Oral Cancer Update – Prevention, Diagnosis, and Management
U9128
Credits: 3

This course offers a comprehensive overview of the current knowledge on the diagnosis, prevention, and treatment of oral cancer and its relationship to systemic diseases. Course participants will become familiar with the current understanding of oral cancer, techniques for early detection and diagnosis, evaluation of medical risk factors for patients with oral cancer, treatment modalities, systemic diagnoses that may present with oral malignant changes, and the role of oral health professionals in screening for oral cancer.

New Drug May Aid in Oral Cancer Treatment

Written by Dentistry Today

There could be a new method to treat mouth sores normally associated with cancer.

Mouse model studies have shown that protein Smad7, when given genetically or topically, could thwart the mouth sores that develop in cancer patients.

Mouth sores are a major problem for some cancer patients. They can become so severe that feeding tubes are necessary for nutrition and painkillers are later needed. Roughly 40 to 70 percent of patients with upper-body radiation encounter this problem. And, unfortunately for these patients, there is no known treatment as of now.

The study involving this new protein appears in Nature Medicine.

The group of researchers would like to further explore the possibilities of Smad7 as a way to combat human oral mucositis. In some of the studies, Smad7 was combined with a short peptide to permit the protein to cross through cell membranes. This was produced from cultured bacteria. After the substance was applied to the mouse’s oral cavity, it prevented oral mucositis, in addition to healing ulcers that were already present.

The ultimate goal from this research is to create a drug that can be given topically that will treat oral mucositis and deter more sores from developing.

The mice were engineered in a manner that they developed oral mucositis similar to the condition that human cancer patients are afflicted with. This made way for numerous tests and experiments.

The Use of Fluoride in Modern Dental Practice: History, Mechanism, Efficacy & Safety

U9027

Credits: 2

The single most common chronic disease in children worldwide, including the United States, is dental caries. These high rates in children and adults may be attributed to the fact that dental caries is a chronic, infectious and transmissible disease of multi-factorial origin. There are a multitude of preventive regimens designed to control or reduce demineralization of the tooth structure associated with this infectious disease process. Fluoride holds a special place in this paradigm because of its documented effectiveness in controlling and reducing dental caries. This course discusses the pre-eruptive and post-eruptive mechanisms of fluoride action and identifies the U.S. standards for water fluoridation. The processes of demineralization and remineralization are explained along with the concept of dental fluorosis.

New Study Indicates Fluoride Lowers Tooth Decay

Written by Dentistry Today

The debate will continue but a new study recently demonstrated the positive impact fluoride has on dental health.

The researchers from the University of North Carolina at Chapel Hill and the University of Adelaide in Australia concluded that when fluoride is placed in drinking water, there are positive results and less tooth decay. This even applies to people who weren’t exposed to fluoridated water as children.

Some previous studies came to the conclusion that only children who consumed fluoride from birth could benefit from it. But this study debunks that notion. This information shows that even more people may benefit from fluoride than most studies would even indicate.

To compile the data, the research team looked at nearly 3,800 people aged 15 and older in Australia from 2004 through 2006. The researchers examined the levels of decay of the people based on where they lived since 1964. The locations were then matched up to see if the people lived in communities with fluoridated water. A determination was then made on how much fluoride each person had been exposed to and if there was any correlation with tooth decay or other oral health problems.

The information also shows that people who spent more than 75 percent of their lifetime living in towns with fluoridated water had as many as 30 percent less instances of tooth decay when compared to their counterparts who lived with fluoridated water for less than 25 percent of their life.

The study appears in the Journal of Dental Research.

The reason for the study is because many Australian cities without fluoridation want to add fluoride to their cities, which is a no-brainer according to Kaye Roberts-Thomson, one of the study’s co-authors. Many of the people against fluoride, however, would beg to differ.

Please read the news article below (taken from Dentistry Today) and then take action by ordering this informative course from The American Dental Institute today:

Selected Topics in Oral Oncology
U9001
Credits: 4

This course discusses the epidemiology of oral cancer including associated risk factors and common sites where it is found in the oral cavity. The vast majority of oral cancers are squamous cell carcinomas and this course explains the impact of early detection on survival rates. The difficulties associated with the diagnosis of pigmented lesions are addressed. Course participants will become familiar with HIV-associated malignancies in the oral cavity.

Alcohol Consumption Increases Oral Cancer Risk for Men
Written by Dentistry Today

Oral cancer risk in men goes up significantly as a result of alcohol consumption, according to a new study.

The American Journal of Public Health study indicated that there are about 20,000 cancer deaths each year in the United States that stem from cancer. Men are at the largest increased risk for oral cancer while breast cancer risk in women goes up based on alcohol consumption.

There were roughly 6,000 deaths in men that resulted from some type of cancer in the esophagus, mouth or throat. About the same number of deaths in women was caused by breast cancer.

People who could be considered light drinkers—1.5 drinks or fewer daily—even comprised 30 percent of the alcohol-related cancer deaths, based on research from the Boston University School of Medicine and the School of Public Health.
Many previous studies have shown that men increase their risk of developing cancer in the esophagus, larynx, liver, oral cavity and pharynx by consuming alcohol.

The study concludes that about 3.5 percent of all cancer deaths stem from alcohol in some way. The study also makes it clear that more needs to be done to reduce alcohol consumption.

Some researchers suggest that since alcohol is an accepted human carcinogen, there is not a level of consumption that could be considered safe and that people should eschew alcohol entirely.

Our goal at American Dental Institute is to keep you up-to-date on the latest dental news. Every day, we search the web for the hottest, most current dental-related topics. We recently found an article in The New York Times (below) – about technology that allows dentists to create crowns while the patient waits – and wanted to share it with you.

You see, American Dental Institute offers an informative continuing education course – Aesthetic Indirect Inlays and Onlays – that relates to The New York Times article. It describes the evolution of aesthetic direct posterior restorative materials and their limitations, then goes on to identify the characteristics, indications, and limitations of aesthetic indirect inlays and onlays.

A New Tooth, Made to Order in Under an Hour
By Gina Kolata

I was chewing a piece of steak on a Saturday night last month when an old filling shattered. Suddenly, along with steak I had chunks of gray amalgam and shards of tooth in my mouth. I felt the hole with my tongue – it seemed as large as a crater.

My dentist later confirmed that I now had a big hole in a molar, too big for a filling. But, the dentist said, if I could spare an hour he could make a crown and put it in, right then and there.

An hour? Aren’t crowns – those tooth-shaped caps that fit over teeth – supposed to require at least two visits? First, the dentist numbs the area and drills the tooth, filing it down to make room for the crown. Then, he or she makes an impression of the tooth to send to a lab. The hole in the tooth is covered with a temporary filling while you wait for your crown.

It arrives at the dentist’s office two or three weeks later. You return for another appointment. The dentist numbs the area, removes the temporary filling and glues the crown in place.

Now, new technology has produced a better way. My dentist happened to be one of the approximately 10 percent who use CAD/CAM – computer-aided design and computer-aided manufacturing – to create a crown while a patient waits. The result is a ceramic crown that can be glued in place. You are done less than an hour after you first sit down in the dentist’s chair.

Maybe you think that dentists are stuck in the technological dark ages, waving pliers and babbling about fluoride. In truth, the profession has quietly embraced sophisticated technology, and I was lucky enough to stumble upon a prime example.

The process starts the same way it used to: The area is numbed, and the dentist drills the tooth to shape it for the crown. But instead of making an impression of the tooth, the dentist uses a tiny camera to create a three-dimensional image of the drilled tooth. A computer program uses that to construct an image of what the tooth will look like with the crown in place. I could see it on the computer screen – a tooth that looked just like mine would when I left the dentist’s office.

Then all the details – the size and shape, the little ridges and indentations – are transmitted to a machine in an adjacent room that mills the crown from a chunk of porcelain. The result is an exact replica of what I saw on the computer screen. When the crown is ready, about 15 minutes later, the dentist glues it in.

I was thrilled, if it is possible to be thrilled with a visit to a dentist.

Sirona, a company with 95 percent of the market for CAD/CAM crowns, began distributing its system, Cerec, in the 1990s, said Roddy MacLeod, a vice president of Sirona, adding that the technology had gone through several generations of upgrades. The system costs the dentist about $100,000. (The company provides a registry of dentists who offer it at findcerec.com.)

Some dentists who use it, like Dr. Matthew Messina of Cleveland, a spokesman for the American Dental Association, do not charge more for CAD/CAM crowns. “The market won’t bear charging more,” Dr. Messina said.

Still, Dr. Stephen Campbell, a prosthodontist at the University of Illinois at Chicago, said that before dentists invest in the equipment they should have a business plan to recoup their costs. For many, that can mean charging more for a CAD/CAM crown. (Prosthodontists are dentists with specialty training in aesthetic and reconstructive procedures, implants and digital technologies.)

There are limitations to the use of the technique, though. The crown I had made, Dr. Campbell said, “is a good way to do a simple little restoration.”

The tooth, for example, cannot have broken off below the gum line or the scanning device will not be able to make a precise 3-D image. And since the crown is carved from a solid ceramic block, it cannot have the complex visual nuances of a real tooth. Outside labs can create crowns for teeth that are highly visible, like front teeth, and that look exactly like the real thing. They use a variety of techniques and materials, including alloys, to make crowns that are strong enough to withstand the forces on back teeth and are realistic enough in their coloring to be used on front teeth.

But even when an outside lab makes the crown, computerized systems come into play, Dr. Campbell said, although patients may not realize it. The cast made from a mold of a tooth is scanned and digitized, and the central lab sends back an image of what the crown will look like. The dentist can approve it or ask for modifications. Then, using machines that can cost one million dollars, the lab makes a crown that can fit a tooth broken below the gum line or that fits and matches a front tooth.

In the past, Dr. Campbell said, the dentist and patient had little control over the result. “It is what it is,” he said.

The new technology is even more important for tooth implants, where precision is critical. Dentists start by implanting a sort of artificial root in the bone to hold the artificial tooth in place. But it is not the same as a real root, which lets the tooth move and flex. Then, the dentist puts a screw in a sort of artificial tooth stub and attaches it to the artificial root. A crown goes on top of the stub.

It is best if the stub is custom-designed for the patient, Dr. Campbell said. The fit must be precise. If not, parts of the implant can break and the implant can fail.

These days, Dr. Campbell said, almost half of all-ceramic crowns and many implant stubs are made with this behind-the-scenes CAD/CAM technology, and he encouraged patients who need crowns or implants to ask their dentists if they use it. If not, he said, they might want to find a dentist who does.

“It’s an incredible world right now,” he said. “What they are doing is so cool.”

Copyright 2012. The New York Times Company. All Rights Reserved.

DID YOU KNOW?

- Horse teeth have intertwined enamel and dentin and permanent teeth continue growing after full eruption?

- Dogs rarely get cavities because their saliva has an extremely high pH which prevents demineralization?

- Elephants grind down their molars, which can weigh up to 10 lbs, then grow replacements six times during their lives?

- Moose only have lower incisors with no opposing uppers?

- Whale teeth are completely encased in cementum, except for the tips of teeth in older whales where the cementum has worn away to reveal the enamel below?

- Snails can have over 25,000 teeth – which are located on the tongue?

- Bunnies typically lose their baby teeth in utero?

- Sharks exfoliate old teeth to be replaced by new?

Read the full blog post on animal teeth facts here and be sure to keep up-to-date on your dental CE with ADI’s extensive selection of continuing education courses.

Looking to get all your CE requirements completed in an easy-to-use state pack? Click here.

Aesthetic Indirect Inlays and Onlays
Author: J. Robert Kelly, DDS, MS, DMedSc
3 CE Hours
Item #: U9146

Incorporating Magnification into Your Dental Practice
Author: Glen van As, DMD
2 CE Hours
Item #: U9131

Temporomandibular Disorders: Surgical Concepts in Diagnosis and Treatment
Author: John F. Kross, DMD, MSc
3 CE Hours
Item #: U9120

Mastering Esthetics in the Smile Zone
Authors: David Kurtzman, Gregori Kurtzman, Peter C. Shatz, Lee H. Silverstein
2 CE Hours
Item #: U9083

Prosthodontics – Is it for you?
By Erin Aying
There are currently 9 dental specialties recognized by the American Dental Association (ADA) that you can pursue after dental school. One of those specialties, prosthodontics, pertains to the diagnosis, treatment, and maintenance of the oral health of a patient associated with missing teeth. They’re the dental specialists that make dentures, bridges and crowns. Forbes even listed prosthodontics as one of America’s most competitive jobs.

At the Arizona School of Dentistry & Oral Health (ASDOH), I interviewed Clark Chen, a 2012 dental school graduate, about his journey. Thank you!

How did you know that prosthodontics was for you?
I had developed an earlier interest in prosthodontics because of my background in bioengineering in undergrad. The two disciplines have many overlapping principles, so I have always viewed treatment planning as just one big engineering problem. My desire to pursue a prosthodontics residency came sometime in the middle of my third year as I was exposed to more complex cases. These cases lead me to on-going conversations with the prosthodontic faculty, which made me realize how much more there was to learn about treatment planning and prosthodontics principles.

What extra measures did you do in dental school to make you an ideal candidate?
I would start off by saying that a solid personal statement and letters of recommendation from prosthodontic faculty should be a given. As for extra measures, I would recommend going out a visiting residency programs. I had the opportunity to visit a handful of program to observe what an average day is like and to get to know the residents and faculty. These visits not only helped me figure out what I was looking for in a program but it also gave me the motivation to follow through with the application. I also attended the America College of Prosthodontics annual session. The conference is a great way to network and to learn more about the profession.

Where is your residency, and what tips do you have for hopeful applicants?
I am doing my residency at UCSF and started in July of 2012. The best advice I would give to hopeful applicants would be to seek out a faculty member has extensive prosthodontic knowledge and is also willing to mentor you. The most valuable lessons will come from these one-on-one moments.

Article Source: adsablog.com – Mouthing Off: The Blog of the American Student Dental Association. Blog post written by Michael Capp

“Children with chronic medical, developmental, and psychosocial conditions experience significantly more oral health problems than children without these conditions,” according to Karen Hallisey, DMD, Dental Planner for GSC Home Study Courses. Providing dental professionals with the foundational knowledge to better care for this growing patient population is the impetus behind Dental Management for Pediatric Patients with Complex Needs, a new continuing education course from GSC Home Study Courses – a leading Academy of General Dentistry approved continuing education program provider.

According to the U.S. Department of Health and Human Services’ most recent 2009- 2010 National Survey of Children with Special Health Care Needs, 15.1 percent of US children (11.2 million children ages 0 – 17) have special health care needs, and more than one in five US households with children have at least one child with a special health care need. This translates into almost nine million households nationally. Individuals with special health care needs experience more oral health problems and require a greater level of oral health management than their healthy counterparts. Children with special health care needs are especially vulnerable to the oral effects of systemic diseases.

“This GSC Home Study course is a great example of how the company provides healthcare professionals with the educational information they need to provide exceptional care to all patients, especially those with complex medical conditions,” said Christian Feuer, CEO of SC Publications, parent company of GSC Home Study Courses. “Our courses allow busy professionals to keep abreast of the issues and challenges they face in their everyday practices.”

About GSC Home Study Courses
The mission of GSC Home Study Courses is to promote public health by providing healthcare practitioners with structured home study continuing education and educational resources for advancing post-graduate knowledge and life-long professional proficiency. For more information, visit www.gscce.com.

The Controversy Over Amalgam
Author: Christine Wisnom, RN, BSN
1 Credit

The use of amalgam, as a restorative material, has been documented for over 150 years. However, its use has declined in recent years due to the rapid evolution of alternative, tooth-colored restorative materials. This course reviews the metal and chemical compounds contained in dental amalgam and describes the clinical situations when amalgam should and should not be the restorative material of choice. The course also explains the origin of mercury in wastewater and improved mercury hygiene techniques.

Visit: https://www.adinet.org/Courses/CourseDetail.aspx?pid=896 for complete information and course objectives.

NYU Goes “Amalgam Free”

Citing environmental concerns, the New York University College of Dentistry announced in a letter to students and faculty last week that it has decided to go “amalgam free”. According to a letter written by Dr. Mark Wolff, D.D.S., Ph.D., Chair of the Department of Cardiology and Comprehensive Care and Associate Dean for Pre-doctoral Clinical Education:

Beginning immediately:
All treatment plans should consider alternative restorative materials other than amalgam.
Existing amalgam restorations that are deemed clinically acceptable should NOT be replaced.
Amalgam will still be available at the supply area and will require justification by faculty for placement.
Students will still receive pre-clinical training in the use of amalgam with special attention to the indications and contra-indications.
Strict mercury hygiene when using amalgam will be maintained in both the clinic and pre-clinical settings.

The letter stressed that the changes were made out of concern about mercury pollution in the environment and that the evidence still supports the safety of amalgam for patients. ASDA’s position on amalgam restorations states:

I-6 Amalgam Restorations (1990)
It is the position of the American Student Dental Association that, based on available scientific data, the continued use of amalgam as a restorative material does not pose a health hazard to the non-allergic patient. The removal of clinically serviceable dental amalgam restorations solely to substitute a material that does not contain mercury is unwarranted, improper, unethical, and intentional misrepresentation to the patient.

While the change in policy does not appear to directly conflict with ASDA’s position, it is sure to generate discussion. Students at NYU were shocked and frustrated with the new policy.

The new policy has come under withering criticism from proponents of the use of amalgam. In an email obtained by ASDA, Dean Charles Bertolami tried to assuage the concerns of critics of the policy, saying:

The NYU College of Dentistry has not stopped teaching the use of amalgam nor does it intend to do so. Further, amalgam is now and will continue to be used in our clinics whenever indicated.

Amalgam will still be available in our supply areas; students will still receive pre-clinical training in the use of amalgam; and amalgam will continue to be used whenever indicated.

While that may be technically true, the school is still putting significant barriers around the use of amalgam. Dr. Wolff hints at the underlying reasoning when he says in his letter, “Recently the United Nations Environmental Program, supported in part by the United States Department of State, has proposed a legally binding global treaty on mercury pollution and is recommending phasing out the use of mercury containing products including amalgam.” A strong case could be made that these moves are more along the lines of phasing out the use of amalgam than continuing to use amalgam whenever indicated.

A full copy of Dr. Wolff’s letter can be found here: http://www.asdablog.com/wp-content/uploads/2012/07/Amalgam-policy.pdf

Article Source: adsablog.com – Mouthing Off: The Blog of the American Student Dental Association. Blog post written by Michael Capp

What’s Cool About Drool? 6 Saliva Secrets To Share With Patients

Ever since the first loogie was hocked, saliva has been consistently earning itself a bad rap.

Expectoration in the western world has become taboo and cuspidors have largely disappeared from dental offices (although the spittoon curiously lives on in the U.S. Supreme Court). Patients may be quick to disregard salivary secretions as useless dribble – it’s our job to teach them why saliva is nothing to spit at.

Aside from lubrication and digestion, here are several important points to share with your patients:

1)  Saliva physically cleans our teeth. The flow of spit helps to clear food debris and bacteria from the enamel surface and oral mucosa.

2)  Saliva is antibacterial. Saliva is rich in protective enzymes. The enzyme lysozyme cleaves linkages in the bacterial cell wall, both in gram-negative and gram-positive microbes. IgA controls the colonization of bacteria. Lactoperoxidase prevents bacterial growth in specific strains by preventing the accumulation of the lysine and glutamic acid sources these bacteria require. Lastly, a substance called myeloperoxidase inhibits the attachment of Actinomyces strains to the hydroxyapatite in enamel.

3)  Saliva neutralizes acid. Bicarbonate-carbonic acid helps maintain physiologic pH levels at the epithelial cell surface and tooth surface, minimizing the duration of time teeth are exposed to a demineralization environment (below pH 5.5).

4)  Saliva often contains white blood cells. Depending on the severity of gingival inflammation, PMNs will migrate into the oral cavity through the lining of the sulcus. Once there, they can live in the saliva and reach other areas of the oral cavity.

5)  Saliva helps strengthen teeth. Inorganic factors are delivered to teeth by way of saliva, such as phosphates and calcium. These substances are essential for tooth recovery from acid exposure and remineralization.

6)  Saliva helps wounds to heal. Multiple factors in blood (including VIII, IX, X, PTA, and Hageman factor) speed up coagulation to more quickly protect wounds from invading bacteria.

Too often, we don’t appreciate the seemingly insignificant until it’s gone. As I examined my first patient of the afternoon, I couldn’t help but notice a multitude of missing posterior teeth, and a remaining dentition of which every tooth was crowned. She noted “PBC” – primary biliary cirrhosis – in her health history. Based on signs and symptoms, I suspect she is one of the unfortunate 50% of patients who develop Sjogren’s Syndrome secondary to this liver condition. The toll xerostomia takes on a mouth is significant, reinforcing how powerful and critical our saliva is for our oral health.

Behold the power of spit. Now spread the word, but please…don’t spray it.

Source: Excursives.com
http://excursives.com/2012/03/28/whats-cool-about-drool-6-saliva-secrets-to-share-with-patients/

Looking to fulfill your CE requirement and to continue to improve the level of care you provide your patients? Visit www.adinet.org today!

Research has revealed that over 12 million Americans suffer from Obstructive Sleep Apnea (OSA), a condition that occurs when the upper airway (tissues at the back of the mouth and throat) collapse causing significant airflow disruption or even no airflow whatsoever for 10 seconds or more. It can leave you feeling tired, depressed, irritable, as well as cause memory loss and poor concentration. But, did you know that we can help treat your sleep apnea?

The primary method dentists who are trained in sleep medicine use to treat OSA is through the use of an oral appliance. Similar in look to an orthodontic retainer or sports mouth guard, oral appliances are designed to maintain an opened, unobstructed, upper airway during sleep. And while there are many different oral appliances available in the marketplace, less than 20 have been approved through the FDA (Food and Drug Administration) for treating sleep apnea. The key to success is to avoid those over-the-counter (OTC), generic mouth guards and instead use a professionally made and custom-fitted oral appliance, made from a precise model of your teeth and mouth. They are best at keeping your airway open and preventing the muscles and soft tissues from sagging down when relaxed during sleep. Other advantages of custom-fit oral appliances are that they can reposition your lower jaw, tongue, soft palate and uvula (the tissue in the back of the throat that dangles like a punching bag); stabilize your lower jaw and tongue; and increase the muscle tone of your tongue.

Is Treatment Really That Important?
Absolutely! If undiagnosed and/or left untreated, sleep apnea can be life threatening. It can cause heart attacks, strokes, impotence, irregular heartbeat, high blood pressure, and heart disease — many of which can kill you.

Want To Learn More? ADI has the courses you are looking for.

Sleep Breathing Disorders: A 21st Century Epidemic?
Author: Kent B. Smith, DDS
Item # U9084 | $20.00 | 2 Credits

The Benefit and the Necessity of Sleep
Author: Judith A. Porter, MA, EdD
Item #U9049 | $20.00 | 2 Credits