Dental Implications of Herbal Supplements
*Nutrient Supplementation* • Some ____% of adults in the United States take daily nutrient supplements. • A well-balanced diet of ________ calories/day provides the nutrient requirements of a healthy adult. • Vitamin ________________ may be hazardous to your health.
- 50 - 1200 - megadoses
Dong Quai: *Contraindications and Adverse Reactions/Oral Effects* • ____________________ medications • Increased risk of ____________
- Anticoagulant - bleeding
St. John's Wort: *Benefit Claim* • ______________________ • Mild ________________
- Antidepressant - tranquilizer
Ginkgo Biloba: *Contraindications* • _____________ disorders or ___________________ therapy
- Bleeding - anticoagulant
Flax Seed and Flax Seed Oil: *Adverse Reactions/Oral Effects* • ______ can be well-tolerated • Few side effects reported • Should be taken with plenty of _______ as it may cause constipation • May decrease _______________ of other drugs if taken at the same time
- Both - water - absorption
Licorice: *Contraindications* • ____________ or other medications that reduce the body's potassium levels could cause dangerously low ___ levels • In large amounts, it can affect the body's levels of ___________ hormone and related steroid drugs, such as _______________
- Diuretics, K+ - Cortisol, Prednisone
FDA Regulation: Drug vs. Supplement: *FDA Approved Drugs* • ___________ established • ________________________ well-characterized • ___________ is standardized • Proof of ________ required
- Dosage - Pharmacokinetics - Potency - purity
*FDA & Herbal Supplements* • The ________ is responsible for overseeing the safety of U.S. food and drug products. • The FDA does not have authority to approve ________ supplements before they are sold. • While herbal supplements are supposed to contain what their labels claim, that is _____ always the case.
- FDA - herbal - not
FDA Regulation: Drug vs. Supplement: *Dietary Supplements* • _______________ may or may not exist • Pharmacokinetics ________ known • Potency ________ (growing conditions, time harvested, plant part used) • Purity _______ greatly
- Guidelines - rarely - varies - varies
Black Cohosh: *Adverse Reactions/Oral Effects* • _______________ and ___ upset
- Headaches - GI
*Anatomy of Dietary Supplement Labels* • Statement of _________ • Net ____________ of contents • ____________-Function Claim • ______________ for use • Supplement ________ Panel • Other _______________ • _______ and _______ of business of manufacturer, packer, or distributor
- Identity - quantity - Structure - Directions - Facts - ingredients - Name, place
Garlic: *Benefit Claim* • ___________ booster • ________________________
- Immune - Antihypertensive
Grape Seed Extract: *Adverse Reactions/Oral Effects* • ________________ have not been carefully studied • Side effects reported-headache; ____, itchy scalp; _______________; nausea
- Interactions - dry, dizziness
Ginkgo Biloba: *Benefit Claim* • ____________ enhancement • ________________ • Increased ____________ blood flow
- Memory - Antioxidant - cerebral
Dietary Supplementation Safety: *Before starting a dietary supplement, it is always wise to check with a medical doctor. It is especially important for people who are:* • _____________ or breastfeeding • Chronically ill • __________ • Under 18 years-old • Taking _________________ or over-the-counter medications
- Pregnant - Elderly - prescription
Milk Thistle: *Benefit Claim* • ______________ effects on liver and improve function • Lower ________________ levels • Reduce insulin _______________ in people with Type __ Diabetes
- Protective - cholesterol - resistance, 2
FDA Regulation: Drug vs. Supplement: *FDA Approved Drugs* • ___________ control required • Cost-Wide range; ______ for patented drugs • ______________ coverage
- Quality - high - Insurance
Ephedra-Ma Huang: *Adverse Reactions/Oral Effects* • _________ blood pressure • Stresses the ___________ system
- Raises - nervous
Garlic:*Contraindications and Adverse Reactions/Oral Effects* • FDA Alert-Interferes with effectiveness of ______________ • Inhibits ___________ aggregation • Increased risk of ______________
- Saquinavir - platelet - bleeding
Valerian: *Benefit Claim* • _______ aid • Anti-_________ • Helps with _____________ cramps
- Sleep - anxiety - menstrual
Goldenseal: *Contraindications* • ________ doses considered safe for adults • Infants and small children should ________
- Small - avoid
*Dietary Supplement Variations* • __________ • Capsules • ___________ • Soft gels • __________ → Tea → Syrups • Lotions
- Tablets - Powder - Liquids
*Dietary Supplement* • ___________ • Mineral • _______ or Botanical • Amino Acid
- Vitamin - Herb
*Oral Manifestations of Herbal Supplement Utilization* • The recognition of possible oral ___________ effects of herbal supplements can be helpful in making appropriate treatment _________________________.
- adverse - recommendations
Grape Seed Extract: *What does Science say?* • Laboratory studies have shown it contains _______________ • Studies are being conducted to evaluate _______ and prostate ________ prevention and to study potential benefits of the ________ and protective effects in the _______
- antioxidants - breast, cancer, heart, brain
Kava Kava: *What does Science say?* • Studies suggest maybe helpful towards ______, however, linked to risk of severe _______ damage
- anxiety - liver
Kava Kava: *Benefit Claim* • Helps reduce __________ and _____________ • ____________ agent • Reduces _________________ symptoms
- anxiety, insomnia - Numbing - menopausal
Black Cohosh: *Benefit Claim* • Improves __________ and __________ pain • Decrease _________________ symptoms
- arthritis, muscle - menopausal
Garlic: *What does Science say?* • Some evidence shows that it may slow the development of _______________________ and decrease blood ________________ levels
- atherosclerosis - cholesterol
Ephedra-Ma Huang: *What does Science say?* • No evidence that ephedra products enhance __________ performance • Little evidence of ______-term weight loss
- athletic - short
Echinacea: *Contraindications* • Avoid with _______________ disorders • Counteracts with _____________________________ drugs
- autoimmune - immunosuppressant
Feverfew: *What does Science say?* • Studies suggest may increase ____________; affect blood ____________
- bleeding - platelets
*Why do we use dietary supplements?* • Believed to be ____________ than drugs • Believed to be ______ → Seen to be natural • More ______________ • __________ approach • _____________ of manufacturer's advertisements
- cheaper - safer - accessible - Holistic - Influence
Dong Quai: *Benefit Claim* • Menstrual _________ relief • ____________________ health and ______ support
- cramp - Cardiovascular, liver
Glucosamine and Chondroitin: *Contraindications* • People who have ____________ should talk with doctor before they take because may influence ____________ levels
- diabetes - glucose
Probiotics: *Research has suggested that probiotic bacteria can* • Help reduce risk of certain _____________ illnesses • Assist lactose intolerant people with ___________ digestion • Enhance ____________ function
- diarrheal - lactose - immune
Tumeric: *Benefit Claim* • Aid ____________ and liver function; relieve arthritis pain, ___________, wound healing, ______________, stomach ulcers, ______________; reduce inflammation, regulate menstruation • Prevent and treat __________
- digestion, eczema, heartburn, gallstones - cancer
Valerian: *Adverse Reactions/Oral Effects* • Headaches, _____________, upset stomach, ______________ in morning after using the night before
- dizziness - tiredness
FDA Regulation: Drug vs. Supplement: *Dietary Supplements* • Manufacturers doe not have to provide FDA with evidence that dietary supplements are __________ or safe, however, they are not permitted to market unsafe or _______________ products. • Evidence of safety _____ required.
- effective, ineffective - not
Tumeric: *What does Science say?* • Little reliable evidence to support use for any health condition because _____ trials conducted Tumeric: *Adverse Reactions/Oral Effects* • Considered ______ for most adults • High doses or long-term use may cause ______________ • People with _____ bladder disease should avoid use as it may worsen condition
- few - safe - indigestion - gall
Echinacea: *What does Science say?* • Does not appear to prevent colds, ___, or other infections • Some studies show it may be beneficial in treatment of _________ respiratory infections
- flu - upper
*Probiotics* • Available in ________ and dietary supplements (capsules, tablets, and powders) • Food sources: → __________ → Soy beverages → Fermented/unfermented _____ → Tempeh (Fermented soybeans)
- foods - Yogurt - milk
*Vitamin* • Calorie-_____ molecules needed by the body in very small quantities to help with _______________ processes • Two Types: ____-Soluble and ________-Soluble
- free, metabolic - Fat, Water
Oral Manifestations of Herbal Supplement Utilization: *Adverse Effects * • Patient _____________ • ____________ • ______ • Possible tooth _____ • Increased _____________ • Decrease __________________ of another drug
- function - Infection - Pain - loss - bleeding - effectiveness
Goldenseal: *What does Science say?* • Little scientific evidence to support using it for any ________ problem • Berberine, compound for in herb, has an antimicrobial effect against S. __________
- health - mutans
Grape Seed Extract: *Benefit Claim* • Used for conditions such as atherosclerosis, _____ blood pressure, high cholesterol, poor ______________, diabetes complications, _______ and _____ damage, macular degeneration, __________ prevention, and wound healing
- high - circulation - nerve, eye - cancer
Licorice: *Adverse Reactions/Oral Effects* • May cause ______ blood pressure, salt and water______________, and low _____________ levels, which could lead to ________ problems • _____________ women should avoid ingesting large amounts due to increase risk of ____________ labor
- high, retention, potassium, heart - Pregnant, preterm
*Mineral* • Found in ___________ and ___________ and assist the body in metabolic processes • Two types: ________ and ________
- hormones, enzymes - Major, Trace
*Dietary Supplement Health & Education Act (DSHEA)* • Purpose: To provide for _____________ research on dietary _________________, from ______________ to consumer _______________
- increased - supplements - education - protection
*Dietary Supplement* • Dietary substance to supplement the diet by ______________ total daily intake, or a concentrate, _______________, constituent, __________, or combinations of these ingredients
- increasing - metabolite - extract
Anatomy of Dietary Supplement Labels: *Structure-Function Claim* • "This ______________ has not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, _______, cure, or ___________ any disease."
- statement - treat - prevent
Milk Thistle: *What does Science say?* • No conclusive data at this time; current _________ are being conducted Milk Thistle: *Contraindications* • ________ indicated Milk Thistle: *Adverse Reactions/Oral Effects* • Few side effects-upset stomach and ____________
- studies - None - diarrhea
Ephedra-Ma Huang: *Benefit Claim* • Appetite _________________ • __________ relief • ________________________
- suppressant - Allergy - Bronchodilation
Feverfew: *Contraindications* • May interact with anti-_______________ medications, including _________ and ___________ • Interfere with _____ absorption in persons who take supplemental iron
- thrombotic, aspirin, warfarin - iron
Feverfew: *Adverse Reactions/Oral Effects* • Oral/Aphthous _______, tongue and ____ irritation, increased risk of ___________
- ulcers - lip - bleeding
Anatomy of Dietary Supplement Labels: *Net quantity of contents* • "____ capsules"
60
Ginseng: *Contraindications* • _____________ already taking blood glucose medications should be cautious
Diabetics
The ______ is responsible for overseeing the safety of U.S. food and drug products.
FDA
The FDA does have authority to approve herbal supplements before they are sold. *(True or False)*
False (The FDA does *NOT* have authority to approve herbal supplements before they are sold.)
Anatomy of Dietary Supplement Labels: *Statement of Identity* • "___________"
Ginseng
A plant or plant part that is used for its flavor, scent, and/or therapeutic properties
Herb or Botanical
Echinacea: *Benefit Claim* • ____________ booster-prevents colds, flu, and other infections
Immune
Ginseng: *Adverse Reactions/Oral Effects* • ______________ risk of bleeding
Increased
Probiotics: *Main two groups* • ___________________ and Bifidobacterium
Lactobaccilus
Found in hormones and enzymes and assist the body in metabolic processes
Mineral
Saw Palmetto: *Contraindications* • ________ indicated
None
Live microorganisms which when administered in adequate amounts confer a health benefit on the host
Probiotics
Glucosamine and Chondroitin: *Adverse Reactions/Oral Effects* • ____________ allergy
Shellfish
While herbal supplements are supposed to contain what their labels claim, that is *NOT* always the case. (True or False)
True
Calorie-free molecules needed by the body in very small quantities to help with metabolic processes
Vitamin
St. John's Wort: *Adverse Reactions/Oral Effects* • _______________
Xerostomia
Ginkgo Biloba: *Adverse Reactions/Oral Effects* • Increased risk of ____________
bleeding
Glucosamine and Chondroitin: *What does Science say?* • Some research indicates that it can help restore ____________
cartilage
Ginkgo Biloba: *What does Science say?* • Some memory improvement for _____________ patients, however, more larger studies must be conducted
dementia
Kava Kava: *Adverse Reactions/Oral Effects* • Oral ______________
dyskinesia
Black Cohosh: *What does Science say?* • Not enough reliable data to determine whether it is _______________ for rheumatism of other uses
effective
Valerian: *What does Science say?* • Not enough _____________ to determine benefit claims are actual
evidence
Echinacea: *Adverse Reactions/Oral Effects* • Tongue ______________
numbness
Anatomy of Dietary Supplement Labels: *Directions for use* • "Take _____ capsule daily"
one
Saw Palmetto: *What does Science say?* • Not enough scientific evidence to support use for reducing ____ of enlarged prostate or for any other conditions
size
Saw Palmetto: *Adverse Reactions/Oral Effects* • Mild side effects, such as ___________ discomfort
stomach
Dietary Supplements and the Dental Professional: *Comprehensive Medical History* • By knowing the ______________(s) for a particular herb, the dental professional can be alerted to the presence of unreported concerns and diseases. • Advise patient to discuss with their physician ____ medications that they take → Prescription, Over-the-counter, Dietary Supplements • Discuss with patient any possible side effects that may occur if they are taking both ________________ medications and _________ supplements • Discuss with patient possible _____ side effects that may occur as a result of taking herbal supplements
- indication - all - prescription, herbal - oral
Cinnamon: *Benefit Claim* • Insulin-like activity and increase effectiveness of _______ Cinnamon: *What does Science say?* • Study showed ¼ tsp. of cinnamon each day can reduce daily blood ________ Cinnamon: *___ side effects found*
- insulin - sugar - No
*Why do patients not disclose used of dietary supplements?* • Feel healthcare providers are not ______________ or knowledgeable about them • Consider that dietary supplements are not "______" drugs • __________________ to reveal use of unconventional therapies
- interested - true - Embarrassed
Glucosamine and Chondroitin: *Benefit Claim* • Glucosamine can be taken separately as supplement for _______ • Can help with __________________ and improve function
- joints - osteoarthritis
Flax Seed and Flax Seed Oil: *Benefit Claim* • Flaxseed most commonly used as ___________; relieves hot flashes and _________ pain • Flaxseed oil used for different conditions than flaxseed, including ___________ • Both used for high ________________ levels and to prevent __________
- laxative, breast - arthritis - cholesterol, cancer
Flax Seed and Flax Seed Oil: *What does Science say?* • Effective __________ • _________ results about lowering cholesterol levels and decreasing hot flashes
- laxative - Mixed
Kava Kava: *Contraindications* • FDA Alert-Advise consumers of the potential risk of severe ______ injury • May interact with ________________ medications • Avoid with _____-___________ medications
- liver - Parkinson's - anti-anxiety
Ginseng: *What does Science say?* • Some studies show it may ________ blood glucose and possible benefits to immune system, however, studies are not _______________ enough at this time
- lower - conclusive
Ginseng: *Benefit Claim* • Increase overall _________ and __________ health • ________ immune system • Lower blood ___________ and control blood ___________
- mental, physical - Boost - glucose, pressure
Feverfew: *Benefit Claim* • Reduces the frequency, severity, and duration of ____________ headaches, arthritis pain, _________, and vomiting • Anti-___________________
- migraine, nausea - inflammatory
FDA Regulation: Drug vs. Supplement: *Dietary Supplements* • Quality control ____ required • Cost-_________ • Rarely ____________ by insurance
- not - Varies - covered
Licorice: *Benefit Claim* • Reduces problems associated with _________ and ______________ ulcers, relieves sore _________, acts as a mild ___________
- peptic - duodenal - throat - laxative
*Herb or Botanical* • A _______ or plant part that is used for its ________, scent, and/or _________________ properties • Examples: ___________, leaves, bark, _______, seed, stems, and _______; substances produced by plants; algae
- plant, flavor, therapeutic - flowers, fruits, roots
Anatomy of Dietary Supplement Labels: *Other ingredients* • In descending order of ______________________ and by common _______ or proprietary blend
- predominance - name
Black Cohosh: *Contraindications* • No interactions with __________________ medication • May cause preterm labor and _________________
- prescription - miscarriages
Goldenseal: *Adverse Reactions/Oral Effects* • Women who are pregnant or breastfeeding should avoid-increase risk of ___________ labor or miscarriage; life-threatening ______ problems in nursing infants • Rare side effects-nausea and ___________
- preterm, liver - vomiting
Saw Palmetto: *Benefit Claim* • Reduce complications associated with an enlarged ____________ gland • Reduces chronic ________ pain, bladder disorders, increases ____ drive, improves hair loss, and improves _____________ imbalances
- prostate - pelvic, sex, hormone
St. John's Wort: *Contraindications* • With ___________________ drugs and reduced ___________________ of heart medications • FDA ALERT-Advise consumers of drug interactions with ____________, reduces the ___________________ of the drug
- psychoactive, bioavailability - Indinavir,effectiveness
Dong Quai: *What does Science say?* • More __________ need to be conducted • Herb contains ______________-like substance with anticoagulant properties
- research - coumadin
*Office of Dietary Supplements within the National Institutes of Health (NIH)* • Purpose: To expand ____________ and to expand consumer ________________ regarding dietary supplements
- research - information
Goldenseal: Benefit Claim* • Improves _______________ tract infections, canker sores, _____ diseases, gingivitis • Anti-__________________
- respiratory, skin - inflammatory
FDA Regulation: Drug vs. Supplement: *FDA Approved Drugs* • Manufacturers must obtain FDA approval by providing convincing evidence that a drug is both _____ and _____________. • _________ must be well-studied and documented
- safe, effective - Safety
Valerian: *Contraindications* • Increases effects of general anesthetics, ______________, barbiturates, CNS _________________
- sedatives - depressants
Anatomy of Dietary Supplement Labels: *Supplement Facts Panel* • Lists serving _____, amount, and _________ ingredient(s)
- size - active
Licorice: *What does Science say?* • Not enough evidence to show help with stomach _______
ulcers