Dentistry

Some Electric toothbrushes Are More Effective Than Manual Brushing

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Whenever I read some of these studies I always wonder who funds them. The latest missive in this subject comes from Peter Robinson of Sheffield University in Sheffield, England:

British researchers say some powered toothbrushes are better at removing plaque and reducing the risk of gum disease than are ordinary manual toothbrushes.

Peter Robinson of Sheffield University in Sheffield, England, and his colleagues, made the discovery in a study that has been published in the April issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates medical research.

The kind of powered toothbrushes that demonstrate superior performance are those with circular bristle heads that rotate in alternating directions.

Ok, but is that what they are really saying?

Next, read this take on the same story. this one from ABC News:

The circling motion unique to certain power toothbrushes is better at sweeping away dental plaque than the traditional ‘up-and-down’ technique used with manual brushes.

That’s according to a new review of 42 different studies, involving more than 3,800 participants, that found circle-motion electric toothbrushes outperformed simpler, hand-manipulated models.

The review’s British authors found that over one to three months, powered toothbrushes with circular heads that rotate in alternating directions reduced plaque 11 percent better than manual toothbrushes and reduced signs of gum inflammation (gingivitis) 6 percent better than manual toothbrushes.

After more than three months of use, the powered toothbrushes reduced gingivitis 17 percent better than manual toothbrushes. The researchers found no evidence that powered toothbrushes of any kind caused more gum damage than manual toothbrushes.

They stressed that even though the powered toothbrushes provided better results, the benefits of regular brushing “occur whether the brush is manual or powered, and the results of this review do not indicate that tooth brushing is only worthwhile with a powered toothbrush.”

“We did not want to say that electric brushes are necessary, just that they can help. It is possible to clean one’s teeth perfectly well without an electric brush,” review co-author Peter Robinson of Sheffield University said in a prepared statement.

Ionic brushes — which makers say reverse the polarity of teeth, improving cleaning — and powered toothbrushes that do not use a circular, alternating motion, were no better at removing plaque and gingivitis than manual toothbrushes, the review concluded.

The review was published in the April issue of the journal The Cochrane Library

Now read the manual toothbrushes are just fine slant to the same story. This time the piece is from Canada’s globe and Mail:

Most electric toothbrushes are no better at cleaning your teeth than the old-fashioned manual ones.

That’s the conclusion of researchers at the University of Sheffield in England, after reviewing 42 trials of all sorts of toothbrushes.

In fact, the only type of electric toothbrush more effective than a traditional brush is one with a so-called “rotating-oscillating” head. (It has a circular head that moves a quarter turn in one direction and then back a quarter turn.)

“These results show that many people may be wasting money on toothbrushes they believe will clean their teeth better, when actually a much cheaper traditional brush would do the job just as well,” Prof. Peter Robinson said in a statement released with the study.

His team looked at trials that assessed how well various brushes removed dental plaque — a gooey mix of bacteria and detritus — which can cause gingivitis, an early form of gum disease that undermines teeth.

There are a wide range of electric brushes, including those that move bristles with ultrasound, and those that move side to side, or round and round — and those of the rotating-oscillating variety.

Compared with manual toothbrushes, the rotating-oscillating gadgets removed 11-per-cent more plaque and cut gingivitis by a further 17 per cent after three months of use, according to the study in the Cochrane Database of Systematic Reviews.

Prof. Robinson said the other electric gadgets don’t do any harm. “However, if [people] bought an electric toothbrush to get their teeth as clean as possible, then it is worth investing in a brush with a rotating-oscillating head.”

Other experts also recommend regular flossing, rinsing with an antibacterial mouth wash and periodic trips to a dentist’s office for a professional cleaning.

So, what is the truth of the matter – BRUSH YOUR TEETH, FLOSS THEM, WATER IRRIGATE THEM, USE ANTIBACTERIAL MOUTHRINSES AND SEE THE DENTIST AND HYGIENIST REGULARLY.

And forget about worrying about what type of toothbrush you use because it is simply one portion of dental hygiene and doesn’t really matter.

And to researchers….. you have better things to study – Heh!

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Health

U.K. Proposal on Alzheimer Drugs – Removal From Formulary

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Internal Medicine News has this story about Alzheimer Drug rationing in the United Kingdom:

A British proposal to remove four antidementia drugs from the National Health System formulary is unlikely to affect Medicare coverage of these agents, but some experts in the United States worry that it could influence private payers here.

The National Institute for Clinical Excellence (NICE), the independent body that recommends which medical therapies the National Health System (NHS) should provide in England and Wales, has proposed that donepezil, rivastigmine, galantamine, and memantine no longer be used to treat Alzheimer’s disease. Although acknowledging that the drugs provide moderate, short-term cognitive and behavioral benefit for some Alzheimer’s patients, NICE’s proposal holds that the drugs fail to delay time to institutional placement and thus are not cost effective.

The proposal appears to be a wholly economic one, according to the draft document and experts in both the United Kingdom and the United States. Although the drugs aren’t prohibitively expensive on an individual basis—annual therapy runs about $2,000 per patient—they cost the NHS the equivalent of $92 million in 2004. As in the United States, the United Kingdom has projected steadily increasing Alzheimer’s drug expenditures, saying spending could exceed $134 million by 2006. The total NHS 2004 budget was about $151 billion.

Withdrawing the drugs from the NHS could save $29 million the first year and $115 million by the third year, the document said.

The U.K. proposal would have no effect on national policy this side of the Atlantic, said Peter Ashkenaz, spokesman for the Centers for Medicare and Medicaid Services. The federal government has already committed to offering at least two cholinesterase inhibitors as part of the Medicare Prescription Drug Improvement and Modernization Act of 2003. The new coverage will begin in January 2006. Mr. Ashkenaz did not know which two in the class would be covered.

“As long as these drugs are approved by the Food and Drug Administration for Alzheimer’s, they will be covered under the new prescription drug benefit,” he told this newspaper.

But should the proposal pass, some U.S. dementia experts are concerned about spillover into the policies of private payers and managed care systems. “Insurance companies worldwide are always looking to minimize their expenses,” said Samuel Gandy, M.D., professor of psychiatry, neurology, and gerontology at Philadelphia University and director of the Farber Institute for Neurosciences, Philadelphia. “I would predict that the U.S. insurance companies are watching this very closely.”

This country’s private health care system is a “patchwork” of different companies that make decisions based on both economic and clinical factors, Lon S. Schneider, M.D., said in an interview. A national dictum condemning a class of drugs as not cost effective will get plenty of notice, he predicted.

“Private payers are really this country’s prescription benefits managers, and they are constantly assessing whether the drugs on their formularies are working and are cost effective,” said Dr. Schneider, professor of psychiatry, neurology, and gerontology at the University of Southern California, Los Angeles. “They are very interested in the NICE decision and analyses, which may have implications into how these companies manage their pharmacies.”

If the recommendation is accepted, no new prescriptions for antidementia drugs will be written through the NHS, although the drugs will not be withdrawn from patients already taking them.

Physicians, advocacy groups, and families in the United Kingdom have bitterly criticized the proposal, announced on March 1. Protesters contend that the drugs’ true value can’t be measured by a single outcome and have complained that the public comment period of only 3 weeks was far too short. They also said the decision would contribute to health care disparity in the country, since patients could still obtain the drugs through a full-price private prescription.

Britain’s health minister, Stephen Ladyman, said his department will ask NICE to reconsider its cost analysis, taking into account the economic and social benefits the drugs provide to caregivers, as well as to patients. But the minister also said he wouldn’t interfere with NICE’s decision-making process.

NICE is expected to render its final recommendation in July.

Damn! And the U.K calls itself a civilized society?

How could you possibly equate the rationing of Alzheimer’s disease care with cost?

I suggest that Tony Blair and his Labour Party get off their arses, privitize a few industries and use the resulting mega-increase in tax revenues to support their own citizens.

Indeed!

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Health

Stem Cell Therapy – An ALS Treatment?

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The Associated Press has the following story about the use of Stem Cells to possibly treat ALS – Lou Gehrig’s Disease:

A University of Wisconsin-Madison researcher said he would ask federal regulators Friday to approve the first clinical trial injecting special stem cells into the spinal cords of people with the degenerative nerve ailment called Lou Gehrig’s disease.

The trial would test whether a technique anatomy professor Clive Svendsen has pioneered on rats afflicted with the disease is safe to use on people. If successful, Svendsen said a much larger clinical trial aimed at treating the disease could be under way in two or three years.

About 30,000 Americans currently have the disease, which gradually kills brain cells that control muscle movement. The disease, formally known as amyotrophic lateral sclerosis, or ALS, typically can lead to death in a few years and has virtually no treatment.

Svendsen and his colleagues are asking the U.S. Food and Drug Administration for approval to bypass testing the technique on primates, typically the next step after rats, and to go straight to humans. The trial would involve five ALS patients treated by neurosurgeons at the Cleveland Clinic.

The trial would build on research Svendsen published this week in the journal Human Gene Therapy, which found that injecting certain types of stem cells into the spinal cords of rats could help stave off the disease and potentially prolong their lives.

Svendsen and his colleagues said the study was the first to show that the stem cells carrying a protein that fights ALS could flourish after being injected into their bodies.

The ALS Association, which is spending millions of dollars to fund Svendsen and other researchers rushing to find a cure, called the research encouraging.

“It is so exciting to see how rapidly ideas are moving from the laboratory into potential clinical applications through strong collaborations with leading investigators,” the association’s science director, Lucie Bruijn, said in a statement Thursday.

While noting the promise of his research, Svendsen sought to play down expectations, saying a cure of the debilitating disease was still years away.

“We’re not going to cure ALS in the first clinical trial,” Svendsen said Thursday at a forum on bioethics in Madison. “We’re going to tell the patients that as well.”

The research does not involve human embryonic stem cells, the blank-slate cells derived from human embryos that can be molded into any type of tissue cell in the body.

Researchers are instead using neural progenitor cells in fetal brain tissue, which are in the early stages of brain development. Those cells – derived from miscarried fetuses – are obtained through the National Institutes of Health.

Svendsen’s research team first created stem cells that pumped the disease-fighting protein, and then had to find the exact location in the rat’s spinal cord to inject them to fight ALS. The latter step took months of trial and error but may help surgeons deliver the treatment to humans.

Svendsen acknowledged the clinical trial proposal was risky. If the research on humans fails or is deemed unsafe, it could set back the field for years.

But he said waiting to unleash a potential cure for the lethal disease was unacceptable and the research has been safe so far.

“We’re hoping the FDA doesn’t require a lot more animal work,” he said.

Having seen this devastating disease ravage at least three men I have known, I can only pray that these trials will be successful.

Note: this treatment invovles Stem-Cells but not Embryonic Stem-Cells from Aborted fetuses.

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