Oral Cancer Linked to Virus

Increase in Oral Cancers Linked to HPV

The human papillomavirus is contributing to the growing number of  head and neck cancers in the United States, according to a new study Monday in the Journal of Clinical Oncology.

The study found that the number of cases of oropharyngeal cancer - cancers of the tonsil, back of the mouth (throat) and base of the tongue - has been on the rise since the mid-1980s.  The study suggests that one reason could an increase in the number of people having oral sex resulting in oral human papillomavirus  exposure.

Researchers say these cancers fall into two categories–those caused by tobacco and alcohol and those caused by the sexually transmitted virus, HPV. They now believe approximately 70% of all oropharyngeal cancers are caused by HPV infection.

"We used to think of oropharyngeal cancer as one cancer," said senior author Dr. Maura Gillison, The Ohio State University Comprehensive Cancer Center in Columbus. "Now we know the disease is comprised of two biologically and epidemiologically distinct cancers. This new understanding will increasingly enable us to improve and better personalize care for patients with each form of the disease."

Researchers tested cancer tissue samples from almost 6,000 patients in Hawaii, Iowa and Los Angeles between 1984 and 2004. They found the HPV-positive cancers increased 225% while HPV-negative oropharynx cancers dropped 50%–most likely because of a reduction in smoking and tobacco use. Even so, patients with HPV-positive cancers live longer.

"Patients with HPV positive cancers have better survival rates," said principal investigator Dr. Anil Chaturvedi of the National Cancer Institute. "The precise reasons for the survival benefits are not clear, but tumors in HPV-positive patients tend to have less genetic damage. Because of that, they are more responsive to cancer therapies like radiation treatment."

"The HPV status of a patient's tumor is the single greatest determinant of whether a person lives or dies after a diagnosis of local-regionally advanced oropharynx cancer," Gillison said. "HPV-positive patients have an approximate 60% reduction in risk of death after their diagnosis when compared to HPV-negative patients."

Gillison says about 95% of the HPV-positive oropharynx cancers were caused by HPV16, a strain targeted by Gardasil and Cervarix, the two vaccines currently on the market to prevent cervical cancer. Gardasil is manufactured by Merck & Co. and Cervarix is made by GlaxoSmithKline.

Gardasil was approved in 2006 for use in females  ages 9-26 to help prevent cervical cancer and genital warts. It was approved in 2009 for  males9-26 to reduce the risk of genital warts. It has not been recommended for use in preventing HPV-associated cancers, according to the National Cancer Institute. Cervarix was approved in 2009 for use in females 10-25. It is not approved for males.

The findings are important because the increase in these cancers has been relatively rapid compared with other HPV associated cancers like cervical cancer, Chaturvedi says. With cervical cancer, incidence rates have declined over time because of screening, but currently there is no screening in place for oropharyngeal cancers.

"Should the observed declines in cervical cancer and the observed increases in HPV positive oropharyngeal cancers continue into the future," Chaturvedi said.  "HPV positive oropharyngeal cancers will be the leading HPV associated cancers over the next decade–by around 2020."

There were almost 35,000 new cases of oral and oropharyngeal cancers this year, according to the American Cancer Society. While about 7,000 Americans will die this year, death rates associated with these cancers has actually been declining over the last 30 plus years.

"The burden of invasive HPV-caused cancers will shift from women to men in the US, largely due to the rise of HPV-positive oropharynx cancers among men," Gillison said. "HPV infection and its consequences have long been considered a women's problem, and women will continue to bear the brunt of the morbidity associated with the infection. However, gender equity is being achieved with regard to the burden of HPV-caused cancers. HPV infection is therefore a problem for both men and women."

Using Infrared Cameras to Search for Breast Cancer

Here is How They Work:

A cell puts out energy as it grows and divides into multiple cells. The faster this growth occurs, the higher is the energy output. This energy output increases the heat; that is, a breast cancer is, among other things, a severe inflammation that does not respond to normal anti-inflammation drugs, whether they are OTC or prescription. 

This increase in energy production has been known for a very long time. In the 1960s and 1970s, Xerography was used, but the printouts of the pictures taken of the breast hot spots took the form of a series of life-size pictures on sheets of computer paper that might be yards long. The sheer inconvenience of Xerographic heat detection made it impracticable and eventually it was largely though not totally abandoned. What we now know as traditional mammography, which is radiation-based and was in use before Xerography was tried, took its place. 

But problems with mammography abound. There are many false positives, which must be ruled out by biopsy, and much more serious, there are many false negatives. Breast cancer is the second leading malpractice-related condition with most lawsuits arising out of misdiagnosis and delayed treatment. One problem is that a mammogram may be negative, even for women with a breast lump, but a negative mammogram does not definitively rule out breast cancer. Further tests are necessary. Another problem is that women under 50 can get breast cancer, but many doctors will assume a diagnosis of breast fibrocystic disease because of their age. 


It is in that area of women under 50 years old that infrared camera, viewing their digital images on computer screens rather than yard-long paper, are the most useful. Although fibrocystic breast disease puts out some heat, it does not involve the very rapid cell growth and proliferation seen in cancer. For that reason, an infrared camera will show a much hotter image on a cancer than on a cyst or fibroid. This lowers the likelihood of a false positive and a false negative. According to a brochure on Breast Health, infrared screening is especially appropriate for younger women (30 to 50) whose denser breast tissue makes it more difficult for mammography to be effective. 

However, infrared cameras also have limitations. The most important one is that infrared cameras do not have the penetrating effectiveness of radiology. Therefore, a cancer an inch from the skin will almost certainly be picked up by infrared photography, but a cancer clinging to the back of the breast wall will be missed. This cancer will probably be missed by traditional mammography as well. 

Ultimately, the responsibility for breast cancer detection falls to each individual woman. She must see to it that the early detection guidelines are followed.  Annual Infrared Imaging (thermography) screening for women of all ages.  Mammography, when considered appropriate for women who are aged 50 or older. A regular breast examination by health professional Monthly breast self-examination. Personal awareness for [sic] changes in the breast.  Readiness to discuss quickly any such changes with a doctor. 

That last is critically important. Most women quickly become aware of changes in their breasts, but all too many women won't report the changes to their doctors because they are afraid they have breast cancer and somehow convince themselves that if they don't have the cancer confirmed medically it will go away. The best technology in the world will not save a woman from a breast cancer if she won't allow to be diagnosed or treated.

by Anne Wingate, Ph.D

About the Author

My first mammogram, when I was in my late 20s, was a Xerograph. I still remember how LONG that sheet of paper was. My mother and her mother both died of breast cancer. Last year I was on an every three months mammography schedule, but after one last month they put me back on an every six month schedule. I have read every book on breast cancer I could get my hands on, including some from the University of Utah's medical school library.

Whitening Toothbrush Maker Responds to Criticism

J&J to Modify Some Toothbrush Whitening Claims

September 9, 2011 -- The National Advertising Division (NAD) of the Council of Better Business Bureaus has recommended that Johnson & Johnson Healthcare Products modify certain claims for its Reach Total Care + Whitening toothbrush to clarify that the brush whitens teeth through the abrasive action rather than through bleaching.

As part of its routine monitoring program, NAD -- the advertising industry's self-regulatory forum -- requested substantiation for express claims that included the following:

• "Ordinary toothbrushes clean teeth. Reach whitens them."
• "At the core of this revolutionary toothbrush Reach has engineered a unique row of bristles infused with calcium carbonate microwhitening technology. That means each time you brush, you're whitening teeth and removing stains.*" (*in lab tests)

NAD also examined the implied claim that the Reach Total Care + Whitening toothbrush has been proven to actually whiten teeth when used in the same manner as an ordinary toothbrush.

According to Johnson & Johnson, the toothbrush, launched in 2010, was designed with bristles embedded with calcium carbonate, recognized by the U.S. Food and Drug Administration as an abrasive used in fluoride toothpastes.

In support of its claims, Johnson & Johnson provided NAD with evidence that demonstrated that bristles infused with calcium carbonate do, in fact, provide statistically significantly better stain removal than brushes with ordinary bristles. The company also provided testing to demonstrate that its advertised toothbrush provided significantly better plaque removal than the other two ordinary toothbrushes tested. In addition, Johnson & Johnson's evidence demonstrated that the difference in whitening and stain removal was meaningful to consumers, according to NAD.

Following its review of evidence, NAD determined that Johnson & Johnson could support the claim that "[o]rdinary toothbrushes clean teeth. Reach whitens them."

However, NAD recommended that the company modify the claims "whitens and removes stains" and "each time you brush you're whitening and removing stains" to ensure that consumers are aware that stain removal is accomplished extrinsically, through the stain-removing abrasive action of the bristles, not intrinsically through bleaching.

According to NAD, Johnson & Johnson said it is disappointed with the NAD recommendation, "given the industry practice of making unqualified whitening claims based on data showing extrinsic whitening only. Nevertheless, we understand NAD's recommendations and will take them into consideration in future advertising."

      - Dr. Green's sidenote


Patients often ask me for product recommendations (the best toothpaste, toothbrush, etc.) that they can use at home.   We evaluate 100s of products every year to make these recommendations.  Johnson & Johnson is one of the leading manufacturers of these at-home products and to be fair, I will say that the vast majority of their products are excellent and safe.  By posting this article I am in no way suggesting to my readers that they should ban J&J products from their household.  The objective of this post is to educate my readers on the potential dangers of store-bought whitening products.
When I recommend any product to my patients, I always consider it's method of action (how it does what the manufacturer claims it does).  With whitening toothpaste or toothbrushes the method of action usually involves the removal of surface staining rather than through the whitening of the tooth enamel (which is how whitening solutions and gels work).  This is accomplished through the use of coarse abrasives, not whitening solutions.

The best analogy I can use would be to compare toothbrushing to sanding a piece of wood.  In order to take raw wood from being splintery and rough to a smooth surface that's ready to stain, a carpenter will start with a fairly coarse grit of sandpaper and use progressively finer grits until the board is smooth.  When you brush your teeth you are basically doing the same thing-you use a toothbrush and toothpaste containing a minty abrasive to remove the plaque and food debris from your teeth.  I always recommend the use of a soft or ultra-soft bristled toothbrush and a traditional toothpaste (non-whitening and non-tartar control) for my patients.  This will do more than enough to clean your teeth on a daily basis - without damaging or removing the protective enamel.  If you have issues with stain accumulation related to heavy coffee consumption, smoking or drinking colas or red wines, that's where we come in.

Regular visits to a dental hygienist are always essential to maintaining optimum dental health, especially if you accumulate stain easily! 

Limitations Suggested for Osteoporosis Medications

FDA advisers consider time limit for bone drugs

By Reuters Health

September 9, 2011 -- ADELPHI, Md. (Reuters) - U.S. health advisers are considering a time limit for taking a class of drugs used by millions of women to prevent bone fractures, due to concerns over unusual fractures linked to the medicines and possible higher cancer rates.

Two U.S. Food and Drug Administration advisory panels were jointly meeting on Friday over whether to recommend a "drug holiday" or otherwise clarify how long people should take a class of osteoporosis drugs known as bisphosphonates.

These drugs include Merck & Co's Fosamax, Warner Chilcott's Actonel, Roche's Boniva, and Novartis' Reclast.

Widely taken by women after menopause to prevent osteoporosis, drugmakers told the advisers that a sweeping imposition of an interruption in treatment may leave patients vulnerable to more fractures.

FDA staff said rare femur fractures appear to be associated with use of the drugs, and the risk of jaw bone death may increase the longer people take them orally. But they said the evidence for an increased cancer risk was inconsistent.

No advantage exists in staying on the drug beyond five years, FDA researchers said.

"In light of the risk-benefit challenges, the available data suggest that therapy can be safely discontinued without the loss of efficacy," said Dr. Marcea Whitaker, an FDA medical officer from the reproductive and urologic drugs division. "However, additional data are needed to further define an appropriate duration of drug cessation."

Some 4.5 million Americans over the age of 55 filled prescriptions for bisphosphonates in 2009. The medicines are commonly taken for osteoporosis, a progressive bone-thinning condition that typically causes bone fractures in the hip, wrist, or spine.

Boniva is available as either an injection or a tablet, Reclast is an injection, and the other drugs are taken orally.

Since Merck's Fosamax became the first bisphosphonate to get approval for osteoporosis in 1995, the labels for the drugs of this class have undergone multiple reviews and changes.

In 2005, a warning of higher risk of osteonecrosis of the jaw was added to labels, and in 2009, a caution about adverse gastrointestinal reactions. Earlier this year, the labels added a warning of atypical femur fractures and Reclast's label was changed to highlight a higher risk of kidney failure.

Just last month, a federal judge threw out part of a bellwether lawsuit against Merck, but said the plaintiff could pursue her claim that Merck's Fosamax had a design defect and caused her jawbone tissue to die.

Still, bisphosphonates remain a widely-used treatment option for women facing a risk of bone fractures.

"I have to tell my patients that we have no magic bullet, that our drugs decrease the risk of fracture but we have nothing that eliminates fracture," said Dr. Robert Adler, an invited speaker at the advisory meeting and endocrinology professor at the Virginia Commonwealth University.

"Despite rare side effects, those patients who take bisphosphonates have fewer fractures and lower mortality, and these findings need to be shared with our patients," he said.

Makers of the drugs emphasized that studies have not directly linked or explained the connection between their medicines and adverse side effects. They voiced concerns about the lack of data on what happens to patients who go off treatment and suggested "drug holiday" decisions are best done for each patient individually.

"A drug holiday may be appropriate for some patients, but that decision should be based on an individual risk-benefit basis, and a physician is in the best position to make that decision overall," said Joseph Kohles, international medical leader for Boniva at Roche.

Whitening - How to Reduce Sensitivity & Damage to Your Teeth

Can Remineralizing Agents Mitigate Whitening Side Effects?

September 14, 2011 -- Teeth whitening is one of the most popular cosmetic procedures today, but it can have negative side effects. For example, some studies have reported that whitening agents containing carbamide peroxide or peroxide may soften dental hard tissues.

But a new study has found that adding a remineralizing agent such as casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) to the bleaching agent could mitigate this effect (Operative Dentistry, August 5, 2011).

"I decided to conduct this research since there is still a debate over whether carbamide peroxide- or peroxide-containing agents can soften dental hard tissues," said lead study author Boniek Castillo Dutra Borges, DDS, an assistant professor at the school of dentistry at Potiguar University, in a DrBicuspid.com interview. "We were surprised to find that the use of a CPP-ACP paste (MI Paste, GC America) with carbamide peroxide bleaching agents increased the bleached enamel's microhardness and did not have an influence on whitening efficacy."

“CPP-ACP-containing paste with carbamide peroxides could protect enamel against the demineralization. ...”
— Boniek Borges, DDS

Although a large body of scientific evidence demonstrates that CPP-ACP could promote the remineralization of even enamel subsurface caries lesions, this study is the first to analyze the effect of MI Paste in conjunction with carbamide peroxides on bleached enamel microhardness, the study authors noted.

To evaluate the efficacy of an at-home bleaching technique using 10% or 16% carbamide peroxide modified by CPP-ACP and its influence on the microhardness of bleached enamel, the researchers studied 40 bovine incisors that were stained using a mixture of red wine and tea.

The samples were divided into four groups of 10 each and stored in artificial saliva for a 14-day bleaching regimen. The four groups were bleached using the following:

• 10% carbamide peroxide only
• A blend of 10% carbamide peroxide and a CPP-ACP paste
• 16% carbamide peroxide only
• A blend of 16% carbamide peroxide and a CPP-ACP paste

For two of the 10% and 16% peroxide groups, the peroxides were mixed with MI Paste by combining 1 mL of the bleaching gels with 1 mL of MI Paste until a homogeneous paste was obtained, which was then inserted into a 5-mL syringe. In addition, the peroxides alone were put into 5-mL syringes.

The researchers assessed the microhardness and color of the teeth at baseline and immediately after the 14-day bleaching regimen using a microhardness tester and a spectrophotometer. The degree of color change was determined by the Commission Internationale de l'Eclariage (CIE) L*a*b* system and Vita shade guide parameters.

Among the study's findings:

• The teeth that were bleached with a blend of peroxide (10% or 16%) and the CPP-ACP paste presented increased microhardness values after the bleaching regimen compared with the baseline measurements, whereas the samples that were bleached with peroxide only did not show any differences in their microhardness values.
• All the bleaching agents were effective at whitening the teeth and did not show a statistically significant difference using the CIE L*a*b* system or the Vita shade guide parameters.

Even though the concentration of carbamide peroxides was reduced to half after mixing them with MI Paste, this was not sufficient to affect color change after a 14-day bleaching regimen, the authors wrote.

"The use of a casein phosphopeptide-amorphous calcium phosphate (CPP-ACP)-containing paste with carbamide peroxides could protect enamel against the demineralization caused by these bleaching agents," Dr. Borges said. "This improves safety and might even reduce in vivo tooth sensitivity during the bleaching process."

The authors did note, however, that more studies are needed to evaluate how long this microhardness increase could last. Other bleaching peroxides should be tested in association with the CPP-ACP paste because the results of this study are not applicable to all types of bleaching systems, they added.

Stem Cells & Dentistry - FAQ

As dental physicians, it is our duty to keep up with the most current technology available in order to afford our patients the best care possible. Recently, dental retrieval and storage of stem cells has become a topic of interest in the dental community. To help you understand this exciting advancement in the dental field, this article will answer some of the most commonly asked questions about stem cells.

The history of stem cells

• 2000: Dental pulp stem cells discovered by a researcher at the National Institutes of Health.
• 2003: National Institutes of Health announces viable stem cells are in dental pulp of teeth.
• 2004 to present: Over 1,000 published studies identifying therapeutic potential of dental mesenchymal stem cells.
• 2008: Surgeons from Spain announced the world’s first tissue-engineered whole organ transplant procedure, using a trachea made with the patient’s own adult mesenchymal stem cells. (Mesenchymal stem cells are found within the dental pulp of deciduous teeth, developing third molars, and the follicular tissue surrounding unerupted or developing teeth and permanent teeth with healthy pulp.)
• 2009: Scientists from Italy announced the first-ever human clinical application using patients’ own dental stem cells to repair mandibular bone defects.

7 Common questions about stem cells

1. What are stem cells?

Stem cells are immature, unspecialized cells in the body that are able to grow into specialized cell types by a process known as “differentiation.” There are two primary sources of stem cells: embryonic stem cells and adult stem cells. Adult stem calls are found in many organs and tissues in the human body, including the dental pulp contained within teeth. Embryonic stem cells have the ability to grow into any cell type in the body. However, there is great ethical controversy regarding obtaining and using these stem cells for medical research and treatment purposes. Until recently, it was thought that adult stem cells could only turn into cells that were the same as those in the tissues and organs in which they were found. It is now known that adult stem cells taken from one area of the body can be transplanted into another area and grown into a completely different type of tissue. This ability to grow and regenerate tissues is the focus of the emerging field of personalized medicine, which uses a patient’s own stem cells for biologically compatible therapies and individually tailored treatments.

2. How are stem cells being used in medicine?

Stem cell-based therapies are being investigated for the treatment of many conditions, including neurodegenerative conditions such as Parkinson’s disease and multiple sclerosis, liver disease, diabetes, cardiovascular disease, autoimmune diseases, musculoskeletal disorders, and nerve regeneration following brain or spinal cord injury. Currently, patients are being treated using stem cells for bone fractures, cancer (bone marrow transplants), and spinal fusion surgery. New stem cell therapies are continually under review, or have already been approved by the U.S. Food and Drug Administration. Many other therapies are in various stages of product development. As the number of people affected by degenerative diseases continues to increase, there will be a greater need for new treatment options for the ever-growing aging population. Harvesting and storing stem cells now will ensure their availability in the future when they will be needed most.

3. How difficult is it to obtain stem cells to bank for future use?

In the case of dental stem cells, the process is not at all difficult. In fact, it is easy. Healthy stem cells are discarded on a daily basis as the result of routine dental procedures (tooth extractions). The stem cells contained within the pulp of healthy teeth are the most easily accessible stem cells that can be recovered. When compared to other types of stem cells and their corresponding methods of recovery — i.e., stem cells obtained from embryos, cord blood, bone marrow, adipose (fat tissue), and peripheral blood — obtaining stem cells from teeth is ethically uncontroversial, non-invasive, less dependent on timing, and far less expensive. As opposed to stem cell recovery from cord blood, wherein there is one single opportunity immediately following the birth of a child, there are numerous opportunities to obtain stem cells from teeth. It is best, however, to recover and store dental stem cells at an early age. Those obtained from the extracted loose baby teeth of a healthy child and those extracted from a healthy adolescent (i.e., bicuspid teeth removed in preparation for orthodontic treatment and extracted wisdom teeth) are ideal.

4. Why should I consider banking stem cells from my or my child's teeth?

Tooth-derived stem cells are readily accessible and provide an easy and minimally invasive way to obtain and store stem cells for future use. Banking one's own tooth-derived stem cells is a reasonable and simple alternative to harvesting stem cells from other tissues. Obtaining stem cells from baby teeth is simple and convenient, with little or no trauma. Every child loses baby teeth, which creates the perfect opportunity to recover and store this convenient source of stem cells — should they be needed to treat future injuries or ailments — and presents a far better alternative to simply discarding the teeth or storing them as mementos. Furthermore, using one's own stem cells poses few, if any, risks for developing immune reactions or rejection following transplantation, and also eliminates the potential of contracting disease from donor cells. Stem cells can also be recovered from developing wisdom teeth and permanent teeth. Individuals have different opportunities at different stages of life to bank these valuable stem cells. It is best to recover stem cells when you or your child is young and healthy and the cells are strong and proliferative.

5. When can I bank stem cells from my child's teeth or from my own teeth?

With regard to your children, the best time to recover baby teeth with stem cells is before the teeth become very loose, as the cells in the dental pulp will remain more viable if they continue to have a blood supply. Your dentist will determine the optimal time for the removal of these teeth. StemSave provides you with the opportunity to recover the teeth for stem cell preservation once the teeth have been removed. Remember that your child will not be sacrificing a tooth, as baby teeth are lost naturally to allow for the permanent teeth to erupt. Adolescents have two excellent opportunities for banking their dental stem cells: following extraction of bicuspid teeth in preparation for orthodontic treatment, and after the extraction of their wisdom teeth. Although these teeth are typically discarded, you can ask your dentist to participate in the StemSave program, which provides an opportunity to recover and preserve your family’s dental stem cells.

6. Are stem cells being used today to treat any systemic diseases?

Yes. Mesenchymal stem cells are being used to treat cardiac infarctions, muscular dystrophy, Parkinson’s disease, liver disease, etc.

7. If I do not have neurological damage or some other stem cell therapy-associated disease, why should I care about stem cells?

On the surface, stem cells might seem irrelevant to you because you lack certain disorders, such as spinal cord injury, diabetes, etc. However, stem cells could be important to any disease due to their unique property of being forever "young" and being responsive to change. An understanding of these properties would lead to insights into the biology of other diseases. For example, an individual might have a condition that could eventually lead to a disorder such as Parkinson’s. By understanding the biology of stem cells, drugs could be developed to prevent the dysfunction of stem cells.

#1 Worst Food for Weight Gain

Yahoo News recently reported on a study conducted by Harvard University scientists that analyzed changes in diet and lifestyle habits of 120,877 people. The weight of the participants was measured every four years for up to two decades.  And on average, participants gained nearly 17 pounds over the 20-year period.


But the fascinating thing about the study was they were able to link specific foods and activities to a precise amount of weight gain.

And the biggest offender was... potato chips!


Each daily serving of potato chips containing 1 ounce (only about 15 chips) led to a 1.69-pound increase over four years.  For potatoes other than chips, the gain was 1.28 pounds.  Other foods or actions they were able to correlate to weight gain included:

• Soda added a 1 pound increase.

• An alcoholic drink per day: 0.41 pound increase.

• Sweets and desserts: 0.41 pound increase.

• Watching an hour of TV per day: 0.31 pound increase.

• Quitting smoking: 5 pound increase.

One of the leaders of the study, Dr. Frank Hu noted, “There is no magic bullet for weight control.  Diet and exercise are important for preventing weight gain,but diet clearly plays a bigger role.”