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Oral health is the gateway to overall health!

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October 2007

Early Communication of an Ongoing Safety Review

Bisphosphonates: Alendronate (Fosamax, Fosamax Plus D), Etidronate (Didronel), Ibandronate (Boniva), Pamidronate (Aredia), Risedronate (Actonel, Actonel W/Calcium), Tiludronate (Skelid), and Zoledronic acid (Reclast, Zometa)

This information reflects FDA’s current analysis of available data concerning these drugs.  Posting this information does not mean that FDA has concluded there is a causal relationship between the drug products and the emerging safety issue.  Nor does it mean that FDA is advising health care professionals to discontinue prescribing these products. FDA is considering, but has not reached a conclusion about whether this information warrants any regulatory action.  FDA intends to update this document when additional information or analyses become available. 

Publications in a recent issue of The New England Journal of Medicine have raised the question about the association of atrial fibrillation with the use of bisphosphonates.  FDA has reviewed some safety data and requested additional data to further evaluate the risk of atrial fibrillation in patients who take bisphosphonates. 

An article and an accompanying letter to the editor in the May 3, 2007, issue of The New England Journal of Medicine describe increased rates of serious atrial fibrillation (defined by the authors as life-threatening or resulting in hospitalization or disability) in two different studies of older women with osteoporosis treated with the bisphosphonates, Reclast and Fosamax.  In both studies, more women who received one of the bisphosphonates (Reclast-1.3% or Fosamax-1.5%) reportedly developed serious atrial fibrillation as compared to women who received placebo (Reclast study-0.5%, Fosamax study-1.0%).  In both studies, the rates of all atrial fibrillation (serious plus nonserious) were not significantly different between groups treated with bisphosphonate versus placebo.

What does FDA know about this concern?

The FDA reviewed spontaneous post-marketing reports of atrial fibrillation reported in association with oral and intravenous bisphosphonates and did not identify a population of bisphosphonate users at increased risk of atrial fibrillation. In addition, as part of the data review for the recent approval of once-yearly Reclast for the treatment of postmenopausal osteoporosis, the FDA evaluated the possible association between atrial fibrillation and the use of Reclast. Most cases of atrial fibrillation occurred more than a month after drug infusion. Also, in a subset of patients monitored by electrocardiogram up to the 11th day following infusion, there was no significant difference in the prevalence of atrial fibrillation between patients who received Reclast and patients who received placebo.   

Atrial fibrillation is a  heart rhythm disorder common in individuals 65 years old and older, the same age range of many of the patients studied in the article published in The New England Journal of Medicine.  Upon initial review, it is unclear how these data on serious atrial fibrillation should be interpreted.  Therefore, FDA does not believe that healthcare providers or patients should change either their prescribing practices or their use of bisphosphonates at this time.

This early communication is in keeping with FDA’s commitment to inform the public about its ongoing safety reviews of drugs.  FDA is seeking additional data to allow for an in-depth evaluation of the atrial fibrillation issue for the entire class of bisphosphonates.  It may take up to 12 months to complete the evaluation at which time FDA will communicate the conclusions and any resulting recommendations to the public.  Moreover, FDA is continuing to monitor spontaneous post-marketing reports of atrial fibrillation reported in patients who have taken bisphosphonates.

Bisphosphonates are a class of drugs used primarily to increase bone mass and reduce the risk for fracture in patients with osteoporosis.  Bisphosphonates are also used to slow bone turnover in patients with Paget’s disease of the bone and to treat bone metastases and lower elevated levels of blood calcium in patients with cancer.  There are 7 FDA-approved bisphosphonates: alendronate (Fosamax, Fosamax Plus D), etidronate (Didronel), ibandronate (Boniva), pamidronate (Aredia), risedronate (Actonel, Actonel W/Calcium), tiludronate (Skelid), and zoledronic acid (Reclast, Zometa).

The FDA urges both healthcare professionals and patients to report side effects from the use of bisphosphonates to the FDA's MedWatch Adverse Event Reporting program. 

bulleton-line at www.fda.gov/medwatch/report.htm
bulletby returning the postage-paid FDA form 3500 (available in PDF format at www.fda.gov/medwatch/getforms.htm) to 5600 Fishers Lane, Rockville, MD 20852-9787

Date created: October 1, 2007

 

September 2007

Please remember to be in prayer for those who are protecting us in the military.  Be sure to thank them, we
owe our freedom to them!

Stress May Leave Your Mouth a Mess

Stress may play a role in the development of periodontal diseases

A literature review saw a strong relationship between stress and periodontal diseases; 57% of the studies included in the review showed a positive relationship between periodontal diseases and psychological factors such as stress, distress, anxiety, depression and loneliness. Patients who minimize stress may be at less risk for periodontal disease.

Researchers speculate that the hormone cortisol may play a role in the possible connection between stress and periodontal diseases. A study in the July issue of the JOP found that increased levels of cortisol can lead to more destruction of the gums and bone due to periodontal diseases. It is well known that periodontal diseases left untreated can ultimately lead to bone loss or tooth loss.

Individuals with high stress levels tend to increase their bad habits, which can be harmful to periodontal health. They are less attentive to their oral hygiene and may increase their use of nicotine, alcohol or drugs. Patients should seek healthy ways to relieve stress through exercise, balanced eating, plenty of sleep and maintaining a positive mental attitude.

Patients should to also keep in mind their “pocket size guide” to periodontal health; periodontal probing depths of one to two millimeters with no bleeding are not a concern but probing depths of three and four millimeters may need a more in depth cleaning called scaling and root planing. Probing depths in excess of 5mm may require more advanced treatment and patients should talk to their dental specialist.

www.perio.com Journal of Periodontology (JOP) August 2007

 

New CPR Promises Better Results by Compressing Abdomen, Not Chest"

WEST LAFAYETTE, IN -- September 6, 2007 -- A biomedical engineer at Purdue University has
developed a new method to perform cardiopulmonary resuscitation that promises to be more
effective than standard CPR because it increases nourishing blood flow through the heart
by 25% over the current method. A new technique is desperately needed because
conventional CPR has a success rate of 5% to 10%, depending on how fast rescuers are able
to respond and how well the procedure is performed. For every one minute of delay, the
resuscitation rate decreases by 10%. "In other words, at 10 minutes, the resuscitation is
absolutely ineffective," said Leslie Geddes, Showalter Distinguished Professor Emeritus
in Purdue's Weldon School of Biomedical Engineering. "Any medical procedure that had that
low a success rate would be abandoned right away. But the alternative is not very good,
either: Don't do CPR and the person is going to die." Geddes has developed the first new
CPR alternative, called "only rhythmic abdominal compression," or OAC-CPR, which works by
pushing on the abdomen instead of the chest. "There are major problems with standard
CPR," Geddes said. "One is the risk of breaking ribs if you push too hard, but if you
don't push hard you won't save the person. Another problem is the risk of transferring
infection with mouth-to-mouth breathing." The new CPR method eliminates both risks,
Geddes said. Findings will be detailed in a research paper appearing this month in the
[American Journal of Emergency Medicine, published by Elsevier Inc. The paper was
authored by Geddes and his Purdue colleagues Ann E. Rundell, assistant professor of
biomedical engineering, biomedical engineering doctoral student Aaron Lottes, and basic
medical sciences graduate students Andre Kemeny and Michael Otlewski.
In standard chest-compression CPR, which has been in practice since the 1960s, the
rescuer pushes on the chest and blows into the subject's mouth twice for every 30 chest
compressions. However, the risk of infection is so grave that many doctors and nurses
often refuse to administer mouth-to-mouth resuscitation. In one 1993 study of 433 doctors
and 152 nurses, 45% of doctors and 80% of nurses said they would refuse to administer
mouth-to-mouth resuscitation on a stranger.


"This is the real world that nobody knows about, and it's a sobering thought," Geddes
said.OAC-CPR eliminates the need to perform mouth-to-mouth resuscitation.The American Heart Association requires that rescuers administering CPR push with enough force to depress the chest 1 and a half to 2 inches at a rate of 100 times per minute.

"To depress the chest 1.5 to 2 inches takes 100 to 125 pounds of force," Geddes said. "So
you have to push pretty hard and pretty fast, and two people are needed to perform it
properly. One blows up the lungs and the other compresses the chest. And when the one
who's compressing the chest gets tired, they change positions."

OAC-CPR requires only one rescuer.Instead of two breaths for every 30 chest compressions, the new procedure provides a breath for every abdominal compression because pushing on the abdomen depresses the
diaphragm toward the head, expelling air from the lungs. The release of force causes
inhalation.

Researchers have known since the 1980s that pushing on the abdomen circulates blood
through the heart. The idea was originated by Purdue nursing doctoral student Sandra
Ralston, Geddes said."She made the remarkable observation that if you pushed on the abdomen after each chest
compression you could double the CPR blood flow," he said. "So I started thinking, what
would happen if you just pushed on the abdomen and eliminated chest compression entirely?"

The procedure provides a new way to effectively perform "coronary perfusion," or pumping
blood through the heart muscle, which is critical for successful resuscitation because
the heart muscle is nourished by oxygenated blood, Geddes said."Unfortunately, in standard chest-compression CPR, blood sometimes flows in the wrong direction, which means the coronary blood flow goes backward, bringing de-oxygenated blood back into the heart muscle," Geddes said. "This retrograde flow reduces the
likelihood of resuscitation."

Findings showed that OAC-CPR eliminates this backward flow. The Purdue researchers compared coronary artery blood flow during standard chest-compression CPR with the flow resulting from only abdominal compression CPR.Findings showed that using the new method and pushing with the same force recommended for standard CPR provided 25% more blood flow through the heart muscle without retrograde
flow in the coronary arteries.

The researchers followed the standard recommended by the American Heart Association,
pushing with 100 pounds of pressure 100 times per minute."With OAC-CPR, you really don't have to press as hard or as often, but we followed the American Heart Association standard to avoid possible criticism from people who could have said we didn't observe the standard," Geddes said.

Another benefit of OAC-CPR is that it eliminates rib fractures, which are commonly caused
by compressing the chest. Rib fractures cause the chest to recoil more slowly, but
effective CPR requires that rescuers wait until the chest recoils fully before
compressing.

Geddes created a wooden "pressure applicator" that resembles a scaled-down version of a
baseball home plate. It is contoured so that it can be used to compress the abdomen
without pushing on the ribs. However, a rescuer could push with the hands to perform the
procedure if no applicator were available.Abdominal organs contain about 25% of the total blood volume in the body."You can squeeze all of that into the central circulation when you press on the abdomen,"
Geddes said.Whether the procedure gains widespread acceptance depends on whether other researchers
can duplicate the results."In research, you publish data and then the scientific community looks at the data and
tries to duplicate it to verify that it works," said Geddes, who was awarded the National
Medal of Technology from President George W. Bush in a White House ceremony on July 27.
It is the nation's highest honor for technological innovation.

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Temporal Arteritis: Don't Let This Disease Fool You

 
 Could your reoccurring headache be a sign of a much more severe disease? Older individuals who experience variable signs, symptoms, and pain in the head and jaw could be suffering from temporal arteritis, a disease characterized by inflammation in and damage to the walls of various blood vessels. Headaches typically are the characteristic feature in 60 percent of temporal arteritis cases.
 
Though the cause is unknown, dentists who encounter patients with puzzling complaints that are not explained by oral and physical findings may encourage their patients to take additional steps in order to properly diagnose this disease. Patients with temporal arteritis should be referred for medical evaluation and treatment before serious complications occur such as sudden blindness.Temporal arteritis is a disease that usually affects individuals older than 70 and increases in frequency with age.” Women, however, are three times more likely than men to suffer from this disease.
 
Signs of Temporal Arteritis:
 
bullet
Headaches
bullet
Pain in the mouth
bullet Pain when combing hair
bullet Weight loss
bullet Anemia
It is recommended that if the clinical symptoms suggest the possibility of temporal arteritis, the patient should be referred to a physician for sedimentation or a C-reactive protein (CRP) test. Both are blood test designed to detect the amount of CRP released in the blood due to the inflammation of blood vessels.

January/February 2007 issue of General Dentistry, James Allen, MD,

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August 2007

Human Papilloma Virus (HPV) Vaccines May Decrease Chances of Oral Cancer

 

 

The Centers for Disease Control report that nearly 25 million women are infected with some form of the Human Papilloma Virus (HPV).  Of those, more than three million are thought to have one of the four strains known to cause cases of cervical cancer and genital warts.

 

HPV is linked to oropharyngeal cancer and may be linked to oral cancers as well, and vaccines that have been developed to treat HPV might decrease the risk of these cancers. It has been found that oral and oropharyngeal squamous cell carcinoma (OOSCC) have been linked to high-risk HPV strains, the same strains that cause cervical cancer.Recently, a vaccine was developed to treat patients with HPV against cervical cancer, and this could have an effect on women’s oral health.

 

More than 100 strains of HPV have been identified, they have been shown to cause other benign and malignant disorders, which now include those in the mouth.  Nearly 30,000 new cases of oral and oropharyngeal cancer are reported each year.  It’s possible that oral and oropharyngeal cancers could be reduced if vaccination were more widespread; however, additional research is needed.

 

Additional research could result in a comprehensive test for dentists at patients’ semiannual visits.  However, a dentist can perform a head and neck exam to detect early signs, despite the lack of a specific test. A possible connection between HPV and oral cancers, and the stronger link to oropharyngeal cancers, is even more of an indicator that patients should visit the dentist twice a year to identify irregularities early.

 

Visiting the dentist on a regular basis is an important factor in the detection of any oral health complication. Taking preventive measures is especially important, and your dentist can check for early signs of oral cancer.


Oral Health Tips for Women:

 

bullet Keep your dentist informed about changes in oral health.
bullet Visit the dentist regularly, which will help them to detect changes in the mouth.
bullet Ask your dentist to take a full medical history to determine if you are at risk for certain problems.
bullet Ask your dentist to perform a complete a head and neck exam to detect early signs of certain conditions

May/June issue of General Dentistry, James J. Closmann, BS, DDS,(AGD).

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July 2007

ADA Affirms Benefits of ADA-Accepted Antimicrobial Mouth Rinses and Toothpastes, Fluoride Mouth Rinses

Recently, the ADA’s Council on Scientific Affairs highlighted the oral health benefits of other ADA-Accepted products such as antimicrobial mouth rinses and toothpastes that can help prevent and reduce plaque and gingivitis, and fluoride mouth rinses that can provide extra protection against tooth decay over that provided by fluoride toothpaste alone. Gingivitis is an inflammation of the gums caused by the accumulation of plaque along the gum line.

It is important to note that the ADA’s daily oral hygiene recommendations have not changed—people should still brush twice a day with an ADA-Accepted fluoride toothpaste; clean between their teeth daily with an ADA-Accepted floss or ADA-Accepted interdental cleaner; eat a balanced diet and limit between meal snacks; and visit their dentist regularly for professional cleanings and oral examinations.

Antimicrobial mouth rinses and toothpastes

Antimicrobial mouth rinses and toothpastes reduce the bacterial count and inhibit the bacterial activity in dental plaque that can cause gingivitis, an early, reversible form of periodontal (gum) disease. ADA-Accepted antimicrobial mouth rinses and toothpastes have substantiated these claims by demonstrating significant reductions in plaque and gingivitis.

Fluoride mouth rinses

Fluoride mouth rinses are used to help reduce and prevent tooth decay. Clinical studies have demonstrated that use of a fluoride mouth rinse in addition to fluoride toothpaste can provide extra protection against tooth decay over that provided by fluoride toothpaste alone. The use of fluoride mouth rinse is not recommended for children six years of age and younger because they may swallow the rinse. Consumers should always check the manufacturer’s label for precautions and age recommendations and talk with their dentist about the use of fluoride mouth rinse. ADA.org

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June 2007

Infective Endocarditis

New guidelines for prevention of infective endocarditis were released by the American Heart Association April 19. The AHA and ADA now recommend that fewer dental patients with heart disease receive antibiotic prophylaxis before dental procedures to prevent the heart infection called infective endocarditis (IE). The guidelines were developed by a group appointed by the AHA that included experts in infectious disease and cardiology and members representing the ADA. The guidelines were endorsed by the Infectious Diseases Society of America and the Pediatric Infectious Diseases Society.

After reviewing relevant scientific literature from 1950-2006, the group concluded that bacteremia resulting from daily activities is much more likely to cause IE than bacteremia associated with a dental procedure. In addition, only an extremely small number of IE cases might be prevented by antibiotic prophylaxis, even if prophylaxis is 100% effective. Based on these conclusions, antibiotic prophylaxis is now recommended before dental procedures only for patients with underlying cardiac conditions associated with the highest risk of adverse outcome from IE, such as patients with artificial heart valves, a history of endocarditis, certain serious congenital heart conditions and heart transplant patients who develop a problem with a heart valve.
For more details see ADA.org

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May 2007

Perio & Your Heart

bullet

91% of patients with coronary artery disease suffered from moderate to severe periodontitis, compared to 66% in non-cardiac patients.

bullet

Patients with severe periodontal disease are nearly 3 times more likely to have a cardiac incident.

bullet

Periodontal disease is an independent risk factor for cerebral ischemia in men and younger subjects.

National Women’s Health Week May 13-19, 2007

Snap on Teeth

 

Reality TV has provided the general public with a glimpse into the world of cosmetic dentistry with shows like “Extreme Makeover”—and people like the “quick-fix” they see. One of these quick fixes is a resin appliance (known as a clip-on smile or snap-on teeth), designed to fit over the teeth to create an esthetically appealing smile. People want a quick, inexpensive, non-invasive way to have what they perceive as a Hollywood smile. Snap-on teeth are being used by many patients to obtain a beautiful smile.

Benefits of using snap-on teeth:

bulletA dentist can determine whether or not a patient can tolerate a permanent cosmetic dental treatment, such as the placement of veneers.
bullet Provide patients with the opportunity to see how their teeth will look before choosing a more permanent solution.
bulletPatients with special needs (i.e. those who fear the dentist or who are medically compromised and should not undergo long, stressful procedures) may also benefit from the use of snap-on teeth.

Snap-on teeth, however, are not appropriate for all patients:

bullet Those with protrusive teeth, removable teeth, or who are not interested in improving their dental health are not good candidates for the appliance.
bulletPatients need to be aware that snap-on teeth are temporary and may need to be replaced often.
bulletThe product is limited to the patient’s natural bite, occlusion, and smile-line.

The fix is temporary; patients are going to need a permanent solution. The snap-on product, if used in the proper patient case, can be a safe, inexpensive, and effective temporary procedure, however, the patient can’t have unrealistic expectations; they need to know their smile will not look like Julia Roberts.

Items to note before you quick-fix:

bulletQuick-fix dentistry is just that, a “quick fix.” Treatment done is temporary and is meant to be a stepping stone to a more permanent solution.
bulletWhen approaching your dentist about snap-on teeth, be sure to discuss dental needs you should consider before opting for a cosmetic solution, such as decay and periodontal problems.
bulletThe overall look of snap-on teeth is dictated by a patient’s bite, occlusion, and smile-line (the front part of the teeth that is only visible when someone smiles).
bulletCosmetic dentistry is about creating an esthetically appealing look. You may, however, be able to get a better cosmetic look with crowns or veneers rather than using the temporary snap-on teeth.

January 2007 issue of AGD Impact

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April 2007

In honor of those serving in Iraq: Oral Fitness Resources and Fact Sheets

Fast Facts
Oral Cancer in the United States

2007 Estimates
New cases: 30,990
Deaths per year: 7,430
Five-year relative survival rate for localized stage: 82%
Five year relative survival for all stages combined: 59%
A simple toothache can be fatal.

That is the sobering message a 12-year-old Maryland boy left when, after his dental problems went untreated, he succumbed to a severe brain infection.

Deamonte Driver's life could have been spared if his infected tooth was simply removed — a procedure costing just $80.However, the Driver family faced obstacles with Medicaid, poverty, and access to resources, resulting in an easily preventable health problem turning deadly.In the end, Driver endured two surgeries and weeks of hospital care totaling about $250,000 in medical bills. Sadly, it was too late to save the boy, and he passed away on Feb. 25. "Unfortunately, this is more common than we'd like it to be," says Sally Cram, a practicing periodontist in the Washington, DC area. "A lot of children don't get dental care."

In fact, data from the Centers for Disease Control cites tooth decay as one of the most common chronic infectious diseases among U.S. children. By the age of 11, approximately half of children have decay, and by the age of 19, tooth decay in the permanent teeth affects about 68 percent of adolescents.For children in low-income families, like the Drivers, there is nearly twice the risk for untreated tooth decay."I think it is probably the least covered of our health benefits across the nation," she adds.

While this lack of care is a known problem, there are a number of issues that stand in the way."The dentist doesn't break even," says Cram. In fact, experts say the low rates Medicaid offers to cover dental services are less than what it costs the doctor to do the actual treatment

People seem to think "teeth are not a big deal," says Cram. But it's not just about your mouth. "Infections in your teeth and mouth can lead to more problems," she points out. When a cavity goes untreated for months or years, the decay eats into the center of the tooth, and eventually enters the nerves and blood vessels. From there, bacteria get into the blood stream and can travel virtually anywhere. By taking advantage of basic preventative services — like cleanings and filling cavities — people can drastically reduce their chances for severe dental disease. And with the benefit of Medicaid funding, a tremendous amount of budget funds could be saved in the long run. Across the board, education on the benefits of prevention is the most important that can be done. "It's sad that a child has to die for people to wake up," says Cram. "We need to stop putting our heads in the stand and start working together — it takes education

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New Women's Oral Health Issues by American Dental Association: Women's Dental Health Issues 2007

 

Effects of Soft Drink Consumption on Nutrition and Health: A Systematic Review and Meta-Analysis

In a meta-analysis of 88 studies, we examined the association between soft drink consumption and nutrition and health outcomes. We found clear associations of soft drink intake with increased energy intake and body weight. Soft drink intake also was associated with lower intakes of milk, calcium, and other nutrients and with an increased risk of several medical problems (e.g., diabetes).

Study design significantly influenced results: larger effect sizes were observed in studies with stronger methods (longitudinal and experimental vs cross-sectional studies). Several other factors also moderated effect sizes (e.g., gender, age, beverage type). Finally, studies funded by the food industry reported significantly smaller effects than did non–industry-funded studies. Recommendations to reduce population soft drink consumption are strongly supported by the available science.

Lenny R. Vartanian, PhD, Marlene B. Schwartz, PhD and Kelly D. Brownell, PhD The authors are with the Department of Psychology, Yale University, New Haven, Conn. Correspondence: Requests for reprints should be sent to Kelly D. Brownell, PhD, Department of Psychology, Yale University, PO Box 208205, New Haven, CT 06520-8205 (e-mail: kelly. brownell@yale.edu ).

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March 2007

Dr. Peterson's Father Died of Lung Cancer this month. 

February 2007

Oral Wounds Heal Slower in Women and Older Adults

Wounds in the mouth heal more slowly in women and older adults, a new study at the University of Illinois at Chicago reveals.

`While wounds to the skin heal more quickly in women than in men, our study suggested the opposite is true for healing of wounds inside the mouth,' said Dr. Phillip Marucha, head of periodontics at the UIC College of Dentistry.We discovered that, regardless of age, men's mouth wounds heal faster than women's.'

Older women were at the highest risk for delayed healing, their wounds closing half as slowly as younger men, Marucha said. The findings of the study, he said, could have important implications for surgical practices.

`There are an increasing number of surgical procedures being performed in older populations,' Marucha said. `A greater emphasis needs to be placed on accelerating the healing process. Discovering the reasons behind these age and sex differences will help us improve treatment, and postsurgical recovery times may be reduced.'

The study consisted of creating a small, standardised circular wound, half the diameter of a pencil, between the first and second molar of 212 male and female volunteers aged 18 to 35 years and 50 to 88 years. The wounds were videographed at the same time for seven consecutive days to assess closure.

Testosterone may help mouth wounds heal faster in men, said Christopher Engeland, research assistant professor at UIC and lead author of the study.It's a potent anti-inflammatory hormone that is abundant in saliva,' he said. Women are generally more prone to inflammatory diseases, such as rheumatoid arthritis, Engeland said. In skin, women's wounds heal faster than men's in part because inflammation causes them to close faster.

`The more inflammation a person has inside the mouth, the slower wounds appear to heal,' Engeland said. `We were surprised to learn that oral wounds heal more slowly in women than in men. It's one of the few times in the field of healing where men have an advantage over women.This indicates that the healing process in skin and mouth tissues is different in some fundamental way not previously expected.'

[www.smile-on.com Friday 2nd February 2007]

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Periodontal disease, cancer may be linked in men
 
By Jennifer Garvin

A new study reports that men with a history of periodontal disease could have an increased risk of developing pancreatic cancer.

The study, conducted by researchers at the Harvard School of Public Health, the University of San Juan and the Dana-Farber Cancer Institute, reviewed more than 51,000 male health professionals between the ages of 40 and 75. During a 16-year follow-up period between 1986 and 2002, 216 men developed pancreatic cancer.

After adjusting for age, smoking history, diabetes, obesity, diet and other potentially confounding variables, the researchers concluded that men with a history of periodontal disease had a 63 percent increased risk of pancreatic cancer compared to men without a history of periodontal disease.

The researchers presented their findings at the 2006 Frontiers in Cancer Prevention Research meeting in Boston, hosted by the American Association of Cancer Research.

While the prospective cohort study provides a long-term statistical association between periodontal disease and pancreatic cancer, it does not establish a definitive cause-effect relationship between the two conditions.

The summary of this study is among the latest in research findings posted regularly on ADA.org in the "Science in the News" section.

For more information about the link between pancreatic cancer and periodontal disease, visit, www.ada.org/prof/resources/topics/science_perio_pancreatic.asp.

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Dental DNA bank starts up at UOP
 
 

The University of Pittsburgh School of Dental Medicine has pioneered a new approach to clinical research with its Dental Registry and DNA Repository—possibly the world's first dental DNA bank.

The program, which started the initial collection of cases in September 2006, seeks clinical information and a biological sample from those seeking treatment at the dental school. Patients who sign up are asked for saliva samples and permission to look at their medical and dental charts for use in future research projects.

The project, which has 200 registrants, is the brainchild of Dr. Alexandre Vieira, the program's director and a professor of oral biology at the school.Dr. Vieira said he believes the project is "revolutionary" because "it eliminates the need for further institutional review board evaluations for projects seeking to use data from the registry."

Any time a research project deals with human subjects or identifiable information from humans, the project must be evaluated and approved by the local institutional review board or ethics in human research committee, said Dr. Vieira.

This project was designed so that any future investigation using data or samples from the registry will not be classified as human research since researchers will not be in touch with the subjects. In other words, he said, participants are protected beyond the regular standards because their samples are blind to the investigators."We have 85 percent compliance—the majority of people we approached to participate in the study said yes," he said.

For more information, visit www.dental.pitt.edu/vieira_lab/dental_registry.php 

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January 2007

Using Software to Screen Panoramic Radiographs for Osteoporosis Risk Assessment

According to new research from the University of Manchester, image analysis software is under development for measuring mandibular cortical width in digitized panoramic radiographs as a potential screening test for osteoporosis. The study received online coverage from WebMD Link opens in separate window. Pop-up Blocker may need to be disabled. and other news agencies. However, the technology still has some way to go. As the researchers acknowledge in the study, there is diagnostic potential for panoramic radiographs in the early detection of osteoporosis, but the technologies are still under investigation to determine the precise threshold for minimizing false positives.

Osteoporosis is a systemic skeletal disorder characterized by low bone mass and fragility, especially for postmenopausal women. Although the condition affects women primarily, it also occurs in men and is commonly associated with a decrease in bone mineral density. The condition has several modifiable risk factors, including smoking, inadequate dietary calcium and estrogen deficiency. Previous research Link opens in separate window. Pop-up Blocker may need to be disabled. has also reported an association between osteoporosis and tooth loss, along with alveolar bone loss. Based on current estimates, over 10 million Americans over the age of 50 have osteoporosis, and nearly 34 million individuals are at risk.1

The new study, published in the online edition of the journal Bone Link opens in separate window. Pop-up Blocker may need to be disabled.2, was performed as part of a three-year evaluation called the OSTEODENT project, which recruited 652 women aged 45 to 70 from four European centers, based in Greece, Belgium, Sweden and England. The research team developed analytical software, based on active shape modeling, to measure the width of the mandibular cortex on digitized panoramic radiographs. The researchers looked specifically at mandibular cortical width because of its reported correlation with bone mineral density at the hip, lumbar spine and forearm, three common areas of osteoporotic bone fracture.

Results from the computerized evaluation of panoramic radiographs were compared to a standard method of diagnosing osteoporosis: dual energy X-ray absorptiometry (DXA) of the hip, spine or femoral neck. With DXA scans, 140 women were identified as having osteoporosis at one of the three measurement sites. By comparison, the software evaluation of panoramic radiographs identified over half of the 140 women whose osteoporotic status was confirmed with DXA scans. The research team claimed that, with further refinement, more at-risk individuals could be identified using their software-based screening test for skeletal osteoporosis.

Because the diagnostic accuracy of cortical width measurements is less than perfect, the dental panoramic radiograph would not be taken for osteoporosis screening per se, but could be evaluated for osteoporosis if the radiographs were exposed for dental purposes. The researchers also caution that radiographic measurements cannot be used as the sole basis for referral, and that the patient's medical history must be evaluated before undertaking further referral or investigation.

Footnotes

1 U.S. Department of Health and Human Services. Bone Health and Osteoporosis: A Report of the Surgeon General. Rockville, MD: U.S. Department of Health and Human Services, Office of the Surgeon General, 2004. Available at: “http://www.surgeongeneral.gov/ library/bonehealth/content.html Link opens in separate window. Pop-up Blocker may need to be disabled.“. Accessed January 10, 2006 .

2 Devlin H, Allen PD, Graham J, Jacobs R, Karayianni K, Lindh C, van der Stelt PF, Harrison E, Adams JE, Pavitt S, Horner K. Automated osteoporosis risk assessment by dentists: as new pathway to diagnosis. Bone 2006 Dec 21; [Epub ahead of print].  ADA 1.07

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October 15, 2007

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