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Entries in Dentistry (5)

Tuesday
Jul172012

Colorado Dental Patients Advised to Get HIV, Hepatitis Testing

A screen grab from Dr. Stephen Stein's former dental practice website. (www.drstephenstein.com)(DENVER) -- Patients of a former Colorado oral surgeon have been advised to get tested for HIV and hepatitis infections after a state health department investigation accused him of reusing syringes and needles on patients receiving intravenous medications for nearly 12 years.

Any patient who received an IV injection, including sedation, from licensed dentist Dr. Stephen Stein between September 1999 and June 2011 might have been exposed to HIV, hepatitis B and hepatitis C, the Colorado Department of Public Health and Environment said in a statement July 12.

Denver police are also involved in the case.

"Right now [Stein's] case is an active ongoing investigation for prescription fraud," police spokeswoman Raquel Lopez said. "We received the information on April 3 of this year."

Stein sold his practice in September 2012 to Dr. Jeremey Miner, an oral surgeon, according to a woman who answered the phone at his former practice. They had not worked together previously.

Meanwhile, the state health department issued about 8,000 letters to some of Stein's former patients at both his Highlands Ranch and Denver, Colo., offices, urging them to get tested, department spokesman Mark Salley said.

Records were only available for Stein's patients from 2005 to 2011, so they will be the only ones receiving the notifications, Salley said. The patients he treated before then will not receive a notice to seek testing.

Without the records, Salley added, there's no way to know how many patients were at risk in the earlier years.

Salley said the state health department began its investigation in April after receiving a report of alleged unsafe injection practices from the Colorado Department of Regulatory Agencies, which licenses dentists statewide.

The investigation determined that the "syringes and needles used to inject medications through patient's IV lines were saved and used again to inject medications through other patients' IV lines."

"This practice has been shown to transmit infections," according to the health department's statement.

But by the time the Department of Public Health was notified of Stein's allegedly unsafe practices, the dentist had already entered into an interim agreement with the Colorado Board of Dental Examiners to stop practicing in June 2011, Salley said.

Salley declined to provide details and Stein's lawyer, Victoria Lovato, has not returned telephone messages requesting comment.

Salley said that even if Stein's former patients test positive for any of the diseases, it does not mean they contracted it through Stein's injection practices.

The health department has asked health providers who test Stein's former patients to report any positive tests for HIV, hepatitis B and hepatitis C to their county or state health departments, according to the statement.

"We don't have any results back and we're not likely to for a couple of weeks," Salley said. "It might be that there are no positive tests to come back."

The risk to Stein's former patients' health is likely to be low and a negative result should not require additional follow up, said Dr. Joseph Perz, a health care epidemiologist at the Centers for Disease Control and Prevention in Atlanta.

"My understanding is that for the majority of patients affected, the exposure would have taken place a considerable while ago and so the issues around incubation shouldn't be a factor for the vast majority of patients," he said.

But Perz said special treatment must be given to blood- borne viruses because there is potential for chronic infection.

Perz said that while the CDC takes a firm stance that safe injection practices are every health provider's responsibility, there have been multiple incidents of doctors reusing syringes for significant time periods that led to mass patient notification.

"This is sort of the latest in a string of these events that really do leave us scratching our heads," he said.

Salley said individuals at risk who have health insurance should contact their health care providers for testing. Those who don't, he said, should contact the state health department's hotline for a list of information by county.

Copyright 2012 ABC News Radio

Friday
Jul132012

Parents: What to Watch Out For at the Dentist

Design Pics/Thinkstock(NEW YORK) -- As detailed in a report on Thursday's Nightline, an ABC News investigation found that American children are being put at risk by inadequately trained dentists who often seek to enhance profits by sedating their young patients for even routine tooth cleaning and cavity treatments.

There is no national registry of dental deaths, but according to the Raven Maria Blanco Foundation, more than a dozen children have died after being sedated by dentists. Some experts say many deaths go unreported or are never officially tied to dental sedation.

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To lessen the risk for young patients, the American Dental Association has prepared the following list of questions that parents and guardians should ask about sedation or anesthesia for children.

Questions to Ask Your Dentist about Anesthesia and Sedation for Your Child

The ADA offers the following questions that parents and guardians should ask concerning in-office sedation or general anesthesia for their children provided either by the dentist or by a separate sedation/anesthetic practitioner in that dental office. The ADA recommends talking to your dentist about any concerns you might have about the treatment plan prior, during and after the procedure:

Prior to the procedure:

  • Who will provide the pre-operative evaluation of my child including their past medical history such as allergies, current prescription medications and previous illnesses and hospitalizations?
  • What is the recommended time that my child should be without food or drink prior to the procedure (with the exception of necessary medications taken with a sip of water)?
  • Will any sedation medication be given to my child at home prior to their coming to the office and, if so, how should they be monitored?
  • What training and experience does the sedation/anesthesia provider have in providing the level of sedation or anesthesia that is planned for the procedure? Does this training and experience meet all of the standards of the ADA Guidelines for the Use of Sedation and General Anesthesia by Dentists?
  • Does the staff assisting in the procedure have current training in emergency resuscitation procedures, such as Basic Life Support for Healthcare Providers, and other advanced resuscitation courses as recommended by the ADA Guidelines? Is this training regularly renewed?
  • Does the state dental board require a special sedation/anesthesia permit or license that allows for the sedation/anesthesia provider to administer this specific level of sedation or anesthesia in the dental office?


During the procedure:

  • In addition to the use of local anesthesia (numbing), what level of sedation or general anesthesia will be given to my child? Is it minimal sedation (relaxed and awake), moderate sedation (sleepy but awake), deep sedation (barely awake) or general anesthesia (unconscious)?
  • How will my child be monitored before, during and after the procedure until the child is released to go home? Are the appropriate emergency medications and equipment immediately available if needed, and does the office have a written emergency response plan for managing medical emergencies?


After the procedure:

  • Will the sedation/anesthesia provider give me instructions and emergency contact information if there are any concerns or complications after returning home?


For more information on oral health topics for you or your family, please visit the American Dental Association's website www.MouthHealthy.org

The Raven Maria Blanco Foundation, which seeks to alert parents to the potential dangers of the use of oral sedatives on young patients, has its own recommended sedation checklist for parents. CLICK HERE for the foundation's "Pediatric Dental Care Checklist."

The foundation is named for 8-year-old Raven Blanco of Chesapeake, Virginia, who died after her dentist, Dr. Michael Hechtkopf, gave her "three times the average range" of sedatives, according to the Virginia Board of Dentistry.

The dentist had his license restricted for three months and was ordered to complete seven hours of continuing education in record keeping and risk management. He has since retired.

A lawyer for Dr. Hechtkopf said the dentist "regretted" what happened.

Raven's parents, Robin and Mario Blanco, set up the foundation in their daughter's name to urge dentists to be better prepared for emergencies and to warn parents that what happened to their daughter could happen to others.

Copyright 2012 ABC News Radio

Wednesday
Jun062012

Dental Therapists Insufficiently Trained, Dental Associations Say

Design Pics/Thinkstock(NEW YORK) -- Nearly 17 million U.S. children fail to see a dentist every year, according to the Pew Charitable Trust. Now, a new group of dental professionals, called dental therapists, is hoping to bring them treatment.

Dental therapists receive specialized training, including how to perform local anesthetic, cleanings and apply sealants in kids and adults. The hope is that the specialized groups trained in some dental procedures will ease the burden of the growing gap in dental care, particularly for children, the Los Angeles Times first reported Sunday.

"They say they're only going to do simple procedures but, oftentimes, you can't say whether it was simple or not until after you're finished and you decide it was simple," said Dr. Howard Gamble, president of the Academy of General Dentistry.

Gamble said even most dentists right out of dental school do not jump into their own private practice. Instead, many work under another dentist who has more experience for a few years.

Alaska set up the first dental therapy program in 2005 for people living in rural tribal areas.

The Minnesota legislature passed legislation in 2008 that created a task force to determine how a midlevel dental provider should be created in the next legislative session, said Dr. Karl Self, head of the department for Dental Therapy Programs at the University of Minnesota School of Dentistry in Minneapolis.

Students enter the dental therapy program after completing a minimum of one year of prerequisite college course work. The full-time, 28-month program blends a solid dental clinical education, with the biological, behavioral, and social sciences, and the liberal arts, said Self.

California, Connecticut, New Hampshire and Oregon are states that are considering the practice.

"Our country's health-care system needs to continue to evolve in order to improve the health of its citizens," Self said. "This includes reducing health disparities as well as meeting the challenges of increasing access to care while increasing the quality of care and lowering the cost of care."

But Dr. Bill Calnon, president of the American Dental Association, said the solution isn't so simple.

"This is a very one-dimensional answer to an extremely complex problem," Calnon said. "People who are proposing this believe that more people treating individuals will solve the problem, but we're finding this won't necessarily help."

Neither Gamble nor Calnon believes the new wave of dental therapists will make general dentists lose business, but there are a "tremendous" number of barriers that should be examined, including education, cultural differences and geographical location, Calnon said.

"The vast majority of dental disease in this country is preventable," Calnon said. "That's good news and bad news. We have to figure out how to convince and educate people on oral health literacy."

Instead, to curb the growing gap of dental care in the United States, Gamble suggested education is key in teaching people how and when to brush and floss. It's also important to encourage people to put down the sugary foods and drinks. Gamble also suggested giving tax credits to dentists who work in underserved or rural populations.

But Self said dental therapy could be another tool in the arsenal to help kids get the dental care they need, particularly in the development years.

"While there is no one solution that will eliminate access to care issues or eliminate health disparities for our underserved populations, I believe that dental therapy can be an important piece that will contribute to improving those issues," said Self. "In Minnesota, legislation requires the dental therapist to work primarily in settings that serve low-income and underserved patients or in a dental health professional shortage area."

Self said the idea of midlevel professionals to provide basic dental work has been discussed for years. Now, he said, it's time to take action.

"It is encouraging that new and creative solutions are being discussed in every state," Self said. "But we need to do more than just talk, we need to implement some of these ideas."

Copyright 2012 ABC News Radio

Wednesday
Jan182012

Calif. Clinic Brings Free Dental Care to Developmentally Disabled

Comstock/Thinkstock(MORENO VALLEY, Calif.) -- For most adults, a cavity calls for a quick prick of novocaine and a 20-minute filling. But for 40-year-old Tina Lumbley of Moreno Valley, Calif., the routine procedure was a day-long ordeal.

Lumbley has autism, a developmental disorder that makes the sounds, smells, tastes and bright lights of the dentist's office overwhelming.

"She would get so anxious and have meltdowns," Lumbley's mom, Marjorie, told ABC News. "When she was a child, we had a great pediatric dentist and she was fine. But as she got older, it just wasn't working."

Most dentists refused to take Lumbley after she turned 18. And the few who were willing would only treat her under general anesthetic, which raises the risk and price of the procedure.

Lumbley is not alone. Across the country, adults with intellectual disabilities suffer from a lack of access to dental care.

"It's the biggest health care problem in the country today," said Dr. Steven Perlman, professor of pediatric dentistry at Boston University School of Dental Medicine. "People with intellectual disabilities are the most medically underserved population we have, and dental care is by far the most unmet need."

Adults with disabilities are usually covered by Medicaid. But the reimbursement rate is so "pathetically low that no dentist wants to participate in the program," Perlman said. And they don't have to. Dental schools are not even required to teach students how to treat disabled patients.

"These kids are coming out of school with huge loans," said Perlman. "What are they going to do when they get out? I'll tell you who they're not going to treat: people who are poor or disabled."

In 2009, California dropped dental coverage for all adults on Medicaid. That prompted Marianne and Russell Benson to open We Care, a nonprofit that brings free dental care to people with disabilities.

Now Lumbley, with her parents, makes the hourlong trip to the Rancho Mirage-based dental clinic where she gets cleanings and fillings like any other patients, without general anesthetic. The clinic has four dentists and student volunteers from nearby Western University of Health Sciences College of Dental Medicine.

"They treat her with dignity and respect and expect her to come out with a beautiful smile," said Marjorie Lumbley. Other dentists, she recalled, suggested pulling her daughter's teeth. "Yes, Tina has a lot of challenges but she has a right to have decent teeth."

Having healthy teeth and gums not only looks good; it also guards against disease. And for people with disabilities who are unable to communicate, a minor toothache can quickly evolve into a major emergency.

Marjorie Lumbley said she's grateful for We Care but worries about the future, as her daughter's dental and medical needs will surely grow.

"They have all the same things that go along with people getting older, but they still have these needs that can't be met any other way," she said. "I think people forget what happens to them after they grow up. They're not cute anymore. She's 40 years old and she deserves good care."

Copyright 2012 ABC News Radio

Friday
Dec022011

When Dentists Drill Too Much

Comstock/Thinkstock(NEW YORK) -- By the time a dentist finds a cavity, that tooth has been through several stages of a chronic infectious disease called dental caries, where acids dissolve tooth enamel, letting bacteria inside. Unchecked, the tooth can die.

Dentistry today focuses on early intervention to prevent bacterial invasion of the dentin, a layer just inside the enamel, and the vital pulp. Laser scanning, fiber optics and fluorescent technologies have allowed dentists to better visualize weakened, decayed enamel before it becomes visible on an X-ray or to the naked eye. Some dentists say high-tech tools enable them to perform minimally invasive dentistry, which preserves more of the tooth, often by treating "incipient carious lesions," also called microcavities. These abnormalities begin as white spots, which can progress to dark, stained pits and fissures.

Dentistry has evolved from "drill and fill" mechanics to a disease model focused on averting decay, supported by a 2001 National Institutes of Health consensus statement that identified a shift toward improving the diagnosis of early lesions and stopping their progression.

However, this early treatment may -- but need not -- involve the good old dental drill.

Some dentists want to fill all these little pits and flaws, sometimes warning of cavities to come, perhaps leading to a dreaded root canal, or losing the tooth. "Some dentists may honestly believe they're doing a patient a favor by treating early," said Dr. James C. Hamilton, now retired from the University of Michigan dental school. "Some dentists would convince patients caries is like cancer. 'Do you want me to leave a little cancer in your mouth? No.'"

Hamilton led a five-year study that found early treatment of microcavities using an air drill (less painful than a traditional drill) and a composite filling failed to conserve more of the tooth than watchful waiting until caries were diagnosed.

"We found no benefit at any time for early treatment," Hamilton said in an interview Thursday. He worries that expensive equipment pushes some dentists toward more aggressive treatment to get a "return on their investment."

"When you buy this new technology to treat incipient carious lesions, you have increased your overhead. You now have to make this piece of equipment pay for itself," Hamilton said. With the cost of a filling ranging from about $100 to $250, dentists might be "using this to find and treat those lesions when in fact they ought to be just watching them," he said.

Patients may balk at what they perceive as overzealous dentists proposing unnecessary and costly filling of microcavities before they've eaten into the dentin. That's why they should ask for a second opinion as they would for a medical issue, said Dr. Irwin Mindell. His mid-town Manhattan dental practice is very conservative and often proposes "watchful waiting" for microcavities.

"We have a very aggressive recall system. It's not that if you don't do it now, chances are you aren't going to come back to the dentist for another three years and at that time, we have another major problem," Mindell said. "I know I'm going to see the patient six months hence."

Mindell, who has been in practice since the 1950s, said that if damage hasn't reached the dentin, "you don't treat, because it may take years and years and years to become something. A lot of stuff never goes any further." For patients who aren't prone to cavities, removing the compromised enamel could lead to "greater loss of tooth than what the decay process will do."

But there's also a third way, said Dr. Peter Arsenault, a clinical professor at the Tufts University dental school in Boston. "Does treating mean drilling? Not in my eyes. That's what carpenters do," he said.

For the appropriate patient, Arsenault proposes a treatment plan that requires "a lot of dedication and a lot of education." It relies on neutralizing acidity in the mouth with frequent use of pH-boosting sprays and drops; killing mouth bacteria with xylitol--a sugar alcohol derived from birch trees, and using re-mineralizing toothpastes that stabilize and shore up weakened enamel.

Arsenault teaches dental students and dental colleagues the Caries Management by Risk Assessment (CAMBRA) approach, which uses a patient's history of cavities and dental work, oral hygiene habits and consumption of acid-promoting sugary foods, among other factors, to categorize them as low-risk, moderate-risk or high-risk for developing cavities.

"For each level of risk, there's a bit of an art, and a bit of science to it," Arsenault said Thursday. He described a low-risk, highly motivated patient who came to him a year ago with four small spots in her dental enamel and conscientiously adhered to the recommended treatments. When he examined her teeth earlier this week, the spots had shrunk. "She's thrilled I didn't have to drill this tooth," he said.

Arsenault first learned about CAMBRA at an NYU conference four years ago, where he said that at first, "it sounded like hogwash." But he was quickly won over and brought CAMBRA to Tufts. "We're showing with low-risk patients we can slow down, freeze and reverse" the caries process, he said. With extreme-risk patients, they can fill decayed teeth with materials that release fluoride to safeguard the other teeth.

CAMBRA is now being taught at dental schools. Although the American Dental Association supports a risk assessment approach to dentistry, it hasn't yet taken a position on treating microcavities. "Evidence-based things are slow-moving," Arsenault said. "It's a momentum thing. It's on its way. We're getting closer."

Copyright 2011 ABC News Radio







ABC News Radio