Let’s Focus on Quality, not Quantity

By Mark Doherty, DMD, Executive Director, DentaQuest Institute

It’s hard to miss the fact that our health care system is in the middle of a lot of change. I read about “pay for performance,” “accountable care organizations” and “value-based care” all the time. Oral health is not usually part of the discussion but that won’t be for long. The growing cost of care, the variation in treatments and care outcomes and the significant disparities faced by disadvantaged groups are important issues for dental care delivery too.

So I am very excited by the strong interest and motivation among my peers to find opportunities to focus on quality rather than quantity in America’s oral health care delivery system. I just returned from a meeting in Washington, D.C. with leaders in oral health and health care from across the care delivery spectrum (ADA, ADEA, CDHP, ADHA, CDC, HRSA, IHI, CMS, dental educators, providers, hospitals, health policy experts, insurers and more) where quality improvement and accountability were the central topics. Folks left the meeting ready to take part in this Quality Journey.

The impetus for the meeting was a new report (just released), edited by Paul Glassman DDS, MA, MBA, professor of dental practice and director of the Pacific Center for Special Care at the University of the Pacific Arthur A. Dugoni School of Dentistry. The report, Oral Health Quality Improvement in the Era of Accountability, is a call for a new dialogue on how to improve quality and increase access to affordable dental care.

Until now, the limited evidence of best practice for most dental procedures has led to widespread variation in clinical decisions among dentists; [Read the blog post, To Fill or Not to Fill by my colleague Dr. Doyle Williams to understand the variability in treatment approaches.] And today, there are few incentives to implement quality improvement programs.

But we need to. Dental expenses are now one of the highest out-of-pocket health costs for consumers. And 37 percent of African American children and 41 percent of Hispanic children have untreated tooth decay, compared to 25 percent of white children. The disparity is unacceptable.

Take a close look at the ideas in this report. We need to look at the opportunities to do better.

At the DentaQuest Institute, we’re emphasizing prevention and disease management in our quality improvement initiatives. The good news is that this approach works. When we apply a disease management model to the care of a chronic disease like Early Childhood Caries (ECC), we are seeing longer-term improvements in the patient’s oral health.

The DentaQuest Institute will post the presentations from the meeting in Washington on our website.

This is an exciting time for those of us who are passionate about better oral health for all.

New Year, New Design

From the Oral Health Matters team

You may have noticed some changes here at Oral Health Matters. We decided to improve the blog, much like our commitment to improving oral health.

We redesigned the blog so it’s easier for you to read. You’ll notice there is more white space in the new design, and the photos of our contributors have been moved to a new column on the left to help keep them in view. Tools for sharing and searching the blog are more prominently displayed at the top of the right hand column, making it simple to share posts and search by topic.

We will continue to share our thoughts, ideas, stories and news in oral health innovations with you in 2012.

We invite you all to tweet at us to let us know what you think! If you’re not already following us on Twitter, come check us out: @dentaquest

Best,
Doyle, Fay, Steve, Ralph, & Mark

A [Dental] Wake Up Call for Baby Boomers

Guest Post by Dr. Michael Monopoli, DentaQuest Foundation Director of Policy and Programs

The baby boom generation has consistently enjoyed better health and better oral health than any previous generation. Thanks to community water fluoridation, fluoride toothpastes and having dental insurance as part of employer-sponsored health plans, this generation is the first where a majority will keep and maintain their natural teeth over their entire lifetime.

This is wonderful news, and the facts support it. CDC data shows that over the past decade, the number of adults missing all their natural teeth has declined from 31 percent to 25 percent for those aged 60 years and older. And more good news: Seventy percent of adults at or above the poverty level said they visited a dentist in the past 12 months (CDC Fact Sheet). This is a generation that cares about and values its good oral health.

But there’s a serious dental wake-up call on the horizon for this first wave of boomer retirees. Even with largely good oral health, today’s retiring adults are realizing they will have to plan to pay largely out of pocket for dental care to maintain their oral health beyond their working years.

Many have all of their teeth and received routine dental care through their lives. They are now struggling with the realization that Medicare generally doesn’t cover routine dental procedures, such as cleanings or fillings. Medicaid, the jointly-funded Federal-State health insurance program for low-income people, funds dental care for low income and disabled elderly in a few states, but reimbursements are low. Most dental plans that cover the necessary services to maintain good oral health are based on employment and these dental benefits are lost with retirement. Retirees now have to figure out how they can continue the level of dental care they enjoyed through their working lives, and will need to balance these expenses along with other important needs like food, housing, and the rest.

And to add insult to injury, over the past decade, the value of retirement funds and IRAs has been shrinking with the ups and downs of the economy. Some retirees are facing the fact that their retirement funds may no longer support the lifestyle they were used to or hoped for – including good preventive health services.

It’s not a comfortable feeling to have to decide what dental care you are willing to pay for in order to have good oral health -- especially when we know good oral health is an integral part of overall health.

This is one of the issues that was discussed by the new U.S. National Oral Health Alliance, leaders from dentistry, medicine, dental education and the dental industry, health advocates, policy makers and philanthropy at their first leadership colloquium in 2011. Without access to oral health care and prevention, our nation’s most vulnerable families are at high risk. Many middle class elders will begin to face dental issues that our nation’s most vulnerable families have faced for many years. Hopefully, this larger group will change the conversation.

Best Wishes for Optimal Oral Health!

Grantees of the Oral Health 2014 Initiative, the DentaQuest Foundation's multi-year campaign to strengthen and accelerate state and community action on behalf of better oral health, met as a group for the first time on November 9 and 10 in Washington, DC. Grantees, advisors and DentaQuest Foundation staff gathered for an Oral Health 2014 group photo.

Best Wishes for Happy Holiday Season and a Healthy New Year

No matter what holiday you celebrate this season, we wish you good oral health.
Happy Holidays from all of us at DentaQuest.

View our video greeting here: DentaQuest Holiday

Better Care for Today; a Better Healthcare System for Tomorrow

Guest blog post by Cindy Hannon, DentaQuest Institute Quality Improvement Manager

I just had an inspiring experience at the Institute for Healthcare Improvement’s (IHI) 23rd Annual Forum. Over 6,000 participants (yes 6,000!) converged on Orlando, Florida to focus on quality in healthcare. Over the last year, I have been working with DentaQuest Institute partners on three Quality Improvement projects in dental care – Dental Sealants for Adolescents, Early Childhood Caries (ECC), and Elimination of Dental Disease.

I wanted to attend this year’s IHI Forum because the DentaQuest Institute is gearing up for an exciting 2012 with a strong focus on quality and a prevention-focused, disease management model of care. There is a lot to be learned from the work of the Institute for Healthcare Improvement. Its successes are lessons in the kind of change management that facilitates improvements within a care system. Time and again, people that I met in sessions and around the conference said they were so happy to have people involved in dentistry at the quality table.

Maureen Bisognano, President and CEO of IHI started the two-day forum reminding us of our purpose -- we are capable of “making better care for today and a better healthcare system for tomorrow.”

With Quality Improvement, we are “acting for the individual but learning for the population.” Stories of patients and their families are important tools: “Stories,” Maureen reminded us “are first personal, then they become public, and then collective, and lastly, they become political.” There is a connecting thread: we help the individual and what we learn supports improvement for others. A compelling patient story helps grab attention today and builds the will for change. Our patient encounters help us understand the situation (patient, disease and environment) and devise better solutions. Data help us make the case to move change through the system. Quality improvement, at its core, is applying reliable new knowledge (science-based evidence) with a goal of better outcomes.

On the plane returning to Massachusetts, I sat in my seat tired but full of energy. Charlie Homer, MD, MPH, President of the National Initiative for Children’s Health Quality (NICHQ) and a national leader in improving the quality of healthcare for children, was on the same flight. Jane Taylor, EdD, an Improvement Advisor for IHI, was also on the flight. I was just a few rows behind them. It occurred to me –dentistry may be behind medicine in this quality improvement work, but we are all on the same flight, headed for the same destination… better health outcomes. And, I am thinking about the stories we will have to tell.

To Fill or Not to Fill: That is the Question

By Dr. Doyle Williams, Chief Dental Officer, DentaQuest

Recently, the New York Times published an article, “A Closer Look at Teeth May Mean More Fillings for Dentists,” which discussed microcavities and the different ways dental care providers treat them. A 22 year old college student who had grown up without ever having a cavity visited a dentist while at college and found out she had a cavity – in fact, multiple cavities. Somehow, in just 12 months, she went from perfect oral health to having many cavities. How can that be?

Ever new technologies make it possible for dentists to find very early stage cavities (microcavities) that can’t be seen with X-rays or the naked eye. These technologies are an effective tool in identifying early decay and allowing dentists to address it before it progresses to become a bigger and more painful problem.

The microcavities they detect are abnormalities which can be an indication of the beginnings of tooth decay. For patients who previously had perfect oral health, hearing they may have a number of cavities that need to be filled is a shock. If you are concerned that a diagnosis doesn’t match up with your prior dental history (and there has been no change in your home care or health), it is never a bad idea to get a second opinion.

Today, when dental teams catch disease in an early stage, there are more options for patients than the traditional filling. For example, dentists can watch and wait to see what happens as suggested in the article by Dr. James Bader, a research professor at the University of North Carolina School of Dentistry.

Another approach is to take preventive steps. The diagnosis of a microcavity may lead a dentist to recommend the application of sealants, a thin plastic coating applied to the teeth to protect them from the bacteria that causes dental disease and the potential for further decay.

Or, a dental health professional may attempt to help “heal” the tooth. At the DentaQuest Oral Health Center, the dental team would take steps to reduce the level of the decay-causing bacteria in the patient’s mouth, and enhance the body’s natural ability to replace minerals. So instead of placing fillings that will need to be replaced in the future, they use other measures to stop early decay, help the tooth heal, and then make it more resistant to future decay. It’s a prevention-focused approach to oral health care.

My colleague, Peter Blanchard, DDS, MBA; Director, Evidence-based Practice, DentaQuest Oral Health Center, wrote an op ed in response to the New York Times article entitled “To fill or not to fill: That is the question” which was published on DrBicuspid.com.

Finding cavities early is never a bad idea. It gives us more options to help our patients stay disease free.