California Performs Poorly on Oral Health Report Card

The Golden State received a mediocre grade in oral health care and ranked only slightly above the low national average on America’s first Oral Health Report Card, issued in October. California received an overall C grade while the nation as a whole rated a C- in the report that offers a state-by-state look at the specifics of oral care, including prevention, access to care, and health status.

The report card, issued by the nonprofit advocacy group Oral Health America and reviewed by the federal Centers for Disease Control and Prevention, made a significant splash as media from coast to coast transmitted the rather gray findings concerning the nation’s "pearly whites."

"We were hoping to alert America that we are in the position of a student with straight A potential in danger of failure," said Robert Klaus, president of Oral Health America. "The report card was not meant to embarrass or put anyone on the spot, but was intended as an impact statement and a wakeup call to policy makers that many of these oral health problems are preventable and solutions are affordable."

"Our primary goal was to raise public awareness," said Elizabeth Rogers, director of communications for Oral Health America. "We were looking to extend the message of Surgeon General David Satcher’s report on oral health and use it as an advantage to help raise the profile of oral health."

The Oral Health Report Card highlights significant variation between the states on a number of issues, especially in the categories of prevention and health status. In the general category of prevention, fluoridation grades ranged from A’s to F’s; and 24 state sealant programs received an incomplete. Grades in the health status category were also all over the board with B grades in Arizona, North Carolina, and Utah contrasting with F’s in Kansas and Minnesota.

Nationwide, grades were consistently low in the access-to-care category where a few C+ grades in Maryland, Oregon, and Wyoming were sprinkled among many D’s, F’s, and I’s. In grading access to care in the individual states, Oral Health America looked at the prevalence of dentists and dental clinics, Medicaid programs, and dental insurance for adults and elders. California rated a C- in overall access to care and a D in dental insurance for the elderly. Dental insurance for people over 65 received the most abysmal marks with an F grade issued in 41 states. Roughly 108 million people in the United States, including 85 percent of the elderly, lack dental insurance.

These disappointing grades in access confirm the long-standing recognition in the dental health field that oral health is inextricably linked with general health and needs to be addressed this way in shaping public policy.

"The most important information to come out of this report deals with the great disparity in access to care," Klaus said. "We have really hit a mark in this area and have to work to change the perception of the public and of policy makers so they understand that oral health care is health care." Klaus used the example of the health insurance offered to his son, who is a teacher in Chicago’s public school system. It did not include coverage for dental care. "Labor unions need to understand that this is not an option, and this kind of exclusion can’t be made. Oral health care is health care."

"The report confirms that public policy, which could contribute to oral health improvements, has been lagging in funding and resources when compared to medical resources," said Jared I. Fine, DDS, MPH, of the Office of Dental Health in Alameda County. "When politicians talk about health coverage and insurance, they don’t mean dental. For every child who is uninsured for medical care, there are two to three children who are uninsured for dental care. This report points to the gaps we need to bridge in the minds of policy makers at federal, state, and local levels."

Other issues illuminated by the report include fluoridation of community water, where California received its only F. Several other states suffered a failing grade in fluoridation including Hawaii, Idaho, Mississippi, and Montana. States that ranked an A included West Virginia, Tennessee, Illinois, Indiana, and Iowa.

"When California began its fluoridation efforts in the early ’90s, about 17 percent of the state’s water was fluoridated," said Tim Collins, DDS, MPH, dental director of Public Health Programs and Services for the County of Los Angeles Department of Health Services and chair of the California Fluoridation Task Force. "With the fluoridation of Los Angeles’ city water in 1998 and Sacramento in 2000, the percentage is up to about 25-30 percent, and we have not finished our work. The Oral Health Report Card shows how important fluoridation is and should serve to boost our efforts."

Klaus noted that Oral Health America is aware of California’s diligent fluoridation efforts. "Once the state’s fluoridation grade is up, it will be one of the national leaders in oral health."

Fluoridation was in the general category of prevention in which California received an overall C-. In accessing the level of preventive care, Oral Health America looked at state oral health programs, the use of sealants, visits to the dentist for adults and elderly, and the use of smokeless tobacco. The highest grade of a B+ in prevention went to North Dakota.

Klaus hopes to see improvement when the next Oral Health Report Card comes out. "Right now, the plan is to issue another report at the same time next year. We look forward to collaborating with state dental associations and state and territorial dental directors on the next report and hope for incremental improvements."

The entire Oral Health Report Card can be viewed online at http://www.oralhealtharmerica.org.

California’s Grades on National Oral Health Report Card

STATE GRADE: C

PREVENTION: C-

Fluoridation: F
State oral health program: D
Sealants: D
Visits to dentists -- Adults: C
Visits to dentists -- Elderly: B
Use of smokeless tobacco: B

ACCESS TO CARE: C-

Prevalence of dentists: C
Prevalence of dental clinics: C
Medicaid program: C
Dental insurance -- adults: C
Dental insurance -- elderly: D

HEALTH STATUS: B-

Oral health of children: B
Adult tooth loss: B
Edentulous elderly: B
Oral cancer -- male: B
Oral cancer -- female: D

Look at Sectors When Diversifying Portfolio

By Marios P. Gregoriou

Investors hear a lot about portfolio diversification, and there are a number of ways to diversify. When it comes to stocks, one way to help ensure adequate diversification is to include stocks from several different market sectors.

An economic sector is made up of industries that have certain characteristics in common. The industries in a given sector tend to react similarly to trends in the overall economy. Good or bad news affecting a major stock in one industry may trickle through to stocks in other industries in the same sector. Thus, by including stocks from more than one sector in a portfolio, one may be able to lessen the effect on investments from potential losses in any one segment.

Here are some of the key stock market sectors and types of industries within each sector:

* Basic materials: aluminum, building materials, chemicals, containers, gold mining, metals, paper and forest products, steel.

* Capital goods: aerospace/defense, electrical equipment, engineering and construction, machinery, pollution control.

* Consumer cyclicals -- durable goods: automobiles, auto parts, hardware and tools, manufactured housing, furniture and appliances. (Cyclical stocks tend to rise quickly before the economy turns up and fall quickly before the economy turns down.)

* Consumer cyclicals -- nondurable goods: broadcast media, entertainment, hotels/motels, leisure-time companies, photography/imaging, publishing, restaurants, retail stores, specialty printing, toys.

* Consumer noncyclicals: beverages, foods, household products, housewares, shoes, textiles/apparel, tobacco.

* Energy: integrated oils, oil and gas drilling, oil exploration and production.

* Financial: banks, insurance companies, investment banking, real estate investment trusts.

* Health care: Drugs, HMOs, hospital management, medical products and services.

* Technology: airlines, railroads, trucking companies.

* Utilities: electric companies, natural gas distribution pipelines, telecommunications.

In seeking to diversify the equity portion of a portfolio, individuals may wish to consider reducing stocks from sectors in which they are overweighted and adding stocks in areas where they lack exposure. Of course, certain sectors can be featured more prominently in one’s portfolio, based on current market trends, economic conditions, and one’s own financial goals.

It is best to ask one’s financial adviser how trends in the stock market and economy may affect investments and how one can best take advantage of those trends. Individual financial objectives should be kept at the forefront of decision-making. Although representation from each sector may enhance diversification, other concerns, such as the need for income or a short-term investment time horizon, may indicate a different sector structure for an individual’s portfolio.

Marios P. Gregoriou is associate vice president financial adviser with Morgan Stanley Dean Witter in Sacramento. He can be reached by calling (800) 755-8041. This article is published for information purposes and is not an offer or solicitation to sell or buy securities or commodities. Any particular investment should be analyzed based on its terms and risks as they relate to individual circumstances and objectives.

CDC Forecasts Top 10 Public Health Challenges

The Centers for Disease Control and Prevention outlined the top 10 public health challenges the United States must address and said the tools already exist to combat them, in a commentary published in the Oct. 4 issue of the Journal of the American Medical Association.

Jeffrey P. Koplan, MD, MPH, director of the CDC, and David W. Fleming, MD, deputy director for Science and Public Health at the CDC, wrote the commentary, which recognizes the past century’s advances in saving and improving lives through vaccines, fortified foods, clean water and many other public health achievements and cautioned that the United States must be prepared for both old and new challenges to the country’s health.

"No doubt, unanticipated challenges of similar magnitude lie ahead," the authors wrote. "Whether working in the public, private, or academic arenas, physicians can only hope to have the powers of observation to detect these challenges early and the resources and will to act wisely in response."

They point out that at least 10 public health challenges can be anticipated and the tools exist to address them. These challenges are to:

* Institute a rational health care system.

* Eliminate health disparities.

* Focus on children’s emotional and intellectual development.

* Achieve a longer "healthspan."

* Integrate physical activity and healthy eating into daily lives.

* Clean up and protect the environment.

* Prepare to respond to emerging infectious diseases.

* Recognize and address the contributions of mental health to overall health and well-being.

* Reduce the toll of violence in society.

* Use new scientific knowledge and technologic advances wisely.

"In many of these areas -- child development, mental health, obesity and physical activity, the environment, bioterrorism, and aging -- promising science-based interventions are available and deserve support and broader implementation," the authors wrote. "For example, missed opportunities for cost-effective preventive services in clinical settings, including tobacco cessation counseling, pneumococcal vaccine, and chlamydia screening, can be identified."

Toes Make Good Replacements for Fingers

Patients whose fingers or thumbs are lost in an accident and have a toe or toes removed from their feet to take their place are able to function quite well, according to Kevin C. Chung, MD, one of the few surgeons to perform the procedure in the United States.

Chung, director of the University of Michigan Hand Center in Ann Arbor, described his intricate surgical work during the American Medical Association’s Science Reporters Conference.

"Because Michigan is in the farm belt, we see a lot of farmers whose fingers or thumbs are cut off from farming accidents. Of course, without fingers or thumbs, it is virtually impossible for them to perform the necessary tasks on the farm. So, I reconstruct the hand by transferring toes to make the thumb and a couple of fingers so they can drive, pick things up and milk cows," Chung explained.

The procedure typically takes eight or nine hours, depending upon the amount of reconstruction performed. It involves removing various parts from the foot, including tendons, nerves, veins, arteries, bone and skin and then re-connecting them at the hand.

"When a patient has just lost a thumb, making a new thumb is very standard. My preference is to remove the second toe to make a thumb, because it is not as noticeable on the foot. However, some people prefer to use the big toe because it is bigger and more resembles a thumb. When a patient presents without any fingers at all, that surgery has a higher magnitude of difficulty, and I take three toes to create a thumb and two fingers that can be used to pinch things and pick them up," he said. It takes approximately three months of rehabilitation to regain function.

Chung said a collaborative study conducted with a Taiwan hospital that also performs the procedure was recently published in the Journal of Hand Surgery and showed that toe transfers make the hand perform just as well as a normal hand.

As for the feet of those patients whose toes have been removed, Chung said patients have no problem walking or running, but that some complain of occasional pain from the incision.

Patient Education Key to Increasing Cosmetic Dentistry

The majority of the American public does not know or think about cosmetic dentistry, and more than 50 percent of the population doesn’t care, wrote Roger P. Levin, DDS, in the summer 2000 issue of the Journal of Cosmetic Dentistry.

According to Levin, the American public’s view of the dental practice is the same as it has always been: the dentist’s job is to fix broken or decayed teeth.

To learn why the public is not demanding more cosmetic dentistry, Levin conducted informal interviews with 400 people. He concluded that the American public does not really think of dentists as professionals who enhance smiles, but rather as individuals who just "fix teeth."

Levin said the concept of building the cosmetic component of a practice does not mean eliminating other types of dentistry, but instead adding a subset of cosmetic services for patients. The problem, he acknowledges, is that patients are aware only of the more traditional services and are not learning about cosmetic services.

Merely placing a few brochures in the reception room has not created the revolution that some dentists had hoped for in cosmetic dentistry.

Levin said the first step in beginning to build a cosmetic practice is to change all new-patient exam formats. Dentists who truly want to build cosmetic services should include the cosmetic services as the first aspect of a dental exam, followed by a review of the medical and dental history.

Levin does not advocate giving up on the complete, comprehensive muscle, tissue, periodontal, and tooth-by-tooth examination. He suggest setting new priorities for how dentists approach patients so that patients can be educated about a practice’s full range of cosmetic services.

The future of cosmetic dentistry will depend more on patient education within each practice than on broad-based media and advertising, Levin wrote.

Meskin to Retire, Search Begins for New JADA editor

Although he will be on the job until the end of 2001, the search for a successor to JADA Editor Lawrence H. Meskin, DDS, has already begun.

Meskin recently announced his decision to retire after 10 years as editor, effective Dec. 31, 2001.

At its meeting in September, the Board of Directors of ADA Business Enterprises Inc. -- the ADA subsidiary that includes the publishing division -- approved a transition plan that called for a search committee to begin the process of finding a new editor for the Journal of the American Dental Association.

The eight-member committee, now in place, includes practicing dentists, dental researchers and educators, publishing professionals, editors, and ADA leadership.

The committee’s role is to review applications from prospective candidates, interview those who appear most qualified, narrow the field and make a recommendation to the Business Enterprises board at its August 2001 meeting.

The Board expects to appoint a new editor by Oct. 1, 2001, informing the ADA Board of Trustees of its choice prior to next year’s annual session. The new editor would be in place three months before Dr. Meskin’s departure.

Dentists interested in the JADA editorship can obtain an application and position description by contacting Laura A. Kosden, publisher and chief operating officer, ADA Publishing Division, ADA Business Enterprises Inc., Suite 2010, 211 E. Chicago Ave., Chicago, IL, 60611. Kosden also can be reached at (312) 440-4671 or at kosdenl@ada.org.

The deadline for submission of applications is March 31, 2001.

Orthodontic Needs Increasing Among Special Needs Patients

During the past 30 years, more than three-fourths of people with mental retardation/developmental disabilities have been de-institutionalized, and there has been a corresponding need to increase awareness among orthodontists about the growing necessity for treatment of these individuals within their communities, according to the an article in the July 2000 issue of the American Journal of Orthodontics and Dentofacial Orthopedics.

The authors -- H. Barry Waldman, DDS, PhD; Steven P. Perlman, DDS; and Mark Swerdloff, DDS -- noted that changing social policies, favorable legislation for people with disabilities, and class-action legal decisions have led to the establishment of community-oriented group residences, and enhanced personal family residential settings, accompanied by the closure of many large, state-run facilities. However, the success of community-based programs depends on the availability of support services, the authors stated -- particularly private practitioners who are convenient and accessible to de-institutionalized individuals and trained and willing to deliver care.

To provide some insight into the need for orthodontic services for these youngsters and adults, the authors asked: "Do we believe that persons with disabilities need functional and esthetic considerations comparable to those of ‘normal’ persons?"

The reality is that youngsters with mental retardation/developmental disabilities grow older and that periodontal disease is an increased possibility with a maloccluded dentition, they answered. Severe esthetic malocclusions can compromise already difficult social relationships and potential employment opportunities, the authors added.

Children and adolescents with special needs exhibit a higher percentage of malocclusions than the normal population. Children with mental retardation/developmental disabilities may have dentition difficulties resulting from habits such as mouth breathing and tongue thrusting, diets lacking enough rough and coarse foods that require thorough chewing, increased levels of caries, and the loss of teeth and space maintenance, the authors explain. Individuals with mental retardation may not comprehend the need for oral hygiene, the authors note, and those with physical disabilities may lack the dexterity to accomplish the needed oral hygiene.

Honors

Gordon L. Douglass, DDS, has been installed as vice president of the American Academy of Periodontology.

Gary Armitage, DDS, MS, has received the Gold Medal Award, the highest honor bestowed by the American Academy of Periodontology.

Upcoming Meetings

2001

Feb. 9-10 Interdisciplinary Care Conference, Dallas, (314) 993-1700, Ext. 260

Feb. 21-22 American Equilibration Society 46th Annual Meeting, Chicago, (847) 965-2888, www.occlusion-tmj.org.

Feb. 28-March 4 American Academy of Dental Practice Administration Annual Meeting (open to nonmembers), San Antonio, Texas, (800) 689-7515

March 4-10 U.S. Dental Tennis Association Spring Meeting, Longboat Key, Fla., (800) 445-2524

April 19-22 CDA Scientific Session, Anaheim, (916) 443-3382, Ext. 4470

May 4-8 Australian Dental Congress, Brisbane, +61 (0) 7 3369 0477

May 18-20 California Society of Periodontists, San Francisco, (805) 962-7144

Sept. 14-16 CDA Scientific Session, San Francisco, (916) 443-3382, Ext. 4470

To have a meeting included on this list, please send the information to Upcoming Meetings, CDA Journal, P.O. Box 13749, Sacramento, CA 95853 or fax the information to (916) 443-2943.