Survey: Hispanics face oral health care barriers

The majority of Hispanics in the U.S. believe more information about good oral health habits, access to affordable oral health care, and more Hispanic and Spanish-speaking dentists and dental hygienists in their communities would help them “a lot” in achieving better oral health.

The findings — from a national survey led by the Hispanic Dental Association (HDA) and sponsored by Procter & Gamble (P&G) brands Crest and Oral-B — were presented Nov. 3 at the opening ceremony of the HDA Annual Meeting in San Diego.

The survey examined U.S. Hispanics’ perceptions and attitudes about oral health care, barriers toward achieving good oral health and the role of influencers in passing along oral health habits. The survey, “Hispanics Open Up About Oral Health Care,” is part of an initiative by the HDA, Crest and Oral-B to raise the profile of the state of oral health among Hispanics, the fastest-growing minority group in the country, representing 16 percent of the total U.S. population.1 The survey was conducted among 1,000 Hispanic adults and 1,000 adults from the general population, age 18 and older, who live in the continental U.S.

“As we can see from the survey findings, there is still a need within the Hispanic community for more Spanish-speaking dental heath professionals,” said Sarita Arteaga, DMD, MAGD, and spokesperson for the HDA. “Further, with oral health literacy a concern for this population and family serving as key influencers, it is imperative that we improve the communication between these professionals and patients to ensure that the right teachings are being passed along to future generations.”

Top barriers to better oral health

The survey found that knowledge gaps (oral health literacy), high cost (access to affordable care and insurance) and language/culture differences (Hispanic/Spanish-speaking dental health professionals) are barriers to many Hispanics in achieving good oral health. Specifically, the results found:

• When asked if cavities will go away on their own if you brush regularly, almost one-third of Hispanics (30 percent) responded that they believe this statement is true or did not know the answer, when in fact the statement is false. About half or more Hispanics also incorrectly answered true/false statements or were uncertain about the importance of brushing versus flossing, whether bleeding is normal during brushing and if mouthwash provides oral health benefits beyond just freshening breath.
• Close to half (45 percent) of Hispanics lack dental insurance and nearly one in five (18 percent) have not visited the dentist at all in the past two years, compared to 12 percent of the general population.
• Approximately six in 10 Hispanics feel that a higher representation of Spanish-speaking and Hispanic dentists/hygienists in their community would help them “a lot” in achieving and maintaining better oral health.

Other survey findings include:

• While most Hispanics, as well as the general population, rated their overall oral health as excellent or good, Hispanics experience more oral health problems.
• 65 percent of Hispanics said they experienced at least one oral health issue in the past year versus 53 percent of the general population. For more than one-third of Hispanics (36 percent), oral health problems experienced in the past year were severe enough to impact their daily activities, compared with 22 percent of the general population.
• Among Hispanic parents, many of these same knowledge gaps exist, as does the desire for more oral health information. Yet, eight in 10 Hispanic parents (82 percent) consider themselves an excellent or a good source for teaching their children about oral health habits.
• Aside from their dentist, Hispanics rely mostly on their parents and physician for oral health education and information.

“Crest and Oral-B are thrilled to partner with the HDA on this initiative to help shed light on oral health care practices among Hispanics in the U.S. and identify existing challenges,” said Ivan Lugo, DMD, MBA and P&G spokesperson. “This survey uncovered key gaps that can help provide the oral health care community with a concrete starting point from which to turn awareness into action.”

The HDA, Crest and Oral-B are committed to working together to improve the state of oral health among the growing U.S. Hispanic population. As a first step following the survey, the HDA, Crest and Oral-B have collaborated on an informational brochure highlighting key facts and debunking top misperceptions about oral care that will be placed in dental offices and other public areas nationwide.

(Sources: Hispanic Dental Association and Procter & Gamble)

Source: http://www.dental-tribune.com/articles/content/scope/news/region/usa/id/7135

Plasma brush disinfects and cleans out cavities for fillings

Engineers at the University of Missouri and their research collaborators at Nanova, a corporation that designs, patents and sells medical and non-medical devices, are one step closer to a painless way to replace fillings. After favorable results in the lab, human clinical trials are underway on the plasma brush. If the studies go well and the FDA authorizes its use, the researchers’ timeline indicates the brush could be available to dentists as early as the end of 2013.

 According to the developers, the plasma brush uses chemical reactions to disinfect and clean out cavities for fillings in less than 30 seconds. In addition to its bactericidal properties, the cool flame from the plasma brush forms a better bond for cavity fillings. The chemical reactions involved actually alter the surface of the tooth, which allows for a strong and robust bonding with the filling material.

“There have been no side effects reported during the lab trials, and we expect the human trials to help us improve the prototype,” said Qingsong Yu, associate professor of mechanical and aerospace engineering at MU, and Meng Chen, chief scientist at Nanova, which holds a co-patent for the plasma brush with MU.

“200 million tooth restorations cost Americans an estimated US$50 billion a year, and it is estimated that replacement fillings comprise 75 percent of a dentist’s work. The plasma brush would help reduce those costs,” said Hao Li, associate professor of mechanical and aerospace engineering in the MU College of Engineering. “In addition, a tooth can only support two or three restorations before it must be pulled. Our studies indicate that fillings are 60 percent stronger with the plasma brush, which would increase the filling lifespan. This would be a big benefit to the patient, as well as dentists and insurance companies.”

Human clinical trials are expected to begin early this year. The researchers believe the human clinical trials will provide the data to allow Nanova to obtain investors and take the next steps in releasing the product to the market.

Souce: http://www.dental-tribune.com/articles/content/scope/news/region/usa/id/7129

In California: Botox, dermal filler procedures now treated no differently than getting a filling

California dentists can now perform Botox and dermal filler procedures for dental esthetic and dental therapeutic uses. Dr. Louis Malcmacher, president of the American Academy of Facial Esthetics (AAFE), was asked to present to the California Dental Board in August of this year on the use of Botox and dermal fillers in dentistry.

The board took the matter up at the November meeting where it heard other perspectives as well and considered comments received in a public session from groups such as the California Medical Association, California Dental Association and California Academy of General Dentistry.

“The bottom line is that Botox and dermal fillers are allowed within the scope of dental practice for use by general dentists for dental esthetic and dental therapeutic uses with appropriate training,” Malcmacher said. “Now Botox and dermal fillers in California by dentists is just like any other area of dentistry and will be treated as such. No special statement is necessary from the board allowing Botox and dermal fillers because they are like any other dental procedure, as long as they are being used for dental esthetic and dental therapeutic uses, which is what we teach in our courses and relates to 99 percent of these procedures done in the oral and maxillofacial areas.”

California now joins the majority of states that allow dentists to do Botox and dermal filler procedures for dental esthetic and dental therapeutics.

The AAFE is a Dental Board of California registered provider for continuing education and has this same status in many states where it offers its full two-day live patient hands-on Botox/Dysport and dermal filler training for dentistry.

About the AAFE

The American Academy of Facial Esthetics is a professional and multi-disciplinary membership organization whose primary mission is teaching the best non-surgical and non-invasive facial esthetic techniques, such as Botox and dermal filler training courses for physicians, dentists and health care professionals around the world.

The AAFE has trained nearly 6,000 dental professionals in these techniques through more than 50 live patient hands-on mentored one-on-one training programs every year throughout North America.

(Source: American Academy of Facial Esthetics)

 Source: http://www.dental-tribune.com/articles/content/scope/news/region/usa/id/7196

Dentists Could Screen 20 Million Americans For Chronic Physical Illnesses

Nearly 20 million Americans annually visit a dentist but not a general healthcare provider, according to an NYU study published in the American Journal of Public Health.

The study, conducted by a nursing-dental research team at NYU, is the first of its kind to determine the proportion of Americans who are seen annually by a dentist but not by a general healthcare provider.

This finding suggests dentists can play a crucial role as health care practitioners in the front-line defense of identifying systemic disease which would otherwise go undetected in a significant portion of the population, say the researchers.

“For these and other individuals, dental professionals are in a key position to assess and detect oral signs and symptoms of systemic health disorders that may otherwise go unnoticed, and to refer patients for follow-up care,” said Dr. Shiela Strauss, an associate professor of nursing at the NYU College of Nursing and co-director of the statistics and data management core for NYU’s Colleges of Nursing and Dentistry.

During the course of a routine dental examination, dentists and dental hygienists, as trained healthcare providers, can take a patient’s health history, check blood pressure, and use direct clinical observation and X-rays to detect risk for systemic conditions, such as diabetes, hypertension, and heart disease.

The NYU research team examined the most recent available data, which came from a nationally representative subsample of 31,262 adults and children who participated in the Department of Health & Human Services 2008 annual National Health Interview Survey, a health status study of the U.S. population, which at that time consisted of 304,375,942 individuals. Physicians, nurses, nurse practitioners, and physician assistants were among those categorized as general health care providers for the purposes of the survey.

When extrapolated to the U.S. population, 26 percent of children did not see a general health care provider. Yet over one-third of this group, representing nearly seven million children, did visit a dentist at least once during that year, according to survey results.

Among the adults, one quarter did not visit a general healthcare provider, yet almost a quarter — nearly 13 million Americans — did have at least one dental visit. When combined, adults and children who had contact only with dentists represent nearly 20 million people.

Ninety-three percent of the children and 85 percent of the adults had some form of health insurance, suggesting that while many of those who did not interact with a general healthcare provider may have had access to general health care, they opted not to seek it.
Source: http://www.medicalnewstoday.com/releases/239315.php

Lab-Made Tissue Picks Up the Slack of Petri Dishes in Cancer Research

 New research demonstrates that previous models used to examine cancer may not be complex enough to accurately mimic the true cancer environment. Using oral cancer cells in a three-dimensional model of lab-made tissue that mimics the lining of the oral cavity, the researchers found that the tissue surrounding cancer cells can epigenetically mediate, or temporarily trigger, the expression or suppression of a cell adhesion protein associated with the progression of cancer. These new findings support the notion that drugs that are currently being tested to treat many cancers need to be screened using more complex tissue-like systems, rather than by using conventional petri dish cultures that do not fully manifest features of many cancers.

“Research on cancer progression has been drawn largely using models that grow cancer cells in plastic dishes. Our research reveals a major shortcoming in the experimental systems used to study cancer development. When using simplified culture systems in which cells are grown on plastic, cancer cells grow as a two dimensional monolayer and lack the three-dimensional tissue structure seen in human cancer. As a result, complex interactions that occur between the cancer cells and the surrounding tissue layers are not accounted for,” said first author Teresa DesRochers, PhD, a graduate of the Sackler School of Graduate Biomedical Sciences at Tufts, currently in the department of biomedical engineering at Tufts University School of Engineering.

The researchers report that the three-dimensional network of cell interactions activates epigenetic mechanisms that control whether genes critical for cancer development will be turned on or off. By imitating the structure of the tumor microenvironment seen in different stages of cancer, the research team was able to observe that cell-to-cell interactions that are inherent in tissue structure are sufficient to turn on the cell adhesion protein, E-cadherin, that can delay cancer development.

Since both invasion and metastasis occur when cells break away from the primary cancer site, an event correlated with loss of E-cadherin, treating cancers to induce re-expression of this protein through epigenetic control may be an important way to control cancer progression.

“Our findings show the reversible nature of E-cadherin when cancer cells are placed in a three-dimensional network of cells that mimics the way cancer develops in our tissues. This confirms that cancer biology needs to move into the “third dimension” where cancer cells can be studied in a network of other cells that can control their behavior. We know now that the plastic dish alone is not good enough,” said senior author Jonathan Garlick, DDS, PhD, a professor in the oral and maxillofacial pathology department at Tufts University School of Dental Medicine.

Jonathan Garlick is also a member of the Cell, Molecular & Developmental Biology program faculty at the Sackler School at Tufts and the director of the Center for Integrated Tissue Engineering (CITE) at Tufts University School of Dental Medicine.

This study, published in the January issue of Epigenetics, was performed in collaboration with Laurie Jackson-Grusby, PhD, associate in pathology at Children’s Hospital, Boston, and assistant professor at Harvard Medical School. Additional authors of the study are Yulia Shamis, MSc, a PhD student at the Sackler School of Graduate Biomedical Sciences; Addy Alt-Holland, MSc, PhD, an assistant professor at Tufts University School of Dental Medicine; Yasusei Kudo, DDS, PhD, and Takashi Takata, DDS, PhD, both of the department of oral and maxillofacial pathobiology, Graduate School of Biomedical Sciences, Hiroshima University, Japan; and Guangwen Wang, PhD, previously a fellow at Children’s Hospital Boston, now a senior scientist at Stemgent.

This research was supported in part by grant #DE017143 from the National Institute of Dental and Craniofacial Research, part of the National Institutes of Health.

Source: http://www.sciencedaily.com/releases/2012/01/120111103906.htm

Dental Health Experts At Nationwide Children’s Hospital Remind Parents About Scheduling Toddlers For Dental Visits

While infants under 12 months old may only have a few teeth, experts say they should been seen by a dentist within the first year of life. The American Academy of Pediatric Dentistry’s revised guidelines on infant oral health recommend infants 6 to 12 months old should to be seen by a dentist. More than 40 percent of children have tooth decay by the time they reach kindergarten. In order to help prevent tooth decay, dental experts at Nationwide Children’s Hospital are reminding parents to schedule dental appointments for their toddlers.

Studies have shown that if children experience tooth decay in their baby teeth, they are more likely to develop tooth decay in their permanent teeth. By bringing their child to a dentist at an early age, parents learn about the structure of the child’s mouth, preventative information on infant oral health and introduce their toddlers to the act of brushing their teeth.

“Infant oral health is the foundation for preventing future tooth decay,” said Paul Casamassimo, DDS, MS, chief of Dentistry at Nationwide Children’s Hospital. “If a child experiences tooth decay at an early age, it is a very difficult process to stop. The purpose of this initial visit is not only to introduce these toddlers to visiting the dentist, but also to provide preventative information to prevent tooth decay.”

The Dental Clinic at Nationwide Children’s sees about 35,000 patients and many of these patients under the age of 3. Dr. Casamassimo and his team formed a Baby Dental Clinic in the early 90s for toddlers from birth to 3-years-old. As one of the first baby dental clinics in the country, this clinic has proven to be successful in helping educate families on infant oral health.

“By establishing the relationship between family and dentist, parents learn early on how to take care of their toddler’s teeth,” said Dr. Casamassimo, also professor of Pediatric Dentistry at The Ohio State University College of Dentistry. “Taking a proactive approach to infant oral care can make a difference that will last a life time.”

For parents of a toddler, here are a few tips for taking care of a toddler’s teeth:

– Move your toddler off the bottle as soon as possible. By no later than one year, toddlers should be drinking liquids from some form of a cup

– When your toddler’s teeth start coming in, start brushing their teeth to get them used to the idea of brushing

– Confine sugar intake to mealtime. Experts suggest sugared-sweetened beverages should not be consumed throughout the day

During a toddler’s first dental visit, parents can expect to meet with a dental hygienist and a dentist. Normally seated in a parent-assisted position (knee-to-knee), the hygienist or dentist will do a brief examination of the toddler’s mouth; they are examining the oral structure of the mouth while also introducing the toddler to the feeling of a toothbrush. After the examination, parents will learn about dental and oral development, fluoride adequacy, teething, non-nutritive habits, injury prevention, dietary information and oral hygiene instructions. The hygienist or dentist will also explain future age-specific needs and dental milestones including scheduling the next appointment.
Source: http://www.medicalnewstoday.com/releases/239754.php

Dried Licorice Root Fights The Bacteria That Cause Tooth Decay And Gum Disease

Scientists are reporting identification of two substances in licorice – used extensively in Chinese traditional medicine – that kill the major bacteria responsible for tooth decay and gum disease, the leading causes of tooth loss in children and adults. In a study in ACS’ Journal of Natural Products, they say that these substances could have a role in treating and preventing tooth decay and gum disease.

Stefan Gafner and colleagues explain that the dried root of the licorice plant is a common treatment in Chinese traditional medicine, especially as a way to enhance the activity of other herbal ingredients or as a flavoring. Despite the popularity of licorice candy in the U.S., licorice root has been replaced in domestic candy with anise oil, which has a similar flavor. Traditional medical practitioners use dried licorice root to treat various ailments, such as respiratory and digestive problems, but few modern scientific studies address whether licorice really works. (Consumers should check with their health care provider before taking licorice root because it can have undesirable effects and interactions with prescription drugs.) To test whether the sweet root could combat the bacteria that cause gum disease and cavities, the researchers took a closer look at various substances in licorice.

They found that two of the licorice compounds, licoricidin and licorisoflavan A, were the most effective antibacterial substances. These substances killed two of the major bacteria responsible for dental cavities and two of the bacteria that promote gum disease. One of the compounds – licoricidin – also killed a third gum disease bacterium. The researchers say that these substances could treat or even prevent oral infections.

The American Chemical Society is a non-profit organization chartered by the U.S. Congress. With more than 163,000 members, ACS is the world’s largest scientific society and a global leader in providing access to chemistry-related research through its multiple databases, peer-reviewed journals and scientific conferences. Its main offices are in Washington, D.C., and Columbus, Ohio.

Source: http://www.medicalnewstoday.com/releases/239945.php

Nanocrystals Make Dentures Shine

The hardest substance in the human body is moved by its strongest muscles: When we heartily bite into an apple or a schnitzel, enormous strengths are working on the surface of our teeth. “What the natural tooth enamel has to endure also goes for dentures, inlays or bridges”, glass chemist Prof. Dr. Dr. Christian Russel of the Friedrich Schiller University Jena (Germany) says. After all, these are worn as much as healthy teeth. Ceramic materials used so far are not very suitable for bridges, as their strengths are mostly not high enough. Now Prof. Russel and his colleagues of the Otto-Schott-Institute for Glass Chemistry succeeded in producing a new kind of glass ceramic with a nanocrystalline structure, which seems to be well suited to be used in dentistry due to their high strength and its optical characteristics. The glass chemists of Jena University recently published their research results in the online-edition of the science magazine Journal of Biomedical Materials Research (doi: 10.1002/jbm.b.31972).

Glass-ceramics on the basis of magnesium-, aluminium-, and silicon oxide are distinguished by their enormous strength. “We achieve a strength five times higher than with comparable denture ceramics available today”, Prof. Rüssel explains. The Jena glass chemists have been working for a while on high density ceramics, but so far only for utilisation in other fields, for instance as the basis of new efficient computer hard drives. “In combination with new optical characteristics an additional field of application is opening up for these materials in dentistry”, Prof. Rüssel is convinced.

Materials, to be considered as dentures are not supposed to be optically different from natural teeth. At the same time not only the right colour shade is important. “The enamel is partly translucent, which the ceramic is also supposed to be”, Prof. Rüssel says.

To achieve these characteristics, the glass-ceramics are produced according to an exactly specified temperature scheme: First of all the basic materials are melted at about 1.500 °C, then cooled down and finely cut up. Then the glass is melted again and cooled down again. Finally, nanocrystals are generated by controlled heating to about 1,000 °C. “This procedure determines the crystallisation crucial for the strength of the product”, the glass chemist Rüssel explains. But this was a technical tightrope walk. Because a too strongly crystallised material disperses the light, becomes opaque and looks like plaster. The secret of the Jena glass ceramic lies in its consistence of nanocrystals. The size of these is at most 100 nanometers in general. “They are too small to strongly disperse light and therefore the ceramic looks translucent, like a natural tooth”, Prof. Rüssel says.

A lot of developing work is necessary until the materials from the Jena Otto-Schott-Institute will be able to be used as dentures. But the groundwork is done. Prof. Rüssel is sure of it.

Source: http://www.medicalnewstoday.com/releases/239993.php

Jaw Size Linked to Diet: Could Too Soft a Diet Cause Lower Jaw to Stay Too Short and Cause Orthodontic Problems?

 New research from the University of Kent suggests that many of the common

Dr von Cramon-Taubadel compared the shape of the cranium (skull) and mandible (lower jaw) of 11 globally distributed populations against models of genetic, geographic, climatic and dietary differences. (Credit: Image courtesy of University of Kent)

orthodontic problems experienced by people in industrialised nations is due to their soft modern diet causing the jaw to grow too short and small relative to the size of their teeth.

The research, which was conducted by Dr Noreen von Cramon-Taubadel from the University’s School of Anthropology and Conservation, tested the long-debated theory that the transition from a largely hunter-gatherer to an agricultural subsistence strategy across many parts of the world has had a knock-on effect on the growth and development of the human skull and lower jaw.

Dr von Cramon-Taubadel compared the shape of the cranium (skull) and mandible (lower jaw) of 11 globally distributed populations against models of genetic, geographic, climatic and dietary differences. She found that lower jaw shape, and to some extent the shape of the upper palate, was related to the dietary behaviour of populations, while the cranium was strongly related to the genetic relationships of the populations.

In particular, the lower jaw reflects whether populations are primarily hunter-gatherer or agriculturalist in nature, irrespective of what part of the world they come from. This therefore suggests that chewing behaviour causes the lower jaw to grow and develop differently in different subsistence groups, while the skull is not affected in the same way.

Overall, the hunter-gather groups had longer and narrower mandible, indicating more room for the teeth to erupt correctly, while the agriculturalists had generally shorter and broader mandibles, increasing the likelihood of dental crowding.

Dr von Cramon-Taubadel, a lecturer in Biological Anthropology with research interests in human and primate evolution, and in particular the causes of modern human skeletal diversity, said: ‘Chewing behaviour appears to cause the lower jaw to develop differently in hunter-gatherer versus farming populations, and this holds true at a global level. What is interesting, is that the rest of the skull is not affected in the same way and seems to more closely match our genetic history.’

Source: http://www.sciencedaily.com/releases/2011/11/111122112032.htm

ADA creates new committee, process to maintain CDT Code

By Kelly Soderlund, ADA News staff

Dr. Richeson

The ADA Council on Dental Benefit Programs is launching a new process to maintain the CDT Code.

The goal is to allow the Code to be more responsive to the needs of the profession and the public, said Dr. Jim Richeson, CDBP chair. CDBP is reaching out to all stakeholders, including third-party payers and dental specialty organizations. 

“At the forefront of the council’s thinking, as they fulfill their ADA Bylaws responsibilities for maintaining the Code on Dental Procedures and Nomenclature, is to consider all points of view before making decisions,” Dr. Richeson said. During the past decade, decisions on changes to the CDT Code have been made by the Code Revision Committee, in accordance with the initial term of a legal settlement agreement. That settlement agreement remains in effect, but the parties have moved into a different term of the agreement, where there is no provision for the CRC. 

A new committee is being formed, called the Code Advisory Committee, which will provide a forum for testimony and discussion regarding code change requests from all stakeholders. Its first meeting is scheduled for Feb. 10-11 at ADA Headquarters.

During the period when the CRC was responsible for approving changes to the Code, complaints arose from both dentists and third-party payers that the Code was not adequately responsive to an evolving profession.

The nature of the process also created a situation where deadlock because of even minor differences between the participants was common, Dr. Richeson said.

“This was not an optimal process to promote dialogue, and it did not provide for an efficient mechanism to move ahead with changes to the Code when any differences of opinion remained. The primary purpose of the CDT Code is to achieve uniformity, consistency and specificity in accurately reporting dental treatment,” Dr. Richeson said.

The CDT Code also provides for the efficient processing of dental claims. The CDT Code supports documentation on patient records—paper and electronic—as well as on claim submission and adjudication.

The ADA has always maintained the viewpoint that the CDT Code should have sufficient detail to accurately document services provided. Gaps in the CDT Code are identified when a dentist is forced to record a code that only comes close to correctly describing the service rendered, or must use an unspecified code, usually with the last three digits being 999. “Since claims data is mined for numerous purposes, accuracy and specificity in the CDT Code are essential,” Dr. Richeson said.

A code set that provides specificity is also needed to allow dentists to code for what they do. This has always been the position of the ADA; that dentists must accurately code for the procedure that is performed, not for any other reason, including maximizing claims adjudication. It is only possible to fulfill that mandate if the code set provides the means to accurately and specifically code for what a dentist does. Having an accurate code for each procedure performed does not mean that there will be a third-party payer benefit provided for the procedure, Dr. Richeson said. This is consistent with the stated purpose of the CDT Code. All procedures need a means to record and report them but not all procedures will have a reimbursable benefit, Dr. Richeson said.

The new maintenance process centers around the creation of the CDBP Code Advisory Committee. Work on the next version of the CDT Code, effective Jan. 1, 2013, continues on schedule. Changes previously accepted by the CRC during its two meetings in 2011 will be included in the next version, as well as additional changes arising from CDBP consideration of requests submitted after the last CRC meeting in August.

CDBP’s action on requests in the queue will be the final step in the council’s new CDT Code maintenance process. During its December meeting, the ADA Board of Trustees approved the advisory committee’s formation. Invitations to participate on the CAC have been sent to organizations involved in prior discussion of changes to the CDT Code, such as third-party payer and dental specialty organizations, as well as other sectors of the dental community. 

CAC comment will be considered by the council when it determines whether to accept or decline a requested change. The CAC’s initial composition has five current or past council members, one of whom will serve as the chair, plus one representative from each of the nine recognized dental specialty organizations, one representative from the Academy of General Dentistry, one representative from each of the five payer organizations formerly on the CRC, including the Centers for Medicare and Medicaid Services and one representative from the American Dental Education Association.

CAC composition may change over time. The council is aware that evolving technology and regulatory mandates can prompt the need for advice and comment from additional sectors of the dental community. All CAC meetings are open to any interested party, including the public, other dental organizations or suppliers, and payer entities who may not be directly represented on the advisory committee.

CDBP considered how best to improve the code maintenance process, being particularly cognizant to provide for multiple avenues for comment during the decision process, Dr. Richeson said. The expansive opportunity for comment at the CAC meeting is not the only time when comment can be made. After the Subcommittee on the Code makes preliminary recommendations, those recommendations will go out for comment. The council will consider the subcommittee’s recommendations and the comments on those recommendations when making final decisions. Code change submitters who have had their submissions declined will have an opportunity to appeal based on new information, if available.

About 140 change requests are in the queue for comment by the CAC and subsequent action by CDBP. This includes requests that were previously declined by a 6-6 vote, from all submitters. This is indicative of the care the council took to ensure fairness in the process to all.

The former CRC process included the availability of an appeal process for 6-6 votes. Since the CRC process no longer exists, submitters of code change requests that failed due to a 6-6 vote would have been disenfranchised of their right to appeal. Therefore, those requests will be given the full, fair and open treatment of the CAC process.

This opportunity is being provided equally to requests submitted by providers and payers. Requests that were previously passed by the CRC during the current revision cycle will not be reviewed.

The council will consider the following when decisions are made to accept a change request:

• Advice and comment from the CAC;
• Recommendations to accept or decline from the CDBP Subcommittee on the Code;
• Comment on the recommendations of the subcommittee;
• Change request evaluation guidelines adopted by the ADA Board of Trustees and posted on ADA.org.

The guidelines include:

• Code change request evaluation should be based on the need for documenting procedures based upon the patient’s dental needs and not on services covered by any applicable dental benefit plan;
• Procedures that are being provided by dentists to patients should have a code available for documentation;
• Procedure code nomenclatures and descriptors should be clear and unambiguous;
• Nomenclatures and descriptors address the manner in which the procedure is delivered, and should not include references to time intervals when the procedure may be reported, or limitations on reporting with other procedures;
• The alleged potential for abuse or fraudulent use of a code should not be considered as an evaluation guideline;
• Community standards of care should not limit consideration of other evaluation criteria.

Final decisions on the remaining change requests will be made during the council’s April  meeting and submitters will have an opportunity to appeal. All accepted changes will be in the next version of the CDT Code. This process will be repeated each year to enable the CDT Code to be responsive to the needs of the profession.

Information about the CDBP CDT Code maintenance process, featuring a simplified change request submission, will be posted on ADA.org to replace out-of-date material. There will be periodic additions and updates to the material posted at www.ada.org/3827.aspx.

Questions and requests for additional information may be directed to CDBP staff via email at dentalcode@ada.org or via telephone to the ADA toll free.

Source: http://www.ada.org/news/6670.aspx