Monday, September 17, 2007

A Busy Dentist Steps Back for Family Time

Patients of Steven K. Kousournas quickly learn two things about the East Hartford dentist.

One, he is earnest about his work, and two, he can't carry a tune in a bucket. He's the kind of dentist your parents probably had, someone you'd invite to graduations, weddings, family gatherings. (This, even though he once made me late to a meeting because the filling he was building just didn't feel right to him. And he hummed off-key the whole time.)

There's probably a Greek word to describe him, but for the rest of us, he's a mensch, a good guy. And he tells about his recent dark night of the soul as an object lesson.

Kousournas came from Greece to a cold-water flat in Hartford in 1969 with his parents and sister. He was 8; the family carried an English dictionary in a trunk packed with olive oil they feared they'd miss in their new country.

Young Steve wasn't the only immigrant at Burns School. His class was crowded with Italians, Portuguese and other Greeks. His father worked two, sometimes three jobs. A tailor by trade, the elder Kousournas never talked about the sacrifices he and his wife made to give their children a better opportunity. Their move to America - learning English, becoming citizens - was their leap of faith.

Kousournas did so well in school that his teachers encouraged him to be a doctor. His sophomore year in high school, he latched onto dentistry. He went to college, then to dental school (while setting sales records at a men's clothing shop at Westfarms Mall). His parents bought a house in East Hartford, and they renovated the downstairs for their son's dental office. He took over the mortgage, and for a while, his sister worked the front desk.

He set about building the business. He met his wife, Maria, while looking for another receptionist. He called her about the job; she was happy where she was but called him back just to talk. It took him a year to realize she was the woman for him, and if you've ever met Maria, who is half-Greek, you wonder what took him so long.

In his defense, he was putting his immigrant's can-do energy toward advertising, expanding and bringing in more patients. Maria took over the front desk and brought a gentle energy to the go-go drive of her new husband. They had a daughter, Rena, now 12, a studious and artistic girl who grew up in the office. Along came Evi, the middle child, now 4, followed by Kosta, now 9 months, named for his grandfather, the hard-working tailor.

But a few months ago, Kousournas found himself at one of those crossroads no one can warn you about. Those weekends eaten up with lab work started to weigh on him. He always told his staff that family comes first. A beloved dental technician had one girl, then left to stay home with her second. A new dental technician wanted more hours, but if he gave her more hours, he'd have to take on more patients, giving him less time with his family.

He kept coming back to this: You can't buy time. A smaller practice would afford him time.

It's a hard decision, when you're the son of immigrant parents who instilled in you the notion that you work hard, and then you take on more work just because. But he took a deep breath and decided not to hire another dental technician. He would allow the practice to take care of itself. He wouldn't advertise. He'd still see patients, but not at his former frenetic pace. He'd watch his son grow and wonder about what he'd missed with his daughters.

And so that is what he's done. But let's be honest: The decision still bugs him a little, but he attended a friend's wedding recently with Rena, the 12-year-old, and while guests watched a video of the bride and groom growing up apart and then coming together, he welled up a little. Rena noticed and asked, "Daddy, are you thinking of me?"

At first he said no. And then he said yes. And then he knew he'd made the right decision. The practice, he says, will always be there. You can't buy time. This is his leap of faith.

Lab on a Chip for Oral Cancer Shows Promise

Finding out whether that unusual sore in your mouth is cancerous should become a lot faster and easier in the years ahead. Scientists supported by the National Institute of Dental and Craniofacial Research (NIDCR), part of the National Institutes of Health, have engineered the first fully automated, all-in-one test, or lab on a chip, that can be programmed to probe cells brushed from the mouth for a common sign of oral cancer.
About half the size of a toaster, the portable device yields results in just under 10 minutes, or well within the duration of a routine visit to a dentist or doctor. Currently, patients must undergo an often painful tissue biopsy and usually wait three days to a week for the lab results. “What’s exciting is the speed and efficiency that this test will bring to the diagnostic process,” said John McDevitt, Ph.D., a scientist at the University of Texas at Austin and the senior author on the paper, published in the August issue of the journal Lab on a Chip. “No longer will patients need to endure referrals, long waits for test results, and scheduling follow up consultations. Patients will get immediate results and feedback from their dentist or doctor on how best to proceed.”
McDevitt said his group’s proof of principle study showed that their test could accurately measure levels of epidermal growth factor receptor, or EGFR, on three distinct types of oral cancer cells. This protein, which is normally displayed on the surface of our cells, tends to be overproduced in oral tumor cells and serves as a measurable marker of oral cancer.
His group’s next step is to program the device to read not just EGFR levels but those of other proteins and genes that, when altered, are indicative of a developing oral tumor. This work already is well under way, and the group anticipates evaluating their test in the clinic with patients in the foreseeable future. “It could take several months to more than a year before we make the transition,” said McDevitt. “But the diagnostic platform has been built, and it’s just a matter of fine tuning the components that already are in place.”
According to McDevitt, the lab on a chip evolved from a conversation that he had a few years ago with Dr. Spencer Redding of the University of Texas Health Sciences Center in San Antonio about the difficulties of diagnosing oral cancer. Redding explained that dentists routinely face the dilemma of whether or not to refer patients to an oral surgeon for biopsies of suspicious sores, particularly possible recurrences of a previously diagnosed oral cancer. On the one hand, early detection is a key to fighting cancer and saving lives and, on the other, if the pathology report comes back negative, dentists risk upsetting their patients.
McDevitt was uniquely qualified to consider the problem. He studied in his laboratory functional molecular assemblies, or manipulating individual molecules to assemble miniaturized electronic or sensor components. This area of research has contributed greatly toward developing nano scale devices and popularizing the new discipline of nanotechnology.
The McDevitt laboratory already had an excellent track record of assembling novel, easy-to-use sensing devices that involve microfluidics, the science of precisely controlling micro or nano volumes of fluid. Among their accomplishments were a novel, miniaturized sensor to detect anthrax spores for the Nation’s biodefense efforts and thereafter a test for HIV infection and immune function in resource poor African nations. The laboratory also was working in the mouth, having received an NIDCR research grant to develop similar tests that use saliva, rather than blood, as a diagnostic fluid.
Combining these areas of research expertise, the McDevitt laboratory developed a test for oral cancer that begins with brushing cells from a suspicious lesion, suspending them in fluid, and loading roughly a drop of the mixture into their device. When activated, the device conveys the fluid down a tiny, microfluidic channel to a chamber with a porous membrane.
“The cells stick to the membrane floor like starfish in a net,” said Shannon Weigum, a member of the McDevitt laboratory and lead author on the paper. “The floor has little exit holes that drain the fluid out of the chamber and allow us to pump in a cocktail of, in this case, antibodies that are tagged with a fluorescent dye and that are programmed to seek out and attach to the EGFR displayed on the cells.”
“The chamber creates a nice, miniaturized platform with a digital camera interface to display the fluorescent tags for analysis on a computer screen,” she continued. “We can then read the level of fluorescence and determine how much EGFR is present on the cell surface. It automates a process that is done now by a pathologist. Think of the test as pathology on a chip.”
In their initial experiments, the all-in-one test detected significantly higher levels of EGFR in three known oral cancer cell lines compared to normal cells, which would have been expected. This indicated that the lab on a chip had excellent specificity for its protein target. The scientists also found that their results correlated well with those using flow cytometry, the current gold-standard analytical technique to quantify protein expression.
The scientists reported that their lab-on-a-chip protocol took about nine minutes to complete, from sample collection to digital display. For flow cytometry, the protocol took two hours and five minutes. “We are doing our immune function test in eight minutes, and that includes the software manipulation and collecting the sample,” said McDevitt. “I feel comfortable saying that, with further manipulations, the oral cancer test ultimately will be completed somewhere between five and ten minutes. We have developed tests that can be performed in thirty seconds, but there is some loss in accuracy when you do things in an ultra fast manner.”
The Food and Drug Administration approved the EGFR-targeted monoclonal antibody called cetuximab in March 2006 to treat oral squamous cell carcinoma, the most common type of oral cancer. This marked the first new drug approved for this cancer in 45 years. But challenges remain to identify patients who might benefit from this therapy. With further development and clinical validation, the oral cancer lab on a chip could one day fill this diagnostic niche.
The National Institute of Dental and Craniofacial Research (NIDCR) is the Nation’s leading funder of research on oral, dental, and craniofacial health.
The National Institutes of Health (NIH) — the Nation's Medical Research Agency — includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. It is the primary federal agency for conducting and supporting basic, clinical and translational medical research, and it investigates the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit

Comprehensive study of mercury in dental fillings

$3 million NIH study builds on ongoing research into mercury and fish

The presence of mercury in dental amalgams, or fillings, is relatively common knowledge; however, whether its presence affects the neurological system is a debate that has been ongoing for 150 years. A new study beginning in less than a week will – for the first time – study whether prenatal exposure to mercury vapor from fillings affects neurological development.

As part of the world’s longest-running study of the health effects of low levels of mercury exposure, Gene Watson, D.D.S, Ph.D., an associate professor in the Eastman Department of Dentistry at the University of Rochester Medical Center, will begin an almost $3 million, National Institutes of Health-funded study on prenatal exposure to mercury from dental amalgams or fillings. Watson will collect hair samples from children in the Indian Ocean island nation the Seychelles, who were enrolled in a study in 2001 to determine their exposure to methyl mercury from fish and other seafood. He will also record how many fillings the children have and how many and which surfaces of the teeth they cover as an indication of exposure to mercury vapor.

Because these children were enrolled prior to their birth, more information is available than any previous mercury/dental filling study. “This study can go back prenatally because we know what the mother’s dental history was prior to and during the pregnancy,” said Watson, who is also an associate professor in the Department of Environmental Medicine and the Department of Pharmacology and Physiology. “Little is known about detrimental effects of early exposure, and we need to examine this because studies suggest the developing brain is more susceptible to mercury than the adult brain.”

Earlier studies on postnatal mercury vapor from dental fillings showed no significant effect on children’s neurological function. While comprehensive, those studies did not examine whether children may have been exposed through their mother’s dental work while still in the womb.

“Comprehensive studies like these are impossible without cross-departmental collaboration. Dr. Watson’s work will add another important layer to understanding the impact of prenatal exposure to mercury that he and the Eastman Dental Center are uniquely able to provide,” said Cyril Meyerowitz, B.D.S, M.S., chair of the Eastman Department of Dentistry. This study expands on knowledge gathered in the Seychelles on the neurological effects of methyl mercury by a group of researchers at the University of Rochester Medical Center, including Philip W. Davidson, Ph.D., a senior investigator and professor of Pediatrics. The team has not found any ill effects of low level mercury exposure. Davidson said this new study is integral to further understanding the potential impact of all environmental exposures of methyl mercury.

“It’s the only study ever conceived where we’ll be able to look at exposure in the main ways people are exposed to mercury – fish and seafood, and dental amalgams” Davidson said. “No one has ever done this before.”


Mercury has been known to have detrimental effects on the nervous system for centuries; however, it wasn’t until an environmental disaster in Minamata, Japan, that the world began to take notice of prenatal methyl mercury poisoning. In the mid-1950s, heavy mercury pollution in Minamata Bay contaminated seafood the community ate as a major source of food. Thousands of people were poisoned to varying degrees, and many children born of mothers who were exposed to methyl mercury were also affected – even if their mothers didn’t show any obvious signs of poisoning themselves. The children’s symptoms ranged from speech delay to mental retardation.

During a series of poor harvests in Iraq in the late 1960s and early 1970s, the Iraqi government bought cheap seed treated with a mercury-based fungicide to give to their people for farming. However, much of the seed arrived too late to be planted, so against orders not to eat it, the seed was ground and eaten. Thousands of people became ill. Much of the grain was dumped in ditches and beside rivers after it was pinpointed as the cause of the poisoning. From there, it entered the food chain again through poisoned fish and birds. As many as 20,000 people were poisoned and half of those died. The team at the University of Rochester Medical Center, including Gary Myers, M.D., a pediatric neurologist and a senior member of the team of researchers studying Seychelles, began its studies of mercury with this tragedy.

The two incidents together showed that levels of exposure that had little or no effect on a mother can seriously damage her fetus’s developing brain and they inspired the University of Rochester team to find the ideal population to study prenatal exposure to mercury. The team chose Seychelles for two main reasons – the fish consumed there have an average level of mercury and mothers eat 12 meals of fish each week (much higher than the average American). Since 1989, 779 children have been followed and no adverse effects on developmental outcomes were attributed to prenatal exposure to mercury in seafood. Studies on these and other children in Seychelles are ongoing.

Regulation of Dental Restorations for Patient Safety?

Industry Asks FDA to Improve Regulation of Dental Restorations to Protect Patient Safety

National Association of Dental Laboratories Finds Cause for Concern in Lax Regulation of Imported and Domestic Dental-Restoration Products

The National Association of Dental Laboratories – the leading trade group for the $5.5 billion U.S. dental-restoration products industry – has formally asked the Food and Drug Administration to implement more stringent regulations governing the dental restorations affixed into the mouths of millions of Americans each year.

Dental-restoration products – the porcelain crowns, provisionals, dentures and bridges that American dental patients have permanently seated in their mouths – are under-regulated, with few legal requirements for technicians to be certified and no mandates for dentists to document or disclose the source of dental work to patients, the association asserted in a Sept. 10 letter to the Presidential Interagency Working Group on Import Safety.

Although dentists prescribe the type of device they need for a dental patient, the product is actually manufactured by a dental technician employed by a dental laboratory, which could be located in the United States or anywhere in the world. Due to the growing number of Americans seeking dental restorative treatment and the growing pressure by dentists to cut costs and increase profit margins, much of the dental work Americans carry in their mouths is now imported from countries such as China, Pakistan, the Philippines and India.

Those products are not tested or inspected for sterilization, for the long-term safety or quality of their components, or for the precision of the fit as required for proper dental care. Even for products manufactured within the United States, most domestic dental laboratories are exempt from registering with the FDA, and most typically employ just 3.5 people.

To protect public confidence in the industry, the association asserted that the FDA must act to protect Americans and:

• Promote certification of dental technicians employed at both domestic and foreign labs.

• Require that dentists label and disclose to patients the source of dental devices, so all dental-restoration products can be traced back to the laboratory that made them.

• Step up inspections of the content and quality of imported dental-restoration products.

• Mandate that dental labs register with the FDA or with state health departments.

• Require that dentists include the registration number of their contracting dental laboratory on a prescription that is kept in patients’ dental records; so that dental devices can be traced even long after they have been implanted in patients’ mouths.

“Such common-sense regulations are critical because in many cases, the dental technician – not the prescribing dentist – makes the selection of dental materials that will be used for a particular patient’s restoration,” said Bennett Napier, CAE co-executive director of the National Association of Dental Laboratories. “Without having some requirement for the person or manufacturer creating the device to have the appropriate knowledge and training, the issue of material selection and/or safety is left to chance.”

Many of the dental crowns and bridges imported into the United States are either porcelain fused to metal or metal-alloy devices. If manufactured incorrectly, these products could be contaminated with lead or other toxic heavy metals that could make patients sick.

“If a problem occurs with a U.S. patient due to a dental restoration that contains a toxic material, chances are that the patient would report their health issue to a medical doctor and not their dentist to determine the root of the health problem,” Napier said. “It is unlikely that the problem would be immediately traced back to the dental device, as most patients are unaware of what materials are in their dental restoration and even less likely to know where it was manufactured.”

Anecdotal evidence has pointed to contamination problems with products imported from emerging markets such as China, but there is no comprehensive data about the scope of the problem because there have been no large-scale inspections of such products.

The National Association of Dental Labs is a trade association with 43 affiliated state and regional commercial dental laboratory associations representing more than 1,400 members. For more information, please visit

Oklahoma Dental History

The state's first dental office was opened in 1885 by Dr. J.E. Wright in the Choctaw nation hamlet of Savanna near what now is McAlester…
A handful of dentists in the 1890s had portable dental equipment carried by horse and buggy from one small town to another.
They often found working conditions less than ideal, according to association historians.
Dr. Theresa Hunt's 1901 practice in Watonga was sandwiched between two saloons, and her patients often showed up inebriated. Once a patient drew a gun on Hunt, demanding she hand over the false teeth she had made for him without being paid.
The Oklahoma Territorial Dental Association was formed in 1891, and the Indian Territory Association in 1903. With the advent of statehood, one inclusive association was believed to be in order. So during a joint session of the two groups in June 1907, the Oklahoma Dental Association was formed.
Now with 1,500 members, the Oklahoma Dental Association is celebrating its centennial milestone…

To see complete article:

Tuesday, September 11, 2007

Dentists Happy to Offer Dentures:

The Wealthy Dentist Survey Results

]The clear majority of dentists (94%) report that their dental practices offer in-house denture services for prosthodontic patients, according to a poll by The Wealthy Dentist. Only 6% of dentist respondents say they refer patients out to a prosthodontist for dentures.

Many dentists questioned whether prosthodontists were really more qualified. "I don't know why one would refer to a prosthodontist. Many of us are more highly trained than some of them are," said a Florida dentist. "Why? Unless it is maxillo-facial reconstruction work, what do they know that I do not?" asked a Pennsylvania dentist. "Prosthodontists certainly cannot make dentures better than I can. Send all of your cases to me, a dentist," wrote a Texas dentist.

Lots of general dentists never refer patients out to prosthodontists. "I have not referred a case in 32 years of practice," stated a Texas dentist. "Having made many thousands of dentures over the years, with the facility of an in-house dental lab with a certified technician at my side, I've never referred a denture patient to a prosthodontist. I have, however, received denture referrals from prosthodontists," claimed a New Jersey dentist.

Of course, the patient's needs always come first. "The needs of the patient take precedence," pointed out a California dentist. "When the patient's needs require the services of a specialist, the dentist refers to the specialist. When the dentist has the capability to treat the case himself, he does so. This has always been true for all types of dental treatment, not just prosthodontics."

In general, dentists only refer out denture patients with specific dental problems. "Only for the most difficult cases. I do not like sending profits out the door," wrote a Delaware dentist. "I refer out very complicated cases, but I have found that most dentures can be handled in my office with the support of a good lab," said a California dentist.

Prosthodontists are particularly likely to end up with not just difficult cases, but difficult patient personalities. "They are a great place to send your nightmare patients," commented an Illinois dentist. "Thank goodness for these specialists. I referred my 'denture patient from hell' to a dentist that specializes in dentures, and he told me the only mistake I made was taking this patient on," wrote a New Mexico dentist.

Dental implant technology gives patients other options besides dentures. "I never enjoyed doing dentures until I began offering dental implants for support and retention; now every complaint has a solution," wrote a California dental implantologist.

"It would seem that there's money to be made off of dentures," said Jim Du Molin, dental marketing consultant and founder of The Wealthy Dentist. "As a dental consultant, I'm surprised to learn that so many general dentists are treating denture patients in-house, but it's clear that they don't want to lose high-value patients by referring them out to prosthodontists."

For additional information on this and other Wealthy Dentist surveys in the areas of Cosmetic Dentistry, Dental Implants, Braces and Sedation Dentistry, as well as more dentists' comments, visit

The Wealthy Dentist is a dental marketing and dental management resource featuring dental consulting expert Jim Du Molin. The site’s weekly surveys and dental newsletters are viewed by thousands of dentists across the United States and Canada. The Wealthy Dentist is a sister company of the Internet Dental Alliance, Inc. ( IDA is the largest provider of websites for dentists, email patient newsletters and dental directories in North America.

Wednesday, September 5, 2007

Eliminate Pain from Cavity Treatment Procedures

New Technology Aims to Eliminate Pain from Cavity Treatment Procedures

Tooth decay and cavities are no smiling matter - especially when fillings are required. The drilling procedure is cumbersome and outright painful in some cases. To alleviate the discomfort and improve the durability and quality of fillings, Missouri researchers are developing a high-tech device that will offer improved treatment for cavities.

Overseeing the project is Qingsong Yu, assistant professor of mechanical and aerospace engineering at the University of Missouri-Columbia. His collaborators are Hao Li, assistant professor of mechanical and aerospace engineering at MU, and Yong Wang, associate professor and director of craniofacial bioengineering at the University of Missouri-Kansas City. The team of researchers recently received a three-year, $270,000 National Science Foundation grant to lay the groundwork for their endeavor - a non-thermal plasma brush using a low-temperature chemical reaction to disinfect and prepare cavities for fillings

"Successful development of the plasma brush could replace the painful and destructive drilling currently practiced in dentistry," Li said.

The brush, researchers said, will operate without vibrations and heat, which disturbs tooth nerves and causes much of the pain that is felt using current dental procedures. In addition, it will operate silently - without the distinctive noise of a drill.

"Plasma treatment would be a painless, nondestructive and tissue-saving way to care for and treat cavities because it relies on chemical reactions instead of heat or mechanical interactions," Yu said. "And the chemical bonding between teeth and fillings that the plasma treatment would create would be much stronger than dentists currently get with drills or laser techniques."

Along with eliminating pain, the brush will change the surface chemistry of its target - resulting in a stronger bond to extend a tooth's lifetime. In addition to patients, the emerging technology also will benefit dentists.

"In general dentistry practices, nearly 75 percent of the dentist's time and effort is devoted to replacing fillings that fail prematurely," Wang said. "The premature failure of materials used to repair and replace damaged tissues in the mouth can be traced to breakdown of the bond or seal formed between the filling and the tooth surface."

Yu and Yixiang Duan, a scientist at Los Alamos National Laboratory, have filed two U.S. patent applications for the plasma brush.