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MARQUETTE UNIVERSITY ASDA CHAPTER

FALL 2009

The Progress Note M.O.M. Volunteers Have Something to Smile About

In This Issue: Mission of Mercy

1

ASDA Logo

1

Marquette ASDA

2

MASDA Board Members 3

Ryan Dulde ’11 Wisconsin’s first Mission of Mercy project went above and beyond its goals, providing $850,000-worth of free dental care to the 1,533 patients helped. Among the treatments performed were a staggering 135 treatment partials, 1,525 restorations, and 1,700 extractions. Additional information about this year’s M.O.M. project can be found at WDA.org. ASDA has submitted student feedback regarding the project to the M.O.M. Planning Committee. Plans for

ASDA Events

3

Legislative Committee

4

Midlevel Providers

4-5

Nonpatient Exam

6

Calendar of Events

6

Amalgam Classification

7

ASDA Bags Tournament

7

Louisville

8

next year’s project are in the works, and ASDA’s Community Service Committee will work with MUSOD administration and the M.O.M. Committee to define the role students will play in future missions. In the wake of the success in Lacrosse this past June, Mission of Mercy has garnered a wealth of local, state, and national attention, including an upcoming article in the fall issue of Marquette Magazine and recent coverage on CBS Evening News. Thank you to the Marquette students, faculty, and staff among the 903 volunteers who made this event possible!

WE NEED YOUR HELP Marquette ASDA is looking for someone to design a logo for our local ASDA Chapter. There will be a $50 cash prize for the chosen design. You can get as creative and innovative as you want to with your design. This logo will be used for marketing Marquette ASDA, apparel, and in this newsletter. The design of the

logo should incorporate Marquette University School of Dentistry, American Student Dental Association, and Marquette University. Once all of the designs are in, ASDA members will be able to vote on which logo they want to represent our Marquette Chapter. The deadline for submission is October 15, 2009.P lease submit your design to jared.harding@mu.edu.

IF YOU WANT TO BECOME MORE INVOLVED IN ASDA CONTACT RYAN.DULDE@MU.EDU

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MARQUETTE UNIVERSITY ASDA CHAPTER!

Marquette

FALL 2009

2009-2010

OUR ROADMAP FOR STUDENT ADVOCACY Committees

Chapter Goals ’09-‘10

• Three expanded issues of The Progress Note • Improve collaboration with other student organizations • Increase pre-dental involvement • Host Fall Vendor Fair • Host Winter Holiday Party • Community Service • Twice-monthly Lunch and Learn programs • Fundraising • Organize lunch-time fundraisers • Ideal ASDA • Establish regular meeting schedule • Representation at Regional Meeting, National • Legislative Lobby Day, and Annual Session • Lunch and Learn • Expanded policy programs including Legislative • Newsletter Week and ADPAC Drive • Involvement in 2010 MOMs Project • Pre-dental • Restructure and improve State Lobby Day • Social • Automatic enrollment in Free Life Insurance • Vendor Fair for all ASDA Members • Additional, worthwhile community service The best way to become active with our • opportunities Launch ASDA website ASDA chapter is to join a committee. • Strengthen relationship with WDA Contact your class rep or a committee • Submit portfolio for “Ideal ASDA” awards • Submit resolutions to House of Delegates chair to get started! • Promote Marquette Dentistry nationally

The Marquette Chapter reaches its goals through the efforts of our nine committees:

NATIONAL LEADERSHIP

Tim Moriarty UConn ‘10 ASDA President

McKenzy Boyd Marquette ‘10 District 7 Trustee

IF YOU WANT TO BECOME MORE INVOLVED IN ASDA CONTACT RYAN.DULDE@MU.EDU!

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MARQUETTE UNIVERSITY ASDA CHAPTER!

FALL 2009

CHAPTER LEADERSHIP Ryan Dulde

David Burrus

Gina Corrado

President

D4 Class Rep

Fundraising

Emily Bugger

Erin Franken

Eddie Morales

Vice President,

D4 Class Rep

Historian (Ideal ASDA)

Vendor Fair

McKenzy Boyd

Nick Valeri

Jared Harding

Immediate

Pre-dental

Newsletter

Past-President

D3 Class Rep

Kristin Corcoran Secretary,

Allison Lehman

Elizabeth McCourt

Community

Social,

Licensure Rep

Service

D2 Class REp

Beth Hoge

Jared Robertson

Paul Covell0

Treasurer

D2 Class Rep

Lunch and Learn $

$

Michael Payne

Dr. William

Legislative,

Lobb

D3 Class Rep,

ASDA Advisor

$

Student Organization Liaison

IF YOU WANT TO BECOME MORE INVOLVED IN ASDA CONTACT RYAN.DULDE@MU.EDU!

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MARQUETTE UNIVERSITY ASDA CHAPTER assemble a series of legislative panels to give us more information and answer any questions about these topics. The first panel of experts, planned as an after school event on Michael Payne ’11 Sept. 28, will discuss the mid-level provider issue and non-patient It is very important based board exams. In addition to for dentists and dental this, the legislative committee is students to be aware and also planning a legislative week knowledgeable about current topics from Oct. 19th -22nd, which will that are being presented to legislators. include more presentations on In order to become more informed current dental issues, as well as an on some of these topics, the ADPAC drive. If there are any topics legislative committee is planning to you would like to learn more about

FALL 2009

LEGISLATIVE COMMITTEE EVENTS

in rural communities under the general supervision of a dentist, who sometimes was over 200 miles away. Among the irreversible procedures they were permitted to perform Michael Payne ‘11 were: fillings, simple extractions, pulpotomies and stainless steel Access to care has crowns. If there was treatment been a major issue in needed beyond this set of dentistry and there have procedures, the patient was been many options referred to the overseeing dentist. proposed to solve this This model allowed for the problem. One of the many different radiographs, exams, restorative ways that the access to care issue has procedures and simple extractions to been addressed is the addition of a be done by the dental therapist while mid-level provider in the dental the more lucrative procedures could profession. There are many different be performed by the dentist. By 1987, models that have been discussed or the dental health of children in implemented to add the mid-level Saskatchewan went from the worst to provider to the dental team. These the best of any province in Canada. mid-level providers would play an By 1993, the amount of dentists and analogous role in the dental setting dental therapists in Saskatchewan that nurse practitioners currently fill outweighed the dental care need so in the health care system. The current the program was ended. task is to observe the models The program was brought back in currently in place and find a system 1997 due to decreasing dental health that works well and is accepted by in Saskatchewan and the dental dentists and dental hygienists. therapists were allowed to work in The mid-level provider system private practice under general was adopted by Saskatchewan and supervision of a dentist. This allows Northwest Territories, Canada in the dental therapist to perform 1972. This was part of an initiative to procedures in the rural areas of improve the children’s dental health Saskatchewan and have examinations in this province and territory. In this and radiographs completed before the model, mid-level providers, known as dentist arrives so he/she is able to dental therapists, would work and live provide as much care as possible.

OVERVIEW OF MIDLEVEL PROVIDER MODEL

during legislative week, please email suggestions to michael.payne@mu.edu. The following articles are brief overviews of the topics to be discussed during the legislative panel on Sept. 28th. According to certain studies, the work done by these dental therapists are above the standard of care and this may be due to the periodic evaluation of their work by the supervising dentist. The Canadian dental therapy program was the model for the creation of the Alaskan Dental Health Aide Therapist (DHAT) program, but some enhancements were made. The DHATs are required to practice 400 hours under the immediate supervision of a dentist and have the dentist confident in their abilities before they are able to practice in the rural areas. Also, all clinics must have intraoral digital radiographs and cameras so that the dental therapist can discuss findings and treatment plans with the supervising dentist. The clinics are also required to employ EMT staff, so there is an immediate response of the medical team in an emergency situation. In 2008 there were 10 DHATs in Alaska and 10 more in training and they serve 42 isolated communities. The original 10 DHATs were trained in New Zealand where there is a similar program. Article continues on page 5

IF YOU WANT TO BECOME MORE INVOLVED IN ASDA CONTACT RYAN.DULDE@MU.EDU

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MARQUETTE UNIVERSITY ASDA CHAPTER! OVERVIEW OF MIDLEVEL campaign to raise public awareness of PROVIDER MODEL CONTINUED the legislative proposal to allow the Now there is a program where the unsupervised performance of DHATs are trained in Anchorage, AK irreversible dental procedures. with University of Washington dental school faculty for the first year and in Bethel, AK for the second year. The Alaskan DHAT program allows the mid-level providers to perform procedures similar to those in the Canadian model, but try to assure the quality of care with the modifications made in the program.

Along with this opposition, the University of Minnesota School of Dentistry introduced a different dental therapist model that was eventually passed into law. This legislation created two new positions, the dental therapist and advanced dental therapist, which are separate from dental hygienists, who will provide care for the underserved populations in the state. The situation in Minnesota is Dental therapists are, according to slightly different than the Canadian Karen Fox, “a licensed provider with a dental therapy and DHAT programs. bachelor’s degree in dental therapy Originally the Advanced Dental who will work with MinnesotaHygiene Practitioner (ADHP) and licensed dentists to provide Oral Health Practitioner (OHP) preventative, dental services, models were proposed as state restoration of primary and permanent legislation but it faced major opposition from the Minnesota Dental teeth, extraction of primary teeth and Association (MDA) and the ADA. The select other dental treatments.” Advanced dental therapists must have ADHPs would have been licensed a bachelor’s degree in dental therapy, dental hygienists educated at the practice as a dental therapist for at Master’s Degree level. This model least 2,000 hours, graduate from a would have allowed ADHPs to perform surgical procedures, including master’s program in advanced dental restoration and non-surgical extraction therapy and pass a board-approved exam aimed to assess competency. of primary and permanent teeth, These advanced dental therapists will pulpotomies, emergency temporary placement of crowns and restorations, be able to practice without a dentist present, but must obtain consent from placement of preformed crowns, and the supervising dentist before pulp capping, without on-site performing restorative or surgical supervision or preauthorization by a procedures. They will also be able to dentist. In addition to this, The perform nonsurgical extractions of ADHPs would have been able to prescribe medication for anti-infective noncarious periodontally involved permanent teeth when authorized by a therapies and non-narcotic pain dentist. Neither the dental therapist management and prevention. The nor the advanced dental therapist will ADHP model was successfully be able to prescribe medications. opposed by the MDA but a law was These new positions are integrated passed authorizing the creation of an OHP with no specifications about the members of the dental team as opposed to other proposed legislative procedures to be performed or the models, which had very limited degree of supervision. A Department interaction between the mid-level of Health work group was given the task of specifying this scope of practice provider and the dentist. There will be a comprehensive outcomes assessment and eventually approved guidelines conducted to study the impact of the similar to those of the ADHP, which dental therapists and the quality of included “unsupervised surgery and care they provide. fragmentation of the dental team.” In response to this, the MDA launched a

FALL 2009 These models, which allow midlevel providers to perform irreversible procedures, are opposed by the ADA and ASDA. According to articles C-1 and C-2 of the ASDA Current Statements of Position and Policy, “Only the dentist should perform the following functions…a. Examination, diagnosis and treatment planning b. Prescribing work authorizations c. Performing irreversible dental procedures d. Prescribing drugs and/or other medications” and “The American Student Dental Association is strongly opposed to independent dental hygiene practice, and favors the team approach for providing comprehensive dental care.” The Community Dental Health Coordinator (CDHC) is a midlevel provider program that is accepted by the ADA and its goal is to provide dental care to the underserved communities. Under the supervision of dentists, the CDHCs could work in health and community centers and perform screenings, fluoride treatments, placement of sealants, temporary fillings and simple teeth cleanings until further treatment could be rendered by a dentist or hygienist. The pilot program of the CDHC model began in 2007 in urban areas of Pennsylvania, rural areas of Oklahoma and Arizona, and the Native American populations served by the Indian Health Services facilities. The ADA estimates that every dollar spent on fluoride treatment saves $18 in dental care, and this preventative benefit is the basis of the support for this program. The effectiveness of this program is being investigated with funding from the ADA. It is important to understand what procedures that mid-level providers are able to perform in the different models and continue to have monitor the effects of these models to find the whether this is a viable option for addressing the access to care issue in other areas of the country.

IF YOU WANT TO BECOME MORE INVOLVED IN ASDA CONTACT RYAN.DULDE@MU.EDU!

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MARQUETTE UNIVERSITY ASDA CHAPTER MINNESOTA MOVES TO NONPATIENT-BASED EXAM

Eddie Morales ‘10 How many times have we seen seniors struggling to find “ideal lesions” or scrambling to find back-up patients the morning of boards. Just this past year, I witnessed patients being turned down by boards examiners because the lesions presented were too small; lesions deemed acceptable by group leaders at school. Even to the most competent and confident clinicians, these added pressures are more than enough to ruin an otherwise successful exam. These are among the many reasons Minnesota adopted the Canadian dental licensing exam. The exam is composed of a written exam and an Objective Structured Clinical

Exam (OSCE), which is the nonpatient-based portion. According to Dr. Patrick Lloyd, Dean at the U of M School of Dentistry, “The Canadian exam tests the decisionmaking ability of dental school graduates in a manner consistent with the ethical principles of the ADA, the Minnesota Dental Association and the American Dental Education Association.” Some ethical problems referenced by Dr. Lloyd include premature treatment, lack of follow-up care, deferred treatment needs, and care by someone other than the provider of record. Patient-less boards exams have been a topic of discussion since 2001 when the ADA House of Delegates passed a resolution supporting the elimination of human subjects from the licensure process by 2005. The Minnesota dental association had a similar resolution in their house of delegates. A study published in JADA in 2006 demonstrated a lack of validity and reliability when using patient-based licensure exams to

WHAT MINNESOTA RESIDENTS HAD TO SAY

Megan Harriman ‘11

“I think this is a very important step toward a more ethical, objective test.

FALL 2009 determine competence for practice. In addition, the study illuminated the flaw in performing a select few procedures for boards rather than learning from a decision making component that would be more beneficial in private practice. The OSCE is a station type exam that is administered in 2 sessions (morning and afternoon) on the same day. The exam features 25 stations that each have approximately 2 extended multiple answer questions. The candidate has 5 minutes at each station to answer questions using the provided information (e.g. casts, radiographs, case history, photographs, models). The candidate may also need to prescribe a medication commonly prescribed in dentistry. As the first state to do so, Minnesota will offer the exam this spring to its UofM 2010 graduates. The state dental board is hoping other states will follow suit and thinks this is a stepping stone to the ultimate goal of a national dental exam.

Calendar of Events: September 18-20, 2009

It rea$y focuses on the student dentist becoming an analytical, diagnostic clinician instead of a tradesman. One problem I forsee, however, is that Minnesota is going to have it's own licensure exam, so those at U of M Dental School are stuck practicing there unless they want to go outside the state to take a more widely accepted exam, and vice versa. To students, I think the bi'er issue is nationalizing the dental boards.”

District 7 Retreat September 28, 2009 Legislative Panel Discussion September 22, 2009 LnL - Tax Basics October 16-18, 2009 Central Region Retreat October 19-22, 2009 Legislative Week November 18, 2009 ASDA Vendor Fair

IF YOU WANT TO BECOME MORE INVOLVED IN ASDA CONTACT RYAN.DULDE@MU.EDU

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MARQUETTE UNIVERSITY ASDA CHAPTER AMALGAM: THE NEW FDA CLASSIFICATION

Michael Payne ’11

Amalgam has been at the center of many controversies throughout its life as a restorative material in dentistry. Now there is a bit more clarity about its safety that can be used to inform patients. In the past, elemental mercury and powder alloy were classified separately by FDA, but there was no classification for encapsulated amalgam. According to the new regulation, dental amalgam is now classified as a Class II device (moderate risk), which allows the FDA to enforce special controls to ensure amalgam’s safety and effectiveness. Since the FDA first proposed the new classification, the ADA has supported a class II designation of amalgam. This classification, which is based on the results of 200 scientific studies, places encapsulated amalgam in the same category as other restorative materials

such as composite resin and gold. The FDA specifically is recommending that new product labeling include a warning against its use in patients with mercury allergies, the need for adequate ventilation when handling amalgam, and the benefits and risk of dental amalgam, including the risks of inhaled mercury vapor, based on scientific literature. This will allow the dentist and patients to make educated decisions about its use. During a recent press conference Dr. Susan Runner, acting director of the FDA's Division of Anesthesiology, General Hospital, Infection Control and Dental Devices, Center for Devices and Radiological Health stated, “The best available scientific evidence supports the conclusion that patients with dental amalgam fillings are not at risk for mercury-associated adverse health effects.” She also specifically mentioned the current scientific data suggests that there are no adverse health effects to developing fetuses, breast-fed infants and children under age six. This is supported by two articles that were recently published in the Journal of the American Medical Association (JAMA), "Neurobehavioral Effects of

FALL 2009 Dental Amalgam in Children" and "Neuropsychological and Renal Effects of Dental Amalgam in Children," which compared the health effects of children treated with dental amalgam with those treated with composite resin. These studies concluded that there are no adverse effects on neurological and kidney function in children with amalgam restorations. The mercury levels in urine of the children with amalgam restorations increased, but were within the range of normal background levels. All of this information supports the ADA’s stance that, “The material is a safe and effective restorative option for patients”, and, "The minute amount of mercury released by amalgams during eating and drinking does not affect health adversely." This new FDA classification gives dentists and dental students another reference to cite when asked whether amalgam is safe. Understanding this new classification and the scientific evidence on amalgam is essential to be able to inform patients and allow them to make educated decisions about treatment.

ASDA’S BAGS TOURNAMENT

A$ison Lehman ‘12

ASDA’s first annual bags tournament, which coincided with Thriller at Miller on July 11, 2009, was a success. We had a total of 28 teams enter the tournament, which gave students, faculty, friends, and family members an opportunity to shine. In particular, Gina Corrado (D3) and Anthony Varchetto (D3) took the day by storm. The duo Honorable mention goes to Chris Goettl (D2), Andy successfully took on five different teams, claiming 1st place Rasmussen (D2), Lindsay Porath (D3), and Matt Marks. bragging rights and the $100 prize. Samantha Pack (D4) ASDA thanks everyone for their interest and support and Dave Perry put up a good fight taking 2nd place and in the tournament. We look forward to seeing everyone the $50 prize. out on the pavement again next year. IF YOU WANT TO BECOME MORE INVOLVED IN ASDA CONTACT RYAN.DULDE@MU.EDU

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MARQUETTE UNIVERSITY ASDA CHAPTER

FALL 2009

ASDA NATIONAL CONFERENCE IN LOUISVILLE Chief or Contributing Editor, District Trustee, Speaker of the House, or ASDA President. McKenzy Boyd ‘10 This year I was elected to serve as one of eleven district trustees. This past March, It has been one of the most ASDA sent nine students rewarding and interesting things to the annual meeting in I have ever been a part of. As Louisville. Over 300 trustee, I represent the six dental dental students from schools in our district (MU, U of I across the nation joined together to Chicago, Southern Illinois, Indiana, discuss hot topics such as mid-level providers, ethics in the profession and Kentucky, and Louisville). I primarily function as the portal of in dental school, and a non-patient based board exam. Networking with communication between these schools and the ASDA Executive Committee other dental students and discussing (President and VPs). It has been a issues aecting our profession is what long time since Marquette had a makes the annual meetings a valuable student elected to a national position; intangible experience. Attending these meetings makes you realize there however, the first ever president of ASDA was a Marquette are several opportunities to become student. On September 18th, we more involved in ASDA on a national will be hosting the first ever district level. For example, you could become an ASDA Extern, Member-at- retreat at MU. The schools in attendance will enjoy some heated large, Committee Chair, Editor-in-

discussion on pressing issues, receive a tour of the dental school, and have some fun at a Brewers game. I would highly encourage anyone who is interested in the future of our profession and organized dentistry to pursue a national position. You could do something as short-lived as an ASDA extern or as grand as running for president. All national position bios and deadlines can be found on the ASDA website at www.asdanet.org. You can also contact me for more information. GEAUX ASDA!

IF YOU WANT TO BECOME MORE INVOLVED IN ASDA CONTACT RYAN.DULDE@MU.EDU

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