BOSTON (April 3, 2013) — Researchers from Tufts University School of Dental Medicine have discovered a statistical association between the injection of local dental anesthesia given to children ages two to six and evidence of missing lower wisdom teeth. The results of this epidemiological study, published in the April issue of The Journal of the American Dental Association, suggest that injecting anesthesia into the gums of young children may interrupt the development of the lower wisdom tooth.

“It is intriguing to think that something as routine as local anesthesia could stop wisdom teeth from developing. This is the first study in humans showing an association between a routinely- administered, minimally-invasive clinical procedure and arrested third molar growth,” said corresponding author, Anthony R. Silvestri, D.M.D., clinical professor in the department of prosthodontics and operative dentistry at Tufts University School of Dental Medicine.

Wisdom teeth are potentially vulnerable to injury because their development – unlike all other teeth – does not begin until well after birth. Between two and six years of age, wisdom tooth (third molar) buds begin to develop in the back four corners of the mouth, and typically emerge in the late teens or early adulthood. Not everyone develops wisdom teeth, but for those who do, the teeth often become impacted or problematic.

The American Association of Oral and Maxillofacial Surgeons reports that nine out of 10 people will have at least one impacted wisdom tooth, which can cause bad breath, pain, and/or infection. For this reason, many dentists recommend surgery to remove wisdom teeth to prevent disease or infection.

A developing wisdom tooth, called a bud, is vulnerable to injury for a relatively long time because it is tiny, not covered by bone, and only covered by a thin layer of soft tissue. When a tooth bud first forms, it is no bigger than the diameter of the dental needle itself. The soft tissue surrounding the budding tooth is close to where a needle penetrates when routine dental anesthesia is injected in the lower jaw, for example when treating cavities.

Using the Tufts digital dental record system, the researchers identified records of patients who had received treatment in the Tufts pediatric dental clinic between the ages of two and six and who also had a dental x-ray taken three or more years after initial treatment in the clinic. They eliminated records with confounding factors, such as delayed dental development, and analyzed a total of 439 sites where wisdom teeth could develop in the lower jaw, from 220 patient records.

Group one, the control group (376 sites), contained x-rays of patients who had not received anesthesia on the lower jaw where wisdom teeth could develop. Group two, the comparison group (63 sites), contained x-rays from patients who had received anesthesia.

In the control group, 1.9% of the sites did not have x-ray evidence of wisdom tooth buds. In contrast, 7.9% of the sites in the comparison group – those who had received anesthesia – did not have tooth buds. The comparison group was 4.35 times more likely to have missing wisdom tooth buds than the control group.

“The incidence of missing wisdom teeth was significantly higher in the group that had received dental anesthesia; statistical evidence suggests that this did not happen by chance alone. We hope our findings stimulate research using larger sample sizes and longer periods of observation to confirm our findings and help better understand how wisdom teeth can be stopped from developing,” Silvestri continued. “Dentists have been giving local anesthesia to children for nearly 100 years and may have been preventing wisdom teeth from forming without even knowing it. Our findings give hope that a procedure preventing third molar growth can be developed.”

Silvestri has previously published preliminary research on third molar tooth development, showing that third molars can be stopped from developing when non- or minimally-invasive techniques are applied to tooth buds.

“The study of bib clips from the hygiene clinic demonstrates that with the current disinfection protocol, specific aerobic and anaerobic bacteria can remain viable on the surfaces of bib clips immediately after disinfection,” said Addy Alt-Holland, M.Sc., Ph.D., Assistant Professor at the Department of Endodontics at Tufts University School of Dental Medicine and the lead researcher on the study. “Although actual transmission to patients was not demonstrated, some of the ubiquitous bacteria found may potentially become opportunistic pathogens in appropriate physical conditions, such as in susceptible patients or clinicians.”

The study analyzed the clips on 20 dental bib holders after they had been used on patients treated in a dental hygiene clinic. The bib clips were sampled for aerobic and anaerobic bacterial contaminants immediately after treatment (post-treatment clips) and again after the clips were cleaned using disinfecting, alcohol-containing wipes (post-disinfection clips) according to the manufacturer instructions and the clinic’s disinfection protocol.

Led by Dr. Bruce Paster, Chair of the Department of Microbiology at the Forsyth Institute, microbiologists at the Forsyth Institute used standard molecular identification techniques and a proprietary, one-of-a-kind technology that can detect 300 of the most prevalent oral bacteria, to analyze the sampled bacteria from the bib clips. The analyses found:

• Immediately after treatment and before the clips had been disinfected, oral bacteria often associated with chronic and refractory periodontitis were found on 65% of the clips.
• After disinfection, three of the bib clips (15%) still had anaerobic Streptococcus bacteria from the oral cavity and upper respiratory tract. Five percent (5%) of the clips still harbored at least one bacteria from the Staphylococcus, Prevotella and Neisseria species.
• Additionally, after disinfection, nine clips (45%) retained at least one anaerobic bacterial isolate from skin.

“The results of our analysis show that there is indeed a risk of cross-contamination from dental bib clips. The previous patient’s oral bacteria could potentially still be on the clip and the new patient has a chance of being exposed to infection by using that same bib clip,” said Dr. Paster. “It is important to the clinician and the patient that the dental environment be as sterile as possible; thus it’s concerning that we found bacteria on the clips after disinfection. This situation can be avoided by thoroughly sterilizing the clips between each patient or by using disposable bib holders.”

Researchers involved in the study hypothesized that bacteria found on bib clips after patient care could have been transferred from patients and clinicians to the clips in different ways:

1. Oral bacteria present in the patient’s saliva and the spray or spatter produced during dental treatments may contribute to the presence of bacteria on the disinfected bib clips.
2. Bacteria can also be transferred from the gloved hands of dental practitioners to the clips prior to- or during the patient’s treatment.
3. Bacteria can be transferred from the patient’s hands to the clips if the patient touches the clip.

In a previous study published in August 2012 by researchers at Tufts University School of Dental Medicine and the Forsyth Institute it was found that 20% to 30% of dental bib clips still harbor aerobic bacterial contaminants even after proper disinfection procedures. Rubber-faced metal bib clips were found to retain more bacteria than bib clips made only of metal immediately after treatment and before disinfection. Four other research reports have found bacterial contamination on dental bib holders, including research conducted by U.S. infection control specialist Dr. John Molinari, the University of North Carolina at Chapel Hill’s School of Dentistry Oral Microbiology lab and the University of Witten/Herdecke in Germany.

But that’s exactly what has happened to some users of the battery-powered Arm & Hammer Spinbrush—or the Crest Spinbrush, as it was called before 2009.

“It’s important that consumers know how to avoid the risks associated with using the Spinbrush,” says Shumaya Ali, M.P.H., a consumer safety officer at the Food and Drug Administration. “We’ve had reports in which parts of the toothbrush broke off during use and were released into the mouth with great speed, causing broken teeth and presenting a choking hazard.”

FDA regulates toothbrushes—whether manual or electric—as medical devices that are intended to help prevent tooth decay. Safety precautions should be taken with all kinds of electric toothbrushes.

“Electric toothbrushes can be very effective in removing dental plaque, and so they can help prevent dental decay and gum disease,” says Susan Runner, D.D.S., chief of FDA’s dental devices branch. “At the same time, it’s important to supervise children when they use these brushes, and to look out for any malfunctions of the toothbrush that might cause an injury.”

Injuries reported from using the Spinbrush powered toothbrush include

• chipped or broken teeth
• cuts to the mouth and gums
• swallowing and choking on broken pieces
• injury to the face and eyes

FDA is alerting the public about the potential for injury while using the following models of Spinbrush:

• Spinbrush ProClean
• Spinbrush ProClean Recharge
• Spinbrush Pro Whitening
• Spinbrush SONIC
• Spinbrush SONIC Recharge
• Spinbrush Swirl
• Spinbrush Classic Clean
• Spinbrush For Kids
• Spinbrush Replacement Heads
• Parts Popping Off

The Spinbrush handle contains batteries and a motor that operates the brushes, which are attached to a brush head. In the models of Spinbrush made for adults, the brush head is removable and can be replaced.

But the brush head should not pop off during normal use, says Ali. “In some cases, the brush head popped off to expose metal pieces underneath that can—and have—poked individuals in the cheek and areas near the eyes, causing  injuries.”

The “Spinbrush for Kids” models, which have different handle designs, such as Spiderman and Thomas & Friends, do not have removable brush heads.  Nonetheless, problems with the Spinbrush for Kids have also been reported, such as cut lips, burns from the batteries, and bristles falling off and lodging in a child’s tonsils.

“FDA’s concern is that the unexpected release of any part of this battery-powered toothbrush during use poses a risk of injury,” says Steven Silverman, director of the Office of Compliance in FDA’s Center for Devices and Radiological Health. “And the risk is higher in children or adults who may need assistance but are not supervised while using the toothbrush.”

FDA Actions
FDA’s inspection last year of Church & Dwight Co. Inc., which manufactures the Spinbrush, uncovered evidence that there had been numerous consumer complaints that had not been reported to the agency. On May 16, 2011, FDA warned the company of its violations of the Federal Food, Drug, and Cosmetic Act, including failure to report—within a reasonable time frame—serious injuries.

After further discussions with Church & Dwight about the risks of the battery-powered Spinbrush, the company has taken some actions:

improved the labeling to caution consumers to change the brush head every three months or sooner if the brush is worn or parts are loose
added bristles that change color with wear to give consumers a visual reminder of when to replace the brush head
issued a safety notice about Spinbrush in television and print ads; the safety notice also appears on the Spinbrush website and the interactive voice response to consumers who call the company’s toll-free telephone numbers.
Safety Notice: Please remember to replace your brush head after 3 months of use, or if the brush is damaged, or if parts become loose. Extended usage, loose parts or excessive wear could lead to brush head breakage, generation of small parts and possible choking hazard. Inspect brush for loose parts before use.

Many people have crooked or misaligned teeth that they would like to straighten. However, they do not want to wear ugly metal braces. Modern solutions, like Invisalign aligners, allow patients to correct their smile with a clear tray that fits seamlessly over the existing teeth. For teeth that are jagged, misshapen, cracked or discolored, there are porcelain veneers and Lumineers, which bond to the surface of the teeth. Individuals who have lost one or more teeth can replace them with dental implants. They do more than just improve one’s appearance and actually aid in things like chewing and speaking.

Tooth discoloration is caused by a variety of factors including tobacco use, caffeine, foods, drinks, medications, heredity and aging. Therefore, it is a common affliction that many people strive to improve the appearance of their teeth with a teeth whitening procedure. While there are several viable options, the fastest and most effective is zoom whitening. The entire series of steps takes less than one hour and a single session with the dentist. Afterward, patients emerge from the office with teeth that are up to eight shades lighter than when they arrived.

In response to the growing trend of electronic prescribing in dental offices, this product offering combines eprescribing capabilities with direct access to Lexicomp Online for Dentistry™, Lexicomp’s dental-specific drug and clinical information solution, to deliver the information that dental professionals need to safely and efficiently prescribe medication and check for dangerous drug interactions. “We are very pleased to offer this first-of-its kind combined dental eprescribing and medication management tool to dental professionals”, commented Steven Kerscher, Vice President and General Manager, Lexicomp. “Dental professionals are now able to review their patient’s saved medication history and receive patient safety alerts regarding drug interactions, drug allergies and procedure safety checks for dental treatment. Having these capabilities, in addition to electronic prescriptions, will save dentists valuable time and help avoid adverse medication events.”

The pilot Text2Floss project was founded by  Tony S. Hashemian, D.D.S. , Assistant Dean to Global Oral Health at ASDOH, who explained, “The Mission of the Global Oral Health program at Arizona School of Dentistry & Oral Health is to create Global Oral Health Solutions through improving oral health, leadership development, innovation, dental education, new technology, and the promotion of peace through collaboration and the provision of compassionate care to the underserved locally and worldwide.”

Dr. Hashemian continued, “Health and wellness organizations are in need of a mobile solution that turns the already ubiquitous SMS text messaging medium into a powerful, HIPAA-compliant communications tool; enabling healthcare organizations and vendors to communicate patient data and other medical information via secure text messaging to clinicians’ and patients’ mobile devices.”

CellTrust’s founder and CEO, Sean Moshir, added, “With a secure SMS solution, organizations are able to send and receive text messages with real-time Protected Health Information (PHI) from personal mobile phones, web-portal interfaces, email exchange servers, electronic medical records, customer relationship management systems, lab systems, and other applications.”

By directly providing physicians and clinicians with required patient information to make informed decisions, a secure SMS solution improves the quality of healthcare with decreased response times and accurate decision-making, allowing for quicker interventions and improved patient outcome.

1.    Better Smile

2.    Better Breath

3.    Better Health

“Typically we get a lot of calls at the first of the year from people who say ‘This is the year I’m going to do something about my teeth’,” says Dr. Martin. “What most of them are talking about is improving the appearance of their teeth and their smile. What they don’t realize are the physical health benefits that also go along with good dental health.

The good news is that today’s dentistry can result in smile improvement almost immediately. So what should the savvy dental consumer – even one who hasn’t been to a dental office in years – expect when he or she finally makes that appointment?

Patients who haven’t seen a dentist in a long time should plan to discuss their dental history and the kind of treatment they’re seeking. Then they’re ready for a complete dental workup, diagnosis and treatment plan.

“When a patient who has neglected their teeth comes in, we first do an interview to find out exactly what has brought them to our office,” Dr. Martin says. “Typically there’s an impending event like a reunion, a wedding or a graduation where they want to look their best or they’re newly single and are self-conscious about meeting people. It usually takes a significant life event for people to take a good look at their teeth and decide it’s time to take action. It can also be a dental problem that brings people to a dentist – a toothache, broken tooth, swelling in the mouth or bad breath that can’t be controlled with over the counter treatments.”

In a diagnostic visit, a patient should expect their dentist and hygienist to do a clinical exam that includes not just a look in the mouth, but x-rays, photographs, molds of the teeth and a record of their bite. The dentist should also check for gum disease and oral cancer. During a first visit they may take the patient’s blood pressure along with a complete medical history. The importance of this exam is to assess where a patient is right now and what treatments will help them meet their dental health goals.

The importance of a smile is known and accepted for those in the public eye such as political candidates, but it’s equally important for teachers, students, customer service employees, retail clerks… just about anyone in any profession can enhance their approachability and appearance with an attractive smile.

“Think about the people you meet who never smile,” says Dr. Martin. “How do they make you feel? Typically people who are unhappy with the way their teeth look will keep a stern look on their face. They may put a hand over their mouth before speaking or look away from you when they talk. What’s even sadder are the people I see who have, for some time, refused to leave their home because of the appearance of their teeth.

“Ironically health issues aren’t usually what finally drive the reluctant patient to the dentist’s office, but frequently people find that getting their teeth taken care of properly they are able to reach other goals like losing weight because they can now chew firmer foods and eat a healthier, lower calorie diet,” says Dr. Martin. “Gum disease has been linked to many serious illnesses like diabetes, stroke and heart attack – even cancer. Getting a patient’s mouth healthy can help them improve their physical health.

“Many people are blind to how their teeth really look until something in their life causes them to take a close look at their appearance,” Dr. Martin adds. “Maybe they’ve lost out on a big promotion at work or have lost a job and need to go job hunting and want to look their best. Often for these patients, a bad dental experience in the past has frightened them away from the dental chair. Whatever the reason, visiting a dentist’s office for a complete diagnosis and treatment plan can improve more than just your smile.”

Often combining procedures such as dental implants orporcelain veneers, Dr. Salazar says a smile makeover offers patients the opportunity to customize their treatment to meet each of their individual needs. Through personalized attention and a custom plan for improving one’s dental aesthetics, Dr. Salazar says patients can revitalize their appearance and feel confident going into the holidays and the upcoming new year. Patients can also include several other procedure options during a smile makeover such as gum recontouring or Invisalign®. “The best results for veneers is with teeth whitening also. A bright white smile enhances the appearance of good health.”

Dr. Ross adds that patients looking to enhance their smile for the holidays can also choose more subtle options for feeling rejuvenated and confident, such as teeth whitening or routine cleanings. Regardless of whether patients are seeking a comprehensive, custom smile design or a single procedure, Dr. Ross says choosing an experienced and qualified dentist is essential for achieving the highest quality results. He adds that through the skilled and dedicated work of a passionate practice, patients can revitalize their mouth and feel healthy and confident in time for the holidays. “During the holidays, people always feel that they want to look their best around friends and family. A nice smile radiates health and confidence.”

Oral cancer has existed outside the consciousness of much of the public, which is one reason 37,000 Americans will be newly diagnosed this year alone. That is about 100 new people a day. That lack of awareness has contributed to this cancer not being discovered until very late in its development. By implementing a public awareness campaign, OCF wants to educate the public about the risk factors, early signs and symptoms of the disease, as well as the need for all adults to undergo an annual oral cancer screening. In the early stages of oral cancer’s development, it is often is painless, and physical signs may not be obvious to an individual. This makes it a very dangerous disease and is also the reason it is crucial to have an annual oral cancer screening. OCF is asking dental and medical professionals nationwide to act as the first line of defense against oral cancer through the process of early discovery, and to raise public awareness of this cause by opening their doors for at least a half-day, during the month of April, to opportunistically screen members of their community.

These screenings are more important now than ever. Oral cancer is one of the few cancers that are on the rise in the U.S. When found early, oral cancers have an 80% or better survival rate. Unfortunately, most oral cancers are found in late stages, when the five-year survival rate plummets to about 30%. Late stage diagnosis can be greatly reduced through increased public awareness of these facts, and OCF believes that a national program of opportunistic screenings is the best means of creating that awareness.

A visit to the dentist is no longer just about a cleaning or restorative procedures; when a dental exam includes a simple, painless, visual and tactile oral cancer screening, it can save your life. The Oral Cancer Foundation urges you to find out if your local dentist is participating in Oral Cancer Awareness Month this April by visiting OCF’s event section of the website at http://ow.ly/8jzhN. If you do not see your dental practice listed, please encourage them to contact the Foundation for more information on how easy it is for them to participate.  Like other screenings you may receive, such as cervical, skin, prostate, colon and breast examinations, oral cancer screenings are an effective means of finding cancer at its earliest and highly treatable stage. Of all these screenings, the one for oral cancer is the least invasive and time-consuming.  It is also affordable and in many cases, it may even be free.

The Oral Cancer Foundation is a big believer in the development of strategic partnerships. In April 2012, OCF will again join forces with both professional societies and private sector companies who are stakeholders in this disease. The American Dental Association, the American Academy of Oral and Maxillofacial Surgery, the Academy of General Dentistry and the American Academy of Oral Medicine form the core of the professional society sponsorship. OCF has also aligned with private sector entities Henry Schein Inc., LED Dental, and Bristol-Myers Squibb, who are asking their customer base to be active in this April’s endeavor. In addition, the 21 treatment facilities with head and neck departments that participated in 2011′s effort are expected to participate again in 2012. With the help of these partners in 2011, OCF was able to create over 2,000 screening sites/events, a ten-fold increase over any previous year.  These events, combined with 7 major walk/run awareness events coordinated by OCF, resulted in over 50,000 individual screenings for this deadly disease during April alone.  For 2012, the Foundation and its partners have set of goal of at least doubling those results.

Oral cancer is not a rare disease. Each hour of every day, one American dies of the disease, and four more Americans are newly diagnosed. These staggering statistics are the result of the public’s low awareness of the diseases risk factors, which makes these free screening events so crucial.  This disease can be defeated, but only with an informed public supported by involved professionals who want to make a difference in the world of oral cancer.

“Consumers worry about pain when it comes to the dentist, but the financial burden of yet another medical expense is the greatest concern of all. It’s worrisome that so many people are putting off dental care due to cost constraints,” said Nancy Metcalf, senior program editor, Consumer Reports.

“Because cost is an issue, consumers need to be clear about the line between dental care that is necessary and the procedures they can live without.  Many dentists are trained to push for procedures, both cosmetic and non cosmetic, that will boost their bottom line,” said Metcalf.  “We were struck by the finding that nearly a half of those who had had a cosmetic procedure had been prompted to do so by their dentist.”

Some examples of treatments that might not be necessary include teeth whitening, amalgam filling replacement, unnecessary restorations, precautionary removal of wisdom teeth, x-rays, and temporomandibular joint disorder (TMJ) surgery.

The Cost Barrier

Seventeen percent of respondents who had a dental procedure for health reasons said they had delayed it, notes the report.  That’s a much lower percentage than in nationally representative surveys.  Even readers with insurance put off a treatment they needed; 23 percent did so because insurance wouldn’t cover the procedure, and 24 percent because they had already used up the maximum that their insurance plan would cover for the year.   According to Metcalf, there are several ways consumers can keep costs down or get by without insurance:

• Shop around and bargain.  Look up typical insurance paid rates in your area at FairHealthConsumer.org and HealthCareBlueBook.com, then ask providers to accept that amount, or less, as a cash payment.
• Consider Free and low-cost clinics and health centers.  Some community health centers offer dental care with fees based on the ability to pay. Consumers should call their local health department to find one nearby.  But they should expect to encounter waiting lists in some locations.
• Look into dental and dental-hygienist schools.  Consumers who are willing to be treated by supervised students can avail themselves of schools that offer free or discontinued care to the public. A list of schools is available at www.ada.org/267.aspx.
• Investigate dental discount plans.  For an annual membership fee of around $50 to $100, one can get access to a network of dentists who have agreed to discounted rates.  But Consumer Reports recommends that consumers watch out for pricey add-ons and extra procedures they don’t need.

The report notes that having dental insurance is better than not having it, especially if an individual’s insurance is job based. But don’t expect free or nearly-free care.  Consumer Reports’ survey found that of the 71 percent of respondents who had dental insurance, 90 percent received some sort of coverage.  But only 46 percent said it covered more than half of the cost.

Here’s what subscribers with and without insurance paid for some common dental procedures.  The costs are based on average out-of-pocket payments.