PHS Oral Health Coordinating Committee
June 13, 2003
9:00-11:45
Building 31, 2C-19 NIH Campus
Minutes
Attendees:
Stan Bastacky, Bureau of Health Professions (BHPr), Health Resources and Services (HRSA),
DHHS
Caswell Evans, Office of the Surgeon General, DHHS
Conan Davis, Centers for Medicare and Medicaid (CMS)
Bruce Dye, National Center for Health Statistics (NCHS), Centers for Disease Control and
Prevention (CDC), DHHS
Isabel Garcia, National Institute of Dental and Craniofacial Research (NIDCR), National
Institutes of Health (NIH), DHHS
Dushanka Kleinman, Office of the Surgeon General, and NIDCR/NIH, DHHS (Chair)
James Lipton, NIDCR/NIH, DHHS
William Maas, National Center for Chronic Disease Prevention and Health Promotion
(NCCPDHP)/CDC, DHHS
Nicholas Makrides, Federal Bureau of Prisons, Department of Justice (DJ)
Richard Manski, Agency for Healthcare Research and Quality (AHRQ), DHHS
Kevin Mulry, Food and Drug Administration (FDA), DHHS
Ellie Murcia, NIDCR/NIH, DHHS
Ruth Nowjack-Raymer, NIDCR/NIH, DHHS
Barry Waterman, HIV/AIDS Bureau, HRSA, DHSS
By Phone:
Chris Halliday, Division of Oral Health, Indian Health Service, (IHS), DHHS
Daniel Hickey, Federal Bureau of Prisons, DJ (Dental PAC Chairperson)
Mark Nehring, Maternal and Child Health Bureau (MCHB)/ HRSA, DHHS
Lee Shackelford, IHS, DHHS
Jim N. Sutherland, Office of Performance Review, Denver Regional Division, HRSA, DHHS
Guests:
Norm Braveman, NIDCR/NIH, DHHS
Larry Tabak, NIDCR/NIH, DHHS
Introductory Comments: RADM Dushanka V. Kleinman welcomed members and introduced
Dr. Larry Tabak, NIDCR Director to the group to provide the agency overview for the
NIDCR/NIH.
NIDCR Update. Oral Health Science: Advances & Opportunities: In his presentation Dr.
Tabak described how the National Institute of Dental and Craniofacial Research (NIDCR) carries
out its mission and operates within the Department of Health and Human Services. His talk
evolved around four challenges faced by the institute: Addressing multiple complex diseases,
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attracting researchers with required competencies, encouraging adoption and application of new
technologies, and closing the knowledge gap. He stated that most oral, craniofacial and dental
diseases and conditions are complex in nature and used dental caries as an example of a complex
disease. His presentation stimulated many questions from participants. CAPT Mark Nehring
asked how we can ensure that the latest findings emanating from research could be incorporated
efficiently into PHS programs. It was decided that this topic be placed on the next PHS
OHCC agenda. The attached presentation was sent to all participants.
Action: Future Agenda item: Discussion on how to incorporate latest research findings into PHS
programs.
Initiative Updates:
Amalgam Review: Dr. Braveman provided an update on activities relating to dental amalgam.
He reported on the review of the literature on dental amalgam and indicated that a contract had
been signed between NIDCR’s task-order contractor, BETAH Associates, Inc and the Life
Sciences Research Office of FASEB. The review will be conducted totally by them and will not
involve any organizations or individuals with an apparent or real vested interest in the outcome
of the review. It is expected that the review will take approximately 10 months to complete,
including the issuance of a report. This review will address only the question of adverse health
effects of amalgam. Dr. Braveman also spoke briefly about a hearing held by the House
Government Oversight Committee last November on the topic of dental amalgam. A subsequent
hearing was held several weeks ago, however the NIDCR was not involved in that hearing. Dr.
Braveman referenced the report from Sweden: Mercury in dental-filling materials –– an updated
risk analysis in environmental medical terms. The report can be found at:
http://www.dentalmaterial.gov.se/Mercury.pdf. This report is notable in reflecting a change in
position of a leading Swedish scientist regarding this issue. Dr, Braveman also stressed that this
review does not include a reassessment of the PHS policy statement on dental amalgam. A
separate process will be undertaken for this assessment after the literature review is completed.
National Call to Action to Promote Oral Health: Dr. Caswell Evans gave a brief overview of
how A Call to Action to Promote Oral Health (Call to Action) evolved and how it was released
in Milwaukee on April 29, 2003 by Surgeon General Richard Carmona. Dr. Jim Sutherland
stated that the federal response is needed. He also informed the OHCC that Colorado oral health
coalition held a meeting to begin developing a state plan and that Dr. Diane Brunson developed a
template using the five actions described in the Call to Action. One first step discussed was to
have an inventory of the oral initiatives and programs in each agency. Dr. Evans emphasized the
importance of the federal sector developing an implementation plan to facilitate public-private
partnerships. He explained the challenges of designing an implementation plan and putting it to
work. He asked the OHCC members from federal agencies that have an oral component to start
thinking about different ways in which they would like to participate in the implementation of
the Call to Action. In addition, RADM (ret) William Maas raised the need to discuss how to
stimulate and maintain partnerships. This topic will need to be pursued upon receipt of the
inventory.
Action: Dr. Caswell Evans will lead the Inventory Working Group, membership to this group is
open. Drs. William Maas, Mark Nehring, Jim Sutherland and Ms. Ellie Murcia were nominated
to help in the development of the process of setting up an inventory. Later the OHCC can select
common action steps and plan initiatives to be collaboratively implemented.
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Healthy People 2010: Dr. William Maas distributed a handout “Update on HP2010 for OHCC
meeting June 13, 2003” that describes five items of interest on behalf of the four HP2010 coleads: 1) A national summit, “Putting Prevention into Practice,” held April 14-15 in Baltimore,
Maryland, to launch President Bush’s HealthierUS initiative. 2) A session was related to HP
2010 at the National Oral Health Conference, held April 2003 in Milwaukee, Wisconsin. The
title of the session was "Taking Action to Meet Healthy People 2010." 3) Several activities
related to Memoranda of Understanding (MOU) are under way: A MOU is in the final stages of
development with Oral Health America. In addition, the American Dental Hygienists'
Association (ADHA) is in the process of developing an MOU. 4) The co-leads from HRSA,
CDC, IHS and NIH have been asked to comment on the status of the developmental objectives
on our list of HP 2010 objectives. 5) The Healthy People 2010 Oral Health Toolkit has been
through the final editing stage. See attached.
Workforce and Training Initiative: CAPT Jim Lipton updated the OHCC on the latest
developments of the Centers for Medicare and Medicaid Services (CMS) Proposed Rule that
would, in essence, repeal support for the dental Graduate Medical Education (GME) residency
training programs. Since 1987, Medicare has allowed hospitals to claim direct GME payments
for residents training in non-hospital settings. The CMS proposal, scheduled to be finalized on
August 1, does not just impact dental programs, but would affect residents of any health
profession training program in a non-provider site. It also affects federal service residents.
ADEA is seeking to enact legislation that will enable federal services residents to be counted as a
partial FTE (at least 0.5) for Medicare GME funding purposes. See attachments.
CAPT Jim Lipton briefly described the NIDCR dental school research infrastructure and
curriculum development grants initiatives. His formal PowerPoint presentation of these
activities will be sent to OHCC members. He also mentioned that he will be completing the PHS
directory of the training programs and will get together with CAPT Stan Bastacky to ensure all
HRSA programs are covered.
National Oral Health Data: National Oral Health Data Coordinating Committee Update: CDR
Bruce Dye informed that the Oral Health Data DHHS Consultant list as well as the non DHHS
experts list are ready and will be sent out soon. He also provided several updates:
On June 10, 2003 NCHS data describing national estimates of dental care service utilization and
unmet dental care needs by Asians and Native Hawaiian or other Pacific Islanders: United States
was released for 1997-2000. Data from 1997-2000 National Health Interview Survey (NHIS)
were used for this Advanced Data Report. See attached
CDR Bruce Dye also distributed the Dietary Intake of Ten Key Nutrients for Public Health.
United States: 1999-2000. Data from the 1999-2000 National Health and Nutrition Examination
Survey (NHANES) were used to produce this Advanced Data Report. See attached.
A Board of Governors for NCHS was approved by the Secretary, DHHS. It is believed that this
Board will be a combination of an Advisory panel and a Board of Scientific Review. It will
have 15 members. The first meeting will be in October, 2003.
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CDR Bruce Dye also informed that a NCHS Series 10 Report using data from the 1999 NHIS—
Oral Health Module—is planned for release at the end of the year. Dental insurance and
questions exploring reasons why dental care was not sought comprised this special module.
CMS activities: Dr. Conan Davis reported that the Guide to Dental Care is being updated. It is
at the Director’s desk for final review. He mentioned that the National Governors Association
activity on Medicaid reform may be stalled.
Dr. Davis also stated that the ADA Dental Code Revision Committee—on which he represents
CMS— is looking at the modifiers for dental codes. This lead to a discussion of diagnostic codes
and the need for them in dentistry.
Public Health Expertise Workforce Concept: CAPT Chris Halliday (IHS) noted that he and
LCDR Karen Sicard (IHS) have developed an Introduction to Dental Public Health course which
is offered to IHS dental providers and dental support staff. The course is comprised of several
modules which cover a variety of topics related to dental public health. RADM Kleinman has
viewed some of the modules and has encouraged the offering of such dental public health
training courses. CAPT Halliday also noted that there has been a renewed interest in the offering
long-term dental public health training through the IHS Division of Oral Health. The University
of North Carolina, Capitol Hill, has expressed initial interest in considering applications for
distance learning from students being sponsored by IHS. Dr. Halliday will check with other
schools of public health to see if there is similar interest in training USPHS employees sponsored
by the IHS Division of Oral Health.
Round Robin Major Issues
Dr. Kevin Mulry invited everyone to the FDA Public Workshop: Innovative Systems for
Delivery of Drugs and Biologics: Scientific, Clinical, and Regulatory Challenges to be held on
July 8, 2003 from 8:00 a.m. to 5:30 p.m. at Bethesda Marriott, 5151 Pooks Hill Road, Bethesda,
MD 20814. Phone 301 897-9400. For more information please go to:
http://www.fda.gov/cdrh/meetings/070803.html.
NIDCR and AHRQ are working on a review of the evidence of the effectiveness of local antimicrobials in the treatment of chronic periodontitis among adults. A final report is expected
sometime this summer.
RADM (ret) William Maas referenced the CDC report which highlights significant events since
the last PHS OHCC meeting. See attached.
RADM Kleinman thanked everyone for their prompt reports and their presentations and
requested that attendees check the 2004 OHCC proposed dates for meetings.
Adjournment: The meeting adjourned at 12:00 noon.
Next Scheduled Meetings: October 17, 03 (9:00-11:30); February 27, 04 (Tentative) (10:301:00); June 25, 04 (Tentative) (10:30-1:00); October 22, 04 (Tentative) (10:30-1:00)
Handouts:
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-PowerPoint: NIDCR Update: Oral Health Science: Advances & Opportunities
-Update on HP2010 for OHCC meeting June 13, 2003
-Memo from Division of Oral Health, NCCDPHP, Centers for Disease Control and Prevention Report for
the PHS Oral Health Coordinating Committee: Significant CDC Activities since January Report
-ADEA Washington Update. Volume 1, No. 15, May 20, 2003. First two pages.
-ADEA Washington Update. Volume 1, No. 16, June 3, 2003. First two pages.
-ADEA May 12 Memo to Council of Deans, Board of Directors, and Legislative Advisory
Committee.
-Federal Register / Vol. 68, No. 96 / Monday, May 19, 2003 / Proposed Rules – pages 7 (27209)
and 10-16 (27212-27218).
-Medicare GME Reimbursement for Hospital Dental Residency Training, Background of
Military Training Issues.
-Qiu Y, Ni H. Utilization of dental care services by Asians and native Hawaiian or other Pacific
Islanders: United States, 1997-2000. Advance data from vital health statistics; no 336.
Hyattsville, Maryland: National Center for Health Statistics. 2003.
-Wright JD, Wang CY, Kennedy-Stephenson J, Ervin RB. Dietary Intake of ten key nutrients for
public health. United States: 1999-2000. Advance data from vital and health statistics; no 334.
Hyattsville, Maryland: National Center for Health Statistics. 20003.
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