NEW YORK — Between 1965 and 2004, the distribution of states with the highest mortality changed dramatically. In 1965, the states with the highest mortality (Rhode Island, Alaska, Delaware, Pennsylvania, and New Hampshire) were spread across geographic regions. By 2004, however, the states with the highest mortality were geographically contiguous, and located in the south. The Central South (Alabama, Kentucky, Mississippi, and Tennessee) had the highest mortality rates in the United States. A new study by Andrew Fenelon of Brown University explores the possibility that smoking behaviors account for this situation.

Fenelon used US mortality data from vital statistics on cause of death for the period 1965-2004 and, for the purposes of this study, considered lung cancer deaths to be indicative of cigarette smoking. In the US, more than 90 percent of lung cancer deaths among men and more than 80 percent among women result from smoking. Although the prevalence of smoking declined in all states in that time period, southern states, particularly Kentucky, have maintained overall high levels of smoking.

Fenelon found that in the Central South, mortality attributable to smoking peaked later than in other regions and at a significantly higher death rate, indicating a greater and more persistent burden of smoking. By 2004, the gap in mortality attributable to smoking between the Central Southern states and states in other regions was exceptionally large: among men, smoking explained as much as 75 percent of the difference between the Central South and other US regions.

Laws and policies in the Central South do not strongly discourage smoking. There are currently 10 states with no statewide ban on smoking (for example, in workplaces or restaurants); nearly all of these states are in the South. State taxes on tobacco products also remain low in the Central Southern states compared to other states with lower mortality from smoking. Studies have shown that smoking bans and tobacco taxes reduce the prevalence of smoking.

This study highlights geographic inequalities in health and mortality within the US and underscores the importance of narrowing these gaps as a public policy goal.

This article is available free of charge for a limited time at https://onlinelibrary.wiley.com/doi/10.1111/j.1728-4457.2013.00630.x/abstract

Population and Development Review (PDR) seeks to advance knowledge of the relationships between population and social, economic, and environmental change and provides a forum for discussion of related issues of public policy. PDR is published quarterly on behalf of the Population Council by Wiley-Blackwell.

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Flu vaccination prevented an estimated 6.6 million influenza-associated illnesses, 3.2 million medically attended illnesses, and 79,000 hospitalizations during the 2012-2013 flu season, according to a Centers for Disease Control and Prevention (CDC) report in the Morbidity and Mortality Weekly Report (MMWR). CDC also reported recently that despite the benefits of flu vaccination, only 40% of Americans 6 months and older had reported getting a flu vaccine this season as of early November 2013.

The estimated benefits of vaccination for the 2012-2013 season are higher than any other season for which CDC has produced similar estimates. These high numbers are attributable to the severity of the season. The report estimates that last season there were a total of 31.8 million influenza-associated illnesses, 14.4 million* medically attended illnesses, and 381,000 hospitalizations in the United States.

“The estimated number of hospitalizations reinforces what we have always known about flu: that it is highly variable and can be very serious,” said CDC Director Tom Frieden, M.D., M.P.H. 

Children aged 6 months through four years and persons aged 65 and older, who are among those most vulnerable to influenza, accounted for an estimated 69% of prevented hospitalizations.

CDC often cites flu as being responsible for 200,000 hospitalizations each season. This average is taken from data during the 1990s, when annual estimates ranges from 158,000 hospitalizations in 1990-1991 to a high of 431,000 hospitalizations in 1997-1998.

“Most of estimated hospitalizations last season were in people 65 and older. This shows how hard a severe H3N2 season can hit this vulnerable group,” Dr. Frieden said.

Estimates for illnesses and medical visits during 2012-2013 were elevated as well, but lower than what was seen during 2009-2010, when an H1N1 pandemic resulted in an estimated 52 million influenza illnesses and 24 million medical visits. 

The CDC Director said that while older adults were hardest hit last season, “there were also 169 deaths among children reported to CDC, the highest number in a non-pandemic season since this type of reporting began in 2004.”

Three influenza deaths among children have been reported to CDC so far this season.

“We could prevent even more illness by increasing use of flu vaccines among people of all ages” said Dr. Frieden. The MMWR report estimates if 70% of the population had been vaccinated last season, another 4.4 million flu illnesses, 1.8 million medically attended illnesses, and 30,000 flu hospitalizations could have been prevented.

CDC also posted reports on its website on estimated flu vaccination uptake so far this season. National early-season vaccination coverage estimates are that 40% of Americans 6 months and older had received a flu vaccination by early November 2013 (39% of adults and 41% of children). This is similar to flu vaccination coverage last season at the same time.

Other online coverage reports indicated that vaccination among pregnant women (41%) and health care providers (63%) is about the same as it was this time last year. Among health care providers, the agency again noted high vaccination rates among clinical providers like pharmacists (90%) physicians (84%), and nurses (79%) but much lower vaccination rates among assistants or aides (49%) and health care providers working in long-term care facilities (53%).

“We are happy that annual flu vaccination is becoming a habit for many people, but there is still much room for improvement,” said CDC’s Anne Schuchat, MD.  “The bottom-line is that influenza can cause a tremendous amount of illness and can be severe.  Even when our flu vaccines are not as effective as we want them to be, they can reduce flu illnesses, doctors' visits, and flu-related hospitalizations and deaths.”

Seasonal influenza activity is increasing in parts of the United States.  Further increases in influenza activity across the U.S. are expected in the coming weeks.  “If you have not gotten your flu vaccine yet this season, you should get one now,” said Dr. Schuchat. 

CDC released today’s reports in concert with National Influenza Vaccination Week (NIVW), a national observance taking place from December 8-14, 2013. Past flu vaccination coverage estimates have shown flu vaccination activity drops quickly after the end of November. NIVW was established by CDC and its partners in 2005 to underscore the importance of continuing flu vaccination throughout the flu season.  Peak weeks of influenza activity have occurred in January through March in more than 90% of seasons during the past 20 years, and significant circulation can occur as late as May.

*Please note correction from original posting

Teenagers are notorious for chewing a lot of gum. The lip smacking, bubble popping, discarded gum stuck to the sole give teachers and parents a headache.

Now, Dr. Nathan Watemberg of Tel Aviv University-affiliated Meir Medical Center has found that gum-chewing teenagers, and younger children as well, are giving themselves headaches too. His findings, published in Pediatric Neurology, could help treat countless cases of migraine and tension headaches in adolescents without the need for additional testing or medication.

"Out of our 30 patients, 26 reported significant improvement, and 19 had complete headache resolution," said Dr. Watemberg. "Twenty of the improved patients later agreed to go back to chewing gum, and all of them reported an immediate relapse of symptoms."

Right under our noses

Headaches are common in childhood and become more common and frequent during adolescence, particularly among girls. Typical triggers are stress, tiredness, lack of sleep, heat, video games, noise, sunlight, smoking, missed meals, and menstruation. But until now there has been little medical research on the relationship between gum chewing and headaches.

At Meir Medical Center's Child Neurology Unit and Child Development Center and community clinics, Dr. Watemberg noticed that many patients who reported headaches were daily gum chewers. Teenage girl patients were particularly avid chewers — a finding supported by previous dental studies. Dr. Watemberg found that in many cases, when patients stopped chewing gum at his suggestion, they got substantially better.

Taking a more statistical approach, Dr. Watemberg asked 30 patients between six and 19 years old who had chronic migraine or tension headaches and chewed gum daily to quit chewing gum for one month. They had chewed gum for at least an hour up to more than six hours per day. After a month without gum, 19 of the 30 patients reported that their headaches went away entirely and seven reported a decrease in the frequency and intensity of headaches. To test the results, 26 of them agreed to resume gum chewing for two weeks. All of them reported a return of their symptoms within days.

Two previous studies linked gum chewing to headaches, but offered different explanations. One study suggested that gum chewing causes stress to the temporomandibular joint, or TMJ, the place where the jaw meets the skull. The other study blamed aspartame, the artificial sweetener used in most popular chewing gums. TMJ dysfunction has been shown to cause headaches, while the evidence is mixed on aspartame.

Gumming up the works

Dr. Watemberg favors the TMJ explanation. Gum is only flavorful for a short period of time, suggesting it does not contain much aspartame, he says. If aspartame caused headaches, he reasons, there would be a lot more headaches from diet drinks and artificially sweetened products. On the other hand, people chew gum well after the taste is gone, putting a significant burden on the TMJ, which is already the most used joint in the body, he says.

"Every doctor knows that overuse of the TMJ will cause headaches," said Dr. Watemberg. "I believe this is what's happening when children and teenagers chew gum excessively."

Dr. Watemberg says his findings can be put to use immediately. By advising teenagers with chronic headaches to simply stop chewing gum, doctors can provide many of them with quick and effective treatment, without the need for expensive diagnostic tests or medications.

Posters to educate patients and staff about hepatitis B testing are available from the CDC's "Know Hepatitis B" program, which is a national communications campaign promoting hepatitis B testing among Asian Americans and Pacific Islanders (AAPIs).

Posters are now available in Burmese, Hmong,  Khmer, Lao, Chinese, Vietnamese, Korean, and English. English, Chinese, Korean, and Vietnamese. Also available are multi-lingual posters. Click here to order a limited number.

CHICAGO–With more than 600 guests registered, early bird tickets for Oral Health America’s (OHA) 24th Annual Gala & Benefit at Chicago's Palmer House Hotel on Wednesday, February 19, 2014 from 6-9:30 p.m. are becoming the most sought after ticket in town. Now through December 31, supporters can obtain discounted rates for the charity event.

The theme, Smiles Across Generations, will spotlight Oral Health America’s programs aimed at improving the oral health of vulnerable populations of all ages. Additionally, the evening will celebrate the organization’s history while looking toward its future. Since 1955, the Chicago-based non-profit has dedicated its work to connecting communities with resources to increase access to care, education, andadvocacy for all Americans.

"There has been tremendous demand to engage with our work," said Beth Truett, President & CEO. “We are overwhelmed by the outpouring of support for our programs and initiatives in 2014.”  OHA will honor Anthony Volpe, a leader in public health dentistry for over 40 years, at a separate reception before the gala.

The Palmer House’s Grand and State Ballrooms will host a gourmet dinner, a live and silent auction, and live music. The highly anticipated cocktail hour in the hotel’s Red Lacquer Room will be presented by the Kavo Kerr Group. In addition to Kavo Kerr Group’s Presenting Sponsorship, the gala and benefit is generously supported byTechnology Sponsors Ivoclar Vivadent and Patterson Dental; Diamond Sponsors Colgate, Henry Schein, Philips Sonicare, SciCan, Septodont, DentaQuest and DENTSPLY International; Platinum Sponsors Chicago Dental Society, Darby Dental, DentalEZ, and Midmark Raffle Sponsor Aspen Dental and Gold Sponsors Karwoski & Courage, Burkhart, Unilever, Planmeca, Atlantic Precious Metals Refining and Bisco.

To purchase tickets, sponsorships, or additional information, please visit oralhealthamerica.org/participate/gala or contact Brittany Wright at (312) 836-9900 or brittany.wright@oralhealthamerica.org.

CHICAGO – A new study finds nearly one in four healthcare workers' hands were contaminated with Clostridium difficile spores after routine care of patients infected with the bacteria. The study was published in the January issue of Infection Control and Hospital Epidemiology, the journal of the Society for Healthcare Epidemiology of America.

"This is the first known study focusing on the carriage of viable C. difficile spores on healthcare workers hands," said Caroline Landelle, PharmD, PhD, lead author of the study. "Because C. difficile spores are so resistant and persistent to disinfection, glove use is not an absolute barrier against the contamination of healthcare workers' hands. Effective hand hygiene should be performed, even in non-outbreak settings."

Researchers compared hand contamination rates among healthcare workers caring for patients with C. difficile with healthcare workers caring for non-colonized patients after routine patient care and before hand hygiene. All patients with C. difficile were being treated with infection control measures that consisted of (1) placing patients into a single-bed room with dedicated equipment; (2) wearing disposable gowns with full-length sleeves and a pair of gloves on entering the room; (3) hand hygiene with alcohol-based hand rub before wearing gloves, before and after body fluid exposure, and hand washing with medicated soap and water followed by use of alcohol-based hand rub after glove removal; and (4) daily room cleaning with a hypochlorite-based disinfectant.

Contamination of healthcare workers' hands occurred with high-risk contact (e.g., patient washing, digital rectal exam, bed linen change, colonoscopy) or when workers didn't use gloves. Hand contamination was also associated with the duration of high-risk contact and was more common among nursing assistants (42 percent) than among other healthcare workers (19 percent for nurses and 23 percent for physicians), likely because nursing assistants had more high-risk contact.

In a commentary accompanying the study, author Aurora Pop-Vicas, MD, notes that "this study offers a vivid insight into why C. difficile might be so stubbornly persistent in our hospital…much work remains to be done in implementing what is known about the prevention of the spread of this bacteria through horizontal transmission. Additional measures include improvement in antimicrobial stewardship programs and effective environmental cleaning within healthcare institutions."

The number of patients hospitalized with a primary C. difficile diagnosis in the United States more than tripled during 2000-2009. Key risk factors of contracting C. difficile include prior receipt of antibiotic therapy, age, severity of underlying disease, length of hospital stay and prior occupancy of patient rooms. However, many healthcare workers may be passing on this highly contagious bacteria to patients even after routine alcohol-based hand rubbing. This points to the need for routine hand washing with soap and water, rather than alcohol-based hand rub, after care of C. difficile patients in all settings.

In the Compendium of Strategies to Prevent Healthcare-Associated Infections, SHEA recommends that health professionals clean hands with soap and water after caring for patients with C. difficile infections. Evidence shows that soap and water is superior to alcohol-based sanitizers for removing C. difficile spores. SHEA plans to release an updated Compendium in 2014.

PORTLAND, Maine — After a national search, the University of New England earlier this month appointed James B. Hanley, DMD as the new Dean of the College of Dental Medicine, effective April 1, 2014.

Dr. Hanley has an extensive background in private practice, dental education and administration that positions him to lead UNE’s newest College, which enrolled its inaugural class in August 2013.  This includes a distinguished 34-year career at Tufts University School of Dental Medicine, most recently as Associate Dean for Clinical Affairs and Associate Professor of Periodontology.

At Tufts, Dr. Hanley has demonstrated a successful record of collaborative engagement with students, faculty, staff and administrators, working as a member of the senior leadership team on initiatives related to strategic planning, curriculum revision, patient care, research, accreditation, budget, advancement, recruitment and interprofessionalism.

In his role as Associate Dean for Clinical Affairs at Tufts’ School of Dental Medicine, Dr. Hanley leads a team of 65 staff members who support the care of 650 patients a day in Tufts’ complex educational environment.

“Dr. Jim Hanley’s outstanding background in dental education and practice, his leadership experience, his close connection to the New England area, his commitment to the mission of UNE and the College of Dental Medicine, and his strong dedication to the student experience uniquely position him to lead our College forward.” stated Dr. James J. Koelbl, Founding Dean of the College of Dental Medicine and Provost and Senior Vice President of UNE.  “I am extremely pleased to be able to turn the deanship over to someone of Dr. Hanley’s caliber as I move forward in 2014 in my new role as Provost.”

Dr. Hanley has received numerous honors and awards, including the 2012 Provost’s Award for Teaching and Service at Tufts. He was named a Fellow of the American Dental Education Association Leadership Institute in 2011, a Fellow of American Academy of Dental Science in 2009, a Fellow of the American College of Dentists in 2006, and a Fellow of the International College of Dentists in 2006.

Dr. Hanley received his D.M.D and his Advanced Education Certificate in Periodontology from Tufts University School of Dental Medicine.  He was awarded Diplomate status by the American Board of Periodontology in 2005.

UNE’s College of Dental Medicine inaugural class of 64 includes 24 students from Maine, representing 11 counties and more than 20 towns. There are also five students from New Hampshire, four from Vermont and other students representing 16 states in addition to Canada.

Once UNE’s Oral Health Center is fully operational, faculty and students will provide approximately 12,000-15,000 patient visits per year in the Center, with an additional 20,000-25,000 visits per year provided in the community-based network.

Source: University of New England

Tooth wear is an increasingly common problem, particularly among young adults. ESCARCEL, a recent pan-European study supported by GSK, found that almost one third (29.4%) of study subjects, aged 18-35, have experienced tooth wear¹ and therefore identifies a need to regularly screen patients for the condition.²

The ESCARCEL study looked at tooth wear risk factors and found that those with frequent acidic food intake had higher levels of damage.¹ Adherence to modern lifestyles including consumption of diets rich in acidic food such as fruits, juices, tea and sodas, was identified as a likely contributor to the increase of the condition.

While initial enamel softening is reversible, once the enamel is lost from teeth, it is lost forever, raising the importance of proactive prevention and management of the condition.¹

On October 28^th 2013, a round table of highly recognized dentists and dental hygienists was hosted in New Jersey supported by GSK, the manufacturers of ProNamel® toothpaste. The meeting discussed the recently released European data (ESCARCEL study) and insights on prevalence and significance of tooth surface acid erosion, approaches to identifying erosion in the dental office, and the management of patients at risk of wear.

The panel universally reported seeing acid erosion on a weekly basis in clinical practice, confirmed the condition is a significant threat to a patient’s oral health and agreed that the prevention of acid erosion is the most effective form of management. The role of the dental professional in identifying those patients at risk was recognized as critical.

The need for recommendations was made evident by the lack of a simple and accepted index for the identification and recording of acid erosion in the dental office, as well as the lack of robust data on the prevalence of acid erosion within the US population.

The Basic Erosive Wear Examination, a simple recording tool for use in practice to guide clinicians through the diagnostic process and assist them in determining appropriate case management, was presented and discussed. The panel determined that the Basic Erosive Wear Examination would be a useful tool in indexing and recording acid erosion amongst patients at risk.

The panel made a series of recommendations to raise awareness of the condition and the Basic Erosive Wear Examination amongst practicing dental professionals, and to improve dental education. The meeting also highlighted the need for further research within the US dental patient population.

Summary of key findings

- Acid erosion presents a significant risk to patients’ oral health

- There is a growing need to establish the prevalence of acid erosion amongst the US population

- A healthy balanced diet is important but care needs to be exercised in the frequency and method of consumption of acidic foods

- Prevention of acid erosion is the most effective form of management and the role of the dental professional in identifying patients at risk is critical

- Management of acid erosion should be targeted at those patients most at risk

- The Basic Erosive Wear Examination index could be a valuable tool in supporting dental professionals in accurately and consistently identifying and recording acid erosion

ProNamel® toothpaste has been specially developed with an optimized fluoride formulation to help reharden acid-softened enamel and make it more resistant to future acid challenges.

The specially developed fluoride polymer technology of ProNamel® Fluoride Rinse enhances the delivery of fluoride to the tooth surface.³

Use of ProNamel® toothpaste and ProNamel® Fluoride Rinse together can help to provide extra protection against the effects of acid erosion.

For more information on Acid Erosion, the Basic Erosive Wear Examination or ProNamel® products please contact your local GSK representative or visit www.dental-professional.com.

1. Bartlett DW et al. J Dent 2013; 41: 1007-1013. | 

2. Bartlett DW. International Dental Journal 2005; 55: 277-84. | 

3. Nehme M et al. Polymer-Augmented Fluoride Uptake into Enamel Erosive Lesions. Presented at IADR, Seattle, March 2013. #174399.

Source: GSK

The American Association of Endodontists Foundation has awarded $1.7 million to the University of Maryland School of Dentistry (UMSOD) and two collaborating institutions to fund an innovative, multi-center clinical trial. The trial, "Regeneration of pulp-dentin development in teeth with necrotic pulps and immature roots," is being developed at UMSOD by the Department of Endodontics, Prosthodontics and Operative Dentistry in collaboration with Loma Linda University and the University of Texas Health Science Center at San Antonio.

The goal of the clinical trial is to evaluate whether dental pulp can be successfully regenerated in immature teeth of pediatric patients. "Children are frequently exposed to trauma and decay, or develop congenital anomalies in their teeth. These conditions may render the dental pulp, which is the tissue inside the tooth, dead," explains Professor Ashraf Fouad, BDS, DDS, MS, chair of the Department of Endodontics, Prosthodontics and Operative Dentistry.

Treating pediatric patients who suffer from dead tooth pulp is technically difficult, and may render the tooth susceptible to fracture. After permanent teeth erupt in the mouth of a patient, which usually starts at age 6 and continues through adolescence, it takes about three years before the teeth reach complete maturation and can be treated using conventional endodontic techniques and materials.

Fouad and his collaborators will evaluate the effectiveness of two different regenerative approaches for the dental pulp, compared with the traditional method: MTA apexification. The latter involves using MTA, a calcium silicate-based material, to create a barrier between the tissues that surround the root end and a conventional dental restoration placed in the root canal. This traditional technique tends to leave teeth with thin walls that are very weak.

The second method to be evaluated, called revascularization, involves cleaning out the root canal, using topical antibiotics to fight the infection and then inducing a blood clot that allows new tissue to grow inside the root canal. This method is problematic because the new tissue is not comprised of dentin and pulp, which are the hard and soft tissues that form the normal root structure.

The third method is a novel approach that utilizes the same tooth-disinfection method as revascularization, but adds commercially-available growth factors into the root canal that may induce the growth of dentin and pulp. If true regeneration occurs, it would offer a major benefit for patients because tooth pulp would resist new bacterial infections. In addition, dentin would strengthen the root and allow conventional endodontic treatment.

Fouad and his colleagues will evaluate the treatment provided to pediatric patients to determine the success of each procedure. They will also examine how thick the root develops with time and determine if there are different healing patterns for each technique. The trial, which is planned to begin later this spring, will continue for six years. "Our short-term goal is to address a condition that is very difficult to treat in a way that will hopefully make the long-term outcomes for these children much better. Down the road, if we are successful in regenerating pulp and dentin, we will start to think about whether we can apply the regenerative technique to permanent teeth," states Fouad.

Source: University of Maryland

Fluoride levels in drinking water do not lead to a greater risk of primary bone cancer, a new study has found.

Researchers at Newcastle University found that higher levels of natural or artificial fluoride in drinking water in the UK had no impact on the incidence of either osteosarcoma or Ewing’s sarcoma in people aged 0-49.

The study, funded by charity Bone Cancer Research Trust (BCRT), analyzed 2,566 osteosarcoma and 1,650 Ewing’s sarcoma cases during 1980 and 2005.

Artificial fluoridation of drinking water to improve dental health has long been a controversial topic, with opponents citing a possible link with increased risk of primary bone cancer.

Dr Richard McNally of the Institute of Health & Society at Newcastle University, who led the study, said: “This is the largest study that has ever been conducted examining the possible association between fluoride in drinking water and risk of osteosarcoma or Ewing sarcoma.

“Karen Blakey used sophisticated software to link together data on the geographical distributions of bone cancer incidence and fluoride levels. Statistical modelling of these data showed that there was no evidence of an association.”

Andy Hall, chairman of BCRT’s Independent Scientific Advisory Committee, welcomed the findings of the study.

“Bone cancer is diagnosed in about 550 patients every year in the UK and Ireland, many of whom are children. However, at present, very little is known of the factors which trigger the disease.

“The study funded by the Bone Cancer Research Trust and reported by the team in Newcastle provides very important reassurance to patients and their relatives that fluoride is not involved in this process and shows that more research is needed to find out how this potentially devastating form of cancer can be prevented.”

Source: Bone Cancer Research Trust