It’s Really Just a Conversation! 5 Easy Steps to Help Your Team Resolve Conflict!

May 6th, 2013

Head in the sand

By Judy Kay Mausolf

Unless you live in some remote jungle or under a rock and only work with plants you will probably interact with lots of other people during your lifetime.  The people I am talking about are not the strangers you make brief eye contact with for a second or pass in a hallway.  I am referring to the people you consistently interact with on a daily basis.  Your success depends greatly on these relationships!  Life would also be much more enjoyable if conflict did not exist between you and them.  But that isn’t real life!

The problem is that many of us go thru life trying to avoid dealing with conflict out of fear!  We hope it will just go away!  But the more we try to avoid it the more it builds until eventually it escalates to a point to where there is serious damage to the relationship.

Our fear of conflict is the problem, and it seems bigger the more we dwell on it.   Here is the funny thing… fear is really only a negative prediction about the future and not reality.  Whether or not we take action is governed by a simple ratio: our perception of danger versus our confidence in our ability to handle the conflict.

If we believe we can resolve the conflict, the amount of fear we feel is minimized and we will take action.  This is why it is so important to teach our teams the mindsets and skill sets they need to give them confidence that they can handle conflict.

The first step is to start with our mindset about conflict!  If we tear it apart; conflict is really just conversation where there is a disagreement because of a difference of opinion or expectation!  So what is so scary about talking about a difference of opinion or expectation?  We can eliminate the negative emotional energy from the conversation by coming from a place of care and concern instead of judgment and criticism.

Next step is the skill sets!  The following 5 step process will give our team the skill sets they need to successfully resolve conflict.  It will change the focus of the conflict conversation from who did what wrong to what we can do in the future!

Here are 5 easy steps to help your team resolve conflict!

  • Set up time to meet with the person you have a concern or conflict (they may not have time right at the moment) and don’t tell anyone else!
  • Be open and listen; don’t come to the table with the solution, you don’t know the why behind their reasons.
  • Don’t personalize; instead of saying you did this, say I am not sure what you meant by…or can we talk about what happened today?  Talk about the situation and not the person.
  • Focus on the solution, what can be done to prevent in the future versus who did what wrong.  It will not be perfect for anyone, but can be good for everyone.
  • If you can’t resolve; all team members involved meet together with whoever handles conflict resolution and agree on a solution.

It is so important to teach our teams the mindsets and skill sets they need to give them confidence that they can handle conflict.

Ta-dah!  Conflict resolved now onto more enjoyable relationships!

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Judy Kay Mausolf owner and president of Practice Solutions Inc, is a dental practice management coach, speaker and author.  She coaches dentists and managers who want to grow their practice by becoming better leaders, getting their teams to work together better, communicating more effectively and creating a practice environment they enjoy coming to! She is President of National Speakers Association Minnesota Chapter, member of the National Speakers Association, Academy of Dental Management Consultants, Speaking Consulting Network.  She is author of Rise & Shine; An Evolutionary Journey to Get Out of Your Way and On Your Way to Success, and a contributing author for many dental magazines.  She also publishes a monthly newsletter entitled “Show Your Shine”.

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There is No Excuse for No Dental Care – Overcoming Dental Phobias

April 2nd, 2013

Scared girl at Dentist's teeth checkup

By Harvey Levy, DMD, MAGD

I have been practicing clinical dentistry and been on this planet long enough to have heard every reasonable excuse for avoiding dental care. I have yet to hear a good one.

Our dental practice has successfully treated thousands of phobic, anxious, mentally challenged, autistic, and medically compromised patients. We’ve been able to accommodate infants through Alzheimers patients. What I have learned is whatever the reason given for avoiding the dental office, there’s always a way to overcome the problem.

Are you afraid of the dentist? Perhaps a dry-run walking through the office will calm you down, or learning more about the treatment using videos or demo models will make you less afraid. If it doesn’t, we can prescribe pills or liquid drugs that you can take right before your appointment. If you’re even more apprehensive, you can also take an oral sedation pill before going to bed the night before your appointment, and be treated with nitrous oxide (laughing gas) to relax you during treatment. Other options to deal with anxiety include behavior modification, hypnosis or acupuncture.

If your loved one is an infant, or is mentally challenged, autistic, or suffers from Alzheimers, they can and should still receive effective dental treatment. Intravenous sedation can be offered in an office setting, or these patients can be treated in a hospital or surgical center operating room. There, the patient is totally asleep while all the needed work is being performed, and has no recollection when they wake up.

An extremely anxious patient can also be treated in this manner, with the advantage that work that would typically require multiple office visits can be successfully performed in only one visit to the O.R.

If you cannot come to the office due to mobility issues, age, or medical complications, dentists with portable equipment can come to you, be it in a nursing home, private home, institution, or in-patient facility. Mobile vans are fully equipped to handle most dental problems. Mobile teams use hand-held x-ray units with self-developing films or laptop instant imaging systems to diagnose problems. Portable x-rays with protective radiation barriers, are coupled with mobile dental carts, and provide the same dental procedures available at the office.

Whatever reason kept you or your loved one away from the dentist, the road back is readily available and easier than you think! Over the past 38 years our practice has successfully performed over 32,000 oral sedations in our office. Three percent of the time, oral sedations at our office couldn’t be done, or failed due to autism, severe combativeness, or major medical concerns. All those patients were able to receive treatment, safely and successfully, with the help of an anesthesiologist in a hospital operating room.

Whatever excuse I hear for someone not going to the dentist, know that there’s always a way to overcome it. What is not acceptable are the complications resulting from the lack of dental care – from bad breath to infections that start in the mouth and threaten your health.

 

LevyHarvey Levy, DMD, MAGD is a 1974 Tufts Dental graduate who practices general and hospital dentistry in Frederick, MD. He holds eight fellowships, four diplomats, Board certification in Integrative Medicine, and has earned Mastership and three Lifelong Learning Service recognition awards from the Academy of General Dentistry. He is a recipient of the ADA Access to Care Award, the AGD Humanitarian Award, the Maryland Governor’s Doctor of the Year Award, and ran the 2002 Winter Olympic Torch in honor of his dental care for special-needs patients in Maryland. He has written and lectured extensively on management of anxious and special-needs patients. For more information, visit  www.DrHLevyAssoc.com or contact him at drhlevy@gmail.com

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The Ethical Case for Confidentiality

March 6th, 2013

By Gary T. Chiodo, DMD, FACD and Phyllis Beemsterboer, EdD

 

All health care providers are well-aware of the legal protections extended to patient information via the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule.  With few exceptions, all information that patients provide to us in the form of their medical history and all data related to the care we deliver to them are protected by the HIPAA rules and may not be released to any third party without patient consent and authorization.  While HIPAA may impose strict legal parameters on how patient information must be protected and how it may be released, there are ethical obligations that provide even more persuasive arguments for the bond of doctor-patient confidentiality.  These ethical obligations are based in the ethical principles of respect for autonomy and nonmaleficence.

Respect for autonomy is the ethical principle that allows, with few limitations, patients to determine what will and will not be done to their bodies.  In normal health care practice, patient autonomy is facilitated and respected through the process of informed consent.  The well-informed patient who has capacity to consent has the right to select from various treatment options, the treatment or treatment plan that is most concordant with his/her values and wishes.  Because the informed consent process is essential in this dynamic, health care professionals must collect and analyze complete information about the patient.  For example, surgical options for repair of a periodontal defect may very well change if the dentist knows that the patient has a bleeding problem.  Plans to remove teeth may be mitigated by a history of bisphosphonate therapy.  In cases like these, patient autonomy cannot be truly facilitated and respected unless the dentist has complete and accurate information about the patient’s medical conditions and history.  If the patient is not entirely comfortable with complete disclosure because he/she doubts that confidentiality will be respected, then important information may be withheld.  When this happens, not only will the patient’s autonomy be compromised, but the dentist’s obligation of nonmaleficence, or avoiding harm to the patient, will be in jeopardy.  While most patients would not be reluctant to reveal a bleeding problem or a history of bisphosphonate therapy, some may hesitate to reveal things they consider to be embarrassing or intensely personal.  For instance, the patient who is receiving treatment for mental health issues or chemical dependency may opt to omit that from the medical history out of concern that it will not be treated with strict confidentiality.  The male patient who is using a phosphodiesterase-5 inhibitor on occasion, may decide to leave that out of his medical history so he does not need to worry about who may have access to that information.  A young woman who takes a hormonal contraceptive may decide that her dentist simply does not need to know that.  While we are well-aware of the potential harms that may come to patients when we do not have complete medical information, patients are less likely to appreciate those harms or, if they are aware of them, may simply decide to keep the information private and accept the risk.

Part of the challenge in obtaining complete and accurate medical information from our patients comes from making sure they understand why we need this information and this process takes chairside time.  However, another important part of the challenge is in ensuring that they trust us to keep it strictly confidential.  If we are not successful in creating that trust, critical information may be withheld and we will not be able to meet our ethical obligations of respect for autonomy and nonmaleficence.  In the best case scenario, breaching confidentiality will result in a patient who feels betrayed and goes elsewhere for care.  In the worst case scenario, the patient will develop a lack of trust in other health care providers, will withhold vital information, and will be seriously harmed.  If we emphasize the protections that we afford their personal information and assure them that they may trust us to keep it strictly confidential we are honoring our ethical principles and serving our patients best.

 

 

Gary Chiodo, DMD, FACD is currently the interim dean at OHSU School of Dentistry. Most recently, he served as the Chief integrity Officer for OHSU, a position he held for 10 years. He is a professor of Community Dentistry and Association Director of the Center for Ethics in Health Care. Dr. Chiodo received his Certificate in Health Care Ethics form the University of Washington School of Medicine in 1992.

 

 

 

Phyllis L. Beemsterboer, MS EpD, FACD is a Professor and Associate Dean for Academic Affairs in the School of Dentistry at OHSU in Portland. She is and associate director in the Center for Ethics in Health Care at OHSU and co-chairs the inter-professional ethics education program. Her research interest is in bioethics education and she is currently president of the American Society For Dental Ethics, a special section of the American College of Dentists.

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My Greatest Reward

February 4th, 2013

Dr. Stacy Geisler

July 7th, 2011 began like any other day for me. I remember that there was a beautiful  sunrise that morning. I had a compressed, busy schedule in my oral and maxillofacial surgery practice in Lake Oswego. “We have a trauma patient coming in, Doctor” my front staff informed me when I arrived at my office. We already had fifteen patients scheduled that morning for me to see, three of whom were surgery patients. How would I find the time to see this other patient?

My add on trauma patient turned out to be a wonderful woman named Sunny. From my first meeting with her, I could see why her friends had given her this affectionate nickname. Sunny has a type of effervescence which surrounds her. Joy bubbles out of her. You can’t help feeling good just by being in her presence.  At this first meeting, I was struck by her amazingly positive attitude. It was hard for her to speak clearly because part of her upper right jaw was missing. She kept holding up her hand to hide the right side of her face. Slowly she was able to tell me her story.

Sunny had been at an outdoor function with her soon to be husband on a Saturday afternoon. As she was walking along an unfamiliar path, her foot slipped and she went down. This happened so quickly that she was not able to break her fall, but landed on her right face against a curb. Stunned and bleeding profusely, she sat up. Part of her upper jaw was missing. Looking down, she saw what she thought were bits of bone and tooth on the ground.

Sunny’s partner took her immediately to the closest emergency room for care. They were hoping to have a diagnosis made and treatment. An exam was performed as well as imaging studies.  Since this hospital was not part of Sunny’s health maintenance organization (HMO), she was told by the emergency room to contact the HMO for definitive care. When she called the HMO that evening, she was told that she would have to wait a week for an exam and treatment (she was told this is their policy to allow for swelling to resolve). When Sunny was finally able to see a surgeon at her HMO hospital, it was six days later. The surgeon told her that she had a dental injury and would need to follow up with her dentist. There wasn’t anything he could do for her. She was sent home with a prescription for Amoxicillin.

Sunny called her dentist from the parking lot of the HMO in tears. She knew that something was seriously wrong with her and she was struggling to understand why she couldn’t get the care she needed. Her dentist’s receptionist asked her to come in to his office immediately. When the dentist saw Sunny, he knew that this was more than a dental injury. He could see that part of her upper jaw appeared to be missing, as well as teeth in the anterior maxilla. His office called my office, thus the “add-on” patient for an already busy morning.

Examination of Sunny demonstrated a severe, avulsive injury involving the right anterior maxilla. Computed tomography scanning performed at the emergency room six days previously demonstrated fractures extending through the frontal process of the right maxilla, including the anterior nasal spine and vomer. She had fractured teeth #7 and #8 which were displaced into the right maxillary hard palate and not visible in the oral cavity. Tooth #9 also was extruded and was in hyperocclusion with her mandibular dentition.

Sunny’s dentist had sent electronic records for me to review and I was able to review her CT scan. I was stunned by the severity of her injury. At this point in my career, I have seen many, many things. Not much surprises me any more when it comes to the maxillofacial skeleton. But I was not prepared for how bad this injury was given the mechanism of injury. What Sunny had was more similar to a gun shot wound without the accompanying soft tissue devastation seen with a high velocity injury.

I knew that Sunny needed surgery and that she needed it soon. I also knew that she needed to be asleep for what I was planning for her. Since she had eaten that morning, we scheduled her for surgery the next day. I explained to her the nature of her injuries, that the wound needed to be cleaned, the broken bones stabilized and the damaged teeth removed. I explained that she might need root canals on some of her other teeth, and that she might require more extensive reconstructive surgery to rebuild the missing part of her jaw. I told her that she would also probably require dental implants since her teeth were damaged beyond repair. I prescribed antibiotics and pain medication for her to begin immediately. Sunny agreed to everything that I suggested. One concern was her upcoming wedding. Could I have all the reconstruction done in time for her wedding which was scheduled for December 2012? I told Sunny that I would try my best.

Over the next year Sunny underwent several surgeries to rebuild her maxilla. We began with debridement and fixation of broken bones. As I suspected, the right anterior maxilla had been pulverized by her fall and her wound was quite dirty. I found pebbles and asphalt at that first surgery.  I confirmed that Sunny would require a large bone graft to reconstruct her upper jaw if she ever had any hope of having a normal facial appearance. Hip grafting to the right maxilla was completed in February of 2012 and three dental implants were placed in June 2012.

Sunny handled all aspects of her year long reconstruction with grace and humor. She is a third grade teacher and saw an opportunity to use her injury to teach her class of eight year olds about anatomy and jaw reconstruction. She told me on one follow up visit, “I took out my prosthesis and showed my students how I was missing teeth, just like them. The kids loved it and had all kinds of questions about how my teeth would be put back. They couldn’t believe that part of my hip would become my new jaw!”

It was an amazing privilege to provide surgical care for Sunny following her facial injury. I feel so grateful that things went well: healing progressed as expected and we achieved the outcomes we were hoping for.  I can’t claim sole responsibility for her healing. Sunny’s reconstruction was brought about by a dedicated group of professionals whose sole goal was to restore her to health.

Sunny’s health maintenance organization initially denied medical  benefits for her reconstruction. Several letters were written from those involved in Sunny’s care and eventually she received the benefits needed to cover the cost of her reconstruction. Martha, my front office insurance expert, was instrumental in making this happen. I am grateful to Sunny’s dentist who recognized that she needed speciality care. I also feel lucky to have such a positive working relationship with Dr. Scott Dyer, who handled Sunny’s prosthodontic reconstruction.

Sunny recently stood before her friends and family as a bride and made a commitment to her partner just a few weeks ago. She told me via email “The wedding was spectacular and everything that we had both hoped for.” For a surgeon, there just isn’t any higher reward than that.


Stacy Geisler, DDS, PhD is a board certified oral and maxillofacial surgeon practicing in Lake Oswego, Oregon. She lectures extensively throughout the Pacific Northwest and is known for providing outstanding surgical care of her patients. Dr. Geisler serves as an evidence-based reviewer for the JOurnal of the American Dental Association and has had numerous peer-reviewed publications.

 

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An Analogy of Tooth Decay – How our Teeth Stay Strong

January 7th, 2013

Dr. Terri Baarstad

I have a little analogy that I use with my patients that seems to help them understand. I say something like:

There are bacteria in your mouth that “eat” carbohydrates. These bacteria have waste products and those waste products are acidic. Acid “dissolves” our teeth and makes it so we get cavities.

Imagine that your teeth are brick walls. They have all these bricks going in and out of the wall all the time- they are not static, they change. So when your mouth is at PH7 –that is neutral- the bricks go in and out at the same rate- there is no net change. Teeth stay healthy. But, when you eat or drink anything that has carbohydrate (sugar, bread, pretzels, even croutons) the PH of your mouth drops and the environment becomes acid. When your mouth is in acid- more bricks go out than come back in, so there is net loss of tooth structure. It takes about 20 minutes for your mouth to return to neutral after eating, so, if you are snacking, taking a bite or a sip of a soda pop every few minutes over an period of time, say 2 hours, then your mouth will be in acid for 2 hours and 20 minutes. If this occurs regularly over time, there is more net loss of “bricks” and eventually there begins a cavity. Once the cavity begins there is more acid because the bacteria have multiplied and they make more acid, leading to more cavities. The cure for the cavity is to have it treated with a filling or a crown. But the cure for not getting more cavities is reducing “exposure” to the acids. Fluoride on and in the teeth is like having mortar for those bricks- it makes it so much more resistant to acid.

Knowing the way that teeth “dissolve” you can understand what might help slow down this process

If you brush your teeth, chew sugarless gum, or rinse vigorously with water after eating, the Ph raises to neutral more quickly. Conversely, a dry mouth doesn’t return to neutral very quickly. The dry mouth patient is also at a higher cavity risk because the acid is that much more concentrated. Water, mints and gum, or even a change of medications might be in order.

Since it is all about acid, and acid comes from bacteria, and the bacteria live in plaque, reducing plaque (by brushing and flossing) reduces acid and therefore cavities. Xylitol (gum and mints) reduce bacteria and increases saliva flow, thereby minimizing acid exposure. Eating your food less frequently (eating the entire candy bar or drinking the entire soda all at once) will decrease exposure time, thereby reducing the risk.

 

Dr. Baarstad appreciates the value of community service, and devotes herself to improving the dental health of those who live around her.  After attending the University of Oregon, Dr. Baarstad graduated as a DMD from the Oregon Health Sciences University in Portland. She is an active member of the American Dental Association, the Oregon Dental Association and the Academy of General Dentistry, and a recipient of the Dr. William Howard Award for Excellence in Fixed Prosthetics. She donates services to charitable organizations and sponsors many community events, including high school fundraisers. Dr. Baarstad expresses a special interest in helping young men and women explore a career in dentistry through volunteering at local high school career symposiums.

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Oral Health: A Window To Drug Addiction

October 8th, 2012

By: Victor J. DeNoble, Ph.D. & Kimi F. DeNoble, MS

Research has shown that oral health problems are very common among people who are addicted to drugs.  Many abused drugs produce chronic tooth decay, cracked teeth, gingivitis and other forms of gum disease.  For example, alcohol is high in sugar which contributes to an increase in tooth decay and frequent chronic consumption can de-mineralize tooth enamel.  Stimulants like ecstasy, amphetamines or cocaine cause severe clenching and grinding of teeth, as well as dry mouth when the individual is under the influence of the drug.  Users of stimulants are also known to have a high intake of sugar.  This combination of side effects can cause serious tooth decay.  Methamphetamine prevents saliva from being produced that results in a condition called “meth mouth” which is characterized by discoloration, rotting and broken teeth, as well as  extreme tooth decay.  The chemical composition of methamphetamine includes a wide range of highly toxic chemicals such as lithium, and muriatic and sulfuric acids all of which are highly corrosive.  Tobacco can cause a wide range of oral problems such as delayed wound healing, sinusitis, soft tissue damage and oral cancer.

Because the relationship between substance abuse and oral pathology is well documented, the dental visit can provide the ideal setting for drug abuse identification and intervention.  In addition, having an understanding drug addiction will assist dental professionals in making decisions when medications with potential for abuse are being considered as part of the overall treatment paradigm for these patients.

Years ago, drug addiction was viewed as a character flaw, an inability to control one’s own behavior.  Today, we know that drug addiction is a disease.  Further, it is a self-inflicted disease; no one addicts us, we addict ourselves.  The motive for drug addiction varies from person to person but the decision to use and eventually abuse the drug is still an individual choice.  Drug addiction is not an event that happens all at once.  It’s a biochemical process that takes time and will eventually result in long-term changes in brain function.  These changes are the underlying mechanism for compulsive drug abuse.  The time it takes to complete this biochemical change varies for each drug.  For some drugs like methamphetamine or crack cocaine, the brain changes can occur in one to three weeks. However, with other drugs such as alcohol or tobacco, the process can take several months.  No matter how long or short the process is the first time, re-addiction for all drugs is fast – - sometimes it can occur within a day.  Therefore, once you are addicted to a drug, you are at risk for re-addiction for the rest of your life.  This makes the choice of pain management medication in dental and medical procedures more difficult.

Everyone is born with specific areas of the brain that recognize and respond to addictive drugs; therefore no one is immune from addiction.  In fact, we are all at risk for addiction.  Once an addictive drug enters our blood, it will be transported to the brain and the process of altering brain function begins.  But why do people use addictive drugs?  Simple.  Addictive drugs make us feel good, at least for a brief period of time.  The major neurotransmitter mediating the addictive process is dopamine.  Dopamine has a wide range of functions in the brain, however, the feeling of happiness is mediated in the mesolimbic system. The mesolimbic system is commonly called the “pleasure center”.  When dopamine levels are normal, we feel comfortable.  If they fall, we can be depressed and, if they rise sharply, we can experience euphoria.  All drugs that are addicting change the way dopamine functions in the mesolimbic dopamine system.  The mechanism for dopamine alteration for each addictive drug is different.  These different mechanisms explain why we can be addicted to several drugs at the same time.  Unlike the normal release of dopamine, when drugs are used to activate this system the resulting dopamine response goes far beyond what the system is supposed to produce and the process of addiction begins.

Addictive drugs make us feel good but the feel good feature of these drugs does not lead to health problems.  Aside from the oral manifestations, these drugs have a wide range of pharmacological side effects that have  other health consequences.  For example, cocaine makes us feel good for about 40-60 minutes, however, the side effects of cocaine put the user at risk for potential life threatening conditions for days.  Atrial fibrillation induced by cocaine has been shown to last for up to 3 days whereas cocaine is metabolized and excreted within 24 hours.  Cocaine renders the addict at risk for heart attacks, strokes, kidney failure and pulmonary embolisms.  Each addictive drug has its own constellation of unique side effects that can be further reviewed at the National Institute of Drug Abuse website.

Research has shown that drug addiction results in dental complications many of which will appear before other less visible complications, e.g., organ failure.  Since many Americans visit their dentists more often than they visit their physicians, dental professionals have an increased likelihood of detecting drug abuse and therefore an increased potential for intervention.

 

Dr. DeNoble has a Doctorate in Experimental Psychology from Adelphi University, NY and two postdoctoral fellowships from NIAAA and NIDA.  He was recruited by Philip Morris to study the behavioral and physiological effects of nicotine on the brain.  He subsequently conducted drug discovery research in CNS diseases for the pharmaceutical industry.  In 1994, after a congressional release from a confidentially agreement with Philip Morris, he testified before Congress and became a key witness in the federal government’s case against the tobacco industry. Currently, he is the Vice President of Hissho, Inc., a scientific and medical communications company.

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Cavity Management by Risk Assessment Improves Access to Care

October 1st, 2012

By Dr. V. Kim Kutsch, DMD

Recently PBS broadcast a Frontline special report entitled “Dollars and Dentists”. The report presented a “broken dental system” in the US, amidst a rising epidemic with decay. PBS actually did a very good job describing the current issues facing dentistry today: rising healthcare costs, increasing decay rates in children and adults, limited access to care, an entitlement system that doesn’t adequately reimburse private practitioners, and corporate America seeing a profit opportunity in treating (mistreating) these children, and the concept of mid-level providers to help solve the access issue. However, the report failed to examine the real issues at play, and missed a huge opportunity to report the truth.

Here are the facts: the decay rate in our small children is rising at epidemic proportions, there is limited access to care, but the focus of the system is still in the wrong place. The Medicaid system will reimburse for crisis care for a child in a hospital setting to the tune of $12-18,000, and again when the same child needs the same procedure 20-24 months later, but won’t adequately reimburse a private practicing dentist to provide the necessary preventive management to avoid the crisis in the first place. What part of this expensive, out-dated system should we consider successful?

Corporate America got involved and suddenly there is an increase in the number of stainless steel crowns being placed on these children and less preventive services. Is anybody really surprised by that? The system rewards placements crowns but doesn’t adequately compensate a private practitioner to provide real preventive care and counseling. What might happen if the system paid $300 for fluoride varnish, professional therapy products, and nutrition counseling and $30 for a stainless steel crown?  There would be a lot fewer stainless steel crowns and there might also be fewer $18,000 crisis scenarios and better treatment outcomes.

Organized dentistry provides a lot of free care to help with the epidemic, take the success of the MOM program for example, or Donated Dental Services. Or consider the fact that individual dentists routinely provide pro-bono care to people in need. This was never mentioned in the report, but we all donate care as best we can. Unfortunately it still isn’t enough for the crisis we’re in.

Dr. Bob Barkley summed it up pretty accurately over 40 years ago. The problem we have is the house is on fire, and we’re trying to solve the problem with carpenters. We need to send in the firemen. The bottom line is dental caries is a multifactorial, complex, pH-specific biofilm disease. Too late we’ve learned that the drill has little to do with actually treating the disease. Increasing the number of Pediatric Dentists, operating suites, corporate dental practices, or mid-level practitioners isn’t going to solve this epidemic. We can’t drill and fill our way out of this crisis, regardless of who is running the drill. We don’t need more carpenters. We need to put the fire out.

To solve the healthcare crisis we face in dentistry today, we need to move from a treatment model to a healing model. CAMBRA, or caries management by risk assessment identifies and addresses the cause of the disease for each patient. By understanding the cause of dental caries we can focus on targeted strategies and effectively manage it. Armed with this knowledge we can coach patients back to long-term sustainable health. Through real preventive management of this disease we can provide the treatment outcomes we are looking for. The system we’ve got is truly broken and not functioning. The decay epidemic is direct evidence of that. But the solution won’t be found incarpenters, we need to change the “system” so that it fairly rewards firemen. That would reduce the decay epidemic, reduce the cost burden, improve access to care, and provide a genuine long-term solution. We need to fix the system. That’s the real story, and Frontline missed it completely!

 

 

Dr. Kutsch received his undergraduate degree from Westminster College in Utah and then completed his DMD at University of Oregon School of Dentistry in 1979. He is an inventor, product consultant, internationally recognized speaker, in past president of the Academy of Laser Dentistry, and WCMIID.  He has also served on the board of directors for the WCLI and AACD.  As an author, Dr. Kutsch has published dozens of articles and abstracts on minimally invasive dentistry, caries risk assessment, digital radiography and other techonologies in both dental and medical journals and contributed to several textbooks. He also acts as a reviewer for several journals.  Dr. Kutsch also serves as CEO for Oral biotech, as a clinician.  He is a graduate and mentor in the prestigious Kois Center and maintains a private practice in Albany, Oregon.

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Portland City Council Unanimously Votes to Fluoridate Water!

September 18th, 2012

Over the past year and half, the Oregon Dental Association, as a member of the Everyone Deserves Health Teeth Coalition, has been working on a new effort to fluoridate the Bull Run water system. The Bull Run system serves about 900,000 people, or almost one-fourth of Oregon’s population. More than 74 percent of the United States is served by optimally fluoridated community water supplies to protect dental health – and Portlanders will soon join them.

Last week, after a colorful public hearing on September 6th, the City Council unanimously voted in favor of fluoridation. Portland is no longer the largest city in the U.S. that has yet to approve fluoridation to combat tooth decay. The ordinance calls for the city water to be fluoridated by March 2014.

Oregon Dental Association has long been an advocate of community water fluoridation and we were not alone in the fight this time. As a founding member of the Everyone Deserves Healthy Teeth Coalition,  made up of dental and medical professionals, children’s advocates, business leaders, and Portland citizens, we called on the Portland City Council to fluoridate Portland’s water as a safe, effective and affordable way to increase the oral health of our community.

One in three Oregon children has untreated cavities, jeopardizing their health and educational success. Financially, dental decay accounts for 30 percent of all health care costs for children. Dental–related emergency room visits by Oregon’s Medicaid enrollees jumped 31 percent in the past few years, causing a tremendous increase on healthcare costs.

Fluoridating Portland’s water is affordable and will save money. Initial start-up costs are estimated to be about $5 per person with an annual cost of $0.61 per person, based on average water use.That is less expensive than providing fluoride treatments in dental offices and schools. The return is very high: every $1 invested in fluoridation saves over $30 in decreased treatment costs for fillings and more serious dental work. Cheers to healthier teeth!

Visit www.everyonedeserveshealthyteeth.org to learn more.

William E. Zepp, CAE, is the Executive Director of the Oregon Dental Association. Bill previously served as Executive Director of both the Virginia and Montana Dental Associations and has been involved in association management for twenty five years. Bill is also active with the American Society of Association Executives, serving as a past chair of the Small Staff Associations Committee. He has given presentations on non-dues revenue and management at several ASAE Annual Sessions. He is a past-president of the Oregon Society of Association Management.

 

 

EVERYONE DESERVES  HEALTHY TEETH COALITION

African American Health Coalition

African Partnership for Health

African Women’s Coalition

American Medical Student Association, OHSU Chapter

Albina Head Start

Asian Health & Service Center

Asian Pacific American Network of Oregon (APANO)

Capitol Dental Care

Causa

Center for Intercultural Organizing

Central City Concern

Children First for Oregon

Coalition of Communities of Color

Coalition of Community Health Clinics

Component Dental Societies

Dental Foundation of Oregon

Familias en Acción

Friends of Creston Children‘s Dental Clinic

Health Share of Oregon (Tri-County CCO)

Kaiser Permanente Northwest

Knowledge Universe

Latino Network

Legacy Health

Lutheran Community Services Northwest

Native American Youth Association (NAYA)

Northwest Health Foundation

Medical Teams International

OEA Choice Trust

OPAL Environmental Justice Oregon

Oral Health Outreach

Oregon Academy of Family Physicians

Oregon Community Foundation

Oregon Dental Association

Oregon Dental Hygienists’ Association

Oregon Dental Services Companies

Oregon Head Start

Oregon Health & Science University

Oregon Latino Health Coalition

Oregon Latino Agenda for Action

Oregon Medical Association

Oregon Nurses Association

Oregon Oral Health Coalition

Oregon Pediatric Society

Oregon Primary Care Association

Oregon Public Health Association

Oregon Public Health Institute

Oregon School Nurses Association

Oregon School-Based Health Care Network

Pew Center on the States

Philippine American Chamber of Commerce of Oregon

Physicians for a National Health Program, OHSU Chapter

Portland African American Leadership Forum

Providence Health & Services – Oregon

P:ear

Regence BlueCross BlueShield of Oregon

SEIU Local 49

Urban League

Upstream Public Health

Virginia Garcia Memorial Health Center

Willamette Dental

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Medical Teams International Mobile Dental Program

September 10th, 2012

By Matt Stiller, MTI Mobile Dental Program Manager for Oregon

Kirk was the very last patient treated by Dr. and Mrs. Fankhauser.  Dr. Fankhauser, vibrant at 80 years old, has decided not to renew his dental license, which expires in two more days.  After more than 10 years of volunteering with Medical Teams International and providing more than $800,000 of free dental care, Dr. Fankhauser and his wife -assisting chair side all along the way – are retiring, again, from dentistry.

A month earlier, Kirk had come to Medical Teams International’s mobile dental clinic at the Canby Center to have two lower teeth extracted, and was treated by the Fankhausers.  “They’re really fast at extractions,” said Kirk. “They did two in 30 minutes.”  Did it hurt?  “I didn’t feel a thing.”

Kirk appears to be in his early twenties.  Most of his teeth are broken off at the gum line and all of them are beyond saving.  “I used to use drugs.  No one tells you the drugs will mess up your teeth so bad.  I’m cleaned up and I want people to know (the effects of drugs on teeth), and to stay off drugs.”

Now that he has quit using drugs, Kirk’s goal is to have all of his teeth extracted and get dentures. He’s been told the entire process will cost around $5,000.  With the two extractions performed earlier in the month Kirk estimates that the mobile clinic saved him $400 of the total expense so far.

At this clinic, their very last clinic, the Fankhausers stay late to extract 5 more of Kirk’s teeth.

“Teeth go out fast – over the last six months they have crumbled.  I thought I would have a year.  Last month I started getting abscesses, one after another.  My whole face just went.” Kirk makes an explosion sound and gestures with his hand to indicate his face “blew up” with severe swelling from the infections.

Kirk shares all this smiling.  Not about what has happened, but because he made a choice, he has a plan and he is taking steps toward his goals.  He has relocated, away from the places he used to use drugs.  He wants to replace his ruined teeth with dentures and today he will get a little bit closer to that goal.

Has the Mobile Dental Program been good for him?  “I was so glad when I heard the dental van was here.  I live right around the corner,” says Kirk, with a smile.

This all took place on March 29th this year, and I got to be there.  I’m not a dentist, but many times recently I’ve told myself that I should have been.  By talking with so many of our volunteer dental professionals and the patients they have provided relief and hope to over the past several months,  I’ve learned how painful, debilitating and detrimental to one’s health a toothache can be.

After this notable clinic, our site partner, The Canby Center, invited our volunteer dentist and his wife inside for a surprise celebratory retirement party.  Several previous patients had arrived and waited, while the Fankhausers carefully treated all of the day’s patients, just to thank the Fankhausers for the treatment they had received as well as the kindness and care it was administered with.  The Fankhausers leave big shoes to fill.

The party was a special event that day, but the clinic, only due to the commitment of so many volunteers, was just one of 15 Medical Teams International clinics in Oregon that week.  Since July 1, 2011 volunteer dentists, chair side assistants and hygienists have provided free urgent dental treatment at over 820 clinics in Oregon, reaching more than 8,700 patients.  Medical Teams International has simply been the vehicle, literally, as all these volunteers gave their time on board one of our 6 Oregon based Mobile Dental vans.

I appreciated reading Dr. Sean Benson’s story posted here on June 18th.  In it he encourages all dental professionals to volunteer in some way and in some place.  Here I’d like to thank all of you who have volunteered with us at Medical Teams International or in any other capacity.  It is a privilege to contribute in a small way to the gracious work that you all do. We look forward to seeing you again very soon, or to meeting you for the first time.

 

Matt Stiller is the  Mobile Dental Program Manager for Oregon. He  joined Medical Teams International in 2011 from an extensive background in the construction products manufacturing industry.  He was a key management team member at Contech Construction Products, Inc. for twelve years, before becoming a consultant for manufacturing and environmental companies. At Medical Teams International, his focus is on optimizing the Mobile Dental Program while seeking effective ways to expand its reach. Questions? Matt can be reached at  503-624-1095 or  800-959-HEAL (4325) or mstiller@medicalteams.org 

 

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The Truth about Fluoride – Debunking the Myths

August 27th, 2012

By Dr. Weston Heringer, Jr.

Fluoride is natures cavity fighter with small amount present in all water sources such as lakes, rivers and wells. Communities fluoridate their water supply as a cost-effective public health measure to help prevent tooth decay and cavities in both children and adults. According to the best available scientific evidence, water fluoridation is safe and effective. Thousands of studies and more than 65 years of experience tells us that water fluoridation is effective in preventing tooth decay and is safe for children and adults. Even with all the science, there are still a lot of misconceptions about community water fluoridation so let’s talk through them.

 

1. Fluorosis. Fluorosis can occur before teeth erupt from the gums if teeth are exposed to too much fluoride. The vast majority of fluorosis is very minor, barely detectable white spots on the teeth, that does not affect how they function or a person’s overall health. There are studies that suggest that fluoride occurs more frequently in African American children, however more research is needed on the topic. Fluoridation is implemented because dental decay is widespread, the burden of which falls unfairly  among some  population groups.  The National Dental Association, representing African American dentists, and the Hispanic Dental Association both endorse community water fluoridation as safe and beneficial.

2. IQ. According to the best available scientific evidence, there is no association between fluoridation and brain development or lower IQ. The studies often cited are from China, India, and Mexico where environmental conditions are significantly different than those in Oregon. The vast majority of these studies have never been published in peer-reviewed journals and the quality of these studies does not stand up to scientific scrutiny.

3. Osteosarcoma. In 2011, a team of researchers from Harvard University, the Medical College of Georgia and the National Cancer Institute published a study that analyzed hundreds of bone samples from nine hospitals over an 8 year period from patients with osteosarcoma and a control group to measure fluoride in levels in the bone. Considered the most extensive study to date, the results indicated NO CONNECTION between fluoride levels and osteosarcoma. All the other organizations and agencies that have looked at this issue – including the FDA, National Cancer Institute, California EPA Office of Environmental  Health Hazard Assessment – have concluded the same thing.

4. Infant Formula. Although we encourage all parents and caregivers to talk to their dentist of physicians about their child fluoride intake, community water fluoridation has been proven to be safe for children, including babies. Babies who are fed powdered or liquid concentrate infant formula mixed with optimally fluoridated water might develop mild enamel fluorosis, which is a cosmetic condition and has no effect on how they function.

 

Water that has been fortified with fluoride is similar to fortifying salt with iodine, milk with vitamin D and orange juice with vitamin C. Community water fluoridation saves more than it costs. Studies show that community water fluoridation prevent at least 25 percent of tooth decay.

Want more information on fluoride? You can find extensive information in Fluoridation Facts, the ADA’s comprehensive publication with facts from over 350 scientific references.

 

Dr. Heringer is a retired pediatric dentist and has served on 19 overseas dental trips. He operated a private practice in Salem for 30 years with a satelite office in Lincoln City for 26 years. For the last two years of his career he was the full time dentists on the Tooth Taxi, a mobile dental van providing free care to children in Oregon. Dr. Heringer is a past president of the Oregon Dental Association and is a board member of the Dental Foundation of Oregon.

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