Wednesday, September 30, 2009

Reducing early childhood caries by 77 percent

Training clinicians helps reduce rates of early childhood cavities

Researchers at Boston University School of Medicine (BUSM) have found that pediatricians provided with the proper communication, educational and information technology tools and training could reduce the rates of children developing early childhood caries (ECC) or cavities by 77 percent. This study appears in the October issue of the Journal Medical Care.

ECC, the most common chronic illness among children, can lead to serious complications if untreated, including abscesses requiring costly surgery. Infection and pain caused by ECC can also impair growth, weight gain and limit school attendance.

BUSM researchers provided pediatric clinicians with communication skills training to help them more effectively counsel parents and caregivers to reduce children's ECC risk. Pediatricians as well as clinical nurses participated in a one hour study training session, and they were also provided with educational brochures to give to parents. The electronic medical record was also adapted to prompt clinicians to remember to counsel. After the educational program, a simultaneous recruitment of children affected with ECC was conducted at a comparison site, where the clinicians did not receive training.

Parents and caregivers of children aged six months to five years were asked to participate in a clinical exam and interview that consisted of a series of questions inquiring about the parent or caregiver's discussion with the child's doctor or nurse. This interview assessed the degree the clinician covered the topics on which they had been trained to counsel regarding ECC risk reduction. This process was repeated approximately one year later.

The findings show that providers at the intervention site had greater knowledge and conducted more counseling, and patients at that site had significantly reduced odds of developing ECC over time. "Pediatric clinicians at Boston Medical Center are committed to children's oral health, and to addressing the deficit in clinical preparation to help prevent ECC," explained lead author, Nancy R. Kressin, PhD, an associate professor of General Internal Medicine at Boston University School of Medicine. "We developed and implemented a multi-faceted pediatric practice based intervention where children especially vulnerable to ECC received enhanced care to prevent this disease from occurring or reoccurring, and it had marked effects on reducing children's rates of developing ECC" said Kressin.

This study was funded by the National Institutes of Health the National Institute of Dental and Craniofacial Research.

Tuesday, September 29, 2009

American Dental Association Podcast Programs

The American Dental Association (ADA) is launching “Straight from the Mouth,” a new video podcast series for the public, to provide oral health information in amusing three to five-minute Webisodes.

Posted monthly, the podcasts are a new resource for people seeking health information online and will be available on iTunes and the ADA Web site The podcasts feature such dental health topics as tooth whitening, overcoming dental anxiety, dental care for children and dental care while traveling to other countries.

“We’re having a lot of fun with these, but at the heart of each episode is sound clinical and scientific information to help people maintain their oral health,” said Ruchi Nijjar Sahota, D.D.S., a practicing dentist in Freemont, Calif., who co-hosts the show with Eric Grove, D.D.S, who graduated from Loma Linda University School of Dentistry just this year.

The first episode of “Straight from the Mouth” focuses on overcoming dental anxiety.
“Movies and TV shows make fun of dental anxiety,” said Dr. Grove. “But people who suffer from it also can suffer the consequences of neglecting their teeth and gums, and that’s no joke. In our podcast, we joke around a little, but we also offer practical tips to help people overcome anxiety. Regular dental care is important, and dentists want to make their patients’ visits as comfortable as possible.”

Tuesday, September 22, 2009

Stem cell studies at the U. of MD. Dental School

New stem cell studies at the University of Maryland Dental School demonstrate that surgeons could one day routinely use strong, moldable, and injectable pastes to regenerate needed bone tissue to repair broken bones, fractures, genetic defects, even combat bone wounds.

Human stem cells seeded in a tissue engineering scaffolding exhibited “excellent attachment and osteogenic differentiation,” which is the process of laying down new bone material.

The researchers said the new findings buoy hopes that an injectable paste of stem cells will be available one day to fill any shape of cavity from bone defects, breaks or wounds by regenerating needed bone tissue.

In test tube studies, stem cells from bone marrow, when placed into an injectable scaffold of calcium phosphate and chitosan, started growing and forming minerals needed for new bone tissue.

Xu, an associate professor, is the principal investigator of a $230,000 grant from the Maryland Stem Cell Research Fund for “Stem Cell Delivery via Injectable, Nano-apatite Scaffolds for Bone Engineering,” and a $1.84 million grant from the National Institute of Dental and Craniofacial Research.

The Dental School researchers have so far tested four scaffolding materials for gripping and holding the stem cells. “Which of the materials will be used in a commercial product really depends on where you want to place the material, whether in the jaw bone, the cranium or other bones,” said Weir, a research assistant professor.

Weir said, “Ultimately we want this to be an injectable paste so we can put it into voids that are not square, rectangular or circular, that they are irregular shapes that need to be filled. The paste will include the cells.”

Xu added that such a product could also be used in periodontal bone repair, mandibular and maxillary ridge augmentation, reconstruction of frontal sinus and craniofacial skeletal defects, and other stress-bearing orthopedic applications. After a tumor removal or traffic accident, there may be a need to repair the damage or void left. It will beneficial, he said, to have a paste that can be shaped easily to achieve a high degree of aesthetics. After shaping, the paste hardens to form a solid scaffold full of pores and channels and still containing stem cells throughout, still living and growing to form new bone. Eventually the scaffold material degrades and is replaced entirely by new bone tissue grown from the stem cells.

The researchers found that a significant number of the cells were alive after a few weeks in the scaffolding material. They then discovered that the cells were differentiating into osteoblasts, essentially turning into bone cells. (From Greek words for bone, an osteoblast cell is responsible for bone formation.)

After staining the scaffold, the researchers found the osteoblasts forming “a lot” of the mineral, which then forms the bone after only 21 days, said Weir. In a subsequent experiment, the cells survived even better when mixed in a gel of the scaffolding material.

The researchers have recorded similar success with umbilical cord-derived stem cells, which “appear to be more potent in terms of growth and transforming into osteoblasts on the scaffold than the cells from bone marrow,” said Xu. It is likely that the umbilical cord cells are more vital because they are younger than stem cells obtained from the adult bone marrow and in theory will act more quickly to repair wounds or bone defects.

Xu explained: “When a 16-year-old breaks a bone, it usually takes a few weeks to heal. In a 60-year-old, it likely takes a few months. Umbilical cord stem cells are only 9 months old and hence are fast in healing.” Xu said human umbilical cord stem cells have the promise to be a superior alternative to bone marrow-derived stem cells, the latter requiring an invasive procedure to harvest. For combat medics, the umbilical cord derived stem cells could potentially be on the shelf and used in the field without causing immunuorejection, said Xu.

Xu said that after a literature search, he believes his laboratory is the first to investigate the seeding of umbilical cord-derived stem cells in injectable and load-bearing scaffolding for bone tissue engineering.

“We are excited about the promise of encapsulating umbilical cord stem cells in an injectable scaffold for stem cell delivery and bone regeneration.” Xu said. “Our research is still in an early stage. We will perform more systematic investigations and animal studies. If indeed human umbilical cord stem cells delivered using injectable scaffolds are more effective in bone regeneration than the commonly studied bone marrow stem cells, it will broadly impact the field of stem cell-based regenerative medicine.”

Friday, September 11, 2009

International Report: No Amalgam Bans in Effect

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Dentists around the world are using amalgams (silver fillings)
every day to fill decayed teeth, despite some erroneous news reports
stating that many countries have banned the use of amalgams.
International dental experts meeting recently at the American Dental
Association (ADA) headquarters in Chicago discussed the use of amalgam
in their respective countries.

Sweden is often cited as an example of a country that has banned
amalgam, but that is not true, according to Professor Maud Bergman of
University. Professor Bergman said it is unlikely Sweden will ban the
use of amalgams in the near future. Nor do Sweden's neighbors, Norway
and Denmark ban the use of the filling material. Representatives from
Germany and the Netherlands also said amalgam is not banned in their
countries. Dr. Elmar Reich of Germany's University of Saarland said
that some limited restrictions on the use of amalgam may even be
loosened when the classification of amalgam changes in mid-1998 to a
medical device from its current designation as a therapeutic
agent. Dentists from South Africa, Australia, New Zealand, Japan and
Canada reported that amalgam is not banned in their countries either.
Although the Canadian government has recommended some restrictions on
the use of amalgam, the Canadian Dental Association (CDA) has requested
that the government provide scientific documentation to back up some of
the recommendations that the CDA is questioning.

The World Health Organization, FDI World Dental Federation and the ADA
all support the continued use of dental amalgam as a safe, durable and
cost-effective material to restore teeth based on current scientific
knowledge. There is currently no credible scientific evidence that
exposure to mercury from amalgam restorations poses a serious health
risk in humans, except for the exceedingly small number of allergic
reactions. In 150 years of use, there have been only about 100
documented cases of allergic reactions to amalgam in the dental
literature. A joint WHO/FDI meeting is scheduled in Geneva,
Switzerland, in March, 1997, to review the latest scientific evidence on
the safety of dental amalgam.

Wednesday, September 9, 2009

Prevent Periodontitis To Reduce The Risk Of Cancer

Chronic periodontitis, a form of gum disease, is an independent risk factor for head and neck squamous cell carcinoma. This suggests the need for increased efforts to prevent and treat periodontitis as a possible means to reduce the risk of this form of cancer.

"Prevent periodontitis; if you have it already, get treatment and maintain good oral hygiene," said Mine Tezal, D.D.S., Ph.D., assistant professor in the Department of Oral Diagnostic Sciences, School of Dental Medicine, University at Buffalo, and NYS Center of Excellence in Bioinformatics and Life Sciences at the University of Buffalo. She is also a research scientist in the Department of Dentistry and Maxillofacial Prosthetics at Roswell Park Cancer Institute, which is where the study was conducted.

Results of this study are published in Cancer Epidemiology, Biomarkers & Prevention, a journal of the American Association for Cancer Research.

Chronic periodontitis is characterized by progressive loss of the bone and soft tissue attachment that surround the teeth. The researchers assessed the role of chronic periodontitis on head and neck squamous cell carcinoma, as well as the individual roles on three subsites: oral cavity, oropharyngeal and laryngeal. They used radiographic measurement of bone loss to measure periodontitis among 463 patients; 207 of whom were controls.

Findings showed that chronic periodontitis might represent a clinical high-risk profile for head and neck squamous cell carcinoma. The strength of the association was greatest in the oral cavity, followed by the oropharynx and larynx, according to Tezal.

When they stratified the relationship by tobacco use, they found that the association persisted in those patients who never used tobacco. The researchers did not expect the periodontitis-head and neck squamous cell carcinoma association to be weaker in current smokers compared to former and never smokers, according to Tezal. However, this interaction, although statistically significant, was not very strong.

"Confirmatory studies with more comprehensive assessment of smoking, such as duration, quantity and patterns of use, as well as smokeless tobacco history are needed," she said.

"Our study also suggests that chronic periodontitis may be associated with poorly differentiated tumor status in the oral cavity. Continuous stimulation of cellular proliferation by chronic inflammation may be responsible for this histological type. However, grading is subjective and we only observed this association in the oral cavity. Therefore, this association may be due to chance and needs further exploration," Tezal added.

Andrew Olshan, Ph.D., said these results lend further support to the potential importance of poor oral health in this form of cancer. Olshan is professor and chair of the Department of Epidemiology at the Gillings School of Global Public Health, and professor in the Department of Otolaryngology/Head and Neck Surgery, School of Medicine, University of North Carolina at Chapel Hill.

"The study of poor oral health including the possible carcinogenic role of microorganisms is part of a rapidly growing interest in how a community of microbes that live in the various environments of the human body can affect health," Olshan said. "Although the study is comparatively small, the researchers were able to also see an association between bone loss and the risk of head and neck cancer."