Wednesday, May 30, 2007

Dentists need more training in oral cancer detection

More than 92 percent of Illinois dentists provide oral cancer examinations for their patients, but many are not performing the procedures thoroughly or at optimum intervals, according to a new University of Illinois at Chicago study.

With an incomplete understanding of the nature of pre-malignant lesions and of proper examination techniques, some dentists in Illinois "are not doing all they should be doing to detect oral cancers in their patients," said Charles LeHew of the UIC Cancer Center's Center for Population Health and Health Disparities and the Institute for Health Research and Policy.

More than 500 dentists in 19 Illinois counties responded to the 38-item questionnaire that was used to gauge the extent of their knowledge of oral cancer prevention and early detection. A greater than 60 percent response rate indicated that Illinois dentists "take seriously their important role in addressing the state's oral cancer burden," said LeHew, who was the lead researcher of the study.

According to LeHew, the majority of dentists correctly identified squamous cell carcinoma, the most common form of oral cancer, as well as the most common sites for oral cancer and the most-common types of early lesions. Many, however, were not able to answer those questions correctly.

Moreover, dentists lacked knowledge needed for risk assessment and counseling. For example, when asked which of several risk factors is least important, the most frequent answer was age -- which is actually an important factor, LeHew said.

"Some dentists incorrectly identified tobacco or alcohol as the least important risk factor, when in fact they are the two most important," he said.

Two-thirds of the dentists had had oral cancer continuing education; however, 40 percent had trained more than two years prior to the survey. And training in risk counseling was rare, LeHew said. "There is a clear need for additional training and for greater vigilance."

Approximately 31,000 Americans will be diagnosed with oral or pharyngeal cancer this year; it will cause more than 8,000 deaths. Of the newly diagnosed patients, only half will be alive in five years, according to the Oral Cancer Foundation. Survival has not significantly improved in decades.

The death rate for oral cancer is higher than for cervical cancer; Hodgkin's disease; and cancer of the brain, liver, testes, kidney or skin (malignant melanoma).

Early detection is essential in increasing the survival rate for oral cancer. Symptoms include a mouth sore that fails to heal or that bleeds easily; a white or red patch in the mouth that may not be painful but will not go away; a lump, thickening or soreness in the mouth, throat or tongue; and difficulty chewing or swallowing food.

"Illinois dentists face many barriers to providing early detection and risk counseling services to their patients," said Dr. Linda Kaste, associate professor of prevention and public health sciences who co-authored the study. "Lack of proper training and adequate time appear to be chief among them."

To increase awareness of the disease, UIC has been working with organizations in several Illinois counties that have high incidences of oral cancer to develop and distribute public health education materials, Kaste said. Oral cancer screenings are also provided to the underserved populations. The counties are located in northeast, central, western, and southwestern Illinois.

LeHew said the findings of the study were similar to studies in other states. Illinois dentists are performing at levels similar to dentists in other parts of the country, he said.

"Dentists are not going to diagnosis cancer," he said. "They are going to find potentially dangerous lesions and refer the patient to an oral surgeon. Because dentists are intimately familiar with the oral cavity, they can take a look around while they are examining a patient.

"The expectations are not clear for what dentists should do in regards to oral cancer. We need to identify what the best practices are. There is still a lot of work to be done to get there."

New Online Dental Supply Store

Historically dentists have ordered supplies through a commissioned sales representative. Carson's dental supply store lets dentists, dental assistants and hygienists order common supplies such as burs, gloves and paper disposables through a secure, easy-to-use online ordering system that minimizes clicks. Carson Dental will beat other suppliers' costs by 5 percent, with a low price guarantee believed to be the first in the industry. Many of Carson Dental's products are already priced 20 to 30 percent less than competitors, thus allowing dentists to achieve higher profit margins by reducing supply costs. Shipping is free on all orders over $100 and comes with an on-time delivery guarantee.

"The average dental office spends $43,710 annually on dental supplies," said Charlie Holley, chief executive and founder of the Atlanta-based company. "That's 6.2 percent of the average annual gross of the average dental office, according to the ADA. By offering competitive prices and eliminating a layer of the ordering process, Carson Dental helps dentists save time and money, thereby increasing profits and improving patient care."

"Ordering from Carson Dental can also eliminate hidden supply costs that run from 20 to 30 percent of some dentists' supply budget," says Janet Kaup, Finance Director, Carson Dental. The hidden costs that Carson often eliminates for their customers include mark ups by commissioned sales reps, unapproved additional product quantities, shipping costs, lost business due to meeting with a sales rep and order entry mistakes.

In addition, many dental practices don't have time to search for better prices or even know that they can negotiate prices on various dental products. "At Carson Dental, our low prices are always up to date, inventory is assured, no time is wasted flipping through outdated catalogs, and we don't have any special pricing tiers," Holley said. "Dentists will save time and money using our online store and we're excited about the opportunity for the industry."

Tuesday, May 29, 2007

Successful Dental Web Marketing

Once upon a time, a dental practice could just throw together a website, toss it up on the Internet and wait for clients to flock to their site.

With the exponential growth of Internet sites, however, this outdated strategy ensures Google™, Yahoo!® and MSN® search engines will relegate such websites to their bargain-basement pages.

It wasn’t long before a new specialty emerged: Search Engine Optimization. This complex process employs a variety of tactics to ensure the site appears on the first pages of the major search engines. When combined with dental website design and development, SEO is a sure-fire method of improving the volume and quality of traffic for a website.

A 2006 study by Jupiter Research corroborated what had already become common knowledge: “62 percent of search engine users click on a search result within the first page of results, and a full 90 percent of users click on a result within the first three pages of search results.”

The study also found 88 percent of surfers unable to find the desired information in the first three pages are more likely to change their search engine terms than to look through additional results pages.

Is it any wonder page ranking became a vital aspect of Internet dental marketing?

Burying “keywords” into a websites code and content is the primary key to optimization. Keywords are the words or phrases surfers use to find the information they seek.

Sinai Marketing CEO Ali Husayni offered an example of how this dental website marketing process can move a site to those highly desirable first pages.

“The cosmetic dentists at Smile South Florida came to us because they weren’t getting the desired traffic to their site,” said Husayni. “When we first began working in January with Dr. (Charles) Nottingham and his team, they appeared just twice on the first pages of Google and nine times on Yahoo!® for their 212 primary keywords. They were practically non-existent on MSN®.”

By implementing a variety of SEO techniques, including link building (creating inbound links to a website) and regularly updating site content, the Fort Collins, Colo.-based Sinai Marketing blew Smile South Florida’s competitors out of the water.

“By April, they were appearing on the first pages of Google for 208 of their 212 keywords,” said Husayni. “They were amazed to see such fast results.”

The numbers for Yahoo and MSN were equally impressive. For the same 212 keywords, Yahoo posted 176 and MSN posted 514 first-page appearances. (MSN indexes for duplicate appearances.)

First page placement proved just the ticket to attract pre-qualified, potential patients, saving Smile South Florida an enormous amount of time, energy and money.

“In my 30 years of dentistry, I have never seen so many new patient consultations,” said Dr. Nottingham.

SEO expert John Reese perhaps put it best: “The key to dominating any market online (now or in the future) is simple. It comes down to who has the highest average visitor value and who has the most traffic.”

Friday, May 25, 2007

ADA Supports Essential Oral Health Care Act

American Dental Association President-Elect Announces Association's Support for Rep. Albert Wynn's 'Essential Oral Health Care Act of 2007'

Good afternoon. I'm Mark Feldman, a practicing endodontist and president-elect of the American Dental Association.

I participate in Medicaid and I know firsthand the devastation that severe, untreated dental disease can wreak on the lives of the most vulnerable people-children and adults from low-income families and other underserved groups.

Like Rep. Wynn and everyone here, I was saddened and dismayed by the death of 12-year-old Deamonte Driver, who lived a short distance from here. We have an obligation to honor this child and his family by saying, "No more." No more needless deaths; No more children unable to eat or sleep properly; unable to pay attention in school; unable to smile because of dental disease that could easily have been prevented and treated.

If we don't resolve to reform the system now, we are ignoring the warning that this tragedy is sending us, and the nation's children will continue to suffer the consequences. And it isn't just the poor. Developmentally disabled children and adults also face severe barriers to receiving oral health care.

Every dentist I know provides some free or discounted care to people who need it and otherwise wouldn't get it.

We do this both individually and collaboratively. One study published in the mid-nineties estimated that dentists delivered $1.6 billion in free or discounted care in a single year. But the sad fact is that all of our volunteer and charitable efforts aren't enough, and they never will be. Because charity isn't a health care system.

In most states, Medicaid reimbursement is so meager that, in most cases, it doesn't cover dentists' overhead. The paperwork is onerous and confusing. The whole process is so frustrating that it discourages dentists from participating in the program at all.

It is critical that we build the preventive infrastructure that, ultimately, is the only way that we will end what former Surgeon General David Satcher famously called the "silent epidemic." To that end:

- Every child should see a dentist within six months of the appearance of the first tooth, and no later than the child's first birthday.

- We need more community-based initiatives, such as water fluoridation, and the broader availability of dental sealants and topical fluoride.

- We must embrace innovations in the dental workforce. The ADA has modeled a new type of allied dental professional, the Community Dental Health Coordinator, which could greatly enhance the productivity of the dental team, by extending our reach into underserved communities. The CDHC model is unique, in that it combines the provision of preventive services with triage, case management and referral to fully qualified dentists when needed. Rep. Wynn's legislation would provide for the training of CDHCs.

Ninety percent of the nation's dentists are in private practice. We need to make it possible for more of them to participate in Medicaid.

Congressman Wynn's "Essential Oral Health Care Act" will help states improve the delivery of Medicaid services and make it easier for more dentists to participate. His bill will help ensure that kids get the continuity of care necessary to avoid tragedies like Deamonte's.

The most vulnerable among us - especially children - deserve better. Better than the fate that befell Deamonte Driver, better than the untold numbers of children who are suffering with untreated disease. Dentists can do more, but only if state and federal governments give us the support we need. The American Dental Association asks every member of Congress to work with Rep. Wynn and others to ensure that every American child can face his or her future with a smile.

“Quitlines” Helps Dental Patients Stop Smoking

Dentists may be able to help their patients stop smoking by referring them to tobacco-use telephone “quitlines,” according to a pilot study published in the May issue of The Journal of the American Dental Association (JADA).

Dentists who intervene with patients to help them stop using tobacco can play a significant role in decreasing tobacco-related illness and death. However, providing support for such patients requires time and resources that oral health care professionals may not always have. So, researchers at the Mayo Clinic College of Medicine, Rochester, Minn., identified the need to conduct a pilot study to evaluate whether the speedier measure of referring patients to tobacco-use quitlines was also effective in helping patients stop smoking.

The authors randomly assigned eight general dental practices in Minnesota to provide either brief counseling regarding smoking cessation or brief counseling along with referrals to a tobacco-use quitline for patients who reported that they were currently smoking cigarettes.

Of 82 patients, 60 were referred to the tobacco-use quitline and 22 received only brief counseling. At six months, 25 percent of the patients in the quitline group and 27.3 percent of the patients in the brief-counseling group had abstained from tobacco use. Abstinence rates among patients in the quitline group rose if those patients completed more telephone consultations.

The authors cite research indicating that although more than 60 percent of dentists believe their patients do not expect tobacco-use cessation services from them, about 59 percent of patients believe that dentists should provide such services.
“By facilitating engagement in a tobacco-use quitline,” the authors write, “dental practitioners can close the gap between patients’ expectations and the current standard of practice.”

JADA, a monthly journal, is the ADA’s flagship publication and the best-read scientific journal in dentistry.

2 new Web self study guides for Dental Ed

MetLife Introduces Two New Dental Quality Resource Guides in ADA Approved Continuing Education Program

MetLife today announced two new additions to its series of Web-based self study continuing education guides for the dental community, Medical Emergencies: Preparation and Management and Treatment Planning. MetLife is approved by the American Dental Association (ADA) as a recognized provider under its Continuing Education Recognition Program (CERP), and these new offerings may be used to fulfill licensing requirements where applicable. MetLife’s educational offerings are also approved by the Academy of General Dentistry. Access to these and other Quality Resource Guides in MetLife’s Dental Continuing Education Program are available at

The first new guide, Medical Emergencies: Preparation and Management was developed by Stanley F. Malamed, DDS, a Professor of Anesthesia & Medicine at the University of Southern California, School of Dentistry. By highlighting the most common medical emergencies that may occur in a dental setting, Dr. Malamed underscores the essentials of prevention and preparation when it comes to emergency management. The guide addresses how to prepare a dental office, the assignment of responsibilities to various members of the dental team and the essential drugs and equipment that should be readily available to manage emergency situations.

The second guide, Treatment Planning by Clarence Trummel, DMD, PhD, Emeritus Professor of Periodontology at the School of Dental Medicine, University of Connecticut, addresses the steps needed to develop a comprehensive and integrated treatment plan tailored to the unique needs of patients, starting with the use of well-designed forms for documenting and evaluating a patient’s oral examination and his or her medical and dental history. The guide emphasizes the importance of understanding patients’ desires and expectations, the need for patient education as well as the need to establish realistic objectives for determining the effectiveness of the treatment plan.

The purpose of the MetLife Quality Resource Guides is to provide dentists with easy to access, up-to-date information important to their dental practices. MetLife was the first commercial dental carrier to develop educational offerings recognized by the ADA Continuing Education Recognition Program.

The MetLife continuing education courses are designed so that dental practitioners or dental hygienists can view or print the materials from the internet and, at their convenience, take an online test to determine their familiarity with the course material. Test results are immediate, and certificates can be printed on demand. The ability to receive continuing education credits online saves dentists the time and expense of traveling to a physical site and provides the convenience of access 24-hours-a-day. The continuing education credits from MetLife are free to network dentists and available at a minimal charge to dentists not in the MetLife network.

The MetLife Dental Advisory Council (DAC) reviews data and identifies the educational needs of dentists who participate in the Preferred Dentist Program. The DAC is comprised of practicing and academic dentists, as well as corporate benefit representatives. The Council serves as the oversight committee for the MetLife Quality Initiatives Program. The DAC has recommended important changes designed to make participating in the MetLife Preferred Dentist Program easier for dentists and their support staff.

MetLife administers dental benefits for nearly 21 million people, more than any other commercial carrier. The continuing education program is open to both MetLife participating and nonparticipating dentists; however, as a benefit of participation, dentists and their office staff in the MetLife Preferred Dentist Program may enjoy continuing education credits at no charge. Non-participating PDP dentists can access MetLife educational offerings at no charge and if educational credits are desired, for a small fee they may take the test and earn credit.

ADA Affirms Benefit of Toothpastes and Rinses

ADA Affirms Benefits of ADA-Accepted
Antimicrobial Mouth Rinses and Toothpastes, Fluoride Mouth Rinses

For more than 75 years, the American Dental Association (ADA) Seal of Acceptance program has helped consumers make informed decisions about safe and effective oral care products. Certain toothpastes, toothbrushes and floss are well-known products in the ADA Seal of Acceptance program.

Recently, the ADA’s Council on Scientific Affairs highlighted the oral health benefits of other ADA-Accepted products such as antimicrobial mouth rinses and toothpastes that can help prevent and reduce plaque and gingivitis, and fluoride mouth rinses that can provide extra protection against tooth decay over that provided by fluoride toothpaste alone. Gingivitis is an inflammation of the gums caused by the accumulation of plaque along the gum line.

It is important to note that the ADA’s daily oral hygiene recommendations have not changed—people should still brush twice a day with an ADA-Accepted fluoride toothpaste; clean between their teeth daily with an ADA-Accepted floss or ADA-Accepted interdental cleaner; eat a balanced diet and limit between meal snacks; and visit their dentist regularly for professional cleanings and oral examinations.

The ADA simply wants consumers to be aware of the additional oral health benefits provided by ADA-Accepted antimicrobial mouth rinses, toothpastes and fluoride mouth rinses.

Antimicrobial mouth rinses and toothpastes
Antimicrobial mouth rinses and toothpastes reduce the bacterial count and inhibit the bacterial activity in dental plaque that can cause gingivitis, an early, reversible form of periodontal (gum) disease. ADA-Accepted antimicrobial mouth rinses and toothpastes have substantiated these claims by demonstrating significant reductions in plaque and gingivitis.
Fluoride mouth rinses

Fluoride mouth rinses are used to help reduce and prevent tooth decay. Clinical studies have demonstrated that use of a fluoride mouth rinse in addition to fluoride toothpaste can provide extra protection against tooth decay over that provided by fluoride toothpaste alone. The use of fluoride mouth rinse is not recommended for children six years of age and younger because they may swallow the rinse. Consumers should always check the manufacturer’s label for precautions and age recommendations and talk with their dentist about the use of fluoride mouth rinse.

“People may think cavities only impact children, but adults can get tooth decay, too,” says Maria Lopez Howell, D.D.S., consumer advisor for the ADA. “Adults can also get gingivitis. If allowed to progress, gingivitis can lead to advanced gum disease, and that can lead to tooth loss.”

A recent report from the U.S. Centers for Disease Control and Prevention states that 27 percent of people age 65 and older experience complete tooth loss.

“It’s important for people of all ages to follow good oral hygiene to keep their smiles healthy,” Dr. Howell advises. She added that consumers should look for oral health care products that carry the ADA Seal of Acceptance—their assurance that the ADA Council on Scientific affairs has found that the product meets objective, scientific criteria for safety and effectiveness. The ADA requires products to display a statement on the package informing consumers why the product was awarded the ADA Seal.

According to a national public opinion survey, a majority of consumers recognize the American Dental Association’s (ADA) Seal of Acceptance, and of those, 81 percent reported purchasing an oral hygiene product with the ADA Seal. For a list of products bearing the ADA Seal of Acceptance and descriptions of the various types of oral hygiene products available, visit

Implant & Graft Market to Top $4.5 Billion by 2012!

Global sales of dental implant systems, fast becoming the preferred restoration for replacement of missing or extracted teeth or as supports for dentures, crowns and bridges, are expected to maintain double-digit growth over the next five years, soaring to more than $4.5 billion, according to Implant-Based Dental Reconstruction: The Worldwide Dental Implant and Bone Graft Market, 2nd Edition, a new study from Kalorama Information.

Sales of dental implants and abutments rose more than 15% in 2006 alone reaching nearly $2 billion, led by Europe, where the popularity of implants saw sales peaking at $760 million or 42% of the global market.

Advanced bone grafting and regeneration techniques have radically expanded the possibilities for implant-based restorative dentistry. World sales of dental bone grafts reached $130 million in 2006, up 12% over 2005. The report projects the use of bone grafts will more than double by 2012 with revenues reaching $266 million.

Grafting techniques are making it possible to expand the candidate pool for implants to include a sizable population of edentulous patients who were poor candidates for dental implantation due to severe bone resorption.

“The most closely watched research and development projects in dental bone grafting today involve bone morphogenic protein (BMP) products. BMPs have the potential to transform the bone grafting market and surpass all other products on the market including synthetic substitutes, allografts, and demineralized bone matrices,” notes Anne Anscomb, the report’s author. “With the announcement in March that the FDA approved Medtronic’s InFuse Bone Graft for certain oral maxillofacial and dental regenerative bone grafting procedures, the future of BMP and increased use of grafts and implants looks very promising..”

Implant-Based Dental Reconstruction includes revenue forecasts for each segment through 2016, global market share for four geographic regions, over 35 tables and figures with detailed market data, reviews of new products, and computer aided dentistry and reimbursement trends. It can be purchased directly from Kalorama Information by visiting It is also available at

Dental Institute Plays Key Role in Heart Study

Delta Dental Institute Plays Key Role in Groundbreaking Heart Study

An extensive analysis of treatment data by Delta Dental’s Research and Data Institute played a key role in developing new treatment guidelines that are expected to reduce the unnecessary use of antibiotics for dental patients at risk for a potentially deadly heart infection. The Institute is operated by the affiliated Delta Dental plans of Michigan, Ohio, Indiana and Tennessee.

New guidelines released by the American Heart Association (AHA) in April recommend that only patients whose heart disease places them at the highest risk for infective endocarditis (an infection of the heart lining that can lead to congestive heart failure, stroke, and even death) should receive antibiotics as a preventive measure prior to dental treatment.

This is a major change from previous recommendations, which called for premedication of a much larger group of patients with a lower risk of infective endocarditis. Appropriate use of antibiotics is critical because their overuse contributes to the creation of “super bugs,” or bacteria that are resistant to drugs, and side effects which are a public health concern worldwide.

For the AHA study, the Delta Dental Research and Data Institute, through its extensive data warehouse, provided data on the frequency of dental procedures received by millions of patients over a 12-month period. This included data from nearly 22 million dental claims from Delta Dental-covered individuals located throughout the United States. Personal identification information was removed from the data to protect individuals’ privacy rights.

“The size and nature of the dental procedure data from Delta Dental was critical to showing that the change in the way we now describe dental procedures that might put patients at risk would not result in significantly more procedures or patients being covered with antibiotics,” said Dr. Peter Lockhart, chair of oral medicine at the Carolinas Medical Center in Charlotte, NC, and a member of the AHA Writing Committee that examined this issue.

The new AHA recommendations, which have been endorsed by the American Dental Association, provide additional confirmation of the importance of oral health to overall health. It found that an individual’s overall level of oral health may be the most important factor in avoiding infective endocarditis, and that antibiotics prior to dental treatment may be ineffective and unnecessary for many patients with heart valve disease.

“Advancing scientific knowledge on oral health and its connection to other health conditions is a major priority at Delta Dental,” said Dr. Jed J. Jacobson, senior vice president and chief science officer of Delta Dental of Michigan, Ohio, Indiana, and Tennessee.

“This study provides more evidence that good oral health contributes to good overall health,” he said.
Delta Dental founded the Research and Data Institute in 2005. Key areas of study include the connection between oral and overall health, changing patterns of dental disease in the population, and the changes in dental plan design based on scientific evidence.

“Because of the scope of our data warehouse and our informatics expertise, we are in a unique position to contribute to important policy issues like this,” he said. “The AHA guidelines will change how dentists manage their patients and Delta Dental strongly encourages individuals with heart conditions to discuss these new guidelines with their dentists.”

The affiliated Delta Dental companies of Michigan, Ohio, Indiana, and Tennessee collectively are one of the largest dental plan administrators in the nation. In 2006, the enterprise paid out more than $1.7 billion for dental care for more than 6.2 million enrollees. Offices are located in Okemos, Farmington Hills and Grand Rapids, Michigan; Columbus and Cleveland, Ohio; Indianapolis, Indiana; and Nashville, Knoxville, and Memphis, Tennessee.