Dentistry for People With Special Needs

Efforts to expand access and improve the delivery of dental health services to Californians with special needs are under way. The University of the Pacific School of Dentistry has selected eight regional centers as partners to expand oral health care programs for people with special needs. The project is funded in part with a $2 million grant from the California Endowment, the state’s largest health foundation.

"The California Endowment is committed to expanding access to health-related services to persons with special needs," said Marion Standish, senior program officer with the California Endowment. "We are pleased to support the UOP School of Dentistry in this statewide effort that will have a significant and positive impact on the dental health outcomes for people living with developmental disabilities."

There are 21 regional centers throughout the state of California. A regional center is a social service agency for people with developmental disabilities. They are under contract with the state Department of Developmental Services and perform triage, referral, and advocacy services. Each center has a case manager, who is responsible for seeing that individuals receive the services they need.

UOP’s grant program, called the Statewide Task Force on Oral Health for Persons with Special Needs, focuses on eight regional centers throughout the state: the Alta California Regional Center in Sacramento, Central Valley Regional Center in Fresno, East Bay Regional Center in Oakland, Lanterman Regional Center in Los Angeles, Harbor Regional Center in Long Beach, Inland Regional Center in San Bernardino, North Bay Regional Center in Napa, and San Gabriel/Pomona Regional Center in Pomona.

UOP has helped facilitate the establishment of eight community-based networks that implement local oral health treatment and prevention delivery networks that link people with developmental disabilities to locally available dental screening, treatment, and preventive services.

"Because of the difficulty in accessing dental services, many individuals with disabilities have significantly poorer oral hygiene and higher rates of dental disease than the rest of the population," said Paul Glassman, DDS, MA, MBA, project co-chair and director of UOP’s advanced education and general dentistry program.

Without regular dental care and preventive practices, people with disabilities generally see a dentist only in emergency situations, when visits are not only painful and stressful, but also expensive and may require extensive travel to dental schools or local hospitals.

"With the cooperation of these centers, we are mounting a statewide effort to improve access to local dental services for people with disabilities," said Christine Miller, RDH, MHS, MA, project co-chair and UOP’s director of community services.

Now finishing the second year of a three-year grant project, a number of goals and objectives have been implemented. Dental coordinators have been hired and trained in all eight regional centers. The part-time coordinators provide case management, assessment, and referrals for the clients of the regional centers. The coordinators also provide oral health education, dental care resource development, and education for professionals, caregivers, and consumers.

Additionally, an electronic oral health tracking system has been established in the eight regional centers to monitor the progress of clients they are serving in rural and urban communities throughout the state.

UOP also hosts a popular one-day continuing education course for interested volunteer dentists, titled Dentistry for People with Special Needs, in various cities in California several times throughout the year that are funded by the California Endowment.

For information online, UOP, through its Center for Oral Health, has developed a resource guide for materials related to prevention and treatment of dental disease for people with special needs. This resource guide lists books, pamphlets, videotapes, prevention supplies, treatment materials, and other resources useful in preventing or treating dental disease for people with special needs. It is available at www.dental.uop.edu/resource. Materials can be displayed for a particular category, audience, subject, or format.

E-News Alerts Can Bring in More Patients

By Dell Richards

Generally, there are three ways to generate more profit from a dental practice: Cut costs, recruit new patients, or encourage existing patients to use more services. Since many dentists already are doing everything they can to pare down costs, finding ways to bring patients into the office is the only alternative.

E-newsletters and alerts not only cut the cost of traditional newsletters, but also are a perfect tool for reminding current and prospective patients how valuable their dental health is. Yet few dentists use them -- or any other material -- to follow up on initial contacts.

Statistics shows that 20 percent of all leads are never followed up on. And, 90 percent of businesses give up after the first attempt -- even for people who have shown interest by contacting them.

In addition, the average response time between the initial contact and the first piece of information is 58 days, with 12 percent taking up to six months to respond.

In 1995, Performark, a leads closing firm, calculated from a six-year study of 10,000 marketers that the loss in advertising dollars from lack of timely follow-through was 82 percent.

Understandably, sending out literature or asking staff to make phone calls is a huge expense. Brochures are costly, as are envelopes, postage, and mail house prices.

All that changed with the advent of e-mail, however. Literature in the form of e-newsletters and e-news alerts can go out for much lower costs. Once a database is set up for patient groups, the only costs are research, writing, and "mailing" time.

To do e-newsletters, set up a template with your company logo at the top. Break text into 2/3 and 1/3 columns. That way, you can get in one "feature article" and a related "sidebar" with statistics -- or another shortie. The equivalent of one printed page (single-spaced) usually is enough, less than 500 words.

However, the trick is to use the "news" in newsletter. Trite, self-serving articles that do not show concrete benefits to the patient will only be seen as more spam, dumped faster than junk mail.

Newsletters must have easy-to-read, but not chatty, content that uses current health news as the basis for the articles. Those 500 words must be chock full of facts and figures that tell the reader important information. Quirky stats also can work, if they fall into the "Wow, I didn’t know that" category.

Be honest with yourself on this score. If you don’t have the time or the ability to write journalist-style news, farm it out. There are many companies that do e-newsletters and alerts for dentists and other health care professionals.

E-newletters generally go out more often than traditional newsletters. Because e-newsletters are scanned so easily, some companies send them out two or three times a week. Once or twice a month, however, is enough to keep your practice in the person’s mind, reminding them that they would be healthier if took care of their teeth better -- and came into your office more often.

The best system is to personalize the address and include the name of the recipient in the heading so that it seems like a personal letter. If you do not have that capability, send mass emails by blind copy. Never list names or email addresses.

Although it may take time to motivate patients and prospects to act, you will get more business if you make contact on a regular basis rather than wait for them to do so.

The Sacramento public relations firm Dell Richards Publicity specializes in health care clients.

Injectable Gel Effective in Treating Head and Neck Cancer

An injectable gel combining cisplatin, a chemotherapy drug, and epinephrine is effective in treating cancers of the head and neck, according to a new study published in the Archives of Otolaryngology and Head and Neck Surgery.

Squamous cell carcinoma originates in a particular type of cell found in many different parts of the body. Head and neck squamous cell carcinoma refers to this type of cancer in the head or neck.

Head and neck squamous cell carcinoma is diagnosed in about 40,000 Americans each year and more than 600,000 people worldwide. Barry L. Wenig, MD, MPH, of Northwestern Medical School, Evanston, Ill., and colleagues investigated the use of cisplatin/epinephrine gel injected directly into the tumor in patients with such cancer. Cisplatin given intravenously has been shown to be a potent agent for treatment, but because it affects the entire body when given intravenously, it can have serious adverse effects.

The authors wrote, "Therapeutic options for advanced head and neck squamous cell carcinoma are limited. These patients generally have undergone extensive surgery, have received near-maximum tolerated doses of radiation, and are often poor candidates for aggressive combination therapy. Therefore, for more effective local and regional control of head and neck squamous cell carcinoma and to minimize systemic exposure and toxicity, locally injectable therapies have been investigated."

Scientists Map DNA Segment Associated With Oral Cancer

Researchers from the University of Pittsburgh Graduate School of Public Health have produced the first detailed map of a segment of DNA associated with poor outcomes in oral cancer treatment and discovered a new gene they suspect may play a key role in cells becoming malignant.

The DNA segment, known as 11q13, contains at least nine different genes and is "amplified" -- found in excess -- in almost half of all head and neck cancers, the researchers said in an Aug. 6 report in the Pittsburgh Post-Gazette.

Using the 11q13 map developed at the university’s Oral Cancer Center, scientists will be able to quickly compare the 11q13 segments that are amplified in different cancers, possibly speeding the development of molecular markers to help them diagnose cancers and choose proper treatments.

The researchers said they don’t yet know what the newly discovered gene, called TAOS1, does but its activity increases with the number of copies of 11q13. Extra copies of the 11q13 segment are associated with poor response to treatment in oral cancer patients.

The map could also prove useful for research into other cancers associated with multiple copies of the DNA segment, including breast, bladder, and esophageal cancers, the researchers said.

The National Institute of Dental and Craniofacial Research has given the University of Pittsburgh scientists a $1.6 million grant to continue studying the 11q13 segment.

Taste Receptor for Amino Acids Discovered

Scientists recently reported the discovery of a new taste receptor that recognizes most of the 20 naturally occurring amino acids, leading them to speculate that it evolved to help humans select foods rich in these essential nutrients.

Published in Nature, the report is the latest in a series of articles resulting from a five-year collaboration between investigators jointly led by Dr. Nicholas Ryba at the National Institute of Dental and Craniofacial Research and Dr. Charles Zuker of the Howard Hughes Medical Institute at the University of California at San Diego.

According to Ryba, "The amino acid receptor is related to the sweet taste receptor that we identified and characterized last year: Both are combinations of a family of taste receptors referred to as T1R."

They made this new discovery by inserting mouse T1R genes into cells engineered to respond to and report receptor activation. Surprisingly, the investigators found that different combinations of the T1R receptors resulted in either a sweet taste receptor or an amino acid taste receptor.

The scientists note that in mice, the same taste receptor recognizes nearly all amino acids, but that the human receptor is much more specifically tuned to recognize one in particular -- glutamate.

Glutamate occurs naturally in certain foods, such as seafood, and is often added to processed food as the flavor enhancer monosodium glutamate. It has a unique flavor known as "umami," a Japanese word meaning delicious. According to Ryba, "the human receptor is far more sensitive to glutamate than other amino acids and is very likely to be a major receptor for the umami taste."

There are benefits to deciphering the umami taste pathway, Ryba noted. He pointed out that while many associate the umami taste of MSG with processed or snack foods, some researchers are using MSG to stimulate consumption of nutritious foods by those with poor appetites, such as the elderly and people with diabetes.

Scientists Report New Resin Matrix Passes Initial Tests

Scientists report in the July issue of the journal Dental Materials that two synthetic molecules designed in their laboratory to improve the durability of composite fillings had acceptable strength and good biocompatibility during initial tests.

According to the scientists, these results suggest the structure of these so-called oxirane, or epoxy, molecules can be further refined in the laboratory to produce a nonshrinking resin matrix, the chemical backbone of a composite filling.

"There has been a need in restorative dentistry for a safe, nonshrinking composite matrix," said Dr. David Eick, a scientist at the University of Missouri at Kansas City and lead author on the study. "These results mark a small, but important, research step toward meeting this need."

To eliminate the shrinkage problem, scientists need to improve the chemistry of the composite’s matrix backbone, the main source of the shrinkage. One hope is to develop a suitable synthetic molecule, or monomer, that polymerizes without losing volume as it forms chemical bonds with other monomers.

According to Eick, a strong candidate is oxirane, which polymerizes cationically. Its monomers open their aromatic rings and expand to form chemical bonds. Current composites are based on free-radical chemistry, in which their rings contract during bond formation, resulting in a slight loss of volume.

Travelers Guide to Safe Dental Care Available

A new brochure designed to assist individuals on how to receive safe dental care when traveling outside the United States is now available from the Centers for Disease Control and Prevention and the Organization for Safety and Asepsis Procedures Foundation. The Traveler’s Guide to Safe Dental Care provides tips for people when selecting a dental provider abroad and identifies basic infection control principles and practices that help travelers avoid unnecessary risks.

"In many areas, items such as gloves, sterile instruments, disposable needles, and safe water are not routine elements of dental practice," said Dr. Jennifer L. Cleveland, who manages the infection control activities of CDC’s oral health program. "This new resource can help international travelers obtain safe dental care when traveling and avoid potential situations that could lead to exposure to microorganisms or other contaminants."

The guide provides a series of steps people can take before leaving home to minimize the potential for a dental emergency. It also offers suggestions for finding a dentist, choosing medications, and assessing infection control practices in a dental office. A checklist provides a series of questions for the overseas dental office to ensure that it uses appropriate precautions to prevent disease transmission. Some questions include:

* Do staff wash their hands with soap between patients?

* Do staff wear gloves for all procedures?

* Are new needles used for each patient?

* Is sterile water used for surgical procedures?

To obtain a free copy of the Traveler’s Guide to Safe Dental Care, contact OSAP at (800) 298-OSAP. To view the brochure online, go to http://www.osap.org/patients/articles/travelguide.htm

CDA Officer Slate Forwarded to House

The Board of Trustees, acting as the Nominating Committee, has forwarded to the House of Delegates its slate of nominations for Executive Committee positions.

Per Bylaws Chapter IX, Section 30 B (c), this slate of officer candidates is being published to notify members of the slate at least 45 days prior to the House. The House of Delegates will be held Nov. 22 through 24 in San Diego, Calif.

The slate is as follows:

President Elect: Debra S. Finney, DDS
Vice President: Russell I. Webb, DDS
Treasurer: Dennis W. Hobby, DDS
Secretary: Ronald B. Mead, DDS
Speaker of the House: Matthew J. Campbell, Jr., DDS

Honors

William Lundergan, DDS, MA, professor and chair of the Department of Periodontics at the University of the Pacific School of Dentistry, has received the 2002 Pacific Distinguished Faculty Award. The award, given annually, recognizes one faculty member from the university who fulfills the highest aspirations of faculty service to students, colleagues, the profession and the community.

Upcoming Meetings

2002

Oct. 7-11 Comprehensive Dental Infection Control Course, Annapolis, MD, 800-298-OSAP

Oct. 11-13 National Association of Filipino Dentists in America Annual Meeting, San Francisco, (818) 988-3910.

Oct. 19-23 ADA Annual Session, New Orleans, (312) 440-2500.

Nov. 2 Association of Managed Care Dentists, Los Angeles, (310) 453-3439, www.amcd.org

Nov. 3-9 United States Dental Tennis Association Annual Meeting, Palm Desert, Calif., (800) 445-2524.

Nov. 6-9, American College of Prosthodontists’ Annual Session, Orlando, (312) 573-1260

Nov. 7-9, Excellence in Dentistry, Las Vegas, (800) 337-8467.

2003

March 5-8 Academy of Laser Dentistry 10th Annual Conference and Exhibition, Destin, Fla., (954) 346-3776, www.laserdentistry.org

April 24-27 CDA Spring Scientific Session, Anaheim, Calif., (916) 443-3382, Ext. 4470.

April 29-May 4 19th Annual American Academy of Cosmetic Dentistry Scientific Session, Orlando, Fla., (800) 543-9220, www.aacd.com

June 19-22 OSAP 2003 Symposium, Tucson, Ariz., 800-298-OSAP

Oct. 25-29, ADA Annual Session, San Francisco, (312) 440-2500.

To have a meeting included on this list, please send the information to Upcoming Meetings, CDA Journal, P.O. Box 13749, Sacramento, CA 95853 or fax the information to (916) 443-2943.