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March 2019

DENTAL THERAPIST BILL IS BACK! The 2019 version of the Dental Therapist Bill, on first reading, looks very good. All the compromises and agreements from the 4/27/2018 iteration of a dental therapist bill seem to have been preserved. This bill, S1215, is well written by State Senator Harriette Chandler. Let us hope that S1215 survives as it is now as it passes through the various committees. With everyone remembering the GOAL: Oral health care for the consumers/citizens in the Commonwealth who are the most vulnerable and in the most need of our help. OHP4C will be paying special attention to Section 10 (i) to be sure that dental therapists have a yearly patient panel of at LEAST 50% of the most needy among us. OHP4C will also be tracking the results of the 5 year study mandated in Section 14 as the bill is now written. GOOD SHOW! to all who have worked together to truly help (instead of just hoping to help) consumers in need of oral health services.

ORAL HEALTH DEFINED: Includes but is not limited to: The ability to speak, smile, taste, touch, chew, swallow, and convey a range of emotions through facial expressions with confidence and free from pain or discomfort, and disease.

(international definition of oral health)

April 27, 2018:

Announced this week: there has been an agreement reached between the MA Dental Society, the Pew Charitable Trusts, and the MA Senate and House that has resulted in legislation which would establish dental therapists. The legislation/bill has to be passed before July 31, 2018.

Under this legislation dental therapists would have to obtain a bachelors degree followed by Master's level training in dental therapeutics, have at least 50% of their patients be on Medicaid or be considered underserved and would only be able to preform surgical procedures under the direct supervision of a dentist.

OHP4C (formally the Dental Posse) is extremely pleased with this legislative compromise.

The only OHP4C consumer recommendation not fully in this bill: 50% rather than 80% of the underserved.

Thank-you to the MA Senate, House, and the Pew Charitable Trust for taking the time to understand the detriment to all consumers and especially the underserved consumers their original bill would have posed.

This post will stay up until July 31, 2018 (c) OHP4C.com 4/2018

March 2019 TO DATE: Four States in the USA are doing Battle with SMILE DIRECT (a do-it-yourself braces company)

Those involved:

The state Dental Boards of each state. These boards are tasked with granting licenses to practice dentistry to qualified candidates and overseeing any malpractice by any licensed dentist. Their mandate is to protect the health of the citizens of their state.
The orthodontists and state dental societies. If you are a sceptic you would say "of course, they are protecting their market". If you know the field you say "PLEASE STOP them... because if you don't we'll be the ones who have to deal with trying to fix the mess this company is going to make in people's mouths (if we can...without bone graphs, implants, et cetera)"
The Smile Direct Company who has seen a market it wants to fill and looks at all these suits and bad press as impeding trade and defamation of their company.
Dentists who do not have an understanding of how malpractice is defined. In all states, to protect the citizens of the state from harm, the State Board of Examiners requires an examination and x-ray check of a patient before recommending orthodontic treatment. Without this the dentist is committing malpractice. It is also malpractice to recommend orthodontic treatment for a patient with cavities or bone loss or certain systemic, debilitating illnesses.

So who is suing who? Smile Direct is suing the state boards of dental examiners. To date those suits have been dismissed. The orthodontists and dental societies in the states are suing the dentists who work for Smile Direct for malpractice. The State Boards of Dental Examiners are suing Smile Direct for the unlawful practice of dentistry.

BOTTOM LINE FOR CONSUMERS: Beware, not only of medical harm but of being left in a mess.. if/when Smile Direct is no more. Also once even the clueless dentists realize that they are committing malpractice to recommend braces without first checking for bone loss and cavities there will be no dentists looking at your case...which, very frankly, is already happening in most transactions.

see March 2019 article this site for more information (c) March 2019 OHP4C

March 2019 An INTERESTING LEGAL CASE SETTLED: There are only 4 large dental supply companies in the USA. They sell all the equipment, supplies, medicines, laboratory products, et cetera to dentists. The last time you went to the dentist an estimated 95% of everything you saw and everything used to treat you...inside and outside your mouth...came from one of these 4 supply houses.

These four dental supply houses agreed to a settlement of eighty million dollars for price fixing between 2008 and 2016. They were breaking the anti-trust laws of the USA. The judge still has to certify the settlement number (which is very low).

What this means to you, the consumer: between 2008 and 2016 your dentist was being charged inflated prices, fixed by the only suppliers available to him/her. (remember it is unlawful to buy drugs and materials not FDA approved). One of the many problems that impacts the consumer in a negative way.

Tell your family and friends about the OHP4C!.

Speaker's Page

Check it out

Rival DENTAL THERAPIST BILLS in MA State Legislature

(H2474/S1169) and (H2820)

Incorporating the four points below Massachusetts will have a good bill to meet the oral health needs of the underserved citizens of the Commonwealth

OHP4C recommends that a final bill incorporate the following:

1. Education of the Dental Therapist should mirror that of a nurse practitioner: 4 year college degree (including a two year dental hygiene associate degree) and a masters degree in dental theraputics

2. Direct supervision by a dentist is not needed if education described in one (1) above is completed.

3. A dental therapist, by law, is mandated to work in under served areas of the Commonwealth 80% of his/her working hours per year or lose his/her license.

4. Allow dental therapists with advanced internships in extractions to extract teeth under the direct (via visual +audio electronic communication), off site, supervision of a dentist AND a signed prescription of a dentist.

________________________________________________________________________(c) Dental POSSE, LLC

NEW PRODUCT ALLERT: AMABRUSH: DNB (Do Not Buy) See March 2018 Article for details.

An Act establishing medicare for all in Massachusetts (S683) was introduced this legislative session

by State Senator Jamie Eldridge

SEPTEMBER 2019

This is something to keep an eye on. OHP4C fully supports the United Nation's statement that health care is the right of all humans. This translates to a healthcare insurance/law that guarantees all citizens have access to good, basic, free health care. This requires us to act as a society. The form this action is taking in MA right now is the above S683. I applaud this bill while saying that many AMENDMENTS, CHANGES are needed to make it fiscally responsible AND good health care.

Let's start with the first 11 needed changes:

1. ALL current insurance billing codes, medical conditions definitions, and universal medical insurance forms having been in place for years, approved by all practitioners and all insurance companies be left in place. (Said another way: no reinventing the wheel as far as billing. Any such would add huge unneeded costs to medical care as the staff, computer programs, universal forms are all already in place and understood by all the parties/stake holders. Also it would save a good service industry, coding, and many Commonwealth of MA jobs)

2.The Executive Director of the new Medicare system will have at least 10 year experience running a for-profit medical insurance company. (The rational: Anyone with that experience has the background to understand and know the medical industry, the insurance industry, and has the education to be able to do a non-profit as well as a for-profit model. His/her background would allow the director to understand how to implement this law without adding unneeded administrative costs AND where costs cutting can be done without damage to patient care.)

3. The 1% for prevention is grossly inadequate. If we want true prevention that figure needs to be greater than 25%. (examples: true prevention means having patients with serious medical conditions seen for pre-care, follow-up care, lab tests, at home instructions and visits, et cetera. More importantly for CONDITIONS that COULD BECOME SERIOUS but CAN BE STOPPED with attention to TRUE PREVENTIVE MEASURES.

4. The board of directors should have 25% citizen and 25% medical doctors and/or hospital administrators. (Asking a board to regulate a business, medicine, without significant members of the business/profession on the board is a recipe for failure.)

5.The "savings" figures being circulated are not credible. They have no basis is firm facts. (Their origins need to be transparent. They are not.)

6. Out of state, out of USA patients with medical insurance need to be billed directly by the provider to the patients' out of state/country insurance. With direct payment in the manner now in place. (The method described in the bill creates several layers of MA bureaucracy that will increase MA medical administrative expenditures taking dollars away from patient care for needless administration costs.)

7. All federal Medicare be left in place, as is, for the first five years of the program.

8. Supplemental medical insurance needs to be allowed. (To not do so will drive healthy/mobile patients to seek care in other states and have physicians and healthcare facilities relocating to other nearby states.)

9. Section 13/3/b Violates patient's rights and jeopardizes care.( I doubt the electorate will go for it.)

10. Section 14/2 This is most likely against many laws both state and federal. (It will drive practitioners out of state. I wouldn't practice in MA.)

11. Section 15-4 Need to specify that administrative costs be less than 8%. (5% would be better, but this is MA and I am a realist)

AS ONE OF MY MENTORS ALWAYS SAID," DO IT RIGHT! DO IT NOW or DON'T DO ANYTHING". Not doing anything is unacceptable. SO let's DO IT RIGHT!

The Action for Dental Health Act: legislation aimed at improving oral health and access to oral health care IS NOW LAW

February 2019: a Senate bipartisan bill, Competitive Health Insurance Reform Act (S 350) , calls for the Federal Trade Commission and the Justice Department to enforce the federal antitrust laws against health insurance companies engaged in anti-competitive conduct (in other words, all health insurance companies... who thanks to the McCarran-Ferguson Act of 1945 have been free to price fix for decades). IF this bill passes it will be a great step forward for consumers in bringing DOWN the price of health (including dental ) Insurance. Be sure to contact your Senators and Congressman/woman to ask them to pass this Reform Act into law. (c) March 2019 ohp4c

December 19, 2018 ; Senate introduces a bill to amend McCarran-Ferguson Act of 1945: this would force health insurance companies to abide by the federal antitrust laws. (note: health and dental insurance companies are now exempt from these antitrust laws)

DENTAL THERAPIST BILL / MA 2018/

KILLED BY LEGISLATORS

JULY 31, 2018 The Dental Therapist bill was never taken to the floor of the legislator to be voted on. It was killed (in the Public Health Committee?). It would appear that if a certain legislator didn't get her way the agreed upon language from the stake holders ( see April 27th entry below) ,who wished to protect the rights of the underserved consumers of our state, made no impact. All that work by all the parties of interest was lost. OHP4C will watch this issue again if it surfaces in the next session. Since the "underserved" consumers needs got disregarded by the legislators for another 2 years.

PO BOX 1417

Concord MA 01742

PRODUCT ALLERT: a book: 'WELL' by Dr. Sandro Galea R (recommend!) one of the best books on healthwritten. Read as a patient, a doctor , or a legislator

2019 FEDERAL LEGISLATION WATCH:

PRODUCT ALERT: Hager Aquamed DryMouth Spray, Dry Mouth Drops and Chewing gum. All 100% xylitol with no other sugars. R (Recommended). See October 2018 Article for details

Late one evening Fred and Dr. Val

had a heated, nose to nose "discussion" about a presentation the doctor was writing. Fred had some strong opinions.

GO TO "ABOUT US" page TO FIND OUT WHAT THEY WERE "DISCUSSING"

June 2019: DELTA received an 8.8% decrease in fees they need to pay to the dentists.The big question? When will dentists figure out that they have to stand up and fight for their patient's? Until then more profits to DELTA. Less money for patients. And the dentists again get the (you finish sentence...what needs to be said is impolite and unprofessional...)

March 2019

Delta Dental of MA is back at the DOI (Division of Insurance) in MA asking for a 10% decrease in fees paid to dentists.

This is the only not-for-profit Delta operating in the state. All the for-profit Deltas are covered not by state laws but by Federal laws. This non-profit Delta is the Premier Plan...the plan patients pay more money (higher premiums) for to have more services available. It is important to the dentists that patients have available to them a plan that will cover more procedures. This has made many dentists too fearful to just say "no" to a 10% decrease in fees. BUT as in the article below written in January of this year...that is a foolish stance. It is hoped that the DOI will not allow Delta Dental of MA to decrease fees to dentists. Stay tuned for more on this subject as it unfolds. (c) March 2019 ohp4c

2019 STATE (Massachusetts) LEGISLATION WATCH and INSURANCE ISSUES:

Your mouth is connected to your body and your body to your mouth. What happens in one impacts the other.

We each have ONE, WHOLE, INTERGRATED, HUMAN BODY

NOTE: If you wish to read the letters written about this bill in the Stow Independent /fall of 2017, please email: info@ohp4c.com and type "dental therapist letters" in the subject line. The letters will be emailed to you.

 ORAL HEALTH POSSE FOR CONSUMERS, LLCr

education, advocacy, consultation

Copyright
© 2015 Dental POSSE, LLC/OralHealthPosse for Consumers

PRODUCT ALLERT: Teething Jewelry FDA WARNING DNB!(do NOT buy) See February 2019 article

Product Allert:

SMART MOUTH (mouthwash) DNB

(Do Not Buy) See May 2019.

EMAIL: info@ohp4c.com

SOME INFO ON WHY OHP4C MADE THE RECOMMENDATIONS IT DID

Note the MA Dental Therapist bill, as written, requires only 3 years of education TOTAL...including the 2 years it takes to become a dental hygienist.

Some hygienist's organizations are saying that is " just one year less than what dentists receive"

WRONG! INCORRECT!

TO BE A DENTIST: It is required that the individual complete a four year college degree that includes the following either as part of a major or an elective: 6 semester hours of inorganic chemistry, 6 semester hours of organic chemistry, 6 semester hours of physics, 6 semester hours of biology, and 6 semester hours of English/Humanities. The individual also needs to take and do well on the Dental Aptitude Test: a day long didactic, hands-on carving, and spacial acuity test.

Next the individual has to be accepted at a dental school. Most often there are one to two thousand applicants for just 100 to 200 spots in a first year class. Not an easy task to get accepted.

Dental school is four years. During those four years the individual who wishes to become a dentist must complete courses in the medical school ( examples: gross anatomy...yes, your dentist dissected a human cadaver...histology, neuroanatomy, biochemistry, microbiology, et cetera ...all at least one semester long, many two semesters).

Concurrently with these studies the individual spends time in the laboratory learning materials: metallurgy, ceramics, sculpture, casting, et cetera.

Concurrently with the above two studies the individual who would be a dentist spends time in the dental clinic treating live patients. The first year, second semester, only doing dental hygiene things, but second year on the dental student becomes proficient in all aspects of dentistry under the supervision of a dentist clinical instructor. Included are courses on how each procedure is done, the possible side effects, both medical and dental, and how to deal with and reverse each.

During these four years of 18 hour days, 7 days per week the dental student is required to take and pass 2 two day national board examinations, sitting for one after the second year of study and the other in the last semester of the fourth year. These examinations cover all aspects of the individual's studies.

Once all this has been accomplished and the individual graduates from dental school with a doctorate in dentistry, he/she must take and pass a two day, live patient, multi procedure state or regional dental board exam to become a licensed dentist.

TO BE A HYGIENIST: The individual wishing to be a dental hygienist must complete two years of dental hygiene school after high school. After which there is a national board and a state board that test at the level the hygiene student was taught.

In the bill as written only one more year of training would be needed to be a dental therapist.

When I began my practice I moonlighted for three years as an instructor at Middlesex Community College's Dental Hygiene Program. Among other things, I taught the one semester pharmacology course. The dental hygiene pharmacology books available for use are significantly watered down versions of what is taught in a dental school.

THERE IS NO EDUCATIONAL EQUIVALENCY BETWEEN A DENTIST'S EDUCATION AND A HYGIENIST'S.

411

S1169/H2474 Both the MA Dental Hygienist Association and the MA Dental Hygienists PAC sponsor Rep Hogan's bill.

Here is the real 411:

For the past 35 years or so the MA Dental Hygienists have wanted to work independently from a dentist. This bill without mandates is a dream come true for dental hygienists.

For the last 35 years I have been one of the few dentists in MA who have supported the MA Dental Hygienists' desire to do dental hygiene tasks separately from a dentist's office. Now, in 2017, it is an even easier desire to support. With records, x-rays, models and questions/photos all easily shared electronically between a dentist's office and a dental hygiene's office.

If the MA Dental Hygienists want my support for such a bill I AM THERE. To try to get to that goal through a bill meant to help those in dental provider shortage areas or on medicaid is not being transparent.

I would ask hygienists to work with the POSSE to get Dental Therapists who WILL and MUST go to under servered areas. Who will spend 80% of their work year working with underserved populations. THEN I will work with hygienists to get routine dental hygiene separated from the dentist's office.

Dr Valentina Pasquantonio 10/16/2017

HELPING CONSUMERS ACHIEVE AND MAINTAIN ORAL HEALTH

through education, advocacy, and consultation

January 2019 DELTA: The latest news from the dental community in it's ongoing fight to make Delta pay for patient's dental care has just gotten interesting(...or uglier depending on your viewpoint). In the December 17, 2018 issue of "Dentistry Today" Dr Michael Davis of NM wrote an article comparing how Washington state and Massachusetts state dental societies are interfacing with Delta (a national organization who pretends to be local in every state). Dr. Davis writes that the dental oragizations in Washington state are working in concert with one another to hold Delta to it's contracts and promises to both dentists and consumers. Dr Davis goes on to accuse members of the Massachusetts Dental Society of selling out their constituants for personal grain/perks from Delta (agreeing to a 9% decrease in fees instead of the 10% decrease in fees that Delta wanted AND not advocating for the 0% decrease in fees their constituent dentists wanted...who wants a decrease in money coming into his/her business when costs are going up?). The dentists in Massachusetts were then forced to put together another advocacy group. BIG MESS.

What you as a consumer need to know:(a) Delta Dental of MA pro-ports to be a non-profit but pays it's executives 6 figure salaries. (b)Dentists started the non profit Delta 40+ years ago to help patients pay for dental work...then the dentists extricated themselves from the product. (c) With the high costs of offering continuing education courses and meetings the dental societies have slowly allowed themselves to take money from different companies. Delta being a BIG contributor...oh, there were foundations formed, and good deeds touted; but at the end of the day there is the appearance of, if not the actual, bad acts. I wish I didn't have to say this but dentists are not bad...just DUMB! Becasue it is DUMB to think a big corporation is doing good things for you just to be nice.

DELTA/ALL INSURANCE COMPANIES/ ARE THERE TO MAKE MONEY...NOT TO HELP YOU (consumer or dentist) ALWAYS REMEMBER THAT!

(an important consumer question: Do you pay insurance premiums with the expectaion that the money will be used for your and your family's dental care? OR do you pay pemiums to support a Delta foundation that gives hundreds of thousands of dollars to dental societies and dental schools?...my dental school just got a MILLION DOLLAR grant from Delta...think what your yearly maximum might be if all that money was actually used for the direct dental care the consumers who paid delta expected! )