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Periotherapist digest dated 28th Jan 2006

Periotherapist Group Digest - 28th Jan 2006

1. Some good pharm info to keep on hand from: "Lynne H. Slim"

please share this information with your staff

Hydrocodone/APAP (generic for Vicodin, Lorcet, Lortab, Co-gesic, Anexia, Norco, Maxidone, Norco and Zydone)

Hydrocodone bitartrate and acetaminophen is used as a pain reliever and comes in various combinations of both drugs of 2.5, 5, 7.5, 10 mg of hydrocodone and 325, 500, 650 or 750mg of acetaminophen; FYI Vicodin is 5/500 and Vicodin ES is 7.5/750

Atorvastatin (Lipitor): lipid lowering agent, helps lower cholesterol
Lisinopril (Prinivil, Zestril): BP medication; long acting ACE inhibitor
Atenolol (Tenormin): BP medication; beta blocker
Levothyroxin (generic for Synthroid, Levoxyl, Levothroid, Novothyrox, Unithroid): hypothyroidism
Amoxicillin (generic for Amoxil, Trimox, Moxillin, DisperMox): antibiotic
Hydrochlorothiazide or HCTZ (generic for Microzide, Oretic, Aquazide): BP medication; diuretic
Azithromycin (Zithromax): antibiotic
Furosemide (Lasix): BP medication; diuretic
Amlodipine (Norvasc): BP medication; calcium channel blocker
Metaprolol (generic for Lopressor, Toprol-XL): BP medication; beta blocker
Alprazolam (Xanax): anti-anxiety
Albuterol (generic for Proventil, Ventolin, Volmax, VoSpire): bronchodilator
Sertraline (Zoloft): depression, OCD
Simvastatin (Zocor): lipid lowering agent
Metformin (generic for Glucophage, Fortamet, Riomet): type 2 diabetes
Ibuprofen (generic for Advil, Motrin, among others): pain reliever
Triamterene with HCTZ (generic for Dyazide, Maxzide): BP medication; combination diuretic
Zolpidem (Ambien): sleeping agent
Cephalexin (Keflex, Biocef, Panizine, DisperDose): antibiotic
Esomeprazole (Nexium): GERD
Lansoprazole (Prevacid): GERD
Escitalopram (Lexapro): anti-depressant
Prednisone: corticosteroid
Cetirizine (Zyrtec): antihistamine

2 ADHA Releases Recommendations on Dental Hygieneıs Future

Three years ago, a selected group of dental hygienists met to establish what
the future would hold for their profession if it were determined by those in
the field. The result is Dental Hygiene: Focus on Advancing the Profession.

The report, which was released officially at annual session, takes a
progressive stance with controversial statements and recommendations, such
*    baccalaureate degree recommended as the entry point for dental hygiene
*    traditional method of providing dental hygiene services through a
private dental practice is inadequate to meet the oral health needs of the
country and must be expanded,
*    given the conflict of interest that occurs when employer dentists
regulate their own employees, dental boards make frequent decisions that
limit the publicıs access to dental hygiene services,
*    dental hygiene professionals should have the authority to regulate
*    promoting expanded practice settings and removing restrictive
supervision barriers is essential to the current and future health of the
*    warning that without the development of an advanced dental hygiene
practitioner, other allied health professionals (i.e. physicians, nurses)
will assume the responsibility of meeting the diverse oral health care needs
of the public, especially the underserved.

Message: 3 Burning mouth Syndrome Date: Thu, 26 Jan 2006 01:57:03 -0000 Subject: CHX and side effects ??????????? In the last year, i see much more side effects in mouth after use CHX % 0.2 %(allergic contact stomatitis and contact stomatitis). What are your observations? Are CHX not so harmless as meant? Sincerely..... Dr.HASAN H. DDS, PhD Periodontology
Date: Sat, 28 Jan 2006 00:11:49 -0500 From: "Lynne H. Slim" Subject: Burning Mouth Syndrome For Cher Frazier from Lynne Slim P.S. I have also had patients w/ burning tongue on anterior portion that I think turned out to be geographic tongue. . . . symptoms would come and go and so would areas on the tongue. From the Mayo Clinic: The possible causes of burning mouth syndrome are many and complex. Each of the following possible causes applies to only a small portion of all people who complain of a burning mouth. More than one-third of people have multiple causes. Identifying all of the causes is important so that your doctor can develop a treatment plan tailored for you. Possible causes include: Dry mouth (xerostomia). This condition can be related to use of certain medications, including tricyclic antidepressants, central nervous system depressants, lithium, diuretics and medications used to treat high blood pressure. It can also occur with aging or Sjogren's syndrome, an autoimmune disease that causes dry mouth and eyes. Other oral conditions. Oral yeast infection (thrush) is a common cause of a burning mouth that may also occur with other causes, such as diabetes, denture use and certain medications. Geographic tongue, a condition that causes a dry mouth and a sore, patchy tongue, also may be associated with burning mouth syndrome. Psychological factors. Emotional disorders, particularly depression but also anxiety and fear of cancer, are often associated with burning mouth syndrome. Although such problems can cause a burning mouth, they may also result from it. Nutritional deficiencies. Being deficient in nutrients, such as iron, zinc, folate (vitamin B-9), thiamin (vitamin B-1), riboflavin (vitamin B-2), pyridoxine (vitamin B-6) and cobalamin (vitamin B-12), may affect your oral tissues and cause a burning mouth. These deficiencies can also lead to vitamin deficiency anemia. Irritating dentures. Dentures may place stress on some of the muscles and tissues of your mouth. The materials used in dentures also may irritate the tissues in your mouth. Nerve disturbance or damage (neuropathy). Damage to nerves that control taste and pain in the tongue may also result in a burning mouth. Allergies. The mouth burning may be due to allergies or reactions to foods, food flavorings, other food additives, fragrances, dyes or other substances. Reflux of stomach acid (gastroesophageal reflux disease). The sour- or bitter-tasting fluid that enters your mouth from your upper gastrointestinal tract may cause irritation and pain. Certain medications. Angiotensin-converting enzyme (ACE) inhibitors, used to treat high blood pressure, may cause side effects that include a burning mouth. Oral habits. These include often-unconscious activities such as tongue-thrusting and teeth-clenching (bruxism), which can irritate your mouth. Endocrine disorders such as diabetes and underactive thyroid (hypothyroidism). Your oral tissues may react to high blood sugar levels that occur with diabetes. Hormonal imbalances, such as those associated with menopause. Burning mouth syndrome occurs most commonly among postmenopausal women, although it affects many other people as well. Changes in hormones may affect the composition of your saliva. Excessive irritation. Irritation of the oral tissues may result from excessive brushing of your tongue, overuse of mouthwashes or consuming too many acidic drink In the most current ADA Guide to Dental Theraputics, CHx is not listed as having any adverse effects. I have never come across any but perhaps other clinicians have. I'll ask around. - Lynne H. Slim RDH, BSDH, MSDH I've used .2% CHX for 18 yrs. I've only had 2 reactions and 2 who made the mistake to use the 5%concentrate. OOPS. Other than that the bacteria hates the stuff and that is good. My pts. generally only use it during the treatment phase and then I change them to something else.- Sandy Sheffler RDH Sandy, Tell me a little more about CHX messing with "taste buds?" This Pt was using CHX routinly for quite a while. I cant recall off the top of my head if she stopped due to the tongue burning or if the tongue burning occured after??? Ill check. - Cher Frazier RDH Cher, Prolonged use of CHX can dull the tastebubs with some people. I'm not sure about burning but it's possible I guess. I think the taste comes back after being off. I think like you though that it sounds more systemic than anything else but she's lucky to have you looking out for her. - Sandy Thank you Dr. Hasan for your report. Chlorhexidine mouthrinses are meant for a very short duration (up to 3 weeks) to eliminate microbes. I find many professionals indiscriminately prescribe CHX for their patients for longer than recommended dosage. Due to its inability to discriminate between normal flora and disease producing bacteria, over use is over kill and does not support a healthy balance in oral flora. They also contain alcohol, which essentially robs the mouth of its moisture balance, thereby leading to contact stomatitis. I am a laser periodontal co-therapist and have been using and recommending Oxyfresh mouthrinses for over 13 years now and have not found allergic or contact stomatitis in my patients who use Oxyfresh mouthrinses. They are state of the art in keeping a balanced oral flora and have been alcohol free for over 25 years, long before it became "fashionable" or "evidence-based" to recommend alcohol free mouthrinses. The active ingredient is Stabilized Chlorine Dioxide, which works when the degradation of bacteria and by-products that produce sulfur gases and methylmercaptans are eliminated and the periodontal membrane's permeability is thwarted. There is never any free chlorine released and breaks down to a simple body salt. The newest rinse contains both aloe vera for its healing properties and lemon which stimulates saliva. Feel free to log on to my website and click on the left hand column "". to answer some of your questions. I'll be happy to connect you to other periodontists who use and recommend this "peace of mind" mouthrinse. Joan Fitzgerald, Marketing Director Oxyfresh Worldwide, Inc. Dear Lynne H. Slim here a medline plus drug informatione notice about CHX: And here a another link to contact stomatitis: I would not like that I am wrongly understood. I am not against CHX. I think still very good for CHX. Each medicine has side effects. But we must use it correctly. I think we have there a problem. I think as dentists have we also errors. The patients are not so well instructed by us unfortunately. And I had a female patient those the CHX %0.2 , 15 minute long stand let. And the dentist said nothing to her. The patients look for light therapie ways. They do not want to deseam the teeth. Most require equal a medicine. I think, we must talk with them still more and tell the toothbrush still more. They must know from which the illness come. No medicine may be used long. Thus I believe.... I think the best medicine are the patient cooperation. I will read anything about Chlorine Dioxide. Thanks Joan Fitzgerald RHD for the suggestion and web site... Thanks for their thoughts.. Dr. Hasan H DDS, Phd Date: Sat, 28 Jan 2006 09:20:10 -0500 From: "Lynne H. Slim" Subject: Burning Mouth Syndrome, cont. Cher Frazier, There's a good burning mouth case study on the Oral B website. Just go to and click on dental professionals. There's a listing of case studies and one on burning mouth.
Date: Sat, 28 Jan 2006 09:40:10 -0500 From: "Lynne H. Slim" Subject: Low Dose Doxycycline Hi all, There's been some discussion in this group and on Amy's group about antibiotic resistance and low dose doxycycline (20 mg bid) (which by the way is now available in a generic form). Bill Landers from Oratec initiated the discussion based on an article he read about antibiotic resistance in dermatology because of low dose antibiotic therapy for dermatology patients. I have requested the article from him so we can look at it, too. Anyway, my point here is that I don't think we should jump to conclusions about low dose doxy (in terms of antibiotic resistance) until we know that it is a real problem. Perhaps it is and maybe it isn't. At this point, it's only rumor and speculation. There is evidence (from a systematic review conducted by periodontal researchers and published in the AAP) that low dose doxycycline, when administered as directed, showed statistical significance (w/ respect to probing depth reduction and clinical attachment gain) as an adjunctive agent to definitive scaling and root planing. The resistance issue has not been discussed before (not that I know of anyway) and we also need to recognize that lots of clinicians report great results w/ some patients who take the drug. So, we need to be open to new information (thanks, Bill for bringing it to the group's attention) but, at the same time, we need to be cautious in not jumping to any conclusions at this time. Does this make sense or am I way off base? I try to look at the SCIENCE and then also weigh in with clinicians' perspectives on various issues. Science is not perfect and sometimes we don't have the answers we are looking for. Always try to balance science w/ clinical expertise and don't forget the patient prespective. Our patients LOOK UP TO US for answers and they respect us more if we do our best to present the truth. Truth can be colored in many different ways and sometimes it's tough to find the truth.
Date: Sat, 28 Jan 2006 10:01:59 -0500 From: "Lynne H. Slim" Subject: povidine iodine This is an anecdotal story but here goes: I have a 5 mm pocket that will not quit and I keep experimenting with it. I have used a proxabrush, floss, baking soda tracing w/ a rubber tip, triclosan toothpaste (Total) and here's what I have found helps me the most: about three times a week I irrigate w/ a squirt of povidine iodine to one and a half cups of warm water. I use a cordless Waterpik (w/ a regular tip) and it keeps the inflammation down. For the life of me, I can't figure out why this approach works better for me than proxabrushing the area. Dr. Keyes, can you shed some light on this for me? Thanks, Lynne