Laura Dorr is the former executive editor of DPR's Modern Dental Network and a regular contributing author.

Laura Dorr

	While dental amalgam has been the most popular dental filling material for a century and a half, new research is introducing an exciting alternative that could actually help repair teeth damaged by caries.

 and chair of physical sciences at the Institute of Dentistry at 

, announced that the new composite material could reduce the use of mercury-based amalgams and lengthen the life of composite fillings.

	The new composites, made of bioactive glass, help repair tooth decay through the release of fluoride, calcium and phosphate; components that are all key to the formation of tooth mineral.  While amalgam fillings are made up of inert materials, the bioactive glass actually replenishes these minerals that were lost due to tooth decay. Additionally, the bioactive glass can prevent oral bacteria from infiltrating the tooth further, by filling in the gaps with tooth mineral.

More emerging research: New study finds way to eliminate pain caused by tooth decay

	“Research in the US suggests this will potentially prolong the life of fillings and slow secondary tooth decay because the depth of bacterial penetration with bioactive glass fillings was significantly smaller than for inert fillings,” 

. “Not only did the bioactive glass composite remineralize the partially decayed teeth, but it also creates an alkaline environment that discourages the bacteria that caused the initial decay.

	“There is huge pressure to eliminate mercury based amalgam fillings by 2020, which is outlined in a host of international agreements,” says 

, CEO of BioMin Technologies.  “Using this type of bioactive glass composite to fill cavities eliminates the need to use mercury-based amalgam by offering esthetic white fillings which help heal the tooth."

	BioMin Technologies has licensed the new technology from Queen Mary Innovations, with plans to incorporate the remineralizing properties from their 

 into restorative dental products. “This is a really exciting development which is attracting interest from a number of commercial companies,” states Whatley.

Related reading: New toothpaste can rebuild teeth while you sleep

, available for public distribution, contains the same BioMinF ingredient that is included in the new composite. By releasting calsium, phosphate and fluoride ions over and eight to 12-hour period, the toothpaste can forms fluorapatite minerals to rebuild, strengthen and protect tooth structure. This slow release of fluoride, a key factor of the bioactive glass composites, has been identified as being particularly beneficial in prevention of tooth decay. 

 conducted in the United Kingdom, 90 percent of adults and two-thirds of young adults ages 16-24 in the UK has at least one filling. On average, adults had seven fillings, with 84 percent of all filled teeth restored with dental amalgam. Across the ocean in the United States, the average American has three dental fillings, with a quarter of the population having 11 or more fillings.

	Amalgam, made up a mixture of silver, mercury, tin and other metals, has 

 to contribute to higher mercury levels in patients’ blood, making finding an alternative to traditional amalgam fillings increasingly important. High levels of mercury can be toxic, and can cause brain, heart, lung and immune system issues, among other concerns. 

 found that patients with more than eight fillings had approximately 150 percent more mercury in their blood than individuals who had no fillings. 

Articles

While dental amalgam has been the most popular dental filling material for a century and a half, new research is introducing an exciting alternative that could actually help repair teeth damaged by caries.

New dental fillings could actually REPAIR tooth decay

	Veterans often struggle to get quality healthcare and dental coverage, but a new bill passed by the Senate aims to rectify that.

 from North Carolina and cosponsored by Montana’s John Tester, the 

VA Dental Insurance Reauthorization Act of 2016

 will increase dental coverage options for veterans, by extending the dental insurance pilot program established in 2014.

Trending article: Supreme Court dental regulatory board case examines federal antitrust laws

	The pilot program, which has provided dental care access to eligible veterans and dependents, was set to end in 2017, potentially leaving tens of thousands of veterans and their families without dental care. The new legislation transitions the dental care program into a statutory program.

	Through the program, veterans can purchase low-cost dental coverage from private insurers, including Delta Dental and Metlife. This is important, as the VA only provides dental care to a few classes of veterans: those that are 100 percent disabled, former POWs and veterans who have a “service connected dental disability or condition;” leaving many veterans without access to VA dental care. Veterans who are eligible for dental care through the VA can continue to do so and are not affected by the program.

Trending article: 5 facts you should know about dental insurance coverage

	Making sure veterans have dental care is the right thing to do,” says Senator Burr. “The veterans’ dental insurance pilot program has a track record of success and it is time to open it up to all veterans. Medical professionals have long known that proper dental care is linked to better overall health. I am pleased the Senate has recognized the value of this dental benefit for veterans and has passed my bill.”

Veterans often struggle to get quality healthcare and dental coverage, but a new bill passed by the Senate aims to rectify that.

New Senate bill provides low-cost dental coverage to veterans

	Hydration is crucial when working out or playing sports-but now, researchers say, hydrating is actually destroying children’s teeth.

 found that almost 90 percent of students ages 12-14 face an increased risk of tooth erosion due to regular social consumption of sports drinks. The sugary, low pH level drinks lead to a higher rate of dental caries and tooth enamel erosion, as well as obesity and other health problems. The beverages, although designed for athletes for performance-enhancing purposes, are popular with the children because of their sweetness, low cost and prevalent availability. Only 18 percent of the survey participants reported partaking in the sports drinks for enhancement of sporting ability.

More on children's dental health: Chemicals in water bottles, food containers may permanently damage children's teeth

	“The proportion of children in this study who consume high carbohydrate drinks, which are designed for sport, in a recreational non-sporting context is of concern,” comments Dr. Paul D. Jackson, president of the FSEM UK.“Sports drinks are intended for athletes taking part in endurance and intense sporting events, they are also connected with tooth decay in athletes and should be used following the advice of dental and healthcare teams dedicated to looking after athletes. Water or milk is sufficient enough to hydrate active children, high-sugar sports drinks are unnecessary for children and most adults.”

	To study the rate of sports-drink consumption among children, questionnaires were distributed to four schools in South Wales. Out of the 160 respondents, 89.4 percent reported drinking the sugary beverages, with 50 percent of that group said they had them at least two times per week. 90 percent of the respondents also reported that the “nice taste” of the sports beverages was their main motivation for drinking them. The study also found that more boys drank sports drinks during physical activity than girls (77.9 percent of boys, versus 48.6 percent of girls), while girls reported a higher rate of drinking them socially (51.4 percent versus 48.5 percent).

Related reading: Is dental anesthesia destroying children's teeth?

	The study also found that many of these sports drinks are being marketed at children in this age group.

	“Sports drinks are rarely a healthy choice, and marketing them to the general population, and young people in particular, is grossly irresponsible,” says Russ Ladwa, chair of the British Dental Associtation’s Health and Science Committee. “Elite athletes might have reason to use them, but for almost everyone else they represent a real risk to both their oral and their general health.”

	Elite athletes are however also not immune to the detrimental dental effects of these sports drinks, as recent studies have shown. 

Research published in the British Journal of Sports Medicine

 reported recently that nearly four out of 10 professional soccer players in the United Kingdom have active tooth decay, while another 

study published in the Scandinavian Journal of Medicine and Science in Sports

 discovered that runners and triathletes had significantly higher levels of tooth erosion than non-athletes. Sports drinks were cited as a contributing factor in both.

Related reading: Runners at higher risk for tooth decay

	“The triathlete’s high carbohydrate consumption, including sports drinks, gels, and bars during training, can lower the mouth’s pH level below the critical mark of 5.5,” said Cornelia Frese, author of the study published in the Scandinavian Journal of Medicine and Sciences in Sports. “That can lead to dental erosion and caries. Also, the athletes breathe through the mouth during hard exercise. The mouth gets dry, and produces less saliva, which normally protects teeth.”

	Since many parents are not aware of the dangers these beverages present to their children’s oral health, it is important for dental health professionals to educate both children and parents on the potential problems consumption of sports drinks can pose for dental health.

Trending article: Study finds children of stressed mothers are more likely to develop cavities

	“Dental health professionals should be aware of the popularity of sports drinks with children when giving health education or advice or designing health promotion initiatives,” states Maria Morgan, Senior Lecturer in Dental Public Health at Cardiff University.

A survey of sports drinks consumption among adolescents

,” was published in the British Dental Journal. 

Hydration is crucial when working out or playing sports-but now, researchers say, hydrating is actually destroying children’s teeth.

Is staying hydrated destroying children's teeth?

	Getting high may mean new lows for dental health: A recent study has found that cannabis users suffer from higher rates of periodontal disease than their weed-free peers.

 studied the relationship between pot-smoking and physical health problems over the course of 20 years to see if there was a correlation between increased medical issues and marijuana use. 

 included 1,037 participants born in Dunedin, New Zealand in the 1970s, and examined them until the age of 38. Study participants were assessed on the frequency of marijuana consumption and dependence at the ages of 18,21, 26, 32 and 38.

More on marijuana and dentistry: Dentist arrested for allegedly trafficking 20-30 pounds of marijuana EVERY MONTH

	Researchers measured participants overall oral and physical health with laboratory measures, as well as self-evaluations completed by the participants. 675 of the study participants reported that they had used cannabis. Those who smoked marijuana between the ages of 18-38 had poorer periodontal health at the study’s conclusion at age 38.

	“We found that marijuana is associated with adverse effects,” says study author 

, an assistant professor in the psychology department at Arizona State University.

	Researchers are not sure what causes the correlation, but suspect that it may be related to dry mouth, which is common among marijuana smokers and can create a breeding ground for oral bacteria.

	While cannabis was found to be a factor in poor periodontal health, researchers found that marijuana use was unrelated to other physical health problems in midlife, such as lung function, higher levels of inflammation and metabolic health. The study did not examine participants for long enough to determine whether pot use increased the risk for later-in-life oral health problems.

	“Unlike tobacco smoking, cannabis smoking is associated with few physical health problems in midlife, with the exception of periodontal disease,” Meier states in a 

. “Physicians should convey to patients that their cannabis use puts them at risk for tooth loss.”

More trending research: New study shows smokers are at higher risk of losing teeth

, which discovered a correlation between periodontal combined attachment loss (a sign of irreversible periodontal disease) and cannabis use. That study, “

Cannabis smoking and periodontal disease among young adults

,” examined three cannabis exposure groups (no exposure, some exposure and high exposure). Ultimately, 23.6 percent of high-exposure participants in the high-exposure group had attachment loss, as opposed to 6.5 percent in the no-exposure cohort.

 by Meier and colleagues discovered that in addition to contributing to poor oral health, marijuana use could affect IQ and socioeconomic mobility.

Associations between cannabis use and physical health problems in early midlife: A longitudinal comparison of persistent cannabis versus tobacco users

Getting high may mean new lows for dental health: A recent study has found that cannabis users suffer from higher rates of periodontal disease than their weed-free peers.

Study finds getting high will kill your smile

	A recent study has identified certain types of oral bacteria that have a correlation with the risk of developing pancreatic cancer.

	Oral bacteria have been linked to a slew of medical conditions, including heart attack, stroke, breast cancer and more, and researchers believe pancreatic cancer can be added to the list. In a recent study from the 

, researchers discovered that the presence of two specific types of bacteria, 

, significantly raised the likelihood of developing pancreatic cancer. Both bacteria have previously been tied to periodontitis and other oral diseases.

	“These bacterial changes in the mouth could potentially show us who is most at risk of developing pancreatic cancer,” says study author 

, associate director of population sciences at the Perlmutter Cancer Center and associate professor the NYU Langone.

	To identify the link, researchers studied bacterial contents in mouthwash samples from over 700 Americans participating in a larger ongoing cancer study through the 

. After mouthwash samples were obtained, study participants, who were all healthy at the beginning of the study, were monitored for several years to determine how many would develop pancreatic cancer. Ultimately, 361 of the study participants developed pancreatic cancer, and researchers determined that those that had 

 had a 59 percent greater chance of doing so than those without the bacteria. Similarly, patients whose oral bicrobiomes contained 

 faced a 50 percent greater risk of developing the disease.

	In addition to the discovery of the bacteria correlation, researchers also found other contributing factors.

	"Our study offers the first direct evidence that specific changes in the microbial mix in the mouth -- the oral microbiome -- represent a likely risk factor for pancreatic cancer along with older age, male gender, smoking, African-American race, and a family history of the disease," says Ahn.

	While the study cannot show direct cause and effect, researchers believe it is a step in identifying risk factors for developing pancreatic cancer, although they have not yet determined why the bacteria contribute to this increased risk. The hope is that if researchers can identify the exact role of oral bacteria in pancreatic cancer, new screening techniques could be developed to increase early intervention, or even prevent cancer. 

 that about 53,070 people will be diagnosed with pancreatic cancer in 2016, and approximately 41,780 patients will die from the disease. While the average lifetime risk of the disease is low (about 1 in 65 or 1.5 percent), pancreatic cancer has a poor prognosis, as it spreads quickly and often escapes early detection, making prevention critical.

	The research was presented on April 19 in New Orleans at the annual meeting of the American Association for Cancer Research.

A recent study has identified certain types of oral bacteria that have a correlation with the risk of developing pancreatic cancer.

Oral bacteria linked to risk of pancreatic cancer

	Harmful bacteria can be powerful and hard to combat, but researchers at the University of Florida have found a way to fight fire with fire. 

 has discovered a superhero strain of oral bacteria that can subdue bad caries-causing bacteria in the mouth. The identification of this strain, a previously unidentified type of Streptococcus called A12, could open the door for the development of a supplement or probiotic that could be taken orally to stave off cavities.

Trending research: Study finds oral bacteria transmission from parent to child increases dental health risks

	Since cavities often form when the pH levels in the mouth become acidic, maintaining a neutral pH can be key to dental health. Previous research discovered that ammonia assists with maintaining this healthy pH level, as it helps neutralize acid in the mouth. To create the ammonia, bacteria breaks down two compounds in the mouth, urea and arginine. Patients with an increased ability to break down these compounds were found to have fewer or no cavities.

	As such, researchers wanted to identify which bacteria was the most effective at breaking down urea and arginine. To do this, study co-author 

, and her team collected plaque samples and isolated over 2,000 types of bacteria.  Of the 2,000 kinds, the team identified 54 bacteria that metabolized arginine.  Out of these 54, A12 was determined to be the most promising for a probiotic application.

	“Like a probiotic approach to the gut to promote health, what if a probiotic formulation could be developed from natural beneficial bacteria from humans who had a very high capacity to break down arginine?" 

 “…the idea is that you could prevent a decline in oral health by populating the patient with natural beneficial organisms.”

	Surprisingly, researchers discovered that in addition to metabolizing arginine in the mouth, A12 also kills 

, particularly nasty bacteria that raises pH levels in the mouth and leads to caries development.

	“[A12] effectively inhibited growth and two intercellular signaling pathways of the dental caries pathogen 

,” the study reported. “A12-like organisms may play crucial roles in promotion of stable, health-associated oral biofilm communities by moderating plaque pH and interfering with the growth and virulence of caries pathogens.”

Trending research: Study finds oral bacteria linked to risk of stroke

 does not grow very well or make biofilms, also known as dental plaque, properly,” explained Burne.

	In addition to exploring the promising future of A12 as a probiotic supplement, Burne and Nascimento plan to explore using A12 levels as a risk assessment tool. “If we get to the point where we can confirm that people who have more of this healthy type of bacteria in the mouth are at lower risk of cavities, compared to those who don’t carry the beneficial bacteria and may be at high risk, this could be one of the factors that you measure for cavities risk,” said Nascimento. Patients with low levels could then receive supplements to raise their A12 levels.

	The study, “Characterization of a highly arginolytic 

Harmful bacteria can be powerful and hard to combat, but researchers at the University of Florida have found a way to fight fire with fire.

Preventing cavities may soon be as simple as popping a pill

	In recent months, gum disease has been linked to increasing number of major health problems - and researchers have now discovered another illness to add to the list.

	Researchers from the University of Louisville School of Dentistry examined the relationship between 

. In a study of 130 patients, (100 with esophageal squamous cell carcinoma [ESCC] who had undergone esophagectomy surgery and 30 normal controls) researchers discovered that 61 percent of patients with ESCC had the bacteria. 

 only presented in 12 percent of noncancerous tissue adjacent to cancerous cells, and was entirely undetected in normal tissue.

Trending article: American Dental Association releases new guidelines on gum disease treatment

	To come to these conclusions, the research team examined the presence of the bacteria’s cell DNA in esophageal tissue, and measured the level of an enzyme unique to 

 called lysine-gingipain. The cell DNA and lysine-gingipain enzymes were found to be significantly more prevalent in the cancerous tissue of ESCC patients. The researchers also discovered that the bacteria correlated with other factors, including metastasis and overall survival rate.

	“Mounting evidence suggests a causal relationship between specific bacterial infections and the development of certain malignancies,” 

 stated. “These findings demonstrate for the first time that 

infects the epithelium of the esophagus of ESCC patients … and suggest 

infection could be a biomarker for this disease. More importantly, these data, if confirmed, indicate that eradication of an oral pathogen could potentially contribute to a reduction in the overall ESCC burden.”

	Esophageal cancer is difficult to diagnose, as by the time patients show symptoms -such as difficulty swallowing-most are in very advanced stages of the disease.  According to 

, the overall five-year survival rate for esophageal cancer is only around 15%, making prognosis for the disease incredibly grim. If 

 is a contributing factor in the cancer, it is possible preventative measures could be taken.

	“These findings provide the first direct evidence that 

infection could be a novel risk factor for ESCC, and may also serve as a prognostic biomarker for this type of cancer,” said study author Huizhi Wang, M.D., Ph.D., assistant professor of oral immunology and infectious diseases at the UofL School of Dentistry. “These data, if confirmed, indicate that eradication of a common oral pathogen may contribute to a reduction in the significant number of people suffering with ESCC.”

Related research: Is there a link between gum disease and prostate disease? 

	Wang posited that there could be two explanations for the connection between ESCC and the oral bacteria: Either having 

 encourages esophageal cancer development, or the bacteria prefer ESCC cancerous cells. 

 prove to cause ESCC, the implications are enormous,” Wang said. “It would suggest that improving oral hygiene may reduce ESCC risk; screening for 

 in dental plaque may identify susceptible subjects; and using antibiotics or other antibacterial strategies may prevent ESCC progression.”

Presence of Porphyromonas gingivalis in esophagus and its association with the clinicopathological characteristics and survival in patients with esophageal cancer

In recent months, gum disease has been linked to increasing number of major health problems - and researchers have now discovered another illness to add to the list.

Gum disease linked to highly deadly cancer

	 There’s been a lot of buzz about oral systemic health in the news lately, and for good reason: A whole host of new discoveries have pinpointed that poor oral health is linked to some very serious medical conditions - and that treating oral health conditions could potentially serve as a preventative measure.

Oral bacteria have long been known to play a role in overall health, but lately periodontal disease and the bacteria that cause it have been specifically linked to health conditions including several types of cancer, pulmonary infection, heart attack, stroke and more. Researchers are hard at work pinpointing whether treating oral health issues could lessen the risk of these serious medical events, but for now, it’s critical to recognize the link and impress upon dental patients the importance of good oral health - because their lives could depend on it.

	Good oral health can be the difference between life and death for some patients with kidney disease: New findings from the University of Birmingham show that patients with chronic kidney disease patients and periodontitis have a higher mortality rate than those with chronic kidney disease alone.

	In a study of patients entering the hospital for acute stroke, researchers have discovered a connection between certain types of stroke and the presence of oral bacteria.

	Periodontal disease has been linked to a host of medical problems, but now researchers say there’s another risk to be added to the list: breast cancer. Recent research discovered that postmenopausal women with periodontal disease are more likely to develop the cancer than those without the oral health condition.

	Being in the hospital is bad enough without developing secondary infections. New research shows vulnerable patients in the ICU who received enhanced oral care from a dentist were at significantly less risk for developing a lower respiratory tract infection, like ventilator-associated pneumonia, during their stay in the hospital.

	In recent months, gum disease has been linked to increasing number of major health problems - and researchers have now discovered another illness to add to the list: esophageal cancer. Esophageal cancer is difficult to diagnose, as by the time patients show symptoms -such as difficulty swallowing-most are in very advanced stages of the disease.  According to 

, the overall five-year survival rate for esophageal cancer is only around 15%, making prognosis for the disease incredibly grim. If oral bacteria is a contributing factor in the cancer, it is possible preventative measures could be taken.	 

	Want to avoid a heart attack? Take good care of your teeth. A recent study found that tooth loss could be a predictor for future cardiovascular events, such as heart attacks, coronary heart disease, myocardial infarctions and even death.

	The debate about potential links between Alzheimer’s disease and dental infection and treatment has been grabbing headlines recently. Now, two researchers have examined an extensive collection of research and determined a potential correlation between the disease and oral bacteria.  

	Researchers at Case Western Reserve University in Cleveland have found a critical reason to treat periodontal disease as soon as possible. In a 

, they discovered the byproducts of bacteria in gum disease, called metabolic small chain fatty acid (SCFA), can work together to activate HIV in dormant T-cells, causing the virus to replicate.

	Researchers from the Case Western Reserve University School of Dental Medicine and the Departments of Urology and Pathology at University Hospitals Case Medical Center reported that treating gum disease reduced symptoms of prostate inflammation.

There’s been a lot of buzz about oral systemic health in the news lately, and for good reason: A whole host of new discoveries have pinpointed that poor oral health is linked to some very serious medical conditions - and that treating oral health conditions could potentially serve as a preventative measure.

9 of the Scariest Medical Conditions with Links to Oral Health

9 of the scariest medical conditions with links to oral health

	Mouthbreathers beware: Annoying your spouse isn’t the only downside of breathing through your mouth while you sleep. A new study has found that people who breathe through their mouth while sleeping are at a higher risk for tooth decay.

	Saliva plays a key role in caries prevention in a variety of ways (a 

 found that salivary mucins limit the growth of cavity-causing bacterial 

 that forms on a tooth’s surface), and mouth breathing can dry out the mouth. This can cause the oral environment to become acidic, and higher acidity levels can lead to the erosion and loss of 

More emerging research: Study finds nanodiamonds might prevent tooth loss after root canals

	But can breathing through your mouth overnight really affect overall acidity? The 

University of Otago’s Sir John Walsh Research Institute

 in New Zealand, analyzed oral pH levels to see if sleeping open- or closed-mouthed made a difference.

	While they slept, the 10 study participants wore a device that continuously recorded the pH and temperature of their mouths.  To ensure that participants breathed through their mouth, they wore a nose clip for two of the four nights for comparison purposes.

	Researchers discovered that on the nights that the participants were breathing through their noses, their mouths had a neutral pH level of seven (pH levels above seven are defined as acidic in nature, while those below seven are considered alkaline or basic). When mouth breathing however, the pH levels dropped to a slightly acidic level of 6.6, while some periodically even dropped as low as 3.6. According to researchers, this drastic drop is below the critical 5.5 pH threshold, when tooth enamel can begin to demineralize.

	"Intraoral pH decreased slowly over the hours of sleep in all participants, but showed greater falls over a longer period of time when participants were forced to mouth breathe," 

. “Our findings support the idea that mouth breathing may indeed be a causal factor for dental diseases such as enamel erosion and caries."

Related research: Study finds saliva plays key role in caries prevention

	While the average temperature in the mouth differed between day and night (33.1 degrees Celcius versus 33.3 degrees Celcius respectively), there was no statistical difference between the temperature when mouth or nose breathing.

	“The results suggest that mouth breathing during sleep is related to a decrease in intraoral pH compared with normal breathing during sleep,” the study concluded, “and this has been proposed as a causal factor for dental erosion and caries.”

Intraoral pH and temperature during sleep with and without mouth breathing

Mouthbreathers beware: Annoying your spouse isn’t the only downside of breathing through your mouth while you sleep. A new study has found that people who breathe through their mouth while sleeping are at a higher risk for tooth decay.