May 2020 Volume LV Number 3


Policy Center Updates

March 2019 Volume LIV Number 2

 Speak Up for Patient Health: Critical Conversations on Controversial Issues
The Policy Center has a full roster of speakers for its Pre-Conference Program at the 2019 Annual Session in Chicago on Thursday, May 23, 2019. This interactive educational session will offer commu- nication strategies for difficult adolescent-oriented concerns such as obesity, eating disorders, substance use, STDs, pregnancy and transgender issues. The objective of the session is to boost the communication confidence and skills of pediatric dental professionals in addressing topics that might make parents and adolescents feel embarrassed, judged negatively, or unlikely to return to the pediatric dental practice.

  • Karen Bernstein, M.D., M.P.H., Associate Professor of Pediatrics, University of Illinois College of Medi- cine, Chicago, Ill.
  • Cora Collette Breuner, M.D., M.P.H., Pediatrics and Adolescent Medicine, Seattle Children’s Hospital, Seattle, Wash.
  • Scott Herbert, J.D., Attorney, Cunningham, Meyer & Vedrine P.C., Chicago, Ill.
  • Sharon Parsons, D.D.S., general dentist in private practice, Columbus, Ohio
  • Scott B. Schwartz, D.D.S., M.P.H., Assistant Professor, University of Cincinnati Department of Pediat- rics, Cincinnati, Ohio
  • Robin Wright, Ph.D., Director, AAPD Pediatric Oral Health and Policy Center, Chicago, Ill.
Evidence-Based Dentistry Committee Update
The Evidence-Based Dentistry Committee (EBDC) is overseeing two new clinical practice guidelines:
  • Clinical Practice Guidelines for Use of Non-Vital Pulp Therapies in Primary Teeth, and
  • Clinical Practice Guideline on Behavior Guidance for Pediatric Dental Patients.
The Non-Vital Pulp Therapy Guideline Workgroup had submitted "Systematic review and meta- analysis of  non-vital pulp therapy for primary teeth" protocol to PROSPERO (International prospective register of  systematic reviews, National Institute for Health Research). The protocol is currently under review.1  The protocol is available at the following link: php?ID=CRD42018099107.
The meta-analysis is projected to be completed by May 2019 and the systematic review is anticipated to be completed by end of the year 2019. Drs. Coll and Vargas will present the results of the meta-analy- sis to the board members at the May 2019 Annual Session in Chicago.
Selected systematic reviews were evaluated by the Behavior Guidance Guideline Workgroup. Draft PICO was developed. The workgroup members will evaluate and appraise the latest systematic review using one of the validated appraisal instruments, AMSTAR, CASP.
James A. Coll, Kaaren Vargas, Abdullah A. Marghalani, Shahad Al Shamali, Chia-Yu Chen, Reva Bhushan. Systematic review and meta-analysis of non-vital pulp therapy for primary teeth. PROSPERO 2018 CRD42018099107. Accessed December 10, 2018.

A Columbia Space Shuttle Disaster Is Lurking in Your Office
Guest Editorial by Dr. Jade Miller, chair, Safety Committee
On Feb. 1, 2003, the Space Shuttle Columbia disintegrated upon re- entry into the earth’s atmosphere, killing all seven astronauts on board. The chain of events leading to the disaster had begun 16 days earlier when the Shuttle was launched. During ascent, 81 seconds after liftoff, a large piece of insulating foam broke off, damaging critical thermal tiles. The tiles subsequently failed when exposed to the intense heat upon re- entry. The video from the newscast is etched on the minds of most of us. Those events led to an intense focus on safety and the culture of safety in the space program.
Now, closer to home, in our dental offices—imagine you have a 5-year-old patient on nitrous oxide and oxygen as you are completing a restorative procedure. While preparing the tooth without water spray, you hit the rubber dam clamp and sparks fly. In an instant, a flash of flames engulfs the child’s mouth and upper airway, resulting in severe burns throughout the lips, mouth and oropharynx. Your mind tries to assess what just happened.
An airway fire related to an oxygen-rich environment, ignition source and something combustible is a potential event few think about or perhaps don’t even recognize as a possibility. The resulting tragic occur- rence leads to serious injury or even death to a patient. It is estimated that more than 600 surgical fires occur each year in hospitals. We do not know if such events are increasing within dental offices due to lack of required reporting. With the use of in-office general anesthesia, nitrous oxide and oxygen, lasers and zirconia crowns (ceramic material sparks easily if contacted by a bur), the risks for such an event are higher.
The purpose of this scenario is to highlight the risks and raise the awareness of why we must be vigilant about safety within our offices for patients, team members and ourselves. As an ongoing commitment to our membership and patients, the American Academy of Pediatric Dentistry has committed significant resources toward a culture of safety and has appointed a committee for this sole purpose.
1.Increasingly, state agencies across the country are requiring the documentation of an independent accreditation process for in- office deep sedation/ general anesthesia services, in addition to the Provider Permit now required by virtually all states. We want to be ahead of the game for our members by giving them accreditation options to consider. It is not a far stretch to imagine accreditation will become a requirement for moderate sedation as well. The accreditation process will be specific to anesthesia services delivered within dental offices.
The AAPD is developing a voluntary sedation/general anesthesia accreditation model for pediatric dental practices. The intent is to offer an opportunity for pediatric dental offices to voluntarily choose to be accredited by an independent organization documenting safe and competent delivery of deep sedation and general anesthesia in their office setting. This accreditation process will then be expanded for in-office moderate sedation services. Currently, we are engag- ing the American Association for Accreditation of Ambulatory Surgical Facilities (AAAASF). AAAASF is one potential partner the AAPD may consider partnering with for this voluntary accredita- tion process.
2.An online safety resource manual/toolkit is in development. This dynamic online tool will provide members with many resources related to safety, offering links to entities with areas of expertise like the Centers for Disease Control and Prevention, Organization for Safety, Asepsis and Prevention, and many others that are critical for your practice.
3.The AAPD Safety Symposium is planned for November 2019. We are at the final stages in the development of this exciting educational opportunity for both members and staff. Sample topics include:
  • Sedation/General Anesthesia: Provider responsibility and prevention of adverse events
  • Infection Control related to new bacterial strains
  • Higher risk areas in your office you don’t even think about
  • Case Studies and understanding of adverse events at highest potential for risk
  • Malpractice carriers and what risk exposures are the greatest
  • Medicine’s evolution of patient safety – where is dentistry going
Regulatory requirements for offices and providers are on the rise. If they aren’t required in your state now, it is only a matter of time before they will. If it is not a state requirement, your patient families will begin to expect it. These requirements may include documentation of infection control, medication prescribing practices, independent accreditation for in-office sedation and general anesthesia services, to name a few. Be proactive for your and your patient’s well-being.
Conference Participation Builds Awareness of AAPD
Policy Center staff disseminated information about current research projects through the AAPD exhibit booth, poster presentations and lectures at several dental and medical conferences this fall. On the three-year Policy Center research project, "Predictive Model for Caries Risk Based on Determinants of Health Available to Primary Care Providers," Leola Royston presented a poster at the American Academy of Pediatrics National Conference & Exhibition on Nov. 2–6, 2018, in Orlando, Fla., and gave a lecture at the Society of Teacher of Family Medicine Conference on Prac- tice Improvement on Dec. 7, 2018, in Tampa, Fla.
Royston also presented a poster on the caries risk predictive model project at the National Network for Oral Health Access Annual Conference on Nov. 11-14, 2018, in New Orleans, La. She was joined at the poster session by Robin Wright on the topic of, "Can Kids Find Dental Care? Access to Vital Oral Health Services for Children Today and Tomorrow" and Wayne Stephens presenting his Harris Fellow project, "A profile of the pediatric dental safety net at FQHCs."
Stop by the AAPD Booth at the National Oral Health Conference in Memphis, Tenn., on April 15–17, 2019!

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