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Confessions of a taxaphobic—Strategies for reducing tax time stress

Whether you are taxaphobic or not, tax time can be stressful. Anne Guignon shares her tips for making tax time less painful and for making sure you file correctly. My husband and close friends all know I will do nearly anything to avoid getting my act together when it comes to getting ready for tax time. I don’t mind doing what it takes to make the money, but getting all of the tax information together drives me nuts. For decades, my income has come from a variety of sources that included both clinical employee wages and a complex array of independent contractor payments from writing, consulting, and speaking. Dealing with nonemployee income is tedious and time consuming. In addition to keeping track of the payments, the federal government expects the worker to file quarterly estimated tax payments. My husband, Derek, has a degree in finance. His job involves accounting duties all day long, and he is an employee so his office issues a single W2 every year. The last thing in the world he wants to do when he comes home is help me assemble receipts and tally expenses. Every year I promise Derek I will try to get the annual chore done without filing an extension. And every year, I break my promise. Our tax advisor, Denise, has prepared our return for decades. Thankfully, she has a full appreciation of our income sources and a keen understanding of my struggle with taxaphobia.1 Organize your paystubs/document income Even if you only work in one office as a clinical dental hygienist, it is smart to make copies of all pay stubs. At the end of the year, make sure all wages and tax payments add up to what is reported on your W2 statement. Mistakes happen, and it is far easier to get a form corrected before you file your return. The Social Security Administration keeps track of FICA and Medicare payments made by you and your employers. It makes sense to keep track of the figures, so accurate records are important. When it comes time to apply for Social Security, benefit payments are based on a worker’s earning history and age.2,3 To help workers plan for their future, the Social Security Administration sends workers an annual report that contains estimates on amounts that will be paid at different retirement times. Know who is doing your taxes There are a number of options regarding who can prepare your taxes. You can do your own, use a software-based tax package, hire an online tax preparation service, or meet in person with a tax specialist who works with a firm that prepares tax returns. If you choose to use a firm or preparer at this level, it is smart to pick someone who voluntarily participates in the IRS Annual Filing Season Program.4 When your tax situation becomes more complex than getting a few W2 forms a year, it may be worthwhile to have your return prepared by someone who can actually represent you if there is ever a dispute. Tax professionals at this level hold serious credentials and must fulfill significant continuing education requirements that keep them abreast of changes in tax law. There are three professional preparers who fall into this category: certified public accountant, lawyer that deals with taxes, and an IRS registered agent. Each is qualified to prepare tax returns; but their focus may vary.4 It is best to understand if their services are a good fit for your needs. Be familiar with your state licensure laws Tax preparation specialists and tax prep computer software programs are not mind readers. They are familiar with general tax laws and changes in the tax laws over time. While the topic of dental hygienists being misclassified as 1099 independent contractors is hot in our world, it is unrealistic to expect that the person preparing your taxes knows this profession-specific detail that is tied to the basic dental hygiene license. In nearly all clinical situations, dental hygiene practice requires supervision by a licensed dentist. Supervised workers can’t be independent contractors.5 They should be paid as employees. It is important to have an open and frank conversation with the preparer about all income to determine the proper taxes based on worker classification and how the income is reported. Deciding on an SS8/adding form 8919 When a dental hygienist receives employee wages, the employer pays half of the Social Security and Medicare taxes, and the worker pays the other half. The entire tax burden shifts to the worker who accepts independent contractor wages.5-7 This translates to a 7.65% loss of actual income.6 Even though the IRS has repeatedly ruled that we are employees, there are hygienists who are paid as contractors. In order to avoid paying the employer portion of these two taxes, a misclassified worker has the right to submit IRS Form SS8 to determine classification status.5,6 When choosing this route, it is best to submit the SS8 form prior to filing your current tax return to avoid getting your return bogged down due to a misclassification issue. It takes time to process an SS8. Adding Form 8919 to the year’s tax return allows the worker to pay taxes at an employee level while waiting for a determination.5 Report all income Some think that the only income that needs to be reported is what is listed on a W2 or a 1099-NEC form, but this is not the case. All wages must be reported.8 Even if one earns less than $600 as an independent contractor, the wages still have to be reported. The same goes for all under-the-table cash payments. There is simply no free money. Businesses are not required to issue Form 1099 to the worker if the amount is less than $600 in any one year,9 but businesses will deduct the wages as a business expense on their returns, so there is an actual record of wages being paid to each worker. Side gig income Earning money outside of clinical can be fun and rewarding and it still needs to be declared. 8 An added benefit to having your own business venture, or working as an independent contractor, is the opportunity to deduct certain business expenses that relate to this specific income.10 Changes in the 2018 federal tax bill dramatically changed what expenses can be claimed, but it is worth a chat with your tax expert. Even after passing legislation, the IRS and state taxing authorities can make additional modifications or clarifications over time, factors that keep tax specialists on their toes. A relationship with your tax specialist It can make sense to stick with the same preparer from one year to the next providing it is a good fit. If your tax situation is complex at all, your preparer will become familiar with how you earn income. This is particularly important to those who have both clinical and nonclinical income streams. It is also helpful when there is a major life change such as marriage or divorce, becoming a parent or guardian, or when retiring. Final thoughts Typically, my articles offer suggestions based on what I have found works, but this one is full of advice that should help you avoid my annual tax stress headaches. I can just hear Derek and Denise muttering, “Is she turning over a new leaf?” Refer link: https://www.dentistryiq.com/dental-hygiene/article/14197288/confessions-of-a-taxaphobicstrategies-for-reducing-tax-time-stress

2nd March, 2021

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4 ways to make reception welcoming again

If someone had told me three years ago that we would not be welcoming patients into our reception area before appointments, instead making them sit in their car until we escort them in, I would have said they were crazy. I have been stressing the importance of the reception area since the beginning of my speaking career in dentistry. I’ve worked very hard to change the perception of this area being a “waiting room” and calling it instead a “reception area.” Words do matter, and this is where we should welcome patients, make them feel comfortable, and take the time to talk with them prior to leading them back for their appointment. This has long been something I’ve felt strongly about, but then 2020 happened, and now we tell patients to stay out, wait in their car, wear a mask, stay six feet away from us, and then get out as soon as they can when their appointment is over. Wow, what a change. Well, we did it! We made the change. We had to, after all. There were no other options, and now here we sit: slowly coming out of the pandemic and moving back toward normal. I know for many, there is a desire to get back to the way things were. As much as I agree, I suggest that before we fully open our offices back up, we take a little time to decide what that means now after everything we’ve been through. Let’s take a few minutes to reflect and learn from all of this. One thing we’ve learned is that change can be good, and it’s ultimately inevitable. There are many offices where, prior to 2020, change was hard and the “way we’ve always done it” prevailed as part of the culture. Well, that attitude no longer exists since everyone was forced to learn how to change quickly in order to get through this past year. Take a moment to pat yourself and your team on the back and acknowledge that you did it! You are still standing. There are many businesses, unfortunately, that cannot say the same. Second, now that we are piecing our offices back together, let’s make sure we don’t just go back to old habits because it’s the easy thing to do. This is the perfect opportunity to identify areas of the practice that could use some improvement. In this article, I am going to address a few specific things that relate to the reception area. Apart from all of the personal protective equipment (PPE) we are wearing to see patients during this time, the patient check-in and check-out processes have seen the most changes. Keep the enthusiasm going Over the past year, we lost the close interaction with people that many of us took for granted before. Greeting someone with a handshake and a smile. That all went away, but now we can welcome it back in a bigger and better way. When the time is right and we can safely go mask-less and shake hands again, have the team make the most of that feeling of excitement and relief. Keep this going long after the initial excitement has worn off. Make sure that your team holds onto the energy we are about to feel when things start to get back to normal. Always let patients know that you’re excited to see them with a handshake and a smile. Revamp reception Next, make sure your reception area is a place patients want to be and feel comfortable. They’ve been forced to quarantine in their cars, and it’s time to welcome them back into our offices. Look for ways to make reception fresher, calmer, and more inviting. Possibly take a few hours to add a new coat of paint, update the furniture, add a coffee area, freshen the magazines, and eliminate the news playing on the television. This is the time to make patients’ first impression of the office a great one. Remove the reminders I am fearful that some of the businesses we visit in our everyday lives will keep reminders of COVID around for a very long time. The stickers on the ground to remind us to socially distance from others. The barriers that no longer protect us from anything, but are up to show compliance. One day, these will no longer be needed in our daily operations, so don’t let them remain. Look for ways, when you are ready, to remove the things that no longer make sense and will just begin to look ratty over time. Don’t get so used to them that you forget they are there. Keep your staff and patients informed Finally, recognize that there are no hard and fast rules for how this all plays out. The most important thing to do during this migration back to the new normal is to keep your team and your patients abreast of the ways in which your practice is working to keep them comfortable and safe. Courtesy:https://www.dentistryiq.com/front-office/article/14205471/4-ways-to-make-the-most-of-your-dental-practices-reception-area-postpandemic

20th July, 2021

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Product accessibility: Setting up our patients for success

How many times a day do we make product recommendations to our patients? Whether it be for whitening products, toothpastes, or dry mouth remedies, our patients are always looking to us for answers. It is our job as hygienists to stay current, but our obligation does not stop there. We not only answer our patient’s questions on products they are looking for, but we also recommend products that our patients need to improve their oral health. Most of the time our recommendations are around ways to battle xerostomia, how to introduce more fluoride to combat decay, and interdental cleaning. It is important that we set our patients up for success by stocking these items in our office. When I was in hygiene school, I do not remember making a lot of product recommendations to my patients. At most, I may recommend a sensitive toothpaste when needed. But once I got into practice and established my patient base, I realized just how often I was either answering patient questions on products or recommending them to improve patient’s oral health. It is important that we understand the importance of stocking, within reason, some of the products we are recommending to our patients. Now, understandably, we cannot stock every sensitive toothpaste or over-the-counter whitening agents we may recommend. But there are some items that we really should stock in the office so that our patients can take them home and begin using them right away. One of the top products we should consider stocking in the office is our prescription-strength fluoride toothpaste. It is understandable that offices would not want to buy the product and have it expire before being able to sell it all. However, many of these products have an expiration date of close to two years, and if you start small with ordering, offices should be able to avoid wasting products. We must keep in mind that if we give our patients a prescription to then take to a pharmacy, the likelihood of them following through with that is slim. When it comes to prescription toothpaste we are recommending that for our high-caries risk patients, we want to make it as easy as possible for them to begin using the product. Another benefit to having the toothpaste in stock is that you can give direct instructions on how to use the product. It is imperative that our patients use the product as directed or it will not be as effective as we need it to be. It is hard enough for our patients to remember what we tell them in the office, much less if they must drop a prescription off at a pharmacy to then pick up a few hours or days later. And lastly on the fluoride, it is important to keep in mind that pharmacies may not be filling exactly what you have recommended for your patients. I was recently listening to A Tale of Two Hygienists episode Steve Pardue with Elevate Oral Care mentioned that several pharmacies often buy the generic versions of the prescription toothpastes. This is a great point to keep in mind. By stocking our offices with the prescription toothpaste we recommend, we can be sure what they are getting. The other product worth keeping in the office would be a dry mouth product. Now I realize that there are a ton of options when it comes to attempting to alleviate xerostomia but offering various forms of xylitol in the office is a great start. I remember having so many patients ask me about dry mouth relief, and I would make a couple of recommendations, and write them down for them, but honestly, most of them probably didn’t follow through with purchasing. And we all know how intimidating the dental aisle can be with options. So, I would encourage you to investigate some xylitol options that you can offer your patients and stock those products to help your patients find the relief they need. Lastly, I would highly recommend stocking your offices with interdental cleaning options for patients. I found myself often working with patients who suffered from dexterity issues on interdental cleaning. One option I often recommended for my patients was Sunstar GUM’s Soft-Picks. These were great options for not only patients with dexterity issues, but my patients in orthodontics. Because the office I worked in at the time kept Soft-Picks in the office, I was able to show my patients how to use them and send them home with some. I believe this makes all the difference in the world when it comes to patient compliance. As hygienists, we are all already such advocates for our patients, this is just one more way we can help meet their oral health needs. It can be helpful to have a hygienist in your office or on your team take on the role of ordering some of these products in small batches to ensure products are not wasted. I think that you will find when you start stocking your office with some of the products you recommend, patient compliance is increased and ultimately so is the patient’s oral health. I strongly believe that stocking certain products in your office conveys the importance and belief you, as a clinician, have in the use of those products and your patients will be incredibly grateful for your commitment to their oral health. refer link: https://www.dentistryiq.com/dental-hygiene/patient-education/article/14184048/product-accessibility-setting-our-patients-up-for-success

2nd December, 2020

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Increase your IQ with Dentsply Sirona

Propex IQ The Propex IQ® apex locator is the perfect complement to your dental practice. Reliable and easy to use, the Propex IQ® guarantees reliable monitoring of file progression, works with various irrigation* solutions if liquid is used, doesn’t require any calibration and is extremely lightweight at only 80g. Although the Propex IQ® can be used as a standalone item, its true advantages stand out when it is used in combination with the X-Smart IQ® via connection to the Endo IQ® App. When used with the X-Smart IQ® and the Endo IQ® App, the Propex IQ® allows you to efficiently and visually monitor file progression whilst shaping the canal at the same time. *The following solutions have been tested: NaCl, NaOCl, EDTA, Qmix. Gutta-Smart Fill canals conveniently and reliably with the Gutta-Smart™ cordless obturation device and Conform Fit™ gutta-percha master cones. Designed to work together, they feature the same low-temperature flow characteristics and radiopacity for a total warm vertical obturation solution. • The efficiency of a total solution. Paired with the enhanced fit of Conform Fit™ master cones, Gutta-Smart™ provides the efficiency you expect in a complete obturation solution. • Patient safety. You can feel confident knowing the unique formula is not made with natural rubber latex. • Gutta-percha with low-temperature flow. In both Conform Fit™ master cones and Gutta-Smart™ cartridges, the gutta-percha formula flows at a lower temperature, requiring less heat from the handpieces. • The right fit you can feel. Conform Fit™ master cones provide a snug apical fit for accurate tug-back, while the cordless Gutta-Smart™ handpieces provide precise control and excellent tactile feedback. • All-day power*. A single charge gives you the power to complete an entire day’s work. • Durable, cordless performance. Well-balanced, lightweight and comfortable to use, both handpieces are cordless for freedom of movement. *The battery capacities of the Flow and Pack handpieces allow for them to be used for up to five procedures per day on a single charge. Refer link: https://www.dentalnews.com/2019/05/24/increase-your-iq-dentsply-sirona/

18th March, 2021

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Is there a 'rule' that dentists must contact previous employers before hiring?

QUESTION: I’ve been told that there is a "rule" that some employers swear by that says someone must call a previous employer before hiring one of their employees. I had an employer call me today and accuse me of stealing one of her employee. She told me I should call first and if she cannot afford to lose the employee, I should look elsewhere for another employee. We are simply posting our job online and gathering candidates. They are seeking us out. These employers in the area want us to call them before even contacting a candidate who is still employed by them. Basically, they want to know that we are interviewing one of their employees. I feel this is a conflict as we may not hire a candidate and they might be unnecessarily punished in their current office depending on the temperament of the current employer. I want to make sure that I understand the law because these employers have gotten quite angry with me. This happens when I call for references. Am I required to first get permission from the applicant before I do this? ANSWER: I am so sorry that your peer is not happy with potentially losing her employee. I agree, employees have free will and can apply for any job they see fit and leave their current employer at any time. If you did not purposefully solicit the peer's employees and the candidates applied for your open position, then that is exactly what I would share with your peer. I 100% agree with you that contacting your peers when one of their employees has simply applied with you to give them a heads up would likely result in a negative outcome for the person who is applying for the position. If you started doing this, it is likely you would see your candidate pool dwindle. The law does not require that you receive permission from an applicant to call on their references, if you are doing the calling. If you are going to use a third party to call the references then you would have to have signed consent. As for the peer who cannot afford to lose her employee, that is not your problem. She should have thought of that when creating the culture and benefits for her employees. It is likely the employee is not looking to leave your peer for better pay or benefits, but more likely your peer is not providing the environment in which this employee wants to work. Your peer's anger toward you is likely just a sample of how she treats her employees. I understand this is a delicate matter. You do not want your peers to be upset thinking you are "stealing" their employees, but at the same time you have to staff your practice. If you are the employer of choice that just means you are doing things right. Hopefully over time this will pass and everyone will be able to move on. Refer link:https://www.dentistryiq.com/practice-management/human-resources/article/14187773/human-resources-questions-for-dentists-rule-about-contacting-previous-employers

4th January, 2021

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Grit and resilience in your career and life

During these continued times of challenge and change, individuals respond, react, and cope in different ways. As students, you are likely thinking: “I don’t think this is what I signed up for!” Quite possibly, many of us are saying that about life these days. Perspective I saw a post this week on a friend’s timeline that spoke to all of the changes we have experienced in 2020, and it was through the lens of all that we have lost. I read it, and my reaction was: “Ugh, that does not make me feel better.” In fact, the negativity just added to the heaviness of our current environment. But then, a mutual friend posted and took a completely different perspective. Her focus was not on all of the things we can no longer do, but rather on the things we have gained during this time. Here are a few that were mentioned: No days are wasted; time with family has been gained—perhaps not in person, but many of us have connected with friends and family virtually whom we have not seen for some time. If you have students at home, this is valuable quality time. There is more time—for conversations with a partner or spouse, to learn new technology, or to try things we may never have had the opportunity for pre-COVID. Think of the virtual concerts that have been made available for the first time. I heard that the Nutcracker will not be performed in New York City live for the first time in many years, but it will be streamed virtually—how many more people will see this in 2020? Wow! Perspective can dramatically change the optic of any situation. Practice mindfulness with regard to how you approach situations, and you may recognize an improved positive perspective with this shift. Learning and growing in adversity Grit and resilience are also worth thinking about not just during this time, but also in a broader sense of life and planning for the future. Cultivating grit and resilience can help us cope with stress, face adversity, respond to trauma, and bounce back from life’s unexpected challenges.¹ Grit is described as courage and resolve of character, while resilience is the capacity to recover quickly from difficulties. According to Dr. Erica Warren, some of the most important characteristics of grit and resilience include:1 Managing emotions—being open to one’s feelings and able to modulate them in oneself Awareness of strengths—cognizant of one’s talents or strong abilities Persistent determination—continually pursuing a course of action despite difficulties or opposition Passion-driven focus—actively persevering with a powerful and clear intention Resourcefulness—acting effectively or imaginatively, especially in difficult situations Personal sense of control—subjective awareness that one is initiating, executing, and managing one’s own actions Ability to reach out to others—pursuing connections and assistance from those around us Problem-solving skills—finding solutions to difficult or complex issues Bouncing back—quickly recovering after a setback or when facing significant stress, adversity, or trauma Developing and nurturing your sense of grit and resilience can position you for success as you continue in your educational, professional, and life’s journey. There will always be unexpected and unplanned events, and the journey to success is not a straight line; it has unexpected twists and turns, with each experience—good or bad—teaching us something. Enjoy the experiences along the way with a conscious perspective of learning and growing as a result of each challenge. Refer link: https://www.dentistryiq.com/dental-hygiene/career-development/article/14189232/grit-and-resilience-in-your-career-and-life

18th December, 2020

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The ever increasing cost of oral cancer treatment in India

India spent approximately INR 2,386 crore on oral cancer treatment in 2020, which will increase to more than INR 23,000 crore in the next ten years. These numbers have been revealed in a study conducted by a team of senior oncologists from the Tata Memorial Centre (TMC) in collaboration with Guy's Hospital, London, UK. "A prospective study to determine the cost of illness for oral cancer in India" - is the first-ever study in India on costs of treating oral cancer in India, published in the journal E-cancer. India accounts for almost a third of oral cancer's global incidence and the rate has increased by 68% in the past two decades, making it the most common cancer among Indian males. For this reason, the current study holds great significance. Researchers conducted the study from a healthcare provider’s perspective using a validated bottom-up method. Treatment costs and service utilization were obtained using probabilistic sensitivity analyses. Findings of the study: Total INR 16,001,368 (USD 214,237) was the direct healthcare cost to treat 100 patients with oral cancer. Of this, the salaries of healthcare personnel contributed the highest (56.9%) to the total costs. Next were the variable (24.2%) and capital (18.9%) costs. The personnel costs for OT (27.1%) were the highest followed by the IPD (24%) Medical equipment, with MRI imaging being the highest, accounted for 97.8% of capital costs. The unit cost of treating early-stage disease was INR 1,17,135 that jumped to INR 202,892 for advanced-stage disease. Also, compared to the early stage, the variable costs for oral cancer surgery in advanced stages were 1.4 times higher. The average cost of oral cancer treatment increased by 44.6% with adjuvant therapy compared to surgery alone. Early detection and prevention are critical. They can help with a 20% reduction in advanced-stage disease, which could save India Rs 223 crores annually. Author: Dr. Divyesh Mundra (BDS) completed his Masters in Public Health (MPH) Administration from the School of Health Systems Studies (SHSS), Tata Institute of Social Sciences (TISS), Mumbai. Courtesy: Dental Tribune

14th July, 2021

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The changing goalposts of vaccine effectiveness – Dr. Ameet Revankar

The measured efficacy/ effectiveness of the vaccine is only a guide for approval and not a benchmark for claiming superiority of one vaccine over another. Unknowns are a norm in the uncertain COVID 19 pandemic world. When vaccines were first announced for mass distribution, their efficacy and effectiveness were widely debated. Efficacy refers to the ability of the vaccine to prevent symptomatic disease in the trial participants, whereas effectiveness refers to the same in the real-world setting. One amongst the forerunners was the viral vector-based Oxford-University -AstraZeneca vaccine known by various names in different regions - Covishield, Vaxzevria. The efficacy of this vaccine was reported to be ranging from 50 to 80 percent as per trial data under different dosages/ intervals. When the mRNA-based vaccines (Pfizer BioNtech & Moderna) vaccines were approved for use in the United States, they showed more than 95 percent efficacy. The real-world effectiveness of these mRNA-based vaccines also showed an effectiveness above 90 percent in preventing symptomatic disease1. As vaccine recipients, we are all desiring vaccines that have higher effectiveness. However, the vaccine's effectiveness in preventing 'breakthrough' infections also depends on external factors such as the kind of population being vaccinated and their exposure levels. The apparent effectiveness of the vaccines is an outcome heavily dependant on the levels of exposure to the virus. It is virtually impossible to assess the true efficacy of the vaccines unless challenge trials are designed wherein the trial participants are deliberately exposed to the virus, which understandably is unethical. Furthermore, it is pertinent to note that the more vaccine coverage in the community, the lesser exposure would translate into better effectiveness and vice versa. Thus, the measured efficacy/ effectiveness of the vaccine is only a guide for approval and not a benchmark for claiming superiority of one vaccine over another. The recent paper from the UK confirms this fact wherein both the AstraZeneca and Pfizer vaccines were found to be equally effective in preventing symptomatic disease. Akin to the preventive mitigation measures with Covid 19 that emphasized community rather than individual behavior, the vaccine effectiveness also increases with greater community coverage. With only a minority immunized, the vaccines would fail to protect individuals when the disease incidence or test positivity rate is high during an outbreak, which is currently in India. Several reports of immunized individuals developing symptomatic disease, with questions being asked on the effectiveness of vaccines being used in this program (Covishield predominantly and Covaxin in the minority). I am pretty confident that the mRNA-based vaccines would also face a similar fate under the present circumstances. Therefore widespread immunization of the community is required not only to rein in the outbreak at a community level but also to ensure that the immunized remain protected. Get vaccinated and motivate others to do the same - Together, we can win! Courtesy: Dental Tribune

14th July, 2021

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Dental procedures present low risk of aerosol transmission of SARS-CoV-2—study

BRISTOL, UK: The largest study to date specifically measuring aerosol generation in dental settings found that many common procedures produced negligible volumes of aerosol. The study is yet to be peer-reviewed; however, according to the authors, the findings support current guidance that deems many dental procedures as posing a low risk of SARS-CoV-2 transmission and suggests that the level of risk associated with the use of ultrasonic instruments could be downgraded. Led by researchers at the University of Bristol, the study pointed out that the existing classification of dental procedures as posing a high or low risk of aerosol transmission was based on the limited evidence that had been available in the early months of the pandemic. “One challenge in aerosol research is separating this salivary-contaminated aerosol from the non-salivary contaminated instrument source,” the authors wrote. They explained that there are three possible sources of aerosol during dental procedures and that not all of them are considered to pose a risk of SARS-CoV-2 transmission. Aerosol generated by the patient—during speech or coughing, for example—may be infectious, aerosol generated by dental instruments is not considered to be infectious, and saliva-contaminated aerosol generated by the use of an instrument in the mouth of an infected patient may be infectious. The study aimed to quantify the aerosol concentration produced during a range of dental procedures and, where it was detected, to separate saliva-contaminated aerosol from that originating from an instrument not contaminated with saliva. A total of 41 patients underwent 15 different periodontal, oral surgical, and orthodontic procedures, and these were captured using time-stamped protocols. No aerosol was detected in nine of the 41 procedures, and only six procedures generated a volume of aerosol that was detectable above background levels. “Examination with dental probe, hand scaling, local anesthetic delivery, routine extraction (with forceps and/or elevator), raising a soft-tissue flap, orthodontic bracket removal, alginate impression taking, three-in-one water only, and suturing did not generate detectable aerosol and do not appear to pose an aerosol transmission risk,” the study read. It continued: “For the other six procedures where aerosol was detected, the percentage of total procedure time that aerosol was observed was 12.7% for ultrasonic scaling, 19.9% for three-in-one air only, 42.9% for three-in-one air + water, 28.6% for high-speed drilling, 32.9% for slow speed drilling and 35.8% for surgical drilling.” “[Other] procedures, such as ultrasonic scaling, do not appear to generate additional aerosol above that of the instrument itself and do not increase the risk to dentists” – Dr. Mark Gormley, University of Bristol A University of Bristol press release explained that the authors found that an ultrasonic instrument produced significantly lower aerosol volume than a high-speed dental drill, despite the two instruments currently requiring the same precautions. “Also, aerosol produced during the ultrasonic scaling procedure was consistent with the clean aerosol produced from the instrument itself and did not show additional aerosol is produced that could potentially spread COVID-19.” Dr. Tom Dudding, joint first author of the study and restorative dentistry specialty trainee in the Bristol Dental School at the University of Bristol, said in the press release: “Our study confirms much of the guidance around dental procedures deemed as low risk of spreading COVID-19 is correct, but suggests that the ultrasonic instrument could be seen as lower risk than it currently is.” Dudding added that the findings of the study could advocate for a reduction in the precautionary measures that have been put in place during the pandemic and, thereby, allow for the expansion of dental therapy. Dudding singled out these precautionary measures as including fallow times and additional personal protective equipment. Dr. Mark Gormley, senior author of the study and consultant senior lecturer at the Bristol Dental School, said: “[Other] procedures, such as ultrasonic scaling, do not appear to generate additional aerosol above that of the instrument itself and do not increase the risk to dentists, relative to the risk of being near the patient.” The study, titled “A clinical observational analysis of aerosol emissions from dental procedures”, was published online on 12 June 2021 on medRxiv.org. Courtesy: Dental Tribune

14th July, 2021

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Comparing the COVID-19 Vaccines: How Are They Different?

Even if you’re still waiting for a vaccine, watching the first people get their COVID-19 vaccinations may have felt like a huge relief. As the weeks pass, countless reports are coming out about the effectiveness of new vaccines that may be approved. It’s important to keep up, but it’s also a daunting task, given the flood of information (and misinformation) coming at us from so many directions. So, how do they differ? Here’s what we know so far. Vaccines from Pfizer-BioNTech and Moderna are being administered in the U.S. right now, Johnson & Johnson just received emergency use authorization (EUA) from the Food and Drug Administration (FDA) for its COVID-19 vaccine, and others are on track to do the same. Even though you will likely not be able to choose which vaccine you will get, it’s still helpful to know how each one is different. With that in mind, we mapped out a comparison of the most prominent vaccines so far. The three vaccines authorized by the FDA Pfizer-BioNTech On December 11, 2020, this became the first COVID-19 vaccine to receive an FDA EUA, after the company reported positive clinical trial data, which included news that the vaccine was up to 95% more effective than a placebo at preventing symptomatic disease. But the Pfizer-BioNTech vaccine has had strict requirements involving how the vaccine is stored. For instance, it has required shipping in ultra-cold temperature-controlled units (-94 degrees Fahrenheit). In mid-February, the company submitted new data to the FDA demonstrating the stability of the vaccine at temperatures more commonly found in pharmaceutical refrigerators and freezers. Approval would make the vaccine easier to distribute. Status: Emergency use in the U.S. and other countries Recommended for: Anyone 16 and older. Pfizer-BioNTech is still testing the vaccine in kids ages 12-15. Dosage: Two shots, 21 days apart Common side effects: Chills, headache, pain, tiredness, and/or redness and swelling at the injection site, all of which generally resolve within a day or two of rest, hydration, and medications like acetaminophen. (If symptoms don’t resolve within 72 hours or if you have respiratory symptoms, such as cough or shortness of breath, call your doctor.) On rare occasions (as in, 11 cases in 18 million vaccinations), mRNA vaccines have appeared to trigger anaphylaxis, a severe reaction that is treatable with epinephrine (the drug in Epipens®). For that reason, the Centers for Disease Control and Prevention (CDC) requires vaccination sites to monitor everyone for 15 minutes after their COVID-19 shot, and for 30 minutes if they have a history of severe allergies or are taking a blood thinner. How it works: This is a messenger RNA (mRNA) vaccine, which uses a relatively new technology. Unlike vaccines that put a weakened or inactivated disease germ into the body, the Pfizer-BioNTech mRNA vaccine delivers a tiny piece of genetic code from the SARS CoV-2 virus to host cells in the body, essentially giving those cells instructions, or blueprints, for making copies of spike proteins (the spikes you see sticking out of the coronavirus in pictures online and on TV). The spikes do the work of penetrating and infecting host cells. These proteins stimulate an immune response, producing antibodies and developing memory cells that will recognize and respond if the body is infected with the actual virus. How well it works: 95% efficacy in preventing COVID-19 in those without prior infection. The researchers report that the vaccine was equally effective across a variety of different types of people and variables, including age, gender, race, ethnicity, and body mass index (BMI)—or presence of other medical conditions. In clinical trials, the vaccine was 100% effective at preventing severe disease. How well it works on virus mutations: So far, the Pfizer-BioNTech vaccine has been found to protect against the variant that was first detected in Great Britain (B.1.1.7), but it may be less effective against the variant first detected in South Africa (B.1.351). Moderna Moderna’s vaccine was the second one authorized for emergency use in the U.S.—it received FDA EUA on December 18, 2020, about a week after the Pfizer vaccine. Moderna is also an mRNA vaccine, using the same technology as the Pfizer-BioNTech one and with a similarly high efficacy at preventing symptomatic disease. There are two key differences: The Moderna vaccine can be shipped and kept in long-term storage in standard freezer temperatures, and stored for up to 30 days using normal refrigeration, making it easier to distribute and store. Also, the Moderna vaccine was slightly less effective in clinical trials—about 86%—in people who are 65 and older. Status: Emergency use in the U.S. and other countries Recommended for: Adults 18 and older. Moderna is still testing the vaccine in children ages 12-17. Dosage: Two shots, 28 days apart Common side effects: Similar to the Pfizer vaccine, side effects can include chills, headache, pain, tiredness, and/or redness and swelling at the injection site, all of which generally resolve within a day or two. On rare occasions, mRNA vaccines have appeared to trigger anaphylaxis, a severe reaction that is treatable with epinephrine (the drug in Epipens®). For that reason, the CDC requires vaccination sites to monitor everyone for 15 minutes after their COVID-19 shot, and for 30 minutes if they have a history of severe allergies. How it works: Similar to the Pfizer vaccine, this is an mRNA vaccine that sends the body’s cells instructions for making a spike protein that will train the immune system to recognize it. The immune system will then attack the spike protein the next time it sees one (attached to a real SARS CoV-2 virus). How well it works: 94.1% effective at preventing symptomatic infection in people with no evidence of previous COVID-19 infection. The vaccine appeared to have high efficacy in clinical trials among people of diverse age, sex, race, and ethnicity categories and among persons with underlying medical conditions (although as mentioned above, the efficacy rate drops to 86.4% for people ages 65 and older). How well it works on virus mutations: Some research has suggested that Moderna’s vaccine may provide protection against the B.1.1.7 and B.1.351 variants. Researchers are still studying this. Johnson & Johnson On February 27, 2021, the FDA granted emergency use approval for a different type of vaccine, called a carrier, or virus vector, vaccine. In comparison to the Pfizer and Moderna vaccines, this one is easier to store (in refrigerator temperature), and requires only a single shot, both of which could make it easier to distribute and administer. An analysis released by the FDA in late February showed that the vaccine may reduce the spread of the virus by vaccinated people. Status: Emergency use in the U.S. and other countries Recommended for: Adults 18 and older. The company also expects to start testing the vaccine on children. Dosage: Single shot. In November, Johnson & Johnson announced it would launch a second Phase 3 clinical trial to study using two doses, two months apart, to see if that regimen will provide better protection. Common side effects: Fatigue, fever headache, injection site pain, or myalgia (pain in a muscle or group of muscles), all of which generally resolve within a day or two. It has had noticeably milder side effects than the Pfizer and Moderna vaccines, according to the FDA report released in late February. No one suffered an allergic reaction in clinical trials for the vaccine, according to the company. How it works: This is a carrier vaccine, which uses a different approach than the mRNA vaccines to instruct human cells to make the SARS CoV-2 spike protein. Scientists engineer a harmless adenovirus (a common virus that, when not inactivated, can cause colds, bronchitis, and other illnesses) as a shell to carry genetic code on the spike proteins to the cells (similar to a Trojan Horse). The shell and the code can’t make you sick, but once the code is inside the cells, the cells produce a spike protein to train the body’s immune system, which creates antibodies and memory cells to protect against an actual SARS-CoV-2 infection. How well it works: 72% overall efficacy and 86% efficacy against severe disease in the U.S. How well it works on virus mutations: This vaccine’s effectiveness has been shown to offer protection against the B.1.1.7 variant. According to the analyses the FDA released in late February, there was 64% overall efficacy and 82% efficacy against severe disease in South Africa, where the B.1.351 variant was first detected. Four vaccines not (yet) available in the U.S. Oxford-AstraZeneca This vaccine, which is currently being distributed in the United Kingdom, is distinguished from some of its competitors by its lower cost—it’s cheaper to make per dose, and it can be stored, transported, and handled in normal refrigeration for at least six months. Some countries temporarily suspended use of this vaccine in March after a small number of recipients developed blood clots, although the European Medicines Agency (EMA), which monitors the safety of medicines, among other things, stated that there is “no indication that vaccination has caused these conditions.” The WHO and EMA continue to endorse the vaccine. Status: Not available in the U.S., but approved for emergency use in other countries Recommended for: Adults 18 and older Dosage: Two doses, four to 12 weeks apart Common side effects: Tenderness, pain, warmth, redness, itching, swelling or bruising at the injection site, all of which generally resolve within a day or two. To read the complete article, click on the link below: https://www.dentalnews.com/2021/05/21/comparing-the-covid-19-vaccines-how-are-they-different/

13th July, 2021

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