Dentists rely on x-ray imaging and visual inspection to detect caries. However, x-rays can’t detect occlusal early caries. And by the time that dentists can see caries with their naked eye, the decay is fairly advanced.
Researchers at York University of Toronto, though, are using low-cost thermophotonic lock-in imaging (TPLI) to detect developing caries much earlier than x-rays or visual analysis.
TPLI uses a long-wavelength infrared camera to detect the small amount of thermal infrared (IR) radiation emitted from dental caries after stimulation by a light source. It is a noncontact and noninvasive process.
To test the technology, the researchers induced early demineralization of an extracted human molar by submerging it in an acid solution for 2, 4, 6, 8, and 10 days.
The TPLI image taken after just 2 days revealed a lesion, whereas a trained dental practitioner could not visually detect the same lesion even after 10 days of demineralization.
“This paper will have a high impact on the way dentists diagnose incipient caries. The long-wave IR thermophotonic imaging technology is at its nascent steps, but this paper brings it closer to actual clinical practice,” said Andreas Mandelis, professor of mechanical and industrial engineering at the University of Toronto.
The study, “First Step Toward Translation of Thermophotonic Lock-In Imaging to Dentistry As an Early Caries Detection Technology,” was published by the Journal of Biomedical Optics.
More than half of the opioids prescribed to patients after the extractions of wisdom and other teeth go unused, the University of Pennsylvania reports. Yet the researchers suggest that disposal kiosks in pharmacies and small financial incentives can increase proper disposal of excess opioids by more than 20%.
“When translated to the broad US population, our findings suggest that more than 100 million opioid pills prescribed to patients following surgical removal of impacted wisdom teeth are not used, leaving the door open for possible abuse or misuse by patients, or their friends or family,” said lead author Brandon C. Maughan, MD, MHS, MSHP.
According to the US Department of Justice, 3,900 people use opioids such as oxycodone, hydrocodone, and codeine outside of their legitimate medical purposes and supervision each day, with 78 people dying of overall opioid-related overdoses each day in 2014. The department expects the number of deaths in 2016 to be far higher.
“Given the increasing concern about prescription opioid abuse in the United States, all prescribers—including physicians, oral surgeons, and dental clinicians—have a responsibility to limit opioid exposure, to explain the risks of opioid misuse, and educate patients on proper drug disposal,” Maughan said.
The researchers examined prescription opioid use for 79 patients after dental impaction surgery. They also looked at how a small financial incentive and information about a pharmacy-based drug disposal program would affect patients’ willingness to properly dispose of unused medications. And, they tested the effectiveness of a text-message-based platform to collect data on medication use.
Participants received a debit card preloaded with $10 upon enrollment. Surveys assessing pain levels and medication use were delivered via text each day for the first week and on days 14 and 21 following surgery. For each survey completed, patients would get a $3 credit on the debit card for a possible $27 total. Patients who completed a follow-up health interview received an additional $10.
Just 24 hours after surgery, patients reported an average pain score of 5 out of 10 while taking pain medication. By the second day, 51% reported a low pain score of zero to 3 out of 10. By the fifth day, almost 80% had a low pain score.
Also, 94% received an opioid prescription to manage pain, with 82% also receiving a prescription-strength nonsteroidal anti-inflammatory drug (NSAID) and 78% receiving a prescription antibiotic. On average, the 93% of patients who did not have post-surgical complications received prescriptions of 28 opioid pills, but 3 weeks after surgery had only used 13, leaving more than 1,000 unused pills. Only 5 patients used all of the prescribed pills.
“Results of our study show within 5 days of surgery, most patients are experiencing relatively little pain, and yet, most still had well over half of their opioid prescription left,” said co-author Elliot V. Hersh. “Research shows that prescription-strength NSAIDs, like ibuprofen, combined with acetaminophen, can offer more effective pain relief and fewer adverse effects than opioid-containing medications. While opioids can play a role in acute pain management after surgery, they should only be added in limited quantities for more severe pain.”
Furthermore, offering a one-page overview of a pharmacy drug disposal program led to a 22% decrease in the number of patients who had properly disposed of or planned to properly dispose of leftover opioids. Patients in the control arm received routine post-operative instructions with a controlled substance information sheet about the risks of keeping unused opioids and explaining that a study hotline was available for information on drug disposal.
“Expanding the availability of drug disposal mechanisms to community locations that patients regularly visit such as grocery stores and retail pharmacies may substantially increase the use of these programs,” said Maughan. “By providing a one-page information sheet coupled with a small financial incentive, patients were significantly more interested in proper disposal of unused opioid pills. The results suggest that future trials might also use similar low-intensity and low-cost interventions to reduce the misuse of opioid medications.”
The study supports similar recent research from the Johns Hopkins Bloomberg School of Public Health reporting that 60.6% of all medical patients who are prescribed opioids have leftover pills. Also, nearly half of the patients in that survey reported receiving no information on safely storing their medications or disposing of any excess pills.
Meanwhile, the US Drug Enforcement Agency (DEA) says 13.9% of high school seniors used a prescription drug non-medically in the past year, and about 80% of new heroin users try heroin after abusing prescription opioids. Prescription drug abuse, the DEA adds, causes more than half of the drug overdose deaths in the United States.
Reviews are one of the most useful tools that the Internet has to offer. Anyone with a smartphone can use Angie’s List, Consumer Reports, Google, or more before deciding when and how to spend their money. When you’re a business or dental practice on the bad end of a review, however, the World Wide Web can seem small and unfriendly.
A negative review doesn’t have to destroy your digital presence, though. With a few smart tricks, you can even use a zero-star rating to demonstrate your loyalties to your patients.
The best thing to do to avoid negative reviews is to be proactive. Before patients leave your office, ask them about their experience. If they were pleased, suggest that they leave a review. If they weren’t, handle it right then and there to let them know they are valued.
Also, use an email campaign to solicit reviews from your regulars—who, let’s face it, wouldn’t be regulars if they weren’t happy with you. Make sure that your positive reviews far outweigh your negative reviews. That way, the negative reviews won’t stand out so much or hold a lot of weight.
Stop Negativity in Its Tracks
The occasional negative review is inevitable. Whether it’s due to a miscommunication or something completely out of your control, unhappy patients leave negative reviews to gain a sense of control over their situation. When you do receive a negative review, address it immediately and publicly so others know you take your reputation seriously.
Suppose a new patient was asked to wait longer than he expected. The anonymity of online reviews allows him to exaggerate to his heart’s content and claim that your office has no time management and does not value your patients’ time. This is an opportunity to make that person feel that he matters, as a little validation goes a long way.
Respond to that patient with an apology, thank him for giving you an opportunity to improve your practice, and offer to have an office manager call to discuss his disappointment. Not only is this a best practice, but also anyone who reads that review will see that your practice prioritizes the needs of your patients.
Even when referred by a friend or family member, consumers use your Internet presence to determine if your practice is right for them. Managing your website, email, and social networking pages might be technologically tricky and time consuming, but doing so is well worth the effort. If negative reviews are addressed quickly, and positive reviews keep rolling in, you’re bound to be “liked” in more ways than one.
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 My Dental Agency. Since starting her company, she and her team have helped a wide variety of practices all over the nation focus their message, reach their target patients, and grow their practice through effective marketing campaigns. When she isn’t helping dental practices 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. For more information, call (800) 689-6434.
Dental assistants can play a greater role in ensuring the safety of the clinical environment, prompting the Dental Assistants’ Foundation (DAF) to award the Organization for Safety, Asepsis and Prevention (OSAP) Foundation a $95,000 grant. OSAP will use the funding to support research, scholarship, and education for these valuable employees.
“The DAF recognizes the mission and goals of the OSAP Foundation to be in alignment with the DAF’s mission and goals as it applies to the education of dental assistants,” said DAF chair Ellen Landis.
The grant was given in memory of Anna Nelson, CDA, RDA, MA, an advocate for advancing dental assistants’ understanding of and compliance with the guidelines, regulations, and best practices to prevent disease transmission in dental settings. It also is being awarded in the wake of the DAF’s dissolution, as its leadership distributes its assets to organizations with similar missions.
The OSAP Foundation will use the grant to fund a comprehensive safety education, scholarship, and research program geared toward dental assistants. Its goal will be to underscore the importance of dental assistants, particularly in regard to their role in infection control.
Specifically, the program will support dental assistants who serve or want to serve as the infection control coordinator in their practice setting. In fact, OSAP has named September its Dental Infection Control Awareness Month, spotlighting guidelines, resources, and the role that infection control coordinators can play in practice safety.
“OSAP is focusing on the infection control coordinator this month and is offering multiple free resources to support this important member of the dental team,” said OSAP executive director Therese Long. “We are anxious to further advance these efforts through this new grant and by leveraging our partnerships and resources.”
The University of Florida College of Dentistry is launching a new graduate education program in its department of restorative sciences for general dentists who want to earn a master’s degree in operative dentistry. Applications will be accepted through December 16, with the first classes beginning on July 1, 2017.
“This is a 3-year program, and it will be designed to meet the growing need for future educators in operative dentistry,” said Patricia Pereira, DDS, PhD, who will direct the program. “We’re having search committees for faculty, and it’s really complicated to find educators in operative dentistry.”
Operative dentistry addresses the diagnosis, treatment, and prognosis of defects of the teeth that do not require full coverage restorations for correction. It should result in the restoration of proper tooth form, function, and aesthetics while maintaining the physiologic integrity of the teeth and their relationship with adjacent tissues.
“It’s general dentistry but more focused on aesthetic dentistry and preserving tooth structure,” said Pereira. “Operative dentistry is not a CODA recognized specialty like periodontology or endodontics, but it is in the process of becoming a specialty. Some branches of dentistry recognize operative dentistry as advanced training.”
First-year students in the program will be prepared to see patients while learning how to be educators. Courses in subsequent years will expand upon the basic knowledge of cariology, prevention, advanced operative dentistry, aesthetics, materials science, and urgent patient care.
For example, first-year students will spend 30% of their time in patient care, with the rest of their work divided between didactic courses and teaching preclinical and clinical students. In the later years, 40% of their time will be in patient care, with the remainder split between didactic teaching and research.
“There definitely will be teaching in the clinics and in the preclinical courses in the labs—when those students do their first tooth preparation, for example,” Pereira said. “They also will be presenting seminars for the other master’s students in other programs within the school. Our dental students are going to be more hands-on in terms of clinical and preclinical labs and in the seminars.”
Digital dentistry including CAD/CAM technologies will play a central role in the curriculum too. Students will learn how to scan teeth with intraoral cameras, design restorations on the computer, and mill composite ceramic blocks that will best fit their patients. Conventional impressions, Pereira said, are no longer necessary.
“We have at least 10 milling machines at the school. And the clinic where students will be working already has 4 scanners with 4 milling machines,” Pereira said. “Everything here is pretty much digital, and we foresee moving more toward that.”
Looking ahead, Pereira hopes to launch partnerships with different equipment companies to get their products in the hands of her students. That way, these students will get exposure to a variety of tools—and once they’re finished with the program, they may have a preference.
“For example, digital scanner companies can bring in their scanners and students can try all of them. When they leave school, they can decide which one they like best and what they want to buy,” said Pereira. “It’s going to be a good time for companies to start investing in terms of collaboration.”
The program will be small, however, with 3 students admitted each year. That’s because it’s an intense program that requires a lot of manpower on the faculty’s behalf. There also will be an intern program for students who do not want to enter the full master's program.
It’s a demanding program too. Students must complete a minimum of 38 credits and carry a 3.0 GPA. Plus, they need to publish their thesis in a peer-reviewed journal and present it at a national or an international meeting—not at an in-house research event.
“If they want to be eligible for an academic career, they have to know how to publish. They have to know how to lecture. They have to know how to teach,” said Pereira. “We’re going to make these students eligible for an academic career or private practice with evidence-based dentistry as a background for them.”
Evidence-based dentistry, integrating clinical expertise with the patient’s needs and preferences and with the most current clinically relevant evidence published in peer-reviewed journals, will be the foundation of the program’s clinical work.
“As long as there’s evidence in the literature showing that something works, and has been retested, and we see that it works, then, yes, it will be the focus of our program, using evidence-based dentistry to treat our patients,” Pereira said.
Prior to joining the University of Florida’s faculty, Pereira spent 12 years teaching, including 6 years at the University of North Carolina at Chapel Hill in operative dentistry. She has published more than 80 peer-reviewed articles and book chapters and has presented many scientific research programs and continuing education courses.
Among other members of the faculty, Pereira will be joined by Saulo Geraldeli, DDS, MS, PhD, associate professor, and Alejandro Delgado, DDS, MS, clinical assistant professor, both with the school’s restorative dental sciences operative division.
“We have a very good body of professors here from different backgrounds. It’s a very cohesive division,” said Pereira. “We’re all very tight together.”
For more information and to apply to the program, go to http://admissions.dental.ufl.edu/advanced-graduate-programs/programs-application-process/masterscertificate-in-operative-dentistry/.
3M will donate 3,000 introductory sealant kits to the ADA Foundation to use during the 2017 Give Kids a Smile (GKAS) program. With an estimated fair market value of $250,000, these kits will enable GKAS volunteers to place more than 400,000 sealants on underserved kids’ teeth next year.
“In our collaborations with oral health professionals around the world, we see the importance that our customers place on giving back to their communities, and it is one we share wholeheartedly,” said John Tobin, director of US sales and marketing at 3M Oral Care.
Each kit can provide approximately 140 sealant applications and includes a pair of 1.2-mL 3M Clinpro Sealant syringes, a 3-mL 3M Scotchbond Etchant syringe, 20 sealant syringe tips, and 25 etchant syringe tips.
A sealant kit will be included in each of the 3,000 Henry Schein Dental professional kits distributed to those who register and are awarded products for GKAS programs in January of 2017. Kits will be available from the ADA Foundation while supplies last.
“GKAS programs from around the country have been asking for sealant material because they are highly effective and a safe means of preventive dental care,” said Dr. Jeff Salin, ADA Foundation GKAS committee member. “A lot of kids will benefit greatly from this generous donation of product.”
In August, the Journal of the American Dental Association published a systemic review showing that children treated with sealants have about a 70% to 80% reduction in the incidence of occlusal caries compared to children who do not receive sealants. The review also produced guidelines for the use of pit-and-fissure sealants.
Older adults with significant tooth loss are less functional, both physically and cognitively, than peers who have lost fewer teeth, based on research from more than 60,000 community-dwelling people age 65 and older who did not meet criteria for long-term care in Japan.
The subjects answered questions about how many teeth they had, their medical and mental health history, how many falls they had over the previous year, whether they smoked or drank alcohol, their body weight, and how well they were able to perform common activities in daily life.
The researchers reported that the effect of edentulism on higher-level functionality was between that of having a history of stroke and having a history of diabetes mellitus. Oral health also was associated with speech, smiling, and laughing, influencing the ability to live independently.
Several pathways influence this relationship, the researchers noted. Inflammation has been associated with physical and cognitive disability, for example. Also, oral health may affect the ability to communicate, in turn impacting functionality. Nutrition plays a role in oral health and functionality as well.
The study underscores the importance of maintaining teeth later in life to maintain functional capacity, the researchers said. They recommend that older adults receive appropriate support to maintain oral hygiene practices, while clinical dental teams offer high-quality evidence-based care to help them retain their teeth.
The Orange County (OC) Health Care Agency and other public health organizations are investigating mycobacterial dental infections among pediatric patients who had been treated with pulpotomies at the Anaheim location of the Children’s Dental Group. So far, one case has been confirmed with 13 additional probable cases.
“Mycobacteria are commonly occurring bacteria in the environment that generally pose minimal risk,” said Jessica Good, public information officer with the agency. “In rare instances, water sources within a facility can become contaminated with higher levels of bacteria, increasing risk to patients receiving pulpotomies or other invasive procedures.”
According to Good, the confirmed case involves illness consistent with mycobacterium abscessus infection, a history including a visit to the Children’s Dental Group Anaheim practice, and a culture that has tested positive for mycobacterium abscessus. The affected children range in age from 3 to 9 years old.
“The infection causes localized dental abscess, but may infect nearby bone,” said Good. “Treatment generally involves IV antibiotics and treatment of the site.”
Symptoms have appeared anywhere from 15 to 85 days after these pulpotomy procedures, often coming on slowly over days to weeks. These symptoms may include swelling, redness, and pain around the infected tooth. Quick identification of the infection is key to effective treatment.
Children’s Dental Group is now reaching out to patients at risk, which includes about 500 children who received pulpotomies in Anaheim between April 6 and August 28 of this year. The Centers for Disease Control and Prevention (CDC) reports that, during a 2014 and 2015 outbreak following pulpotomies in Georgia, the infection rate was about 1% to 2% of those who had the procedure.
“We are asking all of these patients, even in the absence of any symptoms, to come in for x-rays, an examination, and a health history so that we can evaluate whether any signs of infection exist and prescribe appropriate care if necessary,” the company said in an official statement.
The OC Health Care Agency has also ordered the clinic to stop using water for its procedures since 5 on-site water samples have tested positive for mycobacteria. A plan to replace the water system is underway and will be submitted to the OC Health Care Agency for approval. Until then, the practice will be limited to x-rays and exams.
To prevent infections associated with waterlines, the CDC urges dental practices to follow manufacturer guidelines for disinfection, monitor water quality to ensure recommended bacterial counts, use point-of-use water filters, and eliminate dead ends in plumbing where stagnant water can enable biofilm formation.
Healthcare providers who identify patients with symptoms consistent with oral mycobacterial infection following treatment at the Children’s Dental Group Anaheim office are asked to call 714-221-1112 for further assessment and treatment. Information on possible cases or questions about the investigation should be referred to the OC Health Care Agency Epidemiology Program at 714-834-8180.
Meanwhile, parents who have concerns about the care that their children received at the facility are encouraged to file a written report with the Dental Board of California at hdbc.ca.gov/consumers/_complaint_info.shtml.