The Morning Drill: December 16, 2011

Santa Monica, California looking towards Malibu

A Friday morning drill today even though most dentists take Fridays off.

The reason: I am on call for Jury Duty at the Ventura County Court on Monday.

On to today's dentistry and health headlines.

Should dentists offer health screenings?

Each year, nearly 20 million men, women and children in the United States fail to see a family physician or similar health care professional, but they do pay at least one visit to the dentist, according to a new study in the American Journal of Public Health.

For this segment of the population, dentists may be the only doctors in a position to spot the warning signs of chronic illnesses, such as diabetes, and provide referrals or advice to prevent serious complications, says Shiela M. Strauss, Ph.D., the lead author of the study and an associate professor at New York University's Colleges of Dentistry and Nursing.

Oral or dental abnormalities can signal a broad range of body-wide health problems, including HIV, sexually transmitted diseases, eating disorders, and substance abuse, in addition to diabetes. In a previous study, for instance, Strauss and her colleagues found that 93% of patients with gum disease (such as gingivitis) also met the criteria that should trigger blood-sugar screening under American Diabetes Association guidelines.

"I'm not advocating for dentists to become general health care providers," Strauss says. But, she adds, dentists can easily measure blood pressure and administer simple screening questionnaires - both of which could potentially make a big difference to the health of someone at risk for diabetes who hasn't seen a doctor recently.

In the new study, Strauss and her team analyzed data from the Medical Expenditure Panel Survey, a nationally representative government-sponsored survey of health care use. In 2008, the researchers found, roughly one-quarter of adults did not see a physician, nurse practitioner, or other general health care provider - but of that group, 23% did see a dentist. The pattern was similar among children.

Will Regrowing Your Teeth Replace Fillings?

For anyone who has ever lost a tooth—including the 25 percent of Americans over 65 who have lost all theirs due to decay or gum disease—it may be possible to get natural replacements someday, thanks to breakthroughs being made at the University of Illinois at Chicago. On the fourth floor of the school’s College of Dentistry, researchers are inducing lab rats to form new dentin to fill cavities in their choppers. It’s the first step toward the holy grail of dentistry: regrowing teeth. Eventually people may be able to get replacement teeth—even a whole set of 32—made of human dentin and enamel and attached to the jaw with human fibers (rather than the titanium posts used today).

To create those new teeth, researchers are attacking the problem layer by layer, attempting “to copy how nature has done it,” says Anne George, professor of oral biology at UIC. George and her ten-member team of students and scientists are focusing on ways to produce dentin, the part-mineral, part-protein material inside teeth that provides cushioning during chewing. They drill a hole in a rat’s tooth and fill the cavity with a protein that attracts cells that make dentin. “It’s best to get cells to do the work,” she says. “What we are trying to do is see what molecules will help us repair and make new dentin.” George predicts that within five to ten years people will be able to generate their own natural fillings.

More Floridians are taking their toothaches to the ER

More Floridians who go without routine dental care are resorting to hospital emergency rooms when the pain of tooth decay or infection becomes too terrible to bear, costing taxpayers and hospitals nearly $90 million last year.

In Southwest Florida, the cost of ER dental care amounted to more than $3.2 million in 2010.

Health experts said too few dentists accept Medicaid patients in Florida, where reimbursement rates are among the lowest in the nation.

The average ER charge of $770 per visit contrasts with an estimated $130 to cover a year’s worth of preventive oral care in childhood, said Frank Catalanotto, who chairs the Department of Community Dentistry at the University of Florida.

And in many cases, ER visits only result in treating the pain — not the underlying cause, resulting in a costly cycle of return visits.

Supreme Court Denies Petition for Review in California Dentist Suit Over Disclosure of Medical Records

The U.S. Supreme Court Dec. 12 said it will not review a California Supreme Court decision that held the federal Fair Credit Reporting Act (FCRA) does not preclude a lawsuit alleging a debt collector disclosed medical records in violation of a California medical information privacy statute (Mortensen v. Brown, U.S., No. 11-434, review denied).

The high court action leaves standing a June decision in which the California Supreme Court reinstated claims brought against Stewart Mortensen, d/b/a Credit Bureau Services, alleging he violated California's Confidentiality of Medical Information Act (CMIA), Cal. Civ. Code §56 et seq., in sending personally identifiable family dental records to credit reporting agencies (see previous article).

The state high court said the FCRA provisions impose obligations on debt collectors that furnish information to credit bureaus, but those provisions do not evince an intent by Congress to preempt state laws that impose additional health information privacy obligations on, or provide for additional remedies against, debt collectors.

The court noted that the Consumer Credit Reporting Reform Act of 1996, which amended FCRA to add provisions applicable to “furnishers,” was passed nearly contemporaneously with the Health Insurance Portability and Accountability Act. HIPAA, the state supreme court continued, expressly allowed for more stringent state law regulation of health information privacy.

Enjoy your morning!