Dental sealants may expose children to an estrogen-like chemical

A new study shows that dental sealants used to treat and prevent cavities may expose children to an estrogen-like chemical called BPA.BPA, or bisphenol A, is a "toxic chemical" that has been linked to a variety of health problems in human and animal studies, says Philip Landrigan, director of the Children's Environmental Health Center at the Mount Sinai School of Medicine in New York, and co-author of a study in today's Pediatrics.


Studies have linked BPA to altered hormone levels in men and an increased risk of diabetes and heart disease in adults. Depending on a child's age, 20% to 41% have had their teeth sealed, the study says.

GET THE FACTS: What you need to know about BPA
Materials used in white fillings or as sealants — which prevent future decay — can break down into BPA after coming in contact with saliva, says co-author Abby Fleisch, a pediatrician at Children's Hospital Boston.

BPA levels in saliva can spike to 88 times higher than normal immediately after a dental sealing, Fleisch says. Tests can detect BPA in saliva for up to three hours after the procedures, although levels quickly drop off after that.

Doctors don't know how much BPA is absorbed into the body, however, or what its effects might be, Fleisch says. But dental materials probably cause far less BPA exposure than other consumer goods, such as plastic bottles and the linings of metal cans.

Overall, the benefits of dental sealants outweigh the potential risks of a brief BPA exposure, says co-author Burton Edelstein, president of the Children's Dental Health Project, who continues to recommend the procedures. BPA generally passes out of the body quickly and doesn't build up in tissue.

www.usatoday.com

A hearing aid with teeth

The non-surgical, and removable hearing solution has been designed to transmits sound via the teeth to help people with single sided deafness.

A novel hearing aid that transmit sound via the teeth has been developed in the US.

The non-surgical, and removable hearing solution has been designed to transmits sound via the teeth to help people with single sided deafness.

The Soundbite hearing system is a ‘nearly invisible' digital audio device and relies on a principle called bone conduction that can deliver clear, high quality sound.

It consists of a small microphone unit worn behind the ear and an easy-to-insert-and-remove dental retainer-like device which requires no modification to the teeth.

The hearing system, developed by US company Sonitus Medical Inc, is currently for investigational use only but clinical trials are planned.

A spokesman for the company said: ‘We currently have a clinical trial underway for an intended first indication of single-sided deafness with an intended first approval from the (US) FDA in mid 2010. The trial is only happening in the San Francisco Bay area and is now fully enrolled.'

Sonitus Medical Inc. is also planning to address the needs of patients with conductive or mixed hearing loss, too.

To learn more about Sonitus Medical and the SoundBite hearing system, visit
www.sonitusmedical.com.

Her new dentist said gingivitis; her old dentist said baloney

Lorna Dewalle has been to the dentist every six months and takes care of her teeth.

So when she moved to the Triangle last summer from Texas, she found a new dentist to keep up her regimen.

In January she went for a cleaning at Spelios and Associates in Cary. But she thinks the dentist tried to persuade her to do an expensive procedure her clean mouth didn't need.




So Dewalle contacted Triangle Troubleshooter about it.

At her appointment, Dewalle said, the hygienist would not clean her teeth until the dentist saw her to determine what kind of cleaning she would need - something Dewalle had never experienced before.

The dentist said she had gingivitis and severe tartar buildup and would need to do a full mouth debridement before routine cleaning was done. Debridement refers to the removal of plaque and calculus that have accumulated on the teeth.

Dewalle said she had to wait three months for this cleaning appointment, but the dentist's office had an opening that afternoon for the debridement procedure. The treatment, she said, would have cost her $400 out of pocket.

"I knew based on my history and oral hygiene, this couldn't be possible," she wrote in a formal complaint against the dental practice.

So she left.

Later, she called her former dentist in Texas and asked if she'd ever needed this procedure. The answer was no. She then found a new dentist, and that dentist, too, said she did not need a debridement.

Dewalle turned to www.insiderpages.com to check reviews on the practice and found complaints similar to hers.

She has since tried to get the dentist's office to reverse the charges on her insurance for X-rays and for a new patient exam. That's because her insurance pays for X-rays only once every five years, and a new patient exam once every six months. But the practice won't refund her money, she said.

So about two weeks ago, she filed a complaint with the N.C. Dental Society, which provides nonbinding mediation to patients who have disagreements with dentists. Dewalle, who gave Troubleshooter a copy of the complaint, is waiting to hear about her mediation date.

Troubleshooter tried contacting the dental practice in Cary, but no one called us back. So we contacted Mitch Spelios, president and COO of Spelios and Associates, based in Alpharetta, Ga. He did not know of Dewalle's case, but said he is confident in his staff's clinical assessments.

His practices (there are several in the Triangle) have been through mediations with the dental society, he said, and each time the society has sided with his dentists. Spelios said the dentist who saw Dewalle is no longer with the Cary practice, but he did not say why.

Troubleshooter learned that Dewalle can also make a complaint to the N.C. State Board of Dental Examiners, which is affiliated with the state Attorney General's Office and oversees dentist licenses.

"Every case that comes to us gets investigated and reviewed by dentists," said Bobby White, the board's attorney. "We'd love to hear from her."


http://www.newsobserver.com/1147/story/1461257.html

'Early-warning' mouth cancer detector hits UK

The Velscope is a small system developed by the Canadian company, LED Dental Inc., in conjunction with the British Columbia Cancer Agency and other institutions.

It is used to shine a safe blue light into the patient's mouth, which excites the mucosal tissue.

Optident has revealed that it is the sole UK distributor of the Velscope, a breakthrough in the detection of mouth cancer.

The launch was held at the company's headquarters in Ilkley, Leeds, with presentations from Dr Vinod Joshi, founder and chief executive of the Mouth Cancer Foundation, John Pohl, from LED Dental, and David Bloom from Senova Dental Studios based in Watford, Hertfordshire.

The Velscope is a small system developed by the Canadian company, LED Dental Inc., in conjunction with the British Columbia Cancer Agency and other institutions.

It is used to shine a safe blue light into the patient's mouth, which excites the mucosal tissue.

This will show up as apple green when viewed through the special filters.

Any abnormal tissue will appear as a dark patch.

Once a suspicious area has been noticed the patient should then be referred for a biopsy to determine the diagnosis.

The Velscope shows up problems that the naked eye cannot see, meaning that mouth cancers can be detected much sooner, increasing the patient's chance of survival.

Because it shows up early stages of the disease, the true extent of the cancer can be determined.

Dentists can decide exactly how much tissue to remove, eliminating the chance of any cancer being left behind after surgery.

Mouth cancer most commonly affects those who smoke or chew tobacco, consume alcohol and are over 40.

However, there has been a significant increase in the number of younger people being diagnosed who do not smoke or abuse alcohol.

The cause of this in a lot of cases appears to be the human papilloma virus, which can be contracted during sexual intercourse, especially oral sex.

Speaking at the launch, Dr Joshi said: ‘Early detection can increase survival rate up to 80-90% in many cases.

‘The Mouth Cancer Foundation is extremely pleased that the Velscope is available in the UK.

'The introduction of this product means that dentists will be able to screen patients for mouth cancer beneath the surface, where visual check-ups may otherwise miss.

‘Fortunately the survival rate for mouth cancer is extremely high if it is caught during the early stages. This is why the Velscope is such an important innovation in dentistry.'

Health experts are recommending there should be an annual oral cancer exam for those over the age of 18, or every six months for those who are more at risk, such as smokers.

David Bloom, of Senova Dental Studios, has been using the Velscope in his practice as part of routine check-ups.

He believes that ‘dentists should see themselves as oral physicians rather than just dental
surgeons,' and every dentist should be checking for mouth cancer.

http://www.dentistry.co.uk

Men’s bad teeth are a top 10 turn-off

Men with bad teeth might do well to invest in some cosmetic dental work if an online survey of women is anything to go by.

In a survey on women.aol.co.uk, bad teeth is the second-most unappealing characteristic in a man, beaten only by poor body odour.

And that spells good news for cosmetic dentistry!

Sally Gill, a teacher from Wolverhampton, told the portal: ‘I could never, ever fancy a bloke with bad teeth. You see so many blokes with furry, crusty yellow teeth and they usually have bad breath as a result. Eugh, no thanks.'

Other top turn-offs included missing the toilet, spitting, fake tan and complicated facial hair.

Large ‘man boobs', strong aftershave, ear and nose hair and horrible feet also made the top 10 list.

Yesterday, Dentistry.co.uk revealed that a survey of UK adults – commissioned by dental plan providers, Denplan – found men were more likely to brush their teeth just once a day, and less likely to use mouthwash, dental floss or breath mints.

A Mintel survey for the British Academy of Cosmetic Dentistry recently found that 32% of the population are ‘concerned' by the appearance of their teeth.

Lip stabilisation with botulinum toxin

Abstract
This article examines a non-surgical treatment option for reducing the excessive gingival display (‘gummy smiles’), which can be found in many patients. I have termed this ‘lip stabilisation with botulinum toxin’. If carefully administered, this procedure is a very quick, reliable and predictable treatment option for most appropriate cases and should be considered as a viable modality before embarking on any anterior cosmetic dentistry or indeed facial aesthetic treatment for the lips themselves.

Introduction
Treating patients with a high lip line has always added to the complexity of the cosmetic dental case. Apart from the obvious un-aesthetic appeal of an excessive gingival display in the smile, the skill of both dentist and technician are put to the ultimate test to ensure that the margins of the indirect restorations placed are undetectable. This becomes even more of a challenge when implant supported restorations are an integral part of the anterior aesthetics.

Fortunately, there have been a number of treatments described so as to help alleviate the excessive gingival display however, many of these options are indeed invasive and despite being fairly successful do not allow a patient to ‘test drive’ the final aesthetic outcome (see Table 1).

Botulinum Toxin (BTX) lip stabilisation
In order for us to understand how to incorporate this extremely valuable treatment modality in our clinical practice we must first explore the basic principles of functional smile musculo-dynamics. Rubin (1974, 1999) described three types of functional smiles in his studies.

(i) Mona Lisa Smile - Figures 4 and 13 (approximately 67% of patients studied). Characterised by a sharp elevation of the corners of the mouth and a mild elevation of the central upper lip. This resultant smile will typically expose approximately 80% of the upper central incisors and canines and often all of the lateral incisors. In such cases the dominant muscles are zygomaticus major and to a lesser extent zygomaticus minor (Figure 1).

(ii) Canine smile - (31- 35% of patients studied). In such patients a high central elevation of the upper lip occurs initially before the corners of the lip are elevated. The dominant muscles here are the levator labii superoris and levator labii superious alaeque nasi and to a lesser extent depressor septi nasi. If excessive activity of these centre lip elevators occurs during the smile dynamics then an excessive gingival display is likely as well as well pronounced nasio-labial furrows (Figures 3 and 11).

(iii) Full denture smile - Figure 16 (approximately 2% of patients studied). This is characterised by all the upper and lower lip retractors contracting simultaneously to reveal a large percentage of the upper and lower dentition.
Hence a comprehensive assessment of the patient must be made prior to treatment to establish the musculo-dynamics of the smile and the relative position of the free gingival margins of the upper and lower incisors. Naturally before contemplating any aesthetic dental work the lip positions must be evaluated and a position chosen from which the usual smile design parameters can be organised.

As is universally accepted, in an aesthetic smile the lower border of the upper lip will rest approximately at the free-gingival margins of the upper incisors and canine teeth. The curvature of the upper border of the lower lip will follow the same curvature of a line extrapolated from the incisal edges of the upper teeth.

Case studies
The following cases will demonstrate the concept of using BTX for reducing an excessive gingival display.

Case 1 (Figures 2-9)
Dr Alexis Zander, a 26-year-old GDP from Adelaide, Australia presented to me with a desire to minimise her ‘gummy smile.’ Alexis also requested a moderate chemo- brow lift to help improve the shape and contour of her eyebrows (Khanna, 2007).

On examination, an average of 7mm gingival display was recorded at maximal smile. This was measured from the mid-points of the free gingival margins of the central incisors and canines on both sides to the lower border of the upper lip. Naturally, all the possible treatment options available were given to Alexis (Table 1) but she was keen to have the non-invasive approach with BTX.

In order to ‘normalise’ the display in this case the levator labii superious and levator labii superioris alaeque nasi and depressor septi nasi were targeted with intra muscular injections of BTX using a 30 gauge needle. A total dose of 35 I.U. Dysport (approximately 12 I.U Botox) was administered. The patient was reviewed after three weeks and the results can be seen in Figures 4 and 6.

The important point to note here is that the goal of treatment was of course to convert the smile to a ‘mona lisa’ smile without affecting the rest position of the upper lip (Figures 2, 7, 8 and 9). In this way, not only can the lip aesthetics be maintained, but the phonetics are unaffected by the carefully controlled chemo-denervation of the selected muscles.

Case 2 (Figures 10-15)
Sarah, a 34-year-old nurse was presented to me with a similar complaint. On examination, an average of 8mm gingival display was noted (using the parameters described in case 1). After treatment acceptance the levator labii superoris and levator labii superioris alaeque nasi muscles were injected both sides with a total dose of 30 I.U Dysport (10 I.U Botox). These muscles were the dominant central elevator muscles in this case (note the excessive elevatory pull in the canine regions compared to case 1).

The depressor septi nasi was not targeted here as it was felt that if treated this may have contributed to a further nasal lip elevation and un-aesthetic larger nasio labial angle (Khanna, 2007).

The patient was reviewed after three weeks and the result is shown in Figures 13 and 14. The smile dynamics were fully normalised without affected the rest position and phonetics. Note also the softening of the nasio-labial folds particularly towards towards the ala of the nose.

Case 3 (Figures 16 and 17)
Francis, a 43-year old teacher was referred to me by her GDP for a full mouth aesthetic rehabilitation. As part of her full case assessment, it transpired that the patient was very dissatisfied with the appearance of her obviously very ‘gummy’ smile. She exhibited a typical ‘full denture smile’ as described earlier.

On examination, an average of 8mm gingival display was noted for the upper arch. Additionally as can be seen, the lower lip took on an un-aesthetic appearance on maximum smile. The dominant muscles in this case are therefore the levator labii superioris and levator labii superoris alaeque nasi and to a lesser extent depressor septi nasi. The lower lip was being depressed in a position dictated by the excessive bilateral action of depressor labii inferioris. The upper central lip elevators received a total dose of 35 I.U Dysport (approx 14 I.U Botox). The depressor labii inferioris received a total of 20 I.U Dysport (10 I.U/side).

The three-week review photograph is shown in Figure 17. Note the slight asymmetry on the patients left side of the upper lip is maintained. If desired this could be alleviated by an extra chemo-denervation with BTX to the left levator labi superioris alaeque nasi. However, caution must be exercised in administering different doses across the midline of the mouth so as to avoid the possibility of phonetic impairment.

Discussion
I have deliberately termed the treatment of excessive gingival display with BTX as lip stabilisation as opposed to lip repositioning since the former describes a limiting action on the smile dynamics following treatment as opposed to bodily repositioning the lip, which as has been discussed is not the goal of treatment. Clearly an accurate and comprehensive assessment of the smile dynamics must be made prior to treatment and particularly prior to any anticipated anterior dental aesthetic treatment.

As with other facial muscles, the duration of treatment results with BTX is typically three to four months. However, the patients in my experience of such treatment over the last four years is that the patients slowly return to the starting position within the period of time, as opposed to a dramatic return to the day 0 position. An additional observation that has been made is that repeated treatments of BTX lip stabilisation have resulted in sustained results and a lowered required dose of BTX in subsequent treatment episodes. One can postulate that this is due to the induced atrophy of the muscles being targeted coupled with a change in the habitual smile dynamics.

Hence, BTX lip stabilisation is certainly a valuable treatment option for both operator and patient. Typically such treatments will take less than a minute to perform, and if carefully conducted in trained hands, is a relatively painless and predictable procedure.

I would like to thank all my patients used in this article for their kind permission to depict their clinical photographs.

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Dentistët e së ardhmes

Simroid, pacienti robotik me nje ngjajshmeri te mbinatyrshme humane, eshte vrojtuar ne Panairin Internatcional 2007 ne Tokio.
I dizajnuar kryesisht si vegel trajnuese per dentistet, pacienti robotik mund te ndjek udhezimet e folura, te monitoroje ekzekutimin e dentistit gjate marrjes se mases, dhe te reagoje si nje njeri gjate dhembjeve orale.

Per shkak se paraqitja dhe sjellja reale e Simroid-it motivon njerezit ta trajtojne si nje qenie njerezore, ajo ndihmon studentet te mesojne si duhet te komunikojne me mire me pacientet.
Duke i'u falenderuar gojes se saj te mbushur me sensore, ajo dine kur studenti ben ndonje gabim. Si dhe te shfaq dhimbje, grimasa, levizje duarsh dhe sysh dhe te thote "Aty me dhemb".

Journal of Contemporary Dental Practice

The lead article in this issue presents the results of an investigation of fluoride uptake in human enamel after use of toothpastes containing different fluoride compounds, or combinations of fluoride actives.

There is also an interesting look at the erosive potential of soft drinks on enamel using both scanning electron and light microscopy.

Two other research articles in this issue focus on the effect of light curing units on the temperature of dentin and the dental pulp during polymerization of composite resins. Another article examines the influence of different curing protocols on dentin marginal adaptation and the hardness of two composite resin products.

In the clinical technique section you will find a presentation of a simple technique for stabilizing a lingual fixed retainer wire in place with good adaptation to the teeth and for checking for occlusal interferences prior to the bonding procedure.

I hope you will find this issue of the journal interesting and informative and will join us again online at The Journal of Contemporary Dental Practice.

Europe's newest dental school

Costing £5.25m, it is one of the first new dental schools to be built in Britain for over a century, providing world-class teaching facilities and aiming to set new standards in dental training.

Europe's newest dental school will open at the University of Central Lancashire (UCLan) next month.

Costing £5.25m, it is one of the first new dental schools to be built in Britain for over a century, providing world-class teaching facilities and aiming to set new standards in dental training.

The school, which is to be officially opened by England’s chief dental officer Barry Cockcroft, will incorporate a range of state-of-the-art technologies including a phantom head room where students will carry out practical techniques on manikin heads, and a prosthetics laboratory where they will learn to make dental appliances such as crowns and dentures.

Professor Lawrence Mair, an experienced academic and consultant in restorative dentistry, is head of the school. He said: ‘This is a very exciting time for us. We had 181 applications for the first intake so the selection process was very competitive.’

The new school is the result of work undertaken by the Cumbria and Lancashire Medical and Dental Education Consortium, a joint venture between UCLan and the Universities of Liverpool, Lancaster and Cumbria. They, together with the NW Strategic Health Authority and local PCT Trusts, responded to government figures identifying the chronic need for more qualified dentists in the north west and were awarded funding from the Higher Education Funding Council to train an additional 32 students per year. Liverpool University has provided the curriculum and UCLan will be responsible for its delivery, supported by Liverpool and Consortium members.

The new four-year graduate entry course offers a balance of theoretical study and practical training, and will provide a new core of qualified dentists across the north west. Students will spend their first year studying on campus in the new school at the University of Central Lancashire, before relocating for three years' clinical training at one of four newly-established Dental Education Centres (DECs) in Accrington, Blackpool, Carlisle and Morecambe Bay. The DECs will be clinical training centres where students will treat patients under supervision and gain first-hand experience within the communities they are most likely to serve after graduation.

Professor Mair added: ‘The successful applicants have now started the undergraduate programme in our new purpose-built school. This new school is very different from the established schools, in that we have four clinical education centres distributed around the north west rather than being confined to one location, which will allow our students to gain experience in the local communities. Four years may seem a long time before these first cohorts qualify but, even while they are training, they will be providing treatment in the local areas.’

Dentists To Help People Quit Smoking in UK

The training, which will mainly be given to dental nurses, will be carried out over the next two years, but it is expected the first surgeries could be advising patients within the next few months.

Smokers could soon be persuaded to give up by their dentists under new health plans for Bolton.

Staff at the borough's NHS dental surgeries will be trained in offering support and advice to smokers when they call in for check-ups.

Health experts hope the measure will enable them to reach more smokers than ever before and are confident people will welcome the extra help.

Adrian Butterworth, manager of Bolton's Stop Smoking Service, said: "Dental staff are being trained in brief intervention methods which will enable them to direct patients to the right place to get the support they need to give up."

"The patient group involved isn't the same as that which visits their GP, and dental visits are generally at least every 12 months, which is more frequent than most people go to see their doctor, so this is a great place to push the public health message."

The training, which will mainly be given to dental nurses, will be carried out over the next two years, but it is expected the first surgeries could be advising patients within the next few months.

Local NHS dentists have welcomed the move, which they agree will make a big difference to Bolton's high smoking rates.

Dentist Chris Brooks, who has a surgery in Chorley New Road, said: "It's a great idea. We will obviously have to handle the issue sensitively, but it's something that we could certainly help with."

"Smoking cessation advice is something that's part of the overall oral health care assessment and the focus needs to be on the whole patient, rather than just their teeth."

http://www.ash.org.uk