Researchers at Trinity College Dublin have examined the sustainability of different models of the most commonly used oral health product - the toothbrush - to ascertain which is best for the planet and associated human health.
Although the toothbrush is a widely recommended healthcare device worldwide, there is currently little quantitative data available for its impact on the planet. The research study, in collaboration with Eastman Dental Institute at University College London, is published in the British Dental Journal today (Tuesday, 15th September 2020). It represents the first time a life-cycle assessment (LCA) has been used to measure environmental consequences of a healthcare product.
Healthcare is a major emitter of environmental pollutants that adversely affect health, but awareness of these effects remains low both in the industry and in the general consumer population. There is currently little evidence or guidance regarding the sustainability of specific healthcare interventions, services or devices.
Researchers considered different manufacturing models of the toothbrush and measured the environmental impact (carbon footprint) and human health impact (DALYS) of the toothbrush. The electric toothbrush, the standard plastic brush, the plastic brush with replaceable head, and the bamboo brush were used. The team found that the electric toothbrush was comparatively harmful for planetary health.
The findings highlight the human health burden of the toothbrush manufacturing process. The electric toothbrush causes 10 hours of disability measured in Disability-Adjusted Life years or DALYS mainly for the people associated with the process of making and producing the devices. This is five times higher than a normal plastic brush.
The team found that the most environmentally sustainable toothbrush was not bamboo, as could perhaps be popularly believed, but a hypothetical continually recycled plastic toothbrush.
This simple comparative LCA showed that a plastic manual replaceable head toothbrush and bamboo manual toothbrush perform better than traditional plastic manual and electric toothbrushes in every environmental impact outcome measure used in this study. These results could be used to inform individual consumer choice, oral health recommendations, procurement of toothbrushes for public health programmes, and toothbrush manufacturers. Using LCA to inform healthcare policies and recommendations will help healthcare providers move towards a more environmentally sustainable system.
Dr Brett Duane, Associate Professor in Public Dental Health at Trinity College and lead researcher said:
"There are billions of toothbrushes used and discarded every year. Our research shows that electric toothbrushes are actually harmful for the planet and to the people involved in the manufacturing process and distribution. There is not a lot of evidence to show they are more effective unless you struggle to clean your teeth with a normal toothbrush. We have also shown bamboo toothbrushes are not the answer. Using them just stops land from being put to better use such as helping biodiversity, or in growing forests to offset carbon emissions.
The ideal toothbrush is one which uses plastic which is recycled in a continuous process. Plastic brushes which can be recycled don't take up a lot of land and they don't need lots of water to grow. The important thing here is to keep the plastic in the recycling chain. We need a system where plastic toothbrushes can be collected like batteries and then recycled into new products. If the plastic escapes the recycling chain, it needs to be able to be easily and naturally broken down into harmless products.
Manufacturers, consumers, health professionals, and health policy makers should consider environmental sustainability as well as money and people's health when recommending products. Governments and industry should consider how they could support recycling programmes. More funding is also required to support sustainability research in this area."
The research papers: 'Combining evidence-based healthcare with environmental sustainability: using the toothbrush as a model' and 'Incorporating sustainability into assessment of oral health interventions' can be viewed in the British Dental
Journal here: https://www.nature.com/bdj/volumes/229/issues/5
Notes for the Editor
Life cycle assessment (LCA) is used to measure the environmental impact of different services or products. Also referred to as a cradle-to-grave analysis, LCA considers all aspects of a product along its life cycle, including raw materials, manufacture, use, transport, and disposal.
The four types of toothbrush used in this research were:
1. Plastic manual: plastic handle with fixed head.
2. Bamboo manual: bamboo handle with fixed head.
3. Plastic manual replaceable head: reusable plastic handle (made from a bio-plastic) with replaceable heads.
4. Electric: handle and charging unit, with replaceable heads.
About UCL Eastman Dental Institute
UCL Eastman Dental Institute is a world-leading, academic centre for postgraduate dentistry and translational research, based in London. Research is focused upon preventing, diagnosing and treating common oral disorders such as childhood dental decay, gum disease and oral cancer. Postgraduates and staff are also engaged in research that has a wider impact on collective public health, investigating antibiotic resistance, bone repair and soft-tissue reconstruction. For more information please visit http://www.ucl.ac.uk/eastman
Botox injections to manage jaw and facial pain do not result in clinically significant changes in jaw bone when used short term and in low doses, according to researchers at NYU College of Dentistry. However, they found evidence of bone loss when higher doses were used.
The researchers, whose findings are published in the Journal of Oral Health Rehabilitation, call for further clinical studies to track bone- and muscle-related changes with long-term use of Botox for TMJD, or temporomandibular muscle and joint disorders.
TMJDs are a group of common pain conditions that occur in the jaw joint and surrounding muscles, with the most common type involving the muscles responsible for chewing. While many individuals manage their TMJD symptoms with conservative treatments such as jaw exercises, oral appliances, dietary changes, and pain medication, some do not respond to these treatments.
Botox (or botulinum toxin), an FDA-approved injectable drug known for its wrinkle-reducing capabilities, is approved to treat certain muscle and pain disorders, including migraines. It works in part by temporarily paralyzing or weakening muscles. In the U.S., a Phase 3 clinical trial is currently underway to study the use of Botox to treat TMJD, but in the meantime, it is increasingly being used off-label.
Thus far, small studies using Botox to treat TMJD in humans have had mixed results. In animal studies, Botox injections in jaw muscles have led to major bone loss in the jaw. This is thought to be due to the muscles not being used to exert force needed for bone remodeling, but Botox may also have a direct effect on bone resorption, the process of breaking down bone tissue.
“Given these concerning findings from animal studies, and the limited findings from clinical studies, more research on the safety of Botox for jaw muscles and bones is critically important,” said Karen Raphael, professor in the Department of Oral and Maxillofacial Pathology, Radiology and Medicine at NYU College of Dentistry and the study’s lead author.
The NYU study included 79 women with TMJD affecting their facial muscles: 35 of whom received Botox injections (between two and five rounds in the past year) and 44 who were not treated with Botox but may have used other TMJD treatments. Using specialized CT scans, the researchers measured participants’ jaw bone density and volume.
The researchers found that jaw bone density and volume were similar between women who had Botox injections to treat their TMJD and those who did not. While most study participants were given relatively low doses of Botox—smaller than in most clinical trials for TMJD—individuals who received higher doses of Botox were more likely to have lower bone density.
Raphael and her colleagues recommend that more human studies be conducted to better understand the impact of the long-term use of Botox on jaw muscles and bones—and whether it just reduces muscle force on bone or also plays a direct role in altering bone resorption.
“Should Botox receive regulatory approval for the treatment of TMJD, we would recommend that a phase IV study be done using low-radiation CT and MRI to track bone- and muscle-related changes with Botox use, examining both dose and long-term use,” said Raphael. “Unless specialized imaging of muscle and bone are conducted among patients who receive Botox treatment over long periods, true cumulative effects will remain unknown.”
In addition to Raphael, study authors include Malvin Janal, Vivian Santiago, and David Sirois of NYU College of Dentistry, as well as Aditya Tadinada and Alan Lurie of the University of Connecticut School of Dental Medicine. This research was supported in part by the National Institutes of Health's National Institute of Dental and Craniofacial Research (R01DE024522).
About NYU College of Dentistry Founded in 1865, New York University College of Dentistry (NYU Dentistry) is the third oldest and the largest dental school in the US, educating nearly 10 percent of the nation’s dentists. NYU Dentistry has a significant global reach with a highly diverse student body. Visit http://dental.nyu.edu for more.
A new study by researchers at the University of Illinois Chicago and the University of Pittsburgh suggests that a significant proportion of older patients receiving opioids at dental visits also use psychotropic medications — a potentially harmful combination. Their findings are published in the journal Pharmacotherapy.
Rates of polypharmacy, or taking multiple medications, are high among older adults who are more likely to be managing more than one health issue at any given time. Psychotropic medications that act on the central nervous system, such as antianxiety or antidepressant medications, are especially dangerous if taken with opioids because they can interact with each other and have negative effects.
“Some of the most concerning negative outcomes of these combinations include overdosing on opioids or falling, which can necessitate a visit to the hospital, which in itself carries greater risk for older adults,” said Gregory Calip, associate professor of pharmacy systems, outcomes and policy at the UIC College of Pharmacy and corresponding author on the paper.
The researchers looked at medical, dental and pharmacy claims data from 40,800 older adult dental patients who visited a dentist between 2011 and 2015 and were prescribed opioids. The data was from the IBM Watson MarketScan databases.
The average age of the patients included in the study was 69 years old and 45% were female. Of these patients, 10% were taking medications that are associated with increased risks for harm with opioid prescriptions.
There were a total of 947 hospitalizations or emergency room visits among these patients.
The researchers found that among patients prescribed opioids by their dentist, 1 in 10 were already taking a prescription medication that should not be prescribed with opioids.
They also found that patients inappropriately prescribed an opioid medication combination by their dentist were 23% more likely to be hospitalized or visit an emergency department in the 30 days after the dental visit where they were prescribed an opioid, compared with dental patients who were not prescribed an opioid medication.
“Dentists are among the top prescribers of opioids,” said Katie Suda, professor of medicine at the University of Pittsburgh School of Medicine and principal investigator of the study. “It seems that the increased messaging regarding limiting opioid prescriptions has been aimed primarily at medical physicians and not tailored to other specialist providers, including dentists. This can have dire consequences. As we saw in our study, opioid interactions with other medications was likely responsible for the significant rise in emergency room visits and hospitalizations.”
“Although the percentage of opioids prescribed by dentists has decreased in the last 20 years, dentists must continue interprofessional collaboration with primary care physicians, pharmacists, and other health care providers to address devastating and preventable drug interactions affecting vulnerable patients who look to them for safe and compassionate care,” said Dr. Susan Rowan, executive associate dean and associate dean for clinical affairs at the UIC College of Dentistry.
Jifang Zhou and Rosanne Perez of UIC, Jessina McGregor of Oregon State University, Charlesnika Evans of the Northwestern University Feinberg School of Medicine and Walid Gellad of the University of Pittsburgh are co-authors on the paper.
This study was funded by a grant award from the Agency for Healthcare Research and Quality (R01HS25177).
The software manufacturer exocad has expanded its integrated workflow with the vhf dental milling machine Z4. Now, titanium abutments and so-called titanium-based hybrid implant restorations can also be manufactured within the ChairsideCAD software. A demonstration of the new possibilities will be given at the vhf booth during the exocad Insights in Darmstadt on September 21 and 22. The hybrid event will take place both onsite and online.
The particular advantage of the integrated workflow is that users can complete all the necessary steps under a consistent software interface: From modeling and restoration to placing the work in the block. The full material selection tested by vhf is available, so that now, for example, users can choose from more than 800 prefab titanium abutments from eleven manufacturers. The possibility to drill screw channels for ceramic implant restorations on titanium bases directly into the ceramic blocks is also particularly economical. This eliminates the need to use expensive prefabricated “meso” blocks. The University of Washington recently confirmed the feasibility and economy of this procedure in a scientific study.
vhf has developed the Z4 for the sophisticated requirements of prosthetic same-day dentistry. The futuristic housing contains a high-precision milling and grinding machine for wet processing of blocks. It produces perfect restorations made of glass-ceramics, PMMA, zirconia and composites as well as prefabricated titanium abutments within minutes. With the tool-free block clamping system, the material block is automatically fixed and can be changed in seconds. Other user-friendly innovations include the integrated PC and a touchscreen, which makes it easy to control the work processes. This, together with the integrated compressed air generation, means that the Z4 requires no connection other than a power supply and can therefore be easily set up anywhere in the practice.
Just as all vhf machines are open systems which can process all materials available on the market, exocad also allows the use of different scanners which are integrated in an easy to use workflow. ChairsideCAD is available in the EU, USA (currently without implant module), Japan, South Korea and Australia.
Founded in 1988, vhf is a leading manufacturer of CNC milling machines, milling tools and CAM software for the dental sector, industry and sign making. Headquartered in Ammerbuch, Germany, vhf employs more than 250 people and is constantly expanding. With its subsidiary vhf Inc. in the state of New York, it provides North American customers with inventory, sales, service, and support.
exocad GmbH is an innovative software company with the mission to expand the possibilities of digital dentistry and to offer flexible, reliable and easy-to-use CAD/CAM software for dental laboratories and dental practices. Leading OEMs (Original Equipment Manufacturers) worldwide rely on exocad for the integration of their dental CAD/CAM offers. More information at: exocad.com.
This Friday kicks off Bid For Smiles, a week-long, online auction that helps America’s ToothFairy increase access to dental care for children in underserved communities. Dental practices are invited to register at BidForSmiles.org to bid on dental products and equipment, with starting bids set at a 50% discount.
“The COVID shutdown has made life more difficult for all businesses, but especially for dental offices,” said Jill Malmgren, Executive Director of America’s ToothFairy. “The savings that we’re offering will not only help practices operate during this uncertain time, but their participation will also help our nonprofit program members who are struggling to serve families in financial crisis.” Bid For Smiles raises funds safely online to provide aid to these organizations. Thanks to the support of Kleer, 100% of the proceeds will benefit the cause.
Most items up for bid include discounts of up to 50% off retail prices, and include:
Paradigm Deep Cure Curing Light donated by 3M Oral Care
Tornado X LK Air Turbine donated by Bien-Air
Dentapen Electronic Syringe donated by Septodont
Easyshade V Digital Shade Taking Device donated by VITA North America
An assortment of products from GC America including MI Paste and Fuji Automix
plus Level 3 masks, iSmile Take Home Kits, an Apple Watch, and much more
Additional items are still being accepted and added daily. The online auction will be held September 18-25th. To register as a bidder visit BidForSmiles.org. To learn more about becoming a sponsor or donating an auction item, contact Jill Malmgren at firstname.lastname@example.org or call 704-965-2070.
About America’s ToothFairy: National Children’s Oral Health Foundation
As a resource provider, America’s ToothFairy increases access to oral health care by supporting nonprofit clinics and community partners delivering education, prevention and treatment services for underserved children. Since its inception in 2006, America’s ToothFairy has distributed more than $21 million in donated products, educational materials and financial grants to improve oral health outcomes for children and youth in need. For more information, visit AmericasToothFairy.org.
"The Quality of Esthetics” conference in Mexico has been a staple of the dental events calendar in Latin America for more than 25 years. This year, the conference, which is one of the world’s premier dental industry meetings, was held online for the first time—and it proved to be a resounding success.
In 2019, “The Quality of Esthetics” conference broke all previous attendance records, attracting more than 6,300 participants to the World Trade Center (WTC) in Mexico City. This year’s event, which was held in the new online format, drew more than 16,000 participants from 23 different countries. The US and Brazil registered the largest numbers, with more than 1,300 and 800 delegates respectively.
Live and online
During live virtual sessions, participating dental practitioners and technicians were given the opportunity to gain first-hand knowledge of the latest findings of renowned international dental experts in addition to an insight into their work and experience. Best practice methods and techniques, industry trends, and the latest technologies were presented in exciting talks, workshops, and demonstrations on patients, forming the basis for a lively exchange between the participants and the speakers. The digital equipment used to conduct the congress was of the highest quality. Real-time simultaneous interpretation allowed the attendees to follow the subject matter in both Spanish and Portuguese. Furthermore, a sophisticated sound system and several high-resolution cameras conveyed every single detail of the demonstrations from many different angles for a very special experience. In total, the presentations and lectures were viewed online more than 70,000 times. Moreover, a large number of the participants took advantage of the opportunity to gain valuable continuing education credits from two prestigious institutions—UNAM (National Autonomous University of Mexico) and the AGD (Academy of General Dentistry).
Making the most of young talent
Apart from two forums each dedicated to dental technicians and dental professionals, a forum was specially organized for dental students. At this year’s meeting, Ivoclar Vivadent went the extra mile once again to respond to the needs of young dental professionals. This aspect of the conference proved to be very popular: 28 up-and-coming speakers thrilled their online audience on the virtual stage. More than 600 dental students from 23 dental training institutions took advantage of attending the event free of charge.
Joining forces for the well-being of patients
David Hidalgo, Managing Director of Ivoclar Vivadent Mexico, CAC & SAN, summarized the conference as follows: “We are proud to have been able to gather such a large international crowd of dental practitioners and technicians for this virtual meeting under the present conditions. We all have one thing in common, which is our aim to consistently improve the quality and standard of dental medicine and dental laboratory technology. It is our responsibility to set new standards together—for the health and well-being of our patients.”
VOCO is proud to present GrandioSO Light Flow, the low viscosity nano-hybrid flowable composite for special occasions. Due to VOCO’s proprietary designer nano-technology, GrandioSO Light Flow has the filler degree of a universal composite on one hand, and an extremely flowable viscosity on the other that allows for targeted and precise applications using an ultra-fine intraoral tip—even finer than a periodontal probe.
With a filler content of 76% by weight, GrandioSO Light Flow’s 3-point flexural strength of 151 MPa is an example of how it effortlessly attains physical property values much higher than traditional flowables that often have lower fill rates and higher viscosities.
GrandioSO Light Flow allows the practitioner new options in performing precise, minimally invasive dentistry without compromising the quality and longevity of the restorations. GrandioSO Light Flow comes with two different sizes of intraoral tips to offer a range of options for each indication.
Shofu Dental Corporation is proud to announce that its EyeSpecial digital dental camera has once again received the prestigious Cellerant Best of Class Technology Award. For the 6th consecutive year, the EyeSpecial, which allows anyone in the practice to take a perfect picture, has been recognized as a valuable tool for documentation, communication, and increased production. The EyeSpecial continues to receive the Cellerant Best of Class Technology Award based on the nine internal shooting modes. Once the user selects the appropriate mode, the camera makes all of the necessary adjustments for a perfect picture every time without the need for photographic knowledge or specialized camera training. For additional information or an in-office demonstration, please contact Shofu Dental at 800-827-4638.
YAPI, a leading software provider of patient communication and paperless solutions for dental practices, announced today that it has secured a growth investment from M33 Growth, a Boston-based venture and growth stage investment firm. The investment will be used to build out YAPI's account management, customer success, and R&D teams, in addition to bolstering its existing sales and marketing programs.
M33's investment in YAPI comes as the company's product suite, which enables dental practices to automate administrative tasks so they can spend more time focusing on their patients, is being recognized by industry groups and used by a growing number of dental practices. Despite disruption from the COVID-19 pandemic, YAPI recorded its strongest quarter in Q2 – adding more dental offices to YAPI's platform than any other period in its nine-year history – highlighting the platform's ability to help dental offices reopen and operate in a contactless manner. From personalized appointment reminders and automated patients recalls, to streamlining intra-office practice communication and digitizing paper-based forms, YAPI's product suite enables patients and dentists to remotely access important practice & patient information, positioning dental offices to succeed in an increasingly digital world.
As further proof of its industry leadership, YAPI has been named a winner of the 2020 Cellerant Best of Class Technology Award. Presented by Cellerant Consulting Group, an incubator and accelerator for dental companies, the award is selected by a panel of prominent technology leaders across dentistry with a mission to create awareness around innovators driving the discussion as to how practices will operate now and in the future with potentially practice-changing technologies.
"This year has proven just how critical paperless software is to keeping operations running as smoothly as possible at dental practices across the country so that we can all focus on what matters most—our patients," said Dr. Gina Dorfman, Co-Founder and CEO. "This recognition from Cellerant and investment from M33 Growth validates our vision for YAPI, and we're eager to bring that vision to life by accelerating the growth of the business, building out and investing in the YAPI team, and working closely with seasoned advisors at M33 Growth."
Founded in 2009, YAPI began as a small custom-designed software solution to address the pain points Dr. Dorfman was seeing in her own dental office. In 2011, YAPI entered the market for dental offices and began transforming the way thousands practice dentistry.
"Founders who are experts in their space and have identified opportunities to better improve workflows in their own industry bring to market a unique perspective that directly benefits their customers," said Gabe Ling, Co-Founder and Managing Director of M33 Growth. "The team at YAPI understands the pain points of today's dental practices, and we see tremendous opportunity in addressing these market challenges—especially in today's environment. As a partner, M33 Growth seeks to help YAPI expand its market reach through investments in customer success, sales & marketing, and R&D teams." To learn more about YAPI, visit www.yapiapp.com.
YAPI is an automation and productivity software, built to enhance the business side of dentistry. Born in a dental office in 2010, YAPI is the longest-standing provider of electronic patient forms and has evolved into an all-in-one solution for the modern dentist. All products integrate seamlessly with the most common dental practice management software and range from online and iPad dental forms, automated patient communication, remote access, reputation management, intra-office chat, and more. With YAPI, dentists can take care of their patients, and automate the rest.
About M33 Growth
M33 Growth is a venture and growth-stage investment firm that partners with founders and CEOs who have successfully bootstrapped their companies to strong growth and are positioned to rapidly scale their companies and breakthrough as market leaders. With deep experience fueling sales and marketing engines, driving acquisitions, and building value through data assets, M33 Growth seeks to propel portfolio companies to succeed in their markets. Founded by veterans of renowned investment firms with considerable operational experience, the Boston-based firm seeks to invest in companies in the software, healthcare, and services sectors throughout North America. Learn more at m33growth.com
Crest+ Oral-B is set to kick off a new webinar focused on the importance of dental medical integration, "Oral Systemic Health: The Case for Accelerated Dental Medical Integration: A Panel Discussion with Four Nationally Regarded Thought Leaders." In partnership with the Pacific Dental Services® (PDS®) Foundation, this new webinar, which is moderated by Daniel Burke, Chief Enterprise Strategy Officer at Pacific Dental Services, features an impressive panel of industry thought leaders: Dr. Jack Dillenberg, President Association of State and Territorial Health Officials and Dental School Dean Emeritus; Judith Haber, PhD, APRN, BC, FAAN; Erin Hartnett, DNP, APRN-BC, CPNP; and Anne O. Rice, RDH, BS. The event takes place on Thursday, September 17th at 9:00 AM PT and will center on oral systemic health, focusing on research that shows maladies of the mouth are connected to numerous systemic conditions throughout the body. Attendees will have the opportunity to ask questions during this interactive webinar and earn two continuing education (C.E.) credits. The live event is sponsored by Crest+ Oral-B. Click here to register for this free webinar.
Course objectives include:
• The oral systemic link, including the latest research connecting oral health to systemic conditions, such as diabetes, lupus, heart disease, and dementia.
• The connection between periodontal disease and severe expressions of COVID-19.
• The evolving role of healthcare professionals both in medical and dental.
• Innovative technology, which can improve access and health outcomes.
The mission of the PDS Foundation is to improve overall health, by improving oral health through opportunities to serve locally, nationally, and internationally. In addition to its long-standing initiatives focused on special needs, dental assistant scholarships, the Mobile Dental Clinic, and international service trips, the Foundation has also been actively championing the expansion of Medicare to include dental care for the nation’s elderly.
Research has shown that harmful bacteria and inflammation in the mouth can indicate and even cause systemic conditions throughout the body. The PDS Foundation is focused on educating people about the link between oral health and whole-body health, known as the Mouth-Body Connection®. Diseases of the mouth, including periodontal disease, may be linked with other medical conditions including cardiovascular disease, oral cancer, diabetes, Alzheimer’s disease, rheumatoid arthritis, and more.
For more information or to register or the webinar in advance, click HERE.
About Pacific Dental Services® Foundation
The Pacific Dental Services Foundation is a 501 (c)(3) charitable organization whose mission is to improve overall health, by improving oral health through opportunities to serve locally, nationally, and internationally. By creating opportunities to serve, the PDS Foundation will positively enhances the lives of those in need, and in turn, those who serve. The Foundation provides access and advocacy to disadvantaged and underserved communities in four key areas: PDS Foundation Mobile Dental Clinic, Special Needs Advocacy and Training, Dental Assistant Education Scholarships, and International Trips.
For more information, visit www.pdsfoundation.org.