Dentists are less likely to prescribe antibiotics after they receive a personalised report detailing their past prescription rates, according to a randomised controlled trial of UK dentists published in PLOS Medicine, by Linda Young, NHS Education for Scotland, UK, Jan Clarkson, University of Dundee and Craig Ramsay, Health Services Research Unit, University of Aberdeen, and colleagues.
Dentists prescribe about 10 percent of the antibiotics dispensed in UK community pharmacies. Previous studies have found that, despite clear clinical guidelines, they often prescribe antibiotics in the absence of clinical need. To test an "audit and feedback" intervention to reduce these inappropriate prescriptions, the RAPiD (Reducing Antibiotic Prescribing in Dentristry) trial relied on dental prescribing and treatment claim data that was already routinely collected by the National Health Service. The researchers randomly assigned all 795 antibiotic prescribing general dentist practices in Scotland (a total of 2566 dentists) to either receive or not receive a graph plotting their monthly antibiotic prescribing rate. A random subset of practices in the intervention group also received a written behaviour change message reiterating national recommendations.
At the start of the trial, the total number of antibiotics prescribed per 100 NHS treatment claims was 8.3 in the control group and 8.5 in the intervention group. Over the 12 months following the start of the intervention, dentists in the control group practices prescribed antibiotics at a rate of 7.9 per 100 claims, and dentists in the intervention group practices at a rate of 7.5, representing a 5.7% reduction in antibiotic prescriptions in the intervention group relative to the control group. Furthermore, dentists who received a written behaviour change message had an even greater reduction, of 6.1% relative to intervention dentists who did not receive this message.
While the findings suggest that providing individualised graphical feedback derived from routinely collected data can reduce the antibiotic prescribing rate of dentists, it was not possible to evaluate the impact on the quality or appropriateness of dentists' antibiotic prescribing in this study.
"The feedback provided in this study is a relatively straightforward, low cost public health and patient safety intervention that could potentially help the entire healthcare profession address the increasing challenge of antimicrobial resistance," the authors say.
This study was conducted as part of the TRiaDS programme of implementation research which is funded by NHS Education for Scotland (NES). The Health Services Research Unit which is funded by the Chief Scientist Office of the Scottish Government Health and Social Care Directorates supported the study. The funder had no influence over the design, conduct, analysis and write up of the study.
I have read the journal's policy and the authors of this manuscript have the following competing interests: Authors LY and JEC are employed by NHS Education for Scotland, which is responsible for supporting NHS services in Scotland by developing and delivering education and training for those who work in NHS Scotland. Author AE declared that during the course of the study, he was in paid full-time employment firstly by the University of Aberdeen and subsequently by Glasgow Caledonian University. The research was carried out on behalf of the TRiaDS Research Methodology Group (of which AE is a member). This group is funded by NHS Education for Scotland. No other competing interests exist.
Elouafkaoui P, Young L, Newlands R, Duncan EM, Elders A, Clarkson JE, et al. (2016) An Audit and Feedback Intervention for Reducing Antibiotic Prescribing in General Dental Practice: The RAPiD Cluster Randomised Controlled Trial. PLoS Med 13(8): e1002115. doi:10.1371/journal.pmed.1002115
NHS Education for Scotland (NES), Dundee Dental Education Centre, Frankland Building, Dundee, United Kingdom Dental Health Services Research Unit (DHSRU), University of Dundee, Park Place, Dundee, United Kingdom Health Services Research Unit (HSRU), University of Aberdeen, Health Sciences Building, Foresterhill, Aberdeen, United Kingdom NMAHP Research Unit, Glasgow Caledonian University, Cowcaddens Road, Glasgow, United Kingdom
IN YOUR COVERAGE PLEASE USE THIS URL TO PROVIDE ACCESS TO THE FREELY AVAILABLE PAPER:https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002115
NHS Education for Scotland
Dundee Dental Education Centre
Dundee, DD1 4HN
Nobilium announced it has obtained the rights to market Therm-O-Flex® from Advanced Dental Products.
Therm-O-Flex is a laboratory-processed “resilient” material that makes an excellent night-guard, occlusal splint, or denture reline. The material is not soft, but it does yield to pressure when at body temperature, providing retention in undercuts and relief from sore spots.
Master ceramist Peter Pizzi, MDT, CDT, will offer one-on-one help through a Virtual Study Club beginning October 18.
The study club allows users to study with Pizzi in their homes, laboratories, or offices. Attendees will learn how advances in materials are affecting case planning and the form, function, and esthetics of restorations.
To register, go to jensendental.com/vsc.
BUFFALO, N.Y. — There’s no need to reinvent the genetic wheel.
That’s one lesson of a new study that looks to the saliva of humans, gorillas, orangutans, macaques and African green monkeys for insights into evolution.
The research, published on Aug. 25 in Scientific Reports, examined a gene called MUC7 that tells the body how to create a salivary protein of the same name. The protein, which is long and thin, forms the backbone of a bottlebrush-shaped molecule that helps to give spit its slimy, sticky consistency.
The study found that within the MUC7 gene, instructions for building important components of the bottlebrush were repeated multiple times in each of the five primate species studied. Gorillas had the fewest copies of this information (4-5), while African green monkeys had the most (11-12). Humans fell somewhere in between, with 5-6.
Through an in-depth analysis of MUC7’s evolutionary history, the researchers concluded that having numerous copies of the repeated instructions likely conferred an evolutionary advantage to primates — possibly by enhancing important traits of saliva such as its lubricity and, perhaps even more importantly, its ability to bind to microbes (a capability that may help curb disease).
The takeaway lesson?
Evolution can favor the expansion of tried-and-true genetic tools, in addition to the development of totally new ones, says University at Buffalo biologist Omer Gokcumen, who led the study together with Stefan Ruhl, a salivary researcher in UB’s oral biology department.
“You don’t always have to invent a new tool,” says Gokcumen, PhD, an assistant professor of biological sciences in UB's College of Arts and Sciences. “Sometimes, you just need to amplify the tool you already have.”
In the case of MUC7, repeating key genetic instructions over and over resulted in longer, denser proteins, which are likely better at performing two protective tasks: lubricating the mouth — which facilitates talking, chewing and other vital functions — and latching onto microbes, an action that’s thought to expedite the removal of disease-causing pathogens from the oral cavity.
The evolution of MUC7
The genetic instructions that are repeated within the MUC7 gene are what scientists call tandem repeats — short strings of DNA found multiple times inside the gene.
The new study shows that as primates evolved, the DNA in their MUC7 tandem repeats sometimes changed in places (a normal part of evolution).
But the genetic material stayed the same in one key way: Pieces of DNA that told the body how to make the amino acids serine and threonine, two vital building blocks of the bottlebrush backbone, persisted in all primates. The directions for creating serine and threonine were found in the same location in tandem repeats across humans, gorillas, orangutans, macaques and African green monkeys.
The likelihood of this happening at random is small, which hints that those genetic sequences provided an evolutionary advantage to their hosts, Gokcumen says.
This hypothesis is bolstered by the crucial role that serine and threonine play in the MUC7 protein’s function. Within MUC7, the two compounds act as anchoring points for sugar molecules, which protrude from the protein backbone like the bristles of a brush. It’s these bristles that carry out the important task of binding to microbes.
The research elucidates how tandem repeats may serve as modular building blocks for rapid evolutionary adaptation.
“Tandem repeats may be a major way that many different genes in the genome quickly adapt to their environments,” says Duo “Erica” Xu, the study’s first author and a PhD student in biological sciences in the UB College of Arts and Sciences.
The research builds on the groundbreaking work of scientists in UB’s oral biology department, who discovered the MUC7 protein more than 30 years ago and sequenced the MUC7 gene, says Ruhl, a professor in that same department, which is part of the UB School of Dental Medicine.
“Saliva is an important body fluid which has been for a long time underappreciated by mainstream biomedical science,” Ruhl says. “It is amazing to see the research on MUC7 take off again with modern technology. In the next few years, we expect to learn a lot more about the importance of saliva for human health through such cross-disciplinary studies with evolutionary geneticists.”
The research team also included scientists from the Foundation of Research and Technology in Greece and the University of Minnesota Twin Cities.
Imagine how much dental care you’d need if you had 300 or more teeth packed together on each side of your mouth.
Duck-billed dinosaurs (hadrosaurs), who lived in the Cretaceous period between 90 million and 65 million years ago, sported this unique dental system, which had never been fully understood until it was examined at the microscopic level through recent research conducted by Aaron LeBlanc, a University of Toronto Mississauga PhD candidate; his supervisor, Professor Robert Reisz, the University of Toronto Mississauga vice-dean, graduate, and colleagues at the Royal Ontario Museum and the Museum of the Rockies.
Rather than shedding teeth and replacing them with new ones like other reptiles, hadrosaurs’ mouths contain several parallel stacks of six or more teeth apiece, forming a “highly dynamic network” of teeth that was used to grind and shear tough plant material. Although hadrosaur teeth appear to be fused in place, LeBlanc and his colleagues show that the newest teeth were constantly pushed towards the chewing surface by a complex set of ligaments. When viewed under the microscope, the columns of teeth are not physically touching and are held together by the sand and mud that can get in between the teeth following the decay of the soft ligaments after the animals died.
“Hadrosaur teeth are actually similar to what we have because our teeth are not solidly attached to our jaws. Like us, hadrosaur teeth would have had some fine-scale mobility as they chewed thanks to this ligament system that suspended the teeth in place,” says Reisz.
As they reached the grinding surface, hadrosaur teeth were essentially dead, filled with hard tissue – unlike humans, whose teeth have an inner core filled with blood vessels and nerves.
“Since the teeth were already dead, they could be ground down to little nubbins,” Reisz says.
LeBlanc says this tooth structure—with its tough grinding surface—was “well-adapted to break down tough plant material for digestion,” through both shearing and grinding. This adaptation may have contributed to the hadrosaurs’ longevity and proliferation.
Reisz says that hadrosaurs had “probably the most complex dental system ever made.”
“It’s very elegant – not a single brick of teeth working as a solid unit,” he says. “It’s more like chain mail, providing flexibility as well as strength.”
LeBlanc notes that the duck-billed dinosaur has been known for over 150 years and its dental system has long been recognized as unique, but no one had taken a look inside it at the microscopic level previously. He created thin sections of entire dental assemblies from the upper and lower jaws, that he then ground down, polished and examined under a powerful microscope. Working with their museum colleagues, he and Reisz were also able to explore how hadrosaur teeth form in embryos and hatchlings, providing a more complete picture of this unique model of dental evolution and development.
“The amazing thing is how consistently these dental assemblies conform to our hypothesis of how the system works,” LeBlanc says. “Even in the youngest specimens, the same processes that maintained dental assemblies in the adults were visible.”
The paper, published online in BMC Evolutionary Biology, is part of LeBlanc’s PhD research into the evolution and development of teeth in reptiles and mammals.
Heraeus Kulzer today announced the introduction of My Digital Denture, the company’s latest initiative in the digital denture space. My Digital Denture is a private label opportunity that relieves dental laboratories of the challenging and time-consuming setup and design steps in the denture process while still allowing them the freedom to use their preferred workflow prior to setup. This enables the laboratory to offer the exceptional fit and precision facilitated by digital dentures while freeing their technicians’ time to focus on other, more critical work.
My Digital Denture enables laboratories to offer exceptional fit and precision dentures facilitated by digital design while freeing their technicians’ time to focus on other, more profitable work. This is made possible through the hands-on training provided by Heraeus Kulzer’s Pala Digital Team to laboratory technicians on the processing and finishing of a digitally designed denture.
“In 2015, our Pala Digital Denture revolutionized the way laboratories process dentures, providing them and their dental practice customers with unprecedented precision in two to three visits versus six or more visits with conventional dentures,” said Christopher Holden, president of Heraeus Kulzer North America. “While the Pala Digital Denture System has helped laboratories grow their business, we know there is also a desire by many laboratory partners to control more of the processing and finishing. With My Digital Denture, we are giving laboratories more control than ever in choosing their level of involvement in delivering a digital denture.”
My Digital Denture is the first digital solution that gives laboratories the freedom to use their preferred workflow prior to setup by enabling them to scan models with bite rims without requiring special impression trays or changing the dentist’s workflow. This innovative system also gives laboratories the option of choosing either Heraeus Kulzer’s state-of-the-art Mondial®/Mondial i denture teeth or the company’s economy-priced Artic® Digital denture teeth. The Pala Digital Denture team will train partner laboratories on the use of various processing techniques, including injection, pouring and press-pack.
Heraeus Kulzer offers each laboratory the marketing flexibility of treating My Digital Denture as a private label offering so the laboratory can brand the final denture in whatever way best meets their marketing needs. Laboratories will also benefit from a nearly 50% increase in productivity due to the fact that their more skilled technicians will be freed up from having to perform the setup and design steps. Laboratory bottom lines will grow as these technicians are able to devote more time to higherrevenue cases.
To make it as convenient as possible for laboratories to enjoy the benefits of My Digital Denture, Heraeus Kulzer provides Friday hands-on training sessions near its South Bend, Indiana headquarters. Training dates for 2016 include October 21 and December 2. In addition, the company will offer training at LMT Lab Day East in Atlantic City, New Jersey on September 17, and in-lab sessions may also be arranged upon request. For more information, laboratories may contact their Heraeus Kulzer representative, or visit https://paladigitaldentures.com/handsontraining.
Debra Zafiropoulos, RDH, a leading dental hygiene key opinion leader known for her tireless advocacy for the early detection of oral cancer is broadening her efforts to include other forms of cancer with the formation of the National Cancer Network, a non-profit 501(c)(3) organization.
According to Zafiropoulos, commonly known as “Debbie Z”, “Dental professionals are the early warning system of the healthcare profession because we see our patients on an average of once a year and they spend a lot of time in our chairs. In addition to conducting a thorough oral exam, we can be paying closer attention to any abnormalities we notice on the patient’s skin or any complaints described in their patient history form such as persistent sore throat, cough, zone tingling or tenderness, etc.”
When something suspicious is discovered, Zafiropoulos says it is the responsibility of all dental professionals to integrate with other allied health professionals and make the appropriate qualified referrals sooner rather than later. “By taking the initiative to break down the silos between the various health care disciplines, we can significantly reduce the mortality rates of a wide variety of cancers.
Two of the cornerstones of the National Cancer Network are consumer awareness and professional training in the form of live patient screening events and professional training courses throughout the country.
What’s more, at the heart of NCN’s consumer and clinician awareness campaign is the introduction of a new exam protocol called “Screening for Oral and Skin Abnormalities” or SOSA™.
The first event of this type is being held in conjunction with the First District Dental Hygiene Society component of the Tennessee Dental Hygiene Association on September 16th in Kingsport, TN. The event will be based around one of Debbie Z’s most popular lectures, “HPV: It’s Not the Hanky-Panky Virus the Media Says it Is”.
To learn more about this and other upcoming NCN events, visit https://nationalcancernetwork.org/hpv/. For more information on how you or your organization can support NCN, contact Debra Zafiropoulos at DebbieZ@NationalCancerNetwork.org. Individual and corporate donations are can be made via PayPal at https://nationalcancernetwork.org/donate/
The Thomas P. Hinman Dental Meeting has named its first female General Chairman in its 105-year history. Dr. Jane Puskas, Hinman member and prominent Atlanta dentist, will lead Hinman 2017 at the Georgia World Congress Center in Atlanta on March 23-25, 2017. The meeting’s theme is “The Changing Face of Dentistry.”
“The theme of the meetings says it all. Hinman 2017 will focus on the changing face of dentistry and how we can take advantage of new technology and medical advancements to deliver the best possible care to our patients,” said Puskas. “We’ll celebrate our past, but also celebrate change in our profession with more contemporary techniques, more diversity and more innovative tools at our fingertips.”
Puskas has been planning for Hinman 2017 for the past 3 years, along with her program chairmen, Dr. Bob O’Donnell and Dr. Eddie Pafford. The meeting will feature many fan-favorite speakers, such as Dr. Gordon Christensen, Dr. Robert Edwab, Dr. John Svirsky, and Dr. Harold Crossley. In addition, many of dentistry’s most prominent women dentists will be speaking, including: Drs. Rella Christensen, Mollie Winston, Barbara Steinberg, Linda Niessen, and Lee Ann Brady. The program also will include many new speakers, including several affiliated with Spear Education - Drs. Jim Janakievski, Greg Kinzer, and Ricardo Mitrani.
“I’m truly honored to be the first female General Chairman for the Hinman,” added Puskas. “There are so many great women leaders in dentistry here in Georgia. I feel a strong responsibility to serve them well and host a meeting that not only features the latest in dentistry, but celebrates the different insights and strengths that women bring to the profession.”
A busy mom, wife and dentist in private practice, Dr. Puskas has risen through the ranks of Hinman, serving in many leadership roles, including President of the Hinman Dental Society in 2014. She is a graduate of the Harvard School of Dental Medicine and practiced in both Boston and Toronto before moving to Atlanta in 1994 with her husband, John, a cardiothoracic surgeon.
She became a Hinman member in 1996 and said that the organization helped her become established in the Atlanta dental community. The following year, Puskas bought the dental practice of Dr. Harold Lanier, a personal mentor to her and a Hinman past general chairman. She continues to practice today in the Buckhead area of Atlanta.
When not practicing dentistry or volunteering with Hinman, Puskas has been very focused on her three children and husband. She has been very involved in the lives and activities of her children – serving as team mom and volunteering at the Westminster Schools where all three of her children graduated high school. Her son Alex (24) graduated from Wake Forest and works in New York City at Ad Media Partners; daughter Jillian (22) is a senior at Princeton; and youngest daughter Caroline (19) is a sophomore at Dartmouth.
“I knew that I wanted a strong family life and felt that dentistry would better enable me to achieve a more rewarding work-life balance,” she said. “I am so happy that I did choose dentistry as I have managed to attain a happy family life with a successful professional life. I also love being a general dentist because of the special bond and relationship I share with my patients. It is rewarding to be an integral part of their health and smile.”
Registration for Hinman 2017 will open on December 1, 2016. Please visit www.hinman.org for more information.
An event designed for dedicated clinicians interested in a comprehensive approach to 3D imaging integration in their practices, the second annual Dental 3D University (3DU), features a lineup of world-class educators. Recent updates and additions to this roster include:
-Highly respected in the dental corporate and education community, President and CEO of Cellerant Consulting Group Dr. Lou Shuman, will be taking on the moderator role, bringing his unparalleled ability to make innovation accessible and help dentists across the technology adoption spectrum get the answers they need to make smart choices. Cited by Dr. Gordon Christensen as “one of the most influential dentists in the country today,” Dr. Shuman will also offer his unique expertise in Internet strategy, emerging technologies, e-learning and digital marketing as they relate to the dental community, speaking from his perspective as a Venturer in Residence at Harvard’s Innovation Lab.
-A new name on the esteemed list of presenters is Dr. Kevin AminZadeh, an international speaker and a key opinion leader in the field of digital dentistry, implantology, and microscope enhanced dentistry. He has built his practice upon digital treatment planning of complex oral rehabilitations. He is a consultant for oral and maxillofacial surgeons, periodontists, and general dentists. In 2015 Dr. AminZadeh founded Implant Genius, an implant treatment planning company based in Vancouver. He is an expert in digital workflow stages from digital record taking, implant treatment planning using implant planning software, implant placement using surgical guides, and custom prosthodontic restorations.
Held October 7-8, 2016, in Boston, MA, 3DU is hosted by KaVo Kerr Group imaging brands Gendex™, NOMAD™, SOREDEX™and Instrumentarium™. The 2-day event offers dental professionals an educational environment dedicated to Cone Beam 3D (CBCT) solutions — worth up to 11 CE credits — that will enhance their practice and put them in full control of treatmentoutcomes. In addition to Drs. Shuman and AminZadeh, other speakers include:
-Lou Graham, DDS, on his Journey to 3D
-Gy Yatros, DMD, on 3D Airway Analysis
-Kaveh Ghaboussi, DMD, on using 3D for Implant Planning and more
-Douglas Chenin, DDS, on Success with surgical guides
-Terry Work, DMD, on Simple, Predictable Implant Planning
-Lisa Koenig, BCHD, DDS, MS offering Anatomy and Pathology Review
-Christine Taxin on Medical Billing and Insurance Reimbursement
The complete agenda will dive into the role of 3D in endodontics, reading 3D scans, real life case presentations and software training, and best practices for incorporating 3D into the practice in order to maximize your investment.
For a limited time, dental professionals can enter to win FREE tuition and a 2-night stay in Boston for the event. Go to dental3DU.com/winfor details and additional information about the event.