Dental India newsletter dated 4th Feb 2007 - Celeberating 10th year of online in Feb 2007 Participate in Dental India tourism page This newsletter is sponsored by IDS 2007 The world trade fair for dental technology and dentistry - Cologne - Germany IDS 2007: The future of dental medicine and dental technology With some 1,700 exhibitors from 50 countries IDS 2007 will be the leading international show for the dental world. Every two years the entire industry meets at Cologne to communicate and share information at product presentations and live demonstrations. It’s where you will find innovation and pioneering concepts for every area of dental medicine and dental technology. You will see the future for the dental world – so make sure you do not miss out on this opportunity to be a front runner. Join us at Cologne!   -    more details
ORAL bisphosphonates.  Here's a quick summary:   The main concern for orthodontists is that the balance between ostoblastic and osteoclastic activity (which is obviously key for tooth movement) is altered.  This means tooth movement is unpredictable, however, it doesn't mean orthodontic treatment is contraindicated.  A trial period to evaluate tooth movement on individual patients to assess their response, before proceeding to more complex treatment is recommended.  Extraction therapy can be done (following recommended protocols), but again, even if the extraction sites heal successfully, tooth movement being unpredictable still means you might be unable to close the extraction spaces.  Approx 200 cases of osteonecrosis have been reported on patients taking oral bisphosphonates, mostly related to tooth extraction.  No cases have been reported due to orthodontic treatment alone. IV bisphosphonates are absorbed 50-60% while oral bisphosphonates <1%, however they both have a strongest affinity for bone with a high turnover rate (ie areas undergoing tooth movement).  Bisphosphonates incorporate themselves directly into into the crystalline structure of hydroxiapatite and have a half life of up to 12 years!  Therefore, there is NO benefit (in fact there could be serious risks), for orthodontic purposes, to have the patient suspend their bisphosphonate treatment.  Ortho treatment is contraindicated in ALL patients being administered INTRAVENOUS bisphosphonates, and on orthognathic surgery patients taking any kind of bisphosphonates, because of serious risks of extensive osteonecrosis.    Martha Mejia-Maidl D.D.S., M.S. El Paso, TX P.S. Dr. John Helstein is a clinical professor at the department of oral pathology, radiology, and medicine, Univ. of Iowa, College of Dentistry. He's a curerent member of the ADA expert panel working on proposals on how to manage patients with oral bisphosphonate use.    (Courtesy: ESCO Digest)
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Implant fixtures with horizontal microthreads Interesting discussion there, as two or three of those guys are principles in different companies, and thus their responses are predictable.  The horizontal microgroove design of astra does seem to be of some significance in the maintenance of the bony crest.  I base that statement on a couple of things: 1.  It is being copied.  Nobel, biolock, implant direct and others now all sport horizontal microgrooves of some type at the top 2.  The classic wisdom is that the threads somehow dissipate or at least better distribute forces at the crest, and that may be  why the bone stays stable 3.  the other theory I have heard espoused deals with the horizontal microgrooves presenting a mechanical barrier to fibroblasts in the soft tissue from "jumping the gap" and invaginating apically, similar to the way a gtr membrane fixes the race between soft tissue and hard tissue. Many place the success of the astra fixture more prominently on the conical connection.  I'm not convinced that the microgrooves might be of primary importance.  I'd like to get a few more years in with the new nobel replace units with the microgroove fixtures and see how they fare. - Gary  - ROOTS
Good articles on laser        Upper First Bicuspid - slide show      Six hour molar case    Troughing advice      Sinus lift       Silver retreat
Busch, D. F., V. L. Sutter, Finegold, S. M. (1976). "Activity of combinations of antimicrobial agents against Bacteroides fragilis." J Infect Dis 133(3): 321-8. Thirty-two clinical isolates of Bacteroides fragilis were tested against nine pairs of antimicrobial agents by means of an agar dilution technique. A synergistic effect was observed with the combination of clindamycin and metronidazole. End points were achieved with 17 strains. Of these strains, 13 (76%) were inhibited by the combination of clindamycin and metronidazole; each drug was present at a concentration of less than or equal to 25% of its minimal inhibitory concentration when tested alone. This combination also showed synergistic bactericidal activity against three of six strains examined by a tube dilution technique. No antagonism was noted with any strain. The other eight combinations tested failed to show a consistent synergistic effect, although no antagonism was observed. These in vitro data indicate that antagonism is not likely to be encountered when combination therapy is used for B. fragilis infections. For selected B. fragilis infections, the combination of clindamycin and metronidazole may be useful. Baumgartner, J. C. and T. Xia (2003). "Antibiotic susceptibility of bacteria associated with endodontic abscesses." J Endod 29(1): 44-7. Antibiotics to treat endodontic infections are routinely prescribed based on previously published susceptibility tests. There is increased concern that bacteria have increased resistance to the currently recommended antibiotics. The purpose of this investigation was to perform antibiotic susceptibility tests on a panel of bacteria recently isolated from endodontic infections. The bacteria in this study were aseptically aspirated with a needle from endodontic abscesses, cultivated, and identified at the species level. Each of the 98 species of bacteria was tested for antibiotic susceptibility to a panel of six antibiotics using the Etest. The antibiotics were penicillin V, amoxicillin, amoxicillin + clavulanic acid, clindamycin, metronidazole, and clarithromycin. The percentages of susceptibility for the 98 species were penicillin V: 83/98 (85%), amoxicillin: 89/98 (91%), amoxicillin + clavulanic acid: 98/98 (100%), clindamycin: 94/98 (96%), and metronidazole: 44/98 (45%). Metronidazole had the greatest amount of bacterial resistance; however, if it is used in combination with penicillin V or amoxicillin, susceptibility of the combination with penicillin V or amoxicillin increased to 93% and 99%, respectively. Clarithromycin seems to have efficacy, but it is still considered an antibiotic under investigation because the minimum inhibitory concentration has not been established.	Brook, I., J. C. Coolbaugh, et al. (1984). "Synergism between penicillin, clindamycin, or metronidazole and gentamicin against species of the Bacteroides melaninogenicus and Bacteroides fragilis groups. " Antimicrob Agents Chemother 25(1): 71-7. Clinical isolates of the Bacteroides melaninogenicus and Bacteroidesfragilis groups were tested for in vitro and in vivo susceptibility to penicillin, clindamycin, and metronidazole, used singly or in combination with gentamicin. The in vitro tests consisted of determinations of minimal inhibitory concentrations (MICs) carried out with or without constant amounts of gentamicin. When used alone, gentamicin had negligible effects on the bacteria but significantly reduced the MICs of penicillin, clindamycin, and metronidazole against 11, 10, and 3, of the 15 strains of the B. melaninogenicus group, respectively. The 15 strains of the B. fragilis group were all beta-lactamase producers and were highly resistant to penicillin or the combination of penicillin and gentamicin. However, gentamicin reduced the MICs of clindamycin and metronidazole against 1 and 7 strains of this group, respectively. The in vivo tests were carried out in mice and consisted of measurements of the effects of the antimicrobial agents on the sizes and bacterial content of abscesses induced by subcutaneous injection of bacterial suspensions. The results of the in vivo tests were generally consistent with those obtained in vitro with strains of the B. melaninogenicus group. Synergism between gentamicin and penicillin, clindamycin, or metronidazole was shown in 13, 10, and 3 strains of this group, respectively. In vivo synergism was not clearly demonstrated with the strains of the B. fragilis group, possibly because clindamycin and metronidazole used alone were highly efficacious. We suggest that the synergistic effect of gentamicin is due to its increased transport into the bacterial cell in the presence of penicillin and, possibly, other antimicrobial agents. The newly recognized in vitro and in vivo synergism between penicillin and other antimicrobial agents and an aminoglycoside in B. melaninogenicus may have clinical implications that deserve to be investigated.
Important questions to ask your patients with diabetes From Lynne Slim and Cynthia Stegeman, Certified Diabetes Educator,  Registered Dietician (To Periotherapist Group) Many people have symptoms of type 2 diabetes when they are diagnosed,  but diabetes screening and identification procedures are oftentimes  inadequate.8  Less than half complain of diabetes symptoms like  polyuria, lethargy, or polydipsia .  Because classic symptoms do not  always appear, it is imperative that healthcare providers, including dentists and dental hygienists, participate in more aggressive  screening to identify people with type 2 diabetes or prediabetes.   The updated medical history and oral exam offer excellent  opportunities to assess each patient.  In reviewing a patient’s  medical history, here are some practical questions that you can ask,  keeping in mind that questions should be individualized to help  determine the patient’s glycemic control and overall approach to  diabetes care management: a.     What type of diabetes do you have, and when was it diagnosed? b.     Have you been experiencing any health problems over the last  few days, weeks, or months? c.     Are you taking all of the medications that have been  prescribed for you?  If not, which one(s) don’t you take and why? d.     What is your A1c level?  Do you have information on A1C levels?* e.     How often do you check your blood glucose level, and what was  the most recent value? f.      Do you watch your carbohydrate intake and follow an exercise  regime?  (This question will give you hints about how well-educated  the patient is about their disease.) g.     Who helps you manage your diabetes?  Do you see your  physician, nurse, or dietitian on a regular basis? h.     Do you smoke or use any tobacco products?  If so, how much? i.      Do you drink alcoholic beverages?  If so, how often and how  much do you drink on a weekly basis? * A1C level refers to the hemoglobin A1c test.  Table 2  provides the accepted value.  This is a simple lab test that shows  the average amount of glucose in a patient’s blood over the last  three to four months.  Glucose binds to hemoglobin in the red blood  cells, which has a life span of 120 days.  It’s the best way to find  out if the patient’s blood glucose is under control.  Monitoring  blood glucose values via a glucometer can be equated to taking  pictures with a camera.  Each value is a snapshot of that moment.   Blood glucose levels vary throughout the day.  Having and A1C is  similar to a video.  This value gives a longer running value, an  average over 3-4 months.  All people with type 2 diabetes should have  a hemoglobin A1C test one to four times a year depending on the  glycemic control. - Lynne H. Slim, RDH, MS