Dentist apologizes for stealing body parts

Dentist apologizes for stealing body parts

June 13, 2008 -- A former New Jersey dentist who pleaded guilty in March to stealing body parts from more than 1,000 corpses faced the victims' relatives in court, reported ABC News.

Michael Mastromarino, 44, was the leader of a $4.6 million operation that operated in New York, New Jersey, and Pennsylvania, stealing body parts from funeral homes and selling them to doctors for transplants.

As part of the scheme, a team of "cutters" removed bones, skin, and tendons in an unsanitary embalming room, according to prosecutors. Some patients underwent periodontal surgery using tissue and bone implants from the cadavers.

One of the corpses was that of famous British journalist Alistair Cooke.

Mastromarino at one time had a "thriving" dental practice off Fifth Avenue in New York City, according to a Washington Post article from 2006, when the story first broke. But drug abuse and malpractice lawsuits forced him to surrender his license in 2000. He then founded Biomedical Tissue Services, a tissue recovery business.

"I am truly sorry for the pain that I have caused," Mastromarino told the victims, according to ABC News. "May God have mercy on my soul."

He faces 18 to 54 years in prison.

Tooth soap: A viable alternative to toothpaste?

Tooth soap: A viable alternative to toothpaste?

June 13, 2008 -- "Wash your mouth out with soap" is no longer just a threat parents use to scare foul-mouthed children, but an actual recommendation some dentists are making to their patients.

Vitality Products' Perfect Prescription Tooth Soap, an all-natural oral-care soap made from whole-food ingredients such as palm oil, coconut oil, and extra virgin olive oil, is available online and in certain health stores. It contains no chemicals such as fluoride, glycerin, dyes, artificial flavors, or sweeteners .

The founder and natural health buff, Karen Adler, started the healthnbeauty.com Web site in 1998 and was looking for natural oral-care protocols when she came across research by Gerard F. Judd, Ph.D., a professor, chemist, and researcher. Judd's book, Good Teeth Birth to Death, recommends brushing teeth with pure soap.

Inspired by his work, Adler developed Tooth Soap, which hit the market in October 2003. She has been advocating its advantages over toothpaste ever since.

"Certain ingredients in toothpaste can damage teeth. For example, silica can be abrasive and glycerine can coat the teeth and prevent remineralization," Adler explained. "Soap cleans the mouth and allows saliva to remineralize the teeth naturally."

Adler also has concerns about another common toothpaste ingredient -- sodium lauryl sulphate.

"It is a cheap foaming agent and that is why it is so widely used by personal-care product manufacturers," Adler said. "It is also a known irritant that has been shown in studies to cause canker sores. It does not belong in any oral-care product."

Tooth Soap comes in both liquid and solid form. The solid form is shredded into individual servings that people can bite into, then brush off. One bottle of soap costs $24.95.

Kerry Maguire, D.D.S., M.S.P.H, director of professional advocacy at Tom's of Maine, a manufacturer of natural toothpaste, does not agree that the inclusion of ingredients such as silica, glycerine, or sodium lauryl sulphate in toothpaste is bad for consumers. It is the way these ingredients are sourced that is important, she explains.

"Our ingredients come from plant and mineral sources," Dr. Maguire said. "The sodium lauryl sulphate, for example, comes from a coconut oil."

From a formulation and sustainability standpoint, these ingredients are necessary, she added.

There are no clinical trials to prove that Tooth Soap actually works. It is labelled as a cosmetic product by the FDA and has not been tested by the ADA.

"Perfect Prescription Tooth Soap ... is safe, effective and good for you and your family," Adler's Web site claims.

"Where is the data to back up this claim?" questioned Clifford Whall, Ph.D., director of the ADA Acceptance Program and member of the Council on Scientific Affairs.

The lack of fluoride and silica in Tooth Soap concerns Whall, who questions whether teeth can then be protected effectively against caries or kept free of stains. Silica is a mild abrasive that serves an important purpose, he added.

"It is necessary to clean stains off teeth, otherwise teeth will become dull and dingy," Whall said. "All toothpastes with the ADA seal of approval meet a certain level of abrasivity."

Because Tooth Soap contains zero abrasives, it comes with a bottle of Tooth Brightener to be used once a week.

The lack of research behind Tooth Soap also concerns Jean Conner, president of the American Dental Hygienists Association.

However, "when you get a natural product, it is more of a personal choice than an evidence-based one," she acknowledged. "There are many different oral-care products on the market, and patients need to check with their healthcare professional about which one is right for them."

Also, this product is quite pricey, Conner points out.

"As a healthcare product it does not fit in the family budget," she said.

These concerns have not stopped some dentists from recommending the product to their patients.

Jerome Cohen, D.D.S., who practices in Richmond, VA, says he recommends Tooth Soap because he is not happy with ingredients like glycerin, fluoride, and sodium lauryl sulphate in commercial tooth paste.

"They [the makers of Tooth Soap] say glycerine keeps teeth from remineralizing, and I think that makes sense," Dr. Cohen said. "Like everything you put in your mouth, the less processed it is the better."

As for the product being expensive, Dr. Cohen feels a little bit of soap goes a long way and overall works out to be quite economical.

"This product does not have any negative ingredients, nothing toxic, and is completely innocuous," agreed Barry White, D.D.S., who practices in Kingston, NY.

He tries to keep his patients away from toothpaste with sodium lauryl sulphate and glycerine.

"We have [Tooth Soap] available for patients as it is hard to find a product that is 'pure,'" he said.

Thanks to a growing demand for natural products, business is booming for Adler. The company saw sales of more than $400,000 last year, up from $150,000 in 2004.

But the lack of research behind Tooth Soap might make it harder for the product to succeed in the mainstream market.

"It is not enough to claim that natural is good," Whall said. "There are plenty of things in nature that can kill you."

Patterson Dental offers free practice management software

Patterson Dental offers free practice management software

June 12, 2008 -- Patterson Dental Supply of St. Paul, MN, will now provide its EagleSoft practice management software to dental professionals free of charge.

The software also comes with a data import process, CD-ROM, and Web-based training materials.

"Providing Patterson EagleSoft practice management software at no cost eliminates a major hurdle for dentists seeking better software or looking ahead toward future digital technology purchases," said Scott Anderson, president.

Although the software and accompanying services are free, dental professionals must commit to a one-year service agreement with the company at a monthly fee.

Patterson Dental also provides its EagleSoft digital imaging software at no cost, but only with qualifying digital technology purchases.

Amalgam ban unlikely, new warnings possible

Amalgam ban unlikely, new warnings possible

June 11, 2008 -- It was a Rashmon moment. Like the famous movie in which characters remember the same events differently, the ADA and opponents of dental amalgam have offered conflicting versions of what transpired at the FDA last week.

No one disputes that the FDA settled a lawsuit with groups seeking a total ban on amalgam. But the ADA portrays the change as a bureaucratic reshuffling that might not matter at all to dentists. Amalgam opponents describe it as the beginning of the end for the dental treatment they hate. So who's right?

According to the official word from the FDA, the consequences of the settlement will most likely fall in the middle; the agency is unlikely to withdraw dental amalgam from the market in the foreseeable future, but it might warn dentists against using it in certain groups of patients.

Already the FDA has changed information about dental amalgam on its Web site, singling out "developing children and fetuses" as a group worthy of special attention.

But contrary to the implication in many newspaper headlines, the new statements on the agency's Web site do not directly warn pregnant moms and their babies away from amalgam. Instead, it says, "Pregnant women and persons who may have a health condition that makes them more sensitive to mercury exposure, including individuals with existing high levels of mercury bioburden, should not avoid seeking dental care, but should discuss options with their health practitioner."

In its most literal interpretation, the statement just means dentists should just go on doing what they already do -- talking to their patients about the choice of restoration material.

Until July 28, 2008, the agency is accepting public comment on possible new regulations. And it has promised to take all these comments into consideration and issue new regulations by July 28, 2009.

A ban is unlikely

But whatever comments the agency receives, new regulations aren't likely to prohibit dentists from using the material altogether, said FDA spokesperson Peper Long. "Banning has a very high evidence bar," she said. "We might perhaps be more likely to have more warnings." Warnings can take various forms, the strongest of which is contraindication -- a statement that a drug or device should not be used in certain patients.

Even then, police officers aren't going to storm your office if you place an amalgam filling. Enforcement would happen in court. "We're going to encourage lawsuits," said Charles G. Brown, chief counsel for Consumers for Dental Choice, one of the amalgam opponents. "If a dentist wants to keep his yacht or his second home, he better stop giving this to people."

Brown sees the FDA's new Web site statements as the beginning of a process that will eventually result in no one using dental amalgam -- the goal his group has been fighting to reach. "I think we got them," he said. "I think this is the death knell."

He hopes the final rules will include a warning against amalgam not just for pregnant and lactating women but for all women of childbearing age. Even if the FDA only issues a warning about pregnant women and, say, children younger than 6, Brown reasons that parents will not want the material placed in their older children either. And if they don't want it placed in their children, they won't want it for themselves.

He also focuses on the phrase "persons who may have a health condition that makes them more sensitive to mercury exposure." Dentists will bear the onus of identifying these individuals, he argued. "If dentists can figure those out, then that's beyond me," he said. So for the sake of avoiding malpractice suits, he predicts, dentists will have to stop using the material altogether.

The actual proposal

The ADA, on the other hand, takes a more literal view of the recent settlement. It "simply sets a definite deadline (July 28, 2009) for the FDA to complete what it began in 2002 -- a reclassification process for dental amalgam," according to an ADA press release.

The ADA makes no mention of changes on the FDA Web site (and the ADA declined requests from DrBicuspid.com to comment further.) Instead, the ADA focuses on the next step in the bureaucratic process: The FDA is officially taking comments on its current proposal to take dental amalgam out of class I and put it in class II. That change in designation simply allows the agency to regulate the use of the substance.

In the proposal, drafted in 2002, the FDA doesn't envision any warnings at all. (The words "pregnant," "fetus," and "child" don't appear in the 11,000-word document.) Rather it reviews research on the issue and finds no compelling evidence that anyone is at risk.

If this rule becomes law, the only new regulations would be labeling requirements that would spell out in greater detail what each package of encapsulated amalgam contains, instructions for how to handle it safely, and standards for what each package should contain.

That document was written -- as the ADA notes -- in 2002. So what changes since then have prompted the FDA to consider warnings against amalgam? A casual observer might assume that the mention of "developing children and fetuses" on the FDA Web site resulted from some new important research pointing to risk for young folks.

Oddly enough, the most important research on the topic -- in fact, the only large, randomized, clinically controlled trials of dental amalgam -- added to the evidence on the other side of the scale. Two similar studies, one conducted in New England and the other in Portugal, both found that children with amalgam restorations showed no signs of harm.

Even some opponents of dental amalgam acknowledge that there isn't any evidence to show it hurts children more than anyone else. That includes Boyd Haley, Ph.D., a University of Kentucky chemist who filed an affidavit in the recently settled lawsuit. He would like to see dentists stop using dental amalgam, he told DrBicuspid.com. And there is evidence that mercury accumulates more rapidly in children than in adults. But "there haven't been any studies showing a neurological result."

Rather, the concern about children and fetuses comes from observations about other substances. For example, according to James S. Woods, Ph.D., M.P.H., a Washington University heavy metals researcher who participated in the Portugal study, pregnant women who consume too many fish containing methyl mercury (a different type and different dosage from the mercury in amalgam) are more likely to have children with birth defects. And studies on many other toxins show that developing brains are more likely to be damaged than already-developed brains.

This theoretical concern -- rather than new evidence -- may underlie the FDA's new statements about children and fetuses. The agency's Web site cites positions taken by the governments of Canada, France, and Sweden that it describes as having taken the "precautionary principle" towards dental amalgam; these countries see the restoration material as guilty until proven innocent. Since other materials -- such as composite resins -- seem to work pretty well, the thinking goes, why take a chance?

For decades now, the FDA has been unable to decide whether to subscribe to that reasoning or to the argument that whatever damage amalgam may be causing is outweighed by its benefits.

Perhaps the most important result of the new settlement is that the dickering and hesitation is over. Over the next 12 months the agency will have to climb off the fence.

Dental work, anesthesia safe for pregnant women, study finds

Dental work, anesthesia safe for pregnant women, study finds

June 11, 2008 -- The oral-systemic link has elevated the importance of oral health in the public eye, but for pregnant women the stakes are even higher. And dentists have often been overly cautious in their treatment of expecting moms as a result.

But a recent study in the Journal of the American Dental Association (June 2008, Vol. 139:6, pp. 685-695) finds that it is safe for pregnant women to get essential dental treatment (EDT) as well as topical and local anesthetics at 13 to 21 weeks' gestation.

"The consensus in the obstetrics community is that few risks are associated with routine dental care during pregnancy," wrote the study authors. "Many obstetricians, however, believe that dentists are overly cautious about providing dental care to pregnant women."

Study authors noted several reasons for dentists' concern when treating pregnant women. It could be fear of a malpractice suit or harming the woman or fetus. They may be concerned that anesthetics, antibiotics, and analgesics commonly used in dentistry could lead to fetal malformations, or that bacteremias caused by some dental procedures may lead to uterine infections, spontaneous abortions, or preterm labor.

The research team, led by Bryan Michalowicz, D.D.S., a professor of periodontics at the University of Minnesota School of Dentistry, looked at data from the multicenter randomized controlled Obstetrics and Periodontal Therapy (OPT) Trial. The team recruited 823 women from obstetrics clinics at the Hennepin County Medical Center in Minneapolis, the University of Kentucky in Lexington, the University of Mississippi Medical Center in Jackson, and Harlem Hospital in New York City.

All the women had periodontitis, meaning they had four or more teeth with a probing depth of at least 4 mm, a clinical attachment loss of at least 2 mm, and bleeding on probing at 35% or more of tooth sites.

A group of 413 women were randomly assigned to receive scaling and root planning before 21 weeks' gestation, and 395 completed part of the treatment. A control group consisted of 410 women who received treatment after delivery.

Dentists determined that 483 women were in need of essential dental treatment (EDT), which meant they had an odontogenic abscess, decayed teeth that could become symptomatic during the course of the study, or fractured/decayed teeth that were affecting the health of adjacent soft tissues. Of these women, 351 were treated for EDT.

Researchers had pregnancy outcome data for 814 (98.9%) of 823 women. In total, 82 pregnancies ended in live preterm births, 6 in spontaneous abortions (before 20 weeks' gestation), 13 in stillbirths (from 20 weeks' gestation to 36 weeks, six days' gestation), and 2 in elective abortions.

"The results of this study show that EDT administered at 13 to 21 weeks' gestation was not associated with an increased risk of experiencing serious medical adverse events, preterm deliveries, spontaneous abortions or stillbirths, or fetal anomalies," the authors stated. "Use of topical and local anesthetics for scaling and root planing also was not associated with an increased risk of experiencing these adverse events and outcomes."

However, "additional large retrospective and prospective studies, as well as studies of other dental treatments, are needed to confirm the safety of dental care during pregnancy," the authors concluded.