Clinical Briefs



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Am Fam Physician. 2001 Sep 1;64(5):876.

CDC Report on Human Exposure to Chemicals

The Centers for Disease Control and Prevention (CDC) has released the first “National Report on Human Exposure to Environmental Chemicals.” This new research tool will provide better information on the levels of exposure to environmental chemicals, and over time is expected to help reveal what these levels mean for public health.

According to the report, biomonitoring allows the CDC to measure chemicals directly in blood and urine samples rather than estimating exposures by measuring air, water or soil samples. Using this new scientific method, the report provides data on actual levels of chemicals in humans. Based on this data, researchers are expected to be able to determine possible health effects and design appropriate public health strategies.

The report provides information on the exposure of the U.S. population to 27 chemicals, which are grouped into four categories as follows:

  • Metals—lead, mercury, cadmium, cobalt, antimony, barium, beryllium, cesium, molybdenum, platinum, thallium, tungsten and uranium.

  • Tobacco smoke—cotinine (a metabolite of nicotine that tracks tobacco smoke exposure).

  • Organophosphate pesticides (six metabolite measurements that represent exposure to 28 pesticides)—dimethylphosphate, dimethylthiophosphate, dimethyldithiophosphate, diethylphosphate, diethylthiophosphate and diethyldithiophosphate.

  • Phthalate metabolites—mono-ethyl, mono-butyl, mono-2-ethyl-hexyl, mono-cyclohexyl, mono-n-octyl, mono-isononyl and mono-benzyl.

The CDC plans to expand the report to include exposure data from studies of persons exposed from localized or point-source exposures (e.g., data on levels of mercury in persons who consume fish contaminated with mercury from a polluted river). For additional information on the report, visit the CDC Web site at http://www.cdc.gov or call 866–670–6052.

Minocycline Approved for Adult Periodontitis

The U.S. Food and Drug Administration has approved minocycline (Arestin) microspheres for the adjunctive treatment of adult periodontitis following scaling and root planing. Periodontal disease is a vastly under-treated health problem that carries serious health risks. An estimated 50 million persons in the United States have periodontal disease. Treatment is important because the disease may be linked to conditions such as coronary heart disease, stroke, diabetes and low-birth-weight preterm infants.

According to the drug manufacturer, periodontal disease destroys supporting gum tissue and bone, forming “pockets” around the teeth in which plaque and bacteria accumulate. The severity of periodontal disease is measured in part by the depth of these pockets. In a healthy state, the depth of unattached gums is 2 to 3 mm. Patients with pockets with a depth of more than 4 mm have periodontal disease and patients with pocket depth of more than 6 mm have advanced periodontal disease.

Through microsphere technology, minocycline is delivered beneath the gum, directly into the infected periodontal pocket after deep cleaning of the teeth and gums with a procedure known as scaling and root planing, a common method of treatment. The medication does not require mixing or refrigeration and is easy to administer. The manufacturer reports that minocycline is painless and easy to apply. The antibiotic does not require dressing or removal because it is completely resorbed and patients can resume routine oral hygiene 12 hours after treatment.

In clinical trials, treatment with minocycline following scaling and root planing significantly reduced pocket depth compared with scaling and root planing alone. This was true even in the sites that were hardest to treat and with the most challenging patients, such as smokers, those with cardiovascular disease and those older than 50 years.



Copyright © 2001 by the American Academy of Family Physicians.
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