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Cracking the Root of Tooth Strength

After years of biting and chewing, how are human teeth able to remain intact and functional? A team of researchers from The George Washington University and other international scholars have discovered several features in enamel—the outermost tooth tissue—that contribute to the resiliency of human teeth.

Newswise April 2009— Human enamel is brittle. Like glass, it cracks easily; but unlike glass, enamel is able to contain cracks and remain intact for most individuals’ lifetimes. The research team discovered that the major reason why teeth do not break apart is due to the presence of tufts—small, crack-like defects found deep in the enamel. Tufts arise during tooth development, and all human teeth contain multiple tufts before the tooth has even erupted into the mouth. Many cracks in teeth do not start at the outer surface of the tooth, as has always been assumed. Instead cracks arise from tufts located deep inside the enamel. From here, cracks can grow towards the outer tooth surface. Once reaching the surface, these cracks can potentially act as sites for dental decay. Acting together like a forest of small flaws, tufts suppress the growth of these cracks by distributing the stress amongst themselves.

“This is the first time that enigmatic developmental features, such as enamel tufts, have been shown to have any significance in tooth function” said GW researcher Paul Constantino. “Crack growth is also hampered by the “basket weave” microstructure of enamel, and by a ‘self-healing’ process whereby organic material fills cracks extended from the tufts, which themselves also become closed by organic matter. This type of infilling bonds the opposing crack walls, which increases the amount of force required to extend the crack later on.”

This research evolved as part of an interdisciplinary collaboration between anthropologists from The George Washington University and physical scientists from the National Institute of Standards and Technology in Gaithersburg, Md. The team studied tooth enamel in humans and also sea otters, mammals with teeth showing remarkable resemblances to those of humans.

The article, “Remarkable resilience of teeth” appears in the April 2009 edition of Proceedings of the National Academy of Sciences.

Located four blocks from the White House, The George Washington University was created by an Act of Congress in 1821. Today, GW is the largest institution of higher education in the nation’s capital. The university offers comprehensive programs of undergraduate and graduate liberal arts study, as well as degree programs in medicine, public health, law, engineering, education, business and international affairs. Each year, GW enrolls a diverse population of undergraduate, graduate and professional students from all 50 states, the District of Columbia and more than 130 countries.

Acupuncture Eases Radiation-Induced Dry Mouth in Cancer Patients

Twice weekly acupuncture treatments relieve debilitating symptoms of xerostomia – severe dry mouth – among patients treated with radiation for head and neck cancer, researchers from The University of Texas M. D. Anderson Cancer Center report in the current online issue of Head & Neck.

© 2009 Newswise — Twice weekly acupuncture treatments relieve debilitating symptoms of xerostomia – severe dry mouth – among patients treated with radiation for head and neck cancer, researchers from The University of Texas M. D. Anderson Cancer Center report in the current online issue of Head & Neck.

Xerostomia develops after the salivary glands have been exposed to repeated doses of therapeutic radiation. People who have cancers of the head and neck typically receive large cumulative doses, rendering the salivary glands incapable of producing adequate saliva, said Mark S. Chambers, M.S., D.M.D., a professor in the Department of Dental Oncology. Saliva substitutes, lozenges and chewing gum bring only temporary relief, and the commonly prescribed medication, pilocarpine, has short-lived benefits and bothersome side effects of its own.

“The quality of life in patients with radiation-induced xerostomia is profoundly impaired,” said Chambers, the study’s senior author. “Symptoms can include altered taste acuity, dental decay, infections of the tissues of the mouth, and difficulty with speaking, eating and swallowing. Conventional treatments have been less than optimal, providing short-term response at best.”

M. Kay Garcia, LAc, Dr.P.H., a clinical nurse specialist and acupuncturist in M. D. Anderson’s Integrative Medicine Program and the study’s first author, noted that patients with xerostomia may also develop nutritional deficits that can become irreversible.

Garcia, Chambers and their team of researchers conducted a pilot study to determine whether acupuncture could reverse xerostomia. Acupuncture therapy is based on the ancient Chinese practice of inserting and manipulating very thin needles at precise points on the body to relieve pain or otherwise restore health. In traditional Chinese medicine, stimulating these points is believed to improve the flow of vital energy through the body. Contemporary theories about acupuncture’s benefits include the suggestion that needle manipulation stimulates natural substances that dilate blood vessels and increase blood flow to different areas of the body.

The M. D. Anderson study included 19 patients with xerostomia who had completed radiation therapy at least four weeks earlier. The patients were given two acupuncture treatments each week for four weeks. The acupuncture points used in the treatment were located on the ears, chin, index finger, forearm and lateral surface of the leg. All patients were tested for saliva flow and asked to complete self-assessments and questionnaires related to their symptoms and quality of life before the first treatment, after completion of four weeks of acupuncture, and again four weeks later.

The twice weekly acupuncture treatments produced highly statistically significant improvements in symptoms. Measurement tools included: the Xerostomia Inventory, asking patients to rate the dryness of their mouth and other related symptoms; and the Patient Benefit Questionnaire, inquiring about issues such as mouth and tongue discomfort; difficulties in speaking, eating and sleeping; and use of oral comfort aids. A quality-of-life assessment conducted at weeks five and eight showed significant improvements over quality-of-life scores recorded at the outset of the study.

“In this pilot study, patients with severe xerostomia who underwent acupuncture showed improvements in physical well-being and in subjective symptoms,” Dr. Chambers said. “Although the patient population was small, the positive results are encouraging and warrant a larger trial to assess patients over a longer period of time.”

Garcia said that a phase III, placebo-controlled trial is planned and is currently under review. She also noted that in other studies, the M. D. Anderson researchers are examining whether acupuncture can prevent xerostomia in patients treated for head and neck cancer, not just treat it.

“Recently, we completed a study at Fudan University Cancer Hospital in Shanghai, China that compared acupuncture to usual care to prevent xerostomia. We have now started a two-arm placebo-controlled pilot trial in Shanghai. In the prevention trials, acupuncture is performed on the same day as the radiation treatments,” Garcia said.

In addition to Chambers and Garcia, other authors on the all-M. D. Anderson study include: Joseph S. Chiang, M.D. and Thomas Rahlfs, M.D., Department of Anesthesiology and Pain Medicine; Lorenzo Cohen, Ph.D. and Qi Wei, M.S., Department of Behavioral Science/Integrative Medicine; Meide Liu, LAc, Place of Wellness; J. Lynn Palmer, Ph.D., Department of Palliative Care and Rehabilitation Medicine Research; David I. Rosenthal, M.D., Department of Radiation Oncology; and Samuel Tung, M.S. and Congjun Wang, Ph.D., Department of Radiation Physics.

About M. D. Anderson

The University of Texas M. D. Anderson Cancer Center in Houston ranks as one of the world’s most respected centers focused on cancer patient care, research, education and prevention. M. D. Anderson is one of only 40 comprehensive cancer centers designated by the National Cancer Institute. For four of the past six years, including 2008, M. D. Anderson has ranked No. 1 in cancer care in “America’s Best Hospitals,” a survey published annually in U.S. News & World Report.

© 2009 Newswise. All Rights Reserved.

Baltimore Dental Study Offers Model Program to Reduce Tooth Decay in Urban Children

University of Maryland, Baltimore study shows early preventive dental care to toddlers may significantly reduce cavities and cavity-causing bacteria levels in children.

 

© 2009 Newswise — A new study by researchers at the University of Maryland, Baltimore recommends a model program for urban pediatric clinics that can significantly reduce dental cavities in low socioeconomic infants and toddlers.

The researchers at the University of Maryland Dental School conducted the 26-month study of 219 children, ages six to 27 months, at the University’s Pediatric Ambulatory Care Center, a pediatric primary care clinic serving mostly low-income residents. Oral conditions of very young children were compared with those of older children at their first visit.

A “prevention group” of 109 children, ages six to 15 months, showed more than eight times less cavity-causing oral bacteria and significantly less cavities at their final dental visit, than did a control group of 110 children, ages 18 to 27 months at their first visit who had not received previous preventive care. Each child in the younger group received assessments of dental caries, monitoring of oral bacteria levels, fluoride varnishing, dental health counseling, periodic recalls, and referral to a dentist.

The study showed that if infants and toddlers can be provided with some preventive care, their oral health will be much better at the age of two years old than if they did not receive preventive care, says study leader and Dental School professor Glenn Minah, DDS, PhD.

Outcome measures included number of decayed tooth surfaces, oral counts of cavity-causing bacteria, and caregiver responses to a questionnaire about the child’s diet and home care.

Children who needed immediate treatment for caries were referred for treatment and those with high microbial counts were considered high risk and recalled for additional prevention.

Tooth decay can begin as soon as the first teeth emerge in toddlers, Minah says. And the study confirmed that children with early childhood dental caries are at higher risk for developing new carious lesions at a later age. Early childhood caries is a $3 billion problem annually, according to the researchers.

The desired improvements in dental care for young urban children can happen “by working with the physicians to assess children for caries-risk, screening them for early caries, referring them to dentists, and applying topical fluoride varnish,” says Minah.

He said that the success of the study was largely possible by placing a full-time nurse or dentist with pediatric experience at the clinic who was solely dedicated to oral care, and the use of microbial screenings as a primary caries-risk indicator for the study. The risk assessments and screenings helped the staff identify low-risk subjects and children who were experiencing caries-promoting conditions.

Norman Tinanoff, DDS, MS, program director of the School’s Department of Pediatric Dentistry, says that dental caries in preschool is a big program now and a “rather ignored” program until 10 years ago. The problem was referenced in only two separate sentences in the 2000 report of the U.S. Health and Human Services Department (HHS) Surgeon General’s report on the nation’s health. “Now it has bloomed as a public health problem and a research problem,” said Tinanoff. Dental caries is now recognized by HHS as the most widespread chronic disease and most common unmet health care need of childhood.

The study identified potential drawbacks of the model, such as added costs for laboratory equipment for analysis of the microbial screenings and recalling the young children for follow-up preventive measures.

A more cost-efficient model suggested by the study may be one that assumes every enrolled child is at high risk for tooth decay, providing fluoride varnish at the first visit and at six-month intervals, referring each child for dental treatment when cavities appear, re-examining them for oral problems at each or most medical visits, and emphasizing dental education at each visit. The study is published in the journal Pediatric Dentistry, vol. 30, no. 6.

© 2009 Newswise. All Rights Reserved.

Guest Column: The Business Sense of Dentistry

Profile of Dr. Vincent Dolce, DMD

By Charles Friedman

Dr. Vincent Dolce

Dr. Vincent Dolce

As a National Geographic documentary producer, I have had the opportunity to see the world, weave between cultures, and meet many extraordinary individuals. Currently I am working on a documentary for the Florida Department of Education which will be shown to high school students throughout the state. This particular presentation is career oriented with a heavy focus on leadership skills and innovation. Eleven careers were chosen and Dentistry was one of them.

The essence of leadership, which is the core of the documentary, is the combination of personality, integrity, setting a consistent standard, and the ability to motivate and inspire your staff. Yet it is important to convey to these future leaders that an individual who exhibits these traits is still not guaranteed that the end results will be positive. We had to find a common thread among leaders that wasn’t just success.

The common thread between all eleven leaders chosen for the documentary was vision, which takes courage and there are still no guarantees. Vision means thinking outside the box, it means change, and it means taking chances and that’s why our dentist of choice was Dr. Vincent Dolce of Palm Beach County.

But beyond just a documentary, I thought that his own profession would be interested in knowing more about him. I found him to be exceptional. My first indication that Dr. Dolce was unique was when I learned he hosted a weekly radio show throughout southern Florida. He actually brings on other dentists to educate the public about the future of dentistry and the health risks if you do not take care of your oral health. He pays for the show out of his own pocket and he does not take any sponsorship, nor does he run any commercials. This humane gesture revealed to me the caliber of his character. It’s the manner in which he thinks, the manner in the way he acts, the manner in the way he talks, and the manner in which people respond to him. He is a man of dignity, and substance. But dignity and substance are still no guarantees of success.

As I was proceeding with my documentary I was also being introduced to the Dolce philosophy of Dentistry. It was most reassuring that Dr. Dolce turned out to be who I thought he was. When I asked him if I could write this article knowing that I would be giving away certain business techniques, I was fully expecting to receive his approval but not really sure. He was not protective of his techniques in the least and there was no hesitation, he wants every dentist to get the most joy, satisfaction, and financial gain out of the profession that can be achieved. A great deal of his personality is his passion for people to succeed, as well as his lightning quick sense of humor. What made a significant impact on me was his ability to captivate other dentists during a lecture. Although Dr. Dolce is only 51 years old, other dentists approach him with the awe of approaching an ancient Zen dentistry master. These other dentists are curious about his approach because Dr. Dolce has noticeably doubled his income and is expanding his business while many are trying to keep theirs alive. He developed training programs that improve the efficiency of the hygienist, treatment coordinator, dental assistant, and receptionist. After a few of his industry friends saw his numbers start to increase he developed a series of training modules so that dentists could be smarter and better business people.

Dr. Dolce’s business sense of dentistry can be broken down into roles which even include the environment. The roles are divided between the staff and the atmosphere.

The Office of Dr. Vincent Dolce

The Office of Dr. Vincent Dolce

When you walk into Dr. Dolce’s West Palm Beach, Fl office it appears like any other dental office. However, beyond the reception area, sequestered yet not obtrusive, is a room that felt more like an elegant showroom than a dental office. This room would make George Lucas envious, and it was done at very little expense.

That is another aspect of Dr. Dolce’s business sense. It is part photography gallery, part exhibit hall, part high technology – with all the elegance of a museum setting.

“This room has more than paid for itself,” Dr. Dolce explained. “As I’m explaining how each patient (whose before and after pictures appear) benefited from taking their oral health seriously, I’m also educating the patient on how their oral health is integrated into their overall health.”

When someone is in the consulting room, they can be taken on a pathway to possible consequences of neglecting their oral health. This one room opens up a whole new line of dialog with his patients. Instead of reacting to the dentist’s office in a negative way, they now begin to understand the dentist and his office as a proactive approach to their health.

“That is the beginning of a new form of relationship between a dentist and his patients.” Dr. Dolce told me.

How is that new relationship best defined? Dr. Dolce and his staff continually educate a patient of the correlation between their overall health and their oral health. This is accomplished in a genuine and sincere matter-of-fact nature that the patients are 100% attentive to. Dr. Dolce’s training initiates the patient to inquire and investigate what they need to be healthier and happier. Empowering the patient is a major first step; a dentist’s office has to make money to prosper.

Dr. Dolce reminded me of a typical visit to the dentist – put the patient in the chair, take x-rays, and diagnose what they need. What they don’t do is energize and inspire the patient to be proactive in taking care of their oral health. “That’s not what they teach you in college. They don’t teach you the psychology of dentistry, they teach you the mechanics. There is a psychology of dentistry, there is a philosophy of dentistry, and there is a business of dentistry,” he said.

The next phase is the human element phase. This is where teamwork and training comes into play. Dr. Dolce assembled a team of training specialists which included curriculum developers from the United States Navy, Harvard University, and the Department of Justice. He wanted to develop interactive training modules that challenged and educated every one of his employees to meet the individual needs of every patient. These interactive training modules are the basis for his expansion initiative. His goal was to increase his gross amount considerably without depending on new patients as his only source of growth. To Dr. Dolce’s satisfaction, the training method worked.

An x-ray machine is an x-ray machine is an x-ray machine, but the dialog between the person taking the x-rays and the patient does not have to be the typical conversation. Dr. Dolce’s training teaches his staff a new way to communicate with the patients. Basically Dr. Dolce believes that the lifeline of successful dentistry is education in communication with the patients. Dr. Dolce also believes that every patient should be secure in the fact that his staff has listened to them.

Since I was producing a documentary, his patients that participated had all agreed to be on camera. My original thoughts were to observe the doctor and his leadership skills and the patients were just props. However, as I was seeing and experiencing his philosophy I really became curious about what the patients thought of their interaction with him. So before he even started working with them I started asking patients what they thought about their introduction to the doctor.

Everyone felt that this was a person who could be trusted. I did not know exactly what that meant until the next phase. The next phase as you probably know is the reviewing of the treatment plan. I did not even really realize what was happening or the impact that the doctor training modules had had. I learned through a conversation at lunch with his treatment coordinator.

The treatment coordinator said, “I have worked for three other dentists before Dr. Dolce. I have never experienced patients so willing to pay for their dental health and so willing to be proactive about their dental health as here in Dr. Dolce’s office. Usually there is a wall of resistance as soon as you explain the costs of dental work. People are not usually proactive about oral health, but the way Dr. Dolce has trained us in explaining their dental needs has them lower their resistance.”

Dr. Dolce invited me to attend a lecture that was being given for dentists in his region. It focused on the restorative phase of implants. I went because I wanted to talk to other dentists and see how they interacted with their patients. What I learned and overheard was that most of these dentists were there to learn how to make more money.

I asked him about this as we were heading back to his office. He said, “Most dentists don’t look at their office or their office procedures as a combination of trained staff and bedside manner. They expect their staff to bill properly and know the techniques as well as the sterile parts of dentistry, but really they expect their staff to be already trained to be business oriented.” The most unique difference being that Dr. Dolce inadvertently reaps the rewards of a high volume of the most expensive and most productive dental procedures such as veneers, implants, and total reconstruction through a highly trained staff, an aesthetic environment, and personal attitude.

I would like to leave you with an excerpt from one of Dr. Dolce’s speaking engagements to a local group of high school students:

“The future of dentistry could never be brighter. With the aging of the baby boomers, and the population in general, plus the cosmetic revolution, not to mention the direct health connection between the mouth and the body, the business of dentistry is perfectly positioned to make any dentist a millionaire. However, if you do not have passion, if you do not consider the patient an individual and a treasure, and you only enter the field of dentistry to make money you will be disappointed. Dentistry is a competitive field. The business sense of dentistry is not a course that is offered in college. The business sense of dentistry is developing a highly trained staff, providing an education and vision to the patient, and nourishing and maintaining the patients trust.”

Chuck Friedman is a former executive producer for National Geographic Television. Mr. Friedman has worked as a video producer/director for a long list of companies and government agencies that include the United States Army and Navy, State of Florida, U.S.D.A., St. John’s University, Michelin, Minolta, Pony Shoes, United Way, the Air Force, Drug Free America, Major League Baseball, DuPont and many others. Mr. Friedman is also well known for developing effective multimedia training programs, and for providing marketing and strategy consultation for a wide variety of clients.

Device screens patients in minutes for periodontal disease

A portable saliva test device developed by a University of Michigan School of Dentistry professor could tell patients in just minutes if they have periodontal disease, a hefty improvement over current methods which require hours of analysis at an off-site lab.

The saliva test device was developed jointly by University of Michigan’s Dr. William Giannobile and Dr. Anup Singh of Sandia National Laboratories. Testing with the kit has progressed to the point where a dentist would need only a drop of saliva from a patient and less than 10 minutes of time to analyze the sample to determine if the patient has periodontal disease. Current sample analysis requires hours of time at a laboratory away from a dental office.

Giannobile, director of the Michigan Center for Oral Health Research, said that in recent months MCOHR has been conducting tests that are adaptable to using microfluidic technology. “Using a miniaturized lab-on-a-chip approach, we have been able to separate and analyze proteins quickly, typically within minutes of sample separation,” he said. Established in 2003, MCOHR takes discoveries from research laboratories and attempts to find ways to use them to benefit oral health care professionals and their patients.

The saliva test kit measures a tissue-destructive enzyme, matrix metalloptoteinase-8, a molecule which is released from cells that tend to migrate to periodontal lesions.

“Using just a very small sample of saliva, we found our tests to be highly accurate in identifying patients with periodontal disease, without the need for a more time consuming and comprehensive clinical examination,” Giannobile said. “This method could one day be used to screen large patient populations which could have major implications for oral health.”

From late 2005 through 2006, 130 patients were tested at MCOHR clinics in northeast Ann Arbor.

Collaborating with Giannobile are Mark Burns, professor with the U-M College of Engineering, and Dr. Christoph Ramseier and Janet Kinney, both MCOHR research fellows. The National Institutes of Health provided funding for the test studies. The lab-on-a-chip technology was developed and manufactured by Sandia National Laboratories, which has major research and developmental interests in national security, energy, and environmental technologies.

The results of an analytical test appeared in the March 27 issue of the Proceedings of the National Academy of Sciences.

The University of Michigan School of Dentistry is one of the nation’s leading dental schools engaged in oral health care education, research, patient care, and community service. General dental care clinics and specialty clinics providing advanced treatment enable the school to offer dental services and programs to patients throughout Michigan. Classroom and clinic instruction prepare future dentists, dental specialists and dental hygienists for practice in private offices, hospitals, academia and public agencies. Research seeks to discover and apply new knowledge that can help patients worldwide. For more information about the School of Dentistry, visit: www.dent.umich.edu.

SOURCE: University of Michigan School of Dentistry

Half of General Dentists Placing Dental Implants

The Wealthy Dentist Survey Results

Half of general dentists offer their patients surgical dental implants, according to a survey conducted by The Wealthy Dentist. On the other hand, fully four out of five specialists place implants. Dental implants are an essential part of modern dental care. When it comes to implant dentistry and tooth implants, both passions and controversy run high.

Approximately half of general dentists are placing dental implants. In a recent dental consulting survey conducted by TheWealthyDentist.com, each dentist was asked if they place implants themselves. Fifty-three percent of the general dentists in the poll indicated that they do dental implant placement themselves. The remaining 47% of general dentists refer patients to a specialist.

Not surprisingly, dental specialists had a very different profile than general dentists. Four out of five specialists responding to this poll place dental implants, as opposed to only one out of two general dentists. Those who do not place implants are endodontists, prosthodontists, and pediatric dentists.

Dental implants are a permanent solution to lost teeth. Rather than a removable denture, patients are given titanium implants. Because of its ability to bond with bone, titanium is an ideal material for surgical implants. An artificial tooth is then placed over the implant. In the past several decades, dental implants have exploded in popularity, offering a more natural tooth replacement than any other current dental technique.

Many general dentists are more than happy to accept straightforward implant patients, but refer out the more difficult cases. As a Florida general dentist said, “I place implants myself, but only in ideal situations.” Another agreed, saying, “I offer implants. It depends on the complexity of the case; some are sent to a specialist.”

Some questioned the ability of general dentists to properly place implants, a North Carolina general dentist explained, “I have neither the experience nor knowledge of anatomy that would allow me to feel comfortable placing implants.” A Florida general dentist questioned the wisdom of a single practitioner offering too many services. “Like they say: if you try to be a jack of all trades, you will be a master of none. I am fortunate to have one of the best implant specialists in the entire country in my backyard. I never have to worry about improper or sloppy placement like I get from other ‘professionals.’”

A number of dentists were left unimpressed by the performance of some specialists. “After referring to specialists for the last few years and getting back poor work (acentric, too facially inclined, off the center of the ridge, non-ossiointegrated), I thought: How much worse can I do?” commented a Georgia general dentist. “Now I offer implants. For practice doing sinus lifts I’ll get a couple of sheep or pig heads.”

From a patient’s perspective, generalists who offer dental implants can be convenient. A general dental practice in Minnesota has been pleased with the results. “After going to training in January and February, we started placing implants right away. Patients love that we can do the whole process from beginning to end.”

More and more general dentists are interested in getting into the business of offering implants. “I refer implant patients to a specialist, but I am seriously considering placing them in some of the more straightforward cases,” commented a California general dentist. A dentist from Greece agreed: “I’m taking a course in implantology, so soon I will offer them myself.”

Restorations are quite another matter. “I restore implants and I refer placements out,” said a Massachusetts general dentist. A Tennessee prosthodontist agreed, saying, “I restore but do not place implants.”

A few dentists criticized specialists and the perception of them as more qualified to place dental implants than general dentists. “Every general dentist who can extract a tooth can do most implant surgeries,” opined an Oregon dentist. “I feel that oral surgeons really do not want you to know how easy it is to do. All dentists owe it to themselves and to their patients. I restore 75% more implants now because I am placing my own. The acceptance was astonishing.”

Many general dentists are proud of the success they have had with dental implants. “I’ve been placing implants since 1984. I did an internship in implants at Midwest Implant Institute. In twenty years, I have only ever lost one dental implant due to implant non-integration,” proclaimed a Michigan general dentist. A Virginia dentist agreed, saying, “Most implants are well within the abilities of GPs. The expertise comes in knowing which ones to refer out.”

The need for referrals helps to foster a healthy relationship between general dentists and specialists (at least in some cases). “We do the prosthetic portion of the process; we do not do the surgical placement of the implant,” explained a New Hampshire general dentist. A Pennsylvania doctor was in a similar situation: “I use mini-implants in office where and when I’m able. I refer out traditional implants.” A New York dentist described his process: “I have a specialist come to my office. I do the restorative portion myself.” One Virginia prosthodontist is lucky enough to have in-house assistance: “I pick and choose. Those patients who need a more complex treatment are referred to our in-house oral surgeon or periodontists.”

“Those of you who aren’t in the industry might not know how passionate dentists can be about dental implants,” said The Wealthy Dentist founder Jim Du Molin. “Implants have been one of the most significant developments in dental care over the last century. The only problem is, it’s still not entirely clear who is (and who should be) placing them. This is so often the issue: improving access to health care without compromising the quality of care patients receive.”

For additional information on this and other Wealthy Dentist surveys, as well as more dentist comments, visit www.thewealthydentist.com/survey.

The Wealthy Dentist is a dental marketing and dental practice management resource featuring founder Jim Du Molin. The site’s weekly surveys and dental newsletters are viewed by thousands of dentists across the United States and Canada. The Wealthy Dentist is a sister company of the Internet Dental Alliance, Inc. (www.internetdentalalliance.com). IDA is the largest provider of websites for dentists, email patient newsletters and dental directories in North America.

SOURCE: PR.com

Fluoridated beverage consumption and dental fluorosis:

There’s a connection

Fluoride is a mineral that protects against dental cavities; however, too much fluoride during tooth formation can lead to dental fluorosis, which is usually characterized by white streaks or splotches on the teeth. Fluoride is naturally present in well water in various concentrations, is added to many public water systems to protect against cavities, and is found in beverages made with these water sources. Fluoride is readily available from toothpastes, mouthrinses, food, and beverages, and its increased availability may be increasing children’s likelihood of developing fluorosis.

The amount of fluoride consumed from beverages is due to the amount of beverage consumed and the concentration of fluoride in the beverage. A team of researchers from the University of Iowa, during the 35th Annual Meeting of the American Association of Dental Research (AADR), presented the results of a study in which they examined the relationship between beverage fluoride intakes and fluorosis of the permanent incisors (i.e., front teeth).

As part of the Iowa Fluoride Study, they have been following children, currently 10-13 years old, from birth. Their parents have recorded food and beverage intakes multiple times throughout the years. The researchers have analyzed well waters and purchased beverages for fluoride concentrations. When they were between 7.7 and 12 years of age, the children had dental examinations, at which the investigators looked for teeth showing evidence of fluorosis. Beverage intakes and the amounts of fluoride consumed were compared between children with and those without fluorosis in their permanent incisors.

About 35% of the children had some evidence of dental fluorosis, most of which was mild. Dietary records collected at 16 months of age showed that children with fluorosis had consumed slightly more 100% juice that had children without fluorosis. More importantly, children with fluorosis consumed more fluoride from their beverages than did children without fluorosis. At 6, 9, 12, 16, 24, and 36 months, children with fluorosis had higher fluoride intakes from all beverages than did children without fluorosis.

At multiple ages, children with fluorosis had higher fluoride intakes from infant formulas and 100% juice than did children without fluorosis. The results suggest that fluoride intake from beverages during infancy and early childhood can increase the risk of the child’s developing fluorosis in permanent incisors. High fluoride intake from beverages could be due to either drinking too much of a beverage prepared with accepted fluoride concentrations, or normal intake of beverages prepared with water having naturally high fluoride concentrations. The association between fluoride ingested from beverages and dental fluorosis should be carefully balanced with fluoride’s benefits in preventing caries.

Another research team from the University of Iowa, recognizing that sugared beverages are playing a larger role in the diet of the American population, assessed erosion of enamel and root surfaces following exposure to select sugared beverages, including Coke®, Diet Coke®, Gatorade®, Red Bull®, and apple juice. Extracted teeth were painted with fingernail polish, leaving a small window of either enamel or root surface exposed to the environment. These teeth were soaked in one of the beverages for 25 hours, sectioned into thin slices and viewed through a microscope. The amount of erosion was measured and compared among beverages for both enamel and root surfaces.

Gatorade® caused the most enamel erosion, followed by Red Bull® and Coke®, with Diet Coke® and apple juice exhibiting the least erosion. Gatorade® was also shown to have caused the most erosion on the root surface, followed by Red Bull®, Coke®, apple juice and Diet Coke®. Erosion depths were greater in root surfaces compared with enamel following exposure to Red Bull®, Coke® and apple juice. Erosion depths were greater in enamel than root surfaces with Gatorade®. Enamel and root surface erosion depths did not differ in Diet Coke®. It was concluded that exposure of teeth to sugared beverages caused significant erosion of both the enamel and root surfaces, but it was not consistent between beverages, with some specific beverages causing more erosion than others.

SOURCE: American Association for Dental Research

Profile: Dr. Nancy Summer Lerch, DDS

Dentistry and Women’s Advocacy

Practice: Center for Esthetic Dentistry

Location: New Haven, Connecticut

Dr. Nancy Summer Lerch is an evangelist for women in dentistry. “Being a woman in dentistry is a very great asset. Like any asset it’s something to be shared. It’s a very, very good thing,” she said.

Dr. Lerch explained, “Dentistry is a great career for women because we can arrange our career and work time any we want. It is set up to be very beneficial for women in juggling family in terms of managing time and resources. There are a lot more serious, seasoned male dentists looking for female associates to augment their practices. New female dentists can write their tickets any way they want. The opportunities are abundant.”

Dr. Lerch is very familiar with how those opportunities can be utilized. “I rented space from a dentist friend in his off hours and saw my own patients on a $10,000 loan from a bank in 1982,” she said.

From that modest loan, she built a thriving practice and today she has one of the most acclaimed dental practices in New Haven, Connecticut.

Her practice has received the “Best of New Haven County” award by the regional Advocate newspaper for eight years running.

She has had articles featuring her practice and cosmetic dentistry in the New Haven Register and has been consulted by national magazines like Vogue and Redbook, for articles they were writing about cosmetic dentistry.

Even given her excellence and her accolades, Dr. Lerch knew something needed to change in her practice to boost it to the next level. She wanted her practice to become more organized and productive than it was. She wanted to grow but didn’t know what was stopping her.

“My production had flatlined. I wanted to know how to handle that…what to do to expand my practice to the next level,” she said. With that in mind, Dr. Lerch hired a practice management consulting firm to help her achieve these new goals.

“The biggest difference consulting has made is the change in my staff. They got properly trained and grew in competency. I also moved my hygienist into the practice manager position so now I don’t have to sweat the small stuff. The management consultant saw that she knew how to run the office and train the staff. Now I have someone to handle the day to day management of the practice and staff for me,” she declared confidently.

Dr. Lerch has now been in practice for 22 years after graduating from the University of Washington School of Dentistry in 1982 and spending two years at the University of Connecticut School of Dentistry in Family Dentistry Residency. Her undergraduate degree was obtained from Whitman College in Walla Walla, Washington.

She is also very active in and dedicated to ensuring the future of ethical dentistry in Connecticut. She is the immediate Past President of the New England Academy of Cosmetic Dentistry and attained her Accreditation in Cosmetic Dentistry in 1990, given by the American Academy of Cosmetic Dentistry (AACD). She is the fourth woman to ever do so. She now serves as an official Examiner and mentor for the Accreditation process. She also served as editor of the AACD Journal from 1992 through 1994.

She loves reading and swimming and being with people. She is also a wine and food enthusiast. She has a son and daughter, ages 10 and 18 respectively. She, along with her husband and children, ski as a family and her son recently came in 8th in the state of Connecticut for children 10 and under at a major skiing tournament. Her family has a camp in the Adirondacks that they’ve owned for nearly 100 years. Her time with her family, enjoying the fruits of her labor, has undergone a nice change since implementing the systems provided by her consultant. Increased quality of life went hand in hand with increased production.

She advises women dentists to “Get into the community and mingle. It is totally possible for any woman to do this. Being gentle and nurturing can help a woman start any practice she wants. It’s still a bit of a novelty. People are surprised at the difference between a male and a female dentist.”

You can learn more about Dr. Lerch and her practice at www.theartofsmiles.com.

AADR Testifies in Support of Dental Amalgam at FDA Hearing

On behalf of the American Association for Dental Research (AADR) and the American Dental Education Association (ADEA), AADR member Steve London, D.D.S., Ph.D., testified in support of the use of dental amalgam as a restorative material at the Food and Drug Administration’s (FDA) Joint Meeting of the Dental Products Panel of the Medical Devices Advisory Committee of the Center for Devices and Radiological Health and the Peripheral and Central Nervous System Drugs Advisory Committee of the Center for Drug Evaluation and Research.

London, associate dean for research and basic sciences at the College of Dental Medicine at the Medical University of South Carolina (Charleston), testified that any decision about the use of amalgam as a restorative material should be based on sound science and empirical evidence-based research.

“Dental amalgam has a well-documented history of safety and efficacy in dentistry,” said London, quoting AADR’s official policy position on dental amalgam, which was instituted in 1996 and last revised in 2004. “Its advantages include ease of handling, durability and relatively low cost. Dental amalgam has numerous indications for use, especially for restorations in stress-bearing areas. Its main disadvantages are poor esthetics and the necessity for sound tooth structures to be removed in order for retention to be obtained. Its use in restorative procedures is still indicated.”

In conclusion, London stated, “Dental amalgam is the most thoroughly researched and tested restorative material among all those in use today. To date, no scientific peer reviewed study has proved a link between amalgam restorations and any medical disorder. As dental researchers and dental educators, we will continue to investigate dental amalgam and other restorative materials.”

The American Association for Dental Research (AADR) is a non-profit organization with more than 4,000 members in the United States. Its mission is: (1) to advance research and increase knowledge for the improvement of oral health; (2) to support and represent the oral health research community; and (3) to facilitate the communication and application of research findings.

SOURCE: American Association for Dental Research and U.S. Newswire

AGD Launches Dry Mouth Awareness Effort

Some Medication Warning Labels Are Tough to Swallow

More than 32 million adults are at risk of dry mouth, or xerostomia, caused mainly by prescription and over-the-counter drug products. Dry mouth can lead to extensive decay, serious oral infections and make it difficult to swallow and speak. More than 80 percent of patients complain about dry mouth and dry mouth symptoms per week, according to an online member poll conducted by the Academy of General Dentistry (AGD).

To help the public better understand dry mouth as well as find the most effective treatment, the AGD developed a new print public service announcement (PSA) intended to raise awareness about the causes and consequences of dry mouth. The AGD also developed a special section on its Web site — http://www.agd.org — which provides free tools the public can use to learn more about this very serious issue.

“Our profession and our members continue to see an increase of cases of this condition due to a rise in medication consumption by the public,” says AGD President Bruce DeGinder, DS, MAGD. “We want to educate the public that more than 400 prescriptions and over-the-counter drugs are known to cause dry mouth and that their general dentist can help provide solutions to this problem.”

Dry mouth is caused by a decrease in the amount of saliva in the mouth when the salivary glands do not work properly. The salivary glands help keep the mouth moist, which helps prevent decay and other oral health problems.

Many medications, prescription and over-the-counter, may decrease saliva flow and they can contribute to symptoms associated with dry mouth. The most common troublemakers are anti-hypertensives, anti-depressants, painkillers, tranquilizers, diuretics and antihistamines. Dry mouth can cause extensive tooth decay, even in people who have had a healthy mouth for years, and it contributes to many other oral health problems. Dry mouth may be a sign of a serious health condition or may occur when a person is upset or experiences stress.

“The PSA educates the public that their general dentist can help identify medications that may be responsible for causing dry mouth,” says Cindy G. Bauer, DDS, MAGD, chair of the AGD’s Council on Public Information. “They may recommend home remedies such as sucking on ice chips, sucking on sugar-free hard candy or chewing gum and rinsing with a mixture of baking soda and water.”

SOURCE: Academy of General Dentistry and US Newswire