California Physicians to Go to Court to Block Medicaid Pay Cuts

The latest flap is over the latest 10 per cent cut of physician's fees by the State of California.

The California Medical Association (CMA) will go to court again to block the latest cut to already stingy Medicaid reimbursement rates in that state, a CMA leader said today.

The association contends that the 10% reduction in provider reimbursement will drive more physicians out of the program and make it harder for the poor to receive medical care, violating federal requirements that govern the Medicaid program.

"When regulators don't follow their own rules, legal action is our only recourse," CMA Vice Speaker Ted Mazer, MD, told Medscape Medical News. "They've just destroyed the program."

No California physician in his right business mind would accept Medi-Cal (California's Medicaid), especially with all of the governmental regulations.

Here we have another consequence of ObamaCare and the Medi-Cal cuts actually undermine it. I mean, how can you have affordable medical care when there are no providers of such care?

The CMA has repeatedly argued that by approving the reduction in Medi-Cal rates, the Obama administration is undermining its own Affordable Care Act, which will add 3 million individuals to the state program beginning in 2014 as a result of expanded Medicaid eligibility.

"On one hand, [the administration] is trying to create the infrastructure for healthcare reform where they put at least a third of the newly insured into Medicaid, and at the same time the administration is gutting the Medicaid program in California," said Dr. Mazer. "CMS has set a precedent — balance your budget on the backs of the poor. I'm sure other states will follow suit."

Carol Havens, MD, the president of the California chapter of the American Academy of Family Physicians, agrees with Dr. Mazer about the effects of the rate cut on healthcare reform.

"Having insurance means nothing if you don't have access to care," Dr. Havens told Medscape Medical News. "I see a world of hurt in this decision.

The Morning Drill: October 31, 2011

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

FTC mulls NC dental board teeth-whitening appeal

The U.S. Federal Trade Commission (FTC) is considering the North Carolina State Board of Dental Examiners' appeal of a July ruling that the board's efforts to block nondentists from providing teeth-whitening services constitute an illegal anticompetitive conspiracy.

The dental board's actions violated the law, according to a decision issued July 14 by Chief Administrative Law Judge D. Michael Chappell, who concluded it was "unreasonable restraint of trade and an unfair method of competition."

Chappell determined that "dentist members of the dental board had a common scheme or design, and hence an agreement, to exclude nondentists from the market for teeth-whitening services and to deter potential providers of teeth-whitening services from entering the market," the FTC said.

The board filed an appeal of that decision on August 25 that, among other things, claimed that Chappell "engaged in a cherry-picking exercise to consider only evidence of potential economic harm caused by exclusionary conduct" and "did not consider the context in which such conduct occurred, i.e., as an enforcement mechanism by a state agency charged by statute with regulating the practice of dentistry in North Carolina."

On October 28, during the appeal hearing, three FTC commissioners heard testimony from both sides.

"There were some good questions," Noel Allen, attorney for the dental board, told DrBicuspid.com. "But my every instinct is that this is a foregone conclusion because the heart of the matter is about state action and public protection, and they indicated early on that those are not considerations. They made up their minds a long time ago."

Boy's death at dentist ruled accidental; no charges filed

The death of 5-year-old Dylan “Dilli Man” Shane Stewart after being sedated for dental work in 2010 has been ruled accidental by the Alachua County Sheriff’s Office.

Dylan died in April 2010 after going into cardiac arrest shortly after being sedated during an appointment with longtime Gainesville-area pediatric dentist Dr. Ronnie Grundset.

In a final report on the death that was made public Friday, Detective Sheryl Strickland wrote: “It was determined that the death of Dylan Stewart was accidental. … The State Attorney’s Office has determined that criminal charges will not be pursued in this case.”

Chicago dentist says Iowa murder suspect seduced, drugged him in extortion plot

Chicago oral surgeon Joseph A. LaSpisa says he hasn't spoken to Tracey Richter in a decade. During those years, he's tried to get past an evening in a dentist's chair that he says mixed seduction, laughing gas and forged documents to create an extortion plot for which he still feels angry and stupid.

His history with Richter is in some ways more bizarre than the stories emerging from testimony at her trial on charges that she shot and killed a 20-year-old neighbor, which resumes Monday in a courtroom in Fort Dodge.

LaSpisa spoke recently with detectives investigating the 2001 death of Dustin Wehde, but a week into the trial, his name hasn't yet come up. Neither has the long and nasty civil lawsuit in which Richter accused LaSpisa of sexual assault and he accused her of extortion. It's possible jurors will never hear the story and details of the four-year legal feud that followed, which LaSpisa said embarrassed him and set back his career.

He's now watching the murder trial with interest, thinking about what sentence Richter might face should she be found guilty. Iowa doesn't have the death penalty, but LaSpisa said an execution "wouldn't bother me one bit."

"She set me up from day one," LaSpisa, 53, told The Associated Press in a phone interview. "Maybe I was just an easy target, I don't know. A dumb target."

Richter is charged with first-degree murder in Wehde's death, a slaying she insists was an act of self-defense during a home invasion but one that prosecutors describe as a convoluted plot to frame her ex-husband. Authorities argue she forced Wehde to write a diary claiming her ex-husband hired him to kill her. They argue Richter then shot the 20-year-old Wehde to keep him quiet.

Scott Bandstra, who is defending Richter on the murder charge, noted LaSpisa has been sanctioned by state regulators for misconduct and "there was a settlement" in the civil lawsuit. He declined further comment.

Dentists collecting extra Halloween candy for troops

Two local dentists have decided to keep kids a bit healthier and make things a little sweeter for U.S. troops this Halloween season.

The dental office of Michael Z. Hopkins has teamed up with Operation Gratitude to exchange excess candy from trick-or-treaters for toys, cool orange-and-black toothbrushes and coupons from participating sponsors in the area. There will also be a drawing to win a Sonicare toothbrush.

The candy will be collected at 1706 S. Elena Ave., Suite B, in Redondo Beach from 8 a.m. to 5 p.m. starting Tuesday and continuing the same hours through Thursday. The loot will be shipped to troops overseas.

For more information, call 310-378-9241.

At Torrance Dental Arts, Dr. Steve Sutherland will collect unwanted candy at the third annual Halloween Candy Buy Back, designed to promote healthy living for local children. Children will be given prizes that include electric glowing toothbrushes for every pound of candy they turn in.

The candy will be shipped to the troops as a gift of appreciation.

The unopened candy will be collected from

10 a.m. to 5 p.m. Tuesday at 23326 Hawthorne Blvd., Suite 190, Torrance. Call 310-378-8209 for more information.

Enjoy your morning and Happy Halloween!

Dental Death of 13 Year Old Marissa Kingery Settled for $ 1 Million

Marissa Kingery

You remember the story, as I have posted about it a number of times previously.

Now, the lawsuit, regarding Marissa Kingery's death has been settled - and settled for about a $ 1 million.

The insurance company representing Lorain dentist Henry Mazorow has agreed to pay nearly $1 million to the parents of 13-year-old Marissa Kingery, who died after intravenous sedation before dental surgery.

Marissa’s parents, Amber McEwen of Elyria and Jason Kingery of Sheffield Lake, each will receive $331,056, and their attorney Michael Czack will receive $318,000 and about $4,000 in expenses, according to documents filed in Lorain County Common Pleas Court on Thursday.

McEwen and Kingery declined to comment, but the child’s paternal grandmother, Judy Kingery, said she hopes that regulations about administering anesthesia to children will be changed to avoid future deaths.

“It just breaks our hearts,” Judy Kingery said of Marissa’s death.

Mazorow said that his insurer, CNA Insurance Company, settled the case against his wishes.

“If there was a settlement, it was not done by me, because I demanded an investigation,” Mazorow said.

Following Marissa’s death, Mazorow, 81, stopped giving intravenous sedation, and he agreed to retire Sept. 1 after consultation with the Ohio Dental Board.

The settlement documents stated that Marissa died on Jan. 3 from diffuse hypoxic-ischemic encephalopathy due to respiratory arrest caused by complications associated with intravenous sedation during the surgery, performed on Dec. 21, 2010, by Mazorow.

Hypoxic-ischemic encephalopathy is damage to the brain that also occurs in carbon-monoxide poisoning and many cases of shaken baby syndrome.

Marissa’s death was ruled accidental by the Cuyahoga County coroner. The coroner’s report stated that the drugs propofol — an anesthetic that was listed as a “contributing factor” in pop star Michael Jackson’s death — ketamine, remifentanil and Versed, or midazolam, were administered in Mazorow’s office to Marissa in what is commonly known as “twilight sleep,” or light sedation.

Court documents stated that Marissa “never regained consciousness” and was taken by paramedics to Mercy Regional Medical Center and later transferred to Rainbow Babies and Children’s Hospital in Cleveland, where she was on life support until her death.

Based on a “lengthy and comprehensive investigation into the facts” and consultation with experts, a wrongful death claim was made with Mazorow’s insurer, which retained counsel to oversee the claim, the documents stated.

The doctor and his practice have a $1 million liability insurance “wasting” policy, which means that the policy limits “waste” or are reduced with every dollar the insurance company spent on legal fees and case expenses, court records stated.

The settlement of $984,080 was reached “after extensive research, investigation, on scene inspections, measurements, videotaping and photographing and extensive discussions and negotiations,” the court documents stated.

The documents called it “a partial settlement,” and stated the estate will remain open pending a continued investigation into circumstances surrounding Marissa’s death and the potential for additional litigation against other parties or entities.

The money cannot repay the parents for their daughter and the grief the have suffered.

Since this is not the first time that this oral surgeon, Henry Mazorow, has had problems with sedation and a DEATH, you have to wonder why the Ohio Dental board allowed him to practice at such an advanced age without supervision.

One would think that with IV sedation/general anesthesia, there would be a re-certification procedure for a dentist or oral surgeon, say over the age of 70, just like for automobile driving.

The Ohio Dental Board dropped the ball on appropriately supervising Mazorow.

The Morning Drill: October 27, 2011

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

UF dentistry school scales back expansion, will team with FAMU, UCF

The University of Florida is scaling back plans to expand its dental school and working with two universities that had planned to create new dental schools.

Florida A&M University is dropping its proposal for a new dental school, instead proposing to help recruit minority students to the UF College of Dentistry.

The University of Central Florida is still proposing to create its own dental school, but the UF college would now serve as an adviser on the project.

UF is currently the only state university with a dental school.

It had proposed to expand its school by 80 students over five years, but reduced the number to 48.

UF College of Dentistry Dean Dr. Teresa Dolan said the change is an acknowledgement of limited state funding, while working with Florida A&M will help increase enrollment of minority students.

"We are committed to improving the diversity of both the student body and our workforce," she said.

The Florida Board of Governors, the governing body for the state university system, will consider the plans at its meeting next month.

Illegal dentistry conviction for Oakland man

A man has been convicted of practicing dentistry without a license at an office along Oakland's bustling Grand Avenue, prosecutors said Monday.

Mario Alfredo Pacheco, who accepted cash only from mostly low-income patients, was convicted Friday by an Alameda County jury of two misdemeanors and two felonies relating to practicing unlicensed dentistry.

During the trial, a victim testified that Pacheco ground all her teeth to little nubs as part of a plan - at a cost of $10,000 - that he had said would give her a "Colgate smile," said Deputy District Attorney Bob Hartman. Pacheco never gave her permanent crowns and sprayed diluted bleach on her gums to treat an infection, authorities said.

A second victim told jurors that he gave her two root canals against her will and that his work led to her going to an emergency room after she fainted, Hartman said.

WVU launches new plan to encourage health sciences students to choose rural practices

Medical and dental students at West Virginia University now have a new incentive, worth as much as $40,000, to choose a career in a rural area.

Five students a year who agree to practice in West Virginia after graduation will be eligible for free tuition for two years under the program that is part of an overhaul of the 16-year-old Rural Education Health Partnership. Dr. Larry Rhodes, director of WVU's new Institute for Community and Rural Health, announced the changes Wednesday at a conference in Morgantown.

In May, the Higher Education Policy Commission shifted control of the 16-year-old program to West Virginia and Marshall universities, and the School of Osteopathic Medicine in Lewisburg by giving them the $2.3 million in funding.

Through required rotations, RHEP had paired students with nine community health centers and hospitals across the state. But the commission voted to change the way the program works after legislative audits in 2004, 2006 and 2009 raised questions about the long-term value of the program and a lack of financial oversight.

The medical schools will now be able to manage it to better suit their students' needs.

WVU still considers rural rotations important for both students and communities, and they remain mandatory for students in medical, dental, pharmacy, nursing and other health sciences schools. But the new program supports students who are interested in committing to a rural practice after they graduate.

Each year, it will pay five students — one fourth-year dental student, two third-year medical students and two fourth-year medical students — for rural service in exchange for a commitment to work in West Virginia.

That could save each student as much as $40,000 per year, Rhodes said.

Dentist to go to jail for groping patients

A Rotterdam dentist who groped several teenage patients in his office is headed to jail for six months.

Frank Izzo, 53, of Schenectady, also must surrender his license to practice and register as a sex offender under a plea deal reached Monday.

Izzo, who had been licensed since 1990, pleaded guilty to two counts of sex abuse, both misdemeanors, during an appearance before Rotterdam Town Justice Kenneth Litz.

His victims ranged in age from 13 to 22, said Assistant District Attorney Jessica Lorusso, who prosecuted the case.

The prosecutor said Izzo touched at least nine patients on their breasts over their clothing as they sat in his dental chair. She said the investigation into the dentist started when one of the victims told an employee.

Izzo was arrested Oct. 12, 2010, as he arrived at his office at 3049 Broadway.

A report issued by the state Education Department's Office of Professional Discipline last year said two former and one current employee told investigators they witnessed Izzo "repeatedly and intentionally place his hand on the breasts of numerous female patients."

The report noted that it was "particularly disturbing" that seven of the 10 Izzo patients who gave sworn statements were under 18.

Enjoy your morning!

The Morning Drill: October 26, 2011

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

UCF tweaks dental school plan, but will it be enough?

A month after a state committee sharply criticized the University of Central Florida's plan to open a dental school in 2014, the college has fine-tuned its proposal and asked for another review.

It's hoping a new partnership with University of Florida's top-ranking dental school will help it earn approval next month.

UCF plans to hire UF as a consultant to help develop curriculum and clinical programs for UCF's 394-student College of Dental Medicine, which would be built in Lake Nona's emerging Medical City.

But it's unclear if that change will be enough to win over the Florida Board of Governors. A committee of the board, which oversees public universities, remains highly skeptical of any plans for dental schools in Florida — a state that's strapped for money and, according to some studies, doesn't need more dentists.

Last month, the committee rejected plans by UCF and Florida A&M University to open dental schools and a plan by UF to expand its program. The group directed the universities to collaborate and bring back proposals for meeting a pressing need with little or no additional state funding.

Those plans will be reviewed next month.

"The Board of Governors is extremely fearful — extremely fearful — of approving any project that, in the long run, could come back and affect us financially because we just don't have the money," said Mori Hosseini, a board member from Daytona Beach.

The details of how UCF and UF would work together still need to be worked out. But UCF's revised plan, as with the previous one, would not require state funding. It would operate on student tuition and fees, private donations, research grants and money collected from patients of a student-run clinic.

Dental nurse killed husband in a row over watching football on TV

A DENTAL nurse who stabbed her husband to death in a row about him watching ­football on TV was yesterday convicted of manslaughter.

Leonora Sinclair, 50, plunged a kitchen knife in Lloyd Sinclair’s thigh then delayed calling 999.

The church driver, 73, died in hospital hours after the attack on January 15.

Sinclair denied murder and at first claimed her husband of 10 months fell on a broken wine glass, then that he had stabbed himself at home in Enfield, North London.

She said: “I put Harry Hill on TV and he went berserk.”

An Old Bailey jury cleared her of murder but found her guilty of manslaughter after a two-and-a-half-week trial.

The court heard Mrs Sinclair had previously been seen to hit and humiliate Lloyd.

“He was just a quiet man,” said his brother Clinton.

Judge Stephen Kramer QC ordered psychiatric reports before she is sentenced on December 6.

WHO Calls for 'Phase Down' of Dental Amalgam

A World Health Organization (WHO) committee this month called for a worldwide reduction in the use of dental amalgam to cut the flow of mercury into the natural environment.

"In an environmental perspective, it is desirable that the use of dental amalgam is reduced," Poul Erik Petersen, DDS, DrOdontSci, responsible officer of the Global Oral Health Programme, told Medscape Medical News.

Dr. Petersen chaired a 2-day conference on amalgam as part of a United Nations effort to organize a worldwide treaty on mercury. The WHO released a report of the proceedings on October 11.

At a meeting in Geneva, Switzerland, from November 16 to 17, 2009, 29 experts from 15 countries concluded that the use of dental amalgam results in 180 to 240 metric tons of mercury being discharged into the atmosphere, soil, and water every year. In contrast, 80 to 100 metric tons are recycled, sequestered, or disposed of securely, the report said. However, the report concludes, amalgam should not be banned outright because alternative filling materials are more expensive and not as reliable.

The report calls for research to improve filling materials and said the use of all dental filling materials should be reduced through measures that prevent caries.

The report drew praise from an antimercury activist group, World Alliance for Mercury-Free Dentistry, which released a statement calling the report a "road map for the end of amalgam."

However, a spokesman for the American Dental Association said it is not necessary to reduce the use of dental amalgam at all. "There is no reason per se to phase down amalgam," Rodway Mackert, DMD, PhD, a professor of dentistry at Georgia Health Sciences University in Augusta, told Medscape Medical News. "The effect of doing that on the amount of mercury going into the environment is negligible."

Dental caries are becoming an increasing problem in middle- and low-income countries as they adopt Western lifestyles, including high consumption of sugars, but have not yet begun widespread preventive programs, such as fluoridation, the report says. As a result, the need for filling materials is expected to grow in these countries.

Already, dental amalgam is releasing "a significant amount" of mercury into the environment, the report found. This pollution results from amalgam made for dental use but diverted to other purposes, from poor disposal practices, and from cremation, the report said.

It laid out "best management practices," including bulk mercury collection, chair-side traps, amalgam separators, vacuum collection, recycling, and commercial waste disposal to prevent mercury from being released into the environment. It cited a US Environmental Protection Agency estimate that 3.7 tons of mercury are discharged into the environment from US dental practices each year.

Dr. Mackert said this is trivial compared with the 1500 tons generated by mining and other industrial uses in the United States, and he cited an US Environmental Protection Agency report saying that human activity only accounts for a third of the total mercury released into the environment. "Most of the mercury in tuna and things like that comes from natural sources like undersea volcanic vents," he said. "Reducing man-generated mercury is so much silliness."

He said the American Dental Association supports best management practices because if mercury gets into sewage sludge, then waste management companies cannot sell the sludge. However, amalgam has clear advantages over other restorative materials, so it should remain available to US dentists, Dr. Mackert said.

Enjoy your morning!

Federal Government Medical Panel Recommends HPV Vaccine for Boys

A doctor holds the human papillomavirus vaccine Gardasil in his hand at his Chicago office. The controversial HPV shot given to girls should also be given to boys, in part to help prevent the spread of the virus through sex, a government medical panel said Tuesday, Oct. 25, 2011

I think this recommendation will be even a harder sell to Americans.

The controversial HPV shot given to girls should also be given to boys, in part to help prevent the spread of the virus through sex, a government medical panel said Tuesday.

The expensive vaccine, which protects females against cervical cancer, hasn't been popular. And doctors admit it will be a tough sell to parents of 11- and 12-year-old males, too.

For males, the vaccine is licensed to prevent genital warts and anal cancer. Experts say another key benefit of routinely vaccinating boys could be preventing the spread of the human papilloma virus to others through sex — making up somewhat for the disappointing vaccination rate in girls.

The Advisory Committee on Immunization Practices made the recommendation Tuesday. Federal health officials usually adopt what the panel says and asks doctors and patients to follow the advice.

The vaccine has been available to boys for two years but Tuesday's vote was the first to strongly recommend routine vaccination. Officials acknowledged the disappointing rate in girls encouraged them to take a new, hard look.

Just 49 percent of adolescent girls have gotten at least the first of the recommended three HPV shots, which have been recommended for girls for five years. Only a third had gotten all three doses by last year.

"Pretty terrible," said Dr. Anne Schuchat, a U.S. Centers for Disease Control and Prevention administrator who oversees the agency's immunization programs.

She attributed the low rates for girls to confusion or misunderstanding by parents that they can wait until their daughter becomes sexually active. It works best if the shots are given before a girl begins having sex.

The vaccine is approved for use in boys and girls ages 9 to 26; but it is usually given to 11- and 12-year olds when they are scheduled to get other vaccines.

The committee also recommended the vaccination for males 13 through 21 years who have not been vaccinated previously or who have not completed the three-dose series.

Tuesday's vote follows recent studies that indicate the vaccine prevents anal cancer in males. A study that focused on gay men found it to be 75 percent effective. But while anal cancer has been increasing, it's still a fairly rare cancer in males, with only about 7,000 cases in the U.S. each year that are tied to the strains of viruses targeted in the HPV vaccine. In contrast, about vaccine-preventable 15,000 cervical cancers occur annually.

I don't think parents like to be put in a position of having a vaccine that encourages straight or gay sex for their children.

And, vaccinating boys to protect girls, is a lot to ask.

The government can recommend all it wants, but I don't think the Gardasil Vaccnie will be used any more with this recommendation.

The Morning Drill: October 25, 2011

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

Is dentistry facing an ethical dilemma?

Scandals, lawsuits, a growing focus on commercialization and self-promotion, and dentists who prescribe excessive treatments are tarnishing the profession's image, according to a presentation on ethics at the recent ADA annual session in Las Vegas.

Most dentists may be surprised that a Google search on ethical scandals among health professions shows that dentistry now gets more hits than medicine, nursing, chiropractics, and pharmacology, according to Ann Boyle, DMD, interim provost and vice chancellor for academic affairs at Southern Illinois University.

Some of the public's changing perceptions toward dentistry can undoubtedly be traced to ubiquitous media coverage of scandals and malpractice lawsuits involving medical professionals, Dr. Boyle noted.

Gordon Christensen, DDS, MSD, PhD, discussed the decline of dentists' credibility in a 2001 article, noting a Gallup poll showed that their ranking among professions had fallen below nurses, physicians, and veterinarians (Journal of the American Dental Association, August 2001, Vol. 132:8, pp. 1163-1165).

Dentists were ranked third among the most trusted professionals in 1995 but slipped to ninth in 2001, according to Gallup poll rankings; they ranked sixth in 2009.

Negative influences, according to Dr. Christensen, included commercialization and self-promotion, excessive treatment and fees, providing service only when it's convenient, and refusing to accept responsibility when treatment fails prematurely.

Dr. Boyle recalled hearing from frustrated emergency room doctors who complained that they cannot adequately treat dental emergencies and said many patients come to them because no dentist will see them.

"We know there are reasons for this that MDs don't understand," she said, "but we must also realize that these front-line physicians consider us uncaring, selfish, and greedy and unprofessional and will tell anyone who will listen, including politicians."

SC Medicaid agency may reinstate dental coverage

South Carolina's Medicaid agency may reinstate paying for tooth extractions in 2012-13.

The state Department of Health and Human Services cut emergency dental service for adults last spring as it sought to close a $228 million deficit. Federal law doesn't require state Medicaid programs to cover dental service for adults.

However, the cut may actually be costing the state, if people with severe toothaches end up instead in hospital emergency rooms.

Agency director Tony Keck says the agency is negotiating with dentists, and a study is under way to determine whether cutting one program is shifting higher costs elsewhere.

Keck's budget request for 2012-13 says he may seek $3.7 million to reinstate the limited program, depending on the study's outcome. He says the analysis will take several months.

Many Young Children Off to a Poor Start With Dental Health

Although child health experts recommend that children begin oral health care by age 1 or when their first teeth emerge, a new report from the University of Michigan Health System C.S. Mott Children's Hospital National Poll on Children's Health shows that most children ages 1-2 have not yet started seeing a dentist.

In May 2011, the National Poll on Children's Health asked parents of children ages 1-5 about dental health care for young children. The poll found that only 23% of 1-year-olds had been to the dentist and only 44% of 2-year-olds had been to the dentist.

"Dental problems such as early childhood caries (cavities in the baby teeth) are the leading cause of chronic disease for young children," says Sarah Clark, M.P.H., Associate Director of the Child Health Evaluation and Research (CHEAR) Unit at the University of Michigan. "Most dental problems can be prevented through good oral health care."

Parents may not be aware of recommendations for early dental health care and finding a dentist who will see young children – especially those covered by Medicaid – is a long standing problem in some communities. To address these issues, pediatricians and health care providers are now seen as important partners in oral health and are encouraged to discuss oral health during well-child visits.

Straumann CEO Says U.S. Dental Market Hasn’t Recovered Yet

Straumann Holding AG, the world’s biggest dental implant maker by sales, views the U.S. dental market as stable at best, Chief Executive Officer Beat Spalinger said in an interview.

“The whole discussion about sovereign debt is clearly influencing consumer confidence,” Spalinger said by phone today. “Consumer confidence is key for our business in terms of market growth.”

The company has started a share repurchase program of up to 100 million Swiss francs ($1143 million), Spalinger said. There is no timeframe for completion, he said.

Straumann earlier today reported a 5 percent rise in third- quarter sales in local currencies to 150.7 million Swiss francs. The strength of the franc against the euro and dollar cost the company 60 million Swiss francs during the first nine months of the year, it said.

Straumann still expects an operating profit margin for 2011 in the high teens, excluding an impairment charge related to business affected by the earthquake and tsunami in Japan. Straumann expects the market will grow in the low-to-mid-single digit percentage range this year.

Enjoy your morning!

The Morning Drill: October 24, 2011

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

U.S. State Department Announces Position on Mercury Fillings

For the first time in history, the U.S. Department of State (DOS) is evaluating international regulations that would ban mercury-containing products including silver/amalgam dental fillings, which contain 50% mercury and are already in the mouths of more than 122 million Americans.

The DOS will present their official position on the use of mercury in amalgam fillings and other medical devices at a stakeholder meeting on Monday, October 24th, from 11:00 AM to 12:30 PM at the DOS headquarters on 2201 C Street, N.W., Washington, D.C. Injured consumers and members of the International Academy of Oral Medicine and Toxicology (IAOMT) will attend the meeting to encourage a ban on mercury/silver dental amalgam fillings.

The U.S. government's monumental decision about mercury fillings is being made in preparation for the third session of the United Nations Environmental Programme (UNEP) Intergovernmental Negotiating Committee (INC3), scheduled for later this month in Nairobi, Kenya. The committee was created with the specific purpose of developing a global, legally-binding instrument on mercury due to its significant negative effect on human health and the environment.

Monday's DOS meeting about the U.S. position on the INC treaty will set the international stage for the future of mercury in dentistry, which many hope will be the end of drilling a potent neurotoxin into the mouths of an unsuspecting international public.

Durian fruit extract has antibacterial mouth rinse potential

Student researchers from Thailand are exploring the potential for a new kind of oral healthcare product gleaned from the spiky husk of the durian, a pungent, popular fruit in Southeast Asia.

In a study conducted by Faculty of Dentistry students at the University of Chulalongkorn in Bangkok and presented at the recent ADA annual session in Las Vegas, a mouth rinse made with durian polysaccharide gel (DPG) gleaned from durian fruit reduced the presence of Streptococcus mutans as effectively as 0.2% chlorhexidine in the first and third hour after use.

It also reduced bad breath and proved to be nontoxic after 21 days of testing on lab rats, the researchers noted.

Thailand is a major consumer and exporter of durian, which is notorious for being banned in some hotels and public transportation due to its pungent odor.

In this study, the researchers tested the feasibility of using DPG as an alternative to chlorhexidine and alcohol mouth rinse solutions.

"These chemical substances can cause irritation and allergy when used over a long period," they noted.

The researchers also tested the toxicity of the mouth rinse and its ability to reduce S. mutans in saliva.

"Our study was to find whether polysaccharide gel could be used as an active ingredient and [be] commercially developed into oral healthcare products to prevent dental caries and oral malodor," the researchers stated.

The DPG mouth rinse successfully reduced S. mutans in each time frame, they added. In fact, it had the same effectiveness as the 0.2% chlorhexidine in the first and third hour. However, at one week DPG had 52% S. mutans relative to baseline, while the 0.2% chlorhexidine had 17%.

Oral malodor was also reduced by the DPG mouth rinse, although not as effectively as the 0.2% chlorhexidine mouth rinse, the researchers concluded.

Dentists, patients feel economy's bite in Sacramento area

Douglas Lott sees it in the faces of many young people sitting in his Sacramento dentist's chair.

"I have more people unable to pay for treatment," Lott said. "The hardest hit are the younger kids, who … don't have a steady job, or insurance, or are in college. When you tell them they need a root canal or crown for $2,500, they have a look on their face like it's not real."

But Sacramento's double-digit jobless rate and bleak economic conditions are all too real, and they're affecting dentists along with their patients. Like many small businesses, Sacramento area dental practices are getting drilled by the economy, state budget cuts and insurance plan changes.

Dentists in the Sacramento region are reporting that business dropped by as much as 25 to 30 percent in the last three years, said Cathy Levering, executive director of Sacramento District Dental Society. That number is about even with the statewide figures for decreased dental business, she said.

Dentists are also struggling with lost retirement funds in the stock market, which is delaying retirement and making it tough for younger dentists to move into practices. Meanwhile, cuts to Denti-Cal, the lack of free dental clinics and decreasing insurance coverage over the last decade are chipping away at dentists' profits.

Because of state budget shortfalls, the state's Denti-Cal program eliminated adults from its program in 2009, making only children and pregnant women eligible for subsidized dental care and further reducing patient loads.

Eight of 10 dentists in California are sole practitioners, according to the California Dental Association, which means they bear the brunt of financial downturns.

The poor economy means patients are forgoing routine and elective care, coming in only for more complicated and expensive emergency treatments. Many dental offices are finding it necessary to get more creative with financing.

Carmichael dentist Gabrielle Rasi said her business is off by about 10 to 15 percent since the recession hit, mostly in elective and cosmetic procedures. Five to six years ago, her patients would take out home equity loans or charge their credit cards to have elective procedures, but these days, patients are more conservative, she said.

Optional Medicaid benefits face state cuts

States are using a variety of strategies to control rising Medicaid costs even as they look ahead to a massive expansion of the state-federal health insurance program for the poor beginning in 2014.

The weak economy is driving more jobless Americans into Medicaid, increasing enrollment at the same time that medical costs keep going up.
To deal with the higher costs, states are pushing Medicaid recipients into managed-care plans run by private insurers, cutting reimbursement rates to hospitals and doctors and reducing benefits.

The new federal health law requires states to maintain Medicaid eligibility and enrollment standards until 2014, when the expansion begins to add 16 million Americans to the program. States are still free, however, to cut optional benefits, which include drugs, vision care and visits to certain providers such as chiropractors and podiatrists.

Within those restrictions, many states have enacted benefit cuts in fiscal 2012.
This month, Nebraska began limiting how many adult diapers it pays for to 180 a month. In July, Colorado stopped covering circumcisions. Tennessee ended coverage of adult acne medicine.
Other steps:

•California plans to eliminate adult day-care coverage and limit Medicaid patients to seven doctor visits a year, as of November.
•North Carolina this month stopped covering regular eye examinations and eye glasses for adults in Medicaid.
•Connecticut in July cut the number of dental exams covered for adults in Medicaid from twice a year to once a year.
•Pennsylvania began requiring adult Medicaid patients to get state permission for crowns and certain other dental procedures.

"The benefit cuts are indicative of the real cost pressures on states and that there are only so many things you can do to address them," said Stacey Mazer, senior staff associate at the National Association of State Budget Officers.

Enjoy your morning!

U.S. Senators Ask World Series Teams to Forego Chewing Tobacco

Red Sox manager Terry Francona was among the most visible users of smokeless tobacco

Yeah, like that will happen during the World Series.

U.S. senators and health officials are taking on a baseball tradition older than the World Series itself: chewing tobacco on the diamond.

With the Series set to begin Wednesday between the St. Louis Cardinals and Texas Rangers, the senators, along with health officials from the teams' cities, want the players union to agree to a ban on chewing tobacco at games and on camera. They made the pleas in separate letters, obtained Tuesday by The Associated Press.

"When players use smokeless tobacco, they endanger not only their own health, but also the health of millions of children who follow their example," the senators wrote to union head Michael Weiner.

The letter was signed by Dick Durbin of Illinois, the No. 2 Democrat in the Senate, and fellow Democrats Frank Lautenberg of New Jersey, Richard Blumenthal of Connecticut and Senate Health Committee Chairman Tom Harkin of Iowa.

The senators noted that millions of people will tune in to watch the World Series, including children.

"Unfortunately, as these young fans root for their favorite team and players, they also will watch their on-field heroes use smokeless tobacco products," they wrote.

I understand the argument and the horrible health effects of smokeless tobacco. But, Spring training and the start of the baseball season is the appropriate time to wean players off a very addictive drug, as tobacco is.

There is no way these players can be expected to give up chewing tobacco "cold turkey" and expect to perform well on the field.

The Morning Drill: October 21, 2011

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

UCLA gets $2.8 million from NIH to develop saliva test to diagnose Sjögren's syndrome

In August, tennis star Venus Williams withdrew from the U.S. Open, saying she was suffering from fatigue and other symptoms related to Sjögren's syndrome, an autoimmune disorder that results in the loss of the ability to produce saliva and tears. Her announcement focused public attention on this malady, which affects nearly 4 million Americans.
 
While women are nine times more likely than men to develop Sjögren's, the disorder affects virtually every racial and ethnic group. Most patients develop symptoms after age 40, including dry eyes, dry mouth and often joint pain and chronic fatigue. And because of their paucity of saliva and the antibacterial chemicals it contains, patients may also develop tooth decay and cavities.
 
While much is known about the symptoms of Sjögren's, the disease is complex and poorly understood, and in some cases, it can take more than six years to be diagnosed.
 
The UCLA School of Dentistry has now received a $2.8 million grant from the National Institute of Dental and Craniofacial Research, part of the National Institutes of Health, to support a multi-center clinical trial of a diagnostic test that uses patients' saliva to determine whether they have Sjögren's syndrome. This simple, non-invasive test will permit a diagnosis within minutes, rather than the weeks currently required when using blood or other tissue samples.
 
The project will be led by Dr. David Wong, associate dean for research and the Felix and Mildred Yip Endowed Professor in Dentistry at the UCLA School of Dentistry. For Dr. Wong and his colleagues, who have been conducting research on using saliva as a diagnostic tool for biomarkers of oral cancer, early-stage pancreatic cancer and other maladies for several years, this is an important step in moving from the research realm to actual clinical trials and, eventually, to use by medical and dental practitioners.

Dental care in big demand at free LA health clinic

Avery Shapiro has had tooth pain for several years. Pat Morris' dental insurance wouldn't cover the tab for a filling. Chenell Bass had to stop driving because her eyesight got so weak.

Such stories were typical among the first 1,200 people filing into a huge free medical clinic that opened Thursday at the Los Angeles Sports Arena.

The four-day clinic, organized by Los Angeles-based nonprofit CareNow, is expected to draw 5,000 uninsured and underinsured patients who spent hours in line Monday to obtain wristbands to enter the event. Some even camped out overnight.

It's the fourth such event that CareNow has organized around Los Angeles County with the help of 800 medical professionals volunteering their services, and supplies and equipment donated by manufacturers.

"We hope to keep doing these until we're obsolete," said CareNow President Don Manelli. "There are 2 million uninsured in L.A. County. We're doing what we can do."

At all the clinics, dental treatment is the overwhelming request followed by vision care. "If you have a toothache, there's no ER to go to," Manelli said. "About 60 percent ask for dental care."

Board Votes To Remove Fluoride From Lawrenceburg Water Supply

Members of the board of directors for the Lawrenceburg Utility Systems voted unanimously Thursday evening to discontinue the practice of adding fluoride to the local water supply.

Board members have discussed the matter during recent meetings. Utility systems near and far have opted recently to take this same action. Leaders in Waynesboro, Hohenwald and Spring Hill have recently made the same decision.

The practice of adding fluoride to public water systems began in 1945 in order to help prevent tooth decay. Since fluoride is now available through different sources, such as toothpaste and rinses, many governments have opted to discontinue the practice.

During Thursday’s meeting, board members considered a letter of recommendation submitted by State Representative Joey Hensley, M.D. Hensley recommended that the practice be discontinued.

With one board member absent, representatives voted unanimously to make the change. It is expected to result in a cost savings to the water department of approximately $22,000 per year.

Talk of treaty ban on mercury concerns scientists

Scientists are warning officials negotiating a global treaty on mercury that banning the deadly chemical completely would be dangerous for public health because of the chemical's use in vaccines.

The ban option is one of several proposals on the table for a meeting later this month in Nairobi, but a final treaty isn't expected until 2013.

According to the World Health Organization, mercury is one of the top 10 chemicals of public health concern and is highly toxic. Most of the worry is centered on mercury emissions from burning coal, gold mining and people eating mercury-tainted fish.

Mercury in small amounts is also found in many products including light bulbs, batteries and thermometers. WHO advises such products to be phased out, suggesting for example, that health systems switch to digital thermometers instead.

The problem is that a proposed ban might include thiomersal, a mercury compound used to prevent contamination and extend the shelf life of vaccines, many scientists say. It is used in about 300 million shots worldwide, against diseases including flu, tetanus, hepatitis B, diptheria and meningitis.

"Not being able to use mercury is not a viable option," said David Wood, a WHO vaccines expert.

Wood said there isn't a viable alternative to thiomersal at the moment. If banned, pharmaceuticals would likely have to switch to preservative-free vaccines, which would complicate the supply chain and vaccination campaigns in poor countries, since the injections would have a much shorter shelf life. Costs would also spike since manufacturers would need to reconfigure their factories.

Thiomersal has mostly been removed from childhood vaccines in the U.S. and Canada. In some European countries, including Norway and Sweden, manufacturers have been encouraged to make thiomersal-free vaccines — and no other uses of mercury as a medical preservative are allowed.

Fears about thiomersal in vaccines were first raised after a flawed medical study in 1998 linked a common childhood injection to autism. But numerous studies since have found no sign the mercury compound is risky.

Experts hope countries won't go overboard in their attempts to control the substance.

Enjoy your morning!

Should the Federal Government Develop a New Nutritional Rating System for Food and Beverages?

Yes, according to a new government committee report.

Federal agencies should develop a new nutrition rating system with symbols to display on the front of food and beverage packaging that graphically convey calorie counts by serving size and a "point" value showing whether the saturated and trans fats, sodium, and added sugars in the products are below threshold levels.This new front-of-package system should apply to all foods and beverages and replace any other symbols currently being used on the front of packaging, added the committee that wrote the report.

"Our report offers a path to develop an Energy Star® equivalent for foods and beverages," said committee chair Ellen Wartella, Sheikh Hamad bin Khalifa Al-Thani Professor of Communication, professor of psychology, and director, Center on Media and Human Development, School of Communication, Northwestern University, Evanston, Ill."A successful front-of-package nutrition rating system would enable shoppers to instantly recognize healthier products by their number of points and calorie information.It would encourage food and beverage producers to develop healthier fare and consumers to purchase products that are lower in calories and food components that contribute to chronic disease."

I have to admit I don't like the government spending money needlessly, but the current nutrition labels are hard to read and I use a computer program (MyFitnessPal.com) to help wade through them.

Easily understood graphics would help you choose foods and beverages in a more expeditious manner.

Now, as to restaurants - can there not be some voluntary compliance?

The Morning Drill: October 20, 2011

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

Unvaccinated Kids Behind Largest U.S. Measles Outbreak in Years: Study

The largest U.S. outbreak of measles to occur in 15 years -- affecting 214 children so far -- is likely driven by travelers returning from abroad and by too many unvaccinated U.S. children, according to new research.

The finding could highlight the dangers of a trend among some U.S. parents to skip the measles-mumps-rubella (MMR) vaccine for their children, out of what many experts call misguided fears over its safety.

Dr. Andrew Pavlo, professor of pediatrics at the University of Utah and spokesman for the Infectious Diseases Society of America (IDSA), said, "The good news is that we are seeing introductions of measles that are being contained as small outbreaks."

Pavlo credits containment to high levels of vaccination and the rapid response by public health officials. However, if an outbreak occurred in a "really susceptible population the outcome could be very different," he said.

"What would happen in an area with a lot of vaccine refusers? Then you might see a much larger outbreak," he said.

Several measles-related studies were unveiled at the annual IDSA annual meeting, currently being held in Boston.

In the first report, U.S. Centers for Disease Control and Prevention (CDC) researchers chronicled the nation's ongoing outbreaks in 2011.

Most of those sickened were not vaccinated against the disease, CDC researchers said.

Before the vaccine became available in the 1960s, some three to four million people contracted measles every year. Of those, 48,000 were hospitalized, 1,000 were permanently disabled and about 500 died, the CDC said.

Unfortunately, "we have experienced an increased incidence of measles this year," said Huong McLean, lead researcher and CDC epidemiologist. "Typically we see 60 to 70 cases a year, this year we have 214 as of Oct. 14."

Among those people infected, 86 percent were unvaccinated or their vaccination status was unknown. Thirteen percent were under one year old -- too young for vaccination.

Throughout the United States, 68 of the patients have been hospitalized, 12 with pneumonia.

Free LA medical clinic to draw 5,000 uninsured

More than 5,000 people are expected to show up for free medical care at a Los Angeles arena starting Thursday.

The four-day clinic, organized by nonprofit CareNowLA, aims to provide health services for the impoverished and uninsured ranging from filling cavities to eye exams to cardiology checkups.

CareNowLA has lined up some 800 medical professionals to volunteer their services at the Los Angeles Memorial Sports Arena, but the nonprofit says still more dentists, nurse practitioners and primary care physicians are needed.

People lined up more than 24 hours in advance earlier this week to obtain wristbands that will allow them to enter the clinic. After treatment, patients will be referred to local medical centers that have offered to provide free follow-up care to the patients.

How Do I Run Barefoot With Shoes on?

There is a plausible theory that mankind came down from the trees to run across the African savannah in pursuit of prey. Running is not much in demand as a survival skill anymore, but it is by far and away the most popular participation sport in industrialized nations. This may be great for cardiovascular health, but it is apparently a disaster orthopedically; a typical estimate is that 60% of runners suffer injuries a year. Such high injury rates seem somewhat of an anomaly if we were indeed "born to run." I doubt that, for example, 2 out of every 3 eagles suffer wing injuries each year.

Some runners have used the evolutionary origins of running as a premise to argue that we should run barefoot (those proto-humans in Africa many millions of years ago were certainly not wearing Nike Lunarglides). Recent years have seen some runners abandon high-tech running shoes in favor of bare feet or "minimalist" shoes that mimic a barefoot running style. This has led to debates about whether the best way to avoid injury is to run with or without shoes.

Certain aspects of this debate are fairly settled. Few dispute that barefoot running is a very recent phenomenon in the United States or that, whatever the relative overall rates of injury, barefoot runners are more likely to experience ankle and foot injuries whereas those in running shoes suffer injuries of the knee, thigh, and hip. This makes the barefoot running debate pretty much guaranteed to generate more rhetorical light than scientific heat:

More Than One in Ten Americans Take an Antidepressant

Prozac Nation, indeed — 11% of Americans aged 12 and up now take an antidepressant medication, though less than one third of them have seen a mental-health professional in the past year.

So say stats from the Centers for Disease Control and Prevention that paint a portrait of who used the medications in 2005-08. The report covers nearly 13,000 participants in the ongoing National Health and Nutrition Examination Survey (NHANES).

The rate of antidepressant use has been climbing, rising by almost 400% since 1988-94, the CDC says. Women are significantly more likely to take antidepressants in every age group except the youngest tracked in this report — ages 12 to 17. The high-water mark for antidepressant use is 23%, seen in women aged 40 to 59.

Nearly 14% of whites take antidepressants, far more than the 4% of blacks and 3% of Mexican-Americans who report taking the medications. But income level is not a determinant of use, the report finds.

Despite the widespread use of antidepressants, the majority of people with severe depressive symptoms — about 66% — are not taking the drugs. Only 20% of men with the most severe symptoms are taking a drug.  About 8% of people reporting no depressive symptoms are taking the drugs, which could be because they’re being successfully treated by the drugs, or because they’re taking the drugs for other conditions.

And the data indicate that a significant number of people who are taking antidepressants — even more than one — haven’t seen a mental-health professional in the past year. Just 29% of those taking one drug and 48% taking two or more report seeing a psychologist, psychiatrist, psychiatric nurse or clinical social worker in that time period.

Enjoy your morning!

The Morning Drill: October 19, 2011

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

FQHCs: Second home for retired dentists?

Healthcare reform funding will double the number of federally qualified health centers (FQHCs) in the U.S. and create new opportunities for dentists young and old, according to a panel discussion last week at the ADA annual session in Las Vegas.

In addition to providing care for the underserved, FQHCs also supply valuable training for dental students and a "second home" for many retired dentists, the panel members noted.

More than 19 million people received medical treatment at the 1,200 federally qualified health centers (FQHCs) in the U.S. last year. Approximately 75% of the centers now have dental clinics, which provided dental care to 3.7 million people in 2010.

And the Affordable Care Act includes $11 billion to create twice as many clinics over the next 10 years, but the amount keeps getting cut during ongoing budget negotiations.

Most patients are children, Medicaid patients, minimum wage workers, and families with no dental insurance.

Skip Homicz, DDS, a dentist from Portsmouth, NH, was coaxed out of retirement to become the dental director of the Families First Health and Support Center. He was one of four medical professionals, including three dentists, who told a crowded room what it's like to go from a private practice treating patients who usually had insurance or could pay, to doing extractions and fitting dentures for the poor and homeless who pour into the Portsmouth clinic.

The main problem, Dr. Homicz noted, is dealing with the "black abyss": those over 19 years old who need complicated treatments. "That's where we're seeing people who haven't been to the dentist in 10 years," he said. "I've got to tell you, we're not doing a lot of root canals. The resources aren't there to do full crowns. We do a lot more exodontia, removable bridge work. We do a lot more dentures. We take a lot of people out of pain and take care of a lot of infections."

Dentists could use their professional and managerial skills to help run dental centers and mentor dental students and new graduates, Dr. Homicz said. He stressed the importance of being under one roof with physicians with whom he can consult before treating patients with chronic conditions such as high blood pressure.

The speakers encouraged those attending to contact their state or local dental association to volunteer at FQHCs or join the boards that oversee them. Retired dentists who have run their own practices can provide crucial input and put their experience to use, they noted.

Malaria eradication no vague aspiration, says Gates

Eradicating malaria is not a vague, unrealistic aspiration but a tough, ambitious goal that can be reached within the next few decades, the billionaire philanthropist Bill Gates said on Tuesday.
In an interview with Reuters at his Gates Foundation's Malaria Forum in Seattle, the Microsoft founder who now spends his time and money on global health and development projects rejected skepticism about focusing his aim on wiping out the killer mosquito-borne disease worldwide.

"It's not a near-term goal," Gates said, but one that can "certainly" be achieved within his lifetime.

"I'd be disappointed if within 20 years we're not very close to eradicating this globally," he said.

Malaria currently kills about 780,000 people a year -- the vast majority of them children and babies in sub-Saharan Africa -- and is endemic in about 100 countries.

Gates said a renewed focus and substantial increases in funding for malaria, partly spurred by his call in 2007 for global eradication of the disease, was steadily "shrinking the malaria map" and would continue to do so.

He pointed to Madagascar, Papua New Guinea and Ethiopia as "likely early candidates" for being able to eliminate the disease from within their borders in the near future.

Giving a boost to anti-malaria efforts was news on Tuesday of an experimental vaccine from GlaxoSmithKline that halved the risk of African children getting malaria.

However experts stressed the vaccine was no quick fix for eradicating malaria. The new shot is less effective against the disease than other vaccines are against common infections such as polio and measles.

Gates' eradication call in 2007 -- the first time the "e-word" was revived since a global malaria eradication push launched in 1955 faltered and failed -- was seen by some experts in the field as an unwelcome and fanciful notion.

Coralville dentist gets probation for unnecessary dental work, fraudulent billing

A Coralville dentist has been given four years of probation by the Iowa Dental Board for charges related to performing unnecessary dental work and fraudulent billing practices.

However, Dr. John R. Strief said Tuesday he does not agree with the charges.

“We work very hard to provide our patients with the best care possible,” he said. “I think our patients will know these charges are not correct.”

The dental board filed a six-count statement of charges against John R. Strief in April. The board accused Strief of unprofessional conduct by submitting an insurance claim to a third party reporting incorrect treatment dates, obtaining a fee by fraud or misrepresentation, unprofessional conduct by performing unnecessary dental services or procedures, failure to maintain a “reasonably satisfactory” standard of competency, willfully or repeatedly violating board rules by failing to maintain proper records and willfully or repeatedly billing patients for services he did not provide.

According to the statement of charges, the board launched an investigation into Strief in March after a complaint. The board obtained numerous patient records, which were reviewed by consultants. The consultants determined Strief was not “practicing to an acceptable standard of care,” according to dental board documents.

The board found that Strief regularly submitted multiple insurance forms in which he misrepresented the dates of service to receive payment.

Strief was given a chance to respond in writing to the board’s allegations; however, his records contained “little or no evidence” supporting the treatment he provided, according to the board.

Strief said the investigation was the result of a single complaint lodged by a former employee, who he described as “very disturbed” and disgruntled.”

However, Strief said he agreed that the charges were “very serious.” He said they stemmed from omissions in patient records or errors in claim forms from 11 patients, which he said gave the appearance that patients were charged for work that was not done.

Under the terms of his probation, Strief has agreed to repair or replace any of the unnecessary work he performed within the next five years. Strief has been given 30 days to submit a practice monitoring plan to review his clinical and billing practices. He also was ordered to complete a record-keeping course and the Professional/Problem-Based Ethics Program.

Additionally, Strief has been ordered to pay a $10,000 civil penalty to the board within the next seven months.

State to clinics: Send back payments for dental care

California’s health program for the needy is approaching the state’s clinics with a controversial request: Send back those checks for root canals, tooth extractions and other dental services rendered within the last year.

State coverage for Medi-Cal patient dental and podiatry services was cut amid budget shortfalls in mid-2009, but reinstated by court order after clinics sued in October of last year.

Clinics offered the services again until May, when the state met the procedural hurdle to eliminate state coverage of benefits such as dental care and podiatry, which are considered optional under the state and federal Medicaid program.

Now, leaders of clinics are bracing for bills in the hundreds of thousands of dollars as the Department of Health Care Services says it wants its money back.

“We can’t take money from a dentist’s paycheck, take dental supplies back or get part of our light bill back,” said Jennette Lawrence Shea, director of government and community relations for Family Health Centers of San Diego. “It puts all of the burden on community clinics, and that’s just not right. We’re the safety net, here to help the most vulnerable. We’re struggling to do that with all of these cuts.”

Lawrence Shea said the clinic provided 5,300 dental visits from October to May at sites throughout San Diego County and expects to be on the hook for about $850,000.

Norman Williams, spokesman for the Department of Health Care Services, said in an e-mail that providers were warned during the court-order period that they may have to send back the money.

“We have a responsibility to protect the fiscal integrity of the Medi-Cal program," Williams said.

Williams did not have an estimate for the total amount owed to the state or how many clinics would be expected to send refunds. The state has issued an advisory letter on the matter but hasn't started billing individual clinics yet.

The effects are expected to be felt statewide.

Marty Lynch, executive director of LifeLong Medical Care in Berkeley, said his organization provides a range of care to about 23,000 low-income and homeless adults each year. He estimates the organization will owe about $400,000 worth of dental services.

Enjoy your morning!

First Malaria Vaccine Successful in a Major Clinical Trial

What great news!

An experimental vaccine from GlaxoSmithKline halved the risk of African children getting malaria in a major clinical trial, making it likely to become the world's first shot against the deadly disease.

Final-stage trial data released on Tuesday showed it gave protection against clinical and severe malaria in five- to 17-month-olds in Africa, where the mosquito-borne disease kills hundreds of thousands of children a year.

"These data bring us to the cusp of having the world's first malaria vaccine," said Andrew Witty, chief executive of the British drugmaker that developed the vaccine along with the nonprofit PATH Malaria Vaccine Initiative (MVI).

While hailing an unprecedented achievement, Witty, malaria scientists and global health experts stressed that the vaccine, known as RTS,S or Mosquirix, was no quick fix for eradicating malaria. The new shot is less effective against the disease than other vaccines are against common infections such as polio and measles.

"We would have wished that we could wipe it out, but I think this is going to contribute to the control of malaria rather than wiping it out," Tsiri Agbenyega, a principal investigator in the RTS,S trials in Ghana, told Reuters at a Seattle, Washington, conference about the disease.

Malaria is endemic in around 100 countries worldwide and killed some 781,000 people in 2009, according to the World Health Organization.

Control measures such as insecticide-treated bednets, indoor spraying and use of combination anti-malaria drugs have helped significantly cut the numbers of malaria cases and deaths in recent years, but experts have said that an effective vaccine is vital to complete the fight against the disease.

The new data, presented at the Bill & Melinda Gates Foundation's Malaria Forum conference in Seattle and published simultaneously in the New England Journal of Medicine, were the first from a final-stage Phase III clinical trial conducted at 11 trial sites in seven countries across sub-Saharan Africa.

The trial is still going on, but researchers who analyzed data from the first 6,000 children found that after 12 months of follow-up, three doses of RTS,S reduced the risk of children experiencing clinical malaria and severe malaria by 56 percent and 47 percent, respectively.

Thanks to funding from the Bill and Melinda Gates Foundation, this breakthrough was achieved. Malaria has plagued the poor third world for centuries and finally there is some hope to cut down on the number of people who die from this parasitic disease.

Malaria is caused by a parasite carried in the saliva of mosquitoes. The RTS,S vaccine is designed to kick in when the parasite enters the human bloodstream after a mosquito bite. By stimulating an immune response, it can prevent the parasite from maturing and multiplying in the liver.

Without that immune response, the parasite gets back into the bloodstream and infects red blood cells, leading to fever, body aches and in some cases death.

Althouhg most health experts like to see an effective rate of 80% for most vaccines, a 50% plus rate will continue to save many lives. If everyone breaks right, the vaccine should be available in 2015.

Here is the life cycle of the malaria parasite.

The Morning Drill: October 18, 2011

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

Massachusetts Dentist Chosen President-Elect of the American Dental Association

Robert A. Faiella, D.M.D., M.M.SC., who practices Periodontics in Osterville, Mass., was recently selected as president-elect of the American Dental Association (ADA). Dr. Faiella's election took place during a meeting of the ADA House of Delegates in Las Vegas.

Dr. Faiella will assume the ADA presidency in October 2012, when he will lead the 156,000-member organization, America's leading advocate for oral health.

Dr. Faiella has just completed a four-year term on the ADA Board as the trustee from the 1st District, which represents Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island and Vermont. Dr. Faiella's previous responsibilities with the ADA include serving on various councils and committees, including terms as chair of the Compensation Committee and the ADA Electronic Health Record Workgroup. Since June 2009, Dr. Faiella has served as chairman and sole director of ADA Business Enterprises, Inc., a wholly owned subsidiary of the ADA.

Dr. Faiella is a past president of the Massachusetts Dental Society. He received his pre-doctoral education from Villanova University, receiving two Bachelor of Science degrees and a D.M.D. degree from Fairleigh Dickenson University School of Dental Medicine. He received his graduate training in Periodontology as a Post-Doctoral Fellow at Harvard School of Dental Medicine, as well as a Masters of Medical Science degree from Harvard

Dentists say ending fluoridation in Pinellas County will affect poor kids most

Dentists say low-income families will be hurt the most when Pinellas stops adding fluoride to its water system around the end of the year, a move that will save the county about $205,000 a year.

Sandra's dentist, Dr. Haychell Saraydar of the Health Department, said the girl's problems were with her baby teeth, which came in prior to fluoridation of the water. The dentist said her adult teeth are in better shape.

Though opponents to water fluoridation rightly point out that fluoride is more available than ever — in toothpastes, dental rinses and supplements — dentists and public health officials maintain that having it in tap water is the best, cheapest and easiest way to protect against tooth decay.

"It reaches people of all socioeconomic groups," said Dr. William Bailey, chief dental officer of the U.S. Public Health Service and acting director of the division of oral health at the Centers for Disease Control and Prevention. He called the county's recent decision "disheartening."

Numerous studies and government data show a strong correlation between poverty and kids' oral health. Poor children go to the dentist less frequently and have higher rates of untreated cavities. Poor children in Florida have it particularly tough, with only about a quarter of those covered by Medicaid — such as the Cruz-Quezada family — actually receiving dental services.

A study released this year by the Pew Center on the States gave Florida an F grade for access to dental care for disadvantaged children. Florida ranked last among the 50 states for the percentage of low-income children receiving dental services. Only 25.7 percent do, compared to the national average of 43.8 percent.

Many Pinellas dentists say they're certain what's going to happen once the county closes the taps on fluoridated water.

"There will be higher rates of decay and infection," said Saraydar, who directs the county Health Department's dental program.

Saraydar has seen the difference fluoridated water makes, having provided dental services to the county's poorest children since 1988, years before fluoride was added to the water.

A few years after it was added to the St. Petersburg/Gulfport area water supply around 1993, "we started to see a marked difference in tooth decay," she said. And after it was added to the rest of the county in 2004, "we started seeing the change in children in the other areas as well."

More U.S. employers cutting dental benefits

Healthcare costs continue to rise, driving more employers to stop offering dental coverage -- resulting in only 57% of Americans covered by a dental plan, compared with more than 85% who have medical insurance, according to the latest Healthcare Transparency Index from Change Healthcare.

The index is compiled from a subset of the Change Healthcare client database, which analyzed more than 30,000 in-network insurance claims in the U.S. over a 12-month period.

Varying dental plans are creating higher out-of-pocket costs for patients, making the market for dental services more consumer-driven, according to Change Healthcare. These concerns are creating an alarming trend, the company noted: Employees and their dependents are skipping regular visits and neglecting dental care.

Women were more likely to receive dental care, averaging 1.31 visits per year versus only 1.11 for men, the index found. Seniors age 60 and older were also the most likely to receive dental care, compared with young adults ages 21 to 30 representing the least likely.

The Healthcare Transparency Index also revealed considerable price disparities and local savings potential for the most common dental services, including adult and pediatric preventive exams with and without x-rays, adult caries repair, application of braces with pre- and follow-up visits, and third-molar removal with sedation or anesthesia. Amounts for dental services could vary by more than 400% in the same area for the same service, according to the index.

Among the index's other findings:

• With cost now a significant barrier to proper care, the index found that the same preventive exam for adults could cost as much as $240 and as low as $55 in the same area, and pediatric exams ranged from $180 to just $35.
• Claims data indicated that caries repair at the high-end could cost as much as $360, making these services unattainable for many and leading to long-term health issues, according to Change Healthcare.
• The index reported a high of $6,960 for orthodontic services (including a previsit, braces application, and follow-up visit), compared with a low of $2,400 in the same area.

Oropharyngeal Exam Predicts Severity of Sleep Apnea

A simple oropharyngeal exam can provide key information regarding the severity of obstructive sleep apnea syndrome (OSAS), according to results from a study of more than 300 patients that was carried out in Spain.

The study appears in the October issue of the Archives of Otolaryngology Head and Neck Surgery.

Although the pathogenesis of OSAS has not been definitively established, it is generally blamed on partial or complete obstruction of the upper airway with involvement of the oropharynx.

However, senior and corresponding author Christian Domingo, MD, PhD, from the Pneumonology Service, Hospital Parc Tauli, Barcelona, Spain, and colleagues note that in spite of recent medical advances, up to 80% of patients remain undiagnosed.

"To some extent, this is due to the fact that patients are not aware of the disease, but the logistic difficulties of diagnosis should also be borne in mind," they write. They add there is no simple, fast physical exam that can facilitate screening of patients to assess whether they have sleep apnea and, if so, how severe it may be.

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100 Year Old Man Sets Marathon Record

Fauja Singh grimaces as he crosses the finish line Sunday in the Scotiabank Toronto Waterfront Marathon

Fauja Singh finishes in 8 hours to become oldest person to complete full marathon

Fauja Singh secured a spot in the Guiness World Book of Records on Sunday at the Scotiabank Toronto Waterfront Marathon.

The 100-year-old accomplished an amazing feat, completing the gruelling 42.195-kilometre marathon and becoming the oldest person ever to complete a full-distance marathon.

It took Singh over eight hours to cross the finish line — more than six hours after Kenya's Kenneth Mungara won the event for the fourth straight year — and he was the last competitor to complete the course. But his time wasn't nearly remarkable as the accomplishment itself.

"Beating his original prediction, he's overjoyed," said coach and translator Harmander Singh. "Earlier, just before we came around the [final] corner, he said, 'Achieving this will be like getting married again.'

"He's absolutely overjoyed, he's achieved his life-long wish."

Although event workers dismantled the barricades along the finish line and took down sponsor banners even as Fauja Singh made his way up the final few hundred metres of the race, a throng of media, family, friends and supporters were there when Fauja Singh made marathon history.

And Fauja Singh, who only speaks Punjabi, also surprised himself. Through his interpreter, he said he had set a goal of finishing the race in about nine hours.

"He said he achieved this through the help of God but even God must be getting fed up of helping him," Harmander Singh said, drawing chuckles from assembled media after the race.

Sunday's run was Fauja Singh's eighth marathon — he ran his first at the tender age of 89 — and wasn't the first time he set a record. In the 2003 Toronto event, he set the mark in the 90-plus category, finishing the race in five hours 40 minutes and one second.

And on Thursday in Toronto, Fauja Singh — whose first name means soldier — broke world records for runners older than 100 in eight different distances ranging from 100 metres to 5,000 metres.

Wow! What an accomplishment.

This gives me some inspiration to keep going for a few more years - hopefully 40 or so.....

Here is the video of Fauja finishing:

Vaccines Being Developed to Prevent or Treat Addiction

Well, if they work for infectious diseases, why not?

Up to now, vaccines have been used effectively against a variety of infectious diseases, but what if they could be developed to treat and/or prevent addiction?

Take smoking, for example. Someone who wanted to quit would go through their usual lighting up routine, but when nicotine does not arrive in the brain, they would probably extinguish the cigarette and not light another. Without feeling nicotine's effects, it is likely they would view smoking as a waste of money.

Or consider a vaccine against methamphetamine: Snorted or injected, the drug would not give the user a high, so what would be the point of going to the trouble of scoring this illegal drug in the first place?

Now both vaccines, for nicotine and for methamphetamine, have gone beyond the dreaming stage. Recently, the National Institute on Drug Abuse (NIDA) awarded "visionary" grants to 2 scientists who believe that in the not-too-distant future, vaccines will be available not just for smallpox and whooping cough but also for substance abuse.

Two scientists proposing to develop vaccines against methamphetamine and nicotine have been selected to receive NIDA's second Avant-Garde Awards for Innovative Medication Development Research.

The scientists, Thomas Kosten, MD, from Baylor College of Medicine, Houston, Texas, and Peter Burkhard, PhD, from the University of Connecticut, Storrs, will each receive $500,000 per year for 5 years from NIDA to support their research.

Addiction vaccines could be life-changing for the estimated 22 million drug abusers in the United States. NIDA estimates that every year, addiction costs the country $84 billion in direct healthcare costs, lost earnings, crime, and accidents. The cost trend is rising, and researchers hope that addiction vaccines may reverse it, not only by treating addicts but also by immunizing young people before they become addicted.

Just like regular vaccines, substance abuse vaccines work by provoking the immune system to produce antibodies, which then causes the body to suspend and reject the drug before it reaches the brain. That is the goal, but thus far, success in humans has been elusive.

Clinical trials on these vaccines may start in five years.

They cannot be developed fast enough.

"Seven million people die from smoking addiction every year," Dr. Burkhard told Medscape Medical News, "that's like wiping out Switzerland. It's a tremendous step forward to have a vaccine to prevent smoking, not only for these 7 million who die but also for the other countless millions who are living with their smoking addiction."

The Morning Drill: October 17, 2011

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

VA whistle-blower suffered heart attack before fatal crash

Wallace “Ray” Perdue of Fairborn, a key figure in recent investigations of infection-control practices at the Dayton VA Medical Center dental clinic, had a fatal heart attack behind the wheel of his Corvette, which crashed into a tree on Kemp Road in Beavercreek shortly before noon on Saturday, Oct. 15.

“Just before we crashed, Ray said he couldn’t see; that he had lost his eyesight. He was blacking out,” said his widow, Sherry Perdue, who was in the car with him. “I grabbed the wheel, but his foot was on the gas.”

Mr. Perdue, 45, who was recovering from pneumonia, was pronounced dead at the scene just west of Beaver Valley Road. Mrs. Perdue, who was taken to Miami Valley Hospital and released later Saturday with minor injuries, said the official cause was a heart attack.

The Perdues, who worked in the dental lab as technicians for a decade but were reassigned to other VA facilities after expressing concerns to authorities along with a third informant, were still involved in investigations related to VA dentist Dr. Dwight Pemberton’s failure to sterilize instruments and change latex gloves between patients.

They resigned in November 2010, later found jobs in Chillicothe, but were laid off in August. They had sought to get their old jobs back at the Dayton VA Center, plus lost pay.

“We just started drawing unemployment benefits,” Mrs. Perdue said. “We lost everything because we came forward about the VA.”

Lindsay Lohan makes unflattering red carpet appearance - dental hygiene neglect

Lindsay Lohan has had a very public struggle with drugs and alcohol, and it appears her habits have taken a toll on the 25-year-old’s appearance.

Lohan attended the launch of the new video game Saints Row: The Third in Los Angeles on Wednesday, where she showed off an unflattering look. The actress noticeably had streaks of nail polish on her hands, and her teeth were worn down, yellow, and stained.

According to a Beverly Hills dentist, Lindsay’s teeth are being neglected.

"There are signs of definite neglect," Dr. Naz Tofigh of Thirty-2 Advanced Dentistry told RadarOnline.com. "This is what someone looks like when they haven’t been to the dentist for a long time and they just haven’t taken care of themselves."

"There are a lot of stains on her teeth, the yellow spots are typical of people who drink a lot of red wine and smoke," he added.

Lohan reportedly hasn’t eased up on her hard partying ways.

“As someone that is supposed to be in recovery to an addiction to drugs and alcohol, Lindsay shouldn't be partying until the wee hours of the morning," a source told the website, but still, Lindsay’s rep won’t comment on her unhealthy smile.

New ADHD Guidelines Include Preschoolers, Older Teens

In new guidelines released Sunday, the American Academy of Pediatrics has expanded the age range for the diagnosis and treatment of attention-deficit hyperactivity disorder (ADHD) to children as young as 4 and as old as 18.

For the youngest children, the academy is emphasizing the use of behavior treatments over medication in most cases.

"I think the most significant changes are expanding the ages from preschool through adolescence. The original guidelines were from 6 to 12, because that's where the evidence was. We've been able to broaden the scope of the guidelines because there was more evidence available for preschoolers and adolescents," said the lead author of the new recommendations, Dr. Mark Wolraich, CMRI Shaun Walters Professor of Pediatrics and the Edith Kinney Gaylord Presidential Professor at the University of Oklahoma Health Sciences Center in Oklahoma City.

Wolraich added that the new guidelines also give pediatricians advice on managing inattention or hyperactivity problems that don't quite meet the definition of ADHD.

The new guidelines will be presented at the academy's annual meeting in Boston and will be published in the November issue of Pediatrics.

More than 5 million children in the United States have been diagnosed with ADHD, according to the U.S. Centers for Disease Control and Prevention. Children with the disorder show signs of inattentiveness, impulsivity and hyperactivity. They may be unable to pay attention in class, or may spend a lot of time fidgeting in their seats or talking nonstop. Although most kids may display this type of behavior at one time or another, it becomes a problem when it occurs most of the time, according to the U.S. National Institute of Mental Health.

Treatment for ADHD may include medications or behavior therapy, or both. In fact, Wolraich said that "the combination of both medication and behavioral therapy is probably the best choice when possible."

Obama drops long-term health care program

Citing cost concerns, the Obama administration said Friday it has halted a long-term care insurance program that was part of the massive health care law passed in 2010.

Called the CLASS Act (Community Living Assistance Services and Supports), the program was canceled by Health and Human Services Secretary Kathleen Sebelius after a 19-month effort to find a way to make it financially viable.

In a letter to Congress, Sebelius wrote, "Despite our best analytical efforts, I do not see a viable path forward for CLASS implementation at this time."

The CLASS program was similar to long-term care plans available in the private sector in which workers sign up and pay a monthly premium. It was voluntary and was to be paid for entirely by the premiums from those who signed up. In return, subscribers would get a daily benefit.

But a senior administration official told CNN that there were big questions whether CLASS could be self-sustaining even when the health care reform law was being considered by Congress. And as a result, lawmakers specified that the HHS secretary had to determine that the program would be sustainable for 75 years before certifying it.

Enjoy your morning!