Drinking in the Success
By David G. Jones
Fluoridated drinking water, maligned by its opponents as anything from poison to a nefarious
political plot, has been chosen by the Centers for Disease Control and Prevention as one of 10
great public health measures of the century.
The CDC, in observance of National Public Health Week, determined that fluoridation's
scientifically proven oral health benefits place it among other significant public health
measures.
According to CDC, since the beginning of the 20th century, the average American life span has
lengthened by more than 30 years, 25 of which are attributable to advances in public
health.
"Fluoridation of water supplies has meant less tooth loss, less pain and suffering, and less time
lost from school or work, and all that adds up to a major improvement in our quality of life due
to better oral health," says Scott Presson, DDS, chief of the CDC's Program Services Branch,
Division of Oral Health, in Atlanta. "Now members of each generation are taking more teeth
with them as they move into later years, so seniors are increasingly able to smile at their
grandchildren with their real teeth rather than false ones."
Presson said that the significance of fluoride's inclusion in the list is that it recognizes the
important contribution of oral health to general well-being and a satisfactory quality of life.
"From the beginning, when science discovered fluoride's role in the prevention of tooth decay, to
its application in public health programs to extend fluoridation to a large portion of the U.S.
population, it has been a public health success story," he says.
Presson also emphasized that a message sometimes obscured by antifluoridation rhetoric is the
benefit to all ages -- not children only.
"When older adults retain more teeth, their gums can recede making the roots at risk for root
caries, so fluoridation can help prevent tooth decay even in adults and elders," he says. "So the
decision to fluoridate was the right one in 1945, and it's still the right decision in 1999."
Michael W. Easley, DDS, an assistant associate professor at the State University of New York
and a nationally recognized fluoride expert, says the CDC's statement is consistent with the many
endorsements received from public health and scientific organizations over the past 50
years.
"It also reminds me of what former Surgeon General Luther Terry said in the 1960s," Easley
says. "He was the one who issued the first surgeon general's report linking smoking and cancer,
and he talked about the 'four horsemen' of public health -- chlorination, pasteurization,
vaccination, and fluoridation."
In dentistry, fluoridation also reflects the hard work of members of the profession, according to
one of the nation's top dental experts.
"It celebrates the dedication of the dental profession to promote oral health and reduce disease,"
says Harold Slavkin, DDS, director of the National Institute of Dental and Craniofacial Research
in Bethesda, Md. "In 1995, before California's fluoridation legislation, approximately 110
million Americans benefited from daily consumption of fluoridated drinking water. Since one
out of every eight Americans lives in California, current efforts to fluoridate more California
water districts would have a significant effect on our nation's public health progress."
Easley emphasizes that before fluoridation's introduction, people sometimes died of
complications of oral disease.
"We couldn't prevent caries with fluoridation before 1945, so a lot of people got caries that
proceeded to major systemic disease that in quite a few cases killed people," he said. "It was a
life or death issue for many in the old days."
Timothy R. Collins, DDS, chair of the California Fluoridation Task Force, believes the CDC's
announcement further underscores what organized dentistry and fluoridation supporters have
long said.
"This is one of the most important public health measures that has come along," he says. "Now
we have a very clear statement as to how it relates to other public health measures, and it's
another way to demonstrate fluoridation's benefits to the public. It's safe, effective, economical,
and is the golden bullet that prevents tooth decay."
A state lawmaker who in 1995 put her political will behind a bill calling for fluoridation of many
of the states municipal water systems lauds the CDC's high-profile endorsement.
"After helping to ensure that fluoride will become a reality for more Californians, it's wonderful
to see that one of the nation's top health agencies has recognized its benefits for public health,"
says Sen. Jackie Speier, D-Hillsborough, author of AB 733. "This reinforces the fact that
fluoridation is safe and effective in preventing dental disease."
Slavkin says promotion of fluoridation must continue while scientists work to develop safe
vaccines for at-risk children to reduce or eliminate dental caries.
"Such a strategy worked for smallpox and polio, and we feel it could also work for dental caries,"
he says.
The CDC's Morbidity and Mortality Weekly Report is profiling the 10 public health
achievements in a series of reports published through December. Fluoridation will be examined
in an October issue.
| The CDC's list of 10 great public health achievements of the 20th century: | |
| 1 | Vaccination |
| 2 | Motor vehicle safety |
|
3 |
Safer workplaces |
| 4 | Control of infectious diseases |
| 5 |
Decline in deaths from heart disease and stroke |
| 6 | Safer and healthier foods |
| 7 | Healthier mothers and babies |
| 8 | Family planning |
| 9 | Drinking-water fluoridation |
| 10 | Recognition of tobacco use as a health hazard |
Fitting Into the Publicity Picture
By Dell RichardsMost dentists give back to their communities through charitable involvement. Volunteerism
usually goes hand-in-hand with the profession.
If a dentist takes the time to belong to a nonprofit organization, he or she may want to maximize
its potential. Here are a few ways to get the most from one's involvement:
* A professional shouldn't be shy about passing out business cards during introductions at
meetings and events.
* Whenever introducing oneself -- or being introduced -- a dentist can casually mention his or
her profession and office location: "I'm Dr. So-and-So. My dental office is just down the street at
the plaza."
* The dentist should let patients know about his or her involvement with the organization. The
nonprofit affiliation should be included on all marketing materials, brochures, fliers and other
printed material. Affiliations should be listed vertically in small type, not in a paragraph of
brochure copy.
* Information about the nonprofit's drive or fund-raiser should be included in the dental office
newsletter.
* The dentist should become acquainted with the nonprofit's public relations chief and find out
how to become involved in providing publicity or support for events. Sometimes a call from a
professional can make a potential story more impressive to a reporter. The pitch should be kept
short and to the point. Two sentences will do. The reporter may need a source again in the future
and will remember someone who was quotable.
* If the dentist feels he or she has received more than he or she has given -- or learned something
profound -- from the experience of volunteering, the dentist should call the editor of the local
daily or weekly newspaper and ask to write a column about the lesson. Small papers are usually
interested in stories that help recruit volunteers for nonprofits.
Dell Richards is owner of Dell Richards Publicity in Sacramento.
Filling Comparison is Study's Target
A five-year study funded by the National Institute of Dental and Craniofacial Research will
compare dental amalgam and alternative filling materials in an effort to measure the mercury
exposure in children with amalgam fillings and evaluate any associated health effects, writes
Mary Tavares, DMD, MPH, in the winter 1999 issue of Forsyth Dental Center.
Subjects were recruited from six clinical sites within two geographic areas in New England:
Boston/Cambridge and Maine. In one of the treatment areas, subjects were randomized to receive
amalgam restorations. In the other, subjects received composite/glass ionomer.
According to Tavares, some dental scientists have long wondered whether the very low levels of
mercury from dental amalgam could cause problems. High levels of mercury exposure, Tavares
writes, have been alleged to be associated with tremors, loss of memory, insomnia, fatigue,
headaches, irritability, slowed nerve conduction, appetite loss and kidney disorders.
There is no evidence that any of these health effects occur because of the low levels of mercury
exposure from dental fillings, Tavares notes. However, because of the concern that small
amounts of mercury vapor are being released from amalgam fillings with such activities as
chewing or brushing, and that this mercury might accumulate in the tissues of the body, the
NIDCR funded the study to thoroughly investigate any possible effects of mercury exposure
from dental amalgam in children.
Check Cycle for Clues
By Marios P. GregoriouBusiness activity tends to go in cycles, and understanding the stages of a business cycle can provide clues that may help investors identify favorable opportunities.
While some stocks tend to be immune to economic swings, others perform better or worse during different stages of the business cycle.
The business cycle can provide insight, but it is important to realize that the U.S. economy rarely follows this cycle precisely, and that time spent in each cycle varies. In addition, the economy does not always expand to its fullest levels, nor does it always dip into recession. It does, however, tend to proceed through six typical stages. The following are some general guidelines to which market sectors are inclined to benefit in each cycle.
Stage 1: Economic SlowdownIn a period of economic slowdown, utilities and financial company stocks usually react favorably as it becomes clear to investors that the economy is sluggish. Long-term interest rates peak, and shorter rates begin to fall as the Federal Reserve implements strategies to stimulate the economy.
Thus, investors often buy interest-rate sensitive stocks. Utilities, which generally have high debt levels, benefit as rates decline. Financial companies also benefit as rates (and therefore their cost of funds) decrease and loan demands increase.
Stage 2: Anticipated Recovery
With anticipated economic recovery, consumer stocks typically rise, as low interest rates encourage consumers to spend more. Stock prices are generally very low during this stage of the economic cycle.
Stage 3: Mid-Cycle Recovery
In a mid-cycle recovery, interest rates begin to go up, and early signs of inflation emerge. At this stage, stocks generally perform better than bonds. Industrial companies, such as those producing electrical equipment, machinery and construction come into favor.
Stage 4: Full Expansion
During the full expansion stage of the business cycle, interest-rate sensitive stocks generally peak by the time the cyclical expansion is fully under way. Opportunities may appear among companies that benefit during higher inflation and in higher interest-rate environments, such as chemical technology and energy stocks.
Stage 5: Economic Peak
At the economic peak of the cycle, the major stock market indexes may dip below their 12-month moving averages. Basic materials companies (including chemicals and metals) and energy stocks are often favored by investors since inflation is probably peaking during this cycle.
Stage 6: Economic Decline
When the business cycle reaches economic decline, investors attempt to protect their portfolios as the economy slows by moving back into "early-cycle" stocks, beginning with consumer noncyclicals, which are companies that sell products and services whose demand is not tied to the economic cycle.
The Cycle Is Not Precise
While tracking the business cycle can be a useful barometer for investors, keep in mind that the business cycle is not precise. In addition, pinpointing particular stages of economic activity is not always easy, and sometimes even economists cannot agree on exactly where the economy stands in any particular cycle.
Marios Gregoriou is associate vice president financial adviser with Morgan Stanley Dean Witter in Sacramento. This article is published for general information purposes and is not an offer or solicitation to sell or buy any securities or commodities. Any particular investment should be analyzed based on its terms and risks as they relate to specific circumstances and objectives.
Word of Mouth
Lack of coverage about oral cancer in the popular press provides a partial explanation of
the public's lack of knowledge and misinformation about oral cancer, write Maria T. Canto,
DDS, MPH; Yogo Kawaguchi, DDS, PhD; and Alice M. Horowitz, PhD, in the Journal of
Public Health Dentistry. The public's lack of awareness of oral cancer was documented in a 1990 National Center for Health Statistics survey that found that fewer people perceived smoking as a risk factor for oral cancer compared with other medical conditions, and just 13 percent knew that regular alcohol use increases the risk for oral cancer.
From April 1997 to March 1998, 50 articles and news items (18 from newspapers and 32 from magazines) discussing oral cancer were identified and analyzed, write the authors. While 94 percent of the articles mentioned at least one risk factor for oral cancer, many failed to list all the causes.
More than half of the articles (56 percent) identified spit tobacco as the major risk factor. Far fewer mentioned either cigarettes (32 percent) or cigars (12 percent). Less than 50 percent mentioned warning signs for oral cancers, and less than half (42 percent) discussed preventive measures. Only one-third (32 percent) recommended cessation of tobacco use.
The authors note that previous press studies have shown that most magazine articles on cancer discuss breast cancer and skin cancer. The authors surmise the reasons for that are the strong involvement of advocacy groups and the fact that the treatment for these cancers could be cosmetically disfiguring to the patient.
Some Pain is in the Perception
Pain caused by treatment provided by a dentist who is perceived as caring is likely to have
less psychological impact than pain from treatment by a dentist who is perceived to be cold and
controlling, according to an article in the March 1999 Journal of Dental Research.The article "Age of Onset of Dental Anxiety" discusses a survey of 6,630 residents of Etobicoke, one of five municipalities within metropolitan Toronto. The results of the survey challenge the view that dental anxiety is invariably a fear with childhood origins. It also addresses the causes of fear and who is most likely to be affected.
According to the study, about 16 percent of the subjects were dentally anxious and characterized by several factors: physiological responses during dental treatment, including increased breathing rate, increased heart rate, and nausea; avoidance of dental care, including canceling appointments or failing to keep appointments; and fears about the dentist-patient relationship regarding communication, belittlement, lack of control, and trust.
The study separated fear into two categories: exogenous (fear caused by conditioning) and endogenous (fear caused by overall vulnerability to anxiety disorders).
The researchers report only half of dentally anxious people became so in childhood. One-fifth reported onset of dental fear in adolescence, and almost one-third reported onset in adulthood.
Many of the people surveyed reported that their fear began when they had their first traumatic dental experience. However, 42.4 percent of the adult-onset subjects admitted being fearful about all aspects of life, compared with 27.1 percent of the adolescent-onset subjects and 21.6 percent of the child-onset subjects. The fact that many people became fearful much earlier or much later than their first traumatic dental experience shows that the relationship between traumatic experience and dental anxiety is not simple. However, traumatic experiences were more likely to give rise to dental anxiety if they occurred early in an individuals dental care history than if they were preceded by a series of relatively painless dental visits.
The exogenous conditions that cause fear in children differ from those that cause fear in adults. According to the article, children who became fearful did so after a dental experience that caused pain, fear, or embarrassment. Most fearful children (55 percent) also had family members who were fearful. In contrast, adults were not affected by painful or embarrassing experiences -- frightening experiences alone induced exogenous dental anxiety in adults. Child-onset subjects were more fearful of invasive dental procedures, and adolescent- and adult-onset subjects were more negative concerning dentists' behaviors.
Implants Take Root
The average number of dental implants surgically placed by dentists who perform the
procedure nearly tripled from 1986 to 1996, a new ADA survey shows. In 1986, the average
number of procedures per implant-placing dentist was 17.7. By 1996, this average had climbed to
51.5.In 1997, about 12 percent of all responding dentists reported that they had ever surgically placed a dental implant. When broken out by dental specialty, those most likely to have performed the procedure were oral and maxillofacial surgeons (97.5 percent have placed an implant), periodontists (64.1 percent) and prosthodontists (31.8 percent.)
The number of implants placed by oral and maxillofacial surgeons who perform the procedure rose from an average of 34.3 implants in 1992 to 62.4 in 1996. General practitioners who perform the procedure placed an average of 17.2 surgical dental implants in 1992 and an average of 21.0 in 1996.
When asked to indicate their current level of formal implant training, even if they had never placed a dental implant, in 1997 about six in 10 dentists (59.5 percent) reported having had some type of formal training in the procedure.
Some Assembly Required
A majority of the "blueprint of human beings," the human genome sequence, will be
completed in the coming year, which will enable researchers to determine hereditary factors,
causes, and treatments for major diseases -- such as heart disease, diabetes and common cancers
-- according to Francis Collins, MD, PhD, director of the National Human Genome Research
Institute at the National Institutes of Health.The U.S. Human Genome Project officially began in 1990 as a 15-year program to find the estimated 80,000 human genes and determine the sequence of the 3 billion DNA building blocks that underlie all of human biology and its diversity. The complete set of instructions for making an organism is called its genome. It contains the master blueprint for all cellular structures and activities for the lifetime of the cell or organism. For each organism, the components of the slender DNA threads encode all the information necessary for building and maintaining life, from simple bacteria to remarkably complex human beings.
Dr. Collins expects a working draft of 90 percent of the human genome sequence, what he calls the "book of life -- the blueprint of human beings," to be completed in about a year, not 2005 as originally expected.
Proposal for Research Online Draws Fire
A proposal from the director of the National Institutes of Health to post scientific research
on the Internet has drawn criticism that doing so would devalue scientific journals.Dr. Harold Varmus, director of the NIH, counters that posting research online would let scientists exchange information much faster by eliminating the delay created by the publishing process.
But others counter that the proposed web site would be detrimental to journals.
"It would make the journal -- the paper journal, and also the journal web site -- merely archival, redundant," says Dr. Marcia Angell, executive editor of the New England Journal of Medicine. "Insofar as that happened, it would weaken the journals and maybe even destroy them."
The proposed E-biomed site would have two archives. One would accept nearly everything. Submissions would be rejected only if two reviewers found them "extraneous or outrageous."
The other archive would include only papers that have been accepted for publication by journals, but would post them immediately upon acceptance, rather than waiting until publication.
Those against the proposed archives believe they will lower the quality of scientific research and lead to a bloated taxpayer-supported site that few will visit.
Honors
Steven G. Detsch, DDS, was honored by the California Society of Periodontists for his outstanding service to the organization.
Upcoming Meetings
1999
Sept. 1-4 Surfaces in Biomaterials '99, Scottsdale, Ariz., (612) 512-9103
Sept. 2-4 Academy of Surgical Research Annual Meeting, Scottsdale, Ariz., (612) 545-1919
Sept. 16-18 CDA Scientific Session, San Francisco, (916) 443-3382, Ext. 4470
Sept. 17-18 Society for Advanced Dentistry Annual Meeting, New Orleans, (317) 290-2613
Sept. 25-29 American Academy of Periodontology Annual Meeting, San Antonio, Texas, www.perio.org
Oct. 15-17 Dental Lab Owners Association Dental Lab Expo, San Diego, (714) 997-9513
Oct. 21-23 American Society for Dental Aesthetics International Conference on Aesthetic Dentistry, Bal Harbour, Fla., (800) 454-2732
Oct. 28-Nov. 1 FDI Annual World Dental Congress, Mexico City, +44 171 935 7852
2000
April 6-8 Dentistry 2000 -- British Dental Association Annual Conference and British Dental Trade Association Dental Showcase Exhibition, Birmingham, England, 01934 844408
April 13-16 CDA Scientific Session, Anaheim, Calif. (916) 443-3382, Ext. 4470
Sept. 17-20 American Academy of Periodontology Annual Meeting, Honolulu, www.perio.org
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.
