‘INCENTIVIZING’ DENTAL PRODUCTIVITY OR THE FOUR ‘MUST-HAVES’ OF AN EFFECTIVE INCENTIVE PLAN

NOTE: The NNOHA newsletter is for information sharing & discussion purposes. NNOHA does not endorse all included viewpoints or authors.

Juris Svarcbergs, DMD, MPH Dental Director, CAMcare Health Corp, Camden, NJ NNOHA Board Member svarcbergs@camcare.net

We all need incentives to overcome inertia. The smell of fresh coffee brewing at 6 AM may be enough to get you out of bed and down to breakfast, but bigger efforts re-quire commensurately bigger incentives. It’s not that we don’t mean to do well every-day, but somehow an appropriate incentive is what takes intent to action. Case in point: I start thinking about yard work when early signs of spring appear. But ‘next weekend’ is the usual plan, until….. miraculously. ……the Home Depot ‘$25 off when you spend at least $25.01 within the next week’ cou-pon arrives in the marketing mail. How can you resist…it’s a great deal, and you need lawn fertilizer anyway! I spend at least a $100, am glad to save $25, and yard work is no longer deferred……action is gladly taken! Dental Incentive ‘Systems’ should be like that. They should empower us to be glad to see that extra ‘walk-in’ just minutes before lunch, and gladly pack that schedule the week before and after vacations. Yet most ‘marketing incentives’ fail to get us moti-vated. Why…they give something ‘free’ with purchase of multiple items, or offer re-bates that require extraordinary actions to get back a pittance. Many Dental Incentive plans are like that: they give you a % of Medicaid collections, and a different % for private insurance collections, and maybe even nothing for self-pay ‘subsidized’ pa-tients. In my opinion, these complicated for-mula incentives do nothing but encourage “cherry picking” of patients and procedures,

and bring out “the worst” in otherwise well intentioned providers. I believe there are 4 “must haves” for a really effective and ‘satisfying’ incentive program. Such an in-centive system must:

1. Be simple and easy to understand.

2. Allay Administration fears.

3. Be based on a target ‘goal’ that di-rectly influences the organization’s income.

4. Have an achievable goal AND a re-ward that is big enough to strive for, yet small enough so that it would not be a catastrophe to not achieve it in any time period. Our FQHC has had such a system in place for over a decade, and has maintained high productivity and provider satisfaction over all those years. The simple formula: reach the productivity goal for a quarter, and you get a separate ‘bonus check’ equal to 10% of your contracted salary. As an example, if your contract is $100,000/year, you get a $2,500 bonus check in each successful quarter ($10,000 for all 4 quarters). Easily enough to cover the new car payments, or take some nice vacations! And, if you were sick during that quarter, had family emergencies, or just couldn’t seem to get it together that quarter, you may have to pass on that vacation…..but life will still go on. Since most FQHC’s are on tight budgets, the

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THANK YOU: DR. JURIS SVARCBERGS, DR. MICHAEL DOWNING, DR. JEFFREY L. TURCHI, JEFF MITCHELL, DR. HUONG LE, DR. THEODORE P. CROLL, DR. HOWARD BAILIT, LUANA HARRIS-SCOTT, AND COLLEEN LAMPRON FOR CON-TRIBUTING ARTICLES OR INFOR-MATION. EDITORIAL BOARD: NEAL DEMBY, TIFFANI CONRAD, AMY LALICK-TOMES, YEDE DENNIS, LUANA HARRIS-SCOTT, COLLEEN LAMPRON, AND TERRY HOBBS

IF YOU HAVE A SUGGESTION

FOR ARTICLES OR AUTHORS TO INCLUDE IN FUTURE NEWSLETTERS, PLEASE CONTACT TERRY HOBBS AT TERRY@NNOHA.ORG

NNOHA CELEBRATES HRSA CHIEF DENTAL OFFICER

2

FROM PRIVATE PRACTICE TO A HEALTH CENTER

3

FOUNDATION BONE AUGMENTATION MATERIAL

4

UPCOMING CONFERENCES AND EVENTS

5

ADHA EXPLORES NEW MODES TO PROVIDE NEEDED ORAL CARE

6

MID-LEVEL PROVIDER RESOLUTION

7

HIT WHITE PAPER PROJECT 8

GLASS-IONOMER RESTORATIVE CEMENT

9

MEMBER RECOGNITION 10

ADVISORY COMMITTEE RECOGNITION

11

CALIFORNIA PIPELINE PROGRAM STUDY

12

Inside this issue:

Fall 2008 NNOHA NEWS, Volume 1, Issue 4

N A T I O N A L N E T W O R K F O R O R A L H E A L T H A C C E S S Q U A R T E R L Y N E W S L E T T E R

Dr. Juris Svarcbergs

CEO and CFO must also feel secure that there will not be an endless or unexpected payout for every patient that is seen; they simply budget a 10% max above contract for every provider, and only pay out the fixed amount when a provider has reached the predetermined goal. Our goal is a conservative 636 visits per quarter. If 635 is the provider’s productivity, they only get their regular contractual salary…but if their pro-ductivity is anywhere from 636 to 900+ (?!?), they receive their special $2,500 check, personally from the CEO or CFO. And, with the bonus check comes a “Thank you for working hard to make us viable……we want to share this success with you, by giv-ing you this bonus check.” If for whatever reason, a provider does not reach the bo-nus goal, it is understood that there was no ‘profit’ to share! For us, each Medicaid PPS visit payment to an FQHC is worth well over $100 in the center’s revenue. Most ‘new’ providers take about 1-3 quarters to

(Continued from page 1) reach the required bonus goal level, and once there, tend to continue at that level. Naturally, all providers plan their work schedules and vacations to be able to still reach the bonus goal level. (This also re-sults in more rational provider coverage.) And most importantly, just to ensure that the bonus goal is achieved, every provider aims to have productivity well ABOVE the goal level - just to be sure to achieve it,

should those rare quiet days or un-expected down times occur at the end of the goal period. SIMPLE, NON-STRESSFUL, ACHIEVABLE, and REVENUE GENER-

ATING are the attributes of this system. (Note: This System is geared towards in-centivizing the direct producers of reve-nue……the provider. This is based on the ‘must have’ consideration that there is a direct correlation to the organization’s in-come stream. It would be interesting to look at systems that incentivize support staff, and to learn if they are viable……Are there any out there?)

THE FOUR ‘MUST-HAVES’ OF AN EFFECTIVE INCENTIVE PLAN continued...

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NATIONAL NETWORK FOR ORAL HEALTH ACCESS

“...with the bonus check comes a “Thank you for working hard to make us viable……we want to share this success with you.”

NNOHA CELEBRATES HRSA CHIEF DENTAL OFFICER Dr. Elizabeth Duke, Health Resources and Services Administration (HRSA) Administra-tor, designated Jay Anderson, DMD, MHSA, as HRSA’s Full Time Chief Dental Officer (CDO) effective October 12, 2008. He had been in the role previously in an acting ca-pacity, but is now formally the Chief Dental Officer. In his new role, Dr. Anderson will: • Assist the Oral Health Coordinator in

coordinating oral health activities across all HRSA programs,

• Advise the Oral Health Coordinator and HRSA on the recruitment, assign-ment, deployment, retention, and ca-reer development of dentists and other oral health professionals within HRSA,

• Serve as principal dental consultant for all HRSA oral health programs, and

• Advise the Administrator of HRSA on all matters concerning oral health.

From NNOHA’s perspective, having a Chief Dental Officer is crucial to maintain-ing adequate resources and awareness of the importance of oral health to overall health for underserved populations. NNOHA congratulates Dr. Anderson on this important role at HRSA. NNOHA thanks Dr. Duke and her team for demon-strating their commitment to oral health by naming a Chief Dental Officer at HRSA. Dr. John McFarland, NNOHA’s president, believes “Jay has the vision and leader-ship to make a great impact as Chief Den-tal Officer. We’re especially pleased be-cause Jay is one of us, having begun his career as a Health Center Dentist. Jay has been actively involved with NNOHA from the beginning and is one of the origi-nal board members of NNOHA dating back to 1992.”

Dr. Jay Anderson

1. SIMPLE 2. NON-STRESSFUL 3. REVENUE GENERATING 4. ACHIEVABLE are the attributes of this system.

Michael Downing, DDS Director, Riverstone Health – Dental NNOHA Board Member mike.dow@riverstonehealth.org

I think I have always looked at Dentistry as a service career, a type of mission. It is kind of the way I was raised. There were four generations of dentists on my Mother’s side, and four generations of physicians on my Dad’s, the most recent my son. All were and are very active in their communities. When I moved to Montana after my ser-vice obligation, I asked where they needed a dentist. That’s how I started in Hardin, a small town (3,000 pop.), surrounded on three sides by the Crow Indian Reservation. When I went to the Big Horn Bank in Har-din, Montana, to see about a loan, the president told me there would be no prob-lem with whatever amount I needed to set up my practice. He advised me to do three things to become part of the commu-nity as a professional, things he felt I was obligated as one with more education than most in the town. He encouraged me to join a political party, a service club, and a church. I told him that would be no problem and reached for the check. As I headed for the door, money in hand, he stopped me. “One more thing,” he said. “Try very hard to serve the community well.” I told him that was a given. But he said, “I mean every-one, even the ones that can’t afford your fees.” That hit home. A conservative banker encouraging me to include charity work in my business plan! It put an exclamation point on values that had been placed in me by my family, especially my parents. Since the day I opened my practice, my staff and I tried hard to include as many Medicaid and other disadvantaged pa-tients into the practice as was financially possible. I moved my dental office to the Community Health Center on the south side of Billings in 1996 in hopes of providing more access

to dental care for the growing popu-lation of disadvantaged folks in our area. My dental practice and the pharmacy were the only entities in the building that weren’t part of the CHC/City-County Health Department, The local dental society, of which I was an active member, had never seemed to be able to get a grip on how to deal with the ER situations at the hospitals, much less that whole segment of our community without

dental care. I also made this move in hopes of becoming involved in some way with the new (and only one in the state) Rural Family Practice medical residency. I didn’t have the expertise to set up a non-profit and felt the folks at the CHC would be able to help. After five years of waiting, and lots of hard work getting some of the private dentists in our camp, the laws were passed in the Montana State Legisla-ture to allow Community Health Centers to own dental practices. The day that law passed my private office became a non-profit, and it has been a financial juggling act ever since. I have no regrets for my decisions. We are helping some wonderful people who for one reason or another are denied access to dental treatment. The work is hard, the dental situations of-ten hopeless, but it is a joy to work with dedicated people, medical and dental, and a very diverse clientele. As an aside, we have just completed setting up the curriculum for the medical residents for a weeklong rotation through our Dental pro-gram. The residency is a three-year pro-gram with 6 residents in each class. I firmly believe that communities that truly value and support the gifts of all people, regardless of gender, race, age, sexual orientation or economic level, will thrive in positive, healthy ways. My goal in life is to have my professional and personal life reflect this philosophy.

A CAREER IN SERVICE: FROM PRIVATE PRACTICE TO A HEALTH CENTER

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NNOHA NEWS, Volume 1, Issue 4

“TRY VERY HARD

TO SERVE THE

COMMUNITY

WELL”. I TOLD

HIM THAT WAS

A GIVEN. BUT

HE SAID, “I

MEAN

EVERYONE,

EVEN THE ONES

THAT CAN’T

AFFORD YOUR

FEES…”

Dr. Michael Downing

Billings, Montana

Jeffrey L. Turchi, DDS Director of Educational and Clinical Affairs, Morita JTurchi@JMoritaUSA.com

Every time a tooth is extracted, the pa-tient’s remaining alveolar bone will begin to resorb at a faster rate than in a non-edentulous site. Once the bone resorbs, it is gone for good. Patients who are partially or fully edentulous must rely on the remain-ing bone to support prostheses. The emer-gence of an implant supported denture as a treatment of choice can significantly im-prove the patient’s quality of life. Placing some type of bone graft or aug-mentation material into extraction sockets is rapidly approaching “standard of care” status, according to Dr. Jon Suzuki, Director of the Graduate Periodontics program at Temple University School of Dentistry. The emergence of Implant Dentistry as treat-ment of choice is undeniable and along with this movement the preservation of the alveolar ridge will be critical for success. The “autogenous” graft is considered the

“Gold Standard” of grafts because it util-izes the patient’s own bone. Despite the predictability of using ones own bone, the need for a second surgical site is a disad-vantage. The “allograft” also utilizes hu-man bone but in this case the bone is col-

lected from a person other than the pa-tient, usually a cadaver. Although it is un-common, there is a small risk of disease transmission especially if the source of the allograft is not well monitored. There are also synthetic materials that either act as artificial bone or act as a framework for bone to grow into at its normal rate. J. Morita introduced a new bone augmen-tation product in February of 2006 and it provides an easy and economical method of maintaining and/or augmenting bone growth in the extraction socket. The prod-uct is called Foundation. The FDA has issued a 510(k) clearance for the sale and distri-bution of the product. It has also been re-cently approved for sale by Health Can-ada. The FDA has indicated Foundation for use as follows: “The Foundation device is a collagen-based bone filling augmentation material for use in the filling of extraction sockets.” Foundation is a unique material based on the following features:

• stimulates new bone growth at an accelerated rate • a solid, bullet shaped plug for easy placement into the socket • no need to use multiple ma-terials or membranes • has been used in Japan since 1998 with great clinical success. The majority of the collagen is made into a framework for the bone to grow into. The rest of the collagen is treated in a way that stimulates bone growth cells to be drawn to it. All the collagen is then joined back together and formed into a solid, bullet-shaped plug for easy placement into the extraction socket. Foun-dation comes in two sizes, Small (8mm x 25 mm) and Medium

(15mm x 25mm). Socket preservation or alveolar ridge aug-mentation will be a key to practice of im-plant dentistry so continued research into these products is important.

FOUNDATION BONE AUGMENTATION MATERIAL

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NATIONAL NETWORK FOR ORAL HEALTH ACCESS

“The emergence of an implant supported denture as a treatment of choice can significantly improve the patient’s quality of life.”

Here is a case where #12 was extracted and Foundation was placed for a future implant. (Note: If you are reading a hard copy of the newsletter in black & white, color versions of these photos can

be found on the online newsletter: http://www.nnoha.org/resources.htm)

• The National Primary Oral Health Conference takes place November 9-13, 2008. This annual conference, run in cooperation between NNOHA and HRSA, will take place in Dallas, Texas at the Gaylord Resort and Convention Center. There will be CE credits available for both clinical and administrative topics. Come to the only na-tional conference specifically for Health Center dental providers! To view the agenda or register, visit: https://www.team-psa.com/2008oralhealth/home.asp

• The 26th Annual State and Regional Primary Care Association Conference will take place November 17-19, 2008 in Delray Beach, Florida. The 26th S/RPCA Con-ference is designed specifically for staff and board members of S/RPCAs. The two day conference addresses the most important issues facing SRPCAs today and in-cludes updates from NACHC and HRSA/BPHC.

http://www.nachc.org/primary-care-conference.cfm • The 3rd National Leadership Summit on Eliminating Racial and Ethnic Disparities

in Health takes place February 25-27, 2009, in Maryland. Visit the website for more information: http://www.omhrc.gov/npasummit2009/

• The National Oral Health Conference, sponsored by ASTDD, AAPHD, Health Re-sources and Services Administration and the Centers for Disease Control and Preven-tion, will take place April 20-22 in Portland, Oregon.

http://www.nationaloralhealthconference.com/ • Save the Date! The 2009 Farmworkers Conference will take place at the Hilton

Palacio del Rio in San Antonio, TX on May 12-14, 2009. If you know of any additional conferences that would be of benefit to Health Center dental providers, please contact Terry Hobbs at terry@nnoha.org to have them listed on NNOHA’s website and in future newsletters.

UPCOMING CONFERENCES AND EVENTS

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NNOHA NEWS, Volume 1, Issue 4

Communicate with Your Colleagues: NNOHA’s listserv is for those who appreci-ate daily communication among their peers and want to post questions and give feedback. It requires a separate sign-up from the newsletter. If you would like to be subscribed to NNOHA's listserv, send an e-mail to MAJORDOMO@ohsu.edu with the text "Subscribe NNOHA" in the body of the e-mail. All of this text needs to be in plain text format.

WELCOME NEW NNOHA BOARD MEMBERS

After an intensive review of applications, the NNOHA Board is pleased to welcome 5 new members to serve on the Board of Directors: Chris Shea – Cherry Street Health Services, Grand Rapids, MI Allen Patterson - Heart of Texas Community Health Center, Waco, TX Dr. Steve Geiermann - American Dental Association, Chicago, IL Dr. Margaret M. Drozdowski– Community Health Center, Inc., New Britain, CT Dr. Greg Baber – Community Health Development, Inc., Uvalde, TX NNOHA is honored to have these accomplished people in service. Additional thanks are given to all of those who submitted applications.

According to the U.S. Surgeon General’s Report issued in 2000 as well as projections provided by the Bureau of Labor Statistics, we are facing a critical shortage of den-tists in this nation while the dental hygiene profession continues to grow. The development of new dental practitioners who are for-mally educated, licensed by the state and trained to work with un-

derserved populations combined with Medicaid reform provides a model that will help ensure that no community’s oral health needs go unmet. Sealant programs in schools are one very tangible way that the ADHP model could significantly improve the oral health of our children. The US Center for Disease Control recommends that all communities adopt school based sealant programs. CDC Di-rector, Julie Gerberding, MD stated, “If more communities would implement these programs, we could save many children from needless pain and suffering and save the nation millions of dollars in dental care costs.” The vision for the ADHP, like the nurse practitioner, is designed to augment the dental team and address the lack of ac-cess for the nation’s unserved communities. This is not a new concept. Currently, 22 states across the U.S. have laws in place that enable dental hygienists who meet specific requirements to work with less re-striction in a variety of public health set-tings. Additionally, similar oral health pro-vider models are currently used in Canada, the United Kingdom and New Zea-land. Through the development of a new provider with a Master’s-level education and increased scope of practice, ADHA expands upon a concept that has proven successful in many communities throughout the country and around the world. The ADHP is not designed to take the place of the dentist but to act as another profes-sional colleague in an integrated health-care team dedicated to improving the na-tion’s overall health.

Jeff Mitchell Director of Communications American Dental Hygienists' Association jeffm@adha.net

It’s just common sense that children can’t learn if they have a toothache and oral health is an important compo-nent of overall health. The U.S. faces a growing gap in the ability to provide proper oral health care to all those in need. This gap forces growing numbers of American school children to miss classes and other activities due to the pain result-ing from untreated dental decay. According to the Surgeon General’s Report on Oral Health, although dental decay is almost completely preventable, almost 51 million hours of school are lost annually due to dental problems. Tooth decay is the sin-gle most common chronic childhood dis-ease; five times more common than asthma and seven times more common than hay fever. One need only consider the case of Maryland’s Deamonte Driver, who died needlessly due to an abscessed tooth and lack of access to dental care to understand the magnitude of a problem that the U.S. Surgeon General referred to as a “silent epidemic in this nation.” The American Dental Hygienists’ Associa-tion (ADHA), along with many other oral health care organizations, has made ex-ploring different dental workforce models to find solutions to expanding access to care a top priority in recent years. In 2004 ADHA created the concept of an Ad-vanced Dental Hygiene Practitioner (ADHP) as a practice model designed to have greater reach and impact upon the underserved populations in the U.S. This position would be particularly effective when used in school or headstart settings to provide both the preventive and basic re-storative procedures that elude so many children, especially in urban and rural set-tings. ADHA is currently seeking funding via federal or private grants to mount a pilot project to demonstrate how this new work-force model would function to serve those in need.

ADHA EXPLORES NEW MODES TO PROVIDE NEEDED ORAL CARE

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NATIONAL NETWORK FOR ORAL HEALTH ACCESS

“The vision for the

ADHP, like the

nurse practitioner,

is designed to

augment the

dental team and

address the lack

of access for the

nation’s unserved

communities.”

Jeff Mitchell

SUPPORT DEVELOPMENT OF MID-LEVEL ORAL HEALTH PROVIDERS

• WHEREAS Oral health is an integral and critical part of overall health; • WHEREAS Diseases of the oral cavity are some of the most prevalent health conditions in

the United States, yet 59% of children ages 5-17 and 85% of adults over 18 still experi-ence dental caries and 61% of adults 25 years and older and 86% of adults 45 and older have evidence of periodontal disease;

• WHEREAS most oral health problems are entirely preventable but significant morbidity and even deaths from dental diseases still occur;

• WHEREAS there continues to be a lack of access to oral health services, especially in rural and low-income areas;

• WHEREAS mid-level oral health programs can facilitate a division of labor that allows den-tists to manage and treat more acute and complex issues and maximize delivery of effi-cient and effective comprehensive oral health care;

• WHEREAS prevention activities by mid-level practitioners can assist in the primary preven-tion of severe and expensive problems; and

• WHEREAS several mid-level programs are currently in development and should be sup-ported to determine if they can be successful.

THEREFORE BE IT RESOLVED that we, the members of the National Network for Oral Health Access (NNOHA), support innovative programs that increase access to oral health services. We support the development, implementation, and evaluation of a number of pilot midlevel programs including, but not limited to, dental therapists, the Community Dental Health Co-ordinator, Oral Preventive Assistants, and Advanced Dental Hygiene Practitioners. NNOHA Background: The National Network for Oral Health Access (NNOHA) is a non-profit organization that was founded in 1990 by a group of dental directors from Federally Qualified Community Health Centers (FQHCs) who recognized the need for peer-to-peer networking, services, and collabo-ration to most effectively operate Health Center dental programs that serve underserved popu-lations. NNOHA has a diverse membership of Health Center oral health providers: dental di-rectors, dental hygienists, and their supporters. The membership represents the diversity of Health Center oral health settings – from novice to experienced dental directors (from 30 days to 30+ years) to diverse Health Center settings - from isolated, rural, one-dentist clinics, to large urban practices with 20 or more dentists. NNOHA’s mission is to improve the oral health status of the underserved through advocacy and support for health centers.

NNOHA MEMBERSHIP MID-LEVEL PROVIDER RESOLUTION

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NNOHA NEWS, Volume 1, Issue 4

At the National Primary Oral Health Conference in Dallas, Texas November 9-13th, the NNOHA membership will be asked to vote on a resolution regarding support of mid-level providers. The membership meeting will take place on Monday, November 10th. The resolution follows:

gram. The costs to obtain each product including training and on-going support, the potential interface with other products, the questions to ask when considering a Request for Proposal (RFP) are discussed in the document. There is also excellent infor-mation on digital radiography systems. While we do acknowledge that there is no one-size- fits–all product, we believe that the Dental Directors can use the results in the resource guide to determine which product will meet the needs of their Health Center. At the National Primary Oral Health Conference in Dallas, November 9-13, 2008, the HIT committee will proudly debut the NNOHA HIT White Paper, so we hope you will join us. It has been an honor to serve as Chair of the committee. I would like to acknowl-edge all of the committee members. Be-

cause of their serious com-mitment, hard work, and dedication, the White Paper is a great success. I feel very privileged to have had a chance to work with the best, the most intelligent profes-sionals in the Community Health Center world,

whom I feel very proud calling “friends” and “colleagues.” Thanks again, Maggie, Cliff, Lohring, and Lan-Tu for working with me on this project. I would like to thank Colleen Lampron, NNOHA Executive Direc-tor, for giving us the opportunity to contrib-ute to NNOHA membership through the Cooperative Agreement. Finally, NNOHA is grateful for the HRSA funding that al-lowed us to embark on this important work. DISCLAIMER: We would like to emphasize the evaluation comments and ratings in the HIT White Paper are purely the opinion of the committee members, derived from ei-ther our understanding on how the practice management programs work based on our own experience using the products, or per-ception of the product from demonstration presentations by the representatives of the products. These ratings in no way are in-dicative of NNOHA endorsements of any particular product.

Huong Le, DDS Chair of HIT Committee, NNOHA Board Member Dental Director, Asian Health Services Community Health Center hle@ahschc.org

As part of a Cooperative Agreement with HRSA, NNOHA agreed to do an analysis of the different electronic dental records products currently available to Health Cen-ters and produce a white paper on Health Information Technology in Health Center Dental Programs. This was how the NNOHA HIT committee was formed. At the December 2007 National Primary Oral Health Care Conference (NPOHC), a group of volunteers came together and immediately started their work plan for this project. Present at that initial meeting were Drs. Margaret Drozdowski, Clifford Hames, Lan-Tu Holem, Lohring Miller, Colleen Lampron, NNOHA’s Executive Director, and me, Huong Le. After our consultant, SA Kushinka of Full Circle Projects, was hired in February, the committee went into full swing and started working very hard to make the deadline We quickly found out it was not easy to decide which products to consider for our project. The selection came down to four products for evaluation, based on the number of users of the prod-ucts among the Health Centers. These were Dentrix, Eagle Soft, Practice works and Quality Systems, Inc. or QSI. In September 2008, after many conference calls, an in-person meeting in June in Denver, and many more email exchanges that followed, we finally came up with a White Paper that we can say we are very proud of. The NNOHA HIT White Paper contains a wealth of information on the different re-quirements, both technical and operational, for a good electronic dental record prod-uct. It lists the various criteria that Dental Directors and their teams should look for when considering an electronic dental re-cord (EDR) product, initial costs, and tips on how to write a Request for Proposal. The products are rated based on a list of crite-ria that the members felt important to the operations of a Health Center dental pro-

HIT WHITE PAPER PROJECT

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NATIONAL NETWORK FOR ORAL HEALTH ACCESS

THE DOCUMENT INCLUDES “THE COSTS TO OBTAIN EACH PRODUCT … THE POTENTIAL INTERFACE WITH OTHER PRODUCTS, THE QUESTIONS TO ASK WHEN CONSIDERING A REQUEST FOR PROPOSALS...”

ELECTRONIC NEWSLETTER

The NNOHA newsletter will eventually be distributed in an

electronic format only. This is a great way to reduce paper usage plus you’ll receive the newsletter earlier. If you are not currently

receiving your newslet-ter via E-mail, sign up

online at http://www.nnoha.org/about.htm.

If you’re having prob-lems receiving it, ask

your IT department to assure that your SPAM

filters allow E-mails from nnoha.org and

NNOHA@mail.vresp.com.

NANO-FILLED RESIN-MODIFIED GLASS-IONOMER RESTORATIVE CEMENT

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NNOHA NEWS, Volume 1, Issue 4

Theodore P. Croll, DDS 3M ESPE Opinion Leader nmckeon@mmm.com

The addition of a resin component to glass-polyalkenoate (ionomer) cement systems has had a profound impact on restorative dentistry. The glass-ionomer restorative and luting cements that were first introduced throughout the 1970s and 1980s had disadvantages that discouraged dentists from using them routinely. The major problems of poor handling, low fracture strengths and low wear resistance, as well as excessively slow hardening times, were substantially solved in the early 1990s with the market introduction of the resin-modified glass-ionomer (RMGI) restorative cements. Although RMGI restorative materials have been shown by research and clinical reports to be highly successful, dentists have been slow to abandon silver amalgam and resin-based composite materials, especially for use in the primary dentition. In 2007, 3M ESPE introduced the first “nano-ionomer” filling material called Ketac™ Nano Light-Curing Glass Ionomer Restora-tive. It is composed of two pastes based on bonded nanofiller technology, which are blended to ideal consistency for repair of primary and permanent teeth. This restora-tive cement is considered a “nano-ionomer” because the formulation is based on bonded nanofiller technology. Inclusion of nanofiller and nano-clusters of filler material influences strength, optical properties and abrasion resistance, making for enhanced esthetics, improved polishability and enhancement of physical characteristics of the hardened ma-terial in the mouth. Ketac Nano restorative material shows a higher wear resistance than other resin-modified glass ionomers, making it an ideal glass ionomer repair alternative for certain posterior applications. Similar to conventional and resin-modified glass ionomer restoratives, Ketac Nano has excellent fluoride release – making it ideal for patients with high caries susceptibility—and is “rechargeable,” picking up more fluo-ride ions when exposed to a topical fluoride source. Additionally, in-vitro tests show a

caries inhibition zone is created in the tooth structure adjacent to Ketac Nano after acid exposure. The nanofiller tech-nology incorporated into Ketac Nano di-minishes the gap that exists between glass-ionomer systems and the resin-based composite restoratives. Wear measurement is critical as an indica-tor of longevity in a dental restorative material. Restorations made with Ketac Nano have excellent esthetics and perform well in abrasive environments. When tested against other resin-modified glass ionomers, Ketac Nano shows a higher wear resistance, making it an ideal glass ionomer solution in many posterior appli-cations. Ketac Nano is useful for a wide range of clinical applications. The two-paste for-mula is an ideal esthetic dental restorative material for children, teens, adults and especially in geriatric patients. It is prov-ing itself to be most useful for high caries risk patients, pediatric patients requiring rapid treatment with minimal clinical time, erosion lesions, and transitional restora-tions in both the primary and permanent dentitions (e.g. prior to preparation for crowns, temporary restorations, tooth trauma). Ease-of-use for the dentist and dental as-sistant is enhanced by the double-barreled Clicker™ Dispenser, which makes for faster and easier dispensing and ensures appropriate dosage and precise blend of components for each procedure. Mixing and delivery of Ketac Nano into a pre-pared tooth is simplified considerably compared to the procedure for powder/liquid systems. Glass-ionomer restorative systems have developed into the best direct application dentin replacement material available. Ketac Nano can be used in many cases for combined dentin and enamel replacement. This material, capturing advantages of both glass-ionomers and resin-based com-posites, should be considered a major step toward development of the ideal direct application adhesive tooth restorative sys-tem.

Fig 1B- Dr. Croll applies Ketac™ Nano Primer before the nano-filler is injected and compressed

Fig 1A- 3M™ ESPE™ Ketac™ Nano Light-Curing Glass Ionomer Restorative

“IT IS PROVING ITSELF TO BE MOST USEFUL FOR HIGH CARIES RISK PATIENTS...”

NNOHA currently has 500 members and is regularly in contact with 1,300 providers and staff at Health Centers, and other oral health partners. The following people have re-cently initiated or renewed their NNOHA membership and we recognize them for their commitment: A. Clark · A”Lise Steward · Allison Levans · Amos Deinard · An Nguyen · Anthony Boschetti · April Washington · Arathi Reddy · Barb Smith · Beck Demers · Brandie Ard · Brian Higa · Bruce Wilcox · Brian Macall · Carmelina D’Arro · Charles Rim · Chris Schryer · Christine Bender · Daria Stone · David Schlottman · Deborah Mosley · Debra Lake · Den-nis Lewis · Dulce Suarez · Edward Dye · Eleonora Jenkins · Eric Miller · Eric Taylor · Estelle Foser · Eugene Kim · Eumeka Hogans · Frank Torrisi · Franklin Pierce · Frazier Moore, Jr. · Gary Podschun · Gerald Hino · Geoff Ping · Grant Korsmo · Gregory Waite · Harvey Shaw · Howard Blessing · Huong Le · Inez Lopez · James Quartey · Jane McGinley · Ja-red Simpson · Jay Balzer · Jean Leconte · Jennifer Lim · Jerry Fingerut · Jim Pawlecki · Joe Schneider · Juanita Lozano-Pineda · Julie Janssen · Karyl Pattern · Kimberly Vale · Kristen Haun · Kyong Kong · Lawrence Li · Leslee Slaughter · Letedra Collins · Lewis Lampiris · Linda Niessen · Lindsay Cassidy · Lindsay Robinson · Lisa Baldwin · Lisa Bozzetti · Marcy Borofsky · Margo Woll · Maria Resende · Mario Rosario · Mark Mullenbach · Mary Alten-berg · Mark Koday · Mary O’Connor · MaryLou Bagby · Maryann Rayani · Mary-Margaret Warrick · Maureen Calvo · Maureen Catipon · Monica MacVane-Pearson · Nicole Stoufflet · Paula Brown · Philip Woller · Quynh Nguyen · Rebecca Schaffer · Rhys Jones · Ricardo Garcia · Robert Llopis · Ronald Bloy · Rudy Blea · Sandra Kim · Saravana Karunagaran · Satish Kumar · Scott Bibbens · Serese Cannon · Sergio Cuevas · Shig Ho-soyama · Stephanie Jackson · Steve Davis · Tabitha Taylor · Teresa Grygo · Thomas Spangler · Thomas Ward · Tishra Beeson · TJ Dorsey · Trent Loiseau · Tyrone Rodriguez · Uma Arunkumar · Vinod Miriyala · William Burns · Yanli Ding · Yesenia Gonzalez

GOLD CIRCLE ORGANIZATIONAL MEMBERS

MEMBER RECOGNITION

Page 10

NATIONAL NETWORK FOR ORAL HEALTH ACCESS

These organizations have recently contributed at least $250.00 to become 2008 organ-izational members of NNOHA. We recognize their commitment to supporting NNOHA and improving access to oral health services for underserved populations: • American Dental Association – Steven Geiermann, CAPIR Senior Manager • Blackstone Valley Community Health Care – Lalita Bhattaharya, DMD • Central Counties Health Centers, Inc. – Forrest Olson, President and CEO • Mississippi Primary Health Care Association • Samuel U. Rodgers Community Health Center – Charlene Mason Dozier, DDS To become an organizational member, visit NNOHA’s website and fill out the member-ship form at: http://www.nnoha.org/about.htm.

Let us Know: What could we do to increase the value of your NNOHA membership? Contact NNOHA staff at info@nnoha.org.

NNOHA’s Advisory Committee is comprised of representatives from major dental manu-facturers in the country. This group recognizes the importance of providing care for the underserved and has committed funding, resources, and expertise to NNOHA to help us achieve our mission. We are grateful for the contributions from these corporate supporters:

º 3M ESPE º Henry Schein, Inc º Dentsply º Independent Dental º GC America º Kerr Dental º Mydent º Dental Recycling of North America

If you are a corporate representative and are interested in supporting NNOHA’s activi-ties through the advisory committee, contact Colleen Lampron at colleen@nnoha.org.

ADVISORY COMMITTEE RECOGNITION

Page 11

NNOHA NEWS, Volume 1, Issue 4

2009 NNOHA MEMBERSHIP APPLICATION If you are not currently a member, please complete the following information and mail to:

PMB 170 7476 East 29th Ave. Denver, CO 80238

Select one: ____ Individual membership $25.00 ____ Organizational membership $250.00 (If you select organizational membership, please attach a separate sheet with names, titles, and E-mail address of those included.)

Contact Information: _______________________________________ Name

_______________________________________ Title

_______________________________________ Organization

_______________________________________ Address

_______________________________________ _______________________________________ Phone

_______________________________________ E-mail

Committees: ____ I am interested in receiving committee information. ____ I am not interested in participating on a committee at this time. Method of Payment: _____ Check _____ Bill Me _____ Credit Card _________________________________________ Credit Card # Security Code Exp. Date

_________________________________________ Signature

DO YOU KNOW OF A NEW

HEALTH CENTER DENTAL CLINIC

OR NEW DENTAL DIRECTOR?

HELP US SHARE THE RESOURCES AVAILABLE TO

THEM THROUGH NNOHA.

FORWARD THIS NEWSLETTER OR

LET A NNOHA STAFF MEMBER

KNOW WHO TO CONTACT:

INFO@NNOHA.ORG.

LET’S STAY CONNECTED!

Use the Discounts: Henry Schein, Inc. offers a Health Center discount. To enroll in the Henry Schein, Inc. discount program, members may contact Kathleen Titus at (916) 772-0424 or kathleen.titus@henryschein.com.

ing the data. NNOHA will also receive funds for every clinic that participates. To protect FQHC and patient privacy, data on individual FQHCs will only be available to that FQHC, and only ag-gregate FQHC data will be published. No information will be collected on patient names, addresses, or any other patient identifiers. This project has been approved by the Human Subjects Committee of the University of Connecticut Health Center. This project has the full support of the NNOHA Board, and according to NNOHA President John McFarland, “this pro-ject has great potential for helping us advance the cause of FQHC dental programs and reduce access disparities.” Interested FQHCs can obtain more information by contact-ing Howard Bailit from the Pipeline program (860-679-5487, bailit@nso1.uchc.edu), Colleen Lampron from NNOHA (720-838-7739, info@nnoha.org) or the NNOHA website (http://www.nnoha.org).

NNOHA is working with the California Pipeline program to study FQHC dental program finances. Funded by The Cali-fornia Endowment, this study will collect data from up to 40 FQHC dental programs. The goal is to assist individual FQHCs improve their ef-fectiveness and efficiency and at the national level, to build the case for more public support. The project is aimed at FQHC dental programs that have electronic den-tal record systems. Par-ticipating clinics will be asked to complete a brief survey and down-load 12 months of patient visit data. They will receive a detailed analysis of their financial operations, an aggregate analysis of all par-ticipating FQHCs, and $200 to help cover the cost of provid-

PARTICIPATE IN THE NNOHA AND CALIFORNIA PIPELINE PROGRAM STUDY

PMB: 170 7476 East 29th Avenue Denver, CO 80238

Phone: 303.957.0635 Fax: 866.316.4995 E-mail: info@nnoha.org

Visit the website:

www.nnoha.org!

The Community of Migrant, Homeless, and Health Center Dental Providers.

N A T I O N A L N E T W O R K F O R O R A L H E A L T H A C C E S S Q U A R T E R L Y N E W S L E T T E R

NOTE: The NNOHA newsletter is for information sharing & discussion purposes. NNOHA does not endorse all included viewpoints or authors.