Ergonomics for Dental Professionals Colleen A
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THE NEW YORK STATE DENTAL JOURNAL Volume84 Number3 April 2018 15 The Interprofessional Management of Geriatric Patients Undergoing Head and Neck Cancer Treatment in U.S. Nursing Homes Rashidah Wiley, D.D.S.; Vidushi Gupta, D.M.D.; Riddhi A. Daftary, D.M.D.; Jessfor Baugh, D.M.D.; Anh H. Tran, D.M.D.; Dorothy Lynne Cataldo, D.M.D.; Yang Kang, D.D.S., Ph.D.; Takashi Komabayashi, D.D.S., M.D.S., Ph.D. A dental approach toward interprofessional management, treatment planning and rehabilitation of diagnosed individuals undergoing cancer therapies is essential. Literature review focuses on presurgery oral hygiene instructions, pre-radiography/chemotherapy dental clearance, complications and management during radiotherapy/chemotherapy; post-radiotherapy/ chemotherapy oral healthcare; and adjunctive measures. 24 Stress Relief through Ergonomics for Dental Professionals Colleen A. Watson, D.D.S.; Anupama Sangadala, D.D.S.; Peter Marino, C.P.T. Dentistry is a physically taxing profession. Chronic neck, shoulder and back Cover: The elderly, whose numbers are pain among practitioners is not uncommon, but it needn’t be inevitable. increasing, are at particular risk of develop- ing cancer, including in the head and neck Targeted exercises that can be done in the office or at home can strengthen region. Though necessary to the successful muscles and help ward off injury or pain. treatment of cancer patients, oral healthcare may not be a priority, especially when the patient is confined to a nursing home. 28 What Grows on Your Implants? Erica Lavere, D.D.S.; Nicola Alberto Valente, D.D.S., M.S.; 2 Editorial Midlevel providers Sebastiano Andreana, D.D.S., M.S. What happens to implants after they are introduced into the oral environment? 4 Attorney on Law Do they keep their sterility, or are they colonized by bacteria? These are among Catching up on legal matters questions answered through a review of the literature aimed at providing a general overview of critical concepts in peri-implant microbiology. 8 Viewpoint Seeking and finding redemption 33 Idiopathic Gingival Fibromatosis Divya Khera, D.D.S.; Elizabeth Philipone, D.M.D.; Richard Yoon, D.D.S. 10 Perspectives The case of an adolescent patient with unilateral idiopathic gingival Providing for disabled fibromatosis, a rare condition, is presented, along with a literature review of the condition and treatment. 12 Association Activities 38 General News 42 Component News 48 Read, Learn, Earn 51 Classifieds 53 Index to Advertisers 56 Addendum A positive outlook The New York State Dental Journal is a peer reviewed publication. Opinions expressed by the authors of material included in The New York State Dental Journal do not necessarily represent the policies of the New York State Dental Association or The New York State Dental Journal. EZ-Flip version of The NYSDJ is available at www. Use your smartphone to scan this QR Code and access the current online version nysdental.org and can be downloaded to mobile devices. of The New York State Dental Journal. editorial Midlevel Providers Know the “What” and “How,” Not the “Why” and “When” There is no substitute for a fully trained dental professional. Policymakers and legislators do a great disservice dards, regulations and laws place the oral healthcare to the dental profession and to patients when they decision-making authority in the hands of a licensed enable lesser-trained technicians to perform irrevers- dentist, the individual in the best position to act in ible procedures independently, without the direct the patient’s best interest. Since these competencies supervision of a dentist. The reduced education of and principles set a minimum standard of care, any midlevel providers (MLPs) leaves them only partially program that incorporates only some, but not all, of prepared to practice to the current standard of care the required standards, by definition, cannot certify of a dentist. While they might technically handle its graduates competent to perform all the tasks re- basic cases, they could place patients with more served for a graduate of an accredited program. intricate and unusual needs at risk. MLPs generally receive an average of three years Proponents contend states should utilize MLPs of dental education after high school. No doubt to improve access to care for the underserved. How- they learn “what” to do and “how” to do it. The key ever, engaging lesser-trained technicians to provide element of the advanced education and training of symptomatic care will not prevent future disease a doctor of dental surgery (or medicine) that distin- or remove the barriers to the utilization of existing guishes dentists from midlevel-trained technicians care from dentists. As such, midlevel care does not is the perspective attained in the broader context of serve patients’ best interests. Hence, implementing the study of the biologic, dental, clinical and behav- such a proposal violates dentistry’s contract with ioral sciences. In essence, CODA competencies and society, which, ultimately, will threaten dentistry’s the legal standard of care require that to earn the status as a profession. privilege and autonomy to perform irreversible pro- Current dental school curricula, accreditation cedures, dentists must not only possess the knowl- standards, licensing, scope-of-practice laws and the edge of “what” and “how” to perform, but also legal standard of care all evolved to set a minimum demonstrate the wisdom of understanding “why” quality level and protect the public. The Commis- conditions exist, “why” treatment should be ren- sion on Dental Accreditation (CODA) sets the dered and “when” to take or not take certain action. minimum competencies dental schools must teach We can certainly teach MLPs the techniques to and students must master as a prerequisite for the drill, fill and pull teeth. However, midlevel programs D.D.S./D.M.D. degree and, ultimately, licensure. cannot prepare MLPs to competently interpret com- These competencies developed for a critical reason. plex history, lab and radiographic findings, or man- They progressed and advanced to ensure practitio- age patients with bleeding disorders, artificial heart ners will apply state-of-the-art scientific knowledge valves, diabetes, oral malignancies and life-threat- safely to the public. Courts look to the principles ening infections, among others. We can teach, in a taught in dental curricula as a basis for setting the scaled down MLP course, techniques, observations legal standard of care. These competencies, stan- and entry-level knowledge. We cannot develop in 2 APRIL 2018 ● The New York State Dental Journal THE NEW YORK STATE DENTAL JOUR NAL EDITOR Chester J. Gary, D.D.S., J.D. MANAGING EDITOR Mary Grates Stoll ADVERTISING MANAGER Jeanne DeGuire ART DIRECTORS Kathryn Sikule / Ed Stevens EDITORIAL REVIEW BOARD Frank C. Barnashuk, D.D.S. David A. Behrman, D.M.D. the MLP the clinical judgment to know why a certain technique is appropriate, or when Michael R. Breault, D.D.S. to revise treatment in the face of complicated dental and psychosocial problems or a Alexander Corsair, D.M.D. compromised medical history. Ralph H. Epstein, D.D.S. Some advocates of MLPs claim such a system works in medicine, so it should Joel M. Friedman, D.D.S. succeed in dentistry. This argument fails, since the comparison is flawed. Dentistry G. Kirk Gleason, D.D.S. stands as more of an unofficial surgical specialty of medicine and should be more ap- Kevin J. Hanley, D.D.S. propriately compared to surgical medical specialties, not medicine in general. Medical Brian T. Kennedy, D.D.S. MLPs, such as physician assistants and nurse practitioners, do not perform surgery on Stanley M. Kerpel, D.D.S. patients’ brains, hearts, eyes or feet. Policymakers who take the position that MLPs can Elliott M. Moskowitz, D.D.S., M.Sd perform fillings and extractions indirectly imply that dental surgery is somehow not as Francis J. Murphy, D.D.S. complex or important as surgery in other parts of the body, which, of course, is absurd. Eugene A. Pantera Jr., D.D.S. We can all agree organized dentistry needs to work to increase access and uti- Robert M. Peskin, D.D.S. lization of oral healthcare services to the underserved. However, the MLP model in Pragtipal Saini, B.D.S., D.D.S., M.S.D. dentistry offers little more than a politically expedient proposal, which will not suc- Robert E. Schifferle, D.D.S., MMSc., Ph.D. ceed because it fails to address the removal of key barriers to utilization, such as oral PRINTER healthcare literacy and prevention. Society bestows professional status upon dentistry contingent upon the dental pro- Fort Orange Press, Albany fession’s commitment to act in the best interests of patients. Patients have a right to know they are protected and will receive the level of competency necessary for the safe NYSDJ (ISSN 0028-7571) is published six times a year, in January, March, April, June/July, August/September delivery of oral healthcare. It seems unjust to take a position that makes potentially and November, by the New York State Dental Association, substandard care available to the underserved, when much more could and should be 20 Corporate Woods Boulevard, Suite 602, Albany, NY 12211. In February, May, October and December, sub- done to remove barriers to the utilization of available care. scribers receive the NYSDA News. Periodicals postage paid at Albany, NY. Subscription rates $25 per year to Society expects dentistry to work with other professional organizations, govern- the members of the New York State Dental Association; ment agencies and community groups to fight this fight. Together, we must not lose rates for nonmembers: $75 per year or $12 per issue, U.S. and Canada; $135 per year foreign or $22 per issue.