The Morning Drill: September 21, 2011

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

Texas AG investigates dental chain

The Texas attorney general (AG) is investigating charges of Medicaid fraud against the Smile Center, a chain of dental clinics in San Antonio, according to a blog post on the WOAI-TV website.

A representative from the attorney general's office confirmed that its Medicaid fraud control unit removed 180 boxes of records from several Smile Center locations. In addition, the agency's civil Medicaid department has filed a complaint in civil court against the Smile Center.

Meanwhile, the Crosley Law Firm of San Antonio is gearing up to file a lawsuit against the Smile Center on behalf of the parents of 100 former patients. In some cases, the parents of these children believe that they have been victims of substandard dental care leading to injuries and requiring additional treatment, according to the law firm's website.

The law firm also alleges the following:

•     Many of the parents were approached in parking lots and lured into Smile Center with the promise of dental exams for their children at no out-of-pocket cost to them.
•     In most cases, the children were covered by Medicaid, and Smile Center would bill Medicaid directly. Often the dental care consisted of pulpotomies and the placement of stainless steel crowns.
•     For some clients, the dental work may have been unnecessary, and resulted in a large bill to Medicaid.
•     In some instances, the injuries caused from the dental care necessitated visits to the emergency room and/or hospitalization.

Stephen Simpton, DDS, owner of the Smile Center, has filed a defamation lawsuit against WOAI and one of its reporters, according to the WOAI blog.

New polio outbreak hits China

An outbreak of polio has been confirmed in China for the first time since 1999, leaving one person dead and hospitalizing another nine, according to the World Health Organization (WHO).

The disease, a contagious viral illness that in its most severe form causes paralysis, difficulty breathing and sometimes death, broke out in the prefectures of Hotan and Bazhou in the country's western Xinjiang province.

Among the ten cases confirmed, six are in children under three years old and four are young adults.

The WHO said evidence indicates the virus is genetically linked to polio cases currently circulating in Pakistan, which borders Xinjiang. Pakistan has been affected by the nationwide transmission of the same WPV1 strain.

It also warned the virus could spread beyond the current affected area.

"Although other areas in China or other countries are not immediately at risk due to the geographic distance to the affected province, the polio virus can travel great distances and find susceptible populations, no matter where they live," Helen Yu, from the WHO's Beijing office told CNN.

According to China's Center for Disease Control and Prevention, the Ministry of Health has dispatched a group of public health experts to the affected region to help treat the virus.

It said the local government had launched a mass vaccination campaign starting in early September. WHO confirmed initial vaccination campaigns carried out by mid-September had reached over 3.5 million children -- children being particularly vulnerable to polio.

Preemies Have Higher Mortality Risk as Young Adults

Young adults born prematurely had as much as twice the increased mortality risk as matched adults carried to term, an analysis of a large Swedish database showed.

The mortality hazard associated with prematurity emerged in early childhood, disappeared after age 5, and then reappeared at age 18.

In young adulthood, the mortality hazard declined with increasing gestational age, ranging from 0.94 per 1,000 person-years for 22 to 27 weeks' gestation to 0.46 per 1,000 person-years for 37 to 42 weeks (full term), investigators reported in the Sept. 21 issue of JAMA.

"To our knowledge, this is the first study to report the specific contribution of gestational age at birth on mortality in adulthood," Casey Crump, MD, PhD, of Stanford University, and co-authors wrote in their discussion.

"These findings underscore the need for more effective strategies to prevent preterm birth, better understanding of causal pathways, and increased awareness of the long-term health sequelae through the life course," they added.

Common Stimulant May Speed Recovery from General Anesthesia

Administration of the commonly used stimulant drug methylphenidate (Ritalin) was able to speed recovery from general anesthesia in an animal study conducted at Massachusetts General Hospital (MGH). The report, appearing in the October issue of Anesthesiology, is the first demonstration in mammals of what could be a safe and effective way to induce arousal from general anesthesia. While there are drugs to counteract many of the agents used by anesthesiologists -- such as pain killers and muscle relaxants -- until now there has been no way to actively reverse the unconsciousness induced by general anesthesia.

"Currently at the end of a surgical procedure, the anesthesiologist just lets general anesthetic drugs wear off, and the patient regains consciousness," says Emery Brown, MD, PhD, of the MGH Department of Anesthesia, Critical Care and Pain Medicine, senior author of the paper. "If these findings can be replicated in humans, it could change the practice of anesthesiology -- potentially reducing post-anesthesia complications like delirium and cognitive dysfunction in pediatric and elderly patients."

General anesthesia has been an essential tool of medicine since it was first demonstrated at the MGH in 1846, but only in recent years have researchers begun to investigate the neurobiology of general anesthesia and to understand exactly how anesthetic drugs produce their effects. Studies by Brown and other scientists have shown that the state of general anesthesia is actually a controlled and reversible coma and bears little similarity to natural sleep. Several neurotransmitter pathways in the brain are known to be generally involved in arousal, but which ones may contribute to recovery from general anesthesia is not yet known.

The stimulant drug methylphenidate, widely used to treat attention-deficit hyperactivity disorder, is known to affect arousal-associated pathways controlled by the neurotransmitters dopamine, norepinephrine and histamine. The current study was designed to see whether methylphenidate could stimulate arousal in rats receiving the anesthetic drug isoflurane. The first experiments showed that animals receiving intravenous methylphenidate five minutes before discontinuation of isoflurane recovered significantly faster than did rats receiving a saline injection. Another experiment showed that methylphenidate induced signs of arousal -- movement, standing up, etc. -- in animals continuing to receive isoflurane at a dose that would have been sufficient to maintain unconsciousness. EEG readings taken during that experiment showed that brain rhythms associated with arousal returned within 30 seconds of methylphenidate administration. Giving a drug that interferes with the dopamine pathway blocked the arousal effects of methylphenidate, supporting the role of that pathway in the drug's effects.

Enjoy your morning!