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– Web-Op has released a new at-home teeth-whitening product that uses a cleaning formula based on concentrated hydrogen peroxide, glycerin USP (United States Pharmacopoeia), carbomer, and propylene glycol.

The product provides dentist-grade teeth whitening but does not require a dental visit, according to the company.

In addition to the custom upper and lower teeth-whitening tray, Pure Dental Whitening includes a touch-up pen, allowing users to make corrections between applications.

        

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By Laird Harrison
The approach contradicts what most dentists learned in dental school. And it can add another step to the process of placing an indirect restoration. But a growing chorus of researchers, taking their lead from Pascal Magne, D.M.D., Ph.D., says it’s well worthwhile to seal dentin before placing a temporary.

The notion goes back at least to 1992 when David Pashley, D.M.D., Ph.D., a Medical College of Georgia professor, proposed sealing dentin immediately after preparation for a crown.

Now evidence is mounting for immediate dentin sealing (IDS), not only for crowns but also for inlays, onlays, and veneers. At least one adhesive company — Bisco — has taken the approach into consideration in designing its latest products. And IDS is being debated at widely attended symposia on restoration techniques, including the 2008 ADA meeting in San Antonio.

“I meet people all the time who are enthusiasts,” Dr. Magne told DrBicuspid.com. Dr. Magne, a University of Southern California associate professor, has extensively researched the method and become its leading proponent. “It seems like it’s obvious that it’s a useful procedure. There’s nothing to lose.”

But at the recent ADA meeting, Jeff Brucia, D.D.S., co-director of the Foundation for Advanced Continuing Education (FACE), suggested that a careful variation of the conventional technique might be more practical than IDS.

In his latest paper (Journal of Prosthetic Dentistry, September 2007, Vol. 98:3, pp. 166-174), Dr. Magne and his colleagues prepared 30 extracted human molars and immediately bonded their dentin: 15 with OptiBond FL (Kerr Dental) and 15 with SE Bond (Kuraray). They then restored the teeth with Tempfil Inlays (Kerr) and soaked them in saline solution for 2, 7, or 12 weeks before removing the temporaries, cleaning and sandblasting them, and applying more adhesive to restore them with Z100 (3M ESPE).

For comparison purposes, they placed Tempfil Inlays on 10 molars without bonding the dentin first, and soaked these in saline solution for two weeks before using either OptiBond FL or SE Bond to attach the Z100.

They found that the microtensile bond strength of the permanent restorations on the IDS teeth was between 5 and 33 times stronger than it was on the conventionally restored teeth.

One reason IDS is stronger is that dentin bonds best to composite when the dentin is freshly cut, Dr. Magne said. Provisional cement, saliva, and bacteria can all contaminate the dentin and weaken the seal.

Also, curing the adhesive before placing the restoration may result in a stronger bond because the cured adhesive keeps collagen fibers from collapsing under pressure when the restoration is put in place.

Another reason the bond may be stronger is that the copolymerization continues for several days before it takes on an occlusal load.

IDS also results in less sensitivity when the temporary is removed and the permanent restoration placed; in fact, with IDS no anesthesia is required during this step (unless needed for the rubber dam), Dr. Magne said.

Finally, if you seal the dentin before making the impression, the impression includes the contours of the adhesive.

He lays out complete instructions for his approach in the Journal of Esthetic and Restorative Dentistry (May 2005, Vol. 17:3, pp. 144-155).

The technique is becoming so popular that Bisco’s instructions for All-Bond 3 — released in February 2007 — explain how to use it prior to impression making for crowns. In addition, the company is planning to launch a new product, Pro-V Coat, which can be used to keep temporaries from bonding to the adhesive used in IDS.

(Dr. Magne uses OptiBond FL as the adhesive and applies a layer of glycerin jelly to isolate the temporary.)

Speaking at an ADA seminar on new restorative techniques, Dr. Brucia agreed that it’s important to seal the dentin right after preparing it. He said he’d tested the IDS technique described by Dr. Magne and found it “excellent.”

But he also noted that many dentists are likely to make mistakes in applying it. For example, he argued that it’s difficult to bond to the cured adhesive unless the surface is roughened by proper sandblasting. He thinks many dentists will omit this step or will use aluminum oxide instead of CoJet (3M ESPE). Or, he said, many dentists will use unfilled adhesive, which isn’t thick enough to stand up to such sandblasting.

Because of the difficulty of the technique, Dr. Brucia, “It’s not accepted within the dental industry.”

So he proposed an alternative. “Pascal will tell you that the only time you can get excellent bond strength to dentin is the day that you prepped it,” Dr. Brucia said. “That’s not exactly true. If you can keep that tooth clean and refreshen the dentin at cementation, you will be able to produce that exact bond.”

The key, he argued, is to find a cement that bonds to the tooth rather than to the temporary restoration. This will seal the tooth until it’s time to place the permanent restoration. Dr. Brucia uses Durelon (3M ESPE). He removes it with an ultrasonic scaler, a process he said takes him only about 20 seconds.

“I disagree, of course,” said Dr. Magne, when asked about this approach. “It would be a dream if the cement would do everything. But you will not get the effect of desensitizing the tooth once and for all.”

Dr. Magne usually doesn’t need to anesthetize his patients for try-in procedures or when placing the permanent restoration, while Dr. Brucia does.

Dr. Magne also argued that curing the adhesive just before placing the permanent restoration results in a layer that changes the contours of the surface being restored. And leaving the adhesive uncured when placing the final restoration results in a weaker bond.

In the end, though, both experts agree on one important principle: seal your dentin when you place the temporary.

        

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or all-ceramic, inevitably leads to cases of chipped restorations. Researchers from the New York University College of Dentistry and the University of Maryland School of Dentistry have completed a study that dentists in such situations may find useful.

In this literature review, the researchers examined how frequently chipping occurs in certain systems and why it happens. The second aspect of the study explored the various means and strategies for repairing chipped porcelain restorations. They also had recommendations for working with different materials.

“Because of differences in the material composition of ceramic systems, different treatments are required for the exposed material surfaces after chipping,” the researchers wrote (Journal of the American Dental Association [JADA], January 2013, Vol. 144:1, pp. 31-44). “Use of hydrofluoric acid etching, air abrasion, tribochemical coating, silanization, and metal primers or zirconia primers seem to be the most successful conditioning methods for durable bonding and repair.”

While significant long-term data about the life span of all-ceramic restorations has yet to arrive, it appears to be similar to PFM single crowns, and when fractures occur, the veneering porcelain seems to be the most susceptible.

“The results of the majority of studies indicate that chipping of the veneering porcelain is the most frequent complication of zirconia-based restorations,” the researchers explained. They also found a wide range of chipping rates, from 0% to 54%, for fixed dental prostheses (FDPs) with zirconia frameworks in at least one and up to three years. But the figures are statistically significantly lower for metal-ceramic FDPs, with one study finding a chipping rate of 3% after five years.

The data for the JADA study was sourced from a PubMed search of scholarly journals using several key words and no language restrictions. The researchers pared down 300 titles to 97 in vitro studies, 21 clinical investigations, and six systematic reviews.

Cracking & chipping

Several different causes of veneering porcelain failure were addressed by these studies. Coefficient of thermal expansion (CTE) is a possibility, which stems from the tensile stresses in the zirconia-porcelain interface where a thermal expansion mismatch could exist. “Researchers generally agree that residual tensile stresses from a CTE mismatch could be highly harmful, affecting both the veneer and the ceramic core material,” the authors wrote.

Zirconia’s low thermal conductivity was cited as well. Cooling rate disparities between the core material and the veneer can result in high residual stress inside. “The incidence of cracks is expected to increase with greater porcelain veneer thicknesses, especially in combination with fast cooling rates,” according to the researchers.

Cracks can also result from phase transition at the porcelain-zirconia interface. While zirconia is incredibly strong, “phase transition leads to tensile stresses on the bottom of the veneering porcelain, probably resulting in starting points for cracks,” the authors explained.

They also addressed aging and framework design as potential culprits. In their review, the researchers found studies suggesting that chipping can be reduced with anatomically designed copings and a consistent veneering porcelain thickness. The method of veneering also is a factor, with studies showing “better results for hand-layered veneering porcelain than for veneering porcelain pressed over the frameworks,” the researchers stated.

How to fix them

The authors explained that, more often than not, chipping is cosmetic and the restoration can be saved without removing it. Intraoral repairs make sense because, while temporary, they cause less discomfort in the patient and require less time and money, they noted. When a chip is too large to polish out most surface flaws, practitioners should consider repairs.

The researchers offered three options:

Replacing the chip with composite-based resin.
Reapplying it with resin cement.
Adhesively bonding a new veneer to the restoration after preparing it.
Surface conditioning, the researchers noted, is an “essential” aspect of a successful repair and the treatment must be chosen with surface material in mind. The means of creating micromechanical retention, by air abrasion with an intraoral sandblaster or with hydrofluoric acid etching, also is important.

For the latter, the researchers stated that “the application of 2.5% to 10% hydrofluoric acid for 60 seconds is the easiest way to prepare the fractured surface chairside,” but they warned that it is only indicated for silicate-ceramic materials. Additionally, it should never be used without a rubber dam. When dentin or enamel is exposed, phosphoric acid should be used instead.

Air abrasion is minimally hazardous to the patient but can potentially damage the surface of the restoration, impacting its performance long-term if small surface flaws created during the process become cracks. This preparation is not recommended for pure silicate materials. “With regard to the ultimate strength of the restoration and its future performance, silicate-ceramic restorations should be etched rather than air-abraded,” the researchers wrote. They also had a specific recommendation for oxide-ceramic materials: Lower the pressure to 0.5 bar to limit the harmful effects of air abrasion on them. The bond strength will not be compromised.

Achieving a chemical bond with salines between a ceramic or metal surface and a hydrophobic resin is a “sensitive step,” the researchers cautioned. They urged practitioners to use a dental dam to help avoid inactivation of the saline by allowing it to come into contact with water or other solutions.

In cases involving oxide-ceramic surfaces, the two methods the researchers examined appear to be equally effective: a silicate-ceramic surface treatment with CoJet (3M ESPE) chairside system and air abrasion. For the former, in a tribochemical coating procedure, metal- and oxide-ceramic materials can bond to salines if the practitioner silicatizes them first. The CoJet accomplishes this, the researchers noted, by enriching the ceramic surface with silica so that it reacts with silane. The system is also effective for bonding silanes to metal.

“Air abrasion,” the researchers noted, “is effective only in combination with resin cements that contain phosphate monomers or primers, because silanes cannot bond to the blank oxide-ceramic surface.”

For metal surfaces, the recommended procedure is similar. “Air abrasion in combination with use of phosphate monomers and use of CoJet silicate-ceramic surface treatment followed by application of a silane are the most effective methods,” the researchers stated.

Lastly, bifunctional phosphate monomers, which come in metal and ceramic primer varieties, can be used along with a corresponding resin cement. “Bifunctional phosphate monomers bond oxides of the metal or oxide-ceramic surface on one side and to the resin on the other side,” the researchers explained.

Keys to success

The researchers acknowledged that a lack of in vivo studies make choosing the “best” surface treatment difficult. However, there are aspects of repairing fractured ceramic restorations that deserve focus. “For silicate-ceramic surfaces, use of silane seems to be essential, whereas the appropriate etching and mechanical treatment methods are controversial,” the researchers wrote. “Hydrofluoric acid etching and air abrasion seem to be equally successful.”

Therefore, practitioners have a choice to make. Is the ease of hydrofluoric acid etching and less potential for detrimental effects on silicate-ceramic material worth the risk of using a substance that could harm staff and the patient? If so, use protective measures such as rubber dams and latex gloves.

Next, the application of silane to bond resin and the ceramic material is “crucial,” according to the researchers.

Repairs to PFM and zirconia- and alumina-based restorations “should be treated on the basis of the material that is exposed on the fractured surface,” the researchers explained. Consequently, chipped restorations of this type can be treated with the same procedure as an all-ceramic restoration. But if both materials are exposed on the fractured surface due to a failure related to delamination, the researchers recommended “using the CoJet system followed by the application of a silane and a phosphate monomer.”

With these recommendations at their disposal, practitioners can avoid a full-replacement as a treatment option for chipping.

        

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Maimuna , a native of Malappuram who suffered from a toothache had a worst day in her life at the Government Dental College Hospital on Saturday. The doctor at the Government Dental College extracted the wrong tooth. Instead of extracting the molar tooth, the dentists extracted the three teeth in the front row.

According to Maimuna, she went to the Government Dental College last month and after preliminary check-up the doctor had asked her to come to the hospital on Saturday to extract the tooth. Maimuna said that she had informed the doctor to extract the molar tooth prior to the administration of anaesthesia but the doctor extracted the wrong teeth telling that they are conducting the procedure on the basis of prescription in her hand. Maimuna came to know about the removal of teeth only after the completion of extraction. Maimuna has been admitted to the Kozhikode Medical College Hospital.

        

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The CBI has moved the Madras High Court to cancel the advance bail granted to S Srilekha, Managing Director of Adhiparasakthi Dental College and Hospital in Melmaruvathur, and the bail given to its administrative officer K Ramabadhran and Adhiparasakthi Charitable Medical Educational and Cultural Trust trustee R Karunanidhi, on the ground that they were hampering the investigation and tampering with the witnesses.

The petition is likely to come up for hearing on February 25.

The accused persons, if allowed to remain in bail, would continue with the nefarious activities with scant regard to the law of the land, the CBI added.

        

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taken from Nutrition and Disease:
Since the days of John Hunter it has been known that when the enamel and dentine are injured by attrition or caries, teeth do not remain passive but respond to the injury by producing a reaction of the odontoblasts in the dental pulp in an area generally corresponding to the damaged tissue and resulting in a laying down of what is known as secondary dentine. In 1922 M. Mellanby proceeded to investigate this phenomenon under varying nutritional conditions and found that she could control the secondary dentine laid down in the teeth of animals as a reaction to attrition both in quality and quantity, independently of the original structure of the tooth. Thus, when a diet of high calci­fying qualities, ie., one rich in vitamin D, calcium and phosphorus was given to the dogs during the period of attrition, the new secondary dentine laid down was abundant and well formed whether the original structure of the teeth was good or bad. On the other hand, a diet rich in cereals and poor in vitamin D resulted in the production of secondary dentine either small in amount or poorly calcified, and this happened even if the primary dentine was well formed.
Thus, in dogs, the factors that affect tooth healing are the same factors that affect tooth development:
The mineral content of the diet, particularly calcium and phosphorus
The fat-soluble vitamin content of the diet, chiefly vitamin D
The availability of minerals for absorption, determined largely by the diet’s phytic acid content (prevents mineral absorption)
What about humans? Drs. Mellanby set out to see if they could use their dietary principles to cure tooth decay that was already established. They divided 62 children with cavities into three different diet groups for 6 months. Group 1 ate their normal diet plus oatmeal (rich in phytic acid). Group 2 ate their normal diet plus vitamin D. Group 3 ate a grain-free diet and took vitamin D.

In group 1, oatmeal prevented healing and encouraged new cavities, presumably due to its ability to prevent mineral absorption. In group 2, simply adding vitamin D to the diet caused most cavities to heal and fewer to form. The most striking effect was in group 3, the group eating a grain-free diet plus vitamin D, in which nearly all cavities healed and very few new cavities developed. Grains are the main source of phytic acid in the modern diet, although we can’t rule out the possibility that grains were promoting tooth decay through another mechanism as well.

Dr. Mellanby was quick to point out that diet 3 contained some carbohydrate (~45% reduction) and was not low in sugar: “Although [diet 3] contained no bread, porridge or other cereals, it included a moderate amount of carbohydrates, for plenty of milk, jam, sugar, potatoes and vegetables were eaten by this group of children.” This study was published in the British Medical Journal (1) and the British Dental journal. Here’s Dr. Edward Mellanby again:
The hardening of carious areas that takes place in the teeth of children fed on diets of high calcifying value indicates the arrest of the active process and may result in “healing” of the infected area. As might be surmised, this phenomenon is accompanied by a laying down of a thick barrier of well-formed secondary denture… Summing up these results it will be clear that the clinical deductions made on the basis of the animal experiments have been justified, and that it is now known how to diminish the spread of caries and even to stop the active carious process in many affected teeth.
Dr. Mellanby first began publishing studies showing the reversal of cavities in humans in 1924. Why has such a major medical finding, published in high-impact peer-reviewed journals, faded into obscurity?

Dr. Weston Price also had success curing tooth decay using a similar diet. He fed underprivileged children one very nutritious meal a day and monitored their dental health. From Nutrition and Physical Degeneration (p. 290):
About four ounces of tomato juice or orange juice and a teaspoonful of a mixture of equal parts of a very high vitamin natural cod liver oil and an especially high vitamin butter was given at the beginning of the meal. They then received a bowl containing approximately a pint of a very rich vegetable and meat stew, made largely from bone marrow and fine cuts of tender meat: the meat was usually broiled separately to retain its juice and then chopped very fine and added to the bone marrow meat soup which always contained finely chopped vegetables and plenty of very yellow carrots; for the next course they had cooked fruit, with very little sweetening, and rolls made from freshly ground whole wheat, which were spread with the high-vitamin butter. The wheat for the rolls was ground fresh every day in a motor driven coffee mill. Each child was also given two glasses of fresh whole milk. The menu was varied from day to day by substituting for the meat stew, fish chowder or organs of animals.
Dr. Price provides before and after X-rays showing re-calcification of cavity-ridden teeth on this program. His intervention was not exactly the same as Drs. Mellanby, but it was similar in many ways. Both diets were high in minerals, rich in fat-soluble vitamins (including D), and low in phytic acid.

Price’s diet was not grain-free, but used rolls made from freshly ground whole wheat. Freshly ground whole wheat has a high phytase (the enzyme that degrades phytic acid) activity, thus in conjunction with the long yeast rises common in Price’s time, it would have broken down nearly all of its own phytic acid. This would have made it a source of minerals rather than a sink for them. He also used high-vitamin pastured butter in conjunction with cod liver oil. We now know that the vitamin K2 in pastured butter is important for bone and tooth development and maintenance. This was something that Dr. Mellanby did not understand at the time, but modern science has corroborated Price’s finding that K2 is synergistic with vitamin D in promoting skeletal and dental health
to design the ultimate dietary program to heal cavities that incorporates the successes of both doctors, it would look something like this:
Rich in animal foods, particularly full-fat pastured dairy products (if tolerated). Also meat, organs, fish, bone broths and eggs.
Fermented grains only; no unfermented grains such as oatmeal, breakfast cereal, crackers, etc. No breads except true sourdough (ingredients should not list lactic acid). Or even better, no grains at all.
Limited nuts; beans in moderation, only if they’re soaked overnight or longer in warm water (due to the phytic acid).
Starchy vegetables such as potatoes and sweet potatoes.
A limited quantity of fruit (one piece per day or less), but no refined sweets.
Cooked and raw vegetables.
Sunlight, high-vitamin cod liver oil or vitamin D3 supplements.
A generous amount of pastured butter.
No industrially processed food.

        

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A new breakthrough By Tawnya Ann Bobst RDH, BS
Can natural dental products provide effective cleaning and de-sensitization with less abrasion? Why would we care to switch?

I have been using therapeutic grade essential oil infused oral hygiene products on myself and sharing this information with my patients with exceptional results. Anything that I put in my mouth or on my skin goes into the blood stream so I want the products that I use to be non-toxic and safe. Just as nitroglycerin works under the tongue, chemicals in mouth products are absorbed into the mucosa and travel throughout the body.

Bacteria from the teeth can affect the joints and the heart, that is why there are pre-medication guidelines for people with joint replacements and certain heart conditions. The link between cardiovascular disease and dental plaque has been well established. The oral pathogens linked to periodontal disease cause inflammation that can be linked to heart disease, according to periodontist Dr. Sally Cram, DDS, spokesperson for the ADA.(1)

What if we could offer our patients a way to get antibacterial and antimicrobial products that only attack the bad microbes and not the healthy tissue?

Dr. Jean Valnet, MD, said, “Essential oils are especially valuable as antiseptics because their aggression toward microbial germs is matched by their total harmlessness toward tissue.”(2)

Frankincense essential oil was used in a University of Oklahoma study on bladder cancer. It eliminated the bladder cancer cells and left the other cells unharmed!(3,4) Frankincense was more precious than gold in biblical times.(5)

The Thieves oil blend of oral hygiene products that I use contains essential oils of peppermint, wintergreen, eucalyptus, thyme, clove, lemon, cinnamon, and rosemary. At Andhra University, Department of Biochemistry, essential oils of cinnamon, clove, rosemary, eucalyptus and lemon were tested and found to have effective anti-bacterial properties.(6)

The Thieves blend of oils contain these five oils. At the Medical University at Lodz, Poland, they studied the microbial action of thyme oil. They found that it strongly inhibited the growth of the bacteria tested.(7)

In the Journal of the American Dental Association, the efficacy of an essential oil containing antiseptic mouth rinse has been demonstrated in numerous double blind studies.(8,9)

Many of my patients are concerned about tooth sensitivity and plaque build-up. They complain about canker sores, sloughing tissue, and sore gums from the toothpaste and mouthwash that they are using. What solutions do we have to offer them?

Fluoride, desensitizers in toothpaste, and varnishes only offer a band aid approach. Once the product is discontinued, the sensitivity returns. The toothpaste for sensitivity contains a chemical, potassium nitrate, and an abrasive agent, hydrated silica. Hydrated silica is a form of sand.

Does it make sense to use a chemical to desensitize and then brush it on with an abrasive?

The particle size of toothpaste should be very small so it does not cause excess wear of the dentin and enamel. Most commercial toothpastes use large size abrasive particles. Scanning electron microscope photos of enamel show the damaging effects of popular household toothpastes with large particle sizes as compared to using ultra-fine particle size toothpaste. After viewing these photos, it is clear that the bigger particles damage the fine tooth structure.(10)

Some toothpaste contains strong chemicals that cause the tissue to slough off. I have seen long strings of sloughed tissue on the buccal mucosa of people using certain toothpastes. Tartar control toothpastes are especially damaging to the mucosa. Zinc Citrate containing toothpastes have been shown to reduce calculus naturally by 26%.(11)

I attended a seminar given by Integrative Body Psychotherapy (IBP) with Naturopathic Doctor, Dr. Merrily Kuhn, ND, RN, PhD.(12) Dr. Kuhn said that an antibacterial chemical in popular toothpastes is proving to be an endocrine disruptor in the American bullfrog.(13)

The FDA reported that is has been shown to alter hormone regulation in animals.(14) This chemical is also used in antibacterial hand soaps and hand sanitizers. The chemical kills the good and bad bacteria. Thieves foaming hand soap and hand purifiers offer a great alternative to the chemical products.

When I was in dental hygiene school, the fluoride representative came to speak to us. After hearing his presentation, I was convinced that fluoride was the next best thing to heaven. It was reported to work for decay, sensitivity, plaque, and gingivitis. Prescriptions were given by the dentist as a take home treatment for patients with adult periodontal disease and root decay problems. I was convinced that everyone needed it to protect the teeth.

I later learned about a little boy that ingested too much fluoride in a dental office treatment and had to be rushed to the hospital. Because we now have natural tooth products available that don’t carry the warning label “call poison control if ingested” on the tube, does it make sense to use chemical brands?

Dr. Joe Mercola wrote in a recent article: You’re Still Told Fluoridation Prevents Tooth Decay, but Science Proves Other Wise. He interviewed Dr. Bill Osmunson, a dentist with a Masters Degree in Public Health, who has been studying the literature on fluoride. Dr. Osmunson said that fluoride did not reduce decay to any significant degree, and it has many health risks such as lowered IQ, impaired thyroid function, weakened bones, and lowered immune function. He says it is more toxic than lead.

Fluoride is found in toothpaste, water, nonstick pans, processed food and beverages, and many teas. Certain types of tea leaves are rinsed with fluoride.(15) Dr. Mercola’s interview with Dr. Osmunson can be viewed on his website.(16)

Dr. Joan Barice, MD, recommends not using fluoride toothpaste.(17) Dr. Barice recommended using a toothpaste called Thieves Dentarome Ultra, containing the blend of oils that was used during the plague in 15th century France that the grave robbers used to stay healthy during the plague. The toothpaste formula contains edible ingredients. It has no fluoride, sodium laurel sulfate (which has been linked to canker sores), sugar, synthetic chemicals, hydrated silica or colors.(18)

It contains calcium and xylitol, shown to inhibit bacteria linked to decay and periodontal disease, and zinc citrate for tartar control. The Thieves mouthwash contains similar essential oils with no alcohol. KidScents toothpaste has no fluoride and is formulated with essential oils and xylitol.(19)

Dr. Ulrich Bruhn, a German dentist, has had remarkable results using xylitol on patients with caries and periodontal disease. He said that teeth tightened up and periodontal problems were improved. Xylitol inhibits strep mutans in dental caries.(20)

As a personal testimonial, I have been using Thieves Dentarome Ultra since 2008, I have had no sensitivity, decay, or bleeding since using this toothpaste. One of my patients, a 65-year-old male with diabetes, with severe periodontal pockets, bleeding, inflammation and exudate, began using Dentarome Ultra. At his next visit, he exhibited pink gingiva, no bleeding, and no exudate. I was very impressed.

My friend in Virginia, a smoker, said her dental hygienist was so pleased with the change in her dental health that she wanted to know what she was doing differently. Her cleaning time was also reduced by half.

The Thieves lozenges have worked for my sore throats. They contain stevia, no sugar, and the blend of lemon rind, clove, cinnamon, eucalyptus, rosemary and peppermint essential oils. Thieves mouthwash is equally effective and can be used as a gargle for sore throats. A drop of Thieves oil on the bottom of the feet is great at the first sign of a cold.(21)

I have used a drop of Thieves essential oil on a Q-Tip and placed it on a canker sore. The sore dried up in a couple days as opposed to weeks. While treatment with debacterol (sulfuric acid/phenolics solution) is often recommended to patients by the dentist for the canker sores, I prefer the Thieves oil.(22) It burns for a minute but reduces the healing time.(23)

        

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Elusive substrate protein identified in the most common form of heritable rickets

Diagnosed in toddlers, X-linked hypophosphatemia (XLH) is the most common form of heritable rickets, in which soft bones bend and deform, and tooth abscesses develop because infections penetrate soft teeth that are not properly calcified. Researchers at McGill University and the Federal University of Sao Paulo have identified that osteopontin, a major bone and tooth substrate protein, plays a role in XLH. Their discovery may pave the way to effectively treating this rare disease.

The findings were made by the laboratories of Marc McKee, a professor in the faculty of dentistry and the Department of Anatomy and Cell Biology at McGill University, and of Nilana M.T. Barros, a professor at the Federal University of Sao Paulo. The team built upon previous research that had shown that mutations in the single gene PHEX are responsible for causing XLH. The results of this latest research by Drs. McKee and Barros will be published in the March issue of the Journal of Bone and Mineral Research.

“XLH is caused in part by renal phosphate wasting, which is the urinary loss from the body of phosphate, an important building block of bones and teeth, along with calcium.” says Prof. McKee. “In pursuing other factors that might contribute to XLH, we used a variety of research methods to show that PHEX enzymatic activity leads to an essentially complete degradation of osteopontin in bones.”

This loss of osteopontin, a known potent inhibitor of mineralization (or calcification) in the skeleton and dentition, normally allows bones and teeth to mineralize and thus harden to meet the biomechanical demands placed on them. In XLH patients lacking functional PHEX enzyme, osteopontin and some of its smaller potent inhibitory peptides are retained and accumulate within the bone. This prevents their hardening and leads to soft, deformed bones such as bowed legs (or knock-knees) seen in toddlers.

While not life-threatening, this decreased mineralization of the skeleton (osteomalacia), along with the soft teeth, soon leads to a waddling gait, short stature, bone and muscle pain, weakness, and spontaneous tooth abscesses.

The fact that these symptoms are only partially improved by the standard treatment with phosphate — which improves circulating phosphate levels — prompted the researchers to look for local factors within the bone that might be blocking mineralization in these patients.

“With this new identification of osteopontin as a substrate protein for PHEX,” says Professor Barros, “we can begin to develop an enzyme-replacement therapy to treat XLH patients who have nonfunctional PHEX, much as has been done using a different enzyme to treat another rare bone disease called hypophosphatasia.”

This research was jointly funded by the Canadian Institutes of Health Research (Canada) and Fundação de Amparo ȧ Pesquisa do Estado de São Paulo (Brasil).

        

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The central government does not have much powers to act against the Dental Council of India (DCI) as it has been constituted under an act of parliament, union Minister for Health and Family Welfare Ghulam Nabi Azad said on Thursday.

“Under the present act, the government does not have much powers because the dental council has been constituted under an act of parliament. The council elects its own secretaries and representatives,” Azad said while answering a query on the DCI scam.

Two senior members of the DCI were arrested recently on charges of demanding bribe to provide accreditation to courses offered by dental colleges.

The health minister was in Mamallapuram, about 70 km from here, to attend ‘India’s Call to Action Summit for Child Survival and Development’, a three-day summit organised by his ministry.

He said under the present law, the government was powerless unless “we dissolve and change the law to assume the powers”.

According to Azad, for the four years he has been the health minister none of the council members made a courtesy call on him.

He agreed that the existing set up is flawed and that parliament should dissolve the DCI and the government should bring in a new legislation through ordinance.

On action to be taken against the colleges allegedly involved in the scam, Minister of State for Health and Family Welfare S. Gandhiselvan said: “The investigating agencies are looking into the matter and only after the probe is completed that the government will take any action.”

        

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The article was written by:
Prof. Mauro Labanca
Today, about 65 % of Italian dentists are prac tising implantology. In Italy alone, over a million implants are placed every year. A survey commissioned by the Italian Society of Osseointegrated Implantology on implant perception among the Italian population found that 68 % of the respondents would request an implant should the need for an artificial tooth arise.
One Italian out of three has undergone oral implant surgery. It follows that osseointegrated implants will be offered by a growing number of professionals and be placed in an ever-larger population in the future.[1]
It should also be noted that the economic crisis has severely affected even the dental field, and the repercussions of this phenomenon have been reported by newspapers, professional associations and the Ministry of Health in Italy. The Osservasalute report, an overview of health in Italy (compiled by the National Observatory on Health Status in the Italian Regions, based at the Universita Cattolica del Sacro Cuore’s campus in Rome), reported in 2010 that Italians are being forced to save and that both the food and dental industries will suffer as a result.[2]
Past president of the Italian National Association of Dentists (ANDI) Dr Roberto Callioni analysed the consequences of the economic crisis and future prospects at a conference held under the auspices of the Ministry of Health on 29 March 2011. He stated that, according to a survey by ANDI in 2010, 30 % of Italian dentists have less work because of the crisis.[3]
However, he also observed an increase in offerings owing to the extension of retirement age and the number of graduates, and a decline in demand related to the decrease in purchasing power, a decline in birth rate and a decrease in the DMFT index.[3]

In addition, dentists have to compete against low-cost dental offers and dental tourism to some locations in Eastern Europe (as was the case in the 1990s with regard to the Netherlands). The increase in offerings and the reduction in demand have resulted in the average practitioner having higher costs and lower revenues, also owing to the instability of supply and demand. Oral implantology is affected, as are other disciplines of dentistry, by the current socio-economic situation. Yet, the sense is that of a greater demand by the public and a need for the dentist to offer treatment at a lower cost.
In Italy, there are more than 300 different implant systems (probably not an accurate estimate, considering the difficulty in recording copies of copies). These systems usually have the certification necessary for the market, but only a small proportion of them are supported by scientific evidence, based on studies appropriately designed and conducted by independent research institutions, attesting to their clinical performance, especially in the long term and with the proper follow-up. These are the considerations that, together with the lack of reference measure for quality, led the Italian Society of Osseointegrated Implantology to or ganise the quality forum in implantology, held in Verona from 15–17 November 2008, in which a large number of experts analysed the various aspects of quality in implantology.
The selection of an implant system suited to the demands of the professional is strongly felt to optimise costs when trying to increase profits where possible without interfering with the quality delivered. As written by Pierluigi La Porta in the context of the forum of quality in implantology[4]:
The professional liability requires that the professional has all the factors of production under his control by deploying useful tools to measure the quality of his works, the results that follow and the tools used to achieve performance. Moreover, the information asymmetry that characterizes the doctor-patient relationship is known in the health field, making patients entrust themselves to the professionals’ decisions in order to solve their health problem. This assignment essentially denotes the inability of the patient to decide what is really best to do in that situation, even if he is well informed. His expectations are related to the solution of the problem, but he rarely pays attention to the way it is resolved or the instruments used, so the professional is solely responsible. The case law indicates the responsibility of the doctor to “act like a good father” when he is the one to decide for his patient. So be sure that the quality of his performance becomes a must of his action. When professionals begin to question the quality of their performance, then you are facing a true and profound cultural change.
To these considerations, one might add: why would a patient choose to seek treatment in a dental centre?
“The dentist? A mechanic who changed parts of your car but, not being technical, you never know if you’re rubbing or not.”
This in how one interviewee responded to the request by the well-known psychologist and professor of marketing and communication Alberto Crescentini to describe the figure of the dentist.[5] The average patient finds it difficult to evaluate the quality of a medical service from a technical point of view because he simply does not have the skills. It is our duty not to betray him, and act according to the science and our knowledge. Bearing this all in mind, we should determine the possible savings in the management of implants and whether buying an implant at a lower cost will sult in cost effectiveness. To quote Charles Darwin:
“It is not the strongest species that survive, nor the most intelligent, but the ones most responsive to change.”[6]
In the literature, there are various articles about implant placement techniques, biomaterials and loading protocols, but there is only very little in formation about cost analysis in relation to implant-prosthetic procedures.
Questions regarding the cost of implant placement and the amount a dentist can earn by placing fixtures tend not to be discussed at congresses, as if in fact the one and only important aspect is the finalisation of the case. In a country like Italy, where dentistry is largely private, the economic aspects are fundamental for the acceptance of the treatment plan by the patient. Even in ethical terms, if the dentist believes that his implant is really the most appropriate solution for that particular case, prohibitive costs could deprive the patient of that possible solution or push him towards other choices, both operational (other restorative solutions) and logistic (low-cost dentist or travel to a dentist abroad).
As observed earlier, there are over 300 different types of implants in Italy. Conventionally, these are divided into classes based on various aspects, one of which is purchase price. We could argue, however, that all implants are osseointegrated in the end and that implants that are more expensive are simply more advertised, but in essence they are the same as others. In Italy, many “homemade” and low-cost implant systems are available on the market whose traceability is practically absent in the literature and whose manufacturers are not able to guarantee long-term reliability.[7] If we evaluate the sales data of the leading implant-producing companies, eight to ten leading companies hold 90 % of the existing market share. As a logical consequence, the remaining 10 %, amounting to approximately 100,000/150,000 units, can be divided among the remaining 300 or more companies on the market. What can the average number of implants sold by each of these be (despite what their dealers tell dentists)? Are they supported by case studies or other scientific literature? We should not forget that the intervention of implantation entails placing a foreign object, even if this is made of titanium, into the mouth of a patient, hopefully for life, and with undeniable biological effects. In order to do this in a verified and ethically correct way, I believe that the operator should ask questions and go beyond just checking the CE marking, much as he would do in the case of a drug prescription. Who would recommend taking an antibiotic available on the market a few years ago and tested on an insufficient number of patients?
Cost considerations
After these considerations, procedural and ethical, I turn to what may be the cost items for the realisation of an implant-prosthetic restoration. This assessment does not come from the perspective of a marketing expert or an economic expert, but from the pure and simple perspective of a daily operator who must evaluate which elements actually affect daily clinical practice.
It takes into consideration the variable costs and fixed costs. Variable costs change more or less in proportion to changes in the production volume (the insertion of two implants and two crowns costs more than that of only one; paying an assistant for two hours costs less than paying him for eight hours). Fixed costs are defined costs that are not derived from the production volume. Fixed costs in dentistry are all the costs linked with the activity of the practice, such as those related to radiation protection, verification of the electrical system, steril isation, waste disposal, insurance policy, building rental/payments and utilities in general.
The fixed costs are taken into account for any type of service rendered by the practice (Table 1). It is generally believed that a cheaper implant system is needed to save costs (Table 2) regarding implant treatment. From an analysis of the variable costs, it is evident that the costs of the storeroom and of the implant components are significant.
If an implant system entails many surgical steps, requires the use of many drills, has different platforms depending on the diameter of the neck, requires a surgical screwdriver and a prosthetic screwdriver or if different healing abutments are required for each implant placed, the final cost will change significantly, together with an increased risk of errors and inaccuracies (Tables 3 & 4). In particular, if the implant system offers different diameters, each requiring a different healing abutment, a different transfer and a different analogue, the amount of material to be kept in stock will be much higher, considering the prosthetic solution for every case. In terms of the healing abutment, stocking different heights and diameters according to each size available (at least four for the major implant systems) requires dozens of healing abutments even if only a few implants are placed. All this also inevitably leads to mistakes, organisational miscommunication, etc.
If the cover screw and the healing abutment came together with the implant, and therefore already included in the package (and price), things would be much more ergonomic. There would no longer be a need to stock other material or to re-use titanium healing abutments with the inevitable associated risk of inducing peri-implantitis during uncovering.
Costs related to sterile conditions
In a study on the success rates of osseointegration for implants placed under sterile versus clean conditions, Scharf and Tarnow found that the difference in the success rates was not statistically significant.[8] Sterile surgery took place in an operating room setting and followed a strict sterile protocol.
Clean surgery took place in a clinic setting with the critical factor that nothing touched the surface of the implant until it contacted the prepared bone site. The results indicate that implant surgery performed under both sterile and clean conditions can achieve the same high rate of clinical osseointegration. This means that, while it is therefore not essential to incur the costs related to absolute sterile conditions (Table 5), dentists should not undertake surgery without taking adequate precautions in this regard. The modest savings achieved with regard to the total cost of the intervention could lead to a significant increase in the risk of failure.
We have to consider that an insufficiently tested implant system may lead to trivial errors (difficulty in taking an accurate impression, tightening the components, rotation or loosening of the prosthetic components), resulting in an inevitable loss of time, which in turn affects the cost and delivery. What sense does it make to save € 50 on the cost of the implant system when you have to spend as much or more in buying components separately or in seeing the patient several times owing to these trivial errors (considering the hourly rate given above)?
Also, if failure is always a factor to be taken into consideration, it follows that dentists must seek to eliminate predictable and avoidable failures, which are those for which the dentist is partly responsible (the aforementioned poor management of sterility, improper surgical planning, and an incorrect or adequate surgical sequence). Predictable and avoidable failure may not only result in easily quantifiable economic damage, but also lead to important and less easily quantifiable damage in terms of the reputation and credibility of the practice, which could affect the patient’s confidence in the dentist and his willingness to promote the practice.
Conclusion
In conclusion, we should consider the following with regard to cost management in implant surgery:
-paying particular attention to the significant costs;
-simplification and streamlining of clinical and extra-clinical procedures;
-identification of alternative treatments with a different cost–benefit analysis; and
-a schedule for reduction or elimination of errors and significant associated costs.
All this will contribute towards a better understanding, and in a more responsible and ethical way, of when it is really necessary to try a new implant system and by what criteria its actual reliability can be evaluated. What is the true effect of the price of the implant on the total cost for the practice? We should not be misled in selecting an item that does not appear to be of primary importance in terms of absolute cost. A final consideration is the cost in terms of the practice’s reputation, for example in the case of an avoidable failure.
In the light of these considerations, by selecting protocols and materials more rigorously and by giving greater consideration to ethics in our eval uations, we will be able to achieve a real reduction in cost in areas that do not involve interference in the final quality of our work output. We should attempt to save money in areas that affect the final result, with important consequences for us, for our professionalism and for patients who gave us their trust and confidence when entrusting their health to us. Do we have the right to betray their trust, or do we rather have the duty to preserve and respect it?

        

[drmithila]

Texas Biomed scientists in San Antonio have found that moderate gum disease in an animal model exposed to an AIDS- like virus had more viral variants causing infection and greater inflammation. Both of these features have potential negative implications in long term disease progression, including other kinds of infections, the researchers say in a new report.
The public health message from the study is that even mild inflammation in the mouth needs to be controlled because it can lead to more serious consequences, said Luis Giavedoni, Ph. D, a Texas Biomed virologist and first author of the study.
“This is important because moderate gum disease is present in more than 50 percent of the world population. It is known that severe gum disease leads to generalized inflammation and a number of other health complications, but the conditions that we created were moderate and they were mainly localized in the mouth,” he added.
“After infection with the simian AIDS virus, the generalized acute inflammation induced by the virus was exacerbated in the animals with gingivitis, indicating that even mild localized inflammation can lead to a more severe systemic inflammation,” he added.
The study, funded by the National Institutes of Health (NIH) and conducted at Texas Biomed’s Southwest National Primate Research Center (SNPRC), appears in the February 2013 issue of the Journal of Virology. Collaborators included scientists at the Dental School at UT Health Science Center San Antonio and at Seattle Biomed in Washington State.
Giavedoni and his colleagues studied whether inflammation of the mouth would increase the susceptibility of the monkeys to becoming infected with the monkey AIDS virus. This was based on epidemiological evidence that shows that infection and inflammation of the genital mucosa increases the chances of becoming infected with HIV by the sexual route.
The scientists induced moderate gum inflammation in a group of monkeys, while a second group without gum inflammation served as a control. After exposing both groups of macaques to infectious SIV, a monkey virus similar to AIDS, in the mouth they did not observe differences in the rate of infection, indicating the moderate gum disease did not increase the chances of getting infected with the AIDS virus.
“However, we did observe that the animals that had gum inflammation and got infected had more viral variants causing infection and they also showed augmented systemic inflammation after infection; both of these findings may negatively affect the progression of the viral infection.” Giavedoni said.

        

[drmithila]

Postgraduate medical and dental seat aspirants staged a protest in Bangalore on Sunday pressing for the need to have one common examination for admission in medical and dental colleges across the country. They alleged that there was corruption in the seat selection process and stated that the National Eligibility cum Entrance Test (NEET) would bring in transparency in the process.

They also protested against the alleged corruption in the admission process across the country due to multiple examinations conducted by various private examination bodies and colleges.

Pritam Kitoy, a graduate from Jawaharlal Nehru Medical College, Belgaum, said, “We have come here in support of NEET. Almost 90,000 students appeared for NEET last year and private colleges have filed a case against NEET.” “NEET offers thousands of seats under the umbrella of one exam, offering more opportunities nationally for deserving candidates,” said Madhumita S., a medical graduate from Tamil Nadu.

        

[drmithila]

Days after CNN-IBN aired stories of rampant corruption in the Dental Council of India, another Dental Council executive committee member has resigned. Jammu and Kashmir’s nominee to the Dental Council Riyaz Faruq has quit.
Dr Faruq told CNN-IBN that he was stepping down as he wasn’t aware of what was going on in the executive committee. Last week, CNN-IBN had accessed letters written by the members of Dental Council of India (DCI), raising serious questions against the present Chairman of the Council, Dr Dibyendu Majumdar. In one of the letters, written by a member of the DCI Dr Joseph Issac to the Union Health Ministry, questions the manner in which the Council is being managed to suit private colleges.
A petition was also filed in the Kerala High Court against the DCI chairman Dr Majumdar and others for alleged acts of corruption and impropriety. On January 18, the President of the DCI of Tamil Nadu, Dr Gunaseelan, was arrested by the Central Bureau of Investigation for his alleged involvement in a multi-crore scam in private dental colleges across the country.

Dr Gunaseelan’s aide, Dr Murugesan was caught red handed by the CBI with a bribe Rs 25 lakh in cash, taken from a private dental college, in lieu of permissions being granted for starting a post-graduate course. The arrest was made after the investigating body conducted raids across several places in Tamil Nadu, Kerala and Andhra Pradesh.
This is not the first time that the DCI is at the centre of a storm. Allegations of similar nature have been made against some members of the Council in the past.
The allegations have always been related to either increasing seats in colleges or showing enough faculty members, even if it is just on paper. CNN-IBN has been reporting on flaws within the Dental Council for almost three years now.
When a specific complaint was made before the Health Minister Ghulam Nabi Azad in May 2012, he had promised that the matter will be looked into and some action will be taken. However, nothing has been done till now.

        

[drmithila]

Amending the admission policy for post graduate degree/diploma courses in all government and private medical and dental colleges of the state, the Himachal Pradesh government on Friday sliced the quota for General Duty Officers (GDO) from 90 per cent to 66.6 per cent.
Besides this, the state government also increased the direct quota to 33.3 per cent.

The amendment followed the decision taken by the cabinet in this regard yesterday which reviewed the issue and observed that 90 per cent quota was “impractical” and sufficient numbers of GDOs were not available.

Principal Secretary-Health, Ali R Rizvi disclosed that the amended policy would come into force from 2013-14 academic session and the amendment would apply to 160 PG degree and diploma seats available in the state.

Further, the admission to PG Courses for 2013-14 would be on the basis of the National Eligibility Test conducted by the Government of India.

The application/ information brochure will be available from February 16 to March 16, 2013 and last date of receipt of applications would be March 30 while the tentative date for counselling will be April 5, 2013.

Rizvi said that the GDOs quota would have two categories, one for doctors who are working on regular basis and other for those appointed on contract basis.

The division of seats in both regular General Duty Officers and doctors on contract basis would be on the basis of their respective strength in the cadre.

        

[drmithila]

The Armed Forces Medical College ((AFMC) will no longer conduct its own entrance examination for medical courses and the students wishing to join the institute will now have to appear for the National Eligibility cum Entrance Test (NEET) which will come into effect this year.

The NEET will be held for the first time on May 5 across the country. NEET is a qualifying entrance exam for students wishing to pursue undergraduate medical or dental course or a post-graduate course in government and private medical colleges in the country. NEET – UG, for MBBS and BDS courses, will be conducted by the Central Board of Secondary Education. NEET – UG will replace the All India Pre Medical Test (AIPMT) and all individual MBBS exams conducted by states or colleges themselves.

NEET was proposed to be held from 2012 but was deferred by a year by the CBSE and the Medical Council of India (MCI) owing to technical issues.

AFMC Commandant Air Marshal B Keshav Rao said as per the new guidelines, the college will no longer conduct its own examination. The National Board of Exam will make the merit list and students will have to mention their options for admission to AFMC. Last year, as many as 70,484 candidates appeared for the UG entrance examination. A total of 1,194 were shortlisted for the interview for 150 seats at AFMC.

The Commandant said the college has also started psychometric assessment of medical cadets. Besides, the college has also approved the setting up of an examination centre with a seating capacity of 1,000 students. A training course on sports medicines will also be introduced this academic year, he said.

        

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