The Intra-Oral Camera

The intra-oral camera is a fantastic tool to allow the patient to see exactly what the dentist sees while working. The camera picture is sent to your TV or computer screen and allows multiple magnification options for patients to get a closer look. The patient is able to see cracks, chips, and other problems with their teeth early before the problems become more severe. Many times cracking or chipping can happen and the patient not be aware of it because they haven’t grown large enough or decayed enough to become painful.


The intra-oral camera can also be used to document what work is being done with a patient without always having to use an X-ray because sometimes the problems will not show up properly on an x-ray compared to a camera. Unfortunately the intra-oral camera is not a replacement for the x-rays which are still the mainstay of the insurance company for documenting what work is being done.


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Healing Times for Dental Implants Could Be Cut

ScienceDaily (June 16, 2011) — The technology used to replace lost teeth with titanium dental implants could be improved. By studying the surface structure of dental implants not only at micro level but also at nano level, researchers at the University of Gothenburg; Sweden, have come up with a method that could shorten the healing time for patients.

“Increasing the active surface at nano level and changing the conductivity of the implant allows us to affect the body’s own biomechanics and speed up the healing of the implant,” says Johanna Löberg at the University of Gothenburg’s Department of Chemistry. “This would reduce the discomfort for patients and makes for a better quality of life during the healing process.”

Dental implants have been used to replace lost teeth for more than 40 years now. Per-Ingvar Brånemark, who was recently awarded the European Inventor Award, was the first person to realise that titanium was very body-friendly and could be implanted into bone without being rejected. Titanium is covered with a thin layer of naturally formed oxide and it is this oxide’s properties that determine how well an implant fuses with the bone.

It became clear at an early point that a rough surface was better than a smooth one, and the surface of today’s implants is often characterised by different levels of roughness, from the thread to the superimposed nanostructures. Anchoring the implant in the bone exerts a mechanical influence on the bone tissue known as biomechanical stimulation, and this facilitates the formation of new bone. As the topography (roughness) of the surface is important for the formation of new bone, it is essential to be able to measure and describe the surface appearance in detail. But roughness is not the only property that affects healing.

Johanna Löberg has come up with a method that describes the implant’s topography from micrometre to nanometre scale and allows theoretical estimations of anchoring in the bone by different surface topographies. The method can be used in the development of new dental implants to optimise the properties for increased bone formation and healing. She has also studied the oxide’s conductivity, and the results show that a slightly higher conductivity results in a better cell response and earlier deposition of minerals that are important for bone formation.

The results are in line with animal studies and clinical trials of the commercial implant OsseoSpeedÓ (Astra Tech AB), which show a slightly higher conductivity for the oxide and also an exchange between hydroxide and fluoride on the surface of the oxide. Surfaces with a well-defined nanostructure have a larger active area and respond quickly to the deposition of bone-forming minerals.

The project is a collaboration between the University of Gothenburg and Astra Tech AB in Mölndal, and will be further evaluated in follow-up studies.

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Nano-Sized Advance Toward Next Big Treatment Era in Dentistry

ScienceDaily (July 5, 2010) — Scientists are reporting an advance toward the next big treatment revolution in dentistry — the era in which root canal therapy brings diseased teeth back to life, rather than leaving a “non-vital” or dead tooth in the mouth. In a report in the monthly journal ACS Nano, they describe a first-of-its-kind, nano-sized dental film that shows early promise for achieving this long-sought goal.

Nadia Benkirane-Jessel and colleagues note that root canal procedures help prevent tooth loss in millions of people each year. During the procedure, a dentist removes the painful, inflamed pulp, the soft tissue inside the diseased or injured tooth that contains nerves and blood vessels. Regenerative endodontics, the development and delivery of tissues to replace diseased or damaged dental pulp, has the potential to provide a revolutionary alternative to pulp removal.

The scientists are reporting development of a multilayered, nano-sized film — only 1/50,000th the thickness of a human hair — containing a substance that could help regenerate dental pulp. Previous studies show that the substance, called alpha melanocyte stimulating hormone, or alpha-MSH, has anti-inflammatory properties. The scientists showed in laboratory tests alpha-MSH combined with a widely-used polymer produced a material that fights inflammation in dental pulp fibroblasts. Fibroblasts are the main type of cell found in dental pulp. Nano-films containing alpha-MSH also increased the number of these cells. This could help revitalize damaged teeth and reduce the need for a root canal procedure, the scientists suggest.

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Molar Power: Milk Teeth Wanted for Stem Cell Palace Art Project

Children across Britain are being asked to donate their milk teeth to create “Palaces” — a spectacular glittering sculpture made from crystal resin and decorated with retired pearly whites. The project is a part of an art-science collaboration that aims to inspire the nation with the regenerative potential of adult stem cells.

Artist Gina Czarnecki and stem cell biologist Professor Sara Rankin from Imperial College London hope that thousands of children will contribute to their participatory art project — one aim of which is to raise awareness of different sources of stem cells in the body, as well as questioning contemporary belief systems that dismiss age-old myth and folklore. Along with a form to send in with one’s tooth, the project website provides a token which children can leave under their pillow to inform the Tooth Fairy of their donation to her palace.

The finished artwork will resemble a coral castle under water, two metres high and two metres wide, made from donated milk teeth. It is due to go on display at the Bluecoat, Liverpool in December 2011, and at the Science Museum in London in 2012.

In recent years, scientists have discovered that discarded body parts such as bones from joint replacements, umbilical cords, and fat from liposuction are unexpectedly rich sources of stem cells — master cells of the body that can proliferate indefinitely to replace lost or damaged tissue. Medical researchers are beginning to uncover the huge therapeutic potential of these adult stem cells for treatment of illness and injuries, including broken bones, heart disease and cancer.

Adult stem cells can also be extracted from the pulp of milk teeth. Scientists are investigating the potential of these cells to grow new teeth.

“The artwork will provide a focus to engage young people with this research and increase awareness, understanding and informed debate about these new biomedical possibilities and their social, cultural and ethical implications,” says Professor Sara Rankin, from the National Heart and Lung Institute at Imperial College London.

“At the moment the debate around stem cell research is predominantly focused around ethical issues associated with the use of embryonic stem cells. We want to promote awareness about adult stem cells, such as those found in bone marrow or umbilical cord, which could be used to develop new treatments without any ethical issues.”

“Different cultures have different traditions about where these teeth go, and what they are used for,” said artist Gina Czarnecki. “Through exhibition and informed discussion, we’re looking to explore the questions this raises about the value of waste matter and our attitudes to our own bodies as sources and beneficiaries of recyclable material.”

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Oral Health Inequalities in Older People

The International and American Associations for Dental Research (IADR/AADR) have published two studies about oral health inequalities in older people and low income individuals. The articles are published in the Journal of Dental Research, the official publication of the IADR/AADR.

The study by Barnebe and Mercenes explores the relationship between state income inequality and individual tooth loss among 386,629 adults in the United States who participated in the 2008 Behavioral and Risk Factor Surveillance System. Multilevel models were used to test the association between income inequality and self-reported tooth loss after sequential adjustment for state- (median household income) and individual level confounders (sex, age, race, education and household income) as well as state- (percent receiving fluoridated water and dentist to population ratio) and individual-level mediators (marital status and last dental visit). Income inequality, as measured by the Gini coefficient, was significantly associated with tooth loss even after adjustment for state- and individual-level confounders and potential mediators. A 5 percent change in state Gini coefficient was associated with almost 20 percent higher odds of reporting greater tooth loss. This study provides support for the relationship between state income inequality and individual tooth loss in the United States.

The purpose of the study by Listl was to describe income-related inequalities in dental service utilization by the elderly populations residing in different European countries. Listl and his team used data from the Survey of Health, Ageing, and Retirement in Europe (SHARE Wave 2), which contains information on utilization of dental services by 33,358 individuals aged 50+ from 14 different countries, and assessed income-related inequalities in dental attendance, preventive and/or operative dental treatment. The team’s findings indicate disproportionate concentration of access to treatment among the rich elderly populations in all countries included in the study. In terms of absolute inequality, the team similarly observed significantly higher access to treatment by individuals located in the highest income group compared with peers located in the lowest income group within all countries except Italy and Czechia.

“Inequalities in oral health and access to care are a growing global concern,” said IADR President E. Dianne Rekow. “These JDR articles address this growing concern and its impact on elderly populations and low-income individuals.”

A perspective article was written by Georgios Tsakos. In it, he calls for an urgent need to address inequalities in oral health — rather than only dental services — and to put more emphasis on the social determinants of health.

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Snoring and Sleep Disorders: A Dental Approach to a Major Public Health Issue

Over seven million people in Spain are at risk of developing sleep apnoea (SA), a health problem caused by obstructed air intake during sleep. The disorder has become a common issue in public health, affecting patients’ quality of life and potentially leading to hypertension, cardiovascular disease and neurological disorders, as well as increasing the likelihood of traffic, workplace and domestic accidents with personal, financial and healthcare repercussions. In children, SA is often associated with learning difficulties and behavioural and attention disorders.

Almost two million people in Spain show symptoms of SA requiring treatment, but only 5% are conclusively diagnosed. Following almost a decade of research, in 2009 the Snoring and Sleep Apnoea Diagnosis and Treatment Unit was opened in the UB’s Josep Finestres Foundation-Dental Clinic (Bellvitge Health Sciences Campus). The specialized unit is devoted to the study and treatment of respiratory sleep disorders from a novel perspective that places dentists at the centre of research, diagnosis and treatment. The unit is formed by Maribel Pascual, qualified in medicine and surgery and a specialist in stomatology, and the qualified dental physicians Eva Willaert and Lluís Nogués, lecturers at the Department of Dentistry and Stomatology of the UB’s Faculty of Dentistry, and experts in dental prosthetics and craniomandibular dysfunction for the UB-specific master’s degree in Occlusion and Oral Rehabilitation directed by Dr. Joan Salsench, Dr. Maria Peraire and Dr. Jordi Samsó from the University of Barcelona (UB).

The team was created in 2000 through an initial collaboration agreement between the experts Maribel Pascual and Carme Monasterio (director of the Sleep Unit of the Pneumology Service at Bellvitge University Hospital) and was the first in Spain to introduce the study of respiratory sleep disorders, sleep apnoea and treatment with mandibular advancement devices (MAD) at postgraduate level for the master’s degree they contribute to as experts.

A disease largely unknown among the public

Maribel Pascual explains that, “diagnosis and treatment of sleep apnoea are placing a strain on the healthcare system and generating substantial expense. As dentists, we can bring a new therapeutic perspective to deal with the complex symptoms involved, which can be exhibited in the respiratory apparatus but treated through the stomatognathic system, that is, the oral cavity, so we can add to the treatment options provided by other experts (pneumologists, neurophysiologists, maxillofacial surgeons, dieticians, etc). According to the National Consensus Document on Sleep Apnoea, drawn up by the Spanish Sleep and Breathing Group, patients with SA are between seven and eight times more likely to suffer traffic or workplace accidents than the general population.

Excess weight, alcohol consumption, smoking, polymedication, nasal obstruction, menopause and unhealthy lifestyle habits in general have a negative impact on health and the sleep cycle. “As healthcare professionals, our obligation is to encourage people to correct habits that are harmful to their health to improve sleep hygiene and quality of life. We must use our knowledge to guarantee effective medical treatment for patients. Professionals with responsibility for the health and safety of others, such as ourselves, or chauffeurs and pilots, for example, know that our work is helping to save lives and to save companies money,” says Maribel Pascual. As Eva Willaert explains, “In the case of snoring, the model has changed completely: before we thought it was a sign of sleeping well, but snoring can be the first sign of respiratory difficulties during sleep. Statistics show that 60% of men over 50 and 40% of women in the same age group snore. Not everyone that snores develops SA, but snoring can lead to other health conditions and it is always worth reviewing clinical histories.”

Dentists, the key to early diagnosis

Dentists play a vital role in detecting diseases associated with dental health and facilitating earlier and less costly treatment of snoring and SA. In the specific case of sleep apnoea, failure to treat the disorder in its early stages can increase the cost of subsequent treatment two- or threefold. Lluís Nogués believes that, “dentistry has an increasing presence in the field of respiratory diseases, but hospital Sleep Units rarely have dentists as part of their teams. When dental professionals are required, hospitals seek the help of external partners to ensure the best service for their patients.” Nogués goes on to explain that, “At present, dental sleep medicine is a highly specialized area of study and requires specific postgraduate training. In the university sphere, we are pioneers not only in the teaching of this specialism but also in the care setting. Nevertheless, in Spain, the dental profession has become synonymous with business, and we must fight against this image and seek ways to work more closely with other specialists in the public healthcare system.”

Conducting research to improve quality of life

The standard diagnostic test for respiratory sleep disorders is polysomnography, which records respiratory flow, heart rate, blood oxygen and sleep phases, etc. The most common treatment for snoring and SA until recently was continuous positive airway pressure (CPAP), administered using a device consisting of a nose piece or full mask that supplies a constant air pressure during sleep. A newer alternative, the mandibular advancement device (MAD), alters certain characteristics of the upper airways, leading to improvements in people affected by snoring and by mild and moderate cases of SA, making it the preferred treatment option for both disorders. MAD can also be used intermittently to aid or replace CPAP if this option is rejected or due to other considerations such as travel or social commitments.

The Snoring and Sleep Apnoea Diagnosis and Treatment Unit, which receives referrals from the public healthcare system (Bellvitge University Hospital, Hospital Clínic, Hospital del Mar, Hospital de Viladecans, Hospital de Terrassa, etc.), also applies diagnostic techniques (imaging, polygraphs, etc.) to potential SA patients to establish the best course of treatment in each case or to identify the appropriate specialist unit for referral. As such, it functions essentially as a screening unit.”Our main mission is to assess the patient as thoroughly as possible,” says Maribel Pascual. “As dentists, we are in the best position to detect cases that have not been diagnosed. In lower-risk patients, MAD can be useful for reducing the symptoms of the disease and preventing further development, but the devices must be tailored to each case to match the specific clinical diagnosis.”

The unit conducts exhaustive follow-up of each patient and their symptoms and has also achieved recognition for its research, in particular “for studies published in prestigious dentistry journals on the impact of MAD and the possible side effects appearing in the mouth, which are often extremely minor, provided that patients are monitored thoroughly,” says Eva Willaert, who explains that, “We have also set up a research area that focuses on the quality of life of patients fitted with MAD, which are among the most recent treatments to emerge in the field of dental health.” As Maribel Pascual explains, “in ten years of clinical experience we have also observed that certain prosthetic dental treatments can aggravate snoring and SA in some patients.”

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Dirty Mouths Lead to Broken Hearts

“Poor oral health can lead to pneumonia and cardiovascular disease as well as periodontal disease,” said Rita A. Jablonski, even though these illnesses are not usually associated with the mouth. According to Jablonski, assistant professor of nursing, Penn State, persons with dementia resist care when they feel threatened. In general, these patients cannot care for themselves and need help.

Jablonski and her team introduced an oral hygiene approach called Managing Oral Hygiene Using Threat Reduction (MOUTh) specifically for dementia patients. Many of their strategies focus on making the patient feel more comfortable before and while care is provided, the researchers report in the current issue of Special Care in Dentistry.

“We have come up with 15 strategies — techniques to help reduce threat perception,” said Jablonski. These strategies include approaching patients at eye level if they are seated, smiling while interacting, pantomiming, and guiding patients to perform their own care by placing a hand over the patient’s hand and leading.

People with dementia are often no longer able to distinguish low or non-threatening situations from highly threatening situations. This happens when the parts of the brain that control threat perception — particularly the fight, flight or freeze responses — begin to deteriorate. The amygdala is the part of the brain that houses the fear response. The hippocampus and cerebral cortex receive and send messages to the amygdala, telling it how to react.

“Think of the hippocampus, cerebral cortex and amygdala as being in the woods,” said Jablonski. “In a person with dementia, the path in the woods is blocked with tumbleweeds and the message from the cortex and hippocampus can’t get to the amygdala.” In turn, patients with dementia often react to something as intimate as a nurse brushing their teeth as a perceived threat.

In the past 30 years the number of nursing-home residents who still have their own teeth has risen significantly. Many of these people need assistance with their dental hygiene, as well as with other hygiene.

Jablonski and her team conducted a pilot study with seven people who had either moderate or severe cases of dementia. The researchers used the MOUTh technique on the subjects for two weeks, recording the state of the patients’ mouths and how the patients reacted throughout the study.

At the beginning of the study all seven subjects had poor oral health, as determined by the Oral Health Assessment Tool. Eight categories concerning oral health are scored between zero and two. The lower the score the healthier the mouth. The average score for the subjects at the start of the study was 7.29. By the end of the study the average score was 1.00.

“To my knowledge, we are the only nurses in the country who are looking at ways to improve the mouth care of persons with dementia, especially those who fight and bite during mouth care,” said Jablonski. “Our approach is unique because we frame resistive behavior as a reaction to a perceived threat.”

Other researchers on the project were Ann Kolanowski, Elouise Ross Eberly Professor; Mia Gabello and Alexandra Brock, graduate students, all in the school of nursing, Penn State; Barbara Therrien, associate professor in nursing, University of Michigan; and Ellen K. Mahoney, associate professor in nursing, Boston College.

The Brookdale Leadership in Aging Foundation supported this pilot study. Jablonski is the 2009-2011 Brookdale Leadership in Aging Fellow. The National Institutes of Health has awarded Jablonski a grant to continue this research.

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Struggling With Headaches? Visit Your Dentist

If you have a headache, quite often the first port of call is the medicine cabinet for pain relief or a visit to the Doctors. However, if the problem persists it might be something you should mention to your dentist as the persistent cause may lie inside your mouth.

The cause of your headaches could actually be the way your teeth meet when your jaws bite together, otherwise known as dental occlusion. Temporo-Mandibular Joint (TMJ) disorder is a neuromuscular jaw condition caused by an imbalanced bite. When the joint causes pressure to be put on the nerves muscles and blood vessels that pass near the head, the result can be headaches and migraines, a condition that affects one in seven people in the UK.

Chief Executive of the British Dental Health Foundation, Dr Nigel Carter, believes this information serves as a timely reminder to arrange a visit to the dentist during National Smile Month, which runs until 15 June 2011.

Dr Carter said: “If you suffer from continual headaches or migraines, especially first thing in the morning, pain behind your eyes, sinus pains and pains in the neck or shoulders, you should consider visiting your dentist, as well as a Doctor, as soon as possible.

“Many people have imperfect dental occlusion yet never show symptoms as they adjust to their problem. For those who do suffer, teeth and gums may be affected straight away, and instead of headaches you may encounter broken teeth, fillings, loose teeth and toothache with no apparent cause. If you have any of these problems, visit a dentist immediately.”

Depending on the problems you are having, it can be possible to spot the signs of dental malocclusion. Your dentist may be able to help you or may refer you to a specialist who deals with occlusal problems. Your teeth may need to be carefully adjusted to meet evenly, as changing the direction and position of the slopes that guide your teeth together can often help reposition the jaw. If your teeth are too far out of line or in a totally incorrect bite position, it may be necessary to fit a brace to move them into a better position.

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Researchers Identify New Dental Cavity-Causing Species

A team of scientists from Boston has confirmed that the bacterium Streptococcus mutans is a primary culprit in early childhood caries (EEC) cavities on the first set of teeth, and has identified a new species of bacterium, Scardovia wiggsiae, which they suspect is also a major contributor. They report their findings in the Journal of Clinical Microbiology.

The study’s ultimate goal was to determine which bacterial species should be suppressed “to prevent cavity formation,” says Anne Tanner, of the Forsyth Institute, Cambridge, MA. EEC is the most common chronic infectious disease of childhood in the US. It afflicts one quarter of the relevant population, and more than one half among certain disadvantaged socioeconomic groups.

In this study, the researchers compared the bacterial populations in samples of dental plaque taken from deep cavities in afflicted children, with plaque from matched sites in cavity-free children. They identified species using 16S ribosomal RNA (16S rRNA). Ribosomes are the machinery that translate the genetic code into protein, and 16S rRNA differs among species. Since high acidity causes caries, and since only acid tolerant bacteria can survive in levels of acidity associated with active caries, they cultured bacteria under acidic conditions to select for species likely to play important roles in cariogenesis.

“We detected the major caries pathogen of childhood caries, S. mutans, in many of the children with advanced caries,” says Tanner. In addition, they the found the new species, S. wiggsiae, in a high proportion of plaque samples from cavities, including in several such samples from which S. mutans was absent. S. wiggsiae can tolerate the level of acidity in active caries, leading the team to speculate that it causes cavities.

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Shuman named president of Pride Institute

By DrBicuspid Staff

October 1, 2009 – Lou Shuman, D.M.D., has been hired as president of the Pride Institute, a practice management company founded by Jim Pride, D.D.S., in 1976.

Prior to joining the Pride Institute, Dr. Shuman served as vice president of strategic relations for Align Technology for seven years. During that time, he was responsible for the clinical creation of general practitioner and orthodontic clinical programs, integrating the Invisalign technique into orthodontic and dental school curriculums throughout North America, as well as into associations, institutes, and organizations including the ADA, the Academy of General Dentistry, the Dawson Center for Advanced Studies, the Pankey Institute, and the Scottsdale Center for Dentistry.

“As president, Lou will partner with me to lead the team to new levels of awareness, delivery, and results,” said Amy Morgan, CEO of Pride Institute, in a press release. “Our goal is to continue the foundation that Jim Pride created while developing new delivery models and methods that address the ever-evolving needs of our clients.”


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