Archive | January, 2015

What to Do about Patients Who Call After Hours Wanting Prescription Drugs

An interesting article titled “Addressing after-hours requests for prescription drugs,” appears in the April, 2014, issue of  JADA written by G. J Muller II (vol. 145, no. 4, pp. 389-390). The article discusses how the oral and maxillofacial surgeon has had several instances of after hours or weekend phone calls from people claiming to be current or past patients who have had a sudden onset of a toothache and want narcotic pain medication. The surgeon says that the people always agree to be seen in his office the next day or following Monday if it is a weekend. However, often the person will not follow up with the surgeon and not show up for the appointment after having received the medication. The surgeon says occasionally he checks if the person is a patient of record and sometimes the person is not, other times it may have been someone who was last seen a long time ago. The surgeon is concerned that many of these people who call are drug seekers and are not legitimate. In the article, tips to handle such a situation are discussed. The first thing to determine is if the person has an emergency. This is easy to […]

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The Cost of Health Care in the U.S. compared to Other Countries

An interesting article titled “How affordable is health care in the United States and other countries,” appears in the May 2014, issue of JADA written by Dr. Marko Vujicic (vol. 145, no. 5, pp. 482-483). The article discusses how the cost of medical and dental care stacks up against 10 other countries. The article opens by addressing how the U.S. spends more on health care than any other country but that the by measures of access, efficiency, and satisfaction of health care the U.S. ranks below lower spending countries. This is believe to be partially due to wasteful spending which the Affordable Care Act may help reduce. The article discusses data from the Commonwealth Fund which presents data for 11 Organization for Economic Cooperation and Development (OECD) countries showing the percentage of adults who can not obtain medical or dental care due to cost. This shows that in the U.S. the percentage of adults who do not obtain both medical and dental care is higher than all the 10 other countries (New Zealand, Australia, Norway, Canada, France, Netherlands, Sweden, Switzerland, Germany, United Kingdom). It also shows that the financial barriers to dental care are much higher than for medical care in most […]

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Migraine attacks can increase after a stress let down

A new study published in Neurology discusses how migraine sufferers who experience reduced stress from one day to the next are at an increased risk on a migraine attack. Migraine is a chronic condition that affects millions of Americans. Numerous triggers are believed to contribute to a migraine attack. In the study the researchers at the Montefiore Headache Center and Einstein College of Medicine conducted a three month electronic daily diary study which recorded over 2,000 diary records and 110 migraine attacks in 17 participants.  The study compared levels of stress and reduction in stress as possible headache predictors. The study found an association between reduction in perceived stress and the occurrence of migraine headaches. The results were found to be strongest during the first six hours where decline in stress associated with a five fold increased risk of migraine attack. The hormone cortisol rises during times of stress and reduces pain which may contribute to the headache attack during relaxation. In the diary participants recorded information about their migraine attacks, stress ratings, hours of sleep, foods eaten, drinks and alcohol consumed, and information about their menstrual cycle. The study is important to migraine sufferers as stress is implicated here […]

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Gum Disease Bacteria may Facilitate Rheumatoid Arthritis

As stated over on the risks of keeping wisdom teeth page, gum disease (periodontal disease) has been shown to have associations with many different systemic diseases. One such systemic disease is rheumatoid arthritis (RA). So far, any mechanism has remained elusive. In a recent study appearing in PLoS Pathogens, researchers at the University of Louisville School of Dentistry Oral Health and Systemic Diseases and other researchers from the European Union’s Gums and Joints project have uncovered how the bacteria responsible for periodontal disease known as Porphyromonas gingivalis effects rheumatoid arthritis. The researchers showed that this bacteria leads to faster progression, greater severity and earlier onset of RA and can cause bone and cartilage destruction. The researchers found the bacteria produces a unique enzyme, peptidylarginine deiminanse (PAD), which enhances collagen-induced arthritis (CIA), which is an arthritis produced in the lab designed to mimic RA. PAD changes residues of some proteins into citrulline that the body recognizes as intruders which leads to an immune attack. In RA patients, this leads to chronic inflammation which causes  bone and cartilage destruction in joints. Another oral bacteria known as Prevotella intermedia was also studied by did not produce this response to PAD as Porphyromonas gingivalis […]

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Using Teeth to Determine Where you are From

An interesting article titled “The Pb isotopic record of historical to modern human lead exposure,” appears in the journal Science of The Total Environment written by George D. Kamenov and Brian L. Gulson (vol. 490, pp. 861-870, 2014). George Kamenov is a University of Florida geology professor. The article describes how trace amounts of lead present in teeth can give clues about what geographical region the teeth (and the person) came from. What is interesting about this article, is that the lead in the teeth can be used to pinpoint the geographic area where the teeth originated from. This is because lead is composed of four different isotopes which fluctuate in different rocks and soils around the world. As children grow they inhale dust and ingest soil which contains the different isotopes of lead. As tooth enamel forms during childhood, it locks in the lead signals from the environment. The first molar has its enamel formed by around age 3, incisor and canine enamel is formed by around age 5, and third molar (wisdom teeth) enamel is formed by around age 8. If a child moves geographic regions during this time, the different teeth can persevere the lead in the environment […]

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