Tuesday, November 13, 2018

The Federal Employees Dental and Vision Insurance Program Will Replace the Tricare Retiree Dental Program Later this Year - Eligible Members MUST Sign Up

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According to the ADA News, the Tricare program will be transitioning to the Federal Employees Dental and Vision Insurance Program.  The plan will begin coverage on January 1, 2019.  Information regarding enrollment and webinars that explain the enrollment process can be found via this link.  
The important thing for those affected is that you must enroll during open season if you'd like FEDVIP dental and/or vision coverage in 2019.
Here is all the info courtesy of the American Dental Association:

Participants may begin enrolling in the federal program Nov. 12 through Dec. 10 for coverage that starts Jan. 1, 2019.

Delta Dental previously administered the program. The move from Delta Dental to a federal plan resulted from  the 2017 National Defense Authorization Act, which mandated giving military retirees access to a vision plan that was not previously available to them in Tricare.

Under the new plan, retired uniformed service members and their families who are eligible for the Tricare Retiree Dental Program will be eligible to enroll in dental coverage under the Federal Employees Dental and Vision Insurance Program. 

The federal plan will give enrollees the option of choosing from six national plans: Aetna Dental, Delta Dental, FEP BlueDental, GEHA, MetLife and United Concordia Dental, and four regional plans: Dominion Dental, EmblemHealth, Humana and Triple-S Salud. 

For dentists who receive questions from patients, Delta Dental is urging them to have patients select a FEDVIP dental plan in order to continue their dental benefits. The switch is not automatic: Patients must sign up during the open enrollment period.

Tricare is also encouraging patients to use its online comparison tool for figuring out which plan works best for them. The comparison tool can be found here. By entering specific ZIP codes, patients will receive estimates on what to expect from coverage costs.

"Many dental offices may be treating patients who are retired from the military and using the Tricare dental plan," said Dr. Steven Snyder, chair, ADA Council on Dental Benefit Programs. "Following enrollment in the Federal Employee Dental and Vision Insurance Plan, their benefits may be significantly different. Offices should have a conversation about the patients' needs and their new benefits along with explaining the office's financial policies. Experiences that offices have with the national carriers already participating in the federal plan may give them a sense of what to expect in terms of processing policies and documentation requirements for claims for these patients."

For more information, including enrollment tips and scheduled webinars on enrollment, visit the Tricare page here.


Monday, November 12, 2018

FDA alerts patients and health care professionals that some EpiPen auto-injectors may not readily slide out of carrier tube

For those of you with EpiPens in your office medical emergency kit and also for those of you with loved ones that have severe allergies, here is a recent release by the FDA.
FDA is alerting patients, caregivers and health care professionals that the labels attached to some EpiPen 0.3mg and EpiPen Jr 0.15mg auto-injectors, and the authorized generic versions, may block access to the auto-injector and prevent the ability to easily access the product.
In a letter to health care professionals from Pfizer, the manufacturer of the Mylan EpiPen, the label sticker on the auto-injector unit may have been improperly applied, causing resistance when removing it from the carrier tube. The carrier tube is the immediate package in which the auto-injector is contained. In some cases, the patient or caregiver may not be able to quickly remove the epinephrine auto-injector from the carrier tube.
The auto-injector device and the epinephrine it delivers are not affected by this issue and can be used as prescribed. It is vital for lifesaving products to work as designed in an emergency situation, and patients and caregivers should inspect their epinephrine auto-injector prior to needing it to ensure they can quickly access the product.
The letter also describes how to inspect potentially affected products and explains that patients should contact Mylan Customer Relations at 800-796-9526 if an auto-injector does not slide out easily from the carrier tube ORthe label is not fully adhered to the auto-injector. Pharmacists should inspect the products before dispensing them to patients to ensure quick access to the auto-injector and should not dispense any product which does not easily slide out of its carrier tube.   
FDA is not aware of any adverse event reports associated with improperly applied EpiPen or EpiPen Jr auto-injectors, or their authorized generics label. As stated on the product label, consumers should always seek emergency medical help right away after using their epinephrine auto-injector.

Thursday, November 8, 2018

Learn About Orthodontics and Obstructive Sleep Apnea in Las Vegas March 2019

We are at an exciting time in dentistry.  The problems related to OSA (Obstructive Sleep Apnea) are becoming more well known and better understood.  
I find it fascinating that as knowledge of any subject increases, we often find out that treatments that were considered “scientific breakthroughs” and “state of the art” can sometimes be realized to create new problems or actually make some situations worse.  During the late 1800s morphine addiction was a serious problem and some well respected scientific minds favored treated those addicted to morphine with cocaine.  Obviously this didn’t work out too well, but it was a popular idea for a few years.  Medical history is full of examples like this.
There have also been some similar situations in orthodontics over the years.  Even into the early 80s, it was very common to do what is referred to as “4 bicuspid extraction”.  This was a treatment where, to decrease crowding, 4 permanent teeth (usually first bicuspids) were extracted to create room and then the anterior teeth were moved backward to fill the space.  This made straightening the teeth pretty easy, but at the time no one seemed to consider the option of keeping all the teeth moving the anterior teeth forward to increase arch length.
The other option was to use “headgear” which is an extra oral appliance that attached to the molars and had an elastic strap that went behind the patient’s neck.  This moved the molars in a posterior direction, creating space in front of them.
What we have learned since then, is that all of this “distalization” actually caused the airway to become more constricted.  When you think about it logically, it makes sense.  You have a finite space in the patient and as you move things backward, the tube that is the airway becomes pushed back and compresses against the spine.  This causes the airway to become more narrow which decreases the volume of air that can pass through it.  Think of this in terms of breathing through a drinking straw.  A straw with a large diameter is easy to breath through, but a very narrow straw makes it very difficult.
To the rescue comes Dr. William Hang.  Here is his bio:

A traditionally trained orthodontist, early in his career Dr Hang saw serious limitations in esthetics and function with the orthodontics he had been taught. Having rejected retraction - in all of its obvious and not so obvious forms - he learned and developed innovative techniques to protect and enhance the airway while enhancing esthetics and function.

Patients from more than 25 states and several foreign countries have come to Dr. Hang for non-retractive orthodontics &/or resolution of their E.R.R.S.™ (Extraction Retraction Regret Syndrome™). In his presentation Dr. Hang will outline these nonretractive techniques as well as give a step-by-step protocol to reopen extraction spaces which often eliminates symptoms such as TMJ pain, facial pain, sunken lips, and SDB/OSA.


Dr. Hang has spoken on orthodontics, facial esthetics and airway locally, nationally, and internationally. He was awarded the AAPMD Lifetime Achievement Award in 2016 for his contribution to the field of airway orthodontics.

Dr. Hang is presenting a seminar on methods and treatment that can provide great aesthetic results while also protecting or opening the airway.  

The seminar is being held at the Aria Hotel in Las Vegas on march 22-23, 2019.

If you are interested in attending, here is a link to the website.  





Wednesday, November 7, 2018

What NFL Retirees Need to Know About Sleep Apnea and the Concussion Settlement

As a board member of the Foundation for Airway Health, helping patients sleep better and not suffer with sleep apnea has become a passion of mine.  Recently I was approached by the Advocacy for Fairness in Sports.  This is a group that provides lots of information to former players regarding the NFL concussion lawsuit and settlement.  The NFL is a multi-billion dollar business run by multi-billionaire owners who are fighting with everything they have to prevent having to pay for the poor health suffered by former players to do the physical trauma they endured while playing.
The latest tactic NFL lawyers are using is to claim that players who suffer from sleep apnea are experiencing mental problems not due to all the head trauma they endured while playing, but because they are not wearing their CPAP devices.  The science behind this is dicey at best, but that doesn’t mean a lawyer cannot argue it.
So… the group asked if I could write an explanation to help players be able to verify their proper CPAP usage.  Here’s what they published:
Word has it that current NFL strategies to disqualify players from the concussion settlement can involve blaming the symptoms and effects of Obstructive Sleep Apnea (OSA). The NFL seems to be approaching this from the perspective of saying that OSA can mimic the same symptoms and problems of repeated concussive head trauma.

The best way for this to be dealt with is to use a CPAP that tracks usage and then sends it to a secure website that is run by the manufacturer.

While manufacturers and devices vary in the amount of data they can create, at a minimum tracking the amount of time the CPAP is used is crucial.  Some machines will track pressure, mask fit, AHI, and time worn, among other statistics.

Some CPAPs will store usage data in the machine itself, while others can connect to the user’s phone via Bluetooth.  While both of these options are better than no tracking data at all, I feel that using an impartial storage system from the manufacturer will help head off potential arguments that data could have been altered.

CPAP units such as the Philips Respironics Dreamstation connect to the manufacturer via a built in cellular transmitter and send the data directly to the Philips servers.  This data can be accessed by your doctor and, if authorized, your insurer.

This uploaded data allows your doctor to review your nightly statistics to better understand your condition.  Reviewing the data can allow the doctor to make changes to the CPAP to better treat your condition and help you get more restful sleep.

Your health insurance company may request access to this data to prove that you are using the machine as instructed and therefore help you pay for your CPAP supplies.

Obviously with doctors and insurers relying on this data, this aids in verification that you are using your device as prescribed which should proved that OSA is not the cause of your problems.

As an aside to this if, despite CPAP usage your numbers show you are still being deprived of oxygen while you sleep, you should consult a dentist who treats sleep apnea.  Often mouthpieces can be created and worn while you sleep to correct airway problems.  Some patients wear only these specialized mouthpieces without a CPAP while more difficult cases require a mouthpiece and a CPAP.

If you have questions about your CPAP and recording data, ask your doctor or check the company’s website.  It’s important for these records to be kept to help protect you.

Editor’s Note: Special thanks to Dr. Flucke for providing this valuable information to instruct players with sleep apnea as how to best preserved their rights in the NFL Concussion Settlement, as the NFL has been questioning dementia diagnoses of players with this condition and blaming impaired memory and function on the sleep apnea as opposed to concussive hits in football play. Some players have been required to provide proof of using a CPAP and Dr. Flucke has provided great instruction in this regard.  You can follow him on Twitter @jflucke .

Tuesday, November 6, 2018

Don’t Be A Statistic - Courtesy of Delta Dental

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After my Delta post last week, I thought I’d post this in the interest of fair play, I thought I’d post a nice guest column that appeared on the Delta Dental of Missouri website that discusses basic cybersecurity.
The author is Tom Terronez, who is the CEO of Medix Dental.  Here is his guest column:

Every day, my company helps practices overcome IT nightmares they never before anticipated. Dental professionals are extremely busy, and often can’t find the time to prioritize and implement preventive measures that keep their business and patients safe. Hackers are having a hay-day right now, and your office’s network filled with sensitive information is a goldmine. This keeps a dental technology company like ours quite busy, as we assist with everything from standard tech issues to the prevention of critical problems. This includes protecting networks from breaches, proactively fighting malicious malware, and mitigating devastating data loss.

If you don’t currently work with a trustworthy dental IT partner, a cybersecurity assessment is a great place to start. A good assessment helps you identify needed protections for your practice and serves as a helpful road map to security. If you do have an IT partner, a trusted third-party assessment is a great way to see if you are being protected as strongly as you assume. In either case, it’s important to know where exactly where your practice’s security stands.

Delta Dental of Missouri has agreed to allow us to introduce a special value-add offering to preferred providers like you. You may request your complimentary cybersecurity assessment at medixdental.com/DDMO1. Your assessment results are 100% confidential, and will not be shared with Delta Dental. Your practice will receive a comprehensive report detailing vulnerabilities found in your practice, prioritized by importance. You may resolve the issues with your current IT provider, otherwise we will be happy to provide guidance. The assessment takes about one hour and does not interfere with practice operations.

Medix Dental is a Midwest-based dental technology integration and support provider. Since founding in 2003, we’ve partnered with dental practices all over the nation to manage their IT as well as advise strategically on practice technology decisions and security. By becoming an extension of their clients’ practices, Medix Dental is able to minimize technology issues, increase practice profitability, and improve practice contentment. We look forward to helping your practice become more secure and efficient than ever before.

If you’d like to see the article as it originally appeared.  Here is the link.  

Monday, November 5, 2018

Help in Avoiding Phishing Scams

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We live in a time where security needs to be at the forefront of everything we do before we click or tap a screen.  You could easily be giving away access to your phone, your tablet, your computer, or God forbid your corporate network.  It’s a very easy mistake to make and happens all the time.  All of the recent data break-ins that I’ve researched recently have started with a phishing attack like the one shown above.
The concept behind phishing is pretty simple.  Send someone an email and convince them to click on a link that downloads malicious code to the device.  Usually the email comes from what appears to be a “trusted source” such as a friend, co-worker, or as in the case above a credit card company.  These emails also frequently utilize some psychology that is referred to as “impending doom” to get you to act.  This impending doom in the example above is “avoid temporary block of your card”.  Many folks see this and panic thinking they are about to have their card shut off.  In that temporary moment of fear, they panic and, not thinking rationally, click the link… and that is all that it takes.  The link unleashes nefarious software that then takes control.  Of course the user is never aware of this.  The device/computer continues to function perfectly in a normal fashion.  However, in the background, the device begins to leak information like the proverbial sieve.
If this is a personal device, everything you do, type, every website you visit, EVERYTHING is sent to a bad guy somewhere who can then begin draining bank accounts, sending SPAM with your device, access and attempt to phish your contacts.  They can also control your camera and your microphone to use your device as a way to spy on you personally.
The only thing worse may be having this happen at work and the only reason that’s worse is that it may get you reprimanded and best and terminated at worst.  That’s because all of the above and more can be stolen from your employer’s network.  Hackers will soon gain administrative logins and then begin to steal or delete data.  They may also trigger a Ransomware attack that encrypts essential hard drives and then demands a payment to send you the unlock code… if they ever send it.
Ransomeware is becoming a much bigger threat every day.  I personally know of several people who have fallen victims to it.
So how do you avoid these types of scams?
The number thing to do is t be vigilant!!!  Cyber criminals count on either frightening us into action or lulling us into a false sense of security, either of which can then get us to act against our own self interests.  The above screen shot is a great example.  It appears come from a trusted source that you depend on and also uses the fear of having your account inactivated.
Some good advice for these situations is, first of all, stay calm.  No matter how great the impending doom, the delay of a few minutes won’t really make it any worse.  So stop, take a couple of deep breaths, and then re-read the notice.
By looking at the notice calmly and with a clear head, you may notice things out of the ordinary such as misspellings, mistakes in grammar, or incorrect use of a word which is a homonym for another.  There and their are classic examples.
Also check the *actual* email address my hovering over it.  In the example listed above, the sender was “American Express” but the actual address was some gibberish account.  The one you see when you hover, is the real address that your email will be sent to.
Also check with the company itself.  AmEx has a huge section on their website related to security.  I have even forwarded copies of emails to the fraud protection department of companies to find our if they are legit or not.  Amazingly, every one of them I have sent has been a fake.  If it is from a friend, text or call them and make darn sure they sent you the questionable email.  A few minutes of checking can save you inordinate amounts of time and grief trying to “undo” a security breach.
Also do some research on phishing scams.  There are many good websites out there with great advice and info.
Remember, preparing for an emergency is the best way to prevent one!

Thursday, November 1, 2018

Delta Dental of California Announces Departure of Chief Executive Officer Tony Barth - Due to "Consensual Relationship"

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Well, well, well it seems that those of us practicing dentistry are not the only ones being *ahem* taken advantage of by Delta Dental (BTW you have no idea how difficult it was not to be more blunt there).
Delta Dental of California appointed Tony Barth as CEO not quite 2 years ago (January 2016 if memory serves) and they have now announced he is being terminated… or “departing” in dental insurance speak.  The reason?  It seems, according to Delta, that Mr. Barth was "engaging in and failing to report a consensual relationship with a subordinate employee”.  
While his career has ended in shame, he won’t be living out of a cardboard box.  According to the company’s Form 990 for the fiscal year of 2016,  Barth managed to eke out a subsistence living on a mere $8.2 million that year.  That’s a pretty good draw FOR A NON-PROFIT CORPORATION.  Sorry for the all caps, but Delta is notorious for being stingy with doctors, while they seem to have no problem paying Mr. Barth the equivalent of a good MLB middle reliever.
Here is the official press release from Delta Dental California announcing the termination:

Delta Dental of California and affiliates announced today that the Board of Directors has terminated the employment of Chief Executive Officer Tony Barth, effective immediately, for reasons relating to his engaging in and failing to report a consensual relationship with a subordinate employee.

Lynn Franzoi, Chair of the Board of Directors of Delta Dental of California, said, “Delta Dental’s culture is based on a strong set of ethics and values, including trust, service, excellence and innovation. As one of the nation’s largest dental benefits providers, these values are vital to our culture, guide how we operate and treat one another, and are essential to our future success.”

The Board of Directors is taking several steps to ensure strong leadership and continuity during this transition. The Board has formed an Office of the CEO and appointed Chief Financial Officer Mike Castro as acting CEO to lead the Company. Mr. Castro will be supported by Steven McCann, a member of the Board of Directors, who will serve as Special Advisor to the CEO, and Chief Human Resources Officer Sarah Chavarria. The Office of the CEO will report to the Board and have oversight over all operations of the company throughout the transition.

The Board intends to launch a formal search process to identify a permanent CEO. It has also appointed Senior Vice President of Finance Alicia Weber as acting CFO while Mr. Castro serves as acting CEO.

Mr. McCann said, “Mike has been a widely respected leader at this company for almost two decades and he has the full confidence and support of Delta Dental’s Board. With a strong acting CEO and talented senior leadership team, we expect a seamless transition.”

Mr. Castro said, “I thank the members of our board for placing their trust in me and look forward to leading the company during this transition, with the support of Steven and Sarah and the rest of our outstanding senior management team. In the meantime, it will be business as usual, and our day-to-day operations will not change. We are more committed than ever to serving the customers and enrollees who rely on us.”

Wednesday, October 31, 2018

Burning Mouth Syndrome

Burning Mouth Syndrome can also be related to a condition called Benign Migratory Glossitis.  Many folks suffer from glossitis with no pain, but others (around 2% of the population) have this condition with a resultant burning sensation.  I have several patients that suffer from Burning Mouth Syndrome and it’s difficult to find a consistent treatment regimen.  What works for some, doesn’t work for others.  It’s a constant battle for both me, as the doctor, and the patient, as the sufferer.
For those readers who may not have an extensive oral pathology background, I thought I’d provide the following info.  This is from an article by Jayne Leonard that appeared on medicalnewstoday.com
Here is an excerpt that you may find helpful:
A burning tongue, or burning mouth syndrome (BMS), is a condition that causes a sensation of burning in the mouth. People with this condition often describe the burn as feeling similar to a hot drink scald. There are several known causes of BMS, but the reason for its onset can be unclear. The treatment will depend on the cause.

According to the American Academy of Oral Medicine (AAOM), approximately 2 percent of people in the United States have BMS. It can affect the following parts of the mouth:

  • tongue
  • the roof of the mouth
  • inside of the cheeks
  • gums
  • lips

What are the causes of a burning tongue?

Some people with a burning tongue may have scalded their mouth with a hot drink or piece of food, in which case they do not have BMS.

The pain or discomfort of a minor physical burn may remain for several hours or more, but it will typically resolve without treatment.

Causes of BMS

True BMS may be primary, meaning that it results from a direct cause, or secondary, which means that the cause is indirect.

According to the Genetic and Rare Diseases Information Center, the primary form of BMS results from damage to the nerves that control taste and pain sensations.

Secondary BMS may occur because of other medical conditions or treatments, including:

  • allergies to specific foods or dental products
  • anxiety or depression
  • diabetes
  • dry mouth
  • gastroesophageal reflux disease
  • geographic tongue
  • an underactive thyroid, called hypothyroidism
  • medications, such as high blood pressure medicines
  • mouth infections
  • nutritional deficiencies

Other secondary causes may include a person's habits, such as:

  • biting the tip of the tongue frequently
  • consuming too many acidic foods or drinks
  • grinding the teeth on a regular basis
  • overbrushing the tongue
  • overusing mouthwash or abrasive oral hygiene products
  • wearing ill-fitting dentures

In many cases, the cause of BMS is unclear.

The symptoms of BMS, including a burning tongue, may:

  • appear suddenly or develop over time
  • come and go or remain constant
  • be mild, moderate, or severe
  • improve when eating or drinking

BMS commonly affects the tongue, but people may also experience discomfort in the:

  • lips
  • gums
  • throat
  • roof of the mouth
  • inside of the cheeks
  • It is also possible to have symptoms that affect the whole mouth.

Common BMS symptoms include:

  • a burning or scalding sensation in the mouth
  • a bitter or metallic taste
  • a dry mouth
  • difficulty swallowing
  • increased thirst
  • loss of taste

Tuesday, October 30, 2018

Evaluation and Testing of DEXIS Titanium Sensor

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If you are following my Twitter feed, you know that I’ve been fortunate enough to be chosen to work with the next generation of DEXIS intraoral sensors, the DEXIS Titanium.
It’s incredible that even after all these years of improvements in digital sensors, companies continue to provide improvements.  However, that’s the great thing about technology and progress, no one is sitting around resting on their laurels.  If you are not moving forward, you’re moving backward.
The Titanium has a couple of things that I personally think are really outstanding.  The first is the wire.  While that may not seem like a big deal, the wire/cable is a critical failure point for many sensors.  To combat that, Titanium uses 4 different things to ensure good images and cable stability.
  1. Tough, durable external jacket better handles external forces such as biting, twisting, tugging and eliminates cable drag and tangling
  2. Inner protective shield made from tinned soft copper alloy for even more added strength
  3. Kevlar-reinforced fill protects inner power cables, and helps prevent kinks and twists of wires to safeguard signal performance
  4. Carefully selected signal wires and power lines often used for robotics, retain the best signal performance to deliver reliable imaging results over time 

The system also actualizes over the Internet so there is no need to keep CDs around anymore that correspond to each sensor.

I’ll be posting some images and other impressions as we get the test rolling.  Any questions or comments, hit the comment section.

Monday, October 29, 2018

Cloud Companies Continue to Make Major Investments into Data Centers

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As many of you know, I’ve been evangelizing for Cloud Services for quite a while now.  Leaving the “messy” part of technology to experts who know the best ways to backup, secure, and maintain your data is smart, in my opinion.  And… with the increased volume of data we are creating (both business and personal) it’s a great idea to not trust these processes to someone that is not an educated well-trained expert in the area.
Along those lines, I've recently seen discussion on not only the proliferation of data in the Cloud, but how much companies that provide Cloud services are investing to make sure they stay state of the art with their storage and processes.
The 3 biggest players in this market are Amazon, Alphabet (parent of Google), and Microsoft.  By taking a look at these companies expenditures, we can get a basic idea and overall feel for their dedication and support of the platform.
Afraid to give too much information away to their competitors, companies are hesitant to mention exact numbers.  Instead, they choose to list expenditures is overall categories, but from those categories we can glean some pretty interesting info.
For instance, Alphabet listed expenditures of nearly $5.6 billion (yup, with a B)  on “data center construction, production equipment, and facilities in Q3 2018.  That’s a pretty whopping big number, especially when one backtracks and realizes the same category was $3.6 billion during Q3 of 2017.  We are looking at an increase of $2 billion in expenditures over the same period as one year ago.  That should really tell you something.  One also needs to factor in that Google is #3 in this category, so they are most likely spending in an effort to play “catch up” with Amazon and Microsoft.
The folks at Amazon, as a way of comparison, are actually spending less than they did a year ago, The company reports that in 2017 their spending was up 69% for data centers (compared to 2016) while this year it is only up 9% (compared to 2017).  That makes it pretty obvious that Amazon spent heavily last year on their cloud capacity.
Something else to remember is that these companies are doing hard core analytics on where things are going in the future.  The reasons they are spending so much money on building out their cloud services is because their customers are spending on clout services.  They are simply following the demand of the customer.  With that in mind, one can reasonably see the continued increase in cloud computing and cloud storage.

Thursday, October 25, 2018

MouthWatch Redefining Teledentistry During GNYDM 2018

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The Company Will Be Demonstrating its Upgraded TeleDent™ Platform and Announcing the Winners of the First Annual “Tellie” Awards

MouthWatch, LLC a leader in innovative teledentistry solutions, digital case presentation tools and intraoral imaging devices, will be redefining teledentistry during the Greater New York Dental Meeting.

First, with the GNYDM debut of its newly-enhanced TeleDent all-in-one teledentistry platform and also by announcing the winners of the first annual Teledentistry Innovation Awards – A.K.A. “The Tellies.” MouthWatch will be exhibiting at booth #3120

TeleDent Upgrade with Enhanced Workflow Capabilities

Since its launch in 2016, TeleDent has enabled the collection and sharing of patient data, clinical information, and intraoral images and videos in real-time or via store-and-forward technology. The HIPAA-compliant teledentistry platform was originally designed to enhance referrals, screenings, consultations and collaboration between GPs and specialists, group practice locations, and hygienists in public health or private practice. 

The company is once again raising the bar on teledentistry functionality. According to MouthWatch CEO and founder, Brant Herman, “Our focus for the latest version of TeleDent was to optimize workflow in order to make collaboration and communication more efficient between internal dental teams and external care providers across virtually any public health or private practice application.”

TeleDent’s latest release will be demonstrated at booth #3120 and includes these features:

• Enhanced User Interface
• New Task Assignment Capability
• Optimized Synchronization
• Improved Workflow
• More Efficient Patient, Provider and Practice Management
• New Audio Recording Capability During Appointments

The enhanced version of TeleDent is ready to order and like its predecessor, requires a MouthWatch intraoral camera for best results and can utilize virtually any Windows 10 tablet or laptop for local data collection and image capture. Current TeleDent clients will be upgraded to the latest version free of charge. For more information, download the TeleDent product sheet at https://MouthWatch.co/TeleDent1sheet .

The First Annual Teledentistry Innovation Awards

Earlier this year, MouthWatch opened the application process for the First Annual Teledentistry Innovation Awards. The purpose of the “Tellie” Awards is twofold:

• Highlight the many ways that teledentistry is being implemented across a broad spectrum of dental care including public health, private practice and organizational settings.

• Recognize individual, forward-thinking dental providers who are realizing the full potential for connected dental care technology and who are reshaping the practice of dentistry and the state of oral health globally.

According to Herman, “Our goal is to shine a light on those teledentistry innovators and pioneers who are leading the way and proving by example that teledentistry technology can enhance dentistry, reach more patients, and improve oral health and overall health.” 

The winners of Teledentistry Innovation Awards will be announced during an invitation-only cocktail reception on Monday, November 26th Winners will be named in three main categories:

• Dentists / Specialists
• Expanded Hygiene Applications
• Public Health Programs

Winners will be announced immediately after the ceremony on social media and in a follow-up news release. Nominations for next year’s Tellie Awards are currently being taken online at
http://teledentistryinnovationawards.com/ and self-nominations are welcome.

About MouthWatch, LLC:
Headquartered in Metuchen, New Jersey, MouthWatch, LLC is a leader in leader in innovative teledentistry solutions, digital case presentation tools and intraoral imaging devices. The company is dedicated to finding new ways to constantly improve the dental health experience for both patient and provider.

The founders and management team of MouthWatch have relevant backgrounds and successful track records in dentistry, consumer products and communications. Since 2012, this team has pioneered the integration of digital imagery and communications technology in the field of dentistry. Their cumulative experience makes it possible for the company to take the lead in introducing the benefits of telemedicine to the world of dentistry. For more information, visit www.MouthWatch.com .

Wednesday, October 24, 2018

Security in Legacy Healthcare Devices

The potential for security vulnerabilities exists in medical and dental devices just as it exists in anything that uses digital data, but especially if it is connected to the Internet.  We recently updated our network and in order to assure the safety of the PC that runs our 3D imaging system, we disconnected it from the Internet.  Why?  Quite simply it was because the manufacturer still has that machine running Windows XP.  If you don’t know this yet, let me let you in on a little secret, Microsoft stopped issuing security updates on that OS years ago.  That means that the only way we could protect ourselves was to make sure that machine couldn’t be touched from the outside.
I’m always doing research on technology and recently security has become a bigger and bigger problem for all of us.  It is even worse when we are forced to use legacy systems that were put in place *way* before the current security threats existed.  When I contacted my 3D provider I was told that newer systems ran on Windows 10.  Of course that would mean buying a completely new system which seems silly when the one I have is working perfectly.
I came across an article lately from HealthTech Magazine that goes over some of the problems we face with legacy systems.  The article itself is a good one by Jen Miller and definitely worth a read.  Here is an excerpt:

Healthcare organizations are facing a mounting security challenge: Not only is patient data a ripe target for hackers, but legacy hardware systems have such holes in their security that ERI called the current situation a “perfect storm.”

According to the report, 3.15 million patient records were compromised in 142 healthcare data breaches in the second quarter of 2018. A full 30 percent of privacy violations involved repeat offenders.

For the full article, you can find it here.  

Tuesday, October 23, 2018

Ultradent Pledges $25,000 for Hurricane Florence and Hurricane Michael Relief Efforts

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Ultradent Pledges $25,000 for Hurricane Florence and Hurricane Michael Relief Efforts

and Announces Special Discount Program to Help Affected Dentists Rebuild Practices

It’s always great to see and work with a company that strives to always do the right thing.  That is just one of the reasons I’m a big supporter of Ultradent.  Their company motto is “Improving Oral Health Globally” and believe me when I say “they mean it!”


Here is the latest announcement from Ultradent regarding helping those trying to recover from the recent hurricanes:

In response to the catastrophic devastation caused by Hurricane Florence and the most recent damage caused by Hurricane Michael, Ultradent Products, Inc., has pledged $25,000 to All Hands and Hearts Smart Response. These funds will be used to aid in the rescue, relief, and rebuilding efforts of those affected by the storms.

In addition to these donations, Ultradent is offering to help dentists whose practices have been damaged by these hurricanes. Ultradent has offered any dentist whose office has sustained substantial physical damage by Hurricanes Florence or Michael $500 worth of free consumable product, plus 40% off all consumable products and 15% off all equipment purchases exceeding the initial $500 on that order. Through this offer, Ultradent hopes to provide some aid in the rebuilding efforts of the dental community.

Ultradent’s president, Dirk Jeffs, says, “Care is an important core value at Ultradent, and we want to extend a helping hand and show our care for the people who have been affected by these devastating storms.”

Ultradent has a strong culture of giving. The company contributed to relief efforts associated with the Pulse Nightclub shooting, Typhoon Haiyan, the earthquakes in Haiti and Ecuador, and Hurricanes Sandy, Harvey, and Irma. Additionally, Ultradent has donated more than 1.6 million pounds of food over the past 10 years to the Utah Food Bank. Ultradent also contributes to various national and international dental humanitarian missions. To find out more about Ultradent’s disaster relief efforts, please visit www.ultradent.com/relief.



About Ultradent Products, Inc.

Ultradent Products, Inc., is a leading developer and manufacturer of high-tech dental materials, devices, and instruments worldwide. Ultradent’s vision is to improve oral health globally. Ultradent also works to improve the quality of life and health of individuals through financial and charitable programs. For more information about Ultradent, call 800.552.5512 or visit ultradent.com.

Monday, October 22, 2018

Impressions from America's Dental Meeting ADA Hawaii 2018

In case you’ve all been worried about me… like I know that would happen… I’ve spent the last few days in Honolulu at the 2018 American Dental Association meeting.
Now before you all hit the comments section with jokes about how hard I must have worked, let me tell you,  I honestly did work!  In fact, considering how far some folks had to travel, the meeting was very well attended.  Sometimes when a meeting is in an exotic tropical location, folks spend more time on the beach than at the meeting.  this time, however, I spoke with lots of dentists who had traveled for some down time, but were serious about attending both lectures and the exhibits.
As most of you know, I am part of the Cellerant Best of Class that selects products every year that we feel are truly “Best of Class”.  We also have an area on the exhibit floor for the panel members to lecture to attendees and it also allows the attendees to be able to interact with the winning products.  Because of that setup (which we do at every ADA meeting), we get a tremendous opportunity to speak with doctors.
What I discovered is that dentistry is thriving again.  Since the economy tanked in the late 00’s, experts have been analyzing data on a yearly basis and determining that dentistry was “flat”; basically not shrinking but also not growing.  What I learned in Honolulu is that the “flat” trend is over and the “up trend’ has begun.  Our Cellerant Best of Class lecture area was continually busy every day and every course was sold out.
Doctors are excited about dentistry and are planning and purchasing accordingly.  I had 5 different events during the 3 day meeting that allowed me to interact with the doctors in attendance and I can tell you, those crowds were enthusiastic about our future.
To back that up, the vendors I spoke with also reported good visibility with good sales.  I did not get a chance to hear actual attendance numbers, but all indications point to a very exciting future for our profession.

Tuesday, October 16, 2018

Anthem to Pay Record $16 Million for HIPAA Violations Exposing 79 Million Patient Records

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Anthem has agreed to a fine by the Department of Health and Human Services that is the largest fine ever paid for exposing patient Protected Health Information.  The fine is 16 million dollars.
The company states it is unaware of any illegal action that has happened due to the breach, but that might be difficult to prove.  The company is the second largest health insurer in the United States and currently insures 40 million people as well as selling individual and employer coverage in places such as California and New York.
The payment is in lieu of any and all civil penalties that the Department of Health and Human Services might have imposed.
The sad and embarrassing part of this story is that the breach was facilitated by a spear-phishing attack that convinced Anthem employees to divulge usernames and passwords.  Having that information then allowed the bad guys to eventually get System Administrator privileges.  This, in turn, let them run rampant through the system.
The data breach was discovered in 2015 which always makes you wonder who else has had a breach we have yet to learn about…

Monday, October 15, 2018

Evaluation of the Goby Electric Toothbrush

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I’ve been tinkering with and using the Goby powered toothbrush for several months now and I have to say I’ve come away impressed.
Quite honestly, I feel I owe the folks at Goby an apology.  I had expected a device that was less expensive than major brands and would show it… but I was wrong.
The device feels solid in your hands and is well made.  I’ve used it for a few months now and it still looks and performs as if it had just come out of the box.  Those that know me know I *love* the color black and the black brush they sent me hasn’t faded, scratched, skuffed, or weathered in the lather and toothpaste.
By eliminating the big retail sales distribution chain, they’ve been able to keep their costs low which also being able to keep the quality high.  The device has a 2 minute timer broken down into 30 second segments.  This lets you know you’ve brushed one quadrant long enough and it’s time to move on to the next one.  After 2 minutes, it shuts itself off automatically.
It is an oscillating brush head that I’ve found to be the right size to fit everywhere in my mouth… even those areas that can be hard to reach.
The charger is USB and comes with an AC adapter.  You can plug it into any outlet OR the USB port on your laptop.  The charger is also very small and can even be taken apart for trips.  The stand that charges the device is composed of 2 parts.  The part that actually holds your brush and keeps it vertical and a small “paddle” or “slab” that fits into the stand and provides the charge.  This “paddle” can be removed from the stand during travel.  How does it charge the brush?  There is a small magnet in the “paddle” that attaches it to the right spot on the back/bottom of the handle and allows the brush to charge. I find that to be genius.
I’m also impressed with the cost of the brush heads.  Most companies charge well over $10 for one and some can be more than $15.  Goby brush heads are $6 apiece.  You can buy them from their website, or you can go on auto shipment and receive a package every 2 months.  That’s a great way to know you are keeping your brush young and flexible so it can do its job.  Doing auto shipment is the best way to go.
When you consider that you can get all of this for a $50 payment, I’m impressed.  I’m advising patients who are on a budget to get a Goby and save themselves some dollars in the process.  If you’ve always wanted an electric toothbrush but the cost has kept you away, take a look at the Goby.
This product is highly recommended!!!

Thursday, October 11, 2018

FDA Approves Expanded use of Gardasil 9 to Include Individuals 27 Through 45 Years Old

The leading cause of oral and pharyngeal cancer in the US is HPV 16 which is a strain of the Human Papilloma Virus (hence HPV).  Because of that simple fact, for years now, experts have been advocating for inoculation of both girls and boys with Gardasil with is the HPV vaccine.  Now the FDA has approved the use of Gardasil to the age range of 27 to 45 years old.  Read on for the info from FDA…

The U.S. Food and Drug Administration today approved a supplemental application for Gardasil 9 (Human Papillomavirus (HPV) 9-valent Vaccine, Recombinant) expanding the approved use of the vaccine to include women and men aged 27 through 45 years. Gardasil 9 prevents certain cancers and diseases caused by the nine HPV types covered by the vaccine.

“Today’s approval represents an important opportunity to help prevent HPV-related diseases and cancers in a broader age range,” said Peter Marks, M.D., Ph.D., director of the FDA’s Center for Biologics Evaluation and Research. ”The Centers for Disease Control and Prevention has stated that HPV vaccination prior to becoming infected with the HPV types covered by the vaccine has the potential to prevent more than 90 percent of these cancers, or 31,200 cases every year, from ever developing.”

According to the CDC, every year about 14 million Americans become infected with HPV; about 12,000 women are diagnosed with and about 4,000 women die from cervical cancer caused by certain HPV viruses. Additionally, HPV viruses are associated with several other forms of cancer affecting men and women.

Gardasil, a vaccine approved by the FDA in 2006 to prevent certain cancers and diseases caused by four HPV types, is no longer distributed in the U.S. In 2014, the FDA approved Gardasil 9, which covers the same four HPV types as Gardasil, as well as an additional five HPV types. Gardasil 9 was approved for use in males and females aged 9 through 26 years.

The effectiveness of Gardasil is relevant to Gardasil 9 since the vaccines are manufactured similarly and cover four of the same HPV types. In a study in approximately 3,200 women 27 through 45 years of age, followed for an average of 3.5 years, Gardasil was 88 percent effective in the prevention of a combined endpoint of persistent infection, genital warts, vulvar and vaginal precancerous lesions, cervical precancerous lesions, and cervical cancer related to HPV types covered by the vaccine. The FDA’s approval of Gardasil 9 in women 27 through 45 years of age is based on these results and new data on long term follow-up from this study.

Effectiveness of Gardasil 9 in men 27 through 45 years of age is inferred from the data described above in women 27 through 45 years of age, as well as efficacy data from Gardasil in younger men (16 through 26 years of age) and immunogenicity data from a clinical trial in which 150 men, 27 through 45 years of age, received a 3-dose regimen of Gardasil over 6 months.

The safety of Gardasil 9 was evaluated in about a total of 13,000 males and females. The most commonly reported adverse reactions were injection site pain, swelling, redness and headaches.

The FDA granted the Gardasil 9 application priority review status. This program facilitates and expedites the review of medical products that address a serious or life-threatening condition. 
The FDA granted approval of this supplement to the Gardasil 9 Biologics License Application to Merck, Sharp & Dohme Corp. a subsidiary of Merck & Co., Inc.

The FDA, an agency within the U.S. Department of Health and Human Services, protects the public health by assuring the safety, effectiveness, and security of human and veterinary drugs, vaccines and other biological products for human use, and medical devices. The agency also is responsible for the safety and security of our nation’s food supply, cosmetics, dietary supplements, products that give off electronic radiation, and for regulating tobacco products.

Wednesday, October 10, 2018

FAQ Regarding the EPA Ruling on Mandatory Amalgam Separators in Dentistry

EPA developed these FAQs based on the Dental Office Category Rule at 40 CFR Part 441. Dental facilities may be subject to additional or more stringent state or local requirements than those in the rule.

Who must comply with this rule?

The vast majority of dental facilities that discharge wastewater into a publicly owned treatment works (POTW) (e.g., municipal sewage system) are subject to this rule (“dental dischargers”). However, there are some exceptions.

Dental dischargers that do not place dental amalgam, and do not remove dental amalgam except in limited emergency or unplanned, unanticipated circumstances are exempt from any further requirements as long as they certify as such in a one-time compliance report to their Control Authority.

Dental dischargers that exclusively practice one or more of the following specialties are not subject to any of the rule’s requirements, including submission of a one-time compliance report to their Control Authority:

• Oral pathology
• Oral and maxillofacial radiology • Oral and maxillofacial surgery
• Orthodontics
• Periodontics
• Prosthodontics

Additionally, mobile units are not subject to any of the rule’s requirements, including submission of a one-time compliance report to their Control Authority. A mobile unit is a specialized mobile self-contained van, trailer, or equipment used in providing dentistry services at multiple locations.

Dental facilities that do not discharge their amalgam process wastewater into a POTW are also not subject to any of the rule’s requirements, including submission of a one-time compliance report to their Control Authority. For example, dental facilities that discharge amalgam process wastewater into a septic system are not subject to this rule.

To determine if the EPA rule applies to your facility, see § 441.10 (Applicability).

What are the basic requirements of the rule?

The requirements for dental dischargers subject to the rule are detailed in the rule. Here, they are summarized as follows:

Ensure the removal of dental amalgam solids from all amalgam process wastewater via amalgam separator(s) or equivalent device(s) that meet the standard of the final rule. See § 441.30(a)(1-2) for an existing source and § 441.40 for a new source.
Implementation of two best management practices. See § 441.30(b) for an existing source and § 441.40 for a new source.
Comply with reporting requirements. See § 441.50(a).
Maintain and make available for inspection certain records documenting compliance. See § 441.50(b).

What are the compliance deadlines?

Dental dischargers (under any ownership) that were discharging into POTWs prior to July 14, 2017 (“existing sources”), must be in compliance with the standards by July 14, 2020, and submit a one-time compliance report certifying such by October 12, 2020.

Dental dischargers whose first discharge to a POTW occurs after July 14, 2017 (“new sources”) must be in compliance with the standards immediately and submit a one-time compliance report certifying such within 90 days after first discharge to a POTW.

If the dental discharger transfers ownership, what are the deadlines for a new owner to submit a one-time compliance report?

If an “existing source” dental discharger transfers ownership, the new owner must submit a new one-time compliance report to the Control Authority by October 12, 2020, or if the transfer occurs after July 15, 2020, no later than 90 days after the transfer. If a “new source” dental discharger transfers ownership, the new owner must submit a new one-time compliance report to the Control Authority no later than 90 days after the transfer.

Does this rule require standards for the type of amalgam separator I install?

Yes. For an existing source see § 441.30(a)(1-2). For a new source, see § 441.40.

Do I have to replace my existing separator?

It depends. § 441.30(a)(1)(iii) of the rule allows dental dischargers that had installed and were using an amalgam separator prior to June 14, 2017 to continue to use it until June 14, 2027 if it is functioning properly and does not need to be replaced. This is referred to as a “grandfathering” provision or clause. The facility must still file a one-time compliance report certifying such by October 12, 2020. If the amalgam separator meets the standards of the rule, see § 441.30(a)(1-2), the grandfathering provision need not apply.

If a dental discharger covered by the grandfather clause transfers ownership, the new owner may continue using the grandfathered separator until June 14, 2027 if it is functioning properly and does not need to be replaced. The new owner must still file the one-time compliance report.

What are the correct dates that are relevant to the grandfathering provision in § 441.30(a)(1)(iii)?

In the original Federal Register publication of the final rule, there was a typographical error in one of the dates in the grandfathering provision. The corrected version of the provision is: “A dental discharger subject to this part that operates an amalgam separator that was installed at a dental facility prior to June 14, 2017, satisfies
the requirements of paragraphs (a)(1)(i) and (ii) of this section until the existing separator is replaced as described in paragraph (a)(1)(v) of this section or until June 14, 2027, whichever is sooner.” (emphasis added)

I have a wastewater retaining tank technology that collects all amalgam process wastewater and my dental facility does not discharge any amalgam process wastewater to a POTW. Am I exempt from the Dental Office Category Rule?

Yes. See § 441.10(e). As long as the dental facility does not discharge any amalgam process wastewater from the tank or otherwise, it is not subject to any of the rule’s requirements, including submission of a one-time compliance report to their Control Authority.

My dental facility has a technology that removes amalgam from wastewater as efficiently as an amalgam separator, but it is a different type of device, and therefore does not qualify to meet the ISO standard for amalgam separators. Does this device satisfy the requirements of this rule?
The rule includes a provision at § 441.30(a)(2) that allows the performance standard of the rule to be met with the use of an amalgam-removing technology other than an amalgam separator (i.e., equivalent device). EPA included this provision to allow use of amalgam removal devices that are equivalent to amalgam separators in several respects (e.g. the percentage of removal of mass of solids) but that may not fall under the amalgam separator classification. The equivalent device is required to meet the same requirements and removal efficiencies, as specified in § 441.30(a)(1-2) or § 441.40.

Does this rule have record keeping requirements for dental dischargers?

Yes. See § 441.50.

Does this rule have inspection or maintenance requirements for dental dischargers?

Yes. See § 441.30.

What information must be in my one-time compliance report?

See § 441.50. A sample one-time compliance report that includes the information required by the rule may be found at www.epa.gov/eg/dental-effluent-guidelines.

• Note to dental dischargers: Please contact your Control Authority to ensure that you have obtained the correct form from your Control Authority. In addition, you may be subject to additional reporting requirements in accordance with state and local law.

Where should dental dischargers send their one-time compliance report? Who is my “Control Authority?”

Dentists should obtain and send their one-time compliance report to their pretreatment Control Authority. Your Control Authority is either a local wastewater utility, a state environmental agency, or a U.S. EPA Regional Office.

If your dental facility is in Alabama, Connecticut, Mississippi, Nebraska or Vermont: your Control Authority is your state agency. Contact information for each state is available at www.epa.gov/npdes/contact-us-national-pretreatment-program (select the “State Agency Contacts” tab).
For dentists in all other states: contact your U.S. EPA Regional Office, your local wastewater utility, or your state agency Pretreatment Coordinator to identify your Control Authority. Pretreatment contact information for EPA headquarters, EPA Regions, and state agencies is available at www.epa.gov/npdes/contact-us-national-pretreatment-program (select the appropriate tab).

My practice is in compliance with the standards in the rule and has submitted a one-time compliance report. It is now changing ownership. Do I or the new owner need to submit a new one-time compliance report?
Yes. If a dental discharger transfers ownership of the facility, then the new owner must submit a new one-time compliance report to the Control Authority. See above for compliance deadlines and § 441.50(a)(4).

Is there a website where I can submit my one-time compliance report electronically?

Check with your Control Authority.

Does the final rule prohibit the use of oxidizing or acidic cleaners in dental unit water lines, chair-side traps, and vacuum lines?

Yes. The clause that follows (“including but not limited to...”) is not an exhaustive list of oxidizing or acidic cleaners or qualities that make a cleaner oxidizing or acidic. For example, a cleaner that is oxidizing would be prohibited even if its pH is between 6 and 8.

Does the prohibition on the use of oxidizing or acidic cleaners in dental unit water lines apply to cleaners used in the water supply lines that connect to items such as handpieces, ultrasonic scalers or air/water syringes?

No. The purpose of the best management practice (BMP) specified in § 441.30(b)(2) is to prohibit the use of cleaners that solubilize mercury from dental amalgam in the wastewater lines in a dental facility. In developing the rule, EPA did not evaluate the use of cleaning products that may be used in dental equipment that is connected to water supply lines such as handpieces, ultrasonic scalers, or air/water syringes. While de minimus amounts of such products may eventually be indirectly discharged through a wastewater line in a dental facility, the prohibition in § 441.30(b)(2) was not intended to prohibit dental unit water line cleaning products when those products are used in water supply lines to ensure the safety of the water that dentists place in their patient's mouth.

Is the amalgam collected in the separator considered a hazardous waste under the Resource Conservation and Recovery Act (RCRA)?

Yes. The amalgam collected in a separator is likely to be a hazardous waste under RCRA due to the mercury and silver content of the amalgam. However, dental offices producing less than 100 kg of hazardous waste/month AND less than 1 kg of acute hazardous waste per month are considered “Very Small Quantity Generators” (VSQGs are regulated under § 262.14) and are exempt from most RCRA requirements for the disposal of their hazardous waste (Note that VSQGs were formerly called “conditionally exempt small quantity generators” (CESQGs) but were renamed in November 2016). EPA generally does not expect dental offices collecting amalgam waste to be above the VSQG threshold.

A generator must count all of the hazardous waste it generates in a calendar month, not just the amount of amalgam, to determine what RCRA generator category is appropriate. If you believe you may qualify as a “Small Quantity Generator” (dental office that produces 100-1000 kg of hazardous waste per month AND less than 1 kg acute hazardous waste per month) or a “Large Quantity Generator” (dental office generates more than 1000 kg of hazardous waste per month OR more than 1 kg of acute hazardous waste per month), please contact your state hazardous waste authority to understand your requirements for the management of hazardous waste. Links to state environmental agencies are on EPA’s website at www.epa.gov/hwgenerators/links-hazardous-waste-programs-and-us-state-environmental-agencies

What about state and local requirements?

The EPA rule is a floor (i.e. a minimum requirement), not a ceiling, for regulating discharges of dental office wastewater to POTWs. There may be additional requirements under state or local law that go beyond those in EPA’s Dental Office Category Rule.

Where can I find more information?

The Federal Register notice for the rule, along with other information, can be found on EPA’s Effluent Guidelines website at www.epa.gov/eg/dental-effluent-guidelines.

Tuesday, October 9, 2018

How New Technology will impact Treatment Planning

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As a writer, every once in a while you get lucky.  You happen to find a subject that strikes home with your audience and it takes off better than you might have initially expected.  That has happened to me recently with an article I wrote on high tech treatment planning.  I’ve received some nice public and private comments on the article.  For me its a tremendous honor.  As the Technology Evangelist, I look upon my job as being the person who points out the great advantages new products and ideas bring to us.  That’s it in a fairly complete description.  So, of course, whenever I get feedback I’m incredibly honored by that.
Here’s the article…

One of the true game changers in our profession as of late has been the development of cone beam computed tomography (CBCT). That combined with the market penetration of digital radiography, which is now well over 50 percent, has created an environment of visual co-diagnosis that has dramatically changed the way we communicate with patients and the way we diagnose.

I’m a huge supporter of visually-based technologies for the simple reason that human beings rely heavily on their sense of sight. Whether it’s computer images, photos or working under high magnification, the ability to see well gives you the ability to “do” well.

Combining multiple factors of visually-based practice systems allows for greater efficiency of treatment and greater predictability of outcomes.

For the past two or three years, I’ve been encouraging development of integration between cone beam scans and the file sets created by chairside digital impression systems. I’d be thrilled to see a continually updated patient where an initial 3D scan is taken and then updated with data from the digital impression system whenever a new chairside scan is done. Imagine keeping a 3D digital record of your patients that’s constantly updated to reflect their current situation. That would be incredible!

However, another new process has caught my eye as of late. Many of you have probably heard of VR, or virtual reality. The idea is to wear goggles that create a “virtual world” where it feels like you’re actually inside a video game. VR looks to be one of the next big things in the gaming world, for real estate tours, and potentially for education and tourism. However, short of perhaps patient education, VR doesn’t have much of a potential in the dental industry for the foreseeable future.

While VR my not have dental applications on the immediate horizon, a technology referred to as AR just may hold promise. AR stands for “augmented reality” and is defined by whatis.com as “The integration of digital information with the user's environment in real time. Unlike virtual reality, which creates a totally artificial environment, augmented reality uses the existing environment and overlays new information on top of it.”

Let’s stop and consider that for a moment. Imagine the possibility (as I mentioned above) of the merged cone beam and digital impression files. Now, let’s imagine that you’re prepping for a bridge on teeth #4-6. You prep the teeth, scan the case with the acquisition unit and then merge the clinical scan with the cone beam data. At this point the doctor can don the AR goggles that are loaded with your patient’s digital 3D data, and when you look at the patient, you’ll actually see the 3D rendering “on the patient.” This allows you to check for proper clearance and proper draw.


For the full article, you can finish reading at Dental Products Report.  

Monday, October 8, 2018

NuSmile SummitSet for February 15-16, 2019

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Unprecedented CE event targets pediatric dentists, general dentists and their teams


NuSmile Ltd., the worldwide leader in pediatric esthetic restorative dentistry, announced today that the second annual NuSmile Summit will be held February 15-16, 2019 in Clearwater Beach, Florida. The event’s format allows doctors and their team members to create their own schedule by choosing the specific courses that best meet their individual needs. Attendees will receive up to 16 continuing education credits from a combination of hands-on and lecture courses taught by several of the world’s most respected pediatric dentistry experts.

“When we conceived the NuSmile Summit over two years ago, our vision was a simple one: to create the premier continuing education event in pediatric dentistry,” said Diane Johnson Krueger, NuSmile founder and CEO. “The response we got from attendees of last year’s inaugural event told us we were on the right track, leading us to add a whole new Dental Team Member Curriculum. We’re convinced that this year’s Summit will be the finest event of its kind ever held.”

“We’re very excited to invite dental team members to attend our Summit courses and learn from the distinguished experts we’ve been able to assemble to lead them,” said Mike Loessberg, NuSmile Director of Sales, U.S. and Canada. “We’re especially proud our ‘Progressive Esthetics’ hands-on workshop, which provides everything doctors and their teams need to know about pediatric esthetic crown treatment.” According to Mr. Loessberg, workshop topics include treatment planning and the Express Prep technique, as well as high-yield, detail- oriented tips and tricks around proper cementation of pediatric zirconia and pre-veneered crowns.

Throughout the course of the Summit, doctors and their staffs will be able to choose from an unmatched array of course options:

Doctor curriculum (up to 16 CE credits)

“Esthetic Primary Crowns and Silver Diamine Fluoride (SDF): A Perfect Match” (LaRee Johnson,DDS, MS)
“Radiographic Findings in Pediatric Diseases” (Shailesh Kottal, DDS)
“Managing Those Hair Pulling Out, Drive You to Drink, Make You Want to Scream Situations in

Pediatric Dentistry (Bill Waggoner, DDS, MS)
“New Approaches to Pediatric Pulp Therapy” (Jessica Lee, DDS, MPH, PhD)
“Pedonomics and Pedometrics” (Roger G. Sanger, DDS, MSD)
“Managed Care Insurance and Pediatric Dentistry – Opportunities or Problems?” (Dr. Sanger)
“Advanced Zirconia Treatment Cases” (David Evans, DMD / David Salar, DMD / Eric Ellis, DMD)
Dental team curriculum (up to 14 CE credits)
• “Infection Control – Do You Know the Nitty Gritty?” (Rhea Haugseth, DMD)

“Parents – Are Yours Backseat Drivers?” (Dr. Haugseth)
“Know it, Show it and Sell it – Getting Parents to Say Yes” (Dr. Haugseth)
“Telling your Story on Facebook and Instagram” (Scott Childress)
“Big Bad Fluoride – Why the Controversy?” (Stacey Zaikoski, DDS)
“Behavior Guidance for the Pediatric Dental Team” (Dr. Zaikoski)

Hands-on workshop (full day)
• “Progressive Esthetics” (David Salar, DMD; David Evans, DMD; Eric Ellis, DMD)

The event’s keynote speaker will again be Gary Zelesky, who will speak on the theme, “Developing Passionate Leadership, Leading Passionate Lives.” Mr. Zelesky’s presentation at last year’s NuSmile Summit helped convince Twana Duncan, DDS of Antlers, OK to bring her 14-person staff to the 2019 Summit. “I found his speech to be so inspirational that I immediately thought, if my team could hear this, we would definitely be having a lot more positivity in our morning planning meetings,” said Dr. Duncan. “Also, we have a lot of new staff members, and they need to be able to talk knowledgeably to our parents and explain things like why we’re recommending a zirconia crown even though it might not be covered by the patient’s insurance. I also knew that my staff would feel comfortable asking questions in the Summit environment.”

The 2019 NuSmile Summit will again take place at the luxurious Grand Wyndham Resort in Clearwater Beach, Florida, named the “#1 Beach in the U.S.” by Trip Advisor. To take full advantage of this beautiful location, Summit attendees will have the option of participating in several fun activities, including Friday morning yoga on the beach, a Friday afternoon beach party, a Friday sunset reception at the pool, a Saturday morning 3K run, and a Saturday afternoon beach/pool party.

NuSmile will be awarding three residents scholarships to attend the 2019 NuSmile Summit. The scholarship includes registration, Thursday & Friday night hotel accommodations, breakfast & lunch for Friday and Saturday, as well as all of the extra curricular events scheduled for the weekend.

Doctors and their teams may pre-register for the event by calling 800-346-5133 or visiting nusmile.com.

Thursday, October 4, 2018

Patterson Eaglesoft To Remove Integration with DemandForce and Sesame Communications...


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Are you an Eaglesoft user? Do you love the integration the program provides? Are you currently using DemandForce or Sesame Communications in your practice? If so, get ready to miss that integration you’re so happy to have. Patterson recently made the decision to eliminate the connections between Eaglesoft and those two products.


In mid to late summer, Patterson Dental, owner of Eaglesoft, sent a letter to its users that also utilize DemandForce and Sesame. The letter stated:

Eaglesoft has elected to terminate its current interface agreements with Internet Brands, effective October 31, 2018. At that time, any interface between Eaglesoft and Internet Brands’ products, including Demandforce and Sesame Communications, including any data exchanged between these products and Eaglesoft will no longer be permitted.

In dentistry—no matter who you are, whether you work in a small office or corporate office, or what aspect of care you provide—you have one job: Supporting the patient. Everyone in dentistry has one employer: The patient. Everyone in dentistry *should have one focus and that focus should be the patient*. We all work for the patient. They are at the center of what we do and the sole person we are responsible to.

As a dentist running my own practice, I’m frustrated by the ways this decision by Patterson hampers my ability to support my patients. As a journalist, I felt the need to run down the story and report on what I found.

I have a big problem with corporate speak that spins profit and share holder value as noble under the charade of being more “helping the doctor better serve the patient.” That talking point hasn’t been rolled out yet, but it underscores the primary problem I have with this decision: Eliminating the doctor’s choices in this way does not better serve the patient.

Over the years, I’ve seen plenty of tech companies try to use proprietary systems to force users to stay with their platform. The lack of choice is touted as a good thing. However, I think that in almost any situation competition is a good thing. It creates an environment where people try their very best because if they don’t, someone else most assuredly will—and the customers will follow. I worry that eliminating the ability of the customer to migrate to your competitors, allows companies to rest on their laurels and not prioritize improvement or innovation in the same way. The opposite of this is open source integration, when you let everyone compete and the best products win. The sudden market for digital impression scanners and mills is a great example of this. You can buy the scanner you like best and if you want to mill, you can buy the mill you like best. The spurs competition, which creates better products, which ultimately benefits the patients. That’s what I’m in favor of!

In the case of Patterson’s decision, it is important to acknowledge that DemandForce and Sesame *did* enter into an agreement with Henry Schein, one of Patterson’s main competitors. I can understand if Patterson had concern about how this dual access could be compromising. That’s would be a decent enough argument—if they’d offered it or any explanation—but it still hurts the dental offices caught in the middle, which means it hurts the patients of those offices. So, my question remains: How does this help the patient? If you are worried about security, write better code, but don’t use your customers and their patients in some corporate game of chicken.

This isn’t the first time Eaglesoft considered a move like this. A few years back there was an issue with Gendex and Patterson attempted to eliminate its integration. It wasn’t too long before good IT people figured out how to address the concern without cutting ties. The company never apologized and tried to cover it up with corporate speak on how it was actually a good thing. Once again, I’m at a loss as to how the patient benefited from the doctor being unable to take x-rays with his or her existing system.

I have no idea what the affected dental offices will do this time around. This very well may cost them money as they have to reconfigure how they do business due to Patterson’s choices. There may be broken contract fees or yearly charges that are already paid. There may be new setup fees or they may be locked into services that they don’t want to use or contracts that they must sign and pay for, but now have no choice. There has been no word from Patterson or Eaglesoft to address these concerns, which adds insult to injury and just isn’t a great way of doing business.

Before I wrote this article, I wanted to make sure I had the full story, so I contacted Eaglesoft in my capacity as Technology Editor and Chief Dental Editor of Dental Products Report. They confirmed that this was, in fact, moving forward. When I asked if they had a position, this is what they had to say:

Internet Brands, the parent company of Demandforce and Sesame Communications, announced the completion of an agreement to combine its dental products, including Demandforce and Sesame Communications, into a joint venture with a directly competing practice management software company. Unfortunately, this has resulted in a separation of our agreement with them. Patterson offers competitive alternatives available in Eaglesoft, including RevenueWell, Solutionreach, and others and Patterson will continue to look for ways to expand our portfolio of solutions available to Eaglesoft customers.

They “will continue to look for ways to expand our portfolio of solutions available to Eaglesoft customers.” Until they don’t. When they have a reason to cut off those “expanded portfolio of solutions,” they will. The past tells us this will happen because they’ve already done it twice.

I am an Eaglesoft user in my practice, but I am not a customer of DemandForce or Sesame. Henry Schein, Patterson’s competitor, owns Dentrix and Dentrix is a sponsor of this blog. With all those disclaimers in mind, I want to explain to you why this post was so important for me to write. Quite honestly, I’m fed up with my profession being held hostage by these types of situations.

I’m fortunate to have a platform to voice my concerns and I’m taking this opportunity to speak up for my fellow colleagues in private practice. I’d like to think I am giving a voice for those whose only choice will be to complain to their local Patterson sales representative (and that representative has a snowball’s chance in the Sahara of getting the word to *anyone* at the top of the corporate ladder who really needs to hear this.)

I’m open to a response from Patterson on this and will be happy to post is verbatim here if they choose to reach out to me.



What DemandForce provides:

Automate Appointment Reminders
Call Tracking
Reactivate Lost Patients
Manage Online Reviews
Enhance Your Practice Listings
Sesame Communications

What Sesame provides:

Patient Communications
Web Design
Search Engine Optimization
Pay per Click advertising
Social Media & your online Social Media presence
Integration with Health Grades

Wednesday, October 3, 2018

Convergent Dental Announces The Next Generation of Solea®

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On Monday, I had a chance to chat with Solea founder Michael Cataldo.  We spent some time discussing the newest edition of the company’s Solea CO2 laser.  I’ve known Mike for several years, pretty much since Solea came on the market.  He is a smart individual who is driven to make a better laser platform for dentistry.  The new Solea is detailed below.  I think you’ll be impressed…
New, Smaller Solea Cuts Faster, Smoother and 99.2% Anesthesia-Free 
Convergent Dental Inc., developers of Solea®, the industry-leading CO2 all-tissue dental laser, is pleased to announce The Next Generation of Solea. The latest advancements provide unprecedented performance, significant software upgrades, improved ergonomics, increased accessibility and a smaller footprint.

“This new generation of Solea provides a quantum leap in performance at every level. Most importantly it enables dentists to do virtually 100% of cavity preps anesthesia-free,” remarked Convergent Dental CEO Michael Cataldo. “In addition, Solea now cuts faster and smoother so dentists get more done in less time with an even better patient experience.”

Solea earned its reputation for enabling dramatic practice growth and reduced stress for dentists and patients by taking anesthesia, bleeding, sutures, and discomfort out of the dental experience. Before the launch of this new platform, Solea dentists reported doing 4 – 6 more procedures per day while feeling like they were doing less work. With this new generation, Solea dentists will benefit from even more growth while enjoying an even more relaxing work day. Better still, it all comes in a smaller package that is even easier to use.

Unprecedented Clinical Performance - Statistics collected from over 1,000 procedures in early use of the new Solea platform include:

  • Improved anesthesia-free performance - nearly 100% of cavity preps were completed without anesthesia and without discomfort. 
  • Faster hard tissue cutting by 31% compared to the previous platform.
  • 10% smoother surface finishes providing better margins and reduced prep time.
  • Faster soft tissue cutting with minimal to no bleeding.
  • Smaller Footprint - Solea is 15% slimmer, making it easier to move around the office and operatory.
  • Enhanced Software – User-customizable options, user-specific profiles and faster start-up.
Enhanced Ergonomics - A lighter, more maneuverable handpiece with improved rotation and a wider range of motion.

Improved Remote Access – A 4G LTE mobile data connection has been added along with the existing Wi-Fi capability, improving Solea’s accessibility for software updates and remote service and support.

Actual results: 99.2% of 833 cavities and 132 soft tissue procedures treated successfully without local anesthesia in early use.

For further information about Solea, please visit www.convergentdental.com or call 844.GOSOLEA.

About Convergent Dental, Inc.

Tuesday, October 2, 2018

ADA Presents HIPAA Security Risk Analysis Webinar

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As I preach here on a regular basis, you cannot be too concerned about your data security.  It is imperative that all offices make rock solid sure that they are prepared from a full on security standpoint.  There area also the nuances of HIPAA that must be learned and followed.  To help with this, the ADA is putting on a HIPAA Security Risk Analysis Webinar  that will help doctors understand this situation better.

About this event
This webinar is intended for Dental Practice Team Leaders with HIPAA Security Official responsibilities in their job roles. 

The webinar will discuss how to comply with the HIPAA Security Rule's Risk Analysis requirement using a qualitative risk analysis methodology. It will also cover some reasonable risk mitigation strategies and suggest resources for further study. 

While the webinar can serve as part of a covered dental practice's HIPAA training, it is not intended as a replacement for an ongoing, tailored, well-documented workforce training program.


About the presenters
Patrick Cannady

Patrick is a Manager at the ADA's Department of Dental Informatics and holds a Master of Science in Health Care Informatics from the University of Illinois at Chicago and a Certified in Healthcare Privacy and Security certification from the American Health Information Management Association (AHIMA). He is a primary contact and member resource for HIPAA Privacy, Security, and Breach Notification resources. He also serves as the ADA representative to the X12 electronic transaction standards development organization and as a co-chair to Workgroup on Electronic Data Interchange Dentistry Sub Workgroup. Patrick is an acknowledged expert on Privacy and Security requirements and frequently advises state and local society leadership.

Jean P. Narcisi

Jean P. Narcisi is the Director of Dental Informatics for the American Dental Association (ADA) and her primary responsibilities include the management and coordination of the internal and external activities related to the areas of electronic data interchange (EDI); electronic health record and vocabulary standards; the use of technology in dentistry; and federal and state administrative simplification activities. She is an ADA representative to the Dental Clinical Reference Group at SNOMED and was appointed as an expert by the ANSI-Accredited U.S. Technical Advisory Group to the ISO/Technical Committee 215 (Health Informatics).

If you would like to be a part of this webinar, follow this link.