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| Fall / Winter 2007 |  |
In This IssueChange in Antibiotic Prophylaxis to Prevent Infectious Endocarditis Medical Security Hires New Director of Dental Operations Kim Clevenger, Dental Relations Coordinator Dr. Michael Ruff's Testimonial Drs. Sid and Marcella Sockwell's Testimonial When was the last time your commercial insurance coverage had a checkup? Cone Beam Computer Tomography Liability Issues |
 Change in Antibiotic Prophylaxis to Prevent Infectious EndocarditisThe American Heart Association and the American Dental Association have revised the treatment recommendations for antibiotic prophylaxis for patients with certain heart conditions who may be at a higher risk for Infectious Endocarditis (IE). The new guidelines do not include any changes in antibiotic premedication for those patients with artificial joint replacement. Upon the completion of scientific studies and MEDLINE database searches from 1950-2006, it was determined that unnecessary use of antibiotics for the prevention of IE may be more harmful to the patient than the risk of getting this infection. It was also determined that only an extremely small number of cases of infective endocarditis might be prevented by antibiotic prophylaxis for dental procedures even if such prophylactic therapy were 100% effective. The risks versus benefits have been evaluated and there are a select few cases that will continue to require this prophylactic dose of antibiotics prior to dental treatment. They include:
According to the ADA's statement, patients who may no longer benefit from antibiotic prophylaxis prior to a dental appointment are those patients who have:
It is imperative that you obtain a complete and updated medical history from your patients every six months, and verbally ask if there are any changes during every visit. There may be a variety of conditions, medications and past medical history that a physician will consider in keeping these patients on a prophylactic regime. It is crucial to emphasize to your patients that they should obtain a medical release from their cardiologist or internist, which may require a current and complete physical examination by their physician. The risks of staying on the regime are an increased chance of allergic reactions that can lead to anaphylactic shock, nausea and intestinal problems, and development of antibiotic-resistant bacteria. In essence, the regime also has a global effect. The ADA recommends that a dentist exercise his or her independent professional judgment in applying any guideline. It is not your obligation to treat a non-compliant patient. We suggest obtaining an informed consent signed by the patient after reviewing the new guidelines, utilizing a physician medical release form. It is ultimately your responsibility to present the new guidelines and allow the patient to make an educated decision after reviewing the risks and benefits. We also suggest that you follow guidelines established by your local dental society (www.ncdental.org). Please review the ADA 's website (www.ada.org) to become informed about study groups used, the period of study, and any other questions you or your patients may have. Remember, every patient is an individual and each patient's entire health should be considered prior to your decision to change the regiment. Suggested wording to your patient: "There is a new development concerning infectious endocarditis. A study performed by the American Heart Association has concluded that certain heart conditions no longer require antibiotics before your dental appointment to prevent IE . I would like you to read an article and sign an acknowledgment about this new development. You may choose to discuss this with your physician. I also suggest that you obtain a medical release from your physician. We will be happy to help you obtain that release via fax if you have had a recent physical examination. If you would like us to obtain a release for you, please provide us with your physician's name, address, phone and fax number." Please contact Renee Pfefferle, Director of Dental Operations for Medical Security, at 800.662.7917, ext. 7518 or at renee.pfefferle@mmicnc.com to request a sample Acknowledgement and Consent form and a Medical Release form. Seminars and Events
January 11, 2008
February 15-17, 2008
March 13-15, 2008
May 15-18, 2008 Medical Security Hires New Director of Dental Operations
Renee Pfefferle, Director of Dental Operations, Medical Security
Renee graduated from the University of North Carolina with a Bachelor of Science in Dental Hygiene and began her career as a Dental Hygienist. She is also a dental software expert specializing in practice management and peripheral clinical components such as intraoral cameras, digital radiography, and voice recognition for dental charting. Renee has facilitated a curriculum in dentistry and technology for dental schools and auxiliary schools, and she is the author of the textbook Dental Practice Management: Utilizing Computer Technology for the Entire Dental Team. Prior to joining Medical Security, Renee worked with dentists in North Carolina and the Southeast through her consulting firm, Dental Evolutions. Please call Renee at 919.878.7518 or e-mail her at renee.pfefferle@mmicnc.com with comments and suggestions for future topics. What challenges do you face? What issues are important to you? Your ideas are always welcome! Kim Clevenger, Dental Relations Coordinator
Kim Clevenger, Dental Relations Coordinator, Medical Security
Kim can be reached at 919.878.7572, or at kim.clevenger@mmicnc.com. Dr. Michael Ruff's Testimonial
"It was frightening to be in the court room, yet powerful when supported by such a strong team." "It made me feel better when I knew my attorney was a superstar." "It didn't cost me much more to have the maximum coverage, and that's what you need." - Dr. Michael Ruff Drs. Sid and Marcella Sockwell's Testimonial
"It was absolutely critical to have a local insurance agency. We simply cannot over-emphasize the importance of having a quick response during such a tragic situation. Selective was there the first day and they stayed on top of the process even after we were up and running again. Switch companies? No thanks!" - Drs. Marcella Sockwell and Sid Sockwell Oxford, North Carolina When was the last time your commercial insurance coverage had a checkup?Commercial insurance coverage offered through MMIC Agency, Inc. offers the business, property and liability protection your practice needs. Customized coverage includes business income protection, employee dishonesty, and ERISA , as well as property enhancements such as blanket coverage for building and business personal property, accounts receivable, business computers, and valuable papers. You can manage your costs with a choice of deductibles and payment plans, and you will receive outstanding claims service 24 hours a day, 7 days a week. Choose from these commercial insurance products:
Consider the benefits of commercial insurance coverage offered through MMIC Agency, Inc.:
Cone Beam Computer Tomography Liability IssuesBY W. BRUCE HOWERTON, DDS , MS Dental professionals are no longer limited to diagnostic information revealed solely through traditional intra and extraoral radiographic procedures. The introduction of Cone Beam Computer Tomography (CBCT ) has offered a significant advancement in dental imaging with its detail and three-dimensional views. CBCT has been accepted rapidly in the dental community and has posed important issues regarding its use in improving patient standard of care. Using the axial, coronal, and sagittal multiplanar reconstructed images seen with CBCT , the hard tissues of the oral and maxillofacial complex are available for interpretation. Whether determining the quantity of hard tissue obtainable for dental implant placement, the position of impacted canines or third molars, or the extent of erosion due to the presence of benign and malignant neoplasms, CBCT provides precise data for all hard tissue relationships. However, because this technology is available for purchase by any dentist in North Carolina, liability issues regarding the use of this technology also exist. The UNC School of Dentistry offers a three-year graduate program leading to a Master of Science degree in Oral and Maxillofacial Radiology. Each person who completes this program is qualified to manipulate and interpret not only CBCT data but also other imaging modalities in medicine such as magnetic resonance imaging (MRI ). Graduates of this program also are encouraged to become diplomates of the American Academy of Oral and Maxillofacial Radiology. Dental specialists including oral surgeons, periodontists, and orthodontists may have had training in interpreting medical CT film images. Because any dentist in North Carolina can purchase this technology, it is imperative to receive an education that allows an individual to use the technology correctly and know when to refer data to an oral and maxillofacial radiologist for further interpretation. To help educate individuals using and/or interested in CBCT , continuing education courses are being offered that focus on its use and data interpretation. When used correctly, the data derived from CBCT imaging provides unparalleled insight and treatment planning for patient care. Precise image layer curves must be drawn to create coronal and sagittal crosssectional images that provide accurate measurements. An example of a measurement that must be exact includes millimeters of bone present for implant placement. Time must be taken to create and sculpt threedimensional volume renderings to illuminate hard tissue architecture and to enter correct anatomical relationships. Lack of attention to detail will lead to inaccurate measurements, and adverse surgical results will lead to increased liability of the practitioner. Skill in using this technology is as important as correct interpretation of the data. A typical scan with CBCT provides much information of the head and neck region. Once the volume of data is collected, is it the responsibility of the dentist to interpret the entire data set, not only the region of interest? In North Carolina, the Division of Oral and Maxillofacial Radiology at UNC School of Dentistry teaches that the volume of data should be interpreted for cysts, tumors, calcifications, and soft tissue abnormalities within the amount of information presented. It is not acceptable to present to the patient a consent form relieving the dentist of the responsibility of interpreting the volume outside of the region of interest. The following scenario illuminates the increased liability that exists if data is not interpreted completely: "Mrs. Jones presents to a dental office requiring placement of a dental implant in the region of site #12. In order to illuminate the quantity and quality of hard tissue available for possible dental implant placement, a CBCT scan is acquired. While focusing in the region of site #12, the dentist fails to identify a small radiolucency in the posterior right ramus of the mandible. Seven years later, Mrs. Jones notices the lower right jaw expanding and is referred to an oral surgeon to evaluate the region. A second CBCT scan is acquired illuminating an ameloblastoma that will require resection of a portion of the mandible and years of reconstruction. The patient remembers a CBCT scan that was taken seven years earlier in which the radiolucency was present but missed. From this discovery, the dentist who acquired the first scan and failed to identify the radiolucency is liable." CBCT is a significant advancement in diagnostic imaging that should be treated with respect and approached cautiously. Through education and invested time, CBCT can provide unparalleled insight into the oral and maxillofacial complex, leading to increased patient care and decreased liability. Dr. Howerton is an Oral and Maxillofacial Radiologist who practices at Carolina OMF Imaging in Raleigh, Greensboro and Asheville, North Carolina with Dr. Maria Mora DDS , MS. He received a DDS degree from West Virginia University School of Dentistry and a Master of Science from the Oral and Maxillofacial Radiology program at the University of North Carolina. Dr. Howerton is a Diplomate of the American Board of Oral and Maxillofacial Radiology. Employee Embezzlement - Is Your Practice At Risk?BY JIM KAY , VICE PRESIDE NT OF SALES AND MARKETING With the hectic schedules that dentists typically follow, many are happy to turn over the financial details of their practice to their staff. In a practice without the sufficient internal controls, however, that move could be very costly. Employee embezzlement is an unfortunate trend that is on the rise across the country. According to the U.S. Department of Justice, internal theft within businesses totals over $60 billion a year. Dental practices are no exception, and may even pose additional temptations due to the cash transaction nature of co-payments, deductibles and out-of-pocket payments. Some experts estimate that 3 out of 4 dentists will suffer a significant loss due to employee dishonesty at least once in their careers. We've heard of practices where even long-time, trusted employees are caught stealing. Perhaps a $10 co-payment was "borrowed" to buy lunch. An unscrupulous employee might think that if the missing $10 didn't show up in the books, maybe $50 wouldn't either. Soon, a trusted employee, but one who may be resentful at what seems like a low salary, begins to siphon off small amounts of cash or deposit a few insurance checks into a personal account. Many times, no one notices the missing revenue because the embezzler is often the one who records the payments and balances the books. In these cases, the practice does not have the appropriate checks and balances in place, and the embezzling continues unnoticed. You may be concerned that your receipts are not what they should be, but you can not explain why. It is important, where possible, to segregate duties and cross-train employees so that different employees handle and record cash. For example, many practices assign specific employees to open mail, prepare deposits, and post receipts to the practice management system. This creates a system of checks and balances in handling money, in that no one employee has control over revenue, expenses, or inventory. It is impossible to keep watch over your employees every minute of the day. But naively assuming they have your practice's best interest at heart could lead to financial distress, if not ruin. To protect your practice, it is imperative to implement the appropriate internal controls, and to purchase "Employee Dishonesty" insurance coverage. This coverage may be the only way to recover losses if they do arise. If you would like additional information regarding Employee Dishonesty coverage, appropriate controls for your practice, and/or a list of potential warning signs, please contact Teri Breci at the MMIC Agency, Inc. at 800.662.7917, ext. 7587. Medical Security Partners with UNC School of DentistryAs the only professional liability company founded and operated by North Carolina dentists, Medical Security is proud to partner with the University of North Carolina School of Dentistry on a number of educational and Risk Management projects. Our team has provided five Risk Management and Ethics Seminars to students and faculty at UNCSOD this year. The seminars covered timely and relevant topics, including:
MSIC Announces Scholarship for Dental Students Medical Security is also working to ease the application process for residents and faculty by participating in the orientation process. We have provided box lunches to dental students, their assistants, and patients during the CITA Board process. We look forward to more opportunities to serve SOD students in the future, and to a long and healthy partnership between our organizations. |
Dr. Michael Ruff discovered a suspicious lesion on the floor of the mouth of a patient who had been referred for a periodontal evaluation. A simple biopsy of the lingual frenum area was performed. The patient alleged that Dr. Ruff had severed the Wharton Duct or sutured it closed, resulting in infection and ultimate loss of the submandibular gland. The patient claimed he had life altering injuries and demanded $5 million in damages. The case resulted in a "no pay" defense verdict. The jury found no negligence on Dr. Ruff's part, as the biopsy was performed away from the Wharton's Duct and he did not injure it. The case was won through the efforts of MSIC defense counsel, Kenny Jones, utilizing sophisticated graphics and dental illustrations, and the convincing testimony of a pathologist as one of his expert witnesses. As evidenced by the testimonial below, Dr. Ruff thought highly of his MSIC defense team.
Drs. Sid and Marcella Sockwell's dental office was destroyed by a fire in October of 2006. Fortunately, their building, equipment, business income, and worker's compensation were all well-protected due to the recommendations of their Commercial Account Manager at MMIC Agency, Inc., Teri Breci, and their business owner's policy with Selective Insurance Group. A Selective representative arrived immediately at the scene of the fire to assess the damage and to help the Sockwells find a temporary location for their practice. When it was time to move into their new location, Selective was on hand to ensure that the transition went smoothly.