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The CDA (California Dental Association) and a coalition are looking into options to help overturn laws that are reducing return rates on Medi-Cal. The ninth circut court of appeals has been dealing with appeals to the Medi-Cal reimburstment rate since October of 2012, when a coalition which includes the California Medical Association, the California Dental Association, California Pharmacists Association, National Association of Chain Drug Stores, California Association of Medical Product Suppliers, AIDS Healthcare Foundation and American Medical Response. This was in response to Last spring of 2011, when the California legislature passed and Gov. Jerry Brown signed AB 97, which included a 10% reimbursement rate reduction for pharmacists, doctors, dentists and other providers for Medi-Cal, California’s Medicaid program.

As of currently, these cuts are effecting patients. The pharmacists got it the worst, with many medicines having to be at cost to simply allow patients to be able to afford them. These cuts will have an even greater negative impact on vulnerable Californians if implemented, as the state seeks to shift 875,000 into the Medi-Cal program from the Healthy Families program in 2013. “One must first be able to access care to obtain quality care. Existing Medi-Cal payments are the worst in the nation. Medicare pays $73 for the most common level office visit – Medi-Cal a paltry $23. Or, how about $168 from Medi-Cal for a surgery such as a tonsillectomy? This in an environment where the cost to provide medical care – rent, salaries, equipment, etc. – has risen year after year above inflation, without any significant increase in reimbursements for over two decades”. Source.

Over the course of the next year, approximately 800,000 children will be moved from a (what was) functional Healthy Families Program, into this failing Medi-Cal program. All over a program that physicians don’t think will save the state any money. Where will these patients go when they cannot find a primary care doctor, or their clinic cannot find a specialist to see them under Medi-Cal? To the emergency room, where care is notably more costly than timely care in the doctor’s office.

Dr. Sean McLaren traveled to Boston to help two gorillas who were in need of some dental work. McLaren and his assistant are professors for the Eastman Institute for Oral Health, and they came to Boston to work on the teeth of Kiki and Gigi, two western lowland gorillas who reside at the Franklin Park Zoo. McLaren had worked on Gigi’s teeth in the past, and this time was looking to remove some of Kiki’s teeth as well. Gorilla’s teeth are a lot like human teeth, they are just much larger.

“They went well,” said McLaren about the procedures. He had donated his time to perform the extractions. “It takes a long time, because their bone is much more dense than human bone, and their teeth are larger. Kiki and Gigi both recovered beautifully with no complications at all. So it’s important to arrange the dental procedure in a way that won’t impact their routine. There are a lot of logistics behind the scenes that need to occur before and after the procedure.”

It actually has not become that uncommon for a dentist to come in and work on a gorilla’s teeth- it happened just a year before in San Fransisco when a gorilla’s canine became abscessed,

The closest thing to a great example of this I could find is “Gorilla Dentist”, a flash game.

I often find myself going to Wikipedia to read up on dental related subject matter- but it honestly falls to the same issue that most content falls into on a dentist’s “procedure” section. Its all fluff speak- and reads like an advertisement. I think this is mostly because there are a few people with some very light things to say on most subject matters, and a whole lot of people looking to get a loosely associated back link. It makes everything read so bulky and the article not very fun to read. Its also not as informative as you would like to think given the amount written.

A great example of this? http://www.dentistry.leeds.ac.uk . They have links everywhere through Wikipedia. And, for example, the one on the “dental plaque” website doesn’t even go anywhere on their website. At least that one tries to link to something relevant that might actually matter. On the “scaling and root planing” page someone is offering a reference for the notation “scaling and root planning is one of the most effective periodontal methods of treating gum disease before it becomes severe”.

If you go to the tooth paste page, you find “SLS has been proposed to increase the frequency of mouth ulcers in some people, as it can dry out the protective layer of oral tissues, causing the underlying tissues to become damaged.[16]“… referenced to a page that just talks about canker sores. A few sentence before that is “with the exception of toothpaste intended to be used on pets such as dogs and cats, and toothpaste used by astronauts, most toothpaste is not intended to be swallowed, and doing so may cause nausea or diarrhea.” ‘Tartar fighting’ toothpastes have been debated.”. That is right, they invoke astronauts… linking to www.toxictoothpaste.org, a website that no longer exists. Wikipedia is just riddled with faulty dental practices.

It gets worse the more you look. including a link to herbal toothpaste… ” Due to the increased demand of natural products, most of the toothpaste manufacturers now produce herbal toothpastes”.

I am considering going through these articles and cleaning them up… but then what would I have to write about?

The Patient Protection and Affordable Care Act passed and became active as of 2013. There is an additional 2.3% of tax on the sale of all medical devices. The FDA assigns a product code to medical devices, which would list it as medical or not. In general, the FDA requires a device defined in section 201(h) of the FFDCA that is intended for human medical management to be a part of the group. Oddly, biological devices don’t seem to count, but devices that are not intended for humans (such as sterilization equipment) do count. Included devices are:

• Nitrous and oxygen delivery systems and gas
• Computer equipment used for diagnostic purposes
• X-ray equipment, sensors, cone-beam CT systems, caries detection devices, and cameras
• Surgical equipment
• Handpieces
• Replacement parts
• Remanufactured or refurbished equipment
• Instruments
• Imaging equipment
• CAD/CAM machines
• Prosthetic devices

This impacts privately run medical practices the most, especially those that don’t focus on holistic businesses (since they are unaffected). Dentists mostly fall into this category, and it can put an unnecessary strain on dentists, since single devices often cost 2000 or more dollars. The majority of Dentists are looking at this as something that needs to be passed on to patients as fees- which is an issue, as many patients feel the prices at dental offices are already too high. A bigger risk is that doctors will simply take longer to upgrade their equipment and will use less cutting edge technology- something that will stifle innovation and prohibit new products from entering the dental realm very easily. This is not something I think that should be thought of lightly, as I often enjoy learning about new dental technology and the innovations in the dental world. Time will tell the long term effects on this change.

A British children’s television show has recently done the horrible history of dentists. You can watch the portions of it here:

A funny tribute to the old dental practices.

You can learn more about this show here: Horrible Histories.