IALD & the LANAP® Protocol Featured in Ivanhoe Broadcast News Segment

Dr. James B. Miller is a Scottsdale, Arizona family and cosmetic dentist.  He has been utilizing the LANAP laser gum procedure since 2008 and is a fellow with the Institute for Advanced Laser Dentistry.  For more information about Dr. Miller and LANAP www.scottsdalelanap.com or www.drjamesmiller.com

Oral Health Report

Institute of Medicine issues report on U.S. oral healthcare

By DrBicuspid Staff

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April 11, 2011 -- The Institute of Medicine (IOM) has released its "Advancing Oral Health in America" report, which emphasizes the inextricable link between a person's oral health and overall health and also includes several recommendations for improving oral healthcare in the U.S.

In 2009, the Health Resources and Services Administration (HRSA) asked the IOM to assess the current oral healthcare sys­tem and recommend strategic actions for the U.S. Department of Health and Human Services (HHS) agencies.
Evidence shows that oral health complications may be associated with adverse pregnancy outcomes, respira­tory disease, cardiovascular disease, and diabetes.
Accessing oral healthcare is particularly difficult for certain populations, including people whose income falls below the federal poverty level, African Americans, Latinos, and children covered by Medicaid, the report noted.
Dental coverage largely determines access to oral healthcare and also predicts those who will seek it, but many people -- older adults, for example -- often do not have dental coverage. Even when individuals have dental coverage, they frequently do not receive needed services because of transportation barriers or a lack of providers who accept public insurance, among other factors, the IOM found.
The IOM's report included these organizing principles for a new oral health initiative based on what the group says are the areas in greatest need of attention, as well as approaches that have the most potential for creating improvements:

• Establish high-level accountability.
• Emphasize disease prevention and oral health promotion.
• Improve oral health literacy and cultural competence.
• Reduce oral health disparities.
• Explore new models for payment and delivery of care.
• Enhance the role of nondental healthcare professionals.
• Expand oral health research and improve data collection.
• Promote collaboration among private and public stakeholders.
• Measure progress toward short- and long-term goals and objectives.
• Advance the goals and objectives of the Healthy People 2020 initiative.

"HHS needs to have consistent messages for patients and healthcare professionals about the importance of oral health, but it is as critical for the department to have con­sistent messaging within its own organization that oral health is a priority," the report concludes. "HHS has the opportunity and responsibility to bring together different sectors to effect change in oral healthcare. There are many reasons that HHS should seize this opportunity. However, most important is that in spite of improvement, the American people continue to suffer, often silently, from avoidable and treatable oral diseases."
"Millions of Americans lack access to oral healthcare services," said Howard Koh, MD, assistant secretary for health, in a written response to the report. "This has to change."

Dr. James B. Miller is a Scottsdale, Arizona family and cosmetic dentist.  His websites are www.drjamesmiller.com and www.scottsdalelanap.com

Lasers in Periodontal Treatment

Lasers continue to make waves in periodontology

By Rochelle Sharpe, DrBicuspid.com contributing writer
"Lasers are a wonderful option for doctors and patients to consider in treating periodontal disease," Dr. Tilt said at the American Academy of Periodontology (AAP) annual meeting in Boston last month.
But just five days before Dr. Tilt delivered his lecture, complete with new statistics showing the advantages of laser treatments over traditional techniques, the AAP endorsed the ADA's cautionary policy on laser use. The ADA's Council on Scientific Affairs warned in its policy, released last April, that it was still too early to know "to what extent LANAP [laser-assisted new attachment procedure] is safe and effective across the spectrum of patients with chronic periodontitis."
The policy was another blow to Millennium Dental Technologies, which invented the LANAP procedure and began selling its PerioLase laser in 1999 for removing dental caries as well as diseased tissue in periodontal pockets. In its policy statement, the ADA dismissed the laser curettage procedure for periodontal pockets as having "no known clinical value."
But the criticism didn't deter Dr. Tilt, a Utah periodontist and instructor for Millennium's Institute for Advanced Laser Dentistry.
Speaking at the AAP meeting, he told a crowded room of periodontists that the ADA should "take another look" at the laser research. He presented data on 107 patients he'd followed over the past 10 years, comparing his results to three other periodontal studies. Only 46 of the 2,696 teeth he treated with lasers were lost to periodontitis, he said. That's just 1.7% teeth lost for patients followed for 6.2 years, on average.
By contrast, in the three studies examining patients treated with more traditional methods, 9.8% of teeth were lost in one study and approximately 5% of teeth were lost in the other two. The authors of these studies, however, followed patients much longer than Dr. Tilt did. The studies showing 5% tooth loss followed patients for 12.5 years and 13.6 years, while the one showing 9.8% tooth loss followed patients for 19 years.
Dr. Tilt also said that only 4.7% of his patients were going downhill after six years, compared to the longer studies where 14.3%, 15.8%, and 23% of patients were. Even though the other studies were longer, he said, their duration could not account for the poorer performance results.
Not only do patients get better results with LANAP, he said, but they are more likely to accept the laser treatment. With lasers, he said, there is no postoperative swelling or bleeding, no additional gingival recession, and no extra tooth sensitivity.
Dr. Tilt stressed the necessity of treating all his patients' teeth. "It's important to disinfect the entire mouth," he said, pointing out the laser's capacity to reduce infections. In the studies of more conventional methods, dentists did not treat each tooth.
Effectiveness questioned
In spite of such testimonials, though, few periodontists use lasers in their practices. Dr. Tilt estimates that fewer than 8% of his colleagues use them.

With LANAP, the laser fiber is inserted between the periodontal tissue and tooth to selectively remove diseased or infected pocket epithelium from the underlying connective tissue. Image courtesy of Millennium Dental.

The low numbers are partially due to the controversy over the lasers' effectiveness.
"There isn't a huge amount of research," said Meg Dempsey, an AAP spokeswoman. "There isn't anything conclusive."
Indeed, there are few studies on laser use for periodontal work, and they have generated vigorous debate. Even online forums are filled with heated discussions. A recent post about LANAP on a dentistry online forum generated 63 responses, with dentists analyzing the latest research studies and spinning conspiracy theories.
"The AAP is terrified of GP's with lasers," John G. McAllister, a California dentist, wrote on the OsseoNews forum. "And the AAP has every reason to be afraid of GP's having an effective tool for treating moderate to severe gum disease."
For its part, Millennium continues to cite the work of Raymond Yukna, D.M.D., M.S., director of advanced periodontal therapeutics at the University of Colorado, Denver School of Dental Medicine. In a 2007 study published in the International Journal of Periodontics and Restorative Dentistry (Vol. 27:6, pp. 577-587), Dr. Yukna reported his examination of a dozen teeth, half of which had been treated with the LANAP procedure. All six of the LANAP-treated teeth showed new cementum and new connective tissue attachment, whereas five of the six teeth in the control group showed no such attachments, he found.
The ADA position paper said the study "provides no more than pilot validation for this treatment concept." The small sample size and the condition of the diseased teeth make it difficult to extrapolate the results to the general population, it said.
Millennium vigorously opposed the ADA's analysis, calling it "inaccurate, misleading, and scientifically unsubstantiated."
"It is terribly unfortunate that ... the use of lasers for the purposes of treating periodontal disease, and the research that supports it, continues to be marginalized," wrote Delwin McCarthy, D.D.S., chief technology officer of Millennium, in a formal rebuttal to the ADA policy.
Millennium argues that Dr. Yukna's study was not small, given what it was examining. It is the fourth largest human histology study in the periodontal scientific literature, it said, pointing out that institutional review boards strictly limit the size of such studies.
History of skepticism
Using lasers for periodontal treatment has met with skepticism for years. Douglas Dederich, D.D.S., Ph.D., former vice-chair of the ADA's Council on Scientific Affairs and former chair of an ADA committee outlining laser standards, has repeatedly voiced uneasiness with laser procedures.
In 2000, he wrote the U.S. FDA that there was "significant concern" in the dental community that applying the laser in the gingival sulcus "represents a serious risk to the dental pulp." The damage may not be detectable by standard pulpal tests, he wrote, but research with animal tissue examined under a microscope had shown severe pulpal damage. If such damage were to occur in humans, it would require root canal therapy.
Later, in a 2004 article in the Journal of the American Dental Association titled "Lasers in dentistry: Separating science from hype" (Vol. 135:2, pp. 204-212), he and co-author Ronald Bushick, D.M.D., Ph.D., wrote that laser curettage "appears to be neither scientifically nor ethically justified." They did say, however, that early evidence shows "exciting potential" for lasers to produce superior attachment levels after root debridement compared to mechanical planing.
Dr. Dederich could not be reached for comment as to whether he thinks that potential is now any closer to reality. And the AAP declined to comment beyond its formal endorsement of the ADA policy.
So, for now, the controversy continues, with dentists relying on their own judgment, experience, and existing research to figure out what is best for their patients.
Copyright © 2009 DrBicuspid.com
Dr. James Miller is a Scottsdale, Arizona general dentist.  He has been using the LANAP procedure since 2008. Dr. Miller's websites are www.drjamesmiller.com and www.scottsdalelanap.com
October 12, 2009 -- As the first periodontist in the U.S. to practice laser-assisted new attachment procedure (LANAP) in his practice, Lloyd Tilt, D.D.S., M.S., has carefully tracked his patients' experiences over the past decade -- and been delighted with his findings.

New Toothpaste Tablet

Toothpaste tablets: The end of the tube?

By Rob Goszkowski, Assistant Editor
The tablets offer a "laundry list" of advantages over a tube delivery system, according to Scott Jacobs, president of Archtek and creator of the Toothpaste Tablet.

“I'm dumbfounded that after 140 years we're still dealing with the same delivery system.”
— Scott Jacobs, Artchtek president

"The first is sanitation because you're not swiping the tube against a used brush, which transfers all the microbes from the brush onto the end of the tube," he said. "There's an environmental advantage because the product comes in a recyclable container. None of the toothpaste tubes on the market can be recycled, and there's about 560 million per year in the U.S. alone that end up in landfills."
The tablets, which come in 60-tablet bottles or boxes of 100 individually wrapped doses, are also tidy. "I have two boys, so I've lived with the mess toothpaste makes," Jacobs laughed. "You've got goo on the sinks, the counter, the floor, inside the drawers. ..."
Traversing Transportation Security Administration checkpoints at airports with the toothpaste tablets is easier than with traditional tubes since the dry tablets are not subject to the 3 oz. liquid limit guidelines for carry-on items.
"I'm dumbfounded that after 140 years we're still dealing with the same delivery system," Jacobs said. "So many advances have been made in other areas toward mobility, sanitation, and lessening environmental impact."
The tablets contain cranberry extract (Exocyan), which reduces plaque, and xylitol to help mitigate the formation of caries. Two clinical studies, which are scheduled to be finished in June, are being performed at two different universities that Jacobs hopes will provide enough data for approval. He declined to name them until the studies are completed.
A clinical study conducted by Archtek provided enough evidence for the Dental Advisor to award it the Top Innovative Consumer Product of 2011 in January, according to Jacobs. The tablets received an 86% clinical rating from the Dental Advisor reviewers, with 57% saying they would recommend the product and 29% saying they would switch from a paste to the tablet.
8 years in the making
Jacobs first had the idea for a tablet-delivered dentifrice about eight years ago.
"I tried to introduce an effervescent tablet that created an amazing foaming action as soon as you put it in your mouth without ever needing a brush, but there were stability issues and expense-related ones," he said.
The idea for a tablet stuck, however. "The more I thought about a tablet-based delivery system, the more the advantages became apparent," he added.
Creating a cost-comparable product with similar dosing were two primary obstacles. The first aspect was overcome during research and development. Sorting out the matter of dosing and public perception will take more time.
"People often ask me, 'How many uses do I get out of a tube of paste?' " Jacobs said. "The recommended dose is somewhere around 12 brushings per ounce. But because there's never been anything different in the marketplace, the thought process of the public is, 'How do I compare a 60-tablet bottle to a tube of paste. Is it equal to one? Two?' They flat out don't know."
Jacobs referenced a recent Wall Street Journal article that reported the existence of more than 350 varieties of toothpaste. "It's tough for the consumer to perceive the nuances between them," he said.
Archtek, which was started in the 1960s by Jacobs's father after he invented the boiling water mouthguard, is hoping to gain the ADA seal of approval for the tablets. Jacobs is also working to add the tablets to consumer store shelves; the Wal-Mart travel section will begin carrying the product in June. Archtek has also had a presence at dental and travel goods conventions while courting organizations such as Cardinal Health and smaller, independent pharmacies.
"We're hitting everything from big boxes to brushing stations at dental offices," Jacobs said. "It's all about whether or not I can gain enough market acceptance early on before the really monster companies get into it."
Other companies are marketing similar products, although so far not on the same scale that Jacobs is working to achieve. Akina's Ceto-Q toothpaste tablets are being sold to travelers as a toothpaste alternative, and Lush, a U.K.-based cosmetics company, has launched a similar product in Europe that reportedly will be available in the U.S. beginning in June.

Dr. James Miller is a Scottsdale Family dentist.  His websites are www.drjamesmiller.com and www.scottsdalelanap.com
March 16, 2011 -- The dentrifice delivery system has changed little since the first tube of toothpaste was filled more than 100 years ago. But that could change with the introduction of chewable toothpaste tablets, which are less messy and more environmentally friendly.

Fruits and Veggies Prevent Oral Cancer

Fruits and vegetables can help prevent oral cancer

By Donna Domino, Associate Editor
"Current evidence supports a recommendation of a diet rich in fresh fruits and vegetables as part of a whole-foods, plant-based diet with limited consumption of meat, particularly processed meat," wrote Nita Chainani-Wu, DMD, PhD; Joel Epstein, DMD; and Riva Touger-Decker, PhD, in the JADA article.
In addition to discussing tobacco and alcohol use with patients (and, if relevant, betel nut and gutka consumption), as well as the risk of sexual transmission of human papillomavirus (HPV), clinicians should provide dietary advice for preventing oral cancer as part of routine patient education practices, they recommended.
Why fruits and vegetables?
Over the past 50 years, researchers have conducted more than 40 epidemiologic studies of the relationship between fruits and vegetable consumption and oral cancer risk, the JADA authors noted. A 2006 meta-analysis identified strong evidence of the protective role of vegetables and fruits, particularly citrus fruits, in the prevention of oral cancer (American Journal of Clinical Nutrition, May 2006, Vol. 83:5, pp. 1126-1134).
Similarly, a cohort study of risk factors for second primary cancers in patients with a history of oral and pharyngeal cancer (OPC), researchers at the National Cancer Institute of the National Institutes of Health found that eating fruits and vegetables has a protective effect (Nutrition and Cancer, 1994, Vol. 21:3, pp. 223-232). In another study, researchers at the School of Dentistry in San Juan, Puerto Rico, found fruit consumption to be protective against oral premalignant lesions (American Journal of Epidemiology, September 15, 2006, Vol. 164:6, pp. 556-566).

Oral cancer statistics More than 400,000 cases of oral and pharyngeal cancer (OPC) occur annually worldwide, and OPC is among the most common cancers, according to the World Health Organization. In the U.S., approximately 36,500 new cases and 7,800 deaths resulting from OPC occurredin 2010, according to the National Cancer Institute. More than 90% of oral cancers are squamous cell carcinomas. Prevention of these cancers in dental practice settings has focused mainly on early detection of oral premalignant mucosal changes. According to the American Cancer Society's Guidelines on Nutrition and Physical Activity for Cancer Prevention, one-third of the more than 500,000 cancer deaths that occur in the U.S. each year can be attributed to diet and physical activity habits, including overweight and obesity.

While the mechanisms by which diet influences cancer risk are not fully understood, the JADA authors wrote, certain compounds in food may be protective against cancer. Vitamins C and E have antioxidant properties and may prevent DNA damage by reducing exposure to free radicals of oxygen. Terpenes, a group of compounds present in certain plants such as citrus fruits, can influence cell cycle progression and induce apoptosis. In addition, fruits and vegetablescontain micronutrients -- also known as phytonutrients -- that may act synergistically to prevent cancers, including OPC, the researchers noted.
Fruits, particularly berries that are high in ellagic acid, help prevent oral cancer, as do the isothiocyanates in cruciferous vegetables such as broccoli, cauliflower, cabbage, and Brussels sprouts, according to Tieraona Low Dog, MD, a clinical associate professor of medicine at the University of Arizona Health Sciences Center.
"We should all be helping our patients learn how to incorporate a minimum of five servings per day of fruits and vegetables into their diet," Dr. Low Dog told DrBicuspid.com.
In addition to cancer prevention, a growing body of data demonstrates the beneficial effects of omega-3 fatty acids, probiotics, and vitamin D for preventing periodontal disease, she added.
Other food components, such as nitrites in processed meats, which may form carcinogenic nitrosamines, may increase the risk of developing cancer, the JADA authors noted. In addition, eating salted meat, processed meat, and animal fat increases the risk of developing oral cancer. A 2008 study conducted at the Louisiana State University Health Sciences School of Public Health showed that high consumption of dairy products is a risk factor for head and neck squamous cell cancers and also has been associated with an increased risk of developing prostate cancer and ovarian cancer (Head & Neck, September 2008, Vol. 30:9, pp. 1193-1205).
Education is key
In addition to performing thorough head and neck and oral mucosal examinations to identify precancerous changes, oral healthcare professionals should educate patients about oral cancer prevention, including nutrition, the JADA authors concluded. This is particularly important for patients at an increased risk of developing OPC, including:

• Those who use tobacco or have a history of tobacco use
• Those who consume alcohol, betel nut, or gutka
• Patients with oral premalignant conditions such as leukoplakia, erythroplakia, submucous fibrosis, or lichen planus
• Those with a history of head and neck or upper aerodigestive tract cancers

"I applaud the dental community for increasing the education and awareness of their professionals with regard to the importance of nutrition and oral health," Dr. Low Dog said.

Dr. James Miller is a Family and Cosmetic Dentist located in Scottsdale, Arizona.  His websites are www.drjamesmiller.com or www.scottsdalelanap.com
March 3, 2011 -- Oral healthcare professionals can play an important role in preventing oral cancer by educating patients about oral cancer prevention strategies, including eating lots of fruits and vegetables, according to a study in the Journal of the American Dental Association (JADA, February 2011, Vol. 142:2, pp. 166-169).

Obesity and Periodontal Disease

Obese patients at higher risk of perio disease

By Rabia Mughal, Associate Editor

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February 24, 2011 -- A recent study conducted by researchers from the University of North Carolina found that dentists are interested in helping patients with serious weight issues but are afraid of offending them and appearing judgmental.

A large number of dentists would be more willing to have such discussions if obesity were definitively linked to oral disease, the study authors noted.
Now researchers from the University of Pittsburgh have found a positive association between periodontal disease and obesity, according to data from a study to be presented next month at the International Association for Dental Research (IADR) conference in San Diego.
"The prevalence of obesity is the public health challenge of our time as it can damage quality of life, boost medical costs, and is recognized as a predisposing factor to major chronic diseases ranging from cardiovascular disease to cancer," the study authors noted.
They hypothesized that the prevalence of periodontal disease would be greater in obese individuals and used electronic health records from the University of Pittsburgh School of Dental Medicine to retrospectively identify 4,537 unique individuals (2,445 female, 2,092 male, average age 54). The patient records documented weight, height, age, sex, type 2 diabetes status, and periodontal evaluation.
Periodontal disease was classified as periodontal pocketing of 4 mm or greater. Body mass index (BMI) was calculated, and patients with a BMI of 30 or higher were classified as obese, while those with a BMI below 30 were classified as nonobese.
"Statistical analysis of the retrospective data collected established that periodontal disease is more prevalent in obese individuals," the authors noted.
Systemic condition?
Obesity might represent a systemic condition influencing onset and progression of periodontal disease through the gateway of metabolic syndrome, the proinflammatory state characterized by insulin resistance and oxidative stress, in a bidirectional relationship, the researchers added.
"Obesity is an obvious national problem and is increasingly a global problem as well, affecting societies that never before were necessarily affected by obesity," study author Pouran Famili, DMD, a professor and chair of the department of periodontics and preventive dentistry at the University of Pittsburgh School of Dental Medicine, told DrBicuspid.com. "Not much has been done about it and its relation to dental issues."
While not surprising, the findings do indicate that more research regarding the relationship between obesity and periodontal disease needs to be conducted, she added.
Positive associations are repeatedly demonstrated between prevalent periodontal disease and obesity, but establishing any physiological mechanism behind this relationship will require well-designed prospective research, Dr. Famili and her colleagues concluded.
Other studies have come to similar conclusions.
Dentists in clinical practice can expect a higher prevalence of periodontal disease among obese adults, although the evidence pointing to a direct link between obesity and periodontal disease is limited, according to a recent study in the Journal of Periodontology (December 2010, Vol. 81:12, pp. 1708-1724).
"This positive association was consistent and coherent with a biologically plausible role for obesity in the development of periodontal disease," the authors of that study concluded. "However, with few quality longitudinal studies, there is an inability to distinguish the temporal ordering of events, thus limiting the evidence that obesity is a risk factor for periodontal disease or that periodontitis might increase the risk of weight gain."
Robert Genco, DDS, PhD, a distinguished professor of oral biology and microbiology at the State University of New York at Buffalo School of Dental Medicine, has conducted similar research (Journal of Periodontology, November 2005, Vol. 76:11-s, pp. 2075-2084). He noted that while there is no new information in this new study, the findings are "confirmatory."
In addition, he said, it is possible that inflammatory cytokines produced by adipose tissue could increase the inflammatory response to periodontal bacteria.
"The dentist can better understand why obese individuals may be at greater risk for periodontal disease, let the patient know this, and encourage weight loss as part of management of periodontal disease," he concluded.

For more information about periodontal disease and its treatment www.scottsdalelanap.com or www.drjamesmiller.com/lanap.html

Is Europe Preparing to Ban Amalgam?

Is Europe looking to ban dental amalgam?

By Rob Goszkowski, Assistant Editor
At present, the EC's position is that dental amalgams and various alternative materials are considered effective and safe to use, based on a 2008 assessment by the Scientific Committees on Emerging and Newly Identified Health Risks (SCENIHR) and the Scientific Committee on Health and Environmental Risks (SCHER).
February 14, 2011 -- Fresh challenges to the use of dental amalgam in Europe may arise following the release next month of a new European Commission report that is expected to recommend a phase out of amalgam. Some countries are already moving in that direction.

But in a preliminary report published online in July, Bio Intelligence Service (BIOIS) -- the French environmental and health consulting firm tasked with producing the EC report to be released in March -- recommended phasing out mercury amalgam dental restorations throughout Europe.

“There is no project aimed at banning dental amalgams so far.”
— Julie Aurnaud, European
     Commission press officer

Even so, "There is no project aiming at banning dental amalgams at the European level so far," Julie Aurnaud, press officer for the French representation of the EC, told DrBicuspid.com in an e-mail. "The commission will take a position on dental amalgams once the results are analyzed."
Currently in the EU, Denmark and Sweden have banned dental amalgam altogether, and Germany and Norway have restricted its use. The U.K. and France have done neither, although the new EC report could change France's position on the restorative material since it is already viewed unfavorably by many there, according to a recent article in the Guardian.
"France's 40,000 dentists use it less and less for two reasons: The fuss about mercury has made them cautious, but also for reasons of appearance," Michel Goldberg, spokesman for the French Dental Association, told the Guardian.
Mercury phase down
The EC has been working to reduce mercury exposure to humans since the completion of a 2005 Extended Impact Assessment by the EC's Directorate-General Environment of the Commission Services. That report contained a 20-point plan for limiting emissions, reducing supply and demand, protecting people from exposure, developing a better understanding of the problems mercury poses, and promoting international action.
More recent reports on the matter call for greater use of amalgam separators and more research into the impact of amalgam on health. BIOIS' preliminary report does acknowledge SCENIHR/SCHER's opinion that amalgam is safe. However, BIOIS also proposes a ban as a potential action and suggests that the conclusions of the SCENIHR/SCHER report could be revised and reassessed to support such a ban. It also notes the importance of taking into account information gaps highlighted in the 2008 assessment.
In its preliminary report, BIOIS weighed the potential impact of legislation banning dental amalgam on providers and patients, including costs, the life span of alternative restoratives, and environmental concerns. Ultimately, it sees caries prevention as a key strategy going forward.
BIOIS also referenced a December 2008 EC study, Options for reducing mercury use in products and applications, and the fate of mercury already circulating in society, conducted by Consultancy within Engineering, Environmental Science and Economics (COWI). According to BIOIS, COWI concluded that there is "sound basis for concluding that dental amalgam ... should be seriously considered for further restrictions."
BIOIS also believes that changing the guidelines for the exportation of elemental mercury should be considered. The EU is the world's largest exporter of mercury, and although a ban on exportation begins on March 15, 2011, an exception for medical usage exists for amalgam. There is concern that in some countries it is purchased under the guise of medical use and diverted to small-scale mining, BIOIS noted. Extending the ban to medical usage is suggested as an option, the organization concluded.

Dr. James Miller is a Family and Cosmetic Dentist located in Scottsdale, AZ.  His website is located at www.drjamesmiller.com or www.scottsdalelanap.com

Tongue Piercings: An Expensive Habit

Tongue Piercing: An Expensive Hobby

By Arthur Perry, MD, FACS

Do you have your tongue pierced? Sure, it only cost you $40, and that includes the jewelry. But in the end, it might just be the most expensive hobby you have. It turns out that the gums of people with piercings are exposed to high amounts of all sorts of bacteria, and that causes the gums in the front teeth to recede, leading to something called periodontal disease. As if that’s not enough of a problem, half of people with piercings wind up with chipped teeth, mostly in the back of the mouth. Dentistry to salvage your teeth can dwarf the cost of the initial piercing, even if you have a diamond stud.

Whether you care about the appearance of your teeth or not, piercings will eventually make your gums bleed and become sore – that’s called gingivitis. And when the roots of the teeth are exposed, they become sensitive to cold and heat and eventually lead to tooth loss.

But that’s not the only problem associated with tongue piercings. It turns out that bacteria love the channel that traverses your tongue. And these germs set up little communities called biofilms on the surface of the studs. The bugs create little fortresses that make the bacteria resistant to mouthwash and even antibiotics. Studs made of stainless steel make the best homes for these colonies of bacteria and ones made of the plastic called polypropylene make the worst. Bacteria in your mouth cause increased inflammation in your body. Many doctors think that this type of inflammation can lead to all sorts of problems, including heart disease.

So, the simple act of piercing your tongue, seemingly so cool to 17-year-olds, can lead to all sorts of dental and medical problems.

Think about this: the next time you pucker up and kiss your pierced mate, as you entwine your tongues, you will be visiting the 80 or more different species of bacteria that call that piercing “home."

Dr. James Miller is a Scottsdale Arizona Family and Cosmetic Dentistry. His website is www.drjamesmiller.com

US Regulators Call For Less Fluoride in Drinking Water

U.S. regulators call for less fluoride in drinking water

January 7, 2011 -- Americans are getting fluoride from a variety of sources that did not exist in the 1940s, when community water fluoridation first got under way. Water consumption patterns have changed too.

So, while continuing to stress the benefits of fluoride, officials from the U.S. Department of Health and Human Services (HHS) have proposed that the recommended level of fluoride in drinking water be set at the lowest end of the current optimal range to prevent tooth decay. At the same time, officials from the U.S. Environmental Protection Agency (EPA) announced they are initiating a review of the maximum amount of fluoride allowable in drinking water.
In a joint statement released January 7, officials from both agencies framed the actions as a way of maximizing the health benefits of water fluoridation to Americans by continuing to prevent tooth decay while reducing the possibility of ill effects.
"One of water fluoridation's biggest advantages is that it benefits all residents of a community -- at home, work, school, or play," said HHS Assistant Secretary for Health Howard Koh, MD, MPH, in the statement. "And fluoridation's effectiveness in preventing tooth decay is not limited to children but extends throughout life, resulting in improved oral health."
EPA Assistant Administrator for the Office of Water Peter Silva stressed that the agencies are reviewing fluoride levels in response to "the most up-to-date scientific data."
"EPA's new analysis will help us make sure that people benefit from tooth decay prevention, while at the same time avoiding the unwanted health effects from too much fluoride," he said.
Fluoride occurs naturally in drinking water, but levels vary from low to high in different regions of the U.S.
Lifestyle changes
At what are considered optimum levels, public health officials and the ADA have long promoted fluoride as a way of reducing dental caries. But research has also found that consumption at excess levels may cause fluorosis and skeletal deformities (Journal of the American Dental Association, November 2008, Vol. 139:11, pp. 1457-1468; October 2009, Vol. 140:10, pp. 1228-1236; January 2011, Vol. 142:1, pp. 79-87).
For the past 65 years, communities across the country have been supplementing naturally occurring fluoride in their water supplies to reach a level considered sufficient to promote oral health, especially among children. The fluoride level long recommended by health officials to prevent caries has been set at a range of 0.7 to 1.2 milligrams per liter (mg/L) of water. The HHS is now proposing the level be set at 0.7 mg/L of water.
The reassessment was initiated in part due to new research into changes in diet and lifestyle, as well as regional water consumption patterns seen over time, officials said. The old range was in part based upon differences in regional climate and water consumption that have become somewhat outdated with the advent of air conditioning. In addition, Americans have access to more sources of fluoride than in the past. Besides water, other sources of fluoride include dental products such as toothpaste and mouth rinses, prescription fluoride supplements, and fluoride applied by dental professionals.
The findings are also being used to guide the EPA in making a determination of whether to lower the maximum amount of fluoride allowed in drinking water. Under the Clean Water Act passed by Congress in 1974, the EPA must determine the level of contaminants in drinking water at which no adverse health effects are likely to occur. The EPA has set the maximum contaminant level goal for fluoride at 4.0 mg/L, based on the best available science to prevent potential health problems.
But in 2006, an analysis by the National Research Council concluded the EPA's drinking water standard was too high to protect against adverse health effects.
And the National Academy of Sciences reviewed new data on fluoride and issued a report recommending that EPA update its health and exposure assessments to take into account bone and dental effects and to consider all sources of fluoride.
Any formal change to the drinking water regulation would be made only after a formal proposal, public comment period, and finalization process.
As of 2008, 195.5 million Americans, or 72.4 % of the population on public water systems, had access to optimally fluoridated water, according to the most recent statistics available from the Centers for Disease Control and Prevention, which has hailed the fluoridation of drinking water as one of the 10 great public health achievements of the 20th century.
Opposition and support
In some communities, however, efforts have met continued resistance from opponents who contend that fluoridation amounts to forced medication or an unwanted intrusion of government into private life.
Fluoridation opponent Paul Connett, PhD, who heads the Fluoride Action Network, dismissed the January 7 announcement as "spin and collusion" between federal health officials and the dental establishment to continue fluoridation, which he argues is dangerous, especially to children.
"It's a stupid bloody practice," Connett said. "Once you put a medicine in the water, you can't control the dose."
The ADA commended the move by health officials to revisit fluoride guidelines and standards.
"As a science-based organization, the ADA supports the Department of Health and Human Services' recommendation," the ADA said in a statement. "This adjustment will provide an effective level of fluoride to reduce the incidence of tooth decay while minimizing the rate of fluorosis in the general population."
ADA President Raymond Gist, DDS, called the HHS recommendation "a superb example of a government agency fulfilling its mission to protect and enhance the health of the American people."
Shelly Gehshan, director of the Pew Children's Dental Campaign, praised the actions of the HHS and EPA.
"These announcements show that federal health officials are carrying out their proper role and relying on the best science to do so," she told DrBicuspid.com. "The public can feel reassured that optimally fluoridated water is a safe, effective way for people of all ages to prevent tooth decay."
The notice of the proposed recommendation will be published in the Federal Register soon, and HHS will accept comments from the public and stakeholders on the proposed recommendation for 30 days at CWFcomments@cdc.gov. HHS is expecting to publish final guidance for community water fluoridation by spring 2011.
Copyright © 2011 DrBicuspid.com
By: Mary Otto, DrBicuspid.com contributing writer
Dr. James Miller is a Scottsdale, Arizona family dentist. www.drjamesmiller.com

Medicine and Oral Health Screenings

Many physicians still resist doing oral health assessments

December 30, 2010 -- It's been 10 years since the U.S. surgeon general's report on oral health in America, which among other things advocated interdisciplinary training between medical and dental providers. But current research shows that primary medical care providers are still not comfortable performing basic oral health assessments, and many consider oral health outside their realm of practice.

"The time has arrived for each profession to recognize the benefit of coordinated treatment plans to better manage patients," Charles Cobb, DDS, PhD, professor emeritus at the University of Missouri-Kansas City School of Dentistry and co-author of a new study that used the theory of planned behavior to examine nurse practitioners' understanding of the link between periodontal disease and systemic health (Journal of Periodontology, December 2010, Vol. 81:12, pp. 1805-1813).
The researchers surveyed 200 primary care providers about practice behaviors, attitudes, opinions, and knowledge regarding the periodontal disease-systemic link and used 137 partially and fully complete questionnaires for their data analyses. Of the 137 questionnaires, 123 were completed by nurse practitioners.
Dr. Cobb and colleagues found that 22% of the respondents reported they always or routinely screen for periodontal disease. Using the theory of planned behavior -- which explains behavior as a function of intent, including such factors as attitudes, social norms, and perceived control -- they found that the likelihood of screening increased if the providers felt confident in their training (attitude), felt like it was within their scope of practice (social norm), and felt that they had control over office protocols (control).
"A change in professional and peer expectations about periodontal assessments would be an important factor in improving rates of screening," said Dr. Cobb. Limited time and concerns over reimbursement were also found to be factors.
Interdisciplinary/interprofessional education
In addition to recognizing the importance of the oral and systemic health link, primary medical care providers are being asked to assess oral health to help overcome disparities in access to care. Low-income and minority children, the elderly, people with developmental disabilities, and adults with less than a high school education are at particular risk for limited access to oral health services and a shortage of dental providers, according to the U.S. Centers for Disease Control and Prevention.
To address these disparities, health personnel who encounter patients without oral healthcare need to be able to perform simple assessments (Journal of Dental Education, May 2004, Vol. 68:5, pp. 505-512). Personnel also need to be aware of oral health resources in the community that will take patients on referral. In the case of infants and young children in the U.S., 95% have a physician but very few have a dentist, the researchers noted.
Other studies have shown that pediatric residents receive little training before completing their programs. When 661 pediatric graduating residents were surveyed in 2006, 35% of respondents stated they received no oral health training during residency (Pediatrics, August 2008, Vol. 122:2, pp. e465-e471). Of those who did receive some training, 73% had less than three hours of training and only 14% had clinical observation time with a dentist.
Similarly, a survey sent to 1,618 postresidency fellows of the American Academy of Pediatrics found that while more than 90% of pediatricians said they should examine their patients' teeth for caries and educate families about preventive oral health, in practice only 54% reported examining the teeth of more than half of their 0- to 3-year-old patients (Academic Pediatrics, November-December 2009, Vol. 9:6, pp. 457-461). In addition, the survey found that less than 25% of pediatricians had received oral health training.
Primary care training for adults fared no better. In a survey issued to incoming internal medicine trainees, 82% of the 115 respondents reported they never asked patients if they had been diagnosed with periodontal disease, and 90% reported not receiving any training about periodontal disease in medical school (J Periodontol, March 2010, Vol. 81:3, pp. 359-363). Nearly 70% reported that they were not comfortable "at all" doing a simple periodontal exam, 46% felt that discussing/screening for periodontal disease was outside their role as physicians, and 23% said they never referred patients to dentists.
"Somehow, there must be a recognition of value to doing even a 'tongue blade' visual examination of the oral cavity to determine obvious signs of inflammation," says Dr. Cobb. "Currently, such a visual examination is not part of the routine in medicine and nursing."
However, the "historic separation" of medicine and dentistry have kept the systems of education and training, financing, and service delivery separate, noted Wendy Mouradian, MD, MS, professor of pediatric dentistry and pediatrics at the University of Washington Schools of Dentistry and Medicine and co-author on the 2009 Academic Pediatrics and 2004 Journal of Dental Education papers.
"While microorganisms know no such barriers, health professional education and primary care practice lags behind today's science," she told DrBicuspid.com. "What is needed are cultural changes within medicine and dentistry and practical strategies to ensure better communication between practitioners and integration, or at least coordination, of health services."
Improving education
Efforts are under way to address these disparities. A 2003 Institute of Medicine (IOM) report, "Health Professions Education: A Bridge to Quality," concluded that all health professionals should be educated to:

• Provide patient-centered care
• Work in interdisciplinary teams
• Employ evidence-based practice
• Apply quality improvement approaches
• Utilize informatics

Using the IOM report as a guide, and as part of a study initiative called "New Models of Dental Education" funded by the Josiah Macy Jr. Foundation, three panels were convened to discuss the future of dental education. Panel 2 of the Macy Study, held in December 2006 and co-sponsored by the American Dental Education Association (ADEA) and the Association of American Medical Colleges (AAMC), discussed education and clinical training of both dentists and physicians (J Dent Educ, February 2008, Vol. 72:2 Suppl., pp. 73-85).
The panel concluded that medical providers would best be trained in oral health using a "spiral curriculum" on oral-systemic health in five key areas: caries, periodontal disease, dental public health issues, oral cancer, and the oral-systemic health relationship. Optimally, content from each of these five areas would be interspersed throughout medical training, starting in basic science courses and then reinforced at higher educational levels and in clinical rotations.
The 19th-century distinction between medicine and dentistry is becoming obsolete as the relation between oral and systemic health blurs, the Macy Panel 2 noted. To integrate new knowledge across the research literature, the panel recommended that clinicians become "sophisticated users of science and technology and avid consumers of interdisciplinary research to best implement the latest in evidence-based practice."
Building on this work, the AAMC will be mounting an effort to expand and disseminate curriculum resources available to medical schools through a cooperative agreement awarded by the Maternal and Child Health Bureau of the Health Resources and Services Administration (HRSA), Dr. Mouradian noted. This award reflects a new focus on oral health within the federal government. Both HRSA and the U.S. Department of Health and Human Services have identified the integration of oral health into primary care as strategic priorities.
"All this will take time and work," Dr. Mouradian said. "But without such efforts, we will be seriously hampered in our ability to address the profound oral health disparities identified by the surgeon general."
Copyright © 2010 DrBicuspid.com
By: Erin Archer, R.N., DrBicuspid.com contributing writer
Dr. James Miller is a Scottsdale Arizona family dentist. His website is http://www.drjamesmiller.com/