Nicholas Hamm

	E-cigarettes have often been touted as a healthy alternative to conventional cigarettes. Instead of smoke, they produce vapor, which is often believed to be relatively harmless. 

, this vapor still contains a variety of harmful chemicals that can damage the epithelial lining of the mouth. The 

, found that e-cigarettes are more dangerous than many believe.

Related article: New study finds that dental visits can reduce the risk for pneumonia

	"Contrary to what one might think, e-cigarette vapor isn't just water," explains Dr. Mahmoud Rouabhia, a researcher at the university whose team conducted the research. "Although it doesn't contain tar compounds like regular cigarette smoke, it exposes mouth tissues and the respiratory tract to compounds produced by heating the vegetable glycerin, propylene glycol and nicotine aromas in e-cigarette liquid."

	The study focused its efforts on the effects of e-cigarette vapor on gingival epithelial cells. The team placed cells into a small chamber containing a saliva-like liquid. The cells were then introduced to e-cigarrette vapor equivalent to two five-second inhalations per minute for 15 minutes a day.

Related: Study finds smoking dangerously alters oral microbiome

	In normal circumstances, the epithelial cells would have died off at a rate of two percent. In the experiment, after one, two and three days, the cells died off at rates of 18, 40 and 53 percent, respectively.

	The research is worrying to Dr. Rouabhia, who reminds us that the "mouth epithelium is the body's first line of defense against microbial infection,” and that it “protects us against several microorganisms living in our mouths." At DPR, we’ve shown you 

 just how dangerous these oral microorganisms can be.

	The effects of the damage have not been studied in detail, but the potential effects do give Dr. Rouabhia, who is also a member of the 

 at Université Laval, a reason to be concerned. Says Dr. Rouabhia, "Damage to the defensive barrier in the mouth can increase the risk of infection, inflammation and gum disease. Over the longer term, it may also increase the 

. This is what we will be investigating in the future."

Articles

A new study from Université Laval takes a look at the effects of e-cigarettes on gingival epithelial cells.

E-cigarettes shown to be detrimental to oral health in new study

	We all know that dental health is of critical importance. But not everyone knows that, and many don’t have access to adequate dental care.

2017’s States with the Best & Worst Dental Health

”  explores which states have the best 

, considering factors such as availability of care, amount of care, ental costs and dentists per capita, along with several others. The report provides an overall ranking based on “Dental Habits & Care” and “Oral Health” rankings. These rankings show not only where dental care is the most widely available and utilized, but also where there needs to be significant improvement.

Related article: From 1 to 50, the best and worst states to work in a dental practice

	Minnesota leads the country with a “Dental Habits & Care” rank of 1 and an “Oral Health” rank of 3. West Virginia is ranked last in the country with a “Dental Habits & Care” rank of 33 and an “Oral Health” rank of 51 (Washington D.C. is included in the study) combining to give it the lowest score. The study also provides valuable information on topics such as the percentage of adolescents who visited a dentist in the past year or the lowest and highest treatment costs per state.

A look at the state rankings for the best and worst dental health.

The states with the best and worst dental health

	"This research may be the closest we've come to uncovering the root cause of RA," says Maximilian Konig, M.D., a former Johns Hopkins University School of Medicine fellow now at Massachusetts General Hospital.

 that found a link between the bacterium responsible for periodontal disease and rheumatoid arthritis. In their report in the journal 

, the researchers from Johns Hopkins found that the bacterium 

 is the common denominator between periodontal disease and RA.

	While many other studies have shown a link between RA and periodontal disease, many (especially in the last 10 years) have concentrated on the bacterium 

but no evidence has been found that this bacterium can begin the process of RA, says 

, the senior study investigator and associate professor of Medicine at the Johns Hopkins University School of Medicine. However, his team kept exploring the link between the two diseases because the links between them are obvious.

	The team decided to focus on a link called hypercitrullination. Citrullination, Andrade explains, occurs naturally as a means of regulating protein functions. However, in people with RA the process goes into overdrive, which results in an excess of citrullinated proteins. This causes a large production of antibodies, which cause inflammation and attack a person’s own tissues-the major symptoms of RA.

Related article: Oral bacteria linked to risk of pancreatic cancer

out of all the bacteria associated with periodontal disease, is the only one able to induce hypercitrullination in neutrophils, white blood cells that are the most abundant inflammatory cells found in the joints and gums of people with RA. These cells have been studied as the major source of hypercitrullination in RA.

 1.3 million people in the U.S. alone, and as much as one percent of the world. The current treatment methods involving steroids, immunotherapy drugs and physical therapy may help some patients, but not everyone. A new treatment method is needed, and it is hoped that this research could help slow or stop the disease.

	However, Konig cautions that, in a study they based some of their findings on, only 50 percent of patients with RA had evidence of an infection with 

This may indicate that other bacteria in the gut or elsewhere could be using a similar method to induce hypercitrullination. Andrade also cautions that the study only focused on RA patients at a single point, and that more research will be needed to establish cause and effect. Says Andrade, “If we know more about the evolution of both combined, perhaps we could prevent rather than just intervene.”

Related article: Study finds oral bacteria linked to risk of stroke

This isn’t the first time we’ve looked at the links between oral bacteria and serious medical issues

. Do your patients know about these links? Caring for the mouth means caring for the whole person-make sure that both you and your patients realize that!

Researchers at Johns Hopkins may have found one of the root causes of RA.

Researchers find a link between periodontal disease and rheumatoid arthritis

	New research suggests that there is a link between pneumonia and visits to the dental office.

™ found that regular dental cleaning decreases the risk of pneumonia caused by oral bacteria.

	“There is a well-documented connection between oral health and pneumonia, and dental visits are important in maintaining good oral health,” says Michelle Doll, MD, lead author of the study and assistant professor of internal medicine in the Division of Infectious Disease at Virginia Commonwealth University, Richmond. “We can never rid the mouth of bacteria altogether, but good oral hygiene can limit the quantities of bacteria present.”

 is a serious problem in the United States. Each year almost one million Americans contract the illness and 50,000 are killed by it. Most of the people affected by pneumonia are elderly, or suffer from autoimmune or lung diseases, but the illness can affect anyone. 

Even the rich and famous aren't safe from it

, and found that 441 of 26,246 people in the database, 1.68 percent, had bacterial pneumonia, and that those who never had dental checkups had an 86 percent increased risk of pneumonia compared to those who had twice-yearly appointments.

	The problem is due to the high concentration of bacteria in the mouth. Bacteria can be inhaled or aspirated into the lungs and cause pneumonia. Common bacterial culprits are treptococcus, haemophilus, staphylococcus, and anaerobic bacteria. Routine dental visits may reduce the amount of bacteria that can be aspirated, says Dr. Doll.

	“Our study provides further evidence that oral health is linked to overall health, and suggests that it’s important to incorporate dental care into routine preventive healthcare,” says Dr. Doll.

This isn’t the first time we’ve looked at the link between dental hygiene and deadly illnesses

. Dental care goes beyond the mouth-an unhealthy mouth means an unhealthy body!

Dental cleanings do more than just keep teeth and gums healthy, they can even prevent deadly diseases.

New study finds that dental visits can reduce the risk for pneumonia

	With the complications of balancing new patients, changing regulations and intricate financial information with the need for streamlined efficiency, it’s no wonder that so many practices rely heavily on their practice management software. There’s no doubt that this product is essential to the modern dental practice. 

	However, not every practice knows what’s out there for them. We at Dental Products Report wanted to take a look at the latest and best in the practice management market to help practices of all sizes make the right choice for their software. 

Many practices are afraid of changing or upgrading software because they believe that it will be too big of a project, too expensive or that it might be too complicated. But today’s 

 is easier to use and more streamlined than ever. Best of all, you can find software that meets the specific needs of your practice, allowing you to save money and be as efficient as possible.

Related article: 25 ways practice management software can save you money

	So whether you’re looking for software options for your new practice, or are just looking to make an upgrade, make 2017 the year you finally fall in love with your practice management software. We’re here to help by bringing you everything you need to know about this exciting industry. 

	Up next: Some of the best product managment softwares systems available

	In the dental software business for over 20 years. ACE-Dental will reportedly save you thousands in up-front costs and annual fees. ACE is said to have a familiar, easy user interface that does not require costly training. Built-in features are said to make your office so efficient that your staff will have more time to focus on what really affects your practice most: making money. Very few third-party connections are required for ACE. Features include: built-in eligibility, online patient forms, reputation management, e-reminders-which include email, text and phone-and simple customizable reports. 

	ADSTRA offers both cloud-based and on-premise dental software solutions that provide dental professionals with paperless patient management, appointments, charting, imaging and communications. Dentists and office managers can recognize the value of the all-inclusive maintenance service that covers software installation, unlimited interactive training, telephone and remote support and all software updates. ADSTRA has been used since 1994 in thousands of private dental practices, clinics and educational institutions, as well as government agencies.

	CS SoftDent Cloud & CS PracticeWorks Cloud

 Cloud reportedly allows more time to focus on your patients and practice and less time worrying about IT infrastructure and software upgrades. Your concerns for data security and storage are also said to be a thing of the past, thanks to SoftDent Cloud’s secure, offsite and HIPAA-compliant storage. The centralized platform lets you access the same file system and database, regardless of log-in location-ideal for multi-office practices. That means your data, applications and 2D images are available at any time. No matter where your log-in location is, your user experience reportedly remains the same.

 Cloud reportedly gives you all the great features and functionality of its predecessor and takes away one of the biggest hassles you face when running a practice: the complexity of maintaining a computing infrastructure. With CS PracticeWorks Cloud, you can access all of your data, applications and 2D images in real time from any web-connected location. You can also access the actual images-rather than compressed files-for enhanced viewing and diagnoses. Enjoy financial predictability with monthly subscription fees and the ability to add users, with no need to purchase additional software. Plus, you’re always using the latest software version.

	Curve Dental provides a new solution to managing your practice. The cloud-based software is said to sport a clean look and a refreshing amount of lifestyle flexibility. Curve Dental leads the profession with eight years of cloud development experience, delivering a comprehensive solution that includes: native digital imaging features, charting capabilities, powerful scheduling tools, billing controls and more. Customers are said to enjoy continuous, no-hassle upgrades, worry-free and secure data backup, and access-from-anywhere convenience.

	DentiMax integrates with digital X-rays, allowing you to easily view X-rays and treatment plans from the same screen. The software also includes integrated patient texting to remind patients of their next appointments, a cloud kiosk where patients can enter their information online before they come into the office and a clinical note entry screen. DentiMax software flows just like your office. From creating appointments with the easy-to-use scheduler, to electronically prescribing medication, to taking X-rays to treatment planning, DentiMax mirrors your practice’s actual workflow. Additionally, DentiMax offers online training, as well as a complete two-day in-office training package. 

	Dentrix Enterprise from Henry Schein is dental software that allows multi-location practices to centralize all provider and patient data. This is said to enable efficient business operations and set the stage for growth and improved profitability. By streamlining organizational, administrative and financial aspects of the practice, managers can reportedly improve economies of scale and maintain consistency. Dentrix Enterprise includes award-winning clinical tools and integration with leading dental equipment to enable high quality patient care. 

	MacPractice DDS is practice management and clinical software native to Mac OS and iOS with features including: a modern interface for Mac-native digital imaging and next-generation charting, integrated secure messaging, network fax, iOS native apps for iPad, patient communications and reputation marketing “built inside.” MacPractice has built in AES data encryption qualifying MacPractice users for HIPAA’s Safe Harbor in the event of a breach. In addition, MacPractice users are reportedly safe from the ransomware, internet outages and brownouts which security experts predict will explode in 2017.

	Open Dental practice management software is reportedly a great fit for many types of practices: from the single practice to Enterprise Dental Service Organizations, from start-up general dentistry to established multi-faceted practices. Open Dental prioritizes interoperability, and provides no-cost bridges to third party software (imaging, patient communication, reporting, etc.). The software provides an easy-to-use interface for both providers and office staff. Each clinic, even in a multi-group practice, can set up appointment views customized to specific needs. Additional e-services provide automation and online accessibility, which streamline processes previously performed manually. 

We took a look at some of the leading practice management software solutions.

Managing your practice digitally: A practice management software product roundup

	Infection is often cited as the main reason that most implants fail. If the risk of infection could be reduced, or even removed altogether, implant success would be much more likely.

	To accomplish this, a team of researchers at the 

Control of the degradation of silica sol-gel hybrid coatings for metal implants prepared by the triple combination of alkoxysilanes

	The coatings are not only able to prevent bacterial infection from occurring, but can also eliminate infection if it does occur. The coatings also have osseointegrating properties, which give greater strength to the implant.

	Beatriz Palla, a researcher in the Biomaterials Group of the UPV/EHU's Department of Polymer Science and Technology, explains that finding a surface capable of preventing bacterial growth "is a subject of undoubted interest, borne out by the huge number of publications that have been developed in this field," adding that “about 10 percent of implants have to be removed due to osseointegration problems or to the onset of infections.”

Read more: New study finds troubling rates of dental implant compllications

	The difficulty of producing a material capable of combatting those risks is mainly due to the resilience of bacteria. As bacteria become more and more resitant to antibacterial products, it becomes increasingly difficult to find a material capable of defeating them. It is also important to note the difficultly of trying to provide a coating for titanium implants.

	Says Palla, “We had already obtained coatings that facilitate the generating of bone around the implant and thus facilitate anchoring to the bone. In a bid to go a step further, we looked at how to turn these coatings into bactericides."

	To accomplish this, the team turned to sol-gel synthesis. Sol-gel synthesis relies on the preparation of a precursor solution, sol, that forms a gel. This gel can then be used to coat the surface of the titanium screw. The screw undergoes a heat treatment, which bonds the gel to the implanting screw. "We used silica as the precursor, because in many studies this compound has been shown to be osteoinductive, so it facilitates one of the objectives we wanted to achieve. What is more, to provide the materials with antibacterial characteristics, we added various antibacterial agents" says Palla.

	Three prototypes for the coating were developed in the study. Each had a different method of dealing with 

-either prophylactically by preventing the bacteria from becoming adhered initially and the subsequent infection or by eliminating it once it has developed-before a solid method was discovered.

	The coating chosen "is designed to be used 

at the dentist's surgery itself, on the infected screw without any need to extract the implant from the patient. This new material is in the process of being patented and remains a trade secret," says Palla.

Related article: Common oral bacteria could treat troublesome illness

	Palla believes that “it is possible to confirm that coatings with an antibacterial capability and which do not affect the proper integration of the implant into the jawbone have been developed." However, she does admit that the design is far from being market ready. "Apart from all the trials that remain to be carried out, it would also be advisable to pursue the research a little further to optimize the results more."

A team of researchers out of UPV/EHU-University of Basque Country have developed a coating for implants that could help stop infections.

New coating could make dental implants better than ever

	Scientists at King’s College London have discovered a method for healing tooth pulp naturally. Normally, a tooth produces a thin band of dentine to cover the pulp when a tooth is damaged in some way. But this dentine is not always enough to really protect the pulp. For larger holes, such as caries, the dentine is not enough to fully heal the wound.

	To make up for this, dentists use synthetic cements and fillings to treat these larger holes. However, while these do fill the hole, they fail to restore the normal mineral level of the tooth because they do not disintegrate.

Related: New dental fillings could actually REPAIR tooth decay

 began studying the effects of stem cells, specifically how to renew in order to facilitate dentine production, as reported in 

Promotion of natural tooth repair by small molecule GSK3 antagonists

, they found that a drug currently in clinical trials to treat neurological disorders like Alzheimer’s disease, 

, was effective in stimulating stem cells in the pulp to create dentine.

 and then applied to the tooth. As the sponge degraded, dentine replaced it. This led to natural, complete repair and protection of the tooth. The researchers hope "this simple, rapid natural tooth repair process could potentially provide a new approach to clinical tooth restoration."

	The potential benefits of this treatment method are enormous. Dentists would no longer have to rely on synthetic materials, instead allowing natural dentine to treat a large caries. Gone would be the need to drill a larger hole to fill, meaning the tooth could be healthier and more intact after treatment. Perhaps best of all, if fillings and cements could be removed, there would be a decreased chance of infection.

Related: Preventing cavities may soon be as simple as popping a pill

	Scientists hope to be able to put this method into clinical trials soon. Because Tideglusib is already in clinical trials and collagen sponges are commercially available, scientists hope the process could be relatively quick.

	Lead author of the study, Professor Paul Sharpe from King's College London says: "The simplicity of our approach makes it ideal as a clinical dental product for the natural treatment of large cavities, by providing both pulp protection and restoring dentine.

	"In addition, using a drug that has already been tested in clinical trials for Alzheimer's disease provides a real opportunity to get this dental treatment quickly into clinics."

A team of researchers at King’s College London have found evidence that tooth pulp can be naturally healed with the help of an Alzheimer’s drug.

Could this drug mean the end of dental fillings?

	The FDA ban on powder for gloves is now in effect. The final ruling on the ban was issued on December 16, 2016 and was due to take effect on January 18, 2017.

	The ban includes powdered surgeon's gloves, powdered patient examination gloves and absorbable powder for lubricating a surgeon's glove.

 that these products “present an unreasonable and substantial risk of illness or injury and that the risk cannot be corrected or eliminated by labeling or a change in labeling.” 

Related article: The top 10 dental discoveries of 2016

	A long review concucted by the FDA found multiple health risks associated with the use of powdered gloves. These include “health care worker and patient sensitization to natural rubber latex (NRL) allergens, surgical complications related to peritoneal adhesions and other adverse health events not necessarily related to surgery, such as inflammatory responses to glove powder.”

	More specifically, the risks included “severe airway inflammation, hypersensitivity reactions, allergic reactions (including asthma), allergic rhinitis, conjunctivitis, dyspnea, as well as granuloma and adhesion formation when exposed to internal tissue.”

Related: The hidden danger of the gray market

	It is important to note that the ban does not include a ban on powder used in the manufacturing process of powder-free gloves. Powder-free gloves are to have, according to FDA guidelines, no more than 2 milligrams of residual powder and debris per glove.

	When studied, it was found that benefits of powdered gloves were few-it was easier to take them on and off, they decreased tackiness and added a small amount of comfort-and the benefits far outweighed the possible costs. This is especially true because there are already many alternatives to powdered gloves on the market.

	The FDA believes that this ban will have a net positive impact. More and more manufacturers were switching to powder-free gloves before the ban went into effect, meaning there will be no large or long-term economic consequences. They believe the rule will be overwhelmingly positive, with estimates of a net gain between $26.8 million and $31.8 million annually.

, having only banned one other device in the past-prosthetic hair fibers in 1983.

The FDAFDA ban on powdered examination gloves is now in effect.

FDA ban on powdered examination gloves now in effect

	Scuba diving can have a direct impact on the amount of dental symptoms a person may experience.

, a whopping 41 percent of divers experience dental symptoms while in the water. This is due to the constant jaw clenching involved, along with the frequent and rapid changes in atmosphere. The symptoms experienced could be anything from tooth, jaw and gum pain to loosened crowns and broken dental fillings.

	The study, "Prevalence of dental problems in recreational SCUBA divers" appeared in the November 2016 issue of the 

 The study recommends that recreational divers talk to their dentist before diving if they recently had dental work done.

	Of the 41 participants who reported dental symptoms, 42 percent experienced barodontalgia, 24 percent reported pain from holding the air regulator in their mouths too tightly and 22 percent reported jaw pain. Another five percent experienced loosened crowns during the dive, and one person even reported a broken dental filling.

	"Divers are required to meet a standard of medical fitness before certification, but there are no dental health prerequisites," says the lead author Vinisha Ranna, BDS. She is a student in the UB School of Dental Medicine, and is also a certified stress and rescue scuba diver.

	"Considering the air supply regulator is held in the mouth, any disorder in the oral cavity can potentially increase the diver's risk of injury. A dentist can look and see if diving is affecting a patient's oral health."

	The research was inspired by Ranna’s first experience scuba diving in 2013. She experienced barodontalgia and was inspired to look into the problem. 

	There are few published studies regarding recreational divers, says Ranna, because they tend to focus on military divers. She conducted her own study so she could learn more about the problem. She created an online survey that she gave out to 100 certified recreational divers. Those who were under 18, ill or taking decongestant medication were excluded.

	“The potential for damage is high during scuba diving,” says Ranna. “The dry air and awkward position of the jaw while clenching down on the regulator is an interesting mix. An unhealthy tooth underwater would be much more obvious than on the surface. One hundred feet underwater is the last place you want to be with a fractured tooth.”

	Ranna says that she hopes to see oral health requirements taken into consideration for scuba certification. She is conducting a new study with over 1,000 participants to glean even more data.

	Additional investigators on the study include Hans Malmstrom, DDS, professor; Sangeeta Gajendra, DDS, associate professor; Changyong Feng, PhD, associate professor; and Michael Yunker, DDS, assistant professor, all of the University of Rochester School of Medicine and Dentistry.

	Ranna earned her bachelor of dental surgery from the 

, Mumbai. Ranna is earning her DDS at the UB School of Dental Medicine through the International Dentist Program, a two-year program for internationally-trained dentists who seek to practice in the U.S.

We take a look at a University of Buffalo study on the effects of scuba diving on oral health.