Whiplash May Result in Delayed Jaw Pain

THURSDAY, Aug. 30 (HealthDay News) -- About one in three people who suffer whiplash is at risk of developing delayed jaw pain/dysfunction that may require treatment, a Swedish study finds.

Publishing in the August issue of the Journal of the American Dental Association, researchers at Umea University studied short- and long-term temporomandibular joint (TMJ) pain and dysfunction in 60 patients involved in rear-end car collisions. The patients were checked when they were brought to hospital emergency rooms after a crash, and again one year later.

Patients who suffered whiplash were five times more likely to have TMJ pain and/or dysfunction immediately after a crash than uninjured people in a control group. A year later, 34 percent of whiplash patients had developed TMJ symptoms, compared with 7 percent of those in the control group.

The TM joints, located on each side of the head, work together to enable movements needed to speak and chew. Problems that affect the proper function of this system of muscles, ligaments, discs and bones can result in a painful TMJ disorder, according to the American Dental Association.

More information
The U.S. National Institute of Dental and Craniofacial Disorders has more about TMJ disorders.

FDA Advisers Reject Safety Report on Dental Fillings

(HealthDay News) -- Federal health advisers have rejected a government report suggesting that mercury-containing amalgam dental fillings are safe, saying instead that further study is needed.

The U.S. Food and Drug Administration advisory panel's decision is not a declaration that the widely used fillings are unsafe, the Associated Press reported late Thursday. However, in a 13-7 vote, the panel said a large federal review of data fails to clearly and objectively present the current body of knowledge on the subject.

In a second vote, also 13-7, the panelists said the report's conclusion that amalgam fillings are safe is not reasonable, according to the AP.

The announcement came after FDA committee meetings held Wednesday and Thursday --the first public hearings in more than a decade on the safety of these fillings.

The FDA is not compelled to act on the advice of its advisory committees, although it frequently does.

Dental Amalgam contains elemental mercury combined with other metals such as silver, copper, tin and zinc. The fillings, about 50 percent mercury, have been used for generations to stabilize decaying teeth. Dental experts contend that when mercury is bound to the other metals it's encapsulated and doesn't pose a health risk. Consumer groups, however, contend that mercury, a known neurotoxin, does leak out in the form of mercury vapor and then gets into the bloodstream.

According to the American Dental Association (ADA), the use of Amalgam is declining. In 1990, dental amalgams made up 67.6 percent of all dental restorations, by 1999 45.3 percent and, in 2003, an estimated 30 percent. Cavities that previously would have been treated with dental amalgam are now mostly filled with a resin composite.

Several European and other countries, including Canada, Norway, Sweden, Britain, Germany and Denmark, currently advise dentists against using mercury fillings in pregnant women.

The ADA, however, said the recommendation was made despite there being no scientific evidence of systemic health problems or toxic effects.

The ADA maintains its position that dental Amalgam should remain an option for patients.

"Our position is one of looking at the scientific evidence and believing it's safe and effective and that dentists and patients should have the option," said Dr. Ron R. Zentz, senior director of the ADA Council on Scientific Affairs.

Zentz pointed, in particular, to two studies (the Children's Amalgam Trials) published in the April issue of the Journal of the American Medical Association. Those trials compared the use of amalgam to composite dental fillings in children.

The studies found no differences in IQ, memory, attention, kidney function or other measures between children with amalgam fillings and children with composite fillings.

The fillings may even be superior to other materials in certain instances, such as in the back of the mouth where the forces and stress on the fillings are stronger, Zentz said.

According to the Associated Press, officials at the FDA also asked committee members to carefully review findings from an internal agency "meta-analysis" of 34 recent studies. That review found "no significant new information" that might change the FDA's conclusion that amalgam fillings pose no harm to the vast majority of patients.

Earlier on Thursday, one consultant to the panel said the review fell short. "Just by looking at this paper, we are in a sense really limiting ourselves. I am not convinced we are doing justice to the topic at hand," Vanderbilt University professor of pediatrics and pharmacology Michael Aschner told the AP.

Several groups are vehemently opposed to the use of these fillings.

On Sept. 5, a consortium of organizations including Consumers for Dental Choice, the Mercury Policy Project and the International Academy of Oral Medicine and Toxicology filed a petition to the FDA to immediately ban mercury fillings for pregnant women so as to protect their unborn children. The FDA has six months to respond to the petition.

"We're doing this primarily as a precautionary measure to protect unborn children from unnecessary exposure to mercury," said Michael Bender, director of the Mercury Policy Project, located in Montpelier, Vt. "We're very concerned that our government is not doing what it should to protect the unborn."

"Why isn't the FDA joining Health Canada and the other countries in banning the placement in expectant mothers?" he continued. "FDA silence over mercury is the same kind of silence our government once had for tobacco."

Still, any ban could have consequences. A study by dentist Howard Bailit and colleagues at the University of Connecticut found that a ban on Amalgam fillings would boost costs, cut down on cavities filled and hurt America's oral health.

"Our recommendation is, do not ban the use of dental amalgams," Bailit told the Associated Press.

More information
To learn more about amalgam fillings, visit the U.S. Centers for Disease Control and Prevention.

Health Tip: While Chewing Gum May Relieve Stress ...

(HealthDay News) -- While chewing gum may help you feel better when you're stressed, don't overdo it, advises the University of Texas Southwestern Medical Center at Dallas.

When you're stressed, you may be prone to chewing more vigorously, which can strain your jaw.

Chewing too hard can cause fatigue and soreness in the jaw. It can also trigger a condition called TMJ, affecting the temporomandibular joint. The condition can causes pain in the head and the neck, and difficulty in opening and closing the jaw.

If you have any of these symptoms, give your jaw a rest and stop chewing gum for a few days. If symptoms don't subside, see a doctor.

Healthy Lifestyle Key To Cancer Prevention

(HealthDay News) -- While the number of deaths from cancer have been declining, many malignancies could be prevented by exercising, eating right, maintaining a healthy weight and not smoking, a new federal report finds.

The President's Cancer Panel issues a report every year that focuses on one aspect of what is happening in the United States in terms of cancer.

This year's effort "centers on lifestyle changes, and two issues that are actually quite different," said panel member Margaret L. Kripke, executive vice president and chief academic officer at the University of Texas M. D. Anderson Cancer Center, in Houston.

One issue is nutrition, exercise and the fight against obesity, and the other is the battle to cut tobacco use, Kripke said.

"We tried to think of what would have the biggest impact on reducing cancer mortality," she said. "If you consider that 15 to 20 percent of cancer deaths are related to obesity and another 30 percent of cancer deaths are due to tobacco use, that's 50 percent of all people with cancer."

And quitting smoking and avoiding obesity are things that people can do themselves, Kripke noted. But, as she and other experts know, it's not easy to get people to make the lifestyle changes they should.

"The most serious lack, in terms of what we know, is what motivates people to live a healthier lifestyle," she said.

The experts call for a move toward a "culture of wellness" in the United States. This culture would embrace healthy living as a goal and promote a healthy lifestyle as a way of achieving wellness.

Despite progress in diagnosis and treatment, cancer continues to account for more than a half million deaths each year in the United States, with almost 1.5 million new cases diagnosed annually. Two-thirds of these deaths, and many thousands of new cases, could be avoided through lifestyle changes, according to the report.

Tobacco is the leading cause of lung cancer, but it's also responsible for most cancers of the larynx, oral cavity and pharynx, esophagus and bladder. In addition, it is a cause of kidney, pancreatic, cervical and stomach cancer, along with acute myeloid leukemia. "We really need to get rid of tobacco," Kripke said.

Obesity has been linked to a variety of cancers, including colon, breast, kidney, ovarian and pancreatic cancer. "There are very definitive studies showing that moderate exercise reduces your risk of breast cancer and colon cancer," Kripke said.

In addition, living a healthy lifestyle lowers a person's risk of cancer recurrence and improves outcomes after cancer, Kripke said.

The causes of the obesity epidemic in the United States are complex, Kripke said. The epidemic started in the 1970s about the time that food makers started using high fructose corn syrup as an additive. In addition, portion sizes in restaurants increased as schools cut back on exercise programs.

The obesity problem has grown steadily over the past 30 years. "I don't think there is going to be a quick fix," she said.

One recommendation the panel made in the report is to have subsidies for corn farmers curtailed. "There doesn't seem to be coordination between agricultural subsidies and public health policy for diet and nutrition," Kripke said.

"Subsidies for corn make corn syrup very cheap and it's not nutritionally what you want in all of your foods," Kripke said. "It might make more sense to make agricultural subsidies for fruits and vegetables that would be more healthy for the population."

Although the White House doesn't usually comment on the report, Kripke hopes that it will spur government officials to develop programs that help people make necessary lifestyle changes.

One expert agreed that societal changes are to blame for ever-heavier Americans.

"Obesity has been brought about by changes in our environment, not by any increase in the number of susceptible people," said Eugenia Calle, director of Analytic Epidemiology at the American Cancer Society.

Calle argues that while once fats and sugars were relatively expensive, they are now cheap. "It used to be impossible to buy a great deal of calories for $2.99, and now it is possible to buy one day's allotment of calories for less than $10," she said. "So now calorie-dense foods are cheap."

In contrast, fruits and vegetables are more expensive than they used to be, Calle said. "So, it becomes economically more difficult to make good food choices, especially if you don't have a lot of income," she said. In addition, people have become more sedentary, she added.

"The best idea in the report is implementing a culture of wellness in the U.S., so that the social and cultural norm is one of health," Calle said.

More information
For more information on cancer and lifestyle, visit the American Cancer Society.

Health Tip: Problems With Your Dentures?

(HealthDay News) -- Dentures must be properly fitted and cared for to prevent dental problems, discomfort and the need for repair.

Here are suggestions on caring for your dentures, courtesy of the U.S. National Library of Medicine:

• Don't use toothpicks on your dentures.
• After eating, thoroughly clean your dentures with plain soap and lukewarm water.
• Keep your gums in good health with daily massaging, rest from your dentures, and a salt water rinse.
• For dentures that don't fit perfectly, try a denture adhesive. If you still have discomfort, see your dentist.

Toothbrushing May Strengthen Gums

(HealthDay News) -- It may seem contradictory, but the cell damage caused by brushing your teeth may help keep your gums healthy, U.S. researchers say.

Toothbrush bristles tear holes in the epithelial cells that line the gums and tongue, causing a momentary rupture, explains a team at the Medical College of Georgia.

"It's very clear that brushing your teeth is a healthy thing to do; no one questions that brushing removes bacteria and that's probably it's main function," corresponding author and Dr. Paul L. McNeil, a cell biologist, said in a prepared statement.

"But we are thinking that there might be another positive aspect of brushing. Many tissues in our bodies respond to mechanical stress by adapting and getting stronger, like muscles. We think the gums may adapt to this mechanical stress by getting thicker and healthier. It's the 'no pain, no gain' theory, the same as exercising," McNeil said.

For this study, he and his colleagues injected fluorescent dye into the bloodstream of rats and then brushed the rats' teeth, gums and tongues.

Calcium (which is abundant in saliva) then moves into the cells and triggers internal membranes to move up and patch the holes, the researchers reported in the August issue of the Journal of Dental Research.

This repair takes a few seconds. During that time, growth factors that promote the growth of collagen, new blood cells and blood vessels leak out of the damaged epithelial cells. The injury to these cells also turns on expression of a gene (c-fos) that's often activated under stress and may be the first step in a response such as cell division or growth, the researchers said.

More information
The American Dental Association has more about cleaning your teeth and gums.

Brain Studies Show ADHD Is Real Disease

(HealthDay News) -- Attention-deficit/hyperactivity disorder (ADHD) is a real disease linked to changes in production of the brain chemical dopamine, two new reports suggest.

In the first report, researchers found that a variant of the dopamine receptor gene may help cause the behavioral condition but also improve its long-term outcome.

"If you have a certain variant of this gene, you have a greatly increased risk of having ADHD," said lead researcher Dr. Philip Shaw, a researcher in the Child Psychiatry Branch at the U.S. National Institute of Mental Health. However, "what we found that was surprising was that having this variant was also associated with having a better outcome from ADHD," he said.

"The kids who had the risk gene tended to get better," Shaw said. "They also tended to be a little bit more intelligent."

Not all children with ADHD have this particular gene variant, Shaw said. "About one-quarter to one-fifth of children with ADHD has this gene variant," he said. "That's higher than the general population where about a fifth to a sixth has the variant."

In a second study, scientists found that, in contrast to the common wisdom, ADHD is associated with lowered dopamine production.

Both reports were published in the August issue of the Archives of General Psychiatry.

In the first gene study, Shaw's team compared 105 children with ADHD with 103 healthy children. The youngsters averaged about 10 years of age.

The researchers looked at the children's MRI brain scans as well as their DNA. In addition, 67 of the children with ADHD were evaluated six years later.

Shaw's team found that a variant in the dopamine D4 receptor gene (DRD4) was associated with ADHD. This form of the gene is linked with thinner tissue in areas of the brain that control attention.

Among the children with ADHD seen over six years, those who had this gene variant had better outcomes and had regained healthy tissue thickness in the affected brain region. This may explain ADHD's natural history of improvement with age, the researchers noted.

Further research could help develop treatments that will help children recover from ADHD more quickly, Shaw said.

One expert said the study may be a milestone in understanding ADHD.

"This is a very important study as it adds increasing evidence that ADHD is a heritable disease with genetically determined neurobiological underpinnings and adds further evidence that this is a valid mental disorder, often requiring neurobiological interventions [such as] psychopharmacological treatment," said Dr. Jon A. Shaw, professor and director of child and adolescent psychiatry at the University of Miami Miller School of Medicine.

A second study -- led this time by Dr. Nora D. Volkow, director of the U.S. National Institute on Drug Abuse -- suggests that the ADHD drug Ritalin works by increasing the brain's production of dopamine.

This finding implies that reduced production of dopamine is involved in ADHD and may help explain why many people with the condition also abuse drugs.

"Individuals with ADHD have a decreased function of the brain dopamine system," Volkow said. "ADHD, clearly, is associated with a biochemical dysfunction," she added.

The finding is important, because it belies the myth that ADHD is not a real disease but was just created "to sell medication," Volkow said. Instead, "this finding explains why stimulant medications, such as Ritalin, are beneficial, because they increase dopamine function in the brain," she said.

In the study, Volkow's team performed brain scans of 19 adults with ADHD who had never received Ritalin, as well as 24 healthy individuals. The scans were done after the participants were given shots of Ritalin or placebo.

The team found that the people with ADHD released less dopamine into their blood than those without the disease. However, Ritalin caused less of a decrease in dopamine than usual in these individuals. This reduction in dopamine was associated with typical symptoms of inattention, the researchers found.

Volkow noted that drugs such as nicotine, cocaine and methamphetamine also improve dopamine brain function.

"This may be the reason why individuals that have ADHD are at a much greater risk of abusing substances than the general population, because drugs of abuse increase dopamine brain function, and they will 'feel better,' " Volkow said.

More information
For more on ADHD, visit the U.S. National Institute of Mental Health.

Health Tip: Swollen Gums Can Signal Poor Health

(HealthDay News) -- Swollen gums are a symptom of problems ranging from poor hygiene to a serious health problem such as lack of vitamin C (scurvy). If you discover that you have swollen gums, speak to your doctor or dentist about determining a cause.
Here are possible explanations for swollen gums, courtesy of the U.S. National Library of Medicine:
Viral or fungal infection.
Gingivitis.
Ill-fitting dentures.
Reaction or sensitivity to toothpaste or mouthwash.
Side effect of medications.
Poor nutrition or malnourishment.
Scurvy.
Pregnancy.

Religion Not Always a Motivator for Doctors Who Care for Poor

(HealthDay News) -- Although providing aid and comfort to the less fortunate is a fundamental tenet of organized religion, a new U.S. survey suggests religious doctors are slightly less likely to care for poor and underserved patients than doctors who say they aren't religious.

As reported in the July/August issue of Annals of Family Medicine, 35 percent of doctors who described themselves as either atheist, agnostic, or without religious affiliation said they practiced medicine among the underserved, compared to 31 percent of religious physicians.

Study lead author Dr. Farr Curlin, an assistant professor of medicine with the MacLean Center for Clinical Medical Ethics at the University of Chicago, described the spread between the numbers as "slight, statistically speaking."

"However, the important point is that it doesn't seem to matter much what a physician's general religious characteristics are," he said. "They are more or less equally likely to care for the underserved."

The researchers found that, for many physicians, helping those most in need can be its own reward. The impulse is often rooted in deeply held values, whether religious or secular.

On the down side, doctors who decide to work with the poor, the uninsured and the underserved typically do so at a considerable cost in terms of salary, prestige, free time, administrative control, and academic opportunity, the researchers said.

To gauge the impact that faith might have on a doctor's decision to embark on the more self-sacrificing route, Curlin and his team analyzed questionnaires completed by 1,144 physicians from across the United States.

All the respondents were under age 65, and all were asked about their religious beliefs and whether or not they attended to underserved patients. "Underserved" patients included people who were uninsured, receiving Medicaid, or attending a so-called "safety-net setting" -- such as a free clinic, community or migrant health center, public or county hospital, or rural health center.

Slightly more than 25 percent of those doctors surveyed said they work among underserved patients. Those who did so tended to be slightly younger, female, and more likely to work in an academic setting.

Among types of doctors, 40 percent of psychiatrists said they work in an underserved environment -- the highest ratio observed. Only 21 percent of those performing medical sub-specialties indicated a similar choice -- the lowest ratio observed.

In terms of religious convictions, doctors who considered themselves to be "highly spiritual" -- but not necessarily affiliated with a religion -- were about twice as likely to attend to underserved patients than those indicating they were not so spiritual.

The researchers theorized that the connection between strong spirituality and attending to poor patients might be rooted in a liberal social justice tradition that, they said, informs much of today's mainstream and liberal Protestant churches.

Doctors who said they had no religious affiliation or who grew up in families that stressed service to the underprivileged were also among the most likely to care for the underserved.

"Everybody knows caring for the poor is a good thing," noted Curlin, who describes himself as an orthodox Protestant Christian. "Yet there are a lot of reasons to not care for the poor. A lot of selfish reasons. Because it's hard and it costs you. But what religious communities do with respect to those behaviors that are good, but are costly, is give people support and exhortation to live up to that calling, even though it's hard."

Dr. Peter Ubel, a professor in the department of medicine at the University of Michigan, applauded Curlin for conducting "a great study on a great topic."

"I think this hits at a fundamental question in medical practice," he said. "Which is: Are we here to do well by doing good? The nice thing about being a physician is that you're saving peoples lives, and making people feel better. Oh, and by the way, we're paid pretty well by doing it. So it almost becomes impossible to know what our primary motivation is anymore. Is it because I'm well reimbursed and respected as a status figure, or because I want to do good? And I expect most physicians can't figure it out."

"Now, you might expect it to be different for doctors who are religious," Ubel added. "But I would say that morality is not owned by religious people. In fact, many agnostics are driven by a strong sense of right and wrong. And so one thing that comes out of this study is to remind people of that fact. And it suggests that if you want to know if people have good intentions, don't ask them if they go to church on Sunday. Judge people by their actions, not by their congregation."

More information
To learn more, visit the University of Southern California, Center for Religion and Civic Culture.