The Morning Drill: October 18, 2011

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

Massachusetts Dentist Chosen President-Elect of the American Dental Association

Robert A. Faiella, D.M.D., M.M.SC., who practices Periodontics in Osterville, Mass., was recently selected as president-elect of the American Dental Association (ADA). Dr. Faiella's election took place during a meeting of the ADA House of Delegates in Las Vegas.

Dr. Faiella will assume the ADA presidency in October 2012, when he will lead the 156,000-member organization, America's leading advocate for oral health.

Dr. Faiella has just completed a four-year term on the ADA Board as the trustee from the 1st District, which represents Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island and Vermont. Dr. Faiella's previous responsibilities with the ADA include serving on various councils and committees, including terms as chair of the Compensation Committee and the ADA Electronic Health Record Workgroup. Since June 2009, Dr. Faiella has served as chairman and sole director of ADA Business Enterprises, Inc., a wholly owned subsidiary of the ADA.

Dr. Faiella is a past president of the Massachusetts Dental Society. He received his pre-doctoral education from Villanova University, receiving two Bachelor of Science degrees and a D.M.D. degree from Fairleigh Dickenson University School of Dental Medicine. He received his graduate training in Periodontology as a Post-Doctoral Fellow at Harvard School of Dental Medicine, as well as a Masters of Medical Science degree from Harvard

Dentists say ending fluoridation in Pinellas County will affect poor kids most

Dentists say low-income families will be hurt the most when Pinellas stops adding fluoride to its water system around the end of the year, a move that will save the county about $205,000 a year.

Sandra's dentist, Dr. Haychell Saraydar of the Health Department, said the girl's problems were with her baby teeth, which came in prior to fluoridation of the water. The dentist said her adult teeth are in better shape.

Though opponents to water fluoridation rightly point out that fluoride is more available than ever — in toothpastes, dental rinses and supplements — dentists and public health officials maintain that having it in tap water is the best, cheapest and easiest way to protect against tooth decay.

"It reaches people of all socioeconomic groups," said Dr. William Bailey, chief dental officer of the U.S. Public Health Service and acting director of the division of oral health at the Centers for Disease Control and Prevention. He called the county's recent decision "disheartening."

Numerous studies and government data show a strong correlation between poverty and kids' oral health. Poor children go to the dentist less frequently and have higher rates of untreated cavities. Poor children in Florida have it particularly tough, with only about a quarter of those covered by Medicaid — such as the Cruz-Quezada family — actually receiving dental services.

A study released this year by the Pew Center on the States gave Florida an F grade for access to dental care for disadvantaged children. Florida ranked last among the 50 states for the percentage of low-income children receiving dental services. Only 25.7 percent do, compared to the national average of 43.8 percent.

Many Pinellas dentists say they're certain what's going to happen once the county closes the taps on fluoridated water.

"There will be higher rates of decay and infection," said Saraydar, who directs the county Health Department's dental program.

Saraydar has seen the difference fluoridated water makes, having provided dental services to the county's poorest children since 1988, years before fluoride was added to the water.

A few years after it was added to the St. Petersburg/Gulfport area water supply around 1993, "we started to see a marked difference in tooth decay," she said. And after it was added to the rest of the county in 2004, "we started seeing the change in children in the other areas as well."

More U.S. employers cutting dental benefits

Healthcare costs continue to rise, driving more employers to stop offering dental coverage -- resulting in only 57% of Americans covered by a dental plan, compared with more than 85% who have medical insurance, according to the latest Healthcare Transparency Index from Change Healthcare.

The index is compiled from a subset of the Change Healthcare client database, which analyzed more than 30,000 in-network insurance claims in the U.S. over a 12-month period.

Varying dental plans are creating higher out-of-pocket costs for patients, making the market for dental services more consumer-driven, according to Change Healthcare. These concerns are creating an alarming trend, the company noted: Employees and their dependents are skipping regular visits and neglecting dental care.

Women were more likely to receive dental care, averaging 1.31 visits per year versus only 1.11 for men, the index found. Seniors age 60 and older were also the most likely to receive dental care, compared with young adults ages 21 to 30 representing the least likely.

The Healthcare Transparency Index also revealed considerable price disparities and local savings potential for the most common dental services, including adult and pediatric preventive exams with and without x-rays, adult caries repair, application of braces with pre- and follow-up visits, and third-molar removal with sedation or anesthesia. Amounts for dental services could vary by more than 400% in the same area for the same service, according to the index.

Among the index's other findings:

• With cost now a significant barrier to proper care, the index found that the same preventive exam for adults could cost as much as $240 and as low as $55 in the same area, and pediatric exams ranged from $180 to just $35.
• Claims data indicated that caries repair at the high-end could cost as much as $360, making these services unattainable for many and leading to long-term health issues, according to Change Healthcare.
• The index reported a high of $6,960 for orthodontic services (including a previsit, braces application, and follow-up visit), compared with a low of $2,400 in the same area.

Oropharyngeal Exam Predicts Severity of Sleep Apnea

A simple oropharyngeal exam can provide key information regarding the severity of obstructive sleep apnea syndrome (OSAS), according to results from a study of more than 300 patients that was carried out in Spain.

The study appears in the October issue of the Archives of Otolaryngology Head and Neck Surgery.

Although the pathogenesis of OSAS has not been definitively established, it is generally blamed on partial or complete obstruction of the upper airway with involvement of the oropharynx.

However, senior and corresponding author Christian Domingo, MD, PhD, from the Pneumonology Service, Hospital Parc Tauli, Barcelona, Spain, and colleagues note that in spite of recent medical advances, up to 80% of patients remain undiagnosed.

"To some extent, this is due to the fact that patients are not aware of the disease, but the logistic difficulties of diagnosis should also be borne in mind," they write. They add there is no simple, fast physical exam that can facilitate screening of patients to assess whether they have sleep apnea and, if so, how severe it may be.

Enjoy your morning!