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.

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.

Declining student interest and scholastic abilities in the sciences are concerns for the health professions. Additionally, the National Institutes of Health is committed to promoting more research on health behaviors among US youth, where one of the most striking contemporary issues is obesity. This paper reports findings on the impact of a partnership between Oregon Health and Science University (OHSU) and the Oregon Museum of Science and Industry linked to a 17-week exhibition of BodyWorlds3 and designed to inform rural underserved youth about science and health research. Self-administered survey measures included health knowledge, attitudes, intended health behaviors, and interest in the health professions. Four hundred four surveys (88% of participants) were included in analyses. Ninety percent or more found both the BodyWorlds (n = 404) and OHSU (n = 239) exhibits interesting. Dental care habits showed the highest level of intended behavior change (Dental = 45%, Exercise = 34%, Eating = 30%). Overall, females and middle school students were more likely than male and high school students, respectively, to state an intention to change exercise, eating and dental care habits. Females and high school students were more likely to have considered a career in health or science prior to their exhibit visit and, following the exhibit, were more likely to report that this intention had been reinforced. About 6% of those who had not previously considered a career in health or science (n = 225) reported being more likely to do so after viewing the exhibits. In conclusion, high quality experiential learning best created by community-academic partnerships appears to have the ability to stimulate interest and influence intentions to change health behaviors among middle and high school students.

This study explored oral health disparities associated with food insecurity in working poor Canadians.

We used a cross-sectional stratified study design and telephone survey methodology to obtain data from 1049 working poor persons aged between 18 and 64 years. The survey instrument contained sociodemographic items, self-reported oral health measures, access to dental care indicators (dental visiting behaviour and insurance coverage) and questions about competing financial demands. Food-insecure persons gave ‘often’ or ’sometimes’ responses to any of the three food insecurity indicators used in the Canadian Community Health Survey (2003) assessing ‘worry’ about not having enough food, not eating enough food and not having the desired quality of food because of insufficient finances in the previous 12 months .

Food-insecure working poor persons had poor oral health compared with food-secure working poor persons indicated by a higher percentage of denture wearers ( P < 0.001) and a higher prevalence of toothache, pain and functional impacts related to chewing, speaking, sleeping and work difficulties ( P < 0.001). Fewer food-insecure persons rated their oral health as good or very good ( P < 0.001). Logistic regression analyses showed that oral health disparities between food-insecure and food-secure persons related to denture wearing, having a toothache, reporting poor/very poor self-rated oral health or experiencing an oral health impact persisted after adjusting for sociodemographic factors and access to dental care factors ( P < 0.05). Food-insecure working poor persons reported relinquishing goods or services in order to pay for necessary dental care.

This study identified oral health disparities within an already marginalized group not alleviated by access to professional dental care. Working poor persons regarded professional dental care as a competing financial demand.

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.

Scenarios involving dental services investigate whether Asian cultures are similar enough to allow standardization of service offerings. The authors control and manipulate levels of service quality and performance to yield a 2 x 2 experimental design, with Japanese, Chinese, and Korean subjects (N = 637) selected to test the invariance of the measures. The findings yield significant cultural differences with the Chinese respondents perceiving significantly higher service quality and expressing greater customer satisfaction when performance is high and expressing less customer satisfaction when performance is low than do the Japanese and Korean respondents. Thus, even though all three countries are considered high-context cultures, having their roots in Confucianism, differences in national culture lead to the conclusion that “one size does not fit all” in terms of service offerings

In humans eating unrefined diets, the dentition eventually becomes severely worn [1]. Since the Industrial Revolution, the diet in the West has become softer and easier to masticate and this has resulted in a marked reduction in tooth wear: while postcanine teeth in modern humans wear at 15– 20 m/year [2], incisors wore at 280– 360 m/year in prehistoric humans [3]. Because tooth wear in modern Western populations is ordinarily low, pronounced wear tends to have pathological causes. The main forms of abnormal wear are cervical wear associated mainly with excessive toothbrushing, heavy occlusal wear associated with bruxism, and erosive wear at many surfaces due to ingestion of acidic substances or regurgitation of acid. This paper is concerned with the wear processes that operate in these conditions, and with their interactions to produce the clinically observable result. The term tooth wear denotes the gradual loss of dental hard tissues through three processes: abrasion (wear produced by interaction between teeth and other

materials), attrition (wear through tooth– tooth contact) and erosion (dissolution of hard tissue by acidic substances). It has been postulated that in a fourth wearrelated process (abfraction) abnormal occlusal loading predisposes cervical enamel to mechanical and chemical wear [4]. All four processes are distinguished from loss of dental tissues through dental caries on the one hand and acute trauma on the other. The terms abrasion, attrition and erosion have been adapted from everyday usage and their meanings in the dental context can diverge from those in other fields, in particular from that of tribology, the science of wear, friction and lubrication. Tribology recognises a variety of mechanisms by which wear can occur, of which the most relevant to the present paper are twoand three-body abrasion and tribochemical wear [5]. In two-body wear, two moving surfaces contact each other directly and wear is produced by breaking away of asperities. In three-body wear, two moving surfaces are separated by an intervening slurry of abrasive particles, which remove material from both surfaces. In tribochemical wear, attack by a chemical agent weakens the superficial region of the material and enhances its susceptibility to mechanical forces. Clearly, in tribological terms, attrition would be subsumed under abrasion, erosion would be described as a form of tribochemical wear and abfraction as a form of fatigue [5]. It has been suggested that the time has come to align tooth wear terminology with tribology [6] but it seems likely that the terms outlined above, most of which have had their current meaning for decades, will persist despite their limitations. Each tooth wear process can, under some circumstances, operate alone. For example, nocturnal grinding of teeth will cause wear by attrition alone, drinking an acidic drink through a straw directed at the labial surface of the central incisors will cause wear by erosion alone, and brushing the teeth immediately on awakening will produce wear by abrasion alone. Yet, as many authors have suggested, the tooth wear observed in an individual will have resulted from a combination of all three main processes even though one may predominate [5, 7, 8]. If tooth wear were due to purely mechanical causes (abrasion and attrition), the total tissue loss at surfaces would fit a simple additive arithmetic model but wear is less simple. For example, tooth loading could create cracks which could cause particles of hard tissue to break off and act as an abrasive, thus converting a two-body attrition process into three-body abrasion [5], or the cracks would make the tissues more susceptible to abrasion, as suggested for abfraction [4]. If there is significant erosion, then the possibility of using simple arithmetic models to predict total tooth wear over time becomes remote, because erosion both removes hard tissue directly and renders tooth surfaces more susceptible to mechanical wear. As with any oral condition which is complex even when modelled in vitro, it is always tempting to discuss the aetiology of wear without reference to the

Overall medical and pharmacy costs in people with diabetes can be lower by more than 10 percent per year in individuals receiving regular, non-surgical periodontal services, according to a recent University of Michigan study. The study also showed the same procedures were linked to as much as 19 percent lower diabetes-related medical costs. The research findings further underscore the importance of the link between medical and dental health (see also <http://www.newsrx.com/library/topics/Diabetes.html> Diabetes).

“Working with the Michigan Blues, we found insured adults with diabetes in Michigan who receive routine periodontal treatment, such as dental cleanings and scaling, have significantly lower medical care costs than those who do not,” George Taylor, D.M.D., the study’s principal investigator and associate professor at The University of Michigan School of Dentistry, said. “The results of our analyses provide additional evidence supporting a beneficial role for periodontal treatment in improving overall health in people with diabetes and in lowering overall costs.”

The study analyzed five years of claims data from Blue Care Network, a Michigan-based HMO, and was funded by the Blue Cross Blue Shield of Michigan Foundation. The claims data pool consisted of 2,674 members with diabetes aged 18-64 with at least 12 consecutive months of medical, dental and pharmaceutical coverage.

“Our belief is that research like this can have positive effects on the quality of care and cost of treating patients with diabetes,” Dr. Ira Strumwasser, executive director and CEO of the BCBSM Foundation, said. “This study demonstrates our effort to improve the health of all Michigan residents.”

“The Michigan Blues are in a unique position to offer members health plans that take advantage of the proven link between oral health and overall health,” says Douglas R. Woll, M.D., senior vice president and chief medical officer for Blue Care Network. “Those with a Blue medical and dental plan benefit from health information and care integration that can lead to improved health and lower costs.”

The Blue Cross Blue Shield of Michigan Foundation is dedicated to improving the health of Michigan residents by supporting health care research and innovative health programs. The foundation’s grant programs are conducted in Michigan by Michigan-based researchers and nonprofit community health care organizations.

Over the past 25 years, the BCBSM Foundation has contributed approximately $20 million in grants for research and $5 million for community health programs. This funding has resulted in enhancements to quality, patient safety and access to care for the people of Michigan. The foundation also supports efforts to control the rising costs of health care through research, demonstration and evaluation projects.

The BCBSM Foundation is the philanthropic affiliate of Blue Cross Blue Shield of Michigan. The foundation is a 501(c)(3) nonprofit organization and an independent licensee of the Blue Cross and Blue Shield Association. For more information, visit bcbsm.com/foundation.

Blue Care Network of Michigan and its subsidiaries have 648,000 members. Blue Care Network features award-winning disease management programs and the largest HMO network of physicians and hospitals in the state, with more than 4,000 primary care physicians, 10,100 specialists and 118 hospitals. Blue Care Network, a nonprofit corporation, is the affiliated HMO of Blue Cross Blue Shield of Michigan and an independent licensee of the Blue Cross and Blue Shield Association.

Keywords: Dentistry, Diabetes, HMO, Health Insurance, Health Maintenance Organizations, Pharmaceuticals, Quality of Care, Blue Cross Blue Shield of Michigan Foundation.

As layoffs and furlough days continue to eat away at pocket books, local dentists say they’ve noticed a decrease in the area’s appetite for oral health care.

Dental health care experts are concerned.

“I think a lot of preventative care has become affected by people’s economic situations,” said Randall Lawson, a doctor of dental surgery and owner of College Avenue Dental in Jacksonville.

“I have two hygienists that do preventive care, cleanings, et cetera, and they have seemed to become less busy as of late.”

He said although the summer time is busier due to children being out of school, his office has seen more cancellations than usual.

William Weller, a doctor of dental surgery with an office on West Lafayette Avenue, has seen a similar trend at his practice.

“Whenever we have a downturn or anything like this there are several things that happen,” Dr. Weller said. “Probably the most significant is people looking for ways to cut corners — looking to delay or postpone their six-month checkups. It’s kind of unfortunate because yes, they’ll save 100 bucks on a checkup but they’ll pay later.”

Dr. Weller said the people he and his fellow dentists treat in the area, for the most part, “are really honest people.”

“If they don’t have the money they don’t want to come in and incur a debt,” he explained. “Which is laudable to some degree, but something that we worry about.”

They worry for many reasons.

One, most patients end up paying more when they do get back in the chair because problems like cavities, gum diseases and cracked teeth go undetected and get worse.

Patients are also skipping an oral cancer screening when they skip a check up, Mr. Weller said. “It’s rare, but serious.”

Dentists also worry from a business perspective. When the economy does turn around, the their offices will face a pile up of patients who avoided care.

Elective dental work has also apparently been affected by the economic slowdown.

“People seem to be delaying elective sorts of things, cosmetic services, whitening procedures,” Dr. Lawson said. “Currently it’s just being delayed but eventually it might end up being abandoned.”

Dr. Weller said he has seen patients cancel appointments to have their teeth capped.

Another indicator of how bad the economic situation is, Dr. Weller added, is the number of patients deciding to have teeth removed rather than treated and saved.

“Root canals and crowns can cost $1,000 to $2,000,” he said. “When insurance first began to become popular, the maximum annual coverage was about $1,000 to $1,500. Today it’s still $1,000 to $1,500. Now, you can easily reach that with one tooth.”

economy downoral health

According to the American Diabetes Association, nearly 24 million people have diabetes. Of that number, unfortunately, 5.7 million people are unaware that they have the disease. Diabetes can affect multiple parts of the body, including the kidneys, nerves, heart and even the mouth (see also <http://www.newsrx.com/library/topics/Diabetes.html> Diabetes).

Because diabetics are more prone to several oral health problems, including tooth decay, periodontal (gum) disease, salivary gland dysfunction and infection, the Pennsylvania Dental Association (PDA) reminds diabetic patients of the importance of maintaining optimal dental health.

It is important to let your dentist know if you suffer from diabetes and if the disease is under control.

“At each dental visit tell your dentist about the status of your diabetes,” said Dr. Bruce Terry, a PDA member and endodontist from Wayne. “Let the dentist know your most recent glycosylated hemoglobin (HgA1C) level to determine how well your diabetes is controlled. A good value should be under 7 percent. Inform your dentist of any recent hypo or hyperglycemic episodes. Uncontrolled diabetics are at higher risk for complications from local anesthetics (lidocaine) as well as complications with oral surgery and even simple tooth cleanings. If you take insulin, tell your dentist when you normally take insulin and when your last dose was taken.”

Diabetic patients are at greater risk for tooth decay due to the presence of higher bacteria levels found in saliva when diabetes is not under control. As diabetes can lower resistance to infection, periodontal disease can develop.

Brushing twice a day and flossing daily will help remove plaque, the sticky film of bacteria that causes tooth decay and periodontal disease. Using fluoride toothpaste and an antibacterial mouthrinse is another way to help fight tooth decay.

It is imperative to visit the dentist at least twice a year for routine checkups and professional cleanings. The dentist may recommend more frequent checkups and cleanings for diabetic patients. Though brushing and flossing removes some plaque, it can’t remove it all. If plaque isn’t removed, it hardens to form tartar, which can lead to chronic inflammation and infection in the mouth.

Diabetic patients should contact their dentist immediately if they observe any of the warning signs of periodontal disease, including, red, swollen or tender gums or gums that bleed easily or are pulling away from the teeth; chronic bad breath or a bad taste in the mouth; teeth that are loose or separating; pus appearing between the teeth and gums when the gums are pressed; or changes in the alignment of the teeth.

Diabetic patients often suffer from dry mouth (xerostomia), which greatly increases their risk of tooth decay and periodontal disease. Talk with your dentist if you are experiencing dry mouth. He or she may recommend a saliva substitute, as well as fluoride treatment to prevent tooth decay. Chewing sugarless gum or mints, drinking water or sucking on ice chips may help to ease the discomfort of dry mouth.

Bacteria, viruses and fungi occur naturally in the mouth. Oral candidiasis, a fungal infection in the mouth, appears to occur more frequently among people with diabetes, including those who wear dentures. If a diabetic patient smokes, has high blood glucose levels or takes antibiotics, he or she is more likely to have a problem with a fungal infection of the mouth.

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