescribing opioids for chronic pain conditions.

· Dentists should continually educate themselves regarding addictive behaviors and disease and pain management related to opioid prescribing.

Finally, the ADA included a statement supporting dentists and responsible, professional prescribing of opioid medications in their practices: “Dentists who are practicing in good faith and who use professional judgment regarding the prescription of opioids for the treatment of pain should not be held responsible for the willful and deceptive behavior of patients who successfully obtain opioids for non-dental purposes.”

The new resolution encourages a dialogue between dentists and their patients if opioids are being considered as a treatment option.

New Policy on Opioids Adopted by ADA

A new method of stimulating natural tooth repair is under investigation by scientists at 

. If further testing proves successful, this new treatment method could transform the way dental treatments for large cavities are performed.

In an article published in Scientific Reports

, researchers showed a way to stimulate new dentin growth following infection or trauma involving the use of stem cells contained in a tooth’s pulp. The stem cells were used to help repair damage from large cavities, which are typically treated using man-made cements or fillings.

Stimulation of the stem cells was catalyzed through the use of 

 to treat neurological disorders like Alzheimer’s disease. The research team applied low doses of the drug to teeth through the use of a biodegradable collagen sponge. Over time, the sponge degraded and was replaced by new dentin. For the teeth involved in the study, complete, natural repair was achieved.

The scientists noted that this method of repairing teeth was simple and fast, and it could lead to a new approach in tooth restoration. Lead author of the study, Professor Paul Sharpe, 

, “The simplicity of our approach makes it ideal as a clinical dental product for the natural treatment of large cavities, by providing both pulp protection and restoring dentin. In addition, using a drug that has already been tested in clinical trials for Alzheimer's disease provides a real opportunity to get this dental treatment quickly into clinics.”

In healthy individuals, a thin band of dentin is naturally produced in response to injury in order to seal the tooth pulp. However, the dentin band cannot effectively repair large holes in teeth that might be the result of trauma or severe infection. The use of contemporary therapeutic interventions, like cements, means that larger cavities and holes in teeth are never fully restored because the mineral level of the tooth cannot be returned to pre-injury levels. Further, fillings occasionally fail and infections spread, and dentists have to perform additional work to fill in an area that is larger than the original problem. Ultimately, the tooth might have to be extracted. 

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.

Alzheimer's Drug Could Change How Dentists Treat Large Cavities

It’s a common tradition that’s apparently shared by people worldwide: Having cake, or other sweet treats, to celebrate events and milestones at the office. However, dentists in Great Britain are pushing for a change to this tradition and are calling for an end to “workplace cake culture.” In light of the current health problems affecting citizens of the United States, this call to action could take root right here at home.

, Professor Nigel Hunt, dean of faculty at the Royal College of Surgeons, said that office parties involving lots of sweets could be the result of managers wanting to reward staff, colleagues celebrating the holidays or other life events, and people bringing presents into the office, especially after the New Year. However, Hunt also noted that such treats are ultimately detrimental to employees’ health, suggesting that offices country-wide make a New Year’s resolution to fight cake culture in 2017.

“While these sweet treats might be well meaning, they are also contributing to the current obesity epidemic and poor oral health,” said Hunt. He also added, “We need a culture change in offices and other workplaces that encourages healthy eating and helps workers avoid caving in to sweet temptations such as cakes, sweets and biscuits."

Unsurprisingly, there has already been pushback from people who want their cake and want to eat it too. British citizens have said that there’s nothing wrong with a little cake, that some cake occasionally won’t kill anybody, and that this call from dentists is an example of the “nanny state” trying to shape citizens’ lives when it isn’t necessary.

The Faculty of Dental Surgery has released a list of suggestions for cutting sugar out of the workplace, including:

Avoiding snacks and keeping sugar as a lunchtime treat

Establishing a “sugar schedule” to keep track of and limit intake

This call to action isn’t the first step in the fight against excessive sugar consumption. In addition to dentist’s recommendations, the government of England plans to begin charging a fee to makers and importers of soft drinks containing more than a set amount of sugar in 2018. 

Similar taxes on sugary drinks have already been adopted by several cities across the United States.

 Indeed, support for sugar-limiting measures is increasing worldwide as rates of obesity hit epidemic proportions in both children and adults. 

Dentists in Great Britain are pushing for a change to this tradition and are calling for an end to workplace cake culture.

The End of Cake in the Office? British Dentists Want to Stop Tradition

Dentists, it’s that time of year again — tax season. The holidays are over and you’re ready to face the New Year with new business goals in place to help your practice succeed. Part of your success needs to include your strategy for dealing with the IRS. If you have a plan in place, you can be sure to maximize your deductions and reduce the amount you might owe.

Lowering your tax bill as a small business owner means finding and taking advantage of all the hidden opportunities to save that are provided by the United States tax code. Missing these opportunities can cost you thousands of dollars, but there’s hope. Check out this list of deductions you can take to cut down your tax bill in April.

Many dentists don’t realize how much money they can save on taxes by squirreling away money into retirement accounts. There are several retirement accounts you can contribute to, each with different tax implications.

Individual retirement accounts (IRAs) allow you to contribute a specific amount of money each year toward your retirement. In 2016, the amount was $5,500 for anyone under the age of 50. If you have a traditional IRA, you can deduct the amount you contributed during the tax year you made those contributions. This does make your retirement distribution taxable when you decide to take it.

Conversely, if you contribute money to a Roth IRA, you’re essentially putting “after-tax” dollars into your retirement. This means that contributions made to a Roth IRA are 

 taxable when you take a distribution. There is a limit to the amount of money you can contribute to Roth IRA, which is based on your income. However, it might be possible to invest in a “backdoor” Roth IRA — in this scenario, you put money into a traditional IRA and then roll it over into a Roth IRA. You should check with a CPA in your state to see if this strategy could work for you.

Additionally, if you contribute to a 401(k) plan, you should be sure you’re contributing enough money each year. For 2016, the maximum amount of cash you could put into this type of account was $18,000 — you can then roll your money into either a traditional or Roth IRA. However, you need to be aware of the 10 percent penalty you’ll face if you choose to withdraw funds from your 401(k) early. Most 401(k) plans don’t let you withdraw funds until you’re at least 59.5 years old.

It might seem obvious, but many dentists miss out on tax deductions associated with running a business simply because they don’t realize what’s deductible and what isn’t. There are a surprising number of things you can deduct from your taxes as long as they are expenses that occur in the course of doing business. For instance, if you travel often, you can deduct travel expenses like flights or car rentals, meals, and accommodations. Office supplies, dental equipment purchases, communications expenses, and licensing or board exam fees can all be written off. Expenses associated with taking continuing education courses can be tax deductible as well. If you own your business, you can probably take many deductions like this. Even paying the employer portion of your own payroll taxes is deductible!

Health Insurance and Health Savings Accounts (HSAs)

It’s no secret that paying for health insurance can be very, very expensive. As a self-employed dentist, you can write off your health insurance premiums as a business expense incurred throughout the year. Many dentists choose to fully fund a HSA as a way to use tax-free money to pay for healthcare-related expenses before you’ve met your deductible. HSA contributions are deducted from your total gross income, and you don’t have to itemize this expense. Any earnings on an HSA are also tax-free.

Contributions to a HSA are tax deductible, but you do have to meet certain requirements to be able to deposit funds into one of these accounts. Your health insurance plan must be a qualified high deductible plan, and you can’t have any additional health care coverage. You also can’t be a dependent or be enrolled in any type of Medicare program.

Dentists tend to be charitable people. For tax purposes, any donations you make to qualified charities are deductible. If you donate large items to a charity, like a car or a boat, you can probably deduct that too. Even smaller donations, like bags of used clothing, can be written off if you keep track of the value of the items you’re donating. Further, the miles you put on your car driving to and from charity events can be deducted, as can any other expenses you incur while donating your time and efforts to the charity of your choice. 

Lowering your tax bill as a small business owner means finding and taking advantage of all the hidden opportunities to save that are provided by the United States tax code.

Trying to Lower Your Tax Bill? These 4 Deductions Might Help

As dental and medical care move toward a more patient-centered, precision-based model, you might have already noticed your patients expecting a more personal relationship with you when they visit your office. It isn’t enough to simply treat a patient anymore — now, patients and healthcare consumers assume that you will take a more intimate, personalized approach toward addressing their dental needs.

The key to being successful with this growing trend is all about developing authentic, positive patient relationships. By demonstrating to your patients that you value them as people, you build trust in your relationship with them and make it easier to provide more effective treatment. In turn, you might find that your patients refer their family and friends to your practice, driving growth and generating more revenue for you. How, then, do you grow your practice with a model of patient care based off exclusivity? Read on for some tips.

Start with the Right Communication Tactics

If you want to build trust and rapport with your patients, whether they’re new to your practice or not, you have to be mindful of how you communicate with them. It’s not just verbal communication that can sink your relationship — being aware of your body language is also important.

Some common guidelines for effective communication include:

· Greeting your patients in a warm, friendly manner at the beginning of every appointment.

· Sitting down when speaking with patients. Standing puts you in a dominant, assertive position and might prevent your patient from feeling comfortable with you.

· Listening to your patient without interrupting.

· Responding to patient concerns with empathy.

It might take some practice to adopt some of these habits. For instance, you might find it difficult to listen to your patients for a few minutes before you get started with the appointment. However, your patient needs to be able to fully explain what’s going on. If you let them, you’ll probably gather all the information you need. It’s ok to interrupt if you need to refocus, but try to let them talk as much as possible before you speak.

It only takes a few minutes to be friendly. When you greet your patient, ask about their family or work, depending on information they’ve already shared with you. If you show you have an interest in their lives outside of the dentist-patient relationship, it makes you more approachable and encourages the patient to open up to you. At first, it might seem like conversations unrelated to dentistry might be a waste of time, but these types of interactions are actually the basis of a strong relationship. This, in turn, can lead to a loyal, long-lasting patient who might refer others to you simply based off your approachability.

In addition to being friendly, take the time to explain the unique benefits of visiting your office. Maybe you’ve been trained in a certain procedure that no one else in your area can do, and you have a patient that would benefit from it. You might also share how your dental practice focuses on patient education — then, show your patient the equipment you’ll use during their procedure before you begin your work. How you highlight your practice and skills is up to you, but if you take the time to explain your particular value to your patients, you will strengthen the connections you have.

Help Your Patients Feel Involved and Appreciated

Depending on their reasons for seeking care, your patient might have a variety of treatment options available to them. Beyond merely suggesting the best treatment, go over each appropriate option with your patient in detail. Providing in-depth patient education assures your patient will feel they are a part of the decision-making process. Instead of treatment being dictated by a dentist, patients want to feel like they have some input in their dental care decisions. They will be more likely to follow treatment recommendations and adhere to follow-up appointment schedules if they know you are concerned about their thoughts on their condition and treatment. Since they are ultimately responsible for their own health, you might also find you have better compliance rates and a more engaged patient population if you can get your patients to see that you value them as a team member in their dental care.

It's also nice to add a personal touch after an appointment. After all, the relationship with your patient doesn’t end when they leave your office — if anything, you need to ensure that you strengthen the bond you have with them so that they are motivated to return. Showing your appreciation for their business can take many forms, but it doesn’t have to be complicated. Adding patients to your online newsletter, or taking the time to mail thank you postcards helps you stay connected long the appointment. Simple, personal touches like this can help increase the odds they will return again in the future and remember to refer their friends and family to your practice.

Building authentic relationships with your patients doesn’t have to be hard. Simple techniques can help shift your practice mindset to a more personal, patient-centric model of care. You’re probably already doing some things to show your appreciation to your patients — taking it a step or two further in 2017 can strengthen your reputation as a dental professional that truly cares about the people you serve while driving more patients to your practice. 

By demonstrating to your patients that you value them as people, you build trust in your relationship with them and make it easier to provide more effective treatment.

Building Relationships Key to Growing Your Practice in 2017

 has forecast the global dental imaging market to grow by a compounded annual growth rate (CAGR) of 8.5 percent, becoming a $2.4 billion industry by 2024. 

 predicted even more growth, with the imaging market expected to grow by a CAGR of more than 12 percent, according to their forecast models.

Over the past decade, the dental imaging market has grown significantly as the prevalence of oral diseases worldwide has increased. Other factors contributing to previous growth include an expanded focus and awareness of oral health, and a push for more educational efforts targeted to consumers who want to prevent oral health issues.

The growth of the market through 2024 can be attributed to an upsurge in the number of periodontitis and dental caries cases, the upsurge in the cosmetic dentistry sector, technological advances in imaging equipment, and certain demographic factors, like a growing geriatric population that is more susceptible to oral-health problems.

Additionally, the increased demand for radiographic diagnostic procedures is helping to drive market growth. Tooth decay and caries have already been identified as a common worldwide cause of oral disease affecting children and adults. Increased diagnosis of these two problems is helping to drive the expansion of the imaging market as dentists use radiologic equipment to carry out diagnostic, preventative, and routine oral checkups.

The United States is expected to lead the growth of the market, since a shift toward the incorporation of digital imaging systems, instead of analog imaging systems, in clinical practice is already occurring throughout the country. Analog systems are typically used by more experienced dentists and include systems that utilize cassettes, film and an intensifying screen.

However, as more dentists recognize the speed and simplicity that digital imaging systems offer, more practitioners are transitioning away from analog systems in favor of their digital counterparts. The government is also taking steps to encourage the use of digital systems. According to the report, a 20 percent reduction in Medicare reimbursement is scheduled to begin in 2017 for medical tests that make use of analog X-ray systems. 

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

Significant Growth Predicted for Dental Imaging Market Through 2024

Dental implants fail for a variety of reasons. The most common tends to be infections in the oral cavity. In an effort to increase the success of dental implants, scientists at the UPV/EHU-University of Basque Country are 

working to develop new dental implant coatings with antibacterial properties.

One of the researchers on the project, Beatriz Palla, said “about 10 percent of implants have to be removed due to osseointegration problems or to the onset of infections.” This figure has spurred the search for implant surfaces capable of preventing bacterial colonization and adhesion in the area surrounding the implant. However, several key challenges stand in the way, including the difficulty of providing titanium implant surfaces with antibacterial properties and the significant resistance bacteria have to conventional antibiotic therapies.

In the process of developing new antibacterial coatings, the research group at the University found success with sol-gel synthesis. This method of developing a coating uses a precursor solution (sol) that, when left on its own for a certain period of time, turns into a gel. The gel is then used to coat titanium screw surfaces and is next subjected to a heat treatment to firmly adhere the gel to the screw.

In this case, the precursor solution was silica, which has already been shown to be osteoinductive in many studies. The researchers then added various antibacterial agents to the gel.

In total, three different types of coatings were developed for testing, each different based on their antibacterial properties. However, each coating had a mechanism for dealing with bacterial infections, ranging from bacterial prophylaxis to eliminating a colony once it was established on the coating. One of the coatings, for now a trade secret, was designed to be used 

 during dental procedures on infected screws so that there was no need to remove the implant from the patient’s mouth.

Since initial results from tests with the three types of coatings were viewed as a success, Palla believes that “it is possible to confirm that coatings with an antibacterial capability and which do not affect the proper integration of the implant into the jawbone have been developed. Apart from all the trials that remain to be carried out, it would also be advisable to pursue the research a little further to optimize the results more."

In an effort to increase the success of dental implants, scientists at the UPV/EHU-University of Basque Country are working to develop new dental implant coatings with antibacterial properties.

Coatings with Antibacterial Properties Being Designed for Dental Implants

For years, oral health has been defined as the absence of disease. Now, the American Dental Association (ADA) has adopted a new, more comprehensive definition.

The revision was initially proposed by the FDI Dental World Federation General Assembly. The FDI Dental World Federation is the principle representative body for more than one million dentists worldwide. The Federation works to develop health policy, educational opportunities, and works to advocate for dentists and patients globally.

According to FDI Dental World Federation, the 

“multi-faceted and includes the ability to speak, smile, smell, taste, touch, chew, swallow and convey a range of emotions through facial expressions with confidence and without pain, discomfort and disease of the craniofacial complex.” Further, the definition also includes several attributes:

· Oral health is a fundamental component of health and physical and mental well-being. It exists along a continuum influenced by the values and attitudes of individuals and communities.

· Oral health reflects the physiological, social and psychological attributes that are essential to the quality of life.

· Oral health is influenced by the individual’s changing experiences, perceptions, expectations, and ability to adapt to circumstances.

More than 200 national dental organizations, including the ADA, have accepted and adopted the new definition of oral health. 

In an editorial published in the Journal of the American Dental Association (JADA)

, a change in the definition was hailed as an opportunity for the dental profession to reflect on what oral health encompasses. It was also viewed as a reason for the profession to examine the implications of the new definition in regard to clinical practice and oral health policy.

As the authors of the editorial said, “A definition was needed that included the full scope of health and wellbeing and, ultimately, one that could be agreed on by all. A common definition can bring stakeholders together to advocate for the importance of oral health; to influence and shape parameters of care, health policies, research, education, and reimbursement models; and to shape the future of our profession.”

Further, the authors wrote that the new definition echoes definitions already in use by the World Health Organization (WHO), moves dentistry from a treatment approach to providing preventative care and support for oral health, uses language already commonly used in healthcare, and raises awareness of the different aspects of oral health that are all embedded in the wider framework of overall good health.

According to FDI Dental World Federation, the new definition of oral health is multi-faceted and includes the ability to speak, smile, smell, taste, touch, chew, swallow, and convey a range of emotions through facial expressions with confidence and without pain, discomfort, and disease of the craniofacial complex.