How Would You Go About Finding a Dentist in Toronto?
A. Nutt asked:
There are actually a pretty large number of dentists and oral care specialists in and around the Toronto area, so it should be no problem what so ever to find one that can treat you. The problem is, with so many dental professionals to choose from, how do you find the right one?
No one wants to have an unpleasant experience at the dentist; most adults don’t see an oral care specialist nearly as often as they should because they are afraid of having a bad experience. So you can avoid this conundrum and keep your smile shinning and your teeth as healthy as they can and should be – here are some ways to track down the prefect dentist for you.
Word of Mouth
This is one of the absolute best methods of advertisement, and for good reason, especially when trying to locate a good medical professional – who would know more about how a doctor or dentist treats their patients than one of their patients?
This method of locating a dentist can also help you learn which ones would be better to avoid. If a friend, loved one or co-worker has had a difficult time with one dentist in particular, whether it was due to sub-standard care, lack of compassion or an excessively high bill you would know that this may not be the best choice for your business.
There’s not much of a better endorsement that you can get than the seal of approval from someone or from many that you really trust.
The Internet
The internet is, quite possibly, the single best resource available to get as much information in as little time as possible.
You can visit the individual practice’s websites in and around Toronto to find out all of the pertinent information of that particular office: how many dentists are in the office; what, if any specialists perform services there; the schedule; the history of the practice and you may even be able to read some patient reviews of endorsements.
There are also established websites developed with the interest of helping you find the best dental practitioner for your situation. Websites like Torontosdentist.ca have a list of well respected dental clinics that provide care in the Toronto area, as well as descriptions of the services that each provide, where exactly they are located and direct links to their respective web pages so you can narrow down the difficult decision to a few select choices.
Trial and Error
Now that you’ve been able to narrow down your choices based on the testimonials of your friends and loved ones and through some intense research on the World Wide Web, if you’ve still got a few options to choose from – it’s time to pay them a visit.
Schedule a preliminary appointment for a check-up with the first on your narrowed down list and take their services for a test drive. Pay close attention and look for things that you like about the practice and the things that you don’t. Questions to ask yourself during and after the visit are: Was everyone (the receptionist, the hygienist and the doctor) as friendly, courteous and helpful as you would have liked them to be? Is the office as neat and clean as it should have been (including the waiting room)?; Was the check-up comfortable?; Would you be willing to schedule a follow up appointment? If the answer was yes to all of the questions that you posed to yourself – then you may very well have found your dentist.
Choosing a dentist can be a big decision, just as with a doctor, you’re putting a large portion of your health in this person’s hands. There is by no means a shortage of qualified oral care practitioners in the Toronto area, but there may only be a few that are a good fit for you. Follow the steps above and you’ll be much more likely to locate the best dentist for you as quickly as possible.
Rapid Learn Centre
There are actually a pretty large number of dentists and oral care specialists in and around the Toronto area, so it should be no problem what so ever to find one that can treat you. The problem is, with so many dental professionals to choose from, how do you find the right one?
No one wants to have an unpleasant experience at the dentist; most adults don’t see an oral care specialist nearly as often as they should because they are afraid of having a bad experience. So you can avoid this conundrum and keep your smile shinning and your teeth as healthy as they can and should be – here are some ways to track down the prefect dentist for you.
Word of Mouth
This is one of the absolute best methods of advertisement, and for good reason, especially when trying to locate a good medical professional – who would know more about how a doctor or dentist treats their patients than one of their patients?
This method of locating a dentist can also help you learn which ones would be better to avoid. If a friend, loved one or co-worker has had a difficult time with one dentist in particular, whether it was due to sub-standard care, lack of compassion or an excessively high bill you would know that this may not be the best choice for your business.
There’s not much of a better endorsement that you can get than the seal of approval from someone or from many that you really trust.
The Internet
The internet is, quite possibly, the single best resource available to get as much information in as little time as possible.
You can visit the individual practice’s websites in and around Toronto to find out all of the pertinent information of that particular office: how many dentists are in the office; what, if any specialists perform services there; the schedule; the history of the practice and you may even be able to read some patient reviews of endorsements.
There are also established websites developed with the interest of helping you find the best dental practitioner for your situation. Websites like Torontosdentist.ca have a list of well respected dental clinics that provide care in the Toronto area, as well as descriptions of the services that each provide, where exactly they are located and direct links to their respective web pages so you can narrow down the difficult decision to a few select choices.
Trial and Error
Now that you’ve been able to narrow down your choices based on the testimonials of your friends and loved ones and through some intense research on the World Wide Web, if you’ve still got a few options to choose from – it’s time to pay them a visit.
Schedule a preliminary appointment for a check-up with the first on your narrowed down list and take their services for a test drive. Pay close attention and look for things that you like about the practice and the things that you don’t. Questions to ask yourself during and after the visit are: Was everyone (the receptionist, the hygienist and the doctor) as friendly, courteous and helpful as you would have liked them to be? Is the office as neat and clean as it should have been (including the waiting room)?; Was the check-up comfortable?; Would you be willing to schedule a follow up appointment? If the answer was yes to all of the questions that you posed to yourself – then you may very well have found your dentist.
Choosing a dentist can be a big decision, just as with a doctor, you’re putting a large portion of your health in this person’s hands. There is by no means a shortage of qualified oral care practitioners in the Toronto area, but there may only be a few that are a good fit for you. Follow the steps above and you’ll be much more likely to locate the best dentist for you as quickly as possible.
Rapid Learn Centre
For a Clean and Healthy Mouth, Do the Brushing and Flossing Thing Daily
Abigail Franks asked:
When it comes to good oral care, nothing beats the toothbrush and a good flossing. These marvels of modern society come in a variety of colors. There’s also the electric speed toothbrush to the latest sonic toothbrushes. They range in price from the 3 dollar simple toothbrush to about 100 dollar sonic type brush.
Personally, I think the best toothbrush for the job is the one you’re most comfortable with using. Low cost electric toothbrushes are fast and can help kids do a good job brushing. The newer sonic type brushes work even better however. I use a manual type brush while my wife prefers the ultra modern sonic brush. She has problems with adult plaque build up regardless of how often or how much she brushed with a regular toothbrush. The new sonic brush seems to break up the plaque and she says leaves her teeth feeling clean and smooth.
As for flossing, I prefer the waxed stuff and get the lowest priced floss at the store. I do NOT however use plain brand but like the consistency of the major brands like Johnson and Johnson, Oral-B and the like.
For kids and those just finding the joys of flossing, choose one that’s designed to be fray resistant. These have a little more coating that makes them mush easier to use. There are also floss tools, flat or round profile, textured, flavored floss and flossing holders to make the job easier. The point here is to do it and on a regular basis. I like it so much that I actually floss daily! Go figure ?
It’s the best thing you can do to keep your dental costs down and give you a clean and health mouth.
Brushing and flossing prevents tooth decay by keeping the damaging bacterial off your teeth. Brushing and flossing also prevent gum disease, which is a primary cause of tooth decay, lost teeth and teeth pain.
Healthy teeth make dental appointments shorter because there is less that needs to be done. You save money by practicing good dental hygiene. Here is a case where prevention can help avoid costly and complicated dental procedures.
The first line of defense in preventing dental disease is regular brushing and flossing. Serious tooth problems can be prevented or limited simply by keeping your teeth cleaned regularly. Brushing and flossing can also help prevent bad breath by ridding your mouth of the bacteria that cause bad breath. So now you see that dental cleaning is not only a good practice but can save big money when visiting the dentist. Good teeth care helps contribute to your overall good health and feelings.
Rapidlearn.org
When it comes to good oral care, nothing beats the toothbrush and a good flossing. These marvels of modern society come in a variety of colors. There’s also the electric speed toothbrush to the latest sonic toothbrushes. They range in price from the 3 dollar simple toothbrush to about 100 dollar sonic type brush.
Personally, I think the best toothbrush for the job is the one you’re most comfortable with using. Low cost electric toothbrushes are fast and can help kids do a good job brushing. The newer sonic type brushes work even better however. I use a manual type brush while my wife prefers the ultra modern sonic brush. She has problems with adult plaque build up regardless of how often or how much she brushed with a regular toothbrush. The new sonic brush seems to break up the plaque and she says leaves her teeth feeling clean and smooth.
As for flossing, I prefer the waxed stuff and get the lowest priced floss at the store. I do NOT however use plain brand but like the consistency of the major brands like Johnson and Johnson, Oral-B and the like.
For kids and those just finding the joys of flossing, choose one that’s designed to be fray resistant. These have a little more coating that makes them mush easier to use. There are also floss tools, flat or round profile, textured, flavored floss and flossing holders to make the job easier. The point here is to do it and on a regular basis. I like it so much that I actually floss daily! Go figure ?
It’s the best thing you can do to keep your dental costs down and give you a clean and health mouth.
Brushing and flossing prevents tooth decay by keeping the damaging bacterial off your teeth. Brushing and flossing also prevent gum disease, which is a primary cause of tooth decay, lost teeth and teeth pain.
Healthy teeth make dental appointments shorter because there is less that needs to be done. You save money by practicing good dental hygiene. Here is a case where prevention can help avoid costly and complicated dental procedures.
The first line of defense in preventing dental disease is regular brushing and flossing. Serious tooth problems can be prevented or limited simply by keeping your teeth cleaned regularly. Brushing and flossing can also help prevent bad breath by ridding your mouth of the bacteria that cause bad breath. So now you see that dental cleaning is not only a good practice but can save big money when visiting the dentist. Good teeth care helps contribute to your overall good health and feelings.
Rapidlearn.org
Obstructive Sleep Apnea, Cardiovascular Consequences, and Treatment Options
Bharat Bista asked:
Obstructive Sleep Apnea affects approximately 20 million people in the U.S. alone, and millions more are affected worldwide. Over the last 10 years, significant research has been performed and now there is overwhelming evidence of the connection between Obstructive Sleep Apnea (OSA) and cardiovascular disease. Specifically, people affected by sleep apnea are at increased risk for hypertension (also known as high blood pressure), coronary artery disease (AKA atherosclerosis), heart attacks, strokes, cardiac arrhythmias, heart failure, diabetes, and even death.
This scary list of adverse health outcomes demonstrates the significance of diagnosing sleep apnea in a timely manner, in order to initiate treatment t. This last comment is actually the point — fortunately, sleep apnea is a treatable condition. And you might be surprised that there are different options for treatment. With the right guidance from qualified experts, successful treatment is readily attainable.
First of all, we must dispel any myths, which prevent many people affected with sleep apnea from seeking the appropriate medical attention. The biggest myth is that only overweight or obese people get OSA. That is simply not true. In fact, many people who are considered to be at their ideal body weight, based on BMI (Body-Mass Index), are in fact diagnosed with OSA or Upper Airway Resistance Syndrome (UARS). UARS is a form of sleep-related breathing disorder in which a person has frequent arousals from sleep due to respiratory airway collapse or obstruction. Often, the events are not as obvious as seen in OSA, and in many cases, a person affected by UARS may not even snore. However, people with UARS may complain of unrefreshing sleep, frequent nocturnal awakenings, or excessive daytime sleepiness or fatigue. UARS, like OSA, is a treatable medical condition.
So how does one get sleep apnea?
Well, most people who have sleep apnea are predisposed very early in life. It is actually the size and shape of the jaw and upper airway that determines whether a person will develop OSA. A narrow jaw and upper airway (i.e., oral cavity and throat) results in less space for air to flow during breathing. When a person sleeps, the soft tissues and muscles of the upper airway relax and collapse, leading to increased airflow resistance and airway obstruction. The airway obstruction is what causes OSA.
OSA is simply a repetitive, cyclical pattern in which a person stops breathing or nearly stops breathing for periods of longer than 10 seconds each time. The following is a description of what happens during an episode. As a person sleeps, the upper airway and jaw relax, resulting in collapse of the upper airway (i.e., the back of the throat). The lower jaw often relaxes and drops back a few millimeters when we sleep. Since the tongue base is attached to the lower jaw, the tongue will also drop back a few millimeters further during sleep. This combination of events leads to a very narrow passageway for air to flow through the back of the throat during sleep. Occasionally, the upper airway is so collapsed that little or no air can pass. These episodes are called apneas (complete obstruction with no air movement) or hypopneas (partial obstruction with minimal air movement). When an apnea or hypopnea occurs, it lasts for a period of 10 seconds or more. In some cases, the episodes can last for over a minute! During this time, the blood oxygen saturation starts to drop, because no fresh air or oxygen is being delivered to the lungs. As the blood oxygen saturation drops, the body goes into a fight-or-flight response, resulting in increased heart rate and elevation of blood pressure. In essence, the heart is beating faster in an attempt to bring in more fresh blood and oxygen from the lungs. This sequence of events continues until, ultimately, a person has an arousal from sleep, resulting in a change in body position, a deep breath or gasp, or a brief awakening from sleep for 2-3 seconds (which most people don’t recall). This cycle of events may then repeat itself several times per hour or even hundreds of times per night, depending on the severity of the case. These cyclical arousals not only disrupt and fragment one’s sleep by resulting in a very shallow and unrefreshing sleep, but they also cause repetitive stress on the cardiovascular system with the elevations in heart rate and blood pressure. This repetitive stress causes the heart to work harder. Night after night, this chronic extra stress on the heart is what many scientists believe leads to the long-term adverse cardiovascular events (such as heart attacks, strokes and cardiac arrhythmias) and the impairment of blood pressure and blood sugar control.
Fortunately, as stated before, sleep apnea is a treatable condition. Further, effective treatment of OSA results in reductions in daytime blood pressure. Effective treatment not only reduces the risk of cardiac arrhythmias such as atrial fibrillation, but it can also reduce the risk of recurrent episodes of arrhythmias. The incidence of stroke and death is also significantly less in people treated for OSA. As compared to those who remain untreated for OSA, people who are treated have lower levels of blood glucose. Studies have highlighted how closely linked OSA and diabetes are. Therefore, people with OSA and diabetes who undergo treatment for OSA have much better control of their diabetes. Finally, treatment of OSA improves sleep quality and duration, associated with deeper and more refreshing sleep. This improvement in sleep carries on into the daytime, resulting in reduced daytime sleepiness and increased energy levels.
In fact, there is more than one form of treatment available. The American Academy of Sleep Medicine recognizes three forms of treatment that have been demonstrated to be effective for sleep apnea. The first of these options is known as CPAP, or Continuous Positive Airway Pressure. CPAP is still the gold standard of treatment for OSA, because it is a very safe and effective form of treatment. It is also generally successful for all degrees of OSA severity, including mild, moderate, severe, and very severe. CPAP is a device weighing less than 10 pounds that sits on your nightstand and filters the air in your room. Once it filters the room air, it blows it out at a higher, fixed pressure through a tube that connects to a mask. The mask, which can come in a multitude of varieties, either sits on your nose, under your nose, or over both your nose and mouth. The device is used during sleep to keep the upper airway stented open, using the higher, fixed air pressure delivered from the machine, through the tube, to your mask. It is not a ventilator, so it does not force you to breathe (although there are some models which do have this feature for very unique cases). However, it does make it easier to breathe, by keeping the upper airway open and preventing its collapse during sleep.
It does take time to get adjusted to using CPAP. Most people become adjusted to CPAP within 2-3 weeks. The real issue is getting used to sleeping with a mask on your nose, or under your nose. Once you get used to this new habit, then treatment with CPAP becomes easy. Generally, most people become comfortable using CPAP within one month, and at that point, they are able to sleep with CPAP for 4 or more hours per night. Research studies have shown that using CPAP for at least 4 hours per night results in associated health benefit. Therefore, it is important to sleep with CPAP for at least 4 hours per night, once the initial adjustment period is over. Further, the more time spent using CPAP during sleep, the more beneficial it is for your health. There are over 1 million people across the United States successfully using CPAP on a regular and continual basis, and if you ask one of them how well they sleep, they will likely tell you how CPAP has dramatically improved their sleep and changed their life for the better.
For people who do not succeed with CPAP or for those who prefer a different option, surgery can be an effective form of treatment. Generally, there is about a 50-70% chance of successful cure of sleep apnea with surgical intervention. This number takes into account all cases, including mild, moderate, severe, and very severe degrees. This statistic also accounts for the varied skills of surgeons who perform these types of procedures. In most cases, surgery usually improves the impairment in sleep-related breathing disorders, and generally, there is a reduction in the severity of OSA after surgery. It is important to discuss your individual situation with the ENT surgeon who will be performing the surgery. The risks and benefits of surgery should be examined prior to moving forward with surgery. Some risks associated with this type of surgery are bleeding, infection, and the risks commonly associated with general anesthesia. Further, it is vital to make certain that the ENT surgeon you choose has a breadth of experience in the type of procedure you plan to undergo. Not all ENT surgeons receive specialized training in sleep apnea surgery, so it is important to make sure that you find someone with extensive training and experience in this area for better results.
So what exactly do they do for surgery? Well, the most common surgical procedure for sleep apnea is called uvulopalatopharyngoplasty (UPPP). It basically means removing the uvula that hangs in the back of the throat, along with any excess tissue around the soft palate. At the same time, any residual adenoid or tonsil tissue will be resected, to increase the size of the airway to improve air flow. This type of surgery is quite painful due to the sensitive nerve fibers in that area, so recovery time is usually about 1 week after surgery. Your doctor will provide you with medications for pain during this time. You should then repeat a sleep study 2-3 months after surgery to reassess for any persistent, residual sleep apnea. If the UPPP is not completely successful, then a second phase of surgery may help to resolve the problem. The most common second phase of surgery is called genioglossal advancement (GA) with or without hyoid suspension. This surgery involves making a small window in the bone at the front of the lower jaw, to pull it forward a few millimeters. By fixing this part of the lower jaw forward, it also brings the tongue base forward a few millimeters, thus opening up space in the back of the throat. This procedure can be performed with or without a hyoid suspension, which is a surgery to done to bring the hyoid bone in the throat forward, thereby increasing the space in the upper airway.
Again, these surgical interventions can help to successfully treat OSA, especially in mild to moderate cases. For very severe cases, other more involved surgeries may be the only way to a surgical cure. For individuals who are extremely obese with OSA, gastric bypass surgery or lap-band gastric surgery may be the only realistic surgical option. This type of surgery is considered a major surgery and careful planning and discussion with both your sleep disorders doctor and the surgeon is necessary.
A third option for treating sleep apnea is oral appliance therapy, also known as mandibular advancement splint. These oral appliances look very similar to retainers. They work by holding the lower jaw in a slightly forward position during sleep. This helps to increase the space for air flow in the upper airway, thereby reducing the frequency of respiratory events during sleep. It is important to be aware that oral appliances are only approved to treat snoring and cases of mild-to-moderate sleep apnea. They have not been shown to be successful in treating severe cases of OSA, due to the limitations on forward movement of the lower jaw.
The oral appliances are custom-made by dental labs. Generally, to get an oral appliance made for yourself, you will have to visit a dentist who is familiar with the use of these devices for the treatment of snoring or sleep apnea. You can talk to your sleep disorders doctor to find a dentist with this specialized training in your area.
Oral appliances can sometimes cause dental pain, TMJ pain, or jaw discomfort. These issues can usually be resolved with further adjustments of the device by your dentist. Often 2-3 regular follow-up visits with the dentist can help to prevent problems from developing. However, there are some cases in which an individual is unable to adjust to this form of treatment. Another issue with oral appliance therapy is that health insurance companies, historically, have not covered the cost for this type of treatment. Further, dental insurance has never provided coverage for oral appliance therapy. Nevertheless, with the growing medical evidence for oral appliance therapy, some health insurance companies are beginning to recognize this as a viable medical treatment alternative. Just as with surgery, a follow-up sleep study should be performed 2-3 months after starting treatment with an oral appliance, to ensure adequate treatment of snoring and sleep apnea.
Hopefully this review of obstructive sleep apnea, the significant cardiovascular consequences, and the treatment options will bring more awareness and understanding to this very important health issue. OSA is a treatable condition. Untreated sleep apnea is associated with an increased risk for hypertension (or high blood pressure), heart attacks, strokes, heart failure, cardiac arrhythmias, and diabetes. People with hypertension and untreated sleep apnea are more likely to have higher blood pressures. People with diabetes and untreated sleep apnea are more likely to have higher blood glucose levels. If you or someone you know may have sleep apnea, please consult a sleep disorders specialist with formal training in sleep medicine. The American Academy of Sleep Medicine (www.aasmnet.org/) and the American Board of Sleep Medicine (www.absm.org/) are helpful resources for finding a board-certified sleep disorders doctor near you.
Rapidlearn.org
Obstructive Sleep Apnea affects approximately 20 million people in the U.S. alone, and millions more are affected worldwide. Over the last 10 years, significant research has been performed and now there is overwhelming evidence of the connection between Obstructive Sleep Apnea (OSA) and cardiovascular disease. Specifically, people affected by sleep apnea are at increased risk for hypertension (also known as high blood pressure), coronary artery disease (AKA atherosclerosis), heart attacks, strokes, cardiac arrhythmias, heart failure, diabetes, and even death.
This scary list of adverse health outcomes demonstrates the significance of diagnosing sleep apnea in a timely manner, in order to initiate treatment t. This last comment is actually the point — fortunately, sleep apnea is a treatable condition. And you might be surprised that there are different options for treatment. With the right guidance from qualified experts, successful treatment is readily attainable.
First of all, we must dispel any myths, which prevent many people affected with sleep apnea from seeking the appropriate medical attention. The biggest myth is that only overweight or obese people get OSA. That is simply not true. In fact, many people who are considered to be at their ideal body weight, based on BMI (Body-Mass Index), are in fact diagnosed with OSA or Upper Airway Resistance Syndrome (UARS). UARS is a form of sleep-related breathing disorder in which a person has frequent arousals from sleep due to respiratory airway collapse or obstruction. Often, the events are not as obvious as seen in OSA, and in many cases, a person affected by UARS may not even snore. However, people with UARS may complain of unrefreshing sleep, frequent nocturnal awakenings, or excessive daytime sleepiness or fatigue. UARS, like OSA, is a treatable medical condition.
So how does one get sleep apnea?
Well, most people who have sleep apnea are predisposed very early in life. It is actually the size and shape of the jaw and upper airway that determines whether a person will develop OSA. A narrow jaw and upper airway (i.e., oral cavity and throat) results in less space for air to flow during breathing. When a person sleeps, the soft tissues and muscles of the upper airway relax and collapse, leading to increased airflow resistance and airway obstruction. The airway obstruction is what causes OSA.
OSA is simply a repetitive, cyclical pattern in which a person stops breathing or nearly stops breathing for periods of longer than 10 seconds each time. The following is a description of what happens during an episode. As a person sleeps, the upper airway and jaw relax, resulting in collapse of the upper airway (i.e., the back of the throat). The lower jaw often relaxes and drops back a few millimeters when we sleep. Since the tongue base is attached to the lower jaw, the tongue will also drop back a few millimeters further during sleep. This combination of events leads to a very narrow passageway for air to flow through the back of the throat during sleep. Occasionally, the upper airway is so collapsed that little or no air can pass. These episodes are called apneas (complete obstruction with no air movement) or hypopneas (partial obstruction with minimal air movement). When an apnea or hypopnea occurs, it lasts for a period of 10 seconds or more. In some cases, the episodes can last for over a minute! During this time, the blood oxygen saturation starts to drop, because no fresh air or oxygen is being delivered to the lungs. As the blood oxygen saturation drops, the body goes into a fight-or-flight response, resulting in increased heart rate and elevation of blood pressure. In essence, the heart is beating faster in an attempt to bring in more fresh blood and oxygen from the lungs. This sequence of events continues until, ultimately, a person has an arousal from sleep, resulting in a change in body position, a deep breath or gasp, or a brief awakening from sleep for 2-3 seconds (which most people don’t recall). This cycle of events may then repeat itself several times per hour or even hundreds of times per night, depending on the severity of the case. These cyclical arousals not only disrupt and fragment one’s sleep by resulting in a very shallow and unrefreshing sleep, but they also cause repetitive stress on the cardiovascular system with the elevations in heart rate and blood pressure. This repetitive stress causes the heart to work harder. Night after night, this chronic extra stress on the heart is what many scientists believe leads to the long-term adverse cardiovascular events (such as heart attacks, strokes and cardiac arrhythmias) and the impairment of blood pressure and blood sugar control.
Fortunately, as stated before, sleep apnea is a treatable condition. Further, effective treatment of OSA results in reductions in daytime blood pressure. Effective treatment not only reduces the risk of cardiac arrhythmias such as atrial fibrillation, but it can also reduce the risk of recurrent episodes of arrhythmias. The incidence of stroke and death is also significantly less in people treated for OSA. As compared to those who remain untreated for OSA, people who are treated have lower levels of blood glucose. Studies have highlighted how closely linked OSA and diabetes are. Therefore, people with OSA and diabetes who undergo treatment for OSA have much better control of their diabetes. Finally, treatment of OSA improves sleep quality and duration, associated with deeper and more refreshing sleep. This improvement in sleep carries on into the daytime, resulting in reduced daytime sleepiness and increased energy levels.
In fact, there is more than one form of treatment available. The American Academy of Sleep Medicine recognizes three forms of treatment that have been demonstrated to be effective for sleep apnea. The first of these options is known as CPAP, or Continuous Positive Airway Pressure. CPAP is still the gold standard of treatment for OSA, because it is a very safe and effective form of treatment. It is also generally successful for all degrees of OSA severity, including mild, moderate, severe, and very severe. CPAP is a device weighing less than 10 pounds that sits on your nightstand and filters the air in your room. Once it filters the room air, it blows it out at a higher, fixed pressure through a tube that connects to a mask. The mask, which can come in a multitude of varieties, either sits on your nose, under your nose, or over both your nose and mouth. The device is used during sleep to keep the upper airway stented open, using the higher, fixed air pressure delivered from the machine, through the tube, to your mask. It is not a ventilator, so it does not force you to breathe (although there are some models which do have this feature for very unique cases). However, it does make it easier to breathe, by keeping the upper airway open and preventing its collapse during sleep.
It does take time to get adjusted to using CPAP. Most people become adjusted to CPAP within 2-3 weeks. The real issue is getting used to sleeping with a mask on your nose, or under your nose. Once you get used to this new habit, then treatment with CPAP becomes easy. Generally, most people become comfortable using CPAP within one month, and at that point, they are able to sleep with CPAP for 4 or more hours per night. Research studies have shown that using CPAP for at least 4 hours per night results in associated health benefit. Therefore, it is important to sleep with CPAP for at least 4 hours per night, once the initial adjustment period is over. Further, the more time spent using CPAP during sleep, the more beneficial it is for your health. There are over 1 million people across the United States successfully using CPAP on a regular and continual basis, and if you ask one of them how well they sleep, they will likely tell you how CPAP has dramatically improved their sleep and changed their life for the better.
For people who do not succeed with CPAP or for those who prefer a different option, surgery can be an effective form of treatment. Generally, there is about a 50-70% chance of successful cure of sleep apnea with surgical intervention. This number takes into account all cases, including mild, moderate, severe, and very severe degrees. This statistic also accounts for the varied skills of surgeons who perform these types of procedures. In most cases, surgery usually improves the impairment in sleep-related breathing disorders, and generally, there is a reduction in the severity of OSA after surgery. It is important to discuss your individual situation with the ENT surgeon who will be performing the surgery. The risks and benefits of surgery should be examined prior to moving forward with surgery. Some risks associated with this type of surgery are bleeding, infection, and the risks commonly associated with general anesthesia. Further, it is vital to make certain that the ENT surgeon you choose has a breadth of experience in the type of procedure you plan to undergo. Not all ENT surgeons receive specialized training in sleep apnea surgery, so it is important to make sure that you find someone with extensive training and experience in this area for better results.
So what exactly do they do for surgery? Well, the most common surgical procedure for sleep apnea is called uvulopalatopharyngoplasty (UPPP). It basically means removing the uvula that hangs in the back of the throat, along with any excess tissue around the soft palate. At the same time, any residual adenoid or tonsil tissue will be resected, to increase the size of the airway to improve air flow. This type of surgery is quite painful due to the sensitive nerve fibers in that area, so recovery time is usually about 1 week after surgery. Your doctor will provide you with medications for pain during this time. You should then repeat a sleep study 2-3 months after surgery to reassess for any persistent, residual sleep apnea. If the UPPP is not completely successful, then a second phase of surgery may help to resolve the problem. The most common second phase of surgery is called genioglossal advancement (GA) with or without hyoid suspension. This surgery involves making a small window in the bone at the front of the lower jaw, to pull it forward a few millimeters. By fixing this part of the lower jaw forward, it also brings the tongue base forward a few millimeters, thus opening up space in the back of the throat. This procedure can be performed with or without a hyoid suspension, which is a surgery to done to bring the hyoid bone in the throat forward, thereby increasing the space in the upper airway.
Again, these surgical interventions can help to successfully treat OSA, especially in mild to moderate cases. For very severe cases, other more involved surgeries may be the only way to a surgical cure. For individuals who are extremely obese with OSA, gastric bypass surgery or lap-band gastric surgery may be the only realistic surgical option. This type of surgery is considered a major surgery and careful planning and discussion with both your sleep disorders doctor and the surgeon is necessary.
A third option for treating sleep apnea is oral appliance therapy, also known as mandibular advancement splint. These oral appliances look very similar to retainers. They work by holding the lower jaw in a slightly forward position during sleep. This helps to increase the space for air flow in the upper airway, thereby reducing the frequency of respiratory events during sleep. It is important to be aware that oral appliances are only approved to treat snoring and cases of mild-to-moderate sleep apnea. They have not been shown to be successful in treating severe cases of OSA, due to the limitations on forward movement of the lower jaw.
The oral appliances are custom-made by dental labs. Generally, to get an oral appliance made for yourself, you will have to visit a dentist who is familiar with the use of these devices for the treatment of snoring or sleep apnea. You can talk to your sleep disorders doctor to find a dentist with this specialized training in your area.
Oral appliances can sometimes cause dental pain, TMJ pain, or jaw discomfort. These issues can usually be resolved with further adjustments of the device by your dentist. Often 2-3 regular follow-up visits with the dentist can help to prevent problems from developing. However, there are some cases in which an individual is unable to adjust to this form of treatment. Another issue with oral appliance therapy is that health insurance companies, historically, have not covered the cost for this type of treatment. Further, dental insurance has never provided coverage for oral appliance therapy. Nevertheless, with the growing medical evidence for oral appliance therapy, some health insurance companies are beginning to recognize this as a viable medical treatment alternative. Just as with surgery, a follow-up sleep study should be performed 2-3 months after starting treatment with an oral appliance, to ensure adequate treatment of snoring and sleep apnea.
Hopefully this review of obstructive sleep apnea, the significant cardiovascular consequences, and the treatment options will bring more awareness and understanding to this very important health issue. OSA is a treatable condition. Untreated sleep apnea is associated with an increased risk for hypertension (or high blood pressure), heart attacks, strokes, heart failure, cardiac arrhythmias, and diabetes. People with hypertension and untreated sleep apnea are more likely to have higher blood pressures. People with diabetes and untreated sleep apnea are more likely to have higher blood glucose levels. If you or someone you know may have sleep apnea, please consult a sleep disorders specialist with formal training in sleep medicine. The American Academy of Sleep Medicine (www.aasmnet.org/) and the American Board of Sleep Medicine (www.absm.org/) are helpful resources for finding a board-certified sleep disorders doctor near you.
Rapidlearn.org
Acne Skin Care – How to Make Embarrasing Blemishes Vanish
Ken Black asked:
Acne affects almost everyone of all races and ages. It is most common in adolescents and young adults. Around 85 percent of people between the ages of 12 and 24 develop the disorder. For most people, acne tends to diminish by the time they reach their thirties; however, some people in their forties and fifties continue to have this skin problem. Nearly 17 million people in the United States have acne, making it the most common skin disease.
I remember when I used to get acne myself. Was that annoying. And it sure ruined my social life, that’s for sure. There is nothing more embarrasing than going out in public with acne all over your face. You know people are staring at you. You know they don’t want to get near you because of those ugly marks on your face. I think they think it’s contagious, which is not true at all. It’s a good way to lose friends quickly.
So, how did I get rid of my acne ? Well, before you can clear up your skin, you should know exactly who the enemy is and what you’re up against. Here’s a summary for you and some real solutions.
What is Acne?
Acne is a disorder resulting from the action of hormones on the skin’s oil glands (sebaceous glands), which leads to plugged pores and outbreaks of lesions commonly called pimples or zits. Acne lesions usually occur on the face, neck, back, chest, and shoulders.
Although heredity may be a cause of this problem, it is more associated with hormonal levels and how you care for your skin (e.g. rubbing your skin too much will cause it). Chocolate and greasy foods are often blamed, but foods seem to have little effect on the development and course of acne in most people. In addition, dirty skin does not cause acne and neither does stress.
How Is Acne Treated?
You can buy over the counter medicine (OTC), see your family doctor, or a dermatologist (skin doctor).
Over-the-counter(OTC) Medicines
Benzoyl peroxide, resorcinol, salicylic acid, and sulfur are the most common topical OTC medicines used to treat acne. Topical OTC medications are available in many forms, such as gel, lotion, cream, soap, or pad.
Prescription Topical Medicines
Several types of prescription topical medicines include benzoyl peroxide, tretinoin, adapalene, and azelaic acid. Some people develop side effects from using prescription topical medicines including stinging, burning, redness, peeling, scaling, or discoloration of the skin.
Prescription Oral Medicines
Oral antibiotics are thought to help control acne by curbing the growth of bacteria and reducing inflammation. Examples are clindamycin, erythromycin, sulfur, or isotretinoin. Some people experience side effects when taking these antibiotics, such as an increased tendency to sunburn, upset stomach, dizziness or lightheadedness, changes in skin color, and dry skin.
Other treatments
There are lazer treatments for rare serious cases and there are safe and natural herbal medications that work like over the counter medications, but often with less side effects.
How Should People With Acne Care for Their Skin?
*Clean Skin Gently with a mild cleanser 3 or 4 times a day.
*Avoid Frequent Handling of the Skin.
*Shave Carefully.
*Avoid a Sunburn or Suntan.
*Use Non-Oily Cosmetics.
In summary, there are many treatments out there for acne skin problems. The top products are reviewed at our site. Talk to your doctor if you’re unsure what to do. Try some of the suggestions mentioned here. In no time at all, you’ll look better, feel better, and you’ll be back out there enjoying your social life, your friends, and your family much more.
Rapidlearn.org
Acne affects almost everyone of all races and ages. It is most common in adolescents and young adults. Around 85 percent of people between the ages of 12 and 24 develop the disorder. For most people, acne tends to diminish by the time they reach their thirties; however, some people in their forties and fifties continue to have this skin problem. Nearly 17 million people in the United States have acne, making it the most common skin disease.
I remember when I used to get acne myself. Was that annoying. And it sure ruined my social life, that’s for sure. There is nothing more embarrasing than going out in public with acne all over your face. You know people are staring at you. You know they don’t want to get near you because of those ugly marks on your face. I think they think it’s contagious, which is not true at all. It’s a good way to lose friends quickly.
So, how did I get rid of my acne ? Well, before you can clear up your skin, you should know exactly who the enemy is and what you’re up against. Here’s a summary for you and some real solutions.
What is Acne?
Acne is a disorder resulting from the action of hormones on the skin’s oil glands (sebaceous glands), which leads to plugged pores and outbreaks of lesions commonly called pimples or zits. Acne lesions usually occur on the face, neck, back, chest, and shoulders.
Although heredity may be a cause of this problem, it is more associated with hormonal levels and how you care for your skin (e.g. rubbing your skin too much will cause it). Chocolate and greasy foods are often blamed, but foods seem to have little effect on the development and course of acne in most people. In addition, dirty skin does not cause acne and neither does stress.
How Is Acne Treated?
You can buy over the counter medicine (OTC), see your family doctor, or a dermatologist (skin doctor).
Over-the-counter(OTC) Medicines
Benzoyl peroxide, resorcinol, salicylic acid, and sulfur are the most common topical OTC medicines used to treat acne. Topical OTC medications are available in many forms, such as gel, lotion, cream, soap, or pad.
Prescription Topical Medicines
Several types of prescription topical medicines include benzoyl peroxide, tretinoin, adapalene, and azelaic acid. Some people develop side effects from using prescription topical medicines including stinging, burning, redness, peeling, scaling, or discoloration of the skin.
Prescription Oral Medicines
Oral antibiotics are thought to help control acne by curbing the growth of bacteria and reducing inflammation. Examples are clindamycin, erythromycin, sulfur, or isotretinoin. Some people experience side effects when taking these antibiotics, such as an increased tendency to sunburn, upset stomach, dizziness or lightheadedness, changes in skin color, and dry skin.
Other treatments
There are lazer treatments for rare serious cases and there are safe and natural herbal medications that work like over the counter medications, but often with less side effects.
How Should People With Acne Care for Their Skin?
*Clean Skin Gently with a mild cleanser 3 or 4 times a day.
*Avoid Frequent Handling of the Skin.
*Shave Carefully.
*Avoid a Sunburn or Suntan.
*Use Non-Oily Cosmetics.
In summary, there are many treatments out there for acne skin problems. The top products are reviewed at our site. Talk to your doctor if you’re unsure what to do. Try some of the suggestions mentioned here. In no time at all, you’ll look better, feel better, and you’ll be back out there enjoying your social life, your friends, and your family much more.
Rapidlearn.org
Want to Keep Your Pearly Whites in Good Shape? Avoid Crest Pro-health Rinse
gladys906 asked:
Mouthwash products such as Listerine are great tools which help us fight gingivitis and kill potentially dangerous bacteria but, what if we told you that one of the most famous mouthwash products can cause brown stains in your teeth? — this is the case of the Crest pro-health rinse. According to several reviews and testimonials of people who have purchased this product a short while after using it they noticed that they’ve temporarily lost the ability of tasting foods, particularly those which have salt and to top it all 12 to 24 hours later those who experienced the loss of taste now face a different problem, their teeth have brown stains.
Those who are interested in maintaining good oral health will definitely be interested in the way of their smile looks, that’s just the way it works but, when it comes to using the Crest pro-health rinse it all comes down to whether or not you’re willing to sacrifice the aesthetic look up your smile in order to fight gingivitis and bacteria. For most people the answer is very easy, they will most likely not use this product because there are several other brands and mouthwash products do what they advertise to do, which is to kill bacteria, help fight gingivitis as well as plaque buildup without causing negative aesthetic effects.
The active ingredient in Crest pro-health rinse which causes brown stains in teeth is called Cetylpyridinium chloride which is also referred to as CPC, this compound is used because it helps kill bacteria and other microorganisms but sadly enough it has an undesirable side effect. People who provided their own reviews and opinions regarding the product are not alone, the same effects were reported by WebMD which is a highly reputable health website managed by several doctors and professionals in the health field, eMedicine has also provided similar reviews and Amazon also joins to the ranks by reporting that this product does stain your teeth which again is a side effect that not many people will be pleased about.
Rapid Learn Centre
Mouthwash products such as Listerine are great tools which help us fight gingivitis and kill potentially dangerous bacteria but, what if we told you that one of the most famous mouthwash products can cause brown stains in your teeth? — this is the case of the Crest pro-health rinse. According to several reviews and testimonials of people who have purchased this product a short while after using it they noticed that they’ve temporarily lost the ability of tasting foods, particularly those which have salt and to top it all 12 to 24 hours later those who experienced the loss of taste now face a different problem, their teeth have brown stains.
Those who are interested in maintaining good oral health will definitely be interested in the way of their smile looks, that’s just the way it works but, when it comes to using the Crest pro-health rinse it all comes down to whether or not you’re willing to sacrifice the aesthetic look up your smile in order to fight gingivitis and bacteria. For most people the answer is very easy, they will most likely not use this product because there are several other brands and mouthwash products do what they advertise to do, which is to kill bacteria, help fight gingivitis as well as plaque buildup without causing negative aesthetic effects.
The active ingredient in Crest pro-health rinse which causes brown stains in teeth is called Cetylpyridinium chloride which is also referred to as CPC, this compound is used because it helps kill bacteria and other microorganisms but sadly enough it has an undesirable side effect. People who provided their own reviews and opinions regarding the product are not alone, the same effects were reported by WebMD which is a highly reputable health website managed by several doctors and professionals in the health field, eMedicine has also provided similar reviews and Amazon also joins to the ranks by reporting that this product does stain your teeth which again is a side effect that not many people will be pleased about.
Rapid Learn Centre
Paxil’s Usefulness on Getting Rid of Depression
Jacob Miller asked:
Paroxetine hydrochloride or Paxil is a psychotropic drug. It is used to treat depression, social anxiety disorder, generalised anxiety disorder, panic disorder, obsessive compulsive disorder and post traumatic stress disorder. Depression is one such disease which is caused by chemical imbalance in the brain. If this imbalance goes on for a long duration it may result in major health concern at a later stage.
Paxil anti-depressant is available in the forms of tablets and suspension for oral administration. Each film coated Paxil tablet contains paroxetine hydrochloride and inactive ingredients such as dibasic calcium phosphate dehydrate, magnesium stearate, polyethylene glycols and sodium starch glycolate etc. In its suspension form the active agent remains the same while inactive reagents differ. It is an anti-depression drug manufactured and marketed by GlaxoSmithKline.
Patients with a history of suicidal thought and behaviour should not be given the dosage of this medication. Young adults of 18-24 years of age shows more suicidal tendency in comparison to other adults hence the dosage of Paxil should be given to such individuals with proper care. Side effects associated with Paxil are somnolence, insomnia, agitation, tremor, anxiety, dizziness, constipation, nausea, diarrhoea, dry mouth, vomiting, flatulence, asthenia, abnormal ejaculation, sweating etc.
Paxil from GlaxoSmithKline is a prescription drug hence a prescription from a doctor is must to start its dosage. Though this drug gives suicidal tendency to a user of this drug, a doctor prescribes this drug considering its benefits on getting a patient out of depression. If one has problem in getting out of home to consult a doctor he or she can also apply for online prescription for Paxil through various online websites. One needs to provide personal information through such facilities and that way can avail the online prescription. But a patient is to give only the true information on his or her health on such websites as the correctness of the information would ultimately decide whether a patient should be taking Paxil or not.
After availing online prescription one should go for buying the drug. This anti-depressant can be bought from a local drug store or an online store. Buying Paxil from an online store means easy availability of the drug with various discounts. But buying it online also means susceptibility to malicious websites that sell spurious drugs or are unethical online stores duping patients.
In such scenario collecting information from various online reviews can be of help. Through these reviews one can see whether one should go for the drug or not. A patient also finds much information on the customer handling of the respective website through these online forums or reviews.
Buy Paxil with a prescription with a consultation with a doctor. It may be the ultimate answer in your hunt for getting the right anti-depression drug.
Rapidlearn.org
Paroxetine hydrochloride or Paxil is a psychotropic drug. It is used to treat depression, social anxiety disorder, generalised anxiety disorder, panic disorder, obsessive compulsive disorder and post traumatic stress disorder. Depression is one such disease which is caused by chemical imbalance in the brain. If this imbalance goes on for a long duration it may result in major health concern at a later stage.
Paxil anti-depressant is available in the forms of tablets and suspension for oral administration. Each film coated Paxil tablet contains paroxetine hydrochloride and inactive ingredients such as dibasic calcium phosphate dehydrate, magnesium stearate, polyethylene glycols and sodium starch glycolate etc. In its suspension form the active agent remains the same while inactive reagents differ. It is an anti-depression drug manufactured and marketed by GlaxoSmithKline.
Patients with a history of suicidal thought and behaviour should not be given the dosage of this medication. Young adults of 18-24 years of age shows more suicidal tendency in comparison to other adults hence the dosage of Paxil should be given to such individuals with proper care. Side effects associated with Paxil are somnolence, insomnia, agitation, tremor, anxiety, dizziness, constipation, nausea, diarrhoea, dry mouth, vomiting, flatulence, asthenia, abnormal ejaculation, sweating etc.
Paxil from GlaxoSmithKline is a prescription drug hence a prescription from a doctor is must to start its dosage. Though this drug gives suicidal tendency to a user of this drug, a doctor prescribes this drug considering its benefits on getting a patient out of depression. If one has problem in getting out of home to consult a doctor he or she can also apply for online prescription for Paxil through various online websites. One needs to provide personal information through such facilities and that way can avail the online prescription. But a patient is to give only the true information on his or her health on such websites as the correctness of the information would ultimately decide whether a patient should be taking Paxil or not.
After availing online prescription one should go for buying the drug. This anti-depressant can be bought from a local drug store or an online store. Buying Paxil from an online store means easy availability of the drug with various discounts. But buying it online also means susceptibility to malicious websites that sell spurious drugs or are unethical online stores duping patients.
In such scenario collecting information from various online reviews can be of help. Through these reviews one can see whether one should go for the drug or not. A patient also finds much information on the customer handling of the respective website through these online forums or reviews.
Buy Paxil with a prescription with a consultation with a doctor. It may be the ultimate answer in your hunt for getting the right anti-depression drug.
Rapidlearn.org
A Review of the Organic and Natural Enterprise Group Income Opportunity
Brian Garvin asked:
The Organic and Natural Enterprise Group (or ONE group) is a company that offer you the chance to earn income using several different marketing strategies selling certified organic health, wellness and cleaning products. Their product range includes skincare, hair care, body and oral care products, cosmetics as well as household cleaning products and health care products.
They all of which have been certified as organic by leading agencies world wide such as the US department of Agriculture and the official organic certification organizations in Europe and Australia. The health and wellness industry and the organic industries are both rapidly growing markets with high appeal to consumers. The Organic and Natural Enterprise Group are based in Australia, but are an international company with a team of distributors and retailers world wide.
The Organic and Natural Enterprise Group is committed to being environmentally friendly and not only produce and market certified organic products but use environmentally friendly packaging for both their products and shipping as well as completely offsetting all of their carbon consumption in both production and administration so that the entire company is carbon neutral.
This environmentally friendly attitude of the company is also attracting customers to their products as many people feel hypocritical when they are being environmentally friendly at home but through lack of choice are forced to buy products that are manufactured etc in ways that may be doing damage to the environment.
One of the benefits of the business opportunity offered to you by the Organic and Natural Enterprise Group is the huge potential for repeat sales. The products are high quality, reasonably priced products that people use everyday. Repeat sales are a must in whatever business you decide to enter.
You want to be able to build a loyal customer base that will continue to buy from you. The fact that the products are used every day in several areas of their homes will also encourage other people to join your distributor team. The Organic and Natural Enterprise group offer a fantastic bonus system to you for any distributors you bring into the organization.
You can choose to market your business in several ways, the Organic and Natural Enterprise Group provide you with a website including a online store and shopping cart, and allow you to build your own web site as well if you are so inclined.
They also provide high quality training and tools to teach you how to market the products through the web sites, in home demonstrations, at markets or shows etc or even with newspaper and other advertising techniques. Retail sales are also allowed in several countries and many beauticians, hairdressers etc now stock the products in their shops.
If you are considering different business opportunities, the income opportunity provided by the Organic and Natural Enterprise Group should be at the top of your list of potential candidates. As well as the profits to be made by marketing the products and the generous bonus system; the environmentally friendly and responsible attitude of the company will also bring you sales and the ability to introduce distributors to grow your business.
Rapid Learn Centre
The Organic and Natural Enterprise Group (or ONE group) is a company that offer you the chance to earn income using several different marketing strategies selling certified organic health, wellness and cleaning products. Their product range includes skincare, hair care, body and oral care products, cosmetics as well as household cleaning products and health care products.
They all of which have been certified as organic by leading agencies world wide such as the US department of Agriculture and the official organic certification organizations in Europe and Australia. The health and wellness industry and the organic industries are both rapidly growing markets with high appeal to consumers. The Organic and Natural Enterprise Group are based in Australia, but are an international company with a team of distributors and retailers world wide.
The Organic and Natural Enterprise Group is committed to being environmentally friendly and not only produce and market certified organic products but use environmentally friendly packaging for both their products and shipping as well as completely offsetting all of their carbon consumption in both production and administration so that the entire company is carbon neutral.
This environmentally friendly attitude of the company is also attracting customers to their products as many people feel hypocritical when they are being environmentally friendly at home but through lack of choice are forced to buy products that are manufactured etc in ways that may be doing damage to the environment.
One of the benefits of the business opportunity offered to you by the Organic and Natural Enterprise Group is the huge potential for repeat sales. The products are high quality, reasonably priced products that people use everyday. Repeat sales are a must in whatever business you decide to enter.
You want to be able to build a loyal customer base that will continue to buy from you. The fact that the products are used every day in several areas of their homes will also encourage other people to join your distributor team. The Organic and Natural Enterprise group offer a fantastic bonus system to you for any distributors you bring into the organization.
You can choose to market your business in several ways, the Organic and Natural Enterprise Group provide you with a website including a online store and shopping cart, and allow you to build your own web site as well if you are so inclined.
They also provide high quality training and tools to teach you how to market the products through the web sites, in home demonstrations, at markets or shows etc or even with newspaper and other advertising techniques. Retail sales are also allowed in several countries and many beauticians, hairdressers etc now stock the products in their shops.
If you are considering different business opportunities, the income opportunity provided by the Organic and Natural Enterprise Group should be at the top of your list of potential candidates. As well as the profits to be made by marketing the products and the generous bonus system; the environmentally friendly and responsible attitude of the company will also bring you sales and the ability to introduce distributors to grow your business.
Rapid Learn Centre
“me-too” Drugs: Good or Bad?
Yogesh Murti asked:
Introduction
A drug that is structurally very similar to already known drugs, with only minor differences. The term “me-too” carries a negative connotation. However, me-too products may create competition and drive prices down1.
The majority of the new products the industry puts out, are “me-too” drugs, which are almost identical to current treatments but “no better than drugs already on the market to treat the same condition.” Around 75 percent of new drugs approved by the FDA are me-too drugs. They can be less effective than current drugs, but as long as they’re more effective than a placebo, they can get the regulatory green light2.
This isn’t surprising at all, as someone who works in the field, but these so-called “me-too” drugs, which are reportedly better than their forebears, is driving costs. A “me-too” drug is a drug that has its origins in another drug. Probably the most famous example of this is Prilosec (“The Purple Pill”) and Nexium (“Today’s Purple Pill”). Prilosec’s active ingredient is omeprazole. Nexium’s active ingredient is called esomeprazole. The difference is that Nexium is the left-handed version of omeprazole. In chemistry, S stands for sinister, which means the molecular conformation has a left-handed orientation. (D would be right handed.) So this S-omeprazole is one half of the mixture that comprises its predecessor. By specifically picking only the S conformation, the drug is made more potent. This sounds great, but its efficacy is only marginally better than Prilosec-, which has a generic version, and costs about a third less than Nexium. Some other “me-too” drugs are: Claritin (loratidine) and Clarinex (desloratidine), Celexa (citalopram) and Lexapro (escitalopram)3.
What are “Me-Too” drugs?
Ever since the advent of modern chemotherapy, when drugs were discovered and developed through the process of screening thousands of molecules for a variety of disease conditions, using animal models, there has been a growing criticism that too many molecules were developed with similar chemical structure and the same pharmacological profile, with very little to distinguish them from each other in terms of their therapeutic utility. In other words, once the first breakthrough discovery is made of a new pharmacological activity for a new molecule, subsequent years saw the emergence of a host of new molecules or “me-too” drugs from the same chemical class and possessing the same pharmacological profile.
Such follow-up drugs have been termed molecular modifications, molecular roulettes or copycats, the development of which are alleged to be motivated by purely commercial considerations. They are also deemed to involve lower levels of innovation, compared to the original molecule. It is important to analyze in a historical perspective the end results of such efforts in different therapeutic areas of developing new molecular entities, as later generation products, after an initial breakthrough discovery has been made and the technical, medical and commercial merits of developing such drugs.
Development of “Me-Too” drugs
The success rate in the discovery of new chemical entities with fundamentally new chemical and biological profiles of activity are very low. In fact, even chemical entities within the same structural class of an approved drug are becoming rare now, compared to the period of sixties to eighties. In 2001, $ 26 billion was spent on developing new drugs and the U.S. FDA approved only 9 new chemical entities. At the same time, two thirds of the drugs approved from 1989 to 2000 were modified versions of existing drugs or even identical to those, in newer forms and formulations4.
Of the 1,035 drugs approved by FDA during 1989 to 2000, only 361 or 35% contained new active ingredients. Of these, only fewer than half were granted priority review status by the FDA. One impression is that these drugs are slightly altered versions of existing drugs, with little to offer in terms of better activity or tolerance, let alone new pharmacological profiles. The implication is that such drugs are developed, as patents on top-selling original drugs run out and not many truly new medicines are discovered. The indication that many of these drugs do not offer any major advantages over existing drugs is given by FDA’s unwillingness to grant priority review for most of them.
On the other hand, conventionally, the Regulatory Agencies, including the FDA, are not obliged to consider better efficacy over existing drugs as a criterion for approval; rather, they require only the establishment of efficacy and safety of the new drug over a placebo.
How good are they?
Notwithstanding such perceptions, historically, many “me-too” drugs have proved to be considerably better than their original counterparts. Examples are a series of generations of beta-blockers, which came up after the original drug Propanalol was discovered by ICI, with most of them having merits in terms of better efficacy, cardio-selectivity and safety. Ranitidine, the first follow-up drug after the introduction of the first H-2 receptor antagonist, Cimetidine, was followed by Famotidine and in each case these “me-too” drugs had notable merits over the original drug.
Apart from the major breakthrough in the development of orally active beta lactam antibiotics of the Penicillin and Cephalosporin class, within the same oral derivatives, there have been considerable improvements brought about by change in the side chains incorporated by condensation of specific agents with 6-APA, 7-ADCA and 7-ACA. A whole new range of broad-spectrum antibiotics of these structural classes could thus be developed. In each of the major classes of antibiotics, classified according to the mechanisms of their action, namely inhibition of cell wall synthesis (Beta Lactams, Vancomycin), inhibition of bacterial protein synthesis (Erythromycin, Tetracycline, Streptomycin), inhibitors of DNA or RNA replication (Quinolones, Rifamycins), inhibition of Folate Coenzyme biosynthesis (Sulfa drugs, Trimethoprim), there have been several “me-too” drugs marketed.
An important recent example to show that ‘me-too” drugs need to be developed is the case of the oral hypoglycemic drug Troglitazone, approved as an anti-diabetic drug in 1997. The drug was withdrawn from the market following reports of unacceptable hepato-toxicity. The follow-up “me-too” drugs, Rosiglitazone and Pioglitazone are much less toxic and are today widely used. If these drugs were not developed, the withdrawal of Troglitazone would have left a major therapeutic gap in anti-diabetic therapy.
“Me-Too” drugs: Strategies for New Drug Research for Indian Companies
Breakthrough innovations in pharmaceutical industry, of new drugs, such as the first beta blocker, the first NSAID, the first of each class of Antibiotics, Calcium Channel blockers, ACE inhibitors, Sulfonyl Ureas, Biguanides, Insulin, Glitazones, Glinides, Tricyclic Anti Depressants,major and minor Traquillisers, Selective Serotonin Receptor inhibitors, H-1 and H-2 Receptor antagonists, Proton Pump inhibitors etc are relatively rare and even though a few of the original drugs under these classes are still very much in use, they have been superceded in most cases, by later generation products, many of them “me-too”. The newer drugs are discovered both through incremental innovations on the original drugs as well as through new research.
Generally the original discovery leads to feverish activity both within the innovator company as well as in Competitors’ laboratories, to develop better products in the same therapeutic category. The essential caveat for commercial success, however, is that the newly discovered molecules should meet the minimum standards of patentability. For example within three years of the discovery of the highly successful Sildinafil Citrate (Viagra), three more new versions for the same indications have been patented and developed5.
Me-too drugs also provide therapeutic advantage6. For the practicing physicians, there’s the benefit of established drug MoA with a “me-too” medication, coupled with clinical studies that – hopefully – show patient-centered benefits such as better adverse events profiles, less frequent dosing, less bothersome potential for drug/drug interactions, and so forth. A “me-too” drug is a helluva lot easier to incorporate in practice than a totally novel medication7.
“Me-Too” drugs: The hidden dynamics
The most common criticism of drug development centers on the so-called “me-too” drugs that employ the same biological mechanism as pioneer brands. This involves a lot more than such high-profile targets as the anti-ulcer drug Nexium. We should be thinking about antidepressants, cholesterol-reducing drugs, diabetes treatments, anti-psychotics, and other therapeutic categories that have seen both blockbuster sales and rapid innovation. There is quite a bit of evidence that follow-on drugs do a lot of patients a lot of good. The newer statins, for example, often out-perform the older ones in clinical trials where the endpoints are the number of heart attacks and deaths prevented.
Me-too drugs are also a powerful tool for cutting health care costs. We should be glad that our research industry does not target only brand new biological mechanisms. That would be a very expensive business model indeed. Fortunately, the industry also works on marginal improvements, exploiting opportunities to make drug therapy better and sometimes opening the door to really radical improvements that happen to lie more or less next-door, scientifically speaking. In the meantime, we get price competition as a by-product. Me-too’s almost always undercut the prices of the pioneer drugs.
Another part of the me-too story gets almost completely ignored even though it is extraordinary important. For me-too manufacturers, advancing the science is a way to gain a competitive advantage. The classic example is the statin class of cholesterol drugs. Research on one of the follow-on drugs (Pravachol) demonstrated for the first time that using a statin to reduce cholesterol would actually prevent deaths from heart attacks, something that had previously been assumed without proof. Additional trials for several statins, including Lipitor, the formidable challenger to Zocor and Pravachol, have demonstrated that serum cholesterol is far more important than almost anyone thought (for preventing strokes, for example).
There are lots of other stories about the benefits of new research from me-too drugs, but they are part of a larger story: new uses for old drugs. The data showing a slowdown in new drug approvals exclude essential information: discoveries of new uses for old drugs. This kind of discovery has become so common that it amounts to a “new-use” revolution. One of the scientific ironies of the new era of pharmaceutical research is that as drugs become more tightly targeted on biological mechanisms, their uses actually become more diverse. This is because the body typically uses specific mechanisms over and over again, sometimes in what appear to be completely unrelated ways.
Consider the SSRI antidepressants. A recent Science article on the diverse and unexpected applications of drugs that fiddle with serotonin reuptake which is what the SSRIs do concluded that the very term “antidepressant” is misleading because there is no scientific reason to think of this drug as being just for depression. Fighting depression just happened to be the first really useful condition that was explored for this very interesting class of drugs.
Another example is the Cox-2 inhibitors like Celebrex (and Vioxx, which is important in this story and may return to the market partly for this reason). These were invented to relieve arthritis pain. But the Cox-2 enzyme turns out to be important for lots of things including cancer and Alzheimer’s. Clinical trials to exploit these leads have been underway for years. Celebrex has already been approved for reducing the risk of colorectal cancer, and Vioxx has also achieved promising results. Of course, the big news recently has been that these drugs may cause heart attacks. But even here, me-too economics is of surpassing importance. The traditional NSAIDS (non-steroidal anti-inflammatory drugs) like Alleve and Advil may have the same heart attack risks. The potential risk has been there for decades, but only the new drugs-the Cox-2s-have been put through large-scale long-term clinical trials because those are the only ones still under patent. This is an example of how me-too drug development adds importantly to the research base. Thanks to the me-too’s, we are learning about NSAIDs, heart attacks, cancer and probably much more.
Also dominated by new uses are the new-targeted cancer drugs, which attack such specific biological mechanisms that they avoid killing every fast-growing cell in sight (as traditional chemotherapy tends to do).
The implications are clear. The annual count of new drug approvals will only show a tick when a new cancer drug or a new statin gets its very first approval. But a new use for an old drug can be as valuable as an entirely new drug, or even more valuable when you consider that we know more about the safety profile of old drugs and one drug will sometimes do the work of two (preventing both heart attacks and strokes, for example)8.
Me-too products can sometimes have important advantages on tolerability or dosing. It could help create more competition and lower the price. If you have five me-toos, possibly the sixth is something that is a little better. That is for the plans to decide on behalf of their patients. And even if it has the same mechanism of action, more competition could help drive down the price of the entire class. That’s an important influence, with potentially an improvement in health from greater access.
How bad are they?
Even though the major problem of antibiotic therapy, namely drug resistance cannot be addressed by the development of “me-too” drugs, due to the propensity of the same class to develop cross resistance; in most cases, the new semi-synthetic derivatives had distinct advantages over the earlier ones. Thus, for example, the first generation Cephalosporins are useful for gram-positive infections, while the second-generation drugs cover a broader spectrum including gram-negative organisms. The third generation drugs provide resistance against the beta lactamase enzyme, as well as acting against some of the most intractable infections, such as those caused by Pseudomonas and Klebsiella strains.
Even while the pharmaceutical industry turns out families of me-too drugs for relatively mild conditions in affluent people, it pays almost no attention to serious diseases, such as malaria, affecting impoverished people. It also gives short shrift to less profitable drugs, so there now are shortages of some vaccines and life-saving drugs9.
The big problem with me-too drugs is that they are chemically very similar to other drugs already available, yet they are marketed as if they were important new breakthroughs, with very high prices. Many new, expensive me-too drugs are not necessarily better than older and less expensive drugs. Most of the time they are compared with placebos and not older drug comparisons.
“Me-too” drugs are responsible for 80% of increased spending in recent years, and on average they are four times more expensive than the comparable, older alternatives10. By Patented Medicines Pricing Review Board’s (PMPRB) definitions, at the time of their introduction “me-too” drugs were judged to provide moderate, little or no improvement – in terms of effectiveness and safety – compared to older alternatives. However, on average, “me-too” drugs cost about 2.5 times as much per prescription as comparable older drugs. The question is whether the perceived or real differences justify the increased costs. New drugs do have a role in some situations and for some patients. However, it makes sense to use the older equally effective drugs whenever possible11.
Changing FDA rules to discourage me-too drug approvals would make R&D far more expensive, would discourage competition and therefore raise healthcare costs, and would forestall the wave of new research that has revolutionized our scientific understanding of the therapeutic categories where competition has been most intense.
Conclusion
New drugs are not required to improve on old ones, and there’s usually no way to know whether they do. Although the FDA must test drugs before they are marketed, they don’t need to be compared with similar drugs already on the market. The FDA only requires they be reasonably safe and better than nothing-a low standard indeed. This loophole in FDA regulations opens the door for an unlimited number of me-too drugs, which are easier to develop than innovative drugs.
Given everything, it should come as no surprise that these more expensive “me-too” drugs cost the medical industry money. The prevalence of the me-too’s really says an awful lot about the lack of innovation within the pharmaceutical industry. If you look at the new drugs marketed over the last six years, 78 percent weren’t even new chemical compounds. They were just new combinations or different formulations of old drugs. And 68 percent were classified by the F.D.A. as unlikely to be improvements over drugs already on pharmacy shelves.
At the same time, there are shortages of some important drugs that the pharmaceutical companies aren’t much interested in making because they are not as profitable as the me-too’s. But the companies don’t have to turn out needed drugs, if they are not lucrative. And they don’t.
References
1. http://www.medterms.com/script/main/art.asp?articlekey=33748
2. http://www.motherjones.com/news/qa/2004/09/09_401.html
3. http://polyscience.org/2005/09/me-too-drugs
4. http://www.shvoong.com/books/465475-me-too-drugs
5. http://www.pharmabiz.com/article/detnews.asp?SecArch=&articleid=14604§ionid=46
6. http://direct.bl.uk/bld/PlaceOrder.do?UIN=162532605&ETOC=RN&from=searchengine
7. http://www.archivum.info/sci.med/2005-09/msg00257.html
8. http://www.aei.org/publications/filter.all,pubID.27443/pub_detail.asp
9. http://blogs.wsj.com/health/2007/05/17/in-praise-of-me-too-drugs
10. http://www.chepa.org/KnowledgeExchange/LabelleLectureship/tabid/84/Default.aspx
11. http://www.ti.ubc.ca/pages/letter59.html
Rapid Learn Centre
Introduction
A drug that is structurally very similar to already known drugs, with only minor differences. The term “me-too” carries a negative connotation. However, me-too products may create competition and drive prices down1.
The majority of the new products the industry puts out, are “me-too” drugs, which are almost identical to current treatments but “no better than drugs already on the market to treat the same condition.” Around 75 percent of new drugs approved by the FDA are me-too drugs. They can be less effective than current drugs, but as long as they’re more effective than a placebo, they can get the regulatory green light2.
This isn’t surprising at all, as someone who works in the field, but these so-called “me-too” drugs, which are reportedly better than their forebears, is driving costs. A “me-too” drug is a drug that has its origins in another drug. Probably the most famous example of this is Prilosec (“The Purple Pill”) and Nexium (“Today’s Purple Pill”). Prilosec’s active ingredient is omeprazole. Nexium’s active ingredient is called esomeprazole. The difference is that Nexium is the left-handed version of omeprazole. In chemistry, S stands for sinister, which means the molecular conformation has a left-handed orientation. (D would be right handed.) So this S-omeprazole is one half of the mixture that comprises its predecessor. By specifically picking only the S conformation, the drug is made more potent. This sounds great, but its efficacy is only marginally better than Prilosec-, which has a generic version, and costs about a third less than Nexium. Some other “me-too” drugs are: Claritin (loratidine) and Clarinex (desloratidine), Celexa (citalopram) and Lexapro (escitalopram)3.
What are “Me-Too” drugs?
Ever since the advent of modern chemotherapy, when drugs were discovered and developed through the process of screening thousands of molecules for a variety of disease conditions, using animal models, there has been a growing criticism that too many molecules were developed with similar chemical structure and the same pharmacological profile, with very little to distinguish them from each other in terms of their therapeutic utility. In other words, once the first breakthrough discovery is made of a new pharmacological activity for a new molecule, subsequent years saw the emergence of a host of new molecules or “me-too” drugs from the same chemical class and possessing the same pharmacological profile.
Such follow-up drugs have been termed molecular modifications, molecular roulettes or copycats, the development of which are alleged to be motivated by purely commercial considerations. They are also deemed to involve lower levels of innovation, compared to the original molecule. It is important to analyze in a historical perspective the end results of such efforts in different therapeutic areas of developing new molecular entities, as later generation products, after an initial breakthrough discovery has been made and the technical, medical and commercial merits of developing such drugs.
Development of “Me-Too” drugs
The success rate in the discovery of new chemical entities with fundamentally new chemical and biological profiles of activity are very low. In fact, even chemical entities within the same structural class of an approved drug are becoming rare now, compared to the period of sixties to eighties. In 2001, $ 26 billion was spent on developing new drugs and the U.S. FDA approved only 9 new chemical entities. At the same time, two thirds of the drugs approved from 1989 to 2000 were modified versions of existing drugs or even identical to those, in newer forms and formulations4.
Of the 1,035 drugs approved by FDA during 1989 to 2000, only 361 or 35% contained new active ingredients. Of these, only fewer than half were granted priority review status by the FDA. One impression is that these drugs are slightly altered versions of existing drugs, with little to offer in terms of better activity or tolerance, let alone new pharmacological profiles. The implication is that such drugs are developed, as patents on top-selling original drugs run out and not many truly new medicines are discovered. The indication that many of these drugs do not offer any major advantages over existing drugs is given by FDA’s unwillingness to grant priority review for most of them.
On the other hand, conventionally, the Regulatory Agencies, including the FDA, are not obliged to consider better efficacy over existing drugs as a criterion for approval; rather, they require only the establishment of efficacy and safety of the new drug over a placebo.
How good are they?
Notwithstanding such perceptions, historically, many “me-too” drugs have proved to be considerably better than their original counterparts. Examples are a series of generations of beta-blockers, which came up after the original drug Propanalol was discovered by ICI, with most of them having merits in terms of better efficacy, cardio-selectivity and safety. Ranitidine, the first follow-up drug after the introduction of the first H-2 receptor antagonist, Cimetidine, was followed by Famotidine and in each case these “me-too” drugs had notable merits over the original drug.
Apart from the major breakthrough in the development of orally active beta lactam antibiotics of the Penicillin and Cephalosporin class, within the same oral derivatives, there have been considerable improvements brought about by change in the side chains incorporated by condensation of specific agents with 6-APA, 7-ADCA and 7-ACA. A whole new range of broad-spectrum antibiotics of these structural classes could thus be developed. In each of the major classes of antibiotics, classified according to the mechanisms of their action, namely inhibition of cell wall synthesis (Beta Lactams, Vancomycin), inhibition of bacterial protein synthesis (Erythromycin, Tetracycline, Streptomycin), inhibitors of DNA or RNA replication (Quinolones, Rifamycins), inhibition of Folate Coenzyme biosynthesis (Sulfa drugs, Trimethoprim), there have been several “me-too” drugs marketed.
An important recent example to show that ‘me-too” drugs need to be developed is the case of the oral hypoglycemic drug Troglitazone, approved as an anti-diabetic drug in 1997. The drug was withdrawn from the market following reports of unacceptable hepato-toxicity. The follow-up “me-too” drugs, Rosiglitazone and Pioglitazone are much less toxic and are today widely used. If these drugs were not developed, the withdrawal of Troglitazone would have left a major therapeutic gap in anti-diabetic therapy.
“Me-Too” drugs: Strategies for New Drug Research for Indian Companies
Breakthrough innovations in pharmaceutical industry, of new drugs, such as the first beta blocker, the first NSAID, the first of each class of Antibiotics, Calcium Channel blockers, ACE inhibitors, Sulfonyl Ureas, Biguanides, Insulin, Glitazones, Glinides, Tricyclic Anti Depressants,major and minor Traquillisers, Selective Serotonin Receptor inhibitors, H-1 and H-2 Receptor antagonists, Proton Pump inhibitors etc are relatively rare and even though a few of the original drugs under these classes are still very much in use, they have been superceded in most cases, by later generation products, many of them “me-too”. The newer drugs are discovered both through incremental innovations on the original drugs as well as through new research.
Generally the original discovery leads to feverish activity both within the innovator company as well as in Competitors’ laboratories, to develop better products in the same therapeutic category. The essential caveat for commercial success, however, is that the newly discovered molecules should meet the minimum standards of patentability. For example within three years of the discovery of the highly successful Sildinafil Citrate (Viagra), three more new versions for the same indications have been patented and developed5.
Me-too drugs also provide therapeutic advantage6. For the practicing physicians, there’s the benefit of established drug MoA with a “me-too” medication, coupled with clinical studies that – hopefully – show patient-centered benefits such as better adverse events profiles, less frequent dosing, less bothersome potential for drug/drug interactions, and so forth. A “me-too” drug is a helluva lot easier to incorporate in practice than a totally novel medication7.
“Me-Too” drugs: The hidden dynamics
The most common criticism of drug development centers on the so-called “me-too” drugs that employ the same biological mechanism as pioneer brands. This involves a lot more than such high-profile targets as the anti-ulcer drug Nexium. We should be thinking about antidepressants, cholesterol-reducing drugs, diabetes treatments, anti-psychotics, and other therapeutic categories that have seen both blockbuster sales and rapid innovation. There is quite a bit of evidence that follow-on drugs do a lot of patients a lot of good. The newer statins, for example, often out-perform the older ones in clinical trials where the endpoints are the number of heart attacks and deaths prevented.
Me-too drugs are also a powerful tool for cutting health care costs. We should be glad that our research industry does not target only brand new biological mechanisms. That would be a very expensive business model indeed. Fortunately, the industry also works on marginal improvements, exploiting opportunities to make drug therapy better and sometimes opening the door to really radical improvements that happen to lie more or less next-door, scientifically speaking. In the meantime, we get price competition as a by-product. Me-too’s almost always undercut the prices of the pioneer drugs.
Another part of the me-too story gets almost completely ignored even though it is extraordinary important. For me-too manufacturers, advancing the science is a way to gain a competitive advantage. The classic example is the statin class of cholesterol drugs. Research on one of the follow-on drugs (Pravachol) demonstrated for the first time that using a statin to reduce cholesterol would actually prevent deaths from heart attacks, something that had previously been assumed without proof. Additional trials for several statins, including Lipitor, the formidable challenger to Zocor and Pravachol, have demonstrated that serum cholesterol is far more important than almost anyone thought (for preventing strokes, for example).
There are lots of other stories about the benefits of new research from me-too drugs, but they are part of a larger story: new uses for old drugs. The data showing a slowdown in new drug approvals exclude essential information: discoveries of new uses for old drugs. This kind of discovery has become so common that it amounts to a “new-use” revolution. One of the scientific ironies of the new era of pharmaceutical research is that as drugs become more tightly targeted on biological mechanisms, their uses actually become more diverse. This is because the body typically uses specific mechanisms over and over again, sometimes in what appear to be completely unrelated ways.
Consider the SSRI antidepressants. A recent Science article on the diverse and unexpected applications of drugs that fiddle with serotonin reuptake which is what the SSRIs do concluded that the very term “antidepressant” is misleading because there is no scientific reason to think of this drug as being just for depression. Fighting depression just happened to be the first really useful condition that was explored for this very interesting class of drugs.
Another example is the Cox-2 inhibitors like Celebrex (and Vioxx, which is important in this story and may return to the market partly for this reason). These were invented to relieve arthritis pain. But the Cox-2 enzyme turns out to be important for lots of things including cancer and Alzheimer’s. Clinical trials to exploit these leads have been underway for years. Celebrex has already been approved for reducing the risk of colorectal cancer, and Vioxx has also achieved promising results. Of course, the big news recently has been that these drugs may cause heart attacks. But even here, me-too economics is of surpassing importance. The traditional NSAIDS (non-steroidal anti-inflammatory drugs) like Alleve and Advil may have the same heart attack risks. The potential risk has been there for decades, but only the new drugs-the Cox-2s-have been put through large-scale long-term clinical trials because those are the only ones still under patent. This is an example of how me-too drug development adds importantly to the research base. Thanks to the me-too’s, we are learning about NSAIDs, heart attacks, cancer and probably much more.
Also dominated by new uses are the new-targeted cancer drugs, which attack such specific biological mechanisms that they avoid killing every fast-growing cell in sight (as traditional chemotherapy tends to do).
The implications are clear. The annual count of new drug approvals will only show a tick when a new cancer drug or a new statin gets its very first approval. But a new use for an old drug can be as valuable as an entirely new drug, or even more valuable when you consider that we know more about the safety profile of old drugs and one drug will sometimes do the work of two (preventing both heart attacks and strokes, for example)8.
Me-too products can sometimes have important advantages on tolerability or dosing. It could help create more competition and lower the price. If you have five me-toos, possibly the sixth is something that is a little better. That is for the plans to decide on behalf of their patients. And even if it has the same mechanism of action, more competition could help drive down the price of the entire class. That’s an important influence, with potentially an improvement in health from greater access.
How bad are they?
Even though the major problem of antibiotic therapy, namely drug resistance cannot be addressed by the development of “me-too” drugs, due to the propensity of the same class to develop cross resistance; in most cases, the new semi-synthetic derivatives had distinct advantages over the earlier ones. Thus, for example, the first generation Cephalosporins are useful for gram-positive infections, while the second-generation drugs cover a broader spectrum including gram-negative organisms. The third generation drugs provide resistance against the beta lactamase enzyme, as well as acting against some of the most intractable infections, such as those caused by Pseudomonas and Klebsiella strains.
Even while the pharmaceutical industry turns out families of me-too drugs for relatively mild conditions in affluent people, it pays almost no attention to serious diseases, such as malaria, affecting impoverished people. It also gives short shrift to less profitable drugs, so there now are shortages of some vaccines and life-saving drugs9.
The big problem with me-too drugs is that they are chemically very similar to other drugs already available, yet they are marketed as if they were important new breakthroughs, with very high prices. Many new, expensive me-too drugs are not necessarily better than older and less expensive drugs. Most of the time they are compared with placebos and not older drug comparisons.
“Me-too” drugs are responsible for 80% of increased spending in recent years, and on average they are four times more expensive than the comparable, older alternatives10. By Patented Medicines Pricing Review Board’s (PMPRB) definitions, at the time of their introduction “me-too” drugs were judged to provide moderate, little or no improvement – in terms of effectiveness and safety – compared to older alternatives. However, on average, “me-too” drugs cost about 2.5 times as much per prescription as comparable older drugs. The question is whether the perceived or real differences justify the increased costs. New drugs do have a role in some situations and for some patients. However, it makes sense to use the older equally effective drugs whenever possible11.
Changing FDA rules to discourage me-too drug approvals would make R&D far more expensive, would discourage competition and therefore raise healthcare costs, and would forestall the wave of new research that has revolutionized our scientific understanding of the therapeutic categories where competition has been most intense.
Conclusion
New drugs are not required to improve on old ones, and there’s usually no way to know whether they do. Although the FDA must test drugs before they are marketed, they don’t need to be compared with similar drugs already on the market. The FDA only requires they be reasonably safe and better than nothing-a low standard indeed. This loophole in FDA regulations opens the door for an unlimited number of me-too drugs, which are easier to develop than innovative drugs.
Given everything, it should come as no surprise that these more expensive “me-too” drugs cost the medical industry money. The prevalence of the me-too’s really says an awful lot about the lack of innovation within the pharmaceutical industry. If you look at the new drugs marketed over the last six years, 78 percent weren’t even new chemical compounds. They were just new combinations or different formulations of old drugs. And 68 percent were classified by the F.D.A. as unlikely to be improvements over drugs already on pharmacy shelves.
At the same time, there are shortages of some important drugs that the pharmaceutical companies aren’t much interested in making because they are not as profitable as the me-too’s. But the companies don’t have to turn out needed drugs, if they are not lucrative. And they don’t.
References
1. http://www.medterms.com/script/main/art.asp?articlekey=33748
2. http://www.motherjones.com/news/qa/2004/09/09_401.html
3. http://polyscience.org/2005/09/me-too-drugs
4. http://www.shvoong.com/books/465475-me-too-drugs
5. http://www.pharmabiz.com/article/detnews.asp?SecArch=&articleid=14604§ionid=46
6. http://direct.bl.uk/bld/PlaceOrder.do?UIN=162532605&ETOC=RN&from=searchengine
7. http://www.archivum.info/sci.med/2005-09/msg00257.html
8. http://www.aei.org/publications/filter.all,pubID.27443/pub_detail.asp
9. http://blogs.wsj.com/health/2007/05/17/in-praise-of-me-too-drugs
10. http://www.chepa.org/KnowledgeExchange/LabelleLectureship/tabid/84/Default.aspx
11. http://www.ti.ubc.ca/pages/letter59.html
Rapid Learn Centre
Human Papilloma Virus – a Review
Sameera Mohotti asked:
HUMAN PAPILLOMA VIRUS – A REVIEW
Sameera Mohotti (BSc, MSc, MD(MA))
INTRODUCTION
HPV is one of the most common sexually transmitted viral diseases. It is
estimated that 80% of sexually active adults have been infected with one or more genital HPV types at one point of their life time. The prevalence of HPV is increasing worldwide. Although it is
difficult to estimate the overall prevalence of HPV infection, it is estimated that the prevalence could be as high as 20 million (Revzina 2005). The total health care cost associated with the screening and treatment of cervical cancer in the U.S. is estimated to be $6 billion per year (Koutsky 1997). A US sero prevalence study performed by Revizina et al revealed that the highest prevalence of
HPV is among college students and women attending STD clinics Data from clinics in Australia indicate a prevalence of 4- 13% among STD clinic attendants Following initial infection, HPV establishes latent infection, from which symptomatic recurrences may develop periodically (Revzina 2005),(Armstrong 1986).
The main aim of this review was to evaluate the current literature regarding the types of HPV, symptoms and its pathogenesis.
SPECTRUM OF HPV INFECTION
Over 200 types of HPV have been classified on the basis of their DNA sequence homology. 85 HPV genotypes are well characterized.
HPV can be grouped as high risk HPV and low risk HPV based on their association with cancer and precursor lesions. High risk HPV’s have a high oncogenic potentials. This group includes serotypes 16,18,31,33, 34, 35,39,45,51,52,56,58,59,66,68. Low risk HPV’s have less oncogenic potentials and usually results in the formation of low grade precancerous lesions. This group includes
serotypes 6, 11, 42, 43, 44. This difference in the capacity to induce malignant transformation is due to the functional difference seen in E6 and E7 proteins of the two groups (Burd 2003; Longworth and Laimins 2004).
Although many HPV infections are sub clinical, symptomatic HPV infection typically results in lesions. Each HPV serotype infects certain parts of the body and responsible for different types of lesions. According to the current classification system (Bethesda system) of HPV lesions, there are three main groups. They are anogenital warts, low grade squamous intraepithelial lesions (cervical / anal intraepithelial neoplasia and mild dysplasia) and high grade squamous intraepithelial lesions (moderate and severe dysplasia).Cervical/anal/vulvar/penile carcinomas usually develop from high grade squamous intraepithelial lesions (University 2001).
Genital warts (proliferative foci of epithelial keratinocytes infected with HPV) appear as bumps or abnormal growths in the genital area. This is one of the commonest clinically recognized disease manifestations of genital HPV. These are usually found in vulva, urethra, anus, and vagina and on the cervix. Warts are extremely contagious and they occasionally lead to cancer of the cervix in
women or cancer of the penis in men (Lacey 2005).
The presence of abnormal cells on the surface of the skin is called dysplasia.
Dysplasia is not a cancer and mild dysplasia is likely to self resolve. However, mild, moderate and severe dysplasia could be progressed in to a cancer, if not detected and treated at its early stage. Studies indicate that even adolescents with low grade squamous intraepithelial lesions and high grade squamous intraepithelial lesions are also at high risk for progression to high-grade cervical abnormalities (Wright, Pinto et al. 2004).
BASIC VIROLOGY
HPV is a nonenveloped, double stranded circular DNA virus with a diameter of 5.5 nm. The genome is approximately 8 Kb in size and encased in an icosahedral capsid which is composed of 72 capsomeres. Capsid comprises of an outer protein coat which consists of two capsid proteins, L1 (major) and L2 (minor) (Sapp, Volpers et al. 1995).
HPV genome is functionally divided in to 3 regions .They are the upstream regulatory region, early region and the late region. The upstream regulatory region involves in viral replication and also controls the transcription of some sequences in the early region. The early region of the genome encompasses 6 open reading frames (ORF’s) named E1, E2, E4, E5, E6 and E7. These encode proteins involved in viral replication, transcription and cellular transformation. E6 and E7 regions are responsible for the oncogenic properties of HPV. The late region encompasses two ORF’s and these encode L1 and L2 structural proteins which is necessary for capsid production (Sapp, Volpers et
al. 1995).
PRODUCTIVE HPV INFECTION
HPV gain entry into the host cells through the basal layer of the epithelium. In initial infection HPV is present as an episome. It has been proposed that HPV-6 attaches to the host cells via ?6-intergrin in the epithelium cells; where as, HPV16 and HPV 33 attach to host cells via cell surface heparin sulphate. The papilloma viral gene expressions are linked with the differentiation stages of the epithelium and virus multiplies as it progresses through the natural epithelial cell maturation (Giroglou, Florin et al. 2001).
During viral replication, the E1 gene product (E1 protein) binds to the viral origin of replication and this result in the extra chromosomal replication of the viral genome. The E2 gene product (E2 protein) down-regulates the E6 and E7 regions to allow the normal differentiation process of the cell. The capsid genes L1 and L2 synthesize the capsid protein and envelopes each episomal DNA in a protein capsid. The E4 gene product (E4 protein) is associated with the maturation and release of papilloma virus particles(Burd 2003),(Longworth and Laimins 2004).
The productive viral stage results in flat or papillary lesions. Since the papilloma virus replication goes hand in hand with the epithelial cell differentiations, as the lesions are formed the superficial and intermediate epithelial layers would contain a large amount of viral DNA. The accumulations of viral particles in the superficial epithelial layers provoke the cells to the koilocytosis cytopathic effect. This gives rise to koilocytes, in which the cellular nucleus is displaced to the side with a ‘hollow’ appearance of the cytoplasm. The virus particles are released as dying koilocytes are shed (zur Hausen 1991; Longworth and Laimins 2004).
PATHOGENESIS OF ONCOGENIC HPV
When a person gets infected with high-risk HPV, it may take up to 20 years for the
cancer changes to appear. This persistency of HPV infection is necessary for the malignant transformation of the cells. In HPV associated benign lesions, the HPV DNA is usually located extra chromosomal where as in HPV associated cancers , the HPV DNA is usually found integrated in to host genome. Integration of high risk HPV DNA in to the host cell disrupts the E2 region. This results in the loss of normal E2 down-regulation of E6 and E7 which leads to the up-regulation of the two HPV viral oncogenes; E6 and E7.These E6 and E7 gene products has the ability to destabilize the cell growth regulatory and modify the cellular environment in which it replicates (Jan M. M. Walboomers 1999; Yoshinouchi, Hongo et al. 1999; Burd 2003).
pRB and pRb related proteins are critical components of the cell cycle as they seize the
transcription factor E2F which is necessary for the functions of the cell cycle. When E7 proteins bind to the pRB, pRB-E2F complex gets disrupted and this results in the E2F liberation. This disruption affects the normal functions of the cell. E6 viral gene product, the E6 protein, targets the immunosuppressor protein p53 (low risk HPV type’s bind p53 in decreased affinity). The p53 protein prevents cells from completing the cell cycle and up-regulates genes involved in DNA repair, if it comes across any DNA damage. Another important function of the p53 protein is to instruct a cell with DNA damage to commit suicide. If the p53 function is inactivated then these damaged cells would continue to divide and accumulate mutations which would eventually lead to the formation of a tumor.
When E6 protein binds to p53, E6 associated ubiquitin ligase catalyzes ubiquitin ligase mediated p53 degradation. This destroys the tumor suppressive properties of p53 (Syrjanen 1999; Ha and Califano 2004).
The ability of E6 and E7 gene products to disrupt the cellular p53 and pRB protein functions result in, increase cell proliferation and genomic instability. Eventually the cell accumulates damaged DNA/mutations which may lead to the formation of fully transformed cancerous cells. The low risk HPV’s appear to be unable to integrate in to the host genome. But low risk serotypes like HPV 6, 11 may result in chromosomal instability which would lead to the accumulation of mutational events, which in turn may form fully transformed cancerous cells .In addition to the E6 and E7 protein function, methylation of viral DNA, telomere activations, humoral and immunogenic factors also contribute to the cellular transformations (Holowaty, Miller et al. 1999; Burd 2003).
REFERENCES
Armstrong, B. K., O. V. Allen, B. A. Brennan, I. A. Fruzynski, N. H. de Klerk, E. D. Waters, J.
Machin, and M. M. Gollow (1986). “Time trends in prevalence of cervical cytological abnormality in
women attending a sexually transmitted diseases clinic and their relationship to trends in sexual
activity and specific infections.” Br J Cancer 54: 669-75.
Burd, E. M. (2003). “Human Papillomavirus and Cervical Cancer.” Clin. Microbiol. Rev. 16: 1-17.
Burd, E. M. (2003). “Human Papillomavirus and Cervical Cancer.” Clin. Microbiol. Rev. 16(1): 1-17.
Giroglou, T., L. Florin, et al. (2001). “Human Papillomavirus Infection Requires Cell Surface Heparan Sulfate.” J. Virol. 75(3): 1565-1570.
Ha, P. K. and J. A. Califano (2004). “The role of Human Papilloma Virus in oral carcinogenesis.” Crit Rev Oral Biol Med 15(4): 188-196.
Holowaty, P., A. B. Miller, et al. (1999). “Natural History of Dysplasia of the Uterine Cervix.” J. Natl. Cancer Inst. 91(3): 252-258.
Jan M. M. Walboomers, M. V. J., M. Michele Manos, F. Xavier Bosch, J. Alain Kummer, Keerti V. Shah,
Peter J. F. Snijders, Julian Peto, Chris J. L. M. Meijer, Nubia Muñoz, (1999). “Human papillomavirus is a necessary cause of invasive cervical cancer worldwide.” The Journal of Pathology 189(1): 12-19.
Koutsky, P., Laura. (1997). “Epidemiology of Genital Human Papillomavirus Infection.” The American Journal of Medicine 102: 3-8.
Lacey, C. J. N. (2005). “Therapy for genital human papillomavirus-related disease.” Journal of
Clinical Virology Supplement: Human Papillomaviruses 32(Supplement 1): 82-90.
Longworth, M. S. and L. A. Laimins (2004). “Pathogenesis of Human Papillomaviruses in Differentiating Epithelia.” Microbiol. Mol. Biol. Rev. 68(2): 362-372.
Revzina, N. V., and R. J. Diclemente (2005). “Prevalence and incidence of human papillomavirus infection in women in the USA: a systematic review.” Int J STD AIDS 16: 528-37.
Sapp, M., C. Volpers, et al. (1995). “Organization of the major and minor capsid proteins in human papillomavirus type 33 virus-like particles.” J Gen Virol 76(9): 2407-2412.
Syrjanen, S. M., and K. J. Syrjanen. (1999). “New concepts on the role of human papillomavirus in cell cycle regulation.” Ann Med 31: 175-187.
University, J. s. H. (2001). “HPV-induced Anal Dysplasia: What Do We Know and What Can We Do About It?” (Online)
Wright, J. D., A. B. Pinto, et al. (2004). “Atypical Squamous Cells of Undetermined Significance in Girls and Women .” Obstet Gynecol 103(4): 632-638.
Yoshinouchi, M., A. Hongo, et al. (1999). “Analysis by Multiplex PCR of the Physical Status of Human Papillomavirus Type 16 DNA in Cervical Cancers.” J. Clin. Microbiol. 37(11): 3514-3517.
zur Hausen, H. (1991). “Human papillomaviruses in the pathogenesis of anogenital cancer.” Virology
184: 9-13.
Rapid Learn Centre
HUMAN PAPILLOMA VIRUS – A REVIEW
Sameera Mohotti (BSc, MSc, MD(MA))
INTRODUCTION
HPV is one of the most common sexually transmitted viral diseases. It is
estimated that 80% of sexually active adults have been infected with one or more genital HPV types at one point of their life time. The prevalence of HPV is increasing worldwide. Although it is
difficult to estimate the overall prevalence of HPV infection, it is estimated that the prevalence could be as high as 20 million (Revzina 2005). The total health care cost associated with the screening and treatment of cervical cancer in the U.S. is estimated to be $6 billion per year (Koutsky 1997). A US sero prevalence study performed by Revizina et al revealed that the highest prevalence of
HPV is among college students and women attending STD clinics Data from clinics in Australia indicate a prevalence of 4- 13% among STD clinic attendants Following initial infection, HPV establishes latent infection, from which symptomatic recurrences may develop periodically (Revzina 2005),(Armstrong 1986).
The main aim of this review was to evaluate the current literature regarding the types of HPV, symptoms and its pathogenesis.
SPECTRUM OF HPV INFECTION
Over 200 types of HPV have been classified on the basis of their DNA sequence homology. 85 HPV genotypes are well characterized.
HPV can be grouped as high risk HPV and low risk HPV based on their association with cancer and precursor lesions. High risk HPV’s have a high oncogenic potentials. This group includes serotypes 16,18,31,33, 34, 35,39,45,51,52,56,58,59,66,68. Low risk HPV’s have less oncogenic potentials and usually results in the formation of low grade precancerous lesions. This group includes
serotypes 6, 11, 42, 43, 44. This difference in the capacity to induce malignant transformation is due to the functional difference seen in E6 and E7 proteins of the two groups (Burd 2003; Longworth and Laimins 2004).
Although many HPV infections are sub clinical, symptomatic HPV infection typically results in lesions. Each HPV serotype infects certain parts of the body and responsible for different types of lesions. According to the current classification system (Bethesda system) of HPV lesions, there are three main groups. They are anogenital warts, low grade squamous intraepithelial lesions (cervical / anal intraepithelial neoplasia and mild dysplasia) and high grade squamous intraepithelial lesions (moderate and severe dysplasia).Cervical/anal/vulvar/penile carcinomas usually develop from high grade squamous intraepithelial lesions (University 2001).
Genital warts (proliferative foci of epithelial keratinocytes infected with HPV) appear as bumps or abnormal growths in the genital area. This is one of the commonest clinically recognized disease manifestations of genital HPV. These are usually found in vulva, urethra, anus, and vagina and on the cervix. Warts are extremely contagious and they occasionally lead to cancer of the cervix in
women or cancer of the penis in men (Lacey 2005).
The presence of abnormal cells on the surface of the skin is called dysplasia.
Dysplasia is not a cancer and mild dysplasia is likely to self resolve. However, mild, moderate and severe dysplasia could be progressed in to a cancer, if not detected and treated at its early stage. Studies indicate that even adolescents with low grade squamous intraepithelial lesions and high grade squamous intraepithelial lesions are also at high risk for progression to high-grade cervical abnormalities (Wright, Pinto et al. 2004).
BASIC VIROLOGY
HPV is a nonenveloped, double stranded circular DNA virus with a diameter of 5.5 nm. The genome is approximately 8 Kb in size and encased in an icosahedral capsid which is composed of 72 capsomeres. Capsid comprises of an outer protein coat which consists of two capsid proteins, L1 (major) and L2 (minor) (Sapp, Volpers et al. 1995).
HPV genome is functionally divided in to 3 regions .They are the upstream regulatory region, early region and the late region. The upstream regulatory region involves in viral replication and also controls the transcription of some sequences in the early region. The early region of the genome encompasses 6 open reading frames (ORF’s) named E1, E2, E4, E5, E6 and E7. These encode proteins involved in viral replication, transcription and cellular transformation. E6 and E7 regions are responsible for the oncogenic properties of HPV. The late region encompasses two ORF’s and these encode L1 and L2 structural proteins which is necessary for capsid production (Sapp, Volpers et
al. 1995).
PRODUCTIVE HPV INFECTION
HPV gain entry into the host cells through the basal layer of the epithelium. In initial infection HPV is present as an episome. It has been proposed that HPV-6 attaches to the host cells via ?6-intergrin in the epithelium cells; where as, HPV16 and HPV 33 attach to host cells via cell surface heparin sulphate. The papilloma viral gene expressions are linked with the differentiation stages of the epithelium and virus multiplies as it progresses through the natural epithelial cell maturation (Giroglou, Florin et al. 2001).
During viral replication, the E1 gene product (E1 protein) binds to the viral origin of replication and this result in the extra chromosomal replication of the viral genome. The E2 gene product (E2 protein) down-regulates the E6 and E7 regions to allow the normal differentiation process of the cell. The capsid genes L1 and L2 synthesize the capsid protein and envelopes each episomal DNA in a protein capsid. The E4 gene product (E4 protein) is associated with the maturation and release of papilloma virus particles(Burd 2003),(Longworth and Laimins 2004).
The productive viral stage results in flat or papillary lesions. Since the papilloma virus replication goes hand in hand with the epithelial cell differentiations, as the lesions are formed the superficial and intermediate epithelial layers would contain a large amount of viral DNA. The accumulations of viral particles in the superficial epithelial layers provoke the cells to the koilocytosis cytopathic effect. This gives rise to koilocytes, in which the cellular nucleus is displaced to the side with a ‘hollow’ appearance of the cytoplasm. The virus particles are released as dying koilocytes are shed (zur Hausen 1991; Longworth and Laimins 2004).
PATHOGENESIS OF ONCOGENIC HPV
When a person gets infected with high-risk HPV, it may take up to 20 years for the
cancer changes to appear. This persistency of HPV infection is necessary for the malignant transformation of the cells. In HPV associated benign lesions, the HPV DNA is usually located extra chromosomal where as in HPV associated cancers , the HPV DNA is usually found integrated in to host genome. Integration of high risk HPV DNA in to the host cell disrupts the E2 region. This results in the loss of normal E2 down-regulation of E6 and E7 which leads to the up-regulation of the two HPV viral oncogenes; E6 and E7.These E6 and E7 gene products has the ability to destabilize the cell growth regulatory and modify the cellular environment in which it replicates (Jan M. M. Walboomers 1999; Yoshinouchi, Hongo et al. 1999; Burd 2003).
pRB and pRb related proteins are critical components of the cell cycle as they seize the
transcription factor E2F which is necessary for the functions of the cell cycle. When E7 proteins bind to the pRB, pRB-E2F complex gets disrupted and this results in the E2F liberation. This disruption affects the normal functions of the cell. E6 viral gene product, the E6 protein, targets the immunosuppressor protein p53 (low risk HPV type’s bind p53 in decreased affinity). The p53 protein prevents cells from completing the cell cycle and up-regulates genes involved in DNA repair, if it comes across any DNA damage. Another important function of the p53 protein is to instruct a cell with DNA damage to commit suicide. If the p53 function is inactivated then these damaged cells would continue to divide and accumulate mutations which would eventually lead to the formation of a tumor.
When E6 protein binds to p53, E6 associated ubiquitin ligase catalyzes ubiquitin ligase mediated p53 degradation. This destroys the tumor suppressive properties of p53 (Syrjanen 1999; Ha and Califano 2004).
The ability of E6 and E7 gene products to disrupt the cellular p53 and pRB protein functions result in, increase cell proliferation and genomic instability. Eventually the cell accumulates damaged DNA/mutations which may lead to the formation of fully transformed cancerous cells. The low risk HPV’s appear to be unable to integrate in to the host genome. But low risk serotypes like HPV 6, 11 may result in chromosomal instability which would lead to the accumulation of mutational events, which in turn may form fully transformed cancerous cells .In addition to the E6 and E7 protein function, methylation of viral DNA, telomere activations, humoral and immunogenic factors also contribute to the cellular transformations (Holowaty, Miller et al. 1999; Burd 2003).
REFERENCES
Armstrong, B. K., O. V. Allen, B. A. Brennan, I. A. Fruzynski, N. H. de Klerk, E. D. Waters, J.
Machin, and M. M. Gollow (1986). “Time trends in prevalence of cervical cytological abnormality in
women attending a sexually transmitted diseases clinic and their relationship to trends in sexual
activity and specific infections.” Br J Cancer 54: 669-75.
Burd, E. M. (2003). “Human Papillomavirus and Cervical Cancer.” Clin. Microbiol. Rev. 16: 1-17.
Burd, E. M. (2003). “Human Papillomavirus and Cervical Cancer.” Clin. Microbiol. Rev. 16(1): 1-17.
Giroglou, T., L. Florin, et al. (2001). “Human Papillomavirus Infection Requires Cell Surface Heparan Sulfate.” J. Virol. 75(3): 1565-1570.
Ha, P. K. and J. A. Califano (2004). “The role of Human Papilloma Virus in oral carcinogenesis.” Crit Rev Oral Biol Med 15(4): 188-196.
Holowaty, P., A. B. Miller, et al. (1999). “Natural History of Dysplasia of the Uterine Cervix.” J. Natl. Cancer Inst. 91(3): 252-258.
Jan M. M. Walboomers, M. V. J., M. Michele Manos, F. Xavier Bosch, J. Alain Kummer, Keerti V. Shah,
Peter J. F. Snijders, Julian Peto, Chris J. L. M. Meijer, Nubia Muñoz, (1999). “Human papillomavirus is a necessary cause of invasive cervical cancer worldwide.” The Journal of Pathology 189(1): 12-19.
Koutsky, P., Laura. (1997). “Epidemiology of Genital Human Papillomavirus Infection.” The American Journal of Medicine 102: 3-8.
Lacey, C. J. N. (2005). “Therapy for genital human papillomavirus-related disease.” Journal of
Clinical Virology Supplement: Human Papillomaviruses 32(Supplement 1): 82-90.
Longworth, M. S. and L. A. Laimins (2004). “Pathogenesis of Human Papillomaviruses in Differentiating Epithelia.” Microbiol. Mol. Biol. Rev. 68(2): 362-372.
Revzina, N. V., and R. J. Diclemente (2005). “Prevalence and incidence of human papillomavirus infection in women in the USA: a systematic review.” Int J STD AIDS 16: 528-37.
Sapp, M., C. Volpers, et al. (1995). “Organization of the major and minor capsid proteins in human papillomavirus type 33 virus-like particles.” J Gen Virol 76(9): 2407-2412.
Syrjanen, S. M., and K. J. Syrjanen. (1999). “New concepts on the role of human papillomavirus in cell cycle regulation.” Ann Med 31: 175-187.
University, J. s. H. (2001). “HPV-induced Anal Dysplasia: What Do We Know and What Can We Do About It?” (Online)
Wright, J. D., A. B. Pinto, et al. (2004). “Atypical Squamous Cells of Undetermined Significance in Girls and Women .” Obstet Gynecol 103(4): 632-638.
Yoshinouchi, M., A. Hongo, et al. (1999). “Analysis by Multiplex PCR of the Physical Status of Human Papillomavirus Type 16 DNA in Cervical Cancers.” J. Clin. Microbiol. 37(11): 3514-3517.
zur Hausen, H. (1991). “Human papillomaviruses in the pathogenesis of anogenital cancer.” Virology
184: 9-13.
Rapid Learn Centre
Why Dental Hygiene Is So Lucrative In Canada
David Weiszloff asked:
Everyone loves a winning smile. It’s a symbol of success as well as physically appealing to look at. This probably explains North America’s fixation with brushing, flossing, whitening and gargling; everyone aspires to those shiny pearly whites.
Chances are this isn’t going to change anytime soon. In light of the current recession, job security is at the top of everyone’s priority list. If you’re looking for job security, look no further than a career in dental hygiene.
Becoming A Dental Hygienist
Canada has a wealth of options for the post-secondary student looking to pursue a career in dental hygiene. From the University of British Columbia to Dalhousie University, schools across the country offer programs in dental hygiene.
To pursue a degree in dental hygiene, students generally must have the following secondary school credits or International Baccalaureate / Advanced Placement (IB/AP) equivalents in order to qualify for an admission to first year:
English 11, English 12, A Grade 11 language course, Biology 11, Biology 12, Chemistry 11, Chemistry 12, Principles of Mathematics 11, Social Studies 11 or First Nations Studies 12, One other approved provincially examinable Grade 12 course.
What To Expect
Dental hygienists are registered and certified health professionals trained to maintain your oral integrity. Specializing in the prevention of oral health problems and mouth diseases, dental hygienists work with individual clients or communities to prevent tooth, gum and mouth diseases and injuries that can affect a patient’s overall health.
One of the interesting aspects of being a dental hygienist is the range of the patient base. Dental hygiene services are provided to people of all ages, ranging from parents in pre-natal classes to the elderly in long-term health care centres. A typical workday could involve assessment, planning, implementing and evaluating health care data and include:
Teaching an elementary class about oral health care, Counseling a family about oral health, Providing fluoride treatments to patients during a dental visit, Administering local anesthetic for dental hygiene or dental treatment, Teaching long-term care staff about mouth care for their clients, Working with nurses to prevent sports and playground injuries, Screening seniors for signs of oral cancer, Performing head, neck and oral examinations, Applying pit and fissure sealants to teeth, Reviewing literature and conducting research, Scaling, root-planning, and so on.
Preventive health care is another part of a dental hygienist’s profession. Many dental hygienists deliver health promotion programs in their community to parent and special needs groups; schools, day cares and long-term seniors’ care facilities. These programs usually include tobacco cessation advocacy, sports/mouth guard clinics and baby care seminars.
Practicing Dental Hygiene in Canada
In order to practice dental hygiene in Canada, registered dental hygienists (RDHs) must complete a recognized dental program, and be registered or licensed with the appropriate provincial or territorial regulatory authorities.
Clinical vs. Community Practice
Dental hygienists have the option of working in both community and clinical practices.
Clinical Practice
In clinical practice, dental hygienists most often work with general practitioner dentists or specialty practice dentists. They work directly with patients to prevent and treat gum disease and tooth decay. They are trained to:
Assess tooth and gum health, Prepare individualized dental hygiene treatment plans, refer patients to a dentist for dental treatment.
The role of the clinical dental hygienist is not solely limited to looking after the cosmetic appearance of teeth and gums, but also perform complex services like scaling and root planning to treat gum infections.
Some Canadian provinces allow dental hygienists to own their own dental hygiene practice. For example, RDHs can practice independently in British Columbia, Ontario and some American states. Increasingly, as more provincial/territorial legislation allows dental hygienists to open their own clinical practice, entrepreneurial skills are becoming more important for dental hygienists.
Community Practice
Dental hygienists working in community practices varies in scope. They may work with individuals on a one-to-one basis, or deal with entire communities. Dental hygienists may perform health surveys for a community and work with other health professionals to design a health program for those communities.
They often evaluating the effectiveness of current health care procedures and programs while identifying the need for ones. A dental hygienist will work with a variety of health professionals and community members including nurses, speech pathologists, injury prevention coordinators, dentists, physicians and dietitians.
Community members may include school principals, teachers, parents, coaches, day care providers, health advocates, government departments, and administrators of other health promotion programs in the community.
Some dental hygienists choose to specialize in health programs for new Canadians, cancer (oncology) patients, expectant moms or homeless teens. Community health practice offers much variety to a dental hygiene career.
There are many interesting and exciting career opportunities for dental hygienists. Dental hygienists may find themselves with a variety of roles and responsibilities to choose from. These include roles as: Clinicians, Educators, Administrators, Researchers.
Depending on whether they choose to work in a clinical or community practice, dental hygienists may practice in a variety of environments such as: Private dental practices, Public health and community health centres, Professional dental hygiene associations and regulatory bodies, Homecare and outreach programs, Universities and community colleges, Government (policy and planning, lobbying), Industry (insurance and dental supply companies), Consulting, Research.
Salary
The median hourly wage of Canadian dental hygienists with less than one year of experience is roughly C$ 31.16, according to PayScale.
Is Dental Hygiene Right For You?
Dental hygiene is a profession that offers job security as well as a wealth of different job opportunities. Graduates of post-secondary degree institutions have the option of working in either clinical or community practices, and with a wide range of clients.
The multitude of available roles leaves room career diversity for dental hygienists to hone their various skills. If this sounds appealing, than dental hygiene may just be the career to put a smile on your face.
Rapidlearn.org
Everyone loves a winning smile. It’s a symbol of success as well as physically appealing to look at. This probably explains North America’s fixation with brushing, flossing, whitening and gargling; everyone aspires to those shiny pearly whites.
Chances are this isn’t going to change anytime soon. In light of the current recession, job security is at the top of everyone’s priority list. If you’re looking for job security, look no further than a career in dental hygiene.
Becoming A Dental Hygienist
Canada has a wealth of options for the post-secondary student looking to pursue a career in dental hygiene. From the University of British Columbia to Dalhousie University, schools across the country offer programs in dental hygiene.
To pursue a degree in dental hygiene, students generally must have the following secondary school credits or International Baccalaureate / Advanced Placement (IB/AP) equivalents in order to qualify for an admission to first year:
English 11, English 12, A Grade 11 language course, Biology 11, Biology 12, Chemistry 11, Chemistry 12, Principles of Mathematics 11, Social Studies 11 or First Nations Studies 12, One other approved provincially examinable Grade 12 course.
What To Expect
Dental hygienists are registered and certified health professionals trained to maintain your oral integrity. Specializing in the prevention of oral health problems and mouth diseases, dental hygienists work with individual clients or communities to prevent tooth, gum and mouth diseases and injuries that can affect a patient’s overall health.
One of the interesting aspects of being a dental hygienist is the range of the patient base. Dental hygiene services are provided to people of all ages, ranging from parents in pre-natal classes to the elderly in long-term health care centres. A typical workday could involve assessment, planning, implementing and evaluating health care data and include:
Teaching an elementary class about oral health care, Counseling a family about oral health, Providing fluoride treatments to patients during a dental visit, Administering local anesthetic for dental hygiene or dental treatment, Teaching long-term care staff about mouth care for their clients, Working with nurses to prevent sports and playground injuries, Screening seniors for signs of oral cancer, Performing head, neck and oral examinations, Applying pit and fissure sealants to teeth, Reviewing literature and conducting research, Scaling, root-planning, and so on.
Preventive health care is another part of a dental hygienist’s profession. Many dental hygienists deliver health promotion programs in their community to parent and special needs groups; schools, day cares and long-term seniors’ care facilities. These programs usually include tobacco cessation advocacy, sports/mouth guard clinics and baby care seminars.
Practicing Dental Hygiene in Canada
In order to practice dental hygiene in Canada, registered dental hygienists (RDHs) must complete a recognized dental program, and be registered or licensed with the appropriate provincial or territorial regulatory authorities.
Clinical vs. Community Practice
Dental hygienists have the option of working in both community and clinical practices.
Clinical Practice
In clinical practice, dental hygienists most often work with general practitioner dentists or specialty practice dentists. They work directly with patients to prevent and treat gum disease and tooth decay. They are trained to:
Assess tooth and gum health, Prepare individualized dental hygiene treatment plans, refer patients to a dentist for dental treatment.
The role of the clinical dental hygienist is not solely limited to looking after the cosmetic appearance of teeth and gums, but also perform complex services like scaling and root planning to treat gum infections.
Some Canadian provinces allow dental hygienists to own their own dental hygiene practice. For example, RDHs can practice independently in British Columbia, Ontario and some American states. Increasingly, as more provincial/territorial legislation allows dental hygienists to open their own clinical practice, entrepreneurial skills are becoming more important for dental hygienists.
Community Practice
Dental hygienists working in community practices varies in scope. They may work with individuals on a one-to-one basis, or deal with entire communities. Dental hygienists may perform health surveys for a community and work with other health professionals to design a health program for those communities.
They often evaluating the effectiveness of current health care procedures and programs while identifying the need for ones. A dental hygienist will work with a variety of health professionals and community members including nurses, speech pathologists, injury prevention coordinators, dentists, physicians and dietitians.
Community members may include school principals, teachers, parents, coaches, day care providers, health advocates, government departments, and administrators of other health promotion programs in the community.
Some dental hygienists choose to specialize in health programs for new Canadians, cancer (oncology) patients, expectant moms or homeless teens. Community health practice offers much variety to a dental hygiene career.
There are many interesting and exciting career opportunities for dental hygienists. Dental hygienists may find themselves with a variety of roles and responsibilities to choose from. These include roles as: Clinicians, Educators, Administrators, Researchers.
Depending on whether they choose to work in a clinical or community practice, dental hygienists may practice in a variety of environments such as: Private dental practices, Public health and community health centres, Professional dental hygiene associations and regulatory bodies, Homecare and outreach programs, Universities and community colleges, Government (policy and planning, lobbying), Industry (insurance and dental supply companies), Consulting, Research.
Salary
The median hourly wage of Canadian dental hygienists with less than one year of experience is roughly C$ 31.16, according to PayScale.
Is Dental Hygiene Right For You?
Dental hygiene is a profession that offers job security as well as a wealth of different job opportunities. Graduates of post-secondary degree institutions have the option of working in either clinical or community practices, and with a wide range of clients.
The multitude of available roles leaves room career diversity for dental hygienists to hone their various skills. If this sounds appealing, than dental hygiene may just be the career to put a smile on your face.
Rapidlearn.org