Inventiveness Is a Useful Travel Partner

By David G. Jones

Deep into the hinterlands he treks, taking with him little more than his initiative, training, a armload of equipment and supplies -- and an ability to improvise.

Implicit as the animating facet for the travels and trials of Kenneth O. Crosby, DDS, is a desire to bring modern dental care to the world's technological backwaters.

The results of his forays into exotic realms such Nepal and Albania are people whose pain has eased and whose smiles have gained luster.

Since 1992, Crosby, a CDA member who practices in Fresno, Calif., has made four trips as part of a six-person team to provide dental care to people living in medical dark ages.

Crosby began his long-distance dental work when he was invited to join the team on a trip to Albania, where that country's people found their care provided by a corroded medical system reeking of communist obsolescence.

How bad was it? No anesthesia was used for fillings or root canals because none was available.

But when the team arrived, Crosby and his colleagues opened their suitcases, pulled out instruments and supplies, and set up shop on a local dentist's front porch.

"The local dentists couldn't believe these Americans could set up a whole clinic just out of a couple of suitcases," Crosby says. "One of the nice things about dentistry is that you can put everything you need for two or three weeks in the field into a couple of suitcases. And the work you do lasts for many, many years."

But inventiveness has been a necessary overseas companion. The team found that cardboard platforms passing for dental chairs became useless when wet, so Crosby went to work.

"I took some corrugated plastic and made a dental chair that weighs about five pounds, folds for travel in a suitcase, yet can hold up to 275 pounds," he says.

Crosby found many of the local dentists to be relatively well-trained, but they lacked supplies. Subsequently, the team gave the dentists supplies that had been donated for the trip such as 2,500 doses of anesthetic, burs, endodontic instruments and other basics. The team also exposed the local dentists to procedures that were unfamiliar or even unknown to them.

At least one bit of work done by Crosby in Albania gave a potential career boost to his patient.

"I had the opportunity to do composite fillings and crowns on teeth 4 through 12 for a television personality there," Crosby says. "You could see her cavities from across the room, but their television system is so grainy, I suppose viewers didn't see it on their sets.

"And doing a blue light composite was like walking on water to the local dentists."

Composites became a huge challenge on a subsequent trip to a remote area of Nepal which had no running water or electricity. To reach the village in the Himalayan foothills, the team crossed a rope suspension bridge -- " 'Indiana Jones' type," Crosby says.

Root canals were done with the assistance of handpieces powered by generators the team packed in, but only another extemporaneous adjustment by Crosby answered the composite question.

"I couldn't cure the composites, so I invented a solar-powered unit," he says.

Using an 11-inch Fresnel lens, Crosby focused 121 square inches of sunlight onto a quarter-inch spot and funneled the energy through a fiber optics bundle to a curing want fitted with a blue filter.

"It did the trick," he says.

The need in Nepal, where, as with Albania, he has twice traveled, was "mind blowing."

"We saw 745 patients in the (tent) clinic on this trip, and I personally saw 88 patients in one day," he says.

And the patients? Very grateful, very tough.

"To do root canals, we used 25-gauge needles to administer the anesthetic and didn't use any topical anesthetic, and nobody even said 'boo,' " Crosby said. "They had some teeth rotted off at the gum line, so it was no big deal."

But the goodwill -- not mention the spirit of help and useful improvisation -- left behind by the team and its supporters will be felt long after the anesthesia has worn off and the memory of long-endured pain subsides.

When Relief Becomes an Opportunity

By Marios P. Gregoriou

Designed primarily to reduce the federal deficit and balance the budget, the Taxpayer Relief Act of 1997 contains changes in tax law that could have a significant impact on an individual's financial strategy now and in the future.

The historic legislation contains provisions that affect a variety of financial goals, including: capital gains tax rates; retirement savings; education funding; home sales; estate taxes; and tax credits for many families with children.

The Act profoundly enhances investment opportunities for millions of Americans. Following are a few important provisions of particular interest to investors:

Significant reductions in capital gains tax rates: The maximum rate for long-term capital gains from the sale of stocks, bonds and most other investments has been lowered from 28 percent to 20 percent. The law also creates a new 10 percent capital gains rate for taxpayers in the 15 percent income tax bracket. The new 20 percent and 10 percent rates are applicable to investments that have been held for longer than one year and sold after May 6, 1997, and before July 29, 1997. Investments sold after July 28, 1997, must have been held longer than 18 months to qualify for the new rates.

New and enhanced Individual Retirement Accounts: The Act enhances traditional IRAs and creates two new IRA alternatives, the Roth IRA and the Educational IRA.

Enhanced traditional IRA. When an individual participates in an employer-sponsored retirement plan, income limits for fully deductible IRA contributions will gradually be increased over the next several years, ultimately doubling the current limits to $50,000 for single tax filers by 2005 and $80,000 for joint tax filers by 2007. (For 1998, income limits for making fully deductible contributions will be $30,000 for individuals and $50,000 for people filing jointly.) In addition, spouses of active participants in employer-sponsored retirement plans who are not covered by their own plans can make fully deductible IRA contributions, regardless of whether they are wage earners, if the couple's adjusted gross income is $150,000 or less in 1998.

Also, the IRA account holders will be able to make withdrawals without penalties before the age of 59 if the funds are used to purchase a first home or to pay expenses associated with higher education. (The home withdrawal has a lifetime maximum of $10,000,)

Roth IRA. Eligible participants may make a contribution of up to $2,000 per year. All contributions will be non-deductible; however, earnings accumulate on a tax-deferred basis. Withdrawals will be tax-free if the account has been open for more than five years and the investor is at least 59 , is disabled or dies or the funds are used to finance a first-time home purchase ($10,000 lifetime maximum).

Any distribution not meeting the five-year rule and any of the other four requirements will be taxable to the extent distributions exceed previous contributions. The 10 percent premature distribution penalty will apply unless one of the exceptions to the penalty for distribution from traditional IRAs applies.

The adjusted gross income limits to determine whether investors are eligible for the Roth IRA begins at $95,000 for single taxpayers and at $150,000 for people filing jointly. Those whose income is above the limits to be eligible for a Roth IRA or to deduct a traditional IRA contribution can still make non-deductible contributions to a traditional IRA.

Eligible taxpayers can contribute to both types of IRA each year, but total contributions cannot exceed $2,000.

Educational IRA. This third IRA category will allow individuals who fall within certain income limits to contribute up to $500 per year per child to this account until the child reaches 18. Like the Roth IRA, contributions will not be tax deductible, but the earnings accumulate on a tax-deferred basis, and there will be no taxes on withdrawals, provided the funds are used to pay for the child's qualified higher-education expenses.

The legislation offers welcome tax relief and creates new opportunities for individual investors. For more information, contact your investment professional.

Mr. Gregoriou is an associate vice president for investments with Dean Witter. He can be reached at (800) 755-8041. Dean Witter is not a tax adviser, and investors should consult their individual tax advisers before making tax-related investment decisions.

Honors

Robert Ibsen, DDS, of Santa Maria, the founder and president of Den-Mat Corporation, received the 1997 Dental Trade Industry Award by the Pierre Fauchard Academy.

(photo)

Bill Harman, PhD, associated dean for Student Services at the University of the Pacific School of Dentistry was awarded honorary membership in the American Dental Association.

Focus of IRS Can Be Taxing

The IRS may direct dentists nationwide to convert their accounting method from a cash to an accrual basis, if some recent incidents in Chicago have a national bearing, reports AGD Impact, the newsmagazine of the Academy of General Dentistry.

An Illinois dentist, who asked not to be named, was notified last year that the IRS would be examining his financial records for the 1995 tax year. He later learned that four other dentists in his town were also being audited.

The IRS concluded that the dentist should convert his accounting method from a cash to an accrual basis. Under the cash basis, income is taxable when the cash is received, while under the accrual basis, income is taxable when the service is performed.

The Illinois dentist believes the IRS may be planning to establish accrual-basis accounting for dentists nationwide. The change, while not necessarily resulting in more taxes being paid, would put the money in the IRS' hands sooner.

Rating Providers Spurs Them to Change

Giving consumers reports on health care providers not only helps patients and their families make informed decisions, but also prompts physicians and hospitals to make changes in their practices, according to an article in the Nov. 19 issue of The Journal of the American Medical Association, an issue devoted to quality of care.

Daniel R. Longo, ScD, from the University of Missouri-Columbia School of Medicine, and colleagues at the Missouri Department of Health examined consumer reports issued in 1993 to all Missouri hospitals providing obstetrical services. Like consumer reports for automobiles or home appliances, consumer reports for health care can provide information that can be used by consumers in deciding which physician or hospital to use. A survey of hospitals was conducted a year later to determine, among other things, what changes were made at Missouri hospitals following the release of the consumer report.

The authors write, "Consumer reports are gaining a great deal of attention from consumer groups, health care delivery organizations such as hospitals, and managed care organizations and physicians. They are included as a requirement in many state and national health system reform proposals. They are also being developed by managed care plans and some hospitals as a marketing tool to differentiate themselves based on both quality and cost."

Researchers found that hospitals with either low or average patient satisfaction quality indicators were more likely to have changed, or be planning to change, policies relating to those indicators than hospitals with high quality scores. However, only about 20 percent of those hospitals with low or average indicators expressed any consideration being given to changes in policies.

The researchers discovered hospitals that did not provide a service mentioned in the survey and that had a competitor in the same community were more likely to institute a service after the consumer report was published.

"It appears that although consumer reports were initially designed to assist patients in making better decisions about personal health care, they have been carefully evaluated by health care clinicians and delivery organizations," the authors write. "This phenomenon is fortuitous and should be explicitly taken into account by future consumer report releases."

Ketoprofen Climbs Over the Counter

Ketoprofen, a nonsteroidal anti-inflammatory drug, has been approved as an over-the-counter analgesic at a 12.5 mg dosage.

In a study published in The Journal of Clinical Dentistry, Vol. VIII, No. 4, dental researchers explored the analgesic efficacy and safety of 12.5 mg of ketoprofen in patients experiencing pain following removal of impacted third molars.

Researchers found that ketoprofen has an analgesic onset of within one hour and an analgesic duration of nearly four hours. Somnolence was the most often reported side effect, experienced by about 13 percent of patients in the study group.

The study concluded that 12.5 mg of ketoprofen is a safe and effective analgesic for relief of postsurgical dental pain. The researchers noted that they found the overall efficacy of the 12.5 mg dosage impressive for an over-the-counter analgesic.

Wooden Nickels Accepted Here

Dr. William Robinson, an orthodontist in Sherman, Texas, has rewarded his patients with wooden nickels for such things as good oral hygiene and keeping appointments. Patients save and redeem the nickels for prizes including toys, notebooks, compact discs and telephones.

An article in The Bulletin, from the American Association of Orthodontists, July/August, reports that Robinson's treatment coordinator explains the program to new patients, who receive three tokens on their first visit. Robinson estimates the program costs from $300 to $400 a month, but the cost has been balanced by increased patient compliance and cooperation. The nickels also serve as a marketing tool: Each one has Robinson's name and address printed on the back.

It's Progress But Not Parity

Women seem to be making consistent progress in higher education, according to the Bulletin of Dental Education of the American Association of Dental Schools, September 1997.

The number of women presidents of colleges and universities has more than tripled, from 148 in 1976 to 453 in 1996. The number of women faculty members has also increased, and women now receive 54 percent of all bachelor degrees and 38 percent of all doctorates. Sixteen percent of all top leaders in U.S. higher education institutions are women.

However, in the United States, only six medical school deans are women, with only 4 percent of medical school chairs being women. In the 55 U.S. dental schools, there is only one acting female dental dean. Nearly half of U.S. dental schools lack women at the assistant and associate dean level; only 6 percent of department chairs are women.

Though there is data indicating progress, little has been done to understand the social, cultural and psychological dynamics that influence the advancement of women. Often biases and assumptions about women in positions of authority go unexamined and unaddressed.

The Bulletin article suggests a need to understand the dynamics in institutions and how the social and professional climates influence women and their development.

ITMD Linked to General Health

Several studies have revealed that temporomandibular disorders and general health are associated.

In 1992, Marjaana Kuttila, DDS; Seppo Kuttila, MD; Yrsa Le Bell, DDS, PhD; and Pentti Alanen, PhD, began analyzing the relationship between need for treatment of temporomandibular disorders, sick leaves, and use of health care services in a study population of 441 adults.

The authors' findings, published in the Journal of Orofacial Pain, Vol. 11, No. 3, 1997, indicated that these were strongly associated, suggesting that stomatognathic disorders are one link between medicine and dentistry in health care.

The study showed that subjects with TMD were on sick leave more often, visit physicians often and use much medication, physiotherapy or massage. Limited awareness of the physician to diagnose and treat TMD often leads to unnecessary radiographs, antibiotics and pain medications.

The authors believe that proper treatment for TMD patients would be referring the patient to a stomatognathically experienced dentist to minimize suffering and total cost.

The clear association between TMD treatment need and the use of health services emphasized the necessity of comparing different treatment modalities in chronic pain conditions in the head, neck and shoulder areas, the authors concluded.

Disinfectants Still Clean Up Against Bacteria

As bacteria become more resistant to antibiotics, they do not become more resistant to disinfectants, according to the American Journal of Nursing, November 1997.

The article cites researchers who tested the germicidal power of two disinfectants against 12 strains of seven bacterial pathogens.

The study pitted antibiotic-susceptible and -resistant bacteria against representative disinfectant products from two common classes (a phenol and a quaternary ammonium compound) at two strengths (recommended use-dilution and twofold concentrated solution in sterile distilled water).

The researchers found no correlation between antibiotic resistance and germicide resistance at either concentration. For five pathogens, they compared a susceptible and a more antibiotic-resistant strain. Only in one of 20 comparisons was the more antibiotic-resistant strain significantly more resistant to the germicide (Klebsiella pneumoniae, exposed to quaternary ammonium compound at use-dilution strength).

Current disinfection and housekeeping protocols don't have to be altered to account for antibiotic-resistant bacteria, nor do resistant bacteria need to be routinely monitored for susceptibility to disinfectants, the study authors conclude.

Given the tendency to use disinfectants at a much higher concentration than the minimum inhibitory concentrations, they say, even the more antibiotic-resistant strains should be controllable.