Evidence-Based Dentistry Web Site

Initial Database Features Over 1300 Systematic Reviews

The American Dental Association (ADA) announces the launching of EBD.ada.org (http://www.ebd.ada.org), the Web site dedicated to evidenced-based dentistry (EBD). EBD.ada.org allows easy and quick access to a database of systematic reviews of oral health clinical information from one centralized location.

EBD, according to the ADA, is an approach to oral health care that requires the judicious integration of systematic assessments of clinically relevant scientific evidence, relating to the patient's oral and medical condition and history, with the dentist's clinical expertise and the patient's treatment needs and preferences.

Supported by a grant from the National Library of Medicine and the National Institute for Dental and Craniofacial Research (grant number G08 LM008956), EBD.ada.org also features critical summaries of systematic reviews that assess information within systematic reviews in a concise format so that health care workers can incorporate scientific evidence in clinical decision making.

Key features of the EBD Web site include:

o A database of systematic reviews-- The database features over 1300 systematic reviews, with quarterly updating.

o Critical Summaries of systematic reviews -- One-page synopses of the key elements of a systematic review that a member of the dental team needs to know when making treatment decisions. Authors of the summaries are practicing dentists trained in critical assessment of published studies.

o Clinical Recommendations -- These provide evidence-based guidance on the application of current scientific evidence to patient care.

o Suggest Clinical Ideas-- A section where dentists can let the ADA know the clinical questions they encounter in trying to provide the best care to their patients.

o Links to other useful resources-- This central resource for EBD information will include links to many outside resources, including tutorials, glossaries, and databases.

"This is just a first step for EBD.ada.org," explains John S. Findley, D.D.S., ADA president. "We will continue to gather feedback to make sure the Web site provides the most clinically relevant and current information in a concise and user-friendly manner for dental and health care professionals."

Gene Responsible For Formation Of Enamel

"Subjects afflicted by DiGeorge syndrome exhibit teeth with enamel defects. We have demonstrated that a direct link between impaired Tbx1 function and enamel defects exists. Enamel forms via the mineralization of specific enamel proteins that are secreted by dental epithelial cells called ameloblasts. Our results clearly show that teeth of Tbx1 null mice lacked enamel and ameloblasts," explains Prof Mitsiadis.

Dentistry Of Future? Gene Responsible For Formation Of Enamel Discovered

A team of researchers lead by Professor Dr Thimios Mitsiadis at the University of Zurich, Switzerland, has identified a gene responsible for the formation of enamel, which is the key component of the teeth. The experiments were accomplished in mice carrying a deletion of the transcription factor Tbx1, a gene that plays a principal role in several human malformations (heart, thymus, parathyroid, face, and teeth) associated to the DiGeorge syndrome.

These findings, just published in Development Biology, represent a major contribution to the understanding of the production of enamel, the "hardest organic tissue" found in nature.

An American group of researchers from the University of Oregon have also shown a relationship between another transcription factor (Ctip2) and the production of enamel, but in the words of Prof Mitsiadis "our investigations better demonstrate the lack of enamel in teeth. Because of the early lethality of the Tbx1 mutant mice, we have used long-term culture techniques that allow the unharmed growth of teeth until their full maturity. No such studies were performed from our American colleagues."

Could dental treatment benefit in the future from this revolutionary study? The answer is definitively "yes." "The understanding of the genetic code controlling tooth development and repair will permit us to imagine and generate new products and replacement tissues for injured and unhealthy teeth. However the requirements for functional tooth repair and/or formation are complex. Yet, a single approach has not allowed an effective clinical therapy," says Prof Mitsiadis.

Is it possible to use dental stem cells to stimulate the growth of new enamel? This represents the biggest challenge in the discipline of tooth engineering. "Our results show that Tbx1 is involved in the maintenance of dental epithelial stem cells that are responsible for ameloblast formation. In some cases of genetic tooth anomalies, regeneration and repair of teeth could be treated by stem cells. Aggregates of dental stem cells could be used in the future for local transplantation in the dental tissues," explains Prof Mitsiadis

Green tea for healthy teeth and gums

Recent study suggests that antioxidants in green tea may help reduce periodontal disease.

With origins dating back over 4,000 years, green tea has long been a popular beverage in Asian culture, and is increasingly gaining popularity in the United States. And while ancient Chinese and Japanese medicine believed green tea consumption could cure disease and heal wounds, recent scientific studies are beginning to establish the potential health benefits of drinking green tea, especially in weight loss, heart health, and cancer prevention. A study recently published in the Journal of Periodontology, the official publication of the American Academy of Periodontology (AAP), uncovered yet another benefit of green tea consumption. Researchers found that routine intake of green tea may also help promote healthy teeth and gums. The study analyzed the periodontal health of 940 men, and found that those who regularly drank green tea had superior periodontal health than subjects that consumed less green tea.

"It has been long speculated that green tea possesses a host of health benefits," said study author Dr. Yoshihiro Shimazaki of Kyushu University in Fukuoka, Japan. "And since many of us enjoy green tea on a regular basis, my colleagues and I were eager to investigate the impact of green tea consumption on periodontal health, especially considering the escalating emphasis on the connection between periodontal health and overall health."

Male participants aged 49 through 59 were examined on three indicators of periodontal disease: periodontal pocket depth (PD), clinical attachment loss (CAL) of gum tissue, and bleeding on probing (BOP) of the gum tissue. Researchers observed that for every one cup of green tea consumed per day, there was a decrease in all three indicators, therefore signifying a lower instance of periodontal disease in those subjects who regularly drank green tea.

Green tea's ability to help reduce symptoms of periodontal disease may be due to the presence of the antioxidant catechin. Previous research has demonstrated antioxidants' ability to reduce inflammation in the body, and the indicators of periodontal disease measured in this study, PD, CAL and BOP, suggest the existence of an inflammatory response to periodontal bacteria in the mouth. By interfering with the body's inflammatory response to periodontal bacteria, green tea may actually help promote periodontal health, and ward off further disease. Periodontal disease is a chronic inflammatory disease that affects the gums and bone supporting the teeth, and has been associated with the progression of other diseases such as cardiovascular disease and diabetes.

"Periodontists believe that maintaining healthy gums is absolutely critical to maintaining a healthy body," says Dr. David Cochran, DDS, PhD, President of the AAP and Chair of the Department of Periodontics at the University of Texas Health Science Center at San Antonio. "That is why it is so important to find simple ways to boost periodontal health, such as regularly drinking green tea – something already known to possess certain health-related benefits."

Modern lifestyle prevents tooth decay

New research has found that modern lifestyle habits may play a bigger role than food alone, when it comes to tooth decay.

A review of the scientific evidence over the past 150 years found that the effects of fluoride toothpaste, good oral hygiene and health education, may override the effects of food alone on tooth decay. The research is published online in a Supplement to the journal Obesity Reviews.

Professor Monty Duggal, an author of the review explained 'Nowadays, it's not enough to just look at what we eat when talking about tooth decay, as other factors seem to be as important. Fluoride toothpaste changes the effect that some foods have on the teeth, as do other good oral hygiene practices'.

He added 'Future research should investigate a number of lifestyle factors together with different foods that might affect tooth decay. Times have changed and with that, the foods we eat, and how we care for our teeth'.

Professor Duggal is a consultant and head of paediatric dentistry at Leeds dental institute. He has published over 65 research papers in international scientific journals.

The overall aim of the review was to look at the evidence for the claim that sugar was the main cause of dental caries (tooth decay). The authors concluded that out of 31 studies carefully reviewed, the majority did not find a relationship between the amount of sugar consumed and dental caries, but the frequency of consumption may be important.

Thanks to dental health education most people now know the best way to prevent tooth decay is to brush with fluoride toothpaste twice a day, especially before going to bed. Rates of tooth decay have fallen dramatically over the past 20 years.

Durability Of Dental Fillings Can Be Improved

Durability Of Dental Fillings Improves If The Enzyme Activity Of Teeth Is Inhibited

A dental filling is more durable if the enzyme activity of the tooth can be inhibited. Professor Leo Tjaderhane of the Department of Pedodontics, Cariology and Endodontology at the University of Oulu, together with wide international collaborative team, has been developing this method with funding from the Academy of Finland.

Composite dental fillings have one problematic feature, in that the bond between the filling and the dental tissue deteriorates over time – in fact, sometimes by as much as 50 per cent in one year. As the bond deteriorates, it may allow bacteria to enter and this brings a high risk of further tooth decay.

Professor Tjäderhane has researched the occurrence of certain enzymes, matrix metalloproteinases (MMPs), in the dental tissue and their role in dental conditions. The MMPs break down the extracellular matrix, including collagen, which is a major component of dentin. As a result of international research collaboration, Tjäderhane's research team has shown that human dentin contains the key MMP for breaking down collagen. The bonding of composite resins with dental tissue is based on the use of collagen bonds, and the tooth's own MMPs are responsible in part for the deterioration of the bond over time. By inhibiting the activity of these enzymes, the research team has succeeded in significantly slowing down the deterioration of the bond between dental tissue and a composite filling, and in some cases to prevent deterioration completely.

The best results have been obtained in clinical trials, where deterioration of the bond has been more or less completely prevented. MMP enzyme activity in the tooth can be rapidly and easily inhibited when a filling is put in place by using chlorhexidine, a substance which is already on hand at all dental practices. This means that the research results are immediately applicable in dental care for the best benefit of the patients. The research in question also strongly indicates that MMP inhibitors might help slow down tooth decay. These observations are based only on animal testing so far, so further research on the subject will be needed before pratical applications can be made available

Dentist Trains Others At Special Olympics

Sanford Fenton, D.D.S., could feel the electricity in the air.

Everywhere he turned, he saw smiling faces as his ears filled with the excited voices of this year’s athletes in the 2009 Special Olympics World Winter Games held Feb. 17-13 in Idaho.

Fenton, chair of pediatric dentistry at The University of Texas Dental Branch at Houston, played a vital role in trying to keep the teeth in those smiling faces healthy through free dental screenings of the athletes.

As a global clinical adviser for Special Olympics, Fenton also trained 35 pediatric and general dentists who will become local clinical directors around the world.

“They left with knowledge on how to treat patients with developmental and intellectual disabilities,” Fenton said. “I, along with the trainees, performed oral screenings for the athletes. We also talked to them about oral hygiene and good nutrition. During the examination, the athletes were also fitted for mouth guards for the games.”

If an athlete needed further dental care, 270 volunteers were standing by to provide dental treatment in a mobile dental van, local dental offices or, if necessary, transportation to an emergency center.

“One of the athletes I examined had a serious infection in his mouth. He needed immediate treatment and was placed on antibiotics. He was also scheduled to see an oral surgeon for multiple extractions,” Fenton said.

Of the athletes at the games, typically 45 percent have untreated decay and up to 60 percent have excessive periodontal disease, while 13 to 15 percent of the athletes report mouth pain, Fenton said.

Trainees learned how to initiate, coordinate and implement Special Olympics Special Smiles Programs in their local communities. They also learned hands-on how to manage the behaviors of individuals with intellectual disabilities.

Steven Hackmyer, D.D.S, associate professor of pediatric dentistry at the UT Dental Branch, was a trainee this year. “The experience of being trained, as well as being part of the games, was truly phenomenal. It was the experience of a lifetime and one I will always remember,” Hackmyer said. “Meeting, examining and teaching oral care to the athletes, most of whom did not speak English, was quite enjoyable and wonderful. It was rewarding to see the impact and difference we had on so many of the athletes.”

New approach to dental visits may ease kids' fears

For many children, a trip to the doctor or dentist is a stressful experience. The sensory environment (i.e., the sounds, smells, and lights associated with the clinical setting) can cause a child's anxiety levels to rise. This is especially true in children with developmental disabilities who may have difficulty understanding the unfamiliar clinical environment. A new study soon to be published in The Journal of Pediatrics explores the relationship between the sensory environment and anxiety levels in children.

Dr. Michele Shapiro of the Issie Shapiro Educational Center and colleagues from Hebrew University in Israel studied the effects of the sensory environment on a child's anxiety levels during two separate routine cleaning visits to the dentist. The researchers observed 35 children between the ages of 6-11 years, 16 of whom were developmentally disabled. They measured the anxiety levels of the children during each visit using a behavior checklist and monitored each child's electro-dermal activity, an objective measure of arousal.

The first trip included the typical sensory experiences of a dental office, including fluorescent lighting and the use of an overhead dental lamp. During the second trip, however, the researchers created a sensory adapted environment that modified the experience of the children. No overhead lighting was used, a slow moving repetitive color lamp was added, and the dental hygienist wore a special LED headlamp that directed the light into the child's mouth. The children listened to soothing music and were wrapped in a heavy vest that created a "hugging" effect. The dental chair itself was also modified to produce a vibration.

Dr. Shapiro and her colleagues found that anxiety levels decreased in all children when the sensory adapted environment was used. The duration of anxious behavior dropped significantly, from an average of 3.69 minutes to 1.48 minutes in typical children. The decreased anxiety levels were even more notable in children with developmental disability, with averages dropping from 23.44 minutes to 9.04 minutes. Dr. Shapiro and her colleagues are hopeful that this new method may have a potential use in other medical settings as well. As Dr. Shapiro notes, "This new approach may even replace sedatives and other invasive procedures in the future."