Sarah Handzel, BSN, RN

As we begin the New Year, it’s common to focus on aspects of our lives we’d like to change. Maybe you’ve made a resolution to get to the gym more often, or you want to take up a new hobby you’ve been thinking about for a while. But what about your career? Are there any aspects of your dental practice that you’d like to focus on improving in 2017? While you’re thinking about resolutions for your personal life, why not decide on some professional New Year’s resolutions that can help you improve yourself as a dentist and business owner.

Up until now, you may have taken a hands-on approach to running your dental practice. Beyond providing treatment, are you also overseeing the accounting for your business? Do you take part in the hiring (and firing) of employees? Do you help to make out a work schedule for everyone in your practice? If you’re interested in taking your practice to the next level, it might be helpful to delegate some of the non-clinical tasks to certain employees. Being pulled in too many directions at once makes it easy to lose your focus, and things inevitably start to slip through the cracks. Let someone else sweat the small stuff so you can target your efforts on providing the best patient care possible.

Remove a negative influence from your professional life.

We all have at least one professional commitment that’s a drain on our time and resources. Admit it — there’s something related to your dental practice that gives you a headache just thinking about it. If you can, try to limit your exposure or remove this influence from your professional life entirely. Getting this negativity out of your life lets you start the New Year with a fresh, positive perspective.

Set time aside to “clean up” your practice.

It’s easy to let things get out of hand, especially if your practice is hopping with patients. Set some time aside early in the new year to clean off your desk, wrap up loose ends, and develop better business processes that help your practice run more smoothly. If you can try to make your business neat and tidy, you should be able to breathe easier and not feel so stressed and overwhelmed. You could also try to set aside some time at the end of each day to answer emails and tidy up your office. You’d be amazed at how much better you’ll feel with a neat, organized area in which to work.

Your commitments outside of work might be causing extra stress, but it’s easy to get a handle on them if you ask for help. Whatever your commitments, ask your colleagues to see if there’s anything you can do to make life easier for everyone. Maybe you could work through lunch a few days a week if you need to leave a little early to check on an elderly parent. Also, commit to helping others when you see they need a hand. Could you cover another dentist’s lunch while they run out for an hour? Would you be able to switch shifts with co-worker if they need to handle something at their child’s school? By helping others, you can make your life more fulfilled and your practice a more positive place in which to work. It’s a win-win for everyone.

An effective team is a well-informed team. It’s important to clearly communicate the direction in which you’d like your business to grow, and the ways in which you’d like to achieve your professional goals. Try setting some time each week where your employees can all come together to discuss concerns, successes, and goals for the practice. Keeping an open-door policy helps your team feel like they are valued, and that all achievements are a part of the big picture in your practice.

This may be a resolution you’ve made in the past, but you’ve never quite been able to step away from your practice for too long. Keep in mind that there are only so many hours in the day, and there is never going to be the perfect time to take a break. However, it’s important to stop working and recharge — breaks increase productivity and positivity while reducing rates of burnout. Try planning out breaks or vacations in order to achieve better balance between your professional life and your personal life. We all only get a brief period of time in which to live our lives … it’s important not to let your whole life pass you by.

Do you want to learn a new treatment technique that will allow you to offer more services to patients? Perhaps you want to expand your business to include a few new locations? Would you like to guest lecture at your local dental school? Whatever your professional goals are for 2017, think about the steps you need to achieve those goals and then make a plan to do so. Big, life-changing goals take planning, but smaller, more easily accomplishable goals can be easily achieved with small steps.  

Articles

While you're thinking about resolutions for your personal life, why not decide on some professional New Year's resolutions that can help you improve yourself as a dentist and business owner.

7 Professional Resolutions for the New Year

In an effort to curb the amount of mercury released into the environment, the United States Environmental Protection Agency has adopted a 

 that requires all dental offices, clinics, and schools to purchase and use dental amalgam separators in their treatment areas. The new rule includes reasonable exemptions and a phase-in period, as well as considerations for dental practices that already have such systems installed.

	According to the EPA, this rule was adopted to prevent mercury from entering municipal sewage treatment plants, otherwise known as publicly owned treatment works (POTWs). Dental offices have been identified as the primary source of mercury discharges into POTWs, since they regularly dispose of mercury and other metals that typically make up dental amalgams. By requiring the use of dental amalgam separators, the amalgam itself can be recycled after collection. 

 that each dental amalgam separator will cost dental offices an average of $800 per year. Compliance with the new rule is expected to reduce the discharge of all metals into POTWs by at least 10.2 tons every year. About half of that amount is made up of mercury. The projected annual cost will be around $59 — 61 million. 

	The new rule does not apply to mobile dentistry units or to offices where only the following specialty dentistry is performed: oral pathology, oral and maxillofacial radiology, oral and maxillofacial surgery, orthodontics, periodontics, and prosthodontics.

In a statement released by the American Dental Association (ADA)

, President Gary L. Roberts, DDS, notes, “We believe this new rule -- which is a federal standard -- is preferable to a patchwork of rules and regulations across various states and localities.”

	“The ADA is in the process of reviewing the rule and background statement in detail, which is more than 90 pages in length, in order to develop practical resources which will be posted on 

 to aid member dentists with questions they may have regarding compliance. In addition, ADA’s Business Resources has partnered with HealthFirst, a vendor that offers ADA member dentists special pricing on an amalgam separator device that will meet the federal regulatory requirements along with recycling services,” writes Roberts.

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.

New Mercury Ruling: Dental Offices Must Comply with EPA Regulation

The evidence supporting the importance of good dental practices continues to grow as more research shows just how critical oral health is to the rest of the body. 

A new study published in Science Translational Medicine

 has shown that bacteria commonly connected with periodontal infections might also be responsible for more serious autoimmune diseases like rheumatoid arthritis (RA).

	The study was carried out by investigators at Johns Hopkins University after other findings implied that mucosal surfaces are the sites where diseases like rheumatoid arthritis typically begin. Since many RA patients also have periodontal dysbiosis, or an imbalance in the bacterial flora in the mouth, the investigative team hypothesized that this imbalance might trigger the production of disease-specific autoantibodies and arthritis in those individuals that are already susceptible.

	For the study, the team used mass spectrometry to identify the bacterial composition of gingival crevicular fluid in two groups of patients — one with preexisting periodontal disease and another, healthy control group. A certain type of autoantigen was present in the periodontitis samples that has also been identified as the primary immune target in cases of RA. 

	The link was further strengthened after the team found this autoantigen in rheumatic joints, leading to the conclusion that the gingiva is the site of initiation in RA pathogenesis. Additionally, the investigators were able to identify a certain bacterial species, Aggregatibacter actinomycetemcomitans (Aa), as a common pathogen in the periodontitis samples. This bacterium induces hypercitrullination in neutrophils, mimicking the pathways by which inflammation and damage occurs in RA joints. 

	Exposure to Aa was confirmed in RA patients included in the study. However, not all of the study participants with RA were exposed to Aa, indicating that there may be other bacteria located elsewhere in the body that could be responsible for inducing this type of inflammation.

Centers for Disease Control and Prevention estimated that there were 1.5 million individuals living with RA in the United States

. Typical treatments include antirheumatic drugs, steroids, and treatments such as physical therapy. However, evidence such as this could lead to the development of new, more effective treatments targeting the bacterial factors causing diseases like RA.

The study was carried out by investigators at Johns Hopkins University after other findings implied that mucosal surfaces are the sites where diseases like rheumatoid arthritis typically begin. 

Bacteria Responsible for Periodontal Disease Might Also Cause Rheumatoid Arthritis

In 2014, Kentucky’s Medicaid program was expanded and access to adult dental coverage was increased for millions. However, the program’s growth has brought to light the problem of access to treatment. It has now been found that, since the program’s expansion, more people have used emergency departments (EDs) for treatment of their dental conditions than before the program went into effect.

In a new study published by Health Affairs

, it was shown that many patients who enrolled in the Medicaid expansion program used local EDs for a variety of dental issues, many of which could have been prevented. The study authors used data from several state sources, and found evidence of significant problems that only arose after the Medicaid expansion took effect:

· Among adults who enrolled, the proportion who were discharged from EDs for dental or oral health conditions that could have been prevented with access to primary dental healthcare services rose from 22 percent in 2010 to 33 percent in 2014.

· The number of adults enrolled in the program who were discharged from EDs with dental or oral health conditions increased from 6,328 in 2013 to 18,844 in 2014.

· The number of discharges for uninsured adults fell, from 20,453 in 2013 to 7,796 in 2014.

· Medicaid enrollees who were discharged from an ED with a dental or oral health condition in addition to another chronic comorbid condition, like diabetes, increased from 41 percent in 2010 to 51 percent in 2014.

· In 2014, inflation-adjusted costs for ED discharges for Medicaid enrolled adults with dental or oral health conditions increased by over $4.2 million, or 219 percent.

After the expansion of the Medicaid program, the study authors found that the adults who enrolled were in poorer dental and general health when compared to previously covered adults. This was attributed to these adults facing greater challenges when attempting to access dental care. In fact, the research found that there was a great effort in Kentucky to help Medicaid enrollees understand their benefits and connect them with primary healthcare providers, but the same type of effort did not exist for the dental coverage portion of the plan.

As one of the study authors, Dr. Jane Grover, director of the Council on Advocacy for Access and Prevention at the American Dental Association (ADA), 

, “In a state where — according to the ADA's Health Policy Institute – 1 in 5 low-income adults said their mouth and teeth were in poor condition, this increased use of EDs for dental care likely stems from unmet oral health needs that can also greatly affect overall health. While expanding coverage is an important first step in improving health outcomes, our findings suggest that this must be paired with appropriate support to increase opportunities for beneficiaries to more easily access the right dental care from the right provider.” 

In a new study published by Health Affairs, it was shown that many patients who enrolled in the Medicaid expansion program used local emergency departments for a variety of dental issues, many of which could have been prevented.

Emergency Department Visits for Dental Conditions Increase After Kentucky Medicaid Expansion

 has examined the nationwide shortage of minority dentists, who represent a smaller percentage of the dental workforce than previously reported. Minority dentists are also distributed unevenly in relation to minority populations within the United States, according to the study.

The study authors found that African Americans, Hispanics or Latinos, and American Indians or Alaska Natives within the country are disproportionately underrepresented in the dental field. The study showed that for parity, as many as 53,753 minority dentists are needed nationwide. This calculation is based off data collected from a 2012 national sample survey of underrepresented minority dentists.

In the 2012 survey, the minority dentists’ practice patterns were also examined in relation to the attributes of members of their surrounding communities. The researchers found that members of minority groups made up larger portions of minority dentists’ patients within these communities. In comparison to counties where there were no underrepresented minority dentists, counties with one or more minority dentists were more racially diverse and affluent. However, these same counties were also more unequal economically and socially.

The lead author of the study, Elizabeth Mertz, PhD, MA, 

, “We found a daunting shortage of underrepresented minority dentists, which indicates that the cumulative impact of current policy efforts to increase workforce diversity is woefully inadequate — despite initiatives at the local, state and federal level. Dentists who want to serve high-need communities may be unable to do so, given the current economics of the dental practice environment and the lack of oral health parity.”

The study results indicate a need for policy improvements that enhance the diversity of the dental workforce. Recommendations include the development of a longer, more comprehensive and sustained educational pipeline for minority students, better systems of care, and an absolute culture of inclusion within the dental community. As evidence has already shown, improvements to workforce diversity promote social justice and help to increase access to and quality of health and dental care to minority patients.

“Dentistry policymakers are aware of current issues related to underrepresented minority dentists. However, the underlying problem is not a lack of vision or options but rather a lack of political will and resources to implement change,” writes Mertz.

The study authors found that African Americans, Hispanics or Latinos, and American Indians or Alaska Natives within the country are disproportionately underrepresented in the dental field.

Study Identifies Nationwide Shortage of Minority Dentists

, up to 7.4 percent of adults in the United States are living with asthma, a chronic inflammatory condition characterized by spasms and swelling of the airways. The number of children suffering from the condition is estimated at 8.6 percent of the population. Asthma patients are often prescribed either a metered dose inhaler or a dry powder inhaler, but the use of these drugs often has an unintended side effect: dental erosion and dentin hypersensitivity.

To better examine the impact these types of medications have on asthmatic patients’ teeth, 

researchers at the University of Medical Sciences and Technology, Sudan began a study

 to measure the severity of dental erosion among adults with asthma. The study was arranged according to gender as well as by the type and duration of asthma medication used. Participants in the study were selected from a pool of patients admitted to a short-stay unit in a hospital following an acute asthma attack.

The research team presented each patient with a structured interview-based questionnaire that included questions about each person’s demographic data and medical history. Measurement of dental erosion was carried out using the 

. The patients were also tested for dentin sensitivity using a 

 to capture the intensity of their feelings along with sensations like pain, which cannot be measured directly. Patients were asked to rate their perception of pain after retaining ice water in their mouths for 20 seconds.

When the results were analyzed, it was found that asthmatic patients had a higher degree of dental erosion compared to non-asthmatic patients, but there was no significant relationship found between dental erosion and gender or the type of inhaler each patient used. The asthmatic patients were also found to have a higher degree of dentin sensitivity compared to non-asthmatics.

Since the number of people living with asthma has grown in the last century, it is important for dentists to remain alert when examining and treating these patients. Dental vigilance is important for the reduction and prevention of dental erosion. Treatment should include appropriate referrals to dental professionals and patient education regarding proper oral healthcare techniques. 

When the results were analyzed, it was found that asthmatic patients had a higher degree of dental erosion compared to non-asthmatic patients, but there was no significant relationship found between dental erosion and gender or the type of inhaler each patient used.

Study Links Dental Problems to Asthma Medications

Efforts to improve the oral health of young children have been in the news frequently, and now there is a new effort underway to positively affect oral health in kids living in the U.S. and Canada. The 

 (ACFF) has recently awarded three grants totaling $50,000 to fund projects taking place in both countries, starting next year. Each grant was awarded to help the recipients reduce the number of dental caries in pediatric populations. According to ACFF, dental caries is the most common preventable chronic disease on the planet.

In the U.S., Children’s Mercy Hospital in Kansas City, Mo. was awarded a portion of the grant money to create a program aimed at improving dental referrals for children deemed at high risk for caries. The hospital plans to expand the role of a dedicated staff member to help these specific children move through the referral process and will coordinate care between the patient and providers. The organizers of the program estimate that by 2018, 80 percent of children identified as being at highest risk for caries will already have a formal dental referral completed.

This is the first time the grant program has awarded funding, and ACFF hopes the program will bring together practitioners from multiple disciplines to help underserved communities. 

, the grants focuses on specific pediatric populations in communities with high rates of caries, as well as patients living in more remote areas and low-income or special needs communities.

The ACFF is a worldwide network of dental experts who have come together to promote integrated clinical and public health action focused on stopping caries initiation and progression. Ultimately, the goal of the organization is to move toward a cavity-free future for people of all age groups. As part of their mission, the group believes that global collaborative action is needed in order to compel global leaders and stakeholders toward action in delivering caries prevention and management services in their communities.

ACFF works with a worldwide panel of dental experts and authorities in public health. The grant awards were made possible through funding by Colgate-Palmolive.

The Alliance for a Cavity-Free Future (ACFF) has recently awarded three grants totaling $50,000 to fund projects taking place in both countries, starting next year.

Kansas City Hospital Awarded Portion of Dental Grant Funding

While the fate of the Affordable Care Act is unknown, the program has already drastically improved access to medical services for many people who might otherwise not have contact with healthcare providers. However, access to dental care is covered only under a portion of the law, specifically pertaining to children on Medicaid. Dental coverage for American adults is not guaranteed. As a result, many adults have noted one common barrier they face when seeking out oral health care — affordability.

, a group of researchers set out to better understand the financial barriers preventing American adults from accessing a wide range of healthcare services, including dental care. They used data from the 2014 National Health Interview Survey, which collected information from 112,053 adults and children.

Data was also utilized from the Oral Health and Well-being Survey, conducted by the American Dental Association’s Health Policy Institute. This survey collected responses from 14,962 adults and included questions related to oral health status, dental care coverage, and barriers to receiving dental care.

The researchers found that, regardless of age, the percentage of people reporting financial barriers as a deterrent to receiving dental care was higher than in any other type of medical specialty. In the study, 12.8 percent of non-elderly adults did not receive needed dental care because of the expense. Even among non-elderly adults with private dental insurance, 5.3 percent did not receive treatment because of finances.

Income levels were also taken into account in the study, and it was shown that those people with an income below the poverty level avoided needed dental care in the previous year, ultimately because of the cost. In contrast, less than 5 percent of individuals in the highest income bracket reported financial barriers to dental care.

According to the Oral Health and Well-being Survey, finances were 2.7 percent more likely to be cited as the reason for skipping needed dental care, compared to the next most common reason. Among adults who had not been to their dentist within the past year, 59 percent reported cost as being the reason they missed appointments.

The results clearly showed that the cost of dental care is the most common and most significant factor preventing Americans from receiving the dental care they need. Since dental care for adults is not considered an essential health benefit under the country’s current health system, the authors of the study suggested policy makers rethink mandates at both the federal and state levels to help remove financial pressures from those seeking care. 

In a study recently published in Health Affairs, a group of researchers set out to better understand the financial barriers preventing American adults from accessing a wide range of healthcare services, including dental care.

More Patients Skipping Dental Care due to Cost

 is continuing to grow in healthcare as doctors seek new ways to connect with their patients. Now the practice is starting to take root in dentistry. 

As Dentist’s Money Digest previously reported

, teledentistry can mean many things, from dentists emailing X-rays to each other to the creation of 

, providing care to patients with limited access to dentists.

Even though this trend is taking off, there are still challenges to be found in the implementation of such teledentistry systems, especially when it comes to more rural populations. 

A new study published by the International Electronic Journal of Rural and Remote Health Research, Education, Practice and Policy

 examined the integration of teledentistry in Australia, where much of the population live in locations distant from dental providers.

Such studies can help dentists in the United States better understand the challenges of providing teledentistry services in their own communities. In the study, researchers were able to identify several constraints to growth regarding teledentistry practices, primarily related to individuals, community infrastructure, and the healthcare system as a whole.

Regarding individual patients, it was noted that many patients, especially in more rural areas, have poor levels of information technology (IT) literacy, and they might be resistant to using new technologies to contact their providers. There were also concerns about data security and access to dental records, as well as concerns about a decline in the quality of health information received and accuracy of diagnosis for their individual dental problems.

Many remote areas lack reliable internet access, and there are often incompatibilities between the hardware and software required to provide teledentistry services. The study also identified a lack of technical expertise and training available for the new technology. The absence of ongoing technical support was a common issue to providing services through teledentistry.

Finally, at an organizational level, it was noted that the current healthcare system was incompatible with a teledentistry model, and that there was a lack of reimbursement structure for dentists using these types of service structures. It was also found that there were no set guidelines regarding copyright, licensure, and taxation for such systems. Perhaps not surprisingly, bureaucratic difficulties contributed to the difficulty implementing such systems.

The expansion of teledentistry will require strong support from policy makers, the public, and dentists themselves if the practice is to expand throughout rural America. Changes to our technology infrastructure will be required, and regulations and laws will have to change to reflect the new way of doing business. Perhaps most important, dentists will have to show that this type of service can still result in accurate diagnoses and cost-saving treatment options for patients in order for the teledentistry to become more widely accepted and used. 

A new study published by the International Electronic Journal of Rural and Remote Health Research, Education, Practice and Policy examined the integration of teledentistry in Australia, where much of the population live in locations distant from dental providers.

As Telemedicine in Dentistry Expands, So Do the Challenges

Bite-mark identification has been used for many years to identify individuals and help convict criminals. However, increasing skepticism is calling the use and validity of this type of identification into question. 

, bite-mark identification, along with several other types of forensic science, has increasingly been shown to lack the scientific foundation needed to justify its continued use as trial evidence.

In recent years, there have been a number of individuals who have been exonerated using DNA evidence to overturn convictions made on the basis of bite-mark identification. This has resulted in increased legal and scientific scrutiny of the practice, with many believing that there is no sound basis for believing forensic dentists can identify individuals based on a bite mark alone.

, recent reviews of empirical evidence seem to have underscored the lack of reliability and legitimacy of the fundamental claims of forensic dentists to be able to identify bite-mark sources on human skin. In a review of 13 studies, all aimed at determining whether human dentition was unique, none was able to support a conclusion of dental uniqueness. Nine of the reviewed studies could not identify uniqueness at all.

The Journal suggests many broader implications of such findings, including the law’s difficulty in evaluating and responding to such unreliable and unscientific evidence. 

As noted by the National Academy of Sciences’ Committee on Identifying the Needs of the Forensic Science Community in 2009

, “The bottom line is simple: in a number of forensic science disciplines, forensic science professionals have yet to establish either the validity of their approach or the accuracy of their conclusions. Much forensic evidence including, for example, bite marks … is introduced in criminal trials without any meaningful scientific validation, determination of error rates, or reliability testing.”

Bite-mark identification has been used in trials across the United States since 1975, when a person was convicted using this type of forensic science during a trial in California. Now, the California Supreme Court stands ready to hear a case that could start a nationwide trend of disregard for forensic odontology in trials. To date, no court in the U.S. has excluded this type of evidence for failing to meet the requisite legal standard for admission of expert testimony.

According to a new study in the Journal of Law and the Biosciences, bite-mark identification, along with several other types of forensic science, has increasingly been shown to lack the scientific foundation needed to justify its continued use as trial evidence.