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Researchers at Tokyo Medical and Dental University have injected a gelatin-based gel carrying the peptide OP3-4 and recombinant human bone morphogenetic protein 2 (BMP-2) into the jawbones of mice to trigger local augmentation of bone around the injection site, promising potential nonsurgical treatment for alveolar bone loss.

BMP-2 has been used before to stimulate osteogenesis in humans, but high levels can cause inflammation and tumor development. OP3-4, meanwhile, has been shown to inhibit bone decay and stimulate the differentiation of cells that form bone.

By injecting these agents, the researchers avoided the need for surgical implantation, swelling, and other complications. They saw a region of increased bone mass around the BMP-2 and OP3-4 injection site that was larger than that seen in mice injected with BMP-2 alone or with other controls.

Additionally, the mass had significantly higher bone mineral content and density. Microscopic examination revealed the deposition of calcified tissue, or mineralization, throughout the newly formed bone of the mice treated with BMP-2 and OP3-4.

“Mineralization of the outer region evidently took place before that of the inner region,” said lead author Tomoki Uehara. “We speculate that the size of the new bone is determined before calcification starts and that OP3-4 plays an important role in making a regeneration site at the early stage of bone formation.”

“OP3-4 further enhanced the number of bone-forming cells induced by BMP-2 treatment and greatly increased the expression of genetic markers of bone formation,” said corresponding author Kazuhiro Aoki, DDS, PhD.

The study, “Delivery of RANKL-Binding Peptide OP3-4 Promotes BMP-2-Induced Maxillary Bone Regeneration,” was published by the Journal of Dental Research.

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Persistent orofacial pain, which is defined as pain in the face that lasts more than 3 months, affects about 7% of the population in the United Kingdom. Yet these patients often need to see different medical and dental practitioners during an average timeframe of 6 months at a cost of £642 (about $846) before they get effective treatment.

More rapid care, then, could relieve their suffering sooner and save the National Health Service millions, according to Newcastle University. This alleviation would begin by screening patients with a well-established chronic pain scale to ensure those most severely affected immediately receive specialist care.

The university interviewed 198 patients who also completed the graded chronic pain scale (GCPS) questionnaire to measure what treatment that they had received in the previous 6 months. Patients who ranked “high” on the GCPS were considered to have significant pain-related disability and needed more care.

These high-ranking patients should be referred to a specialist in a central hub for care, according the researchers. Patients who have low levels of disability based on their questionnaire results would be seen and treated by a range of healthcare professionals in regional clinics.

“It is likely that this hub-and-spoke model would be more efficient and effective for patients but can only work if there is investment and enough experts are recruited,” said Justin Durham, PhD, senior lecturer and National Institute for Health Research clinician scientist at Newcastle University.

“Ultimately, it is likely this model would provide faster, more effective treatment for patients but at a lower cost,” Durham said.

The study, “Healthcare Cost and Impact of Persistent Orofacial Pain,” was published in the Journal of Dental Research.

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Dentists who need assistance with food, water, clothing, and shelter in the wake of the recent flooding in Louisiana can seek immediate aid from the ADA Foundation’s Emergency Disaster Grant Program. The program can quickly provide up to $2,000 in aid to those dentists in declared disaster areas.

Dentists may apply by submitting an application form directly to the ADA Foundation. The application is available at adafoundation.org. Dentists do not have to be members of the ADA to receive aid. Also, the Louisiana Dental Foundation is offering disaster grants and a list of disaster preparedness and recovery resources for all dentists.

The ADA has additional information on disaster recovery and emergency planning at ADA.org. The ADA Foundation and accepts contributions for its Emergency Disaster Grant Program. To donate, call (312) 440-2547 or visit adafoundation.org/en/how-to-help. Donors can contribute to the Louisiana Dental Association Foundation as well.  

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The growing threat of antimicrobial resistance (AMR) could reduce or even eliminate the effectiveness of many common medications, putting people’s health and lives at risk. In response, global health experts have banded together to urge the United Nations to set global targets for reduced antibiotic consumption.

According to their recommendations, countries should consume no more than the current median global level of antibiotics, which is 8.54 defined daily doses per capita per year. This amount would reduce global antibiotic use by more than 17.5%, they say. Each country would have to determine its own strategy for reaching that goal.

In lower-income and middle-income countries that lack public health infrastructure, improving public health and sanitation could reduce antibiotic use. But wealthier nations, which often exceed the 8.54 dose target, will require public educational campaigns directed at physicians and patients alike to discourage the inappropriate use of antibiotics.

The experts note that the general public often doesn’t know when antibiotics should be used. In a recent European Commission survey, 57% of respondents incorrectly answered if antibiotics can kill viruses. In a recent US survey, 40% said antibiotics were the best treatment for a runny nose or sore throat.

“We need to measure progress and have some idea of what progress will look like,” said Ramanan Laxminarayan, PhD, MPH, lead author and director of the Center for Disease Dynamics, Economics & Policy in Washington, DC. He also noted that targets are the only way public officials will be able to tell if their efforts are working.

The United Nations will discuss strategies for preserving global access to effective antimicrobials during its September 21 General Assembly meeting. Laxminarayan believes this meeting is important because AMR isn’t an imminent threat like Zika or Ebola, so people don’t have a sense of how it could affect them personally.

“Getting people to respond to a problem that is creeping up slowly,” he said, “is difficult.”

The researchers estimate that $5 billion would be needed annually to develop new vaccines that would reduce the need for antibiotics, diagnostic tools that can determine the nature of an infection more quickly, and novel alternatives to antibiotics. New antibiotics are needed but aren’t a long-term solution, they said, because resistance to them will develop quickly.

To supervise these efforts, the authors call for the creation of a high-level coordinating mechanism that would bring together the World Health Organization, the UN Food and Agricultural Organization, the World Organization for Animal Health, and other UN agencies and stakeholders to coordinate support for the development, implementation, and monitoring of national AMR plans.

“Having goals is one thing, but having the architecture is absolutely critical,” said Laxminarayan.

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Surindar “Sindi” Bhaskar, DDS, who served as a major general in the United States Army Dental Corps before retiring, died on August 4, 2016 at the age of 93 in his home in Monterey, Calif. He was an oral pathologist, an educator, a periodontist, an author, and the first Asian-born general in the United States military.

Bhaskar was born in the state of Punjab in Northern India in 1923. He completed dental school at the University of Punjab by the age of 19 years and then practiced general dentistry in Bombay. At the age of 21, he came to the United States to attend the Northwestern University School of Dentistry, where he received his DDS in 1946.

Next, Bhaskar completed his master of science and doctor of philosophy degrees as well as specialty training in oral pathology and oral medicine at the University of Illinois and the University of Chicago. He entered the U.S. Army Dental Corps in 1955, serving in numerous positions and rising to the rank of major general before being promoted to chief of the corps and assistant surgeon general for dental services.

Additionally, Bhaskar was a professor at Georgetown University School of Medicine and Dentistry and wrote more than 200 scientific papers and 4 textbooks. After retiring from the military, he entered a residency to obtain a certificate in periodontics at the UCLA School of Dentistry, VAMC Wadsworth, which he completed in 1980.

Later, he practiced periodontics with the Monterey Peninsula Dental Group. An internationally renowned lecturer on oral pathology and periodontics, he delivered more than 10,000 hours of education before retiring in 2005. He was awarded the Legion of Merit and the Meritorious Service Medal for his work as well.

Bhaskar is survived by his wife, Norma; his sons, William, Philip, and Thomas; his brothers, Kedar, Som, and Prem; and his grandchildren, Elizabeth, Brian, and Emma. He was laid to rest at Arlington National Cemetery with full military honors.

Memorial donations may be sent to the S. N. Bhaskar Scholarship Endowment at the University of the Pacific Dugoni School of Dentistry, Development Office, 155 Fifth St., San Francisco, Calif. 94103.

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Debra Zafiropoulos, RDH, a proponent for the early detection of oral cancer, is continuing her advocacy efforts by launching the nonprofit 501(c)(3) National Cancer Network.

“Dental professionals are the early warning system of the healthcare profession because we see our patients on an average of once a year, and they spend a lot of time in our chairs,” said Zafiropoulos.

“In addition to conducting a thorough oral exam, we can be paying closer attention to any abnormalities we notice on the patient’s skin or any complaints described in their patient history form such as persistent sore throat, cough, zone tingling or tenderness,” she said.

When something suspicious is discovered, Zafiropoulos said that it is the responsibility of all dental professionals to integrate with other allied health professionals and make the appropriate qualified referrals sooner rather than later.

“By taking the initiative to break down the silos between the various healthcare disciplines, we can significantly reduce the mortality rates of a wide variety of cancers,” Zafiropoulos said.

The National Cancer Network will focus on consumer awareness and professional training in the form of live patient screening events and professional training courses throughout the country, including the introduction of a new exam protocol.

The group’s first event will be held in conjunction with the First District Dental Hygiene Society component of the Tennessee Dental Hygienists Association on September 16 in Kingsport, Tenn.

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The Professional Conduct Committee of the United Kingdom’s General Dental Council (GDC) has removed Desmond D’Mello from its register of dental professionals, meaning he is no longer allowed to practice. The organization found the dentist guilty of 55 of 56 alleged infection control breaches that prompted the National Health Service to recall thousands of patients for blood tests.

A whistleblower at D’Mello’s Daybrook Dental Practice in Nottingham filmed him committing these violations, which included:

  • Failure to maintain basic standards of infection control, such as wearing the same surgical gloves to examine different patients, not wearing a new surgical mask, not washing his hands between patients, and not sterilizing dental equipment after each use;
  • Failure to ensure that good infection control practices were followed by the staff working with him, such as allowing them to operate computers while wearing surgical gloves and failing to ensure surfaces and equipment were thoroughly cleaned after each patient;
  • Prescribing antibiotics without a thorough assessment of the patients’ needs.

“His failures to maintain appropriate cross infection controls in his treatment, such as failing to wear or change his gloves and surgical mask, and wiping his hands on his tunic and trousers instead of washing them, enabled him to sustain what was a contemptible circus of gravely hazardous practices that placed his patients at serious risk of infection,” said Gavin Scott, chair of the Professional Conduct Committee.

“Once the risk of exposure to infection had been realized, more than 2,000 patients were offered a recall for blood tests, of which in excess of 6,000 submitted themselves for testing. Each of these patients had placed their trust in Mr. D’Mello’s competence and integrity as a dental professional, a core responsibility of a dental professional being that the risk of infection will be minimized,” Scott said.

D’Mello chose not to attend the GDC’s hearing addressing these charges on August 18. Earlier, he said that he has no plans of practicing as a dentist again and that he had applied for voluntary erasure from the register of dentists. Meanwhile, Caroline Surgey, a dental nurse at Daybrook Dental Practice, attended the hearing to admit to 27 charges against her, also related to infection control breaches.

Surgey is now subject to conditional registration for 12 months with a review prior to the expiration of the order. She will be able to continue to work as a dental nurse but must accept various conditions and be under close supervision.

“The committee was of the view that, in her reflections and oral evidence, Ms. Surgey has shown significant insight into all aspects of her misconduct,” said Scott. “Her remedial steps have been broad in scope, and it is difficult to see what more Ms. Surgey could have done to remedy her failings, given the breadth and magnitude of her efforts.”

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Fluoride has long been an effective tool in fighting tooth decay. But research from Case Western Reserve University (CWRU) investigated whether it has added to the growing rates of diabetes in the United States since it is a known preservative of blood glucose.

Kyle Fluegge, PhD, used mathematical models to analyze publicly available data on fluoride water levels and diabetes incidence and prevalence rates in 22 states. He also included adjustments for obesity and physical inactivity collected from national telephone surveys to rule out confounding factors.

“The models look at the outcomes of [diabetes] incidence and prevalence being predicted by both natural and added fluoride,” said Fluegge, who performed his research as a post-doctoral fellow at the CWRU School of Medicine.

Now, Fluegge is a health economist with the Division of Disease Control for the New York City Department of Health and Mental Hygiene and co-director of the Institute of Health and Environmental Research in Cleveland, Ohio.

Two sets of regression analyses suggested that supplemental water fluoridation was significantly associated with increases in diabetes between 2005 and 2010. A 1.0 mg increase in average county fluoride levels predicted a 0.17% increase in age-adjusted diabetes prevalence.

Also, Fluegge found differences between the types of fluoride additives used by each region. The additives linked to diabetes in the analyses included sodium fluoride and sodium fluorosilicate. Fluorosilicic acid seemed to have an opposing effect and was associated with decreases in diabetes incidence and prevalence.

Counties that relied on naturally occurring fluoride in their water and did not supplement with fluoride additives also had lower diabetes rates. Fluegge found the positive association between fluoridation and diabetes when he adjusted fluoride exposure levels to account for estimated per capita tap water consumption.

“The models present an interesting conclusion that the association of water fluoridation to diabetes outcomes depends on the adjusted per capita consumption of tap water,” said Fluegge. “Only using the concentration [of added fluoride] does not produce a similarly robust, consistent association.”

As a result, Fluegge adjusted his calculations to incorporate tap water consumption instead of sticking to parts-per-million measurements of fluoride in the water. He also used several estimations, including calculations of county-level water fluoride levels, per capita county tap water consumption, and county measures of poverty, obesity, and physical activity.

Fluegge doesn’t suggest that his work should trigger policy changes. However, he does indicate that it should serve as a call for additional research on the association between fluoridation and diabetes.

“This is an ecological study. This means it is not appropriate to apply these findings directly to individuals,” said Fluegge. “These are population-level associations being made in the context of an exploratory study. And water is not the only direct source of fluoride. There are many other food sources produced with fluoridated water.”

Furthermore, Fluegge noted, his models indicate that natural environmental fluoride has a protective effect from diabetes, though it is not universally present in water supplies.

The study, “Community Water Fluoridation Predicts Increase in Age-Adjusted Incidence and Prevalence of Diabetes in 22 States from 2005 and 2010,” in the Journal of Water and Health.

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