Tuesday, August 16, 2011

The Morning Drill: August 16, 2011

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

Should all obese people lose weight?
You may be obese, but does that automatically mean you're unhealthy?

The conventional wisdom is that if you're overweight or obese, you're in mortal danger because that extra weight is like a ticking time bomb ready to unleash diabetes, heart disease and other health complications.

But doctors have known for years that obesity doesn't affect all people the same way. An obese person could lead a healthy life while another person with the same body mass index, or BMI, could have severe medical problems.

Two studies published Monday suggest reframing the way medical practitioners look at overweight and obese patients. The studies question the notion that BMI and weight determine health -- even when someone is severely obese.

"Our study challenges the idea that all obese individuals need to lose weight," said Dr. Jennifer Kuk, assistant professor in York University's School of Kinesiology & Health Science in Toronto. One in five obese people may not have medical problems, the authors estimated.

The challenge is determining who are the "healthy obese" and those who may not have complications now but may develop them in the future.

The studies appear in two publications, the Canadian Medical Association Journal and Applied Physiology, Nutrition and Metabolism.
Lawsuit seeks Medicare coverage of medically related dental care
Medicare's refusal to cover extensive dental treatment that is often needed to treat patients with diseases such as oral cancer and Sjögren's syndrome is unreasonable and arbitrary, according to a lawsuit pending in U.S. federal court.

The litigation, originally filed in 2008 on behalf of one plaintiff, was recently amended by the Center for Medicare Advocacy (CMA) in the U.S. District Court for the District of Arizona against U.S. Health and Human Services Secretary Kathleen Sebelius on behalf of three Medicare beneficiaries who needed medically related dental care stemming from underlying medical conditions.

Medicare policy, which excludes coverage of "routine" dental care, does cover dental services when they are "incident to and an integral part of" eligible medical care. Dental procedures that are covered include extractions in preparation of radiation treatment of neoplastic disease, reconstruction of ridges that are performed simultaneously with the surgical removal of oral tumors, and the wiring of teeth if done in connection with jaw fractures.

"We have argued that this is a misinterpretation of the Medicare statute," said CMA attorney Sally Hart, who filed the suit. "We think that beneficiaries who require extensive dental services because of damage from Sjögren's syndrome, as well as cancer radiation treatment and other conditions that destroy the production of saliva, should not fall within the exclusion."
Can Oral Care for Babies Prevent Future Cavities?
New parents have one more reason to pay attention to the oral health of their toothless babies. A recent University of Illinois study confirms the presence of bacteria associated with early childhood caries (ECC) in infant saliva.

ECC is a virulent form of caries, more commonly known as tooth decay or a cavity. Cavities are the most prevalent infectious disease in U.S. children, according to the Centers for Disease Control and Prevention.

"By the time a child reaches kindergarten, 40 percent have dental cavities," said Kelly Swanson, lead researcher and U of I professor of animal science. "In addition, populations who are of low socioeconomic status, who consume a diet high in sugar, and whose mothers have low education levels are 32 times more likely to have this disease."

Swanson's novel study focused on infants before teeth erupted, compared to most studies focused on children already in preschool or kindergarten -- after many children already have dental cavities.

"We now recognize that the "window of infectivity," which was thought to occur between 19 and 33 months of age years ago, really occurs at a much younger age," he said. "Minimizing snacks and drinks with fermentable sugars and wiping the gums of babies without teeth, as suggested by the American Academy of Pediatric Dentistry, are important practices for new parents to follow to help prevent future cavities."

In addition, his team used high-throughput molecular techniques to characterize the entire community of oral microbiota, rather than focusing on identification of a few individual bacteria.

"Improved DNA technologies allow us to examine the whole population of bacteria, which gives us a more holistic perspective," Swanson said. "Like many other diseases, dental cavities are a result of many bacteria in a community, not just one pathogen."

Through 454 pyrosequencing, researchers learned that the oral bacterial community in infants without teeth was much more diverse than expected and identified hundreds of species. This demonstration that many members of the bacterial community that cause biofilm formation or are associated with ECC are already present in infant saliva justifies more research on the evolution of the infant oral bacterial community, Swanson said.

Could manipulating the bacterial community in infants before tooth eruption help prevent this disease in the future?
Vitamin D Linked to Skin Cancer
Higher levels of vitamin D, still within the normal range, are associated with an increased risk of nonmelanoma skin cancer, researchers reported.

In a cohort study, people with higher serum 25-hydroxyvitamin D (25(OH)D) were more likely to develop squamous cell or basal cell carcinoma, according to Melody Eide, MD, and colleagues at Henry Ford Hospital in Detroit.

But other factors – such as increased exposure to sunlight – probably complicate the relationship, Eide and colleagues reported online in Archives of Dermatology.

Ultraviolet B light is known to cause skin cancer, but it also increases cutaneous vitamin D synthesis, the researchers noted, adding that the relationship between vitamin D and skin cancer is complex and studies have yielded conflicting results.

Indeed, some research suggests that vitamin D might reduce the risk of basal cell carcinoma, but other studies have had the opposite outcome.
Enjoy your day!

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