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Monday, February 18, 2013

NYSDA criticizes oral medical center closures

NYSDA criticizes oral medical center closures

The New You are able to Condition Dental Association (NYSDA) is demeaning New You are able to Town Gran Eileen Bloomberg's suggested closings of New You are able to Town Department of Wellness oral treatment centers, according to an argument.

The closures, part of capturing citywide cuts declared lately by the mayor, would effect 44 public health oral treatment centers serving 17,000 of the town's neediest kids.

"Shutting down New You are able to City's oral system shows a lack of knowledge of the effect of oral disease on the of New Yorkers, and shows a neglect for the town's most insecure communities who most need and benefit from entry to these programs," said Stephen Gold, D.D.S., NYSDA president and a childrens dental professional, in the news launch.

The NYSDA lately endorsed for regulation demanding the region's university regions to request that kids receive a oral examination before entering university. New You are able to Town schools obtained an omission from the law because the town was already providing sufficient entry to kids for tests and solutions. The town's school-based oral treatment centers have been the principal resource for ensuring the accessibility to these solutions.

Transitioning patients from the treatment centers to a Medicaid-based system as others have suggested would not be the answer, the NYSDA said in its news launch. Despite the town's considerable patient registration in both Condition medicaid programs and Child Wellness Plus and the exceptionally high number of dental practitioners available to see these kids, the NYSDA said it considers that New You are able to Town performs badly with respect to kids getting effective preventive oral treatment.

New You are able to City's Condition medicaid programs system reports the lowest rates of kids getting sealants in New You are able expressing, according to the NYSDA.

Regional categories maintain management of Higher NY Dental

Regional categories maintain management of Higher NY Dental

Looks like the Higher New You are able to Oral Conference -- charged as the biggest dental meeting on the globe -- will stay in the arms of the two local categories that have lengthy co-sponsored it: the New You are able to Nation Oral Community (NYCDS) and the Second Region Oral Community (SDDS).

Last July, after the New You are able to Legislature elected to look at a invoice that would provide the New You are able to Condition Oral Organization (NYSDA) the right to "expel" the NYCDS, there was a quantity of editorials in New You are able to magazines asking the purposes of many of those engaged, such as New You are able to Gov. Bob Paterson.

Last weeks time, the NYSDA panel made the choice to keep well enough alone.

"Our panel did elect this season to have another element providing New york, but at last week's panel meeting they made the choice not to do this," said Sandra DiNoto, the association's home of advertising. "They elected to have only one element providing one county." She dropped to opinion further on the board's choice.

As a outcome, the association that was established a few months ago to take the place of the NYCDS -- the New york Oral Organization -- has been disbanded.

"For a time there was a second element providing that place, but they do not are available any longer," DiNoto said. "The NYCDS provides New york."

She also ignored rumours that management of the meeting might have altered had the NYSDA worked out its right to get rid of the NYCDS.

"The Higher New You are able to Oral Conference has always been a individual, individual company of the two local county dental categories," DiNoto said. "It was never aspect of this formula."

Thus it will be company as regular at this seasons Higher New You are able to Oral Conference, which reveals Nov 28 at the Edward K. Javits Meeting Middle and operates through Dec 3.

"There are no changes with the Higher New You are able to Oral Conference. It will be larger and better than ever!" said Ellen Gerber, professional home of the NYCDS.

The Project on Government Oversight

The Project on Government Oversight

The FDA has an incident reporting database called MAUDE. While this database is interesting, it has no search parameters for electrical injury and death resulting from causes related to product safety. Additionally, this database is a voluntary reporting database for incidents, relying on a variety of different sources. Many of these sources are people who have no training in electrical safety, and are not even minimally qualified to judge the root cause of the incident, much less to determine if an incident was the result of leakage current. In the end, this database is not a reliable source for any scientific analysis of electrical injury or death from equipment.

The FDA also ignores the issue of electrical safety certification to U. S. standards. Many do not understand that because a device functions correctly that does not mean it is electrically safe. Additionally, The Project on Government Oversight reports that decisions by senior FDA officials in 2006 eliminated critical measures that keep manufacturers of medical devices compliant with high quality standards.8 Many other problems with the FDA make it a highly questionable source for research on the subject.

In a recent regulatory bulletin provided by Bureau Veritas, it was revealed that under the provisions of legislation introduced earlier this year in the U.S. House of Representatives, manufacturers may soon face liability for medical devices that harm consumers, even if those devices received pre-market approval from the U.S. Food and Drug Administration (FDA). The proposed H.R. 1346: Medical Device Safety Act of 2009 would amend the Federal Food, Drug and Cosmetic Act to provide legal recourse to patients who are injured by a medical device that malfunctions. 9

Why would the U.S. Congress be considering a bill that would allow lawsuits against FDA-approved products? Most likely because FDA-approved products have injured and killed, and the Supreme Court decision of 2008 was a grave mistake. As many of us in product safety are well aware, the FDA 510(k) Premarket approval process is a flawed and highly questionable regulatory requirement. As more product recalls are being reported by the media, a new administration in Washington, D.C., and a newly appointed FDA commissioner has said “there obviously have been some problems” at the Center for Devices and Radiological Health and has designated device reform as “a high priority” for the immediate future. Former FDA Commissioner David Kessler described the device center as “dysfunctional” and “in meltdown.” According to the new FDA chief, Margaret Hamburg, “Agency scientists have said some devices that received 510(k) approval should have been required to show more data on safety and efficacy”. 10

In addition to these problems, the FDA has historically ignored the requirements for electrical safety and federal workplace law. Obviously the FDA in its current state is an unreliable source for any research or meaningful data.

Our biomedical/clinical engineering departments are a major force protecting our patients and healthcare staff. These specially trained and hardworking technicians and engineering professionals are working every day to insure the safety and proper operation of equipment for our procedures and operations. Their diligence and commitment to patient safety is generally unseen and under-appreciated, much like product safety certification experts.

Biomedical engineers and technicians perform preventive maintenance of portable equipment. These duties include repair and maintenance (cords, leads, equipment subject to abuse…), leakage current, grounding and other tests, depending on the equipment being used. They also ensure equipment is operating properly so that patients will not be put at risk from faulty equipment. Grounding is the weak link and doorway to leakage current injury. Regular tests are critical to ensuring these conditions do not put our healthcare workers and patients at risk. Frequency of tests required or recommended by product varies from three months to two years, depending on the type and use of the equipment. This is a well-known fact in the biomedical engineering field. These biomedical departments are on the front lines of electrical safety in healthcare facilities. Recently, these departments have been reporting the use of regular consumer computer equipment in patient areas as being non-certified, but their objections have been ignored by hospital administrators.

Scott Trombley is a certified biomedical equipment technician (CBET) who has been working in this field for over twenty-five years, previously with COHR MasterPlan, then with hospitals in Atlanta and now Central Florida. He is currently on the Agency for Healthcare Administration’s (AHCA) expert list and was a speaker at the 23rd AHCA seminar. Scott and his employer InterMed work closely with the biomedical advisory board of Santa Fe College. He is also a founding member of Tyler’s Hope, a non-profit organization in search of a cure for Dystonia Scott is currently vice president of InterMed Biomedical Services where he oversees operations, employee safety and writes policy procedures to comply with authorities having jurisdiction. These AHJs include The Joint Commission, Agency for Healthcare Administration, and city and county electrical inspectors. Scott has the answers for questions about leakage current and other testing in healthcare facilities.

Monday, January 28, 2013

Featherstone named dean of UCSF School of Dentistry

By DrBicuspid Staff

September 8, 2008 -- John Featherstone, M.Sc., Ph.D., has been named dean of the School of Dentistry at the University of California, San Francisco (UCSF).

In an e-mail message to the campus community on September 5, UCSF Chancellor J. Michael Bishop, M.D., said that Dr. Featherstone, who has been serving as interim dean, would become the next dean pending approval by the UC Board of Regents.

"Dr. Featherstone has been on the UCSF faculty for 13 years, and his exemplary service demonstrates how well-suited he is to serve as the dean on an ongoing basis," Dr. Bishop wrote. "As interim dean, he has demonstrated excellent leadership and management skills, with accomplishments that include selecting and appointing a department chair, establishing the new position of associate dean for clinical affairs as well as restructuring the school administration accordingly, and improving the clinical infrastructure and the financial situation of the predoctoral dental clinics."

Ultrasonic surgery eases sinus lifts and tooth extractions

By Rosemary Frei, MSc, DrBicuspid.com contributing writer

September 8, 2008 -- The use of very high-frequency sound waves -- ultrasound -- isn't just for bats and dolphins anymore. It is the new standard for everything from industrial cleaning to abdominal imaging. And now it's entering the world of dental surgery.

Ultrasonic surgery, also known as piezosurgery, can be used for cutting or grinding bone in sinus lifts, ridge augmentation, bone grafting, bone-block harvesting, and extraction of impacted teeth and roots. The ultrasonic devices developed for dentistry operate at frequencies of 20-35 KHz. The high-frequency sound waves sail right through adjacent soft tissues without damaging them, thus avoiding many of the complications associated with traditional surgical tools such as chisels and burs.

For example, perforation of the Schneiderian membrane occurs about a third of the time when conventional rotary instruments are used to do sinus lifts. But with ultrasound instruments the complication is relatively rare, noted Stephen Wallace, D.D.S., a New York University professor and a periodontist in private practice in Waterbury, CT. He was also one of the first people in the U.S. to perform ultrasonic dental surgery.

"We did a human study and showed the perforation rate is cut by 75%, to just 7%," Dr. Wallace said (International Journal of Periodontics and Restorative Dentistry, September/October 2007, Vol. 27:5, pp. 413-419).

In that study, Dr. Wallace and other periodontists from New York University and Israel pooled the analyses of their consecutive sinus lifting cases using the Piezosurgery device manufactured by Mectron Medical Technology. They noted a total of 7 sinus perforations in 100 procedures -- 3 caused by an extremely thin membrane and the others by the presence of a septum. The perforations all occurred during the hand elevation that followed use of the ultrasonic device, Dr. Wallace noted.

Which ultrasonic system should you buy?

Five ultrasonic surgical systems are now commercially available in the U.S. for cutting or grinding bone in dental applications.

Mectron Medical Technology was one of the first companies to offer this technology to the dental market with its Piezosurgery device. The Piezotome made by Satelec and marketed by Acteon is also available in the U.S., as is the Ultrasonic Bone Surgery device made by Resista and sold by Ace.

Also available are Piezon Master Surgery by Electro Medical Systems (EMS) and VarioSurg made by NSK and sold by Brasseler. Other units currently awaiting 510(k) marketing clearance from the FDA are BioSaf's Easy Surgery and Esacrome's SurgySonic.

The price of these systems ranges from $8,000 to $17,000.

If you are interested in reading what users of these products think about these products and why, check out this forum.

Another study found that using an ultrasonic device to perform bilateral sagittal split osteotomies of the mandible was more time-consuming compared to conventional techniques involving saws, chisels, and burs, but the osteotomies had a higher level of precision. In addition, the ultrasonic procedure offered the advantage of a blood-free surgical field (International Journal of Oral and Maxillofacial Surgery, September 2005, Vol. 34:6, pp. 590-593).

But not all the research has been positive. A recent report from Italy showing a 30.8% membrane-perforation rate in sinus-elevation procedures performed with the Piezosurgery device, versus a 23% perforation rate with conventional instruments (Clinical Oral Implants Research, May 2008, Vol. 19:5, pp. 511-515).

The investigators performed a prelift osteotomy for sinus access in 13 patients using the Piezosurgery system on one side of the maxilla in each patient and rotary diamond burs on the other side. Each side was completed in approximately the same amount of time, but 4 (30.8%) perforations occurred with the Piezosurgery device and 3 (23%) with the conventional instruments.

"It's the only negative report on the Piezosurgery device I've seen in the last 20 years," Dr. Wallace said. "In the program in which I teach residents from around the world how to use these instruments, they're uniformly successful using the Piezosurgery device, even though they're novices. So why there were these complications in the Italian paper, I can't explain."

Dr. Wallace learned how to use the Piezosurgery device about six years ago, at the elbow of one of its inventors, Tomaso Vercellotti, M.D., D.D.S., and he has been training other dentists how to use the technology ever since. He now teaches a two-year fellowship in implant dentistry at New York University that includes instruction in ultrasonic surgery. He also taught a course on ultrasonic surgery in September at the American Academy of Periodontology's annual meeting.

"None of the ultrasonic surgery companies were highlighted at the course at the AAP, but all of them were represented there," he said. "It was like a 'cage match' in wrestling, where people were able to try the five different machines on the same piece of bone. It was an opportunity people never have in their own clinical practices."

Jeff Thomas, D.D.S., a periodontist in private practice in Newbern, NC, is also a proponent of ultrasonic surgery. He just started his fourth year of teaching courses on ultrasonic surgery, and also performs hundreds of procedures with this technology every year in his own practice.

"I can't say I use it every day, but sometimes I use it three or four times in one day; it just depends on the type of surgery I'm doing," he told DrBicuspid.com. "It's not something you have to have. But it's something I couldn't do without. I can do more procedures less traumatically and more predictably than before ultrasonic surgery was invented."

Zenith donates fluoride varnish to kids' foundation

By DrBicuspid Staff

September 8, 2008 -- Zenith Dental recently donated more than 56,000 units of ClearShield 5% Sodium Fluoride Varnish to the National Children's Oral Health Foundation (NCOHF), the company announced.

The NCOHF is an international organization whose mission is to eliminate pediatric oral disease for millions of economically disadvantaged children. The NCOHF will donate the fluoride varnish to several nonprofit pediatric oral health facilities.

According to the NCOHF, because of Zenith's ongoing support and donations to the organization, the foundation is honoring Zenith with a grant in the company's name that will be awarded to an as-yet-unnamed children's oral health facility.

Sunday, January 27, 2013

The changing face of dentistry: Part I

By Vanessa Richardson

June 23, 2008 -- Ah, the allure of entrepreneurship: Be your own boss. Set your own hours. Make a decent living and help people in need.

Surprisingly, despite dentistry being one of the most attractive small-business ventures around, in recent years there has been a shortage of dentists in the U.S. -- due in large part to a "generation gap" between retiring and incoming dentists, with not enough of the latter to replace the former. But now this trend is shifting, and with it the face of dentistry.

According to the American Dental Education Association (ADEA), the peak year for new dentists was 1983, when 5,756 dental students graduated. In 2005, total graduates only numbered 4,478, a 23% decrease.

"Those nearing retirement age were part of a big surge of graduating students in the mid-1970s to late 1980s, so actually too many dentists were being produced for the need," said Laura Neumann, ADA's senior vice president of education and professional affairs. "Now things have equalized and once again there's an increase in dental school applicants."

In fact, the ADA expects the number of dentists to increase by 8% between now and 2025, with many more women and minorities stepping into the lead role. In 2005, 12,287 students applied to dental school.

There still aren't enough seats for all the dental school applicants. In addition to a decline in the number of dental schools (56 in 2005, down from 60 in the 1980s), the capacity of those schools is restricted, said John Williams, D.D.S., dean at the University of North Carolina at Chapel Hill School of Dentistry.

"It's not like undergraduate schools where they only need to provide instructors and space," he said. "Huge infrastructure is needed for a new dental school, like labs and clinic spaces. So the small increases we're seeing in dental school enrollment is primarily due to new schools opening up."

But help may be on the way. Three new schools have opened in the past decade, and a new one in Virginia is under way.

The reasons why more people are opting to enter dental school these days vary, but the key seems to be the promise of independence and entrepreneurship. In 2006, when the ADEA polled people about to enter dental school and asked them why they chose that profession, more than 80% listed the top reasons as "ability to control my work time," "self-employment," "income potential," and "service to others."

The values of this generation coincide with dentistry, according to Anne Wells, ADEA's associate executive director for Education Pathways. "They value lifestyle. Income is important but not only the thing; they want control over their practice. It's much more significant to them to develop a meaningful philosophy in life."

Those are the reasons Rhett Raum, a 28-year-old senior at the University of Alabama School of Dentistry in Birmingham and vice president of the American Student Dental Association, went into dentistry. "I have a degree in business management and I used to run a B&B, so I have an entrepreneurial background. What drew me to dentistry was the ability to be a small-business owner, be my own boss, and have financial flexibility."

Raum is an anomaly of sorts, however, because he is purchasing a practice in a small Tennessee town with a population of 4,000. Most dental school graduates are opting to go to urban and suburban areas where there are already plenty of dentists, leaving sizable portions of the U.S. without access to oral care.

"It's less of a shortage and more of a maldistribution," Neumann said. That means dentists in inner cities, rural areas, and small towns who are planning to retire will have a harder time finding their replacements.

Some young people are being lured away from medical school when they hear about equally lucrative and less hectic careers in dentistry. In 2004, general practitioners earned an annual average of $186,000, while specialists averaged $315,000, according to the ADA.

"My physician friends send their kids to dental school because they don't like what's going on with the laws in their industry, whereas the dental industry has not been nearly as encumbered," said Paul Gruber, a 64-year-old dentist in Sheboygan, WI.

Who’s signing up

What will the next generation of dentists look like? In terms of demographics, one population that is taking off is women, who now account for 44% of all dental school graduates and 19% of all dentists, according to the ADEA.

While these numbers are expected to continue to increase, however, another trend is worth noting: a growing number of female dentists will work part time to balance career and family. According to the ADA, 14% of dentists now work part time; this number is expected to reach 19% by 2025, with most being female dentists.

Jack Dillenberg, D.D.S., dean of the University Arizona School of Dentistry & Oral Health, worries about that figure. "Women make up half our class and they are great dentists, but they don't work as long and therefore won't be as productive overall."

But others argue that the flexible hours of dentistry will allow women to be at least as productive as men. That's the opinion of Laura Rammer, a 29-year-old general dentistry student who graduated from Marquette University Dental School in Milwaukee last summer. She mentored with Dr. Gruber in Sheboygan, and is considering taking over his practice when he retires.

"It's now an option for the woman to be a full-time worker and the husband a stay-at-home parent," she said. "I'm going to keep going to the office. Besides, I work four days, from 7 a.m. to 5 p.m. That's accommodating for families."

The flexibility of dental work is also attracting many women to become hygienists. The number of dental hygiene programs has steadily increased during the past decade, numbering 270 with 7,200 graduates in 2004. That's nearly twice the amount of dental school graduates -- and the education is half the cost of dental school.

Dental hygiene is the fifth fastest growing profession in the U.S., said Jean Connor, president of the American Dental Hygienists' Association (ADHA). "They are mostly women, often because hygienists stay licensed for their life cycle, so it's good for women who want to have kids and a flexible or part-time career. It's a good-pay salary. And you can be a healthcare professional, but unlike nursing you don't have to work nights or weekends."

Hygienists are expected to be on the front lines of expanding oral care to underserved populations. The ADHA is developing a curriculum to create a master's degree for advanced dental hygiene practitioner. Graduates would be able to do many services a dentist does -- such as cavity prep, extractions, and prescriptions -- and without a dentist's supervision. The goal is to have them serve in lieu of dentists in underserved areas.

"They can be a long arm reaching out to people in need," Connor said. "They'll be important because they can provide dental services and get people on the learning curve of oral health."

Serving the underserved

While the number of female dentists is on the rise, minority enrollment is lagging. More Asians are enrolling, which accounts for the vast majority of minority applicants. However, blacks and Hispanics currently comprise less than 10% of U.S. dentists, far below their numbers in the U.S. population.

This is where targeted minority recruitment of dental students and mentoring can play a key role. The ADEA found that dentists of an ethnic minority background, especially Asians and Hispanics, often chose the career because they wanted to serve their ethnic group or a low-income population in general.

"It's a priority for dental schools as well as for organized dentistry to raise those numbers," Neumann said. "It's a concern about our ability to meet the needs of the public because people want to go to a health provider that comes from their own background and speaks the same language."

In its numerous programs to boost minority representation, the ADEA is working with the Association of American Medical Colleges on the Summer Medical and Dental Education Program that identifies college freshmen and sophomores interested in dentistry and give them a summer-school education.

"This can enhance their chances to do well in both undergrad and dental school," Wells said. Nearly 1,000 students currently participate, along with 12 medical and dental schools.

In part II of this series on the future of dentistry, author Vanessa Richardson tells how dental education is changing, from revised dental school curriculums to targeted recruitment and mentoring.