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Microneedles may increase the effectiveness of topical anesthesia

LUBBOCK, Texas, U.S.: Fear of injections is not an uncommon condition, and when coupled with a fear of dentists, some people may avoid dental treatment until the absolute last minute. In new research, scientists from Brazil and the U.S. are testing a strategy to increase the effectiveness of topical anesthesia used in dentistry. Their hope is to reduce patient discomfort and ensure the anesthetic can reach further into the mucosa.
For their study, researchers from Texas Tech University (TTU) and the University of Campinas School of Dentistry of Piracicaba developed a small device that contains 57 microneedles. When this device is placed on the gingivae, cheek or any other location of the mouth to be anesthetized, it creates tiny holes through which anesthetic medications, like lidocaine, can penetrate deeper into regions of the oral mucosa.

According to lead researcher Dr. Harvinder Singh Gill, Associate Professor and Whitacre Endowed Chair of Science and Engineering at TTU, conventional methods of topical anesthesia cannot completely assure protection for the patient. This is particularly true when a deep injection is needed to block a nerve. “That situation causes anxiety for patients and dentists alike, and could compromise the treatment outcome,” said Gill.

Although to date the device has only been tested on ten patients, according to Gill, the outcomes have been positive. However, pain reduction of the injection is not the only area of interest. Other objectives of the study are to measure the pain caused by the 700 μm microneedles, as well as to determine the effectiveness of the system in expanding the area of the topical anesthesia.

The research was funded by the São Paulo Research Foundation and carried out under the scope of its São Paulo Researchers in International Collaboration program.


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Investigating the enigmatic link between periodontal inflammation and retinal degeneration

Many clinical studies link Chronic Periodontitis (CP) to various systemic disorders and lately age-related macular degeneration (AMD), a leading cause of irreversible vision loss in elderly, is found to be associated with periodontal disease. The keystone oral-pathobiont and one of the major causative organism for CP, Porphyromonas gingivalis (Pg), has been identified with the ability to invade epithelial, fibroblasts and dendritic cells. "Our study was designed with an objective to interrogate the role of Pg and its fimbriae-mediated infection of human retinal-pigment epithelial cells and retro-orbitally injected mice retina, thus revealing possible molecular links between CP and AMD," said Hyun Hong (Predoctoral dental student, Summer Research Program, Dental College of Georgia) and Dr. Pachiappan Arjunan, the Principal Investigator, who directed this study (Assistant Professor, Department of Periodontics, Dental College of Georgia, Augusta University).

Human retinal-pigment epithelial cells were infected with Pg and its isogenic mutant strains and genes were analyzed by qPCR.

The results showed that human retinal-pigment epithelial cells take up Pg381 and that qPCR shows a significant increase in expression levels of genes, important in immunosuppression and angiogenesis/neo-vascularization markers compared with uninfected control.

Certain complement regulatory-related genes were upregulated, while others were downregulated. In a mouse model, AMD-related effects on mouse retinae were induced by Pg-injection compared to control group.

Dr. Arjunan states that, "This is the first study to demonstrate the link between oral pathobiont infection and AMD pathogenesis and that Pg can invade human retinal-pigment epithelial cells & elevate AMD-related genes which might be the target molecules for both diseases."

Further, successive ongoing studies in Dr. Arjunan's laboratory in collaboration with Dr. Christopher W Cutler (Professor and Chair, Department of Periodontics, Dental collage of Georgia, Augusta University), could distinguish specific causal role of Pg in AMD pathogenesis. The first part of this work will be published very soon, he added.

This work was funded by the Department of Periodontics, Dental College of Georgia, Augusta University and seeks additional funding support from National Institutes of Health (NIH) to accomplish the objective of this innovative study.

At the 47th Annual Meeting of the American Association for Dental Research (AADR), held in conjunction with the 42nd Annual Meeting of the Canadian Association for Dental Research (CADR), Hyun Hong, The Dental College of Georgia at Augusta University, presented a poster titled "Investigating the Enigmatic Link Between Periodontal Inflammation and Retinal Degeneration."


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Coalition Calls for an End to Dental Amalgam in the United States

A coalition of 50 environmental, public health, and children’s rights group is calling for an end to the use of dental amalgam in American children and for a two-year general phase-out of its use in the United States. These supporters include the Sierra Club, Greenpeace, Health Care Without Harm, Clean Water Action, Consumers for Dental Choice, and the Learning Disabilities Association of America.

“Starting July 1, the European Union bans amalgam for children under 15. The US needs to act too,” said Charlie Brown, president of the World Alliance for Mercury-Free Dentistry.

The coalition announced its position, which it calls the Chicago Declaration, at the University of Illinois at Chicago. Also, the coalition notes that amalgam’s main component is mercury, which is a neurotoxin and heavy metal. It further says that amalgam usage is now in sharp decline and has been discontinued in several countries.

“Mercury-free dentistry is practical, it is a superior technology, and it is tooth-friendly—minimally invasive—while amalgam is not,” said Jessica Saepoff, DDS, former commissioner of the Washington State Dental Quality Assurance Commission.

Other signatories on the Chicago Declaration include the Environmental Working Group, the Mercury Policy Project, the Organic Consumers Association, the International Indian Treaty Council, Physicians for Social Responsibility-Chicago, the Organic and Natural Health Association, the Environmental Justice Health Alliance, the Ecology Center, and the Alliance for Natural Health-USA.

“Mercury’s impact on young people’s health through its presence in fish remains an unresolved problem in this country and around the world. Reducing and eventually virtually eliminating mercury use in ‘silver’ dental fillings by replacement with other effective restorative materials will go a long way in removing this environmental threat to our children in the future,” said Peter Orris, MD, of Health Care Without Harm.

As other mercury uses decline, dental amalgam has become the single largest use of mercury in the United States, according to the United States Geological Survey. Once amalgam is released, the Environmental Protection Agency (EPA) says, microorganisms can change elemental mercury into methylmercury, which is a highly toxic form of the substance that can build up in fish, shellfish, and animals that eat fish.


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Parodontitis kann zum Verlust des Sehvermögens führen

Die Auswirkungen der chronischen Entzündung des Zahnhalteapparates auf den restlichen Körper wurden schon in zahlreichen Studien belegt. So werden Diabetes, verschiedenen Krebsarten oder auch kardiovaskuläre Erkrankungen mit Parodontitis assoziiert. Eine aktuelle Untersuchung, die beim 47th Annual Meeting of the American Association for Dental Research vorgestellt wurde, zeigt nun, dass Parodontitis auch zum Erblinden führen kann.

Für ihre Studie untersuchten die Forscher den Zusammenhang von Porphyromonas gingivalis, dem Markerkeim für Parodontitis, und der altersbedingten Makuladegeneration, eine Hauptursache für schwere Sehbehinderungen ab 60 Jahren. Da bereits bekannt ist, dass sich Porphyromonas gingivalis im gesamten Körper z. B. über Makrophagen ausbreiten kann, wurde seine Wirkung auf retinale Pigmentepithelzellen genauer betrachtet. Im Test mit Mäusen konnten die Wissenschaftler zeigen, dass der Markerkeim der Parodontitis die retinalen Zellen angreift, damit nachhaltig schädigt und so zur altersbedingten Makulardegeneration beiträgt.

Die gesamten Studienergebnisse sollen in Kürze veröffentlicht werden.


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Ibuprofen, acetaminophen more effective than opioids in treating dental pain

Opioids are not among the most effective -- or longest lasting -- options available for relief from acute dental pain, a new examination of the results from more than 460 published studies has found.

Ibuprofen and other nonsteroidal anti-inflammatory drugs (NSAIDs) alone or in combination with acetaminophen are better at easing dental pain, according to new research conducted with the School of Dental Medicine at Case Western Reserve University.

The study examining relief of acute pain in dentistry -- recently featured on the cover of The Journal of the American Dental Association -- evaluated the safety and efficacy of dozens of pain-relief options.

"What we know is that prescribing narcotics should be a last resort," said Anita Aminoshariae, an associate professor in the dental school's Department of Endodontics and one of the study's authors.

Each day, more than 115 Americans die as a result of an opioid overdose, according to the National Institutes of Health.

"No patient should go home in pain," Aminoshariae said. "That means that opioids are sometimes the best option, but certainly should not be the first option."

Aminoshariae said the goal of the systematic review was to summarize data -- using five in- depth studies -- of the effectiveness of oral-pain medications.

"The best available data suggests that the use of nonsteroidal medications, with or without acetaminophen, offers the most favorable balance between benefits and harms, optimizing efficacy while minimizing acute adverse events," she said.

She cited the national opioid epidemic as one of many reasons why health-care providers should take note of the findings.

The research found that, for adults, a combination of 400 milligrams of ibuprofen and 1,000 milligrams of acetaminophen was superior to any opioid-containing medications studied.

"Our aim was to create a compendium detailing both the benefits and harms of these medications as a resource for dentists to use in their clinical decision-making," Aminoshariae added.

The study also found that opioids or drug combinations that included opioids accounted for the most adverse side effects -- including drowsiness, respiratory depression, nausea/vomiting and constipation -- in both children and adults.


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How Competent Are You with Endodontics in Your Practice?

The American Association of Endodontists has just released a white paper on the topic of competency of endodontic care.  This paper defines the requisite skills required by all dentists who perform endodontic diagnosis and treatment regardless of whether the clinician is a generalist or specialist.

Topics covered include:

  • Proper pulpal and periapical diagnosis
  • Identifying odontogenic pain from non-odontogenic pain
  • Proper emergency treatment for traumatic dental injuries
  • Role of patient interview in endodontic diagnosis
  • Distinguishing features of irreversible pulpitis
  • The importance of multiple findings in determination of pulpal pathosis


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Antibiotics for dental procedures linked to superbug infection

Antibiotics prescribed by dentists may contribute to the growing problem of Clostridium difficile (C. diff), a serious and potentially deadly infection that causes severe diarrhea, suggests research presented at IDWeek 2017. And many of those antibiotics are likely unnecessary, researchers note.

Taking antibiotics can put patients at risk for developing C. diff and illustrates the importance of using the medications only when needed. The Minnesota Department of Health (MDH) tracked community-associated C. diff infections -- meaning those in patients who did not have an overnight stay in a hospital or nursing home -- in five counties in the state. During the six-year period, researchers determined 15 percent of those with the infection who had taken antibiotics had them prescribed for dental procedures.

But one-third of those patients' medical charts included no mention of receiving dental procedure-related antibiotics, researchers determined. An earlier survey conducted by the MDH found 36 percent of dentists prescribed antibiotics in situations that are generally not recommended by the American Dental Association (ADA) and reported challenges to making appropriate antibiotic prescribing decisions, including confusion about or perceived conflicts among prescribing guidelines.

"Dentists have been overlooked as a source of antibiotic prescribing, which can potentially delay treatment when doctors are trying to determine what is causing a patient's illness," said Stacy Holzbauer, DVM, MPH, lead author of the study and career epidemiology field officer for the CDC and MDH. "It's important to educate dentists about the potential complications of antibiotic prescribing, including C. diff. Dentists write more than 24.5 million prescriptions for antibiotics a year. It is essential that they be included in efforts to improve antibiotic prescribing."

Dentists appropriately prescribe antibiotics in certain situations, such as to treat infections stemming from a tooth abscess. However, some dentists prescribe antibiotics prophylactically before a dental procedure to prevent a heart infection in patients with heart conditions, or to prevent an infection of an artificial joint, such as a hip or knee replacement. The ADA no longer recommends preventive antibiotics in most of those cases, as it once did. "It is possible some dentists aren't aware of the updated recommendations or are being asked by other healthcare providers to continue preventive antibiotics despite the change," said Dr. Holzbauer. Current recommendations note the risk of taking antibiotics -- such as developing C. diff -- is greater than the risk of an infection in those cases. Further, the inappropriate use of antibiotics helps fuel the creation of drug-resistant bacteria, which are very difficult to treat and are an increasing public health threat.

In the study, MDH researchers interviewed 1,626 people with community-associated C. diff between 2009 and 2015. Of those, 926 (57 percent) reported they had been prescribed antibiotics, 136 (15 percent) of those for dental procedures. The study found patients who were prescribed antibiotics for dental procedures tended to be older and more likely to receive clindamycin, an antibiotic that is associated with C. diff infection. Of those who had received antibiotics for a dental procedure, 34 percent had no mention of antibiotics in their medical charts, illustrating the disconnect between dental and medical care. During routine medical appointments, patients should bring up dental visits and medications, including antibiotics -- they have taken. In addition, healthcare providers should ask patients about dental visits and medications taken for dental reasons.

Antibiotics kill bad and good bacteria in the gastrointestinal (GI) system. Wiping out the protective bacteria can allow the growth of C. diff bacteria, leading to severe and potentially deadly diarrhea. C. diff can occur after just one dose of antibiotics and is one of the top three most urgent antibiotic-resistant threats identified by the CDC. It caused almost half a million infections and led to 15,000 deaths in a single year, according to CDC estimates.


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