American Association of Dental Consultants Articles

The Beacon: Spring 2010

2010-03-11T22:57:13Z

The Spring Issue of the Beacon is now available for download in the Members Area.

The Beacon: Fall 2009

2009-10-02T21:13:55Z

The Fall Issue of the Beacon is now available for download in the Members Area.

Parameters of Soft Tissue Grafting

2009-06-04T19:20:42Z

AADC Positions Committee* Parameters of Soft Tissue Grafting Position Statement June 4, 2009 Gingival recession, as defined by the American Academy of Periodontology (AAP), is the location of the gingival margin apical to the cementoenamel junction. There may be several causes for recession that include mechanical factors (trauma, tooth brush abrasion), inflammatory factors (poor oral hygiene, periodontal disease, restorative considerations), anatomical factors (minimal vestibular depth, frenum involvement, thin periodontium, root prominence and tooth position), and/or heredity factors. The effects of these factors have been shown to contribute to sensitivity, cervical abrasion, root caries and compromised esthetics. You must download this file to continue reading... ]]> Adobe Acrobat® Reader® to view and print it.
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The Beacon: Spring 2009

2009-04-07T20:13:18Z

The Spring Issue of the Beacon is now available for download in the Members Area.

Amalgam Safety

2009-01-28T19:37:35Z

AADC Positions Committee Position Statement: Amalgam Safety Amalgam has been utilized as a restorative material in dentistry for more than 150 years (source: Statement by the ADA to the Government Reform Committee, US House of Representatives on "Mercury in Dental Amalgams: An Examination of the Science"; November 14, 2002). More recently the safety of dental amalgam has been challenged due to the fact that dental amalgam contains mercury. Free mercury, like other heavy metals, has been shown to be toxic. However, the mercury in dental amalgam is not free mercury and therefore does not share the same toxic characteristics. You must download this file to continue reading...]]> Adobe Acrobat® Reader® to view and print it.
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Oral Cancer Screening-Adjunctive Diagnostic Aids

2009-01-27T19:41:57Z

AADC Positions Committee Position Statement: Oral Cancer Screening-Adjunctive Diagnostic Aids Oral cancer has emerged as a significant health concern. Current statistics show that approx. 34,000 people will be diagnosed with oral cancer this year and upwards of 8,000 will die from the disease. Oral cancer has typically been diagnosed primarily in older patients (40+ years old) or patients with known risk factors including tobacco and alcohol use. There is some evidence that these trends may be changing and a larger cross section of the population may be at risk. The link between certain strains of human papilloma virus and oral cancer has increased the risk of disease in the 20-40 year old demographic. You must download this file to continue reading...]]> Adobe Acrobat® Reader® to view and print it.
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The Beacon: Fall 2008

2008-12-01T22:44:32Z

The Fall Issue of the Beacon is now available for download here.

The Beacon: Spring 2008

2008-09-10T21:23:52Z

The Spring Issue of the Beacon is now available for download in the Members Area.

Laser Fluorescence in Caries Diagnosis

2007-05-28T23:19:39Z

AADC Positions Committee Position Statement Laser Fluorescence in Caries Diagnosis Throughout the history of dentistry, technology has played a crucial role. From early developments such as anesthesia, vulcanite for dentures, x-rays, and amalgam to more recent developments in the twentieth century that include improvements in dental materials and the introduction of 'the high-speed' drill powered by compressed air, advances in dentistry have resulted from a combination of increased scientific understanding of oral diseases and their treatments and technological improvements. The pace of technological change has continued to accelerate and has significantly impacted dentistry with the recent development of digital imaging of teeth, understanding of the concept of osseointegration with dental implants, development of software for computergenerated tooth restorations, and the use of lasers (Light Amplification by the Stimulated Emission of Radiation) that cuts both hard and soft tissues. There have historically been setbacks with some of the more notable being the TMJ Proplast implants, early filled polymer crowns (Artglass), and Caridex to name a few. These disappointments are good examples of technologies that did not meet the dental community's expectations, thereby falling into disfavor. You must download this file to continue reading... ]]> Adobe Acrobat® Reader® to view and print it.
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Ethics Summit Initiative Report to American Association of Dental Consultants

2007-04-06T22:11:54Z

Prepared by Richard M. Celko, DMD, MBA February 2, 2004 Ethics Summit Initiative Truth Claims in Dentistry Westin Grand Bohemian Orlando,FL January 20-21, 2004 The Ethics Summit Initiative began with an opening session on Tuesday January 20, 2004.]]> Introduction of the keynote speaker, Dr. Charles Dwyer, Academic Director of the Aresty Institute's Managing People Program in the Wharton School and Associate Professor in the Graduate School of Education at the University of Pennsylvania was made by Program Facilitator and Subject Matter Expert, David W. Chambers, EdM, Ph.D,MBA, editor of the Journal of the American College of Dentists and Professor and Associate Dean for Academic Affairs, University of Pacific, School of Dentistry. Dr. Dwyer's opening remarks focused on "Values, Perceptions and Truth". He mentioned that "Ethics provides a better solution than an alternative and when Ethics fail, there are laws and when laws fail, there is war". Additional comments were made regarding truth in advertising and what leads people to be untruthful. Dr. Chambers made remarks and outlined the expectations and sessions to be held. There were plenary sessions with the general assembly, led by Dr. Chambers which outlined broad topics and specific questions to be discussed in the smaller subgroups which followed the plenary. Subgroups were identified and assembled and led by a Subject Matter Expert (SME). Group Three's SME was Dr. Thomas Hasegawa, Professor and Associate Dean of Clinical Services, Baylor College of Dentistry, and Chairperson of the American College of Dentists Ethics Committee. Members of Group Three were P.D. Miller, Phil Bonner, Tammy Byrd, Esther Scherb, Larry Farrell, Richard Jones, Ken Follmar, Evelyn Ireland , Robert Klaus and G. Siminovsky. Richard Celko Dr. Hasegawa made a few comments regarding the format and then the discussion focused on truth in dentistry. Topics included truth in advertising of certain products and how claims are made. The need for standards and program guidelines was discussed. Truth in submission of claims was also mentioned. It was defined that the reason claims are submitted with improper codes tend to be so that additional benefits are obtained. Mentioned in addition, was that approximately 60% of physicians have made statements (untrue) to insurance carriers in an effort to obtain coverage for the patient. Motivating factors contributing to untruthful or partially truthful behavior were also discussed. 1. money, greed 2. ego, pride, acceptance 3. easy way to avoid conflict,/confrontation/ 4. sense of security 5. covers for incompetence Discussion then focused on whether this translated into just the dental professions, all professions or society as a whole. It was decided that this was prevalent within the society and that it would be of future initiatives would be necessary to identify all components. There was discussion about the need for standards within all of the organizations represented. It was mentioned that some organizations have strict measures and educational requirements before allowing participation or membership, as well as passing certain examinations (ex. Board examination for specialty) whereas other may only have a financial requirement which would be limited to paying dues. Consensus was reached that the need for establishing guidelines and criteria for all associations to be measured was necessary. The purpose would be to gain consistency within the respective profession. An example that was mentioned was the need for standards in advertising with substantial evidence as basis rather than presentations based on testimonials. The need for reliable data and the ability to reproduce results with certainty and validity would lend credibility. Additional plenary discussion took place with the general assembly and Dr. Chambers asked the SME to provide brief synopsis of each of the subgroup discussions. Dr. Chambers quantified some results and these will be part of a paper for publication for the JACD. Also discussed was the need to identify and prioritize barriers to truthful behavior. The five most important behaviors as identified by group three included: 1. Debt burden 2. Lifestyle expectations 3. Incompetence, overtreatment 4. Peer pressure 5. Financial repercussions Conclusion was reached that some people are untruthful and provide services or due to the need to satisfy financial obligations. Others may not be truthful as a means to cover lack of experience or competence with certain procedures. Some people would choose to state that they may be familiar with how to do something when in reality they may have very limited knowledge or exposure. The discussion focus then changed and concentrated on the need to identify opportunities for truthful behavior and these included: 1. Full disclosure (example manufacturer and a paid consultant) 2. Peer review (Literature basis), Evidence Based Dentistry 3. Increased communications, raise awareness 4. Establishing and enforcement of credential and standards specific to industry. 5. Education of providers and consumers. In conclusion, the purpose of this summit was to recap the progress made in the prior summits as well as identify the opportunities and barriers to truth and truthful behavior. 1. There was discussion regarding the need to establish and provide consistency in content of Ethics courses taught within Dental Schools. 2. The establishment on a voluntary basis of credentialing bodies and certification programs for all allied healthcare professions. A follow up article regarding the data will be published in the JACD (unknown date). I would be available for discussion if more details or further information is necessary. Respectfully submitted, Richard M. Celko, DMD, MBA National Dental Director of Utilization Management, Aetna AADC Representative for the 2004 American College of Dentists Ethic Summit Initiative

Is collegiality between dentists and benefit consultants possible?

2007-03-14T19:53:52Z

By: Dr. Robert Laurenzano Let's be honest. There are many dentists who view third party payers with suspicion and regard those who work with them—such as dental benefit consultants—as the enemy. But it's also important to understand who the consultants are: in many cases, the parties on both sides are dentists, professionals who share much in terms of common education, hands-on practical knowledge, experience with the realities and hardships of clinical practice and a desire to be part of a profession that upholds high ethical standards.]]> Source: ADA NEWS, Vol. 38 No. 5 March 5, 2007 Dr. Robert Laurenzano, a certified dental consultant, is AADC president-elect and is in general practice in North Potomac, Md.

Emerging Opportunities for Oral Health

2006-08-12T18:14:08Z

By: Harold C. Slavkin, DDS The human characteristics of curiosity, wonder and ingenuity are as old as mankind. For tens of thousands of years people around the world have been harnessing their curiosity into inquiry and the process of scientific methodology. The international fruits of these endeavors have resulted in agriculture, transportation, global networks of communications, energy resources, housing, environmental considerations, enhanced computational powers, entertainment, and biomedical research that has improved the quality of life as well as the human lifespan during the 20th century in many nations around the world.]]>

These and hundreds of other "scientific and technological highlights" reflect a "tipping point" or that time in human history when scientific discoveries are rapidly translated into improved oral health care for people around the world

Oral fluids have become "informative fluids" that can be used for diagnostics, the management of drug therapy, and a number of forensic applications. The science and technology of miniaturization (nanotechnology) now enables a full clinical laboratory to be compressed upon a miniature chip and this "lab-on-a-chip" technology is being applied to rapid and sensitive analyses using saliva as a diagnostic fluid for oral as well as systemic diseases and disorders. These and hundreds of other "scientific and technological highlights" reflect a "tipping point": or that time in human history when scientific discoveries are rapidly translated into improved oral health care for people around the world. Oral health care is nested within a much larger context that blends social, economic and political processes but it takes much more than scientific discovery and translation to application. In the United States, we have fragmented or segmented health care with profound correlations to SES (social and economic status). For example, the Surgeon's General Report Oral Health in America, released by Surgeon General David Satcher in May 2000, indicated that 110 million Americans do not have dental insurance and that almost one-third of the population does not have access to oral health care. Oral health disparities are very significant in America with particular impact upon children born into poverty, the poor and working poor adult populations, and the poor elderly. Further, we have tensions between dental and medical "enhancements" versus disease- and disorder- directed diagnostics, treatments and therapeutics. We have confusion between conditions versus diseases as recently indicated with respect to obesity versus diabetes or hypertension. Globally, the World Health Organization (WHO) proposed a shift in definition form health being equal to the absence of disease, to health being part of quality of life and a sense of wellness. These major forces of change must be acknowledged. Oral health care is related to education and social values, culture, health values, economics and macro- as well as micro- trends that impact the individual, family, community and population. The emerging opportunities for oral health are enormous! Suggested Readings U.S. Department of Health and Human Services. Surgeon General's Report Oral Health in America. U.S. Department of Health and Human Services 2000; Washington D.C. 2. Cohen DW, Slavkin HC. Periodontal disease and systemic disease. In: Periodontal Medicine, Eds. Rose LF, Genco RJ, Cohen DW, Mealey BL, B.C. Decker Inc., Hamiltion, Canada 2000; 1-10 3. International Human Genome Sequencing Consortium. Initial sequencing and analysis of the human genome. Nature 2001; 409:860-921. 4. Venter JC et al. The sequence of the human genome. Science 2001; 291:1304-1351. 5. Evans WE, Relling MV. Pharmacogenomics: translating functional genomics into rational therapeutics. Science 1999; 286: 487-491. 6. Peltonen L, McKusic VA. Dissecting human diseases in the postgenomic era. Science 2001; 291: 1224-1229. 7. Syvanen AC. Accessing genetic variation: genotyping single nucleotide polymorphisms. Nature Reviews: Genetics 2001; 2:930-942. 8. Slavkin HC. Toward molecular based diagnostics for the oral cavity. J. Am Dent Assoc 1998; 129:1138-1143. 9. Slavkin HC. The Surgeon General's Report and special needs patients: a framework for action for children and their caregivers. Special Care Dentist 2001; 21(3):88-94. 10. Slavkin HC. Expanding the Boundaries: Enhancing Dentistry's Contribution to Overall Health and Wellbeing. J. Dental Education 2001; 65:1323-1334 11. Slavkin HC. The Human Genome, Implications for Oral Health and Diseases, and Dental Education. J. Dental Education. 2001; 65:463-479. 12. Genco RJ, Scannapieco FA, and Slavkin HC. Oral Reports. The Sciences 2000; 25-30. 13. Slavkin HC, Baum BJ. Relationship of Dental and Oral Pathology to Systemic Illness. J of Amer. Med. Assoc. 2000; 84: 1215-1217. 14. Eichelbaum M, Evert B. Influence of pharmacogenetics on drug disposition and response. Clin Exp Pharm Physiol 1996; 23: 983-985. 15. Slavkin HC. Applications of pharmacogenomics in general dental practice. Pharmacogenomics. 2003; 4:163-170. 16. Chai Y, Slavkin HC. Prospects for tooth regeneration in the 21st century. Microscopy Research & Technique. 2003; 60-469-479. Dr. Harold C. Slavkin is Dean of the University of Southern California School of Dentistry and past director of the National Institute of Dental and Crainofacial Research. He will also be presenting the Keynote Address at the 2004 AADC Spring Workshop in Fort Myers, FL.

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Data Warehouses and the Dental Consultant

2006-08-10T18:23:49Z

By: Michael del Aguila, MS, PhD Data warehouses in the dental insurance industry are a well-recognized reality. However, the misperceptions surrounding them both exaggerate their misuse and underestimate their potential. Understanding the composition and requirements for appropriate use of these tools can dispel some of the mistrust, and open dialogue on the best uses of these tools. Without question, the appropriate use of a data warehouse can contribute substantively to the construction, deployment and evaluation of the next generation of dental benefits products. Getting to that point is not easy because it requires constant reexamination and refinement of basic assumptions and analyses.]]> Dr. Michael del Aguila is a member of the AADC and president and CEO of Delta Dental Data and Analysis Center.

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The Role of Dental Insurance In The Future-State of Medicaid

2006-08-08T18:28:04Z

By: Gary A. Colangelo, DDS Assumptions The American Dental Association's Medicaid dental initiative should hasten the evolution of this federal/state partnership toward a more accountable program that demonstrably improves the oral health of Medicaid eligible citizens. Success of the ADA's initiative can lead to a Medicaid dental program that will:]]> Assumptions The American Dental Association's Medicaid dental initiative should hasten the evolution of this federal/state partnership toward a more accountable program that demonstrably improves the oral health of Medicaid eligible citizens. Success of the ADA's initiative can lead to a Medicaid dental program that will:

Emphasize outcome measures that reflect improvement in the oral health of eligible Medicaid recipients.
Require actuarially sound and market-based reimbursements to dentists and health care facilities.
Allow community-based care delivery innovation.
Promote the development of symbiotic collaborations in the community to improve access and effectiveness of oral health care delivery.
Maintain state level dentist peer review oversight to assure appropriate, cost effective Medicaid oral health care delivery.
Promote state financial risk retention as well as eligibility determination and provide incentives to expand dental coverage for under served populations.
Require state program management and cost control through partnerships with organized dentistry, dental plans and consumer representatives.

The Role of Dental Plans Dental plans should play a central administrative role in the future state of the Medicaid dental program. Dental plan core competencies are claim management, utilization management, cost control, network development and maintenance, and outcome reporting. Dental plan personnel also have experience in quality assurance and oral health care delivery models. Dental Medicaid Program Administration With market-based dentist reimbursements, Medicaid eligible recipients can be provided coverage that is no different form commercial dental plan products. Rather than create a separate Medicaid dental program, existing dental plan products can be modified to comply with EPSDT or other state and federal requirements. In addition to being a more efficient administrative process, Medicaid recipient will no longer be stigmatized by having present a Medicaid identification card when seeking dental care. A core function of dental plans, is the management of reimbursement arrangements using sophisticated claim processing platforms. Coupled with trained and motivated customer service representatives, existing claim processing efficiencies and dentist acceptance can be integrated into the Medicaid dental program. Medicaid financial risk retention by states will remove the dental plan disincentive related to improving access to care. Dental plans should contract with states through administrative service agreements while states collaborate with dentists and financial consultants to develop Medicaid resource allocation and control procedures compatible with the availability of public funds and state legislative agendas. Network Development Dental plans have heavily invested in the development and maintenance of dental networks and have established standards to assure assess to general dentists and specialists. The creation of an adequate Medicaid dental network has been a failure in most of the United States. The use of existing networks will not only reduce Medicaid costs but also better assure adequate assess. Program Innovation Community based collaborations Dental plans often include community service as part of strategic business development. These initiatives may include collaboration with health care and social service agencies that have missions related to oral health care delivery. Many community-based collaborative models with documented positive outcomes are available for study and replication. Care delivery models Dental plans operate staff model oral health care delivery systems where there is inadequate dental manpower in the private practice sector or where there are positive strategic business relationships with other health care entities such as hospitals. Many of these models have long term financial and clinical success and could be suitable for Medicaid care delivery replication. Outcome Reporting Most dental plans use claim-processing systems that allow data formatting or downloading for a variety of outcome reports. Outcome measures need not be costly direct patient oral assessment. Indirect, NCQA-like indicators such as preventive procedure frequencies, self-care knowledge assessments and mix of restorative procedures can be used to indicate program effectiveness. Greater accountability of the dental Medicaid program can be attained through the use of dental claim history data:

Utilization reports that demonstrate frequency and cost by dental treatment codes
Retrospective studies to determine the appropriateness of rendered dental care
Retrospective reviews must include peer review panels of dentists who can render opinions on practice patterns and care appropriateness
Comparative studies using claim history and epidemiological data such as caries assessment studies

Quality Assurance Credentialing of dentists most often includes these components:

Primary source accredited dental school graduation and state licensure certification
Disclosure of past or pending malpractice litigation, license restrictions or health care facility sanctions
Office inspections to assure OSHA compliance, adequate record keeping and patient access standards compliance

In addition to credentialing, dental plans also maintain a patient complaint resolution service, pre-payment review procedures, denied claims appeal systems and utilization management programs. Communication Dental plans have regular patient and doctor communication vehicles for administrative and clinical information. Newsletters, check stuffers and single-issue announcements are commonly used. Many health care plans are investing in health promotion education on Web sites and in written media. All of these sources are available for Medicaid program communication. Gary A. Colangelo, DDS Gary.colangelo@carefirst.com 410 528 7908

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