- Email: [email protected]
ASSOCIATION BETWEEN IBUPROFEN, ASPIRIN THERAPY FOUND
N
E
W
S
ANTIBIOTIC PRESCRIPTION RATES DROP
he rate of antibiotics prescribed to nonhospitalized patients decreased by about one-fourth in the 1990s, according to a study presented at the Interscience Conference on Antimicrobial Agents and Chemotherapy in December. Researchers from the Centers for Disease Control and Prevention analyzed data from two national surveys that included about 2,500 physicians and 500 hospitals annually, as well as 29,000 patient visits for each site per year. They found that prescription rates dropped from 599 antibiotics prescribed per 1,000 population to 440 antibiotics prescribed, and from 166 antibiotics prescribed per 1,000 patient visits to 127 antibiotics prescribed. Prescription rates, however, did not change in emergency departments and outpatient clinics. One troubling finding of the study, according to researchers, was an increase in the number of prescriptions for the antibiotics azithromycin and clarithromycin and for quinolones, a class of drugs that includes ciprofloxacin. Prescription rates for azithromycin rose more than 400 percent from 1992 to 1999. Every time these broadspectrum drugs are taken, the risk of resistance to them increases, said researchers. They pointed to ciprofloxacin and its importance in treating people who may have been exposed to anthrax. The more a drug like ciprofloxacin is used unnecessarily, the more likely bacteria are to develop resistance to it. Researchers concluded that
T
278
efforts are needed to encourage appropriate antibiotic use in emergency departments and hospital outpatient clinics, and more studies are needed to investigate the rise in the number of prescriptions for broadspectrum antibiotics. MOUTHGUARDS LOWER DENTAL INJURIES
esearchers at the University of North Carolina have found that custom-fitted mouthguards can protect against dental injuries in athletes who play men’s college basketball. In the January issue of Medicine and Science in Sports and Exercise, a publication of the American College of Sports Medicine, researchers reported findings from a prospective study of 50 men’s Division I college basketball teams during the 1999-2000 season. Each week, the teams’ athletic trainers reported data on the players’ dental injuries and concussions. Researchers compiled the data and then compared the injury and concussion rates of players who wore custom-fitted mouthguards with those who did not. They found no significant differences in the rates of concussions and oral soft-issue injuries among mouthguard users and nonusers. They did, however, find that mouthguard users had significantly lower rates of dental injuries and referrals to dentists than did nonusers. “Dental injuries can be permanent and disfiguring,” said lead author Cynthia R. LaBella, M.D. “They also are universally expensive to treat.” The research team of Dr. LaBella, Bryan W. Smith, M.D.,
R
and Dr. Asgeir Sigurdsson estimated that the minimum initial cost per dentist referral for treatment of a serious dental injury was $1,000. “There is no question that this is substantially more expensive than the cost of providing an entire team with custom-fitted mouthguards, for which the direct cost in materials is less than $20 per player,” they wrote. They concluded that their study provides a strong rationale for health care providers to recommend mouthguard use in college basketball players, as the devices can reduce significantly the morbidity and expense resulting from dental injuries. ASSOCIATION BETWEEN IBUPROFEN, ASPIRIN THERAPY FOUND
buprofen treatment in patients who are at increased risk of developing cardiovascular disease may limit the cardioprotective effects of aspirin therapy, according to a study in the Dec. 20 issue of the New England Journal of Medicine. Researchers at the University of Pennsylvania School of Medicine administered 81 milligrams of aspirin two hours before administering 400 mg of ibuprofen to subjects every morning for six days, followed by a washout period of at least 14 days. They then administered the drugs in the reverse order. A second group of subjects received 1,000 mg of acetaminophen for six days and then the same drugs in the reverse order. A third group received aspirin two hours before receiving 25 mg of the cyclooxygenase-2 inhibitor rofecoxib and Continued on page 280
I
JADA, Vol. 133, March 2002 Copyright ©2002 American Dental Association. All rights reserved.
N E W S
QU E STION OF TH E MONTH In the aftermath of the Sept. 11 terrorist attacks, have you noted any quantifiable effect on your dental practice? “Our practice experienced a six-week mourning period,” said a dentist who responded “yes” to December JADA’s Question of the Month. Overall, 56 percent of respondents said the terrorist attacks of Sept. 11 had had a quantifiable effect on their practices. Several of these dentists said they noticed changes in their patients’ behavior, including wanting anthrax vaccinations, being “sad and edgy” and wanting to talk about the attacks, as well as an increase in clenching and broken teeth. “We began calling the increased ‘jaw pain’ we saw in September ‘CNN syndrome’ and counseled patients to turn off the 24-hour news reports,” said one dentist. “Then we saw a wave of cusp fractures on posterior teeth through the end of October. Coincidence?” About three-fourths of the dentists who answered “yes” said they saw a decrease in revenue and production after Sept. 11. “The bottom dropped out of my practice,” said one. “September and October were down 50 percent compared with the other months in 2001.” “December was so slow it wasn’t even worth the effort to show up to work,” said another. Some also attributed these slowdowns to the weak economy. “Patients who are uncertain about the future of their jobs are some-
what reluctant to initiate large cases or extensive care,” said one reader. “And those who have lost employment and benefits are not seeking dental care.” A handful of respondents said their practices have gone back to normal. “After Sept. 11, we did have a slowdown,” said one. “Fortunately, things have picked up. In fact, production seems to be better.” Forty percent of respondents said they did not notice any quantifiable effects on their practices resulting from Sept. 11. A few, however, did mention they had cancellations for a few days afterwards, but then things got back to normal. “Initially, everyone seemed to be in shock, but within two to four weeks our practice returned to a very normal pace,” one respondent wrote. Many of those who noticed a slowdown in their practices attributed it to the downward trend in the economy. “Here in Michigan, the economic recession has affected my practice more than the Sept. 11 events,” said a respondent. “Production per day was quantitatively down starting in July 2001,” said another. Four percent of respondents said they did not know if the terrorist attacks had affected their practices. “Any decrease may be due to the ‘dot com’ decline here in California and then there could have been a delay in the economy recovering due to Sept. 11,” said one reader. ■ Reported by Amy E. Lund, editorial coordinator.
JADA’s Question of the Month is presented as an opportunity for readers to express their views on the issues of the day, for the interest of their colleagues in dentistry. The Question of the Month does not qualify as a scientific survey, and its findings should not be construed as statistically significant.
JADA, Vol. 133, March 2002 Copyright ©2002 American Dental Association. All rights reserved.
279
N E W S
Continued from page 278 then received the same drugs in the reverse order. Researchers also examined the effects of a single daily dose of enteric-coated aspirin administered two hours before the first of three 400-mg doses of ibuprofen and enteric-coated aspirin administered two hours before the first of two 75-mg doses of delayed-release diclofenac. Results show that serum thromboxane B2 (an index of cyclooxygenase-1 activity in platelets) and platelet aggregation reached their maximum inhibition levels 24 hours after
aspirin was administered on day 6 in subjects who took aspirin before a single daily dose of any other drug, as well as in subjects who took rofecoxib or acetaminophen before taking aspirin. When a single daily dose of ibuprofen was administered before aspirin or when multiple daily doses of ibuprofen were administered, however, inhibition of serum thromboxane B2 formation and platelet aggregation by aspirin was blocked. Researchers found that concomitant administration of rofecoxib, acetaminophen or diclofenac with aspirin did not
MEETINGS
tact Petra Mottmann by phone at 011-49-221-821-3586, by fax at 011-49-221-821-2092 or by e-mail at “[email protected]”. dThe American Academy of Oral Medicine will hold its 56th Annual Meeting April 23-27 in Ft. Lauderdale, Fla. For more information, contact Joyce Caplan by phone at 1-410-6028585 or visit “www.aaom.com”. dThe American Cleft PalateCraniofacial Association will hold its 59th Annual Meeting April 30-May 5 in Seattle. For more information, contact Nancy Smythe by phone at 1-919-933-9044, by fax at 1-919933-9604 or by e-mail at “[email protected]”. dThe British and Ireland Dental Associations’ Conference will be held May 2-4 in Belfast. For more information, contact Siobhán McManus by phone at 011-44-20-7563-4490, by fax at 011-44-20-7563-4491 or by e-mail at “events@bda-dentistry. org.uk”.
dThe American Association of Endodontists will hold its 59th Annual Session April 10-14 in Chicago. For more information, contact Lori Edmunds by phone at 1-312-266-7255, by fax at 1-312-266-9867 or by e-mail at “[email protected]”. dThe American College of Oral and Maxillofacial Surgeons will hold its 23rd Annual Conference April 10-14 in Biloxi, Miss. For more information, contact Emelie Schnettler by phone at 1-210-344-5674, by fax at 1-210-344-9754 or by e-mail at “[email protected]”. dThe Danish Dental Association will hold its annual meeting April 11-13 in Copenhagen. For more information, contact Dr. Frank Senderovitz by phone at 011-45-33-48-7768, by fax at 011-45-33-48-7795 or by e-mail at “[email protected]”. dIDEM Singapore 2002 will convene April 12-14 in Suntec City. For more information, con-
280
affect the pharmacodynamics of aspirin. CORRECTIONS
dThe telephone number for the Virginia Dental Association was incorrectly listed in the December JADA Calendar of Events. The correct number is 1-804-261-1610. dThe source of the January JADA news item “White Blood Cell Defect May Lead to Periodontitis” was cited incorrectly. The correct source is the June 2001 issue of the Journal of Clinical Periodontology. Compiled by Amy E. Lund, editorial coordinator, and Janice Snider, project editor.
dThe American Academy of Pediatric Dentistry will hold its 55th Annual Session May 23-28 in Denver. For more information, contact Catherine Hay by phone at 1-312-337-2169, by fax at 1-312-337-6329 or by e-mail at “[email protected]”. dThe Canadian Dental Association will hold a joint convention with Les Journées Dentaires Internationales du Québec May 25-29 in Montreal. For more information, contact Susan MacDonald by phone at 1-613-523-1770, by fax at 1-613523-7736 or by e-mail at “[email protected]”. dThe Academy of Dental Sleep Medicine will hold its 11th Annual Conference June 7-9 in Seattle. For more information, contact Mary Beth Rogers by phone at 1-724-935-0836, by fax at 1-724-935-0383 or visit “www.dentalsleepmed.org”. dThe FDI World Dental Federation will hold its Annual World Dental Congress Oct. 1-5
JADA, Vol. 133, March 2002 Copyright ©2002 American Dental Association. All rights reserved.
E
W
S
ANTIBIOTIC PRESCRIPTION RATES DROP
he rate of antibiotics prescribed to nonhospitalized patients decreased by about one-fourth in the 1990s, according to a study presented at the Interscience Conference on Antimicrobial Agents and Chemotherapy in December. Researchers from the Centers for Disease Control and Prevention analyzed data from two national surveys that included about 2,500 physicians and 500 hospitals annually, as well as 29,000 patient visits for each site per year. They found that prescription rates dropped from 599 antibiotics prescribed per 1,000 population to 440 antibiotics prescribed, and from 166 antibiotics prescribed per 1,000 patient visits to 127 antibiotics prescribed. Prescription rates, however, did not change in emergency departments and outpatient clinics. One troubling finding of the study, according to researchers, was an increase in the number of prescriptions for the antibiotics azithromycin and clarithromycin and for quinolones, a class of drugs that includes ciprofloxacin. Prescription rates for azithromycin rose more than 400 percent from 1992 to 1999. Every time these broadspectrum drugs are taken, the risk of resistance to them increases, said researchers. They pointed to ciprofloxacin and its importance in treating people who may have been exposed to anthrax. The more a drug like ciprofloxacin is used unnecessarily, the more likely bacteria are to develop resistance to it. Researchers concluded that
T
278
efforts are needed to encourage appropriate antibiotic use in emergency departments and hospital outpatient clinics, and more studies are needed to investigate the rise in the number of prescriptions for broadspectrum antibiotics. MOUTHGUARDS LOWER DENTAL INJURIES
esearchers at the University of North Carolina have found that custom-fitted mouthguards can protect against dental injuries in athletes who play men’s college basketball. In the January issue of Medicine and Science in Sports and Exercise, a publication of the American College of Sports Medicine, researchers reported findings from a prospective study of 50 men’s Division I college basketball teams during the 1999-2000 season. Each week, the teams’ athletic trainers reported data on the players’ dental injuries and concussions. Researchers compiled the data and then compared the injury and concussion rates of players who wore custom-fitted mouthguards with those who did not. They found no significant differences in the rates of concussions and oral soft-issue injuries among mouthguard users and nonusers. They did, however, find that mouthguard users had significantly lower rates of dental injuries and referrals to dentists than did nonusers. “Dental injuries can be permanent and disfiguring,” said lead author Cynthia R. LaBella, M.D. “They also are universally expensive to treat.” The research team of Dr. LaBella, Bryan W. Smith, M.D.,
R
and Dr. Asgeir Sigurdsson estimated that the minimum initial cost per dentist referral for treatment of a serious dental injury was $1,000. “There is no question that this is substantially more expensive than the cost of providing an entire team with custom-fitted mouthguards, for which the direct cost in materials is less than $20 per player,” they wrote. They concluded that their study provides a strong rationale for health care providers to recommend mouthguard use in college basketball players, as the devices can reduce significantly the morbidity and expense resulting from dental injuries. ASSOCIATION BETWEEN IBUPROFEN, ASPIRIN THERAPY FOUND
buprofen treatment in patients who are at increased risk of developing cardiovascular disease may limit the cardioprotective effects of aspirin therapy, according to a study in the Dec. 20 issue of the New England Journal of Medicine. Researchers at the University of Pennsylvania School of Medicine administered 81 milligrams of aspirin two hours before administering 400 mg of ibuprofen to subjects every morning for six days, followed by a washout period of at least 14 days. They then administered the drugs in the reverse order. A second group of subjects received 1,000 mg of acetaminophen for six days and then the same drugs in the reverse order. A third group received aspirin two hours before receiving 25 mg of the cyclooxygenase-2 inhibitor rofecoxib and Continued on page 280
I
JADA, Vol. 133, March 2002 Copyright ©2002 American Dental Association. All rights reserved.
N E W S
QU E STION OF TH E MONTH In the aftermath of the Sept. 11 terrorist attacks, have you noted any quantifiable effect on your dental practice? “Our practice experienced a six-week mourning period,” said a dentist who responded “yes” to December JADA’s Question of the Month. Overall, 56 percent of respondents said the terrorist attacks of Sept. 11 had had a quantifiable effect on their practices. Several of these dentists said they noticed changes in their patients’ behavior, including wanting anthrax vaccinations, being “sad and edgy” and wanting to talk about the attacks, as well as an increase in clenching and broken teeth. “We began calling the increased ‘jaw pain’ we saw in September ‘CNN syndrome’ and counseled patients to turn off the 24-hour news reports,” said one dentist. “Then we saw a wave of cusp fractures on posterior teeth through the end of October. Coincidence?” About three-fourths of the dentists who answered “yes” said they saw a decrease in revenue and production after Sept. 11. “The bottom dropped out of my practice,” said one. “September and October were down 50 percent compared with the other months in 2001.” “December was so slow it wasn’t even worth the effort to show up to work,” said another. Some also attributed these slowdowns to the weak economy. “Patients who are uncertain about the future of their jobs are some-
what reluctant to initiate large cases or extensive care,” said one reader. “And those who have lost employment and benefits are not seeking dental care.” A handful of respondents said their practices have gone back to normal. “After Sept. 11, we did have a slowdown,” said one. “Fortunately, things have picked up. In fact, production seems to be better.” Forty percent of respondents said they did not notice any quantifiable effects on their practices resulting from Sept. 11. A few, however, did mention they had cancellations for a few days afterwards, but then things got back to normal. “Initially, everyone seemed to be in shock, but within two to four weeks our practice returned to a very normal pace,” one respondent wrote. Many of those who noticed a slowdown in their practices attributed it to the downward trend in the economy. “Here in Michigan, the economic recession has affected my practice more than the Sept. 11 events,” said a respondent. “Production per day was quantitatively down starting in July 2001,” said another. Four percent of respondents said they did not know if the terrorist attacks had affected their practices. “Any decrease may be due to the ‘dot com’ decline here in California and then there could have been a delay in the economy recovering due to Sept. 11,” said one reader. ■ Reported by Amy E. Lund, editorial coordinator.
JADA’s Question of the Month is presented as an opportunity for readers to express their views on the issues of the day, for the interest of their colleagues in dentistry. The Question of the Month does not qualify as a scientific survey, and its findings should not be construed as statistically significant.
JADA, Vol. 133, March 2002 Copyright ©2002 American Dental Association. All rights reserved.
279
N E W S
Continued from page 278 then received the same drugs in the reverse order. Researchers also examined the effects of a single daily dose of enteric-coated aspirin administered two hours before the first of three 400-mg doses of ibuprofen and enteric-coated aspirin administered two hours before the first of two 75-mg doses of delayed-release diclofenac. Results show that serum thromboxane B2 (an index of cyclooxygenase-1 activity in platelets) and platelet aggregation reached their maximum inhibition levels 24 hours after
aspirin was administered on day 6 in subjects who took aspirin before a single daily dose of any other drug, as well as in subjects who took rofecoxib or acetaminophen before taking aspirin. When a single daily dose of ibuprofen was administered before aspirin or when multiple daily doses of ibuprofen were administered, however, inhibition of serum thromboxane B2 formation and platelet aggregation by aspirin was blocked. Researchers found that concomitant administration of rofecoxib, acetaminophen or diclofenac with aspirin did not
MEETINGS
tact Petra Mottmann by phone at 011-49-221-821-3586, by fax at 011-49-221-821-2092 or by e-mail at “[email protected]”. dThe American Academy of Oral Medicine will hold its 56th Annual Meeting April 23-27 in Ft. Lauderdale, Fla. For more information, contact Joyce Caplan by phone at 1-410-6028585 or visit “www.aaom.com”. dThe American Cleft PalateCraniofacial Association will hold its 59th Annual Meeting April 30-May 5 in Seattle. For more information, contact Nancy Smythe by phone at 1-919-933-9044, by fax at 1-919933-9604 or by e-mail at “[email protected]”. dThe British and Ireland Dental Associations’ Conference will be held May 2-4 in Belfast. For more information, contact Siobhán McManus by phone at 011-44-20-7563-4490, by fax at 011-44-20-7563-4491 or by e-mail at “events@bda-dentistry. org.uk”.
dThe American Association of Endodontists will hold its 59th Annual Session April 10-14 in Chicago. For more information, contact Lori Edmunds by phone at 1-312-266-7255, by fax at 1-312-266-9867 or by e-mail at “[email protected]”. dThe American College of Oral and Maxillofacial Surgeons will hold its 23rd Annual Conference April 10-14 in Biloxi, Miss. For more information, contact Emelie Schnettler by phone at 1-210-344-5674, by fax at 1-210-344-9754 or by e-mail at “[email protected]”. dThe Danish Dental Association will hold its annual meeting April 11-13 in Copenhagen. For more information, contact Dr. Frank Senderovitz by phone at 011-45-33-48-7768, by fax at 011-45-33-48-7795 or by e-mail at “[email protected]”. dIDEM Singapore 2002 will convene April 12-14 in Suntec City. For more information, con-
280
affect the pharmacodynamics of aspirin. CORRECTIONS
dThe telephone number for the Virginia Dental Association was incorrectly listed in the December JADA Calendar of Events. The correct number is 1-804-261-1610. dThe source of the January JADA news item “White Blood Cell Defect May Lead to Periodontitis” was cited incorrectly. The correct source is the June 2001 issue of the Journal of Clinical Periodontology. Compiled by Amy E. Lund, editorial coordinator, and Janice Snider, project editor.
dThe American Academy of Pediatric Dentistry will hold its 55th Annual Session May 23-28 in Denver. For more information, contact Catherine Hay by phone at 1-312-337-2169, by fax at 1-312-337-6329 or by e-mail at “[email protected]”. dThe Canadian Dental Association will hold a joint convention with Les Journées Dentaires Internationales du Québec May 25-29 in Montreal. For more information, contact Susan MacDonald by phone at 1-613-523-1770, by fax at 1-613523-7736 or by e-mail at “[email protected]”. dThe Academy of Dental Sleep Medicine will hold its 11th Annual Conference June 7-9 in Seattle. For more information, contact Mary Beth Rogers by phone at 1-724-935-0836, by fax at 1-724-935-0383 or visit “www.dentalsleepmed.org”. dThe FDI World Dental Federation will hold its Annual World Dental Congress Oct. 1-5
JADA, Vol. 133, March 2002 Copyright ©2002 American Dental Association. All rights reserved.