Dentists Take Dimmer View of Patients' Smiles

-- People tend to be much happier with the condition of their teeth and smiles than their dentists are, Norwegian researchers report.

Patients also view eyes and teeth as the most important aspects of facial attractiveness, and younger people under 50 are most at ease with the appearance of their teeth, the study found.

"Patients had much higher opinions of their smiles than dentists assessing their smiles," said study author Dr. Oystein Fardal, a periodontist in private practice in Egersund, Norway.

Yet despite the inclination towards more favorable assessments, patients did not usually rank their pearly whites as being the best that they could be.

"They only gave themselves scores of six out 10," he noted. "This could mean that they are content, but realize that they do not compare with the 'perfect smiles' of Julia Roberts, Angelina Jolie, etcetera."

Fardal and co-author Jannike Jornung, a graduate student in the department of orthodontics in Sweden's Sahlgrenska Academy at Goteborg University, published their findings in the December issue of the Journal of the American Dental Association.

To gauge patient and dentist perceptions, the researchers first interviewed 78 patients at a general dental practice in a small rural Norwegian community during September of 2004.

The patients were between the ages of 22 and 84 and, at the time, none were seeking any kind of aesthetic dental care. Nearly two-thirds were women.

Written questionnaires were completed, in which patients assessed on a scale of one to 100 the shape of their lips; the appearance of the soft tissue (gingiva) surrounding their teeth; the shade, shape and alignment of their teeth; and the overall state of their smile.

Patients were also asked to indicate if they thought they had crooked teeth and/or receding gums.

No photographs or mirrors were provided, as patients were asked to grade themselves from memory.

In addition, all the men and women also ranked various facial features according to how important they believed they were to overall attractiveness. Features included hair and hairline, eyes and eyebrows, nose, skin, ears, lips, teeth, chin and the shape of the head.

Digital photos were then taken of the smiles of the first 40 patients, and both the attending dentist and Fardal independently arrived at aesthetic scores based on assessments of tooth shade, spacing, crowding, inflamed tissue and overall appearance.

At no time had Fardal been involved in the dental care of any of the patients.

The authors found that on a scale of 100, average patient satisfaction with the state of their smile came to just over 59 -- a figure that rose significantly among patients under the age of 50.

By contrast, the two dentists' assessments taken together registered at about 40 on the scale.

Specifically, patients were most satisfied with the state of their soft tissue (gingiva) when they smiled. They were least satisfied with the color of their teeth, which they generally described as being too dark.

Skin condition followed teeth and eyes as the most important features contributing to a person's facial attractiveness. Female patients said that teeth and hair were more important to them than did the men, while the men said head shape was more critical.

Fardal and Jernung suggested that dentists should remember that their opinion of the aesthetics of a patient's smile may not match that of the patient.

"Whether the 'perfect smile' exists is a different question," said Fardal. "The smile is made up of the teeth, gums, lips and jaws, and we as dentists use criteria and guidelines attempting to produce the 'perfect smile.' However, how many people actually fulfill these criteria is not known."

"Furthermore, the beauty is in the eye of the beholder," he added. "So there are a lot more smiles that are found to be attractive than just the 'media-created smile'. In addition, social and cultural differences exist, where different features are deemed attractive."

Dr. Edmond Hewlett, a consumer advisor to the American Dental Association, and an associate professor in UCLA's School of Dentistry in Los Angeles, agreed that dentists are trained to look for certain agreed-upon tooth proportions, symmetries, sizes, shapes and coloring when assessing a person's smile.

"I think there is a notion of what the components of an optimally attractive smile," he said. "There are certain parameters that are commonly utilized when a dentist looks at a smile. Then you take these very general parameters and apply them to every individual person with their unique features."

"It's certainly not a cookie-cutter situation, like a Julia Roberts template that we want to stick in everybody's mouth," he stressed. "But when you look at a beautiful smile you do see a lot of the same features -- either because the person is blessed or through orthodontic work -- which we all find appealing.

"Models, for example, consistently have central incisors which tend to be a little bit wider and longer than the other teeth in the front," Hewlett noted. "And yet when you look at two famous actresses -- Kirsten Dunst and Patricia Arquette -- both have a type of crookedness. The incisors are actually tilted back a little, and the canine teeth look more prominent like fangs. Yet both have commented in interviews that they are tired of people telling them to change their teeth. They're quite confident and comfortable."

"And that's the subjectivity of attractive teeth personified," he noted. "They're comfortable in their own skin, and they don't feel the need to conform to some culturally driven ideal of beauty. And that's something I think that dentists need to be sensitive to as well."

Night-time coughing: Honey is the best remedy

Honey is about the best remedy to give your child if he or she is unable to sleep because of coughing fits. It outperforms cough remedies, and it’s certainly better than doing nothing.
Even a single dose given 30 minutes before bedtime can reduce the cough, researchers have found.

They tested several approaches on a group of 105 children who had suffered from a persistent cough caused by an upper respiratory tract infection. On the first evening they did nothing, on the second they gave the children one dose of buckwheat honey and, on the third, an over-the-counter cough remedy that contained honey.

Honey on its own outperformed the other two approaches, and in most cases gave the child – and the parents – a good night’s sleep.

How long should we sleep? It's seven hours to keep us healthy

Seven hours seems to be the ideal amount of sleep that we should aim to get every night – it may even keep us trim. A new study has found that people who slept significantly more or less than the optimum seven hours were overweight or even obese.
It’s not clear if the lack or excess of sleep caused people to put on weight, or if it was obesity that caused the irregular sleeping habit, but Spanish researchers discovered that people were more likely to be overweight if they slept for five hours or less, or for nine hours or more.

NOW Foods and Nourish America Help the Big Apple’s Hungry Weather the Flu Season in Health


SANTA BARBARA, CA)— Thanks to a generous contribution from NOW Foods, Nourish America recently provided over 18,000 bottles of high quality liquid echinacea to The River Fund of New York, a food pantry for New York’s working poor and homeless. The donation of echinacea will support the immune systems of River Funds’ clients and help them fight infection. While the common cold and other illnesses are traveling fast this winter season, these recipients now have access to a safe, natural herb with antioxidant properties that they could not afford for themselves.
According to a 2006 study, approximately one out of every six New York City residents live in households facing food insecurity, and over 400,000 of them are children.

Without proper daily nutrition, these New Yorkers are more susceptible to illness, diseases, and other health problems.

“Today there is a severe snowstorm in New York. Despite this, there’s a long line of people running outside of our pantry and onto the sidewalks. The people here are really in need,” says Swami Durga Das, Director of The River Fund. “The donation of echinacea has been a God send – a great, quality product from a well known brand. We have a volunteer grant writer here who is also a chiropractor. She was very impressed that we received this donation as she uses this particular echinacea product from NOW Foods for her personal use and in her practice.”

Smoking: Drug Company Thinks You're a Crudo



Are you a crudo or a jurassic? If you’re a latter, tobacco manufacturer British American Tobacco (BAT) wants to hear from you.
BAT has just classified young people either as progressive, a crudo or a Jurassic, and they reckon that 40 per cent of the Argentinean market – where they have begun the market analysis – is Jurassic. To be a member of the Jurassic sector, you will tend to have values such as family, friendships, love of country, and the importance of the father-son relationship.

To market to the Jurassic sector, BAT is employing images such as flowers, ribbons, leaves, birds and, of course, the tango (well, it was in Argentina, after all).

Pain control: Massage is just as good as drugs

Doctors immediately think of giving drugs to patients who are in pain after major surgery. But a new study has found that massage is just as effective, and far safer.
A group of 605 patients who had undergone major surgery, and who were in great pain for more than four days afterwards, reported a significant improvement after massage.

The patients received either standard, drug care, or 20 minutes of massage, or back massage for five days after surgery. Both massage groups reported a greater lessening of pain and unpleasantness than those in the drug group.

For people with high cholesterol, national study shows importance of nutrition help from registered dietitian
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[FONT=Comic Sans MS]Many patients can reach LDL cholesterol goal through dietary changes alone
ANN ARBOR, Mich. - Worried about your cholesterol? You may want to schedule a few appointments with a registered dietitian, to get some sound advice about how to shape up your eating habits, according to a new national study led by University of Michigan Health System researchers.
Not only are you likely to lower your cholesterol levels, you may be able to avoid having to take cholesterol medication, or having to increase your dose if you're already taking one. And you'll probably lose weight in the process, which also helps your heart.
The new results, published in the February issue of the Journal of the American Dietetic Association, are based on data from 377 patients with high cholesterol who were counseled by 52 registered dietitians at 24 sites in 11 states.
In the group of 175 patients who started the study with triglycerides less than 400 milligrams per deciliter of blood (mg/dL), and who had their cholesterol measured before they changed or added medication, 44.6 percent either reduced their levels of "bad" cholesterol by at least 15 percent, or reached their cholesterol goal.
The results reflect progress in approximately eight months, after three or more appointments with a dietitian. But the results add further evidence that medical nutrition therapy, as it is called, can make a big difference in a patient's life.
All of the R.D.s in the study based their advice to their patients on the latest research-based evidence about eating habits and cholesterol levels available at the time of the study: the American Dietetic Association's 1998 Medical Nutrition Therapy Hyperlipidemia Protocol.
Since that time, the ADA has updated the clinical guideline based on new research, which means that patients who see an R.D. today may have even more success.
The study was funded by the ADA and its Clinical Nutrition Management Dietetic Practice Group, and based on a framework developed for a pilot project carried out in Michigan by the Michigan Dietetic Association and led by U-M cardiovascular dietitians.
"Everyone knows that nutrition is important for cholesterol management, and that a registered dietitian is the professional most thoroughly trained to help patients choose foods wisely," says lead author Kathy Rhodes, Ph.D., R.D., manager of Nutrition Services with the U-M Cardiovascular Medicine program at Domino's Farms and the U-M Cardiovascular Center. "But this is the first national study to show what happens when high-risk patients work with R.D.s to follow nutrition guidelines grounded in the best evidence."
Key nutrition issues in the 1998 guidelines used in the study include reducing saturated and trans fat and increasing "healthy" fats such as olive oil; increasing soluble and insoluble fiber; eating fish twice a week; increasing fruits and vegetables; regular exercise and healthy weight management. Information about food-label reading and dining out was also included.
Called the Lipid Management Nutrition Outcomes Project or LMNOP, the national study was launched by Rhodes and her U-M colleagues Melvyn Rubenfire, M.D., and Martha Weintraub, MPH, R.D., after the successful completion of the Michigan-wide pilot project. Rubenfire, Weintraub and Christina Biesemeier, M.S., R.D., FADA, of Vanderbilt University are co-authors of the new study.
The study gives us an important "real world" picture of what happens when R.D.s try to implement evidence-based nutrition guidelines in daily practice, Rhodes notes.
Some commercial health insurance plans are beginning to cover appointments with registered dietitians, but many still do not. Only dietitian visits for diabetes or kidney disease are covered by Medicare. It is important for people to check their specific health insurance plan to see whether nutrition is covered, Rhodes says. But even if individuals need to pay for the appointments out of their own pocket, they may find that an R.D.'s advice will pay off in the long run, she says.
To get uniform data, the researchers brought lead R.D.s from each state to U-M for training on the cholesterol and nutrition guidelines, and on the data collection practices used in the study. R.D.s at Veterans Affairs hospitals got their training by phone conferencing. R.D.s then returned to their own practices, trained their colleagues and implemented the ADA guidelines.
The study included only patients between the ages of 25 and 70 years who had high cholesterol levels, or triglyceride levels over 200 mg/dL, and who met other inclusion criteria including no recent changes in their cholesterol medication status. Neither the R.D.s nor their patients were paid to participate in the study.
The "real world" aspect of this study included the disappointing finding that many patients dropped out of nutrition counseling after one or two visits, when three or four sessions with an R.D. is recommended to make and sustain truly effective changes in eating habits. Lack of insurance coverage was a major factor in this dropout rate.
Patients whose doctors changed their cholesterol medication status, either by starting them on a drug for the first time, or increasing their dose before assessing the effect of diet change, were not included in the analysis. But for the 219 patients who didn't have any change in their medication status, the impact of the R.D. counseling became apparent in the first year after the initial visit.
"Although some patients may already be eating a relatively healthy diet, medical nutrition therapy can increase patient's knowledge of 'cardioprotective foods' and assist them in individualizing the guidelines to fit their preferences and lifestyle," says Weintraub. A significant number of patients reduced the fat in their diets to less than 30 percent of calories, as recommended for a heart health. Many participants also lost weight and/or increased the number of days each week on which they exercised for 30 minutes or more.
"Often, we see heart patients who are on multiple cholesterol medications but have never seen a dietitian. And even when a patient with high cholesterol does get to see an R.D., their care team may not allow enough time to see how effective diet is before they add additional treatment," says Rhodes. "We hope that this demonstration of how well cholesterol can be lowered without medication or increases in medication will be very useful for patients and physicians, and perhaps insurers too."
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New York State Survey Provides Key Data on the Public’s Eye Care Needs

WASHINGTON – Results from a survey conducted by the New York State Department of Health (NYSDOH), with the support of the American Academy of Ophthalmology, highlight the need to raise awareness of the risk of eye disease. The NYSDOH has recently released its analysis of the data, which is based on a telephone survey of 4,258 people aged 40 and older conducted in 2006. New York is one of the first states to include vision related questions in the survey of health-related behaviors, called the Behavioral Risk Factor Surveillance System (BRFSS), which is conducted in all 50 states and U.S. territories.
“These data are extremely valuable in the fight against age-related disease,” said H. Dunbar Hoskins, Jr., MD, executive vice president of the Academy. “By identifying the areas where behavior and access present barriers to supporting eye health, the survey will help identify problems and target disease prevention activities where they are needed most.”
Among the key findings of the New York survey:

• One in six adults has distance vision impairment, based on their ability to recognize a friend across the street.
• More than a third of New Yorkers aged 40 and older have not visited an eye care professional in the past year. Almost half of those who have not visited an eye care professional said that they had no reason to do so.

Based on the data, the NYSDOH estimates that more than 1.5 million New Yorkers have cataracts. In order of prevalence, glaucoma, macular degeneration and diabetic retinopathy affect more than 1 million additional New Yorkers.
“This survey highlights the importance of educating New Yorkers about their risk for eye disease,” said Diane J. Kraus, MD, president of the New York State Ophthalmological Society. “Even though you have no symptoms of eye disease, you can still be at risk for a potentially blinding disease. It’s important to have a baseline eye disease screening in order to catch diseases before they damage your vision.”




As part of its EyeSmart campaign, the Academy recommends that adults with no signs or risk factors for eye disease get a baseline eye disease screening at age 40—the time when early signs of disease and changes in vision may start to occur. Based on the results of the initial screening, an ophthalmologist will prescribe the necessary intervals for follow-up exams.
The BRFSS uses a telephone interview of a random sample of adults to gather data about health behaviors, risk factors, clinical practices, health care access and health-related outcomes. The CDC provides significant financial assistance to all states to conduct the surveys, but funding is limited to surveying a core set of questions. The Academy provided financial support to the NYSDOH to help defray the costs of adding the vision module to the state survey.
New York is one of the first states in the nation to include vision-related questions in its survey. The vision questions focused on age-related eye diseases including retinopathy, glaucoma, macular degeneration and cataract, as well as work-related eye injuries. A key question about the last time the respondent had an eye exam will help the state monitor trends in obstacles to care.
The prevalence of visual impairment, often a chronic and disabling condition in adults, will rise as the population ages and as conditions like diabetes that are linked to eye problems increase. Current estimates indicate that three percent of Americans aged 40 and older are either blind or visually impaired. The public health costs of blindness and low vision are estimated at $68 billion annually nationwide.