Tuesday, May 1, 2018

Acupuncture possible treatment for dental anxiety



Researchers have found evidence that acupuncture could help people who experience dental anxiety.
Dental anxiety affects up to an estimated 30% of the adult population in countries world-wide. Patients can experience nausea, difficulty breathing and dizziness at the thought of going to the dentist, during an examination, and following treatment.
Reasons behind dental anxiety can be various, such as fear of pain, needles or anaesthetic side effects, as well as embarrassment or feeling a loss of control.
In a review of six trials with 800 patients, researchers used a points scale to measure anxiety and studies show that anxiety reduced by eight points when dental patients were given acupuncture as a treatment. This level of reduction is considered to be clinically relevant, which means that acupuncture could be a possibility for tackling dental anxiety.
Previous clinical trials have involved acupuncture for treatment on a range of conditions, including lower back pain, depression, and irritable bowel syndrome. There is, however, limited research detailing its impact on specific cases of anxiety.
More than 120 trials across England, China, Spain, Portugal and Germany were identified as having investigated the effects of acupuncture on patients with dental anxiety, and six trials were eligible for review, with two demonstrating high quality methods.
Professor of Acupuncture, Hugh MacPherson, at the University of York's Department of Health Sciences, said: "There is increasing scientific interest in the effectiveness of acupuncture either as a standalone treatment or as an accompanying treatment to more traditional medications.
"We have recently shown, for example, that acupuncture treatment can boost the effectiveness of standard medical care in chronic pain and depression.
"Chronic pain is often a symptom of a long-term condition, so to further our understanding of the various uses of acupuncture we wanted to see what it could achieve for conditions that occur suddenly, rapidly and as a reaction to particular experiences."
Studies that compared anxiety levels between patients that received acupuncture and those that did not, showed a significant difference in anxiety scores during dental treatment. A clinically relevant reduction in anxiety was found when acupuncture was compared with not receiving acupuncture.
No conclusions could be drawn, however, between patients that received acupuncture as an intervention and those that received placebo treatment, suggesting that larger scale controlled trials are needed to increase the robustness of the findings.
Professor MacPherson said: "These are interesting findings, but we need more trials that measure the impact of acupuncture on anxiety before going to the dentist, during treatment and after treatment.
"If acupuncture is to be integrated into dental practices, or for use in other cases of extreme anxiety, then there needs to be more high quality research that demonstrates that it can have a lasting impact on the patient. Early indications look positive, but there is still more work to be done."
The research is published in the European Journal of Integrative Medicine.

Monday, April 30, 2018

Systematic treatment of periodontal disease: Advantage of further therapeutic approaches

Better results particularly for attachment level, more studies and analyses
Institute for Quality and Efficiency in Health Care
The German Institute for Quality and Efficiency in Health Care (IQWiG) investigated the advantages and disadvantages of different treatments of inflammatory disease of the periodontium. The final report is now available. According to the findings, there are now an indication or hints of (greater) benefit for six therapeutic approaches, mostly regarding the outcome "attachment level". In the preliminary report, this had only been the case for two types of treatment. The assessment result is now notably better because additional studies have become available to the Institute, and further analyses were possible.
In the worst case, tooth loss is possible Periodontal disease is the scientific term for disorders of the tissues surrounding the tooth, called the periodontium. The periodontium consists of the gums (gingiva), the periodontal ligament, cementum and the tooth sockets (dental alveoli), i.e. the sockets in the jaw bone that contain the roots of the teeth and keep them in place.
Periodontitis, one of the most common forms of periodontal disease, is a bacterial inflammation that occurs in the gums, for example, if food residue cannot be removed from the gingival pockets with tooth brushing. Left untreated, this can initially lead to bleeding and pus. In the long term, the periodontium may be damaged, resulting in loosening and eventual loss of teeth.
Periodontitis is a common disease. It is estimated, for example, that about 53 per cent of people aged between 35 and 44 years in Germany have a moderate form of periodontitis.
Variety of therapeutic approaches Today there is a large variety of therapeutic approaches. Besides mechanical and surgical procedures, methods also include antibiotics, laser therapy, photodynamic interventions or air-polishing systems. These methods are used to clean the gingival pockets, polish the root surfaces and kill or remove bacteria.
Not all these methods are currently covered by German statutory health insurance funds. A prerequisite for reimbursement is that the patients provide an active contribution, i.e. improve their oral hygiene (tooth brushing, flossing, etc.).
More study results usable On the one hand, the IQWiG researchers were able to include additional randomized controlled trials (RCTs) in the final report. On the other, they were able to use additional data from studies that had already been included.
This was possible for two reasons: In its literature search for the preliminary report, IQWiG had identified a number of studies investigating the appropriate research question. For many studies however, the results had been presented in the publications in a way that made them unusable for the benefit assessment. This could later be corrected for the final report. The basis for this correction was a statistical factor calculated by a team at the University of Greifswald specifically for this purpose from one of their epidemiological studies.
Analysis of data on the attachment level now possible In addition, in the oral hearing, the Institute and external experts agreed on a threshold value above which a treatment effect is to be considered as relevant to health. This threshold value allowed the inclusion of results on the outcome "attachment level" from a large number of further studies. Attachment refers to the fixation of the tooth to the jaw. The attachment level describes to what extent the periodontium is intact or destroyed.
Relevant differences in six types of treatment Conclusive study data showing health-relevant differences in the treatment results were now available for a total of six therapeutic approaches; this had been the case for only two therapeutic approaches in the preliminary report. The Institute had been able to derive a hint for each of these two, indicating a relatively low certainty of conclusions. In the final report, in contrast, IQWiG determined a hint of (greater) benefit for four treatments, and even an indication of (greater) benefit for two other treatments.
Initially, the IQWiG researchers had only been able to assess the outcome "gingivitis" (inflammation of the gums) for most of the studies. Now it was also possible to assess the attachment level for all studies.
Scaling and root planing: indication instead of hint of benefit The assessment result was better particularly for non-surgical subgingival debridement ("scaling and root planing") compared with no treatment. In scaling and root planing, suitable instruments are used to remove tartar and bacteria from the gingival pockets and plane the root surface. In view of greater gain in attachment, IQWiG now saw an indication of a benefit for this method; this had been a hint in the preliminary report.
Treatment results were better in combination with systemic antibiotic treatment than with scaling and root planing alone. Again, the attachment level was decisive for granting the indication of greater benefit. No differences between the study groups were detected for topical antibiotics, however.
Surgical interventions had no advantage Four further comparisons each showed a hint of greater benefit. In these comparisons, laser treatment and a special photodynamic method as well as instructions on oral hygiene were used, mostly in addition to scaling and root planing.
Only surgical pocket elimination as an addition to scaling and root planing resulted in a disadvantage (lesser benefit) than scaling and root planing alone.
Still hardly any data on tooth loss or side effects The newly available data, from which conclusions on benefit or harm can be derived, also only refer to "gingivitis" and "attachment level". The studies only contained sporadic data on important other criteria, such as tooth loss, side effects of treatment, or quality of life.
And there was still no evidence on structured after-care in the form of instructions on oral hygiene and regular teeth cleaning using special equipment. However, the publication of a probably decisive and with more than 1800 participants relatively large study has been announced for 2018 (IQuaD). The Institute could then conduct a supplementary assessment of these data.
Constructive use of the commenting procedure "We are pleased that our appeals had an effect and that study authors and other researchers used the commenting procedure for a constructive input of their expert opinion", says Martina Lietz, dentist and project manager of the report in the Non-Drug Interventions Department. "This cooperation was much appreciated, given that we had received such harsh initial criticism of our preliminary report", she adds. "There is now better evidence overall, even though it is still far from sufficient."
Process of report production IQWiG published the preliminary results in the form of the preliminary report in January 2017 and interested parties were invited to submit comments. At the end of the commenting procedure, the preliminary report was revised and sent as a final report to the commissioning agency in March 2018. The written comments submitted are published in a separate document at the same time as the final report. The report was produced in collaboration with external experts.

Saturday, April 28, 2018

Fluoride varnish in the primary dentition can prevent caries



Whereas caries in adults and adolescents is declining, studies in children under the age of 3 have shown that caries in this age group has hardly decreased: On average, about 14% of all 3-year-olds in Germany have caries in the primary dentition. Fluoride varnish effectively helps in the remineralization of the tooth surface and prevents the development and progression of caries. The use of fluoride varnish has advantages especially for small children because it hardens quickly. Due to a lack of conclusive data it is unclear, however, whether fluoride application also has advantages regarding further patient-relevant outcomes such as tooth preservation, toothache or dental abscesses.
This is the conclusion of a rapid report published by the German Institute for Quality and Efficiency in Health Care (IQWiG) on 26 April 2018.
Primary teeth are particularly prone to caries Caries is caused by bacteria in the dental plaque, sugary foods and drinks, and a lack of oral hygiene. Children are especially likely to have caries because the enamel on baby teeth is more sensitive than the enamel on permanent teeth. Permanent teeth are sensitive at first too: When they break through, their enamel has not yet fully hardened, making it susceptible to caries. If the primary teeth already have caries lesions, subsequent permanent teeth are often also "infected" with caries at an early stage. Particularly in young children, oral hygiene and caries prevention can be challenging, however.
Children until the age of 6 years, with or without caries of their primary teeth, were included in the research question of the present rapid report: Does the application of fluoride varnish to the primary dentition have advantages in comparison with standard care without specific fluoride application?
Studies focused on caries The IQWiG researchers extracted results from 15 randomized controlled trials (RCTs), in which a total of 5002 children were treated with fluoride varnish, whereas 4705 children received no such treatment. In many studies, further measures for caries prevention in addition to the application of fluoride varnish were offered. These included trainings on oral hygiene, instructions on the correct tooth brushing technique or provision of toothbrushes and fluoridated toothpaste. The follow-up observation period was mostly two years, in some cases up to three years.
The outcome "caries" was investigated in all studies; side effects were investigated in almost all studies. Further outcomes such as tooth loss, toothache, dental abscesses or inflammation of the gums (gingivitis) were only rarely investigated. The respective data showed no difference between intervention and control group so that no conclusions on advantages or disadvantages of fluoride varnish application could be derived. Data on oral health-related quality of life were lacking completely.
Fluoride varnish promotes remineralization A clear advantage of fluoride varnish was determined despite the very heterogeneous study results: Caries of primary teeth was less common after application of fluoride varnish than without it. This treatment could completely prevent caries in about every 10th child. And it would at least reduce progression of caries in further children. Apparently, it did not make a difference for the benefit of the fluoride varnish whether the children already had caries or whether their teeth were completely intact.

Wednesday, April 25, 2018

Study: Drug-filled, 3-D printed dentures could fight off infections


Nearly two-thirds of the U.S. denture-wearing population suffer frequent fungal infections that cause inflammation, redness and swelling in the mouth.
To better treat these infections, called denture-related stomatitis, University at Buffalo researchers have turned to 3-D printers, using the machines to build dentures filled with microscopic capsules that periodically release Amphotericin B, an antifungal medication.
A study describing the work, recently published in Materials Today Communications, found that the drug-filled dentures can reduce fungal growth. Unlike current treatment options, such as antiseptic mouthwashes, baking soda and microwave disinfection, the new development can also help prevent infection while the dentures are in use.
Video/Photo: https://bit.ly/2qVC9pG
"The major impact of this innovative 3-D printing system is its potential impact on saving cost and time," says Praveen Arany, DDS, PhD, the study's senior author and an assistant professor in the Department of Oral Biology in the UB School of Dental Medicine.
The technology allows clinicians to rapidly create customized dentures chair-side, a vast improvement over conventional manufacturing that can vary from a few days to weeks, says Arany, who also has an appointment in UB's Department of Biomedical Engineering, a joint program in the Jacobs School of Medicine and Biomedical Sciences at UB and the School of Engineering and Applied Sciences.
Applications from this research, says Arany, could be applied to various other clinical therapies, including splints, stents, casts and prosthesis.
"The antifungal application could prove invaluable among those highly susceptible to infection, such as the elderly, hospitalized or disabled patients," he says.
The dental biomaterials market - worth more than $66 billion in 2015 - is expected to grow 14 percent by 2020. A large part of the industry is focused on dental polymers, particularly the fabrication of dentures.
UB researchers printed their dentures with acrylamide, the current go-to material for denture fabrication. The study sought to determine if these dentures maintained the strength of conventional dentures and if the material could effectively release antifungal medication.
To test the strength of the teeth, researchers used a flexural strength testing machine to bend the dentures and discover their breaking points. A conventional lab-fabricated denture was used as a control. Although the flexural strength of the 3-D printed dentures was 35 percent less than that of the conventional pair, the printed teeth never fractured.
To examine the release of medication in the printed dentures, the team filled the antifungal agent into biodegradable, permeable microspheres. The microspheres protect the drug during the heat printing process, and allow the release of medication as they gradually degrade.
The investigation involved the development of an innovative form of acrylamide designed to carry antifungal payloads, and a novel syringe pump system to combine the dental polymer and microspheres during the printing process.
The dentures were tested with one, five and 10 layers of material to learn if additional layers would allow the dentures to hold more medication. The researchers found the sets with five and 10 layers were impermeable and were not effective at dispensing the medication. Release was not hindered in the more porous single layer, and fungal growth was successfully reduced.
Future research aims to reinforce the mechanical strength of 3-D printed dentures with glass fibers and carbon nanotubes, and focus on denture relining. - the readjustment of dentures to maintain proper fit.

Tuesday, April 24, 2018

Drinking affects mouth bacteria linked to diseases


When compared with nondrinkers, men and women who had one or more alcoholic drinks per day had an overabundance of oral bacteria linked to gum disease, some cancers, and heart disease. By contrast, drinkers had fewer bacteria known to check the growth of other, harmful germs. These are the main findings of a study published in the journal Microbiome online April 23 and led by NYU School of Medicine researchers.
"Our study offers clear evidence that drinking is bad for maintaining a healthy balance of microbes in the mouth and could help explain why drinking, like smoking, leads to bacterial changes already tied to cancer and chronic disease," says study senior investigator and epidemiologist Jiyoung Ahn, PhD.
According to Ahn, associate director of population sciences at NYU Langone Health's Perlmutter Cancer Center, her team's study offers evidence that rebalancing some of the 700 types of bacteria in the mouth, or oral microbiome, could potentially reverse or prevent some health problems tied to drinking. Ahn says roughly 10 percent of American adults are estimated to be heavy drinkers, which experts define as consumption of one or more drinks per day for women, and two or more drinks per day for men.
Doctoral student and study first author Xiaozhou Fan, MS, says previous studies have examined alcohol consumption and its broad links to disease and some changes in the microbiome, but the new report is the first to directly compare drinking levels and their effects on all oral bacteria. Previous work at NYU Langone and elsewhere has tied the risk for head and neck cancers, and for gastrointestinal cancers, to microbial changes in the mouth.
Specifically, drinkers had more of the potentially harmful Bacteroidales, Actinomyces, and Neisseria species, and fewer Lactobacillales, bacteria commonly used in probiotic food supplements meant to prevent sickness.
The study involved 1,044, mostly white participants between the ages of 55 and 87. All came from two ongoing, national cancer trials, and all were healthy when they enrolled in either study and provided mouthwash samples of their oral microbiome, along with detailed information about their alcohol consumption. Laboratory testing was then used to genetically sort and quantify the oral bacteria among the 270 nondrinkers, 614 moderate drinkers, and 160 heavy drinkers. Results were plotted on graphs to determine which bacteria in drinkers stood out -- and grew more or less -- than in nondrinkers.
Researchers note that while their study was large enough to capture differences between bacteria among drinkers and nondrinkers, more people would be needed to assess any microbiome differences among those who consumed only wine, beer, or liquor. Some 101 wine-only drinkers were involved in the latest study, in addition to 39 who drank only beer and 26 who drank only liquor.
Ahn, an associate professor at NYU Langone in the Department of Population Health, says her team's next steps are to work out the biological mechanisms behind alcohol's effects on the oral microbiome. And she emphasized that her work is still a long way from determining if blocking or promoting any particular changes in the microbiome would lead to healthy bacteria levels similar to those found in nondrinkers.
Possible explanations for drinking-related microbiome imbalances, Ahn says, could be that acids in alcoholic beverages make the oral environment hostile for certain bacteria to grow. Another reason, she says, could be the buildup of harmful byproducts from alcohol's breakdown, including chemicals called acetaldehydes, which along with the harmful toxins in the mouth from tobacco smoke, are produced by certain bacteria, such as Neisseria.

Wednesday, April 18, 2018

Statins save lives of people with high levels of LDL cholesterol

Cholesterol-lowering drugs are more likely to save thousands of additional lives when used in people with higher levels of LDL cholesterol, or "bad" cholesterol, according to a new study from the University of Iowa, published in the Journal of the American Medical Association (JAMA).

Jennifer Robinson, a physician, professor of epidemiology in the UI College of Public Health, and study coauthor, says the findings show that doctors should more aggressively treat patients who have high levels of LDL cholesterol with statins, and patients should feel safe using them.

"Statins are the safest drugs we have to reduce the risk of heart attacks, strokes, and death in a wide range of patients," says Robinson. "Patients with higher LDL cholesterol levels are likely to experience even greater health benefits from taking statins and some of the newer cholesterol drugs."

The study analyzed 34 previous studies that involved more than 270,000 participants. The analysis found that statins were more likely to reduce the risk of death when LDL cholesterol levels were 100 milligrams per deciliter (mg/dl) or greater, whether or not they were used with other LDL-lowering drugs.

Robinson says the study found the lives of an additional 4.3 in 1,000 people were saved every year when treated with LDL cholesterol lowering therapy. The greatest benefit--and the greatest reduction in death rates--came to those with the highest levels of LDL cholesterol, she says.

LDL cholesterol causes fat and plaque to build up in arteries, increasing the risk for heart attacks and strokes. Levels below 100 mg/dl are considered optimal, as people with that reading are less likely to develop cholesterol plaques as they age. Readings above 100 mg/dl are considered unhealthy.

Given that 12.4 percent of American adults--or about 30 million people--have LDL levels above 160 mg/dl, Robinson says the findings show statins save tens of thousands of lives annually.

"Unfortunately, most Americans with higher cholesterol levels are not treated, and lives are unnecessarily being lost," she says.

Those with excess LDL can reduce their levels through an improved diet, increased exercise, and by taking medications such as statins. People who already have cardiovascular disease or genetic causes of high cholesterol also may benefit from adding other LDL-lowering drugs to statin therapy.

The study shows that LDL-lowering drugs can be effective for preventing heart attacks and stroke in people with risk factors even when LDL cholesterol levels are low, but even more heart attacks and death are prevented when people have LDL levels above 100 mg/dl.

The study, "Lipid lowering and mortality and cardiovascular outcomes," was published in the April 3, 2018, issue of JAMA





Ibuprofen, acetaminophen more effective than opioids in treating dental pain




Opioids are not among the most effective--or longest lasting--options available for relief from acute dental pain, a new examination of the results from more than 460 published studies has found.

Ibuprofen and other nonsteroidal anti-inflammatory drugs (NSAIDs) alone or in combination with acetaminophen are better at easing dental pain, according to new research conducted with the School of Dental Medicine at Case Western Reserve University.

The study examining relief of acute pain in dentistry--recently featured on the cover of The Journal of the American Dental Association--evaluated the safety and efficacy of dozens of pain-relief options.
"What we know is that prescribing narcotics should be a last resort," said Anita Aminoshariae, an associate professor in the dental school's Department of Endodontics and one of the study's authors.

Each day, more than 115 Americans die as a result of an opioid overdose, according to the National Institutes of Health.

"No patient should go home in pain," Aminoshariae said. "That means that opioids are sometimes the best option, but certainly should not be the first option."

Aminoshariae said the goal of the systematic review was to summarize data--using five in- depth studies--of the effectiveness of oral-pain medications.

"The best available data suggests that the use of nonsteroidal medications, with or without acetaminophen, offers the most favorable balance between benefits and harms, optimizing efficacy while minimizing acute adverse events," she said.
She cited the national opioid epidemic as one of many reasons why health-care providers should take note of the findings.

The research found that, for adults, a combination of 400 milligrams of ibuprofen and 1,000 milligrams of acetaminophen was superior to any opioid-containing medications studied.

"Our aim was to create a compendium detailing both the benefits and harms of these medications as a resource for dentists to use in their clinical decision-making," Aminoshariae added.

The study also found that opioids or drug combinations that included opioids accounted for the most adverse side effects--including drowsiness, respiratory depression, nausea/vomiting and constipation--in both children and adults.