United Concordia - 40 Years and 7.5 Million Members 1

A WORD FROM DR. QUINN DUFURRENA

Dear Colleagues,

Welcome to the fourth installment of our Did You Know? eNewsletter. This quarterly initiative by United Concordia highlights practical educational resources from experts in their fields, in addition to updated news

and events to inspire your continuing education.

Two on-demand continuing education courses from our online CE portal are featured. Being prepared for medical emergencies in the dental office is not only prudent but imperative for the well-being of patients. Understanding what injectable medications are necessary to keep on hand and how and when to use them is important for the entire dental team. Mana Saraghi, DMD, an attending anesthesiologist at St. Barnabas Hospital, discusses the correct applications of these medications as they pertain to a dental practice.

In “Local Anesthesia: A Primer on Safety and Efficacy,” Scott Dickinson, DMD, provides a fundamental review of local anesthetics and their mechanism of action, along with considerations for local anesthetic overdoses and paresthesia.

For those of you who prefer webinars for your continuing education, I invite you to check out our portal at united-concordia.cdeworld.com. You’ll find an interesting mix of webinar topics, along with additional courses, updated continually.

With nearly 7.5 million members and a 40-year history of providing exceptional dental coverage, United Concordia Dental’s mission is to deliver high quality, accessible, and affordable experiences, outcomes, and solutions for our customers. As we continue to bring you these resources, we look forward to hearing from you and hope you find these materials advantageous to your practice goals.

Cordially,

Quinn Dufurrena, DDS, JD Chief Dental Officer, United Concordia Dental

April 2017

WHAT’S INSIDECE 1 Being Prepared for Medical Emergencies in the Dental

Office: Part 2: Injectable Medications by Mana Saraghi, DMD

CE 2 Local Anesthesia: A Primer on Safety and Efficacy by Scott Dickinson, DDS

New from the United Concordia CDEWorld PortalView the latest educational offerings.

Importance of Early Childhood Dental VisitsAAPD and ADA reaffirm this critical milestone

Periodontal Disease May Increase Risk of Death in Postmenopausal Women New findings published in the Journal of the American Heart Association

Dental News and ResearchBioengineered tooth restoration and other trending stories

Dental Health CentereCigarettes safer than smoking

Clinical Newsletter

October 2015

Dental Industry DigestYOU KNOW?

united-concordia.cdeworld.com 2

Being Prepared for Emergencies in the Dental Office: Part 2. Injectable MedicationsMana Saraghi, DMDJune 2016 Course - Expires June 30th, 2019

ABSTRACTAs health professionals, dental professionals carry the responsibility for the safety and well-being of their patients and should always be prepared for all types of emergencies. The second installment of this two-part series presents a discussion of injectable medications, their proper use and storage, and their correct applications.

Dental professionals are responsible for protecting their patients’ well-being. This includes effectively recognizing and managing medical

emergencies that may develop in the dental office. Although rare, serious emergencies can and do arise, along with a host of more common medical problems. A key tool in the dental office is having the necessary equipment and medications on hand. The first of this two-part series reviewed the emergency equipment and noninjectable medications recommended for inclusion in a standard dental-practice emergency kit. This part will discuss the injectable medications.

Must-Have Medications for the Emergency Kit

Epinephrine

Epinephrine mediates the fight-or-flight response by its effect on the alpha- and beta-adrenergic receptors; this results in increased blood pressure, faster heart rate, and increased circulation to the skeletal muscle. It also can cause bronchodilation. The indication for its use is a severe allergic reaction (anaphylaxis) or severe bronchospasm (which can occur during an asthmatic event or anaphylaxis).1,2

Among commercially available epinephrine

auto-injectors is the EpiPen®. Its label and packaging describe in detail the steps needed to use it. Another auto-injector, the Auvi-Q®, incorporates synthesized vocal instructions that guide users through every step of the drug-administration process.1,2

Although administering epinephrine in a life-threatening emergency has no contraindications, the drug should be used cautiously for patients with preexisting cardiovascular disease or arrhythmias or those who take medications such as diuretics, digitalis, and anti-arrhythmics, which may sensitize the heart to the effects of epinephrine. Such patients already have limited cardiovascular capacity. Nonetheless, epinephrine is the drug of choice for a life-threatening allergic reaction.1,2

Epinephrine is for intramuscular administration only. It should be injected aseptically into the lateral thigh. The dose for adults is 0.3 mg, while the pediatric dose is 0.15 mg. Any patient who receives an accidental injection of epinephrine in the hand or foot should be taken immediately to an emergency room, as intravenous injection poses a risk for ischemia. Also, intravenous administration is not indicated; the high concentration of the drug (1:1,000) can cause a venospasm or cardiac arrhythmia.1,2

LEARNING OBJECTIVES:• List which medications should be included in the dental-office emergency kit.

• Describe how these medications should be used and for which indications.

• Discuss how these medications can help a dental patient in a life-threatening situation.

CONTINUING EDUCATION 1

Sometimes patients need more than one dose of epinephrine during a severe anaphylactic reaction, as epinephrine has both a quick onset and offset. Additional doses may be indicated if symptoms such as pruritis, edema, hives, and breathing difficulty persist. For this reason, most emergency kits include additional glass ampoules of epinephrine to be used in case a supplemental injection is required. These come at a concentration of 1:1000 (equivalent to 1 mg/mL). The administration of epinephrine, which has significant hemodynamic effects, underscores the importance of monitoring vital signs throughout the management of a medical emergency.1,2

As a final note about epinephrine, drawing epinephrine into a syringe and leaving that in the emergency kit is never recommended as a routine measure. Although prefilled syringes are sometimes offered for sale in catalogues, these come in a concentration of 1:10,000—ie, 10 times as diluted as the auto-injectors and ampules. Such doses are intended for advanced cardiac life support in cardiac arrest. Given to help restart the heart, they are injected intravenously and are inappropriate as a response to an allergic reaction. Epinephrine to counter severe anaphylactic reaction is not designed to be left in a syringe in a medical kit for any extended period. Quality-control measures are absent; sterility or efficacy of the syringe’s contents cannot be guaranteed.1,2

Diphenhydramine

Diphenhydramine is available both as an injected and oral medication. An antihistamine, it blocks H1 receptors and decreases edema and pruritus during allergic reactions. It is indicated either for mild allergic reactions or as an adjunctive treatment for severe allergic reactions. For severe allergic reactions, epinephrine is still considered the first-line drug, followed by an injected antihistamine.1,3,4

Contraindications include hypersensitivity to the medication or any of its components. Also, patients with narrow-angle glaucoma, ulcers, pyloroduodenal obstructions, bladder and neck obstructions, or symptomatic prostate hypertrophy have a relative contraindication to its use. Diphenhydramine is given at 25 mg to 50 mg orally every 6 to 8 hours. The intravenous or intramuscular dose is 10 mg to 50 mg.1,3,4

Among potential adverse events that come with the administration of diphenhydramine are thickened bronchial secretions and upset stomach. It also can be sedating, although in children, some degree of excitation may result.

To read the complete article for CE credit, visit our United Concordia CE Portal at https://united-concordia.cdeworld.com/courses/20449

CONTINUING EDUCATION 2

United Concordia - 40 Years and 7.5 Million Members 3

Research and development of blocking anesthesia harkens back to 1784, when pressure-

point anesthesia was used to compress nerves and vasculature to numb parts of the body. Cocaine was introduced 100 years later as the first local anesthetic for surgical procedures for glaucoma, followed in 1905 by procaine (ie, Novocain), which changed the way dentistry is performed. Despite procaine’s shortcomings (eg, high level of allergenicity, slow onset, short pulpal anesthesia duration), its use continued until the more potent and less allergenic lidocaine was synthesized in 1943. Demonstrating a more rapid onset,

lidocaine remains safe and efficacious among the many local anesthetics available today.

The efficacy and safety of local anesthetics are dependent upon their molecular structure. How these molecules interact with the body—which vary among local anesthetics—impacts their potency and duration of anesthetic effects. Therefore, it behooves clinicians to understand the basics of local anesthetics, their componentry, and their mechanism of action in order to deliver them appropriately and effectively.

Basic Principles of Local Anesthetics

Local anesthetics are either esters or amides based on the aromatic ring in their molecular structure (Table 1). Other portions of their molecules include an amine group and an intermediate linkage. The aromatic portion is responsible for lipophilicity (ie, lipid/water distribution and protein-binding characteristics).

Local Anesthesia: A Primer on Safety and EfficacyScott C. Dickinson, DMD January 2017 Course - Expires January 31st, 2020

To read the complete article for CE credit, visit our United Concordia CE Portal at https://united-concordia.cdeworld.com/courses/20629

CONTINUING EDUCATION 1

united-concordia.cdeworld.com 4

NETWORK NEWSFEED

On-Demand CE • April 2017 Online CE Courses from the UCCI Portal at united-concordia.cdeworld.com

Restoring Dental Implants While Mitigating Peri-Implant Disease Risk Greg Gillespie, DDS

Infection Prevention and Control Kathy Eklund, RDH, MPH

Being Prepared for Emergencies in the Dental Office: Part 1 - Emergency Equipment and Non-Injectable Medications Mana Saraghi, DMD

The Oral-Medical Disease Connection: Pregnancy, Cardiovascular Disease, and Diabetes Scott S. DeRossi, DMD; and Thomas P. Sollecito, DMD, FDS, RCS(Ed)

Continuing its commitment to provide high-quality resources that meet dental professionals' needs, United Concordia is pleased to announce the latest offerings from its CDEWorld portal. United Concordia members are

eligible to take advantage of these CE opportunities free of charge as a membership benefit.

From the United Concordia CDEWorld Educational Portal

Featured United Concordia Webinars ON-DEMAND WEBINARImproving Safety in Office-Based SedationPresented by Robert C. Bosack, DDS

Cost: $0

Credits: 1 CEU

Provider: Dental Learning Systems, LLC

Supported by: United Concordia Dental Insurance

All dental professional should be cognizant of inherent patient risks of sedation in the dental office. This presentation will provide a detailed review of 6 patient safety initiatives to reduce these risks.

LIVE WEBINAR Dry Mouth: Causes, Implications, and Management in the Elderly Presented by Domenica Sweier, DDS, PhD

June 13, 2017 @ 7 PM ET

Cost: $0

Credits: 1 CEU

Provider: Dental Learning Systems, LLC

Supported by: United Concordia Dental Insurance

This presentation will review the common complaint of dry mouth in the geriatric population. It will cover causes, symptoms, clinical consequences, and management of dry mouth in geriatric patients in a general dental practice setting.

REGISTER TODAY! VIEW THE WEBINAR

United Concordia - 40 Years and 7.5 Million Members 5

The mouth is the missing piece of total health.“What’s the missing piece to your overall health? Your mouth.” Oral health is about more than bright smiles. It’s the missing piece of complete health care. Not only do our mouths play a crucial role in our everyday lives but they also hold the key to better overall health. United Concordia Dental is bringing together the people and technologies that help create healthier mouths and healthier people.

These days, an estimated 75% of total U.S. health care expenses go toward treating chronic conditions. Given that statistic, it’s easy to understand why employers need comprehensive prevention and wellness programs. But there is one piece of the puzzle that’s often neglected — the mouth.

Healthier mouths are the key to healthier bodies. Now that research has revealed important connections between certain chronic illnesses and periodontal disease, we know how poor oral care can negatively affect the population. When oral health is recognized as an essential part of overall health, everyone benefits. In terms of healthcare savings, periodontal health is more valuable than quitting smoking.

When people treated oral health as a key piece of wellness, their overall health care costs and hospital admissions went down across all the condition categories. The right dental coverage makes it easy for members to get the care they need to improve their overall wellness. We can customize the right combination of plans and riders to make an opportunity for significant medical cost savings. We also have the resources to provide an integrated solution that delivers education and targeted outreach to engage members to take control of their oral health to improve their overall wellness. And, with access to health information, we can work with medical care providers to identify and track members with both chronic conditions and gum disease who can benefit most from better dental care. We can help close the gap between oral health and total body health.

For more information about these products or United Concordia and related subsidiary carriers, visit: www.UnitedConcordia.com.

Smile for Health®– Wellness, an innovative program that combines improved dental benefits and targeted outreach for better oral health care.

United Concordia - 40 Years and 7.5 Million Members 54Current Dental Terminology © 2015 American Dental Association. All Rights Reserved.

Mail to: Steri Check Systems, Inc., P.O. Box 659, Deer Park, NY 11729 • Or, Fax: (631) 242-9546

Sterilizer Make: □ Steam □ Dry Heat □ Chemical □ GasMonitoring Frequency: □ 52 (Weekly) □ 26 (Bi-weekly) □ 12 (Monthly)Dentist or Group Name: (to appear on certificate)

Address: City: State: Zip:

Phone: Fax: Contact Name:

Signature: UCCI Provider Number: □ Payment Attached (Payable to Steri Check Systems, Inc.)Credit Card: □ Visa □ Mastercard

Credit Card Number: Expiration Date: Security Code:

Credit Card Billing Address:

To monitor your office sterilizers at the special rates listed above, complete and return the below response form or contact Steri Check at:

800-67-STERI (800-677-8374)

Reminder: Sterilizer Monitoring Discount Available!United Concordia® Dental has partnered with Steri Check Systems* to offer sterilization monitoring (spore testing) at a discounted rate. As a value-added benefit available to United Concordia dentists nationwide, the Steri Check monitoring service:

9 Can be used to monitor steam, chemical vapor, dry heat and ethylene oxide gas sterilizers 9 Includes laboratory culturing service and free shipping 9 Provides a certificate of compliance, sterilizer monitoring log and full documentation

Both the ADA and CDC recommend periodic use of biological indicators (spore tests) to verify the proper functioning of sterilization cycles. Register to use Steri Check today for the safety of your patients and to comply with proper infection control protocol.

Monitoring Frequency Regular Rate Discount Rate

Spore-Wise® 52 (weekly testing) $269/yr $157/yr

Spore-Wise® 26(bi-weekly testing)

$169/yr $119/yr

Spore-Wise® 12 (monthly testing) $79/yr $64/yr

Please note this discounted rate is only available to providers currently participating in one or more United Concordia networks

* Steri Check Systems, Inc. is not affiliated with United Concordia, and is solely responsible for its own products and services

DENTAL NEWS AND RESEARCH

united-concordia.cdeworld.com

Gum disease and tooth loss may be associated with a higher risk of death in postmenopausal women but not increased cardiovascular disease risk, according to new research in Journal of the American Heart Association, the Open Access Journal of the American Heart Association/American Stroke Association.

Loss of all natural teeth also was linked with an increased risk of death in postmenopausal women.

“Beside their negative impact on oral function and dietary habits, these conditions are also thought to be related to chronic diseases of aging,” said Michael J. LaMonte, Ph.D., M.P.H., study author and research associate professor in epidemiology and environmental health at the University at Buffalo in New York.

Researchers analyzed the health information from the Women’s Health Initiative program — a study of 57,001 women, 55 years and older.

Read More

Gum Disease, Tooth Loss May Increase Risk of Death in Postmenopausal Women

6

Bioengineered Tooth Restoration in a Large MammalResearchers at Okayama University report in Scientific Reports successful tooth regeneration in a postnatal large-animal model. The approach used involves the autologous transplantation of bioengineered tooth germ into a canine jawbone; the in vivo artificially created tooth has the structure, composition and physiological characteristics of a natural tooth.

Read More »

Breath Test Could Help Detect Stomach, Esophageal Cancers A test that measures the levels of five chemicals in the breath has shown promising results for the detection of cancers of the esophagus and stomach in a large patient trial presented at the European Cancer Congress 2017.

Read More »

SUBSCRIBE TO DID YOU KNOW...

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DENTAL HEALTH CENTER

E-cigarettes are less toxic and safer to use compared to conventional cigarettes, according to research published in Annals of Internal Medicine this week.

Cancer Research UK-funded scientists found that people who swapped smoking regular cigarettes for e-cigarettes or nicotine replacement therapy (NRT) for at least 6 months, had much lower levels of toxic and cancer causing substances in their body than people who continued to use conventional cigarettes.

Read More »

eCigarettes Safer Than Smoking, Says Long-Term Study

Genetic Defects in Tooth Enamel Conducive to Caries Development

DID YOU KNOW? Consumption of Low-Calorie Sweeteners Jumps by 200% in US ChildrenRead More »

Researchers Close to Identifying Crucial Gene for Human Cleft Lip and Palate Read More »

AAPD, ADA Reaffirm Importance of Early Childhood Dental Visits Read More »

Researchers from the University of Zurich have now pinpointed a gene complex for the first time that is responsible for the formation of tooth enamel. Two teams from the Centre of Dental Medicine and the Institute of Molecular Life Sciences used mice with varying mutations of the enamel proteins involved in the so-called Wnt signaling pathway.

Read More »

United Concordia - 40 Years and 7.5 Million Members 7

united-concordia.cdeworld.com 8 united-concordia.cdeworld.com 8

4Current Dental Terminology © 2015 American Dental Association. All Rights Reserved.

Mail to: Steri Check Systems, Inc., P.O. Box 659, Deer Park, NY 11729 • Or, Fax: (631) 242-9546

Sterilizer Make: □ Steam □ Dry Heat □ Chemical □ GasMonitoring Frequency: □ 52 (Weekly) □ 26 (Bi-weekly) □ 12 (Monthly)Dentist or Group Name: (to appear on certificate)

Address: City: State: Zip:

Phone: Fax: Contact Name:

Signature: UCCI Provider Number: □ Payment Attached (Payable to Steri Check Systems, Inc.)Credit Card: □ Visa □ Mastercard

Credit Card Number: Expiration Date: Security Code:

Credit Card Billing Address:

To monitor your office sterilizers at the special rates listed above, complete and return the below response form or contact Steri Check at:

800-67-STERI (800-677-8374)

Reminder: Sterilizer Monitoring Discount Available!United Concordia® Dental has partnered with Steri Check Systems* to offer sterilization monitoring (spore testing) at a discounted rate. As a value-added benefit available to United Concordia dentists nationwide, the Steri Check monitoring service:

9 Can be used to monitor steam, chemical vapor, dry heat and ethylene oxide gas sterilizers 9 Includes laboratory culturing service and free shipping 9 Provides a certificate of compliance, sterilizer monitoring log and full documentation

Both the ADA and CDC recommend periodic use of biological indicators (spore tests) to verify the proper functioning of sterilization cycles. Register to use Steri Check today for the safety of your patients and to comply with proper infection control protocol.

Monitoring Frequency Regular Rate Discount Rate

Spore-Wise® 52 (weekly testing) $269/yr $157/yr

Spore-Wise® 26(bi-weekly testing)

$169/yr $119/yr

Spore-Wise® 12 (monthly testing) $79/yr $64/yr

Please note this discounted rate is only available to providers currently participating in one or more United Concordia networks

* Steri Check Systems, Inc. is not affiliated with United Concordia, and is solely responsible for its own products and services