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Helping You Be a Better Dentist

Learn how to identify drug-seeking patients in upcoming webinar

An upcoming webinar aims to educate dentists on how to interview patients with addiction problems and identify those who are just seeking drugs.

prescription drugsInterviewing and Counseling Patients with Substance Use Disorders and Drug-Seeking Patients is scheduled for Feb. 18 from 2-3 p.m. Central time. Michael O’Neil, Pharm.D., professor of pharmacy practice at South College in Knoxville, Tennessee, will lead the webinar and review basic interview and counseling skills that help optimize patient care and protect dentists from patients who may have criminal intent.

Dentists may find themselves the targets of prescription drug diversion scams and schemes and the webinar will provide tips on how to talk to patients about their intentions and counseling that will help minimize risks to the patient and dentist.

To register, contact Alison Siwek at siweka@ada.org. Registration closes Feb. 16.

Integrating checklists into your practice is key to get things right

Time outs are performed minutes before a procedure begins. In dentistry, this is commonly done before an extraction or a root canal. Do I have the right patient? Is the correct radiograph displayed? Is the necessary equipment present? Do I know which tooth? How often do we breeze through this checklist or not read it at all?

Dr. Carolyn Norton

Dr. Carolyn Norton

The Checklist Manifesto by Atul Gawande shows how checklists which identify critical steps or points of failure can make up for our own human inadequacies. Checklists don’t stop at the example above. As the volume of dental procedures I preform increases every day, I have developed my own mental checklists to make sure I’m working efficiently and producing quality dentistry. Even your morning huddle is a checklist.

In 2001, a central line placement checklist was implemented at Johns Hopkins Hospital by critical care specialist Peter Pronovost. Nurses were allowed to intervene if they saw a doctor not following the checklist. After two years of data collection, the central line infection rate went from 11 percent to zero. Dr. Pronovost found that checklists, “establish a higher standard of baseline performance, help with memory recall, and set the minimum necessary steps in a process.”

When the World Health Organization (WHO) contacted Gawande in 2006 to help create a solution to prevent death and/or harm in surgery throughout the world with no funding, Gawande went to visit a master of checklists, Daniel Boorman from the Boeing Company. Aviation heavily relies on checklists. “Only 1 in 500,000 flights ever suffers an accident of any kind.” Was your last flight delayed for 45 minutes due to maintenance? Someone was using a checklist.

Mr. Boorman says checklists must be “precise and to the point. They do not try to spell out everything — a checklist cannot fly a plane.” He suggests keeping the list between five and nine items. It should take no more than 60 to 90 seconds to run the list. “You must define a clear pause point at which the checklist is supposed to be used.” My favorite part of this book: a checklist for making checklists is provided in the appendix.

Dr. Gawande’s WHO safe surgery checklist included seven checks before anesthesia, seven checks before the first incision, and five checks before removing the patient from the operatory. The effect of their safe surgery checklist was studied in eight hospitals around the world. In every hospital, complication rates fell 36 percent and deaths fell 47 percent. Seventy eight percent of hospital staff “actually observed the checklist to have prevented an error in the operating room.” When asked if they wanted the checklist used if they were to have surgery, 93 percent of hospital staff said “yes.”

After reading Dr. Gawande’s book I see checklists all around me, and I believe they work. No one is perfect, and checklists are great tools to help even doctors to get things right. “The volume and complexity of what we know has exceeded our individual ability to deliver its benefits correctly, safely, or reliably. Knowledge has both saved us and burdened us.”

How do you use checklists in your dental practice? Share your best ideas and checklists with us below.

 

Dr. Carolyn Norton is a New Dentist Now guest blogger and a 2014 graduate of the University of Florida College of Dentistry. She is half way through a 12-month general practice residency at the North Shore University Hospital in Evanston, Ill., affiliated with the University of Chicago. Dr. Norton was a contributing editor for the American Student Dental Association from 2012-14.

 

Know anyone who has volunteered internationally?

Do you know a dentist who has generously given their time, talents and skills by volunteering internationally?

Int'l Volunteer Svc LogoApplications are due April for the Certificate for International Volunteer Service, a program that recognizes ADA members who have volunteered in developing countries to improve the oral health and overall health of individuals.

Criteria for applying for and receiving the certificate include:

  • Be an active, life, student or retired member of the American Dental Association.
  • Have served in an international location with a program sponsored by a dental school or recognized nonprofit organization for a minimum of 14 days, either in one period or in several visits, in any 24-month period.
  • Have provided clinical dental service and/or taught local dental personnel or assisted in training initiatives to improve the local oral healthcare infrastructure.
  • Supply evidence of the dates of the service with a comprehensive, detailed breakdown of activities and the value of the contribution by means of a letter or testimonial from the director of the program or other appropriate official (for student members working in a dental school program this requirement shall be the responsibility of the dean or director of the outreach program).
  • Be nominated by a component or constituent society, federal dental service or dental school.
  • Be verified in writing to be a member in good standing by the component society, if such exists, or by the constituent society, commanding officer or dean of the dental school as appropriate.

Nominations are reviewed by the ADA Board of Trustees at the June meeting. Recipients will be announced within 30 days of the meeting and the certificates will be distributed to the recipient, or to the nominating component or constituent societies upon request. A certificate may be awarded to the same individual more than once.

For more information on the Certificate for International Volunteer Service or to submit a nomination, click here.

Know the difference between accidents and signs of domestic violence?

In a year where high-profile accusations of family violence have rocked the National Football League, the ADA House of Delegates streamlined Association policy on family violence during its meetings at ADA 2014 — America’s Dental Meeting in San Antonio, according to ADA News.

An employee crying

Resolution 89H-2014, Educating Dental Professionals in Recognizing and Reporting Abuse, states that “the ADA supports educating dental professionals to recognize abuse and neglect across all age groups and reporting such incidences to the proper authorities as required by state law.” The House rescinded policies from 1993 and 1996.

“Family violence has been a hot topic in the news media as high-profile players in the NFL have been accused of violence against children or partners,” said Dr. Lynn Douglas Mouden, chief dental officer for the Centers for Medicare & Medicaid Services. “There is a universal mandate for U. S. dentists to report suspected cases of abuse or neglect of children, but dentists should also be aware that some states also mandate reporting cases that deal with adults and elders as well.”

Are you able to discern the difference between accidents and intentional injuries or signs of violence? Do you know what your state’s law in regards to reporting family violence?

If your answer is “no,” Dr. Mouden suggests attending the 7th Biennial National Conference on Health and Domestic Violence, set for March 19-21, at the Renaissance Washington, D.C. Downtown Hotel.

“With training, dentists are better able to discern the difference between accidents and intentional injuries, or between otherwise normal conditions and the signs of violence,” Dr. Mouden said. “Because laws vary from state to state, dentists should work with their state dental association to learn more about the laws regarding reporting of family violence and about opportunities to learn more about preventing family violence.”

For more details on the conference, hotel accommodations or to register, click here.

10 steps to increase provider participation in Medicaid/streamline administration

Here are 10 steps to increase provider participation in Medicaid and to streamline the administrative process from Action for Dental Health, a nationwide, community-based movement aimed at ending the dental health crisis facing America today.

Action for Dental Health

  • Step 1: Talk with the manager of Provider Enrollment for your state and review the process for enrolling in the Medicaid program. Confirm basic information such as documentation expectations, electronic filing and ability to participate on a limited basis.
  • Step 2: Identify populations of interest that your practice will serve. Determine how those patients will access your practice, whether via local community outreach or referrals from the local community health center after being triaged.
  • Step 3: Discuss with your state dental association the current baseline of provider participation and the data that will be coordinated as reported by your state to the Centers for Medicare and Medicaid Services in its CMS 416 report. This information is the basis for determining what positive results are being seen due to increased provider participation.
  • Step 4: Participate in a state Dental Medicaid Advisory Committee or form a committee if one does not exist in your state. Invite other Medicaid providers, both private practice dentists and those working within community health centers, to participate.
  • Step 5: Review Medicaid rates, prior authorization and enrollment processes for your state. Are adult Medicaid benefits available? Was there an increase in providers if rates were increased? Learn what negotiation and compromise efforts were performed.
  • Step 6: To streamline your credentialing and provider eligibility process, review those states making a positive difference (Oklahoma, California, Maryland and Kentucky). Invite the people who perform the enrolling process to your Medicaid advisory committee to investigate what might be done in your state to expedite credentialing.
  • Step 7: Meet with the manager of your state Medicaid Integrity Program to learn of the processes they follow for chart audits and review. Explain the need for uniform compliance training for auditors for reviews. Discuss with your Medicaid Advisory Committee.
  • Step 8: Maintain strong lines of communication with the state Medicaid program, the state oral health program, the ADA and Medicaid-CHIP Dental Association who can be resources for you.
  • Step 9: Share program successes and failures with your local dental society.
  • Step 10: Write an article for your state dental association journal about your Dental Medicaid Advisory Committee, your experiences in treating the underserved and the value that dentistry can provide in communicating with the local medical community about the importance of integrating oral health for patient overall health.

To view the full 10-step process, click here. For more information about the ADA’s Action for Dental Health, visit ADA.org/action.

10 steps to starting a Head Start program in your office

Head Start began as a summer program in 1965 and serves the nation’s most vulnerable children. It focuses on school readiness with inclusion of medical, dental, nutrition and mental health.

Action for Dental HealthAction for Dental Health has created a basic 10-step process to launching your own Head Start program in your dental office.

In essence, the 10 steps are:

  • Step 1: Call the local Community Action Agency and speak with the director about oral exam federal compliance opportunities.
  • Step 2: Discuss with local officials (county commissioners) what percentage of their Head Start children have received dental exams and what more can be done.
  • Step 3: Arrange appropriate follow-up care for those children identified with dental needs.
  • Step 4: Present in-services on early childhood decay to local pediatricians/family medicine staff and promote the need for caries risk assessment, anticipatory guidance and referrals to establish a dental home.
  • Step 5: Become a registered state dental Medicaid provider.
  • Step 6: Meet with community leaders from United Way, local foundations or faith-based communities to discuss health needs/support for young children to access dental exams.
  • Step 7: Discuss opportunities to partner with local business community in holding events aimed at Head Start children receiving dental screening services and oral health education.
  • Step 8: Utilize local dental society meetings to coordinate Head Start screenings and follow-up care.
  • Step 9: Evaluate the success of the program.
  • Step 10: Visit the Women, Infant, Children Department (WIC) in the local health department or county offices and determine need for children under age 5 to have dental exams.

To read more on the 10 steps to starting a Head Start program in your office, click here. For more information, contact Dr. Jane Gover, director of the ADA Council on Access, Prevention and Interprofessional Relations at groverj@ada.org. For more information on Action for Dental Health, visit ADA.org/action.

Editors’ Pick: Favorite New Dentist Now blog posts of 2014

It’s been an eventful 2014 for New Dentist Now as it continues to feature resources for new dentists and dental students, along with news and insight on the dental profession and beyond.

Just in case you missed them, here’s a look back to some of our favorite and most popular blog posts of the year.

Small GPR program in Evanston, Ill. delivers volumes of experience

Dental school is only the tip of the iceberg. The more I learned, the more I realized what I didn’t know. A general practice residency (GPR) was the next logical step.

Dr. Carolyn Norton

Dr. Carolyn Norton

I was looking for a small residency program with sufficient fixed prostho and endo experience. What I got was exactly that plus significant oral surgery experience, my own full time assistant, and a wealth of mentors who also teach for some of the best continuing education institutes in the country. Being one of two residents at the NorthShore University Hospital in Evanston, Illinois, my dental education is specific to my interests and my patients’ needs. My attendings ask me what I want to learn, and that’s what we pursue. The attendings are truly there because they love to teach and want to help me succeed as a general dentist.

I also wanted a program where I had responsibility. I wanted to deal with emergencies and difficult cases. In dental school, all difficult cases were sent to the graduate specialty clinics, or an oral surgery resident would swoop down and save the day. I needed to learn how to take care of business myself. I alternate the call schedule every seven days with my co-resident, covering four hospitals within the NorthShore University System. Every time I get paged and go in for an emergency, I see something I have never seen before and learn something valuable. Being on call is never time wasted. It is exactly what I needed.

If you’re interested in a GPR, it’s important to know what you want out of the experience. Go visit the program and talk to previous residents. You can find more information about my GPR program here. All programs are very different, so you need to do your research.

I still find plenty of time for the gym, spending time with loved ones and enjoying Chicago. I am more than happy with my GPR experience and already feel confident about entering private practice. And to think, I still have six months of learning left.

 

Dr. Carolyn Norton is a New Dentist Now guest blogger and a 2014 graduate of the University of Florida College of Dentistry. She is half way through a 12-month general practice residency at the North Shore University Hospital in Evanston, Ill., affiliated with the University of Chicago. Dr. Norton was a contributing editor for the American Student Dental Association from 2012-14.

Institute for Diversity in Leadership members discuss opportunities, challenges in advancing inclusion, diversity in ADA

Dr. Amanda Hemmer, 2014-15 class member of the Institute for Diversity in Leadership

Dr. Amanda Hemmer, 2014-15 class member of the Institute for Diversity in Leadership

The Institute for Diversity in Leadership 2014-15 class members engaged the ADA Board of Trustees this week in a panel discussion at ADA Headquarters.

The goal: For the ADA Board of Trustees to gain insights and perspectives from the current class participants of the Institute, which includes new dentists, regarding opportunities and challenges related to advancing diversity and inclusion throughout the ADA.

Sponsored, in part, through generous contributions from Procter & Gamble Oral Health and Henry Schein Dental, the Institute provides a diverse group of dentists with education and experience to build a lifetime of relationships and set new leadership paths within the dental profession and their community. Core to the program’s philosophy is that lasting leadership learning is lifelong and based on experience.

As key part of the leadership learning experience, each participant also designs and completes a personal leadership project for their community or the profession. The 16 members will work with leading educators from Northwestern University’s Kellogg School of Management and Duke University’s Fuqua School of Business during three sessions.

For more information on the Institute, visit ADA.org/diversityinstitute.

What do you think are the opportunities and challenges related to advancing diversity and inclusion throughout organized dentistry?

Here are more photos from the panel discussion:

Dr. Zellisha Quam

Dr. Zellisha Quam

 

Dr. Mark Limosani

Dr. Mark Limosani

Dr. Darwin Hayes

Dr. Darwin Hayes

(From left) Drs. MarkLimosani, DeryckPham and Abe Abdulwaheed

(From left) Drs. Mark Limosani, Deryck Pham and Abe Abdulwaheed

Dr. Yau selected for 2014 John W. Stanford New Investigator award

Dr. Robert Yau is the winner of the 2014 John W. Stanford New Investigator Award. The ADA Council on Scientific Affairs selected Dr. Yau, who is pursuing specialty training in oral and maxillofacial surgery, to receive the award, which is being bestowed for just the second time in as many years.

Dr. Yau earned his D.M.D. at the University of Connecticut School of Dental Medicine in May. He is studying oral and maxillofacial surgery at Kings County Hospital Center/SUNY Downstate Health Science Center in Brooklyn, New York.

Dr. Yau

Dr. Yau

He will present his winning research project, “Influence of Core/Veneer Thickness Ratios on Failure of Bilayered Dental Ceramic Crown Systems,” at the ADA Standards Committee on Dental Products annual meeting in Boston, March 9-11, 2015.

The John W. Stanford New Investigator Award honors the contributions of one of the ADA Standards Program’s most vital figures, the late Dr. Stanford, who died in February 2011 after a 40-year career with the ADA. Dr. Stanford played a pivotal part in standards setting and development. He is credited with establishing the ADA’s current standards program.

The new investigator award honors Dr. Stanford each year, underscoring the crucial role that dental standards play in patient health and safety and in the efficacy of dental products. The award acknowledges the original research that dental students and new dentists produce in the realm of dental standards.

Dental students and new dentists, who have earned their dental degrees no more than five years prior to the time of selection, may apply for the 2015 John W. Stanford New Investigator Award. Submission deadline is Sept. 30, 2015. For more information or to apply, visit ADA.org/dentalstandards.