April is Oral Cancer Awareness Month

April is Oral Cancer Awareness Month

Oral Cancer awareness in the American public is low. Approximately 49,750 people in the U.S. will be newly diagnosed with oral cancer this year. Every day 132 new people in the U.S. will be newly diagnosed with an oral cancer, and that one person EVERY HOUR OF THE DAY, 24/7/365 will die from it

While smoking and tobacco use are still major risk factors, the fastest growing segment of oral cancer patients is young, healthy, nonsmoking individuals due to the connection to the HPV virus. We cannot stop this virus from spreading; our only hope to save lives by performing oral cancer screenings on every patient, every time they are in our office.  

As a commitment to our patients and our community Dr. Henley serves as member of the Head and Neck Tumor Board at Baptist MD Anderson.  The tumor board is a multi-specialty group that works together using the latest in dentistry and medicine to ensure that patients have the best possible outcomes.

To learn more about oral cancer see the links below:

https://www.henleyandkelly.com/head-and-neck-cancer/

http://oralcancerfoundation.org

https://www.baptistjax.com/services/baptist-md-anderson-cancer-center/head-and-neck-cancer

Caring For Our Elderly, Oral Health Care is Key

UNC School of Medicine researchers led a study to determine risk factors associated with malnutrition among older adults receiving care in the emergency department. The study, published in the Journal of the American Geriatrics Society, suggests that food scarcity and poor oral health are major risk factors for malnutrition that leads an older adult -- already at high risk of functional decline, decreased quality of life, and increased mortality -- to land in the emergency department.

Of the risk factors studied, poor oral health was found to have the largest impact on malnutrition. More than half of the patients in the study had some dental problems, and patients with dental problems were three times as likely to suffer from malnutrition as those without dental problems.

Read the article at sciencedaily.com

Sharks May Have the Healthiest Teeth in the Animal Kingdom

You’d think with all those seals, fish and the occasional surf board, sharks’ teeth would be a mass of cavities and bad dental hygiene. Not the case. Sharks may have the healthiest teeth in the animal kingdom, it turns out. Scientists just found that their pearly whites contain fluoride, the active ingredient in most toothpastes and mouthwashes.

Discovery News reports: “(The surface of) shark teeth contains 100 percent fluoride. In principle, sharks should not suffer from cavities. As they live in water and as they change their teeth regularly, dental protection should not be a problem for sharks.”

Unfortunately for humans, we missed out on this feat of evolution. Our teeth contain hydroxyapatite, which is an inorganic substance also found in bone. In other words, not cavity resistant in the least. And let’s not forget that, in addition to their unique cavity-preventing composition, sharks have the ability to replace their teeth time and time again. When it comes to dental matters, sharks have the edge

Read the full article at the Smithsonian  

Midlevel Dental Provider

As published in Today's FDA Vol. 29, No.1

By: C.J. Henley, DMD

The call for a midlevel dental provider (MDP) in dentistry has been growing in the past few years. Organizations like Pew Charitable Trusts and The W.K. Kellogg foundation have been some of the most outspoken advocates of the development and implementation of the MDP. In a recent report, the Pew Center states that "State leaders, dentists, public health advocates and other stakeholders should be heartened to know that expanding the dental team is an effective strategy to improve access to care, but they cannot overlook the importance of setting adequate Medicaid reimbursement rates.” 

Often the need for the MDP is propagated on the basis that there is an acute need for dentists in the United States. According to a study recently published by the American Dental Association (ADA), the population of dentists in the US will grow steadily through 2035. This indicates that as the population in the US grows so will the number of dentists. However, this is in stark contrast with a report published by the Health Resources and Services Administration that estimates it would take a net increase of nearly 9,500 providers to address the unmet need today.

Another case to support the use of MDPs are studies that highlight Alaska as a success story for the implementation and use of MDPs. While there was, and is, very little doubt that there is a need to improve the access to dental care in Alaska. This is based on the fact that Alaska has the largest landmass in the US, but there are only 710,231 residents and only 14 percent of Alaskans are American Indian/Alaska Natives. There are roughly 215 villages spread throughout Alaska, often these remote locations are only accessible by boat, bush plane or snowmobile. Many of these communities have no on-site dental services and require culturally specific providers to administer health care. It has been for these reasons that MDPs have been successful at helping promote dental care in underserved areas such as remote Alaskan villages. It is difficult to use Alaska as a “apples to apples” comparison to what is going on elsewhere in the US due to the geographic uniqueness of the state.

It is interesting that the push to introduce the MDP has gained so much traction when attempting to improve our existing system would seem logically to be the most simple path. I reached out to Pew and asked them just that. Why is there such and emphasis on the MDP as opposed to improving medicaid reimbursement? John Grant, director of Pew’s dental campaign stated that “for dental policy, we work in states on proven, cost-effective solutions that improve access to dental care.”

Often the MDP is compared to a physicians assistant (PA) or a Nurse Practitioner (NP). But is that really a fair comparison? If the ultimate goal of the MDP is to provide care to the underserved, then the comparison to the PA or the NP cannot be made. A study published in 1997 stated that of the total NPs practicing in the US, 85 percent were located in metropolitan counties. How is this geographic distribution of NPs serving any benefit to underserved populations in rural areas? A 2009 RAND study found that, in Massachusetts, visits to NPs and PAs cost 20 percent to 35 percent less than visits to physicians. However, many of the costs in dentistry are fixed, for example: rent, staff, restorative materials, and sterilization costs. With states, such as Florida, medicaid reimbursements hover around 35 percent of the usual and customary rate. With reimbursements at this rate it will still be difficult to generate enough revenue to sustain a viable practice.

In a recent study published by the ADA’s Health Policy Institute, it was noted that in 2007 The Texas Medicaid program increased dental reimbursement by more than 50 percent, implemented loan forgiveness programs for dentists who agreed to practice in underserved areas, and allocated more funds to dental clinics in underserved communities. By 2010, dental care use among Medicaid enrolled children in Texas had increased so much that it exceeded the rate among children with commercial dental insurance.

The Affordable Care Act made dental care for children an “essential health benefit” so it is easier for children to obtain Medicaid coverage. However, Ron Waters, a contributor of Forbes.com recently stated in an article entitled: Owww! If You Think The U.S. Medical Care System Is Broken, Take A Look At Dental Care, that the in the US, Medicare provides healthcare to almost all elderly people in the U.S., but it specifically excludes dental care. Seniors may buy their own private dental insurance, but only 12 percent do so and less than half of Medicare recipients saw a dentist in the past year. So the question stands, how can we improve the issue of access to dental care in the US?

I don't think that any dentist would deny that as health care providers we have an obligation to help care for our underserved populations. Fortunately, programs like Give Kids a Smile and Mission of Mercy have helped thousands find the desperately needed health care that they need. However, as amazing as these programs are, they are just scratching the surface of what the US needs in order to help patients that need dental care the most. An often cited story tied to the access to care issue is the story of Deamonte Driver. A young man who died from a dental abscess in 2007. Deamonte's death and the ultimate cost of his care, which totaled more than $250,000, underscore our country’s issues with access to dental care and the cost to our communities for failing to treat dental problems in a timely manner.

The vast majority of dentists cite the reason for not taking medicaid because the reimbursements are too low, and the patients likelihood to no-show appointments. According to the ADA, making Medicaid reimbursement rates for dental care closer to commercial dental insurance levels, in conjunction with other reforms, could increase provider participation and access to dental care for Medicaid enrollees. In order to close the gap in dental care utilization between low-income and high-income adults policy makers can look to the success stories and promising practices of states, such as Texas, in considering reforms to their Medicaid program.

It is also imperative not to understate the difference between lack of access to care versus under utilization. I worked for a dental service group that provided Medicaid dental services to children in need in Florida for nearly three years. While many of the patients were grateful, it was also clear that many parents and caregivers were not educated of the importance of oral health care for both themselves and their dependents. It is possible that a lack of education with respect to dietary considerations, oral hygiene, and failure to understand the importance of good dental care are at the crux of the problem.

I am not enthralled by the idea of dentistry following the current model of medicine in the US. I believe that what makes our profession so great is our ability to own our own businesses, control the quality of care that we provide, and spend time with our patients. I worry that if we introduce MDPs, dental practices will become “mills” and if anyone has been in a physicians office recently knows, that the larger the practice, the more likely you are to be “just a number”. Moreover, I hate the idea of legislators, who are not dentists, advocating for MDPs when they are not on the front line of dentistry everyday and don't understand how a private practice functions. I fail to understand how the introduction of the MDP in the continental US is truly going to have a significant impact on access to care. I would encourage our legislators to increase Medicaid reimbursements and eliminate the “red tape” associated with becoming a provider. Lastly, we can all help solve the problem today by regularly treating a limited number of patients in need in our offices. In my practice, we make it a point to extract teeth, place fillings, and fabricate partials for patients that typically could not afford the care. We ask only to “pay what they can, when they can.” Protecting our profession starts with each one of us, in our communities, helping the people that need it the most, not in Washington, DC.

Endnotes:

1. It should be noted that depending on the state, various names have been developed to describe the MDP such as Advanced Dental erapist (ADT), Dental erapist (DT), and Advanced Dental Hygiene Practitioner (ADHP) with varying scopes of practice, however for this discussion all variants will be grouped as a MDP.

2. Pew Center on the States. It Takes a Team; How New Dental Providers can bene t patients and practices. Washington, DC: e Pew Center, 2010.

3. Bradley Munson, B.A.; Marko Vujicic, Ph.D. Number of Practicing Dentists per Capita in the United States Will Grow Steadily. Washington, DC: American Dental Association, 2016.

4. A Report from Chairman Bernard Sanders Subcommit- tee on Primary Health and Aging U.S. Senate Committee on Health, Education, Labor & Pensions February 29, 2012.

5. Sho stall-Cone, Sarah, Williard, Mary; Alaska Dental Health Aide Program. Int J Circumpolar Health 2013, 72: 21198.

6. Lin, Ge, Burns Patricia, Nochajski omas. e Geographic Distribution of Nurse Practitioners in the United States. Applied Geographic Studies, Vol. 1, No. 4, 287–30, 1997.

7. Rand Corporation Policy Brief. Controlling Health Care Spending in Massachusetts. 2009.

8. Kamyar Nasseh, Ph.D.; Marko Vujicic, Ph.D.; Cassandra Yarbrough, M.P.P. A Ten-Year, State-by-State, Analysis of Medicaid Fee-for-Service Reimbursement Rates for Dental Care Services. Washington, DC: American Dental Association, 2014.

9. Otto, Mary. For Want of a Dentist. Washington Post. February, 28, 2007.

10. Galewitz, Phil. Medicaid Patients Struggle to Get Dental Care. USA Today. February, 15, 2015.

11. Nasseh, Kamyar Ph.D.; Vujicic, Marko Ph.D.; Yar- brough, Cassandra M.P.P. A Ten-Year, State-by-State, Analysis of Medicaid Fee-for-Service Reimbursement Rates for Dental Care Services. Washington, DC: American Dental Association, 2014. 

End of fillings in sight as scientists find Alzheimer's drug makes teeth heal themselves

End of fillings in sight as scientists find Alzheimer's drug makes teeth heal themselves

Fillings could be consigned to history after scientists discovered that a drug already trialled in Alzheimer's patients can encourage tooth regrowth and repair cavities.

Researchers at King's College London found that the drug Tideglusib stimulates the stem cells contained in the pulp of teeth so that they generate new dentin – the mineralized material under the enamel.

You can read the complete article at the Telegraph 

Be a Part of FDA's New Mentorship Program

Be a Part of FDA's New Mentorship Program

As Published in Today's FDA Vol. 28, No. 8

By: Dr. C.J. Henley

This month the Florida Dental Association is rolling out a ambitious new mentorship program. The program is aimed at helping dental students and new dentists gain practical and professional exposure to dentistry though experienced member dentists.  In order for it to be successful, it will require the participation of experienced dentists willing to donate their time and expertise.

Because the landscape of our healthcare system is changing at a rapid pace, it is imperative that experienced dentists help foster a generation of clinicians that will not only protect our future and prosperity, but help provide our communities with the best that dentistry has to offer.   

Sharing advice, experience and skills with a young protege gives us great personal satisfaction. However, mentoring is much more than that. The relationship offers other tangible benefits for mentors willing to contribute to the development of the next generation of dentists.  Mentoring can:

1. Enhance your own professional growth.  
2. Inspire new ideas.  By stepping out of your normal circle of referrals and friends, you may find new inspiration.
3. Challenge you to stay abreast of the latest technology.  Younger dentists that have had exposure to newer techniques and technology may be the catalyst you need to incorporate new technology into your practice.
4. Provide insight to your own actions. In our private offices, most of us do not question our own rational for our actions and treatment decisions on a regular basis.  The question “Why?” from a protege can promote opportunity for internal reflection and thought.
5. Increase the mentor's sense of self-worth.
6. Foster a sense of community and collaboration
7. Develop personal leadership.
8. Leave a legacy.
9. Invigorate passion in our careers.  Mentors are less likely to “burn out” or plateau when compared to colleagues who are not mentors.

A study conducted in 2010 asked current mentors what they perceived as the benefits of being a mentor.  The majority of respondents stated that being a mentor led to an increased interest in their career and increased reflections regarding their own values and work practices.  

So much more goes in to practicing dentistry than simply practicing dentistry.  Managing a staff, marketing your practice, navigating insurance plans, finding work-life balance, and accepting complications are all a part of what we do on a daily basis.  Most of these lessons were never taught in dental school, but I think we would all agree they are critical to the success of our practices.

One aspect of dentistry that I find most challenging is the ability to understand that complications are part of what we do.  As dentists, we are all perfectionists.  We want to provide an ideal, functional and esthetic result on every patient every time.  But we are human and part of being human is learning to cope with failures.  A mentor of mine in dental school, Dr. Jim Green, always reminded me that “if you are not having complications, then you are not doing enough cases.” As dentists, we should always strive for perfection but accept excellence.  It takes experience to understand that failures can and will happen in one’s career.  A great mentor can help a new dentist both understand and accept this truth.

Philosophically, being a mentor is be an altruistic endeavor.   It takes an investment of time and emotion.  Being a mentor could provide you with a new and exciting challenge in nearly any stage in your career.  Your legacy in dentistry just might be helping a new dentist start their profession.  In summary, if you still need a reason to be a mentor, you’ll find it the moment you start.

E-cigarettes 'just as harmful as tobacco' for oral health

E-cigarettes 'just as harmful as tobacco' for oral health

In an article published by Medical News today discussed that  a recent study found that the chemicals present in electronic cigarette (e-cigarette) vapor were equally as damaging - in some cases, more damaging - to mouth cells as tobacco smoke. Such damage can lead to an array of oral health problems, including gum disease, tooth loss, and mouth cancer.

E-cigarettes are battery-operated devices containing a heating device and a cartridge that holds a liquid solution. The heating device vaporizes the liquid - usually when the user "puffs" on the device - and the resulting vapor is inhaled.

While e-cigarette liquids do not contain tobacco - a highly harmful component of conventional cigarettes - they do contain nicotine and other chemicals, including flavoring agents.

According to the Centers for Disease Control and Prevention (CDC), the use of e-cigarettes has increased in recent years, particularly among young people. In 2015, 16 percent of high-school students reported using the devices, compared with just 1.5 percent in 2011.

You can read the whole article here

New peanut allergy prevention guidelines start in infancy

New peanut allergy prevention guidelines start in infancy

The recommendations fall into three categories: 

The first category includes children who are believed to be most likely to develop a peanut allergy: infants who have severe asthma, egg allergy or both. Parents can either introduce these children to peanut-containing food at 4 to 6 months or get a reference to an allergist who will give the child a skin prick test or a blood test to see whether the infant is allergic to peanuts. 
If not allergic, parents should follow the recommendation of introducing peanut-containing foods at 4 to 6 months. However, if the infant is allergic, parents should refrain.

The second category includes children with mild to moderate eczema; less likely to have an allergy, these infants should be introduced to peanut-containing foods about 6 months of age.

The third category belongs to children with no eczema or food allergies and no family history of such. These children can either be fed peanut-containing foods or not at any age, based purely on family and cultural preference

You can read the entire article at www.cnn.com

Drs. Henley and Kelly Honored as One of Jacksonville's Best Doctors by Jacksonville Magazine.

Congratulations to both Dr. Henley and Dr. Kelly for being honored as one of Jacksonville's Best Doctors by Jacksonville Magazine.  

Your Dental Benefits: Use Them or Lose Them

When it comes to dental benefit plans, millions of people each year are ringing in the New Year leaving money on the table. According to the National Association of Dental Plans, only 2.8% of people with PPO dental plan participants reached or exceeded their plans annual maximum. Many people also have Flexible Spending Accounts, which help pay for dental and medical care with pre-tax dollars. 

Whether you’re paying for dental care through a benefits plan or using an FSA, your current plans will most likely run out on December 31. Don’t let your hard-earned dental dollars go to waste. Here is a breakdown of what these benefits are, when you need to use them by and how to make the most of your benefits. 

Dental Benefit Plans

Many people with dental benefits get them through their employers, though individual plans are also available through Health Insurance Marketplaces established by the Affordable Care Act. Remember, when you buy a plan you and your employer are paying some premium – upfront dollars – that are wasted if you don’t see your dentist.

When You Need to Use Them By

Many insurance companies have a benefit deadline of December 31, and this means that any of your unused benefits don’t roll over into the New Year for most dental plans. Still, some plans may end at different times of the year, so check your plan document or ask your employer to be sure. 

Tips for Making the Most of Your Plan

• The key with this type of coverage is to take advantage of any benefits before they expire for the year.
• Prevention is better than cure both for your health as well as your pocketbook. Most plans typically pay 100% for preventive visits, so if you have not had one yet, this may be a good time to schedule one.  
• Start thinking about using your coverage early. During a dental appointment that's over the summer or in the fall, talk to your dentist about what your dental needs are and what treatment you might need before the end of the year. (For example, a back-to-school appointment is a great time to bring this up.) Make any upcoming appointments early so you can take care of them before the holidays.
• Once you've determined what your dental needs are, work with your dentist and benefits provider to figure out what is covered. Often, your dentist's office will look into this information for you. You can also call your plan using the 800 telephone number on your identification card, or go to their website for information.

Flexible Spending Accounts

A Flexible Spending Account (FSA) is an account you can set up through your employer. During open enrollment, you choose how much money to put into this account, and a portion of this amount is deducted from each paycheck pre-tax. FSAs generally cover services or products that help keep your mouth healthy, including cleanings, braces needed for dental health reasons, benefit plan co-pays, dentures and more.

Many FSAs work like debit cards, and you can use that card to pay for various medical and dental expenses, including some products available at your local drugstore. 

When You Need to Use Them By

Generally, you must use the money in an FSA within the plan year by December 31. However, your employer may offer one of two options that give you a little more time to spend what’s in your account:

• Some provide a grace period of up to 2½ extra months to use the money in your FSA.
• Others may allow you to carry over up to $500 per year to use in the following year.
• Whether it’s at the end of the year or a grace period, you lose any money you haven’t spent. Check with your employer or FSA administrator to see what your plan allows.

Tips for Making the Most of Your FSA

• Plan carefully so you don’t put more money in your account than you will spend within a year on dental or other health care costs.
• As with dental benefit plans, talk with your dentist in the summer or fall during regular appointments to see if you have any needs or procedures that need to be completed. You may be able to use your FSA to pay for these needs or use your FSA to pay any associated co-pays or co-insurance.
• Contact your FSA administrator for a list of covered services and products (usually referred to as eligible expenses). However, most FSA accounts cannot be used for cosmetic procedures and services like whitening, veneers or cosmetic braces. 
• Make any remaining dental appointments as soon as you know you need them to ensure your FSA dollars can be used in time.