The Morning Drill: June 27, 2011

A collection of dentistry and health related links/comments to start your day.

Articaine Found Superior to Lidocaine in Meta-Analysis

Articaine works better than lidocaine for infiltrations, but the evidence for superiority in mandibular blocks is still weak, researchers reported in the May issue of the Journal of the American Dental Association.

"When we considered infiltration data only, we found that the results of our meta-analysis indicated that articaine is an estimated 3.81 times more likely to produce anesthetic success than is a similar volume of lidocaine," write the researchers, from the University of Michigan, Ann Arbor, and led by Ryan G. Brandt, DDS.

Introduced to the US market in April 2000, articaine has steadily grown in popularity, reaching 25% of total dental anesthetic sales in 2007, second to lidocaine's 54%, the researchers said. Because articaine contains a thiophene ring, as opposed to the benzene ring in lidocaine and other amide local anesthetics, it is more soluble in lipids, and thus diffuses better through nerve membranes.

Some randomized controlled trials have reported a superiority for this newer agent, but others have been equivocal, and a few have reported a greater risk for adverse events. "It does seem like articaine is significantly better in some types of anesthesia, but there are reports of paresthesia that have some people concerned," Sean Boynes, DMD, who has published previous research on articaine, told Medscape Medical News.

Calories, Not Protein or Carbs, Are Key to Weight Loss: Study

Curbing calories is the key ingredient for diabetics seeking to lose weight, and low-fat diets that are either high in protein or high in carbs are equally effective, researchers say.

"I think there are two key messages from this study," said study lead author Jeremy D. Krebs, a senior lecturer with the school of medicine and health sciences at the University of Otago in Wellington, New Zealand. "The first is that no matter what diet we prescribe, people find it extremely difficult to sustain the changes from their habitual diet over a long time. But if they are able to follow either a high-protein diet or a high-carbohydrate diet, they can achieve modest weight loss."

Krebs said this first message conveys flexibility and allows people to choose the approach that best suits them and "even to swap between dietary approaches when they get bored."

The second point "is that for people with diabetes, if they can adhere to either diet and achieve weight loss, then they do get benefits in terms of their diabetes control and cardiovascular risk," he added.

Krebs and his colleagues are scheduled to report their findings Sunday in San Diego at the American Diabetes Association meeting.

U.S. Plans Stealth Survey on Access to Doctors

Alarmed by a shortage of primary care doctors, Obama administration officials are recruiting a team of “mystery shoppers” to pose as patients, call doctors’ offices and request appointments to see how difficult it is for people to get care when they need it.

The administration says the survey will address a “critical public policy problem”: the increasing shortage of primary care doctors, including specialists in internal medicine and family practice. It will also try to discover whether doctors are accepting patients with private insurance while turning away those in government health programs that pay lower reimbursement rates.

Federal officials predict that more than 30 million Americans will gain coverage under the health care law passed last year. “These newly insured Americans will need to seek out new primary care physicians, further exacerbating the already growing problem” of a shortage of such physicians in the United States, the Department of Health and Human Services said in a description of the project prepared for the White House.

Plans for the survey have riled many doctors because the secret shoppers will not identify themselves as working for the government.

“I don’t like the idea of the government snooping,” said Dr. Raymond Scalettar, an internist in Washington. “It’s a pernicious practice — Big Brother tactics, which should be opposed.”

Shutdown could lock out thousands of medical professionals

Medical professionals have just one week to submit their renewal applications before the boards that license them may be forced to close.

Thousands of Minnesota doctors and nurses who who miss that deadline would be prohibited from working as soon as their license expires.

Some licensing boards are loosening up their renewal guidelines during the next week, just in case they have to close their doors for a long government shutdown. The Minnesota Board of Medical Practice, which licenses physicians, adjusted its computer system to allow doctors to renew their licenses through September. Typically the Board deals with renewals one month at a time.

That change in guidelines has already put a lot of pressure on the Board's computer system as doctors scramble to submit their online renewal applications. Executive Director Robert Leach says more than 3,800 physicians are due to renew their licenses in the next three months.

"We've gotten a great many phone calls from individuals who are getting error messages and not allowing them to complete the process, Leach said. "We're having to tell them just go back and just try it again. It's due to the increased traffic on the system."

The Minnesota Board of Nursing has also seen a surge in its online renewals. Executive Director Shirley Brekken says renewals have more than doubled from just a week ago.

"We are having more renewals, especially for this time of the month than we usually do. And we certainly are noticing that nurses whose licenses are due to expire further out are renewing now," Brekken said.

So far in June, Brekken says more than 3,510 nurses have renewed their licenses. That's 1,257 more renewals than during the same period last year.

Online license renewals are also up at the Minnesota Board of Dentistry. But a decision by the Board to not accept August and September renewals sparked a firestorm of complaints from its dentist members, who are voicing frustrations that their licenses could expire during a shutdown.

"It's ugly," said Marshall Shragg, the dentistry board's executive director.

The dentistry board is not expanding its renewal guidelines because it lacks the resources to deal with the increased demand for renewals before the end of the month.

"They're saying that it's unfair that the Board would not accept early renewals and that they want special accommodations to be made. And it's unfortunate that we're not able to do that," Shragg said.

Enjoy your morning drill!