Monday, October 24, 2011

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!

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