TAG: "Dentistry"

Dentist shortage bites California as more choose to practice out of state

Older dentists nearing retirement, newer dentists more specialized.

A lingering recession, the elimination of Medicaid dental reimbursements and a glut of established dentists in wealthier, populated areas may explain why more new dentists are practicing outside California, according to a new policy brief from the UCLA Center for Health Policy Research.

“Good access to dental care depends on having a robust supply of new dentists in California,” said Nadereh Pourat, director of research at the center and lead author of the study. “We need a new generation of dentists to replace the many dentists who are close to retirement.”

While California still saw an increase in the number of dentists and had more licensed dentists —35,000 plus — than any other state in 2012, the number of those licensed to practice in California who opted to reside or work out of state grew 6 percent between 2008 and 2012.

The migration is especially noticeable among new dentists. In 2012, 86 percent of those licensed within the previous five years practiced in the state — a 10 percent drop from 2008. In addition, new dentists in 2012 made up a smaller share of the state’s overall supply. Of all regions, the San Joaquin Valley tallied the highest percentage of new dentists, who made up 15 percent of the local supply.

A noteworthy development: Analysis showed one group — women — made up almost half of all newly licensed dentists in California in 2012.

Age may also start affecting supply. Nearly one-quarter of actively licensed dentists in California have been practicing for 30 years or more and are close to retirement age. Northern and Sierra counties had the highest proportion of dentists nearing retirement, at 40 percent.

The report also suggests that it may become tougher for adults to get basic oral care than gum surgery, as more new dentists are specializing.

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Study connects smoke-free laws, dentists’ advice to quit

Smoke-free laws can help influence behavior and attitudes.

Cigarette buttsSmoke-free laws may help encourage dentists to recommend that their patients kick the smoking habit, according to new research co-authored by UC Merced professsor Mariaelena Gonzalez.

The paper, published in the American Journal of Public Health, suggests the societal change manifested by smoke-free laws can contribute to an atmosphere in which dentists pay more attention to patients’ smoking habits.

“Smoke-free laws can have strong effects – and not just on stopping individual-level behavior,” said Gonzalez, whose research focuses on tobacco control. “These laws can influence other behavior and attitudes, as our study shows with dentists. They can have a huge effect on people’s preferences, such as a preference for clean indoor air. Even smokers like clean indoor air.”

Gonzalez co-authored the study “Association of Strong Smoke-Free Laws with Dentists’ Advice to Quit Smoking, 2006-2007,” with Stanton A. Glantz, a professor of medicine at UC San Francisco, and Ashley Sanders-Jackson, a postdoctoral fellow at Stanford University. All three have been associated with the UCSF-based Center for Tobacco Control Research and Education, where Glantz is the director.

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Students learn by doing good

Global children’s oral health, nutrition program helps stem tooth decay around the world.

Global Children's Oral Health and Nutrition ProgramEvery year since 2010, Dr. Karen Sokal-Gutierrez, Dr. Susan Ivey and a group of students have taken toothbrushes, toothpaste, and a big pink and white model of teeth to Latin America and, since 2011, Asia. There, they teach communities about nutrition and oral health. The Global Children’s Oral Health and Nutrition Program was created to stem the epidemic rise in tooth decay in developing countries around the world. Sokal-Gutierrez is an associate clinical professor and Ivey an associate adjunct professor in the UC Berkeley School of Public Health. Both teach in the UC Berkeley-UC San Francisco Joint Medical Program.

The program began in El Salvador in 2003, where Sokal-Gutierrez noticed a trend in tooth decay of children up to 6 years old. Since then, the program has expanded to Nepal, India, Vietnam, Ecuador and Peru. Sokal-Gutierrez and Ivey estimate that the program has served about 10,000 children and their parents since its inception. But the Children’s Oral Health and Nutrition Program has also made another big impact, this time on the UC Berkeley campus: bringing transformative experiences to students launching their careers in public health, medicine and dentistry.

“How can we do our best to improve the health of children, and how can we do our best to mentor the students and give them this good hands-on opportunity?” asks Sokal-Gutierrez. “I’m always trying to pay attention to both of those things.”

In the decade since it began, nearly 200 volunteers have participated in the program. Most are UC Berkeley undergraduates who plan to pursue careers in public health, medicine, and dentistry. They also include graduate students and professionals from the fields of medicine, dentistry and public health. Additionally, Sokal-Gutierrez and Ivey often seek out students whose families emigrated from countries where this program might be needed. It offers a chance for students to connect abstract concepts to real-world scenarios, take on positions of leadership, and be mentors in medicine and public health.

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How nanotechnology can help fight cancer

UCLA researcher highlights advances.

Dean Ho, UCLA

Dean Ho, UCLA

As cancer maintains its standing as the second leading cause of death in the U.S., researchers have continued their quest for safer and more effective treatments. Among the most promising advances has been the rise of nanomedicine, the application of tiny materials and devices whose sizes are measured in the billionths of a meter to detect, diagnose and treat disease.

A new research review co-authored by a UCLA professor provides one of the most comprehensive assessments to date of research on nanomedicine-based approaches to treating cancer and offers insight into how researchers can best position nanomedicine-based cancer treatments for FDA approval.

The article, by Dean Ho, professor of oral biology and medicine at the UCLA School of Dentistry, and Edward Chow, assistant professor at the Cancer Science Institute of Singapore and the National University of Singapore, was published online by the peer-reviewed journal Science Translational Medicine. Ho and Chow describe the paths that nanotechnology-enabled therapies could take — and the regulatory and funding obstacles they could encounter — as they progress through safety and efficacy studies.

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Free health care clinic

UCLA health care staff help treat thousands at Care Harbor clinic.

A team of more than 200 UCLA health professionals helped staff a free health care clinic last week that provided vital basic medical services to approximately 3,000 uninsured and underserved people in Los Angeles.

They were among the nearly 3,000 medical and general volunteers at Care Harbor’s annual urban health clinic — held Oct. 31 through Nov. 3 at the Los Angeles Sports Arena just south of downtown Los Angeles — who provided more than 5,700 medical, dental and vision exams.

“To me it’s part of the mission of being a physician to care for people,” said Dr. Colin McCannel, a UCLA ophthalmologist. ” It’s part of what I should be doing so doing it makes me feel like I’m doing what I’m supposed to.”

There were 16 volunteers from UCLA Jules Stein Eye Institute, who conducted eye exams, donated 10 free cataract surgeries and prescribed free eye glasses. UCLA’s team also included seven doctors from family medicine, 17 general internists, and one physician from internal medicine/pediatrics, as well as some specialists and medical students.

The Care Harbor clinic provides a wide range of services for people who lack the means to get medical care on a regular basis. The health professionals screened for diabetes and hypertension, administered immunizations, offered mental health counseling and provided teeth cleanings, among many other basic services. For those patients who had more severe problems or conditions that required longer term care, the volunteers provided referrals to followup services.

The UCLA School of Dentistry staffed 10 dental chairs providing oral hygiene services for hundreds of patients.

“Service is part of the core missions and I want to take every opportunity I can to give back,” said Dr. Edmond Hewlett, a professor in the school of dentistry.

In addition to the doctors, UCLA volunteers included nearly 80 nurses from Ronald Reagan UCLA and Santa Monica medical centers; six clinical lab scientists and a pathologist from the department of pathology who interpreted the pap smears; and six nurse practitioners.

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UCLA dental school teams with community bank to serve neighbors in need

Nearly 250 local residents receive free oral health screenings.

A woman being examined at the UCLA dental clinic inside the lobby of Wilshire Bank in Koreatown.It was anything but a typical Saturday at the bank. On Oct. 12, inside the lobby of Wilshire Bank in Koreatown, nearly 250 local residents lined up for oral health screening appointments offered free of charge by UCLA School of Dentistry students, residents and faculty.

For many of the primarily Korean participants, this was their first dental check-up in several years — not so surprising in the low-income community, and a factor that had prompted the bank to collaborate with UCLA to bring free dental care to its neighbors in a new program set to take place every year for five years. A $100,000 pledge to the dental school from Wilshire Bank – which is headquartered in Los Angeles but has 28 branches in four states — helped cover the costs of bringing in 30 dental students and 17 supervising faculty and residents who volunteered their services during the inaugural event. The funding also helped pay for topical fluoride treatments and dental home care kits given to those in dire need of dental care.

In addition, the School of Dentistry will contribute more than $100,000 in in-kind donations including faculty time and expertise, and additional supplies and staff support in the school clinic.

But the check-ups at the bank were just the beginning: Of the 250 people who were seen, about half were referred for free follow-up treatment a week later, on Oct. 19, at several of the dental school’s more than a dozen clinics in Westwood, with Wilshire Bank providing the patients with free transportation.

A number of the patients presented very complex cases requiring multiple procedures and treatment from multidisciplinary dental teams.

“I was told by some patients that the service and attention they received at the screening and treatment days was much more thorough than what they experienced at a private dentist,” said Dr. Paulo Camargo, associate dean of clinical dental sciences, who was in charge of coordinating the treatment day.

Ultimately, it is hoped, this collaborative effort will prompt patients from the Koreatown community to maintain their oral health by becoming regular patients of the UCLA dental clinics.

“The partnership we have embarked on with Wilshire Bank is a testament to both organizations’ commitment to the health of the people in the community,” said Dr. No-Hee Park, dean of the UCLA School of Dentistry. “These screenings and corresponding treatment create an opportunity for those severely lacking in access to receive definitive dental care and oral health education at the UCLA School of Dentistry’s clinics.”

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UCLA study shows that pancreatic cancer biomarkers reside in saliva

Study provides mechanistic support for validity of salivary diagnostics.

David Wong, UCLA

David Wong, UCLA

Pancreatic cancer is one of the deadliest forms of cancer. Most of those with the disease will die within the first year of diagnosis, and just 6 percent will survive five years.

The disease is typically diagnosed through an invasive and complicated biopsy. But a discovery by researchers at the UCLA School of Dentistry may be one major step toward creating a noninvasive tool that would enable clinicians and oncologists to detect pancreatic cancer through a simple risk assessment test using saliva.

In a study on a tumor-ridden mouse model, the UCLA researchers were able to definitively validate that pancreatic cancer biomarkers reside in saliva. The team was led by Dr. David Wong, the dentistry school’s associate dean of research and the Felix and Mildred Yip Endowed Professor in Dentistry.

The findings are published in a recent issue of the peer-reviewed Journal of Biological Chemistry.

To date, salivary biomarker panels have been successfully developed for cancers of the breast, ovaries, lungs and pancreas. However, researchers in the field of salivary diagnostics are still attempting to understand how biomarkers produced by other parts of the body ultimately appear in the mouth. Scientists have surmised that RNA molecules — which translate genetic code from DNA to make protein — are secreted into extracellular spaces and act as an information signal system, representing an innovative model in intercellular signaling.

With this understanding, Wong’s research team was able to demonstrate that tumor-derived extracellular RNA molecules are transported through organelles called exosome vesicles that originate at the source of the tumor and are re-processed into saliva as biomarkers. To prove it, the researchers examined mice models with pancreatic cancer whose saliva showed evidence of biomarkers for pancreatic cancer. When they inhibited the production of exosomes at the source of the tumor, the researchers found that the pancreatic cancer biomarkers no longer appeared in the mouse’s saliva.

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UCSF dentistry school graduates class of 2013

Graduates encouraged to continue on their path of discovery.

UC San Francisco dental students line up for the procession for the dentistry school's commencement ceremony at Davies Symphony Hall.

The UC San Francisco School of Dentistry celebrated commencement on June 7 as students in the dental hygiene and dental class of 2013 received their degrees at a ceremony at Davies Symphony Hall.

John Featherstone, Ph.D., dean of the dental school, congratulated the class. Featherstone, a professor of preventive and restorative dental sciences, encouraged the graduates to continue on their path of discovery.

Carol Gomez Summerhays, D.D.S., a trustee in the American Dental Association and past president of the California Dental Association, delivered the commencement address. She was joined on the stage by student speakers, Lisa Shizuko Handa, who earned a degree in dental hygiene; Maria Ajlouny, who received her D.D.S. degree; and Malay Mathur, a graduate of the international dental program class.

Notably, two outstanding graduates this year were selected for the Elizabeth Fuhriman Gardner Award, which is given annually to commemorate the woman of the same name who graduated from UCSF’s dental hygiene proram in 1958. Throughout her life, “Libby” exemplified the qualities of caring and service. In particular, she devoted her energies to serving the University of California and was the first person recognized with the title Associate of the President. This year, the Gardner Award went to graduates Shizuko Handa and Joshua Emrick.

Emrick, D.D.S., Ph.D., was elected last year as president of the American Association of Dental Research (AADR) National Student Research Group. He took office in March this year and will serve until the 2014 AADR meeting in Charlotte, North Carolina. “During my term I will focus on the promotion of community and camaraderie between and within student research groups at the various dental schools,” he said at the time of his election. “Understanding that securing research funding is becoming ever more challenging, I also look forward to working closely with individuals who guide our research interests and examining the nuts and bolts of funding for clinical, basic, and translational research from within the AADR.”

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Investigating a link between oral health and kidney function

Study receives major boost from UCSF’s K Scholars program.

Medical research has already documented a link between cardiovascular disease and periodontal disease, or serious gum infection. Now researchers say preliminary studies suggest a connection between gum infections and kidney disease as well.

“This is a very new and emerging area, and there have only been a few studies,” said Vanessa Grubbs, M.D., an assistant professor and pulmonary specialist in the UC San Francisco’s School of Medicine who is determined to advance this research as part of her commitment to preventing the chronic health problems associated with kidney disease.

Vanessa Grubbs, UC San Francisco

“If we at least start to show that treating periodontal disease can slow the progression of kidney disease, the long-term ramifications for dental policy and how we manage patients with chronic kidney disease are huge,” said Grubbs, who is also a nephrologist, or kidney expert, based at San Francisco General Hospital and Trauma Center.

Funding routine dental care for people at all income levels could potentially become a priority as a way to prevent kidney disease, and the cost savings would be significant, she said. “It’s certainly cheaper to pay for preventative dental care than dialysis.”

She also noted that both kidney disease and periodontal disease disproportionately impact poorer populations.

Periodontal disease is an inflammatory response to persistent infection, caused by bacteria getting trapped in the gum’s porous tissues. Just as research indicates this inflamed state can affect major organs such as the heart, possibly through bacteria in the blood stream, studies show kidneys are similarly at risk, Grubbs said. Her goal is to prove this link in longitudinal research.

Teaming up with professors George Taylor, D.M.D., and Mark Ryder, D.M.D., from the UCSF School of Dentistry, Grubbs is launching a first-of-its-kind randomized, controlled study to track the progression of kidney disease in patients receiving treatment for periodontal disease.

All patients will have both conditions. Two-thirds will receive immediate and follow-up periodontal care, and the remaining control group will receive the dental care if it’s medically necessary. Kidney function will be measured in several ways, such as analyzing unique biomarkers in blood and urine associated with kidney damage.

Grubbs received research funding from the National Institutes of Health (NIH), and plans to follow the patients for one year as a pilot study, which could be expanded based on results.

After years in the preliminary stages, the study received a major boost from the K Scholars program managed by UCSF’s Clinical and Translational Science Institute (CTSI), said Grubbs, who was a K Scholar in 2011.

The K Scholars program is designed to support the career development of junior faculty from all UCSF schools who are committed to building careers in clinical and translational research. The program provides support for scholars to conduct high quality research, foster and nurture multidisciplinary collaborations and explore novel research directions, and develop the range of skills necessary to achieve a successful independent academic research career. Types of support include partial salary funding, expert advice, mentoring and regular project review sessions with a multidisciplinary group of K Scholar peers.

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Health professions education growing in new directions, UC report finds

Enrollment has increased significantly in medicine, nursing, pharmacy and public health.

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The University of California has issued a report that highlights some of the recent trends associated with the rapid growth in health professional schools and enrollment.

Enrollment in U.S. health professional schools has increased significantly in medicine, nursing, pharmacy and public health, according to the report, “A New Era of Growth: A Closer Look at Recent Trends in Health Professions Education.” For example, there has been unprecedented growth in total U.S. pharmacy student enrollment through expansion of existing programs and the establishment of new schools. Since 2005 alone, the number of accredited pharmacy schools has risen 48 percent (87 to 129).

The total enrollment and number of new U.S. medical schools also has increased. More striking, however, has been the rapid growth in the number of for-profit international medical schools located in the Caribbean and seeking to attract U.S. students. Growth has been more moderate in dentistry, optometry and veterinary medicine.

The report describes some of the changes in health professions education since 2007, when UC issued “A Compelling Case for Growth,” an in-depth review of health workforce needs as part of a systemwide planning effort that helped pave the way for enrollment growth at all five of UC’s longstanding medical schools, establishment of a new nursing school at UC Davis, and the recent accreditation and establishment of UC’s sixth school of medicine at UC Riverside.

The new report reviews the seven fields in which UC has health professional schools. The report also identifies trends and provides information by profession about the number of schools and enrollment in California and nationally. Information regarding current tuition levels by institution also is included.

“As the nation’s largest health sciences instructional program, UC has an important role to play in informing the public about the state of health professions education,” said Dr. Cathryn Nation, UC associate vice president for health sciences. “The ‘New Era of Growth’ report provides a valuable snapshot of trends that deserve our attention and further discussion.”

Trends identified in the report include:

  • Rapid growth in educational programs and total enrollment. Since 2007, the number of U.S. schools in the seven health professions surveyed has grown by 48 percent (865 to 1,283). As a result, enrollment has increased by 34 percent (252,484 to 339,107), with the majority of this growth taking place primarily in medicine, nursing, pharmacy and public health.
  • Development of new programs and business models. For-profit schools and programs have proliferated, both in the U.S. and the Caribbean, where 22 of the 61 medical schools admitted their first classes in the past decade. Non-research institutions have added new schools of pharmacy and dentistry. Accelerated and alternate-entry programs have grown, particularly in nursing. Professional doctorates have increased, as have programs that deliver education online, with growth in online public health programs.
  • Rising student costs and indebtedness. Between 2005 and 2010, UC medical schools experienced a nearly 50 percent increase, on average, in the four-year cost of attendance. Not surprisingly, student debt also is rising. Viewed over a longer period, the increase is even more dramatic. The total cost of attendance has increased for all UC professional degree programs, posing new challenges for students interested in pursuing careers in public service. For example, the average educational debt of veterinary medicine graduates (excluding undergraduate loans) at UC Davis nearly quadrupled from $29,770 in 1993 to $118,772 in 2011.

Recent growth at UC

Across the UC system, relatively modest, planned enrollment growth in medical student enrollment has occurred over the past decade. This has occurred through new UC Programs in Medical Education (PRIME) that focus on the needs of medically underserved communities. Through this special initiative, UC boosted total medical student enrollment by approximately 350 students across the UC system. However, most of this growth, and most that is occurring in nursing, has been unfunded by the state. Major multiyear budget cuts and a lack of state funding also contributed to a delay in the opening of UC Riverside’s new school of medicine, which will welcome its first class of 50 students in fall 2013.

Looking toward the future

Notwithstanding the growth in enrollment and establishment of new schools across the U.S., workforce shortages persist in many health professions, including medicine, public health and others — needs that will increase dramatically as provisions of health care reform take effect. The balance is currently shifting for some professions. In pharmacy, for instance, the profession has experienced such rapid growth in recent years that some estimates suggest a total national supply of pharmacists that may outpace future demand. Amid these many changes, it will be important to monitor the impact that the new schools and programs make, with particular attention to issues of quality, cost and student success, according to the report.

“As the higher education community plans for the future, the importance of maintaining educational quality, improving access and affordability for students, and improving access and health outcomes for patients are among the central goals that must remain in focus,” the report states.

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Possible trigger for spread of cancer cells discovered

UCLA research sheds light on growth of head and neck squamous cell carcinomas.

Cun-Yu Wang, UCLA

Cun-Yu Wang, UCLA

Very little has been known about the epigenetic events — developmental and environmental factors affecting genes — that occur prior to the invasive growth of head and neck squamous cell carcinomas and their spread to other parts of the body, or metastasis.

However, researchers from the UCLA School of Dentistry discovered what could be a crucial step toward understanding the process that activates the cancer cells. Squamous cell carcinoma is known for being one of the most deadly and debilitating types of tumors.

Led by Dr. Cun-Yu Wang, a UCLA School of Dentistry professor and leading cancer scientist, the group identified the key epigenetic factor KDM4A, which modifies the molecular activation process of protein AP-1. AP-1 is known to regulate gene expression and promote metastasis of squamous cell carcinoma. Their findings show that squamous cell carcinoma’s invasive growth could potentially be repressed by targeting KDM4A.

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Nanodiamonds could improve effectiveness of breast cancer treatment

UCLA study shows versatility of nanodiamond as targeted drug-delivery agent to tumor site.

Nanodiamonds bound to the chemotherapy drug epirubicin are enclosed within a lipid membrane and coupled to antibodies specific to hard-to-treat tumors. These hybrid drug delivery agents cause tumors to regress in size while markedly improving drug tolerance.

Recently, doctors have begun to categorize breast cancers into four main groups according to the genetic makeup of the cancer cells. Which category a cancer falls into generally determines the best method of treatment.

But cancers in one of the four groups — called “basal-like” or “triple-negative” breast cancer (TNBC) — have been particularly tricky to treat because they usually don’t respond to the “receptor-targeted” treatments that are often effective in treating other types of breast cancer. TNBC tends to be more aggressive than the other types and more likely to recur, and can also have a higher mortality rate.

Fortunately, better drug therapies may be on the horizon. UCLA researchers and collaborators led by Dean Ho, a professor at the UCLA School of Dentistry and co-director of the school’s Jane and Jerry Weintraub Center for Reconstructive Biotechnology, have developed a potentially more effective treatment for TNBC that uses nanoscale, diamond-like particles called nanodiamonds.

Nanodiamonds are between 4 and 6 nanometers in diameter and are shaped like tiny soccer balls. Byproducts of conventional mining and refining operations, the particles can form clusters following drug binding and have the ability to precisely deliver cancer drugs to tumors, significantly improving the drugs’ desired effect. In the UCLA study, the nanodiamond delivery system has been able to home in on tumor masses in mice with triple negative breast cancer.

Findings from the study are published online today (April 15) in the peer-reviewed journal Advanced Materials.

“This study demonstrates the versatility of the nanodiamond as a targeted drug-delivery agent to a tumor site,” said Ho, who is also a member of the California NanoSystems Institute at UCLA, UCLA’s Jonsson Comprehensive Cancer Center and the UCLA Department of Bioengineering. “The agent we’ve developed reduces the toxic side effects that are associated with treatment and mediates significant reductions in tumor size.”

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