Inside Dentistry
May 2008
Volume 4, Issue 5

In the News?

News from Industry and Academia

More US Teeth Susceptible to Silent Enamel-Eating Syndrome

A University of Texas (UT) Health Science Center at San Antonio study has found that the incidence of dental erosion is on the rise in the United States.

Bennett T. Amaechi, MS, PhD, associate professor of community dentistry, and colleagues discovered a 30% prevalence rate of dental erosion among 10- to 14-year-olds in the United States. Dr. Amaechi led the San Antonio portion of the nation’s first population-based, multi-center study of dental erosion. The study, involving 900 middle school students, was conducted in 2004 and 2005 at Indiana University, the University of California at San Francisco, and the UT Health Science Center San Antonio.

Dental erosion has not been widely analyzed in the United States. "This study is important because it confirms our suspicions of the high prevalence of dental erosion in this country and, more importantly, brings awareness to dental practitioners and patients of its prevalence, causes, prevention, and treatment," Dr. Amaechi said.

Dental erosion is caused by acids found in products that are being more widely consumed than ever in the US. "When consumed in excess, these products can easily strip the enamel from the teeth, leaving the teeth more brittle and sensitive to pain," Dr. Amaechi said. "The acids in these products can be so corrosive that not even cavity-causing bacteria can survive when exposed to them."

Dr. Amaechi said some medications including aspirin, when taken regularly, have erosive potential. Some underlying medical conditions such as acid reflux disease or disorders associated with chronic vomiting, including bulimia, also can cause dental erosion because of the gastric acids that are regurgitated into the mouth.

"It is important for dental practitioners to identify dental erosion and its causes before it is too late," Dr. Amaechi said. "Because dental erosion creates a smooth and shiny appearance of the enamel and causes no pain or sensitivity in its early stages, most patients are not aware that they are suffering from the condition until the problem becomes severe. Therefore, the responsibility of early detection and treatment falls on the professionals."

Dr. Amaechi’s findings were published in the Dental Tribune and have been translated in 35 languages.

Healthy Gums are Something to Smile About

According to a recent study published in the Journal of Periodontology, a smile may also help convey healthy teeth and gums. Researchers found evidence that periodontal disease, or gum disease, may negatively affect an individual’s smiling patterns and deter someone from displaying positive emotions through a smile.

The study, conducted at the University of Michigan, evaluated the smiling patterns of 21 periodontal patients while viewing a segment of a comedy program. Findings indicated that periodontal disease can impact how a person smiles. The more symptoms of gum disease found in a patient’s mouth, such as periodontal pockets between 4 mm to 6 mm deep or loose or moving teeth, the more likely the patient was to cover his or her mouth when smiling or to limit how widely the mouth opened during the smile. In addition, the more gum recession seen in the patient, the fewer teeth he or she showed when smiling. The way patients perceived their quality of life as a result of their oral health was also significantly correlated with the number of teeth affected by periodontal disease.

"It is already widely known that periodontal disease is connected to systemic health," said Dr. Susan Karabin, president of the American Academy of Periodontology. "These results help demonstrate that periodontal disease may affect more than just overall health. It can also impact actual quality of life and make caring for one’s teeth and gums all the more important."

Summer Research Training Institute

The University of Washington’s School of Dentistry will offer its annual summer research training institute from July 6 to August 15, 2008, for dental school faculty and other oral health professionals interested in clinical research in dentistry. More than 325 faculty from schools in 30 states and 30 foreign countries have participated since the program’s inception in 1992. Courses will be offered in biostatistics, clinical epidemiology/study design, personal computing applications, clinical trials, behavioral research in dentistry, grantsmanship, and case studies in data analysis, along with an elective in oral health applications of molecular biology. There is no tuition charged for the summer institute, unless academic credit is requested (which can be arranged through the University of Washington Summer Quarter Office).

The summer institute is designed to offer training in research methods to which dentists (and other oral health professionals) may not have been adequately exposed during clinical training. For those currently in or seeking academic or other positions involving clinical dental research, the summer institute offers an opportunity to learn research methods which will enhance one’s ability to perform good clinical research. The program lasts a full 6 weeks and is not available in modular form for shorter periods.

For more information visit the Web site:http://depts.washington.edu/dphs/suminst/ or contact: Timothy A. DeRouen, PhD, director, Summer Institute, at 206-221-6887 or derouen@u.washington.edu.

Heavy Marijuana Use Linked to Gum Disease

Heavy marijuana use has been found to contribute to periodontal disease, apart from the effects that tobacco smoke was already known to have.

In a group of more than 900 New Zealanders, smoking cannabis more than 40 times a year since age 18 was found to be responsible for more than one third of the new cases of periodontal disease in participants between ages 26 and 32, according to a study published February 6 in the Journal of the American Medical Association.

"Heavy cannabis use has been linked to greater risks of developing respiratory disease and some psychiatric conditions," said Terrie Moffit, a Duke University professor of psychology and neuroscience who participated in the study. "Gum disease should be added to that list of known hazards."

The study was led by W. Murray Thomson of the school of dentistry at The University of Otago, New Zealand, who measured gum recession at three sites on each tooth at age 26 and again at age 32. The study subjects are part of a longitudinal health and development study that has been tracking nearly 1,000 people born in 1972 and 1973 in Dunedin, New Zealand.

The link between periodontal disease and marijuana use emerged from a statistical analysis that controlled for gender, dental care, socioeconomic status, and dental cleanliness. Most of the self-identified heavy marijuana users also were tobacco users, but that factor was controlled statistically. The researchers also were able to focus on study participants who were not tobacco users, and they still found a link between marijuana use and periodontal disease.

The precise physiology of smoke’s effect on the gums is still not understood, but the team believes it interferes with immune function, inflammatory response, and peripheral blood flow in the gums.

AGD Announces New Team Hire

The Academy of General Dentistry (AGD) is pleased to announce an appointment to its staff, Jimmy Weinland, Administrator, Student Membership Development, who will help the AGD enhance the quality of effective and efficient customer service the association provides to more than 35,000 members.

In this newly created position, Weinland will administer the recruitment, retention, and member/prospect services of dental students, residents, and recent graduates. He will also provide marketing expertise for all dental students, residents, and recent graduates programs and services. In addition, Weinland will create, plan, develop, implement, track results, and evaluate the AGD’s recruitment, retention, and awareness activities.

Practice Makes Perfect with 3-D Dental Simulator

A group of dental and dental hygiene students at the University of Illinois at Chicago (UIC) pick up instruments and prepare to begin a procedure. In their hands, their tools gently rub against the teeth and underneath the gums, feeling for calculi on the tooth root, measuring pocket depth, and searching for periodontal abnormalities.

These students, however, are not practicing on patients. They are using a computer equipped with a 3-D training system to improve their skills.

Researchers at UIC’s Colleges of Dentistry and Engineering are collaborating to develop a life-like training simulator called PerioSim, which uses haptic virtual reality technology. Haptics is the science of applying touch sensation and control to computer applications. It allows the user to "feel" what is pictured on a computer screen.

Over the past several years, dentistry has begun using simulators to train students, but the programs traditionally use tracker technology, not haptics, said Dr. Arnold Steinberg, professor of periodontics at UIC and project leader.

With the PerioSim, students guide a stylus on-screen that resembles an explorer. They can feel life-like tactile sensations as they navigate through various procedures. "We can enhance the learning and training of a wide variety of tasks or procedures using this system," Steinberg said. "The need to practice on mannequins, animals, and patients can be significantly reduced, and in some cases, eliminated entirely." The device also provides a way for professionals and students to further refine their skills even after having experience with patients, he said.

Students can access PerioSim via the Internet. A realistic 3-D human mouth is shown in real-time, and the user can adjust the model position, viewpoint, and transparency level. The haptic device allows the student to feel the sensations in the virtual mouth, and a control panel lets the user choose different procedures to practice and instruments to use, Steinberg said.

The system allows instructors to create short scenarios of periodontal procedures, which can be saved and replayed at any time. The 3-D component permits students to replay from any angle, so the user can observe different views of the placement of the instrument and gingival relationships during a procedure. The recorded file can be viewed on any personal computer, and while not in 3-D, it is an actual representation of the original scenario, which offers great training potential.

The program also allows for a second playback mode, where an instructor leads the trainee through the program. By simply holding onto the haptic stylus, the trainee receives the same sensations felt by the instructor. Trainees can also be tested and evaluated on their ability to mimic the instructor’s periodontal procedures.

A validation study was recently undertaken, finding the simulator to be "very useful," Steinberg said. Results were published in the Journal of Dental Education in December 2007.

Today’s dental schools are faced with rising costs, faculty shortages, and an overloaded curriculum, Steinberg noted. Haptic-based simulators such as the PerioSim require less initial investment, maintenance, and replacement of parts than earlier generation mannequin-based simulators and are more versatile, he said.

AGD Advocacy Conference Connects General Dentists with Congress

The Academy of General Dentistry’s (AGD) second annual advocacy conference, A Great Dentist Goes to Washington, was held March 10 and 11, 2008. Nearly 60 AGD constituent leaders and member general dentists from 30 states learned how to get Congress to listen. They later applied these sophisticated skills to more than 100 Congressional offices on Capitol Hill to convey the interests and concerns of general dentists.

"This year’s advocacy conference, once again, proved to be a major success as AGD leaders and members rallied together to express the issues that affect general dentists to the men and women in Congress," says AGD president Vincent Mayher, DMD.

The 2-day event began at the Westin Embassy Row Hotel in Washington, DC, with attendees involved in a daylong advocacy training session. Mr. Jim Saturno, of the Congressional Research Service, delved into the intricacies of effectively interacting with Congress during a session, "Congress 101." An interactive session, "Decision Makers: Do They Listen?" was a highlight as attendees explored scenarios designed to develop and enhance lobbying skills at the constituent level. Training continued for attendees following the day’s visits with sessions such as, "Taking it to the Hill," "Putting it into Practice," and "The Game Plan Explained in Detail."

"The AGD advocacy conference was well organized and really helped to prepare us for the visits to Capitol Hill," says Lynnette Smith, DDS. "I am thankful to the AGD for providing the 2008 advocacy training and an opportunity to use these skills to benefit our patients."

Deamonte’s Law (HR 2371), the Children’s Dental Health Improvement Act (S 739/HR 1781) and Meth Mouth Bills (S 1906/HR 3186) were three issues, known as "asks" that AGD leaders and members lobbied for during their visits with Congressmen and Senators on the Hill. Within 24 hours of their meetings, Senator Barbara Boxer (D-CA) and Representative Dennis Moore (D-KS) became co-sponsors of the Children’s Dental Health Improvement Act.

The morning of the Hill visits, attendees gathered for the last time as a full group to watch Dr. Mayher present Congressman Mike Simpson (R-ID), a dentist himself, with the AGD’s Legislator of the Year Award. The AGD also honored Reps. Elijah Cummings (D-MD) and Rick Larsen (D-WA) with appreciation awards for their support for oral health initiatives.

"The entire session was extremely informative about issues facing the dental profession, especially the practicing general dentist," said Iowa AGD Legislative Chair, Stephen Thies, DDS. "I strongly believe that dentistry is our profession and it is our responsibility to speak on dental issues to the legislative groups involved. I am glad to lobby either nationally or locally on behalf of the AGD on any issues affecting general dentistry."

AAP Releases Statement on Risk Assessment

The American Academy of Periodontology (AAP) released a Statement on Risk Assessment in the February Journal of Periodontology. The statement encourages dentists to use risk assessment as a key component of all comprehensive dental and periodontal evaluations."It is advantageous for a dental professional to evaluate a patient’s various risk factors for periodontal disease," explains Dr. Susan Karabin, AAP president. "The AAP statement hopes to compel more dental professionals to take a full inventory of their patients’ health, especially any applicable risk factors."

AGD Foundation Donates Silent Auction Proceeds to Special Olympics

The Foundation of the Academy of General Dentistry (AGD) is on a mission to help maintain the smiles of some very special athletes. They are the warm and inspiring smiles seen on the men, women, boys, and girls of Special Olympics. In an effort to ensure that special athletes can protect their teeth and mouths while competing, the AGD Foundation recently presented a check for $20,000 to Special Olympics Special Smiles (SOSS) to use for mouthguards. The donation is a result of the AGD Foundation’s 2007 silent auction held at the AGD’s Annual Meeting and Exhibits in San Diego, California.

With the charitable support of AGD members, corporate alliance partners, and 2007 annual meeting exhibitors who supported the silent auction, the AGD Foundation was able to present the proceeds to SOSS at the 2008 Yankee Dental Congress meeting in Boston, Massachusetts. SOSS is part of the Special Olympics Healthy Athletes initiative that works to provide services to people with intellectual disabilities.

"When members and their organizations come together and show this type of support, they truly do make a difference in the lives of Special Olympics athletes and their families," says AGD Foundation President, Mark Buczko.

The silent auction, held annually, generates funding for programs that make dental care available to underserved populations, as well as educational programs that enhance the general dentist’s ability to serve the elderly, physically and mentally challenged, and children.

"The AGD Foundation wants to empower people with intellectual disabilities to help them reach their full potential," says AGD Foundation Vice President, Raymond Martin, DDS, MAGD. "We are honored to be able to contribute to the success and progress of Special Olympians."

A New, Noninvasive Treatment for TMD

Researchers have developed a gel that rapidly relieves chronic inflammation and temporomandibular joint (TMJ), muscles of mastication, and myofacial pain. The study was published in the December 2007 Journal of Oral Implantology.

The gel is composed of 18% potassium complex, 10% dimethylisosorbide, and 72% aqueous hydroxyethyl cellulose gel. The gel is rubbed onto the facial skin as soon as clinicians identify the TMJ disorder, as the authors have found that the gel routinely and predictably provides rapid pain relief and patient comfort and speeds restoration of the jaw’s functional abilities, usually within 5 minutes after application.

The rapid relief seen from the gel led the authors to recommend that the gel be applied as a first-step procedure before definitive diagnosis and treatment. Once the pain has been eliminated as a complicating factor, a diagnosis and treatment plan concerning the jaw’s biomechanical problems may be identified and dealt with.

The gel can be reapplied by the patient as needed, safely providing self-help for comfort control and aiding in the successful treatment of this troublesome condition. The gel is topically applied and directly targeted. It is also painless, odorless, noninvasive, and routinely and predictably effective.

According to the authors, the gel’s ability to remove pain and inflammation as a first measure minimizes patient anxiety, depression, and psychological concerns. Subsequent diagnosis and treatment of the biomechanical disorders related to TMJ are then more easily and effectively treated.

ADA Unveils Public Service Ad to Support Dentistry in Developing Countries

The American Dental (ADA) is offering a camera-ready print public service advertisement to help garner support for the Health Volunteers Overseas’ (HVO) Dentistry Programs. The ad can be downloaded the four-color public service ad at http: //www.ada.org/ada/international/volunteer/hvo_ad.pdf.

According to the ADA, the purpose of the ad, "ADA, HVO and You—Coming Together to Share Our Care," is twofold. It seeks financial contributions in support of HVO dentistry programs and it reaches out to dentists to volunteer for the programs.

Currently, volunteer assignments are available for dentists in China, Cambodia, Vietnam, Laos, Tanzania, Nicaragua, and St. Lucia. The assignments can range from one to four weeks.

HVO is a private, non-profit organization dedicated to improving healthcare in developing countries through education and training. HVO volunteers travel to resource-poor countries, with an emphasis on educating, clinical training, and increasing the number of local health workers that will benefit the community long after volunteers have departed.

The ADA and its Center for International Development and Affairs is a sponsor of the HVO overseas dentistry program. Dentists interested in learning more about volunteer opportunities can visit www.hvousa.org.

A study published in The Journal of Clinical Dentistry has shown that Nu Radiance® Forté Teeth Whitener promotes the remineralization and recalcification of teeth during the whitening process. The study demonstrated that Forté recalcified incipient lesions to clinically significant depths (100 mm) and improved the surface hardness of the enamel. The studies were performed under the direction of Bruce R. Schemehorn at Dental Products Testing, Indiana University Emerging Technologies Center in Indianapolis, IN.

The Nu Radiance Forté Whitening System is a dentist-provided, tray-based, take-home whitening product that uses calcium peroxide to boost the whitening effect while providing calcium compounds at a healthy high pH to remineralize the teeth and to reduce the dentinal fluid flow, a major cause of tooth sensitivity.

The tests, which simulated in vivo conditions, showed significant uptake of calcium (10% and greater increase) and corresponding increases in surface hardness when using Forté calcium peroxide whitening agent, compared to a non-whitening control (saliva). These results compared favorably with the losses of calcium and decreased enamel surface hardness reported in studies of many conventional whitening agents.

NYU Dental Researchers Find Evidence of Periodontal Disease Leading to Gestational Diabetes

A study by a New York University (NYU) dental research team has discovered evidence that pregnant women with periodontal disease are more likely to develop gestational diabetes mellitus than pregnant women with healthy gums.

The study, led by Dr. Ananda P. Dasanayake, a professor of epidemiology and health promotion at the NYU College of Dentistry, followed 256 women at New York’s Bellevue Hospital Center through their first 6 months of pregnancy. Twenty-two women developed gestational diabetes. Those women had significantly higher levels of periodontal bacteria and inflammation than the other women in the study.

The findings, published in the April 2008 Journal of Dental Research, underscore how important it is for expectant mothers to maintain good oral health.

"In addition to its potential role in preterm delivery, evidence that gum disease may also contribute to gestational diabetes suggests that women should see a dentist if they plan to get pregnant, and after becoming pregnant," says Dasanayake. "Treating gum disease during pregnancy has been shown to be safe and effective in improving women’s oral health and minimizing potential risks."

"In the future,’ he added, "we can expect to see more research on the link between these two conditions involving other high risk groups, such as Asian and Native American women."

Gestational diabetes is characterized by an inability to transport glucose to the cells during pregnancy. The condition usually disappears when the pregnancy ends, but women who have had gestational diabetes are at a greater risk of developing Type 2 diabetes, later in life.

Inflammation associated with periodontal disease is believed to play a role in the onset of gestational diabetes, perhaps by interfering with the normal functioning of insulin, the hormone that regulates glucose metabolism.

Income-Related Incidence of Untreated Cavities

About 31% of low-income children aged 2 to 5 have dental cavities that do not receive treatment, according to the latest News and Numbers from the Agency for Healthcare Research and Quality (AHRQ). A much smaller portion of high-income children—about 6%—have untreated cavities.

AHRQ’S data also show:
• Among children from poor families, untreated cavities were more common in those aged 6 to 11 (37%) than children aged 12 to 17 (27%).
• Among children from wealthy families, untreated cavities were more common among children aged 6 to 11 (12%) than children 12 to 17 (7%).
• Only 36% of poor children visited a dentist in the past year compared to 70% of wealthy children.

This AHRQ News and Numbers summary is based on data from the 2007 National Healthcare Disparities Report, which examines shows disparities in Americans’ access to and quality of healthcare by race, ethnicity, income, and education.

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