July 2007

Bottled Water and Dental Cavities. Plus Grandparent Advisory.
Over the Counter Fountain of Youth
Need to Take Antibiotics Before a Dental Office Visit? Maybe Not
Lumbar Disks Again
Treatment of Muscle Pain for Those Taking Cholesterol Lowering Medications
Dying for a Nicotine Fix
How Much Exercise Is Enough?
Kisses Lower Blood Pressure


Bottled Water and Dental Cavities. Plus Grandparent Advisory!
Fluoride in tap water is known to reduce dental cavities. So the recent increase in the use of bottled water, with some families never drinking any tap water, is troubling. In addition, filtering water removes variable amounts of fluoride. Worse yet, a third of US homes, including most that use well water, contain little or no fluoride. What to do? Fluoride supplements aren’t the answer because they can cause discoloration of the enamel. If the children are largely drinking bottled water, it may be useful to look in the baby-food aisle at the grocery store for "baby water" or "nursery water", which usually contains fluoride. Over-the-counter fluoride rinses and self-applied gels may also be used in children who are able to rinse and spit properly. Grandparent advisory: Carefully weigh the price of another fraught discussion with your grandchild’s parents against the risk of few extra cavities.


An Over the Counter Fountain of Youth
Aging, as some might know, leads to skin that is thin, lax, finely wrinkled, fragile, easily traumatized, and slow to heal. In a randomized, double-blind study, 36 subjects age 80 or older (mean age, 87) applied over-the-counter Vitamin A ointment (0.4% retinol) to one arm and a placebo ointment to the other about three times a week for 24 weeks. Treatments were skipped when the arm became irritated or excessively dry.

A 10-point scale that included wrinkling and roughness was used to evaluate changes from start to the end of treatment. Overall, the effects of aging improved by 1.25 points from Vitamin A and worsened by 0.06 on the control arm. Most subjects experienced some mild irritation on the retinol-treated arm, and five withdrew from the study for this reason. Twenty four weeks after retinol treatment ended , the royal carriage turned back into a pumpkin.

Need to Take Antibiotics Before a Dental Office Visit? Maybe Not
For the past ten years, it had been recommended that, to prevent endocarditis (infection of the heart valves), patients with virtually any kind of heart abnormality, including mitral valve prolapse, should take antibiotics before having a dental procedure. For a long time, many experts have questioned this strategy, noting that exposure to bacteria from tooth brushing or flossing year round gives thousands of times greater exposure than a few dental visits a year.

Recently, the American Heart Association reduced the list of cardiac conditions needing antibiotic prophylaxis before dental visits to four (artificial valves, infected valves, cardiac transplants, and certain congenital heart problems.) Most conditions, including mitral valve prolapse, were removed from the list. Also excluded were genito-urinary procedures unless there is a urine infection present and gastrointestinal procedures. The guidelines are posted on-line at dx.doi.org/10.1161/CIRCULATIONAHA.106.183095.

Lumbar Disks Again
Yet another study, this one of 683 patients, found that people with lumbar disk problems were no better a year after surgery than those who did not have an operation although the former had less pain in the first four to twelve weeks post-op.

Coenzyme Q10 for Muscle Pain in Those Taking Cholesterol Lowering Medication
The most commonly used medications to reduce high blood cholesterol, statins, often cause muscle related pain. They also interfere with the action of coenzyme Q10, which is necessary for producing energy in muscles. Hmm. Maybe giving extra Q10, despite its hokey name, could reduce the muscle pain. Thirty two patients taking statins and having muscle pain were treated with Q10 or a placebo. At 30 days, pain intensity decreased by 40% in those taking Q10 vs. no decrease for those taking placebo.

Dying for a Nicotine Fix
Most readers of Medical-Intelligence might have trouble thinking of an acquaintance who smokes. But they’re still out there. When they are hospitalized for a critical illess, would it hurt to give these poor folks a nicotine patch to ease their withdrawal symptoms? Well yes, it would. During their first 24 hours of admission, 90 smokers were given a nicotine patch and 90 not. Twenty percent of those given the patch died while in the hospital; only 7% of those not given the patch died. Sometimes you’re better off with a doctor who is not so tender hearted.

How Much Exercise Do You Have To Do to Increase Your Good Cholesterol
A recent study found that study participants could increase their HDL by over 2 mg/dL by exercising a minimum of two hours per week. Exercise sessions had to last at least 30 minutes but it didn’t matter how frequent or strenuous they were.

Kisses Lower Blood Pressure
At least five studies have found that people with high blood pressure who ate dark chocolate for varying lengths of time (up to 15 years) had lower blood pressure than those who ate white chocolate or drank tea.. In one study the "dose" of chocolate required to lower pressure was the equivalent of one and a half Hershey Kisses per day.