Using Performance Measurement to Improve Oral Health and Patient Care

This week, I have the pleasure of recognizing my colleague Dr. Rob Compton, who was recently appointed to the American Dental Association’s (ADA) Dental Quality Alliance (DQA) Advisory Committee on Research and Development of Performance Measures.

Dr. Compton, vice president of quality improvement for DentaQuest, is a nationally recognized expert on evidence-based oral health care and cost management methodologies. In 1999, Dr. Compton opened DentaQuest’s model dental office in Massachusetts. Its goal has been to deliver cost-effective, appropriate dental care using scientific, evidence-based technologies and treatments that are tailored to the dental needs of each patient. Today, under the direction of Dr. Peter Blanchard, the DentaQuest Oral Health Center is a thriving multi-specialty dental office—and the American Dental Association’s Adult Preventive Practice of the Year. Disease management and patient education are at the heart of its business and clinical systems. And for patients, that means healthier mouths, keeping their teeth for life, and much less need to drill and fill. The DentaQuest Oral Health Center has become a model for other dental offices who want to emphasize disease management in patient care.

Dr. Compton has brought the same thoughtful care and attention to quality improvement for better patient outcomes to DentaQuest’s dental benefit plan designs. He has encouraged DentaQuest to cover new services once they have been shown to have real impact on slowing the progression of dental and gum disease, particularly in higher-risk patients. His appointment to this ADA committee is acknowledgement of DentaQuest’s role as a major stakeholder and subject matter expert in high quality oral health benefits that emphasize cost and quality and which lead to improved patient outcomes.

The DQA was established by the American Dental Association in 2008 at the request of the Center for Medicare and Medicaid Services (CMS) which is also a co-sponsor. Its mission is to advance performance measurement as a means to improve oral health and patient care and safety through a consensus-building process.

Sweet Breath and Healthy Mouths for Valentine’s Day!

A Valentine’s Day kiss is good for your health! A nice smooch will stimulate saliva production. That helps prevent tooth decay. As you get ready to pucker up, take these steps to be sure your breath is sweet.

Bad breath, or halitosis, can be embarrassing. The best way to prevent bad breath is to eliminate the potential causes. Bacteria lingering in your mouth from food or infections can create odors (and lead to decay). Brushing and flossing your teeth twice a day is a good start. Also clean your tongue –it can retain bacteria. A gentle and thorough cleaning with a tongue scraper or toothbrush can remove lingering food particles.

Foods play a role in lingering bad breath. Most people know they should avoid foods with strong smelling ingredients, like garlic or onion. Did you know that oils from some cheeses and soft drinks are absorbed into your lungs and the smell is given off in your breath for a while! Foods such as apples or oranges contain helpful enzymes that naturally remove bacteria. Crunchy foods like carrots or celery help stimulate the flow of saliva which also helps get rid of odor causing bacteria. Chewing on parsley or mint leaves can also help freshen your breath.

Sometimes the cause of halitosis is a dry mouth and not food. Saliva is a natural cleaner for the mouth, helping to remove food and other particles that may cause halitosis. Some people don’t produce enough saliva to keep their mouth wet.

A side-effect of some medications, such as antihistamines, tranquilizers, and various blood pressure medicines, may be a decrease in the flow of saliva (in children and adults). Diseases like Sjögren's Syndrome, HIV/AIDS, diabetes, and Parkinson's disease can also cause dry mouth. Cancer patients may find salivary glands are impaired after exposure to radiation treatment. Chemotherapy drugs can make saliva thicker, leaving the mouth feeling sticky and dry. If any of these symptoms sounds familiar to you, talk to your dentist and physician. They may be able to suggest alternative medications or prescribe a medicine that helps your salivary glands work better.

People experiencing dry mouth can stimulate the flow of saliva with sugarless gum or candy. It is also a good idea to drink six to eight glasses of water a day. Try to avoid alcohol and tobacco; both are “drying agents” which remove saliva from your mouth. Ultimately that can lead to an increase in bad breath and a higher tendency to tooth decay.

Adding a mouthwash to your daily care routine can help sweeten your breath. Select alcohol-free products -- they are less drying. And, pick a mouthwash with fluoride; it can help prevent cavities by strengthening your teeth.

Happy Valentine’s Day! Brush, floss, and rinse before you pucker up!

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