The Saturday Drill: August 13, 2011

To all of my readers, I have been on vacation for the past week or so....now on to the Saturday Drill.

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

Calif. water district sued over fluoridation program

The Metropolitan Water District of Southern California (MWD) is allegedly using an unapproved drug to fulfill its water fluoridation program, according to a lawsuit filed August 9 in the U.S. District Court for the Southern District of California (Case No. 11-cv-01765-JLS-BLM).

The lawsuit, filed by four Southern California residents "on behalf of themselves and the general public," alleges that MWD is injecting hydrofluosilicic acid into the water supply for the purpose of treating disease and dental caries. It also alleges that hydrofluosilicic acid has never been approved by the U.S. Food and Drug Administration approval for the treatment of disease or dental caries.

"The MWD's use of an unapproved drug to medicate plaintiffs and other persons in order to forcibly treat disease and dental caries without their consent violates the Constitutional rights of these citizens and violates the Food and Drug Administration Act," the lawsuit states.

The industrial-grade hydrofluosilicic acid that the MWD uses is a byproduct of fertilizer production and should not be confused with different fluoride compounds, such as calcium fluoride or sodium fluoride, that are naturally occurring or already approved for certain uses, according to the complaint. Fluoridation is typically accomplished by adding one of three compounds to the water: sodium fluoride, fluorosilicic acid, or sodium fluorosilicate.

"MWD has chosen to medicate the plaintiffs with an unapproved drug without their consent that is not produced with controlled manufacturing practices and consistencies in impurities, and analyses of hydrofluosilicic acid indicate contamination of the unapproved drug with dangerous impurities, including lead and arsenic, and varying amounts of cadmium, mercury, beryllium, and other contaminants," the lawsuit states.

In addition, the plaintiffs claim that MWD has made public declarations that it intended to add fluoride to the water to safely and effectively treat and prevent dental disease, and then, "in a classic bait and switch, selected and initiated use of an unapproved drug to fulfill that intention."

The plaintiffs are not seeking monetary damages but are calling for the product to be thoroughly evaluated and approved before continuing to expose consumers without their consent, according to their attorney, Kyle Nordrehaug.

Connecting the Dots: Dental Medicine Team Describes How Enamel Forms

Researchers at the University of Pittsburgh School of Dental Medicine are piecing together the process of tooth enamel biomineralization, which could lead to novel nanoscale approaches to developing biomaterials. The findings are reported online this week in the Proceedings of the National Academy of Sciences.

Dental enamel is the most mineralized tissue in the body and combines high hardness with resilience, said Elia Beniash, Ph.D., associate professor of oral biology, Pitt School of Dental Medicine. Those properties are the result of its unique structure, which resembles a complex ceramic microfabric.

"Enamel starts out as an organic gel that has tiny mineral crystals suspended in it," he said. "In our project, we recreated the early steps of enamel formation so that we could better understand the role of a key regulatory protein called amelogenin in this process."

Dr. Beniash and his team found that amelogenin molecules self-assemble in stepwise fashion via small oligomeric building blocks into higher-order structures. Just like connecting a series of dots, amelogenin assemblies stabilize tiny particles of calcium phosphate, which is the main mineral phase in enamel and bone, and organize them into parallel arrays. Once arranged, the nanoparticles fuse and crystallize to build the highly mineralized enamel structure.

"The relationship isn't clear to us yet, but it seems that amelogenin's ability to self-assemble is critical to its role in guiding the dots, called prenucleation clusters, into this complex, highly organized structure," Dr. Beniash said. "This gives us insight into ways that we might use biologic molecules to help us build nanoscale minerals into novel materials, which is important for restorative dentistry and many other technologies."

Dental enamel is the most mineralized tissue in the body and combines high hardness with resilience, said Elia Beniash, Ph.D., associate professor of oral biology, Pitt School of Dental Medicine. Those properties are the result of its unique structure, which resembles a complex ceramic microfabric.

"Enamel starts out as an organic gel that has tiny mineral crystals suspended in it," he said. "In our project, we recreated the early steps of enamel formation so that we could better understand the role of a key regulatory protein called amelogenin in this process."

Dr. Beniash and his team found that amelogenin molecules self-assemble in stepwise fashion via small oligomeric building blocks into higher-order structures. Just like connecting a series of dots, amelogenin assemblies stabilize tiny particles of calcium phosphate, which is the main mineral phase in enamel and bone, and organize them into parallel arrays. Once arranged, the nanoparticles fuse and crystallize to build the highly mineralized enamel structure.

"The relationship isn't clear to us yet, but it seems that amelogenin's ability to self-assemble is critical to its role in guiding the dots, called prenucleation clusters, into this complex, highly organized structure," Dr. Beniash said. "This gives us insight into ways that we might use biologic molecules to help us build nanoscale minerals into novel materials, which is important for restorative dentistry and many other technologies."

Appeals court rules against Obama healthcare law

President Barack Obama's signature healthcare law suffered a setback on Friday when an appeals court ruled that it was unconstitutional to require all Americans to buy insurance or face a penalty.

The U.S. Appeals Court for the 11th Circuit, based in Atlanta, ruled 2 to 1 that Congress exceeded its authority by requiring Americans to buy coverage, but it unanimously reversed a lower court decision that threw out the entire law.

The legality of the individual mandate, a cornerstone of the healthcare law, is widely expected to be decided by the U.S. Supreme Court. Opponents have argued that without the mandate, which goes into effect in 2014, the entire law falls.

The law, adopted by Congress in 2010 after a bruising battle, is expected to be a major political issue in the 2012 elections as Obama seeks another term. All the major Republican presidential candidates have opposed it.

Obama has championed the individual mandate as a major accomplishment of his presidency and as a way to try to slow the soaring costs of healthcare while expanding coverage to the more than 30 million Americans without it.

Enjoy your day!

The Saturday Drill: June 11, 2011

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

Government lists formaldehyde as cancer causer

The strong-smelling chemical formaldehyde causes cancer, while styrene, a second industrial chemical that's used worldwide in the manufacture of fiberglass and food containers, may cause cancer, the National Institutes of Health says.

The NIH said Friday that people with higher measures of exposure to formaldehyde are at increased risk for certain types of rare cancers, including those affecting the upper part of the throat behind the nose.

The chemical is widely used to make resins for household items, including paper product coatings, plastics and textile finishes. It also is commonly used as a preservative in medical laboratories, mortuaries and consumer products including some hair straightening products.

The government says styrene is a component of tobacco smoke, and NIH says the greatest exposure to the chemical is through cigarette smoking.

The two chemicals were among eight added to the government's list submitted to Congress of chemicals and biological agents that may put people at increased risk of for cancer.

Drilling Away at Dental Costs

If you lack dental insurance or have a skimpy policy, your options for scoring a better dentistry deal are growing.

More insurers are offering individual dental coverage. Others, such as Aetna and Cigna, are stepping up their efforts to help members with certain medical conditions prevent tooth and gum problems that can wreak havoc on their overall health -- and lead to costly dental and other health-care bills. Meanwhile, a new website called Brighter.com offers members discounts at participating dentists.

About 10 million Americans have lost their dental insurance in the last few years as the recession weakened the reach of employer plans, the dominant source of coverage. Fifty-four percent of people had some form of dental benefit in 2009, down from 57% between 2006 and 2008, says Evelyn Ireland, executive director of the National Association of Dental Plans, a Dallas-based trade group.

Exercise Reduces Silent Brain Infarcts

Older people who exercise regularly may be less likely to develop silent brain infarcts, considered hallmarks of subclinical cerebrovascular disease.

"Encouraging older people to take part in moderate to intense exercise may be an important strategy for keeping their brains healthy," lead investigator Joshua Willey, MD, from Columbia University in New York, said in a news release.

His team's new study was published online June 8 in Neurology.

"These silent strokes are more significant than the name implies because they have been associated with an increased risk of falls and impaired mobility, memory problems, and even dementia as well as stroke," Dr. Willey said

Dental Pilot Program Bill Passes Budget Committee After Three Contentious Votes

Sen. Laurie Monnes Anderson (D-Gresham) and fellow legislators think that Senate Bill 738 will address, for the first time in years, an “extreme need” to provide better access to dental care throughout Oregon, particularly in rural areas.

That bill would fund pilot projects across the state, offering dental services to people whose incomes fall below the federal poverty level, by expanding the scope of practice of dental hygienists.

The bill passed out of the Joint Ways and Means Committee this morning after almost failing on Wednesday and being the subject of three contentious votes today.

When the Joint Ways and Means Committee voted on Wednesday, the bill received a split 12-12 vote, with Rep. Mary Nolan (D-Portland) absent. Nine Republicans, as well as three Democrats representing rural areas, voted against the bill.

Typically bills that receive a split vote do not survive, but Rep. Tina Kotek (D-Portland) changed her vote from “yes” to “no,” a procedure allowing for the bill to be reconsidered.

Kotek made a motion to reconsider the bill, but Republicans tried to stop it by objecting to the motion on parliamentary grounds.

Sen. Fred Girod (R-Stayton) objected on the grounds that a member of the House--Kotek--filed the motion to reconsider a bill that is a Senate bill. He argued that because the motion was not served from a Senator, Kotek's motion was invalid.

"We need to allow bad bills to die and not have someone drop a vote so they can move it to the floor," he said. "I would ask my colleagues on the House side who are Republicans to stick with me on this procedure."

Girod's motion to reject the motion failed, only receiving seven votes. Kotek's motion for reconsideration passed, and received votes from two Republicans.

Then there was a third vote to pass the bill out of the committee so it can proceed to the Senate and House floors. The bill passed out of the committee 17-8.

The bill was not expected to hit the rocky road that it did in the committee, but it was the subject of a short but passionate debate about scope of practice issues on Wednesday.

Girod, who filed a potential conflict of interest because he is a dentist, spoke passionately against the bill when it first came up for a vote on Wednesday.

He believes it will expand a dental hygienists’ scope of practice so much that it will fundamentally change his profession for the worse, by allowing “people who are not allowed to practice dentistry to practice dentistry.”

“For some reason, this committee thinks that any moron can do dentistry,” Girod told his colleagues. “I dare someone to look in the mirror work backwards in a mouth that has saliva, a tongue that won’t sit still, and try to cut [in the mouth]. It is not that easy.”

He argued that it’s just as inappropriate to expand a dental hygienists’ scope of practice as it would be to expand a nurse’s scope of practice to practice medicine.

Enjoy your Saturday drill!

The Saturday Drill: June 4, 2011

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

Hormone-blocking drug, Aromasin, reduces breast cancer risk

Millions of women at higher-than-usual risk of breast cancer have a new option for preventing the disease. Pfizer Inc.'s Aromasin cut the risk of developing breast cancer by more than half, without the side effects that have curbed enthusiasm for other prevention drugs, a major study found.

It was the first test in healthy women of newer hormone-blocking pills called aromatase inhibitors, sold as Arimidex, Femara and Aromasin, and in generic form. They're used now to prevent recurrences in breast cancer patients who are past menopause, and doctors have long suspected they may help prevent initial cases, too.

Prevention drugs aren't advised for women at average risk of breast cancer. Those at higher risk because of gene mutations or other reasons already have two choices for prevention tamoxifen and raloxifene. But these drugs are unpopular because they carry small risks of uterine cancer, blood clots and other problems.
"Here's a third breast cancer prevention drug that may in fact be safer," said Dr. Allen Lichter, chief executive of the American Society of Clinical Oncology.

Training new dental health providers in the United States

Abstract

Objectives: Introduction of dental therapists in the United States involves a wide range of issues including permissive governmental policymaking; determinations of their education, supervision, and deployment; their acceptance by dentists and the public; financing of their services; and, most fundamentally, their training. This contribution re-releases and updates the executive summary of an extensive report comparing therapists' training across five industrialized countries and comparing therapists' training to that of conventional U.S. dental providers.

Methods: Literature reviews, web searches, key informant interviews, and program document reviews.

Results: Internationally, three-year training programs that dually qualify trainees as hygienists and therapists dominate. There are marked differences between non-US and US-based therapist training programs and between US-based programs. Reported goals of establishing dental therapists include expanding the availability of basic dental services to underserved disadvantaged subpopulations; potentially reducing costs of basic care; and enhancing the roles of dentists in providing the most sophisticated care, serving the most complex patients, and managing an expanded dental team. Criteria for establishing training programs include program length, supervisory arrangements, recruitment and incentives, deployment, educational costs, curriculum, oversight, and accreditation.

Conclusion: International experiences can well inform US policy on training of dental therapists.

Minnesota Graduates First Class of Dental Therapists

Christy Fogarty will always remember the man whose wedding she saved. "His front teeth were so decayed he literally couldn't smile," she told Medscape Medical News. Fogarty restored all 6 of the man's front teeth and sent him beaming to his bride. It is the kind of happy ending that many dentists like to reminisce about, but with one key difference: Fogarty is not a dentist.

A dental hygienist in practice as an independent contractor for 7 years, Fogarty, 41, is about to obtain her master of science in oral health care practitioner through a controversial program at Metropolitan State University in Minneapolis, Minnesota. Her class of 7 will graduate June 23, adding a new category of dental practitioner to the state, with duties falling between those of a dentist and those of a hygienist.

The program, enacted into law in 2009 despite continuing opposition from the Minnesota Dental Association (MDA), is only the second in the United States that licenses such dental therapists. Compared with the dental health aide therapist program in indigenous Alaska communities, the Minnesota therapists, who are also being trained at the University of Minnesota, will have more education and more limited capacities.

They will be able to prepare teeth and place all types of direct restoration, as well as stainless steel crowns; do pulpotomies; make prostheses; and extract primary teeth. They will do this work only under the indirect supervision of a dentist, meaning that the dentist must be on the premises but not necessarily in the operatory when the work is done.

With 2000 more hours of clinical practice, and after passing an examination that is as yet to be devised, these dental therapists can become advanced dental therapists, who will also be able to extract mobile permanent teeth and work under a dentist's general supervision meaning the dentist could be miles away from the therapist when the work is done.

Dental Tourism: How Far Would You Go for A Crown?

Have you heard of the term "medical tourism"? If you have, give me a second to explain what it is to everyone else -- essentially, medical tourism is combining a vacation abroad with a medical procedure/operation. The reasoning is, many procedures and operations can be done much cheaper in many other countries.

India is a country that is a popular medical tourism destination. And, from my "outsiders" perspective, with good reason -- in many areas, they have state-of-the-art medical facilities and world-renowned medical professionals.

I'm stating the above because I do not know enough about medical tourism to be a naysayer on the entire industry. But I do have an opinion on it when it comes to medical tourism and dentistry, particularly in the area of Mexico.

Maybe you've seen some ads or websites that state something like: Hey, how about a Mexican vacation, complete with sun, surf and tequila? And while you're here, why not get a dental implant or cheap crown?

Why not indeed... Allow Dr. Connelly to tell you why not.

Bone Drug Bisphosphonate Zometa May Prevent Return of Breast Cancer

A drug that battles bone loss may have added benefits for women with estrogen-sensitive breast cancers, significantly reducing the chance that their cancer will return or spread, a new study shows.

What's more, researchers say, the lowered risk of recurrence seems to last years after the treatment, a bisphosphonate drug called Zometa, is stopped.

"I find that very reassuring. It obviously demonstrates that we can impact on the long-term outcome of our patients with an early intervention. We do not have to give these drugs forever. I'm very enthusiastic about this," says study researcher Michael Gnant, MD, professor of surgery at the Medical University of Vienna in Austria.

For the study, which is published in TheLancet, 1,803 premenopausal women with early-stage, estrogen-driven breast cancers were given a drug which suppresses estrogen production by the ovaries. They were also treated with drugs, Arimidex or tamoxifen, that help prevent cancers from using estrogen to grow.

In addition to those treatments, half were randomly assigned to receive intravenous infusions of Zometa every six months for three years.

Two years after their treatments ended, women who got the bone drug continued to have a 32% reduced risk of cancer recurrence compared to those on estrogen suppression alone.

strogen suppression alone.

Overall, 92% in the Zometa group were cancer-free two years after treatment compared to 88% on estrogen suppression alone

Enjoy your Saturday drill!