The study, published in the American Journal of Public Health, was conducted by a nursing-dental research team at NYU, and is the first of its kind to determine that nearly 20 million Americans annually visit a dentist but not a general healthcare provider.

The research findings give credence to the idea that dentists can play a crucial role as health care practitioners in identifying diseases which would otherwise go undetected in a significant portion of the population.

In the report, Dr. Shiela Strauss is quoted as saying, “For these and other individuals, dental professionals are in a key position to assess and detect oral signs and symptoms of systemic health disorders that may otherwise go unnoticed, and to refer patients for follow-up care.” She is the associate professor of nursing at the NYU College of Nursing and co-director of the statistics and data management core for NYU’s Colleges of Nursing and Dentistry.

During the course of a routine dental examination, dentists and dental hygienists, as trained healthcare providers, could be taking their dental patient’s health history, checking blood pressure, and using direct clinical observation and X-rays to detect risk for certain diseases, such as hypertension, diabetes,  and heart disease.

What do you think? Would you like to see dentists and dental hygienists play a greater role in providing healthcare screenings for serious medical conditions?

This is a heads up to all dental providers across the county. As states near bankruptcy, they will do everything in their power to raid healthcare benefits.

This all started when past California state Governor Arnold Schwarzenegger and law makers approved a state budget that eliminated all non-emergency dental care in the state Medi-Cal program.

The California dental clinics retaliated by suing the state because they felt the state did not follow the correct legal procedures in making the cuts to the state dental program. A federal judge blocked the Medi-Cal cuts from taking effect and California appealed the case to the U.S. Supreme Court.

In May of this year, the state of California met all the legal requirements to implement the cuts and won the right to eliminate all non-emergency dental care. Now the state of California wants back the reimbursements paid to clinics during the temporary reinstatement period from October 2010 – May 2011.

According to California Watch, Norman Williams, spokesman for the Department of Health Care Services, said in an e-mail that providers were warned during the court-order period that they may have to send back the money.

Jennette Lawrence Shea, director of government and community relations for Family Health Centers of San Diego told California Watch that their clinics provided 5,300 dental visits from October to May at sites throughout San Diego County and expects to be on the hook for about $850,000.

Dental clinics state-wide are bracing for the bills to arrive from the state –

What are your thoughts? Do you think dentists should have to repay the stat of California for the dental treatments they provided during the reinstatement period?

For more on this story see: State asking clinics to send back payments for dental care

As reported by CDG, the study indicates that gum disease is a major risk factor for strokes and it most likely has as great of an impact on strokes as high blood pressure.

According to Dr. Tiejian Wu from the State University of New York at Buffalo, it’s the presence of bacteria which leads to the high stroke risk. The bacteria gets into the bloodstream causing clotting and damage to the lining of blood vessels, which increases the risk of stroke.

For more on this story see: Gum Disease More Likely to Cause Strokes than Diabetes and Gum Disease Raises Stroke Risk

Let me repeat…The dental benefits trade organization is spending $1,000,0000 to hire a lobbying firm to convince the Obama administration to fix the provision by the end of 2011.

Is this a good thing? Click here for a 92-page white paper “Road Map” with Delta Dental as a co-sponsor.

The NADP is concerned that, starting in 2014, the almost 44 million people who receive pediatric dental coverage through small business employers will also have to buy coverage through the new health insurance exchanges. It is asking regulators to clarify that their existing coverage meets the law’s requirements.

“Truthfully, this is the No. 1 issue for our industry,” said NADP executive director Evelyn Ireland. “It is the most crucial thing for us to get done.”

NADP wants to ensure that people will be allowed to keep their existing dental insurance coverage under the new health care, a promise President Obama repeatedly made during the heath insurance reform debate.

For a multitude of reasons I have never been a big fan of Delta Dental. However, after reviewing the 92-page white paper I think there may be some merit to this $1,000,000 argument.

Before, I make up my mind, I would like some pro or con feedback from our readers.

Please post your comments below.

In Texas, Medicaid pays dentists for orthodontics per procedure, instead of a lump sum for the “finished mouth” of straight teeth.

This has made Medicaid orthodontia a lucrative dental business in Texas.

WFAA-TV of Texas has been investigating this story for the last six months and has uncovered hundreds of millions of dollars of questionable Medicaid spending on dental braces for children in Texas. Their news reports prompted federal investigators to now audit the Texas Health and Human Services Commission, which controls the Medicaid funds.

According to the WFAA website -

In a letter to the state, the Inspector General says it will examine the “authorization process for orthodontic treatment” under Texas Medicaid. “The objective of our audit,” the letter continues, “is to review the State’s controls to ensure that only medically necessary orthodontic cases are paid.” The time period covered by the audit is September 1, 2008 through May 28, 2011.

The new station’s investigation revealed that during that period, Texas taxpayers spent $424 million on orthodontic braces for children under Medicaid. Taxpayers spent $100 million in 2008, $140 million in 2009, and $184 million in 2010, state records show.

Texas dentist, Dr. Christine Ellis, who teaches at UT Southwestern Medical Center, has twice traveled to Washington in an attempt to convince lawmakers to scale back Texas Medicaid orthodontics payments and divert funds for more pressing dental needs.

Her attempts fell on deaf ears. According to the WFAA-TV article, Ellis said, “There’s no response. No one is putting the brakes on this thing.”

Billy Millwee of the Texas Health and Human Services Commission is now telling WFAA-TV that if taxpayers money has been lost, the Attorney General might take action to get it back. He went on to say that Texas will have a new managed care Medicaid dental program beginning next spring.

For more on this story see: Feds Investigate Texas Dental Medicaid Program and Taxpayers Footing the Bill for Braces in Texas.

"Americans are typically considered to have perfect teeth," said Senator McGrin (R-CA) at a press conference Tuesday. "What is at stake is nothing less than our country's international reputation."

"We will do whatever it takes to stay #1 in the world," agreed Senator Smilestein (D-NY), also speaking at the press conference. "Our plan will guarantee dental veneers for every man, woman and child in the US."

Under the proposed plan, dental veneers would become mandatory for all Americans in 2014.

Well-known for having a perfect smile himself, President Barack Obama is expected to support the bill.

"Cosmetic dentistry is a right!" declared Sen. McGrin. "For too long, dental makeovers have been limited to those who can afford them. It's simply not fair. Mandatory veneers will level the playing field, teeth-wise."

Those who have had braces or who have naturally perfect teeth may be able to apply for a special waiver. However, these individuals would be required to undergo yearly exams from a cosmetic dentist. At the first sign of decay or yellow teeth, porcelain veneers would be immediately required.

But not everyone is thrilled with the new legislation. In fact, Tea Party conservatives and ACLU liberals have joined forces to protest the bill. "Requiring cosmetic dentistry is un-American," declared Glenn Beck of Fox News. "I can't believe I'm saying this, but I completely agree with Glenn Beck," replied the president of the ACLU.

"Who is going to pay for universal cosmetic dentistry?" asked Beck. "The Congressional Budget Office has projected that mandatory veneers or lumineers for all Americans will cost the country half a trillion dollars over the next five years. High-income Americans are taxed enough already. And don't think that higher taxes to pay for this will be limited to people in the upper income brackets. You're going to see tax increases for middle-income Americans also, if this goes through."

While the National Dental Organization supports the measure, opponents have loudly challenged the measure. "What's next?!? Dental implants and dentures for children? Braces for seniors?" demanded one protester. "Why should fat-cat dentists get a special break?"

James Du Molin, president of dental website TheWealthyDentist.com, replied, "Dentists, like other small business owners, are the backbone of our economy. Why are we bailing out banks and other megacorporations? It's small businesses, like the privately-owned dental office, that create 80% of the new jobs in America."

Overall, Senators McGrin and Smilestein remain unfazed. "Government-sponsored veneers are the perfect blend of socialism and capitalism," said Sen. Smilestein. "We're confident that this solution will satisfy everyone… and cement America's position of having the best-looking teeth in the world!"

Even if the Botax is out, there's still a lot to talk about here!

Last week I ran some comments from doctors, most of which suggested that dentists oppose health reform. This week, I'm continuing along the same vein.

Wouldn't it reduce the standard of care?

"It is unbelievable there is anyone out there that thinks government health/dental care in any form will be better than what we have here today in this country. I donate many hours each year to needy patients in our area. I will be forced to stop if the government gets involved. Stop this train before it gets out of the station!"
- Gordon Rye

How much is much at stake?

"This is the end of dentistry as we know it. I get a fair bit of Medicaid patients and work pretty diligently to make a profit. With the high overhead of current dental staff (hygienist, assistants, etc), it is not is not practical to maintain a well-equipped office. It is very difficult to sell these types of insurance patients treatment plans with the attitude 'just do what the insurance covers.'

"Just try doing $60 amalgam fillings, $45 extractions and prophys and see how much it takes to make a decent living. I have to average about five fillings or extractions an hour just to make a decent living.

"If the government expects the bankers who are responsible for making billions in profits to accept $500k salary, I shudder to think what they have in mind for the healthcare practitioners. Too bad we can’t buy our way out of this healthcare bailout."
- doctooth

Will it really change your bottom line?

"We have a high percentage of indemnity patients who get free cleanings and a big percentage of them do not avail themselves of this unless there is pain involved. Therefore I feel that government-run health care for cleanings will not change our practice’s bottom line. But the bottom line in taxes and inflation will be great."
-Kirk Lundell

Do the poor have a fatalistic outlook?

"You really don’t know the people you are talking about, do you?

"Poor people in the US are fatalistic in outlook. Prevention is a hard sell, because they don’t believe it it. They generally believe they are predestined to have good or bad teeth, depending on their ancestry.

"That’s why compliance for preventive Medicaid procedures is so low. All you would end up with if people got free cleanings would be a bunch of no-show appointments."
- Kim Henry DMD

How do Medicaid patients behave?

"When I first got out of school I worked for a Medicaid practice. We had at least a 75% no-show rate when the patients were getting $1000 in free dentistry from the government, and that was in 1977, so today that would be like getting $6000 in free dentistry today.

"Even if we were successful in getting them on the phone when they no-showed, we’d usually hear 'Momma’s at the hairdresser,' 'Momma’s getting her new Cadillac,' or some other excuse for not bringing their kid AGAIN.

"That blatantly says people don’t value what they don’t pay for. The welfare worker would have to threaten the mothers with losing all their welfare money if they no-showed again."
- Loyd

What about CA’s Denti-Cal program?

"Here in California, we have had a system where folks who didn’t have resources got care, called Denti-cal, before the budget crater. Take operating costs from the early 90’s, subtract your office staff, and then you MIGHT break even. Or you can run the Dental/Medical Clinic thing-Every person, every tooth, 50% of surfaces restored with alloy or SSC’s all that day, with indentured servants(I was a new grad once also, just not willing to compromise my ethics to this level)whether they need it or not.

"Just think, you only need to see 10 patients, and place 40 SSC’s and restore 200 surfaces of alloy to make 45% of your existing salary. Or you can Sell, Sell, Sell to the credit patients on inflated contracts, and bait and switch non-precious to ceramic crowns on HMO patients, regardless of appropriate restorations, made in Tijuana from lead glaze, and take Halcion to sleep at night.

"Or you can continue to do what you do now, morally, ethically, and hope the government health plan shift won't dump all your patients onto the public option. I definitely am not looking forward to 50% of the indemnity patients not having coverage except for cleanings, and at $4-8 per patient reimbursement-monthly cap payment.

"How much will the care have to be discounted to keep people buying? 20-40%. Don’t they call that operating at a loss? Guess that means joining the ranks of those corporations who do not generate a profit(GE, GM) but a loss. I just assume that there will be no bailout money from the Govt.

"Sorry about the rant… just venting…"
- socaldds

Is health care a right or a privilege?

"The government, especially this administration, never does anything on a limited basis. Once they get in, we’re going to be just another frog on the stove.

"It pisses me off when I hear you or other dentists trying to find an angle on how to make bad public policy work for them. That’s why the medical profession is where it is today. Physicians get paid a quarter of what they charge and anyone inside our border can walk into an medical facility and get treatment for nothing.

"People value what they pay for. Healthcare is not a right, it’s a privilege. We earn it by going to school, getting a job, and paying for out of our back pockets.

"Get control of your expenses and dump those insurance plans and losers who steel your time, your skill, and your money. If you want to donate your services to the under-served, fine, do it. We don’t have to screw up the whole system to accomplish that.

"And for those of you who think that there is no difference between dealing with insurance companies who are still responsible to their policy holders and dealing with Washington which is no longer responsible to anyone, you are incredibly uninformed or just a idiot."
- wrbattarbee

Are they just getting a foot in the door?

"Government intrusion into currently private dental practice is just a foot in the door… When was the last time you saw any government entitlement program get smaller. The recipient pool always expands and more 'free' services are promised as those in power need to buy more votes every few years.

"With regard to health care reform, don’t forget about tort reform, portability of health insurance, free care to millions of illegal aliens, etc. In dentistry, don’t forget that we are not getting a bailout. We have relatively high-wage employees, high educational debt, expensive facilities, expensive equipment and with such we are able to provide a very high level of quality care.

"As far as providing care to the under served – many of the under served are that way because they do not seek care until a problem escalates. Many have the resources to pay for the care yet they choose to put their money elsewhere (priorities). There are many free clinics around the country, dental schools, and throngs of private dentists who provide treatment for reduced rates and even at no charge on a case by case basis.

"Dentistry is known for being a resourceful industry and generally rises to the occasion – we do not need the government to tell us how to do it. No system is perfect and there will always be those who fall through the cracks – but the system works pretty well now, even if there is some room for improvement.

"Look at the deterioration of our country’s infrastructure – it is falling apart. Health care is next. Don’t let it happen to dentistry."
-Brian

While it's not entirely clear what this would include, cosmetic dentistry will probably be included.

The Senate bill doesn't define cosmetic surgery, but it seems likely it would be similar to New Jersey's tax.

In New Jersey, cosmetic procedures are subject to a 6% tax. (In effect since 2005, it's the only state with such a tax.) It defines “cosmetic medical procedures” as those that are performed to improve appearance without providing significant health benefit.

The state's Treasury website provides a specific example:

"For example, charges for teeth whitening will be taxable, while charges for breast reconstruction or for vision correction by laser treatment will not be subject to the gross receipts tax."
- New Jersey State Treasury

New Jersey has netted about $11 million annually from the tax — half of what was expected.

One of the unintended consequences of the tax? Patients heading to neighboring states for aesthetic procedures.

Senators hope the proposed national cosmetic tax could raise $5 billion annually to help pay for providing health coverage over the next decade.

I'm not comfortable with trying to distinguish "cosmetic medical procedures" from ordinary medical procedures — at least not when it comes to dentistry. Presumably porcelain veneers will be taxable and root canals won't be… but who's to say a dental implant with a beautiful dental crown won't be considered a "cosmetic" procedure?

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I've been so busy it's been hard enough just keeping up with my own blog. But someone forwarded me an email that really caught my eye. It's so dead-on I wish I could take credit for having written it myself.

Here you go:

So let me get this straight…

This health care plan will be written by a committee whose head says he doesn't understand it, passed by a Congress that hasn't read it and whose members will be exempt from it, signed by a president who smokes, funded by a treasury chief who did not pay his taxes, overseen by a surgeon general who is obese, and financed by a country that is dead broke…

What could possibly go wrong?

My article last week about taxing small businesses to pay for health care reform brought in plenty of comments. And since the President's still talking about a national health plan, I thought I'd keep preaching the gospel of capitalism.

Here's a comment from one reader:

"I believe that if the proposed health plan works the way it is proposed; most of your readers would get some relief from the onerous health insurance premiums they are now paying for themselves and their staff."

I won't argue that some insurance premiums are indeed onerous. But if you think the proposed plan will really turn out like its proponents hope, then you've got more faith in the government than I have.

Another reader stood up for me:

"Did you hear the the seething distain directed at this gentleman for his success? Listen up people. You can't create wealth by dividing it. You create wealth by giving people a motivation to work hard and enjoy the fruits of their labor. Part of being free is the freedom to make choices for yourself that lead to different economic outcomes."

Why should I be put in the position of defending my success? My wife and I have done quite well for ourselves. Like most of the doctors we work with,we've done it the old-fashioned way: we've earned it.

For over 20 years, my wife and I have taught practice management and personal financial planning to dentist clients. Following the same rules we taught our doctors, we've amassed a healthy portfolio.

There was no inheritance, no lottery winnings. My father sold magazine subscriptions door-to-door. The kids in the family worked their way through college. Just like most doctors, we worked hard.

Just like most doctors, we invested our savings in our business. And like most doctors, we have shared the pain of this recession.

But we're still going strong – in no small part because of the people dependent on our small business. In our case, nearly 30 people rely on our company to keep their families clothed and fed.

Nationally, small businesses – like ours, like your dental practice – are being asked to carry the burden of health care reform. What too many people don't seem to realize is that too much taxation and regulation on the "Wealthy" will kill small businesses, which are such an essential part of our economy.

The American story is one of success and the ability of all people to achieve it. I do take exception to those whose criticize others for their success, because it is that entrepreneurial success that has brought America to the level of affluence we've achieved today.

In short, if you have a problem with capitalism, then you probably are not a wealthy dentist and have little chance of becoming one… in which case, you are definitely on the wrong website!