Monday, June 13, 2011

The Morning Drill: June 13, 2011

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

Weight-Loss Surgery May Not Lower Death Risk: Study

Weight-loss surgery doesn't decrease the risk of death among severely obese middle-aged adults, a new study says.

U.S. researchers looked at 850 male patients at Veterans Affairs medical centers who had weight-loss (bariatric) surgery between January 2000 and December 2006. Their average age was 49.5 and their average body mass index was 47.4 (a body mass index, or BMI, over 40 is considered severely obese).

The death rate in this group of patients was compared to that of a control group of about 41,000 VA patients (average age 54.7, average BMI 42) who didn't have surgery.

Eleven of the 850 bariatric surgery patients (1.29 percent) died within one month after surgery. Unadjusted analysis of the death rates over a six-year period showed that the bariatric surgery patients had lower death rates than those in the control group, but further analysis showed that bariatric surgery was not significantly associated with reduced risk of death, said Matthew L. Maciejewski, of the Durham VA Medical Center in Durham, N.C., and colleagues.

The study, published online and in the June 15 print issue of the Journal of the American Medical Association, was to be presented Sunday at an AcademyHealth research meeting in Seattle.

Even though bariatric surgery doesn't reduce the risk of death among middle-aged male patients, many of them still decide to undergo the procedure because there's strong evidence that it reduces body weight and obesity-related health problems, and improves quality of life, the researchers said.
Study recommends against autism screening
There is no solid evidence to support screening toddlers for autism, a new study concludes.

It's estimated that autism spectrum disorders, which range from mild Asperger's Syndrome to severe mental retardation and social disability, affect nearly one percent of kids in the U.S., putting a significant burden on families and society at large.

Both the American Academy of Pediatrics and the U.S. Centers for Disease Control and Prevention encourage routine screening for the disorders.

But the new report, a review of the medical literature, suggests those recommendations are premature.

"We don't have research evidence to show how well screening works and whether we do more good than harm," Dr. Jan Willem Gorter, a pediatrician at McMaster University in Hamilton, Canada, told Reuters Health.

While many screening tests exist -- usually based on simple questions about the child's use of eye contact and gestures -- none of them are very accurate, Gorter and colleagues report in the journal Pediatrics.

Often the tests will misdiagnose healthy kids, such as one recent test that yielded false positives a quarter of the time, or they will fail to detect autism.

"The potential burdens on families of receiving a misdiagnosis (either a false-positive or a false-negative) may be enormous," the researchers write, "and there might be labeling effects that can be hard to remove."
Tooth Whitening At Spas, Malls Outlawed
Most tooth whitening services performed in spas, salons and shopping malls were outlawed last week by the Connecticut Dental Commission.

The commission, comprised of six dentists and one lay member, ruled tooth whitening “dentistry,” which must be performed under the supervision of a licensed dentist. Because tooth whitening had not been a licensed enterprise in Connecticut, it is difficult to determine how many businesses are affected by the ruling.

A similar action by North Carolina’s dental board prompted the Federal Trade Commission to sue that state for restraint of trade last year. The federal agency argued that state board, dominated by dentists, was eliminating competitors, who generally offered whitening at a lower cost than dentists themselves. FTC spokesperson Mitchell Katz said the agency had no comment yet on the Connecticut ruling.

“We’re not trying to inhibit any trade in the state,” said Commission Chairwoman Jeanne P. Strathearn, a West Hartford dentist. Strathearn said the commission based its ruling on testimony heard at a December 2010 hearing, where representatives from the state associations representing dentists, hygienists and dental assistants all spoke against non-dentists providing whitening independently.

They warned that the diagnosis of the cause of tooth discoloration requires professional assessment and that the agents used in whitening can be harmful. No one representing independent tooth whitening businesses spoke at the hearing.

“We had very reliable and credible witnesses who presented testimony,” said Strathearn.

The commission’s six-page ruling does not ban over-the-counter whitening strips commonly sold in pharmacy and supermarkets.  “…the selling of teeth whitening gel of differing strengths by non-licensed persons is not, by itself, the practice of dentistry. It becomes the practice of dentistry when such unlicensed person either uses light in an attempt to enhance the product’s effectiveness or a person conducts an analysis of a person’s individual needs based upon an examination or evaluation,” the ruling states.
SWIFT MRI shows promise for endodontics
A new study in the Journal of Endodontics (JOE) further validates the viability of magnetic resonance imaging (MRI) for imaging hard and soft tissue in the oral cavity (June 2011, Vol. 37:6, pp. 745-752).

Researchers from the Center for Magnetic Resonance Research at the University of Minnesota presented findings from early experiments using MRI to image teeth and surrounding soft tissue at the International Association for Dental Research meeting in San Diego earlier this year. Those initial studies, which involved a new MRI technique -- sweep imaging with Fourier transform (SWIFT) -- found that SWIFT MRI achieved simultaneous visualization of enamel, dentin, and soft tissues in the pulp within clinically relevant scanning times and without the use of ionizing radiation.

The JOE study expands on that research, comparing MRI's diagnostic abilities with those of radiography, cone-beam CT, and histology. While MRI offers many diagnostic advantages, including the fact that it does not utilize ionizing radiation and can image soft-tissue structures with great precision and detail, it also has some challenges. The equipment can be claustrophobic to many patients, the imaging process is extremely loud and typically takes 30 to 60 minutes, and it requires several expensive and sensitive components.
Enjoy your morning drill!

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