Are you facing a difficult clinicial situation ? Please post the query on the forums.

  • Sharebar

Fight Back! Proactively Addressing the Caries Process

27 replies [Last post]
DrAnil's picture
Offline
Joined: 12 Nov 2011

Fight Back! Proactively Addressing the Caries Process

 

 

There is a call to action for the profession of dental hygiene to employ the same standards in caries assessment, prevention, and subsequent management as we have in our treatment of periodontal disease. With the vast array of new and innovative products designed to assist both chairside and self-care protocols, we may emerge confident in having a strong impact on preventive intervention. The understanding of the mechanism of both the disease and its prevention is critical in counterbalancing the effects of today's modern lifestyle. The need to intervene in the earliest stages of caries development cannot be overstated. 
Dental caries is ranked as the most prevalent global disease even though we have witnessed a significant reduction during the past several decades. It is defined as a "dynamic disease process" which is caused by acids from bacterial metabolism diffusing into enamel and dentin creating dissolution of the tooth matrix.1 The disease itself is an infectious, communicable disease that, if left untreated, can lead to pain, infection, tooth loss, and cellulitis of significant proportion. The psychological trauma associated with emergency-based care, although not measurable, can be debilitating. The process of dental caries is now well understood and is not the enigma it once was. However, there has been debate about whether early caries turns into eventual cavitation, and whether the different types of caries are both comparable and predictive.2 The predominant bacteria implicated in the process is Streptococcus mutans, which is a gram-positive facultatively anerobic bacterium and an early colonizer in plaque biofilm. The microbe was initially isolated by J. Clarke in 1924. In addition to describing S mutans, he introduced the concept of microbial succession with different bacteria being dominant at different stages of the caries process.3 The clinical significance of this finding becomes essential in the development of a rational approach to risk assessment and the introduction of mechanisms of intervention. 
Assessment, education, treatment, and prevention are all key components of addressing this disease successfully. One of the most critical factors is the recognition of the caries process being cyclic in nature and transitioning from demineralization to remineralization. This provides the dental hygienist with many opportunities to intervene in this dynamic process. Remineralization may be introduced with calcium and phosphate ions in conjunction with minimal amounts of fluoride facilitating a natural reparative process designed to rebuild stronger and less soluble structure than the original mineral. 
The secondary challenge arises with the confrontation of making an evidence-based decision regarding product selection and treatment interventions both chairside as well as self-care recommendations. Fluoride selection falls into this category, given the immense and vast array of product availability. The ADA Council on Scientific Affairs has assisted our profession greatly by evaluating the collective body of scientific evidence as it pertains to the efficacy of professionally applied topical fluoride for caries prevention.4The recommendations were published as a guide, rather than a requirement or regulatory statement, to assist the dental professional in the selection of an effective product. MedLine and the Cochrane Database of Systematic Reviews were both consulted for clinical studies and systematic reviews of professionally applied topical fluoride including gels, foams, and varnishes. The evidence was further graded and classified according to the strength of the recommendations as well as the highest category of evidence. There was clear, strong evidence to support the recommendation of fluoride varnish for prevention of caries in children and adolescents.5 New innovations in fluoride varnish have prompted a shift, with one of the most compelling rationales being the prolonged contact time that fluoride varnish provides.

Figure 1. 3M ESPE Preventive Measures Oral Health Risk Assessment and Management. Figure 2. 3M ESPE Caries Risk Assessment Form.

The primary benefits of topical fluoride include inhibition of demineralization, enhancement of remineralization, and inhibition of bacterial enzymes. Low but slightly elevated levels of fluoride in saliva and plaque help prevent and reverse caries by inhibiting demineralization and enhancing remineralization.6 Remineralization may be further enhanced by providing calcium and phosphate in conjunction with minimal amounts of fluoride. This is due to the fact that fluoride acts as a catalyst and influences reaction rates with dissolution and transformation of various calcium phosphate mineral phases within tooth structure and reacts within the plaque adjacent to tooth surfaces.7 Continuous low levels of a slow release extended contact fluoride varnish containing both calcium and phosphate in a resin-modified glass ionomer applied to site-specific areas of demineralization provide further protection against demineralization and acid erosion. 
Complimentary remineralization strategies may be employed in daily self-care regimens that are simple to incorporate into oral health practices. When the bacterial challenge is high and/or pH is lowered, there is a volatile oral environment that emerges. The added consideration of inadequate salivary flow to provide a buffering capacity further tips the scale towards demineralization. The remineralization process can be successfully integrated through the selection of remineralization toothpastes. Calcium and phosphate technologies such as the casein protein (CPP-ACP) as well as bioactive glasses containing NovaMin have been more recently developed to improve upon the earlier calcium phosphate products. 
Recaldent (CPP-ACP) results in localization of CPP-ACP at the tooth surface by binding to dental plaque biofilm both in the microorganisms and in the extracellular matrix. Higher concentration fluoride toothpastes in combination with both calcium and phosphate have also been developed, producing favorable results when the dose response relationship was observed clinically.8,9NovaMin is a sodium calcium phosphosilicate glass that releases calcium and phosphate ions in an aqueous environment such as saliva. Sodium ions are the driving mechanism that exchange with hydrogen cations allowing both calcium and phosphate ions to be released. The result is a rapid and continuous release and deposition of a natural crystalline hydroxyl-carbonate apatite layer that is chemically and structurally the same as tooth mineral.10,11 
Nature also provides a "secret weapon" to fight back effectively against the caries process, and that product is xylitol. Xylitol is a 5 carbon sugar alcohol or polyol that cannot be metabolized by S mutans resulting in starvation or inability to assist in the demineralization or dissolution of tooth structure. The American Academy of Pediatric Dentistry has recognized the benefits of caries strategies implementing xylitol. Their recommendations were based on the overwhelming clinical data which underlines the caries reduction effects of xylitol. Their goal was to "assist oral healthcare professionals make informed decisions about the use of xylitol-based products in caries prevention."12 Studies suggest xylitol intake that consistently produces positive results ranged from 4 to 10 g per day divided into 3 to 7 consumption periods.13-16

Figure 3. Post-treatment oral hygiene instruction. Figure 4. Philips Sonicare FlexCare+ with UV Sanitizer.
Figure 5. Pretreatment demineralization on tooth No. 7. Figure 6. Two weeks post-treatment VANISH XT (3M ESPE) on tooth No. 7.

CARIES RISK ASSESSMENT
Our standards for the practice of dental hygiene include risk assessment in order to facilitate patient-centered comprehensive care. Caries risk assessment and caries management by risk assessment exemplify a rapidly changing facet of the dental hygiene process.17,18 The dental hygienist plays an integral role in risk assessment determining not only the development and implementation of preventive interventions but also the evaluation of successful treatment outcomes. Risk assessment is not intended to replace clinical judgment regarding individual patient circumstances but rather to aid in applying a comprehensive approach identifying treatment options to achieve and maintain oral health. 
Today's youth is bombarded with nutritional choices that serve to compromise the oral environment. Soft drinks with low pH and corresponding high sucrose levels as well as the advent of energy drinks provide an ideal environment for demineralization. Demineralization happens in an oral environment that falls below a pH of 5.5. The average soft drink or energy drink has a pH of 2.5 to 3. 
There are a number of caries risk indicators as well as protective factors that need to be weighed in order to develop an effective individualized treatment plan (Figure 1). It becomes imperative that daily biofilm management incorporating effective plaque removal and remineralization strategies coupled with education all serve to provide optimal oral health.
The following case report has encompassed risk assessment as part of the assessment phase of the dental hygiene process of care. The product recommendations both for chairside as well as self-care selections are by no means a comprehensive listing of all available therapies. They have been selected to illustrate a patient specific treatment plan.

CASE REPORT
The patient was a 16-year-old female with a noncontributory medical history.
She had a history of routine preventive care and active orthodontic treatment for 3 years (debonded in 2007). Plaque had been noted on several appointments around orthodontic brackets while in active treatment, and she was prescribed home fluoride rinses in past which she was unable to tolerate. Several areas of interproximal incipient caries were noted in 2010; however oral hygiene status had been noted as improving over the last 6 to 12 months. Her care had also included radiographs taken every 6 to 12 months to assess incipient lesions, and in-office fluoride rinse was provided to her at 6 month intervals.

Oral Hygiene Status
Light plaque was visible along gingival margin in posterior areas; both lingual and buccal. Posterior interproximal bleeding on probing was localized to Nos. 2, 3, 14, 15, 18, and 31; all periodontal probing were depths < 3 mm.

Risk Assessment
High risk factors

  • Caries restored in the past 3 years
  • Frequent (> 3x/daily) between meal snacks of sugars/cooked starch
  • Fixed orthodontic retainers on upper/lower arch.

Moderate risk factors

  • Deep pits and fissures
  • Interproximal enamel lesions/radiolucencies
  • Other white spot lesions or occlusal discoloration.

Protective factors

  • Lives/attends school in fluoridated community
  • Uses over-the-counter fluoride dentifrice daily
  • Salivary flow visually adequate (Figure 2).

Clinical Assessment Summary

  • Permanent dentition; Nos. 1, 16, 17, and 32 unerupted
  • Occlusal restorations present on teeth Nos. 2, 15, 18, and 31
  • Pit and fissure sealants on Nos. 3, 14, 19 and 30
  • Fixed lingual orthodontic retainers from teeth Nos. 7 to 10 and 22 to 27
  • Demineralization noted on 6 mesiolabial, 7 labial and mesiolabial, 8 distolabial and mesiolabial, 9 distolabial, 22 labial, 23 mesiolabial, 24 distolabial and mesiolabial, 25 mesiolabial and distolabial, 26 mesiolabial, 29 buccal, 30 buccal
  • Incipient lesions were noted clinically as well as supported by radiographic evidence on 7 mesial, 8 mesial and distal, 9 mesial and distal, 23 mesial, 24 mesial and distal, 25 mesial.

Patient Participation and Comments

  • Infrequent flossing
  • Difficulty tolerating fluoride rinses both chairside and with self-care
  • Brushing twice a day and immediately following ingestion of any soft drinks with a manual toothbrush.

Discussion
Upon completion of risk assessment, the patient was placed in a high-risk category due to having caries restored in the past 3 years. There was also a number of moderate risk factors noted that would automatically place the patient in a high-risk category. The patient stated that she would consume soft drinks during the day and immediately following consumption would brush her teeth. The patient was provided with additional oral hygiene education informing her of the effects of acid erosion and the need to wait a minimum of 30 to 60 minutes before brushing her teeth19 (Figure 3) (Read and Watch video 1).
A power toothbrush was also recommended to meet the specific needs of the patient. One of the main reasons for the suggestion of a power toothbrush is supported by the numerous studies suggesting that a power toothbrush has been found to remove significantly more plaque than a manual toothbrush when used for one minute of brushing. The Philips Sonicare FlexCare+ with UV sanitizer was recommended for a number of reasons for this particular patient. The Philips Sonicare FlexCare+ has an integrated UV sanitizer that effectively kills up to 99% of selected microorganisms on selected toothbrush heads including S mutans, the predominant microorganism associated with the caries process.20 The patient reported infrequent and intermittent flossing. Through the patented technology of dynamic fluid force, Sonicare FlexCare+ has been studied resulting in conclusive evidence that it is able to remove interproximal biofilm beyond the reach of the bristles at a distance of 2 to 4 mm.21 This will aid in delivering the remineralization toothpaste into a number of noted demineralized areas and interproximal incipient lesions (Figure 4). 
The patient was placed on a 3-month interval with a recommended application of fluoride varnish (Figures 5 and 6) (Read and Watch video 2). Extended contact fluoride varnish was placed in site-specific noted areas of demineralization (Read and Watch video 3). In the interim, a remineralization toothpaste was recommended to be used twice daily containing calcium and phosphate as well as a therapeutic regiment of xylitol chewing gum taken after each meal and snack. A radiographic prescription was provided to assess radiolucent areas at regular intervals until the caries risk category had been diminished. Further salivary assessment and bacterial culture testing has also been recommended as well as subsequent caries evaluation using caries detection devices.

CONCLUSION
The preceding case report follows the assessment, dental hygiene diagnosis, and resulting implementation of a patient specific treatment plan. Evaluative outcomes will be measured, reassessed, and revised related to progress toward minimizing caries risk. There exists a powerful opportunity to support minimally invasive dentistry by embracing caries management by risk assessment. It's time to fight back!

up
0 users have Like. User Likes
drmithila's picture
Offline
Joined: 14 May 2011
Fight Back! Proactively Addressing the Caries Process

The majority of the Germans only change their toothbrush every five to six months—not often enough to prevent unpleasant side-effects. According to a new study, using a toothbrush for a period of six months may lead to gingivitis, which in turn increases the risk of other diseases.
For the study, researchers from the University of Göttingen divided participants into two test groups. Over a period of six months, the members of one group cleaned their teeth with one toothbrush, while the participants in the other group were given a new one every four weeks.

After six months, the scientists found an increase in gingival inflammation in the group that had not changed toothbrushes. The participants in the other group showed a better overall state of oral hygiene at any time in the test phase than at the beginning of the study, particularly concerning plaque.

“The results of the study are of significant relevance to oral health in Germany,” said Dr Dirk Ziebholz, research associate at the Department of Preventive Dentistry, Periodontology and Cariology at the University of Göttingen and leader of the study. “Gingivitis can lead to other problems such as periodontitis."

According to the GfK Group, a German market research company, Germans bought an average of 2.5 toothbrushes each in 2010. However, the recommended amount is four. Families in particular tend to change their toothbrushes only rarely (2.3 toothbrushes per year). With 4.5 toothbrushes, single professionals change their toothbrush even more frequently than every three months.

Most Germans change their toothbrush when the bristles are worn-out (70 per cent) or when they are concerned that their toothbrush may no longer be hygienic (66 per cent), according to GfK.

The study was conducted in collaboration with Dr. Best, a brand of GlaxoSmithKline.

 

up
0 users have Like. User Likes

An easy way for you to share and discuss dentistry and more...

For any help on posting on the site, email at [email protected]

An easy way for you to share and discuss dentistry and more...

For any help on posting on the site, email at [email protected]

Drsumitra's picture
Offline
Joined: 6 Oct 2011
Fight Back! Proactively Addressing the Caries Process

 At bedtime, remove partial or full dentures from the mouth. Brush teeth thoroughly with soft toothbrush and regular toothpaste. Floss teeth by sliding the floss up and down each side of each tooth. Note: It is very important to remove all food and plaque from between teeth before using fluoride. Food and plaque can prevent the fluoride from reaching the surface of the tooth.
Place a thin ribbon of the fluoride gel into each upper and lower fluoride tray so that each tooth space has some fluoride. Either 0.4% stannous fluoride (Gel Kam) or 1.1% sodium fluoride (Prevident) may be used. The fluoride can be spread into a thin film that coats the inside of the trays, by using a cotton-tipped applicator, finger or toothbrush.
Seat the trays on the upper and lower teeth and let them remain in place for 5 minutes. Only a small amount of fluoride should come out of the base of the trays when they are placed, otherwise, there may be too much fluoride in the trays.
After 5 minutes, remove the trays and thoroughly expectorate (spit out) the residual fluoride. Very Important - do not rinse mouth, drink or eat for at least 30 minutes after fluoride use.
For head and neck radiation patients, begin using fluoride in the custom trays no longer than one week after radiotherapy is completed. Repeat daily for the rest of your life!! Remember that tooth decay can occur in a matter of weeks if the fluoride is not used properly.
Care for Fluoride Carriers (Trays)
Rinse and dry the trays thoroughly after each use. Clean them by brushing them with a toothbrush and toothpaste.
Occasionally, the trays can be disinfected in a solution of sodium hypochlorite (Clorox) and water. Use one tablespoon of Clorox in about one-half cup of water. Soak them for about 15 minutes.
If the trays become covered with hard water deposits, soak them in white vinegar overnight and brush them the next morning.
Do not boil the trays or leave them in a hot car as they may warp or melt.

up
0 users have Like. User Likes
drmithila's picture
Offline
Joined: 14 May 2011
Fight Back! Proactively Addressing the Caries Process

Researchers from India have successfully tested a method that could help dentists to identify children who are at risk of developing Early Childhood Caries, the highly virulent form of tooth decay. In clinical tests conducted on pre-schoolers from Mangalore in southern India, they reported a link between the children’s bitter taste perception of a drug used in the treatment of autoimmune disease and their oral health status.
Oral bacteria attack children early
According to the researchers, who recently published their results in the Indian Journal of Human Genetics, children who reacted to 6-n-propylthiouracil (PROP) also showed a greater dislike of sweet foods and fewer signs of tooth decay compared with those who could not taste the compound. They also had fewer dental problems than those who did not react to it, the researchers said.

They concluded that taste perception could be used as a future diagnostic tool to identify children at risk of developing dental caries at an early age. “Tasters or sweet dislikers might avoid sweet food because their oral sensations are too intense, thus making tasters less prone to decay,” they stated in the paper.

Besides testing the perception of taste through questionnaires, the researchers observed the facial expressions of the children tested when exposed to the drug.

PROP, which is used in the treatment of Graves’ disease, among other thyroid diseases, is perceived as bitter tasting by the majority of people. However, studies have suggested that one out of three is insensitive to the compound. The ability to taste the drug is controlled by a specific gene that functions as a taste receptor.

First approved in the late 1940s, PROP is currently classified as a Pregnancy Category D drug by the US FDA and, therefore, its use is limited. Reported side-effects include increased risk of agranulocytosis and liver damage, including complete renal failure.

According to figures from Yale University, five to ten children die every year from taking PROP

 

up
0 users have Like. User Likes

An easy way for you to share and discuss dentistry and more...

For any help on posting on the site, email at [email protected]

An easy way for you to share and discuss dentistry and more...

For any help on posting on the site, email at [email protected]

drmithila's picture
Offline
Joined: 14 May 2011
Fight Back! Proactively Addressing the Caries Process

 Seaweed bacterial enzymes could manage to thwart tooth decay.

Scientists at New Castle University in the United Kingdom have isolated an enzyme from the marine bacterium bacillus licheniformis. It has been determined that this seaweed cuts through plaque and cleans the hard-to-reach dental areas.

This bacterial enzyme is generally used to clean the hulls of ships. This information, however, may provide an alternative method for teeth scaling that removes plaque and tartar buildup in the area between the teeth and gumline. Regular brushing can’t always account for this.

While conducting this study, researchers learned that the biofilm created by the bacteria for the adhesion makes it immune to basic oral health treatment. But when the bacterium exits the bacterial colony, it gives off an enzyme that breaks down the external DNA and biofilm. There could soon be various dental products with this enzyme, including toothpaste, mouthwash, and other products.

More research is necessary on this seaweed enzyme. But if it truly does destroy the plaque that contains bacteria, it will soon become widely used.

up
0 users have Like. User Likes

An easy way for you to share and discuss dentistry and more...

For any help on posting on the site, email at [email protected]

An easy way for you to share and discuss dentistry and more...

For any help on posting on the site, email at [email protected]

drmithila's picture
Offline
Joined: 14 May 2011
Fight Back! Proactively Addressing the Caries Process

SMaRT Replacement Therapy™ is designed to be a painless, one-time, five-minute topical treatment applied to the teeth that has the potential to offer lifelong protection against tooth decay caused by S. mutans, the principal cause of this disease. We have extensively and successfully tested the SMaRT strain for safety and efficacy in laboratory and animal models, and we are in the process of commencing a second Phase 1 clinical trial with an attenuated version of our SMaRT Replacement Therapy.

Market Opportunity

Dental diseases are the most prevalent chronic infectious diseases in the world, affecting up to 90% of schoolchildren and the vast majority of adults. Annual expenditures on the treatment of dental caries in the U.S. are estimated to be $40 billion a year according to the Dental, Oral and Craniofacial Data Resource Center. Tooth decay is characterized by the demineralization of enamel and dentin, eventually resulting in the destruction of the teeth. Dietary sugar is often misperceived as the cause of tooth decay; however, the immediate cause of tooth decay is lactic acid produced by microorganisms that metabolize sugar on the surface of the teeth. Studies suggest that of the approximately 700 oral microorganisms, S. mutans , a bacterium found in virtually all humans, is the principal causative agent in the development of tooth decay. Residing within dental plaque on the surface of teeth, S. mutans derives energy from carbohydrate metabolism as it converts dietary sugar to lactic acid which, in turn, promotes demineralization in enamel and dentin, eventually resulting in a cavity. The rate at which mineral is lost depends on several factors, most importantly the frequency and amount of sugar that is consumed.

Fluoride is used to reduce the effect of lactic acid-based demineralization of enamel and dentin. Despite the widespread use of fluoride in public water systems, toothpastes, dental treatments and sealants, and antiseptic mouth rinses, over 50% of 5-to-9-year-olds and almost 80% of 17-year-olds in the United States have at least one cavity or filling, according to the U.S. Surgeon General. In addition to non-compliance with the behavioral guidelines of the American Dental Association such as routine brushing and flossing, there are several factors that are likely to increase the incidence and frequency of tooth decay, including increasing consumption of both dietary sugar and bottled water. Bottled water generally does not contain fluoride, and thus does not impart any of the protective effects of fluoridated water from public systems. In 2008, U.S. consumers drank more bottled water than any other alcoholic or non-alcoholic beverage, with the exception of carbonated soft drinks, according to the Beverage Marketing Corporation.

 

 replacement therapy technology is based on the creation of a genetically altered strain of S. mutans, called SMaRT, which does not produce lactic acid. Our SMaRT strain is engineered to have a selective colonization advantage over native S. mutans strains in that SMaRT produces minute amounts of a lantibiotic that kills off the native strains but leaves the SMaRT strain unharmed. Thus SMaRT Replacement Therapy can permanently replace native lactic acid-producing strains of S. mutans in the oral cavity, thereby potentially providing lifelong protection against the primary cause of tooth decay. The SMaRT strain has been extensively and successfully tested for safety and efficacy in laboratory and animal models.

SMaRT Replacement Therapy is designed to be applied topically to the teeth by a dentist, pediatrician or primary care physician during a routine office visit. A suspension of the SMaRT strain is administered using a cotton-tipped swab during a single five-minute, pain-free treatment. Following treatment, the SMaRT strain should displace the native, decay-causing S. mutans strains over a six to twelve month period and permanently occupy the niche on the tooth surfaces normally occupied by native S. mutans.

Tooth decay is a largely preventable disease through implementation of an appropriate oral care hygiene program including brushing, flossing, irrigation, sealants and antiseptic mouth rinses. Nevertheless, tooth decay remains the most common chronic infectious disease in the world, which indicates that the lack of patient compliance with an overall oral care regimen remains a critical issue in tooth decay prevention. We believe that SMaRT Replacement Therapy addresses the issue of patient compliance by requiring only a one-time, five-minute treatment for the potential lifelong prevention of tooth decay.

The SMaRT strain has been extensively and successfully tested in the laboratory as well as in animal models , and has demonstrated the following:

 No lactic acid creation under any cultivation conditions tested;

 Dramatically reduced ability to cause tooth decay;

 Genetic stability as demonstrated in mixed culture and biofilm studies and in rodent model studies;

 Production of a level of MU1140 that is comparable to its wild-type parent strain, which was previously shown to readily and persistently colonize the human oral cavity;

 Aggressive displacement of native, decay-causing strains of S. mutans and preemptive colonization of its niche on the teeth of laboratory rats.

In addition, during preclinical and early-stage clinical testing of our SMaRT Replacement Therapy, we observed the following:

 No adverse side effects in either acute or chronic testing in rodent models;

 Colonization of the treated subjects following a five-minute application of SMaRT Replacement Therapy in our first Phase 1 study using the attenuated strain;

 No adverse side effects during our first Phase 1 study.

 

 

Manufacturing

The manufacturing methods for producing the SMaRT strain of S. mutans are standard Good Manufacturing Practice, or GMP, fermentation techniques. These techniques involve culturing bacteria in large vessels and harvesting them at saturation by centrifugation or filtration. The cells are then freeze dried or suspended in a pharmaceutical medium appropriate for application in the human oral cavity. These manufacturing methods are commonplace and readily available within the pharmaceutical industry. A single dose of our SMaRT Replacement Therapy contains approximately 10 billion S. mutans cells. The SMaRT strain grows readily in a variety of cultivation media and under a variety of common growth conditions including both aerobic and anaerobic incubations. The SMaRT strain can also utilize various carbon and nitrogen sources and is highly acid tolerant. There is no significant limitation to the manufacturing scale of our SMaRT strain other than the size of the containment vessel. For our first Phase 1 clinical trial, we engaged a contract manufacturer to produce an attenuated version our SMaRT strain, using a standard operating procedure provided by us that we believe is readily transferable to outside contract manufacturers with fermentation capabilities

 

up
0 users have Like. User Likes

An easy way for you to share and discuss dentistry and more...

For any help on posting on the site, email at [email protected]

An easy way for you to share and discuss dentistry and more...

For any help on posting on the site, email at [email protected]

Drsumitra's picture
Offline
Joined: 6 Oct 2011
Fight Back! Proactively Addressing the Caries Process

A double-blind, randomized, cross-over in situ study compared enamel remineralization by chewing sugar-free gum with or without casein phosphopeptide amorphous calcium (CPP-ACP). Remineralization has been shown to be an effective mechanism of preventing the progression of enamel caries. In the study, the enamel lesions were exposed to dietary intake, and some were covered with gauze to promote plaque formation. Participants wore removable palatal appliances containing 3 recessed enamel half-slabs with subsurface lesions covered with gauze and 3 without gauze. Mineral content and plaque composition were analyzed. The study found that for both the gauze-free and -covered lesions, the greatest amount of remineralization was produced by the CPP-ACP sugar-free gum; followed by the gum without CPP-ACP; and then the no-gum control. Recessing the enamel in the appliance allowed plaque accumulation without the need for gauze. There was a trend of less remineralization and greater variation in mineral content for the gauze-covered lesions. The cell numbers of total bacteria and streptococci were slightly higher in the plaque from the gauze-covered enamel for 2 of the 3 treatment legs; however, there was no significant difference in Streptococcus mutans cell numbers. In conclusion, chewing sugar-free gum containing CPP-ACP promoted greater levels of remineralization than a sugar-free gum without CPP-ACP or a no-gum control using an in situ remineralization model including dietary intake irrespective of whether or not gauze was used to promote plaque formation.

 

up
0 users have Like. User Likes
drmithila's picture
Offline
Joined: 14 May 2011
Fight Back! Proactively Addressing the Caries Process

An indicator to assess caries risk of infants is very important. One conventional risk indicator is the number and/or proportions of Streptococcus mutans, but this method reflects the existing situation and is not suitable for assessing caries risk of infants that have not yet been infected with S mutans. Researchers searched for an indicator for the establishment of S mutans. To evaluate the changes caused by the establishment of S mutans in the microbiota of the infant oral cavity, the authors monitored changes in the oral microbiota of 2 predentate infants over a 3-year period and in a cross-sectional study of 40 nursery school-aged children. Saliva was cultivated on nonselective blood agar, Mitis-Salivarius agar, and Mitis-Salivarius agar supplemented with bacitracin combined with identification of selected isolates. Two longitudinal observations suggested that S mutans establishment would induce a decrease in α-haemolytic bacteria in the microbial population of the oral cavity. This suggestion was compensated with the results of the study, and it was revealed that the establishment of 103 CFU/mL of S mutans in saliva might be predicted by a microbiota comprising less than approximately 55% of α-haemolytic bacteria. The authors conclude that a decrease in the proportion of α-haemolytic bacteria in the saliva of infants is applicable as an indicator to predict the establishment of S mutans and to assess dental caries risk. This information can serve as a background for planning dental care and treatment in the infants before infection with S mutans occurs.

 

up
0 users have Like. User Likes

An easy way for you to share and discuss dentistry and more...

For any help on posting on the site, email at [email protected]

An easy way for you to share and discuss dentistry and more...

For any help on posting on the site, email at [email protected]

Drsumitra's picture
Offline
Joined: 6 Oct 2011
Fight Back! Proactively Addressing the Caries Process

Digested coconut oil is able to attack the bacteria that cause tooth decay. It is a natural antibiotic that could be incorporated into commercial dental care products, say scientists presenting their work at the Society for General Microbiology's Autumn Conference at the University of Warwick.

The team from the Athlone Institute of Technology in Ireland tested the antibacterial action of coconut oil in its natural state and coconut oil that had been treated with enzymes, in a process similar to digestion. The oils were tested against strains of Streptococcus bacteria which are common inhabitants of the mouth. They found that enzyme-modified coconut oil strongly inhibited the growth of most strains of Streptococcus bacteria including Streptococcus mutans -- an acid-producing bacterium that is a major cause of tooth decay.
Many previous studies have shown that partially digested foodstuffs are active against micro-organisms. Earlier work on enzyme-modified milk showed that it was able to reduce the binding of S. mutans to tooth enamel, which prompted the group to investigate the effect of other enzyme-modified foods on bacteria.
Further work will examine how coconut oil interacts with Streptococcus bacteria at the molecular level and which other strains of harmful bacteria and yeasts it is active against. Additional testing by the group at the Athlone Institute of Technology found that enzyme-modified coconut oil was also harmful to the yeast Candida albicans that can cause thrush.
The researchers suggest that enzyme-modified coconut oil has potential as a marketable antimicrobial which could be of particular interest to the oral healthcare industry. Dr Damien Brady who is leading the research said, "Dental caries is a commonly overlooked health problem affecting 60-90% of children and the majority of adults in industrialized countries. Incorporating enzyme-modified coconut oil into dental hygiene products would be an attractive alternative to chemical additives, particularly as it works at relatively low concentrations. Also, with increasing antibiotic resistance, it is important that we turn our attention to new ways to combat microbial infection."
The work also contributes to our understanding of antibacterial activity in the human gut. "Our data suggests that products of human digestion show antimicrobial activity. This could have implications for how bacteria colonize the cells lining the digestive tract and for overall gut health," explained Dr Brady. "Our research has shown that digested milk protein not only reduced the adherence of harmful bacteria to human intestinal cells but also prevented some of them from gaining entrance into the cell. We are currently researching coconut oil and other enzyme-modified foodstuffs to identify how they interfere with the way bacteria cause illness and disease," he said.

 

up
0 users have Like. User Likes
drsushant's picture
Offline
Joined: 14 May 2011
Fight Back! Proactively Addressing the Caries Process

A health committee in the United Kingdom may want to re-explore a recent decision.

The Advertising Standards Authority claimed the McDonald’s drink Fruitizz can be part of the five-a-day portions of fruit and vegetables. The five-a-day portions of fruits and vegetables is a program that encourages healthy and drinking for children.

This ruling comes in spite of the fact that the drink contains six teaspoons of sugar.

The drink comprises fruit juice concentrate, fizzy water, natural flavorings and potassium sorbate.

A serving size of 250 mL has roughly 100 calories and 25 g of sugar. These levels of sugar stem from the amount of fruit juice content. Still, these levels did not nullify its ability to be considered healthy, according to the authority that makes these rulings.

This issue was examined after a British commercial mentioned the drink’s health benefits.

The ruling calls into question the standards used to determine a food or beverage’s health value.

Based on various studies, sugary drinks have been determined to cause tooth decay and erosion. There are also various other problems that can result from sugary drinks.

Still, based on the health standards for the five-a-day guidance in the United Kingdom, this drink manages to meet the requirements.

 

up
0 users have Like. User Likes

 Post your case presentations on www.dentistrytoday.info

 Post your case presentations on www.dentistrytoday.info

Drsumitra's picture
Offline
Joined: 6 Oct 2011
Fight Back! Proactively Addressing the Caries Process

There may be a new way to determine the abrasiveness of toothpaste.

A group of researchers from the Fraunhofer Institute for Mechanics of Materials IWM in Halle, Germany recently conducted a study on the subject.

The cleaning particles in toothpaste were examined. These are the particles utilized to mechanically remove dental plaque. If the toothpaste is too abrasive, the tooth enamel can be damaged over time. The damage can be even more pronounced in the dentin.

The abrasive impact of a certain toothpaste on the dentin depends on the hardness level and the quantity and size of the abrasive additives. The abrasiveness was measured on a scale from 30 to 200. The values were assigned after the testers brushed over radioactively marked dentin samples.

The method used in this study differed from the traditional radiotracer system that’s used to determine the abrasiveness of toothpaste.

Human teeth were also part of this study. To achieve the results, toothpaste was diluted with water and saliva to create a solution that corresponded to the mixture of toothpaste and saliva. The friction and wear tests were conducted with a single bristle. An advanced machine was then used to carry out the tests.

The findings from the survey went into intricate details. The results were able to explain the various geometries of toothbrush filaments and how they reacted with toothpaste based on numerous factors.

 

up
0 users have Like. User Likes
Drsumitra's picture
Offline
Joined: 6 Oct 2011
Fight Back! Proactively Addressing the Caries Process

The human mouth is a community bustling with microorganisms that live there. Little knowledge exists about what factors control which types that live there and which don't. In a new study published in Genome Research, investigators have discovered environment has a more controlling stance on determining oral microbiota, an extremely important finding in the field of oral health.

The oral microbiome starts forming as soon as a person is born. We see a plethora of bacteria brought into our mouth during childhood and as an adult, although little knowledge is known about whether nature (genes), or nurture (environment) has a more powerful influence.

Due to differences in the oral microbiome in health and diseases such as bacteremia and endicarditis, there is a need for a better understanding of the factors that effect oral microbiota communities, in order for more efficient prevention and treatment plans.

During this study, the researchers sequenced the microbial DNA found in saliva samples of a group of twins, and then paired the DNA sequences in a database to see which types of bacteria existed in each individual.

Comparing the salivary microbiomes of identical twins with the same genetic make-up and a common environment, the scientists found that their salivary microbiomes were not notably more similar than those of fraternal twins who only share half the genes. Surprisingly, this finding points to the idea that genetic relatedness is not such an important role.

"We were also intrigued to see that the microbiota of twin pairs becomes less similar once they moved apart from each other," added Simone Stahringer, first author of the study.

It was also seen from samples over time that the salivary microbiome changed the most during adolescence, suggesting behavioral changes or puberty may have a significant influence.

The researchers also uncovered another surprising find, that there is a fundamental community of bacteria that exists in all humans.

Ken Krauter, senior author of the study, explains:

"Though there are definitely differences among different people, there is a relatively high degree of sharing similar microbial species in all human mouths."

The authors believe that this study has provided a framework for future studies of the factors that control oral microbial communities. With this knowledge, people can now better understand how oral hygiene, environmental subjection to substances, methamphetamines, and even food can impact these microbes.

 

up
0 users have Like. User Likes
Drsumitra's picture
Offline
Joined: 6 Oct 2011
Fight Back! Proactively Addressing the Caries Process

The Oral Systemic Connection
The premise that oral health may influence systemic health is not new but it has undergone a number of modifications throughout the years. In 400 BC, Hippocrates reported that a patient was cured of arthritis after the extraction of an ill tooth. More recently, the theory that poor dental health can cause several systemic diseases has been called the Theory of Focal Infection. Focal infection can be traced back to the late 19th century when Dr. Willoughby Miller, an oral microbiologist, claimed that cavities played a role in the etiology of gastric problems, lung and brain abscesses, and other medical conditions.

In 1900, Dr. William Hunter, a prominent British physician, drew wide attention to these theories by presenting them in a lecture to the medical students of McGill University in Canada.

Dr. Frank Billings formally introduced the focal infection theory to American physicians. His lectures at Stanford University Medical School were published in 1916 in the book, Focal Infections. Dr. Billings went a step further than Dr. Hunter and promoted tonsillectomies and dental extractions as remedies for focal infections. Even prominent doctors like Dr. Charles Mayo (founder of the prestigious Mayo Clinic) promoted focal infection.

In 1923, Dr. Weston Price, chairman of the Research Section of the ADA, published Dental Infections, Oral and Systemic. Despite Dr. Price himself saying that more research was needed and care should be used in applying focal infection theory, Dental Infections, Oral and Systemic was used as a reference in textbooks and diagnosis guides of the early to mid 1930s.

The focal theory began to lose steam as scientists and physicians began to embrace modern “evidence-based” theories of disease. Perhaps a turning point in the popularity of focal infection was offered in an article published in the Annals of Internal Medicine in 1938. A former proponent of the theory, Dr. Russell Cecil stated that “focal infection is a splendid example of a plausible medical theory which is in danger of being converted by its enthusiastic supporters into the status of an accepted fact.” His study of 200 cases of rheumatoid arthritis documented no curative benefit of tonsillectomies or dental extractions. The final demise of the focal theory can probably be traced to a 1940 paper published in the Journal of the American Medical Association entitled, “Focal Infection and Systemic Disease: A Critical Appraisal,” by Drs. Hobart Reimann and Paul Havens. The authors showed that the theory was completely unproven.

A special 1951 issue of the Journal of the American Dental Association stated: “Many authorities, who formally felt that focal infection was an important etiologic factor in systemic disease, have become skeptical and now recommend less radical procedures in the treatment of such disorder.”

Toward the end of the 20th century, researchers began to view gingivitis and periodontal disease as an infection and chronic inflammatory condition. Like other chronic inflammatory diseases, the results can become widespread. The bacteria and their toxins can enter the bloodstream and reach distant sites, causing havoc and disease in organs throughout the body.

Beginning in the 1980s, a series of journal articles describing the association between periodontal disease and coronary heart disease (CHD), stroke and preterm birth/low-birthweight caught the attention of the medical and dental professions. While in some sense this can be construed as a return to the theory of focal infection, the response from the dental and medical professions has been more conservative. Modern investigative science uses greater sophistication in assaying data. There is a better understanding of the limits of epidemiologic studies in establishing causality and greater appreciation of the etiology of periodontal diseases and associated systemic diseases. In short, we have come to understand that the major killer diseases—cardiovascular disease (CVD) and cancer—have multiple causes and multiple risk factors.

There is no single cause for heart attacks. It is not smoking, not high blood pressure, not obesity, not high cholesterol, not stress, not lack of exercise, not genetics; and no, it is not periodontal disease. Rather it is a combination of these, and other risk factors that add layer upon layer of increased risk of suffering a heart attack. Modern science has come to understand that many chronic diseases such as CVD and cancer are multifactorial in nature, and anything that we can do to eliminate risk factors can go a long way to lengthening our lives.

In the past 2 decades there have been hundreds of studies published in the peer-reviewed medical journals that show periodontal disease is a risk factor for heart attacks. Several thousand more have been published in dental journals. Upon further investigation, it appears clear that brushing your teeth and avoiding periodontal disease really can save your life.

The modern connection between periodontal disease and CVD lies in the chronic, inflammatory nature of gum disease. Periodontal disease, simply put, is a bacterial infection of the gums and structures supporting the teeth. As with most infections throughout the entire body, gum infection leads to inflammation.

 

up
0 users have Like. User Likes
drmithila's picture
Offline
Joined: 14 May 2011
Fight Back! Proactively Addressing the Caries Process

Written by Sam Halabo, DMD
What causes white spots and why do they form? White spots are signs of demineralization underneath intact enamel. Bacteria produce acids which break down apatite to calcium and phosphate ions.1 When these ions are not replaced in the natural remineralization process, porosities are created within the enamel. This usually results in the underlying porosity becoming fluid-filled, developing the classic whitish discoloration associated with demineralization. This discoloration is the result of the difference in refraction of light through healthy enamel and fluid filled porosity.2 White spots can appear in primary or secondary teeth with differing intensities. Most commonly, white spot lesions are seen after orthodontic bands and brackets are removed. Some of the other causes of white spot lesions include fluorosis, hypocalcification, erosion, hypoplasia, xerostomia, tetracycline staining, and trauma. They can also be the result of arrested incipient decay that stopped progressing and remineralized.

Treatments
In the past, the primary approach to the treatment of white spots is remineralization using pastes, creams, and topical treatments. Some of these include fluoride therapy or some form of calcium phosphate paste. Teeth whitening may also be used as an option to alleviate the appearance of these white lesions but usually requires variable amounts of time. These modalities all have unpredictable degrees of success based upon published literature. Other more invasive approaches to dealing with white spot lesions include microabrasion, composite restorations, and veneers or crowns.

Diagnosis
In order to provide a good treatment plan, a proper diagnosis must be made. We have come to depend on visual examination as a primary diagnostic tool, along with probing of suspected surfaces in order to determine the location of areas of concern. Color, hardness, translucency, and opacity all play a role in diagnosing the presence of lesions.

The best way to do a visual analysis is to dry the teeth and then examine them under good lighting with high magnification. While hypocalcifications are visible wet or dry, incipient caries lesions are often visible only when enamel is dry. (Typically carious lesions are visible when dry but disappear when rewetted.) Also, the surface of an inactive white spot lesion is usually smooth and shiny, while a rough, chalky, and dull lesion can indicate an active caries lesion.
As we continue our search for minimally invasive techniques, a product called Infiltration Concept (ICON) was introduced in the United States in 2009 by DMG America. Designed to arrest the progression of incipient carious lesions, Icon gives us a great solution for treating white spot lesions with a simple technique as well. This is a great treatment for stopping early caries and removing opaque lesions, all without any drilling or need for local anesthesia. There is no shade matching necessary as this material blends with the tooth shade and eliminates the white lesions. This procedure has worked well repeatedly in our office. The procedure is simple and can even be done by auxiliary members (check your state dental practice laws).

This product fills and reinforces the pores of these lesions with a light-cured resin material. A very low-viscosity infiltrating resin (Icon-Infiltrant [DMG America]) is pulled deep into the pores of a lesion by way of capillary action. This resin fills the tooth and replaces the lost structure within the pores. The progression of caries is stopped as no further nutrients are allowed into the pores. Icon accomplishes this without changing the shade of the tooth or altering its shape. This procedure is ideally suited for patients with a history of orthodontic therapy, high acid exposure, and/or poor oral hygiene.

Icon is not indicated for patients with fluorosis, hypocalcification, erosion, tetracycline stain or trauma to the teeth. It is indicated for those lesions, both proximal and smooth surface, that are clearly the result of cariogenic bacteria. Simply put, it is indicated for lesions that are the result of acid demineralization of tooth structure.

up
0 users have Like. User Likes

An easy way for you to share and discuss dentistry and more...

For any help on posting on the site, email at [email protected]

An easy way for you to share and discuss dentistry and more...

For any help on posting on the site, email at [email protected]

Drsumitra's picture
Offline
Joined: 6 Oct 2011
Fight Back! Proactively Addressing the Caries Process

Operation Smile is celebrating its 30th anniversary with a yearlong series of events in the U.S. and abroad.

To increase awareness about the urgency of the problem cleft lip and cleft palette, Operation Smile is launching a global campaign entitled Change Forever. Operation Smile's programs are designed to create a permanent global impact and create self-sufficiency in developing countries, according to the organization.

In October and November, more than 350 medical professionals from all over the world are volunteering for a series of anniversary surgical missions in the Philippines, where Operation Smile first started. From November 8-18 and November 22 to December 2, 2012, Operation Smile will provide approximately 16,000 healthcare evaluations and 1,400 life-changing reconstructive surgeries in 24 days through eight surgical sites.

The Change Forever global campaign will also include other events, such as the following:

A large-scale awareness campaign about craniofacial malformations to increase information for families in the U.S. who are affected by orofacial clefts, healthcare providers, and school professionals
An online and social media campaign featuring world-renowned athlete Tony Hawk, which encourages individuals to take a pledge, share their smile, and help create greater awareness of clefting and the impact a smile can make in changing a child's life
Youth initiatives, including the 22nd annual International Student Leadership Conference in Virginia, where more than 600 students from over 20 countries will develop their philanthropic leadership skills

 

up
0 users have Like. User Likes
Drsumitra's picture
Offline
Joined: 6 Oct 2011
Fight Back! Proactively Addressing the Caries Process

In 2010, the Institute of Medicine (IOM) released a report that called for an increase in the recommended daily intake of vitamin D, but also said that the current body of research did not offer the evidence needed to confirm that vitamin D has the larger positive health effects its proponents claim it does.

Research has shown a positive link between vitamin D and oral and systemic health, the IOM noted; however, these studies have yielded "conflicting and mixed results and do not offer the evidence needed to confirm that vitamin D has these effects."

Now a new systematic review, conducted by Philippe Hujoel, PhD, DDS, MSD, MS, of the University of Washington School of Dentistry and School of Public Health, points to a positive association between vitamin D and lower rates of dental caries (Nutrition Reviews, November 9, 2012).

Vitamin D was first discovered in the early 1920s, and at least 20 prospective clinical studies evaluating its impact on dental caries were initiated in Europe, North America, and Asia over the next two decades, according to Dr. Hujoel. However, professional and governmental groups varied widely in their interpretation of the scientific evidence.

For example, the American Medical Association and the U.S. National Research Council concluded around 1950 that vitamin D was beneficial in managing dental caries, but the ADA said otherwise -- based on the same evidence. In 1989, the National Research Council, despite new evidence supporting vitamin D's caries-fighting benefits, called the issue "unresolved."

More recent reviews by the Institute of Medicine, the U.S. Department of Human Health and Services, and the ADA draw no conclusions on the vitamin D evidence as it relates to dental caries, Dr. Hujoel noted in a press release.

"Such inconsistent conclusions by different organizations do not make much sense from an evidence-based perspective," he said.

24 studies, 6 decades

For the Nutrition Reviews study, Dr. Hujoel analyzed 24 controlled clinical trials (CCTs) that met the inclusion criteria. The CCT quality was quantified using a 21-item questionnaire and content-specific measures such as method of treatment assignment, setting, clinician blinding, use of placebo, commercial funding source, and study duration.

The 24 CCTs included in the study spanned the 1920s to the 1980s and were conducted in the U.S., U.K., Canada, Austria, New Zealand, and Sweden in institutional settings, schools, medical and dental practices, or hospitals. All told, the CCTs encompassed nearly 3,000 participants between the ages of 2 and 16 years.

The trials increased vitamin D levels in these children through the use of supplemental ultraviolet (UV) radiation or by supplementing the children's diet with cod liver oil or other products containing the vitamin.

"My main goal was to summarize the clinical trial database so that we could take a fresh look at this vitamin D question," Dr. Hujoel said.

These trials showed that vitamin D was associated with a 47% reduction in the incidence of tooth decay, he noted. No robust differences could be identified between the caries-preventive effects of UV therapy and nutritional supplementation with either vitamin D2 or vitamin D3.

"The analysis of CCT data identified vitamin D as a promising caries-preventive agent, leading to a low-certainty conclusion that vitamin D in childhood may reduce the incidence of caries," Dr. Hujoel concluded.

The vitamin D question takes on greater importance in the light of current public health trends, he noted. Vitamin D levels in many populations are decreasing while dental caries levels in young children are increasing.

"Whether this is more than just a coincidence is open to debate," Dr. Hujoel said. "In the meantime, pregnant women or young mothers can do little harm by realizing that vitamin D is essential to their offspring's health. Vitamin D does lead to teeth and bones that are better mineralized."

Dr. Hujoel added a note of caution: "One has to be careful with the interpretation of this systematic review," he stated. "The trials had weaknesses which could have biased the result, and most of the trial participants lived in an era that differs profoundly from today's environment

 

up
0 users have Like. User Likes
Drsumitra's picture
Offline
Joined: 6 Oct 2011
Fight Back! Proactively Addressing the Caries Process

Coconut oil attacks the bacteria behind tooth decay and could be used in dental care products, according to research.

Scientists found that coconut oil which had been treated with enzymes stopped the growth of Streptococcus bacteria - a major cause of tooth decay.

Tooth decay affects 60% to 90% of children in industralised countries.

Speaking at the Society for General Microbiology's conference, the Irish researchers say that coconut oil also attacks the yeast which causes thrush.

The research team from the Athlone Institute of Technology in Ireland tested the impact of coconut oil, vegetable oil and olive oil in their natural states and when treated with enzymes, in a process similar to digestion.

The oils were then tested against Streptococcus bacteria which are common inhabitants of the mouth.

Only the enzyme-modified coconut oil showed an ability to inhibit the growth of most strains of the bacteria.

Continue reading the main story

Start Quote

It is important that we turn our attention to new ways to combat microbial infection”

Dr Damien Brady
Athlone Institute of Technology
It also attacked Streptococcus mutans, an acid-producing bacterium which is a major cause of tooth decay.

Active acids
It is thought that the breaking down of the fatty coconut oil by the enzymes turns it into acids which are active and effective against bacteria.

Previous research found that enzyme-modified milk could stop Streptococcus mutans from binding to tooth enamel.

Researchers now want to look at how coconut oil interacts with Streptococcus bacteria at the molecular level and which other strains of harmful bacteria it can inhibit.

Dr Damien Brady who led the research at the Athlone Institute of Technology with Patricia Hughes, a Masters student, said coconut oil could be an attractive alternative to chemical additives.

"It works at relatively low concentrations.

"Also, with increasing antibiotic resistance, it is important that we turn our attention to new ways to combat microbial infection."

Their studies are also looking into the workings of antibacterial activity in the human gut.

"Our data suggests that products of human digestion show antimicrobial activity. This could have implications for how bacteria colonise the cells lining the digestive tract and for overall gut health," said Dr Brady

 

up
0 users have Like. User Likes
drmithila's picture
Offline
Joined: 14 May 2011
NEW FILLING MATERIAL

— Scientists in Canada and China are reporting development of a new dental filling material that substitutes natural ingredients from the human body for controversial ingredients in existing "composite," or plastic, fillings. The new material appears stronger and longer lasting as well, with the potential for reducing painful filling cracks and emergency visits to the dentist, the scientists say.

Julian X.X. Zhu and colleagues point out that dentists increasingly are using white fillings made from plastic, rather than "silver" dental fillings. Those traditional fillings contain mercury, which has raised health concerns among some consumers and environmental issues in its production. However, many plastic fillings contain controversial ingredients (such as BisGMA) linked to premature cracking of fillings and slowly release bisphenol A, a substance considered as potentially toxic to humans and to the environment.
The scientists developed a dental composite that does not contain these ingredients. Instead, it uses "bile acids," natural substances produced by the liver and stored in the gallbladder that help digest fats. The researchers showed in laboratory studies that the bile acid-derived resins form a hard, durable plastic that resists cracking better than existing composites

up
0 users have Like. User Likes

An easy way for you to share and discuss dentistry and more...

For any help on posting on the site, email at [email protected]

An easy way for you to share and discuss dentistry and more...

For any help on posting on the site, email at [email protected]

Drsumitra's picture
Offline
Joined: 6 Oct 2011
Fight Back! Proactively Addressing the Caries Process

The free app, developed by Beam Technologies for Android or Apple iOS, tracks brushing habits, including frequency and duration, as well as time spent in each quadrant of the mouth. Users sync data to the smartphone app by pushing a button on the brush handle. The app supports multiple users so families can compare statistics and then upload data to their dentists.

Beam Technologies is providing the connectivity free to dental practices that want to participate and will be selling targeted advertising on the app for dentists to promote their services, according to the company.

In addition, the company is offering a rewards program for people who meet certain targets, including the basic goal of brushing at least twice a day for two minutes each time. The app can play user-selected music for those two minutes.

The Beam Brush and related app received U.S. Food and Drug Administration clearance last June.

Beam Technologies is selling the toothbrush for $49.99. It is available in blue or pink, with adult- or child-size brush heads. Replacement brush heads cost $3.99. The brush draws power from one AA battery.

 

up
0 users have Like. User Likes
Drsumitra's picture
Offline
Joined: 6 Oct 2011
Fight Back! Proactively Addressing the Caries Process

What's App Brush: Bluetooth Beam Toothbrush for Oral Gaming

The daily grind of brushing your teeth just got game, as the app connected Beam Brush allows you to challenge your family and friends to a daily brush off. Utilizing a Bluetooth sensor, the brush sends data about your brushing habits to the app (available on Android and iPhone) and uploads info on brushing length and frequency.

This information is then mapped in a handy chart so you can compare your progress to your family and see where you need to improve. If your phone is with you when you start to brush you can opt for a musical 2 minute timer to encourage you to keep going- and this service is free.

Once you’ve purchased the initial brush, there are no further costs, apart from replacement heads, which are $3.99. Powered by an AA battery, the brush will last around 90, and there are plans for development of an electric model at some point in the future.

Users also have the option to send their data to their dentist ahead of cleanings so oral care habits can be considered in treatment planning. The app displays a timer with the ability to play music for 2 minutes through the app while brushing. It will even tell you when it’s time to replace the brush head and send it to you automatically! By using the Beam Goals feature, users will achieve brushing milestones that result in real-world rewards.

Where this gets really exciting is the potential for real time rewards for brushing well, as the company is in talk with dental insurance plans to enable users to get discounts for brushing efficiency. The app can be authorized to send dentists reports on your brushing which can then be used for insurers to potentially give you lower premiums. Nothing is confirmed so far, but they say they are talking to two major providers, and this will really incentivize people to brush well.

It comes in two colors- pink and blue, and 2 sizes, adults and kids.

 

up
0 users have Like. User Likes
drmithila's picture
Offline
Joined: 14 May 2011
Fight Back! Proactively Addressing the Caries Process

Australian Research Centre for Population Oral Health senior research fellow Dr Jason Armfield is the lead author of a new study of more than 16,800 Australian children that shows 56 per cent of those aged between five and 16 consumed at least one sweet drink, such as soft drink or juice, each day.

The findings, published on the American Journal of Public Health website, show the number of decayed, missing or baby teeth with fillings was 46 per cent higher in children who had three or more sweet drinks a day than those who consumed none.

Dr Armfield said the results highlighted the role soft drinks played in tooth decay.

"There's a lot of problems that excess consumption may cause and these should be included as part of any potential warning package on sweet drinks," he said.

"But the potential tooth decay caused by the drink's high acidity and sugar content should be a focus."

He also said children needed greater access to fluoridated water.

Dr Armfield's call comes as 3000 South Australian children have their teeth examined in a national dental survey.

up
0 users have Like. User Likes

An easy way for you to share and discuss dentistry and more...

For any help on posting on the site, email at [email protected]

An easy way for you to share and discuss dentistry and more...

For any help on posting on the site, email at [email protected]

Drsumitra's picture
Offline
Joined: 6 Oct 2011
Fight Back! Proactively Addressing the Caries Process

GSKCH rolls out global niche toothpaste brand Parodontax
Consumer and healthcare firm GlaxoSmithKline on Friday announced the national roll out of its second global oral care brand Parodontax - a toothpaste that helps in reducing bleeding in gums. The firm already sells Sensodyne toothpaste for sensitive teeth, launched two years back.

The average incidence of bleeding gums globally is 33% and in India too, there's untapped opportunity for specialised oral care products, Jayant Singh, executive VP, marketing, GSKCH said.

 

up
0 users have Like. User Likes
drmithila's picture
Offline
Joined: 14 May 2011
Fight Back! Proactively Addressing the Caries Process

A new breakthrough By Tawnya Ann Bobst RDH, BS
Can natural dental products provide effective cleaning and de-sensitization with less abrasion? Why would we care to switch?

I have been using therapeutic grade essential oil infused oral hygiene products on myself and sharing this information with my patients with exceptional results. Anything that I put in my mouth or on my skin goes into the blood stream so I want the products that I use to be non-toxic and safe. Just as nitroglycerin works under the tongue, chemicals in mouth products are absorbed into the mucosa and travel throughout the body.

Bacteria from the teeth can affect the joints and the heart, that is why there are pre-medication guidelines for people with joint replacements and certain heart conditions. The link between cardiovascular disease and dental plaque has been well established. The oral pathogens linked to periodontal disease cause inflammation that can be linked to heart disease, according to periodontist Dr. Sally Cram, DDS, spokesperson for the ADA.(1)

What if we could offer our patients a way to get antibacterial and antimicrobial products that only attack the bad microbes and not the healthy tissue?

Dr. Jean Valnet, MD, said, “Essential oils are especially valuable as antiseptics because their aggression toward microbial germs is matched by their total harmlessness toward tissue.”(2)

Frankincense essential oil was used in a University of Oklahoma study on bladder cancer. It eliminated the bladder cancer cells and left the other cells unharmed!(3,4) Frankincense was more precious than gold in biblical times.(5)

The Thieves oil blend of oral hygiene products that I use contains essential oils of peppermint, wintergreen, eucalyptus, thyme, clove, lemon, cinnamon, and rosemary. At Andhra University, Department of Biochemistry, essential oils of cinnamon, clove, rosemary, eucalyptus and lemon were tested and found to have effective anti-bacterial properties.(6)

The Thieves blend of oils contain these five oils. At the Medical University at Lodz, Poland, they studied the microbial action of thyme oil. They found that it strongly inhibited the growth of the bacteria tested.(7)

In the Journal of the American Dental Association, the efficacy of an essential oil containing antiseptic mouth rinse has been demonstrated in numerous double blind studies.(8,9)

Many of my patients are concerned about tooth sensitivity and plaque build-up. They complain about canker sores, sloughing tissue, and sore gums from the toothpaste and mouthwash that they are using. What solutions do we have to offer them?

Fluoride, desensitizers in toothpaste, and varnishes only offer a band aid approach. Once the product is discontinued, the sensitivity returns. The toothpaste for sensitivity contains a chemical, potassium nitrate, and an abrasive agent, hydrated silica. Hydrated silica is a form of sand.

Does it make sense to use a chemical to desensitize and then brush it on with an abrasive?

The particle size of toothpaste should be very small so it does not cause excess wear of the dentin and enamel. Most commercial toothpastes use large size abrasive particles. Scanning electron microscope photos of enamel show the damaging effects of popular household toothpastes with large particle sizes as compared to using ultra-fine particle size toothpaste. After viewing these photos, it is clear that the bigger particles damage the fine tooth structure.(10)

Some toothpaste contains strong chemicals that cause the tissue to slough off. I have seen long strings of sloughed tissue on the buccal mucosa of people using certain toothpastes. Tartar control toothpastes are especially damaging to the mucosa. Zinc Citrate containing toothpastes have been shown to reduce calculus naturally by 26%.(11)

I attended a seminar given by Integrative Body Psychotherapy (IBP) with Naturopathic Doctor, Dr. Merrily Kuhn, ND, RN, PhD.(12) Dr. Kuhn said that an antibacterial chemical in popular toothpastes is proving to be an endocrine disruptor in the American bullfrog.(13)

The FDA reported that is has been shown to alter hormone regulation in animals.(14) This chemical is also used in antibacterial hand soaps and hand sanitizers. The chemical kills the good and bad bacteria. Thieves foaming hand soap and hand purifiers offer a great alternative to the chemical products.

When I was in dental hygiene school, the fluoride representative came to speak to us. After hearing his presentation, I was convinced that fluoride was the next best thing to heaven. It was reported to work for decay, sensitivity, plaque, and gingivitis. Prescriptions were given by the dentist as a take home treatment for patients with adult periodontal disease and root decay problems. I was convinced that everyone needed it to protect the teeth.

I later learned about a little boy that ingested too much fluoride in a dental office treatment and had to be rushed to the hospital. Because we now have natural tooth products available that don’t carry the warning label “call poison control if ingested” on the tube, does it make sense to use chemical brands?

Dr. Joe Mercola wrote in a recent article: You’re Still Told Fluoridation Prevents Tooth Decay, but Science Proves Other Wise. He interviewed Dr. Bill Osmunson, a dentist with a Masters Degree in Public Health, who has been studying the literature on fluoride. Dr. Osmunson said that fluoride did not reduce decay to any significant degree, and it has many health risks such as lowered IQ, impaired thyroid function, weakened bones, and lowered immune function. He says it is more toxic than lead.

Fluoride is found in toothpaste, water, nonstick pans, processed food and beverages, and many teas. Certain types of tea leaves are rinsed with fluoride.(15) Dr. Mercola’s interview with Dr. Osmunson can be viewed on his website.(16)

Dr. Joan Barice, MD, recommends not using fluoride toothpaste.(17) Dr. Barice recommended using a toothpaste called Thieves Dentarome Ultra, containing the blend of oils that was used during the plague in 15th century France that the grave robbers used to stay healthy during the plague. The toothpaste formula contains edible ingredients. It has no fluoride, sodium laurel sulfate (which has been linked to canker sores), sugar, synthetic chemicals, hydrated silica or colors.(18)

It contains calcium and xylitol, shown to inhibit bacteria linked to decay and periodontal disease, and zinc citrate for tartar control. The Thieves mouthwash contains similar essential oils with no alcohol. KidScents toothpaste has no fluoride and is formulated with essential oils and xylitol.(19)

Dr. Ulrich Bruhn, a German dentist, has had remarkable results using xylitol on patients with caries and periodontal disease. He said that teeth tightened up and periodontal problems were improved. Xylitol inhibits strep mutans in dental caries.(20)

As a personal testimonial, I have been using Thieves Dentarome Ultra since 2008, I have had no sensitivity, decay, or bleeding since using this toothpaste. One of my patients, a 65-year-old male with diabetes, with severe periodontal pockets, bleeding, inflammation and exudate, began using Dentarome Ultra. At his next visit, he exhibited pink gingiva, no bleeding, and no exudate. I was very impressed.

My friend in Virginia, a smoker, said her dental hygienist was so pleased with the change in her dental health that she wanted to know what she was doing differently. Her cleaning time was also reduced by half.

The Thieves lozenges have worked for my sore throats. They contain stevia, no sugar, and the blend of lemon rind, clove, cinnamon, eucalyptus, rosemary and peppermint essential oils. Thieves mouthwash is equally effective and can be used as a gargle for sore throats. A drop of Thieves oil on the bottom of the feet is great at the first sign of a cold.(21)

I have used a drop of Thieves essential oil on a Q-Tip and placed it on a canker sore. The sore dried up in a couple days as opposed to weeks. While treatment with debacterol (sulfuric acid/phenolics solution) is often recommended to patients by the dentist for the canker sores, I prefer the Thieves oil.(22) It burns for a minute but reduces the healing time.(23)

up
0 users have Like. User Likes

An easy way for you to share and discuss dentistry and more...

For any help on posting on the site, email at [email protected]

An easy way for you to share and discuss dentistry and more...

For any help on posting on the site, email at [email protected]

drsnehamaheshwari's picture
Offline
Joined: 16 Mar 2013
Fight Back! Proactively Addressing the Caries Process

The U.S. Preventive Services Task Force this week released a draft evidence report and draft recommendation statement on how primary care physicians can help prevent dental caries in young children (birth through age 5 years).

The draft recommendation includes two ways that primary care clinicians can help prevent dental caries in young children:

Provide fluoride supplements, usually in the form of drops, tablets, or lozenges, to children whose water supply is deficient in fluoride starting at 6 months.

Apply fluoride varnish to the primary teeth of infants and children once the teeth start coming in.

New evidence showing that children benefit from the application of fluoride varnish has emerged since the task force last examined this topic in 2004, and the evidence in support of oral fluoride supplements remains strong, the task force noted in a press release. However, there is still not enough evidence on whether screening for dental caries by primary care clinicians improves outcomes, so the task force is not able to recommend for or against such screening.

The U.S. Preventive Services Task Force this week released a draft evidence report and draft recommendation statement on how primary care physicians can help prevent dental caries in young children (birth through age 5 years).

These interventions are more vital than ever because, after decades of decline, the rate of tooth decay in children is rising, particularly among 2 to 5 year olds, noted Glenn Flores, MD, a task force member.

 

 

up
0 users have Like. User Likes

 For any help on posting on the site, email at [email protected]

 For any help on posting on the site, email at [email protected]

drsnehamaheshwari's picture
Offline
Joined: 16 Mar 2013
Fight Back! Proactively Addressing the Caries Process

Cargill, an international producer of food, agricultural, financial, and industrial products and services, is poised to step into the global oral health market with a noncaloric sweetener that the company says rivals -- perhaps even bests -- xylitol in preventing caries.

Erythritol, which Cargill has sold commercially under the brand name Zerose since 1994, "looks like sugar, behaves like sugar, tastes like sugar, but has no calories and is noncariogenic," according to Peter Decock, nutrition and regulatory manager for Cargill. It is a member of the polyol family, which typically are hydrogenated carbohydrates used as sugar replacers. Erythritol, however, is made naturally by fermentation.

Available as a sweetening agent in more than 60 countries, Zerose has also been found to be similar to xylitol in its oral health benefits, according to Decock. This prompted the company to sponsor a six-month study comparing three polyols -- erythritol, xylitol, and sorbitol -- to determine their effect on Streptococcus mutans in saliva and dental biofilm (Caries Research, May-June 2005, Vol. 39:3, pp. 207-215).

For this study, 136 teenagers from two public high schools were assigned either to one of the three polyol groups or an untreated control group. Those in the polyol groups were given chewable tablets containing 7 g of the polyol daily, supplemented by twice-a-day use of a dentifrice also containing the polyol.

The study authors, from the University of Tartu, found that the use of erythritol and xylitol was associated with a statistically significant reduction in the plaque and saliva levels of S. mutans (p < 0.001 in most cases), plus a reduction in the amount of dental plaque with the highest reduction for erythritol. These same effects were not observed in the other groups.

"Erythritol and xylitol may exert similar effects on some risk factors of dental caries, although the biochemical mechanism of the effects may differ," the researchers concluded.

3-year follow-up

Those findings gave Cargill the confidence to fund a more extensive study that is slated to be published later this year in Caries Research, Decock explained.

"We were eager to do a caries study, but it has to be done over multiple years and with many subjects," he said. "So we figured it would be more meaningful to first do a shorter test as a proof of concept and to justify an investment in a full-blown caries study."

For the second double-blind, randomized, placebo-controlled study, researchers from the University of Tartu followed 485 first- and second-grade students who were randomly assigned to three groups: erythritol, xylitol, and sorbitol. Over the course of three years, the children were given candies containing one of the sweeteners three times a day during school: in the morning, right after lunch, and at the end of the school day. They consumed about 7.5 g of a polyol per day for 200 days per year. They were also provided oral health education, dietary advice, toothbrushes, and fluoride toothpaste.

The researchers examined the study participants at baseline and then once each year to assess their oral health and the impact of the polyols on plaque and caries, Decock noted.

"The clinical investigators examined every child and all their teeth, the surfaces of their teeth, using the ICDAS [International Caries Detection and Assessment System]," he said. "They were examined for cavities, how much plaque, how much S. mutans in the saliva and plaque -- but mostly to see the impact on caries."

After the second and third years, the researchers found that the number of dentin caries was lowest in the erythritol group and that plaque formation in the erythritol group was lower after the first, second, and third year, according to Decock.

"In past clinical trials using xylitol chewing gum, it was generally accepted that sugar substitution in combination with saliva stimulation was responsible for lowering the risk of caries," he said. "We now understand that there may be important differences between how sugar substitutes affect the oral microbiota and dental health when used in candies -- and that erythritol may offer greater benefits."

New oral health claims

At the end of the study, the researchers also examined an end-point control group made up of children who had not participated in the study but were recruited from the same region and had many similarities, such as living conditions and diet, Decock noted.

"These children had not received any treatment or dietary/oral hygiene advice or dentifrices," he said. "We wanted to know how the three polyol groups compared to them, and we found that all three groups scored significantly better than the end-point group."

Cargill is now looking to work with its customers in the food and personal care products industries to develop new oral care products containing erythritol, Decock added, noting that some erythritol oral care products are already on the market outside the U.S. No additional regulatory clearances are needed; Zerose already is authorized for use in pharmaceutical and food products, and can carry the claim "does not promote tooth decay."

But with this most recent study, the company is looking to add a new claim, Decock noted: "promotes dental plaque reduction."

 

 

up
0 users have Like. User Likes

 For any help on posting on the site, email at [email protected]

 For any help on posting on the site, email at [email protected]

drsnehamaheshwari's picture
Offline
Joined: 16 Mar 2013
Fight Back! Proactively Addressing the Caries Process

                                                                           

Consuming cheese and other dairy products may help protect teeth against caries, according to a new study published in the May/June 2013 issue of General Dentistry (Vol. 61:3, pp. 56-59).

The study sampled 68 subjects ranging in age from 12 to 15, and the authors looked at the dental plaque pH in the subjects' mouths before and after they consumed cheese, milk, or sugar-free yogurt. A pH level lower than 5.5 puts a person at risk for tooth erosion, the researchers noted.

The subjects were assigned into groups randomly. The researchers instructed the first group to eat cheddar cheese, the second group to drink milk, and the third group to eat sugar-free yogurt. Each group consumed their product for three minutes and then swished with water. Researchers measured the pH level of each subject's mouth at 10, 20, and 30 minutes after consumption. 

The groups who consumed milk and sugar-free yogurt experienced no changes in the pH levels in their mouths. Subjects who ate cheese, however, showed a rapid increase in pH levels at each time interval, suggesting that cheese has anticaries properties.

The study indicated that the rising pH levels from eating cheese may have occurred due to increased saliva production, which could be caused by the action of chewing. Additionally, various compounds found in cheese may adhere to tooth enamel and help further protect teeth from acid, the researchers concluded.

 

up
0 users have Like. User Likes

 For any help on posting on the site, email at [email protected]

 For any help on posting on the site, email at [email protected]

drsnehamaheshwari's picture
Offline
Joined: 16 Mar 2013
Fight Back! Proactively Addressing the Caries Process

 Coating toothbrush bristles with chlorhexidine appears to reduce concentrations of some harmful oral bacteria more than coating them with silver nanoparticles.

A study presented at the International Association for Dental Research's 2013 annual meeting found that chlorhexidine-coated toothbrushes (Butler GUM) reduced concentrations of Streptococcus mutans by 99.8% 16 hours after the toothbrushes were immersed for three minutes in a microbe-containing suspension. The silver nanoparticle-coated toothbrushes (Mouth Watchers) reduced the bugs' concentration by 93% at 16 hours. Neither had a statistically significant effect on levels of Candida albicans.

"Mouth Watchers' patent-pending, innovative antibacterial bristles naturally eliminate 99.9% of bacteria to help your teeth, gums, and body stay healthier," the Mouth Watchers website claims.

As lead investigator Lt. Col. Jeremy Hamal, DDS, explains, the Mouth Watchers brushes are relatively new to the market, and the only available research on them is from Korea, where these brushes are manufactured. Moreover, their effectiveness in toothbrush disinfection has proved controversial in prior studies, he noted.

"So I decided to compare them to a control and also to the chlorhexidine brush, which has not been the subject of any independent study to date," said Dr. Hamal, who is an AEGD-2 senior resident at the Dunn Dental Clinic, Joint Base San Antonio - Lackland, TX. "The GUM brush manufacturers have made no overt claims of percent reduction in microbes."

 

Comparing bristles to bristles

The study was funded by the Wilford Hall Clinical Research Division. Dr. Hamal and his group used 80 each of the silver-nanoparticle and chlorhexidine toothbrushes, along with 80 toothbrushes that did not have coated bristles. They immersed half of each type of toothbrush for three minutes in a solution of Streptococcus mutans and the other half in a Candida albicans solution.

They immediately immersed one-quarter of each type of toothbrush in sterile saline and mixed them vigorously for 15 minutes to remove all of the organisms. At eight hours after initial immersion they repeated this (mixing to remove microorganisms) with another 20 of each type of toothbrush. They repeated this, each time with another set of 20 of each type of toothbrush, at eight and 16 hours post-initial immersion. They then diluted and placed on agar plates the resulting saline solutions. After incubating the plates, the investigators counted the resulting colony-forming units.

Reduction in colony-forming units at 3 time periods postimmersion

Microorganism/brush type          8 hours 16 hours               24 hours

S. mutans/control            88.6%    96.3%    95.4%

S. mutans/chlorhexidine              98.8%* 99.8%* 99.3%*

S. mutans/silver nanoparticles   90.6%    93.0%    96.3%

*p < 0.05 compared to control and silver-nanoparticle toothbrushes

The chlorhexidine-coated brushes brushed off more of the S. mutans at all three time periods compared to the other two types of toothbrushes. However, not even the chlorhexidine-coated toothbrushes ever reached the 99.9%-reduction level, which is "a benchmark for disinfection," according to Dr. Hamal.

With the C. albicans groups, the chlorhexidine-coated toothbrushes' level of disinfection peaked at 97.5% at 24 hours, while the nanoparticle-coated toothbrushes reached 99.5% disinfection at this time period. However, Dr. Hamal's team reported that none of the levels of disinfection were statistically significantly greater at any time period and between any of the types of brushes.

DrBicuspid.com queried Dr. Hamal about the potential for antibiotic resistance with the use of broad-based antimicrobial agents: "Antibiotic resistance is certainly a long-term problem in the management of infectious diseases; however, it is not my area of expertise, and I cannot comment on that," he responded.

up
0 users have Like. User Likes

 For any help on posting on the site, email at [email protected]

 For any help on posting on the site, email at [email protected]

drsnehamaheshwari's picture
Offline
Joined: 16 Mar 2013
Fight Back! Proactively Addressing the Caries Process

 Frequent consumption of sugary foods and drinks exposes teeth to acids and prevents the mouth's pH level from stabilizing. Now, U.S. researchers have found that certain combinations of foods and beverages affect dental plaque acidity. In particular, they observed that the consumption of milk reduced plaque pH drop after eating a sugary breakfast cereal.

In the study, 20 adults were given four combinations of foods. The first group ate 20 g of a dry sugary cereal only. The second, third and fourth groups consumed the same amount of this cereal followed by 50 mL of whole milk, 50 mL of 100 percent apple juice and 50 mL of tap water, respectively.

In order to examine the combinations' effectiveness in reducing dental plaque acidity after a sugary meal, the researchers measured the plaque pH in the participants' mouths. While relatively low values were observed in the groups that had consumed the dry cereal (5.83), or juice (5.83) or water (6.02) after the cereal serving, a significantly higher plaque pH (6.48) was found in the group that had consumed the milk after the cereal.

The researchers concluded that drinking milk after a sugary cereal challenge significantly reduced plaque pH drop due to the sugary challenge. "When discussing the cariogenicity of foods and beverages with patients, dentists and other health care professionals should emphasize that the order of ingesting sugary and nonsugary foods is important and may affect their oral health," they recommended.

The study, titled "The Effects of Beverages on Plaque Acidogenicity After a Sugary Challenge," was conducted at the University of Illinois at Chicago. It was published in the July issue of the Journal of the American Dental Association.

up
0 users have Like. User Likes

 For any help on posting on the site, email at [email protected]

 For any help on posting on the site, email at [email protected]