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.

“It’s simple—mouthrinses can reach nearly 100 percent of the mouth’s surfaces, while brushing focuses on the teeth, which make up only 25 percent of the mouth,” says Christine A. Charles, RDH, BS, lead author of the study and director of Scientific and Professional Affairs, Global Consumer Healthcare Research and Development, Johnson & Johnson Consumer and Personal Products Worldwide. “Even with regular brushing and flossing, bacteria often are left behind.”

The General Dentistry study found that using a germ-killing mouthrinse twice a day, in addition to regular brushing, can significantly reduce the occurrence of plaque, as well as gingivitis—the beginning stage of gum disease.

The six-month study included 139 adults with mild to moderate plaque and gingivitis who were separated into two groups. Members of the first group brushed their teeth and rinsed with a germ-killing mouthrinse twice daily; members of the second group brushed their teeth and rinsed with a placebo mouthrinse twice daily.

“Results show that the group using a germ-killing mouthrinse reduced its occurrence of plaque by up to 26.3 percent,” says AGD Spokesperson Janice Pliszczak, DDS, MS, MBA, MAGD. “Furthermore, that same group showed a 20.4 percent reduction in gingivitis.”

Additionally, following the six-month study, nearly 100 percent of participants using the germ-killing mouthrinse showed a reduction in gingivitis, while only 30 percent of the placebo group experienced similar results.

“The study demonstrates the oral health benefits of regular and consistent daily use of a germ-killing mouthrinse,” says Ms. Charles.

“Most people brush their teeth for less than 1 minute, when, at the very least, they should be brushing for 2 minutes. Additionally, only 2 to 10 percent of people floss regularly and effectively,” adds Dr. Pliszczak. “Adding a germ-killing mouthrinse twice a day to your daily routine is another way to attack the germs that can cause significant oral health problems.”

Dr. Pliszczak notes that not all mouthrinses are formulated to kill germs—some are meant for anti-cavity or whitening purposes—so be sure to read product labels.

Poor oral health, dental disease, and tooth pain can put kids at a serious disadvantage in school, according to a new Ostrow School of Dentistry of USC study.

“The Impact of Oral Health on the Academic Performance of Disadvantaged Children,” appearing in the September 2012 issue of the American Journal of Public Health, examined nearly 1500 socioeconomically disadvantaged elementary and high school children in the Los Angeles Unified School District, matching their oral health status to their academic achievement and attendance records.

Ostrow researchers had previously documented that 73 percent of disadvantaged kids in Los Angeles have dental caries, the disease responsible for cavities in teeth. The new study shines light on the specific connection between oral health and performance in school for this population, said Roseann Mulligan, chair of the school’s Division of Dental Public Health and Pediatric Dentistry and corresponding author of the study.

Children who reported having recent tooth pain were four times more likely to have a low grade point average—below the median GPA of 2.8—when compared to children without oral pain, according to study results.

Poor oral health doesn’t just appear to be connected to lower grades, Mulligan said, adding that dental problems also seem to cause more absences from school for kids and more missed work for parents.

“On average, elementary children missed a total of 6 days per year, and high school children missed 2.6 days. For elementary students, 2.1 days of missed school were due to dental problems, and high school students missed 2.3 days due to dental issues,” she said. “That shows oral health problems are a very significant factor in school absences. Also, parents missed an average of 2.5 days of work per year to care for children with dental problems.”

A factor in whether children miss school due to dental health issues was the accessibility of dental care. Eleven percent of children who had limited access to dental care—whether due to lack of insurance, lack of transportation, or other barriers—missed school due to their poor oral health, as opposed to only four percent of children who had easier access to dental care.

“Our data indicates that for disadvantaged children there is an impact on students’ academic performance due to dental problems. We recommend that oral health programs must be more integrated into other health, educational and social programs, especially those that are school-based,” Mulligan said. “Furthermore, widespread population studies are needed to demonstrate the enormous personal, societal and financial burdens that this epidemic of oral disease is causing on a national level. “

Their review of these studies showed that improvements in clinical measures were common in all studies but were scientifically significant in two that used a combination of fish oil and aspirin. Although this is not conclusive evidence, intake of fish oil is recommended for health benefits
beyond the teeth.

“I would recommend that people ensure they have a sufficient intake of long chain omega-3 fatty acids in their diet for general health,” said Coates. “In Australia, these types of fatty acids are considered to be essential with ~500 mg recommended as the suggested dietary target. This
equates to approximately 2 fatty fish meals per week.”

There are no serious dangers to consuming fish oil. At high levels of fish oil above the GRAS limit, people may experience a delayed clotting time and at very high doses potential gastric upset. If people are taking blood thinning medication, then they should consult with a doctor.

The group reports that the evidence for fish oil being effective in reducing periodontal symptoms is building but there is a need for more well designed studies that evaluate the supplement both alone and in combination with aspirin to be able to tease out whether fish oil by itself is
effective. It is important that compliance to treatment is considered and that the dose and length of supplementation is appropriate. A clinical trial is underway in Australia that is investigating the effects of fish oil as adjunct therapy for periodontitis.
 

“The findings suggest that dental x-rays obtained in the past at increased frequently and at a young age, may be associated with increased risk of developing this common type of brain tumor,” said Elizabeth Claus, MD, PhD, a neurosurgeon at BWH and Yale University School of Medicine at New Haven. “This research suggests that although dental x-rays are an important tool in maintaining good oral health, efforts to moderate exposure to this form of imaging may be of benefit to some patients.”

Claus and her colleagues studied data from 1,433 patients diagnosed with meningioma between 20 and 79 years of age between May 2006 and April 2011 and compared the information to a control group of 1350 participants with similar characteristics. They found that patients with meningioma were twice as likely to report having a specific type of dental x-ray called a bitewing exam, and that those who reported having them yearly or more frequently were 1.4 to 1.9 times as likely to develop a meningioma when compared to the control group. Additionally, researchers report that there was an even greater increased risk of meningioma in patients who reported having a panorex x-ray exam. Those who reported having this exam taken under the age of 10, were 4.9 times more likely to develop a meningioma compared to controls. Those who reported having the exam yearly or more frequently than once a year were nearly 3 times as likely to develop meningioma when compared to the control group.

“It is important to note that the dental x-rays performed today use a much lower dose of radiation than in the past,” said Claus.

According to background information in the study, The American Dental Association’s statement on the use of dental radiographs emphasizes the need for dentists to examine the risks and benefits of dental x-rays and confirms that there is little evidence to support the use of dental x-rays in healthy patients at preset intervals.

The study, led by Per Aspenberg, professor of orthopaedic surgery at Linköping University in Sweden, is published in the journal Bone and was highlighted in this week’s edition of the British Medical Journal (BMJ).

The implants are screwed into the jawbone and provide purchase for artificial teeth. Using current technology, it may take four to six months before the bone surrounding the screw has healed and is strong enough so the patient can begin to benefit from surgery.

The coating, developed at Linköping University in Sweden, consists of a nanometre-thin layer of protein that attaches to the metal surface. Attached to the protein is a drug belonging to the bisphosphonates, usually used to treat osteoporosis. Several animal studies have shown that this method allows the bone surrounding the implant to rapidly become denser and stronger.

Now, for the first time, this method has been tested on humans. 16 patients each received two implants; one normal and a similar surface-treated implant as described above. Neither the patient nor the dental surgeon knew which was which. After six months it was noted that for 15 of the 16 patients the treated screw was markedly much better established. Already after two months X-ray images showed positive changes adjacent to the treated screws. No complications occurred.

“It is the first time ever anyone has succeeded in reinforcing the bone around an implant with localised medication”, says Per Aspenberg, professor of orthopaedics, who devised the method of using bisphosphonates in this way.

Pentti Tengvall, professor of biomaterials, developed the method of adhering the drug to the screw and the study was conducted by Jahan Abtahi, specialist MD and PhD, supported by Per Aspenberg. Addbio AB is a Linköping based company now working on commercializing the surface treatment for different types of implants in bone.

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.

Celebrities and TheraBreath® at the Golden Globe Awards
Throughout the event, many celebrities came by the TheraBreath gifting area to discuss their experiences with the product and to also learn more about how these natural products provide fresh breath. Some of the celebrities that were able to enjoy TheraBreath products included Rico Rodriguez of Modern Family, Raven Goodwin of Glee, Bai Ling of The Crow, Booboo Stewart of Twilight, Christian LeBlanc of The Young and the Restless and the 2011 Ms. America – Tracy Broughton, among many others. Needless to say, the products were very popular among the celebrities who are in need of fresh breath during the big Golden Globe Awards events.

Performed by adhering a thin, wafer-like strip of porcelain to the surface of teeth, Dr. Kosdon says the added thickness of the veneers pushes out one’s natural lip curves to create a more rounded, ample shape. With a dental procedure like porcelain veneers in New York City, he adds that patients can experience plump, luscious lips without having to undergo plastic surgical procedures or dermal fillers. “Dental veneers can improve the look of the smile and the entire face, and are permanent unlike dermal fillers. With veneers, patients can permanently enhance their lips and remove or reduce wrinkles in the corner of their mouth without having to endure frequent injections.”

As with any procedure, Dr. Kosdon says he recommends consulting with an experienced and dedicated cosmetic dentist before proceeding with any cosmetic enhancement. However, he adds that through the skilled hands of a qualified dentist, patients can achieve full, natural lips to complement their overall appearance.