AIOB Newsletter: Spring 2006

With the onset of spring, the 63rd Annual Meeting of the American Institute of Oral Biology scheduled for October 20-23,2006 is a little more than five months away. We will again hold our conference at the Palm Springs Hilton Hotel, which is centrally located in Palm Springs, California.

Our President, Dr. Shahrokh Shabahang, D.D.S, M.S., PhD., Associate Professor of Endodontics, School of Dental Medicine, Loma Linda University, has confirmed faculty acceptances, to date, by Arthur Curley, Esq., John G. Thomas, M.S., PhD, HCLD, Yiming Li, DDS, PhD, MSD, David Witherspoon, MD, and past speakers, A. Hari Reddi, PhD, and Dr. Philip Boyne. Past attendees have enjoyed the "Wit and Wisdom," of Attorney Curley of the firm of Bradley, Curley, Asiano & McCarthy, Larkspur, California, who also serves on the Adjunct Faculty, Arthur Dugoni School of Dentistry, University of the Pacific, San Francisco. He is an engaging speaker who most recently spoke to us on the legal ramifications of the digital revolution affecting our profession and society at large. His presentation will include the State of California mandated information on Dental Jurisprudence.

Dr. John Thomas serves as Director, Microbiology & Virology, West Virginia Hospitals, and is Professor, Departments of Pathology and Periodontics, West Virginia University Schools of Medicine and Dentistry, Morgantown, West Virginia. He has particular expertise in the fields of antimicrobials and biofilms.

Remaining members of the Faculty and their topics will be announced as soon as all are confirmed.

As in the past, the meeting will commence with "Lunch and Learn," from 12:00-2 P.M. on Friday, October 20th and will end at 9:50 A.M. on Monday, October 23rd.

As you are aware, we are departing from our past practice, and tuition, for an available 26 Hours Continuing Education Credits, is $525.00 (On-site fee is $575.00) and includes three meals a day, commencing with lunch on Friday and ending with breakfast on Monday. A $175 reduction in fees will be granted to attendees during the first three years after completion of a dental program. An additional food charge of $172.50 for your spouse or guest will be added to your tuition charge, while the daily Hotel Charge of $145 per night/per room (not per person) will be charged by and payable to the Hotel. It is hoped that this change will eliminate some of the confusion experienced at checkout the past few years. (Please see the enclosed notice by Dr. Ron Fink, Meeting Arrangements Chairperson).

An anticipated educational highlight will be the 2nd Annual, Philip J. Boyne Lecture, given in honor of Dr. Boyne, our past president (1970-2003) and Emeritus Professor of Oral & Maxillofacial Surgery, School of Dentistry, Loma Linda University. This year's speaker for the Philip J. Boyne Lecture will be Professor A. Hari Reddi, Professor Ellison Chair of Orthopaedic Research, Department of Orthopedics at the University of California, Davis, School of Medicine. In keeping with tradition, our president, Dr. Shabahang will introduce the Faculty Members at the Friday evening Dinner, He and his wife, Dr. Karin Hatami will host the President's Reception, to which all are invited, on Saturday evening. This is an excellent occasion to meet fellow attendees and converse at length with faculty members.

Spouses are invited and encouraged to attend the Philip J. Boyne Lecture, as well as any other session of interest, on a space-available basis, and at no charge. Additionally, a Spouse's Program will be held on Saturday Morning, chaired by Debby Splaver. A visit to the renovated and greatly expanded Palm Springs Art Museum is scheduled, and the Institute pays Admission fees, so again there is no cost to participants. The Museum is a few short blocks away from the Hilton Hotel and is fully handicapped accessible.

In order to work up an appetite for Breakfast, we have a traditional Sunrise Walk, leaving from the Hilton Lobby at 6:15A.M. and returning by 7:00 A.M., starting on Saturday morning and continuing through Monday. If you're on Eastern Standard Time or just an Early Riser, this increasingly popular activity, is a great way to start the day, and renew or make a new friendship.

Also, please note that the "design elves" are busy working on a prototype of the "Limited Edition" AIOB branded gift for tuition-paid attendees. Early registration for both the conference and the Hilton Hotel assures you a room and greatly assists the Institute in its planning. Please take a moment and confirm your attendance.

Hope to see you all in October for yet another superb continuing education experience.

The Current Report

The May issue of Archives of Neurology contains an interesting observational study, by Peter P. Zandi of Johns Hopkins, et al on the apparent decrease in the rate of development of Alzheimer's disease among those who were taking medications for hypertension. The study followed over 3300 people, over the age of 65 for six years, with 104 people developing Alzheimer's. Diuretics, in general, were associated with a 43% risk reduction, while the potassium-sparing diuretics were associated with the greatest risk reduction, 74%. Antihypertensives overall reduced the risk by 36%. The authors' statistical analysis demonstrated that risk reduction was noted, "independent of the medicine's ability to control blood pressure." Why the potassium-sparing diuretics were associated with such a strikingly effective risk reduction was not determined.

The April issue of the Annals of Neurology contains an article by Dr. Nikolaos Scarmeas, et al, whose conclusion was that eating a Mediterranean diet appeared to reduce the risk of Alzheimer's disease. This was an "observational study," per the lead author in which 2258 New York City Medicare recipients-not suffering from dementia-recorded their consumption of, "olive oil, fruits, vegetables, legumes, cereals, fish, a little alcohol, and very little dairy or meat." The more strictly, participants adhered to the diet, the lower their chances of developing dementia. Ranking the study subjects by their degree of adherence to the diet, it was found that the 1/3 that was most strict was 40% less likely to develop dementia, than the third of the subjects least compliant. The authors warn that the number of study participants was low, and clinical trials might likely lead to conclusions regarding recommendations, and evidence of cause and effect.

Boston University School of Medicine researchers Tuhina Neogi and David Felson are investigating a possible role of Vitamin K in slowing or preventing osteoarthritis. The disease can become debilitating, requiring joint replacement, and symptoms and severity usually are progressive with advancing age. Besides its widely known role in blood clotting, Neogi and Felson hypothesize that Vitamin K may affect the proteins which influence the strength of bone and cartilage. The researchers participated in an "observational study" as part of the Framingham Heart Study, in which it was noted that, "participants with the highest level of Vitamin K in their blood exhibited 30 to 40 percent less osteoarthritis than those in the lowest quartile of Vitamin K levels." In an effort to establish a definitive link between Vitamin K-abundantly found in green leafy vegetables and broccoli-and osteoarthritis the researchers have entered into a double-blind clinical study of 450 people over the age of 60 which will have preliminary findings available by mid 2007. Dr. Sarah Booth of Tufts University who is investigating "possible links between Vitamin K, bone loss, and vascular calcification marker of heart disease is also studying their patient population group.

Significant for angina patients who fail to achieve an "adequate response" from traditional drugs, it was reported on January 27,2006 that the FDA approved ranolazine (CV Therapeutics, Palo Alto, CA) an apparently novel type of drug to treat the disease. A New York Times article stated that ranolazine is "the first new type of drug in more than two decades to treat angina." Traditionally, nitrates, beta blockers and calcium channel blockers have been used with varying degrees of success, however, the undesirable side reactions can be bradycardia and hypotension which are both undesirable and distressing to patients. Importantly, ranolazine appears to cause neither effect while it, taken in combination with a calcium channel blocker, appeared to slightly decrease the number of weekly angina attacks. The drug, which initially failed to secure FDA approval in 2003,appears to exert its effect by blocking the entry of sodium into heart muscle cells. "The net effect is to remove calcium from heart muscles, making the heart less stiff and thus able to beat more efficiently." No drug is without side effects or reactions and there is a theoretical, but as yet unproven concern that it may cause cardiac rhythm problems.

We have previously discussed the introduction and subsequent withdrawal from the market in 2005 of Tysabri, which showed such promise for the treatment of multiple sclerosis. The withdrawal was prompted by the development of fatal progressive multifocal leukoencephalopathy (PML) in three patients. On March 9, an FDA panel recommended that the drug be allowed to be re-introduced and prescribed with tight controls, which included patient tracking. According to a New York Times article of March 9, Tysabri would be allowed for use in the relapsing form of MS, which affects 85% of its victims. Some on the FDA panel suggested that it not be the "first-line" drug of choice while the full panel agreed that physicians prescribing it participate in a semi-annual mandatory reporting system to the manufacturer. The FDA group also agreed that Tysabri should not be given concurrently with other MS drugs. The development of PML is of major concern and the long-term safety and efficacy have yet to be established.

The aggregate conclusions of three major studies seem to be that the use of B Vitamins to lower homocysteine blood levels does not prevent either heart attacks or strokes in high-risk patients. A JAMA paper of 2004, and two papers published in the NEJM on April 13, 2006 studied more than 9000 patients, who were given either B Vitamins or placebo. It has been well established that ingestion of B Vitamins reduces blood levels of homocysteine a non-essential amino acid, which appears to damage the intimal lining of arteries allowing development of atherosclerotic changes, which often precede MI and stroke. Homocysteine appeared to be a measurable blood marker for the risk of development of stroke and MI, while some felt that it was the direct cause of heart disease. The three studies hypothesized that if the patients' homocysteine levels could be decreased, then their rate of cardiovascular and cerebrovascular events would be reduced. The B Vitamins administered decreased the patients' homocysteine levels by almost one third; however, the placebo and study groups had an almost equal number of cerebrovascular and cardiac infarctions. One of the authors, Dr. Salim Yusuf of McMaster University of Hamilton, Ontario was quoted as saying, "We had a significant drop in homocysteine levels but practically no result." ... "Pretty compelling, isn't it?" What was not studied was whether or not there is a protective effect for healthy people taking folic acid, B6 and B12. Also, while the etiologic role of homocysteine in these events is in question, some believe its role is that of a quantitative disease marker.

Revisiting the issue of the safety of the Cox-2 inhibitors, and specifically Vioxx, the May 2, 2006 issue of the Canadian Medical Journal published a large study of the early effects of this class of drugs on patients over the age of 65 in Quebec. After a 2004 study demonstrated that long-term use of the drug was associated with a higher than expected risk of MI, Merck, and its manufacturer withdrew it for the market.

The present study involved 3947 patients taking Vioxx, of which 239 had an MI. Of those patients, "...65 cases happened in people who were first-time users of the drug and had filled only one prescription." Also the risk for an MI was greatest from the 6th through 13th day of exposure. Another study arm involved 5885 Celebrex (Pfizer) users, and the researchers concluded that there was only a slightly higher incidence of MI in the first few weeks of use. Although it was not statistically significant, the primary author, Linda Levesque, Queen's University, Kingston, Ontario, stated, "...there may be an increased early risk with Celebrex... This needs to be verified in a larger study." Merck, in commenting on this observational study, noted that such studies, "...are considered less scientifically rigorous than clinical trials." A Pfizer spokesman noted that, "...last year the Food and Drug Administration said all non-steroidal anti-inflammatory drugs may increase cardiovascular risk."

The March 22nd edition of The Wall Street Journal contained an article by Laura Landro on new Standards for Hospital Rooms, which call for private rooms for all patients. Standards, for new construction, are issued every four years by the Facilities Guidelines Institute (a nonprofit group) and the American Institute of Architect's Academy of Architecture for Health. Reasons cited for the call for single rooms for all patients are "evidence mounts that shared rooms lead to higher infection rates, more medical errors, privacy violations and harmful stress." In addition the article highlighted other design features suggested including planning for isolation areas and improved ventilation systems, such as the "negative air pressure systems" employed in some ORs, due to concern about spread of flu and other infectious disease processes. The article goes on to state that many hospitals have recently added single rooms as a marketing tool, appealing to more affluent individuals, however, this switch apparently makes better economic sense to the institutions, and may actually reduce their cost of operation. Among the cost saving factors cited were: less need to transfer patients among rooms, more private and, therefore, more restful hospital stay, fewer patient falls and injuries, possibly higher bed occupancy rate as there is no need to arrange for same-sex roommates and quicker patient recovery with less disease transmission to roommates. Understandably, the biggest concerns and gains are apparently related to direct spread of infection, One hospital cited, Bronson Methodist Hospital in Kalamazoo, Michigan experienced a 45% decline in infection rates once they built a new all single room building in 2000, with hand washing stations in each room. Apparently the increased building costs were "offset" by savings accrued in decreased operational expenses related to infections and their treatment. Obviously conversion to a single room model is initially expensive and not practical in all parts of the country due to space and land limitations, if not financial issues. The guidelines issued do provide for "semi-private" situations, especially in some areas of the country where seasonal shifts in populations create increased demand for hospital services and inpatient beds.

"Disarming Pathogens - A New Approach for Antibiotic Development (Clinical Implications of Basic Research) by Matthew K. Waldor, Department of Microbiology and Medicine, Tufts University School of Medicine, appeared in Volume 354(3), 19 January 2006 issue of The New England Journal of Medicine. This article discussed the paper published in Science 2005: 310:670-4 by Hung DT et al, entitled "Small molecule inhibitor of Vibrio cholerae virulence and intestinal colonization." All present antibiotic agents are either bacteriostatic or bactericidal, as we are aware. Dr. Waldor explains the alternative approach that Dr. Hung and collaborators took to "disarm" bacteria by utilizing a small molecule to block the production of the virulence factors of the Vibrio organism. Cholera toxin and toxin co regulated pilus (TCP) are the two virulence factors produced by Vibrio, which allow it to grow in the human small intestine. Per Dr, Waldor, "Cholera toxin is the principal inducer of the secretory diarrhea characteristic of cholera, and TCP is required for V. Cholera to colonize the intestine." There is a rather complicated interaction of factors, however, Dr. Hung and co-workers identified a compound, virstatin, which inhibited the action of an activator of gene transcription (ToxT), which was necessary for virulence of the organism. Their study performed on infant mice," suggest that continued production of TCP is essential for persistent intestinal colonization by V. cholerae and that host mechanisms that clear the pathogen are effective in the absence of TCP." The authors further stated that, "The infant- mouse model is not useful for analyses of cholera toxin-induced diarrhea, and the effects of virstatin on cholera production in vivo were not assessed in this study." The significance of their work according to Dr. Waldor is that other "virulence" factors undoubtedly exist and they will be more "pathogen-specific" than our present antibiotics. Development of resistance to these drugs will develop as with antibiotics and Waldor stated that, in fact, Dr. Hung identified a mutant form of ToxT, which was not inhibited by virustatin. It is thought that combination therapy with conventional antibiotics and virulence factor inhibitors may be developed. Additionally, Waldor speculated that since antivirulence factors do not act to inhibit pathogen growth, that "they may facilitate the development of immune responses that will prevent subsequent infection."

For those interested in searching the Web for medical information, a very excellent paper by Dr.Mohammad Al-Ubaydli, a physician and programmer who is employed at the National Institute of Health, Bethesda, MD. was published online in PLOS MEDICINE, Volume 2, Issue 9, September 2005. This should still be available online or I can send you a printed copy. Among other sites, his paper directs you to the Cochrane Collaboration for abstracts of Meta- analyses studies for determining evidence-based "best practices." Importantly, he discusses how to restrict your search of web sites and use various filters, especially within Google to eliminate extraneous material. The references to both Google Images and Google Scholar may be particularly helpful.

Important Information Regarding Changes
Starting the 63rd Annual Meeting
October 20-23, 2006

The following information will list some changes taking place for the October, 2006 meeting.

There will be an increase in the room charge to $145.00 per night. This includes all taxes, fees, etc. and will remain the same for the 2006 and 2007 meetings.

The Seminar Fee will be $525.00. This fee will include three meals a day during the meeting. On site registration will be $575.00. The $175.00 discount for participants during the first three years following graduation will continue. There has been some misunderstanding regarding this discount. It is not offered to participants during the first three years they attend the A.I.O.B. Meeting, only during the first three years after graduation.

When you make your reservations with Hilton, make them directly with the Palm Springs Hilton. (760 320-6868). If you call the main Hilton Hotels 800 number you will get their Central Reservations Office. Hilton Central Reservations is not aware of the A.I.O.B. meeting and is not aware of the special arrangements the Palm Springs Hilton has made for our meeting and our participants. Calling the Palm Springs Hilton directly will eliminate a lot of confusion in making your reservation.

If you have any specific dietary requirements, whether they be related to allergies, Religious restriction or other needs, please contact Catherine Bacher directly. Her phone number is the same as above: (760) 320-6868. Ask for her and she will make the arrangements for you.

The Palm Springs Hilton offers us many perks. They appreciate our continuing business and give us concessions in return. They do not charge us for the use of the meeting room, free local phone calls from the room, free access to the Fitness Center, bar bill discount card in packet, no charge for the "self park" for those who drive to the meeting and stay at the hotel, discounted room and meal rates, etc., etc., etc.

If you have questions regarding the hotel arrangements, please contact me by email or my cell phone.

Copyright 2006 - High Desert Web