December 2002

• Medications for postmenopausal osteoporosis prevention
• Manual vs. Powered Toothbrushes
• Botox injections

Medications for postmenopausal osteoporosis prevention

Risk of osteoporosis increases after menopause, when levels of estrogen — which helps preserve bone density — drop. Until recently, most doctors recommended long-term hormone replacement therapy (HRT) to treat postmenopausal women who need medication to prevent bone loss. But things changed after results from a large trial on a common HRT drug showed that estrogen plus progestin (as the medication Prempro) did more harm than good. An increased risk for breast cancer and cardiovascular events outweighed the benefits of less colorectal cancer and fewer fractures. (See the Update from July 2002 for more information on the trial.)

Health experts now encourage most women who have been taking long-term HRT for osteoporosis prevention to consider an alternative. Fortunately there are several options. Each of the FDA-approved treatments (see chart) has potential benefits and risks that women and their doctors should weigh before making a decision. Even with HRT’s proven risks, it may still be a good choice for certain women — especially in lower doses, which recent data have shown to have bone benefits comparable to higher, standard doses.

December 2002 Update

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Manual vs. Powered Toothbrushes

Good news — you don’t have to buy an electric toothbrush to get clean teeth. As more power toothbrushes hit the store shelves, you may feel pressure to buy one. More expensive is better, right? Not necessarily. According to the American Dental Association (ADA), a manual toothbrush can clean teeth just as well as a power toothbrush. The secret lies in how the toothbrush is used.

By following the tips below you can ensure a good brushing:

• Brush the inner, outer, and chewing surfaces of the teeth with short (teeth-wide), back and forth strokes.
• Place the brush at a 45-degree angle against your gums when brushing along the gum line.
• To clean the inside surfaces of the front teeth, use gentle up and down strokes with the tip of the toothbrush.
• Use a soft touch. Vigorous brushing won’t get more plaque off and can irritate your gums.
• A set time is not necessary; just make sure you are cleaning all the surfaces of your teeth thoroughly.
• Be sure to replace your toothbrush once the bristles have become frayed or every three to four months.

An electric toothbrush may be the right choice for you, however. People with arthritis or other conditions that impair motor skills may need the relative ease of a powered toothbrush to do an adequate job of brushing their teeth. You should talk with your dentist or hygienist to determine which type of toothbrush is best for you.

When purchasing a toothbrush, look for the ADA Seal of Acceptance. To take part in this voluntary program, dental product manufacturers must prove their product meets ADA criteria for effectiveness and safety. Also, scientific studies must support the claims of any packaging or advertising of products bearing the ADA Seal.

December 2002 Update

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Botox injections

With the recent nod of approval from the Food and Drug Administration (FDA), the popularity of Botox injections has surged. Spas, shopping malls, walk-in clinics and even parties advertise the availability of this age-defying treatment. Even before FDA approval, the use of Botox was on the rise, increasing 61% between 2000 and 2001, according to the American Society of Plastic Surgeons.

Botox, the trade name for botulinum toxin type A, is used to lessen the telltale signs of aging by softening frown lines on the forehead and brow, crow’s feet at the corners of the eye, and other wrinkles. But what is this toxin, how does it work, and who should be administering the procedure?

Botulinum toxin type A is one of several proteins secreted by the bacterium Clostridium botulinum. These proteins are neurotoxins; they attack nerve cells and paralyze the affected muscles. Ingestion of botulinum toxins causes the infamous food poisoning botulism. But when the purified form of botulinum toxin type A is injected into the muscles below the skin in very low doses, the result is a reduction in wrinkling.

As we age, our skin becomes less elastic and wrinkles remain even when the muscles controlling the skin are relaxed. Botulinum toxin lessens wrinkles by attaching itself to nerve endings in the muscle and preventing the release of the neurotransmitter acetylcholine. This blocks the nerve signals transmitted from the brain to the muscles and paralyzes or weakens the muscle controlling the wrinkled skin. The result is the smoothing out of the skin from disuse — if it can’t move, it can’t wrinkle.

Botox injections are done in a quick and easy procedure lasting less than 30 minutes. The toxin takes effect within a week. The results are temporary, however, so retreatment is necessary within three to six months. Botox may be used in conjunction with or as an alternative to other facial skin rejuvenation procedures such as chemical peels or laser skin resurfacing. When performed by an experienced physician, the most common adverse side effects of the procedure include headache, respiratory infection, flu syndrome, and nausea.

With the potential results and relative ease, it is easy to forget Botox is a prescription drug and not just an injection. However, the results of the procedure largely depend on the injector’s knowledge of the complex muscular anatomy of the face, the effects of the drug, and the principles of aesthetics. Each face must be treated differently. An inexperienced or careless injector may introduce the toxin into parts of the face that result in droopy eyelids or brows. Injections in several parts of the face at the same time can result in excessive paralysis, leading to a "frozen" or unexpressive look that may take a few months to disappear.

For the best results, anyone considering this procedure should find a dermatologist or dermatologic surgeon with training and experience in the technique. The physician should also spend adequate time with the patient discussing the desired results and the patient’s medical history. A patient must understand the risks, benefits, alternatives, and reasoning for the procedure. The injections should be performed in an appropriate setting such as a medical office with medical personnel and equipment ready to deal with potential complications.

The injections are on the pricey side, though, costing an average of $400.

December 2002 Update

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