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Reflections on Evidence Based Dentistry

7 Responses

1. Dr. Pruitt, on March 31, 2009 at 10:39 AM said:

   ADA transparency experiment

   [We’re making progress]

   Results

   Summary: In the last five weeks, I have sent 9 questions to various email addresses for the ADA. Six have been ignored and three have been honored with responses – one to the Evidence-Based Dentistry link found on the “Contact Us” page from three weeks ago, one to the Science link from two weeks ago and one to an email address for the Science/Professional Affairs from today (33% success).

   Both questions from last week’s test, (1) the follow-up question to the EBD link asking if Ahlstrom will speak at their conference in May and (2) the question to the Dental Practice link, asking if eDRs will save dentists money, failed to get a response.

   The successful question to the Science link was, “Can you tell me if there have been any published studies that have investigated whether managed care dental patients receive more treatment than fee-for-service dental patients?” It was forwarded to the ADA library services where a kind employee properly and respectfully fielded my question.
   ————————

   Overtreatment Studies

   Dr. Pruitt,

   Your question was forwarded to me and I have spent some time searching PubMed, other databases, and our own Library articles files; and I regret to say that I am unable to locate any articles that answer your question. Dental Literature is roughly about 95% clinical and the rest falls under that last 5%. It does not look to me like anyone is writing about this topic. Sorry I could not be of more help to you!

   If you have any further questions or comments about this topic, please feel free to contact me at the e-mail address/phone number listed below. Thank you for using ADA Library Services!

   Sincerely, LS
   ————————-

   LS, thank you for your reply. I have to say, I have asked the ADA this question on several occasions and in several venues, and you are the first person to actually reply. That is encouraging.

   I would like to ask another question that nobody else has bothered to even acknowledge. It is also peripheral to clinical concerns, so don’t feel bad if you cannot find the answer: How many dentists in the nation have NPI (National Provider Identification) numbers?

   If you cannot find the answer, could you give me a suggestion of who to ask?

   Sincerely, Darrell
   ——————————–

   Dr. Pruitt,

   I went to the NPI Registry (which is searchable), however, it does not appear to be searchable via groups (such as Dentists, Pediatricians, etc). You can only search by name or organization (Hospital, Clinic, etc.). In case you are interested here is the link: https://nppes.cms.hhs.gov/NPPES/NPIRegistryHome.do

   We do have a Staff Member who does answers questions about this topic. His name is Patrick Cannady and you can call him at ———-. I am not certain whether he would know either, but he might be worth a call. Sorry that’s the best I can do with this question.

   Thank you for contacting ADA Library Services!

   Sincerely, LS
   ——————————-

   EBD Conference question results

   As I said, today I emailed the unanswered question about Ahlstrom’s participation in the EBD conference to an address I was given in the response from the Science/Professional Affairs department. For the first time, my question was answered almost immediately. I was told that Dr. Ahlstrom is not scheduled to address the EBD conference this year. In addition, I was provided a list of those addressing the group.

   This week’s New Tests

   Test 1: On Thursday, March 26, I emailed the following question to Patrick Cannady in the Department of Dental Informatics: “I am trying to find out how many dentists in the nation have NPI numbers. Can you help me with this?”

   Test 2: (Already completed) As noted earlier, I emailed a question to an address I was given in the response from the EBD link. It was answered almost immediately by the Science/Professional Affairs department.

   Discussion

   EBD Conference

   Concerning the on-again, off-again response from the EBD link on the “Contact Us” page of the ADA Internet site, you may recall that when I sent my soft question asking if I had been accepted to attend this year’s conference, I received a response within a day. However, my follow-up question that I sent to the same link a week later, in which I asked if Dr. Ahlstrom will be speaking at the conference, failed to command a response at all. ADA members should be wondering which ADA employee read the second email and made the decision not to respond to it after responding so promptly to the first.

   For membership, lack of inconsistency is probably the most frustrating grand error an organization can make. It never makes sense to get a response one day, but not the next. We must do better than that, friends.

   Ultimately, though, my question about Ahlstrom speaking at the EBD conference was answered using email instead of the “Contact Us” link. In addition, I was provided with a list of the speakers for this year’s conference, without having to request it. Now that is nice. That is the kind of service ADA members should receive all the time.

   http://www.ada.org/prof/resources/ebd/conferences_champion.asp

   It appears to me that dentists in private practice will be better represented at the EBD conference this year. In 2008, Dr. George Merijohn, a periodontist from California was the only speaker in private practice, and it turns out that his was the only presentation which I thought was worth the trip. Very few of the others seemed to comprehend how dentistry impacts patients beyond academic theory.

   http://community.pennwelldentalgroup.com/forum/topics/evidencebased-dentistry-my?page=1&commentId=2013420%3AComment%3A17377&x=1#2013420Comment17377

   This year, four of the speakers are from private practice, and there are no representatives from the National Health Information Infrastructure (NHII) promoting a bankrupt digital agenda in dentistry, including e-prescribing, electronic dental records and HIPAA. In my giddy moments, I like to think that the future of dentistry looks better in 2009 because I absorbed the expense, and took the time to attend the 2008 meeting – leading me to openly criticize in detail the fantasy presented by ambitious stakeholders who re-define EBD to fit the product they sell.

   (See “Evidence-Based Dentistry – My search for truth.”)
   http://community.pennwelldentalgroup.com/forum/topics/evidencebased-dentistry-my

   Even though I won’t be reporting on the conference this year, I intend to follow up this thread by contacting the Science/Professional Affairs department in early June to request that an “EBD Champion” share with us the EBD information he or she learned at the conference. I can think of no better place than here on the PennWell forum to disseminate news dentists need to hear. Since the focus of recruitment of EBD Champions this year was on attracting attendees who can get the information out, how can the department of Science/Professional Affairs possibly turn down such an invitation? Stay tuned. We’ll know what is so special about EBD in less than 90 days…. or not.

   NPI number

   Concerning Patrick Cannady and the NPI number, this part of the adventure inspired a comment on a separate thread, titled “NPI update.”
   http://community.pennwelldentalgroup.com/forum/topics/why-the-long-npi-bcbstx?page=1&commentId=2013420%3AComment%3A26667&x=1#2013420Comment26667

   Responding to my, “How many dentists have NPI numbers,” is probably the most difficult question of Cannady’s career. He and I have crossed paths before. Three years ago, he told me all I needed to know about HIPAA to know that the amended 1996 mandate is absurd – especially in dentistry. After I asked for… or perhaps rudely demanded from Cannady, clarification of several points about HIPAA that he thought were wonderful – and that I found incredible and unethical – his boss, Dr. John Luther, interceded and asked me to leave his employees alone. Yet the ADA Vice-President was not capable of addressing my concerns either. He finally told me to write a letter to the editor of the JADA if I wasn’t satisfied with his (non) answer about HIPAA.

   Conclusion

   To have even one dead-end Internet address is unacceptable for a modern organization. For one in three addresses to be dead ends is shameful and embarrassing. Let’s not kid ourselves. Hints of unaccountability naturally raise the suspicion that an entity is hiding something even more shameful and more embarrassing. And writing letters to editors is over-rated.

   Until next week.

   D. Kellus Pruitt; DDS

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2. Dr. Pruitt, on December 22, 2009 at 2:21 PM said:

   ADA and Evidence-Based Leadership

   Which ADA Officer do you trust with your patients’ interests?

   A. “The electronic health record may not be the result of changes of our choice. They are going to be mandated. No one is going to ask, ‘Do you want to do this?’ No, it’s going to be, ‘You have to do this.’” – ADA Past-President Dr. John Findley, September 2008.

   B. “One thing is certain: we can and should fight for the opportunity to make our own choices rather than having outside forces decide our future role as health care professionals. I have chosen to look at myself primarily as a health care professional who is proud to be called a dentist.” – JADA Editor Michael Glick DMD, November 2009.

   C. “Much of our work will be seamless and below the radar screen for our members.” – ADA President Dr. Ron Tankersley September 2009.

   Personally, I prefer my chances with Dr. Glick’s ethics than either of the past two ADA presidents. Dr. Findley’s wimpy remark was one of his responses in his interview by Judy Jakush just before he took over as President. He maintained his level of courage throughout his term and was rewarded with a nice plaque in October for not causing problems.

   So that leaves us with a President who prefers to do his seamless work in secret. I’ve indeed learned not to expect transparency from Dr. Ron Tankersley, even though he also told Jakush that credibility is the most important gift he brings to my professional organization.

   Unfortunately for the future of the ADA, Dr. Glick recently left to become a dental school dean.

   Dr. Ron Tankersley looks damn good in photos though, doesn’t he?

   D. Kellus Pruitt DDS

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3. Dr. Pruitt, on July 17, 2010 at 9:41 PM said:

   Remember my “Road Trips” to Chicago in ‘07 and ‘08? Those were the days!

   On Monday, Kelly Soderlund posted an article on ADA News Online announcing the topics to be covered during the 2010 National Dental Benefits Conference to be held on August 20 in Chicago ADA Headquarters.

   http://www.ada.org/news/4417.aspx

   Having attended the benefits conference in 2007 and 2008, I personally experienced the repressed struggle that I assume occurs every summer – pitting fee-for-service dentists who are guarding their patients’ interests against almost everyone else in ADA Headquarters for the day. Soderlund’s juicy list makes me wish I were attending this year. It’s bound to be cooler in Chicago than it is here in Fort Worth, and I’d love to personally heat up the 2nd floor auditorium again – if only to watch the snoozers in the audience wake up snort-awkwardly.

   Friends, those trips were exciting fun. What’s more, by early afternoon, some in the audience audibly cheered me on a few times. I could learn to like applause.

   A few of the ideas presented by Soderlund seem reasonable, yet others are clearly vulnerable to over-reaching control by stakeholders at the expense of the principals – dentists and their patients. On a scale of 1 to 5 measuring the threat of stakeholder intrusion – with 1 being benign and 5 abject tyranny – here is my rating for each topic to be discussed on August 20:

   • Designing a Quality, Evidence-Based Dental Benefit Plan: An Employer’s Perspective will look at how the Massachusetts Public Employees Fund works with network providers to incorporate EBD.

   — Beware. EBD is a wonderful concept. However, the EBD label is routinely hijacked by ambitious stakeholders both inside and outside the ADA for selfish reasons. It’s my bet that a photogenic representative from a huge discount dentistry broker will present this lecture. I’ll even go out on a limb and say that the unnamed representative’s boss is a member of the National Association of Dental Plans (NADP). Oh hell. Let’s make it a trifecta: I say the EBD lecturer’s sponsor is also a former employer of the current ADA Executive Director. That possibility raises the threat score to 4 out of 5 – very threatening.

   • Dental Fraud: The Claim Review Perspective will cover identification and detection of fraudulent and/or suspicious activity from the claim review perspective.

   — Fraud must be stopped, and claims review is the only logical way to detect it. However, watch out for mission creep. Just recently CMS instituted an unjust and oppressive rule: If a claim is overpaid by Medicaid, and the dentist doesn’t catch CMS’s error within 60 days, the dentist will be publicly listed as fraudulent…. The threat score was 3 until a few minutes ago when I heard breaking news that authorities are at this moment conducting the largest Medicare fraud bust ever in 5 different states. That news significantly empowers command-and-control stakeholders and subsequently raises the threat score from 3 to 4. I bet I knew she was going to include mention of the fraud bust in her lecture before she did, at least by hours.

   • The Dental Quality Alliance: What You Need to Know About Evolving Quality Measures for Dentistry will address how the ADA is responding to a federal mandate that quality measures for dentistry be developed.

   — When the words quality, ADA and mandate are all three mentioned in the same sentence, your clueless, gullible patients are about to be strategically fleeced by algorithms. Threat score: 5

   • Federal and State Government Affairs Update will discuss what the ADA has been doing at the national level regarding health care reform and provide an update on state legislative activities.

   — Blah, blah, blah. The ADA has lost almost all credibility with lawmakers. Threat score: 1

   • Angry Bloggers and Egregious Rating Sites: Definitive Solutions for Dentists in the Internet World will focus on dental office considerations regarding frivolous malpractice lawsuits and Internet defamation.

   — It would be interesting to see this topic delivered, and ornery-fun to challenge in front of a crowd of a hundred or so. I can already fault the stakeholder (a consultant possibly?) for taking a defensive rather than a proactive stance to realities of modern communications: Consumers rule. Grow up, loser. Threat score 2

   • Discount Dental Plans and Network Leasing will cover how discount dental plans are competing in today’s dental benefits marketplace. It will also discuss the nuances in network leasing and cover scenarios where dentists have been told they were a participating provider for a plan, but do not remember signing an agreement with the company.

   — This is actually a good idea. It sounds like information that dentists and patients need. Threat score 1

   • Council for Affordable Quality Healthcare Universal Provider DataSource: Simplifying Provider Data Collection will explore data collection on dentists and its use by insurance companies in the credentialing process.

   Remember what I said about the ominous word, “quality”? Well, “insurance credentialing” is earthly vulgar. One should not trust “councils” of any kind until proven worthy. To me, the Council for Affordable Quality Healthcare sounds particularly scary – I wonder if Dr. Robert Ahlstrom is presenting the lecture. This one probably includes information about welcoming the installation of “back doors” into preferred providers’ computers so that insurers and other stakeholders can not only catch fraud in real-time, but quickly correct poor treatment decisions made by the principals – dentists and patients. Threat score: 5

   • Periodontal Treatment and Medical Care Costs in People with Diabetes—a study that shows a cost savings on medical expenses for insureds who access dental benefits—will be presented.

   — I witnessed the hi-jacking of this benign-sounding lecture in 2007 by a United Concordia representative for the benefit of United Concordia, not dental patients. He was unconvincing. Big is now even less influential than it used to be in the marketplace. They’re hurting. Threat score: 2

   If I were attending, I would ask one or more stakeholders if the consistency of a long-term dental home of a patient’s choice has an effect on quality of care. (Preferred provider contracts only last for 12 months).

   In 2008, I witnessed a representative from Delta Dental admit that results from data-mining proprietary Delta dental claims for 11 years showed that “changing dentists causes fillings.”

   Rest easy, Chicago. You’re off the hook this year. Maybe in 2011. I miss the pizza even more than I miss the arguments with a misinformed dentist from Wisconsin.

   D. Kellus Pruitt DDS

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4. D. Kellus Pruitt DDS, on August 20, 2012 at 9:10 PM said:

   EBD and EDRs

   What is the ADA House of Delegates’ motivation for bypassing the principles of Evidence-Based Dentistry?

   I’ve asked dental industry representatives for years if anyone is aware of Evidence-Based studies comparing the cost and safety of electronic dental records to paper. From the total lack of response from dental leaders who should know, it seems I’m the only dentist in the nation who has ever questioned the value of EDRs. To this day, stakeholders often appear to be put out by such “unprofessional” questions and aggressively silence this dentist’s concerns when given the chance.

   If dentistry is based on science and the Hippocratic Oath rather than sales pitches and profit, truth cannot remain hidden from dentists and patients. If EDRs cannot be shown to be an improvement over paper dental records in cost and safety, is there any reason for ADA leaders to continue to encourage dentists to purchase them?

   D. Kellus Pruitt DDS

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5. Darrell, on August 27, 2012 at 11:51 AM said:

   Political boundaries of EBD

   Is politics limiting the reach of Evidence-Based Dentistry?

   A few days ago, I asked if anyone knew of research comparing the cost and safety of EDRs to paper dental records. The absence of leads offered suggests that incredibly, almost no one has dared to publicly question their value. Oblivious to such marketplace concerns, the federal government, private insurers and even the American Dental Association vigorously persuaded thousands of dentists to quickly purchase slippery EDRs – which are apparently more dangerous and expensive than paper records that are stored in noisy metal filing cabinets.

   In contrast to dentists’ traditional stoicism, I estimate that hundreds of physicians have openly criticized their lousy software for years. For example, it’s common knowledge in the HIT industry that physicians – who need internet interoperability much more than dentists do – are experiencing a costly 30% de-installation rate. Nobody is saying how much money dentists needlessly waste on HIT because as far as I can tell, I’m the only one who has ever asked.

   The protective lack of transparency in the dental industry has always been at fault for creating a seller’s market for products of questionable value and unproven safety. Vendors simply don’t care for our patients like we do, Doc. And stakeholders cannot be held accountable to those who are hurt when security predictably fails by the thousands quickly.

   Regardless how dirty it makes some dentists feel, questioning the cost and safety of even ADA-approved technology has never been unprofessional. Protecting patients is always the right thing to do, even at the cost of popularity.

   Darrell

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6. D. Kellus Pruitt DDS, on June 24, 2013 at 9:25 PM said:

   EBD doesn’t reach Minn.

   Minnesota rejects Evidence-Based Dentistry

   Does anyone find it odd that the American Dental Association’s popular “Evidence-Based Dentistry” movement has stayed away from investigating cost and safety problems with electronic dental records – even as Minnesota mandates them.

   Recently, Minnesota passed a law mandating that dentists purchase and meaningfully use federally certified EHRs by January 1, 2015. Since nobody has ever revealed evidence showing that EDRs are cheaper and safer than paper dental records – or that the federal government’s “Meaningful Use” requirements are indeed meaningful instead of a waste of time for dentists – how do you feel about the stakeholder-friendly law, Doc?

   The Minnesota Department of Health’s “Guidance for Understanding the Minnesota 2015 Interoperable EHR Mandate” came out this month.

   Click to access 2015mandateguidance.pdf

   “Currently, there is no fine or formal penalty for not complying with the mandate. Nonetheless, the e-Health Advisory Committee and MDH recommend that all providers [including dentists] demonstrate progress toward achieving the EHR and interoperability requirements.”

   Disregarding the importance of first showing evidence that Minnesota dentists need to be included in such a far-reaching, expensive law, MDH provides lame, anecdotal “potential benefits of compliance” – paid for by dental patients in higher fees and/or faster dentistry:

   • increased efficiency and quality outcomes;

   • improved ability to avoid adverse events; and

   • timely access to information from your patients’ other providers.

   I don’t know about dentists that far north, but when I need immediate access to information from other providers – which is actually very rare – I simply pick up the telephone. The telephone doesn’t require one to be a HIPAA-covered entity and it doesn’t require an ever-changing alphanumeric password to use. It is hard to improve on that handy, safe and cheap device.

   Ironically, just before MDH posted its unsupported claims that CCHIT-certified electronic dental records will increase efficiency and improve dental care as well as improve dentists’ ability to avoid adverse events, the ADA held its sixth annual Evidence-Based Dentistry Champions Conference in Chicago. Jean Williams, ADA News staff, posted a description of the meeting, titled, “Dentists take on the challenge of change.”

   http://www.ada.org/news/8719.aspx

   EBD champion Dr. W. Ken Rich, a practicing general dentist and dental director for Kentucky’s Medicaid department tells ADA News that he regards the conference as complementary to his various leadership roles, including his service on the U.S. National Oral Health Alliance board, as well as his experience as a past ADA 6th District trustee and member of the ADA Dental Quality Alliance – which depends heavily on the use of dentists’ National Provider Identifiers as well as software purchased by dentists and paid for by patients. Dr. Rich says, “The most positive thing about the Champions Conference was that it gives you the tools you need to make the best decisions given the best data of the day.” The ADA is full of irony.

   If ADA officials still permitted this dentist to direct questions to them on the ADA Facebook, I would ask why they promote HIPAA and EDRs while ignoring the overwhelming evidence of increased cost and danger over paper dental records. I would also ask where the ADA stands on Minnesota’s new law. Are the dental leaders whom lawmakers ask for advice, for or against EDR mandates?

   D. Kellus Pruitt DDS

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7. D. Kellus Pruitt DDS, on February 20, 2015 at 12:58 AM said:

   Evidence-Based Dentistry versus electronic dental records

   “Have you heard of Evidence-Based Dentistry? Shouldn’t a dentist demand evidence that [electronic dental records] are safe before surrendering common sense?”

   – posted on Twitter by Darrell Pruitt DDS, July 10, 2010.

   Five years later:

   “But for all the talk of ‘evidence-based medicine,’ the federal government barely bothered to study electronic health records before nationalizing the program”

   – posted in the Wall Street Journal by Dr. Jeffrey Singer, February 16, 2015.

   http://www.wsj.com/articles/jeffrey-a-singer-obamacares-electronic-records-debacle-1424133213

   Not wrong. Just early.

   D. Kellus Pruitt DDS
   http://www.amazon.com/Dictionary-Health-Information-Technology-Security/dp/0826149952/ref=sr_1_5?ie=UTF8&s=books&qid=1254413315&sr=1-5

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