Wednesday, November 30, 2022

AMD Lasers has Special Pricing During Cyber Week!


Over the years I've worked with AMD Lasers quite a bit, both with the products and the company.  I've found their products to be reliable and best of all... affordable.  As anyone in dentistry  will tell you, the cost of equipment can be a serious impediment to adoption.  The good thing is that companies like AMD exist that produce quality equipment while also making that equipment affordable.

I've been using lasers in my practice since the late 1990s and I can tell you from personal experience that they give me a tremendous advantage in what I do.  There are a lot of things that lasers allow you to do and I use them almost every day.

So it's great to be able to tell you that AMD is having a tremendous sale this week.  As you can see from the graphic above, their Picasso diode lasers are 50% off and the Monet handheld curing laser is 30% off.

If you are interested in exploring what a laser can do for you as far as soft tissue surgery or high speed curing, head on over to the AMD website and take advantage of the discounts they are offering this week.  

Tuesday, November 29, 2022

Tech Titan Mark Cuban Working Toward Helping Hospitals to Eliminate Drug Shortages

Most folks, whether you are in healthcare or not, are well aware of all kinds of supply chain issues that were caused by all of the shutdowns during the stop the spread part in the early days of the pandemic.  It's been amazing to see what things are and what are NOT readily available since then.  The automobile industry has been especially hard hit as they depend on *lots* of parts from many, many companies.  Getting things back on track since 2020 is *still* a challenge.

 As most of us in healthcare know, since the whole Covid-19 supply chain problem began to rear its ugly head, there have been shortages of different drugs at different times.  Obviously shortages of medications can be hugely impactful for patients that require certain medications to stay healthy or stay alive.  If you've ever wondered what drugs are impacted by shortages, the FDA has a website that you can consult to find out.  That FDA page also has a link to the Google Play Store and the Apple App Store where you can download mobile apps that will also give you the info.

Needless to say, the solution needs to be uncovered because drug shortages can have serious consequences.  That's why I was happy to come across some info regarding tech entrepreneur Mark Cuban, putting his efforts behind a way to help solve this problem.  He has created the Mark Cuban Cost Plus Drug Company.  The idea is that the company will produce low-cost versions of costly generic drugs.  He has also said the company plans to "provide radical transparency in how we price our drugs."

It seems that in February 2022, the company began construction on an $11 million facility in Dallas to manufacture some of those drugs.  The plant is said to be due to open early in 2023.  

If you are interested in more info on this project, Mr. Cuban recently discussed the concept on a podcast popular with investors.  You can listen to the podcast by following this link...  

Monday, November 28, 2022

General Motor OnStar Partners with NORAD to Track Santa


I will have more info on NORAD Tracks Santa as Christmas Eve approaches, but since today is really the beginning of the Christmas Season I thought I would make today's post about. OnStar's partnership in that endeavour.

Most of us have a preferred car company and for some reason, mine has been Chevrolet.  I have no idea why, but I have a loyalty to the brand.  So I was excited to learn that the General Motors OnStar program has had a long standing partnership with NORAD.

The North American Aerospace Defense Command (NORAD) tracks Santa every Christmas Eve; and as I said earlier, I'll post more on that program on December 23rd... before Christmas Eve.  However, the important takeaway from today's post is that since 2009 General Motors OnStar has been teaming up with NORAD to help in that tracking.

By pushing the blue OnStar button in your vehicle on Christmas Eve, you'll be connected with an OnStar Advisor that can provide you and your child a location of Santa as he journeys around the globe.  In case a child is concerned Santa won't be able to find them, the OnStar Advisor can assure them that the big guy will indeed be on his way!

The service will run from 6 a.m. EST Christmas Eve to 5 a.m. EST Christmas Day.  Also, every time someone pushes the button during those times, GM will donate $1 to the Canadian Red Cross (up to $3000).

A big Thank You to OnStar as well as the great folks at NORAD!

Wednesday, November 23, 2022

Timeout for Thanksgiving!

 The Thanksgiving holiday is upon us here in the U.S. so I won't be posting again until next week.

With the idea of "thanksgiving" in mind for the next few days, I'd like to share a story with you and i hope it puts things into perspective...

When I was a little boy I would occasionally have one of those "kid meltdowns" that all parents are familiar with.  Now not all of these occurred around my mom & dad.  My grandmother used to let me come stay with her on a regular basis and sometimes I'd have one of those moments while I was in her care.  During those moments, my grandma was prone to say, "oh just count your blessings..."

We all have a lot to be thankful for.  Lately I've been talking to patients about the term "first world problems" and when I talk about that, I think of my grandmother.  Somewhere she is smiling knowing that I finally figured out that waiting an  extra 60 seconds for an 8 dollar latte isn't really a problem at all.  There are people out there waking miles to find clean drinking water for their children and I can just turn on the faucet.

I still get frustrated sometimes, but I have learned my "first world problems" aren't really problems at all.  I think we all need to "count your blessings".  Thanks, Grandma.  I miss you!

Tuesday, November 22, 2022

FDA says Naloxone (Narcan) is Likely Safe for OTC Availability

 For those of you who are not healthcare providers, you may not be familiar with the drug Naloxone (also known as Narcan).  The medication is an incredibly fast acting reversal agent for narcotics.  Basically if a person is suffering from an overdose, administering Narcan can completely reverse the overdose situation and bring a patient back from a potentially fatal situation.  

The drug was developed in the early part of the 1960s by Jack Fishman who was a researcher at Sloan-Kettering Institute for Cancer Research.  However, he developed Naloxone while working part time at Endo Laboratories Narcotics Division.  When initially synthesized,  no one saw much use for the drug.   

Fast forward to today and Naloxone has become a major life saver.  It is carried by most police officers who answer emergency calls as well as EMTs.  It works *amazingly fast* and can, in some instances, mean the difference between life and death for an individual.

In my office we have 2 nasal spray units in our emergency medical kit.  These are small unidose dispensers that allow us to insert it into the nasal opening of a patient and then shoot a fine spray of the drug into the nasal passages where it is rapidly absorbed through the sinus lining and quickly delivered into the bloodstream.  These are the same dispensing units that are frequently carried by the first responders.

The FDA is giving consideration to the 4mg nasal spray units as well as the 2 milligram dose that can be given through an auto injector, which is similar to the "epi-pen" many people are familiar with.  Naloxone has a high degree of safety and would be easy to use in these delivery options.

If approved, this decision would have a tremendous opportunity to save lives.

You can read the FDA information on this subject by following this link.  

Monday, November 21, 2022

Amazon Clinic is Coming as The Everything Store Pushes into Healthcare


An interesting move in the telehealth space has been announced recently.  Amazon, which is the world's largest online retailer, has announced Amazon Clinic.

The system will operate in 32 states when it starts.  The idea is to provide "virtual care" for 20 common health conditions such as allergies, acne, and hair loss.  It will be a message based virtual telehealth service that will strive to connect doctors with patients in way that is more convenient for patients and more efficient for doctors.

The basic idea is 

  1. The patient selects the condition they need help with
  2. The patient selects a provider from a list
  3. The patient completes a short intake form questionnaire
  4. The patient is then connected to the provider through a secure message-based portal

While I am a firm believer in the doctor patient relationship, I also realize that many folks need an affordable healthcare option that is available when *they* are.  There are also folks who lack transportation or are in rural areas where a trip to the doctor could require a lengthy amount of travel.  Let's face it, as a doctor of the head and neck, I see certain situations where I could do some remote diagnosis and triage.  There are times when a doctor doesn't absolutely need to "touch" the patient to make an accurate diagnosis.  Now, the flip side is that there ARE times that a physical visit is *absolutely* necessary.  However, if it isn't needed, why make people jump through unnecessary hoops?

My personal feelings are that this is filling a definite need.  There are some "holes" in the U.S. healthcare system and filling those holes is necessary and a *good* thing.  We are seeing rapid expansion in telehealth by many companies currently.  Almost everyone has an Amazon account and if utilizing this service can help some people.  My thoughts are, let's get help to those people.

Thursday, November 17, 2022

CMS Warns their Medicare Users about Deceptive Marketing...

 I *love* a free press!  There are times when the truth has to get out.  According to the Associated Press:

With Medicare’s open enrollment underway through Dec. 7, health experts are warning older adults about an uptick in misleading marketing tactics that might lead some to sign up for Medicare Advantage plans that do not cover their regular doctors or prescriptions and drive up out-of-pocket costs.

I'd like to say this kind of behavior stuns me... but this kind of behavior does NOT stun me.  Taking advantage of older people has probably existed as long as there have been... people.   The troubling part of this is they are trying to take advantage of folks who aren't as mentally sharp as they were in their youth, have less money to spend, AND will need medical services.

Allowing money grubbing crooks to cheat those folks goes against everything we stand for as a nation.

Of course marketing is always trying to convince us to part with our money, but doing so in such an ethical manner is just wrong.  The good news is the CMS (Centers for Medicare and Medicaid Services) is making a concerted effort to stop this practice.  They've started actually using some of their employees as "secret shoppers" to try and find out who is offering these less than honest plans and then shutting them down.

I salute the AP for bringing this to light and I also salute CMS for trying to rein in these unethical people.  The whole story from the AP can be found by following this link.  

Wednesday, November 16, 2022

FDA Head Dr. Robert M. Califf Takes Stand on Twitter Membership

 The fact that Elon Musk now owns Twitter has been a cause of much consternation and concern about what direction Twitter will head in as well as what the future holds for that social network.  While a lot of the concerns seem to be political... many are not.  I try not to enter into political discussions online as I don't reel that is my place.  So with that being said, I *do* think some situations on Twitter bear discussing here...

I was very impressed when I read lately of the decision of Dr. Robert Califf, who head the FDA.  His statement, that was placed on Twitter, reads:

 "The easy thing to do would be to abandon using Twitter, but that’s not the right thing for us to do at this time. More than ever before, it’s important that FDA continues to use Twitter for good and do everything in our power to protect the public from potential harm."

I have to say that I agree with Dr. Califf.  Even though he is a political appointee, I don't feel that statement is political.  Basically his point is that if knowledgeable people leave the platform, than who is there to provide knowledge in that particular subject.

The entire thread of the thought is impressive in my opinion.  You can read the thread by following this link.  I feel the world could use some more calm opinions like this.

Tuesday, November 15, 2022

School of Dentistry-Led Team Takes Novel Approach to Treating Jaw Osteonecrosis

 Here is some potentially good news on a dental discovery which may lead to a cure for the dreaded disease BRONJ.  It seems that a team of very bright folks from the UCLA School of Dentistry have discovered a topically applied medicament that can allow these lesions to heal uneventfully.  

Last week I posted some new info from the AAMOS regarding this disease, and now we have some potentially groundbreaking news from UCLA.

Here is a portion of the article:

A team of scientists led by the UCLA School of Dentistry’s Ichiro Nishimura, D.D.S., D.M.Sc., D.M.D., has discovered a promising treatment to prevent or alleviate bisphosphonate-related osteonecrosis of the jaw (BRONJ) through a newly formulated topical medication. 

 The findings published in an open-access research article in eLife demonstrated how BRONJ – visible as a morbid jawbone lesion – was rapidly closed and chronic gingival inflammation resolved in mice. Based on these promising results, in conjunction with UCLA’s Clinical and Translational Science Institute (CTSI) Nishimura has submitted an application to the FDA requesting information for human trials.

 BRONJ is a rare but severe side effect seen in those who have been prescribed bisphosphonates to slow bone loss, either for bone cancer or more frequently, osteoporosis; those suffering from the latter is condition won a well-publicized 2008 class-action lawsuit against drug maker Merck. In turn, bisphosphonate prescriptions have declined over the past 15 years due to apprehension among patients and healthcare providers, correlating with a rise in bone fractures.

“BRONJ was a previously-unknown disease with persistent and painful jawbone necrosis without any available treatments; the only commonality among these patients was a history of anti-resorptive drug treatment such as bisphosphonates,” said Nishimura. “In 2006, our team at UCLA’s Weintraub Center for Reconstructive Biotechnology hosted a retreat with scientists and clinicians determined to solve this mysterious disease.”

To read the article in its entirety, follow this link.   

Monday, November 14, 2022

Learn Composite Dentistry at the Center for Esthetic Excellence in Chicago

 Announcing the 2023 Continuing Education Lectures and Hands-on Workshops 

The Center for Esthetic Excellence, (CEE) has scheduled a lecture and hands-on workshop, entitled, “Direct Resin in the Anterior Dentition: Approaching the Complex Case,” 

Thursday – Friday, January 19-20, 2023, 8:00 a.m. – 5:00 p.m., presented by Dr. Jason Smithson.

Treat a discolored lateral, a peg lateral, a Class IV and close a diastema all in one arch.

Approach and create a treatment plan with direct resin, using a combination of opaquers, tints and advanced matrixing techniques. Dr. Smithson will carry out each exercise in a stage-by-stage fashion. For more information regarding this course, please contact Erika Heier at 800-837-2321 or

Thursday, November 10, 2022

Sophisticated Attempt of Data Theft - Why You *Have* to Remain Vigilant

 I had an interesting experience last week that I'd like to tell you all about since it could potentially happen to you as well... The good thing is that my installed security stopped the potential problem, but I should have caught it myself.

Since we run a pretty busy practice, we order a lot of supplies.  Every day our UPS driver brings in several boxes.  We have all of our ordering pass through one employee to help us keep a handle on things, but I also order supplies on occasion for specific uses that I am better equipped to know.

Last week I had personally ordered 3 different things all coming in different shipments.  I wasn't sure how the orders would arrive.  We routinely receive things from UPS, FedEx, DHL, and the United States Postal Service.

On Thursday I was sitting at my desk when I received a text message on my mobile phone.  It came from a long distance number that was not in my contacts.  While that alone, would normally raise my suspicions, the message itself helped decrease those concerns.  The message read:

[US-PS]: We cannot deliver your package to you due to incorrect house number. Fill in the correct address online and we will redeliver

The message ended with a link to a website.  The message being from "US-PS" should have made me more cautious, but I thought "the postal service probably uses this all of the time."

I opened the link on my Mac and a webpage opened.  The address was to "" and there were all kinds of blank fields for me to fill out.

Fortunately I had used the US Postal Service website before and I knew their address was "" with NO hyphen.   The suspicious website had a tracking number for my package with a lot of fields  for me to fill in.  Before I clicked anything on the page or input any data, I opened another tab and went to the USPS website where I went to the package tracking page and input the number on the suspicious page.  The search came back with "no package found".

I returned to the suspicious tab and when I looked at it, by now a couple of my security programs popped up warning me that this page looked suspicious and NOT to enter any data or click any links.

Had I been busier or in desperate need of some supply I was expecting, I might very well have filled out the page and submitted the info BEFORE my security apps had caught it.   Fortunately my suspicions paid off and saved me, but I almost committed the cardinal sin of entering or clicking without a second thought.

It's a bit disconcerting knowing that my mobile number is out there in a database for scammers to use, but that is the price of being so connected, I suppose.  However, I wanted to make all of you aware of this situation in case something similar happens to you.

Wednesday, November 9, 2022

Living Security Partners with SpyCloud to More Effectively Identify Enterprise Human Risk

Two Austin-based cyber companies partner to mitigate the effects of security hygiene on enterprise risk

AUSTIN, TX - Nov. 9, 2022 - Living Security, the leader in Human Risk Management, today announced a partnership with SpyCloud, the leader in Cybercrime Analytics, to better identify segments of human risk inside organizations and help security leaders create a proactive plan to mitigate attacks.

Living Security’s Unify Human Risk Management Platform now includes SpyCloud’s Identity Risk Engine, which delivers risk assessments and key risk indicators (KRIs) based on analysis of 300+ billion assets recaptured from data breaches and malware victim logs being traded in the criminal underground. The KRIs link email addresses, usernames, passwords, and PII across employees’ exposed online personas, giving security teams a fuller picture of individuals’ security hygiene, as well as details on the scope, recency, and severity of their darknet exposures. Through this partnership, organizations will be able to better identify the most vulnerable segments within their workforce, including employees with compromised accounts and credentials, so they can best mitigate the human risk exposure and measure their behavior over time.

Eighty-two percent of breaches currently involve the human element. “What is killing organizations is the daily human failures, not the big, notable incidents. These smaller missteps are happening millions of times a day and if you want to lower the onerous demand on your security team, you need to focus on human risk management,” said Dan Walsh, CISO of VillageMD and a member of Living Security’s CISO Advisory Board.

To date, clients using Living Security’s Unify Human Risk Management platform have been able to see their riskiest segments from an “inside-out” view using the internal data from their technology stack, and now they are also able to get the “outside-in” perspective leveraging SpyCloud to decrease risk for their organizations.

“Our focus at Living Security has always been on the human factor. We are disrupting the industry and driving a paradigm shift that enables organizations to leverage behavioral data to effectively manage and mitigate human cybersecurity risk,” said Ashley Rose, CEO and co-founder of Living Security. “This partnership with SpyCloud is an incredible step in this mission, allowing us to access real-time darknet exposure insights that matter to our clients – identifying employees with riskier behaviors and alerting us to those whose credentials and personal data are compromised. This gives our clients the information they need to prioritize the riskiest segments using a data-led approach to keeping their organizations safe.”

“At SpyCloud, we’re continuously working to help businesses stay a step ahead of cybercriminals. Embedding proactive insights in Living Security’s platform helps security leaders understand, at-a-glance, the risk employees pose to the organization,” said Cassio Mello, Senior Vice President of Business Development at SpyCloud. “We share a joint belief with Living Security that staying secure from ransomware, breaches, and account takeover requires taking action on the exposure of individuals in your workforce.”

The partnership comes on the heels of the release of a new Human Risk Management Maturity Model that Living Security is pioneering with other industry leaders to set a new standard of measuring the human risk exposure for organizations. To learn more, visit

About Living Security

Living Security’s mission is to transform human risk to drive dramatic improvement in human behaviors, organizational security culture, and infosec program effectiveness. With our Human Risk Management platform, Living Security engages each employee with innovative and relevant context and content, while simultaneously providing the ability for leadership to identify, report on and directly mitigate the risk brought on by human behavior. Living Security is trusted by security-minded organizations like MasterCard, Verizon, MassMutual, Biogen, AmerisourceBergen, Hewlett Packard, and Target. Learn more at

About SpyCloud

SpyCloud transforms recaptured darknet data to protect businesses from cyberattacks. Its products operationalize Cybercrime Analytics (C2A) to produce actionable insights that allow enterprises to proactively prevent ransomware and account takeover, protect their business from consumer fraud losses, and investigate cybercrime incidents. Its unique data from breaches, malware-infected devices, and other underground sources also powers many popular dark web monitoring and identity theft protection offerings. SpyCloud customers include half of the ten largest global enterprises, mid-size companies, and government agencies around the world. Headquartered in Austin, TX, SpyCloud is home to nearly 200 cybersecurity experts whose mission is to make the internet a safer place. 

To learn more and see insights on your company’s exposed data, visit

Tuesday, November 8, 2022

Outbreaks of Nontuberculous Mycobacteria Infections Highlight Importance of Maintaining and Monitoring Dental Waterlines

 Here is the latest on Dental Unit Waterlines from the CDC...


The Centers for Disease Control and Prevention (CDC) is issuing this Health Alert Network (HAN) Health Advisory to emphasize the importance of following existing recommendations for maintaining and monitoring dental waterlines. Multiple outbreaks of nontuberculous Mycobacteria (NTM) infections have occurred in children who received pulpotomies in pediatric dental clinics where the dental treatment water contained high levels of bacteria. CDC provides guidelines on infection control in dental settings which contain recommendations to treat dental unit waterlines and monitor water quality. Dental providers should be familiar with these recommendations on how to properly maintain and monitor their dental equipment to ensure that dental treatment water is safe for patient care.


While rare, there have been multiple documented cases of disease transmission from dental unit waterlines (narrow-bore plastic tubing that carry water to the high-speed handpiece, air/water syringe, and ultrasonic scaler).1-5 Dental units have unique characteristics that make them prone to biofilm formation.6 Biofilms occur in dental unit waterlines due to the long, small-diameter tubing and low flow rates used in dentistry and the frequent periods of stagnation. As a result, high numbers of common waterborne bacteria can be found in untreated dental unit water systems. Disease-causing microorganisms found in untreated dental unit water can include Legionella, Pseudomonas aeruginosa, and nontuberculous Mycobacteria (NTM).

Dental providers and patients could be placed at risk of adverse health effects if dental unit water is not appropriately treated. In March 2022, CDC was notified of a new cluster of suspected NTM infections in children following dental procedures at a pediatric dental clinic. Investigation into this cluster is currently ongoing, and preliminary site visit data report that dental unit waterline testing results showed microbial counts much higher than the level recommended by CDC.

In 2016, an outbreak occurred at a pediatric dental clinic in Orange County, California, with 71 patients identified as having odontogenic NTM infections following pulpotomy procedures.1 Municipal water stored in a pressurized bladder holding tank was used to fill the dental unit water bottles. The clinic was not using disinfectants on their dental unit waterlines or regularly monitoring water quality. All water samples tested from the dental units showed microbial counts higher than the level recommended by CDC and multiple species of NTM were identified in syringe water samples from five of the six treatment rooms.

In 2015, 24 cases of odontogenic NTM infections were reported in children receiving pulpotomy treatment from a pediatric dental clinic in Georgia.2 Investigators from the Georgia Department of Public Health found that municipal water was used during dental procedures, the clinic was not using a disinfectant in their dental unit waterlines, and the clinic was not regularly monitoring the water quality as recommended by CDC. Microbial testing of the water samples taken from the dental units showed very high microbial counts of Mycobacterium abscessus. The M. abscessus isolates recovered from the water were found to be identical to eight isolates from tissue samples from seven of the patients, suggesting that water was the source of the infections.

The outbreaks in California and Georgia involved young children, with ages ranging from 4 to 8 years. Many of the children developed severe infections with clinical diagnoses such as cervical lymphadenitis and mandibular or maxillary osteomyelitis, and required hospitalization, treatments such as intravenous antibiotics, and surgical procedures. Complications from their infections included permanent tooth loss, hearing loss, facial nerve palsy, and incision fibrosis.

Because of the potential to form biofilm, CDC recommends that all dental unit waterlines be treated regularly with disinfectants to meet the Environmental Protection Agency (EPA) regulatory standards for drinking water (i.e., ≤500 colony forming units (CFU)/mL of heterotrophic water bacteria).7 There are many commercial products and devices available to disinfect and maintain dental unit waterlines. Dental unit water quality must also be monitored routinely as recommended by the equipment manufacturer to ensure that treatments are working effectively and that the water used in dental procedures meets safety standards.6 Dental providers should consult with the dental equipment manufacturer for appropriate methods and equipment to both maintain and monitor the quality of dental water.

Oral surgical procedures involve the incision, excision, or reflection of tissue that exposes the normally sterile areas of the oral cavity. Examples include biopsy, periodontal surgery, apical surgery, implant surgery, and surgical extractions of teeth (e.g., removal of erupted or nonerupted tooth requiring elevation of mucoperiosteal flap, removal of bone or section of tooth, and suturing if needed). During oral surgical procedures, dental practitioners should use only sterile solutions as a coolant or irrigant using an appropriate delivery device, such as a sterile bulb syringe, sterile tubing that bypasses dental unit waterlines, or sterile single-use devices.

For the full post with recommendations & resources, follow this link

Thursday, November 3, 2022

AAMOS Surgical Experts Publish Updated MRONJ Guidance

 On occasion, the best efforts of our medical system can actually solve one problem and unintentionally create another.  One of these situations is a troubling outcome from bisphosphonate therapy.  What follows is the most recent information from AAMOS...

AAOMS prioritizes prevention of the jaw disease, continuing cancer care

The American Association of Oral and Maxillofacial Surgeons (AAOMS) has issued updated guidance for treating a rare but potentially serious jawbone condition that can impact patients taking antiresorptive medications to treat certain cancer types.

Medication-related osteonecrosis of the jaw, or MRONJ, is often-painful and characterized by exposed dying bone in the upper and lower jaws, swelling of the gums and loosening of previously stable teeth.

To help patients and healthcare providers navigate this clinical concern, oral and maxillofacial surgery experts analyzed literature and revised guidance to reflect current best practices. The 2022 recommendations – published in the Journal of Oral and Maxillofacial Surgery – prioritize preventing the disease while continuing cancer treatment necessary to maintain quality of life and support bone health.

"Although no individual nor collection of strategies eliminates all MRONJ risk, certain preventive procedures can make a difference," said lead author Salvatore L. Ruggiero, DMD, MD, a practicing surgeon and professor at the Stony Brook School of Dental Medicine in New York. "Maximizing overall patient well-being is always the preference."

Among strategies for reducing the risk of MRONJ: maintaining good oral hygiene, performing high-risk surgical procedures prior to initiating drug therapies, quitting smoking and optimizing diabetes care.

Authors agree that prevention starts with realizing that patients receiving bone-preserving medications (antiresorptives) face altered wound-healing capacity, another potential risk factor for developing MRONJ. Healthcare providers must recognize the importance of coordinating dental care and treatment planning for osteoporosis and cancers involving these therapies, they wrote.

Doing so requires continuous efforts to educate patients, dentists and medical professionals about the real risks associated with antiresorptives and the clinical paradigm shift needed to mitigate MRONJ, researchers wrote.

AAOMS emphasizes the importance of a multidisciplinary approach to treating patients receiving such treatment. This also may apply to other substances used to stimulate the immune system or targeted therapies taken alone or in combination with antiresorptives (brand names such as Fosamax, Boniva and Prolia). Team-based MRONJ care includes consulting an appropriate dental professional when a doctor determines a patient could benefit from these medications.

"Oral and maxillofacial surgeons are versed in treating this clinical concern, and it is crucial that oncologists, rheumatologists and other providers work with our specialty to prevent and treat it," said Thomas B. Dodson, DMD, MPH, article co-author and editor-in-chief of the Journal of Oral and Maxillofacial Surgery, AAOMS's official journal. "Our goal in issuing this update is to educate both our peers in medicine and patients about the evolving knowledge base in addressing MRONJ."

It is important to understand that patients at risk for or with MRONJ also may present with other issues that appear similar, authors wrote. Commonly misdiagnosed conditions may include dry socket, sinusitis, gingivitis and periodontitis. Therefore, they said it is important for patients to undergo a detailed clinical and radiographic examination by an experienced oral healthcare practitioner to diagnose MRONJ.

There are several other local, potentially predisposing factors – including tooth extraction and operations on the thickened ridge of the bone that contains tooth sockets. Other concerns such as steroid and tobacco use may increase risk. The danger of developing MRONJ is higher in patients who have received antiresorptive medications for metastatic bone disease (less than 5 percent) compared to those receiving such drugs for osteoporosis (less than 0.05 percent).

Surgical management of MRONJ is increasingly considered a viable method of treatment for all stages of the disease, according to the 2022 guidance. These procedures involve the removal of necrotic jawbone until viable bone is encountered. AAOMS has developed a series of algorithms to assist doctors in streamlining and determining the correct care pathway for individual patients. A departure from the three previous position papers, the 2022 recommendations recognize the value of surgical intervention regardless of MRONJ disease stage.

AAOMS supports continued oncologic treatment for MRONJ patients whether they are receiving antiresorptive therapy alone or in combination with immune modulators or antiangiogenic medications. Authors wrote that quality of life is typically managed by preventing new areas of necrosis, controlling secondary infections, offering pain control and educating patients.

Additionally, the new guidance deemphasizes the role of medications other than antiresorptives in causing the condition. Studies suggest the cause is likely multifactorial, stemming both from drugs prescribed alongside inflammation or infection. A research review failed to prove if a drug holiday (ceasing use of medications for a defined period) is beneficial or harmful to patients, the authors wrote.

"Medication-Related Osteonecrosis of the Jaw – 2022 Update" was developed by three authors of the 2014 AAOMS position paper on MRONJ, along with three member of the Association's Committee on Oral, Head, and Neck Oncologic and Reconstructive Surgery. In addition to Drs. Ruggiero and Dodson, authors include Tara Aghaloo, DDS, MD, PhD, UCLA School of Dentistry; Eric R. Carlson, DMD, MD, EdM, University of Tennessee Graduate School of Medicine; Deepak Kademani, DMD, MD, North Memorial Health and the University of Minnesota; and Brent B. Ward, DDS, MD, University of Michigan Hospital.

At an MRONJ presentation during AAOMS's 104th Annual Meeting, Scientific Sessions and Exhibition in New Orleans in September, Carlson told attendees the update was needed to reflect numerous advancements in MRONJ knowledge over the past eight years.

"It became very clear to our national organization that there were many substantial and very interesting changes in terms of our understanding of this disease, particularly with regard to its treatment," he said.

Carlson said the updated definition of an MRONJ case includes three elements:

Current or previous treatment with antiresorptive therapy alone or in combination with immune modulators or antiangiogenic medications.

Exposed bone or bone that can be probed in the maxillofacial region that has persisted for more than eight weeks.

No history of radiation therapy to the jaws or obvious metastatic disease to the jaws.

"MRONJ is preventable, resectable and reconstructable in a very predictable fashion," said Carlson. "The new position paper will help medical and dental professionals in their treatment of patients who require these medications." 

Read the full position paper at

Wednesday, November 2, 2022

Apple Announces that iPhones are Switching to USB-C

  Apple has always been a bit of a "lone wolf" when it comes to hardware.  The company maintains tight control over their hardware and software empire.  In some ways this can be an incredibly good thing.  You don't often buy or hear of an Apple product that has hardware issues or compatibility issues with another piece of Apple hardware.

However, like the Yin and Yang, there are positives and negatives to everything.  Sometimes that means Apple forces its users into hardware formats they may not want to go.  As an example, I'll use my current MacBook Pro.  I purchased it shortly before Covid hit in 2019.  At the time, that model only offered 4 ports and there were *all* USB-C.  Even the power port was USB-C which forced me to use one of the 4 ports just to charge the device.  My previous model had several different ports including HDMI, USB, and even an SD card slot.  My new Mac forced me to buy all kinds of dongles and adapters so that I could connect to an Ethernet cable, HDMI , SD, USB 2.0, and even a second HDMI adapter as I usually am working from 3 screens.

Imagine my frustration when recently the company announced that their new MacBook Pro models would offer a variety of ports to meet consumer demand.  I was *less than thrilled*.

And that brings us to the point of today's post.  In an effort to make things easier for consumers, the European Union placed a mandate on manufacturers to use USB-C to charge their devices.  In the last, probably 7 years (although I'm not sure of the exact amount of time), Apple has used their proprietary "Lightning" connector to charge iPhones, iPads, and iPods.  

Personally I'm grateful to the EU for this little piece of legislation.  I'm tired of having to have a lighting cord with me whenever I want to charge my phone or tablet.  The mandate is set to take affect in autumn of 2024, but Apple is not hiding their angst over it.

For a full discussion, take a look at this page from The Verge...  

Tuesday, November 1, 2022

FDA Announces Shortages on Amoxicillin Suspensions

 A short post today as most of us are probably a bit tired after the big Halloween Celebrations from last night.

I saw this list on the FDA website and found it of interest.  It seems there is a shortage of amoxicillin currently, but only on the suspensions (liquids).

This would mainly affect children and patients who are unable to swallow pills.  Obviously that is a smaller subset of patients, but if it affects you (as a patient) or you (as a prescriber) either situation can create complications.

The good news is that this shortage is supposed to be short lived with the experts expecting things to return to normal in early November.

If you have questions or want more information, here is a link to the FDA website that deals with the shortage.   

Also, if you would ever like to check on information like this, the FDA has a searchable database of Current and Resolved Drug Shortages and Discontinuations Reported to FDA.