Sarah Handzel, BSN, RN

 claims early preventative care for children enrolled in Medicaid in the state of Alabama could lead to more care in the long run.

The study suggests that children younger than 2 years old who receive preventative care from dentists have more frequent subsequent treatments for tooth decay. Ultimately, these children visit a dentist more often and have more money spent on their dental care. According to the study authors, rates of dental caries are on the rise in children under the age of 5, despite efforts to improve preventative care.

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This new research compared tooth decay-related treatments, visits, and dental expenditures in children that received early preventative care to children that received no such treatments. Data from 19,658 children enrolled in Medicaid in Alabama was collected. 25.8 percent of these children received early preventative care from a dentist. The data suggested that:

· Children who received early preventative dental care had more frequent tooth-decay related treatments (20.6 percent versus 11.3 percent).

· Children who received early preventative care had higher rates of visits to dentists.

· Children receiving early preventative care had higher annual dental expenditures ($168 vs. $87).

However, there were several limitations to the study. Other benefits from early preventative dental care, such as improved quality of life, were not measured. Also, the study did not include any information on other oral health behaviors, such as oral hygiene habits or access to fluoridated drinking water.

In response to the published research, the ADA and AAPD both 

 for early dental visits to prevent childhood tooth decay.

Mia Geisinger, D.D.S., M.S. and member of the ADA’s Council on Scientific Affairs said, “As the authors state, this study design did not allow for evaluation of factors such as a genetic predisposition, previous disease and environmental considerations such as diet, frequency of brushing and flossing, the use of fluoride toothpaste and drinking fluoridated water, all of which are crucial in reducing the risk of cavities. Furthermore, there is no evaluation to determine if untreated cavities are present in those individuals who did not seek dental care for restorative treatment, so the data are incomplete. Because of this study’s limitations, we cannot make any definitive conclusions from the data provided and further research is necessary. This study highlights the need to invest in oral health research to address the epidemic levels of tooth decay in some populations of children.”

The ADA and AAPD re-emphasized their recommendation that children visit a dentist at least once before turning 1 year old. The ADA also noted that this study highlighted the importance of reducing cavities among underserved children, but that additional research was necessary to determine best practices for preventative services.

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The JAMA Pediatrics study suggests that children younger than 2 who receive preventative dental care have more frequent tooth decay treatments. These children, the research shows, see the dentist more often. Their parents are also spending more money on their dental care. The study, however, did not account for factors such as genetic predisposition to caries or brushing and flossing habits. As a result, the American Dental Association says no definitive conclusions can be drawn from the study.

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Seniors who were in the study group that received tailored interventions showed overall oral health improvements after six months.

 published in Age and Ageing shows just how important it is to tailor treatment and education to individual patients, especially the elderly. In the study, elderly home care patients receiving personalized interventions related to overall oral health showed significant improvements in the cleanliness of teeth and dentures.

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The study is part of a larger effort called 

, which began in 2013. Investigators chose 151 elderly participants for an intervention group and 118 participants for a control group. The study began with an interview and oral clinical examination for all study participants.

Following initial interviews and examinations, everyone in the intervention group received tailored, personalized education focused on oral and denture hygiene. Participants were advised to brush their teeth at least twice daily with a fluoride-containing toothpaste, and to thoroughly clean interdental spaces, dentures, and oral mucosa each day. The control group did not receive this personalized education.

After six months, each person from both groups included in the study was re-examined and interviewed a second time. In the group that received tailored interventions, researchers found the number of plaque-covered teeth was significantly reduced. Also, denture hygiene showed a notable improvement. Both functional ability and cognitive function were associated with the reduction in the amount of plaque-covered teeth in the intervention group, but regardless of tailored intervention efforts, almost half of the teeth in people in the intervention group still had plaque even though these individuals had received personalized educational efforts.

In contrast, the control group of individuals showed a deterioration in oral health habits at the six-month follow-up. This is significant because, according to the research team, oral health notably influences a patient’s quality of life, nutrition, and general health — especially in the elderly.

The study concluded by emphasizing how it is the responsibility of all dental health providers to plan a personalized — but realistic – treatment and prevention oral health regimen for elderly home care patients.

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A new study shows that seniors who receive individualized oral health counseling tend to have better oral health outcomes. Researchers saw better outcomes with teeth and dentures. The study involved 151 home care patients. Another 118 were part of a control group.

Doctors are already using virtual reality in other fields to help patients with pain management.

One dentist in Minnesota is testing a novel new approach to getting patients through their dental treatments — virtual reality. Bryan Laskin, D.D.S., of 

, is one of the first dentists to test VR headsets during treatment to ease patients’ pain and anxiety.

, Laskin said, “I like to think of virtual reality like digital nitrous. I think that VR in health care is going to take a different path than in the entertainment and gaming industry and I think we are the right people to chart that path.”

In the past, dentists have only had limited options when it comes to helping to keep anxious patients pain free — local anesthetics, nitrous oxide, or general anesthesia. As virtual technology continues to develop, that’s about to change.

VR is already under exploration in other medical applications and research studies, and the benefits of this kind of patient therapy are becoming clearer. In one 

, individuals diagnosed with post-traumatic stress disorder following the September 11 terrorist attacks saw measurable benefits from using VR during therapy sessions. Another 

 focused on pain management techniques for severe burn victims and found that using VR during wound care treatments helped to reduce the amount of pain patients experienced by as much as 50 percent. Also, VR was shown to help reduce the amount of pain post-surgery patients experienced compared to a control group.

As the technology behind VR is further developed, there are hopes that it will find its way into everyday clinical applications — both in dentistry and in medicine. In his own practice, Laskin plans to offer VR headsets during treatment to patients soon, and at no additional cost.

Much of the talk surrounding virtual reality has been confined to the gaming and entertainment industries. However, VR has applications in the medical world, too. A Minnesota-based dentist is one of the early adopters of virtual reality, purchasing headsets for his patients. He hopes the tech will help ease patients' pain and anxiety.

In a lawsuit filed on behalf of dentists in California, the California Dental Association has reached a favorable settlement against Delta Dental, the largest dental plan system in the U.S. The proposed 

 comes after three and a half years of litigation against Delta, which attempted to reduce reimbursement rates for dentists providing services under the company’s Premier Plan.

The CDA claimed that Delta breached its contractual commitments to dentists by attempting to lower reimbursement rates by 8-12 percent for the Premier Plan. When the lawsuit was filed, the CDA alleged Delta’s attempt to change participating dentist agreements amounted to a breach of contract. Further, the CDA said Delta did not adequately notify participating dentists of its plan to reduce reimbursement rates.

During litigation, the CDA also discovered that Delta was imposing additional limitations on dentists’ annual fee filings for participation in the Premier Plan network. These limitations were not authorized in any PDAs.

In response to the litigation outcome, the American Dental Association has expressed support for the CDA and for dentists in California. Gary Roberts, D.D.S. and ADA President, 

, “The ADA is pleased that the California Dental Association has reached a settlement with Delta Dental with terms very favorable to the dentists of California. We support CDA’s efforts on behalf of its members to challenge unilateral revisions of its provider contracts. Ultimately, the settlement benefits the patient, the provider and the profession.”

, the outcome of the lawsuit has saved dental providers in the state almost a half-billion dollars in fee reimbursements. The settlement was reached on behalf of all dentists in California who had a PDA for participation in Delta’s Premier Plan network anytime from January 1, 2011 until December 31, 2016.

Ronald Riggins, D.M.D. and Chair of the ADA Council on Dental Benefit Programs, 

, “This effort should remind all dentists who have contracts with any third-party payers to review your contracts. Dentists should request copies of their contract from the payer and explore whether future changes can be provided as redlined changes to the contract.”

The California Dental association says that the settlement with Delta Dental has saved dentists in the state almost a half-billion dollars in reimbursement fees. The settlement covers all California dentists who participated in Delta Dental's Premier Plan between January 1, 2011 and December 31, 2016.

Dentists place about four million dental implants annually.

. has received clearance from the FDA to market their new robotic guidance system, 

. The company created Yomi as a computerized navigational system for use in dental implant procedures. Yomi is intended to aid dentists in the pre-operative and intra-operative phases of dental implant surgery.

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The Yomi system comes with specialized software to help dentists plan each step of the surgery. The robotic system can also be used to provide navigational guidance of surgical instruments during the procedure. This is accomplished using haptic robotic technology, which constrains the depth, orientation, and position of dental drills.

Currently, Yomi is the only surgical robotic system developed for specific use within the dental industry. Neocis Inc. touts the system as a revolutionary new tool for dentists, allowing dentists complete control over the technology and surgery at all times. Dentists can clearly visualize the surgical site, and it’s possible to dynamically change the surgical plan as needed at any time during the procedure.

Almost four million dental implants are placed each year within the United States. There are nearly 15,000 dental specialists and almost 150,000 general practice dentists that provide implantation services to patients.

Some dentists have already begun to use the Yomi system to provide care to patients. Federico Grande, D.D.S., M.D., 

, “Showing my patients the benefits of robotic guidance with Yomi gives them comfort. They know they are getting state-of-the-art treatment and reliable results.”

Robotic technology is already widely used in a variety of medical applications. While Yomi is the first robotic surgical system developed for the dental industry, it is also an indicator of the future of robotic technology in dentistry. In fact, the surgical robotics market is forecast to grow significantly across several medical and healthcare markets, reaching $20 billion by 2021.

Neocis Inc. is focused on improving health care through robotic assistance. CEO and Co-founder of Neocis, Alon Mozes, Ph.D., 

, “We are excited to achieve this important milestone for Yomi. We look forward to further demonstrating the benefits of Yomi to the surgeon’s practice and their patients and to bringing the system to select key opinion leaders in the United States.”

Yomi, the latest robotic guidance system created by Neocis, will help dentists during dental implant surgeries, providing navigation guidance of surgical instruments during procedures. The system uses haptic robotic technology to constrain depth, orientation, and position of dental drills.

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The American Dental Association lauded the EPA's decision, saying it was reassuring that the agency came "down on the side of sound science."

In November 2016, a group against community water fluoridation petitioned the Environmental Protection Agency (EPA) to ban the practice of adding fluoridating chemicals to drinking water. The petition was started with the claim that high levels of fluoride in community drinking water sources across the country negatively affect the IQ of citizens who consume the water. The EPA has rejected the petition due to a lack of scientifically backed evidence.

Over 211 million American citizens receive water from community sources that have been treated with fluoridating chemicals. Communities across the country fluoridate drinking water supplies as part of efforts to protect individuals from dental disease.

In response to the EPA’s rejection of the ban, American Dental Association (ADA) President Gary Roberts 

, “It is always heartening when our government comes down on the side of sound science. Public health policy recommending community water fluoridation results from years of scientifically rigorous analysis of the amount of fluoride people receive from all sources.”

The EPA’s justification for the denial of the petition was published in February’s issue of the 

. In the justification, the EPA explained, “the petition has not set forth a scientifically defensible basis to conclude that any persons have suffered neurotoxic harm as a result of exposure to fluoride in the U.S. through the purposeful addition of fluoridation chemicals to drinking water or otherwise from fluoride exposure in the U.S."

The EPA’s justification further clarified, "When an association is suggested between an exposure and a disease outcome, the studies need to be assessed to determine whether the effect is truly because of exposure or if alternate explanations are possible. The way to do that is to adjust for potential confounders, such as diet, behavior, and socioeconomic status.”

The benefits of water fluoridation are explained on the ADA’s 

, where interested individuals can read fluoridation facts, news articles, and clinical guidelines explaining the benefits of community water fluoridation. According to the website, more than 70 years of community water fluoridation has been shown to be safe and effective in preventing tooth decay by at least 25 percent in both children and adults.

"Water fluoridation is effective and safe. Today's decision by the EPA is based on solid science,” says Roberts.

The Environmental Protection Agency has rejected a group's petition to ban fluoride from drinking water. The group had claimed that water fluoridation has a negative impact on citizens' IQ. The EPA said that science does not support the outcome, noting that fluoridation has significantly reduced oral disease and tooth decay in communities with fluoridated water.

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 is a new online networking community specifically developed for dentists to help them stay engaged and focused on continuing education and the expansion of their dental knowledge and skills. The site is the brainchild of Lee Ann Brady, D.M.D., who realized there was an unmet need to provide dental professionals with opportunities to participate in post-graduate dental education while also connecting them with other practicing dentists.

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The realization came after Brady spoke with dentists across the world as part of her efforts as a dental educator. In these conversations, there were several themes that emerged as factors that keep dentists excited about and interested in continuing education, including:

· The ability to engage with peers during educational events

· Getting technical support and solutions

· Variety in educational opportunities, instead of events that always stay the same

· Being able to share experiences with other dentists

Also, many dentists indicated a need for learning opportunities to occur in a safe environment, where questioning was welcomed. Further, it was important that respondents can foster relationships with like-minded people that last for years, not just the span of the continuing education course.

Restorative Nation is a members-only website where dentists can go for continuing education videos and webinars. The site’s Clinical Collection provides articles and videos on a variety of dental topics, including esthetics, materials, practice management, restorative techniques, and treatment planning.

Members are also encouraged to participate in the many supportive discussion forums. Additionally, dentists can choose to try a guided treatment planning challenge to test their diagnosis and treatment planning skills with complex dental cases.

Currently, dentists can join Restorative Nation and receive access to all content free for 60 days. After the initial trial period, membership to the community is $49 each month.

Lee Ann Brady, D.M.D, has rolled out a new online network for dental continuing education. Restorative Nation provides dentists with access to new knowledge and skills while also maintaining a networking community. This setup allows for dentists to exchange experiences and ask questions in a safe environment.

New Online Network for Dentists Offers Supportive Learning Community

For $25 per month, Afora provides members with two dental cleanings, an anual exam and X-rays.

, a new kind of dental membership plan that connects patients to dental professionals, has announced plans to expand coverage to customers in Long Island, New Jersey, and Connecticut. Currently, the company only provides services to people in New York.

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The company has been labeled a “disruptor” in the traditional dental insurance industry. Afora saves customers up to one-third of the costs associated with dental treatment and has already been successful with members in New York.

Members choose from one of two dental membership plans. The Basic Coverage plan includes two dental cleanings, and an annual exam and X-ray for only $25 each month. The Premium Coverage option includes everything included in the Basic Plan with the addition of two more cleanings every year. Both plans include access to a flat fee schedule for additional work, and the Premium Coverage plan provides vouchers toward services such as teeth whitening and comprehensive orthodontic services.

The membership plan’s network of dental providers was created by dentists using an interviewing and rating system. Afora is also planning to create a system for member feedback to further evaluate and vet dental professionals within the company’s network of providers. Also, Afora plans to add more dental specialists into the provider network as part of their expansion efforts.

Afora is not dental insurance. Instead, monthly fees paid by members cover all preventative dental services. If a patient needs more in-depth dental care, they can search the provider network and pay a flat-fee rate for the service they need performed. There are no deductibles and no insurance payment caps.

Afora was founded to provide dental coverage for a variety of consumers, including individuals, families, and small businesses. The company prides itself on connecting patients to high-quality, trusted dental professionals that offer transparent pricing.

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Afora, a dental membership plan, is expanding into Long Island, New Jersey and Connecticut. The membership plan allocates basic dental services to patients for a monthly fee. A more expensive version allows for two additional cleanings. Afora focuses on preventative care, but also gives members access to more in-depth care options for flat fees.

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The American Dental Association has thrown its support behind licensed dentists, rather than expand the role of dental therapists, in order to meet the oral health needs of underserved populations.

Expanding the role of dental therapists to meet the needs of at-risk patient populations in several states has been increasingly covered in many media outlets, including 

®. In response, the American Dental Association (ADA) has released a statement further supporting licensed dentists instead of expanding the scope of practice for this new category of dental provider.

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, there is no evidence that shows any new care models have actually increased access to dental care at reduced costs. Instead, data collected by the ADA’s Health Policy Institute indicates the number of dentists in the country will grow through 2035 and will outpace general population growth. The HPI also found that more than 27 percent of dentists currently practicing could add more patients to their practices.

Instead of adding a new category of dental providers, the ADA said there should be a focus on connecting underserved patient populations with dentists who are available to provide care. The ADA offered several solutions to this problem, including targeted outreach efforts from community health workers and improved funding for dental care under Medicaid. The ADA further explained that increased Medicaid funding would also increase the number of dentists who choose to participate in the program.

 from the HPA found that 22 states could add expanded dental benefits to their existing Medicaid programs by adding just 1 percent more to their Medicaid budgets each year. The brief also found that most states only allocate less than 2 percent of their entire Medicaid budgets to dental coverage.

The ADA statement reemphasized that the organization will continue to work toward evidence-based, cost-effective solutions to meeting the dental care needs of the American people while remaining focused on preventing dental disease and expanding access to dental care for underserved patients.

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Amid a flurry of coverage, the American Dental Association has weighed in on the dental therapy debate. As states have looked to authorize dental therapists as a means of providing care to underserved portions of rural populations, the ADA has said that dental therapists have not addressed the issue, even in states where they have already been introduced. Instead, the ADA recommends expanding access to existing dentists and providing additional Medicaid benefits.

ADA Weighs in on Dental Therapist Debate

A new company is looking to solve the problem of finding last-minute coverage for your hygiene team.

	Good hygienists make all the difference to a dental practice and can generate anywhere from $1,300 to $1,500 per day in revenue. But when something happens and a hygienist can’t make it to the office, the practice stands to lose significant funds if patient appointments can’t be rescheduled or shifted to another team. A new startup, 

, wants to change this by connecting temporary job seekers with dental offices in need of coverage.

	Biteline is the brainchild of Barclay McFadden, who learned how difficult it was for a hygienist to find coverage during a dental appointment. As he spoke with his hygienist, who’s child was sick, he learned that she’d reached out to several colleagues at 2 a. m. to try to find a replacement, but was unable to because it was such short notice.

In an interview with the Post and Courier

, McFadden said, “I was sitting there baffled that this was the best process available.”

	Dentists already know they can use temporary agencies to help fill in the gaps when staff members can’t make it into the office, but this can be very expensive. It can also be very difficult for staff members to try to find someone to take over a shift, and people often must rely on texting or social media websites to try and quickly connect with colleagues.

	Biteline was developed to make the process of finding replacement staff much easier. Dentists and hygienists will pay $5 each month — when enrolled in an annual subscription – to be able to use the service. Several key features are included in a monthly subscription, such as:

	· Candidate profiles showcasing education, specialty and software experience, and videos.

	· Performance ratings dentists or hiring managers can view when choosing a replacement. Each candidate is rated by an employer after each job transaction.

	· Candidate work history that shows where and when a person was employed, with detailed candidate performance reviews that allow dentists to decide who would be the best fit.

	· Social connections that allow users to connect to each other.

	· The ability to register and post a job, or apply for a job, in less than 5 minutes.

	· Notifications that show when a candidate has applied for a position, or whether a hygienist has been offered a job.

	Biteline is currently gearing up for beta testing in Charleston, South Carolina. McFadden said, “I’ve designed the software to be simple, fluid and as effective as I possibly can. The beauty about the Charleston market is there is it’s a large enough metro area so that this service could be very beneficial."

Historically, it's been difficult for dental practice team members to find last-minute coverage. This can be particularly problematic for hygienists. And as you know, a day down a hygienist in your practice is a day of lost revenue. A new app is being developed that may help you find last-minute hygiene coverage when you need it.