Vital Record » Dentistry Your source for health news from the Texas A&M Health Science Center Thu, 24 Jul 2014 17:03:48 +0000 en-US hourly 1 Texas dental schools team up to create a standardized course for treatment of sleep-related breathing disorders Fri, 18 Jul 2014 22:33:30 +0000 As the number of Americans with sleep-related breathing disorders continues to grow, so does the need for dentists to have access to continued training to best serve this patient population. ]]>

On June 11, after more than two years of hearings, proposals and discussions, a new rule regarding how Texas dentists may diagnose and treat sleep-related breathing disorders went into effect.

The Texas State Board of Dental Examiners recently approved the rule, making it a part of Texas Administrative Code. It allows dentists to independently diagnose, treat and monitor any dental condition related to benign snoring or obstructive sleep apnea. With this responsibility comes the mandate for dentists to complete 12 hours of education in sleep-disordered breathing the first year of treating patients for such conditions and three hours in subsequent years.

Hand holding dental retainersTo make this process as seamless as possible, alumni and faculty at Texas A&M University Baylor College of Dentistry have teamed up with dentists at the UT Health Science Center dental schools in San Antonio and Houston to create a standardized, statewide course on the discipline.

At the helm is Dr. Keith Thornton, who graduated from Texas A&M Baylor College of Dentistry in 1969 and owns SleepWell Solutions, a Dallas dental practice dedicated entirely to sleep-related breathing disorders.

“This course will include everything that is necessary for a dentist to start treating their patients in his or her office,” says Thornton. “It will be comprehensive and developed by Texas dentists who are experts in the field of sleep-disordered breathing plus representatives from each of the Texas dental schools.”

The program will cover the basics of sleep and sleep-disordered breathing through lecture and hands-on instruction. The goal is for dentists to become comfortable with the technical aspects of fitting patients for and fabricating oral appliances, which are designed to protrude the jaw, preventing the tongue and soft tissues of the throat from collapsing into the airway.

Dr. Amerian Sones, director of continuing education at Texas A&M Baylor College of Dentistry, says she anticipates the college will host the first standardized program by fall 2015. An annual two-day course covering snoring and sleep apnea has already been in place at the dental school for several years, but the need for training within this dental niche continues to grow.

“There is a very big interest in treating these problems,” Sones says. “Sleep-related breathing disorders affect such a big percentage of our population, and those who suffer from it deal with a lack of sleep and really can’t function. They can’t work, drive or be productive because they don’t get the rest that they need.

“We in dentistry are jumping on board because this is a problem that in most cases can be managed, prevented, or treated using dental technology, and so we must be a part of diagnosis and treatment planning.”

The program, which may be structured as a symposium, could include the opportunity for interprofessional collaboration with physicians and ear-nose-and-throat specialists.

In his role as president of the Texas State Board of Dental Examiners, Dr. Rudy Ramos has worked on the rule for the past two years.

“I meet with state board examiners across the country. No one really addresses sleep-disordered breathing,” Ramos says. “Texas is the first to embark on a sleep dentistry rule. It will set the bar across the country.

“A lot of dental schools now are going to have to make this a part of their curriculum. This is going to be a big change for dentistry as a whole.”

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It’s not just about the waistline Tue, 15 Jul 2014 22:04:25 +0000 Juice1

Liquid diets impact your body and your teeth.

Americans are becoming increasingly health conscious, and that’s a good thing. According to a U.S. Department of Agriculture study released earlier this year, the average person’s daily caloric intake dropped by 78 calories from 2005 to 2010. But what is considered healthy eating — including dietary choices trending toward high-protein, low-carb selections, liquid cleanses, vegan lifestyles and raw diets — may not always be good for the mouth. Each diet carries its own set of pros and cons.

“Eating begins in the mouth,” says Lisa Mallonee, a registered dietitian and associate professor in dental hygiene at Texas A&M University Baylor College of Dentistry. “The foods and beverages we consume, the methods and timing in which we consume them, and the frequency of consumption can all impact oral disease risk.”

Packing the protein

One of the most notorious diets for a tendency to produce unintended side effects is a high-protein, carb-curbing lifestyle reminiscent of the Atkins diet, which peaked in popularity a decade ago.

That’s because when a high-protein diet works as intended, the body burns fat at a higher rate, producing ketones. When they accumulate in the saliva, ketones are a culprit for bad breath. Mallonee likens the smell to rotting fruit and suggests some time-tested remedies: alcohol-free mouthwash, xylitol chewing gum, adequate hydration and, of course, diet modification.

“In the oral cavity, ketones are otherwise benign, but from an overall health perspective, individuals can experience light-headedness, headaches and irritability,” says Mallonee.

Not quite so harmless is xerostomia, or dry mouth, associated with water loss from a high-protein diet. In its mildest form, it begins as a sticky, dry feeling in the mouth but can lead to burning, tingling and increased risk for gum disease and tooth decay.

Then there’s blood.

“I’ve heard comments from practitioners that they notice more bleeding in patients on a high-protein diet,” Mallonee says. “This is likely due to the fact they are not eating crunchy fresh fruits and vegetables — since they are avoiding carbohydrates — so there is a higher level of plaque accumulation because a high-protein diet is typically a ‘softer’ diet.”

Vegetarian versus vegan

The major difference in oral health impact between a vegetarian versus a vegan diet boils down to the absence of three nutrients: vitamin B12, vitamin D and calcium. Deficiencies in these can present as soreness in the mouth and tongue, altered taste sensation, increased risk of periodontal disease and weak enamel.

While a lacto-vegetarian diet includes dairy such as butter and cheese, a vegan diet that includes no animal products may put patients at a heightened risk of oral health problems. Mallonee advises it may be necessary to add dietary supplements to include vitamin D, calcium and vitamin B12, the last of which can only be found in animal products.

Duration also plays a role.

“For the otherwise healthy individual, months of exclusion as a result of a vegan diet is not typically as big of a concern,” Mallonee says. “It is more of a concern for those individuals who have committed to a vegan lifestyle for numerous years. Individuals must make a conscious effort to include nutrients in their diet that can only be found in animal products.”

Food in the raw

A raw diet — one consisting of fruits, vegetables, nuts, seeds and grains — lends itself to a high daily intake of vitamins, fiber and minerals. Because a raw diet precludes heating food to more than 118 degrees, it doesn’t bode well for eating much meat, fish and eggs unless you opt to eat them raw.

“A raw food diet can be lacking in protein, iron, calcium and B12,” says Mallonee. “If lots of acidic raw fruits and vegetables are consumed — think grapefruit, oranges, tomatoes and corn — dental erosion could be a problem.”

When acid from these foods attacks the surface of the teeth too often, saliva cannot balance out the oral environment, and the end result is weakened enamel and exposed dentin.

Matters of liquidity

Cleanses come in varied forms: three-day, five-day, seven-day, cheap, expensive. Dieters sip on concoctions composed of ingredients such as tea, lemons, cayenne pepper, even freshly juiced fruits and vegetables.

No solid food is eaten for the duration, and the all-natural ingredients purport to flush out the body, cease cravings, and improve kidney and liver function. Advocates claim it’s like hitting the reset button on myriad bodily processes.

Liquid detoxes can impact the mouth, though.

“The issue with not eating solid food for several days at a time is that chewing is limited,” says Mallonee. Chewing bilaterally minimizes plaque accumulation and ultimately calculus on the tooth surface.”

Diets that mandate juicing or even low calorie, highly caffeinated beverages coupled with herbal supplements have a different effect.

“Juicing is a very healthy dietary trend,” Mallonee says. “However, juicing is acidic and doing so several times a day can lead to dental erosion; patients should be educated to drink water afterwards and to avoid brushing immediately following consumption.”

Discussing diet

Regardless of what patients eat, asking questions about food choices is recommended for every new or recall appointment. Telltale signs of possible diet-related oral health issues may include recurring or new areas of decay and demineralization.

Timing matters.

“We typically ask after the extraoral and intraoral soft tissue exam, periodontal assessment and dental charting has been completed so we can fully relate the importance of the patient’s nutrition habits to oral health and disease risk,” Mallonee says.

Preparations for nonsurgical periodontal treatment also offer a prime opportunity to review a patient’s food choices.

“Although a poor diet doesn’t cause periodontal disease,” Mallonee says, “lack of essential nutrients in the diet may impact immune function, resulting in decreased healing, and resolution of pocket depths and bleeding points.”

“As dental professionals, we need to be comfortable asking our patients about their diet, determining if it might impact their oral health and integrating this information into preventive patient education.”

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Texas A&M Baylor College of Dentistry utilizes federal program to bring much-needed dental care to North Texas Tue, 08 Jul 2014 18:11:47 +0000 Dallas residents lacking adequate access to dental care are benefiting from Texas A&M University Baylor College of Dentistry’s community-based clinical training program. Since January, the dental school has formed partnerships with three area nonprofits]]>

vitalrecord-ndsm.jpgDallas residents lacking adequate access to dental care are benefiting from Texas A&M University Baylor College of Dentistry’s community-based clinical training program. Since January, the dental school has formed partnerships with three area nonprofits: Healing Hands Ministries in Lake Highlands, North Dallas Shared Ministries and Irving Community Clinic.

A trend was apparent at each of the three clinics: Need among patients far surpassed the hours volunteer dentists were available to provide care.

Now, the partnerships have resulted in an influx of fourth-year dental students at two of the three locations, where they perform extractions, fillings and cleanings. Clinical rotations will begin at the Irving location later this summer.

“We’re basically able to do two things at once,” says Dr. Daniel Jones, professor and chair of the dental school’s public health sciences department, which oversees the community-based training program. “We are increasing access to care, because we are expanding the hours that these clinics are open. We’re expanding them by sending the students out there, which means they get more community-based clinical training. That’s going to be a big push for us in the next couple of years.”

Expansion of the college’s clinical rotation sites would not have been possible without utilization of the 1115 Healthcare Transformation waiver.

Established in fall 2011, the waiver works as an incentive for hospitals and other providers to transform their service delivery practices to improve quality, health status, patient experience, coordination and cost effectiveness, according to the Texas Health and Human Services Commission website.

Hospitals and health care providers were given the opportunity to apply for funding from a pool worth $29 billion. Texas A&M Baylor College of Dentistry administrators seized the opportunity, submitting a proposal in 2012 that was met with approval from the commission, making it one of only a handful of dental projects like it across the state.

Now in the third year of a five-year funding period, the waiver has enabled the college to provide new equipment, operatories and electronic health records software at the community clinics, as well as faculty supervision and dental assistants.

“That way, they meet the standards for our students to be there,” says Jones. “This probably would not have happened without the waiver.”

In addition to the community-based clinical training, two other college programs — the senior preceptorship, in which dental students shadow private practitioners and treat patients in community clinics, as well as the school-based sealant program, which provides dental sealants for 10,000 Dallas schoolchildren — opened the door for additional funding through Delivery System Reform Incentive Payments, also a part of the health care waiver.  In total, the value of the college’s three programs approved by the Centers for Medicare & Medicaid Services tops $28 million.

“This federal program came at a really fortunate time because we were looking to expand students’ training, and this gave us the wherewithal to do it,” says Jones. “The waiver is about improving access to care, but it’s also serving our training needs for the students, which is one of the main goals of the school.”

The clinics

While copay amounts vary among the clinics, applicable third-party insurance coverage, Medicare, Medicaid and CHIP will be collected, as the three locations must be sustainable before the healthcare transformation waiver funding ends, so that off-campus patient care and training can continue in perpetuity.

Healing Hands Ministries

Since January 2014, fourth-year dental students have rotated to the site in groups of four for a week at a time, treating approximately 25 patients a day. With five operatories and the potential for another to be added, Paul Hoffmann, TAMBCD’s administrative director for extramural clinics, says the goal is to provide comprehensive dental care for the entire family.

“There’s such a void for adult care. Inevitably what happens is the adult care comes first, and the children follow,” Hoffmann says.

The clinic’s hours are 10 a.m. to 6 p.m., Monday through Friday.

North Dallas Shared Ministries

Fourth-year dental students began clinical rotations at the nonprofit on June 11, treating approximately 25 patients per day in the center’s four operatories. Previously, the all-volunteer clinic was limited to four days a month; now with help from Texas A&M Baylor College of Dentistry students and faculty, patients are seen Monday through Friday, 10 a.m. to 6 p.m.

Judy Rorrie, executive director of the nonprofit, says the dental school’s presence will expand the clinic’s reach exponentially.

“To be able to have our clinic open for eight hours a day, five days a week, for 40 weeks a year is going to provide dental care for a population that is sorely in need of its services,” Rorrie says.

Irving Community Clinic

Clinical rotations will begin at this site in late summer 2014. Close proximity to the emergency room at Baylor Medical Center at Irving means patients with urgent dental needs can be redirected to Irving Community Clinic. Two dental students will work at the clinic for a week at a time, performing extractions, fillings and cleanings. Plans are in the works to provide additional treatment, such as endodontics and fixed prosthodontics.

“What has happened with all of these locations is the initial surge seems to be adults, particularly adults with chronic disease,” says Hoffmann. “We anticipate over time they will bring children and siblings.”

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Regenerating bone to anchor dental implants Tue, 24 Jun 2014 16:23:00 +0000 A new method of prompting localized bone growth reveals a promising option for patients with bone loss who are considering dental implant surgery]]>

BoneRegen1For patients who need dental implants, the process can seem especially daunting if they also need additional bone to support them. Previously this meant a separate surgery to acquire this bone through a graft from the patient’s jaw or hip and reposition it at the implant site.

Thanks to a clinical inspiration by Dr. Marianela Gonzalez, assistant professor of oral and maxillofacial surgery at Texas A&M University Baylor College of Dentistry, patients now have an alternative.

The award-winning treatment idea was sparked through caring for a patient who had lower teeth so loose that extraction was required. Localized bone loss was to blame, and Gonzalez knew that to prepare the patient to receive dental implants, she would need to recreate ample bone to provide a firm anchor.

“For an outcome that works with implants, you need plenty of three-dimensional volume with the new bone,” Gonzalez says. “The problem with the previous bone graft method is that it tends to add only width but not height to the bone and fails more than half the time.”

Gonzalez conceived a new use for a product called Sonic Weld membrane as a potential solution. This resorbable material originally was used by surgeons to repair cranial fractures in children who, because of future bone growth, needed something less permanent than titanium plates for fracture repair. Sonic Weld also had manufacturer-suggested uses inside the mouth, but none leading to the results Gonzalez desired. She had another idea.

Gonzalez attaches the membrane over the top of the gums to create a pocket of space over the area where bone is needed. She then fills the space with Infuse Bone Graft, a protein that binds with existing bone cells and attracts the cells to create bone. Because it can be reabsorbed into the tissue, Sonic Weld is an enticing alternative to methods that use titanium mesh, which require bone grafts and secondary surgeries to remove.

“By using SonicWeld membrane with the Infuse Bone Graft to create bone growth, we got excellent results, and we ultimately placed implants and crowns,” Gonzalez says.

Gonzalez has repeated the technique on several patients, now at varying stages of the implant process. In all cases, she found that within four to six months, the adaptable membrane filled with the protein formed bone with the desired height and width to create an environment suitable for implants.

“Not only does this technique give the patient new teeth, we have a better cosmetic result because it produces extra soft tissue,” says Gonzalez. “This enhances the appearance of the crown attached to the implant because it is surrounded by natural gum tissue.”

Gonzalez and several department faculty members submitted their findings to the Academy of Osseointegration Case Study Poster Competition in March, which occurs during the annual meeting of this international association for dental implant professionals. They won first place among 225 submitted posters.

The team followed up with a presentation in April to the American College of Oral and Maxillofacial Surgeons, and a manuscript will be submitted for publication. Gonzalez reports the new procedure has been met with much interest from professional colleagues.

“It’s exciting because patients can finally have an alternative,” Gonzalez says. “Instead of going to the operating room and taking bone from the jaw or hip, we can recreate bone and be able to place implants, and patients can look natural and have complete function.

“We have a four-year follow up on the first patient treated with this procedure, and he is doing great in terms of bone, implants and crown stability.”

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Texas A&M dentists advocate fluoridated water Thu, 19 Jun 2014 16:08:30 +0000 Without even thinking about it, millions of Americans improve their oral health simply by turning on the tap. That is due to the benefits of fluoride, which occurs naturally in water and is known to harden tooth enamel and help prevent cavities. ]]>

vitalrecord-fluoridationWithout even thinking about it, millions of Americans improve their oral health simply by turning on the tap. That is due to the benefits of fluoride, which occurs naturally in water and is known to harden tooth enamel and help prevent cavities.

For decades, cities have harnessed this mineral’s potential by adjusting the levels found in drinking water. The result: community water fluoridation systems for more than 210 million Americans, including 20 million Texans.

The scant amounts of fluoride in a community water supply — Dallas’ averages 0.4 parts per million — can’t be smelled or seen, but the impact is far reaching, whether grabbing a drink from the sink at home or even a sip from the water fountain at work.

“Fluoride has tremendous benefits on teeth,” says Lawrence Wolinsky, Ph.D., D.M.D., dean of Texas A&M University Baylor College of Dentistry, “not only on developing teeth, but teeth once they’re formed. It strengthens enamel and makes it much easier to fight off tooth decay.”

According to the American Dental Association, community water fluoridation is known to reduce dental decay by at least 25 percent. And it’s touted by the Centers for Disease Control and Prevention as one of the top 10 greatest public health achievements of the 20th century.

While more than 400 U.S. communities have opted to adopt or retain their water fluoridation systems since 2000, these programs are by no means permanent. In the light of intense pressure and campaigning from anti-fluoridation groups, some large cities — like Portland, Ore., and Tucson, Ariz. — have chosen to do away with their water fluoridation programs.

When the issue surfaced this spring in Dallas, the ninth largest city in the U.S., Texas A&M Baylor College of Dentistry joined the dialogue.

Dr. Danette McNew ’88, a part-time faculty member and president of Dallas County Dental Society, says one recurring question has come to light: Why do cavities occur despite fluoridation?

“We cannot push people to drink tap water. We can only encourage them to do so,” says McNew, listing faucet water filtration systems, bottled water, and acidic sports and energy drinks as common culprits that keep residents from maximizing fluoride’s remineralizing effects. “We want to protect as many people as we can,” she adds. “When it comes to serving the public, we think fluoridation is the best method to do so.”

Plus, it’s inexpensive.

“It’s less than a dollar per person per year,” says Wolinsky of Dallas’ $600,000-plus annual water fluoridation budget. “If you look at a typical silver filing, it could cost anywhere from $85 to $150.”

Texas A&M University Baylor College of Dentistry experts speak out on water fluoridation

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Getting to the root of pain Mon, 16 Jun 2014 18:22:15 +0000 This recent graduate’s postdoctoral plans keep her anchored at Texas A&M University Baylor College of Dentistry, where she’ll further the dental school’s research on estrogen and TMJ disorders]]>

02students-stinson.jpgJust weeks ago Dr. Crystal Stinson received her dental degree and certificate in education for health care professionals from Texas A&M University Baylor College of Dentistry. Now she will stay on campus to delve into research involving temporomandibular joint pain — the subject of her dissertation — and an issue she knows about firsthand.

“It definitely was a motivating factor,” says Stinson of the role her own TMJ disorder played in the decision to focus on the topic. “This is a road I may have to cross in the future,” she says of the possibility of undergoing developing therapies.

As part of a $174,000 diversity supplement awarded to Stinson over the next two years from the National Institutes of Health – National Institute of Dental and Craniofacial Research, she will finish her doctorate degree with four years of research under the umbrella of a $1.5 million NIH R01 grant awarded in 2012 to Dr. Phillip Kramer, professor in biomedical sciences. A portion of Stinson’s NIH-approved research stipend will hinge on her ability to maintain her dentistry hand skills, a trend she says is intended to smooth the transition from bench-top study to chair-side care.

With potential clinical applications still years away, Kramer’s current research, “Estrogen and TMJ Pain,” uses animal models to explore the effect of estrogen on myofascial pain, which occurs in the masseter muscle used for chewing. Stinson’s portion will home in on how estrogen levels influence pathways and circuits in the brain that control pain in the mouth, jaws and face.

Her contribution will build upon more than a decade of research at the college, all with a common objective: finding new ways to alleviate pain in the more than 10 million Americans estimated to suffer from TMJ disorders.

“The goal of this research is to discover potential targets in which turning up or down activity — for example, turning on specific neurons — would reduce chronic pain in individuals with disease,” Kramer says.


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Operation East Texas: faculty and students trade summer break for outreach Fri, 06 Jun 2014 15:35:41 +0000 Texas A&M University Baylor College of Dentistry faculty and students are spending part of their two-week summer break providing free dental care to needy individuals in the Southeast Texas area through a partnership with Texas Department of State Health Services. ]]>
TAMBCD faculty and dental students provide dental care in temporary operatories in the gymnasium at Van Junior High School.

TAMBCD faculty and dental students provide dental care in temporary operatories in the gymnasium at Van Junior High School.

Texas A&M University Baylor College of Dentistry faculty and students are spending part of their two-week summer break providing free dental care to needy individuals in the Southeast Texas area through a partnership with Texas Department of State Health Services. Drs. Daniel Jones, Stephen Crane and 34 TAMBCD dental student volunteers traveled to Van, Texas, 72 miles southeast of Dallas. Along with Texas Health Services regional dentist, Dr. Joshua Liescheski, they transformed the Van Junior High School gymnasium into temporary dental operatories for the weeklong event that wraps-up Friday, June 6. The school gym also serves as sleeping quarters at night for the dental team, who sleep on cots after they’ve treated the last patient for the day. The volunteers provided free care to more than 300 patients this week.

The Operation East Texas team was featured on the “Something Good” segment on NBC Channel 5 news in Dallas. 

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Seeing double Fri, 23 May 2014 20:27:12 +0000 It could have something to do with their DNA. Patrick and Austin Hodges, No. 1 and No. 2 in this year’s Texas A&M University Baylor College of Dentistry graduating dental class, are identical twins. It doesn’t take much digging to figure out it’s not the first time these two have demonstrated a penchant for academics]]>

It could have something to do with their DNA. Patrick and Austin Hodges, No. 1 and No. 2 in this year’s Texas A&M University Baylor College of Dentistry graduating dental class, are identical twins. It doesn’t take much digging to figure out it’s not the first time these two have demonstrated a penchant for academics.

The 2014 dental class top two students have more in common than strong study prowess.

The 2014 dental class top two students have more in common than strong study prowess.

Graduation from Tascosa High School in Amarillo, Texas, a class of 483 students, landed Patrick and Austin Hodges at No. 3 and No. 5 in their class, respectively. Both majored in biomedical sciences at Texas A&M University. Both graduated with a 4.0 GPA.

They’re the first members of their family to pursue dentistry. And in July, they start the Graduate Orthodontic Program at Texas A&M Baylor College of Dentistry.

“If you ask anyone, it is obvious that Austin and I have a friendly competitiveness between us,” says Patrick Hodges. “This has definitely helped us to do as well as one another in school and many other things, whether it’s sports, board games or cards.”

Many summer days after their first year in dental school were spent playing tennis, often with classmate Anne Lindley. It didn’t take long for them to commit to the sport with the same intensity as every other task.

“They decided they were going to go all in,” says Lindley. “They had matching tennis racquets, matching court shoes. They ended up copying each other. One couldn’t not do it.”

Studying is a different matter. The two — roommates since college — retreat into separate rooms, taking breaks only to ask each other questions about the material.

“When they study, they’re focused,” says Lindley. “No one can go over there and study with them. I’ll text both of them and ask questions.”

Back on campus, other classmates and faculty alike seek the twins for their input.

“They are smart, naturally, but they have two brilliant minds to collaborate,” says Lindley. “They help students in our class all the time. They go above and beyond for other people.”

Dr. Robert Spears, professor in biomedical sciences, taught the brothers during their first year and has worked with them on several occasions since.

“Every year someone is going to be top of the class, second of the class, but what distinguishes them is they work really hard, and they’re just innately talented as well,” says Spears. “Both of those young men help everybody. It’s almost like they’re instructors in the class — they’re that good, that knowledgeable.”

Dr. Amp Miller, professor in restorative sciences, taught the brothers fixed prosthodontics during clinical labs and now turns to them as a resource.

“I always have had a high regard for their perception of things and the way they approach the whole educational process,” says Miller.

The twins have had some time to soak in the news of their class rank. They picked up their official letters from the registrar’s office in summer 2013. Austin Hodges, No. 2 in the graduating class, was thrilled, especially considering the B+ he made during one course his second year.

The news likely didn’t come as much of a shock to the brothers’ parents, who promptly took their sons to a celebratory steak dinner.

“Our parents have always supported us and have been our biggest fans throughout our academic career,” Austin Hodges says.

In three years’ time, that academic career will conclude with an orthodontics certificate in hand and — from the looks of it — the continuation of another joint venture. Will Amarillo soon have a Hodges & Hodges Orthodontics? Time will tell.




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When prescription drugs cause adverse effects in the jaw Thu, 15 May 2014 21:54:47 +0000 Attending a cancer support group presentation on the side effects of bisphosphonates gave Jerry Sawyer, 73, a jump-start on managing the symptoms when he experienced them himself. ]]>

Attending a cancer support group presentation on the side effects of bisphosphonates gave Jerry Sawyer, 73, a jump-start on managing the symptoms when he experienced them himself.

Dr. Charles W. Wakefield examines Jerry Sawyer during a recent dental appointment at TAMBCD.

Dr. Charles W. Wakefield examines Jerry Sawyer during a recent dental appointment at TAMBCD.

Sawyer, a cancer survivor, learned from Dr. Charles W. Wakefield, professor and director of the advanced education in general dentistry residency program at Texas A&M University Baylor College of Dentistry, how to identify the signs of bisphosphonate-induced osteonecrosis of the jaw – a disease where bone loses blood supply and is non vital.

This condition was a side effect of Sawyer’s lengthy cancer battle, which began in late 1995 when he thought he pulled a hamstring while he was refereeing a professional soccer game in Dallas.

An MRI revealed devastating news. What he believed to be a pulled hamstring was actually his vertebrae collapsing and pinching a nerve due to a tumor in his spinal column. He was diagnosed with multiple myeloma and given a life expectancy of two years or less.

After seeing an oncologist, Sawyer immediately began taking the intravenous prescription drug Aredia, a bisphosphonate. With names like Aredia, Fosamax, Boniva, Actonel, Reclast and Zometa, among others, this class of drugs is used to treat the high blood calcium levels and bone disease experienced by patients with multiple myeloma and other metastatic bone cancers. Bisphosphonates also are prescribed to treat patients with osteoporosis, Paget’s disease and similar conditions found in patients over age 55.

In these diseases, the natural process of replacing old bone tissue with new is thrown out of kilter. Bisphosphonates work by killing off the cells that break down bone, restoring the balance of bone loss/formation that occurs in healthy bodies and decreasing fracture risk.

“Bone is continually remodeled – it is formed and resorbed, usually at a constant balance of resorption and formation,” Wakefield said. “Bisphosphonates, as a rule, can permanently decrease the cells that resorb bone, allowing the other cells that form bone to continue forming it.”

After 14 months on Aredia, Sawyer wanted to stop treatment to avoid becoming immune to the drug. He was symptom-free for several years, then resumed treatment with a different drug.

“Switching drugs became the worst thing I could do,” he said. He developed bisphosphonate-induced osteonecrosis of the jaw (ONJ).

Although osteonecrosis can develop in bone in other areas of the body, the jaws are most susceptible because that area of the skeleton has a very high degree of turnover due to the stress and function of chewing. ONJ is found in the lower jaw 60 percent of the time and upper jaw the other 40 percent, Wakefield said. The condition presents as exposed alveolar bone — the bone that contains the tooth sockets — and occurs spontaneously or following a surgical procedure such as tooth removal, periodontal surgery or dental implant placement.

According to Wakefield, patients receiving bisphosphonates intravenously are most susceptible since the medications are almost totally absorbed by the bone. Bisphosphonates taken orally are partially absorbed in the stomach, so they have less risk, but they still can contribute to ONJ after two to three years of constant use. Regardless of delivery method, this class of drugs remains in the body indefinitely.

“These medications concentrate in bone and remain unaltered metabolically for decades, even after being discontinued,” Wakefield said.

Sawyer recognized the signs of osteonecrosis in his jaw when he discovered something unusual adjacent to his molar.

“I knew what was going on as soon as I felt what seemed like a new wisdom tooth,” Sawyer said.

Sawyer was examined at TAMBCD, and his suspicions were confirmed. The unusual protrusion was exposed bone that Sawyer could remove in pieces with his fingers. After his official diagnosis of ONJ, Sawyer was given antibiotics for 10 days and started on the treatment protocol Wakefield wrote for the college.

“There are many steps in the treatment plan, from just managing the symptoms and exposed bone to surgical removal,” Wakefield said. “Since surgical removal is much more traumatic, normal healing may not occur. Hyperbaric oxygen therapy is an option but is controversial regarding benefits. With no blood supply, the oxygen isn’t delivered to all sites.

“If exposed bone is sharp and causes irritation, we file it smooth for patient comfort. Whenever the patient has any dentistry done, even cleanings, antibiotics are prescribed and the patient is given antimicrobial mouthrinses for 60 days.”

Wakefield said it is important that patients have a thorough dental examination and complete any major dental work such as implant placement and healing, extractions and periodontal procedures before beginning a bisphosphonate regime or as soon as possible after starting the drug therapy.

Sawyer said his oral condition is more aggravating than it is painful.

“I’m fortunate,” he said. “A lot of people who have ONJ get an open mouth sore that won’t heal, they have to live with that and it is painful.”

Sawyer is facing other health challenges beyond the osteonecrosis. More than one of the medications he took for multiple myeloma and its complications caused severe damage to his heart and lungs, he said. In addition, he “is in the midst of relapsing” and expects to have to start treatment again.

The one thing he would change if he could: “I wouldn’t have used the Zometa,” he said. But Sawyer is thankful for his life-extending therapy.

“The drugs that caused my condition, also gave me 16 more years.”

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