Case for Change in Dental Education Curricula

The American Dental Education Association’s (ADEA) Commission on Change and Innovation in Dental Education (ADEA CCI) was created to serve as a focal meeting place where dental educators and administrators, organized dentistry, and the licensure, accreditation, and examining communities could meet and coordinate efforts to improve dental education and the nation’s oral health.

An objective of this commission is to guide dental schools by discussing systemic efforts to foster change and innovation in dental education. As a facilitator of change, ADEA CCI is committed to providing leadership and oversight for a collaborative and continuous process of innovative change in the education of general dentists so that they enter the profession competent to meet the oral health needs of the public and to function as important members of an efficient and effective health care team. To that end, the Commission created two landmark articles published in the Journal of Dental Education, which is published by ADEA

The two articles, “The Case for Change in Dental Education” and “Educational Strategies Associated with Development of Problem-Solving, Critical Thinking, and Self-Directed Learning” address the rationale for change while examining a number of mounting issues, including the high cost of education, the need to promote the provision of oral health care to all Americans, and current students dissatisfaction with the state of dental education.

Answering these questions begins with determining best practices for helping dental students acquire skills necessary for their careers in dentistry, and ultimately become experts through lifelong learning. These papers offer ADEA CCI’s first recommendations on benchmarks that faculty and academic planners can use to assess the degree to which their curricula include learning experiences associated with attaining mastery of the dental profession for future graduates. “Scientific advances driving the delivery of health care are taking place at lightning speed. We can no longer afford to base our education programs on the memorization of present day facts. Programs developing tomorrow’s health care providers must concentrate on the creation of lifelong learners capable of providing evidence-based care that meets the need of society,” said Dr. Kenneth L. Kalkwarf, ADEA President and ADEA CCI Chair.

ADEA CCI’s activities are based on four guiding assumptions:

Assumption 1: Diversity of dental school curricula is a strength of dental education;

Assumption 2: Dental education has been and must remain firmly rooted in scientific discovery;

Assumption 3: Dental education must change in significant ways to develop students into lifelong learners;

Assumption 4: Achieving meaningful change and innovation in dental school curricula is a systemic process.

The Commission consists of representatives from ADEA, dental schools, the ADA Board of Trustees, the Commission on Dental Accreditation, the ADA Council on Dental Education and Licensure, the Joint Commission on National Dental Examinations, the dental licensure community, the ADA Foundation, and allied and advanced dental education programs.

SOURCE: AScribe Newswire

Making Financial Arrangements

Ensuring Your Office Gets Paid 
It is the responsibility of the accounts manager to sit down with the patient/client and work out the best financial arrangement within the framework of the policies of your office. Bear in mind that the ideal plan would be one that facilitates the most immediate payment for service rendered. One would not offer a plan that stretched payments out over a long period of time unless there was no other option that the patient could afford. Firm financial arrangements must be made with patients/clients.

It is most advisable to have only one person discussing payment options with your patient/client and this should rarely, if ever, be the doctor. The doctor should present his case recommendation, and if necessary, briefly outline the general payment options, but without getting into the actual financial arrangements (it is always best if the accounts manager is the only person discussing money with patients/clients).

Once the doctor has presented his treatment plan, he should then tell them that his accounts manager will make the actual arrangements. He should then leave the room and quickly acquaint the financial person with the case, including how soon the first appointment (or several appointments) should be; how much time he will need scheduled for the appointment(s); the total fee for the services the patient/client has accepted.

The accounts manager would then meet with them privately to make the financial arrangements. They should begin by seeing to it that the first appointment is scheduled, and then introduce the topic of finances. A good approach is, “How do you want to pay for this today?”

The accounts manager would strive to secure payment in full, but if necessary, would go over the other options that are available, illustrating with dates and amounts.

Don’t force a person into a hasty decision. If he/she needs time to review his/her finances, then simply write down the total fee and the methods of payment available. Schedule another conference to complete the financial arrangements.

Once the accounts manager and the patient/client have decided on a method of payment, the “agreement” should be summarized in writing, with dates and amounts and have the patient/client sign it. Give a copy to the patient/client.

It is advisable to then send a letter to the patient/client after the meeting, congratulating them for going ahead with your services and outlining the financial agreement again, offering assistance if they have any questions.

Always discuss fees and payment options in a very clear manner with the patient/client before providing any services. It is important to work with them so they have financial arrangements that they feel they can abide by. They will feel better about being your patient/client when they know that you have really worked with them, and that together you have made an agreement which is workable.

Publicize any new payment plans that you institute. You can put a sign in your reception area that says “Ask About Our Payment Policies”. You could also mail statement stuffers which include payment information for your patients/clients. Put together a practice brochure that explains your payment policies. Instruct your front office staff to discuss new payment plans with every person at his/her next appointment (only if appropriate).

The accounts manager’s job does not need to be difficult, time-consuming and frustrating if it is done in an organized and efficient fashion. Two of the most important factors are:

  1. Having firm financial policies
  2. Making sure that the patient/client understands and agrees to his/her obligation

Sight Could Be Restored In Those With Macular Degeneration

A research center newly created by the University of California, Berkeley, and Lawrence Berkeley National Laboratory (LBNL) aims to put light-sensitive switches in the body’s cells that can be flipped on and off as easily as a remote control operates a TV. Optical switches like these could trigger a chemical reaction, initiate a muscle contraction, activate a drug or stimulate a nerve cell – all at the flash of a light.

One major goal of the UC Berkeley-LBNL Nanomedicine Development Center is to equip cells of the retina with photoswitches, essentially making blind nerve cells see, restoring light sensitivity in people with degenerative blindness such as macular degeneration.

“We’re asking the question, ‘Can you control biological nanomolecules – in other words, proteins – with light?’” said center director and neurobiologist Ehud Y. Isacoff, professor of molecular and cell biology and chair of the Graduate Group in Biophysics at UC Berkeley. “If we can control them by light, then we could develop treatments for eye or skin diseases, even blood diseases, that can be activated by light. This challenge lies at the frontier of nanomedicine.”

The research got off the ground this month thanks to a $6 million, five-year grant from the National Institutes of Health (NIH), part of a nanomedicine initiative within NIH’s Roadmap for Medical Research. The initiative, which has funded eight Nanomedicine Development Centers around the country, including one last year at UCSF that involves UC Berkeley collaborators, is designed to “take cutting edge technology from one branch of science – nanotechnology – and apply it to another – medicine,” according to Isacoff.

The nanoscience breakthrough at the core of the research was developed at UC Berkeley and LBNL over the past several years by neuroscientist Richard Kramer, professor of molecular and cell biology, Dirk Trauner, professor of chemistry, and Isacoff – all three members of the Physical Bioscience Division of LBNL. It involves altering an ion channel commonly found in nerve cells so that the channel turns the cell on when zapped by green light and turns the cell off when hit by ultraviolet light.

The researchers demonstrated in 2004 that they could turn cultured nerve cells on and off with this optical switch. Since then, with UC Berkeley Professor of Vision Science and Optometry John Flannery, they’ve injected photoswitches into the eyes of rats that have a disease that kills their rods and cones, and have restored some light sensitivity to the remaining retinal cells.

Isacoff, Kramer, Flannery and Trauner have now joined forces with 9 other researchers from UC Berkeley and LBNL, as well as from Stanford University, Scripps Institution of Oceanography and the California Institute of Technology, to perfect this fundamental development and bring it closer to medical application. Their group, centered around the optical control of biological function, will develop viruses that can carry the photoswitches into the correct cells, new types of photoswitches based on other chemical structures, and strategies for achieving the desired control of cell processes.

“The research will focus on one major application: restoring the response to light in the eyes of people who have lost their photoreceptor cells, in particular, the rods and cones in the most sensitive part of the retina,” Isacoff said. “We plan to develop the tools to create a new layer of optically active cells for the retina.”

Loss of photoreceptors – the light detectors in the retina – is the major cause of blindness in the United States. One in four people over age 65 suffers vision loss as a result of this condition, the most common diagnosis being macular degeneration.

The chemistry at the core of the photoswitch is a molecule – an azobenzene compound – that changes its shape when illuminated by light of different colors. Kramer, Trauner and Isacoff created a channel called SPARK, for Synthetic Photoisomerizable Azobenzene-Regulated K (potassium) channel, by attaching the azobenzene compound to a broken potassium channel, which is a valve found in nerve cells. When attached, one end of the compound sticks in the channel pore and blocks it like a drain plug. When hit with UV light, the molecule kinks and pulls the plug, allowing ions to flow through the channel and activate the nerve cell. Green light unkinks it and replugs the channel, blocking ion flow.

Isacoff said that this same photoswitch could be attached to a variety of proteins to push or pull them into various shapes, even making a protein bend in half like a tweezer.

In 2006, in a cover article in the journal Nature Chemical Biology, the researchers described for the first time a re-engineered glutamate receptor that is sensitive to light, which complements the SPARK channel because the same color of light will turn one on while turning the other off.

“Now we have photochemical tools for an on switch and an off switch for nerve cells,” Kramer said. “This will allow us to simulate the natural activity of the healthy retina, which has on cells and off cells that respond to light in opposite ways.”

Isacoff, Kramer, Trauner and their colleagues are experimenting with other molecules that can force shape changes, looking for improved ways to attach shape-changing molecules to proteins, developing means to shuttle these photoswitches into cells, building artificial genes that can be inserted into a cell’s DNA to express the photoswitches in the correct cell, and searching for ways to get light into areas of the body not possible to illuminate directly.

“I’m struck by how versatile this approach seems to be,” Isacoff said, noting its applications for screening, diagnosing and treating disease. “I’m convinced that we’ll come up with a therapy that will work in the clinic.”

SOURCE: University of California – Berkeley and Medical News Today

AOA Backs Contact Lens Patient Safety Bill

Federal Measure Would Protect Consumers

The American Optometric Association(AOA) announced its support for legislation in the U.S. House of Representatives designed to safeguard consumers from deficient or illegal contact lens prescription verification practices used by the Internet and mail order contact lens sales industry.

Rep. Ed Whitfield (R-Ky.), a leader in Congress on patient safety issues and chairman of the Oversight and Investigation Subcommittee, introduced the Contact Lens Consumer Health Protection Act in response to complaints he received from optometrists and their patients in Kentucky and across the U.S.

“Prescription verification abuse by third-party contact lens vendors is a significant problem,” Rep. Whitfield said. “Completing contact lens sales without properly verifying a patient’s prescription is an unacceptable business practice and clearly contrary to the best interest of consumers’ health. This legislation will facilitate communication between doctors and third-party vendors, ensuring that patients receive products that are safe and compatible with their documented medical history.”

The Whitfield bill seeks to strengthen consumer safeguards on the contact lens prescription verification practices being used by third-party vendors that allow for orders to be filled without a prescription or overfilled beyond what was directed by an optometrist or ophthalmologist. In putting the needs of patients first, Rep. Whitfield’s legislation is aimed at putting a stop to the use of automated telephone system “robo-calls” by sellers into the offices of eye doctors and increasing fines to be imposed by the Federal Trade Commission on online and mail order sellers who violate the law.

All contact lenses, including non-corrective, decorative lenses, are regulated as medical devices by the federal government, and may only be sold pursuant to an eye care professional’s examination and a valid prescription. If not properly manufactured, distributed, fitted, worn and cared for, they may cause serious injury to the wearer.

“Doctors, patients, manufacturers and even sellers themselves have reported serious violations of the law by Internet and mail order contact lens sales companies,” said Dr. Joe Ellis, an optometrist in Benton, Ky., and trustee of the AOA. “By sponsoring legislation to crack down on unscrupulous contact lens sellers, Congressman Whitfield is taking decisive action to safeguard the eye health of my patients in western Kentucky and contact lens patients across America.”

Original co-sponsors of the Rep. Whitfield’s Contact Lens Consumer Health Protection Act include Reps. Charlie Norwood (R- Ga.), John Boozman, O.D. (R-Ark.), Tom Allen (D-Maine) and Ralph Hall (R-Texas). In addition to the AOA, Rep. Whitfield’s bill has been endorsed by the Kentucky Optometric Association and the American Academy of Ophthalmology.

“It’s a sad and disturbing fact that certain Internet and mail order contact lens sellers are putting their profits ahead of our patients,” said Dr. C. Thomas Crooks, AOA president. “Thanks to Rep. Whitfield’s leadership, Congress can take action to ensure that the interests of patients come first.”

“Contact lenses are regulated medical devices requiring a valid prescription from a licensed doctor,” Rep. Whitfield said. “Third-party vendors that overfill prescriptions or who do not verify the prescriptions they are filling endanger the health and welfare of the customers they purport to serve. My legislation will ensure the proper balance of consumer choice and the health and safety of the American public.”

Over the last year, optometrists, consumers, manufacturers and even sellers themselves have reported serious violations of the law by Internet and mail order contact lens sales companies. In October, the Federal Trade Commission (FTC) issued a formal warning letter to 1-800 CONTACTS, Inc, the largest Internet contact lens seller, after evaluating complaints about its prescription verification practices. In late June of 2006, the FTC issued a series of 18 warning letters to sellers of cosmetic contact lenses for failure to comply with the requirements of the Fairness to Contact Lens Consumers Act based on statements on the sellers’ Web sites. More recently, in August, the FTC imposed formal sanctions on Internet contact lens seller Walsh Optical Inc.

SOURCE: U.S. Newswire

Diabetes is the Leading Cause of Blindness Among Most Adults

American Optometric Association Reminds Patients About the Importance of Comprehensive Eye Exams

A survey by the American Optometric Association (AOA), the American Eye-Q™ revealed that while more than 60 percent of adults know that diabetes is detectable through a comprehensive eye exam, only 38 percent of adults who do not wear glasses or contacts have been to an eye doctor in the last two years.

Almost 21 million people in the United States have diabetes and over six million of those are undiagnosed. Additionally, an estimated 54 million Americans aged 40 to 74 have pre-diabetes, a condition that puts them at high risk for developing type 2 diabetes. Diabetes is the number one cause of acquired blindness.

“Individuals who are at high risk for diabetes need to have regular, dilated eye exams and all individuals with known diabetes need to have dilated eye exams each year,” according to Robert Layman, O.D. and Chair of the AOA’s Diabetes Eye Care Project Team. “Individuals should consider an eye exam the first line of detection for this serious disease and its complications,” said Dr. Layman. “Fortunately, in nearly all cases, diabetic retinopathy, a potentially blinding complication of diabetes and sometimes the very first sign of diabetes, can be diagnosed during a dilated eye exam in which drops are put into the eyes.”

Dr. Layman adds that on many occasions, other health-threatening conditions may be discovered during an eye exam. “We can uncover unique signs that may even save someone’s life. The effects of high blood pressure, anemia and elevated blood cholesterol can be seen during a dilated eye exam because the eye is the only place within the body that blood vessels can be seen in their natural state. For this very reason, Leonardo DaVinci often referred to the eye as the ‘window to the body.’”

According to Michael Duenas, O.D. and health scientist at the Centers for Disease Control and Prevention (CDC), Division of Diabetes Translation, “Patients suffering from diabetic retinopathy may not notice any changes in their vision, especially during the early treatable stages of the disease, this fact emphasizes the importance of all individuals with diabetes having yearly dilated eye examinations by an optometrist or ophthalmologist.”

“Affordability, continuity, and regular sources of care, as well as physician advice remain core factors significantly associated with receiving this needed care,” said Dr. Duenas. “There is an obvious disconnect between adults’ knowledge and their actions when it comes to comprehensive eye exams,” said Dr. Layman. He adds, “This is very unfortunate considering that 12,000 to 24,000 people unnecessarily lose their vision yearly because of diabetes complications that can often be prevented through early detection and timely treatment.”

Key facts about diabetes:

* More than 21 million people in the United States have diabetes.

* 6.2 million people with diabetes are unaware they have the disease.

* An estimated 54 million Americans aged 40 to 74 (40.1 percent of the U.S. population in this age group) have prediabetes a condition that puts them at high risk for developing type 2 diabetes.

* Diabetes is the leading cause of new cases of blindness among adults ages 20 to 74.

* People with diabetes are 40 percent more likely to develop glaucoma.

* People with diabetes are 60 percent more likely to develop cataracts.

Source: American Optometric Association and PrimeZone

Guest column: Dental Legal Issues

Is Fraud like Beauty, in the eye of the beholder?

By Dr. Barry Levy, DDS

In a case filed last year, a dentist has been criminally charged with fraud, because the dentist diagnosed decay in two teeth, using clinical skills and a DIAGNOdent (a fluorescent laser method for early caries diagnosis), decay which another dentist decided did not exist. What makes this interesting is that a difference of opinion wound up in a criminal court, when it should have been policed by the profession and been an issue for a review of diagnostic procedures.

The case is interesting because the terms that are being adapted for fraud may be much different from what one expects and can impact on how you practice dentistry. The Ohio Bar Association discussed the fraud issue in an article that they released. They cite examples of fraud that we can easily understand such as double billing, unbundling and changing the dates of services. These issues are objective and easily understood.

But other examples are ambiguous and subjective. Therein lies the problem. Fraud is being defined as excessive treatment, faulty treatment and billing for services that you didn’t actually provide, but were done by others in your office.

So if your philosophy is an aggressive approach to treatment, and not a watch and wait approach, what do you do if your treatment is challenged by a person with a different treatment philosophy? Are you wrong, or is the other person wrong? Are we saying this should be a criminal matter, or a board matter?

I see more and more dentists that are using magnification and video imaging. Suppose your treatment is reviewed by somebody that doesn’t use magnification. Is this a concern, especially when the stakes are so high to you? They are so high, because a fraud case is not a civil board action, but becomes a criminal matter, where malpractice insurance won’t cover the defense and the terms of bail may be that you can’t practice. Is it possible that somebody with a grudge could be biased against you if they had to review your diagnosis?

We will all agree that if you bill for a filling that wasn’t done, it is a fraud. But what would you think of fraud allegations being levied if you bill for treatment done by somebody else in your office? This has already happened in courts. The extent to which lawyers ignored how a dental business is run was staggering. As was the attempt to arrest the staff that did the billing and charging them as co-conspirators. Do you think that a staff person might be turned to testify against you to protect themselves? If you said yes, you would probably be correct.

The scary part is that in these cases, when I would have thought the profession would be a strong advocate for these assaults on the profession and on a colleague, they were strangely quiet. The approach seemed to be a wait and watch. Not exactly what you would want to hear if you were the one caught in the cross hairs of this type of prosecution.

I have two final comments for your review. First, when we have been too busy or unaware of these issues, which can have a profound effect on how we practice, we have created a vacuum that others have rushed to fill. Usually those rushing to fill that vacuum, such as trial lawyers or legislatures, do not have our best interest at heart. Second, having subjective differences of opinion is something that should trouble all of us.

It has often been said that some of the things that I speak about or write about can’t happen. But when I can cite one example that did happen, then that problem can occur again. In an ideal situation I would like to see the dental profession be proactive to change these situations so that they can’t happen again. Short of that, I like to give a heads up to problems so that others can, perhaps, avoid them. It is so much easier to step over the mud, than to try and clean up after stepping into the mud.

Dr. Levy has served as an expert on several cases, and is on the California Board of Dental Examiners panel of expert witnesses to assist in investigations

Guest column: Coping With Conflict

A Layperson’s guide to resolving conflict in the office

By Daniel A. Bobrow, MBA
President, American Dental Company

Part one in a series of two articles

Conflict is inevitable. As long as people possess the capacity for independent thought, there will be differences of opinion. One of the keys to resolving conflict is the ability to listen to and respect the viewpoint of the other person. For, as my law professor put it, “…reasonable people can differ.”

Presented below are models, tenets, and skills used to resolve conflict.

Conflict Resolution Models

Conflict resolution can be classified into four types. They are: The Primitive Model, The Legal Model, Arbitration, and Mediation.

Under the Primitive Model, the major tenet is Might Makes Right e.g. “If my rock is bigger than yours, I’m right.” The advent of civilization is tied very closely to humankind’s ability to resort to other methods for resolution of conflict.

The Legal Model is more “advanced” than the primitive model in that its weapon of choice most often is words, rather than violence or physical restraint. However, the relationship of the parties to the dispute remains adversarial. Americans have raised this form of conflict resolution to new heights, earning us the dubious distinction as the world’s most litigious society.

Arbitration and Mediation are two models of what is called alternative dispute resolution (ADR). Under arbitration, the arbitrator has authority to render a decision based on his or her assessment of the facts as presented by each party to the dispute. If the arbitration is binding, then both parties agree in advance of the proceedings to be bound by the arbitrator’s decision. In non-binding arbitration one or both parties has the option of accepting or rejecting the arbitrator’s decision.

Mediation involves a facilitator whose role is to help the parties communicate and explore, then generate options for resolving the situation that brought them to the mediation.

Tenets of Effective Conflict Resolution

Before a fruitful discussion of how conflict resolution techniques may be applied in a health care office, it is important to recognize those factors that offer the greatest likelihood of a positive outcome. Factors which, for our purposes, are most important are: Environment, Balance of Power, and Impartiality.

Environment

The setting in which a mediation or other attempt at conflict resolution occurs can be critical to the outcome. Is it quiet? Is there privacy? Ideally, the meeting should occur outside the office, so no one is distracted (or perhaps reminded of why they are having the dispute).

Balance of Power

When one party perceives that they are not in control of a situation, it is more difficult to reach an agreement or, if an agreement is reached, it is less likely to last. For this reason, any meeting attempting to resolve a dispute should be structured in such a way that both parties perceive they are, for purposes of the meeting, equal, and that both will be heard and respected.

Impartiality/Neutrality

When you become aware of a conflict between two members of your team, it is vital that you appear neutral with respect to the issues. This is often easier said than done. To help you, remember that, while on the surface an individual’s position may seem unreasonable (or incomprehensible), there are often underlying causes that are responsible for that person’s position. Only in an environment of trust, and through active listening (see below), can you hope to “get at the heart of the matter.”

In the case where you are a party to the conflict, your impartiality is naturally in question. Even if you believe you can remain impartial, it is the perception of others, especially, but not only, the person with whom you have a dispute, which must be considered. If it is not feasible (or you are not comfortable) to have another party preside over a mediation, it is still possible to assume a somewhat more neutral stance. To do so, you should not attempt to have a discussion about a situation when you are emotionally involved. Take a breather. Then, invite your team member to meet with you, preferably outside of the office (see above Environment Section). At this point, you can apply techniques taught by such books as The One Minute Manager, whereby you use the following approach:

    “Mary, today you lost your temper in front of a very important patient/client of ours. And I was embarrassed. I also know you’re much better than that. Yesterday, I saw you attend to the needs of three people at once. That was beautiful. That’s what we’d like to see more. Now let’s have our coffee then get back to work.”

This approach is a cut and dried method for resolving an issue by illustrating the problem and the consequence, then ending on an up-beat note. Where I feel it falls short is in not allowing for the team member to express why she lost her temper. In that respect, the above may only act as a “quick fix” that leaves the root cause to smolder until something triggers a similar (or greater) outburst with more dire consequences.

Therefore, I suggest the following verbiage be used.

    “Mary, I wanted to take time out from our day to let you know I’m concerned. Something seems to be bothering you. If you’re comfortable sharing it with me, I’ll be happy to listen and see what we can do about it.”

Depending on this person’s history with the practice, she will be more or less open to expressing herself. Most people will respond to a request phrased in such an open-ended manner. Once the concern is expressed, options can be explored as to how best to address Mary’s concerns.

These options will be addressed in the next issue of Solutions.

Daniel A. Bobrow, MBA is president of the American Dental Company, a Chicago-Based Consultancy specializing in patient marketing and communications. He is also Executive Director of Climb For A Cause, a non-profit Foundation, whose mission is to provide health care treatment and education to people in need worldwide. He may be reached at 312-455-9488, Dbobrow@AmericanDentalCo.com or Director@ClimbForACause.org.

OHSU discovers potential for treating craniofacial pain

Researchers at Oregon Health & Science University’s (OHSU) School of Dentistry have uncovered an interaction between two proteins in the nerve cells that carry pain information from the head and neck to the brain. The finding could play a significant role in the development of therapies to cure migraines and other craniofacial pain conditions like TMJ (temporomandibular joint) disorder. According to the National Institutes of Health (NIH), approximately 10 percent of Americans suffer from chronic pain conditions and a significant portion of them have chronic craniofacial pain.

The new discovery was published online in the Journal of Neurochemistry, one of the leading peer-reviewed neuroscience journals.

“Our discovery reveals the complexities of pain signaling mechanisms from the head and neck to the brain,” said Agnieszka Balkowiec, M.D., Ph.D., principal investigator, OHSU School of Dentistry assistant professor of integrative biosciences and OHSU School of Medicine adjunct assistant professor of physiology and pharmacology.

Head pain is signaled to the brain by what’s known as the trigeminal nerve. The trigeminal nerve also conveys other types of sensation, such as touch and temperature, from numerous structures of the face, including skin, ears, cornea, temporomandibular joints and teeth. Studies suggest that the trigeminal nerve provides the signaling pathway for pain associated with migraines, TMJ disorder, periodontal pain, dental surgical pain, trigeminal neuralgia, head and neck cancer pain, and other neuropathic and inflammatory pain conditions.

The OHSU study focused on two trigeminal nerve cell proteins: Calcitonin Gene-Related Peptide (CGRP), and Brain-Derived Neurotrophic Factor (BDNF). Previous studies found that during a migraine attack, the stimulation of trigeminal nerve cells releases CGRP at the peripheral end of the cells, widening blood vessels in the brain coverings called meninges. Widening the blood vessels increases the flow of blood through the meninges and initiates an inflammatory process that likely contributes to the pain experience. Recent clinical studies show that blocking CGRP helps alleviate migraine pain.

The discovery by Balkowiec and her team points to BDNF being a likely culprit behind head pain – a previously unknown finding. The OHSU team found that the stimulation of trigeminal nerve cells, as experienced during a migraine attack, leads to release of not only CGRP, but also BDNF. The study also found that BDNF is released by CGRP when trigeminal nerve cells are not stimulated. In fact, said Balkowiec, CGRP’s role at the central end of the trigeminal nerve cells is likely to be the facilitation of BDNF release. BDNF has previously been shown to play an important role in pain signaling from other parts of the body, but this is the first time it has been considered to be a factor in head pain.

“What we now need to better understand is how the interaction between CGRP and BDNF affects pain signaling to the brain in various disorders,” said Balkowiec.

The research at OHSU was funded by grants from the National Institutes of Health, Medical Research Foundation of Oregon, American Association for Dental Research and the OHSU School of Dentistry.

SOURCE: OHSU

AADR Testifies in Support of Dental Amalgam at FDA Hearing

On behalf of the American Association for Dental Research (AADR) and the American Dental Education Association (ADEA), AADR member Steve London, D.D.S., Ph.D., testified in support of the use of dental amalgam as a restorative material at the Food and Drug Administration’s (FDA) Joint Meeting of the Dental Products Panel of the Medical Devices Advisory Committee of the Center for Devices and Radiological Health and the Peripheral and Central Nervous System Drugs Advisory Committee of the Center for Drug Evaluation and Research.

London, associate dean for research and basic sciences at the College of Dental Medicine at the Medical University of South Carolina (Charleston), testified that any decision about the use of amalgam as a restorative material should be based on sound science and empirical evidence-based research.

“Dental amalgam has a well-documented history of safety and efficacy in dentistry,” said London, quoting AADR’s official policy position on dental amalgam, which was instituted in 1996 and last revised in 2004. “Its advantages include ease of handling, durability and relatively low cost. Dental amalgam has numerous indications for use, especially for restorations in stress-bearing areas. Its main disadvantages are poor esthetics and the necessity for sound tooth structures to be removed in order for retention to be obtained. Its use in restorative procedures is still indicated.”

In conclusion, London stated, “Dental amalgam is the most thoroughly researched and tested restorative material among all those in use today. To date, no scientific peer reviewed study has proved a link between amalgam restorations and any medical disorder. As dental researchers and dental educators, we will continue to investigate dental amalgam and other restorative materials.”

The American Association for Dental Research (AADR) is a non-profit organization with more than 4,000 members in the United States. Its mission is: (1) to advance research and increase knowledge for the improvement of oral health; (2) to support and represent the oral health research community; and (3) to facilitate the communication and application of research findings.

SOURCE: American Association for Dental Research and U.S. Newswire

Study Shows Quality of Life For Both Dogs and Their Owners

Can Improve When They Buddy Up To Beat The Battle of the Bulge

A Combined Dog/Owner Partnership Can Help Both Succeed in a Weight Loss Program

A study by Northwestern Memorial Hospital and Hill’s Pet Nutrition, “The People and Pets Exercising Together (P-PET)” demonstrates that people and their pets are both more successful in staying with a weight loss program when they exercise together.

Approximately 65 percent of adult Americans are now overweight or obese, and an estimated 48 million cats and dogs in the U.S. are overweight or obese — that’s 40 percent of the pet population. To combat the obesity epidemic, some public health professionals and veterinarians are endorsing a proactive approach that includes adoption of healthy changes in diet and physical activity. By participating in a weight loss program with your pet, you may be able to improve the quality of life for you and your pet through increased exercise, a strengthened human-animal bond, and a fun and motivating way to trim down together.

Dr. Robert Kushner, Medical Director, Wellness Institute, Northwestern Memorial Hospital and Professor of Medicine, Northwestern University Feinberg School of Medicine explains, “We devised a state-of-the-art weight management program based on previous studies that show that people are more effective at losing weight and maintaining that weight loss when they do it with a friend or companion. The P-PET study proves that a faithful pet provides effective social support for losing weight and maintaining weight for up to one year.”

The 12-month P-PET study consisted of three groups of overweight participants: a dog/owner group (36 people and their dogs), a dog-only group (53 dogs), and a people-only group (56 people). The purpose of the study was to compare the efficacy of weight loss programs for dog-only and people-only groups to that of a combined dog/owner weight loss program for both weight loss and weight maintenance.

During the study, dogs were fed a low-fat, nutritionally balanced food, Hill’s Prescription Diet r/d Canine, which is specially formulated to help dogs lose weight while keeping them feeling satisfied. In addition, pet owners with dogs in the study were provided with a suggested exercise plan (i.e., 30 minutes of moderate-intensity physical activity at least three days per week) and a regular weigh-in schedule. When the ideal body weight was achieved, the dogs were changed to Hill’s Prescription Diet w/d food until the 12-month study was completed. People were provided with meal plans and pedometers and were instructed on personality lifestyle pattern behavioral strategies to control dietary calories and increase physical activities.

Over the course of the 12-month study, both people and dogs lost weight and kept it off: people lost an average of 11 pounds (approximately 5.5 percent of their initial body weight) and dogs lost an average of 12 pounds (approximately 15.9 percent of their initial body weight). The maximum weight loss for dogs was 35 pounds; for people, the maximum loss was 51 pounds. Participants gained the confidence and the motivation to stick to a specific diet and exercise strategies and succeed at weight loss-not just for the moment but for the long term.

Roseann and her dog, Spats, one of the many people and pet pairs who succeeded at losing weight on the P-PET program, learned first-hand how working together could help them both get fit and drop pounds, while spending quality time together. Roseann lost 30 pounds and Spats lost 13 pounds — 15 percent of his initial body weight.

“Caring for and loving my dog is what motivated me to be a part of this program,” says Roseann. “It is a real lifestyle change. We worked together, lost weight and kept it off over the course of a year, and now there’s no turning back.”

The combined dog/owner weight loss program was found to be more effective at maintaining participation than the program in which dogs dieted separately: 80 percent of the dogs in the combined dog/owner group completed the study, versus 68 percent of the dogs-only group. The combined dog/owner group reported a greater improvement in their quality of life (P>0.05) and the quality of life of their pets. Two-thirds of the increase in physical activity in the combined dog/owner group was obtained by engaging in dog-related activities.

Dr. Dennis Jewell, a companion animal nutrition expert at Hill’s Pet Nutrition, said,”People really enjoy spending time with their dogs, and our P-PET study demonstrates that dogs provide the companionship, social support, and motivation to stick with the program until the pounds come off and stay off.”

SOURCE: Hill’s Pet Nutrition, Inc. and PRNewswire