Thursday, March 21, 2019

DMG Offers Two New CE Opportunities for Provisional Restorations

 

 

Live webinar and recorded podcast help clinicians enhance outcomes and efficiency

 

Those of you who are interested in great learning experiences are in for a treat.  Two incredibly knowledgeable and entertaining speakers are going to be providing some great information courtesy of DMG.  Dr. David Little and Dr. Gary Radz will both be bringing their clinical experiences, tips, and tricks to 2 different programs.  I’ve both of these gentlemen for well over ten years and I can tell you first hand that these guys are the real deal.  After these programs you will have good info that you can immediately put to place in your practice the very next day.  Quite honestly, I cannot say enough good things about these 2 individuals.  They are not only tremendous teachers, they are tremendous human beings as well.

Make sure that you set time aside to get these 2 programs into your schedule.  Oh, and be sure to patronize DMG for being gracious and smart enough to provide these programs.

 

Here is all the info:

 

DMG, a leading manufacturer of dental restorative materials and preventive products, announced a new webinar and a new podcast that offer continuing education on the
topic of provisional restorations.


At 7:00 pm ET on Thursday, March 28, 2019, David Little, DDS will conduct a live webinar titled “Solutions for Implant Supported Provisional Restorations.” The webinar will focus on a discussion of materials and techniques for direct implant provisionals as well as indirect techniques, including digital technology. The topic will be of great interest to any clinician who places implants, as provisional restorations play a vital role in achieving predictable and successful outcomes in implant dentistry.


Interested clinicians can register for the webinar at http://dmglearning.com/upcoming.asp. For those who cannot view the live webinar, it will be available on an on-demand basis beginning in early April at
http://dmglearning.com/training.asp. Both live and on-demand viewers will receive 1.0 CEU.


In addition, DMG has released a new podcast, “Efficiencies in Fabrication of a Long Term Provisional Crown.”  Featuring an interview with Gary Radz, DDS, the episode discusses how efficiency can be enhanced in the fabrication of long term provisional crowns as well as in clinical applications and techniques while delivering excellent outcomes. The 15-minute episode, for which listeners will receive 0.25 CEU, can be accessed at https://vivalearning.com/member/podcast.asp?x_podcastId=115.


For information about DMG and its category-defining products, please visit https://www.dmg-america.com/.


About DMG


DMG America LLC manufactures and distributes market-leading restorative materials and preventive products that are internationally recognized for their quality and innovation. Known for breakthrough
material technology, including flagship products Luxatemp, LuxaCore Z Dual, and the revolutionary Icon resin infiltrant, DMG is committed to helping the dental profession meet its materials needs through
innovation, collaboration and dedication. For more information about DMG products, or to find a sales representative, visit them online at dmg-america.com, or call (800) 662-6383.


ADDRESS


DMG America
65 Challenger Road, Suite 340 Ridgefield Park, NJ 07660 | USA

Wednesday, March 20, 2019

Off to the Thomas P. Hinman Dental Meeting

 

I’m off to Atlanta to lecture for the Thomas P. Hinman dental society and their superb Hinman Dental Meeting.

Over the years, I’ve been incredibly blessed to be given the opportunity to lecture at a lot of meetings, and the Hinman meeting ranks up there as one the most amazing experiences.  It delivers top-notch education in a tremendous environment and is topped off by tremendous Southern Hospitality.  The good folks at the Hinman Dental Society do a lot of wonderful things for the profession and the Thomas P. Hinman Dental Meeting is just one of them.  I always have a great time when I’m there and I am truly honored to help carry on the tradition started by Dr. Hinman back in the late 1800’s.  Dr. Hinman had a strong belief and focus on education and that has continued at the meeting to this day.
While I’m there, I’ll be teaching a hands-on course on Endodontics for the General Practitioner, a course on the benefits and science of clinical lasers, and one of my favorite lectures to present “Day to Day Technology” that is a chance for me to share about many of the tech tools that I use on a daily basis.
If you’re at the meeting, please be sure to look me up and say hi.  If you haven’t decided on all of your courses yet, I’d be honored to have you participate in one of mine.
Here is the history of the meeting.  After reading this, I’m confident that you will understand why I am so honored to be asked to be a part of it...
The History of Hinman
The Thomas P. Hinman Dental Meeting is sponsored by the Hinman Dental Society, a non-profit organization. The first meeting was held in 1912 by Dr. Thomas P. Hinman and was considered to be the first clinic strictly for serious-minded educational purposes. The meeting developed a reputation for devotion to detail and hospitality that continued to grow through the years with every meeting. These qualities are represented in the motto: Devotion to detail is the secret of success.

Born in 1870, Thomas Hinman graduated from Southern Dental College in Atlanta with his Doctor of Dental Surgery degree in 1891. The following year, he joined the faculty of his alma mater and became Professor of Oral Surgery. Dr. Hinman held high offices in many professional organizations including the appointment by President Woodrow Wilson as the U.S. Delegate and Honorary Chairman of the Section VIII of the Fourth International Congress of Dentists in London. This nomination was considered one of the highest tributes in the dental world.

The first classes for the Atlanta Midwinter Clinic, later renamed the Hinman Dental Meeting, were initially limited to 40 dentists with strict focus on education. The attendee was honor bound to return to his state dental society and present what he had learned in a formal program.

By the late ‘20's, the clinic was attracting national attention. Year after year, featured clinicians and attendees spread the word about the informative programs offered and the extraordinary hospitality extended to them. As the meeting grew, the location changed. The first meetings were held in the Piedmont Hotel, the Ansley Hotel, and, later, the Biltmore Hotel.

Exhibits were introduced in 1942 with 14 booths appearing in the Ballroom at the Biltmore Hotel. The meeting then moved to the Atlanta Municipal Auditorium at Courtland and Gilmer Streets in 1944 followed by the move to the new Atlanta Marriott Motor Hotel in 1966. In 1977, the meeting expanded to the Atlanta Hilton and Towers, and in 1986, it shared space between the Hilton and the new Atlanta Marriott Marquis. With the continued growth of meetings and exhibits, the Society voted to move the meeting to the Atlanta Market Center, using exhibit and meeting space in INFORUM, the Apparel Mart and the Merchandise Mart. In 1998, the meeting moved to the Georgia World Congress Center.

In 2018, nearly 20,000 dental professionals participated in the 106th annual Thomas P. Hinman Dental Meeting at the Georgia World Congress Center and Omni Hotel at CNN Center. The exhibits program included representatives from nearly 400 companies occupying more than 800 booths. Attendees were housed in 23 hotels in downtown, midtown, and Buckhead. They traveled from all 50 states and as far away as Japan and New Zealand.

Today, the focus is still on providing the best possible continuing dental education, not just for the dentists but also, the whole dental team. The program addresses the needs of the general dentists, specialists, hygienists, assistants, front office staff, laboratory technicians and students.

The Hinman Dental Society today is comprised of 800+ dentist members, primarily located in metropolitan Atlanta. The membership responsibilities include service during the meeting each year. This service enhances the reputation for unparalleled hospitality to continue. The combination of outstanding education and hospitality ensures the position of the Hinman Dental Meeting as one of the top dental programs in the country. 

The excess revenue of the Meeting is invested and then gifted in the form of scholarships to individuals and institutions that foster dental education whether at the undergraduate or post-graduate level. The society has provided nearly $8,600,000 in total giving.

Tuesday, March 19, 2019

Wolverine Solutions Group Notifies 600,000 Patients of Data Breach

 
The breaches just keep on occurring and I keep reporting them in an attempt to help you readers understand how important data security is and how vigilant we all need to be.  If the professionals in this space are getting hacked, it’s that much easier for the bad guys when they turn their attention on us.
 
This latest event comes from the state of Michigan where a company named Wolverine Solutions Group has announced a breach that affected over 600,000 patients.  The company "performs services for health-related business clients”.  Among those clients is Blue Cross Blue Shield of Michigan, Helath Alliance Plan, Three Rivers Health, North Ottawa Community Health System, Mary Free Bed Rehabilitation Hospital, Covenant Hospital, Sparrow Hospital, and McLaren Health Care.  
 
In September, WSG was hit by a Ransomware attack which caused hard drives containing patient data to become encrypted and therefore inaccessible.  The company began to decrypt the files beginning on October 3rd and managed to get all files restored by October 25th.
 
The company began notifying patients and updated their announcement on February 27th, 2019.
 

 

Wolverine Services Group (“WSG”) performs services for health-related business clients, including various health plans and hospital systems (“Healthcare Clients”). We are posting this statement on our website as a precautionary measure and as part of our commitment to patient privacy. WSG takes patients’ privacy seriously, and it is important to us that you and the community that we serve are made fully aware of a recent security incident at WSG, which potentially involves personal information of health plan members and hospital patients.

 

On approximately September 25, 2018, WSG discovered that an unauthorized party gained access to its computer system and infected the system with malware. The malware encrypted many of WSG’s records, which made them inaccessible, in an effort to extort money from us. This is commonly referred to as “ransomware.”

Shortly after WSG learned of the incident, we began an internal investigation and hired outside forensic security experts to help us. A team of forensic experts arrived on October 3, 2018 to begin the decryption and restoration process. All impacted files needed to be carefully “cleaned” of any virus remnants prior to their review by forensic investigators. Most critical programs requiring decryption were restored by October 25, 2018, and WSG’s critical operations were running by November 5, 2018. However, the forensic team continued its decryption efforts on the impacted files to determine the type of information that was affected, the identities of our Healthcare Clients, and the specific individuals involved. Beginning in November and continuing in December, January, and early February, WSG discovered and was able to identify those Healthcare Clients whose information was impacted by the incident. The timing of our notices to impacted individuals has been based on these “rolling” discovery dates.  The first notices were mailed on December 28, 2018. Additional notices have been mailed in February and further notices will be mailed in March.  

 

As a result of our investigation, WSG believes that the records were simply encrypted. There is currently no indication that the information itself was extracted from WSG’s servers. Nevertheless, given the nature of the affected files, some of which contained individual patient information (names, addresses, dates of birth, social security numbers, insurance contract information and numbers, phone numbers, and medical information, including some highly sensitive medical information), out of an abundance of caution, we mailed letters to all impacted individuals recommending that they take immediate steps to protect themselves from any potential misuse of their information.

 

WHAT WE ARE DOING

 

WSG is taking steps to guard against identity theft or fraud. We arranged for affected individuals to have AllClear ID protect their identity. The following identity protection services start on the date of the individual receiving a notice letter and can be used at any time during the next 12 months.

 

AllClear Identity Repair: This service is automatically available to you with no enrollment required. If a problem arises, simply call 855-861-4034and a dedicated investigator will help recover financial losses and restore your credit.

 

AllClear Fraud Alerts with Credit Monitoring: This service offers the ability to set, renew, and remove 90-day fraud alerts on your credit file to help protect you from credit fraud. In addition, it provides credit monitoring services, a once annual credit score and credit report, and a $1 million identity theft insurance policy. To enroll in this service, you will need to provide your personal information to AllClear ID. You may sign up online at enroll.allclearid.com or by phone by calling 855-861-4034. You will need to contact AllClear to obtain a Redemption Code to enroll in this services.

 

We also want to note that following your enrollment, additional steps are required by you in order to activate your AllClear phone alerts and fraud alerts, and to pull your credit score and credit file. Additional steps may also be required in order to activate your monitoring options.

 

We recommend you remain vigilant and consider taking one or more of the following steps to protect your protected health information or personal information:

 

Contact the nationwide credit-reporting agencies as soon as possible to add a fraud alert statement to your credit file at all three national credit-reporting agencies;
Remove your name from mailing lists of pre-approved offers of credit for approximately six months;
Receive a free copy of your credit report by going to www.annualcreditreport.com;
Pay close attention to all bills and credit-card charges you receive for items you did not contract for or purchase;
Review all of your bank account statements frequently for checks, purchases, or deductions not made by you;
If you suspect or know that you are the victim of identity theft, you should contact local police and you also can report this to the Fraud Department of the FTC.
We also recommend that you regularly review statements from your accounts (i.e., account statements and Explanations of Benefits (“EOB”)) and periodically obtain your credit report from one or more of the national credit reporting companies. You may obtain a free copy of your credit report online at www.annualcreditreport.com, by calling toll-free 1-877-322-8228, or by mailing an Annual Credit Report Request Form (available at www.annualcreditreport.com) to: Annual Credit Report Request Service, P.O. Box 105281, Atlanta, GA, 30348-5281. You may also purchase additional copies of your credit report by contacting one or more of the three nationwide consumer reporting agencies listed below.

 

Equifax:           P.O. Box 740241, Atlanta, Georgia 30374-0241, 1-800-685-1111, www.equifax.com

 

Experian:         P.O. Box 9532, Allen, TX 75013, 1-888-397-3742, www.experian.com 

 

TransUnion:    P.O. Box 1000, Chester, PA 19022, 1-800-888-4213 www.transunion.com

 

When you receive your credit reports, account statements and EOBs, review them carefully.  Look for accounts or creditor inquiries, transactions or services that you did not initiate or do not recognize.  Look for information, such as home address and Social Security Number, which is not accurate.  If you see anything you do not understand, call the consumer reporting agency at the telephone number on the report, the company issuing the account statement, your provider rendering services or the insurance company issuing your EOB. Additional information regarding Identity Theft Protection is available here.  We have also posted a list of Frequently Asked Questions, which is available here.

 

We take the protection of your personal information seriously and took steps to prevent a similar occurrence. We migrated to a different computer system that has added protections and trained our workforce in safeguards.

 

If you have further questions about identify protection services, please contact enroll.allclearid.com or by phone by calling 855-861-4034.  We sincerely apologize to you and all our Healthcare clients for concern caused by this incident.

 

Sincerely,

Wolverine Solutions Group

Monday, March 18, 2019

Even the Watchers are Vulnerable to Security Problems

 
 
 
 
In this world where data security is of the upmost importance for both confidentiality AND to avoid costly fines, even those who are in charge of enforcing the regulations must be constantly vigilant of their own data security.
 
The OIG (Office of Inspector General) or the U.S. Department of Health and Human Services, has released a report detailing its penetration testing of several different HHS networks.  Pen testing as it’s known stands for “penetration testing” and is basically utilizing any and all methods to get past security.  This includes both hardware & software hacking over the Internet as well as “Social Engineering” which is convincing someone to give you information that they shouldn’t via some method of manipulation.  
 
No matter who you are, everyone needs to be aware of the ways data can be compromised, and in actuality, it’s more common for social engineering to at least start the process than just straight out hacking.  So even though HHS is in charge of enforcing the laws regarding patient data security, they also are subject to attacks and need to be prepared and informed.
 
To that end, the OIG ran penetration testing on 8 HHS Operating Division Networks and here is what they found:
 
We conducted a series of audits at eight HHS Operating Divisions (OPDIVs) using network and web application penetration testing to determine how well HHS systems were protected when subject to cyberattacks.

 

Our objectives were to determine whether security controls were effective in preventing certain cyberattacks, the likely level of sophistication an attacker needs to compromise systems or data, and HHS OPDIVs' ability to detect attacks and respond appropriately.

 

During fiscal years 2016 and 2017, we conducted tests at eight HHS OPDIVs. We contracted with Defense Point Security (DPS) to provide knowledgeable subject matter experts to conduct the penetration testing on behalf of OIG. We closely oversaw the work performed by DPS, and testing was performed in accordance with generally accepted government auditing standards and agreed-upon Rules of Engagement between OIG and the OPDIVs.

 

On the basis of the systems we tested, we determined that security controls across the eight HHS OPDIVs needed improvement to more effectively detect and prevent certain cyberattacks. During testing, we identified vulnerabilities in configuration management, access control, data input controls, and software patching.

 

We shared with senior-level HHS information technology management the common root causes for the vulnerabilities we identified, information regarding HHS's cybersecurity posture, and four broad recommendations that HHS should implement across its enterprise to more effectively address these vulnerabilities. We also provided separate reports with detailed results and specific recommendations to each OPDIV after testing was completed. We will be following up with each OPDIV on the progress of implementing our recommendations.

 

Based on the findings of this audit, we have initiated a new series of audits looking for indicators of compromise on HHS and OPDIV systems to determine whether an active threat exists on HHS networks or whether there has been a past breach by threat actors.

 

We provided to HHS a restricted roll-up report of the results of our testing at the eight OPDIVs. The report included four broad recommendations that HHS should implement across its enterprise.

 

In written comments on our draft summary report, HHS management concurred with our recommendations and described actions it has taken or plans to take to ensure they are addressed. HHS also indicated that the OPDIVs have incorporated actions to address their individual vulnerabilities and that HHS will follow up with them to ensure that these have all been addressed.

 

We would like to thank HHS and its OPDIVs for the cooperation we received throughout the penetration testing.

Thursday, March 14, 2019

Last Chance Online Registration for ALD 2019: Dentistry’s Laser Meeting

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“The Laser-Systemic Connection: Lighting the Way to a Healthier Mouth and Body” is Taking Place in Dallas on April 4th-6th in Dallas, Texas

 

The Academy of Laser Dentistry (ALD), the only independent and unbiased non-profit association dedicated to improving patient care with the proper use of laser technology, is announcing that March 29th will be the last day to register online for its upcoming annual conference and exhibition.

We’ll still accommodate on-site registrations during the conference, but lectures are expected to be standing room only and several hands-on workshops are already sold out,” explained ALD executive director Gail Siminovsky, CAE.  

Known internationally as “Dentistry’s Laser Meeting”, ALD 2019 is at the Hilton Dallas/Plano/Granite Park from April 4th – 6th. The meeting’s focus is “The Laser-Systemic Connection: Lighting the Way to a Healthier Mouth and Body.”

We’re very excited about the theme of ALD 2019,” said Siminovsky. “For decades, ALD members were the unsung heroes of oral-systemic health. First by applying laser technology to treat periodontal disease and more recently, by applying light therapy to help patients suffering from the oral mucositis side-effects of chemotherapy, TMJ, sleep apnea and other medical conditions.”

The educational tracks and workshops that support the laser-systemic connection theme include the following:

• Innovation, Wellness and Medically Compromised Patients
• Periodontal Disease Diagnosis and Treatment
• Photobiomodulation
• Obstructive Sleep Apnea

The ALD 2019 program is rounded out by educational sessions and/or workshops on the following topics:

• Hygiene
• Pediatric Dentistry
• Endodontics
• Implantology
• Oral Surgery
• Laser Safety Training
• Financial Planning/Wealth Management

Kicking off ALD 2019 will be keynote speaker Charles Whitney, MD, the nation’s leading physician advocate for bridging the oral-systemic gap. Dr. Whitney’s specialty of heart attack, stroke and dementia prevention relies heavily on collaborating with dental clinicians to accurately diagnose and effectively treat periodontal disease.

Dr. Whitney’s presentation will help ALD 2019 attendees connect the dots on how to bring the message of oral-systemic connections into their practices, “I love watching the lightbulb go on in the eyes of my audience when they learn how to take the oral-systemic message to the streets,” commented Whitney. “I hope I can help ALD members recognize that on a good day they can save a tooth and on a great day they can save a life! “

What’s more, Dr. Whitney has seen first-hand the beneficial effects of laser dentistry on his own patients. In fact, he recently referred one of his patients to ALD incoming president Dr. Mel Burchman, who successfully treated the patient’s chemo therapy-induced oral mucositis with photobiomodulation therapy.

“Having Dr. Whitney as our opening keynote speaker will certainly set the tone for ALD 2019,” explains Siminovsky. “Our goal for this meeting is to be the world’s go-to event where the entire dental team can learn how to bridge the oral-systemic gap using laser technology.”

Watch the ALD 2019 preview video by clicking http://bit.ly/2TOAlOL. Register online until March 29th by visiting https://ALD2019.com.

About the Academy of Laser Dentistry:

The Academy of Laser Dentistry (ALD) is the only independent and unbiased non-profit association devoted to laser dentistry and includes clinicians, academicians and researchers in all laser wavelengths. The Academy is devoted to clinical education, research, and the development of standards and guidelines for the safe and effective use of dental laser technology. ALD was founded in 1993, with the merging of the International Academy of Laser Dentistry, the North American Academy of Laser Dentistry and the American Academy of Laser Dentistry. For more information, visit www.LaserDentistry.org.

 

Wednesday, March 13, 2019

Benco and VOCO Announce New Partnership

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Benco Dental announces a new partnership with VOCO, an almost 40-year global leader in the manufacturing of dental materials and technologies.  This collaboration delivers VOCO’s extensive product line of high- quality direct and indirect materials and digital workflow technologies to Benco customers.
 

Benco Dental, headquartered in Northeastern Pennsylvania, is the largest family-owned dental distributor in the United States, offering a full array of supplies, equipment and services to dentists across the nation. Within the past 88 years, the company has developed distribution innovations that have become industry standards and in 2018, launched an Innovation Index. This key metric tracks the percentage of products sold that were introduced in the previous three years.

Based out of Cuxhaven, Germany, VOCO performs extensive research and development in the fields of direct and indirect restoratives, oral care and digital dentistry, setting new standards in the creation of innovative dental products and application aids to provide better solutions to dentists throughout the world. VOCO researchers partner and maintain close contact with over 150 universities and research institutes worldwide, and have been leading several research projects co-sponsored by the German Federal Ministry of Research. This has enabled VOCO to act as a technological forerunner in several material development areas. As a leader in Nano-technology, VOCO products have received high praise and recognition in the U.S. with top ratings from The Dental Advisor, Reality and other independent institutes.

VOCO exports to over 100 countries on six continents. Benco’s national network includes five distribution centers and three design showrooms and features a highly-skilled team of more than 400 professionally trained sales representatives and over 300 factory-trained service technicians.

For details, visit benco.com or call 1.800.GO.BENCO.

Tuesday, March 12, 2019

NSA to Release Ghidra Reverse Engineering Software Tool for Free Download

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Your Tax Dollars at Work!
 
At a recent security conference, RSA, a new reverse engineering software tool was demonstrated by none other than the National Security Agency.  The super secret government organization is the one that provides cyber security as well as cyber tracking.  Osama Bin Laden’s courier was tracked to the house in Abbotobad by these folks.  The group is so super secret about what it does that, for a while, the government would neither confirm nor deny its existence leading to the joke that NSA stood for “No Such Agency”.  This cyber spying agency has been known to break into systems world wide to aid national intelligence.
 
That’s why this story is such a big deal.  NSA’s Senior Advisor Rob Joyce demonstrated the tool which is called “Ghidra”.  In addition to providing a demonstration to the conference attendees, Joyce also made the announcement that the NSA would make the program available for download and they’ve also made it open source.  That means the program will be free and others can tinker and make improvements in it.  Although not yet available, when it is you will be able to download it from this link.
 
Ghidra is said to be a very powerful SRE (software reverse engineering) tool.  It is written in Java which means it is pretty much operating system agnostic.  That will allow it to run on Linux, Windows, and Mac easily.  Because it is in Java there isn’t even an install routine.  Simply download and run.
 
This should provide some fun for tinkerers and some real help for professionals looking to peer into the inner workings of programs.
 
Of course it also makes you wonder.  If the NSA is giving this away it must be no longer useful to them.  What are they using now and how robust is whatever it is?  This is one of those great mysteries that truly, for almost all of us, has no answer.  Still it’s fun to ponder.  These types of security things fascinate me.  If you are a diehard gear head, get your hands on this tool and see what it can do. 

Monday, March 11, 2019

‘Dozens’ of Northwestern Memorial Hospital Employees Fired for Accessing Jussie Smollett’s Medical Records

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Here is an interesting story that I came across and I feel really compelled to share it with you.  As regular readers of the blog know, I’ve got a serious interest security and since I’m also in the healthcare area, that translates to also being concerned about patient data security and PHI (Protected Health Information).  Usually when I think of a HIPAA violation I think of some type of data breach where an intruder steals patient data.  However, this case is completely different and even though it may not apply to very many dental scenarios (as dental offices have exponentially fewer employees) I think it still information that is pertinent to a security discussion.
 
While most of you in dentistry probably do not have a practice filled with celebrities, there are still some lessons to be learned from this story.  The biggest and most important lesson is employees need to know that they can only access PHI if they have a legitimate reason to do so.  
 
The following story is from the HIPAA Journal and details how Northwestern Memorial Hospital in Chicago dealt with employees who choose to access the records of Jussie Smollett without proper authorization or medical reason to do so.  It’s an article that provides some good lessons.
 

A major case of snooping on celebrity medical records has been reported that has resulted in ‘dozens’ of healthcare workers being fired from Chicago’s Northwestern Memorial Hospital for accessing the medical records of Jussie Smollett without authorization.

Jussie Smollett attended the hospital’s emergency room for treatment for injuries sustained in an alleged racially motivated attack by two men on January 29, 2019.

Following a police investigation into the alleged attack, Chicago Police Superintendent Eddie Johnson announced that the Empire actor had been arrested on February 21 and charged with disorderly conduct and filing a false police report. The police allege that the attack was a hoax and that it had been staged by Smollett as a publicity stunt.

Curiosity got the better of some employees at Northwestern Memorial Hospital who searched for Smollett on the hospital’s system, some of whom accessed his chart and viewed his medical records.

Accessing the medical records of patients without authorization is a violation of Health insurance Portability and Accountability Act (HIPAA) Rules and can result in disciplinary action and, in certain cases, criminal penalties for the employees concerned.

Northwestern Memorial Hospital reviewed PHI access logs and took decisive action over the privacy violations. Employees found to have snooped on Smollett’s medical records were fired.

Northwestern Memorial Hospital has neither confirmed that Smollett was a patient nor provided information about the number of employees that have been terminated, stating that HIPAA prevents such information from being disclosed.

Some employees that were terminated have spoken to the media about the incident. CBS Chicago claims dozens of hospital employees have been terminated for the HIPAA violations while NBC Chicago has reported there have been at least 50 terminations for snooping.

Thursday, March 7, 2019

Colgate® Announces Recipients of the Colgate Award for Research Excellence (C.A.R.E.)

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I’m always grateful for those who do research.  Science is a difficult job, but without it advancement in every area of our lives would come to a screeching halt.  The health sciences have expanded their knowledge bases exponentially over the last few years and we owe a debt of gratitude to those folks who toil everyday in a lab/research based world for that knowledge.  Because of that, it’s always awesome to see companies recognize the scientists who work for all of this knowledge, doing so simply because they love what they do and want to see suffering end.

So I was excited to learn about this research recognition program that is done by Colgate.  I want to express my gratitude to Colgate for providing these awards.

 

Colgate is pleased to announce this year’s recipients of the Colgate Award for Research Excellence (C.A.R.E.). The C.A.R.E. Program recognizes a new generation of academic researchers by providing up to $30,000 USD (per project) to support oral health research projects across multiple disciplines.

The four junior faculty members chosen to receive this year’s awards are:

• Abdelhabibe Semlali, MS, PhD — Laval University, Faculty of Dentistry, Quebec, Canada.
Research Topic: “Investigation of a Curcumin Analog (PAC) for oral diseases treatment.”

• Annie Shrestha, BDS, MSc, PhD, FRCD (C) — University of Toronto, Faculty of Dentistry, Ontario, Canada.
Research Topic: “Injectable, Thermosensitive Scaffolds Modulate Immune Cells and Regulates Healing.”

• Brian Partido, MSDH, BSDH — The Ohio State University, College of Dentistry, Columbus, Ohio.
Research Topic: “Impact of peri-implant treatment using glycine powder air-abrasive debridement on the oral microbiome.”

• Keith Da Silva, DDS, MSc, FRCD (C) — University of Saskatchewan, College of Dentistry, Saskatoon, Saskatchewan, Canada.
Research Topic: “Developing a multi-disciplinary and integrated approach to improve oral health for vulnerable children in Saskatoon.”

Proposals were reviewed by an independent, esteemed group of senior academic dental researchers. Winners were selected based on program criteria, which included innovation, clinical significance, originality, and scientific quality. C.A.R.E. grants are typically offered for periods of 12 months.

“The C.A.R.E. Program fosters the development of junior faculty by providing seed research funding to emerging leaders in academia at a time in their career path when it is most needed,” said Maria Ryan, Vice President and Chief Dental Officer, Global Technology at Colgate. “Every year, we look forward to meeting and supporting talented researchers in the early stages of their careers. We are pleased to fund innovative projects that promise to advance industry knowledge and perhaps even revolutionize the field of dentistry. On behalf of Colgate, sincere congratulations to the winners of this year’s grant awards.”

Established in 2016, the Colgate C.A.R.E. Program is designed to foster and provide financial support to young academic researchers. In order to be eligible for the Colgate C.A.R.E. grant, faculty applicants must be in the first five years of an academic appointment.

For more information about the Colgate C.A.R.E. Program for Young Academic Researchers and application guidelines, visit www.colgateprofessional.com/care-program (USA) or www.colgateprofessional.ca/en-ca/care-program (Canada).

 


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Wednesday, March 6, 2019

New Material Under Development May Increase Longevity of Dental Composite Restorations

OHSU logo.jpg
 
Researchers at Oregon Health & Science University have been working on a way to improve dental composite restorations (white fillings).  Currently the research team feels they have created a material that might be able to double the life of fillings.  Currently the standard placement of composite fillings last somewhere between 5-10 according to the majority of studies done on the subject.  OHSU researchers are hoping to double that.
 
Perhaps one of the best things about this discovery, at least for me, is that one of the researchers and developers is Dr. Jack Ferracane.  I’ve known Dr. Ferracane for several years and he is well respected in the industry and a researcher at the top of his game.  Many discoveries show incredible promise but fail to deliver.  I’m optimistic that, with his involvement, this situation will come to fruition.
 
The team is using Thiourethane-Modified fillers to increase the strength of the material and this seems to show great promise in the lab and the results are intriguing and promising.
 
The original report can be found at nature.com if you want to see the tables or download and save it.  In case you just want to read it, here it is:
 
Toughening of Dental Composites with Thiourethane-Modified Filler Interfaces

Ana P. Fugolin, 
Daniel Sundfeld, 
Jack L. Ferracane & 
Carmem S. Pfeifer

Abstract
Stress of polymerization is one of the most significant drawbacks of dental resin composites, since it is related to poor marginal adaptation, postoperative pain, and secondary caries. Previous studies have shown that thiourethane oligomers incorporated into the organic matrix represents a promising strategy to reduce stress and increase fracture toughness in dental composites. However, this strategy promotes a significant increase of the viscosity system, which may represent a challenge for clinical application. The objective of this study was to functionalize the surface of inorganic filler particles with thiouretanes and evaluate the impact on mechanical properties and kinetics of polymerization. Our results showed that composites filled with thiourethane-silanized inorganic fillers showed up to 35% lower stress while doubling mechanical properties values. This was achieved with no prejudice to the viscosity of the material and following a clinically acceptable photoactivation protocol.
Introduction
Resin composites are widely used for direct restorative procedures due to their esthetics and generally acceptable mechanical properties. However, composite restorations last an average of only about 10 years1, with failures being more commonly associated with material fracture and secondary decay2. Stress generation has been hypothesized to facilitate bacterial infiltration and biofilm formation at the interface between the tooth and the restoration, and when combined with composite material degradation by hydrolysis and enzymatic attack, may explain the relatively short life-time of composite restorations3. Therefore, research efforts have concentrated on modifying composition to render the composite material less prone to stress generation at the bonded interface4, and more resistant to fracture5.

Recent studies6,7,8,9 have demonstrated the potential of a relatively simple approach to improve conversion and fracture toughness of dental resin-based composites, while at the same time reducing polymerization stress. It has been shown that the addition of relatively small concentrations of thiourethane oligomers to the organic matrix of resin composites and luting cements leads to a 50–60% reduction in stress and a two-fold increase in fracture toughness6. Since the additive is simply incorporated into the traditional composite during formulation, no modification of the normal operatory technique is required, which in turn should facilitate its translation to clinical practice6. These benefits are achieved through the presence of pendant thiol functionalities on the backbone of the thiourethane additive6. As it has been widely demonstrated for thiol-ene10 and thiol methacrylate reactions11, thiols, via chain-transfer reactions, lead to delayed gelation and vitrification in vinyl-based polymer networks. This, in turn, allows for greater conversion to be achieved12, and for modulus development in the material to be delayed to higher conversion values11, ultimately leading to lower contraction stress generation. In addition, thiol-containing networks have been demonstrated to produce materials with narrow tan delta peaks in dynamic mechanical analysis11, characteristic of more homogeneous polymer networks13. This, combined with the flexibility of thio-carbamate bonds, results in increased toughness8 and reduced polymerization stress14.

One potential pitfall of including pre-polymerized additives, however, is the increase of viscosity, which limits the amount that can be incorporated into the monomer matrix. The addition of thiourethanes above 20 wt% in concentration increases the viscosity of the monomer mixture, which prevents the incorporation of adequate amounts of inorganic filler, and also leads to a slight decrease in elastic modulus6.

One possible way to incorporate the thiourethane oligomer in the composite material and overcome the viscosity issue is to attach it directly to the surface of the filler particle via common silanization procedures15. Others have demonstrated the use of polymer brushes to functionalize silicon-containing surfaces16 with reported decrease in polymerization stress, as well as evidence for strengthening mechanisms such as crack deflection17. Considering the average surface coverage with conventional methacrylate silanes (about 5%) for a composite with 70 wt% filler content, it should be possible to incorporate an equivalent amount of thiorethane in the composite. In that case, the oligomer is distributed throughout the material through attachment to the filler particles, with no negative effect on the viscosity of the monomer matrix itself.

The aim of the present study was to examine different properties of resin composites containing inorganic filler particles silanized with a thiourethane oligomer obtained by the combination of tri- and tetra-functional thiols with different isocyanates. The hypotheses of the study were: (1) Filler particles functionalized with thiourethane will be easily distributed into a resin matrix without negatively affecting kinetics of polymerization and depth of cure, and (2) fracture toughness will be improved and stress polymerization reduced in the groups with thiourethane-silanized particles.
Results
Thermogravimetric Analysis
The TGA results showed that the TU fillers had at least 48.5% more organic content than the commercially obtained methacrylate-silanized filler, i.e., particles functionalized with thiourethanes showed more oligomer available on the filler surface than the commercial particles silanized with methacrylate 

Fracture toughness, polymerization stress, degree of conversion, and viscosity
Compared to the composite with the unsilanized filler and the control with a methacrylate silanized filler, the KIC was significantly increased by the addition of thiourethane-silanized particles, and polymerization stress was significantly reduced (Table 2). In terms of KIC, the exception was TMP:BDI, which presented values statistically similar to SIL-MA control group. In terms of stress, all thiourethane-modified groups presented lower stress than the control, except for PETMP:BDI and PETMP:DHDI, which had similar values compared to the control. In general, the addition of thiourethane-silanized filler particles increased or did not influence the final DC and the viscosity of the composites. DC values ranged from 42–50% (Table 2). TMP:DHDI presented higher values than the controls (SIL-MA and UNS) and PETMP:BDI, and similar to TMP:BDI, TMP:HDDI, PETMP:HDDI, and PETMP:DHDI. Viscosity results ranged from 15.0–11.5 Pa.s and, in general, thiourethane-silanized filler groups presented similar or lower values than the controls.

Polymerization reaction kinetics
There was statistical difference between the maximum rate of polymerization values (Rp max, Table 3). TMP-DHDI was greater than all groups, except for UNS and PETMP-HDDI. The lowest results were obtained for SIL-MA. Figure 1 shows the kinetic profiles for all tested groups. The degree of conversion at maximum rate of polymerization (DC at Rp max), used to estimate the conversion at the onset of vitrification, ranged from 7–14%, and showed a tendency for higher values with the groups containing BDI as the isocyanate, but which presented values similar to SIL-MA.

Depth of polymerization
The degree of conversion as a function of depth is depicted in the 2-D maps shown in Fig. 2. Similar or higher degree of conversion was observed for TU silanized filler groups in relation to the control groups at all depths. In many cases, the depth of cure is defined as the depth at which degree of conversion (or hardness) falls below 80% of the top or maximum value. In this case, all materials showed a depth of cure of at least 3.5 mm, the full depth of these specimens.

Discussion
The addition of thiourethane oligomers to methacrylate-based resin materials has been shown to increase the degree of conversion and fracture toughness, while simultaneously reducing polymerization stress6,7,8,9. In those previous studies, the limitation for the incorporation of oligomers (at about 20–30 wt% of the organic matrix mass) was dictated by an increase in viscosity, which in turn precluded the incorporation of inorganic fillers to the level necessary to produce adequate mechanical properties6. One way to possibly overcome this limitation was tested in this present study: to functionalize the thiourethane oligomers with trimethoxy silane functionality, so that the oligomer itself could be later tethered to the surface of the inorganic filler particle via common silanization procedures15. In this way, we aimed to improve the distribution of the oligomer within the composite, and to harness the same benefits obtained with the incorporation of the oligomer directly in the matrix, but without the drawback of significant increase of the viscosity. In fact, our results have shown that even for the fully formulated, highly filled composite, the viscosity average for the TU-silanized materials were similar or lower than the control groups (Table 2).

In the present study, the concentration of thiourethane used in the silanization procedure was kept constant at 2% of the total mass of the silanizing solution. The resulting fillers were characterized with thermogravimetric analysis to determine the extent of final surface coverage on the particles. It is important to note that even the unsilanized particles showed some mass loss after the test, likely due to the presence of organic contamination. The same contamination is unlikely to be present on the surface of the silanized filler particles, given the fact that the silanization process entails exposure to organic solvent in an acidic environment. In addition, the fillers were kept in sealed containers after silanization, so it is reasonable to assume that the mass loss in those cases was due to mainly the silane coating. The percent of surface functionalization based on the mass loss ranged from 5.45–9.21%, with the TU fillers showing at least 50% greater functionalization in comparison to the methacrylate control (Table 1). Since the filler particles in all formulations had the same size distribution, this difference in part likely reflects the higher molecular weight of the thiourethane silane (around 5 kDa6) as compared with the methacrylate silane (around 0.25 kDa), rather than indicating a more extensive surface coverage. Other studies evaluating silicon-containing surfaces functionalized with polymer brushes found similar results and attributed the mass loss to the formation of a coat of brush heap structures at the surface16,18. In the current study, given the loosely crosslinked nature of the oligomer formed, the surface coating is likely less organized than a conventional polymer brush16. In any case, when the percentage of filler surface coverage was calculated based on the mass loss from the TGA experiment, the average thiourethane concentration in the six composites containing the TU filler was found to be 7.2%. This is nearly one third of the amount of TU added to the resin matrix in previous studies to produce the same effects, such as increased fracture toughness and reduced polymerization stress6.

Degree of conversion for the TU filler composites (except for TMP-BDI) was on average 5–7% higher than for the control (SIL-MA). Previous studies have demonstrated the potential of the chain breaking events caused by the presence of thiols to delay gelation and vitrification in radical polymerizations19. In this reaction, the chain-transfer events lead to a delay of the point in conversion at which monomer mobility limitations hamper polymerization and, thus, allow higher final conversion and delayed modulus development, ultimately delaying and reducing stress development20. Based on these mechanisms and our previous results obtained when incorporating the thiourethane oligomers directly into the organic matrix, it was expected that thiourethane-silanized materials would not only show increased degree of conversion, but that they also would be able to reduce the rate of polymerization and delay vitrification7. The delay in vitrification was estimated by the conversion registered at the onset of deceleration (Rpmax). Contrary to what was expected for the reaction rate, all of the groups containing the thiourethane-silanized filler showed equivalent or higher maximum rate of polymerization compared to the methacrylate control. However, all of the composites with TU filler showed equivalent or significantly lower DC at Rpmax. In any case, there was no significant correlation between the measured stress and the Rpmax or measured stress and DC at Rpmax. One possible explanation is that the overall concentration of thiourethane in the present study was lower, and therefore, the effects on network formation were not as marked as had been seen previously. In addition, because the incorporation of the thiourethanes to the filler surface did not affect the material’s viscosity, its effect on early mobility restrictions observed with the thiourethanes added directly into the matrix was not observed here. Even though gelation and vitrification were not directly assessed in this study, the kinetic profiles are strong indicators for those events21, and it can be speculated that these did not play a role in the decreased stress observed, which then must be explained by other factors.

A specifically low irradiance was used for the kinetics test in order to highlight the differences between the tested thiourethanes. However, to better reproduce clinically relevant conditions, selected groups (Sil-MA, PETMP:BDI and PETMP:HDDI) were evaluated for polymerization kinetics under the same conditions described previously but at a much higher irradiance of 650 mW/cm2. The results (Fig. 3) showed that the polymerization was much faster than with the low irradiance, as expected, but also that there was no significant difference between the groups in terms of Rpmax (3.04, 2.97 and 2.88%.s−1, respectively) and DC at Rpmax (11.8, 13.1 and 13.2%, respectively). Further, the TU-silanized groups showed 4–6% higher final DC than the methacrylate-silanized control, which is in agreement with our previous results22. In combination with the depth of cure data, this shows the general ability of the thiourethanes to maintain or increase the degree of conversion and improve homogeneity of the polymer network, likely due to the chain-transfer mechanism leading to the delayed gelation/vitrification, thus maximizing the degree of conversion before the reaction becomes diffusion-controlled11. Among the tested thiourethanes, PETMP–containing materials showed higher conversion than the control at the bottom of the specimen for two out of the three groups, whereas TMP only led to higher conversion at the bottom for the combination with the DHDI isocyanate, as shown in the heat map plots. This is at least in part explained by the fact that PETMP is tetrafunctional and TMP trifunctional, which results in higher concentration of thiol functionalities pendant from the thiourethane backbone6 available on the filler surface to undergo the chain-transfer mechanism. The cyclic isocyanate DHDI led to consistently high and more uniform conversion throughout the specimen, likely because it represented an intermediate between the stiff backbone imparted by the presence of the aromatic BDI and the highly flexible backbone imparted by HDDI. Interestingly, for the more highly crosslinked PETMP-containing TUs, the use of HDDI led to higher initial DC and then essentially equivalent DC as with DHDI throughout the specimen9,23. As the refractive index is expected to increase with the addition of any of the TU silanes, leading to improved light transmission22, the depth of cure was expected to increase for all TU-containing groups. However, as shown on the plot for percent cure in depth in relation to the conversion at the top, two of the three PETMP are actually the lowest depth of cure in percentage, but when PETMP is paired with DHDI the depth of cure is still high. In fact, the DHDI-containing groups present the highest values in terms of cure throughout, and at the greatest depth (though not the highest absolute conversion value at the top). The TMP groups present the best percent depth of cure with DHDI, and then even slightly better than PETMP when paired with BDI and HDDI. It is important to highlight that the degree of conversion is high throughout the specimens, so these differences are likely non-clinically relevant. In summary, this study demonstrates that TU-additives are capable of maintaining the high conversion at the top throughout the specimen much more efficiently than the non-modified control, and highlights the influence of the TU structure on depth of cure.

There was a significant 15–35% reduction in polymerization stress for materials containing thiourethane silanized filler particles. As previously mentioned, this was true in spite of the apparent lack of delayed gelation/vitrification phenomena, at least as inferred from the polymerization kinetics curves. In this case, other factors likely contributed to the reduced stress values observed. The TGA results demonstrate that the filler coverage with the thiourethane silane represents between 5.4 to 9.2% of the mass of the filler, as compared to only 3% for the methacrylate silane controls. Two factors need to be considered: 1. the same amounts by weight of each molecule were used during the silanization, and 2. each methacrylate silane molecule presents only one trimethoxy silane functionality, compared to multiple functionalities for the TU oligomer silane. Therefore, it is possible that the methacrylate silane formed a mono-layer of molecules, and the TU-silane likely formed a much thicker layer on the filler surface. Also, due to the greater complexity of the molecular structure of the TU-silane, even with a greater mass of silane, it is very unlikely that the surface was covered to the same extent as with the methacrylate silane. It follows that the stress reduction mechanism may stem from two factors. The first is the possibility for the surface of the particle to be more exposed (“unsilanized”) for the TU silane than for the methacrylate controls, which would then reduce stress because the filler particle in part actually acts as a void. This type of behavior was shown when non-silanated nanoparticles were used to fill dental composites24. However, this was not observed here, as the non-silane treated filler showed equivalent stress to the methacrylate-silane control. This suggests that the fillers acting as pores is not likely the explanation for this result. The second, and arguably the most relevant factor relates to the flexible and tough nature of the thiourethane networks, as extensively demonstrated in the literature7,9,23,25. It can be speculated that the presence of the TU around the filler particles acted to locally relieve the stress developed during polymerization, which then resulted in overall less stress generation in the composite. In fact, this mechanism has been proposed in other studies evaluating the efficacy of polymer brush functionalization on stress reduction at interfaces with silicon-containing materials17. Polymer brushes or tethered polymers may stretch away from the surface and accommodate for the change in free volume that accompanies polymerization26,27. Another possible explanation is active strand behavior, demonstrated recently for urethane-containing materials28.

It is important to note that the stress reduction (and also the effect on polymerization kinetics) were dependent on the molecular structure of the precursors used to synthesize the thiourethane silanes. Overall, the groups where the tri-functional thiol (TMP) was used as a precursor exhibited lower stress than groups containing the tetra-functional thiol (PETMP), which then correlates with the likely greater degree of crosslinking provided by PETMP. This has been previously shown in studies using dynamic mechanical analysis to evaluate crosslinking (via the rubbery plateau method)29. Therefore, the more crosslinked material likely produced a stiffer network around the filler particle, which was then less able to relieve stress. Interestingly, the use of more rigid isocyanate precursors (BDI, containing aromatic moieties) did not seem to influence stress development more or less than the other TU silanes, suggesting that the structure of the TU oligomer itself, independent of its base monomer structure, had the greatest influence on stress reduction. The loss and storage modulus obtained with dynamic mechanical analysis (data shown in the Supplementary Information) also demonstrate the lack of correlation between the TU structure and property development, corroborating the fact that the thiocarbamate-based structure has a greater influence on stress development and mechanical reinforcement.

The same mechanisms used to explain stress relief and ultimately overall stress reduction can be used to explain the fracture toughness results. Thiourethane silanized particle groups showed a 25–85% increase in fracture toughness compared to the control groups. Fracture toughness may be important to help predict the clinical behavior of the dental composite restoration as it is related to chipping and bulk fracture30,31. When thiourethanes are added into the methacrylate matrix, the improvement of the mechanical properties is attributed to the flexible nature of the covalent bonds formed between the thiol on the thiourethane with the methacrylate via chain-transfer reactions8, leading to a more uniform and tougher network14,32. In the present study, those flexible bonds were formed around the filler particles, a region where stress concentration occurs33. This, in conjunction with the tough nature of the thio-carbamate bonds in the oligomer structure, likely led to some crack deflection or crack shielding mechanism around the particles33,34, as has been suggested by nanomechanical analysis of silicon interfaces treated with polymer brushes. It is also possible that the thiourethane-based silane bonding to the methacrylated matrix was more efficient due to its multiple methoxysilane functionalities, which could have enhanced the filler particle-matrix interaction leading to an increase in mechanical properties. Furthermore, fracture toughness is correlated to tensile stresses build up around the filler particles, and the efficiency of silane treatment plays an important role in gap formation35. Therefore, it can be speculated that the interfacial bonding between the organic matrix and filler particles was strong enough to resist the polymerization shrinkage, creating fewer gaps. PETMP groups showed better performance than TMP (increase between 40–85% for PETMP groups versus 0–40% for TMP groups) which may be due to PETMP being tetrafunctional while TMP is trifunctional. The greater crosslinking improved the mechanical strength of the matrix around the particles, and while that likely resulted in less efficient stress relief, as described earlier, it led to reinforcement of the material overall. The isocyanate structure did not influence the results, though a trend could be observed for increased mechanical properties and decreased polymerization stress, which could be due to the more flexible nature of this material9,23.

In general, the results of this study demonstrate that the incorporation of thiourethane silanized fillers into resin composites led to increased conversion at faster rates than the control, while increasing fracture toughness, and reducing stress of polymerization. Even though the microbiological aspect was not considered on the scope of this investigation, these materials might be able to reduce gap formation, and hamper bacterial colonization at the bonded interface, ultimately helping avoid restoration failures due to secondary decay. Studies are underway utilizing a secondary caries model to test this hypothesis.
Materials and Methods
Material Composition
The experimental composites were composed of Bis-phenol A diglycidyl dimethacrylate (Bis-GMA), urethane dimethacrylate (UDMA) and triethylene glycol dimethacrylate (TEGDMA) at a 50:30:20 mass ratio. All monomers were purchased from Esstech (Essington, PA, USA). Photoinitiators were added to the monomers as follows: 0.2 wt.% of dl-camphoroquinone (Polysciences Inc., Warrington, PA, USA), 0.8 wt.% of a tertiary amine (EDMAB – ethyl 4-dimethylaminobenzoate; Avocado, Heysham, England), and 0.2 wt.% inhibitor (BHT – 2,6-di-tert-butyl-4-methylphenol; Sigma–Aldrich, St. Louis, MO, USA).

Six thiourethane oligomers were synthesized in solution in the presence of catalytic amounts of triethylamine. Two multi-functional thiols – pentaerythritol tetra-3-mercaptopropionate (PETMP) or trimethylol-tris-3-mercaptopropionate (TMP) – were combined with three di-functional isocyanates – 1,6-hexanediol-diissocyante (HDDI) or 1,3-bis(1-isocyanato-1-methylethyl) benzene (BDI) (aromatic) or 1-isocyanato-4-[(4-isocyanatocyclohexyl) methyl] cyclohexane (DHDI) in 60 ml of methylene chloride. In addition, 1 mol of 3-(triethoxysilyl)propyl isocyanate was also added to each of the six combinations described above – this is the source of trimethoxy silane to be used for the subsequent silanization step. The reaction was catalyzed by triethylamine. The isocyanate:thiol mol ratio was kept at 1:2.5 (with thiol in excess) to avoid macro-gelation of the oligomer during reaction, according to the Flory–Stockmayer theory21, leaving pendant thiols and trimethoxy silanes. Oligomers were purified by precipitation in hexanes and rotoevaporation, and then characterized by mid-IR and NMR spectroscopy6. The disappearance of the isocyanate mid-IR peak at 2270 cm−1 and the appearance of NMR resonance signals at 3.70 ppm were used as evidence for completion of isocyanate reaction and thiourethane bond formation, respectively36.

For the silanization procedures, thiourethane oligomers were combined with 65 ml of an ethanol: distilled water solution (80:20 vol%), previously acidified by the addition of glacial acetic acid (pH = 4.5). Thiourethane was added at 2 wt%, in relation to the solution mass. Five grams of neat barium silicate glass filler (average size = 1.0 ΞΌm; Kavo Kerr Corporation, Orange, CA) was added to the solution, kept under magnetic stirring for 24 hours, filtered, and dried for 4 days in an oven at 37 °C.

The TU fillers were introduced at 50 wt% to the monomer matrix with a centrifugal mixer (DAC 150 Speed Mixer, Flacktek, Landrum, SC, USA) operated for 2 min at 1800 rpm. All procedures were carried out under yellow light.

Control groups were prepared with a commercially available unsilanized (UNS) and methacrylate-silanized (SIL-MA) barium glass filler particles (average size = 1.0 ΞΌm; Kerr Corporation, Orange, CA). All photocuring procedures were carried out using a mercury arc lamp (EXFO Acticure 4000 UV Cure; Mississauga, Ontario, Canada) filtered at 320–500 nm (light guide diameter = 5 mm). In order to verify the achieved functionalization and its efficiency, the different filler particles were analyzed by thermogravimetric analysis (TGA) over a temperature range of 50 °C to 850 °C at 10 °C/minute.


Fracture Toughness (K IC)
KIC was determined using the single-edge notch beam method. Specimens were fabricated according to ASTM Standard E399–9037 by filling a 5 × 2.5 × 25 mm (n = 6) split steel mold with a razor blade insert providing a 2.5 mm long notch in the middle of the specimen. The resin composites were photoactivated for 2 min on each side at an irradiance of 800 mW/cm2. The light guide was kept 7 cm away from the sample and a radiometer (Power Max 5200 – Laser Power Meter, Molectron, Portland, OR, US) was used to measure the power output from the mercury arc lamp and guarantee that 800 mW/cm2 irradiance reached the top surface of the sample. The bending fracture test was performed using a universal test machine (MTS Criterion, Eden Prairie, MN USA) at a cross-head speed of 0.5 mm min−1 and KIC was calculated according to the following equation (1):

𝐾𝑖𝑐=3𝑃𝐿2π΅π‘Š32{1.93(π‘Žπ‘Š)12−3.07(π‘Žπ‘Š)32+14.53(π‘Žπ‘Š)52−25.11(π‘Žπ‘Š)72+25.8(π‘Žπ‘Š)92}Kic=3PL2BW32{1.93(aW)12−3.07(aW)32+14.53(aW)52−25.11(aW)72+25.8(aW)92}
(1)
where P is load at fracture (N), L is the length, W is the width, B is the thickness, and a is the notch length (all in mm).


Polymerization Stress
Polymerization stress in real-time was analyzed using a cantilever beam apparatus (Bioman) previously described38. The surface of the fused silica plate was treated with a thin layer of silane ceramic primer (3 M ESPE, St. Paul, MN, USA) and the surface of the 5 mm diameter steel piston with Z-Prime Plus (Bisco Inc., IL, USA). The composite was then inserted into the 1-mm gap between the upper rod and the lower glass slide and shaped into a cylinder, removing the excess. The samples were light-cured through the glass using the light curing unit for 40 s (n = 5) at 280 mW/cm2. Data were recorded for 10 min on a computer and the final shrinkage-stress calculated.


Kinetics and Degree of Conversion
Three specimens (8 mm in diameter and 0.6 mm in thickness), laminated between two glass slides, were cured and then measured with near-infrared (NIR) spectroscopy (Nicolet 6700, Thermo Electron Corporation, Waltham, MA, US) to calculate the degree of conversion (DC). The area corresponding to the methacrylate double bond overtone at 6165 cm−1 39 was recorded before and after 300 s of irradiation with the light source located 4 cm from the surface of the glass slide, delivering 20 mW/cm2 directly to the specimen. Real-time monitoring of the polymerization kinetics for 300 s was carried out on specimens of the same size at 2 scans per spectrum with 4 cm−1resolution.


Depth of polymerization – 2D Mapping with IR-Microscopy
Samples (2 × 5 mm cross-section and 5 mm depth) were prepared using silicon molds (n = 3) and photocured through a glass slide for 300 s at 20 mW/cm2. After 7 days dry storage, the samples were embedded in slow curing epoxy resin and then sectioned using a diamond saw (Accutom-50) to obtain two slices of 0.4 mm thickness. The degree of conversion of the vinyl groups with depth was measured in near-IR (6165 cm−1) using an IR microscope attached to a spectrometer bench (Continuum and 6700, Thermo Fisher). 2D surface maps of conversion were set up with 200 Β΅m step sizes.


Viscosity
Viscosity was measured in a cone-plate rheometer (ARES, TA Instruments, New Castle, DE, USA). 1.03 g of each unpolymerized resin was placed between 20-mm diameter plates and tested at 1 Hz with a gap size of 0.3 mm (n = 3).


Statistical Analysis
Data for each property was tested for normality and homocedasticity (Anderson-Darling and Levene tests, respectively), and then analyzed with one-way ANOVA and Tukey’s test for multiple comparisons. The significance level was set at 95%.
 

Tuesday, March 5, 2019

FDA provides update on its ongoing investigation into ARB drug products; reports on finding of a new nitrosamine impurity in certain lots of losartan and product recall

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There has been a recent well founded concern from the FDA about contaminants being found in several well known blood pressure medications.  The most recent concerns the chemical  N-Nitroso-N-methyl-4-aminobutyric acid (NMBA) which is a known carcinogen.  While the amounts found have been slight, it’s 

 

The U.S. Food and Drug Administration is updating the public on the agency’s ongoing investigation surrounding the recent voluntary recalls of multiple generic angiotensin II receptor blocker (ARB) drug products used to treat high blood pressure and heart failure. Hetero Labs Ltd. in India has announced a recall of 87 lots of losartan potassium tablets (25 mg, 50 mg and 100 mg). The recalled losartan potassium tablets made by Hetero Labs and distributed by Camber Pharmaceuticals contain the impurity, N-Nitroso-N-methyl-4-aminobutyric acid (NMBA). The impurity is a known animal and potential human carcinogen. This is the first ARB recall resulting from the presence of NMBA, which is the third type of nitrosamine impurity detected in ARB medicines.

Recent testing of these recalled lots of losartan potassium tablets showed NMBA levels higher than the FDA’s interim acceptable intake limits. The FDA’s evaluation suggests that the nitrosamines found in ARBs may be generated when specific chemicals and reaction conditions are present in the manufacturing process of the drug’s API, and may also result from the reuse of materials, such as solvents.

“We are deeply concerned about the presence of a third nitrosamine impurity in certain ARB medications, but it’s important to underscore that, based on the FDA’s initial evaluation, the increased risk of cancer to patients with NMBA exposure appears to be the same for NDMA exposure but less than the risk from NDEA exposure. That said, any presence of such impurities in drug products is not acceptable. Over the past few months, the FDA has conducted a major investigation and has worked with drug companies to address the presence of impurities in these products,” said FDA Commissioner Scott Gottlieb, M.D. “Our ongoing effort has determined that the impurities may be generated by specific chemical reactions in the manufacturing process of the drug’s active pharmaceutical ingredients. FDA scientists have developed novel and sophisticated testing methods specifically designed to detect and measure N-Nitrosodimethylamine (NDMA) and N-Nitrosodiethylamine (NDEA) impurities in ARB medicines. Because of the potential for discovering other nitrosamine impurities, we are conducting an extensive organic chemistry analysis to develop novel testing methods to detect additional nitrosamine impurities, including NMBA. We’re continuing to share these testing methods with international regulators, industry and the public to help manufacturers and other regulators evaluate these products for any potential nitrosamine impurity. We are making important strides at understanding how these impurities form and we are continuing to examine if nitrosamine impurities may also arise during the manufacture of other ARB drug products. The FDA is committed to implementing measures to prevent the formation of these impurities during drug manufacturing processes in the future.”

Hetero Labs identified NMBA in lots of losartan potassium during recent testing. NMBA has not been found in previously recalled ARB products; however, the FDA is continuing its investigation. Previously, two other nitrosamine impurities, NDMA and NDEA, were found in drug products containing the active pharmaceutical ingredients valsartan, losartan and irbesartan and those products containing nitrosamines above the interim acceptable limits were recalled.

Recent FDA analyses of NDMA and NDEA in recalled valsartan found that overall, the risk to individual patients is very low, although this doesn’t diminish the significance of this issue or the FDA’s concerns. The agency continues to evaluate the risks nitrosamines pose to patients. The FDA and drug manufacturers continue to test all ARBs for nitrosamine impurities. If NDEA, NDMA, NMBA, or other nitrosamine impurities are found in products at levels above the interim acceptable intake limits, the FDA will work with companies to swiftly remove affected products from the market.

The FDA will continue to update the list of products included in the recall as more information becomes available from ongoing testing. If patients take an ARB drug product, they should check the list periodically, as information may change.

The FDA reminds patients taking an ARB medication from a recalled lot to continue taking their medicine until their doctor or pharmacist provides a replacement or a different treatment option. Any patient taking an ARB from a recalled lot who has not yet spoken to their pharmacist or doctor should do so promptly. Not all ARBs contain nitrosamine impurities.

The FDA, an agency within the U.S. Department of Health and Human Services, protects the public health by assuring the safety, effectiveness, and security of human and veterinary drugs, vaccines and other biological products for human use, and medical devices. The agency also is responsible for the safety and security of our nation’s food supply, cosmetics, dietary supplements, products that give off electronic radiation, and for regulating tobacco products.

Monday, March 4, 2019

How to Save Money and Frustration by Preventing Sensitivity

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Every dentist deals with postoperative sensitivity.  While it isn’t incredibly common, it can be frustrating for both doctors and the patients that are dealing with it.  The latest issue of Dental Products Reports deals with the finances of the modern dental practice and I thought this month, I’d use my Technology Evangelist column to explore proper restorative techniques that help to decrease the incidence of sensitivity.
 
Obviously, first and foremost this subject is of a tremendous benefit to the patients we serve.  No one likes having a filling done and then suffering with sensitivity afterwards.  However, decreasing the incidence of sensitivity can also be a financial benefit to the practice as dealing with sensitivity issues fills appointment slots with non-productive time.  Over the years I’ve been lucky enough to have studied with some really incredible clinicians as well as some really incredible scientists that create dental materials.  They have imparted to me a knowledge base that I’m grateful for and indebted to them for having provided.
 
Here’s what I came up with in this regard:
 

For those of you over the age of 45, you may remember a character from “Saturday Night Live.” His name was Father Guido Sarducci and was played by comedian Don Novello. In the guise of a Catholic priest, he would offer life lessons as part of Weekend Update.

One of his best bits was The Five Minute University, where he teaches “everything you’ll remember from college classes five years after you’re out of school.” For economics, he says, “supply and demand.” For business, “Buy something at one price and sell it for more.” It’s a great bit that you can view at will on YouTube. Every time I watch it, I laugh.

If you want to run a successful business, you have to have more money coming in the door than is leaving.

One of the things that happens in dentistry that can severely affect things is remakes/redos. My grandpa Flucke used to tell me, “Son, there’s never time to do it right, but there’s always time to do it over.” That little phrase has stuck with me for my entire life, and it certainly holds true for the practice of dentistry.

Having to do something over can have a tremendous impact on your practice. Financially, your overhead continues and the cost of the procedure is being fed by the gross operating revenue of the office. It also affects your scheduling. You’re eliminating time in your schedule that should be devoted to profits, and this compounds to affect your ability to see a patient who would love to be seen for a revenue-generating procedure. Finally, it affects your actual internal marketing strategy. No matter the reason for a redo, you run the risk of a patient losing faith in you. That loss of faith can affect the patient’s desire to refer you or even result in the patient leaving the practice.

I’ll never fault someone for doing the right thing and sometimes, despite our very best efforts, things don’t go as planned, which necessitates redoing something. Handling these cases the right way can even be a practice booster because the patient understands that your desire to do things perfectly outweighs everything else. The best way to avoid the whole scenario is to do everything possible to avoid the situation in the first place. This month let’s take a look at some ways to head off potential problems and keep our redos to a minimum.

Hemostasis and fluid control

When it comes to adhesive dentistry, one of the biggest negative factors we have in bonding is contamination. Whether it’s blood, saliva, or crevicular fluid, any type of biological contamination can directly affect bond strengths. This can lead to sensitivity, marginal leakage/breakdown and shorter lifespan of the restoration. When sensitivity is the issue, we’re often faced with replacing the restoration.

In order to prevent contamination with blood, there are a couple of handy chemistries available that I use routinely. One is ViscoStat®, which is a 20 percent ferric sulfate solution. It does a great job of quickly controlling bleeding. The only drawback is that, due to the iron content, it stains the tissue and has the possibility of making the margin of the restoration appear dark. In the esthetic zone, my agent of choice is ViscoStat® Clear, which is 25 percent aluminum chloride. It isn’t as strong as VicoStat, but since it’s clear, there’s no concern with staining. I also use ViscoStat Clear on Class V restorations, as the AlCl3absorbs crevicular fluid and prevents contamination at the gingival margin.

Fluid control can also be prevented through proper use of the rubber dam. I know a lot of you just rolled your eyes at that last sentence, but hear me out. I don’t really think the rubber dam is that difficult to use if you use the right one.

There are a few brands on the market that now have a built-in flexible plastic frame, that are an all-in-one piece, pre-assembled and ready to go when you open the box. I truly don’t think it’s the dam we hate dealing with — it’s the dam frame (pun intended). These all-in-one systems allow the assistant to place the clamp and then simply snap the assembled dam over it. The process is simple and can be accomplished in just a few seconds. My current favorite is the Insti-Dam and the Relaxed-Fit Insti-Dam from Zirc. Both are latex-free and very durable. You can find others from Aseptico and Hygienic as well.

To view the entire article, head over to the DPR website.  

Thursday, February 28, 2019

VFEmail Suffers Attack from Hacker that Deletes 18 Years of Email... Including the Backups

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It sure seems like I’ve been posting this biohazard symbol a lot lately… maybe because I have been.  
 
This story is just a bad one.  Many of us, myself included, rely on our email providers to keep copies of our emails for us.  It’s one less backup I have to do or worry about.  Or at least I haven’t worried about that until now.
 
The story is the email service VFEmail suffered an attack from an anonymous hacker.  Evidently the hacker was concerned with something that was being stored on the VFEmail severs.  It was obviously something either the hacker or whoever hired them, didn’t want to have be published.  Obviously that is speculation on my part, but it sure seemed to be geared toward keeping something from being found.
 
To prevent that, the hacker gained access to the VFEmail servers and deleted EVERYTHING.  One user lost at least 10 years worth of data which was roughly 60,000 emails.  The attack appeared to be aimed at servers in the US and they were wiped clean.  The company said the hack destroyed roughly 18 years worth of data held in file AND backup servers.
 
I’ve actually visited the Tier 3 Data Center where my email servers are held and I have no doubt about how serious they take their security.  However, now I’m giving serious consideration to implementing a backup of my email from my local machine… just in case.

Wednesday, February 27, 2019

Physical Server Theft in Waco, TX Dental Practice

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Although this doesn’t happen often… it does happen.  In Waco, Texas thieves broke into a dental clinic and actually stole the server.  That’s right, the thieves broke into the office, grabbed the computer, took it away.  Most of us today, heck even those of us who are big on IT Security, don’t consider this as something that happens any more… but it does.  People *still* steal computers and then try to crack into them later.  When you think about it, there is a certain amount security defeat that goes on with that.  You don’t have to crack into the network and *then* break into the server.  You just grab the server and run.  Then at your leisure you try and work through the security on the device itself.
 
Now the good news about this theft is that the clinic had protected the server with 2 layers of password protection.  This means that the actual chances of breaking through BOTH password layers is pretty remote.  Good on the clinic for thinking ahead and making this theft unlikely to be profitable.  They did NOT have the data encrypted which would have added another much more difficult layer of security.  However, I really think this should have been the job of their IT provider to suggest this and then implement it.  Not every doctor is a computer security expert.  
 
I bring this whole story up because anytime something like this happens, it opens the window of opportunity for all of us to learn from these disasters and hopefully close the loopholes that exist in our offices so that these situations are not replicated elsewhere.
 
The other smart thing the office did, was to have a cloud backup system running which ensured that even though the data from the server itself was unreachable, they could still recreate everything from the cloud.
 
As many of you know, I’m a big fan of DDS Rescue and their backup systems.  They were the ones that first tipped me off to this story.  However, that’s not why I’m mentioning them.  Part of their service is to provide you with a FREE security assessment.  During my assessment they advised me to physically lock my server to my facility… which I had not done… yet.  However, they were right.  If your physical server is in someway “chained to your office” there is no easy way for bad guys to just walk out the door with it.
 
I consider that security assessment invaluable as I work to make my IT infrastructure as current and secure as possible.  The assessment allows me to focus on what I do best, which is care for my patients, while I know that DDS Rescue has provided the information necessary for our data to meet and exceed the requirements of HIPAA.
 
Accidents happen.  Severs crash, viruses replicate, ransomware gets installed (somehow), hackers get in through the firewall, there are plenty of ways for bad things to happen to your server and your data.  Using DDS Rescue is a solid way to prepare for the bad things that can happen to good people.

Tuesday, February 26, 2019

Sleep Apnea Patients Who Are Drowsy During the Day at Risk for Heart Woes

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I’ve become very passionate about Obstructive Sleep Apnea and the terrible health related problem it can cause.  Probably some of that stems from the fact that I actually suffer from the disease.  The other reason is because as a practicing dentist it is within my scope of practice to diagnose and treat this debilitating disease.
 
As someone who suffers from OSA, I know just how unpleasant it can be.  After I discovered the problem and got treatment, I felt exponentially better.  That lead me to become a major advocate for treatment of OSA, whether from a dental treatment philosophy or a CPAP.
 
As a sufferer AND a practitioner, it also means I’m constantly scouring all of my sources for more info on how to better treat OSA as well as diseases or symptoms that are linked.  I recently came across the following from the Mayo Clinic.  The article does a great job of explaining lots of things about Obstructive Sleep Apnea and I credit the Mayo Staff for a really great job on this one!
 
If you are a dental professional and are interested in treating OSA and greatly helping your patients but do not know where to start, I highly recommend reaching out to SleepArchiTx.  The company provides a complete turnkey system that educates doctors on everything you need to know and helps you through the process.
 
 

Overview

Obstructive sleep apnea
 
Obstructive sleep apnea is a potentially serious sleep disorder. It causes breathing to repeatedly stop and start during sleep.

There are several types of sleep apnea, but the most common is obstructive sleep apnea. This type of apnea occurs when your throat muscles intermittently relax and block your airway during sleep. A noticeable sign of obstructive sleep apnea is snoring.

 
Treatments for obstructive sleep apnea are available. One treatment involves using a device that keep your airway open while you sleep. Another option is a mouthpiece to thrust your jaw forward during sleep. In more severe cases, surgery may be an option too.

 
Symptoms
Signs and symptoms of obstructive sleep apnea include:

  • Excessive daytime sleepiness
  • Loud snoring
  • Observed episodes of breathing cessation during sleep
  • Abrupt awakenings accompanied by gasping or choking
  • Awakening with a dry mouth or sore throat
  • Morning headache
  • Difficulty concentrating during the day
  • Experiencing mood changes, such as depression or irritability
  • High blood pressure
  • Nighttime sweating
  • Decreased libido
  • When to see a doctor

Consult a medical professional if you experience, or if your partner observes, the following:

  • Snoring loud enough to disturb your sleep or that of others
  • Waking up gasping or choking
  • Intermittent pauses in your breathing during sleep
  • Excessive daytime drowsiness, which may cause you to fall asleep while you're working, watching television or even driving a vehicle
  • Many people may not think of snoring as a sign of something potentially serious, and not everyone who snores has obstructive sleep apnea.

Be sure to talk to your doctor if you experience loud snoring, especially snoring that's punctuated by periods of silence. With obstructive sleep apnea, snoring usually is loudest when you sleep on your back, and it quiets when you turn on your side.

Ask your doctor about any sleep problem that leaves you chronically fatigued, sleepy and irritable. Excessive daytime drowsiness may be due to other disorders, such as narcolepsy.


Causes


Obstructive sleep apnea occurs when the muscles in the back of your throat relax too much to allow normal breathing. These muscles support structures including the soft palate, the uvula — a triangular piece of tissue hanging from the soft palate, the tonsils and the tongue.

When the muscles relax, your airway narrows or closes as you breathe in and breathing may be inadequate for 10 to 20 seconds. This may lower the level of oxygen in your blood and cause a buildup of carbon dioxide.

Your brain senses this impaired breathing and briefly rouses you from sleep so that you can reopen your airway. This awakening is usually so brief that you don't remember it.

You can awaken with a transient shortness of breath that corrects itself quickly, within one or two deep breaths. You may make a snorting, choking or gasping sound.

This pattern can repeat itself five to 30 times or more each hour, all night long. These disruptions impair your ability to reach the desired deep, restful phases of sleep, and you'll probably feel sleepy during your waking hours.

People with obstructive sleep apnea may not be aware that their sleep was interrupted. In fact, many people with this type of sleep apnea think they slept well all night.

Risk factors

Anyone can develop obstructive sleep apnea. However, certain factors put you at increased risk, including:

  • Excess weight. Around half the people with obstructive sleep apnea are overweight. Fat deposits around the upper airway may obstruct breathing.However, not everyone with obstructive sleep apnea is overweight and vice versa. Thin people can develop the disorder, too.
  • Narrowed airway. You may inherit naturally narrow airways. Or, your tonsils or adenoids may become enlarged, which can block your airway.
  • High blood pressure (hypertension). Obstructive sleep apnea is relatively common in people with hypertension.
  • Chronic nasal congestion. Obstructive sleep apnea occurs twice as often in those who have consistent nasal congestion at night, regardless of the cause. This may be due to narrowed airways.
  • Smoking. People who smoke are more likely to have obstructive sleep apnea.
  • Diabetes. Obstructive sleep apnea may be more common in people with diabetes.
  • Sex. In general, men are twice as likely as women to have obstructive sleep apnea.
  • A family history of sleep apnea. If you have family members with obstructive sleep apnea, you may be at increased risk.
  • Asthma. Recent research has found an association between asthma and the risk of obstructive sleep apnea.

Complications
Obstructive sleep apnea is considered a serious medical condition. Complications may include:

  • Daytime fatigue and sleepiness. The repeated awakenings associated with obstructive sleep apnea make normal, restorative sleep impossible. People with obstructive sleep apnea often experience severe daytime drowsiness, fatigue and irritability. They may have difficulty concentrating and find themselves falling asleep at work, while watching TV or even when driving.
  • Children and young people with obstructive sleep apnea may do poorly in school and commonly have attention or behavior problems.
  • Cardiovascular problems. Sudden drops in blood oxygen levels that occur during obstructive sleep apnea increase blood pressure and strain the cardiovascular system. Many people with obstructive sleep apnea develop high blood pressure (hypertension), which can increase the risk of heart disease.
  • The more severe the obstructive sleep apnea, the greater the risk of coronary artery disease, heart attack, heart failure and stroke. Men with obstructive sleep apnea appear to be at risk of heart failure, while women with obstructive sleep apnea don't.
  • Obstructive sleep apnea increases the risk of abnormal heart rhythms (arrhythmias). These abnormal rhythms can lower blood oxygen levels. If there's underlying heart disease, these repeated multiple episodes of low blood oxygen could lead to sudden death from a cardiac event.
  • Complications with medications and surgery. Obstructive sleep apnea also is a concern with certain medications and general anesthesia. These medications, such as sedatives, narcotic analgesics and general anesthetics, relax your upper airway and may worsen your obstructive sleep apnea.
  • If you have obstructive sleep apnea, you may experience worse breathing problems after major surgery, especially after being sedated and lying on your back. People with obstructive sleep apnea may be more prone to complications after surgery.
  • Before you have surgery, tell your doctor if you have obstructive sleep apnea or symptoms related to obstructive sleep apnea. If you have obstructive sleep apnea symptoms, your doctor may test you for obstructive sleep apnea prior to surgery.
  • Eye problems. Some research has found a connection between obstructive sleep apnea and certain eye conditions, such as glaucoma. Eye complications can usually be treated.
  • Sleep-deprived partners. Loud snoring can keep those around you from getting good rest and eventually disrupt your relationships. Some partners may even choose to sleep in another room. Many bed partners of people who snore are sleep deprived as well.
  • People with obstructive sleep apnea may also complain of memory problems, morning headaches, mood swings or feelings of depression, and a need to urinate frequently at night (nocturia).