Dental Visits Critical for Smokers

CDC report: More smokers avoid the dentist

Adult tobacco smokers are four times more likely to develop oral health problems but much less likely than nonsmokers to go to the dentist regularly, according to a report released February 7 by the U.S. Centers for Disease Control and Prevention (CDC).

The study, which included more than 16,000 adults between the ages of 18 and 64 who participated in the 2008 National Health Interview Survey, also found that although more than a third of smokers included in the report said they have three or more dental problems, 20% said they had not been to a dentist in at least five years. Among nonsmokers and former smokers, 10% had stayed away that long.

Cost was cited as the main reason that most adults with an oral health problem did not see a dentist in the past six months; 56% of current smokers, 36% of former smokers, and 35% of never smokers said they could not afford treatment or did not have insurance.

"Overall, current smokers had a poorer oral health status and more oral health problems than either former smokers or never smokers," the report authors noted. "However, current smokers were more likely to think that their oral health problem was important."

The evidence for an association between tobacco use and oral diseases has been clearly shown in every U.S. surgeon general's report on tobacco since 1964. Tobacco use is a risk factor for oral cancers, periodontal diseases, and dental caries, among other diseases.

reported by DrBicuspid.com, Feb 2012.

Dr. Notes:

Because cost is cited as a major factor for smokers and their reluctance to visit the dentist for regular check-ups, I thought I would present some facts.

The average cost for a pack of cigarettes in the state of Minnesota is $6.53.  That’s 33¢ per cigarette.  According to the American Lung Association, the average smoker inhales 3/4 pack, or 15 cigarettes, per day.  After doing the math you'd find that the annual cost for a smoker’s habit totals $1787 plus change.

Now consider this.  The average annual cost of routine dental care (includes 3 cleanings, exams and routine radiographs) would be around $275.  Again, if you crunch the numbers you would find that if the average smoker were to reduce cigarette consumption by 3 cigarettes per day, they could easily afford the out-of-pocket expense of routine dental care.  And these numbers don’t consider the inclusion of dental insurance, which 80% of smokers have, yet don’t utilize.

Our job as a dental office is to address and treat oral health.  We don't give lectures and we don't judge people based on their choices in life, especially their decision to smoke.  But we will provide guidance and advice for those who do.  Regular dental care is crucial for smokers if they wish to minimize the long term effects of their smoking habit.  Routine cleanings and exams can do a lot to help prevent a wide range of problems that smokers are predisposed to and help proactively identify the development of long-term complications that can result from oral tobacco use.

What Does Your Mouth Have to Say About Your Health?

Oral Health Can Provide Clues to Total Body Wellness for Patients

Cardiologists might not check your teeth and gums, but maybe they should start. Mounting evidence suggests a quick peek in the mouth may reveal a whole lot about your general health.

PICTURES: Foul mouth: what yucky signs say about your health

The lips, mouth, teeth and breath can signal medical problems and diseases beyond the plaque, gum disease and gingivitis diagnosed in the dentist's chair. Plaque buildup between teeth due to lax brushing and flossing is very different from plaque that builds up in arteries and causes heart attacks - but the toxins in mouth plaque stimulate a chronic inflammatory response linked to diseases like heart disease.

"The mouth is the gateway to the heart and there's clearly a link between poor dental health and cardiovascular conditions," says Dr. Kevin Marzo, Chief of Cardiology at Winthrop University Hospital in Mineola, New York. For example, he says, cardiac medications you put under your tongue travel quickly through the bloodstream. That means bacteria can too.

"The bacteria that cause dental plaque may promote inflammation in the body beyond the mouth including the lining of the blood vessels, increasing the risk for cardiovascular disease including heart attacks," says Marzo.

Research has shown when people with active gum disease are treated, their arteries actually get healthier. Some experts suggest managing inflammation in the mouth may reduce other inflammatory-related health issues, including arthritis - even wrinkles and aging. Besides heart disease, gum disease has been linked to respiratory diseases, stroke, and osteoporosis.

The mouth can also give doctors clues about a person's sexual health. Warts in the mouth that resemble cauliflower clusters may signal the human papillomavirus, or HPV, one of the most common sexually transmitted infections.

"I see them on the lips, tongue or roof of the mouth," says Dr. Susan Pugliese, Clinical Assistant Professor Division of Oral Medicine and Dentistry Department of Surgery at SUNY Downstate. "And I'm seeing them more frequently in patients over 50 who are dating." Pugliese says this age group may not connect what's going on in their mouth to their sex lives.

HPV is also a driver of oral cancer: the National Cancer Institute, estimates 65 percent of the approximately 8,000 cancers of the tonsils and base of the tongue seen in the U.S. in 2010 were from HPV infections; 80 per cent were in men. Cancers may appear as ulcers on the lips, inside of the cheeks, tongue or back of throat that don't heal, or white patches that don't slough off. A biopsy is typically recommended for suspicious warts or lesions in the mouth and throat.

HIV is often first detected in the mouth, as a bright red outline around the teeth, or as a white coating that can be scraped off the tongue, known as thrush. The coating signals an overgrowth of Candida, the same fungus that causes yeast infections in women and jock itch in men. The white coating can also signal glucose levels are out of whack, poorly managed diabetes or fluctuating hormones. It can also be harmless, signaling a sensitivity to additives in toothpaste, such as tartar control agents. Dentists may recommend an HIV test for young patients presenting with Candida who have other risk factors.

A person's breath also provides health clues. Bad breath may signal serious conditions that require medical attention such as respiratory infections, diabetes, acid reflux and kidney and liver problems. Dry mouth? That's sometimes caused by medications, such as antidepressants, anti-inflammatories, and heart drugs. Drinking water or chewing on fibrous foods such as celery may help.

Good oral hygiene is the best way to prevent gum disease and keep your mouth healthy. Healthy gums hug the teeth and don't pull away, have bounce, and don't bleed from brushing or flossing.

But while a clean, well-cared for mouth can promote good health, it can also disguise serious health problems... so don't skip regular visits to the doctor, and dentist.

Minnesota Taxpayers Suffer As Insurance Carriers Reap Rewards of Government Oversight

Minn. Medicaid under fire for alleged overpayments

March 13, 2012 -- The federal government is investigating whether Minnesota is overpaying the nonprofit healthcare plans that administer its Medicaid programs.  The issue arose after UCare, one of the managed care plans that subcontracts with Medical Assistance (the state Medicaid program), unexpectedly returned to the state $30 million in excess reserves last year when lawmakers were facing huge deficits.

Three other managed care companies -- Blue Plus, Medica, and HealthPartners -- refused to make similar "donations," even though these plans had higher Medicaid operating margins than UCare in 2010, according to Allan Baumgarten, an independent research consultant and author of Minnesota Health Market Review.

In February, Minnesota Department of Human Services (DHS) Commissioner Lucinda Jesson told lawmakers that federal authorities had contacted her last summer about the investigation. But she could not say which federal agency was involved or the scope of their queries.

Dental carriers, too?

As part of the Medicaid program, UCare and the other managed care plans subcontract to four dental carriers, including Delta Dental of Minnesota, which administers the bulk of the state's Medicaid dental benefits. In January 2011 Jesson initiated 1% profit caps and competitive bidding for the health plans, but the possible effect this will have on the dental care subcontractors is yet to be determined.

Joe Lally, vice president for strategic planning at Delta Dental of Minnesota, which supports Medicaid dental services through Medica, Blue Plus, and Metropolitan Health Plan, noted that his company is not part of the federal investigation.

"It is not a risk arrangement; it's a self-insured arrangement," he told DrBicuspid.com. "We're simply paid for the services we provide in terms of getting the network together, processing claims, and providing customer service."

In addition to the federal investigation, Sen. Chuck Grassley (R-Iowa) has launched a separate inquiry into Minnesota's management of the Medical Assistance programs -- a $3.7 billion-a-year business for the health plans the state pays to manage care for public patients. Grassley has sent requests for information to the Minnesota DHS and officials in 49 other states.

Lally had heard from lawmakers that the investigation is likely focusing on the profits that the healthcare plans are making from public health programs.  "I think the concern in some discussions in the Capitol is that people are making money from public programs as opposed to breaking even or having a slight margin or loss," Lally said.

“The states should not make it possible for HMOs to make higher profits on Medicaid plans than they're making on employer group plans.”

— Allan Baumgarten, Minnesota Health Market Review

In 2010, Minnesota paid an average of $441 per month per Medicaid managed-care enrollee, to Medica, Blue Plus, HealthPartners, and UCare, according to DHS. In Michigan, the average monthly amount paid to big plans was $283, according to Baumgarten, and in Wisconsin, the amount was $298 in 2009.

There was also a striking difference in the annual profits that the plans made on Medicaid programs. In 2010, the average annual profit margin in Minnesota was 8.9%; Michigan's 2010 average was 2.4%, and Wisconsin's 2009 average was 2.6%.

Step in the right direction

In an opinion piece in the Star Tribune, Julie Brunner of the Minnesota Council of Health Plans wrote that Minnesota often provides more extensive benefits than other states, which "greatly influences" costs. She also pointed out that profits vary from year to year. The average profit over the past five years for all of Minnesota's public programs was 1.6% of revenue -- less than the margins for both Michigan and Wisconsin.

"I do know the health plans have lost a lot of money in certain years, and in other years they've come out ahead," said Delta's Lally. "So it depends on the year.”  The profit caps and competitive bidding for the health plans initiated by Jesson are steps in the right direction, according to Baumgarten.

"It's probably something the state should have done long ago, but better now than never," he told DrBicuspid.com. "Through competitive bidding or better analysis of data on care being delivered, the state should be able to reset rates paid to HMOs to cover necessary care while carrying a reasonable margin, which is not 8.9%. The states should not make it possible for HMOs to make higher profits on Medicaid plans than they're making on employer group plans."

Competitive bidding saved about $175 million this year, and reforms to managed care are expected to save a total of $242 million, according to Jesson.  "Looking ahead, we intend to move to more performance-based purchasing, creating incentives for quality and efficiency in both managed care and fee for service," she said in a statement to DrBicuspid.com.

This spring her office will begin a demonstration project to contract directly with providers, which will give them flexibility and provide the opportunity to share in the savings they create, she added.

A 2010 report [PDF] from the U.S. Government Accountability Office found inconsistent federal oversight of states' payments to managed-care organizations. A bill calling for an independent audit is being considered in the Minnesota legislature.

Snoring Tied to Kids' Risk of Behavioral Problems

Regular dental visits can help identify problems at an early stage

By Reuters Health

March 7, 2012 -- Young children who snore a lot or have other breathing problems at night may have a heightened risk of behavioral and emotional problems later on, a new study suggests.

The study, published in the journal Pediatrics, is not the first to link behavioral issues to so-called sleep-disordered breathing.

"We didn't invent the association," noted lead researcher Dr. Karen Bonuck, of the Albert Einstein College of Medicine in New York.

But, she said, this is the largest study yet to look at the question, following more than 13,000 children from infancy to the age of seven.  Of those kids, 45% remained free of nighttime breathing problems, based on parents' reports. The rest had symptoms at some point during infancy or early childhood.

Eight percent of the children fell into what the researchers dubbed the "worst case" group; they had breathing symptoms that peaked between the ages of two and three and then persisted.

Overall, Dr. Bonuck's team found, children with sleep-disordered breathing at any time were more likely to develop symptoms of behavioral or emotional disorders -- like attention deficit hyperactivity disorder (ADHD) or anxiety -- by age seven.

About 13.5% had such symptoms at age 7, versus just over 8% of kids who'd been free of sleep-disordered breathing.  And the biggest risk was seen in the worst-case group. By age 7, nearly 18% of those kids had possible behavioral or emotional disorders.

The researchers can't say for sure whether all of those children had outright disorders, such as ADHD. Their results are based on a screening questionnaire given to parents.  What's more, it's not certain that the breathing problems are directly to blame.  But, Dr. Bonuck said, the researchers did control for a range of variables that could help account for the link -- like parents' income and education, race, birth weight, and whether moms smoked during pregnancy.

"Even considering all those variables, overall, sleep-disordered breathing seemed to have the strongest effect," Dr. Bonuck said.

Among the "worst case" kids, for example, sleep-disordered breathing was linked to a 72% increase in the risk of behavioral and emotional symptoms at age seven -- even with other factors considered.

"This provides strong evidence that the (breathing) symptoms we looked at could promote these behavioral and emotional symptoms," Dr. Bonuck said.

Still, she stressed, no one is saying sleep-disordered breathing is the whole story. "Certainly, emotional and behavioral disorders are multi-factorial," Dr. Bonuck said.

"What [the study] found is intuitively what we'd expect to see," said Dr. Sanjeev V. Kothare, interim medical director of the Center for Pediatric Sleep Disorders at Children's Hospital Boston.

Dr. Kothare noted that the American Academy of Pediatrics (AAP) already recommends that pediatricians should screen all children for snoring and, if needed, refer them to a sleep center for further evaluation.

In many kids, especially 3- to 6-year-olds, sleep-disordered breathing is caused by enlarged tonsils or adenoids, and removing the tissue can improve nighttime breathing -- as well as daytime symptoms, Dr. Kothare noted.  For other children, excess pounds feed the nighttime breathing problems and most will improve if they shed the extra weight, according to the AAP.

Heart Disease - Are We to Blame?

World Renown Heart Surgeon Speaks Out On What Really Causes Heart Disease

PreventDisease.com

March 1, 2012

We physicians with all our training, knowledge and authority often acquire a rather large ego that tends to make it difficult to admit we are wrong. So, here it is. I freely admit to being wrong.. As a heart surgeon with 25 years experience, having performed over 5,000 open-heart surgeries,today is my day to right the wrong with medical and scientific fact.

I trained for many years with other prominent physicians labelled “opinion makers.” Bombarded with scientific literature, continually attending education seminars, we opinion makers insisted heart disease resulted from the simple fact of elevated blood cholesterol.

The only accepted therapy was prescribing medications to lower cholesterol and a diet that severely restricted fat intake. The latter of course we insisted would lower cholesterol and heart disease. Deviations from these recommendations were considered heresy and could quite possibly result in malpractice.

It Is Not Working!

These recommendations are no longer scientifically or morally defensible. The discovery a few years ago that inflammation in the artery wall is the real cause of heart disease is slowly leading to a paradigm shift in how heart disease and other chronic ailments will be treated.

The long-established dietary recommendations have created epidemics of obesity and diabetes, the consequences of which dwarf any historical plague in terms of mortality, human suffering and dire economic consequences.

Despite the fact that 25% of the population takes expensive statin medications and despite the fact we have reduced the fat content of our diets, more Americans will die this year of heart disease than ever before.

Statistics from the American Heart Association show that 75 million Americans currently suffer from heart disease, 20 million have diabetes and 57 million have pre-diabetes. These disorders are affecting younger and younger people in greater numbers every year.

Simply stated, without inflammation being present in the body, there is no way that cholesterol would accumulate in the wall of the blood vessel and cause heart disease and strokes. Without inflammation, cholesterol would move freely throughout the body as nature intended. It is inflammation that causes cholesterol to become trapped.

Inflammation is not complicated -- it is quite simply your body's natural defence to a foreign invader such as a bacteria, toxin or virus. The cycle of inflammation is perfect in how it protects your body from these bacterial and viral invaders. However, if we chronically expose the body to injury by toxins or foods the human body was never designed to process,a condition occurs called chronic inflammation. Chronic inflammation is just as harmful as acute inflammation is beneficial.

What thoughtful person would willfully expose himself repeatedly to foods or other substances that are known to cause injury to the body? Well,smokers perhaps, but at least they made that choice willfully.

The rest of us have simply followed the recommended mainstream dietthat is low in fat and high in polyunsaturated fats and carbohydrates, not knowing we were causing repeated injury to our blood vessels. This repeated injury creates chronic inflammation leading to heart disease, stroke, diabetes and obesity.

Let me repeat that: The injury and inflammation in our blood vessels is caused by the low fat diet recommended for years by mainstream medicine.

What are the biggest culprits of chronic inflammation? Quite simply, they are the overload of simple, highly processed carbohydrates (sugar, flour and all the products made from them) and the excess consumption of omega-6 vegetable oils like soybean, corn and sunflower that are found in many processed foods.

Take a moment to visualize rubbing a stiff brush repeatedly over soft skin until it becomes quite red and nearly bleeding. you kept this up several times a day, every day for five years. If you could tolerate this painful brushing, you would have a bleeding, swollen infected area that became worse with each repeated injury. This is a good way to visualize the inflammatory process that could be going on in your body right now.

Regardless of where the inflammatory process occurs, externally or internally, it is the same. I have peered inside thousands upon thousands of arteries. A diseased artery looks as if someone took a brush and scrubbed repeatedly against its wall. Several times a day, every day, the foods we eat create small injuries compounding into more injuries, causing the body to respond continuously and appropriately with inflammation.

While we savor the tantalizing taste of a sweet roll, our bodies respond alarmingly as if a foreign invader arrived declaring war. Foods loaded with sugars and simple carbohydrates, or processed withomega-6 oils for long shelf life have been the mainstay of the American diet for six decades. These foods have been slowly poisoning everyone.

How does eating a simple sweet roll create a cascade of inflammation to make you sick?

Imagine spilling syrup on your keyboard and you have a visual of what occurs inside the cell. When we consume simple carbohydrates such as sugar, blood sugar rises rapidly. In response, your pancreas secretes insulin whose primary purpose is to drive sugar into each cell where it is stored for energy. If the cell is full and does not need glucose, it is rejected to avoid extra sugar gumming up the works.

When your full cells reject the extra glucose, blood sugar rises producing more insulin and the glucose converts to stored fat.

What does all this have to do with inflammation? Blood sugar is controlled in a very narrow range. Extra sugar molecules attach to a variety of proteins that in turn injure the blood vessel wall. This repeated injury to the blood vessel wall sets off inflammation. When you spike your blood sugar level several times a day, every day, it is exactly like taking sandpaper to the inside of your delicate blood vessels.

While you may not be able to see it, rest assured it is there. I saw it in over 5,000 surgical patients spanning 25 years who all shared one common denominator -- inflammation in their arteries.

Let’s get back to the sweet roll. That innocent looking goody not only contains sugars, it is baked in one of many omega-6 oils such as soybean. Chips and fries are soaked in soybean oil; processed foods are manufactured with omega-6 oils for longer shelf life. While omega-6’s are essential -they are part of every cell membrane controlling what goes in and out of the cell -- they must be in the correct balance with omega-3’s.

If the balance shifts by consuming excessive omega-6, the cell membrane produces chemicals called cytokines that directly cause inflammation.

Today’s mainstream American diet has produced an extreme imbalance of these two fats. The ratio of imbalance ranges from 15:1 to as high as 30:1 in favor of omega-6. That’s a tremendous amount of cytokines causing inflammation. In today’s food environment, a 3:1 ratio would be optimal and healthy.

To make matters worse, the excess weight you are carrying from eating these foods creates overloaded fat cells that pour out large quantities of pro-inflammatory chemicals that add to the injury caused by having high blood sugar. The process that began with a sweet roll turns into a vicious cycle over time that creates heart disease, high blood pressure, diabetes and finally, Alzheimer’s disease, as the inflammatory process continues unabated.

There is no escaping the fact that the more we consume prepared and processed foods, the more we trip the inflammation switch little by little each day. The human body cannot process, nor was it designed to consume, foods packed with sugars and soaked in omega-6 oils.

There is but one answer to quieting inflammation, and that is returning to foods closer to their natural state. To build muscle, eat more protein. Choose carbohydrates that are very complex such as colorful fruits and vegetables. Cut down on or eliminate inflammation- causing omega-6 fats like corn and soybean oil and the processed foods that are made from them.

One tablespoon of corn oil contains 7,280 mg of omega-6; soybean contains 6,940 mg. Instead, use olive oil or butter from grass-fed beef.

Animal fats contain less than 20% omega-6 and are much less likely to cause inflammation than the supposedly healthy oils labelled polyunsaturated. Forget the “science” that has been drummed into your head for decades. The science that saturated fat alone causes heart disease is non-existent. The science that saturated fat raises blood cholesterol is also very weak. Since we now know that cholesterol is not the cause of heart disease, the concern about saturated fat is even more absurd today.

The cholesterol theory led to the no-fat, low-fat recommendations that in turn created the very foods now causing an epidemic of inflammation. Mainstream medicine made a terrible mistake when it advised people to avoid saturated fat in favor of foods high in omega-6 fats. We now have an epidemic of arterial inflammation leading to heart disease and other silent killers.

What you can do is choose whole foods your grandmother served and not those your mom turned to as grocery store aisles filled with manufactured foods. By eliminating inflammatory foods and adding essential nutrients from fresh unprocessed food, you will reverse years of damage in your arteries and throughout your body from consuming the typical American diet.

Dr. Dwight Lundell is the past Chief of Staff and Chief of Surgery at Banner Heart Hospital , Mesa , AZ. His private practice, Cardiac Care Center was in Mesa, AZ. Recently Dr. Lundell left surgery to focus on the nutritional treatment of heart disease. He is the founder of Healthy Humans Foundation that promotes human health with a focus on helping large corporations promote wellness. He is also the author of The Cure for Heart Disease and The Great Cholesterol Lie.

Thirsty?

Steering You Kids

to Better Drinks

In an ideal world, kids would drink only water and milk in the quantities recommended by dietary guidelines: 16 ounces of nonfat or low-fat dairy for children ages 2 or 3; 20 ounces for children ages 4 to 8; and 24 ounces for anyone 9 and older.

But the lure of sodas, fruit drinks, sports drinks, flavored milks and flavored waters that have made sugar-sweetened beverages the leading source of added sugar in children's diets — and, consequently, a prime culprit in tooth cavities and childhood obesity — is as unavoidable as Justin Bieber's singing toothbrush.

How can you steer your kids toward more healthful choices? Here are some tips.

Practice what you preach

Pour yourself a glass of milk when you give one to your child, and don't keep sugary drinks in the house, Dr. Mary Lou Gavin, a pediatrician specializing in weight management at Nemours/Alfred I. DuPont Hospital for Children in Wilmington, Del., and a medical editor at kidshealth.org. The younger your child is when you instill healthy habits, the easier it will be.

Limit fruit juice

Though it provides some nutrients, 100 percent fruit juice has loads of sugar and, being liquid, doesn't offer the same fiber and fullness you get when you eat an actual piece of fruit, Gavin said. The American Academy of Pediatrics recommends no more than 4 to 6 ounces of 100 percent fruit juice per day for children age 1 to 6, and no more than 8 to 12 ounces for kids older than 6.

Treat sugary drinks as dessert

Rather than ban them outright, which might make them all the more appealing, allow them as occasional treats, said Marlene Schwartz, deputy director of the Rudd Center for Food Policy and Obesity and Yale University.

Visualize the sugar content

A can of full-calorie soda has 39 to 44 grams of sugar — the equivalent of 10 to 11 teaspoons of sugar, an image that just might give a kid pause, Schwartz said. Convert grams of sugar to teaspoons by dividing by 4.

Avoid diet drinks

Although they can be useful tools when weaning overweight or soda-addicted kids off of sugary beverages, it's generally best not to feed kids artificial sweeteners when we don't know their potential long-term effects, Schwartz said.

Interpret ingredient lists

Added sugars and artificial sweeteners can be hard to spot because they come under many names. Some common aliases for added sugar, according to the Rudd Center: high fructose corn syrup, fruit juice concentrates, corn syrup, fructose, sucrose, glucose, crystalline fructose, cane sugar. Artificial sweeteners might go by acesulfame potassium, aspartame, sucralose, stevia/rebiana.

Fun alternatives


Instead of: Store-bought flavored milk

            Try: Nonfat or low-fat milk with a dollop of chocolate or strawberry syrup

Instead of: Vitamin water or flavored water

            Try: Regular water with a twist of lemon or lime, or a slice of cucumber or watermelon

Instead of: Soft drinks

            Try: Seltzer water with a splash of 100 percent fruit juice

Instead of: Fruit drinks, sports drinks and sweetened teas

            Try: Homemade, unsweetened tea with a splash of juice

Instead of: 100 percent fruit juice

            Try: A fruit smoothie with real fruit, low-fat yogurt and no added sugar

Electronic conversion from Chicago Tribune - 3 March 2012