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Professional News Articles : : ON PRACTICE MANAGEMENT by Janyce Hamilton : Where do dentists go for herbal therapeutic data?

Where do dentists go for herbal therapeutic data?

September 01, 2006

Peer-reviewed journal articles on which natural and herbal products have therapeutic dental and oral health benefits or detriment are hard to come by. Books specifically for dentistry on the topic don't exist. The closest is the 3rd edition of the PDR for Herbal Medicines (2004) by Thomson PDR in Montvale, NJ, or the soon-to-be published 4th edition of the PDR/ADA Guide to Dental Therapeutics, which has an herbal section.

The 3rd edition of the PDR for Herbal Medicines was a major update managed by Bette LaGow, director of editorial services, who used a number of medical writers to research and update the content. There was no single author or editor of the text.

I interviewed her to understand the process of assembling such a reference book.

The Interview

Janyce Hamilton (JH):  Is there any other publication in North America that is as comprehensive and well-organized and as cross-referenced with various indexes, that includes monographs showing studies supporting the information given on each herb, as your PDR for Herbal Medicines?

Ms. LaGow (BL): While there are a number of herbals out there, the PDR book is likely the only one to include clinical trials data and management of possible interactions (where available and applicable; this info is provided for approximately the top 10 percent of herbs in the book—the ones most used by patients).

JH: By the way, I am sure you know that you are partnering with the American Dental Association to publish this year a new edition of their drug book—the PDR/ADA Guide to Dental Therapeutics. From the Thomson PDR perspective, why was this something you wanted to get involved in publishing?

BL: Two authoritative organizations partnering to produce a comprehensive book like this can only improve an already successful product.

JH:  On the jacket of the PDR Guide to Herbal Medicines, I read about your information sources. Who is PhytoPharm U.S. Institute of Phyto Pharmaceuticals? Why are they to be trusted and how do they have clinical information on herbal pharmacology and usage that is generally not found in other sources?” Will they be your partner on the next edition of this text?

BL: Phytopharm provided the material for the first edition; PDR has augmented this info in subsequent editions with more US-based clinical trials info (Phytopharm is based in Germany; herbal usage in Europe is much more widespread and of longer duration than the US. The Commission E data is analogous to FDA approval here in the US—herbs are not regulated in this country but German Commission E examines the efficacy of herbals for particular uses and only approves an indication after the evidence has shown to hold up).  We will continue to use Phytopharm's herbal database as the foundation for future editions—none of which are planned at this time.

JH:  In the forward, Dr. Heber of UCLA writes that this PDR is intended to help physicians provide intelligent advice on herbal use/misuse. This is exactly how I am going to advise dentists use this book.

BL: Use of herbal remedies has been increasing. As such, doctors need an authoritative reference to find info on the herbs their patients are taking. That was why we created this book.

JH: Numerous references are at the end of each herb's listing in the book. Does this mean your PharmD editors on staff actually reviewed these studies for clinical relevance, or are were they picked up from the PhytoPharm and Commission E's published findings?

BL: This referential listing either came from Phytopharm's research or from the Thomson Micromedex database on herbals, which includes data on clinical trials.

JH: It seems no prescribing advice is given as opposed to PDR of Medicines.  Instead, we're given how herbs are supplied and how it is taken. Why this format? Sometimes the dosage has names and years of studies this information comes from in parentheses afterward, sometimes not. When not, whose advice is it?

BL: Herbs are not FDA regulated and as such there are no approved dosages. We cited references when available.

JH: The dosage doesn't necessarily say which indication(s) it is for, I noticed. I guess one would just try that dose for all or any of their problems listed in the book under that herb, and see if it helps?

BL: One should look back to the indications; suggested dosage would be applicable to the cited indications unless otherwise noted.

JH: Are there few herbal compounds that have been studied using randomized, blinded, controlled clinical trials—or for whom a Cochrane Review has scrutinized its body of published studies—preferably with a large number of subjects and longer term?

BL: Herbs have not been studied widely in this country, though we tried to provide as much trial info as was available—usually trials are looking at efficacy, not adverse effects. Much of that info was from Phytopharm's original data.

JH: All the herbs listed don't necessarily have safety advice beyond drug interactions. Does this mean that as far as you know they are safe to use continually for prevention and treatment, or is it like Prilosec OTC for acid reflux, short 14-day course only (and only once every four months) as there are no long-term, well-designed safety studies?

BL: No herb or natural medicine should ever be assumed safe unless noted. Preferably patients should discuss use of any substance, including herbs, with their doctor or another experienced healthcare professional.

JH:  Your drug-herb interaction guides are awesome. How did you assemble these?

BL: Thomson has an incredible wealth of drug and drug interaction data. We assemble information for this guide using a combination of data from our PDR index, and from databases from our sister business, Micromedex.

JH: Do you view this book as a starting point rather than an end-all reference book on herbal medicines? I mean, there's nothing better that I know of published yet, so this is a valuable text for anybody to get information on herbal medicines, which don't have to go through clinical trials to gain FDA approval. But should it be a doctor's only source? If not, what other sources do you recommend he/she investigate on herbal medicines?

BL: The NIH now has a division of complementary and alternative medicine. I'd suggest that as a starting point, as it likely references other noteworthy publications as well.

 JH: Some of what the Forward's author, Dr. Heber, had to say included that herbal medicines, when properly used, have preventive benefits and potential lack of toxicity as features compared with traditional medicines. Do you agree? Also he said he predicts they are The medicines of the century as they will be used to treat/prevent many modern chronic diseases of aging.

BL: I'd like to let his comments stand on their own—this is a specialty of his and clearly he is very well versed in the literature of herbs and supplements. Almost any drug or herb for that matter has a potential for toxicity if used incorrectly. We hope this book can at least provide more information than doctors previously had or can serve as a starting point if they wish to study the data further.

Conclusion

The PDR for Herbal Medicines is a good start for researching legitimate uses in treating patients. Perhaps the NIH's complementary and alternative medicine division will team up with the NIDR, and the FDA will expand their funding for herbal medicine investigations and for evidence-based reviews of such studies. It would help in case the day comes when dentists are called on by homeopathic and herb apothecary reps.

For the upcoming PDR/ADA Guide to Dental Therapeutics, or the PDR for Herbal Medicines, visit www.pdrbookstore.com

Janyce Hamilton is a Chicagoland freelance dental writer and editor. Send suggestions for topics to be covered, or any comments on this column, to review@cds.org.

Copyright 2006, Chicago Dental Society