EPA Adopts The Dental Amalgam Rules

The U.S. Environmental Protection Agency issued last week its pretreatment standards to reduce discharges of mercury from dental offices into publicly owned treatment works (POTWs).

Dental offices discharge mercury present in amalgam used for fillings. According to the Agency, "amalgam separators are a practical, affordable and readily available technology for capturing mercury and other metals before they are discharged into sewers that drain to POTWs." EPA anticipates that once captured by a separator, mercury may be recycled.

Approximately fifty percent of dental amalgam is elemental mercury by weight. Dental amalgam is a dental filling material used to fill cavities caused by tooth decay. It has been used for more than 150 years in hundreds of millions of patients. EPA expects compliance with this final rule will annually reduce the discharge of mercury by 5.1 tons as well as 5.3 tons of other metals found in waste dental amalgam to POTWs.

EPA indicated that the rule will apply to offices, including large institutions such as dental schools and clinics, where dentistry is practiced that discharge to a POTW. "It does not apply to mobile units or offices where the practice of dentistry consists only of the following dental specialties: oral pathology, oral and maxillofacial radiology, oral and maxillofacial surgery, orthodontics, periodontics, or prosthodontics."

The final rule purports to ease administrative burdens from those initially proposed. "Administrative burden was a concern of many of the commenters on the 2014 proposed rule and EPA has greatly reduced that burden through streamlining the administrative requirements in this final rule." The Agency claims that to simplify implementation and compliance for the dental offices and the regulating authorities, the final rule establishes that dental dischargers are not Significant Industrial Users (SIUs) as defined in 40 CFR part 403, and are not Categorical Industrial Users (CIUs) or "industrial users subject to categorical pretreatment standards" as those terms and variations are used in the General Pretreatment Regulations, unless designated such by the Control Authority.

"While this rule establishes pretreatment standards that require dental offices to reduce dental amalgam discharges, the rule does not require Control Authorities to implement the traditional suite of oversight requirements in the General Pretreatment Regulations that become applicable upon the promulgation of categorical pretreatment standards for an industrial category." This, the EPA asserts, will significantly reduce the reporting requirements for dental dischargers that would otherwise apply by instead requiring them to demonstrate compliance with the performance standard and BMPs through a one-time compliance report to their Control Authority.


The approach will also eliminate additional oversight requirements for Control Authorities that are typically associated with SIUs, such as permitting and annual inspections of individual dental offices. "It also eliminates additional reporting requirements for the Control Authorities typically associated with CIUs, such as identification of CIUs in their annual pretreatment reports."

In its proposal EPA estimated that there approximately 160,000 dentists working in over 120,000 dental offices who use or remove amalgam in the United States – "almost all of whom discharge their wastewater exclusively to POTWs." According to the EPA news release at that time, "this is a common sense rule that calls for capturing mercury at a relatively low cost before it is dispersed into the POTW."

Specifically the rule requires dentists to cut their dental amalgam discharges to a level achievable through the use of the "best available technology," known as amalgam separators, and the use of other Best Management Practices. Amalgam separators are devices designed to remove amalgam waste particles from dental office wastewater.

In response to the proposed rule the American Dental Association said that it believes the "new federal regulation represents a fair and reasonable approach to the management of dental amalgam waste.... The rule includes reasonable exemptions, a phase-in period and considerations for dental practices that have already installed the devices."

The compliance date for existing facilities is three years from the rule publication in the Feedral Register.

Dental implants with antibacterial activity

The quest for surfaces capable of preventing bacterial colonisation and adhesion in the area surrounding the implant "is a subject of undoubted interest, borne out by the huge number of publications that have been developed in this field," explained Beatriz Palla, researcher in the Biomaterials Group of the UPV/EHU's Department of Polymer Science and Technology. The fact is that "about 10% of implants have to be removed due to osseointegration problems or to the onset of infections," she added.

When it comes to designing strategies to combat these problems, one has to bear in mind the challenge posed by providing the surface of titanium implants with antibacterial properties, and at the same time, by the tremendous resistance that bacterial strains are capable of developing to conventional therapies with antibiotics.

That was the challenge that the UPV/EHU group, which has for some time been developing materials geared towards dental implants, was keen to tackle. "We had already obtained coatings that facilitate the generating of bone around the implant and thus facilitate anchoring to the bone. In a bid to go a step further, we looked at how to turn these coatings into bactericides," said the researcher.

The method they used for this was sol-gel synthesis. Sol-gel synthesis is based on the preparation of a precursor solution (sol) that when left on its own for a while turns into a gel that can be used to coat the surface of the titanium screw, and after heat treatment at a high temperature in the kiln ends up finally being adhered to the screw that will be implanted. "We used silica as the precursor, because in many studies this compound has been shown to be osteoinductive, so it facilitates one of the objectives we wanted to achieve. What is more, to provide the materials with antibacterial characteristics, we added various antibacterial agents".

Three prototypes, one of them a trade secret

In the study carried out, Palla developed three types of coatings depending on the various antibacterial agents chosen; each one had a mechanism to tackle bacterial infections, either prophylactically by preventing the bacteria from becoming adhered initially and the subsequent infection, or else by eliminating it once it has developed.

What was needed in the case of prophylactic coatings was "a material with a very long degradation time so that it would remain adhered to the screw and work for as long as possible preventing bacteria from becoming adhered," said Palla. In the coatings designed to eradicate an infection that has already taken hold, however, "a rapidly degrading material is needed so that it can release the antibacterial agent as quickly as possible to attack the infection". What is more, one of the coatings developed for this purpose "is designed to be used in situ, at the dentist's surgery itself, on the infected screw without any need to extract the implant from the patient. This new material is in the process of being patented and remains a trade secret," pointed out the researcher.

In view of the results, Palla believes that "it is possible to confirm that coatings with an antibacterial capability and which do not affect the proper integration of the implant into the jawbone have been developed". She also admits, however, that there is still a long way to go until they can be applied and used at dentists' surgeries: "Apart from all the trials that remain to be carried out, it would also be advisable to pursue the research a little further to optimize the results more".

Training to become a scuba diver? Start at the dentist

Scuba divers may want to stop by their dentist's office before taking their next plunge. A new pilot study found that 41 percent of divers experienced dental symptoms in the water, according to new research from the University at Buffalo.

Due to the constant jaw clenching and fluctuations in the atmospheric pressure underwater, divers may experience symptoms that range from tooth, jaw and gum pain to loosened crowns and broken dental fillings.

Recreational divers should consider consulting with their dentist before diving if they recently received dental care, says Vinisha Ranna, BDS, lead author and a student in the UB School of Dental Medicine.

"Divers are required to meet a standard of medical fitness before certification, but there are no dental health prerequisites," says Ranna, who is also a certified stress and rescue scuba diver.
"Considering the air supply regulator is held in the mouth, any disorder in the oral cavity can potentially increase the diver's risk of injury. A dentist can look and see if diving is affecting a patient's oral health."
 
The study, "Prevalence of dental problems in recreational SCUBA divers," was published last month in the British Dental Journal.

The research was inspired by Ranna's first experience with scuba diving in 2013. Although she enjoyed being in the water, she couldn't help but notice a squeezing sensation in her teeth, a condition known as barodontalgia.

Published research on dental symptoms experienced while scuba diving is scarce or focuses largely on military divers, says Ranna, so she crafted her own study. She created an online survey that was distributed to 100 certified recreational divers. Those who were under 18-years-old, ill or taking decongestant medication were excluded.

Her goal was to identify the dental symptoms that divers experience and detect trends in how or when they occur.

Of the 41 participants who reported dental symptoms, 42 percent experienced barodontalgia, 24 percent described pain from holding the air regulator in their mouths too tightly and 22 percent reported jaw pain.

Another five percent noted that their crowns were loosened during their dive, and one person reported a broken dental filling.

"The potential for damage is high during scuba diving," says Ranna, who has completed 60 dives.
"The dry air and awkward position of the jaw while clenching down on the regulator is an interesting mix. An unhealthy tooth underwater would be much more obvious than on the surface. One hundred feet underwater is the last place you want to be with a fractured tooth."

The study also found that pain was most commonly reported in the molars and that dive instructors, who require the highest level of certification, experienced dental symptoms most frequently. This frequency is likely attributed to more time spent at shallower depths where the pressure fluctuations are the greatest, says Ranna.

The Professional Association of Diving Instructors has issued more than 24 million certifications around the world. As scuba diving gains popularity as a recreational sport, Ranna hopes to see oral health incorporated into the overall health assessments for certification.

Patients should ensure that dental decay and restorations are addressed before a dive, and mouthpiece design should be evaluated by manufacturers to prevent jaw discomfort, particularly when investigating symptoms of temporomandibular joint disorder in divers, says Ranna.

Children's oral health disparities persist despite equal dental care access

Oral health of children who receive dental care through Medicaid lags behind their privately insured peers, even though the children receive the same amount of dental care, according to a study from the Columbia University College of Dental Medicine.

The study was released in Health Affairs' December issue, and was discussed by Jaffer A Shariff, DDS, MPH, at a Washington, D.C., health policy briefing on December 7. 

"If poor and low-income children now enjoy equal access to dental care but do not have equal oral health, then the remedy should focus more tightly on the day-to-day factors that put them at higher risk for dental problems," said lead author Burton L. Edelstein, DDS, MPH, chair of the Section of Population Oral Health, professor of dental medicine at the College of Dental Medicine (CDM), and professor of health policy and management at Columbia's Mailman School of Public Health. "Low-income families often face income, housing, employment, and food insecurities that constrain their ability to engage in healthy eating and oral hygiene practices," he noted. 

The study considered data from the 2011-2012 National Survey of Children's Health, which included parent reports of oral health and use of dental care for 79,815 children and adolescents (age 1 to 17 years) of all social strata. No differences were found between Medicaid-insured and commercially-insured children in the odds of their having a dental visit, preventive or otherwise. However, parents of children enrolled in Medicaid were 25 percent more likely to report that their child did not have an "excellent or very good" dental condition and were 21 percent more likely to report that their child had a dental problem within the last year than were parents of commercially insured children.

"Because we found that low-income kids are seeing dentists at similar rates as privately insured children, we believe that other issues may negatively impact low income children's oral health. Addressing this would require attention from those currently outside the dental profession, such as social workers, health educators, nutritionists, and community health workers," said Jaffer A. Shariff, DDS, MPH, a research associate in the Section of Population Oral Health, a periodontal resident at CDM, and co-author of the study. "We need to develop an oral health promotion system that complements traditional dental care."

Medicaid's Equal Access Provision mandates that Medicaid beneficiaries have access to equivalent health services as the general population. While the study confirms that the mandate is being followed, it also shows that, "equal access to dental care does not ensure that low-income children obtain and maintain oral health at the same levels as other children," Dr. Edelstein said. 

Dentists need to "rethink the nature of oral health care by seeing it as part of a child's total health care and by treating tooth decay as the chronic disease that it is. We can't segregate oral health from overall health," Dr. Edelstein cautioned. "Evolving health systems that bring teams of providers together to promote healthy behaviors can address common risk factors that benefit a child's overall and oral health. But if you segregate dentistry, especially for Medicaid kids, then you lose that opportunity."

Periodontitis therapeutic vaccine trials could start in 2017

A world-first vaccine developed by Melbourne scientists, which could eliminate or at least reduce the need for surgery and antibiotics for severe gum disease, has been validated by research published this weekend in a leading international journal.

A team of dental scientists at the Oral Health CRC at the University of Melbourne has been working on a vaccine for chronic periodontitis for the past 15 years with industry partner CSL. Clinical trials on periodontitis patients could potentially begin in 2018.

Moderate to severe periodontitis affects one in three adults and more than 50 per cent of Australians over the age of 65. It is associated with diabetes, heart disease, rheumatoid arthritis, dementia and certain cancers. It is a chronic disease that destroys gum tissue and bone supporting teeth, leading to tooth loss.

The findings published in the journal NPJ Vaccines (part of the Nature series) represent analysis of the vaccine's effectiveness by collaborating groups based in Melbourne and at Cambridge, USA.

The vaccine targets enzymes produced by the bacterium Porphyromonas gingivalis, to trigger an immune response. This response produces antibodies that neutralise the pathogen's destructive toxins.

P. gingivalis is known as a keystone pathogen, which means it has the potential to distort the balance of microorganisms in dental plaque, causing disease.

CEO of the Oral Health CRC, Melbourne Laureate Professor Eric Reynolds AO, said it was hoped the vaccine would substantially reduce tissue destruction in patients harbouring P. gingivalis.

"We currently treat periodontitis with professional cleaning sometimes involving surgery and antibiotic regimes," Professor Reynolds said.

"These methods are helpful, but in many cases the bacterium re-establishes in the dental plaque causing a microbiological imbalance so the disease continues."

"Periodontitis is widespread and destructive. We hold high hopes for this vaccine to improve quality of life for millions of people.

Few older Americans have dental insurance

Only 12 percent of older Americans have some form of dental insurance and fewer than half visited a dentist in the previous year, suggests new Johns Hopkins Bloomberg School of Public Health research on Medicare beneficiaries.

Insurance status appeared to be the biggest predictor of whether a person received oral health care: For those with incomes just over the federal poverty level, 27 percent of those without dental insurance had a dental visit in the previous year, compared to 65 percent with dental insurance, according to an analysis of 2012 Medicare data.

Income also played a role: High-income beneficiaries were almost three times as likely to have received dental care in the previous 12 months as compared to low-income beneficiaries, 74 percent of whom reported receiving no dental care. Many high-income beneficiaries - even those with dental insurance - paid a sizable portion of their bills out of pocket.

The findings, published in the December issue of the journal Health Affairs, suggest an enormous unmet need for dental insurance among those 65 and older in the United States, putting older adults at risk for oral health problems that could be prevented or treated with timely dental care, including tooth decay, gum disease and loss of teeth. It also highlights the financial burden associated with dental visits, among both the insured and uninsured.

"Medicare is focused specifically on physical health needs and not oral health needs and, as a result, a staggering 49 million Medicare beneficiaries in this country do not have dental insurance," says study author Amber Willink, PhD, an assistant scientist in the Department of Health Policy and Management at the Bloomberg School. "With fewer and fewer retiree health plans covering dental benefits, we are ushering in a population of people with less coverage and who are less likely to routinely see a dentist. We need to think about cost-effective solutions to this problem."

Eighty percent of Americans under the age of 65 are covered by employer-sponsored programs that offer dental insurance, which covers routine cleanings and cost-sharing on fillings and other dental work. Many of them lose that coverage when they retire or go on Medicare. The vast majority of Medicare beneficiaries who have dental insurance are those who are still covered by employer-sponsored insurance, either because they are still working or because they are part of an ever-dwindling group of people with very generous retiree medical and dental benefits.

For the new study, the researchers analyzed data provided by 11,299 respondents to the 2012 Cost and Use Files of the Medicare Current Beneficiary Survey. The data included information collected on income, dental insurance status, dental health access and out-of-pocket expenditures.

Among the findings: On average, Medicare beneficiaries reported spending $427 on dental care over the previous year, 77 percent of which was out-of-pocket spending. An estimated seven percent reported spending more than $1,500. Dental expenses, on average, accounted for 14 percent of Medicare beneficiaries' out-of-pocket health spending.

Poor dental hygiene not only contributes to gum disease, but the same bacteria linked to gum disease has also been linked to pneumonia, a serious illness that increases the risk of hospitalization and death. It can also contribute to difficulty eating, swallowing or speaking, all of which bring their own health challenges. Nearly one in five Medicare beneficiaries doesn't have any of his or her original teeth left, according to the Centers for Disease Control and Prevention.

The researchers took the research a step further. They analyzed two separate proposals for adding dental benefits to Medicare, estimating how much each would cost. One was similar to the premium-financed, voluntary Medicare Part D benefit that was added to Medicare a decade ago to help cover prescription drugs for seniors. The other was similar to a proposal that has been introduced in Congress that would embed dental care into Medicare as a core benefit for all of the program's 56 million beneficiaries, which is not expected to pass before Congress recesses.

The first proposal, which would cost an average premium of $29-a-month and would come with a subsidy for low-income seniors who couldn't afford that, would run an estimated $4.4 to $5.9 billion annually depending on the number of low-income beneficiaries who participate. The second, with a $7 monthly premium and subsidies for low-income people, would cost between $12.8 and $16.2 billion annually. The packages would cover the full cost of one preventive care visit a year and 50 percent of allowable costs for necessary care up to a $1,500 limit per year to cover additional preventive care and treatment of acute gum disease or tooth decay.

First-ever study shows e-cigarettes cause damage to gum tissue

A University of Rochester Medical Center study suggests that electronic cigarettes are as equally damaging to gums and teeth as conventional cigarettes.

The study, published in Oncotarget, was led by Irfan Rahman, Ph.D. professor of Environmental Medicine at the UR School of Medicine and Dentistry, and is the first scientific study to address e-cigarettes and their detrimental effect on oral health on cellular and molecular levels.

Electronic cigarettes continue to grow in popularity among younger adults and current and former smokers because they are often perceived as a healthier alternative to conventional cigarettes. Previously, scientists thought that the chemicals found in cigarette smoke were the culprits behind adverse health effects, but a growing body of scientific data, including this study, suggests otherwise.

"We showed that when the vapors from an e-cigarette are burned, it causes cells to release inflammatory proteins, which in turn aggravate stress within cells, resulting in damage that could lead to various oral diseases," explained Rahman, who last year published a study about the damaging effects of e-cigarette vapors and flavorings on lung cells and an earlier study on the pollution effects. "How much and how often someone is smoking e-cigarettes will determine the extent of damage to the gums and oral cavity."

The study, which exposed 3-D human, non-smoker gum tissue to the vapors of e-cigarettes, also found that the flavoring chemicals play a role in damaging cells in the mouth.

"We learned that the flavorings-some more than others--made the damage to the cells even worse," added Fawad Javed, a post-doctoral resident at Eastman Institute for Oral Health, part of the UR Medical Center, who contributed to the study. "It's important to remember that e-cigarettes contain nicotine, which is known to contribute to gum disease."

Most e-cigarettes contain a battery, a heating device, and a cartridge to hold liquid, which typically contains nicotine, flavorings, and other chemicals. The battery-powered device heats the liquid in the cartridge into an aerosol that the user inhales.

"More research, including long term and comparative studies, are needed to better understand the health effects of e-cigarettes," added Rahman, who would like to see manufacturers disclose all the materials and chemicals used, so consumers can become more educated about potential dangers.

Cognitive Behavioral Therapy Resource for Children's Dental Anxiety

The International and American Associations for Dental Research (IADR/AADR) have published an article titled "Development and Testing of a Cognitive Behavioral Therapy Resource for Children's Dental Anxiety" in the OnlineFirst portion of JDR Clinical & Translational Research. In this study, Jenny Porritt, Department of Psychology, Sociology, and Politics, Sheffield Hallam University, UK, et al describe the development of a guided self-help cognitive behavioral therapy (CBT) resource for the management of children's dental anxiety and provide preliminary evidence for the feasibility and acceptability of this approach with children aged between nine and 16 years.

CBT is an evidence-based treatment for dental anxiety; however, access to therapy is limited. This study employed a mixed methods design where within phase one, a qualitative "person-based" approach informed the development of the self-help CBT resource. Guidelines for the development and evaluation of complex interventions were also used. Within phase two, children aged between nine and 16 years who had elevated self-reported dental anxiety and were attending a community dental service or dental hospital were invited to use the CBT resource. Children completed questionnaires, which assessed their dental anxiety and health-related quality of life prior to and following their use of the resource. Recruitment and completion rates were also recorded.

Acceptability of the CBT resource was explored using interviews and focus groups with children, parents/caregivers and dental professionals. A total of 85 children were invited to participate in the feasibility study and trial the CBT resource. The recruitment rate (proportion of children invited to take part in the study who agreed to participate) and completion rate (proportion of children who agreed to participate who completed the study) was 66 percent and 86 percent, respectively. A total of 48 patients completed the study.

At the conclusion of the study, the authors ascertained that there was a significant reduction in dental anxiety and an increase in health-related quality of life following the use of the guided self-help cognitive behavioral therapy resource. The results of this study will inform the design of a definitive trial to examine the treatment and cost-effectiveness of the resource for the reduction of children's dental anxiety.

"Having launched this year, JDR Clinical & Translational Research provides a unique opportunity for oral health research leaders to publish their research and effectively translate their findings to those who need the information to deliver evidence-based prevention and care. On behalf of the International Association for Dental Research, I am pleased that the authors of this study contributed their research to this publication," said IADR President Jukka Meurman.

Why some dental implants work and others don't

Each year, about 500,000 North Americans get dental implants. If you are one of them, and are preparing to have an implant, it might be a good idea to start taking beta blockers, medication that controls high blood pressure, for a while. And to stop taking heartburn pills.

A body of research from McGill led-teams indicates that in order to raise the odds that dental implants will attach properly, there are clear benefits to taking certain common medications and avoiding others.

Bone cell growth, healing and death

"The success of procedures like dental implants depends mainly on how the existing bone accepts the implants to create a connection between the living bone and the surface of the implant," says Prof. Faleh Tamimi, who teaches in the McGill Faculty of Dentistry, and is the senior author on a number of papers published on the subject in recent weeks. "Because some medications affect bone metabolism and the way that bone cells heal and multiply or die, they can have an important effect on the success of implants."

The McGill research team reviewed data about the integration of dental implants gathered from over 700 patients who were operated on at the East Coast Oral Surgery Clinic in Moncton, New Brunswick between 2007-2015. They then confirmed the results they saw in human patients through studies in rats.

Implications for hip and knee replacements

"We believe that this research may have implications for orthopedic interventions such as hip and knee replacements, because the same mechanisms of bone cell growth break down, and healing take place in all the bones in the body," says Tamimi. "Our work with implants in rats suggest that this is indeed the case, but further research will be needed to confirm it."

Drugs that aid integration of implants - Beta blockers

Conclusions are based on 1499 dental implants in 728 patients between Jan. 2007 -- Sept. 2013 at the East Coast Oral Surgery in Moncton, New Brunswick

• 327 implants were in 142 people who took beta blockers for hypertension
• 1172 implants were in 586 people who didn't take beta blockers
• Failure rates of implants for people using beta blockers was 0.6%
• Failure rates of implants in people who don't take beta blockers was 4.1%
• More than 640 million patients around the world take beta blockers to control hypertension.

"We carried out this study because we knew that beta blockers have been reported to increase bone formation," says Prof. Tamimi from McGill's Faculty of Dentistry. "So we thought it was possible that they would also decrease the risk of failure of dental implants. However we didn't expect that there would be such a clear difference in the failure rates for implants between users and non-users of beta blockers. Randomized clinical trials will need to be carried out as well as other studies of large numbers of patients to investigate this phenomenon in more depth."

Drugs that impede integration of dental implants - Heartburn treatment

Conclusions are based on 1773 dental implants in 799 patients between Jan. 2007 -- Sept. 2015 at the East Coast Oral Surgery in Moncton, New Brunswick

• 133 implants were in 58 people who took heartburn medication
• 1640 implants were in 741 people who don't take heartburn medication
• Failure rates of implants for people using heartburn medication were 6.8%
• Failure rates of implants for people not taking heartburn medication were 3.2%
• More than 20 million Americans, about one in 14 people, take heartburn medication.
• Heartburn medication is rapidly becoming the third most prescribed pharmaceutical product worldwide, especially for elderly people, who take it either on an occasional or long-term basis.

"Scientists already knew that drugs for heartburn reduce calcium absorption in bones and generally increase the risk of bone fractures," says Faleh Tamimi, of McGill's Faculty of Dentistry. "That is why we wanted to look at how it affects the integration of implants and bone healing after this type of surgery. But we didn't expect to find that the negative effects of these type of drugs would be as great as they are. Further work will need to be done to find the appropriate dosages and time periods that people should take or avoid these medications."

To read the full articles on effects of Beta blockers

In humans: "Antihypertensive medications and the survival rate of osseointegrated dental implants: A cohort study" by X. Wu et al in Clinical Implant Dentistry and Related Research: http://onlinelibrary.wiley.com/doi/10.1111/cid.12414/full

Regular dental visits may help prevent pneumonia

That twice-yearly trip to the dentist could do more than keep teeth and gums healthy: It may decrease the risk of pneumonia by reducing bacteria in the mouth, suggests research being presented at IDWeek 2016™.

Nearly one million Americans become ill with the infection every year and 50,000 die. While it is more common among older people and those with conditions such as AIDS or lung disease, anyone can get pneumonia. Based on an analysis of a national database of more than 26,000 people, the new research found that people who never get dental checkups had an 86 percent greater risk of pneumonia than to those who visit the dentist twice a year.

"There is a well-documented connection between oral health and pneumonia, and dental visits are important in maintaining good oral health," said Michelle Doll, MD, lead author of the study and assistant professor of internal medicine in the Division of Infectious Disease at Virginia Commonwealth University, Richmond. "We can never rid the mouth of bacteria altogether, but good oral hygiene can limit the quanitities of bacteria present."

Researchers analyzed data obtained from the 2013 Medical Expediture Panel Survey, which asks about healthcare utilization (including dental care), costs and patient satisfaction. They found 441 of 26,246 people in the database had bacterial pneumonia (1.68 percent) and that those who never had dental checkups had an 86 percent increased risk of pneumonia compared to those who had twice-yearly appointments.

The body contains 10 times as many microbes (bacteria, fungi and viruses) as human cells on or in the body, from the skin to the gastrontestinal system (including the mouth). Some microbes are good and some are bad, but even bad microbes only cause disease under certain circumstances. In some cases, bacteria can be accidentally inhaled or aspirated into the lungs and cause pneumonia. Bacteria that commonly cause pneumonia include streptococcus, haemophilus, staphylococcus, and anaerobic bacteria. Routine dental visits may reduce the amount of bacteria that can be aspirated, said Dr. Doll.

"Our study provides further evidence that oral health is linked to overall health, and suggests that it's important to incorporate dental care into routine preventive healthcare," said Dr. Doll.

Benefits of laser treatments for dental problems

Researchers have developed computer simulations showing how lasers attack oral bacterial colonies, suggesting that benefits of using lasers in oral debridement include killing bacteria and promoting better dental health.

In a study published in the journal Lasers in Surgery and Medicine, the researchers show the results of simulations depicting various laser wavelengths aimed at virtual bacterial colonies buried in gum tissue. In humans, actual bacterial colonies can cause gingivitis, or gum inflammation. Gingivitis can develop into periodontal disease, which involves a more serious infection that breaks down the bones and tissues that support teeth.

"The paper verifies or validates the use of lasers to kill bacteria and contribute to better health following periodontal treatments," said co-author Lou Reinisch, Ph.D., associate provost for academic affairs at New York Institute of Technology.

Drawing on his background in physics, optics, and calculus, Reinisch, an expert in laser surgery and an associate editor with the journal, created mathematical models based on optical characteristics of gum tissues and bacteria. He then produced simulations of three different types of lasers commonly used in dentistry and their effects on two types of bacterial colonies of various sizes and depths within the gum models.

"One of the questions we asked is how deep could the bacteria be and still be affected by the laser light," said Reinisch. The simulations indicate that 810 nm diode lasers, when set to short pulses and moderate energy levels, can kill bacteria buried 3 mm deep in the soft tissue of the gums. The 1064 nm Nd:YAG laser is also effective with similar penetration depth. Both lasers spare the healthy tissue with the simulations showing minimal heating of the surrounding tissue. Minimizing the thermal damage leads to faster healing, says Reinisch.

"The findings are important because it opens up the possibility of tweaking the wavelength, power, and pulse duration to be the most effective for killing bacteria," Reinisch says. "The doctors will look at this and say, 'I see there is a possible benefit for my patients in using the laser.'"

"The study reveals what's going on in the tissue, so I hope that we're educating the medical professionals by demonstrating that you can do a good job of killing bacteria with certain lasers," says co-author David Harris, Ph.D., director of Bio-Medical Consultants, Inc., which specializes in medical laser product development. "When you do this treatment, you remove an infection and allow tissue to regenerate. Getting rid of the infection means the tissue can heal without interference."

The cost of dental lasers can range from $5,000 to over $100,000, according to Reinisch, and health care professionals require extra training to use them. These costs are passed on to the patient so Reinisch notes there must be a definite benefit for the patient to justify these costs.

Harris noted that the Academy of Laser Dentistry estimates that at least 25% of US dental offices have dental laser capability for periodontal treatment as outlined in the paper, along with a host of other soft tissue surgical procedures and hard tissue procedures like removal of dental decay.

Harris said the video simulations demonstrate what happens when lasers hit buried bacterial colonies.

"This is a great way to present to the doctor esoteric scientific findings in a clinically meaningful format," he said. "The model is a great tool for making predictions of what can happen in the tissue. Our study confirms its use as a way to determine the most effective laser parameters to use clinically."

In a first for the journal, the published results include video depictions of the computer simulations. The journal readers can actually see the soft tissue of the virtual gums and bacteria heat up and cool down as the simulated laser is scanned over the tissue.

The study's methodology of simulating how laser light interacts with tissue has implications beyond dentistry; physicians and surgeons use lasers in various treatments, including vocal cord procedures and dermatological treatments, including those for toenail fungus.

Guided by the results presented in this study, both Reinisch and Harris expect that clinical trials will be designed to validate the findings.

The study, entitled "Selective Photoantisepsis," is published in the October issue of Lasers in Surgery and Medicine.

Dental Sealant Use and Untreated Tooth Decay Among U.S. School-Aged Children

Key Points

• Tooth decay is one of the most common chronic diseases of childhood. If left untreated, tooth decay can have serious consequences including problems with eating, speaking, and learning.

• Two years after placement, dental sealants prevent >80% of cavities in the permanent molars, in which nine in 10 cavities occur. Most children, however, do not have dental sealants, especially children from low-income families. These children are twice as likely as higher-income children to have untreated tooth decay.

• Providing sealants through school-based programs is an effective way to increase sealant use. The benefits of school-based dental sealant programs exceed their cost when they serve children at high risk for tooth decay. The programs become cost-saving after 2 years and save $11.70 per sealed tooth over 4 years.

• In this study, approximately 60% of children aged 6–11 years from low-income families (approximately 6.5 million children), did not have dental sealants. Although sealant prevalence during the last decade increased by 72% among low-income children, these children were still 20% less likely than children from higher-income families to have dental sealants. Children without sealants had almost three times more cavities in permanent first molars compared with children with sealants.

• Providing sealants to the approximately 6.5 million low-income children who currently do not have them would prevent 3.4 million cavities over 4 years.

• Additional information is available at http://www.cdc.gov/vitalsigns.


Abstract

Background: Tooth decay is one of the greatest unmet treatment needs among children. Pain and suffering associated with untreated dental disease can lead to problems with eating, speaking, and learning. School-based dental sealant programs (SBSP) deliver a highly effective intervention to prevent tooth decay in children who might not receive regular dental care. SBSPs benefits exceed their costs when they target children at high risk for tooth decay.

Methods: CDC used data from the National Health and Nutrition Examination Survey (NHANES) 2011–2014 to estimate current prevalences of sealant use and untreated tooth decay among low-income (≤185% of federal poverty level) and higher-income children aged 6–11 years and compared these estimates with 1999–2004 NHANES data. The mean number of decayed and filled first molars (DFFM) was estimated for children with and without sealants. Averted tooth decay resulting from increasing sealant use prevalence was also estimated. All reported differences are significant at p<0 .05.="" br="">
Results: From 1999–2004 to 2011–2014, among low- and higher-income children, sealant use prevalence increased by 16.2 and 8.8 percentage points to 38.7% and 47.8%, respectively. Among low-income children aged 7–11 years, the mean DFFM was almost three times higher among children without sealants (0.82) than among children with sealants. Approximately 6.5 million low-income children could potentially benefit from the delivery of sealants through SBSP.

Conclusions and Implications for Public Health Practice: The prevalence of dental sealant use has increased; however, most children have not received sealants. Increasing sealant use prevalence could substantially reduce untreated decay, associated problems, and dental treatment costs.


Introduction

National data from 1999–2004 indicate that by age 19 years, approximately one in five children have untreated tooth decay (1). Children living in poverty are more than twice as likely to have untreated decay (27%) than are children in families whose income exceeds 200% of the federal poverty level (FPL) (13%). Untreated tooth decay can lead to pain and infection, resulting in problems with eating, speaking, and learning (2). Approximately 16% of children living in poverty were reported by a parent to have had a toothache within the last 6 months (3). A recent multivariate analysis also found that children with poor oral health miss more school days and receive lower grades than children with good oral health (4).

Approximately 90% of tooth decay in permanent teeth occurs in the chewing surfaces of the back teeth (5). Much of this decay could be prevented with the application of dental sealants. Sealants are plastic coatings applied to the pits and fissures in tooth surfaces to prevent decay-causing bacteria and food particles from collecting in these hard-to-clean surfaces. Studies on sealant effectiveness indicate that sealants delivered in clinical or school settings prevent about 81% of decay at 2 years after placement, 50% at 4 years and can continue to be effective for up to 9 years through adolescence (6); no clinically significant adverse effects have been associated with receipt of sealants (6). Sealants are underused, especially among low-income children who have the highest risk for decay. National data from 1999–2004 indicated the prevalence of sealant use among children aged 6–11 years living in poverty was 21% compared with 40% among children from families with incomes >200% of the FPL (1). Increasing sealant use prevalence is a national health goal (7) and the National Quality Forum* has endorsed dental care performance measures aimed at increasing sealant use prevalence in children at elevated risk for tooth decay (8).

School-based sealant programs (SBSP) typically deliver sealants in schools attended by a large number of children participating in the free/reduced-price meal program (i.e., family income ≤185% of the FPL) (6). The Community Preventive Services Task Force† (Task Force) recommends SBSP, on the basis of strong evidence that these programs prevent tooth decay and increase the number of children receiving sealants at schools (6). A second, systematic review of economic evaluations of SBSP conducted for the Task Force found that the benefits of SBSP exceed their cost when they serve children at high risk for tooth decay, becoming cost-saving after 2 years (6) and saving $11.70 per tooth sealed over 4 years (9).

In this report, CDC estimated prevalence of sealant use and untreated tooth decay among low-income (≤185% of FPL, the qualification point for free/reduced-price meal program) and higher-income children aged 6–11 years using data from the recently released 2011–2014 NHANES and compared these data with data from the 1999–2004 NHANES. Estimates of tooth decay averted by providing sealants to children were also calculated.

Methods

To estimate current prevalences of sealant use and untreated decay for U.S. children aged 6–11 years, CDC combined the two most recent cycles of NHANES data (2011–2012 and 2013–2014). NHANES is a multistage probability sample of the noninstitutionalized U.S. population.§ A child was classified as having sealants if at least one permanent tooth was assessed by a dentist to have a sealant present and as having untreated tooth decay if at least one permanent tooth had untreated decay.

Sealant use prevalence is presented for all children aged 6–11 years as well as for the following characteristics: sex; race/ ethnicity; family income ≤185% of FPL versus >185% of FPL; and highest level of education achieved by the head of household. Sealant use and untreated decay prevalence stratified by family income from NHANES 2011–2014 were compared with prevalences from NHANES 1999–2004. Sealant use and untreated decay status were assessed in the same way for both periods (1). Among children aged 7–11 years,¶ the mean number of decayed and filled first molars (DFFM) was estimated for children with and without sealants, by family income status. For each income group, CDC used a published methodology to estimate the number of DFFM that would have occurred over 4 years if a child had not received sealants soon after eruption of the first molars (10). This value was multiplied by the prevented fraction (50%) (6) to estimate averted DFFM per child attributable to sealants over 4 years. Estimates were standardized by year of age to the distribution in the 2000 U.S. Census (1).

Analyses were conducted using statistical software that accounts for the complex sample design of NHANES. Estimates from NHANES were obtained using the examination sample weights. All statistical tests were conducted at a 95% significance level (p<0 .05="" errors="" estimates="" relative="" standard="" with="">0.3 were classified as unstable. To test whether sealant use prevalence varied with the characteristic of the child during 2011–2014, CDC used a chi-square test of independence. A t-test was used to determine whether changes in sealant use and decay prevalences between surveys or mean DFFM by sealant status and income were significant.

Results

Approximately 43% of children aged 6–11 years received at least one dental sealant (Table 1), and sealant use prevalence among low-income children (38.7%) was approximately 9.1 percentage points lower than among higher-income children (47.8%). Sealant use prevalence was highest among non-Hispanic white children (46.0%) and children from households where the head of household had more than a high school education (45.2%) and lowest among non-Hispanic black children (32.2%) and children from households where the head of household had a high school education (37.7%).

From 1999–2004 to 2011–2014, overall prevalence of dental sealant use increased from 31.1%–43.6% (Table 2); increased by 16.2 percentage points to 38.7% (relative increase of 72.0%) among low-income children; and increased by 8.8 percentage points (relative increase of 22.6%) among higher-income children. Untreated decay decreased by 4.9 percentage points to 7.5% among low-income children and remained at about 4% among higher-income children.

Among children aged 7–11 years, the mean DFFM was significantly lower for both higher-income and low-income children with at least one sealant (0.19 and 0.29, respectively) compared with children with no sealants (0.52 and 0.82, respectively) (Table 3). The difference in mean DFFM between children with and without sealants was 0.33 and 0.52 for higher- and low-income children, respectively.

The estimated average annual probability of a permanent first molar developing decay, calculated with DFFM data by year of age for children aged 7–11 years, was 0.07 for low-income children (data not shown). Because of unstable estimates, this probability was not estimated for higher-income children. Over 4 years, sealing all four permanent first molars of low-income children is estimated to prevent 0.52 DFFM per child (Table 4). The NHANES 2011–2014 data set had sealant and income information for 1,371 low-income children aged 6–11 years, representing 10.5 million children nationally. Based on the proportion of low-income children without sealants in the NHANES data set, it is estimated that approximately 6.5 million low-income children currently are not receiving the preventive benefits of dental sealants. Providing sealants to these low-income children would prevent 3.4 million DFFM over 4 years.


Conclusions and Comments

Increasing sealant use prevalence among low-income children could substantially reduce tooth decay. Because the benefits of sealants can last up to 9 years, and untreated decay prevalence is about twice as high for adolescents and young adults aged 12–19 years compared with younger children, it is likely that much of the pain and limitations in eating and learning associated with untreated decay could be prevented by timely application of sealants. In addition, providing sealants to these children could save societal resources. The systematic review of economic evaluations of SBSP conducted for the Task Force found that SBSP became cost-saving within 2 years of placing sealants (6). That review further found that delivering sealants to children at high risk for tooth decay could be cost-saving to Medicaid (9).

Data from the Agency for Healthcare Research and Quality indicate that less than half of children aged 6–11 years from families with incomes <125 2013="" 60="" a="" accessing="" among="" an="" application="" applying="" be="" but="" by="" care="" children="" dental="" effective="" equipment="" few="" found="" fpl="" had="" have="" health="" high-need="" i.e.="" important="" in="" increase="" is="" lack="" licensed="" low-income="" majority="" might="" must="" not="" of="" offer="" one="" oral="" past-year="" placed="" prevalence="" professional="" programs.="" programs="" reason="" regular="" sbsp="" schools="" sealant="" sealants.="" sealants="" state="" states="" strategy="" survey="" that="" the="" their="" therefore="" these="" timely="" to="" visit="" visits="" with="">50% of students participating in free/reduced meal program) (12). Financing is a major barrier to implementing and maintaining SBSP (13). Federal funding of state oral health programs is largely competitive and varies widely by state (13). Many state and local SBSP cover part of their expenses by Medicaid billing (13). Because labor accounts for about two thirds of SBSP costs (6), revenues from Medicaid billing are more likely to cover costs if state policies allow dental hygienists or therapists to assess a child’s need for and to place sealants without a dentist being present. For example, in South Carolina, SBSPs managed and staffed by dental hygienists deliver sealants in approximately 40% of high-need schools (12). These SBSP are primarily financed by Medicaid billing (13).

Another barrier to children receiving sealants in clinical and school settings is low health literacy. A study of California third graders found that their parent’s health literacy and speaking English at home were strong predictors of the child having sealants (14). An Institute of Medicine report on increasing access to dental care among vulnerable and underserved populations also found that low oral health literacy was a major barrier to receiving preventive dental services (15).

The findings in this report are subject to at least one limitation. Because NHANES is not designed to provide estimates by year of age, a large number of estimates of DFFM by year of age and sealant status were unstable. However, among low-income children, all estimates of DFFM used to estimate the annual probability that an unsealed first molar developed decay were stable.

Children with sealants can still be at risk for tooth decay. Whereas fluoride can prevent decay in all teeth, sealants are primarily used to protect the back teeth from decay. Healthy behaviors documented to prevent decay include brushing with fluoride toothpaste and drinking fluoridated water or taking fluoride supplements if drinking water is not optimally fluoridated (2). Many of the studies included in the evidence informing the Task Force’s recommendation for SBSP were conducted among children using fluoride toothpaste in communities with fluoridated water (6), suggesting that sealants provide additional benefit even among children receiving fluoride. Regularly scheduled dental visits are important to deliver preventive services (e.g., topical fluoride) and to monitor and control tooth decay and other oral conditions (2). SBSP can help caregivers of eligible children enroll in public insurance programs (5,6) and can increase utilization of dental care by identifying tooth decay in children who are not regularly seen by a dentist and referring them for needed dental treatment.

New imaging method could enable dentists to detect and heal tooth cavities much earlier

Dental caries-- tooth decay -- is the most prevalent dental disease among children and adults around the world. Left too long before treatment, the disease results in difficulty eating, infection, and even tooth loss. New research published by SPIE, the international society for optics and photonics, in the Journal of Biomedical Optics describes a method enabling much earlier detection using inexpensive long-wavelength infrared imaging.

A cavity begins with a minute amount of mineral loss from the tooth enamel surface, resulting from the acidic environment of dental plaques. If caries can be detected early enough, the progression can be stopped or even reversed.

Dentists currently rely on two methods to detect early caries: x-ray imaging and visual inspection of the tooth surface. But both of these diagnostics have limitations: dentists can't see caries until it is relatively advanced, and x-rays can't detect occlusal early caries -- those on the biting surface of the tooth.

In "First step toward translation of thermophotonic lock-in imaging to dentistry as an early caries detection technology," Ashkan Ojaghi, Artur Parkhimchyk, and Nima Tabatabaei of York University in Toronto describe a low-cost thermophotonic lock-in imaging (TPLI) imaging tool that would allow dentists to detect developing caries much earlier than x-rays or visual analysis.

The TPLI tool uses a long-wavelength infrared camera to detect the small amount of thermal infrared radiation emitted from dental caries after stimulation by a light source.

To test the effectiveness of this new imaging tool, the authors artificially induced early demineralization on an extracted human molar by submerging it in an acid solution for 2, 4, 6, 8, and 10 days. The TPLI image taken after just 2 days clearly showed the presence of a lesion, whereas a trained dental practitioner could not visually detect the same lesion even after 10 days of demineralization.

Journal associate editor Andreas Mandelis, professor of mechanical and industrial engineering at the University of Toronto, said, "This paper will have a high impact on the way dentists diagnose incipient caries. The longwave IR thermophotonic imaging technology is at its nascent steps, but this paper brings it closer to actual clinical practice."

The tool has the benefits of being noncontact, noninvasive, and low-cost, and has great potential as a commercially viable diagnostic imaging device for dentistry.

Immediate dental implant placements using osteotome technique

Immediate implant placement using the osteotome technique is a gentle technique and offers several significant advantages over the traditional graded series of drills:

1.    This technique retains the total bone mass which is necessary to preserve the remaining bone and improve its quality, mainly, when the alveolar bone is compromised in quality or quantity.
2.    It is an alternative to block grafting in select cases to increase the ridge width for implant placement.
3.    It allows immediate placement of implants in narrow ridges at the time of expansion.
4.    Osteotomes take advantage of the fact that bone is viscoelastic and can be compressed and manipulated. Compression creates a denser bony interface with increased bone to implant contact and therefore good initial stabilization of the dental implant.
5.    Heat is a major detriment to osseointegration, but the osteotome technique is an essentially heatless and therefore should not destroy the viable bone-forming cells.
6.    This technique also allows for greater tactile sensitivity.
7.    It is minimally invasive and cost effective.
8.    Faster prosthetic restoration is possible.

In spite of this Straumann dental implants with an SLA endosseous surface offer a promising solution for rapid anchoring in the bone and the bone-to-implant contact is found to be higher on rougher surfaces than on smoother interfaces with high percentage contact in descriptive histomorphometric studies and high removal torque values in functional studies. This procedure for a better and faster bone integration of SLA implants in the initial healing period which is optimized mechanically and topographically.


The research has been published in The Open Dentistry Journal, Volume 10, 2016.

NEW DENTAL FILLINGS THAT WILL REPAIR TOOTH DECAY

WILL ALSO PROLONG LIFE OF FILLINGS AND HELP ELIMINATE NEED FOR MERCURY CONTAINING AMALGAM


The first data on dental fillings that can actively repair tooth decay is presented by Professor Robert Hill. Professor Hill is Chair of Physical Sciences at the Institute of Dentistry at Queen Mary University of London and co-founder and director of research at BioMin Technologies.


Over 80 percent of the population in the UK has at least one filling, with seven being the average while eight million cavities are filled with amalgam each year.


This data, indicating smart repair of tooth decay, prolonging the life of composite fillings and reducing the need for mercury based amalgams indicates a significant step forward in tooth restorative materials.


Professor Hill outlines how new bioactive glass composites are unique in their ability to release fluoride as well as the significant quantities of calcium and phosphate that are needed to form tooth mineral.


Professor Hill explains that while current dental fillings include inert materials, the data on the new bioactive glass composite shows that it interacts positively with the body providing minerals that replace those lost to tooth decay.


“Our scientists and dentists at Queen Mary replaced the inert tooth filling materials with our new bioactive glass, explained Professor Hill. “Not only did this bioactive glass composite remineralize the partially decayed teeth, but it also creates an alkaline environment that discourages the bacteria that caused the initial decay.


“The new bioactive glass also fills in the gaps with tooth mineral thus preventing the oral bacteria which cause tooth decay from establishing themselves. Research in the US suggests this will potentially prolong the life of fillings and slow secondary tooth decay because the depth of bacterial penetration with bioactive glass fillings was significantly smaller than for inert fillings.”


Richard Whatley the CEO of BioMin Technologies who has recently licensed the technology from Queen Mary Innovations adds “We plan to translate the remineralizing technology developed with the BioMinF® toothpaste into restorative dental products. This is a really exciting development which is attracting interest from a number of commercial companies.”


He added, “There is also huge pressure to eliminate mercury based amalgam fillings by 2020 which is outlined in a host of international agreements. Using this type of bioactive glass composite to fill cavities eliminates the need to use mercury based amalgam by offering aesthetic white fillings which help heal the tooth.”

Losing teeth raises older adults' risks for physical and mental disability

Maintaining good oral health may help older adults prevent a variety of health problems and disabilities. However, the effect of tooth loss on physical or cognitive health and well-being is unknown.

In a study published in the Journal of the American Geriatrics Society, researchers explored this connection. To do so, they examined information from the Japan Gerontological Evaluation Study (JAGES) project.

In their study, the research team examined information from more than 60,000 community-dwelling people aged 65 and older who did not meet the Japanese criteria for needing long-term care.

The participants were given questionnaires to complete. They answered a number of questions, including providing information about:

• How many teeth they had
• Their medical and mental health history
• How many falls they had over the last year
• Whether they smoked or drank alcohol
• Their body weight
• How well they were able to perform common activities of daily life

The researchers learned older adults who have significant tooth loss are less functional when compared with people who lose fewer teeth.

The research team suggested that it is essential that older adults receive the support they need to maintain good oral health self-care practices, and that they receive adequate dental care.

Hidden tooth infections may predispose people to heart disease

According to a study carried out at the University of Helsinki, an infection of the root tip of a tooth increases the risk of coronary artery disease, even if the infection is symptomless. Hidden dental root tip infections are very common: as many as one in four Finns suffers from at least one. Such infections are usually detected by chance from X-rays.

"Acute coronary syndrome is 2.7 times more common among patients with untreated teeth in need of root canal treatment than among patients without this issue," says researcher John Liljestrand.

The study was carried out at the Department of Oral and Maxillofacial Diseases of the University of Helsinki, in cooperation with the Heart and Lung Centre at Helsinki University Hospital. Its results were published in the latest issue of the Journal of Dental Research.

Dental root tip infection, or apical periodontitis, is a bodily defence reaction against microbial infection in the dental pulp. Caries is the most common cause of dental root tip infection.

Today, information is increasingly available about the connection between oral infections and many common chronic diseases. For example, periodontitis, an inflammatory disease affecting the tissues that surround the teeth, causes low-grade inflammation and is regarded as an independent risk factor for coronary artery disease and diabetes. Dental root tip infections have been studied relatively little in this context, even though they appear to be connected with low-grade inflammation as well.

The study consisted of 508 Finnish patients with a mean age of 62 years who were experiencing heart symptoms at the time of the study. Their coronary arteries were examined by means of angiography, and 36 per cent of them were found to be suffering from stable coronary artery disease, 33 per cent were undergoing acute coronary syndrome, and 31 did not suffer from coronary artery disease to a significant degree. Their teeth were examined using panoramic tomography of the teeth and jaws, and as many as 58 per cent were found to be suffering from one or more inflammatory lesions.

The researchers also discovered that dental root tip infections were connected with a high level of serum antibodies related to common bacteria causing such infections. This shows that oral infections affect other parts of the body as well. The statistical analyses took account of age, gender, smoking, type 2 diabetes, body mass index, periodontitis and the number of teeth as confounding factors.

Cardiovascular diseases cause more than 30 per cent of deaths globally. They can be prevented by a healthy diet, weight control, exercise and not smoking. With regard to the health of the heart, measures should be taken to prevent or treat oral infections, as they are very common and often asymptomatic. Root canal treatment of an infected tooth may reduce the risk of heart disease, but more research is needed.

Link between periodontal and cerebrovascular diseases

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A new study has revealed a relationship between chronic periodontitis and lacunar infarct, two common diseases in the elderly. Chronic periodontitis is an inflammatory disease of the gums, whereas lacunar infarct is a type of cerebral small vessel disease that can lead to a stroke.

Additional research is needed to understand this link. It is hypothesized that periodontitis leads to systemic inflammation and, as a result, the health of the blood vessels could be affected. On the other hand, chronic periodontitis and lacunar infarct may share common vascular risk factors such as hypertension, diabetes, and high cholesterol.

"We observed that people diagnosed with periodontal disease had about a 4-fold increased risk of developing lacunar stroke compared with those without periodontitis. If further prospective cohort studies confirm our findings, interventional studies should be performed to assess the potential benefit of periodontal therapy in patients with lacunar stroke and periodontitis," said Dr. Yago Leira, lead author of the European Journal of Neurology study. "Periodontal treatment may also decrease systemic inflammation and, therefore, it may reduce the risk of developing lacunar infarct."

Exposure to chemicals in plastic and fungicides may irreversibly weaken children’s teeth

Chemicals commonly found in plastics and fungicides may be weakening children's teeth by disrupting hormones that stimulate the growth of dental enamel, according to a new study presented today at the European Congress of Endocrinology.

Endocrine disruptors are chemicals that interfere with mammalian hormones. Bisphenol A (BPA) is one of the most prevalent, found in every-day items including refillable drink bottles and food storage containers. Vinclozolin is another endocrine disruptor that was commonly used as a fungicide in vineyards, golf courses and orchards.

Molar incisor hypermineralisation (MIH) is a pathology affecting up to 18% of children aged 6-9, in which the permanent first molars and incisors teeth that erupt have sensitive spots that become painful and are prone to cavities. These spots are found on dental enamel, the tough outer covering of teeth that protects it from physical and chemical damage. Unlike bone, enamel does not regrow and so any damage is irreversible. Previous rat studies have shown that MIH may result from exposure to BPA after finding similar damage to the enamel of rats that received a daily dose of BPA equivalent to normal human BPA exposure, though the exact mechanism of action remains unclear.

In this study, researchers from the French National Institute of Health and Medical Research (INSERM) gave rats daily doses of BPA alone or in combination with vinclozolin, equivalent to an average dose a human would experience daily, from birth till they were thirty days old. They then collected cells from the rats' teeth surface and found that BPA and vinclozolin changed the expression of two genes controlling the mineralisation of tooth enamel.

In part two of their experiment, the team cultured and studied rat ameloblast cells, which deposit enamel during the development of teeth. They found that the presence of sex hormones like oestrogen and testosterone boosted the expression of genes making tooth enamel, especially male sex hormones. As BPA and vinclozolin are known to block the effect of male sex hormones, the findings reveal a potential mechanism by which endocrine disruptors are weakening teeth.

"Tooth enamel starts at the third trimester of pregnancy and ends at the age of 5, so minimising exposure to endocrine disruptors at this stage in life as a precautionary measure would be one way of reducing the risk of enamel weakening," said Dr Katia Jedeon, lead author of the study.

Pot-Smokers Harm Gums; Other Physical Effects Slight

Long-term study finds no differences in metabolism, lung function, inflammation

A long-term study of nearly 1,000 New Zealanders from birth to age 38 has found that people who smoked marijuana for up to 20 years have more gum disease, but otherwise do not show worse physical health than non-smokers.

The international research team assessed a dozen measures of physical health, including lung function, systemic inflammation and several measures of metabolic syndrome, including waist circumference, HDL cholesterol, triglycerides, blood pressure, glucose control and body mass index.
Tobacco users in the study, which appears online the week of June 1 in JAMA Psychiatry, were found to have gum disease as well as reduced lung function, systemic inflammation and indicators of poorer metabolic health.

“We can see the physical health effects of tobacco smoking in this study, but we don’t see similar effects for cannabis smoking,” said Madeline Meier, an assistant professor of psychology at Arizona State University who conducted the study with colleagues at Duke University, King’s College in the UK and the University of Otago in New Zealand.

While study participants who had used marijuana to some degree over the last 20 years showed an increase in periodontal disease from age 26 to 38, they did not differ from non-users on any of the other physical health measures. To measure cannabis use, they asked study subjects to self-report their use at ages 18, 21, 26, 32 and 38.

The study’s statistical analysis found that the decline in periodontal health in pot smokers was not explained by tobacco smoking, alcohol abuse or less tooth brushing and flossing. The lack of physical health problems among cannabis users also was not attributable to their having had better health to begin with or to living healthier lifestyles.

“We don’t want people to think, ‘Hey, marijuana can’t hurt me,’ because other studies on this same sample of New Zealanders have shown that marijuana use is associated with increased risk of psychotic illness, IQ decline and downward socioeconomic mobility,” Meier said.

“What we’re seeing is that cannabis may be harmful in some respects, but possibly not in every way,” said study co-author Avshalom Caspi, the Edward M. Arnett Professor of psychology and neuroscience at Duke. “We need to recognize that heavy recreational cannabis use does have some adverse consequences, but overall damage to physical health is not apparent in this study.”

“Physicians should certainly explain to their patients that long-term marijuana use can put them at risk for losing some teeth,” said Terrie Moffitt, the Nannerl O. Keohane University Professor of psychology and neuroscience at Duke and co-director of the Dunedin Multidisciplinary Health and Development Study, from which these data were gathered.

What is the best way to whiten teeth? (video)

In the age of selfies, it seems everyone wants to have a whiter, brighter smile. While one option to achieve this involves a trip to the dentist for a professional whitening, many people have turned to over-the-counter teeth-whitening treatments. How do these work, and are they safe?

Non-inflammatory destructive periodontal disease

Although, bacteria are a critical etiologic factor that are needed to develop periodontal disease, bacteria alone are insuficiente to induce a periodontal disease. A susceptible host is also required, and the host's susceptibility as local and/or general predisposing risk factors, are important determinants of the disease status. An accurate diagnosis is often essential in developing a predictable and suitable treatment plan, which, when executed, gives a guide to the resolution of the periodontal disease's activity. The majority of all forms of periodontal diseases, are considered as microorganism-induced diseases, which promote an inflammatory host defense response against the bacteria and noxious materials from bacterial plaque. 

The inflammatory process inactivates bacteria, but produces the liberation of bacterial and neutrophil derived products such as enzymes, which induce periodontal tissue destruction by lytic activities. Therefore, the characteristics of the most common periodontal disease are: presence of gingival inflammation, ulceration of the junctional epithelium, loss of connective tissue and alveolar bone, causing apical migration of the junctional epithelium and development of periodontal pockets. 

However, not all types of periodontal disease seem to be caused by periodontopathogenic bacteria, and not all are distinguished by an evident inflammatory process, and periodontal tissue destruction associated with periodontal periodontal pocket formation and progressive deepening. Non inflammatory destructive periodontal disease (NIDPD), is a severe destructive periodontal disease, which is characterized by periodontal attachment loss, alveolar bone loss, generalized gingival recession without pathognomonic sign of inflammation, and periodontal pocket development. 

Conventional periodontal therapy and antimicrobial therapy are ineffective, in preventing further progression of the disease. A NIDPD case was studied in order to analyse features of the disease, and discuss the possible etiologic factors as an association of endogenous opportunist bacteria with anatomical aspects, occlusion pattern, emotional stress and mouth breathing condition.

Breakthrough toothpaste ingredient hardens your teeth while you sleep

The new BioMinF toothpaste ingredient, developed by Queen Mary University of London, provides a new tooth repair technology which will bring relief to the millions of adults and children around the world who are prone to tooth decay and sensitivity

QUEEN MARY UNIVERSITY OF LONDON

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A new toothpaste ingredient which puts back the lost minerals from tooth enamel and helps prevent decay and treat sensitivity while you sleep is available online and from specialist dental distributors now. It is expected to be available through high street stores by the end of the year.

The new BioMinF toothpaste ingredient provides a new tooth repair technology which will bring relief to the millions of adults and children around the world who are prone to tooth decay and sensitivity. 

Dental decay is the most prevalent disease worldwide and the majority of adults will also experience tooth sensitivity at some stage during their lives. Decay is the single biggest reason for children being admitted into hospital with between 60-90 percent of school children being affected.

Tooth decay and sensitivity is estimated to affect 13.5million people in the UK alone.

Toothpastes containing BioMInF are able to slowly release calcium, phosphate and fluoride ions over an 8-12 hour timeframe to form fluorapatite mineral to rebuild, strengthen and protect tooth structure. The slow release of fluoride has been identified to be particularly beneficial in prevention of tooth decay. 

"Using remineralising toothpaste makes teeth far more resistant to attack from acidic soft drinks like fruit juices and sodas. It is also much more effective than conventional toothpastes where the active ingredients, such as soluble fluoride, are washed away and become ineffective less than two hours after brushing," said Professor Robert Hill, Chair of Dental Physical Sciences at Queen Mary, University of London, who led the team which developed BioMin and won the 2013 Armourers and Brasiers Venture Prize. 

"This breakthrough innovation could significantly reduce dental decay and also tooth sensitivity problems which are often experienced by people eating or drinking something cold," said Professor Hill. 

"The technology behind BioMin is not however exclusively designed for toothpastes," added Professor Hill. "It can also be incorporated in other professionally applied dental products such as cleaning and polishing pastes, varnishes and remineralising filling materials."

Professor Hill has co-founded, BioMin Technologies, which aims to commercialise the development. The company will be led by chief executive Richard Whatley who has 30 years international management experience within the dental industry working for market leading companies such as Dentsply and KaVo.

"We are very excited by the prospects of developing the patented technology which has been licensed from Queen Mary University of London and Imperial College," said CEO Richard Whatley." We are in the process of establishing licencing agreements with toothpaste and dental materials manufacturers around the world.

"A key element of our business model includes business partners also becoming investor stakeholders in the company thus reducing the need for traditional third party financing from venture capitalists. Our aim is for the BioMin brand to become synonymous for the treatment of tooth sensitivity in the eyes of both the dental profession and the general public."

Dr David Gillam, with expertise in the management of dentine hypersensitivity and a consultant and co-founder of BioMin said," Tooth sensitivity is caused by open tubules in the teeth allowing access to the nerve receptors which may affect the quality of life of individuals particularly when eating and drinking hot and cold food and drink. BioMin containing toothpastes are effective by sealing the tubules with acid resistant fluorapatite which act as a barrier to hot and cold being transmitted inside the tooth."

A fluoride free version of BioMin is also being developed for individuals who do not want or need fluoride toothpaste.

BioMinF is available from dental practices and distributors now or via http://www.biomin.co.uk at £4.99 for 75ml tube.

Is there a link between oral health and the rate of cognitive decline?

Better oral hygiene and regular dental visits may play a role in slowing cognitive decline as people age, although evidence is not definitive enough to suggest that one causes the other. The findings, published in the Journal of the American Geriatrics Society, come from the first systematic review of studies focused on oral health and cognition--two important areas of research as the older adult population continues to grow, with some 36% of people over age 70 already living with cognitive impairments. 

Researchers have questioned whether an association exists between oral health and cognitive status for older adults. "Clinical evidence suggests that the frequency of oral health problems increases significantly in cognitively impaired older people, particularly those with dementia," said Bei Wu, PhD, of Duke University's School of Nursing in Durham, NC. "In addition, many of the factors associated with poor oral health--such as poor nutrition and systemic diseases like diabetes and cardiovascular disease--are also associated with poor cognitive function."

To look for a link between oral health and cognitive status, Dr. Wu and her colleagues analyzed relevant cross-sectional (data collected at one specific point in time) and longitudinal (data collected over an extended period of time) studies published between 1993 and 2013. 

Some studies found that oral health measures such as the number of teeth, the number of cavities, and the presence of periodontal disease (also known as "gum disease") were associated with an increased risk of cognitive decline or dementia, while others studies were unable to confirm any association. Researchers were also quick to note that findings based on the number of teeth or cavities are conflicting, and limited studies suggest that periodontal conditions such as gingivitis are associated with poorer cognitive status or cognitive decline.

"There is not enough evidence to date to conclude that a causal association exists between cognitive function and oral health," said Dr. Wu. "For future research, we recommend that investigators gather data from larger and more population representative samples, use standard cognitive assessments and oral health measures, and use more sophisticated data analyses."