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

Laura Dorr

	In the fight against dental caries, we commonly utilize exogenous materials such as fluoride or sealants. However, a recent study has found that a key tool for fighting caries-causing bacteria may be our own saliva.

, a cariogenic bacterium that sticks to teeth with adhesive polymers and forms a bacterial biofilm. This biofilm provides a protective haven on the tooth for the bacteria and its organic acid byproducts, leading to the creation of caries. The study’s authors found that salivary mucins, previously believed to do little beyond keeping saliva mucas slippery, actually play a role in defending against bacterium like 

, by keeping it suspended in a liquid medium, reducing its ability to form the bacteria-welcoming biofilms.

Trending article: Dental caries susceptibility linked to hair

While the salivary mucins did not alter the growth of 

, or kill the bacteria, it limited biofilm formation through the liquid suspension. This is particularly significant for 

 and similar bacteria that only cause cavities when they are in a biofilm on a tooth’s surface.

The study stemmed from previous work examining mucins that had protective effects against common lung pathogens. Defects in mucin production have been linked to diseases such as asthma, ulcerative colitis and cystic fibrosis. The study’s first author, Erica Shapiro Frenkel, of Harvard University, believes that this research proves that mucins aren’t just part of mucus for structure, but rather also play an active role in pathogen protection. 

Salivary mucins protect surfaces from colonization by cariogenic bacteria

"  was published in Applied and Environmental Microbiology, a publication of the 

Trending article: Must-see products at the Greater New York Dental Meeting

Articles

 In the fight against dental caries, we commonly utilize exogenous materials such as fluoride or sealants. However, a recent study has found that a key tool for fighting caries-causing bacteria may be our own saliva.

Saliva plays key role in caries prevention

 in Australia is challenging the belief that people with tooth loss actually need dentures.

Australian Research Centre for Population Oral Health

, the study examined whether people with tooth loss found their quality of life compromised by having missing teeth. 2,750 patients aged 15 years and up participated in the study. To be eligible, participants needed to have intact anterior teeth.

The research showed that quality of life was not interfered with for the study participants, provided they still had a certain number and type of teeth left.  These patients, considered to have “shortened dental arches,” still maintained functional use of many teeth. The study found that there was a cutting-off point where tooth loss did become detrimental to quality of life, but only patients that reach that point are in need of dentures.

The findings have big implications for dental healthcare costs for patients, as well as public dental health resources. 

, a co-author of the study, said in a recent 

, “For the public health sector, this work raises the question of how to allocate resources, especially if many people are currently receiving dentures or other corrective procedures when they may not need to do so. These resources could instead be allocated to the prevention of further tooth loss, diagnostic services and follow up for the patient, rather than prosthetic procedures.”

Researchers now believe that as many as 434,000 Australians who, under current thinking, would be said to need dentures at some point in their lives, may not actually need them.

 summed up the research, saying, “For years, it has been taken for granted that if people experience tooth loss, they will need dentures, bridges, implants or other corrective processes to replace the missing teeth. "What we've found is that it really depends on the position of the teeth that have been lost, as well as the number."

Recent research: Study finds human tooth enamel development is linked to weaning

Do people with shortened dental arches have worst oral health-related quality of life than those with more natural teeth? A population-based study

Community Dentistry and Oral Epidemiology.

 Recent research out of the University of Adelaide in Australia is challenging the belief that people with tooth loss actually need dentures.

Do people with tooth loss really need dentures?

	New research out of England has found that weaning in human babies is tied to prenatal tooth enamel growth rates.

, calculated the prenatal rate that enamel increases in thickness and height on deciduous canines, incisors and molars. Researchers found that incisors develop quickly in the early stages of the second trimester, while molars and canines grow at a slower rate in the third trimester. This ensures that incisors will be able to erupt sooner after birth, at approximately six months of age.

This fact that this timing coincides with the transition from breast-feeding to weaning and the introduction of additional foods is no coincidence. In some primates (such as chimpanzees), weaning occurs much later than that, meaning that, compared to other primates, there is less time for human incisors to form, making it crucial that they develop faster. To compensate, the enamel in human teeth grows rapidly.

 unit, plays into an anthropological debate on at what point in evolution early weaning in humans began.

The new information on tooth enamel growth can help solidify this timeline by increasing understanding of weaning in fossil ancestors. This has previously been hard to determine, as dental problems don’t present in every tooth the same way, and enamel cells deposit new tissue at different rates in different tooth types.

Up until this point, anthropologists have had to rely on the rare discovery of infant fossil skulls that were just presenting tooth eruption at the time of death – discoveries that have proven to be few and far between. The new research can help anthropologists by providing a prenatal enamel growth record that lasts long past tooth eruption and even death.

“Dental fast track: Prenatal enamel growth, incisor eruption and weaning in human infants,”

 New research out of England has found that weaning in human babies is tied to prenatal tooth enamel growth rates.

New research finds human tooth enamel development is linked to weaning

Twenty-five years of private practice haven’t changed the core values of Dr. Jeff Blank’s philosophy of care. Providing comprehensive care, not just esthetic treatment, is the main focus of his Fort Mill, S.C., practice, where he specializes in complex restorative reconstruction and cosmetic enhancement procedures.  

“The comprehensive approach is critical,” said Dr. Blank. “It’s like building a house: You don’t get to pick out the drapes until you have a good foundation. It’s very easy as a dentist to become a tooth mechanic, and only look at individual teeth. I think what is at the core of our practice is that we’re really taking a whole-patient view in terms of the entire system working together.” 

Dr. Blank and his team work with each patient to establish a long-term care plan, and emphasize the importance of communicating with their patients to ensure they can understand and feel comfortable with their diagnosis and subsequent treatment plan. He and his treatment coordinator use scans of the patients’ mouths to visually explain areas of concern and show patients exactly what they are talking about, communicating with them to diagnose the entire mouth at once.  

Dr. Blank also cites how critical it is to use high-quality products that will ensure a patient’s treatment is successful, and won’t require him or her to return for extra visits.

“Durability and esthetics of the products we use are big components, but patients always want procedure time to be short,” explained Dr. Blank. “No one likes to sit in the dental chair for an endless amount of exacting steps.”  This is where 3M ESPE products become a must-have for his practice.

By using 3M™ ESPE™ cements, Dr. Blank gets patients out of the chair quicker than ever before, while still ensuring that the final result will be high quality the first time around. 3M ESPE’s cement solutions minimize the number of steps–and time–required to complete procedures, due to their ease of use in handling, application and cleanup.

Check out this video to hear what Dr. Blank has to say about 3M ESPE cements

 Ideal for porcelain, composite and ceramic veneers, 3M™ ESPE™ RelyX™ Veneer Cement has an easy-to-use syringe delivery, and Dr. Blank praises it for its viscosity and consistency: “A lot of veneer cements are too runny or too viscous. 3M has found the right consistency for veneer cement, and the handling factors are fantastic.” 

Color matching is also simple, with try-in pastes that match the cure color of the cement – a crucial feature in thin ceramic restorations, where the cement can influence the overall appearance of the restoration.

For other cases, such as full-coverage crowns or zirconium restorations, Dr. Blank relies on 3M™ ESPE™ RelyX™ Ultimate Cement. The versatile cement can be used for total-etch, selective-etch or self-etch procedures, and is easy to use, since the system includes only two components (an automix syringe and bottle). With tooth-like fluorescence, high bond strength and high wear resistance, 

is excellent for any type of indirect restoration – and has yet to cause any post-op sensitivity in Dr. Blank’s patients.

“There are things in dentistry that, if you cut corners, can lead to considerable problems for you, your practice and the patient,” explained Dr. Blank. “Cements are definitely something where you don’t want the bottom of the barrel, which is why I use 3M ESPE products.” 

And 3M ESPE cements have proven to be top of the line: Dr. Blank has been using RelyX™ Ultimate Cement since its release in 2012, and RelyX™ Veneer Cement for close to 10 years, and has not seen any failure related to the cements. “Cement failures can be a big, big problem, and we’ve had them with other brands. It’s a profit killer, time killer and a confidence killer. It doesn’t reflect well on me as a physician and is incredibly disappointing to have a product failure related to a poor choice in product.”

Dr. Blank has also found success with 3M™ ESPE™ Scotchbond™ Universal Adhesive, a bonding solution that he believes can’t be any more efficient.

“The Scotchbond one-bottle system couldn’t be easier to use. The dual-cure system is amazing, because you know you’re going to have that cure even if you don’t get the light through the denser restorations.”  

Effective on all surfaces, Scotchbond Universal Adhesive has consistent bond strength to moist and dry etched dentin, with the added bonus of causing virtually no post-op sensitivity.  

Because of his amazing experiences with 3M ESPE cements and adhesives, Dr. Blank also integrates other 3M ESPE products into his practice, including the new 3M ESPE Imprint™ 4 VPS Impression Material. 

Imprint 4™ VPS impression material delivers precise impression results in the shortest intra-oral setting time, letting Dr. Blank get quality impressions in a fraction of the time. “This material sets faster than any other product on the market,” he said. “It’s a very novel thing to see. The material sets in just 75 seconds without compromising working time, which is about half the time of other brands. On top of that, we don’t see tears, drags or pulls in impressions.”

The interior of Dr. Blank's Fort Mill, S.C. practice

In addition to 3M ESPE’s impression materials, Dr. Blank uses 3M™ ESPE™ Directed Flow Impression Trays, which eliminate the need for a tray adhesive and simplify preliminary and final impressions. Dr. Blank also saves post-op time by using the single-use trays, which eradicates the need to disinfect or clean.  The trays have a built-in reservoir to reduce patient gagging, a directed-flow design to minimize flow defects and striations that prevent tooth/tray contact, making it a hassle-free experience for patient and doctor alike.

“The Directed Flow impression trays are 

 probably the best disposable silicone universal series of trays that we’ve ever used in the history of the practice,” said Dr. Blank. “They have pretty much revolutionized our practice.” 

With such revolutionary results, it’s not surprising that Dr. Blank can’t recommend 3M ESPE products enough. “I am confident in 3M ESPE products because they do the required research and never launch products before they’re ready. 3M ESPE wants to be number one, and they really are! When something novel or revolutionary comes out with their name on it, it’s definitely going to catch my attention.” 

Dr. Jeff Blank graduated from the Medical University of South  

Carolina, College of Dental Medicine in 1989 and maintains a full-time private practice at the Carolina Smile Center in Fort Mill, S.C. He is the founder of New Millennium Education, which offers personalized mentoring programs for those seeking to advance their skills in esthetic and complex restorative dentistry. He has lectured extensively both domestically and abroad since 1998, published numerous clinical manuscripts and dental research, and is a Fellow and active member of numerous dental societies. For questions, comments, or to arrange for Dr. Blank to speak at your upcoming local, regional or national dental program, he can be reached at jblank@comporium.net or by visiting www.newmillenniumedu.com and www.carolinasmilecenter.com.

RelyX Ultimate adhesive resin cement delivers bond strength, ease of use and world-class esthetics. Used in combination with Scotchbond Universal adhesive, the two products provide exceptional strength and simplicity. Requiring fewer working steps, the cement’s formulation includes an integrated component that activates the dark cure function of the adhesive and eliminates the need for an additional activator. Approved for a wide range of indications, RelyX Ultimate cement is well suited for CAD/CAM and glass ceramic restorations.

RelyX Temp NE and Temp E Cements provide reliable retention with simple removal. The quick and easy removal of both excess cement and the provisional makes this dependable material a go-to choice for dentists. The cements are formulated to provide an optimal fit and precise adhesion. The strong material, in both eugenol (RelyX Temp E) and non-eugenol (RelyX Temp NE), saves time during clean-up and gives peace of mind during the cementation process. 

RelyX Veneer cement offers a customer-preferred shading system and delivery. The cement is extremely color-stable and offers matching try-in pastes, providing dentists more choice and flexibility when cementing veneers. The light-cure formula allows for easy handling and clean-up and provides simple and efficient bonding of porcelain, ceramic and composite veneers to ensure stability and long-lasting results. RelyX Veneer cement provides excellent esthetics and consistently delivers an optimal end product.

 In this Featured Practice Profile, DPR spoke with Dr. Jeff Blank about how 3M ESPE products and cements have made it simpler than ever for his practice to provide reliable comprehensive care.

How 3M ESPE cements make restorative dentistry easy [VIDEO]

 to reduce the release of mercury into the environment from dental offices.

being released into the environment. Amalgam, which contains mercury and various metals, is discarded into public water systems via chairside drains when dentists remove or make dental fillings.  Mercury coming from dental offices makes up about 50 percent of the total amount entering water treatment systems; The EPA stated that the new standards would reduce this discharge into the system by almost 9 tons a year.

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“This is a common sense rule for capturing mercury at a relatively low cost before it is dispersed into publicly owned treatment works,” stated Kenneth Kopocis in an agency news release. Kopocis is the deputy assistant administrator for the EPA’s Office of Water.

 recommends measures such as amalgam separators and other practices to reduce the release of mercury from dental offices, and many local and state governments already require that steps such as these be taken.

Trending article: Why responsible pediatric dental radiology is a must

“The rule would strengthen human health protection by requiring removals based on the use of a technology and practices that approximately 40 percent of dentists across the country already use,” Kopocis added in the release.

The EPA is currently accepting public input on the proposed rule, which is expected to be finalized in Septemeber 2015. 

 The Environmental Protection Agency (EPA) announced the proposal of new standards to reduce the release of mercury into the environment from dental offices.  

Newly proposed EPA standards will affect dentists

	While oral hygiene habits and diet influence the risk of tooth decay, genetics are also at play in regards to susceptibility for dental caries development … genetics that can also determine hair disorders. 

Trending article: Sleeping in dentures can pose major health hazards

Strong enamel is obviously crucial to dental health, as it protects teeth from caries and decay, so those with structural abnormalities in their enamel can be at an increased risk for such dental issues.  A new 

 has found not only that enamel structure can influence an individual’s predisposition to caries, but also that 

Using genetic and intraoral examination statistics from 1,092 study participants, researchers found that epithelial hair keratins – proteins associated with strong hair that play a large role in maintaining the strength and integrity of the sheaths that support hair shafts – are essential organic components of enamel. As part of tooth enamel’s protein composition, keratin can influence tooth enamel structure and integrity.

Additionally, the study found that individuals that had keratin mutations associated with hair disorders also had abnormal enamel structure that resulted in tooth weakness, thus increasing the risk of dental caries.

The full study (“Hair keratin mutations in tooth enamel increase dental decay risk,”) was published in the 

How and why DEXIS CariVu changed one practice for the better [VIDEO]

 While oral hygiene habits and diet influence the risk of tooth decay, genetics are also at play in regards to susceptibility for dental caries development … genetics that can also determine hair disorders. 

Dental caries susceptibility linked to… your hair?

has found that your morning java can provide some surprising dental health benefits.

Related reading: Nutritional supplements combat the effects of periodontal disease

Researchers studied more than 1,000 men for up to 30 years, and found that those who drank at least one cup of coffee per day had less periodontal bone loss. Less acidic than other popular beverages such as soda or juice (which have been shown to weaken tooth enamel), coffee was found to have no association with any markers of periodontal damage. 

. believes that the antioxidants in the coffee may explain it’s protective nature. “They could be muting the body’s own inflammatory processes that normally would be harmful to the gums and jawbone,” he said.

So, while you may be sporting some unsightly staining from your favorite morning caffeine jolt, at least you’ll be reducing your chance of periodontal disease – certainly good news for all the dedicated coffee drinkers out there.

On-demand webinar: How to expand your practice using a laser to manage periodontal patients

Coffee Consumption and Periodontal Disease in Males

") was published in the August 2014 edition of the Journal of Periodontology. 

 While coffee may stain your teeth, research from Boston University has found that your morning java can provide some surprising dental health benefits.

A cup a day keeps periodontal bone loss away

	Halloween season can feel like a real-life horror movie for dentists, with all of the candy, sweets and sugar damaging seemingly healthy smiles.  This year, help your patients avoid the dental risks of too much sugar with a Halloween candy buy-back program.

Candy buy-back programs encourage children to donate or trade in their Halloween candy for a small reward, reducing the amount of sugar they consume and

. Some practices offer $1 per pound of candy that a child turns in, or give participants goody bags filled with healthier treats or prizes. 

Wanted: Your dental practice horror stories

 (HCBB) take things one step further. Now in its 10

 year, the national HCBB program partners with 

, an organization that ships over 100,000 care packages per year to troops serving abroad. Operation Gratitude includes the candy collected by HCBB in care packages to give soldiers a well-deserved sweet treat. During the duration of this partnership, the HCBB program has collected over 130 tons of candy to be included in the packages.  But don’t worry about the troops’ teeth: Many of the care packages also include toothbrushes!

So this year, “trick” those kids into donating their candy to give the troops a treat! Whether you partner with HCBB, or do a program on your own, Halloween candy buy-back programs give practices a chance to 

 children and families on good oral health habits, while also promoting good nutrition – and helping reduce the number of horrifying cavities walking through the doors in coming months!

To get tips about setting up a candy buy-back event, or to learn more about 

 – and sign up for the program – go to HCBB’s website at 

 Halloween season can feel like a real-life horror movie for dentists, with all of the candy, sweets and sugar damaging seemingly healthy smiles.  This year, help your patients avoid the dental risks of too much sugar with a Halloween candy buy-back program.

Support healthy smiles – and the troops – this Halloween

	Traditionally, medicine and dentistry have been considered distinctly different fields, with medicine taking precedence over dentistry. However, with a better understanding of oral disease – and how it can affect the rest of the body – insurance programs and the medical system need to catch up.

5 facts you should know about dental insurance coverage

The separation between the two fields is nothing new; historically, they have been seen as inherently different. This extends back to the dental profession’s humble beginnings in barbershops, when, until the 1800s, 

, pulling teeth and performing bloodletting. Because of the often painful and gruesome procedures, the field was not regarded as sophisticated, instead falling into the shadow of its more refined medical cousin.

With the current understanding that dental health can 

, it is thus surprising that dental care is still often shunted to the side and overlooked. While programs like 

 have greatly expanded opportunities for medical care, approximately 

130 million people in the U.S. have no dental insurance

 – and neither Obamacare nor most Medicaid plans have dental care as a required benefit.  Generally, only children and, in some cases, pregnant women receive dental coverage under Medicaid, leaving many people without proper oral care.

How to discuss dental benefit summaries with your patients [VIDEO]

“There are states that will not even provide relief of pain or treatment of active infection just because it’s between the nose and the chin,” 

, a professor of dental medicine and health policy at Columbia University, told 

. He believes that the disconnect between medicine and dentistry “has been a lasting, physiologically, medically, morally, and ethically inappropriate separation.”

To see exactly how crippling this problem has become, 

Only 10% of smokers receive advice from dental professionals to quit

 Traditionally, medicine and dentistry have been considered distinctly different fields, with medicine taking precedence over dentistry. However, with a better understanding of oral disease – and how it can affect the rest of the body – insurance programs and the medical system need to catch up.

Why are some insurance companies excluding dental care?

	There has been much research and discussion on the efficacy and benefits of certain toothpastes or mouthwashes when it comes to eliminating oral bacteria – but what about toothbrushes? 

 has found that bacteria growth is more prevalent on certain types of toothbrushes, which could have negative impacts on oral health.

The University of Texas Health Science Center at Houston (UTHealth)

 found that hollow-head toothbrushes had up to 3,000 times more bacterial growth than solid-head toothbrushes. The research showed that in 9 out of 10 comparisons, microbial counts were lower in solid-head toothbrushes than hollow-head toothbrushes.  

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“A solid-head design allows for less growth of bacteria,” said 

, R.D.H., M.Ed., lead author and professor at the UTHealth School of Dentistry. “It is also important to disinfect and to let your toothbrush dry between uses.”

Participants in the study brushed twice daily for three weeks with one of three power toothbrushes. Participants used non-antimicrobial toothpaste and flossed, but refrained from using other products like mouthwash. The brush heads were exposed to five categories of oral microorganisms, including anaerobes and facultative microorganisms, yeast and mold, oral streptococci and oral enterococci anaerobes, Porphyromonas gingivalis and Fusobacterium species.

Oral-B introduces first interactive electric toothbrush with Bluetooth 4.0 connectivity

“The packaging on most power toothbrushes won’t distinguish between a hollow-head and solid-head design,” reported Morris. “The best way to identify a solid-head design is through the connection to the body of the power toothbrush.”

The article did make note that there is no study to date that has proven that bacteria on toothbrushes can lead to systematic health effects, but pointed out that several of the observed microorganisms have been associated with systematic diseases.

Health organization takes stance on AHA statement about possible link between periodontal disease and cardiovascular disease

“Some of these other bacteria have been linked with cardiovascular disease,” stated Morris. “There is a high association with gum disease and cardiovascular disease. Researchers have been able to culture the same bacteria around the heart that causes gum disease. ”

., and published in the August issue of the 

. Information for this story was gathered from that publication.

 There has been much research and discussion on the efficacy and benefits of certain toothpastes or mouthwashes when it comes to eliminating oral bacteria – but what about toothbrushes? Recent research has found that bacteria growth is more prevalent on certain types of toothbrushes, which could have negative impacts on oral health.  