Heart Your Smile's Innovation 360°

30th Apr 2013

Dental charity Heart your Smile launched its Innovation 360° at its AGM on the Saturday of the BDA Conference

The dental charity, aimed at promoting positivity within the profession as well as to the public, is looking for ways to turn oral heath around for patients. It is offering support in the form of mentorship, grants and products to help dental teams get innovative oral health initiatives out into the community.
Based on these pilots, the team will share the best ideas with the rest of the profession to support them to innovate in the arena of improving oral health, attendance and uptake of dental services.
The charity is offering multiple grants of £360 to support dental teams to innovate in the area of oral health promotion, with 50% provided as funds to help with logistical expenses and 50% provided in the form of an amazing Heart your Smile Oral Health Kit. 
A selection committee will choose the most innovative projects to support. Successful projects will be assigned a Heart Your Smile mentor for the duration if the project and these pilot projects will form the basis of case reports on which others may model their oral health programmes. 
For more, visit www.heartyoursmile.co.uk.

Register now for ISDH 2013 Cape Town

Register to attend the ISDH 2013 14th- 17th August 2013 in Cape Town South Africa. Reduced fees for early registration close TODAY, April 30th. All registration details are at http://www.embassyconferences.co.za/portfolio/present/19th-international-symposium-on-dental-hygiene/10

Register for the ISDH meeting!!

Ergonomics: Be a Part of Your Health

San Francisco Dental Hygiene Society along with Occupational Health Branch of the California Department of Public Health & UC Berkeley Ergonomic are working together to help prevent and alleviate musculoskeletal injuries for dental hygieneist.   Why are we doing this? CDPH has identified dental hygienists as reporting higher cases of workers compensation and want to help our profession stay healthy.    CDPH wants to work with local RDHs as advisors to develop a useful message, CE courses and short videos.    CDPH has an occupational health doctor, data folks, and a health educator, working on this project.   UC Berkeley has an occupational health doctor, an ergonomist, and an engineer.   San Francisco has amazing RDH that want the best for ourselves, each other and our profession.   I have a few more spots for RDH to get on this advisory board. It's our stories, our knowledge of the profession and our physical health concerns that will move our profession forward to ensure long, healthy careers.   Join us on Tueday April 30, 2013 from 6:30-8:30pm at a Union Square location to be a part of this collaborative opportunity.   Contract Michael Long, RDH at sfbayareardh@gmail.com for complete location detail.

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Toothbrush Selection Simplified

Brushing one's teeth is not a human instinct. It is a skill developed to defend against cariogenic agents which, if left undisturbed, will attack oral structures. Toothbrushes are invaluable in protecting against these threats, but, with a dizzying array of brushes on the market, it is not always clear which will provide the most benefit for a particular patient. And even when a patient selects a product that's an ideal match, the toothbrush may not perform effectively if it's not used properly.

For these reasons, it is vital to educate patients so they can make informed buying decisions and exercise proper brushing technique. In this Sunstar E-Brief, dental hygiene educator Caren M. Barnes, RDH, MS, of the University of Nebraska Medical Center's (UNMC) Department of Dental Hygiene, shares insights into the latest developments in toothbrush design. She also explains how to clear up any confusion patients may have about which features are right for them, and offers tips for dental hygienists to help patients get the most from brushing.

The first step is for clinicians to factor in data collected from the comprehensive dental hygiene patient assessment. This, Barnes says, will provide insight into a patient's self-care regimen. More importantly, it identifies products the patient currently uses, as well as how they are being used. At this point, the dental hygienist can identify the type of toothbrush that will provide the greatest benefit. Barnes suggests this approach is a marked improvement over the long-held practice of keeping one type and brand of toothbrush in the dental office to distribute to all patients, regardless of their oral hygiene status—a routine she says should be abandoned.

"Given the huge selection of oral hygiene products, dental hygienists can assist patients in the purchase process by writing the names and specific descriptive information about recommended products," she advises. "In essence, provide the patient with an oral hygiene prescription for those products, along with instructions for use." This will help avoid confusion when the patient faces the variety of oral hygiene products available in stores.

BRISTLES MAKE A DIFFERENCE

For decades, toothbrushes were manufactured only with a predictably straight, utilitarian design. Current models, however, are sophisticated dental tools built to meet highly personalized demands. The market offers an array of toothbrushes with various handle shapes, heads, tufts and bristles. One of the most recent trends in toothbrush design has been the introduction of tapered bristles, which are engineered to improve the effectiveness of cleaning and, by extension, enhance plaque removal. This feature was at the heart of a UNMC-based study that Barnes led comparing—under identical conditions—the efficacy of a toothbrush with soft, tapered bristles to one with soft, straight bristles.¹ The study results, published in the American Journal of Dentistry, demonstrated that tapered bristles provide superior cleaning ability.

According to Barnes, the study's most significant finding was that the soft, tapered bristles were better able to access the most difficult areas for patients to clean, including areas between the teeth, the gingival margin and subgingival areas. Toothbrush performance in these areas is vital, because an inability to clean interproximal spaces leads to interproximal caries, interproximal infection and inflammation of the gingiva.

Considering how toothbrushes vary in performance, patients should understand exactly the type of bristles built into the model they purchase. It is particularly important to point out that a toothbrush with soft bristles of varying heights doesn't necessarily mean that its bristles are tapered. Barnes suggests that patients look for packaging that clearly indicates the product features tapered bristles.

ADJUNCTS COMPLETE THE CARE

Although today's toothbrushes are engineered to be more effective than ever for disrupting biofilm and removing plaque, even the best toothbrush should not be considered the only tool needed for optimized oral care. Many patients still require oral hygiene adjuncts to complement toothbrushing and flossing, such as interproximal brushes and mouthrinses. Patients who have wide interproximal spaces for which dental floss would not be effective, for example, must use interproximal brushes wide enough to fill the interproximal space to remove dental plaque and biofilm. Mouthrinses may also be an advisable addition to brushing for patients with periodontal disease.

These aids are also important in the care of patients who lack the physical function to effectively use a toothbrush, and therefore cannot rely on brushing to remove plaque properly. The use of oral hygiene adjuncts may also be warranted for patients affected by specific physical or medical conditions, as noted in the comprehensive dental hygiene patient assessment.

PERSONALIZED PROGRAM

In tailoring a personalized care program, the most important thing a dental hygienist can do is base oral hygiene instructions and recommendations on individual patient needs. "It is also prudent to record the findings and recommendations in the patient's chart," notes Barnes. Clinicians should accept that some patients will refuse a recommendation for any care product other than what they already use. This, she says, should also be documented in the chart.

"These patients like the products they use—they're comfortable with them, and are not open to change," she explains. "In these cases, the best thing a dental hygienist can do is work with the products the patient will use, and provide appropriate instructions to remove the largest amount of dental plaque and biofilm possible." That's not to say that clinicians can't continue to delicately suggest that patients at least try the products that will likely benefit them most.

While advances in technology have improved the performance of today's toothbrushes, their effectiveness ultimately hinges on daily use and proper brushing technique. By helping patients choose the best brush for each individual, and educating them about effective self-care regimens—including brushing technique and adjunctive care products—dental hygienists can significantly contribute to their patients' oral health.

1. Barnes CM, Covey DA, Shi X, Yankell SL. Laboratory evaluations of a bi-level, extremely tapered bristled toothbrush and a conventional uniform bristled toothbrush. Am J Dent. 2009;22:84–88.

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INFECTIVE ENDOCARDITIS

Diagnosis of endocarditis is usually based on clinical, microbiologic, and echocardiographic findings. Treatment involves antimicrobial therapy targeted to the identified organism. Surgical indications include heart failure, uncontrolled infection, and prevention of embolic events.

Link to NEJM Article

Key Clinical Points

INFECTIVE ENDOCARDITIS

	• Staphylococci and streptococci account for 80% of cases of infective endocarditis, with staphylococci currently the most common pathogens.
	• Cerebral complications are the most frequent and most severe extracardiac complications. Vegetations that are large, mobile, or in the mitral position and infective endocarditis due to Staphylococcus aureus are associated with an increased risk of symptomatic embolism.
	• Identifying the causative microorganism is central to diagnosis and appropriate treatment; two or three blood cultures should routinely be drawn before antibiotic therapy is initiated.
	• When infective endocarditis is suspected, echocardiography should be performed as soon as possible.
	• Indications for surgery include heart failure, uncontrolled infection, and prevention of embolic events.
	• Treatment should involve a multidisciplinary team with expertise in cardiology, cardiac surgery, and infectious disease.
	• Indications for antibiotic prophylaxis have been restricted to invasive dental procedures in patients with a prosthetic valve, a history of infective endocarditis, or unrepaired cyanotic congenital heart disease. Bruno Hoen, M.D., Ph.D., and Xavier Duval, M.D., Ph.D. N Engl J Med 2013; 368:1425-1433April 11, 2013DOI: 10.1056/NEJMcp1206782

An island in dental need

Link to Article

10th Apr 2013

Zanzibar conjures up so many exotic images but there is another side to ‘spice island’, one that brings a special kind of visitor. Iqbal Fasal report

Ru MacDonagh, a consultant urologist from Taunton, Dr Jon Rees, my GMP and a doctor at Nailsea, Bristol, amongst several other medical professionals, have been instrumental with local teams in Zanzibar, in setting up HIP~Z Health Improvement Project, Zanzibar,a British charity, which is now in a joint venture agreement with the Ministry of Health,
Interestingly, the singer Peter Andre is also now involved with HIP~Z, helping to raise awareness of the serious lack of medical facilities and extremely low life expectancy on the island.
Over the past few years, HIP~Z has grown to encompass organisation and management of two hospitals, which offer essential very low cost treatments for up to 250,000 of the islanders who would otherwise be unable to afford surgical, maternity or other even basic, primary health care.
There is still a lot to do; a lot of medical items to be procured with many challenges ahead, but, encouragingly, lives are being saved and made better, one at a time.
Dental clinics
Retired Brighton-based dentist, Dr Feroz Jafferji, originally from Zanzibar, returned to the island three years ago and linked up with old classmates to set up OZ, Outreach Zanzibar (http://outreachzanzibar.org).
OZ has now combined forces with HIP~Z to organise at least two new fully functioning dental clinics, based in two separate hospital locations in Zanzibar, to offer so many people a chance to have simple restorative dentistry, who would otherwise have no access to any dentistry, except perhaps the most basic form of pain relief from locally trained therapists.
This is a really ambitious plan, one which I have committed to assist and enable – as a UK-based dentist with East African origins and many fond childhood memories.
Appeal
I hope fellow dentists can donate any redundant dental items – large equipment, hand instruments, consumables (in date or even slightly out of date are acceptable). From my previous experience when I appealed on behalf of Dental Help Africa many years ago, we were overwhelmed with almost 600 parcels arriving from all over the UK.
We do have ‘a man and a van’ available, so are able, within limits, to collect certain essential large equipment, by mutual agreement, if you feel your items have some use.

To donate, visit http://www.hipz.org.uk/donateHIPZ. Send any items to:
HIP~ Z Appeal for Zanzibar, c/o Dentalsaver (UK), Unit 9
, Carey Develoments, Tweed Road, Clevedon, 
BS21 6RR. Ring 01275 853323
or email bev@dentalsaver.co.uk.

Dental patients to be given direct access to hygienists and therapists

A decision by the General Dental Council (GDC) to give patients direct access to dental hygienists and therapists will mean more and more people benefit from these professionals’ expertise, according to a major dental payment plan provider.
From next month, patients will be able to see other members of a dental practice’s team, such as a hygienist, without first needing an appointment with, or prescription from, a dentist.
The GDC said it has taken the decision with patient safety as “an upmost priority”, noting that dental care professionals must only treat patients directly if they are appropriately trained, competent and indemnified.
Colin Perry, corporate channel manager at Denplan, said the change means that dental care professionals can see and care for patients within their individual skill sets, without the need for patients to see a dentist for an initial examination.
He said this is unlikely to have a significant impact on costs, but will allow patients to have scaling and polishing, oral hygiene advice or straightforward fillings done without the need for an additional preliminary examination by a dentist, thereby enhancing the link between dentistry and overall health.
Perry said: “Currently dental care professionals such as hygienists and therapists are relatively few in number, compared to dentists.
“However over the coming years, more and more patients will benefit from their particular skills and will see ‘a trip to the dentist’ becoming more of a ‘visit to the oral care team’. Maybe the old image of ‘drill and fill’ will begin to fade.”

Link to article

Maine Lawmakers Consider Bill to Allow 'Dental Therapists'

Link

04/10/2013 04:10 PM ET

Supporters say the bill will increase access to dental care, but opponents, including many dentists, say they're concerned that patients will be put at risk.

Supporters and opponents of a bill that would permit mid-level dental hygiene therapists to provide limited oral care under the supervision of a dentist are expected to square off tommorow at the State House. At issue is a bill, sponsored by House Speaker Mark Eves, that's intended to expand access to dental care in Maine, where 1 in 2 children currently lack access to dental services. Dr. Mary Williard has supervised a similar program in Alaska and she says Maine is ready for the new category of licensing for dental hygiene therapists. "The people in Maine hope to increase access to dental care for all people, especially people with MaineCare who are having trouble receiving the dental care in their communities," Willard says. Many dentists oppose the bill, and question whether the 500 hours of training required for the licensure is sufficient for performing invasive surgical procedures. The bill, LD 1230, will be heard in the Labor, Commerce, Research and Economic Development Committee Thrusday at 1 p.m. This story was reported by A.J. Higgins.

Study: Regular scaling can reduce atrial fibrillation risk

 

By Erin Archer, RN, DrBicuspid.com contributing writer

Link to Article

April 9, 2013 -- Is there a relationship between periodontal health and cardiac dysrhythmia? Yes, according to a study in the International Journal of Cardiology (March 1, 2013).

In fact, the study authors propose a way to lower the risk of developing atrial fibrillation (AF), the most common type of sustained cardiac dysrhythmia: by undergoing dental scaling at least once a year.
"Oral infections due to poor oral hygiene may also predispose patients to new-onset AF by adding to the inflammatory burden of the individuals," the researchers from Taiwan wrote.
Atrial fibrillation affected approximately 2.7 million Americans in 2010, according to the U.S. Centers for Disease Control and Prevention (CDC). AF's disorganized cardiac electrical impulses and incomplete atrial emptying place patients at significantly increased risk for clots, strokes, and heart failure, the CDC noted.
For this study, the researchers used data from Taiwan's National Health Insurance Research Database (NHIRD) for the year 2000 to identify 28,909 subjects age 60 or older who had no history of cardiac dysrhythmias. The NHIRD is a cohort database of medical claims data for 1 million Taiwanese citizens that is representative of the 26 million citizens enrolled in Taiwan's mandatory National Health Insurance (NHI) universal coverage program, according to the study authors. Although each individual's identity is encrypted to protect confidentiality, the code remains consistent throughout the dataset, which allowed the study authors to follow insurance claims by the same subject.
Large-scale data
Subjects from this group who had received dental scaling at least once per year from 1998 to 2000 (n = 3,391) were referred to as the "exposed" group. This group was then matched to a total of 13,564 individuals with similar age, sex, and significant underlying diseases using risk set sampling and International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes. The "nonexposed" group had not received scaling from 1998 to 2000.
All subjects were followed until five years after enrollment or occurrence of new-onset atrial fibrillation, as defined by hospital discharge diagnosis or confirmed more than twice in an outpatient setting.
The researchers found that the group that had regular dental scaling also had a lower occurrence rate of new-onset AF (2.2% versus 3%, p = 0.017). After further adjustment for age, sex, and other comorbidities, dental scaling was associated with a reduced risk of AF (hazard ratio = 0.671, p = 0.002).
The researchers also found that more frequent dental scaling visits led to further reduced risk. Patients who had received dental scaling twice a year over a three-year period had a hazard ratio of 0.340 (p < 0.001).
"The present study suggests that the risk of AF can be reduced through dental scaling," the study authors concluded. "Given the high prevalence of periodontal diseases in the population, improvement of oral hygiene through dental scaling may be a simple and effective way to decrease the inflammatory burden and prevent AF."
Related research
Other studies have linked systemic inflammation with the onset and perpetuation of atrial fibrillation (Journal of the American College of Cardiology, November 20, 2007, Vol. 50:21, pp. 2021-2028). And animal (dog) studies have shown an increased susceptibility for atrial fibrillation among subjects with periodontitis (Journal of Electrocardiolology, July/August 2010, Vol. 43:4, pp. 359-366). Large human studies have also linked poor oral hygiene and edentulousness to increased risk of cardiovascular events, particularly death by stroke (PLoS One, 2012, Vol. 7:2, e30797).
However, researchers continue to explore whether the data merely correlates or if a causal relationship exists. Last year, the American Heart Association issued a statement that periodontal disease has not been proved to cause atherosclerotic heart disease or stroke, and that treating periodontitis has not been proved to prevent heart disease or stroke. However, many researchers contend that while no causal link has been quantitatively established, the role of inflammation in both periodontitis and heart disease suggests an association.
"Poor oral hygiene is the major cause of periodontal disease, which has been found to be a potential risk factor for coronary heart disease, ischemic stroke, and peripheral vascular disease," the current study authors wrote. "Systemic inflammation could represent the underlying mechanism that links oral health and cardiovascular disease."
They acknowledged, however, that their current study had limitations.
"We presumed that the improvement of oral hygiene through dental scaling may decrease the inflammatory burdens and prevent patients from AF," they wrote. "However, a further prospective trial is necessary to confirm our findings and prove this speculation."

Esther Wilkins Education Program Volunteer in the News!

When discussing this innovative America's ToothFairy program geared toward dental hygienists, Dr. Esther Wilkins said, "I am so proud to have been able to launch the Esther Wilkins Education Program to engage children and their caregivers in preventive, smile-saving behavior."
Like so many of our dedicated Esther Wilkins Education Program volunteers, Sharon Kuttler, RDH, is doing just that!  In fact, she recently made the news when she used her America's ToothFairy Community Education Kit to teach children at Marshall Elementary School about good oral health practices.  An active community oral health educator, Sharon is one of the growing number of volunteer dental hygiene professionals that are making an impact on dental disease through education.

Click here for the entire article

New Guidance for Management of Women with Abnormal Cervical Cancer Screening Results

The American Society for Colposcopy and Cervical Pathology has issued updated recommendations in the form of 19 algorithms.

In 2012, the American Cancer Society, American Society for Clinical Pathology, and American Society for Colposcopy and Cervical Pathology (ASCCP) issued new guidelines for cervical cancer screening (JW Women's Health Apr 12, 2012). Now, the ASCCP has updated its recommendations (first published in 2006) for managing women with abnormal cervical cancer screening tests and cancer precursors. This guidance was developed based on a literature review, input from 23 professional societies, and clinical experience with 1.4 million women seen at Kaiser Permanente Northern California. The 19 algorithms cover clinical scenarios ranging from unsatisfactory cytology to various grades of squamous and glandular intraepithelial neoplasia. They are timely, given that co-testing (cytology plus assessment for high-risk human papillomavirus [HPV]) has become increasingly common.
One notable algorithm concerns management of women aged 21 to 24 with cytology indicating either atypical squamous cells of undetermined significance (ASCUS) or low-grade squamous intraepithelial lesion (LSIL). The 2006 guidelines recommended colposcopy with cervical biopsy for women with ASCUS plus positive reflex HPV test results, as well as for those with LSIL. The current guidelines do not recommend initial colposcopy for women in this age range. Instead, when HPV reflex testing is negative in women with ASCUS cytology, routine screening should resume. If the initial screen reveals ASCUS with positive HPV — or LSIL — repeat cytology is recommended at 12 months. The results of this 12-month cytology then determine whether colposcopy or repeat cytology at 12 months is indicated.
A second noteworthy algorithm relates to management of women with LSIL (for whom colposcopy had been recommended under the 2006 guidance). If LSIL is found during the course of co-testing and the HPV result is negative, repeat co-testing in 12 months is now the preferred action. In contrast, if LSIL is not accompanied by an HPV test — or if such testing is positive — colposcopy continues to be recommended.
Comment: Many clinicians may find the 19 algorithms too complicated to memorize. I plan to keep a copy handy whenever I see patients; other clinicians who evaluate women with abnormal cervical cancer screening results might choose to do the same.
— Andrew M. Kaunitz, MD
Published in Journal Watch Women's Health April 4, 2013

LINK

Citation(s):

Massad LS et al. 2012 updated consensus guidelines for the management of abnormal cervical cancer screening tests and cancer precursors. J Low Genit Tract Dis 2013 Apr; 17:S1. (http://dx.doi.org/10.1097/LGT.0b013e318287d329)

• Medline abstract (Free)

Massad LS et al. 2012 updated consensus guidelines for the management of abnormal cervical cancer screening tests and cancer precursors. Obstet Gynecol 2013 Apr; 121:829. (http://dx.doi.org/10.1097/AOG.0b013e3182883a34)

ADHA Response to Allegations of Unsanitary Practices at Oral Surgeon’s Office in Tulsa

ADHA STATEMENT ___________________________________________________________________________

Response to Allegations of Unsanitary Practices at Oral Surgeon’s Office in Tulsa

LINK

The American Dental Hygienists’ Association (ADHA) wants to reassure the public that dental hygienists maintain the highest standards in infection control to optimize patient safety and health. The isolated incident in Tulsa, Oklahoma, in which an oral surgeon allegedly exposed as many as 7,000 patients to HIV, hepatitis B and hepatitis C through unsanitary dental practices, in no way reflects the level of care expected of dental hygienists.

As part of its Standards for Clinical Dental Hygiene Practice (adha.org/practice), ADHA advocates for dental hygienists to maintain compliance with established infection control standards that follow the most current evidence-based guidelines to reduce the risks of healthcare-associated infections in patients, and illnesses and injuries in healthcare personnel.



The standards are used by dental hygienists to shape their knowledge, attitudes, beliefs, practices and behaviors that support and enhance oral health with the ultimate goal of improving overall health.

"ADHA urges all dental hygienists to maintain the highest standards and employ the best practices for infection control," said ADHA President Susan Savage, RDH, BSDH. "Adherence to recognized infection control practices ensures patient health and safety."

As part of ADHA policy, the organization advocates the development and utilization of emerging technologies that maximize human health and safety. ADHA also supports the Occupational Safety and Health Administration standards relating to workplace training and safety, according to ADHA policy.

Kathy Eklund RDH MHP, Secretary, Board of Directors, Organization for Safety, Asepsis and Prevention, said OSAP has assembled information from CDC, OSHA, other federal agencies and organizations to help hygienists and other oral healthcare workers with training and education to ensure the safe and infection-free delivery of care (see www.osap.org).

"As dental hygienists we can demonstrate our skills as prevention experts and educators to let our patients know about the policies, protocols and procedures in place to keep them safe," Eklund said.

ADHA encourages patients to discuss proper infection control procedures with their dental hygienists and dentists.

About the American Dental Hygienists' Association ADHA is the largest national organization representing the professional interests of more than 150,000 dental hygienists across the country. Dental hygienists are preventive oral health professionals, licensed in dental hygiene, who provide educational, clinical and therapeutic services that support total health through the promotion of optimal oral health. For more information about ADHA, dental hygiene, or the link between oral health and general health, visit ADHA at www.adha.org

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Esther Wilkins Education Program Welcomes New Dental Hygiene Schools

  LINK

Chaired by Michele Darby, BSDH, MS, Maria Perno Goldie, RDH, MS, Anna Pattison, RDH, MS and Rebecca Wilder, RDH, MS, the Esther Wilkins Education Program has attracted volunteers throughout the U.S., Canada and military bases around the world as well as a majority of the dental hygiene schools in the U.S.  Established with a founding gift from Dr. Esther Wilkins, this innovative program from National Children’s Oral Health Foundation: America's ToothFairy^®/ Canada’s ToothFairy provides dental hygiene professionals and students with engaging oral health lessons for their outreach activities.  

America's ToothFairy
would like to welcome the following dental hygiene schools to the program: 

Mississippi Delta Community College

Georgia Perimeter College

Colorado Northwestern Community College

Lake Superior College

St. Petersburg College

University of Mississippi Medical Center

University of Hawaii Maui College

Valencia College

Delta Technical College

Students at these schools will join the growing number of dedicated volunteer dental hygiene professionals and students reaching thousands of children and families with oral health education through this program. 

And now, dental hygienists can help fuel this movement for children's oral health promotion as members of the Esther Wilkins Legacy League!  As the philanthropic arm of the program, Esther Wilkins Legacy League members support ongoing volunteer efforts.  Each contribution goes directly to providing volunteer dental hygienists and students with America's ToothFairy Community Education Kits to help encourage good oral health practices among children, parents and caregivers. Each kit includes lessons appropriate for prenatal through young adult learning levels and cover topics including nutrition, germ transmission prevention and oral hygiene. 

"The America's ToothFairy Community Education Kit helped us interact with the children and made the teaching experience more fun!"

Sylva and Gail, dental hygiene students at Hudson Valley Community College

 There is a variety of giving levels and members are eligible for an array of benefits including special recognition, ToothFairy pins from RDH, drawings for Orascoptic^® loupes and other prizes, and an invitation to the exclusive Esther Wilkins Legacy League Luncheon and CE course featuring Maria Perno Goldie, MS, at RDH Under One Roof!  To join the Legacy League and support this smile-saving cause, click here.

 

 

 

A Prospective Study of Medical Diagnostic Radiography and Risk of Thyroid Cancer

1. Gila Neta*, Preetha Rajaraman, Amy Berrington de Gonzalez, Michele M. Doody, Bruce H. Alexander, Dale Preston, Steven L. Simon, Dunstana Melo, Jeremy Miller, D. Michal Freedman, Martha S. Linet and Alice J. Sigurdson

1. ↵*Correspondence to Dr. Gila Neta, Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, 6120 Executive Boulevard, EPS 7049, MSC 7238, Bethesda, MD 20892-7238 (e-mail: netagil@mail.nih.gov).

Link

Abstract

Although diagnostic x-ray procedures provide important medical benefits, cancer risks associated with their exposure are also possible, but not well characterized. The US Radiologic Technologists Study (1983–2006) is a nationwide, prospective cohort study with extensive questionnaire data on history of personal diagnostic imaging procedures collected prior to cancer diagnosis. We used Cox proportional hazard regressions to estimate thyroid cancer risks related to the number and type of selected procedures. We assessed potential modifying effects of age and calendar year of the first x-ray procedure in each category of procedures. Incident thyroid cancers (n = 251) were diagnosed among 75,494 technologists (1.3 million person-years; mean follow-up = 17 years). Overall, there was no clear evidence of thyroid cancer risk associated with diagnostic x-rays except for dental x-rays. We observed a 13% increase in thyroid cancer risk for every 10 reported dental radiographs (hazard ratio = 1.13, 95% confidence interval: 1.01, 1.26), which was driven by dental x-rays first received before 1970, but we found no evidence that the relationship between dental x-rays and thyroid cancer was associated with childhood or adolescent exposures as would have been anticipated. The lack of association of thyroid cancer with x-ray procedures that expose the thyroid to higher radiation doses than do dental x-rays underscores the need to conduct a detailed radiation exposure assessment to enable quantitative evaluation of risk.

OSAP comments on Tulsa oral surgeon's infection control violations

Link

March 29, 2013

By DentistryIQ Editors                                                

The Organization for Safety Asepsis and Prevention (OSAP) said the March 28^th reports regarding the investigation of a Tulsa, Okla., oral surgeon was as “shocking” to the dental profession as it was to dental patients in Tulsa.
OSAP said the investigation that led to the testing of 7,000 dental patients treated by the oral surgeon “is as shocking to dental healthcare professionals as it is to the patients for whom we provide oral healthcare. While none of us outside of that practice and the officials investigating the reported violations can know all of the details, the Associated Press reports and other news agencies suggest that there is at least one suspected case of HCV transmission to a patient.”
OSAP noted the media reports that the dentist used instruments that were rusted and pitted, rendering them unsuitable for proper sterilization.
Exclusive interview with Susan Rogers of the Oklahoma Board of Dentistry on Dr. Scott Harrington
Tulsa dental patients screened after investigation of dentist
ADA Statement on Infection Control in Dental Settings
“He also is suspected of using single vials of medications on multiple patients and allowing unlicensed individuals to perform procedures that would require licensure, such as administration of intravenous medications,” OSAP said in a statement. “The office had no written infection control protocol. The Organization for Safety, Asepsis and Prevention (OSAP) would like to provide practitioners with information that may be helpful in reassuring patients who become fearful of receiving dental care due to the widespread reporting of this case. It is important to focus on why patients should feel safe in our clinics and offices.”
OSAP said “talking points” with patients include:

• Inform patients that the practice uses evidence-based infection control precautions as recommended by the Centers for Disease Control and Prevention.  The latest recommendations and other resources can be downloaded from the CDC at http://www.cdc.gov/oralhealth/infectioncontrol/index.htm.
• Explain that dental anesthetics are provided using sterile single-use needles and cartridges of anesthetic and that these items are properly discarded after each patient.
• If IV medications are used, those medications are either from single-dose vials or that multi-dose vials are accessed only once with a single needle and syringe and that additional medications, even for a single patient, are drawn with a new syringe and needle. 
• An explanation of the sterilization process, including thorough cleaning, examination and then sterilization of instruments.
• Reassurance that instruments are maintained in sterile pouches or wrap until they are needed for patient care. It may be particularly useful to only open pouches once patients have arrived, so they may see for themselves that the instruments are properly packaged.
• Discussion of processes used for sterility assurance, including chemical indicators on and/or in packs of instruments and the regular monitoring of the sterilization process though the use of a biological indicator (spore test).
• Reassure the patient that all procedures requiring licensure or certification are provided only by professionals licensed to provide those services.  More information may be found through the American Dental Association (www.ada.org).

“Finally, this case serves as a reminder to ensure all professionals understand the guidelines and regulations related to infection control practices in dentistry,” OSAP noted. “Every dental health-care professional should periodically review infection control procedures and have those procedures in writing. Communication between team members is also essential to ensuring everyone understands their role in the infection control processes. At least annual review of written protocols should include all team members, and the scientific literature as well as other resources such as the CDC, OSAP and ADA should be reviewed for changes in recommendations.”
OSAP has a broad array of instructional content and educational resources available to dental clinicians at www.OSAP.org.  The organization will continue to monitor the situation and post new information and resources as they become available.

Okla. oral surgeon may face criminal charges

 

By DrBicuspid Staff
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April 1, 2013 -- The Oklahoma Board of Dentistry is asking prosecutors to file criminal charges against a Tulsa oral surgeon who was cited as a health "menace" after investigators found rusty instruments and lax sterilization procedures in his office.

The executive director of the Oklahoma Board of Dentistry, Susan Rogers, met with Tulsa County District Attorney Tim Harris Monday to discuss whether W. Scott Harrington, DMD, should be charged with criminal negligence, according to an Associated Press (AP) story.
State health officials have notified approximately 7,000 of Dr. Harrington's patients about potential exposure to HIV, hepatitis B, and hepatitis C.
Dr. Harrington and his staff could face at least two felony charges, including practicing dentistry without a license and aiding or abetting another person who is violating the state's dental act. The charges carry prison terms of up to four years and a $10,000 fine.
The dental board launched an investigation of Dr. Harrington last month after being notified that state health officials were looking into a complaint about potential hepatitis C contamination at his practice. One patient with no known risk factors has tested positive for HIV and hepatitis C after being treated by Dr. Harrington, according to a 17-count complaint by the dental board.
Health department and dental board investigators found numerous violations of health and safety laws, including the use of rusty instruments on patients known to have infectious diseases.
Dr. Harrington, who has practiced in the area for 39 years, surrendered his license on March 20 and is cooperating with investigators, according to health officials. His offices are currently closed, and he could not be reached for comment. His Tulsa attorney, Jim Secrest, did not respond to calls for comment.
More than 400 people lined up outside a Tulsa health clinic on March 30 to get tested, and dozens more did on April 1 also, according to the AP story.
Dr. Harrington was sued for medical malpractice in 1994 and for negligence in 1997, according to court records. Both cases were settled out of court.

Sheri's Solutions: Patient expectations

 

By Sheri B. Doniger, DDS

LINK

April 3, 2013 -- By now you've no doubt heard about the events in the offices of Dr. W. Scott Harrington of Tulsa, OK.

Unfortunately, this turn of events will give patients yet another reason not to visit the dentist. With the recent headlines from the current issue of the ADA News, stating "Fewer adults visiting the dentist," this does not help. Aside from fear of the unknown and the cost of care, dental patients do not need any other excuse not to visit us.

Sheri B. Doniger, DDS.

Interestingly, due to all the media attention, I had a very interesting day yesterday.
One of my long-time patients came in and said, "You were the topic of conversation at dinner last night." I was honored. She went on to say that she and her son were talking about the Tulsa incident and the cleanliness level in the office. He said, "I never even thought about it." She said, "Me neither, I expected it to be clean."
After she told me this, I took this patient on a tour of our office, showing her the new autoclave, the difference between autoclaved and nonautoclaved bags, and our spore-testing history. She didn't ask, but I wanted to do a show and tell.
She said she had no doubt. She saw the bags being opened and the cassettes being utilized. She knew I wore (and changed) gloves at each procedure, sometimes even during the procedure. She expected me to be clean.
But I had a different experience with a new patient. Although she did not formally ask, I felt compelled to discuss our infection control procedures. I opened the sealed bags with a flourish, showing her the heat indicator marking and discussing our habit of donning fresh gloves and masks, and why I wear safety glasses. We spoke about infection control, and she, too, said, "I expected it to be clean here."
Patients have expectations of a clean, safe dental office. We do so many things behind the scenes that patients take for granted (or, as per my patient, rarely even give a passing thought). Not showing a patient a needle prior to injection is a smart practice builder; not discussing the office's infection control protocol may not be. As with my small sampling of patients yesterday, only one mentioned the incident in Tulsa. Others were confident that safety and security were implicit and inherent in our practices.
With major news media outlets giving tips to patients to watch for gloves and office cleanliness, expect a few questions from even your most loyal dental patients these next few weeks. And if they do not ask, be proactive and let them know what your infection control protocols are.