Saturday, July 31, 2010

Chest compressions only is at least as good as CPR with both compressions and mouth-to-mouth ventilations

July 28, 2010 (Boston, Massachusetts) — Two prospective randomized trials appearing in the July 29, 2010 issue of the New England Journal of Medicine should add heft to recent recommendations--based largely on observational data--that performing cardiopulmonary resuscitation (CPR) using chest compressions only is at least as good as CPR with both compressions and mouth-to-mouth ventilations [1,2].

In one study, by Dr Leif Svensson (Karolinska Institutet, Soåndersjukhuset, Sweden) and colleagues, medical dispatchers all across Sweden who were contacted by people who'd witnessed out-of-hospital cardiac arrests randomly assigned callers to provide either compression-only CPR or standard CPR (with pauses in compressions to perform ventilation). They report that, among 1276 patients who received CPR over a four-year period, rates of 30-day survival were similar between the two CPR groups: 8.7% in the compression-only group and 7.0% in the standard CPR group (p=0.29).

"Overall, this [nationwide] study lends further support to the hypothesis that compression-only CPR, which is easier to learn and to perform, should be considered the preferred method for CPR performed by bystanders in patients with cardiac arrest," Svensson et al concluded.

In the second study, known as DART, Dr Thomas D Rea (University of Washington, Seattle) and colleagues employed a similar trial design, with dispatchers "randomizing" their instructions to callers seeking help for someone who'd experienced an apparent cardiac arrest. Two regions in Washington State and the city of London, UK, participated in the study.

In all, 1941 patients in DART were randomized equally to chest compressions only or to compressions plus rescue breathing, and here again, no differences were seen in patients who survived to hospital discharge--12.5% and 11%, respectively (p=0.31)--or in rates of patients with favorable neurologic outcomes.

Of note, Rea et al continue, patients with a cardiac cause of arrest and those with shockable arrhythmias (both prespecified subgroups) both showed trends toward higher hospital-discharge survival rates if they'd received chest compressions only.

"These results support a strategy for CPR performed by laypersons that emphasizes chest compression and minimizes the role of rescue breathing," Rea et al conclude.

Hands-On, Mouth-Off

Indeed, that approach is already advocated by the American Heart Association (AHA), which issued its "call to action" for "hands-only" CPR back in 2008 [3], as Dr Myron L Weisfeldt (Johns Hopkins Medicine, Baltimore, MD) points out in an editorial accompanying the two Journal papers [4]. Weisfeldt notes that a "straightforward message" from these papers is that advocating compression-only CPR should increase the likelihood that bystanders will attempt resuscitation, since "performance of mouth-to-mouth rescue breathing is far more difficult than proper chest compression, and . . . may be viewed with distaste and raise concerns about risks associated with mouth-to-mouth contact."

Commenting on all of the papers, Dr Michael Sayre (Ohio State University, Columbus), lead author on the 2008 AHA recommendations, told heartwire that the two new studies "reinforce what we're already saying and provide randomized clinical-trial evidence that what we recommended in 2008 is reasonable."

But he also emphasized the "two levels" to the question of whether or not rescue breathing is warranted. The first speaks to the fact that only one-quarter to one-third of cardiac-arrest victims get any form of resuscitation before emergency medical services (EMS) arrive.

"So the first question is, What do you want bystanders to do? And in that case, simple is clearly best. It might not be physiologically optimal for some victims, but the problem is that we need people to do something. That's more psychology than medicine."

But once EMS arrive, "we have choices," Sayre continued, and this is where resuscitation research still is hunting for answers. Echoing points also made by Weisfeldt in his editorial, Sayre notes that there may be groups in whom rescue breathing is desirable--drowning victims being one obvious example--and other patients in whom breathing could actually be detrimental.

"That's one possibility suggested by the studies we've just read today," Sayre points out. "Both of them show a trend toward improved outcome in the compression-only group. I haven't done the math to see whether, if you lump them together, that trend reaches statistical significance, but it's an interesting idea."

Keep in mind, he adds, that these are untrained laypeople. The difference between compression only and standard CPR may have been greater if trained professionals had been performing the two forms of CPR. At present, however, there are no good ways for a layperson to determine in the field, and particularly "over the telephone," whether any given patient might benefit from breathing or be harmed by it.

Missed Opportunities

As an aside, Sayre stressed that he thinks physicians have not really heard the message about compression-only CPR or realized that this simpler technique means family members might be more likely to save the life of a loved one with known heart disease.

"I'm not sure we really do a good job of recommending that our patients or families get trained, even with our own families," Sayre told heartwire . "I made sure my parents learned, but I suspect many physicians may not do that."

Friday, July 30, 2010

Dental Disposables Help Perpetuate Petroleum Dependency


Eco-Dentistry Association™ Says Dental Disposables
Help Perpetuate Petroleum Dependency

According to the Authority on Green Dentistry, the Gulf of Mexico Disaster is Another Reason Why the Dental Industry Needs to Curb the Use of Petroleum-Based Plastics

Berkeley, CA (July 29, 2010) – According to the Eco-Dentistry Association™ (EDA), an international association promoting environmentally sound practices in dentistry, the widespread use of disposable dental supplies, such as chair covers and sterilization pouches, helps perpetuate the country’s dependency on petroleum because single-use plastics are made
from oil.

According to Susan Beck, Director of the Eco-Dentistry Association, “The oil catastrophe in the Gulf of Mexico is causing many Americans to consider the true risk and cost of pollution-based energy. The dental industry can show leadership by helping curtail our nation’s dependence on fossil fuels.”

It’s not just about turning off the lights. Many dental practitioners don’t think about the “embodied energy” hiding in everyday dental supplies. “Embodied energy represents all the energy used in the life cycle of an item, from raw material to its final resting place,” explains Beck. 

“The biggest offenders for hidden embodied energy in the typical dental office are disposables. Because disposables are by definition single-use, the return on the energy investment for the product is extremely low. Tremendous energy resources are used to extract raw materials, which are generally petroleum-based, to create a product that is manufactured, packaged, shipped, stored, and then shipped again to a dental practice to be used once. Additional energy is consumed to transport that product to a landfill, where it may sit for thousands of years,” states Beck.


The EDA recommends choosing reusable dental supplies wherever possible. For example,
a single plastic sterilization pouch represents nearly 60 watts of embodied energy (
www.wattzon.org), which is the same amount of energy as leaving a 60-watt incandescent lightbulb turned on for 5 hours! 

An average dental office can use as many as 55 plastic sterilization bags per day,1 which equates to leaving a 60-watt incandescent lightbulb on for eleven and a half days. By the end of the year, the practice would have utilized enough energy, in plastic pouches alone, to fuel a 60-watt incandescent bulb non-stop for six years and three months. Conversely, a dental office would have to use a cloth pouch over 4,800 times before it would have used the energy represented by one plastic pouch. 

Even without adding in the cost of embodied energy to the dental supplies invoice, many practitioners are surprised to find that disposables actually increase supply costs. For instance, a large disposable autoclave pouch costs about 20 cents per use, while a reusable pouch costs about half as much per use. Disposable items for infection control and sterilization can cost a dental practice as much as $2,337 per year more than an office making the greener choice of reusable items.2 

What’s more, choosing disposable paper or plastic rinse and swish cups instead of reusable substitutes can cost a practice $178 or more per year, even when the cost of a dishwasher is included in the assessment.2 One member of the Eco-Dentistry Association reports a reduction in materials costs of up to 30% after shifting to energy-conserving supplies.

Here are three steps each dental practice can take to reduce its dependency on disposables and save money:

(1)  Switch to reusable infection control barriers and sterilization pouches made of cloth. Choose plastic-free, FDA-registered brands and follow the EDA’s Best Practices for Waste-Reducing, Pollution-Preventing Sterilization and Infection Control. (www.ecodentistry.org)

(2)  Choose reusable rinse and swish cups. You’ll not only eliminate wasted embodied energy, but it is also a great way to reflect your practice personality. Some EDA members use small teacups; others use a glass shot glass!

(3)  If you don’t choose reusables, choose compostables. Although disposable, compostable plastics are made from plants, rather than petroleum; they require less energy to produce and decompose relatively quickly.

The biggest bang for a dentist’s buck comes from a reusable item. The more times it is used, the lower the embodied energy cost, and the higher the return on your energy investment. Don’t forget that once an item’s life cycle is complete in the dental office, it doesn’t mean it’s ready for the grave. Many EDA dental practice members donate their reusable cloth items to animal shelters to extend the item’s life, contributing to meeting an important community need. 

About the Eco-Dentistry Association™
The EDA is an educational organization that provides standards, best practices, and certification for green dental offices, and offers the public access to dental professionals who share their values of wellness and environmental stewardship. More information can be found at www.ecodentistry.org.

References:
1.     Adams E. Eco-friendly dentistry: not a matter of choice. J Can Dent Assoc. 2007 Sep;73(7):581-
2.     Natural Logic. Study of economic impact of dental office environmental innovations. Published 2008.

Thursday, July 29, 2010

Its All In The Family- Genetic Power of Aggressive Periodontal Disease

We have all heard the comments of everyone in family has/had gum disease. MJ

Braz Dent J. 2010;21(2):137-41.

Genetic power of a Brazilian three-generation family with generalized aggressive periodontitis.

Federal University of Bahia, Salvador, BA, Brazil.

Abstract

Aggressive periodontitis is a multifactorial disease with strong familial aggregation. Genetic linkage analysis is a method to localize causative or predisposing genes along the chromosome, thus helping to unravel important pathogenic pathways. Prior to applying this method, however, it is essential to estimate the power of the study design. The aim of this study was to estimate the power of a large Brazilian family with generalized aggressive periodontitis (GAgP) for future linkage analysis. A three-generation family was seen at the Dental School of the Federal University of Bahia. A full-mouth periodontal probing at 6 sites/tooth was performed in all 23 family members. Five out of 10 siblings were affected with GAgP. A parametric simulation (? = 0) was performed on 100 replicates using the statistical software SLINK for linkage analysis. The linkage LOD score criteria for complex diseases described by Haines was adopted. There was maximum expected LOD scores of 3.56 and 3.48 at penetrance rate F = 0.98, and both studied phenocopy rates p=0.0 and p=0.02, respectively. The analyzed family showed statistical power for future genetic linkage analysis of candidate genes to GAgP.

Tuesday, July 27, 2010

Participate in a quick survey and win an IOC

I received an email recently from Jenine who is a graduate student at Stanford. She is conducting research into some technological innovations in the dental field.
 
You can help her out by going to 

 http://www.surveymonkey.com/s/ZJ7M2M2
 
and filling out the survey. It should take you only a couple of minutes. 
 As a way to say thank you for your participation, you will be
 entered into a drawing for a free intraoral camera upon completion. 
  
Go help a student out!

Monday, July 26, 2010

Decay of baby teeth may be linked to obesity, poor food choices, study suggests

Decay of baby teeth may be linked to obesity, poor food choices, study suggests

A preliminary study of young children undergoing treatment for cavities in their baby teeth found that nearly 28 percent had a body mass index (BMI) above the 85th percentile, indicating overweight or obesity.

That percentage is more than 5 percent higher than the estimated national average, adding more fuel to the growing concern that poor food choices, including those sugary drinks and fruit juices so popular and convenient, likely are contributing to both obesity and tooth decay in very young children.

The findings will be presented today (June 22) at the 2010 annual meeting of the Endocrine Society being held in San Diego, Calif. The study is one of 38 abstracts (out of 2,000 accepted) selected for inclusion in the society's Research Summaries Book, which is provided to the media for future reference.

Kathleen Bethin, MD, associate professor of pediatrics at the University at Buffalo and director of the pediatric endocrinology and diabetes fellowship program at Women and Children's Hospital of Buffalo, is first author.

Dental cavities are the most common chronic disease of childhood, according to Healthy People 2010 -- 5-10 percent of young children have early childhood cavities -- and childhood obesity has more than tripled in the past 30 years, reaching nearly 20 percent by 2008.

"We hypothesized that poor nutritional choices may link obesity and dental decay in young children, but there is very little published data associating these two health issues," says Bethin.

"The aim of our study was to obtain preliminary data on BMI, energy intake and metabolic profiles in young children with tooth decay."

The study involved 65 children ages 2-5 who were treated in the operating room at Women and Children's Hospital. All children required anesthesia due to the severity of their dental problems or other issues.

The children, who had been fasting for 8-12 hours, were weighed and measured for height. After the patients were anesthetized, researchers measured waist circumference and drew blood. Parents completed a food questionnaire while their children were in surgery.

The data showed that:

Eighteen of the 65 children, approximately 28 percent, had a BMI above the 85th percentile, which Bethin noted might be higher if the children hadn't been fasting.
Waist circumference compared to height was significantly higher in the overweight and obese children compared to the children of normal weight, measurements showed.
Approximately 71 percent of the children had a calorie intake higher than the normal 1,200 per day for their age group.
"The main point of our findings is that poor nutrition may link obesity to tooth decay," says Bethin. "Thus the dental office, or 'dental home,' may be an ideal place to educate families about nutrition and the risks of obesity and dental decay.

"Our results found no difference in total calories consumed by the overweight and healthy-weight kids," noted Bethin, "so the problem isn't overeating, per se, just making the wrong food choices."

Bethin and colleagues now are analyzing whether the overweight children eat more processed sugar, drink more juice and have other unhealthy eating habits compared to the healthy-weight children.

Saturday, July 24, 2010

Give your Eyes a Break with the 20-20-20 Rule

The 20-20-20 rule suggest that after every 20 minutes, you (the computer user) should take a break for at least 20 seconds and look at objects that are 20 feet away from you.

Read what to do in this article. to help save your eyes from excessive strain.

Friday, July 23, 2010

PULPDENT HELPS SPECIAL OLYMPICS ATHLETES SMILE

PULPDENT HELPS SPECIAL OLYMPICS ATHLETES SMILE

WATERTOWN, MA:  July 21, 2010— Pulpdent recently participated in Special Olympics International’s Special Smiles initiative. More than 35 athletes received up to 300 sealants at a Georgia Special Olympics event as a result of Pulpdent’s donation of EMBRACE™ WetBond™ Pit and Fissure Sealant, ETCH-RITE™ Etch Gel, and FLECTA™ Disposable Mirrors.

Since 1996, the Special Smiles initiative has been providing Special Olympics athletes with free oral health screenings, services, and information at local, regional, state, and national games.  Special Olympics/Special Smiles raises awareness of the dental needs of the developmentally disabled population and the difficulties many face in finding care.

“Pulpdent is delighted to be a part of Special Olympics/Special Smiles,” says Fred Berk of Pulpdent. “Embrace is the ideal sealant for this kind of setting, as it does not require a dry field. It can be applied quickly and is both hygienist and patient friendly.”

Also participating in the project were the Georgia Public Health Department and Help A Child Smile, 3M/ESPE, The Coca Cola Company, Delta Dental, Benco Dental, and Colgate.

Pulpdent Corporation’s Embrace™ Pit and Fissure Sealant is the only resin-based sealant that bonds to the moist tooth. A recent study published in the Journal of Dentistry concluded that Embrace had the longest lasting antibacterial activity of those studied.  Among the leading pit and fissure sealants, only Embrace contains no Bis-GMA, and therefore there is no possibility of bisphenol A (BPA).

Pulpdent manufactures high-quality products for the dental profession, including adhesives, composites, sealants, cements, etching gels, calcium hydroxide products, endodontic specialties and bonding accessories. For more information call 800-343-4342 or visit www.pulpdent.com

Thursday, July 22, 2010

Greater Concentrations Of Fluoride In Tea Than Once Thought

Greater Concentrations Of Fluoride In Tea Than Once Thought

15 Jul 2010  

Black tea, a Southern staple and the world's most consumed beverage, may contain higher concentrations of fluoride than previously thought, which could pose problems for the heaviest tea drinkers, Medical College of Georgia researchers say.

"The additional fluoride from drinking two to four cups of tea a day won't harm anyone; it's the very heavy tea drinkers who could get in trouble," said Dr. Gary Whitford, Regents Professor of oral biology in the School of Dentistry. He presented his findings at the 2010 International Association of Dental Research Conference in Barcelona, Spain.

Most published reports show 1 to 5 milligrams of fluoride per liter of black tea, but a new study shows that number could be as high as 9 milligrams.

Fluoride is known to help prevent dental cavities, but long-term ingestion of excessive amounts could cause bone problems. The average person ingests a very safe amount, 2 to 3 milligrams, daily through fluoridated drinking water, toothpaste and food. It would take ingesting about 20 milligrams a day over 10 or more years before posing a significant risk to bone health.

Whitford discovered that the fluoride concentration in black tea had long been underestimated when he began analyzing data from four patients with advanced skeletal fluorosis, a disease caused by excessive fluoride consumption and characterized by joint and bone pain and damage. While it is extremely rare in the United States, the common link between these four patients was their tea consumption - each person drank 1 to 2 gallons of tea daily for the past 10 to 30 years.

"When we tested the patients' tea brands using a traditional method, we found the fluoride concentrations to be very low, so we wondered if that method was detecting all of the fluoride," Whitford said, noting that the tea plant, Camellia sinensis, creates a quandary when measuring fluoride. Unique among other plants, it accumulates huge concentrations of fluoride and aluminum in its leaves - each mineral ranges from 600 to more than 1,000 milligrams per kilogram of leaves. When the leaves are brewed for tea, some of the minerals leach into the beverage.

Most published studies about black tea traditionally have used a method of measuring fluoride that doesn't account for the amount that combines with aluminum to form insoluble aluminum fluoride, which is not detected by the fluoride electrode. Whitford compared that method with a diffusion method, which breaks the aluminum-fluoride bond so that all fluoride in the tea samples can be extracted and measured.

He tested seven brands of store-bought black tea, steeping each for five minutes in deionized water, which contains no fluoride. The amount of fluoride in each sample was 1.4 to 3.3 times higher using the diffusion method than the traditional method.

The new information shouldn't deter tea drinkers, as the beverage is safe and some teas even have health benefits, Whitford said. "The bottom line is to enjoy your favorite tea, but like everything else, drink it in moderation."

Including Whitford's presentation, School of Dentistry faculty and students are making 24 oral and poster presentations at the International Association for Dental Research conference July 14-17.

Wednesday, July 21, 2010

Vets Warn Dog Owners About Dangers Of Artificial Sweeteners

Vets Warn Dog Owners About Dangers Of Artificial Sweeteners

16 Jul 2010

The British Veterinary Association (BVA) is warning dog owners of the danger that the artificial sweetener, Xylitol, can pose to their pets. Xylitol is not considered harmful to humans, but if ingested by a dog the substance is dangerous because it triggers a sudden release of insulin which causes a dramatic drop in blood sugar (hypoglycaemia) and can lead to liver damage.

Xylitol is increasingly used as a sweetener in sugar-free chewing gum and other confectionary; it is used in dental hygiene products and is also found as an excipient in many medicines. Of particular concern are the sugar substitute products that contain Xylitol which are used in home baking as well as in manufactured goods. Cakes, biscuits and other goodies made with it are toxic to dogs. Owners may not be aware of these dangers and may not associate clinical deterioration with ingestion of these foodstuffs.

Other animals such as ferrets and cats may be similarly affected and the Veterinary Poisons Information Service (VPIS) is monitoring all referred cases.

BVA Past President Nicky Paull commented:

"While most dog owners are now aware that foods such as chocolate and grapes can be toxic to their pets few are aware of the dangers if their dog eats a cake or muffin containing Xylitol.

"If you think your dog may have eaten chewing gum or a sweet or cake containing Xylitol and appears unwell, perhaps vomiting or lacking coordination, then contact your vet for advice immediately and be ready to provide information on what's been consumed."

The BVA Animal Welfare Foundation and the Veterinary Poisons Information Service (VPIS) have produced an easy reference guide to keeping pets safe from harmful substances. The 'Pets and poisons: keeping your animal safe' leaflet can be easily downloaded from the BVA AWF website or you can request a copy from the Foundation.

Alexander Campbell, Head of Service at VPIS, added:

"With the increasing number of products containing Xylitol on the market the VPIS recognises the extreme importance of raising awareness of the danger to dogs of ingesting this substance, particularly in the light of a case we handled the other evening which involved a dog eating a muffin made with this sugar substitute.

"This is yet another instance where a food or food additive deemed safe for human consumption proves to be dangerous for other species. Pets should really only be given foodstuffs formulated for them.

"It is possible that other animals such as ferrets or cats might be affected similarly, but few cases are yet documented. The VPIS continues to monitor all referred cases in all animals with the aim of clarifying the situation in other species as and when more data become available.

"The VPIS would like to see manufacturers of these products provide some visible warnings and information on the packaging and to inform the retail outlets they supply of the potential risks to dogs."

Tuesday, July 20, 2010

1 in 4 Californian children have never seen a dentist, study finds

1 in 4 Californian children have never seen a dentist, study finds


Lack of dental care continues to be a significant problem for American children, who miss about 1.6 million school days each year due to dental disease.

A new study published in the July issue of the journal Health Affairs reveals that in California, nearly 25 percent of children have never seen a dentist and that disparities exist across race, ethnicity and type of insurance when it comes to the duration between dental care visits.

The study, "Racial and Ethnic Disparities in Dental Care for Publicly Insured Children," examines barriers to dental care among California children age 11 and under, using data from the 2005 California Health Interview Survey. The study contains data on nearly 11,000 children.

Researchers Nadereh Pourat, of the UCLA Center for Health Policy Research, and Len Finocchio, of the California HealthCare Foundation, found that Latino and African American children with all types of insurance were less likely than Asian American and white children to have visited the dentist in the previous six months — or even in their entire lifetime.

Similarly, researchers found that Latino and African American children in public insurance programs, including Medicaid and the Children's Health Insurance Program (CHIP), went to the dentist less often than white and Asian American children with the same insurance coverage. Overall, children with private insurance saw a dentist more often than those with Medicaid or CHIP.

"The findings suggest that having insurance isn't always enough," said Pourat, Ph.D., director of research planning at the UCLA Center for Health Policy Research. "We need to address the other barriers that keep children from getting the help they need."

The authors note the findings raise concerns about Medicaid's ability to address disparities in dental care access. Ultimately, they observe, more strategic efforts are necessary to overcome systemic barriers to care, including raising reimbursement rates paid to dentists who serve the Medicaid population and increasing the number of participating Medicaid providers.

"These findings indicate that many poor children in California do not make routine dental visits or simply never receive any dental care," said Finocchio, Dr.P.H., senior program officer at the California HealthCare Foundation. "Even with Medicaid coverage, there are tremendous barriers to getting services."

Despite the disparities, the authors say, having any form of dental insurance significantly increases the odds of seeing a dentist on a regular basis. The studied showed that 54 percent of privately insured children and 27 percent of publicly insured children had seen the dentist during the previous six months, compared with 12 percent of children without dental coverage.

"The data tell us that Medicaid and CHIP have improved children's ability to get dental care," Pourat said. "However, both programs need to do more to reduce disparities."

Monday, July 19, 2010

How Is Your Office's Customer Service?

Customer service is very important to every business. It doesn't matter if the customer is a patient or your buying gasoline. Small things can have a big impact. Recently I have dealt with customer service for Bien Air, Dental-EZ and Continental Airlines.  For the dental companies it was for small equipment repairs, Continental Airlines was to change a flight. Some of these events can seem like nightmares and picking up the phone or sending an email is dreaded, such was the case with my recent dealings with a Chase credit card.

Well this was not the case with the first three companies. The Bien Air representative expertly diagnosed the problem with my electric handpiece motor over the telephone. He offered to send the hose to my office. I asked to have a loaner motor sent, just in case that was also not working. The parts arrived for my next scheduled day of patients. It turns out the telephone diagnosis was correct and I shipped the loaner handpiece back. Less then a day treating patients with an air handpieces.

DentalEZ was a similar event an email was sent and viola everything was taken care of. Continental Airlines made changing my flight simple and without a charge. So here I am a happy customer telling everyone about the great customer service.

So what does this have to do with your dental office? Just how good is your customer service? As the doctor you may not even know? The best way to find out is by surveying patients. After all they are the ones experiencing your customer service. We do this in my office with LighthousePLZ but there are other services that can survey your patients such as Demand Force, Doctorbase and Smile Reminder to name a few.

Ask the questions and review the answers yourself. Don't just leave it to the staff to review, after all it is your business!

So how good or bad is your customer service!

Saturday, July 17, 2010

Electric Toothbrushes: Are They for You?

WebMD has a nice article on electric toothbrushes. I have been using various electric toothbrushes for almost 20 years. For the past 10 years I have been using Philips Sonicare. I do believe that electric sonic brushes do a much better job then a manual brush in the same amount of time.

So go over to WebMD and read the article.

Friday, July 16, 2010

Interventions for replacing missing teeth: antibiotics at dental implant placement to prevent complications.

Cochrane Database Syst Rev. 2010 Jul 7;7:CD004152.

Interventions for replacing missing teeth: antibiotics at dental implant placement to prevent complications.

Department of Oral and Maxillofacial Surgery, School of Dentistry, The University of Manchester, Higher Cambridge Street, Manchester, UK, M15 6FH.

Abstract

BACKGROUND: Some dental implant failures may be due to bacterial contamination at implant insertion. Infections around biomaterials are difficult to treat and almost all infected implants have to be removed. In general, antibiotic prophylaxis in surgery is only indicated for patients at risk of infectious endocarditis, for patients with reduced host-response, when surgery is performed in infected sites, in cases of extensive and prolonged surgical interventions and when large foreign materials are implanted. To minimise infections after dental implant placement various prophylactic systemic antibiotic regimens have been suggested. More recent protocols recommended short term prophylaxis, if antibiotics have to be used. With the administration of antibiotics adverse events may occur, ranging from diarrhoea to life-threatening allergic reactions. Another major concern associated with the widespread use of antibiotics is the selection of antibiotic-resistant bacteria. The use of prophylactic antibiotics in implant dentistry is controversial. OBJECTIVES: To assess the beneficial or harmful effects of systemic prophylactic antibiotics at dental implant placement versus no antibiotic/placebo administration and, if antibiotics are of benefit, to find which type, dosage and duration is the most effective. SEARCH STRATEGY: The Cochrane Oral Health Group's Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and EMBASE were searched up to 2nd June 2010. Several dental journals were handsearched. There were no language restrictions. SELECTION CRITERIA: Randomised controlled clinical trials (RCTs) with a follow up of at least 3 months comparing the administration of various prophylactic antibiotic regimens versus no antibiotics to patients undergoing dental implant placement. Outcome measures were prosthesis failures, implant failures, postoperative infections and adverse events (gastrointestinal, hypersensitivity, etc). DATA COLLECTION AND ANALYSIS: Screening of eligible studies, assessment of the methodological quality of the trials and data extraction were conducted in duplicate and independently by two review authors. Results were expressed as random-effects models using risk ratios (RRs) for dichotomous outcomes with 95% confidence intervals (CIs). Heterogeneity was to be investigated including both clinical and methodological factors. MAIN RESULTS: Four RCTs were identified: three comparing 2 g of preoperative amoxicillin versus placebo (927 patients) and the other comparing 1 g of preoperative amoxicillin plus 500 mg 4 times a day for 2 days versus no antibiotics (80 patients). The meta-analyses of the four trials showed a statistically significant higher number of patients experiencing implant failures in the group not receiving antibiotics: RR = 0.40 (95% CI 0.19 to 0.84). The number needed to treat (NNT) to prevent one patient having an implant failure is 33 (95% CI 17 to 100), based on a patient implant failure rate of 5% in patients not receiving antibiotics. The other outcomes were not statistically significant, and only two minor adverse events were recorded, one in the placebo group. AUTHORS' CONCLUSIONS: There is some evidence suggesting that 2 g of amoxicillin given orally 1 hour preoperatively significantly reduce failures of dental implants placed in ordinary conditions. No significant adverse events were reported. It might be sensible to suggest the use of a single dose of 2 g prophylactic amoxicillin prior to dental implant placement. It is still unknown whether postoperative antibiotics are beneficial, and which is the most effective antibiotic.

Thursday, July 15, 2010

Tooth preparation for rest seats for cobalt–chromium removable partial dentures completed by general dental practitioners

Tooth preparation for rest seats for cobalt–chromium removable partial dentures completed by general dental practitioners

Journal of Oral Rehabilitation

Published Online: 7 Jul 2010

J. A. RICE, C. D. LYNCH  , R. McANDREW  & P. J. MILWARD 

ABSTRACT

Summary The aim of this project was to examine tooth preparations made by general dental practitioners (GDPs) for occlusal and cingulum rest seats for cobalt–chromium removable partial dentures (RPDs). Master casts and prescribed denture designs for cobalt–chromium RPDs produced by a commercial dental laboratory from impressions made by 45 GDPs across Wales were evaluated over a period of 5 months. Rest seats and associated interocclusal clearances were assessed using pre-determined criteria. A total of 68 casts were examined. Of these, 33 did not have rest seats included in their prescription. Of the remaining 35 casts, 81 rests had been prescribed of which only 24 (30%) had signs of tooth preparations for these rest seats. Using pre-determined criteria, 60% of rest seats were under-prepared in the mesio-distal plane and 30% were over-prepared in the bucco-lingual plane. In 17 cases where natural teeth opposed the rest seat, the mean interocclusal clearance was 1·5 mm (range 0·6–3·5 mm) with 6 of the 17 rests (35%) being less than the recommended thickness. In total, 18 of the 24 rests prepared did not meet the criteria, and 11 of the 21 rests prescribed had no obvious preparation and insufficient occlusal clearance. Where prescribed, the majority of rests did not meet the identified criteria. The rest seat preparations varied greatly in all planes including the interocclusal clearance. Further emphasis should be given to aspects of denture design in undergraduate and continuing education programmes for dentists.

Wednesday, July 14, 2010

Presencence of bisphosphonate associated osteonecrosis of the jaws in multiple myeloma patients

Head & Face Medicine 2010, 6:11doi:10.1186/1746-160X-6-11

Published: 8 July 2010

 

Abstract (provisional)

Background

Bisphosphonate-associated osteonecrosis of the jaws (BP-ONJ) is an adverse effect of bisphosphonate treatment with varying reported incidence rates.

Methods

In two neighboring German cities, prevalence and additional factors of the development of BP-ONJ in multiple myeloma patients with bisphosphonates therapy were recorded using a retrospective (RS) and cross-sectional study (CSS) design. For the RS, all patients treated from 01/00-02/06 were contacted by letter. In the CSS, all patients treated from 10/06-03/08 had a physical and dental examination. Additionally, a literature review was conducted to evaluate all articles reporting on BP-ONJ prevalence. PubMed search terms were: bisphosphonat, diphosphonate, osteonecrosis, prevalence and incidence.

Results

In the RS, data from 81 of 161 patients could be obtained; four patients (4.9%) developed BP-ONJ. In the CSS, 16 of 78 patients (20.5%) developed BP-ONJ. All patients with BP-ONJ had received zoledronate; 12 of these had had additional bisphosphonates. All except one had an additional trigger factor (tooth extraction [n=14], dental surgical procedure [n=2], necrosis at the mylohyoid ridge [n=3]).

Conclusion

The prevalence of BP-ONJ may have been underestimated to date. The oral examination of all patients in this CSS might explain the higher prevalence, since even early asymptomatic stages of BP-ONJ and previously unnoticed symptomatic BP-ONJ were recorded. Since nearly all patients with BP-ONJ had an additional trigger factor, oral hygiene and dental care might help to reduce BP-ONJ incidence.

Monday, July 12, 2010

Regenerating the Dental Pulp

Nanostructured Assemblies for Dental Application



Millions of teeth are saved each year by root canal therapy. Although current treatment modalities offer high levels of success for many conditions, an ideal form of therapy might consist of regenerative approaches in which diseased or necrotic pulp tissues are removed and replaced with healthy pulp tissue to revitalize teeth. Melanocortin peptides (α-MSH) possess anti-inflammatory properties in many acute and chronic inflammatory models. Our recent studies have shown that α-MSH covalently coupled to poly-l-glutamic acid (PGA-α-MSH) retains anti-inflammatory properties on rat monocytes. This study aimed to define the effects of PGA-α-MSH on dental pulp fibroblasts. Lipopolysaccharide (LPS)-stimulated fibroblasts incubated with PGA-α-MSH showed an early time-dependent inhibition of TNF-α, a late induction of IL-10, and no effect on IL-8 secretion. However, in the absence of LPS, PGA-α-MSH induced IL-8 secretion and proliferation of pulp fibroblasts, whereas free α-MSH inhibited this proliferation. Thus, PGA-α-MSH has potential effects in promoting human pulp fibroblast adhesion and cell proliferation. It can also reduce the inflammatory state of LPS-stimulated pulp fibroblasts observed in gram-negative bacterial infections. These effects suggest a novel use of PGA-α-MSH as an anti-inflammatory agent in the treatment of endodontic lesions. To better understand these results, we have also used the multilayered polyelectrolyte films as a reservoir for PGA-α-MSH by using not only PLL (poly-l-lysine) but also the Dendri Graft poly-l-lysines (DGLG4) to be able to adsorb more PGA-α-MSH. Our results indicated clearly that, by using PGA-α-MSH, we increase not only the viability of cells but also the proliferation. We have also analyzed at the nanoscale by atomic force microscopy these nanostructured architectures and shown an increase of thickness and roughness in the presence of PGA-α-MSH incorporated into the multilayered film (PLL-PGA-α-MSH)10 or (DGLG4-PGA-α-MSH)10 in accordance with the increase of the proliferation of the cells growing on the surface of these architectures. We report here the first use of nanostructured and functionalized multilayered films containing α-MSH as a new active biomaterial for endodontic regeneration.

Friday, July 09, 2010

1-800-DENTIST® Partners with Dental Senders™ to Provide Complete Marketing Solutions for Dentists

1-800-DENTIST® Partners with Dental Senders to Provide Complete Marketing Solutions for Dentists

LOS ANGELES, CA (July 6, 2010) – 1-800-DENTIST®, the nation’s leading dental marketing company for both consumers and dentists, announced today that they have partnered with Dental Senders, the web-based company that offers free, automated patient communications for dentists.

The combination of the two established brands means dentists can now find comprehensive marketing all in one company. While 1-800-DENTIST® is known for providing screened new patient referrals, the addition of Dental Senders allows them to now help dentists generate more revenue by keeping their patients coming back regularly.

“These two services complement each other wonderfully,” said Tony McManus, CEO of Dental Senders. “Having the power of the 1-800-DENTIST® brand behind Dental Senders is going to help grow our service exponentially. We’re looking forward to the integration of new services and new functionality to simplify patient communications.”

“Dental Senders is an amazing free service that fits in perfectly with our goal of helping dentists grow their practices,” said Gregg Coccari, CEO of 1-800-DENTIST®. “By joining together we plan to offer dentists one source that can help them grow their patient base and their production.”

Thursday, July 08, 2010

Dentium USA Introduces the DASK – Dentium Advanced Sinus Kit

Dentium USA Introduces the DASK – Dentium Advanced Sinus Kit

The DASK Enables Safe, Easy, and Reliable Access to the Maxillary Sinus Cavity

Cypress, CA (July 2, 2010) – Dentium USA, a premier manufacturer of dental products developed by clinicians for clinicians, introduces a sinus elevation kit called DASK (Dentium Advanced Sinus Kit), an ideal new surgical approach for a simplified and conservative technique for a reliable sinus lift procedure.

The DASK is a comprehensive solution for easy and reliable sinus lift and elevation procedures. Instruments included in the new DASK kit provide straightforward exposure to the sinus cavity, substantially reducing chair time and dramatically decreasing post-surgery discomfort for patients. Dental professionals can perform both safe and reliable crestal and lateral approaches with the all-inclusive DASK.

Dr. Jaime L. Lozada, a practicing prosthodontics specialist located in Loma Linda, California, recently put DASK to the test. “One DASK kit conveniently enabled both crestal and lateral approaches for all of my procedures,” remarked Dr. Lozada. “I was pleasantly surprised that the DASK is compatible with all my implant handpieces, and the diamond coated bur is like added security that prevents sinus perforation. I particularly enjoyed the cooling effect of the internal irrigation; and the gentle hydraulic pressure provided a nice extra lift during procedures.”

Dentium’s new advanced DASK is the first and only sinus kit to include a variety of drills for both crestal and lateral approach, pre-defined stoppers, sinus elevation instruments, osteotome inserts, and Dentium’s own OSTEON™ Sinus & Lifting material. The DASK allows dental professionals to perform a well-controlled maxillary sinus augmentation with all the necessary components readily accessible in one complete kit.

The DASK’s diamond-coated burs were designed to help prevent sinus perforation and provide an optimal irrigation function. The internal irrigation not only has a pleasant cooling effect, it also adds hydraulic pressure, which slightly lifts the sinus during the procedure. Drill speeds for all DASK drills range from 800 to 1,200 rpm, and 30-45N.cm with the irrigation process.

The comprehensive DASK includes 6 implant drill bits (3 drills for crestal approach and 3 for lateral), 4 screw-on stoppers, 4 sinus elevation instruments, and 5 osteotome inserts. Dentium’s OSTEON™ Sinus & Lifting package includes two sinus bone substitute materials for both the Sinus and the Lifting kits, each containing different particle size compositions for simple and fast bone grafting.

The DASK was designed to be a universal kit, and can be used as a precursor to any brand of implant. For more information on the DASK, please call 1-877-304-6752, e-mail info@dentiumusa.com, or log onto www.dentiumusa.com

Wednesday, July 07, 2010

Extracted Teeth Could Be Easy Source Of Stem Cells

Extracted Teeth Could Be Easy Source Of Stem Cells

28 Jun 2010  

New research from Japan suggests that dental pulp from extracted teeth may be an easy source of Induced Pluripotent Stem (IPS) cells, which like embryonic stem cells, have the potential to form several different cell types, but without the controversial ethical problems.

These were the findings of a study led by K. Tezuka from the Gifu University Graduate School of Medicine in Japan, that was published online in the journal Journal of Dental Research on 16 June. Tezuka did the research with colleagues from Gifu University and from Japan's Kyoto University, where the first IPS cell was generated in 2006.

There are not many places in the human body where you can harvest potential IPS cells with a minimally invasive procedure, which is why Tezuka and colleagues decided to evaluate how easy it might be to culture stem cells from dental pulp, which can easily be obtained from extracted teeth.

From six cell lines they tested they produced 5 that were viable:

"From all 6 DPC [dental pulp cell] lines tested with the conventional 3 or 4 reprogramming factors, iPS cells were effectively established from 5 DPC lines," they wrote.

Also, further tests revealed that these lines could make stem cells that are genetically compatible with 20 per cent of the Japanese population:

"... determination of the HLA types of 107 DPC lines revealed 2 lines homozygous for all 3 HLA loci and showed that if an iPS bank is established from these initial pools, the bank will cover approximately 20% of the Japanese population with a perfect match," added Tezuka and colleagues.

They concluded that:

"Analysis of these data demonstrates the promising potential of DPC collections as a source of iPS cell banks for use in regenerative medicine."

They also suggested further studies may show the cell lines match more than 20 per cent of the Japanese population.

William Giannobile, Editor in Chief of the journal said in a statement that:

"This work is significant in that it proposes the exciting potential of stem cell banking from readily available extracted teeth."

"Although at an early stage of development, this innovation offers prospects for cell therapy approaches for the treatment of human disease," he added.

Professor Jacques Nör, a researcher at University of Michigan's School of Dentistry and who was not involved with the study, said that he and others have been able to extract stem cells from teeth that would have fallen out anyway, reported ABC Science.

Although Nör said one of the exciting things about using dental pulp as a source of stem cells is how accessible it is, especially when you consider primary teeth. However, he cautioned that they don't want to create false expectations either:

"We know this isn't going to be a cure for everything," said Nör.

"As long as people keep this in mind, it may be useful in five, 10, 15 years from now as a treatment for significant diseases," he added.

"Dental Pulp Cells for Induced Pluripotent Stem Cell Banking."
N. Tamaoki, K. Takahashi, T. Tanaka, T. Ichisaka, H. Aoki, T. Takeda-Kawaguchi, K. Iida, T. Kunisada, T. Shibata, S. Yamanaka, and K. Tezuka.
Journal of Dental Research, First published online 16 June 2010.
DOI: 10.1177/0022034510366846

Monday, July 05, 2010

Register Now for Sirona’s CEREC 25th Anniversary (C25) Celebration and Take Advantage of Enhanced CE and Hotel Promotions



 
CEREC® 25th Anniversary Celebration to be held August 26 – 28th
at Caesars Palace in Las Vegas

Charlotte, NC (July 2, 2010) – As part of its continuing effort to provide “CAD/CAM for everyone,” Sirona Dental Systems, LLC announced that it is expanding and extending its special promotions to enable as many  dental and laboratory professionals as possible to experience the 25-year celebration of its CEREC® CAD/CAM system.   

Doctors and laboratories are encouraged to take advantage of special C25 registration packages just made available throughout the month of July:

  • Register in the months of June and/or July and receive Thursday (Aug. 26) night free at Caesars Palace with full-price tuition OR receive a reduced rate of $99 per night at the Paris Hotel and Casino from August 22nd through August 28th
  • Sign up in June and/or July:  Bring along 2 staff/lab personnel members at regular tuition rate and get 1 staff member free!   

The milestone CEREC 25th Anniversary Celebration (C25) will take place August 26 – 28th at Caesars Palace in Las Vegas.  Participants can earn up to 18 CE credits while enjoying CAD/CAM-focused workshops, premium entertainment, and plenty of memorable celebrations among luxurious accommodations provided by Caesars Palace

Following Sirona’s “CAD/CAM for Everyone” philosophy, the CEREC 25th Anniversary program offers an extensive list of CAD/CAM courses for the entire dental team.  Programs include clinical techniques, practice management, marketing, hygiene, and hands-on workshops.  The celebration is open to all who want to advance their CAD/CAM education and experience. 


Attendees can also explore the C25 exhibit hall showcasing top dental companies and their products and services. 

Sirona plans to present a “who's who” of digital dentistry during the CEREC 25th Anniversary.  An outstanding educational curriculum will be taught by the most prominent lecturers in the dental and lab community, including:

  • Dr. Gordon Christensen
  • Dr. Rella Christensen
  • Dr. Dennis Fasbinder
  • Mr. Jim Glidewell
  • Dr. Paul Homoly
  • Mr. Imtiaz Manji
  • Dr. Edward A. McLaren
  • Prof. Dr. Albert Mehl
  • Dr. Mark Morin
  • Prof. Dr. Werner H. Mörmann
  • Mr. Bill Mrazek
  • Dr. Sameer Puri
  • Mr. Matt Roberts
  • Dr. David Roessler
  • Dr. Frank Spear
  • Mr. Ingo Zimmer, and many more! 

Celebrity entertainment includes appearances by Olympic Gold Medalist Rulon Gardner, the Second City Comedy Troupe, and five-time Emmy® Award winning comedian and actor Dennis Miller. 
 
Attendees are also invited to celebrate in style at the sophisticated WHITE PARTY taking place at Pure Nightclub on Saturday night.  The WHITE PARTY promises to be the hottest dental event of the decade!  An “Entertainment-Only Pass” is also available for a spouse or guest who chooses to attend social events only. 

“We want as many dental and lab professionals to take advantage of this once-in-a-lifetime opportunity to build long-lasting business relationships with thousands of fellow CEREC and inLab® owners and learn from A-list educators.” explained Michael Augins, President of Sirona Dental Systems.  “The C25 celebration is not only a great place for additional CAD/CAM education, it will be a great networking and communication forum for Sirona, our colleagues, clients, associates, and other professionals who believe in the patient and business benefits of CAD/CAM technology.  This event is intended for everyone, and is another example of Sirona’s goal to provide CAD/CAM for everyone.”

For more information and/or to register for Sirona’s CEREC 25th Anniversary Celebration, please log onto www.CERECVIP.com, or call 877-360-6275. 

Sunday, July 04, 2010

Independance Day

I wish everyone a happy and safe 4th of July. I also wish to thank the Founding Fathers for their wisdom and sacrifices to allow us all to be here hundreds of years later to celebrate their gift to human kind. I can only hope that our current leaders find the wisdom that these men possessed to guide us forward to another 300+ years.

Saturday, July 03, 2010

The teeth of cadavers reveal their identity

The teeth of cadavers reveal their identity

IMAGE: No two people have the same teeth.

Click here for more information.
Researchers from the University of Granada have shown that a person's dental patterns can be used as proof of their identity with the same degree of reliability as DNA testing, the method that forensic police use to reveal the identity of dead bodies. The researchers came to their conclusion after analyzing the dental patterns of more than 3,000 people.
"There is sufficient dental diversity between people to enable a scientifically-based human identification method to be developed for forensic purposes", Stella Martín de las Heras, lead author of the study and a professor of Legal and Forensic Medicine at the University of Granada (UGR), tells SINC.
In order to reach this conclusion, the researcher and her team carried out a statistical analysis of 3,166 full and partial sets of teeth taken from the databases in the three most recent National Surveys of Oral Health (1993, 2000 and 2005).
Using these data, the team estimated "conditioned dental diversity", eliminating cases where people had all their teeth "present and healthy" or people who were "edentulous" (without a single tooth in their mouth), as these were of no use for identification purposes.
The results of the study, published in the journal Forensic Science International, show variability values of 0.999 (on a scale of 0 to 1), "which is comparable to the rates for a scientifically-based identification method such as mitochondrial DNA", stresses Martín de las Heras.
However, the scientist does acknowledge the limitations of using dental patterns: "Dental characteristics have low stability within the population compared with mitochondrial DNA sequences, which are only affected by mutations and heteroplasmy (different types within the same mitochondria, cell or individual)".
The dental patterns of a population depend on oral health status and, therefore, on age (decay is a cumulative disease) and the therapeutic dental approach of the time. At present, we are in a restorative phase (where teeth are restored) as opposed to extractive (when teeth are removed), as they were previously.
"But by analysing the data bases of dental patterns in Spanish populations according to different age groups and birth cohorts, we found test results with high homogeneity for all the databases, which shows the value of this system for identifying people, and its forensic utility", says the researcher.
Comparing teeth before and after death In this procedure, an oral autopsy makes it possible to obtain a cadaver's dental data. To do this, forensic scientists use a range of techniques depending upon the body's state of preservation. In some cases they have to remove the maxillary bones in order to find details that cannot be identified in any other way.
The post mortem dental pattern is compared with the dental data of the person in life, information that is provided by dentists, although it can also come from doctors and family members. Various IT programmes are used to help in comparison and identification.
Aside from this finding, the team has developed a piece of software to identify bite marks. This tool makes it possible to superimpose, precisely and in 3D, the mark left by a bite over the tooth arrangement of a possible suspect.