The Morning Drill: November 2, 2011

A collection of dentistry and health related links/comments for your day.

Henry Schein Reports Record Third Quarter Results

Henry Schein, Inc. HSIC +1.80% , the largest provider of healthcare products and services to office-based practitioners, today reported record financial results for the quarter ended September 24, 2011. The Company noted that influenza vaccine sales and related profits were lower this quarter than in the prior year quarter. In order to provide more meaningful commentary the Company will be discussing results including and excluding this impact.

Net sales for the third quarter of 2011 were $2.1 billion, an increase of 11.5% compared with the third quarter of 2010. This consists of 7.4% growth in local currencies and 4.1% growth related to foreign currency exchange. Internal sales growth in local currencies was 3.3% (see Exhibit A for details of sales growth). Excluding sales of seasonal influenza vaccines from both periods, net sales increased 12.9%, with 8.6% growth in local currencies including 4.3% internal sales growth.

North American Dental sales of $682.4 million increased 2.5%, consisting of 1.8% growth in local currencies and 0.7% growth related to foreign currency exchange. The 1.8% growth in local currencies included 2.9% growth in Dental consumable merchandise sales and a 2.1% decline in Dental equipment sales and service revenues.

"Growth in sales of Dental consumable merchandise is slightly ahead of our estimate for market growth and we believe reflects consistent patient traffic to dental offices," commented Mr. Bergman. "Dental equipment sales were impacted by a cautious environment for capital equipment purchases. However, as we entered the fourth quarter, our Dental equipment order book was significantly stronger than it had been entering the third quarter."

Cost keeps many women from getting dental care

Cost remains a significant barrier for many U.S. women who need dental care, according to Women's Health USA 2011, the 10th edition of an annual data book released by the Health Resources and Services Administration (HRSA).

The report identifies priorities, trends, and disparities in women's health.

The 2011 edition highlights several new topics, including secondhand tobacco smoke exposure, Alzheimer's disease, preconception health, unintended pregnancy, oral healthcare utilization, and barriers to healthcare. For the first time, the special population section of the report features data on the health of lesbian and bisexual women, as well as Native Hawaiian and other Pacific Islander women. Data on American Indian and Alaska Native women also are featured.

The data indicate that historically underserved subpopulations of women are at increased risk for multiple negative health outcomes. Preventive care, increased access to vital health services, support, and resources can promote the health and well-being of all women.

Managing 'Meth Mouth'

Methamphetamine (MA) is a schedule 2 central nervous system stimulant, which in low doses has been US Food and Drug Administration approved for use in the treatment of narcolepsy and attention-deficit/hyperactivity disorder. Among illicit drug users, it is commonly known as meth, speed, chalk, ice, crystal, tina, fire, glass, or crank.[1,2] Recreational users of the drug take it by smoking, snorting, injection, and oral or rectal routes.[3] This highly addictive, relatively inexpensive, and easily manufactured cousin of amphetamine has become the nonmedical drug of choice for many recreational stimulant drug abusers throughout the United States.

The National Survey on Drug Use and Health reported that approximately 21.8 million American adults (8.7%) used illicit drugs in 2009.[4] This represents a 9% increase over the 2008 rate, the highest rate since 2001. The number of nonmedical users of stimulants also increased from 904,000 (0.4%) in 2008 to 1.3 million (0.5%) in 2009, credited to an increase in the number of MA users from 314,000 (0.1%) to 502,000 (0.2%). This increase was considered statistically significant (P < .05).

ADA: Chlorhexidine Rinses Do Not Help Caries

Chlorhexidine and thymol in a varnish can prevent root caries, but chlorhexidine rinse is probably useless against caries of all kinds.

This finding is perhaps the biggest surprise in a comprehensive review of nonfluoride caries-preventive agents performed by a panel of the American Dental Association (ADA) and published in summary in the September issue of the Journal of the American Dental Association, with a more detailed report available on the organization's Center for Evidence-Based Dentistry Web site.

"We are moving toward management of caries as a chronic condition, rather than putting in a filling and watching until it breaks," Michael Rethman, DDS, lead author of the review and vice president for scientific research at the ADA foundation, told Medscape Medical News.

Most dentists agree that proper hygiene, diet, and use of fluoride can help prevent caries, but there is little consensus on what else works.

For example, 7.7% of children and 17.3% of adults were prescribed chlorhexidine rinse, according to a survey cited in the review. About a third of adults and children were told to use xylitol gum.

The confusion is not surprising, as there has not been enough research performed on most such substances, the ADA panel found. Dr. Rethman cautioned that the panel was only reporting on the scientific data and said individual clinicians should also bring their experience to decisions about these substances. In addition, in an accompanying statement, the ADA pointed out that the findings only summarized the scientific evidence and should not be interpreted as the standard of care.

Stuart Fischman, DMD, professor emeritus of oral diagnostic sciences at the State University of New York at Buffalo, said the panel had taken the right approach in emphasizing that no substances have been as well proven as fluoride for preventing caries. "I think they have taken the right tone," he told Medscape Medical News.

Still, the recommendations could prove disappointing to practitioners casting about for a reliable tool in cases of caries that resist fluoride and other well-established treatments. For example, many companies have recently marketed products containing calcium phosphate as a means of remineralizing dental lesions. Perhaps the most familiar in the United States is MI Paste (GC America).

The panel found a handful of studies suggesting promise for calcium phosphate in various forms, but it could not pool the results because the substances were too different from each other. It concluded that the evidence was "insufficient" to recommend either for or against them.

In contrast, the panel found several adequate studies on 0.05% to 0.12% chlorhexidine rinses for coronal caries. It pooled the results from 4 randomized controlled trials and found that the difference between the number of decayed, missing, or filled surfaces in patients who used chlorhexidine and those who used a placebo was not statistically significant. The panel obtained similar findings for root caries.

Dr. Fischman said he was not surprised by the results. "The role in caries has never really been accepted by professionals," he said. However, he added that this review said nothing about the potency of chlorhexidine varnishes for periodontal disease.

In addition, for a varnish combining chlorhexidine with thymol, the panel found 3 randomized controlled trials showing efficacy against root caries, and concluded that this approach works.

In contrast, studies on chlorhexidine and thymol varnish for coronal caries did not show a statistically significant advantage, so the panel did not support this treatment.

There was not enough evidence to make conclusions about chlorhexidine varnish without thymol for adults, and 10% to 40% chlorhexidine varnish without thymol did not seem to reduce the incidence or caries in children.

Evidence for chlorhexidine gels was also lacking.

Among the panel's other findings were that:

•     Xylitol chewing gum marginally reduces the incidence of caries in children, and children with caries experience could also benefit from xylitol lozenges or hard candy, but there is not enough evidence to recommend xylitol syrup for children younger than 2 years or to recommend xylitol dentifrice.
•     There is not enough evidence for using triclosan, iodine, or sialogues against caries.
•     There is not enough evidence that xylitol, chlorhexidine, or calcium products given to mothers can reduce caries in children.

Enjoy your morning!