FYI

Dentist blog from Delta Dental

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

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.” 

Your dental policy brief: The 5 biggest stories as of August 4, 2021

From mask mandates to Medicare promises, it’s been a busy month for dental news and policy updates. Here are the five biggest stories from the past month for you to peruse.

1. Vaccine mandates become a reality for California and VA dentists

Starting August 9, health care workers in California, including dentists and staff, will be required to show proof of COVID-19 vaccination or submit to regular tests if unvaccinated. Full compliance is required by August 23. Additionally, on July 26, the Department of Veterans Affairs (VA) announced that dentists who serve Veterans must get fully vaccinated within eight weeks. The VA mandate covers Title 38 health care personnel, including dentists and other patient-facing workers.

2. The American Dental Association updates its guidelines

On July 13, the American Dental Association updated its pandemic procedures for offices to help fight COVID-19. Hazard assessments are encouraged, pre-appointment screenings are still necessary, and dentists are encouraged to exercise their best judgment when setting a safety plan for their practices.

3. Senate Democrats’ proposed budget would add dental coverage to Medicare

On July 13, Senate Democrats agreed to pursue a $3.5 trillion reconciliation bill that would add dental coverage to Medicare. Medicare serves almost 63 million members, so this could mean an influx of senior citizen patients if the bill passes.

4. Paycheck Protection Program (PPP) loan forgiveness deadline coming due

If you received a PPP loan last year, be sure to apply for forgiveness before the next deadline passes you by in September. Under the program’s rules, borrowers who don’t apply for forgiveness within 10 months of the end of the covered period will need to begin making payments to their lender.

5. Department of Health and Human Services bans balance billing

At the beginning of the month, the Department of Health and Human Services prohibited balance billing, effective January 1, 2022. The new rule, “Requirements Related to Surprise Billing; Part I,” applies to dental plans embedded in medical plans, but not to standalone dental.

How dental technology can help take your care to the next level

As technology rapidly evolves, innovative new software and hardware have begun to appear in dental offices and schools around the country. Here are a few interesting and promising technologies that might be coming to your office soon.

Teledentistry

Thanks in part to the COVID-19 pandemic, teledentistry has been expanding rapidly — in a recent survey, 34% of dentists reported that they see patients via telehealth platforms or plan to use it in the near future — and it’s projected to be a $2.6B industry by 2027.

A variety of services fall under the teledentistry umbrella, including:

  • Teleconsultation, in which a patient receives a consultation via a mobile device or computer
  • Telediagnosis, where images and data received from patients are used to evaluate and diagnose dental issues
  • Telemonitoring, where patients who have undergone treatment can be monitored without frequent in-person visits to the dentist

Along with making dental care more accessible to patients during the pandemic, teledentistry has proven to be a useful tool treating for underserved populations. Low-income patients, rural patients, elderly patients in assisted living facilities and physically and intellectually disabled patients can face obstacles with in-person visits.

While teledentistry has shown great promise, the technology associated with it can be challenge for both dentists and patients. To help, we’ve introduced Delta Dental – Virtual Consult. This free, video-based platform enables you to consult with Delta Dental members virtually through a secure, HIPAA-compliant platform.

Artificial intelligence

While the first thing that pops into you head when you hear the term “artificial intelligence” might be science fiction, the science behind artificial intelligence isn’t fiction. And it’s available to help you right now.

Artificial intelligence, or AI, uses software to process information and learn patterns. As it gathers more information, it learns to assess situations and then make decisions or predict outcomes. As a result, AI can improve your ability to detect dental conditions quickly and accurately, and consistently provide you with the appropriate treatment. In ambiguous situations, AI can provide you with a second opinion.

So far, AI has proven to be a versatile tool for dentists, with these applications:

  • Making objective, consistent diagnoses for issues such as cavities
  • Diagnosing certain dental conditions, especially ones that may be caused by multiple factors, such as jaw issues and canker sores
  • Identifying patients at risk for developing oral cancers
  • Creating precise aligners
  • Determining orthodontic dental plans, including how the patient’s teeth should be moved, how much pressure should be applied to teeth and where pressure points on specific teeth are

Extended reality

Speaking of science fiction, another emerging technology that might have seemed impossible just a few years ago is extended reality, which includes several technologies:

  • Virtual reality (VR), a computer-generated, interactive, three-dimensional reality
  • Augmented reality (AR), an enhanced version of reality that combines real objects with computer-generated images, sounds or other sensory elements
  • Mixed reality (MR), a combination of the two

These technologies have potential applications in the dental field, including:

  • Planning and executing oral and maxillofacial surgeries, particularly implant placement and head and neck reconstructions. For example, with mandibular and maxillary reconstructions, a study found an excellent match between the virtual surgery plans and the actual outcomes, including the resection planes and the distance between the transplanted segments and the bone.
  • Education and training. Immersive 3D training with haptic feedback can be an effective and cost-saving training tool. Particularly useful is the ability to not only simulate a procedure in 3D, but also to be able to feel how much pressure to apply during drilling, cutting and milling through haptic feedback. The virtual simulations also enable students to assess their performance and then refine their technique.

3D printing

Invented in the early 1980s, 3D printers transform digital files into physical objects by stacking layers of material to form three-dimensional objects. Today, 3D printers can make objects from a variety of materials, including metals, ceramics, plastics and plaster.

3D printers are so adept at creating dental devices that the dental industry has become one of the leading users of 3D printing. Clear aligners are one of the highest volume applications for 3D printing technologies in the world.

3D printers may enable dental labs and offices to produce dental devices more quickly, accurately, consistently and inexpensively than human technicians can. With this improving technology and the exponential growth of clear aligner production, it’s estimated that by 2022 as many as 500 million dental devices and restorations will be produced annually with 3D printing technology. These include:

  • Crowns
  • Bridges
  • Dentures
  • Dental models
  • Retainers
  • Surgical guides for implants
  • Veneers
  • Orthodontic models

These are just a few of the innovations coming to your office soon. New technology continues to provide innovative ways to help you improve the accuracy, efficiency and value of the dental care you provide to your patients.

Teledentistry is now available in Texas

On June 16, Gov. Greg Abbott of Texas signed HB 2056 into law, making it legal for Texas dentists to provide teledentistry services to their patients. Among other provisions, the law:

  • Requires informed consent from the patient
  • Establishes standards of care for teledentistry
  • Protects patient privacy
  • Promotes care for underserved areas
  • Addresses teledentistry’s use in treating patients with special needs
  • Sets up rules for Medicaid and teledentistry
  • Requests biennial reports on teledentistry’s effectiveness
  • Empowers the Texas Medical Board and State Board of Dental Examiners to set rules for teledentistry

Building up teledentistry services from scratch can seem daunting, but there are tools and resources out there that make it easy. From guides on how to see patients to tools like Delta Dental – Virtual Consult that help you easily expand your practice, Delta Dental makes it easy for you to find success with teledentistry.

Interested? Just fill out the interest form and we’ll reach out to you about getting started with Virtual Consult.

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