American Dental Association

	With the number of cases of HPV-associated cancers on the rise, the American Dental Association (ADA) has adopted a policy that urges dentists to support the use and administration of the human papillomavirus (HPV) vaccine.

 estimated that there would be more than 50,000 new cases of oral and oropharyngeal cancers in 2018, of which 70 to 80 percent would be attributable to HPV. The HPV vaccine could help prevent the vast majority of oropharyngeal cases, but compared to other vaccines in the U.S., it is underutilized. According to the ADA Council on Scientific Affairs, the single best predictor of whether a young person or adolescent receives the vaccine is a recommendation from a trusted health care professional.

Read more: Raising awareness about HPV-linked oropharyngeal cancer

“There is incontrovertible evidence that this virus is responsible for the sharp uptick in oropharyngeal cancers, especially in younger patients and young adults,” says Paul Eleazer, DDS, immediate past chair of the ADA Council on Scientific Affairs. “I’m pleased the ADA is taking action to combat this crisis.”

	The Centers for Disease Control and Prevention (CDC) Advisory Committee on Immunization Practices as well as the American Academy of Pediatrics recommend that boys and girls receive the HPV vaccine during adolescence. For adults who did not receive the vaccine in adolescence, the U.S. Food and Drug Administration recently announced approval for persons ages 27 to 45 to be vaccinated.
	 

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Oral cancers stemming from HPV are on the rise, and dental professionals are urged to support patients to receive the vaccination. 

ADA adopts new HPV vaccine policy for the prevention of oral HPV infection

	A new policy from the American Dental Association (ADA) “strongly discourages the practice of direct-to-the-consumer (DTC) dental laboratory services because of the potential for irreversible harm to patients.” The new policy expands upon a 2017 ADA policy titled “Do-It-Yourself Teeth Straightening” to include the sale of partial dentures, teeth whitening trays, snoring appliances, veneers and mouth guards, in addition to DTC orthodontic services.

	The traditional role of a dental laboratory is to manufacture prosthetics and devices at the direction of the dentist. The dentist writes a prescription to the laboratory customized to the specific clinical needs of the patient citing the materials to be used and any special design features requested.

	Recently, however, some laboratories have offered to sell such products directly to consumers. Bypassing the involvement and oversight of the dentist eliminates the dentist’s essential role in diagnosing oral health conditions, creating treatment plans to meet those needs and safely managing treatment needs through the course of dental care. Self-delivered, unsupervised dental treatment, in the view of the ADA, creates the risk of damage and irreversible harm to patients. 

Read more: ADA commends efforts to update Surgeon General's Report on Oral Health

	By circumventing the involvement of a licensed dentist, patients lose a very important quality control checkpoint-their dentist-to ensure all aspects of their treatment are performed and are progressing in the best interests of the patient. This includes oversight of the manufacture of prosthetic devices, including disclosure of materials used and country of origin, ensuring that they are to the satisfaction of both patient and dentist.  Moreover, if consumers experience problems with a DTC manufactured dental prosthetic, their ability to resolve the situation is greatly impaired in the absence of a dentist who has prescribed the prosthetic device.

However, another avenue is available. Because dental prosthetics, such as aligners, partial dentures and snoring appliances are considered medical devices by the FDA, the FDA encourages consumers as well as healthcare professionals, in case of problems, to utilize and submit the 

 to help improve safety by bringing attention to particular issues. More general information about the FDA medical device reporting program can be found here.

	In the view of the ADA, the dentist is ultimately responsible for the patient’s care, and is the only individual licensed and qualified to accept responsibility for prosthetic care. By adopting this new policy, the ADA strongly discourages the practice of direct to consumer dental laboratory services. Visit MouthHealthy.org/DIYdentistry to learn more.

The expanded policy includes the sale of partial dentures, teeth whitening trays, snoring appliances, veneers and mouth guards.

ADA adopts further policy discouraging direct-to-consumer dental services

	A new research study has determined that vaping sweet e-cigarettes can increase the risk of dental cavities.

	The study investigated changes in cariogenic potential when tooth surfaces were exposed to certain e-cigarette aerosols in a controlled environment. The combination of the viscosity of e-cigarette liquids and some classes of chemicals in sweet flavors contribute to the increase, according to the lead researcher Jeffrey Kim, DDS, Ph.D.

	Scientists systematically evaluated e-cigarette aerosols and found that the aerosols have similar physio-chemical properties to high-sucrose, gelatinous candies and acidic drinks, and interact with hard tissues of the oral cavity in such a way that can adversely affect teeth. Among more than 400 available e-liquid brands, 84 percent offered fruit flavors and 80 percent offered candy and dessert flavors, according to 

Read more: E-cigarettes shown to be detrimental to oral health

	“This study will give dentists further information to help educate patients that using e-cigarettes can have detrimental effects on their mouths,” says Thomas Hart, DDS, Ph.D., senior director of the 

The study suggests the complex impact of e-cigarettes on human health goes beyond respiratory and cardiac systems and may have significant implications on oral health.

	“[FDA has] data to show that use of e-cigarettes, while potentially posing much less harm than combusting tobacco, is not benign. It causes its own health effects … [Youth e-cigarette prevention] may be the most important thing I can accomplish in my role as the agency’s commissioner,” says FDA Commissioner Scott Gottlieb, MD, in a statement released by the U.S. Food and Drug Administration.

	The study was supported by the ADA Foundation and published in

, a peer-reviewed open access scientific journal published by the Public Library of Science since 2006.

	Scientists from the following organizations participated in the study: ADA Foundation Volpe Research Center; Department of Chemical and Biological Engineering, University of Colorado Boulder; National Institute of Standards and Technology; Molecular Characterization and Analysis Complex, University of Maryland; Johns Hopkins University; and the Department of Chemistry and Biochemistry, University of Maryland.

Study finds sweet e-cigarettes can increase risk of dental cavities

	The American Dental Association (ADA) commends the federal agencies that announced an update is in the works to the 2000 Surgeon General’s Report on Oral Health. The ADA looks forward to taking part in the public process as the updated report is developed.

	“The role that dentists play in patients’ oral as well as overall health is greater than what it was almost 20 years ago when the first Surgeon General’s report was released,” says ADA President Joseph. P. Crowley, DDS. “Dentists are leading the way in scientific advancements and clinical treatments that improve patients’ oral health and by extension their overall health. I am excited to see the progress that has been made and the challenges that remain so the ADA can lead inter-disciplinary efforts to address them.”

Trending article: The states with the best and worst oral health in 2018

First issued in 2000, the Surgeon’s General’s Report on Oral Health focused nationwide attention to “silent epidemic” of oral disease, addressed determinants for oral health and disease and concluded oral health is integral to overall health.

	According to the U.S Department of Health and Human Services, the updated report will document progress in oral health over the past 20 years, identify existing knowledge gaps and articulate a vision for the future. No timetable was provided for the completion of the update to the Surgeon’s General report.

The updated report will document progress in oral health over the past 20 years.

ADA commends efforts to update Surgeon General’s Report on Oral Health

	The American Dental Association (ADA) today announced a new policy on opioids supporting mandates on prescription limits and continuing education in what could be the first of its kind among major healthcare professional organizations.

		The ADA supports mandatory continuing education in prescribing opioids and other controlled substances.

		The ADA supports statutory limits on opioid dosage and duration of no more than seven days for the treatment of acute pain, consistent with the Centers for Disease Control and Prevention evidence-based guidelines.

		The ADA supports dentists registering with and utilizing Prescription Drug Monitoring Programs (PDMPs) to promote the appropriate use of opioids and deter misuse and abuse.

	“As president of the ADA, I call upon dentists everywhere to double down on their efforts to prevent opioids from harming our patients and their families,” says ADA President Joseph P. Crowley, D.D.S. “This new policy demonstrates ADA’s firm commitment to help fight the country’s opioid epidemic while continuing to help patients manage dental pain.”

Trending research: Are dentists getting greedy over X-rays? 

	Most opioids prescribed to patients in the U.S. are written by physicians and other medical professionals for management of chronic (long-term) pain. Dentists with an appropriate license may also prescribe opioids, and do so most often for management of acute (short-term) pain such as severe tooth decay, extraction of teeth and root canals. In 1998, dentists were the top specialty prescribers of opioid pain relievers, accounting for 15.5 percent of all opioid prescriptions in the U.S. By 2012, this number had fallen to 6.4 percent.
	
	New data published in the April issue of The Journal of the American Dental Association (JADA) continue to shed light on opioid prescriptions from a dental perspective. The data indicates:

		Benefits and Harms Associated with Analgesic Medications Used in the Management of Acute Dental Pain: Authors examined five systematic reviews and concluded non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and acetaminophen are equal or superior to using opioids for dental pain. The findings support the ADA’s 2016 policy statement that dentists “consider [NSAIDs] as the first-line therapy for acute pain management.”

		Opioid Prescribing Practices from 2010 through 2015 Among Dentists in the United States: Authors from the ADA Health Policy Institute used data in several existing databases to review opioid prescription claims from 2010 to 2015 for about 1.1 million privately insured dental patients. Findings indicate that patients who received an opioid prescription from a dentist were given a median supply to last three days. Across all age groups over a six-year period, opioid prescriptions increased by 17 per 1,000 dental patients. The largest increase in opioid prescriptions was among patients aged 11 to 18; and 11-18 and 19-25 age groups received a higher median dose than all other age groups.

		Gender and Race/Ethnic Disparities in Opioid Prescriptions for Dental Diagnoses among Patients with Medicaid: Authors reviewed claims of more than 890,000 Medicaid patients from 13 states between 2013 and 2015. Findings indicate emergency departments prescribed opioid medications almost five times more often than dentists and nurse practitioners prescribed opioids nearly three times as often compared to dentists. Women were 50 percent more likely than men to receive an opioid prescription for pain management of a dental condition. Both Whites (non-Hispanic) and African-Americans were around twice as likely to receive an opioid prescription as Hispanics.

		Prescription Monitoring Program (PMP) Data: Authors from Harvard School of Dental Medicine, Tufts University School of Dental Medicine and a retired Massachusetts State Police Detective Lieutenant provided 10 clinical scenarios dental prescribers might encounter and how to assess the PMP data from a clinical, risk assessment and law enforcement perspective.

	“The JADA articles shine an important light on a public health epidemic from the dental perspective, and signals that while the percentage of opioids prescribed by dentists has decreased since 1998, we can continue to do even more to help keep opioids from being a source of harm,” says Dr. Crowley. “Working together with physicians, pharmacies, other healthcare professionals, policymakers and the public, we believe it is possible to end this tragic and preventable public health crisis that has been devastating our families and communities.”
	
	For more information on how the ADA is working to combat opioid abuse, visit 

The policy supports mandates on prescription limits and continuing education. 

American Dental Association announces new policy to combat opioid epidemic

	According to the Centers for Disease Control and Prevention, 2.3 million Americans smoke tobacco from pipes, and many of those who smoke waterpipes, or hookahs, believe it’s less harmful than cigarettes.

The Journal of the American Dental Association (JADA)

 suggests hookah smoking is associated with serious oral conditions, including gum diseases and cancer.

	“We found that waterpipe smoking is associated with serious health problems affecting the head and neck region,” said 

study author Teja Munshi, BDS, MPH, of Rutgers University

. “The public needs to know they are putting themselves at risk. They should be made aware of the dangers of smoking hookahs.”

Related reading: New study shows smokers are at higher risk of losing teeth

	The authors conducted a literature review that focused on waterpipe smoking and head and neck conditions. They found waterpipe smoking to be associated with gum diseases, dry socket, oral cancer and esophageal cancer, among other conditions. According to 

, smoking a hookah is the equivalent of smoking 100 cigarettes, based on the duration and number of puffs in a smoking session.

	“This study sheds light on the common misconception that smoking from a waterpipe is somehow safer than smoking a cigarette,” said JADA Editor Michael Glick, DMD. “Whether you are smoking a cigarette, an e-cigarette, a cigar or tobacco from a waterpipe, smoking is dangerous not only to your oral health but to your overall health.”

 on Nov. 19, 2015, an annual event that encourages smokers of all kinds to give up the habit. The event asks smokers to quit even for just one day to take a step toward a healthier life.

More on smoking: Study finds secondhand smoke exposure linked to increased dental decay in children

	Millions of Americans still use traditional methods of smoking, but emerging trends in the smoking industry, such as hookah smoking and e-cigarettes, pose danger,s as well. E-cigarettes are devices that turn liquid into a vapor containing nicotine. In an editorial in the 

, authors warned readers of the potential dangers of e-cigarettes, indicating oral health effects of their use have been inadequately investigated.

	“Additional research is needed on the impact smoking has on overall health, but it’s clear that smoking of all kinds has the potential to be dangerous,” Dr. Glick said.

	Dentists have an important role in advising patients of the dangers of smoking. The American Dental Association has long been a proponent of educating the public about its hazards and has urged for continued research into the adverse health effects of tobacco use. For more information on smoking and its oral health effects, visit 

Related reading: Studies find sunbathing linked to gum disease prevalence

	Watch the video below to see Dr. Glick disucuss the hazards of hookah smoking:

More on oral health: The comprehensive assessment is critical in diagnosing periodontal disease

According to the Centers for Disease Control and Prevention, 2.3 million Americans smoke tobacco from pipes, and many of those who smoke waterpipes, or hookahs, believe it’s less harmful than cigarettes.