Best Practice Management Consultant, 2011

My colleague, Safety Net Solutions founder and DentaQuest Institute Executive Director Mark Doherty, DMD, MPH, CCHP was recognized as Best Practice Management Consultant in Dr.Bicuspid’s 2011 Dental Excellence Awards. Dr. Doherty is a passionate advocate for oral health, and has a strong background in public health dentistry. Under his direction, the DentaQuest Institute’s Safety Net Solutions program has helped strengthen many dental clinics in communities across the country.

The Safety Net Solutions program is unique among dental management consultants because it is focused on the urgent need to preserve and strengthen the oral health safety net which serves 16 million+ uninsured and medically underserved Americans every day. Oral health safety net providers are the dentists who work at your local community health center. They are critical to good individual and community health. But they are very challenged by poor reimbursement, operational difficulties, and limited resources. Historically, these programs struggle to maintain financial viability.

The DentaQuest Institute’s Safety Net Solutions (SNS) program works collaboratively with program administrators, dental directors, and staff. Its advisors provide customized technical assistance to enhance the business infrastructure behind the delivery of care—with an appreciation for the uniqueness of safety net clients and their care needs. The SNS Improvement Model is especially helpful for programs in environments with low levels of public reimbursement because it teaches programs to operate more efficiently. Many public and private funders of safety net sites have started including Safety Net Solutions technical assistance in their plans to ensure that grantees implement sustainable, results-oriented business practices, and develop access metrics that deliver a return on the investment.

Since the program began in 2006, SNS has worked with more than 90 safety net dental programs in 19 states. And they are now advising the growing number of community health centers that are starting new or expanding existing dental programs, using critical resources mandated in health reform.

Safety Net Solutions is making a difference. Within one year of receiving SNS technical assistance, a dental care safety net program is stronger.

Overall, through technical assistance, sites experienced on average…
· 35,063 more dental visits in the past year
· An increase of 1,594 visits
· Gross productivity increased by $752,006
· Net revenue of dental services increased by $5,475,937

The Dr.Bicuspid award is a well-deserved recognition of Mark’s hard work and the DentaQuest Institute’s leadership in strengthening America’s dental safety net and innovating improvements to the care delivery system.
Learn more about the Safety Net Solutions program at www.dentaquestinstitute.org/safetynetsolutions

The Cost of Treating a Preventable Disease

This is pretty interesting stuff. Dental expenditures in 2007 (latest available) equaled the cost of treating cardiovascular disease. It is more than twice as much as was spent for diabetes or normal maternity. And it is mostly caused by a little bacteria that can be prevented!

Source: Medical Expenditure Panel Survey 2007, AHRQ, US Dept of Health and Human Services

Community Water Fluoridation Rules Change

Last Friday, the U.S. Department of Health and Human Services (HHS) and the U.S. Environmental Protection Agency (EPA) issued the first changes in the recommended amount of fluoride for public drinking water supplies in nearly 50 years.

Public health officials and professional dentistry believe that water fluoridation and fluoride toothpaste are largely responsible for the decline in tooth decay in the U.S. over the past several decades.

The new guidelines set a balance where people will be able to get tooth decay prevention benefits while avoiding unwanted health effects from too much fluoride. Consuming too much fluoride during the years when teeth are forming (8 years old and younger) may lead to a condition called dental fluorosis where light white markings or spots become visible on the tooth’s enamel.

Over the last 50 years, Americans have access to more sources of fluoride than they did when water fluoridation was first introduced in the 1940s. Water is just one of several sources which also include toothpastes and mouth rinses, prescription fluoride supplements, and fluoride applied by dental professionals.

Read the full press release at http://www.hhs.gov/news/press/2011pres/01/20110107a.html

How to Prevent the Gift of Cavities

Caregivers need to watch their mouths around children. I’m not talking about what they say—I’m talking about what they spread (cavities).

Most people don’t know that very young children can “catch” the bacteria that causes cavities. But they can.

Cavities (caries) are a bacterial infection. Now here’s a really interesting fact: babies most often get this bacteria from family members. How does a child get the bacteria? Most likely, it is through some form of exchange of saliva from an adult or another child in their lives.

Think about how this can happen. It can be through something as harmless as sharing a spoon, ‘cleaning’ the pacifier that fell on the floor in your mouth before returning it to the child, or biting off a piece of apple to share with a child. The bacteria in the adult’s mouth just found a pathway to the child.

Once in the child’s mouth, the cavity-causing bacteria cling to the surfaces of the teeth like a film. Your dentist calls this biofilm. Acids in the bacteria eat away at the enamel (the hard coating of the tooth), and can cause white spots. If you see these, they are early signs of cavities. Call your dentist! Untreated, the next step is a cavity (hole) in the enamel. If the infection is caught early, your dentist can remineralize and ‘heal’ the tooth—no drilling involved! This is most often done with a high concentration of fluoride.

Once cavity causing bacteria are in a child’s mouth, they are there for life. Caregivers have to be on top of what goes into the child’s mouth. Watch out for:

- Sugars and acids in foods and drinks – they encourage the cavity-causing bacteria to multiply. Did you know that the milk in a baby’s bottle contains sugars? Or that fruit juices, soda, sports and energy drinks are full of sugars and acids too? Starting when the child is an infant, wipe the inside of a baby’s mouth with a soft wash cloth after eating to reduce the acid attacks on the teeth.

- Be sure to only give water to baby at bedtime or naptime. Putting a child to bed with milk, juice or soda (all sugary and/or acidic drinks) is just feeding the bacteria and encouraging the start of cavities.

- Clean the child’s teeth every day. If the child is too young to brush his or her own teeth, wipe the teeth with a soft, clean, damp washcloth. As the child is able to cooperate, you can brush the teeth using a pea-sized dot of fluoride toothpaste. Once a child is 4 or 5, he or she can brush on his/her own with parental supervision. (Be sure the child spits out and does not swallow the toothpaste.) It is important to remove food from all the surfaces of the teeth every day so the bacteria can’t settle in and start the decay process.

Untreated, tooth decay can have serious, negative effects on a child’s physical and educational development. Mouth pain makes it difficult to eat a healthy diet, to learn to speak properly, and to concentrate in school. Untreated tooth decay in baby teeth can damage a child’s permanent teeth. Plain and simple, early tooth decay can quickly put kids at a lifelong disadvantage.

What can parents do? Taking care of your teeth improves your own oral health, and sets a good example for your child to follow. Make sure you visit your dentist regularly. Take your child for a first check-up at twelve months of age. The dentist will determine the child’s risk of developing dental disease. Follow a healthy diet and be sure to brush after every meal.

Taking care to reduce the risk of transmitting cavity-causing bacteria to children will better position them to fight off tooth decay as they grow.

A Resolution to Smile About

The many family gatherings and holiday parties are not only trying times for your waistline, but can also be quite tough on your teeth. Billions of candy canes are eaten each holiday season and each person puts away an estimated 12 pounds of premium chocolates.

But it’s not just the food.

Americans, on average, drink enough for every person to have 7 bottles of liquor, 12 bottles of wine and 230 cans of beer. All capped off with a customary glass of champagne on New Year’s Eve.

If you don't bother to make good decisions about what you are eating and drinking, or to properly clean your pearly whites afterward, you could end up with tooth decay, gum disease and possible tooth loss.

With this in mind, I want to share a couple of oral health tips that will help keep your smile intact this holiday season and into the next:

1. If you choose to drink wine, choose red over white. While many people think red wine is worse because of its staining power, white wine contains more sugar which is actually more harmful for your teeth in the long run. Regardless of which wine you choose to drink, you should always rinse your mouth out with water before you brush your teeth.

2. If you choose to drink spirits or liquor the opposite is true. You should actually choose the lighter or clear liquids to avoid higher sugar contents. However if you are mixing a clear alcohol with a sugary juice or other drink then you still aren’t doing yourself any favors. As with the wine, you should rinse your mouth out with water after you drink and before you brush your teeth.

3. You should always consume candy in moderation – sugar free if possible. But if you are choosing between a candy cane and a piece of chocolate, go with the piece of chocolate. Sticky candies are less likely to wash out from between your teeth with saliva and therefore get more time in contact with your teeth. This is also true for fruit cake.

4. No matter how exhausted you may be from hosting your family or attending your fifth holiday party in a row, always remember to brush your teeth before you go to bed. If all the acid from the food you ate gets 8 hours to fester in your mouth it can do a whole lot of damage that could have been prevented with 2 minutes, a toothbrush, and some floss.

Good dental habits throughout the holidays – and year round – will help make for a happier New Year. As you make plans for 2011 I hope you all will resolve to be better to your teeth because that’s something we can all smile about.

-Dr. Linda Vidone, Associate Dental Director for DentaQuest

Risky Business

I graduated from dental school 30 years ago and enjoyed many years of private practice. Working on the benefits side of dentistry as I do now has also been rewarding in many of the same ways. My son graduated from dental school this past summer and during his four years, I joined the faculty at Tufts and lectured about the business side of dentistry.

Although I have done some volunteer dentistry since leaving private practice, I hadn’t had a personal patient encounter in several years. That was before I was introduced to a young man (26 years old) a couple of months ago. He was wearing his army fatigues, even though he was now a civilian. My son is an Army dentist, so I started up a conversation.

This young man was suffering from multiple abscessed teeth from some poor decisions that he had made since high school. When I say suffering, I mean the kind of suffering that had caused him to try to pull out his own tooth with pliers. A few years ago, his teeth were fine. But following some drug abuse and lack of home care, his 26-year old mouth was in serious trouble. I connected him with program that would give him some care, but this young man was unable to keep the appointments because his employer would not give him the time off. A colleague in our office who maintains a dental practice one day a week offered to help this young man and opened her office for him on a Saturday.

Now I would like to make two points about this experience. First, returning to clinical dentistry is like riding a bicycle and we were able to help this young man over two Saturdays. The second point is I was struck by the sense of invincibility in young people—they believe they can take chances and nothing will hurt them. I was alarmed and saddened to see how devastating their decisions can be, even a few years later.

Not taking care of your teeth is risky business. Whether it is the overuse of sports drinks or sugary sodas, prescription drug misuse, lack of oral hygiene, playing sports without a mouth guard, or driving without a seat belt, the speed of dental decay and its lasting devastation can change a young person’s life forever. Maintaining good oral health takes very little effort. Don’t ignore it!

Kids think that dentures are only for grandparents. In this case, they belong to a 26 year young man.


Doyle Williams, DDS

Bionic teeth

Losing a tooth in adulthood isn't exciting as it was when we were young. In fact, adult tooth loss has serious consequences--like difficulty chewing food or not wanting to smile at school or work. Missing teeth can also weaken the overall structure of your mouth.

In the next few years, there may be a "bionic" option for replacing lost teeth: re-growing them. We have seen the technology work in animals and we hope it will be available for commercial use in the next decade.

Scientists have discovered stem cells in baby teeth and that may put our friend the tooth fairy out of a job. In animals, scientists have used scaffolding to re-grow teeth. Work on the human genome has identified a gene that may actually re-grow a duplicate tooth in your own mouth. This technology is still maybe years away from being realized, yet there is reason to believe that stem cells from baby teeth will eventually be used to grow your own teeth for replacement. Instead of putting teeth under the pillow, parents may be sending their children’s teeth to stem cell banks for cryogenic storage.

A viable option for a lost tooth today is the dental implant. (Incidentally, November is Dental Implant Month). These replacements not only act and feel like natural teeth, but they also offer solid, non-mobile support. It may take three to six months for your new implant to feel fully functional in your own mouth following an extraction of a tooth, but dental implants restore proper chewing functions, allowing you to be able to enjoy foods you love.

Read more about tissue regeneration for teeth at http://www.popsci.com/science/article/2010-05/new-technique-uses-bodys-stem-cells-regenerate-teeth