It's Time to Say 'Thanks for the Assist'

By David G. Jones

They're not unlike the mortar that bonds individual bricks into a wall, or the spokes that make a wheel so strong. They're a legion of almost 60,000 dental assistants across the country, from New York City to San Diego, who are working to help bind together the team of dental professionals who each day seek to improve the oral health of Americans.

Their work is so significant that two decades ago the American Dental Association and American Dental Assistants Association established Dental Assistants Recognition Week. Its purpose is to promote teamwork and recognize dental assistants as an essential part of the dental team. Dental Assistants Recognition Week this year is March 8-14.

"Some dental assistants are fortunate enough to be appreciated on a daily basis, but since they're such a vital part of the dental office, someone once said all dental assistants need to be appreciated, and this is a great way of doing it," says Ruby Roach, CDA, RDA, and president of the California Dental Assistants Association.

Recognizing the importance of dental assistants, CDA annually offers, in conjunction with its subsidiaries, more than $15,000 in scholarships to students who seek to enter the field. The association also has a three-member Auxiliary Recruitment and Retention staff that promotes dental assisting as a career. The ADA and ADAA provide kits to state and local associations to promote activities recognizing dental assistants and sponsor a contest to recognize notable efforts.

"The dental assistant helps the dentist by performing dental treatment procedures they're licensed to do, thereby maximizing both production and profits," says Janet Mitrovich, coordinator of CDA's Council on Education and Professional Relations.
She also said that use of a dental assistant helps improve patient communication.
"Patients are often more willing to ask questions and express concerns to someone other than the dentist," Mitrovich says.

An expert in dental assisting provided another viewpoint honed through more than 40 years of chairside and front office experience.

"There are many duties delegated to RDA's now that in turn allow dentists to do much more diagnostic and other work," says Sally Ingram, CDA, RDA, who began her career in 1954 in the Los Angeles area. "This, and the fact that RDA's are high-quality sorts of individuals, goes a long way in helping to reduce the stress and strain on dentists. Dental fees would also go out of reach of many people if RDA's didn't take more of a role in direct patient care."
Before introduction of the ultra high-speed handpiece in the late 1950s, there was less need for direct patient care, Ingram says, but after its introduction, dental assistants became more important, resulting in "a tremendous evolution in duties."

"We got more involved with direct patient care, and we were excited to be doing it, because we had the opportunity to promote more togetherness in the office because of our ability to do more duties, which helped to integrate us into the team."

Recognizing the increasing importance of the duties dental assistants were performing, the California Board of Dental Examiners in 1976 required testing and registration. Ingram took and passed the first written exam.

"If you're a good worker, you can earn a good salary, and if you're good, you'll always have a job," she says.

Average hourly compensation for dental assistants nationally is $12.60, according to Kristy Borquez, CDA, RDAEF, immediate CDAA past president and ADAA trustee for District 12. Nationally, the highest-paying district, at $15.21, is the 12th, consisting of California, Nevada, Hawaii and Guam. While financial compensation remains a driving force in working as a dental assistant, one dentist, prominent in the profession, explained how good workers in the field can also move up the career ladder.

"In my practice, I have seen three dental assistants take their interest in dentistry to another level," says Eugene Sekiguchi, DDS, CDA's executive director. "Their interest turned to enthusiasm, and I'm proud to say they pursued an educational path to become dentists."

In 1997, 1,985 new dental assistants were registered in California, according to BDE figures. One was Christine Aguilar, who turned her love for children into a dental assisting job at the office of Linda Rafferty, DDS, a Sacramento pediatric dentist.

"I talk to the parents about importance of oral care, and provide some hygiene tips, so by the time I'm done the patient is ready to see the dentist," says Aguilar, a 1997 graduate of Sacramento City College. "It's also a good challenge to help calm down the apprehensive children. I try to make it fun for the kids."

Whether its calming an anxious child, or performing one of a myriad of other challenging duties, dental assistants work to enhance our oral health. And according to Borquez, Dental Assisting Recognition Week provides, "a little recognition that goes a long way toward achieving a winning team which benefits everyone."

Ancient Dental Work Was Ironclad

A 1,900-year old skull from Roman Gaul has yielded surprising evidence of an ancient form of a viable dental implant.

The skull, from a man in his 30s who died in the first or second century, had a fully osseointegrated wrought iron "tooth" where the right second upper premolar should have been, according to an article in the Jan. 1 issue of the journal Nature.
Authors Eric Crubezy and colleagues believe that the original tooth was used as a model for the implant and that the implant was set by impaction soon after the original was lost. The iron's rough surface seems to have provided sufficient adhesion for the bone. It is thought that the implant was placed at least a year before the man's death.

Because of the osseointegration and good positioning, it is believed that the tooth may have been functional.

Denturism Doesn't Take a Bite Out of Prices

In Ontario, denturists have had the right to provide complete dentures to the public since 1974 and partial dentures since 1991. Legislation allowing these changes was passed based on denturists' claims that they could provide these services to patients at a lower charge than dentists could.

A study published in the November 1997 issue of Journal of the Canadian Dental Association, however, finds that no substantial cost savings is being realized.
The study focused on the fee guides published by the Ontario Dental Association and the Denturists Association of Ontario. It did not take into account the differences in training or approach.

The fee guides are published to assist respective members of the associations in setting their own fee schedules. They are also used by third parties and government agencies to establish reimbursement rates for procedures. They represent the maximum a provider would charge for a procedure under normal circumstances.

The study showed that a number of procedure fees were on average 15 percent higher in the ODA fee guide; however, a wide range of prosthetic services were less expensive in the ODA fee guide.

Author Stephen H. Abrams, DDS, says, "An analysis of the fees listed in the 1996 ODA and DAO fee guides revealed no substantial differences between the suggested clinical fees charged by dentists and denturists. In fact, when the cost of laboratory services are factored in, the cost of treatment is higher when the denturist's fee guide is used."

HIV Risk Falls With Postexposure Zidovudine

Postexposure prophylaxis with zidovudine following percutaneous exposure appears to reduce the risk of HIV infection, according to a study published in the Nov. 20, 1997, issue of The New England Journal of Medicine.
The study also found that the risk of HIV infection after percutaneous exposure increases with a larger volume of blood and a higher concentration of HIV in the source blood.
The case-controlled study looked at health care workers with occupational, percutaneous exposure to HIV-infected blood. The case patients were those who seroconverted after exposure, as reported by national survey systems in France, Italy, the United Kingdom and the United States. The controls were health care workers who were exposed but did not seroconvert.

Significant risk factors for seroconversion were found to be deep injury, injury with a device visibly contaminated with blood, procedures involving a needle placed in the source patient's artery or vein, and exposure to blood from a source patient who died of AIDS within two months.

Also, the study indicated that the odds of HIV infection among health care workers who took zidovudine prophylactically after exposure were reduced by 81 percent.

Income Increases for Most Dentists

Three-quarters of dentists in the Pacific region of the United States saw their gross personal income increase in 1996, according to a survey published in the November/December issue of Dental Practice & Finance.

The Pacific region -- consisting of Alaska, California, Hawaii, Oregon and Washington -- lagged behind the rest of the nation in several financial areas according to the survey. At 75.4 percent, the number of dentists whose gross personal income increased was less than the 76.5 percent figure nationally. Also, 70.5 percent of respondents took home more pay (before taxes) than the year before. That figure was 73.2 percent nationally.

Pacific region dentists led the pack in one significant area: cutting overhead. Just more than 24 percent were able to reduce their overhead expenses from the year before while 20.7 percent of dentists nationally were able to accomplish this task.

Other information from the survey:

One-third of the Pacific region's dentists (32.8 percent) take home less than $100,000.

Half the region's dentists (50.7 percent) take home from $100,000 to $200,000.

Of the respondents whose take-home pay increased, most cited working harder and increasing production as the reason.

The information was gathered in a survey of 3,500 dentists, with 1,300 responding overall and 930 providing information on their take-home pay.

Teeth Flee Smokers' Mouths

Smoking increases the risk of tooth loss, and quitting smoking can reduce that risk, according to a study published in the October 1997 issue of the Journal of Dental Research.
The study looked at rates of tooth loss and edentulism of 248 female smokers from the Boston area and 977 male smokers participating in the VA Dental Longitudinal Study in Boston.

The study showed that smokers had increased rates of tooth loss over nonsmokers: 2.4 times for men and 3.5 times for women.

The rates of tooth loss in men were significantly less after they quit smoking but still higher than those of men who never smoked. Although quitting smoking reduces the risk of tooth loss, the authors conclude that it could take decades before the rate declines to that of never smokers.

The study showed no significant differences by smoking history in plaque, tooth mobility, probing depth of less than 2 mm, filled and decayed teeth, and bleeding on probing.

Study Supports Efficacy of Sealants

A study of a sealant program in Australia has shown that the procedure is an excellent way to prevent caries in school children.

The School Dental Service in Victoria places dental sealants on school children. A total of 5,363 sealants placed on 2,875 permanent teeth were examined for retention. Some of the findings on retention rates were as follows after 4 1/2 years:

On premolars, 86 percent were completely retained and 9 percent partially retained.
On maxillary first molars, 63 percent were completely retained, 30 percent partially retained.
On mandibular first molars, 62 percent were complete retained, 32 percent partially retained.

Under partially retained sealants, the caries rate was 4.5 percent. Under completely retained sealants, the caries rate was 0.4 percent. The authors conclude that the School Dental Service sealant program is a sound preventive dental public health approach.

Honors

Dr. Arthur A. Dugoni, dean of the University of the Pacific School of Dentistry, has been selected as the 1997 recipient of the Dr. Irving E. Graber Award, which recognized excellence in the advancement of dental education.

Dr. Gregory P. Johnson of Irvine has been elected president of the California Association of Orthodontists.

Upcoming Meetings - 1998

March 27-29 10th annual National Conference on Special Care Issues in Dentistry, Chicago (312) 440-2660

April 3-7 American Society for Laser Medicine and Surgery Annual Meeting and Courses, San Diego (715) 845-9283

April 23-25 British Dental Association's National Dental Conference, Harrogate, Yorkshire, England 0171 935 0875,
Ext. 286/233

April 30 - May 2 American Academy of Periodontology's Periodontal and Restorative Conference, Chicago, (312) 573-3243.

May 6-10 American Association of Endodontists 55th annual session, New York, (312) 266-7255, Ext. 3006

Sept. 11-14 Sixth Oral Health 2000 Consortium, San Diego (312) 836-9900

1999

April 13-17 International Dental Show, Cologne, Germany, http://www.koelnmesse.de/ids