Much room for improvement in access to preventive dental care in the USA

Selected coverage: Medical Daily, WebMD

The uptake rate of preventative dental care increased over a ten-year period in the United States, but there remains a large disparity among ethnic groups, reports one of the largest and most comprehensive studies on the subject, published in the open-access journal Frontiers in Public Health.

Neglect of dental care can have serious consequences like decay, inflammation, and loss of teeth, and an increased risk of malnutrition. Gum disease has been implicated in an increased risk of cardiovascular and respiratory disease. Easy access to affordable preventive dental care – in the form of regular checkups and cleanings by dentists or dental hygienists – can help to improve the quality of life of a population.

Oral health is particularly important in a rapidly aging population, because middle-aged and older people are more likely to develop chronic conditions and complications. Yet few studies have focused on the dental health-practices of older persons.

In a new study, Professor Bei Wu, Director for International Research at Duke University’s School of Nursing, and her colleagues analyzed self-reported oral health behaviors of almost 650,000 middle-aged and elderly Americans in a phone survey conducted between 1999 to 2008 by the National Center for Statistics and Prevention. This study is the first to compare dental care between Caucasians, Hispanics, African Americans, Asian Americans, and Native Americans.

Respondents were asked when they last had their teeth cleaned by a professional, because dental cleaning is a commonly used indicator of access to dental services. They were also asked about their gender, age, marital status, income, education, ethnicity, weight, general health, number of teeth removed, and drinking and smoking habits.

Results show that the number of people who received preventive dental care underwent a slight yearly increase in all five ethnic groups. But there is a long way to go, as 23% to 43% of Americans received no preventive dental care in 2008, depending on ethnicity.

Key findings include:

  • People with health insurance were 138% more likely to receive preventive dental care.
  • Women were 33% more likely to receive preventive dental care than men.
  • 77% of Asian Americans and 76% of Caucasians reported receiving preventive dental care in 2008. Hispanics, Native Americans, and African Americans, were significantly less likely (62%, 62%, and 57% of interviewees, respectively) to receive preventive dental care.
  • Differences between Caucasians and other ethnic groups (except African Americans) in access to preventive dental care can be explained by socioeconomic differences such as income, education, and having health insurance.
  • African Americans’ reduced access to preventive dental health might be due to an insufficient number of culturally competent dental care professionals, and to a lack of awareness of oral health and dental care services within this ethnic group.
  • Many Native Americans in reservations receive inadequate dental care, partly because not enough dental care professionals are motivated to work for the Indian Health Services.
  • Smokers were less likely to receive preventive dental health care. This is of particular concern since oral health is negatively affected by tobacco use.

The researchers conclude that it is imperative to develop public dental health programs that target middle-aged and elderly Americans, improve dental care access, and to train a dental workforce that is culturally competent

A neurological basis for the lack of empathy in psychopaths

Selected coverage: Scientific American, WebMD

When individuals with psychopathy imagine others in pain, brain areas necessary for feeling empathy and concern for others fail to become active and be connected to other important regions involved in affective processing and decision-making, reports a study published in the open-access journal Frontiers in Human Neuroscience.

Psychopathy is a personality disorder characterized by a lack of empathy and remorse, shallow affect, glibness, manipulation and callousness. Previous research indicates that the rate of psychopathy in prisons is around 23%, greater than the average population which is around 1%.

To better understand the neurological basis of empathy dysfunction in psychopaths, neuroscientists used functional magnetic resonance imaging (fMRI) on the brains of 121 inmates of a medium-security prison in the USA.

Participants were shown visual scenarios illustrating physical pain, such as a finger caught between a door, or a toe caught under a heavy object. They were by turns invited to imagine that this accident happened to themselves, or somebody else. They were also shown control images that did not depict any painful situation, for example a hand on a doorknob.

Participants were assessed with the widely used PCL-R, a diagnostic tool to identify their degree of psychopathic tendencies. Based on this assessment, the participants were then divided in three groups of approximately 40 individuals each: highly, moderately, and weakly psychopathic.

When highly psychopathic participants imagined pain to themselves, they showed a typical neural response within the brain regions involved in empathy for pain, including the anterior insula, the anterior midcingulate cortex, somatosensory cortex, and the right amygdala. The increase in brain activity in these regions was unusually pronounced, suggesting that psychopathic people are sensitive to the thought of pain.

But when participants imagined pain to others, these regions failed to become active in high psychopaths. Moreover, psychopaths showed an increased response in the ventral striatum, an area known to be involved in pleasure, when imagining others in pain.

This atypical activation combined with a negative functional connectivity between the insula and the ventromedial prefrontal cortex may suggest that individuals with high scores on psychopathy actually enjoyed imagining pain inflicted on others and did not care for them. The ventromedial prefrontal cortex is a region that plays a critical role in empathetic decision-making, such as caring for the wellbeing of others.

Taken together, this atypical pattern of activation and effective connectivity associated with perspective taking manipulations may inform intervention programs in a domain where therapeutic pessimism is more the rule than the exception. Altered connectivity may constitute novel targets for intervention. Imagining oneself in pain or in distress may trigger a stronger affective reaction than imagining what another person would feel, and this could be used with some psychopaths in cognitive-behavior therapies as a kick-starting technique, write the authors.

EurekAlert! PR: http://www.eurekalert.org/pub_releases/2013-09/f-anb092313.php

Study: http://journal.frontiersin.org/article/10.3389/fnhum.2013.00489/full