Tag Archives: Doctors

Lloydspharmacy Is To Become The First Major Healthcare Brand To Supply Tamiflu Online

Customers can now buy Tamiflu via the Lloydspharmacy Online Doctor service. “We are playing as full a role as possible in the distribution of Tamiflu to NHS patients,” said Andy Murdock, Governance and Pharmacy Relations Director of Lloydspharmacy, “but it is clear that there is a significant demand for private prescriptions of the drug.

Supply Tamiflu Online

“We have decided to become the first recognised healthcare brand to sell Tamiflu online in advance of need so that people who want to buy the treatment can get it from a reputable online source which they can trust to dispense Tamiflu.”

Lloydspharmacy’s Online Doctor service is run in partnership with online health experts Dr Thom, the only online doctor to be regulated by the Care Quality Commission* specifically to prescribe medicines online.

Packs of 10 x 75mg Tamiflu will be available via the online pharmacy. All medicines will be dispatched using Royal Mail Special Delivery for delivery the next working day.

“Anyone displaying symptoms of swine flu, would be advised to call the NHS service appropriate to their area,” said Andy Murdock. “The Lloydspharmacy service is for people who want to ensure they have Tamiflu available if and when they need it and for people who will be travelling abroad at some point in the future.

“In the information sent out with every Tamiflu order Lloydspharmacy doctors will explain the symptoms people should look out for and the circumstances under which they should begin treatment.”

Lloydspharmacy has pioneered the development of online diagnosis and prescriptions. The Lloydspharmacy Online Doctor service is expanding and already offers treatments for impotence, hair loss and cystitis plus oral contraceptives, sexual health tests and travel medications.

About Lloydspharmacy
Lloydspharmacy has around 1700 pharmacies across the UK. These are based predominantly in community and health centre locations. The company employs over 16,000 staff and dispenses over 145 million prescription items annually. Lloydspharmacy is the trading name of Lloydspharmacy Ltd, a wholly owned subsidiary of Celesio AG based in Stuttgart. Celesio is the leading pharmaceutical distribution company in Europe and is represented in 16 countries. With its three divisions, Patient and Consumer Solutions, Pharmacy Solutions and Manufacturer Solutions, the group covers the entire scope of pharmaceutical trade and pharmaceutical-related services.

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Eating Disorders, Just Like All Other Addictions, Are Also Diseases

Sunset Malibu, an exclusive treatment center on the California coast, has long been a transformational force in the field of rehabilitation and recovery. Now, Sunset is announcing its redoubled efforts in the fight against eating disorders.

Eating Disorders

Anorexia nervosa and bulimia are diseases. Like all diseases, they exist outside the willful control of their victims. No one ever decides to be sick. And, by the same token, no one can ever simply decide to get better. In the end, those individuals who try to recover without professional eating disorder treatment are invariably doomed to fail.

The good news, though, is that Sunset Malibu’s eating disorder treatment programs really do change lives.

With its world-class caregivers and elegant accommodations, Sunset Malibu is an unparalleled recovery destination. The center has always catered to upscale individuals from every corner of the globe. Now Sunset is renewing its commitment to its core values, with the goal of delivering specially-tailored eating disorder treatment to individuals who seek it. Even for Teen Eating Disorders, the facility can help sufferers find the right treatment. At Sunset Malibu, the client’s needs always come first.

“Eating disorders are an increasingly pernicious problem in America and around the world,” said Sunset Malibu owner Richard Taite. “We believe that our focus on eating disorder treatment puts us at the fore of a growing field of therapy. More importantly, we know that our eating disorder treatment programs have a measurable impact on the lives of our clients. “

It’s this forward-thinking philosophy that makes Sunset almost unique among its competitors.

Many drug and alcohol rehab facilities dabble in eating disorder treatment. But very few make a concerted commitment to the eating disorder recovery process. In fact, many of the most expensive eating disorder treatment centers in California provide their clients with insufficient levels of care. It should come as no surprise that many of those clients rarely achieve lasting success.

Taite insists that such shortcomings are unacceptable.

“Eating disorder treatment can literally be a matter of life and death,” Taite said. “There are no second chances, no do-overs. At Sunset Malibu, we’re humbled by the faith our clients invest in us, and we take our responsibility with the utmost seriousness. We believe that our record of success reflects our commitment to healing process.”

Sunset Malibu has a long history of helping clients rebuild their lives from the ground up. Now more than ever before, the center promises to effect meaningful and lasting wellness for every individual who walks through its front doors. Anorexia nervosa and bulimia are awful diseases—but they aren’t unconquerable. As Sunset’s successful graduates have learned firsthand, there really is a tried-and-true way forward.As with all co-occurring disorders, Sunset Malibu treats eating disorders as a co-occurring disorder with drug and or alcohol abuse.

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Sunset Malibu – Chronic Depression Treatment

Sunset Malibu, an exclusive treatment center on the California coast, has long been a transformational force in the field of rehabilitation and recovery. Now, Sunset is announcing its redoubled efforts in the fight against clinical depression.

Sunset Malibu - Chronic Depression Treatment

Depression ruins lives. To succumb to the disease is to be stripped of one’s dignity, and one’s capacity for hope. The good news is that professional depression treatment really can help to solve the problem—but only if it’s administered with empathy and expertise. In the end, anything less than exceptional care is a recipe for failure.

Those considerations, in turn, are at the heart of Sunset Malibu’s depression treatment strategies, from Bipolar Disorder Treatment to severe depression treatment.

With its world-class caregivers and elegant accommodations, Sunset Malibu is an unparalleled recovery destination. The center has always catered to upscale individuals from every corner of the globe. Now Sunset is renewing its commitment to its core values, with the goal of delivering life-changing depression therapy to individuals who seek it. At Sunset Malibu, the client’s long-term wellness always comes first.

“Successful depression treatment allows patients to rediscover life as they used to know it,” said Sunset Malibu owner Richard Taite. “Our depression treatment programs are specially designed to help clients rebuild their world from the ground up, by giving them the skills and strength they need to heal on their own terms. That, in a nutshell, is why we’re so successful in our depression treatment efforts.”

But that success, unfortunately, is precisely what sets Sunset apart from its competitors.

It’s one thing for a rehab facility to offer depression treatment services to its clients. It’s quite another for that facility to make a sustained and meaningful commitment to the depression treatment process. Many Los Angeles treatment clinics claim to meet the emotional needs of their clients, but few of them actually deliver. Institutions that fail to provide proper care can’t be expected to produce lasting recovery.

Under the circumstances, argues Taite, those sorts of shortcomings are inexcusable.

“Our clients trust us with their health,” said Taite. “There’s no more important responsibility than that, and we take it with the utmost seriousness. At the end of the day, we believe that our record of success speaks to the commitment we make to each and every one of our residents.

No depression victim needs to be told about the perils of the disease. On the other hand, graduates of successful depression treatment do not need to be told about the true effectiveness of complete recovery. Sunset Malibu has a long history of helping clients heal from the inside-out. It’s hard to imagine that any gift could ever be more valuable. As with all co-occurring disorders, Sunset Malibu treats depression disorders as a co-occurring disorder with drug and or alcohol abuse.

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The U.S. Department Of Commerce Selects Medelita To Exhibit At Medica 2009

Medelita®, maker of breakthrough scrubs and lab coats for female clinicians, today announced that it has been selected by the United States Department of Commerce to participate in Medica 2009, a leading international trade fair for the medical industry, which will be held in Dusseldorf, Germany, November 18-21. Medica 2009 is comprised of more than 135,000 individuals, representing over 100 countries, that come to learn about current and future trends in both in-patient and out-patient care.

medelita

“As the largest medical trade show of its kind, Medica 2009 is the ideal venue for us to launch a new product line and showcase current Medelita products to an international audience,” said Joe Francisco, chief operating officer, Medelita. “We are extremely pleased to have been selected as one of an esteemed group of companies, to attend this year and showcase our unique lab coats and scrubs.”

Medelita is one of only ten U.S.-based medical supply companies invited to attend Medica 2009 and exhibit with the U.S. Department of Commerce, Office of Textiles and Apparel (OTEXA). In a recent statement, OTEXA reports that the medical textiles segment of the medical sector is experiencing one of the highest expansion rates in the technical textile market. According to recent research, over the next few years the world market for technical textiles and industrial nonwovens will increase by 3.8% per year – a volume value of nearly $126 billion.

In a bid to capture its share of this growing market, Medelita will be exhibiting its innovative medical apparel at the OTEXA USA Sample Pavilion. The company plans to introduce its men’s line of lab coats at Medica 2009. Medelita products are available direct to consumers and through its retail channels. Wholesale orders also are available to hospitals and large groups.

Made f r o m 100 percent high-denier cotton, the Medelita lab coat is designed specifically for women with a focus on fit and function. The fluid resistant lab coats are treated with Advanced Dual Action Teflon® fabric protector, which allows fabric to repel and release stains. Tailored for a feminine shape, the coats feature traditional side slits, French finish inside seams and hidden inside pockets that are great for carrying handheld devices and mobile phones.

In addition to high quality lab coats, Medelita provides a line of performance women’s healthcare apparel, including clinician scrubs and nursing scrubs, which are available for purchase at www.medelita.com.

Medelita will be exhibiting at the USA Business Information Office, set up by OTEXA, E10, Hall 16. To schedule a SKYPE pre-briefing, please email joe@medelita.com or call 1-877-987-7979.

About Medelita
Medelita has one purpose: to reinvent the way women of all healthcare professions present themselves at work by offering the highest quality, best fitting, and most comfortable medical apparel available, including lab coats, women’s lab coats and women’s scrubs. Medelita caters to professional women who want their uniforms to embody the poise and confidence already displayed f r o m within. For more information, visit our website at http://www.medelita.com or call (877) 987-7979.

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Leading Cosmetic Surgery Providers The Hospital Group Has Helped Inform Teenage Surgery-Seekers In A BBC3 Television Programme

Two thirteen-year-old girls undertook a week-long journey to decide whether they really did want to take the plunge and have breast augmentation surgery as part of the ‘Boob Job: My Big Decision’ programme.

thehospitalgroup

The ‘grand finale’ of the week was a visit to The Hospital Group’s specialist cosmetic surgery hospital in Bromsgrove. During the week, the girls, Kianna and Kat, met women who had already had surgery and quizzed a group of boys to find out their views on breast size and the fake vs real debate. The girls also had a session with a family counsellor to explore their motivations for surgery plus a day’s work experience as a dancer and a chef to get a taste of adult working life.

The girls’ journey ended with an opportunity to sit in on a consultation with a real-life patient and consultant surgeon Mr Sulaiman, with the chance to pose all their questions to both the surgeon and the patient. They then followed the patient into theatre to experience first-hand the reality of undergoing a cosmetic procedure.

Following the experience, both Kianna and Kat decided that surgery wasn’t the answer at this stage in their lives. Although Kat still intends to have plastic surgery when she is older, Kianna realised that she is still growing and larger breasts could hinder a career in
dance. While The Hospital Group is one of the country’s leading surgery providers, it remains stringent in its values.

David Ross, Chief Executive of The Hospital Group, said: “We were delighted to take part in ‘Boob Job: My Big Decision’. The Hospital Group is a responsible surgery provider and we are proud of our values. We have an extensive consultation process prior to surgery to discuss the realities of surgery with our patient – including what outcome they should expect as a result of the surgery as well as the recovery implications and the risks. Being involved in informing and challenging these two young girls’ thinking was very worthwhile.

“Women as young as Kianna and Kat would never be treated at The Hospital Group as we only treat patients over the age of 18. However, we do have interest from younger patients so this was a useful educational process.”

The Hospital Group’s role in ‘Boob Job: My Big Decision’ follows gastric surgeon Paul Super’s appearance on Channel 4 programme ‘The Hospital’, where he advised obese patients on bariatric (weight loss) surgery.

Since The Hospital Group was established in 1992, it has grown from a small pharmaceutical company to one of the UK’s foremost cosmetic surgery and weight loss surgery providers. The Hospital Group is committed to providing the very highest standards and all procedures are performed by an expert medical team in state-of-the-art facilities that are second to none.

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Even Eating Disorders Can Be Treated In Luxury

Sunset Malibu, an exclusive treatment center on the California coast, has long been a transformational force in the field of rehabilitation and recovery. Now, Sunset is announcing its redoubled efforts in the fight against anorexia and bulimia.

An eating disorder is a disease, whether its anorexia or Binge Eating. Like any disease, it can only be eradicated by professional medical treatment. Sufferers who try to get better without the help of eating disorder treatment specialists are invariably doomed to fail. In the end, healing is not and cannot be a solitary undertaking.

The importance of professional expertise, in turn, lies at the very heart of Sunset Malibu’s eating disorder treatment philosophy.

With its world-class caregivers and elegant accommodations, Sunset Malibu is an unparalleled recovery destination. The center caters to upscale residents from every corner of the globe. Now Sunset is renewing its commitment to its core values, with the goal of delivering life-changing eating disorder treatment to all individuals who seek it. At Sunset Malibu, the client’s personal needs always come first.

“Eating disorder treatment is an enormously delicate process,” said Sunset Malibu owner Richard Taite. “To be successful, treatment must be administered by people who know exactly what they’re doing. Our eating disorder specialists at Sunset Malibu are leading figures in their respective fields, which helps to explain why our clients enjoy such a robust rate of success.”

It is that emphasis on clinical excellence that makes Sunset almost unique among its competitors.

Every eating disorder treatment facility pays lip service to the importance of caregiver expertise. But many institutions fail to put that principle into practice. Indeed, the most high-priced clinics in Los Angeles routinely devote insufficient resources to their eating disorder treatment personnel. Predictably, those clinics rarely help their clients achieve lasting recovery.

Under the circumstances, argues Taite, such shortcomings are inexcusable.

“Eating disorder treatment saves lives,” Taite said. “At Sunset Malibu, we understand the depth of trust that our clients put in us, and we take our responsibility with the utmost seriousness. Simply put, we see it as our duty to be the best in the world at what we do.”

It’s no secret that eating disorders ruin lives. To succumb to anorexia or bulimia is to be stripped of one’s dignity, and one’s sense of self-control. Sunset Malibu has a long history of helping clients rebuild their lives from the ground up. As the center’s successful graduates have learned firsthand, no gift could ever be more precious than that.

Contact Details: As with all co-occurring disorders, Sunset Malibu treats eating disorders as a co-occurring disorder with drug and or alcohol abuse. Sunset Malibu is a luxury Eating Disorders Treatment and addiction treatment center located in Malibu, California. For further details about Sunset’s treatment strategies, for example Treating Anorexia, accommodations, or other general facts, please call 1-800-332-9202 or visit our Web site at http://www.drugrehabsunsetmalibu.com/.

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Menopause Blamed For Rise In Receding Hair

Hair loss is often the hardest aspect of growing old, but for a number of people the problem is not confined to their later years.

And it’s not just men suffering from the affliction, with studies suggesting an increasingly number of post-menopausal women are finding their hairlines receding.

This new epidemic is a type of alopecia, which damages hair follicles so that hair falls out and cannot grow back.

The condition known as Frontal Fibrosing Alopecia (FFA) can cause women to lose up to five inches from their hairline as well as their eyebrows. If FFA goes undiagnosed, women can even lose hair at the sides and back of their head.

Scientists believe that FFA is a result of the immune system attacking hair follicles, which causes inflammation at the root. This can damage stem cells in the follicles and prevents hair from growing back entirely.

The only treatment available involves controlling this inflammation, so only offers a reduction in overall hair loss rather than a cure.

However, the damage for most has already been done and the only alternative is to undergo a hair transplant.

The Hospital Group, one of the country’s leading cosmetic surgery providers, is at the forefront of hair restoration surgery, treatments and techniques. Those seeking a solution to their hair loss can undergo a hair transplant, which involves splitting the follicles of existing hairs and relocating them in the sparse area.

Providing expert advice and assistance, The Group carries out more hair transplantations than any other clinic in the UK and recognises that hair restoration is an art just as much as a surgical procedure.

Since The Hospital Group was established in 1992, it has grown from a small pharmaceutical company to one of the UK’s foremost weight loss surgery providers.

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Gordon Ramsay Is Famous For A Number Of Reasons; His Cooking, Short Temper, Foul Mouth And, Notably, His Furrowed Brow And Chin

But not for much longer. Ramsay has admitted to having BOTOX® injections only a month after telling Australian TV presenter, Tracy Grimshaw, that she needed the treatment herself.

Gordon Ramsay

The controversial chef and host of “The F word” had his haggard chin smoothed after close friend, Simon Cowell, teased him about his looks.

When comparing pictures it is clear that his furrowed brow and lines on his chin looks far less pronounced.

There is also speculation that Ramsay may have had a number of facial fillers and a slight face lift under local aesthetic.

The chef is just one of many Brits who have decided to undergo non-surgical procedures to lift their spirits during the credit crunch.

The Hospital Group, one of the country’s largest provider of both surgical and non-surgical treatments reported a 226 per cent increase in the number of non-surgical procedures performed in 2008. A total of 5,200 treatments were carried out across the group last year with treatments such as BOTOX®, hyperhidrosis and face peels rising in popularity.

Since The Hospital Group was established in 1992, it has grown from a small pharmaceutical company to one of the UK’s foremost cosmetic surgery providers. The Group is committed to providing the very highest standards and all procedures are performed by an expert medical team in state-of-the-art facilities that are second to none.

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Medelita Announces Record Second Quarter Performance

Medelita®, maker of breakthrough medical apparel for female clinicians, today announced that its second quarter fiscal year 2009 revenues have increased 119 percent, over last quarter. Medelita has been in business just over one year and sells its innovative lab coats and medical scrubs direct to consumers online, through authorized resellers and wholesale. In addition, the company sells its lab coats and scrubs at national and regional medical conferences.

medelita

“The economy has not slowed the growth of Medelita, with our second quarter seeing a 119 percent increase in revenue from our online and medical conference sales,” said Joe Francisco, chief operating officer, Medelita. “We are experiencing a tremendous conversion rate through our ecommerce channel and what’s even more impressive is the rate of returning visitor conversion, which is up almost 73 percent.”

Returning visitor conversion rate is up 72.50 percent, from 7.82 percent to 13.49 percent. This significant increase reflects the strength of Medelita products in a marketplace that offers limited choices for quality lab coats and scrubs.

Satisfied customers are returning to purchase new styles and additional colors, steadily replacing their existing medical wardrobe with Medelita products. The company attributes the garments’ high value and performance to building a solid return clientele base and is receiving unsolicited testimonials about its products superiority, fast turnaround and courteous customer service.

Medelita’s innovative approach to medical apparel was born out of necessity when founder, Lara Manchik, emergency room PA turned entrepreneur, failed to find alternatives to the frumpy, unisex medical apparel made for the male figure and representative of a time when men dominated the field.

Made from 100 percent high-denier cotton, Medelita lab coats are designed specifically for women with a focus on fit and function. The fluid resistant lab coats are treated with Advanced Dual Action Teflon® fabric protector, which allows fabric to repel and release stains. Tailored for a feminine shape, the coats feature traditional side slits, French finish inside seams and hidden inside pockets that are great for carrying handheld devices and mobile phones.

In addition to high quality lab coats, Medelita provides a line of performance women’s healthcare apparel, including clinician scrubs and nursing scrubs, which are available for purchase at www.medelita.com.

About Medelita
Medelita has one purpose: to reinvent the way women of all healthcare professions present themselves at work by offering the highest quality, best fitting, and most comfortable medical apparel available, including lab coats, women’s lab coats, women’s scrubs and medical scrubs. Medelita caters to professional women who want their uniforms to embody the poise and confidence already displayed from within. For more information, visit our website at http://www.medelita.com or call (877) 987-7979.

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Dental Facelift Offered At Smile South Florida Cosmetic Dentistry

At Smile South Florida Cosmetic Dentistry, our top cosmetic dentists look at the whole picture when it comes to cosmetic and restorative dental work.

As we age, our teeth wear down and our faces appear more short. The cheeks also become sunken in and there is a collapse of the dental arches. This creates the appearance of more defined lines around the mouth and lower face, as well as an aging effect due to discoloration and reduced quality of the dental aesthetics. This is why Smile South Florida performs a dental restorative facelift.

A dental facelift is the use of cosmetic dentistry to create the effect of a traditional facelift, without intrusive plastic surgery.

A dental facelift can take years off of the face by restoring the fullness of the face lost over time. It can have a significant impact on not just the look of the patients face, but also on the function by having proper tooth, bite, and jaw alignment.

As we reach middle age, the dental arches, especially on the lower teeth, have a tendency to collapse inward given a sunken in look to the jaw. Widening the smile is one important method to help in giving back the fullness of the cheeks. We take into consideration replacing lost tooth structure and improving the height of the teeth. The teeth also start to become chipped, worn, crooked, discolored, and can even fall out/be missing. This also presents severe aging effect to the mouth, and especially the entire face.

Here are some of the dramatic results that can be achieved through cosmetic and restorative dentistry at Smile South Florida:

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Dental Restorative Facelift at Smile South Florida dentistry Dental Restorative Facelift at Smile South Florida dentistry

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Dental Restorative Facelift at Smile South Florida dentistry Dental Restorative Facelift at Smile South Florida dentistry

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Dental Restorative Facelift at Smile South Florida dentistry Dental Restorative Facelift at Smile South Florida dentistry

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Dental Restorative Facelift at Smile South Florida dentistry Dental Restorative Facelift at Smile South Florida dentistry

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Dental Restorative Facelift at Smile South Florida dentistry Dental Restorative Facelift at Smile South Florida dentistry

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Dental Restorative Facelift at Smile South Florida dentistry Dental Restorative Facelift at Smile South Florida dentistry

Smile South Florida Cosmetic Dentistry can give you back that youthful look to your ace, and keep you smiling all of the time.  Come in today for a complimentary consulation, and see if you are a candidate for a dental restorative facelift.  You can call our office toll-free or email us!

About Smile South Florida Cosmetic Dentistry

The cosmetic dentists at Smile South Florida Cosmetic Dentistry have offices in Broward County and West Palm Beach and provide Boca Raton Dentistry, Fort Lauderdale Dentistry and Miami Dentistry. The dentists specialize in dental aesthetics including porcelain veneers, dental implants, extreme makeovers, Invisalign, and sedation dentistry.

About Dr. Charles Nottingham

Charles Nottingham, D.D.S., Fellow in the Academy of General Dentistry, is an internationally and nationally renowned cosmetic dentist. He has been creating dazzling, healthy smiles for his patients since 1974.

About Dr. Kenneth Anenberg

Besides being an excellent cosmetic dentist, Dr. Anenberg specializes in Invisalign, a revolutionary alternative to metal braces, and sedation dentistry & sleep dentistry.

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Orange Juice And Teeth – A Rotten Cocktail

A refreshing glass of orange juice with your breakfast might not be quite as beneficial as you once thought.

Recent studies have revealed that some juices are so acidic they erode teeth enamel with every sip. Dr Yan-Fang Ren, of the Eastman Institute for Oral Health, reported that the acid in orange juice ‘is so strong that the tooth is literally washed away’.

Using a revolutionary vertical scanning microscope for the first time, the researchers were able to see the extensive surface detail on teeth.

Such juice-drinking has further, negative implications; the unnatural acceleration of erosion of the teeth that it causes substantially increases the risk of development and spread of tooth decay.

However, for those among you on a quest for healthy, pearly whites, fear not! The Hospital Group, one of the country’s leading plastic surgery providers, offer a range of dental treatments in its specialist cosmetic dentistry clinics located around the UK.

Teeth whitening, pain-free veneers, white fillings and porcelain crowns are just a few of the popular treatments available at the NuSmile dentistry treatment centres across the country.

Since The Hospital Group was established in 1992, it has grown from a small pharmaceutical company to one of the UK’s foremost plastic surgery providers. The Group is committed to providing the very highest standards and all procedures are performed by an expert medical team in state-of-the-art facilities that are second to none.

For further information on The Hospital Group’s range of dentistry procedures please visit www.thehospitalgroup.org or call 0845 762 6727.

Contact Details: For further information on The Hospital Group’s range of dentistry procedures please visit www.thehospitalgroup.org or call 0845 762 6727.

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Eating Disorder Treatment for Elite Clientele

Cliffside Malibu, an elegant recovery center on the Malibu coast, has long been a leading light in the California treatment community. Now, the center is pleased to announce its renewed commitment to helping eating disorder victims achieve physical and psychological wellness.

cliffsidemalibu

Eating disorder treatment is a delicate art form. To be successful, it has to be administered exactly the right way, with a nuanced attention to detail. The best treatment facilities are those which pay closest attention to the unique individual needs of their unique individual clients. In the end, the healing process can’t go forward on any terms other than those.

That principle, in turn, is the bedrock of Cliffside Malibu’s eating disorder treatment philosophy.

With its expert caregivers and posh amenities, Cliffside Malibu is a world-class institution. The center has always catered to an elite clientele. Now Cliffside is expanding its mission, with the goal of delivering the best eating disorder therapy on the planet to those who need it. From Anorexia recovery to Bulimia treatment, at Cliffside Malibu nothing less than excellence will ever be acceptable.

“Eating disorder recovery depends first and foremost on the quality of eating disorder treatment,” said Cliffside Malibu Program Director Dr. Georgina Smith. “At Cliffside Malibu, we recognize that our treatment programs have the power to change lives, and we do everything in our power to live up to that responsibility. We believe that we owe that much to the clients who trust us with their health.”

That sense of obligation, in no uncertain terms, is precisely what distinguishes Cliffside from its competitors.

There’s no shortage of eating disorder treatment centers in Los Angeles. All too often, many of those clinics employ inexperienced or unqualified caregivers. Predictably, these facilities generally fall short of the promises they make to their clients—with disastrous consequences for those clients and the people who care about them.

Given the stakes in the eating disorder recovery process, that sort of failure is simply unacceptable.

“Eating disorders ruin lives,” said Patricia Freeberry, Cliffside’s Clinical Director. “Eating disorder treatment can help to fix what’s broken, but only if it’s delivered by people who know exactly what they’re doing. At Cliffside Malibu, our eating disorder specialists are the best in the world at what they do.”

Eating disorder victims don’t need to be told what they stand to lose in the fight against their diseases. What might not be so obvious, though, is the value of what they stand to win. Cliffside Malibu helps clients rediscover life as they used to know it, before anorexia and bulimia made them strangers to everything and everyone they’d ever cared about. It’s hard to imagine that any lesson could ever be more worth learning than that.

Contact Details: Cliffside Malibu is a luxury residential eating disorder treatment center located in Malibu, California. For further details about Cliffside’s treatment methods, amenities, or other general information about the eating disorder clinic, please call 1-800-501-1988 or visit our Web site at www.cliffsidemalibu.com.

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Lexington Medical Center Has Made Medical History By Becoming The First Hospital In South Carolina With Incisionless Surgery

Lexington Medical Center has made medical history by becoming the first hospital in South Carolina with incisionless surgery.

incisionless surgery

The South Carolina Obesity Surgery Center, a physician practice affiliated with Lexington Medical Center, is now offering “the ROSE procedure” and performed it for the first time at Lexington Medical Center this week. ROSE stands for Restorative Obesity Surgery, Endoscopic. This procedure is for patients who have gained weight back after gastric bypass surgery. Currently, only approximately 30 facilities in the United States offer this treatment.

During ROSE, the surgeon will insert an endoscope through the patient’s mouth into the stomach pouch. The doctor then creates folds to make the stomach pouch smaller. Because there are no external cuts into the body, the procedure offers the advantages of reduced risk of infection, less post-operative pain, faster recovery time and no scars. The treatment can be especially important in South Carolina, which ranks 5th in the nation for obesity.

Dr. Marc Antonetti and Dr. Glen Strickland of the South Carolina Obesity Surgery Center completed special training to do the ROSE procedure at the Baylor College of Medicine in Houston, Texas earlier this year. Each procedure takes about 1 ½ hours. Patients may be in the hospital less than one day. The ideal candidate is someone who had gastric bypass two years ago, lost greater than 50% of their excess weight and regained greater than 10%.

Before the ROSE procedure, patients who regained weight after gastric bypass surgery had few treatment options. Scarring from the initial procedure made revision surgery challenging, with longer recovery time and an increased risk for complications.

Some patients regain weight after gastric bypass surgery because of gradual enlargement of the surgically altered small stomach pouch. In weight loss surgery, the stomach pouch is made very small, which creates a feeling of fullness after just a small volume of food is eaten. When the pouch gradually enlarges, the feeling of fullness is no longer present, patients can eat larger meals and weight regain occurs.

Doctors say similar incisionless surgery may have future application for gall bladder surgery and appendectomies.

The South Carolina Obesity Surgery Center is dual-certified as a Center of Excellence in bariatric surgery by the American College of Surgeons and the American Society for Bariatric Surgery. Its doctors are Dr. Antonetti, Dr. Strickland and Dr. Jim Givens. The surgeons there have completed more than 3,000 bariatric surgeries.

News reporters who wish to do a story on the procedure, its patients and doctors should call Jennifer Wilson at Lexington Medical Center at 803-791-2191. For more information on the South Carolina Obesity Surgery Center and the ROSE procedure, go to www.scobesity.com.

About Lexington Medical Center
Lexington Medical Center, in West Columbia, S.C., anchors a county-wide health care network that includes six community medical centers throughout Lexington County and employs a staff of 5,100 health care professionals. The network also includes the largest extended care facility in the state, an occupational health center and physician practices. At its heart is the 384-bed state-of-the-art Lexington Medical Center, with a reputation for the highest quality care. Lexington Medical Center was voted one of the “Best Places to Work” by the South Carolina Chamber of Commerce, “Best Hospital” by readers of The State for nine years in a row, “Best Hospital” by readers of the Free Times and “Best Place to Have a Baby” by readers of Palmetto Parent. Visit www.lexmed.com or www.lexmed.tv.

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An Increasing Number Of Men Are Now Undergoing Breast Reduction Surgery In A Bid To Improve Their Physical Appearance

New figures reveal a vast amount of men are opting for procedures such as surgery for gynaecomastia (commonly known as ‘man boobs’). More than 320 of these operations were performed last year, compared with just 22 five years ago.

According to the British Association of Aesthetic Plastic Surgeons (BAAPS), the number of men having cosmetic surgery has now risen to almost one in 10 patients. And with an increase of 44% since last year, male breast reduction surgery has surpassed other rises in overall breast enlargement and tummy tucks.

Nigel Mercer, President of the BAAPS, said: “Wide media coverage has helped to educate the public about the latest advances and choices available, and we are encouraged by the fact that more people are doing their research carefully and choosing reputable providers. The Hospital Group, the UK’s leading provider of cosmetic surgery, perform a wide range of aesthetic procedures in specialist clinics across the country. It carried out 46 male breast reduction procedures last year, compared with just five in 2004.

David Ross, Chief Executive of The Hospital Group, said: “Many men have body image problems and low self-esteem from gynaecomastia. They may have been teased at school or in the gym about the fat on their chests. Some men even refuse to show their chests in front of their partners because they’re so embarrassed. The surgery is fantastic because men see results so quickly, which gives them the get up and go to live happier lifestyles.”

Excessive chest tissue can be the result of hormonal changes, disease, certain drugs or hereditary conditions. It can also be exaggerated with weight gain or loss and may affect one or both breasts. The condition can often cause embarrassment and can affect males of any age.

As well as male breast reduction, The Hospital Group performs other cosmetic procedures such as liposculpture fat removal, abdominoplasty (tummy tuck) and arm lift surgery.

Since The Hospital Group was established in 1992, it has grown from a small pharmaceutical company to one of the UK’s foremost cosmetic surgery providers. The Group is committed to providing the very highest standards and all procedures are performed by an expert medical team in state-of-the-art facilities that are second to none.

Contact Details: For further information on The Hospital Group’s procedures please visit www.thehospitalgroup.org or call 0845 762 6727.

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An International Panel Of Physicians Reports About A Special Way Of Healing On The Spiritual Path

An extraordinary series of lectures will be held in Fairfax, VA (near Washington, DC) and Los Angeles, CA in May, 2009. Seven Medical specialists from four countries will report about a free special way of healing for everyone. Medical doctors, veterinarians and psychologists from Europe, America, Asia, Australia and Africa have formed the Medical Scientific Group of Specialists (MWF). The task of this group, which belongs to the Bruno Groening Circle of Friends, is to record and verify healings the spiritual way. A compilation of more than 200 concise healing reports can be found on our web site: www.bruno-groening.org/english/ under the link Healings.

The international panel of physicians includes:

G. Blaettner, M.D., Germany,Board Cert. ENT
M. Galante, M.D., USA
L. Colizoli, M.D., USA, Board Cert. Psych.
K. Winchester, M.D.,USA Board Cert., Opthal.
Prof. G. Beketova, M.D., Ph.D., Ukraine, Board Cert. Pediatrics, Prof.Univ. of Kiev
R. Friewald, M.D., D.V.M., Germany
F. Gringinger, M.D., D.O., Austria, Board Cert. Family Prac.
R. Leo, USA

They will speak about their experiences on the following dates.

Saturday, May 2, 2009 at 3 – 7 pm 
(incl. 30 min. break):

George Mason University, 
Fairfax Campus
Lecture Hall, Room 1
4400 University Drive
Fairfax, VA 22030
Contact: Mrs. Heidi Gewehr at 571-313-0267 or h.gewehr@web.de
*Sunday, May 3, 2009 ~ 3 -7 pm 
(incl. 30 min. break)*:

Anderson School of Management, UCLA 
(park in structure 4)
Korn Convocation Hall – C Building 
110 Westwood Plaza
Los Angeles, CA 90095
Contact: Chris Runge at 323.394.4691 or chrismwf.info@yahoo.com

During these lectures, physicians will talk about persons who have experienced healing and freedom from long lasting, severe and chronic diseases in a miraculous way. Medical documents will be presented; the experts will explain the intricacies of a superior healing power that has been widely forgotten in modern medicine. The teachings of Bruno Groening (1906-1959), who became world famous due to extraordinary healings in the fifties, are taken as a basis for the lectures. Bruno Groening said time and again: “There is no incurable – God is the greatest physician”. He spoke about a higher power that he called the healing stream, life power or divine energy. This power is abundantly available for everyone. The knowledge about how to make use of this power is passed on free of charge in the worldwide non-profit, volunteer based organization of the Bruno Groening Circle of Friends.

The work of the MWF is supported by some well-known people in the United States, e.g. Dr. Christiane Northrup and Dr. Carl Simonton. Link to information online: http://www.bruno-groening.org/english/lectures2009.htm.

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Wrongful Convictions Of Physicians By Department Of Health (NYSDOH) Linked To Patient Mortality

The proliferation of wrongful convictions in New York State prompted the NYS Bar Association to create a Blue Ribbon task force to study its systemic, procedural and statutory causes, and to propose solutions. Indeed, a report by the Innocence Project found New York State to be the national leader, outpacing all other states in its rate of wrongful convictions. The Blue Ribbon findings, embodied in a document entitled “ Final Report of the New York State Bar Association’s Task Force on Wrongful Convictions” was unanimously endorsed by the Association’s House of Delegates on April 4.

The findings of the Task Force provide a disturbing commentary on flagrant errors by the New York State judicial system, leading to convictions of innocent individuals. In over 50% of cases, the failures of government practices – such as misconduct by prosecutors – were to blame for the wrongful convictions.

Wrongful convictions do not solely implicate the New York State criminal justice system. They are reportedly rife in the legal practices of the NYS Department of Health (NYSDOH), known for ignoring due process and abusing power in its disciplinary actions against physicians. Several bills aiming to redress these inequities were all vetoed. Reported among many of these due process violations is the denying of witnesses for phy sicians’ defense, the use of tainted judges, and the coaching of plaintiffs by prosecutors to lie – indeed, “winning” cases is vital for their career advancement. Especially targeted in these malicious prosecutions are physicians practicing complementary medicine. One physician who wished to remain anonymous for fear of retribution remarked, “Convicting doctors is a cinch: just don’t allow them any witnesses; then the Department is free to make up whatever it wants.”

The tragedy of wrongful convictions in matters of health care affects far more than physicians. The plight of patients suddenly obliged to forgo the continuity of their medical care by the forcible removal of their long term physicians via the challenging of their license is illustrated in press and Internet releases entitled, “Patient Mortality Linked to Judicial Errors.” Noted are certain fragile patients who, “vulnerable, sick, alone, frightened and suddenly deprived of their main lifeline (their physician), became acutely demoralized, refused referrals to other doctors or failed to bond with them, eventually giving up their will to live and neglecting their medical needs.” One physician reported the untimely deaths of 7 patients, including one from suicide, the rapid decline of 8 Alzheimer’s and the relapses of 12 psychiatric patients leading to their serial hospitalizations.”

In response, petitions have now been forwarded to agencies concerned with patient20welfare, calling for independent impact studies on state-ordered patient abandonment. Agencies contacted include the U.S. Health and Human Services Administration (HHS) and the Centers for Medicare and Medicaid. The petition has also been sent to Health Commissioner Richard F. Daines, NYSDOH.

This landmark study, of major interest to medical, psychiatric and medico-legal communities and the public at large, would aim to show that abruptly severing medical and psychiatric services by state agencies has serious and sometimes fatal consequences for patients – especially patients who are disadvantaged, infirm, chronically ill or psychiatrically disabled. It would also suggest remedial action. Indeed, if state agencies assume the power of terminating the basic care to patients provided for by their physicians, they presumably also should accept the responsibility for adequately supporting said patients through crisis, by providing them with life-saving continuity of care.

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Recent Research Published By The American Journal For Medicine Showed 87% Of Diabetics Either Saw A Complete Cure Or Improvement After Weight Loss Surgery

As the focus on the nation’s expanding waistlines grows, medical experts now believe that weight loss surgery can completely eliminate all types of Diabetes.

The UK’s number one weight loss surgery provider, The Hospital Group, has seen outstanding long-term results for its gastric band patients over the last three years. Of the 106 gastric band operations performed in January 2007, the total weight loss was a massive 300 stone. Obesity is the main risk factor for Diabetes, so sustained weight loss on this level goes a long way towards fighting the condition, which affects 2.5 million people in the UK, according to Diabetes UK.

The research published by the American Journal for Medicine showed that following obesity surgery, 87% of diabetics either saw a complete cure or improvement.

David Ross, Chief Executive of The Hospital Group, said: “More and more people are choosing to have obesity surgery with The Hospital Group and it’s fantastic because people see results so quickly, which gives them the get up and go to live healthier lifestyles – some free from Diabetes. You wouldn’t think it, but Australia is the gastric band capital of the world. Their government recognises the long-term savings it can make by funding obesity surgery on their national healthcare system – and in the same way, obesity surgery in the UK is saving the NHS money by curing Diabetes patients, which is currently costing the NHS £1m an hour.”

The huge surge in demand for obesity fighting treatments such as Gastric Bands, Balloons and Bypasses from The Hospital Group has more than doubled in the last year, rising from 111 operations in February 2008 to 225 in the same month in 2009. Continuing the trend, enquiries into gastric band surgery have risen by almost 25% from 727 in February 2007 to 963 in February 2009. Health-conscious surgery-seekers in February 2008 made 815 enquiries into The Hospital Group’s obesity surgery.

The Hospital Group is committed to providing the very highest standards and all procedures are performed by an expert medical team in state-of-the-art facilities that are second to none. Since The Hospital Group was established in 1992, it has grown from a small pharmaceutical company to one of the UK’s foremost cosmetic surgery providers, and the same high standards remain to this day. For further information of The Hospital Group’s range of gastric procedures, surgery-seekers should visit the website www.thehospitalgroup.org or call our patient care coordinators on 0845 762 6727.

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Mack’s® Earplugs Are #1 Doctor-Recommended Brand According To New Research

Mack’s® Earplugs (www.macksearplugs.com), a world leader in hearing protection products, is the #1 doctor-recommended brand according to new research completed by Kelton Research (www.keltonresearch.com), a leading independent market research firm with clients that include McDonald’s, ESPN, Whole Foods, Wal-Mart and Proctor & Gamble. Mack’s® Earplugs are manufactured by McKeon Products, Inc.

In research conducted in November 2008 involving 151 Ear, Nose and Throat doctors from across the U.S., Mack’s® was found to be the brand that doctors recommend most. Mack’s® is the #1 doctor-recommended brand for both its moldable silicone and soft foam earplugs. Additionally, when the doctors were asked about specific issues including prevention of hearing loss and getting a good night’s sleep with a snoring spouse, Mack’s® moldable silicone earplugs and its foam earplugs are the #1 doctor-recommended brands. The research also revealed Mack’s® is the #1 doctor-recommended brand of moldable silicone earplugs to help prevent swimmer’s ear.

“This research is further validation of the excellent quality of all Mack’s® Earplugs products,” said Devin Benner, President and CEO, McKeon Products, Inc.“We’ve worked hard to provide comfortable, effective and convenient products that meet the needs of people concerned with ear health and hearing safety. We’re pleased that Mack’s® is the #1 doctor-recommended brand of earplugs.”

Innovation is an important element of the Mack’s® Earplugs success story. The company recently unveiled Mack’s® Roll-Upsâ„¢ Wallet Earplugs, designed to address the biggest problem faced by earplug wearers – not having them when you need them. Mack’s® Roll-Upsâ„¢ Wallet Earplugs feature patent-pending technology and fit easily into a wallet. Each package is smaller than a credit card and includes a pair of silky smooth strips of foam that roll up quickly and easily — providing the ultimate in convenience, comfort and hearing protection.

Mack’s® is the #1 doctor-recommended brand in the U.S., with a variety of products designed for sleep, travel, swimming and overall noise reduction. Since 1962, McKeon Products, Inc. has led the retail ear care industry with its original and #1-selling Mack’s® Pillow Soft® silicone earplugs. Today, McKeon manufactures a full range of earplugs for a variety of uses. The Mack’s® line of products also includes sleep masks, ear drying aids, lens wipes and earwax removal drops. McKeon, an ISO 9001:2000 quality certified company, is committed to supplying the highest quality, innovative products at the lowest possible price.

McKeon Products, Inc. is based in Warren, Mich. The phone number is (586) 427-7560.

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Full-Mouth Rehabilitation and Bite Management of Severely Worn Dentition

Introduction
Creating a beautiful smile for a patient is extremely rewarding for the dentist as well as for the team, and this should never be taken for granted. We are blessed with the ability to change someone’s self esteem, confidence and, possibly, the course of their life.

The case presented here was featured on the cover of the Spring 2008 issue of The Journal of Cosmetic Dentistry. While it was quite challenging, I will never forget this case,, as it changed the life of a recovering bulimia patient. Eating disorders affect approximately seven million people in the United States. Although I have seen the effects of bulimia on the dentition previously, never have I witnessed it to this extent.

The patient was diagnosed with loss of vertical dimension as a direct result of bulimia and bruxism.

Patient History
The patient, a 30-year-old female, wanted to improve her smile and to address the constant fracturing of her teeth. Although it was difficult for her to discuss, she told me about her history of bulimia and that after a long struggle, she is now recovered. She was ready not only to change her smile, but also to see what could be done about her “collapsing” face, as she put it. She confessed that her unwillingness to smile was affecting her socially and that she always covered her mouth when she laughed (Fig 1).

Clinical Evaluation and Diagnosis
After performing a thorough clinical examination, I noted a severely worn dentition, widespread abfraction lesions, and multiple fractured teeth and restorations. The palatal surfaces of the maxillary anterior teeth were completely eroded and devoid of enamel, as is typically seen with bulimic patients (Figs 2 & 3). As expected, the patient’s teeth were very sensitive to temperature changes. Tooth #5 had been extracted due to a fractured root, and in its place was a successfully osseointegrated implant (Straumann USA; Andover, MA) that had been placed one year earlier. She had lost approximately 30% of the length of her central incisors due to attrition. Upon radiographic examination, no severe decay or pulpal pathology was evident. Periodontal probing depths were within normal limits.

The patient suffered f r o m many typical symptoms of temporomandibular disease (TMD), such as joint pain, severe headaches, tinnitus, and orofacial muscle pain with spasms.1These symptoms were not surprising, as craniomandibular dysfunction is often seen with loss of vertical dimension. She was also a severe bruxer and said this provided her with relief. Due to this vertical loss, the lower third of her face was collapsed and disproportionate. The patient was diagnosed with loss of vertical dimension as a direct result of bulimia and bruxism; this was accompanied by multiple fractured, eroded teeth, and worn restorations. Additionally, the patient had facial asymmetry and multiple TMD symptoms due to craniomandibular dysfunction.2

She tolerated the orthotic well and felt much better with it in place.

Treatment Plan
Initially this case was overwhelming, as there were so many factors necessary to achieve a successful treatment outcome. After mounting and studying the casts, it was obvious that the patient’s vertical dimension had to be increased to a proper, comfortable position, which has been called the physiologic neuromuscular position.3 Once this position was determined, an orthotic appliance would be worn to verify that this proposed position was in fact well tolerated and that the TMD symptoms had decreased significantly. During the orthotic therapy phase, this appliance would be worn for a minimum of three months (for a minimum of 22 hours a day), to determine whether it would help before any permanent alteration of the patient’s teeth.

During this time, her condition would be evaluated for elimination of symptoms, proper occlusion, improvement in facial symmetry, esthetics, and acceptable phonetics. If we had not seen improvements during the orthotic phase, the first thing we would have looked at was compliance. If it had been determined that the patient was not wearing the appliance as instructed, or if the therapy had had to be extended beyond three months (due to inconsistent symptoms or an unstable bite position), we would have used a fixed orthotic appliance, which would have been fabricated to the same vertical dimension as the removable orthotic.4

The goal, for any clinician, is to find a position in which the patient’s symptoms are eliminated, or at least decreased significantly. The facial and dental esthetics also must be greatly enhanced. Although there is more than one way to find this physiologic position, in this case I objectively measured muscle activity by using electromyography (EMG) instrumentation (Myotronics-Noromed; Kent WA). This enabled me to locate the correct resting position for the mandible where the muscles are at rest, as well as the correct opening and closing trajectory.5 During the course of orthotic phase therapy, which can last several months to a year, the patient returns to verify the bite and evaluate symptoms several times. Once it is determined that the patient is comfortable, facial esthetics are improved, and the EMG muscle activity is verified to be physiologic, then the restoration phase can begin.6,7

Treatment Discussion
The first step in this case was to determine how much to increase the patient’s vertical dimension. Once this position was determined, it was imperative to test and verify it; and, most importantly, to maintain it throughout the different phases of treatment. The treatment phases were as follows: Orthotic, preparation, temporization, and cementation.

Finding the Bite
To evaluate the state of the patient’s habitual bite position, we had to record and evaluate EMG readings of several muscle groups bilaterally (K7 instrumentation, Myotronics-Noromed). The muscle groups measured were the anterior and posterior temporalis muscles, the masseters, and the anterior digastrics. Electrodes were placed over these muscle groups and electromyographic recordings were made. High EMG readings represented a state of muscle hypertonicity and unrest. The goal was to find the occlusion where the muscles that control jaw position are in a relaxed state, and therefore are at their ideal resting length for optimal function and comfort.8,9

To find a more optimal bite position, a series of diagnostic tests were performed. These included electrosonography to record and analyze joint sounds, electromyography to record and analyze muscle activity, and computerized mandibular scanning (CMS) to track and analyze jaw movements. It was determined that the patient’s habitual occlusion was in a muscular state of hyperactivity when at rest and in light centric occlusion (Fig 4). In order to relax her muscles, which were in a chronic spasmodic state, ultra-low frequency transcutaneous electrical neural stimulation (TENS) was applied using a myomonitor (Myotronics). The myomonitor stimulates cranial nerves V, VII, and XI to relieve hypertonicity, restore normal blood flow, and wash away toxic wastes such as lactic acid. This restores the muscles temporarily to a relaxed and normal resting length (Fig 5). These muscles become “deprogrammed,” and, by measuring their pre- and post-relaxation status, we are provided with precise and objective comparative data.10,11 The details of all the tests performed during the three-hour diagnostic appointment are beyond the scope of this article.

The position at which this patient’s muscles were in their most relaxed state was captured by using a polyvinyl siloxane bite registration material (Regisil, Dentsply Caulk; Milford, DE). Impressions were then taken (Aquasil Ultra, Ivoclar Vivadent; Amherst, NY) and sent to the laboratory with the bite to fabricate a lower removable orthotic. Upon delivery of this appliance, I explained to the patient that it must be worn a minimum of 22 hours a day. Each follow-up visit always consisted of 45 minutes of TENS, followed by any necessary occlusal adjustments to the orthotic. The patient was seen at one-, two-, three-, four-, and sixweek intervals. She tolerated the orthotic well and felt much better with it in place; therefore, compliance was not an issue.12,13

Once it was determined that the bite was stable and that symptoms were significantly reduced, EMG recordings were taken again to verify that the muscles were not hypertonic in this new position. In this case the EMG readings were more than satisfactory, and the patient’s headaches and other symptoms were reduced significantly. Therefore, I had great confidence as to where to restore her occlusion.14 Her bite was opened 4 mm. The next phase of treatment was the restorative phase.

Bite Management
(Laboratory Phase) Much effort was spent determining the proper physiologic position for this patient, and much care had to be taken in managing and maintaining this position throughout the course of treatment. Prior to the preparation appointment, new impressions were taken and sent to the laboratory, along with the actual adjusted orthotic to mount the case. In addition, three measurements were provided so that the laboratory could verify that the case was properly mounted. These measurements were taken with a digital Boley gauge. The areas measured were where the most apical areas of tooth surface intersect with the gingiva between teeth #8 and #25, #14 and #19, and #3 and #30 (Figs 6 & 7). In this situation, the dentist and the laboratory must measure in the exact same three locations throughout the course of treatment, so as to ensure accuracy and precision in maintaining the new vertical (Figs 8 & 9).

Once the laboratory mounted the casts with the adjusted orthotic in place and the three measurements were verified, a bite stent (Sil-Tech, Ivoclar Vivadent) was made, to be utilized during the preparation appointment to ensure accuracy in maintaining the new vertical dimension. The appliance was then immediately returned to the patient so that she could continue to wear it. The laboratory also was provided with detailed instructions concerning the smile design, including widths and lengths of anterior teeth, shapes, and proportions.15

Because the patient’s maxillary anterior teeth were short, it was determined that crown lengthening was necessary to support the restorations. Therefore, the proposed amount of hard and soft tissue removal was relayed to the laboratory so that they could compensate for the change in measurement in this area. With this information in hand, they waxed up the 28 teeth in the new position, taking into consideration the hard and soft tissue reduc-tion in the anterior; and once again verified the three measurements (Fig 10). From this wax-up, they prepared a temporization stent made f r o m Sil-Tech putty and relined with a light-body wash material (Aquasil XLV, Dentsply Caulk). This would be used to fabricate the 28 temporaries after tooth preparation, with the same vertical dimension and occlusion as the orthotic.

Bite Management
(Preparation Phase) Prior to the preparation appointment, I ensured that I received everything necessary f r o m the laboratory. First, I verified that the waxed-up models were consistent with the three measurements I had provided to the laboratory, by measuring the teeth in the exact same three locations. Second, I verified that I was satisfied with the smile design and occlusion. As this was to be a lengthy appointment, the clinical team met and reviewed procedures.

After the patient was seated, I verified the bite stent that had been made on her unprepared, mounted models by placing it in her mouth and having her close down on it. I again measured the same three locations and verified that those measurements were the same as they were with the orthotic in place (Fig 11). I was confident that all of my numbers were accurate, so it was time to begin preparing the teeth.

It was imperative not to lose control of the bite at any time during the preparation.

After anesthetizing the patient, the first step was to perform the soft and hard tissue crown lengthening in the maxillary anterior region to improve the length of her short clinical crowns. To accomplish this, I used an Er,Cr:YSGG hard/soft tissue laser (Waterlase, Biolase Technologies; Irvine, CA) and at the same time performed a frenectomy between the maxillary central incisors. Using this laser provided a predictable result and gave me a clean field within which to work. I removed 1.2 mm of tissue and therefore changed the location of my uppermost point for measurement after the crown lengthening. I had to adjust my number for verification f r o m this point on, in this area only16 (Fig 12).

It was imperative not to lose control of the bite at any time during the preparation. To help in maintaining this vertical dimension, I used the bite stent provided by the laboratory to sequentially reline it while I prepared one quadrant at a time. Beginning with the upper right quadrant, I prepared ##3-8, while leaving #2 unprepared to provide extra stability while I relined the bite stent. To register the bite, I sat the patient upright and placed a small amount of fast-setting bite registration material (Regisil Rigid) in the bite stent, being careful not to overfill it and to reline only the prepared teeth. This was then placed in the mouth with the patient biting into it. While the stent was in her mouth, the same three locations were measured again, remembering that the anterior area had a new measurement. If the measurements had not matched those taken previously it would have been necessary to repeat the reline, as the patient might have been biting incorrectly or the bite stent might not have been seated over the teeth properly.

Once it was determined that the measurements were correct, the stent was removed, trimmed, and set aside for the next quadrant. The same procedure was repeated for the upper left quadrant, preparing ##9-14 and leaving tooth #15 unprepared. This quadrant was then relined the same way. After the measurements were verified, I prepared #2 and #15 (Fig 13). This procedure was repeated for the bottom right quadrant and then the bottom left. A final check of the measurements was made and the bite stent was set aside to send to the laboratory along with final impressions. For these, I used a PVS heavy-body material and an extra-low viscosity wash material (Aquasil Ultra-heavy and XLV). A symmetry bite was also taken, indicating to the laboratory the proper occlusal plane and midline. Photographs of the preparations, which showed the measurements with the final bite stent seated and with the symmetry bite in place, were provided for the laboratory.

Temporization
The provisional restorations were fabricated using the temporary stents made f r o m the wax-up. The stents were filled with temporary material (Luxatemp shade B1, Zenith/DMG; Englewood, NJ) and placed over the maxillary prepared teeth. After three minutes the stent was removed, as was a small amount of flash. This procedure was repeated for the bottom teeth. Once the provisionals were in place, all three measurements were once again verified; at this time we evaluated esthetics and occlusion. To properly maintain the health of the gingival tissue during the four-week provisional phase, the patient was given a sonic toothbrush (Sonicare, Philips Healthcare; Andover, MA), as well as instructions on how to use rubber tips to massage her tissue. A follow-up visit was scheduled for the next day to confirm that the occlusion was comfortable and that we were both satisfied with the smile design.

Laboratory Communication
Proper communication with the laboratory is crucial for a successful outcome in each and every case sent to our ceramist. In this case, it was important to send as much information as possible with regard to maintenance of the patient’s vertical dimension, as well as esthetics. Photographs showing all three measurements in the final bite stent, as well as in the provisionals, were sent to the laboratory. In addition, retracted frontal and lateral views of the preparations were provided, as well as a picture showing the prepared shade (Vita A3, Vident; Brea, CA).17 When the laboratory received the case, the first step was to verify the measurements after mounting the prepared models. This was accomplished by using the relined bite stent and verifying the accuracy of the vertical dimension in the same three locations.

For the smile design, we decided on a “soft” look with square oval central incisors and slightly rounded laterals and canines, with the lateral incisors 0.5 mm shorter than the centrals. The requested width of the central incisors was 8.25 mm and the length was 10.75 mm. The lateral incisors were approximately 10.25 mm long. Golden proportion rules and smile design principles were adhered to, which provided the patient with a very soft and esthetically pleasing smile. Our final shade choice was OM2 body with a cervical blend to OM3 (Vita 3D Master shade guide), with the canines blending f r o m OM2 to 1M1 cervically. We selected Authentic pressable ceramic (Jensen Indus-tries; North Haven, CT) for all anterior teeth and bicuspids, using an OP1+ ingot with cutback technique and adding intense opaque modifiers to increase vitality and a natural appearance (Fig 14).18All of the molars were restored with Noritake CZR pressable ceramic (Zahn Dental, Henry Schein; Melville, NY) over zirconia copings.19 The #5 implant was restored with a custom abutment with Creation porcelain (Jensen Industries). Prior to the fabrication of the restorations, the models were mounted using the preparation bite stent, and all the measurements were verified by the laboratory (Figs 15-18).

Cementation
After we received the case f r o m the laboratory, I checked the restorations on the models for proper margins and contacts, and to ensure that the smile design had been followed. Once all the restorations were mounted on the models, the three areas were measured to verify that the laboratory maintained the vertical dimension. Once the patient was anesthetized, the provisional restorations were removed. The prepared teeth were cleaned with pumice, followed by hydrogen peroxide and chlorhexidine (Consepsis, Ultradent; South Jordan, UT). Each restoration was tried on with water and inspected individually. Contacts and margins were examined, as was the overall smile design.

Once we were satisfied with restorations, they were cleaned with 37% phosphoric acid, rinsed, dried, and set aside. The molars were cemented first using Multilink (Ivoclar Vivadent), a self-etching universal resin cement, with the inside of the restorations coated with the metal/zirconia primer (Ivoclar Vivadent). Then all of the remaining upper teeth except #5 were etched with 37% phosphoric acid and rinsed, after which a wetting agent was applied (Super Seal, Phoenix Dental; Fenton, MI).20 Then the bonding agent (Excite, Ivoclar Vivadent) was placed on the teeth according to manufacturer’s directions and light-cured. The restorations, which had previously been etched with hydrofluoric acid, were coated with Silane primer (Kerr; Orange, CA). The luting resin used for cementation was Variolink Veneer +2 (Ivoclar Vivadent). All of the restorations were placed simultaneously and spot-cured. The excess was then removed, followed by the final light-cure. Tooth #5 was cemented with implant cement (Premier Dental; Plymouth Meeting, PA).21 The same technique used on the maxillary teeth was applied to the lowers. Once all teeth were cemented, the three measurements were once again verified to confirm maintenance of the vertical dimension (Fig 19). The patient returned for follow-up appointments to make sure her bite was stable and that she remained symptom-free.

Conclusion and Discussion
This patient’s case involved many of the challenges we face daily in our practices. Just a few years ago, however, I would not have known in which direction to take her treatment. Perhaps I simply would have provided her with a bruxism appliance, while “patching up” some of her fractured restorations and attempting to improve her smile by restoring some of her anterior teeth with direct resins. These would have failed repeatedly, causing us both much frustration.

I conducted a series of diagnostic tests using computerized instrumentation, which provided me with objective data that I was able to use in my treatment planning.

The key point is that this patient initially exhibited severe occlusal disharmony and craniomandibular dysfunction. This can be the case in many of our patients, and much effort should be spent in proper diagnosis and treatment planning.22 I did not prepare 28 teeth in one visit and deliver them a few weeks later. Instead, I conducted a series of diagnostic tests using computerized instrumentation, which provided me with objective data that I was able to use in my treatment planning. Not until the patient’s new vertical dimension position was tested for several months did I dare touch a single tooth with a handpiece. Once I did, however, it was with great confidence, because I knew in which direction I was headed (Figs 20 & 21).

It is well accepted that there is more than one philosophy or method that can be utilized to arrive at a physiologic bite position. A discussion of these different philosophies— whether centric relation, centric occlusion, or neuromuscular—is beyond the scope of this article.23 However, as responsible clinicians, we should study the different treatment modalities available to our profession before making a decision as to which one suits us. Whichever method you apply in your practice, the most important factor is that it must be in your patients’ best interests.24 Before proceeding to final restorations, it is imperative to establish a comfortable, stable bite derived f r o m verifiable, objective clinical data (Figs 22-29).

Acknowledgments
The author thanks Duckee Lee, CDT (Protech Dental Studio, Sterling, VA), for his passion, talent, and technical excellence in creating the beautiful restorations in this case. A debt of gratitude also goes to the American Academy of Cosmetic Dentistry for 13 years of excellent continuing education, camaraderie, and a remarkable credentialing program, in which he learned during his Accreditation journey that, “your hand can only perform what your eyes have been trained to see and comprehend”; and to the Las Vegas Institute for Advanced Dental Studies for its dedication to postgraduate education. Finally, thanks, appreciation, and best wishes goto Erica, the patient in this case, for her patience, kind spirit, and courage.

References

1. Okeson JP. Management of Temporomandibular Disorders and Occlusion (3rd ed.). St. Louis, MO: Mosby; 1985.

2. Coy RE, Flocken JE, Adib F. Musculoskeletal etiology and therapy of craniomandibular pain and dysfunction. Cranio Clin Int 1(2):163-173, 1991.

3. Jankelson RR. Neuromuscular Dental Diagnosis and Treatment. Volume 1 (2nd ed.). Tokyo: Ishiyaku EuroAmerica; 2005.

4. Naeije M, Hansson TL. Short-term effect of the stabilization appliance on masticatory muscle activity in myogenous craniomandibular disorder patients. J Craniomand Disord Facial Oral Pain 5:245-250, 1991.

5. Ormianer Z, Gross M. A 2-year follow-up of mandibular posture following an increase in occlusal vertical dimension beyond the clinical rest position with fixed restorations. J Oral Rehab 11:877-883, 1998.

6. Liu ZJ, Yamagata K, Ito G. Electromyographic examination of jaw muscles in relation to symptoms and occlusion of patients with TMJ disorders. J Oral Rehab 26(1):33-47, 1999.

7. Neill DJ, Howell P. Computerized kinesiography in the study of mastication in dentate subjects. J Prosthet Dent 55(5):629-638, 1986.

8. Mongini F, Tepia-Valenta G, Conserva E. Habitual mastication in dysfunction: A computer-based analysis. J Prosthet Dent 1:484-494, 1989.

9. Jankelson B. Three dimensional orthodontic diagnosis and treatment: a neuromuscular approach. J Clin Orthod 18(9):627-636, 1984.

10. Ow RK, Carlsson GE, Jemt T. Craniomandibular disorders and masticatory mandibular movements. J Craniomand Disord Facial Oral Pain 2(2):96-100, 1988.

11. George J, Boone M. A clinical study of rest position using the kinesiograph and myomonitor. J Prosthet Dent 41(4):456-462, 1999.

12. Konchak P, Thomas N, Lanigan D, Devon R. Freeway space using mandibular kinesiography and EMG before and after TENS. Angle Orthod 58(4):343-350, 1988.

13. Balciunas BA, Stahling LM, Parente FJ. Quantitative electromyographic response to therapy for myo-oral facial pain: A pilot study. J Prosthet Dent 58:366-369, 1987.

14. Isberg A, Widmalm S, Ivarsson R. Clinical, radiographic, and electromyographic study of patients with internal derangement of the temporomandibular joint. Am J Ortho 88(6)453-460, 1985.

15. Griffin JD. How to build a great relationship with the laboratory technician: Simplified and effective laboratory communications. Contemp Esthet 10(7):26-34, 2006.

16. Colonna M. Crown and veneer preparations using the Er,Cr:YSGG Waterlase hard and soft tissue laser. Contemp Esthet Rest Pract 10:80-86, 2002. 17. Bengel W. Mastering Dental Photography Hanover Park, IL: Quintessence Pub.;2002.

18. Magne P, Belser U. Bonded Porcelain Restorations in the Anterior Dentition: A Biomimetic Approach. Hanover Park, IL: Quintessence Pub.; 2002.

19. Ludwig K. Studies on the ultimate strength of all-ceramic crowns. Dent Laboratory 39:647-651, 1991.

20. Kanca J. Improving bond strength through acid etching of dentin and bonding to wet dentin surfaces. JADA 123:35-44, 1992.

21. Garg AK. Practical Implant Dentistry (1st ed.). Dallas, TX: Taylor Publishing; 2007.

22. Tingey EM, Buschang PH, Throckmorton GS. Mandibular rest position: A reliable position influenced by head support and body posture. Am J Orthod Dentofac Orthop 120(6):614-622, 2001.

23. Pully ML, Carr S. Solving the pain puzzle: Myofascial pain dysfunction (3rd ed.). Albuquerque, NM: TMData Resources; 1997. 24. Shankland WE . Temporomandibular disorders: Standard treatment options. Gen Dent 52(4):349-355, 2004.

 

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