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DENTISTS NEEDED – KOOL SMILES ($20K Sign On and Paid Relocation)

Kool Smiles is a growing dental practice with a mission of providing high quality dental care to underserved communities. With offices in multiple states across the country, we provide general dentistry to children and adults. We are currently hiring General and Pediatric Dentists for our Evansville, Indiana. This location is offering a $20k Sign On Bonus and Paid Relocation! All candidates must have a degree in dentistry and an active license to or be willing and able to obtain licensure. Please E-mail resume/CV to Heidi Houston at hhouston@ncdrllc.com

Ethical advertising in dentistry

Advertising in dentistry is evolving. Social media posts, postcard coupons showing up in your mailbox – there seems to be endless ways to publicize your practice. A new practitioner is faced with an important question: how will you market your practice ethically in the midst of ever-changing advertising options?

A little history on advertising in dentistry: the ADA prohibited advertising dental services until 1977. Then two years later through negotiations with the Federal Trade Commission, the ADA’s principles of ethics concerning advertising was revised. Today, you can read these policies in this document of 2012 Current Policies, which is applicable through 2013 (click here to download and look on pages 32-35). From this time on, advertising has been regulated by state dental boards with the help of professional organizations.

Examples of unethical advertising in dentistry may be a claim to be the best dentist in the city or a specialist in an area of dentistry that is not formally recognized as a specialty by the ADA. It is important to note advertising dental services is not inherently wrong. In fact it can help patients discover the available options of care and assist them in finding the office that will best suit their needs and preferences. Some practical suggestions for approaching advertising in your practice include referring to your state’s statutes and rules and discussing your advertising plan with your attorney.

Looking to the future of advertising in dentistry, it seems a major obstacle will be monitoring social media. As young dentists engage the arena of public relations, important decisions will be made here. Please feel free to comment on this post with your thoughts and observations on the evolution of dental advertising.

Thank you to Dr. Scott Morrison, a faculty member at the Arizona School of Dentistry & Oral Health, for his presentation on the ethics of advertising in dentistry. Dr. Morrison sat on the Board of Dental Examiners in Arizona for four years and helped enforce Arizona’s statutes and rules concerning advertising.

Jessica Giles, Arizona ’16, associate, Council on Professional Issues

Medicaid clinics forced to extract just one tooth at a time

At Boston University, part of our clinical curriculum places students at community health centers across New England and in Florida on 10-week rotations. Students get the opportunity to work in a fast paced setting, and it is not unusual to see 5-10 patients a day. My placement was at a federally qualified health center with a unique focus on pediatric patients on Medicaid insurance, and I was able to treat hundreds of children placing restorations and performing pulp therapy. While the treatment I delivered gave me a sense of reward and fulfillment, I was also caught in the midst of an ethical dilemma.

I recall treating a particularly anxious three-year-old whose mother could not afford to travel to the closest pediatric dentist. Almost every tooth in her mouth was decayed. The clinic had an interesting arrangement with Medicaid whereby reimbursement was made on an appointment-by-appointment basis and was not dependent on the type of procedure performed. In fact, no matter the complexity of the procedure or number of procedures performed in one appointment the reimbursement rate was the same, about $100. This meant that a preventative resin restoration (PRR) had the same profitability as an extraction. All too often children were scheduled for appointments where only one PRR was performed at a time. Full mouth extractions took months to complete, as only one tooth could be extracted in a single visit.

Many private practices have a hard time weaving through Medicaid reimbursement paperwork and regulations, but this federally qualified health center operated seamlessly. As a dental student, it was difficult to justify the one tooth at a time approach to dentistry as we were taught in our education to treat one quadrant at a time. The three-year-old patient I saw may have been uncomfortable getting local anesthesia for just a single tooth at every visit, but it was the protocol of the clinic.

In addition, when an adult patient came to the clinic with pain in a single tooth, they were given antibiotic and pain control medications. It seemed as though two appointments were always necessary to extract one tooth. We were told over and over again by practice managers that we were never to extract a tooth on the same day as the emergency consultation. Many times I wished we could have alleviated the patient’s pain by extracting on the same day, the way we did at the dental school clinic and in private practice. But, at this clinic the reimbursement schedule by Medicaid regulated how care was delivered to the patients.

It was clear that students like me had expressed the same sentiments year after year. In fact, clinic management had a rehearsed line that they were providing a valuable health service to a group of patients that no one was willing to take on. The only way they could be an established clinic was to compromise the timeliness of treatment. While treating patients on Medicaid may present an administrative and financial behemoth, should it mean compromising the ethical treatment of patients? Should we scrutinize delivery of care by federally qualified health centers more closely and evaluate if the trends emerging are ethically sound? Let us know your thoughts in the comments below.

~Sameet Gill, Boston ’14

Midlevel providers in the Last Frontier

As a third year dental student, the start of my career is on the horizon. But unlike most dental students, I will head back to one of few states with midlevel providers: Alaska. The question for any new dentist is: how will this affect my career?

I decided to get some insight as to what I should expect if I want return to the Last Frontier to practice. Dr. James Driskell, a practicing Anchorage dentist, advised “I don’t think that is has affected my practice yet, but I also don’t think it’s working up here…midlevel providers need to do more preventative care and education, its like having a Physicians Assistant pull out your third molars”.

Dr. James Yassick, a past president of the Anchorage Dental Association, also spoke to me about the level of care being provided in the state of Alaska: “When the Public Health Service was providing care to the Alaska Natives, care was equal to or better than the rest of the US, whereas now, you can’t say that someone with 18 months of training can deliver that quality of care.”

Neither dentist I spoke with felt as though their practice had suffered a loss of patients due to the newer implementation of MLPs Nor do they expect a loss because this system is set up for rural Alaska. However they did note that while this system is currently only in villages, it is only a matter of time until the big money behind this program attempts to bring it to Anchorage. “These are the type of programs that are looking to expand to more procedures and bigger cities. The problem is there is no way of actually tracking their success or, even worse, their failed procedures,” stated Dr. Driskell.

So what does this mean for someone like me considering opening a practice back in Alaska? Unfortunately, I can’t predict the MLP impact in two years or more importantly ten years. But what I do know is that preventative treatment and education are the most significant problems in rural Alaska and no amount of fillings or stainless steel crowns will eliminate caries. The current system employing MLPs in Alaska will not eradicate the access to care problem in the state, let alone the US. However, if we can continue to work on education and prevention, we can find a safe and reasonable improvement from our current situation.

~Samantha Dubin, Western, ’15, Districts 10-11 legislative coordinator