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CONTENTS 4 OFFICIAL PUBLICATION OF THE UTAH DENTAL ASSOCIATION

CONTRIBUTING WRITERS Dr Mike Smuin Dr Drew Jones Dr Val Radmall Dr Kay Christensen Dr Mark Taylor Dr Scott Theurer Dr Darren Chamberlain Dr Ken J. Baldwin Dr Gary Herman Dr Emily Iskhanian Dr Greg Gatrell

Eunice J. Scotto Dr Brent A Larson Dr AJ Smith Dr Rodney Thornell Dr Cody Calderwood Dr Kim Michelson Brooke Meyer Dr Rich Herman Shaylee Avery Becky Waters Dr Jerald Boseman

PRESIDENT'S MESSAGE Our Association

ASSOCIATION 8 2020-21 UDA Board of Directors 10

Huddle Up!

Getting Utah Dentists Back to Work

What if Organized Dentistry Went Away?

UDA Dental Hygiene Affiliate Membership

Collaborative Dentistry

CONVENTION 6 Salt Palace Convention Center Cancels the UDA 2021 Convention

Salt Palace Convention Center Cancels the UDA 2021 Convention (Cont)

EDITORIAL 5 The Snowman COVER PHOTO Antelope Island Image Credit: Â© Kim Lund

PUBLISHER: Mills Publishing, Inc. PRESIDENT Dan Miller

OFFICE ADMINISTRATOR Cynthia Bell Snow

ART DIRECTOR Jackie Medina

GRAPHIC DESIGNERS ADVERTISING REPRESENTATIVES Paula Bell Ken Magleby Paul Nicholas Patrick Witmer

The Utah Dental Association holds itself wholly free from responsibility for the opinions, theories or criticisms herein expressed, except as otherwise declared by formal resolution adopted by the association. The UDA reserves the right to decline, withdraw or edit copy at its discretion.

UDA Action is published bi-monthly. Annual subscriptions rates are complimentary to all UDA members as a direct benefit of membership. Non-members $30. Utah Dental Association, 801-261-5315 1568 500 W Ste. 102, Woods Cross, Utah 84010 uda@uda.org. UDA Action is published by Mills Publishing, Inc. 801-467-9419; 772 East 3300 South, Suite 200, Salt Lake City, Utah 84106. Inquiries concerning advertising should be directed to Mills Publishing, Inc. Copyright 2021.

LEGISLATIVE

LETTER

PUBLIC HEALTH

University Of Utah School Of Dentistry Assumes Responsibility For Former Family Dental Plan Clinics And Expanding Medicaid Dental Benefits To Adults

Utah Department of Health Closes Dental Clinics McCarran-Ferguson Act Medicaid - Significant Changes Have it Look Up

PRACTICE

Putting Dental Insurance Companies in their Place

Non-Covered Services

Proper Referrals Help All of Us

He Wants You to do What? Ethical Issues of Providing Second Opinions

Practicing Dentistry without a License in Utah?

How Much Would your Practice Benefit if you Could Focus Solely on Caring for Your Patients?

The Rise of Addiction Problems in Dentists and How to Get Help

Life Threatening Emergencies in the Dental Office

How COVID-19 has Changed Dental Schools

COVID-19 Vaccinations and Testing in Dentistry

PRESIDENT'S MESSAGE

OUR ASSOCIATION We made it through 2020, and that was no small achievement. I certainly hope that your holidays were filled with joy, rest, family time, and good will. 2021 hopefully will be less dramatic that 2020. This edition of the UDA Action is going out to all dental professionals in the state as opposed to members only. We intend for this issue to have a positive affect on membership in the UDA/ADA. The voice of influence of the UDA/ADA is strengthened by the percentage of dental professionals that support “our association”. In saying “our association” I am not referring to the national or state leadership or their boards; I am referring to us as individual dental professionals. These associations are “OURS”. The UDA/ADA are professional associations that are leading, educating, representing, protecting, defending, and supporting dental professionals through-out the country and state. The benefits of these associations go far beyond those who are current members. Many of the benefits, most notably government advocacy, extend to all dental professionals not just dues paying or contributing members. As a leader in the UDA I have come to appreciate the work and mission of the associations. Obviously not everything that is done is agreeable to everyone. I think we all realize that is impossible, each of us has experienced this in the practice of dentistry, you can’t please them all. The same is true of the associations, however the overall impact of their work has promoted and protected dentistry for many years. Often as practitioners we are lost in our own worlds and the wins of the associations go relatively unnoticed. Because of my involvement in the leadership for the past 4 years, I have come to appreciate that the wins are true wins, and even the losses many times are wins. Occasionally, the associations have to make a compromise in order to prevent a more adverse outcome, we were unable to have it our way, a loss, but it could have been much worse, which is a win. Without the involvement of the associations dentistry and the public would have been negatively impacted.

membership dues in Utah are among the lowest in the country. This is a result of the UDA staff and leadership being mindful of the cost of membership and trying to provide quality service at a modest price. The UDA staff are awesome! To those who, for whatever reason, are not dues paying or contributing member’s please reconsider. There is no doubt that you are benefiting from the work of the associations. This year with all of the COVID-19 happenings I don’t think there has ever been a better example of how the voice of influence has worked to benefit all of dentistry not just members. I am certain that everything which was said or done did not please everyone, we received plenty of phone calls to verify that statement, we were all navigating through the pandemic not knowing where we would land. Even at the time of this writing there are still plenty of question marks. The work of the associations have definitely influenced dentistry for the good, this was certainly true right here in our state with getting back to work in May. In order for “our association” to grow and continue to have a powerful impact locally and nationally we need you. I have no doubt that the benefits of membership far exceed the cost. The fact of the matter is that you are already benefitting from the work of the associations without paying for it. Some may consider that a win, I consider that a loss. Free lunch is not really free, someone somewhere is paying for it. In this case it is your fellow dental professionals. If you see no value in the UDA/ADA do some research on the advocacy efforts of the associations over the years, where would we be without these efforts? If you think the cost outweighs the benefits look at the member benefits more closely and find a way to get a better return on your investment. “Our profession” needs you. Who knows what 2021 will bring but I do look forward with optimism for “our profession” and “our association” Dr Mike Smuin UDA President

In this issue the UDA leadership will shed light on many of the member benefits of the UDA/ADA that we believe have great value for our members. This is just a sampling of what is available through the associations. The member benefits just continue to grow and I would guess most of us, as members, don’t utilize a fraction of what is available. Take the time and read about these benefits and use them to improve your professional and personal life. As dues paying members these benefits will bring added value to your membership. Membership dues come with a cost, thankfully for us

January / February 2021

EDITOR'S MESSAGE

THE SNOWMAN Fairfield, Utah January 14, 1949 Dear Son Garth, We were all glad to hear from you and that you were ahead of the storms on your transcontinental trip. Since you left we have had an old-fashioned winter with drifts fence-deep and temperatures dropping as low as minus 25 degrees. Only one day there was a let up. I took advantage of it and built a huge snowman--much taller than I and several feet around. That night we soaked him with water and then came the cold weather. For ten days he has had a roguish, robust appearance. The colder the better for him. But late today came a sharp break in the weather, with warming skies and a gentle rain. Now, at 8 P.M. he looks gaunt, sickly, weak and rotten. His features gone, he leans heavily toward Sammie’s and the hat, once way too small, slouches down nearly to his neck. The long icicles which we thrust onto his upper torso for outstretched arms, have dwindled to pipe stems, and the back of him, once so solid and smooth, is deeply pocked and tiny streams of water trickle down his legs and disappear under the melted snow. Ah yes, Garth, it has been a discouraging afternoon for the Snowman, and unless the mercury drops sharply, by morning the Snowman will have run his course. After all, he was only made of snow and “strong men should be made of sterner stuff”. So build solidly as you go and your success will be enduring. But I didn’t mean this to be a lecture to you! It will, however, give you an idea of the weather we have had, and still are having; although I should add that the two little girls have greatly enjoyed their passing acquaintance with the Snowman. Well Garth--keep on the sunny side and guard your health. With best wishes for success. DAD This letter was written from my grandfather to my father on January 14, 1949 while he was away attending college at Penn State University. Now about how The Snowman can help you understand the benefits of being a UDA member. The sentence I will emphasize here is, “After all, he was only made of snow and strong men should be made of sterner stuff ”. All of us have a little bit of the Snowman in us. When things get hot, we melt. A broken endo file, a paresthesia from a surgery, a threatened lawsuit, a bad review on the internet, an aspirated bur, a medical emergency, a disgruntled employee, a HIPPA or OSHA inspection can make us “guant, sickly, weak

and rotten”. A COVID pandemic, loss of income, marital problems, ill-fitting crowns, peri-implantitis, bounced checks, personal illness, more government regulations, low insurance reimbursement and any number of other things can turn you into a discouraged, melting chunk of ice. One thing has been particularly helpful for me to be able to battle the “discouraging afternoon” when my “outstretched arms have dwindled to pipe stems” and my back “once so solid and smooth is deeply pocked”---- Are my friends and acquaintances, many who I have met through my involvement in the Utah Dental Association. As I look back over my 40 plus years as a dentist of which 38 have been in Utah, the Utah Dental Association has helped me become a stronger dentist. How might you say? First, their programs--Continuing education, the annual convention, assisting me with the changing landscape of regulations and laws and constantly providing me with valuable information. Every dentist in Utah should be a member for this reason alone--Dr. Mark Blaisdell helped get the sales tax removed from dental products saving every dentist in the state thousands of dollars every year. Second, and most important, the UDA has given me the opportunity to meet other dentists become their friends and participate in meetings, events and service. The friends I have made through the UDA have greatly enriched my professional life. Dentistry is a profession where you can become isolated. The UDA has been a great organization to get to know other dentists that can provide personal and professional help. One of the best decisions I ever made was attending a UDA meeting at Diamond Lil’s SteakHouse on North Temple about 30 years ago. I met Monte Thompson who was the executive director for the UDA at the time. We hit it off and suddenly I had a friend at the dental association. You will find out in life and definitely in dentistry the more friends you have the better. When you break an endo file, you know a good endodontist. You are threatened with a lawsuit, you know Dr. Engar. Your crowns don’t fit, you know a good lab. You need help from an oral surgeon, and you met someone at a UDA meeting. Your implants have peri-implantitis and you met a periodontist. If you need help with government regulations (amalgam separators, HIPPA, OSHA) they can advise you there too. You never have enough friends. Join the Utah Dental Association!!! Dr Drew Jones UDA Action Editor

UDA Action

CONVENTION SALT PALACE CONVENTION CENTER CANCELS THE UDA 2021 CONVENTION 1568 S 500 W Ste 102 Woods Cross, UT 84010 801-261-5315 uda@uda.org www.uda.org

Utah Dental________________ Association

3 Feb 2021

Important Information: The 2021 UDA Convention, scheduled for 8-9 April 2021, has been cancelled by the Salt Palace Convention Center. Please Read As recently as early January we were all hopeful that conditions would improve and permit moving forward with our carefully planned “COVID modified” meeting plan. Last Friday, however, we received notice from the Salt Palace Convention center that the Salt Palace would become a county vaccination center through at least the end of March and possibly beyond. Because of this and other uncertainties we were informed that they could not commit to moving forward with our meeting in April and cancelled our use of the building for the planned 2021 dental convention. We considered converting to a virtual format, but others’ negative experience with this led us to hold out for a live, rather than a virtual alternative. Consequently, we will be moving forward with plans for a pared down 1-day live event in September. Look forward to receiving more information soon on this CE event once we settle on a definite date and venue where we can gather together, learn together, celebrate our great profession and renew friendships. As a convention committee, we are so disappointed to cancel 2 years of hard work that went into trying to bring this excellent lineup of speakers, exhibitors and activities to the Salt Palace Convention Center for our annual meeting. But the biggest disappointment is to not be able to be with each of you in this unique meeting environment once again this year. There is nothing like the synergy and excitement of a live dental meeting. We have begun active planning for the September live meeting. We have also begun planning a great 2022 LIVE UDA Convention at the Salt Palace. Please make plans to join us at both of these events! September, Friday (TBD), 2021 – Live 1 day UDA CE Event March 31-April 1, 2022 – UDA Convention at the Salt Palace Convention Center Until then, stay safe and well. Kindest regards, Jerald J Jerald Boseman DDS Convention Coordinator Utah Dental Association 6

Please see page 23 for official letter from Salt Palace January / February 2021

LETTER

McCARRAN-FERGUSON ACT I wanted to highlight a giant political win that has gone quietly under the radar. In December the senate unanimously voted to repeal the McCarran-Ferguson act. Why is this a big deal? Let’s give some background info. Back in 1945 the federal government passed the McCarran-Ferguson act to give insurance companies exemption from anti-trust laws. The federal government was concerned that the fledgling health insurance companies wouldn’t be able to get off the ground without protections. Fast forward 75 years and you will see that the most profitable businesses in our country are health care companies. And often they are supposed to be non-profit. Anyway, that act has allowed these health insurance companies to take advantage and possibly hide behind federal laws. They engage in very questionable and possibly unethical practices that would get most other business fined or their owners thrown in prison. And yet health insurance companies skate by unaffected and get to play by a set of different rules than the rest of us. When I was on the board of the Utah Dental Association, we worked very hard to try and get it passed. The American Dental Association has worked tirelessly over the years to get this terrible law repealed to try and make health care more affordable, more ethical, and more reasonable. Thanks to the efforts of a dentist-congressman, Paul Gozar from Arizona, this proposal was put before the House of Representative 3 different times previously and passed with almost unanimous support and was then sent to the senate for vote. The first two times it passed the house the senate majority leader Harry Reid sat on it and didn’t ever let it see the senate floor for a vote. While that’s completely legal and he has the right to decide which bills get voted on, it’s so unethical. The insurance companies were in Harry Reid’s back pocket and had him bought and paid for.

Finally, Reid’s tenure ended once the Republicans gained the majority in the senate. Those of us involved with trying to get this bill passed rejoiced! We thought we could finally get the antiquated McCarran-Ferguson act repealed. Unfortunately, Mitch Mcconnell did the exact same thing as Reid. He was bought and paid for by health insurance companies and he didn’t let the bill see the light of day after passing through the house. But thankfully this year is different. It was finally presented on the senate floor and passed unanimously. Woohoo! It has passed the house and the senate and just awaits the president’s signature. This isn’t the end of questionable health insurance practices, but this is a giant step in the right direction and is hopefully only the beginning. These are the kinds of measures that need to be taken if we want to see our health care quality improve and costs go down. Dr Cody Calderwood

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UDA Action

ASSOCIATION

2020-2021 UDA BOARD OF DIRECTORS

Mike Smuin DDS President

Greg Gatrell DDS President Elect

Scott L Theurer DMD ADA Delegate 2017-2021

Kay B Christensen DDS Treasurer

Rodney J Thornell DMD ADA Delegate 2018-2022

Mark R Taylor DDS Secretary

Brent A Larson DDS ADA Delegate 2019-2023

Darren Chamberlain DDS Past President

Ken J Baldwin DDS ADA Delegate 2020-2024

PRACTICE

COVID-19 VACCINATIONS AND TESTING IN DENTISTRY There have been a large number of inquiries to the ADA and UDA on COVID-19 testing and vaccinations when it comes to dentistry. I’ll try to give you what we know at the time of this writing. But as we all know, when it comes to things with COVID-19, the landscape changes rapidly. I’ll try to reference websites where information is continually updated with the latest information. Testing Let’s start with testing. Can a dentist perform COVID-19 testing in their office? Point of Care Testing for COVID-19 has been discussed on a state level unofficially with DOPL representatives. As with many tests of medical conditions, a dentist may run tests to assist in forming an appropriate dental diagnosis and treatment plan. The tests need to be of a nature that stays within the scope of practice for dentists. We commonly will take blood pressures to determine if the patients BP is within a range you are comfortable to proceed to treat oral conditions. If the dentist discovers a patient has an elevated BP, they may choose to delay oral treatment and recommend

examination by a physician. It would be inappropriate to try to give a diagnosis of High Blood Pressure and even more inappropriate to try and treat that patient for HBP. Unofficially, COVID testing should be the same. If you are using the tests to determine the appropriateness of treating the patient’s oral needs, then you may be justified. For any dentist testing for COVID, it would still be inappropriate to diagnose a patient as “having COVID” or “not having COVID”. You should only use the information to determine if it’s the appropriate time or conditions to treat the patient’s oral needs. Considering COVID testing is readily available upon request in most areas these days. It would seem significantly less troublesome to send someone for a test to a local testing center, than to obtain and run the tests yourself in a dental office. Testing can fall under the review of the federal government too. Certain tests require certification. The Clinical Laboratory Improvement Amendments (CLIA) regulate laboratory testing and require clinical laboratories to be certified before they can

January / February 2021

accept human samples for diagnostic testing. CLIA generally requires all facilities that perform even one applicable test, including waived tests, on “materials derived from the human body for the purpose of providing information for the diagnosis, prevention, or treatment of any disease or impairment of, or the assessment of the health of, human beings” to meet certain Federal requirements. If a facility performs tests for these purposes, it is considered a laboratory under CLIA and generally must apply and obtain a certificate from the CLIA program that corresponds to the complexity of tests performed. Our observation has unofficially shown the desire for a dentist to run point of care testing for COVID-19 has been rather low. There is a significant amount of certification and other red-tape that has deterred most dentists from pursuing implementation of testing in their dental office. Although many have inquired, most decide it’s not worth the effort. The ADA has put together a “COVID-19 & Lab Testing Requirements Toolkit” for those that would like to investigate the possibilities further. https://www.ada.org/~/media/CPS/Files/Articles/Toolkits/ ADA_CLIA_Toolkit.pdf Vaccinations Vaccinations can be looked at in two ways. When can we receive one? And can I give the Vaccinations? Let’s start with the first question. When can we receive the vaccine? We, at the UDA, have been asked many questions as to where dentistry exists in the vaccination priority order for the State of Utah. Many of you are aware that the CDC has declared “healthcare workers” are a top priority to receive the Covid-19 vaccination. Although each individual state can adjust those guidelines as needed. We are happy to report that the Utah Department of Health Immunization officials have confirmed, dentists and their whole dental team members are included in that top priority “healthcare worker” definition. At the time of this writing, the vaccination delivery for hospital-based healthcare workers is just about to begin.

Can I give COVID-19 Vaccinations? Let’s start with another question. Are you sure you really want to give the vaccination? From all reports to date of this article writing, the vaccine handling is very specific, complicated and requires specialized training and equipment. For most dental offices, this would be a self-limiting factor making it unreasonable to get involved with vaccination administration. If a dentist still has interest, I’d recommend becoming familiar with the requirements. You could start at https://immunize.utah.gov/covid-19-vaccine/ . Having said all of that, if it becomes necessary that additional healthcare workers are needed in the vaccine distribution, dentists have been recommended as a knowledgeable and capable group. With a little extra training and orientation, dentists would be a very logical group to help in time of need. If anyone wants additional information on anything COVID, including vaccinations and testing, there is frequently updated information available from the ADA by going to www.ada. org/virus. COVID-19 information specifically for Utah can be found at https://coronavirus.utah.gov/ Information on “COVID-19 Vaccination: Key Facts” can be found specifically at https://success.ada.org/~/media/CPS/Files/ COVID/ADA_Vaccine_Insight_Key_Facts.pdf?la=en Vaccinations have been deemed to be the beginning of the end for the COVID-19 pandemic. I think we can all agree that an end to this pandemic would be exactly what we all want and need. We are all anxious to see our lives return to normal or at least a more reasonable “New Normal”. Dr Val Radmall UDA, Executive Director

As with all parts of this ever-evolving pandemic, it is unpredictable and impossible to have exact details for the administration of the vaccine for healthcare workers in the dental profession. Most Dental offices should anticipate getting their dental team’s vaccinations from their Local Health Department (LHD). Each LHD may handle administration differently. It will be necessary to become familiar with your LDH’s plans for distribution and how they plan to schedule vaccinations. The LHD’s have been making plans for what will work in their area for administration of the vaccine. Many LHD staffers are swamped with this massive task of administration. Please patiently work with your LHD in planning for your vaccinations. At this writing, the UDA is compiling the plans from each LDH. We plan to have this available on the UDA website homepage, www.uda.org. To find additional or updated information on Vaccines in Utah, go to: https://coronavirus. utah.gov/vaccine.

UDA Action

Text to: 1. 2.

801 -261 -5315

I nc l ud e y o ur Fi rs t a nd La s t N a m e Yo ur i nt e re s t s t o ge t i nv o l v e d : a) b) c) d) e)

House of Delegates - Governance UDA Action Committee- Publications UDPAC Committee – Legislation I know my legislators – Name them & connection I’d be willing to be a Collaborative Dentist

ASSOCIATION

HUDDLE UP! Last August I shared a presentation to our district leaders about my “Top Ten” reasons to be a UDA/ADA member. One of the things that made my top ten list was the sharing of news and information from the ADA through its various communications

and publications, including the ADA Morning Huddle. I’ve also learned to appreciate the valuable information available from the ADA Weekend Huddle, and the ADA Finance and Operations Huddle

“The ADA Morning Huddle compiles news stories from a wide range of sources to let you know what the general media is saying about dentistry, whether or not it agrees with the ADA’s views. Publication of an article in the Morning Huddle in no way implies ADA’s endorsement, agreement, or promotion of a particular article. ADA Morning Huddle is a digest of the most important news selected from thousands of sources by the analysts of SmartBrief. This service is being provided to quickly disseminate news items of interest to American Dental Association members. This complimentary copy of The Morning Huddle was sent … as part of your ADA membership. … Neither SmartBrief nor the American Dental Association is liable for the use of or reliance on any information contained in this briefing. The presence of advertising does not endorse, nor imply endorsement of, any products or services by ADA.” (Morning Huddle editor’s note; italics added) As I’ve taken time to read through the information included in the ADA Morning Huddle, and the other huddles, I’ve been able to gain a much better appreciation and understanding of how organized dentistry, particularly the ADA, works so hard to help its members, as well as the millions of recipients of oral health care throughout the country. Examples are almost without number, but let me share a few that have stuck out in my mind or impacted me in the recent months. • I’ve learned that we have five dentists currently serving in Congress, Representatives Brian Babin from Texas, Drew Ferguson from Georgia, Paul Gosar from Arizona, Mike Simpson from Idaho, and Jeff Van Drew from New Jersey. They definitely have the backs of dentistry and other health care providers as they’ve come together in calls for action, including, among other things, calling for CDC action regarding infection control shortages. • I’ve learned of various calls to action from the ADA, such as calling for streamlining PPP loan forgiveness; loan expense deduction for PPP related expenses and IRS implications; how EIDL funds factor in; an FDA ban on menthol tobacco products, to name a few.

• The ADA has called on Congress to act on pandemic relief, and gives us, as individuals, the resources and information we need to contact our lawmakers and let our voices be heard and united with those supporting legislation which benefits the dental profession, specifically, and health care in general. From the Huddle…. “ADA calls for Congress to act on pandemic relief. The ADA sent a letter to leaders of the US House and Senate urging the chambers to pass a new pandemic relief package and take further action to support dental professionals, according to ADA News. The ADA outlined measures that could shore up practices, including permitting Paycheck Protection Program loan borrowers to deduct expenses covered with the loans, developing a more streamlined forgiveness process and allowing borrowers to purchase personal protective equipment with the funds. The ADA also called for supporting businesses' investment in PPE and safety improvements with tax credits and providing states with fiscal relief intended to prevent states from cutting adult dental benefits in Medicaid.” Also from the Huddle…. “ADA, other groups call on Congress to prioritize oral health. The ADA, along with the American Academy of Pediatric Dentistry, American Dental Education Association and American Association for Dental Research, sent a letter to the heads of the House and Senate Appropriations committees calling for the 2021 Labor, Health and Human Services and Education, and Related Agencies Appropriations bill to maximize funding for programs related to dentistry and oral health. The groups outlined key priorities, including for the Senate to maintain the $493 million set aside for the National Institute of Dental and Craniofacial Research, saying the investments in the institute

January / February 2021

"have led to improvements in oral health for millions of Americans," according to ADA News. They also called for increased funding for the CDC Division of Oral Health, among other priorities.â€? I do not know about you, but I donâ€™t think I really carry much weight or influence as an individual in Washington, with the CDC, or FDA, or other governing type organizations. But I know that when I join with you, and other colleagues, and have the backing and support of a

body as influential and respected as the American Dental Association, or the Utah Dental Association, we can form a strong team that, together, can accomplish what, individually, we cannot. If we huddle up, become informed, and work together to pay the price of success, we will come to know that the ADA and UDA are there for us, and absolutely worth the price paid. Dr Kay Christensen UDA Treasurer

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UDA Action

PRACTICE

PUTTING DENTAL INSURANCE COMPANIES IN THEIR PLACE Disclaimer: I am writing this article as a concerned dentist in the State of Utah. I represent neither the ADA, the UDA, nor anyone or anything else in organized dentistry. I only represent myself. I write this to share my experience. As dentists, we are in the driver’s seat when it comes to dental insurance issues, yet we often fail to realize this fact. Why is that? There is a game that is being played. They players are dentists, patients and dental insurance companies. As with any game, there are winners and losers. Ask yourself this: When it comes to dental insurance, do you feel like a winner? Do you think our patients feel like winners when it comes to the denial of a claim or a severely limited benefit? How would the insurance companies answer this question? If the size of their office buildings in every major metropolitan area of our country is any indication, I think we have their answer. Why is that? Who put them in charge and made them the winners? We did. We owned the gold mine, but gave them control. And now, borrowing from the lyrics of a popular country music song from a few decades ago by Jerry Reed, they got the gold mine, and we got the shaft. Why did we do such a thing? Why did we allow them to gain so much power in this game? It certainly doesn’t make sense from a business standpoint. I remember this topic being discussed many years ago in a large dental meeting in our state. I listened to dentist after dentist stand and complain about how they and their patients were being taken advantage of by the dental insurance industry. There was much anger and frustration as they spoke. After listening to the complaints for a while, I stood up and posed this question, “If a dental insurance company came to town and offered you $3,000.00 for a single crown in their table of allowances, would you sign up with that company?” To my disappointment, but not surprisingly, except for me, not one dentist in the entire room said they would decline such an offer. Certainly, this overlygenerous offer from an insurance company is unrealistic; but, the question, and more importantly their answer, is instructive. The issue is not money. The issue is control. Insurance companies are masters at this game. They are very content to sacrifice a small amount of money, upfront, in exchange for control over the long-term. This is how they play the game. Sign up as many dentists as possible with a reasonable table of allowances. Then, over time, as they control a larger and larger segment of the marketplace, and as more and more of your patients are insured through their company, they start putting on the squeeze. Either they don’t raise their fees over time to keep up with your increasing expenses, or they raise them by such small amounts that you are left making less and less. Then, when 30 to 40 percent of your patients are insured with that company, they begin to play hardball. They know they have you over a barrel, all because you have relinquished control. Stop playing their game! There is no game without you. It is within your power to take back control of your practice. Do it 12

for yourself. Do it for your patients. There are many dentists around the state who are just saying no, and their experiences are, without exception, positive. Quit worrying about what other dentists are either going to do, or not do. Make a wise business decision for yourself and cut the cord. Don’t do it all at once but start the process. You will be glad you did. I have never signed a contract with a dental insurance carrier. In fact, for the past 20+ years, I have not even accepted assignment of benefit. It has been wonderful! I have never felt controlled by insurance companies. Has it been difficult? At times, certainly. But, overall, it was the single best practice management decision that I have ever made. Was there some pushback from patients and insurance companies? Absolutely. Did I lose a few patients? Yes, but not enough to ever force me to reconsider the decision. In spite of the fact that I never entered into a contractual agreement with a dental insurance company, roughly 50% of my patients had dental insurance that allowed them freedom of choice. My staff was very good at helping these patients with their claims and facilitating that aspect of their experience with our office. But we were careful not to allow the insurance companies to burrow in and interfere in that doctor/patient relationship that we all work so hard to build and maintain. Accepting assignment of benefit allows them to do just that. As the saying goes, “He who pays the piper calls the tune.” In other words, the payer controls the payee. When the insurance company pays you, they control you. Would you rather have the insurance company continue to be in charge, or force them to relinquish that control back to the patient by only accepting checks from the patient? As it should be, I enjoy making patients happy. As dentists, we work for our patients. They should be in charge. Although they would never admit to it, insurance companies love assignment of benefit because it puts them in charge. Think about it. Over the years, when discussing with other dentists this approach to assignment of benefit, invariably I am asked, “But, what happens when the patient chooses not to pay you, and instead, spends their benefit?” Yes, that is a potential risk. It happened to me less than a handful of times over more than 20 years, not quite enough for me to abandon the policy. As you well know, there should always be a clear financial arrangement made with each patient. That is the most effective way to keep your patients from spending their benefit on other things. The bottom line is this: You can beat insurance companies at the insurance game. Just refuse to play it on their terms. But you have to start by taking back control. Do it gradually. But do it. Put them on notice that you have had enough of their game. Give them the shaft and take back the gold mine. As I said before, do it for yourself, do it for your patients, but do it! You will feel freedom like never before. Dr. Mark Taylor UDA Secretary January / February 2021

PRACTICE

NON-COVERED SERVICES Hey, the schedule of fees you sent for my patients’ dental benefit plan says you don’t cover this procedure – so why are you telling me what I can charge for a service you don’t cover? The term Non-Covered Service refers to an amount billed or charged a patient for a procedure which is ineligible for payment as a benefit in a patient’s dental plan. Many times finding out a procedure isn’t covered occurs after the treatment is complete and the Explanation of Benefits (EOB) arrives. Seeing $0.00 in the Plan Pays column with a code nearby explaining why a service is not a paid benefit, can be a surprise to both the patient and the dental office. Usually the explanation code on the EOB will be something like these: - service not covered under plan - this procedure is not included as a covered procedure in your plan - not a benefit based on patient’s age - not a benefit due to frequency limitations - this service is not included in the fee schedule, or contracted fee arrangement - service is not a covered benefit of the policy - annual limit this category of service has been met Medical plans for years have conditioned our patients to only consent to services that their plan will pay a benefit for – “I only want what my insurance will cover” is commonly heard when treatment plans are reviewed with patients. This is reinforced when patients review their EOB’s and try to understand the sometimes confusing language and perhaps even more misleading explanations. We all know “Non-Covered” doesn’t mean “Not Necessary”. If you are contracted with a PPO Dental Plan the EOB will likely list the Amount Allowed, Charged or Contracted; and if $0.00 benefit is being paid, there will be an explanation which many include that the service you completed is, “not a covered benefit of the patient’s plan.” Unwittingly, you may have even signed a PPO contract, where hidden in pages and pages of legal jargon, you agreed not to bill a patient for a Non-Covered Service. Another example of abusing claims paying is the tiny Allowed or Contracted fee. Some plans offer very limited benefits for Non-Covered services - in effect mandating that your fees will be deeply discounted for procedures the plan will not ever pay a benefit for.

Utah Code was amended to help protect dentists against unfair “Non-Covered Service” policies by dental benefit plans. Effective January 1, 2018, changes to the Utah Code (31A22-646) defined ‘Covered Dental Services’ as dental services for which reimbursement is available or would be reimbursable under an enrollee’s dental plan - subject to deductibles, copayments, co-insurance, waiting periods, annual and lifetime maximums, frequency limitations, and alternative benefit payments. (That’s a lot of reasons a dental plan doesn’t have to payout a claim!) More importantly the reimbursement can’t be “nominal” in order avoid non-compliance with the updated Utah law. For example, before Senator Christiansen’s bill passed, an impression was made for an occlusal guard (CDT Code D9943) and your standard fee is $400. When you get the EOB back from the LZY PPO Dental Plan, you note that the “Allowed Amount” for the bite guard is the “nominal” $40, with an explanation that the plan is paying $0.00 because D9943 is Non-Covered Service. It turns out the PPO contract you signed, states you can’t bill the patient more than the allowed $40 -- completely surprising both you and your patient. The patient cheers because they get a quality custom night guard for $40 and you shrink, realizing the $40 you were allowed to bill the patient, won’t begin to cover the chair time, materials and lab expenses. With passage of this bill, since 2018, Utah law states that “A contract between a dental plan and a dentist to provide ‘covered services’ may not prohibit the dentist from offering or providing ‘Non-Covered’ dental services to a covered individual at a fee determined by the dentist and the individual who will receive the ‘Non-Covered’ service.” This means we can ignore the amount a dental plan tells us their fee schedule allows for a Non-Covered Service, and then arrange in good faith, a fair fee, that our patients are willing to pay for needed dental treatment. Thank you, UDA, for helping us take care of our patients and helping dentists be successful. Dr Scott Theurer ADA Delegate

In 2017, thanks to timely lobbying by the Utah Dental Association and with highly appreciated sponsorship of a bill by pediatric dentist and state senator, Dr Allen Christensen; the UDA Action

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PRACTICE

GETTING UTAH DENTISTS BACK TO WORK I’ve been asked to relay the circumstances around getting Utah dentists back to work in mid to late April. The UDA is proud of the fact that Utah became the first state in the Union to allow dentists and surgeons to perform non-emergent care after the nation was shut down with the initial COVID-19 outbreak. I’ve also had multiple requests to share the letter that was written to the Utah COVID-19 Taskforce at that time. I share the following with sincere appreciation to the UDA Board of Directors and to all of the dentists in the state that went out of their way to make sure that dentists practiced our profession in a safe and productive environment during the end of 2020 and will continue to practice into the future. In the evening of April 17th at approximately 10:30 pm, I received a text from a colleague that the state’s COVID-19 recovery task force was trying to reach out to a representative from dentistry regarding new guidelines for opening the state. Finally, after multiple attempts on our part, we were making a connection with the ‘powers that be’ for the state of Utah. After a phone conversation that night, she sent an email with the preliminary guidelines which showed that Dentists couldn’t start seeing elective patients until the reported cases of new COVID-19 positive tests decreased for four consecutive weeks. That night I went to bed at 12:30 am thinking that it would be weeks, maybe even months, before dentists could see hygiene patients or preform simple operations. After a restless night, I awoke with a start at 4:15 am and realized that I needed to draft a letter to the people that could make a difference for dentists in the state. This is that letter… To Utah’s COVID-19 Taskforce: I am writing this letter as someone that wears multiple hats simultaneously. I am a pediatric dentist with offices in Springville and Payson, UT. I am also the President of the Utah Dental Association (UDA). I am a small business owner with 28 employees. I am not only on the board of directors for the UDA, but also Riverwoods surgical center in Provo, and a not-forprofit organization called Share-a-Smile. Most importantly I am a husband and father of five children. After reading the parameters and guidelines established by your group, I felt it necessary to submit my email, knowing that it is currently past the eleventh hour, and that it might not make a difference. However, I feel like I owe it to the people that I represent to be an advocate for their wellbeing. The first group I need to advocate for are my patients. I am going into my 16th year as a pediatric dentist. I love my profession and I love the patients who come into our offices. They rely on me to be able to care for their oral health. It has 14

pained me during this last month to turn so many of them away from our practice. Unfortunately, because we have not been able to perform routine check-ups, cleanings and simple procedures, I am starting to see some of my favorite people in the world experience oral pain. I am grateful that I can at least help to remove that pain by performing extractions and root canals, but I went into this profession to be able to prevent pain, and under the current restrictions, I am no longer able to use my training to teach children and their parents the best ways to prevent the disease that is ravishing some of their mouths. Dentistry has always been proactive about infection control. During the HIV epidemic of the late 80's and early 90's dentists were among the first to implement precautions to protect themselves, their staff, and their patients against the threat of a blood borne illness. The American Dental Association is currently working with the Centers for Disease Control on guidelines to protect those same people from an air borne illness. We are hoping to see those regulations within a day or two and expect that changes to the way we practice will protect the general public from contracting the disease in our offices. I personally understand that, in the current environment, I can no longer daily see 55 to 60 patients. And that measures need to be in place that maintain the «social distancing» protocols that have been adopted by society. Dentists collectively have had the training and discussions to understand that when we return to performing «elective» procedures, that they will be performed under a different environment than was the standard of care even one month ago. We, as dentists, have postponed elective treatment to preserve PPEs for medical workers and to postpone the spread of the virus. Now is the time to allow us to use the training that we have received and our best professional judgement to take care of the people of Utah. The next group I need to advocate for are my dental colleagues. Utah has the largest percentage in the nation of solo dentists who own their own practice. These small business owners need to open their doors to support themselves, and their staff ’s families. The UDA has done our best to guide them through the alphabet soup of government help, but very few have received relief from the government’s promised SBA, PPP, or EIDL loans. We have many that cannot support their staff under the current conditions and have had to furlough their staff placing a burden on the state’s unemployment offices. Recent research by the ADA has shown that if the current environment persists, 4% of practices in the nation will have to close their doors by the end of April, 18% by the end of June, and 46% by the end of August. Knowing that dentistry in Utah is far less profitable than in 48 other states, those numbers will be higher if you were to poll Utah dentists. I cannot sit back and watch as half of my friends and colleagues go bankrupt.

January / February 2021

In my role on the board of Riverwoods Surgery Center, and with hospital privileges at two Intermountain hospitals, I have insights into the conditions of healthcare in the state. It is comforting to know that we have a healthcare system in the state that is prepared for this type of a pandemic. I can understand the need to “flatten the curve” as much as anyone. The concern is that in our state, the vast majority of hospital beds are currently empty. We have done an amazing job of containing the spread of this virus. I know what I'm about to say will be controversial, but in order for us to get over this virus, we have to open up society a little bit and let people get sick. We need to establish a “herd immunity” and the only way to do that is either through vaccines (which won’t be developed for another year), or to allow a large segment of the population to develop antibodies. I can understand the COVID-19 Taskforce’s role is to minimize illness and death in Utah, but if we don’t allow people to interact more, we will prolong the pain and suffering of a society that cannot function, and an economy that will not be able to rebound. Hospitals, surgical centers and doctors throughout the state will have the same fate as a large number of the dentists in the state, and there will be nowhere to turn when we are sick. The last group I need to advocate for is the poor and needy. The Share-a-Smile Foundation is a group of volunteer dentists that freely give of their time to help the indigent population of Utah County. We provide a service to a group of people that has nowhere else to turn. Unfortunately, because of the current situation, these clinics have had to close their doors. Those that cannot afford, and need oral healthcare more than anyone, are not receiving these services. Because this population does not have a place to obtain their necessary oral healthcare, I am concerned that they will turn to the hospital’s Emergency Departments to look for relief from their pain and suffering. Both dentists and healthcare workers realize that the best place for these individuals to obtain the proper oral healthcare is in dental clinics. I love giving of myself to others, that is the main reason I went into dentistry, to improve the lives of my fellowman. I would like to get back to providing these services as quickly as possible, but the current plan will delay us reopening these clinic doors and countless people will suffer as a result. As I mentioned in the first paragraph of this letter, my wife and I are the proud parents of five beautiful children. Their lives have been forever altered by this pandemic. I understand that the things that I am proposing in this letter, heighten my risk of getting COVID-19, and that there is a chance that if I do contract the disease, that I might not recover. As a dentist, I went into this profession with the understanding that there are risks to performing dentistry. I am willing to take that risk if it means that my children will have a better life on the other side of this pandemic. They need to be proud of the people that they will become because they survived the COVID scare of 2020. I truly believe that the only way to overcome this disease is to tackle it head on with as many precautions as we can take. I can assure you that the UDA will do everything we can to educate members of our profession to protect themselves, their staff

and their patients. Just as I know you will do everything you can to protect the people of Utah. Thank you for your time and for everything you have done for Utah. Sincerely, Darren Chamberlain, DDS President, Utah Dental Association I’m assuming that this letter was well received by the taskforce, because within the hour of sending it, they asked for the regulations that we would suggest be in place so that we could return to work. I quickly wrote an email with the guidelines that were recommended by the ADA’s Recovery Taskforce, and discussed by Utah’s Dental Recovery Taskforce which consisted of representatives from both dental schools in the state, dental representatives from the Utah Department of Health, a member of the Utah State Legislature, the President of the state’s major dental malpractice insurer, and the UDA board of directors. As part of that e-mail, I also asked that dentistry be considered an “essential occupation.” When the guidelines came out later that day, we, the UDA board of directors, were discouraged because they were similar to what I had seen the night before. However, everything changed on Tuesday, April, 21st, when we received an email from the Department of Health asking us to approve the guidelines for all elective medical procedures. The guidelines matched the suggestions that I had emailed a few days before, with just a few slight alterations. We, of course, readily approved of the guidelines and were informed that if the governor approved the measure, dentists and others in the medical field would be able to perform elective procedures immediately. That night, we were delighted when the governor announced that finally after 6 weeks of anxiety, fear and uncertainty, dentists and others in the medical field were able to start fully practicing their profession. I don’t tell you this story to brag, but to give insight into the purpose of organized dentistry. During this crisis, I had conversations with state association presidents from Hawaii to Tennessee. I can assure you that every state in the union, and every dentist in this country had the same concerns and questions that we had here in Utah. There was a lot of uncertainty at the time, and there continues to be uncertainty regarding the future. I’m proud of us as a profession in this state. We have tackled this challenge head on and are better because we were able to come together to find a solution. Even though I don’t know what the future holds, one thing I do know is that the ADA and the UDA will always be there looking out for me. That is why I’ll always be a member of the Utah Dental Association. Darren Chamberlain, DDS Immediate Past President, UDA

UDA Action

PRACTICE

PROPER REFERRALS HELP ALL OF US I have been blessed in my professional career to work with wonderful dentists and physicians who refer patients to me for specialized care. My overriding concern, like that of all specialists, is to provide the best care possible and ensure that the patient has the best experience under the circumstances. We have to be honest. As a specialist, most people do not want to come see me. There is a certain level of fear and concern when going to see a strange and unknown specialist rather than having treatment with their regular dental provider with whom they are comfortable. They are concerned about a possible serious problem, coming to a new and unfamiliar situation and office, and the potential costs associated with seeing specialists. As we consider proper referrals, most of what I am going to share is from the American Dental Association and their recommendations on specialty referrals. All of this is available online including referral forms for physician and dental specialists. Ethically, we are obligated to seek consultation when we feel that it will benefit our patients. Possible considerations for referrals may include any of the following reasons: • Level, training, and experience of the dentist. Sometimes referrals are simply necessary to safeguard the welfare of our patients. • Dentist area of interest. I work with a wonderful dentist who is a great friend and colleague who simply does not like doing endodontic therapy. He is more than qualified to treat the vast majority of his patients that require endodontic therapy. However, he simply refers them out because he does not like doing them. Furthermore, some of our colleagues are simply so busy that they refer certain procedures that are more time consuming because of a large patient load. • Extensiveness of and complexity of the problem. Sometimes problems arise in our practice and with our patients in an area that we are uncomfortable proceeding on our own. I have heard many referring dentists say they had a, “gut feeling” that they should refer the patient rather than allow themselves to be talked into treating the patient in their office. The patient is always more comfortable in their own dentist’s office with whom they have a long-term relationship. However, it is always better to maintain the patient’s trust and high esteem by making honest, appropriate referrals. I have treated many patients after they spent hours at their dentist. Normally, I see them after a long attempt to complete a procedure and the patients are unenthusiastic about completing it. This has the potential to destroy a wonderful relationship

that the dentist has spent many years building. Always refer early if the situation looks like it may become unmanageable in your office. This allows the specialist to see the patient before things go awry. Furthermore, it is very easy for the referring dentist to inform the patient that because of your care and concern for them, you are not going to start or complete the procedure and instead will refer them to a competent specialist. All the specialists that I have worked with emphasize to the patient that they were referred because their dentist cares for them and wants the best result. • Patients with comorbidities such as serious medical problems frequently require referral a physician and/or dental specialist. • Patient desires always play a role in the possibility of referral. Behavioral concerns may also necessitate referral. This is frequently seen with pediatric patients and referrals to the pediatric dentist. The dentist should always provide a written referral that can either be hand carried by the patient or mailed, emailed, faxed, or otherwise transmitted to the specialist. All prescriptions for treatment by the specialist must be reviewed and signed by the referring dentist. Do not delegate this to your staff or secretary. Furthermore, make sure to communicate to the patient as to the necessity of the referral. It is important to help them understand the reasons. However, we all know that it is very difficult for patients to completely understand. In my office, it is very common to have patients referred for an extraction and the patient is not sure which tooth needs to be removed. Please do not be offended if the specialist calls you on the phone more than once to verify your recommendations and prescription. Mistakes in treatment have been made based on unconfirmed and/or misunderstood prescriptions. It is also recommended that the dentist gain personal knowledge of the specialist, including inquiries about training, experience, participation in continuing education, and other areas where it may aid the referring dentist in determining where to refer particular patients. Every general dentist should have at least two dental specialists in each area to whom they can refer as this allows referrals to take into consideration insurance concerns, geographic location, availability of the specialist when needed, and potential personality conflicts. The dental specialists that I know would be very happy to have potential referring dentists visit their office. This gives the dentist an opportunity to see the specialist’s office, voice concerns, ask questions, and to develop a personal rapport. After consultation and/or treatment the referring dentist should expect a report back from the specialist indicating preliminary January / February 2021

diagnosis, anticipated treatment, and progress reports if treatment is extended over a long period of time. The final report to the referring dentist should include what was done, any further recommendations, and if final x-rays or other diagnostic images were taken. If they were taken, these should also be copied and sent to the referring dentist. All specialists are required to return patients back to the referring dentist. I, and the other specialists I work with, are always upset when patients ask to be referred somewhere else. In these cases, I always inform the patient that I will call their referring dentist and let them know the situation. I know other specialists do the same. The specialist cannot cavalierly refer the patient to someone else and they are ethically obligated to recommend that the patient return to their regular provider. A final consideration is that even specialists have complications. The occlusion may not be perfect after treatment with

orthodontics, a root canal may not go smoothly, or the orthognathic surgical procedure may not go exactly as planned. However, I learned from a nationally renowned and respected oral and maxillofacial surgeon and a great mentor of mine, that everyone who operates has complications. A surgeon who says that they do not have complications is either lying or they do not operate. The same is true for every dental and medical specialist. We need to be slow to condemn one another and remember that there is plenty of room in the woodshed for all of us. I can confidently speak for all of the dental specialists—we are very grateful for the confidence that is shown by the referral of your patients and we consider it a privilege and an honor to treat them. Dr. Ken J. Baldwin ADA Delegate

PRACTICE

HE WANTS YOU TO DO WHAT? ETHICAL ISSUES OF PROVIDING SECOND OPINIONS Mr. Jones, a 52-year-old new patient, presented for a “second opinion.” The last dentist he visited recommended six crowns to deal with “cracks and wear,” two possible root canals and clear retainer orthodontics. My examination revealed only two existing small composite fillings that appeared sound. His mouth had minimal, asymptomatic wear. The patient had slight mandibular crowding, which did not bother him, but he did need periodontal therapy. I did not know how to proceed. First of all, the “second opinion” in dentistry is generally not the same as in medicine. If a significant treatment is recommended, an additional consultation is encouraged to assure that all options and possibilities are discussed and an informed consent for the procedure has occurred. Generally in dentistry a second opinion is initiated by a patient when they do not like or understand what they heard the first time. If a patient truly is receiving a second opinion from you, it is implied that you are providing a service to the patient by confirming that the procedure is appropriate or that a different treatment option could be considered. It is clearly not designed to convince the patient to see you for treatment rather than the first dentist. It is proper for you to be compensated for your expertise and for you to inform the patient of the need to continue care with the first dentist, unless the patient expressly reveals a different preference (CDA Code of Ethics, Section 9). The more common scenario in dentistry is a patient requesting another diagnosis and treatment plan with the hope that the second plan is less invasive, less time-consuming and, most

frequently, less costly. Realistically, if the first treatment plan and presentation were thorough, the patient would have received all reasonable options of care with the associated risks and benefits of each. The patient should then have had enough information to make a free and fully informed decision. Your obligation to the patient the second time around is to do what the first dentist may not have done. By calmly and thoroughly presenting all of the information to the patient, including alternative treatment options, you will be following the ethical principles of autonomy and nonmaleficence, providing a free and fully informed consent and practicing to the standard of care. By focusing on your comprehensive exam and findings, rather than bad-mouthing the original dentist, you will be honoring the principle of beneficence: doing good for the profession. Additionally, your truthful portrayal of the patient’s oral condition will satisfy the principle of veracity. And finally, by providing this level of treatment planning for both your first and second opinions, you will be fair to all of your patients, thus including the principle of justice in your practice. By making sure that all of your patients always receive a full, appropriate diagnosis and treatment plan, you will be hitting the ethical grand slam and practicing dentistry to a high ethical standard. Dr Gary Herman CDA

UDA Action

ASSOCIATION

WHAT IF ORGANIZED DENTISTRY WENT AWAY? Recently I was at a meeting with a friend who graduated with me from dental school. During the meeting, she made the comment that “organized dentistry was going away.” The comment struck me, and it took me a moment to process what she said. Over the days following the meeting, her comment ate away at me. What would my life look like, or better yet, what would my profession look like if organized dentistry dissolved over time? To name a few… • Who would advocate for me as a dentist, and serve as an educated and informed voice while I was able to treat patients? • Who would create the ethical standards that I abide by in order to put patients first? • Who would offer peer review so that I would be able to resolve a potential issue with a patient rather than navigate the legal system on my own, which can be expensive and time-consuming? • Who would have negotiated interest savings for members on student loan refinancing programs? Who would acknowledge the importance of state and local societies and other loan refinancing programs as well, promoting healthy competition to give members options? • Who would fight for dentist’s rights on Capitol Hillrepealing the medical device tax, promoting the Student Loan Refinancing Act and postponing compliance of Sec 1557 of the Affordable Care Act while serving as one of the strongest national political action committees?

• Who would engage the public and be a resource through Mouthealthy.org? • Whose members would treat 350,000 kids annually and provide over 5 million dollars in donated dental services while bringing awareness to oral health in America through Give Kids A Smile? The ADA. Without the ADA, these things would never exist. I’m proud to be a member of the ADA. I’m honored to be a part of an organization that is 159,000 dentists strong. I know that if I need something the ADA is there not just to get me through…but also to make sure that I’m successful. And even when I don’t know what I need, it’s the ADA that is the first to inform me and provide me with resources so that I can spend my time doing what I do best…. serving patients. It’s not about discounts and offers, but rather the peace of mind I receive knowing that for the cost of a cup of coffee a day, I have someone looking out for the small business owner, the young professional, the healthcare provider. I’m doing my part to be a cohesive voice, active member and support an organization that works tirelessly so that I can succeed. Without truly understanding the benefits of organized dentistry and being an active member, organized dentistry will dissolve. But I hope in my lifetime, I never see that day. I hope that my colleagues see that without the ADA, without your state and local societies…there’s no network, no unified voice. I’d rather stand united with 159,000 ADA members than alone. Where do you stand? Dr. Emily Iskhanian ADA New Dentist Committee

January / February 2021

PRACTICE

PRACTICING DENTISTRY WITHOUT A LICENSE IN UTAH? Fortunately practicing dentistry without a license is not a headline we see in the news on a regular basis but dentists practicing outside of their scope of practice is a headline we could be seeing more of.

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Class E: (Deep sedation) General Anesthesia along with all of the above Many dentists converted from a class II license to a Class B and not to the Class C license. Using an enteral drug for Sedation with a Class B license is considered practicing beyond the scope of licensure. During our CQI discussions this fall we found many members who had the wrong classification of licensure. In the event of a lawsuit, it is unlikely that your malpractice insurance will cover you if practicing outside of your scope of license. We recommend every dentist look at their license to verify it cover the type of anesthesia and sedation you are using. You can also visit www.dopl.utah.gov and clicking on the link: Is My Professional Licensed? If you do not have the correct license you can contact Larry Marx at the Utah Department of Professional Licensing at lmarx@utah.gov or by calling 801-530-6254. You will likely need to provide documentation of current CPR/BLS/ ACLS and certificates of anesthesia training to upgrade your license. Greg Gatrell D.D.S. UDA President Elect UDA Action

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PRACTICE

HOW MUCH WOULD YOUR PRACTICE BENEFIT IF YOU COULD FOCUS SOLELY ON CARING FOR YOUR PATIENTS? Human Resource Basics for Busy Practitioners Regardless of the size of your practice employees serve as an integral part of the success of your business. When instances occur in employees’ personal or professional lives that impact their ability to focus on the job at hand, it takes a different level of care on your part to guide them through the process. With ever-evolving laws and regulations and a full schedule of your own, confronting a human resources issue can seem daunting and time-consuming – more so when conflicts arise between colleagues, placing you in the middle as both mediator and judge. As a human resource professional, I provide guidance to dental providers with their human resources or payroll needs. This role enables me to collaborate as a neutral party to coach teams through conflicts or to provide on-the-spot advice on recruitment, employee benefits, employees relations, federal and state compliance, and employee handbooks, thereby freeing up time for practitioners to focus on their craft and the revenue-generating side of their practice. If you are considering whether a human resources solutions partner would work for you, included below are some of the pressing issues encountered by a typical practice. Recruitment Inviting a new employee into your practice stirs excitement in envisioning the positive impact an individual may have on the team and practice. There can also be an underlying level of hesitation about making a mistake, so how can you assume you are bringing in the right person? The truth is, humans are complicated creatures. The individual who shows up on Monday may differ slightly from the one on Tuesday, but implementing a value-centered hiring strategy will help remove some of the guesswork. Although individuals may have an off day, employees with a high level of integrity will do their best to show up to work on time, albeit with a tighter smile than yesterday, because it is the right thing to do. Formulate your job posting and interview questions around the virtues that matter to you. Is it essential for candidates to have a sense of urgency to get things done or improve processes? Would you prefer someone who is amiable and can gauge if a patient needs a higher level of interaction? How important is humility? Try asking, “How do you define integrity?” or “Tell me about someone who is better than you in an area that really matters to you?” An ego-driven person will not be comfortable answering these questions and won’t be able to appreciate those who are more skilled or talented than themselves. When asked the

dreaded, “What is your biggest weakness?” question, consider how long the employee took in answering and whether the responses was authentic. The key is to look for someone who is willing to acknowledge their limitations and sincerely wants to improve in this area. Avoid asking any questions regarding an applicant’s race, skin pigmentation, national origin, religious affiliation, pregnancy status (current or future), sexual orientation, gender identity, martial status, age, disability, or genetic information. While you may include follow-up questions on responses or any provided materials including an application, cover letter, resume or curriculum vitae, or supporting documents, you cannot ask a candidate if they have committed a crime before the initial interview. Instead, let the background screening do the work. Maintaining the safety of your workplace is one of your top priorities, and this starts with verifying any information an applicant provided during the hiring process and by reviewing their criminal history. However, criminal checks can only be completed after a job offer has been extended and with written authorization from the candidate. Some things to look for could include any charges or incarceration for acts of violence, sexual misconductrelated crimes if the job requires interaction with minors, and financial charges for those who will be handling funds. Navigating Professional Relationships Working relationships are an essential aspect of our professional lives and take a different level of dedication than those with our family and friends. They matter because of the shared purpose of the work we do and the amount of time we spend together on a day-to-day basis, often in close quarters. Within that arena are set limitations on how we interact with one another in order to maintain a respectful workplace. Regardless of a colleague’s or potential employee’s physical appearance, treating each other as an equal is paramount in valuing each other’s contributions and well-being. While we may become familiar and develop inside jokes, there is a point where simple teasing turns unlawful when remarks become offensive. As a rule, it’s best to avoid making comments or jokes focusing on an individuals gender, and to respect each other’s personal space by limiting touching to handshakes and high fives. Often individuals fail to recognize that something is inappropriate until it is too late. Implementing a respectful workplace policy helps solidify a positive work culture and avoids any potential problems due to bullying or sexual harassment. Provide methods for reporting instances confidentially and train employees about your code of conduct. Most importantly, take claims seriously and consistently enforce your polices.

January / February 2021

Employee Documentation From unemployment disputes to worker’s compensation claims, properly documenting an employee’s progress will serve you well in the event of litigation. The official personnel file should be kept in a locked, secure area or within your human resources office, allowing you to maintain a working file that includes performancerelated information such as production goal progress reports, notes of appreciation or concern, and supporting evidence for performance improvement plans or annual evaluations. In accordance with the Health Insurance Portability and Accountability Act (HIPAA), medical related items are to be kept in a separate file. Documents containing private medical information such as doctor notes or Family Medical Leave Act (FMLA) documents or OSHA or workers’ compensation-related items such as CPR cards, hepatitis-B records, injury or illness reports, and investigation reports can be kept in this file. Just as you would with a patient’s chart, document situation in a timely manner, and stick to the facts, so you (or a potential reviewer) have a clear depiction of what transpired. Transfer formal writeups such as verbal or written notifications, performance evaluations, promotion or merit increase requests, performance improvement plans, or other disciplinary documentation to the personnel file, with a copy provided to the employee. Doing so will maintain transparency of the process and

ensures your human resources team has the necessary information to meet a request for the personnel records or when responding to workers’ compensation or unemployment claims. Note to files should document dates of meetings and detail any decisions or plans of action, including progress reports. It is best if you focus on the behavior and not the individual when identifying problems. Use measurable terms to avoid using words such as “always” and “never.” Notate which policies or procedures or performance expectations the employee has violated. Include when and how performance expectations, work schedules, or policies were communicated to the employee. Note any behavioral influences within the employee’s control such as clocking our early, failing to clock out, tardiness, unprofessional behavior, rudeness towards patients or colleagues, using cell phone outside of break area, taking drugs or drinking alcohol within the job site, or not performing the full scope of job duties. Include video evidence or supporting documents such as a copy of the work schedule or payroll record. Call to Action Giving yourself some time to get familiar with that is required for you as an employer will save you time in the long run. Eunice J. Scotto

We have practice in selling your practice. We have all of the experience, tools, and resources necessary to help you transition your practice into the right hands. With our help, you can avoid common pitfalls. We provide expertise on appraisals, practice sales, mergers, partnerships, and everything you might need for a fulfilling practice transition.

801.298.4242 | ctc-associates.com Randon Jensen | Larry Chatterley

UDA Action

ASSOCIATION

UDA DENTAL HYGIENE AFFILIATE MEMBERSHIP With the completion of 2020, the UDA completed its first year with having Registered Dental Hygienists as Affiliate Members. Although 2020 did not go according to anyone’s plans, the Dental Hygiene Affiliate Members were still able to participate in multiple CE opportunities and the UDA was able to provide resources to them, just like the UDA is a resource for the dentists of Utah. With the cancelation of the UDA Convention in March 2020, the UDA Board and Convention Committee, came together to work to provide CE Opportunities for member dentists and hygienists. This obviously had to be done virtually. Dr Larisse Skene spoke on Peri-Implantitis, Dr David Okano spoke on the Newest Classification of Periodontitis, Dr Kel Faddis – Abuse and Forensic Investigation Dr Jeremy Manwaring - Soft Tissue Management Dr Dan Thunell – Soft Tissue Grafting Dr Leslie Halpern – IPV Nancy Dewhirst – Infection Control after the Covid-19 Crisis Dr Sean McKeown – Etiology and Treatment of Periodontal Disease Dr Darren Chamberlain – Silver Diamine Fluoride These courses were recorded and placed on the UDA Website to be viewed for free with membership in the UDA. These courses including others would provide the Affiliate member hygienist,

approximately one third of their required CE’s to maintain their license in Utah. Originally the UDA had planned a Fall Hygiene Seminar to be held in September. This event also had to be moved virtual, like so many others during 2020. We had Dr Enrique Varela speak on Local Anesthesia, Dr David Okano review the Periodontitis classification and Gayle Masters speak on Ergonomics. This event was able to be done at no cost to Affiliate Members and was enjoyed by all. The UDA Dental Hygiene Affiliate Membership is open to all Utah Dental Hygienists. Membership goes from January – December and cost is $50. Benefits for 2021 include: • Discount to 2021 UDA Spring Seminar – Feb 26th • Discount to 2021 UDA Convention – April 8-9th • Access to CPR Courses throughout the year • Fall Hygiene Seminar - TBD

• CE Opportunities through-out the year – Online and In-person (or whatever is appropriate here) Register for Dental Hygiene Affiliate Membership at uda.org. Becky S. Waters, RDH

Your patients rely on your expertise to evaluate and make recommendations to keep them healthy. Your local independent insurance agent can do the same for you when it comes to suggesting the right combination of coverage to protect the practice you’ve worked hard to build.

SPEND YOUR TIME EXAMINING YOUR CLIENT’S TEETH, NOT YOUR COVERAGE.

Find an independent agent representing The Cincinnati Insurance Company by visiting cinfin.com or by calling Mike Terrell, 800-769-0548.

January / February 2021

CONVENTION

SALT PALACE CONVENTION CENTER CANCELS THE UDA 2021 CONVENTION (CONT)

February 01, 2021

Dr. Jerald Boseman, DDS Utah Dental Association 1568 South 500 West Suite 102 Woods Cross, UT 84010 Re: Event Cancellation Dr. Boseman, You are receiving this letter as notice of cancelation for the 2021 Utah Dental Association event. Due to the continued and ongoing health risks associated with COVID-19 (coronavirus), it has become apparent that the continued pursuit to host the Utah Dental Association this April is no longer feasible for both the Salt Palace Convention Center and Utah Dental Association. This letter is being sent to provide notice (in writing) of this cancelation, and to formally trigger the Force Majeure (Section 20. (d)) clause in your executed License Agreement. The triggering of the clause relieves both parties of any damages associated with the event cancellation. The current and continued partnership between both parties is of the utmost importance, and we recognize the tremendous hardships the Covid-19 pandemic has had on our industry. With the health and safety of our attendees and employees at the center of this decision, we believe the choice to cancel is appropriate. Continued conversations will be needed, and you should expect to be contacted by your Sales Manager to discuss next steps. Moving forward we are dedicated to providing your future events with the utmost care and concern, and hope our facility returns to a normal operating position soon. We want to thank you for your patience and understanding during this difficult time.

Dan Hayes General Manager Salt Palace Convention Center

UDA Action

PUBLIC HEALTH

MEDICAID - SIGNIFICANT CHANGES HAVE IT LOOKING UP Over the past few years, we have seen a number of changes to our Medicaid Dental Program. Some have been administrative, but others have made nice improvements for Medicaid patients and the Dentists that treat them. Our traditional Medicaid program, which covers mostly children and pregnant women is now under managed care. Medicaid use to be administered by the State. The program is now administered by two management companies, Premier Access and MCNA. In order to participate you need to be credentialed by Utah Medicaid and enrolled with one or both of the management companies. Patients sign up with, or are assigned to, one of the management companies and must see a dentist on their list. Reimbursement comes through the management company, and they can send you out their fee schedule. Providers can get reimbursed at a higher level by seeing higher numbers of Medicaid patients. Thanks to the efforts of Dr. Allen Christiansen, a Utah State Legislator and Dentist, State allocated reimbursements were raised 20 percent. Codes that are now covered have been expanded to allow tori removal and teledentistry exams. Silver Diamine Fluoride has not yet been opened but is under consideration. The BIG CHANGES that have occurred pertain to Adult coverage. The University of Utah School of Dentistry, because it is a State Institution, qualifies for federal money for Medicaid patients they treat. Because of the efforts Dr. Glen Hanson, with his understanding of the intricacies of Medicaid programs, and U of U School of Dentistry’s ability to negotiate with the State Legislators as well as the Federal Medicaid folks, we are seeing doors open into Medicaid coverage for some adults through the University of Utah School of Dentistry. This has been a step by step process and so far, has resulted in comprehensive Dental Medicaid coverage for: 1. The Blind and Disabled 2. The Targeted Adult Medicaid Population or “TAM” group. These are individuals suffering with Substance Abuse Disorder (addiction). These people may be dealing with medical conditions, they may have been in jail or in substance abuse programs. 3. The Elderly anyone over 65 can qualify here. This new adult coverage is comprehensive except for implants. It even includes porcelain crowns. This is NOT part of the managed care Medicaid program run by MCNA and Premier Access.

The billing is fee for service and is done directly with the State. For participating private offices payment comes from the State and even bypasses the U of U, which makes it very simple. The 20% fee increase previously mentioned pertains to this program and the Dental School does not charge a management fee. All incentives are passed on to the dentists resulting in higher reimbursement. Participating dentists are working through the U of U and so the Dental School will provide the fee schedule. In order to participate in this program you must be credentialed by Utah Medicaid and paneled by the U of U School of Dentistry. Once affiliated with the University of Utah and Medicaid, dentists qualify as a provider for these adult populations. Those interested should contact Lynn Powell DDS or Glen Hanson DDS PhD at the School of Dentistry and the Utah Medicaid office. There is a need in all areas for dentists to participate. But there is a particular need for dentists in rural Utah. Participating in this program will be a service for these needy patient populations and your community. It will also, for many, be a win for your dental practice. It is gratifying to see the impact our Dental Schools are having as they continue to teach and serve with a constant effort to not compete. Respectfully submitted Brent A Larson DDS UPDATE ON THE UTAH PUBLIC HEALTH DENTAL CLINICS Due to budget cutbacks the State decided earlier this summer to close the Mobile Outreach Program and the two Family Dental Plan Clinics; the Rose Park Clinic in Salt Lake City and the Academy Square Clinic in Ogden. This has been hard on the patient population that relied on these clinics and eliminated access to care for many families. All this at a time when adult Medicaid eligibility is expanding. Fortunately, the University of Utah School of Dentistry has acquired these clinics and taken over the Mobile Outreach Program. The Rose Park clinic in Salt Lake will have a soft opening on Jan 2, 2021. The Academy Square clinic in Ogden is hoping for a soft opening in March. We are happy to see our Adult Medicaid expanding and our Public Health Dental Clinics still up and running.

January / February 2021

PUBLIC HEALTH

UNIVERSITY OF UTAH SCHOOL OF DENTISTRY ASSUMES RESPONSIBILITY FOR FORMER FAMILY DENTAL PLAN CLINICS AND EXPANDING MEDICAID DENTAL BENEFITS TO ADULTS Family Dental Plan (FDP) Clinics have provided valuable care for underserved and vulnerable populations for many years. Funding for the FDP Clinics was redirected due to anticipated shortfalls with the COVID pandemic. As a result, this action ceased all dental care for patients who sought care at the FDP Ogden and Rose Park clinics. Fortunately, Utah Department of Health worked with the state Legislature and the Medicaid Office to help these patients find care through the University of Utah School of Dentistry (UUSOD). One of the Schoolâ€™s primary missions is to provide comprehensive oral health care to underserved Utahns. Consequently, the UUSOD will assume full responsibility for the operation of both the Ogden and Rose Park Dental Clinics. When the clinics formally reopen in early 2021, they will house programs in dental education, dental hygiene education (in collaboration with state hygiene programs), and include University of Utah dental providers who will treat complex patients. Both dental clinics will focus on caring for patients eligible for adult Medicaid.

changes while providing much-needed dental care to our underserved populations. If you are interested in joining us, please contact Dr. Lynn Powell (lynn.powell@hsc.utah.edu) for additional details. The UUSOD looks forward to administering the University of Utah dental programs at Rose Park and Ogden beginning in 2021 and collaborating with many of you for care of patients with adult Medicaid coverage. Together we will provide excellent care for vulnerable populations and dramatically improve oral health in Utah. Dr AJ Smith University of Utah Dental School

Patterning after the mobile efforts of FDP, the UUSOD will continue robust mobile services to rural areas. The rural mobile effort will bring significant primary care to those with limited financial resources while referring many Medicaid patients to local independent dentists coordinating with the UUSOD network. Public health data shows a large number of Utahns lack access to dental care because of low income, lack of insurance, or location. Many of these individuals qualify for Medicaid or fall within the charity care coverage available at the UUSOD. Legislative action in the last couple years has expanded Medicaid coverage for dental care to include 1) the Blind and Disabled, 2) Targeted Adult Medicaid patients who are in substance use disorder programs, as well as 3) adults over 65 years of age. The UUSOD philosophy is to provide dental education through caring for adult Medicaid and other underserved populations in a manner that avoids competition with privately practicing dentists. The good news embedded into the expansion of Medicaid coverage is for practicing dentists throughout the state, and particularly in rural areas, who are willing to provide dental care to adult Medicaid patients. The state Medicaid office has granted jurisdiction to the UUSOD to contract with private practitioners in providing a dental home for adult Medicaid patients. This move is a collaborative opportunity for dental practitioners across Utah to address the increased adult patient load associated with the recent Medicaid UDA Action

WHEN YOUâ€™RE BUZZED,YOU GET IDEAS. LIKE ASKING EVERYONE INSIDE THE TACO TRUCK WHAT DRIVING AROUND IN A KITCHEN IS LIKE AND THEN ORDERING 22 TACOS WITH EXTRA GUACAMOLE AND ALL THE CHEESE FOR EVERY DRUNK PERSON IN LINE. BAD IDEA FOR YOUR WALLET, BUT NOT AS BAD AS DRIVING HOME BUZZED.

ASSOCIATION

COLLABORATIVE DENTISTRY It is a few weeks before Christmas and I find myself watching “Its a Wonderful Life” and reflecting on the struggles of George Bailey. George wants to build a successful business and help the people in his town, but after years of hard work he is still financially struggling and has a major setback. George may lose his business and not be able to care for the people that count on him. Sometimes, some of us dentists can empathize with George Bailey. We also want to be successful and to serve our towns and to care for our patients. Like George, we work hard but because of a setback we may experience times when we struggle to make money and care for the people who need us. Practicing dentistry may not have turned out for us as we anticipated when we began our dental careers. Many of us are looking for other ways to supplement our income and better position ourselves financially within our practices. Due to high overhead, low insurance reimbursement and Covid shutdowns, it can be difficult for our practices to really thrive at this time. Wouldn’t it be nice if there was something that would both help the lives of others and improve our financial position? The answer might be something new that is slowly being introduced to our industry, collaborative dentistry. This new option for dental treatment may be something that can help. Collaborative dentistry is a relatively new method of practicing. In collaborative dentistry, a licensed dental hygienist performs approved treatment for patients unable to visit a dental office. All treatment is coordinated and approved by a collaborating dentist. This dentist is off-site, just a Zoom call away for an exam. There is a high desire for dental care by people who are unable to visit a dental office. Many people find it too difficult, or just feel more comfortable receiving treatment in their own homes. But you can still give them the benefit of seeing a dentist and receiving dental care by using collaborative dentistry. Here’s how it works. A contracted and licensed dental hygienist, with proper mobile equipment and training, visits a patient who needs care. A virtual tele-dental exam is conducted by the collaborating dentist, and treatment is diagnosed and scheduled. Hygienists can perform several modes of treatment under a collaborating-dentist’s watchful eye. Taking x-rays, recording perio numbers, taking intraoral pictures, placing sealants, applying fluoride, applying silver diamine fluoride and dental prophylaxis are some. With the average cost of mobile equipment for the hygienist for such care averaging between 15 - 20K, return on investment could be very favorable. Written contracts between the dentist and hygienist need to be formed so that both parties can be protected. Liability insurance for the hygienists can be obtained through the ADHA. Proper

systems need to be establish and communication with your liability insurance company is important to determine the best options for liability protection. Further investigation is needed to ensure adequate protection for both hygienist and dentist. Any dental software could work for Collaborative care dentistry, but a cloud based software could help for better and quicker communication of care. Accurate and secure note taking is paramount for the protection and care of these patients. If proper data is not communicated effectively, our patients could suffer unnecessary pain and discomfort if dental treatment needs are not corrected in a timely fashion. Consistent communication between hygienist and dentist must be prioritized for the success of this treatment model. Hygienists who are collaborating already, have reported very high personal satisfaction at serving patients in this capacity. Collaborative dentistry is akin to home hospice care. Just as a medical nurse travels from home to home caring for people where they reside, Hygienists do the same thing for patients dental hygiene needs. One reported caring for a Parkinson patient with limited mobility in his own home. Another told about treating an Alzheimer’s patient unable to care for themself and living in a care facility. These hygienists are reporting high job satisfaction as they fill a need in our community. You might say that we already have protocols in place to care for these types of patients. Our profession goes to great lengths to caring for most patients in these circumstances. But collaborative dentistry fills the gap for patients who are not covered by some sort of insurance, and for patients whose physical limitations make it nearly impossible for their family members to bring them to our offices. Up until now, most of these services in the elder care facilities and in home care, have paid fee-for-service out of pocket. Insurance companies are slowly improving “teledentistry” reimbursements and we anticipate further improvements as this type of care grows. Even students, in Title 1 schools, whose parents are too busy working to bring their children to the dentist, can be served by collaborative care. It is my opinion, that collaborative dentistry can help expand our circle of influence to help those who cannot help themselves. As this is still a new area of practice, there are many opportunities for improvement and growth. As a dental board we are dedicated to helping with the success of this venture. We would like to see dentists and hygienists succeed both emotionally and financially. There is still much that we can do to improve the success of this venture. We invite you to consider if this new opportunity would be right for you. If you are interested in becoming a collaborative dentist, please contact either the UDA or the UDHA offices for help in this venture. I wish you all a very happy and successful new year and hope that we all truly feel that this is a wonderful life. Dr Rodney Thornell ADA Delegate January / February 2021

LEGISLATIVE

UTAH DEPARTMENT OF HEALTH CLOSES DENTAL CLINICS Because of the COVID-19 pandemic, the Utah legislature made budget cuts during special sessions of the Utah Legislature held earlier this year, in order to balance the state budget. As a result, the Utah Department of Health closed the final remaining dental clinic operated by them at the end of October, the Family Dental Plan Clinic in Salt Lake City. The Ogden dental clinic closed the middle of August. The Family Dental Plan Clinics’ scope of services was primarily providing care for patients covered by Utah Medicaid, CHIP, and low income uninsured patients. Dental care was also provided for varying periods of time under agreements with Vocational Rehabilitation, Fourth Street Clinic, Senior Charity Care Foundation, Odyssey House, Orange Street Women’s Center, Christmas Box House, Division of Juvenile Justice Services (DJJS), and others. The Family Dental Plan Clinics also operated the Community Partnered Mobile Dental Services program which provided mobile dental missions for the underserved in over 35 rural areas in most of

Utah’s rural counties. The dentists and dental assistants would usually stay for a week providing care with mobile equipment in settings such as churches, schools, and fire stations. COVID-19 has certainly brought about many changes. It has had, and is still having, an impact on all of us. It has affected the poor, the middle class, and the wealthy. Some of those that were considered wealthy or middle class are now struggling. It is important for us to continue to do what we can to help those around us as we all work to get through this. Thanks for all you and your staff do to help with the oral health care needs in Utah. You as dental professionals are essential in helping us all to be healthy. Kim Michelson, DDS State Dental Director, Utah Department of Health

Utah Dental Association CE Event September 2021

UDA Action

PRACTICE

THE RISE OF ADDICTION PROBLEMS IN DENTISTS AND HOW TO GET HELP In 2020, the United States saw a rise in mental health and addiction concerns in conjunction with the COVID-19 Pandemic. According to the National Survey on Drug Use and Health, 20.3 million adults in the United States battle a substance use disorder.1 Unfortunately, dentists are not immune. The statistics show that dentists are as likely as the general population to have an addiction.2 What drives addiction among dentists? There are many factors in a dentist’s professional life that can contribute to or drive addictive behaviors. The work of a dentist can be stressful and isolating. Long hours and the pressure of running a business may not support an optimal work/life balance. These and other professional pressures can cause dentists to look for relief in substances like drugs or alcohol. The serious impact of addiction The consequences of addiction are far-reaching. Addiction not only impacts the person with the addiction. Family and friends may also suffer under the weight of a loved one’s addiction. Trust is often the first casualty, leading to a breakdown of relationships with children, spouses or partners as well as extended family. In one study, substance abuse was cited as a cause in one-third of the divorces analyzed.3 Professionally, addiction makes it difficult to uphold the highest levels of professionalism and competence. It can strain patient interaction and the impair a dentist’s ability to manage a dental practice. It can also lead to censure by professional organizations and sometimes lead to malpractice suits. New innovative treatment options offer hope Treatment options for those struggling with addiction continue to evolve. There are programs specifically designed for the needs of working professionals. These programs often have schedules that minimize the amount of time away from business and maximize healing during a short time and are especially attractive to those who may have stayed away from treatment due to the needs of their business. In addition, innovative treatments are helping to dramatically reduce or eliminate cravings, restore healthy brain functions and rebuild relationships. These treatments include: IV Amino Acid Therapy Amino acids are compounds that are produced by the body and found in the foods we eat. These acids combine in unique ways to make proteins that help the body build muscles, transport nutrients, prevent illness, and carry out other critical functions. They also enhance the brain’s ability to produce and use dopamine correctly.

IV Amino Acid Therapy helps to reset the imbalance of dopamine and other neurotransmitters. With adequate neurotransmitters in place, two things happen: (1) the healthy cycle of message transmission resumes, and (2) the number of receptors goes back to normal. In effect, amino acid therapy helps the brain to work correctly again. Feelings of pleasure and joy are experienced at normal levels, thus significantly reducing or eliminating the uncontrollable urge to use drugs or pursue the addictive behavior. Ketamine-Assisted Psychotherapy Ketamine has been widely used since the 1960s for pain relief/anesthetic purposes and, more recently, is being used to treat addiction. Recent research indicates that it is useful in treating substance abuse – specifically cocaine, opioids, and alcohol. John Abenstein, MD, and president of the American Society of Anesthesiologists said, “In the right hands, [ketamine] is a miracle.”4 Often people with addiction are struggling with past trauma as well as depression and anxiety. Like the amino acid therapy, ketamine is administered intravenously. Ketamine-assisted psychotherapy is a powerful combination that creates a relaxed state to help individuals in an addiction recovery program work through past trauma and other challenges. This allows them to move forward and create a more meaningful life without those burdens of the past. A holistic approach Addiction recovery programs with a bio-psycho-social-spiritual model of treatment incorporate varied modalities to treat the whole person. Exercise, nutrition, therapy and experiential learning are all important parts of a program designed to help someone struggling with addiction begin their recovery and develop a meaningful life free of addiction. Some programs include an initial comprehensive physical exam (including extensive blood tests) to provide information about body systems that may not be functioning correctly and how to improve them. To overcome addiction issues, it is imperative that the body properly works. Physical activity is an important part of tapping into the body’s natural abilities to heal and restore proper brain functioning in addiction recovery. A healthy exercise routine reduces stress, improves mental health and self-esteem, prevents weight gain, contributes to enhanced sleep, and reduces addictive cravings. A pro-recovery diet supports the nutritional needs of the body as it heals.

January / February 2021

Recovery from drug abuse and addiction does not stop when an in-patient or onsite program ends. While the treatment modalities discussed can help heal the brain and prepare a person for sustained recovery, without implementing other changes, someone in recovery may return to the same environment, the same stressors, the same relationships, and ultimately the same habits. For that reason, finding a program with robust aftercare support is critical.

of working professionals. For a complimentary and completely confidential consultation, please call (801) 477-7493. Brooke Meyer Ampelis 1 https://www.samhsa.gov/data/sites/default/files/cbhsq-reports/ NSDUHNationalFindingsReport2018/NSDUHNationalFindingsReport2018.pdf 2 Academy of General Dentistry, 2011, “Impact of drug abuse/dependence on dentists” by Eric Y.K. Fung, PhD and Brian M. Lange, PhD 3 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4012696 4 https://www.webmd.com/depression/features/what-does-ketamine-do-yourbrain#1

It can be challenging to know where to start when looking to get help for yourself, a colleague or a loved one. Ampelis Recovery is one option if you’re looking for a program tailored to the needs

PRACTICE

LIFE THREATENING EMERGENCIES IN THE DENTAL OFFICE A safe dental office will have in place a plan of action for when a life-threatening emergency occurs. After all, an emergency, either medical or dental, can present at any time and successfully handling it requires a plan of action that the entire staff understands and has practiced. After all, it may be the dentist having the medical emergency! Emergency policies must be developed specific to the size and type of dental practice. What is appropriate for a small general practice is entirely different than that of a large clinic, which is yet again different from what would be expected from an oral surgery practice. Regardless of the type of practice, an emergency plan aims to manage the patient until help arrives. This comes down to maintaining an oxygen supply to heart and brain, thus managing the airway, breathing and circulation.

In this situation, the entire staff must have current CPR training, which now includes the use of an AED. There is a staff member (and backup) appointed to call 911 stat. An oral surgeon’s office or a practice that utilizes sedation or general anesthesia should have access to more resuscitation equipment and be able to provide more advanced care. In both settings, only repeated practice can result in calm, clear communication and effective addressing of the emergency. The takeaway…have a basic plan and practice! Dr. Rich Herman Chair, ADA Culture of Safety in Dentistry Workgroup ddsrph@aol.com

The small or solo practice may have a simple policy of two basic steps: 1. Calling 911 2. Instituting Basic Life Support (BLS) procedures to support oxygenation culminating in the use of an automated external defibrillator (AED).

UDA Action

Follow Utah Dental Association on Instagram @utahdentalassociation

PRACTICE

HOW COVID-19 HAS CHANGED DENTAL SCHOOLS COVID-19 has disrupted the world in many ways, and dental education did not go unscathed. Already dental school is known for being challenging and grueling, but COVID-19 has added extra pressures that I hope no other future dental student has to bear. Most dental students already have to practice delivering local anesthetic to each other, this surely does increase our empathy for our patients when we are practicing on them. However, I never would have guessed that we would also have to undergo ten nasopharyngeal swabs in order to actually treat our patients in clinic. My nose still hurts. I used to think that learning how to use a mirror properly was tricky, but learning how to see through loupes and a plastic face shield proves extra tricky. Especially for those of us that have to wear Powered Air Purifying Respirators (PAPRs). It’s not all bad, a classmate rose up to the challenge and 3D printed attachments for our lights on our face shields, which greatly increased our vision.

If you’re not overheating from the respirator mask and the surgical mask, then you are experiencing short term hearing loss while wearing the PAPR. There’s no escaping the assault to our different senses. I see my classmates with raw nose bridges from the tightness of the respirator masks, and I see others’ PAPR cords getting snagged on anything in their way. But it keeps us safe. This augmented PPE has contributed to our clinic being a safe place in comparison to the rest of Utah. The routine COVID-19 testing helps us keep our building secure. There is reason to these present discomforts, but it adds more stress to dental school (and I didn’t think that was possible). However, by far the hardest part of COVID-19 and its reach is the inability to gather with my classmates. The best part of dental school is my fellow classmates, and now that we cannot socialize like we used to during our last year of dental school, it is truly heartbreaking. We have spent three full years together and now we hardly see each other. We also don’t know if we will be able to gather together for our graduation ceremony. Despite all of that, my cohort remains strong and connected. We connect in clinic by helping each other whenever we see the opportunity. We connect virtually, sending jokes to each other so that we can get through these strange times. We connect when we walk past each other, making sure our eyes express our smiles of greeting. I was silly to think that COVID-19 would disrupt the bond formed between 50 people and the hurdles we overcame together. There is so much COVID-19 has changed, and perhaps we are at a paradigm shift in history and healthcare. It is humbling to be a dental student during this historical event, and we will have many stories to tell the younger generation. Shaylee Avery UDA Convention Committee Uof U Dental Student

January / February 2021

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