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After a June 9 infection prevention and control inspection at Upper Middle Dental in Burlington, Ontario, the Halton Region Health Department reports that clients who received dental services there may have been exposed to improperly cleaned instruments used for procedures. 

“Improperly cleaned dental instruments carry a low risk of transmitting infectious diseases such as hepatitis B, hepatitis C, and human immunodeficiency virus (HIV) to clients,” said Daniela Kempkens, MD, acting medical officer of health for the Halton Region.

“As a precaution, the Halton Region Health Department recommends that all clients who have ever received dental services at Upper Middle Dental contact their physician (or go to a walk-in clinic if they do not have a physician) to discuss testing for hepatitis B, hepatitis C, and HIV,” said Kempkens.

A Halton Region Health Department re-inspection on June 14 confirmed that the dental office now meets required infection prevention and control standards. The health department has sent letters to past and current clients of the dental office to notify them and recommend that they contact their physician. 

The Royal College of Dental Surgeons of Ontario notes that cases like this are extremely rare, with dentists extensively trained on infection prevention, including mandatory continuous education on the subject. The organization is now reviewing its Guidelines on Infection Prevention and Control in the Dental Office.

For more information about the investigation and potential infection, patients can visit halton.ca or call the Halton Region Health Department at 311, (905) 825-6000, or (866) 442-5866. Inquiries related specifically to Upper Middle Dental can be directed to the Royal College of Dental Surgeons of Ontario at rcdso.org.

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CLINICIAN’S CHOICE Dental Products will present a series of continuing education (CE) classes this summer as part of its “Better Dentistry” lineup. Seminars will cover the latest restorative techniques and products with an eye on enhancing productivity and navigating the rapid changes in the profession.

“The seminar series is designed to expand knowledge, improve skills and efficiency, and teach new approaches to clinical challenges to provide the highest standard of care,” said Peter G. Jordan, president of Clinician’s Choice Dental Products. “Our commitment to teaching better dentistry allows our CE programs, presented by the industry’s leading and most respected key opinion leaders, to be second to none.”

The series will include:

  • July 26, Missoula, Mont: Clinical Problems… Solved! Provisionals and Final PVS Impressions with Gregg Tousignant, CDT
  • July 27, Helena, Mont: Clinical Problems…. Solved! Provisionals and Final PVS Impressions, with Gregg Tousignant, CDT
  • July 28, Billings, Mont: Clinical Problems… Solved! Provisionals and Final PVS Impressions, with Gregg Tousignant, CDT
  • July 28, Dublin, Calif: The General Practice Restorative Update 2017, with Stace Lind, DMD
  • August 4, Atlanta: The General Practice Restorative Update 2017, with Stace Lind, DMD
  • August 11, Spokane, Wash: The General Practice Restorative Update 2017, Stace Lind, DMD

More information including a complete list of events in the “Better Dentistry” series is available online. OnDemand CE webinars also are available online.

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Dental professionals who want to improve the oral health of their communities but don’t know how to get started can take advantage of resources from the National Children’s Oral Health Foundation: America’s ToothFairy. Its 2017-2018 Oral Health Education Program Project Guide offers ideas that often build upon each other, ranging from the simple to the complex, with little to no costs.

The guide is built upon the public health model with the understanding that people are influenced by the systems and supports around them when it comes to making healthy decisions and choices. Projects are based on 3 categories—changing beliefs, changing behaviors, and changing the environment—with the goal of making it easier for dental professionals to help communities that already struggle with maintaining oral health. 

“It’s a problem that we know how to solve. There’s a solution out there. It’s just a matter of engaging the dental community, and they’ve been so wonderful and supportive, and building upon that as well as promoting oral health to educate the public about its importance. Oral health often has been overlooked, and it’s so critical to one’s overall health,” said Jill Malmgren, executive director. “So there’s a great opportunity to really impact lives.” 

For example, the guide suggests that oral health beliefs can be changed via social media, posters and flyers, demonstrations, and “health clubs” at schools and community centers. Dental professionals also can document local issues, such as whether the community has fluoridated water, the number of available dental health professionals, and school nutrition data, using that information to build awareness or oral health needs in the community.

To change behaviors, oral health advocates could establish tooth-brushing programs in their local elementary schools so children can learn and practice effective oral hygiene habits. Backpack stuffing programs can provide students with toothbrushes and toothpaste to continue those practices, along with tooth-friendly foods. Meanwhile, bullying prevention programs can help those children who are teased for their poor dental health. 

By changing the environment, the guide explains, people in the community can more easily exercise habits and choices that improve their oral health. For example, advocates can address water fluoridation where it is missing or under threat. Sugar-sweetened beverages can be removed from school cafeterias and vending machines. And by establishing and replenishing hygiene closets at school, students in need can always have access to oral healthcare products.

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The Dental Wings iSeries Dental Impression Scanner allows dentists to go digital without changing their familiar impression-taking protocol while gaining access to a world of restorative opportunities normally associated with intraoral scanning. Likewise, laboratories can benefit from important workflow efficiencies and precision with in-lab impression scanning.

The technology was designed to address the varied constraints encountered when scanning impressions, including cases with deep narrow pockets frequently found with lower anteriors. The scanner features a powerful computer, according to the company, along with 2 on-board measuring cameras at complementary angles, 5 axes of movement, and a live video camera for previews.

Additionally, the iSeries integrates seamlessly with the DWOS Chairside CAD Software, which enables users to review and edit scans. The software also features scan alignment reviews and cleanings, automated proposals, design tools, and nesting and machining. Its .stl output can be used with any open in-office mill. And, dentists can specify customized material parameters for quality restorations.

For more information, visit dentalwings.com/wheretobuy.

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The FAM20B gene is necessary for cartilage development. But when it’s selectively removed in mouse models, higher states of mineralization result in enamel, and additional teeth begin to grow, according to the Texas A&M College of Dentistry. Now, researchers there will use a 5-year, $1.8 million grant from the National Institute of Dental and Craniofacial Research to explore their work’s implications.

“The supernumerary teeth phenotype was completely a surprise to everybody,” said principal investigator Xiaofang Wang, PhD, MDS. “Clinically, the presence of supernumerary teeth is a bad thing, as they can cause many complications. Scientifically, it is a good thing, because it reminds us that if we figure out the mechanism, we may use it to regenerate teeth and, of course, prevent supernumerary teeth.”

Wang’s lab will use the funding to study the signaling mechanism behind the formation of supernumerary teeth. The researchers hope their findings will advance their understanding of what’s happening at the molecular level in supernumerary tooth formation. They also note that the extracellular components known as proteoglycans that help control signaling in tooth development are present in nearly all tissues, potentially affecting multiple body systems.

“The novel link between proteoglycans and the regulatory signaling cascades that govern tooth formation is very exciting, as it opens a new window for the regulatory mechanism of tooth development,” said Rena D’Souza, DDS, MS, PhD, a collaborator and former biomedical sciences department chair now serving as associate vice provost for research at the University of Utah School of Dentistry.

Due to the complicated nature of the signaling network, Wang doesn’t want to presume that their findings could directly lead to tooth regeneration or the prevention of additional teeth. However, he does note that the findings could enhance their knowledge base in both of these areas.

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By kindergarten, 40% of children have been diagnosed with early tooth decay or cavities, reports the American Dental Society of Anesthesiology. Children at that age face significant anxiety in going to the dentist, though, which is why many practitioners use sedatives in treating them. Researchers at the Ohio State University in Columbus recently investigated common anesthetic regimens to determine the best course of care for reducing anxiety and uncooperative behavior in young patients to improve treatment.

Midazolam is the most commonly used pediatric sedative. The researchers examined the use of oral midazolam alone, nasal midazolam, and oral midazolam in combination with other sedative and analgesic medications in 650 cases during a 24-month period in a hospital-based pediatric dental clinic staffed by pediatric dentistry residents. The subjects included 333 boys and 317 girls. Success rates were determined by procedure completion, behavior during sedation, sedation effectiveness, and number of teeth treated.

Though the cases all were short in duration, all 3 regimens had completion rates of more than 85%. Oral midazolam alone was the most effective, followed by nasal midazolam and then the combinations. Fewer than 4% of cases involved post-procedural nausea or vomiting, and 62% of those involved the combination regimen. Paradoxical reaction, where the sedative caused the opposite effect due to the loss of emotional control, was only present in 6% of cases, with no significant difference among the regimens.

Overall, the researchers found all 3 regiments to be effective and safe for children undergoing dental procedures, with minimal side effects. The study, “Safety and Efficacy of 3 Pediatric Midazolam Moderate Sedation Regimens,” was published in Anesthesia Progress.

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The Planmeca USA ProMax 2D S3 panoramic x-ray system features anatomically accurate extraoral bitewings using patented Selectively Compliant Articulated Robotic Arm technology. This technology enables precise, free-flowing arm movements, permitting a variety of imaging programs not possible with fixed-rotation panoramic units, according to the company. It also allows for future 3-D upgrades. The system’s unique Autofocus feature automatically positions the focal layer using a low-dose image of a patient’s central incisors to capture an ideal panoramic image, minimizing retakes.

Also, open patient positioning and side entry are designed to minimize errors caused by incorrect patient positioning, allowing clinicians to monitor the patient freely from both the front and side. Side entry is designed for easy access for all patients, standing or seated. The triple laser beam system indicates correct anatomical positioning points to assist patient positioning as well. Plus, the full-color graphical user interface provides clear texts and symbols to guide users through the procedure. Settings are logically grouped and easy to understand, Planmeca says, speeding up imaging and allowing users to focus on their patients.

For more information, call (855) 245-2908 or visit planmeca.com.

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Candida albicans, a type of yeast, takes advantage of an enzyme produced by Streptococcus mutans to form a particularly intractable biofilm that can lead to early childhood caries. Now, researchers at the University of Pennsylvania School of Dental Medicine have pinpointed the surface molecules on the fungus that interact with the bacterially derived protein. Blocking that interaction impairs the yeast’s ability to form a biofilm with S mutans on the tooth surface.

“Instead of just targeting bacteria to treat early childhood caries, we may also want to target the fungi,” said senior author Hyun (Michel) Koo, DDS, MS, PhD, professor in the Department of Orthodontics and Divisions of Pediatric Dentistry and Community Oral Health. “Our data provide hints that you might be able to target the enzyme or cell wall of the fungi to disrupt the plaque biofilm formation.”

Candida can’t effectively form plaque biofilms on teeth on its own, nor can it bind S mutans, unless it’s in the presence of sugar. Children who consume sugary foods and beverages in excess are at risk for early childhood caries. The researchers previously discovered that the GftB enzyme, secreted by S mutans, uses sugar from the diet to manufacture glue-like polymers called glucans. Candida promotes this process, resulting in a sticky biofilm that lets the yeast adhere to teeth and bind to S mutans.

The researchers suspected that the outer portion of the Candida cell wall, comprising molecules called mannans, might be involved in binding GftB. So, they measured the binding strength between various mutant Candida strains and GtfB using biophysical methods. They found that the enzyme bound much more weakly to mutants that lacked components of the mannan layer than the wild-type Candida.

Next, the researchers examined the abilities of the mutant Candida to form biofilms with S mutans in a laboratory assay. The mutants that had impaired binding with GftB were mostly unable to form biofilms with S mutans, resulting in significantly fewer Candida cells and reduced production of the sticky glucans molecules.

Additionally, the researchers tested how stable the biofilms were when attached to a tooth-like surface. While low-shear stress, roughly equivalent to the force generated by taking a drink of water, removed only a quarter of the wild-type biofilm, the same force removed 70% of the biofilms with mutant Candida. When the forces were equivalent to a vigorous mouthrinse, the mutant biofilms were almost completely dislodged.

To ensure their findings translated to in vivo conditions, the researchers examined biofilm formation in a rodent model that can mimic the development of early childhood caries. When animals were infected with both S mutans and either of the wild type of defective mutant yeast strains, the researchers observed clear differences. While biofilm formation was abundant if the wild-type yeast was used, it was substantially reduced in animals infected with the mutant strain. More precise analysis revealed that these defective biofilms lacked viable Candida cells, and S mutans were reduced by more than fivefold.

According to the researchers, these findings point to a new direction for treatment of early childhood caries. The current standard of care, beyond the use of fluoride as a preventive approach, is to target only the bacteria with antimicrobials or to use surgical interventions if the tooth decay has become too severe. The researchers now are working on therapeutic approaches for targeted interventions with potential for clinical use.

“The disease affects 23% of children in the United States and even more worldwide,” said Koo. “In addition to fluoride, we desperately need an agent that can target the disease-causing biofilms and, in this case, not only the bacterial component but also the Candida.”

The study, “Candida Albicans Mannans Mediate Streptococcus Mutans Exoenzyme GtfB Binding to Modulate Cross-Kingdom Biofilm Development In Vivo,” was published by PLOS One.

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Dentists are turning to silver diamine fluoride (SDF) to prevent caries in children and adults alike. Fortunately, researchers at the University of California, San Francisco (UCSF), found that topical SDF was safe and effective in arresting dental caries in preschool children. Meanwhile, researchers at Rio de Janeiro State University agree that SDF is efficacious for caries prevention, compared to fluoride varnish.   

The UCSF study was a Phase III multi-site double-blinded randomized placebo-controlled trial with a pair of parallel groups and primary endpoint of caries inactivity 14 days after the intervention. Conducted in community settings in Oregon, 36 subjects were treated with a placebo, while 30 were treated with SDF. The researchers completed follow-up evaluations of 64 of the subjects. 

The subjects treated with SDF showed a 0.72 mean fraction of arrested caries, while those who received a placebo only showed a 0.05 mean fraction, which the researchers called a significant difference. While there were 4 adverse events in each group, none were attributed to the SDF. The researchers then concluded that topical SDF was effective and safe in arresting dental caries in preschool children.  

The Brazilian researchers reviewed 9 electronic databases, 4 registers of ongoing trials, and the reference lists of identified review articles to examine if SDF application results in caries prevention. They found 49 publications addressing randomized or quasi-randomized trials on SDF for caries prevention in primary teeth with at least 12 months of follow-up. After further review for potential bias, 4 trials met their inclusion criteria.

Two trials compared SDF to a placebo, one compared SDF to a placebo and to a sodium fluoride varnish, and one compared SDF to high-viscosity glass ionomer cement. After 12 months, glass ionomer cement was more effective than SDF, but the difference was not seen as statistically significant. After 24 months, SDF was more effective than the placebo and the sodium fluoride varnish. The researchers concluded, then, that SDF is an effective preventive treatment.

Jeremy Horst, DDS, PhD, of UCSF presented “RCT of Silver Diamine Fluoride for Caries Arrest in Children” and Branca Oliveira, DDS, of Rio de Janeiro State University presented “SDF for Caries Prevention in Primary Teeth: A Systematic Review” at the 95th General Session & Exhibition of the International Association for Dental Research at Moscone West in San Francisco in March.

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The United States Court of Appeals for the Fifth Circuit has ruled that Texas, Louisiana, and Mississippi may not enforce provisions that prohibit dentists from advertising as specialists in areas not recognized by the ADA. Ruling in favor of the American Academy of Implant Dentistry (AAID), the court said that such rules would be an unconstitutional restriction on the right to free commercial speech. The ruling affirmed a lower court decision by a 2 to 1 majority.

The lower court declared Texas administration regulation Section 108.54 of the Texas Administrative Code unconstitutional. The regulation restricts specialties in Texas to only those recognized by the ADA. AAID, along with 3 other dental organizations and 5 individual Texas dentists, filed suit challenging the regulation.

The Court of Appeals wrote that “Section 108.54 completely prohibits the plaintiffs (AAID, et al) from advertising as specialists in their fields solely because the ADA has not recognized their practice areas as specialties. The Board [Texas State Dental Board of Examiners] has not justified Section 108.54 with argument or evidence.” 

“This is a major step forward for patients throughout the Fifth Circuit. More information will now be available to help them decide who to use for their dental needs,” said AAID president Shankar Iyer, DDS, MDS. “Patients won’t need to guess whether a dentist who is trained in treating gum disease or extracting teeth is also experienced in the complex and comprehensive field of implant placement and restoration.” 

“This affirmation by the Court of Appeals clearly validates the recognition of Diplomate status earned through our board,” said Arthur Molzan, DDS, president of the American Board of Oral Implantology/Implant Dentistry. “Our requirements demand extensive knowledge of both the surgical as well as the restorative phases of implant dentistry.”

“This Court of Appeals decision continues a string of legal victories supporting the proposition that non-ADA recognized specialties in fact do exist, are bona fide, and dentists board certified in those fields such as implant dentistry may inform the public of their specialization,” said Frank Recker, DDS, JD, AAID general counsel.

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