Tuesday, May 01, 2012

The Morning Drill: May 1, 2012

Good Tuesday Morning!

And, a special good morning to the attendees of the Colgate Connect Conference in New Jersey. A family illness has required me to remain in California and I hope to join you next year.

On to today's dentistry and health headlines:

Grand Blanc dentist arrested for allegedly faking prescriptions to get painkillers

Anthony Carbajal

A 55-year-old dentist who had an office in Grand Blanc was arrested last week near a Fenton pharmacy after he picked up a prescription he filed under a fake name, according to police.

Anthony Carbajal of Livonia is charged with three counts of obtaining a controlled substance by fraud and a count of possession of hydrocodone, according to police. Police allege Carbajal was calling in prescriptions for the pain killer under a fake patient's name and then going to pick them up at various pharmacies.

Carbajal picked up a prescription on April 23 at the Walgreens Pharmacy on Silver Lake Road, but employees suspected fraud and called police. Police made a traffic stop and found 40 pills of hydrocodone.

He admitted to having a drug problem, according to police.

Carbajal has had a history of drug use, according to the state department of licensing and regulatory affairs. He was put on probation in 2009 after testing positive for cocaine, according to state records. He was ordered to take random drug screenings.

After entering a 10-day substance abuse program in July 2009, he returned to his Grand Blanc office located about a month later, according to records.

Phoenix dental clinic helps kids, teens without insurance

Elizabeth Mize, 15, was reluctant to open her mouth on a recent visit with dentist Dr. Zoltan Varadi despite the pain niggling by her tooth.

The Phoenix teen, suffering an oral infection, admitted to Varadi that she brushes her teeth maybe “once a day.”

“And do you eat candy?” Varadi said.

“I eat a lot of chocolate,” Elizabeth said.

“I think you have to change a little bit your diet,” Varadi said before he prescribed Elizabeth a medicated rinse and antibiotics. “Almost none of your teeth is completely healthy.”

Elizabeth is the typical kind of case Varadi encounters working at the Boys & Girls Club Children’s Dental Clinic near 15th Avenue and Grant Street, southwest of downtown Phoenix, where he treats uninsured children and teens every week.

“The biggest issue I see in this clinic is neglect,” Varadi said. “Until they find the clinic, until their parents actually find it … sometimes these kids don’t see a dentist for years and years. I see kids who are 15, 14, 13 who have never seen a dentist.”

The club recently renovated its 15-year-old clinic to add two more dentist chairs — raising its number to four — so it can also treat twice as many patients as the 800 it normally sees in a year.

Bridget McDonald, a vice president for the area club, said the clinic has an even broader mission: to address oral-health problems that have worried health, school and city officials for years.

E.R. Doctors Face Quandary on Painkillers

Dr. Bruce Lobitz, an attending physician in the emergency department at Upstate Carolina Medical Center in Gaffney, S.C., sees about 10 patients a week complaining of toothaches. “The bane of our existence,” he calls them.

It’s not just that doctors like him lack the training and tools to solve their dental problems. Many of these patients, he fears, complain of tooth pain simply as a ruse to get prescriptions for narcotics.

“Almost all dental patients request a prescription for narcotic pain pills,” Dr. Lobitz said. “ ‘I just need something to tide me over until I can see a dentist’ — that’s the classic line.” Sometimes, drug-seekers will show their cards: “They’ll say they’re allergic to everything except Vicodin.”

Dental patients — mostly uninsured or indigent — are not unusual in emergency rooms. Poor patients may forgo preventive care and delay treatment until they face a medical crisis. In many states, adult dental benefits under Medicaid, the government insurance program for the poor, have been scaled back or eliminated. And dentists often don’t accept Medicaid patients.

But emergency physicians like Dr. Lobitz cannot know whether someone who claims to be in agony from dental issues is telling the truth — or simply plans, he said, to “go to the next emergency room, next town over, and get another 30 Vicodin.”

Dr. Gail D’Onofrio, chairwoman of the emergency medicine department at Yale School of Medicine, has studied alcohol and drug abuse in emergency rooms. “The overuse of narcotics is a huge problem, and when a patient presents, especially for dental pain, it’s difficult to make an objective assessment,” she said. “It puts the physician in a difficult situation to assess whether or not someone truly needs pain medications. We err on the side of treating pain, and it is a huge potential for abuse.”

The frequent prescription of narcotics in emergency departments for dental pain has been quantified for the first time by research financed by the National Institutes of Health, bringing to light another way opioids get into circulation and contribute to the rampant abuse of painkillers in the United States.

Oral Health – More Than Just Cavities - A Report by Ontario’s Chief Medical Officer of Health

Ontario’s low income dental programs need to be reviewed to improve their effectiveness, efficiency and reach, says the province’s Chief Medical Officer of Health.

Dr. Arlene King says Ontario has made significant progress in providing dental care to low-income Ontarians, but more needs to be done. There are a number of publicly funded programs available including the Children In Need of Treatment (CINOT) dental program, Healthy Smiles Ontario, Ontario Works and the Ontario Disability Support Program. According to Dr. King, these programs amount to a patchwork of services that are difficult for people to navigate, and difficult to assess in terms of health outcomes achieved and return on investment.

In her report, “Oral Health – More Than Just Cavities,” Dr. King calls on the province to consider integrating these programs to make it easier for people to access the care that is needed, when it is needed.

Dr. King also calls on the province to :

  •     Ensure all Ontarians have access to fluoridated drinking water
  •     Review how publicly funded oral health programs are monitored and evaluated
  •     Improve access to oral health care as well as awareness of oral health services available to First Nations people in Ontario.

Enjoy your morning!

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