NEWSLETTER - Delaware State Dental Society

Transcription

NEWSLETTER
Summer 2014
President’s Message
politically active individual.
Getting involved with organized
dentistry was someone else’s
problem and not my own, so I
felt. I was asked by Dr. Sharon
Welsh, DSDS President at the
time, to join the EC in the Fall of
2009. After much coercion from
Dr. Welsh and Missy Jones
telling me to “Just Do It,” I
wholeheartedly jumped into the
process and have never
regretted or looked back on the
decision to become part of this
great organization.
Mission of Mercy Project. At
this event, over 1,000 patients
are expected to show up at the
Wicomico Civic Center for
dental treatment.
Many
volunteers are needed and at
the last event two years ago,
continued on page 4
Inside this Issue...
Editorial ..............................................2
2015 Annual Session ..........................3
President’s Message continued ...........4
12th Annual Give Kids A Smile ...........5
Curtis J. Leciejewski, DDS
President
Hot fun in the summer time!!!
My hope is that everyone is
enjoying a great safe summer,
and you are all outdoors doing
what you most enjoy! Living at
the beach, as I do, I have always
longed for these days since
coming to the Delaware shore
since 1988.
By means of introduction, I am
Curtis J. Leciejewski, DDS,
newly installed President of the
DSDS. What an honor it is to
serve in this capacity for such a
wonderful state.
Having
practiced in BelAir, Maryland,
for 13 years prior to my moving
to Rehoboth in the Fall of 2000,
I had never considered myself
an organized dentist or
I have learned a great deal about
the importance of being involved
with organized dentistry, all the
while learning that if we are to
maintain what we have, we must
be active in our profession.
Being that we are a small state
has shown me even more the
need for willingness and
commitment
in
joining
organized dentistry. If we plan
on keeping our profession
intake, then it is essential that
our voice be heard on a local as
well as national level. We here
on the Executive Council and
other DSDS committees strive
to move our organization
forward.
Some may ask how they can
become involved. One event
that we will be working on will
be taking place next April 17-18,
2015. It is the Eastern Shore
CE Series “Dr. Harold Crossley” .......6
Editorial Continued.............................7
Dentsply Workshop..............................7
CE Series “Dr. Stanley Malamed”......8
General Membership Meeting.............9
Seal-A-Smile Program.......................10
151st DSDS Annual Session .......11&12
Important DSDS Survey ....................13
Legislative Update ............................14
Classified Ad .....................................14
Eastern Shore MOM ....................15-17
Glove Program..................................18
Mark Your Calendar ..................19&20
NCDHM Poster Winners...................21
ADA Annual Session..........................22
Medical Emergencies Preparation & Management ........23-27
New DSDS Website............................29
Membership Benefits.........................30
Page 2
DElAWArE StAtE DENtAl SOCIEty NEWSlEttEr
DSDS NEWSLETTER
200 Continental Drive, Suite 111
Newark, DE 19713
302.368.7634 PH 302.368.7669 FAX
_____
Editor in Chief:
Louis K. Rafetto, DMD
_____
Executive Director:
B.J. Dencler
OFFICERS
Curtis J. Leciejewski, DDS
[email protected]
President
_____
Robert J. Kacmarcik, Jr., DDS
[email protected]
President-Elect
_____
James K. Kramer, DMD
[email protected]
1ST Vice President
_____
Joseph C. Kelly, DDS
[email protected]
2ND Vice President
_____
D. Michael Gioffre, Jr., DDS
[email protected]
Treasurer
_____
Rachel A. Maher, DMD
[email protected]
Secretary
_____
Paul R. Christian, DMD
[email protected]
Immediate Past President
REPRESENTATIVES
Bruce E. Matthews, DDS
[email protected]
New Castle County
_____
David R. Deakyne, Jr., DMD
[email protected]
Kent County
_____
Norman S. Steward, Jr., DDS
[email protected]
Sussex County
Unless specifically stated, all view
points expressed in the Newsletter
are those of the authors, and do not
necessarily reflect the positions of
the D.S.D.S.
Summer 2014
Editorial
By Dr. Louis Rafetto
WHAT CAN WE DO TO MAKE A
DIFFERENCE...
Glance at any newspaper or cable
news channel and you cannot escape
the serious events of our days.
While dentistry occupies a very small
part of the world we see in the media,
we have our own issues that occupy
and sometimes overwhelm our days.
Consider the time and effort we
Louis K. Rafetto, DMD
spend on the dichotomies that cross
Editor
our paths; dentists vs. hygienists vs.
mid-level providers, the every extraction site needs a graft vs. those who
never see an indication, the insurance industry view of what is necessary
care vs. patients’ view of what they should be responsible for, and, of
course, the less important but ever present Eagles vs. Cowboys.
Most of us pursued a career in dentistry because of a desire to help
others. Our profession has high entry barriers. It takes commitment, vision,
compassion, and a boatload of patience. As an oral surgeon, I have always
taken great pride in the fact that we are able to “fix” what is broken in our
patients. Nothing is quite as gratifying as a note from someone we have
touched, such as the thank you I received recently from a patient for “saving
her life” after she needed an emergency procedure to drain a serious neck
infection caused by a carious tooth.
Such moments offer a welcome boost from today’s litigious and
contentious social climate that threatens our mission of care and often put
us on the defensive, wasting energy that could be put to better use. It is
important that we do not allow polarized discourse to transform our “art”
into a series of financial, legal, and regulatory transactions.
Instead we should direct our focus on making a difference in our own
corner of the world by doing the “little” things, like spending an extra few
minutes to explain to patients and families what we are doing and why, by
comforting each patient, be sure every procedure is done as well as we
know how, and to improve how we communicate our needs to our staff.
In the final analysis, we may be powerless to impact the crisis in the
Middle East or break the stalemate in Congress, but we can commit
ourselves to putting our experience and expertise to its best use in the
community in front of us. As we put down our newspapers and turn down
the media noise around us, we can be gratified in the fact that every day we
go to “work” with an opportunity to make our community a better place. It
may well be the best way we have to repair the world, one person and one
procedure at a time.
continued on page 7
Summer 2014
Page 3
Annual
Session
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Page 4
President’s Message...
continued from page 1
39% of the 1,000 treated were
Delaware residents with only
one Delaware dentist in
attendance. That must change
this year!! Go to the website
www.easternshoremissionofmercy.org
and you can now sign up to
volunteer for this great event.
Mr. Richard VanGelder, who
is in charge of this event,
will be one of our speakers at
the October 16th General
Membership meeting at Dover
Downs. My hope is that we
will have a good turn out and
that Delaware has good
representation at this event. A
temporary license can be issued
for this event by following the
online form. I personally signed
up for two days at this event,
and I am looking forward to
seeing many of you there.
Another change that will take
place in my term will be that
General Membership meetings
and Executive Council meetings
will be held on Thursday’s this
coming year. Since serving on
the EC, it has always saddened
me to see such a low turnout for
these meetings. In changing
the meetings to Thursday, my
thought was that this will enable
many more colleagues to come
out and participate without
having to worry about rushing
into the office on Friday. Please
prove to me that I am correct in
this assumption and make an
effort to attend these very
important meetings so that you
can be kept abreast of all that is
currently going on, as well as
developing a bit of camaraderie
with your fellow professionals.
Accolades go out to the
Legislative Council for their
efforts in passing Senate Bill
189
which
clarified
the
Academic
Licensing
for
Dentistry here in the state.
Great work was done from this
council led by Dr. Sean Mercer,
in conjunction with Dr. Daniel
Meara of Christiana Healthcare
and Dr. Joseph Napoli of
Nemours Children’s Clinic.
They were able to get this bill
signed into law by Governor
Jack Markell on June 19, 2014.
Thanks goes out to our lobbyist,
Mr. Joe Farley, as well as Drs.
Tom Conaty, Dave Williams,
Jeffrey Cole, Ray Rafetto, Joe
Kelly, Anthony Vattilana, and
past DSDS President Paul
Christian for their time and
dedication that went into the
development of this bill and the
preservation of our licensure. If
you have ever wondered where
your dues dollars have been
utilized, you need not look any
further than here.
The
representation and guidance we
had with Mr. Farley allowed this
process to be a slam dunk.
Again, congratulations to all
who helped make this bill a
reality.
If you are reading this, then I
thank you for your continued
support of organized dentistry.
As of July 1, 2014, there were
12 Delaware members who
decided not to continue their
support of DSDS and the ADA.
Over the past several years, the
ADA has noticed a decline in
membership, but up until
Summer 2014
recently they have been able to
have it level off slightly. Now is
not the time to abandon ship!
As I mentioned earlier, being
that we are a small group, every
membership is of the utmost
importance. When out and
about with colleagues, ask them
if they are members of DSDS
and if not please encourage
them to join so that we may
continue on in our endeavors.
Use the above-mentioned
legislation as an example
of
how
important
our
organization is working to
preserve our practices. What
this also means with declining
membership
is
declining
revenues to DSDS. We are
facing budget income shortfalls
in other areas as well. The
budget committee will be
meeting this August to finalize
the upcoming budget for this
year.
The idea of a dues
increase may be on the agenda
if the numbers do not match up.
Consider this a forewarning of
what may be on the horizon but
rest assured we will be working
diligently on keeping things to a
minimum.
On a final note, thank you all
again for this great opportunity
to serve, and I will do my very
best to see that we remain a
strong voice for dentistry here in
the state. I will look forward to
seeing you all this October 16th
in Dover. Have a very pleasant
rest of your summer!!
Summer 2014
Page 5
Page 6
Summer 2014
Summer 2014
Editorial continued from page 2
CLINICAL GUIDELINES
there is a lot of talk today about role of clinical
guidelines in practice.
In essence, they are
recommendations based on literature reviews, intended
to improve care by providing guidelines for clinicians
to follow and benchmark their practices. they have
been used in medicine for several decades. However,
third parties and the impact of the ACA have made them
more and more a part of discussions about coverage and
indications for treatment.
I think we are all behind the concept of improving
the care we provide to our patients. I welcome honest
and well-done efforts to distill the available knowledge
into something useful and understandable if it helps us
make better care decisions. Of course, this assumes that
the evidence considered truly represents the “best
Page 7
available” (and hopefully practice-based) evidence, not
just the most philosophically convenient evidence to
suit particular needs.
If we get out in front (as a profession, we are already
behind) by identifying and developing clinical
guidelines ourselves, we can do our best to be sure that
“imposter” guidelines do not have undue control over
the care we provide to our patients. While this is not a
small task, we are the ones best able to recognize and
analyze the evidence and most qualified to translate this
into a useful form.
Guidelines aside, we must insist that the care we
ultimately provide not be controlled by any document,
but that it recognizes and emphasizes the role of the
clinician’s judgment based on the specific needs of his
or her patient and the role of the patient (after an
informed discussion) in determining what treatment
they want and are willing to receive.
Page 8
Summer 2014
Summer 2014
Page 9
GENERAL MEMBERSHIP MEETIN G
DOVER DOWNS HOTEL, DOVER, DELAWARE
THURSDAY,
OC TOBER 16 , 20 14
6 : 0 0 P M – C a s h B a r & Buffet Dinner
7:00 PM Business Meeting – 7:30 PM Program
B USINESS AGENDA …7:00 PM
C all to Or der
App roval o f Ap ril, 20 14, G M Mi nute s
Trea su rer’ s Rep ort
Report o f Oct ober Exec utive Co uncil Action s
Unfi nished Bu sine ss
New B usi ness
AD JO UR NM EN T
EVENING PROGRAM…7 :30 PM
Dick Van Gelder, Community Chairperson
EASTER N SHOR E M ISSION OF M ERC Y PR OJ EC T
ESMOM is excited to welcome the inv olv ement of the Del awar e State Dental
Society an d the Del aware Hy gienists Association to this special community proj ect
scheduled for April 17 & 18, 2015, at the Wicomico Youth & Civic Center in
S alis bur y, M ar yland, f r om 6 AM to 6 PM . J oin Dick Van Gelder an d volunte er s f r om
the ESMOM project to learn the history of this program and
how the DSDS fits into this project.
Cocktails and Dinner ar e optional
and begin at 6:0 0 PM. Please complete the form below to register for dinner.
------------------------------------------------------------------------DIN N ER AN D/O R M EETI NG RES ER VA TIO N F O RM
Reser vation s are re quire d fo r dinne r and mu st be made n o later than Octo ber 10, 2 014. Dinne r is a cost of $45.
______ I WILL ATTEND DINNER: Check Enclosed: $_______
Credit Card #___________________________Exp. Date_______Signature______________________
______ I WILL ONLY ATTEND THE BUSINESS MEETING & PROGRAM
FAX TO: 302-368-7669 OR MAIL TO: 200 Continental Drive, Suite 111, Newark, DE 19713
NO LATER THAN OCTOBER 10, 2014
Page 10
Summer 2014
Seal-A-Smile Program
The Delaware Division of Public Health (DPH) completed another successful year of its SealA-Smile program that targets second grade children who do not have a regular source of dental
care. Individual school selections are based on the economic status of the school’s students, as
indicated by the percentage of students who are eligible for free or reduced lunch subsidies.
Participating schools must meet the minimum threshold of at least 50% of students who are
eligible for the free/reduced lunch program. The U.S. Task Force on Community Preventive
Services includes school sealant programs as having strong evidence for reducing dental caries
in children. Delaware ranks among the highest states for providing sealants to schools as well
as the overall percentage of children who have sealants, as determined in the recent survey of
third grade children.
The program is a collaborative effort with the Dental Society, where dentists volunteer to
provide the dental screenings for the children and the DPH dental hygienist provides sealants,
fluoride varnish, home care instructions and an appropriate referral for continuing care in a
dental home. Rumiko Nelson, the DPH dental hygienist, manages the program that went to 26
schools this year and screened 482 children, with 345 (72%) receiving sealants on the first
molars. Thirty-nine percent of the children had untreated dental caries, while 29 children had
urgent care needs and received referrals for immediate care. The services are provided on the
Division’s dental van.
The program was hampered this year by the severe weather, but plans to increase the number of
schools to approximately 40 next year. A notice will be sent to all DSDS members in early fall
that will explain how to volunteer, as many new volunteers are needed.
Summer 2014
151st DSDS Annual Session
Business Meeting/Reception & President’s Party
May 8 & 9, 2014
Page 11
Page 12
151st DSDS Annual Session
Business Meeting/Reception & President’s Party
May 8 & 9, 2014
Summer 2014
Summer 2014
Page 13
AN IMPORTANT DSDS SURVEY IS COMING YOUR WAY …
A TALE OF TWO DENTISTS …
DENTIST “A” …probably won’t read this, he or she is too busy! The phone won’t stop ringing
with new patients who want to come to their office and pay them for their professionalism and care.
They are planning on expanding their hours, hiring new staff, including an associate dentist and
hygienist to keep up with demand and may even refer out procedures they are capable of
performing! They may even be considering opening another location. Forget about low
reimbursement insurance plans or Medicaid; their time is too valuable with fee for service patients!
DENTIST “B”… on the other hand might just read this twice. His or her phone may be broken, at
least that is what they ask their front desk! How else can you explain why it’s not ringing? They
have plenty of time to read the mail, the newspaper, and scan the internet. They might be
considering cutting back on their office hours to get home early; maybe letting someone go to part
time employment, instead of full time; don’t want to pay all that staff to just sit around! Maybe
they are doing procedures they used to refer, but with open chair time, why not pull those third
molars or treat that screaming child myself? If only you had more patients you could fill all that
empty chair time.
Which dentist sounds like you? Some people in our great state assume that we are all more like
Dentist “A.” They have been told that to answer the problem of access to care we just need more
dentists, or even better yet, expanded function hygienists and DHAT’s! In essence more supply.
The DSDS Executive Council believes the problem is not on the supply side, but on the demand
side! We believe that there is excess capacity in dental offices across the state now to more than
meet the needs of Delaware residents. Sadly, in 2014, our word was not good enough for some!
We need hard data to refute claims that there just aren’t enough dentists in Delaware. THIS IS
WHERE YOU CAN HELP!
The DSDS Executive Council is currently contracting with a national survey company to find out
exactly how much capacity there is in our state. The first step will be to contact you by email.
Please watch for this survey notice. When you are contacted, PLEASE take the time to answer and
return the survey. If we are correct, we will be able to continue to provide Delaware residents with
the best dental care in the country. If we find there is a need for more dental practitioners, you can
rest assured we will want the highest quality dentists to join us. We believe this can be
accomplished by maintaining our high standards for licensure. Either way we need the facts.
PLEASE REMEMBER…IT’S YOUR DENTAL SOCIETY, SO STAY INVOLVED. THANK
YOU.
Dr. Robert J. Kacmarcik
DSDS President-Elect
Page 14
Summer 2014
LEGISLATIVE UPDATE:
Governor Jack Markell signed SB 189 into law on June 19th, 2014. Senate Bill 189
creates an Academic License which allows Delaware’s CODA approved residency
programs to hire faculty necessary to remain accredited and strengthen their
programs. The DSDS would like to thank Dr. Daniel Meara from Christiana Care and
Dr. Joseph Napoli from A.I. Dupont for their hard work during the legislative process.
(Standing from left to right): Devon O'Dwyer, Archmere Academy - Girls State Governor for
the Day followed by: Christine Schlitz, Joe Farley, Anne Farley, George Meldrum,
Representative Rebecca Walker, Dr. Sean Mercer, Senator Bethany Hall-Long, Dr. Curt
Leciejewski, Dr. Joe Napoli, Dr. Paul Christian, and Dr. Dan Meara
Classifieds:
Full-time (or part-time) dentist needed for a busy, well-established general and cosmetic
dental office. Our practice has two modern office facilities (Wilmington/Newark) both equipped
with the last technology. This position offers an excellent compensation and benefits package as
well as outstanding continuing education opportunities. If interested please email
[email protected] or call 302-438-8584 (Eric).
Summer 2014
Page 15
Page 16
Summer 2014
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Page 17
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Truth:
Dare:
2 out of 3 dentists* choose
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Be the next one. Try the no-pressure,
in-office Challenge.
Are you up for it?
We’re daring dentists nationwide to try
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and put your current composite to the test.
So c’mon, we dare you. Get your free
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at www.TPHSpectra.com/demo-kit
*Based on TPH Spectra® Truth or Dare Challenge results. **An independent, non-profit, dental
education and product testing foundation, Clinicians Report®, January, 2014. The full report is
available from DENTSPLY Caulk. Data on file. ©2014 DENTSPLY International. All rights reserved.
Contact: Cindy Hoogasian
(517) 346-9467
Page
F18
Summer 2014
P
BeeSure Slim Nitrile Sale Extended through
September, Free Shipping Continues
In response to strong demand, Association Gloves has extended the special promotional price on
the BeeSure Slim nitrile glove through September 2014. Until Sept. 30, this glove will be
available for just $4.80 per 100, or $96 for a case of 2,000 gloves. This sale price is available
only from Association Gloves, which is endorsed by the Delaware State Dental Society.
Contact Association Gloves to request free samples of BeeSure Slim or any of the 60-plus other
name-brand gloves carried. The product line is always expanding, so if you have not shopped the
program for a while, now is the perfect time to see how much you can save.
Making our program even more attractive, we now offer free shipping on all our products,
every day. You’ll find that our prices are lower than those at most dental supply companies or
other glove purveyors.
•
•
•
•
Powder-free nitrile start at $4.80 per 100 gloves
Powder-free latex start at $6.40 per 100 gloves
Powdered latex start at $7.25 per 100 gloves
Fitted start at just $7.50 per 100 gloves
Masks now available
Kimberly-Clark masks are now part of the program. Ear loop masks start at just $4.00 per 50
masks. We also have an assortment of tie masks. You get two boxes of masks free with the
purchase of one case of masks, saving you even more money!
Supporting your dental association
When you buy from Association Gloves, your purchase supports organized dentistry in
Delaware. Association Gloves is the only glove distributor that returns all revenues to organized
dentistry. You have to buy masks and gloves. Why not buy them from the only company
established to save you money and support the programs and services offered by your
professional association?
View the complete catalog of gloves and masks and order online by visiting
www.dsdsgloves.com. Or, for personal assistance, to request glove or mask samples or place an
order call 877-484-6149 between 8 a.m. and 5 p.m. Eastern Daylight Savings time.
Summer 2014
Page 19
MARK YOUR CALENDAR FOR THESE IMPORTANT DATES …
2014 …
September 19, 2014
DSDS CE Course – Dr. Hal Crossley –
“Medical & Dental Implications of the Most Prescribed Medications”
Chase Center, Wilmington
October 9 – 12, 2014
ADA Annual Meeting – San Antonio, Texas
October 16, 2014
DSDS General Membership Meeting & Dinner –
“Eastern Shore Mission of Mercy” presentation – Dover Downs Hotel
October 17, 2014
DSDS/DENTSPLY CE Course – Dr. Nicholas Conte, Jr.
“The Keys to Successful, Predictable & Efficient Direct Composite
Restorations,” – Dentsply Caulk Facility, Milford
November 20, 2014
DSDS General Membership Meeting & Dinner –
“Report from ADA Delegation” – Sheraton Wilmington South
November 21, 2014
DSDS CE Course – Dr. Stanley Malamed
“Emergency Medicine in Dentistry” – Chase Center, Wilmington
2015 …
January 23, 2015
DSDS CE Course – Dr. Leonard Tau
“21st Century Marketing” – Chase Center, Wilmington
February 6 & 7, 2015
ANNUAL GIVE KIDS A SMILE IN DELAWARE
Friday, February 6, 2015 – Delaware Technical Community College, Wilmington
Saturday, February 7, 2015 – LaRed Health Center, Georgetown
Page 20
Summer 2014
February 20, 2015
DSDS CE Course – Dr. Barbara Steinberg
“Medical Update for the Dental Team” – Chase Center, Wilmington
March 19, 2015
DSDS General Membership Meeting & Dinner
Dover Downs Hotel
April 17 & 18, 2015
The Eastern Shore Mission of Mercy (ESMOM) project
at the Wicomico Youth & Civic Center, Salisbury, MD
March 27, 2015
DSDS CE Course –
Speaker and Topic to be announced
May 14, 2015
DSDS 152nd Annual Business Meeting & President’s Reception –
Bellmoor Inn, Rehoboth Beach
May 15, 2015
DSDS 152nd Annual Session CE Course – Rehoboth Country Club,
Featuring Mr. Gary Zelesky “The Passion Centered Practice”
May 15, 2015
DSDS 152nd President’s Dinner, honoring Dr. Curtis Leciejewski,
Kings Creek Country Club, Rehoboth Beach
September 18, 2015
DSDS CE Course
Speaker and Topic to be announced
October 16, 2015
DSDS CE Course – Dr. Rella Christensen
“New Data On Critical Dental Questions…including Infection Control”
November 5-10, 2015
ADA Annual Meeting – Washington, DC
Summer 2014
Page 21
DSDS CONGRATULATES
2014 NCDHM POSTER COMPETITION WINNERS...
During the DSDS 151st Annual Session in Wilmington, Dr. Cathy Harris,
Chair, DSDS National Children’s Dental Health Month, recognized the
winners of the Annual NCDHM Poster Competition. Eligible were third
grade students throughout New Castle, Kent, and Sussex Counties. The
grand prize winner, Neela Moody from Gallaher Elementary, New Castle
County, received a $100 gift card to Toys R Us, while the runners up,
Bethany Maniyatte, New Castle County, and Alyssa McCleary, Kent County,
received a $50 gift card each. A special thank you to the school nurses
and art teachers who encouraged participation in this annual program.
Grand Prize Winner, Neela Moody,
Gallaher Elementary,
New Castle County,
proudly displays her winning
poster alongside her parents.
All three prize winners (L to R), Alyssa McCleary, Neela Moody and Bethany Maniyatte
with Gallaher Elementary School Nurse, Maria Weeks; Dr. Cathy Harris and Gallaher
Elementary School Art Teacher, Kelly Walzl.
Page 22
Summer 2014
Welcome to San Antonio!
Join thousands of your colleagues at ADA 2014 – America’s Dental Meeting at the Henry B. Gonzalez
Convention Center in San Antonio.
ADA 2014 is the premier event for dentists and dental professionals who are looking for the highest
quality, most innovative and effective continuing education to improve patient care.
Bring your entire dental team, including hygienists, dental assistants, business assistants and lab
technicians, to take advantage of the continuing education and browse the exhibit hall.
ADA 2014
W
Continuing Education
Oct. 9-12
Exhibit Hall
Oct. 9-11
House of Delegates
Oct. 10-14
Summer 2014
Page 23
Medical Emergencies – Preparation and Management
Dr. Stanley F. Malamed
Dentist Anesthesiologist, Professor of Anesthesia & Medicine
Herman Ostrow School of Dentistry of USC, Los Angeles, CA
Dr. Malamed is a consultant to HealthFirst Corporation.
Introduction
Medical emergencies can and do
happen in the practice of dentistry.
Recent surveys of dentists in
Australia,1 New Zealand,2 the United
Kingdom3 and U.S.A.4 demonstrate
that, though rare, potentially lifethreatening situations do develop in
the dental office. Table 1 lists the
most common emergencies found in a
survey of 4309 dentists practicing in
North America. These constituted
98.7% of the 30,608 emergencies
reported.4
Dental offices must be prepared to
promptly recognize and effectively
manage medical emergencies. Though
no ‘national standard’ exists in the
USA for preparation, some specialty
groups (e.g. American Association of
Oral & Maxillofacial Surgeons;
American Academy of Pediatric
Dentistry, and the American Academy
of Periodontology) have published
Guidelines for their members and
other interested parties.5-7
In a medical emergency it is the
obligation of the Healthcare Provider
“to keep the victim alive until they
either recover or until help arrives on
scene to take over management,
provided that they are better qualified
to handle the situation.”
Prevention
Prevention of an emergency is
much more desirable than managing
one once it occurs. Approximately
75% of medical emergencies are
preventable. Thorough evaluation of
the medical history, recording vital
signs, assessment of medical risk
(ASA classification), and use of
treatment modifications, as needed,
can prevent ‘stress-induced’
emergencies.
Table 2 lists other Quality Resource
Guides discussing dental management
of higher-risk patients.
Preparation
Preparation of the dental office and
staff to recognize and manage medical
emergencies is essential to a
successful outcome. Table 3 is an
SUMMER 2014
example for an office preparation plan
listing the components involved in
adequate preparation. Each dental
office should develop their own
detailed and specific plan fitting their
circumstances.
(1) Basic Life Support. Without
doubt basic life support (BLS) is THE
most important element in successful
management of medical emergencies.
Though not all state dental boards
mandate BLS (also known as ‘CPR’)
for licensure, the drug package insert
accompanying all local anesthetic
drugs states:8
“Dental practitioners and/or
clinicians who employ local
anesthetic agents should be well
versed in diagnosis and management
of emergencies that may arise from
their use. Resuscitative equipment,
oxygen, and other resuscitative drugs
should be available for immediate
use.”
Resuscitative equipment has been
interpreted in court as integral to the
ability to perform BLS. Training in
the use of all resuscitative equipment
is essential for proper utilization.
BLS Healthcare Provider (BLSHCP) is the minimum level of training
required. Though states mandating
current-BLS cards for dental licensure
require recertification every 2 years,
multiple studies have demonstrated a
significant decrease in technical
prowess after as little as 6 months.9-10
It is suggested that BLS-HCP
recertification be done annually.
Where BLS is mandated it is often
required only of the doctor, perhaps
the dental hygienist and more rarely
the assistant. From a practical
perspective, emergencies can happen
to anyone, anytime, anywhere. In the
Page 24
surveys cited above,1-4 a number of
medical emergencies developed in
dental office personnel, including the
doctor. BLS-HCP certification should
be included in the job description of
all dental office personnel.
As we are preparing ourselves to
manage emergency situations in the
dental office, it is strongly suggested
that BLS-HCP courses be taken IN
YOUR DENTAL OFFICE placing the
mannequin in dental ‘situations,’ such
as in the dental chair and on the floor
in the reception room.
All staff members should be trained
to ventilate using a mask. ‘B’
[breathing] in BLS has always been
the step rescuers are most reluctant to
perform, especially when the victim is
a stranger. Regurgitation commonly
occurs in unconscious victims.
Additionally, it is likely that the
mouth will contain blood, pus, or
other debris associated with the dental
treatment. Learning to ventilate with a
mask enables the rescuer to deliver
oxygen to the victim (1) mouth-tomask [16% O2]; (2) bag-valve mask
device [21% O2]; or (3) with positive
pressure O2 [100% O2] (though
positive pressure O2 is no longer as
highly recommended due to the risk
of overventilation).
Chest compression, if needed, CAN
be effectively performed with the
victim still in the dental chair. Lepere
demonstrated that the modern dental
chair provides firm support for the
spinal cord, enabling sufficient blood
volume to be circulated during cardiac
arrest.11
Training in use of the AED is an
essential component of the BLS-HCP
course. When available in an office
Summer 2014
it’s use should be reviewed
periodically by all staff members.
Lay person BLS has, in certain
specific instances, been modified so as
to eliminate ventilation. CPR
consisting of chest compressions is
taught in these situations. It is
important to remember that as
Healthcare Providers the dental office
staff is STILL OBLIGATED TO
VENTILATE THE APNEIC VICTIM.
(2) Dental office emergency team.
When an emergency arises all office
personnel should be able to respond
rapidly and efficiently. This mandates
existence of a predetermined plan
describing each persons function. A
simple plan is described:
MEMBER #1 is the first person at
the scene of the emergency. When the
situation develops in the dental chair
this might be the doctor, hygienist or
assistant. Where the situation occurs
in the reception area it is the ‘front
office’ people who will respond first.
Thus the earlier recommendation that
all office personnel be BLS-HCP
trained.
Member #1 (1) remains with the
victim; (2) administers BLS, as
needed; and (3) activates the dental
office emergency team (e.g. Yells for
help!).
MEMBER #2 is assigned to
immediately ‘bring the stuff’ to the
site of the emergency. The oxygen
cylinder, emergency drug kit, and
automated external defibrillator
(AED) are kept together in an easily
accessible location (e.g. near a
telephone).
MEMBER #3 is, in fact, the
remaining members of the office staff.
Possible duties include: activation of
EMS; waiting outside for arrival of
EMS and escorting them to the office;
‘holding’ the elevator in the lobby for
EMS; monitoring vital signs;
preparing emergency drugs for
administration; keeping a written
record of the event, including a time
line and treatment (e.g. 10:15 AM –
SUMMER 2014
1
Summer 2014
EMS called; 10:21 EMS arrives in
dental office); and assisting in BLS.
The dentist remains the team
leader, the one legally responsible for
the health and safety of the patient
(e.g. victim). Tasks may be delegated
as long as the person performing the
task is capable of doing it well under
the dentist’s supervision.
(3) Summoning assistance. Two
questions: WHEN? And WHOM?
WHEN TO CALL FOR HELP:
Emergency medical assistance should
be sought as soon as the doctor (the
person legally responsible for the
patient) feels it is needed. This occurs
(1) if the diagnosis of the problem
remains unknown; (2) when the
diagnosis IS known but is disturbing
to the doctor; and (3) at any time the
doctor feels uncomfortable and wishes
help.
Never hesitate to seek assistance in
managing a medical emergency if you
feel it is warranted.
WHOM TO CALL: Emergency
medical services (EMS) are the first
responders to life-threatening medical
emergencies in your community. In
most areas of the USA 9.1.1. is the
EMS number. EMS response times
vary significantly from community to
community. Where response time is
prolonged and the dental office is
located in a ‘medical-dental’ complex
there might be available another
healthcare professional well trained in
emergency management. It is this
authors opinion that the Oral &
Maxillofacial Surgeon usually meets
that standard since they are generally
trained in Advanced Cardiovascular
Life Support.
Once EMS arrive at the site of the
emergency they will take over its
management. Primary duties of EMS
are to (1) stabilize the victims
condition at the scene and (2)
transport to the emergency department
of a hospital for definitive care, if
needed.
1
SUMMER 2014
(4) Emergency drugs &
equipment. (Table 4) Many, if not
most, dentists admit they would be
quite uncomfortable administering
drugs during a medical emergency.
Given, however, that the availability of
emergency drugs is mandated (see
local anesthetic package insert,
above), it seems prudent to prepare an
emergency drug kit consisting of
drugs which are considered to be
essential. Dentists should continue to
seek continuing education to upgrade
their knowledge and ability to safely
and successfully employ emergency
drugs.
The following seven drugs
represent the ‘bare bones basic’
emergency kit. It contains seven
drugs: 2 injectable and 5 noninjectable.
Injectable drugs: Epinephrine
1:1000 (1:2000 for children [15 kg to
30 kg]) in a preloaded syringe
represents the most important drug in
the emergency kit and, happily,
probably the least likely to be used.
Page 25
The availability of two TwinJect® (2dose) preloaded epinephrine syringes
is recommended. A histamine-blocker,
such as diphenhydramine (Benadryl®),
50 mg/mL, is the other injectable
drug. It is recommended that the
emergency kit contain 2 or 3 1-mL
ampules of diphenhydramine.
Both injectable drugs are used to
manage the allergic reaction, be it
non-life-threatening
(diphenhydramine) or life-threatening
(anaphylaxis – epinephrine and
diphenhydramine).
Non-injectable drugs: Oxygen
(available in an “E” cylinder) can be
administered during almost any
emergency situation. An ‘E’ cylinder
provides O2 for approximately 30
minutes during ventilation of an
unconscious, apneic adult.
Nitroglycerin, a vasodilator, is used to
manage the acute anginal episode.
Recommended for the dental office is
the spray form, Nitrolingual Spray®
rather than sublingual tablets
(NitroStat®). Albuterol is the preferred
Page 26
bronchodilator used to manage
bronchospasm (acute asthmatic
episode). Hypoglycemia (low blood
sugar) is a common occurrence in
dentistry. An antihypoglycemic, a
source of sugar such as a tube of a
glucose gel should be included in the
emergency drug kit. Alternatively, 12ounces of orange juice or soft drink
(non-diet) can be used. Aspirin,
preferably chewable, is recommended
in the prehospital management of
‘suspected myocardial infarction’
victims. A dose of 325 mg (one adult
tablet) is chewed then swallowed.
Aspirin inhibits platelet aggregation
thus minimizing the size of the blood
clot developing during the ‘heart
attack.’
Equipment: (Table 5) Oxygen
delivery system including a positive
pressure mask and/or a bag-valvemask device with several sized face
masks (pediatric, small- and largeadult). Also recommended is a pocket
mask to aid in mouth-to-mask
ventilation. An automated external
defibrillator (AED) is considered an
absolutely essential part of emergency
preparedness as early defibrillation is
THE most important intervention in
successful resuscitation from cardiac
arrest. Other equipment includes:
syringes and needles for drug
administration; suction and suction
tips; tourniquets; and Magill
intubation forceps (for easy retrieval
of foreign objects from the posterior
part of the oral cavity or the pharynx).
These items are described in table 5.
Recognition & Management
Prompt recognition and efficient
management of a medical emergency
are essential to a successful outcome.
Recognize the presence of a
problem, discontinue dental treatment
and institute emergency management
as soon as the problem is noted.
Recognition is based upon
presenting signs and symptoms (S&S)
including altered consciousness,
respiratory distress, and chest pain. If
ever a patient reports any unusual
S&S immediately stop the dental
procedure and try to determine the
cause of the situation and to manage it
as efficaciously as possible.
The following algorithm represents
the management sequence for all
emergency situations except cardiac
arrest: P→A→B→C→D (Figure 1).
The cardiac arrest algorithm has been
changed (October 2010) to
P→C→A→B, chest compression
commencing immediately on
determining apnea and pulselessness. 12
Position the patient appropriately. If
conscious (e.g. speaking, moving) the
position of choice is whatever is most
comfortable for them.
Unconsciousness is defined as the
absence of response to sensory
stimulation (e.g. verbal or physical
stimulation). A decrease in blood flow
to the brain (e.g. low blood pressure)
is, far and away, the most common
cause of unconsciousness. All
unconscious persons are placed, at
least initially, into the supine position
with their legs elevated slightly.
Airway, breathing and circulation
are assessed and implemented as
Summer 2014
needed. In the conscious victim who
can speak A, B and C are deemed to
be ‘adequate’ (by virtue of the patient
being conscious and capable of
speech). With loss of consciousness
each step must be assessed
individually. In most unconscious
persons, head-tilt chin – lift (A)
provides for a patent airway. However
airway patency must still be assessed
using the ‘look’, ‘listen’ and ‘feel’
technique (B) with two rescue breaths
(e.g. mouth-to-mask) delivered in the
absence of spontaneous respiratory
efforts (e.g. apnea). Next, the carotid
pulse is palpated for not more than 10
seconds (C) and, if absent, (e.g.
cardiac arrest), chest compression
begun. With cardiac arrest, 30 chest
compressions are delivered rapidly (at
least 100/minute), forcefully (at least
2 inches [adult]; about 2 inches for the
child) minimizing interruptions as
much as possible, prior to delivery of
2 breaths.12
The goal of the steps (P→A→B→C)
described thus far is to ensure that the
victim’s brain and heart are receiving
an adequate supply of blood
containing oxygen and ‘sugar’, the
fuels required by the cells of the body
to maintain normal function.
SUMMER 2014
1
Summer 2014
Page 27
REFERENCES
Definitive care represents the final
step of management. Possible
components of definitive care include
diagnosis, drugs and defibrillation.
When possible, a diagnosis is made
and treatment proceeds accordingly
(examples of easily diagnosed
problems are: asthma, hypoglycemia,
and angina).
Drugs, other than oxygen (which
may be administered in any
emergency situation) are rarely
needed. Notable exceptions are acute
bronchospasm (asthma) and anginal
pain. In both cases the patient (who
arrives in the office with a pre-existing
history of asthma or angina) will (1)
diagnose the problem; (2) likely have
their own bronchodilator or
vasodilator available; and (3) medicate
themselves. In the highly unlikely
event of cardiac arrest prompt
defibrillation is essential.
Emergency medical services (EMS)
should be summonsed at any time it is
felt necessary.
Space precludes in-depth discussion
of management of specific
emergencies. The interested reader is
referred to textbooks such as
Handbook of Medical Emergencies in
the Dental Office.13
SUMMER 2014
Conclusion
The legal obligation of the dentist
managing a medical emergency is to
keep the victim alive until (1) they
recover or (2) someone, better trained
in emergency care, takes over
management of the victim.
The ultimate goal for a dentist
managing a medical emergency is to
prevent the death of the victim, a goal
achieved through office preparation,
prompt recognition and effective
management. In the most common
dental office emergency, syncope (e.g.
‘fainting’), simply instituting the steps
of BLS (P→A) leads to the prompt
recovery of consciousness. Drugs are
never the first line of management.
The management sequence introduced
in the algorithm is adhered to in ALL
emergency situations except cardiac
arrest, in which chest compression is
started immediately.
1. Chapman PJ: Medical emergencies in dental practice
and choice of emergency drugs and equipment: A survey
of Australian dentists. Austral Dent J 42(2) 103-108,
1997
2. Broadbent JM, Thomson WM: The readiness of New
Zealand general dental practitioners for medical
emergencies. New Zeal Dent J 97 82-86, 2001
3. Atherton GJ, McCaul JA, Williams SA: Medical
emergencies in general dental practice in Great Britain.
Part 1: their prevalence over a 10-year period. Brit Dent J
186(2) 72-79, 1999
4. Malamed SF. Managing medical emergencies. J Am Dent
Assoc 124:40-53, 1993
5. American Association of Oral and Maxillofacial
Surgeons: Parameters of care for oral and maxillofacial
surgery: a guide for practice, monitoring and evaluation,
Rosemont, Ill, 1995, The Association.
6. American Academy of Pediatric Dentistry: Clinical
Guideline on the Elective Use of Minimal, Moderate, and
Deep Sedation, and General Anesthesia for Pediatric
Dental Patients, American Academy of Pediatric
Dentistry, Reference manual 2004-2005
7. Academy Report: The Use of Conscious Sedation by
Periodontists. J Periodontol 74:933, 2003
8. Septocaine® Drug Package Insert. Septodont, Inc. New
Castle, Delaware. May, 2006
9. Woolard M, Whitfeild R, Smith A, Colquhoun M,
Newcombe RG, Vetteer N, Chamberlain D. Skill
acquisition and retention in automated external
defibrillator (AED) use and CPR by lay responders: a
prospective study. Resuscitation 60(1):17-28, 2004
10. Riegel B, Nafziger SD, McBurnie MA, Powell J,
Ledingham R, Sehra R, Mango L, Henry MC. PAD Trial
Investigators. How well are cardiopulmonary
resuscitation and automated external defibrillator skills
retained over time? Results from the Public Access
Defibrillation (PAD) Trial.Acad Emerg Med 13(3):254263, 2006
11. Lepere AJ, Finn J, Jacobs I. Efficacy of cardiopulmonary
resuscitation performed in a dental chair. Aust Dent J
48(4):244-247, 2003
12. Field JM, Hazinski MF, Sayre MR, Chameides L,
Schexnayder SM, Hemphill R, Samson RA, Kattwinkel J,
Berg RA, Bhanji F, Cave DM, Jauch EC, Kudenchuk PJ,
Neumar RW, Peberdy MA, Perlman JM, Sinz E, Travers
AH, Berg MD, Billi JE, Eigel B, Hickey RW, Kleinman
ME, Link MS, Morrison LJ, O’Connor RE, Shuster M,
Callaway CW, Cucchiara B, Ferguson JD, Rea TD,
Vanden Hoek TL. Part 1: Executive Summary. 2010
American Heart Association Guidelines for
Cardiopulmonary Resuscitation and Emergency
Cardiovascular Care. Circulation 122(suppl 3)S640S656, 2010
13. Malamed SF. Handbook of Medical Emergencies in the
Dental Office, ed. 6, 2007, C.V. Mosby, St. Louis
For additional information, or to register for
Dr. Malamed’s “Medical Emergencies” seminar
on Friday, November 21, 2014, at the
Chase Center on the riverfront, go to:
www.delawarestatedentalsociety.org.
Page 28
Summer 2014
Summer 2014
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Page 29
Page 30
Summer 2014
The DSDS Executive Council and Council on Membership are studying the Delaware membership statistics
from the ADA for 2013/2014. Our 2014 overall membership share is 83.4% down from 84.4% in 2013. The
largest number of non-members and non-renews can be found in the category of dentists in practice 10 years
or more. When these dentists are contacted regarding DSDS membership, the first question they ask is "what
am I receiving for my dues." In an effort to address this question, not only to non-members and non-renews,
but to our loyal active members, a top ten list of membership benefits has been developed by the Council on
Membership. Please keep this list in mind as you receive your dues renewal notice in December for the calendar
year 2015, and if you know a non-member, think about passing this list onto them.
Just what am I getting???
MEMBERSHIP Benefits of the American Dental Association (ADA)
& Delaware State Dental Society (DSDS)
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NEWSLETTER - Delaware State Dental Society

Transcription

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