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.
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.
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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.”
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.
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.
Coltene’s Alpen Carbides feature one-piece construction that eliminates the need for a brazed joint, which can lead to rusting. These high-performance carbide burs are offered within several key product groups, such as operative, surgical, trimming and finishing, crown and bridge, and metal cutters. The array of bur profiles and shank types assists in meeting the needs of everyday dentistry.
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The American Dental Hygienists’ Association (ADHA) installed its 2017-2018 officers at its 94th Annual Conference in Jacksonville, Fla. Tammy Filipiak, RDH, MS, of Mosinee, Wis, will serve as the organization’s president.
“In our changing healthcare environment, ADHA is working tirelessly to support our members in every stage of their career,” said Filipiak. “I am privileged to collaborate with this great leadership team to move the organization and profession forward.”
A member of the ADHA since 1986, Filipiak has served the organization as a council member and chair, as a member of the task force that developed the Standards for Clinical Dental Hygiene Practice, and as District VII trustee.
Also, Filipiak has held a number of leadership positions within the Wisconsin Dental Hygienists’ Association, including a term as the organization’s president. She received a presidential citation from the ADHA in recognition of her leadership and vision as well.
Filipiak succeeds Betty Kabel, RDH, BS, of Fort Walton Beach, Fla, as president. Kabel will remain on the Board of Trustees serving both as ADHA immediate past president and as the 2017-2018 chair of the ADHA Institute for Oral Health.
Additional officers installed at the conference include Michele Braerman, RDH, BS, of Fallston, Md, as president-elect; Matt Crespin, RDH, MPH, of West Allis, Wis, as vice president; and Donnella Miller, RDH, BS, MPS, of Clarksville, Tenn, as treasurer.
The newly installed district trustees for 2017-2018 are Rachelle Gustafson, RDH of Thompson, ND, District VII; Cynthia Baty, RDH, BS of Tulsa, Okla, District IX; and Trinity Cleveland, RDH, of Chandler, Ariz, District XI.
Dentsply Sirona’s Orthophos XG 3D is available in standard and HD mode. With a volume of 8 by 8 cm, this hybrid unit is designed for daily practice tasks with superior image quality in both 2-D and 3-D. The clinical workflow advantages of having both options results in emitting the lowest possible effective dose. The 2-D module offers extensive panoramic and cephalometric x-ray programs, and 3-D is there to boost diagnostic accuracy. Also, its ASTRA software algorithm is designed to improve the quality of 2-D panoramic and cephalometric images by minimizing black margins around metal fillings and eliminating excessive contrast that could, for example, lead to the misdiagnosis of caries.
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Patients are becoming more educated, as a world of information is readily available at our fingertips night and day. How is Sonendo helping to “debunk the myths” about root canal treatment, now that GentleWave is available to dentists? Chief commercial officer Chris Rabbitt tells us.
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GentleWave and Patient Response
Doctors are thrilled with Sonendo’s GentleWave system, but what are patients saying? Watch as a number of dentists report their findings of overwhelming patient response.
The University of California at Los Angeles (UCLA) will lead a pilot program to expand preventive dental care for 500,000 Los Angeles children enrolled in Medi-Cal, California’s Medicaid healthcare program. It will be the largest of 15 such county and community programs approved by the state’s Department of Health Care Services as part of the Medi-Cal 2020 Dental Transformation Initiative, running through December 2020.
The Centers for Medicare & Medicaid Services report that only about a third of the state’s 6.1 million children and adolescents enrolled in Medi-Cal receive preventive dental care each year. The UCLA program will focus on 3 primary goals: using information technology to enhance the quality and continuity of care; developing new ways to expand preventive services both within clinics and community settings; and integrating oral healthcare services across dental, medical, and community providers.
“The Dental Transformation Initiative provides an incredible opportunity to expand UCLA’s recent work with local community partners to improve the oral health of children at greatest risk for dental disease throughout Los Angeles County,” said James Crall, DDS, MS, ScD, project director, professor of public health and community dentistry, and director of the UCLA-First 5 LA Oral Health Program.
“Our First 5 LA-funded work has demonstrated the power of combining resources from the university and community partners to address challenges that require collaborative solutions,” said Crall. “Given that one quarter of all California children enrolled in Medi-Cal live in Los Angeles County, we clearly need to engage more critical stakeholders to create the meaningful system changes that will truly transform oral healthcare for children on Medi-Cal.”
“This is an excellent opportunity for UCLA Dentistry to further engage the Los Angeles community and improve oral healthcare for generations to come,” said Paul Krebsbach, DDS, PhD, dean of the UCLA School of Dentistry. “This program is on par with our broader vision for the dental school to get our student dentists, residents, and faculty members providing dental services to underserved Angelenos.”
The dental school also will seek partnerships with Los Angeles County agencies, organizations, and community programs focused on improving the health and well-being of children and families. Awards for the 15 selected local dental pilot projects led by UCLA will total $150 million over 4 years. Each of these projects is unique and uses local entities to leverage existing infrastructure to address the oral health needs of their respective communities.
For example, the Sacramento County Division of Public Health’s “Every Smile Counts!” program will use $10 million in grant funding to build dental services capacity for children and bridge the gap between dental care and primary care in systems currently used by low-income families. It also will work with the Arthur A. Dugoni School of Dentistry to provide virtual dental homes using teledentistry equipment at local schools.
Also, the Cavity Free Sonoma program from the Sonoma County Department of Health Services will work with Santa Rosa Junior College’s community health worker certification program to deploy workers to 10 community health centers to serve as “Health Coaches” who will conduct oral health assessments of children, coordinate their care with the clinic, educate parents about oral health, and provide encouragement and coaching for children to adopt healthy behaviors. Also, a smartphone app will remind parents about dental appointments and provide access to dental health records and healthcare coverage information.