Dental Tribune U.S. Edition

Publisher & Chairman Torsten Oemus t.oemus@dental-tribune.com Chief OPerating OffiCer Eric Seid e.seid@dental-tribune.com grOuP editOr Robin Goodman r.goodman@dental-tribune.com editOr in Chief dental tribune Dr. David L. Hoexter feedback@dental-tribune.com managing editOr u.s. and Canada editiOns Robert Selleck r.selleck@dental-tribune.com managing editOr Fred Michmershuizen f.michmershuizen@dental-tribune.com managing editOr Sierra Rendon s.rendon@dental-tribune.com managing editOr shOw dailies Kristine Colker k.colker@dental-tribune.com PrOduCt & aCCOunt manager Mara Zimmerman m.zimmerman@dental-tribune.com marketing manager Anna Kataoka-Wlodarczyk a.wlodarczyk@dental-tribune.com sales & marketing assistant Lorrie Young l.young@dental-tribune.com C.e. direCtOr Christiane Ferret c.ferret@dtstudyclub.com Dental Tribune America, LLC 116 West 23rd St., Ste. #500 New York, N.Y. 10011 (212) 244-7181 Published by Dental Tribune America © 2012 Dental Tribune America, LLC All rights reserved. Dental Tribune strives to maintain the utmost accu- racy in its news and clinical reports. If you find a fac- tual error or content that requires clarification, please contact Managing Editor Robert Selleck at r.selleck@ dental-tribune.com. Dental Tribune cannot assume responsibility for the validity of product claims or for typographical errors. The publisher also does not assume responsibility for product names or statements made by advertisers. Opinions expressed by authors are their own and may not reflect those of Dental Tribune America. editOrial bOard Dr. Joel Berg Dr. L. Stephen Buchanan Dr. Arnaldo Castellucci Dr. Gorden Christensen Dr. Rella Christensen Dr. William Dickerson Hugh Doherty Dr. James Doundoulakis Dr. David Garber Dr. Fay Goldstep Dr. Howard Glazer Dr. Harold Heymann Dr. Karl Leinfelder Dr. Roger Levin Dr. Carl E. Misch Dr. Dan Nathanson Dr. Chester Redhead Dr. Irwin Smigel Dr. Jon Suzuki Dr. Dennis Tartakow Dr. Dan Ward Tell us what you think! Do you have general comments or criti- cism you would like to share? Is there a particular topic you would like to see articles about in Dental Tribune? Let us know by e-mailing feedback@dental- tribune.com. We look forward to hear- ing from you! If you would like to make any change to your subscription (name, address or to opt out) please send us an e-mail at database@dental-tribune.com and be sure to include which publica- tion you are referring to. Also, please note that subscription changes can take up to six weeks to process. DENTAL TRIBUNE The World’s Dental Newspaper · US Edition Letter to the editor in chief Dear Dr. Hoexter, The recent article in the American Heart Association’s journal Circulation, [titled] “Periodontal Disease and Ath- erosclerotic Vascular Disease: Does the Evidence Support an Independent As- sociation? A Scientific Statement From the American Heart Association” (pub- lished online 4/18/2012), combined with the American Heart Association’s press release of the same day, was discourag- ing in and of itself, and made more so by the prototypical way The New York Times reported on the story the next day. Although I suspect that Circulation is not responsible for the AHA’s press re- leases, the statement in the announce- ment that researchers who showed a “stronger relationship between” chronic periodontitis (PD) and ASVD “didn't ac- count for the risk factors common to both diseases,” is incorrect and incon- sistent with the manuscript. Unfortunately, the Circulation article is similarly afflicted; insofar as its au- thors appear to have had an agenda that went beyond the scientific publications they reviewed. Although I agree with the authors that an unquantifiable number of ill- informed or unscrupulous practitioners engage in hucksterism with regard to the several putative periodontal-sys- temic disease links, the statement in the article's abstract that “Patients and pro- viders are increasingly presented with claims that PD treatment strategies of- fer ASVD protection; these claims are often endorsed by professional and in- dustrial stakeholders” is not supported by the data presented in the review. Also revealing of the authors’ appar- ent bias is the final sentence of the ar- ticle, which reads: “...statements that im- ply a causative association between PD and specific ASVD events or claim that therapeutic interventions may be use- ful on the basis of that assumption are unwarranted.” Hence, it appears as if the AHA’s rec- ommendation to dentists, dental hy- gienists and others may be accurately paraphrased: “Although we at AHA ac- knowledge that there are unexplained links between the incidence of PD and ASVD, because we can find no clear caus- al links, it is unwarranted for dental pro- fessionals to inform patients that bet- ter oral health is associated with better cardiovascular health in any way if used to encourage better periodontal health and improved home oral hygiene.” Do the Circulation authors, editors and the AHA really believe that this is a sound message, especially in light of the reality that an overwhelming majority of the “interventions” decried in the fi- nal sentence of the manuscript consist of encouraging improved (and inexpen- sive) dental hygiene self-care at home? Regards, Michael P. Rethman, DDS, MS • Diplomate, American Board of Periodontology • Vice President (Scientific Research), American Dental Association Foundation • Clinical Associate Professor (Adjunct), University of Maryland School of Dentistry • Clinical Assistant Professor (Adjunct), College of Dentistry, The Ohio State University • Former Chair, Council on Scientific Affairs, American Dental Association • Past President, American Academy of Periodontology • Past Director, U.S. Army Institute of Dental Research • Former Chair, The Columbia Association “ ACCESS, page A1 R. Calnon, DDS, said in a news release, "We hope that our few areas of disagreement do not obscure our welcoming Sen. Sanders to this fight. His bill aims high, and that has long been needed. We fully support his in- tent, to help extend good oral health to all Americans." The proposed legislation addresses much of what the subcommittee heard from witnesses in February. That testimony fre- quently focused on the costs of dentistry and dentistry education — and the impact such costs have on where dentists practice and the types of patients they most typi- cally serve (those with dental insurance or other means of paying for care). At the hearing's 90-minute mark Sub- committeeChairmanSanderssaid,“Gener- ally speaking, dentists make a pretty good income. Why is it that we have a dental shortage in this country? Why do we not have enough dentists?” In response, Shelly Gehshan, MPP, direc- tor of the Pew Children’s Dental Campaign, PewCenterontheStates,basedinWashing- ton, D.C., said the supply of dentists ebbs andflowswiththeeconomy,withthe1970s and 1980s producing a large contingent of dental school graduates before reces- sions forced closure of a number of dental schools. As a result, today's large number of dentists retiring every year exceeds the annual number of dental school graduates. Grant Whitmer, MSM, executive direc- tor at Community Health Centers of the Rutland Region, Rutland, Vt., said his orga- nizationjusthiredtworecentdentalschool graduates, each of whom had more than $350,000 in debt from financing their edu- cations. He said it was only because of the National Health Services Corps and loan re- payment assistance that the two were able to take the positions, which focus on deliv- ering care to underserved populations. Burton Edelstein, DDS, MPH, professor of dentistry and health policy and manage- ment at Columbia University, New York, N.Y., said that dental training requires uni- versities to fully fund their own operato- ries and high-end equipment purchases, unlike medical schools, which can rely on non-university hospitals for clinical train- ing. Dentists opening their own private practices face similar expenses. The result: Providingdentalservicesand/ortrainingis a highly expensive proposition. Gregory Folse, DDS, president of Out- reach Dentistry in Lafayette, La., which is primarily a mobile concept serving the poor, disabled and elderly, praised the fed- eralincometaxsystem’s“incurredmedical expense allowance,” which he said enables himtoearnenoughtofocushispracticeon underserved populations. But he acknowl- edged that his income places him in the lower 10 to 15 percent of the profession in earnings.HespokeinsupportoftheSpecial Care Dentistry Act, which he said enables development of a stronger infrastructure for delivering treatment to underserved populations. Subcommittee members repeatedly re- ferred to the access-to-care issue as a crisis. Sanders said more that 130 million people in the United States lack dental insurance, andforthosewhohaveit,benefitstypically are capped at $1,000 to $2,000 per year, which covers only basic services. He said 47 million people live in areas where it is a challenge to find dental care. “This is an is- sue of enormous importance, and does not get the attention it deserves,” Sanders said. The proposed legislation references the need for nearly 9,500 additional dental providers to meet the nation's current oral health needs. Various witnesses and sub- committee members spoke of the grow- ing body of research linking oral health to overall health. Also acknowledged were the financial impacts on hospitals that have seen increasing numbers of patients using emergency rooms as their only option for dental care, which typically means just im- mediate symptoms are being addressed, not underlying causes and prevention. The proposed legislation takes a multi- pronged approach with a variety of pro- grams that would make it more financially viable for dental professionals to provide care to people falling outside of current care-delivery models. “We’re going to shine a spotlight on an issue that is not much talked about and we are going to do our best to solve this problem,” Sanders said. Dental Tribune U.S. Edition | June 2012A2 NEWS/LEttErS Questions on American Heart Association’s stance on periodontal disease and heart health Sen. Bernard Sanders, I-Vt., chairman of the U.S. Senate Subcommittee on Primary Health and Aging, leads the hearing on “Dental Crisis in America: The Need to Expand Access.” Photo/Provided by U.S. Senate Committee on Health, Education, Labor and Pensions See page D2 for the American Dental Hygienists’ Association stance on the access-to-care proposals