Washington—More than one-third of Americans say they did not visit the dentist at all in the past year, according to a new Gallup poll. 

The two-thirds of U.S. adults in 2013 who said they did visit the dentist at least once in the past 12 months is the same percentage as the one reported in 2008. Women are more likely than men to report visiting the dentist annually. 

The report, released April 28, details findings based on interviews in 2013 with 178,072 American adults and interviews in 2008 with 354,645 adults as part of the
 Gallup-Healthways Well-Being Index. Results for all years between 2008 and 2013 are similar. 

Among the findings: 

• Fifty-five percent of both African-Americans and Hispanics reported visiting the dentist in the past year. Whites and Asians are at about 70 percent. 

• There are smaller differences across age groups in reported dental behaviors. Adults age 18-29 are least likely to have visited the dentist but only marginally less so than those who are middle aged or older. An improved rate among seniors since 2008 is offset by a similarly sized decline among those 30-44. 

• The most pronounced differences in dental habits are those across income groups. Those who earn $120,000 or more annually are about twice as likely as those who earn less than $12,000 to say they visited the dentist in the past year—82 percent and 43 percent, respectively. Dental visit rates have held steady since 2008 for higher income individuals, while they have declined for all other groups, particularly for low- and middle-income households with incomes between $24,000 and $60,000 per year.

• Dental visit rates are essentially unchanged in all regions compared with 2008. Rates are lowest in the South—60 percent— and highest in the East—69 percent. 

• Married adults are more likely than single adults to visit the dentist. 

The ADA recommends all adults visit their dentists regularly. Regular dental visits are important because they can help spot oral health problems early on when treatment is likely to be simpler and more affordable. MouthHealthy.org, the ADA’s website for the public, lists 15 signs that should prompt people to visit the dentist.

Two health care entities paid settlements to the federal government after possibly violating the Health Insurance Portability and Accountability Act when unencrypted laptops were stolen.

An unencrypted laptop was stolen from one of Concentra Health Services’ facilities, the Springfield Missouri Physical Therapy Center, resulting in a $1,725,220 fine. QCA Health Plan Inc., of Arkansas, reported that an unencrypted laptop was stolen from a workforce member’s car. The company agreed to a $250,000 settlement.

“These major enforcement actions underscore the significant risk to the security of patient information posed by unencrypted laptop computers and other mobile devices,” according to a U.S. Department of Health and Human Services Office for Civil Rights news release.

OCR’s investigation into Concentra revealed the health care provider had recognized in previous risk analyses that a lack of encryption on its laptops, desktop computers, medical equipment, tablets and other devices containing electronic protected health information was a critical risk. While steps were taken to encrypt the devices, Concentra’s efforts were incomplete and inconsistent over time, leaving patient protected health information vulnerable.

The investigation also found that Concentra had insufficient security management processes in place to safeguard patient information. In addition to the settlement, Concentra agreed to adopt a corrective action plan.

In Arkansas, the stolen unencrypted laptop from a workforce member’s car contained the electronic protected health information of 148 people. QCA encrypted their devices following the breach but OCR’s investigation found that the company failed to comply with multiple requirements of the HIPAA Privacy and Security Rules.

Along with the monetary settlement, QCA is required to provide HHS with an updated risk analysis and corresponding risk management plan that includes specific security measures to reduce the risks to and vulnerabilities of its electronic protected health information. The health plan must also retrain its workforce and document its ongoing compliance efforts.

The resolution agreements for both providers are available at hhs.gov/ocr/privacy/hipaa/enforcement/examples/stolenlaptops-agreements.html.

OCR has six educational programs on compliance with various aspects of the HIPAA Privacy and Security Rules for health care providers. They’re each available with free continuing education credits for health care professionals, with one module focusing specifically on mobile device security, at hhs.gov/ocr/privacy/hipaa/understanding/training.

The ADA Complete HIPAA Compliance Kit (J598) has tools to help dentists design and implement a comprehensive HIPAA compliance program. The kit includes two products: The ADA Practical Guide to HIPAA Compliance: Privacy and Security Manual and The ADA Practical Guide to HIPAA Training CD-ROM. It’s available to members for $300 and $450 retail. Visit adacatalog.org to purchase.

The ADA develops and provides a slew of tangible products that members can hold in their hands.

The Association’s newest venture is one you can’t touch but one that provides a multitude of practice management resources with the click of a mouse. The ADA Center for Professional Success, Success.ADA.org, is a unique Web portal for dentists who are looking to succeed as dental practitioners and small business owners.

The website includes everything from frequently asked questions about dental codes to debt calculators to health insurance resources for members. Dentists can easily find help managing their careers; expanding their knowledge; and balancing their life.

The Center for Professional Success launched in September 2013 as a way to address members’ needs when they have questions about the day-to-day tasks of running a business. It’s evolved into a potpourri of articles, continuing education opportunities, calculators and more, with hundreds of members logging on every day.

“We designed the Center for Professional Success portal with member experience as the top priority,” said Dr. James Willey, senior director of the ADA Practice Institute. “We believe our members will discover a practice management website that is unique, innovative, convenient and fun.”

Four ADA staff members maintain and update the website on a daily basis, with member input from the Council on Dental Practice and its advisory committee to the Center for Professional Success. They rely on market research and advanced analytics as they continue to grow the content and products on the website, which include written articles, podcasts and videos.

One of the website’s newest features is the ADA Oral Pathologist App. This chairside reference to oral pathology conditions can assist dentists with confirming their diagnoses and considering potential treatment options.

The content for the app, which is compatible with Android and Apple devices, was developed and written by Dr. Michael Kahn, chair and tenured professor of the Department of Oral and Maxillofacial Pathology at Tufts University School of Dental Medicine. Dentists can search more than 200 conditions by name or enter clinical observations into the app to obtain a differential diagnosis. The oral pathology app costs $59.99. The Center also offers guidance for new dentists and associates on how to handle and understand employment agreements. Employment Agreements: The Devil’s in the Details, Success.ADA.org/en/practice/professional-pathways/employee/employment-agreements-the-devils-in-the-details, alerts employee or employer dentists to the key legal terms they should understand before they sign an agreement. Members can also download the free white paper “Dentist Employment Agreements: A Guide to Key Legal Provisions.”

Dentists can also use the several financial calculators offered on the website at Success.ADA.org/calculators. These calculators assess the cash flow generated by their practice and determine how long it would take to get a return on their operatory investment and calculate basic loan term, loan payment, debt load and overhead.

The ultimate goal of the Center for Professional Success is to provide specific and accurate answers to questions members have as they balance their professional lives with their personal goals.

“The ADA has always been a strong resource for practice management support, but the Center highlights other learning opportunities and the work/life balance dentists say they want. The website itself is continuously evolving with new articles, white papers, apps and tools,” Dr. Willey said. “Our goal is simple: to help all ADA members achieve the personal and professional success they desire.”

Two dental schools have implemented the Systemized Nomenclature of Dentistry in their electronic dental records systems.

The University of Detroit Mercy School of Dentistry and the New York University College of Dentistry are both SNODENT licensees that will use the clinical coding set to help their students correlate the best treatment to a diagnosis.

“In medicine, it’s normal to apply a diagnosis to every condition prior to treating. Dentists may empirically know that a patient is at high risk for caries or that they are treating a failed restoration, but they are not directly attaching a diagnosis code to the condition they are treating,” said Dr. Mark Wolf, Ph.D., associate dean for pre-doctoral clinical education at NYU. “Using diagnosis codes and having students attach a diagnostic rationale for care to every treatment trains them in the medical model of patient care.”

Dr. Wolff

Dr. Aksu

SNODENT is a vocabulary designed for use in the electronic health records environment. Any dentist who uses electronic health records or who plans to in the future should be aware the use of diagnostic codes is on the horizon. SNODENT will be an important component within certified Electronic Health Records Systems for the federal and state governments’ Medicaid and Medicare meaningful use incentive reimbursement programs.

SNODENT was developed by the ADA with input from representatives of all the recognized national dental specialty organizations and the Academy of General Dentistry. The Council on Dental Benefit Programs is responsible for maintaining SNODENT, and it will be updated continuously to keep pace with developments in dentistry and dental terminology.

SNODENT-enabled electronic dental records systems can benefit dentists, educators and patients through recording consistent information during patient visits. It also enables the analysis of patient care services and outcomes, sharing of clinical details and patient characteristics between providers, identification of patients who need follow up for specific conditions and improved coordination of care.

The widespread adoption of SNODENT in electronic dental health records may also benefit the public by enabling better identification and monitoring of oral health issues, reducing errors, ensuring high quality demographic and clinical data and enabling point of care decision support.

“The opportunity to incorporate SNODENT will advance the ability to track disease patterns, prevalence, and assist in tracking student experiences with specific disease conditions,” said Dr. Mert N. Aksu, dean of the University of Detroit Mercy School of Dentistry. “As one of the first schools of dentistry to incorporate SNODENT, UDM hopes to contribute valuable feedback in furthering the development of database searchable diagnostic indices, such as SNODENT.”

Dental schools may license SNODENT files and maps for research and educational purposes at no cost. Commercial licenses for SNODENT terminology products are also available. See ADA.org/snodent for details.

When discussing dental materials in the gray market, it’s appropriate to rely on a pun and say it’s a gray area.

The term gray market generally refers to products that are sold outside the established distribution chain, according to the U.S. Food and Drug Administration.

“For example, a supplier may purchase products intended for a foreign market and then import and sell the product in the U.S. The original manufacturer did not intend the product for the U.S. market, and it may or may not comply with U.S. laws and regulations,” according to a statement from the FDA Center for Devices and Radiological Health.

The legalities are different, depending on the sale, the FDA says. If a product is identical to what’s legally marketed in the U.S., gray market sales may not violate any FDA-related requirements. But versions of products sold in the U.S. may be different than ones sold in foreign markets, even if they have the same name. In that case, the foreign market device is an unapproved device in the U.S. and sales within the U.S. would be illegal, the FDA said.

“If the gray market version is not the legally marketed version, it may not meet U.S. safety and effectiveness standards. It may lack essential information in labeling or the labeling may not even be in English,” according to the FDA. “A significant concern is that products available on the gray market may be defective products that have been diverted from planned destruction or products that may have been recalled.”

“As an association, we encourage all manufacturers and distributors to be selling parts that are authorized for sale in the United States,” said Fred Freeman, vice president of member services at the Dental Trade Alliance.

The DTA encourages dentists to purchase products that have met all FDA safety regulations.

“We never want anybody to be accidentally hurt or injured by a product that was approved for use here in the United States,” Mr. Freeman said. “Nobody should be selling or promoting or using nonrecognized products.”

DENTSPLY International Inc. is also taking a stand against gray market products. The company announced in May that it obtained a consent decree that permanently enjoins Omni Dental Supply Inc.—a Brooklyn, New York-based dental products distributor—and its principals from directly or indirectly acting as unauthorized resellers of DENTSPLY brand products.

The permanent injunction was issued in a federal lawsuit that DENTSPLY filed challenging Omni’s unauthorized distribution of gray market DENTSPLY brand products. It came after both companies entered into a settlement agreement providing for monetary and injunctive relief.

Under the terms of the settlement, Omni must discontinue all sales of DENTSPLY products by July 30.

“In the utmost interest of patient safety, DENTSPLY is committed to combatting the unauthorized sale of its products in the U.S. and intends to take appropriate action against unauthorized resellers,” according to a DENTSPLY news release.

Executives with Midwest Dental Equipment and Supply, a dental products manufacturer based in Wichita Falls, Texas, believe the company has a responsibility to educate its dentist clients, said Tim Cluley, chief operating officer. Midwest Dental Equipment and Supply has partnered with larger companies—3M ESPE, DENTSPLY, and DMG America, for example—and publishes an article quarterly to educate dentists on gray market products, he said.

If dentists see a product that is half the price of what the legitimate dealer is selling it for, that should be a trigger point that it may be a gray market product, Mr. Cluley said.

“As a legitimate dealer, obviously it’s in our best interest to promote that the doctors buy from someone who’s an authorized dealer of a product. It’s also in the best interest of the patient,” Mr. Cluley said. “There are a lot of reasons why the gray market is bad for all aspects of the industry: bad for the patients, bad for the doctors, bad for the manufacturers.”

The gray market isn’t just related to professional products that dentists use. It can also include oral care products that consumers can buy over the counter, such as toothpastes and mouth rinses.

In June 2007, the FDA Center for Drug Evaluation and Research warned consumers to avoid using any toothpaste labeled as “Made in China” because it found levels as high as 3-4 percent of diethylene glycol—a poisonous chemical typically used in antifreeze, said Clifford Whall, Ph.D., director of the ADA’s Seal of Acceptance Program. One of those was a junior brand, presumably for children’s use, he said. Following this, the FDA issued an import alert to prevent Chinese manufactured toothpaste containing diethylene glycol from entering the United States.

“Consumers can be confident that the formulations of over-the-counter oral care products that bear the ADA Seal of Acceptance have been thoroughly checked before the Seal is awarded,” Dr. Whall said. “In addition, products with the ADA Seal have gone through a rigorous, independent, scientific review by the ADA Council on Scientific Affairs, to ensure that the products are safe and effective for their intended use.”

To check out which products have the ADA Seal and to learn more about the ADA Seal Program, visit ADA.org/seal.

Dentists who have questions about specific products or companies should contact the FDA at 1-800-638-2041 or dsmica@fda.hhs.gov.

 

Any dentist who treats Medicare beneficiaries must either enroll in the program or opt out in order to prescribe medication to their qualifying patients with Part D drug plans, according to the federal government.

Either way, dentists who fit this requirement must take action by June 1, 2015. They either have to opt in or opt out.

The Centers for Medicare and Medicaid Services published a final rule in May that requires all physicians and eligible professionals—including dentists—who prescribe Part D covered drugs to be enrolled in Medicare or opt out for those prescriptions to be covered under Part D. By signing an affidavit opting out of the program, and entering into private contracts with patients as appropriate, dentists are out of Medicare for two years and cannot receive any direct or indirect Medicare payment for services provided to Medicare patients.  

CMS officials project that by requiring eligible providers to enroll, it will save the federal government an estimated $1.6 billion over the next 10 years.

“The policies finalized in this regulation will strengthen Medicare by providing better protections and improving health care quality for beneficiaries participating in Medicare health and drug plans,” said Marilyn Tavenner, CMS administrator. “The final rule will give CMS new and enhanced tools in combating fraud and abuse in the Medicare Part D program so that we can continue to protect beneficiaries and taxpayers.”

It’s a change the ADA does not agree with and one Association leadership voiced their concern about in a March 5 letter. ADA President Charles Norman and Executive Director Kathleen O’Loughlin sent a letter to CMS asking that dentists be excluded from the requirement because it “places an unnecessary burden on dentists and their Medicare eligible patients,” and it will not address the underlying rationale for a portion of the law, which is to stop fraud and abuse in the Medicare program.

In 2010, only an estimated 3-4 percent of the 186,000 practicing dentists were enrolled as Medicare providers, likely because the program only covers a limited set of dental procedures, most of which are recognized by CMS as necessary before the patient has certain covered medical procedures, Drs. Norman and O’Loughlin wrote in the letter.

“There is no reason to believe that the number of enrolled dentists has risen significantly because of the relative modest impact of the ordering and referring provision,” the letter stated. “On the other hand, this new requirement will affect the majority of dental practices.”

Despite the ADA’s expressed concerns, CMS moved forward with the enrollment or opt-out requirement.

“Dentists who don’t take action won’t see an impact until next year but it will be when their local pharmacy or patient starts to complain that they are not being reimbursed for the prescriptions the dentist writes,” said Dr. Andrew Vorrasi, chair of the Council on Dental Benefit Programs. “We’re not sure how the pharmacies will handle this. Will they refuse to accept the prescription? Will they accept the prescription but force the patient to pay and tell them it’s because Medicare won’t reimburse the pharmacy or patient because their dentist didn’t comply with the law? How will the patients react if they file their own claim for reimbursement that is denied? While the ADA opposed this action, it is one of those situations where the decision was beyond our control. Complying with this law will save practitioners much time and aggravation come June 15, 2015.”

To read the ADA’s Frequently Asked Questions on Medicare enrollment, visit ADA.org, click on the Member Center, then Member Benefits, then Legal Resources, Publications & Articles, Reimbursement, Medicare Enrollment Decision Tool: Introduction Medicare Enrollment, then Medicare Enrollment FAQ. The Reimbursement section can also take you to a Medicare enrollment decision tree and information on how to opt out of the Medicare program.

Dr. James Stephens

Sacramento, Calif.—The California governor and legislature approved funding a state dental director and an epidemiologist in the 2014-15 state budget.

The budget provides $474,000 for the first year to assess oral health needs in the state, develop and manage a state oral health plan and apply for and manage federal and private grants to support oral health. The role will also include establishing prevention and oral health literacy projects and working to secure funding for prevention-focused oral health and essential disease prevention services, particularly for children.

The state dental director must be a licensed dentist.

“This is the most impactful state oral health achievement in decades,” Dr. James Stephens, CDA president, said in a news release. “CDA members have collectively worked for and supported the establishment of a state dental director for many years. This is a significant step toward addressing the oral health care crisis facing millions of Californians through coordinated state oral health education and preventive programs led by a dental director and partnered with care provided by dentists across the state.”

Establishing a dental director was the top priority of the CDA in its 2011 access to care plan, “Phased Strategies for Reducing the Barriers to Dental Care in California.”

The CDA advocated to the governor’s office that the selected dental director must have extensive experience running a state or large county dental program. The state will begin the hiring process immediately and the CDA is committed to helping. Members can stay informed through CDA’s newsletter and on cda.org.

Racing toward good oral health: Students from Williamstown Elementary School in Williamstown, Ky., pose with Dee-Bo, the 3M Pit Bull mascot, June 27 as part of a Give Kids A Smile education event.

Cincinnati is a hilly city, so it made sense that students at Roberts Academy didn’t see the surprise awaiting them.

The nearly 130 students walked from their school building to the blacktop parking lot June 26 knowing they were going to learn about oral health. But they didn’t know what was down the hill.

A trailer emblazoned with the 3M logo, NASCAR driver Greg Biffle’s name and No. 16 sat behind a stage, but it wasn’t until the students heard the loud roar of an engine that they knew what they were in for.

Prize winners: Students at Roberts Academy in Cincinnati smile with their toy cars modeled after the one NASCAR driver Greg Biffle drives.

The students’ mouths opened wide and they covered their ears as the No. 16 3M Ford Fusion car burned up the hill into the parking lot. The children ran to get a closer look of the race car, in awe that something that loud and that fast was in their presence.
“Wow, that’s pretty cool, isn’t it kids?” said Wendy Venturini, Fox Sports host, who emceed the event. “That’s the car Greg Biffle is going to be racing this weekend at the Kentucky track not too far from here. Now, there’s another race we can win too but I need your help. That’s the race for good dental health. How many of you want to help me win?”

As part of the NASCAR race week at the Kentucky Speedway prior to the Quaker State 400 race June 28, the ADA’s Give Kids A Smile program and 3M Racing visited Roberts Academy in Cincinnati on June 26 and Williamstown Elementary School in Williamstown, Kentucky, on June 27 to educate students on good oral health and caries prevention.

Vrroom: Brayden Peeples, 8, student at Williamstown Elementary School in Kentucky, won the chance to sit in the No. 16 3M Ford Fusion race car.

“We’re going to challenge you to a race you can win—one with no cavities and good checkups at your dentist,” Dr. Jeff Dalin, GKAS co-founder, told the students.
Dr. Dalin and Dr. Marie Callen, a pediatric dentist in Cincinnati, helped Ms. Venturini emcee the Roberts Academy event, with Dr. Callen translating everything into Spanish for the large international student population. Ms. Venturini was joined in Williamstown by Dr. W. Ken Rich, who practices in the town, Stephanie Mayfield Gibson, M.D., commissioner of the Kentucky Department of Public Health, and Erin Hoben, chief policy advisor for the Department for Medicaid Services in Kentucky.

Dr. Mayfield Gibson spoke to the children about smoking and chewing tobacco, one of Kentucky’s major health initiatives.

“We’re here today to show our young people we care about them,” said Dr. Mayfield Gibson, who is also the vice chair of the kyhealthnow oversight team—a statewide health initiative with a goal of reducing the percentage of children with untreated dental decay by 25 percent and increasing adult dental visits by 10 percent by 2019. “Kentucky sees mental, physical and oral health as just health.”
The children also won prizes for answering questions about their oral health, got to meet and take photos with Dee-Bo, the 3M Pit Bull mascot, and received brushing tips from dental hygiene students from the University of Cincinnati, University of Kentucky and University of Louisville.

The goal of GKAS, 3M ESPE Dental, ADA Foundation, Henry Schein Inc., CareCredit, Church & Dwight, and Oral Health America is to use NASCAR racing and Greg Biffle to get children excited about their oral health. During the 2014 NASCAR season, GKAS is bringing the Brush with the Biff program to 11 racetracks. At the Kentucky Speedway June 28, race fans of all ages visited the 3M display booth and received Church & Dwight SpinBrushes and ToothTune toothbrushes.

Dr. Rich and his son, Dr. Jonathan, took some time to hand out dental care kits and spread the ADA’s message of brushing for two minutes twice a day (2min2x.org) prior to the race.
“Tooth decay is totally preventable,” Dr. W. Ken Rich said. “If we’re constantly just filling teeth, we’re on the wrong end of the disease spectrum. These educational events bring the drawing power of NASCAR. Kids love cars. Kids love race car drivers. We put them together to educate children about oral health.”

The mission of educating children and race fans on good oral health will continue in Bristol, Tennessee, Chicago and Phoenix surrounding NASCAR races. Through a grant from the ADA Foundation made possible by funding from CareCredit and a grant from Healthy Smiles, Healthy Children: The Foundation of the American Academy of Pediatric Dentistry, students will have an opportunity to learn about Give Kids A Smile, Greg Biffle, 3M Racing and get smart dental tips that will improve their dental health, confidence, and ability to pay attention in school.

“Bringing the Give Kids A Smile program to Kentucky and Ohio helps create even more visibility and awareness for the Brush with the Biff education message,” said John Stefanick, director of industry relations for the 3M ESPE Dental Division. “And, being able to visit two schools helps expand our efforts to help children win the race for good dental health.”

For more smart dental tips, visit 2min2x.org, MouthHealthy.org and Facebook.com/GiveKidsASmile.

The National Quality Measures Clearinghouse announced in its April newsletter it has accepted the Dental Quality Alliance’s measures in its database.

The NQMC is a public resource for evidence-based quality measures and measure sets and is an initiative of the Agency for Healthcare Research and Quality, which is part of the U.S. Department of Health and Human Services. The NQMC also hosts the HHS Measure Inventory, which publicly lists the measures currently being used by HHS agencies for quality measurement, improvement and reporting. To view the measures, visit www.qualitymeasures.ahrq.gov and search for “Dental Quality Alliance.”

“The DQA has passed another milestone in its quest to develop usable quality measures for the oral health care system,” said Dr. W. Ken Rich, DQA chair. “Endorsement from the National Quality Measures Clearinghouse is essential for universal acceptance of DQA measures. The DQA remains a shining example of what can be accomplished when a diverse group of stakeholders work together to promote a common goal.”

The DQA, formed in 2008 through a request from the Centers for Medicare and Medicaid Services, is comprised of multiple stakeholders from across the oral health community who are committed to development of consensus-based quality measures. Last year, the DQA approved its first set of performance measures in dentistry—Dental Caries in Children: Prevention and Disease Management. View the measure set here.

The DQA is scheduled to meet at ADA Headquarters in Chicago on July 11 and discuss the submission of measures to the National Quality Forum and the future of the DQA.

For more information on the DQA, visit ADA.org/dqa.

Dr. Jones

Madisonville, Kentucky—Dr. Joseph W. Jones Jr., former ADA vice president, died July 14. He was 92.

Dr. Jones served as vice president on the ADA Board of Trustees from 1984-85. He also served as president of the Kentucky Dental Association, was a member of the KDA executive board and served as the state’s first speaker of the house from 1979-82.

Dr. Jones, who was born in Dawson Springs, Kentucky, in 1922, graduated from the University of Louisville School of Dentistry and received oral surgery training at Louisville General Hospital and the University of Alabama. He entered private practice as an oral surgeon in Madisonville in 1963.

Dr. Jones served as a captain in the U.S. Army from 1952-54 and was a member of the University of Alabama School of Dentistry faculty from 1957-60.

He married his wife, Martha, in 1945 and they had two children: Cynthia Ann and Joe W. Wilson III. Condolences can be sent to Mrs. Martha Jones at 1725 Hillcrest Drive E., Madisonville, KY 42431-2221.

Memorial contributions can be made in Dr. Jones’ honor to the Mahr Cancer Center, Baptist Health, 900 Hospital Drive, Madisonville, KY 42431 or by calling 1-270-825-5800. Visit the Mahr Cancer Center website for more information.