SCIENCE NEWS AND RESOURCES
Is NIH Funding Relevant Research?
For years, many of us have wondered about the application of research to clinical dental practice. On Oct. 2, 2003, Congressman Joe Pitts (R-Pa.) charged at a hearing of the Senate Health, Education, Labor, and Pensions Committee that the National Institutes of Health (NIH) is currently funding irrelevant research. This committee also discussed the release of the NIH "Roadmap for Medical Research," available at http:nihroadmap.nih.gov. WDJ is proud to be at the forefront of translational research to assist NIH and other research institutions in its publication by enhancing the speed of translating research into relevant clinical dental practice.
DISEASE UPDATE
Hepatitis A Through G
WDJ readers have asked about various hepatitis infections. Here are the facts:
Hepatitis A is an acute illness transmitted by fecal/oral transmission or fecal contamination of food, water, or a body part. Usually not fatal, it is characterized by jaundice.
Hepatitis B is spread by blood, semen, and other infectious body fluids. Causing a chronic infection, the majority of persons may not have jaundice. About two-thirds of persons infected with hepatitis B recover with immunologic markers of previous infection.
Hepatitis C is a blood-borne infection that is acquired through infected blood. A progressive illness, most infected persons do not become ill until many decades of infection. Arthritis may be a result of autoimmunity, with diagnosis made by biopsy. Today's treatments are combination therapies, usually interferon and ribavirin. (See site below for current recommendations which are updated regularly). Online training on hepatitis C is available at no charge at http://www.cdc.gov/ncidod/diseases/hepatitis/c_training/edu/default.htm.
Hepatitis D is also acquired by blood to blood contact and cannot cause infection alone; it is accompanied by co-infection with hepatitis B.
Hepatitis E is very common among persons from Asia or South America.
Hepatitis F is bloodborne and similar to hepatitis C, with the exception of rare cases of acute liver failure.
Hepatitis G is transmitted by blood, sexual transmission, and, like hepatitis B, may be transmitted by saliva as well.
For general information on all hepatitis infections, go to http://cdc.gov/ncidod/diseases/hepatitis/ resource/index.htm. For Spanish language information on hepatitis go to http://www.cdc.gov/spanish/ enfermedades/hepatitis.htm. There are many materials available for you and your staff.
WOMEN'S HEALTH
WDJ has highlighted the science of women's health. Below is an abstract of an RCT (randomized controlled trial), which is often considered to be the best evidence for determining associations between a condition and an outcome.
Effects of Estrogen Plus Progestin on Risk of Fracture and Bone Mineral Density
The Women's Health Initiative Randomized Trial
Jane A. Cauley, DrPH; John Robbins, MD; Zhao Chen, PhD; et al.
SOURCE: JAMA 2003; 290:1729-1738
Context: In the Women's Health Initiative trial of estrogen-plus-progestin therapy, women assigned to active treatment had fewer fractures.
Objective: To test the hypothesis that the relative risk reduction of estrogen plus progestin on fractures differs according to risk factors for fractures.
Design, Setting, and Participants: Randomized controlled trial (September 1993 to July 2002) in which 16,608 postmenopausal women aged 50 to 79 years with an intact uterus at baseline were recruited at 40 U.S. clinical centers and followed up for an average of 5.6 years.
Intervention: Women were randomly assigned to receive conjugated equine estrogen, 0.625 mg/d, plus medroxyprogesterone acetate, 2.5 mg/d, in 1 tablet (n = 8506) or placebo (n = 8102).
Main Outcome Measures: All confirmed osteoporotic fracture events that occurred from enrollment to discontinuation of the trial (July 7, 2002); bone mineral density (BMD), measured in a subset of women (n = 1024) at baseline and years 1 and 3; and a global index, developed to summarize the balance of risks and benefits to test whether the risk-benefit profile differed across tertiles of fracture risk.
Results: Seven hundred thirty-three women (8.6 percent) in the estrogen-plus-progestin group and 896 women (11.1 percent) in the placebo group experienced a fracture (hazard ratio [HR], 0.76; 95 percent confidence interval [CI], 0.69-0.83). The effect did not differ in women stratified by age, body mass index, smoking status, history of falls, personal and family history of fracture, total calcium intake, past use of hormone therapy, BMD, or summary fracture risk score. Total hip BMD increased 3.7 percent after 3 years of treatment with estrogen plus progestin compared with 0.14 percent in the placebo group (P<.001). The HR for the global index was similar across tertiles of the fracture risk scale (lowest fracture risk tertile, HR, 1.20; 95 percent CI, 0.93-1.58; middle tertile, HR, 1.23; 95 percent CI, 1.04-1.46; highest tertile, HR, 1.03; 95 percent CI, 0.88-1.24) (P for interaction = .54).
Conclusions: This study demonstrates that estrogen plus progestin increases BMD and reduces the risk of fracture in healthy postmenopausal women. The decreased risk of fracture attributed to estrogen plus progestin appeared to be present in all subgroups of women examined. When considering the effects of hormone therapy on other important disease outcomes in a global model, there was no net benefit, even in women considered to be at high risk of fracture.
Dark Chocolate Helps the Heart?
In a recent abstract, dark chocolate may be more protective for hypertension that other kinds of chocolate. Here is one citation that may be of interest this holiday season as you choose those holiday goodies. We have many volunteers who wish to participate in future studies sampling dark chocolate for several weeks and milk chocolate for several weeks. Please note that study power was low and future studies will be needed to validate this.
SOURCE: Taubert D, Berkels R, Roesen R, Klaus W. Chocolate and Blood Pressure in Elderly Individuals With Isolated Systolic Hypertension. JAMA 2003; 290:1029-1030.
UPCOMING CONFERENCES
Yankee Dental Congress 2004 Annual Meeting — Jan. 29-Feb. 1, 2004; Hynes Convention Center; Boston, Mass.; www.massdental.org; (800) 342-8747 (in state) or (800) 943-9200 (national)
CDS (Chicago Dental Society) 2004 Midwinter Meeting — Feb. 19-22, 2004; McCormick Place Convention Center; Chicago, Ill.; www.cds.org; [email protected]; (312) 836-7300
ALD (Academy of Laser Dentistry) SOURCE 2004: Lasers in Dentistry — March 3-6, 2004; Renaissance Esmeralda Resort; Indian Wells ~ Palm Springs, Calif.; www.laserdentistry.org; [email protected]; (877) 527-3776
RDH Under One Roof Conference (sponsored by RDH Magazine/PennWell) — March 4-6, 2004; Hilton Costa Mesa; Costa Mesa, Calif.; www.rdhmag.com; [email protected]; (888) 299-8016
CDA (California Dental Association) Spring 2004 Scientific Session — April 16-18, 2004; Anaheim Hilton; Anaheim, Calif.; www.cda.org; (916) 443-3382
KUDOS
...to Marion Eisenberg, who heads Volunteers in Health Care (VIH) for working to broaden access to dental care for low-income people through eight community organizations. Nearly $240,000 in grants were awarded to the project "Community Collaborations To Increase Oral Health Care Access," a partnership between VIH, the American Dental Association (ADA), and the American Dental Association Foundation (ADAF). Contact [email protected] or (877) 844-8442.
WOMEN-OWNED BUSINESS NEWS
Women businesses are essential to the business of America. The top 500 women-owned businesses in the United States were recognized at the National Diversity Gala and will be honored at the 4th Annual Multicultural Business Conference to be held at Foxwoods Casino on March 16-18, 2004. Div200.com is an online resource center for women-owned businesses that facilitates contacts and communication. For more information, go to www.div200.com.
ORAL HEALTH MATTERS
Keeping nails short is important because most bacteria and viruses are found underneath the nails. Although the relationship between fingernail length and wound infection has not been studied prospectively, dental professionals should keep nails short enough to thoroughly clean underneath them and to prevent glove tears. Glove failure increases when nail edges are torn or broken, and glove failure increases when nails are long. Persons with artificial nails have been shown to have a greater chance of carrying certain gram negative bacteria than others. Freshly applied nail polish does not increase the microbial load, while chipped nail polish may harbor more bacteria.
Sending Patient Education Home
"My patients want to consult with family and friends before making decisions about their dental care," says Dr. Pamela West from her practice in Las Vegas, Nev. "Sending these patients home with a CD of presentations explaining procedures and alternatives — a CD that can be shared with other family members — is invaluable."
This summer, Dr. West used a software program called CAESY at Home that enables her to create a take-home educational CD for her patients. Dr. West can burn up to 10 multimedia patient-education presentations on a single CD to give patients for viewing on their home computers. A recently added feature, which allows users to add up to 20 of their own digital photos on the patient CD, is one Dr. West says she will use a lot in her practice.
Each CD can be customized for a patient's unique health concerns, with presentations specifically selected for them. Dr. West also notes that the ability to standardize CDs and have them ready for patients is a real timesaver. For instance, you can create a series of standard presentations on a CD for new patients and send it with the new-patient packet. You can also use a template message or write your own, which displays when the patients pop the CD into their computers.
A summary report can be printed out later, which includes the patient name, practice name, patient message, and a list of the presentations on the CD. This report can be placed in a patient's file to track the presentations they've viewed, and it is a convenient method for informed-consent documentation.
In addition to being a beneficial educational tool, the CD is a powerful marketing tool for the practice. Each disc is branded with the doctor's name, contact information, and Web site, so when a patient shares it with friends, the practice name is accessed by potential new patients. "A take-home CD gives my patients a better understanding of the quality of dentistry I'm making available to them," says Dr. West.
