Wednesday, June 30, 2010
A tooth-bleaching agent may improve the oral health of elderly and special-needs patients, say dentists at the Medical College of Georgia and Western University of Health Sciences.
Standard oral hygiene, such as brushing and flossing, can be difficult or impossible for patients with mental challenges or impaired manual dexterity. Additionally, when health problems or medications cause xerostomia, or dry mouth, the lack of saliva reduces the mouth's natural protective mechanisms. These problems lead to plaque accumulation, cavities and periodontal disease, and could further impact the patient's health.
A report featured on the cover of this month's Journal of the American Dental Association noted that applying the tooth whitener carbamide peroxide through a custom-fit mouth tray might combat those problems. The report was based on a literature review and the authors' clinical experiences with special-needs patients and tooth bleaching.
"What we've noticed through whitening patients' teeth over the years is that as they bleached, their teeth got squeaky clean and their gingival health improved," said Dr. Van Haywood, professor in the Medical College of Georgia School of Dentistry and co-author of the report.
Dentists have used carbamide peroxide, or urea peroxide, for decades to whiten teeth, but its original use was as an oral antiseptic. It removes plaque, kills bacteria and elevates the mouth's pH above the point at which enamel and dentin begin to dissolve, which results in fewer cavities.
"All these benefits lead us to believe that tray bleaching can be a very effective supplemental method of oral hygiene for patients facing greater challenges keeping their mouths clean," said Dr. David Lazarchik, associate professor in the Western University of Health Sciences College of Dental Medicine and the report's co-author.
The trick is in the tray, Haywood said. After a complete dental exam, the dentist can make the custom-fit tray that the patient can wear comfortably at night or for several hours during the day. The carbamide peroxide gel can be prescribed or purchased over-the-counter.
Lazarchik said further research is needed to determine a specific protocol for using tray-applied carbamide peroxide specifically to improve oral health.
Wednesday, June 23, 2010
A preliminary study of young children undergoing treatment for cavities in their baby teeth found that nearly 28 percent had a body mass index (BMI) above the 85th percentile, indicating overweight or obesity.
That percentage is more than 5 percent higher than the estimated national average, adding more fuel to the growing concern that poor food choices, including those sugary drinks and fruit juices so popular and convenient, likely are contributing to both obesity and tooth decay in very young children.
The findings will be presented today (June 22) at the 2010 annual meeting of the Endocrine Society being held in San Diego, Calif. The study is one of 38 abstracts (out of 2,000 accepted) selected for inclusion in the society's Research Summaries Book, which is provided to the media for future reference.
Kathleen Bethin, MD, associate professor of pediatrics at the University at Buffalo and director of the pediatric endocrinology and diabetes fellowship program at Women and Children's Hospital of Buffalo, is first author.
Dental cavities are the most common chronic disease of childhood, according to Healthy People 2010 -- 5-10 percent of young children have early childhood cavities -- and childhood obesity has more than tripled in the past 30 years, reaching nearly 20 percent by 2008.
"We hypothesized that poor nutritional choices may link obesity and dental decay in young children, but there is very little published data associating these two health issues," says Bethin.
"The aim of our study was to obtain preliminary data on BMI, energy intake and metabolic profiles in young children with tooth decay."
The study involved 65 children ages 2-5 who were treated in the operating room at Women and Children's Hospital. All children required anesthesia due to the severity of their dental problems or other issues.
The children, who had been fasting for 8-12 hours, were weighed and measured for height. After the patients were anesthetized, researchers measured waist circumference and drew blood. Parents completed a food questionnaire while their children were in surgery.
The data showed that:
Eighteen of the 65 children, approximately 28 percent, had a BMI above the 85th percentile, which Bethin noted might be higher if the children hadn't been fasting.
Waist circumference compared to height was significantly higher in the overweight and obese children compared to the children of normal weight, measurements showed.
Approximately 71 percent of the children had a calorie intake higher than the normal 1,200 per day for their age group.
"The main point of our findings is that poor nutrition may link obesity to tooth decay," says Bethin. "Thus the dental office, or 'dental home,' may be an ideal place to educate families about nutrition and the risks of obesity and dental decay.
"Our results found no difference in total calories consumed by the overweight and healthy-weight kids," noted Bethin, "so the problem isn't overeating, per se, just making the wrong food choices."
Bethin and colleagues now are analyzing whether the overweight children eat more processed sugar, drink more juice and have other unhealthy eating habits compared to the healthy-weight children.
The study, published in Pediatric Dentistry, indicates that ATP-driven (adenosine triphosphate-driven) bioluminescence is a useful tool at the dentist's office for predicting children at high risk for tooth decay
PORTLAND, Ore. — Researchers at the Oregon Health & Science University School of Dentistry have determined that ATP-driven (adenosine triphosphate-driven) bioluminescence — a way of measuring visible light generated from ATP contained in bacteria — is an innovative tool for rapidly assessing in children at the chair-side the number of oral bacteria and amount of plaque that can ultimately lead to tooth decay.
The study is published online in the May-June 2010 issue of Pediatric Dentistry.
Caries (microbial disease) prevention is one of the most important aspects of modern dental practice. Untreated, large numbers of cariogenic bacteria adhere to teeth and break down the protective enamel covering, resulting in lesions and cavities. There is a critical need in dentistry to develop better quantitative assessment methods for oral hygiene and to determine patient risk for dental caries, because disease as well as restorative treatment results in the irreversible loss of tooth structure. Previous caries risk assessments have focused on social, behavioral, microbiologic, environmental and clinical variables.
The goal of the OHSU study was to examine the use of microbiological testing, specifically ATP-driven bioluminescence, for quantifying oral bacteria, including plaque streptococci, and assessment of oral hygiene and caries risk. Thirty-three randomly selected OHSU pediatric patients, ages 7 to 12, were examined, and plaque specimens, in addition to saliva, were collected from one tooth in each of the four quadrants of the mouth. The oral specimens were then assessed to count total bacteria and streptococci and subjected to ATP-driven bioluminescence.
The OHSU team found statistical correlations, linking ATP to the numbers of total bacteria and oral streptococci. Their data indicated that ATP measurements have a strong statistical association with bacterial numbers in plaque and saliva specimens, including numbers for oral streptococci, and may be used as a potential assessment tool for oral hygiene and caries risk in children.
"The use of ATP-driven bioluminescence has broad implications in dentistry and medicine and can be used translationally in the clinic to determine the efficacy of interventional therapies, including the use of mouth rinses and perhaps in the detection of bacterial infections in periodontal and other infectious diseases," noted Curt Machida, Ph.D., principal investigator and OHSU professor of integrative biosciences and pediatric dentistry.
Monday, June 21, 2010
Children with Special Needs Are at Increased Risk for Oral Disease Common Medical Conditions Can Negatively Influence Dental Health
At the beginning of 2010, as many as 17 percent of children in the United States were reported as having special health care needs. Behavioral issues, developmental disorders, cognitive disorders, genetic disorders and systemic diseases may increase a child’s risk of developing oral disease, according to an article published in the May/June 2010 issue of General Dentistry, the peer-reviewed clinical journal of the Academy of General Dentistry (AGD). For a child with special health care needs, special diets, frequent use of medicine and lack of proper oral hygiene can make it challenging to maintain good oral health.
“By the time these children are 12 months old, they should have a ‘dental home’ that will allow a dentist to administer preventive care and educate parents about good oral health habits tailored to fit their child’s needs,” says Maria Regina P. Estrella, DMD, MS, lead author of the article.
For example, some parents may not know that special diets for children with below-average weight or unique food allergies can unintentionally promote tooth decay. Underweight children may be directed to consume drinks containing high amounts of carbohydrates, which can cause demineralization of teeth. Medications can also be a source of concern. Because children often find it difficult to swallow pills, many of their medicines may utilize flavored, sugary syrups. When parents or guardians give these syrups to a child, especially at bedtime, the sugars can pool around the child’s teeth and gums, promoting decay.
“Children should continue with the diet and medications as directed by their physician, but a dentist may recommend more frequent applications of fluoridated toothpaste and mouthrinse and rinsing with water to decrease the risk of decay,” says Vincent Mayher, DMD, MAGD, spokesperson for the AGD.
Additionally, adults will need to help children who lack the dexterity to brush their own teeth. When brushing a child’s teeth, it may be helpful for caregivers to approach their child from behind the head, which will provide caregivers with good visibility and allow them to control the movement of both the child’s head and the toothbrush. This approach is especially helpful with wheelchair-bound children.
Taking children with special health care needs to the dentist is as important as caring for their other medical needs. A dentist who understands a child’s medical history and special needs can provide preventive and routine oral care, reducing the likelihood that the child will develop otherwise preventable oral diseases.
Thursday, June 17, 2010
Defined sets of factors can reprogram human cells to induced pluripotent stem (iPS) cells. However, many types of human cells are not easily accessible to minimally invasive procedures. In a paper published in the International and American Associations for Dental Research's Journal of Dental Research, lead researcher K. Tezuka and researchers N. Tamaoki, H. Aoki, T. Takeda-Kawaguchi, K. Iida, T. Kunisada and T. Shibata all from the Gifu University Graduate School of Medicine, Japan; and K. Takahashi, T. Tanaka and S. Yamanaka, all from Kyoto University, Japan, evaluate dental pulp cells as an optimal source of iPS cells, since they are easily obtained from extracted teeth and can be expanded under simple culture conditions.
From all six cell lines tested with the conventional three or four reprogramming factors, iPS cells were effectively established from five lines. Furthermore, determination of the HLA types of 107 DPC lines revealed two lines homozygous for all three HLA loci and showed that if an iPS bank is established from these initial pools, the bank will cover approximately 20 percent of the Japanese population with a perfect match.
Analysis of these data demonstrates the promising potential of dental pulp cell collections as a source of cell banks for use in regenerative medicine. Direct reprogramming of patients' somatic cells would allow for cell transplantation therapy free from immune-mediated rejection. An alternative approach is to establish an iPS cell bank consisting of various human leukocyte antigen (HLA) types. Safety issues must be considered as to which types of somatic cells should be used for such iPS cell banks.
"This work is significant in that it proposes the exciting potential of stem cell banking from readily available extracted teeth," said JDR Editor-in-Chief William Giannobile. "Although at an early stage of development, this innovation offers prospects for cell therapy approaches for the treatment of human disease."
The complete research study is published in the Journal of Dental Research.e
Thursday, June 10, 2010
The U.S. Food and Drug Administration today announced plans to hold an advisory panel on Dec. 14-15, 2010, to discuss several scientific issues that may affect the regulation of dental amalgam, used for direct filling of carious lesions or structural defects in teeth. The panel meeting will focus particularly on the potential risk to vulnerable populations, such as pregnant women, fetuses, and young children.
Used to treat tooth decay, dental amalgam is a mixture of metals, composed of liquid mercury and a powdered amalgam alloy, composed primarily of silver, tin, and copper.
On July 28, 2009, the FDA issued a final rule that reclassified dental mercury from a class I device to class II, classified dental amalgam as a class II device, and designated special controls for dental amalgam, mercury and amalgam alloy. The special control for the devices is a guidance titled, “Class II Special Controls Guidance Document: Dental Amalgam, Mercury and Amalgam Alloy.”
Since that time, the agency has received several petitions raising various issues relating to the final rule and special controls.
The concerns raised include the adequacy of the risk assessment method used by the FDA in classifying dental amalgam, the bioaccumulative effect of mercury, the exposure of pediatric populations to mercury vapor, and the adequacy of the clinical studies on dental amalgam. In addition, a recent report on risk assessments issued by the National Academy of Sciences, titled “Science and Decisions: Advancing Risk Assessment, NAP 2009,” proposes new approaches to conducting risk assessments. These may be some of the issues the agency asks the advisory committee to review.
Details about the advisory panel meeting will be published in the Federal Register on June 11, 2010 and is available for advanced viewing today only.
For more information:
Petitions on dental amalgam:
Monday, June 7, 2010
According to new research, the majority of U.S. dental schools have not adequately prepared their graduates to screen for sleep disorders, which affect more than 70 million adults in the U.S.
Researchers from the University of California - Los Angeles (UCLA) School of Dentistry surveyed each of the 58 U.S. dental schools to determine the average number of curriculum hours offered in dental sleep medicine (DSM). DSM focuses on the management of sleep-related breathing disorders, such as snoring and obstructive sleep apnea (OSA), with oral appliance therapy (OAT) and upper-airway surgery.
Forty-eight schools responded to the survey, indicating that dental students spend an average of 2.9 instruction hours during their four years of dental school studying sleep disorders.
According to lead author Michael Simmons, DMD, D. ABOP, part-time instructor at both UCLA and USC, sleep medicine is being introduced at the majority of U.S. dental schools, but the total hours taught are inadequate given the epidemic proportion of people with OSA.
More than 18 million Americans suffer from OSA. An estimated 80 to 90 percent of patients with OSA are undiagnosed and more go untreated. Untreated sleep apnea can raise a patients' risk for heart attack, stroke, hypertension, diabetes, and obesity, among other health problems and premature death.
The survey asked which sleep topics were taught, which treatments were covered, and which departments were responsible for the teaching of dental sleep medicine.
Results show that classroom topics covered diagnosis of obstructive sleep apnea, sleep bruxism, snoring and upper-airway resistance syndrome, and treatments including oral appliance therapy, continuous positive airway pressure and surgery. Eight schools also discussed at-home sleep tests, which dentists can use to monitor treatment success.
Oral Surgery, TMJ/Orofacial Pain, Oral Medicine, Prosthodontics, and Orthodontics, were the most common academic departments that taught sleep medicine. The researchers were surprised by the variety of dental departments teaching sleep disorders, and that DSM could not be attributed to any particular discipline.
The authors suggest that because dentists see patients on a regular basis, they can notice early warning signs of sleep disorders.
"Dental students and dentists need to screen for sleep-related breathing disorders as part of patients' routine work-ups. Then, with additional interest and adequate training, they can learn to co-treat these serious medical conditions with their patients' physicians as an integral part of the sleep medicine team," said Simmons.
According to new research, nasendoscopy may help dentists predict oral appliance therapy success in sleep apnea patients. Nasendoscopy involves a flexible endoscope being inserted through the nasal cavity. The tip of the scope is placed at the level of the velopharynx and oro-/hypopharynx.
OAT has been shown to be a safe and effective treatment for patients with obstructive sleep apnea (OSA). This therapy is indicated for use in patients with mild to moderate OSA on the basis of the apnea-hypopnea index (AHI). However, it has been reported that some patients with severe OSA also benefit from OAT. Such findings suggest that patients should not be selected for OAT based on AHI alone.
This Japan-based study included 21 severe OSA patients (AHI>30) comprised of 18 men and three women. OSA severity was diagnosed with overnight polysomnography (PSG). Subjects ranged from 35 to 78 years of age.
During the nasendoscopy, patients laid supine in a dental chair. Researchers observed changes in the width of the velopharynx and oro-/hypopharynx.
After several weeks of wearing an oral appliance during sleep, each subject took a second PSG with the device. AHI reduction rates from OAT were compared between patients who did and did not show throat widening during the nasendoscopy.
All severe OSA patients showed improved AHI following OAT. All subjects experienced oro-/hypopharyngeal widening, but only 16 subjects demonstrated velopharyngeal widening.
The AHI reduction rate for patients with velopharyngeal widening was 79 percent. The reduction rate for patients without velopharyngeal widening was 45 percent. The difference between the two groups was significant. The direction of the velopharyngeal widening, 'all-round' or 'lateral dominant,' was independent of patient response.
Results indicate that patients who showed velopharyngeal widening during a nasendoscopy responded most effectively to OAT. These findings suggest that velopharyngeal widening observed when advancing the mandible from the centric occlusal position is associated with better OAT outcome.
Lead author Yasuhiro Sasao, DDS, PhD, suggests that nasendoscopies can help dentists predict patient response to OAT, reducing waste of resources and time.
"In Japan, nasendoscopy is used in dentistry and medicine to diagnose or evaluate oral function such as speech and swallowing – the system is simple and relatively inexpensive," said Sasao.
Mandibular advancement appliances (MAA) have been shown to safely and effectively treat mild to moderate obstructive sleep apnea (OSA). The aim of this study was to assess the efficacy of two different MAA over time from a previous comparative study (PCS).
This Canada-based study included four women and 10 men who had participated in a PCS that tested two oral appliances in a randomized cross-over design. The participants were 52 years of age on average.
Each participant took three polysomnograms (PSG): one baseline from the PCS, a night with the appliance they selected at the end of the PCS, and a follow-up night.
Results indicate that respiratory disturbance index (RDI) was significantly reduced from baseline (10.4±1.3) to the night at the end of the PCS (5.7±1.1) and remained low at follow-up (4.5±0.7).
Before each PSG, subjects completed the Epworth Sleepiness Scale (ESS), the fatigue severity scale (FSS), and a quality of life questionnaire (FOSQ). Questionnaire results revealed that the ESS, FSS, and FOSQ were all significantly improved from baseline to the night at the end of the PCS and remained improved at follow-up. Participants reported a high compliance, wearing their MAA 7.1 hours a night, 6.4 nights a week.
A second arm was added to fit a dorsal harness in an attempt to eliminate positional apnea. The addition of a dorsal harness was effective, although compliance was poor. Five subjects agreed to wear the harness. It was effective for four subjects, but only one agreed to wear it after a one-month trial.
"The study showed excellent long-term compliance with oral appliances as well as a high efficiency and a very positive effect on blood pressure and cardiac rhythm," said lead author Luc Gauthier, DMD, MSc.
"Efficiency continued to improve even though, on average, the subjects had a higher body mass index during follow-up," said Gauthier.
According to new research, the ratio between tongue volume and bony enclosure size in patients with obstructive sleep apnea (OSA) may help dentists calculate oral appliance treatment success.
Although mandibular advancement splints (MAS) have been shown to be a safe and effective treatment for OSA, predicting efficacy in individual patients is problematic.
The researchers assessed whether anatomical factors such as craniofacial size, upper-airway soft tissue volume, and/or the anatomical balance between them, were associated with MAS treatment outcome.
The study included 49 OSA patients. Patients were at least 18 years of age and had mild to severe sleep apnea. They were without other sleep disorders or serious comorbid medical or psychiatric disorders.
Each patient was fitted for a custom two-piece MAS, which was worn during sleep. Treatment outcome was assessed by polysomnography after approximately six weeks of oral appliance therapy.
Of the 49 patients, 24 responded to the treatment, demonstrating an apnea-hypopnea index (AHI) reduction of 50 percent or more. Body mass index and age did not differ between responders and non-responders, but responders did have a lower baseline AHI, indicating that their sleep apnea was less severe before treatment.
Tongue cross-sectional area (CSA) was measured in a subset of 28 patients, including 12 responders and 16 non-responders. The measurements were taken using cephalometric soft-tissue imaging. Responders had a larger tongue CSA than non-responders, but there was no difference in the bony oral enclosure CSA. The ratio of tongue to bony enclosure CSA significantly differed between responders and non-responders, indicating the ratio as a significant predictor of response to treatment.
Because patients who responded to MAS treatment had a larger tongue volume for a given oral cavity size, the researchers suggest that determining this ratio may help predict MAS treatment success.
"While this study re-affirms the difficulties in predicting OSA treatment response to mandibular advancement splints, responders seem to have a larger tongue volume for a given oral cavity site, suggesting that MAS may help correct anatomical imbalances," said lead author Whitney Mostafiz.
According to new research that will receive the Graduate Student Research Award on Saturday, June 5, at the 19th Annual Meeting of the American Academy of Dental Sleep Medicine, questionnaires can help dentists screen for sleep-disordered breathing (SDB) in a pediatric population. SDB includes obstructive sleep apnea (OSA), upper-airway resistance syndrome, and snoring.
The researchers evaluated two SDB questionnaires in children undergoing orthodontic treatment in the undergraduate program at the University of British Columbia.
The study included 189 children, of which 48.2 percent were male. The patients ranged from seven to 15 years of age.
Craniofacial abnormalities, such as small jaw, narrow upper arch, or high palatal, are considered a common cause of SDB in children. Each child underwent a routine orthodontic examination of the upper, lower and total face height, hyoid position, soft palate length, mandibular length, vertical airway length, overjet and overbite to determine craniofacial characteristics.
Each parent or guardian completed two sets of questions for his or her child: the OSA 18 and the Pediatric Sleep Questionnaire (PSQ). Both questionnaires evaluated SDB symptoms.
Questions on the OSA 18 were divided into five domains: sleep disturbance, physical symptoms, emotional symptoms, daytime functions and caregiver concerns. Scores greater than 60 indicated a greater probability of SDB and/or a reduced quality of life. The PSQ questionnaire included 22 "yes, no, or don't know" type questions. If the number of "yes" responses surpassed eight, it indicated a high risk of SDB.
The OSA 18 suggested that two children were at risk for SDB while the PSQ suggested that 11 children were at risk. Twenty percent of the subjects reported snoring, which is a common symptom of SDB.
Lead author Hiroko Tsuda, DDS, PhD, explained that dentists have more opportunity than physicians to detect pediatric SDB because they see patients on a regular basis.
"Based on this study, family dentists may find the preliminary risks of SDB by using simple questionnaires," said Tsuda.
Tsuda emphasized that SDB must be properly diagnosed by a sleep specialist.
Tuesday, June 1, 2010
The obvious advice is get to a dentist right away, but the type of injury suffered will influence how the damaged teeth can be treated, according to Joseph Orrico, DDS, president-elect of the American Academy of Implant Dentistry (AAID), www.aaid.com, who practices in Elmwood Park, Ill. and played semi-pro hockey.
“Sometimes teeth are completely knocked out -- roots and all, so in those cases place the tooth or teeth in a container of cold milk and get to a dentist within thirty minutes for a reinsertion procedure,” said Orrico. “There’s a short window of opportunity in which the remaining living tissue on the root surface can be kept alive. Milk has a neutral ph balance and is fortified with vitamins to make it an excellent fluid to help preserve teeth.” He stressed that time has the greatest influence on the success rate for replacing teeth this way.
In situations when teeth are broken above the gum line, a dentist could recommend performing a root canal procedure to save the tooth structure and restore with a crown. If a tooth is fractured below the gum line, it may be best to extract the fragment and insert a dental implant, a bridge or a removable dental prosthesis. Age is a factor determining treatment options, says Orrico, because bone loss in the jaw over the years could be significant for younger patients with bridges or removable unsecured prostheses, causing oral health and cosmetic problems later in life.
Implants function like natural teeth and preserve the integrity of the jawbone. Orrico has treated hockey players and other young athletes who have suffered severe mouth trauma and believes implants probably are the best long-term option for Keith, a player with many years left in his pro hockey career. “An implant-secured prosthesis can be removed by the team dentist before games and reinserted afterward. For a young man in his twenties, the dental implants will protect against progressive bone loss. This is a better option than wearing an unsecured prosthetic, like many pro hockey players do, which does nothing to preserve the jawbone,” Orrico advised.
About Dental Implants
Dental implants are artificial tooth roots inserted into the jaw to replace missing teeth. They are titanium screws a dentist inserts into the jawbone and affixes a prosthetic tooth or crown. Titanium implants over time fuse naturally with bone, a process known as osseointegration. Implant surgery can replace one or more teeth provided there is sufficient bone to support the implants. Today, implants with attached crowns are the preferred method for treating tooth loss because they function the same as natural teeth and help preserve the jaw structure by preventing atrophy from bone loss. Bridgework and dentures address the cosmetic problem of missing teeth but do not prevent bone loss. Permanent implants maintain proper chewing function and exert appropriate, natural forces on the jawbone to keep it functional and healthy.