Visiting virtual beach improves patient experiences during dental procedures

Imagine walking along a South Devon beach on a lovely day. The waves are lapping on the shore, rabbits are scurrying in the undergrowth, and the bells of the local church are mingling with the calls of the seagulls. Then, as you turn to continue along the coast path feeling calm and relaxed you suddenly hear your dentist say "Fine, all done, you can take the headset off now". For patients at one dental practice in Devon, England, such Virtual Reality encounters are resulting in demonstrably better experiences in the dentist's chair. 

A link to what the patient sees is here - https://youtu.be/n5kjETt8cZI.

In a study published today (Wednesday 14th June 2017) in the journal Environment & Behaviour, a team of researchers at the Universities of Plymouth, Exeter and Birmingham worked with Torrington Dental Practice in Devon to find out whether experiences like these could improve the patient's experience during routine dental procedures, such as fillings and tooth extractions. 

Patients, who had agreed to take part in the study were randomly allocated to one of three conditions: a) standard care (i.e. normal practice), b) a virtual walk around Wembury beach in Devon (using a headset and handheld controller), or c) a walk around an anonymous virtual reality city. Results found that those who 'walked' around Wembury were less anxious, experienced less pain, and had more positive recollections of their treatment a week later, than those in the standard care condition. These benefits were not found for those who walked around the virtual city. 

Dr. Karin Tanja-Dijkstra was the lead author of the study. She said: "The use of virtual reality in health care settings is on the rise but we need more rigorous evidence of whether it actually improves patient experiences. Our research demonstrates that under the right conditions, this technology can be used to help both patients and practitioners."

The authors of the research stress that the type of virtual reality environment the patient visits is important. Virtual Wembury was created by Professor Bob Stone and colleagues at the University of Birmingham, and the fact that only patients who visited Wembury, and not the virtual city, had better experiences than standard care is consistent with a growing body of work that shows that natural environments, and marine environments in particular, can help reduce stress and anxiety. 

Co-author Dr. Mathew White from the University of Exeter explained: "We have done a lot of work recently which suggests that people are happiest and most relaxed when they are at the seaside. So it seemed only natural to investigate whether we could "bottle" this experience and use it to help people in potentially stressful healthcare contexts." 

Dr Sabine Pahl, the project's coordinator at the University of Plymouth, added: "That walking around the virtual city did not improve outcomes shows that merely distracting the patients isn't enough, the environment for a patient's visit needs to be welcoming and relaxing. It would be interesting to apply this approach to other contexts in which people cannot easily access real nature such as the workplace or other healthcare situations."

The Torrington Practice dentist involved in the research, Melissa Auvray, agreed: "The level of positive feedback we got from patients visiting Virtual Wembury was fantastic. Of course, as dentists we do our very best to make the patient feel as comfortable as possible but we are always on the look out for new ways to improve their experiences." 

Professor David Moles from the University of Plymouth added "This research is one of a number of initiatives we at Plymouth University Peninsula School of Dentistry have been working on alongside the fabulous team at Torrington Dental Practice and it clearly demonstrates the benefits that can be achieved when academics work in partnership with clinicians in order to address problems that really matter to patients."

The team are hoping to now investigate whether Virtual Wembury can help patients in other medical contexts and whether certain additions to the virtual environment could make the experience even better.

Study: Use of prefabricated blood vessels may revolutionize root canals

While root canals are effective in saving a tooth that has become infected or decayed, this age-old procedure may cause teeth to become brittle and susceptible to fracture over time. Now researchers at OHSU in Portland, Oregon, have developed a process by which they can engineer new blood vessels in teeth, creating better long-term outcomes for patients and clinicians.

Their findings will publish online in the journal Scientific Reports on June 12, 2017. 

More than 15 million root canals are conducted annually in the United States. The current procedure involves removing infected dental tissues and replacing them with synthetic biomaterials covered by a protective crown. 

"This process eliminates the tooth's blood and nerve supply, rendering it lifeless and void of any biological response or defense mechanism. Without this functionality, adult teeth may be lost much sooner, which can result in much greater concerns, such as the need for dentures or dental implants," says principal investigator Luiz Bertassoni, D.D.S., Ph.D., assistant professor of restorative dentistry in the OHSU School of Dentistry, and assistant professor of biomedical engineering in the OHSU School of Medicine.

To address this issue, Bertassoni and colleagues used a 3D printing-inspired process -- based on their previous work fabricating artificial capillaries -- to create blood vessels in the lab. They placed a fiber mold made of sugar molecules across the root canal of extracted human teeth and injected a gel-like material, similar to proteins found in the body, filled with dental pulp cells. The researchers removed the fiber to make a long microchannel in the root canal and inserted endothelial cells isolated from the interior lining of blood vessels. After seven days, dentin-producing cells proliferated near the tooth walls and artificial blood vessels formed inside the tooth.

"This result proves that fabrication of artificial blood vessels can be a highly effective strategy for fully regenerating the function of teeth," says Bertassoni, who also serves as an honorary lecturer in Bioengineering at University of Sydney-School of Dentistry. "We believe that this finding may change the way that root canal treatments are done in the future."

Common periodontal pathogen may interfere with conception in women

According to a study carried out at the University of Helsinki, Finland, a common periodontal pathogen may delay conception in young women. This finding is novel: previous studies have shown that periodontal diseases may be a risk for general health, but no data on the influence of periodontal bacteria on conception or becoming pregnant have been available.

"Our results encourage young women of fertile age to take care of their oral health and attend periodontal evaluations regularly", says periodontist and researcher Susanna Paju, University of Helsinki.

Study population comprised 256 healthy non-pregnant women (mean age 29.2 years, range 19 to 42) who had discontinued contraception in order to become pregnant. They were enrolled from the general community from Southern Finland. Clinical oral and gynecological examinations were performed. Detection of major periodontal pathogens in saliva and analysis of serum and saliva antibodies against major periodontal pathogens as well as a vaginal swab for the diagnosis of bacterial vaginosis at baseline were carried out.

Subjects were followed-up to establish whether they did or did not become pregnant during the observation period of 12 months.

Porphyromonas gingivalis, a bacterium associated with periodontal diseases, was significantly more frequently detected in the saliva among women who did not become pregnant during the one-year follow-up period than among those who did. The levels of salivary and serum antibodies against this pathogen were also significantly higher in women who did not become pregnant.

Statistical analysis showed that the finding was independent of other risk factors contributing to conception, such as age, current smoking, socioeconomic status, bacterial vaginosis, previous deliveries, or clinical periodontal disease.

Women who had P. gingivalis in the saliva and higher saliva or serum antibody concentrations against this bacterium had a 3-fold hazard for not becoming pregnant compared to their counterparts. Increased hazard was nearly to 4-fold if more than one of these qualities and clinical signs of periodontitis were present.

"Our study does not answer the question on possible reasons for infertility but it shows that periodontal bacteria may have a systemic effect even in lower amounts, and even before clear clinical signs of gum disease can be seen", says Dr. Paju. "More studies are needed to explain the mechanisms behind this association."

Infertility is a major concern, and increasing healthcare resources are needed for infertility treatments. More attention should be paid to the potential effects of common periodontal diseases on general health. Young women are encouraged to take care of their oral health and maintain good oral hygiene also when they are planning pregnancy, suggests Dr. Paju.

Recreational cannabis, used often, increases risk of gum disease

Columbia University dental researchers have found that frequent recreational use of cannabis--including marijuana, hashish, and hash oil--increases the risk of gum disease.

The study was published in the March issue of the Journal of Periodontology.

Periodontal (gum) disease is an inflammatory reaction to a bacterial infection below the gum line. Left untreated, gum disease can lead to receding gums and tooth loss. Longstanding periodontal disease has also been associated with a number of non-oral health issues, from preterm labor during pregnancy to heart disease.

Jaffer Shariff, DDS, MPH, a postdoctoral resident in periodontology at Columbia University School of Dental Medicine (CDM) and lead author, noticed a possible link between frequent recreational cannabis use and gum disease during his residency at a community-based dental clinic in Manhattan.

"It is well known that frequent tobacco use can increase the risk of periodontal disease, but it was surprising to see that recreational cannabis users may also be at risk," said Dr. Shariff. "The recent spate of new recreational and medical marijuana laws could spell the beginning of a growing oral public health problem."

Dr. Shariff and colleagues from CDM analyzed data from 1,938 U.S. adults who participated in the Centers for Disease Control's 2011-2012 National Health and Nutrition Examination Survey, administered in collaboration with the American Academy of Periodontology. Approximately 27 percent of the participants reported using cannabis one or more times for at least 12 months.

Periodontal exams focus on a patient's gum tissue and connection to the teeth. Among other assessments, periodontists look for plaque, inflammation, bleeding, and gum recession. The clinician uses a probe to measure the space between teeth and their surrounding gum tissue. 

Healthy gums fit a tooth snugly, with no more than one to three millimeters of space, known as pocket depth, between the tooth and surrounding gum tissue. Deeper pockets usually indicate presence of periodontitis. 

Among the study participants, frequent recreational cannabis users had more sites with pocket depths indicative of moderate to severe periodontal disease than less frequent users.

"Even controlling for other factors linked to gum disease, such as cigarette smoking, frequent recreational cannabis smokers are twice as likely as non-frequent users to have signs of periodontal disease," said Dr. Shariff. "While more research is needed to determine if medical marijuana has a similar impact on oral health, our study findings suggest that dental care providers should ask their patients about cannabis habits."

Commenting on the study, Dr. Terrence J. Griffin, president of the American Academy of Periodontology, said, "At a time when the legalization of recreational and medical marijuana is increasing its use in the United States, users should be made aware of the impact that any form of cannabis can have on the health of their gums."

Dentists in good compliance with American Heart Association guidelines, according to Rochester epidemiology project

In the first study examining dental records in the Rochester Epidemiology Project, results show that dentists and oral surgeons are in good compliance with guidelines issued by the American Heart Association (AHA) in 2007, describing prophylactic antibiotic use prior to invasive dental procedures.

The Rochester Epidemiology Project is a collaboration of medical and dental care providers in Minnesota and Wisconsin. With patient agreement, the organizations link medical, dental, surgical procedures, prescriptions, and other health care data for medical research.

Prior to 2007, the AHA guidelines recommended prophylactic antibiotics for patients with cardiac conditions who were at moderate or high risk of developing infective endocarditis -- a potentially deadly infection of the heart valve. After 2007, AHA recommended that only high-risk patients receive the antibiotics. This group represents a very small fraction of the individuals receiving antibiotics before 2007, says Daniel DeSimone, M.D., study lead author and infectious diseases and hospital internal medicine physician at Mayo Clinic. The study will be released May 23 online in Mayo Clinic Proceedings.

Earlier studies by Dr. DeSimone's team determined the incidence of infective endocarditis in Olmsted County before and after 2007, using Rochester Epidemiology Project data. They found no significant increase in cases of infective endocarditis following the introduction of updated AHA guidelines.

However, "the major limitation of these studies was the lack of access to dental records," says Dr. DeSimone.

"The inclusion of dental records in the Rochester Epidemiology Project provides a unique opportunity unlike any population health database in the United States," he says.

"The primary criticism of the earlier studies was, 'Are dentists actually following the 2007 AHA guidelines, or do patients continue to receive antibiotics when no longer indicated?'" reports Dr. DeSimone. "How could we prove that dentists were actually following the guidelines, rather than assuming they were? Now we can."

Dr. DeSimone also says, there are a number of health risks for patients when taking antibiotics. "Plus overuse of antibiotics can result in increased bacterial resistance, which is a widespread public health problem," he says.

In addition, while the cost to patients might only be a few dollars a dose, Dr. DeSimone says that when added up, this group of moderate-risk patients could spend well over $100 million per year.

"Using the Rochester Epidemiology Project, we have shown that the new guidelines were very helpful in reducing unnecessary antibiotic use and related issues, without an increase in new cases of infective endocarditis."

Although this was the first study using the newly linked dental records, it was just one of more than 2,600 medical research publications using the Rochester Epidemiology Project. Using medical and dental records, researchers can identify what causes diseases and how patients with certain diseases respond to surgery, medication or other interventions. They also can determine what the future holds for patients with specific diseases or medical conditions.

Extra weight may increase dental risks

Being overweight or obese was linked with an increased likelihood of having poor oral health in a recent study.

In the study of 160 participants, those with BMI ?23 had generally more severe periodontitis, total inflammatory dental diseases, and leukocyte counts than normal weight individuals. Patients who were obese (BMI ?25) had almost a 6-times increased risk for severe periodontitis compared with normal weight participants. Altered inflammatory molecules that are associated with obesity may play a role.

The results are published in Oral Diseases.

Grape seed extract could extend life of resin fillings

A natural compound found in grape seed extract could be used to strengthen dentin -- the tissue beneath a tooth's enamel -- and increase the life of resin fillings, according to new research at the University of Illinois at Chicago College of Dentistry.

No filling lasts forever, whether it's composite-resin or amalgam. But dentists find amalgam -- a combination of mercury, silver, tin or other materials -- easier to use and less costly. Plus, it can last 10 to 15 years or more. Composite-resin fillings are more aesthetically pleasing because the mixture of plastic and fine glass particles can be colored to match a patient's teeth. However, the fillings typically last only five to seven years.

In research published in the Journal of Dental Research, Ana Bedran-Russo, associate professor of restorative dentistry, describes how grape seed extract can make composite-resin fillings stronger, allowing them to last longer. The extract, Bedran-Russo said, can increase the strength of the dentin, which comprises the majority of the calcified extracellular tissue of teeth, forming the layer just beneath the hard external enamel.

Dentin is mostly made of collagen, the main structural protein in skin and other connective tissues. Resins have to bind to the dentin, but the area between the two, or the interface, is a weak point, causing restorations to breakdown, Bedran-Russo said.

"When fillings fail, decay forms around it and the seal is lost. We want to reinforce the interface, which will make the resin bond better to the dentin," she said. "The interface can be changed through the use of new natural materials."

More than 90 percent of adults between the ages of 20 and 64 have cavities, according to a federal report. A cavity is a hole that forms in the tooth when acid produced by bacteria erodes the minerals faster than the tooth can repair itself. The dentist removes the decay, or caries, with a drill and seals the hole with a filling.

Secondary caries and margin breakdown are the most frequent causes of failed adhesive restorations, Bedran-Russo said. Despite numerous advances in dental restorative materials, degradation of the adhesive interface still occurs.

Bedran-Russo has discovered that damaged collagen can repair itself with a combination of plant-based oligomeric proanthocyanidins -- flavonoids found in most foods and vegetables -- and extracts from grape seeds. Interlocking the resin and collagen-rich dentin provides better adhesion and does not rely on moisture.

"The stability of the interface is key for the durability of such adhesive joints, and hence, the life of the restoration and minimizing tooth loss," Bedran-Russo said.

One of the possible benefits of using grape seed extract is that it prevents tooth decay, she said. She and Guido Pauli, professor of medicinal chemistry and pharmacognosy in the UIC College of Pharmacy, recently collaborated on another study that showed extract from the root bark of Chinese red pine trees has similar properties to the grape seed extract.