Slides from Sept. 19th lecture

1. BIO4360 Oral Medicine Etiology of Pathologies II Monday, Sept. 19 th , 2011

2. Metabolic Inflammatory Neoplasms Developmental Metabolic a) Hormonal b) Nutritional c) Compromised Organ Systems Inflammatory a) Trauma b) Infection – viral, fungal, bacterial c)Immunologic - autoimmune ‘ MIND’ Algorithm

3. Inflammatory – c) immunologic i) immune response to body’s own antigens (autoimmune) -pemphigus, pemphigoid ii) allergic reaction to external antigen - cinnamon, toothpaste, medications, etc. ‘ MIND’ Algorithm

4. Inflammatory – c) immunologic i) immune response to body’s own antigens (autoimmune) -pemphigus, pemphigoid ii) allergic reaction to external antigen - cinnamon, toothpaste, medications, etc. Inflammatory – d) reactive -body’s response to chronic, physical irritation -papillary hyperplasia, pyogenic granuloma, epulis fissuratum ‘ MIND’ Algorithm

7. 12 Questions to Ask “ Listen to your patient and the patient will give you the diagnosis” Sir William Osler

12. 12 Questions to Ask 6) What can you do/have you done that makes it better or worse? -if stopped using product and it resolved…immunologic -hypersensitivity/allergic rxn -improves with salt water, worsens with orange juice -ulceration/erosion

13. 12 Questions to Ask 6) What can you do/have you done that makes it better or worse? -if stopped using product and it resolved…immunologic -hypersensitivity/allergic rxn -improves with salt water, worsens with orange juice -ulceration/erosion 7) Does it come and go/change during the day? -if rapid change…….trauma related -if stress related…..less in morning, worse later in day -around mealtime?

14. 12 Questions to Ask 8) Do you remember injuring the area of the lesion? -identify trauma or recurrent trauma

15. 12 Questions to Ask 8) Do you remember injuring the area of the lesion? -identify trauma or recurrent trauma 9) Do you have any lesions on other parts of your body? -increased potential for immunologic cause -auto-immune diseases with dermatologic symptoms -some developmental lesions also have skin changes (café au lait spots)

16. 12 Questions to Ask 8) Do you remember injuring the area of the lesion? -identify trauma or recurrent trauma 9) Do you have any lesions on other parts of your body? -increased potential for immunologic cause -auto-immune diseases with dermatologic symptoms -some developmental lesions also have skin changes

17. 12 Questions to Ask 10) Do other people in your family have anything similar? -family Hx points to developmental problem (usually)

18. 12 Questions to Ask 10) Do other people in your family have anything similar? -family Hx points to developmental problem (usually) 11) How is your general health? Other than the oral problem, do you feel medically well? -if ‘yes’ less likely due to metabolic or systemic disease

19. 12 Questions to Ask 10) Do other people in your family have anything similar? -family Hx points to developmental problem (usually) 11) How is your general health? Other than the oral problem, do you feel medically well? -if ‘yes’ less likely due to metabolic or systemic disease 12) Are you taking any medication for any reason currently or were you taking medication recently? -verifies info about general health -oral effects of meds

20. 12 Questions to Ask REMEMBER: -intra-oral exam is NOT all that’s required to arrive at diagnosis -need to combine with info gained from questioning -either confirm Dx or lead to next step in tmt plan -biopsy, drug therapy, or ‘watchful waiting’ depends on suspected etiology

22. Available Online

23. BIO4360 Oral Medicine Monday, Sept. 19 th , 2011 Herbal Products and Supplements

24. Come One, Come all

25. Come One, Come all

26. Come One, Come all

27. The products and the claims made about specific products on or through this site have not been evaluated by Herbal Remedies or the United States Food and Drug Administration and are not approved to diagnose, treat, cure or prevent disease. The information provided on this site is for informational purposes only and is not intended as a substitute for advice from your physician or other health care professional or any information contained on or in any product label or packaging. You should not use the information on this site for diagnosis or treatment of any health problem or for prescription of any medication or other treatment. You should consult with a health care professional before starting any diet, exercise or supplementation program, before taking any medication, or if you have or suspect you might have a health problem . Disclaimer

32. Beliefs -Canadian studies have shown herbal medicines being used by 30-35% of people “ Patients often believe that herbs are natural alternatives to prescription medications, and do not recognize that herbs are composed of bio-active chemicals which may be toxic and can interact with other medications” Arch Fam Med 1998;7(6):523-36 " Better Living Through Chemistry "

33. Beliefs -Canadian studies have shown herbal medicines being used by 30-35% of people “ Patients often believe that herbs are natural alternatives to prescription medications, and do not recognize that herbs are composed of bio-active chemicals which may be toxic and can interact with other medications” Arch Fam Med 1998;7(6):523-36 "The miracles of science"

34. Ethnobotany Botany + Anthropology

35. Ethnobotany Botany + Anthropology

36. Ethnobotany Phillippus Aureolus Paracelsus 1493-1541AD “ It’s the dose that makes the poison” Botany + Anthropology

37. Ethnobotany Poisonous plants are medicinal plants & Medicinal plants are poisonous plants Herbal medications are important

38. Ethnobotany Poisonous plants are medicinal plants & Medicinal plants are poisonous plants Herbal medications are important

39. Herbal based Medicines -1900’s – herbal supplements hallmarks of pharmaceutical industry -67% of all medicine listed in US Pharmacopeia were botanicals……now only 2% - >1/2 of “modern” prescription & OTC drugs have botanical origins (aspirin, caffeine, cyclosporine, digoxin, quinine)

40. Herbal based Medicines -1900’s – herbal supplements hallmarks of pharmaceutical industry -67% of all medicine listed in US Pharmacopeia were botanicals……now only 2% - >1/2 of “modern” prescription & OTC drugs have botanical origins (aspirin, caffeine, cyclosporine, digoxin, quinine) -ethnobotany very important - < 0.5% of the world’s vanishing tropical plant species have been investigated for their medicinal qualities

43. Definitions Herbal supplements : -are one type of dietary supplement -An herb is a plant or plant part (leaves, flowers, seeds, roots) that is used for its flavor, scent, and/or therapeutic properties -&quot;Botanical&quot; is often used as a synonym for &quot;herb.&quot; -may contain a single herb or mixtures of herbs.

44. Regulations (USA) -US Dietary Supplement Health and Education Act (1994) -compromise -exempts vitamins, minerals, & botanical products from meaningful FDA regulation

45. Regulations (USA) -US Dietary Supplement Health and Education Act (1994) -compromise -exempts vitamins, minerals, & botanical products from meaningful FDA regulation -burden of proof? -2006 – Changes to Federal food, Drug and Cosmetic Act -require industry to report all serious dietary supplement related adverse drug effects to the FDA -2007-10 – manufacturers must test for purity, -ensure no contaminants -verify contents match labeling information

46. -Labeling according to the DSHEA: -prevents use of therapeutic claim ex: “for treatment of hypertension” -must be labeled as dietary supplement -CAN contain claims of effect on structure or function of body (ex: increases immunity) Regulations (USA)

48. -Labeling according to the DSHEA: -prevents use of therapeutic claim ex: “for treatment of hypertension” -must be labeled as dietary supplement -CAN contain claims of effect on structure or function of body (ex: increases immunity) -info does not have to be scientific, but cannot be false or misleading (responsibility in hands of FDA) Multiple violations / near violations Regulations (USA)

49. … your webpage …. bears the following claim: &quot;[F]our recent studies in people at risk for coronary disease have shown a significant cholesterol lowering effect from tea or tea flavonoids ... One of these studies, on post-menopausal women, found that total cholesterol was lowered by 8% after drinking 8 cups of green tea daily for 12 weeks ....“ The therapeutic claims on your website establish that the product is a drug because it is intended for use in the cure, mitigation, treatment, or prevention of disease. Regulations (USA)

50. Your Sparkling Green Tea Ginger Ale bears the claim, &quot;ENHANCED WITH 200 mg OF ANTIOXIDANTS FROM GREEN TEA & VITAMIN C**&quot; with the double asterisk referring to the statement, &quot;* *Each 8 oz serving contains 200 mg of antioxidants from Green Tea Flavonoids and Vitamin C&quot; on the principal display panel of the product label. In the context of this label the term &quot;enhanced&quot; is an unauthorized synonym for a &quot;more&quot; nutrient content claim. FDA has defined the nutrient content claim &quot;more&quot; and its authorized synonyms in 21 CFR 101.54(e). Regulations (USA)

51. -Labeling according to the DSHEA: -prevents use of therapeutic claim ex: “for treatment of hypertension” -must be labeled as dietary supplement -CAN contain claims of effect on structure or function of body (ex: increases immunity) -info does not have to be scientific, but cannot be false or misleading (responsibility in hands of FDA) -information can be physically separate from the product (ie: product on one shelf, info in another isle) HUH????? Regulations (USA)

52. Canada: Natural Health Product Regulations (2004) -allowed for sale of products otherwise not allowed under the Food and Drug Regulations -pre-2004 natural health products either drugs, or foods ( Food and Drug Act ) Regulations (Canada)

53. Canada: Natural Health Product Regulations (2004) -allowed for sale of products otherwise not allowed under the Food and Drug Regulations -pre-2004 natural health products either drugs, or foods ( Food and Drug Act ) -different sets of reg’s for cosmetics, foods, drugs, etc. -burden of proof varies Regulations (Canada)

54. Canada: Natural Health Product Regulations (2004) -allowed for sale of products otherwise not allowed under the Food and Drug Regulations -pre-2004 natural health products either drugs, or foods ( Food and Drug Act ) -different sets of reg’s for cosmetics, foods, drugs, etc. -burden of proof varies Regulations (Canada)

55. Canada: Natural Health Product Regulations (2004) Natural health products (NHPs) are defined as: -vitamins and minerals, -herbal remedies (ex: St. John’s Wort), -homeopathic medicines ** -traditional medicines (Traditional Chinese Medicines), -probiotics, Regulations (Canada)

56. Canada: Natural Health Product Regulations (2004) Natural health products (NHPs) are defined as: -vitamins and minerals, -herbal remedies (ex: St. John’s Wort), -homeopathic medicines ** -traditional medicines (Traditional Chinese Medicines), -probiotics, Regulations (Canada)

57. Canada: Natural Health Product Regulations (2004) Natural health products (NHPs) are defined as: -vitamins and minerals, -herbal remedies (ex: St. John’s Wort), -homeopathic medicines ** -traditional medicines (Traditional Chinese Medicines), -probiotics, -other products like amino acids and essential fatty acids. Regulations (Canada)

58. Canadian Database

60. Energy Drinks -call for Health Canada to get involved with regulating -if considered ‘foods’ only have to list ingredients -talks about natural product not having to label caffeine containing herbal ingredients -if ‘natural health products’ also have to have appropriate warnings packs 505 mg of caffeine and 5000 mg of taurine Beverage…..or drug delivery systems??

61. Energy Drinks -call for Health Canada to get involved with regulating -if considered ‘foods’ only have to list ingredients -talks about natural product not having to label caffeine containing herbal ingredients -if ‘natural health products’ also have to have appropriate warnings packs 505 mg of caffeine and 5000 mg of taurine Beverage…..or drug delivery systems??

62. Energy Drinks

63. Energy Drinks

64. Energy Drinks

65. Alcoholic Energy Drinks

66. Alcoholic Energy Drinks