Millenium Bug Can Bite Dentists, Too

By David G. Jones

The year 2000 computer problem -- a.k.a. the Millennium Bug -- is arguably one of the most important issues facing industry and government worldwide.

When the new millennium arrives just 17 months from now, computer systems and networks around the world are subject to failure because of an inability to properly interpret dates beyond 1999. The problem is one of the most significant to face the world of commerce and government in history; experts estimate the cost of averting a major disaster to be about $600 billion worldwide.

Most dentists will have to pay their share of the cost before the year 2000 because their computers, software, digital X-ray equipment -- anything digital using dates -- has to be year 2000, or "Y2K," compliant. That means the equipment must be capable of "rolling over" its internal clock and successfully passing it to the software to properly operate in the new century.

"Dentistry is a cottage industry, and dentists are responsible for their actions on a day-to-day basis," says Michael J. Danford, DDS, chairman of CDA's Council on Dental Research and Developments. "I want to make dentists aware of the problem, to make sure their equipment and software is Y2K compliant."

Danford and his council have found that the problem could affect dental office computers and practice management programs.

"Practice management software may be the lifeblood of the practice and must be upgraded to handle aging of account balances, future appointment dates, and many other important functions," Danford says.

According to Danford, there is a definite hierarchy in dealing with the potential problems of the bug.

"First, your hardware needs to be compliant, and your operating system (OS) must be able to get the right date from the system's internal clock. Your software must also be able to process the date correctly," he says. "Windows 3.x and older versions of Windows 95 will need upgrading. Older Pentiums and most 486 and earlier processors are not compliant. All network and printer servers need to be checked as well."

Danford said that a Basic Input/Output System (BIOS) upgrade may be available for an individual PC from the manufacturer or via the Internet. If an upgrade is not available, he said that a new PC or main board (motherboard) may be needed. Finally, he suggested contacting software companies or checking their web sites for upgrades, patches and maintenance releases to upgrade operating systems and software.

The cost to individual dentists will depend on how much work has to be done to make their systems compliant. It could be nothing if all systems are already compliant, or it could run into the thousands of dollars if major systems and software have to be upgraded or replaced.

The next tier of potential problems are with the companies the practitioner interacts with, including third-party payers, supply and insurance companies, electronic clearinghouses, payroll services, banks and investment houses, as well as other participants in the local economy.

"It's not just your office equipment and software, but also everyone down the line has to be compliant," Danford says.

Few vendors will guarantee Y2K compliance, but dentists should ask where their vendors stand in fixing their systems and choose another vendor if needed to ensure compliance.

One major dental insurance company is putting forth massive effort to get its systems ready.

"When the scope of the problem first dawned on us about two years ago, there was a sense of dread and overwhelm," says Delta Dental spokesman Jeff Album. "We've since turned the corner, and we'll complete the testing of all our systems in June 1999."

Delta has dedicated 100 people full time to rewrite more than a million lines of computer code to fix the problem. By the time the process is complete, the company will have spent $28 million.

"This has exerted tremendous financial pressure on the company," Album says. "From a dentist's perspective, we have to ensure our systems are certified so payments can be made on time."

Another problem is the digital chips, which may not be Y2K compliant, embedded in many types of modern equipment. After midnight on Dec. 31, 1999, timed heating and air conditioning systems may not turn on or off at proper times, or may not work at all. Security systems, voice mail and faxes may malfunction. All of those problems could cut into a dental office's operation. If a device displays or uses two-digit dates, then it is suspect; and an appropriate service agency should be called.

At CDA headquarters, the Information Technology Department is approaching the problem from the ground up.

"From our perspective, this is not really an issue because we have to replace every bit of our equipment anyway due to obsolescence," says department Director Valerian Szyntar. "It's important that we do the replacement, and it cuts across all levels of CDA's operations and subsidiaries."

A Problem to Wine About

An occupation that requires wine tasting can be hazardous to one's teeth, according to a case reported in the January 1998 Australian Dental Journal.

The article discusses the case of a 38-year-old man who had worked in the wine industry for 10 years. His job involved the daily testing of an average of 20 wines. He complained of dental sensitivity to heat, cold, and wine.

Although the man's oral mucosa appeared moist and healthy and he had evidence of previous caries experience but no active lesions, he showed widespread cervical erosion, particularly bacilli. Occlusal enamel erosion was present.

To confirm that wine could cause erosion, two freshly extracted, unerupted lower third molars were tested. They were cut in half, and half of each tooth was washed in deionized water and placed in 50 ml of white wine with a pH of 3.3 at 37 degrees Celsius for 24 hours. The other half of each tooth was placed in deionized water under identical conditions.

Electron micrographs of the water-only specimens depicted the typical appearance of the ends of the enamel rods, while those from the wine showed irregular areas of erosion.

The authors suggested that people in the wine industry who must taste wine frequently consider rinsing their mouths with water after each taste to minimize erosive effects while leaving tasting acuity intact. They also suggested a topical fluoride rinse at least daily.

Use Discretion When Emotion Takes Over

Is it unethical to treat your spouse, children, parents, or siblings? What about a boyfriend or girlfriend?

In the fall 1997 issue of the Journal of the Massachusetts Dental Society, Ronald I. Maitland, DMD, and Robert Duthie, DDS, point out that when serious, potentially life-threatening or disfiguring decisions must be made during treatment of a loved one, emotional interference may affect clinical judgment.

According to the authors, discretion is the proper route; let a colleague make decisions that may involve conflicts.

The ADA Code of Ethics contains no family treatment prohibitions. Routine care should pose no problem. Dentists may treat conditions they are trained to treat, within the scope of their license.

According to the authors, however, although a dentist may treat family members, it is often inadvisable. Anyone sitting in a dental chair is a patient first, regardless of family status or social relationship. The same prohibitions, rules and regulations apply to loved ones as to the general public. All dental treatment should be accomplished in the presence of office staff during normal office hours or in the presence of a witness after hours.

A complete record must be kept for each patient, documenting all diagnoses and services and including a proper history and appropriate radiographs.

Court records reveal incredible breakdowns in family and social relations because of close relations between dentist and patient, often ending in bitter battles. The authors write that dentists may continue to treat loved ones, but they should treat them with the same cautions, competence and legality that is applied to all other patients.

"Don't let your guard down for special people," they conclude. "Special people can, under unexpected circumstances, create special problems."

Healing Can Depend Upon Nutrition

Nutritional status is one variable affecting the wound healing process in oral surgery patients, according to Julie A. Patten, PhD, in the January 1998 issue of the Journal of the Greater Houston Dental Society.

Patten lists such common causes of depleted nutritional status as poor diet, malabsorption, the catabolic effect of illness, and drug-nutrient interactions.

In the wound healing process, Patten writes, nutrients function individually and cooperatively. Because nutrients depend on one another for absorption and transport, a well-balanced diet that is properly absorbed is vital for tissue repair.

Patten writes that although no dietary guidelines guarantee good health, eating patterns based on moderation and variety help build sound, healthy bodies more resistant to the stresses of inflammation and wound healing.

Oral surgical patients require attention to their nutrient needs, Patten writes. Evaluating patients' diet histories by comparing them with the USDA's Guide to Daily Food Choices can help assess their nutritional status and potential of optimal wound healing.

Characteristics of patients at risk nutritionally include:

• Being severely underweight (less than 80 percent of standard for height) or overweight (more than 120 percent of standard for height);
  
  
• Recent loss of 10 percent or more of body weight;
  
  
• Substance abuse, especially alcohol;
  
  
• Acute or chronic disease; and
  
  
• Use of drugs such as steroids, immunosuppressants and antitumor agents with antinutrient or catabolic properties.
  

Caries in Little Ones is Still a Big Problem

Although baby bottle tooth decay continues to receive considerable attention, the issue of caries experience in preschoolers has, by and large, been neglected, according to a study by S.M. Hashim Nainar, BDS, MDSc, and James J. Crall, DDS, ScD, and reported in the November-December 1997 issue of the Journal of Dentistry for Children.

The lack of caries experience data on preschoolers, coupled with the observation that low socioeconomic status has been shown to be associated with increased risk for caries development, underscores the importance of fielding data on caries prevalence in inner-city preschoolers, write the authors, who studied caries experience in a sample of inner-city children aged 5 years and younger at the time of their initial dental visit.

Of preschool subjects who came to the inner-city clinic for their first dental visit, 67 percent exhibited caries. Those younger than 3 averaged 4.3 decayed surfaces; those aged 3 to 5 years averaged 7.08 decayed surfaces. Mean caries prevalence increased with age for all surfaces, the authors report. Buccal/lingual caries was the predominant type in subjects younger than 3 years of age, with a mean of 1.75 decayed surfaces. Occlusal caries predominated in 3- to 5-year-olds, with a mean of 3.24 decayed surfaces.

The majority of the children in the study sample had caries levels that place them at high risk for caries in the permanent dentition. Results of the study, the authors write, are significant from epidemiological and public health perspectives and support arguments for targeted early intervention programs.

The findings are also relevant to those responsible for financing and delivering dental services for preschoolers. A high proportion of preschoolers from households of low socioeconomic status exhibiting considerable untreated dental disease is a factor that bears consideration in formulation of managed-care arrangements. The need to use sedation or general anesthesia to provide dental services for many preschoolers with advanced dental treatment needs is an aspect that has financial and delivery system implications. The requirement not only increases treatment cost, but also requires a higher level of training and expertise on the part of clinicians providing services for these children, the authors write.

Road to Brazil

The American Dentists for Foreign Service Inc. is asking dentists to volunteer their services at dental operatories in various areas of Brazil.

Dentists are needed on a continuing basis starting this month in Macapa and Marahoe in the city of Sao Luis. Lodging and food will be provided, but dentists are asked to supply their own instruments, supplies, syringes, and anesthesia. A copy of one's dental license will be required in Brazil. Dentists interested in volunteering should call the service program at (718) 436-8686.

Sjögren's Study Volunteers Needed

Women age 18 or older, with a diagnosis of primary Sjögren's syndrome, may be eligible to take part in a National Institute of Dental Research study that will examine the effects of treatment with the hormone DHEA (dehydroepiandrosterone). Earlier studies for other conditions indicate that DHEA will be effective in Sjögren's patients. Sjögren's is a systemic autoimmune disease that usually occurs in women. The most common complaints of patients with Sjögren's are dry mouth and dry eyes. Those who participate in the study will receive care by some of the nation's leading experts in the field. Evaluation, diagnosis and study medication are provided to patients at no cost. For more information, contact the National Institutes of Health's Patient Recruitment and Referral Center, at (800) 411-1222, or fax (301) 480-9793, or email prrc@nih.gov.

Upcoming Meetings
1998
July 11-17 National Wellness Conference, Stevens Point, Wis. (800) 243-8694
Aug. 14-15 Academy of LDS Dentists Conference, Provo, Utah (801) 378-4851
Sept. 11-13 Oral Health 2000 Consortium, San Diego (312) 836-9900
Sept. 13-16 American Academy of Periodontology's Annual Meeting, Boston (312) 573-3210
Sept. 16-19 American College of Prosthodontists Annual Session, San Diego (800) 378-1260
Oct. 1-3 Annual Scientific Session of the Academy of Surgical Research, Nashville, Tenn. (612) 927-6707
Oct. 2-3 Society for Advanced Dentistry Inaugural Meeting, New Orleans (317) 290-2613
Oct. 8-12 World Dental Congress, Barcelona, Spain +44 171 935 7852
Oct. 8-10 American Society for Dental Aesthetics International Conference on Aesthetic Dentistry, Chicago (800) 454-2732
Oct. 24-28 ADA Annual Session, San Francisco (312) 440-2500
Oct. 31-Nov. 3 Pacific Coast Society of Orthodontists Annual Session, Palm Springs, Calif. (415) 441-2410
Nov. 19-21 International Dental Showcase, NEC Birmingham, U.K. 01722 335599
1999
April 8-11 CDA Scientific Session, Anaheim (916) 443-3382, Ext. 4470
April 13-17 International Dental Show, Cologne, Germany, http://www.koelnmesse.de/ids
Aug. 20-22 CDA Scientific Session, San Francisco (916) 443-3382, Ext. 4470
Sept. 17-18 Society for Advanced Dentistry Annual Meeting, New Orleans (317) 290-2613
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) 443-3382.