Dental Causes of Disease Finally Recognised by Insurers

The Wall Street Journal: Health Plans Expand Dental Benefits

Health Plans Expand Dental Benefits

Studies Linking Gum Disease
To Health Problems Spur New Focus
On Preventive Treatments

By M.P. MCQUEEN
September 19, 2006; Page D1

Amid mounting evidence linking poor oral hygiene to a range of expensive medical problems, health plans are starting to cover more dental treatments and preventive services.

The idea, insurers say, is that paying for certain services now, such as additional cleanings, gum treatments and prescription mouth washes, can reduce the incidence of other health problems down the road. A number of studies suggest that early prevention and treatment of gum disease may result in significantly improved outcomes for pregnancy, heart disease and diabetes, often leading to substantial medical-cost savings.

Many of the insurers' enhanced benefits are focused on people with these health risks. Cigna Corp.'s Oral Health Integration Program, implemented earlier this year, covers additional deep cleanings known as scaling and root planing during pregnancy at no extra cost, or an additional regular cleaning (over the usual two a year) for pregnant women who don't require scaling and root planing. A similar benefit is available for patients in Cigna's diabetes and cardiac-care disease-management programs.

In March, Washington Dental Service, a member of the Delta Dental Plans Association, introduced enhanced benefits, including coverage of antimicrobial mouthwashes for pregnant women, to its members in 2,000 companies in the state. Aetna Inc., with 8.8 million members who have both dental and medical coverage, has conducted pilot programs designed to get pregnant women and people with chronic disease to visit a dentist. The company expects to offer a third regular cleaning each year, or additional deep cleanings as needed, to all such at-risk patients next year.

"We can save medical costs by getting people to have dental care at the right time in their lives," says Glenn Melenyk, dental consultant at Blue Cross Blue Shield of Michigan in Detroit. The insurer, with 1.1 million dental members, started pilot programs in 2005 that cover an additional regular cleaning per year for diabetics and heart patients. In July, it expanded the pilots to include pregnant women who obtain a coupon from their obstetrician.

The enhanced benefits come at a time when many employers are under pressure to cut medical costs. But some big employers are signing on. Ford Motor Co. and Kellogg Co. are among those offering benefits in Michigan via Blue Cross Blue Shield, and Pacific Research Laboratories and KCTS Public Television are participating in Washington Dental's enhanced benefits. Some health plans, including Michigan Blue Cross, Washington Dental and MetLife Inc., are offering the extra coverage at no additional cost to employers or employees. Washington Dental says it achieved this by cutting back coverage of other services for which there is less evidence of benefits, such as routine X-rays. (Currently, insurers say, dental care makes up only about 4% of employers' overall health-care budget.)

Costco Wholesale Corp. of Issaquah, Wash., earlier this year participated in a pilot with Aetna Medical & Dental, in which nurses called employees with diabetes or heart disease or who were pregnant, to encourage them to visit a dentist. Donna Sexton, Costco's director of employee benefits, says nurses reached about 2,200 of Costco's more than 153,000 Aetna members. About 36% of them have indicated they would go see a dentist as a result. That is "pretty good compared to other types of outreach," Ms. Sexton says. "The bottom line is, if it helps the health of the baby, or the health of an employee or dependent improves, there will be an overall reduction in costs."

Insurers who offer both dental and medical-care coverage say they expect that spending more on preventive dental care will yield big savings on the medical treatment of costly chronic illnesses. Insurers that offer only dental coverage expect to save money on periodontal surgery. Stand-alone plans also say they want to be more attractive to workers, who increasingly have to pay all or part of their dental-insurance costs themselves as more employers make group dental a voluntary rather than an employer-paid benefit.

The emphasis on preventive care is the result of an increasing number of studies linking oral health to general health and well being, dental specialists and insurers say.

The reasons for the connection aren't fully understood. In the case of preterm births, bacteria around the tooth root may cause the body to produce a substance that induces labor. The evidence suggests that the same bacteria in the mouth can provoke the body into producing factors that clog arteries, worsening heart disease and stroke risk. With diabetes, any inflammation in the body makes controlling blood sugar more difficult, according to Kenneth Krebs, president of the American Academy of Periodontology.

A two-year study of 144,000 insured patients by Aetna and the Columbia University College of Dental Medicine released in March found that earlier periodontal treatment reduced overall medical-care costs by 9% for diabetes, 16% for coronary artery disease, and 11% for cerebrovascular disease, or stroke.

Another recent study of pregnant women with a serious gum disease published in the Journal of Periodontology found that early treatment with scaling and root planing (which removes plaque and tartar from around the tooth root) reduced preterm births by 84%. Additional research is under way to try to explain the association between these illnesses and periodontal disease.

[Ounce of Prevention]Gum disease is a common health problem in the U.S. More than three-quarters of the adult population over the age of 35 eventually suffer from some type of it, ranging in severity from inflammation and sensitivity, to advanced periodontitis, a serious gum infection that can lead to tooth loss. Some insures are also now covering topical or injected antibiotics for gum disease.

In addition to preventive treatments, some insurers have also begun offering more coverage of costlier advanced treatments for missing or damaged teeth. Some employers are looking to offer dental implants and newer filling materials, say the insurers, because workers are demanding the latest technologies. Principal Financial Group Inc. will introduce new supplemental benefits by mid-2007, including coverage for dental implants, for employers who pay for it, according to company officials.

A number of insurers, such as Guardian Life Insurance Co. and Cigna, have created new ways for consumers to increase their coverage limit for extraordinary expenditures such as root canals and dentures -- for instance by allowing consumers to "roll over" unused dental allowance from previous years. More plans also cover composite or "white" fillings at the same level as metal fillings, says Sally Cram, a periodontist in Washington, D.C., and spokeswoman for the American Dental Association.

Some insurers, including Guardian, Cigna and Principal Financial Group, are offering to cover dental implants as an alternative to traditional partial dentures or bridges. Titanium dental implants, which are tooth-root replacements surgically placed in the jaw, have been regarded as experimental though they have been used for more than 20 years, and rarely were covered by most health plans. Many plans have based payments on the least-expensive treatment that can be used. A single tooth implant costs $4,000 to $5,000 with surgical placement and restoration; traditional bridgework to replace a missing tooth costs about $3,000, according to Richard Goren, national and group dental director of Guardian.

But implants are in increasing demand because they work better for people who have lost bone mass, or who have only one or two missing teeth, and they last longer than bridgework, dentists say. "More than half our new customers [employers] have requested it since June 2005," says Dr. Goren. Most insurers that include implants cover them at 50% of cost, says the American Academy of Implant Dentistry.

Dr Larry Clapp Comment-This is very consistent with our clinical experience, which has shown in 100s of patients and a pilot study, over 11 years, the connection of Dental problems to Prostate Cancer and Prostatitis. We have seen, without exception, patients' prostate cancer, BPH, Prostititis heal when the mouth is cleaned up by a Biologocal dentist, followed by committed detoxing, and conversely prostates that won't heal until the mouth is cleaned up, removing all infections, especially infected root canals. Root Canals are often dubbed the biggest single cause of Proatate Cancer and really need to be looked at carefully. For more info see: prostate90.com

Prostate cancer treatments up risk for diseases and non-cancer mortality

BOSTON, Sept. 20 (UPI) -- Men with prostate cancer have high five-year survival rates, but they also have higher rates of non-cancer mortality, finds a U.S. study.

Study author Dr. Nancy Keating of Harvard Medical School says that the principal systemic therapy for prostate cancer involves blocking testosterone production -- either by removal of the testes or, more commonly, by regular injections of a gonadotropin-releasing hormone, or GnRH. GnRH agonists are the main therapy for metastatic prostate cancer and may also improve survival for some men with locally advanced cancers.

"Our study found that men with local or regional prostate cancer receiving a GnRH agonist had a 44 percent higher risk of developing diabetes and a 16 percent higher risk of developing coronary heart disease than men who were not receiving hormone therapy," says Keating, who is also a physician at Brigham and Women's Hospital.

Given the number of men receiving GnRH agonists, often for many months or years, these increased risks can have important implications for the health of prostate-cancer survivors, says Keating.

Additional studies are needed to fully understand the biological mechanisms responsible for these increased risks, according to the study published in Clinical Oncology.

Dr Larry Clapp Comment-This is very consistent with our clinical experience which has also shown that men without adequate Testoterone are not very happy, have no sex life, get osteoporosis, brain fog, skin problems, have very low energy and a shortened life expectancy. At least as important, is our experience and the increasing evidence that low testosterone means higher estrogen, which is the real cause of prostate cancer. Men with high testosterone do not get prostate cancer, men with high estrogen do. Natural Prostate Treatments do not have these problems, in fact, result in a healthier, happier man with extended lfespan and higher quality of life. For more info see: www.prostate90.com and www.prostate90.com/HormoneBalancing.htm

Internet tools help men predict, cope with prostate cancer

Last Updated Wed, 20 Sep 2006 12:07:33 EDT

CBC News

New website tools can help men predict the likelihood that they have prostate cancer and determine how advanced it might be, as well as steering them through testing and treatment options.

The Prostate Cancer Research Foundation of Canada launched the feature on its website in English and French this week. The foundation said it hopes the tools will help men cope with a disease that will be diagnosed in an estimated 20,700 Canadian men this year and kill another 4,200 of them.

The foundation also hopes the Prostate Cancer Assessment Tools will cut down the number of biopsies. About 80 per cent of biopsies bring back negative results, but the procedure can be uncomfortable and carry a small risk infection and bleeding.

"We'd like to prevent as many biopsies as possible that aren't needed," said Dr. Robert Bristow, the chair of the foundation's scientific advisory committee.

The foundation adapted an interactive online program used by doctors. Unlike other prostate cancer websites, which offer a general overview, these tools give information specific to each man, are more comprehensive and are based on extensive data from clinical trials.

The foundation said it has made the program more user-friendly for patients.

Dr. Pierre Karakiewicz, who helped developed the Prostate Cancer Assessment Tools, said the tools can predict the probability of whether a man has prostate cancer based on:

• His age.
• The results of his rectal examination.
• The results of blood tests that measure the levels of a prostate specific antigen (PSA).

Based on the data entered, the program will help the patient and his doctor decide whether the results should be confirmed with a biopsy.

Can help determine what to ask doctors

For men who are already diagnosed with prostate cancer, the web tools can help a man understand his diagnosis and treatment options over time.

Karakiewicz, a urologic oncologist at the University of Montreal Hospital Centre, said the patient can use the information to ask his doctor critical questions.

When asked if the diagnostic tools should be left in the hands of doctors alone, he replied, "We most certainly should rely on doctors."

But Karakiewicz also told CBC News: "Doctors [don't] always have the time and don't always have the opportunity of accessing these tools to provide these most objective and evidence-based answers to patients. So this is a means of facilitating the patient-doctor interaction."

The foundation said the program will be updated as new research becomes available.

Dr Larry Clapp Comment-Yea for the Canadian effort to avoid/reduce biopsies and for the recognition that biopsies result in ongoing problems for patients! For more info and alternatives to biopsy, see: www.PhoenixSonograms.com/

Prostate Hormone Treatments shown to cause Heart Attacks and Diabetes

Prostate cancer treatment has health risks-Diabetes and Heart Attacks


By Liz Szabo, USA TODAY
For the first time, research shows that hormone therapy, a common treatment for prostate cancer, can raise the risk of diabetes and heart disease.
Experts say the study suggests that doctors should be cautious when prescribing the drugs, especially to men with limited disease and a long life expectancy, who may have the least to gain and the most to lose from the treatment.

Hormone therapy, which lowers levels of the testosterone that feeds prostate cancers, is a mainstay of treatment for prostate cancers that have spread to the bone. The drugs, typically given as injections every one to four months, can't cure prostate cancer. They may slow its growth, however, and relieve pain. Many men in advanced stages of the disease choose to have the shots, in spite of their side effects: osteoporosis, muscle loss, fat gain, hot flashes and impotence, says the study's main author, Nancy Keating, an assistant professor at Harvard Medical School.

Research has never proved that hormone therapy can help men with less extensive disease, Keating says. Yet more and more men treated with surgery or radiation for "local" or "regional" tumors — those confined to the prostate or nearby lymph nodes — are taking hormone therapy if blood tests suggest their cancer may have returned, she says. Many of these men have no signs of the disease other than a cancer-related protein in their blood, called PSA.
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Some of these men may need no further treatment, says Otis Brawley, a professor at Emory University in Atlanta who was not involved in the study. Men with this type of cancer live a median of about a decade before their tumors cause any symptoms. That makes it important to preserve their long-term health.

Keating and her colleagues were concerned to find the risk of diabetes and heart disease rise in as little as a few months. Researchers examined the records of 73,000 Medicare participants diagnosed between 1992 and 1999. Doctors were able to follow the men's progress for an average of 4.5 years, according to a study released Monday in the Journal of Clinical Oncology. According to the study, if doctors treat 1,000 men with hormone therapy for a year, doctors would find 29 cases of diabetes, eight more than among men not treated; 14 heart attacks, three more than among men not treated; and 13 sudden cardiac deaths, four more than among men not treated.

"It raises the question that maybe this is not the right drug for these early-stage cancers," Keating says. "If the prostate cancer isn't going to progress on its own, why are we giving them other diseases? For pure prevention, we probably shouldn't be giving potentially toxic medication until we know there is a clear benefit."

Brawley says the study's design and size make it very powerful, even though doctors did not conduct a true experiment, one in which patients who are assigned the drugs are compared with patients who don't take the therapy. Such a study would be too difficult and expensive, he says.

Because Keating's study is the first to find these increased risks, she says researchers should try to confirm her results. Still, Howard Scher of New York's Memorial-Sloan Kettering Cancer Center says the study probably will change the way doctors talk to their patients about risk.

Scher suggests that doctors should consider patients' heart health before prescribing hormone therapy. Physicians also should help patients reduce their risks through diet and exercise and carefully monitor patients' blood sugar, cholesterol and other measures.

Brawley says he will show the study to patients who are considering hormone therapy. Many such patients might be better served through watchful waiting.

Brawley says doctors are learning more about which patients may get the most from hormone therapy. Research shows that men whose PSA level doubles in a short amount of time, for example, are at very high risk of a life-threatening relapse and may benefit most from the therapy.

Dr Larry Clapp Comment-This is very consistent with our clinical experience which has also shown that men without adequate Testosterone are not very happy, have no sex life, get osteoporosis, brain fog, skin problems, have very low energy and a higher death rate. At least as important, is our experience and increasing evidence that low testosterone means high estrogen, which is the real cause of prostate cancer. Men with high Testosterone do not get prostate cancer, men with high Estrogen do. For more info see: www.prostate90.com/HormoneBalancing.htm

Heated seats in cars blamed for low male fertility and prostate problems

Heated seats in cars blamed for low male fertility

Deutsche Presse Agentur
Published: Tuesday September 5, 2006

Dusseldorf- Heated seats in cars may be more to blame for declining male fertility than tight trousers, a urologist warned Tuesday, two days before a German conference on men's illnesses. Herbert Sperling, who is to chair the meeting in Dusseldorf, said electrically heated seat covers, which are popular in wintry places, could reduce the growth of sperm.

Slow and mis-shapen sperm were also more common in drivers who spent long periods on hot seats.

"I think heated seats are a bigger risk than tight trousers," said Sperling, referring to common guidance that loose clothing may promote male fertility. The seats heated the temperature of the testicles to 38 degrees celsius, 3 degrees more than normal, he said.

© 2006 DPA - Deutsche Presse-Agenteur<br>

Dr Larry Clapp Comment-This is very consistent with our clinical experience which has shown that fertility and prostate health are closely related. For more info see: www.prostate90.com/

SMRI to Sarasota (We find PCD Sonograms to be far Superior).

Sarasota to get new prostate cancer detection center

Tampa Bay Business Journal - 11:03 AM EDT Monday

The Diagnostic Center for Disease will be opening its headquarters in Sarasota in December. The center offers advanced detection imaging technology and interpretation for prostate disease, a release said.

The new scanning equipment, a Magnetic Resonance Imaging Spectroscopy, will eliminate the need for biopsies in many cases and will stop the "over treatment" of prostate cancer, the company said.

"The MRIS is a non-invasive diagnostic technology that gives the patient and the doctor a clear road map for treatment while tailored to the individual patient; doing what is necessary and nothing more," said Hedvig Hricak, chairman of the Department of Radiology at Memorial Sloan-Kettering Hospital in New York, in a release.

Dr Larry Clapp Comment-Our clinical experience, over 10 years with 1,000s of prostate sonograms, has shown that the PCD Sonogram shows a clearer image and mesures blood flows to any tumor. For more info see: www.prostate90.com/ See also: www.PhoenixSonograms.com

Prostate Imaging-SMRI No Benefit over std MRI, for staging

Combined MRI and MR Spectroscopy of the Prostate Before Radical Prostatectomy

Axel Wetter¹, Tobias A. Engl², Darius Nadjmabadi¹, Klaus Fliessbach³, Thomas Lehnert¹, Jessen Gurung¹, Wolf-Dietrich Beecken² and Thomas J. Vogl¹

¹ Institute for Diagnostic and Interventional Radiology, University of Frankfurt, Theodor-Stern-Kai 7, 60389 Frankurt, Germany.
² Department of Urology, University of Frankfurt, Frankfurt, Germany.
³ Department of Epileptology, University of Bonn, Bonn, Germany.

OBJECTIVE. The purpose of this study was to evaluate a routine protocol for combined MR and spectroscopic imaging of the prostate for staging accuracy.

SUBJECTS AND METHODS. Fifty patients with biopsy-proven prostate carcinoma were examined with our sequence protocol, which consisted of T2-weighted fast spin-echo sequences and a pelvic T1-weighted spin-echo sequence. For spectroscopy, we used a 3D chemical shift imaging (CSI) spin-echo sequence. Image interpretation was performed by two radiologists. The total number of tumor voxels and tumor voxels per slice were counted to estimate the tumor volume in every patient. The potential of MR spectroscopy to differentiate between T2 and T3 tumors, based on the estimated tumor volumes, was compared with the staging performance of MRI.

RESULTS. The MR measurement time was 19.01 minutes, and the total procedure time averaged 35 minutes. Seventy-six percent of the spectroscopic examinations were successful. Statistically significant differences in the number of tumor voxels per slice and tumor volumes were found between T2 and T3 tumors. The descriptive parameters of MRI and MR spectroscopy did not differ significantly; sensitivity and specificity were 75% and 87%, respectively, for MRI and 88% and 70%, respectively, for MR spectroscopy. The combination of both methods resulted in only a slight improvement in staging performance and was not statistically significant.

CONCLUSION. Combined MRI and MR spectroscopy of the prostate has no diagnostic advantage in staging performance over MRI alone. The mean tumor volumes, estimated by MR spectroscopy, differ statistically significantly between T2 and T3 tumors.

DOI:10.2214/AJR.05.0642
AJR 2006; 187:724-730
© American Roentgen Ray Society

Dr Larry Clapp Comment-This is very consistent with our clinical experience which has also shown that PCD Sonograms are far more effective, at amuch lower cost, to image and measure any tumors and measure any blood fows to tumors, reflecting it's agressivity, very clearly. For more info see: www.PhoenixSonograms.com and www.prostate90.com/

Plastics Causing Prostate Cancer - L A Times

Chemical in Plastics Is Tied to Prostate Cancer - BPA Leeches from Containers - California attempt to ban defeated

By Marla Cone
Times Staff Writer

June 1, 2006

Linking prostate cancer to a widespread industrial compound, scientists have found that exposure to a chemical that leaks from plastic causes genetic changes in animals' developing prostate glands that are precursors of the most common form of cancer in males.

The chemical, bisphenol A, or BPA, is used in the manufacture of hard, polycarbonate plastic for baby bottles, microwave cookware and other consumer goods, and it has been detected in nearly every human body tested.

Scientists and health experts have theorized for more than a decade that chemicals in the environment and in consumer products mimic estrogens and may be contributing to male and female reproductive diseases, particularly prostate cancer.

The new study of laboratory rats suggests that prostate cancer, which usually strikes men over 50, may develop when BPA and other estrogen-like, man-made chemicals pass through a pregnant woman's womb and alter the genes of a growing prostate in the fetus. One in every six men develops prostate cancer, a rate that has increased over the last 30 years.

Researchers at the University of Illinois at Chicago and the University of Cincinnati exposed newborn rats to low doses of BPA and found the structure of genes in their prostate cells was permanently altered, a process of reprogramming in early life that promotes cancer in adulthood. One key gene was switched on, producing too much of a cell-damaging enzyme that has been detected in cancerous prostate cells but not normal cells.

Also, as the rats aged, they were more likely than unexposed animals to develop precancerous lesions, or cellular damage, in the prostate that have been known for years to lead to prostate cancer in humans.

"The present findings provide the first evidence of a direct link between developmental low-dose bisphenol A … and carcinogenesis of the prostate gland," according to the researchers. Results from the team, led by Gail S. Prins, associate professor of andrology at the University of Illinois at Chicago, and Shuk-mei Ho, chair of environmental health at the University of Cincinnati, are reported today in the journal Cancer Research.

Exposure to the chemical "may provide a fetal basis for this adult disease" in humans, the report said.

Dr. Rebecca Sokol, a USC medical school professor who specializes in male hormone research, called the study "cutting-edge." She said it added to a growing body of research, called epigenetics, that suggested environmental chemicals could alter how DNA sequences turned on and off in a fetus, permanently imprinting the genes of a child and sensitizing him or her to disease in adulthood.

Such findings could have major implications for human disease and could, in part, explain why the prostate cancer rate has surged. BPA, used for about half a century, is a key building block in the manufacture of polycarbonate plastic and ranks among the world's most widely used industrial chemicals.

Prins, Ho and other researchers cautioned that the study was conducted on rats, which sometimes reacted differently to chemicals than humans did. Replicating the work in humans is virtually impossible because 50 or more years usually pass from exposure in the womb to the onset of prostate cancer.

"You can't say from the results of this study that this is going to affect humans," Sokol said. But she said the results were in line with previous animal research that showed chemicals could induce genetic changes that altered sperm and other reproductive functions.

The prostate gland, which develops in human males when they are fetuses, is extremely sensitive to natural estrogen. As a result, scientists have long theorized that prostate cancer could be increasing in men because of their exposure to estrogen-like chemicals in the womb.

Unlike carcinogenic chemicals that can cause profound damage to DNA, BPA seems to inflict subtle changes that are passed from one generation to the next, Sokol said.

"The big focus today is whether or not environmental toxicants will induce heritable changes in gene function…. In other words, is there something that happens to alter genes without actually altering the genetic code?" asked Sokol, who studies the effects of chemicals on sperm. "This [new study] is cutting-edge research in this field and the role that environmental toxicants may play in altering the genetics of exposed offspring."

Steve Hentges, a representative of the American Plastics Council, called it "fascinating research, a good piece of research" that should be studied further. But he said the "real question is what does this mean for human health," because there are too many limitations in the study for it to apply to humans.

"No one has actually observed prostate cancer after any treatment with BPA," he said.

The study's authors said the animals developed the precancerous lesions and genetic changes when exposed to low concentrations of the chemical similar to the amounts found in human blood and fetuses.

But Hentges said the rats were injected with doses 100 to 1,000 times higher than the most recent human testing done by federal officials in 2004.

In recent years, evidence has been building that BPA causes changes in the hormones and reproductive tracts of male and female animals. Lower sperm counts, decreased testosterone and enlarged prostates were reported in male animals, and early puberty and disrupted hormonal cycles in female animals.

Of more than 100 studies that examined low doses of the chemical, 94 funded by government agencies found harmful effects in lab animals, and 11 funded by industry reported no effects, according to a 2005 review by Frederick vom Saal of the University of Missouri.

Polycarbonate, which cannot be manufactured without BPA, is a clear and shatter-free plastic. In addition to beverage bottles, utensils and food packaging, it is used in automobiles, medical equipment and compact discs.

Small amounts of the chemical can leach from plastic containers, especially when heated, cleaned with harsh detergents or exposed to acidic foods or drinks. It also is used in children's dental sealants and as a resin lining metal food cans.

Last year, the California Legislature considered a bill, introduced by Assemblywoman Wilma Chan (D-Oakland), that would have banned children's products that contained BPA or other plastic compounds called phthalates. It died in an Assembly committee after sparking a scientific debate and intense lobbying by the plastics industry.

Dr Larry Clapp Comment-This is very consistent with our clinical experience which has focused on healing prostate cancer by cleansing past toxins, rebuilding the immune system and careful nutrition to reduce/eliminate new toxins. These toxins are known to raise estrogen, which is the real cause of BPH and prostate cancer. Men with high testosterone do not get prostate cancer, men with high estrogen do. For more info see: www.prostate90.com/