Sarah Handzel, BSN, RN

The Kentucky Department for Public Health has awarded $2 million to the 

University of Louisville School of Dentistry

 in an effort to better meet the needs of underserved HIV/AIDS patients in the state.

As part of the Ryan White HIV/AIDS Treatment Extension Act of 2009, the state’s 

 program provides grants to states and United States territories in order to improve the quality, availability, and organization of HIV healthcare and support services. Part B explicitly funds core medical services and support services, including outpatient and ambulatory healthcare services. All support services funded must be linked to medical outcomes, and grant recipients are required to spend at least 75% of their award on core medical services, with no more than 25% being spend on support services.

Only one of 12 federally funded oral health programs in the United States, the university’s Community Based Dental Partnership Program (CBDPP) is the only one of its kind in the state of Kentucky. The grant has been awarded for 2016—2018. The program first received federal funding in 2014 as part of a six-month pilot program to expand the reach of oral health services for HIV/AIDS patients. Part of the initial goal was also to create a statewide network for improving access to comprehensive oral healthcare and improved outcomes for the target patient population. 

The new two-year grant was based in part on the success of that initial pilot program. The goal of the program is now to provide increased access to dental care for patients living with HIV/AIDS, while also providing continuing education and clinical training for dental care providers. 

The program director for CBDPP, Catherine Binkley, DDS, MSPH, PhD, said that “patients who have issues with their teeth begin to limit the types of food they eat. This can result in malnourishment, which in turn affects the absorption of HIV medications. The end effect is a more compromised immune system. Restoring teeth for patients in all these situations impacts their lives in major ways.”

People with HIV/AIDS living in Kentucky commonly have unmet dental needs, including fillings, crowns, bridges, and dentures. In 2015, University of Louisville dental care providers performed over 6,000 procedures for nearly 600 HIV/AIDS patients.

Articles

The $2 million in funding is designed for the unmet oral health needs of patients with HIV/AIDS.

University of Louisville Receives Funding to Meet Oral Health Needs of HIV/AIDS Patients

An Orange County (OC) dental office has been linked to an outbreak of 

, a bacterium that is distantly related to other types of bacteria that cause tuberculosis and leprosy. 

Orange County Health Care Agency (OCHCA) says

 22 patients are showing signs of infection after undergoing the same dental procedure at a Children’s Dental Group practice in Anaheim, CA. Three of the cases are confirmed infections; the other 19 are listed as “probable.” Six of the children were in the hospital as of Tuesday.

The OCHCA says the infections came after the children underwent pulpotomy procedures to treat infected teeth. 

The agency is currently awaiting preliminary test results on the suspected cases, according to multiple published reports. The OCHCA says the patients who are believed to have been infected had dental procedures between April and July of this year, and the symptoms began 15 to 85 days after the procedures.

 bacterium is commonly found in dust, water, and soil. It is known to contaminate medical devices and can cause dental abscesses and other infections of the skin, soft oral tissue, and bone. It is treated with antibiotics over a long period of time.

The OCHCA has partnered with the California Department of Health, the Centers for Disease Control and Prevention (CDC), and the Dental Board of California to investigate this issue. 

 this week that mycobacterium was found in the practice’s water system, which has since been shut off. The agency has expressed concern that, because of the bacterium’s incubation period and the recent discontinuation of the procedure at the clinic, more cases could be identified.

In response to the infection investigation, the Children’s Dental Group 

, in which the dental group says it follows “industry standards for care and uses modern equipment and instruments.” The group also said that, “

to protect the health and safety of our patients, upon seeing this we began a review and testing of our systems, equipment, water, and other elements in the office.”

Operators at the Children’s Dental Group practice have urged all patients that had the procedure during a specific time period to visit the office for a dental exam and X-rays.

Public health authorities now say as many as 22 children might have have contracted an infection after undergoing procedures earlier this year at a California dental clinic.

Infection Outbreak from California Dental Clinic Grows to 22 Cases

The American Dental Association (ADA) is scheduled to have its annual meeting in late October, but before that meeting occurs, a prominent dental researcher is planning to hold a 

 to address provider concerns about sedation dentistry. The teleconference will be hosted by Raymond A. Dionne, DDS, PhD, a dental educator and researcher who has published over 100 scientific manuscripts related to dental pain and pain control. 

The dental Town Hall is scheduled for Oct. 10 at 8 pm Eastern. Dentists and their team members from anywhere in the United States are encouraged to attend the meeting, which will be 45 minutes long. Time will be allotted for questions from participants. Those who register but are unable to attend the live conference will have access to an audio replay of the entire teleconference after the meeting is held.

The meeting comes ahead of the ADA’s vote on the controversial 

, which will occur at the annual ADA meeting. This resolution could change practice guidelines for use of sedation and general anesthesia by dentists, as well as the guidelines for teaching pain control and sedation to dentists and dental students.

Compendium of Continuing Education in Dentistry

, the passage of Resolution 37 "may have far-reaching and unintended consequences." The new resolution could impact dentists, future dentists, and patients by limiting the ability of dental practitioners to administer sedation or general anesthesia. This could, in turn, discourage and prevent patients from seeking dental care for fear of pain during the treatment they would receive. Dionne noted in the article that, since the year 2000, more than 22,000 dentists have received training on providing oral conscious sedation to patients in outpatient clinical settings. 

Dionne has argued that "if implemented, the proposed revisions of the [ADA] guidelines will not appreciably improve the safety of enteral sedation but may eventually limit the ability of general dentists to provide sedation services to patients who would otherwise avoid restorative and preventive dental procedures." 

The ADA says it is committed to basing practice and educational guidelines on current evidence-based research. During the Town Hall meeting, Dionne plans to educate ADA delegates and general members of ADA on why he believes Resolution 37 does not meet evidence-based dentistry. 

Registration is free and may be completed at:

https://docs.google.com/forms/d/e/1FAIpQLSdnrpBqoCWPZTC_7GALyCqX57WlcHSzMf2bin9zl5I4qDT6_Q/viewform

One of the hot topics at this year's American Dental Association meeting will be sedation dentistry. One prominent dental health expert is hoping to educate members on the issue ahead of the meeting.

Prominent Researcher Plans Pre-Convention Town Hall to Discuss Sedation Issues

A new nasal spray recently approved by the Food and Drug Administration (FDA) has proved to be safe and effective in a Phase 3 clinical trial led by a 

University of Pennsylvania School of Dental Medicine

 research team. The nasal spray is the first of its kind to be used in dentistry as an alternative to the injection of a numbing agent prior to procedures.

, has been in development for over 10 years. The spray combines tetracaine HCl, a local anesthetic, and oxymetazoline HCl, a nasal decongestant, in a single spray dose. It is intended for use as a topical anesthetic for restorative procedures on teeth 4-13 and A-J in adults and also in children who weigh 40 kg or more.

The research was conducted during the Phase 3 double-blind, randomized clinical trial with 150 adult participants, 100 of whom received the actual product instead of a placebo. Kovanaze was used as an anesthetic during single dental filling procedures involving the upper bicuspids, canines, or incisors. Each patient received one spray, waited four minutes, and then received a second spray. Ten minutes after receiving the second spray, test drilling was performed to determine whether the anesthetic was effective. If not, the patient received a third spray of the product. If, after three sprays, patients still experienced pain, an injection of a common local anesthetic was provided in order to complete the procedure.

In 88% of participating patients, pain was completely prevented by Kovanaze. This success rate is comparable to commonly used injectable anesthetic agents. Patients reported runny nose and nasal congestion as the most common side effects. No serious side effects were reported.

As a follow up to the trial, researchers plan to test whether Kovanaze could be used in more invasive dental procedures, like root canals or oral tissue biopsies. Further studies should also evaluate whether the product can be used in children weighing less than 40 kg.

Many individuals fear the pain that might come with certain dental treatments. As a result, they often delay or avoid treatment altogether. Researchers hope that Kovanaze could replace the need for injections of anesthetics, which are sometimes the most painful part of dental procedures. As Dr. Elliot Hersh, the trial’s lead author, noted, "there is really nothing else like this. It would certainly make for a more stress-free dental office visit for children as well as adults if we could replace some of these anesthetic injections with a simple spray.”

A successful Phase 3 trial suggests dentists may soon be able to use a nasal spray instead of a syringe when numbing patients for procedures.

New Nasal Spray Deemed Safe and Effective Anesthesia for Dental Procedures

It’s becoming a disturbingly common trend in dentistry: patients who take matters into their own hands and try their luck at do-it-yourself (DIY) dentistry. Just running a quick Google search brings up all sorts of options for home dentistry kits that promise to help patients take perfect teeth impressions to make their own full sets of dentures and other dental devices. There are online instruction manuals for everything from constructing and implanting fillings to tooth extraction. What patients don’t realize is the real danger they put themselves in by performing these dental procedures on themselves at home.

So why are patients taking matters into their own hands? One major reason is economics. Since the recession in 2008, many people seem to consider dentistry to be an “optional” part of their healthcare. A huge part of this problem, even today, is that people can’t afford to purchase dental insurance if they don’t have coverage offered by an employer. They also can’t afford to pay the out-of-pocket costs for dental treatment. According to the 

US Department of Health and Human Services

, about 108 million Americans have no dental insurance.

It’s not just money that’s a factor in people forgoing dental care. In today’s busy world, many people skip dental appointments simply because they don’t have the time. This is a problem that’s been noticed by Greg M. Vallecorsa, DDS, who thinks that “some patients seem to have a lot of other things going on in life and don’t feel that it’s important enough to get in to be seen.” He thinks patients might also put off visits to the dentist because they aren’t in pain or having any other noticeable symptoms of dental problems.  

One big area of DIY dentistry involves patients taking their own teeth impressions for the creation of custom dentures and other devices. But there’s not a whole lot of information available as to the actual quality of DIY tooth impressions. 

Consumers can order impression kits from several online companies

. They receive the impression material, plastic trays, and instructions. But even though this seems simple enough, experts say it’s dubious to claim that inexperienced consumers can create dental impressions matching the quality of a product produced by a professional who’s been through two or three years of orthodontic training. Some consumers have reported using impression kits only to have the finished product fit improperly. Other patients have used retainers made from impressions that did not extend to the second molars, resulting in super-erupted teeth.

Examples of DIY dentistry extend far beyond teeth impressions. It’s possible to purchase DIY filling kits on 

 that claim to supply the buyer with enough material for up to 15 tooth repairs. This is only supposed to be a temporary measure until a licensed dentist can see the patient. Many people choose to skip the dental appointment and live with temporary fillings as permanent solutions, often for months, and often by reapplying some of the mix to the temporary filling as needed.

But there’s a huge risk in using temporary fillings as a permanent treatment. Leaving these fillings in place can trap bacteria, resulting in infection and decay of the affected tooth and surrounding gums. In his private practice, Vallecorsa saw this first-hand with a new patient who’d filled her own cavities with what appeared to be a “temporary, putty-like material, clearly not done by another dentist. It looked like the temporary filling had been in place for a couple months, but it was hard to know the exact amount of time it was in place.” This filler was purchased from a local pharmacy, and the patient installed it herself in a few of her teeth. 

Upon removal of the temporary material, Vallecorsa saw the decay was a “lot worse than if she’d just come in and let us do it in the first place. (The patient) had just sealed in the decay, sealed in any sort of infection, which just made it worse when (she) did come to see us.” While the patient’s outcome was positive — she’s now doing well after other work was completed – Vallecorsa stressed the patient’s “cavities were to the point where…they were already wide open and she’d just kind of filled them herself. It creates more work for us when we have to go in. If she’d let it go for another few months, eventually she’d have symptoms on the tooth and we’d probably be doing more extensive treatment rather than just replacing and cleaning out and doing the filling.” 

Perhaps the most alarming trend in DIY dentistry is involves tooth extraction. This is a dangerous procedure when attempted at home — patients can break off part or most of their tooth, leaving the root behind and possibly exposing the nerve or causing severe infection. Another quick search online results in a 

complete set of instructions for tooth extraction

, written by an “old country doctor”. 

Another person recommends using a flathead screwdriver and a pair of pliers to remove a tooth

, even though he then discourages the original poster from attempting to remove a tooth using this method. 

As Morris N. Pool, DDS of the American Association of Orthodontists says

, “anytime a dental procedure is undertaken by an untrained individual there is a substantial risk for irreparable damage.” Dentists are in a unique position to education patients on the dangers of DIY dentistry when patients are seen for treatment. It’s hard to know what people are reading online, but having discussions about what people are reading can help influence patients toward more positive outcomes. As Vallecorsa advises patients, “(we) are getting much more questions, which is good. It generates good conversation. Bring your questions to us - you’re going to save yourself a lot (more trouble) than if you try to do something yourself at home and end up with a much bigger problem.”

As so-called "do-it-yourself" dentistry becomes popular online, dental experts warn the dangers far outweigh the potential cost savings.

Patients Get What They Pay for with Do-it-yourself Dentistry

The employment outlook for dentists is good: according to the 

United Stated Department of Labor Bureau of Labor Statistics

, the need for licensed dentists is expected to increase by a whopping 18% between now and 2024, with an expected 26,700 new dentists welcomed into the profession. What’s driving this need? While there are several factors affecting this growth, one of the biggest is the increase in global demand for cosmetic dentistry. 

Recent reports forecasting the growth of cosmetic dentistry show that the demand for cosmetic services is trending upward. A 

 conducted by Grand View Research, Inc. showed that the global cosmetic dentistry market is expected to reach $27.95 billion dollars by 2024. Another 

 forecast that the global oral hygiene market will grow at a compound annual growth rate of 4% through the year 2020. 

There are several factors driving the worldwide growth of cosmetic dentistry. These services are in high demand partially because consumers around the world have more disposable income to spend on their appearance. This is important: right here at home, the American Academy of Cosmetic Dentistry estimates that around 99% of people think that their smile is their most important social asset. 

The growth of wages, and therefore disposable income, in developing countries has helped to drive the demand for cosmetic dentistry internationally. In fact, dental tourism, similar to medical tourism, is becoming a popular option for patients who don’t mind traveling to save money in order to obtain cosmetic dental procedures, or who don’t have access to these services at home.

Some of the most frequent cosmetic procedures patients want are teeth whitening and correction of the alignment of teeth. From a cosmetic standpoint, many people already use over-the-counter products designed to whiten teeth by removing stains and treating discoloration, but many are beginning to recognize the need for professional teeth whitening by a licensed dentist. Consumers also care about the placement and function of their teeth, and many receive veneers, crowns, inlays, or onlays as part of the effort to improve their appearance and function. 

Even though the demand for cosmetic dentistry services is expected to increase over the next several years, there are some factors that could inhibit growth in this sector. Many insurance companies don’t reimburse for cosmetic procedures, and some procedures require expensive dental imaging that is also not covered by insurance plans. But increased marketing of products and services, through online and in person contact with patients and consumers, is helping to increased consumer awareness of all cosmetic dentistry has to offer. This could mean that the growth in this field is unaffected by insurance reimbursement factors as more people seek out treatment to improve their appearance. 

Cosmetic dentistry is one of the fastest-growing areas of the dental industry. Studies suggest it will continue to grow at a rapid pace.

Demand for Cosmetic Dentistry Expected to Increase in Coming Years

For decades, American dentists have been treating tooth decay with the implantation of dental fillings. Now, a Japanese method of treating tooth decay is gaining popularity in the United States as a possible alternative to the “drill and fill” method of treating dental caries.

This summer, at an International Association of Dental Research meeting, a new 

 was presented exploring the effectiveness of 

 (SDF) on stopping the advance of root caries in an elderly population of Japanese citizens. Participants in the study were split into two groups: one group that received treatment with a 38% SDF solution, and one control group that didn’t receive treatment with the solution. The solution was painted onto test group participants’ affected teeth annually, and the teeth were then inspected every six months over a total period of 18 months. 

SDF has been used as a treatment option for tooth decay in Japan for over 80 years, and the results of the study emphasized how effective a treatment this mixture can be. After 18 months, the teeth that received treatment with the SDF solution were analyzed. Researchers found that 75-87% of the study participants showed an arrest in the rate of decay on their affected teeth after annual application of SDF. 

The findings are particularly relevant based on new interest in SDF as a treatment method for cavities here in the US. Scientists have long known that silver has antimicrobial properties, and fluoride has been shown to prohibit tooth decay. SDF has also been shown to be an effective treatment for tooth pain.

The US Food and Drug Administration (FDA) approved SDF as a treatment for dental sensitivity in 2014, but recently some dentists have begun to use the solution as an off-label treatment for caries. Dentists simply brush the solution on the affected tooth to kill bacteria and stop the spread of the cavity. Using the solution is painless and requires no injection of local anesthetic, unlike the traditional method of treatment that includes local anesthetic injection, drilling the tooth, and filling with a predetermined material. 

There are a few downsides to using the solution. SDF is a relatively inexpensive treatment alternative compared to drilling and filling, but it’s not yet covered by all insurance plans. SDF also causes tooth discoloration. Application of the solution blackens the affected tooth at the treatment area. Also, some teeth have decay that extended far into the exterior of the tooth, making a traditional filling necessary. 

Scientists who worked for the original FDA approval of the product are now seeking FDA approval to use the solution as a treatment for dental caries, and clinical trials are underway to further study the solution’s effectiveness.

A Japanese tooth decay treatment that doesn't involve drills or anesthetic is becoming more popular in the US.

Japanese Tooth Decay Treatment Gaining Popularity as Alternative to 'Drill and Fill'

With Autumn’s arrival, some families want to squeeze in that last trip before the chill of Winter arrives. After all, the weather’s not as hot, the leaves are just beginning to turn — it’s the perfect time to get out of the office for a few days and enjoy yourself! But sometimes it’s impossible to bring the whole family – namely, your pets - on that last vacation. 

Our pets enrich our homes and lives, but unfortunately they’re not always welcome at the places we visit. So what if you can’t bring your pets on the trip you’ve got planned? There are plenty of options for the care of your furry friends — here’s what to look for so you can have peace of mind on your trip.

Sure, it’s the most obvious tip, but some people are still hesitant to ask their friends to pet-sit. If you have a friend you trust with your animal and your home, you can ask them to visit your home several times during the day, depending on the animal, to feed, exercise, and spend time with your furry friend. 

. Be sure to leave your friend with everything necessary for the proper care of your pet, like food, food dishes, leashes, and toys. Also, leave important information with your friend, like your veterinarian’s phone number, just in case something happens to your pet and they need medical care. If your pet is taking medications, be sure to discuss them with your friend prior to leaving, and leave the medications out in a safe place so your friend can easily find them.

Depending on how long you’re gone, it’s probably a good idea to discuss your pet’s behavior in certain circumstances, like thunderstorms, so no one come back to a house that’s been torn to shreds. You have to know your critter’s quirks and communicate them to your pet sitter. It’s also important to discuss health problems your pet might have and any special needs resulting from these problems.

Since your friend is doing you a huge favor by taking care of your pet when you’re away, it’s important to show gratitude and consideration toward them. After all, it might mean they’d be willing to watch your animal again in the future. Consider paying for your friend’s fuel if they’re driving far out of the way to your home, or bring back a small token of appreciation from your vacation. A little thank you goes a long way!

Sometimes, if you don’t have friends available, you might have to shell out some cash to hire a professional pet sitter. If you choose to go with this option, some preparation is key to ensuring a good experience. Make sure you take time to introduce your animal to the pet sitter. If the sitter will be caring for your pet at their home, it’s a good idea to take your pet to their house before leaving on vacation — that way, your pet is more familiar with their temporary surroundings and any other animals that might be present in the sitter’s home. 

Your sitter might watch your pet in your own home. This might be a better option, but introductions to unfamiliar people are still important. Ask your sitter to stop by your place to meet your pet shortly before you leave on your trip. 

Regardless of where your animal will be cared for, it’s important for you to assess compatibility between your pet and your sitter. Just like with people, animals don’t get along with everyone. If you suspect there might be a conflict, you’ll have time to find another sitter before leaving. 

If a friend can’t watch your pet, and no pet sitters are available, you might have to pay to board your pet at a reputable kennel. How much you’ll pay and what services you can expect will vary depending on the kennel, but regardless of where you choose to board, 

there are several things you should look for

 to make sure your pet has the best experience possible.

First, make sure the facility looks and smells clean. You want to make sure that the entire kennel, not just the inside, is clean and orderly. Ask to see the outside area where animals can play to make sure it’s clean. There should be good ventilation to prevent offensive odors, and the temperature inside should be adequate — not too hot, not too cold. The outside play area should be protected from the elements, and it should be secure so that your pet can’t escape if they’re exercising outside. 

Ask how frequently kennel areas are cleaned. You should also check to see if there are resting boards or other bedding provided to allow animals to rest off concrete floors. Make sure there is enough space for multiple animals to move around comfortably, and that there’s adequate space between food bowls and litter boxes. Ask how often pets are fed.

Responsible kennel owners and operators will require pets to be current on their vaccinations. This requirement helps protect your pet and the other animals at the facility from common communicable diseases, like canine kennel cough, that can be expensive and time consuming to treat. You should also ask if there are veterinary services at the facility, or what veterinary services are used if there are none present on site. 

Finally, make sure it’s OK to bring some of your pet’s favorite toys from home! They help comfort your furry friend while you’re gone, and help make the boarding experience a more positive one. You might come back to find your pet had as much fun on his “vacation” as you did!

Pets can be a great vacation companion. If your destination won't allow pets, though, follow these tips to ensure they're safe and healthy back home.

Can't Travel with Pets? Make Sure They're Well Cared for While You're Gone

US Centers for Disease Control and Prevention (CDC) last month

 awarded $3 million in aid to six state health departments as part of an effort to strengthen collaborative efforts between oral health initiatives and programs focused on several chronic diseases. 

The six states that will benefit from this award include Alaska, Colorado, Georgia, Maryland, Minnesota, and New York. Each state will receive $500,000 over a period of two years. The funds will be distributed in order to help each state’s oral health departments to develop and implement programs aimed at improving the oral health of state residents. The funds will also be used by state health departments to develop plans to help prevent and control several prevalent chronic diseases, such as diabetes and hypertension. 

Each state oral health department chosen to receive a portion of the award has already allocated the funds for the following projects.

In Alaska, the money will help train dental professionals and other providers to better educate and counsel pediatric patients and their caregivers in an effort to reduce the consumption of beverages containing high amounts of sugar. Instead, the program is focused on emphasizing the importance and increasing the consumption of water.

A plan is being developed in Colorado that will increase collaboration with oral health and primary healthcare providers. This plan will ensure a more comprehensive, patient-centered treatment approach to diabetes prevention and management in community health settings.

 toolkit for dental professionals to encourage providers to refer patients to the Georgia Tobacco Quit Line. Young women who are at high risk for tobacco use during pregnancy are specifically targeted with this initiative.

Maryland dental health professionals will be encouraged to provide blood pressure screenings during routine dental visits. They will also be encouraged to provide counseling to patients with previously undiagnosed hypertension, and will be given the tools to refer these patients to medical professionals for further evaluation and treatment.

In Minnesota, a program will be tested to increase patient access to dental and medical screenings for periodontal disease and hypertension. Increased screening will be achieved by increased referrals by both dental and medical professionals. Primary care providers will also have access to tools and information necessary to screen patients for periodontal disease.

New York state is planning to create and implement a healthy beverage media campaign. The campaign will target both African-American and Hispanic teenage boys in the western part of the state.

A new $3 million grant program aims to support programs that link oral health and the prevention of chronic diseases.

CDC Awards $3 Million for State Oral Health and Chronic Disease Programs

National Institute of Diabetes and Digestive and Kidney Diseases

, as many as one in 141 Americans currently lives with celiac disease. 

 is an autoimmune disorder wherein the small intestine is damaged by the consumption of gluten. When gluten, a protein found in wheat, rye, and barley, is eaten, it triggers the body’s immune response, which attacks the small intestine and damages the villi that help it absorb nutrients properly. 

Celiac disease is one of the most common gastrointestinal disorders in the world. Diagnosis can be difficult since there are many symptoms attributed to the condition, including but not limited to bloating, chronic diarrhea, constipation, gas, nausea, stomach pain, and vomiting. Additionally, there are a multitude of dental complications that patients with celiac might experience, but these symptoms are much less well known, even to dentists.

The exact cause of dental complications in celiac patients is unknown, but it’s thought that damage is caused by the heightened immune response in these patients. One of the biggest complications from celiac disease is dental enamel defects. Children as especially vulnerable to enamel defects, which could cause life-long oral health issues. Nicholas Calcaterra, DDS, explained that “if a child has celiac, and he or she consumes gluten in any substantial quantity as the teeth are developing, they can end up with a defect in the enamel as a result of gluten consumption. Post teeth formation, as with teenagers and adults, there can be other types of complications as well, although typically not as severe as the enamel defects that can occur.”

Most enamel defects resulting from celiac disease place patients at very high risk for decay or other issues. Discoloration typically occurs, with patients noticing white, yellow, or brown spots on the teeth. The enamel itself can be mottled and weak, sometimes exhibiting pitting, grooving, or lines across the teeth. 

 include delayed eruption of teeth, cheilosis, and atrophic glossitis. Many people also experience issues with frequent aphthous ulcers, otherwise known as cold sores. These sores can be especially painful, and sometimes require prescribed medication to relieve them. Another common problem is dry mouth syndrome, which, when coupled with dental enamel defects, puts patients at greater risk for tooth decay and cavity formation.

How Can Dentists Help Celiac Patients Limit Their Exposure to Gluten?

Many patients are able to avoid gluten entirely at home through a special diet. 

 naturally include fruits, vegetables, meat and poultry, fish and seafood, dairy, and beans, legumes, and nuts. Unfortunately, strict adherence to a gluten-free lifestyle might not limit all exposure — in fact, many celiac patients are routinely exposed to gluten at their dentist’s office.

Some dental practices have begun to go gluten-free, as is the case with 

 in Connecticut. When researching celiac disease and oral health in peer-reviewed journals, Calcaterra found gluten-containing dental products can cause “quite an unpleasant response” in patients with gluten-sensitivity. For instance, if a celiac patient has a biannual dental cleaning and a hygienist uses prophy paste that contains gluten, the patient might have a negative reaction to the product. “The type of response and severity of it depends on the patient, and further research is needed. It all depends on how thorough the dental cleaning was, and the concentration of gluten in the prophy paste that as used” he said.

Calcaterra also found that colored dental products generally tend to have gluten in them. Based on his research and conversations with product vendors, Calcaterra said that “where we see gluten in dental products is primarily in the preventative products. That’s what people are exposed to the most.” Patients can be exposed to gluten in a variety of preventative products - toothpaste, prophy paste, polishing pastes, topical fluoride, and even topical anesthetics might contain gluten.

“If you’re getting a cleaning every six months, you’re going to be exposed to gluten every six months” notes Calcaterra. Since many patients with gluten sensitivity do see dentists every six months for preventative care, “that’s where dentists and patients really have to do their homework.”

What Can Dentists Do If They Suspect a Patient Has Celiac Disease?

Since dentists are uniquely trained to recognize dental abnormalities, they can be instrumental in identifying patients that should be screened further for celiac disease. If you suspect a patient might have celiac disease, 

there are several steps you can take to see if further screening is appropriate.

• Ask the patient about other symptoms of celiac disease they might be experiencing, like abdominal pain, diarrhea, and chronic fatigue. But remember, celiac disease cannot be ruled out in the absence of further symptoms.

• Ask about other immune system disorders, especially thyroiditis and type 1 diabetes. The presence of other immune system diseases can increase the likelihood of developing celiac disease.

• Ask about other family members that might have celiac disease. It is a hereditary disorder.

• To confirm a diagnosis of celiac disease, refer the patient to their primary medical care provider. A simple blood test is used to diagnose the condition.

It’s important to remember that not all dental complications result from celiac disease or gluten exposure. Problems like dental enamel defects are fairly common in celiac patients and can help dentists identify patients who might be suffering from the disease, but they can result from other conditions. However, regarding celiac disease and its effect on oral health, Calcaterra notes, “It’s not like this is well known within the dental community. I would estimate that most dentists don’t know much about this at all. I’d wager 95% of dentists, if you asked them are there oral manifestations of celiac disease, they’d say I don’t know.”

“I don’t know if it’s included in dental school curriculum today,” he said. “There’s no sort of standard protocol that I’m aware of. Hopefully there will be.”

Celiac disease has made a major impact on family physicians and internists, but thus far it hasn't changed the way most dentists treat patients. One dentist says it should.