2009-07-31. 本週大事是FDA召開媒體記者會，聲明銀粉對人體無害。 但FDA 將銀粉歸於第二類器材，意即具有中度危害。(有可能吸入汞蒸氣)。美國牙醫學會所(ADA) 則聲明 , 由患者及牙醫師決定是否使用銀粉填補。
1. FDA: Mercury Fillings Not Harmful 銀粉填補對人體無害
Kathleen Doheny. WebMD Journalist.
FDA Media Advisory, July 28, 2009. — The mercury used in dental amalgam fillings is not at a level high enough to cause harm in patients, according to the FDA, which today issued its final regulation on the controversial tooth filling material.
However, the dental amalgams are classified as Class II devices, deemed a moderate risk, instead of the lower risk Class I devices. At high levels, mercury can cause adverse health effects to the brain and kidneys.
FDA's Final Rule on Amalgams
At a media advisory to announce the final rule, the FDA's Susan Runner, DDS, said, ''The best available scientific evidence supports the conclusion that patients with dental amalgam fillings are not at risk for mercury-associated adverse health effects.
The special controls are spelled out in a guidance document that includes recommendations on labeling and other parameters. Among the labeling recommendations:
- A warning against the use of the filling material in those with a known mercury allergy
- A warning to dentists and other dental professionals to use adequate ventilation when handling the dental amalgam
- An informed decision : statement talking about the risk and benefit of the dental amalgams, including the risks of inhaled mercury vapor.
FDA Ruling: Reactions
In a statement issued July 28, 2009, the American Dental Association (ADA) said: "The ADA agrees with the U.S. FDA's decision not to place any restriction on the use of dental amalgam, a commonly used cavity-filling material." And according to the ADA, leaving the decision up to patients and their dentists is the correct approach.
As a practical matter, the new ruling will make little difference to many dentists. "Amalgam filling use is in decline, other options, such as white composite or porcelain filling materials, look better and are preferred by many patients”, one dentist says.
Ideally, says Charles Brown, national counsel for Consumers for Dental Choice, the agency should have warned against the filling use for children, pregnant women, and nursing mothers. As a practical matter, the new ruling will make little difference to many dentists. "Amalgam filling use is in decline, other options, such as white composite or porcelain filling materials, look better and are preferred by many patients”, one dentist says.
另外讀到一篇文章討論如何因應患者爽約，有興趣的人不妨瀏覽一下。
Part 2. Best Wa ys to Deal With No-Shows 如何因應患者爽約 (摘錄)
Elizabeth Woodcock, MBA. 07/14/2009
1. Let the Patient Suggest the Appointment Time 讓患者挑選約診時間
According to a recent University of Missouri survey that looked at 11,000 scheduled patient visits, patients who suggested the most convenient time for an appointment were more likely to show up than when the scheduler suggested the appointment time.
2. Call to Confirm Upcoming Appointments 電話提醒/確認約診時間
Place reminder calls or send e-mails 2 days in advance of the appointment. For new patient visits, procedures, and other lengthy appointments, ask the patient to call back to confirm can be very helpful.
3. Establish a Priority List of Patients Who Will Come in if a Last-Minute Opening Occurs 建立等待優先名單(以取代約診未到者)
Manage the list on a computer instead of paper. When patients call to cancel, having a ready list of other patients willing to come earlier than scheduled, can save the day.
4. Track Offenders 追蹤約診未到者
Past actions can often predict future behavior, so track patients' missed appointments in your scheduling system. Dismiss frequent offenders from your practice after a predetermined number of no-shows (for example, 3). Give chronic offenders appointments on a 'Dr. No-show' template, or tell chronic no-show patients that they will be seen on a walk-in basis only.
5. Overbook 超額約診
Consider over-scheduling some appointment slots. Use yield management techniques, which are popular in the airline industry, and known as ' strategic overbooking.' I
6. Charge Patients Who Don't Call to call off 罰款未取消約診者 (台灣行不通吧？)
7. Let Patients Know How Much You Appreciate Their Calling in Advance to Cancel告知患者：感謝他們提前取消約診
8. Look Within for the Cause 檢視診所內部的問題
Some estimates indicate that physician practices may average from 5% to 10% no-shows. Is your practice doing something to cause more no-shows?
Don't forget the basics -- reducing missed appointments improves your practice's bottom line, and takes the heat off you. 
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