Maybe you can skip teeth cleaning at the dentist’s

My sister suggested I write a blog post about whether it’s necessary to get your teeth cleaned at the dentist's—a procedure called “scaling and polishing.” She tells me her 99-year-old friend—who is mentally sharp and takes good care of herself—never gets that treatment. It never occurred to me that this annual or semi-annual practice may not be necessary.

My research shows that it’s not! My go-to source for such information is Cochrane Review, an organization that searches for and collates research that meets their stringent guidelines for reliability—essentially evidence-based studies. In evaluating the studies comparing people who had the cleaning and those who didn't, they “found little or no difference” between those who had regular treatments and those who had none: “we can be confident that routine scale and polish does not significantly reduce the signs of mild gum disease…” They also found no difference between groups who had treatments twice a year and those who had treatments once a year.

As it happens, just when I got the blog suggestion from my sister, new research was published showing a possible link between gingivitis and Alzheimer’s disease! Gingivitis is a gum disease caused by the bacterium, Porphyromonas gingivalis. Researchers found an enzyme produced by these bacteria in the brains of people who had Alzheimer’s. When scientists introduced the enzyme into mice, the mice developed signs of Alzheimer’s.

Even so, since teeth cleaning doesn’t appear to have much value in preventing gingivitis, I think I might quit getting my teeth cleaned—or at least start by cutting back from semi-annual to annual cleaning. I’m already fighting the dentist over x-rays. She may fire me.

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.

Dreaming

Every now and then I wake up with my first thought being the solution to a problem I’d been mulling over. Most recently, it was an idea of what to give our grandson and his bride as a wedding gift. I’d been pondering this for months and had not come up with anything. Then one morning I woke up with the answer: airline miles for a trip to California. Not momentous, I grant you, but a rather creative solution and totally out of the blue. This has probably happened to you, too. For one thing, I think it’s pretty common to discover that you’ve got the answer to a troublesome crossword clue that had you stumped the night before. 

Our brains do work things out while we sleep. Research has shown that the rapid-eye-movement (dreaming) segment of our sleep cycle helps us synthesize new pieces of information with existing knowledge and to make creative lateral connections.

There are plenty of examples of people who have woken up with new ideas and solutions to problems, usually as the result of a dream. For Niels Bohr, it was the structure of the atom; for Paul McCartney, it was the entire melody for “Yesterday;” for Jack Nicklaus, it was a change in his golf grip; for Mary Shelley, it was Frankenstein.

Elias Holmes, the inventor of the lock-stitch sewing machine, became stumped in his design. One night he dreamed he was building a sewing machine for a savage king who gave him 24 hours to complete it. As he was about to be executed, he noticed that the warriors carried spears that were pierced near the tips (the eyes of needles are usually at the heel). He leapt out of bed at four in the morning and finished his design by nine. 

While it’s nice to solve little problems in your sleep, it would be even nicer to come up with something you could patent—as did Holmes. You can always dream…

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.

Killing pain--or maybe painkillers

You are probably tired of hearing about the opioid epidemic, but I was surprised to learn a few new tidbits from a book written by the chief of addiction medicine at the Stanford University School of Medicine. To begin with, the majority of the misused prescription drugs come directly from doctors. Only four percent are obtained from a drug dealer or stranger.  One of the chief culprits is Purdue Pharma, the manufacturer of OxyContin and other addictive painkillers. For many years, this company misled doctors about the dangers of opioids and promoted them heavily. Now they're being sued by the state of Massachusetts. (Recently, internal emails were brought to light in which their strategy was to “hammer abusers in every way possible” calling them “reckless criminals.”) But the damage has been done.

To promote their products, Purdue helped to fund the educational materials for a nationwide pain management program under the aegis of the Joint Commission on Accreditation of Healthcare Organizations. For one thing, the commission added “pain” as the fifth vital sign—something that hospitals must measure. Of course, pain can’t be measured objectively. Hence, The Visual Analog Scale of pain. 

You’ve all seen the posters. Purdue helped to fund their production and dissemination. It turns out that the posters helped Purdue’s business: research shows that the use of these scores increases opioid prescribing and use.

In the past, pain was viewed as part of the healing process—something to be endured. Today we think of pain as intolerable—something that must be eliminated. In fact, the Federation of State Medical Boards urged state medical boards to punish doctors for undertreating pain, such that doctors now live in fear of disciplinary action.

Maybe hospitals should substitute their little face posters with the slogan, “no pain, no gain.”

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.

A primer of FDA "scheduled" drugs

“Scheduled” prescription drugs are those that have the potential for addiction and/or physiological dependence, which means that your body relies on the drug to maintain biochemical equilibrium—that is, to feel “normal.” The FDA has classified such drugs ("controlled substances") as follows:

• Schedule I: Deemed to have no medical benefit and cannot be prescribed by a doctor under any circumstances. Examples: heroin, LSD, “ecstasy,” and marijuana [!].
• Schedule II: Most opioid painkillers, including morphine, opium, codeine, Vicodin, Demerol, OxyContin, Percocet. Doctors are not supposed to provide more than a month’s worth of these, with no refills allowed with a single prescription. Stimulants, such as Adderall, Dexedrine, and Ritalin are also in this group.
• Schedule III: This seems to be a mixed bag of drugs deemed to be less addictive than Schedule II drugs, but more addictive than Schedule IV drugs. Examples include Suboxone, ketamine (an anti-depressant), and anabolic steroids. Doctors can provide limited refills with one prescription.
• Schedule IV: These include the benzodiazepine sedative-narcotics, such as Xanax, Klonopin, Valium, Ativan, Versid, Halcion, and Restoril. The muscle relaxant, Soma, and sleeping pill, Ambien, are also Schedule IV drugs. As with Schedule III, drugs, a prescription cannot be refilled more than five times.
• Schedule V: These are drugs that contain limited amounts of opioids, such as cough preparations with codeine.

Alert to you elderly readers: the Expert Panel of the American Geriatrics Society warns older adults to avoid the benzodiazepine drugs listed under Schedule IV drugs. Such drugs “have been found to be associated with poor health outcomes, including confusion, falls, and mortality.”

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.