Study finds decrease in opioid prescriptions in under 18-year-olds

NEW YORK, U.S.: The over-prescription of opioids in the United States is a subject that has been addressed significantly in recent years. An issue that is relevant in both dentistry and medicine, the aftereffects of over-prescribing opioids is still in the process of being clarified. However, recent findings could indicate positive change, since scientists from the Brigham and Women's Hospital in Boston have observed a downward shift in opioid prescriptions in children and adolescents.

While the opioid crisis still remains a major health concern for patients of all ages, there has been little research into their prescribing trends for younger populations. “Prior studies have shown that—between 1997 and 2012—the rate of hospitalizations due to opioid poisonings nearly doubled in U.S. children and adolescents. Understanding patterns of opioid use in children and adolescents is important, because use in early life has been associated with a higher likelihood of opioid misuse in the future,” said lead author Dr. Joshua Gagne from the Division of Pharmacoepidemiology and Pharmacoeconomics at the hospital. Data for the study was obtained from an extensive commercial insurance database where the rates of opioid prescriptions between 2004 and 2017 for outpatients and long-term opioid use (three or more consecutive months) was evaluated in individuals aged 18 years or younger. The database included diverse populations from all 50 U.S. states, with approximately 2.5 million individuals in the age range for each year. The analysis included all oral opioids that could be used for pain, excluding cough suppressants. Calculating the monthly prevalence of opioid prescriptions per 1,000 individuals for each year, the results showed that in 2004, an average of three in every 1,000 children and adolescents received an outpatient opioid prescription in a given month. Between 2009 and 2012, this number increased to four in every 1,000 before dropping to two per 1,000 children and adolescents in 2017. According to the researchers, this downward trend was driven by a decrease in prescriptions of hydrocodone bitartrate, one of the most commonly dispensed opioids to children and adolescents. The dispensation of oxycodone remained stable over time and did not increase after the U.S. Food and Drug Administration approved an extended-release version for children in 2015. The study, titled “Trends in opioid prescription in children and adolescents in a commercially insured population in the United States, 2004–2017”, was published on November 12 in JAMA Pediatrics.

Tags: adolesencys, opioids, prescriptions
December 7, 2018
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Researchers develop new method for identifying oral cancer

SÃO PAULO, Brazil: In a discovery that may help the early identification of oral squamous cell carcinoma (OSCC), researchers in Brazil have found a correlation between the cancer’s progression and the abundance of specific proteins present in tumor tissue and saliva. The discovery offers parameters for predicting the progression of the disease and may help in overcoming the limitations of clinical and imaging exams.

“We worked on the study for five years until we achieved this breakthrough,” said contributing author Adriana Franco Paes Leme, a researcher at the Brazilian National Bioscience Laboratory—part of National Energy and Materials Research Center (CNPEM) in São Paulo. During the first phase of the study, researchers used laser microdissection and proteomics to map the proteins in mouth cancer tissue and correlate them with the clinical characteristics of the patients. This analysis enabled the identification of several proteins, such as CSTB, NDRG1, LTA4H, PGK1, COL6A1, ITGAV and MB—with differing levels of abundance depending on the tumor area—and link them to key clinical outcomes. After identifying and quantifying proteins in about 120 tumor tissue samples, the second phase of the study saw researchers deploy two protein verification strategies. “One strategy consisted of gauging the abundance of the selected proteins in independent tissue samples using immunohistochemistry with antibodies. The other consisted of monitoring the same preselected targets in patients’ saliva,” explained Paes Leme. “Saliva is a promising source of markers, as well as being a fluid obtained by noninvasive collection,” she explained. “We verified the proteins in saliva from 40 patients. Technical triplicates were analyzed to achieve the highest possible confidence level for the results in this phase of the study.” After analyzing the saliva samples, researchers used bio-informatics and machine learning techniques to obtain prognostic signatures. From here, they were able to verify which of the proteins or peptides were selected during the first phase and could thereby distinguish between patients who had or did not have cervical lymph node metastasis. According to the study’s results, it was possible to identify three specific peptides—LTA4H, COL6A1 and CSTB —that can be used as a signature to classify patients with and without cervical lymph node metastasis. Researchers believe that this could potentially help doctors overcome the limitations of clinical exams and guide personalized treatment strategies. “The data led to robust results that are highly promising as guides to defining the severity of the disease. We suggested potential markers of the disease in the first phase of the study and verified these markers in the second phase, enhancing the reliability of the findings and showing that these markers are effective in classifying patients with cervical lymph node metastasis,” said Paes Leme. Scientists are now working on a new study designed to use translational techniques to build affordable biosensors that are capable of detecting prognostic signatures in patients’ saliva. The study, titled “Combining discovery and targeted proteomics reveals a prognostic signature in oral cancer”, was published on September 5 in Nature Communications. Partners of the study included the São Paulo State Cancer Institute, the University of Campinas's Piracicaba Dental School and Institute of Computing, the University of São Paulo's Mathematics and Computer Science Institute in São Carlos, the Dental School of the West Paraná University, as well as other institutions in and outside of Brazil. It was funded by the São Paulo Research Foundation, with the research conducted at the National Energy and Materials Research Center.

Tags: dental, oral cancer, saliva
December 7, 2018
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Tested and Reviewed, Part 4: BlueM toothpaste, mouthwash and oral gel

When it comes to oral health, consumers and dentists can choose from a wide range of toothpastes, mouthwashes and toothbrushes on the market, which makes it extremely hard to decide which products one should buy or recommend. So, which products are worth recommending to patients who want to improve their oral health? Which products are safe to use by children, pregnant women or people who have undergone implant surgery? This series of reviews aims to answer these questions by evaluating innovations from the world of dentistry.

What’s in the box? The BlueM toothpaste without fluoride comes in a 75ml tube, the mouthwash in a 500ml bottle and the implant care oral gel in a 15ml tube. BlueM also provides a special applicator for the gel for those hard-to-reach areas in the mouth. The gel is a medical-grade product—marked with the CE marking, indicating that the product was developed according to the European Economic Area’s health, safety and environmental protection standards and regulations. The toothpaste and the mouthwash are also available as handy travel kits and come in smaller containers of 15ml each. All the products’ packaging and designs were kept simple and instead of luring consumers with bright colours or eye-catching slogans, BlueM preferred to convince people with their contents. Taste and consistency True to its name, the toothpaste and mouthwash are blue in colour. Their strong, minty taste could feel a bit overwhelming for some, but does leave a fresh feeling in the mouth. As the toothpaste is free of abrasive components, it is a very homogeneous mass and has a jelly-like consistency. The oral gel tastes less strong and spicy, but has a refreshing effect as well. Active agents Among other active agents, all the products in the range contain a high amount of oxygen, which kills anaerobic bacteria. These cause most oral health problems and therefore, the BlueM products accelerate the wound healing process. Summary BlueM products can generally be recommended to everybody, but specifically to people with implants, as they support the wound healing process. However, the taste of the toothpaste and mouthwash might be bit strong for the average person who is used to a milder flavour. However, BlueM also offers a more gentle mouthwash, specially developed for the sensitive mouth. The BlueM toothpaste was voted the Best Product of the Year 2017–2018 by Dutch consumers this year.

Tags: BlueM, dental, mouthwash, toothpaste
December 7, 2018
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UK government rejects energy drink ban for children

LONDON, UK: After a period of public consultation, advisors to the UK government have concluded that there is insufficient evidence to warrant a ban on the sale of energy drinks to children. While advisors found that energy drink consumption by young people correlated with other risky behaviour, such as alcohol consumption and smoking, they stressed that it is not possible to determine whether a causal link exists.

In August, the UK government launched a public consultation process regarding a potential ban on selling energy drinks to anyone under the age of 16. Research from Fuse, the Centre for Translational Research in Public Health has suggested that UK children under 16 were the highest consumers of energy drinks in this age group in Europe. [bannercontainerslideinbanner id="202226"] These beverages typically contain high amounts of sugar and caffeine and have been linked to a range of health issues, including headaches, insomnia and tooth decay. The high acidity of energy drinks can further exacerbate dental erosion—a condition that affects up to 44 per cent of 15-year-old British children. Several major UK supermarket chains have already ceased selling energy drinks to children under 16 due to the associated health concerns. In response to the UK government’s decision, the Science and Technology Committee has argued that society’s concerns and evidence from school teachers could justify a ban, which is supported by the British Dental Association (BDA). “Dentists see the devastating impact energy drinks are having on children's oral health every day,” said BDA Chair Dr Mick Armstrong. “It is bizarre that we are still having this debate over products that are habit-forming, highly acidic and can come laced with 14 teaspoons of sugar—far more than a can of coke,” he continued. “No PR blitzes or tokenistic reformulations can distract from the fact that industry cynically views children as a target market for these drinks. If the government is even half serious about prevention, they will take them off the menu.” The Royal College of Paediatrics and Child Health (RCPCH), in response to the decision, called on government to increase the price of energy drinks to reduce their appeal. “We welcome the government’s recent focus on child health through the Childhood Obesity Plan and its Prevention Vision and agree that in relation to energy drinks, more research is needed in order to evaluate their full impact to child health,” said Prof. Russell Viner, President of the RCPCH. “However, we believe that the evidence is already compelling that energy drinks bring no benefits and only harms to children. In the meantime, I call on the government to protect children by bringing in a minimum price for energy drinks, as we know their cheap price tag is a key driver for their purchase and this would make other drinks more affordable and appealing.”

Tags: dental health, energy drinks, oral health, oral health children
December 7, 2018
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Molar-Incisor-Hypomineralization – From Science to Practice

- Know the case definition of MIH - Be able to grade and stage MIH cases and lesions - Deduce treatment options for different MIH lesions

Molar incisor hypomineralization (MIH) is a highly prevalent enamel developmental disorder. The lecture will systematically present how to detect and diagnose, to stage and grade MIH, and to deduce appropriate treatment options based on scientific evidence.
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