The Saturday Drill: June 4, 2011

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

Hormone-blocking drug, Aromasin, reduces breast cancer risk

Millions of women at higher-than-usual risk of breast cancer have a new option for preventing the disease. Pfizer Inc.'s Aromasin cut the risk of developing breast cancer by more than half, without the side effects that have curbed enthusiasm for other prevention drugs, a major study found.

It was the first test in healthy women of newer hormone-blocking pills called aromatase inhibitors, sold as Arimidex, Femara and Aromasin, and in generic form. They're used now to prevent recurrences in breast cancer patients who are past menopause, and doctors have long suspected they may help prevent initial cases, too.

Prevention drugs aren't advised for women at average risk of breast cancer. Those at higher risk because of gene mutations or other reasons already have two choices for prevention tamoxifen and raloxifene. But these drugs are unpopular because they carry small risks of uterine cancer, blood clots and other problems.
"Here's a third breast cancer prevention drug that may in fact be safer," said Dr. Allen Lichter, chief executive of the American Society of Clinical Oncology.

Training new dental health providers in the United States

Abstract

Objectives: Introduction of dental therapists in the United States involves a wide range of issues including permissive governmental policymaking; determinations of their education, supervision, and deployment; their acceptance by dentists and the public; financing of their services; and, most fundamentally, their training. This contribution re-releases and updates the executive summary of an extensive report comparing therapists' training across five industrialized countries and comparing therapists' training to that of conventional U.S. dental providers.

Methods: Literature reviews, web searches, key informant interviews, and program document reviews.

Results: Internationally, three-year training programs that dually qualify trainees as hygienists and therapists dominate. There are marked differences between non-US and US-based therapist training programs and between US-based programs. Reported goals of establishing dental therapists include expanding the availability of basic dental services to underserved disadvantaged subpopulations; potentially reducing costs of basic care; and enhancing the roles of dentists in providing the most sophisticated care, serving the most complex patients, and managing an expanded dental team. Criteria for establishing training programs include program length, supervisory arrangements, recruitment and incentives, deployment, educational costs, curriculum, oversight, and accreditation.

Conclusion: International experiences can well inform US policy on training of dental therapists.

Minnesota Graduates First Class of Dental Therapists

Christy Fogarty will always remember the man whose wedding she saved. "His front teeth were so decayed he literally couldn't smile," she told Medscape Medical News. Fogarty restored all 6 of the man's front teeth and sent him beaming to his bride. It is the kind of happy ending that many dentists like to reminisce about, but with one key difference: Fogarty is not a dentist.

A dental hygienist in practice as an independent contractor for 7 years, Fogarty, 41, is about to obtain her master of science in oral health care practitioner through a controversial program at Metropolitan State University in Minneapolis, Minnesota. Her class of 7 will graduate June 23, adding a new category of dental practitioner to the state, with duties falling between those of a dentist and those of a hygienist.

The program, enacted into law in 2009 despite continuing opposition from the Minnesota Dental Association (MDA), is only the second in the United States that licenses such dental therapists. Compared with the dental health aide therapist program in indigenous Alaska communities, the Minnesota therapists, who are also being trained at the University of Minnesota, will have more education and more limited capacities.

They will be able to prepare teeth and place all types of direct restoration, as well as stainless steel crowns; do pulpotomies; make prostheses; and extract primary teeth. They will do this work only under the indirect supervision of a dentist, meaning that the dentist must be on the premises but not necessarily in the operatory when the work is done.

With 2000 more hours of clinical practice, and after passing an examination that is as yet to be devised, these dental therapists can become advanced dental therapists, who will also be able to extract mobile permanent teeth and work under a dentist's general supervision meaning the dentist could be miles away from the therapist when the work is done.

Dental Tourism: How Far Would You Go for A Crown?

Have you heard of the term "medical tourism"? If you have, give me a second to explain what it is to everyone else -- essentially, medical tourism is combining a vacation abroad with a medical procedure/operation. The reasoning is, many procedures and operations can be done much cheaper in many other countries.

India is a country that is a popular medical tourism destination. And, from my "outsiders" perspective, with good reason -- in many areas, they have state-of-the-art medical facilities and world-renowned medical professionals.

I'm stating the above because I do not know enough about medical tourism to be a naysayer on the entire industry. But I do have an opinion on it when it comes to medical tourism and dentistry, particularly in the area of Mexico.

Maybe you've seen some ads or websites that state something like: Hey, how about a Mexican vacation, complete with sun, surf and tequila? And while you're here, why not get a dental implant or cheap crown?

Why not indeed... Allow Dr. Connelly to tell you why not.

Bone Drug Bisphosphonate Zometa May Prevent Return of Breast Cancer

A drug that battles bone loss may have added benefits for women with estrogen-sensitive breast cancers, significantly reducing the chance that their cancer will return or spread, a new study shows.

What's more, researchers say, the lowered risk of recurrence seems to last years after the treatment, a bisphosphonate drug called Zometa, is stopped.

"I find that very reassuring. It obviously demonstrates that we can impact on the long-term outcome of our patients with an early intervention. We do not have to give these drugs forever. I'm very enthusiastic about this," says study researcher Michael Gnant, MD, professor of surgery at the Medical University of Vienna in Austria.

For the study, which is published in TheLancet, 1,803 premenopausal women with early-stage, estrogen-driven breast cancers were given a drug which suppresses estrogen production by the ovaries. They were also treated with drugs, Arimidex or tamoxifen, that help prevent cancers from using estrogen to grow.

In addition to those treatments, half were randomly assigned to receive intravenous infusions of Zometa every six months for three years.

Two years after their treatments ended, women who got the bone drug continued to have a 32% reduced risk of cancer recurrence compared to those on estrogen suppression alone.

strogen suppression alone.

Overall, 92% in the Zometa group were cancer-free two years after treatment compared to 88% on estrogen suppression alone

Enjoy your Saturday drill!