• Dentistry

    Dentistry Today: Amoxicillin Use May Be Linked to Tooth Enamel Defects

    Use of the antibiotic amoxicillin during infancy appears to be linked to tooth enamel defects in permanent teeth, according to a study in the October issue of Archives of Pediatrics and Adolescent Medicine, one of the JAMA/Archives journal.

    Dental fluorosis, a result of exposure to excessive fluoride during enamel formation, is one of the most common developmental enamel defects, according to background information in the article. The clinical signs range from barely noticeable white flecks, to pits and brown stains. Amoxicillin is one of the most common antibiotics used among pediatric patients, mainly for treatment of otitis media–infection and inflammation of the middle ear. There has been some evidence that amoxicillin use could be associated with dental enamel defects, and, the authors suggest, even a small effect on dental enamel could have a significant effect on the public’s dental health because of the widespread use of amoxicillin.

    Liang Hong, D.D.S., M.S., Ph.D., of the University of Iowa, Iowa City, and colleagues assessed the association between dental fluorosis and amoxicillin use during early childhood. (Dr. Hong is now with the Department of Dental Public Health and Behavioral Science, University of Missouri – Kansas City.) The researchers analyzed data from the Iowa Fluoride Study, a prospective study investigating fluoride exposures, biological and behavioral factors, and children’s dental health. They followed 579 participants from birth to 32 months, using questionnaires every three to four months to gather information on fluoride intake and amoxicillin use.

    “The results show that amoxicillin use during early infancy seems to be linked to dental fluorosis on both permanent first molars and maxillary central incisors,” the authors report. “Duration of amoxicillin use was related to the number of early-erupting permanent teeth with fluorosis.”

    By the age of one year, three-quarters of the subjects had used amoxicillin. By 32 months, 91 percent of participants had used amoxicillin. “Overall, 24 percent had fluorosis on both maxillary central incisors,” the authors write.

    Amoxicillin use from three to six months doubled the risk of dental fluorosis. “The significantly elevated risk for dental fluorosis associated with amoxicillin use during early infancy was found at all levels of statistical analyses, even after controlling for other potential risk factors, such as fluoride intake, otitis media infections, and breastfeeding,” the authors report.

    The authors emphasize that additional laboratory and clinical studies–including controlled animal studies with specified amoxicillin dosages, chemical analysis and histological examination of affected teeth, and additional well-designed epidemiological studies–are needed to confirm the results.

    “The findings suggest that amoxicillin use in infancy could carry some heretofore undocumented risk to the developing teeth,” they conclude. “While the results of this one study do not warrant recommendations to cease use of amoxicillin early in life, they do further highlight the need to use antibiotics judiciously, particularly during infancy.”

    (Arch Pediatr Adolesc Med. 2005;159:943-948)

    An interesting study and requires follow-up.

    Flap will post any updates.

    Stay tuned.

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  • Dentistry,  Oral Surgery

    Dentistry Today: Bisphosphonates: Zometa (zoledronic acid) & Aredia (pamidronate disodium) Associated with Osteonecrosis of Jaw – REDUX

    Previously at the FullosseosuFlap’s Dental Blog, Bisphosphonates: Zometa (zoledronic acid) & Aredia (pamidronate dis odium) Associated with Osteonecrosis of Jaw

    An update from the Journal of Endodontics, Critical Information for Patients About Possible Side Effect of Bisphosphonates.

    An article titled, “Bisphosphonate-associated Osteonecrosis of the Jaws and Endodontic Treatment: Two Case Reports,” in the October issue of the Journal of Endodontics (JOE), a publication of the American Association of Endodontists (AAE), suggests patients using bisphosphonates as part of their cancer treatment and for debilitating bone diseases, such as osteoporosis and Paget’s disease, may be at risk of experiencing a painful, disfiguring condition known as osteonecrosis of the jaw, a disease that leads to the breakdown of the bone. The word osteonecrosis literally means “death of bone” (osteo = bone, necrosis = death).

    Initial symptoms include burning, tingling or localized pain in the jaw, and may lead to more serious complications, such as infections and jawbone degeneration. Patients who think they may be experiencing symptoms of osteonecrosis of the jaw should seek counsel from their general physicians and oncologists, and inform their dentists, endodontists and other dental professionals that they are undergoing treatment with bisphophonates.

    The latest generation of bisphosphonates includes: alendronate (Fosamax®); pamidronate (Aredia®); and zoledronate (Zometa®). Bisphosphonates help strengthen bone and prevent fractures in the hip, spine and other skeletal regions by inhibiting bone loss.

    The article indicates that at the same time bisphosphonates support the buildup of bone in areas weakened by disease or as a side effect of treatment, some patients taking bisphosphonates may experience the opposite effect in the lower and upper jawbones. “Considering the large number of patients around the world using bisphosphonates for prevention or treatment of osteoporosis, dentists may be dealing with a significant potential complication,” write the authors.

    Written by Aaron P. Sarathy, D.M.D., Sidney L. Bourgeois, Jr., D.D.S. and Gary G. Goodell, D.D.S., M.S., M.A., the article suggests that problems in some patients using bisphosphonates may be triggered by a dental procedure, such as a tooth extraction, or could occur spontaneously.

    To prevent complications, the article suggests that those who take bisphosphonates seek counsel from their medical and dental providers before any elective dental procedures, and that any non-elective dental work – especially extractions, which, the article notes appear to “precipitate the majority of this condition” – be done before starting bisphosphonate therapy. When dental work is required after starting bisphosphonate therapy, patients, physicians and general dentists should consult with appropriate dental specialists, including endodontists, because non-surgical root canal treatment may be a safer alternative to extraction.

    “Bisphosphonates are important drugs that help manage the side effects of cancer treatments, as well as bone loss in people who have osteoporosis,” says JOE Editor Kenneth M. Hargreaves, D.D.S., Ph.D.. “But, as this article indicates, both healthcare professionals and patients should be aware of the risks so together they can ensure optimal dental treatment.”

    Updates will be posted as they occur.

    H/T Baltimore Tales

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  • Harriet Miers,  Politics,  Supreme Court

    Harriet Miers Watch: Message to the White House From the RIGHT – NEGATIVE

    White House counsel and Supreme Court nominee Harriet Miers stands with Senate Minority Leader Harry Reid at the U.S. Capitol, Monday, Oct. 3, 2005, in Washington after President Bush nominated Miers to replace retiring Justice Sandra Day O’Connor.

    The reaction from Conservatives on Harriet Mier’s nomination to the United States Supreme Court has been largely NEGATIVE.

    Michelle Malkin has MESSAGE TO THE WHITE HOUSE.

    130pm EDT. Dick Cheney just finished an interview with Rush Limbaugh. Cheney pleads for Rush to “trust” him. First caller after the segment is a Republican woman who is “so disappointed” with Bush and the GOP…they don’t seem to care about their base…we fought hard to get a Republican majority…I am so dismayed…”

    Hearing the same from scores of rank-and-file Republican e-mailers today.

    Rush made a half-hearted attempt to frame the cronyism concern as liberal MSM-generated. But the concern is as strong, if not stronger on the right than on the left.

    Next caller: “George Bush has caved on just about everything.” He lists education spending, campaign finance, budget, tariffs. Bush “advocates conservatism to placate the base and then he acts like a moderate because he is a moderate.”

    Senator Chuckie Schumer and Senate Minority Leader are OK with the pick. And this is good news?

    Hugh Hewitt is OK with the pick.

    So is Carol Platt Liebau here, here and here.

    But others…….

    Captain Ed has Harriet Miers Gets The Nod

    Miers may make a great stealth candidate, but right now she looks more like a political ploy. Color me disappointed in the first blush.

    John Hinderaker at Powerline has A Disappointment.

    The only positive spin I can think of is this: President Bush knows Miers well, and it is almost inconceivable to me that he is insincere in his repeated descriptions of what he is looking for in Supreme Court justices. He also is acutely aware that the Souter nomination was one of the chief blots on his father’s administration. Is it possible that he would waste a Supreme Court nomination on someone who isn’t a conservative? It’s hard for me to believe, but the evidence so far isn’t encouraging.

    RedState.org has Harriet Miers — A Profound Disappointment

    We can be convinced that Miers is stellar. We can be convinced that Miers will be an originalist willing to reject the liberal dogma of Roe. But from where we sit now, this is a profoundly disappointing nomination, a missed opportunity, and an abdication of responsibility to make sound, well qualified nominations. Whether it is also a betrayal of first principles is still to be determined.

    XRLQ has Harriet Who?

    Patterico via Angry Clam has Is this Really the Best They Can Do?

    The only positive things about Miers going around on the blogs have essentially three sources. They’re all weak.

    David Frum from National Review Online has MADAME JUSTICE

    The Miers nomination, though, is an unforced error.

    Flap continues the sentiment.

    Woefully disappointed the nominee was not Priscilla Owen.

    Update #1

    Dr. James Dobson of Focus on the Family is carefully supporting Miers’ nomination.

    Update #2

    Pat Buchanan has Miers’ Qualifications Are ‘Non-Existent’

    Handed a once-in-a-generation opportunity to return the Supreme Court to constitutionalism, George W. Bush passed over a dozen of the finest jurists of his day — to name his personal lawyer.

    In a decision deeply disheartening to those who invested such hopes in him, Bush may have tossed away his and our last chance to roll back the social revolution imposed upon us by our judicial dictatorship since the days of Earl Warren.

    This is not to disparage Harriet Miers. From all accounts, she is a gracious lady who has spent decades in the law and served ably as Bush’s lawyer in Texas and, for a year, as White House counsel.

    But her qualifications for the Supreme Court are non-existent. She is not a brilliant jurist, indeed, has never been a judge. She is not a scholar of the law. Researchers are hard-pressed to dig up an opinion. She has not had a brilliant career in politics, the academy, the corporate world or public forum. Were she not a friend of Bush, and female, she would never have even been considered.

    Well said Pat.

    And William Kristol of the Weekly Standard is Disappointed, Depressed and Demoralized.

    And…. Rush Limbaugh

    “This is a pick that was made from weakness. There was an opportunity here to show strength and confidence, and I don’t think this is it. There are plenty of known quantities out there who would be superb for the court.”

    Stay tuned.

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  • John Roberts,  Politics,  Supreme Court

    Chief Justice John Roberts Watch: The John Roberts Era Begins

    Reuters has Supreme Court enters the John Roberts era.

    At 10:35 a.m., new Chief Justice John Roberts opened the 2005-2006 Supreme Court session on Monday and launched the highest U.S. judicial body into the Roberts era, which could last for decades.

    “On behalf of all the members of the court, it is a pleasure to extend to you a warm welcome,” Justice
    John Paul Stevens told the conservative Roberts before the official opening in a brief ceremony attended by
    President George W. Bush.

    Stevens wished Roberts “a long and happy career in our common calling” as the country’s 17th chief justice. Roberts succeeds his mentor,
    William Rehnquist, who died a month ago after 33 years as the court’s foremost conservative voice.

    Roberts, at 50, is the youngest chief justice in more than two centuries. He takes over a court in which every other member has as least 11 years seniority and one, Stevens, has 30. In a lifetime post, Roberts could have a major impact on the legal system.

    Roberts, who spoke of the need of judges to be modest before his confirmation, entered the courtroom with his eight fellow justices dressed in a plain black robe like them.

    Gone were the four gold stripes Rehnquist added to each sleeve before presiding over the Senate impeachment trial of President
    Bill Clinton in 1999 — an adornment inspired by a costume in a Gilbert and Sullivan comic opera.

    Roberts said he was happy to announce the opening of the session that will run until June, then immediately went into the first arguments of the term.

    And so the John Robert’s era begins for the United States Supreme Court.

    In this artist’s rendering, U.S. Supreme Court Chief Justice John Roberts, right, with Justices Ruth Bader Ginsburg, left to right, David Souter, Antonin Scalia, and John Paul Stevens, takes the bench for the first time, Monday, Oct 3, 2005 in Washington.

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  • Politics,  Supreme Court

    Harriet Miers Watch: Nominated by President Bush to Replace Justice Sandra Day O’Connor

    U.S. President George W. Bush (R) listens to remarks from Harriet Miers at the White House in Washington D.C. October 3, 2005. Bush had earlier nominated Miers to fill the vacancy in the U.S. Supreme Court. White House counsel Miers would replace Justice Sandra Day O’Connor if she is confirmed by the U.S. Senate.

    The ASSociated Press has High Court Nominee Has Never Been a Judge.

    President Bush nominated White House counsel Harriet Miers to the Supreme Court on Monday, turning to a lawyer who has never been a judge to replace
    Sandra Day O’Connor and help reshape the nation’s judiciary.

    “She has devoted her life to the rule of law and the cause of justice,” Bush said as his first Supreme Court pick, Chief Justice John Roberts, took the bench for the first time just a few blocks from the White House.

    If confirmed by the Republican-controlled Senate, Miers, 60, would join Justice
    Ruth Bader Ginsburg as the second woman on the nation’s highest court and the third to serve there. Miers was the first woman to serve as president of the Texas State Bar and the Dallas Bar Association.

    Flap is disappointed that the President did not appoint Federal Appeals Court Judge Priscilla Owen

    or any of these other female federal appeals court judges:

    Janice Rogers Brown

    Edith Clement

    Edith Hollan Jones

    Harriet Mier’s background, education and legal CV are underwhelming at best for a U.S. Supreme Court Justice.

    This was a CRONY pick.

    The LEFT must be laughing its ASS off.

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