A DODGY accent and startling false teeth were all that was needed to turn Canadian actor Mike Myers into the British super-spy Austin Powers. In “The Simpsons”, a television show, Ralph Wiggum’s dentist scares him into brushing with the decaying snaggle-teeth of the (fictional) “Big Book of British Smiles”. And there is some truth behind the awful stereotype: the factory workers of Britain’s Industrial Revolution were fed on sugar from the colonies, and led the known world in dental caries. Early in the 20th century Americans were brushing and flossing while some British dentists still believed that chomping on hard foods kept teeth strong. As recently as 1968, well over a third of British adults had not a single natural tooth in their heads.

So it is hardly surprising that, since its founding in 1948, the National Health Service has struggled to cope with the dentalplans coupon needs of the population. During its first two years it supplied 100m false teeth, and the first patient charges it introduced, in 1951, were for dentures. The legacy of bad teeth is still putting NHS budgets under strain. In recent years many dentists have turned to private practice as fees for doing NHS work have been squeezed.

On June 22nd came the latest attempt to fix NHS dentistry: an independent government-commissioned review, the third on the subject in 18 years. Changes in 2006 had been intended to simplify payments for NHS work, and to encourage dentists to concentrate less on drilling and filling and more on prevention. Instead they had unintentionally rewarded dentists for over-treating fewer patients, and forced more than ever to suffer or go private. This week’s review recommends re-complicating rates a bit, and once again paying dentists partly according to the number of NHS patients on their books. It is quite a U-turn.

How could the 2006 reforms have missed the mark so widely? By not being piloted, for one thing: the review team wants its prescriptions tested in a few areas before they are applied nationwide. A less tractable problem is that the evidence about what works is weak. Crowns and fillings are a success only if they last; trials must run for many years, by which time new materials and methods are in use.

“That means wide variations in practice, and lots of wiggle-room for dentists to respond to financial incentives,” says the review’s lead author, Jimmy Steele, a professor of dentistry at Newcastle University. And respond to the 2006 changes dentists did, doing fewer tricky root canals and more extractions, referring more acute cases to dental hospitals and halving the treatments involving laboratory work.

More generally, the gap between the necessary and the cosmetic is wider in dentistry than other areas of medicine, making it hard to agree on what the state should subsidise. Bridges or implants? How crooked is too crooked? How stained is too stained? The value placed on saving a tooth varies wildly from person to person, the review team found, from nothing at all to as much as Pounds 10,000 ($16,500) for a molar. Generations differ, too. Few of Britain’s “heavy metal generation”–the 45-75-year-olds with mouths full of amalgam–aspire to Hollywood-style teeth, because they look far too similar to their parents’ and grandparents’ dentures. Should their taxes go towards capping and bleaching the teeth of youngsters who rather fancy the perfectly even, blue-white look?

As for advising on prevention, which is probably the most important part of modern dentistry, there is a problem. Britons who visit the dentist feel cheated if all they get is a quick peer and a reminder to floss. But that may change, and surprisingly quickly. Probably because treatment is easily available to children on the NHS, Britain is one of a handful of OECD countries where 12-year-olds have fewer than one decayed, filled or missing tooth per head. (In Europe, only Danish and German children do as well.) British teeth could soon be dazzling the world.

So it is hardly surprising that, since its founding in 1948, the National Health Service has struggled to cope with the dentalplans coupon needs of the population. During its first two years it supplied 100m false teeth, and the first patient charges it introduced, in 1951, were for dentures. The legacy of bad teeth is still putting NHS budgets under strain. In recent years many dentists have turned to private practice as fees for doing NHS work have been squeezed.

On June 22nd came the latest attempt to fix NHS dentistry: an independent government-commissioned review, the third on the subject in 18 years. Changes in 2006 had been intended to simplify payments for NHS work, and to encourage dentists to concentrate less on drilling and filling and more on prevention. Instead they had unintentionally rewarded dentists for over-treating fewer patients, and forced more than ever to suffer or go private. This week’s review recommends re-complicating rates a bit, and once again paying dentists partly according to the number of NHS patients on their books. It is quite a U-turn.

How could the 2006 reforms have missed the mark so widely? By not being piloted, for one thing: the review team wants its prescriptions tested in a few areas before they are applied nationwide. A less tractable problem is that the evidence about what works is weak. Crowns and fillings are a success only if they last; trials must run for many years, by which time new materials and methods are in use.

“That means wide variations in practice, and lots of wiggle-room for dentists to respond to financial incentives,” says the review’s lead author, Jimmy Steele, a professor of dentistry at Newcastle University. And respond to the 2006 changes dentists did, doing fewer tricky root canals and more extractions, referring more acute cases to dental hospitals and halving the treatments involving laboratory work.

More generally, the gap between the necessary and the cosmetic is wider in dentistry than other areas of medicine, making it hard to agree on what the state should subsidise. Bridges or implants? How crooked is too crooked? How stained is too stained? The value placed on saving a tooth varies wildly from person to person, the review team found, from nothing at all to as much as Pounds 10,000 ($16,500) for a molar. Generations differ, too. Few of Britain’s “heavy metal generation”–the 45-75-year-olds with mouths full of amalgam–aspire to Hollywood-style teeth, because they look far too similar to their parents’ and grandparents’ dentures. Should their taxes go towards capping and bleaching the teeth of youngsters who rather fancy the perfectly even, blue-white look?

As for advising on prevention, which is probably the most important part of modern dentistry, there is a problem. Britons who visit the dentist feel cheated if all they get is a quick peer and a reminder to floss. But that may change, and surprisingly quickly. Probably because treatment is easily available to children on the NHS, Britain is one of a handful of OECD countries where 12-year-olds have fewer than one decayed, filled or missing tooth per head. (In Europe, only Danish and German children do as well.) British teeth could soon be dazzling the world.

A little toothache can pretty quickly turn into a big headache -not just for your mouth but for your wallet too. That’s why CIGNA’s new series of dental HMO plans places an even greater emphasis on affordability and promoting wellness by covering more preventive dental care services.

For example, under the new plans, up to four routine cleanings a year – two at no cost and two for a minimal copay — are covered when recommended by the dentist. Children are covered for two fluoride treatments a year to help prevent tooth decay, one of the most common chronic infectious diseases among U.S. children1.

“If you have dental insurance, you might pay nothing or very little out of your pocket for a routine dental visit (cleaning, x-rays and exam), compared with an average of $150 or more if you don’t have coverage,” said Dr. Miles Hall, chief dental clinical director for CIGNA*. “If you need to have a cavity filled, on average the cost would be $115 or more without insurance compared to low or no cost with our dental HMO plan. Waiting too long to treat a small cavity could mean you’d pay many times more for more costly dental procedures, such as a root canal, and spend more time away from work and personal life to recover. The key message we’re sending with the new plan designs is ‘prevention matters, so don’t wait.’”

Hall said CIGNA is also changing some aspects of plan rules to make it easier for people to schedule their preventive dental care. Under the new plans, which are available now, the company is doing away with the requirement that cleanings be done at least six months apart.

In addition, the new plans cover teeth whitening – the kind of gel bleaching with take-home trays that many dentists offer. The plans continue to include important preventive features such as no age limitation on sealants, no referrals needed for orthodontic care, no referrals needed for care by a network pediatric dentist for children under 7, and coverage for procedures to help detect oral cancer early.

According to Bebe Shuler-Mure, assistant vice president of product for CIGNA’s dental products, CIGNA has been working to broaden the network of dentists who participate in the dental HMO plan and now has over 13,600 unique dentists who practice among over 43,500 office locations in the network, one of the largest dental HMO networks in the country. Individuals can locate an in-network dentist using the dental directory on www.cigna.com.

At a time when the affordability of coverage is a concern for both employees and employers, the new plans are offered with a range of benefit and copay options.

“CIGNA’s new dental HMO plans have more options available than many other carriers, including standard plans, plans with and without orthodontia coverage, specialty dental care discount, and split copay plans where copays are lower for using a general dentist and higher for dental specialty care,” said Shuler-Mure. “This array of options gives employers flexibility to continue to provide a dental plan, even if their benefits budgets are under strain due to the economic downturn. The plans are also available on what is known as a voluntary (employee-paid) basis, where employees can get the advantage of obtaining insurance at lower, group rates.”

CIGNA is also using its diverse product capabilities to provide value-added services for people in its dental plans. CIGNA will offer identity theft resolution services free of charge for individuals covered under the new series of dental HMO plans. Someone who falls victim to identify theft can be guided through the steps to recovery by an identify theft expert, 24 hours a day, 7 days a week, at no charge.

In addition, through the CIGNA Healthy Rewards(R) Program, individuals can get discounts on gym memberships, weight management programs such as WeightWatchers(R) and NutriSystem(R), retail coupons through Linkwell, massage therapy, laser vision correction, tobacco cessation and more.

*Estimated costs without dental coverage may vary based on location and dentists’ actual charges. These estimated costs are based on charges submitted to CIGNA as of February, 2009.

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Thorstensson H, Johansson B. Does oral health say anything about survival in later life? Findings in a Swedish cohort of 80+ years at baseline. Community Dent Oral Epidemiol 2009; 37: 325-332. © 2009 John Wiley & Sons A/S

Oral health is an integral part of general health; oral health contributes to and is influenced by a nexus of inputs from biological, psychological, and social functioning. Little is known about the relationship between markers of oral health and subsequent survival in late life.

The aim of this study was to examine the relative importance of oral health indicators in the context of demographic and psychosocial variables on subsequent survival during an 8-year period in a population-based sample of the oldest-old.

The study sample comprised 357 individuals with a median age of 86 years who were selected from participants in the comprehensive longitudinal Origins of Variance in the Old-Old: Octogenarian Twins (OCTO-Twin) study, which examined monozygotic and dizygotic twins aged 80 years and older on five occasions at 2-year intervals. The OCTO-Twin study includes a broad spectrum of biobehavioural measures of health and functional capacity, personality, well-being, and interpersonal functioning. Oral health variables were number of teeth, per cent decayed and filled surfaces (DFS%), and periodontal disease experience. A longevity quotient (LQ), the ratio between years actually lived and those statistically expected, was determined. The survival categories were shorter than expected, as expected, or longer-than-expected. Multivariate analyses and the Kaplan-Meier method were used in the survival analyses.

No associations between LQ and number of teeth, edentulousness, and periodontal disease experience were found. But survival of men with severe periodontal disease experience was shorter than expected. DFS% was significantly associated with survival. Individuals with a low number of decayed and filled surfaces (DFS) had a shorter-than-expected survival time compared with those with high DFS scores. The overall predictor of survival was cognitive status, independent of age and gender when dental variables were analysed in the context of psychosocial factors. In addition, number of teeth, smoking, and better financial status in childhood and during working life were also significant predictors.

Oral health was significantly associated with subsequent survival in a sample of oldest-old individuals, although psychosocial factors were stronger predictors.

Watson JM, Logan HL, Tomar SL, Sandow P. Factors associated with early-stage diagnosis of oral and pharyngeal cancer. Community Dent Oral Epidemiol 2009; 37: 333-341. © 2009 John Wiley & Sons A/S

The objective of this study was to examine the characteristics and treatment-seeking behaviors of patients diagnosed with oral and pharyngeal cancer (OPC) and to determine whether seeing an oral healthcare provider in the preceding year was associated with an earlier stage of diagnosis.

Trained interviewers administered a pretested survey instrument to a sample of 131 patients newly diagnosed with OPC at two cancer centers in Florida. Analyses were conducted to compare characteristics of patients by cancer summary stage (early or advanced) on receipt of OPC examination, patterns of dental care, and number of initial signs and symptoms. In addition, analyses were also conducted for characteristics of patients’ dental care utilization (regular primary care dentist, time of most recent dental visit, and regular dental care) by receipt of OPC examination.

Overall, 25.3% of participants reported receiving an OPC examination at their last dental visit and participants who received an OPC examination were significantly more likely (79%) to be diagnosed at early stages than those who did not receive an oral cancer examination (48%). Patients with a regular primary care dentist were more likely to be diagnosed at early stages (65%) than those without a regular primary care dentist (41%). Factors significantly associated with receiving an OPC examination included having a regular primary care dentist ( P < 0.001), having a dental visit in the preceding 12 months ( P < 0.001), and receiving regular care ( P < 0.001). The number of signs or symptoms reported by the patient was significantly associated with the stage at diagnosis ( P = 0.002) and the most common initial symptom reported by patients was soreness in the mouth.

Thorstensson H, Johansson B. Does oral health say anything about survival in later life? Findings in a Swedish cohort of 80+ years at baseline. Community Dent Oral Epidemiol 2009; 37: 325-332. © 2009 John Wiley & Sons A/S

Oral health is an integral part of general health; oral health contributes to and is influenced by a nexus of inputs from biological, psychological, and social functioning. Little is known about the relationship between markers of oral health and subsequent survival in late life.

The aim of this study was to examine the relative importance of oral health indicators in the context of demographic and psychosocial variables on subsequent survival during an 8-year period in a population-based sample of the oldest-old.

The study sample comprised 357 individuals with a median age of 86 years who were selected from participants in the comprehensive longitudinal Origins of Variance in the Old-Old: Octogenarian Twins (OCTO-Twin) study, which examined monozygotic and dizygotic twins aged 80 years and older on five occasions at 2-year intervals. The OCTO-Twin study includes a broad spectrum of biobehavioural measures of health and functional capacity, personality, well-being, and interpersonal functioning. Oral health variables were number of teeth, per cent decayed and filled surfaces (DFS%), and periodontal disease experience. A longevity quotient (LQ), the ratio between years actually lived and those statistically expected, was determined. The survival categories were shorter than expected, as expected, or longer-than-expected. Multivariate analyses and the Kaplan-Meier method were used in the survival analyses.

No associations between LQ and number of teeth, edentulousness, and periodontal disease experience were found. But survival of men with severe periodontal disease experience was shorter than expected. DFS% was significantly associated with survival. Individuals with a low number of decayed and filled surfaces (DFS) had a shorter-than-expected survival time compared with those with high DFS scores. The overall predictor of survival was cognitive status, independent of age and gender when dental variables were analysed in the context of psychosocial factors. In addition, number of teeth, smoking, and better financial status in childhood and during working life were also significant predictors.

Oral health was significantly associated with subsequent survival in a sample of oldest-old individuals, although psychosocial factors were stronger predictors.

Mutations in the NHS (Nance-Horan Syndrome) gene lead to severe congenital cataracts, dental defects and sometimes mental retardation. NHS encodes two protein isoforms, NHS-A and -1A that display cell-type dependent differential expression and localization. Here we demonstrate that of these two isoforms, the NHS-A isoform associates with the cell membrane in the presence of intercellular contacts and it immunoprecipitates with the tight junction protein ZO-1 in MDCK (Madin Darby Canine Kidney) epithelial cells and in neonatal rat lens. The NHS-1A isoform however is a cytoplasmic protein. Both Nhs isoforms are expressed during mouse development. Immunolabelling of developing mouse with the anti-NHS antibody that detects both isoforms revealed the protein in the developing head including the eye and brain. It was primarily expressed in epithelium including neural epithelium and certain vascular endothelium but only weakly expressed in mesenchymal cells. In the epithelium and vascular endothelium the protein associated with the cell membrane and co-localized with ZO-1, which indirectly indicates expression of the Nhs-A isoform in these structures. Membrane localization of the protein in the lens vesicle similarly supports Nhs-A expression. In conclusion, the NHS-A isoform of NHS is a novel interactor of ZO-1 and may have a role at tight junctions. This isoform is important in mammalian development especially of the organs in the head.

Most brand extension studies follow the assumption that brand extensions use the full original parent brand name (e.g., Oral-B tooth brush may extend to Oral-B dental floss). However, some companies use derived brand names in their brand extension strategies (e.g. Nestea Iced Tea). This study explores the advantages and disadvantages of derived brand extensions compared to full name extensions. The study examines the importance of target market effects on the evaluation of both brand extension strategies. Findings support the idea that derived brand names leverage parent brand evaluations and protect parent brand from extension failures.

Nishimura et al conducted a two-year longitudinal study to show the predictive abilities of a caries activity test, and to include the predicted screening indexes that were based on previous caries activity test results and lifestyle factors that influence caries activity. Results show that caries activity test score at 18 months of age not only reflected caries incidence but also predicted caries incidence and screening results in 2- and 3 ½-year-old children. They conclude that a caries activity test could predict 3 ½-year-old children’s caries risk based on 18-month and 2-year-old test results and early weaning, less sucrose intake and toothbrushing by parents were effective in reducing a child’s caries risk.

This was an Australian case-control study. CASE-CONTROL SELECTION: Cases were recruited from children referred for dental treatment under general anaesthesia at free public hospitals in eight health service districts in the state of Queensland, Australia [early childhood caries (ECC) public cases], and three private specialist paediatric dental clinics (ECC private cases). Controls were selected from a full list of all childcare facilities in the area using a selection ratio of one in seven children. As dental health status of the children was unknown prior to recruitment, a subgroup of 62 children with ECC was recruited in the control cohort (ECC childcare) and formed the third source of ECC cases. ASCERTAINMENT: The teeth of children in dental clinics or childcare facilities were examined using lighting from an examiner’s head-lamp, with the child placed on the laps of the mother and examiner. A child was considered to have ECC if at least one cavity was present. Caries was charted using the World Health Organization oral health survey basic methods criteria(1) and enamel hypoplasia using the modified Developmental Defects of Enamel index. Presence of Streptococcus mutans was also assessed. Mothers were interviewed and screened to determine their social, medical and dental histories; dental caries experience; absence or presence of plaque and gingival inflammation; and presence of S. mutans. Validated questionnaires were used to obtain social, medical, dental, dietary and toothbrushing histories of the mothers. DATA ANALYSIS: Group comparisons of continuous variables (such as age and birthweight) were compared for statistical significance using analysis of variance. Categorical variables were compared for statistical difference across groups using contingency chi2 tests together with multinomial logistic regression modelling. RESULTS: A large proportion of children tested positive for S. mutans if their mothers also tested positive. A common risk indicator found in ECC children from childcare facilities and public hospitals was visible plaque [odds ratio (OR), 4.1; 95% confidence interval (CI), 1.0-15.9; and OR, 8.7; 95% CI, 2.3-32.9, respectively). Compared with ECC-free controls, the risk indicators specific to childcare cases were enamel hypoplasia (OR, 4.2; 95% CI, 1.0-18.3), difficulty in cleaning the child’s teeth (OR 6.6; 95% CI, 2.2-19.8), presence of S. mutans (OR, 4.8; 95% CI, 0.7-32.6), sweetened drinks (OR, 4.0; 95% CI, 1.2-13.6) and maternal anxiety (OR, 5.1; 95% CI, 1.1-25.0). Risk indicators specific to public hospital cases were presence of S. mutans in the child (OR, 7.7; 95% CI, 1.3-44.6) or mother (OR, 8.1; 95% CI, 0.9-72.4), ethnicity (OR, 5.6; 95% CI, 1.4-22.1), and access of mother to pension or healthcare card (OR, 20.5; 95% CI, 3.5-119.9). By contrast, a history of chronic ear infections was found to be protective for ECC in childcare children (OR, 0.28; 95% CI, 0.09-0.82). CONCLUSIONS: This case-control study showed that children of different socioeconomic backgrounds who have ECC share the common risk indicators of visible plaque, consumption of sugary snacks and presence of S. mutans. Additional risk indicators in children from childcare facilities were enamel hypoplasia, difficulty in cleaning the child’s teeth, sweetened drinks and maternal anxiety, whereas ethnicity and mothers’ access to pension or healthcare cards were specific

Yoshioka et al report two cases of paresthesia in the mental region. No lesions were readily apparent on the patients’ panoramic radiographs. To exclude the presence of disease in the mandible that could have been responsible for the NCS, computed tomographic (CT) images should be obtained. The images identified metastases to the mandible from primary malignant tumors elsewhere in the body. To prevent misdiagnosis of numb chin syndrome (NCS), dentists need to be aware of the clinical manifestations of NCS, the need for CT imaging, the shortcommings of panoramic radiographs and the value of obtaining detailed and accurate medical and dental histories from patients.