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Evolution and economics in dental office design May 18, 2008

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Pat Carter and Jeff Carter, DDS

Most people would agree that designing an effective dental facility requires an intimate understanding of dentistry and a thoughtful identification of the design objectives for a specific practice. That statement alone involves a multitude of details and design decisions that can be quite overwhelming (assuming you want to attend to all the details and get it “right”). And while that is the primary part of the designing process, evolving factors outside of the control of practitioners will greatly impact the design and economics of current and future facilities.

What are some of those factors?

• Regulatory factors

In the early 1990s, the Occupational Safety and Health Administration (OSHA) regulations required appropriate labeling, storage, and inventory access to certain regulated dental materials and drugs. It also mandated protective eyewear, gloves, and gowns for the dental staff; appropriate disposal of biohazardous materials; and compliance with sterilization processes to protect the general public (your patients). In response, dental office design began to include appropriately sized and accessible storage and inventory areas, staff areas with changing rooms and storage for gowns, appropriately labeled and located disposal drops, and thoughtfully conceived central sterilization areas.

 

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Designing for young children – a competitive advantage May 18, 2008

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Renee Reback

Providing creative waiting rooms and play spaces for children is an important consideration in today`s competitive marketplace. Given the current high U.S. birth rate, the census forecasts a total of over 40 million children under the age of 10 during the next decade. With a much stronger focus on the benefits of preventative dental care and early treatment, odds are that a significant portion of them will be in your waiting rooms. With some forethought and professional advice, designing space and providing the appropriate products to engage children can offer benefits beyond occupying them while in your office.

James Barnard is president of Playscapes Children`s Environments, a company that designs and manufactures children`s furniture and activities with emphasis on its use in the medical environment. “When you design for children in a health-care environment,” Barnard says, “you`re really designing for four separate clients – children, their parents, staff, and the facility owner. They all have separate needs which should be taken into account.”

Jay Levitt, DDS, is the owner of four Dentistry for Children PC practices outside Atlanta, Ga. Dr. Levitt worked with professionals to help him create waiting areas that function as more than just a place to sit and wait.

“Our waiting area is designed to communicate how important our patients are to us,” Dr. Levitt emphasized. “I not only want everything to look terrific, [but] I want an environment that makes our patients feel comfortable. We used to have staff bring in old books, puzzles, and games, but small pieces were lost and the game or puzzle became worthless. We now select more durable equipment without small pieces that can be lost or swallowed.”

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Dental Office Design and productivity for the rest of us May 17, 2008

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by David J. Ahearn, DDS

In every practitioner’s life there comes a time when it is clear that a physical office change must occur. For some doctors, this happens early in practice; for others, a reawakening occurs later in the practice life that makes this transition desirable. Nevertheless, it is a point through which every dedicated caregiver crosses at some time.

Because office redesign is such a rare event, we do not gain enough knowledge or experience to do justice to this critical task. For example, we place composites every day, and, as a result, our trade journals have hundreds of articles about them each month. Our knowledge is great in such areas — not so regarding future office planning.

Dental supply companies frequently will supply you with a floor plan at no up-front cost. Unfortunately, they can’t be expected to spend a great deal of time on productivity enhancements that only an actual practitioner would understand, nor can they be expected to labor long and hard to save you money. These plans tend to be simple to draw and very expensive to equip. It isn’t the supplier’s fault. Everything costs money and there is no such thing as a free lunch. This is a reasonable choice for practices that are relocating but not expanding, or for offices that are simply purchasing new equipment to replace outdated hardware rather than re-engineering or re-invigorating their practices.

High-end office designers offer great service and have the benefit of prior dental practice experience. They are noted for creating “image” practices for those dentists who desire them. Design costs alone for such offices can run into the tens of thousands of dollars as each step in the design process is individually handled. Moreover, due to the one-of-a-kind nature of the design, it is common for a project to take up to two years to complete.

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UK Dentists offering Botox alongside fillings May 17, 2008

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Telegraph News

A growing number of dentists who have left the NHS are setting up lucrative sidelines in beauty treatment, offering Botox injections alongside fillings and check-ups.

One in four dentists are now able to offer the cosmetic injections to freeze facial muscles, as well as anti-ageing fillers and facial peels, a survey found.

The leading cosmetic training body for dentists, run by Dr Bob Khanna, has taught 4,000 of England’s 20,000 dentists procedures such as Botox, while experts said a conservative estimate would suggest one in four are either offering “cosmetic injectables” or preparing to enter the market.

The survey included NHS dentists, some of whom do private work that could include beauty treatments.

More than 1,000 dentists have left the NHS since the Government’s introduction two years ago of a contract that many claim loses them money.

Almost half the population in England – more than 23 million people – had no NHS dental care in the two years to last September.

But increasingly, those paying privately for the perfect smile appear to be open to cosmetic work.

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Electronic Prescribing Legislation May 17, 2008

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Investigative reporter Darrell Pruitt, DDS

 

The article below states that the AMA “has been considered the largest barrier to enacting e-prescribing legislation” because of the group’s “concerns over the cost of adopting and implementing the technology”

 What does the ADA say?  They are all for e-prescribing, no questions asked.  Darrell

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Kaiser Daily Health Policy Report

 

    AMA Officials Outline Provisions Physicians Would Accept in Electronic Prescribing Legislation

The American Medical Association on Friday discussed a set of standards that physicians would accept for any electronic prescribing requirement under Medicare, CongressDaily reports. According to CongressDaily, AMA “has been considered the largest barrier to enacting e-prescribing legislation” because of the group’s “concerns over the cost of adopting and implementing the technology” (Edney, CongressDaily, 5/9).

Some consumer, labor, insurer and business groups have said that the Medicare package that the Senate Finance Committee is drafting should include language to require physicians participating in Medicare to e-prescribe, CQ HealthBeat reports. In addition, separate legislation (S 2408, HR 4296) would require e-prescribing in Medicare and would offer payment incentives to encourage e-prescribing adoption. AMA officials announced the proposal at a forum sponsored by the Brookings Institution’s Engelberg Center for Health Care Reform (Carey, CQ HealthBeat, 5/9).

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Bug Responsible For Bad Breath Found May 11, 2008

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NEW YORK (Reuters) - Solobacterium moorei is the organism largely responsible for chronic bad breath, or halitosis, biologists reported Saturday at the annual meeting of the American Association for Dental Research in Dallas.

Persistent bad breath, which can be very embarrassing, is often caused by the breakdown of bacteria in the mouth, producing foul-smelling sulfur compounds that reside on the surface of the tongue. “Tongue bacteria produce malodorous compounds and fatty acids, and account for 80 to 90 percent of all cases of bad breath,” said Betsy Clark, a student at the State University of New York at Buffalo School of Dental Medicine. Some cases of bad breath originate in the lungs or sinuses.
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In a study of 21 people with chronic bad breath and 36 subjects without this problem, Clark and colleagues found S. moorei in every patient that had halitosis compared with only four comparison subjects. The four people without halitosis infected with S. moorei all had periodontitis, an infection of the gums that can also lead to chronically bad breath. 

In a previous study of eight patients with halitosis and five without, S. moorei was “always found in patients with halitosis and never in patients who did not have this problem,” Dr. Violet I. Haraszthy, who was involved in both studies, noted in a telephone interview with Reuters Health. “A number of other studies have also found this bacterium in halitosis patients.”

Haraszthy points out that, at present, “not much is known about this particular organism.”

“As we identify and find out more about the bacteria that cause bad breath, we can develop treatments to reduce their numbers in the mouth,” Clark added in a university-issued statement.

As reported Friday on Reuters Health, the same team of investigators has found that brushing twice a day with antibacterial toothpaste and using a toothbrush with a built-in tongue scraper can eliminate chronic bad breath.

 

 

 

Arginine Candies May Reduce Caries May 11, 2008

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State University of New York (SUNY)

Candies containing a novel formula of arginine bicarbonate and calcium carbonate reduced decayed, missing, and filled surfaces by two thirds in a new study on children’s molars.

A team of researchers at the State University of New York (SUNY), Stonybrook have trademarked their formula as CaviStat and have licensed it to specialty pharmaceutical firm Ortek Therapeutics of Roslyn Heights, NY, which is seeking approval from the FDA to market the candy as a cavity-fighting drug under the name BasicMints. CaviStat is already on the market as a desensitizing agent under the name SensiStat.

In the study — published in the March issue of the Journal of Clinical Dentistry — 96 Venezuelan children aged 10 and 11 sucked four mints fortified with CaviStat per day. A control group of 99 children sucked on sugarless mints without CaviStat. At the end of a year, the CaviStat group had 61.7 percent fewer decayed, missing, or filled surfaces in molars than the placebo group, the researchers reported.

Arginine is an amino acid that causes bacteria to produce base, counteracting the acid that demineralizes teeth, the researchers write. The bicarbonate produces an additional buffering effect, while the calcium carbonate provides a source of calcium to replace any that is dissolved in acid.

The study was funded by Ortek, where lead researcher Israel Kleinberg, D.D.S., Ph.D., a SUNY professor of oral biology, serves on the board of directors.

 

 

 

 

 

Getting tough on deadbeat clients May 11, 2008

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Transworld Systems

Paul Donadio is 6 feet 4 inches tall, 230 pounds and all Italian. “I don’t carry a baseball bat, but I definitely fit the role for this business,” he jokes.

As district manager for the collection agency Transworld Systems, Donadio knows as much as anyone about overdue dental bills. He told a recent audience at the Yankee Dental Congress that such debt is a growing problem, but that most dentists could collect more than they do.

As health and dental insurance costs have increased, the portion of these bills paid out of pocket is now 35 percent, three times higher than in 1980, says Donadio.

But out of 20 high-priority bills an average person must pay, the dental bill ranks 17. “People are far more likely to pay their cable, cellular, and legal bills,” says Donadio. “But at least they’ll pay your bill over the vet bill.”

Unfortunately, Donadio says, the average recovery rate for medical and dental bills is 10.8 percent. “It’s a pretty high failure rate.”

Why are dentists so low on the priority list? “They think you’re rich and don’t need the money.”

Many dentists don’t threaten to collect unpaid bills for fear of alienating patients, but the more reluctant they are to collect, the more money they leave on the table.

Debt depreciates a half a percent less for each day you don’t collect, Donadio says.

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Oral test could predict lung cancer, study finds May 11, 2008

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WASHINGTON (Reuters)  – Damage to cells lining the mouth can predict similar damage in the lungs that eventually leads to lung cancer in smokers, U.S. researchers reported on Sunday.

They hope it may be possible to some day swab the mouths of smokers to predict who is developing lung cancer — saving painful and dangerous biopsies of the lung.

The process may also lead to tests that will predict other cancers, said Dr. Li Mao, an expert in head, neck, and lung cancer at the University of Texas M. D. Anderson Cancer Center in Houston.

“Our study opens the door to enhancing our ability to predict who has higher probability of getting tobacco-related cancers,” Mao said in a statement. “Not only lung cancer, but pancreatic, bladder, and head and neck cancers, which also are associated with tobacco use.”

Smoking is the leading cause of lung cancer, but only about 10% of smokers ever get it. It causes few symptoms until it is advanced, which means patients are rarely diagnosed or treated until it is too late for a cure.

Mao’s team wanted to find a way to monitor patients taking a drug — the COX-2 inhibitor celecoxib, sold by Pfizer under the brand name Celebrex — in the hopes of preventing lung cancer.

They looked at two genes known to help prevent the development of cancer — p16 and FHIT. “There is substantial damage (to the two genes) long before there is cancer,” Mao said.

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U.S. FDA says Zila mouth rinse promotion misleading May 11, 2008

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WASHINGTON (Reuters) April 23 – The U.S. Food and Drug Administration (FDA) has warned Zila Pharmaceuticals Inc. about promoting its Peridex oral rinse without including information about possible risks, according to a letter released on Tuesday.

A company letter and a brochure for the rinse, which is approved to treat gingivitis, also made unproven claims about how well Peridex worked and made false statements about competitors’ products, the FDA wrote in an April 18 letter to Zila Pharmaceuticals, a unit of Zila Inc.

Zila Senior Vice President and General Manager David Barshis said the company disseminated the materials in late 2006 and early 2007 before 3M acquired full rights to Peridex in May 2007. 3M’s Omni Preventive Care unit had already been selling the product since 2000 under a separate arrangement.

Barshis said it would make that point to the FDA, calling the letter a “nonissue.”

“It’s a long time ago. I’m really kind of surprised that there’s such a lag because we haven’t even owned the business (Peridex) for a year,” he told Reuters.

A spokeswoman for the FDA did not have immediate comment.

The agency said in its letter that Zila’s promotion claimed that the effect of Peridex could last up to 12 hours and kill up to 97% of bacteria.

“These claims as to the effectiveness of Peridex in the oral cavity are misleading because they are not supported by substantial evidence or substantial clinical experience,” the FDA wrote.

Zila’s letter and the brochure were intended to be mailed together to health professionals along with the product’s FDA-approved label information, according to the FDA.

Barshis said the mailing went to general dentists, but did not have more details.

Including the label, which details the product’s risks, was not sufficient, the FDA wrote in the letter, posted on its Web site