Sarah Handzel, BSN, RN

Some data indicate that oral cancer diagnoses in the U.S. rose by 61 percent from 2011 to 2015.

Dentists, whether they realize it or not, are on the frontline of the war against cancer. With the prevalence of oral cancer on the rise, dentists are positioned to provide patients with critical diagnostic care. Suddenly, dentists find themselves not in the business of cavities and crowns, but saving potentially countless lives.

In the United States, oral cavity squamous cell carcinoma is the most common cause of malignancy in all head and neck cancers, accounting for about 90 percent of cancers that are diagnosed in this anatomical region.

 It’s estimated that about 49,670 people in the U.S. will be diagnosed with a form of oral cancer in 2017. Worldwide, oral cancer is the sixth most common form of cancer

, most often diagnosed in male patients and typically appearing after it has metastasized

Diagnosis of this form of cancer typically occurs about age 62, although slightly more than one-quarter of these types of cancers develop in younger patients

. Recently, there has been an increase in public awareness efforts regarding oral cancer and the role dentists play in screening for the disease.

“We’re in a place in history that is unique: Americans, in general, have never been more interested in their own health,” says Brian Hill, founder and executive director of The Oral Cancer Foundation. “The interest in cancer screenings has become a normal part of our lives, and things that we normally didn’t think about 20 years ago, we’re regularly getting screened for now.

“The good news is that the American public is receptive to screening. Our government is also realizing that treatment is way more expensive than early discovery. Right now, we have an audience that wants information.”

Since the mid-1970s, the incidence of oral cancer has increased about 15 percent

, with a 0.5 percent annual increase in positive diagnoses

. According to some data, privately billed insurance claims in the U.S. related to oral cancer diagnoses rose by 61 percent from 2011 to 2015

“There are publications that show the rate of oral cancer — not oropharyngeal cancer – in young patients is increasing,” says Brian Schmidt, D.D.S., M.D., Ph.D., an ADA spokesperson. “It’s hard to get exact numbers on this, but it seems oral cancers are increasing. We don’t yet understand the etiology of this.”

The term “oral cancer” can be misleading since it is often used as a single diagnostic term when discussing all cancers of the head and neck. It is important to distinguish between true oral cancers — those occurring in the oral cavity on the tongue, gums, buccal mucosa, or floor of the mouth – and oropharyngeal cancers that occur on the soft palate, the base of tongue, and the tonsils

. Squamous cell carcinoma can certainly develop in this region independently of any growth in the mouth itself

Infection with human papillomavirus (HPV) has recently emerged as a major risk factor for the development of oropharyngeal cancers.

 Most commonly, HPV infection is associated with squamous cell carcinoma of the tonsils and the base of the tongue

. In the U.S., HPV infection has been shown to account for more than 60 percent of all oropharyngeal cancers

There is now some debate over whether HPV infection could be a causative factor in the development of oral cavity squamous cell carcinomas. HPV colonization within the oral cavity can be identified in 2-8 percent of the healthy adult population, but studies suggest these infections typically resolve within a year.

 In individuals engaging in frequent high-risk oral sexual behavior, or those with weakened immune systems, HPV infections are more likely to persist and may be a critical factor for the development of HPV-related cancers

In the body, HPV infects basil epithelial cells and can remain latent within these tissues. Research has shown HPV can infect gingival tissue, invading the periodontal pocket where basil cells are exposed to the enviornment

. In individuals with periodontitis, chronic inflammation leads to increased basil cell proliferation, which in turn leads to higher viral loads in the oral cavity and saliva. There is some speculation that this process could create a reservoir within the oral cavity, leading to sustained HPV infection and the development of oral cancers

However, there is still no clear association between HPV infection and the development of oral cavity squamous cell carcinoma

. As Hill says, “At the end of the day, the ubiquitousness of this virus is unlike anything that we’ve had to deal with in the dental community ever before.”

WHY IS IT SO HARD TO DETECT ORAL CANCERS EARLY?

Unfortunately, oral and oropharyngeal cancers often remain undetected until later stages, when treatment is difficult and often unsuccessful. For individuals with cancer that is diagnosed after metastasis, the five-year relative survival rate is about 38 percent.

 This rate hasn’t improved substantially for many years.

Traditionally, dentists have used oral examinations, including visual inspection and palpation, to screen for oral cancers, but it is possible for smaller, more subtle lesions to remain undetected, especially in the oropharyngeal region.

 “It’s a difficult area to examine. Dentists are formally trained to examine both the inside and outside of the mouth, and part of the examination of the inside of the mouth would be the base of the tongue and the tonsils,” Schmidt says. “However, it’s hard to see those areas — sometimes directly examining the base of the tongue and the tonsils can be difficult.”

Unfortunately, many dentists do not encounter patients until the cancer has metastasized.

“Many of the oropharyngeal cancers that are related to HPV present with metastasis to the neck,” Schmidt says. “These patients will often present with a lymph node in the neck that the dentist can palpate. They might not show anything in the mouth.”

“Dentists are very good at picking up oral cancers early, but for certain populations — and it depends on access to care – some of these cancers are picked up later,” says Schmidt.

Typically, elderly, low-income, or uninsured patients present with later staged cancers because of economic factors and other barriers to regular dental screening and care.

HOW CAN DENTISTS BETTER SCREEN FOR ORAL CANCERS?

Effective oral and oropharyngeal cancer screening starts with effective dental education. University programs in the U.S. instruct dental students on appropriate screening methods for oral cancers, but educational efforts should not stop once a dentist graduates. Because oral cancer detection curriculum can vary in dental schools, some research has suggested that proficiency in performing an oral cancer examination should be a requirement for graduation and licensure.

  Also, continuing education courses that incorporate information about oral cancer epidemiology, pathology, and differential diagnosis offer opportunities to help keep dentists up to date on the latest research and trends.

Currently, the National Institute for Dental and Craniofacial Research (NIDCR) recommends dentists perform a thorough head and neck inspection as part of each patient’s routine visit. This examination should include gathering information about each patient’s tobacco and alcohol use, as well as a discussion of other risk factors identified from the patient’s health and dental history. If any suspicious lesions are identified, it is critically important for dentists to follow up with the patient to ensure a definitive diagnosis was made.

Mehdi Karimipour, D.M.D., recommends regular vigilance for higher-risk patients. In an email, he said, “(Dentists should be seen) at least twice a year not only for regular dental checkups, but also for oral cancer screenings. Abnormal tissue growth in and around the mouth can be detected, and X-rays can show signs of cancer.”

In addition to visual inspection, dentists can also use several adjuvant screening methods in efforts to improve cancer detection. Toluidine blue staining has already been used for many years as an oral cancer screening aid,

 allowing dentists to easily identify suspicious oral tissues that are stained dark royal blue. Also, oral brush cytology, in which oral cavity cells are collected after scraping the mucosa with a special brush and analyzed in a laboratory setting, is a non-invasive and inexpensive method of further examination of suspected lesions.

Beyond these methods, many practices have begun screening efforts using new technologies that can be easily incorporated into clinical practice. In her facility, YiChen Wei, D.D.S., makes use of one such technological option, VELscope, to provide better care to her patients.

 “VELscope uses a wireless, handheld scope that uses natural tissue fluorescence to enhance the way (we) can visualize oral mucosal abnormalities that might not be apparent or even visible to the naked eye,” Wei says. “We have implement this into our dental practice and it has become routine during exams.”

As Hill says, “(Screening for oral cancer) is a very small part of your daily practice. It’s not going to be hugely time consuming, and you don’t have to go back to school to learn how to do it. It just requires engagement, and saying ‘I believe this is important in my practice. I am the custodian of these patients’ mouths.’ I think if every dentist approaches their patients with that mentality, they will take the time to do what’s right, and we’ll start finding this stuff earlier.”

1. Chi, A. C., Day, T. A. and Neville, B. W.  “Oral cavity and oropharyngeal squamous cell carcinoma—an update.” 

 65(2005): 401—421. doi:10.3322/caac.21293. doi: 10.3322/caac.21293.

2. Rivera, César. “Essentials of Oral Cancer.” 

International Journal of Clinical and Experimental Pathology

3. “What are the key statistics about oral cavity and oropharyngeal cancers?” American Cancer Society, last modified January 6, 2017, accessed February 06, 2017,  

https://www.cancer.org/cancer/oral-cavity-and-oropharyngeal-cancer/about/key-statistics.html

4. Hübbers, Christian U, and Baki Akgül. “HPV and Cancer of the Oral Cavity.” 

5. “Oral cancer incidence (new cases) by age, race, and gender,” National Institute of Dental and Craniofacial Research, last modified May 24, 2014, accessed February 06, 2017, 

https://www.nidcr.nih.gov/DataStatistics/FindDataByTopic/OralCancer/OralCancerIncidence.htm

6. FAIR Health, “Claims related to oral cancer diagnoses rise 61 percent since 2011,” news release, October 26, 2015, 

http://www.fairhealth.org/servlet/servlet.FileDownload?file=01532000001vhJR

7. “Oral health topics: oral and oropharyngeal cancer,” American Dental Association, last modified January 17, 2017, accessed February 06, 2017, 

http://www.ada.org/en/member-center/oral-health-topics/oral-cancer

8. Mangalath, Ummar et al. “Recent Trends in Prevention of Oral Cancer.” 

Journal of International Society of Preventive & Community Dentistry

9. Jafari, A et al. “Delay in the Diagnosis and Treatment of Oral Cancer.” 

10. Psoter, Walter J. et al. “Increasing Opportunistic Oral Cancer Screening Examinations: Findings from Focus Groups with General Dentists in Puerto Rico.” 

11. Tohoku J. “Non-invasive techniques for detection and diagnosis of oral potentially malignant disorders

.” The Tohoku Journal of Experimental Medicine

. 238 (2016):165-177. doi: 10.1620/tjem.238.165.

12. Babshet, M et al. “Efficacy of Oral Brush Cytology in the Evaluation of the Oral Premalignant and Malignant Lesions.” Journal of Cytology / Indian Academy of Cytologists 28.4 (2011): 165—172. doi:  

Articles

You may think of yourself as being in the business of cavities and crowns, but you're also in the business of saving lives. April marks Oral Cancer Awareness Month. Instances of oral cancer are on the rise, and dentists play a pivotal role in its early detection. Since most people see their dentists more often than any other healthcare provider, you are positioned to be the first to spot the disease.


The Business of Saving Lives: Dentistry and The Fight Against Oral Cancer

Researchers hope that the same procedure will regenerate teeth in humans.

 released in the journal Scientific Reports highlights autologous transplantation of bioengineered tooth germ to successfully regenerate a tooth. The study involved the use of a canine subject, but researchers hope the results could eventually lead to the restoration of natural teeth in humans following disease or injury.

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Currently, treatments for tooth restoration involve replacing the tooth with artificial materials or an osseointegrated dental implant. To begin to develop an alternative to this method, a research team from Okayama University first examined whether bioengineered tooth germ could lead to the formation of a proper tooth.

Embryonic tooth germ cells and tissues from a canine were harvested and then reconstructed. The reconstructed material was transplanted into mice, where, in many cases, the germ resulted in tooth-crown formation after several weeks. The transplanted germ produced both the soft and hard tissues that are present in natural teeth.

With the promising results of the initial study, the researchers next moved on to test autologous transplantation using canine stem cells. Deciduous teeth were extracted from a 30-day old dog, allowing for the generation of tooth germ from the dog’s own tooth cells. After two days of cell culture, the tooth germ was implanted back into the dog’s mandible, resulting in tooth eruption 180 days later.

Interestingly, micro-CT analysis of the new tooth showed its formation was almost identical to that of a natural tooth. Further testing revealed the structure and chemical composition matched that of natural teeth. Finally, subjecting the regenerated tooth to mechanical force resulted in a response consistent with proper physiological functioning of the periodontal ligament.

In humans, immature wisdom teeth could become a source of stem-cell germs, but this would only pertain to individuals seven years old or younger. For older patients, another stem-cell source would first need to be identified. Regardless, researcher Takuo Kuboki and colleagues made a statement expressing hope for future tooth regeneration, saying, “This study highlights the feasibility of fully functional tooth restoration by autologous transplantation of bioengineered tooth germ."

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Researchers harvested tooth germ cells and tissues from a dog, then reconstructed them. This reconstructed material was then transplanted into mice. After several weeks, tooth-crown formation had taken place in many of the mice. The transplant resulted in hard- and soft-tissue formation.

Researchers Use Tooth Germ to Regenerate Teeth in Animal Study

Peri-implantitis, an inflammatory condition that affects the soft tissues and bones surrounding dental implants, is a causative factor in the failure of many dental implants. Over 18 million Americans have some form of dental implant — crowns, bridges, or others – but up to 10 percent of them fail, leading to more necessary dental work and expense for many patients. In an attempt to produce new technology to help prevent implants from failing, researchers from three departments of the University of Plymouth in the United Kingdom have developed a new nanocoating they believe will reduce the risk of a patient developing peri-implantitis.

combination of silver, titanium oxide, and hydroxyapatite nanocoatings

 that they then applied to the surface of titanium alloy dental implants. In clinical tests, the nanocoating combination was shown to successfully inhibit bacterial growth. The coating also reduced the formation of bacterial biofilm on the surface of the implants by as much as 97.5 percent.

In addition, the anti-biofilm properties of the nanocoating combination were shown to support the successful integration of the implant into the surrounding bone. Bone healing was also accelerated during clinical testing.

Alexandros Besinis, lecturer in mechanical engineering at the University of Plymouth and member of the research team, 

, “Current strategies to render the surface of dental implants antibacterial with the aim to prevent infection and peri-implantitis development, include application of 

antimicrobial coatings loaded with antibiotics or chlorhexidine

. However, such approaches are usually effective only in the short-term, and the use of chlorhexidine has also been reported to be toxic to human cells. The significance of our new study is that we have successfully applied a dual-layered silver-hydroxyapatite nanocoating to titanium alloy medical implants which helps to overcome these risks."

The new nanocoating comes at a time that is seeing increases in the number of patients expected to need some type of dental implant. It is anticipated that up to 500,000 new patients will need a dental implant each year, which is reflected in the global dental implant market. That market is expected to grow to $4.2 billion by 2022.

Christopher Tredwin, Head of the university’s Peninsula School of Dentistry, says, “The potential of our work for increased patient comfort and satisfaction, and reduced costs, is great and we look forward to translating our findings into clinical practice."

A team of researchers in the United Kingdom is investigating the effectiveness of a new implant nanocoating to reduce the risk of peri-implantitis. The team coated titanium alloy implants with silver, titanium oxide, and hydroxyapatite, then studied the implants' ability to resist biofilms. The researchers hope these nanocoatings will have longer-lasting effects than what is currently on the market.

The University of Washington’s School of Dentistry has been in financial trouble for some time — a budget deficit has plagued the school since 2007, and by 2015 about half the school’s departments, including endodontics, oral medicine, oral surgery, and pediatric dentistry, were losing money. Since last year, the school’s deficit has grown by another $6 million, putting the total deficit at about $35 million. To save money, the school is freezing reserves and staff hiring for many positions, as well as taking steps to oversee expenses, like hiring a comptroller and performing financial audits.

, Joel Berg, Dean of the School of Dentistry, indicated that he plans to reorganize the school. Currently, there are over 15 separate entities comprised of members from eight different departments within the school who all have a hand in managing the yearly budget.

Berg said, “There are many aspects that are highly fragmented. It must dramatically change.”

However, some faculty members have raised concerns about how well the school is being managed while pointing to specific problems, like the Sand Point pediatric dentistry center.

The center opened in September 2010 with the goal of providing dental services to low-income patients in addition to full-paying and insured individuals. But according to the school’s estimates, 80 percent of patients at the pediatric center and 50 percent of adults at the adult clinic are on Medicaid, which does not reimburse providers fully for the costs of care. In 2015, an estimated $1.7 million was spent providing uncompensated care, in addition to $5 million in undercompensated care.

Berg has indicated that he was working to bring more full-paying patients into the school’s dentistry clinics, while also working to increase the reimbursement rate for services. However, it’s not just the Sand Point clinic that is losing money — records show that by 2015, almost half of the school’s dental departments were in the red. Pediatric dentistry far outpaced the deficit of other departments however, with almost $15 million owed by the end of that year.

Frustration over the budget also extends to concerns about continuing to provide much needed dental care to at-risk individuals. Since the Sand Point clinic provides care to those that probably cannot afford it otherwise, some have come to view it as a last resort for large numbers of individuals and families with no other options. University of Washington President Ana Mari Cauce said in a meeting, “At some point, we need to have a very difficult conversation across the university about what we can do, because in so many ways we’ve become the safety net for the state.”

Faced with mounting debt, the University of Washington's School of dentistry is in the middle of a reorganization. Since 2007, the institution's total debt load has ballooned to about $35 million. The Dental school has implemented a hiring freeze and hired a comptroller to try and get the situation under control.

UW School of Dentistry Restructures amid Financial Crisis

President Donald Trump's 2018 budget proposal includes funding cuts to the National Institutes of Health.

In response to the Trump administration’s proposed budget for 2018, the American Dental Association has released a 

 expressing its concern regarding the reduction in funds for several institutions, including the 

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Gary Roberts, D.D.S and President of the ADA, said in the statement, “The American Dental Association is alarmed by some of the proposals in the Trump Administration’s fiscal year 2018 budget. The president’s proposed cuts could have severe negative impacts on oral health research and access. The unprecedented $5.8 billion in cuts aimed at the National Institutes of Health (NIH), the nation’s premier center for health care research and funding, for example, would dramatically impact NIH’s core mission.”

He continued, “The Association is also concerned by the White House proposal to push for NIH ‘reorganization.’ Though the budget included no details, the ADA urges Administration officials and Congress to retain the independence of individual institutes. As an independent agency within NIH, the National Institute for Dental and Craniofacial Research (NIDCR) has a long history of funding vital research that has led to improvements in oral health for all Americans.”

, funding for the NIH would be reduced by 20 percent, or $6 billion. Other national organizations, such as the Department of Health and Human Services, could see annual budgets reduced by as much as 18 percent. Such cuts could severely impact improvements to dental access and care for underserved and at-risk population groups across the nation.

“On behalf of the ADA and its 161,000 member dentists, I urge congressional appropriators to consider the Trump Administration’s budget proposal very carefully. Cutting health funding so dramatically would be a huge step backwards after years of progress in improving the nation’s oral health,” says Roberts.

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President Donald Trump has proposed reductions in funding for several health institutions in his 2018 budget, including the National Institutes of Health. Now, the American Dental Association has weighed in on those proposed cuts. Gary Roberts, D.D.S., president of the ADA, has said the organization is alarmed by the proposed cuts, adding that the nation's oral health will suffer as a result.

ADA: We're 'Alarmed' by Trump Budget Proposal

Aerodentis uses air pumped into a flexible silicone tube, shown above, to reposition teeth. Image source: YouTube

For years, a mainstay of orthodontic dental treatment has been the application of metal braces to correct crowded teeth. Now, a new product has been developed as a potential game changer — instead of using of metal braces, patients might soon have their crooked smile adjusted by pulsating air.

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Researchers at the University of Alabama at Birmingham School of Dentistry are currently recruiting patients for inclusion in a new 

. The product is not FDA-approved for use in the U.S. currently, but scientists believe it will only be a matter of time before it becomes a standard part of orthodontic treatment.

To be included in the clinical trial, patients must first undergo a screening that, along with measuring other criteria, such as age and oral hygiene status, determines whether their front teeth are too crowded. If approved for inclusion, patients are randomized and receive either the Aerodentis treatment or a clear plastic aligner.

Treatment with Aerodentis includes a custom-made thermo-plastic mold that is fitted over the teeth with an integrated inflatable silicone balloon. This mouthpiece will be specifically tailored to each patient using vacuum-forming technology that later utilizes CAD/CAM manufacturing and 3D imaging.

During treatment, the mouthpiece is connected to a control console by a small, flexible tube. The control console contains sensors that measure and control the pulsating force of the air moving through the mouthpiece in real time. Each patient that receives the Aerodentis device will also be given a smart card that enables researchers to monitor compliance with the treatment.

Trial participants that receive the Aerodentis system must use it for a minimum of 10 hours each day, but they do not have to be consecutive hours. The clinical trial is expected to be complete after 15 months.

The University of Alabama is the only dental facility in the nation to use the device in a clinical trial. In addition to the Aerodentis device, study participants will also receive X-rays, checkups each month, and an additional orthodontic appliance at a discounted price.

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The days of metal braces may be numbered. The University of Alabama is recruiting study participants for a trial of a new orthodontic treatment option that uses air to reposition teeth. Trial participants must wear the device for 10 hours daily. It can be worn while sleeping. The trial is expected to last 15 months.


Many dentists had already purchased mercury amalgam separators prior to the Trump administration's decision to roll back the EPA ruling.

In late 2016, the U.S. Environmental Protection Agency formally ruled to 

require the use of mercury amalgam separators

 in dental facilities across the country. The ruling was created with the intent of capturing harmful metal waste for safe disposal and recycling, but its future is now uncertain. Unfortunately, some dentists are already bearing the financial brunt of the ruling, which is no longer applicable.

The new federal rule on mercury amalgam separators was set to take effect on January 24, but before it could be implemented, the Trump administration issued a 

 instructing federal agencies to roll back many Obama-era rules that had not yet been published. As a result, the EPA withdrew the rule from the Office of the Federal Register.

Before it was withdrawn, the American Dental Association 

, encouraging dentists to follow best management practices for mercury amalgam waste handling and disposal. Unfortunately for many dentists, the roll back has already cost them hundreds, if not thousands, of dollars due to the purchase of equipment that now might be unnecessary. Mercury amalgam separators can cost anywhere from $500 to more than $1,000 each, depending on the amount of dental waste they are designed to process.

 against the EPA to try to save the ruling. The National Resources Defense Council (NRDC) alleges the EPA broke the law by withdrawing the rule without public notice or an opportunity for members of the public to comment. The NRDC also argues that the EPA cannot withdraw the mercury protection ruling because the ruling was final, regardless of the Trump administration’s instructions.

Aaron Colangelo, litigation director of the NRDC, 

, “The Trump White House ordered the EPA and other agencies to violate the law. That puts Americans at greater risk of exposure to this dangerous neurotoxin, which can do harm even in tiny amounts. EPA’s withdrawal of the mercury rule is not just illegal, but senseless. The rule imposes minimal burden, drew widespread praise from dental providers and benefits public health and the environment.”

, compliance with the mercury protection rule could reduce the discharge of mercury by 5.1 tons each year, in addition to reducing the amount of other metal waste by 5.3 tons annually. The agency also noted most of the mercury discharged from dental facilities is subsequently released back into the environment, and that compliance with the ruling would have been practical and affordable for dental practitioners.

With the future of the EPA's ruling requiring dentists to use amalgam separators up in the air, dentists are unsure of whether they should proceed with purchasing the expensive devices. Moreover, many dentists already purchased the devices before the Trump administration rolled back the ruling. Now, an environmental group has filed a lawsuit to try and stop the rollback, casting the ruling's fate in even further doubt.

A new printing platform could be the start of a new era in dental implant manufacturing. 

 a company focused on the creation and sale of 3D products and services, has entered the dental market with a new, modular printing device that will enable smaller laboratories or dental practices to produce thousands of crowns and other dental products each year.

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The new printing technology is based on the company’s 

 materials. 3D Systems expects the new printer to be able to significantly reduce fabrication times and use far less material to produce dental products. The company anticipates this will allow crowns and other dental implants to be fabricated at much less cost and with much less material waste than current manufacturing methods.

Vyomesh Joshi, President and CEO of 3D Systems, says, “Traditional milling machines only mill one crown at a time, making the process slow, ineffective and costly. Our system can print 20-30 crowns in fewer than 15 minutes, which is the same time it takes most milling solutions to produce just one single crown.”

The company plans to offer a system that will allow smaller dental laboratories to produce thousands of dental products each year. Larger labs will also see benefits, as the company expects their fully automated technology to be able to produce more than one million crowns or other dental implants every year.

Dentists and patients can benefit from the use of 3D printing technology. Many dentists already use 3D scanners during patient treatment, and these scans could be used to make 3D printed items like crowns that have a more accurate, comfortable fit. Also, 3D printing can produce a finished product much faster than traditional milling techniques.

3D Systems plans to begin shipment of the new printing platform in late 2017. Demonstrations of the new system were featured at the 

3D Systems is now offering a modular dental printing devices that it says will prove beneficial for smaller dental laboratories and practices. The company says the printer will cut down on printing time and wasted material. 3D Systems says its new printer can make 20-30 crowns in about 15 minutes.

SCOPE debuts with the intention of providing dentists with the information they need to treat obstructive sleep apnea.

A new nonprofit organization has recently launched with the goal of providing dentists with continuing education about dental sleep medicine and craniofacial pain treatment. The organization, called the 

 (Sleep-Apnea & Craniofacial Pain Education) Institute, currently offers a variety of programs for the educational advancement of dentists nationwide.

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The SCOPE Institute’s mission is “To advance the education and implementation of obstructive sleep apnea and craniofacial pain services within dentistry for the sake of alleviating these disorders within the population worldwide.” 

, it’s estimated that up to 22 million people suffer from sleep apnea.

When untreated, obstructive sleep apnea, which accounts for the majority of sleep apnea cases, can result in several serious comorbid conditions, including high blood pressure, heart failure, diabetes, and depression. Obstructive sleep apnea occurs when the airway is blocked, usually due to the tongue collapsing against the soft palate, which in turn collapses against the back of the throat.

The SCOPE Institute offers several continuing education courses to help dentists better understand the role of dentistry in screening for and treating sleep disorders. Depending on the course, focus is given to screening for obstructive sleep apnea, understanding the integration of sleep studies into practice, and using oral appliance therapy as an effective treatment for obstructive sleep apnea.

Dentists can also take more practical management courses designed to facilitate the implementation of dental sleep medicine into their existing practice. Focus is given to marketing techniques dentists can use to drive sleep apnea patients into their practice, as well as techniques for effectively billing sleep apnea patients using appropriate diagnostic codes.

In addition to educational offerings, the SCOPE Institute provides shadowing opportunities to dentists with an experienced dental instructor. Dentists can also take advantage of remote mentorship programs and 4-part mini residencies.

Dentists who are interested in the continuing education opportunities offered by the SCOPE Institute can register for one of four continuing educational courses on the Institute’s 

. Each course grants a certain number of CEUs that can be applied toward licensure requirements.

More dentists are entering the sleep medicine field by offering appliance-based therapies for patients with sleep apnea. To that end, a new nonprofit has launched to provide dentists with the continuing education they need to treat disordered breathing. The American Sleep Apnea Association estimates that 22 million Americans suffer from sleep apnea.

New Organization Educates Dentists on Sleep Apnea

A research team at King’s College London has created a new device, the SafeRoot, to help detect bacterial infections present inside teeth during root canal treatments. The team hopes that, if further testing of the device is successful, SafeRoot could usher in a new era in dentistry where the risk of the root canals failing is minimized and there is no need for follow-up appointments.

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SafeRoot was created to help detect any bacteria that is present inside a tooth after completion of a root canal procedure, before the tooth is filled. Using paper point sampling, florescent dyes, and florescence microscopy and spectroscopy, the device can detect trace amounts of residual live bacteria in the root canal space. During 

, SafeRoot was shown to be effective at detecting bacteria in as little as three minutes.

Currently, almost a quarter of all root canal treatments fail over time because of secondary bacterial infections. Most treatments require at least one or two visits to a dental provider for the work to be completed.

Francesco Mannocci, Professor of Endodontics at the Dental Institute at King’s College London, 

, “The resilient nature of bacteria, combined with often complex root canal structures, make disinfection challenging, leading to a considerable number of persistent infections. This is one of the main causes of root canal treatment failures.”

Since SafeRoot allows for the detection of bacteria inside the root canal itself, dentists can use the device to confirm the procedure has been successful. This confirmation could also reduce the need for tooth extraction or other surgical intervention at a later date.

Tim Watson, another professor at the Dental Institute at King’s College London, 

, “SafeRoot will reduce the time for root canal completion and will increase the success rate of treatments by letting the dentist know when it's safe to proceed with filling the tooth. This should produce fewer acute 'flair-ups' and failed root treatments, as any residual infection in the root canal will be identified.”

British researchers have come up with a bacterial detection system for root canal treatments. In early trials, the system seems to be effective. Currently, the failure rate for root canals from secondary bacterial infections is one in four. SafeRoot, the new system, can detect bacteria in as little as three minutes.