Study Shows That Women Wait Longer for Angioplasty
Emergency angioplasty has the greatest effect when performed within 90 minutes of a patient’s arrival at the emergency room. If this occurs, patients have up to a 50 percent lower risk of dying in the hospital than those who wait longer. A recent study, based on records from 1,069 men and 442 women heart attack patients who had emergency angioplasty at hospitals in Michigan, showed that women on average waited more than 118 minutes before treatment began, compared with 105 minutes for men.
For women, reaching the emergency room took 20 minutes longer than her male counterpart after her symptoms began. These extra minutes can result in more heart damage and less positive long-term outcomes, according to data presented at the American Heart Association annual meeting by cardiologist Dr. Mauro Moscucci. Collated from the Blue Cross and Blue Shield of Michigan Cardiovascular Consortium, the data project was a joint research effort designed to study and improve angioplasty care. This study shows that women and men should recognize and respond to heart attack symptoms as quickly as possible. For more information, go to the University of Michigan Women’s Heart Program Web site at www.2.med.umich.edu.
Drug Therapy: A Gender Issue for Prescribing
We know that there are drug interactions between antibiotics and oral contraceptives (www.ama-assn.org/ama/pub/article/2036-297.html). A recent article notes that the safety and effectiveness of many other prescription drugs may be dependent upon the gender of the user. (Drug Therapy and Gender, by Drs. Viviana Simon and Eileen Resnick U.S. Pharmacist. 2004; 9:37-38). The authors stress that more women than men are likely to develop irregular prolongation of QT intervals between heart muscle contractions for common medications, such as antibiotics, antihistamines, antidepressants, and antipsychotics. Effectiveness of drugs may also be gender specific, as noted in the Surgeon General’s Report on Oral Health, 2000 of the differential impact of kappa opiods as a more powerful pain reliever for women than men. Adverse impacts of drugs may also be sex-related, with eight of 10 drugs removed from the market by the FDA between 1997-2000 having greater health risks for women than men. Education is needed to inform dentists and patients about the gender impact of prescription drugs.
Probotic Research Underway by Oragenics
Oragenics, a biotechnology company, has received permission from the FDA to conduct a Phase I safety trial to determine the impact of genetically modified bacteria which do not have the capability of producing acid to attack tooth enamel. This study comes out of Genomics, or the study of how genes function, and the use of this information to diagnose and treat disease in individuals. Future studies of this altered Streptococcus mutans are designed to address caries as an infectious disease, rather than surgical solutions. These studies include a Phase II safety trial on dentulous individuals and Phase III efficacy trial of dentulous persons. These studies will determine the feasibility of using bacteria by dentists to prevent tooth decay with patient inoculation in future clinical practice. (NYTimes, Nov 30,2004)
Using Radiographs to Diagnose
About 30 to 40 percent of women are expected to develop osteoporosis, along with about 20 percent of aging men. For this reason, diagnosis is key. Bone mass density (BMD), using the World Health Organization standard for detection, are the key to diagnosis. New evidence suggests that dental panoramic radiographs, which are readily available, can provide a screening tool to refer susceptible women for BMD. The study of 316 postmenopausal women showed limited specificity (with false positives), but similar sensitivity (false negatives) to a questionnaire alone in screening for referral for BMD. Conducted by Dr. Akira Taguchi, DDS, PHS, in the Department of Oral and Maxillofacial Radiology at Hiroshima University Hospital in Japan, the study calls for future assessments to quantify the radiographic appearance of mandibular cortical bone in screening for osteoporosis.
New Caries Hierarchy
From: Pitts, N (2004). “ICDAS - an international system for caries detection and assessment being developed to facilitate caries epidemiology, research and appropriate clinical management,” Community Dental Health, 21, 193-198.
A new article (see figure from the article and citation above) reports on the development of the terms to define caries, beginning with sub-clinical decay to pulpal decay, and associated lay terms for this. This has implications for caries preventive agents, with new diagnostic criteria to detect difference in treatment over a shorter period of time than using dentinal decay only.
The article summarizes that caries diagnosis is a professional judgment, with lesion detection and lesion assessment an objective process. Recent diagnostic devices such as Diagnodent, QLF and Difoti have the ability to perform lesions detection and assessment, with more devices being studied. Lesion assessment can provide for sequential assessment of lesions over time, with similar point(s) of reference. Instead of surgical treatment, the authors stated that this represents a paradigm shift to preventive care/nonsurgical care for caries in clinical practice, including reimbursement.
New Statement on Periostat® as Adjunct to Scaling and Root Planing for Periodontitis
The American Academy of Periodontology has issued a statement recommending systemically delivered collagenase inhibitor of orally administered 20-mg capsule of doxycycline hyclate twice a day as an adjunct to scaling and root planing in the treatment of periodontitis. Periostat® has been shown to reduce elevated collagenase activity in the gingival fluid of patients with adult periodontitis.
This evidence-based recommendation emanates from published results of a randomized, multi-center, double-blind, clinical trial comparing the efficacy of scaling and root planing (SRP) plus placebo to scaling and root planing plus Periostat® administered twice a day. The Periostat® arm of the study had statistically significant pocket-depth reduction at three, six, and nine months post initial therapy (for initial depth >7mm, 1.20 vs. 1.68 mm, at depths 4-6 mm, 0.69 vs. 0.95 mm) and clinical attachment gain (for initial depths >7 mm, 1.17 mm vs. 1.35 mm, at depths 4-6 mm, 0.86 vs. 1.03 mm). While mean changes in pocket depth and attachment level were relatively small across the Periostat® arm, individual patients may benefit from use of Periostat®, particularly for deep pocketing. The Periostat® arm showed a >2mm reduction in probing depth in pockets originally demonstrating 5 to 8 mm probing depth. (41% vs. 30%, 886 vs. 640 sites). No data was presented for more than 12 months. Clinicians are advised to review the individual patient and the severity of defects when considering Periostat as an adjunct to scaling and root planning. (Shortened abstract from www.perio.org/resources-products/periostat.htm)
Changing the Face of Academic Medicine and Dentistry: Time to Reform?
With the Sante Fe Group recently announcing the need for reform in dental education in a conference with dental educators from around the country held Aug. 29-30, 2004, little real progress has been made in instituting change in dental education. (www.santafegroup.org) A report chaired by Dr. Louis Sullivan of Morehouse noted the need for increasing diversity in the health professions workforce. (www.kaisernetwork.org/health_cast/uploaded_files/092004_sullivan_diversity.pdf) Specific changes are suggested in a recent article in the British Medical Journal, Gender and Academic Medicine: Impacts on the Health Workforce by Harvard researchers Laura Reichenbach, and Hilary Brown (BMJ Oct 2004; 329:792-795. doi:10.1136/bmj.329.7469.792). Similar to dentistry, the international panel of academic medicine experts noted that academic medicine has failed to provide innovation and excellence in clinical practice, and questions remain about how medicine addresses gender issues.
The authors argue that improving gender equity issues of fairness and justice, rather than equal numbers of men and women or gender equity, is essential for a revitalized academic medicine, a strengthened health workforce, and improved public health.
Changes in enrollment, curriculum and promotion were called for in academic medicine. Unfortunately, neither the Sullivan report nor the Sante Fe Group addressed the issues of changing values and expectations to be more inclusive of gender equity in academic dentistry.
