Month: September 2011

Dentistry

Study: Sugar-Free Polyol Gum, Lozenges and Hard Candy Help Prevent Dental Caries

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Spry Sugar-Free Gum

The study also finds that nonfluoride varnishes also help prevent dental decay.

A multi-disciplinary expert panel, convened by the American Dental Association (ADA) Council on Scientific Affairs, issued a report this month containing clinical recommendations that sugar-free chewing gum, lozenges and hard candy including xylitol or polyol combinations, and a prescription varnish with chlorhexidine and thymol could be beneficial in preventing cavities when used as adjuncts to a comprehensive cavity prevention program which includes the use of fluoride-containing products.

The panel noted in its report that these nonfluoride options could provide an extra benefit to prevent cavities in patients at high risk for developing cavities when used in addition to products such as toothpaste, dental sealants and varnishes that contain fluoride as well as community water fluoridation and good eating habits.

The full report is available on the ADA’s Center for Evidence-Based Dentistry (EBD) website (http://ebd.ada.org/). The executive summary of the report is published in the September issue of The Journal for the American Dental Association. The clinical recommendations from the expert panel were reviewed and approved by the ADA’s Council on Scientific Affairs.

What are the exact recommendations?

  • In addition to a comprehensive cavity-prevention program which includes the use of fluoride, the scientific panel recommended that clinicians consider applying a mixture of cholrhexidine-thymol varnish to the teeth of high-risk adults and the elderly every three months to reduce cavities developing in the root of the tooth.
  • The panel encouraged clinicians to consider advising parents and caregivers of healthy children older than 5 years who are at higher risk for cavities to chew sugar-free polyol gum after meals for 10 to 20 minutes to prevent cavities.

A polyol is a low-calorie sweetener such as xylitol, sorbitol or mannitol, which is not broken down by the bacteria in the mouth and therefore does not contribute to tooth decay. The panel also recommended that sucking xylitol-containing sugar-free lozenges or hard candy after meals may reduce cavities in children.

Fair enough and certainly cheap enough that most patients can avail themselves of the protocol.

Application of the varnish in adults could be an access to care issue, however, since it will have to be done in a clinical setting.

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Health

Virtual Colonoscopy to Become the Standard to Detect Colon Cancer?

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Virtual colonoscopy images

Well, perhaps or not.

Whether the most technologically advanced way to check for colon cancer will become the standard screening method of the future does not appear to be a slam-dunk.

The method, known as virtual colonoscopy, combines X-ray and computer technology to create three-dimensional views of the full length of the colon, the large intestine. It allows doctors to look for polyps, or pre-cancerous growths, or other signs of cancer or other intestinal disease. According to the U.S. National Cancer Institute, virtual colonoscopy can be done with computed tomography (called a CT or CAT scan) or with magnetic resonance imaging (MRI).

Colon cancer is one of the few types of preventable cancer, with doctors able to find and remove pre-cancerous polyps in the colon before cancer can develop. The current “gold standard” procedure for colon cancer screening, however, is colonoscopy, a time-consuming procedure for which preparation is unpleasant and sedation is necessary.

Perhaps because of this, only half of all people older than 50 have gotten this potentially life-saving test for colon cancer, according to the U.S. Centers for Disease Control and Prevention.

Doctors who tout the virtual form of colonoscopy argue that it takes less time and does not require sedation and is a more comfortable procedure for those having it.

Yet others contend that its drawbacks far outweigh its benefits.

“It’s a test that has a tremendous number of questions still yet to be answered,” said Dr. David A. Johnson, chief of gastroenterology at Eastern Virginia Medical School, past president of the American College of Gastroenterology and co-author of the group’s guidelines for colon cancer screening.

Virtual colonoscopy, however, has advanced far enough that it’s now recommended as a frontline screening test by the American Cancer Society and as an alternative to regular colonoscopy by the American College of Gastroenterology.

I postponed my first test a few more years than I should have, but I have to say it was not a bad procedure. Now, the colon prep is a different sotry since you take powerful laxatives and the abdominal cramping is not fun.

But, you have to do the same prep in cleaning out your colon before the virtual colonoscopy anyway.

If the virtual test allows more patients to receive “some” colon cancer screening, then this is a good thing. I am positive the virtual tests will only improve with the technology and time.

Researchers also are working to make virtual colonoscopy even better, Yee said. New computerized, post-processing techniques are being developed to improve the test’s accuracy and lower the radiation dose, and doctors are working to develop a form of the test for which the patient would not need to take laxatives in advance.

At the moment, though, the American College of Gastroenterology still would prefer that people have a conventional colonoscopy done every 10 years because, as Johnson said, it’s a better test that allows doctors to immediately remove any polyps that are found.

However, if the drawbacks of a normal colonoscopy are enough to dissuade a person from undergoing colon cancer screening, then they should consider virtual colonoscopy as an alternative test that they should have every five years, according to ACG guidelines.

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Health

Study: Cigarette Smoking Causes More Aterial Damage in Women

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According to a new study.

The harmful effects of tobacco smoke on atherosclerosis, one of the driving forces of cardiovascular disease, are greater in women than in men.

This result emerges from the large European epidemiological study (Carotid Intima Media thickness and IMT-PROgression as predictors of Vascular Events: the IMPROVE study), funded by EU (Vth Framework Program — Contract n. QLG1-CT-2002-00896). In the IMPROVE study, authors examined 1694 men and 1893 women from Finland, Sweden, Netherlands, France and Italy, and used ultrasound technology to assess the presence of wall thickening and plaques in the carotids, the arteries that bring blood to the brain.

The research shows that the amount tobacco exposure during the entire life significantly correlates with the thickness of carotid arterial walls (an index of atherosclerosis) in both genders. However, the impact is more than doubled in women than in men. Similarly, the effect of the number of cigarettes smoked per day on the progression of the disease over time is more than five-fold in women than in men. These associations are independent from other factors that may affect atherosclerosis, such as age, blood pressure, cholesterol level, obesity and social class.

Elena Tremoli, Professor of Pharmacology at the University of Milan, Italy, and scientific director of the Monzino Cardiology Centre in Milan who led the study, says: “This is a particular relevant finding, especially in view of the fact that educational campaigns carried out in the last years have been less successful in reducing the number of smokers in women than in men.”

According to WHO, while in most European countries a significant proportion of men has quit smoking, in many countries (e.g. Italy and Finland) the percentage of women smokers remained roughly constant in the last three decades, whereas in others (France, Spain) it even increased.

“The reasons for the stronger effect of tobacco smoke on women’s arteries are still unknown, but some hints may come from the complex interplay between smoke, inflammation and atherosclerosis,” says Prof. Tremoli.

Researchers found that other factors, besides smoking, have a differential effect on the arteries of men and women. One of these is education, a well known index of social class: while men who have studied less showed a greater thickening of arterial walls than those who have studied more, the same was not true for women. Similarly, women, in contrast with men, seem to be protected against the harmful effects of systemic inflammation. Indeed, in the IMPROVE study, the relation between arterial wall thickening and the levels of C-Reactive Protein (CRP) and white blood cells (WBC) counts, two indexes of inflammation, is very strong in men, but absent in women.

“It is important to mention, however, that, when women smoke they lose their protection against the harmful effect of inflammation. In particular, if we stratify the female population according to smoking habits, we see that in the group of women who smoke, especially in heavy smokers, the relationship between CRP and arterial wall thickening becomes similar to that observed in men,” says Prof. Tremoli.

“We all know that women are ‘naturally’ protected against cardiovascular disease, particularly before menopause, and this has led to less attention of health professionals and researchers in regard to this disease in women.

Women, who for some reason appear to be less vigilant about heart disease, should take this study to their own heart. If you smoke, you have an increased risk of heart disease – more than the men.

So, stop smoking!

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Concussion

In College Football Running Backs Hit the Hardest to the Head

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USC Trojans Football Helmet

And, linemen receive the most frequent hits to the head according to a new study.

Thousands of college football players began competing around the United States this week, but with the thrill of the new season comes new data on the risks of taking the field. A new study reports that running backs and quarterbacks suffer the hardest hits to the head, while linemen and linebackers are hit on the head most often. The researchers measured head blows during games and practices over three seasons at Brown University, Dartmouth College, and Virginia Tech.

The study, led by Joseph J. Crisco, professor of orthopaedics in the Warren Alpert Medical School of Brown University and director of the bioengineering laboratory at Rhode Island Hospital, documented 286,636 head blows among 314 players in the 2007-09 seasons. Crisco said the new data on the magnitude, frequency, and location of head blows amounts to a measure of each player’s head impact exposure. Ultimately it can help doctors understand the biomechanics of how blows to the head result in injury.

“This allows us to quantify what the exposure is,” Crisco said. “It is the exposure that we need to build upon, so that we can then start understanding what the relationships are with acute and chronic head injury.”

The study appears online in advance in the Journal of Biomechanics.

Concussions and other head injuries have become a source of elevated concern in football and other sports in recent years, with various leagues revising policies to protect players better. In part based on seeing this new data, said Robin Harris, Ivy League executive director, league officials announced earlier this year that full-contact practices would be limited to two a week.

Concussions are a real concern in football.

Protection of the teeth with a custom-fit athletic mouthguard also offers protection of the teeth and jaws. They may also aid in the protection against concussion.

So, players, protect the head and teeth and have a great injury-free season.

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Medicine

Poll Watch: Southern and Western United States Have Highest Uninsured Rates

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According to the latest Gallup Poll.

Texas residents continue to be the most likely in the United States to lack health coverage, with 27.2% reporting being uninsured in the first half of 2011. At the other end of the spectrum is Massachusetts, where health insurance is required and 5.3% of residents lack coverage. These two states have represented the upper and lower bounds of uninsured rates since Gallup and Healthways started tracking coverage in 2008.

These results are based on 177,237 interviews conducted daily from January through June 2011 as part of the Gallup-Healthways Well-Being Index. An average of 16.8% of all American adults were uninsured in the first half of 2011, similar to the 16.4% in 2010. This percentage, however, has been edging up each year since 2008, at which time 14.8% of adults were uninsured. The percentage of uninsured residents in all states so far in 2011 is on par with 2010, but in most states remains higher than in 2008.

And, the Southern and Western United States have the highest uninsured rates.

States in the South and West continue to have higher numbers of uninsured adults than do those in the Northeast — consistent with what Gallup found in 2008, 2009, and 2010. Eight of the 10 states with the highest uninsured rates in the country are in the South and the other two — California and Alaska — are in the West.

Texas, California, and Florida — all three of which have an uninsured rate higher than 20% — have disproportionately large Hispanic populations, the demographic group Gallup finds to be the most likely to be uninsured.

Uninsured rates are lower in the Northeast, with 7 of 10 states with the fewest uninsured residents located there, as in past years.

The chart:

So, what does this mean?

President Obama’s Affordable Care Act has had little effect on people being insured or not. With the states struggling with budgets, it is difficult to see how many more people can be provided insurance without affecting the people that already have coverage.

Uninsured rates across states in 2011 appear to be relatively stable so far compared with 2010, but remain higher than in 2008. This could be seen as good news at a time when states are grappling with deep budget cuts and the implementation of new regulations and programs required under the Affordable Care Act. However, more than 10% of adults lack healthcare coverage in almost all states, with more than 15% going uninsured in 29 states. The fate of uninsured rates in America remains precarious as numerous states are challenging the legality of the new healthcare law in court.

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