The Morning Drill: June 29, 2011

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

White House dumps 'secret shopper' survey of doctors

The Obama administration will not move forward on a controversial proposal to have “secret shoppers” pose as patients to investigate how difficult it is for Americans to obtain primary care.

“On April 28th, the U.S. Department of Health & Human Services submitted a notice to the Federal Register regarding a proposed study that would examine access to primary care,” an HHS spokesman said in a statement.

“After reviewing feedback received during the public comment period, we have determined that now is not the time to move forward with this research project. Instead, we will pursue other initiatives that build on our efforts to increase access to health care providers nationwide.”

While the administration announced the program two months ago, it did not get widespread notice until a New York Times article that ran on Monday.

The program, as outlined in the Federal Register, would have a federal contractor call the offices of 4,185 doctors in nine states. The plan, which the Times characterized as a “stealth survey,” came under criticism from some physicians. As one Texas doctor said in the story, “Is this a good use of tax money? Probably not. Everybody with a brain knows we do not have enough doctors.”  

Can the Internet help you lose weight?

People tend to lose a little more weight with online help than with traditional weight loss programs, according to a new study from Japan.

With obesity on the rise, there have been many attempts to take advantage of the Internet to help people lose weight, mainly because it's thought to be easier and less expensive.

But the effect of including online help in obesity treatment programs was pretty small in the new study.

Overall, patients in programs with a web component lost an average of a pound and a half more than participants in non-Web programs, the researchers reported in the International Journal of Obesity.

The findings are from a review of 23 studies that compared weight control programs with an Internet component to programs that did not involve any online support.

The Internet was used for a variety of purposes in the different weight control programs. These included individualized instruction, communication with lifestyle instructors, counseling, and keeping a record of food intake. In addition, the programs varied in how much participants used the Internet.

How Cavity-Causing Microbes Invade Heart

Scientists have discovered the tool that bacteria normally found in our mouths use to invade heart tissue, causing a dangerous and sometimes lethal infection of the heart known as endocarditis. The work raises the possibility of creating a screening tool -- perhaps a swab of the cheek, or a spit test -- to gauge a dental patient's vulnerability to the condition.

The identification of the protein that allows Streptococcus mutans to gain a foothold in heart tissue is reported in the June issue of Infection and Immunity by microbiologists at the University of Rochester Medical Center.

S. mutans is a bacterium best known for causing cavities. The bacteria reside in dental plaque -- an architecturally sophisticated goo composed of an elaborate molecular matrix created by S. mutans that allows the bacteria to inhabit and thrive in our oral cavity. There, they churn out acid that erodes our teeth.

Normally, S. mutans confines its mischief to the mouth, but sometimes, particularly after a dental procedure or even after a vigorous bout of flossing, the bacteria enter the bloodstream. There, the immune system usually destroys them, but occasionally -- within just a few seconds -- they travel to the heart and colonize its tissue, especially heart valves. The bacteria can cause endocarditis -- inflammation of heart valves -- which can be deadly. Infection by S. mutans is a leading cause of the condition.

"When I first learned that S. mutans sometimes can live in the heart, I asked myself: Why in the world are these bacteria, which normally live in the mouth, in the heart? I was intrigued. And I began investigating how they get there and survive there," said Jacqueline Abranches, Ph.D., a microbiologist and the corresponding author of the study.

Abranches and her team at the University's Center for Oral Biology discovered that a collagen-binding protein known as CNM gives S. mutans its ability to invade heart tissue. In laboratory experiments, scientists found that strains with CNM are able to invade heart cells, and strains without CNM are not.

When the team knocked out the gene for CNM in strains where it's normally present, the bacteria were unable to invade heart tissue. Without CNM, the bacteria simply couldn't gain a foothold; their ability to adhere was about one-tenth of what it was with CNM.

The work may someday enable doctors to prevent S. mutans from invading heart tissue. Even sooner, though, since some strains of S. mutans have CNM and others do not, the research may enable doctors to gauge a patient's vulnerability to a heart infection caused by the bacteria.

Poor Oral Care May Cause Sexual Problems

A recent study has revealed erectile dysfunction can be linked to gum disease.

The research1, carried out on 70 male subjects, showed a correlation between gum disease and the ability to achieve an erection. The data indicates that as the severity of erectile dysfunction increased, so did the prevalence of chronic periodontitis (gum disease). Overall, more than four out of five men (81.8 per cent) with severe erectile dysfunction had gum disease. In comparison, in cases of mild erectile dysfunction, the incidence of gum disease was less than two in five men.

According to the National Institutes of Health2, erectile dysfunction is defined as the inability to attain and or maintain an erection sufficient for satisfactory sexual performance. It is a condition that affects one in 10 men worldwide, and is more commonly experienced after the age of 403.

Chief Executive of the British Dental Health Foundation, Dr Nigel Carter, believes the stigma attached to the subject could be forcing men up and down the country to turn a blind eye on their oral health.

Dr Carter said: "To associate gum disease, the major preventable cause of tooth loss in adults, with such a taboo subject amongst males is not something that should be taken lightly. If, in theory, four out of five men who suffer from erectile dysfunction have poor oral health, the effect it could have on their general health poses a serious health risk to those individuals affected.

"It is a well-known fact that gum disease has been linked to many conditions in the past that can have a detrimental effect on your general health such as heart disease and diabetes. When people have gum disease, bacteria from the mouth can get into their bloodstream, so it should therefore come as no surprise that this piece of research has linked vascular erectile dysfunction, another cardiac-related condition, with gum disease.

"The best way to combat oral health problems is to think prevention and develop a good routine to keep your teeth and gums healthy at home. By brushing for two minutes twice a day using a fluoride toothpaste, by reducing the frequency of how often you have sugary foods and drinks and by visiting your dentist regularly, as often as they recommend and by interdental brushing, you stand a far greater chance of having good oral health."

Enjoy your morning drill!