Aimed at medical students, doctors trying to get (re) acquainted with dermatology and other paramedical staff this new on-line text book is worth investigating by dentists and their teams. Dentists are in the enviable but responsible position of seeing our patients regularly and are therefore better placed to observe changes of the head and neck than other members of the health team.

Follow this link www.skincancer909.com

and yes, there is a family link between the writer of this blog and the author of the book.

The Hippocratic Oath is frequently referred to during discussions about medicine, and by extension dentistry. Portions are quoted but I never knew whether they were taken in or out of context. To my knowledge nobody ever discusses the full words and meaning of the statements, attributed to Hippocrates, some two and a half millennia ago with students and new graduates. So when I came across this article recently I thought I would share the contents.

I was fortunate to visit the impressive plain tree on the Island of Kos which is said to be the site where Hippocrates sat and taught his pupils. Whether the concept of sitting at the feet of a master still exists in these times of “Problem Based Learning” I am not sure, but it impressed me that I was able to enjoy being in a place where fundamental concepts of medicine were defined.

First up is a “modern” take by Louis Lasagna. Then the original.

HIPPOCRATIC OATH: MODERN VERSION

• I swear to fulfill, to the best of my ability and judgment, this covenant:
• I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow.
• I will apply, for the benefit of the sick, all measures [that] are required, avoiding those twin traps of overtreatment and therapeutic nihilism.
• I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon’s knife or the chemist’s drug.
• I will not be ashamed to say “I know not,” nor will I fail to call in my colleagues when the skills of another are needed for a patient’s recovery.
• I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know. Most especially must I tread with care in matters of life and death. If it is given me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God.
• I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person’s family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick.
• I will prevent disease whenever I can, for prevention is preferable to cure.
• I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm.
• If I do not violate this oath, may I enjoy life and art, respected while I live and remembered with affection thereafter. May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help.

—Written in 1964 by Louis Lasagna, Academic Dean of the School of Medicine at Tufts University, and used in many medical schools today.

HIPPOCRATIC OATH: CLASSICAL VERSION

• I swear by Apollo Physician and Asclepius and Hygieia and Panaceia and all the gods and goddesses, making them my witnesses, that I will fulfill according to my ability and judgment this oath and this covenant:
• To hold him who has taught me this art as equal to my parents and to live my life in partnership with him, and if he is in need of money to give him a share of mine, and to regard his offspring as equal to my brothers in male lineage and to teach them this art—if they desire to learn it—without fee and covenant; to give a share of precepts and oral instruction and all the other learning to my sons and to the sons of him who has instructed me and to pupils who have signed the covenant and have taken an oath according to the medical law, but no one else.
• I will apply dietetic measures for the benefit of the sick according to my ability and judgment; I will keep them from harm and injustice.
• I will neither give a deadly drug to anybody who asked for it, nor will I make a suggestion to this effect. Similarly I will not give to a woman an abortive remedy. In purity and holiness I will guard my life and my art.
• I will not use the knife, not even on sufferers from stone, but will withdraw in favor of such men as are engaged in this work.
• Whatever houses I may visit, I will come for the benefit of the sick, remaining free of all intentional injustice, of all mischief and in particular of sexual relations with both female and male persons, be they free or slaves.
• What I may see or hear in the course of the treatment or even outside of the treatment in regard to the life of men, which on no account one must spread abroad, I will keep to myself, holding such things shameful to be spoken about.
• If I fulfill this oath and do not violate it, may it be granted to me to enjoy life and art, being honored with fame among all men for all time to come; if I transgress it and swear falsely, may the opposite of all this be my lot.

—Translation from the Greek by Ludwig Edelstein. From The Hippocratic Oath: Text, Translation, and Interpretation, by Ludwig Edelstein. Baltimore: Johns Hopkins Press, 1943.

Unfortunately in 2011 the phrase that comes to mind is: “You pays your money & you takes your choice.”

John Lee
John Lee, who died on October 8 aged 63, was one of the world’s most eminent ophthalmologists and the first person to bring pharmaceutical Botox (botulinum toxin) into Britain for clinical use.

Lee, who worked as a consultant ophthalmic surgeon at Moorfields Eye Hospital from 1984, brought the toxin in his hand luggage on a plane from the United States in 1982, following a trip to meet Alan Scott, the San Francisco ophthalmologist who first developed botulinum toxin therapy in the early 1970s to treat strabismus (“crossed eyes”) and blepharospasm (uncontrollable blinking).

Lee became a leader in the field of adult strabismus, botulinum toxin therapy as well as paediatric eye conditions, and was the first European to be invited to join the Association for Research in Strabismus (also known as the “Squint Club”). His patients ranged from senior politicians to slum-dwellers in Bangladesh.

The oldest of 11 children of first generation Irish immigrants from Connemara, John Lee was born on October 25 1946 at Kingston-upon-Thames, Surrey. Both his parents were teachers.

A bright child, he sent his spare time reading in the local library and came top in the country in the 11-plus, despite taking the exam a year early, winning a place at St George’s College, Weybridge. As family resources were strained, he worked in a garage to pay for his school uniform. He also worked as a babysitter in order to afford a subscription to a record club, through which he developed a love of classical music.

At the age of 17 Lee won a place to read Medicine at University College, Oxford, after securing five A-levels. There, to help pay for his studies, he worked as a psychiatric nurse during vacations.

After completing his clinical training at Westminster Medical School, Lee did ophthalmology residency training at the Oxford Eye Hospital, and at Moorfields Eye Hospital from 1973 to 1979, and won a fellowship in Paediatric Ophthalmology and Neuro-ophthalmology at the Bascom Palmer Eye Institute, Miami, Florida in the early 1980s.

In 1984 he was appointed to a consultant post at Moorfields eye Hospital, where he became director of the Strabismus and Neuro-ophthalmology Service and raised money for the hospital in charitable donations from private patients. He was also honorary consultant at Great Ormond Street Hospital for Children and the Royal London Hospital

Internationally renowned both for his clinical and his research work, Lee was the author of 115 papers in peer-reviewed journals. He served as president of the International Strabismus Association; vice-president of the European Strabismus Association; president of the ophthalmology section of the Royal Society of Medicine; and president of the Royal College of Ophthalmologists.

Lee was a keen cyclist and would always ride to work from his home in Camberwell. He also had a passion for fishing and a great fondness for the west of Ireland.

He married, in 1971, Arabella Rose, who survives him with two sons.

Here’s some more about the history of the use of Botulinum toxin from October 2007

Ever wonder how Botox evolved from toxin to the antidote for aging?

In her interesting article for MSNBC, Diane Mapes charts the history of Botox from sausages to frozen faces.

Its ability to inject a wonderfully paralyzing and youthful appearance into scores of celebrity and non–celebrity faces was discovered 15 years ago, Mapes writes. But it wasn’t until five years ago that Botox received FDA approval. Take a trip back in time to see how Botox evolved to be the poison of all poisons and the prettiest one.

It all began with the sausage in the 1820’s when Dr. Justinus Kerner conducted case studies and experiments to learn what was behind the deaths of some Germans who had consumed sausage. Turns out it was food–borne botulism. Thanks to Dr. Kerner, we found out more about this poison, including its neurological symptoms—from droopy eyelids to respiratory failure—and using it therapeutically. Then in the 1890’s Dr. Emile Pierre van Ermengem from Belgium identified strains A through G of botulinum toxin, four of which—A, B, E and F—can make us humans sick.

Then in the 1940’s it was time to get creative and use the poison for bad. According to a 2004 article published in the journal Clinical Medicine, during WWII, there was a plan for Chinese prostitutes to plant capsules with botulinum toxin inside the food and drinks of high–ranking Japanese officials. But the poisonous plan never went through.

The 1950’s and 60’s welcomed the good side of botulinum. During these years, Dr. Edward J. Schantz and others purified botulinum toxin type A into crystalline form. Dr. Vernon Brooks discovered that small doses of botulinum relax the muscle temporarily. And ophthalmologist Dr. Alan B. Scott began injecting monkeys with the toxin believing it could help with crossed eyes.

Animal subjects were then replaced with humans in the next decade when Dr. Scott received government approval to use human participants in his scientific work. Results revealed that botulinum toxin type A was a safe and effective treatment for crossed eyes. Other research showed botulinum toxin was helpful in relieving all kinds of spasms from facial to vocal cord spasms. In 1989—a year after Allergen bought the distribution rights to the toxin—the FDA approved botulinum toxin type A for treating crossed eyes and spasms in the eye muscle. Soon Allergen went further and bought Dr. Scott’s company and “Botox” was born!

As more research was conducted, it was uncovered that Botox temporarily cured excessive sweating and cerebral palsy in the 1990’s. Then a serendipitous event occurred when ophthalmologist Dr. Jean Carruthers noticed her patients were looking fabulously wrinkle–free. After Dr. Carruthers and her husband’s (a dermatologist) study on Botox’s ability to decrease frown lines was published, Botox took off—so much so that we actually ran out of it in the late 90’s, but luckily only for a very short time.

With Botox Cosmetic officially approved in 2002 for fixing frown lines and then two years later for excessive underarm sweating, Allergen’s lucrative business has been booming with sales exceeding $1 billion in 2006.

Mapes also writes about a recent backlash with negative portrayals of Botox showing up in several television shows along with concerns about its misuse and the experience and professionalism of those doing the shooting, growing.

Ever the optimist here’s some recent research. From Medical News Today

The Groningen professors Bauke Dijkstra and Lubbert Dijkhuizen have deciphered the structure and functional mechanism of the glucansucrase enzyme that is responsible for dental plaque sticking to teeth. This knowledge will stimulate the identification of substances that inhibit the enzyme. Just add that substance to toothpaste, or even sweets, and caries will be a thing of the past. The results of the research have been published this week in the journal Proceedings of the National Academy of Sciences (PNAS).

The University of Groningen researchers analysed glucansucrase from the lactic acid bacterium Lactobacillus reuteri, which is present in the human mouth and digestive tract. The bacteria use the glucansucrase enzyme to convert sugar from food into long, sticky sugar chains. They use this glue to attach themselves to tooth enamel. The main cause of tooth decay, the bacterium Streptococcus mutans, also uses this enzyme. Once attached to tooth enamel, these bacteria ferment sugars releasing acids that dissolve the calcium in teeth. This is how caries develops.

Three dimensional structure

Using protein crystallography, the researchers were able to elucidate the three dimensional (3D) structure of the enzyme. The Groningen researchers are the first to succeed in crystallizing glucansucrase. The crystal structure has revealed that the folding mechanism of the protein is unique. The various domains of the enzyme are not formed from a single, linear amino acid chain but from two parts that assemble via a U-shaped structure of the chain; this is the first report on such a folding mechanism in the literature.

Functional mechanism

The unravelling of the 3D structure provided the researchers with detailed insight into the functional mechanism of the enzyme. The enzyme splits sucrose into fructose and glucose and then adds the glucose molecule to a growing sugar chain. Thus far the scientific community assumed that both processes were performed by different parts of the enzyme. However, the model created by the Groningen researchers has revealed that both activities occur in the same active site of the enzyme.

Inhibitors

Dijkhuizen expects that specific inhibitors for the glucansucrase enzyme may help to prevent attachment of the bacteria to the tooth enamel. Information about the structure and functional mechanism of the enzyme is crucial for developing such inhibitors. Thus far, such research has not been successful, states Dijkhuizen: ‘The various inhibitors studied not only blocked the glucansucrase, but also the digestive enzyme amylase in our saliva, which is needed to degrade starch.’

Evolution

The crystal structure also provides an explanation for this double inhibition. The data published by the Groningen scientists shows that glucansucrase proteins most likely evolved from amylase enzymes that degrade starch. ‘We already knew that the two enzymes were similar’, says Dijkhuizen, ‘but the crystal structure revealed that the active sites are virtually identical. Future inhibitors thus need to be directed towards very specific targets because both enzymes are evolutionary closely related.’

Toothpaste and sweets

Dijkhuizen points out that in future glucansucrase inhibitors may be added to toothpaste and mouthwash. ‘But it may even be possible to add them to sweets’, he suggests. ‘An inhibitor might prevent that sugars released in the mouth cause damage.’ However, Dijkhuizen doesn’t expect that toothbrushes have had their day: ‘it will always be necessary to clean your teeth.’

Sources: University of Groningen, AlphaGalileo Foundation

Although frequently accused of not listening to its members I have some sympathy for their position as there appears to be as many different views as there are members – all of whom consider themselves to be correct.

The CQC must explain calculations behind proposed fee scale to register dental practices warns BDA
The British Dental Association is calling on the Care Quality Commission to explain the calculations behind its proposed fee scale to register dental practices, following concerns that single practice owners could end up subsidising owners of larger practices.

With registration fees for one practice proposed to start at £1,500, the sliding scale means that the more practices a provider owns, the cheaper the unit cost, despite the CQC’s assertion that the cost of registration would be linked directly to providers’ responsibility for meeting the essential standards.  The CQC’s consultation on registration fees for dental practices gives no indication of the actual cost to CQC of regulating dental practices.

In a letter addressed to the CQC’s Chief Executive, Cynthia Bower, the BDA asks her to explain the details underpinning the proposed fees.
Susie Sanderson, Chair of the BDA’s Executive Board, said:
“The profession has already expressed grave concerns over the Commission’s regulation of dental services and the poor handling of the registration process.  The lack of clarity over how the proposed fee scale was calculated will do nothing to allay these concerns.
“In the first instance, how did the CQC calculate that the minimum fee to register a practice annually should be £1,500, when the fee to register a practice in the equivalent body in Wales is under £100?
“And how can it be equitable that a large number of small providers will effectively subsidise the smaller number of large providers, whether NHS Trusts or chains of practices?”

John Milne, Chair of the BDA’s General Dental Practice Committee, said:
“If the CQC is genuinely interested in feedback from dentists on its proposed fee scale, then it must explain how it calculated it, otherwise this is a pointless exercise and will only further erode the profession’s confidence in a regulation process which seems unnecessary.”

BDA supports members with CQC compliance

The BDA has today announced that it is making available free of charge online to members its dedicated toolkit helping members comply with the CQC requirements.

The toolkit is a value-added product.  It contains not only guidance on how to complete the application form and how to comply with the requirements – which is already free on the website and has been accessed by many members over the past few months – but also over 40 BDA-approved models, protocols and templates to smooth the process.  Part of our ongoing support and advice for members, the kit enables us to get this critical and practical information to the large number of members who have asked us for it.  The toolkit CD-Rom was originally priced at just £75 for members, with a non-member price of £520 more accurately reflecting its commercial value.  The many members who have already paid for a copy will receive a full refund.

The kit is the latest in the BDA’s well-known series of practice aids that are ordinarily available for members to buy. But in this case it will be available on the website by the end of next week at no cost until the end of the registration period at the end of March 2011.

Commenting on the decision to offer such a comprehensive level of support free, BDA Chief Executive Peter Ward said “The BDA has lobbied government consistently that the way CQC regulation is being implemented is plain wrong, being disproportionate, draconian and chaotic.  We will continue to fight for change and are enlisting the support of our members to help by sending a postcard to their MPs asking the Secretary of State to act.  The postcard will be distributed in the December issue of BDA News.

“The fact is though that members do have to comply with these unreasonable demands until change is won and accordingly we have developed a reliable toolkit that will be available to all to help them do so.  The demands of CQC are almost unprecedented in recent times and the BDA has responded rapidly by devoting significant time and expertise in delivering a product that will protect members from some of the unnecessary pressure CQC compliance entails.”

From the Guardian www.guardian.co.uk/politics/2010/nov/12/mcdonalds-pepsico-help-health-policy

McDonald’s and PepsiCo to help write UK health policy
Exclusive: Department of Health putting fast food companies at heart of policy on obesity, alcohol and diet-related disease.

The Department of Health is putting the fast food companies McDonald’s and KFC and processed food and drink manufacturers such as PepsiCo, Kellogg’s, Unilever, Mars and Diageo at the heart of writing government policy on obesity, alcohol and diet-related disease, the Guardian has learned.

In an overhaul of public health, said by campaign groups to be the equivalent of handing smoking policy over to the tobacco industry, health secretary Andrew Lansley has set up five “responsibility deal” networks with business, co-chaired by ministers, to come up with policies. Some of these are expected to be used in the public health white paper due in the next month.

The groups are dominated by food and alcohol industry members, who have been invited to suggest measures to tackle public health crises. Working alongside them are public interest health and consumer groups including Which?, Cancer Research UK and the Faculty of Public Health. The alcohol responsibility deal network is chaired by the head of the lobby group the Wine and Spirit Trade Association. The food network to tackle diet and health problems includes processed food manufacturers, fast food companies, and Compass, the catering company famously pilloried by Jamie Oliver for its school menus of turkey twizzlers. The food deal’s sub-group on calories is chaired by PepsiCo, owner of Walkers crisps.

The leading supermarkets are an equally strong presence, while the responsibility deal’s physical activity group is chaired by the Fitness Industry Association, which is the lobby group for private gyms and personal trainers.

In early meetings, these commercial partners have been invited to draft priorities and identify barriers, such as EU legislation, that they would like removed. They have been assured by Lansley that he wants to explore voluntary not regulatory approaches, and to support them in removing obstacles. Using the pricing of food or alcohol to change consumption has been ruled out. One group was told that the health department did not want to lead, but rather hear from its members what should be done.

Professor Sir Ian Gilmore, the leading liver specialist and until recently president of the Royal College of Physicians, said he was very concerned by the emphasis on voluntary partnerships with industry. A member of the alcohol responsibility deal network, Gilmore said he had decided to co-operate, but he doubted whether there could be “a meaningful convergence between the interests of industry and public health since the priority of the drinks industry was to make money for shareholders while public health demanded a cut in consumption”.

He said: “On alcohol there is undoubtedly a need for regulation on price, availability and marketing and there is a risk that discussions will be deflected away from regulation that is likely to be effective but would affect sales. On food labelling we have listened too much to the supermarkets rather than going for traffic lights [warnings] which health experts recommend.” Employers are being asked to take on more responsibility for employees in a fourth health at work deal. The fifth network is charged with changing behaviour, and is chaired by the National Heart Forum. This group is likely to be working with the new Cabinet Office behavioural insight unit, which is exploring ways of making people change their behaviour without new laws.

Lansley’s public health reforms are seen as a test case for wider Conservative policies on replacing state intervention with private and corporate action.

While public interest groups are taking part in drawing up the deals, many have argued that robust regulation is needed to deal with junk food and alcohol misuse.

The Faculty of Public Health, represented on several of the deal networks, has called for a ban on trans fats and minimum alcohol pricing. Professor Lindsey Davies, FPH president, said: “We are hopeful that engaging with the food industry will lead to changes in the quality and healthiness of the products we and our children eat.  It is possible to make progress on issues such as salt reduction through voluntary agreements, and we’re keeping an open mind until we see what comes out of the meetings, but we do think that there is still a role for regulation.”

Responding to criticism that industry was too prominent in the plans, the Department of Health said: “We are constantly in touch with expert bodies, including those in the public health field, to help inform all our work. For the forthcoming public health white paper we’ve engaged a wide range of people, as we are also doing to help us develop the responsibility deal drawn from business, the voluntary sector, other non-governmental organisations, local government, as well as public health bodies. A diverse range of experts are also involved.”

He added that the government wanted to improve public health through voluntary agreements with business and other partners, rather than through regulation or top-down lectures because it believed this approach would be far more effective and ambitious than previous efforts.

An over-arching board, chaired by Lansley, has been set up to oversee the work of the five responsibility deal networks, with representatives of local government and a regional health director – but it too is dominated by the food, alcohol, advertising and retail industries. Gilmore called for a better balance of commercial interests and independent experts on it.

Other experts have also expressed concern at Lansley’s approach. Professor Tim Lang, a member of the government’s advisory committee on obesity, doubted the food and drink industry’s ability to regulate itself. “In public health, the track record of industry has not been good. Obesity is a systemic problem, and industry is locked into thinking of its own narrow interests,” said Lang.

“I am deeply troubled to be sent signals from the secretary of state about working ‘with business’ and that any action has got to be soft ‘nudge’ action.”

Jeanette Longfield, head of the food campaign group Sustain, said: “This is the equivalent of putting the tobacco industry in charge of smoke-free spaces. We know this ‘let’s all get round the table approach’ doesn’t work, because we’ve all tried it before, including the last Conservative government. This isn’t ‘big society’, it’s big business.”

Please read it in conjunction with my blogpost on the cause of Oral Cancers that I wrote in August last year.

…….On my first full afternoon, tiring of shopping in The Mall and dreading spending any more time than I needed in the 115F desert heat, I took refuge in the multiplex. I chose the new Michael Douglas movie, Wall Street 2, Money Never Sleeps. It’s not a great film (I am a poor film critic usually managing to find some small thing to redeem even the biggest turkey) but Douglas does give a good performance reprising his role as Gordon Gekko, the cigar-smoking financier. The fine Havana cigars are quite a change from the packs of cigarettes that the actor used to consume when a younger man.

As in the first Wall Street film he gets to give a speech about money and greed, I was fascinated, staring at the huge screen, whether I could make out any external sign of the advanced throat tumour that would soon leave the actor devastated by chemotherapy and fighting for his life. His illness being reason that his wife Catherine Zeta-Jones had to leave her native Wales after welcoming the visitors for the Ryder Cup to return to his bedside in New York a couple of days earlier.

November is Mouth Cancer Actions Month; organised by the BDHF and supported by Denplan – some revealing statistics have been published.

•    1 person in 10 has never heard of throat cancer – more awareness predictably being in the over the age of 50.
•    An increasing number of young people are being diagnosed with the disease.
•    It is responsible for 1 death every 5 hours in the UK alone.
•    It kills more people than testicular and ovarian cancer combined.
•    The rates of mouth cancer have increased by 40% during the past decade.
•    There has been an increase in 10% over last year’s figures to 6,000 new cases a year.

Dentistry is primarily associated with quality of life and rarely with life and death. People survive without teeth – although I would not want to be one of them. Mouth cancer is devastating in treatment and consequence.

Sadly it seems there are still some dentists who do not routinely examine their patients for early signs of the disease inside the mouth and fail to examine the areas outside the mouth for lumps and bumps.
So:
•    Tell your patients what you’re looking for
•    Tell them what signs and symptoms are so that they become aware and can share what they know
•    Tell them how many people die of the disease
•    Tell them what the risk factors are
•    Tell them that’s why it’s important to have a regular screening as part of their routine recall
•    Tell them “if in doubt….get checked out”

Why not?
•    Tell your local media all about Oral Cancer Month,
•    Contact your local GMPs to remind them what they should be looking out for,
•    Spend a staff meeting talking about the subject

Isn’t this very least you can do?

I still attend their meetings when I am able and am happy to present advance notice of a couple of good ones upcoming in the next couple of months.

Tell them I sent you and you’ll get a 10% discount on the already very reasonable fee of £270.

To attend get in touch with Mark Smith, Moorend Park Road, Cheltenham, GL53 0JY. 07766 878356. info@gid.org.uk

First up in December, Michael Norton and Nigel Rosenbaum are presenting an “Update on Implants and Dentures”.

In January Derek Mahony & Simon Littlewood present an “Update in Orthodontics for the GDP”

One of my early coaches, David Price, used to pose the question “What will you do for the benefit of your patient if I take your drills away for a few days; and no you can’t take the time off!”

It was a sign of the poor care that he endured whilst an in-patient that none of the nursing staff seemed to be able to help him at all. Why I was surprised or even disappointed I am not sure, let’s face it if he was allowed to develop bed sores (as he was) and little fuss was made then why should anyone be bothered about his mouth?

Fortunately my mother was able to treat his bed sores and help prevent their recurrence. My wife and I were also able to do what we could to make his mouth better with solutions that seemed to be beyond the ken of the nurses.

Hopefully this will help dry mouth sufferers – but will it get past NICE?

New Approach For Treating Dry Mouth Presented In JADA-Published Study

A newly published study in the October 2010 issue ofThe Journal of the American Dental Association (JADA), conducted at New York University’s College of Dentistry, confirms the safety and efficacy of a new novel method for controlling xerostomia, or dry mouth. The double masked, randomized controlled crossover study concludes that use of a unique mucoadhesive patch, affixed to the hard palate inside the mouth, provides statistically significant and sustainable improvements in salivary flow rates and subjective moistness for dry mouth sufferers. An estimated 30 million Americans deal with this uncomfortable oral health condition.

This latest study comes on the heels of another published study (March 2010 issue of Quintessence International) that showed these patches provided better performance for dry mouth sufferers than a leading over-the-counter dry mouth spray.

Chronic dry mouth is an under-diagnosed condition that can have a detrimental effect on oral health by contributing to tooth decay, gum disease and chronic bad breath. It can be a symptom of other medical conditions, such as diabetes or Sjogren’s Syndrome, and is also the result of radiation treatment for head and neckcancer, but it is most often a side effect of many prescription and over-the-counter medications taken daily by millions of Americans (34% of people on three or more medications will likely have this condition).

The mucoadhesive patches tested in the study are available to consumers under the brand name OraMoist™ and sold over-the-counter at retailers, such as Rite-Aid and Walgreen’s, nationwide. Approximately one centimeter in diameter, the patches can adhere to any oral mucosal surface, such as the roof of the mouth or inside the cheek, and the study confirmed can yield a “statistically significant improvement in baseline subjective and objective measures of dry mouth for up to 60 minutes – and possibly longer – after application.”

The JADA study also found that after two weeks of daily use, participants experienced a statistically significant improvement in baseline subjective and objective measures of salivary flow. This, according to the researchers, suggests a sustained effect.

According to Dr. Kerr, OraMoist provides an appealing and convenient alternative to other dry mouth treatments, which are usually in spray, rinse or gel form and require the user to replenish when necessary – which can be up to every 20 minutes. Overnight, the sustained effect is of particular benefit.

“The OraMoist patches offer pleasant tasting and longer-lasting option for the management of dry mouth, which becomes a quality of life issue for sufferers,” says Dr. Kerr. In this and the Quintessence International study, approximately 70% of participants stated they would use the patch again.

OraMoist Dry Mouth Patch is a time-released mucoadhesive patch that moistens and lubricates the mouth, while simultaneously stimulating saliva production, day or night. . The patch can last for up to four hours and is the only such sustained release dry mouth product available over-the-counter.

The placebo mucoadhesive patches used in this study were made using the same unique, patented technology as the OraMoist patches. Unlike the unloaded placebo patch, the loaded patch, OraMoist, is enhanced by natural ingredients including natural lipids, oral enzymes, citrus oil, sea salt, calcium carbonate, natural lemon and xylitol. According to the company, the researchers behind the patch believe that these additional ingredients also play a role in inhibiting bacterial growth and promoting oral health. Based on the results of this study, further investigation of these benefits is warranted.

The patented mucoadhesive patch technology was developed by Professor Abraham J. Domb, PhD, Institute of Drug Research, School of Pharmacy, Faculty of Medicine at the Hebrew University. Dr. Domb is a leading worldwide authority on mucoadhesive technology/bio-degradable polymer research. The same patch technology has also been successfully adapted for the treatment of aphtous ulcers, or canker sores.

- Significant increase in objectively-measured salivary flow rates in those using OraMoist
- A “sustained effect” for OraMoist – the patients using it benefited more on their 4th and 5th weeks than on their 3rd; increased baseline of improvement
- 96% of patients said OraMoist was easy to use; 82% said OraMoist did not interfere with eating or talking; 74% said the flavor was pleasant.
- OraMoist is safe. There were no adverse events reported in the study.

“One of the results was that after two weeks of use of the patch, the amount of saliva in the mouth had increased even during times when there was no patch in the mouth,” says the study’s lead author A. Ross Kerr, DDS, MSD, clinical associate professor at New York University College of Dentistry. “In other words, the patch would seem to have a cumulative beneficial effect.”