Tuesday, November 01, 2011

The Morning Drill: November 1, 2011

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

Does Treatment of Oral Disease Reduce the Costs of Medical Care?

The exploratory studies needed to detect associations between clinical conditions and potential contributing factors (demographic, environmental, genetic, or medical) pose a special challenge in research. On one hand, large sample sizes are needed to detect subtle influences in the presence of strong known effects (eg, smoking) or confounders. On the other hand, the tentative nature of the hypothesis may not justify the effort and cost of large (usually multicenter) randomized controlled trials at an early stage of knowledge. When possible, researchers seek to "mine" historical records as an early step in determining the credibility of a hypothesis. We, as well as others, have found insurance records to be especially rich and reliable sources of health data (such as healthcare costs). What they lack in medical, dental, behavioral, and adherence detail is often offset by their uniformity and sheer size. The trick is to formulate the research question in a way that it can be answered from the available data.

This article discusses how data from a group of large private insurance plans were used to investigate whether periodontal health affects the cost of medical care in patients with type 2 diabetes. Although the findings are interesting, the process may be of interest to other clinicians trying to interpret reports derived from these valuable data sources.
Consumer Survey Triggers Midlevel Dental Provider Debate
A survey suggesting that most Americans would support licensing a new kind of dental practitioner has touched off an argument between the survey sponsor, the W.K. Kellogg Foundation, and US dentists' groups.

"Millions of Americans cannot find affordable dental care in their communities and many want to explore mid-level providers as a way to improve their access to needed oral health care," Kellogg announced in releasing the survey October 4.

The American Dental Association (ADA) and Academy of General Dentists (AGD) quickly fired off critiques of the survey's methodology and of the concept of midlevel providers.

Although both groups agreed with the Kellogg findings that people need better access to dental care, ADA President Raymond F. Gist, DDS, explained in a press release that “[t]he Kellogg Foundation's narrow focus on a single idea — so called 'dental therapists' — and its claim that a vast majority of Americans favor creating dental therapists lacks credibility."

Hired by Kellogg to explore the public's experience with dental care, Lake Research Partners and Knowledge Networks administered an online survey to 1023 adults in July. The margin of error was ±3.1%.

One question on the survey read as follows: "Many efforts are going on to improve affordable access to dental care in our country. One effort is training licensed dental practitioners to provide preventive, routine dental care to people who are going without care. Would you support or oppose this effort to train licensed dental practitioners?"

The question avoided the terms "dental therapist" or "midlevel provider," which have become fighting words among some dentists who follow policy debates.

Seventy-eight percent of the respondents said they supported the idea, with 6% against and 15% neutral.

"Kellogg's survey question regarding dental therapists implied that care by therapists would somehow cost less than care by dentists, said Dr. Gist in the press release. "We know of no data to support this. If such data exists, Kellogg should release it."

Dr. Gist complained that the practitioners in the question were poorly defined. "Kellogg also declined to describe therapists' level of training, whether they would work with a dentist nearby in case something goes wrong, or what types of surgical procedures they would perform," he said. "Absent that information, the survey respondents could not provide informed opinions."

In a separate written statement, the AGD also criticized the way the question was posed, and expressed concern about the idea of nondentists doing "clinical dental procedures that may be irreversible."
Minn. dental therapist students get new clinic
Metropolitan State University has officially opened its new dental teaching clinic for its Master of Science: Oral Health Care Practitioner program students.

The site will enable students, who will be the first and only advanced dental therapists (ADT) in the U.S., to provide low-cost dental care for underserved community members as the students complete required clinical hours for their degree and licensure.

The clinic has seven working stations and is equipped with digital radiography, electronic patient records, and projection capabilities linking the stations to a seminar room located in the clinic. Two of the stations were designed to accommodate patients with special needs.

Major funding for the clinic has been provided by Dental Dental of Minnesota Trust and the Henry Schein Cares Foundation. Additional supporters include 3M, the American Dental Hygienists' Association, Colgate, the Dental Trade Alliance Foundation, the Hardenbergh Foundation, Jean and Bruce Johnson, the Minnesota Department of Health, and the United Way.

Already, through their clinical training at a facility at Normandale Community College, the first class of ADT students in this program have seen more than 1,000 patients. Virtually all of the patients seen are uninsured or unable to afford dental care in a traditional setting.
A Tumor Is No Clearer in Hindsight - Steve Jobs
Was Steve Jobs a smart guy who made a stupid decision when it came to his health?

It might seem so, from the broad outlines of what he did in 2003 when a CT scan and other tests found a cancerous tumor in his pancreas. Doctors urged him to have an operation to remove the tumor, but Mr. Jobs put it off and instead tried a vegan diet, juices, herbs, acupuncture and other alternative remedies.

Nine months later, the tumor had grown. Only then did he agree to surgery, during which his doctors found that the cancer had spread to his liver, according to the new biography by Walter Isaacson. Cancer eventually killed him.

The sequence of events has given rise to news articles and blogs based on 20/20 hindsight, speculating that if only Mr. Jobs had had the surgery right away, doctors could have caught the cancer early, before it spread, and saved him.

But there is no way in this life to know what might have been — not in politics, baseball, romance or the stock market, and certainly not in sickness and health. Mr. Jobs’s wish to avoid or delay surgery was not unusual. And given the type of tumor he had and the way it was found, his decision to wait may not have been as ill considered as it seems at first blush.

His wife, Laurene Powell Jobs, declined requests for an interview and for permission to speak to Mr. Jobs’s doctors. But she did allow one of them to comment briefly: Dr. Dean Ornish, a friend of Mr. Jobs who is also a well-known advocate for using diet and lifestyle changes to treat and prevent heart disease.

Dr. Ornish said that when the diagnosis was first made, he advised Mr. Jobs to have the surgery. But in an e-mail message, he added:

“Steve was a very thoughtful person. In deciding whether or not to have major surgery, and when, he spent a few months consulting with a number of physicians and scientists worldwide as well as his team of superb physicians. It was his decision to do this.

“This type of surgery is a big deal and not to be taken lightly. He had surgery when he decided it was what he wanted to do. Nobody could have been more thoughtful and intelligent about how he went about this.

“No one can say whether or not having surgery earlier would have made any difference because of the possibility of micrometastases.”
Enjoy your morning!

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