‘Sentinels of the Sea’ Featured in Documentary

They take on military assignments impossible for humans, and even robots, to perform. They are rewarded with fresh food, protection from predators and loving human contact. These unheralded, unknown, and often misunderstood marine mammals are saving countless lives during their underwater missions. Now, an edition of the Pentagon Channel’s monthly documentary, Recon, offers a rare glimpse at the work of dolphins and sea lions who are acting as true “Sentinels of the Sea.”

“When people mention the marine mammal program, a lot of people think of Flipper,” said Mike Rothe, biosciences division manager at Space and Naval Warfare Systems Center San Diego, home of the marine mammal program. “They don’t think of the hole in the USS Cole. I’m not saying that dolphins could have prevented that, because they couldn’t. But a well-placed limpet mine could do similar damage, and dolphins could protect against that.”

In March 2003, eight dolphins took part in an active combat situation when they helped military divers locate more than 100 mines and explosives hidden by Saddam Hussein’s forces in the Iraqi port of Umm Qasr.

“Using biosonar ability, dolphins can detect underwater objects at great range with a speed and accuracy no present device can come close to,” said Recon host Air Force Master Sgt. Daniela Marchus, who added that while the job sounds extremely dangerous, in reality the risks are small.

“Mines are designed to go off when hit by a ship, not when bumped by a 300- to 400-pound dolphin,” she explained.

“The thing that’s really cool about marine mammals is that what they do really, really well is look for stuff,” Rothe said. “They look for stuff in shallow water; they look for stuff in complex environments. The Navy studied a broad range of these animals, looking for capabilities that could be applied to missions that were too difficult or dangerous for divers or couldn’t be done by hardware,” he said.

Consider the amazing dive capabilities of sea lions. For humans, diving to depths of a few hundred feet is considered an extremely serious task. Human divers must breathe a mixture of air and gasses mixed under pressure and surface in carefully calculated stages that, depending on the depth of the dive, could take hours.

“But the sea lion can go down and in two and a half, three minutes, they can complete a whole dive, hook up to a target, and we can recover it,” said DruAnn Price, who works with the mammals in San Diego.

“From its start after World War II, up through the end of the Cold War years, this program was classified,” Marchus said. “Still, some word of the Navy’s use of marine animals did get out, soon followed by misconceptions about what they were being trained to do.”

Countless wildly inaccurate rumors have been spread over the years about dolphins and sea lions taught by the military to be merciless killers, a notion this Recon puts to rest.

“There’s never been a thrust in the program to use them offensively,” Rothe said. “They’ve never been trained to drown swimmers. They’ve never been trained to kill people. They’ve never been trained to place mines on the hulls of ships. There’s no dissuading some people about these mysterious missions supposedly part of the marine mammal program.”

The Pentagon Channel crew got a fascinating, up-close look at how the unique social behavior of marine mammals is factored into the training process.

“All of our training emphasizes positive reinforcement,” said Dr. Mark Xitco, chief of scientific and veterinary support for the U.S. Navy Marine Mammal Program. “So we’re giving animals different types of rewards when they do the right thing. Obviously that includes food, but it also includes social attention from us: petting games, toys and even opportunities to engage in other interesting behaviors like going out to the ocean and hunting for mines and swimmers, (which) is a reward in and of itself.”

To get marine mammals deep into targeted areas of operation, sometimes they must be transported by boat miles out to sea. Pentagon Channel cameras captured the unusual process of “beaching,” during which dolphins scoot themselves aboard Navy vessels.

“By riding in the boats with us, the animals can be transported much more rapidly to the work site,” Xitco said. “But it’s not a natural behavior for the animals. It’s actually one of the more challenging things that we teach them.”

In the course of working with dolphins and sea lions over the decades, the program has become the most sophisticated marine mammal health care system on the planet.

“What the Mayo Clinic is to human medicine, the Navy program is to marine medicine,” said Dr. Eric Jensen, managing clinical veterinarian for the U.S. Navy Marine Mammal Program.

No expense is spared to make sure dolphins and sea lions are afforded the best treatment available. That comes to food, which is, in essence, a daily gourmet feast.

“We have folks that work with the vet program that travel all over the world and inspect fish production facilities to make sure that the fish we’re getting for the animals is wholesome, excellent quality, (and that it’s) well taken care of as it’s being caught and as it’s being delivered to San Diego,” Jensen said.

While sailors take the lead in training marine mammals, soldiers are in charge of health care.

“Among the program’s medical staff is a team of veterinarians from the Army, which takes the lead in animal care for all the military services,” Marchus said. “When any of the Navy’s marine mammals are deployed, all the special care taken (in San Diego) goes on the road with them, including some of the Army’s veterinarian staff.”

“This provides us the capability to take our equipment wherever we go,” said Army Capt. Stephen Cassel, chief of clinical veterinary services for the marine program. “So if we need to do an ultrasound or anything like that, this is kind of our home away from home where we do our work.”

“This program has contributed more to the body of science on marine mammals than any other single organization,” Marchus said. “And each new bit of information is used to enhance the health and welfare of marine mammals and further define what they can and can’t do in support of Navy operations around the world.”

Working with dolphins to locate explosives requires weeks of highly specialized training for already well-trained explosive ordnance disposal specialists.

“It’s important to establish a relationship with them to get them to do what we want them to do and then reinforce it by the intimate relationship with the care and feeding of the dolphins,” Navy Senior Chief Petty Officer Brian Ferris explained.

The Pentagon Channel was granted extensive access to these remarkable animals and their trainers, handlers and veterinarians, and afforded rarely seen underwater video of the mammals in action.

“Sentinels of the Sea” not only offers an incredible visual journey, but also dispels many myths about the marine mammal program. For instance, dolphins have not been captured from the wild for the program in more than 20 years. Instead, all are bred in the program’s San Diego headquarters. As for the few dolphins that were born in the wild decades ago, none has attempted to return to the wild. “They get all the love they need, all the attention,” handler John Bridger said.

While sea lions wear tracking devices to measure their progress underwater, none are tethered, and none has chosen to simply swim away. “Sea lions are pretty low energy,” Price said. “We’re providing them with a place to sleep that’s safe. They don’t have any predators to worry about. So because of that, coming home is a good thing.”

“Sentinels of the Sea” is available via podcast and video on demand at www.PentagonChannel.mil.

SOURCE: Press Zoom

From the Editor- Managing Your Practice’s Finances

The Bane and Boon of Your Practice

Did you go to medical school to learn how to juggle your accounts payables and receivables? Did you spend 10 years going to school to figure out how to set up workable collection procedures with your patients and clients? I didn’t think so. Over the years, many doctors have considered managing the patient/client financial arrangements as a necessary evil to practicing medicine. Others, however, turned around their disdain for managing finances and recognized that their net profit can be positively effected by having proper financial policies in place along with workable billing and collection procedures.

Many, many, many of the doctors surveyed by The Practice Solution Magazine’s survey team have little to no experience in managing the finances of their practices. Not surprisingly, many of them have been burned by less than ethical employees or contractors.

While some of the articles in this issue of The Practice Solution are not the cure to extensive training in handling all aspects of your financial procedures, you will find some articles that will be of use at least in getting better collections-to-production ratios and keeping your receivables from getting too old to collect.

Additionally we have three outside contributing writers this issue writing on various subjects.

Our first such article is from Brad Beck, Vice President of Bank of America Practice Solutions. In this article you’ll find very useful information regarding some new, very advantageous tax ramifications of purchasing equipment. This is something that is very relevant to the “bottom line” of all of our readers. It is written in an easy to understand way.

The second article is from Dr. Amy Shroff, owner and chief of staff at the Veterinary Emergency & Specialty Center of New England in Waltham, Massachusetts. Dr. Shroff was originally contacted by one of Solutions Online Magazine’s surveyors and expressed a desire to provide other veterinarians with her hard-earned experience, especially in the area of working with staff. We thought her information to be valuable enough to include in this issue so that other doctors could benefit from what she has learned.

Our other guest writer is Lisa Thayer, co-owner, with her husband Michael, of Goldfish Network.com. I have had the fortunate experience of meeting the Thayers through our local Chamber of Commerce. In the recent past, we have discussed online marketing and how it can be somewhat convoluted. Lisa felt that since many doctors don’t get as much of an opportunity to explore the Internet as most businesspeople get to, they might be able to use some direction in developing marketing for their own websites. The first installment of a four-part series of articles written by Lisa on internet marketing is in this issue.

Additionally, as we do in each issue, we have articles that are relevant to activities in the three health care professions that compose the majority of our readers.

As usual, we hope you find the information in this issue informative and useful. And, if this is your first visit to our magazine, please take the time to look at some of our past issues for additional material that you may find helpful in the management of your practice.

I should caution you, however. I have at least one report of a doctor who lost too much sleep reading back issues of The Practice Solution Magazine late at night.

I can’t be held responsible for missed appointments due to lack of sleep.


Cory D. Radosevich

Managing Editor

The Practice Solution Magazine

Cruel Deaths in Mexico a Result of…

Closing U.S. Horse Processing Plants

Efforts to shut down horse processing plants in the United States have led to increased abandonment and neglect of horses in this country and the inhumane death of horses in Mexico, according to the American Veterinary Medical Association (AVMA).

Dr. Mark Lutschaunig, director of the AVMA Governmental Relations Division, says that the AVMA, far from being pro-horse slaughter, opposes bills banning slaughter because there are no provisions to take care of the more than 100,000 horses that go unwanted annually in the United States.

“If they think that by passing one of these bills they’ll get rid of the problem of unwanted horses, they’re simply fooling themselves,” Dr. Lutschaunig said.

Efforts by groups calling for an end to horse slaughter, such as the Humane Society of the United States (HSUS), have led to the closure of the three remaining processing plants in the United States. Now, as the AVMA has repeatedly warned, horses are being abandoned in the United States or transported to Mexico where, without U.S. federal oversight and veterinary supervision, they are slaughtered inhumanely.

“The reality is, the HSUS has done nothing to address the real issue here, and, in fact, by seeking to ban horse slaughter, they have made things significantly worse,” said Dr. Lutschaunig. “If they really wanted to do something productive to improve the welfare of horses, they would address the issue of unwanted horses in the United States.”

Even if a bill passes banning the transport of horses for slaughter, it would be nearly impossible to enforce. Such a law could easily be circumvented by transporting and selling horses as “working” or “pleasure” horses, only to have them end up in an unregulated foreign slaughter facility.

“The AVMA does not support horse slaughter,” Dr. Lutschaunig said. “Ideally, we would have the infrastructure in this country to adequately feed and care for all horses. But the sad reality is that we have a number of horses that, for whatever reason, are unwanted. Transporting them under USDA supervision to USDA-regulated facilities where they are humanely euthanized is a much better option than neglect, starvation, or an inhumane death in Mexico.”

SOURCE: American Veterinary Medical Association

Veterinary Advisory: Canine Influenza Virus

University of Florida researchers report that outbreaks of canine influenza virus, which causes an acute respiratory infection, have been identified in dogs in shelters, humane societies, boarding facilities and veterinary clinics in Florida, predominantly in Broward, Dade, Palm Beach and Duval counties.

This highly contagious virus is a newly emerging respiratory pathogen in dogs and causes a clinical syndrome that mimics kennel cough. Canine influenza virus infections are frequently mistaken for infections due to the Bordetella bronchiseptica/parainfluenza virus complex.


Because this is a newly emerging pathogen, all dogs, regardless of breed or age, are susceptible to infection and have no naturally acquired or vaccine-induced immunity.

Virtually 100 percent of exposed dogs become infected. Nearly 80 percent have clinical signs.

There are two general clinical syndromes the milder syndrome and a more severe pneumonia syndrome. The milder disease syndrome occurs in most dogs.

In the milder disease, the most common clinical sign is a cough that persists for 10 to 21 days despite therapy with antibiotics and cough suppressants. Most dogs have a soft, moist cough, while others have a dry cough similar to that induced by Bordetella bronchiseptica/parainfluenza virus infection. Many dogs have purulent nasal discharge and a low-grade fever. The nasal discharge likely represents a secondary bacterial infection that quickly resolves with treatment with a broad-spectrum, bactericidal antibiotic.

Some dogs develop a more severe disease with clinical signs of pneumonia, such as a high fever (1040F to 1060F) and increased respiratory rate and effort. Thoracic radiographs may show consolidation of lung lobes. Dogs with pneumonia often have a secondary bacterial infection and have responded best to a combination of broad-spectrum, bactericidal antibiotics and maintenance of hydration with intravenous fluid therapy.


Fatal cases of pneumonia have been documented, but the fatality rate so far is low, at 1 percent to 5 percent.


The incubation period is two to five days after exposure before clinical signs appear. Infected dogs may shed virus for seven to 10 days from the initial day of clinical signs. Nearly 20 percent of infected dogs will not display clinical signs and become the silent shedders and spreaders of the infection.


There is no rapid, real-time test for diagnosis of dogs with an acute influenza virus infection. Current diagnostic tests rely on detection of antibodies to canine influenza virus, which are detected as early as seven days after onset of clinical signs. Paired acute and convalescent serum samples are necessary for diagnosis of recent infection. The convalescent sample is collected at least two weeks after the acute sample. There are many situations in which collection of an acute sample is not feasible. In this case, testing of a convalescent sample will indicate whether the dog was infected at some time in the past. Serology tests not only indicate if a dog was infected, but also serve to alert veterinarians that the virus is present in their community so they can take precautions with dogs presenting for kennel cough.

In addition to serology, the lungs and distal trachea from dogs that died of pneumonia can be tested for influenza virus by PCR analysis and virus culture.


There is no vaccine for canine influenza virus at this time. This virus is spread by aerosolized respiratory secretions, contaminated inanimate objects and even by people moving back and forth between infected and uninfected dogs. This is an enveloped virus that is most likely killed by routine disinfectants, such as quaternary ammoniums and 10 percent bleach. Because the virus is highly contagious and all dogs are susceptible to infection, veterinarians, boarding facilities, shelters and pet stores should use isolation protocols for dogs that have a kennel cough.


Veterinarians can submit serum samples for canine influenza antibody titers. Paired acute and convalescent samples are preferable for confirmation of infection, while single samples collected after seven days of clinical disease are also useful. In addition to determining infection, these samples will contribute toward virus surveillance in Florida. Currently, there is no fee for this testing. The turnaround time for results is less than two weeks. Please see the “”Serum Collection and Shipping”” form for further instructions.

Veterinarians may also submit fresh (no formalin or freezing) lung and tracheal tissues from dogs that die from pneumonia. Canine influenza virus culture and PCR analysis will be performed on these tissues. Virus recovered from these samples will greatly contribute toward development of vaccines and diagnostic tests.

Contact Dr. Crawford in the Department of Small Animal Clinical Sciences at the University of Florida College of Veterinary Medicine for sample submission or for more information via phone (352) 392-4700, ext. 5731; fax (352) 392-6125; or e-mail crawfordc@mail.vetmed.ufl.edu.

SOURCE: Maryland Veterinary Medical Association and Paul Knepley, DVM, Director of the Bureau of Animal Health and Diagnostic Services at the Pennsylvania Department of Agriculture.

Congress Moves Children’s Vision Bill Forward

Legislation an Important Step Toward Addressing the Uninsured

For the first time, the U.S. House of Representatives has approved legislation supported by the American Academy of Ophthalmology to combat undiagnosed and untreated vision problems in children.

In a move that brings the measure one step closer to law, the Vision Care for Kids Act of 2007 (H.R. 507) was passed recently out of the House Energy and Commerce Committee. The Act is part of the Academy’s long-term commitment to see that all children, including those with no insurance, receive an eye screening. The House is expected to vote on the measure before the end of the year.

“The Academy is pleased that this legislation passed unanimously and with bipartisan support. Clearly, Democrats and Republicans agree on the importance of children’s vision issues,” said Michael X. Repka, M.D., the Academy’s secretary for federal affairs and professor of ophthalmology and pediatrics at John Hopkins University School of Medicine. “We look forward to seeing the bill continue to advance and become law.”

Introduced by Reps. Gene Green, D-Texas, Vito Fossella, R-N.Y., Eliot Engel, D-N.Y., and John Sullivan, R-Okla., the bill would bridge a significant gap in vision care. While many states have vision screening programs in place, financial resources are often lacking for uninsured children to have follow-up diagnosis and treatment. This bill would complement existing state efforts by providing funding in the form of state grants for comprehensive eye examinations and treatment for uninsured children who fail a vision screening, authorizing $65 million dollars over five years. The Academy was instrumental in developing language used for the legislation.

“Because there is not a vision mandate under the State Children’s Health Insurance Program (SCHIP), this legislation is important to support and encourage current state efforts to address the needs of our nation’s uninsured children,” said Catherine G. Cohen, the Academy vice president for governmental affairs.

The Academy has joined the American Association for Pediatric Ophthalmology and Strabismus, the Vision Council of America, Prevent Blindness America and the American Optometric Association in making treating children’s vision a top priority for Congress this year.

SOURCE: American Academy of Ophthalmology

‘Twinkle after effect’ can help retinal patients

detect vision loss quickly and cheaply

Scientists hope to make it available online

Scientists at Schepens Eye Research Institute have discovered a simple and inexpensive way for patients with retinal and other eye disease to keep track of changes in their vision loss. In a study published recently in PLoS One, they demonstrate that a compelling visual illusion known as the induced twinkle after-effect (TAE) can accurately identify the location and breadth of actual blind spots in people with retinal disease. The twinkle after-effect is a “twinkling” that people can see in a blind spot when they stare at a blank screen after staring at a noisy visual target such as a detuned television screen.

“Our hope is that we can make this simple technique available online or on a DVD,” says Dr. Peter Bex, associate scientist at Schepens Eye Research Institute and the principal investigator of the study. “This will be particularly helpful with patients who have glaucoma, diabetic retinopathy or macular degeneration where early detection of changes in vision can impact the effectiveness of treatments.”

According to Bex, many people fail to seek help when they develop blind spots in their vision, because their brains automatically compensate or “fill in” the missing information in their visual field. Since everyone has a blind spot where the optic nerve meets the retina, this perceptual “fill in” process is useful for normally sighted people, allowing them a complete visual image. “But this innate process can mask the effects of serious disorders such as diabetic retinopathy and glaucoma and keep sufferers from seeking help until the vision loss is very serious or they bump into objects they can no longer see.”

The traditional gold standard method for detecting blind spots (scotomas) is very expensive and time consuming and must be done in an ophthalmologist’s office. The technique known as retinal specific microperimetry is a diagnostic tool that costs nearly 50 thousand dollars and requires specialized training to apply.

In 1992, scientists became aware of what they eventually named the “twinkle after effect.” They discovered that when someone looks at a television screen filled with static noise while covering part of their visual field with a small patch, the formerly patched area is left with a twinkling sensation after the noise is turned off and the person looks at a blank screen. The rest of the visual field does not experience the twinkling effect, which was described by one patient as resembling a moving cumulous cloud. “While this discovery was intriguing, it wasn’t clear how it could be used for patients,” says Bex.

In the past several years, Bex and his team began to understand its potential. “We theorized that if people with blind spots stared at a noisy screen, the blind areas would “twinkle” when the screen was turned off and their eyes focused on a blank screen. These ‘twinkling’ blind spot areas could then easily be mapped,” he says.

To test their theory, Bex and his team asked eight patients with macular degeneration to undergo the retinal specific microperimetry test and his “twinkling after-effect” test. The team provided a blank touch screen–after the noisy screen–so patients could outline the twinkling areas with their finger.

The team found that the results of the two tests matched in 75 percent of cases, and visual defects could be detected in areas that are not accessible to conventional microperimetry, confirming his belief that TAE could be used diagnostically. “This tool cannot replace the more sophisticated technique but we believe it is a powerful, simple tool that patients can use daily in the privacy of their home to detect any changes in their vision,” he says. “If a patient detects a change, his or her physician can then study it more closely and offer therapy.”

While the results of this small study are very encouraging, Bex says the next step is to do a larger clinical study.

Ultimately Bex sees this type of test being free to the public on the Internet or distributed through a public health entity. “We really believe this could have a great impact on the visual health of the community,” says Bex.

SOURCE: Schepens Eye Research Institute, an affiliate of Harvard Medical School

Scientists Discover How Maternal Smoking

Can Cause Cleft Lip and Palate

Scientists supported by the National Institute of Dental and Craniofacial Research (NIDCR), part of the National Institutes of Health, report that women who smoke during pregnancy and carry a fetus whose DNA lacks both copies of a gene involved in detoxifying cigarette smoke substantially increase their baby’s chances of being born with a cleft lip and/or palate.

According to the scientists, about a quarter of babies of European ancestry and possibly up to 60 percent of those of Asian ancestry lack both copies of the gene called GSTT1. Based on their data, published in the January issue of the American Journal of Human Genetics, the scientists calculated that if a pregnant woman smokes 15 cigarettes or more per day, the chances of her GSTT1-lacking fetus developing a cleft increase nearly 20 fold. Globally, about 12 million women each year smoke through their pregnancies.

Dr. Jeff Murray, a scientist at the University of Iowa and senior author of the study, noted that parents who are considering having a child and need added motivation for the mother to quit smoking might one day be tested to determine their GSTT1 status. Because the fetus inherits its genes from both mother and father, the test would determine the likelihood of the baby developing without the GSTT1 gene to detoxify the cigarette smoke.

“A test that indicates the GSTT1 gene is present certainly would not eliminate a baby’s risk of a cleft because many other genetic and environmental factors can be involved,” said Murray. “But the opposite result would give the mother one more compelling reason to quit smoking for her own health and for the sake of her child.”

In the United States, about one in every 750 babies is born with isolated, also called nonsyndromic, cleft lip and/or palate. The condition is correctable but typically requires several surgeries. Families often undergo tremendous emotional and economic hardship during the process, and children frequently require many other services, including complex dental care and speech therapy.

According to Murray, researchers have built a strong statistical case over the past several years that pregnant women who smoke put their unborn babies at greater risk of developing a cleft. The data raised two related questions. “Do genetic variations in the mother influence her own metabolism of the cigarette smoke and its byproducts, thus setting in motion developmental changes that cause the cleft in the fetus? Or do genetic variations in the fetus itself compromise its ability to metabolize the cigarette smoke and cause the cleft?” said Dr. Min Shi, now a scientist at NIH’s National Institute of Environmental Health Sciences and a lead author of the paper.

To find the answers, Murray’s group teamed with colleagues in Denmark to perform a large, complex, and possibly first-of-its-kind international study. The group first assembled a list of 16 genes of interest, each of which encode proteins that plug into various pathways in the body involved in detoxifying dangerous chemicals. “We picked genes that previous evidence shows either are directly involved in cigarette smoke toxicity or are major players in general toxicity management in people,” said Dr. Kaare Christensen, a scientist at the University of Southern Denmark in Odense and an author on the paper.

“These genes tend to be quite variable from person to person in their precise DNA structure, or spelling,” Christensen added. “We wanted to see if any of these variations might adversely affect a person’s ability to break down the toxic products of cigarette smoke.”

Christiansen and his colleagues then turned to their existing database of kids with clefts, their parents, and siblings. In all, the scientists analyzed 5,000 DNA samples from both continents – including 1,244 from children born with clefts. Importantly, the families in Denmark and Iowa provided the opportunity to independently confirm the findings in two distinct populations.

In addition, they had free public access to the NIDCR-funded COGENE project, a comprehensive online database of genes expressed throughout the various stages of development. Working closely with Dr. Mike Lovett at Washington University in St. Louis, one of COGENE’s founders, the database proved especially helpful because cleft lip and/or palate occurs during the first 5-to-12 weeks of development. This meant the scientists had to be sure not only that their genes of interest are expressed during this vital period but are switched on in fetal craniofacial structures. If the genes met both criteria, the investigators said they hoped their subsequent data might point them to a gene-environment interaction.

As reported, the scientists determined from their analyses that the mother provides the toxic environmental exposure, which then can be greatly amplified by the genetics of the fetus to produce the cleft. This marks the first time a gene-environment interaction in clefting has been documented at a molecular level. The data also point the way for future studies to define the specific molecular chain of events that lead to the cleft, vital information to understand and hopefully one day prevent the process.

While sifting through the data, the researchers took particular note of the GSTT gene and its contribution to clefting. The gene encodes one of the body’s approximately 20 different glutathione S-transferase enzymes. These enzymes collectively play roles in common detoxification processes, ranging from chemically altering drugs and industrial chemicals to detoxifying polycyclic aromatic hydrocarbons, a key component of cigarette smoke.

The scientists found that pregnant women who smoked and also carried fetuses that lacked the GSTT1 enzyme were much more likely to give birth to a baby with a cleft. This finding was true in Iowa and Denmark, and they noted in the COGENE database that the gene is highly expressed in developing craniofacial structures. “It may be that the lip and palate can form normally without GSTT1,” said Murray. “But if the chemicals in cigarette smoke challenge the normal development of these structures, fetuses that lack the gene are at a distinct disadvantage.”

Murray and his collaborators continue their genetic analyses. “We now have data from about 350 genes on this cohort of families,” he said. “It’s certainly a more complicated analysis to perform, but we’re working our way through it and hope to have some very interesting data in the months ahead.”

The article is titled “Orofacial Cleft Risk is Increased with Maternal Smoking and Specific Detoxification-Gene Variants,” and is published in the January 2007 issue of the American Journal of Human Genetics. The authors are Min Shi, Kaare Christensen, Clarice R. Weinberg, Paul Romitti, Lise Bathum, Anthony Lozada, Richard W. Morris, Michael Lovett, and Jeffrey C. Murray.

The NIDCR (www.nidcr.nih.gov) is the nation’s leading funder of research on oral, dental, and craniofacial health.

SOURCE: National Institute of Dental and Craniofacial Research

Periodontal Diseases Are Blind to Age

Two studies suggest that periodontal diseases should be a concern to women of all ages

Two studies in a recent issue of the Journal of Periodontology (JOP) suggest that periodontal diseases are a threat to women of all ages due to hormonal fluctuations that occur at various stages of their lives. One study looked at 50 women who were between the ages of 20 to 35 with varying forms of periodontitis. The study found that women who currently were taking oral contraceptive pills had more gingival bleeding upon probing and deeper periodontal pockets (signs of periodontitis) than those who were not taking oral contraceptive pills.

“Younger women often think that periodontal disease is a condition associated with old age,” explained study author Brian Mullally, PhD. “Our study shows that it is very possible for younger women to experience periodontal disease. It is important for women to alert their dental practitioners about any medications they are taking, such as oral contraceptive pills, because it is possible that their oral health may be affected. It might also be prudent where possible for young women to ensure that their periodontal health has been checked before commencing oral contraceptive therapy.”

Another study in the Journal examined 1,256 postmenopausal women and looked for a potential association between periodontal bacteria and bone loss in the oral cavity. The study results showed that women with periodontal bacteria in their mouths were also more likely to have bone loss in the oral cavity, which can lead to tooth loss if not treated.

“Our study’s findings are important for postmenopausal women because they suggest that good periodontal health is extremely important in the postmenopausal years,” said study author Renee Brennan, PhD. “We found that oral bone loss was associated with presence of oral bacteria. In fact, 62% of the women in our study had at least one species of subgingival bacteria present, and the women with these bacteria had more evidence of oral bone loss. Interestingly, women who had a Body Mass Index in the overweight range were much more likely to have oral bone loss associated with presence of oral bacteria. Oral bone loss has been associated with osteoporosis in this group as well. This association has been difficult to study because many risk factors for periodontal disease and osteoporosis-including smoking, age, medications, and overall general health-are similar. It should be noted that our study was limited in that it included a relatively healthy group of mostly Caucasian women and that future studies are needed to determine the effects of periodontal bacteria on bone loss in other groups of postmenopausal women.”

The American Academy of Periodontology is an 8,000-member association of dental professionals specializing in the prevention, diagnosis and treatment of diseases affecting the gums and supporting structures of the teeth and in the placement and maintenance of dental implants. Periodontics is one of nine dental specialties recognized by the American Dental Association.

SOURCE: American Academy of Periodontology


Root Canals Just as Effective as Dental Implants

Dentists Emphasize Saving Natural Teeth and Patient-Specific Considerations

For patients torn between the best way to treat a compromised tooth, the choice just got clearer. A recent systematic review comparing two of the most common treatment options – root canals and dental implants – found virtually equal success, or survival rates, between both treatments. However, despite this similarity, it was concluded that the priority should always be to preserve the natural tooth before extracting and replacing with an implant. Root canal treatment saves more than 17 million teeth a year.

The results of the treatment analysis were published by The International Journal of Oral and Maxillofacial Implants, the official publication of the Academy of Osseointegration, an organization committed to advancing dental implants. The Academy also published a consensus statement developed by experts from several dental disciplines that supports the comparison’s findings and stresses the importance of patient-specific considerations.

There are several notable differences between the two procedures. Dental implants require extracting the tooth followed by multiple surgeries to insert a metal post in the jaw and affix a porcelain crown to the post. These surgeries often can take three or more visits to complete, and can be timely and costly. During root canal treatment, the source of tooth pain – inflamed pulp – is removed and the inside of the tooth is then cleaned, filled and sealed. Today, most root canals can be completed in one visit and are virtually painless.

Since the comparative analysis uncovered no significant differences in the success rates between the two options, the researchers emphasize that treatment decisions must be based on factors other than outcome, such as case complexity or the patient’s individual health and preferences. To assist dental professionals and their patients in determining the most appropriate treatment, the American Association of Endodontists (AAE), the national association representing root canal specialists, released a position statement on treatment planning when considering a root canal or dental implant.

According to Dr. Shepard S. Goldstein, AAE president and Framingham, Mass. endodontist, the position statement is meant to be used as a guide when deciding how to best treat a compromised tooth. For example, when a patient has diabetes, there are certain factors that the dental professional must consider when determining treatment.

“The recommended treatment must be safe, mindful of the patient’s wishes, and should aim at preserving the natural tooth when possible,” said Dr. Goldstein. “The AAE hopes that this guidance can help ensure that each patient receives the best treatment based on his or her unique case.”

Dr. James A. Abbott, an endodontist from Santa Rosa, Calif., says many of his patients have had to choose between a root canal and a dental implant. “Most patients want to keep their natural tooth,” says Dr. Abbott. “When I explain the details of both treatments and how the tooth can be saved with a root canal, the choice is simple.”

The AAE position statement also is intended to assist dental professionals in evaluating the various risk factors and other implications associated with each of the treatment choices. Risk factors can include smoking, bone quality and estrogen level – for example, women with lower estrogen levels may encounter more treatment failures with implants. According to the AAE statement, it is crucial that the patient’s health and specific oral care needs be the most important considerations when weighing treatment options.

The American Association of Endodontists, headquartered in Chicago, represents more than 6,900 members worldwide, including approximately 95 percent of all eligible endodontists in the United States.

SOURCE: American Association of Endodontists


Search Engine Marketing for Doctors

Article 1 of 4 part series

By Lisa Thayer,


Surveys show that over 80% of internet users find new web sites by using search engines.

The question that seems to be on everyone’s minds today is “How do I get my website top placement on the search engines?” If you have a website, you may have found other websites above yours when you have looked for your site in Google. In order to answer the previous question, I need to give you a little background on the way search engines work.

There are two primary ways (out of many) that your website gets to the top of search engines: one is to pay for placement, the other is to market and design your website so that it rises up through the page ranks “organically” in search engine results.

Before I begin to discuss pay-for-placement online marketing, I have to get on my soap box and make a special announcement: If you glean nothing else from this article, remember this – having a baseline BEFORE you start paying money for advertising is imperative as is tracking results of an online marketing program. A baseline is the point at which you begin a marketing campaign so you can compare the effectiveness of the campaign.

Programs such as Google’s AdWords and AdSense or Yahoo’s Sponsored Search are good examples of paying for placement. Each search engine has their own individual fee structure. The price you pay to advertise in this manner depends on the “keywords” you choose and the competition for those placements. Keywords can be thought of as the words a person would type into the search box on search engines. They can consist of words, phrases, or alphanumerical terms. If you are spending your marketing budget on keyword ads, you need to choose your keywords carefully.

Using keywords that are overly broad such as “best dentist USA” can result in bringing more traffic to your website, but if you only have dental offices in California, that search probably won’t result in a new patient. Conversely, choosing keywords that are overly specific might bring in too little traffic, like “veterinarians who graduated from Purdue in 1983″. Keywords are so important in fact, that selecting keywords has become an industry all its own.

The two top search engines used by the general public are Google and Yahoo. Google and Yahoo also supply some of the smaller search engines such as AOL, My Space Search, Netscape, Alta Vista, etc. with their search results. In fact, if you added up the huge market share of Google it would account for almost 70% of all searches!

As previously mentioned, having a baseline BEFORE you start paying money for advertising is imperative as is tracking results of an online marketing program. You obtain a baseline by having your web designer add a tracking program/ code to your website. We set up Google Analytics on all of our client’s websites.

Google Analytics (GA) is a free service offered by Google that generates detailed statistics about the visitors to a website. Its main highlight is that a webmaster can optimize his/her marketing campaigns through the use of GA’s analysis of where the visitors came from, how long they stayed on the website and their geographical position. Users can define and track conversions, or goals. Goals might include sales, lead generation, viewing a specific page, or downloading a particular file. By using this tool, marketers can determine which ads are performing, and which are not, as well as find unexpected sources of quality visitors.

Many of my clients have asked, “Wait a minute…why is Google Analytics free?” The simple answer is that Google knows that if you have the information to make informed online advertising decisions, you will be more likely to advertise. And, since Google is the giant of the search engine world, chances are they will be able to earn your business.

Next time, I’ll discuss spiders and crawlers and bots…oh my!

Lisa Thayer is owner of GoldfishNetwork.com, a website design and marketing company located just south of Portland, Oregon. GoldfishNetwork.com serves clients across the U.S. Lisa can be reached at 503-783-0440 or by e-mail: Lisa@GoldfishNetwork.com