The number of Americans who have been unable to see the dentist during the pandemic has drawn attention to the importance of regular, accessible dental care. Cecile A. Feldman, dean of the Rutgers School of Dental Medicine, discusses how we can ensure that dental care is within reach for all.

How has COVID-19 affected Americans’ attitude toward oral health?

COVID has put a spotlight on the consequences of going without dental care. Not being able to see the dentist for months unless it was a dire emergency helped people realize how important it can be. Tooth infections that could have been caught early wound up abscessing. Patients who might have just needed a filling between visits required root canals. Dentists are often the first to detect oral cancer, and a lapse in appointments means some cases could have been caught sooner, improving the odds for early intervention and recovery. For people getting crowns or bridges, teeth shifted because they couldn’t see their dentist for work to be redone.

Many people have dirty teeth due to their putting off routine cleanings. Also, there is anecdotal evidence that indicates a rise in bruxism — the term for teeth grinding — because of the stress and anxiety caused by the pandemic.

Prior to the pandemic, what were some of the obstacles to accessing dental care?

For some Americans, geographical access is a problem: They don’t live close to a dentist. In many states, there are a shortage of dentists. Teledentistry, which has become widely used during the pandemic, could help partially fill that need. It could be used for preventive care: Dentists can call patients to ensure they are performing good oral health hygiene and then after checking in to reinforce the importance of oral healthcare.

For far too many patients, seeing a dentist is a financial problem. According to the American Dentistry Association, 33.6 percent of Americans lack dental coverage. Many have trouble affording care even with dental insurance, which, compared to medical insurance, often covers only a small portion of treatment costs. The situation improved with the Affordable Care Act (ACA) after it was approved in 2010. As a result, nearly 500,000 New Jerseyans had access to care that they didn’t have before due to ACA Medicaid expansions. But even under the ACA, dental care was only listed as an “essential” benefit for children.

What would make it easier for more people to get dental insurance and for that insurance to offer more coverage?

Employer health care coverage started out mostly in the 1960s as a way for industries to offer workers something without raising wages. Dentistry wasn’t a part of it because we have a bi-furcated system, where the health of a person’s mouth is somehow not regarded as part of their overall health. That needs to change. Oral health care needs to be seen as just another facet of physical health and wellbeing, and dentists and other oral health providers need to be covered the same way as others specialists, like ophthalmologists or cardiologists.

Organized dentistry initially resisted expanding Medicare and Medicaid to dental visits because they feared the government would force them to lower fees. Medicaid and Medicare still pay dentists extremely low rates compared to other providers. We don’t get paid much for screening or diagnosis. Dentists mainly get paid for actual treatment measures. In addition, there’s a big administrative burden that costs dental offices much time and energy. That must change. We also should reduce the need for documentation. Five different administrative companies are required to credential dentists where instead we could have one universal system for everyone one who has a valid license. We need to do everything we can do make sure affordable oral healthcare is available to everyone, and make the process of providing and obtaining it as easy as possible for both patients and dentists.

According to a new policy from the American Dental Association (ADA), point of care testing to screen patients for chronic diseases and other medical conditions, including COVID-19, that could complicate dental care or put the patient and dental staff at risk is within a dentist’s scope of practice. “Yet currently, rapid and reliable COVID-19 tests are not available to dentists for in-office use, which makes no sense,” states ADA President Daniel Klemmedson, D.D.S., M.D.

Dr. Klemmedson, who holds degrees in both dentistry and medicine, points out that dentists are doctors of oral health. “It is well within dentists’ scope of practice to screen not just for COVID-19 infection but also other medical conditions that may affect dental care such as glucose levels, which help screen for diabetes, and blood pressure, which help screen for hypertension. Patients with abnormal test results would be referred to a physician, other qualified medical professional or medical facility for diagnosis and follow-up care.”

“With strengthened infection prevention protocols and personal protective equipment (PPE), dental offices have re-opened safely around the country,” Dr. Klemmedson said. “Millions of patients have returned for oral health care, which is an essential health service. Dentists should be given access to FDA-authorized point-of-care testing for COVID-19 infection to add to their ability to screen patients and help to identify those infected with the virus.”

Dr. Klemmedson pointed out that dentists' areas of care include not only their patients' teeth, gums and supporting bone but also the muscles of the head, neck and jaw, the tongue, salivary glands, the nervous system of the head and neck and other areas. When appropriate, dentists perform procedures such as biopsies, and screen for chronic or infectious diseases, salivary gland function and oral cancer.

In addition, according to 2013-2016 data from the U.S. Centers for Disease Control and Prevention (CDC), 7.7 percent of people (10.2 million) reported having seen a dentist in the previous 12 months but no other medical professional.

“It makes practical sense for COVID-19 point of care testing to be included in screening procedures dentists perform,” Dr. Klemmedson said.

The U.S. Food and Drug Administration (FDA) includes dentists among those professionals who can test for COVID-19. In addition, the CDC recommends dental facilities consider implementing pre-procedure testing for COVID-19, particularly during PPE shortages.

The ADA and state dental societies are actively advocating state and federal regulatory authorities to:

publicly recognize that point-of-care testing for COVID-19 is within dentists’ existing scope of practice and

make COVID-19 tests available for use in dental practices

“With dental practices reopened across the country, dentists are already screening patients for signs and symptoms of COVID-19, and referring patients for appropriate medical follow-up when indicated,” Dr. Klemmedson said. “Unfortunately, such screening alone will not identify all individuals who are infected. Identifying infected patients is key to being able to protect both patients and dental team members from exposure to the virus.”

Given that patients receiving dental treatment may be pre-symptomatic (infected but will develop symptoms in the next 14 days) or asymptomatic (infected but will never exhibit signs or symptoms of disease), Dr. Klemmedson said it is critical to identify those individuals carrying the virus so that it is possible to minimize their contacting and potentially infecting others.

Editor’s Note: Reporters are invited to follow the ADA on Twitter @AmerDentalAssn

About the ADA

The not-for-profit ADA is the nation's largest dental association, representing 163,000 dentist members. The premier source of oral health information, the ADA has advocated for the public's health and promoted the art and science of dentistry since 1859. The ADA's state-of-the-art research facilities develop and test dental products and materials that have advanced the practice of dentistry and made the patient experience more positive. The ADA Seal of Acceptance long has been a valuable and respected guide to consumer dental care products. The monthly The Journal of the American Dental Association (JADA) is the ADA's flagship publication and the best-read scientific journal in dentistry. For more information about the ADA, visit ADA.org. For more information on oral health, including prevention, care and treatment of dental disease, visit the ADA's consumer website MouthHealthy.org

The Dr. Edward B. Shils Entrepreneurial Fund, Inc., a non-profit organization dedicated to innovative leadership in health care and named after the late Dr. Edward B. Shils, held its virtual 2020 Shils Awards ceremony on October 13. The Shils Awards are given annually to recognize individuals, organizations and programs that have made significant positive impacts on the oral health community and the health of the public.

Dr. Edward B. Shils legacy lives on in elevating the contributions of the next generation. Because of his stewardship, scholarship, and encouragement of innovative business practices in dentistry, the Dr. Edward B. Shils Entrepreneurial Fund was established by the dental industry to recognize those whose contributions reflect a similarly enduring commitment to innovation in the field of oral health.

The 2020 Shils Fund Innovator Awards were presented to:

-Richard Valachovic, DMD, MPH, ADEA President (Retired) – In recognition of his “Excellence in Academia” for his successful stewardship of ADEA and your lifelong commitment of strengthening and expanding dental education in the United States and throughout the world.

-Robert Ganley, Former CEO, Ivoclar Vivadent, Inc., – In recognition of his “Excellence in Industry” for outstanding leadership of Ivoclar Vivadent, Inc. and its innovative research and product development programs to help the dental profession improve the quality of care for its patients.

-Eve Cuny, RDA, MS and Kathy Eklund, RDH, MHP, The Organization for Safety Asepsis and Prevention (OSAP) – in recognition of their “Excellence in a Nonprofit Organization Award” for each’s lifelong commitment to education of the dental community, and OSAP, especially during the Covid-19 pandemic. “I was so honored to receive the Shils Fund award with my good friend and colleague Kathy Eklund”, said Eve. “During the COVID-19 pandemic OSAP has responded by providing evidence-based education and assistance to dental teams and the dental industry. In the true spirit of the Edward B. Shils fund, OSAP has done this by being flexible, responsive, forward-thinking, and sensitive to the needs of the profession and the public we all serve. It has been a privilege to play a role in helping dentistry move forward safely.”

Blake M. Warner, DDS, PhD, MPS, Assistant Clinical Investigator, National Institute of Dental & Craniofacial Research – In recognition of his “Excellence in Research” ground-breaking studies in the NIH Clinical Center that is central to the COVID-19 pandemic and its mitigation.

The Special Recognition Award, which acknowledges people and programs for their work to improve the oral health and well-being of others, was presented to Timothy L. Ricks, DMD, MPH, FICD, Rear Admiral (RADM), Assistant Surgeon General, Chief Dental Officer, U.S. Public Health Service for his leadership and stewardship of creating an oral health collaborative for the public and private sectors of the oral health community during the Covid-19 pandemic. RADM Ricks’ selfless leadership helped facilitate building an innovative network between government agencies and public/private organizations for programs, information, and relationships that improved the oral health community’s ability to provide safe and effective emergency services at the most critical period of the disease’s impact on our country. "I was both honored and humbled by the Special Recognition Award presented by the Edward B. Shils Board of Directors," said RADM Ricks. "To me, this was a group award to recognize and honor the many different dental organizations, state partners, and federal agencies that all came together at the beginning of this pandemic to form the COVID-19 Public-Private Partner Dental Coordination Group. I am so blessed to be surrounded by such strong oral health advocates who selflessly and tirelessly work to improve the health of all Americans, and am so appreciative to the Shils Fund to be included in this year's awards program among many legends in oral health." A second Special Recognition Award was received by Philadelphia FIGHT Health Care Centers, for the Philadelphia FIGHT Family Dentistry’s commitment to providing comprehensive primary oral and overall health services to neighborhood community residents in Philadelphia.

The Shils-Meskin Award named after Dr. Edward Shils and Dr. Lawrence Meskin, a renowned dental educator and former Dean of the University of Colorado School of Dental Medicine and is given to those of great character and modesty in the face of renowned achievement and well-deserved recognition, was given to Dr. Michael Alfano, Professor, Dean & Executive Vice President Emeritus of NYU for his exceptional leadership and expertise as a researcher, educator, author, business executive, academic leader and international thought leader for over 4 decades. Having known and worked with Dr. Edward Shils and fellow Santa Fe Group co-founder, Dr. Larry Meskin, Dr. Alfano is uniquely qualified for this special recognition. "The Shils Entrepreneurial Fund provides great inspiration and educational support to a broad variety of people from the academy, the corporate world, and the not-for-profit sector including special recognition for students”, said Dr. Alfano. I am honored to receive the Shils-Meskin Award this year, two giants in the world of oral health."

The Cohen-Volpe Award is given to those who have made outstanding contributions to dentistry or its allied sciences, and is named for two distinguished clinicians, researchers, and educators: Dr. D. Walter Cohen and Dr. Anthony Volpe. This year’s award was presented to Dan Perkins, Owner/CEO, Aegis for his championing of the importance of oral health in its own right and as part of its vital role in primary care for the professional teams and the public. In addition, Mr. Perkins close association with both Dr. Cohen and Dr. Volpe and hi appreciation and publishing of their important contributions, made him an ideal recipient of this special recognition award.

Presenter and Sponsor Stanley M. Bergman, Chairman of the Board and Chief Executive Officer of Henry Schein, Inc.—the world's largest provider of health care solutions to office-based dental and medical practitioners—delivered remarks about his personal relationship with Dr. Shils and the effect Dr. Shils had on so many people. “I have never met anyone who matched Ed’s entrepreneurial zeal and enthusiasm to connect people,” said Mr. Bergman. “He had an enduring quest for learning and a charismatic optimism that empowered everyone around him, especially young people. We should keep his vision clearly in our minds, his example strong in our hearts, and we should work together to expand the impact of the Shils Fund so we can pass Ed’s enduring legacy from generation to generation.”

Additionally, this year we had the special opportunity to recognize Ed Shil’s beloved wife of over 70 years, Shirley Shils, as she celebrated her 100th birthday.

About The Dr. Edward B. Shils Entrepreneurial Fund, Inc.

Friends and colleagues of Dr. Shils, who are also prominent leaders in the dental industry, founded the Dr. Edward D. Shils Entrepreneurial Education Fund in 2002 because they knew that Dr. Shils wanted to leave a legacy of entrepreneurship. In 2012, the Fund was renamed The Dr. Edward B. Shils Entrepreneurial Fund, Inc. and became a registered 501(c)(3) tax-exempt organization. Through annual awards, partnerships and other branded events, the Fund honors the pioneering vision of Dr. Shils and helps foster inspiration and initiative in current and future healthcare entrepreneurs. For more information, please visit: www.ShilsFund.org.

The AACD Residency program, which launched in August 2018, will continue in 2021 with a group of four preceptors and residents. The program will provide residents the experience needed to jump-start a career in a cosmetic-oriented restorative dental practice.

During the two year program, residents will complete a series of requirements from studying dental literature to implementing simple to complex restorative cases. Under their preceptor’s guidance, they will also gain knowledge and experience relating to all facets of an esthetic restorative dental practice, including effective practice management, diagnostic tools, and restorative considerations. “The AACD Residency program is designed to expose young dentist to the clinical and business side of a fee-for-service style private practice,” says Brian LeSage, DDS, FAACD.

Residents can expect to:

• Learn one-on-one from some of the most successful restorative dentists in the country.

• Observe, document, and execute a variety of cosmetic restorative solutions.

• Gain knowledge and experience related to all facets of an esthetic restorative dental practice including effective practice management, diagnostic tool, and restorative considerations.

• Get the skill and confidence you need to enjoy the professional and financial successes that come with a responsible esthetic dental practice.

Applications are being accepted for the program between now and December 31st, 2020. For more information about AACD’s Cosmetic Dentistry Residency Program, visit https://www.aacd.com/residency.

About the AACD

The AACD is the world’s largest non-profit member organization dedicated to advancing excellence in comprehensive oral care that combines art and science to optimally improve dental health, esthetics, and function. Comprised of more than 5,800 cosmetic dental professionals in 70 countries worldwide, the AACD fulfills its mission by offering superior educational opportunities, promoting and supporting a respected Accreditation credential, serving as a user-friendly and inviting forum for the creative exchange of knowledge and ideas, and providing accurate and useful information to the public and the profession.  

Prodways Tech, specialist in 3D printing and digital manufacturing, continues its partnership with 3Shape to address the growing needs of mass production of thermoformed clear aligners.

Prodways Tech and 3Shape, leaders in the digital dentistry market, have partnered to address the growing demand for clear aligners globally by facilitating turn-key design and manufacturing, integrated into an end-to-end verified digital workflow. 

Medium- and large-sized labs will now have a unique solution for clear aligner design and manufacturing. 3Shape brings expertise in the digital workflow, from award-winning intraoral and lab scanners, open treatment simulations, and treatment review services, to innovative digital treatment planning and automation of the design and production preparation process with clear aligner software.

Prodways brings expertise in manufacturing and industrial automation with advanced additive manufacturing solutions based on the proprietary MOVINGLight® technology, along with internally developed resins. Prodways works in close collaboration with leading players in the digital dentistry world to bring customers an ecosystem that provides a seamless hardware/software integration that covers every step of the manufacturing cycle of clear aligners. 

“The customer experience is extremely important to us at Prodways. With 3Shape software, we can further guarantee to our customers that we have a verified workflow in the increasingly regulated industry of medical devices,” explains Alban d’Halluin, CEO of Prodways. “We found two of the major obstacles for labs to grow their business are: 1) easy-to-use workflow solutions for digital design of clear aligners, and 2) automated and scalable manufacturing. With 3Shape software and our design service partners, we can provide an end-to-end solution for customers looking to scale their clear aligner business, while ensuring we meet the high standards required in clear aligner manufacturing.” 

The Prodways LD10 and LD20 have now been tested and verified by 3Shape to meet the high standards for fabrication of clear aligner models with 3Shape’s Clear Aligner Enterprise solution. 

“I am very pleased to see the addition of the Prodways LD10 and LD20 to high-performance printers supported by 3Shape’s Clear Aligner Enterprise solution”, explains Allan Hyldal, SVP of Orthodontics at 3Shape. “Together with 3Shape’s Enterprise solution, the Prodways LD10 and LD20 printers make up a highly attractive offering for enterprise customers who are targeting high-volume and high-quality clear aligner production,” concludes Allan Hyldal.

We are proud to announce the release of the new HeronClinic software from 3DISC. The Heron IOS is already widely appreciated for its unique user interface and ergonomics, which makes it the perfect choice for daily use by dental professionals worldwide. With this next generation software, 3DISC has developed new and innovative technology which greatly increases scan speed and accuracy while adding even more features to support lab, restorative and implant workflows:

• Improved accuracy even under challenging scanning conditions

• A faster and smoother scanning process

• Exocad dentalProject and DWOS XOrder file export options in addition to STL, PLY & OBJ

• Fully digital and PDF exportable lab prescriptions

• Occlusal distance mapping and jaw opening features

• New implant library with support for major implant manufacturers

And, of course, Heron IOS still has the well-known benefits:

• Less than 5 minutes to unbox, set up and begin scanning

• Plug & Play

• Intuitive user interface

• Single click lab communication or file export

• No. Fees. Ever.

See the Video

Ivoclar Vivadent has developed a unique concept for connecting with all customers, dealers, and partners outside of the International Dental Show (IDS) in March 2021. Refraining from hosting a fair booth, the dental company from Liechtenstein will be offering a hybrid program that keeps everyone connected and informed.

Ivoclar Vivadent has responded to the changing circumstances with a format tailored to presenting content to the global dental industry as safely as possible. As CEO Diego Gabathuler explains, “We believe that a solely physical presence at IDS would limit our ability to connect with those who are unable to travel or have safety concerns that could limit on-site participation. A hybrid format offers convenient access to information for everyone, while minimizing risk.”

Attractive online interaction

Ivoclar Vivadent is redesigning and strengthening their touchpoints with customers, dealers, and partners to ensure responsible, exciting, and informative exchanges. “Our successful experience this year with the first ever online International Experts Symposium (IES) proved to us that new formats for our content are engaging, appealing, and in pace with global developments,” said Gabathuler. “Customer centricity is an essential pillar in the company’s strategy. We’re excited to build on our experience and learnings from the IES 2020 as we continue to innovate for our customers.” Ivoclar Vivadent has created a virtual conference and training program during IDS that will enable close interaction in a variety of formats, from one-on-one to one-to-many.

Safer networking: on-site space

Ivoclar Vivadent will also be present in Cologne in a studio at the Rheinterrassen during the IDS from March 10-13. The studio provides another contact point for Ivoclar Vivadent in a controlled environment. “The health and safety of our employees and guests is our highest priority,” says Gabathuler. “The IDS remains the leading exhibition for our industry. We want to create a conference experience for our guests in the 'new normal' that helps lead the way into the future as a strong community. At the Rheinterrassen location, we will have much more control of the situation.” He continued, “We hope to return to the exhibition halls of IDS in 2023, and I am sure that setting will reflect other innovative solutions than those we are offering in 2021.”

In order to enable trade fairs like the International Dental Show (IDS) 2021 with a physical presence and thus also exhibitors and visitors a safe trade fair experience also in times of the coronavirus, Koelnmesse in Cologne, Germany, is presenting the #B-SAFE4business Village - a prototype of a trade fair that integrates the stipulations of the Corona Protection Ordinance of the state of North Rhine-Westphalia into the event practice of international trade fairs on around 5,000 square meters of Hall 9 of the fair grounds.

A campaign that explains the extensive protective measures of Koelnmesse for the exhibitors and visitors was already launched under the title #B-SAFE4business in June. The campaign has now been enhanced by a real experience in the form of the #B-SAFE4business Village. The #B-SAFE4business Village is open for customers of Koelnmesse upon invitation up until the end of October. 

"DHM + V + C - these five letters have become part of our new everyday routine: Distance, hygiene, masks + ventilation + Corona app," Koelnmesse officials say in a press release. "Simple behavioral measures with a huge impact. Observing these rules faces trade fair organizers with huge challenges worldwide. With #B-SAFE4business Village, Koelnmesse is proving this is possible and that the trade fair organizer is well-prepared for events with several thousands of participants from all over the globe. To this end, the entire customer journey was depicted - from paperless ticketing, to the newly developed eGuard app for guiding the visitor flow, through to a wide range of stand construction concepts, which take the distance regulations into account even when space is limited. New event formats and digital technologies show how exhibitors can extend their reach using hybrid exhibition stands. Among other things, a food service and the hygiene concept of Koelnmesse are being presented for the service section. In addition to several Koelnmesse business sections, diverse service providers are also participating in the Village."

Nobel Biocare and DOCERAM Medical Ceramics are combining their strengths to offer more high-quality restorative solutions, and with ease and flexibility for customers in mind.

Nobel Biocare is a worldwide pioneer in innovative implant-based treatment solutions, including the NobelProcera® service for individualized restorations. DOCERAM Medical Ceramics is an internationally recognized dental ceramics manufacturer with the Nacera brand. The first achievement in this strengthened partnership is the release of the NobelProcera® Zirconia Implant Bridge, which enables restorative flexibility through a simplified workflow and is produced with the high-end Nacera® Pearl zirconia material.

The two dental specialists have already been cooperating for many years in research, development, and production. The crucial factor for both parties throughout has always been the exceptionally high standard of quality and reliability of the products as well as the associated customer satisfaction. Going forward, the aim is to further enhance this successful cooperation strategically.

The even closer cooperation between the two companies creates synergies for mutual advancement, including technical training and customer service.

Dr. Karl-Heinz Klotz, Business Unit Director at DOCERAM Medical Ceramics explains: “We are bringing the cooperation to a new level with the current agreement. This allows us to serve the implant sector through a strong partner with our Nacera products. Due to the extremely high level of expertise in implantology at Nobel Biocare, we can adapt our products exactly to the local dental requirements—development from which the patient ultimately benefits.”

Natasha Haddad, Business Unit Head at NobelProcera® adds: “The comprehensive product know-how of DOCERAM Medical Ceramics supports us above all in the area of research and development and in user support. In this way, we can offer our customers first-class service and are ideally prepared for future challenges.”

For more than 20 years, DOCERAM Medical Ceramics GmbH has used its technical expertise to engage in the development and manufacture of zirconium oxide components for dental technology. The Nacera brand and Nacera Pearl series offer dental technicians a zirconium oxide material combining high bending strength and optimum esthetics. High-quality Nacera process-optimization products and other accessories for finalizing full monolithic restorations are also supplied so that zircon processing can be completed in the laboratory.

In a recent study conducted by the University Hospital of Tübingen, Charité University Medicine Berlin, and the First State Medical University of Setchenow in Moscow, the milled prosthesis materials exhibit better surface properties than comparable test objects from a 3D printer or from conventional production.

The aim of the study from summer 2020 was to examine subtractive and additive samples for their mechanical polishability. Prosthesis materials obtain a smoother surface after polishing. This is particularly relevant with regard to plaque accumulation. Common prosthetic aids must meet certain qualitative criteria for a successful rehabilitation of edentulous patients, including a surface that is as smooth as possible. Abrasive wear during chewing or mechanical cleaning, poor dental hygiene and reduced salivation can lead to increased plaque accumulation and diseases. For this reason, either mechanical or chemical polishing and also coating processes are applied to reduce the microbial adhesion of the denture surface.

Three groups of materials have been produced and examined for the study: conventionally produced denture bases, which are manufactured by cold polymerization of PMMA, denture samples milled with a vhf S1 and test objects from a 3D printer. Ten samples from each group were left untreated. Another ten objects were pre-polished and ten final samples were polished to a high gloss. Afterwards the surface values of the samples were compared among other criteria.

For the fabrication of the milled prosthesis sample, one specimen was designed virtually in a CAD software and the stereolithography file (STL) was then exported to the vhf software DentalCAM. Afterwards, the file was positioned inside a circular blank made of pre-polymerized PMMA and wet milled with the vhf S1.

The result: in all three categories, the milled samples show clearly better surface characteristics than the 3D-printed and conventionally produced ones. Furthermore, the highly polished samples also show the statistically best surface values.

vhf camfacture AG is pleased about the result and the fact that the vhf S1 milling machine was used for the study. The subtractive method as a whole prevailed and proved to have superior characteristics. It has been shown that the precise vhf machine could achieve a better surface finish for more advantageous patient care. Thus, the study also proves that it is possible to achieve excellent results with an affordable and easy-to-operate dental milling machine.

The study entitled: Surface Characteristics of Milled and 3D Printed Denture Base Materials Following Polishing and Coating: An In-Vitro Study, published in the journal Materials, is available online as an open access resource.