Nikhilesh De

Using ink from cuddle fish as a contrast agent, researchers were able to highlight inflamed tissue.

Checking patients’ gums for damage can be a traumatic or painful experience for someone who has inflamed or otherwise damaged periodontal tissue. A new study claims it found a way to relieve that pressure by using a new type of ultrasound device.

 is the practice of checking on patients’ gums by pressing against the tissue with a small metal rod. Generally, the probe does not damage healthy gums, but if a patient has inflamed tissue, the probe could cause bleeding or actually poke a hole into the gum.

While this method can be painful, it is still the primary way dentists test periodontal tissue for issues. A team of researchers at the University of California-San Diego and UC-Irvine may have found a less damaging method of checking structural integrity and finding issues.

, the team outlines a new method using photoacoustic imaging and the results of their initial testing.

 is the method of using brief laser pulses to light up a tissue sample. The tissues heat up, and are then checked with ultrasonic-frequency sound waves. The result allows the doctor to clearly find damage in tissue structures or compare them to normal samples.

The University of California team tested this method on 39 teeth acquired from pigs, inducing excess damage in 12 of them. Cuttlefish ink was used to highlight pockets and parts of the tissue that were undamaged or inflamed, acting as a contrast agent.

The same teeth were also checked with traditional periodontal probes, according to the study.

The study noted that “there were statistically significant differences between the [two] measurement approaches for” the cheek, tongue, and side of the mouth, but not the middle of the mouth area.

In three out of four areas, the probe and the imaging device found different results from each other.

The imaging technology was better able to look at the tissue than the probe was, covering the entire object being studied. The probe, in contrast, can only be used on certain parts of the area.

The nature of photoacoustic imaging also means it was more precise than the probe could be.

The results indicated that the bias values were less than 25 mm, which indicates a low amount of bias. In other words, the results are expected to be accurate and not just the result of hopeful thinking on the part of the study’s authors.

There was also a low amount of variation between five replicated tests.

In essence, photoacoustic imaging is a potentially less invasive, more accurate method of checking gum tissue for damage or disease. While more work must be done to confirm these results, including testing in humans, the initial results are promising.

“This report is the first to use photoacoustic imaging for probing depth measurements with potential implications to the dental field, including tools for automated dental examinations or noninvasive examinations,” the authors of the study said.

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Technology is quickly transforming dentistry. From digital record-keeping to machines that seem straight out of a SciFi feature, the 21st century has gifted the medical industry some amazing devices. Dentists are especially proactive about adopting new technology in their practices, so DMD is bringing you a weekly spotlight on some of the best products on the market. Continue below to read about this week's focus, photoacoustic imaging.

Tech Tuesday: Photoacoustic Imaging May Replace the Probe

Virtual reality helps compensate for the high student to faculty ratio in dental schools. 

The demand for well-trained dentists continues to increase, 

particularly in remote areas with underserved communities

. Training future practitioners can potentially become easier with the rise of virtual technology through new education tools.

Virtual reality can help assist new doctors become more familiarized not only with the human body, but also with practicing treating patients without the risk of harming an actual person, 

according to the University of California — San Francisco

Dentists who learn using virtual reality can become intimately familiar with the different parts of the human mouth, learning where every bit of the interior should be and what it should look like without having to inspect an actual patient’s mouth.

This makes it easier to recognize issues at first glance when they are actually practicing on patients or working in their own offices.

Virtual reality also solves another issue, 

one pointed out by Doctors Roy George, Elby Roy, and Mahmoud Bakr

: There is a lack of qualified and experienced faculty members able to instruct the next generation of dentists.

A single instructor can only teach so many students, and there are not enough instructors for the number of students in the world, according to the study from George et. al.

“With increasing demands in clinical training but the lack of experienced faculty, the cost factor and changing trends of teaching and assessment, there is a need for universities to turn to technology based teaching and learning software to enhance students’ learning,” the authors said.

Practicing in virtual reality also makes it easier for students and instructors to review performance by recording student performance. This allows instructors to more easily discover mistakes or potential issues, again without risk to a living patient.

“The use of virtual reality devices for dental education is visioned [sic] to allow the instructor to better engage students and build on their own knowledge. The ability of these simulators to store and replay students’ work further allows self-learning and assessment,” the study says.

George and his fellow authors did see some issues with virtual reality training in its present state, at least for dentists.

There is no standardized curriculum between the different types of simulators. What one student learns may not be the same as what another student learns, and how they perform subject to interpretation.

To counter that, the authors proposed creating a standard that all of the different simulators would abide by.

“Development of a validated single scoring system to the test the improvement in skills achieved across the various available simulators could help assess benefits of each simulator within the pre-clinical dental education framework,” the authors said.

Virtual reality tools also do not provide a perfect interface for instruction. 

 pointed out the lack of haptic feedback — while students can see what they are doing, they cannot necessarily feel what they would ordinarily feel while treating a patient.

There is really no way to know how something feels physically using only virtual education, so incorporating actual hands-on training is important, according to the study.

Overall, virtual reality can be a powerful tool for students hoping to become dentists, but needs to be refined before it can take its place as a primary learning method. Using virtual reality in conjunction with physical learning methods is likely the best way to help future doctors learn most effectively.

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Virtual reality in dentistry is usually discussed in the context of enhancing the patient experience. But in dental schools, virtual reality is slowly making its way into the classroom. Continue below to learn about the pros and cons of virtual reality technology for clinical training purposes. 

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LANAP is a widely studied and FDA-approved treatment alternative to oral surgery.

A dental laser is simplifying more than a dozen procedures dentists regularly perform on patients, even allowing for true regeneration that includes new bone formation.

The Periolase MVP-7 laser, developed by Dr. Robert Gregg of 

, lets dentists pick one of up to 20 pre-programmed procedures, greatly simplifying the steps needed to treat a patient. The 6-watt laser comes with seven different pulse lengths, allowing for fine control over how much power is being used at any given time.

Dr. Gregg said he developed the Periolase MVP-7 to aid doctors with their procedures. Specifically, his laser can replace a host of other equipment that certain companies generate.

“Implants are complex. There's a lot to keep up with in implants,” Gregg said. “They're very productive for the practice, but not very profitable because there's so much equipment that you have to buy.”

The Periolase MVP-7 ensures patient safety through a variety of methods, ranging from effective training for the tool to a feature that keeps dentists updated on how well a procedure is going.

Many dentists avoid purchasing the equipment to carry out certain procedures due to cost. Using a small, portable device instead allows them the flexibility to work with any patient in any room without compromising patient safety or having to purchase a new set of equipment every few years, Gregg said.

Acquiring a single mobile MVP-7 would simplify many office’s workflow thanks to the device’s ability to be easily wheeled from one room to another.

Millennium Dental, unlike other laser companies, requires physicians looking to implement the MVP-7 to attend hands-on clinical training for the device. As a general practitioner, Gregg puts patient safety at the forefront.

“The (General Physicians) are easier to train because they don’t have bad habits, and we’re not doing anything complicated,” he said.

Training is an essential cornerstone to the Periolase MVP-7 project.

“Most companies that get involved with lasers like to sell a box and not get involved with the clinical training, because they don't know how,” Gregg said. “We started our company to provide the training first, the laser second. You get three days of training, and if you pass, we ship you the laser the following week.”

Dentists must pass the training in order to receive the laser, Gregg said. Those who either do not pass or do not complete the training will receive a laser.

“Training is the hardest part of what we do,” he said. “But it's what is essential to getting the good results and keeping the patient safe. These other companies, they don't do training, they don't do research. They tell the doctors to go off and stick the lasers in the pocket.”

The other key area which aids patients’ safety is that by easing the barrier to entry for dentists, patients no longer need to be referred to a specialist to carry out a relatively simple procedure, Gregg said.

Two out of every three patients referred to a specialist does not go see the specialist, Gregg said. By providing a tool that any doctor can use, it will be easier for patients to receive the treatment they actually need.

“We are extremely effective because the laser is what's doing it, and when you get light energy around the pathologic protein it just dissolves or vaporizes. That's why we are more effective,” Gregg said.

When Dr. Robert Gregg developed the LANAP protocol, he opened a door to less painful and simplified alternatives to oral surgery. This tech Tuesday, DMD explores the options provided by Gregg's Periolase MVP-7 laser, the FDA-cleared LANAP derivative getting patients out of the periodontal penalty box. 

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Technology doesn't catch up with you — your practice catches up with technology. 

Improving efficiency should be a top priority for any dentist, whether they run a small private practice or are part of a large chain of facilities.

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New digital communication technologies, and new uses for existing technologies, are helping improve workflows and streamline diagnostic and treatment processes for dentists and patients, ultimately saving both time and money.

Improving workflow within the office is key to a better work environment. Products like 

 help dentists integrate the information from various clinical tools into one digital package, making it easy for them to see treatment plans, the results of prior appointments, X-rays, and other data about a patient.

These tools, and others like them, allow patients to complete their mandatory paperwork before ever stepping foot into your office, ensuring they are ready to be seen immediately, even on a first appointment.

Paperwork is one of the most time-consuming aspects of dentistry. Eliminating some of these responsibilities can help ensure your office has more time to spend directly treating patients, rather than ensuring every form a patient should have is filed.

 are two software packages that cut down on paperwork through automation. Rather than fill out forms with a pen and making copies, a hygienist or assistant only must type information in once.

More importantly, these software packages make it easy to access any information with a quick search or a few taps of a button. Dentists can make notes or jot down ideas on a tablet and know that they will see the same information when they later sit down at a computer, instead of having to manually copy over data after writing it down on a piece of paper.

Ace Dental also helps dentists coordinate with laboratories to quickly learn the results of tests without waiting for a call or a letter delivery. Similar programs also communicate lab results instantaneously.

 is another such program that integrates the clinical, external, and documentation aspects of an office together. Dentists can store all their data in one easily accessible space, communicate with labs, and check in with their proposed treatment plans without needing to grab a different file for each patient.

While streamlining an office is important, improving the clinical aspect of a dentist’s job is another role digital technology is filling. New and more accurate diagnostic tools make it easier for a dentist to ensure their patients are receiving the best possible care.

, help a dentist visualize not only a problem within their patient’s mouth, but also what possible treatments would look like.

 make it easier for dentists to diagnose patients by more clearly identifying the issue.

While simple imaging technologies help with diagnosing a patient, more advanced products combine diagnoses with automated manufacturing to help with treatments as well. CAD/CAM products like 

 streamline the entire clinical aspect, reducing the time spent treating a single patient while simultaneously ensuring that the treatment is as efficient as possible.

Using a combination of HIPAA-compliant imaging and management technologies can help every office achieve a new level of efficiency, which makes both dentists’ and patients’ lives easier. Taking full advantage of already existing products makes this level of efficiency easy to achieve — the hard part has already been taken care of.

Streamlining your practice doesn't happen magically, it takes time, research, and hard work to implement the new dental technologies available and transition your processes. DMD identified the best in digital products to help simplify everything from paperwork to clinical documentation. Continue below to find out more. 

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Opioids are commonly prescribed for dental pain despite the fact that they are often ineffective.

Root canals, cavity fillings, wisdom teeth removals and similar procedures can often result in days or weeks of residual pain for patients.

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While opioid medication can help, they can easily be abused or otherwise cause further harm to a patient. Using different medications and non-medicinal resources to reduce a patient’s discomfort are key in assisting them through their recovery without risking the side effects associated with opiates.

, an assistant professor of clinical education at the University of North Carolina-Eshelman School of Pharmacy, recommends using multiple methods to help a patient dealing with acute or chronic pain.

, she discusses using a multimodal analgesic approach to helping patients manage both 

, which is caused by damage to the body or some form of external stimulus, and 

According to the National Institutes of Health, patients can suffer from both nociceptive and neuropathic pain after dental treatment.

 in dental patients occurs as a result of some form of underlying damage to a tooth, and may lead to a procedure. If it occurs after a procedure, stop-gap measures should be implemented until the area can fully heal.

Professor McKnight explains that using non-opioid medications can help a patient manage their pain, and recent research developments offer multiple options for patients. These can range from over-the-counter pills with acetaminophen to intravenously delivered ibuprofen. The latter in particular has been shown to be effective in post-operative patients, though oral medications should be prescribed where possible instead.

Non-opiate oral medications used in combination with each other are the most effective, McKnight says.

, which can often be chronic, can occur after root canals and other procedures. The chief issue with neuropathic pain is diagnosing it — many times, there is no clear cause for the discomfort. As a result, it can be misdiagnosed, or an improper treatment may be administered.

Treating neuropathic pain with non-opiate medications is also possible, McKnight says.

 says diagnosing a patient’s pain is a crucial aspect of treating them properly. In a 

, Minnesota Head and Neck Pain Clinic Director of Medical Services 

 explains how doctors can accidentally misdiagnose a patient, as well as how to avoid doing so.

Dr. Belgrade also recommends using less addictive medications in combination with each other to help patients manage their pain and using non-medicinal treatments when possible.

Alternatively, numbing the affected area can help patients manage pain without requiring them to take oral medications. An article published in the 

Journal of the American Dental Association

 found that over-the-counter desensitizing toothpastes are recommended to about half of all patients. Using a fluoride varnish, another non-medicinal treatment, was also used for about a third of the patients in the study.

A fluoride varnish is placed onto the tooth directly by a dentist or other professional and protects it as it heals. Desensitizing toothpaste similarly helps numb problem areas, limiting the discomfort a patient feels. The study found that using both methods at the same time helped the most, echoing McKnight’s recommendation of a multimodal approach.

, the Chair of Dental Specialties with the Mayo Clinic, agrees, 

 combined with covering up a sensitive or damaged part of a tooth using a varnish or other material.

Explaining proper dental care methods like when to brush and floss can also help improve a patient’s quality of life. In Dr. Carr’s example, he recommends avoiding brushing after eating or drinking anything acidic due to the effect acidic substances have on teeth. Brushing can erode the tooth’s enamel more quickly, he says.

Technology is quickly transforming dentistry. From digital record-keeping to machines that seem straight out of a SciFi feature, the 21st century has gifted the medical industry some amazing devices. Dentists are especially proactive about adopting new technology in their practices, so DMD is bringing you a weekly spotlight on some of the best products and research on the market. Continue below to read about this week's focus, alternative pain management. 