Date: Saturday, January 13, 2007 12:33 AM
From: "ESCO automatic digest system" <LISTSERV@LISTSERV.UIC.EDU>
Subject: ESCO Digest - 10 Jan 2007 to 16 Jan 2007 (#2007-5)
To: ESCO@LISTSERV.UIC.EDU

There are 10 messages totalling 666 lines in this issue.

Topics of the day:

  1. Re: habit breakers
  2. MEAWS
  3. FDA notice to Pharmacies compounding Topical Anesthetics
  4. Donnatal Tablets
  5. compounded anesthetics
  6. Employee Handbook
  7. MEAW
  8. Topicals
  9. meaw


Date: Friday, January 12, 2007 8:56 AM
From: blair adams <adams.blair@GMAIL.COM>
Subject: Re: habit breakers

On the topic of habit breakers; Since we switched to using the "bluegrass" appliance we have not failed to eliminate one patient's digital sucking habit. A rotating cylinder resting horizontally at the level of the 1st primary molars on an 036 wire, soldered to adult molar bands is a 'toy' for the child that presents a much friendlier image of the practice. We will often combine this with 'tongue reminders' soldered to a lower lingual arch. (Not so friendly looking but no complaints of discomfort so far) I love to see the parents eyes pop open when 8 months later we bring up the 'before' photos & show the 4mm open bite that has closed to a 2mm ooverbite without touching the incisors.

Blair Adams,
Ottawa


Date: Thursday, January 11, 2007 11:13 PM
From: SCOTT SMORON <scottsmoron@COMCAST.NET>
Subject: MEAW

With the MEAWS wires...I have seen these often, but is there a good
reference on the bio-mechanics of the wires.  Whenever I see them I think
they would work similarly to a reverse curve/exaggerated curve archwire.  I
have used these to address open bites.  Nothing amazing, but they get some
results.

Can someone explain how they are mechanically different from a reverse curve
wire?

Scott Smoron


Date: Thursday, January 11, 2007 11:10 PM
From: "SCOTT SMORON" <scottsmoron@COMCAST.NET>
Subject: Re: FDA notice to Pharmacies compounding Topical Anesthetics

Thanks for the heads up.  However, I think there is more to this.  From your
post I would be concerned that the compound I am using and the manner in
which I am using it is being cracked down on.  It may, it may not.  Here is
why...

TAC20 as compounded by the pharmacy I purchase it from is not actually TAC
(which refered to Tetracaine/Adrenaline/Cocaine).  It is actually a
variation of LET (Lidocaine/Epinephrine/Tetracaine).  An article I found by
googling http://www.aafp.org/afp/20020701/99.html explains some of the
history.

What I would love to know is:
Does the FDA have a list that someone can lay their hands on of approved for
sale topicals...as in every concentration that should be available...like,
we all know T3s, but there also exists approved T1s, T2s and T4s...
Does the FDA have a list of compounding that is approved...because some of
these compounds are not considered new, are well-proven in the field, and
useful.  I assume the FDA has been aware of them for some time.

The link you provide I think relates to just dispensing the product without
proper supervision.  It is not just the drug but the manner the drug is
being dispensed.  I have assisted in operating rooms with anesthesiologists
and seen the combinations of drugs they have knowledge of and how to
manipulate, and how they are used in common combinations, but with extensive
training.  I doubt the FDA is going to crack down on these combinations of
drugs because they are in well-trained hands and dispensed appropriately.

In fact, check out this link for what is available OTC
http://www.skinstore.com/store/category.asp?source=GOOG&link=topical_anesthetic&keyword=topical+anesthetic&CatID=1971&affiliatecode=CS_Google_topical_anesthetic&cshift_ck=67562223cs294498820

In addition, this link
http://www.asds-net.org/Media/ethics/ethicsguidelines.html discusses the
topic of off-label drug use and the ethics behind this.  Basically, the FDA
is aware of off-label use and off-label use of pain control substances is
often covered by mal-practice insurance, even.  However, you better have
knowledge of possible complications and how to handle them.

So does anyone know if these lists exist?

The dosage a patient can get from the injection of a carpule of lido then
prilocaine or marcaine is much greater than what I give them topically.
Having gone through 8 carpules of lido w/epi routinely for extraction of
numerous teeth or other procedures, I believe I can manage what a topical
anesthetic can deliver.  I was also an assistant and a participant at
Northwestern University in research about how quickly the epinephrine in a
typical 1.8cc delivery of 2% lido w/1:50k epi is cleared from the system by
taking blood samples over time.  This research was published in JADA years
ago.  Is there similar work in topicals?

Finally, has anyone used ZARS' 7% lido/7% tetracaine product?  This stuff
might be better than what I use since the Tetracaine is in higher
concentration.

Basically, I think this link to the FDA is an excellent starting point.  Is
there a pharmacist out there who can tell us more?

Scott Smoron

Date: Thursday, January 11, 2007 9:37 PM
From: Gary Hirsh <DrummerDDS@SAN.RR.COM>
Subject: Donnatal Tablets

For years, we have been using Donnatal tablets as our anti-sialogogue when doing indirect bonding or bracketing second molars, etc. It was suggested because of it's relative safety and even though saliva reduction is a secondary effect of the drug, it was chosen because it had been used in childbirth situations and was reported to be very safe.
Recently, my ordering assistant told me that the pharmaceutical supply house we have been using to obtain the pills, told us that it wasn't available any longer. I assumed it was some FDA problem.
Does anyone know if it is still available, and if so where?
If it is not available, what happened to it and what are you using instead?
Thanks,
Gary Hirsh, San Diego

 
From: David Paquette <dave@PAQUETTEORTHO.COM>
Date: Thursday, January 11, 2007 7:10 AM
Subject: Re: compounded anesthetics

The notice does not surprise me.  There was a death near here at a laser hair removal salon from too much compounded topical.  I use an irrigation syringe to deliver it and do not allow my staff to apply it due to potential overdose or toxicity.  

Dave Paquette  

 

Date: Thursday, January 11, 2007 6:21 AM
From: David Paquette <dave@PAQUETTEORTHO.COM>
Subject: Re: Employee Handbook

Leon ,

We do have an office manual and after I had an employee find some small inconsistencies that she took advantage of I had a labor attorney review and revise it for me.  We have not had any issues since and it has made many of the facets of staff management much more straightforward since most things are covered in sufficient detail.

I hope this helps.

Dave

 

Date: Thursday, January 11, 2007 5:26 AM
From: Dr.Kharsa <dr.kharsa@GMAIL.COM>
Subject: Re: MEAD

Dear Dr.Greg Scott:

I used the same technique that you described. It has amazing results,
I treated lots of open  bite cases non-surgically, by changing the occlusal plane with multiloop archwires,
Some times I add to same approach of Dr.Kim the "Kobayashi hooks",
which helps in closing the openbites, adjustment of "tongue thrusting" and conserves the symmetry  . In general, this technique is effective in evading the surgical and orthognathic solutions for a vast scope of openbite cases.
Best Regards.

Dr.M.A. Kharsa

Date: Wednesday, January 10, 2007 10:45 PM
From: SCOTT SMORON <scottsmoron@COMCAST.NET>
Subject: Topicals

I have heard from colleagues in countries other than the US about spray
topicals with 15% lidocaine (Nummit Spray)...
Does anyone know if this can be obtained here in the US?
Also, has anyone used hte Noven DentiPatch topical lidocaine strips?  They
were marketed as an anesthetic delivery for root planing/scaling without the
need for a needle, i.e. hygienist.  Would these work as well.
Finally, I assume just ordering something overseas and having it shipped
here would be illegal...or does the delivery system not matter?
Also, I am using needle anesthesia for implants and topical TAC 20
(20%lido,4%tetra,2%phenylephrine) for the laser, but would love something
cleaner.
Thanks for any help!

Scott


Date: Thursday, January 11, 2007 6:06 AM
From: priscila ribeiro <priscilaribeiro123@YAHOO.COM.BR>
Subject: Re: MEAD

Dr. Greg,

I have been using meaw for open bites for 10 years, its very good, especially for those BIG open bites, but you extract 3 molars. You should read Dr. Kims works, and I will see Dr. Satos.

Good Luck
Priscila

 

Date: Thursday, January 11, 2007 6:06 AM
From: priscila ribeiro <priscilaribeiro123@YAHOO.COM.BR>
Subject: Re: MEAD

Hi Greg,
I have posed this question before, but received no reply, so here it is again.  Can you tell me where the magic lies in this "technique"?  The literature on this is very thin on the ground.  From what I can see it is combining flexible archwires with vertical elastics.  Is this correct?
As a part-time academic and a full-time sceptic, I would like to know what the advantage of this technique would be over NiTi wires and the same elastics?
If, as I suspect, the loops are needed because of the edgewise bracket (effects on adjacent teeth), then NiTi wires and TipEdge or Begg brackets would produce the same results in a simpler fashion.
Standing up in a hammock?
Cheers,
Brett Kerr,
Brisbane,
Australia