Privately billed insurance claims related to oral cancer diagnoses rose 61% from 2011 to 2015, according to data on 21 million privately billed medical and dental claims examined by FAIR Health. The greatest increase involved throat cancer (malignant neoplasm of the nasopharynx, hypopharynx, and oropharynx). The second greatest was in tongue cancer (malignant neoplasm of the tongue).
“Oral cancer is a serious and growing public health problem,” said FAIR Health president Robin Gelburd. “We hope that our data help inform the national conversation on this topic.”
Also, 74% of oral cancer claims were for males while 26% were for females. Tongue and throat cancers in particular were more likely to occur in men than women. However, men and women had similar chances of developing gum cancer (malignant neoplasm of the gums) and an oral tumor that was benign but could become cancerous (neoplasm of uncertain behavior—oral). Tobacco use, excessive alcohol use, and human papillomavirus (HPV) are the chief risk factors.
Oral cancer claims occurred much more frequently among individuals age 46 years and older than in younger individuals, with increases among those age 56 to 65 years and decreases for those age 65 years and older. The American Cancer Society estimates that approximately 48,330 Americans will get cancer of the oral cavity or pharynx in 2016 and about 9,570 will die of the disease.
However, patients who are diagnosed in the early stages of the disease see 5-year survival rates between 80% and 90%. That’s why the ADA recommends oral cancer screenings during routine dental checkups, particularly among patients who use tobacco or consume alcohol heavily. Still, FAIR Health reports, adult males were much less likely than adult females to seek preventive dental examinations and cleanings despite their greater risk for oral cancer.
According to FAIR Health, 2 dental procedures associated with oral cancer screenings have been increasingly performed from 2007 to 2015: CDT codes D0431, an adjunctive prediagnostic test, and D7287, an exfoliative cytological sample collection, or obtaining cells for microscopic study. Approximately 65% of these codes were filed for patients between the ages of 31 and 60 years, with the 41- to 50-year-old segment seeing the most codes at about 24%.
A new regenerative scaffold made of biosafe collagen hydrogel and collagen sponge could retain fibroblastic growth factor-2 (FGF2) and stimulate periodontal tissue regeneration. Developed at the Hokkaido University Graduate School of Dental Medicine, the scaffold would improve the outcome of periodontal regenerative surgery and support to prevent tooth loss compared to exiting scaffold materials, according to the researchers.
In periodontal regenerative therapy, stable periodontal attachments including the cementum and periodontal ligament should be reformed on the instrumented tooth surface and stimulate alveolar bone regeneration. But periodontal attachment is difficult to reform because the rapid growth of the junctional epithelium and gingival connective tissue inhibit the growth of periodontal tissue associated with periodontal attachment.
Predictable periodontal regenerative procedures, then, require the development of compatible biomaterial against the periodontal stem cells, progenitors, and tissues. Collagen hydrogels cross-linked by an ascorbate-copper ion system exhibit high fluidity. To promote its operability, the researchers injected the FGF2-loaded collagen hydrogel into the biocompatible 3-D sponge-form collagen before implantation.
The combination of the collagen hydrogel scaffold and FGF2 exhibited good biodegradability of the scaffold and remarkably promoted periodontal healing, the researchers stated, involving the regeneration of cementum, periodontal ligament, and matured alveolar bone in beagles. Also, the FGF2-loaded hydrogel scaffold facilitated the formation of acellular cementum receiving insertions of Sharpey’s fibers continuous to periodontal membrane fibers (true regeneration).
Regenerated periodontal tissue would be effective for resisting the force of mastication, the researchers concluded. They also believe that this technique could replace the preexisting polymer scaffold and artificial bone graft in periodontal surgical therapy. The study, “Collagen Hydrogel Scaffold and Fibroblast Growth Factor-2 Accelerate Periodontal Healing of Class II Furcation Defects in Dog,” was published by The Open Dentistry Journal.
Children who require both dental and non-dental medical procedures should have them completed during a single general anesthesia session whenever possible, recommends the American Society of Anesthesiologists (ASA) based on research that will be presented at its Anesthesiology 2016 annual meeting this week in Chicago.
“While surgery and anesthesia are safer than they’ve ever been, limiting exposure is preferable, especially in children, because there may be sensitivities or a greater risk of anesthesia-related complications,” said Vidya T. Raman, MD, director of pre-admission testing at Nationwide Children’s Hospital and clinical associate professor at the Ohio State University Wexner Medical Center.
“In addition to improving patient safety, we believe combining procedures decreases costs and improves patient satisfaction,” said Raman, who also was the lead author of the study.
Some children require general anesthesia during restorative dental procedures such as tooth extractions and capping. When possible, the researchers stated, these procedures should be performed with other interventions requiring general anesthesia such as tonsil removal, ear tube insertions, and magnetic resonance imaging (MRI), which requires children to be still.
During the study, 55 children had a dental procedure combined with another non-dental medical procedure under one anesthetic. Only 7 of them (13%) saw complications such as vomiting, pain, fever, and pneumonia. Of those, 4 (7%) required unplanned admission to the hospital. Most of those patients were at increased risk of hospitalization because of severe systemic disease, Raman said.
Additionally, combining procedures saved an average of 30%, leading to a savings of approximately $165,000 for the 55 cases, the researchers said. The joint procedures also enabled these patients to be treated in a single visit instead of during the course of weeks or months.
Physicians can use electronic medical records to identify the recommended procedures that can be performed safely at the same time, Raman said. Everyone involved, including dentists, physicians, and parents, should be aware of all upcoming surgeries the child requires and communicate with all parties, Raman said.
However, she added, procedures that are more urgent and vital should be performed first to ensure safety without being combined, such as surgeries with an increased infection risk, spinal fusion, and heart surgeries.
“It can be logistically complex to schedule several procedures at once,” Raman said, “but combining them can decrease costs and pleases parents because their children don’t have to undergo multiple recoveries and can return to school and activities faster.”
Two research studies published by Lasers in Surgery and Medicine have demonstrated how the 1064-nm wavelength PerioLase MVP-7 dental laser system from Millennial Dental Technologies selectively destroys Porphyromonas gingivalis (Pg). This keystone pathogen directs other gum tissue bacteria to become pathogenically active in the progressive destruction involved in moderate to severe gum disease.
Historically, Pg has been identified as a black pigmented species bacteria based on its visible color in lab cultures. Previous studies have shown that it is destroyed in human treatments following the use of a 1064-nm pulsed Nd:YAG laser. These observations led to conjecture that Pg also was pigmented in the body (in vivo) and that the 1064-nm wavelength kills the bacteria by targeting the visible (black) pigment.
The first study, “The Black Bug Myth, Selective Photodestruction of Pigmented Pathogens,” demonstrated that the PerioLase MVP-7 destroys Pg regardless of the amount of visible pigmentation or complete lack of visible pigmentation in the bacterial. It also suggests that the laser kills Pg by destroying an invisible chromophore. Consequently, periodontal bugs don’t need to be black or even visible to the human eye for the laser to eliminate them.
The second study, “Selective Photoantisepsis,” focused on selectively eliminating pathogens at different depths within a tissue model by analyzing the differences between the absorption of light energy by pathogens and host tissues. It supports selective destruction of Pg and Prevotella intermedia (Pi) at depths of 3 to 4 mm using a 1064-nm pulsed Nd:YAG laser.
Unlike the 1064-nm laser, the 810-nm diode laser requires visible pigment to destroy the bacteria. The 810-nm laser also was lethal to the healthy tissue at an earlier stage. The model indicates no selectivity for the 2940-nm Er:YAG laser.
“These 2 studies add to our understanding of the reasons and mechanisms for the benefits of the PerioLase MVP-7 1064-nm pulsed Nd:YAG laser in reducing the periodontal pathogens associated with gum disease,” said Robert H. Gregg II, DDS, co-inventor of the PerioLase MVP-7 and inventor of the LANAP protocol.
To stem rising rates of tooth decay as well as obesity and type 2 diabetes, the World Health Organization (WHO) is calling for taxes on sugary drinks worldwide. According to WHO, an increase of 20% or greater in the retail price of these beverages would result in proportional reductions in their consumption.
Less consumption means less intake of “free sugars,” or monosaccharides, such as glucose or fructose, and disaccharides, such as sucrose or table sugar, added to these beverages by the manufacturer, cook, or consumer.
“If governments tax products like sugary drinks, they can reduce suffering and save lives,” said Douglas Bettcher, MD, PhD, director of WHO’s department for the prevention of non-communicable diseases. “They can also cut healthcare costs and increase revenues to invest in health services.”
According to WHO, populations face higher rates of dental caries when the intake of free sugars is greater than 10% of total energy intake compared to an intake of free sugars below 10% of total energy intake. Yet WHO believes that total free sugar consumption should be even less than 10%.
“Nutritionally, people don’t need any sugar in their diet. WHO recommends that if people do consume free sugars, they keep their intake below 10% of their total energy needs and reduce it to less than 5% for additional health benefits,” said Francesco Branca, PhD, director of WHO’s department of nutrition for health and development. “This is equivalent to less than a single serving, at least 250 mL, of commonly consumed sugary drinks per day.”
Today, 60% to 90% of children and nearly 100% of adults have dental caries, WHO reports. Globally, about 30% of people between the ages of 35 and 44 years have no natural teeth. Decreased sugar intake and balanced nutrition could prevent tooth decay and premature tooth loss, the organization states.
Furthermore, according to WHO, the oral disease burden is significantly higher among poor and disadvantaged populations, which often see increased rates of sugary drink consumption and tooth decay compared to populations with higher incomes. As a result, these people in addition to young people are most responsive to changes in beverage prices and will benefit the most from a tax.
Mexico already has implemented an excise tax on nonalcoholic beverages with added sugar. Hungary has imposed a tax on packaged products with high sugars, salt, or caffeine levels. The Philippines, South Africa, and the United Kingdom have announced intentions to implement taxes on sugary drinks. In the United States, a tax is in effect in Berkeley, Calif, with another launching in Philadelphia come January 1, 2017.
WHO notes that public support for these taxes can be increased if the revenue they generate is earmarked for efforts to improve health systems, encourage healthier diets, and increase physical activity. The Philadelphia tax, for instance, is expected to raise about $91 million each year for expanding prekindergarten, creating community schools, improving public facilities, and offering a tax credit for businesses that sell healthy beverages.
Researchers from the New York Institute of Technology have developed computer simulations showing how lasers set at different wavelengths can attack oral bacterial colonies, suggesting that the benefits of using lasers in oral debridement include killing bacteria buried in gum tissue and promoting better dental health.
“The paper verifies or validates the use of lasers to kill bacteria and contribute to better health following periodontal treatments,” said co-author Lou Reinisch, PhD, associate provost for academic affairs at New York Institute of Technology and an expert in laser surgery with a background in physics, optics, and calculus.
Reinisch created mathematical models based on the optical characteristics of gum tissues and bacteria. He then produced simulations of 3 different types of lasers commonly used in dentistry and their effects on 2 types of bacterial colonies of various sizes and depths within the gum models.
“One of the questions we asked is how deep could the bacteria be and still be affected by the laser light,” said Reinisch.
The simulations indicate that 810-nm diode lasers, set to short pulses and moderate energy levels, can kill bacteria buried 3 mm deep in the soft tissue of gums. The 1064-nm Nd:YAG laser also is effective with similar penetration. Both lasers spare healthy tissue with minimal heating of the surrounding tissue. Minimizing thermal damage accelerates healing, said Reinisch.
“The findings are important because they open up the possibility of tweaking the wavelength, power, and pulse duration to be the most effective for killing bacteria,” said Reinisch. “The doctors will look at this and say, ‘I see there is a possible benefit for my patients in using the laser.’”
“The study reveals what’s going on in the tissue, so I hope that we’re educating the medical professionals by demonstrating that you can do a good job of killing bacteria with certain lasers,” said co-author David Harris, PhD, director of Bio-Medical Consultants, which specializes in medical laser product development.
“When you do this treatment, you remove an infection and allow tissue to regenerate. Getting rid of the infection means the tissue can heal without interference,” said Harris.
Dental lasers can cost from $5,000 to more than $100,000, Reinisch said, and healthcare professionals require extra training to use them. These costs are passed on to the patient, so Reinisch said there must be a definite benefit to the patient to justify these costs.
At least 25% of dental offices in the United States have laser dental capability for periodontal treatment as outlined in the paper, Harris noted, along with other soft-tissue surgical procedures and hard-tissue procedures like the removal of tooth decay. Harris also said that the video simulations demonstrate what happens when lasers hit buried bacterial colonies.
“This is a great way to present to the doctor esoteric scientific findings in a clinically meaningful format,” Harris said. “The model is a great tool for making predictions of what can happen in the tissue. Our study confirms its use as a way to determine the most effective laser parameters to use clinically.”
The study’s methodology of simulating how laser light interacts with tissue has implications beyond dentistry. Physicians and surgeons user lasers in various treatments, including vocal cord procedures and dermatological treatments, including those for toenail fungus. Guided by the results in this study, Reinisch and Harris expect clinical trials will validate their findings.
Carestream Dental has sold more than 10,000 of its CS 8100 Family imaging systems as of September 2016. Introduced in 2012, the CS 8100 was designed to support the day-to-day panoramic imaging needs of small practices, such as segmented panoramic, temporomandibular joint, and maxillary sinus imaging.
“Over the past 4 years, we’ve built on the success of the original design concept of the CS 8100 by developing a 3-D imaging unit—the CS 8100 3D extraoral imaging system—and a scanning cephalometric unit—the CS 8100SC panoramic and cephalometric imaging system,” said Ed Shellard, DMD, vice president of sales and marketing at Carestream Dental.
After Carestream launched the CS 8100, its engineers realized that dentists wanted the benefits of in-office CBCT without sacrificing office space. The company then introduced the CS 8100 3D in 2014 with the same footprint and imaging capabilities as the CS 8100 with the added benefits of 3-D imaging and 3-D model scanning.
“Some of my favorite features are its compact size, multifunction 2-D/3-D imaging, and easy, mistake-free acquisition. I’ve taken over 50 scans so far and have never missed the area of interest,” said Peter Kapsimalis, DMD, of Summit, NJ. “Not only does the unit feature quick scan times and distortion-free images, it’s also easy for my staff to position patients, and their comfort level really puts my patients at ease.”
Carestream then introduced the CS 8100SC in 2015. According to the company, it offers the fastest scanning times of any scanning cephalometric unit on the market, as low as 3 seconds for an 18- by 24-cm image in fast scan mode. Also, its advanced imaging software recognizes anatomical structures and traces them automatically and can go from scanning to tracing within 90 seconds.
“When I decided to add cephalometric imaging capabilities to my new orthodontic office, I opted for a CS 8100SC, which enables me to perform both panoramic and cephalometric imaging without changing the sensor between scans,” said Noam Green, DMD, of Green Orthodontics in Decatur, Ga. “Training on the system is almost unnecessary because of how straightforward and intuitive the user interface is.”
Steve W. Kess, Henry Schein's vice president of global professional relations and co-founder of the company's global social responsibility program, was inducted this past Friday as a Fellow of the International College of Dentists (ICD).
"I am grateful for the opportunity the ICD has given me, and for the support of Henry Schein, to help advance oral health around the world," said Kess of this honor. "As a Fellow, I am committed to identifying more opportunities to enhance access to care and to further support the ICD USA Section Foundation and the ICD Global Visionary Fund."
The induction ceremony took place at the Sheraton-Downtown in Denver, Plaza Ballroom - PZ Concourse.
For more information about Henry Schein and its events at the ADA meeting, visit henryschein.com.
The global dental implants market will total $6.81 billion by 2024, according to Research and Markets. The analyst company attributes this growth to road accidents and sports injuries, as well as to growing aesthetic awareness among patients, which is pushing people to explore more conservative treatment options.
Dental implants are considered the only restorative technique that preserves and stimulates natural bone, Research and Markets states. Owing to the growing number of edentulous people, the demand for prosthetics is increasing, which also is driving the market.
Research and Markets expects the highest compound annual growth rate (CAGR) in the Asia-Pacific region due to its increasing economic stability and spending capacity. Growing healthcare dispensing power in countries like Japan will aid in the high cost of implant procedures. The increasing base of dentists and implantologists in China will contribute to growth as well.
Europe held the largest share of the market in 2015, with $1.5 billion, primarily due to its high geriatric population base. The presence of key companies also contributes to this market share. Furthermore, Europe in particular has seen a growing number of sports-related facial injuries, leading to growing demand for oral rehabilitation.
Titanium dominates the overall market because of various applications during surgical placements. One-stage and 2-stage titanium implants provide a cost-effective solution for dental implant treatments due to their long lifespan, Research and Markets states. However, titanium is prone to corrosion.
Zirconia implants will grow at a faster CAGR of more than 8.0% through 2024. The research company says that zirconia implants have enhanced the outcome of dental implant treatments. Zirconia also is a corrosion-free material, which is an added advantage.
Oral cancer rates among adults continue to climb due to the spread of the human papilloma virus (HPV). Yet the HPV vaccine has shown early success in preventing the virus’ spread among younger generations. Now, the Centers for Disease Control and Prevention (CDC) is revising its guidelines to make its administration easier, recommending that 11- to 12-year-olds receive just 2 doses at least 6 months apart, rather than 3 doses.
“Safe, effective, and long-lasting protection against HPV cancers with 2 visits instead of 3 means more Americans will be protected from cancer,” said CDC director Tom Frieden, MD, MPH. “This recommendation will make it simpler for parents to get their children protected in time.”
Teens and young adults who start the series later, between the ages of 15 and 26 years, will continue to need 3 doses of the vaccine to protect themselves against cancer-causing HPV infections. Generally, preteens receive the HPV vaccine at the same time as whooping cough and meningitis vaccines. Adolescents who are 13 or 14 years old now also can receive the HPV vaccination on the new 2-dose schedule.
The Advisory Committee on Immunization Practices (ACIP), a panel of experts that advises the CDC on vaccine recommendations in the United States, voted on the new guidelines on October 19. Frieden approved the new recommendations shortly after the committee’s vote. ACIP recommendations approved by the director become agency guidelines on the date published in the Morbidity and Mortality Weekly Report.
The CDC now will provide guidance to parents, healthcare professionals, and insurers on the changes in the recommendations. On October 9, the US Food and Drug Administration approved adding a 2-dose schedule for 9-valent HPV vaccine for adolescents ages 9 through 14 years. The CDC encourages clinicians to begin implementing the 2-dose schedule in their practice to protect preteen patients from HPV cancers.