While dental implants are a key tool in replacing missing teeth, bone loss remains a risk. Researchers from the University of Dammam in Saudi Arabia and the University of Kentucky in Lexington, then, decided to investigate if implants with a microthreaded-neck design would preserve more of the crestal bone than traditional machine- or rough-surface implants.
Based on their review of 23 articles published between 1995 and 2016, the researchers concluded that the addition of deeper threads on the implant allowed for more stabilization between the implant and the bone, especially with weaker bones. Also, the threads created more bone-to-implant contact and allowed for more of the bone to be preserved.
According to the researchers, their work is one of the earliest projects to provide high evidence from literature about the design of the most current generation of dental implants, including a continuous microrough or nanorough surface extending up to the implant neck, along with microthreads in the cervical region. Their systematic review was designed to evaluate and analyze the effect of a microthreaded-neck implant on crestal bone loss as determined by various clinical trials.
The study, the researchers said, shows that thread geometry affects the amount of stress and strain on the implant and that crestal bone loss can be minimized. Practitioners can use this finding to make a more informed decision in choosing an implant type for their patients. The researchers also believe that additional randomized controlled trials are necessary to evaluate how the microthreaded implant will affect different types of bone loss under different implantation techniques.
The study, “Microthreaded Implants and Crestal Bone Loss: A Systematic Review,” was published by the Journal of Oral Implantology.
Only 4 out of 10 Americans floss at least once day, while 20% never floss at all, reports the ADA. Many of these people blame the dexterity and the time that effective flossing requires. Yet a startup known as Flossy Brush has developed an eponymous tool that combines a toothbrush on one end with dental floss on the other, improving hygiene and eliminating excuses for those who don’t floss like they should.
The Flossy Brush’s integrated floss holder is designed for simple and quick placement and replacement of any kind of floss on the market. There are no removable parts or replacement cartridges to purchase. Also, the curved and flexible design is crafted so users can easily reach the hardest places around their teeth. Plus, its compact and flexible head is available in 2 bristle types: ultrasoft bristles with a tapered 0.01 tip to reach below the gum, or Tynex-soft rounded bristles for a more conventional feel.
“Flossy Brush is not just another toothbrush. It is far more effective at removing plaque and simple and convenient to use,” said Zoltan Rusznak, DDS, CEO of Flossy Brush. “Our aim is to sell this widely in the US market, and, as we grow, expand into the European and Japanese markets. Right now, we are looking for investors who have an interest in helping launch the product into the next phase.”
So far, the company has secured manufacturing, warehousing, and transportation, along with an inventory of 35,000 retail-ready Flossy Brushes. It also has established a Fundable page where potential investors can learn more about the product and company.
Antibiotic resistance presents a growing threat to global health, causing 23,000 deaths each year in the United States, according to the Centers for Disease Control and Prevention. As the scientific community searches for alternatives to antibiotics, researchers are exploring how they can replicate the ability of mucus to naturally control pathogenic bacteria, with the help of some familiar oral pathogens and potentially preventing dental caries too.
“My lab and others around the world have begun to engineer mucin-inspired polymers and [synthetic] mucus,” said Katharina Ribbeck, PhD, professor of tissue engineering at the Massachusetts Institute of Technology. “We want to use these engineered polymers to control problematic pathogens inside and outside of the body and to stop the growing threat of antibiotic-resistant microbes.”
The human body produces about a gallon of mucus each day to sustain a protective coating on more than 2,000 square feet of internal surface area, including the digestive tract, mouth, eyes, lungs, female reproductive tract, and nose. Most of the trillions of microbes inhabiting the body live inside the mucus that lines the digestive tract. Ribbeck has been researching how mucus maintains a healthy balance between beneficial and potentially harmful microbes.
“Over millions of years, the mucus has evolved the ability to keep a number of these problematic pathogenic microbes in check, preventing them from causing damage,” said Ribbeck. “But the mucus does not kill the microbes. Instead, it tames them.”
Ribbeck’s team has investigated how mucins, the sugar-coated molecules that form the mucus gel, influence the makeup of the body’s internal microbial communities by constraining the formation of multicellular assemblies (also known as biofilms) by the microbes. As a case study, the researchers looked at the mucins found in saliva, called MUC5B.
Next, they grew 2 types of bacteria known to compete in the mouth: Streptococcus mutans, which forms cavities, and Streptococcus sanguinis, a bacterium associated with healthy oral conditions. They found that S mutans quickly outgrew S sanguinis when grown together outside of saliva or mucin-containing media. But grown in the presence of MUC5B (both in real saliva and in MUC5B-containing synthetic mucus), the 2 species tended to establish a more even balance, suggesting that mucin could be instrumental in supporting greater bacterial diversity.
“We conclude from these findings that MUC5B may help prevent diseases such as dental caries by reducing the potential that a single harmful species will dominate,” said Ribbeck, who plans to continue to investigate the potential role of mucins in maintaining microbial diversity in other mucosal surfaces throughout the body.
It seems like dentists already have lots to do during typical procedures. Yet the University of Buffalo School of Dental Medicine also requires its pre-doctoral students to assess the vital signs of all of their patients at every clinic appointment, including blood pressure, pulse rate, and pulse rhythm. These students are required to assess the capillary blood sugar (CBS) of all diabetic patients at every clinic appointment as well.
“The rationale was to train our students that these vital parameters are a normal component of the medical model for a patient workup, and our students should learn that medical model of patient assessment,” said Michael N. Hatton, DDS, MS, of the department of oral diagnostic sciences at the school. “We felt it would serve them well in their future professional lives to assess their patients in a medically templated way.”
Plus, this information provides baseline data in case of a medical emergency at the school, and personnel then could initiate resuscitative efforts in the best manner. With about 50,000 patient visits each year at the dental school, with many patients in their elder years, there are some high risks during dental care. And on a more practical level, these baseline figures would assist in a legal defense should the school face a lawsuit for a poor outcome.
“All students purchase blood pressure monitoring devices and stethoscopes. The school purchases glucometers and necessary accouterments for assessing CBS,” said Hatton. “All pre-doctoral students are taught blood pressure and blood sugar assessment techniques in their second year and assess all their patients, without exception, in their third and fourth years. They are competency tested on these techniques in their third and fourth years. Again, blood pressure for every patient, CBS for diabetic patients, every visit.”
But when the school surveyed its recent graduates to see if they maintained these practices in their professional lives, it found that only 77% of them generally assessed blood pressure, and only 23% assessed the CBS of diabetic patients—and most of these graduates didn’t follow the school’s strict policies in conducting these assessments, despite their training.
The obstacles to consistent performance of these assessments include a perceived “lack of time” on the part of the practitioners and a perception that they aren’t necessary in dental visits on the part of some patients and in some practices. In fact, when the school began including these assessments as part of its curriculum in 2010, some faculty felt that they were a waste of the dentist’s time, Hatton said, though that attitude has faded away.
“We found that graduates generally do not adhere strictly to what they were taught after graduation. They are apt to assess blood pressure on a case by case basis and more frequently than CBS assessment,” said Hatton. “These assessments may not be highly valued by dentist-owners who graduated long ago.”
These assessments often have practical use during dental procedures, too. For example, the CBS baseline enables dentists to make necessary treatment options based on glucose levels. Diabetic patients who have taken their anti-hyperglycemic medication but who have not eaten may experience dangerously low glucose levels after a lengthy appointment.
“If the glucose reading is what faculty deem low, we have the option of giving the patient a glucose-containing fluid to raise glucose levels prior to treatment,” said Hatton. “We also have the option of reassessing glucose levels prior to exiting the building to make sure they are acceptable for the patient to get home in a reasonably safe manner from a blood sugar standpoint.”
Without a blood sugar assessment, consequences could be dire. A patient who succumbs to hypoglycemia, for instance, could be mistaken for someone who has simply fainted. Unless sugar is introduced into the patient’s system quickly, neurological deficits are possible—and introducing sugar into such an unconscious patient could be very difficult for dentists who aren’t trained in intravenous administration. Blood pressure can be a sign of danger, too.
“In one case, we diagnosed a third-degree heart block, often associated with high morbidity and mortality, simply by noting the abnormally low blood pressure and pulse, getting the patient into care, and having a pacemaker placed within 36 hours,” said Hatton. “That patient is still a patient of the school, but much healthier than when we found the abnormality. She was completely asymptomatic prior to our intervention. Dentists can save lives by doing simple vital assessments on their patients.”
Dentists who want to learn more about the role of vital signs in dentistry should read The ADA Practical Guide to Patients with Medical Conditions, edited by Lauren Patton, DDS, and Michael Glick, DMD, and Dental Management of the Medically Compromised Patient by James W. Little, DMD, MS, et al, Hatton recommends. He also suggests joining the American Academy of Oral Medicine and reading its associated journal.
“The Academy provides pathways for non-oral medicine dentists to achieve the status of Fellow,” Hatton said. “The annual and semi-annual meetings also provide a broad array of medically based issues for the practicing non-oral medicine trained dentist.”
Researchers at Augusta University have obtained a patent for a predictive, diagnostic, and prognostic kit that will help address issues surrounding Sjögren’s syndrome. The autoimmune disease leads to dry eyes, dry mouth, and tooth decay as well as arthritis and, in rare cases, lymphoma. It also affects more than 4 million Americans, or about 1% of the population, and 90% of those who suffer from it are women.
“We noticed that there are a few biomarkers that increase in the patient’s tissue and salivary glands when a person has Sjögren’s syndrome,” said Babak Baban, PhD, associate professor at the Dental College of Georgia at the university. “We worked on these biomarkers and looked at blood circulation and noticed that there is an increase in circulation systemically when the biomarkers increase.”
The researchers have developed a method that could diagnose Sjögren’s syndrome with a simple finger prick. The protocol also can determine if people are susceptible to the disease, if they have it, and how treatment will affect them. Next, the researchers will focus on further advances to develop a kit with the ultimate goal of partnering with a pharmaceutical company to produce it.
“It’s a great feeling to see that your efforts have been recognized not only by the university but by the federal authority,” said Baban. “This patent means they see the importance of the discovery and are recognizing it. They see the value in our research, feel that it is novel, and there is a demand and a need for a diagnostic kit. The recognition is like someone saying, ‘You have something here that is worth being addressed.’”
It’s Every Kid Healthy Week, and oral health is key to overall health. Yet some states do a better job of supporting pediatric oral health than others, according to WalletHub’s 2017 Best & Worst States for Children’s Health Care, which compared the 50 states and the District of Columbia across 28 metrics on a 100-point scale each.
Iowa topped the overall list in terms of oral health, followed by West Virginia, Illinois, Rhode Island, Vermont, Kentucky, Massachusetts, Michigan, New York, and New Hampshire. Nevada was at the bottom of the list, preceded by California, Hawaii, Florida, New Jersey, Louisiana, Arkansas, Wyoming, Alabama, and New Mexico.
By the individual metrics, the report notes that Vermont has the highest percentage of children between the ages of one and 17 years with excellent or very good teeth, followed by New Hampshire, Maine and North Dakota (tie), and Massachusetts and South Dakota (tie). Nevada had the lowest share, preceded by New Mexico, California, Arizona, and Texas.
Vermont also has the highest share of children who have had both medical and dental preventive-care visits in the past 12 months at 81.4%, followed by Connecticut, New Hampshire, Massachusetts, and the District of Columbia. Nevada had the lowest share of children who have had both medical and dental preventive-care visits in the previous year, at 56.0%.
And, Michigan has the highest share of dentists participating in Medicaid for child dental services at 91.7%. That’s 4.5 times more than Ohio, which had the lowest share of dentists participating in Medicaid for child dental services at 20.4%.
Other metrics related to oral health included the share of children aged zero to 17 years lacking access to fluoridated water; the presence of a state oral health plan; the presence of school-based dental sealant programs; dental treatment costs; the presence of a state mandate for dental-health screening; and dentists per capita.
Severe periodontitis as defined by standard periodontology criteria strongly predicts higher all-cause mortality among patients with irreversible scarring of the liver, or cirrhosis, according to an international team of researchers. Presented at the International Liver Congress 2017 in Amsterdam, the study enrolled 184 consecutive patients with cirrhosis who received oral health assessments and were followed for an average of a year.
“Periodontitis may act as a persistent source of oral bacterial translocation, causing inflammation and increasing cirrhosis complications,” said Lea Ladegaard Grønkjaer, PhD, RN, of the Aarhus University Hospital in Denmark and lead author of the study. “As it can be treated successfully, however, we hope that our findings motivate more trials on this subject.”
When the study began, 44% of the patients had severe periodontitis. Nearly half of the included patients died during the follow-up. The association of periodontitis with mortality was adjusted for age, gender, cirrhosis etiology, Child-Pugh score, Model of End-Stage Liver Disease score, smoker status, present alcohol use, co-morbidity, and nutritional risk score. Mortality was mostly attributable to complications of cirrhosis.
In Europe, the researchers noted, cirrhosis is responsible for 1% to 2% of all deaths and is the leading cause of liver transplantation. Meanwhile, more than 35% of the European adult population has periodontitis, with 10% to 15% having severe forms of the disease. Previous studies have suggested that periodontitis is involved in the progression of liver diseases and that it has a negative impact on the clinical course after liver transplantation.
“This study demonstrates the association between gum disease and risk of death in patients with liver disease,” said Philip Newsome, PhD, of the Centre for Liver Research at the University of Birmingham in the United Kingdom and governing board member of the European Association for the Study of the Liver. “Further studies are now required to determine if improving gum care can improve outcomes in patients with liver cirrhosis.”
When you acquire a new piece of equipment to use in your practice, you are pumped about all of the features it has to offer. After all, you’re a dentist, and the features matter. But your patients don’t care so much about its features. In some cases, the features may go right over their heads.
What matters to your patients is how your new acquisitions benefit them. How do your patients benefit from selecting your practice over your corporate competitor down the street? The following are examples of how talking about benefits can help you attract new patients and keep your current patients coming back.
Say you get a new intraoral scanner. You’re excited about the technology and how precise it will allow you to be. But what does that matter to your patients? The way to get your patients excited is to share what that means to them: their appointment time is shorter, they won’t have to choke on goopy impression trays, and their finished product will fit correctly (which means not having to return to adjust the prosthesis). The mere fact that your scanner can save them time is a benefit that your patients can appreciate.
You’ve finally hired a new associate. Of course, you’ll want to share a brief biography with your patients so they’re not taken by surprise (where your associate went to school, how long your new employee has been practicing, etc). But ultimately, your patients care about how they can benefit from your new hire.
Will having an associate dentist allow you to extend your hours? Does your new associate have a different skill set like FastBraces or ClearCorrect certifications that will benefit the practice? It’s easier for your patients to get behind your choice to bring someone new on board if they know how it will make their lives easier.
If you move or expand your practice, that’s exciting, right? New signage, new business cards, new décor—all new! But what about this change matters to your patients? Change can be scary, so to get them excited, explain the benefits. Maybe your new office is more centrally located, or closer to a freeway. Or maybe it’s closer to a favorite shopping complex or eating establishment. Maybe the new décor will function to make your patients feel calm, thereby enhancing their overall experience when they visit for a treatment. If your patients understand how it benefits them, then they’ll be as excited as you to see the new place.
When you’re among other dental professionals, you can discuss the features of your equipment, people, or places to your heart’s content. When you’re reaching patients—especially through social networking, email, blogs, and your website—focus on the patient benefits. You’ll understand the payoff when they return again and again for treatments.