Thursday, January 31, 2019

Periodontal Disease Bacteria Linked to Alzheimer’s Disease

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As a bit of an addendum to yesterday’s post, I have received  further information on the potential Perio and Alzheimer’s link.  This comes from the American Academy of Periodontology which is the U.S. organization for the specialty of Periodontics.  This in information contains comments from the AAP on the current status of this story.
 
Periodontal Disease Bacteria Linked to Alzheimer’s Disease
Periodontal experts stress the importance of gum health in older adults and other at-risk groups

 A recent study has periodontists, experts in the treatment, diagnosis, and prevention of periodontal disease, encouraging patients to maintain gum health in an effort to reduce their Alzheimer’s disease risk.
The study, published in the journal Science Advances, uncovered a potential link between P. gingivalis, the bacteria associated with periodontal disease (commonly known as gum disease) and Alzheimer’s. Researchers analyzed brain tissue, spinal fluid, and saliva from Alzheimer’s patients—both living and deceased—and found evidence of P. gingivalis. Gingipains, the toxic enzyme secreted by P. gingivalis, were found in 96 percent of the 53 brain tissue samples examined, with higher levels detected in those with the pathology and symptoms of Alzheimer’s disease.

Additionally, researchers including co-author Mark I. Ryder DMD, Professor of Periodontology at the University of California, San Francisco, noted that the presence of P. gingivalis increased the production of amyloid beta, a component of the amyloid plaques whose accumulation contributes to Alzheimer’s. The study confirmed via animal testing that P. gingivalis can travel from the mouth to the brain and that the related gingipains can destroy brain neurons. These findings are noteworthy in that they suggest a biological mechanism for how periodontal disease bacteria may play a role in the development and progression of Alzheimer’s.

According to Richard Kao, DDS, PhD, president of the American Academy of Periodontology (AAP), the professional society representing more than 8,000 periodontists, this study underscores the important role of gum health on overall wellness. “Periodontists have long known that a healthy mouth contributes to a healthy body, and research has suggested an association between periodontal disease and dementia conditions, such as Alzheimer’s,” Dr. Kao said. “These recent findings present strong evidence on how periodontal disease can impact the pathogenesis of Alzheimer’s disease and should highlight how crucial it is to manage periodontal disease, especially in older adults or individuals who have increased risk for dementia.”

Although the study results add to the evidence supporting a link between gum disease and Alzheimer’s, additional research is needed to better understand the etiology of Alzheimer’s and how periodontal disease bacteria can exacerbate progression. An upcoming FDA Phase II clinical trial will assess the benefits of using a novel small molecule inhibitor of these P. gingivalis gingipains in hindering the development and progression of Alzheimer’s. This clinical trial may add further insight to the link between gum disease and Alzheimer’s.
 
Dr. Kao encourages older adults and other at-risk individuals to maintain diligent oral care and promptly treat periodontal disease to help mitigate Alzheimer’s risk. “More than half of the U.S. population age 30 and older has some form of periodontal disease. Prevalence increases to 68 percent for those age 65 and older. Routine brushing, flossing once a day, and visiting a periodontist can help identify any disease and treat as needed, potentially diminishing the risk of developing Alzheimer’s.”

To learn more about periodontal disease or to find a periodontist, visit perio.org.
 


About the American Academy of Periodontology 

 
The American Academy of Periodontology (AAP) represents over 8,000 periodontists—specialists in the prevention, diagnosis, and treatment of inflammatory diseases affecting the gums and supporting structures of the teeth, and in the placement of dental implants. Periodontics is one of the nine dental specialties recognized by the American Dental Association.

Wednesday, January 30, 2019

Periodontal Pathogens Found in Brains of Alzheimer's Patients

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Here is an interesting bit of research that has come to light lately.
 
Researchers have established a possible link between gum disease and Alzheimer’s disease.
 
The study looked and both deceased and living patients that were diagnosed or suspected to have Alzheimer’s.  The researchers found bacteria that called Porphyromonas gingivalis that is also found in chronic periodontal (gum) disease.
 
Following this discovery, tests were run on mice that found the bacteria definitely could migrate from the infected gum tissue via the mouth to the brain.  The amazing part is that the Porphyromonas gingivalis secrete a toxic protein that destroys neurons (brain cells).
 
Further testing on mice showed that drugs that can block the toxic protein stopped the brain degeneration.  This isn’t a definite cause and effect yet, but it certainly bears much more intense study.
 

Tuesday, January 29, 2019

Ransomware Knocked Out of Top Spot for Hacking Threat by Trojan Malware

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It seems that what is old is new again.  After a couple of years of Ransomware being the number one threat in healthcare, it has now been replaced by our old nemesis Trojan Malware.
 
Specifically the ones that are being seen in force as of late are called Emotet and Trickbot.  The number of attacks from Trojan type programs toward healthcare IT systems has increased 132 percent since 2017.  That’s a *big* increase.
 
According to a recent report from Malwarebytes, “The trend in information-stealing Trojans being leveraged for business breaches does not appear to be slowing down.”  “However, the deployment of patches, network and data segmentation, as well as user rights management configuration might keep the Trojan invasion from spreading so easily.”
 
I think it’s helpful to download the report via the link above and give it a brief read.  Even if you aren’t particularly tech literate, it will still be interesting to browse.
 
Needless to say, you NEED to have a security and backup system in place.
 
If you are in dentistry, I highly recommend DDS Rescue.  Check them out!

Monday, January 28, 2019

Government Shutdown may begin to Affect Workers Dental and Vision Benefits

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Even though we have now entered a “temporary” restart, I had this story in the queue and I thought it might still have some relevance.  After all, there are no guarantees that the furloughed workers will be continuously employed.  So, just in case, here’s a tidbit.
 
This whole government shutdown thing was ridiculous from the get go, but now it becomes even more so as the stupid rich people use the less entitled as bargaining chips in the neighborhood  bully game of chicken.
 
Now comes word via the Washington Post that "starting with their third missed paycheck, employees will be billed directly for premiums for dental and vision coverage.”  And furthermore "The company that provides long-term care insurance to federal workers also will start billing them directly."
 
You read that correctly.  Those employees who have been wise and proactive enough to have dental, vision, and long term care policies are now being punished for their foresight.
 
While the vision plan can be as low as $3.09 every 2 weeks, the dental plan can be $76.80 for the same time frame.  Expecting people with no income to pay for their benefits that were provided before this stupid mess is just plain wrong.
 
Another problem is that if these employees choose to gamble by not paying and let their policies lapse, they will lose these benefits until the annual enrollment period for the next year.  So… basically being responsible enough to get the benefits & then being conservative enough (and smart) not to use funds they must stretch, costs them basically in 2 ways!
 
I thought I’d bring this out as it has a direct on dental as well as the dental health of those caught up in this craziness.

Thursday, January 24, 2019

iTero HDU End of Life Support Notification

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For those of you who are still using one of the very early iTero units, the HDU, I wanted to make you aware of an announcement made by the company on January 18 of 2019.
 
As of April 30, 2019 the company will no longer support the HDU system.  To the best of my knowledge the HDU came to market around 2007.  A lot has happened since then in the world of dental technology and iTero is rightfully now considering the HDU legacy hardware.
 
While the HDU still can do an amazing job, the development of other scanners in the iTero family such as the Element and Element 2 have really made the HDU a legacy product.
 
For those who are still using the HDU, let me tell you of my own experience.  We purchased the Element when it came on the market.  My plan, since we have a 2 doctor practice was the use the HDU as backup and break it out if/when the schedule had each doctor in need of a machine.  I thought it was the perfect solution.  Instead what I noticed was the HDU never moved form its spot in a storage closet.  When I asked the staff they informed me that the Element is so very, very, fast compared to the HDU that the biggest wait time they had was about 5-7 minutes and because of the ease of use of the Element, they were willing to wait that short amount of time.
 
Now, remember that my staff is incredibly technology literate and love to use the latest and greatest.  I think it speaks volumes that once they got their hands on the Element they had no desire to use the HDU again.  It’s been several years since we upgraded and the HDU is still sitting in the same place in the storage closet that it has occupied since the Element arrived.  Definitely some food for thought there.
 
There’s also the point that the HDU is much more bulky, harder to repair, and much slower as well as being less intuitive to use.
 
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Here is the info I received from iTero regarding the end of life of the legacy HDU unit:
 

Dear iTero Customer,

We would like to thank you for being a valued iTero® intraoral scanner customer. Please be informed that as of April 30, 2019, the iTero® HDU systems will no longer be supported. We will continue to provide parts as reasonably available for the HDU scanners while part supplies last.

What does this mean for you? You may continue to use your iTero® HDU scanner. However, service needs or repairs will no longer be available as of April 30, 2019. After that date, only the iTero Element® , iTero® Element 2, or iTero Element Flex®scanners will be capable of being in compliance with SOC2 to manage customer data security, availability, processing integrity, confidentiality, and privacy. 

We understand that this change may be inconvenient to your daily practice; therefore, we are offering a promotion to trade in your iTero® HDU scanner in accordance with our trade in policy.  Please click on the following link to learn more about our trade-in offer.

Learn More About Our Trade-In Offer>

To learn more about the iTero® Element family of scanners, please visit: iTero.com

We appreciate the opportunity to support your practice with our latest technology. 


Sincerely,
The iTero Team
 

Wednesday, January 23, 2019

New Malware Apps in the Android Store are Using Motion Detection to Evade Discovery

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Google’s App Store is still battling some rather scurrilous entries as of late.  The smart people at Trend Micro (which is a security firm) noticed 2 that have a rather unique way to avoid detection.
 
The apps are “Currency Converter” and “BatterSaverMobi”.  The first, obviously, masquerades as a currency converter, while the other promises to extend your device’s battery life.  While they appear innocent enough, the both install a banking Trojan called “Anubis”.
 
Here’s what happens next:
 
Once downloaded, the malicious app uses the infected device's motion sensor to detect whether or not the user or the device is moving. If both the device and user are still, the malicious code will not run.

As soon as it detects the sensor data, the app runs the malicious code and then tries to trick the victims into downloading and installing the malicious Anubis payload APK with a bogus system update, masquerading as a "stable version of Android."

Not Just Motion Detection...There's More

If the user approves the fake system update, the in-built malware dropper uses requests and responses over legitimate services including Twitter and Telegram to connect to its required command and control (C&C) server and downloads the Anubis banking Trojan on the infected device.
 
Once the “Anubis” Trojan is on your device, it goes about trying to steal your banking credentials by either taking screenshots or using a key logger that is built into it.  These run whenever a banking app is opened.
 
The banking Trojan also has the ability to gain access to contact lists and location, send spam messages to contacts, call numbers from the device, record audio, and alter external storage.
Google has since removed the two malicious apps from its Play Store. Although it is a never-ending concern, the best way to protect yourself from such malware is to always be vigilant when downloading applications even from Google's official Play store.
Most importantly, be careful which apps you give administrative rights to, as it is a powerful permission that can provide full control of your device.
To be forewarned to be fore armed...

Tuesday, January 22, 2019

Washington Post Article Sites Possible Link Between Rheumatoid Arthritis and Gum Disease

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A recent article in the Washington Post looks at the potential of one disease process linked to another.  Pretty fascinating stuff in my opinion.
 
The dental piece of it was very interesting, I’ve copied it below, but you can read the full article by following the link above.  The mouth/oral cavity is definitely connected to the rest of the body and can cause problems a long way from the mouth.  It’s important to remember that.
 
 
Rheumatoid arthritis and gum disease

Rheumatoid arthritis (RA) is a progressive autoimmune disease marked by painful, swollen joints. Gum or periodontal disease causes gum infections that can lead to sore mouth, bleeding, chewing problems and tooth loss.
 

Dentists long ago noticed that people with rheumatoid arthritis were more likely to have gum disease — and vice versa. “People with periodontal disease are at higher risk of RA, and people with RA are at greater risk of having more advanced periodontal disease,” says Mark Bartold, professor emeritus at Australia’s University of Adelaide and co-author of a 2013 review of 19 studies on the topic.

The reason for the connection between the two conditions is unclear, but there’s some evidence that treating periodontal disease improves certain markers for RA.

To reduce your risk: Attend to your dental health. Brush twice a day with fluoride toothpaste; clean between your teeth regularly with dental floss, an interdental brush, a floss pick or a water flosser; quit smoking; and visit your dentist as recommended for checkups and cleanings.

Monday, January 21, 2019

The Future of Dentistry Event is Coming Soon!

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This year, I’ve been honored to be asked to be part of the Future of Dentistry Event.  It’s a series of video interviews with some of the best minds in dentistry and it covers a wide range of topics.  The videos will start being available in a couple of weeks, you can sign up to view them by following this link.  

If you are looking for a way to jump start your 2019, this is a great place to start.  The lineup features a “who’s who” list of experts in every facet of dentistry.

Needless to say, I’m very honored to be selected to be part of the group.  Here is the lowdown.

Dentistry is changing – fast! The good news is that there’s still plenty of opportunity, plenty of options and great profit to be had in dentistry!

The biggest risk is staying the same. 

If you want 2019 to be your best year in practice ever, you can’t just do what you’ve always done.

It’s time to claim what you want and create a plan to get you there. So, I’m inviting you to join me and over 20 of dentistry’s leading experts, for The 2019 Future of Dentistry Event. During this free, online event, you’ll get a practical plan to transform your practice for the future and make 2019 your best year ever!

Click here to REGISTER for this special event.

Don’t let the fast approaching wave of change overcome you.

Learn how you can position yourself and your practice for an unbelievably successful 2019 and beyond!

Thursday, January 17, 2019

Study Suggests Some Dental Floss May Contain PFASs

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Last week I came across some headlines that a study had shown some potentially harmful chemicals in some name brand dental floss.  One of the brands of floss is the one I use in my own mouth, so I was immediately intrigued by the possibilities that this study offered.  Of course, as usual when it comes to mainstream media reporting of scientific work, there was little actual substance to the articles that mentioned the study other than to provide enough “scary click bait” to ensure that the sites could show advertisers how many readers they have.
 
 
After spending some time really reading and digesting the info, I was unimpressed with the control of variables and several other factors.  PFAS chemicals can be found in many sources and it seems to me that there wasn’t very strict control on those variables.  Also when you consider the small size of dental floss and the amount of time that the floss is actually in contact with soft tissue, it would seem that there would have to be a seriously fast uptake of the chemicals to create high dosage numbers in the bloodstream.
 
In a nutshell, I felt this was a non-issue and decided not to do a blog post as I don’t like to give a platform to things that don’t hold much demonstrable science.  However, I changed my mind regarding this when the ADA came out with a statement on the situation.  My feelings are that if the American Dental Association feels that this deserves a statement to calm fears, then I am a willing conduit for that.  It also helps that the position of the ADA is very much inline with my interpretation of the study as well.
 
Here is the ADA statement:
 

CHICAGO — Recent, wide-spread news coverage based upon a recent research study may raise unwarranted concern about the safety of certain types of dental floss. The ADA Science Institute finds the data insufficient to support the conclusions presented in this research and associated media coverage.  

No restrictions on the use of dental floss have been issued by the U.S. Food and Drug Administration, the regulatory agency that oversees clearance of dental products marketed to the public. It is also important to bear in mind that this is a single study. Public health policy and safety decisions should be based on the collective weight of scientific evidence.

The study, published in the Journal of Exposure Science & Environmental Epidemiology, involves a small sample of 178 women and their self-reported use of a wide array of consumer products and foods. 

The study measured blood samples from 178 women and found that those who reported using a certain brand of dental floss had higher levels of a type of PFAS called PFHxS (perfluorohexanesulfonic acid) than those who didn't. 

One of many shortcomings of this study, according to the ADA Science Institute, is that the study measured fluorine as a marker of PTFE (polytetrafluoroethylene), though the women in the study who reported using a particular brand of floss were found to have elevated levels of PFHxS. 

PTFE is often used in food and beverage, pharmaceutical, and cosmetic applications. The fact that the researchers were able to find the PTFE marker in several brands of floss does not mean that it is the source of the PFHxS in the women.  

Given that this was a retrospective study including self-reported use of products, there are likely many other differences between women who did and did not report having used the brand of floss mentioned.

The ADA sees no cause for concern based on current evidence, and above all continues to encourage people to clean between their teeth daily with floss or other interdental cleaner as part of the ADA’s daily oral hygiene recommendations. 

 

Wednesday, January 16, 2019

Dental Recycling North America Introduces Compliance Guide for EPA Amalgam Regulations

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From the EPA:

EPA has promulgated pretreatment standards to reduce discharges of mercury from dental offices into publicly owned treatment works(POTWs). The Dental Office Categoryregulation is codified at 40 CFR Part 441.
 
Dental offices discharge mercury present in amalgam used for fillings. Amalgam separators are a practical, affordable and readily available technology for capturing mercury and other metals before they are discharged into sewers that drain to POTWs. Once captured by a separator, mercury can be recycled.

EPA expects compliance with this final rule will annually reduce the discharge of mercury by 5.1 tons as well as 5.3 tons of other metals found in waste dental amalgam to POTWs.

 

From DRNA:

The good folks at DRNA have put together a compliance guide to help dentists understand and ensure compliance with the new EPA regulations.  The company has a great program to filter out your amalgam and make sure that it is disposed of properly and follows all the regs.  I’ve been using DRNA for several years and recommend them highly.

Interested in obtaining the compliance guide?  Follow this link to get the download.  

Tuesday, January 15, 2019

Cosmedent’s new CEE|Virtual

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Cosmedent’s new CEE|Virtual provides dentists online access to video recordings of some of the Center for Esthetic Excellence’s most popular courses. Experience viewing actual courses filmed live and viewed on-demand from the comfort of your home or office. Learn from some of the world’s top clinicians how to build your skills with composite, plus receive CE credits. These comprehensive courses are packed full of useful information that you can use immediately in your practice. Visit www.CEEVirtual.com to begin your virtual composite education.
 
 

Monday, January 14, 2019

Suni Medical Imaging Seems to be AWOL - Here's What I Know

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Hey Suni, remember all of those customers?  You know, all of those doctors who PAID you for your equipment and software?  How about *THE PATIENTS*  of those doctors?  Do you remember them?  Obviously not.

I’ve said it before and I’ll say it again, everyone in dentistry or healthcare in general works for the patient.  The patient is the one that is the end result of everything we do and we owe them the very, very best efforts we can give them.  Suni, it seems, has forgotten that.

Now, I will say that perhaps things are different than they appear.  Perhaps there is something going on we are all unaware of and Suni will suddenly come forward with an explanation of why they seem to have vanished.  I certainly hope so because there are a lot of patients and doctors depending on them.

Here’s the story:  The publication I write for, Dental Products Report, came forward on January 8th, 2019 with the following statement:

As of the beginning of the new year, the on-going operations of Suni Medical Imaging — the brand name for Apteryx’s XrayVision imaging software — has come under question.  

In an effort to clarify the situation, Apteryx released the following statement on January 8th, 2019: 

“It has been rumored that as of January 1, Suni has discontinued operations. Since learning of this news last week, we have reached out to Suni leadership to clarify the situation without a response. In the interest of getting the facts straight, we will continue our efforts to contact Suni directly. However, we feel an immediate obligation to reassure Suni customers that their software and support needs will continue to be met by Apteryx.”

So Apteryx is doing whatever they can to support their Suni clients, but they are not getting any replies or backups from Suni Medical Imaging.

Also from DPR:

Given that the company does not have direct access to all customers, Suni Medical Imaging customers are invited to call Apteryx at (877) 278-3799, or email support@apteryx.com, for any immediate support needs and to register for on-going support. 

Customers can also visit www.ledapteryx.com/suni for more contact methods. 

“As Suni/ XrayVision customers, please rest assured that you are well positioned to make whatever transitions may be required. Dr. Suni and Prof. Suni, like all Apteryx XrayVision products, are designed as an “open” system meaning that you have plug and play interoperability with other open hardware and software solutions,” says Apteryx officials.

To see the original story, follow this link to DPR.  

Thursday, January 10, 2019

20 Year Old Arrested in Hack that Resulted in Germany's Largest Data Breach

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In an amazing story, a 20 year old German man, with limited computer experience, managed to find and distribute a huge amount of data on public figures such as journalists and politicians last month.
 

Known on Twitter by the name "G0d," the suspect published private data about German politicians, journalists, and celebrities on Twitter, under the username @_0rbit.

Telephone numbers, private chats, and letters, some credit card data, addresses and copies of identity cards of victims were all exposed in what believed to be one of the country's biggest data breaches in the history.

Unlike as initially feared, early evidence suggests no involvement of foreign intelligence or activists for far-right Alternative for Germany (AfD), who was not targeted by the attacker, in the incident.

Besides German politicians, the intrusive hack attacks also affected well-known actor Til Schweiger, two renowned German comedians, Jan Boehmermann and Christian Ehring, as well as dozens of journalists from ZDF and ARD–public-funded German media outlets.

Germany is still in the process of removing the exposed data from the Internet, but there are no signs that any information was released that would be considered politically explosive or increase security risks.

Jai Vijayan has a great piece with lots of details that you can find here.  

Wednesday, January 9, 2019

Dentistry Ranked #4 in U.S. News & World Report "Top 25 Jobs for 2019"

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Dentistry is a great profession for those who love it.  The combination of communication, helping people, and solving sometimes complicated problems are just a few of the reasons I love what I do.
 
It seems that whenever I see some sort of list of great jobs, jobs with great satisfaction, or whatever, dentistry is always ranked pretty highly.  The latest Top 25 Jobs from U.S. News and World Report is just one more example of this.  Here’s what they have to say:
 

Dentists identify and treat problems concerning a patient's mouth, gums and teeth. Their duties include extracting teeth, fitting dentures and filling cavities. Some choose to specialize in areas that range from treating serious oral problems and diseases to straightening teeth and performing oral surgeries. They are assisted by dental hygienists, who complete a patient's teeth cleaning, and by dental assistants, who usually help with recordkeeping and instrument sterilization.

Many people dread the dentist. When they open wide, they're afraid what the dentist will find. Yet another cavity? Or even worse – will it be time for a root canal? Will the dentist embarrass them about their flossing frequency or their coffee drinking? Will they push procedures that patients don't want? 

According to Ada S. Cooper, a consumer adviser for the American Dental Association and dentist with a private practice in New York City, these concerns are why establishing trust is so important. "Patients have to know that dentists are doing what's best for them," Cooper says. And they can do this by being honest, ethical and compassionate – three qualities Cooper looks for when she is hiring at her practice. She also highlights the importance of good communication skills.

The Bureau of Labor Statistics projects 19.4 percent employment growth for dentists between 2016 and 2026. In that period, an estimated 25,700 jobs should open up.

For the full listing follow this link.  

Tuesday, January 8, 2019

Obama health law sign-ups lagging for 2019

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Some interesting info regarding the Affordable Care Act that I’ve scrounged together.
 
With open enrollment now over, the government says sign-ups for coverage under former President Barack Obama’s health care law are lagging when compared with last year.

Figures released recently by the Centers for Medicare and Medicaid Services show that about 3.2 million people have signed up so far for subsidized private insurance, compared with about 3.6 million at the same time last year. Open enrollment ended December 15.

Health law supporters are concerned. The number of new customers is down nearly 18 percent.

Many Democrats blame the Trump administration for the slippage, but independent experts say there may be other reasons, too. In a strong economy people are more likely to find jobs with coverage.

Most of the estimated 10 million currently enrolled will have their coverage renewed automatically.

Thursday, January 3, 2019

Treating Periodontal Disease may help Control Type 2 Diabetes

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According to a recently published article by Reuters, there is a potential benefit for sufferers of Type 2 Diabetes to have their periodontal disease treated and kept under control.
 
For years now, those of us in medical fields have pushed for greater understanding of the connections between the mouth and the rest of the body.  Many patients think that because you see a different provider for Diabetes and your mouth, that the 2 areas really aren’t related that much.
 
However, the mouth is the main entrance to the body for all types of things and the health of it can greatly affect the health of every other body part.  For instance, if your hands bled when you washed them, many folks would be seeking medical treatment asap, yet bleeding gums (a definitive sign of infection) rarely causes the same concerns for patients.
 
Here’s the info from Reuters:
 

Treating chronic gum inflammation might help people with diabetes control their disease, a recent study suggests.

The 264 study participants all had type 2 diabetes and periodontitis, a chronic bacterial infection of the gums that causes ongoing inflammation and is a major cause of tooth loss for adults.

“While more research is needed to explore the exact mechanisms” by which treating gum disease can help people with diabetes, “a reduction of systemic inflammation . . . is the most plausible link,” study leader Francesco D’Aiuto told Reuters Health by email.

Over the course of a year, patients who got intensive periodontal treatment from dentists saw improvements not just in their blood glucose levels but in the health of their kidneys and blood vessels, too.

Type 2 diabetes, the kind linked to obesity and lack of exercise, is a major cause of disability and premature death, mainly from vascular and renal complications, the researchers write in The Lancet Diabetes & Endocrinology. Periodontitis often coexists with diabetes.

Half of the patients in the study were randomly assigned to receive intensive treatment of their gum disease. The remaining patients didn’t get this treatment, but if their gum disease got worse during the year, they received prompt specialist care and were withdrawn from the study.

In the intensive treatment arm, patients got an initial session of whole mouth scaling. Two months later, patients with good oral hygiene and particularly severe gum disease had periodontal surgical therapy. Patients with suboptimum oral hygiene or without severe gum disease at two months continued to receive regular scaling of the root surfaces until completion of the study.

Researchers estimated average blood sugar levels by measuring HbA1c, a protein on red blood cells that indicates blood sugar levels over a period of two to three months. With diabetes, keeping HbA1c test results below seven percent is generally considered to be good blood sugar control.

At the start, the average HbA1c was 8.1 percent in both groups. After 12 months, the HbA1c level averaged 0.6 percent lower in the group that got intensive gum disease treatments.

Two markers of kidney health also improved in the intensive treatment group: blood levels of a substance called creatinine, and the amount of blood that passes through waste filters in the kidneys called glomeruli.

A marker of artery health called flow-mediated dilation also improved in this group.

Not surprisingly, oral health was better in the intensive treatment group, too.

It’s possible, the authors admit, that the findings could be partly attributed to the effects of medicines patients were taking. Still, they suggest, oral health improvement in this population may represent an important therapeutic opportunity.

Researchers estimated average blood sugar levels by measuring HbA1c, a protein on red blood cells that indicates blood sugar levels over a period of two to three months. With diabetes, keeping HbA1c test results below seven percent is generally considered to be good blood sugar control.

At the start, the average HbA1c was 8.1 percent in both groups. After 12 months, the HbA1c level averaged 0.6 percent lower in the group that got intensive gum disease treatments.

Two markers of kidney health also improved in the intensive treatment group: blood levels of a substance called creatinine, and the amount of blood that passes through waste filters in the kidneys called glomeruli.

A marker of artery health called flow-mediated dilation also improved in this group.

Not surprisingly, oral health was better in the intensive treatment group, too.

It’s possible, the authors admit, that the findings could be partly attributed to the effects of medicines patients were taking. Still, they suggest, oral health improvement in this population may represent an important therapeutic opportunity.

Wednesday, January 2, 2019

FDA Warns Against Use of Teething Necklaces, Bracelets, and Other Jewelry Marketed for Relieving Teething Pain or Providing Sensory Stimulation: FDA Safety Communication

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Here is a recent alert for parents of infants that are teething.  This is important info and should be read by all new and recent parents.
 

Audience
Parents or caregivers of infants with teething pain.
Parents or caregivers of individuals with special needs, such as autism or attention-deficit/hyperactivity disorder (ADHD), who use necklaces and bracelets to provide sensory stimulation or redirect chewing.
Health care providers who interact with these caregivers who use or may consider using necklaces and bracelets marketed for relieving teething pain or providing sensory stimulation.

Medical Specialties
All primary care specialties including general pediatrics, pediatric dentistry, family medicine, general internal medicine, family and pediatric nurse practitioners.
Psychologists, psychiatrists, developmental and behavioral specialists, occupational therapists, physical therapists, general nursing and certified nursing assistants.

Product
Teething jewelry includes necklaces, bracelets, and other jewelry that can be worn by either an adult or child, and is often marketed to relieve an infant’s teething pain. The beads of the jewelry may be made with various materials such as amber, wood, marble, or silicone. Jewelry marketed for teething pain is not the same as teething rings or teethers, which are made of hard plastic or rubber, and are not worn by an adult or child.

Teething jewelry may also be used by people with special needs, such as autism or attention-deficit/hyperactivity disorder (ADHD), to provide sensory stimulation or redirect chewing on clothes or body parts.

Purpose
The FDA is alerting parents, caregivers, and health care providers that necklaces, bracelets, and other jewelry marketed for relieving teething pain should not be used with infants or to provide sensory stimulation to persons with special needs, such as autism or attention-deficit/hyperactivity disorder. Such use could lead to strangulation, choking, serious injuries, or death. The safety and effectiveness of teething jewelry to treat teething pain and/or provide sensory stimulation have not been established.

Summary of Problem and Scope
The FDA has received reports of death and serious injuries to infants and children, including strangulation and choking, caused by necklaces and bracelets often marketed for relieving teething pain. Parents and other caregivers may use these products to help relieve teething pain or to provide sensory stimulation in people with special needs. The risks of using teething jewelry include choking, strangulation, injury to the mouth, and infection. Choking may occur if the jewelry breaks and small beads or the whole piece of jewelry enter the child’s throat or airway.

The FDA received a report of a 7-month old child who choked on the beads of a wooden teething bracelet while under parental supervision and was taken to the hospital as a precaution. Strangulation can happen if a necklace is wrapped too tightly around the child’s neck or if the necklace catches on an object such as a crib. The FDA received a report of an 18-month old child who was strangled to death by his amber teething necklace during a nap. Other concerns include potential injury to the mouth or infection if a piece of the jewelry irritates or pierces the child’s gums.

Recommendations for Parents and Caregivers

  • Do not use necklaces, bracelets, or any other jewelry marketed for relieving teething pain. The use of these products can lead to serious injuries including strangulation or choking.
  • Be aware that the use of jewelry marketed for relieving teething pain or provide sensory stimulation to people with special needs can lead to serious injuries including strangulation or choking.
  • Review the American Academy of Pediatrics’ recommendations for treating teething pain .
  • Talk to your doctor about alternative ways you can reduce teething pain such as:gently rubbing or massaging the gums with a clean finger
  • giving the teething child a teething ring made of firm rubberMake sure the teething ring is not frozen. If the object is too hard, it can hurt the child’s gums. Parents and caregivers should supervise the child during use.
  • Avoid teething creams and benzocaine gels, sprays, ointments, solutions, and lozenges for mouth and gum pain in infants and children younger than 2 years. Benzocaine and other local anesthetics can cause methemoglobinemia, a serious condition in which the amount of oxygen carried through the blood is reduced. This condition is life-threatening and can result in death.

Recommendations for Health Care Providers

  • Talk to parents or caregivers about safe ways to reduce teething pain , including the benefits and risks of available treatment options.
  • Discourage use of necklaces, bracelets, and other jewelry marketed for relieving teething pain. 
  • Discourage use of necklaces, bracelets, and other jewelry for providing sensory stimulation to people with special needs

FDA Actions
The FDA is closely monitoring adverse event reports associated with teething jewelry and is committed to protecting public health and assuring the safety of children and others. The FDA will update this communication if significant new information becomes available.

Reporting Problems to the FDA
If you experience an injury or adverse event when using teething jewelry, the FDA encourages you to file a voluntary report by phone at 1-800-FDA-1088 or online at MedWatch, the FDA Safety Information and Adverse Event Reporting program. Please include the following information in your reports:

  • Device Name (Brand Name)
  • Manufacturer’s Name
  • Details of Adverse Event and Medical and/or Surgical Interventions (if applicable)

Prompt reporting of adverse events can help the FDA identify and better understand the risks related to the use of medical devices.

Additional Resources
American Dental Association- Teething Recommendations
FDA Safety Communication- Risk of serious and potentially fatal blood disorder prompts FDA action on oral over-the-counter benzocaine products used for teething and mouth pain and prescription local anesthetics
American Academy of Pediatrics Alert- Amber Teething Necklaces: A Caution for Parents
American Academy of Pediatrics- Sensory Integration Therapy
Consumer Update: Safely Soothing Teething Pain and Sensory Needs in Babies and Older Children

Contact Information
If you have questions about this communication, please contact the Division of Industry and Consumer Education (DICE) at DICE@FDA.HHS.GOV, 800-638-2041 or 301-796-7100.