Inside Dentistry
June 2008
Volume 4, Issue 6

In the News...

News from Industry and Academia.

Oral Health America and British Dental Health Foundation LaunchNational Smile Month in the United States

The importance of brushing, good nutrition, and regular visits to the dentist is the focus of National Smile Month, the largest independent international dental campaign aimed at consumers of all ages. National Smile Month, now in its 32nd year in the United Kingdom, arrived in the United States May 18, through a new partnership between Oral Health America and the British Dental Health Foundation. This year’s theme is “Brush for Health!”

“National Smile Month conveys the importance of self-care, choosing healthy food, and visiting the dentist regularly, messages that are basic but still very much needed in the United States, where tooth decay remains the number one unmet health need for children,” said Robert Klaus, president and CEO of Oral Health America. “It is particularly exciting to lead the US part of an international effort designed to raise awareness of oral health’s importance to overall health.”

“We are delighted to share this very successful campaign with Oral Health America, and support the promotion of oral health in the United States,” said Dr. Nigel Carter, CEO of the British Dental Health Foundation, which founded the program in 1976.

National Smile Month will bring creative messages about oral and overall health to the public and profession via significant media outreach and the distribution of a National Smile Month Guide to thousands of dental practices throughout the country, inviting care providers to share campaign messages with their patients.

Oral Health America is committed to a multi-pronged approach to prevention, including helping communities build infrastructure for school oral health services, and a “back to basics” stance in public education through National Smile Month. Arming consumers with the information they need to help themselves, their children, and their communities is integral to Oral Health America’s mission.

For more information, visit www.oralhealthamerica.org or www.dentalhealth.org.uk.

Phase I Clinical Trial of Photodynamic Therapy (PDT) Underway for Potential New Treatment of Oral Precancerous Lesions

A Phase I clinical trial using a DUSA Pharmaceuticals, Inc product has been launched by the National Cancer Institute (NCI) to study an entirely new approach for the prevention of oral cancer, which may affect more than 30,000 Americans this year. Chronic mouth lesions, the most common of which is a condition known as oral leukoplakia, are early indicators of oral cancer. There is currently no effective treatment for preventing the progression of oral leukoplakia to cancer. The long-term goal is to examine aminolevulinic acid (ALA) photodynamic (PDT) therapy as a preventive treatment for oral cancer by the selective removal of oral leukoplakia.

Oral leukoplakia is a condition involving the formation of white spots on the surfaces of the mouth and tongue. Previous studies have shown that ALA PDT may be used to identify and treat the condition. ALA, the active ingredient in DUSA’s product, Levulan®, is a chemical that is produced naturally at low levels in humans. If ALA is given to the body at higher levels, the drug can build up inside pre-cancerous cells. When a laser light is pointed at a pre-cancerous cell, ALA may increase the effect of the laser, causing the cell to die. This is called photodynamic therapy (PDT). The purpose of the present trial is to examine the safety and tolerability of orally administered ALA PDT and to determine the optimal dose of light therapy.

About the Study
During 2004, DUSA signed a clinical trial agreement with the NCI Division of Cancer Prevention (DCP), for the clinical development of Levulan PDT for the treatment of oral leukoplakia. The NCI DCP will be responsible for the clinical trial costs, while DUSA will provide Levulan, laser light device(s), and the necessary training for the investigators involved in the studies. In the study, the same dose of ALA will be administered orally to six groups of patients with oral leukoplakia. The oral dose will be followed in 3 to 4 hours by laser light treatment (PDT), with the first group getting the lowest light dose and increasing the light dose for each new group. Safety evaluations will be performed after treatment of each group. Biopsies of target oral lesions and/or tissue where oral lesions previously existed will be performed at registration and completion to evaluate treatment.

“DUSA is pleased to support the National Cancer Institute in the development and initiation of this pilot clinical protocol, which presents a unique opportunity to use Levulan PDT as a new treatment for oral leukoplakia, a condition for which there is no standard therapy,” says Bob Doman, president and CEO of DUSA. “The launch of this trial underscores DUSA’s commitment to supporting studies that will examine the potential of Levulan PDT as a preventive cancer treatment across different patient populations.”

Research Shows Energy Drinks are Hard on Tooth Enamel

A professor at the University of Maryland Baltimore Dental School soaked teeth in energy drinks, fitness water, sports drinks, and other beverages for 14 days, measuring the decay. According to reports in General Dentistry and other trade publications, lemonade and energy drinks did the most damage. The professor, Dr. Anthony von Fraunhofer, found that those drinks contain high levels of acids that can destroy enamel.

The American Beverage Association, which represents the manufacturers of sodas, colas, energy drinks, and sports drinks, has been critical of the study, which was meant to replicate 13 years of normal beverage consumption, saying its methodology is flawed. Consumers of the drinks wouldn’t see that sort of damage unless they held the liquids in their mouths without swallowing it, the organization has said. But Dr. John Ruby, a professor in the dental school at the University of Alabama at Birmingham, has done research that reached similar conclusions. Ruby measured the pH levels, or acidity, of dozens of beverages. Energy drinks have such high levels of acid that he recommends consumers not even allow them to touch their teeth. If you must drink them, he said, use a straw.

Drink manufacturers put acid into beverages to balance the sweetness of the sugar. A can of Coke includes 10 teaspoons of sugar, for example, Ruby said. The acid makes it palatable. A low pH level means high acidity, and a high level means the acidity is low. A pH below 4 is enough to dissolve teeth, and all the energy drinks Ruby tested had levels of 3.3 or lower. Some sports drinks, including Powerade and Gatorade, were even worse. Among sodas, root beer was best, with a pH of 4. Energy drinks, sports drinks, and sodas contain a variety of acids, most commonly phosphoric acid, typically found in dark colas, and citric acid, typically found in clearer ones. Damage caused by those acids is basically irreversible, Ruby said.

In the Maryland study, the amount of enamel destroyed by the beverages was highest in KMX energy drink and Snapple Classic Lemonade. Close behind were Red Bull and lemon-lime Gatorade. The most destructive beverages seem to be those with citric acid, Ruby said. The pitting that results can be filled, just like a cavity. But if the damage is closer to the roots, a crown is necessary. More severe damage means lost teeth.

To minimize the damage, Ruby recommends that people who consume energy and sports drinks:

• Use a straw. Anything that keeps the liquid from coming in contact with your teeth helps. If you don’t have a straw, open wide and pour it down, he said.
• Follow the energy drink with water. Rinsing will help remove what remained in your mouth after drinking that Red Bull, and will lessen the amount of acid that comes in contact with your teeth.
• Use sports drinks for their intended purpose. An athlete who gulps down Gatorade after a workout isn’t the one whose teeth are likely to suffer. It’s the office worker who keeps a jug on his desk because he likes the taste.

Oral and Dental Healthcare Practices in Pregnant Women in Australia: a Postnatal Survey

7thSpace reported on a study published in BMC Pregnancy and Childbirth designed to assess women’s knowledge and experiences of dental health in pregnancy and to examine the self-care practices of pregnant women in relation to their oral health.

Methods: Women in the postnatal ward at the Women’s and Children’s Hospital in Adelaide completed a questionnaire to assess their knowledge, attitudes, and practices about periodontal health.

Pregnancy outcomes were collected from their medical records. Results were analyzed by chi-square tests, using the SAS statistical program.

Of the 445 women enrolled in the survey, 388 (87%) completed the questionnaire. Most women demonstrated reasonable knowledge about dental health.

There was a significant association between dental knowledge and practices with both education and socio-economic status. Women with less education and lower socio-economic status were more likely to be at higher risk of poor periodontal health compared with women with greater levels of education and higher socioeconomic status.

Conclusions: Most women were knowledgeable about oral and dental health. Lack of knowledge about oral and dental health was strongly linked to women with lower education achievements and lower socioeconomic backgrounds.

Whether more intensive dental health education in pregnancy can lead to improved oral health and, ultimately, improved pregnancy outcomes requires further study.

Author: Natalie J Thomas, Philippa F Middleton, and Caroline A Crowther
Credits/Source: BMC Pregnancy and Childbirth. 2008;8: 13.

National Children’s Oral Health Foundation Presents $25K Grant to University of North Carolina at Chapel Hill School of Dentistry

The National Children’s Oral Health Foundation (NCOHF) awarded a grant of $25,000 to the University of North Carolina at Chapel Hill School of Dentistry. The grant is earmarked to support the University’s Infant and Toddler’s Oral Health initiative, titled bOHP or baby Oral Health Program.

NCOHF is a national network of progressive, not-for-profit, community-based children’s dental facilities. NCOHF disburses grant funds to members of its affiliate network who increase access to dental care for underserved children. Since 2006, NCOHF has awarded more than $2 million in financial grants and product donations to help provide oral health education and increase access to dental care for children.

NCOHF’s grant will help the University’s School of Dentistry distribute its bOHP™ Kits to graduating dental students, and the general dental community in North Carolina. These kits will help standardize dentists’ training and provide students with a hands-on package they can use in their private practices, thereby equipping them to care for young children. Ultimately, the bOHP Kit will be shared with other dental schools and dental teams nationwide to help integrate oral healthcare for infants and toddlers into their practices.  

 “To break the unfortunate chain of events associated with early childhood caries, dentists must reach children at an earlier age,” says J. Timothy Wright, DDS, MS, Bawden Distinguished Professor and Chair. “Our bOHP program was inspired in part by data suggesting that dentists with hands-on and lecture training in infant and young child oral examinations in dental school are significantly more likely to perform these treatments vs those dentists who only received lecture and/or laboratory-only or no education in this area.

“We believe that with proper support and resources, the bOHP program can provide an opportunity for dental students, residents, and practitioners to increase their knowledge and effectively deliver preventive oral health services to young children,” he adds.

“NCOHF is proud to support the establishment of the bOHP program, which illustrates the University’s commitment to developing innovative solutions to provide every child the opportunity for a healthy smile,” said Fern Ingber, president and CEO of NCOHF. “Members of the NCOHF national Affiliate Network, including the University of North Carolina at Chapel Hill’s School of Dentistry, are eligible to receive grants, donated products and other valuable services to assist their efforts to eliminate pediatric dental disease.”

In other NCOHF news:

• NCOHF hosted and moderated a concurrent session at the National Oral Health Conference in Miami. As part of the program, two NCOHF Affiliates shared their experiences, highlighting how the Toothfairy Island oral health curriculum enhanced their programs.

• NCOHF Affiliates have completed the first round of outcomes testing on the Toothfairy Island educational curriculum. Dr. Chester Douglass, professor in the Department of Epidemiology at Harvard University’s School of Public Health, will analyze the data and develop a report of the results, which will be shared when finalized.

• The approximately $550,000 NCOHF Affiliate grants from 2007 are helping those local communities in their program delivery to underserved children. In addition, many programs will be serving as models to help other Affiliates expand the impact of their community programs. NCOHF is currently exploring venues through which to share high-impact programs.

Medical-Dental Dialogue at New York Academy of Sciences: Transcripts Now Online

An “e-briefing” with both audio and slides is now available online for a conference hosted by the New York Academy of Sciences on January 18, 2008, that examined the data that suggest connections between periodontal infections and systemic disease such as atherosclerosis, renal disease, pre-term births, and cardiac disease. The program was jointly sponsored by Columbia University College of Physicians and Surgeons, Columbia University College of Dental Medicine, The New York Academy of Sciences, and The National Periodontal Disease Coalition, and supported by Aetna Dental, Colgate Oral Pharmaceuticals, Johnson and Johnson Oral Health Care Products, Oral Health America, and OraPharma, Inc.

NYU Dental Professor Discovers Biological Clock Linking Tooth Growth to Other Metabolic Processes

Why do rats live faster and die younger than humans? A newly discovered biological clock provides tantalizing clues.

This clock, or biological rhythm, controls many metabolic functions and is based on the circadian rhythm, which is a roughly 24-hour cycle that is important in determining sleeping and feeding patterns, cell regeneration, and other biological processes in mammals.

The newly discovered rhythm originates in the hypothalamus, as does the circadian rhythm, a region of the brain that functions as the main control center for the autonomic nervous system. Unlike the circadian rhythm, however, this clock varies from one organism to another, operating on shorter time intervals for small mammals, and longer ones for larger animals. For example, rats have a 1-day interval, chimpanzees have a 6-day interval, and humans have an 8-day interval.

New York University (NYU) dental professor Dr. Timothy Bromage discovered the rhythm while observing incremental growth lines in tooth enamel, which appear much like the annual rings on a tree. He also observed a related pattern of incremental growth in skeletal bone tissue—the first time such an incremental rhythm has ever been observed in bone.

Reporting his findings today in the “Late-breaking News” session during the 37th Annual Meeting of the American Association for Dental Research, Bromage said, “The same biological rhythm that controls incremental tooth and bone growth also affects bone and body size and many metabolic processes, including heart and respiration rates. In fact, the rhythm affects an organism’s overall pace of life, and its lifespan. So, a rat that grows teeth and bone in one eighth the time of a human also lives faster and dies younger.”

Humans have by far the most variation in these long-term incremental growth rhythms, with some humans clocking as few as 5 days, and others as many as 10. Correspondingly, humans have the most variability in body size among mammals.

Future research will assess whether there is a link between slower growth rhythms and growth disorders. Because the autonomic nervous system controls human behavior, future research will also assess whether growth rhythms can be linked to variations in human behavior.

Dr. Bromage is an adjunct professor of Basic Science and Craniofacial Biology and of Biomaterials and Biomimetics at the NYU College of Dentistry.

ADA Foundation Helps Prepare Profession for Increased Use of Sedation, Anesthesia

As advances in dental technology offer a greater range of treatments in dental offices, the ADA Foundation is taking a proactive step to help ensure patient safety advances are in step with tomorrow’s dental science through a $100,000 grant to the American Dental Society of Anesthesiology Research Foundation, Inc.

The grant will fund development of curriculum materials and advanced training to help dentists better prevent, recognize, and treat exceedingly rare complications and emergencies that may arise in a dental setting from sedation and anesthesia.

The training will be a combination of electronic-mediated written materials and a laboratory practice component based on the latest scientific knowledge and techniques on the use of sedation and anesthesia, giving special emphasis to airway management and emergencies.

“At a time when dentists are increasing their use of sedation and anesthesia in the dental office, there is a critical need for an advanced course that focuses on emergency management,” says Arthur Dugoni, DDS, MS, president of the ADA Foundation. “The ADA Foundation is taking this opportunity to meet that need, and to fulfill its mission of educating dentists and promoting public and oral health.”

The grantee also will carry out pilot testing of the proposed course. The ADA Foundation will then partner with the American Dental Association (ADA) to make the course widely available sometime in 2009. State dental boards will be encouraged to accept this course as an alternative to currently required emergency certification courses for dental professionals providing sedation and anesthesia. ADA Member dentists wishing more information should contact the ADA Council on Dental Education and Licensure at 312-440-2694.

Henry Schein Extends Support of UN Millennium Villages Project Oral Task Force

Henry Schein extended its support of the UN Millennium Villages Project Oral Task Force in fall 2007 through its global social responsibility program, Henry Schein Cares. The company donated needed dental supplies to support the mission. The oral task force assesses the oral healthcare needs of villagers and incorporates dentistry as an integral component of healthcare. The dental volunteer team from Columbia University of Dental Medicine and Harvard School of Dental Medicine performed oral assessments to more than 1,150 people in three rural African villages: Mayange Village in Rwanda, Mbola Village in Tanzania, and Potou Village in Senegal.

Cavities in Children Reduced More Than 60% by New Experimental Chewable Mints

Ortek Therapeutics, Inc (Roslyn Heights, NY) and Stony Brook University announced today that new data published in the most recent issue of the Journal of Clinical Dentistry demonstrates the effects of a new chewable mint in preventing cavities in children. This investigational product, called BasicMints™, contains CaviStat®, a fluoride-free, caries-fighting complex. CaviStat is designed to mimic the profound cavity-fighting benefits of saliva by neutralizing harmful plaque acids and simultaneously promoting the remineralization of the tooth structure. The results show the children who were administered BasicMints had 62% fewer cavities in their molars after 1 year compared to children in the placebo group.

CaviStat was developed, clinically tested, and patented by researchers in the Department of Oral Biology and Pathology at the State University of New York at Stony Brook and exclusively licensed to Ortek. Ortek will submit an Investigational New Drug application with the US Food and Drug Administration (FDA) later this year. BasicMints are not currently approved for use in the United States.

Caries are the most prevalent disease in children. Almost half of all children have a cavity by second grade and 80% have a cavity by the time they graduate from high school. Approximately 90% of caries in the teeth of children occur in the biting surfaces of the back teeth. By chewing BasicMints and packing CaviStat into these vulnerable surfaces, protection is focused where most cavities form.

The study was published in the March 2008 issue of the Journal of Clinical Dentistry. It showed that after 6 months, children (N = 96) who took two BasicMints with CaviStat twice a day had 68.3% fewer cavities than the placebo group. After 12 months those children had 61.7% fewer cavities as compared to the placebo group (N = 99) (P < .001) in all of the molars studied (first permanent molars, some erupting premolars, second molars and deciduous molars). In the first permanent molars, some early-erupting premolars and second molars, the children who were in the BasicMints study group had 75.6% fewer cavities after 6 months (P < .001) and 50.7% fewer cavities after 12 months (P < .001), as compared to the placebo group. Additionally, the children in the BasicMints study group had 76.2% fewer cavities in the deciduous molars after 6 months and 74.8% fewer cavities after 12 months, as compared to the placebo controls.

Catalyst Institute Launches National Program to Expand Access to Safety Net Oral Healthcare

The Catalyst Institute launched the national expansion of Safety Net Solutions, a program designed to expand access to oral healthcare by providing technical assistance to dental safety net providers. The Safety Net Solutions program seeks to transform the hundreds of struggling oral health programs at community health centers and clinics into financially viable programs so that they are not only preserved as a resource, but also have the ability to expand.

“Safety Net Solutions is a critically needed resource for providing dental care to underserved populations,” said Mark Doherty, project director. “These safety net dental programs are essential to meeting the oral health needs of the uninsured and those on Medicaid. In today’s challenging reimbursement environment, most safety net dental programs struggle to achieve sustainability. There is no question that safety net dental programs provide high-quality clinical care to our nation’s most vulnerable residents. However, without a strong balance between mission-focused care and strong business practices, the sustainability of safety net dental practices is in jeopardy.”

Safety Net Solutions seeks to stabilize dental programs with a thorough audit of business and dental practice systems and operations. Safety Net Solutions provides dental programs with a range of potential strategies they can adopt to enhance efficiency, effectiveness, and financial sustainability, with the ultimate goal of enabling programs to reach more patients. Doherty and his team are recruiting expert advisors from across the United States who will expand the scope and reach of Safety Net Solutions nationally over the next 3 years.

The Safety Net Solutions initiative began in New England in 2006. While the program initiators anticipated working with three to four community health centers in the first year, demand was so strong that Safety Net Solutions assisted 17 organizations in four New England states in the first 18 months alone. Case studies show that while many of these community health center-based oral health programs were being cut back or in danger of closing, they are now experiencing a rise in patient visits and are even expanding. Through collaboration with Safety Net Solutions, community health center dental practices develop business strategies that reduce their dependence on assistance, so they can become financially sustainable through their own operations.

Bone Cells Colonize Glass Scaffolding

Dr. Delbert Day says it’s like seeding a fishing environment by throwing an old Christmas tree into the water. The submerged tree provides good pockets of cover for all kinds of fish. But this isn’t really a discussion about aquatic habitats. Day is trying to explain why human bone cells would want to colonize medical scaffolding made out of glass fibers.

“Nature abhors a void,” he says. “And the body likes certain kinds of glass.”

A Curators’ Professor Emeritus of ceramic engineering at Missouri University of Science and Technology (S&T), Day has developed a number of new applications for glass, including the treatment of liver cancer with tiny, radioactive glass spheres. Day and a group of Missouri S&T researchers are developing 3-D scaffolds made out of bioactive glasses. They plan to use the scaffolds for bone regeneration.

“Cells can get inside the scaffolding, grow, and develop in the pores,” Day says, “just like the fish colonize the Christmas tree.”

But here’s where the analogy departs. Unlike the tree, which never becomes one with the fish, the scaffolding eventually does become part of the bone.

Currently, titanium rods are often used to repair badly damaged bones. But Day and his colleagues say the glass scaffolding is, mechanically, much closer to the composition of real bone. Compared to metal implants, which are smooth and rigid, the scaffolding is porous and downright hospitable.

“Over time, the scaffolding would become indistinguishable from bone,” says Dr. Roger Brown, a professor of biological sciences who is working on the project. “It becomes part of the bone structure.”

The Missouri S&T researchers have formed a partnership—officially called the Consortium for Bone and Tissue Repair and Regeneration—with researchers at the University of Missouri-Kansas City (UMKC). “We do the materials work here,” explains Dr. Len Rahaman, a professor of materials science and engineering at Missouri S&T who is working with Day and Brown. “They do the clinical work at UMKC.”

Four bioactive glasses selected by the Missouri S&T researchers are being evaluated in Kansas City. Once the best glasses are identified, Rahaman will lead the effort to build new scaffolds. Prototypes will then be placed in animals, and, if everything goes according to plan, the method will ultimately be tested in humans.

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