Infection

• As dentistry scholars, we believe Koop also deserves credit for something else.
• Americans who rely on the traditional Medicare program for their health insurance get no help from that program with paying their dental bills aside from some narrow exceptions.
• This group includes some 24 million people over 65 – about half of all the people who rely on Medicare for their health insurance.

‘Medically necessary’ exceptions

• The list of circumstances that would lead patients to be eligible is short.
• Some examples include patients scheduled for organ transplants or who have cancer treatment requiring radiation of their jaws.
• But we believe that dental care is necessary for everyone, especially for older people.

Chew, speak, breathe

• While many working Americans get limited dental coverage through their employers, those benefits are usually limited to as little as $1,000 per year.
• And once they retire, Americans almost always lose even that basic coverage.
• Rich Americans with Medicare coverage are almost three times more likely to receive dental care compared to those with low incomes.

Connected to many serious conditions

• Having diabetes makes you three times as likely to develop gum disease because diabetes compromises the body’s response to inflammation and infection.
• At the same time, treating diabetes patients for gum disease can help control their blood sugar levels.

Chemo can damage your teeth

Many cancer treatments can damage teeth, especially for older adults. As a result, Medicare has started to reimburse for dental bills tied to tooth decay or other oral conditions after they get chemotherapy or radiation treatment.

More than nice to have

• Doctors and dentists are educated separately, and doctors learn very little about dental conditions and treatments when they’re in medical school.
• Most dental electronic health records aren’t linked to medical systems, hindering comprehensive care and delivery of dental care to those in need.
• Medical insurance was designed specifically to cover large, unpredictable expenses, while dental insurance was intended to mainly fund predictable and lower-cost preventive care.

Medicare Advantage plans

• Until Medicare expands coverage to include preventive dental services for everyone, alternative plans such as Medicare Advantage, through which the federal government contracts with private insurers to provide Medicare benefits, serve as a stopgap.
• In 2016, only 21% of beneficiaries in traditional Medicare had purchased a stand-alone dental plan, whereas roughly two-thirds of Medicare Advantage enrollees had at least some dental benefits through their coverage.

Frank Scannapieco is affiliated with The Task Force on Design and Analysis in Oral Health Research, and consults for the Colgate-Palmolive Company. Ira Lamster is a member of the Santa Fe Group. He currently receives consulting fees from Colgate, and research support from the CareQuest Institute.

Orphan designation: (6aR,10aR)-3-(1',1'-dimethylheptyl)-delta-8-tetrahydrocannabinol-9-carboxylic acid- Treatment of cystic fibrosis, 14/10/2016 Withdrawn

Orphan designation: cusatuzumab Treatment of acute myeloid leukaemia, 22/04/2020 Positive

• One day, she explained that she adds apple cider vinegar to improve my health.
• Apple cider vinegar is a natural product made of fermented apple juice that has gone sour.
• I decided to turn medical sleuth and investigate whether apple cider vinegar is as good for health as it sounds.

Claim: disinfectant properties

• But does apple cider vinegar’s decontaminant qualities translate to the human gut?
• Our stomachs produce acid, which acts as a natural barrier to infection, so how can adding more acid help?

Claim: weight loss and management of type 2 diabetes

• There are plenty of anecdotal claims that apple cider vinegar can aid weight loss, supported by limited evidence from several small studies.
• Apple cider vinegar is thought to cause weight loss through its effect on delay of gastric emptying.
• Reduced calorific intake will lead to weight loss – but how are the metabolic effects on blood glucose and lipids mediated?
• In type 2 diabetes there is a reduction in sensitivity to insulin which in turn leads to a reduced uptake of glucose by cells.

Claim: reduces risk of heart disease

• Raised blood lipids are a risk factor for cardiovascular diseases such as myocardial infarction and stroke.
• Well, I’m afraid there’s no scientific evidence that vinegar consumption of any kind reduces cardiovascular morbidity and mortality in those with or without diabetes.

Claim: cancer treatment and prevention

• One of the more outrageous claims of benefits of daily apple cider vinegar consumption is that it may prevent or treat cancer.
• A frequently quoted case-control study from China found that an increased consumption of vinegar was associated with a reduced incidence of oesophageal cancer.

Stephen Hughes does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.