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Am Fam Physician. 2002;65(5):982-987

CDC Fluoride Guidelines to Prevent Tooth Decay

New guidelines for fluoride use to prevent tooth decay have been issued by the Centers for Disease Control and Prevention (CDC). These guidelines reflect the current availability of a variety of fluoride-containing products and the widespread use of bottled water, and they offer information for the professional community and the general public. The guidelines were published in the August 17, 2001 recommendations and reports series of Morbidity and Mortality Weekly Report (MMWR).

Although a significant decline in the incidence and severity of tooth decay has occurred since the 1940s when fluoride was introduced into public drinking water supplies in the United States, certain segments of the population remain at risk for developing tooth decay. Those include persons with low socioeconomic status, those who do not receive regular dental care, those who consume high quantities of sugars, and those who wear orthodontic appliances. Additionally, persons who live in communities where the water supply does not meet established recommendations for fluoridation may experience greater incidences of tooth decay.

The new guidelines apply to children as well as adults, because fluoride is necessary throughout a person's lifetime to prevent and control tooth decay. These recommendations include:

  • Continuing and expanding fluoridation of community drinking water supplies. Currently, about 100 million Americans do not benefit from fluoridated drinking water.

  • Using small amounts of fluoride frequently, including brushing teeth twice daily with fluoridated toothpaste.

  • Using fluoride supplements and products with high concentrations of fluoride judiciously. Supplements are appropriate for children at high risk for tooth decay and who live in communities with low concentrations of fluoride in the drinking water. Professionally applied products that contain high concentrations of fluoride may also most benefit children at high risk.

  • Monitoring the intake (including swallowing) of fluoride in children younger than six years of age because overuse can result in enamel fluorosis. A “pea-sized” amount of fluoride toothpaste is recommended for children younger than six years of age, and a physician or dentist should be consulted about the use of fluoride toothpaste in children younger than two years of age.

  • Labeling bottled water with its fluoride concentration to allow consumers to understand how it may be affecting their fluoride intake. Currently, most bottled waters contain suboptimal levels of fluoride.

  • Educating health care professionals and the public to take advantage of currently available fluoride products.

Scientific Exhibit Deadlines for AAFP Assembly

A call for scientific exhibits has been issued by the American Academy of Family Physicians (AAFP) for possible presentation at the 2002 Scientific Assembly occurring October 16–20, 2002 in San Diego. Applications must be submitted by April 12, 2002. Membership in the AAFP is not a prerequisite for submission. Scientific exhibits provide a forum for the presentation of research that is of interest and educational value to family physicians. The exhibits include those presented by residents and medical students.

Travel grants of $1,000 may be awarded to a maximum of 15 resident/student scientific exhibitors whose applications are accepted for presentation at the assembly. In addition, cash awards for first, second, third, and fourth places may be presented to resident/student exhibitors. Application forms may be obtained from Vicky Binder, Scientific Program Department, AAFP, 11400 Tomahawk Creek Pkwy., Leawood, KS 66211; telephone: 800-274-2237, ext. 6564; or by visiting the AAFP Web site

2001 Cancer Progress Report

The National Cancer Institute (NCI) released a report titledCancer Progress Report 2001, which is the first in a series of reports intended to make scientific information related to cancer easier to access and understand. The information contained in the report is the result of collaborative efforts by NCI, federal agencies including the Centers for Disease Control and Prevention, the American Cancer Society, professional organizations, and cancer researchers. This report analyzes progress made in reducing cancer burden across a continuum. Measurement points on the continuum included prevention, early detection, diagnosis, life after cancer, and end of life.

The report indicates that rates of new cancers and cancer deaths are declining as a result of state-of-the-art treatments, a reduction in the numbers of adults who smoke, and increased screenings for breast, cervical, and colorectal cancers. Areas where the report shows improvements need to be made include the following: reducing tobacco use, especially in youths; addressing increases occurring in certain types of cancer, including melanoma; and understanding cancer-related disparities among certain populations in the United States.

Current data were compared with the cancer-related targets of Healthy People 2010, which contains 10-year objectives established by the U.S. Department of Health and Human Services. The comparisons can be used to identify trends and gaps. The information presented was designed to be used by the public as well as policy makers, researchers, and physicians.

Free copies of the report can be obtained by calling 800–4-CANCER and requestingCancer Progress Report 2001 (T905). The online version is available The online version will be updated every six to 12 months, and the print version will be revised and published biannually.

Call for Papers of Family Practice Research Presentations

A call for papers has been issued by the American Academy of Family Physicians (AAFP) for possible presentation at the 2002 Scientific Assembly occurring October 16–20, 2002 in San Diego. Applications must be submitted by April 12, 2002. Membership in the AAFP is not a prerequisite for submission.

Applications may be submitted in two different categories. Category I is for original research relevant to family practice; Category II includes case studies and literature reviews. Each category has six author classifications: family physicians and fellows primarily in academic medicine, family physicians primarily in clinical practice, family practice residents, medical students, international attendees, and others. The international attendee classification is open to anyone outside the United States who conducted clinical or educational research relevant to family medicine.

Up to six first-place winners in Category I and one first-place winner in Category II will each receive a cash award of $1,000. Up to six runners-up in Category I and one runner-up in Category II will receive $250 cash awards. All awards are given at the discretion of the Subcommittee on Family Practice Research Presentations. Application forms may be obtained by visiting the AAFP Web site or from Carrie Vickers, Scientific Program Department, AAFP, 11400 Tomahawk Creek Pkwy., Leawood, KS 66211; telephone: 800-274-2237, ext. 6568.

First Biologic Treatment for Sepsis

Xigris, a drug developed to treat adults with severe sepsis who have a high risk of dying of the condition, has been approved by the U.S. Food and Drug Administration. The new treatment is a genetically engineered version of a naturally occurring human protein, Activated Protein C, which interferes with some of the body's harmful responses to severe infection.

Sepsis generally develops as the result of an infection from trauma, surgery, burns, or pneumonia. About 750,000 persons in the United States develop severe sepsis annually; almost one third of those persons die.

In clinical trials of the drug, mortality rates were reduced 13 percent (from 44 to 31 percent) in patients who were determined to be at high risk of dying based on their overall health and severity of illness. The most serious side effect of Xigris was bleeding (occurring in 2.4 percent of patients), including that which causes stroke.

Xigris interferes with the body's harmful responses to severe infection, including blood clot formation that can precipitate organ failure and even death. The drug is available in 5- and 20-mg vials to be administered by intravenous infusion. The risks and benefits of treating patients with Xigris must be carefully considered because sepsis is potentially life threatening, and the drug has potentially serious side effects.

New Antiretroviral for HIV Infection

The U.S. Food and Drug Administration has approved tenofovir disoproxil fumarate (Viread), a 300-mg once-daily tablet, to treat patients with human immunodeficiency virus (HIV) infection when taken in combination with other antiretrovirals. In clinical trials, patients who had stopped responding optimally to other antiretroviral therapy because of viral resistance, experienced significant antiviral responses with Viread.

Viread works by blocking an enzyme—reverse transcriptase—that has a role in replicating HIV. Because the drug is a nucleotide, it remains in cells longer than other antiretroviral drugs. In clinical studies, it was added to patients' existing antiretroviral regimens and reduced HIV levels for up to 48 weeks. Resistance to Viread rarely developed and, when it did, it developed slowly.

Adverse side effects included mild to moderate gastrointestinal symptoms such as nausea, vomiting, flatulence, and diarrhea.

Initiatives to Accelerate Bioterrorism Research

Seven new initiatives designed to accelerate bioterrorism research and strengthen the ability of the United States to manage the public health threat created by the threat of bioterrorism have been announced by Health and Human Services Secretary Tommy Thompson. According to Thompson, the goal of the initiatives is to capitalize on the recent increase in ideas generated by academicians and scientists to understand and manage the potential threats of bioterrorism. The initiatives will be carried out by the National Institute of Allergy and Infectious Disease (NIAID), which is the lead institute for bioterrorism research at the National Institutes of Health.

These new initiatives will be a way to expedite the research proposal process with the goal of advancing research as quickly as possible. The initiatives will support research investigating high-priority, Category A biologic diseases—anthrax, botulism, plague, smallpox, tularemia, and viral hemorrhagic fevers—as defined by the Centers for Disease Control and Prevention. Many of these programs will encourage government partnerships with business and academia, and many will expand or build on existing NIAID research programs. These initiatives will include the following:

  • The Anthrax Vaccine Contract is designed to facilitate development of new vaccines against the anthrax toxin.

  • The Rapid Response Grant Program on Bioterrorism-Related Research will shorten the time required to process and fund applications. The program will also encourage the investigation of new prevention, treatment, and diagnostic strategies.

  • The Partnerships for Novel Therapeutic, Diagnostic, and Vector Control Strategies in Infectious Diseases will support new drug development and diagnostics for diseases considered a threat to public health, including those caused by possible agents of bioterrorism.

  • Exploratory/Developmental Grants: Technology Applications to NIAID-Funded Research. These grants will apply the latest technology to currently funded infectious disease research, particularly that pertaining to diseases caused by Category A agents of bioterrorism.

Projects that NIAID previously supported or is currently supporting include:

  • A project at the Institute for Genomic Research to sequence the anthrax bacterium genome.

  • Publication of two studies in the journal Nature that helped explain the cell destruction process of the anthrax toxin and reported developing a compound with the potential to block the toxin.

  • A clinical study to determine the safety of diluting the currently available 15 million smallpox vaccine doses in an attempt to vaccinate more people.

  • Submission of an Investigational Drug Application for the use of cidofovir as an emergency treatment for smallpox.

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Copyright © 2002 by the American Academy of Family Physicians.

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