The Morning Drill: April 16, 2012

Good Monday morning!

On to today's dentistry headlines:

Dental school to be established

The state's medical school is taking steps to establish a dental school at its Little Rock campus.

Foundations have donated large sums to the University of Arkansas for Medical Sciences for its long-range plans to expand teaching at its school of dental hygiene and oral health clinics. It will take several years but eventually the goal is for Arkansas to have its own school of dentistry, which should go a long way toward alleviating the shortage of dental services in many parts of the state.

The director of the UAMS Center for Dental Education said it would take at least five years of preparation to establish a dentistry program.

Arkansas is one of 14 states without its own dental program. Arkansas college students who wish to study dentistry must attend programs in other states. The majority go to Tennessee.

The availability of dental services is best in suburban areas and worst in areas of poverty. The director of the Center for Dental Education said that there is a demand within the state for a dental program. An Arkansas school of dentistry likely will spread out the distribution of dentists throughout the state. Now, most dentists are clustered in the state's eight most populous counties and five rural counties in Arkansas have no dentist at all, he said.

SC sex offender dentist tries for full re-instatement

A Sumter dentist convicted of child molestation and found to have possessed child pornography 12 years ago is trying to regain the privilege he once enjoyed of practicing dentistry without restrictions or reduced restrictions, including treating children as patients.

The case of Russell Hurst Jr. is now playing out in the S.C. Court of Appeals, where his lawyer is arguing in a legal brief that Hurst has in effect been pronounced rehabilitated by a behavioral expert and should be free of all restrictions placed upon him by the S.C. Board of Dentistry – restrictions that currently allow him freedom to oversee a Sumter dental practice but only see adult patients.

Whatever the court decides, Hurst’s case offers a rare window into how the state’s regulatory boards that oversee high-paying S.C. professions such as dentistry handle one of their own when it comes to child sex abuse issues.

In Hurst’s case, a Board of Dentistry lawyer is arguing that although Hurst may have made substantial progress in overcoming whatever led him to be a child sex offender, the rehabilitation rate for people who molest children and have possessed child pornography is low.

“Recidivism should always be a concern in a situation where a person with pedophilia and ... acts as a health care professional and owns the practice,” said a Board of Dentistry brief before the Court of Appeals.

Thus, the restrictions Hurst currently has – including not treating children, undergoing regular polygraph examinations, not prescribing sedatives and not using office computers – should continue, the Board of Dentistry argues.

Hurst’s attorney said neither Hurst nor the partner in his dental practice would comment about the case.

The Hurst case began in 2000, when he pleaded guilty to three counts of committing a lewd act upon a child and one county of contributing to the delinquency of a minor, according S.C. Board of Dentistry findings and criminal records. None of the acts were committed at the office, according to the documents.

At the time, Hurst was the operator of a successful Sumter dental clinic. Hurst’s offenses included being found with numerous images of graphic child pornography on his personal computers and a computer in his dental office, according to legal papers.

Judge Thomas W. Cooper sentenced Hurst to 10 years in prison but suspended the sentence to five years’ probation provided Hurst met certain conditions. Those conditions included not having any position of authority over children, successfully completing sex offender counseling and having no contact with his male victims.

Texas hearing exposes ongoing dental board issues

The Texas State Board of Dental Examiners should address patient complaints faster and dentists' disciplinary actions should be more accessible, according to testimony from patients, dentists, and lawyers during a legislative hearing in Austin this week.

Legislators were also urged to increase oversight of corporate dental clinics, citing concerns that businessmen are exerting too much influence on patient care.

The complaints came during a hearing April 11 by the Public Health Committee, in which the dental board responded to recurring concerns about the difficulty of checking dentists' disciplinary actions.

A 2009 report by the Texas State Auditor's Office chided the board for failing to adequately regulate dental licenses and for not including the names of all dentists who had been disciplined in its database.

Continuing staff turnover has been part of the problem, according to the board's acting executive director, Glenn Parker, a chiropractor and former director of the state's Board of Chiropractic Examiners.

Parker took over as executive director of the dental board last month after Sherri Meek resigned in advance of the public hearing. Meek who cited "personal reasons" for her departure, is one of several dental board directors who have left in recent years.

Parker told committee members that the board doesn't have enough money to oversee nearly 60,000 licensees, including 15,000 dentists, 11,350 hygienists, 32,000 dental assistants, and 900 dental labs. In 2011 the board received almost $9 million in licensing fees but by state law was only allowed to spend $2.6 million to cover costs.

The board receives 500 to 600 complaints annually, which must be reviewed by two dentists, Parker noted. Currently there are 1,270 open cases, half involving standard-of-care issues, which are being handled by nine investigators.

"Should these cases be resolved faster? Absolutely," Parker told the Public Health Committee. "Sometimes people do what's easiest to do instead of what should be done."

ADA explores growth of large group practices

The ADA is taking steps to increase dialogue with large group practices and gather information regarding this rapidly expanding career option.

This sector of the dental workforce has experienced significant growth in a relatively short period of time. According to the ADA Health Policy Resources Center, in just two years the number of large dental group practices has risen 25 percent.

For now, it’s still a small piece of the overall dental delivery system pie. In a 2008 sampling frame, the Health Policy Resources Center concluded that solo dentist practices account for 92 percent of all dental practices, and very large group practices with 20 or more dentists make up only 3 percent.

However, in analyzing its data on individual dentists, the HPRC has concluded that the rate of solo practitioners is falling. In 2010, 69 percent of dentists were solo practitioners compared to 76 percent in 2006.

There are many factors fueling the growth of large group practices supported by dental service organizations, and this practice type has many implications for the profession and organized dentistry. A key aspect of large group practice that sets it apart from traditional dental practice is ownership. Dentists in these settings may have an ownership stake, or part of an ownership stake, but many are employees of the practice. The group practice model offers many benefits to employee dentists that are similar to ADA membership benefits, too. With this segment of the dental profession growing, how can the ADA remain relevant to dentists in large group practice settings?

Enjoy your morning!