Dr. M. Ashraf Khan M.D.
Are you behind on your dental visits, and now you’re being driven in by a toothache, other dental problems, or guilt?
If so, be prepared — not for a lecture from your dentist — but for discovering that there is a host of new options to keep teeth healthy and beautiful.
Here are some of the newer dental care procedures and techniques that leading dentists are bringing into their practices.
Improving Dental Health: How High-Tech X-Rays Can Help
In some dental offices, digitized X-rays (think digital camera) are replacing traditional radiographs. Although digital X-rays have been on the market for several years, they have recently become more popular with dentists.
Digital X-rays are faster and more efficient than traditional radiographs. First, an electronic sensor or phosphor plate (instead of film) is placed in the patient’s mouth to capture the image. The digital image is then relayed or scanned to a computer, where it is available for viewing. The procedure is much faster than processing conventional film.
Your dentist can also store digital images on the computer and compare them with previous or future images to see how your dental health is being maintained.
And because the sensor and phosphor plates are more sensitive to X-rays than film is, the radiation dose is significantly reduced.
Digital X-rays have many uses besides finding cavities. They also help look at the bone below the teeth to determine if the bone level of support is good. Dentists can use the X-rays to check the placement of an implant — a titanium screw-like device that is inserted into the jawbone so that an artificial toothcan be attached.
Digital X-rays also help endodontists — dentists who specialize in root canals — to see if they have performed the procedure properly.
Lasers for Tooth Cavity Detection
Traditionally, dentists use an instrument they call the “explorer” to find cavities. That’s the instrument they poke around with in your mouth during a checkup. When it “sticks” in a tooth, they look closer to see if they find decay.
Many dentists are now switching to the diode laser, a higher-tech option for detecting and removing cavities. The laser can be used to determine if there is decay in the tooth. The dentist can then choose to watch the tooth, comparing the levels at the next visit, or advise that the cavity be removed and the tooth filled.
When healthy teeth are exposed to the wavelength of the diode laser, they don’t glow or fluoresce, so the reading on the digital display is low. But decayed teeth glow in proportion to the amount of decay, resulting in higher readings on the display.
The diode laser doesn’t always work with teeth that already have fillings, but for other teeth, it could mean earlier detection of cavities. Note also that the diode laser does not replace X-rays; it detects decay in grooves on the chewing surface, while bitewing X-rays can find decay between and inside teeth.
Faster Dental Care: CAD/CAM Technology
The CAD in this technology stands for “computer-assisted design,” and the CAM for “computer-assisted manufacture.” Together, they translate into fewer dental visits to complete procedures such as crowns and bridges.
Traditionally when a patient needs a crown, a dentist must make a mold of the tooth and fashion a temporary crown, then wait for the dental laboratory to make a permanent one. With CAD/CAM technology, the tooth is drilled to prepare it for the crown and a picture is taken with a computer. This image is then relayed to a machine that makes the crown right in the office.
Thinner Veneers Preserve More Tooth
Veneers are the thin, custom-made shells or moldings that are used to cover the front of crooked or otherwise unattractive teeth. New materials now make it possible to create even thinner veneers that are just as strong.
What’s the advantage for you? Preparing a tooth for a veneer – which involves reshaping the tooth to allow for the added thickness of the veneer — can be minimal with the thinner veneers. Less of the tooth surface must be reduced and more of the natural tooth is kept intact.
Better Bonding and Filling Materials
If you’ve chipped a tooth, you can have it fixed to look more natural than it would have in the past, thanks to improvements in bonding material and bonding techniques.
Today’s bonding material is a resin (plastic), which is shinier and longer lasting than the substance used in the past. Often, dentists will put layers of resin on a tooth to bond and repair it. Because of the wider range of shades available, they can better blend the bonding material to the tooth’s natural color.
In restorations, when a cavity needs to be filled, many dentists have also abandoned amalgams for “tooth-colored” composite or porcelain fillings, which look more natural.
Better Dental Implants
Implants to replace lost teeth are now more common than in years past. First, a titanium implant or screw-like device is inserted to serve as a replacement root, fusing with the jawbone and protruding above the gum line. An abutment covers the protruding part and a crown is placed over that.
In the past, implants often failed. Now, the typical life of an implant is about 15 years or longer. About 95% of implants today are successful, according to the American Academy of Oral and Maxillofacial Surgeons.
New Gum Disease Treatments for Better Dental Health
When the supporting tissue and bone around your teeth doesn’t fit snugly, “pockets” form in the gums. Bacteria then invade these pockets, increasing bone destruction and tooth loss.
A variety of treatments can help reverse the damage. They range from cleaning the root surfaces to remove plaque and tartar to more extreme measures such as gum surgery to reduce the pockets.
In recent years, the focus of gum disease treatment has expanded beyond reducing the pockets and removing the bacteria to include regenerative procedures. For instance, lasers, membranes, bone grafts, or proteins that stimulate tissue growth can be used to help regenerate bone and tissue to combat the gum disease.
Tooth loss can indicate malnutrition – Study finds
Older adults are at risk for both impaired oral health and malnutrition, according to a study by Rutgers University researchers.
The study, recently published in the Journal of Aging Research and Clinical Practice, analyzed the health records of 107 community-dwelling senior citizens treated at the Rutgers School of Dental Medicine clinic between 2015 to 2016.
The results showed that more than 25 percent of the patients had malnutrition or were at risk for malnutrition. The researchers saw a trend in which patients with 10 to 19 teeth were more likely to be at risk for malnutrition. Those patients classified as having malnutrition had higher rates of weight loss, ate less and more frequently reported that they suffered with dementia and/or depression and severe illnesses than those who had a normal nutrition status.
“The mouth is the entry way for food and fluid intake,” said lead author Rena Zelig, director of the Master of Science in Clinical Nutrition Program at Rutgers School of Health Professions. “If its integrity is impaired, the functional ability of an individual to consume an adequate diet may be adversely impacted.”
Although further studies need to examine the relationships between tooth loss and malnutrition risk, Zelig said the findings show that dental clinics are ideal locations to perform nutritional status screenings as they can identify patients who may not regularly visit a primary care provider and who may be at risk for malnutrition. “Clinicians also can provide patients with referrals to Registered Dietitians and community assistance programs such as Meals on Wheels to prevent further decline in nutritional status,” she said.
This was the first part of a mixed-methods grant to research the associations between tooth loss and nutritional status in older adults. The second part of the grant built on these results and qualitatively studied the eating experience and eating-related quality of life of community-dwelling older adults using qualitative interviews.
The study sets the stage for further research to examine the relationships between tooth loss and malnutrition risk and the impact of tooth loss on the eating experience and eating-related quality of life.
Why seniors don’t eat: It’s complicated
More than half of older adults who visit emergency departments are either malnourished or at risk for malnutrition, but not because of lack of access to health care, critical illness or dementia. Despite clear signs of malnutrition or risk of malnutrition, more than three-quarters had never previously been diagnosed with malnutrition, according to the results of a study.
More than half of older adults who visit emergency departments are either malnourished or at risk for malnutrition, but not because of lack of access to health care, critical illness or dementia. Despite clear signs of malnutrition or risk of malnutrition, more than three-quarters had never previously been diagnosed with malnutrition, according to the results of a study to be published online today in Annals of Emergency Medicine.
“We were surprised by the levels of malnutrition or risk of it among cognitively intact seniors visiting the ER, and even more surprised that most malnourished patients had never been told they were malnourished,” said lead study author Timothy Platts-Mills, MD, of the University of North Carolina Department of Emergency Medicine in Chapel Hill, N.C. “Depression and dental problems appear to be important contributors, as is difficulty buying groceries. Given that seniors visit ERs more than 20 million times a year in the U.S., emergency physicians have an opportunity to screen and intervene in ways that may be very helpful without being very costly.”
Of patients age 65 and older, 16 percent were malnourished and 60 percent were either malnourished or at risk for malnutrition. Of the malnourished patients, 77 percent denied having been previously diagnosed with malnutrition. Malnutrition was highest among patients with symptoms of depression (52 percent), those residing in assisted living (50 percent), those with difficulty eating (38 percent) and those reporting difficulty buying groceries (33 percent). Difficulty eating was mostly attributed to denture problems, dental pain or difficulty swallowing.
In this study, nearly all (95 percent) of patients had a primary care physician, nearly all (94 percent) lived in a private residence and nearly all (96 percent) had some type of health insurance. More than one-third (35 percent) had a college education.
Malnutrition is defined as lacking “adequate calories, protein or other nutrients needed for tissue maintenance and repair.”
“For patients who report difficulty buying groceries, Supplemental Nutrition Program, Meals on Wheels, Congregate Meals Programs or community-based food charities can be helpful, although other factors may also need to be addressed,” said Dr. Platts-Mills. “The growing role of the emergency department as community health resource makes it an essential place for identifying and addressing unmet needs of older adults. Implementation of oral nutritional supplementation is inexpensive and may reduce overall costs by accelerating recovery from illness and reducing readmissions.”
Poor oral health, food scarcity major contributors to malnutrition in older adults
Food scarcity and poor oral health are major risk factors for malnutrition that leads an older adult – already at high risk of functional decline, decreased quality of life, and increased mortality – to land in the emergency department, say investigators.
UNC School of Medicine researchers led a study to determine risk factors associated with malnutrition among older adults receiving care in the emergency department. The study, published in the Journal of the American Geriatrics Society, suggests that food scarcity and poor oral health are major risk factors for malnutrition that leads an older adult — already at high risk of functional decline, decreased quality of life, and increased mortality — to land in the emergency department.
Tim Platts-Mills, MD, senior author of the study, said, “For patients who don’t have enough food at home, the solution is pretty obvious and likely much less expensive than paying for the medical care that results from malnutrition: there is an existing national system of food assistance programs, such as Meals on Wheels, and we believe we can use the emergency department to link patients in need to those programs.”
“Even though such programs are relatively inexpensive — about $6 per individual per day — many programs are underutilized and under-funded. We need to link patients to these programs and fund these programs,” added Platts-Mills, who is also co-director of the Division of Geriatric Emergency Medicine at the UNC School of Medicine.
The study included 252 patients age 65 and older seeking treatment in emergency departments in North Carolina, Michigan, and New Jersey. Participants were screened for malnutrition and then asked about the presence of risk factors.
The overall prevalence of malnutrition in the study sample was 12 percent, which is consistent with previous estimates from U.S. emergency departments and about double the prevalence in community-dwelling adults (those who are not hospitalized and do not live in an assisted-living facility). Of the three sites, patients receiving care in the North Carolina emergency department had the highest rate of malnutrition, 15 percent. The researchers note that North Carolina also has one of the highest rates of older adults living below the poverty line (ranked third out of 50 states).
Of the risk factors studied, poor oral health was found to have the largest impact on malnutrition. More than half of the patients in the study had some dental problems, and patients with dental problems were three times as likely to suffer from malnutrition as those without dental problems. Ten percent of patients experienced food insecurity — the definition of which was based on responses to questions regarding not having enough food, eating fewer meals, and going to bed hungry. Food insecurity was also strongly associated with malnutrition. Other factors associated with malnutrition that may contribute to the problem include social isolation, depression, medication side effects, and limited mobility.
Collin Burks, a UNC medical student and the study’s lead author, said, “Improving oral health in older adults will be more challenging but also important. Medicare does not cover dental care. Fixing dental problems not only makes it easier for these individuals to eat but also can improve their self-esteem, quality of life, and overall health. We need affordable methods of providing dental care for older adults.”
Platts-Mills’s research group is now developing and testing interventions to link malnourished older patients identified in the emergency department to food assistance programs in the community.
Dental research shows that smoking weakens immune systems
As if lung cancer, emphysema and heart disease weren’t enough, there’s more bad news for cigarette smokers.
Researchers at the Case Western Reserve University School of Dental Medicine found that smoking also weakens the ability for pulp in teeth to fight illness and disease.
In other words, smokers have fewer defense mechanisms on the inside of their teeth.
“That might explain why smokers have poorer endodontic outcomes and delayed healing than non-smokers,” said Anita Aminoshariae, associate professor of endodontics and director of predoctoral endodontics. “Imagine TNF-? and hBD-2 are among the soldiers in a last line of defense fortifying a castle. Smoking kills these soldiers before they even have a chance at mounting a solid defense.”
The results of the study were published in the Journal of Endodontics.
Aminoshariae said that, previously, there was little research into the endodontic effects of smoking — the inside of teeth. Smokers had worse outcomes than nonsmokers, with greater chances of developing gum disease and nearly two times more likely to require a root canal.
This new preliminary research set out to explain the possible contributing factors.
Thirty-two smokers and 37 nonsmokers with endodontic pulpitis — more commonly known as dental-tissue inflammation — were included in the study.
“We began with a look at the dental pulp of smokers compared with nonsmokers,” she said. “We hypothesized that the natural defenses would be reduced in smokers; we didn’t expect them to have them completely depleted.”
One interesting find, Aminoshariae noted, was that for two patients who quit smoking, those defenses returned.
Joining Aminoshariae in the study were former students Caroline Ghattas Ayoub and Mohammed Bakkar; faculty members Tracey Bonfield, Catherine Demko, Thomas A. Montagnese and Andre K. Mickel; and research Santosh Ghosh — all from the School of Dental Medicine.
People overestimate benefits, and underestimate risks, of medical interventions
From major heart surgery to a course of minor drugs, people overestimate the benefits and underestimate the risks of a variety of medical procedures, according to new research.
Published in the journal Risk Analysis, the study of 376 adults was led by Professor Yaniv Hanoch from the University of Plymouth School of Psychology, together with Jonathan Rolison from the University of Essex and Alexandra Freund from the University of Zurich.
In several hypothetical scenarios, participants were asked to imagine that their doctor had recommended a treatment — a drug, dental surgery, ear surgery, kidney operation, or to take a newly developed medication — in order to treat an eye infection, a gum infection, a hole in their eardrum, a benign growth, and a life-threatening blood disorder, respectively.
In each scenario, they were provided with precise information about the probability of success (e.g. saving a tooth) or the probability of the risks (e.g. liver damage). The treatments and side effects were taken from medical studies, but the probabilities of their happening were devised by the study authors for the research only.
Participants were then asked to indicate how likely they believed that they were to experience one of the benefits or risks by moving a pointer on a scale from 0% to 100%.
Results showed that on average, people perceived the benefit as higher than the benefit midpoint — in the case of the tooth, the perceived likelihood of benefit was 48%, compared with the midpoint of 45%.
In addition, the perceived risk of the side effects — in the case of the dental procedure, a possible gum infection — was perceived to be 46%, compared to the risk midpoint (or average) of 50%.
The biggest difference was regarding a kidney operation for a benign growth, where the perceived risk of the possible side effect, paralysis (43%) was significantly lower than the actual risk (53%).
Lead author Professor Yaniv Hanoch, Professor of Decision Science at the University of Plymouth, said: “These were really interesting results. By presenting participants with a wide range of medical scenarios — including minor and serious ones, as well as physical, psychological, and dental — our findings lend support to a growing body of evidence regarding unrealistic optimum.
“From an applied perspective, these results suggest that clinicians may need to ensure that patients do not underestimate risks of medical interventions, and that they convey realistic expectations about the benefits that can be obtained with certain procedures.
“It would be good to carry out further studies on a larger population and also explore if and how clinicians can help manage expectations.”
Dr Jonathan Rolison, Senior Lecturer in Psychology at the University of Essex, said: “Participants in the study were given a likelihood range (e.g. 20%-40%) that they would experience the benefits or side effects of a treatment. On average, participants were overly optimistic about the treatment outcomes, underestimating their chances of experiencing the side effects of a treatment and overestimating their changes of experiencing its benefits.
“The findings have worrying consequences for clinical practice. Patients are encouraged to make informed decisions, which may involve deciding on a cancer treatment. Our study shows that patients may have unrealistic expectations about such treatment options.”
Toward dental caries: Exploring nanoparticle-based platforms and calcium phosphate compounds for dental restorative materials
Millions of people worldwide suffer from a toothache due to tooth cavity, and often permanent tooth loss. Dental caries, also known as tooth decay, is a biofilm-dependent infectious disease that damages teeth by minerals loss and presents a high incidence of clinical restorative polymeric fillings (tooth colored fillings). Until now, restorative polymeric fillings present no bioactivity. The complexity of oral biofilms contributes to the difficulty in developing effective novel dental materials. Nanotechnology has been explored in the development of bioactive dental materials to reduce or modulate the activities of caries-related bacteria. Nano-structured platforms based on calcium phosphate and metallic particles have advanced to impart an anti-caries potential to restorative materials. The bioactivity of these platforms induces prevention of mineral loss of the hard tooth structure and antibacterial activities against caries-related pathogens. It has been suggested that this bioactivity could minimize the incidence of caries around restorations (CARS) and increase the longevity of such filling materials. The last few years witnessed growing numbers of studies on the preparation evaluations of these novel materials. Herein, the caries disease process and the role of pathogenic caries-related biofilm, the increasing incidence of CARS, and the recent efforts employed for incorporation of bioactive nanoparticles in restorative polymer materials as useful strategies for prevention and management of caries-related-bacteria are discussed. We highlight the status of the most advanced and widely explored interaction of nanoparticle-based platforms and calcium phosphate compounds with an eye toward translating the potential of these approaches to the dental clinic.