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Electronic cigarettes (e-cigarettes) pose important issues relevant to tobacco harm reduction. This post will review the facts about these products, which have been the subject of exaggerated claims by e-cigarette proponents and nicotine prohibitionists alike. Aswith most complex issues, the truth about e-cigarettes lies somewherein between.

When users draw on them, battery powered cigarettes vaporize a mixture of water, propylene glycol, nicotine and flavorings. Nicotine is one of the most intensively studied drugs in history; while it is highly addictive, it is not the primary cause of virtually any of thediseases related to smoking. In fact, long-term nicotine consumptionis about as safe as that of caffeine. Propylene glycol is approved by the FDAfor use in a large number of consumer products; it, too, is sometimesvaporized, forming artificial smoke in theatrical and otherproductions.

It is almost certain that e-cigarette use (also called vaping) is vastly safer than cigarette smoking, but this is based on limited scientific evidence. Some questions remain unanswered.

The health effects of long-term exposure of the respiratory tract to propylene glycol vapor are unknown, and unknowable. As a health professional, I am more comfortable recommending a product with a defined risk profile, where a clear risk-benefit analysis can be evaluated. That is why I have beena strong supporter of smokeless tobacco products as cigarette substitutes.I recommend these products knowing that we have 50 years ofepidemiology documenting the extremely low level of health risks.E-cigarette consumers must understand that the safety of e-cigarettescan not be guaranteed, despite the likelihood that they pose but a tinyfraction of the health risks of regular cigarettes. But given thepaucity of legitimate research, specific safety claims for e-cigarettescan not be made.

There is a lot of uncertainty with respect to the reliability of e-cigarettes, essentially all of which are imported from China. One of my colleagues ordered numerous products with the intent of performing some routine tests; many of these products did not function properlyright out of the box. According to a recent clinical study of twobrands (abstract here),“…neither of the electronic cigarettes exposed users to measurablelevels of nicotine or [carbon monoxide]…” Not inhaling carbon monoxideis a good thing, but for addicted smokers, not getting nicotine may be aproblem. Many e-cigarette users know that the devices often don’tdeliver enough nicotine to satisfy them, so they re-load cartridges witheven higher doses from commercially available concentrated solutions.Concentrated nicotine is dangerous, and this kind of experimentationis bound to lead to injuries.

The same study showed that “…both [brands] suppressed nicotine/tobacco abstinence symptom ratings.” This is impressive, because it indicates that e-cigarettes simulate the behavioral aspects of smoking and therefore may be successful in ways that no othersmoking cessation product can match.

Electronic cigarette cartridges may contain hazardous contaminants. Last year, the FDA conducted laboratory tests on a few e-cigarette cartridges. Although the tests were biased and flawed (as I discussed here), they found in one cartridge traces of diethylene glycol, a poisonous impurity found previously in propylene glycol (reported here).

Consumer products should be free of contaminants. Cartridges, as well as the hardware, should be subjected to independent quality control testing. The FDA tests underscored the need for regulatory oversight. This could be accomplished if the FDA regulatede-cigarettes as recreational tobacco products under authority from theTobacco Act. Instead, the FDA is attempting, inappropriately accordingto one federal judge, to regulate them as drug-delivery devices(discussed here).That would effectively remove them from the American market, leavinghundreds of thousands of e-cigarette users with no satisfactoryalternative to tobacco combustion.

There is no justification or scientific rationale to ban e-cigarettes. Still, anti-tobacco extremists are campaigning against them, claiming, entirely without proof, that they are a starter tobacco product for children. As with all tobacco products, they should notbe available to minors.

Another battle rages over whether e-cigarettes can be used safely indoors. Some militant users object to any indoor restrictions, while prohibitionists claim that second-hand vapor is annoying and/or toxic. The latter claim is preposterous, but e-cigarette users who arecourteous and respectful toward bystanders are likely to lead longer,healthier and less stressful lives.

Actor Michael Douglas' recent revelation that he has stage IV oral cancer has highlighted the growing incidence of oral cancer, and experts say dentists can help stem the alarming increase of the disease by checking for it during routine examinations.

The actor's cancer includes a walnut-sized tumor at the base of his
tongue, and he will require radiation therapy, chemotherapy, and
surgery. Douglas says his doctors told him he has an 80% survival rate
if it hasn't spread to his lymph nodes.

While tobacco was the prime cause of oral cancer in the past, recent studies have attributed the steady increase of the disease to
the human papillomavirus (HPV). HPV are common viruses that cause
warts. There are approximately 130 versions of HPV but only nine cause
cancers, and the HPV16 version causes almost half of the oral cancers in the U.S., said Brian Hill, executive director of the Oral Cancer Foundation.

"Tobacco is no longer the only bad guy," he told DrBicuspid.com. “HPV16 is increasing in incidence as the causative etiology, and if it
continues on this trend line, it will replace tobacco as the primary
cause of oral cancers."

Dentists can play a key role in catching the disease in its early stages if they check for it during examinations. Most Americans have
never even heard of oral cancer, but it's not as rare or
uncommon as people would like to think it is. This is why an
opportunistic screening by the dental community is so important.

Hill, a nonsmoker, got the same diagnosis as Douglas in 1998 and underwent radiation therapy, chemotherapy, and surgery. Since Hill's
oral cancer had metastasized to both sides of his neck by the time it
was discovered, surgeons removed the right side of his neck to remove
the lymph nodes there. He has been cancer-free for 10 years and said
there are a lot of stage IV survivors out there.

Changing demographics

In the last decade, the demographics of oral cancer have changed dramatically, according to Hill and other experts, pointing to the sexual revolution and accompanying increase in the prevalence of oral
sex. Today almost half of those diagnosed with the disease are younger
than 50 years old -- with some as young as 20, according to Hill -- and
they are usually nonsmokers. According to the American Cancer Society,
oral cancer occurs almost as frequently as leukemia and claims more
lives than melanoma or cervical cancer. The incidence in oral cancer
patients younger than age 40 has increased nearly fivefold, with many
patients with no known risk factors, according to the ADA.

"Social and sexual behaviors have changed," Hill said. "Oral sex is more common. The virus is spreading, especially among young people because sexual contact is more common, and this virus is not only ubiquitous in our society, but the mechanism of transfer is very simple."

Until 2000, scientists were unsure if HPV caused oral cancer, Hill said, but definitive research in 2000 revealed it as a distinct etiology for the disease, and more recent studies have supported this finding.

The disease is dangerous because often there are no symptoms in the early stages that a person might notice. "It's a very insidious disease," Hill explained. He recalled that it was not until a lymph node became swollen that Hill realized something was wrong. Even then, it was not painful, he said. Typically there are no physical signs of oral cancer. But an alert dentist will notice subtle signs and symptoms of oral cancer in a simple three to five minute visual and tactile exam, Hill noted.
"There will be things he'll pick up on, and that's why we're urging that the dental community to become more involved in oral cancer screening," he said. Approximately 36,000 new cases of oral cancer are diagnosed each yearin the U.S., according to the ADA, and some 25% of those people will die of the disease. Only 57% of all diagnosed oral cancer patients will be alive five years after their diagnosis, Hill said. Approximately 100 people in the U.S. will be diagnosed with oral cancer every day, he added, and one person will die every hour from it.

And unfortunately, celebrities with cancer helps bring about much needed public awareness about the disease, said Hill, noting that, in addition to Michael Douglas, such luminaries as Sigmund Freud and Ulysses S. Grant have been among its victims.

"When somebody famous gets the disease, it finally gets the world's attention," he noted.

That's a line by Galagher and it made me think. I'd like to find the knob that turns up the brightness for the dental profession. I don't mean they're stupid...although sometimes I think they have difficulty seeing the light. I also mean dentistry is not such a dark picture!

I'm amazed at how much sifting I have to do to get past the "marketing" blogs, commercials for marketing or the throngs of dentists who promote cosmetics (the commoditization of what is a healing art) to get to anyone talking about the opportunities in the industry rather than lament about how the economy is bringing them down.

What must it be like for those caring souls out there who really want some enlightenment that isn't about market more, blog more, facebook more or sign up for this marketing magic bullet?

Many are highly ineffective with the people they currently serve and don't know what to do about it except go get more people. They don't feel good about selling and don't want to. They feel like they're in a swamp with the alligators licking at their heels. That's from a journal in the early 70's.. the golden days of insurance it was called. For those not a old as me; there was a time when insurance paved the way for dentists who faced the same challenge that remains today; earning the investment of discretionary income. The cosmetic boom with insurance paved another way to profit...it was and remains the easy way out but not the sure and sustaining way to practice...in my opinion.

Dentists, like many others, are drawn to cookbooks and sure fire fixes. The challenge of today is really no different than it has been for many years. It's just more acute as the rich days of cosmetic dentistry fade away. Insurance maximums have remained the same in 30 years while fees have gone up and so now what? The relatively "easy sell" of cosmetics that replaced the nuance of insurance has lost it's appeal. Many dentists are losing considerable market share in part because of the economy, in part because people are sick of the same old message and largely because the health services, true elevation of health have not been the focus of their discussions with patients and faded in their consciousness. Crap detectors go off regularly for the public and the profession, with throngs in the same game, now have to fight fee sensitivity as the shoppers have wised up.

There is enormous opportunity to be truly distinctive. If you look outside of dentistry, permeating other businesses is the knowledge that values are being honed in trying times. People are looking for genuine, true, authentic service and resonance with their providers....be they dentists or otherwise. Look at Starbucks and the drive of many others who promote in their commercials....we're making a difference because we care.

Yoo hoo....does anybody out their hear me? What's next? Will the enormous increase in dentists closing shop be a wake up call? Could now be the pivotal time when dentistry returns to the healing arts?

What ya think?

You may have heard that the mouth is the dirtiest place in the body; this is because saliva contains numerous microorganisms. Human bites are said to be more dangerous than a dog bites as it contains more bacteria says the CDC. Worldwide there are billions of kisses exchanged by people each year. The air kiss, casual peck on the cheek or the cultured kiss on the hand aren’t much of a threat but a kiss that exchanges saliva from one another is a different matter.

Viruses That Can Be Transmitted by Kissing

• Colds: many viruses cause the common cold. It can spread by direct contact with the virus, from airborne droplets, or from
  direct contact with secretions from the infected person’s nose and
  throat.

• Infectious Mononucleosis: also known as kissing disease is caused by Epstein Barr virus. The virus is spread through saliva and infection occurs through contact.

• Herpes Infection: includes varicella zoster (causes chicken pox) and herpes simplex (cold sores in mouth). Herpes is easily spread to others when others when cold sore blisters are forming or have erupted. The virus is shed to others from the site of blisters even when they have healed. So, can you get herpes from kissing: yes.

Fever Blisters

• Hepatitis-B: kissing may also transmit this virus even though it may be contained in higher levels in blood. Infection can
  occur when infected blood and saliva come into direct contact with
  someone else’s bloodstream or mucous membrane. A person may be easily
  infected if they have sores in and around the mouth.

• Warts: these can spread through kissing especially if in case of recent trauma.

• Hand, Foot and Mouth Disease: this is caused by Coxsackie virus and is spread through open sores in the mouth. This
  infection is common in kids especially those in day care. It is spread
  via the fecal oral route (maybe while changing diapers)

Bacteria That Can Be Transmitted by Kissing

Microscopic View of Bacteria

• Meningococcal Disease: this is a life threatening condition which includes meningitis, (inflammation of the membranes that
  surround the brain and spinal cord) and septicemia. Studies show that
  deep kissing seems to be one of the risk factors.

• Tooth Decay: numerous studies indicate that Streptococcus mutans, the main bacteria implicated with caries is
  transmissible. Direct contact occurs most commonly via kissing. Indirect
  contact occurs though shared contaminated objects such as eating
  utensils, toothbrushes, cups and even toys.

There appears to be a strong link between mother and child and transmission usually occurs after the teeth have erupted in babies as S.
mutans has difficulty colonizing other oral surfaces. We love our
babies and it is natural to show them this love and affection, however, kissing babies on the mouth is harmful to their dental health.

Gum Disease

Gum Disease

The American academy of Periodontology says more than 75% of adults over 35 have some form of gum disease.
Since gum diseases are considered the equivalent of open wounds kissing
or having oral sex when you or your partner had bleeding gums is an invitation for the transmission of unwanted organisms.

There is no need to give up kissing; while disease causing bugs can be transferred during a kiss, most won’t cause the disease and the risk
of serious disease is small BUT it may happen. And it’s not all bad.
Research into passionate kissing has uncovered many valuable health benefits. For those who are calorie conscious a 60 second kiss burns 26 calories.

High levels of financial stress and poor coping abilities increase twofold the likelihood of developing periodontal (gum) disease, according to a study in the Journal of Periodontology. After accounting for other risk factors – such as age, gender, smoking, poor dental care and diabetes – those who reported high levels of financial strain and poor coping behaviors had higher levels of attachment loss and dental bone loss (signs of periodontal disease) than those with low levels of financial strain.

"Financial strain is a long-term, constant pressure," said Dr. Robert Genco, chair of the Oral Biology Department at The State University of New York at Buffalo, who carried out the studies with the periodontal
research group at Buffalo and behavioral scientist Dr. Lisa Tedesco of
the University of Michigan. "Our studies indicate that this
ever-present stress and a lack of adequate coping skills could lead to
altered habits, such as reduced oral hygiene or teeth grinding, as well as salivary changes and a weakening of the body's ability to fight infection."

However, people who dealt with their financial strain in an active and practical way (problem-focused) rather than with avoidance techniques (emotion-focused) had no more risk of severe periodontal
disease than those without money problems.

The good news is that many of the risk factors for periodontal disease, such as poor oral hygiene and infrequent professional care, can be controlled with minimal personal time and financial resources. Eliminating periodontal disease also eliminates a risk factor for heart disease, respiratory disease, and diabetes complications, it is especially important for people to do what they can to protect their oral health.

Genco and his colleagues are following more than 1,400 people between the ages of 25 and 74 in the ongoing study, which is one of the first to examine the relationship of periodontal disease to stress, distress
and coping in a large population.

Psychological tests were given to identify and weigh the causes of stress (children, spouse, financial strain, single life and work stress) in participants' daily lives and to measure the ability to cope
with stress. To measure financial strain, study participants answered
nine questions, including:

• At the present time, are you able to afford a home that is large enough?
• Do you have difficulty in meeting monthly payments of your family bills?
• How often is it that you don't have enough money to afford the kind of food, clothing, medical care, or leisure activities you and your family need or want?

Further studies are needed to help establish the time course of stress in respect to the onset and progression of periodontal disease and the mechanisms that explain the association. Intervention studies also are needed to determine the extent to which controlling stress
will influence periodontal disease and its treatment.

Chew On This, Six Dental Myths Debunked.mht

This article derived from the latest news in dentistry, is a break from the norm news. It takes a look at certain myths, mainly by the public, pertaining to oral health. For us we may know these facts, but many whom are not in the field who be surprised at these myths de-bunked!

We always need to be aware of oral health, but sugar is not always the culprit itself when it comes to tooth decay. The amount of time is key. We stress this daily with the children in our practice as part of a recall visit reminder. The frequency of sugar in the mouth is crucial. This also points to another of the myths being false, the age of patients. Some associate decay with small children, but as they get into teenage years soft drinks are on the rise in their diet. The frequent "drenching" of the mouth in this sugary, carbohydrate-packed liqid, changes the PH in the mouth. This , of course, leads to the breeding ground of decay. That then leads us into adulthood and coming to the elderly stage of life. This is also a myth.......that the elderly have a lower decay rate. They often times loose perio health which exposes teeth and make sthem susceptible.

These are just a few of the myths that come up. Reminding ourselves, as dental professionals, that people need to know these facts and myths to be better educated throughout life.

I recieve many requsts on billing for Sleep and TMD. The biggest difference is diagnosis, dental providers are not able to diagnosis sleep. Attend my sleep billing programs to understand the process of billing for medical treatment. Our changes in billing will become more medical as we move into the next year so lets begin the process now.

www.links2success.biz has my programs listed. My phone is 914-450-2906

This workshop will provide participants with American Heart Association ACLS® Certification and provide a full day of emergency airway management techniques. Course consists of didactic lectures, intensive imaging, discussion and hands -on workshop with the world's most realistic airway mannequins and patient simulators.

Audience: This course is appropriate for physicians, dentists, nurses and all allied health and dental professionals who are involved in the administration of sedation & analgesia.

Objectives: At the conclusion of this program , participants should be able to:

1. Recognize and initiate early management of peri-arrest conditions that may result in cardiac arrest or complicate resuscitation outcome;

2. Manage cardiac or respiratory arrest until return of spontaneous circulation and respiration, termination of resuscitation or transfer of care;

3. Recognize other life threatening clinical situations and provide effective initial care and transfer to reduce disability and death;

4. Describe & demonstrate a variety of techniques for maintaining oxygenation;

5. Recognition and anticipation of difficult airways

Devices: Mask ventilation, LMA and King LT rescue Ventilation, AirTraq Opitical Laryngoscope

Direct Laryngoscopy, Malleable Stylets, and Bougies (tube introducers)

Faculty:American Heart Association® Certified ACLS Instructors & Richard Levitan, MD

About: Dr. Levitan has published approximately 30 peer-reviewed articles on emergency airway management and is the author of 2 textbooks. He serves on the Editorial Board of Annals of Emergency Medicine, and is a reviewer for numerous emergency medicine and anesthesia journals. He has been a design consultant and investigator for many airway device manufacturers. He has given approximately 350 lectures on airway management worldwide, and for almost ten years has run a monthly hands-on cadaver-based airway workshop. He is currently an Associate Professor in Emergency Medicine at Thomas Jefferson Medical College in Philadelphia.

Date:October 9 & 10, 2010 8:00 am - 5:00 pm. Breakfast & lunch provided.

Location: Houston Marriott South at Hobby Airport 9100 Gulf Freeway Houston, TX 77017

Fees: $995.00 Physicians & Dentists $ 475.00 Nurses & Auxiliary staff

Seating is limited, pre-registration is required.

Registration can be completed online by clicking here

Or by phone at 888-581-4448 x 2

For more information on this course or other services we offer please visit www.SedationConsulting.com