Flap's Blog – FullosseousFlap's Dental Blog

These are my links for May 5th from 14:23 to 15:40:

• Dilbert May 2, 2011 – Peak Efficiency | Flap’s Blog – FullosseousFlap’s Dental Blog – Dilbert May 2, 2011 – Peak Efficiency #tcot #catcot
• Flap’s Links and Comments for May 5th on 14:00 | Flap’s Blog – FullosseousFlap’s Dental Blog – Flap’s Links and Comments for May 5th on 14:00 #tcot #catcot
• “Getting to Denmark” – By Mark Steyn – The Corner – National Review Online – “Getting to Denmark” – By Mark Steyn
• Capitol Alert: Bill allowing college aid for illegal immigrants passes Assembly – California Bill allowing college aid for illegal immigrants passes Assembly

These are my links for May 5th from 14:00 to 14:17:

• California Bill allowing college aid for illegal immigrants passes Assembly – The Assembly passed legislation Thursday to allow illegal immigrants to receive college scholarships, setting the stage for new fighting over an explosive social issue whose prospects were buoyed last year by the election of Gov. Jerry Brown.

  The Assembly approved the first of two "Dream Act" bills, Assembly Bill 130, which would allow a small segment of undocumented immigrants who currently qualify for in-state tuition to apply for scholarships from private donations. Majority Democrats passed the bill on a 51-21 party-line vote.

  Assemblyman Gilbert Cedillo, D-Los Angeles, proposed both AB 130 and a pending companion measure — Assembly Bill 131 — that would open the financial aid door even wider by allowing those illegal immigrants to qualify for Cal Grants and other publicly funded aid.

  "We cannot afford, our economy cannot afford, to deny educational opportunities to anyone who has the strength of character, the personal discipline, the intelligence, to make it" through California's college or university system," Cedillo said in a statement.

  Cedillo's bills would apply to students who have attended a California high school for three years or more, graduated from a high school or attained an equivalent degree — and, if they are illegal immigrants, commit to legalizing their status if given the chance.

  The group targeted by AB 130 represent only a tiny fraction of college enrollment — 1,941 at the University of California, 3,633 at California State University and 38,202 at community colleges. Of those totals, illegal immigrants comprise about 32 percent of UC's figure and an unknown but perhaps higher percentage of those from state and community colleges, according to a legislative analysis of AB 130.

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  Of course, California has a massive budget deficit but the Democrats want to reward their constituency for their political support.

  The taxpayers be damned.

  It doesn't matter if you are in this country legally or not, California will help you get the subsidized college education.

  How much of an illegal immigrant magnet is this?

• “Getting to Denmark” – By Mark Steyn – The Muslim world is certainly “getting to Denmark.” It’s also getting to the Netherlands, to Austria, to France, and beyond. In Scandinavia and in other advanced Western societies, the state grows ever bolder in constraining freedom of expression and other core Western liberties. In the interests of enforcing the state religion of a hollow and delusional “multiculturalism,” basic tenets of Fukuyama’s “rule of law” — including due process, the truth as defense, and equality before the law — are tossed aside in the multiculti version of heresy trials. As recent decisions in Michigan suggest, America is not immune to this trend.

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  Read it all.

  Hope we don't go the way of Denmark

I have written a number of pieces about the problems associated with bisphosphonates and osteonecrosis of the jaw. My latest post is here.

Now, there is a new study published in the New England Journal of Medicine which sheds new light on the advantages vs. risks of taking these drugs.

Almost 78% of all Swedish women aged 55 years and older who sustained an atypical femur fracture in 2008 had taken bisphosphonates, but the absolute risk for such breaks is small enough to justify prescribing the drugs, according to a study published in the May 5 issue of the New England Journal of Medicine (NEJM).

For patients taking bisphosphonates, the age-adjusted relative risk for an atypical femur fracture — a clean, horizontal break spreading from the lateral side and occurring with minimal or no trauma — was 47.3%, the study reported. The crude incidence of the fractures was 0.09 per 10,000 patient-years among women who had never taken the drug compared with 5.5 among those who had ever taken it.

These results “should be reassuring for bisphosphonate users,” write lead author Jörg Schilcher, MD, from the Department of Experimental and Clinical Medicine, Faculty of Health Science, Linköping University, Linköping, Sweden, and colleagues. “With a correct indication, the benefits of fracture prevention…will greatly outweigh the risk of atypical femoral fracture.”

So, in other words, the benefits of preventing fractures by taking the medications outweigh the risk of an atypical leg (femur) fracture.

So, how does this apply to dentistry?

With more and more patients taking these drugs to prevent osteoporosis, and for longer periods of time, dentists will have to be scrupulous in their medical histories. Osteonecrosis of the jaw, while rare, is a known and serious complication.

An undisplaced femoral fatigue fracture associated with bishosphonate treatment. NIH photo

This study echoes the paper published in February in the Journal of the American Medical Association which I cited a few months ago. The AMA paper is here.

Experts interviewed by Medscape Medical News call the study definitive because researchers not only studied a massive number of participants — all 1.5 million women in Sweden who were aged 55 years or older in 2008 — but also reviewed the x-rays of nearly all those who had particular kinds of femur fractures.

“It’s the largest and most comprehensive study of this issue that I’ve seen,” said Sundeep Khosla, MD, president of the American Society for Bone and Mineral Research (ASBMR) and a professor of medicine and physiology at the Mayo Clinic in Rochester, Minnesota.

The study’s conclusions echo those in other recent studies on the worrisome fractures and the bone-building drugs for osteoporosis. An article published in February in the Journal of the American Medical Association, for example, reported that long-term use of bisphosphonates boosted the risk for these fractures, but those authors noted that the absolute risk for fracture is low and is outweighed by the benefits of the therapy.

And, what about drug holidays – especially since the risk of fracture declines rapidly after drug withdrawal?

Because it is not clear how long patients with osteoporosis can be safely treated with bisphosphonates, the ASBMR recommends that clinicians consider discontinuing them after 5 years. At that point, many physicians give their patients a “drug holiday” for 1 or 2 years and then resume the therapy. Dr. Shane said that the rapid decline in fracture risk after drug withdrawal helps justify a holiday.

“Now there seems to be evidence that giving patients intermittent drug holidays is appropriate to do,” she said. Dr. Khosla agreed, saying the decrease in fracture risk provides “reassurance that a [drug holiday] is good clinical practice.”

Again for dentists, it will be esepcially important to monitor our patients for when they are on or off the medications. Since dental visits may be episodic, and in older patients only in case of an emergency e,g. tooth extraction, proper dental/medical records are mandatory. Appropriate consultation with the patient’s physician is indicated. Treatment plans for dental examination and/or treatment either prior to initial treatment or before resumption of treatment with these drugs would be beneficial to patients.

I will look forward to additional studies on the risk of dental complications using a drug holiday approach – with resumption of drug use.

In the meantime, Flap urges caution for patients taking ORAL Bisphosphonate medications. And,please patients update your health history and tell your dentist if you are using these drugs.

Previous:

Revisiting Bisphosphonates and Femur Fractures

Oral Bisphosphonates Associated with a SLIGHTLY Elevated Risk of Developing Osteonecrosis of the Jaw?

New Dentistry Cause for Alarm for Patients Who Use Bisphosphonates – Fosamax, Actonel, Boniva?

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

Bisphosphonates: Zometa (zoledronic acid) & Aredia (pamidronate dis odium) Associated with Osteonecrosis of Jaw

These are my links for May 5th from 09:43 to 11:50:

• President 2012 Poll Watch: Obama Approval Jumps 6 Points to 52% After Bin Laden Death | Flap’s Blog – FullosseousFlap’s Dental Blog – President 2012 Poll Watch: Obama Approval Jumps 6 Points to 52% After Bin Laden Death #tcot #catcot
• Flap’s Dentistry Blog: Is Submandibular Gland Transfer a Solution for Xerostomia in Cancer Patients? – Is Submandibular Gland Transfer a Solution for Xerostomia in Cancer Patients?
• Flap’s Links and Comments for May 5th on 09:25 | Flap’s Blog – FullosseousFlap’s Dental Blog – Flap’s Links and Comments for May 5th on 09:25 #tcot #catcot
• Poll Watch: U.S. Unemployment Falls to 9.4% But Underemployment Increases to 19.3% | Flap’s Blog – FullosseousFlap’s Dental Blog – Poll Watch: U.S. Unemployment Falls to 9.4% But Underemployment Increases to 19.3% #tcot #catcot
• California to delay sending DMV registration bills | PolitiCal | Los Angeles Times – California to delay sending DMV registration bills – Jerry Brown Holding Out for More Taxes
• Accepting award, Mitch Daniels highlights Syrian background – Byron Tau – POLITICO.com – President 2012: Accepting award, Mitch Daniels highlights Syrian background
• Mitch Daniels: He’d call Dick Lugar! – Right Turn – The Washington Post – Mitch Daniels: He’d call Dick Lugar! But Wait Jennifer Rubin…..

According to the latest Gallup Poll.

Americans’ approval of President Barack Obama is up six points after the death of Osama bin Laden in a U.S. raid on the al Qaeda leader’s Pakistan compound. Obama averaged 46% approval in Gallup Daily tracking in the three days leading up to the military operation and has averaged 52% across the three days since.

This increase in approval rating is not unexpected and is fairly typical, if not low.

Presidents’ popular support often increases in response to major international events, commonly known as “rally events.” Thus, a jump in Obama’s approval after bin Laden’s death is not unexpected.

The six-percentage-point increase in Obama’s approval rating is fairly typical for a rally event. Gallup has compiled data on changes in presidential approval after 48 different international or domestic crises since 1950 and finds a median increase of seven percentage points.

The largest rally Gallup has ever measured was a 35-point increase for George W. Bush after the Sept. 11 terrorist attacks. Other large rally effects include an 18-point increase for George H.W. Bush at the beginning of the 1991 Persian Gulf War; a 16-point jump for Richard Nixon after the Vietnam War peace accords were signed; and 14-point increases for George H.W. Bush after the U.S. sent troops to Kuwait following Iraq’s invasion of the country, and for Lyndon Johnson after he announced he was halting bombing in North Vietnam.

When the U.S. in December 2003 found and captured another “high-value target” — former Iraqi President Saddam Hussein — George W. Bush’s approval rating rose seven points.

So, will President Obama’s bounce in the polls be sustained? I, frankly, doubt it since most on the RIGHT understand he never supported the measures that brought hm success in this operation, including enhanced interrogation methods.

The U.S. military operation that resulted in the death of Osama bin Laden is a major milestone in Obama’s presidency, and now a majority of Americans approve of the job he is doing, and more than at any time since May 2010. The question is whether Obama can sustain that higher level of support, or whether it will quickly dissipate. Most often, a president’s approval rating begins to decline fairly soon after the rally event occurs, with the increases in approval often disappearing in as little as one to four weeks.

These are my links for May 5th from 09:25 to 09:29:

• California to delay sending DMV registration bills – Jerry Brown Holding Out for More Taxes – California drivers who are scheduled to register their cars in July are getting a reprieve –- as the state won’t be sending them their annual registration bill just yet and is waiving any late fees for at least a month.

  But the move is hardly a gift from the cash-strapped state. It is part of an effort by lawmakers and Gov. Jerry Brown to buy time to negotiate a budget package that includes hiking vehicle registration fees.

  Under current law, the annual vehicle license fee that drivers must pay is set to drop from 1.15% of a car’s value to .65% on July 1. But Brown wants to keep the fee at 1.15% — the difference amounts to $5 for every $1,000 a car is worth — and he signed a new law, SB 94, Wednesday to delay sending registration notices.

  The governor doesn’t want drivers to get a smaller bill this month and, should he succeed at extending the rate hike, a second bill asking them to make up the difference later.

  "It is going to eliminate some potential confusion and duplication," said Department of Finance spokesman H.D. Palmer.

  Roughly 2.4 million vehicles are registered in California each month, said Mike Marando, a spokesman for the Department of Motor Vehicles. Drivers with July registration dates will not receive their renewal notices the usual 60 days in advance and they will not have to pay late fees for 30 days, he said. In addition, highway patrol officers will be instructed to ignore late registrations in the month of July.

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  Come on Jerry. Just cut the budget.

  More political machinations from the California Democrats in order to exact more money from California taxpayers.

• President 2012: Accepting award, Mitch Daniels highlights Syrian background – Mitch Daniels drew extensively on his Syrian heritage in accepting an award from an Arab-American group Wednesday night, connecting his own family’s journey to the United States with the uprisings unfolding in his ancestral homeland and elsewhere in the Arab world.

  “There have been the same stirrings, same yearnings for freedom that have busted loose elsewhere," the Indiana governor said during his second public appearance of the day in Washington. “May Syria and all the lands near it soon become places of peace, and freedom and self-determination.”

  Daniels, who gave a major education speech earlier in the day as he mulls a presidential bid, compared his paternal grandfather’s emigration from Syria to Ellis Island in 1905 to the broader struggles against dictatorship and autocracy in the Middle East, identifying the desire for freedom and a better life as the common threads.

  “The same dreams and the same hopes and the same determination to make a great life for themselves that brought Elias Esau Daniels to this country — of which he knew nothing, whose language he did not speak — is alive now in that part of the world,” Daniels said as he accepted the Kahlil Gabran "Spirit of Humanity" award at the Arab American Institute Awards Gala. "And they have a chance to bring the same sort of wonderful opportunities he made possible for my father and ultimately for me.

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  Read it all.

  Decision time coming for Daniels in the next 10 days….