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February 14, 2020: Legislative Update on HB 2630 and HB 2633; Recap of KMOM Dodge City

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Please visit our Popular Topics page for more information on current issues, such as radiation control guidelines, amalgam waste disposal compliance, in-office dental plans, and more!

CDC UPDATE: Data Suggests Lung Injury Cases Have Declined Since Peak in September 2019

​The Centers for Disease Control and Prevention (CDC) reported on January 9, 2020 that, based on syndromic data on emergency department visits, cases of the e-cigarette, or vaping, product use-associated lung injury (EVALI) have been declining since a peak in September. The outbreak began in June 2019. 

Laboratory data supports previous findings that vitamin E acetate is closely associated with EVALI. Vitamin E acetate is used as an additive in the production of e-cigarette, or vaping, products. 

Recent laboratory testing of fluid samples collected from the lungs of 51 patients with EVALI, submitted to CDC from 16 states, found vitamin E acetate in 48 of the 51 BAL fluid samples, but not in the BAL fluid from the healthy comparison group. 

​Health care providers should encourage patients NOT to use e-cigarette, or vaping, products that contain THC, particularly from informal sources like friends, or family, or in-person or online dealers. 

Based on the findings on EVALI patient rehospitalization and death, CDC has updated its guidance to clinicians to minimize these outcomes. Rapid recognition by health care providers of patients with EVALI and an increased understanding of treatment considerations could reduce morbidity and mortality associated with this injury.

As of ​January 7, 2020, a total of 2,602 hospitalized EVALI cases or deaths have been reported to CDC from all 50 states, the District of Columbia, and two U.S. territories (Puerto Rico and U.S. Virgin Islands). Fifty-seven deaths have been confirmed in 27 states and the District of Columbia.

The Kansas Department of Health and Environment (KDHE) has reported that 2 Kansans have died from vaping related illnesses since September 10, 2019. Kansas currently has 23 probable/confirmed vaping related cases, including the 2 deaths.

Of the Kansas cases, 74% are male and the collective ages range from 15-67 years old. 21 of the 23 were hospitalized. Regarding the types of vaping products used, there was a combination or those reporting using only nicotine, only THC, only CBD, and a combination of THC and nicotine.

As this investigation continues, Kansas dentists should report possible cases of EVALI to ​KDHE for further investigation. If EVALI is suspected, a detailed history of the substances used, the sources of products, duration and frequency of use, and the devices used and how they are used should be obtained.

For assistance with managing patients suspected of illness related to recreational, illicit, or other drugs, call your local poison control center at: 

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​KDHE and KSU Remind Dentists of Upcoming Amalgam Rule, Require One-Time Compliance Report

The Kansas Department of Health and Environment ​(KDHE) and Kansas State University Pollution Prevention Institute (KSU PPI) have partnered to help dentists prepare for the upcoming compliance date of the EPA's new amalgam rule. 

The EPA requires amalgam separators to achieve at least a 95% removal efficiency. The EPA final rule on amalgam separators went into effect on July 14, 2017, and the date for compliance is July 14, 2020. Most practicing dentists who discharge wastewater into a publicly owned treatment work (POTW), such as a municipal sewer system, must comply.

Dentists are encouraged to follow dental best management practices, set forth by the ADA, for amalgam waste handling and disposal. Additional highlights and exemptions to the rule can be found at ada.org/recycleamalgam.

Dental offices must also submit a one-time compliance report to the Kansas Environmental Assistance Program by October 12, 2020; OR if you discharge to a POTW with a pretreatment program, you may have different reporting requirements. Check here to see if your city has a pretreatment program and who you would need to contact for further information.

The report can be submitted online, emailed to amalgamrule@ksu.edu,or mailed to 2323 Anderson Ave, Ste 300 in Manhattan, KS 66502.

More information on compliance in Kansas is available on the KSU PPI web site, and contact information for KDHE and our local EPA office is listed below.

KDHE Industrial Programs Section
Bureau of Water
Steve Caspers, Pretreatment Specialist

Environmental Protection Agency
Region 7 (KS, NE, IA, MO)
Paul Marshall, Pretreatment Specialist

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UPDATE: ADA Sets Record Straight on Status of Petition to FDA Regarding SmileDirectClub

The American Dental Association (ADA) believes the public has a right to accurate information concerning the status of its pending citizen petition submitted to the U.S. Food and Drug Administration (FDA) about SmileDirectClub, LLC’s direct-to-consumer plastic teeth aligner business.

SmileDirectClub’s (SDC’s) inaccurate public statements that the ADA’s petition has been “shut down” or “dismissed” may deter customers who have experienced clinical problems in connection with SDC’s aligner “treatment therapy” from reporting their negative experiences to the FDA.  

SDC’s public misstatements, including in its press release on October 4, 2019 are apparently based on a May 30, 2019 letter from the FDA to the ADA. The letter, which can be viewed at the citizen petition landing page, did not reject or dismiss any substantive aspect of the ADA’s citizen petition.

The ADA submitted its citizen petition and a complaint letter to the Federal Trade Commission’s (FTC) Bureau of Consumer Protection out of concern for public safety and customer recourse in the event of negative outcomes from SDC’s orthodontic “treatment therapy.” Plastic teeth aligners are designated by the FDA as a Class II medical device requiring a prescription. The ADA believes SDC is placing the public at risk by knowingly evading the FDA’s “by prescription only” restriction. 

The FDA’s MedWatch voluntary reporting form may be used by both consumers and health care professionals to report poor clinical outcomes associated with medical devices, including plastic teeth aligners. The FTC also offers consumers an online form to report complaints about unfair and deceptive business practices on its website.

For more patient information about direct-to-consumer dentistry, visit the ADA’s consumer website MouthHealthy.org/DIYdentistry.

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Important Notice RE: KMAP Provider Registration

In compliance with the Centers for Medicare & Medicaid Services and the State of Kansas, all KanCare providers must enroll and maintain an active Kansas Medical Assistance Program (KMAP) ID prior to contracting and credentialing with any Managed Care Organization (MCO).

As a valued partner in care with the Kansas Dental Association, Envolve Benefit Options wants to ensure that dentists satisfy this requirement to receive appropriate and timely payment for the services rendered to KMAP members. 

As a reminder, KMAP sent several bulletins detailing the new process and effective dates. 

On January 1, 2018, all new provider enrollments and re-credentialed providers were to enroll with KMAP in order to be enrolled/credentialed with MCOs. 

On November 1, 2018, all providers not currently enrolled with KMAP were to complete the KMAP screening and enrollment process to receive a KMAP ID to continue contracting with MCOs. 

As of January 1, 2019, the MCOs were to deny claims from providers who did not possess an active KMAP ID.

Please visit the KMAP web site to register using the Provider Enrollment Wizard. For questions, call KMAP Provider Enrollment at 1-800-933-6593.

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ADA Releases Statement on Study in JAMA Pediatrics

On Monday, August 19, 2019 the American Dental Association (ADA) released a statement in response to a recently published study linking maternal ingestion of fluoridated water during pregnancy to lower IQ scores in children. 

The ADA remains committed to fluoridation of public water supplies as the single most effective public health measure to help prevent tooth decay.

This commitment is shared by many national and international organizations, including the World Health Organization, US Public Health Service, the Centers for Disease Control and Prevention, the American Medical Association, and the American Academy of Pediatrics.  

Public health policy is based on a collective weight of scientific evidence. The ADA is aware of a new study conducted in Canada in which its authors reviewed maternal exposure to fluoride in pregnancy.

We welcome this and further scientific study of the issue to see if the findings can be replicated with methods that demonstrate more conclusive evidence."

Read the full news release at ada.org

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KDHE Radiation Control Program: Enforcement of Handheld X-ray Device Regulations Began September 1

Radiation has been a hot topic among KDA members over the past year, due to increased dental office inspections and new requirements regarding handheld X-ray units that took effect on September 1, 2019

In an effort to help our members, the KDA sat down with representatives from the Kansas Department of Health and Environment (KDHE) Radiation Control Program to discuss ways we could better inform dentists of the responsibilities in their dental offices, pertaining to radiation.

View a variety of resources pertaining to proper protection, portable X-ray equipment, dental noncompliance issues, and an explanation of dental regulations at ksdental.org/radiation.

If you have questions about radiation regulations or an inspection, contact the KDHE Radiation Control Program at 785-296-1560 or kdhe.xray@ks.gov

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