Dentist blog from Delta Dental

How to tackle antibiotic overprescription

In 2019, American health care providers of all specialties wrote a total of 251.1 million antibiotic prescriptions — that’s enough for three-quarters of Americans to receive at least one. That number wouldn’t necessarily a problem if all of the prescriptions were necessary and prescribed within guidelines set by health care associations, but that isn’t always the case. In fact, nearly a quarter of prescriptions are most likely unnecessary, according to a cross-sectional study.

And, unfortunately, dentists are some of the top antibiotic prescribers in the United States.

Why antibiotic stewardship is important

Being thoughtful when prescribing antibiotics is part of a practice called antibiotic stewardship. Antibiotic stewardship is an effort to improve how antibiotics are prescribed and used. The goal is ultimately to treat infections more efficiently and to combat antibiotic resistance.

The most dangerous result of antibiotic overprescription is antibiotic resistance. When germs are exposed to antibiotics but not killed, they evolve and develop resistance to drugs. Those resistant germs cause infections that are difficult, if not impossible, to treat and can increase the mortality rates of once treatable infections.

When antibiotics are prescribed improperly, patients may have to deal with the adverse physical effects of antibiotic treatment for no reason. Common adverse effects include nausea, abdominal pain and vomiting, and they happen in almost 10% of patients. Even more, antibiotics can be a financial burden. Without insurance coverage, the average cost of generic antibiotics is about $43 for a 500mg dosage.

The dentist’s role in overprescription

According to surveys of antibiotic prescriptions in the U.S., dentists write one in 10 antibiotic prescriptions.  In a study done on prescription rates in Australia, England, the U.S. and British Columbia, dentists in the U.S. were found to be the most prolific antibiotic prescribers. American dentists prescribed twice the amount of antibiotics that Australia, the least prolific, did per 1000 population. Studies reveal that almost 81% of antibiotics prescribed by dentists are used against stewardship guidelines.

Antibiotics are a vital tool in dental health, especially when treating patients with comorbidities that can increase the danger of an infection, like heart disease. The American Heart Association recommends that only patients at the highest risk for adverse outcomes from infections should be prescribed antibiotics. They should absolutely be prescribed when necessary. But before you prescribe, take a moment to consider whether antibiotics are necessary.

There isn’t a “one size fits all” approach to managing antibiotic use. The reason antibiotic overprescription is so prevalent is also the reason it’s difficult to change: medical decision-making is incredibly complex. To tackle overprescription in your own practice, you can:

Use the tips above to be antibiotic aware and to inform your colleagues and patients about the importance of antibiotics stewardship.

Your dental policy brief: Current issues and updates in the news as of September 13

From dental groups advocating for mandatory vaccines to a significant court ruling against a dentist seeking to recover business losses from COVID-19, FYI brings you the most important policy update news.

Here are the five biggest stories from the past month:

1. Groups advocate for mandatory vaccines

Several dental organizations, including the American Dental Hygienists Association, the American Dental Education Association and the National Dental Association, are advocating for mandatory COVID-19 vaccinations for oral health care workers, students and residents. The participating organizations issued a statement September 1. The American Dental Association was not among the organizations to sign the statement but “strongly encourages” all members to get vaccinated. On September 9, President Joe Biden mandated vaccines or weekly testing for all federal workers, businesses with over 100 employees and health care staff.

2. Dentists aren’t insured against COVID-19 financial losses, say high courts

COVID-19-related losses do not trigger insurance coverage for businesses, including dental practices, the Eleventh Circuit Court of Appeals ruled on August 31. In the case, a Georgia-based dental practice filed a claim with its insurer to recover lost income after the business canceled dental procedures at the beginning of the pandemic. The Eleventh Circuit ruled that the incurred losses did not meet the qualifications of “physical loss or damage” required for a successful claim. 

The Eleventh Circuit is the second federal appeals court to make such a decision, joining the Eighth Circuit in its similar July 2 ruling in favor of the insurer.

3. ADA reviews CDT for use beyond claims administration

The ADA has created a new taskforce to enhance and reposition the CDT code for clinical documentation, administrative transactions and data exchange or interoperability.

“The advent of data analytics, the need to measure outcomes and the emergence of artificial/augmented intelligence all necessitate the repositioning of CDT for uses beyond claims administration,” said Randall Markarian, DMD, council chair and leader of the new taskforce.

4. California looks to protect health data by urging businesses to report breaches

California dental offices must report health care data breaches and comply with state and federal privacy laws, California Attorney General Rob Bonta reiterated in a bulletin written in response to a large number of recent unreported ransomware attacks.

Bonta stressed the importance of training staff on data security, maintaining a data back-up plan and using the latest security patches and virus protection software.

5. The ADA continues its push for dental coverage for all adults on Medicaid

The American Dental Association is pushing for dental care to become a required part of Medicaid coverage for adults in all 50 states. Along with nearly 130 organizations, the ADA sent a letter to Congress urging lawmakers to support and advance the Medicaid Dental Benefit Act.

The latest COVID-19 guidelines in the dental office

From the rise of the delta variant to issues about vaccination, the past few months have seen questions arise about the best ways for dental practices to adapt.

The latest recommendations from the ADA

On July 13, the American Dental Association (ADA) released updated recommendations for office procedures during COVID-19. Key points of the update include:

  • Maintain hazard assessments, as required by the Occupational Safety and Health Administration. You must have a safety plan for exposure control and COVID-19. Repeat the hazard assessment regularly as COVID-19 conditions change. Consider the incidence and prevalence of COVID-19 in your area and the rate of testing in your area. The ADA has created a guide and checklist to walk your practice through the process of creating an assessment. 
  • Stay up to date on local mandates. Consult your state dental boards and state and local health departments for current local information for requirements specific to your jurisdiction. 
  • Pre-screen and assess patients for symptoms upon arrival. Call patients prior to their scheduled appointments to ask about their current health status. Consider using temperature checks to screen patients and staff for COVID-19 symptoms on arrival. Although screening for symptoms will not identify asymptomatic or pre-symptomatic individuals, symptom screening can still help to identify those who could have COVID-19, so appropriate precautions can be implemented. Self-assessment information that patients provide themselves is not always reliable.
  • Use your judgment. The adoption of COVID-prevention tactics has largely been left to individual practices. Use your best professional judgment when making decisions. Take an integrative approach, incorporating evidence-based scientific data in conjunction with psychosocial, state and community factors, such as the prevalence of testing in your area.

Delta variant prompts renewed recommendations on masks, vaccination

Concerns about the spread of the delta variant have prompted the American Dental Association to release a new fact sheet.

With the release of the document, the organization strongly reiterates its previous recommendations of:

  • Being vaccinated against the virus. The ADA recommends vaccinations in dental settings (California is the only state where vaccines for health care workers, including dental staff, are currently required). When recommending the vaccine to patients or staff who are resistant, the ADA offers a toolkit of ideas on how to address their concerns.
  • Using personal protective equipment in office settings. Monitor staff for appropriate implementation of PPE. Advise dental staff members to wear additional personal protective equipment (PPE) as appropriate, such as surgical masks or N95 masks, full face shields or goggles with side shields to ensure an environment that is as safe and healthy as possible for patients and the dental team.
  • Practicing social distancing. Avoid close contact with others by keeping six feet of distance whenever possible.

Consistent guidelines

Overall, the ADA and the Centers for Disease Control and Prevention‘s guidelines remain consistent throughout the rise of the delta variant. The guidance from each organization provides thorough, detailed patient management and facility information to consider before, during and after dental appointments.

How to manage office safety throughout the pandemic

The advent of the delta variant reinforces the importance of proper implementation of COVID-prevention tactics.

Successful guideline adherence and low infection rates in dental practices may be the primary reasons why dentists were largely exempted from recent federal COVID-19 requirements for health care settings mandated by OSHA, according to the ADA.

Guidance documents create no new legal obligations and don’t change or establish compliance responsibilities. As always, you need to use your best professional judgment when making decisions for your practice.

“Staying current with recommended safety protocols is important to building the safe environment for patients to seek care and the dental professionals delivering that care,” said Dr. Daniel Croley, Delta Dental’s chief dental officer.  “While following these recommendations is an individual practice choice, we encourage all dentists to adhere to these new guidelines to prevent the introduction of COVID to anyone seeking or delivering dental care.” 

Fall 2021 convention and conference schedule update

In an update to information reported earlier, Delta Dental won’t be attending September’s American Association of Dental Office Management (AADOM) conference in Orlando, FL. Below, find a revised list of the conferences and conventions we’ll attend this year.

October 10–13Las Vegas, NVAmerican Dental Association Annual Meeting
November 28 – December 1New York, NYGreater New York Dental Meeting
Table with conference/convention dates from September through December 2021

If you plan to attend either of these conferences, please visit our booth. It’s a great chance to network and pick up the useful material we’ve created to help you and your practice shine. And we’d love to chat with you, hear how we’re doing and answer any questions you might have.

Reminder: Check your online directory listing

Did you know that you can update your directory listing within Provider Tools? Your patients (and potential patients) will be glad that you did. Millions of Delta Dental members depend on the online directory to find dentists with office hours that work with theirs or employees that speak the same language.

When you ensure that you’re advertising the most up to date information, you’re setting yourself and your practice up for success.

To view or update your current directory listing:

  1. Log in to Provider Tools and select My account.
  2. Click on Directory profile.
  3. Go to Actions and click Open.
  4. Update information, as needed.
  5. Save as draft if you’re not yet ready to publish your updates or select Publish if you’re ready to go live.

Anytime your business information changes, be sure to update your listing. We recommend setting up a yearly reminder to check in on your listing’s accuracy. 

How COVID-19 brought challenges and solutions to dentistry for seniors

Times of crisis call for creative solutions, and that’s never been more evident than during the COVID-19 pandemic. Innovative dentists have sought to adapt many aspects of their practices, but especially those involving the most vulnerable segment of our population: older adults.

New challenges for seniors’ oral health

For many seniors, even before the advent of COVID-19, physical limitations, systemic disease, cognitive decline and dependence on caregivers could all lead to an overall decline in oral health. What’s more, the pandemic worsened many of these same problems while presenting new ones.

“COVID-19 laid bare weaknesses in our elder care system,” said moderator Stephen K. Shuman, DDS, MS, in a webinar on pandemic-related disruptions in oral health care hosted by the Gerontological Society of America.

Some of the challenges in oral health care for seniors during the pandemic have included:

  • Reduced access. Early in the pandemic, many dentists’ offices shuttered, and even when they reopened, fear of COVID-19 led many older adults to delay or entirely forego visits to the dentist’s office. Nearly half of U.S. adults reported delaying dental care due to the COVID-19 pandemic during the spring of 2020, and the increased risk posed by COVID-19 to seniors likely exacerbated the problem among older adults.
  • Reduced care. In long-term care facilities, daily brushing, flossing and other routine care tasks were sometimes put on the back burner as COVID-19 diverted staff members to provide more urgent care to those affected or at risk. Proper oral care could also be challenged by staff members’ fears about the potential for oral transmission of COVID-19. Staffing shortages in facilities and on oral care teams made the situation worse. Georgia and Minnesota reported staffing shortages in long-term care facilities of more than 25% during the pandemic, and a recent poll from the ADA Health Policy Institute found that more than 80% of owner dentists who are currently hiring consider recruitment of dental hygienists and assistants to be extremely or very challenging at this time.
  • Psychosocial problems. The loneliness, anxiety and depression caused by shelter-at-home orders could themselves worsen oral health among older Americans.

Solutions in oral health care for seniors during the pandemic

Just as the COVID-19 presented new problems, it also created potential for positive long-term change.

Teledentistry and teletriage

Through necessity, many dentists began refining techniques for the use of teledentistry and teletriage.

Some companies began implementing or built up their existing “pandemic teledentistry.” Teams used cloud-based electronic health records and taught long-term care facility staff how to take useful images of patient mouths and send them to centrally located dentists.

At the height of the pandemic, 24.8% of responding dentists reported they were conducting remote problem-focused evaluations through virtual technology or telecommunications, according to polling from the American Dental Association’s Health Policy Institute.

Some innovative dentists used what they referred to as assisted, or guided, oral hygiene during the pandemic. They used the latest audio and video technology to guide a patient or caregiver as they carried out oral hygiene on a regularly scheduled basis. Some caregivers, such as Michael J. Helgeson, DDS, of Apple Tree Dental, saw the technology as a key way to maintain dental health care for seniors during the pandemic when in-person care wasn’t possible.

Mobile dentistry

While the pandemic restricted mobile care in some cases, its primary advantage of reducing the need to transport at-risk seniors also caused it to emerge as another possible solution.

Many dentists were already accustomed to setting up mobile units in long term care facilities even before the pandemic. Mobile dentistry helps reduce the potential for stress and confusion caused by moving older patients or those with dementia. With the latest mobile equipment deployed to long-term care facilities, dentists are able to perform simple extractions, restorative work and more in a timely manner. As in many dental offices, mobile units often add an external dental suction that uses ultraviolet light and filters to remove pathogens from the air.

How to support your senior patients through the pandemic

COVID-19 presented extraordinary challenges to your senior patients. The new solutions that helped maintain health care for older adults during the pandemic are likely here to stay.

To support your senior patients throughout the pandemic:

  • Communicate with patients. Oral health care should never be placed on the back burner, and maintaining good communication with your patients is one of the most crucial keys to emphasizing the importance of oral health. As always, keep in mind the systemic relationship between oral health and overall well-being. Use empathic listening and compassionate care to encourage the maintenance of oral hygiene routines among your senior patients throughout the pandemic.
  • Consider adopting new approaches. Teledentistry can now connect oral health care providers with older adults remotely when patients are unable to visit a dental clinic or if there are restrictions on dental providers visiting residential facilities. The use of mobile dentistry during the pandemic likewise bodes well for its future implementation as a solution for the needs of seniors in long term care facilities for whom transport is an issue.
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