The Morning Drill: May 31, 2012

Good Thursday morning!

On to today's dentistry and health headlines:

El Monte Dentist Giving Away Thousands in Free Dental Care

It’s not every day that patients can receive free dental care, and yet, on June 8th, 2012, that’s exactly what will happen for the first 100+ patients to walk through the doors of Mountain View Dental Group.

El Monte and San Gabriel Valley locals are invited to receive free dental care at Mountain View Dental Group in El Monte. Owner Dr. Emily Letran and staff will host this free event in partnership with non-profit Dentistry From The Heart, supporting local residents by providing the community with free dental services.

From 7:00 AM to 4:00 PM Mountain View Dental Group’s dentists, assistants, and hygienists will donate their time and resources to provide the first 100 adult patients with one of the following high-quality dental services: tooth extraction, filling, or cleaning. The purpose for the event is to provide much needed health care and relief to people in the community.

Long-time San Gabriel Valley resident and program sponsor Dr. Emily Letran believes in giving back to the community and not only helping give local residents access to free dental care, but also helping them regain their confidence and ability to smile. “We know it can be tough on families today to get basic dental care,” says Dr. Letran. “Some may have lost their insurance, and others simply can’t afford to pay out of their own pockets. That’s why we wanted to continue offering this program. On Friday the smiles are on us!”

Republicans Target Dental Bill That Private Equity Hates

The likes of Jeb Bush, William Frist, Tommy Thompson and Haley Barbour aren’t typically heard from in the office of Thom Tillis, the Speaker of the North Carolina House of Representatives.

Yet the four Republican Party stalwarts, none of them a Carolina resident, have contacted Tillis’s office over a little- known bill to toughen state regulation of dental companies. They’ve been joined by Grover Norquist, the Tea Party favorite and anti-tax crusader who heads the Washington, D.C.-based Americans for Tax Reform.

“It’s not terribly common to have these types of names” intervening on a state bill, said Jordan Shaw, a spokesman for Tillis.

Their interest marks the Tar Heel State as the front line in a national struggle over dental management companies. Fueled by Wall Street money, at least six such firms are under scrutiny by two U.S. senators and authorities in five states over allegations that they soak taxpayers through excessive Medicaid billings, abuse patients via needless treatments and run afoul of laws that say only licensed dentists can practice dentistry.

The North Carolina bill would place new strictures on such companies, which have become a favored investment of the private equity industry. Private equity firms have bought or put money into at least 25 dental-management companies in the last decade.

Republicans control the North Carolina state Senate, which approved the bill on a 46-2 vote, as well as the state House, where it has stalled.

A dozen companies, at least half of them backed by private equity groups, raised more than $1.1 million to try to stop the bill, which is supported by the North Carolina Dental Society and the state Board of Dental Examiners. The private equity backers include Leonard Green & Partners of Los Angeles, Court Square Capital Partners of New York and Levine Leichtman Capital Partners of Beverly Hills, California.

“They’re looking at North Carolina as their test case,” said Lisa Ward, director of government affairs for the North Carolina Dental Society, which has reported hiring five lobbyists and spending about $400,000 to support the bill. “They’ll do anything they can to win here.”

Bush, who served as Florida’s governor from 1999 to 2007, sent an e-mail to Tillis “asking him to review the bill,” said Jaryn Emhof, a spokeswoman for Bush. The former governor hasn’t taken a position on the legislation, Emhof said. He contacted Tillis at the request of Florida Representative Michael Bileca, she said.

Private equity firms eye big profits in dentistry

A growing number of private equity firms are investing in dental management companies, which they see as one of the few growth areas in the current economic recession.

Small Smiles is one of at least 25 dental management companies that have been bought or backed by private equity firms in the last decade, according to Thomas Climo, a Las Vegas dental consultant. These companies account for about 8% (12,000) of the dentists licensed in the U.S., he said.

Topspin and AUA Private Equity Partners, both New York-based equity funds, announced earlier this month that they had invested an undisclosed amount in Brighter Dental Care, a regional dental practice management company that operates and manages seven affiliated dental practices in New Jersey.

Last November, private equity investment firm JLL Partners paid $398 million to buy American Dental Partners (ADP). ADP is affiliated with 27 dental group practices, which have 282 dental facilities and about 2,400 operatories in 21 states.

And in 2008, the Audax Group bought a majority stake in Great Expressions Dental Centers, expanding the platform from about 100 practices to 152 locations.

Currently, there are 24 large dental practice management companies in the U.S., with annual revenues of more than $100 million, Climo said.

Private equity buyout firms have been attracted to dental practices because they are less regulated than physician groups, and patients often go to their dentists more regularly than to their doctor, according to Sandy Steever, an editor with Irving Levin Associates, a Norwalk, CT, publisher which tracks mergers and acquisitions in healthcare.

"They attract less scrutiny because dental services are seen as more peripheral than physicians' services," he told DrBicuspid.com. "In one sense, I think healthcare is noncyclical because it's a regular need. I have seen a lot of private equity getting into dental servicing companies."

Some of the firms have benefited from the increase in Medicaid payments for dental care, which rose 63% to $7.3 billion between 2007 and 2010, according to the U.S. Center for Medicare and Medicaid Services.

Big bucks and dentistry’s ownership

Who should make decisions about your dental care: you and your dentist – or a big, out-of-state corporation owned by Wall Street private equity funds? That’s the issue in the fight over Senate Bill 655 in the North Carolina legislature.

The N.C. Dental Society, which represents more than 3,600 dentists, supports the bill. It will give the State Board of Dental Examiners the tools it needs to keep “dental management companies” from owning practices and making decisions about patient care.

Here is what has happened in other states when corporate owners gain control: Medicaid fraud, assembly-line dentistry, unnecessary and expensive treatments and even mistreatment of children as young as 4 years old – all in the pursuit of profits. Management companies could bill patients for unneeded care and otherwise operate illegally. Dentists could be pressured to meet quotas and perform more-expensive treatments.

That’s why we support the bill. But we’re up against an opponent that is raising big money from the dental management companies to oppose the legislation. The Alliance for Access to Dental Care political committee is running TV ads attacking the bill.

Watching the ads, you would think the alliance’s members lie awake at night worrying about children’s dental care. Do you believe that Wall Street private-equity funds are spending over $1 million to influence the North Carolina legislature because they care about children? Or do you, like most dentists here, suspect that their real motive is higher profits?

The companies must be profitable. A recent Bloomberg Businessweek investigation found that “at least 25 dental management-services companies (were) bought or backed by private-equity firms in the last decade.” The Bloomberg investigation, by a Pulitzer Prize-winning reporter, noted: “Management companies are at the center of a U.S. Senate inquiry, and audits, investigations and civil actions in six states over allegations of unnecessary procedures, low-quality treatment and the unlicensed practice of dentistry.”

Enjoy your morning!

The Morning Drill: May 30, 2012

Meet Dr. Tom Kalili, dentist

Good Wednesday morning!

On to today's dentistry and health headlines:

Beverly Hills Dentist Accused of Insurance Fraud in Excess of $300,000

A Beverly Hills dentist was arrested Friday on a 101-count felony complaint alleging insurance fraud exceeding $300,000 in losses, according to the Los Angeles District Attorney's office.

Tom K. Kalili, 57, is charged with grand theft and tax evasion with an excessive-taking allegation. Kalili is expected to appear for arraignment early next week.

Kalili owns and operates Beverly Hills Medical Suites, a dental office. A glance at his practice's web site reveals that he and his partners boast a host of celebrity clients, among them Jim Carrey, Kathy Ireland, Adam Sandler, Keanu Reeves, and Vin Diesel.

The filing concludes a multi-year joint investigation by the California Department of Insurance, the California Dental Board and the California Franchise Board.

The defendant's office manager and biller, Claudia Ventura, 38, is charged with 10 felony counts including insurance fraud and accessory after the fact. She will be arraigned with Kalili next week.

Bail for Kalili is recommended at $500,000. Co-defendant Ventura's bail is recommended at $25,000.

If convicted as charged, Ventura faces more than seven years in state prison. Kalili could be sentenced to more than 50 years in prison.

Dental care plan audited by California ceases operations

Community Dental Services, a managed-care dental plan with about 16,000 Medi-Cal members in Sacramento and Los Angeles counties, will cease operations and transfer its enrollees to Liberty Dental Plan on June 1, state officials announced Friday.

The move came in response to an audit by the Department of Managed Health Care, the results of which can't be released until it is finalized, said department spokeswoman Marta Bortner.

But during previous audits, the department identified problems with the way the plan approved or denied care, its grievance and appeal system and its oversight of quality of care, she said.

The plan informed the state during the audit that it would voluntarily cease operations.

"We are taking quick action to ensure that our Medi-Cal dental managed-care enrollees receive quality, timely services from our dental plans," said Toby Douglas, director of the Department of Health Care Services, which administers Medi-Cal.

That audit was prompted by a CHCF Center for Health Reporting story published in February in The Bee about Sacramento County's Medi-Cal dental managed-care program.

The story gave examples of children who had trouble obtaining treatment for painful, rotted or broken teeth, including some who endured pain for more than a year as they awaited care.

Dentist shortage leading to more emergencies

The lack of dentists and specialists in rural Californian counties is leading to high rates of tooth decay and preventable dental emergencies, especially among low-income residents.

Someone living in Eureka would have to drive 3 hours to Redding or 4 hours to Santa Rosa to get to an oral surgeon who accepts Medi-Cal.

There are no dentists in Alpine County, and the nearest dentist accepting Medi-Cal is at the Washoe Tribal Health Center in Nevada, a half-hour away. Medicare patients can go to a dentist 28 miles away in South Lake Tahoe, but that dentist stopped accepting Medi-Cal patients from the county because of the high rate of no-shows.

If they can’t get into either of those offices, patients have to make a 2.5-hour trek to Diamond Springs.

A 2006 survey conducted in four northern Californian rural counties found that this combination of low access and low incomes hurts oral health. More than 28 percent of respondents living at or below the federal poverty level hadn’t been to a dentist in five or more years. Many of them had never seen a dentist. Only 40% of respondents had been to a dentist in the previous year- the recommended length of time between visits.

This is due in large part to a lack of dentists and specialists in the area, especially those who accept Medi-Cal. For example, in the population center of McKinleyville in Humbolt County, there is one dentist for every 4,539 people.

The problem is even worse for those relying on the state’s health care program for low-income people. There’s only one dentist accepting Medi-Cal for every 71,830 county residents.

That’s well above federal standards for a dental care shortage. Counties with a ratio of one dentist for every 5,000 people are federally designated dental health professional shortage areas. But national standards recommend a target ratio of at least one dentist for every 3,000 people.

The survey found that rural counties in northern California have the highest rate of emergency room and urgent care visits for preventable dental issues than the rest of the state.

Los Angeles County record dismal for enabling poor children to get needed dental services

For many of Los Angeles County's poor children, getting in to see a dentist can be as tough as making it in Hollywood, state data show.

Last year, fewer than one in four L.A. County children with Medi-Cal dental managed care saw a dentist, one of the worst records in the state.

As a result, many children suffer for months with painful or rotted teeth before seeing a dentist or getting a referral to a specialist, dentists and children's advocates say.

"It would be like winning the jackpot if you could find a provider who is close to you and has the necessary skills and you can get an appointment in the next week or next two weeks," said Francisco Ramos-Gomez, a professor of pediatric dentistry at the UCLA School of Dentistry.

"Because these kids can't find providers and they go around in circles, their teeth get worse and worse and worse."

L.A. County is just one of two counties in the state that offers dental managed care through Medi-Cal.

In Sacramento County, dental managed care is mandatory for children. But in Los Angeles, parents have a choice. They can either sign their kids up for a dental managed care plan, or opt for the "fee-for-service" approach used in the rest of the state.

Though the majority choose fee-for-service, about 154,000 kids were enrolled in dental managed care last year in Los Angeles County.

Enjoy your morning!

The Morning Drill: May 29, 2012

Hamada Makarita, DDS

Good Tuesday morning!

On today's dentistry and health headlines:

Dentist indicted on prescription, fraud charges

An Oakton dentist has been indicted on charges of illegally distributing prescription pills to patients, professionals and paramours over the past five years and also assuming another dentist’s identity to bill more than $160,000 in claims for work he performed on his family.

A grand jury recently indicted Hamada Makarita, 50, on charges of conspiracy, health care fraud, aggravated identity theft and 12 counts of dispensing controlled substances.

The federal government smoked him out through an investigation known as Operation Cotton Candy, according to the office of Neil H. MacBride, U.S. attorney for the Eastern District of Virginia. Dr. Makarita faces 10 years in prison on the health care fraud charge, 20 years for conspiracy and each of the controlled-substances charges, and a consecutive two-year sentence for aggravated identity theft.

Dr. Makarita distributed drugs such as Percocet, Vicodin and Valium to patients and girlfriends and for “prurient” purposes, “including, but not limited to, consensual and non-consensual sex,” according to the 20-page indictment.

At least once, Dr. Makarita took pictures of a patient he was dating without her consent to the photo while she was under the influence of drugs he had illegally given to her. Dr. Makarita then emailed the photos to friends and employees, prosecutors said.

Dr. Makarita also is said to have provided more than $160,000 in services to his family members and illegally billed them to Aetna using the name of another dentist. He was reimbursed more than $91,000 for the fraudulent claims.

'I look like a monster': Mother left toothless after £4,000 of botched dental work by struck-off Polish dentist

A mother says she feels like a monster after a bungled £4,000 dental procedure left her totally toothless.

Gabriela Andrews, 48, now has just a few jagged bones for teeth and faces a bill for more than £15,000 to repair her smile.

But she has been left powerless to get compensation for the botched treatment because the private dentist who gave her dental implants in Cornwall in January 2010 has since moved to Poland and been struck off.

She said: ‘I have been left looking like a monster.  I’m embarrassed when I talk.

‘I feel like people are staring at me. My confidence has been affected, my speech has been affected, I can’t eat solid food and nobody does you justice.

‘To be left like this, you can’t believe it can happen in this country. There’s nothing I can do. I have a mortgage to pay and bills. I cannot afford to fix this. I don’t want other people to fall in to this situation.’

The work had been undertaken by self-employed dentist Piotr Tadeusz Reichel.

Dr Reichel’s licence to practise has been suspended by the General Dental Council ‘for protection of the public and in the public interest’ - in relation to care of several patients.

Gabriela, from Keysham, Devon, said: ‘I went back to the clinic but they said the dentist is self-employed and it’s his responsibility, his insurance will pay.

Children suffer under dental managed care that saves California money

When state lawmakers learned that Sacramento County's dental program for poor children has one of the worst records in the state, they immediately scheduled hearings and demanded reform.

But a larger Medi-Cal managed care program has a poorer record and hasn't received the same kind of legislative scrutiny.

Four hundred miles south, in Los Angeles County, just 23 percent of the children enrolled in Medi-Cal managed care saw a dentist last year. That's compared with about 31 percent in Sacramento and about half of all Medi-Cal children statewide.

Sacramento and Los Angeles are the only two counties in California that offer Medi-Cal dental managed care, but cost-cutting proposals at the Capitol would bring it to other counties, a prospect that alarms some experts.

"The state has a program that's not working and it seems like they want to grow it," said Scott Jacks, a pediatric dentist and founder of Children's Dental Group, which operates four offices in Los Angeles County that see thousands of patients annually.

Jacks participated fully in the Medi-Cal managed care dental program for a decade, until 2005. Dental plans paid him a monthly fee of between $4 and $6 for each Medi-Cal managed care child assigned to him, a reimbursement that didn't cover costs and forced him to stop taking new Medi-Cal managed care members, he said.

"It's just not sustainable," he said. Expanding the program, he said, "would be disastrous."

DENTISTS mislead some patients over their NHS entitlements to make them pay for private care, a watchdog says.

Half a million people may have paid needlessly.

The Office of Fair Trading report said those patients were not given enough information to make an informed choice of dentist and treatment.

OFT chief exec John Fingleton said: “We unearthed evidence some people may be receiving deliberately inaccurate information about entitlement to NHS dental treatment and we expect to see robust action taken against misconduct.”

The report called for major changes to the dentistry market.

The reforms it wants include removing restrictions that stop patients seeing dental hygienists and clinical technicians without a dentists’ referral. It also said the market should be opened up to more practices and allow others to expand. Health minister Lord Howe said: “The vast majority of dentists behave ethically.”

Enjoy your morning!

Federal Agents Arrest Two Dentists in Medicaid Fraud

Landmark Dental operated by dentist, Mehran Zamani

Feds arrest two, raid dental firms in $20 million fraud case

Federal agents arrested a dentist and a former dentist, and raided offices in Trumbull and New Britain as they continued to investigate fraud allegedly committed in practices throughout the state that bilked Medicaid out of a reported $20 million.

Arrested were Mehran Zamani, a 47-year-old dentist from Pound Ridge, N.J., who practiced in Trumbull, Stamford and West Haven, and Gary F. Anusavice, a former dentist from North Kingstown, R.I., who oversaw the practices. Both were charged with conspiring to commit Medicaid fraud.

Anusavice, convicted in 1997 for submitting false health care claims in Massachusetts, was permanently barred by the U.S. Department of Health and Human Services from participating in federal and state health care programs. In November 2005, he lost his rights to practice dentistry in Rhode Island and Massachusetts.

Federal authorities claim, however, that Anusavice created several dental firms in Connecticut using other dentists, including Zamani, to operate them.

Zamani was involved in Dental Group of Connecticut in Trumbull, Dental Group of Stamford and Landmark Dental in West Haven. Court papers said Anusavice reviewed patient charts, suggested dental procedures, reviewed billing records and income reports, interviewed and hired dentists and helped manage these offices.

The prosecution claims Anusavice hired Zamani in October 2008 and allowed him to operate the businesses here. Zamani then filed the various applications necessary to obtain Medicaid reimbursements. He failed to disclose Anusavice's involvement in the businesses on any of the applications.

Of course, everyone is due their day in court, but it looks like Club Fed for these dentists and/or former dentists.

Here is a video of a practice operated by Mehran Zamani which was earlier closed:

9 dental offices closed in CT: wtnh.com

Heartland Dental Care Expands Corporate Office in Effingham, Illinois

Dr. Rick Workman, CEO of Heartland Dental Care at groundbreaking ceremony

The Heartland Dental Care corporate office expansion mirrors their growth throughout the country.

Heartland Dental Care in Effingham may be doubling the size of its facility, creating 80 new full-time jobs over the next two years and retaining approximately 200 more, but it’s the city’s entrepreneurial spirit that helped keep the rapidly-growing company’s roots in Effingham.

    “You folks here in Effingham, I cannot express how honored I am for you to be a part of Heartland,” said Dr. Rick Workman, founder and chief executive officer of the company.

    Workman spoke to a crowd of approximately 50 people at the company’s groundbreaking ceremony Wednesday, where he talked more about Heartland’s $7.7 billion project that’s estimated for completion in June 2013.

    The building size will double to the west, going from its current square footage of 40,000 feet to 80,000 feet. After the two-year mark, approximately 100 more jobs could be created. Another expansion has been mentioned, but no plans have yet been brought to light.

    “It’s hard to imagine 32 years ago that we’d be doing this today,” Workman said, whose company employs approximately 4,000 workers nationwide.

Heartland Dental Care has certainly grown over the years.

But, increasing scrutiny by federal regulators in Medicaid reimbursements (Heartland manages many dental offices in the Midwest where Medicaid reimbursements have been generous) and pressure on state budgets, makes one wonder if the growth can continue. Heartland's growth plan apparently involves management in more dental markets in many more states - where state dental practice acts allow.

Undoubtedly, financial incentives from the State of Illinois and the City of Effingham have played a role in the expansion.

With this expansion, HDC continues to strengthen its commitment to the state of Illinois and city of Effingham. The construction, estimated to be completed by June 2013, will allow Heartland Dental Care to add up to 175 new local jobs over the next few years. In addition, with the number of out of town guests that visit the home office each year continuing to rise, commerce for local hotels, restaurants and other local businesses will increase. With the increased space and the return of the HDC Institute, HDC projects more than 7,000 local hotel rooms being booked by HDC guests each year.

"My administration is committed to putting the people of Southern Illinois to work in good-paying jobs, and companies like Heartland Dental Care are helping us do just that," Governor Quinn said. "Heartland Dental Care's expansion will create jobs in the Effingham area and help grow the economy."

Heartland Dental Care has over 4,000 employees nationwide. The company is eligible for Economic Development for a Growing Economy tax credits, which are based on job creation, and an Employer Training Incentive Program grant to help increase the skills of its workforce. The company will also benefit from being located in an Enterprise Zone. The state's business investment package, administered by the Illinois Department of Commerce and Economic Opportunity (DCEO), is valued at approximately $3.4 million over 10 years and is contingent on the company meeting its investment and job numbers.

Here is an embedded video of the groundbreaking ceremony:

The Morning Drill: May 23, 2012

Dentist Dr. Robert Edgar Stark

Good Wednesday morning!

On to today's dentistry and health headlines:

Upstate dentist accused of threatening woman, saying he'd 'cut her like a fish'

An Upstate dentist has been charged with unlawful communications after being accused of telling a woman that he wanted to put a bullet in her head and “cut her like a fish,” according to an arrest warrant.

Robert Edgar Stark, 64, of 6208 Yellow Jasmine Drive, Simpsonville, also is charged with resisting arrest, simple possession of marijuana and possession of drug paraphernalia, according to a written statement from the Greenville County Sheriff’s Office.

According to the warrant, the incident occurred Sunday, and Stark also is accused of threatening to burn down the woman’s house.

About 4 p.m. Sunday, deputies went to Stark’s home to arrest him on the unlawful communication charge, and authorities said he became “very argumentative,” refusing to place his hands behind his back. When deputies escorted Stark to retrieve some pants for him to wear to jail, they found a homemade tinfoil smoking device that contained a small amount of marijuana, according to the statement from the sheriff’s office.

Bob Mihalic, governmental affairs coordinator for Greenville County, confirmed Stark performed dental work on a contract basis for that county’s detention center. That contract, he said, is under review.

Film industry offers umbrella license to pediatric dentists

The Motion Picture Licensing Corporation (MPLC), an independent copyright licensing agency, is introducing an umbrella license for pediatric dentists that will allow them to show movies and children's programming in their practices in a compliant manner.

The American Academy of Pediatric Dentistry (AAPD) is among the first to partner with MPLC to offer this license to its members. Through their agreement, AAPD members can obtain the umbrella license at a discounted rate, the academy noted in a press release.

Once a license is secured, pediatric dentist office administrators can rent or purchase movies and play them in their exams or waiting rooms without any further reporting.

Gov. Hickenlooper signs dental assistance bill at Murphy Center

Colorado’s senior citizens have something to smile about.

Gov. John Hickenlooper stopped by the Sister Mary Alice Murphy Center for Hope in Fort Collins on Tuesday morning to sign into law a bill that will provide dental care assistance for Colorado residents age 60 and older.

House Bill 12-1326, sponsored by Rep. John Kefalas, D-Fort Collins, will provide funding for dentures, partials, extractions, fillings and cleanings for Colorado residents who qualify for dental assistance.

“There’s a lot of research that shows we could reduce health-care costs by providing better dental care,” said Eileen Doherty, executive director of the Colorado Gerontological Society.

Prudential Dental Insurance Goes National

Prudential Financial, Inc.'s (NYSE:PRU) Group Insurance business is now offering Dental Insurance in all 50 states. With the expanded offerings of three networks, each with different strengths and regional presence, employees have access to 190,000 provider locations for their dental care, allowing them to choose the dental provider that best meets their particular needs.

"Employees consistently rank dental coverage as one of their most valued benefits," said John Rice, vice president, Product Management for Prudential Dental. "We're very proud of our ability to bring dental coverage at an affordable price to small businesses throughout the country. Prudential Dental is an especially good fit for small businesses when bundled with our other products -- life, disability, and long term care insurance. In fact, more than 30% of our dental clients have already bundled their plans with our life and disability products, to provide their employees with a compelling and competitive benefits package."

With both PPO and Indemnity Plans, Prudential Dental is supported by the nationwide provider networks of DenteMax, CAREington and CONNECTION Dental, along with the 4Most Network in West Virginia and surrounding areas. The CONNECTION Dental Network was added to the Prudential Dental product on May 1.

Enjoy your morning!

The Morning Drill: May 22, 2012

Good Tuesday morning!

On to today's dentistry and health headlines:

Allcare Dental president surrenders NH license

Allcare Dental president Robert Bates, DDS, has surrendered his dental license to resolve allegations of professional misconduct by the New Hampshire Board of Dental Examiners, New Hampshire Attorney General Michael A. Delaney announced in a press release.

Allcare closed all of its dental offices in 13 states, including two in New Hampshire, in January 2011. Patients arriving for appointments found a note on the door informing them that the offices were closed. Allcare has since filed for Chapter 7 bankruptcy protection in U.S. Bankruptcy Court in Buffalo, NY, according to the release.

After Allcare closed, the New Hampshire Department of Justice and the state dental board received more than 143 complaints from patients claiming to have had their dental treatment discontinued, according to the New Hampshire Attorney General's office. Many patients had had their teeth extracted and were waiting for permanent dentures that they never received, and many of these patients had pre-paid for dental care that they did not receive.

PSA test for prostate cancer should be dropped, task force says

The PSA test should be abandoned as a prostate cancer screening tool, a government advisory panel has concluded after determining that the side effects from needless biopsies and treatments hurt many more men than are potentially helped by early detection of cancers.

At best, one life will be saved for every 1,000 men screened over a 10-year period, according to the U.S. Preventive Services Task Force. But 100 to 120 men will have suspicious results when there is no cancer, triggering biopsies that can carry complications such as pain, fever, bleeding, infection and hospitalization.

And if cancer is detected, 90% of men will be treated with surgery or radiation even though most tumors are not life-threatening.

Of 1,000 screened men, as many as 40 will suffer impotence or urinary incontinence as a side effect of treatment, two will have heart attacks or strokes and one will develop a dangerous blood clot in the legs or lungs, the task force concluded after a review of the scientific literature. As many as five of 1,000 men who undergo surgery will die within a month.

"There is a small potential benefit and a significant known harm," said Dr. Virginia A. Moyer, a professor of pediatrics at Baylor College of Medicine in Houston, chairwoman of the task force. The PSA test, she said, "should not be part of your checkup.

"Instead, men who want to protect their health should talk with their doctors about prostate-related problems, such as issues with urinary flow, said task force member Dr. Michael LeFevre of the University of Missouri in Columbia. The digital rectal exam is also an option, he added, although there is not much support for that exam either.

Mission of Mercy dental care truly was one to hundreds

With the still-struggling economy, cuts in social welfare, hikes in college tuition and an increasingly divisive society, it's hard to find something to smile about.

But there were plenty of smiles Friday and Saturday as about 1,650 people received about $1.2 million worth of free dental services at Modesto Centre Plaza.

The first Mission of Mercy clinic in the state drew patients from as far as Oregon, and more than 240 oral surgeons and dentists from Stanislaus County as well as Carmel Valley, Long Beach and other areas throughout the state. More than 1,000 volunteers and 70 sponsors helped, too.

The huge public service event was a collaboration of the Stanislaus Dental Society, the California Dental Association Foundation and the America's Dentists Care Foundation, based in Kansas. The day started with X-rays and led to 7,200 procedures, including fillings, infection care, decayed tooth removals, even one-step dentures.

Many patients said they could not get regular dental care because of layoffs and cutbacks in Medi-Cal funding. Dr. Andy Soderstrom of Modesto, who spearheaded the day, said some patients were desperate for dental treatment.

The need was so great that by 4 a.m. Friday, the line stretched around the convention center.

Charity 'Tooth Taxi' fights decay in Oregon kids

Oregon children have one of the highest rates of dental problems in the nation. But a unique clinic is trying to change that.

From the outside, the Tooth Taxi looks kind of like a tour bus. But step inside, you'll find a state-of-the-art dental office on wheels.

“We are a dental clinic that provides free care and oral health education to under-served children all over state of Oregon,” said Charlie LaTourette, executive director of the Dental Foundation of Oregon.

On Monday, the Tooth Taxi stopped at Rigler Elementary School in Northeast Portland.

Students jumped on-board and got a full dental exam complete with X-rays. Some of the kids had only been the dentist one or two times before.

“Some have never been to the dentist, so everything is new, so we take the time to explain what we are doing, “ said Dr. Jennifer McLeod, the staff dentist on-board.

More than 50 percent of Oregon children suffer from tooth decay. Experts point to a shortage of dental professionals and poor nutrition as causes, but say poverty is the number one reason.

Many parents simply can't afford to take their kids to the dentist and that leads to more than just cavities.

“Untreated dental decay is the leading cause of absenteeism and the leading cause of not being able to focus ... not being able to do homework,” said Cassandra Griffin, with Upstream Public Health.

Enjoy your morning!

The Morning Drill: May 21, 2012

From Dr. Sherri Worth's website

Good Monday moring!

I am recovering from yesterday's Pasadena Half Marathon, but here are today's dentistry and health headlines:

'Dentist to stars' pays $641K in malpractice lawsuit

A prominent cosmetic dentist in California whose ads boast of treating movie stars and sports celebrities has paid a $641,542 award in a malpractice lawsuit, one of six such lawsuits filed against her in nine years.

Newport Beach dentist Sherri Worth, DDS, paid the award following an arbitrator's finding that she did excessive preparation of 22 teeth, plus laser surgery, during a two-hour and 40-minute procedure on March, 5, 2009. As a result, the patient, Ingrid Valdez, suffered irreversible pulpitis and nerve damage which required several root canals.

"She went too fast and too deep and removed too much gum tissue without removing bone, which is needed to treat a 'gummy smile' for a crown lengthening procedure," Valdez's attorney, Edwin Zinman, DDS, a San Francisco attorney who specializes in dental law, told DrBicuspid.com. "She should have referred her to a periodontist before doing the prep work."

Several dentists testified in hearings that Dr. Worth had violated the biologic width of Valdez's gums during laser surgery and did overcontoured restorations that resulted in gross malocclusions that could not be corrected by adjustment. They also testified that Dr. Worth's dental work needed to be removed, the crowns lengthened, and new restorations placed.

The award was one of the largest decisions involving crowns, veneers, and bridges, according to Dr. Zinman.

iPhone records doctor's questionable behavior

The sound of a dentist's drill can make even the toughest patients panic. But for one Valley man, it wasn't the drill that worried him. It's what was said during his dental procedure.

"I had told him I was very uncomfortable going under general anesthesia," said Donovan Cade, who was scheduled to have his wisdom teeth pulled. "He convinced me to anyway during our consultation." 

Both Cade and the dentist, Dr. Brown Harris, will tell you they got off to a rough start after an initial consultation turned into a heated billing dispute. So Harris offered to perform the surgery at a steep discount. Cade booked it and then did something that many of us might not even think of.

"I went ahead and turned on the voice recorder on my phone and left it on the table next to the chair," said Cade.

It's a simple action, taken in a moment of vulnerability, that would capture something unthinkable.

"I know everybody wants to write Dick on his forehead," said a male voice that can be heard on Cade's iPhone recording. He says the voice is that of Dr. Harris, who can then be heard saying, "But I'll just have to sit back and think I could and I chose not to, thus I feel better."

Cade can be heard in the recording multiple times saying, "Ow Ow Ow."

At one point the person identified as Harris asks, "You want to do another shot?" Someone else responds, "Eh, I don't care."

Several people are heard laughing before the man believed to be Harris says, "Well, I tell you this much. I don't think I would go back to a place where I was so mean to just in case they decide to give me a tattoo."

Cade says the entire 28-minute procedure was recorded on his iPhone.

"It had a pretty big impact on me," said Cade. "I was as anybody would be when you find yourself mistreated, when you were completely vulnerable in somebody's care."

State-regulated professionals urge court reversal of FTC order

The Federal Trade Commission lacks jurisdiction over the North Carolina State Board of Dental Examiners, the ADA and associations of state-regulated health care professionals and state dental and medical boards contend in a brief filed May 17 with the U.S. Court of Appeals for the Fourth Circuit.

The eight organization friend of the court brief urges the court to reverse an FTC final order against the North Carolina board. The FTC administrative ruling has drawn congressional and judicial attention.

“Each amicus (interested party) supports the determination by the states that the health professions should be regulated by knowledgeable health care professionals who have practical experience in the profession they are regulating,” says the brief filed on behalf of the American Dental Association, American Osteopathic Association, American Veterinary Medical Association, American Academy of Pediatric Dentistry, American Academy of Periodontology, American Association of Orthodontists and the American Association of Dental Boards and Federation of State Medical Boards.

“Each has a direct interest in assuring that state regulatory boards are able to discharge their statutory responsibilities with accountability to the state legislatures that created them – without intervention and second guessing by the Federal Trade Commission, a federal agency that lacks jurisdiction over these boards, that has no particular expertise in the professions regulated by these boards, and that, by misapplying the federal antitrust laws, seeks to substitute its concept of the public interest for the position taken by the board charged by the state legislature with determining what is in the public interest in the area of its regulatory authority.”

Dr. Ron Goodlin, of Aurora, Ontario, is the new president of the American Academy of Cosmetic Dentistry.

Dr. Ron Goodlin of Aurora, Ontario, took the helm as president of the American Academy of Cosmetic Dentistry (AACD) during the AACD’s 28th Annual Scientific Session in Washington, DC, May 2-5.

Dr. Goodlin is an Accredited member of the AACD and has been involved in the organization since 1997.

Dr. Goodlin practices dentistry at Smiles Dental, located in Aurora, Ontario. In his free time, he is an amateur photographer and is working to open a dental clinic in Tanzania. His objective is to encourage dentists from Canada, the U.S., and Europe to spend a day or two at the clinic as they pass through Tanzania during safari vacations, as well as create an opportunity for dental students to visit and do some work there.

“I am so excited about the upcoming year as president of the Academy,” Goodlin said.
“Together, all of us at the Academy will make a great team and I know we will accomplish a lot and have fun doing it!”

In addition to his work at AACD, he is currently the president of the Toronto Academy of Cosmetic Dentistry, is a co-founder of the Canadian Academy of Cosmetic Dentistry, and served as the Editor of the Canadian Journal of Cosmetic Dentistry from 2000-2008. He remains the Associate Editor and is on the editorial boards of both Spectrum and Teamwork dental journals. He graduated from the University of Toronto Faculty of Dentistry in 1980.

Enjoy your morning!

Texas Dentists Plead Guilty to Medicaid Fraud

Orthogenesis International Centre

Texas Medicaid dentist Dr. Carlos Armin Morales-Ryan and his wife, orthodontist Dr. Nelia Patricia Garcia-Morales have pleaded guilty to charges involving Texas dental Medicaid.

Local dentist Dr. Carlos Armin Morales-Ryan, 45, and his wife, local orthodontist Dr. Nelia Patricia Garcia-Morales, 42, have pleaded guilty to a criminal information admitting they made false statements on bills to Texas Medicaid, United States Attorney Kenneth Magidson announced today.

Morales-Ryan and Garcia-Morales owned and operated Orthogenesis International Centre, a Laredo dentistry and orthodontics business, and a substantial portion of their business was targeted to rendering services to Medicaid-eligible children. Applicable Texas law and Medicaid regulations required them to be in their offices when services were rendered on Medicaid patients as a prerequisite to receiving payment for the services from Medicaid. Similar consumer protection laws and regulations are applicable to most types of physicians for many of the services they render in Texas, regardless of whether the patient is or is not a Medicaid beneficiary.

Morales-Ryan’s signed plea agreement states that though he and Garcia-Morales were in Hawaii on or about October 12, 2007, he falsely represented to Medicaid that he performed an evaluation and management of a new patient on that date claiming entitlement to payment. However, at the time he made this false representation to Medicaid, he and Garcia-Morales knew the statement was false and that neither of them performed that service on or about that date. Similarly, Garcia-Morales admitted that though she and Morales-Ryan were en route to the U.S. Virgin Islands on March 23, 2007, she falsely represented to Medicaid that she performed an orthodontic retention on that date, claiming entitlement to payment. However, at the time she made this false representation to Medicaid, she and Morales-Ryan knew the statement was false and that neither of them performed an orthodontic retention on or about that date.

Texas Medicaid is a health care program funded in part by the federal government through payroll taxes and in part by the state of Texas.

As a result of their plea agreements, they will be sentenced to five years’ probation and will pay restitution in the amount of $686,545 to the Texas Health and Human Services Commission-Office of Inspector General.

Morales-Ryan currently is not licensed to practice dentistry in Texas due to an unrelated criminal proceeding.

A reminder to all dentists - bill for what you do and no more.

The federal government and the states will catch up with you - eventually.

The Daily Extraction: May 17, 2012

Tooth number 2, Upper right second molar to be extracted today

Dr. Tommy Murph uses his Crane Pick to remove this upper second molar.

Here is the pre-operative radiograph (x-ray):

And, the extracted tooth:

Here is the video of the extraction procedure:

Enjoy your daily extraction!

Dr. Murph is a South Carolina dentist who practices general dentistry who really excels in extracting teeth.

For patients in the Myrtle Beach area, I can heartily recommend Tommy as YOUR dentist.

For dentists, Dr. Murph has a number of resources for you in extracting teeth, including one on one courses in his office and travel (outside  the USA) courses with "hands on" instruction.

Dr. Murph's website is here and his extraction manuals are here on e-Bay.

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The Daily Extraction Archive

The Morning Drill: May 17, 2012

Photo courtesy of Raven Maria Blanco Foundation

Good Thursday morning!

On to today's dentistry and health headlines:

Drugmaker discontinues pediatric oral sedative

Pharmaceutical Associates, a South Carolina-based drug manufacturer, has discontinued production of chloral hydrate oral solution, an anesthetic used in pediatric dentistry. The company cited "business reasons" as the source of the decision, which came in March.

I think it's probably going to have a fairly wide impact," Stephen Wilson, DMD, PhD, professor and director of the Division of Pediatric Dentistry at Cincinnati Children's Hospital Medical Center, said in an interview with DrBicuspid.com. "I talked to a couple of colleagues who use it, and they're not quite sure what they're going to do to substitute it with a different drug or combination of drugs. That is the case with us, as well."

A bulletin from the American Society of Health System Pharmacists (ASHP) noted there are no other manufacturers of the oral solution form of the drug. However, 500-mg capsules or powder forms that can be used to create a solution are still available, according to Dr. Wilson.

But its use in dentistry has not been without controversy, and there are mixed opinions about its usefulness.

"Quite frankly, I'm surprised the manufacturer didn't discontinue it sooner," John Liu, DDS, immediate past president of the American Academy of Pediatric Dentistry, told DrBicuspid.com. "There were issues and questions about its effectiveness and safety that I could clearly see in some of the patients I treated with chloral hydrate that concerned me enough that I stopped using it in the late 1980s."

The University of Florida discontinued its use after the death of a five-year-old boy in 2010 who had been sedated with the drug. Dylan Shane Stewart went into cardiac arrest during a procedure to have four fillings and eight crowns placed. The amount administered was reportedly "far more" than the recommended dosage, causing a toxic reaction. While the drug is safe and effective if the exact dosage is used, some experts say it can be "unforgiving" if too much is used.

Former Helena dentist on probation with dentistry board

A 45-year-old dentist charged inHelenafor a sex crime is now on probation with the state Board of Dentistry for not being forthcoming on his renewal about the charge and for being convicted of a charge involving violence.

Jason James Roan, who currently lives inBillings, initially charged with sexual intercourse without consent, entered an Alford plea on a lesser charge of felony criminal endangerment. Roan received a three-year deferred sentence after admitting to creating a substantial risk of serious bodily injury to his victim.

After the charges were filed in April 2010, Roan renewed his dentistry license. On the paperwork, he answered no to a question asking if any legal or disciplinary actions had been instituted against him since his last renewal, according to documents released by the Board of Dentistry on Wednesday.

The board ordered Roan’s license be placed on probation for three years with quarterly updates from his state probation officer, employment-supervising dentist and psychotherapist. He also was fined $4,000 and must be supervised while working.

Sports dentistry symposium to focus on female athletes

For the first time in its 30-year history, the Academy for Sports Dentistry Annual Symposium will offer continuing education that focuses on female athletes as ASD celebrates the 40th anniversary of Title IX.

The special track at the meeting, to convene June 21-23 at the Minneapolis Marriott City Center, will include the courses Girls & Women in Sport: Key Issues 40 Years After Title IX; Women in Sport–From Title IX to 2012; Treating the Female Athlete; Body Image Sports/Eating Disorders; and The Female Athlete Triad and Energy Deficiency. Title IX of the Education Amendments of 1972 protects people from discrimination based on sex in education programs and activities that receive federal financial assistance.

“Saturday, June 23 is the 40th anniversary of Title IX and the ASD is proud to recognize the occasion by discussing the issues affecting treatment for the female athlete,” said Dr. Paul Nativi, ASD president. “Drs. Nicole Lavoi, Joel Boyd, Jillian Lampert and William Roberts will present various topics unique to the female athlete. Women athletes make up an increasing percentage of the athletes we see, making this a very appropriate topic.”

DenMat officially announces move to Lompoc

DenMat Holdings LLC, a dental products provider and major employer with plans to grow, announced Wednesday that it will vacate its facilities in Santa Maria and relocate its 350 employees to Lompoc.

The move by DenMat, which as been talked about behind the scenes for several months, will begin in June and take place over six months, according to Steve Semmelmayer, chief executive officer of DenMat.

“Our current and future space needs dictate a move to a facility where we can consolidate operations under one roof as well as provide room for expansion,” Semmelmayer said in a prepared statement.

DenMat, which also provides laboratory services to dentists in more than 68 countries, will be moving to 1017 W. Central Ave. in Lompoc. The building is now occupied by Central Plastics, Inc., a supplier for DenMat, which is expected to eventually relocate to another building in Lompoc, according to city officials.

Lompoc Mayor John Linn, who was out of town Wednesday but in touch with city hall, said the DenMat announcement is important news for Lompoc.

“This is the largest single-employer gain since the Space Shuttle,” Linn said, referring to the aerospace industry expansion in the 1980s. “It’s going to put a bunch of folks in Lompoc every day.”

Although few if any new hires will occur in Lompoc, DenMat’s expansion plans bode well for the city’s future, Linn said.

Enjoy your morning!

Gregory Flap Cole Named Top Dentist in Social Media for 2012

From 1dental..com

A list of top dentists in social media has been released.

And, I am happy to report that I have been named number one this year!

Thanks to 1dental.com for their kind comments.

The Morning Drill: May 15, 2012

Diaco Dental Chair

Good Tuesday morning!

On to today's dentistry and health headlines:

Dental chairs developed for large patients

The dental school at the University of Texas Health Science Center, San Antonio is using a new line of dental chairs for large patients who have difficulty fitting into conventional dental chairs.

The school has installed a special chair designed to tilt, raise, or lower dental patients weighing up to 1,000 pounds, according to a story in the San Antonio Express-News.

The chair, built by Diaco Dental, cost $30,000, compared to about $10,000 for a standard chair.

Brownback signs bill to help fill Kansas dentist shortage

Gov. Sam Brownback has signed into law a bill that's intended to help the state cope with a dentist shortage but critics say doesn't go far enough.

Brownback signed a law the expands the ability of dental hygienists to deal with tooth decay to help deal with the fact that 93 Kansas counties don't have enough dentists to serve their residents and 13 others don't even have a dentist.

The bill is a much scaled down approach compared to another proposal that would have created a midlevel provider called a registered dental therapist who could perform some of the duties now handled by dentists, including filling cavities and pulling teeth.

Other states have considered similar bills, but only Alaska and Minnesota have comparable laws.

But the Legislature coalesced around the bill supported by dental industry, which feared that the other proposal would put dental patients at risk by giving hygienists the ability to provide types of oral treatment best left to dentists.

Actor Michael Douglas Partners With Oral Cancer Foundation For Early Detection PSA Campaign

Two-time Oscar Winner and Cancer Survivor Encourages Regular Screenings as Counter to Rising Incidence Rates of Oral Cancer-

Actor and producer Michael Douglas has donated his time to help create a television public service announcement (PSA) on behalf of the Oral Cancer Foundation (OCF), a non-profit organization dedicated to helping those affected by the disease. The PSA will support the Foundation's efforts to educate the public about the need for annual screenings to catch oral cancers in their early, most survivable stages. The public service announcement will begin airing in June, and will continue to air nationwide through summer and autumn.

Approximately 40,000 people in the US will be newly diagnosed with oral cancer in 2012. This includes those cancers that occur in the mouth itself, in the very back of the mouth known as the oropharynx, and on the exterior lip of the mouth. There are two distinct pathways by which most people come to oral cancer. One is through the use of tobacco and alcohol, and the other is through exposure to the HPV-16 virus (human papilloma virus version 16), a newly identified etiology, and the same virus which is responsible for the vast majority of cervical cancers in women. While oral cancer has historically been linked to tobacco and alcohol use, this is not simply a smoker's disease any longer. New data shows that the fastest-growing segment of newly diagnosed cases is now young, non-smokers. Most startling, is the fact that while many other cancers have been in decline in recent years, the occurrence of oral / oropharyngeal cancers has increased each of the last six years, and peer reviewed published data shows that the numbers of HPV-related oral cancers will surpass cervical cancers in the near future.

Odd law blocks dental professionals from treating spouses

Dental professionals in Ontario, Canada, hope a review by the province's health minister and a recently tabled bill will correct a problem they call "ridiculous" and "offensive."

Based on current law, a dentist, dental hygienist, or other healthcare professional in Ontario who treats his or her spouse has committed sexual abuse and can be immediately barred from practicing for at least five years without the possibility of an appeal.

In April 2011 the province's health minister commissioned a report on the issue; that report is expected to be completed by June 1. And last month a member of the Ontario parliament introduced a bill focused on dentists that calls for the law to be changed so they can provide treatment to their spouses without fear of punishment.

Enjoy your morning!

All Smiles Dental Files for Bankruptcy

You remember the story on Texas Orthodontic Medicaid fraud investigations.

Now, one of the dental corporations involved, All Smiles Dental, has filed for bankruptcy protection.

All Smiles Dental Center has filed for bankruptcy.

But even today, at least one of its clinics is still advertising "Frenos Gratis Con Medicaid," or free braces with Medicaid, flaunting state regulations which were never supposed to routinely provide free braces.

For the past several months, the chain has been shrinking. From dozens of clinics a year ago, to a handful now. One high-volume clinic on Garland Road in Dallas has closed.

In Chapter 11 filings, All Smiles lists $50-100 million in liabilities, and $1-10 million in assets.

Founder Dr. Richard Malouf is listed as owning 28 percent of the company, while Valor Equity of Chicago owns the remaining 72 percent.

At one point, All Smiles billed as much for Medicaid braces as the entire State of Illinois.

Founder Malouf flaunted two corporate jets, a Bentley in the garage and a Porsche Carerra in his driveway.

And the driveway is connected to a mansion that is a counter to any argument that says a dentist can't make money under Medicaid. The French chateau, listed on tax rolls at $11 million, is nestled among Dallas' most ostentatious properties on Strait Lane.

The mansion is untouchable in the bankruptcy.

In March, Malouf agreed to settle a Medicaid billing case for $1.2 million. The federal government charged him with fraudulent Medicaid billing for four years, ending in 2007, before his biggest billings for Medicaid braces. In settling the case, he admitted no wrongdoing.

And, who gets left holding the bag?

Well, American taxpayers that is who.

Can you imagine what will happen if the United States Supreme Court holds the Affordable Care Act (ObamaCare) as constitutional and the Feds take over the entire medical system?

Here is the video investigation:

The Morning Drill: May 10, 2012

Dr. Bruce Fisher - charges dropped

Good Thursday morning!

On to today's dentistry and health headlines:

Charges against Lewes dentist dropped

Delaware Department of Justice has dropped its offensive touching case against Lewes dentist Dr. Bruce Fisher in Sussex County Family Court.

Jason Miller, spokesman for the Department of Justice, said the charges were dropped because of insufficient evidence before trial. He said the department had no further comment at this time.

Fisher, 44, was arrested March 9 after he allegedly covered the mouth of an 8-year old and told him to shut up. Police said the child was at Fisher’s First State Oral Surgery for a medical procedure and began screaming after the procedure was finished. A family member was in the room and reported Fisher to Delaware State Police.

Cavity-fighting measure sinks along with civil unions

A bill aimed at thwarting cavities in babies became collateral damage in the fight over civil unions in Colorado late Tuesday night.

Senate Bill 12-108 had sailed through earlier hearings and was expected to pass in the House on Tuesday night, then be up for final approval today.

But the bill died along with nearly three dozen other measures that were held hostage during the civil unions standoff.

SB 108 would have provided funding for dental benefits for pregnant moms on Medicaid. Research has shown that mothers who have tooth decay and untreated cavities can pass bacteria to their babies, thus infecting their teeth and causing some babies and toddlers to lose all their baby teeth before age 3. Poor dental health of mothers also has been associated with premature birth, another highly expensive health problem.

Numerous dental experts from Children’s Hospital Colorado and the Colorado Dental Association had worked with advocates for low-income patients and members of the legislature’s Joint Budget Committee to find funding to help pregnant mothers take better care of their teeth.

“We are disappointed,” said Dr. Ulrich Klein, a doctor of dentistry at Children’s Hospital and chair of the pediatric dentistry at the University of Colorado School of Dental Medicine. “We have been fighting this battle for so long.”

New Cautions About Long-Term Use of Bone Drugs

In an unusual move that may prompt millions of women to rethink their use of popular bone-building drugs, the Food and Drug Administration published an analysis that suggested caution about long-term use of the drugs, but fell short of issuing specific recommendations.

The F.D.A. review, published in The New England Journal of Medicine online on Wednesday, was prompted by a growing debate over how long women should continue using the drugs, known as bisphosphonates, which are sold as generic versions of brands like Fosamax and Boniva, as well as Novartis’s Reclast.

The concern is that after years of use, the drugs may in rare cases actually lead to weaker bones in certain women, contributing to “rare but serious adverse events,” including unusual femur fractures, esophageal cancer and osteonecrosis of the jaw, a painful and disfiguring crumbling of the jaw bone.

Although the concerns about the long-term safety of bone drugs are not new, the F.D.A. performed its own systematic review of the effectiveness of bisphosphonates after years of use. The agency’s analysis, which found little if any benefit from the drugs after three to five years of use, may prompt doctors around the country to rethink how they prescribe them.

Scientists Identify Neurotranmitters That Lead to Forgetting

While we often think of memory as a way of preserving the essential idea of who we are, little thought is given to the importance of forgetting to our wellbeing, whether what we forget belongs in the "horrible memories department" or just reflects the minutia of day-to-day living.

Despite the fact that forgetting is normal, exactly how we forget -- the molecular, cellular, and brain circuit mechanisms underlying the process -- is poorly understood.

Now, in a study that appears in the May 10, 2012 issue of the journal Neuron, scientists from the Florida campus of The Scripps Research Institute have pinpointed a mechanism that is essential for forming memories in the first place and, as it turns out, is equally essential for eliminating them after memories have formed.

"This study focuses on the molecular biology of active forgetting," said Ron Davis, chair of the Scripps Research Department of Neuroscience who led the project. "Until now, the basic thought has been that forgetting is mostly a passive process. Our findings make clear that forgetting is an active process that is probably regulated."

Enjoy your morning!

American Dental Association: Dentist Incomes Are Falling

According to a new ADA study.

US dentists' incomes have been dropping steadily since 2005, mainly because Americans are using less dental care, according to a report published in the May issue of the Journal of the American Dental Association.

"That was one of the surprising results," lead author Marko Vujicic, PhD, an American Dental Association (ADA) economist, told Medscape Medical News.

Independent general practitioners' average real net income peaked at $217,850 in 2005 and fell to $192,680 in 2009, the most recent year for which data are available, according to researchers for the ADA. Before that, dentists' incomes had gone up almost every year since 1981, they said.

Dr. Vujicic and colleagues found a number of factors that helped explain the change in income, including a lower portion of the population getting dental care, fewer dental visits per patient, an increase in the number of dentists per capita, an increase in expenses for dental practices, and a lower percentage of billings collected.

The researchers focused on independent general dentists, who make up the vast majority of dentists in the United States.

The authors write that they drew on several sources for these findings. Information about dentists' real net income was derived from the ADA's annual Survey of Dental Practice, a random sample of about 4000 to 7000 dentists in private practice. They used statistical methods to make sure that the results were not skewed by trends in demographic factors such as age, sex, geographical region, and location (urban or rural).

They also drew on US Census Bureau data to find out whether the number of dentists was changing in relation to the general population, and they used the Medical Expenditure Panel Surveys from the US Agency for Healthcare Research and Quality to calculate the percentage of the population who had seen a dentist each year.

No real surprise here and I would say the income propsects for American dentistry is guarded for the next few years.

Many states, including California  have cut back on Medicaid benefits for poor patients. Couple this with a declining private economy with the concomitant cutback of private dental insurance benefits, you have a perfect storm for declining incomes.

Private dental office overhead costs are high and with increasing regulation and taxes, net income may continue to fall.

What is the solution?

A growth oriented economy, including lower corporate and small business taxes will rise all ships in this economy.

The Morning Drill: May 9, 2012

Good Wednesday morning!

I was traveling yesterday for my locum tenens dentistry practice and did not have a chance to post. But, here we go for today.

On to today's dentistry and health headlines:

Story of vengeful jilted dentist WAS too good to be true

A hugely popular news story about a jilted dentist accused of pulling out all her ex-boyfriend's teeth has unraveled as a hoax.

News websites around the world ran the story last week about a woman in Poland named Anna Maćkowiak who took revenge on a man named Marek Olszewski when he turned up at her clinic complaining of toothache, days after dumping her for another woman.

Among the numerous U.S. news sites that picked up the story were Fox News, the Los Angeles Times, the San Francisco Chronicle, Huffington Post, Yahoo! News, MSN, the New York Post, and The New York Daily News. (Msnbc.com is a joint venture of Microsoft, which operates MSN, and Comcast.)
The story even included quotes from the scorned dentist and her toothless ex.

"I tried to be professional and detach myself from my emotions. But when I saw him lying there I just thought, "What a b******," Maćkowiak was quoted as saying.

Quotes attributed to the boyfriend victim meanwhile read: "I knew something was wrong because when I woke up I couldn’t feel any teeth ... When I got home I looked in the mirror and couldn't f******* believe it. The b**** had emptied my mouth."

From secret service to dentist

At 42, age isn’t the only thing non-traditional about Cat Guerrero, a fourth-year dental student at ASDOH. Named by her father after the 1965 movie, “Cat Ballou,” Guerrero decided on dentistry after having two other successful occupations.

Guerrero’s career began in administration with the United States Secret Service where she worked more than five years. She completed background checks, worked in the counterfeiting division, and was also responsible for special details with foreign dignitaries. She even worked a detail for President George H.W. Bush.

It was while working with the Secret Service that the idea of becoming a dentist first occurred to her.

“I was discussing my career with an agent that I knew,” says Guerrero. “At the time, I was taking classes at the Maryland Institute of Art, thinking that I could one day work for Disney doing animation. When the agent said his wife was a dentist, I was impressed. It was the 80s, and women’s career opportunities were limited – mostly clerical jobs or grocery shop clerks.”

After moving to Arizona in 1992, Guerrero found a second career at a large computer distributing company where she configured network systems. But she soon decided that the corporate world was wearing thin.

“I wanted to spend more quality time with my family and be more involved with them,” she says. “I was tired of 60-hour work weeks.”

The thought of becoming a dentist still echoed in her mind. At age 32, Guerrero volunteered at the Central Arizona Shelter Services (CASS) Dental Clinic in Phoenix where she met students from ASDOH.

Dentists 'inventing work to defraud NHS'

Dental surgeries are exaggerating or inventing work they have done for the National Health Service in order to swindle tens of millions of pounds out of taxpayers, according to a check up of dentists’ honesty.

Among the rogue practices were submitting false claims for more treatment than had been carried out and submitting claims on behalf of patients do not exist.

Claims for ‘ghost patients’ were the most blatant in a catalogue of illegal practices uncovered by an audit of 5,000 dentists’ invoices examined by NHS Protect, the anti-fraud unit of the health service.

Overall, 3 per cent of claims examined were deemed to be fraudulent, indicating that dishonest dentists defrauded the NHS out of £73.1m in 2009-2010, when the check was made. By 2014, the NHS could lose a further £146.3m unless the deception was halted, the report, Dental Contractor Loss Analysis Exercise, published today.

The Conservatives claimed the losses exposed in the report stemmed from a new NHS contract introduced by Labour in 2006. Labour blamed the dentists for swindling the taxpayer and called for tougher action from regulators.

Under the new dentistry contracts introduced by Tony Blair, dentists were paid by three broad bands of work rather than for each procedure on a long and complex list.

42% of American adults will be obese by 2030, study says

The ranks of obese Americans are expected to swell even further in the coming years, rising from 36% of the adult population today to 42% by 2030, experts said Monday.

Kicking off a government-led conference on the public health ramifications of all those expanding waistlines, the authors of a new report estimated that the cost of treating those additional obese people for diabetes, heart disease and other medical conditions would add up to nearly $550 billion over the next two decades.

The sobering projections also contained some good news, the researchers said: Obesity's growth has slowed from the record pace of most of the last 30 years. If those trends were to continue, 51% of American adults would qualify as obese in 2030.

Study leader Eric Finkelstein, a health economist at Duke University in Durham, N.C., said it was unclear whether growth had slowed thanks to public policy initiatives aimed at preventing childhood obesity, greater societal awareness of obesity's health risks, or because Americans have hit the maximum level of fatness a population can sustain.

Enjoy your morning!

The Morning Drill: May 7, 2012

Centuries ago, dental calculus would build up through the years, layer after layer, like a stalagmite, sometimes reaching impressive proportions. University of Nevada, Reno researchers have discovered that analysis of tiny fragments of this material can be used effectively in paleodietary research – the study of diets of earlier ancient and populations – without the need to destroy bone, as other methods do

Good Monday morning!

On to today's dentistry and health headlines:

Anthropologists Discover New Research Use for Dental Plaque: Examining Diets of Ancient Peoples

While we may brush and floss tirelessly and our dentists may regularly scrape and pick at our teeth to minimize the formation of plaque known as tartar or dental calculus, anthropologists may be rejoicing at the fact that past civilizations were not so careful with their dental hygiene.

University of Nevada, Reno researchers G. Richard Scott and Simon R. Poulson discovered that very small particles of plaque removed from the teeth of ancient populations may provide good clues about their diets. Scott is chair and associate professor of anthropology in the College of Liberal Arts. Poulson is research professor of geological sciences in the Mackay School of Earth Sciences and Engineering.

Nothing to Smile About

MacKenzie Doolittle, 9, isn’t afraid of the dentist. As she climbs into Dr. Nikki Stone’s exam chair, she chats amiably and explains that she knows all about plaque, cavities, and the importance of brushing her teeth. She started brushing every morning and afternoon after hearing in school that, if she didn’t, she could have “all false teeth” by the age of 28.

“I decided that I didn’t want that,” she says.

Thanks to an enterprising local public-health provider, Doolittle is the rare rural child with access to free dental services that come to her. Every year, a mobile van—donated by the Ronald McDonald House and affiliated with a nearby community health center—visits Doolittle’s elementary school so the dentist can clean teeth, apply sealants, and dispense fluoride treatments.

But when the second-grader opens her mouth, it’s clear she’ll need more than that. Despite her newfound vigilance, she has nine cavities, and Stone can’t fix them. The traveling clinic offers free care, but its mandate is limited to prevention: Kids who need cavities drilled or teeth pulled have to go elsewhere. And in Hazard, like many other rural areas, that’s not easy.

The United States faces a shortage of dentists that is particularly acute in poor, rural regions. Huge pockets of the country have few (or no) providers. The federal government counts 4,503 mostly rural regions where more than 3,000 people share one dentist, making it tough for many residents to find someone to fix their teeth.

Dentistry lacks consistency in restoration decision-making

Dentists who take a conservative approach to placing restorations tend to stay conservative when replacing or repairing them. And dentists who aggressively treat primary caries also stick with their preferred strategy when assessing existing restorations.

But majorities were lacking among decisions dentists made about the repair and placement of restorations, according to a study presented during a poster session at the recent American Association for Dental Research (AADR) annual meeting in Tampa.

"In contrast to the consistency of an individual practitioner-investigator's treatment planning approach, there was considerable variation among practitioner-investigators in their treatment recommendations on the same teeth," noted researchers from the Dental Practice-Based Research Network (DPBRN) Collaborative Group.

Enjoy your morning!

The Morning Drill: May 4, 2012

Augusta Pediatric Dentistry assistant Molly Turner, left, and hygienist Diana DeRocher apply dental sealants to the teeth of Blin Rollins, 8 of Augusta, Maine. Photo: MSNBC

Good Friday morning! It is almost the weekend.

On to today's dentistry and health headlines:

Decay dilemma: Do kids need dental sealants?

But what Rollins didn’t know is that her child’s mouth is part of an ongoing debate over whether enough kids get the liquid plastic coverings that protect what Shenkin calls “the most decayed tooth in the mouth.”

Only about 20 percent of children at poverty level and only 40 percent of kids from higher-income homes actually receive recommended sealants, according to studies by the Centers for Disease Control and Prevention.

That confounds Shenkin, a pediatric dentist and spokesman for the American Dental Association. He says decades of research demonstrate that coating the biting surfaces of 6-year molars with a resin-based sealant can reduce cavities by up to nearly 80 percent immediately -- and up to 60 percent for four years or more.

“It’s imperative that as soon as those adult teeth erupt, that they be sealed,” he said.

In practice, however, less than 40 percent of dentists actually follow the recommendations of the ADA, according to a 2011 study by researchers at Temple University. The study tracked whether dentists were willing to seal teeth with the beginnings of decay, but no actual cavities.

“The lack of dentists doing sealants is a very silent and probably the most significant issue to care we face among children,” said Shenkin. “Parents should be asking for sealants and not taking no for an answer.”

But one of the profession’s most well-regarded dentists has been publicly cautious about sealants, saying there can be a high failure rate -- 50 percent within five years -- and arguing that they shouldn’t be placed if there’s any evidence of decay.

Gordon J. Christensen, who publishes Clinicians Report, widely regarded as the “Consumer Reports of dental products,” says that sealants done properly are “an excellent technique” for combatting decay. But, he adds, the success of the sealant depends largely on the skill of the person who applies it.

 “They have to seek out a practitioner who knows what they’re doing,” he said.

“If they see failure immediately, that opens the window for decay.”

Christensen is concerned about so-called “non-cavitated caries lesions,” early signs of tooth decay that have not yet resulted in cavities. He worries that sealants trap plaque on the tooth, creating an environment that fuels future decay.

CDC researchers say studies have shown that decay does not progress once sealants are added, but Christensen maintains that he’s not convinced.

Dentist charged with possession of crystal meth with intent to sell

A Silver Spring dentist has been busted for allegedly possessing methamphetamines and charged with intending to distribute the drugs.

Dr. Siar Karmand was arrested early Thursday morning at his home in the gated Beekman Place community in Northwest D.C.

D.C. Police claim to have found $11,000 worth of crystal meth and seven ounces of GHB in Karmand's home.

"There's a common denominator to drug use," says Ward 3 D.C. Councilmember Jim Graham. "It applies across the board. It doesn't have any particular group, class or income that it favors over another. It's just that we have stereotypes about all this. And this cuts through the stereotypes."

Karmand maintained an office at a medical building on Georgia Avenue in Silver Spring. At the dentist office next door to his, the staff told us this was a sad day for dentistry. They told us they rarely saw Karmand. They say he kept odd hours.

Aspen Dental Donates More Than $16,000 to Oral Cancer Foundation

Aspen Dental, one of the largest networks of dental care providers in the U.S., is donating $16,255 to the Oral Cancer Foundation in recognition of Oral Cancer Awareness Month. As a commitment to early oral cancer detection, 340 Aspen Dental practices in 22 states donated $5 from every Vizilite Plus screening conducted during the month of April. A total of 3,251 screenings were conducted throughout the month.

"The Oral Cancer Foundation is steadfast in its commitment to saving lives through prevention, research and advocacy, and we're proud to support their efforts through this donation," said Maureen Howes, RDH, MS, director of hygiene services at Aspen Dental Management, Inc.

According to the Oral Cancer Foundation, close to 37,000 Americans will be diagnosed with oral or pharyngeal cancer this year, which is responsible for approximately 8,000 deaths annually. Common risk factors for oral cancer include use of tobacco products (smoked and smokeless), excessive alcohol consumption, and HPV infection.

Coffee Stains Teeth More Indelibly Than Tobacco

Coffee stains return on bleached teeth, whereas cigarette stains may not. In addition, coffee stains cannot be removed by brushing alone, researchers report in an article published in the May issue of the Journal of the American Dental Association.

Soaking cows' teeth in coffee and exposing them to cigarette smoke darkened them about the same amount, but tooth brushing only lightened the smoke-stained teeth, not the coffee-stained teeth, note Juliana Zavala Bazzi, DDS, MDS, from Pontifical Catholic University of Paraná, Curitiba, Paraná, Brazil, and colleagues.

"We didn't expect that cigarette staining would be so easily removed either by tooth bleaching or toothbrushing," corresponding author Evelise M. Souza, DDS, MDS, PhD, a professor of restorative dentistry at the Pontifical Catholic University, told Medscape Medical News in an email.

Although bleaching is well established as a method of whitening teeth, there is not much research to show the susceptibility of bleached teeth to being stained once again, they note.

Enjoy your morning!