Dental News Report

Study Pinpoints Genetic Variation that Raises Risk of Serious Complication Linked to Osteoporosis Drugs

2012-01-27T12:37:00.001-08:00

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Researchers at the Columbia University College of Dental Medicine have identified a genetic variation that raises the risk of developing serious necrotic jaw bone lesions in patients who take bisphosphonates, a common class of osteoclastic inhibitors. The discovery paves the way for a genetic screening test to determine who can safely take these drugs. The study appears in the online version of the journal The Oncologist.

Oral bisphosphonates are currently taken by some 3 million women in the United States for the prevention or treatment of osteoporosis. In addition, intravenous bisphosphonates are given to thousands of cancer patients each year to control the spread of bone cancer and prevent excess calcium (hypercalcemia) from accumulating in the blood. Bisphosphonates work by binding to calcium in the bone and inhibiting osteoclasts, bone cells that break down the bone’s mineral structure.

“These drugs have been widely used for years and are generally considered safe and effective,” said study leader Athanasios I. Zavras, DMD, MS, DMSc, associate professor of Dentistry and Epidemiology and Director of the Division of Oral Epidemiology & Biostatistics at the Columbia University College of Dental Medicine. “But the popular literature and blogs are filled with stories of patients on prolonged bisphosphonate therapy who were trying to control osteoporosis or hypercalcemia only to develop osteonecrosis of the jaw.”

Osteonecrosis of the jaw, or ONJ, often leads to painful and hard-to-treat bone lesions, which can eventually lead to loss of the entire jaw. Among people taking bisphosphonates, ONJ tends to occur in those with dental disease or those who undergo invasive dental procedures.

There are no reliable figures on the incidence of ONJ in patients taking oral bisphosphonates. Estimates range from 1 in 1,000 to 1 in 100,000 patients for each year of exposure to the medication, according to the American College of Rheumatology. ONJ is more common among cancer patients taking the intravenous form of the drug, affecting about 5 to 10 percent of these individuals, noted Dr. Zavras.
Studies have suggested that genetic factors play a major role in predisposing patients to ONJ.

Delving deeper into this question, Dr. Zavras and his colleagues performed genome-wide analyses of 30 patients who were taking bisphosphonates and had developed ONJ and compared them with several bisphosphonate users who were disease free.

The researchers found that patients who had a small variation in the RBMS3 gene were 5.8 times more likely to develop ONJ than those without the variation. The study also identified small variations in two other genes, IGFBP7 and ABCC4, that may contribute to ONJ risk.

“Our ultimate goal is to develop a pharmacogenetic test that personalizes risk assessment for ONJ, a test that you could give to people before they start to use bisphosphonates,” said Dr. Zavras. “Those who are positive for this genetic variation would select some other treatment, while those who are negative could take these medications with little fear of developing ONJ.”

“At the moment, many women discontinue or avoid treatment for serious osteoporosis because they are afraid of losing their jaw bones,” added Dr. Zavras. “There even are reports of dentists who have refused to perform certain invasive procedures in patients taking bisphosphonates. So there is a great need for a pharmacogenetic screening test to determine which patients are really at risk for ONJ.”

The current study looked only at Caucasians. Further studies are needed to determine whether the RBMS3 gene variation is seen in other racial groups, according to the researchers.

The paper is entitled, “Genome-wide pharmacogenetics of bisphosphonate-induced osteonecrosis of the jaw: the role of RBMS3.”

Dried licorice root fights the bacteria that cause tooth decay and gum disease

2012-01-04T13:45:00.001-08:00

Scientists are reporting identification of two substances in licorice — used extensively in Chinese traditional medicine — that kill the major bacteria responsible for tooth decay and gum disease, the leading causes of tooth loss in children and adults. In a study in ACS' Journal of Natural Products, they say that these substances could have a role in treating and preventing tooth decay and gum disease.

Stefan Gafner and colleagues explain that the dried root of the licorice plant is a common treatment in Chinese traditional medicine, especially as a way to enhance the activity of other herbal ingredients or as a flavoring. Despite the popularity of licorice candy in the U.S., licorice root has been replaced in domestic candy with anise oil, which has a similar flavor. Traditional medical practitioners use dried licorice root to treat various ailments, such as respiratory and digestive problems, but few modern scientific studies address whether licorice really works. (Consumers should check with their health care provider before taking licorice root because it can have undesirable effects and interactions with prescription drugs.) To test whether the sweet root could combat the bacteria that cause gum disease and cavities, the researchers took a closer look at various substances in licorice.

They found that two of the licorice compounds, licoricidin and licorisoflavan A, were the most effective antibacterial substances. These substances killed two of the major bacteria responsible for dental cavities and two of the bacteria that promote gum disease. One of the compounds — licoricidin — also killed a third gum disease bacterium. The researchers say that these substances could treat or even prevent oral infections.

How Bacteria Fight Fluoride in Toothpaste and in Nature

2011-12-27T06:46:00.000-08:00

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Yale researchers have uncovered the molecular tricks used by bacteria to fight the effects of fluoride, which is commonly used in toothpaste and mouthwash to combat tooth decay.

In the Dec. 22 online issue of the journal Science Express, the researchers report that sections of RNA messages called riboswitches -- which control the expression of genes -- detect the build-up of fluoride and activate the defenses of bacteria, including those that contribute to tooth decay.

"These riboswitches are detectors made specifically to see fluoride," said Ronald Breaker, the Henry Ford II Professor and chair of the Department of Molecular, Cellular and Developmental Biology and senior author of the study.

Fluoride in over-the-counter and prescription toothpastes is widely credited with the large reduction in dental cavities seen since these products were made available beginning in the 1950s. This effect is largely caused by fluoride bonding to the enamel of our teeth, which hardens them against the acids produced by bacteria in our mouths. However, it has been known for many decades that fluoride at high concentrations also is toxic to bacteria, causing some researchers to propose that this antibacterial activity also may help prevent cavities.

The riboswitches work to counteract fluoride's effect on bacteria. "If fluoride builds up to toxic levels in the cell, a fluoride riboswitch grabs the fluoride and then turns on genes that can overcome its effects," said Breaker.

Since both fluoride and some RNA sensor molecules are negatively charged, they should not be able to bind, he notes.

"We were stunned when we uncovered fluoride-sensing riboswitches" said Breaker. "Scientists would argue that RNA is the worst molecule to use as a sensor for fluoride, and yet we have found more than 2000 of these strange RNAs in many organisms."

By tracking fluoride riboswitches in numerous species, the research team concluded that these RNAs are ancient -- meaning many organisms have had to overcome toxic levels of fluoride throughout their history. Organisms from at least two branches of the tree of life are using fluoride riboswitches, and the proteins used to combat fluoride toxicity are present in many species from all three branches.

"Cells have had to contend with fluoride toxicity for billions of years, and so they have evolved precise sensors and defense mechanisms to do battle with this ion," said Breaker, who is also an investigator with the Howard Hughes Medical Institute. Now that these sensors and defense mechanisms are known, Breaker said, it may be possible to manipulate these mechanisms and make fluoride even more toxic to bacteria. Fluoride riboswitches and proteins common in bacteria are lacking in humans, and so these fluoride defense systems could be targeted by drugs. For example, the Yale team discovered protein channels that flush fluoride out of cells. Blocking these channels with another molecule would cause fluoride to accumulate in bacteria, making it more effective as a cavity fighter.

Fluoride is the 13th most common element in Earth's crust, and it is naturally present in high concentrations throughout the United States and elsewhere. Its use in toothpaste and its addition to city water supplies across the United States sparked a controversy 60 years ago, and the dispute continues to this day. In the United Kingdom, and in other European Union countries, fluoride is used to a much lesser extent due to fierce public opposition.

The new findings from Yale only reveal how microbes overcome fluoride toxicity. The means by which humans contend with high fluoride levels remains unknown, Breaker notes. He adds that the use of fluoride has had clear benefits for dental health and that these new findings do not indicate that fluoride is unsafe as currently used.

Addition of Mannitol Increases Effectiveness of Dental Nerve Block Anesthesia

2011-12-17T08:34:00.000-08:00

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Allowing a patient to be comfortable and pain-free during surgical and restorative dental procedures is an essential part of the process. The most commonly used local anesthetic injection for lower teeth is the inferior alveolar nerve (IAN) block. However, failure rates ranging from 10 to 39 percent have been reported.

The current issue of the journal Anesthesia Progress presents a study testing the efficacy of adding a solution of mannitol to the anesthetic typically used in IAN blocks. Forty adult subjects participated in the study, receiving an IAN block at each of three separate appointments at least one week apart.

The study compared the effectiveness of the standard anesthetic, lidocaine with epinephrine, to the effectiveness of two different volumes of lidocaine with epinephrine plus 0.5 M mannitol. Mannitol is a sugar alcohol that occurs naturally in fruits and vegetables. It is rapidly excreted by the kidneys.

Though its impact is short-lived, mannitol has the positive effect of opening the perineurial membrane. It is believed that, in cases of IAN block failure, the perineurial barrier around the nerve does not allow complete diffusion of the anesthetic into the nerve trunk. The addition of mannitol apparently allows enhanced permeability, increasing the success of an IAN block when administered concurrently.

After injections of the IAN block solutions, subjects’ pain levels were measured by an electric pulp test of their mandibular teeth at 4-minute intervals for 60 minutes. The study concluded that the addition of mannitol to lidocaine with epinephrine significantly increased the effectiveness of the anesthesia.

About Anesthesia Progress

Anesthesia Progress is the official publication of the American Dental Society of Anesthesiology (ADSA). The quarterly journal is dedicated to providing a better understanding of the advances being made in the science of pain and anxiety control in dentistry. The journal invites submissions of review articles, reports on clinical techniques, case reports, and conference summaries. To learn more about the ADSA, visit:

Oral Bacteria Enables Breaking Bond On Blood Vessels to Allow Invaders in

2011-12-17T07:00:00.000-08:00

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A common oral bacteria, Fusobacterium nucleatum, acts like a key to open a door in human blood vessels and leads the way for it and other bacteria like Escherichia coli to invade the body through the blood and make people sick, according to dental researchers at Case Western Reserve University.

Yiping Han, professor of periodontics at the Case Western Reserve School of Dental Medicine, made the discovery in her continued work with the Fusobacterium nucleatum bacterium, one of the most prevalent of the more than 700 bacteria in the mouth.

She found the gram-negative anaerobe has a novel adhesin or bonding agent she's named FadA that triggers a cascade of signals that break the junctures in an interlocking sheath of endothelial cells on blood vessel's surface just enough to allow F. nucleatum and other bacteria into the blood.

A description of bond-breaking process was described in the Molecular Microbiology article, "Fusobacterium nucleatum adhesin FadA binds vascular endothelial cadherin and alters endothelial integrity."

The microbiologist at the dental school has studied the oral bacteria over the past decade and was the first to find direct evidence that linked it to preterm labor and fetal death. But its presence is found in other infections and abscesses in the brain, lungs, liver, spleen and joints.

After finding and genetically matching the oral bacteria in the fetal death, she began to unravel the mystery of how an oral bacterium can be found throughout the body and jumps the blood-brain and placental barriers that usually block disease-causing agents.

Through years of lab work, her research led to the vascular endothelial (VE)-cadherin, cell-cell junctures that link the endothelial vascular cells together on the blood vessels.

These junctures are like a hook and loop connection, but for some unknown reason when F. nucleatum invades the body through breaks in the mucous membranes of the mouth, due to injuries or periodontal disease, this particular bacterium triggers a cascade of signals that causes the hook to recede back into the endothelial cell. The oral bacterium leads the way with any other harmful invaders following along.

This "deceding" was observed by confocal microscopy when Han used cells from human umbilical cord. The researchers introduced F. nucleatum and demonstrated the VE-cadherins break on bonds on the endothelial cells and creating enough space in the endothelium for the invaders to move in.

Lab tests included introducing F. nucleatum with and without other bacteria. When E. coli alone was introduced, the bond did not break. But when F. nucleatum was introduced first, the bond broke, and the E. coli bacteria were able to move through the otherwise intact cell layers.

"This cascade knocks out the guard on duty and allows the bacteria to enter the blood and travel like a bus loaded with riders throughout the system. Whenever the F. nucleatum wants to get off the bus at the liver, brain, spleen, or another place, it does," Han said.

When it disembarks from its ride through the blood, it begins to colonize. The colony of bacteria induces an inflammatory reaction that has a range of consequences from necrosis of tissue to fetal death.

Oral Surgery Protocol to Control Bleeding for Heart Patients Shows Positive Results

2011-12-14T13:14:00.000-08:00

Cardiac patients that take anticoagulant medications and need a tooth extraction face an increased risk of bleeding that must be addressed by the treating clinician. Therefore, a protocol for heart patients is needed that will avoid significant bleeding after dental extractions without suspending anticoagulant therapy.

A study reported in the current issue of the Journal of Oral Implantology evaluated the use of leukocyte- and platelet-rich fibrin biomaterial. This material is commonly used in dentistry to improve healing and tissue regeneration. It was tested as a safe filling and hemostatic material after dental extractions in 50 heart patients undergoing oral anticoagulant therapy.

These heart patients had mechanical valve substitutions, and then were placed on anticoagulant oral therapy with warfarin. It is not recommended that the anticoagulant be suspended and replaced with heparin before a minor surgery, although this substitution may control the risk of postoperative bleeding.

One method of controlling bleeding without suspending the anticoagulant is the use of platelet-rich plasma gel placed in postextraction tooth sockets. Although this protocol has been successful, there are barriers to its daily use. The platelet concentrates are expensive and take a long time to prepare.

Platelet-rich fibrin offers an alternative biomaterial that is simple and inexpensive to prepare. Blood is collected in tubes without anticoagulant and centrifuged. It divides into three layers, creating a strong platelet-rich fibrin clot in the middle layer. Platelet-rich fibrin has proved useful in daily dental practice as filling material for regeneration in order to place implants.

In this study, 50 heart patients following an anticoagulant therapy were treated with leukocyte- and platelet-rich fibrin clots placed into postextraction sockets. Complications of bleeding were reported in only two of these patients, and 10 had mild bleeding. All complications were resolved within a few hours after the oral surgery.

Additionally, the study reported no painful events, quick healing of soft tissue, and complete wound closure within one week after oral surgery. Leukocyte- and platelet-rich fibrin offers an excellent option for use in heart patients on an anticoagulant regimen.

Full text of the article, “Prevention of Hemorrhagic Complications After Dental Extractions Into Open Heart Surgery Patients Under Anticoagulant Therapy: The Use of Leukocyte- and Platelet-Rich Fibrin ,” Journal of Oral Implantology, Vol. 37, No. 6, 2011, is available at http://www.joionline.org/ .

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About Journal of Oral Implantology
The Journal of Oral Implantology is the official publication of the American Academy of Implant Dentistry and of the American Academy of Implant Prosthodontics. It is dedicated to providing valuable information to general dentists, oral surgeons, prosthodontists, periodontists, scientists, clinicians, laboratory owners and technicians, manufacturers, and educators. The JOI distinguishes itself as the first and oldest journal in the world devoted exclusively to implant dentistry. For more information about the journal or society, please visit: http://www.aaid-implant.org/index.html

Dental X-rays can predict fractures

2011-12-06T11:51:00.000-08:00

It is now possible to use dental X-rays to predict who is at risk of fractures, reveals a new study from researchers at the Sahlgrenska Academy reported in the journal Nature Reviews Endocrinology.

In a previous study, researchers from the University of Gothenburg's Sahlgrenska Academy and Region Västra Götaland demonstrated that a sparse bone structure in the trabecular bone in the lower jaw is linked to a greater chance of having previously had fractures in other parts of the body.

X-rays investigates bone structure

The Gothenburg researchers have now taken this a step further with a new study that shows that it is possible to use dental X-rays to investigate the bone structure in the lower jaw, and so predict who is at greater risk of fractures in the future. Published in the journal Bone, the results were also mentioned in both Nature Reviews Endocrinology and the Wall Street Journal.

Linked to risk of fractures

"We've seen that sparse bone structure in the lower jaw in mid-life is directly linked to the risk of fractures in other parts of the body, later in life,"says Lauren Lissner, a researcher at the Institute of Medicine at the Sahlgrenska Academy.

Study started 1968

The study draws on data from the Prospective Population Study of Women in Gothenburg started in 1968. Given that this has now been running for over 40 years, the material is globally unique. The study included 731 women, who have been examined on several occasions since 1968, when they were 38-60 years old. X-ray images of their jaw bone were analysed in 1968 and 1980 and the results related to the incidence of subsequent fractures.

For the first 12 years fractures were self-reported during followup examinations. It is only since the 1980s that it has been possible to use medical registers to identify fractures. A total of 222 fractures were identified during the whole observation period.

One out of five in higher risk

The study shows that the bone structure of the jaw was sparse in around 20% of the women aged 38-54 when the first examination was carried out, and that these women were at significantly greater risk of fractures.

The study also shows that the older the person, the stronger the link between sparse bone structure in the jaw and fractures in other parts of the body.

Applies for both sexes

Although the study was carried out on women, the researchers believe that the link also applies for men.

"Dental X-rays contain lots of information on bone structure," says Grethe Jonasson, the researcher at the Research Centre of the Public Dental Service in Västra Götaland who initiated the fractures study. "By analysing these images, dentists can identify people who are at greater risk of fractures long before the first fracture occurs."

New Mouthwash Targeting Harmful Bacteria May Render Tooth Decay a Thing of the Past

2011-11-17T07:45:00.001-08:00

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A new mouthwash developed by a microbiologist at the UCLA School of Dentistry is highly successful in targeting the harmful Streptococcus mutans bacteria that is the principal cause tooth decay and cavities.

In a recent clinical study, 12 subjects who rinsed just one time with the experimental mouthwash experienced a nearly complete elimination of the S. mutans bacteria over the entire four-day testing period. The findings from the small-scale study are published in the current edition of the international dental journal Caries Research.

Dental caries, commonly known as tooth decay or cavities, is one of the most common and costly infectious diseases in the United States, affecting more than 50 percent of children and the vast majority of adults aged 18 and older. Americans spend more than $70 billion each year on dental services, with the majority of that amount going toward the treatment of dental caries.

This new mouthwash is the product of nearly a decade of research conducted by Wenyuan Shi, chair of the oral biology section at the UCLA School of Dentistry. Shi developed a new antimicrobial technology called STAMP (specifically targeted anti-microbial peptides) with support from Colgate-Palmolive and from C3-Jian Inc., a company he founded around patent rights he developed at UCLA; the patents were exclusively licensed by UCLA to C3-Jian. The mouthwash uses a STAMP known as C16G2.

The human body is home to millions of different bacteria, some of which cause diseases such as dental caries but many of which are vital for optimum health. Most common broad-spectrum antibiotics, like conventional mouthwash, indiscriminately kill both benign and harmful pathogenic organisms and only do so for a 12-hour time period.

The overuse of broad-spectrum antibiotics can seriously disrupt the body's normal ecological balance, rendering humans more susceptible to bacterial, yeast and parasitic infections.

Shi's Sm STAMP C16G2 investigational drug, tested in the clinical study, acts as a sort of "smart bomb," eliminating only the harmful bacteria and remaining effective for an extended period.

Based on the success of this limited clinical trial, C3-Jian Inc. has filed a New Investigational Drug application with the U.S. Food and Drug Administration, which is expected to begin more extensive clinical trials in March 2012. If the FDA ultimately approves Sm STAMP C16G2 for general use, it will be the first such anti-dental caries drug since fluoride was licensed nearly 60 years ago.

"With this new antimicrobial technology, we have the prospect of actually wiping out tooth decay in our lifetime," said Shi, who noted that this work may lay the foundation for developing additional target-specific "smart bomb" antimicrobials to combat other diseases.

"The work conducted by Dr. Shi's laboratory will help transform the concept of targeted antimicrobial therapy into a reality," said Dr. No-Hee Park, dean of the UCLA School of Dentistry. "We are proud that UCLA will become known as the birthplace of this significant treatment innovation."

Teeth Crowded in Seniors, as Jaws Shrink

2011-11-16T05:52:00.000-08:00

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The size of our jaws decreases with age. This is shown in a unique study from the Faculty of Dentistry at Malmö University that followed a cohort of dentists throughout their adult lives.

The unique study started in 1949. Plaster molds were made of the jaws of dental students, who were then in their twenties. Ten years later the procedure was repeated, and in 1989, forty years after the first molds, a final round was performed. On that occasion the researchers were in touch with 18 of the original 30 participants.

"We found that over these forty years there was less and less room for teeth in the jaw," says Lars Bondemark, professor of orthodontics, who analyzed the material together with his colleague Maria Nilner, professor of clinical bite physiology at the College of Dentistry, Malmö University .

This crowdedness comes from shrinkage of the jaw, primarily the lower jaw, both in length and width. While this is only a matter of a few millimeters, but it is enough to crowd the front teeth.

"We can also eliminate wisdom teeth as the cause, because even people who have no wisdom teeth have crowded front teeth."

How much the jaw shrinks is individual, but for some patients the changes are sufficiently great for them to perceive that something is happening to their bite.

"In that case it's good to know that this is normal," says Lars Bondemark, who maintains that dentists need to take into consideration the continuous shrinking of the jaws when they plan to perform major bite constructions on their patients.

"We're working against nature, and it's hard to construct something that is completely stable."

Why the jaws change throughout life is not known, but the magnitude of the change is probably determined by both hereditary and anatomical factors, including what the patient's bite looks like.

Professional dental cleanings may reduce risk of heart attack, stroke

2011-11-14T11:30:00.000-08:00

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Professional tooth scaling was associated with fewer heart attacks and strokes in a study (Abstract 17704) from Taiwan presented at the American Heart Association's Scientific Sessions 2011.

Among more than 100,000 people, those who had their teeth scraped and cleaned (tooth scaling) by a dentist or dental hygienist had a 24 percent lower risk of heart attack and 13 percent lower risk of stroke compared to those who had never had a dental cleaning. The participants were followed for an average of seven years.

Scientists considered tooth scaling frequent if it occurred at least twice or more in two years; occasional tooth scaling was once or less in two years.

The study included more than 51,000 adults who had received at least one full or partial tooth scaling and a similar number of people matched with gender and health conditions who had no tooth scaling. None of the participants had a history of heart attack or stroke at the beginning of the study.

The study didn't adjust for heart attack and stroke risk factors — such as weight, smoking and race — that weren't included in the Taiwan National Health insurance data base, the source of the information used in the analysis.

"Protection from heart disease and stroke was more pronounced in participants who got tooth scaling at least once a year," said Emily (Zu-Yin) Chen, M.D., cardiology fellow at the Veterans General Hospital in Taipei, Taiwan.

Professional tooth scaling appears to reduce inflammation-causing bacterial growth that can lead to heart disease or stroke, she said.

Hsin-Bang Leu M.D., is the study co-author. Author disclosures and funding are on the abstract.

Type of periodontal disease predicts degree of risk for heart attack, stroke, and heart failure

In a separate study (abstract 10576), researchers found that the value of markers for gum disease predict heart attack, congestive heart failure and stroke in different ways and to different degrees.

Anders Holmlund, D.D.S., Ph.D. Centre for Research and Development of the County Council of Gävleborg, Sweden, and senior consultant; Specialized Dentistry, studied 7,999 participants with periodontal disease and found people with:

- Fewer than 21 teeth had a 69 percent increased risk of heart attack compared to those with the most teeth.
- A higher number of deepened periodontal pockets (infection of the gum around the base of the tooth) had a 53 percent increased risk of heart attack compared to those with the fewest pockets.
- The least amount of teeth had a 2.5 increased risk of congestive heart failure compared to those with the most teeth.
- The highest incidence of gum bleeding had a 2.1 increased risk of stroke compared to those with the lowest incidence.

Lose the fat and improve the gums

2011-11-09T12:49:00.000-08:00

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Case Western Reserve University School of Dental Medicine researchers found the human body is better at fighting gum disease when fat cells, which trigger inflammation, disappear.

Findings come from a pilot study of 31 obese people with gum disease. Half of the group with an average body mass index (BMI) of 39 had gastric bypass surgery and had fat cells from the abdomen removed. That half fared better than a control group of obese people with a BMI of 35 who also were treated for gum disease but did not have the gastric bypass surgery or fat removed.

What intrigued the researchers is that the majority of those who underwent surgery had a drop in their glucose levels after the procedure, a result that bodes well for overweight people predisposed to diabetes and insulin-related problems.

All study participants underwent nonsurgical periodontal treatments of scaling/root planing and oral hygiene instructions for home care. While both groups showed improvement, the surgery group did even better on the measures for periodontal attachment, bleeding, probing depths and plaque levels.

Inflammation that continues to brew in the body can have harmful effects over time, and inflammation from gum disease can erode bone and cause tooth loss. It can also cause breaks in the gums where harmful oral bacteria can enter the blood stream. Such bacteria have been linked to preterm birth, fetal death, heart disease, diabetes and arthritis, said Nabil Bissada, chair of the department of periodontics at Case Western Reserve School of Dental Medicine.

Bissada is the lead author of the study, “Response to periodontal therapy in subjects who had weight loss following bariatric surgery and obese counterparts: a pilot study,” published in the Journal of Periodontology.

This study raises two hypotheses about why the surgery group improved.

The first theory is that excessive fat cells (adipocytes) secrete more cytokines (such as TNF and IL-6), which make insulin more resistant to doing its function.

As a result, more accumulation of sugar in the blood (hyperglycemia) occurs. Losing weight, therefore, makes insulin less resistant and improves the diabetic status. This in turn helps in the response to periodontal treatment.

The other theory relates to the presence of the leptin hormone that regulates appetite. Leptin plays a role in regulating metabolism and has been linked to inflammation by increasing the production of cytokines and the –C-reactive protein, which is also linked to inflammation. Bissada said leptin production was reduced after bariatric surgery and may be one explanation for the better outcomes in the periodontal treatment.

As the researchers look to the further their research, their next step will be to conduct a longitudinal study to support their preliminary findings.

Healthy mouth bacteria provide ideal conditions for gum disease

2011-10-27T13:26:00.000-07:00

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Normal bacteria which live in our mouths provide the catalyst for the development of gum disease, a debilitating condition which leads to painful gums and the loosening of teeth, new research from Queen Mary, University of London has found.

The unexpected finding could pave the way for the development of preventative measures in tackling gum, or periodontal disease*, by manipulating the normal bacteria in the same way that probiotic yoghurt works to protect the intestine.

Researchers at Queen Mary's Blizard Institute, including Medical Research Council Clinical Research Training Fellow Mark Payne, worked with scientists in the US; they published their findings in the journal Cell Host and Microbe today (Oct. 27).

The scientists introduced the oral bacterium Porphyromonas gingivalis to mice living in two different test conditions. The mice with normal bacteria in their mouths developed periodontal bone loss but the mice raised under germ-free conditions, in the absence of any normal bacteria, remained disease-free.

Professor Mike Curtis, Director of the Blizard Institute and co-author on the paper, said when the oral bacterium P. gingivalis was introduced under normal conditions "it stimulated the growth of normal bugs leading to a large increase in the number of those organisms already there".

"P. gingivalis was introduced at very low levels yet it had a major affect on both the immune system and the inflammatory system," he said.

"This oral bacterium only appears in small numbers but appears to have a major influence on the overall ecology. It has a keystone effect in a community – working in the same way that starfish, which have relatively small numbers, control the shell fish communities in the sea.

Professor Curtis said although the findings were encouraging in terms of understanding the way gum disease develops, there was still "some way to go" before there was a similar product on the market for gum disease as a probiotic yoghurt is available for the intestine.

"Now we know that periodontal disease only develops through P. gingivalis interacting with the existing bacteria in our mouths, we need to understand the role played by our normal bacteria in both the development of disease and protection from it," he said.

"This may then provide the means to develop preventative measures for the disease."

Professor Farida Fortune, Dean for Dentistry at Queen Mary said the research was encouraging for people who suffer from gum disease which results in bleeding gums and ultimately loose teeth which cause difficulty in both speaking and eating.

"The public still need to be mindful of the way they look after their teeth and gums," she said.

"People need to pay more attention to their oral hygiene. Their local hygienist, dental therapist and dentist can all assist in teaching them effective cleaning techniques. Just these simple preventative measures, as well as not smoking, will go some way to helping them avoid developing gum disease."

Prenatal exposure to dental amalgam

2011-10-27T13:22:00.000-07:00

Background.

Dental amalgams contain approximately 50
percent metallic mercury and emit mercury vapor during the life of
the restoration. Controversy surrounds whether fetal exposure to
mercury vapor resulting from maternal dental amalgam
restorations has neurodevelopmental consequences.

Methods

The authors determined maternal amalgam restoration
status during gestation (prenatal exposure to mercury vapor [Hg0])
retrospectively in 587 mother-child pairs enrolled in the Seychelles
Child Development Study, a prospective longitudinal cohort study of
the effects of prenatal and recent postnatal methylmercury (MeHg)
exposure on neurodevelopment. They examined covariate-adjusted
associations between prenatal maternal amalgam restoration status
and the results of six age-appropriate neurodevelopmental tests
administered at age 66 months. The authors fit the models without
and with adjustment for prenatal and recent postnatal MeHg
exposuhttp://beta.blogger.com/img/blank.gifre metrics.

Results

The mean number of maternal amalgam restorations
present during gestation was 5.1 surfaces (range, 1-22) in the 42.4
percent of mothers who had amalgam restorations. The authors
found no significant adverse associations between the number of
amalgam surfaces present during gestation and any of the six
outcomes, with or without adjustment for prenatal and postnatal
MeHg exposure. Results of analyses with the secondary metric,
prenatal amalgam occlusal point scores, showed an adverse
association in boys only on a letter- and word-identification subtest
of a frequently used test of scholastic achievement, whereas girls
scored better on several other tests with increasing exposure.
Conclusions. This study’s results provide no support for the
hypothesis that prenatal Hg0 exposure arising from maternal dental
amalgam restorations results in neurobehavioral consequences in
the child.

Nearly half of Ontario seniors do not see dentists regularly

2011-10-27T13:20:00.000-07:00

Poor oral health tied to chronic disease and worse overall health

TORONTO -- Forty-five per cent of Ontarians 65 years and older did not see a dentist in the last year, increasing their risk of chronic diseases and a reduced quality of life , a new study by researchers at St. Michael's Hospital, Women's College Hospital and the Institute for Clinical and Evaluative Sciences (ICES) shows.

"Poor oral health can contribute to many serious medical conditions and affect a person's ability to chew and digest food properly, leading to inadequate nutrition," explains Dr. Arlene Bierman, principal investigator of the study. "With dental services not covered under our universal health-insurance program and many older adults not visiting dentists regularly , the findings suggest we need to rethink the services we provide to help keep seniors healthy as they age."

According to the researchers, women make up the majority of the older population. They are more likely to have two or more chronic conditions than men, report more disability and chronic pain, and are less likely to be physically active.

"A focus on prevention and health promotion can help older women remain active and independent as they age as too many are physically inactive and do not eat enough fruits and vegetables ," said Dr. Paula Rochon, study investigator and senior scientist at Women's College Research Institute. "Yet, what we do know is that it's never too late to improve quality of life and health for women, regardless of age. In fact, a focus on strategies to improve health in the older population can help prevent chronic disease and its associated complications."

The findings are detailed in a report of the POWER (Project for an Ontario Women's Health Evidence-Based Report) Study — a joint study from St. Michael's Hospital and ICES. The study is the first in the province to provide a comprehensive overview of women's health in relation to income, education, ethnicity and geography. Findings can be used by policymakers and health-care providers to improve access, quality and outcomes of care for Ontario women. The Older Woman's Health report examines quality and outcomes of care among older women and men in home care, long-term care and in the community. The POWER Study was funded by Echo: Improving Women's Health in Ontario, an agency of the Ontario Ministry of Health and Long-Term Care.

"Since women comprise the majority of the older population in Ontario, we need to be paying closer attention to the specific care and service needs of older women," says Pat Campbell, CEO of Echo. "The POWER Study Older Women's Health report provides key suggestions on how we can begin to do this."

Findings of the POWER Study released today include:

- About 60 per cent of older women reported that they were physically inactive compared to 48 per cent of men.
- Less than 45 per cent of older adults took steps to improve their health in the previous 12 months.
- Nearly 67 per cent of women ages 80 and older reported functional limitations and more than 1 in 3 low-income women reported their activities were limited by pain.
-= Nearly 60 per cent of women admitted to the hospital for heart failure are age 80 and older, and 90 per cent are age 65 and older.

Many health-care providers have little training in the care of older adults -- there are only 1 to 5 geriatricians per 100,000 adults 65 and older in some areas of the province.

Women have different patterns of illness and health-care needs compared to men. According to the researchers, previous generations of women had fewer opportunities and financial resources and less education than women today, and are less likely to pay for supportive care and access to health services that are not publicly funded.

Modest Improvement in Temporomandibular Disorder–Related Pain Associated With Use of Hard Stabilization Appliances Compared With Use of Nonoccluding A

2011-10-25T14:31:00.000-07:00

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Question: Among patients with temporomandibular
disorders (TMDs), does the use of intraoral orthopedic
appliances (IOAs) reduce pain compared with the use of
a placebo control or other treatments for TMD or no
treatment?

Answer:

The results of the study, published in The Journal
of the American Dental Association November Issue,
present limited evidence that use of HSAs leads to
modest improvement in TMD-related pain treatment
efficacy compared with use of NOAs or receiving
no therapy.

There was weak evidence regarding the use of
other types of appliances, including soft stabilization
appliances and anterior bite appliances,in reducing
TMD-related pain compared with notherapy; however,
close monitoring is recommended,as these appliances
might be associated with more adverse events than HSAs.

Many Young Children Off to a Poor Start with Dental Health

2011-10-25T14:17:00.000-07:00

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Dental visits are recommended to begin by age 1, but a new poll shows most children age 1-2 have not received appropriate oral health care

Although child health experts recommend that children begin oral health care by age 1 or when their first teeth emerge, a new report from the C.S. Mott Children’s Hospital National Poll on Children’s Health shows that most children ages 1-2 have not yet started seeing a dentist.

In May 2011, the National Poll on Children’s Health asked parents of children ages 1-5 about dental health care for young children. The poll found that only 23% of 1-year-olds had been to the dentist and only 44% of 2-year-olds had been to the dentist.

“Dental problems such as early childhood caries (cavities in the baby teeth) are the leading cause of chronic disease for young children,” says Sarah Clark, M.P.H., Associate Director of the Child Health Evaluation and Research (CHEAR) Unit at the University of Michigan. “Most dental problems can be prevented through good oral health care.”

Parents may not be aware of recommendations for early dental health care and finding a dentist who will see young children – especially those covered by Medicaid – is a long standing problem in some communities. To address these issues, pediatricians and health care providers are now seen as important partners in oral health and are encouraged to discuss oral health during well-child visits.

“Well-child visits are critical to making sure that parents understand their role in preventing dental problems, such as how to clean the child’s baby teeth and the importance of avoiding sugary beverages and bottles in the crib,” says Clark. “Well-child visits are also a key opportunity for a health professional to examine the child’s baby teeth and make sure that children with early signs of decay are strongly encouraged to see a dentist.”

However, when parents of 1-2 year olds were asked about dental health activities that occurred at their child’s most recent well-child visit, less than half of parents said their health care providers talked to them about cleaning the teeth or taking their child to the dentist and 1 in 3 children did not have their teeth examined at all by their health care provider.

“We know that not all children will see a dentist at age 1, but on the other hand, almost all children have well-child visits with a pediatrician or other health care provider,” Clark continues. “The results of this poll indicate that we need to improve the way oral health issues are addressed during well-child visits so that parents fully understand the need for good oral health care.”

Full report

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U.S. State Department Reviewing Ban on Mercury Fillings

2011-10-24T06:13:00.000-07:00

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For the first time in history, the U.S. Department of State (DOS) is evaluating international regulations that would ban mercury-containing products including silver/amalgam dental fillings, which contain 50% mercury and are already in the mouths of more than 122 million Americans.

The DOS will present their official position on the use of mercury in amalgam fillings and other medical devices at a stakeholder meeting on Monday, October 24th, from 11:00 AM to 12:30 PM at the DOS headquarters on 2201 C Street, N.W., Washington, D.C. Members of the International Academy of Oral Medicine and Toxicology (IAOMT) will attend the meeting to encourage a ban on mercury/silver dental amalgam fillings.

The U.S. government's monumental decision about mercury fillings is being made in preparation for the third session of the United Nations Environmental Programme (UNEP) Intergovernmental Negotiating Committee (INC3), scheduled for later this month in Nairobi, Kenya. The committee was created with the specific purpose of developing a global, legally-binding instrument on mercury due to its significant negative effect on human health and the environment.

Mercury, a potent neurotoxin used in dental amalgam fillings, can damage the brain, kidneys, and nervous system, and is particularly harmful to the fetus and young children. Substantial, peer-reviewed, scientific evidence proving these dangers is documented in IAOMT's Petition for Reconsideration, which was filed with the United States Food and Drug Administration (FDA) in 2009.

The hazards of mercury filings have also been addressed by other international groups. In 1991, the World Health Organization (WHO) concluded that dental amalgam is "the greatest source of mercury exposure for the general population, exceeding those from food and air."

In the United States, President Obama has recognized the hazards of mercury since 2008, and he emphasized the need to protect children from being exposed to mercury in his September 8, 2011 speech to Congress.

Yet, no actions to defend the American public from the known risks of mercury/silver dental fillings have been taken, although a recent submission by the U.S. to UNEP's Intergovernmental Negotiating Committee supports "further consideration of dental amalgam by the INC...with the goal of potential or gradual phasedown of dental amalgam and ongoing research for affordable, viable alternatives."

Such a position is unacceptable to Dr. David Kennedy, past president of IAOMT, who explains, "Using the excuse of alternative materials to further delay protecting the public is illogical because safe alternatives to mercury fillings have already been used for more than 20 years."

Leo Cashman, executive director and volunteer for the non-profit, consumer advocacy group Dental Amalgam Mercury Solutions (DAMS), agrees: "Dental amalgam is not viable when the costs of mercury poisoning to the individual, to families, and to the healthcare industry are considered."

"If we accept the current treaty language of UNEP, WHO, and the U.S. State Department, as well as their associated health declarations that I completely disagree with, the treaty will be about an 'infinite phase down' which won't even begin phasing down mercury/silver amalgam dental filling placement until 2020 the soonest, but more likely 2030, with requested exemptions by the FDI", says Dr. David Simone, who will be representing IAOMT at the DOS meeting. He reiterates, "The way it stands now, the UNEP Mercury Instrument is designed to keep placing mercury amalgams in all populations for another 20 years at least."

Freya Koss, President of the PA Coalition for Mercury-Free Dentistry, was diagnosed with myasthenia gravis after having an old mercury amalgam filling drilled out and replaced with a new one, and she will be at the meeting to insure that the DOS keeps mercury fillings in a proposed ban portion of the INC treaty.

Marie Flowers, President of Dental Amalgam Mercury Solutions (DAMS), experienced neurological symptoms following the removal of a mercury amalgam filling and will likewise be at the DOS meeting on Monday. Flowers has commented, "The U.S. lags behind countries such as Sweden, who initiated a mercury phase out in 1987, followed by Denmark and Norway, who banned dental mercury amalgam in 2009.

Nashville's Fox 17 anchor Stacy Case told her personal story of mercury poisoning to the FDA at a recent Town Meeting in San Francisco: "I had four amalgams unsafely removed and replaced with four shiny mercury fillings, and I got out of bed one day and couldn't walk." However, Case recovered from her diagnosis of multiple sclerosis after her fillings were safely removed. Her message to the U.S. government is clear: "Use your power and position for good. Please right this wrong!"

IAOMT and other groups are strongly urging the DOS to support the position of the U.S. Government as stated in February 2009 by Nancy Sutley, Chair of the White House Council on Environmental Quality, who announced, "Mercury poses a serious threat to public health in communities around the world...The United States will play a leading role in working with other nations to craft a global, legally binding agreement that will prevent the spread of mercury into the environment and improve the health of workers, pregnant women, and children throughout the world."

Monday's DOS meeting about the U.S. position on the INC treaty will set the international stage for the future of mercury in dentistry, which many hope will be the end of drilling a potent neurotoxin into the mouths of an unsuspecting international public.

Tissue Graft Prevents Gum Recession After Tooth Implant

2011-10-21T13:29:00.000-07:00

When a tooth is replaced with an implant, receding of the gums can become a concern. This leaves areas of root exposed and can be painful for the patient. While a single tooth replacement performed as an immediate, one-step process is an accepted treatment, gum recession occurs more often with this method of implant.

The current issue of the Journal of Oral Implantology reports on a case series of 10 patients who received a single immediate tooth replacement in conjunction with subepithelial connective tissue graft. The tissue graft has proven successful in making gingival, or gum, tissue more resistant to recession.

In the immediate tooth replacement procedure, a failing tooth is removed and an implant is immediately placed into the socket. For the tissue graft, tissue is harvested from the palate using a single incision. The graft material is inserted into a prepared space between the labial bony plate and the gingiva of the extraction site. The graft preserves soft tissue levels, making the gum less likely to recede.

Marginal bone level is another way to gauge the success of an implant. A more recent suggestion, which this study evaluates, is that this bone level can be influenced by the way the implant and abutment connect. “Platform switching”—which refers to the size discrepancy between these two components—can be beneficial in maintaining the marginal bone level.

In this study, patients were evaluated before surgery, at the time of tooth replacement, and at three, six, and twelve months after surgery. One implant failed early in the process, but at one year the remaining nine patients showed good integration of tissue and tooth with minimal loss of marginal bone level or facial gingival level. The authors concluded that with proper implant position and the placement of graft material, a favorable success rate can be achieved.

Full text of the article: “Immediate Single Tooth Replacement With Subepithelial Connective Tissue Graft Using Platform Switching Implants: A Case Series

Certain Mouth Bacteria Signal Pancreatic Cancer

2011-10-14T11:39:00.001-07:00

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Particular types of mouth bacteria, some of which are found in gum disease, are associated with the development of pancreatic cancer, indicates a small study published online in the journal Gut.

The finding opens up the possibility of curbing the progress of one of the most difficult cancers to treat, by altering the balance of bacteria, say the authors. Pancreatic cancer usually spreads very quickly, and only around one in 20 patients is still alive five years after diagnosis.

The authors base their findings on an initial comparison of the bacteria found in the spit of 10 patients with pancreatic cancer, which had not yet spread, and 10 healthy people, matched for age and sex.

They found significant differences between the bacterial colonies in the two groups, with 31 additional species and 25 fewer species in the spit of the cancer patients.

They then checked spit samples from a further 28 pancreatic cancer patients and 28 healthy people to verify their findings.

And they checked tissue samples from 28 patients with chronic inflammation of the pancreas (chronic pancreatitis), which is associated with an increased risk of developing pancreatic cancer. Among six suspicious species, two -- Neisseria elongata and Streptococcus mitis -- showed up significantly less often in the mouths of the cancer patients than in those of their healthy peers, while levels of another species -- Granulicatella adjacens -- were significantly higher.

The combination of N Elongata and S mitis accurately differentiated between healthy patients and those with cancer in more than 80% cases.

Furthermore, they found similar differences in the prevalence of S mitis and G adjacens between the chronic pancreatitis samples and the spit of healthy people.

It is as yet unclear whether the presence of particular types of bacteria are a cause or effect of pancreatic cancer, say the authors. But their findings back previous research, which has implicated bacteria in the development of pancreatic diseases.

They go on to suggest that levels of certain bacteria could be used as a non-invasive and credible screen for pancreatic cancer, with the promise of earlier detection for a disease that has no clear symptoms in its early stages.

Cell Transplantation study shows bone growth from implanted tooth and dental pulp stem cells

2011-09-26T11:29:00.000-07:00

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Researchers in Japan have completed a study showing that stem cells derived from deciduous canine teeth and dental pulp can be grafted and produce bone regeneration between parents and offspring. Their results are published in the current issue of Cell Transplantation (20:7), now freely available on-line.

"Bone defects can occur for a number of reasons, and autogenous bone grafting - using the patient's own bone - has been a standard approach to treatment," said study corresponding author Dr. Yoichi Yamada of the Center for Genetic and Regenerative Medicine at the Nagoya University School of Medicine. "However, considering severe invasiveness in self-donor bone sites, and the limited supply of autogenous bone, alternative donor sources are needed."

The researchers note that previous studies have shown that oral and maxillofacial dental tissues contain a variety of stem cells, such as dental pulp stem cells and stem cells from deciduous teeth. Stem cells, they note, can be easily extracted from deciduous teeth, which are routinely lost in childhood and generally discarded.

"Stem cells from human exfoliated deciduous teeth were identified as a novel population of stem cells, capable of differentiating into various cell types, such as osteoblasts, odontoblasts, adipocytes and neural cells," explained Dr. Yamada.

Their study extracted deciduous teeth from canine puppies and grafted them onto parent canine mandibles as an allograft. After four weeks, bone defects were prepared on both sides of the host mandible. The newly formed bone was evaluated at two, four and eight weeks. When compared to controls, the study group demonstrated well-formed mature bone and neovascularization.

The researchers reported that stem cells derived from dental pulp "display increased immunosuppressive activity when compared to bone marrow mesenchymal cells" and will likely have "immunosuppressive activity with potential clinical applications in allogenic in vivo stem cell transplantation, particularly for calcified tissue reconstruction."

Their pre-clinical study could pave the way for stem cell therapy in othropedics and oral maxillofacial reconstruction, concluded Dr. Yamata.

"This study highlights the promise of obtaining stem cells from unusual sources, such as teeth, and their potential benefit in familial treatments for bone reconstruction" said Dr. Julio Voltarelli, professor of Clinical Medicine and Clinical Immunology at the University of Sao Pãulo, Brazil, and section editor for Cell Transplantation. "Due to their potential to also become other cell types such as neural cells, it will be interesting to see what future studies reveal about the possible uses of these cells."

Sugar-free polyol gum, lozenges, hard candy; Nonfluoride varnishes help prevent cavities

2011-09-13T11:01:00.000-07:00

Recommended in conjunction with fluoride for patients at high-risk for developing cavities

A multi-disciplinary expert panel, convened by the American Dental Association (ADA) Council on Scientific Affairs, issued a report this month containing clinical recommendations that sugar-free chewing gum, lozenges and hard candy including xylitol or polyol combinations, and a prescription varnish with chlorhexidine and thymol could be beneficial in preventing cavities when used as adjuncts to a comprehensive cavity prevention program which includes the use of fluoride-containing products.

The panel noted in its report that these nonfluoride options could provide an extra benefit to prevent cavities in patients at high risk for developing cavities when used in addition to products such as toothpaste, dental sealants and varnishes that contain fluoride as well as community water fluoridation and good eating habits.

The executive summary of the report entitled, "Nonfluoride Caries Preventive Agents," is published in the September issue of The Journal for the American Dental Association and is available on the EBD website. The clinical recommendations from the expert panel were reviewed and approved by the ADA's Council on Scientific Affairs.

The ADA recommends that clinicians determine a patient's risk for developing cavities by conducting a caries risk assessment, The Caries Form (Patients Ages 0-6 Years) and the Caries Form (Patients Over 6 Years) which includes completing a caries risk assessment form that can be used as a communications tool with their patients.

Nonfluoride agents

In addition to a comprehensive cavity-prevention program which includes the use of fluoride, the scientific panel recommended that clinicians consider applying a mixture of cholrhexidine-thymol varnish to the teeth of high-risk adults and the elderly every three months to reduce cavities developing in the root of the tooth.

The panel encouraged clinicians to consider advising parents and caregivers of healthy children older than 5 years who are at higher risk for cavities to chew sugar-free polyol gum after meals for 10 to 20 minutes to prevent cavities.

A polyol is a low-calorie sweetener such as xylitol, sorbitol or mannitol, which is not broken down by the bacteria in the mouth and therefore does not contribute to tooth decay. The panel also recommended that sucking xylitol-containing sugar-free lozenges or hard candy after meals may reduce cavities in children.

The panel's recommendations are based on a review of evidence from 71 published articles that described 50 randomized controlled trials and 15 nonrandomized studies to assess the effectiveness of various nonfluoride agents in preventing cavities.

ADA expert panels, Evidence-Based Dentistry

The clinical recommendations, developed by expert multidisciplinary panels convened by the ADA Council on Scientific Affairs, assessed available scientific evidence and developed practice-oriented recommendations through a comprehensive evidence-based process.

Evidence-based clinical recommendations are intended to provide dentists and other health professionals with a review of the latest scientific evidence on particular topics and are not considered a standard of care. Rather, health care professionals can consider clinical recommendations, patient preference and their own clinical judgment when diagnosing and treating patients.

Caries-Preventive Agents: Nonfluoride Caries-Preventive Agents: Executive Summary of Evidence-Based Clinical Recommendations

2011-09-01T06:56:00.000-07:00

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In this report, the authors present evidence-based clinical recommendations regarding the use of nonfluoride caries preventive agents. The recommendations were developed by an
expert panel convened by the American Dental Association (ADA)
Council on Scientific Affairs. The panel addressed several questions
regarding the efficacy of nonfluoride agents in reducing the incidence
of caries and arresting or reversing the progression of caries.

Types of Studies Reviewed

A panel of experts convened by
the ADA Council on Scientific Affairs, in collaboration with ADA
Division of Science staff, conducted a MEDLINE search to identify
all randomized and nonrandomized clinical studies regarding the
use of nonfluoride caries-preventive agents.

Results

The panel reviewed evidence from 50 randomized controlled
trials and 15 nonrandomized studies to assess the efficacy of
various nonfluoride caries-preventive agents.

Clinical Implications

The panel concluded that certain nonfluoride
agents may provide some benefit as adjunctive therapies in
children and adults at higher risk of developing caries. These recommendations
are presented as a resource for dentists to consider
in the clinical decision-making process.

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Sealants and dental caries

2011-09-01T06:52:00.000-07:00

The authors conducted a study to survey the perspectives of dentists
regarding the 2010 American Dental Association (ADA) recommendation to seal noncavitated carious lesions (NCCLs) in children and young adults.

Methods

The authors mailed a questionnaire
to a randomly selected sample of 2,400 general dentists
(GDs) and pediatric dentists (PDs) in the United States.
The sample was chosen by the ADA’s Survey Center. The
questionnaire included two photographs of NCCLs (permanent
first molar and premolar) in a 12-year-old child. Respondents
were provided with radiographic findings and asked to
choose from several management options.

Results

In the absence of radiographic evidence of caries,
37.4 percent and 42.3 percent of GDs and PDs, respectively,
indicated that they would seal the NCCL in the molar. For
the premolar, a significantly lower percentage of GDs than of
PDs indicated that they would seal the NCCL. With radiographic
evidence of caries in dentin, less than 4 percent of all
dentists surveyed indicated that they would seal the NCCLs,
and more than 90 percent indicated that they would remove
the caries and place restorations. Less than 40 percent of
dentists indicated that they sealed NCCLs in their practice.
Conclusions. The U.S. dentists surveyed have not adopted
evidence-based clinical recommendations regarding the
sealing of NCCLs.

Practice Implications

New educational and dissemination
programs should be developed regarding these evidence-based
caries management approaches.

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Implant Prosthesis Offers an Improvement Over Dentures

2011-08-30T13:44:00.000-07:00

As the number of older adults increases, more people are facing a reduced quality of life because of tooth loss. Edentulism is common among the elderly, and one survey estimates that 37 million Americans will need dentures by 2020. With this increasing demand comes an increasing need to offer a better solution.

An article in the current issue of the Journal of Oral Implantology reports on an alternative treatment to dentures. The “All-on-Four” therapy uses four implants to support a fixed prosthesis, and the patient’s new teeth can be put in place the day of surgery.

When compared with patients who have received implant therapy, those with dentures have shown only a marginal improvement in quality of life, according to clinical studies. These patients report pain, discomfort, poor stability, and difficulty eating. Dental clinicians see the need to offer replacements for natural teeth that allow greater satisfaction and improved quality of life for their patients.

The All-on-Four treatment maximizes the use of available bone and allows immediate functionality. Four implants are placed—two near the front and two near the back of the dental area. These support a fixed, full-arch prosthesis that is put in place the same day as the surgery. The success of this therapy is judged not only by its comfort and usability for the patient, but also by its longevity.

The authors evaluated the survival of the All-in-Four treatment for a 29-month period using the NobelActive implant from Sweden’s Nobel Biocare. This implant features a tapered body and variable thread design. Other All-on-Four implant designs have reported high survival rates between 92 percent and 100 percent.

In this study, 165 patients, with a mean age of 59 years, received 708 implants. No significant difference was found between the survival rates of implants in the maxilla and mandible jaws. Overall, the survival rate was 99.6 percent, with only three implants failing.

Full text of the article,
“The All-on-Four Immediate Function Treatment Concept With NobelActive Implants: A Retrospective Study,”
Journal of Oral Implantology, Vol. 37, No. 5, 2011, is available at http://allenpress.com/publications/journals/orim

Permalink to this article

Filling without drilling

2011-08-23T11:50:00.000-07:00

Researchers at the University of Leeds have discovered a pain-free way of tackling dental decay that reverses the damage of acid attack and re-builds teeth as new.

The pioneering treatment promises to transform the approach to filling teeth forever.

Tooth decay begins when acid produced by bacteria in plaque dissolves the mineral in the teeth, causing microscopic holes or 'pores' to form. As the decay process progresses these micro-pores increase in size and number. Eventually the damaged tooth may have to be drilled and filled to prevent toothache, or even removed.

The very thought of drilling puts many people off going to see their dentist, whether or not they actually need treatment. This tendency to miss check-ups and ignore niggling aches and pains means that existing problems get worse and early signs of decay in other teeth are overlooked.

It's a vicious cycle, but one that can be broken, according to researchers at the University of Leeds who have developed a revolutionary new way to treat the first signs of tooth decay. Their solution is to arm dentists with a peptide-based fluid that is literally painted onto the tooth's surface. The peptide technology is based on knowledge of how the tooth forms in the first place and stimulates regeneration of the tooth defect.

"This may sound too good to be true, but we are essentially helping acid-damaged teeth to regenerate themselves. It is a totally natural non-surgical repair process and is entirely pain-free too," said Professor Jennifer Kirkham, from the University of Leeds Dental Institute, who has led development of the new technique.

The 'magic' fluid was designed by researchers in the University of Leeds' School of Chemistry, led by Dr Amalia Aggeli. It contains a peptide known as P 11-4 that - under certain conditions - will assemble together into fibres. In practice, this means that when applied to the tooth, the fluid seeps into the micro-pores caused by acid attack and then spontaneously forms a gel. This gel then provides a 'scaffold' or framework that attracts calcium and regenerates the tooth's mineral from within, providing a natural and pain-free repair.

The technique was recently taken out of the laboratory and tested on a small group of adults whose dentist had spotted the initial signs of tooth decay. The results from this small trial have shown that P 11-4 can indeed reverse the damage and regenerate the tooth tissue.

"The results of our tests so far are extremely promising," said Professor Paul Brunton, who is overseeing the patient testing at the University of Leeds Dental Institute. "If these results can be repeated on a larger patient group, then I have no doubt whatsoever that in two to three years time this technique will be available for dentists to use in their daily practice."

"The main reason that people don't go to the dentist regularly is fear. If we can offer a treatment that is completely non-invasive, that doesn't involve a mechanical drill, then we can change that perceived link between dental treatment and pain. This really is more than filling without drilling, this is a novel approach that enables the patients to keep their natural teeth!"

Sports Dental Injuries Are No Laughing Matter

2011-08-23T11:44:00.000-07:00

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The crunch of helmets as players tangle for a loose football, the swoosh of the net as an outside jumper is made and the crack of the bat as a guaranteed double sails into right center field are awesome sounds to sports fans but for dentists, they’re reminders that a player is just one misstep away from a dental injury.

“Basketball and baseball are the two biggest mouth-injuring sports,” says Stephen Mitchell, D.M.D., associate professor in the UAB Department of Pediatric Dentistry. “And the most common injuries we see are broken, displaced or knocked out teeth, and broken jaws.”

According to a report by the U.S. Surgeon General, craniofacial injuries sustained during sporting activities are a major source of nonfatal injury and disability in children and adults, accounting for up to one-third of all sports injuries. The National Youth Sports Safety Foundation estimates that more than 3 million teeth will be knocked out in youth sporting activities this year.

The increasing participation of girls and young women in competitive sports means that they, just like their male counterparts, should know the risks of dental injuries and use additional protective gear as appropriate, Mitchell says.
Mitchell says mouth guards and helmets with face protectors are the best way for kids to avoid dental injuries while playing sports.

“If the child has a full set of permanent teeth then a custom guard can be made that will provide protection but be small enough to make it easy to communicate with teammates,” Mitchell says. “But if they still have some of their baby teeth, a custom guard is a waste of money. Parents will be better off going to the store and buying one of the guards that can be boiled and molded to their child’s mouth.”

So what should you do if despite your best preventive efforts your child still hurts his or her teeth or jaw?

If a tooth is broken or cracked, see a dentist within 24 hours, Mitchell says. If a tooth or teeth have been displaced or knocked out, Mitchell says, take the child immediately to the emergency room and to try to preserve the tooth.

“A tooth that has been knocked out needs to be back in the mouth within 30 minutes for the best chance of long-term survival,” Mitchell says. He offers these tips for preserving the tooth, which can even help past the ideal 30-minute window:
• Avoid touching the root because it can be damaged easily.
• If the tooth is dirty, hold it by the upper part and rinse it off with milk until most of the dirt is washed away. If you don't have milk, don’t clean it. Wiping it off may cause more damage.
• If your child is old enough not to swallow it, try to gently put the tooth back in its socket for the best chance of preservation.
• If you can’t get it back in the socket, put it in a cup of milk and head for the dentist or emergency room.
“We tell people to put the tooth in milk because the cells around the root are still alive after it is knocked out and milk can provide nutrients to the cells to help keep them alive,” Mitchell adds. “Do not put the tooth in water. It can cause the cells to burst and makes saving the tooth much less likely.”
Jaw injuries may be much less obvious than a broken or knocked-out tooth but they are no less serious, Mitchell says. If a child falls hard enough to cut their chin, or takes an especially hard hit, it could easily cause breaks in the jaw. In an injury such as this, a child should be seen by a doctor within 24 hours.
No matter the injury, Mitchell says caring properly for the mouth afterward is key to successful healing.
“Following an injury a child’s mouth will be sore and they will want to do everything they can to make it not hurt. But, continuing to brush their teeth and practice good oral hygiene is extremely important,” he says. “It is the same as keeping any other wound clean, the cleaner the mouth is kept, the better it heals.”Home
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Sports Dental Injuries Are No Laughing Matter
Released: 8/22/2011 5:30 PM EDT
Source: University of Alabama at Birmingham
Newswise — BIRMINGHAM, Ala. – The crunch of helmets as players tangle for a loose football, the swoosh of the net as an outside jumper is made and the crack of the bat as a guaranteed double sails into right center field are awesome sounds to sports fans but for dentists, they’re reminders that a player is just one misstep away from a dental injury.
“Basketball and baseball are the two biggest mouth-injuring sports,” says Stephen Mitchell, D.M.D., associate professor in the UAB Department of Pediatric Dentistry. “And the most common injuries we see are broken, displaced or knocked out teeth, and broken jaws.”
According to a report by the U.S. Surgeon General, craniofacial injuries sustained during sporting activities are a major source of nonfatal injury and disability in children and adults, accounting for up to one-third of all sports injuries. The National Youth Sports Safety Foundation estimates that more than 3 million teeth will be knocked out in youth sporting activities this year.
The increasing participation of girls and young women in competitive sports means that they, just like their male counterparts, should know the risks of dental injuries and use additional protective gear as appropriate, Mitchell says.
Mitchell says mouth guards and helmets with face protectors are the best way for kids to avoid dental injuries while playing sports.
“If the child has a full set of permanent teeth then a custom guard can be made that will provide protection but be small enough to make it easy to communicate with teammates,” Mitchell says. “But if they still have some of their baby teeth, a custom guard is a waste of money. Parents will be better off going to the store and buying one of the guards that can be boiled and molded to their child’s mouth.”
So what should you do if despite your best preventive efforts your child still hurts his or her teeth or jaw?
If a tooth is broken or cracked, see a dentist within 24 hours, Mitchell says. If a tooth or teeth have been displaced or knocked out, Mitchell says, take the child immediately to the emergency room and to try to preserve the tooth.
“A tooth that has been knocked out needs to be back in the mouth within 30 minutes for the best chance of long-term survival,” Mitchell says. He offers these tips for preserving the tooth, which can even help past the ideal 30-minute window:
• Avoid touching the root because it can be damaged easily.
• If the tooth is dirty, hold it by the upper part and rinse it off with milk until most of the dirt is washed away. If you don't have milk, don’t clean it. Wiping it off may cause more damage.
• If your child is old enough not to swallow it, try to gently put the tooth back in its socket for the best chance of preservation.
• If you can’t get it back in the socket, put it in a cup of milk and head for the dentist or emergency room.

“We tell people to put the tooth in milk because the cells around the root are still alive after it is knocked out and milk can provide nutrients to the cells to help keep them alive,” Mitchell adds. “Do not put the tooth in water. It can cause the cells to burst and makes saving the tooth much less likely.”

Jaw injuries may be much less obvious than a broken or knocked-out tooth but they are no less serious, Mitchell says. If a child falls hard enough to cut their chin, or takes an especially hard hit, it could easily cause breaks in the jaw. In an injury such as this, a child should be seen by a doctor within 24 hours.
No matter the injury, Mitchell says caring properly for the mouth afterward is key to successful healing.

“Following an injury a child’s mouth will be sore and they will want to do everything they can to make it not hurt. But, continuing to brush their teeth and practice good oral hygiene is extremely important,” he says. “It is the same as keeping any other wound clean, the cleaner the mouth is kept, the better it heals.”

Gaps in dental care coverage among retirees may lead to their delaying or stopping use of dental care

2011-08-18T13:40:00.000-07:00

Retirees may be at risk for sporadic dental care or even stopping use due to dental coverage transitions and status of insurance, reports a new study released today in the American Journal of Public Health.

Researchers examined dental care utilization transition dynamics in the context of changing dental coverage status among a population around the age of retirement. They used data from the Health and Retirement Study (HRS) to assess the characteristics of persons aged 51 years and older based on whether they had maintained or changed their dental care use status between the 2004 and 2006 waves of HRS. They were particularly concerned with discovering how changes in dental coverage and changes in retirement status affected the relative likelihood of having irregular dental care utilization patterns.

The sample consisted of 16,345 individuals interviewed in both the 2004 and 2006 HRS, representing 74,047,165 members of the community-based population who were aged 51 years and older at the time of the 2004 interview. They found that Americans aged 51 years and older who lost dental coverage between the 2004 and 2006 survey periods were more likely to stop dental care use between periods, than those without coverage in both periods. Those who gained coverage were more likely to start dental care use between periods, than those without coverage in both periods.

The study’s authors said, “Although we were only able to look at a short time horizon with the HRS data and therefore do not know the longer-term use patterns of those who lose coverage around retirement age, even short-term lapses in preventive coverage can result in more invasive and costly procedures in the future. For retirees on fixed incomes, the high cost of dental procedures could have important financial consequences, and the delay of care could lead to worse overall health status and affect more than only dental costs.”

[From: “The Influence of Changes in Dental Care Coverage on Dental Care Utilization Among Retirees and Near-Retirees in the United States, 2004—2006.” ]

Can oral care for babies prevent future cavities?

2011-08-15T13:17:00.000-07:00

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New parents have one more reason to pay attention to the oral health of their toothless babies. A recent University of Illinois study confirms the presence of bacteria associated with early childhood caries (ECC) in infant saliva.

ECC is a virulent form of caries, more commonly known as tooth decay or a cavity. Cavities are the most prevalent infectious disease in U.S. children, according to the Centers for Disease Control and Prevention.

"By the time a child reaches kindergarten, 40 percent have dental cavities," said Kelly Swanson, lead researcher and U of I professor of animal science. "In addition, populations who are of low socioeconomic status, who consume a diet high in sugar, and whose mothers have low education levels are 32 times more likely to have this disease."

Swanson's novel study focused on infants before teeth erupted, compared to most studies focused on children already in preschool or kindergarten – after many children already have dental cavities.

"We now recognize that the "window of infectivity," which was thought to occur between 19 and 33 months of age years ago, really occurs at a much younger age," he said. "Minimizing snacks and drinks with fermentable sugars and wiping the gums of babies without teeth, as suggested by the American Academy of Pediatric Dentistry, are important practices for new parents to follow to help prevent future cavities."

In addition, his team used high-throughput molecular techniques to characterize the entire community of oral microbiota, rather than focusing on identification of a few individual bacteria.

"Improved DNA technologies allow us to examine the whole population of bacteria, which gives us a more holistic perspective," Swanson said. "Like many other diseases, dental cavities are a result of many bacteria in a community, not just one pathogen."

Through 454 pyrosequencing, researchers learned that the oral bacterial community in infants without teeth was much more diverse than expected and identified hundreds of species. This demonstration that many members of the bacterial community that cause biofilm formation or are associated with ECC are already present in infant saliva justifies more research on the evolution of the infant oral bacterial community, Swanson said.

Could manipulating the bacterial community in infants before tooth eruption help prevent this disease in the future?

"The soft tissues in the mouth appear to serve as reservoirs for potential pathogens prior to tooth eruption," he said. "We want to characterize the microbial evolution that occurs in the oral cavity between birth and tooth eruption, as teeth erupt, and as dietary changes occur such as breastfeeding vs. formula feeding, liquid to solid food, and changes in nutrient profile."

Swanson said educating parents-to-be on oral hygiene and dietary habits is the most important strategy for prevention of dental cavities.

Dentists, Pharmacists Raise Awareness of Medication-Induced Dry Mouth

2011-08-11T10:58:00.000-07:00

Leading dental and pharmacy organizations are teaming up to promote oral health and raise public awareness of dry mouth, a side effect commonly caused by taking prescription and over-the-counter medications. More than 500 medications can contribute to oral dryness, including antihistamines (for allergy or asthma), antihypertensive medications (for blood pressure), decongestants, pain medications, diuretics and antidepressants. In its most severe form, dry mouth can lead to extensive tooth decay, mouth sores and oral infections, particularly among the elderly.

Nearly half of all Americans regularly take at least one prescription medication daily, including many that produce dry mouth, and more than 90 percent of adults over age 65 do the same. Because older adults frequently use one or more of these medications, they are considered at significantly higher risk of experiencing dry mouth.

The American Dental Association (ADA), Academy of General Dentistry (AGD), American Academy of Periodontology (AAP) and the American Pharmacists Association (APhA) are collaborating to expand awareness of the impact of medications on dry mouth, a condition known to health professionals as xerostomia.

With regular saliva production, your teeth are constantly bathed in a mineral-rich solution that helps keep your teeth strong and resistant to decay. While saliva is essential for maintaining oral health and quality of life, at least 25 million Americans have inadequate salivary flow or composition, and lack the cleansing and protective functions provided by this important fluid.

“Each day, a healthy adult normally produces around one-and-a-half liters of saliva, making it easier to talk, swallow, taste, digest food and perform other important functions that often go unnoticed,” notes Dr. Fares Elias, president, Academy of General Dentistry. “Those not producing adequate saliva may experience some common symptoms of dry mouth.”

Signs and symptoms

At some point, most people will experience the short-term sensation of oral dryness because of nervousness, stress or just being upset. This is normal and does not have any long-term consequences. But chronic cases of dry mouth persist for longer periods of time. Common symptoms include trouble eating, speaking and chewing, burning sensations, or a frequent need to sip water while eating.

“Dry mouth becomes a problem when symptoms occur all or most of the time and can cause serious problems for your oral health,” explains Dr. Matthew Messina, ADA consumer advisor. “Drying irritates the soft tissues in the mouth, which can make them inflamed and more susceptible to infection.”

According to Dr. Messina, who practices general dentistry in the Cleveland area, without the cleansing and shielding effects of adequate saliva flow, tooth decay and periodontal (gum) disease become much more common. “Constant dryness and the lack of protection provided by saliva may contribute to bad breath. Dry mouth can make full dentures become less comfortable to wear because there is no thin film of saliva to help them adhere properly to oral tissues,” he adds. “Insufficient saliva can also result in painful denture sores, dry and cracked lips, and increased risks of oral infection.”

Common causes

Once considered an inevitable part of aging, dry mouth is now commonly associated with certain medications and autoimmune conditions such as Sjogren’s syndrome. Both of these can reduce salivary production or alter its composition, but experts agree that the primary cause of dry mouth is the use of medications.
Radiation treatment for head and neck cancer is also an important cause of severe dry mouth. The treatment can produce significant damage to the salivary glands, resulting in diminished saliva production and extreme dry mouth in many cases.
“Saliva plays an important role in maintaining oral health,” says Dr. Donald Clem, president of the American Academy of Periodontology. “With decreased saliva flow, we can see an increase in plaque accumulation and the incidence and severity of periodontal diseases.”

How to relieve dry mouth

Individuals with dry mouth should have regular dental checkups for evaluation and treatment. “Be sure to carry an up-to-date medication list at all times, and tell your dentist what medications you are taking and other information about your health at each appointment," advises Mr. Thomas Menighan, executive vice president and Chief Executive Officer, American Pharmacists Association. "In some cases, a different medication can be provided or your dosage modified to alleviate dry mouth symptoms. Talk to your pharmacist if you have any questions regarding your medication.”

Increasing fluid intake, chewing sugarless gum, taking frequent sips of water or sucking on ice chips can also help relieve dry mouth symptoms. Avoiding tobacco and intake of caffeine, alcohol and carbonated beverages may also help those with the condition. Your dentist may recommend using saliva substitutes or oral moisturizers to keep your mouth wet. Your local pharmacist is also a helpful source for information on products to help you manage dry mouth.

Ultraviolet-B and Vitamin D Reduce Risk of Dental Caries

2011-08-09T11:51:00.000-07:00

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Large geographical variations in dental health and tooth loss among U.S. adolescents and young adults have been reported since the mid-1800s. The first study finding a north-south gradient in dental caries was a report of men rejected from the draft for the Civil War for lost teeth, from 8 per 1000 men in Kentucky to 25 in New England.

Studies by Clarence Mills and Bion East in the 1930s first linked the geographical variation in prevalence to sunlight exposure. They used data for adolescent males aged between 12 and 14 years from a cross-sectional survey in 1933–1934. East later found that dental caries were inversely related to mean hours of sunlight/year, with those living in the sunny west (3000 hours of sunlight/year) having half as many carious lesions as those in the much less sunny northeast (<2200 hours of sunlight/year).
Several studies conducted in Oregon in the 1950s noted that dental caries prevalence was lower in the sunnier regions of the state than in the cloudy regions, a finding that persisted after considering other factors that affect dental caries rates. The mechanism was attributed to vitamin D through its effects on calcium metabolism.

There were also several studies reported on vitamin D and dental caries in the 1920s and 1930s. May Mellanby and coworkers in Sheffield, England, did studies on the role of vitamin D on teeth in the 1920s. The first experiments were with dogs, where it was found that vitamin D stimulated the calcification of teeth. Subsequently, they studied the effect of vitamin D on dental caries in children, finding a beneficial effect. Additional studies were conducted on children in New York regarding dental caries with respect to season, artificial ultraviolet-B (UVB) irradiance, and oral intake of vitamin D with the finding that it took 800 IU/d to prevent caries effectively.
The mechanism whereby UVB reduces risk of dental caries is through production of vitamin D, followed by induction of cathelicidin, which attacks oral bacteria linked to dental caries. Cathelicidin is well known to fight bacterial infections, with findings reported for several bacterial infections including pneumonia, sepsis, and tuberculosis. Several recent papers reported that cathelicidin reduces the risk of caries, but did not link cathelicidin to vitamin D.

Serum 25-hydroxyvitamin D concentrations around 30-40 ng/ml (75-100 nmol/L) should significantly reduce the formation of dental caries. (The average white American has a level near 25 ng/ml, while the average black American has a level near 16 ng/ml.) To obtain these levels, oral intake of 1000-4000 IU/d of vitamin D3 or 15-20 minutes in the sun near solar noon in summer with 20-30% body surface area exposed is suggested.
Good dental health also involves a healthy diet low in sugar, regular tooth brushing, and regular dental checkups.

Use of vitamin D appears to be a better option for reducing dental caries than fluoridation of community water supplies as there are many additional health benefits of vitamin D and a number of adverse effects of water fluoridation such as fluorosis (mottling) of teeth and bones.

The paper is published online with open access:
Grant WB. A review of the role of solar ultraviolet-B irradiance and vitamin D in reducing risk of dental caries. Dermato-Endocrinology, 3:3, 1-6; July/August/September 2011; epub

Gum Disease Can Increase the Time It Takes to Become Pregnant

2011-08-03T06:21:00.000-07:00

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Professor Roger Hart told the annual meeting of the European Society of Human Reproduction and Embryology that the negative effect of gum disease on conception was of the same order of magnitude as the effect of obesity.

Periodontal (gum) disease is a chronic, infectious and inflammatory disease of the gums and supporting tissues. It is caused by the normal bacteria that exist in everyone's mouths, which, if unchecked, can create inflammation around the tooth; the gum starts to pull away from the tooth, creating spaces (periodontal pockets) that become infected. The inflammation sets off a cascade of tissue-destructive events that can pass into the circulation. As a result, periodontal disease has been associated with heart disease, type 2 diabetes, respiratory and kidney disease, and problems in pregnancy such as miscarriage and premature birth. Around 10% of the population is believed to have severe periodontal disease. Regular brushing and flossing of teeth is the best way of preventing it.

Prof Hart, who is Professor of Reproductive Medicine at the University of Western Australia (Perth, Australia) and Medical Director of Fertility Specialists of Western Australia, said: "Until now, there have been no published studies that investigate whether gum disease can affect a woman's chance of conceiving, so this is the first report to suggest that gum disease might be one of several factors that could be modified to improve the chances of a pregnancy."

The researchers followed a group 3737 pregnant women, who were taking part in a Western Australian study called the SMILE study, and they analysed information on pregnancy planning and pregnancy outcomes for 3416 of them.

They found that women with gum disease took an average of just over seven months to become pregnant -- two months longer than the average of five months that it took women without gum disease to conceive.

In addition, non-Caucasian women with gum disease were more likely to take over a year to become pregnant compared to those without gum disease: their increased risk of later conception was 13.9% compared to 6.2% for women without gum disease. Caucasian women with gum disease also tended to take longer to conceive than those who were disease-free but the difference was not statistically significant (8.6% of Caucasian women with gum disease took over one year to conceive and 6.2% of women with gum disease).

Information on time to conception was available for 1,956 women, and of, these, 146 women took longer than 12 months to conceive -- an indicator of impaired fertility. They were more likely to be older, non-Caucasian, to smoke and to have a body mass index over 25 kg/m2. Out of the 3416 women, 1014 (26%) had periodontal disease.

Prof Hart said: "Our data suggest that the presence of periodontal disease is a modifiable risk factor, which can increase a woman's time to conception, particularly for non-Caucasians. It exerts a negative influence on fertility that is of the same order of magnitude as obesity. This study also confirms other, known negative influences upon time to conception for a woman; these include being over 35 years of age, being overweight or obese, and being a smoker. There was no correlation between the time it took to become pregnant and the socio-economic status of the woman.

"All women about to plan for a family should be encouraged to see their general practitioner to ensure that they are as healthy as possible before trying to conceive and so that they can be given appropriate lifestyle advice with respect to weight loss, diet and assistance with stopping smoking and drinking, plus the commencement of folic acid supplements. Additionally, it now appears that all women should also be encouraged to see their dentist to have any gum disease treated before trying to conceive. It is easily treated, usually involving no more than four dental visits.

"The SMILE study was one of the three largest randomised controlled trials performed in Western Australia. It showed conclusively that although treatment of periodontal disease does not prevent pre-term birth in any ethnic group, the treatment itself does not have any harmful effect on the mother or fetus during pregnancy."

Prof Hart said that the reason why pregnancies in non-Caucasian women were more affected by gum disease could be because these women appeared to have a higher level of inflammatory response to the condition.

Study shows bone fluoride levels not associated with osteosarcoma

2011-07-28T12:26:00.000-07:00

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The International and American Associations for Dental Research have released in its Journal of Dental Research a study that investigated bone fluoride levels in individuals with osteosarcoma, which is a rare, primary malignant bone tumor that is more prevalent in males. Since there has been controversy as to whether there is an association between fluoride and risk for osteosarcoma, the purpose of this study, titled "An Assessment of Bone Fluoride and Osteosarcoma," was to determine if bone fluoride levels were higher in individuals with osteosarcoma.

No significant association between bone fluoride levels and osteosarcoma risk was detected in this case-control study, based on controls with other tumor diagnoses.

In the case-control study, by lead researcher Chester Douglass of Harvard University, patients were identified by physicians in the orthopedic departments from nine hospitals across the U.S. between 1993 and 2000. In this report, the study sample included incident cases of primary osteosarcoma and a control group of patients with newly-diagnosed malignant bone tumors. Specimens of tumor-adjacent bone and iliac crest bone were analyzed for fluoride content. The study was approved by the Institutional Review Boards of the respective hospitals, Harvard Medical School and the Medical College of Georgia.

Logistic regression of the incident cases of osteosarcoma (N=137) and tumor controls (N=51), adjusting for age and sex and potential confounders of osteosarcoma, was used to estimate odds ratios (OR) and 95% confidence intervals (CI). There was no significant difference in bone fluoride levels between cases and controls. The OR adjusted for age, gender, a history of broken bones was 1.33 (95% CI: 0.56-3.15).

"The controversy over whether there is an association between fluoride and risk for osteosarcoma has existed since an inconclusive animal study 20 years ago," said IADR Vice-president Helen Whelton. "Numerous human descriptive and case-control studies have attempted to address the controversy, but this study of using actual bone fluoride concentrations as a direct indicator of fluoride exposure represents our best science to date and shows no association between fluoride in bone and osteosarcoma risk."

Use of Twitter for public health surveillance of dental pain

2011-07-18T12:55:00.001-07:00

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The microblogging service Twitter is a new means for the public to communicate health concerns and could afford health care professionals new ways to communicate with patients. With the growing ubiquity of user-generated online content via social networking Web sites such as Twitter, it is clear we are experiencing a revolution in communication and information sharing. In a study titled "Public Health Surveillance of Dental Pain via Twitter," published in the Journal of Dental Research—the official publication of the International and American Associations for Dental Research (IADR/AADR), researchers demonstrated that Twitter users are already extensively sharing their experiences of toothache and seeking advice from other users. Researchers Natalie Heaivilin, Barbara Gerbert, Jens Page and Jennifer Gibbs all from the University of California San Francisco (UCSF), Preventive and Restorative Dental Sciences, authored this study.

The researchers investigated the content of Twitter posts meeting search criteria relating to dental pain. A set of 1,000 tweets was randomly selected from 4,859 tweets over seven nonconsecutive days. The content was coded using pre-established, non-mutually exclusive categories, including the experience of dental pain, actions taken or contemplated in response to a toothache, impact on daily life and advice sought from the Twitter community.

After excluding ambiguous tweets, spam and repeat users, 772 tweets were analyzed and frequencies calculated. Of those tweets, 83% were primarily categorized as a general statement of dental pain, 22% as an action taken or contemplated, and 15% as describing an impact on daily activities. Among the actions taken or contemplated, 44% reported seeing a dentist, 43% took an analgesic or antibiotic medication and 14% actively sought advice from the Twitter community.

This research was funded by grants from the National Institutes of Health, the National Center for Research Resources, the National Institute of Dental and Craniofacial Research, the Office of the Director, and the UCSF Clinical & Translational Science Institute.

"This paper highlights the potential of using social media to collect public health data for research purposes," said JDR Editor-in-Chief William Giannobile. "Utilizing Twitter is an interesting, early stage approach with potential impact in the assessment of large sets of population information."

A perspective article titled "Using Social Media for Research and Public Health Surveillance" was written by Paul Eke of the Centers for Disease Control. In it, he states that the extensive reach of Twitter is currently being used successfully in public health to distribute health information to the segments of the public who access Twitter, but there are major limitations and challenges to be overcome before Twitter and its data products can be used for routine public health surveillance.

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Visit http://jdr.sagepub.com/content/early/recent for links to the complete articles or contact Ingrid L. Thomas at ithomas@iadr.org to request the PDFs.

About the Journal of Dental Research

The IADR/AADR Journal of Dental Research is a multidisciplinary journal dedicated to the dissemination of new knowledge in all sciences relevant to dentistry and the oral cavity and associated structures in health and disease. At .02261, the JDR holds the highest Eigenfactor Score of all dental journals publishing original research and continues to be ranked number one in Article Influence Score, reflecting the influential nature of the Journal's content.

About the International Association for Dental Research

The International Association for Dental Research (IADR) is a nonprofit organization with nearly 11,000 individual members worldwide, dedicated to: (1) advancing research and increasing knowledge to improve oral health, (2) supporting the oral health research community, and (3) facilitating the communication and application of research findings for the improvement of oral health worldwide. To learn more, visit www.iadr.org. The American Association for Dental Research (AADR) is the largest Division of IADR, with nearly 4,000 members in the United States. To learn more, visit www.aadronline.org.

American Academy of Pediatric Dentistry Responds to Institute of Medicine Report

2011-07-18T09:11:00.000-07:00

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Report: "Improving Access to Oral Heath Care for Vulnerable and Underserved Populations"

The American Academy of Pediatric Dentistry (AAPD), the recognized leader in children’s oral health, welcomes the attention and the awareness of the Institute of Medicine (IOM) to improving access to oral health care, especially for the most vulnerable children. The mission of the AAPD is to promote optimal oral health for all children, and our members are the frontline providers of oral health care for the nation’s infants, children, adolescents and patients with special health care needs. By the nature of their training, pediatric dentists are able to provide comprehensive oral health care to children. Pediatric dentists treat a higher percentage of Medicaid and Children’s Health Insurance Program (CHIP) patients than any other type of dentist, and are especially successful with this population because of their advanced clinical training and expertise in behavior guidance. While all pediatric and many general dentists treat children, pediatric dentists train 100 percent of all the dentists who treat children.

The AAPD agrees with many recommendations cited within the IOM report, including the suggestion for raising dental reimbursement rates for Medicaid and CHIP. According to research published in the July 12, 2011 edition of the Journal of the American Medical Association (JAMA), “Higher Medicaid payment levels to dentists were associated with higher rates of receipt of dental care among children and adolescents.”(1) An estimated 70% percent of AAPD members participate in Medicaid and CHIP, but this percentage would be even higher, and would dramatically increase among general dentists, if these programs were funded closer to market-based rates. Indeed, this is far more important to access than the ethnic or gender composition of the dental workforce, since dental office overhead costs are similar for all dentists.

According to AAPD President Dr. Rhea M. Haugseth, “The AAPD is concerned that the IOM report did not emphasize enough the importance of and proven effectiveness in disease prevention by establishing a Dental Home by age one—usually in a private dental practice setting. Such early intervention keeps children from developing oral disease—commonly called cavities—and starts them out on a lifetime of good oral health. It is imperative to have the child and their parent or caregiver in the office at an early age in order to encourage good oral hygiene and diet, and emphasize preventive dentistry. We believe that the IOM report missed a golden opportunity to stress the importance of seeing a dentist by age one. Unfortunately, this could be the result of the IOM having no private practicing pediatric dentists serve on the committee that wrote the report.”

“The IOM report is also much too muted on the importance of oral health literacy. Many organizations, including the AAPD, are working on this front, but these messaging efforts require widespread education in schools and other areas outside of the dental or medical office. Many preventive practices to reduce oral disease can be incorporated at home, such as regular brushing, flossing, and a healthy diet,” concluded Haugseth.

The IOM report suggests spending even more federal funds on oral health services in Federally Qualified Health Centers (FQHCs). In 2000, Congress provided greater state flexibility for creating new and exclusive reimbursement mechanisms for FQHCs under Medicaid. Additionally, in 2002, Congress created a new “facility” shortage designation for FQHCs. This allowed FQHCs to be designated as Health Professional Shortage Area (HPSA) facilities, thereby permitting participation in the National Health Services Corps program. Despite implementation of this additional support for FQHCs, access to oral health care continues to be a challenge for the most vulnerable children. Although FQHCs are an important part of the safety net, they do not have the capacity or efficiency of private dental offices. Indeed, the CHIP reauthorization law of 2009 gives FQHCs the authority to contract out to private dental providers. The AAPD recommends that FQHCs use the option to contract with private practice pediatric dentists, and this approach be vigorously promoted by the Health Resources and Services Administration (HRSA).

The AAPD strongly supports Expanded Function Dental Auxiliaries (EFDAs) to improve dental practice efficiency and expansion of services to more patients. However, other models are promoted in the IOM report without evidence they would have an impact on improving access to care. See the AAPD’s Policy on workforce issues and delivery of oral health care services in a dental home:

http://www.aapd.org/media/Policies_Guidelines/P_Workforce.pdf

Every child deserves a dentist, and all children deserve equal and optimal oral health care at the highest standard. While the AAPD advocates for appropriate preventive counseling and intervention by physicians and other non-dentist providers, such efforts need to be in tandem with the establishment of a Dental Home.

The American Academy of Pediatric Dentistry

Founded in 1947, the AAPD is a not-for-profit membership organization representing the specialty of pediatric dentistry. AAPD’s 8,000 members are predominately pediatric dentists and primary care providers who deliver comprehensive specialty treatments for infants, children, adolescents and individuals with special health care needs. As advocates for children’s oral health, the AAPD aims to promote the use of evidence-based policies and guidelines, foster research concerning pediatric oral health, and educate health care providers and the public to improve children’s oral health.

(1) Decker S, Medicaid payment levels to dentists and access to dental care among children and adolescents, JAMA 2011; 306:187-193.

Millions of Americans Lack Access to Essential Oral Health Care

2011-07-18T09:09:00.000-07:00

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Millions of Americans are not receiving needed dental care services because of "persistent and systemic" barriers that limit their access to oral health care, says a new report by the Institute of Medicine and National Research Council. To remove these barriers -- which disproportionately affect children, seniors, minorities, and other vulnerable populations -- the report recommends changing funding and reimbursement for dental care; expanding the oral health work force by training doctors, nurses, and other nondental professionals to recognize risk for oral diseases; and revamping regulatory, educational, and administrative practices.

"The consequences of insufficient access to oral health care and resultant poor oral health -- at both the individual and population levels -- are far-reaching," said Frederick Rivara, Seattle Children's Guild Endowed Chair in Pediatrics at the University of Washington School of Medicine, Seattle, and chair of the committee that wrote the report. "As the nation struggles to address the larger systemic issues of access to health care, we need to ensure that oral health is recognized as a basic component of overall health."

The report says that economic, structural, geographic, and cultural factors contribute to this problem. For example, approximately 33.3 million people live in areas with shortages of dental health professionals. In 2008, 4.6 million children did not obtain needed dental care because their families could not afford it. And in 2006, only 38 percent of retirees had dental coverage, which is not covered by Medicare.

Lack of regular oral health care has serious consequences, the report says, including increased risk of respiratory disease, cardiovascular disease, and diabetes, as well as inappropriate use of hospital emergency departments for preventable dental diseases. The report offers a vision of oral health care in which prevention of oral diseases and promotion of oral health are a priority and a facet of overall health.

Although all states must provide comprehensive dental benefits for children enrolled in Medicaid or the Children’s Health Insurance Program (CHIP), they are not required to provide such benefits for adults. Because publicly funded programs are the primary source of health coverage for underserved populations, including dental benefits for all Medicaid beneficiaries is a critical and necessary goal, the report says. Toward that end, the committee recommended that the Centers for Medicare and Medicaid Services fund and evaluate state-based demonstration projects that cover essential oral health benefits for adult Medicaid beneficiaries. In addition, Medicaid and CHIP reimbursement rates for providers should be increased and administrative practices need to be streamlined to increase use by both dental providers and patients.

To maximize access to oral health care, state legislatures should amend existing laws so that hygienists, assistants, and other dental professionals can practice to the full extent of their training and can work in a variety of settings under appropriate evidence-based levels of supervision. In spite of national accreditation standards for education and training of oral health professionals, regulations defining supervision and scope-of-practice parameters vary widely from state to state and even by procedure. Legislation should also allow dental professionals to collaborate and supervise remotely via conferencing technology.

The uneven distribution of the dental work force, both in geographic dispersion as well as in specialization, is a long-recognized challenge, the report notes. In addition, graduating dental students report that they feel unprepared to care for older patients and those with special needs.

The report says that efforts should be made to increase recruitment and support for dental students from minority, lower-income, and rural populations, as well as to boost the number of dental faculty with expertise caring for underserved and vulnerable populations. In addition, the Health Resources and Services Administration should dedicate Title VII funding to aid and expand opportunities for dental residencies in community-based settings. These residencies should take place in geographically underserved areas and include clinical experiences with young children, individuals with special health care needs, and older adults.

Rapid prototyping comes to dentistry

2011-07-14T14:20:00.001-07:00

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Printing teeth

What if, instead of waiting days or weeks for a cast to be produced and prosthetic dental implants, false teeth and replacement crowns to be made, your dentist could quickly scan your jaw and "print" your new teeth using a rapid prototyping machine known as a 3D printer?

Researchers in Iran explain how medical imaging coupled with computer-aided design could be used to create a perfect-fit blueprint for prosthetic dentistry, whether to replace diseased or broken teeth and jaw bone. The blueprint can then be fed into a so-called 3D printer to build up an exact replica using a biocompatible composite material. Such technology has been used in medical prosthetics before, but this is an early step into prosthetic dentistry using rapid prototyping.

Writing in the International Journal of Rapid Manufacturing, mechanical engineer Hossein Kheirollahi of the Imam Hossein University and colleague Farid Abbaszadeh of the Islamic Azad University, in Tehran, Iran, explain how current technology used to convert an MRI or CT scan into a prosthetic component requires milling technology. This carves out the appropriate solid shape from a block of polymer but has several disadvantages, uppermost being that it is very difficult to carve out a complex shape, such as a tooth. By contrast, rapid prototyping uses a 3D image held in a computer to control a laser that then "cures" powdered or liquid polymer. Almost any solid, porous, or complicated shape can be produced by this 3D-printing technology.

The Iranian team has now demonstrated how rapid prototyping can be used to fabricate dental objects such as implants and crowns quickly and easily even where features such as overhangs, sharp corners and undercuts are required. The team points out that the most appropriate medical imaging technology, CBCT (cone-beam computed tomography), which is lower cost and exposes the patient to a lower dose of ionizing radiation is best suited to the generation of the computer design for creating such dental objects ready for printing.

Dentists can identify people with undiagnosed diabetes

2011-07-14T14:11:00.000-07:00

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In a study, Identification of unrecognized diabetes and pre-diabetes in a dental setting, published in the July 2011 issue of the Journal of Dental Research, researchers at Columbia University College of Dental Medicine found that dental visits represented a chance to intervene in the diabetes epidemic by identifying individuals with diabetes or pre-diabetes who are unaware of their condition. The study sought to develop and evaluate an identification protocol for high blood sugar levels in dental patients and was supported by a research grant from Colgate-Palmolive. The authors report no potential financial or other conflicts.

"Periodontal disease is an early complication of diabetes, and about 70 percent of U.S. adults see a dentist at least once a year," says Dr. Ira Lamster, dean of the College of Dental Medicine, and senior author on the paper. "Prior research focused on identification strategies relevant to medical settings. Oral healthcare settings have not been evaluated before, nor have the contributions of oral findings ever been tested prospectively."

For this study, researchers recruited approximately 600 individuals visiting a dental clinic in Northern Manhattan who were 40-years-old or older (if non-Hispanic white) and 30-years-old or older (if Hispanic or non-white), and had never been told they have diabetes or pre-diabetes.

Approximately 530 patients with at least one additional self-reported diabetes risk factor (family history of diabetes, high cholesterol, hypertension, or overweight/obesity) received a periodontal examination and a fingerstick, point-of-care hemoglobin A1c test. In order for the investigators to assess and compare the performance of several potential identification protocols, patients returned for a fasting plasma glucose test, which indicates whether an individual has diabetes or pre-diabetes.

Researchers found that, in this at-risk dental population, a simple algorithm composed of only two dental parameters (number of missing teeth and percentage of deep periodontal pockets) was effective in identifying patients with unrecognized pre-diabetes or diabetes. The addition of the point-of-care A1c test was of significant value, further improving the performance of this algorithm.

"Early recognition of diabetes has been the focus of efforts from medical and public health colleagues for years, as early treatment of affected individuals can limit the development of many serious complications," says Dr. Evanthia Lalla, an associate professor at the College of Dental Medicine, and the lead author on the paper. "Relatively simple lifestyle changes in pre-diabetic individuals can prevent progression to frank diabetes, so identifying this group of individuals is also important," she adds. "Our findings provide a simple approach that can be easily used in all dental-care settings."

Higher Medicaid payments to dentists associated with increased rate of dental care among children

2011-07-12T14:14:00.000-07:00

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Children and adolescents from states that had higher Medicaid payment levels to dentists between 2000 and 2008 were more likely to receive dental care, although children covered by Medicaid received dental care less often than children with private insurance, according to a study in the July 13 issue of JAMA.

According to background information in the article, more than one-third of children are covered by public health insurance, primarily Medicaid and the Children's Health Insurance Program (CHIP). Coverage of dental care for children and adolescents covered by Medicaid and CHIP is required, although states have wide latitude in setting payment rates for providers including dentists, with these rates varying greatly by state. Medicaid recipients may not be able to access dental care if dentists decline to participate in Medicaid because of low payment levels or other reasons. Little is known about the effect of state dental fees on participation of dentists in the Medicaid program.

Sandra L. Decker, Ph.D., of the Centers for Disease Control and Prevention, Hyattsville, Md., conducted a study to examine the association of state Medicaid payment rates for dental care with the receipt of dental care among children covered by Medicaid. The study included data on Medicaid dental fees in 2000 and 2008 for 42 states plus the District of Columbia, and these data were merged with data from 33,657 children and adolescents (ages 2-17 years) in the National Health Interview Survey (NHIS) for the years 2000-2001 and 2008-2009.

Of the 42 states plus the District of Columbia considered in the analyses, the 2008 Medicaid dental fees were lower than the (inflation-adjusted) 2000 fees in 23 states. Payment levels to dentists in 2008 were higher than in 2000 in 19 states plus the District of Columbia. In five states (Connecticut, Indiana, Montana, New York, and Texas) plus the District of Columbia, payments increased by at least 50 percent between 2000 and 2008.

The researchers found that the probability that a child or adolescent had seen a dentist in the past 6 months varied by insurance source. In 2008-2009, children and adolescents covered by Medicaid were less likely (55 percent) than children with private insurance (68 percent) to have seen a dentist in the past 6 months, but were more likely to have seen a dentist than children or adolescents without insurance (27 percent). According to the author's, "children were about 6 percentage points more likely to have seen a dentist in 2008-2009 than in 2000-2001. … Those covered by Medicaid or CHIP were about 13 percentage points and uninsured children were about 40 percentage points less likely than children with private insurance to have seen a dentist."

"Changes in state Medicaid dental payment fees between 2000 and 2008 were positively associated with use of dental care among children and adolescents covered by Medicaid. For example, a $10 increase in the Medicaid prophylaxis payment level (from $20 to $30) was associated with a 3.92 percentage point increase in the chance that a child or adolescent covered by Medicaid had seen a dentist," the authors write.

"As future expansions in Medicaid eligibility and insurance coverage more generally are contemplated and possibly implemented, more attention to the effects of provider payment policies on access to care, quality of care, and health outcomes may be warranted."

Dentists are a major source of opioid drugs

2011-07-06T10:36:00.000-07:00

With a cover article in the July edition of the Journal of the American Dental Association (JADA), dentists focus that spotlight on themselves both as major sources of opioid drugs and as professionals with largely untapped power to recognize and reduce abuse.

“Many dentists really haven’t even perceived there to be a problem,” said George Kenna, an assistant professor of psychiatry and human behavior at the Warren Alpert Medical School of Brown University, an addiction psychologist at the Center for Alcohol and Addiction Studies, and the corresponding author of the article. “Dentists write the third-most prescriptions for immediate release opioids in the United States, but they often don’t know the appropriate number of doses to prescribe, how many doses a patient uses, or most importantly what patients do with the leftover tablets they have. Just ask someone the last time they threw away opioid prescriptions in particular. These leftover tablets — accumulated from various sources, not just dentists — that are often left in closets across the country are the primary source for prescription drug use initiation for children and adolescents.”

Last year Kenna helped lead a meeting of dentists and fellow addiction experts and pharmacists at the Tufts Health Care Institute Program on Opioid Risk Management, where he serves as a scientific adviser. The group produced this month’s cover article for JADA, which offered several recommendations for dentists, including:

• Discuss with patients whether they need an opioid for their pain and how likely they are to use what you prescribe.
• Consider writing small quantities and limit refills.
• Do not prescribe drugs to patients you do not know; be suspicious of those who claim their drugs were lost or stolen.
• Use prescription monitoring programs (i.e., state databases), if available, to verify drug-use history.
• Advise patients either to destroy or lockup any excess medication.
• Keep prescription pads locked up.

In the article, the nine authors also call for more research to make the most effective use of opioid and non-opioid painkillers, for instance to determine how much painkiller and which kind patients really need. Without enough evidence to guide them, dentists have often felt obliged to prescribe opioids too often and in too great a quantity, Kenna said.

“Some new data show that ibuprofen as an anti-inflammatory does as well as many painkillers to kill pain for many dental procedures,” Kenna said.

One in two dentists surveyed

Despite the large role dentists have as painkiller prescribers, there has been very little research on dentists’ prescribing practices and experiences, particularly in the context of opioid addiction. To inform their discussion, the group commissioned a survey in 2010, led by Michael O’Neil, a pharmacy professor at the University of Charleston in West Virginia. In all, 52 percent of the state’s dentists responded.

The survey revealed that nine in 10 of the dentists surveyed prescribed opioids in the prior year. Two-thirds prescribed between 10 and 20 doses of the painkillers, but 41 percent acknowledged that patients would probably have some left over.

The survey also found some evidence that dentists can sometimes be shy about raising substance abuse as an issue with patients, even as they realize they are sometimes being used to get drugs. One in three of the dentists said they did not routinely ask new patients about substance abuse, but 58 percent of the dentists said they believed they have been the victim of prescription fraud or theft.

While dentists should guard against over-prescribing addictive drugs, especially to patients they don’t know well, Kenna said, they retain an obligation to help all patients, even ones who are addicted, to manage pain.

“There are ways that dentists can work with patients,” he said. “People who have a substance abuse problem do have legitimate pain. They do have a right to have some pain control and may even need more. But you hope there is a family member who will take control and make sure they only take the recommended dose.”

For all the things dentists could do, especially with more research to clarify the best prescribing practices, Kenna acknowledged that dentists are not currently compensated for the time required to investigate the drug use preferences and habits of their patients.

Kenna said he hopes to learn more about how the profession approaches opioids and addiction with a national survey of dentists.

“It’s a growing problem in the United States,” he said. “It’s a serious problem.”

Gum disease can increase the time it takes to become pregnant

2011-07-06T09:20:00.000-07:00

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For the first time, fertility experts have shown that, from the time that a woman starts trying to conceive, poor oral health can have a significant effect on the time to pregnancy.

Professor Roger Hart told the annual meeting of the European Society of Human Reproduction and Embryology that the negative effect of gum disease on conception was of the same order of magnitude as the effect of obesity.

Periodontal (gum) disease is a chronic, infectious and inflammatory disease of the gums and supporting tissues. It is caused by the normal bacteria that exist in everyone's mouths, which, if unchecked, can create inflammation around the tooth; the gum starts to pull away from the tooth, creating spaces (periodontal pockets) that become infected. The inflammation sets off a cascade of tissue-destructive events that can pass into the circulation. As a result, periodontal disease has been associated with heart disease, type 2 diabetes, respiratory and kidney disease, and problems in pregnancy such as miscarriage and premature birth. Around 10% of the population is believed to have severe periodontal disease. Regular brushing and flossing of teeth is the best way of preventing it.

Prof Hart, who is Professor of Reproductive Medicine at the University of Western Australia (Perth, Australia) and Medical Director of Fertility Specialists of Western Australia, said: "Until now, there have been no published studies that investigate whether gum disease can affect a woman's chance of conceiving, so this is the first report to suggest that gum disease might be one of several factors that could be modified to improve the chances of a pregnancy."

The researchers followed a group 3737 pregnant women, who were taking part in a Western Australian study called the SMILE study, and they analysed information on pregnancy planning and pregnancy outcomes for 3416 of them.

They found that women with gum disease took an average of just over seven months to become pregnant – two months longer than the average of five months that it took women without gum disease to conceive.

In addition, non-Caucasian women with gum disease were more likely to take over a year to become pregnant compared to those without gum disease: their increased risk of later conception was 13.9% compared to 6.2% for women without gum disease. Caucasian women with gum disease also tended to take longer to conceive than those who were disease-free but the difference was not statistically significant (8.6% of Caucasian women with gum disease took over one year to conceive and 6.2% of women with gum disease).

Information on time to conception was available for 1,956 women, and of, these, 146 women took longer than 12 months to conceive – an indicator of impaired fertility. They were more likely to be older, non-Caucasian, to smoke and to have a body mass index over 25 kg/m2. Out of the 3416 women, 1014 (26%) had periodontal disease.

Prof Hart said: "Our data suggest that the presence of periodontal disease is a modifiable risk factor, which can increase a woman's time to conception, particularly for non-Caucasians. It exerts a negative influence on fertility that is of the same order of magnitude as obesity. This study also confirms other, known negative influences upon time to conception for a woman; these include being over 35 years of age, being overweight or obese, and being a smoker. There was no correlation between the time it took to become pregnant and the socio-economic status of the woman.

"All women about to plan for a family should be encouraged to see their general practitioner to ensure that they are as healthy as possible before trying to conceive and so that they can be given appropriate lifestyle advice with respect to weight loss, diet and assistance with stopping smoking and drinking, plus the commencement of folic acid supplements. Additionally, it now appears that all women should also be encouraged to see their dentist to have any gum disease treated before trying to conceive. It is easily treated, usually involving no more than four dental visits.

"The SMILE study was one of the three largest randomised controlled trials performed in Western Australia. It showed conclusively that although treatment of periodontal disease does not prevent pre-term birth in any ethnic group, the treatment itself does not have any harmful effect on the mother or foetus during pregnancy*."

Prof Hart said that the reason why pregnancies in non-Caucasian women were more affected by gum disease could be because these women appeared to have a higher level of inflammatory response to the condition.

Cause of negative outcomes for implants identified

2011-06-30T13:45:00.000-07:00

The health of the surrounding tissue affects the success of a dental implant. Identifying and reducing risk factors is therefore a key step in the implant process. Now a combination of genes has been identified as a possible indicator of greater tissue destruction leading to negative outcomes for implants.

The authors of an article
in the current issue of the Journal of Oral Implantology report on a study of individuals with the combination of interleukin (IL)-1 allele 2 at IL-1A−889 and IL-1B+3954. These people are “genotype positive” and are susceptible to increased periodontal tissue destruction.

Peri-implantitis, or the process of tissue inflammation and destruction around failing implants, is very similar to periodontal disease. The researchers sought to find any association of these genotypes with the severity of peri-implantitis progression and the effect of this combination on treatment outcomes.

This study compared two groups of patients, all of whom had implants. The first group consisted of 25 patients with peri-implantitis, while the second group of 25 patients had healthy tissue. Seventeen patients from the first group and five from the second group were genotype positive.

Patients in the first group, those with peri-implantitis, took part in a treatment and maintenance program. The genotype-positive patients in this group experienced greater periodontal tissue destruction and, increased discharge from tissues. The genotype-negative patients responded better to treatment. Statistically significant differences were noted between the groups.

The combination of these two alleles in patients with inflamed periodontal tissues denotes a risk factor that can lead to further tissue destruction. Patients with the specific genotype can have exaggerated local inflammation. Gene polymorphism may affect the outcomes of treatment for peri-implantitis in genotype-positive people and affect the long-term success of implants.

Full text of the article, “
The Effect of Interleukin-1 Allele 2 Genotype (IL-1a−889 and IL-1b+3954) on the Individual’s Susceptibility to Peri-Implantitis: Case-Control Study,” Journal of Oral Implantology, Vol. 37, No. 3, 2011, is available at http://allenpress.com/publications/journals/orim

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About Journal of Oral Implantology
The Journal of Oral Implantology is the official publication of the American Academy of Implant Dentistry and of the American Academy of Implant Prosthodontics. It is dedicated to providing valuable information to general dentists, oral surgeons, prosthodontists, periodontists, scientists, clinicians, laboratory owners and technicians, manufacturers, and educators. The JOI distinguishes itself as the first and oldest journal in the world devoted exclusively to implant dentistry. For more information about the journal or society, please visit here.

How Cavity-Causing Microbes Invade Heart

2011-06-27T11:05:00.000-07:00

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Scientists have discovered the tool that bacteria normally found in our mouths use to invade heart tissue, causing a dangerous and sometimes lethal infection of the heart known as endocarditis. The work raises the possibility of creating a screening tool – perhaps a swab of the cheek, or a spit test – to gauge a dental patient’s vulnerability to the condition.

The identification of the protein that allows Streptococcus mutans to gain a foothold in heart tissue is reported in the June issue of Infection and Immunity by microbiologists at the University of Rochester Medical Center.

S. mutans is a bacterium best known for causing cavities. The bacteria reside in dental plaque – an architecturally sophisticated goo composed of an elaborate molecular matrix created by S. mutans that allows the bacteria to inhabit and thrive in our oral cavity. There, they churn out acid that erodes our teeth.

S. mutans invading a human coronary artery endothelial cell.
Normally, S. mutans confines its mischief to the mouth, but sometimes, particularly after a dental procedure or even after a vigorous bout of flossing, the bacteria enter the bloodstream. There, the immune system usually destroys them, but occasionally – within just a few seconds – they travel to the heart and colonize its tissue, especially heart valves. The bacteria can cause endocarditis – inflammation of heart valves – which can be deadly. Infection by S. mutans is a leading cause of the condition.

“When I first learned that S. mutans sometimes can live in the heart, I asked myself: Why in the world are these bacteria, which normally live in the mouth, in the heart? I was intrigued. And I began investigating how they get there and survive there,” said Jacqueline Abranches, Ph.D., a microbiologist and the corresponding author of the study.

Abranches and her team at the University’s Center for Oral Biology discovered that a collagen-binding protein known as CNM gives S. mutans its ability to invade heart tissue. In laboratory experiments, scientists found that strains with CNM are able to invade heart cells, and strains without CNM are not.

When the team knocked out the gene for CNM in strains where it’s normally present, the bacteria were unable to invade heart tissue. Without CNM, the bacteria simply couldn’t gain a foothold; their ability to adhere was about one-tenth of what it was with CNM.

The team also studied the response of wax worms to the various strains of S. mutans. They found that strains without CNM were rarely lethal to the worms, while strains with the protein were lethal 90 percent of the time. Then, when Abranches’ team knocked out CNM in those strains, they were no longer lethal – those worms thrived.

The work may someday enable doctors to prevent S. mutans from invading heart tissue. Even sooner, though, since some strains of S. mutans have CNM and others do not, the research may enable doctors to gauge a patient’s vulnerability to a heart infection caused by the bacteria.

Abranches has identified five specific strains of S. mutans that carry the CNM protein, out of more than three dozen strains examined. CNM is not found in the most common type of S. mutans found in people, type C, but is present in rarer types of S. mutans, including types E and F.

“It may be that CNM can serve as a biomarker of the most virulent strains of S. mutans,” said Abranches, a research assistant professor in the Department of Microbiology and Immunology. “When patients with cardiac problems go to the dentist, perhaps those patients will be screened to see if they carry the protein. If they do, the dentist might treat them more aggressively with preventive antibiotics, for example.”

Until more research is done and a screening or preventive tool is in place, Abranches says the usual advice for good oral health still stands for everyone.

“No matter what types of bacteria a person has in his or her mouth, they should do the same things to maintain good oral health. They should brush and floss their teeth regularly – the smaller the number of S. mutans in your mouth, the healthier you’ll be. Use a fluoride rinse before you go to bed at night. And eat a healthy diet, keeping sugar to a minimum,” added Abranches.

Abranches presented the work at a recent conference on the “oral microbiome” hosted by the University’s Center for Oral Biology. The center is part of the Medical Center’s Eastman Institute for Oral Health, a world leader in research and post-doctoral education in general and pediatric dentistry, orthodontics, periodontics, prosthodontics, and oral surgery.

Additional authors of the study include laboratory technician James Miller; former technician Alaina Martinez; Patricia Simpson-Haidaris, Ph.D., associate professor of Medicine; Robert Burne, Ph.D., of the University of Florida; and Abranches’ husband, Jose Lemos, Ph.D., of the Center for Oral Biology, who is also assistant professor in the Department of Microbiology and Immunology. The work was funded by the American Heart Association.

Vitamin D fights gingivitis and periodontitis

2011-06-20T13:41:00.000-07:00

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Laboratory-grown gingival cells treated with vitamin D boosted their production of an endogenous antibiotic, and killed more bacteria than untreated cells, according to a paper in the June 2011 issue of the journal Infection and Immunity. The research suggests that vitamin D can help protect the gums from bacterial infections that lead to gingivitis and periodontitis. Periodontitis affects up to 50 percent of the US population, is a major cause of tooth loss, and can also contribute to heart disease. Most Americans are deficient in vitamin D.

His interest piqued by another laboratory's discovery that vitamin D could stimulate white blood cells to produce natural proteins that have antibiotic activity, Gill Diamond of the UMDNJ -- New Jersey Dental School, Newark, showed that vitamin D could stimulate lung cells to produce LL-37, a natural antibiotic protein, and kill more bacteria. That suggested that , vitamin D might help cystic fibrosis patients. Next, in the new research, he showed that vitamin D has the same effct on gingival cells.

Then, Diamond found that vitamin D also stimulates gingival cells to produce another protein, called TREM-1, which had not been well-studied, but which was thought to be made by white blood cells. He found that it boosts production of pro-inflammatory cytokines.

The new research also showed that vitamin D coordinates expression of a number of genes not previously considered to be part of the vitamin D pathway. Those genes may be involved in additional infection-fighting pathways. A more comprehensive understanding of how vitamin D carries out this regulation at the molecular level -- something Diamond hopes to investigate -- will enable targeted therapies using vitamin D, he says.

Interestingly, Diamond also found that lung and gum cells appear to have the ability to activate inactive forms of vitamin D, says Diamond. "This means that we may even be able to use vitamin D therapy topically, if that proves true."

Vitamin D has become a hot area of research in recent years. In addition to infectious diseases, studies suggest that it has protective effects against autoimmune diseases, and certain cancers.

Diamond says that after he began conducting research on vitamin D, he began taking it as a supplement. Since then, "I have had only one cold in four years, and that one lasted only three days," he says. "Other people I've met who have done the same have seen similar results. We are trying to figure out how it's working, and what other infectious diseases can be mitigated by it."

Healing times for dental implants could be cut

2011-06-14T12:33:00.000-07:00

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The technology used to replace lost teeth with titanium dental implants could be improved. By studying the surface structure of dental implants not only at micro level but also at nano level, researchers at the University of Gothenburg; Sweden, have come up with a method that could shorten the healing time for patients.

"Increasing the active surface at nano level and changing the conductivity of the implant allows us to affect the body's own biomechanics and speed up the healing of the implant," says Johanna Löberg at the University of Gothenburg's Department of Chemistry. "This would reduce the discomfort for patients and makes for a better quality of life during the healing process."

Dental implants have been used to replace lost teeth for more than 40 years now. Per-Ingvar Brånemark, who was recently awarded the prestigious European Inventor Award, was the first person to realise that titanium was very body-friendly and could be implanted into bone without being rejected. Titanium is covered with a thin layer of naturally formed oxide and it is this oxide's properties that determine how well an implant fuses with the bone.

It became clear at an early point that a rough surface was better than a smooth one, and the surface of today's implants is often characterised by different levels of roughness, from the thread to the superimposed nanostructures. Anchoring the implant in the bone exerts a mechanical influence on the bone tissue known as biomechanical stimulation, and this facilitates the formation of new bone. As the topography (roughness) of the surface is important for the formation of new bone, it is essential to be able to measure and describe the surface appearance in detail. But roughness is not the only property that affects healing.

Johanna Löberg has come up with a method that describes the implant's topography from micrometre to nanometre scale and allows theoretical estimations of anchoring in the bone by different surface topographies. The method can be used in the development of new dental implants to optimise the properties for increased bone formation and healing. She has also studied the oxide's conductivity, and the results show that a slightly higher conductivity results in a better cell response and earlier deposition of minerals that are important for bone formation.

The results are in line with animal studies and clinical trials of the commercial implant OsseoSpeed (Astra Tech AB), which show a slightly higher conductivity for the oxide and also an exchange between hydroxide and fluoride on the surface of the oxide. Surfaces with a well-defined nanostructure have a larger active area and respond quickly to the deposition of bone-forming minerals.

Should dentists provide dental care to pregnant women through the second trimester?

2011-05-05T10:58:00.000-07:00

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Every day, dentists across the country decide whether or not to provide dental care to a patient who is pregnant. On the one hand, they realize the patient needs to maintain her good oral health, especially if she has periodontal disease, a relatively common and destructive problem during pregnancy. On the other hand, dentists traditionally have lacked the scientific evidence to make informed decisions about the possible effects of dental care, if any, to the developing child. The lack of data has caused many dentists to err strongly on the side of caution, especially during the second trimester when the child’s development accelerates and, in theory, exposure to infectious oral bacteria or dental products could have adverse effects. But the fundamental questions remain: Should dentists provide dental care to pregnant women through the second trimester? If so, which types of treatment are safe to provide?

Over the last five years, newer scientific evidence has provided answers to these important questions. The data so far indicate that mothers who receive dental care through the second trimester - both general and periodontal treatment – do not appear to increase their risk of adverse events during pregnancy.

Some of the most scientifically rigorous data come from the NIDCR-supported Obstetrics and Periodontal Therapy Trial (OPT). In 2006, the OPT reported in the New England Journal of Medicine that pregnant women, most with early-to-moderate periodontitis, benefitted from general and periodontal care without an increase in preterm births or other negative pregnancy outcomes. All mothers had been randomly assigned to receive either: (1) scaling and root planing of the teeth prior to the 21st week of pregnancy, then monthly tooth polishings or (2) scaling and root planing after delivery, meaning women in this control group did not have their periodontal disease treated during their pregnancies. All women were 16 years or older and between 13 and 17 weeks pregnant upon entry into the study.

Now, as published online in the journal Pediatrics on April 11, the investigators report findings from a follow-up study of the OPT patients and their children born during the original trial. The researchers evaluated the neurodevelopment of 411 children, including 32 preterm infants, two years after the study. They tested the children using the Bayley Scales of Infant and Toddler Development (Third Edition) and the Preschool Language Scale (Fourth Edition). The former is a well-recognized assessment instrument for cognitive and motor functions in young children; the latter is frequently used to assess language skills in this age group.

The scientists found no difference in the neurodevelopment of children from mothers previously assigned to the treatment or control group. They also report slight associations between improvements in a mother’s periodontal attachment loss during the original study and higher cognitive and motor skills in their children. But both the associations are so weak, the scientists considered them “to be of little or no clinical significance.”

* Michalowicz BS, Hodges JS, Lussky RC, Bada H, Rawson T, Buttross LS, Chiriboga C, Diangelis AJ, Novak MJ, Buchanan W, Mitchell DA, and Papapanou PN. Maternal Periodontitis Treatment and Child Neurodevelopment at 24 to 28 months of Age, Pediatrics 2011 April 11 [Epub ahead of print]

Orthodontic researchers ask: Where's your retainer?

2011-03-24T12:14:00.001-07:00

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Have you been wearing your retainer? It's a question countless parents ask of their children post-braces. Now Case Western Reserve University School of Dental Medicine researchers are getting serious about the question.

"We found little written about the kinds of retainers prescribed and how compliant patients are in using them," said Case Western Reserve's Manish Valiathan, an assistant professor of orthodontics and a member of the American Board of Orthodontics. He notes that there is a dearth of information despite the devices being common in orthodontics practice.

Consequently Valiathan and fellow researchers embarked on three studies that examined how people are using retainers, which types are prescribed and what happens when patients don't follow up orthodontic work with a retainer.

After randomly sending 2,000 surveys to orthodontists throughout the country, researchers received responses from 658 practitioners regarding the kinds of retainers they prescribe. The majority (58.2 percent) prescribed removable retainers; about 40 percent opted for fixed lingual retainers that, once in place, are worn for life.

Post-braces, the majority of orthodontists said they required wearing removable retainers full-time for the first nine months and then part-time after that. They also encouraged part-time retainer use throughout life.

Valiathan said that without retainers specific prior conditions may return but that definitive research does not exist as to what conditions require ongoing retainer use. More evidence is needed, he said.

Another survey study of 1,200 patients from four practices focused on patient compliance two years after prescribing retainers. Patients self-reported and 36 percent responded to the researchers' questions regarding type of retainer used, age, gender, length of time since braces were removed, and hours per day and night retainer is worn.

The overall responses showed that 60 percent wore retainers more than 10 hours a day in the first three months and 69 percent wore them every night. By the time retainer users reached 19 to 24 months, 19 percent were not wearing retainers but 81 percent were—even if it was only one night a week. About 4 percent never wore their retainer at all.

Research indicated that many patients were still using their original retainers two years later—a sign that teeth had not moved, Valiathan said. Additionally, researchers found that age, gender and the type of retainer did not impact compliance.

The third study was a pilot research project. It examined the ramifications of no retainer use within the first four weeks after braces removal. Researchers measured patients' teeth before and after for spacing issues, overbites, under bites and tooth crowding.

Thirty patients had the wires removed from their braces but kept the appliances affixed to the teeth to monitor any changes without a retainer. Nearly half of the participants showed no movement, and many showed positive settling of the back teeth including the molars. Some did require additional orthodontic treatment at the end of the four weeks.

"Further studies with a larger study population will let us know if some patients can go without using retainers," Valiathan said.

He added that orthodontic researchers need to study what kinds of conditions require long-term retainer use.

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For more detailed information, consult the studies mentioned in this report:

"Retainer wear and compliance in the first 2 years after active orthodontic treatment," in the American Journal of Orthodontics and Dentofacial Orthopedics (Volume 138, Number 5) was conducted by Case Western Reserve University School of Dental Medicine researchers—Kurtis A. Kacer, Manish Valiathan, Sena Narendran and Mark G. Hans.

"Results of a survey-based study to identify common retention practices in the United States," in the American Journal of Orthodontics and Dentofacial Orthopedics (Volume 137, Number 2) by Manish Valiathan from Case Western Reserve University School of Dental Medicine and Eric Hughes, a private practice dentist from Tuscaloosa, Ala.

"Short-term postorthodontic changes in the absence of retention" in Angle Orthodontist (Volume 80, Number 6) by Nadia Lyotard, private practice dentist from Houston, Texas; and Case Western Reserve University dental researchers Mark Hans, Suchitra Nelson and Manish Valiathan.

Sealing manifest occlusal caries in permanent teeth

2011-03-17T13:31:00.000-07:00

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Today, during the 89th General Session & Exhibition of the International Association for Dental Research, held in conjunction with the 40th Annual Meeting of the American Association for Dental Research and the 35th Annual Meeting of the Canadian Association for Dental Research, lead researcher V. Qvist will hold an oral presentation on a research study titled "Sealing Manifest Occlusal Caries in Permanent Teeth - 2½-year Results."

This research was performed under the objective of investigating the possibility of non-operative sealing of manifest occlusal caries lesions which otherwise would have been treated with conventional restoration. This prospective, randomized study was performed in the young permanent dentition with two parallel treatment arms. The material includes 523 occlusal caries lesions in 523 patients aged 6-17 years. All lesions were assessed to be in need of operative treatment and were limited to the outer half of the dentin. Informed consent was obtained from the patients/parents.

After randomization in the ratio of 2:1, 370 resin sealants and 153 resin restorations were carried out by 72 public dentists from August 2006 to November 2009. The treatments were followed by annual clinical and radiographic control examinations. Chi-square tests were applied for statistical comparisons between sealants and restorations.

After an average observation period of 2½ years, the dropout rate was 3 percent. Of the sealants 76 percent were well-functioning, 10 percent were repaired or renewed, and 15 percent were replaced by restorations. Of the restorations, 96 percent were well-functioning and 4 percent were extended or replaced, which was significantly different compared with the sealant group (p<0.001). The radiographic assessment showed caries progression in 11 percent of the sealed teeth and 1 percent of the restored teeth (p<0.001).

The majority of the sealed lesions were successfully arrested during the first 2½ years. Thus, the results indicate the possibility of extending the criteria for non-operative sealing of occlusal caries lesions in the young permanent dentition. However, a longer observation period is needed for final conclusion, and treatments will be followed for at least 5 years.

Does Treating Periodontitis Improve Diabetes Control?

2011-03-15T13:29:00.000-07:00

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The Stony Brook University School of Dental Medicine is leading a multicenter national clinical trial to evaluate whether treatment of chronic periodontitis will help improve diabetes control. Sponsored by the National Institutes of Health (NIH), the Diabetes and Periodontal Therapy Trial (DPTT) monitors blood sugar levels of those with Type 2 diabetes after periodontal therapy. The trial is the first of its kind in the United States.

The American Diabetes Association reports that Type 2 diabetes is the fifth leading cause of death in the U.S., affecting nearly 24 million Americans. Chronic Periodontitis affects roughly half of all Americans over the age of 55, but it is 2-to-4 times more likely to occur among people with diabetes, according to the American Academy of Periodontology.

“We hope the results of this clinical trial will support the research that clearly shows an association between chronic periodontitis and Type 2 diabetes and evidence that treating periodontal infection and inflammation can improve glycemic control,” says Steven Engebretson, D.M.D., M.S., M.S., Principal Investigator for the trial and Assistant Professor of Periodontics and Implantology at the SBU School of Dental Medicine.

In 2008, Dr. Engebretson and colleagues within the School of Dental Medicine and School of Medicine received a $12.5 million five-year grant from the NIH to develop the format and research plan for a multicenter trial investigating the effectiveness of periodontal therapy in improving blood sugar levels in Type 2 diabetes – now named the DPTT.

In 2011, a supplemental NIH grant for the DPTT to Stony Brook will provide an additional $1.4 million for the trial, bringing the total award to $13.9 million. This two-year grant supplement will be used to further develop a clinical site for ongoing recruitment of study participants through May 2012.

Participants for the trial must be 35 years or older and have Type 2 Diabetes and gum disease. Those who are eligible will receive at no cost: a dental cleaning by a hygienist and a professional evaluation by a dentist; 6-8 office visits, which include periodontal treatment for 6 months; oral hygiene products and diabetic counseling, as well as compensation for time and travel.

The periodontal treatment involves an in-depth cleaning called scaling and root planing (SRP). SRP is a careful cleaning of the tooth root surfaces to remove plaque from pockets and remove bacteria and toxins from tooth root. Dr. Engebretson points out that research has consistently shown that SRP reduces the amount of bacteria associated with periodontal disease. Due to this finding, SRP is usually the first mode of treatment recommended for most patients. Some people do not require any further active treatment after SRP.

The entire trial will span 30 months and include four clinical sites. Stony Brook is the coordinating clinical center, and the other clinical sites are the University of Alabama in Birmingham, the University of Minnesota in Minneapolis, and the University of Texas Health Science Center in San Antonio. The NIH’s National Institute of Dental and Craniofacial Research sponsors the trial.

The shared goal of the four clinical centers is to recruit a total of 600 adults who also have untreated moderate to severe chronic periodontitis. Subjects will be recruited from the diabetes clinics, dental clinics and communities near each center.

Dr. Engebretson believes that in the long-run the study results have the potential to provide a scientific basis for an improvement in the standard of care for patients with diabetes, thus addressing one of the Public Health Service's Healthy People 2010 goals. The trial is also carrying out a mandate from the 2000 Surgeon General’s Report on Oral Health, which identified the relationship between improvement in periodontal health and glycemic control as an area in need of further investigation.

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Could there be more than lunch lurking on your retainer?

2011-03-15T13:12:00.001-07:00

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Insufficient cleaning could allow build-up of microbes on orthodontic retainers, researchers at the UCL Eastman Dental Institute have found. Dr Jonathan Pratten and colleagues looked at the types of microbes which live on retainers. This study, which found potentially pathogenic microbes growing on at least 50% of the retainers, is published today in the Society for Applied Microbiology's journal Letters in Applied Microbiology and could indicate a need for the development of improved cleaning products for orthodontic retainers.

Dr Pratten and his team took samples from the mouths of people without retainers and those wearing either of the two most widely used types. As retainers are frequently removed and then replaced in the mouth, the potential for transmission of microbes is high.

Our mouths are full of different types of bacteria, some of which promote oral health. However, the researchers were looking for microbes which are not normally found in the oral cavity. They were particularly interested in two species of microbes; Candida, a type of yeast, and Staphylococcus including MRSA. Dr Pratten and his team found that species of these microorganisms were present on 66.7% and 50% of retainers respectively regardless of the retainer type. These microbes were also present on the interior cheeks and tongue of retainer wearers.

Candida and Staphylococcus rarely cause problems in healthy individuals but are potentially highly problematic in people with a compromised immune system. The bacteria on the retainers live in biofilms, which are communities of bacteria living together covered in a layer of slime. Once these biofilms form they are very difficult to remove and often have high levels of resistance to antimicrobials.

Dr Pratten says: "With the growing awareness the public has of hospital-acquired infections it is important to be aware of other potential 'hidden reservoirs' of harmful bacteria which could be introduced to environments where we know they can cause problems."

Whilst the researchers are now looking at developing effective methods of cleaning, for now hygiene is the key to reducing the transmission of these bugs. Anyone handling a retainer should wash their hands before and after use. Careful tooth brushing and mouthwash may also help to keep the retainer clean.

Used woodwind and brass musical instruments harbor harmful bacteria and fungi

2011-03-14T12:53:00.000-07:00

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Research has shown that playing a musical instrument can help nourish, cultivate, and increase intelligence in children, but playing a used instrument also can pose a potentially dangerous health risk.

Used woodwind and brass instruments were found to be heavily contaminated with a variety of bacteria and fungi, many of which are associated with minor to serious infectious and allergic diseases, according to a study published in the March/April 2011 issue of General Dentistry, the peer-reviewed clinical journal of the Academy of General Dentistry (AGD).

"Many children participate in their school's band ensemble and often the instruments they play are on loan," said R. Thomas Glass, DDS, PhD, lead author of the study. "Most of these instruments have been played by other students, and without the proper sanitation, bacteria and fungi can thrive for weeks and even months after the last use."

A total of 117 different sites, including the mouthpieces, internal chambers, and cases, were tested on 13 previously played instruments of a high school band. Six of the instruments had been played within a week of testing, while seven hadn't been touched in about one month. The instruments produced 442 different bacteria, many of which were species of Staphylococcus, which can cause staph infections. Additionally, 58 molds and 19 yeasts were identified.

"Parents may not realize that the mold in their child's instrument could contribute to the development of asthma," said Dr. Glass.

Additionally, the yeasts on the instruments commonly cause skin infections around the mouth and lips ("red lips").

"Because these instruments come into contact with the mouth, it's no wonder they're a breeding ground for bacteria," said AGD spokesperson Cynthia Sherwood, DDS, FAGD. "As dentists, we see this same growth of bacteria in dentures, athletic mouthguards, and toothbrushes."

Researchers found that many of the bacteria can cause illness in humans and are highly resistant to the antibiotics normally prescribed by general practitioners. This finding makes sterilization of instruments extremely important.

"Instruments should be cleaned after each use to reduce the number of organisms," said Dr. Sherwood. "And cleaning should not be confined to the mouthpiece, since the bacteria invade the entire instrument."

To avoid transmission of bacteria from instrument to player, parents and students should frequently wipe the surface of the instrument that comes into contact with the skin and mouth. The instrument should be taken apart for thorough cleanings on a regular basis. Dr. Glass suggests using cleaning cloths and solutions made specifically for instruments. Most importantly, students are advised not to share their instruments with others. Students should consult with their band instructor for additional ways to disinfect their instruments.

Coffee drinking linked to reduced stroke risk in women

2011-03-11T10:54:00.001-08:00

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Drinking more than a cup of coffee a day was associated with a 22 percent to 25 percent lower risk of stroke, compared with those who drank less, in a study reported in Stroke: Journal of the American Heart Association.

Low or no coffee consumption was associated with an increased risk of stroke in a study of 34,670 women (ages 49 to 83) followed for an average 10.4 years. It's too soon to change coffee-drinking habits, but the study should ease the concerns of some women, researchers noted.

Coffee is one of the most widely consumed beverages in the world. "Therefore, even small health effects of substances in coffee may have large public health consequences," said Susanna Larsson, Ph.D., lead author of the study and a researcher in the Division of Nutritional Epidemiology, National Institute of Environmental Medicine, Karolinska Institute in Stockholm, Sweden.

Groups who reported drinking 1-2 cups per day, 3-4 cups per day or 5 or more cups per day had similar benefits compared with those who reported daily intake of less than a cup of coffee, researchers said.

The differences were unchanged by smoking status, body mass index, history of diabetes, hypertension or alcohol consumption, indicating that coffee's effects are not influenced by those known cardiovascular risk factors.

Scientists have theorized that coffee could have either beneficial or harmful effects on the cardiovascular system, but earlier studies have been inconclusive. Only one previous prospective study, which was also inconclusive, examined the association between coffee consumption and stroke incidence in healthy women.

"Our research group has previously observed an inverse association between coffee consumption and risk in Finnish male smokers," Larsson said. "We wanted to assess the situation in women."

The women participated in the long-running Swedish Mammography Cohort, an epidemiological study investigating the association between diet, lifestyle and disease development. All the women were free of cardiovascular disease and cancer at baseline in 1997, when they answered the food frequency questionnaire analyzed in the study.

Researchers collected data on cases of first stroke that occurred between Jan. 1, 1998 and Dec. 31, 2008, by linking the study group with the Swedish Hospital Discharge Registry that provides almost complete coverage of Swedish hospital discharges.

Researchers documented 1,680 strokes: 1,310 cerebral infarctions/ischemic strokes (caused by blockages), 154 intracerebral hemorrhages (caused by bleeding inside the brain), 79 subarachnoid hemorrhages (caused by bleeding on the surface of the brain) and 137 unspecified strokes.

After adjustment for other risk factors, coffee consumption was associated with a statistically significant lower risk of total stroke, cerebral infarction and subarachnoid hemorrhage, Larsson said.

The small numbers of intracerebral hemorrhage could have factored in the lack of an association with that stroke subtype, she said. In general, cerebral infarction is most strongly associated with dietary factors.

The food frequency questionnaire made no distinction between regular and decaffeinated coffee but decaffeinated coffee consumption in the Swedish population is low, Larsson said.

Potential ways that coffee drinking might reduce the risk of stroke include weakening subclinical inflammation, reducing oxidative stress and improving insulin sensitivity, she said.

The study's limitations include the use of a self-administered questionnaire to determine medical history and history of coffee consumption — which inevitably includes some measurement error and misclassification of exposure — and the possibility of an unrecognized confounding factor associated with either low or moderate coffee consumption, Larsson said.

"Some women have avoided consuming coffee because they have thought it is unhealthy. In fact, increasing evidence indicates that moderate coffee consumption may decrease the risk of some diseases such as diabetes, liver cancer and possibly stroke."

More studies on coffee consumption and stroke are needed before firm conclusions can be reached, Larsson said.

CWRU RESEARCHER SENDS HEALTH MESSAGE TO POSTMENOPAUSAL WOMEN: “INCREASE YEARLY DENTAL CHECKUPS”

2011-03-11T10:46:00.000-08:00

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Postmenopausal women have a new health message to hear. Two annual dental checkups aren’t enough. Older women need more, according to research findings from the Case Western Reserve University School of Dental Medicine and the Cleveland Clinic.

That message comes from a comparison study of women on and off bone-strengthening bisphosphonate therapies for osteoporosis.

Leena Palomo, assistant professor of periodontics from the dental school, and Maria Clarinda Beunocamino-Francisco from the Center for Specialized Women’s Health at the clinic, set out to study the long-term effects of bisphosphonate therapies on the jawbone, but came up with this new findings that impacts all women after undergoing menopause.

Twenty-eight postmenopausal women with normal bones were compared with 28 women on bisphosphonate therapies for at least two years or more. The participants (all between the ages of 51 and 80) received conebeam CT scans of their jaws and a complete periodontal check for dental plaque, bleeding, and loss of bone attachment and of the alveolar bone socket.

Both groups of women had followed the recommended American Dental Association oral health standards to brush twice daily, floss and have at least two dental checkups a year.

The findings for bone strength and other markers for osteoporosis were similar for both groups. But the researchers found both groups had increased dental plaque levels, which could endanger the jawbone of normal postmenopausal women and reverse any benefits gained in bone mass.

Dental plaque is the fuzzy bacterial material that covers the teeth when you wake up in the morning. The biofilm is a mixture of bacteria, bacterial waste and food particles stuck to the teeth and provide nourishment for more bacteria.

While women from both groups had similar bone health results and women on the long-term oral bone-strengthening therapies showed no signs of bone death, they had abnormal dental plaque.

Their findings were announced in the article, “Is long-term bisphosphonate therapy associated with benefits to the periodontium in postmenopausal women?” that was published in the February issue of Menopause.

Menopausal women at risk for osteoporosis also are at risk for periodontal disease, which affects bone that anchors teeth, says Palomo.

A prior study by Palomo showed that short-term use of bisphosphonates had increased bone density in the jaw.

But over time, if the hard plaque is left on teeth, it triggers the processes for gum disease. Gum disease, also known as periodontitis, is an inflammatory reaction that produces the cytokines protein reaction. Cytokines act like water runoffs on the side of the hill and erodes the socket that anchors the tooth in place.

If that bone loss isn’t stopped, Palomo said, a woman could potentially lose her teeth.

She added that those cytokines also set in motion the process that weakens bones in osteoporosis.

Palomo said women may need to see the dentist as many as four times a year to control dental plaque by deep periodontal cleanings.

“Women also have to realize that bone disease and gum disease are two separate diseases,” Palomo said. The bisphosphonate therapy isn’t enough to keep jawbones strong and healthy, she added, that means getting rid of the dental plaque.

Dental School Warns of Potential Zinc Hazards for Patients

2011-03-04T13:27:00.000-08:00

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Dentists need to take a closer look at potential hazards of exposing patients to zinc, a common ingredient of many dental products, according to a report by Amar Patel, DDS, resident and colleagues at the University of Maryland Dental School in the March/April 2011 issue of the journal General Dentistry.

Small amounts of the element zinc are essential to the proper functioning of nearly every body system, but too much can be toxic. Some patients develop neurological problems from zinc. Toxicity from zinc also can be manifested as nausea, stomachache, and mouth irritation.
The authors reviewed and analyzed a wide range of information now available to dentists and physicians on the use of zinc in dentistry. Many dental patients are regularly exposed to zinc from certain restorative materials, mouthwashes, toothpastes and denture adhesives.

“Dentists are suddenly hungry for more information on zinc,” says co-author Nasir Bashirelahi, PhD, a professor with the School. “It is used in dental products abundantly, especially denture adhesives or pastes.”

Growing concern with denture adhesives may tip the decisions of some patients away from getting fitted with dentures, which may require perpetual pasting to the gums, to opting for dental implants instead, typically a more expensive choice, says Bashirelahi.

In the paper “What Every Dentist Should Know About Zinc,” Patel writes, "Of direct concern to dental professionals ... has been the recent discovery of neurologic disorders resulting from excessive use of denture adhesives, having high leachable zinc contents which can cause copper deficiencies."

They explain that the link of excessive zinc intake has been related to copper insufficiency due to the competition in absorption patterns for the two metals in the gastrointestinal tract. Several studies, according to the review paper, link copper deficient anemia and neutropenia with an increase of zinc intake. (Neutropenia is a blood disorder of abnormally low counts of neutrophils, important white blood cells.)
"Suddenly this issue is very important for the dental profession, with many practical applications," said Bashirelahi, who knows of at least one manufacturer that has added a consumer warning label on a product. And the authors also urge dentists to thoroughly understand the relationship among zinc, health, and dental products because of "legal ramifications." Presently there are zinc-free adhesives in the market.
Bashirelahi lectures in continuing education classes on dentistry where the topic raises eyebrows. He says, "People are living longer these days and want to stay healthy for as long as possible."

Zinc plays an important role in human physiology. It is involved in the proper functioning of the immune system, cellular growth, cell division and normal cell death (a replacement system). The element also plays a key patho-physiological role in major neurological disorders as well as diabetes. Zinc deficiency is a worldwide problem, whereas excessive dietary intake of zinc is relatively rare.
Bashirelahi, a molecular endocrinologist, says that among the principal roles of zinc is proper function of the pancreatic system. Another zinc-dependent process is spermatogenesis, as zinc is important for testosterone metabolism.

Does fluoride really fight cavities by 'the skin of the teeth'?

2011-03-04T12:56:00.001-08:00

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In a study that the authors describe as lending credence to the idiom, "by the skin of your teeth," scientists are reporting that the protective shield fluoride forms on teeth is up to 100 times thinner than previously believed. It raises questions about how this renowned cavity-fighter really works and could lead to better ways of protecting teeth from decay, the scientists suggest. Their study appears in ACS's journal Langmuir.

Frank Müller and colleagues point out that tooth decay is a major public health problem worldwide. In the United States alone, consumers spend more than $50 billion each year on the treatment of cavities. The fluoride in some toothpaste, mouthwash and municipal drinking water is one of the most effective ways to prevent decay. Scientists long have known that fluoride makes enamel — the hard white substance covering the surface of teeth — more resistant to decay. Some thought that fluoride simply changed the main mineral in enamel, hydroxyapatite, into a more-decay resistant material called fluorapatite.

The new research found that the fluorapatite layer formed in this way is only 6 nanometers thick. It would take almost 10,000 such layers to span the width of a human hair. That's at least 10 times thinner than previous studies indicated. The scientists question whether a layer so thin, which is quickly worn away by ordinary chewing, really can shield teeth from decay, or whether fluoride has some other unrecognized effect on tooth enamel. They are launching a new study in search of an answer.

What Every Denture Wearer Needs to Know About Zinc

2011-03-04T12:16:00.001-08:00

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From its involvement in a healthy immune system to its role in cell growth, zinc is an essential mineral for the human body. Zinc deficiency is a worldwide problem that affects approximately 4 million people in the U.S. alone.

Consumed naturally in the human diet, zinc can be found in food sources, such as beef, yogurt, eggs, and fish. Furthermore, zinc is widely used in dental products, specifically denture adhesives.

However, as with any herb, vitamin, or mineral, excess intake of zinc could pose a potential health hazard. Denture wearers are advised to pay special attention to the amount of zinc they consume, according to an article published in the March/April 2011 issue of General Dentistry, the peer-reviewed clinical journal of the Academy of General Dentistry (AGD).

“If a patient wears dentures, it is essential that he or she follows the instructions and recommended dosages on the product label,” advises J. A. von Fraunhofer, MSc, PhD, co-author of the article. “Many times, patients will overuse the adhesive and, although it happens rarely, they can ingest toxic levels of zinc, with adverse neurologic effects.”

The optimal use of denture adhesive involves placing a thin film or a series of dots across the denture surface, which will ensure that a patient is not overusing the adhesive. A single tube should last three to 10 weeks with daily use, although actual usage depends on the number of applications per day.

“An ill-fitting denture is one reason that a patient could be overusing adhesive,” says AGD spokesperson Manuel A. Cordero, DDS, MAGD. “With age, your mouth will continue to change as the bone under your denture shrinks or recedes. If the denture doesn’t fit correctly, the patient tends to use more adhesive to try to get the denture to stay in place.”

To maintain a proper fit over time, patients should be evaluated by a dentist every six months.

“Abusing denture adhesive could cause nausea, stomachache, and mouth irritation,” says Dr. Cordero. “Over time, toxic levels of zinc could cause a copper deficiency, which has been linked to neurological damage.”

Currently, the FDA has issued no warnings regarding the use of denture adhesives, but patients should limit their usage of adhesive in accordance with the manufacturers’ instructions and speak with their dentist if they have additional questions or concerns.

Bone-creating protein could improve dental implant success

2011-03-04T11:53:00.001-08:00

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Using a bone-creating protein to augment the maxillary sinus could improve dental implant success, according to Georgia Health Sciences University researchers.

Dental implants, screws that anchor permanent prosthetic teeth, won't work if the bone in which they are anchored is too thin. Bone-thinning is a common cause and consequence following tooth loss. The current favored solution is to supplement the area with bone grafts to stabilize the implant base. But that technique is problematic "primarily because it involves additional surgeries to harvest the bone," said Dr. Ulf M.E. Wikesjö, Interim Associate Dean for Research and Enterprise in the GHSU College of Dental Medicine.

In animal studies, he and his team at the GHSU Laboratory for Applied Periodontal & Craniofacial Regeneration found that implanting bone morphogenetic protein in the sinus more new bone will form within four weeks than using conventional bone grafting at the same site.

"We found that BMP induced superior bone quality over that following bone grafts, which improves the chances for successful implants," Wikesjö said. "BMP is phenomenal, because it's a true, off-the-shelf product with ease of use that can produce real results, and it could be the new gold standard for this procedure."

According to the American Association of Oral and Maxillofacial Surgeons, 69 percent of adults ages 35-44 have lost at least one tooth due to decay, disease or trauma, and 26 percent of adults have lost all permanent teeth by age 74. Before dental implants were available, the only options for replacing these missing teeth were dentures and dental bridges, both of which could lead to further bone loss. Implants provide patients with numerous benefits, including improved oral health, appearance, speech, convenience, durability and ability to eat.

New insight on childhood dental disease

2011-02-28T13:04:00.001-08:00

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New pathogen contributes to severe early childhood caries

Researchers at The Forsyth Institute have made a significant discovery about the nature of childhood dental disease. The scientific studies led by Anne Tanner, BDS, Ph.D., identified a new pathogen connected to severe early childhood caries (cavities). This bacterium, Scardovia wiggsiae, was present in the mouths of children with severe early childhood caries when other known pathogens such as Streptococcus mutans were not detected. This research may offer the potential to intervene and halt the progression of disease.

Early childhood caries, ECC, is the most common chronic infectious disease of childhood in the United States. Severe ECC can destroy primary teeth, cause painful abscesses and is the major reason for hospital visits for young children. This condition disproportionately affects disadvantaged socio-economic groups. This research, which will be published in the April issue of Journal of Clinical Microbiology, provides new insight on the microbiota of severe early childhood caries.

Dental caries is caused by an interaction between bacteria, host susceptibility and a carbohydrate diet that contains large amounts of sugar. Dr. Tanner published an updated evaluation of the diet associated with severe-ECC in collaboration with Dr. Carole Palmer at Tufts University in the Journal of Dental Research in 2010. The bacterial species Streptococcus mutans is widely recognized as the primary pathogen in early childhood caries. However, it is also present in people without disease and is not detected in all cases of childhood caries. This suggests that other species such as S. wiggsiae are also disease causing pathogens.

"In my work, I have seen the tremendous public health impact of severe early childhood caries," said. Dr. Anne Tanner, Senior Member of Staff, Department of Molecular Genetics, The Forsyth Institute.

"Understanding the causes of severe dental decay in young children is the first step in identifying an effective cure."

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Summary of Study

Severe early childhood caries (ECC), while strongly associated with Streptococcus mutans using selective detection methods (culture, PCR), has also been associated with other bacteria using molecular cloning approaches. The aim of this study was to evaluate the microbiota of severe-ECC using anaerobic culture. The microbial composition of dental plaque from 42 severe-ECC children was compared with that of caries-free children. Bacterial samples were cultured anaerobically on blood and acid (pH 5) agars. Isolates were purified, and partial sequences for the 16S rRNA gene were obtained from 5608 isolates. Sequence based analysis of the 16S rRNA isolate libraries from blood and acid agars of severe-ECC and caries-free children had >90% population coverage with greater diversity in the blood isolate library. Isolate sequences were compared with taxa sequences in the Human Oral Microbiome Database (HOMD) and 198 HOMD taxa were identified, including 45 previously uncultivated taxa, 29 extended HOMD taxa and 45 potential novel groups. The major species associated with severe-ECC included Streptococcus mutans, Scardovia wiggsiae, Veillonella parvula, Streptococcus cristatus and Actinomyces gerensceriae. S. wiggsiae was significantly associated with severe-ECC children in the presence and absence of S. mutans. Dr. Tanner and her team conclude that anaerobic culture detected as wide a diversity of species in ECC as observed using cloning approaches. Culture coupled with 16S rRNA identification identified over 74 isolates for human oral taxa without previously cultivated representatives. The major caries-associated species were S. mutans and S. wiggsiae, the latter of which is a candidate as a newly recognized caries pathogen.

This study was conducted with collaborators at the Goldman School of Dental Medicine, Boston University, and Tufts University School of Dental Medicine and with Dr. Floyd Dewhirst and resources of the Human Oral Microbiome Database (HOMD) at Forsyth Institute. HOMD links several types of information on oral microbes to a consistent naming system. HOMD contains descriptions of the microbes, their metabolism, and their ability to cause disease along with information on their DNA and proteins, as well as to the scientific literature.

Breaking Down Barriers to Oral Health

2011-02-22T08:27:00.000-08:00

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The American Dental Association (ADA) today released the first in a series of papers examining the challenges and solutions to bringing good oral health to the millions of Americans—including as many as one-quarter of the nation’s children—who lack access to dental care, many of them suffering with untreated disease. The paper focuses on workforce, an umbrella term for the numbers, location and makeup of the teams comprising dentists, dental hygienists, dental assistants and other existing and proposed providers.

Breaking Down Barriers to Oral Health for All Americans: The Role of Workforce also emphasizes that workforce changes alone can never overcome the many barriers that prevent too many Americans from attaining good oral health. It warns that focusing on only this one barrier is “the policy equivalent of bailing a leaky boat.” Future ADA papers will address those other barriers, including the tattered public health safety net, and the need to dramatically increase both disease prevention and financing.

The paper disputes the conventional wisdom of a coming shortage of dentists, projecting that later-than-predicted retirement, increased numbers of dental school applicants and the opening of new dental schools will provide an adequate number of dentists through 2030. Instead it argues that the challenges are 1) placing dentists—whether in private practice or government-assisted clinics—in more so-called “underserved areas” that otherwise cannot support a full-time dental practice, and 2) addressing issues that impede securing and keeping dental appointments, such as excessive paperwork, transportation, child care and permission to take time off from work or school.

“We know that the existing delivery model can accommodate millions more people, provided that we address administrative and financing barriers, and workforce distribution,” said ADA President Raymond F. Gist, DDS. “Everyone deserves good oral health, and everyone deserves a dentist.”

Several examples are cited in which states or municipalities have dramatically increased dental services provided to disadvantaged children through a combination of relatively minor funding increases and administrative reforms. They include the children’s dental Medicaid programs in Tennessee, Alabama and Michigan and the creation of a public-private dental clinic in Vermont. The improvements in these programs made it possible for much greater numbers of patients to receive care from the same population of dentists as existed before the reforms occurred.

The paper cautions against a rush to create so-called “midlevel” dental providers who, with as little as 18 months of post-high school training, could be allowed to perform such irreversible/surgical procedures as extracting teeth. Such experiments, it argues, are likely to sap resources better directed toward proven methods for extending the availability of care from fully trained dentists. It does however endorse such workforce innovations as the ADA’s own Community Dental Health Coordinator (CDHC) pilot project. CDHCs follow the highly successful (medical) community health worker model, providing health education and preventive services, identifying patients needing dental care and helping those patients secure and keep appointments with fully trained dentists.

“When all stakeholders—and we are all stakeholders—set aside lesser differences and recognize our aligned purpose, set ambitious yet realistic short- and long-term goals, and pursue those goals with renewed vigor, we can effectively end untreated dental disease in America,” said Dr. Gist.

Commonly prescribed osteoporosis drug associated with very low risk of serious jaw disease

2011-02-14T13:12:00.000-08:00

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A commonly prescribed osteoporosis drug is associated with a slightly elevated risk of developing the rare, but serious condition, osteonecrosis of the jaw; nonetheless the risk remains extremely low. These findings are published online in the Journal of Dental Research, the official journal of the International and American Associations for Dental Research. Although the findings are provocative, study authors say they should be carefully considered against the large benefit of these drugs to prevent and treat osteoporosis.

The study was funded by the National Institutes of Health and conducted by researchers from the Kaiser Permanente Center for Health Research and HealthPartners Research Foundation. The study examined medical records from nearly 600,000 patients and is part of the Dental Practice-Based Research Network — a consortium of participating practices and dental organizations committed to advancing knowledge of dental practice and ways to improve it.

"Oral bisphosphonates, usually prescribed for osteoporosis patients, appear to increase the risk of osteonecrosis of the jaw, but the risk is still very low," said the paper's lead author, Jeffrey Fellows, PhD, an investigator with the Kaiser Permanente Center for Health Research. "Previous studies suggested that about one percent of oral bisphosphonate users may develop osteonecrosis of the jaw, but our study found a much lower rate, less than one-tenth of one percent. The risk is still real and patients should take necessary precautions, but they shouldn't be alarmed."

"These drugs are very helpful in treating osteoporosis and preventing fractures so for the large majority of patients the benefits of taking them far outweigh the small risk found in this study," says Michael Herson, MD, Chief of Endocrinology and Metabolism, Northwest Permanente Medical Group, which was not involved in the study. "If patients have questions about taking these drugs they should consult with their physicians."

Osteonecrosis of the jaw is difficult to treat and occurs when blood flow to the bone is reduced, leaving an area of the jaw bone exposed for longer than 6-8 weeks. Most cases have been reported in cancer patients taking intravenous bisphosphonates; the risk associated with oral bisphosphonates is less clear. This study attempts to quantify that risk in a large, defined population. It is important to establish what the risk is because bisphosphonates are widely prescribed to osteoporosis patients. According to a 2009 paper in the American Journal of Health-System Pharmacy, 4.7 million Americans are taking oral bisphosphonates.

The new paper published in the Journal of Dental Research examined electronic medical records of 572,606 patients from 1995 to 2006. Researchers found 23 cases of osteonecrosis of the jaw, most among patients who were not taking oral bisphosphonates, but had other risk factors including cancer, head and neck radiation therapy, and osteoporosis.

Nearly 4 percent of the patients, or 21,164 people, were prescribed oral bisphosphonates, but only six of those patients, or about one in 3,500, developed osteonecrosis of the jaw. Patients taking oral bisphosphonates were nine times more likely than those who didn't to develop the condition.

"Invasive dental procedures may also increase the risk of osteonecrosis of the jaw, so patients who need those procedures may want to get them before starting on oral bisphosphonates," said Dr. Daniel Pihlstrom, a co-author on the study and associate director for Evidence Based Care and Oral Health Research at Permanente Dental Associates. "Patients who are already taking these drugs don't need to stop in order to get dental care, but if they need an invasive dental procedure they should inform their dentist or oral surgeon that they are taking the drugs," added Pihlstrom.

The authors caution that their confidence in the association between oral bisphosphonates and osteonecrosis of the jaw is limited because they found so few cases. The small number of cases also limited their ability to control for other risk factors. Also, since osteonecrosis of the jaw did not have a diagnosis code before 2007, the authors used a computer program to search medical records for any diagnosis, procedure, or physician chart note that could indicate a possible case. Manual chart review was used to confirm osteonecrosis of the jaw among patients identified by the computer. Some additional cases were found through conversations with general dentists and oral surgeons serving patients from each health care organization. While the search was extensive, there is a chance that some cases were missed.

Dental Coverage Pays Off in Long Run for Older Americans

2011-02-03T13:54:00.001-08:00

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Older Americans could likely have lower overall dental expenses with preventive dental care and more routine dental visits, as indicated by a new study of public records of Medicare beneficiaries, says John Moeller, PhD, MA, research professor at the University of Maryland Dental School.

Moeller and colleagues in the School's Health Services Research Division conducted a uniquely comprehensive analysis of a sample of 10,582 representatives of the nearly 34 million Medicare beneficiaries in community-based homes.

Private insurance records are generally not available for such a national study, says Moeller. But researchers say the Medicare records are frequently reliable as indicative of national trends.

The Dental School study published in the American Journal of Public Health showed that Medicare beneficiaries who used preventive dental care had more dental visits but fewer visits for expensive nonpreventive procedures and lower dental expenses than beneficiaries who saw the dentist only for treatment of oral problems.

"For many retirees, paying for dental care treatment can be difficult," says Moeller. "Without assistance, older Americans who are poorer may choose to delay or forgo dental care, but postponing dental care may lead to expensive complications."

He recommends that adding dental coverage for preventive care to Medicare could pay off in terms of both improving the oral health of the elderly population and limiting the costs of expensive nonpreventive dental care for the dentate beneficiary population.

Moeller and colleagues Haiyan Chen, MD, PhD, research assistant professor, and Richard Manski, DDS, PhD, MBA, professor, conducted the study because younger people have primarily been the focus of previous studies of the impact of preventive dental care visits. "We felt that insufficient attention has been paid to the possibility that preventive dental care may limit expensive nonpreventive dental care procedures among an older population," the team wrote.

To fill the information gap, the team identified characteristics of older adults who used preventive and nonpreventive dental care as well as those who used no dental care at all, using data from the Medicare Current Beneficiary Survey. MCBS is a continuous, multipurpose survey of a nationally representative sample of aged, disabled, and institutionalized Medicare beneficiaries.

MCBS, sponsored by the Centers for Medicare Medicaid Services, is the only comprehensive source of information on the health status, health care use, health insurance coverage, and socioeconomic and demographic characteristics of the entire spectrum of Medicare beneficiaries._

Dental Implants Can be Successful with Less Root than Crown

2011-02-02T13:58:00.000-08:00

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Dental implants are now a common way to replace a tooth. But a dentist must first determine that an implant restoration can be successful for a particular patient. As an indicator, dentists use the crown-to-root ratio—how much of the tooth extends above the jawbone and how much is in the bone. However, the ideal crown-to-implant ratio for the replacement tooth has yet to be determined.

A new study in the current issue of the Journal of Oral Implantology evaluated the health of implants that had been in place more than 5 years. By examining the crown-to-implant ratios in these cases, the authors found that this factor was not as important to the success of implants as previously thought.

Radiographs were used to examine 309 single-tooth short-length implant-supported restorations in 194 patients. All the implants had been surgically placed between February 1997 and December 2005.

The ideal crown-to-root ratio for a tooth to serve as an abutment for a partial denture is considered 1 to 2—twice as much root as crown. But previous studies have given mixed results about ratios for implanted teeth. Excessive crown-to-implant ratios have been named as detrimental to long-term survival of an implant, while disproportionate ratios have been noted in high rates of implant survival.

The current study found an average crown-to-implant ratio of 2 to 1. Natural teeth with such ratios would often be recommended for extraction and replacement. The authors found that stable implants could be produced with less of the tooth serving as root. Additionally, the study found no statistically significant relationship between increasing crown-to-implant ratios and decreasing bone-to-implant contact levels around the implant.

Full text of the article, “Crown-to-Implant Ratios of Short-Length Implants,” Journal of Oral Implantology, Vol. 36, No. 6, 2010, is available at http://www2.allenpress.com/pdf/orim-36-06-425-433.pdf.

Odontoblast cells are part of the immune system and fight to protect teeth from decay

2011-01-24T07:01:00.000-08:00

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It is known that teeth can protect themselves, to some extent, from attack by bacteria but that inflammation within a tooth can be damaging and, in extreme cases, lead to abscess or death of the tooth. New research published in BioMed Central's open access journal BMC Immunology shows that odontoblast cells are part of the immune system and fight to protect teeth from decay.

Inside a tooth odontoblast cells sit between the enamel and pulp and produce a layer of dentin to protect the pulp from wear and infection. This research shows that, when under attack from bacteria, the odontoblast cells also orchestrate an immune response, producing antimicrobial peptides (β-defensins) to fight the infection directly, protein messengers (chemokines) which recruit white blood cells to the site of infection, and pro-inflammatory signalling proteins (IL-1β, IL-1α, and TNF-α) which, in turn, initiate an inflammatory response.

Dr Orapin Horst also found that the odontoblast layer produced proteins involved in the down-regulation of this inflammatory response, such as toll-interacting protein (TOLLIP), TGF-β, and IL-10, which help protect the underlying pulp from inflammatory damage.

Dr Horst says that "For the first time we now have targets to control irreversible inflammatory damage to teeth."

Healthy gums may lead to healthy lungs

2011-01-18T13:25:00.000-08:00

Maintaining healthy teeth and gums may reduce risk for pneumonia, chronic obstructive pumonary disease

Maintaining periodontal health may contribute to a healthy respiratory system, according to research published in the Journal of Periodontology. A new study suggests that periodontal disease may increase the risk for respiratory infections, such as chronic obstructive pulmonary disease (COPD) and pneumonia. These infections, which are caused when bacteria from the upper throat are inhaled into the lower respiratory tract, can be severely debilitating and are one of the leading causes of death in the U.S.

The study included 200 participants between the ages of 20 and 60 with at least 20 natural teeth. Half of the participants were hospitalized patients with a respiratory disease such as pneumonia, COPD, or acute bronchitis, and the other half were healthy control subjects with no history of respiratory disease. Each participant underwent a comprehensive oral evaluation to measure periodontal health status.

The study found that patients with respiratory diseases had worse periodontal health than the control group, suggesting a relationship between respiratory disease and periodontal disease. Researchers suspect that the presence of oral pathogens associated with periodontal disease may increase a patient's risk of developing or exacerbating respiratory disease. However, the study authors note that additional studies are needed to more conclusively understand this link.

"Pulmonary diseases can be severely disabling and debilitating," says Donald S. Clem, DDS, President of the American Academy of Periodontology. "By working with your dentist or periodontist, you may actually be able to prevent or diminish the progression of harmful diseases such as pneumonia or COPD. This study provides yet another example of how periodontal health plays a role in keeping other systems of the body healthy."

Periodontal disease is a chronic inflammatory disease that affects the gum tissue and other structures supporting the teeth. Previous research has associated gum disease with other chronic inflammatory diseases such as diabetes, cardiovascular disease, and rheumatoid arthritis.

Dr. Clem stressed the importance of routine oral care in helping to prevent periodontal disease. "Taking good care of your periodontal health involves daily tooth brushing and flossing. You should also expect to get a comprehensive periodontal evaluation every year," he advised. A dental professional, such as a periodontist, a specialist in the diagnosis, treatment and prevention of gum disease, can conduct a comprehensive exam to assess your periodontal disease status.

New device set to combat fear of the dentist's drill

2011-01-10T13:23:00.000-08:00

An innovative device which cancels out the noise of the dental drill could spell the end of people's anxiety about trips to the dentist, according to experts at King's College London, Brunel University and London South Bank University, who pioneered the invention.

It is widely known that the sound of the dental drill is the prime cause of anxiety about dental treatment, and some patients avoid trips to the dentist because of it. This new device could help address people's fears and encourage them to seek the oral healthcare treatment they need.

The prototype device works in a similar way to noise-cancelling headphones but is designed to deal with the very high pitch of the dental drill. Patients would simply unplug their headphones, plug the device into their MP3 player or mobile phone, and then plug the headphones into the device, allowing them to listen to their own music while completely blocking out the unpleasant sound of the drill and suction equipment. The patient can still hear the dentist and other members of the dental team speaking to them but other unwanted sounds are filtered out by the device.

Containing a microphone and a chip that analyses the incoming sound wave, the device produces an inverted wave to cancel out unwanted noise. It also uses technology called 'adaptive filtering' where electronic filters lock onto sound waves and removes them, even if the amplitude and frequency change as the drill is being used.

The device was initially the brainchild of Professor Brian Millar at King's College London's Dental Institute who was inspired initially by carmaker Lotus' efforts to develop a system that removed unpleasant road noise, while still allowing drivers to hear emergency sirens. Then with over a decade of collaboration with engineering researchers at Brunel University and London South Bank University, a prototype has been designed, built and successfully evaluated.

Although the product is not yet available to dental practitioners, King's is calling for an investor to help bring it to market. Professor Brian Millar said: "Many people put off going to the dentist because of anxiety associated with the noise of the dentist's drill. But this device has the potential to make fear of the drill a thing of the past.

"The beauty of this gadget is that it would be fairly cost-effective for dentists to buy, and any patient with an MP3 player would be able to benefit from it, at no extra cost. What we need now is an investor to develop the product further, to enable us to bring this device to as many dental surgeries as possible, and help people whose fear of visiting the dentist stops them from seeking the oral healthcare they need."

HHS and EPA announce new scientific assessments and actions on fluoride

2011-01-10T10:47:00.000-08:00

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Agencies working together to maintain benefits of preventing tooth decay
while preventing excessive exposure

The U.S. Department of Health and Human Services (HHS) and the U.S. Environmental Protection Agency (EPA) today are announcing important steps to ensure that standards and guidelines on fluoride in drinking water continue to provide the maximum protection to the American people to support good dental health, especially in children. HHS is proposing that the recommended level of fluoride in drinking water can be set at the lowest end of the current optimal range to prevent tooth decay, and EPA is initiating review of the maximum amount of fluoride allowed in drinking water.

These actions will maximize the health benefits of water fluoridation, an important tool in the prevention of tooth decay while reducing the possibility of children receiving too much fluoride. The Centers for Disease Control and Prevention named the fluoridation of drinking water one of the ten great public health achievements of the 20th century.

“One of water fluoridation’s biggest advantages is that it benefits all residents of a community—at home, work, school, or play,” said HHS Assistant Secretary for Health Howard K. Koh, MD, MPH. “Today’s announcement is part of our ongoing support of appropriate fluoridation for community water systems, and its effectiveness in preventing tooth decay throughout one’s lifetime.”

“Today both HHS and EPA are making announcements on fluoride based on the most up to date scientific data,” said EPA Assistant Administrator for the Office of Water, Peter Silva. “EPA’s new analysis will help us make sure that people benefit from tooth decay prevention while at the same time avoiding the unwanted health effects from too much fluoride.”

HHS and EPA reached an understanding of the latest science on fluoride and its effect on tooth decay prevention and the development of dental fluorosis that may occur with excess fluoride consumption during the tooth forming years, age 8 and younger. Dental fluorosis in the United States appears mostly in the very mild or mild form – as barely visible lacy white markings or spots on the enamel. The severe form of dental fluorosis, with staining and pitting of the tooth surface, is rare in the United States.

There are several reasons for the changes seen over time, including that Americans have access to more sources of fluoride than they did when water fluoridation was first introduced in the United States in the 1940s. Water is now one of several sources of fluoride. Other common sources include dental products such as toothpaste and mouth rinses, prescription fluoride supplements, and fluoride applied by dental professionals. Water fluoridation and fluoride toothpaste are largely responsible for the significant decline in tooth decay in the U.S. over the past several decades.

HHS’ proposed recommendation of 0.7 milligrams of fluoride per liter of water replaces the current recommended range of 0.7 to 1.2 milligrams. This updated recommendation is based on recent EPA and HHS scientific assessments to balance the benefits of preventing tooth decay while limiting any unwanted health effects. These scientific assessments will also guide EPA in making a determination of whether to lower the maximum amount of fluoride allowed in drinking water, which is set to prevent adverse health effects.

The new EPA assessments of fluoride were undertaken in response to findings of the National Academies of Science (NAS). At EPA’s request, in 2006 NAS reviewed new data on fluoride and issued a report recommending that EPA update its health and exposure assessments to take into account bone and dental effects and to consider all sources of fluoride. In addition to EPA’s new assessments and the NAS report, HHS also considered current levels of tooth decay and dental fluorosis and fluid consumption across the United States.

The notice of the proposed recommendation will be published in the Federal Register soon and HHS will accept comments from the public and stakeholders on the proposed recommendation for 30 days at CWFcomments@cdc.gov. HHS is expecting to publish final guidance for community water fluoridation by spring 2011. You may view a prepublication version of the proposed recommendation at http://www.hhs.gov/news/press/2011pres/01/pre_pub_frn_fluoride.html. Comments regarding the EPA documents, Fluoride: Dose-Response Analysis For Non-cancer Effects and Fluoride: Exposure and Relative Source Contribution Analysis should be sent to EPA at FluorideScience@epa.gov. The documents can be found at http://water.epa.gov/action/advisories/drinking/fluoride_index.cfm

For more information about community water fluoridation, as well as information for health care providers and individuals on how to prevent tooth decay and reduce the chance of children developing dental fluorosis, visit http://www.cdc.gov/fluoridation. For information about the national drinking water regulations for fluoride, visit: http://water.epa.gov/drink/contaminants/basicinformation/fluoride.cfm

Porphyromonas gingivalis accelerates inflammatory atherosclerosis

2011-01-04T11:49:00.001-08:00

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Atherosclerosis is the leading cause of death in the developed world. While a number of risk factors for atherosclerosis have been defined, scientists continue to study other possible risk factors for this disease. Recent epidemiological and experimental studies link infectious agents with the development of inflammatory atherosclerosis. A hallmark of chronic infection with the oral pathogen Porphyromonas gingivalis is the induction of a chronic inflammatory response. P. gingivalis induces a local inflammatory response that results in oral bone destruction, which is manifested as periodontal disease, an inflammatory disease that affects approximately 100 million people in the US. In addition to chronic inflammation at the initial site of infection, mounting evidence has accumulated supporting a role for P. gingivalis-mediated periodontal disease as a risk factor for systemic diseases including, diabetes, pre-term birth, stroke, and atherosclerotic cardiovascular disease.

In new studies Dr. Caroline Genco together with Dr. James Hamilton at Boston University School of Medicine have begun to define the precise mechanisms contributing to the link between infection with P. gingivalis and atherosclerotic disease. In elegant studies recently published (Atherosclerosis-12-22-10 online publication date) these investigators report on in-vivo high-resolution magnetic resonance imaging (MRI) to document P. gingivalis mediated inflammation and atherosclerosis in a mouse model. MRI is a novel modality that allows for detailed studies of atherosclerosis progression in the same animal that can depict the narrowing of the arterial lumen and small vessel wall areas. Genco and collogues demonstrate that P. gingivalis infection accelerates inflammation and atherosclerosis in the innominate artery, an artery that has a high degree of lesion progression. Lesions in the innominate artery express features characteristic of clinical disease in humans including vessel narrowing characterized by atrophic media and perivascular inflammation and plaque disruption. Plaque rupture is the basis for the coronary thrombosis in acute ischemia. In humans, plaques with extensive macrophage accumulation and inflammation have a greater likelihood of disruption at their luminal surface, and formation of a life-threatening thrombus. Genco's studies are the first to demonstrate progression of plaque in the innominate arteries by in-vivo MRI, and lipid and immunohistochemical analysis following exposure to an infectious agent, and to document protection from plaque progression via immunization. An important question is whether P. gingivalis accelerates atherosclerotic plaque formation in the innominate artery leading to increased numbers of vulnerable plaques, and possibly enhanced plaque rupture. Future studies will explore this possibility as well as the testing of new therapeutic strategies to prevent infection induced atherosclerotic disease.

A New Method Is Developed For Predicting Shade Improvement After Teeth Bleaching

2010-12-22T11:25:00.000-08:00

This is the first time that scientists manage to predict the outcome of bleaching treatments, which will certainly have an important impact on these treatments, which are becoming frequent

Researchers at the University of Granada have developed a new method for predicting the precise shade that a bleaching treatment will bring about for a patient’s teeth. What is innovative about this method is that it allows researchers to successfully predict the outcome of a bleaching treatment, which will have a significant impact on such treatments, which are becoming more frequent.

At present, dental offices routinely employ carbomide peroxide bleaching agents for tooth discoloration. As bleaching treatments have soft side effects –all of them temporary and mild– and are relatively cost-effective, they have become very popular.

While bleaching treatments have been long applied, one of its main problems has been the inability to predict the outcome of the process. This means that, so far, dentists have been unable to predict the results for patients’ teeth. This means that dental physicians could not inform their patients on the shade improvement that the treatment would bring about, which was a limitation to the therapy.

The study was conducted by Janiley Santana Díaz, at the Department of Stomatology of the University of Granada and was coordinated by professors Rosa Mª Pulgar Encinas, Mª Del Mar Pérez Gómez and Luis Javier Herrera Maldonado. Using a fuzzy rule system, scientists had a first approach to the shade improvement that teeth can get after undergoing a 20% carbamide peroxide treatment (Opalescence® PF 20%, Ultradent) two hours a day for two weeks.

Participants

For the purpose of this study, authors took a sample of 53 subjects that subsequently underwent a teeth bleaching treatment. Before the bleaching treatment, participants answered a questionnaire on their eating habits so that scientists analyzed whether such habits had any impact on the prediction models. The researchers found that eating habits are not relevant to such models, so these factors where not considered in the study.

To illustrate the shade change expected after the teeth bleaching treatment, the University of Granada researchers designed a fuzzy system that allows to associate these instrumental measures to the commercial shade guides typically used at dental offices to identify the before-and-after tooth color.

Such association allows to establish a series of objective guidelines that, once the before-tooth color is identified with the closest shade of the guide, will allow both dentist and patient to predict the color that the teeth will get after the treatment.

All in all, researchers warn that, in the long term and given the limitation of any clinical trial, a wider range of patients and initial tooth colors would be required to obtain a more precise fuzzy system.

The protective shield fluoride forms on teeth is up to 100 times thinner than previously believed

2010-12-16T11:15:00.000-08:00

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In a study that the authors describe as lending credence to the idiom, "by the skin of your teeth," scientists are reporting that the protective shield fluoride forms on teeth is up to 100 times thinner than previously believed. It raises questions about how this renowned cavity-fighter really works and could lead to better ways of protecting teeth from decay, the scientists suggest. Their study appears in ACS' journal Langmuir.

Frank Müller and colleagues point out that tooth decay is a major public health problem worldwide. In the United States alone, consumers spend more than $50 billion each year on the treatment of cavities. The fluoride in some toothpaste, mouthwash and municipal drinking water is one of the most effective ways to prevent decay. Scientists long have known that fluoride makes enamel — the hard white substance covering the surface of teeth — more resistant to decay. Some thought that fluoride simply changed the main mineral in enamel, hydroxyapatite, into a more-decay resistant material called fluorapatite.

The new research found that the fluorapatite layer formed in this way is only 6 nanometers thick. It would take almost 10,000 such layers to span the width of a human hair. That's at least 10 times thinner than previous studies indicated. The scientists question whether a layer so thin, which is quickly worn away by ordinary chewing, really can shield teeth from decay, or whether fluoride has some other unrecognized effect on tooth enamel. They are launching a new study in search of an answer.

ARTICLE: "Elemental Depth Profiling of Fluoridated Hydroxyapatite: Saving Your Dentition by the Skin of Your Teeth?"

University of Maryland Dental School Stepping Up Ergonomics Instruction

2010-12-14T15:17:00.000-08:00

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In response to a high prevalence of neck and back pain among working dentists and dental hygienists, the dean of the University of Maryland Dental School Christian S. Stohler, DMD, DrMedDent, has launched an initiative to bring renewed attention to ergonomics into dental education.

Starting with the current semester, every incoming student must take the School’s course “Ergonomics in Dentistry,” before he or she can practice simulations or live-patient dental work. The School wants to be the place where dentists and dental hygienists learn to practice ergonomically correct practices, says Stohler.

“Three out of every five dentists live with the pain,” due to years of practicing with poor posture and other unwise positioning, guest lecturer Lance Rucker, DDS, director of clinical ergonomics and simulation at the University of British Columbia, told this year’s incoming class.

Stohler recruited Rucker as the world’s leading authority on dentistry ergonomics to kick off its course with a lecture and workshops. He greeted the new students with, “If you want to be a healthy, well-postured individual, statistically you have chosen the wrong profession. However, you do have a choice.”

Studies in the U.S. and in Canada over the past 37 years have underscored the need for dentists to adopt more ergonomically correct equipment and positioning, Rucker explained. He said that two-thirds of dentists lose days of practice each year by avoidable muscular skeletal pain.

Retired professor Michael Belenky, DDS, MPH, has taught what he refers to as human center ergonomics at the School for many years,” We first ask a student to identify how he or she would like to stand or sit for optimal visual and physical comfort and effectiveness,” says Belenky “Many dentists eventually need years of physical therapy, go to a chiropractor or even have surgery, but seldom do you hear about the need for preventive solutions, the etiology of the problem.”

Norman Bartner, DDS, a clinical assistant professor who leads the upgraded course, (above with students) says, “We are widely recognized as the no. 1 dental school in the country. Now we want to be known as the School that graduates students with the longest careers, greatest earning capacity, and enjoy the most leisure time because they are healthy.” He added, “This should increase alumni financial support for the School as well.”

Bartner and Belenky have created an instructional video that begins with dentists who have been forced from the profession with musculo-skeletal problems, due to poor ergonomic working conditions.

Bartner says, “I don’t want students developing musculo-skeletal problems from chronic stress on the neck, shoulder, high back, and low back. We start all the dental students off with knowing the proper posture as a dentist for avoiding such career-limiting problems.”

For Your Teeth, Thanksgiving Dinner Is a Real Food Fight

2010-12-13T09:28:00.000-08:00

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If you're lucky, it will all be kisses and hugs around the Thanksgiving dinner table, with friends and family near and dear gathered about, and puppies at your feet waiting for table scraps.

But peace won't reign within the confines of the oral cavity, where Streptococcus mutans and other harmful bacteria will await their own holiday feast. Your meal will enable S. mutans to launch one of its biggest assaults of the year on your tooth enamel.

New work by dental researchers at the University of Rochester Medical Center brings both good and bad news. While bacterial forces in your mouth will exploit your delectables in newly discovered ways, some foods common at the holiday dinner table -- like the cranberry and even wine -- offer new leads in the effort to stop tooth decay.

The Thanksgiving Day battle for oral health hinges on microbes like S. mutans. Most cookies, pies and the like contain mountains of sugar, but it's not the sugar itself that causes tooth decay. Rather, S. mutans and other bacteria in our mouths -- billions of individual microbes all waiting for their next snack -- feast on the sugars, stick on your teeth and then churn out acid that eats away at tooth enamel.

At the front lines is Hyun "Michel" Koo, D.D.S, Ph.D., a dentist turned food scientist and microbiologist who is both exploring the destructive power of S. mutans and scouring foods and natural substances to harness their ability to prevent cavities. With every portion of bad news he delivers about cavities comes good news about compounds that may help prevent tooth decay.

"Natural substances offer tremendous possibilities for stopping tooth decay," said Koo, who earlier this year received a $1.6 million from the National Institute of Dental and Craniofacial Research to conduct his research. "Our time spent in the laboratory is aimed at harnessing the potential of some of these compounds, perhaps eventually incorporating them into a toothpaste or mouth rinse to stop dental decay."

Good news at the dinner table

Koo is hot on the trail of the cranberry as a potential ally in the fight against S. mutans, which is a threat to our teeth primarily because of its ability to form plaque. What appears to us as sticky white gunk along our teeth is actually a formidable fortress of molecules known as glucans -- building blocks of plaque, stacked like bricks in a wall, rife with bacteria. It's a gunky fortress that covers the tooth and gives bacteria a safe haven to munch on sugar, thrive, and churn out acid.

Koo has discovered that compounds within the cranberry disrupt enzymes known as glucosyltransferases that bacteria use to build glucans. Without its glucans, S. mutans and other bad bacteria in plaque becomes vulnerable.

Together with Nicholi Vorsa, Ph.D., director of the Philip E. Marucci Center for Blueberry and Cranberry Research and Extension at Rutgers University, Koo is working to isolate the compounds within the cranberry that are most protective. The pair has identified molecules known as A-type proanthocyanidins as having potential to reduce cavities dramatically. Earlier this year in the journal Caries Research, the team reported that when the molecules were applied, glucan and acid production by S. mutans was reduced by up to 70 percent, and cavity formation in rats was slashed by up to 45 percent.

"Maintaining the natural balance of resident flora in the oral cavity is important for keeping opportunistic pathogens in check," said Koo, a researcher in the Center for Oral Biology and an associate professor in the Eastman Institute for Oral Health and the Department of Microbiology and Immunology. "These molecules don't outright kill S. mutans. Instead, they disrupt the two most harmful actions of this pathogenic organism, acid production and glucan production."

More good news

More good news comes from that delicious glass of wine, or at least the waste in its wake. With funding from the U.S. Department of Agriculture, Koo began a research project with Olga I. Padilla-Zakour, Ph.D., associate professor of Food Processing at the New York Agricultural Experiment Station of Cornell University. They found that the abundant waste from the red-wine-making process -- materials such as fermented seeds and skins collectively known as pomace that are cast away after grapes are pressed -- contains compounds that fight S. mutans. In particular, some polyphenols can inhibit the activity of S. mutans' crucial enzymes by as much as 85 percent and also reduce the amount of acid the bacteria produce.

And the bad news

Last month in PloS One, Koo showed that S. mutans is even more powerful than scientists have realized, responding readily to changing environmental conditions in the presence of starch and sucrose to thrive in the mouth.

In work led by Marlise Klein, D.D.S., Ph.D., research assistant professor, Koo's team analyzed the activity of more than 300 genes in S. mutans under changing conditions. The team found that certain key proteins boost their activity dramatically in the presence not only of sugar but also complex carbohydrates derived from starch digestion. Once the body's own amylase enzymes naturally present in saliva break down starches, S. mutans kicks its glucan-forming machinery into high gear.

"The new research shows how two pillars of the modern diet, starch and sugar, can work cooperatively to bring about tooth decay," said Koo. "A cookie, sugar-covered doughnut, or a piece of pie filled with both sugar and starch provide the perfect recipe for the bacteria that destroy teeth."

Even when the amount of sugar was slashed in half, certain genes central to the ability of S. mutans to create its formidable glucan fortress boosted their activity five-fold in the presence of starch-derived carbohydrates. That enabled the bacteria to create plaque that is hardier, stickier, and capable of producing more acid than plaque created without significant starch present.

On Thanksgiving Day ……

Koo notes people shouldn't simply eat more cranberry sauce or drink more wine to try to prevent cavities. His work is aimed at identifying and then exploiting specific compounds that give the benefit without, for instance, the high levels of acidity or the added sugar that cranberry products might include. Rather, at this point, everything your dentist keeps telling you remains the best advice to prevent cavities.

"On Thanksgiving Day, like any day, brush your teeth, avoid foods filled with sugars as best you can, and don't snack often -- and if you do, brush your teeth again," said Koo. "Consider using a mouth rinse, get some fluoride in there -- and be sure to see a dentist regularly."

Scientists and Citizens Opposed to Mercury Fillings Urge FDA Panel to Restrict Amalgam PR Newswire

2010-12-10T09:20:00.000-08:00

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FDA Device Division, still concerned about mercury toxicity in American dentistry, is convening yet another professional panel review regarding safety issues. A nationwide convergence of scientists, dental and medical professionals, lead by the International Academy of Oral Medicine and Toxicology (IAOMT) are provoking new challenges to the Food and Drug Administration's (FDA) July'09 "no risk" classification of mercury fillings . The Holiday Inn, Gaithersburg MD is the site of FDA's Dental Products Panel meeting December 14 & 15 where scientific and public testimony will be presented.

The use of mercury fillings, deceptively called "silver" by the dental profession, has been controversial since introduced more than 150 years ago, simply because they contain 50% mercury, a known poison which is neurotoxic. A 2006 Zogby poll indicated that 76% of Americans were not aware that their silver fillings contained mercury, and would have chosen non-mercury fillings had they been advised of the mercury content known to be poisonous to every living cell.

Denmark, Sweden and Norway have already banned dental amalgam use, while other countries, including Canada, Germany, France and Italy, have restricted the use of dental amalgam for children, pregnant women, mothers who are breast feeding, people with kidney problems, and/or individuals with mercury sensitivity.

In 2006 FDA convened a joint meeting of its dental and neurology panels asking approval of the FDA "White Paper" which declared mercury fillings were not a danger. In an unlikely turn of events, the Joint Panel voted13 to 7 rejecting the FDA's contention. Despite the fact that FDA had no scientific support of their claim, three years later in July 2009 the FDA strongly endorsed the safety of mercury fillings, still with no credible scientific evidence that the general or vulnerable populations were not at risk.

The FDA's nearly unprecedented hearing next week on the claims of safety versus danger was prompted by a Petition for Reconsideration prepared by the IAOMT's attorneys Jim Love and Bob Reeves, which pointed out that FDA's past reporting of dental mercury disregarded the harm of mercury dosages on the vulnerable population of smaller size and lighter weight children, relying on improper assumptions and outdated reviews of scientific literature.

A new risk assessment by Dr. Mark Richardson and his colleagues at SNC-Lavalin Environmental sent to FDA by Love last month concludes that the mercury vapor from fillings is absorbed and distributed into every tissue and organ in the body including the brain, resulting in excessive exposure of this poison to 122 million Americans. The risk assessment proves that mercury from all sources such as fillings, vaccines, and fish is cumulative and compounded by other toxins particularly lead.

Matthew Young DDS, President of the IAOMT emphasized: "The cumulative dose and health effects of mercury from all sources will eventually force a ban on all optional use of this toxic metal. Mercury based fillings are the greatest contributor to mercury exposure in humans according to this recent risk assessment and the World Health Organization's Mercury Policy Report." Young calls for a ban now instead of years from now, stating "the elimination of mercury fillings will be the greatest health benefit to humankind."

Expecting? Don’t Neglect Your Teeth

2010-11-24T12:34:00.001-08:00

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The effects of pregnancy on oral health

Even though most people are aware that good oral health is essential for the overall health of both mother and child, misunderstandings about the safety of dental care during pregnancy may cause pregnant women to avoid seeing their dentist. The fact is that dentists can create a treatment plan that is safe, effective, and essential for combating the adverse effects of oral disease during pregnancy.

During the course of pregnancy, a woman’s oral health can undergo significant changes. According to an article published in the November/December 2010 issue of General Dentistry, the peer-reviewed clinical journal of the Academy of General Dentistry (AGD), pregnant women can experience gingivitis, pregnancy tumors, and mild to severe gingival enlargement.

Clinically, pregnancy gingivitis is no different than non-pregnancy gingivitis. Patients will experience redness and inflammation of the gums, bleeding on probing, and increased tooth mobility. Between 30 and 100 percent of pregnant women will experience varying degrees of gingivitis.

“Although bleeding and inflammation of the gums has been noted in all trimesters of pregnancy, it typically disappears three to six months after delivery, provided that proper oral hygiene measures are implemented,” says Crystal L. McIntosh, DDS, MS, lead author of the article. “Good oral hygiene and visits to a dentist can help to alleviate gum inflammation.”

Pregnancy tumors are reported by 10 percent of pregnant women. These tumors, which are not cancerous, appear as a growth in the mouth and usually disappear after the child is born. They typically are painless and purple or red in color, but they can exhibit spontaneous bleeding.

“If a pregnancy tumor is painful, bleeds severely, or interferes with eating, surgical removal is the treatment of choice,” says AGD spokesperson Robert Roesch, DDS, MAGD.

Gingival enlargement, which is an overgrowth or an increase in the size of the gums, occurs less frequently than gingivitis and pregnancy tumors. In severe cases, the gums can “grow” to cover the teeth completely.

“Pregnancy gingivitis and gingival enlargement are thought to be the result of a heightened response to bacteria in the mouth,” says Dr. Roesch. “That’s why it is extremely important to educate and motivate patients to maintain good oral hygiene during pregnancy.”

If proper oral hygiene is not initiated prior to or during pregnancy, conditions such as gingivitis, pregnancy tumors, and gingival enlargement can worsen as the pregnancy progresses. Pregnant women should maintain their regular, semi-annual checkups and consult a dentist if they notice any changes in their oral health.Expecting? Don’t Neglect Your Teeth
The effects of pregnancy on oral health

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CHICAGO (November 23, 2010) – Even though most people are aware that good oral health is essential for the overall health of both mother and child, misunderstandings about the safety of dental care during pregnancy may cause pregnant women to avoid seeing their dentist. The fact is that dentists can create a treatment plan that is safe, effective, and essential for combating the adverse effects of oral disease during pregnancy.

During the course of pregnancy, a woman’s oral health can undergo significant changes. According to an article published in the November/December 2010 issue of General Dentistry, the peer-reviewed clinical journal of the Academy of General Dentistry (AGD), pregnant women can experience gingivitis, pregnancy tumors, and mild to severe gingival enlargement.

Clinically, pregnancy gingivitis is no different than non-pregnancy gingivitis. Patients will experience redness and inflammation of the gums, bleeding on probing, and increased tooth mobility. Between 30 and 100 percent of pregnant women will experience varying degrees of gingivitis.

“Although bleeding and inflammation of the gums has been noted in all trimesters of pregnancy, it typically disappears three to six months after delivery, provided that proper oral hygiene measures are implemented,” says Crystal L. McIntosh, DDS, MS, lead author of the article. “Good oral hygiene and visits to a dentist can help to alleviate gum inflammation.”

Pregnancy tumors are reported by 10 percent of pregnant women. These tumors, which are not cancerous, appear as a growth in the mouth and usually disappear after the child is born. They typically are painless and purple or red in color, but they can exhibit spontaneous bleeding.

“If a pregnancy tumor is painful, bleeds severely, or interferes with eating, surgical removal is the treatment of choice,” says AGD spokesperson Robert Roesch, DDS, MAGD.

Gingival enlargement, which is an overgrowth or an increase in the size of the gums, occurs less frequently than gingivitis and pregnancy tumors. In severe cases, the gums can “grow” to cover the teeth completely.

“Pregnancy gingivitis and gingival enlargement are thought to be the result of a heightened response to bacteria in the mouth,” says Dr. Roesch. “That’s why it is extremely important to educate and motivate patients to maintain good oral hygiene during pregnancy.”

If proper oral hygiene is not initiated prior to or during pregnancy, conditions such as gingivitis, pregnancy tumors, and gingival enlargement can worsen as the pregnancy progresses. Pregnant women should maintain their regular, semi-annual checkups and consult a dentist if they notice any changes in their oral health.

Osteoporosis Drug Builds Bone in Patients With Gum Disease

2010-11-24T12:17:00.000-08:00

Science News
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A drug marketed to grow bone in osteoporosis patients also works to heal bone wounds in gum disease patients, a University of Michigan study suggests.

"This new approach for the treatment of periodontal disease could allow us to rebuild some of the bone that is lost due to periodontal disease, which until this point has been very difficult to achieve," said Jill Bashutski, clinical assistant professor at the U-M School of Dentistry and first author on the study. "Current treatments to re-grow bone around teeth affected with gum disease have limited success rates."

The findings are significant because gum disease is the leading cause of tooth loss in adults and is associated with a host of other health problems. Periodontal disease results in loss of teeth and can be devastating because it compromises speaking as well as eating, which can in turn contribute to poor nutrition.

The generic name of the drug is teriparatide and it is marketed by Eli Lilly and Co. under the trade name Forteo. It's a type of parathyroid hormone and the only anabolic (meaning it grows bone) osteoporosis drug approved on the market in the United States. Typically, osteoporosis drugs work by preventing bone loss.

The study appears online in the New England Journal of Medicine Oct. 16 and in the print edition Oct. 28. The study was presented Oct. 16 in Toronto at the annual meeting of the American Society for Bone and Mineral Research.

The study took place at the School of Dentistry's Michigan Center for Oral Health Research, where patients with severe chronic gum disease received the traditional treatment for gum disease, which is periodontal surgery on one-quarter of the mouth. Half of the patients took a six-week course of teriparatide by injection into the skin over the abdomen or stomach, plus calcium and vitamin D supplements, while the other half received a placebo.

After one year, researchers saw a 29 percent improvement in bone-level measurements on x-rays in the teriparatide group, versus a 3 percent improvement in the placebo group, a 10-fold increase.

"I think one really interesting aspect of this study is that even a short dosing of this drug had benefits that lasted a year," said Laurie McCauley, U-M professor and chair of periodontics and oral medicine, and principal investigator on the study.

McCauley's research lab has spent nearly two decades studying how parathyroid hormone works. Animal models suggest that it works even better in certain bone wound-healing situations, such as those that involve surgery, than in osteoporosis, which is a diminishing of the bone rather than a wound.

"There was speculation that the bone that forms in a wound like a fracture or inflammatory disease condition might be more responsive to being built back than other bone," said McCauley, who noted that this proved true in the experimental group.

McCauley said the next step is for U-M researchers to test whether the treatment could be delivered locally to target site-specific bone healing. Forteo is not FDA approved for uses other than osteoporosis, but another possible application could be to help grow bone around dental implants.

Taking a Closer Look at Plaque

2010-11-24T11:25:00.001-08:00

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A team of University of Rochester scientists is using the technique of Raman spectroscopy to study two common dental plaque bacteria, Streptococcus sanguis and mutans. The relative balance of the two may be an indicator of a patient's oral health and risk for tooth decay -- Streptococcus sanguis is associated with "healthy" plaque, while mutans is associated with tooth decay.

Raman spectroscopy offers the potential to analyze samples of the bacterium in a simple, rapid and quantitative manner as compared to microbiology techniques, including the ability to study spatial distributions of bacterial species, living or dead, within samples.

"We're using Raman spectroscopy to study these oral bacterial biofilms, essentially observing how two species scatter light into shifted wavelengths in a unique way. We can then use these characteristic spectra to identify 'unknown' samples of these species," says Brooke Beier, a Ph.D. candidate at the University of Rochester's Institute of Optics. "Studying the spatial distributions of the good vs. bad bacteria under various growth conditions may help scientists determine more effective treatments to prevent tooth decay."

With the ability to identify biofilm samples by species, the researchers can now move on to the study of biofilms grown from a mixture of liquid cultures, where the two species may interact as they grow together.

Substantial Consumption of Fluoride Increases Chance of Mild Fluorosis

2010-11-24T06:50:00.000-08:00

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Young children who consume substantial amounts of fluoride through infant formula and other beverages mixed with fluoridated water or by swallowing fluoride toothpaste have an increased chance of developing mild enamel fluorosis, according to research published in the October issue of The Journal of the American Dental Association and supported by the National Institute of Dental and Craniofacial Research. However, experts say, children can continue using fluoridated water and fluoride toothpaste because fluoride has been proven to prevent tooth decay, and mild fluorosis does not negatively affect dental health or quality of life.

"Nearly all of the fluorosis in our study participants was mild. A recent review of the effects of mild dental fluorosis on oral health-related quality of life concluded that the effect of mild fluorosis was not adverse and could even be favorable," according to the study. "This suggests that concerns about mild dental fluorosis may be exaggerated. Therefore, no general recommendations to avoid use of fluoridated water in reconstituting infant formula are warranted. "

According to the American Dental Association, mild enamel fluorosis appears as barely noticeable faint white lines or streaks on tooth enamel that may occur when children ingest excess fluoride while their teeth are developing.

Researchers concluded that substantial fluoride consumption from beverages with fluoridated water, including infant formula, by children between the ages of 3 to 9 months, elevates a child's prospect of developing mild enamel fluorosis. Substantial fluoride consumption from beverages with fluoridated water and from fluoride toothpaste by children between the ages of 16 to 36 months also elevates a child's probability of developing mild enamel fluorosis.

The American Academy of Pediatrics recommends breastfeeding for infants. If parents are concerned about reducing the chances of their infants developing mild fluorosis through consuming substantial amounts of infant formula mixed with fluoridated water, the researchers suggest that they consult with their family dentist or physician. The researchers also encourage parents to follow recommendations to use small (smear or pea-sized) amounts of fluoridated toothpaste and ensure proper supervision of the child's tooth brushing.

Researchers recruited mothers of newborn infants from eight Iowa hospital postpartum wards between 1992 and 1995 for their children's participation in what would become known as the Iowa Fluoride Study, an investigation of dietary and non-dietary fluoride exposures, dental fluorosis and dental cavities. Researchers sent questionnaires to the parents at regular intervals and 630 children underwent visual dental examinations using standardized techniques and portable equipment. The leader of the research team was Steven M. Levy, D.D.S., M.P.H., the Wright-Bush-Shreves Endowed Professor of Research in the Department of Preventive and Community Dentistry at the University of Iowa's College of Dentistry and Professor of Epidemiology at the College of Public Health.

Women who get dental care have lower risk of heart disease, says study

2010-10-05T13:59:00.000-07:00

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A new study led by a University of California, Berkeley, researcher could give women a little extra motivation to visit their dentist more regularly. The study suggests that women who get dental care reduce their risk of heart attacks, stroke and other cardiovascular problems by at least one-third.

The analysis, which used data from nearly 7,000 people ages 44-88 enrolled in the Health and Retirement Study, did not find a similar benefit for men.

Published online Sept. 29 in the journal Health Economics, the study compared people who went to the dentist during the previous two years with those who did not.

"Many studies have found associations between dental care and cardiovascular disease, but our study is the first to show that general dental care leads to fewer heart attacks, strokes, and other adverse cardiovascular outcomes in a causal way," said study lead author Timothy Brown, assistant adjunct professor of health policy and management at UC Berkeley's School of Public Health.

In the world of health and medical studies, causality is typically determined through randomized controlled trials in which two or more groups of people are essentially equal, except for the receipt of a treatment or intervention, such as a new drug, a periodontal procedure or a health education class. The group that did not receive the treatment – the control group – is compared with the group that did. Differences in outcomes between the groups are attributed to the treatment.

But randomized controlled trials are not always possible, so researchers sometimes turn to a statistical approach called the method of instrumental variables to rule out other potential factors that could account for different outcomes between groups. The use of instrumental variables is common among economists to evaluate the effects of economic policies, but it is less well-known in the clinical setting.

"While relatively short randomized controlled trials of specific types of dental treatment are possible, we can't run long-term randomized controlled trials of whether general dental care reduces cardiovascular disease events like heart attacks and strokes," said Brown, a health economist. "Individuals randomized to the treatment group would enjoy general dental care and those randomized to the control group would get no dental care at all. Many, if not most, people in the control group would simply get dental care on their own, destroying the experimental design, and making the results of the experiment worthless. The method of instrumental variables allows us to avoid this problem."

The method helped researchers rule out self-selection bias, or the possibility that people who seek out dental care are different – perhaps healthier in general – than those who don't.

Data from the Health and Retirement Study had been collected every two years from 1996 to 2004. This longitudinal study followed the same individuals over time, and each biennial survey included questions on whether subjects had visited the dentist and whether they had experienced a heart attack, stroke, angina or congestive heart failure during the prior two years. Deaths from heart attacks or strokes were also included in the analysis. The study took into account other risk factors, such as alcohol and tobacco use, high blood pressure and body mass index.

The fact that men and women did not benefit equally from dental care did not completely surprise the researchers. "To my knowledge, previous studies in this area have found that the relationship between poor oral health and cardiovascular disease markers varies by gender, but none have examined differences between men and women with regard to actual cardiovascular disease events," said Brown, who is also associate director of research at UC Berkeley's Nicholas C. Petris Center on Health Care Markets & Consumer Welfare.

"We think the findings reflect differences in how men and women develop cardiovascular disease," said study co-author Dr. Stephen Brown, a first-year obstetrician/gynecologist resident at the West Virginia University Charleston Division School of Medicine. "Other studies suggest that estrogen has a protective effect against heart disease because it helps prevent the development of atherosclerosis. It's not until women hit menopause around age 50 to 55 that they start catching up with men."

The study authors suggest that for dental care to have a protective effect, it should occur early in the development of cardiovascular disease.

The researchers did not have data on the type of procedures used during the dental visit, but they pointed to other studies that indicated three-fourths of older adult dental visits involved preventive services, such as cleaning, fluoride and sealant treatments.

Oral health experts recommend twice-yearly visits to the dentist, as well as brushing and flossing at least twice a day. Those wearing dentures should make sure they stay clean to prevent the growth and buildup of plaque and bacteria.

New approach for treating dry mouth

2010-10-05T13:57:00.000-07:00

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A newly published study in the October 2010 issue of The Journal of the American Dental Association (JADA), conducted at New York University's College of Dentistry, confirms the safety and efficacy of a new novel method for controlling xerostomia, or dry mouth. The double masked, randomized controlled crossover study concludes that use of a unique mucoadhesive patch, affixed to the hard palate inside the mouth, provides statistically significant and sustainable improvements in salivary flow rates and subjective moistness for dry mouth sufferers. An estimated 30 million Americans deal with this uncomfortable oral health condition.

This latest study comes on the heels of another published study (March 2010 issue of Quintessence International) that showed these patches provided better performance for dry mouth sufferers than a leading over-the-counter dry mouth spray.

Chronic dry mouth is an under-diagnosed condition that can have a detrimental effect on oral health by contributing to tooth decay, gum disease and chronic bad breath. It can be a symptom of other medical conditions, such as diabetes or Sjogren's Syndrome, and is also the result of radiation treatment for head and neck cancer, but it is most often a side effect of many prescription and over-the-counter medications taken daily by millions of Americans (34% of people on three or more medications will likely have this condition).

The mucoadhesive patches tested in the study are available to consumers under the brand name OraMoist™ and sold over-the-counter at retailers, such as Rite-Aid and Walgreen's, nationwide. Approximately one centimeter in diameter, the patches can adhere to any oral mucosal surface, such as the roof of the mouth or inside the cheek, and the study confirmed can yield a "statistically significant improvement in baseline subjective and objective measures of dry mouth for up to 60 minutes – and possibly longer – after application."

The JADA study also found that after two weeks of daily use, participants experienced a statistically significant improvement in baseline subjective and objective measures of salivary flow. This, according to the researchers, suggests a sustained effect.

"One of the results was that after two weeks of use of the patch, the amount of saliva in the mouth had increased even during times when there was no patch in the mouth," says the study's lead author A. Ross Kerr, DDS, MSD, clinical associate professor at New York University College of Dentistry. "In other words, the patch would seem to have a cumulative beneficial effect."

According to Dr. Kerr, OraMoist provides an appealing and convenient alternative to other dry mouth treatments, which are usually in spray, rinse or gel form and require the user to replenish when necessary – which can be up to every 20 minutes. Overnight, the sustained effect is of particular benefit.

"The OraMoist patches offer pleasant tasting and longer-lasting option for the management of dry mouth, which becomes a quality of life issue for sufferers," says Dr. Kerr. In this and the Quintessence International study, approximately 70% of participants stated they would use the patch again.

OraMoist Dry Mouth Patch is a time-released mucoadhesive patch that moistens and lubricates the mouth, while simultaneously stimulating saliva production, day or night. . The patch can last for up to four hours and is the only such sustained release dry mouth product available over-the-counter.

The placebo mucoadhesive patches used in this study were made using the same unique, patented technology as the OraMoist patches. Unlike the unloaded placebo patch, the loaded patch, OraMoist, is enhanced by natural ingredients including natural lipids, oral enzymes, citrus oil, sea salt, calcium carbonate, natural lemon and xylitol. According to the company, the researchers behind the patch believe that these additional ingredients also play a role in inhibiting bacterial growth and promoting oral health. Based on the results of this study, further investigation of these benefits is warranted.

The patented mucoadhesive patch technology was developed by Professor Abraham J. Domb, PhD, Institute of Drug Research, School of Pharmacy, Faculty of Medicine at the Hebrew University. Dr. Domb is a leading worldwide authority on mucoadhesive technology/bio-degradable polymer research. The same patch technology has also been successfully adapted for the treatment of aphtous ulcers, or canker sores.

JADA Study Findings Summary: Use of Mucoadhesive Patch for Relief of Chronic Dry Mouth

Significant increase in objectively-measured salivary flow rates in those using OraMoist

A "sustained effect" for OraMoist – the patients using it benefited more on their 4th and 5th weeks than on their 3rd; increased baseline of improvement

96% of patients said OraMoist was easy to use; 82% said OraMoist did not interfere with eating or talking; 74% said the flavor was pleasant.

OraMoist is safe. There were no adverse events reported in the study.

FDA warns three companies to stop making unproven claims on mouth rinses

2010-10-01T06:13:00.001-07:00

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The FDA has issued warning letters to three companies that manufacture and market mouth rinse products with claims that they remove plaque above the gum line or promote healthy gums. These claims suggest the products are effective in preventing gum disease when no such benefit has been demonstrated.

Warning letters were sent to, Johnson & Johnson (Listerine Total Care Anticavity Mouthwash), CVS Corporation (CVS Complete Care Anticavity Mouthwash), and Walgreen Company (Walgreen Mouth Rinse Full Action).

These mouth rinse products contain the active ingredient sodium fluoride. The FDA has determined that sodium fluoride is effective in preventing cavities but has not found this ingredient to be effective in removing plaque or preventing gum disease.

“It is important for the FDA to take appropriate enforcement action when companies make false or unproven product claims to ensure that consumers are not misinformed or misled,” said Deborah Autor, director of the Office of Compliance in FDA’s Center for Drug Evaluation and Research.

Under federal law, a company cannot claim its product is effective in treating a disease unless those claims have been reviewed and approved by the FDA in a new drug application or the active ingredient has been generally recognized as safe and effective for these claims in an over-the-counter (OTC) drug monograph.

The FDA actions are part of the agency’s effort to curtail an increasing number of Federal Food Drug and Cosmetic Act (FFDCA) violations among the makers/marketers of mouthwashes concerning unproven claims of therapeutic benefits.

To date, the FDA is unaware of any injuries or adverse health effects related to the use of these mouth rinse products. Consumers who have these products may continue to use the products for cavity prevention without risk of injury but should be aware that the FDA has no data to show that these products can prevent gum disease.

Companies that received FDA warning letters are required to take appropriate action to correct these violations within 15 days. Failure to do so may result in seizure of the product, or other civil or criminal penalties.

For more information:

EPA Will Propose Rule to Protect Waterways by Reducing Mercury from Dental Offices

2010-10-01T05:23:00.000-07:00

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The U.S. Environmental Protection Agency (EPA) today announced it intends to propose a rule to reduce mercury waste from dental offices. Dental amalgams, or fillings containing mercury, account for 3.7 tons of mercury discharged from dental offices each year. The mercury waste results when old mercury fillings are replaced with new ones. The mercury in dental fillings is flushed into chair-side drains and enters the wastewater systems, making its way into the environment through discharges to rivers and lakes, incineration or land application of sewage sludge. Mercury released through amalgam discharges can be easily managed and prevented.

EPA expects to propose a rule next year and finalize it in 2012. Dental offices will be able to use existing technology to meet the proposed requirements. Amalgam separators can separate out 95 percent of the mercury normally discharged to the local waste treatment plant. The separator captures the mercury, which is then recycled and reused.

Until the rule is final, EPA encourages dental offices to voluntarily install amalgam separators. Twelve states and several municipalities already require the installation of amalgam separators in dental offices.

Approximately 50 percent of mercury entering local waste treatment plants comes from dental amalgam waste. Once deposited, certain microorganisms can change elemental mercury into methylmercury, a highly toxic form that builds up in fish, shellfish and animals that eat fish.

Fish and shellfish are the main sources of methylmercury exposure to humans. Methylmercury can damage children’s developing brains and nervous systems even before they are born.

More information on mercury from dental offices

More information on mercury and the environment

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New technique to reattach teeth using stem cells

2010-09-30T13:19:00.000-07:00

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A new approach to anchor teeth back in the jaw using stem cells has been developed and successfully tested in the laboratory for the first time by researchers at the University of Illinois at Chicago.

The new strategy represents a potential major advance in the battle against gum disease, a serious infection that eventually leads to tooth loss. About 80 percent of U.S. adults suffer from gum disease, according to the National Institute of Dental and Craniofacial Research.

Researchers in UIC's Brodie Laboratory for Craniofacial Genetics used stem cells obtained from the periodontal ligament of molars extracted from mice, expanded them in an incubator, and then seeded them on barren rat molars. The stem cell-treated molars were reinserted into the tooth sockets of rats.

After two and four months, the stem cells aligned and formed new fibrous attachments between the tooth and bone, firmly attaching the replanted tooth into the animal's mouth, said Smit Dangaria, a bioengineering doctoral candidate who conducted the research. Tissue sections showed that the replanted tooth was surrounded by newly formed, functional periodontal ligament fibers and new cementum, the essential ingredients of a healthy tooth attachment.

In contrast, tooth molars that were replanted without new stem/progenitor cells were either lost or loosely attached and were resorbed, Dangaria said.

The study, published in an online issue of the journal Tissue Engineering, was funded through a grant by the National Institutes of Health.

Dangaria said the natural surface of the tooth played an essential role in the study.

"Our research uncovered the code required to reattach teeth -- a combination of natural tooth root surface structure together with periodontal progenitor cells," he said.

To verify that the ligament was formed by the transplanted stem cells and not by the animal's own cells, stem cells were labeled with green fluorescent protein prior to seeding them on the molars and re-inserting the teeth into the animal's mouth, Dangaria said.

According to Tom Diekwisch, director of the Brodie Laboratory, who is senior author on the paper, this is the first progenitor cell-based regeneration of a complete periodontal ligament in which a functional tooth was attached.

"Our strategy could be used for replanting teeth that were lost due to trauma or as a novel approach for tooth replacement using tooth-shaped replicas," said Diekwisch, who is also professor and head of oral biology.

Gum Disease Found to Be Significant Public Health Concern

2010-09-23T12:46:00.001-07:00

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Centers for Disease Control and Prevention and American Academy of Periodontology suggest more American adults may have gum disease; previous estimates underestimate periodontal disease in the US population.

CHICAGO—September 21, 2010—The prevalence of periodontal disease in the United States may be significantly higher than originally estimated. Research published in the Journal of Dental Research from the Centers for Disease Control and Prevention (CDC) and the American Academy of Periodontology (AAP) suggests that the prevalence of periodontal disease may have been underestimated by as much as 50 percent. The implication is that more American adults may suffer from moderate to severe gum disease than previously thought.

In a National Health and Nutrition Examination Survey (NHANES) pilot study, funded by the CDC’s Division of Oral Health, a full-mouth, comprehensive periodontal examination was conducted on over 450 adults over the age of 35. Periodontal disease was classified according to definitions determined by the CDC in collaboration with the AAP. The prevalence rates were then compared against the results of previous NHANES studies which used a partial-mouth periodontal examination. Historically, NHANES has served as the main source for determining prevalence of periodontal disease in US adults. The pilot study finds that the original partial-mouth study methodology may have underestimated true disease prevalence by up to 50 percent.

Periodontal disease is a chronic inflammatory disease that affects the gum tissue and other structures supporting the teeth. If left untreated, it can lead to tooth loss, and may also interfere with other systems of the body. Several research studies have associated gum disease with other chronic inflammatory diseases such as diabetes, cardiovascular disease, and rheumatoid arthritis.

“This study shows that periodontal disease is a bigger problem than we all thought. It is a call to action for anyone who cares about his or her oral health.” said Samuel Low, DDS, MS, associate dean and professor of periodontology at the University of Florida College of Dentistry, and president of the American Academy of Periodontology. “Given what we know about the relationship between gum disease and other diseases, taking care of your oral health isn’t just about a pretty smile. It has bigger implications for overall health, and is therefore a more significant public health problem.”

Dr. Low explained that the increased prevalence of periodontal disease makes it essential to maintain healthy teeth and gums. “Not only should you take good care of your periodontal health with daily tooth brushing and flossing, you should expect to get a comprehensive periodontal evaluation every year,” he advised. A dental professional, such as a periodontist, a specialist in the diagnosis, treatment and prevention of gum disease, will conduct the comprehensive exam to assess your periodontal disease status.

According to Paul Eke, MPH, PhD, epidemiologist at the CDC and lead author of the study, the findings have significant public health implications. “The study suggests we have likely underestimated the prevalence of periodontal disease in the adult US population,” he said. “We are currently utilizing a full-mouth periodontal examination in the 2009/10 NHANES to better understand the full extent and characteristics of periodontal disease in our adult population.” Dr. Eke added, “Research suggests a connection between periodontal health and systemic health. In light of these findings, understanding the relationships between periodontal disease and other systemic diseases in the adult U.S population is more crucial than ever.”

Periodontal therapy may reduce the risk of preterm birth

2010-09-16T13:42:00.001-07:00

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A collaboration led by a periodontal researcher from the University of Pennsylvania School of Dental Medicine has found a possible link between the success of gum-disease treatment and the likelihood of giving birth prematurely, according to a study published in the journal BJOG: An International Journal of Obstetrics and Gynaecology.

While a number of factors are associated with an increased rate of preterm birth, such as low body-mass index, alcohol consumption and smoking, the study adds to the body of research that suggests oral infection may also be associated with such an increase.

The study looked at 322 pregnant women, all with gum disease. Half the group was given oral-hygiene instruction and treated with scaling and root planning, which consists of cleaning above and below the gum line. The second half received only oral-hygiene instruction.

The incidence of preterm birth was high in both the treatment group and the untreated group: 52.4 percent of the women in the untreated control group had a preterm baby compared with 45.6 percent in the treatment group. These differences were not statistically significant.

However, researchers then looked at whether the success of periodontal treatment was associated with the rate of preterm birth. Participants were examined 20 weeks after the initial treatment, and success was characterized by reduced inflammation, no increase in probing depth and loosening of the teeth.

Within the treatment group of 160 women, 49 were classified as having successful gum treatment and only four, or 8 percent, had a preterm baby. In comparison, 111 women had unsuccessful treatment and 69, or 62 percent, had preterm babies.

The results show that pregnant women who were resistant to the effects of scaling and root planning were significantly more likely to deliver preterm babies than those for whom it was successful.

The mean age of the women in the study was 23.7 years; 87.5 percent were African-American, and 90 percent had not seen a dentist for tooth cleaning.

"First and foremost, this study shows that pregnant women can receive periodontal treatment safely in order to improve their oral health," said Marjorie Jeffcoat, professor of periodontics at Penn Dental Medicine and lead author of the paper. "Second, in a high risk group of pregnant women, such as those patients who participated in this study, successful periodontal treatment when rendered as an adjunct to conventional obstetric care may reduce the incidence of preterm birth."

Future papers will address the role of antimicrobial mouth rinses in reducing the incidence of preterm birth.

"Researchers have previously suggested that severe gum infections cause an increase in the production of prostaglandin and tumour necrosis factor, chemicals which are associated with preterm labor," Philip Steer, editor-in-chief of BJOG, said. "This new study shows a strong link between unsuccessful gum-disease treatment and preterm birth; however, we need to bear in mind that 69 percent of women failed to respond to the dental treatment given. Therefore, more effective treatment will need to be devised before we can be sure that successful treatment improves outcome, rather than simply being a marker of pregnancies with a lower background level of inflammation that will go to term anyway."

Asthma and cavities in kids but not linked

2010-09-16T13:08:00.000-07:00

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There is no apparent link between asthma and tooth decay, according to a study published in the September 2010 issue of the Journal of the American Dental Association.

"Is There a Relationship between Asthma and Dental Caries?: A Critical Review of the Literature" examined the 27 separate studies which looked for a link between asthma and cavities that were reported in 29 papers published between 1976 and March 2010.

"The notion that there is a link between asthma and tooth decay may have its origin in anecdotal statements by emergency room workers who see children with poorly managed asthma. These children could also be more likely to have poorly managed dental conditions, and therefore tooth decay. It's reasonable to believe that poor clinical management may be associated with both conditions, not the asthma that is causing the cavities," said Gerardo Maupomé, B.D.S., M.Sc., Ph.D., professor of preventive and community dentistry at the Indiana University School of Dentistry and a Regenstrief Institute affiliated scientist, who is the first author of the new JADA study.

"We found little evidence to suggest that asthma causes tooth decay. In fact, the two largest studies we reviewed found that children with asthma appear to have fewer cavities than others. This may be because their parents are used to taking them to health-care providers, and routinely bring them to the dentist," said Dr. Maupomé.

The large number of variables involved, including severity of asthma symptoms and the variety of types of treatment for the disease, has made it difficult to unequivocally determine whether there is a causal link between the two.

While not apparently associated, tooth decay and asthma are the two most prevalent chronic childhood diseases in the United States.

Routine home and professional dental care are critical for all children. Parents of children with asthma do not need to be concerned about an increased risk of tooth decay but Dr. Maupomé points out that children who use nebulizers to control their asthma may be inadvertently increasing their frequency of exposure to sugars because these nebulizers use fructose to deliver therapy. The frequency and the amount of certain sugars consumed are major factors leading to cavities.

He also recommends that children who are mouth breathers or who have mouth dryness be checked periodically by their dentists. These conditions may be associated with asthma but they are also found in children who do not have asthma. Many medications used for the long term (such as asthma medications) have been found to reduce the amount of saliva, which is the first protection of teeth.

Impact of chemical BPA in dental sealants used in children

2010-09-10T13:23:00.000-07:00

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Researchers from Mount Sinai School of Medicine have found that bisphenol A (BPA) released from some plastic resins used in pediatric dentistry is detectable in the saliva after placement in children's mouths. BPA is a widely used synthetic chemical that has been associated with changes in behavior, prostate and urinary tract development, and early onset of puberty. The findings are published in the current issue of Pediatrics.

Reins containing BPA are commonly used in preventive and restorative oral care. Children often have their teeth sealed with a dental resin containing BPA to prevent cavities, and it is often used for fillings. Led by Philip Landrigan, MD, Dean for Global Health, Professor and Chair of Preventive Medicine, and Director of the Children's Environmental Health Center at Mount Sinai School of Medicine, the research team conducted a literature review and found that BPA was detectable in saliva for up to three hours after the dental work was completed.

"BPA is commonly used in dental products, and while exposure from dental materials is much less common than from food storage products, we are still concerned," said Dr. Landrigan. "These dental products are still safe and an effective way to promote good oral health, but dentists should take precautions to reduce potential absorption of this chemical and the negative side effects associated with it."

Dr. Landrigan's team reviewed toxicology data over the last 10 years to examine the benefits and potential childhood health risks of using dental materials containing BPA. They determined that dental products contain different derivatives of BPA, and that saliva breaks down the derivative into BPA during the dental procedure and for three hours following it. As a further precaution the authors urge that resins containing BPA not be applied in women during pregnancy.

The authors caution that these results are preliminary, and that data on the absorption of BPA in the body were not available. "Further research is needed to fully grasp the impact of BPA in dental products, and to analyze all dental products that use this chemical," continued Dr. Landrigan. "However, the overwhelming benefit of these dental resins in oral health outweighs the brief exposure to BPA. Dentists should continue to use these products, but manufacturers should disclose specific information about the chemical structures of these products and search for alternatives."

To reduce exposure, the authors recommend the use of one BPA derivative called bis-GMA over another, bis-DMA, as bis-GMA seems to pose less risk. They also recommend that dentists rub the surface of the materials with pumice to remove the top liquefied layer of the sealant. Another preventive measure would be to encourage the patient to rinse for 30 seconds immediately following the procedure to prevent saliva from breaking the chemical down into BPA.

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A smart use for wisdom teeth: Making stem cells

2010-09-10T13:21:00.000-07:00

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For most people, wisdom teeth are not much more than an annoyance that eventually needs to be removed. However, a new study appearing in the September 17 Journal of Biological Chemistry shows that wisdom teeth contain a valuable reservoir of tissue for the creation of stem cells; thus, everyone might be carrying around his or her own personal stem-cell repository should he or she ever need some.

Groundbreaking research back in 2006 revealed that inducing the activity of four genes in adult cells could "reprogram" them back into a stem-cell-like state; biologically, these induced-pluripotent stem cells are virtually identical to embryonic stem cells, opening up a new potential avenue for stem-cell therapy whereby patients could be treated with their own stem cells.

However, despite their promise, making iPS cells is not easy; the reprogramming efficiencies are very low and vary among the cells that can be used for iPS generation and thus require good amount of "starter" cells - which might involve difficult extraction from body tissue (unfortunately skin cells, the easiest to acquire, show very low reprogramming efficiency).

Now, a team of scientists at Japan's National Institute of Advanced Industrial Science and Technology may have found an ideal source: third molars, commonly known as wisdom teeth.

The soft pulp inside of teeth contains a population of cells known as mesenchymal stromal cells that are similar to cells found in bone marrow, a common stem-cell source. However, unlike bone marrow, tooth pulp is more easily obtained, especially in wisdom teeth, which most individuals have removed anyway.

The researchers, led by Hajime Ohgushi, collected tooth samples from three donors and managed to generate a series of iPS cell lines following the similar procedure of activating three key genes (however, in another beneficial change they did not have activate the c-MYC gene which might lead the cells to become cancerous).

The different cell lines displayed varying degrees of robustness but in some cases proliferated quite well, up to 100 times more efficiently than typical skin-cell-derived iPS cells. The molar-derived cells also could differentiate into many other cell types including beating cardiomyocytes (see an attached movie), as expected.

The presence of a supply of MSCs in wisdom teeth could have meaningful therapeutic ramifications. As noted by the researchers and others, wisdom tooth extraction is a common medical procedure in developed nations and, thus, creates a perfect opportunity to remove biological material in a sterilized setting; the teeth subsequently can be frozen and stored for many years until needed. In the meantime, that also provides time for researchers to better understand the details of iPS creation to further increase the efficiency for clinical use.

Tray Bleaching May Improve Oral Health of Elderly, Special-Needs Patients

2010-09-03T10:26:00.001-07:00

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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.

Haywood will lecture on the topic in October at the American Dental Association's 151st Annual Session and World Marketplace Exhibition in Orlando, Fla.

Fluoride in Water Prevents Adult Tooth Loss

2010-08-25T03:59:00.000-07:00

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Children drinking water with added fluoride helps dental health in adulthood decades later, a new study finds.

In an article appearing in the October issue of the American Journal of Public Health, Matthew Neidell reports a strong relationship between fluoride levels in a resident’s county at the time of their birth with tooth loss as an adult.

“Your fluoridation exposure at birth is affecting your tooth loss in your 40s and 50s, regardless of what your fluoridation exposure was like when you were 20 and 30 years old,” said Neidell, a health policy professor at the Mailman School of Public Health at Columbia University.

He combined data from a recent Centers for Disease Control and Prevention community health study and a water census to see the affects of drinking fluoridated water in the 1950s and 1960s on tooth loss in the 1990s.

“We know that the benefits of fluoridation are greatest from birth,” said Howard Pollick, a professor of clinical dentistry at the University of California, San Francisco. “This recent study adds credence to that.”

For children whose adult teeth have not shown yet, fluoride still improves tooth enamel, the highly mineralized tissue on teeth’s surface. Fluoride also helps teeth damaged from the decay process and breaks down bacteria on teeth.

The researchers write that respondents who did not live in the same county their entire lives received differing amounts of fluoride in their water, which complicated study findings. The study, which focused on tooth loss as an indication of overall oral health, could not adjust for factors such as use of toothpaste, which also provides a dose of fluoride.

Pollick said that roughly 75 percent of people served by public water systems have fluoride added. The process uses small amounts of the naturally occurring mineral to increase concentrations to no more than one part per million typically.

The American Dental Association, which has supported fluoridation of community water since 1950, says scientists continue to show adding the mineral to water is safe and aids tooth health. One 2007 study of Kaiser Permanente HMO members found that adults benefitted from community fluoridation more than children.

Pollick pointed to a study of Medicaid dental patients in Louisiana, which showed that for every $1 invested in water fluoridation, the state saw $38 in reduced dental costs.

To prevent tooth decay, Pollick recommends also brushing twice a day with fluoride toothpaste and reducing sugar levels in diet.

New Process Could Improve Dental Restoration Procedures

2010-08-10T13:17:00.000-07:00

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Oral surgeons may one day have an easier, less costly approach to one important aspect of dental restoration, thanks to a newly patented process developed by researchers at Missouri University of Science and Technology (Missouri S&T).

The process computerizes the method for creating a dental bar, also called an over-denture. For dental restoration procedures, the device is the bridge connecting dental implants to dentures.

The computerized approach was developed by Dr. Ming Leu, the Keith and Pat Bailey Missouri Distinguished Professor of Integrated Product Manufacturing at Missouri S&T, and one of Leu’s former students, Amit Gawate, who received a master’s degree in mechanical engineering from Missouri S&T in 2005. Leu and Gawate were recently awarded a patent for their process.

Typically, a dental technician creates the device through a laborious manual process that involves molding and casting. But Leu’s approach is entirely digital and automated.

“This method can reduce the cost as well as the time involved” in fabricating dental bars, Leu says.

The conventional approach involves first making an impression of the area of the mouth where a denture would be placed, then casting a model of the gums and implants. From there, technicians design and fabricate the dental bar from a metal material.

Rather than making a physical model, Leu’s process uses digital imaging technology to take a picture of a patient’s mouth. From there, computer algorithms – developed by Leu and Gawate – crunch the image data to create a computer-aided design model of the actual dental bar. That model can then be fabricated using either an “additive manufacturing” or a computer-numerically controlled (CNC) machining process.

“Additive manufacturing is a way of making a part by adding material, one layer at a time, rather than removing material, as you would do with machining,” he says. The process uses less material than machining or other processes and can be easily tailored to individualized parts of different geometries, Leu adds.

An expert in manufacturing, Leu first became interested in dental surgery after a prosthodontist contacted Leu about some previous research with additive manufacturing. In 2000, Leu developed a way to create prototypes of manufactured parts out of ice, a method he called “rapid freeze prototyping,” and the prosthodontist thought the approach would be a cost-effective way to make models for dental surgery. Together, they obtained funding from the National Science Foundation to investigate the approach. From there, Leu developed the computer-aided method for dental bar design.

Six Dental Myths Debunked

2010-08-06T09:35:00.000-07:00

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Brushing, flossing, and twice-yearly dental check-ups are standard for oral health care, but there are more health benefits to taking care of your pearly whites than most of us know. In a review article, a faculty member at Tufts University School of Dental Medicine (TUSDM) debunks common dental myths and outlines how diet and nutrition affects oral health in children, teenagers, expectant mothers, adults and elders.

Myth 1: The consequences of poor oral health are restricted to the mouth

Expectant mothers may not know that what they eat affects the tooth development of the fetus. Poor nutrition during pregnancy may make the unborn child more likely to have tooth decay later in life. “Between the ages of 14 weeks to four months, deficiencies in calcium, vitamin D, vitamin A, protein and calories could result in oral defects,” says Carole Palmer, EdD, RD, professor at TUSDM and head of the division of nutrition and oral health promotion in the department of public health and community service. Some data also suggest that lack of adequate vitamin B6 or B12 could be a risk factor for cleft lip and cleft palate formation.

In children, tooth decay is the most prevalent disease, about five times more common than childhood asthma. “If a child’s mouth hurts due to tooth decay, he/she is less likely to be able to concentrate at school and is more likely to be eating foods that are easier to chew but that are less nutritious. Foods such as donuts and pastries are often lower in nutritional quality and higher in sugar content than more nutritious foods that require chewing, like fruits and vegetables,” says Palmer. “Oral complications combined with poor diet can also contribute to cognitive and growth problems and can contribute to obesity.”

Myth 2: More sugar means more tooth decay

It isn’t the amount of sugar you eat; it is the amount of time that the sugar has contact with the teeth. “Foods such as slowly-dissolving candies and soda are in the mouth for longer periods of time. This increases the amount of time teeth are exposed to the acids formed by oral bacteria from the sugars,” says Palmer.

Some research shows that teens obtain about 40 percent of their carbohydrate intake from soft drinks. This constant beverage use increases the risk of tooth decay. Sugar-free carbonated drinks and acidic beverages, such as lemonade, are often considered safer for teeth than sugared beverages but can also contribute to demineralization of tooth enamel if consumed regularly.

Myth 3: Losing baby teeth to tooth decay is okay

It is a common myth that losing baby teeth due to tooth decay is insignificant because baby teeth fall out anyway. Palmer notes that tooth decay in baby teeth can result in damage to the developing crowns of the permanent teeth developing below them. If baby teeth are lost prematurely, the permanent teeth may erupt malpositioned and require orthodontics later on.

Myth 4: Osteoporosis only affects the spine and hips

Osteoporosis may also lead to tooth loss. Teeth are held in the jaw by the face bone, which can also be affected by osteoporosis. “So, the jaw can also suffer the consequences of a diet lacking essential nutrients such as calcium and vitamins D and K,” says Palmer.

“The jawbone, gums, lips, and soft and hard palates are constantly replenishing themselves throughout life. A good diet is required to keep the mouth and supporting structures in optimal shape.”

Myth 5: Dentures improve a person’s diet

If dentures don’t fit well, older adults are apt to eat foods that are easy to chew and low in nutritional quality, such as cakes or pastries. “First, denture wearers should make sure that dentures are fitted properly. In the meantime, if they are having difficulty chewing or have mouth discomfort, they can still eat nutritious foods by having cooked vegetables instead of raw, canned fruits instead of raw, and ground beef instead of steak. Also, they should drink plenty of fluids or chew sugar-free gum to prevent dry mouth,” says Palmer.

Myth 6: Dental decay is only a young person’s problem

In adults and elders, receding gums can result in root decay (decay along the roots of teeth). Commonly used drugs such as antidepressants, diuretics, antihistamines and sedatives increase the risk of tooth decay by reducing saliva production. “Lack of saliva means that the mouth is cleansed more slowly. This increases the risk of oral problems,” says Palmer. “In this case, drinking water frequently can help cleanse the mouth.”

Adults and elders are more likely to have chronic health conditions, like diabetes, which are risk factors for periodontal disease (which begins with an inflammation of the gums and can lead to tooth loss). “Type 2 diabetes patients have twice the risk of developing periodontal disease of people without diabetes. Furthermore, periodontal disease exacerbates diabetes mellitus, so meticulous oral hygiene can help improve diabetes control,” says Palmer.

This article appears in the July/August issue of Nutrition Today.

Palmer CA, Burnett DJ, Dean B. July/August 2010. Nutrition Today. 45(4): 154-164. “It’s More than Just Candy: Important Relationships between Nutrition and Oral Health.” doi: 10.1097/NT.0b013e3181e98969

Tongue Piercing May Cause Gapped Teeth

2010-08-03T11:42:00.000-07:00

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Could cost thousands of dollars in orthodontic repairs

Mark this one down as a parental nightmare.

First, your child gets her tongue pierced. Then, as if you needed something else, she starts "playing" with the tiny barbell-shaped stud, pushing it against her upper front teeth. And before you know it, she forces a gap between those teeth -- a fraction-of-an-inch gap that may cost thousands of dollars in orthodontic bills to straighten.

How and why this happens has been documented in a case study by University at Buffalo researchers published in the July issue of the Journal of Clinical Orthodontics.

"It is a basic tenet of orthodontic that force, over time, moves teeth," explains the study's primary investigator, Sawsan Tabbaa, DDS, MS, assistant professor of orthodontics at the UB School of Dental Medicine.

Tabbaa notes that a previous UB dental school survey study of Buffalo high school students revealed that the presence of a barbell implant/stud caused a damaging habit whereby subjects pushed the metal stud up against and between their upper front teeth, a habit commonly referred to among the students as "playing."

"And it happened in very high percent of the cases," said Tabbaa.

That repeated "playing" with the stud may result in a gap as is demonstrated in Tabbaa's current case study.

The study involved a 26- year-old female patient examined at UB's orthodontic clinic who complained that a large space had developed between her upper central incisors or upper front teeth. The patient also had a tongue piercing that held a barbell-shaped tongue stud.

The tongue was pierced seven years earlier and every day for seven years she had pushed the stud between her upper front teeth, creating the space between them and, subsequently, habitually placing it in the space. The patient did not have a space between her upper front teeth prior to the tongue piercing.

"The barbell is never removed because the tongue is so vascular that leaving the stud out can result in healing of the opening in the tongue, said Tabbaa, "so it makes perfect sense that constant pushing of the stud against the teeth -- every day with no break -- will move them or drive them apart."

The patient provided the research team with photos that demonstrated she had no diastema, or space, prior to having her tongue pierced. For the purposes of treating this patient's space, it was assumed that positioning of the tongue stud between the maxillary central incisors or "playing" caused the midline space.

Her treatment involved a fixed braces appliance to push the front teeth back together.

Tongue piercing can result in serious injury not just to teeth but has also been associated with hemorrhage, infection, chipped and fractured teeth, trauma to the gums and, in the worst cases, brain abscess, said Tabbaa.

"The best way to protect your health, your teeth and your money is to avoid tongue piercing."

Pilot safety protocol could help dentists reduce errors

2010-08-03T11:29:00.000-07:00

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Pilots and dentists have more in common than one might think: Both jobs are highly technical and require teamwork. Both are subject to human error where small, individual mistakes may lead to catastrophe if not addressed early.

A dental professor at the University of Michigan and two pilot-dentists believe that implementing a checklist of safety procedures in dental offices similar to procedures used in airlines would drastically reduce human errors.

Illustration by Maria Gunnes Sibbel

Crew Resource Management empowers team members to actively participate to enhance safety using forward thinking strategies, said Russell Taichman, U-M dentistry professor and director of the Scholars Program in Dental Leadership. Taichman co-authored the study, "Adaptation of airline crew resource management (CRM) principles to dentistry," which will appear in the August issue of the Journal of the American Dental Association.

Airlines implemented CRM about 30 years ago after recognizing that most accidents resulted from human error, said co-author Harold Pinsky, a full-time airline pilot and practicing general dentist who did additional training at U-M dental school.

"Using checklists makes for a safer, more standardized routine of dental surgery in my practice," said David Sarment, a third co-author on the paper. Sarment was on the U-M dental faculty full-time before leaving for private practice. He is also a pilot and was taught to fly by Pinsky.

CRM checklists in the dentist's office represent a major culture shift that will be slow to catch on, but Pinsky thinks it's inevitable.

"It's about communication," Pinsky said. "If I'm doing a restoration and my assistant sees saliva leaking, in the old days the assistant would think to themselves, 'The doctor is king, he or she must know what's going on.'" But if all team members have a CRM checklist, the assistant is empowered to tell the doctor if there is a problem. "Instead of the doctor saying, 'Don't ever embarrass me in front of a patient again,' they'll say, 'Thanks for telling me.'"

At each of the five stages of the dental visit, the dental team is responsible for checking safety items off a codified list before proceeding. Pinsky said that while he expects each checklist to look different for each office, the important thing is to have the standards in place.

Studies show that CRM works. Six government studies of airlines using CRM suggest safety improvements as high as 46 percent. Another study involving six large corporate and military entities showed accidents decreased between 36-81 percent after implementing CRM. In surgical settings, use of checklists has reduced complications and deaths by 36 percent.

Many other industries: hospitals; emergency rooms; and nuclear plants look to the airline industry to help craft CRM programs, but dentistry hasn't adopted CRM, said Pinsky.

For the next step, the co-authors hope to design a small clinical trial in the dental school to test CRM, Taichman said

Link between gum inflammation and Alzheimer's disease

2010-08-03T11:15:00.000-07:00

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NYU dental researchers have found the first long-term evidence that periodontal (gum) disease may increase the risk of cognitive dysfunction associated with Alzheimer's disease in healthy individuals as well as in those who already are cognitively impaired.

The NYU study offers fresh evidence that gum inflammation may contribute to brain inflammation, neurodegeneration, and Alzheimer's disease.

The research team, led by Dr. Angela Kamer, Assistant Professor of Periodontology & Implant Dentistry, examined 20 years of data that support the hypothesis of a possible causal link between periodontal disease and Alzheimer's disease.

"The research suggests that cognitively normal subjects with periodontal inflammation are at an increased risk of lower cognitive function compared to cognitively normal subjects with little or no periodontal inflammation," Dr. Kamer said.

Dr. Kamer's study, conducted in collaboration with Dr. Douglas E. Morse, Associate Professor of Epidemiology & Health Promotion at NYU College of Dentistry, and a team of researchers in Denmark, builds upon a 2008 study by Dr. Kamer which found that subjects with Alzheimer's disease had a significantly higher level of antibodies and inflammatory molecules associated with periodontal disease in their plasma compared to healthy people.

Dr. Kamer's latest findings are based on an analysis of data on periodontal inflammation and cognitive function in 152 subjects in the Glostrop Aging Study, which has been gathering medical, psychological, oral health, and social data on Danish men and women. Dr. Kamer examined data spanning a 20-year period ending in 1984, when the subjects were all 70 years of age. The findings were presented by Dr. Kamer at the 2010 annual meeting of the International Association for Dental Research July 16, in Barcelona, Spain.

Dr. Kamer's team compared cognitive function at ages 50 and 70, using the Digit Symbol Test, or DST, a part of the standard measurement of adult IQ. The DST assesses how quickly subjects can link a series of digits, such as 2, 3, 4, to a corresponding list of digit-symbol pairs, such as 1/-,2/┴ ... 7/Λ,8/X,9/=.

Dr. Kamer found that periodontal inflammation at age 70 was strongly associated with lower DST scores at age 70. Subjects with periodontal inflammation were nine times more likely to test in the lower range of the DST compared to subjects with little or no periodontal inflammation.

This strong association held true even in those subjects who had other risk factors linked to lower DST scores, including obesity, cigarette smoking, and tooth loss unrelated to gum inflammation. The strong association also held true in those subjects who already had a low DST score at age 50.

Dr. Kamer plans to conduct a follow-up study involving a larger, more ethnically diverse group of subjects, to further examine the connection between periodontal disease and low cognition.

1 in 4 Californian children have never seen a dentist, study finds

2010-07-07T14:06:00.000-07:00

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Lack of dental care continues to be a significant problem for American children, who miss about 1.6 million school days each year due to dental disease.

A new study published in the July issue of the journal Health Affairs reveals that in California, nearly 25 percent of children have never seen a dentist and that disparities exist across race, ethnicity and type of insurance when it comes to the duration between dental care visits.

The study, "Racial and Ethnic Disparities in Dental Care for Publicly Insured Children," examines barriers to dental care among California children age 11 and under, using data from the 2005 California Health Interview Survey. The study contains data on nearly 11,000 children.

Researchers Nadereh Pourat, of the UCLA Center for Health Policy Research, and Len Finocchio, of the California HealthCare Foundation, found that Latino and African American children with all types of insurance were less likely than Asian American and white children to have visited the dentist in the previous six months — or even in their entire lifetime.

Similarly, researchers found that Latino and African American children in public insurance programs, including Medicaid and the Children's Health Insurance Program (CHIP), went to the dentist less often than white and Asian American children with the same insurance coverage. Overall, children with private insurance saw a dentist more often than those with Medicaid or CHIP.

"The findings suggest that having insurance isn't always enough," said Pourat, Ph.D., director of research planning at the UCLA Center for Health Policy Research. "We need to address the other barriers that keep children from getting the help they need."

The authors note the findings raise concerns about Medicaid's ability to address disparities in dental care access. Ultimately, they observe, more strategic efforts are necessary to overcome systemic barriers to care, including raising reimbursement rates paid to dentists who serve the Medicaid population and increasing the number of participating Medicaid providers.

"These findings indicate that many poor children in California do not make routine dental visits or simply never receive any dental care," said Finocchio, Dr.P.H., senior program officer at the California HealthCare Foundation. "Even with Medicaid coverage, there are tremendous barriers to getting services."

Despite the disparities, the authors say, having any form of dental insurance significantly increases the odds of seeing a dentist on a regular basis. The studied showed that 54 percent of privately insured children and 27 percent of publicly insured children had seen the dentist during the previous six months, compared with 12 percent of children without dental coverage.

"The data tell us that Medicaid and CHIP have improved children's ability to get dental care," Pourat said. "However, both programs need to do more to reduce disparities."

Rapily Assess Children's Tooth Decay Risk

2010-07-02T05:03:00.001-07:00

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.

The OHSU team included Machida; Shahram Fazilat, D.D.S., a 2008 pediatric dentistry graduate; Rebecca Sauerwein, research assistant in integrative biosciences; Jennifer McLeod, a fourth-year dental student who recently graduated; Tyler Finlayson, second-year dental student; Emilia Adam, D.D.S., M.P.H., a second-year pediatric dentistry resident who recently graduated; John Engle, D.D.S., interim chair of the Department of Pediatric Dentistry; Prashant Gagneja, D.D.S., associate professor of pediatric dentistry; Tom Maier, Ph.D., assistant professor of integrative biosciences and oral pathology and radiology.

The research was funded by Oral BioTech, the OHSU School of Dentistry, and the Oregon Clinical and Translational Research Institute, which is funded by a grant from the National Center for Research Resources (NCRR), a component of the National Institutes of Health (NIH). Established in September 2006 through the NIH's Clinical and Translational Science Award (CTSA) program, OCTRI is a unique partnership between OHSU and Kaiser Permanente Center for Health Research -- bringing together an academic medical center and an innovative managed care organization. OCTRI's mission is to improve human health by enhancing clinical and translational research. OCTRI works with institutional partners, community organizations, and industry to engage communities in clinical research efforts and to reduce the time it takes for laboratory discoveries to become treatments for patients.

Tray bleaching may improve oral health of elderly, special-needs patients

2010-06-30T13:19:00.001-07:00

Decay of baby teeth may be linked to obesity, poor food choices, study suggests

2010-06-23T14:34:00.000-07:00

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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.

How to rapidly assess children's tooth decay risk

2010-06-23T14:29:00.001-07:00

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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.

Children with Special Needs Are at Increased Risk for Oral Disease Common Medical Conditions Can Negatively Influence Dental Health

2010-06-21T15:04:00.000-07:00

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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.

Dental pulp cells for stem cell banking

2010-06-17T13:54:00.000-07:00

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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."

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The complete research study is published in the Journal of Dental Research.e

FDA Advisory Panel to Review Dental Amalgam

2010-06-10T13:32:00.000-07:00

Agency to consider risks to vulnerable populations

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:

Advanced viewing - details about the advisory panel meeting

FDA website on dental amalgam

Petitions on dental amalgam:

International Academy of Oral Medicine et al (Titus Hillis Reynolds Love, Dickman & McCalmon) - Citizen Petition

Citizens for Health, et al (Swankin & Turner) - Petition for Reconsideration

Richard F. Edlich, M.D., Ph.D., et al - Citizen Petition

Moms Against Mercury, et al. - Petition for Reconsideration