Dentist blog from Delta Dental

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Find the latest news about dentistry and the dental health industry.

Your dental policy brief: News updates as of August 2

From the latest on Medicare to recent court rulings affecting dentistry, FYI brings you the biggest dental policy stories.

CMS proposes Medicare dental coverage expansion after push from Congress

The U.S. Centers for Medicare and Medicaid Services (CMS) has released a proposed physician fee schedule rule for 2023 that would expand access to dental care services for Medicare beneficiaries. The proposal came after lawmakers in the U.S. House of Representatives and the U.S. Senate requested that the agency broaden the definition of medically necessary dental coverage as a way to expand access for Medicare recipients.

Currently, Medicare Part B only pays for dental services when it is deemed medically necessary to treat a recipient’s primary medical condition. The proposed changes for payments could become effective as early as January 1, 2023.

ADA says ransomware behind recent cyberattack, confirms data theft

The American Dental Association (ADA) has said that the cybersecurity incident it first reported in April was actually a ransomware attack, which ultimately led to the theft of member data. Although the ADA initially claimed that there was no data breach, a recent notice from the organization confirms that data theft occurred.

The notice does not share the precise data impacted, just that it was personal information tied to member names. Impacted members will receive complimentary credit monitoring and identity protection services. The ADA says it has assessed system security and reset relevant account passwords while it works to review and bolster existing policies and procedures.

Federal judge rejects Colorado inmate’s request for change in prison dental policy

A federal judge has denied an inmate’s request to order prison officials to halt their alleged unofficial policy of denying dental crowns to detainees. Beginning in November 2019, an inmate at the U.S. Penitentiary Administrative Maximum Facility in Florence, Colorado, sought treatment for broken and painful teeth. The prison dentist allegedly informed the inmate he needed a crown and teeth fillings, but the dentist could only “do one procedure per inmate per visit.”

The inmate, Peter George Noe, filed suit against the government and multiple medical personnel, claiming delayed and inadequate treatment. He asked for a preliminary injunction that would order the Bureau of Prisons to provide crowns generally, and to specifically perform his needed dental work. The district judge denied the motion, finding Noe had not shown he would suffer irreparable harm in the absence of a court order.

Supreme Court rejects dental hygienist’s medical marijuana workers’ comp case

The U.S. Supreme Court declined to hear the case of a Minnesota dental hygienist challenging denial of workers’ compensation for medical marijuana. The hygienist, Susan K. Musta, began purchasing cannabis to treat chronic pain due to work-related injuries in 2019 under Minnesota’s legal medical cannabis program and was not reimbursed for it under her workers’ compensation coverage for workplace injuries. Minnesota courts ruled that the federal Controlled Substances Act (CSA) prevented her insurer from paying for medical cannabis.

Musta appealed the decision to the U.S. Supreme Court alongside a similar Minnesota case. The U.S. Supreme Court indicated that fewer than four justices believed the legal challenge warranted the court’s consideration. State supreme courts in New Jersey and New Hampshire have ruled the CSA doesn’t preempt their workers’ compensation laws. However, like Minnesota, Maine’s high court reached the opposite conclusion.

Dentists and hearing loss

Dentist offices often try to bring a level of comfort and relaxation to patients, with easy-listening music playing in the background. But in reality, your office is never quiet. Throughout the day, you and your staff are using ultrasonic scalers, high-speed drills, air compressors and instrument cleaners in addition to other tools.

That noise can take its toll on your hearing. Noise levels in a dentist’s office routinely reach 90 decibels, with some machines topping 100 dB. Noises above 70 dB over a long period may damage your hearing, according to the Centers for Disease Control and Prevention.

As a result, dentists are twice as likely to suffer from hearing loss as the general population, and 21% of dental professionals have some type of hearing-related condition.

Learn the signs of hearing loss

So what can you do to avoid hearing loss? Start by establishing a baseline for your hearing. Get your hearing checked by an audiologist, and then periodically get it re-tested to see if there are any changes.

Hearing loss is irreversible but preventable. Learn how to recognize the symptoms of hearing loss, which include:

  • Trouble understanding conversations
  • Not being able to hear people when there is background noise
  • Keeping the radio or TV at a high level
  • Asking people to repeat themselves
  • Complaining that others don’t speak clearly

Protecting your ears in the office

You can take steps to reduce the amount of noise that gets into your ears. Some dentists and hygienists wear earplugs, but this can get in the way of good communication with your patient.

“Going to the dentist is such a vulnerable experience for patients,” said Dr. Jessica Buehler, Delta Dental’s director of dental affairs. “Dentists need to stay in touch with them, and it’s very hard to maintain that level of communication with earplugs in. They need to be able to hear physical responses.”

Luckily, technology is catching up. New earpieces with custom electronic circuitry compress sound when it reaches dangerous levels. When the noise decreases, it allows normal sounds back into the ear. These can cost anywhere from $35 to $600, depending on the technology and the noise compression you want to achieve.

Reducing the noise in your office can also help. Keeping your tools in good repair can lower the volume of sound they emit. You can also upgrade your cleaning and drilling equipment to the latest technology, which tends to be less noisy. Adding acoustic treatments to the walls of your room can help absorb the sound. Also, consider adding doors and soundproofing walls in rooms where the noise gets high, especially those that have your cleaning equipment and are generally empty.

You can also try to scale teeth manually instead of using the ultrasound scaler, one of the biggest culprits of noise in the office. But manual scaling can take a toll on your hands and wrists, especially if you have multiple clients in a day.

It’s impossible to get away from all noise while you’re in the office, but reducing your exposure to the louder sounds will help preserve your hearing and prevent permanent damage in the future.

5 tips for ergonomics in the operatory from Dr. Daniel Croley

Before he moved to the world of dental insurance, Dr. Daniel Croley, Chief Dental Officer at Delta Dental, managed two practices in Chicago. While managing those practices he began to suffer from repetitive strain in one shoulder and this strain developed into a severe shoulder injury. After eight years of practice, he made the difficult decision to look for a new position that would leverage his knowledge without being a risk to his health.

Dr. Daniel Croley
Dr. Daniel Croley

Even with the help of specialists, the risk of permanent injury as a dental professional is high, and it’s not uncommon for dentists or hygienists to experience musculoskeletal disorders (MSDs) due to poor posture. In fact, at least 62% of dentists report having at least one complaint of pain. MSDs are also the leading cause for early retirement for dental professionals.

The good news is that you don’t need to accept pain as a part of your job. Here are Dr. Croley’s tips to reduce the risk of injury when you practice.

1. Position yourself

With packed schedules and deadlines, taking any additional time to properly position yourself may be easy to overlook. But overlooking your positioning time after time will take a toll on your body at some point. When you sit down with a patient, remember to:

  • Move your stool as close as possible to your patient’s head so that you don’t overextend your arms or back.
  • Keep your feet flat on the floor or the footrest of your stool.
  • Adjust your stool height so your thighs slope slightly downward.
  • Hold your wrists in a neutral position and minimize wrist movement.
  • Maintain an erect, neutral spine instead of bending forward or leaning over your patient.
  • Distribute your weight evenly in a tripod pattern, between your two feet on the floor and your stool.

2. Position the patient

The position of your patient is just as important as your own position.

  • Recline the patient so your working area is at or just above your elbow level. If you can’t get an ideal position, adjust your stool height accordingly.
  • Have the patient move to the very end of the headrest with no space at the top.
  • Ask patients to tilt their head as needed to maintain your line of sight instead of leaning.

3. Engage your core

The goal of engaging your core is to use the muscles around your mid-section to act as a brace for your upper body and spine. Whether you’re sitting down to do a procedure or standing for long periods, that support protects the weaker muscles of your upper body from the strain it takes to lean over.

Some people interpret “engage” to mean “suck in,” which doesn’t provide your body any support. Instead of sucking in, think of the way your muscles tighten before you laugh or cough. That tightening is an engaged core.

Engaging your core muscles all day can be exhausting, especially if you’re not in the habit of doing it. Consider training your core muscles to make it easier to maintain good posture for longer.

4. Use equipment

Consider using a loupe to minimize the need to perch on the edge of your stool to see. If your overhead light is too dim or casts too many shadows, consider a head-mounted light as an alternative. Avoid gripping instruments tightly.

5. Stretch and exercise

Stretch to release strain. When possible, take 10 minutes to get up and stretch your spine, arms and legs. Stretching during and after work can help relax strained muscles.

For practice owners, investing in ergonomic training and supporting healthy practices has long-term benefits like preventing unwanted retirement, reducing canceled appointments and lessening the need for disability leave.

With very busy personal schedules and maintaining the production required to maintain a dental practice, it can be difficult to prioritize time-consuming tasks like ergonomic evaluations and training.  Sometimes you just need to get into non-ideal physical positions to gain the required access.  You can’t eliminate all physical strain, reducing it is still helpful. Even small changes can have a huge impact towards becoming an ergonomically healthy practice.

Your dental policy brief: News updates as of June 10

From court rulings to new legislation that could affect your practice, FYI brings you the latest dental policy developments.

More than 3 million could lose insurance if ARPA tax credits expire, study finds

Health premiums will rise, health care spending will decrease by as much as $11.4 billion and more than 3 million people could become uninsured if Congress does not extend the American Rescue Plan Act (ARPA) subsidies, according to a new study released by the Urban Institute.

Originally passed in 2021 as a response to the COVID-19 pandemic, the ARPA increased premium tax credits for Affordable Care Act (ACA) health plans, drawing many more Americans into state health exchanges, where many in turn purchased optional adult dental coverage. Currently under the ARPA, the full cost of COBRA premiums for medical, pediatric dental and vision are subsidized for individuals who qualify after involuntary termination or reduction of hours. Without the ARPA COBRA subsidy, qualifying individuals must pay those premiums themselves, and many once purchasing optional adult dental would likely drop such coverage.

Delta Dental–sponsored bill allows for electronic communications with group opt-in

On May 2, Georgia Gov. Brian Kemp signed into law Georgia House Bill 1308, sponsored by Delta Dental Insurance Company. The legislation allows plan sponsors to consent to electronic mailings on behalf of their employees if certain criteria are met, including that the plan sponsor routinely uses electronic communications with their employees and the option to opt-out of electronic delivery is available to all employees at any time. The legislation applies to health benefit plans and dental and vision carriers licensed to do business in Georgia.  Supporters of the law hope that employer-based “opt-in” protocols can help ensure more consumers receive their documents faster and at lower cost, making for a better overall patient-provider experience.

Biden administration blocks Georgia’s attempt to privatize ACA

President Joe Biden’s administration is blocking Gov. Kemp’s attempt to privatize the state’s Affordable Care Act program. Kemp had planned to bypass and have residents shop for federally subsidized health insurance through private agents. The move could breach federal rules on insurance waivers and cause too many people to drop coverage, according to the Centers for Medicare & Medicaid Services.

Dental hygienist’s medical marijuana case could reach Supreme Court

A Minnesota dental hygienist is petitioning the Supreme Court to rule on her medical marijuana case. The hygienist, Susan K. Musta, began purchasing cannabis to treat chronic pain due to work-related injuries in 2019 under Minnesota’s legal medical cannabis program and was not reimbursed for it under her workers’ compensation coverage for workplace injuries. Minnesota courts ruled that the federal Controlled Substances Act prevented her insurer from paying for medical cannabis, but the New Hampshire Supreme Court and the New Jersey Supreme Court reached opposite conclusions in similar cases, prompting Musta and her lawyers to ask the Supreme Court to rule on the issue.

Your dental policy brief: News updates as of April 6

From the latest on COVID vaccines and policy to new laws that could affect your practice, FYI brings you the biggest dental policy stories.

Millions of children could lose coverage when Medicaid requirement expires

Children in the U.S. currently insured through Medicaid or the Children’s Health Insurance Program (CHIP) have had stability in their coverage during the COVID-19 public health emergency due to a continuous coverage requirement mandated by Congress in March of 2020. This protection is likely to expire sometime in 2022, perhaps as soon as April. The Georgetown University Health Policy Institute estimates that at least 6.7 million children are likely to lose their Medicaid coverage, including dental care, and are at considerable risk for becoming uninsured.

ADA releases new resource for masking

In March, the American Dental Association (ADA) released Indoor Masking in Dental Practice Public Spaces, a new resource to guide dental practices in light of the latest masking recommendations from the Centers for Disease Control and Prevention (CDC). The CDC indicated in February that communities should now take into account new COVID-19 hospitalizations, hospital capacity and new COVID-19 cases to determine risk level and masking requirements in shared spaces. The ADA resource outlines steps dental practices can follow to align their practice with CDC recommendations.

Lawmakers in New York consider health benefits for uninsured immigrants

New York lawmakers are considering expanding the state’s Essential Plan, which offers free or inexpensive health insurance to low-income citizens, to cover undocumented immigrants. The program includes preventive care, prescription drugs and vision and dental benefits. The expansion would follow the lead of California and Illinois, which have recently offered health insurance to older low-income undocumented residents, but New York would be the first state to offer such coverage regardless of age. An estimated 46,000 people in New York who are currently ineligible for public health care programs due to immigration status would gain access to health insurance coverage, including dental benefits, under the proposed legislation.

What to know about sexual harassment by patients

Approximately 86% of dental hygienists in the U.S. reported experiencing inappropriate patient sexual behavior at some point in their careers, according to a study published in the August 2021 issue of the Journal of Dental Hygiene. About 63% of hygienists experienced harassment within the past 12 months, including patients staring at their bodies, grabbing them or making overtly sexual remarks.

This study looked specifically at dental hygienists, but harassment can affect any role in the dental office. Here’s what all office staff should know to handle cases of harassment, and what practice owners should know to support their team.

What staff should know: How to handle patient misconduct

If a patient behaves inappropriately, it’s important to address the behavior promptly and directly.

Before harassment occurs

Familiarize yourself with your office’s policy on harassment. If your office does not have a written policy (some states may not require it for smaller offices), review federal and state laws on the topic. 

In the moment

Using strong body language and a firm voice, tell (don’t ask) the patient to stop their behavior. There is no need to be apologetic.

Try language like:

  • “I don’t appreciate your advances and would like you to stop right now”; or
  • “What you are doing/saying is making me uncomfortable. Please stop immediately.” 

After the incident

Immediately report what happened to your immediate supervisor (or HR representative, if your office is large enough to have one). Be sure to keep your own notes documenting the incident, including details, such as date, time and description of the behavior. It’s critical to document every instance of inappropriate behavior. Remember that retaliation against you for reporting sexual harassment is illegal. 

What dentists need to know: How to support your staff

Know the rules

Federal law (specifically, Title VII of the Civil Rights Act of 1964, or “Title VII”) makes it illegal for employers to allow anyone to be sexually harassed at work by anyone else, regardless of sex, gender or sexual orientation. Sexual harassment can happen to a person of any gender, and the harasser can be of the same or different gender.

While federal laws may be limited in scope, such as only requiring written policies for workplaces with more than 15 employees, state laws may be more stringent.  Be sure to know and adhere to the requirements for your office location, and consider having a policy regarding harassment even if the law does not strictly require you to do so.

Support your team

If hygienists or other staff members report misconduct by a patient, always take them seriously. Listen to their description of the incident and assure them that the issue will be addressed with the patient. Encourage them to report and document any other incidents and thank them for coming forward.

Address the issue with the patient

While it is a difficult conversation to have, discussing the incident with the patient and making it clear that the behavior will not be tolerated and must cease is a critical step. Depending on their response, you may need to take steps to manage the situation, up to and including termination of the patient relationship. 

Having preventive strategies in place including a clear policy and open communication addressing sexual harassment helps you maintain a healthy, respectful and supportive work culture.

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