Sarah Handzel, BSN, RN

Periodontal disease, a serious gum infection, can lead to premature death.

In a new study from the University of Buffalo, researchers have discovered that estrogen used as part of treatment for 

 — a condition in which the bones become brittle and fragile as a result of a loss of bone tissue &mdash; could also help women over the age of 50 avoid severe periodontitis. While previous studies have described the link between osteoporosis and tooth loss, this is the first study to examine the relationship between estrogen therapy and gum disease.

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The results of the study showed that women 50 years old or older who are treated with estrogen for osteoporosis are 44 percent less likely to have severe periodontitis compared to women who do not receive such treatment. Data from the medical records of almost 500 postmenopausal women 

 included. Of these women, 356 were diagnosed with osteoporosis, and 113 received estrogen therapy as a part of their treatment for a minimum of six months.

Each study participant was postmenopausal for a minimum of one year. Factors such as race, educational 

 and income were also included in the study data. It was shown that the women who received estrogen treatments had less periodontal probing depth, less clinical attachment loss and less gum bleeding compared to women who did not receive estrogen therapy. 

Higher family income level and more frequent dental visits were associated with a lower prevalence of gum disease.

These results help confirm the findings of previous studies that suggested that estrogen therapy to prevent osteoporosis could also play a role in the prevention of gum disease,” 

. “By advancing our understanding of how this treatment can impact oral health, we can better work to improve the bone health and quality of life of female patients.”

 part of the normal process of menopause. Many women are prescribed estrogen along with other supplements, like calcium and vitamin D, to help prevent bone loss. However, estrogen therapy has been associated with adverse effects like an increased risk of heart disease and breast cancer. To better understand if estrogen’s role in the prevention and treatment of osteoporosis is beneficial in the prevention of gum disease, further research is needed.

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Estrogen has long been prescribed to women dealing with menopause and osteoporosis. But according to a new study, the hormone's benefits for post-menopausal women does not end there. Continue below to learn about new research on the relationship between estrogen therapy and gum disease. 

For Women Over 50, Estrogen Could Help Prevent Gum Disease

A study found that participants who slept poorly may have less self control when it comes to food choices.

If you needed an excuse to rest more, this one will do it. According to a 

 published in the Journal of Applied Psychology, a good night’s sleep can do more than help you feel rested.

The study, which is one of the first of its kind, shows that good sleep can help workers who experience high levels of job stress manage unhealthy eating habits by reinforcing healthy behaviors throughout the day and allowing individuals to handle job stress more effectively.

The study involved a review of two previous studies of 235 workers in China. While they were not dentists, these workers were employed in fields that typically involve high-stress environments: information technology and telephone call centers. In both cases, stress experienced by employees was linked to negative attitudes and moods on the job, which in turn was linked to unhealthy eating patterns after the workday finished.

“We found that employees who have a stressful workday tend to bring their negative feelings from the workplace to the dinner table, as manifested in eating more than usual and opting for more junk food instead of healthy food,” Chu-Hsiang Chang, study co-author, 

. “However, another key finding showed how sleep helped people deal with their stressful eating after work. When workers slept better the night before, they tended to eat better when they experienced stress the next day."

To explain this outcome, the study authors proposed two explanations. First, workers in stressful occupations may use eating to relieve and control negative feelings and moods. Also, highly stressed individuals could have diminished self-control, which could lead to more unhealthy eating patterns.

Good sleep was shown to help individuals refresh and rejuvenate themselves, which in turn allows them to better deal with stress. This could help people in stressful occupations become less likely to engage in unhealthy eating. The study authors note that companies should consider both sleep-awareness training and flexible scheduling for employees to help address the problem of high stress levels and unhealthy eating. They add that companies could also offer food-related job perks to increase rates of healthy eating among employees.

There are few feelings more satisfying than being well rested. But according to a new study, a full and consistent sleep schedule does wonders for overall health and productivity. Continue below to find out more about how a good night's rest can help you and your practice.  

Study Indicates Sleep Could Help with Job Stress, Unhealthy Eating

Results of a new study suggest breastfeeding exceeding two years can lead to increased caries in children.

	Breastfeeding has long been hailed by pediatricians as the superior nutritional source for babies, and can even lower risks of asthma and allergies. But according to new research, too much of a good thing is potentially detrimental.   

suggests children who are breastfed for two years or more are more likely to develop dental caries. Data for the study was collected over several years from a population of 1,129 children in Brazil, who all had access to fluoridated drinking water from community water supplies. While there have been similar studies conducted in the past, results have not been conclusive as to whether prolonged breastfeeding is a causative factor in the development of caries in children.

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	For this study, information regarding rates of breastfeeding was collected at several intervals: when the children were aged three months, one year and two years old. Additionally, rates of sugar consumption were recorded when the study participants were two, four and five years old. To determine how much sugar was consumed by each child, researchers used a food consumption questionnaire given to parents. Low sugar consumption was noted as being zero to less than two sugary food items consumed daily, while high sugar consumption was used to indicate consumption of sugary foods two or more times each day.

	At five years old, each of the children in the study was examined by a dentist for any decayed teeth, missing teeth or milk teeth requiring filling as a result of caries formation. Dentists also recorded any severe single caries or severe early childhood caries cases, which is usually differentiated from other types of dental disease by the number of cavities present in patients.

	Among the study group, 23.9 percent of the children had severe caries. A full 48 percent of the children were recorded as having at least one tooth surface affected by dental caries. According to statistical analysis, children who were breastfed for two years or more were 2.4 times more likely to have severe dental caries compared to children breastfed for less than a year.

	Lead author of the study, Dr. Karen Peres, 

 that the trend toward the development of caries in children breastfed for longer periods of time could be explained by night feeding. Children breastfed beyond two years tend to feed on demand at night, which could result in stagnation of milk in the mouths of these children. This stagnation could lead to greater numbers of dental caries.

	However, other experts in the field say breastfeeding alone is not the main factor driving cavity formation. They point to other factors, like excessive consumption of sugary foods and lower socioeconomic status, as drivers of cavity development in children worldwide.

Babies who are breastfed show stronger resistance to viruses and bacteria, ear infections, respiratory illnesses and digestive problems. Even mothers can benefit from the release of the hormone oxytocin, which aids weight loss, as well as a lowered risk of breast and ovarian cancer. However, breastfeeding too long may have unexpected consequences. Continue below to find out how prolonged breastfeeding impacts oral health in children. 

Prolonged Breastfeeding May Cause Cavities

Cosmetic dentistry adjusts the color, size, shape, alignment and aesthetic quality of a person's teeth.

 from Research and Markets, the global dental restoration market is expected to grow significantly from 2017 to 2021.

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During this time period, the market is forecast to experience a compound annual growth rate (CAGR), or average year-to-year growth rate over a certain period of time, of 5.16 percent. This analysis is based off information collected from both primary and secondary sources, including data gathered from several industry experts.

A large factor driving the growth of the dental restoration market is the increased demand for advanced cosmetic dental procedures, which are generally used to improve the appearance of the teeth, gums and supporting oral structures. Patients often choose cosmetic dentistry to improve the appearance of their smile since procedures in this field often adjust the color, size, shape, alignment and general appearance of the teeth and other oral structures. As Dentist’s Money Digest 

, some reports estimate the global market for cosmetic dentistry alone will reach $27.95 billion by 2024.

The universal increase in rates of dental caries has been identified as a major factor driving the growth of the dental restoration market. 

, 60 to 90 percent of school-aged children have caries, along with almost 100% of adults. While the prevalence of caries varies by geographical location and availability of dentistry services, many of the most common dental problems, including caries, can be linked to an unhealthy diet and tobacco and alcohol use.

Even though growth in the restoration market is anticipated, some factors could still slow the rate of growth that’s actually experienced. Even though more people are seeking out cosmetic dentistry providers, many lack insurance to be able to pay for such services. Cosmetic dentistry typically costs more than other types of dental procedures, and a lack of insurance, or under-insurance, could make many people unable to afford such expenditures.

Everyone wants a whiter, more attractive smile, and according to research, that desire is creating a goldmine for dentists. With the dental restoration market expected to grow more than 5 percent over the next several years, dental health care providers would be wise to tap into it. Read more about the new report outlining growth trends in cosmetic dentistry below. 

Dental Restoration Market Forecast to Grow Through 2021

Before the ADA's guidelines, prophylactic antibiotics were recommended for all patients with an increased risk of infective endocarditis.

In the first study of its kind, researchers have examined dental records included in the 

 and found that dentists and oral surgeons are in compliance with guidelines put forth by the American Heart Association (AHA) in 2007. These guidelines were intended to direct the use of prophylactic antibiotics administered before invasive dental surgeries and other procedures.

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Before the new guidelines were issued in 2007, the AHA recommended prophylactic antibiotics for all patients with cardiac conditions that put them at a higher risk of developing infective endocarditis, a serious and potentially deadly infection of the heart valves. However, it was determined that this group of patients actually represented a small percentage of people receiving antibiotics prior to dental procedures. As a result, the AHA updated their guidelines to reflect this new data. After the guidelines were updated, there was no significant increase in cases of infective endocarditis recorded.

“Using the Rochester Epidemiology Project, we have shown that the new guidelines were very helpful in reducing unnecessary antibiotic use and related issues, without an increase in new cases of infective endocarditis,” Daniel DeSimone, M.D. and study lead authors, 

The research highlights other problems potentially avoided when patients are not given unnecessary antibiotics.

“Overuse of antibiotics can result in increased bacterial resistance, which is a widespread public health problem,” says DeSimone. Additionally, the estimated cost of antibiotics prescribed to moderate-risk cardiac patients could total over $100 million each year.

While this is the first study to use dental records included in the Rochester Epidemiology Project, there have already been over 2,600 medical publications already presented. The Project features a medical record linkage system that includes data from more than 500,000 patients over the last 50 years. This data allows scientists to examine the causes of many diseases and how patients respond to treatments, including surgery, medication or other alternative interventions while forecasting possible patient outcomes as a result of these interventions.

The American Heart Association put out guidelines in 2007 regarding use of prophylactics prior to dental procedures. A recent study from the Rochester Epidemiology Project has found that since the implementation of the guidelines, dental surgeons have remained compliant. Continue below to learn more about the AHA's efforts to reduce needless antibiotic use.
 

New Report Shows Dentists in Good Compliance with AHA Guidelines

TDSC, a subsidiary of the CDA, aims to make its members more competitive in the market.

The California Dental Association (CDA) has launched its newest subsidiary, 

 (TDSC) to assist and support member dentists with practice management advising and other business-related issues. Formed in response to strong interest from members of the CDA, TDSC also helps member dentists with group purchasing, using the CDA’s large membership base to help obtain better pricing options for interested parties.

A primary goal of TDSC is to help California dentists be more competitive in an ever-changing business environment, while still leaving all clinical and practice ownership decisions in the hands of individual practitioners. Advisors from TDSC are ready to help dentists ramp up their practice management skills by helping to create an action plan focused on specific practice goals. Dentists can receive recommendations in several areas of practice management, including advising, marketing and human resources. Dentists receive specific training and advice from subject matter experts in several key practice management areas, such as:

“We know our members are ready to utilize TDSC’s comprehensive practice management services,” James Stephens, D.D.S. and chair of TDSC’s board of directors, says. TDSC experts are ready to meet these practices and develop a deep understanding of each practice’s vision in order to tailor a plan that meets the practice’s specific goals — at a pace that’s right for them.” 

Additionally, TDSC offers member dentists the opportunity to leverage group purchasing power through TDSC’s 

. Dentists can save on more than 25,000 dental supplies purchased from many of the same vendors most dentists already use.

“The Marketplace allows practice owners to leverage the buying power of CDA’s large membership to attain better supply pricing. I encourage our members to check it out — the site is easy to navigate and the savings are listed on each item," Stephens says.

The Dentists Service Company, the CDA's newest subsidiary, has launched in an effort to provide practice management outreach to dentists. Thanks in part to the CDA's many members, TDSC is the answer to the base's interest in assistance with issues related to business. Continue below to learn how TDSC can help your practice. 

Crest recommends using its Glamour White whitestripes for 30 minutes daily.

While there are many home-use tooth bleaching products on the market today, only one has been granted the American Dental Association’s (ADA) Seal of Acceptance: Crest 3D White Glamorous White Whitestrips. The Seal was granted after the ADA Council on Scientific Affairs found the product is a safe and effective way to whiten natural teeth when used according to Crest’s instructions.

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The ADA Seal of Acceptance program was first implemented in 1931 as a way to recognize products that have proven to be both safe and effective. Currently, more than 200 over-the-counter dental products carry the ADA Seal.

Before any product is awarded the Seal, it must first be submitted to the ADA in an application that includes data from clinical and/or laboratory studies demonstrating both safety and efficacy. The ADA’s Council on Scientific Affairs reviews each product application to ensure the products meet certain 

. In most cases, the ADA also tests each product to verify any supporting data.

“Crest 3D White ‘Glamorous White’ Whitestrips clearly met these requirements and were awarded the ADA Seal of Acceptance, assuring consumers that this product is both safe and effective for home-use tooth bleaching,” John Dmytryk, D.M.D. and chair of the Council on Scientific Affairs Seal subcommittee, says.

Each Crest Whitestrip forms itself to the shape of the teeth and are recommended for use once daily for 30 minutes.

“We want people to know that our whitening technology has been thoroughly vetted by a trusted third party for dental professionals and users alike. When it comes to whitening, there can be some misunderstanding around how effective and safe whitening treatments are to the user,” Paul Sagel, Crest Whitestrips inventor, 

. “We hope having the ADA Seal will provide users even more clarity and confidence in their whitening choice with Crest 3D White ‘Glamorous White’ Whitestrips."

Consumers have always looked for affordable at-home solutions to teeth whitening, but many of them come with a set of risks. Even with the continual use of baking soda and hydrogen peroxide, a whitening trick passed down for generations, damage to tooth enamel outweighs the benefits of a more attractive smile. Now with the ADA's seal of approval, Crest 3D White 'Glamorous White' Whitestrips are providing a safe and effective do-it-yourself product for those looking to whiten their smiles. 


ADA Grants Seal of Acceptance to Crest 3D White 'Glamorous White' Whitestrips

Nature VR settings are most theraputic for patients, according to the study

A growing body of research is helping to confirm what some dentists already know: Using virtual reality (VR) in a patient care setting can dramatically improve the patient experience by lowering stress, anxiety and even pain levels.

 has found a link between the locale a patient visits in VR during dental procedures and increased satisfaction with the dental experience. The study was a combined effort among researchers at the Universities of Plymouth, Exeter and Birmingham, England.

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Study participants were randomly assigned to one of three study conditions: standard care with no VR, a virtual walk around a local beach and a virtual walk in an anonymous VR city. The results indicated that study participants who “walked” around the beach were less anxious, had less pain during their procedure and had more positive memories of their treatment up to a week after the procedure. However, these benefits were not present in participants who walked around the VR city.

“The use of virtual reality in health care settings is on the rise, but we need more rigorous evidence of whether it actually improves patient experiences,” Dr. Karin Tanja-Dijkstra, lead author of the research, 

. “Our research demonstrates that under the right conditions, this technology can be used to help both patients and practitioners."

In reviewing the results of the study, the researchers stressed that the virtual location patients visit during treatment is especially important and consistent with other research suggesting natural environments are most therapeutic. Specifically, marine environments are best to help reduce stress and anxiety.

“That walking around the virtual city did not improve outcomes shows that merely distracting the patients isn't enough, the environment for a patient's visit needs to be welcoming and relaxing,” Dr. Sabine Pahl, study coordinator at the University of Plymouth, says.  

As a follow up to this study, the research team is now planning to examine whether their virtual beach can help patients in other medical settings. They are also planning to explore whether certain additions to the virtual environment could improve the patient experience even further.

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Virtual reality has the power to transport its users. Doctors and dentists have caught on to this technology and taken advantage of it to make their patients more comfortable, but according to a new study, not all VR destinations are created equal. Read on to find out which VR environments are most effective in reducing pain and anxiety during procedures. 



VR Continues to Improve Patient Experiences, But Location Counts

A woman's oral hygiene can potentially impact her body and future plans in more ways than one, according to a new study 

 from the Department of Oral and Maxillofacial Diseases at the University of Helsinki in Finland suggests a possible link between a common periodontal pathogen and a woman’s inability to conceive. While previous studies have shown certain periodontal diseases could be risk factors for general health issues, such as heart disease, no information on the relationship between periodontal bacteria and infertility has previously been available.

The study enrolled 256 healthy women, ranging in age from 19 to 42, who discontinued their preferred methods of contraception to conceive. Initial oral and gynecological examinations were performed on each study participant to determine levels of major periodontal pathogens in saliva along with saliva antibodies against such pathogens. Additionally, vaginal swabs were taken to diagnose any cases of bacterial vaginosis, since this condition can interfere with a woman’s ability to become pregnant.

The research team followed up with all study enrollees after a period of 12 months, at which time it was determined whether or not each woman was pregnant. Saliva samples were also taken. In women who did not conceive, detection of Porphyromonas gingivalis, a bacterium commonly associated with periodontal disease, occurred more frequently in women who did not become pregnant during the study period. Researchers also found saliva antibody levels against this bacterium were significantly higher in non-pregnant women.

It was determined that women who had P. gingivalis in saliva and greater levels of saliva antibodies had a three-fold risk of not becoming pregnant, compared to women without these factors. Further statistical analysis showed that the finding was not connected with any other risk factors, such as smoking, bacterial vaginosis or clinical periodontal disease.

“Our study does not answer the question on possible reasons for infertility, but it shows that periodontal bacteria may have a systemic effect even in lower amounts, and even before clear clinical signs of gum disease can be seen,” Dr. Susanna Paju, periodontist and researcher from the University of Helsinki, 

. “More studies are needed to explain the mechanisms behind this association."

Dr. Paju added that the results of the study mean young, fertile women should be diligent about their oral health and schedule regular periodontal evaluations. Moreover, women who are trying to get pregnant should be encouraged to take good care of their oral health and maintain good oral hygiene.

The latest research from the University of Helsinki revealed some surprising results regarding fertility and oral health. According to the study, a woman's dental hygiene can potentially have adverse affects on her ability to conceive. Read on to see what the researchers advise young women who plan to eventually become mothers.

Study Suggests Delayed Conception Could Result from Periodontal Pathogen

New health care legislation could be good news to doctors, but potentially harmful to patients affected by malpractice

A new bill is drawing widespread support from physician groups nationwide. 

, or the Protecting Access to Care Act of 2017, would allow individual states’ non-economic damage caps to prevail, provided they are already in place in the state in which a malpractice lawsuit is filed.

The bill, set to be voted on by the U.S. House of Representatives in coming weeks, would set a cap on non-economic damages, like those that cause permanent physical disability to a patient, including disfigurement and pain and suffering, at a $250,000 maximum limit for any healthcare-related lawsuit. This stipulation includes suits involving dentists.

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One group, the American College of Physicians (ACP), has suggested adding language to the legislation that would cap damages at $250,000, regardless of individual state laws. One state, California, has had this damage cap in place since 1975, and many tout it as a success.

In addition to the proposed damage cap, the 

		Set a new statute of limitations for filing malpractice lawsuits. A patient would only have three years after the date of the initial injury, or one year after the patient discovers, or should have discovered, the injury.

		Abolish a rule known as the collateral source rule, which specifies the damages a plaintiff receives cannot be reduced because of payments they receive for their injury or disability from another party, such as worker’s compensation.

		Ban joint and several liability in successful malpractice lawsuits. This statute makes each individual defendant in a case responsible for paying the entirety of the damage award if other defendants are unable to pay.

		Set limits to attorney’s contingency fees in malpractice lawsuits.

		Block lump sum jury awards to plaintiffs in successful cases.

		Prohibit plaintiffs from naming hospitals or healthcare providers, including dentists, in lawsuits involving allegedly unsafe medications, regardless of any provider negligence in the prescription or administration of the drug.

 the bill itself is unfair and discriminatory to injured patients. 

“This bill would limit the legal rights of injured patients and families of those killed by negligent healthcare,” a partnership of over 80 health care, legal, labor and public interest groups claimed.

“Recent studies clearly establish that its provisions would lead to more deaths and injuries, and increased healthcare costs due to a 'broad relaxation of care.’”

Initially, the House Judiciary Committee passed the bill by a vote of 18-17. The bill was then set to be voted upon in mid-June, but that vote was cancelled and has not yet been rescheduled.

Malpractice suits are one of the contributors to rising health care spending, which reached 17.8 percent in 2015. New legislation recently passed by the House hopes to put a limit on how much patients, including those with permanent damages as a result of malpractice, can win in court. While doctors, including dentists, can benefit from this potential protection, opponents argue it comes at too great a cost to patients. Read on to find out more about the new bill. 