The Saturday Drill: June 11, 2011

A collection of dentistry and health related links/comments for your day.

Government lists formaldehyde as cancer causer

The strong-smelling chemical formaldehyde causes cancer, while styrene, a second industrial chemical that's used worldwide in the manufacture of fiberglass and food containers, may cause cancer, the National Institutes of Health says.

The NIH said Friday that people with higher measures of exposure to formaldehyde are at increased risk for certain types of rare cancers, including those affecting the upper part of the throat behind the nose.

The chemical is widely used to make resins for household items, including paper product coatings, plastics and textile finishes. It also is commonly used as a preservative in medical laboratories, mortuaries and consumer products including some hair straightening products.

The government says styrene is a component of tobacco smoke, and NIH says the greatest exposure to the chemical is through cigarette smoking.

The two chemicals were among eight added to the government's list submitted to Congress of chemicals and biological agents that may put people at increased risk of for cancer.

Drilling Away at Dental Costs

If you lack dental insurance or have a skimpy policy, your options for scoring a better dentistry deal are growing.

More insurers are offering individual dental coverage. Others, such as Aetna and Cigna, are stepping up their efforts to help members with certain medical conditions prevent tooth and gum problems that can wreak havoc on their overall health -- and lead to costly dental and other health-care bills. Meanwhile, a new website called Brighter.com offers members discounts at participating dentists.

About 10 million Americans have lost their dental insurance in the last few years as the recession weakened the reach of employer plans, the dominant source of coverage. Fifty-four percent of people had some form of dental benefit in 2009, down from 57% between 2006 and 2008, says Evelyn Ireland, executive director of the National Association of Dental Plans, a Dallas-based trade group.

Exercise Reduces Silent Brain Infarcts

Older people who exercise regularly may be less likely to develop silent brain infarcts, considered hallmarks of subclinical cerebrovascular disease.

"Encouraging older people to take part in moderate to intense exercise may be an important strategy for keeping their brains healthy," lead investigator Joshua Willey, MD, from Columbia University in New York, said in a news release.

His team's new study was published online June 8 in Neurology.

"These silent strokes are more significant than the name implies because they have been associated with an increased risk of falls and impaired mobility, memory problems, and even dementia as well as stroke," Dr. Willey said

Dental Pilot Program Bill Passes Budget Committee After Three Contentious Votes

Sen. Laurie Monnes Anderson (D-Gresham) and fellow legislators think that Senate Bill 738 will address, for the first time in years, an “extreme need” to provide better access to dental care throughout Oregon, particularly in rural areas.

That bill would fund pilot projects across the state, offering dental services to people whose incomes fall below the federal poverty level, by expanding the scope of practice of dental hygienists.

The bill passed out of the Joint Ways and Means Committee this morning after almost failing on Wednesday and being the subject of three contentious votes today.

When the Joint Ways and Means Committee voted on Wednesday, the bill received a split 12-12 vote, with Rep. Mary Nolan (D-Portland) absent. Nine Republicans, as well as three Democrats representing rural areas, voted against the bill.

Typically bills that receive a split vote do not survive, but Rep. Tina Kotek (D-Portland) changed her vote from “yes” to “no,” a procedure allowing for the bill to be reconsidered.

Kotek made a motion to reconsider the bill, but Republicans tried to stop it by objecting to the motion on parliamentary grounds.

Sen. Fred Girod (R-Stayton) objected on the grounds that a member of the House--Kotek--filed the motion to reconsider a bill that is a Senate bill. He argued that because the motion was not served from a Senator, Kotek's motion was invalid.

"We need to allow bad bills to die and not have someone drop a vote so they can move it to the floor," he said. "I would ask my colleagues on the House side who are Republicans to stick with me on this procedure."

Girod's motion to reject the motion failed, only receiving seven votes. Kotek's motion for reconsideration passed, and received votes from two Republicans.

Then there was a third vote to pass the bill out of the committee so it can proceed to the Senate and House floors. The bill passed out of the committee 17-8.

The bill was not expected to hit the rocky road that it did in the committee, but it was the subject of a short but passionate debate about scope of practice issues on Wednesday.

Girod, who filed a potential conflict of interest because he is a dentist, spoke passionately against the bill when it first came up for a vote on Wednesday.

He believes it will expand a dental hygienists’ scope of practice so much that it will fundamentally change his profession for the worse, by allowing “people who are not allowed to practice dentistry to practice dentistry.”

“For some reason, this committee thinks that any moron can do dentistry,” Girod told his colleagues. “I dare someone to look in the mirror work backwards in a mouth that has saliva, a tongue that won’t sit still, and try to cut [in the mouth]. It is not that easy.”

He argued that it’s just as inappropriate to expand a dental hygienists’ scope of practice as it would be to expand a nurse’s scope of practice to practice medicine.

Enjoy your Saturday drill!

The American Dental Association Responds to American Association of Public Health Dentistry Curriculum Guidelines for the Training of Dental Therapists

From the Journal of Public Health Dentistry

Remember the issue?

Well, today the American Dental Association weighed into the flap (the entire statement).

The American Association of Public Health Dentistry June 3 announced the publication of a series of papers that highlight curriculum guidelines for the training of dental therapists.

“AAPHD believes that adding dental therapists as members of the dental team may help meet growing U.S. oral health needs, particularly among underserved populations,” read a news release from AAPHD.

The proposed model curriculum is based on a two-year, post-secondary training program. AAPHD credits the papers to an 11-person academic panel “selected for expertise, experience and in-depth knowledge of dental education.” Its work was funded in part by the W. K. Kellogg Foundation and the Josiah Macy Jr. Foundation.

In response, the American Dental Association issued a statement saying that the ADA remains committed to its position that only dentists should perform irreversible/surgical procedures.

“Lawmakers, charitable organizations and other stakeholders—some of them with very little experience in or understanding of oral health care—are proposing various models for so-called ‘midlevel’ dental providers, nondentists who would perform surgical/irreversible procedures,” said the ADA in a statement.

“To date there has been no consensus on the specific prerequisites, scope or duration of educational program, or other critical attributes needed to define any academic model,” said the ADA. “While we appreciate the work that went into [the AAPHD papers], we disagree on a critical point: The ADA does not believe a nondentist should perform surgical/irreversible procedures.”

The ADA further explained why it has taken an approach to workforce needs that emphasizes oral health care and prevention.

“The ADA supports innovations in the dental team that would improve oral health among people who lack adequate access to care, provided that those innovations do not compromise the very system they seek to extend. Our own Community Dental Health Coordinator pilot project seeks to do that by training community health workers who specialize in oral health education and disease prevention, factors that ultimately are the nation’s best hope of ending what we all agree are unacceptable levels of oral disease.”

The AAPHD papers cover principles upon which a dental therapy program should be based; recommended length of training; competencies required for graduates; and general curriculum content. The panel considered the course of study for dental therapists in programs already in the United States (Minnesota and the Alaska Native Tribal Health Consortium/University of Washington program) and throughout the world.

“The AAPHD brought together this panel of academicians and highly respected authorities in dental education to determine an appropriate course of study to be included in a two year education program,” said Dr. Caswell Evans Jr., associate dean for prevention and public health sciences at the University of Illinois at Chicago and convener of the panel.

“There has been a growing interest in adding a new oral health professional designation to the dental workforce by both state and federal legislatures,” said Dr. Evans. “The AAPHD and the panel it convened believe that such a designation could add value to the dental profession as a whole, and could assist the profession in its efforts to improve access to care for difficult-to-reach sectors of the population.”

“AAPHD took on the charge of developing a model curriculum because of the increasing interest in the states and the need to standardize training to assure accreditation of programs, as well as develop a career path for entering the profession to best serve the oral health needs of all populations,” said AAPHD President Diane Brunson, RDH. “We believe that the expert panel recommendations, used as a model to build on, will assure that curricula from school to school and state to state are consistent, of high quality and will pave the way for national accrediting.”

Despite the differences of opinion on the issue of midlevel providers, the ADA reiterated its support for AAPHD in its efforts to improve the nation’s health.

“The majority of dentists who belong to the American Association of Public Health Dentistry are also members of the ADA,” said the ADA in the statement. “They provide valued perspective and resources to our advocacy on behalf of the nation’s oral health. The ADA historically has been among their greatest supporters and advocates, and we will continue to be so. We will continue to work with the AAPHD and all interested stakeholders toward the goal we all share—a healthier more productive nation.

“But, in doing so, the Association will not erode its unequivocal opposition to nondentists performing surgical/irreversible procedures, or to other proposals that we believe run contrary to the public good.”

The entire collection of papers is available online at: http://onlinelibrary.wiley.com/doi/10.1111/jphd.2011.71.issue-s2/issuetoc.

The papers will also be published in a special issue of Journal of Public Health Dentistry in June.

All bold emphasis above is mine.

Game on for the battle of midlevel dental providers (dental therapists) - a dentistry turf war.

One one side will be public health dentists, large charitable foundations like the W.K. Kellogg Foundation and the Josiah Macy Jr. foundation and on the other organized dentistry, namely the American Dental Association.

This turf war will pit organized dental hygienists, and public health dentists against organized private practice and publicly employed dentists. The battle will be fought in state legislatures throughout the United States.

Stay tuned.......

American Association of Public Health Dentistry Publishes Dental Therapist Curriculum Guidelines

Actually it is a special edition of their journal, Journal of Public Health Dentistry.

A renewed interest in finding ways to improve access to oral health care has emerged in the United States since the publication of the Surgeon General's report on the oral health of the nation in the year 2000. This special issue of the Journal of Public Health Dentistry calls upon the reader to consider several pertinent matters in developing educational programs for dental therapists, a well-established provider of oral health care in many countries used to reach underserved populations. While the addition of dental therapists is controversial in the field of dentistry, other types of mid-level providers have been used in providing medical care. For example, currently, there are mid-level nurse practitioners, physician assistants, and certified registered nurse anesthetists. Emergency medical technicians are sometimes included in this classification as well. Mid-level providers can examine patients, diagnose them, and provide some treatments, all of which must be signed off by a supervising licensed physician.

While debate continues in the field of dentistry about the benefits of adding a mid-level provider to the workforce to reach the underserved, dental therapists are being trained and deployed in two states. The Alaska Native Tribal Health Consortium has educated and deployed dental health aide therapists (dental therapists) in several communities in remote areas of Alaska. Legislation in Minnesota permits the education of dental therapists, and models of training have emerged, one at the bachelor's degree level and the other at the master's degree level. Some of the students enrolled in the Minnesota programs will soon graduate and become part of the workforce in that state. In addition, several states have indicated interest in adding dental therapists to the workforce.

It all sounds good, just like ObamaCare does/did and I will review some of the contents of the AAPHD report over the weeks and months ahead.

But, many questions remain.

In the meantime, who is going to hire or who is going to pay dental therapists to practice?

The federal or state governments, who are broke? Or ,will the dental therapists compete directly with better and more comprehensively trained dentists and offer their services for less?

As, I said, many questions remain and organized dentistry will be opposed all along the way in this dental turf war.