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 ​