Strep Throat

I found this at www.dhinfo.org and thought it was really interesting. I have seen a huge increase in the number of people getting strep lately. A few tips I recommend are:

• Throw your toothbrush away after recovering from strep, or any illness for that matter. If you have a Sonicare or another type of electric toothbrush, it is a good idea to sanitize the head or replace it.


• Sanitize your night guard and/or retainer. Be sure and use cold water, not hot, and only use a few drops of bleach to a cup of water. Soak for less than 5 minutes then rinse well.


• Don't let anyone eat or drink after you, even kiddos or your spouse. These pesky germs are very contagious.

Enjoy this great article and stay healthy! Dr. Wade

"Streptococcus was first discovered in 19th century, the name was derived from Greek (strep: chain and coccus: round), which describes how the bacteria grow in pearl-like chains. There are many species of streptococcus and they can cause many kinds of diseases like kidney disease, rheumatic fever and impetigo. In fact, people with pneumonia may be infected with one of eighty types of pneumonia-causing streptococcus bacteria. Sore throat symptoms are caused by three types of streptococcus bacteria. It can be treated effectively with antibiotics, however to prevent antibiotics resistance, the treatment should be focused for symptomatic relief.

Symptoms
When diagnosing strep throat, doctors look for four most common symptoms and when three of these symptoms are present, then the diagnosis can be positive.
• Redness of the throat
• Swelling and white patches on the tonsils
• Swollen glands under the chin or on either side of the throat
• Painful throat

Stomach pain, chills and headache can also be considered as strep throat symptoms. However, nasal congestion and cough are usually not present. If the symptoms appear to be quite severe, the cause could be virus instead of streptococcus.

Diagnosis
Unlike common flu or cold, diagnosis for strep throat may call for additional information. A classic test is called the “throat culture”, in which fluid sample from the back of your throat are taken with cotton swab for lab analysis. The result should be available in 48 hours. The test was first performed in 1954 and since then was regularly used as a tool to diagnose strep throat.

Treatment
Antibiotic penicillin is still the gold standard of streptococcus treatment. It can be prescribed as 10-day course of oral drugs or a single shot. Patients with penicillin allergy may be given erythromycin. If no improvements are detected after seven days, additional testing is required. Severe sore throat that won’t improve after one week of antibiotics treatment could actually be an Epstein-Barr virus infection. Strep throat normally lasts for one week, but tonsils and glands may need two or three weeks to return to their normal state. The enlarged tonsils and glands may cause uncomfortable sensations.

In the 1980’s about 36 millions cultures were tested annually in the laboratories, since then the number of throat cultures has dropped significantly, since better or faster diagnostic methods were introduced. Among the newest tests is rapid antigen test or RAT, which allows doctors to test for the presence of streptococcus antigen in their offices. A doctor still also needs to take a liquid sample from the throat using a cotton swab. The swab will be inserted to a solution to detect the presence of certain antibodies that fight streptococcus Group A.

Unfortunately, RAT is not as reliable as throat culture, which may make false negatives more likely to happen. Put differently, it may indicate that strep throat is not a problem when in reality it causes an infection. However, because it is less expensive and faster, RAT is still used for preliminary test. When it is positive, the patient will be treated with antibiotics for Group A streptococcus and if it is negative, throat culture is performed. Experts advocate that throat culture should be considered as a gold standard in strep throat diagnosis. Although it takes 48 hours to get a definite result, two-day delay won’t increase the rheumatic disease risk, because it takes about 9 days after the first onset, for the complications to occur. If the patient is particularly uncomfortable, the doctor may immediately give the antibiotic treatment.

Transmission
Streptococcus is airborne bacteria, which can infect people through droplets. Additionally, this tenacious microorganism can spread by skin contacts. In school and dorms, strep is often a problem. Children are more vulnerable to strep, due to less developed immune, frequent physical contacts with friends and lack of awareness on hygiene. Streptococcus can also contaminate food, which causes sore throat and fever. If the strep throat outbreak is frequent in your community or family, then there could be a carrier. Carriers are healthy-looking people who were previously under-treated for strep infections, as the result they can still spread the bacteria to others. It is still debatable how a person can remain infectious after he is treated with antibiotics. Streptococcus bacteria shed more quickly on adults but can continue longer on children.

Prevention
Just like any other bacteria, strep is vulnerable to antibacterial agents. During an outbreak, you should wash your hands with antiseptic soaps, regardless of whether you’re already contracted strep throat or not. Additionally, pediatricians recommend that the whole family should be protected with antibiotics if a family member has strep throat.



Complications
Rheumatic fever is a serious heart complication of strep throat. The complication can occur between one to five weeks after the first onset, as the invading bacteria cause widespread inflammation. Inflammation occurs when patient’s own tissue and bacteria cell walls cross-react. It can cause swelling in the joints and discomfort, which mimic the symptoms of regular rheumatic. Unfortunately, the bacteria can also infect myocardium, an important heart muscle. When valves of the heart are affected by rheumatic fever, they can be permanently scarred during the healing process. Consequently, heart works less efficiently and tends to swell. To make matter worse, some particularly vulnerable individuals may have frequent relapses. Each time, the heart and joints can be damaged even more, which can cause death due to heart failure.



A few decades ago, rheumatic fever was common in many parts of the world. Many hospitals run a special rheumatic fever clinic, where people who had recovered would get long-acting penicillin injection every two weeks to prevent a relapse. Children were asked to take antibiotics regularly until they were 20 years old, when a more developed immune system can defeat strep completely.



Today, rheumatic fever has declined significantly in most parts of the world and even in developed countries with the best medical care available, it still occurs.
Another complication of strep throat is a deadly kidney disease called glomerulonephritis, which is actually an immune response to strep bacteria infection. Antibodies work by swallowing the invading bacteria and the resulting mass can clog up the kidneys’ filtering channels (glomeruli). The less efficient kidney may cause debris to build up and prevent normal kidney functions. Common symptoms of glomerulonephritis are hypertension, bloody urine and swelling. Often, dialysis is performed until the antibiotics treatment can bring the situation under control. Antibiotics treatment within seven days after the onset can effectively prevent these complications."

Salivary Diagnostics

Great Article! -Jill Wade

Inside Dentistry, July/August 2011 Issue.

"Salivary diagnostics involves routine and advanced techniques for laboratory testing, with the goal of using saliva as the sample source to identify disease, or for preventing disease and evaluating the risk of disease. However, never to be overlooked is the careful and expert clinical examination. In this day and age, the clinical examination is improved by incorporating digital photography to document and highlight observations from the operatory suite. These images can, in turn, be transmitted to experts via the Internet to create a medium for consultation in real time.

Presently, several areas of research purport that novel proteins, shed or secreted from cells throughout the body, can be measured in saliva. These include markers indicative of breast and pancreatic cancer, cardiovascular disease, incipient infection, and metabolic disorders such as diabetes mellitus. Because of the ease in collection, transport, and storage, it is likely that with further refinement of such molecular and biochemical tests, saliva will be the sample of choice for many screening and diagnostic programs.

Beyond using salivary diagnostics for diagnosing disease is the issue of testing patients “at risk” for disease. This distinction is not subtle. New testing technologies, such as PCR for molecular genetics, or mass spectroscopy for protein analysis, reach levels of sensitivity that go below those required to offer treatment, but at the same time identify people who should be counseled about changes in their lives that can prevent disease from developing. Two examples illustrate this point.

The causes of periodontitis continue to be debated. However, the following two—bacteria and inflammation—are at least known to be involved. Testing for mediators of inflammation, such as cytokines, is not yet available for routine clinical testing, but testing for the genetic markers of high or lower levels of cytokine release is. Therefore, testing patients for variance in the genetic sequences for the interleukin 1 genes classifies patients both with and without bacterial periodontitis into those at high or low risk of this causative factor in disease. This is a powerful vantage for practitioners who seek to promote patient wellness, as well as serve their interest to cure the patient who is sick.

Testing for oral HPV shares a similar vantage of better serving individuals at risk for developing oral cancer than those who already host a lesion on its way to becoming a tumor. HPV testing, by virtue of the sensitivity of the testing methodology, identifies individuals who are at risk of epithelial lesions because it is one of the prerequisite factors that cause hyperplastic growth of infected cells. However, relatively few patients with HPV infection progress, and the virus typically will “become quiet.” With a greater focus on identifying risk and less on confirming a diagnosis, HPV testing is one area where the clinician shows their concern by practicing preventive medicine.

Salivary diagnostics implies the use of tests that are highly sensitive and are thus capable of finding disease before it is detectable by other modalities. In some situations, the effect of this extraordinary sensitivity leaves the clinician without a specific action plan other than to prescribe necessary follow-up, and/or watch and wait. This is a situation where clinicians and patients may become frustrated by dealing with information that places new responsibilities on each, while not relying on a therapy to solve the problem.

For patients coping with test results that project disease risk, the goal to avoid sickness falls on their shoulders. In general, the patient’s responsibility will be centered on changes in lifestyle, diet, exercise, and the obligation to follow-up and watch for changes. This is well exemplified by tests that look for markers of incipient cardiovascular disease, such as C-reactive protein (CRP). CRP levels are measured in the blood or saliva, and elevated levels indicate a heightened state of inflammation that accelerates the progression of atherosclerosis.

For the doctor, practicing preventive medicine means more time committed to patient education and counseling. Ordering CRP levels of patients creates a need for time between clinician and patient focused on what these tests are and what to do to change their values, which is generally about changes that promote good health overall (eg, weight reduction, lowered fat in the diet, and improved periodontal care). In this example, CRP as a marker of cardiovascular health creates the obligation to talk with patients about things outside the office and on matters where there is very little control over the outcome.

The laboratory is a service business. In recent years, innovations in cellular and molecular technology have brought advanced science into the clinical arena, where the type of information created requires better means of communicating those data. For the laboratory, employing genetic counselors and clinical specialists to liaison with the doctor’s office are required to shoulder the ongoing need for educating and updating on the use of these tests.

For the clinician, the best way to incorporate these new technologies is to allow the laboratory to provide these services. Salivary diagnostic testing is a new area of medicine, and many of the standards of practice are not yet established. Using these new types of tests raises concerns by clinicians, who feel they are untrained in subjects now being examined by these tests, and indicates a greater need for doctors and laboratory experts to work together in consultation."

Heart Health in America

I found this information at http://www.heart.org/ and it is scary and insightful. Please join Stonebriar Smile Design in focusing on our health (especially heart health). We are working with the AHA Dallas location and look forward to raising money and awareness for this worthy cause.

-Jill Wade

A Look at Heart Health in America

Nearly four in ten American adults believe they have ideal heart health (39%).

Less than one in ten believes they have poor heart health (5%).

The majority of adults have visited a doctor or health care professional within the past year (80%).

70% of Americans report being told to make lifestyle changes by a doctor or other health care professional.

One third report being told each to exercise more (35%) and that they are overweight (33%).

One in five adults report currently being a smoker (19%).

Fewer than two in ten American adults (15%) achieve AHA’s recommended levels of moderate aerobic exercise, which is 150+ total minutes per week.

For more than four of ten adults, eating 9 servings of fruits and veggies (44%) or eating fish at least 2 times per week (45%) is a rare activity.

Heart disease and stroke affect everyone in this country-- your neighbors, loved ones and even you. But beating these deadly diseases doesn't have to mean radical fad diets and crazy exercise trends that are only temporary fixes. A long life of heart health is about taking small steps each day to change how you eat and live. As those small steps add up, one day you will realize you've changed your life, and perhaps the life of those you love, for the better.

This is exactly what the Stonebrair Smile Design team wants for each of you! We want to help change these numbers for the better. Last year, the American Heart Association launched an ambitious impact goal to get our nation on the road to better heart health. By 2020, the AHA wants to improve the cardiovascular health of Americans by 20% while reducing the deaths from cardiovascular diseases and stroke by 20%.

So stay tuned for activities we will hold and stay aware, informed and involved. We would love for you to join us for such an important cause!