The Morning Drill: September 29, 2011

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

The great partisan Dental Divide: Blue states have better teeth

Richard Florida has written influential works about the US society and economy and on Tuesday he turned his vision to the Great American Dental Divide. Blogging a recent Gallup study on oral hygiene in the United States, he pointed out that the dramatic if unsurprising findings underline the kind of deeply divided nation we all live in today. Dental care, like so many other facets of American life, tracks with income and education levels as well as race and political affiliations. There is a sprawling American country where people go to the dentist regularly and there is an equally sprawling American country where people do not. The shorthand summary for political junkies is that if you don’t believe in climate change or in the benefit of health care reform and are leaning toward casting a ballot for Texas Governor Rick Perry sometime in your future, chances are you have lousy teeth.

“Dental visits closely track socioeconomic class,” Florida writes above a map of the U.S. colored according to the frequency of dental visits state to state. “[Visits] are much higher in states where a higher percentage of the workforce is employed in knowledge, professional, and creative work. The creative class is significantly associated with dentist visits (.31). The same is true of the share of college graduates, a measure of the knowledge base and human capital in a state. The correlation between dental visits and college grads is even higher (.65). On the flip side, visits to the dentist are negatively associated with the working class share of a state’s workforce (-.28).”

Slate Belt grandparents face charges over girl's lack of dental care

Lower Mount Bethel Township grandparents are accused of ignoring their 2-year-old granddaughter's serious tooth decay and not taking her to the dentist.

Lisa Ann Dean, 46, and Richard Dean, 57, of the 9000 block of River's Edge Park in the township, each face charges of endangering the welfare of children and reckless endangerment, court records say.

The Deans were arraigned today and released on $20,000 unsecured bail. The couple was ordered to comply with Northampton County Office of Children, Youth and Families.

By the time the toddler received dental treatment, six of her teeth had to be removed and she had four abscesses in her mouth, records say. The Deans have cared for the baby since she was 3 to 4 months old.

The Deans took her for a checkup at her pediatrician and were told to take her to a dentist as soon as possible, police said. Lisa Dean allegedly later explained that her insurance company told her that the toddler didn't need to visit a dentist until she was 3. Court records say Lisa Dean apparently did not explain the severity of the toddler's dental issues to the insurance company and didn't take her to the dentist.

On Jan. 1, 2010, the baby's paternal grandparents -- identified only as the Shulls -- took her to the dentist, where it was found she had serious, extensive dental problems, records say.

At the time, dentist Melissa Burruezo found 12 of the toddler's 20 teeth exhibited major decay and six were beyond repair, records say. Police said Burruezo noted that the infection and severity of the decay could lead to heart damage or death if left untreated.

The Deans allegedly made a dental appointment for the girl's treatment but didn't keep it. The Shulls then took the girl back to the dentist on July 19, 2010, where it was found her condition had worsened and she needed immediate treatment.

How will healthcare reforms affect your dental practice?

Dentists and their employees should take note of new tax implications and reporting requirements that will take effect in the next two years as part of the U.S. healthcare reform law, according to two presentations at the California Dental Association (CDA) fall meeting last week.

Since the average dentist has fewer than 50 employees, they will not be subject to the Affordable Care Act's (ACA) employer mandates, which begin in 2014. However, as of January 2014, the law requires that everyone in the U.S. must have or purchase health insurance, and insurance exchanges will begin to operate in every state, according to CDA lobbyist Allison Barnett.

"Everyone will be touched by this bill one way or another, and I want to be sure you are aware of any potential obligations as an employer and an individual," she told a packed room during her presentation, "National Health Care Reform: How Will It Affect Your Practice?"

Since more than 90% of dental benefits coverage is provided by standalone plans, dental coverage will be included in the exchanges. Such plans must offer pediatric dental benefits, and there are no cost-sharing requirements, Barnett said.

Most individuals are expected to move to state insurance exchanges unless they are eligible for government coverage because coverage subsidies are only available in exchanges, according to Barnett. Health plans and standalone dental plans participating in state-operated exchanges will be required to provide oral health coverage for children younger than age 21, but they will not be required to offer dental coverage to adults, she noted.

HPV Vaccines Differ in Cost-Effectiveness and Cancer Deaths

Between the 2 vaccines now available for protection against human papilloma virus (HPV), the quadrivalent vaccine may have an advantage over the bivalent vaccine with respect to costs and quality of life, but the bivalent vaccine may prevent more deaths from cervical cancer, according to new research.

Mark Jit, PhD, MPH, a mathematical modeler from the Health Protection Agency in London, United Kingdom, and colleagues published their findings online September 27 in the BMJ.

As described in the article, the HPV bivalent vaccine (Cervarix, GlaxoSmithKline) targets HPV types 16 and 18, which are estimated to cause more than 70% of cervical cancer cases worldwide. In contrast, in addition to HPV types 16 and 18, the quadrivalent vaccine (Gardasil, Merck) also targets HPV types 6 and 11, to which anogenital warts and recurrent respiratory papillomatoses are attributed.

In 2008, the UK government selected the bivalent vaccine for protection against HPV based on a previous analysis led by the same authors, indicating that the bivalent vaccine would have to be £15 to £23 cheaper per dose to be as cost-effective as the quadrivalent vaccine because of "the lack of protection against anogenital warts," as understood at that time. Since then, however, new data have emerged. First, studies have indicated that both the bivalent and the quadrivalent vaccines may also be effective against certain oncogenic HPV types not included in the respective vaccines. In addition, the quadrivalent vaccine has shown protection against vulvar, vaginal, and anal cancer; and the bivalent vaccine has shown some protection against anal infection, which may ultimately translate into prevention of anal cancer.

Enjoy your morning!