The Morning Drill: October 13, 2011

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

Lion down for a root problem

NO one likes the dentist, but it's usually the patient who feels nervous.

Dentist Stephen Coles can be forgiven for making sure his patient was sound asleep before he started treating a tooth that had broken off at the gum.

Ten-year-old Harare weighs 180kg and has fangs longer than a man's fingers.

"You wouldn't put your hands in his mouth unless you were very sure he was asleep," Dr Coles said of the lion.

One of two specialist dental vets in Australia, he is a regular visitor to Melbourne Zoo.

"He'd broken his lower molar at the back of the mouth down to the gumline," Dr Coles said. "The root had become infected and needed to be removed."

Harare's tooth root fused to his jaw bone and Dr Coles and a team had to surgically create a flap in the jaw and then slowly extract the root, piece by piece.

"Then we had to clean it out and sew it back up, taking about six sutures to close it," he said.

"It's a a reasonably tough procedure but we got a good result.

Panel votes against fluoride warnings on toothpaste

Most of us get some fluoride every day when we brush our teeth. But there has been a movement to get it put on California's list of carcinogens.

Fluoride is in your drinking water and in your toothpaste to help fight tooth decay.

But armed with studies that conclude fluoride can cause osteosarcoma, a form of bone cancer, concerned groups asked the state to list it as a carcinogen.

The Office of Environmental Health Hazard Assessment debated whether fluoride belongs on the Proposition 65 list.

California voters passed Proposition 65 in 1986. It's a warning label that the business you're visiting or product you're using could expose you to cancer-causing substances.

While municipalities would have been exempt from telling you the fluoride in your tap water could cause cancer, toothpaste makers would have had to add a Prop. 65 warning label on the box or tube.

Dentists were worried because it could scare people into not brushing their teeth.

"We want to reduce the amount of tooth decay, and we've done a fantastic job in reducing tooth decay, such that half the children now in the United States don't have any tooth decay at all," said Howard Pollick, a dental professor at the University of California San Francisco.

But scientists urged the panel not to dismiss the studies, especially the results in children.

"Exposure to fluoride in tap water during the mid-childhood growth spurt ages 5 to 10 is linked to higher levels of osteosarcoma in males age 10 to 19," said Rebecca Sutton, an Environmental Working Group senior scientist.

In the end, the panel unanimously voted against warning labels on toothpaste because the studies overall were inconclusive.

Public health officials praised the move.

"The science is very clear and very definitive. This is a safe and effective tool to prevent dental decay and it in no way has any ill effects on any individual's health," said Catherine Hayes, American Association of Public Health Dentistry.

Conn. dentist to pay $212K to settle Medicaid fraud case

A Connecticut dentist and her dental practice will pay $212,000 to resolve allegations that they violated the federal and state False Claims Acts by filing false Medicaid claims.
Kristi Rossomando, DMD, and her practice, Children's Dental Group in New Haven, entered into a civil settlement regarding accusations of fraudulent billing to Medicaid for pediatric services.

The services in question were "comprehensive oral evaluations" billed between February 2005 and January 2011. According to the ADA, this service is performed by "a general dentist and/or a specialist when evaluating a patient comprehensively." The service is provided to new patients or established patients who have had a significant change in their health conditions or who have been absent from active treatment for three or more years.

According to the state attorney general's office, Dr. Rossomando often did not see a new patient on his or her first visit, yet the practice billed Medicaid for a comprehensive oral evaluation. At the first visit, the child would usually only see a hygienist, who would then recommend treatment and schedule a follow-up visit. However, Dr. Rossomando would bill Medicaid for a comprehensive oral evaluation, as if she had examined the patient and performed the service. Even on days when Dr. Rossomando was not in the office, Medicaid was regularly billed for comprehensive oral evaluations, according to the attorney general's office.

"It is unacceptable for a dentist to receive payment when no service is performed, or for a staff person to routinely render care that only a dentist is qualified to perform," Connecticut Attorney General George Jepsen stated in a press release. "The state will hold providers accountable for all services billed to Medicaid."

A complaint against Dr. Rossomando was filed in the U.S. District Court in Connecticut under the whistleblower provisions of the federal and state False Claims Acts. The whistleblower, Olivia Estrada, whose child had been treated by Dr. Rossomando, will receive a share of the proceeds of the settlement in the amount of $31,800.

Report Finds U.S. Poorly Prepared For Bioterrorism

The scenario laid out by the movie “Contagion,” about an outbreak of a new virus, was scary enough.

But while “naturally occurring disease remains a serious threat, a thinking enemy armed with these same pathogens, or with multi-drug-resistant or synthetically engineered pathogens could produce catastrophic consequences.”

So says a new report from the Bipartisan WMD Terrorism Research Center that finds the U.S. woefully unprepared to deal with many aspects of different bioterrorism scenarios. The WMD Center is a not-for-profit research and education organization.

It urges the government to focus on improving its ability to detect and deal with large-scale events, both of contagious and non-contagious pathogens. Specifically, it recommends focusing on aspects of the response that now earn a “D” grade: detection and diagnosis; improving the development, approval, availability and dispensing of medical countermeasures; and improving the capability to medically manage an incident.

Enjoy your morning!