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A dentist describes her journey from private practice to legislative assistant. Beginning with work in the ADA's Government Relations Office and then through the American Dental Association's Congressional Fellowship, Dr. Skoulas has now taken a full-time position monitoring and developing legislation for Congressman Edward J. Markey.
Following decades of minimal advancement, the dental licensure reform movement has rallied around the recent introduction of a bold new concept. The New York State Dental Association has introduced and passed legislation that allows the substitution of a successfully completed dental residency program for the traditional clinical licensing examination. The residency must be one approved by the Commission on Dental Accreditation of the American Dental Association. New York's main objective was to elevate the standards required for licensure beyond those of minimal competency. The residency experience provides extensive didactic and clinical experience in a supervised setting relevant to contemporary dental practice.
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This article reviews the 1991 and past two American Dental Association studies on the distribution of dentists, providing specific information on the evolving numbers of oral and maxillofacial surgeons at the national, regional, and state levels.
The biocompatibility and clinical efficacy of dental materials have been and continue to be a major concern of the dental profession. There are some cases of dental materials that have demonstrated problems with biocompatibility, for example, silicone soft liners. Although rare, allergic stomatitis caused by denture base resin is another example. High purity, very large polymer size, and nonoccurrence in nature significantly contribute to the acceptance of polymers used as biomaterials. New Federal Food and Drug Administration law and requirements of the specification and testing program of the American Dental Association will control the biocompatibility and clinical efficacy of dental biomaterials presently available to the dental profession.
The Food and Drug Administration (FDA) is a section of the Department of Health and Human Services of the United States Government, and its primary responsibility is to control the distribution of food, drugs, and medical devices within the country while ensuring public safety. The sale and distribution of dental implants is under the regulatory control of the FDA. Device classification, procedures for approval, and the current status of the approval process for endosseous implants are described in this article. The premarket approval procedure of the FDA is compared with the American Dental Association certification process. Issues related to the safety and effectiveness of dental implants are discussed.
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This article reviews the kinds of electronic transactions required under the Health Insurance Portability & Accountability Act (HIPAA) and relates them to relevant data contained in an electronic oral health record (EOHR). It also outlines the structure of HIPAA transactions using the claim transaction as an example. The relationship of the HIPAA resource management function to those of patient care are discussed. The discussion points out potential future uses of other existing resource management transactions to realize the maximum potential of linking the primary patient care functions to those functions related to managing resources in support of that care. This is needed in all aspects of oral health using the informatics standards activities in which the American Dental Association (ADA) actively participates. The article concludes by providing the dentist a perspective on how to relate these capabilities to his/her individual practice setting.
In 1993, the National Academy of Sciences' Institute of Medicine (IOM) convened a committee to study dental education and to make recommendations regarding the future of dentistry. The study was prompted by educational and professional concerns: specifically, the number of dental school closures, the high cost of dental education, the size of the dental workforce, and the role of dentistry within medicine and the health care system. In January 1995, the IOM's Committee on the Future of Dental Education concluded "Dental Education at the Crossroads-Challenges and Change," a 345-page report that includes eight policy and strategic principles and presents 22 recommendations. The unabridged text of the strategic principles and recommendations is published at the beginning of this paper. The IOM text notes impressive achievements in dentistry, and the recommendations form a foundation for the assessment of the many crucial issues that face dental education and dentistry today. The IOM report urges each dental school to review its curriculum and individually determine how best to fulfill its missions of education, research, and patient care. As dental education looks to the future, the practice of dentistry will be altered by social, economic, political, and technological developments as our consumers (students and patients) demand professional accountability and effectiveness. In the midst of this call for change, the specialty of prosthodontics is faced with many challenges and opportunities. This article is the response to a request from the American Dental Association (ADA) to address the IOM study on dental education as it affects the specialty and practice of prosthodontics. This article presents the position of the American College of Prosthodontists (ACP); however, some sections have been expanded to provide additional background information.
A double-blind, 3-week, randomized, placebo-controlled, parallel-group clinical trial was conducted to evaluate the tooth-whitening efficacy of a novel nontray, "paint-on" liquid whitening gel containing 18% carbamide peroxide (Colgate Simply White Clear Whitening Gel). Efficacy was based on measured Vita tooth-shade scores collected at baseline and after 2 and 3 weeks of product use. Eighty healthy volunteers were balanced into 2 groups based on gender, age, and shade scores (A3 or higher). The duration of product usage was 30 minutes, twice daily, for 3 weeks. Results from this clinical study showed that subjects' teeth in the liquid whitening gel-treated group exhibited an overall mean 3.84-shade improvement and a 3.5-shade difference compared with teeth in the placebo gel group (statistically significant, P < .05) after 3 weeks. Furthermore, this improvement exceeds the minimum requirement to claim "clinical efficacy" as established by the "Guidelines for the Acceptance of Peroxide-Containing Oral Hygiene Products," published by the American Dental Association in 1994. Therefore, it can be concluded that Colgate Simply White Clear Whitening Gel significantly whitens teeth.
The dominance of the marketplace by dentifrices containing fluoride as sodium monofluorophosphate and sodium fluoride has given rise to great academic and commercial interest regarding the comparison of those two fluoride species. Since the 1970's, several comparative clinical trials have been conducted to investigate the relative anticaries efficacy of dentifrices containing these two agents, generally giving rise to equivocal results. Recently, attention has been turned to investigative efforts which employ information derived from the collective body of relevant comparative clinical studies available in the literature to establish an omnibus conclusion concerning this issue. Beginning with the sign test of Beiswanger & Stookey (1989), and continuing through the meta-analyses of Johnson (1993) and Proskin (1993), this line of research remains vital today. The recent publication of two studies (Marks et al, 1994; Stephen et al, 1994) previously documented in the literature only in abstract form (Conti et al, 1993; Stephen et al, 1993) has given rise to the need for the present meta-analytic reconsideration of the available data. As in the previous meta-analyses, the quantitative results obtained depended on the studies which provided data for the calculations. However, as also indicated in previously-documented meta-analyses, the clinical interpretation of the results, which was based on the guidelines published by the American Dental Association (Council on Dental Therapeutics, 1988), did not vary according to study selection.(ABSTRACT TRUNCATED AT 250 WORDS)
The authors investigated the prevalence of immediate (Type I) hypersensitivity to gloves made from natural rubber latex, or NRL, by performing skin-prick tests on 2,166 dental workers over the course of a two-year period (with two one-year intervals). The investigator used two separate eluents made from different brands of natural rubber latex gloves. The study, conducted in 1994 and 1995 as part of the American Dental Association's Annual Health Screening Program, found that 6.2 percent of the participants (dentists, hygienists and assistants) tested positive for Type I hypersensitivity to NRL proteins.
Denturism, an organized movement by dental laboratory technicians to increase their control over the provision of denture services to the public, has generated a great deal of controversy among members of organized dentistry, the National Denturist Association, the Federal Trade Commission, consumer groups, and prepaid dental plans.Denturism is currently legal in Arizona, Colorado, Maine, and Oregon. In the first three States, the denturist must practice under the supervision of a dentist, but in Oregon the denturist is able to enter independent practice.The American Dental Association has held that a denturist is educationally unqualified to provide denture services directly to the consumer, Representatives of organized dentistry have characterized denturists as untrained and unskilled persons who would endanger the public's health and return one phase of dentistry to the apprentice system. They see denturism as constituting a major step backward in health care delivery and having an adverse effect on preventive dental care.The National Denturist Association, however, defines a denturist as a highly skilled person who specializes in the making of full and partial dentures. Denturists maintain that the dentist is an unnecessary middleman in the provision of denture services and is the primary cause of the high cost of dental prostheses. They contend that State dental laws providing that only dentists may render denture services have led to the high cost of these services without contributing significantly to the health and safety of the public.Organized dentistry in the United States has been fighting denturism in a number of ways. One that has met with considerable success has been the establishment of programs to provide people access to dental care, especially denture services, at lower costs. A second alternative under consideration is to license denturists but require them to practice under the supervision of a dentist. A third alternative under discussion is to expand the duties of existing dental auxiliary personnel.The final decision on denturism, however, will not be made by the dental profession or the denturists, but by the voting public and their elected representatives, based on the evidence they have before them.
BACKGROUND: The American Dental Association (ADA) has long relied on available scientific evidence in its commitment to use credible scientific data and analyses in policy-making, and its communications with the dental profession and the public. OVERVIEW: The evidence-based dentistry (EBD) process is a systematic approach that reviews and publishes the evidence relevant to specific clinical questions. The goal of this process is to help practitioners provide patients with quality oral health care. The ADA has developed a strategic plan of EBD initiatives and activities in order to increase the knowledge base and improve educational programs; to encourage significant collaboration on EBD-related issues from interested organizations, specialty groups, and various outside agencies; and to increasingly derive the best scientific evidence for use in clinical practice in concert with professional judgment and patient treatment preferences. CONCLUSION: The ADA endeavors to provide relevant information that can assist dentists in translating systematic-review findings and implementing an evidence-based approach in everyday clinical practice. This supports the Association's goal to continue supporting the best available evidence to assist health care teams in the provision of quality patient care and preventive techniques that improve oral health care outcomes.
Intra-oral studies use caries models from which conclusions are drawn concerning the caries process in the clinical environment. Recently, attention has been drawn to the issue of proper analysis and interpretation of the data from such studies, with particular emphasis placed on a consideration of the role such studies can and should play as a component of product claim submissions to the American Dental Association (ADA). This presentation discusses a number of issues relevant to this consideration, including the validity and reliability of the intra-oral modeling process, the relationship between these concepts and the requirements imposed by the ADA Guidelines for superiority and equivalence claims, and a brief enumeration of several other statistical issues which ought to be considered in the handling of data from such studies.
This paper reviews recent changes in the epidemiology of dental caries and assesses their potential impact on the diagnosis and management of the disease and the planning and operation of sealant programs. These changes, such as the decline in caries and slowing of the rate of progression of the disease, have important implications for diagnosing and treating incipient lesions, predicting caries risk, and conducting effective disease preventive programs. Traditional paradigms for restoring carious lesions are being replaced by newer strategies that emphasize disease prevention and conservation of tooth structure. The search continues for the identification of practical models for predicting caries risk at the individual level. This paper describes a method useful for targeting resources in sealant placement programs by enabling one to determine the relative effectiveness of sealing alternative tooth surfaces in the oral cavity. One guide serves as a widely adopted manual for those who use or intend to use dental sealants in caries prevention programs. This paper provides a brief review of that document, "Preventing Pit and Fissure Caries: A Guide to Sealant Use," as well as guidelines for sealant utilization provided by the American Dental Association, and information regarding dental sealant programs under Medicaid. The final portion of the paper provides a synthesis of the epidemiology reviewed and summarizes the implications of findings for sealant programs.
Recent changes in Medicare reimbursement methods have made the estimation of specific practice and malpractice expenses in maxillofacial prosthetics more important. New reimbursement models such as the resource-based relative value scale used by Medicare and an increasing number of private carriers require accurate and specialty-specific values for these parameters. The Health Care Financing Administration's estimates of practice expense values in all specialties of medicine are significantly lower than those suspected in maxillofacial prosthetics. There is concern that the assignment of erroneous values in maxillofacial prosthetics could lead to inadequate reimbursement. Because the American Dental Association provides only aggregate specialty values, a survey of the general membership of the Academy of Maxillofacial Prosthetics was undertaken to determine these values more accurately. Practice expense values were found to be significantly higher than those in medicine, whereas malpractice expense values were lower. In addition, practice expense values in the survey were found to be greater than the ADA's aggregate specialty calculations.