Screening Prospective Patients for Laser Eye Surgery

LASIK Expert Dr. James Salz Provides Strategies in the Review of Ophthalmology For Doctors to Better Screen Prospective Patients for Laser Eye Surgery

Dr. James Salz was a featured contributor among several doctors featured in an article entitled “Screening for LASIK: Tips and Techniques: Surgeons share helpful strategies for identifying which patients are good candidates -— and which could be trouble.” This article, was featured in Review of Ophthalmology (Vol. 6, Issue 28) and was written by Senior Editor Christopher Kent.

Dr. James Salz provided several tips for laser eye surgeons to improve screening and reduce the incidence of complications, including:

1. Use the proper color scale for corneal maps (topography), which are part of the preoperative workup. This reduces artifacts that are not real abnormalities and makes it easier for laser eye surgeons to interpret true abnormalities.

2. If the corneal maps are suspicious for an abnormality, the surgeon can perform other simple tests to determine if the patient is still a proper candidate for laser eye surgery (either LASIK or PRK). These tests include taking additional thickness readings of the cornea at multiple points, dilating the pupils and checking for abnormal reflexes from a light swept across the pupil, and examining the patient’s prescription history for changes changing indicating the eye is not stable.

3. Pupil size does matter. Carefully measure pupil size in a dark room and discuss in detail the possible increased risk of night vision complaints like halos and glare. This risk can be minimized with customized wavefront based LASIK and by using postoperative drops such as Alphagan at night to reduce pupil size and thus reduce the severity of night vision difficulty.

Laser Vision Medical Associates, Inc. is the refractive surgery medical private practice of Dr. James J. Salz, M.D. and services patients in the Beverly Hills, Los Angeles, and Orange County regions of Southern California. Dr. James Salz, M.D. is the President and primary physician who performs laser vision surgery for the company. Dr. Salz has been researching and publishing studies as well as performing refractive surgery, including LASIK, for over 20 years. Dr. Salz is Clinical Professor of Ophthalmology at the University of Southern California and Co-Director of Refractive Surgery Research at the Discovery Fund for Eye Research at Cedars-Sinai Medical Center in Los Angeles. He has been the principal investigator for several major studies, including 8 FDA excimer laser studies, STAAR Surgical Implantable Contact Lens for Hyperopia FDA clinical trial. Dr. James Salz has been a paid consultant to Visx, and Alcon. Dr. James Salz is an expert of special interest in all aspects of refractive surgery, including LASIK, PRK, and Phakic implants. Dr. James Salz is also an expert in cataract surgery and lens implantation as well as medical legal matters and device and method patents related to ophthalmology.

Laser Eye Associates of Los Angeles, Inc. is an association consisting of about 30 LASIK and laser eye surgeons in the Beverly Hills/Los Angeles area. Laser Eye Associates is one of the few laser vision centers in the world with 3 different FDA approved excimer laser systems (Alcon, Visx and Alegretto): a femtosecond laser (Intralase) for creating the LASIK flap without a blade; (2) a Holmium laser system for treating low degrees of hyperopia; and (3) the only FDA approved procedure for treating presbyopia (the condition which requires reading glasses after age 40) the Refractec Conductive Keratoplasty (CK) instrument. Dr. James J. Salz is currently President of Laser Eye Associates and a shareholder of the company.


Optometry Backs New Bill Before Congress

Optometry Backs New Bill Before Congress to Make Children’s Vision a Top Federal Priority

Senator Christopher Bond Uses Personal Experience and Guidance From AOA to Develop Legislation to Boost State Learning Initiatives

Congress will have the opportunity to consider legislation supported by the nation’s frontline providers of
eye and vision care aimed at making it a national priority to combat undiagnosed and untreated vision problems in school-aged children. “The Vision Care for Kids Act of 2006,” S. 3685, supported by the American Optometric Association (AOA), was introduced by U.S. Sen. Christopher “Kit” Bond (R-Mo.), a leader in Congress on education and health issues who still suffers from permanent vision loss due to his own undiagnosed amblyopia, or lazy eye, as a child.

“Good vision is critical to learning. In fact, 80 percent of what children learn in their early school years is visual. This important legislation will improve vision care for children to better equip them to succeed in school and in life,” Sen. Bond said. “With the support of the American Academy of Ophthalmology, the American Optometric Association and the Vision Council of America, together we will make a difference in the lives of children across the country.”

“Senator Bond’s ‘Vision Care for Kids Act’ is an important assignment for Congress and a timely reminder for America of what needs to be done to help concerned parents and teachers ensure that no child is left behind in the classroom due to an undiagnosed or untreated vision problem,” said C. Thomas Crooks, III, O.D. and president of the AOA. “Optometry is proud to support a true leader like Senator Bond in the effort to provide states with the resources — the federal dollars — they need to make children’s vision and classroom learning a top priority.”

Senator Bond, who was presented with the AOA’s 2006 Health Care Leadership award on May 3, 2006, in Washington, D.C., has been a long-time advocate for eye and vision care for children.

“As Senator, and previously as our Governor, Kit Bond has always put the health and education needs of our children first,” said Thomas Hobbs, O.D. and president of the Missouri Optometric Association. “Today, with the introduction of S. 3685, and his frank discussion about the lifelong challenges he has faced from undiagnosed amblyopia, optometrists across Missouri, and our patients, are particularly proud of him.”

Ten million children suffer from vision disorders, according to the National Parent Teacher Association. Vision disorders are considered the fourth most common disability in the United States, and they are one of the most prevalent handicapping conditions in childhood.

“About 80 percent of all learning during a child’s first 12 years comes through vision. Vision problems that are not diagnosed and treated hinder learning, and — as happened to Senator Bond himself — cause permanent vision loss,” Dr. Crooks said, “That’s why the AOA and Doctors of Optometry across the country are working so hard to respond to this national concern through support for comprehensive eye exam programs in the states, legislation to help identify vision problems, the InfantSEE(TM) initiative and, from today forward, Senator Bond’s ‘Vision Care for Kids Act.’”

S. 3685 would establish a federal grant program focusing on treatment to bolster children’s vision initiatives in the states and encourage children’s vision partnerships with non-profit entities, including groups as committed to the cause of safeguarding the sight of America’s children as state optometric associations.

“Optometrists are on the frontline of eye care in communities across our country, and all too often we see the devastating toll on children and their families of vision disorders that were not diagnosed or treated
early,” said Kentucky’s Joe Ellis, O.D. and member of the AOA Board of Trustees. “S. 3685 recognizes that more must be done, and I’m proud that the AOA is already working with Senator Bond to see it become law.”

According to data from the Making the Grade: An analysis of state and federal children’s vision care policy research study, 32 states require vision screenings for students, but 29 of them do not require children who
fail the screening to have a comprehensive eye examination. Because up to two-thirds of children who fail vision screenings do not comply with recommended eye exams, many children enter school with uncorrected vision problems.

Eye and vision specialists, such as optometrists, are best able to diagnose and treat amblyopia and other vision problems. Amblyopia is treatable and preventable if caught within the early years of a child’s
life, but it remains the leading cause of vision loss in Americans under age 45. Universal eye exams for children entering school are critical for the early intervention needed to treat diseases and disorders such as
amblyopia, strabismus, retinoblastoma, and other serious and potentially blinding problems that can lead to poor school performance and other issues that can ultimately affect quality of life.

SOURCE American Optometric Association and PR Newswire

Survey: America’s Eye Care Knowledge

Survey Says Adults Not Making the Grade When it Comes to Eye Care Knowledge

Nearly One-Third of America’s Children Have Never Been to the Eye Doctor

As millions of students nationwide head back to school, the American Optometric Association’s first American Eye-Q survey finds parents lack important knowledge about eye health and vision care.

While millions of children will start school this year with a vision problem that may inhibit their ability to learn, 44 percent of parents are not aware that behavioral problems can be an indication that a child’s vision is impaired. The survey also revealed that only one in 10 parents adhere to the American Optometric Association’s recommendations that an infant be examined before his or her first birthday. Nearly one-third (29 percent) of all children have never been to an eye doctor.

“Vision is a key factor in the growth, development and daily performance of children,” said Andrea Thau, O.D., of the American Optometric Association. “One of the most important things parents can do to help ensure their child’s ability to learn is to take them for a comprehensive eye exam.”

Since vision changes can occur without a parent or child noticing them, children should visit a doctor of optometry at least every two years, or more frequently, if specific problems or risk factors exist. Regular eye exams, starting when a child is six months old, can help ensure parents that their child’s vision is developing normally.

The survey, which evaluated adults’ level of knowledge and their behaviors associated with eye care, revealed that parents should practice better eye care behaviors when it comes to their children. It also showed they should take better care of their own eye health.

Americans admit that their eyesight is one of their most valued attributes, yet 62 percent of Americans who do not currently wear glasses or contacts have not been to an eye doctor in the past two years. Nearly 20 percent of adults have never been to an eye doctor.

“Just like a child, an adult’s eyesight can change rapidly and frequently, particularly in older adults,” said Dr. Thau. “When you consider how many systemic diseases and disorders can be detected, it is imperative that adults visit their optometrist as often as their children.”

More than 60 percent of adults knew that diabetes and hypertension are detectable through comprehensive eye exams; however, only 23 percent were aware that symptoms of multiple sclerosis also may be detected through a comprehensive eye exam.

The survey also revealed that considerable misconceptions exist around behaviors that may be harmful to one’s eyes. More than eight out of 10 adults believe that sitting too close to the television and reading under dim lights will affect their vision. While they both may cause headaches, they won’t weaken a person’s eyesight. Smoking, drinking alcohol and caffeine, however, can be harmful on the eyes.

“Several common behaviors, including the foods we eat, affect vision,” said Dr. Thau. “Nutrition is important to maintain good eye health, and surprisingly, Americans can do better.”

As parents pack their children’s lunch for school, 70 percent of Americans mistakenly believe that carrots are the best food for their eye health, when in fact it has been proven that while carrots are good for the eyes, spinach and broccoli are better foods for eye health. Eating the equivalent of a half-cup of cooked spinach four to seven times per week can help protect against age-related macular degeneration, the leading cause of
blindness in the United States. It would take four pounds of carrots or 17 cups of iceberg lettuce to meet the same goal.

The American Eye-Q survey was created by the American Optometric Association in conjunction with Opinion Research Corporation. Using a random digit dialing methodology, ORC interviewed 1,000 Americans 18 years and older who embodied a nationally representative sample of U.S. households. The margin of error is +/- 3.1 percent for the general population. All data is weighted to represent the U.S. general populations with respect to age, gender and geographic region.

The American Optometric Association represents more than 34,000 doctors of optometry, optometry students and paraoptometric assistants and technicians. Optometrists provide more than two-thirds of all primary eye care in the United States and serve patients in nearly 6,500 communities across the country. In 3,500 of those communities they are the only eye doctors.

SOURCE: American Optometric Association and PR Newswire

Veterinarian Shortage Poses Threat to Industry, Society

Projected Serious Food Supply Veterinarian Shortage Poses Threat to Industry, Society

– America’s livestock and meat industries have one of the world’s best health and safety records, but that status may be threatened in the years ahead because of a projected severe shortage of food animal veterinarians, according to what may be the most comprehensive veterinary business study ever conducted on the current and future state of the large animal veterinary profession.

While projected demand for food supply veterinarians will increase a modest 12 percent to 13 percent between now and 2016, the research forecasts a shortfall of 4 percent to 5 percent per year. This means for every 100 food supply veterinary jobs available, there will be only 96 veterinarians available to fill them due to decreasing numbers of veterinary students choosing to practice in the fields in food supply specialties and socio-economic trends, including further declines in rural populations.

“With the American public more focused than ever on food safety and security, the role of the food animal veterinarian has never been more important,” said Dr. Lyle Vogel, director of the Animal Welfare Division of the American Veterinary Medicine Association (AVMA). “Needless to say, we can’t afford to have a shortage of large animal veterinarians. It would be catastrophic for the industry and for society.”

The research was published in three articles in the June 1, June 15, and July 1, 2006, issues of the Journal of the American Veterinary Medical Association (JAVMA). The studies, commissioned in 2004 by a coalition of veterinarian organizations and conducted by Kansas State University’s College of Business Administration focused on several aspects of the veterinarian profession: comparison of future demand and supply, veterinary student attraction to food supply careers, and career satisfaction and retention.

The findings were based on a review of current studies and literature, conduct of four focus groups, conduct of 13 expert judgment-based forecasting (Delphi) panels representing different sectors of the food supply profession, and surveys conducted with veterinary students, recent graduates, and veterinarians in practice.

“It is wonderful to see the veterinary profession and industry looking toward the future together for the safety and well being of the entire country,” said AVMA President Henry E. Childers, DVM. “By detailing the seriousness of the shortage of food animal veterinarians, the Food Supply Veterinary Medicine Coalition has taken a huge first step in addressing and eventually solving this problem.”

Survey respondents cited several keys to keeping current food animal veterinarians in the industry, while attracting or converting more students to this specialty. Strategies that received strong support from educators included:

  • Recruiting/admissions strategies, including putting more emphasis on food animal careers at high schools and offering special incentives to those who choose the food animal career track, such as reserved class spots, early admissions, scholarships, and mentoring/ shadowing programs with industry partners.
  • Curriculum/financing strategies, including assigned faculty mentors, paid externships, heavier clinical caseloads, more hands-on experience early on, and legislation that forgives student loans for those who take a job in state.
  • Industry image strategies, including creating regional centers of food animal medicine, improving business literacy within the profession, and shared curricula or rotational programs with partner colleges.
  • Veterinary students who switched to a career focus in food supply overwhelmingly said it was because they were exposed to information about the specialty in veterinary school. More than 70 percent of educators said the main reason veterinary students choose a food animal sequence today is because they are attracted to the rural lifestyle and the prospect of working with animals, while only 6 percent choose it because they can make a positive impact on agriculture or food production.

A high percentage of both recent graduates (78 percent of young beef veterinarians and 80 percent of young dairy veterinarians) and senior alumni (92 percent for both beef and dairy veterinarians) are satisfied with their jobs and 90 percent of both groups are proud of their profession.

The AVMA, founded in 1863, is one of the oldest and largest veterinary medical organizations in the world. More than 73,000 member veterinarians are engaged in a wide variety of professional activities. AVMA members are dedicated to advancing the science and art of veterinary medicine including its relationship to public health and agriculture.

SOURCE: American Veterinary Medical Association

Contagious Cancer In Dogs Confirmed

Origins Traced To Wolves Centuries Ago

A new study in the journal Cell provides evidence that a form of cancer afflicting dogs has spread from one individual to another by the transmission of the tumor cells themselves. The disease demonstrates how a cancer cell can become a successful parasite with a worldwide distribution, according to the researchers.

The findings may have broad implications for conservation biology and for scientists’ understanding of cancer progression, the researchers said.

Robin Weiss of University College London and his colleagues traced the origin of so-called canine transmissible venereal tumor (CTVT) to a single clone. They estimated that the parasitic cancer arose at least 200 years ago in either a wolf or a closely related ancient dog breed. That makes the tumors the oldest cancer known to science, and possibly the longest continually propagated mammalian cell lineage in the world.

“Our results, based on several independent genetic markers in tumor-bearing dogs living on five continents, show that CTVT arose from a common ancestral cancer cell,” Weiss said. “The cancer escaped its original body and became a parasite transmitted from dog to bitch and bitch to dog until it had colonized all over the world.” Early in its evolution, the clone diverged into two separate lineages, each of which now has a broad geographic range, he added.

CTVT, also known as Sticker’s sarcoma, is apparently transmitted among dogs through sexual contact but may also spread through licking, biting, and sniffing tumor-affected areas, the researchers said. Earlier studies found that the cancer could be transmitted only by experimental transplantation of living tumor cells, not by killed cells or cell filtrates. Scientists had also noticed similar chromosomal abnormalities in tumor samples collected in different geographic regions. However, several reports of virus-like particles in CTVT had led some to suspect that a cancer-causing virus might play a role.

“The idea that this cancer in dogs might be caused by the transmission of tumor cells themselves has been around for some time–30 years or more,” said Weiss. “But the actual truth wasn’t there.”

The idea that cancer may be spread by cell transfer has attracted renewed interest due to the recent emergence of a facial tumor apparently transmitted by the bite of the Tasmanian devil, an endangered marsupial species, he added.

In the current study, the researchers applied forensic science to the study of CTVT, systematically examining tumor and blood samples from 16 unrelated dogs in Italy, India, and Kenya. They also examined tumor samples taken from animals in Brazil, the U.S., Turkey, Spain, and Italy.

They quickly found that DNA isolated from the tumor and blood samples were not a match.

“We saw that the tumor cells didn’t belong to the dogs,” Claudio Murgia, the veterinarian who is first author on the study said. Rather the tumors collected from dogs around the world were closely related to one another, stemming from a single cancer clone.

The researchers traced the origin of the CTVT cancer by comparing the sequences of tumor genes to the related genes of gray wolves and dogs. They found that CTVT clustered most closely with gray wolves, suggesting that the disease originated in wolves or a closely related East Asian breed of dog. Based on genetic variation among the very similar CTVT samples, the researchers estimated that the disease has been transmitted among dogs for two centuries or more.

The team further found evidence that CTVT has adapted to evade dogs’ immune responses. Otherwise, the unrelated tumor tissue “ought to be rejected,” Murgia said.

Interestingly, he added, most dogs infected with CTVT develop a tumor that then regresses several months later and disappears.

“It looks like there is an aggressive phase of growth as the foreign tumor initially isn’t recognized by the immune system,” Murgia said. “In the long run, the immune system gets the better of it.”

“As a sexually transmitted cell, CTVT would not have been able to colonize dogs worldwide if it killed them too quickly; the host must survive in a fit state long enough to transmit the tumor, which in the case of females probably entails an estrous cycle.”

The findings in CTVT might lead to new insights for cancer more generally, they said.

“It’s a curiosity of nature, but apart from that, it might also raise important new ideas about the instability of cancer,” Weiss said.

It has become dogma that as cancer develops, it tends toward greater genomic instability and becomes “more and more aggressive,” he added. After the gross chromosomal rearrangements soon after its emergence, however, CTVT–the longest lived of all known tumor clones–bears “no evidence of genome loss or progressive instability.”

The findings challenge the idea that there is “an inevitable progression of cancer towards more instability,” Weiss said.

The study also raises important issues for conservation biology, said Elaine Ostrander in an accompanying preview of the article.

“At present, CTVT can enter the wild canid population through physical contact between individuals (licking and biting) or mating between closely related species,” she said. “For highly endangered canids, exposure to CTVT could theoretically create an immediate threat to the population’s survival.”

It’s also possible that the small population sizes of endangered species like the Tasmanian devil might leave them generally more prone to developing other forms of transmissible cancer.

“It has not yet been checked thoroughly, but the Tasmanian devil tumor looks as if it might be the same phenomenon,” Weiss said.

“The low numbers of these animals has led to inbreeding. Therefore, the tumor probably isn’t recognized as foreign,” he speculated.

Although difficult to study, Weiss said that the possibility of sexually transmitted tumors–for example, prostate or cervical cancer–may have merit in humans, particularly among people with compromised immune systems such as organ transplant recipients and those with AIDS. In humans, occult tumors in donor organs have been known to emerge on rare occasions in immunosuppressed transplant recipients, Weiss noted.

SOURCE: Cell Press

Zoonotic disease control strategies

Zoonotic disease control strategies discussed at 2006 ACVIM forum

As global security issues surrounding mad cow disease, avian influenza and the West Nile virus increase, veterinarians across the globe gathered in Louisville, Ky., at the 2006 ACVIM Forum, to discuss preventative and control strategies to make animals and humans safer.

“In the past decade, there has been an increase in emergent zoonotic disease episodes,” said Dr. Frederick A. Murphy, a veterinarian from the University of Texas Medical Branch at Galveston and the keynote speaker at the 2006 ACVIM Forum. A zoonotic
disease is a disease transmitted from animals to humans.

“In fact nearly all episodes of new, emerging or re-emerging diseases have involved zoonotic or species-jumping infectious agents,” said Dr. Murphy. Dr. Murphy’s keynote address, Emerging Zoonoses, is just one of the over 350 scientific sessions, workshops, special interest groups and case discussions on animal healthcare presented attendees from over 40 countries at the 2006 ACVIM Forum.

Other sessions on zoonotic diseases include practical biosecurity considerations for beef operations, the bacterial infection Bartonellosis, commonly known as cat-scratch disease, and a session on how another common bacterium, Salmonella, can be used as a nonsurgical cancer therapy in animals. The sessions will discuss how to improve early detection systems for zoonotic diseases so a stand-by plan for readiness is available.

“To meet our national need requires that we rebuild a cadre of career-committed professionals, including most prominently a new cadre of veterinarians,” said Dr. Murphy.

The 2006 ACVIM Forum was four days of continuing education for general and specialty veterinary practitioners, veterinary technicians, and veterinary students focusing on new, unpublished data, including a wide range of topics from internal medicine, oncology, neurology, and cardiology from the largest names in veterinary medicine.

The American College of Veterinary Internal Medicine (ACVIM) is the national certifying organization for veterinary specialists in large and small animal internal medicine, cardiology, neurology, and oncology. The ACVIM hosts an annual continuing education meeting (ACVIM Forum) each year where cutting-edge information, technology, and research are showcased for the veterinary community.

SOURCE: American College of Veterinary Internal Medicine

Surgeon Helps Volunteer Group Reach 20-year Milestone

Oral and Maxillofacial Surgeon Helps Volunteer Group Reach 20-year Milestone

When oral and maxillofacial surgeon Louis K. Rafetto, DMD, traveled to Peru to donate his services last February, he became the 5,000th volunteer placement for Health Volunteers Overseas (HVO) – helping the group mark its 20th anniversary.

Since its inception on August 1, 1986, HVO has worked to educate and train healthcare professionals and students across the globe. HVO has sent more than 3,600 highly trained and dedicated healthcare professionals on over 5,000 assignments to 43 countries. The group has also donated more than $18.4 million in textbooks, journals, teaching slides, computers and other related educational and medical equipment to its program sites. HVO volunteers have introduced new techniques in pain management, infection control, trauma care and rehabilitation, resulting in better patient outcomes and a significant reduction in deaths.

Dr. Rafetto is currently the chairman of both the American Association of Oral and Maxillofacial Surgeons (AAOMS) Committee on Continuing Education and Professional Development and the Delaware Institute of Dental Education and Research. He is also a member of the American Dental Association and the Delaware State Dental Society. Dr. Rafetto has been a member of HVO since 1986 and volunteered three times prior to his most recent placement. He traveled to India in 1992, Colombia in 1996 and Cambodia in 2004. The AAOMS has been a sponsor of HVO since its establishment in 1986.

Reflecting upon his assignments with HVO, Dr. Rafetto noted, “Health Volunteers Overseas has provided me the opportunity to share my training and experience with healthcare providers in countries where challenges of limited resources and trained personnel are common. As a result of the people I have met and the experiences I have had, I will never see the world in the same way.”

“I am so pleased that Dr. Rafetto is our 5,000th volunteer placement!” said Dr. David Frost, chairman of HVO’s board of directors. “He is an outstanding example of a clinician teaching in developing countries. Dr. Rafetto is able to unite his personal technical skills with a deep desire to share his knowledge in classroom settings, clinical offices, and operating rooms to the benefit of students, doctors, and patients at the HVO sites where he has volunteered.”

According to the World Health Organization (WHO), there is a global shortage of health workers. WHO estimates that at least 4 million health workers are needed to fill this growing gap. Without these important health workers, prevention and treatment of disease and advances in health care cannot reach those in need. Since its inception, HVO has worked to end this shortage of health workers in developing nations around the world. WHO cites Sub-Saharan Africa in particular is facing the greatest health challenge. HVO has programs in five sub-Saharan countries: Eritrea, Malawi, South Africa, Tanzania, and Uganda. While it has 11 percent of the world’s population and 24 percent of the global burden of disease, it has only 3 percent of the world’s health workers.

A private, nonprofit membership organization, HVO was founded to improve global health through education. HVO designs and implements clinical education programs in child health, primary care, trauma and rehabilitation, essential surgical care, oral health, infectious disease, nursing education, and burn management. In more than 25 resource-poor nations, HVO trains, mentors and provides critical professional support to health care providers.

The American Association of Oral and Maxillofacial Surgeons (AAOMS), the professional organization representing more than 8,000 oral and maxillofacial surgeons in the United States, supports its members’ ability to practice their specialty through education, research and advocacy. AAOMS members comply with rigorous continuing education requirements and submit to periodic office examinations, ensuring the public that all office procedures and personnel meet stringent national standards.

SOURCE: American Association of Oral and Maxillofacial Surgeons

Steroid Abuse Harms Gingival Tissues

Researchers found that using anabolic androgenic steroid is associated with gingival enlargement and may increase gingival index scores

Researchers found that prolonged use of anabolic androgenic steroids (AAS) is closely associated with significant levels of gingival enlargement, according to a study published in the Journal of Periodontology.

Gingival overgrowth is a condition in which the gingival tissues become swollen and grow over the teeth. Overgrown gums make it easier for bacteria found in plaque to accumulate and attack supporting structures of the teeth, potentially leading to severe periodontal infection.

“It was found that AAS abusers had statistically significant levels of gingival enlargement compared to non-users, requiring a gingivectomy (removal of excess or diseased gum tissue) for many cases,” explains Onur Ozcelik, DDS, PhD, Faculty of Dentistry, Department of Periodontology, Cukurova University, Adana, Turkey. “Although it has been reported that many of the adverse effects of AAS abuse are fully reversible within several months after the cessation of the drug, it is not known if gingival enlargement would also regress after the withdrawal of AAS.”

Researchers also found that gingival inflammation was higher in the AAS user group compared to the non-AAS users. “Further studies are required to find out if increased gingival scores in the user group are a direct effect of AAS or if the inflammation is a result of compromised oral hygiene due to gingival enlargement,” said Ozcelik.

“It is not surprising that gingival tissue is a target for the actions of steroid hormones,” said Kenneth A. Krebs, DMD and AAP president. “Clinical changes in tissues of the periodontium have been identified during periods of hormonal fluctuations such as puberty, the menstrual cycle, pregnancy, menopause, contraceptives and ovulation induction drugs in women.”
People taking AAS without medical supervision, should be informed of the adverse effects and strongly encouraged to begin a cessation program. Since periodontal infection may be a risk factor for more serious conditions, such as cardiovascular disease, respiratory disease and pre-term, low birth weight babies it is important for patients to take care of their periodontal health.

Background Information
Researchers examined 24 athletes between the ages of 17 and 29 who had been using AAS for more than one year. All subjects were examined for plaque levels, gingival inflammation and gingival enlargement. The results were then compared with a control group of 20 bodybuilders who had never used AAS drugs and matched for age, educational level and oral habits according to the data obtained from the AAS user group.

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

Fluoridated beverage consumption and dental fluorosis:

There’s a connection

Fluoride is a mineral that protects against dental cavities; however, too much fluoride during tooth formation can lead to dental fluorosis, which is usually characterized by white streaks or splotches on the teeth. Fluoride is naturally present in well water in various concentrations, is added to many public water systems to protect against cavities, and is found in beverages made with these water sources. Fluoride is readily available from toothpastes, mouthrinses, food, and beverages, and its increased availability may be increasing children’s likelihood of developing fluorosis.

The amount of fluoride consumed from beverages is due to the amount of beverage consumed and the concentration of fluoride in the beverage. A team of researchers from the University of Iowa, during the 35th Annual Meeting of the American Association of Dental Research (AADR), presented the results of a study in which they examined the relationship between beverage fluoride intakes and fluorosis of the permanent incisors (i.e., front teeth).

As part of the Iowa Fluoride Study, they have been following children, currently 10-13 years old, from birth. Their parents have recorded food and beverage intakes multiple times throughout the years. The researchers have analyzed well waters and purchased beverages for fluoride concentrations. When they were between 7.7 and 12 years of age, the children had dental examinations, at which the investigators looked for teeth showing evidence of fluorosis. Beverage intakes and the amounts of fluoride consumed were compared between children with and those without fluorosis in their permanent incisors.

About 35% of the children had some evidence of dental fluorosis, most of which was mild. Dietary records collected at 16 months of age showed that children with fluorosis had consumed slightly more 100% juice that had children without fluorosis. More importantly, children with fluorosis consumed more fluoride from their beverages than did children without fluorosis. At 6, 9, 12, 16, 24, and 36 months, children with fluorosis had higher fluoride intakes from all beverages than did children without fluorosis.

At multiple ages, children with fluorosis had higher fluoride intakes from infant formulas and 100% juice than did children without fluorosis. The results suggest that fluoride intake from beverages during infancy and early childhood can increase the risk of the child’s developing fluorosis in permanent incisors. High fluoride intake from beverages could be due to either drinking too much of a beverage prepared with accepted fluoride concentrations, or normal intake of beverages prepared with water having naturally high fluoride concentrations. The association between fluoride ingested from beverages and dental fluorosis should be carefully balanced with fluoride’s benefits in preventing caries.

Another research team from the University of Iowa, recognizing that sugared beverages are playing a larger role in the diet of the American population, assessed erosion of enamel and root surfaces following exposure to select sugared beverages, including Coke®, Diet Coke®, Gatorade®, Red Bull®, and apple juice. Extracted teeth were painted with fingernail polish, leaving a small window of either enamel or root surface exposed to the environment. These teeth were soaked in one of the beverages for 25 hours, sectioned into thin slices and viewed through a microscope. The amount of erosion was measured and compared among beverages for both enamel and root surfaces.

Gatorade® caused the most enamel erosion, followed by Red Bull® and Coke®, with Diet Coke® and apple juice exhibiting the least erosion. Gatorade® was also shown to have caused the most erosion on the root surface, followed by Red Bull®, Coke®, apple juice and Diet Coke®. Erosion depths were greater in root surfaces compared with enamel following exposure to Red Bull®, Coke® and apple juice. Erosion depths were greater in enamel than root surfaces with Gatorade®. Enamel and root surface erosion depths did not differ in Diet Coke®. It was concluded that exposure of teeth to sugared beverages caused significant erosion of both the enamel and root surfaces, but it was not consistent between beverages, with some specific beverages causing more erosion than others.

SOURCE: American Association for Dental Research

Profile: Dr. Nancy Summer Lerch, DDS

Dentistry and Women’s Advocacy

Practice: Center for Esthetic Dentistry

Location: New Haven, Connecticut

Dr. Nancy Summer Lerch is an evangelist for women in dentistry. “Being a woman in dentistry is a very great asset. Like any asset it’s something to be shared. It’s a very, very good thing,” she said.

Dr. Lerch explained, “Dentistry is a great career for women because we can arrange our career and work time any we want. It is set up to be very beneficial for women in juggling family in terms of managing time and resources. There are a lot more serious, seasoned male dentists looking for female associates to augment their practices. New female dentists can write their tickets any way they want. The opportunities are abundant.”

Dr. Lerch is very familiar with how those opportunities can be utilized. “I rented space from a dentist friend in his off hours and saw my own patients on a $10,000 loan from a bank in 1982,” she said.

From that modest loan, she built a thriving practice and today she has one of the most acclaimed dental practices in New Haven, Connecticut.

Her practice has received the “Best of New Haven County” award by the regional Advocate newspaper for eight years running.

She has had articles featuring her practice and cosmetic dentistry in the New Haven Register and has been consulted by national magazines like Vogue and Redbook, for articles they were writing about cosmetic dentistry.

Even given her excellence and her accolades, Dr. Lerch knew something needed to change in her practice to boost it to the next level. She wanted her practice to become more organized and productive than it was. She wanted to grow but didn’t know what was stopping her.

“My production had flatlined. I wanted to know how to handle that…what to do to expand my practice to the next level,” she said. With that in mind, Dr. Lerch hired a practice management consulting firm to help her achieve these new goals.

“The biggest difference consulting has made is the change in my staff. They got properly trained and grew in competency. I also moved my hygienist into the practice manager position so now I don’t have to sweat the small stuff. The management consultant saw that she knew how to run the office and train the staff. Now I have someone to handle the day to day management of the practice and staff for me,” she declared confidently.

Dr. Lerch has now been in practice for 22 years after graduating from the University of Washington School of Dentistry in 1982 and spending two years at the University of Connecticut School of Dentistry in Family Dentistry Residency. Her undergraduate degree was obtained from Whitman College in Walla Walla, Washington.

She is also very active in and dedicated to ensuring the future of ethical dentistry in Connecticut. She is the immediate Past President of the New England Academy of Cosmetic Dentistry and attained her Accreditation in Cosmetic Dentistry in 1990, given by the American Academy of Cosmetic Dentistry (AACD). She is the fourth woman to ever do so. She now serves as an official Examiner and mentor for the Accreditation process. She also served as editor of the AACD Journal from 1992 through 1994.

She loves reading and swimming and being with people. She is also a wine and food enthusiast. She has a son and daughter, ages 10 and 18 respectively. She, along with her husband and children, ski as a family and her son recently came in 8th in the state of Connecticut for children 10 and under at a major skiing tournament. Her family has a camp in the Adirondacks that they’ve owned for nearly 100 years. Her time with her family, enjoying the fruits of her labor, has undergone a nice change since implementing the systems provided by her consultant. Increased quality of life went hand in hand with increased production.

She advises women dentists to “Get into the community and mingle. It is totally possible for any woman to do this. Being gentle and nurturing can help a woman start any practice she wants. It’s still a bit of a novelty. People are surprised at the difference between a male and a female dentist.”

You can learn more about Dr. Lerch and her practice at