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Interviewer: Why you should be excited about the new University of Utah School of Dentistry. We'll examine that next on The Scope.

Announcer: We're your daily dose of science, conversation, medicine. This is the Scope, University of Utah Health Sciences Radio.

Interviewer: University of Utah School of Dentistry is in their brand new building and it's a reason to be excited. Why? We're with Dr. Glen Hanson. He's a professor and the Interim Dean at the University of Utah School of Dentistry. And why is this such an important addition to the University of Utah Health Care System?

Dr. Hanson: If you're concerned about overall health then you cannot ignore oral health. That has to be at the table when you have that discussion. And up until now, that hasn't been here at the University of Utah. We've had all the other pieces, but for many years there has not been the oral health piece that's been represented. And now the package is complete.

All the pieces of the puzzle are together, and now we can deal with the whole system. We can truly be a holistic health care system. Insurance companies, and Federal, and state compensation programs are going to be based on outcomes, they're not going to be based on procedures, which means if your patient is healthy, and healthy is the whole body, if your patient's healthy then that's how you get your maximum compensation.

Well, in order to make the whole body healthy you have to have all of the areas represented in the discussion. How do you prevent disease in general, not just disease in the nose, and disease in the eyes? It's disease throughout the whole body, and the dentist has as much influence and as much expertise to bring to that discussion as anybody else. It represents those various aspects of body and body health.

Interviewer: So you said the School of Dentistry kind of brings this complete picture of health to University of Utah Healthcare. There are other places, though, that a person could go to learn to be a dentist. What makes this School of Dentistry different?

Dr. Hanson: Because we are part of an institution that puts a lot of emphasis on research and we've got that complete health care package that is there now with the School of Dentistry that is unique. There has not been a Dental School that started in those kinds of environments for almost 30 years.

Interviewer: Here in the state?

Dr. Hanson: No, anywhere. Throughout the country.

Interviewer: Oh, really?

Dr. Hanson: There have been dental institutions that had been sort of independent, they've run their own thing, but they've not been part of the larger healthcare system, and they've not been part of the research establishment. So they've been standalone, some of them proprietary, whereas we are state-owned, and we're part of a university that has a reputation for outstanding research and outstanding healthcare in all aspects of health.

Interviewer: So talk about how the school's going to serve under-served populations. I know that's one of the big mission statements of the University of Utah School of Dentistry.

Dr. Hanson: We wanted to identify a specific mission that, one, would allow us to train students to do what dental students are supposed to do so that they can go out and be outstanding clinicians. But, two, we felt that there the University, or the School of Dentistry, had a responsibility to give back to the community. And the way that we felt that that could be best achieved was to help provide dental services for that population that oftentimes does not have access to it. And so we wanted the Dental School to be a tool to accomplish that. So our students, one, get the training to be good dentists; two, they provide a service to their community; and, three, they learn that they have a social responsibility with their skill-set.

Interviewer: So the School of Dentistry here at the University of Utah is not only a school, but also it's research, and you also have a clinic. Talk about the clinic, cause you have some specialized things going on here.

Dr. Hanson: Well, there's a large area of clinical chairs. Some 60+ clinical chairs where our dental students, they start going into the clinic even at the end of their first year. And then, by the second year, they're seeing patients and their doing procedures on them. We have an Oral Surgery Clinic, then we have a Pediatric Dentistry Clinic, and that's going to be one of our main emphases in this Dental School.

And we have several chairs there that are set up with monitors above the chairs, the children can see the monitors, they can have either television programs or movies running, and specially-trained pediatric dentists working with our students to learn how to deal with this population. They have special dental needs.

And then we have a Diagnostic Clinic, where we do the screening. And then we also are doing faculty practice, so some of our faculty do practice on maybe half to one or two days a week in another part of our clinic. So we're doing a lot of different dental procedures within that clinical setting. A very active area and as we have two classes now as we get our four classes that place is going to be hopping every day, morning and night.

Interviewer: How many students will that be then?

Dr. Hanson: We started off with 20 students. When we began, we made a commitment that we will identify the most outstanding 20 students we can find in the state. But we're a regional center. There are not many dental schools in this area, and then there are states, surrounding states, like Idaho, and Wyoming, and Montana, and North and South Dakota, New Mexico, they don't have dental schools, so all of their students have to leave the state. So we feel that we're in a position where we can be a regional dental school. So we're anticipating that we will get up to 40 students a class with 20 in-state and 20 regional students, but we have the capacity eventually to get up to 50 per class. And that will probably take awhile before we get there.

Interviewer: So 200 total students in here.

Dr. Hanson: We could do 200 students easily with the way the building is organized.

Interviewer: Wow. Just got to get more teachers.

Dr. Hanson: There you are. Well, and another thing that we're doing is we're trying to create satellite clinic opportunities. So it's one thing to learn how to practice within this very established and controlled structure that we call a dental school, it's another thing to get experiences that allow you to feel comfortable about going into private practice. And so that's what these satellite clinics will allow us to do. It's to put them into a more real-life dental setting, where they'll see patients in an environment that looks more like what their practice will look like. Plus it gives us another chance to interact with those populations that often times don't have access to dental services.

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Interviewer: A Link Between Methamphetamine Use and Parkinson's Disease, up Next on The Scope.''

Announcer: Examining the latest research and telling you about the latest breakthroughs, the science and research show is on The Scope.

Interviewer: I'm talking with Dr. Glen Hanson, Interim Dean at the School of Dentistry at the University of Utah and Director of the Utah Addiction Center. You've done some researching looking at a long-term and serious side effect of meth use. What did you find?

Dr. Hanson: We were interested in the dependence on drugs, such as methamphetamine and the amphetamines, and we knew -- we've known for quite a while -- that it interacts with that part of the brain that is associated with the neurological disorder known as Parkinson's disease. And from animal studies, our findings suggested that it may lead to Parkinson's disease in humans, and that's what the study looked at. We found that there was a connection between that dependence on these compounds and Parkinson's disease.

Interviewer: So meth use increases your risk for getting Parkinson's disease. How much of an increased risk do you see?

Dr. Hanson: In the general population, it's about a threefold increase.

Interviewer: This increased risk factor for getting Parkinson's disease is one of actually many terrible side effects of meth use.

Dr. Hanson: Correct.

Interviewer: And is this really the first long-term effect that we know of?

Dr. Hanson: It is, that has looked at a neurological piece to it. We know, in human studies, there are changes in some cognitive functions in people who are long-term users, and they find that some of these neuropsych determinants or elements are still compromised in these people, things such as memory. But even these studies typically only go out two or three years, and none of them have asked the long-term question, ''What neurological diseases may happen down the road to this population of amphetamine users?'' These studies are the first ones to show that this long term, maybe ten, twenty years after you've had the amphetamine problem.

Interviewer: So maybe we can back up a second and you can remind us what Parkinson's disease is.

Dr. Hanson: Parkinson's disease is associated with a fairly select group of pathways in the brain that are involved in motor control, and so some of the earliest signs of Parkinson's are things such as tremors, usually hand tremors, the way someone walks, their posture, they tend to become stooped.

Interviewer: And so you were mentioning in the beginning that there's a particular pathway in the brain that leads to Parkinson's disease. You've also shown that, at least in an animal model, that class of drugs can also damage that part of the brain.

Dr. Hanson: So this pathway uses a chemical called dopamine, and dopamine is a big player in mobility, in behavior, in movement. So there is a selected pathway called the nigrostriatal pathway that methamphetamine or the amphetamines damage when they're used continually and they're used in high doses. So the same pathway gets damaged in Parkinson's. A general figure is that if you damage 70% of that pathway, then you start to see signs of Parkinson's disease.
In everybody, that pathway deteriorates over their lifetime, but most of us die before we reach that critical 70%, so the disease doesn't show up. However, if you take a drug like the amphetamines and it pushes you down that pathway, 20% or 30%, that means you're more likely to hit that magic 70% plateau before you die, which means you're going to have Parkinson's because you got pushed down the pathway earlier on because of your drug use.

Interviewer: Getting this information out there, what do you hope that will accomplish?

Dr. Hanson: We would hope that it would educate the population that there are long-term consequences to misusing drugs in general, not just the amphetamines, but other drugs. As we start to discuss things about, "Do we legalize this? Do we legalize that,'' oftentimes we're not asking the long-term questions. We're asking short-term questions, but we don't say, ''Might there be something showing up in 20 years or 30 years?'' Here's Parkinson's, obvious, but what about other neurodegenerative diseases? May they also be linked? Something like Alzheimer's, may that be linked, and some of these other neurological consequences? So we probably need to be looking at that more closely than what we have done in the past.
Now, we focused on the abuse side. That takes you down the road of: 'Well, what about legitimate use, therapeutic use? Are there drugs we're using for long periods of time, and for good medical reasons . . .

Interviewer: Right.

Dr. Hanson: . . . but they may be doing things, should we look at some of these databases and see is there long-term neurological or psychiatric consequences to them that we're not seeing when we just do our short-term studies?

Interviewer: Right, and you did make the point earlier, when we were talking, that methamphetamines are actually in a larger class of drugs called amphetamines, of which there are many kinds, some of which are used under clinical supervision.

Dr. Hanson: Correct. Well, methamphetamine and amphetamine are prescribed. These are Schedule II drugs. But is there consequences? Is there just the dependence situation, where you're using large doses, and maybe you're binging with it and you're injecting it versus therapeutic doses, which are smaller, you're taking them orally, and we need to look at that. My inclination would be I think that there is a difference. Some of the studies we've done in animals say that the brain responds very differently when it's done with therapeutic caution versus when it's done with abuse abandonment, but we need to make sure that that's the case when we look into our human cohorts.

Announcer: Interesting, informative, and all in the name of better health. This is The Scope Health Sciences Radio.