FYI

Dentist blog from Delta Dental

Tag: COVID-19 (Page 1 of 4)

New CDT codes for COVID-19 vaccination

In March 2021, the Code Maintenance Committee of the American Dental Association (ADA) added seven new codes designed to report the delivery of COVID-19 vaccine. These codes have been added to the preventive category of service.

Additionally, a new code for molecular testing has been added to the diagnostic category of service.

These services are covered under medical plans and therefore will not be covered by Delta Dental. If you administer COVID-19 vaccines in your dental office, check with your patients’ medical carriers for more information about coverage.

New CDT codes as of March 29, 2021:

  • D0606 — molecular testing for a public health related pathogen, including coronavirus. This procedure is not a benefit of most Delta Dental plans. The fee is the patient’s responsibility
  • D1701 — Pfizer-BioNTech Covid-19 vaccine administration – first dose. This procedure is not a benefit of most Delta Dental plans. The fee is the patient’s responsibility.
  • D1702 — Pfizer-BioNTech Covid-19 vaccine administration – second dose. This procedure is not a benefit of most Delta Dental plans. The fee is the patient’s responsibility.
  • D1703 — Moderna Covid-19 vaccine administration – first dose. This procedure is not a benefit of most Delta Dental plans. The fee is the patient’s responsibility.
  • D1704 — Moderna Covid-19 vaccine administration – second dose. This procedure is not a benefit of most Delta Dental plans. The fee is the patient’s responsibility
  • D1705 — AstraZeneca Covid-19 vaccine administration – first dose. This procedure is not a benefit of most Delta Dental plans. The fee is the patient’s responsibility
  • D1706 — AstraZeneca Covid-19 vaccine administration – second dose. This procedure is not a benefit of most Delta Dental plans. The fee is the patient’s responsibility.
  • D1707 — Janssen Covid-19 vaccine administration. This procedure is not a benefit of most Delta Dental plans. The fee is the patient’s responsibility.

Stress taking a bite of patients’ dental health

For many, 2020 ushered in feelings of isolation and fear, as well as new concerns about financial stability, safety, family and how to juggle all of it from home. For some dentists, the stress of the situation has become apparent in their patients’ oral health. As of March, over 70% of dentists surveyed by the American Dental Association (ADA) Healthy Policy Institute reported an increase in patients experiencing teeth grinding and clenching since before the pandemic. That number is up nearly 10% from fall of 2020. In fact, more than 80% of Americans have reported emotions associated with prolonged stress, according to a January study by the American Psychological Association (APA).

“Generally, manifestations of stress go away when the stressing event goes away. That’s where the pandemic comes in,” said Dr. Daniel Croley, DMD, chief dental officer for Delta Dental. “One of the ways that some people manifest stress is by clenching and grinding their teeth.”

Dental conditions related to stress go beyond teeth grinding, of course.

Stress-related conditions

Multiple studies have shown that emotions can play a significant role in periodontal disease. Thanks to an increase in inflammation from stress-induced conditions, the gums can become a hotbed for bacteria, leading to gingivitis. According to the ADA, dentists reported recent upticks in all of the following conditions:

  • Bruxism
  • Chipped teeth
  • Cracked teeth
  • Temporomandibular joint disorder (TMJ) symptoms
  • Caries
  • Periodontal disease
  • Xerostomia
  • Halitosis
  • Oral mucosal lesions

Delta Dental’s claim data also suggests a rise in stress-related conditions. Bite guards, commonly associated with treatment for bruxism and TMJ were prescribed 14.3% more by Delta Dental dentists in the second half of 2020 than during the same period in 2019.

Sleep and ergonomics

During the mad rush to convert homes to offices in the early days of the pandemic, couches and stools took the place of lumbar-supported work chairs. Ergonomic workspaces became less of a priority than merely having a functioning workspace and the resulting poor posture may also be to blame for some TMJ issues. If your patients have been working from home, suggest they read up on proper ergonomics for their workstation.

Likewise, stress and disrupted routines likely hurt the chances at restorative sleep, increasing nighttime teeth grinding. Insomnia and restlessness can result in bruxism and TMJ.

Mask mouth

On top of these stress-induced issues is yet another pandemic problem: mask mouth. The facemask has been a staple of pandemic life and has greatly contributed to the slowing of the virus but can come with unfortunate byproducts: bad breath, dry mouth and even gingivitis and tooth decay.

Dental professionals attribute mask mouth to dehydration and mouth breathing when wearing a face covering. Though the ADA found no substantial rise in these specific indicators, the symptoms are preventable through thorough brushings and more regular hydration. On the upside, masks can sometimes help wearers identify their own halitosis, which may stem from more serious problems.

Other reasons for the spike

It is important to note that not all of these conditions are caused solely by anxiety and tension. For instance, a broken tooth could come as the result of anxiety-induced teeth-grinding, but it could also be caused by an accident or prolonged dental problems. Unfortunately, most claim data does not include the cause behind the diagnosis. Without that, it is impossible to say with absolute certainty that stress is the sole reason for a spike in numbers.

“It’s logical to conclude that current stress is leading to those broken and chipped teeth,” Dr. Croley said. “We will monitor and see. As we see broader distribution of the COVID vaccine and our daily lives feel more typical of what we experienced pre-pandemic, we will see our stress subside and as a result the need for bite guards to treat grinding and clenching subside — but our bodies can take some time to re-acclimate. Going back to the typical is still a change from what has been our weird ‘normal’ over the past year, and any change can generate stress.”

Many patients may not realize the correlation between stress and oral health. Educating your patients about how mental health can affect their mouth when signs of stress are detected is an important first step toward solving the issue. The ADA has created a compilation of resources for recognizing and managing stress. These may be especially helpful if you are are working with anxious patients or experiencing stress yourself.

Dentist spotlight: Dr. Amanda Rafi

Going to the dentist isn’t everyone’s favorite errand, but as we all know, a good experience can make all the difference. For dentists like Dr. Amanda Rafi, a dentist has the power to be a fixer, a friend and even an inspiration — and that’s why she’s our Dental Health Partner of the Month.

Dr. Rafi owns and operates three different practices alongside her husband in Orange County and Riverside, California, as well as in her hometown of Scottsdale, Arizona. She says she owes it all to her own formative experiences with going to the dentist.

After graduating with honors from the University of Arizona and earning her Master of Public Health at A.T. Still University, she obtained her Doctor of Dental Medicine degree at the Arizona School of Dentistry and Oral Health. It was during this time that she met her now-husband and business partner, Dr. Ryan Baker. After graduation, the two set off to his home state to build a successful and flourishing practice out of Tustin, California, where she specializes in cosmetic and family dentistry.

What made you want to become a dentist?

When I was younger, about 12, I wanted to be an orthodontist because I just had gotten braces and I really thought it was so interesting and creative. I got interested in it from there, and then I got into dental school and I realized that I really like all aspects of dentistry. So, I didn’t specialize — I focused on cosmetics and things like that, but I love to do it all! I do crowns, bridges and root canals, and all of it’s really fun to me.

What do you love about being a dentist?

Just helping people. I think the biggest thing is making sure that people feel comfortable. When they come to the dentist, people tend to feel very uncomfortable. I don’t know if a childhood experience or what really contributed to that, but when they get here I try to make them feel as at home as possible and make sure that they leave with a smile at the end of the day. 

I think communication is a big part of that, and so is making eye contact. Just talking to them like a normal person and not using big dental terminology is a big thing. I noticed when I shadowed other dentists that they used big words that someone who didn’t go to dental school probably wouldn’t understand. That makes people more uneasy because they don’t know what it is.

I always try to show patients the x-ray or take a picture inside their mouth and put it on the big screen to show them. Being visual myself, I think it’s beneficial for people to see it that way.

What’s the biggest challenge of running your own practice?

It’s really hard making sure that all 10 employees are on the same page and that we’ re a team always. [Employees] can either make the practice or break it. My biggest challenge is just making sure that we’re always moving in the right direction.

How has the pandemic affected your practice?

COVID completely changed our practice. When COVID hit back in March, we had to shut down for two months and that was a big hit on our business. Even when we opened back up again in May, people were scared to come back.

We had to convey to everyone that we’re taking the same precautions as a hospital. We have the same N95 masks, the face shields, the goggles, the gloves and we’re keeping everyone six feet apart and taking their temperatures before they come in. Everyone’s really cautious with gloves and masks and everything — that’s just normal [for dentists].

We’re trying to make people as comfortable as we can with the whole situation, but it was hard to get patients to come back, to tell you the truth. People were scared to go anywhere. 

I’m hoping it gets better. More and more people will be getting vaccinated and we’ll still keep working through it to make sure that when patients come in we’re able to meet their needs.

Tell us a little about how you stay connected to the community.

Previous to the pandemic, we could do a lot more volunteer work. We do anything we can and always try to stay involved in the community. There have been golf tournaments and charity work. We also stay involved in our city council and sponsor a baseball team.

I’ve been doing community work since before dental school. Giving back has always interested me, but now we’re fortunate enough to have what we have, so giving back is really important to me. The whole practice is involved. We do everything together. 

What have your hobbies been like in this past year?

We got a dog during quarantine! He’s a cute little Maltipoo, and he’s that brown cinnamon color like a little teddy bear. His name is Charlie and he’s just been so much fun this whole time. He really lights things up! He just turned one, so he’s still kind of a puppy.

Also, I’m honestly really into 90 Day Fiancé. It’s a reality show and it’s really good. I’ve been binge watching it. There’s so many different seasons, but I’m almost caught up. It’s nice to be away from our reality for a little bit!

If you could go back in time, what advice would you give yourself when you were first starting your career?

I would say to always try to be confident and just remember to do the right thing. If you always do everything by the book and make sure that you’re doing everything the right way, it will always work out. 

In honor of Women’s History Month, can you tell us about a woman in your life who has inspired you?

My mom always showed me how hard she worked supporting our family and keeping us all together. She showed me that family comes first and that you can work hard and play hard. She’s an engineer who worked for Motorola, and she’s built a lot of our homes and some shopping centers. She even built the house that we grew up in! Lots to look up to there.

What are your goals for the future?

Opening more practices! We’re hoping the next one will be in Arizona. My whole family is still out there, and we’re usually there every other week. My family has always been there supporting me and my husband, too. I’m very grateful for everything I have.

Congratulations to Dr. Rafi on being our Dental Health Partner of the Month! You can learn more about her and her practices on her website and on Facebook.

The 2020 elections and the dental industry — what it means for you

In an outcome that defied many polls and predictions, the Democratic Party gained control of the Senate in the 2020 United States elections, while winning the White House and keeping control (just barely) of the House of Representatives.

While the election results were surprising, what’s not a surprise is that this “clean sweep” may have an impact on dentists and the dental industry. Here are some potential outcomes that may affect you.

The Affordable Care Act (ACA) and the health insurance marketplace (exchange) system will be preserved and expanded

President Joe Biden’s administration has made restoring the ACA an immediate priority, and many of the cuts and restrictions imposed by the administration of former President Donald Trump are being reversed.

This is a positive development for dentists, said Jeff Album, Vice President of Public & Government Affairs for Delta Dental.

“Any news that’s good for the ACA and the exchanges is good for dentists,” Album said. “This market attracts people who wouldn’t otherwise get insurance through work, and increases in subsidies also help draw people into coverage. People with coverage are almost twice as likely to see the dentist as people without coverage.”

Among the ACA-related actions that are either underway or soon to happen under this administration:

A special enrollment period to increase exchange enrollment is officially underway

President Biden signed an executive order to create a special enrollment period from February 15, 2021 through May 15, 2021, during which eligible people can enroll in coverage from the federal health insurance marketplace. Uninsured residents in the 36 states that use the federal exchange system, including those who lost coverage because of the pandemic, can look for plans.

States with their own marketplaces are also creating special enrollment periods, although the time frames and eligibility requirements may differ.

The Centers for Medicare & Medicaid Services (CMS) has earmarked $50 million for outreach and education during the enrollment period.

The ACA’s Navigator Program will return

Reversing the prior administration’s move to defund this program, CMS will now provide about $2.3 million to help people find coverage on the federal exchanges, a process that can be confusing. The money will fund 30 Navigator Programs in 28 states. This, Album said, should help bolster dental enrollment.

“Several studies suggests that consumers are completely unaware of marketplace open enrollment dates, including the special enrollment periods,” Album said. “We believe this type of outreach will definitely help promote adult dental voluntary enrollment.”

Subsidies for exchanges will increase

The Biden administration included increases to ACA subsidies in its COVID-19 relief package. Consumers with household income more than 400% the federal poverty threshold will receive federal assistance to ensure that no more than 8.5% of their income goes toward a plan.

“The subsidies are getting better and the Biden administration is trying to bring more people into the exchanges,” Album said. “A great many small business and individuals impacted by the economy and COVID will now have an opportunity to get exchange-based dental coverage.”

Waivers that allow states to circumvent exchanges may be eliminated

Section 1332 of the ACA permits states to apply for a waiver to pursue “innovative strategies” to provide their residents with access to affordable health insurance, so long as they retain the basic protections of the ACA.

However, in 2020, the state of Georgia used the 1332 waiver to effectively eliminate its exchange program and force Georgia residents to purchase plans from private insurers without any kind of centralized platform. As a result, President Biden directed federal agencies to reexamine all waiver policies, including 1332.

“I think this administration is going to be tougher than the former one when it comes to deviating from the ACA’s framework,” Album said. “We’re not likely to see any other states attempt a direct enrollment alternative to centralized state-based exchanges or the federally facilitated exchange.”

Medicaid eligibility under the ACA may expand

The COVID-19 relief package recently passed by the U.S. House of Representatives included incentives to encourage states to expand Medicaid eligibility under the ACA. States that choose to expand would receive a 5% increase in Federal Medical Assistance Percentage (FMAP) payments to current Medicaid enrollees.

“The FMAP increases are important because that’s what allows states to do optional benefits like adult dental,” Album said. “Here in California, the adult dental Medicaid program was going to be in trouble if the state didn’t receive more financial assistance. It now looks very likely that Congress will pass some FMAP increase in the near future.”

A “public option” with a dental benefit could be created — but probably won’t

A public option would be a federal health insurance program offered on states’ exchanges as an alternative to private plans. It would probably be subsidized for lower income Americans and at least partially paid for by enrollees who don’t qualify for subsidies.

While dental coverage wouldn’t be a guaranteed benefit for anyone other than children, it could be made available on a voluntary basis.

Initially, it seemed as though a clean sweep by the Democrats would almost guarantee a public option. Candidate Biden repeatedly said he supported it during his 2020 campaign. And California Attorney General Xavier Becerra, Biden’s pick for Secretary of the U.S. Department of Health and Human Services and a long-time proponent single payer healthcare, said during a recent Senate hearing that he would support Biden’s efforts to do so.

However, the Democratic sweep in the 2020 election might not be enough to push this through. Despite their control of the Senate, the Democratic majority depends on the tie-breaking vote of Vice President Kamala Harris. Furthermore, the Democratic majority in the House narrowed significantly.

“Given the Democrats’ razor-thin majority in both the Senate and the House, and Republican opposition to the concept, a public option currently seems unlikely,” Album said. “I don’t see it happening.”

Leaving the ACA, here are a few other possible issues to consider.

A dental benefit could be added to Medicare

Democrats in the House and Senate have introduced bills to add dental under Medicare Part B. However, as introduced these bills don’t specify which benefits should be added, and neither the House nor the Senate is likely to take these bills up in earnest until the latter half of the year.

There may be changes to tax laws that dentists should be aware of

Biden’s tax plan includes proposals to raise taxes on corporations and people who earn more than $400,000 per year. These are some changes that could affect dentists:

  • The tax rate on incomes above $400,000 would increase to 39.6% from 37%.
  • The Section 199A 20% deduction for practice and real estate profits would be repealed for people whose taxable income exceeds $400,000.
  • Your payroll taxes might increase because a 12.4% Social Security payroll tax, split between you and your employees, would be imposed on earned income that exceeds $400,000.
  • If you plan to sell your practice, be aware that the tax rate on capital gains and dividends would increase to 39.6% (not including the 3.8% Affordable Care Act tax levied on gains) from a maximum of 20% if your taxable income exceeds $1 million.
  • The estate tax exemption would be reduced to $5 million from $11,580,000, and the estate tax rate would increase to 45% from 40%.

As with any new administration, there are more questions than answers at this point, and how — or if — some of these proposed changes will be implemented is uncertain. What is certain, however, is that we can expect more proposals and policy updates that will affect dentists in the upcoming months. Be sure to refer back to FYI for news and updates as they become available.

Common questions your patients may have about the COVID-19 vaccine

As the COVID-19 vaccine is becoming more accessible throughout the country, you may find more of your patients talking about it and asking questions. Unfortunately, there’s a lot of conflicting and inaccurate information being spread through various media channels. Staying on top of the truth can be a full-time job, but here’s a list of common questions and some points you can bring up in case your patients come to you with concerns about the vaccine.

Is the vaccine safe?

Yes. Multiple expert sources, such as the Mayo Clinic and the Centers for Disease Control and Prevention (CDC), have attested to the vaccines’ safety. There are multiple reasons why a patient might be concerned about the vaccine’s safety, but the most common include:

  • Concerns about catching COVID-19 from a vaccine shot. There is no live virus used in the vaccines, so people who receive them can’t contract COVID-19.
  • Concerns about the vaccine damaging cells’ DNA. mRNA vaccines don’t alter cell DNA. Instead, they teach cells how to make a protein, which generates an immune response that will help cells target similar proteins in the COVID-19 coronavirus.
  • Concerns about the vaccines being developed recklessly or too quickly. The vaccines have been tested on tens of thousands of patients. Pfizer and Moderna have published ingredient lists for their vaccines, and the mRNA technology used to make the vaccines has been in development for over 30 years.

I’ve heard reports of people having aches, chills and other symptoms after getting vaccinated. Is this an issue?

No. Some people who have gotten the vaccine have reported muscle pain, chills and headaches, but that is not unusual for vaccines. These are part of the body’s normal immune response. But if you’ve had an allergic reaction to vaccines in the past (which is due to the ingredients used in the vaccines), then you should first consult with your health care provider.

Should I still get a vaccine if I’ve had COVID-19 previously?

Yes. It’s not clear if having contracted COVID-19 previously grants long-term resistance and immunity, like chicken pox does. Even for those who have been infected previously, the CDC still recommends getting vaccinated.

COVID-19 doesn’t seem that deadly. Should I get a vaccine if I’m not in a high-risk category?

Yes. It’s true that as a percentage, most people who contract COVID-19 don’t die from it. Still, there can be serious long-term consequences such as lung, heart or brain damage. And even someone who doesn’t get seriously ill can still spread the disease among others who are more vulnerable. Getting a vaccine helps you protect not just your family and loved ones, but also society as a whole. These are important reasons to get the vaccine.

Once I’ve been vaccinated, do I still need to wear a mask or socially distance?

Yes. Even if a person has been vaccinated, that doesn’t mean that he or she can’t still spread the virus. It takes at least 10 days for the body to develop antibodies, and the number of antibodies present only goes up with more time. Additionally, research hasn’t conclusively determined if the vaccines prevent asymptomatic infection and spread (although it is likely that they do). Wearing a mask and socially distancing are also good behaviors to model for those who haven’t been vaccinated yet. By getting vaccinated and following other preventive measures, you can do your part to end the pandemic sooner!

I’ve heard that the vaccine contains a chip inside that lets the government and corporations track people who get vaccinated. Is this true?

No. Some syringe makers include a microchip within the label of their syringes so that health care providers can track the shipping history and origin of doses of vaccine, but there is no chip in the vaccine itself.

I heard that the vaccine targets a protein that occurs naturally in pregnant women and can cause fertility issues. Is this true?

No. An amino acid sequence is shared between COVID-19 and a placental protein found in pregnant women, but the sequence is too short to trigger an immune response by itself. COVID-19 vaccines won’t cause fertility issues in women.

For further information on key facts about the vaccine and how you can play a role as a trusted health care provider, please consult the American Dental Association’s COVID-19 vaccine page.

Dentists and the COVID-19 vaccine: what to know

After a somewhat rocky start, the COVID-19 vaccine rollout seems to be progressing favorably for dental professionals. Most states now consider dentists to be essential health care workers eligible for priority vaccination, and many states now allow dentists to administer the vaccine to their patients. 

Most dentists can get the vaccine

Most states now include dentists as essential health care workers eligible for their first phase of vaccination, according to the most recent information complied by the American Dental Association (ADA).

  • Currently, more than half of states place dentists in the highest priority tier, 1a, for immunization.
  • Several states, including Florida, Minnesota, and Nevada, also include dentists in their first phase of immunizations, but give counties the discretion to prioritize them higher or lower within that phase.
  • Other states, including Colorado, Louisiana and North and South Dakota, include dentists in their first phase of immunizations but place them in a lower-priority tier than other essential health care workers.

Only a few states don’t consider dentists to be essential workers. Oklahoma classifies dentists as part of a group of “allied health fields and general outpatient health service priority groups” that will be eligible for the vaccine as part of the state’s second phase of immunizations. Texas, meanwhile, has not yet determined where dentists will fall within its immunization plan.

Some dental staff can also get the vaccine — and may be required to do so

Several states, including Arkansas, Georgia, Iowa, New York and Wisconsin, consider dental office staff such as dental hygienists to be essential health care workers eligible for priority vaccination.

Dental practice owners may also be able to require their staff to receive the vaccine. There are some important caveats to consider, though. For instance, if your practice has 15 or more employees, a vaccination requirement must accommodate disabilities, including pregnancy-related issues, under the Americans with Disabilities Act, and must respect staff members’ religious beliefs. You may also be required to pay for the vaccinations.

Despite these challenges, it might be an option worth pursuing. A recent survey found that 64% of patients who were hesitant to return to their dental office would be willing to do so if the entire staff had received the COVID-19 vaccine.

Many dentists can administer the vaccine

Currently, dentists in at least 20 states can administer the COVID-19 vaccine. It’s worth noting, however, that not all these states will necessarily allow dentists to vaccinate patients in their dental offices.

For instance, the California Dental Association says it’s unlikely that dentists in the state will be able to administer vaccines from their dental offices because of storage requirements, billing issues and space requirements for patients who need to be monitored after they receive the vaccine. More likely, they say, is that dentists will be able administer the vaccine at hospitals or through government vaccination programs, such as mass vaccination sites.

In New York, dentists can administer the vaccine only at sites overseen or approved by the state or a local health department and supervised by physicians, physician assistants or nurse practitioners.

Members of your staff may also be able administer the vaccine. For instance, California and some other states will allow dental hygienists to do so.

To help you determine your state’s rules about administering the vaccine, the ADA has created an interactive map with the latest updates.

In eligible states, dentists and dental hygienists who wish to administer the vaccine may also have to complete training beforehand. The ADA has compiled a state-by-state guide that includes information about the vaccine, educational resources and training.

Finally, the ADA is also requesting that the federal government grant liability protection to dentists who administer the COVID-19 vaccine.

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