University of Birmingham

	Research into the science behind ultrasonic scalers, used by dental professionals to remove built up plaque, has identified that the formation of tiny bubbles around the head is key to the cleaning process.

	The bubble formation, or cavitation, of water around the head of the scaler was observed using high-speed cameras. Scalers of differing power, and head shape, were used and compared to quantify the patterns of cavitation.

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	A research team at the University of Birmingham believes that the methods developed in the study will help to test new instrument designs to maximize cavitation, with the aim of designing ultrasonic scalers that operate without touching the tooth surface. By doing so, the process of teeth cleaning at the dentist would become both less painful and more effective.

, are the first to prove that cavitation takes place around the free end of ultrasonic scalers.

 at the University of Birmingham, explained, “Removing dental plaque and calculus, that is the build-up of what we know as tartar or hard plaque, is a big part of maintaining oral health and a regular occurrence in dental check-ups. These findings will help us to understand how to make the tools as effective as possible.”

	A Satelec ultrasonic scaler, operating at 29 kHz with three different shaped tips, was studied at medium and high operating power using high speed imaging at 15,000, 90,000 and 250,000 frames per second, and the tip displacement was recorded using scanning laser vibrometry.

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	The team were not only able to show that cavitation occurred at the free end of the tip, but that it increases with power, and the area and width of the cavitation cloud varies for different shaped tips.

, lead author of the paper from the University of Birmingham, said, “Other studies we have done, using electron microscopy, have shown that removal of plaque biofilm is increased when cavitation is increased. Putting the pieces together, we can therefore say that altering the shape and power of these commonly used tools make them more effective, and hopefully, pain-free.”

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Research into the science behind ultrasonic scalers, used by dental professionals to remove built up plaque, has identified that the formation of tiny bubbles around the head is key to the cleaning process.

New research identifies role of tiny bubbles in tooth cleaning

	New findings from the University of Birmingham show that patients with chronic kidney disease patients and periodontitis have a higher mortality rate than those with chronic kidney disease alone.

	The research adds to the growing evidence for poor oral health being associated with other chronic diseases.

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	Data from 13,734 participants in the US-based 

Third National Health and Nutrition Examination Survey

 (NHANES III) were analyzed to show that individuals with both 

 and chronic kidney disease had an all-cause mortality rate of 41 percent at 10 years, compared to 32 percent for those with chronic kidney disease alone.

	To put this into context, the increase in 10-year mortality associated with 

 in patients with chronic kidney disease, independent of periodontitis, is from 32 percent in non-diabetics to 43 percent in diabetics.

	Periodontitis is a chronic non-communicable disease, and in its most severe form is the sixth most prevalent human disease, affecting 11.2 percent of the world's population.

	Chronic non-communicable diseases, such as kidney disease, are increasingly prevalent, partly as a result of an aging population and an increase in sedentary lifestyles and refined diets. Their impact upon the global disease burden and healthcare economy is significant, and evidence suggests that 92 percent of older adults have at least one chronic disease.

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, explained, "It's important to note that oral health isn't just about teeth. The mouth is the doorway to the body, rather than a separate organ, and is the access point for bacteria to enter the bloodstream via the gums. A lot of people with gum disease aren't aware of it, perhaps they just have blood in their spit after brushing teeth, but this unchecked damage to gums then becomes a high risk area for the rest of the body."

, a co-author of the study, added, "We are just beginning to scratch the surface of the interplay between 

 and other chronic diseases; whether that be kidney disease, diabetes or 

. Knowing the heightened risk that gum disease presents to patients who already have another chronic disease tells us that oral health has a significant role to play in improving patient outcomes."

	Following this paper, the team are now investigating the link between gum and kidney disease further, to identify if the association is causal, and if so, whether treating gum disease and maintaining oral health can improve the overall health of patients with kidney disease.

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	Professor Chapple said, "It may be that the diagnosis of gum disease can provide an opportunity early detection of other problems, whereby dental professionals could adopt a targeted, risk-based approach to screening for other chronic diseases."

Association between periodontitis and mortality in stage 3-5 chronic kidney disease: NHANES III and linked mortality study

This post was adapted from materials provided by the University of Birmingham. It has been edited for content and length.

New findings from the University of Birmingham show that patients with chronic kidney disease patients and periodontitis have a higher mortality rate than those with chronic kidney disease alone.