To create those new teeth, researchers are attacking the problem layer by layer, attempting “to copy how nature has done it,” says Anne George, professor of oral biology at UIC. George and her ten-member team of students and scientists are focusing on ways to produce dentin, the part-mineral, part-protein material inside teeth that provides cushioning during chewing. They drill a hole in a rat’s tooth and fill the cavity with a protein that attracts cells that make dentin. “It’s best to get cells to do the work,” she says. “What we are trying to do is see what molecules will help us repair and make new dentin.” George predicts that within five to ten years people will be able to generate their own natural fillings.

On the same floor where George works, Thomas Diekwisch, head of oral biology and orthodontic research at UIC, is growing gums and enamel, the harder-than-bone substance that forms the outer layer of a tooth. It’s made of crystals arrayed in a picket-fence-like structure that “prevents the enamel from splintering while providing sufficient hardness,” he explains.
Diekwisch has already grown frog and cow enamel in lab mice and is also developing ways to attach teeth. He is implanting new teeth in rats—or putting back their old ones—using so-called progenitor cells that can grow into dental tissues, including pulp, dentin, and ligaments, and can even re-form lost tissues. He and his team have already successfully replanted teeth in 35 rodents. Within five years, he expects he will be able to use cells to reattach human teeth, which eventually could end the need for dentures for millions of Americans.

For people with tooth troubles today, dentists are already using materials and techniques that might once have seemed like science fiction. They fill cavities with tooth-colored composite resins instead of silver. For implants, some dentists are putting in crowns made of new high-strength ceramics, making it easier to achieve “excellent cosmetics,” says David Shonberg, a board-certified prosthodontist in Chicago. Conventional fixed bridges (false teeth cemented onto adjacent ones) and dentures—usually made from acrylic or composite resin—are more comfortable and look more natural than in the past.

Meanwhile, back at UIC, George envisions a day when implants, bridges, dentures, and the like will no longer be necessary. The next phase of research: raising crops of new teeth. Tissue engineers could figure out how to replicate the signals that tell the body to grow a new set of teeth. Or they could make new teeth in the lab by creating a scaffold that provides a sponge in which cells can grow. The trick: “It’s not so easy to re-create the shape of the natural tooth,” says Diekwisch. Eventually dentists would move these new pearly whites to a patient’s mouth, where it might take a month or so for them to fasten themselves.

What folks at UIC can’t say is exactly when some of these developments will migrate from the lab to the dental office. “There’s a big difference between being able to do it theoretically and a practical application,” says Diekwisch. “It’s very hard to predict this field.”

New York University investigators analyzed data from more than 31,200 adults who took part in the 2008 U.S. National Health Interview Survey.

Based on those findings, the researchers determined that 26 percent of U.S. children did not see a general health care provider (physician, physician assistant, nurse, nurse practitioner), but more than one-third (7 million) of those children did visit a dentist at least once in 2008.

One-quarter of U.S. adults did not visit a general health care provider, but nearly a fourth (13 million) of those adults visited a dentist at least once in 2008.

Eighty-five percent of the adults and 93 percent of the children had health insurance. This suggests that many of those who did not see a general health care provider may have had access to general care, but chose not to seek it, the researchers said.

They said their findings suggest that dentists could play an important role in identifying health problems that might otherwise go undetected in a large segment of the population.

“For these and other individuals, dental professionals are in a key position to assess and detect oral signs and symptoms of systemic health disorders that may otherwise go unnoticed, and to refer patients for follow-up care,” Dr. Shiela Strauss, an associate professor of nursing at the New York University College of Nursing and co-director of the statistics and data management core for NYU’s Colleges of Nursing and Dentistry, said in an NYU news release.

She explained that dentists and dental hygienists can take a patient’s health history, check blood pressure and use direct clinical observation and X-rays to detect risk for systemic health disorders.

The study was published Dec. 15 in the American Journal of Public Health.

She found the gram-negative anaerobe has a novel adhesin or bonding agent she’s named FadA that triggers a cascade of signals that break the junctures in an interlocking sheath of endothelial cells on blood vessel’s surface just enough to allow F. nucleatum and other bacteria into the blood.

A description of bond-breaking process was described in the Molecular Microbiology article, “Fusobacterium nucleatum adhesin FadA binds vascular endothelial cadherin and alters endothelial integrity.”

The microbiologist at the dental school has studied the oral bacteria over the past decade and was the first to find direct evidence that linked it to preterm labor and fetal death. But its presence is found in other infections and abscesses in the brain, lungs, liver, spleen and joints.

After finding and genetically matching the oral bacteria in the fetal death, she began to unravel the mystery of how an oral bacterium can be found throughout the body and jumps the blood-brain and placental barriers that usually block disease-causing agents.

Through years of lab work, her research led to the vascular endothelial (VE)-cadherin, cell-cell junctures that link the endothelial vascular cells together on the blood vessels.

These junctures are like a hook and loop connection, but for some unknown reason when F. nucleatum invades the body through breaks in the mucous membranes of the mouth, due to injuries or periodontal disease, this particular bacterium triggers a cascade of signals that causes the hook to recede back into the endothelial cell. The oral bacterium leads the way with any other harmful invaders following along.

This “deceding” was observed by confocal microscopy when Han used cells from human umbilical cord. The researchers introduced F. nucleatum and demonstrated the VE-cadherins break on bonds on the endothelial cells and creating enough space in the endothelium for the invaders to move in.

Lab tests included introducing F. nucleatum with and without other bacteria. When E. coli alone was introduced, the bond did not break. But when F. nucleatum was introduced first, the bond broke, and the E. coli bacteria were able to move through the otherwise intact cell layers.

“This cascade knocks out the guard on duty and allows the bacteria to enter the blood and travel like a bus loaded with riders throughout the system. Whenever the F. nucleatum wants to get off the bus at the liver, brain, spleen, or another place, it does,” Han said.

When it disembarks from its ride through the blood, it begins to colonize. The colony of bacteria induces an inflammatory reaction that has a range of consequences from necrosis of tissue to fetal death.

The problem with external marketing is two-fold. First, it can get very expensive. Second, there is rarely a pay-off. Levin Group Data Center™ has found that more than 80% of the time, there is a negative return on investment. It doesn’t pull in enough new patients to even cover what it costs.

However, there is something that works really well and costs very little — internal marketing.  Internal marketing relies on existing patients to bring in new customers. Our data indicates that this type of marketing, when implemented correctly, is highly effective and usually very inexpensive.

To make an internal marketing program successful, dentists need to know the new rules of the game:

In fact, there are 24 components to a proper internal marketing system. They include new patient referrals, reactivation of inactive patients, scheduling 98% of all potential new patient, and using Value Creation Scripting™ to double the average production per new patient.

Practices that implement a true internal marketing program will grow. Those that don’t, won’t. It’s that simple.

Dental visits can include more than a simple cleaning and a check for cavities. Many dentists are using new technologies to check their patients for oral cancers and other diseases.

Great Falls dentist Dr. Levi Maltby uses a special light to look for cancerous areas inside his patients’ mouths.

“Oral cancer screenings have always been something that dentists need to do more of,” Maltby said.

The old-fashion way to check for oral cancer was to look for it with the naked eye and palpitate inside the mouth.

Maltby’s Identafi intra-oral screening light makes the disease easier to spot. The light can change between violet, green and plain white.

“When we look with the violet light, the areas of higher cellular activity stand out,” he said.

High cellular activity is a sign of possible cancer.

The green light allows Maltby to take a close look at veins inside the mouth.

It’s important to catch cancer early, but in early stages, cancer causes very subtle visual changes. Using the Identafi light makes those subtle chances easier to see.

“I see a lot more things with it than without it,” Maltby said. “I feel more comfortable with my screening using it.”

The light isn’t a diagnostic tool, he said. It just allows dentists to see areas that may need a biopsy or follow-up from a specialist.

The light screening tool has been around for about 10 years and has become popular in the past five years, Maltby said.

However, even newer technology could soon replace it.

Some dentists offer oral DNA testing to help screen patients for gum disease or oral cancer.

Dr. Jessica Lawson of Lawson Family Dentistry in Urbandale, Iowa, began offering the tests last spring. Two tests involve gum disease and a third for oral human papillomavirus, or HPV, assesses risks for oral cancer.

Researchers anticipate salivary testing may become the diagnostic tool of the future, in some instances even replacing blood work, Lawson said.

“It really supports what we’re doing with our patients,” she said. “We’re looking to prevent, rather than treat and fix.”

According to the manufacturer, OralDNA Labs, the periodontal tests have been available for nearly two years and the HPV test since January 2010.

OralDNA Labs doesn’t list any dentists in Great Falls who offer the tests. However, dentists in Helena, Bozeman and Kalispell do.

Lawson’s staff educates all patients about testing, especially existing gum disease patients who don’t respond to frequent cleanings. Tests cost $150 each.

So far, 24 of her patients have undergone one of the gum disease tests. A handful had the HPV test, which can be a more difficult discussion because transmission is associated with sexual contact.

Testing is simple. Patients swish saline in their mouths for 30 seconds and spit it into a collection tube. The HPV test requires that patients gargle because the virus typically lives in the soft palate, esophagus and throat — similar to tissue in the cervix, where HPV is also present. Results are returned in seven to 10 days.

An estimated 50 percent to 60 percent of Americans have gum disease — some undiagnosed. Those patients usually have cleanings every three months. One test shows a patient’s genetic susceptibility to gum disease. It’s also a good test for new patients, Lawson said.

The other periodontal test shows what concentration of bacteria are present in the saliva and what antibiotic best treats it. The manufacturer recommends re-testing in six weeks.

The test also is recommended for pregnant women to identify the presence of a specific oral bacteria associated with a higher rate of pre-term, low birth weight babies.

The HPV test targets two strains associated with squamous cell carcinoma of the head and neck, which affects 40,000 Americans every year.

As sexual activity is beginning at younger ages, the virus has become a hot topic, Lawson said.

“The prototype has changed for oral cancer. It used to be middle-aged to older men who were heavy tobacco users, abused alcohol and had other risk factors. Eighteen- to 40-year-olds are now the high risk population for oral cancer due to increased sexual activity and skin-to-skin or mucous membrane transmission.”

Because there is no evidence Gardasil, an HPV vaccine, will protect against oral cancer, dentists may recommend exams every three months if needed.

Caught early, the prognosis for oral cancer is good, Lawson said, adding that actor Michael Douglas was treated for the same condition. Initial symptoms include earaches, sore throat, changes in voice box and swollen, hard lymph nodes.

“We’re hoping with this test we’re monitoring things so at the first sign of symptoms we get them referred to the appropriate physicians,” she said.

The study, conducted at the Max Planck Institute in Berlin, showed that people are most likely to underestimate the age of a person if he or she is smiling. We tend to find smiling faces more attractive, youthful and upbeat. A smile or laugh’s age-defying power may lay in the fact that smile lines make it challenging for an observer to correctly predict a person’s true age, according to Dr. Ed Lowe, editor-in-chief of the American Academy of Cosmetic Dentistry’s (AACD) Journal of Cosmetic Dentistry.

Many people start to see their smile deteriorate during their 30s and early 40s due to lifestyle and health habits that wear teeth and damage skin over time. The AACD shares these tips on how to reverse the effects of aging on your smile.

Tooth contouring and reshaping

Dentists can often tell a patient’s age by checking the wear patterns of their teeth. Teeth naturally wear down, crack or chip as people get older.

Common procedures cosmetic dentists use to rejuvenate smiles include:

Tooth contouring and reshaping. This procedure can correct minor imperfections by simply polishing the worn edges and sharp angles of your teeth, making them appear more aligned and symmetrical.

Porcelain veneers and crowns can restore and enhance a portion or nearly all of a tooth’s original structure, function and esthetics.

Dental bonding conceals gaps, chips and stains by sculpting a tooth colored resin composite to give the appearance of more attractive teeth.

Wrinkle, wrinkle go away

Wrinkles around the mouth are a definite sign of aging. Try these tips:

Use moisturizer around your lips and wear a lipstick or gloss with a SPF of at least 15, preferably higher. This will help prevent further development of new wrinkles.

Stop smoking and try to avoid second-hand smoke as much as possible.

Prevent premature aging and wrinkles by eating foods rich in antioxidants like berries, beans and even dark chocolate.

Replace silver mercury amalgam fillings

Black silver mercury amalgam, which has been used for decades to repair cavities, expands and contracts, causing tiny cracks in teeth that can possibly be a concern over time. Replacing that material with a new tooth-colored composite resin filling may be a prudent approach to both brighten and alleviate any further breakdown of the tooth. For the same reason that tooth decay looks bad, black mercury fillings show your age as well.

Whiten teeth

Teeth become discolored over time from drinking, smoking and neglect. Whitening advice:

Don’t overdo it. A youthful smile is not overly white, but healthfully white.  Cosmetic dentists are trained to select the appropriate, natural shade of white.

Once teeth are whitened, avoid staining drinks such as grape juice, red wine, tea and coffee, and definitely don’t smoke.

Dr. Lowe also says that one simple preventative measure is to rinse with water after you eat or drink anything to proactively prevent stains from developing in the first place.

About the AACD

The AACD is the world’s largest non-profit member organization dedicated to advancing excellence in comprehensive oral care that combines art and science to optimally improve dental health, esthetics and function. Comprised of more than 6,300 cosmetic dental professionals in 70 countries worldwide, the AACD fulfills its mission by offering educational opportunities, promoting and supporting a respected accreditation credential, serving as a user-friendly and inviting forum for the creative exchange of knowledge and ideas, and providing accurate and useful information to the public and the profession.

Designed by Yu-Hsin Lin, Chu-Che Chang and Shang-Hsuan Lu, the Tooth Guardian would have a tiny CCD camera on the backside of its head, capturing a real-time image of your teeth and gums as you brush. An LED ring encircles the camera lens and automatically turns on when you place the toothbrush in your mouth.

The toothbrush would wirelessly transmit its images to an LCD screen built into your mirror, so you can see how good a job you’re doing keeping your choppers pearly white.

By installing the camera on the flip-side of the head, it allows the bristles to be easily replaced, but means you won’t see the surface you’re brushing right now, but what you need to brush when you flip the toothbrush over. Still it’s a great idea for making sure you’re doing a good job when brushing. When done, the Tooth Guardian stows in a handy UV sanitizer to help kill any extraneous germs.

While the Tooth Guardian design was a recipient of a 2011 red dot design concept award, there’s no word on if or when it will be produced. However, everything here is readily available technology, so I don’t see why someone can’t bring these to market sometime soon.

This is according to the third quarter results from the American Dental Association’s Survey of Economic Confidence. An executive summary paired with the survey, conducted by the Association’s Health Policy Resources Center, describes the results as unfavorable but consistent with the perception of the general economy.

“The downturn in the third quarter results is similar to that of previous third quarter results,” according to the summary. “However, the drop in confidence this year was more severe than last year. According to most economists, the U.S. economy is growing, but at a very slow pace, and survey results are likely a reflection of that.”

Nearly six out of 10 of dentists who responded to the survey said their net income in the third quarter was lower than in the second quarter. About three in 10 said it remained the same.

Dentists dealing with decreased income, gross billings and collections are also seeing patients with their own hardships. But many who responded to the survey said they are trying to help their patients continue their care, despite limited resources.

“Dentists always try their best to be supportive to their patients, no matter the circumstance,” said Dr. Mark Zust, chair of the ADA Council on Dental Practice. “But the state of the economy and its effects has become a shared experience for many. Given the strain on their own business and income, dentists can understand what their patients are going through and are doing what they can to help.”

Nearly two-thirds of dentists said they extended treatment durations to help patients pay for care. Fifty-four percent of respondents offered their patients third-party financing to pay for their care and nearly half offered discounts. Dentists also made changes to their businesses and increased their range of services.

When asked what kinds of economic improvements would most help patients pay for dental care, about half of responding dentists said a reduction in unemployment rates. One in four respondents noted issues related to patients obtaining insurance and insurance reform.

Other findings include:

• Dentists over 65 were more negatively impacted than younger ones. Six out of 10 respondents in the 65 and up age group reported their net income decreased in the third quarter, compared to nearly 54 percent of those in the 25-34 age group.
• Gross billings decreased in the third quarter for more than 52 percent of dentists who responded. Thirty-four percent indicated no change in their gross billings.
• Only 12 percent of respondents stated they had more new patients in the third quarter than in the previous one. Almost half of dentists said their new patient index decreased while 39 percent said it remained the same.
• Dentists remained on the negative side when asked about their confidence in future economic conditions. Around 8 percent were very confident, 41 percent were somewhat confident, and 51 percent were not at all confident.

“Dentists have become accustomed to the lackluster news from the ADA’s economic surveys, but their peers’ responses clearly mirror what’s happening in the national economy,” said Dr. Jonathan Knapp, vice chair of CDP. “It’s important for dentists to remain optimistic and do whatever they can to ease this time for their patients and for themselves.”