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Brace Yourself for DIY Orthodontia

28 Aug 2015
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Do-it-yourself braces. Really. People are wearing orthodontia that they made themselves. No, they aren’t trained clinicians. They’re mostly teenagers who have seen videos of other kids doing it online, so they decided they could do it themselves too. And it’s not just a few people, either.

One popular YouTube video explaining how elastic bands could be used to move teeth has more than 830,000 views. Another one showing dental floss being used to tie teeth together has more than 780,000 views. A couple of videos explain how to remove your braces on your own using needle-nose pliers. And, quite a few clips show kids making “fake braces” for costume purposes or even just to be trendy.

(No, we aren’t linking to these videos. That would only encourage them.)

The detrimental consequences are obvious. Indeed, many commenters on these videos berate the posters and beg them to see a real orthodontist instead. But with an audience of hundreds of thousands, it’s difficult to say that their good advice is having any effect. So, we spoke with Dr. Juan Rendon, DDS, MSD, of Jefferson Dental Clinics to get a clinician’s view of this troubling fad.

Q: What is driving this trend of people making their own braces?

A: People are looking for aesthetics. They want to correct features that they consider unattractive, especially on their anterior teeth. There may be some kind of financial hardship and they cannot afford treatment. So, they do not want to reach out to the orthodontist. This also plays an important role for teenagers. Social media and the Internet are used to find the answers to their questions. They find media showing that there is an easy way to go themselves and might have a successful outcome.

Q: So social media is a major factor?

A: Yes, because they can look it up, and they’ll find instructions on how to do it. Normally the users show the good results, but they’re never going to show the bad results because they are going to be embarrassed, showing that something that they did was bad or caused some kind of damage.

Q: Is there anybody out there who got it right?

A: I’m not going to say it’s right. The space was bothering them, and somehow the space was diminished, made smaller. That might be considered successful, even though the tooth movement was not done properly, and the final root position and crown position is not adequate.

Q: What are some of the common “techniques” that these do-it-yourselfers are using on their teeth?

A: The most common technique is the use of rubber bands to close the spaces between their anterior teeth. They can use rubber bands from hairbands or they can even purchase orthodontists’ rubber bands online. The rubber band is stretched out around 2 or 4 teeth, and it will recover its original size, and the teeth will move together. That’s basically how they do it. They try to wrap the rubber band around the teeth and they’ll wait for the effect of getting them all together.

Q: What kinds of problems result from do-it-yourself braces?

A: Due to their elasticity, elastic rubber bands have a tendency to move toward the narrower portion of the tooth, to the gingival portion. This occurs because there is not an attachment mechanism to hold the rubber band in place, so the rubber band will be free to move around on its own. If undetected, the rubber band will initiate a foreign body reaction that can create aggressive, presumptive bone loss. Patients usually experience a painful sensation and inflammation at the interdental area. The rubber bands are not detected by x-rays. They are radiolucent, so locating them is more difficult. Other risks can include an allergic reaction to latex.

Q: So the rubber band can become so embedded that if these people go to their dentist, their dentist or hygienist might not spot it right away?

A: Sometimes they can’t even see it. These patients don’t tell the hygienist or the dentist that they have been using the rubber bands.

Q: How long does it take for some of these problems to manifest once patients have put on their own braces?

A: Once they put on the rubber bands, they’re going to have a lot of pressure. In a couple of hours, there will probably be pain, but it’s going to start to dissipate. The shape of the teeth determines how soon the rubber band is going to start going into the gingival portion. If the rubber band is left in contact with the soft tissues, the damages will continue to exacerbate. The longer they are there, the more and more damage they are going to cause.

Q: In some of these videos, it looks like the teeth have moved into place. Are they shifting, or is this an illusion?

A: As a result of the pressure created by the rubber band, the teeth will get together as they tilt toward each other. That’s not an ideal tooth movement. We want to have a controlled movement of the teeth, where there is no tipping or tilting. The roots should appear to be parallel to each other. When the rubber band slips into the gingival sulcus, it acts as a foreign body, resulting in an inflammatory reaction affecting the soft tissues and bone, thereby destroying the periodontal attachments. Basically, it’s an induced periodontal disease. 

Q: What happens to the teeth once the self-made orthodontia is removed?

A: Any dental movement without proper retention will tend to relax. The problem occurs when the rubber band is inside the gums. It is going to create bone destruction. Severe bone loss is also going to change the prognosis of the teeth. They might be really mobile. Construction might be needed at that time.

Q: So the patient runs the risk of losing the teeth.

A: Yes. When the rubber band embeds into the gingival tissue, the teeth will undergo severe periodontal damage. The teeth can get mobile and extrude. The rubber band will continue its displacement along the root, damaging all the supporting structures. The teeth may eventually become loose and have to be removed.  

Q: If a patient shows up at an orthodontist with these problems, what kinds of solutions will be required to fix them?

A: It depends on how bad the damage is. The rubber band could be treated by a combination of periodontal surgery and orthodontics. Moving the teeth when you have the periodontal support compromised is more difficult. Dentition eventually is going to have severe mobility and extrusion of the teeth. If the patient confirms that he or she has used rubber bands, and exploratory surgery by the periodontist may be indicated, you get cases where extraction of the affected teeth is recommended. The patient then may need orthodontic training to obtain adequate space for dental implants or restorative treatment.

Q: It sounds much more complicated than an otherwise healthy patient going in for a standard set of braces.

A: Yes, because they’re going to have to use all the specialties to first get the patient healthy and all the inflammation removed, and then you can proceed to determine if it’s a tooth you can save. Once it has healed, you can proceed with orthodontics and start moving the tooth to the normal position. But it’s going to be different, because the amount of bone support is different than a tooth that has all the bone surrounding the roots.

Q: Even if the situation is treated, could there still be long-term and permanent effects?

A: Yes, because if the rubber bands are given enough time to damage the periodontal tissue around the teeth, it’s going to change how the gums look. The prognosis is virtually decided by the separation of the dentition. In many cases, it’s going to influence the healing.

Q: What can the dental community do to put a stop to this trend?

A: We need to communicate with our community and our patients. They need to understand that when they do some kind of treatment on their own, there are side effects and risks that they cannot control. When trained personnel like orthodontists perform the treatment, the risks are minimized, and long-term stability is improved. Patients need to be more analytic of all the information they can get, especially if the procedures will change or affect their own body.

Dr. Juan Rendon completed his DDS degree at CES University (Medellin, Colombia) in 1989. He then continued his studies at the same university and completed his master’s degree in pediatric dentistry and interceptive orthodontics in 1995. He practiced and taught in Colombia until 2001 and then moved to the United States, where he received another master’s degree in orthodontics from Saint Louis University (Saint Louis, Mo) in 2004. During his residency in St. Louis, he also completed a one-year fellowship in the cleft palate and craniofacial anomalies program at the Cardinal Glennon Children’s Hospital. For the last 11 years, he has worked in the Dallas-Fort Worth area for large orthodontic groups and currently works as the orthodontic director for Jefferson Dental Clinics. He also has his private practice, Rendon Orthodontics, in Allen, Tex.

When tumors emerge in the jaw, surgeons typically implement a fibula free flap. They replace the section of jawbone and soft tissue where the tumor is located with a portion of the fibula. It’s a complicated reconstructive process completed in stages over a year or more.

But doctors at New York University’s Langone Medical Center have come up with a quicker option, trademarked as Jaw in a Day. Using computer-aided, 3-D surgery simulation, oral and maxillofacial surgeons plan the procedure to fit a dental prosthesis with laboratory-produced teeth that align with the patient’s natural teeth, all with near perfection.

Patients undergoing fibula free flap wake up with missing teeth. With Jaw in a Day, that section of fibula is outfitted with dental posts and prosthetic teeth, even while the bone is still receiving blood flow in the patient’s leg.

The piece of fibula is then taken from the leg and placed in the gap created by the removal of the tumor-covered jawbone, where it will fuse with the remaining bone and give the patient normal function. The patient wakes up with temporary prosthetic teeth that are replaced with permanent ones 6 to 12 months later.

“NYU Langone has performed eight procedures, and we expect the program will continue to grow,” said Dr. Jamie Levine, a plastic and reconstructive microsurgeon and chief of microsurgery at NYU Langone. He also was on the first Jaw in a Day surgery team. “We’ve made significant improvements in the technology since we’ve started, working closely with 3D Systems, that allow for extremely accurate placement and outcomes.

Based in Colorado, 3D Systems works with NYU Langone and the University of Mississippi Medical Center (UMMC) to generate images included in a virtual surgical plan that is very specific to each Jaw in a Day patient. The JPS Health Network in Fort Worth, Texas, has performed the procedure as well.

Patients who don’t get surgery will have trouble chewing and increasingly suffer pain and bone tissue destruction. Tumors can grow so large that patients will lose jaw function. Faces can become swollen and disfigured, and airways can be affected.

Jaw in a Day surgery can last up to 12 hours. The surgical team begins by completely removing the tumor and affected portion of jawbone. Then, the team cuts into one of the patient’s legs to expose the fibula, which isn’t needed to support a person’s weight and will heal itself.

Surgeons use the digital plan to place dental posts in the fibula while the bone is still inside the leg and receiving blood. Prosthetic teeth that have been shaded to match the patient’s own teeth are placed on the posts.

“A millimeter too high or low can make a difference,” said Dr. Mohammed Qaisi, assistant professor in the department of oral and maxillofacial surgery in the UMMC School of Dentistry. “Everything is planned to the smallest detail. We’re so specific with our technology that we can fit each cuspid and molar on the fibula before it’s placed in the jaw.”

Once the section of fibula with the posts and teeth has been moved to the jaw, the surgeons use a microscope and hair-thin needles to connect blood vessels so the new bone and tissue will have good blood supply. They also make sure the bone fits with the adjacent bone and the teeth fit with the adjacent and opposing teeth.

During the subsequent intensive care, nurses check the jawbone every hour to ensure good blood flow and that no clots have formed. Patients go home in 7 to 10 days and are closely monitored over the following 4 months. Doctors perform a CT scan at 4 months to make sure the bone has fully fused. But the surgery’s success depends just as equally on its preparation.

“You have to see that end result digitally, before the procedure is done,” said Dr. Harold Kolodney, a maxillofacial prosthodontist, professor of dentistry at the UMMC School of Dentistry, and professor of oral oncology at the UMMC department of otolaryngology and communicative sciences in the School of Medicine. “During the procedure, someone is working on the patient’s leg at the same time that someone is working in his oral cavity.”

Insurance generally covers the tumor removal and jaw replacement. However, it doesn’t cover implantation of the dental posts and prosthetic teeth because it is considered cosmetic. Patients must come up with about $10,000 for the implants and teeth or go without them.

“This is not cosmetic,” Qaisi said. “They have no choice but to lose part of their jaw.”

“It would be harder to go for 6 months to a year without having some of your front teeth,” Kolodney said. “This surgery immediately gives them teeth on an interim basis.”

“Anything that disfigures our face has an enormous impact on our lives,” said Fayette Williams, DDS, MD, of the JPS Health Network. “Tumors of the face strike at our identity. What if you couldn’t smile? What if people couldn’t understand you when you spoke? This is about quality of life.”

“I was in the hospital for 11 days and was back at work three weeks after that,” said Stacy Bledsoe, a patient at the JPS Health Network who was diagnosed with ameloblastoma. “I feel great.”

“There have been days that I’ve thought about the what-ifs,” said Jacob Reeves, who suffered from an ameloblastoma tumor removed by Qaisi and his team. “But I’m really happy that I took this path.”

 

Today’s oral cancer detection products typically rely on revealing abnormalities or detecting HPV. Yet these tests aren’t necessarily accurate or timely, discovering dangers sometimes long after they are underway. Driven by a passion for science and personal challenges, Matthew Kim believes dentists can do better.

“It’s that standard of care that’s so lacking that hasn’t impacted the high mortality rates that have existed for decades. That contributes to the late-stage intervention that causes 40% to 50% mortality with late-stage treatment,” he said.

Kim is the founder, chair, and CEO of Vigilant Biosciences. Its OncAlert Oral Cancer Risk Assessment System uses protein biomarkers to identify patients’ risk for developing the disease. Its swish-and-spit procedure is as easy as a pregnancy test too, requiring little training or time during a typical dental checkup.

Its simple potential for early detection could have a huge influence on reducing the suffering of those diagnosed with oral cancer, which total 45,750 each year in the United States, says the Oral Cancer Foundation. When caught early, oral cancers have a survival rate of 80% to 90%. But the trick lies in that early detection.

“There’s no symptom of oral cancer per se. It could be a lesion. It could be a trauma from a coffee burn or you biting into your cheek. It could be ill-fitting dentures, coarseness of breath,” Kim said. “As a result, it often gets overlooked or misdiagnosed. So when they realize it’s cancer, more often than not, 2 out of 3 times, they’re catching it a late stage, stage 3 or stage 4.”

According to Kim, the OncAlert Oral Cancer Risk Assessment System is the first and only test that uses a tumor-initiating biomarker to assess the early development of oral cancer specifically, accurately, and cost effectively, as opposed to uncovering other oral health issues such as an infection or trauma.

“You have the light-based systems. There’s a variety of them on the market and coming onto the market. They provide an enhanced view of what can be visible. But it does not tell you if what you are seeing is a leukoplakia, trauma, or oral cancer,” Kim said. “As a result, they are very poor in their accuracy for objective assessment of an oral cancer developing in the mouth.”

Kim sees flaws in other detection systems as well. For example, he says that salivary and lab-based tests only detect HPV without telling if that infection is going to develop into cancer. Other tests require lesion validation, but dentists must find those lesions first, again failing to meet the unmet need for early validation.

The OncAlert Oral Cancer Risk Assessment System comprises 2 components: the qualitative Rapid Point-of-Care (POC) Risk Assessment Test and the quantitative CD44 + Total Protein Lab Test (Lab Assay). Dentists and hygienists can administer either test prior to other treatment during a routine checkup. Patients swish a saline solution for 5 seconds, gargle for 5 seconds, and spit into a cup.

When personnel are administering the POC Risk Assessment, they insert a test strip into the cup. Within minutes, the strip produces a color change that shows whether or not the patient has the biomarkers indicating risk of oral cancer.

“We don’t want to obsolete the conventional oral exam, which dentists still need to continue to do,” said Kim. “But our test can elevate and be disruptive in what it can do, but it’s very minimally disruptive in the fact that it can be seamlessly integrated into the current protocol in a clinician’s office.”

If the POC Risk Assessment shows the potential for oral cancer, the dentist will direct the patient to see a specialist like an oral surgeon or an ENT physician who will use the Lab Assay. There, the patient will rinse and spit the solution again. After it has been dipped, the physician will send the strip to a reference lab.

“The reference lab will actually give you the exact concentration of our biomarkers,” Kim said. “They can tell the patient that they’re at, for example, twice or 5 times the likelihood or 10 times or 25 times the likelihood of developing oral cancer.”

The system is not a diagnostic tool, Kim notes. However, he does say that it can be a very useful tool for avoiding behaviors that put patients at risk for oral cancer. Its physical evidence of biomarkers could inspire patients to cut back on tobacco and alcohol consumption, for example, or practice safer sex.

“We have some data where interventions such as a smoking cessation program actually reduced the levels of these biomarkers and therefore reduce your likelihood of developing oral cancer,” he said. “We also have data that shows that if you increase healthy lifestyle habits such as eating a green, leafy salad once a day, that will also help you reduce those biomarker levels.”

Later this year, Vigilant Biosciences will publish its data as part of its CE studies. Kim cites encouraging results from the University of Miami, which tested the biomarkers on close to 500 patients to date reflecting more than 15 years of research. The proof of concept studies have produced specificity as high as 95%, which indicates a 5% false positive rate, and sensitivity of about 88%, or a false negative rate of about 12%.

“We’re very excited about the accuracy of the test, especially when you compare that to the standard of care, which is far below that. When you look at the other adjuncts and their ability to specifically and accurately assess oral cancer risk versus a lesion or HPV or an abnormality, ours is far and away the superior product,” he said.

Patients who go to their dentist expecting a cleaning and get surprised by a positive biomarker reading should not panic, though. For example, if there’s a physical or visual symptom along with the biomarker indication, patients would follow up with a specialist. If it is positive with no physical or visual symptom, patients would be asked to return in one to 3 months, depending on their clinical presentation.

“And if they are a tobacco user or a heavy drinker, we would provide some information to encourage them to adopt more healthy lifestyle choices so that they may reduce their level of risk of possibly developing oral cancer,” Kim said.

Kim is familiar with how an unhealthy lifestyle can lead to such as diagnosis. Both of his parents were oral cancer survivors. His father didn’t have an HPV infection, but he was a lifelong smoker and drinker, passing away earlier this year. These habits, Kim said, exponentially increased his odds for developing the disease.

“But he was also a poster child for early detection,” Kim said. “He found it early and they were able to treat it, and he only had to undergo one round of treatment. The result of that was very successful, and he lived 15 great years as a result of that early intervention.”

His mother’s story, though, was perhaps more compelling in his drive to found Vigilant Biosciences and develop a detection system. She is currently a 5-year survivor of oral cancer.

“She was not a tobacco user or drinker. She was not infected with HPV. If anything, she was a chronic secondhand smoker,” he said. “Unfortunately, like most people who find out they have oral cancer, hers wasn’t really identified until it was a late stage.”

As a result of that late diagnosis, she had to undergo several rounds of aggressive treatment, including chemotherapy, radiation, surgery, and reconstruction. Kim witnessed first-hand how the disease and its treatment affected her ability to speak and eat, in addition to the social stigma of reconstruction.

“It’s a new normal, and it requires a major adjustment to do a lot of the things that we take for granted every day—the inability to speak, eat, drink the things that we want, to smile, and to just interact socially the way that we do on an everyday basis,” he said.

Surprisingly, Kim is not a dentist or a doctor. He is an attorney with a bachelor’s degree in biology from Washington University in St. Louis and a JD from Georgia State University. During college, though, he was fascinated by science and medicine as well as their research and application.

“When I went into law school, I had a very strong interest in intellectual property,” he said. “I started off interning my way through law school at the tech transfer office at the Centers for Disease Control and Prevention (CDC), and that was a great nexus between business law and science.”

During his tenure with the CDC, Kim worked on a novel drug platform that converted high-end biologics into an aerosol that could be used to deliver them very efficiently to the lungs. After leaving the CDC and entering the private sector, he licensed out the technology and launched a startup called AerovectRx.

Kim also was the founder of IP Guidance, a strategic intellectual property asset management consulting group. Additional medical commercialization experience includes the development of a point-of-care continuous glucose monitor, a noninvasive bilirubin detection for jaundice, a noninvasive diabetes screening system, and a novel imaging technology for cervical cancer screening.

Vigilant Biosciences, however, is only just beginning. Kim says that the company has data indicating its biomarkers can be leveraged as a platform for detecting other cancers that have common risk factors such as tobacco use, alcohol consumption, and HPV, and it is looking to develop that pipeline in its long-term corporate development.

“We are an oncology-focused company, really focusing on early intervention and enabling early intervention and detection for improving outcomes,” he said.

As for the OncAlert Oral Cancer Risk Assessment System, Vigilant Biosciences is in close discussions with the Food and Drug Administration and is exploring a variety of opportunities and go-to-market strategies depending on the claims that it would like to make. It already has distribution deals in France, Algeria, Morocco, Tunisia, Scandanavia, Korea, and New Zealand.

“Our current path shows that we will have the Lab Assay on the market in 2016. We hope to have our Point-of-Care Assay shortly after that,” he said.

Education will be a challenge, though. Vigilant Biosciences conducted a survey of 1,050 US consumers and found that 68% knew little or nothing about oral cancer, and only 36% were screened during their last dental checkup. Yet the survey also found that consumers want to learn more about how to prevent oral cancer and are interested in simple, effective screening tools to assess their risk.

In fact, more than 80% would like to be screened for oral cancer at every dental checkup. More significantly, 85% would be in favor of simple rinse and spit screenings like Vigilant’s and would be willing to pay $25 or more for them. However, less than 24% recall talking to their dentist about oral cancer risks at their last checkup.

“We want to continue to leverage the efforts of the ADA and the Oral Cancer Foundation and the CDC in promoting awareness of oral cancer and the behaviors that put people at risk,” Kim said. “I think the challenge is to educate the marketplace on where our product can truly address the current unmet need of early intervention.”

Once that education is accomplished, Kim is bullish about the future of the company and the future of people who may develop the disease.

“It’s been incredibly exciting to know that this technology is finally going to be in the hands of clinicians and benefit so many patients’ lives so that people will have better outcomes with oral cancer and will not have to endure as aggressive a treatment as my mother had to go through,” he said. “I just can’t be more excited about where we are today and where we are headed and beyond.”

Have you ever been online searching for a new repair service, and after visiting a few websites, you notice the same image of the smiling young woman wearing a headset, ready to take your call? Or maybe you have searched for a more professional service like a new accountant or an attorney, and you saw the same photo of a diverse group of business people wearing suits and standing together, ready to take you on as one of their clients. 

Most patients want to feel connected with your practice. The best way to achieve this is through real imagery. Yes, stock imagery is more cost effective. However, there is no better way to engage your patients than through your practice’s personality.

Photographer Bob Thompson of Thompson Brand Images has been producing creative and incisive images for businesses and individuals for more than 20 years. He has 5 pointers for building your brand and, thus, your dental practice with authentic images.

Market to Fit Your Practice’s Personality

You want your prospective patients to get a good feeling about your practice from the moment they land on your homepage. Cohesive color schemes and lighting effects in your images are a good place to start. Perhaps you have already considered these factors in selecting your stock imagery, but too much of a difference from how your practice really looks can have a more intuitive patient heading right back out the door. 

Visually Introduce Your Staff on Your Website 

Putting names to faces ahead of time can help allay some of your new patients’ anxieties when it comes to seeing the dentist. Remember to tie these photos into your office’s overall theme, having employees wear colors that match or contrast effectively with the office colors. And, of course, smile!

Use Camera Phones to Inspire Consumer Confidence

Dental marketing through social media is becoming standard practice. A quick, candid snapshot and caption can go a long way in boosting your brand. Make sure you review your photos and select only the clearest, best-lit ones to publish. Also, don’t forget to include a heartwarming story.

Match Your Illustrations with Your Message

Finding an image to match the message on your website is a massive challenge. Instead, take photos of what actually happens in your dental practice. Then, describe what those photos are portraying.

Avoid Too Much Staging

Try to take candid photos, even when photographing your staff, so your practice will look more trustworthy than if everyone is staged and unnatural. Just make sure no one is frowning or upset in the photos you ultimately use 

What’s Next?

The more professional and consistent your online dental marketing is, the more patients you will attract to your practice. Prospective patients want to see what sort of atmosphere they will be treated in, what kind of work is done, and what sort of people will be treating them. Only original images can successfully show your clients these highly influential factors.

With over a decade of experience in corporate dental laboratory marketing and brand development, Jackie Ulasewich decided to take her passion for the dental business and marketing to the next level by founding Vantage Point Partners. Since starting her company, she and her team have helped a wide variety of business owners all over the nation focus their message, reach their target audience, and increase their sales through effective marketing campaigns. When she isn't helping business owners reach their full potential, she can be found at the beach with her three dogs or immersed in everything food-related with her large Italian family. To learn more about how she can help you strategize and optimize your marketing activities, call (352) 428-9144 or email This email address is being protected from spambots. You need JavaScript enabled to view it..

The National Institute of Dental and Craniofacial Research (NIDCR) administers millions of dollars in grants each year. But how does the organization determine which research gets funded? It starts with your input.

As part of its budget planning process for fiscal year 2017, NIDCR is identifying topical themes for development into research initiatives. During the process, it welcomes feedback from its scientific advisory boards, the extramural community, interested organizations, and the public at large.

Institutes and centers use initiatives to communicate future research goals to the National Institutes of Health, the Department of Health and Human Services, and Congress. NIDCR begins the initiative development process by identifying broad research topic areas, or themes. It then develops a specific initiative proposal for each theme, considering the input received.

“Initiatives are not a complete picture of the institute’s planned research portfolio for the year indicated, nor do they signal that themes highlighted the previous year have been abandoned,” said Martha J. Somerman, DDS, PhD, director of NIDCR.

“Several initiatives from last year have become formal funding opportunities and are posted on NIDCR’s website. Others are still under development. Proposed FY 2017 initiatives will be integrated into this larger landscape as they are considered for funding,” Somerman explained.

NIDCR has proposed 5 themes:

  • Factors Underlying Differences in Female and Male Incidence Rates for Certain Dental, Oral, and Craniofacial Diseases
  • Glycoprofiling HIV and HIV/AIDS-related Oral Pathogens that Persist During Antiretroviral Therapy
  • Tailoring Dental Treatment Guidelines for Patients with Genetic Disorders and Other Conditions Known to Impact Oral Health
  • Three-dimensional Dental, Oral, and Craniofacial Tissue Models to Mimic Human Diseases
  • Wireless Biosensors in the Oral Cavity for Precise, Individualized Medical Care

When identifying themes for potential funding initiatives, NIDCR considers scientific opportunity, alignment with the mission and goals of the institute’s strategic plans, robustness of the existing portfolio into a particular theme area, both currently and in the year and under consideration, and current budgetary climate.

Comments and suggestions related to these specific themes may be sent to This email address is being protected from spambots. You need JavaScript enabled to view it.. Suggestions for additional topic areas and comments on the process for developing research initiatives may be sent to the same email address. Comments and suggestions must be received by Friday, Sept. 4, 2015.

Mercury has a toxic reputation. But it looks like dentists have little to fear, according to a report in the September issue of JADA, as researchers investigated the effects of chronic occupational exposure to elemental mercury (Hg0). The objective was to evaluate the association of occupational Hg0 exposure with multiple sclerosis (MS) and tremor.

The study included 13,906 dentists who attended the ADA’s annual meeting over 24 years (1986-2007 and 2011-2012). Participants reported MS and tremor and provided urine specimens for Hg0 analysis. The authors estimated mean Hg0 exposures over time and used logistic regression to estimate the associations of 3 Hg0 exposure measures with MS or tremor.

Among participants, 0.18% reported MS and 1.24% reported tremor. Hg0 exposure was not associated with MS (odds ratio [OR] per 191 µg per liter in cumulative Hg0 exposure, 0.85; 95% confidence interval [CI], 0.39-1.85). Increased prevalent risk of tremor was found with exposure to both urinary Hg0 exposure (OR, 1.10 [95% CI, 1.00-1.22]) and cumulative Hg0 exposure among younger dentists (less than 51 years old; OR, 1.13 [95% CI, 1.05-1.22]).

The researchers concluded that occupational Hg0 exposure in U.S. dentists has decreased over time and is now approaching that of the general population. Results suggest a positive association between Hg0 exposure and tremor. The authors say studies with more sophisticated outcome and exposure measures, including more retired dentists, would provide critical information toward understanding the relation of Hg0 exposures to MS and tremor risk.

“We view this paper as a very positive finding in showing that dentists today are at a minimal risk for adverse neurological effects through their practice of dentistry and use of amalgam,” said Stephen E. Gruninger, MS, study co-author and senior research fellow at the ADA Science Institute.

In September, the ADA Health Policy Institute will ask dentists via email to complete an online survey related to the study. It will inquire about neurological health and diseases that may be associated with mercury exposure. Results will be used for further investigation.

The ADA Science Institute, Rush University, and the University of Illinois at Chicago conducted the research using data from the ADA Health Screening Program. Authors also included Julia Anglen, MS; Hwai-Nan Chou, MS; Jennifer Weuve, ScD; Mary Ellen Turyk, PhD; Sally Freels, PhD; and Leslie Thomas Stayner, PhD.

 

Even little investors have something to smile about this week despite the stock market’s wild ride. If today’s 6-year-olds invest all the money they receive from the Tooth Fairy, they could be sitting on a combined total of roughly $70 billion by the time they reach 67, according to Delta Dental Plans Association—that’s $21,000 per child, if they invest everything they find under their pillow.

According to Delta’s Original Tooth Fairy Poll, the Tooth Fairy visited 81% of the homes in the United States, with 3.35 million gifts for the 4.1 million 6-year-olds out there. (The average age of the first tooth loss is 6 years old.) According to Delta Dental, the average Tooth Fairy gift is $4.36 per tooth. Delta then calculated 6.5% in-mouth inflation (the typical increase for Tooth Fairy gifts from year to year) for each subsequent tooth and a 9.6% return based on historic S&P 500 performance.

Retirement savings vary by region. With an average 2014 Tooth Fairy gift of $4.16, kids in the Northeast will see $20,477. Midwesterners, who get $2.83 per tooth, will tally $13,910. In the South, the $5.16 gift will yield $25,362. Out West, a $4.68 gift will produce $23,004 in earnings.

The 2014 average of $4.36 per tooth is up 24.6% from 2013’s average of $3.50. Also, the Tooth Fairy gave a total of $255 million in 2014. Overall, in 11 of the past 12 years, the trend in average giving has tracked with the S&P 500’s movement too. Around the world, Japanese teeth are good for 525.32 yen. Teeth in Ireland and Spain get 3.87 Euros. English teeth are worth 2.83 pounds each. And in Canada, a tooth will get you $5.78.

Delta releases the results of the Tooth Fairy Poll to help promote good dental hygiene habits that encourage healthy smiles. It surveys more than 1,000 primary caregivers via email interviews with a sample designed to capture a broad spectrum of the U.S. population, not just those with dental insurance.

“We’re happy that, in addition to money, the Tooth Fairy is leaving gifts that help get kids excited to brush and floss their teeth,” said Jennifer Elliott, vice president of marketing at Delta Dental Plans Association. “Delta Dental also encourages parents to introduce the Tooth Fairy as a way to discuss the importance of good oral health habits even before a child loses the first tooth.”

Researchers at the University of North Carolina are working with Xintek Inc. to develop a clinically viable 3-D intraoral imaging system, with the potential of changing the way dental radiographs are taken in the future. If successful, the researchers say, patients would benefit from improved diagnostic outcomes.

“This work is important in dentistry because, for the first time, we may have a device that can actually improve the detection of dentoalveolar disease without increasing the dose to the patient,” said Dr. Enrique Platin, clinical professor in the UNC School of Dentistry’s department of diagnostic sciences and one of the lead researchers on the project.

The experimental technology is based on dental tomosynthesis and a UNC-invented method of x-ray generation. Dental tomosynthesis uses a limited number of radiographs taken from different angles to produce a series of images that lets the dentist visualize the patient layer by layer.

“The innovation of the current technology lies in the new x-ray generator developed at UNC, which is based on carbon nanotube technology,” said Dr. André Mol, clinical associate professor in the department of diagnostic sciences and lead researcher on the project.

“This generator resembles a regular x-ray source. But instead of having one focal spot, it has multiple focal spots that can be fired in sequence to rapidly obtain images at different angles without the need to move the source,” Mol explained. “Development of advanced reconstruction algorithms has resulted in high-quality image slices of dentoalveolar hard tissues.”

As a result, dental professionals can move through the structure, revealing hidden anatomical details. Preliminary results show the technology can deliver rapid, low-dose, high-resolution 3-D images. Initial evaluation indicates improved detection rates of proximal caries. Further studies are planned to assess the diagnostic efficacy of the system for root fractures, periodontal lesions, and other dentoalveolar diseases.

The team consists of Drs. Otto Zhou, Jianping Lu, and Jing Shan and Gongting Wu of the UNC Department of Physics and Astronomy; Pavel Chtcheprov of the Department of Biomedical Engineering; Drs. Platin, Mol and Lars Gaalaas of the UNC School of Dentistry Department of Diagnostic Sciences; and Dr. Andrew Tucker of Xintek Inc., Research Triangle Park, N.C. Funding for this research was provided by the National Institutes of Health through a Small Business Innovation Research grant and with aid from the Department of Physics and Astronomy.



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