Engineers on the Research Train
By David G. Jones
A new research program in Northern California may break new ground in improving tissue repair and maintenance of tissue integrity.
One of six studies funded by the National Institute of Dental and Craniofacial Research, the project is designed to help develop greater understanding of how to engineer better tissue repair. Researchers hope to use what is learned to improve people’s oral, dental, and maxillofacial health.
The California study, funded at $1.5 million for each year of the five-year research program, is being managed by the University of California, San Francisco, School of Dentistry.
Caroline Damsky, PhD, is a professor of stomatology at the UCSF dental school. She is also director of the Comprehensive Oral Health Research Center of Discovery.
"The idea is to speed the path from the research bench to the chairside," Damsky says. "NIDCR asked us to choose a theme for our research and approach it from the perspectives of basic and clinical research, treatment, prevention, and community outreach. We chose tissue repair and maintenance of tissue integrity -- including 12 projects in all -- from basic research to behavioral science, all related to the theme. Our goal is to enhance oral/craniofacial tissue repair and to prevent deterioration of these tissues."
Ann Sandberg, PhD, is chief of NIDCR’s Neoplastic Diseases branch and has shepherded 22 grant applications through the receipt, review, and award process.
"We’re looking to try to understand mechanisms of oral and craniofacial diseases and disorders, and identify mechanisms to either intervene or prevent them," Sandberg says. "All of the projects we fund are geared to finding the answers and applying them so they can be applied to mainstream oral, dental, and craniofacial medicine. The goal certainly would be to improve the oral, dental, and craniofacial health of the nation."
"Each of the six research centers selected nationwide has to have an institutional sponsor, so as the host institution, the majority of individuals participating in the research are faculty of the dental school or UCSF," says dental school Dean Charles N. Bertolami, DDS. "And we’re also using a lot of their expertise in these research areas."
The research is being performed by a team of 35 -- including principal investigators, co-investigators, graduate students, postdoctoral fellows, and hygienists -- all working on a dozen fronts simultaneously.
"On the prevention side, for example, we’re looking at improved risk-assessment and prevention for early childhood caries, and certain types of TMD," Damsky says. "From the clinical research side, we’re investigating fracture repair and improving restoration of damaged or missing tissues resulting from trauma or congenital anomaly. And we also want to gain a better understanding of oral maxillofacial issues."
One example of the research set to begin is a project on early childhood caries prevention, managed by Associate Center Director Jane Weintraub, DDS, MPH.
"We’re trying to find out ways to prevent early childhood caries and, in particular, to test the efficacy of fluoride varnish in preventing early childhood caries," says Weintraub, who is also currently interim co-chair of the Department of Dental Public Health and Hygiene, and chair of the Division of Oral Epidemiology. "We’ll do a randomized clinical trial on very young children, 6 to 36 months old, and follow them for two years, and at two different sites specializing in populations especially vulnerable to early childhood caries."
The early childhood caries project is an example of how it and the other 11 center projects fit into the center’s overall theme.
"Our overall theme is enhancing tissue integrity," Weintraub says, "so here we’re talking about applying the varnish to try to prevent disease to preserve the enamel. We’ll also look at biological and chemical salivary markers as well as behavioral and demographic factors to see if they are predictors of caries."
Bertolami says that when the NIDCR in the past supported research programs, it was enough to make a proposal, receive the funding, do the work, and publish the results.
"That’s no longer the case, because we’re now held to a higher standard," he says. "Rather than hoping that someday someone will pick it up and find a practical application, the outcome is expected to translate into practical benefit."
Damsky, like Bertolami, wants to see the data from basic research lead to more translational and clinical research.
"We hope that risk assessment projects will lead to more effective screening for oral and dental disease, and that the prevention and education projects will lead to a reduction in destructive behaviors that affect tissue integrity," she says.
Bertolami says that the center approach better organizes the research to accelerate the transition from the bench to the chairside.
"What I see the centers doing is organizing the process in a way that makes it more likely that discovery can be developed and applied sooner than in the case of a more informal or less organized fashion that has usually been the case in the past," he says.
Steven G. Detsch, DDS, CDA’s chair of the Council on Dental Research and Developments, is excited about what the study could portend for the practice of dentistry and oral health.
"The types of research being done on tissue repair and regeneration could revolutionize the practice of dentistry as we know it," he says.
SIDEBAR
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The center’s research program studies include: |
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Bone remodeling and repair |
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Tissue engineering |
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Structural properties of dentin |
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Periodontal bone loss |
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Childhood caries |
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Prevention of the destructive effects of smoking |
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Better evaluation of treatment outcomes for cleft lip and palate |
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Increased understanding of the etiology of certain TMD |
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Health care provider education on the prevention of domestic violence |
A Dose of Information Is Good Fluoride Prescription
With all the talk and activity in the state regarding the benefits of fluoridation, dental professionals may need a refresher on when and in what dosage fluoride supplements should be prescribed for children.Before prescribing supplemental fluoride, the dentist will need to know several things about the child's current fluoride intake. A thorough history can provide that information, and the dentist should query several areas. Is the child drinking bottled water and, if so, is it fluoridated? Is the child taking prescribed supplemental vitamins from his or her pediatrician and, if so, are they supplemented with fluoride? Does the child live in a fluoridated community and, if so, is he or she drinking tap water or is his or her formula prepared with fluoridated water? Does the child live in a suboptimally fluoridated community and, if so, what is the fluoridation level of the child's drinking water? The local water district is the authority responsible for carrying out fluoridation and therefore should know the fluoride ion level in its water. Well water can be tested for fluoride by the county health department.
Once the level is known, a dentist can use the accompanying chart from the ADA Council on Access, Prevention and Interprofessional Relations to determine the appropriate amount to prescribe. The National Academy of Sciences through its National Research Council, the U.S. Public Health Service, and the Institute of Medicine's Dietary Intake Reference manual all recognize that there are numerous sources of fluoride intake in food materials as well. Having taken that into consideration, the following chart will provide you with the recommended supplementation guide for children age birth to 16 years.
Spend some time talking with your patients about the proven dental health benefits of fluoride. Reinforce the concept of supervised brushing with fluoridated toothpastes for toddlers up to age 4. Educating your patients and their parents will help clear the misconceptions that are being thrown around by a small, poorly informed group of nay-sayers about the purported harmful effects of properly prescribed fluoride supplements and optimally fluoridated drinking water.
Dietary Fluoride Supplement Schedule 1994
Approved by the American Dental Association, American Academy of Pediatrics, American Academy of Pediatric Dentistry.
Dietary Fluoride Supplement Schedule 1994 |
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Approved by the American Dental Association, American Academy of Pediatrics, American Academy of Pediatric Dentistry |
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Age |
Fluoride ion level in drinking water* |
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<0.3 ppm |
0.3-0.6 ppm |
>0.6 ppm |
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None |
None |
None |
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6 months – 3 years |
0.25 mg/day** |
None |
None |
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3 – 6 years |
0.50 mg/day |
0.25 mg/day |
None |
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6-16 years |
1.0 mg/day |
0.50 mg/day |
None |
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* 1.0 part per million (ppm) = 1 mg/l |
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** 2.2 mg sodium fluoride contains 1 mg fluoride ion. |
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| Reprinted with permission from American Dental Association, Council on Access Prevention and Interprofessional Relations. Caries diagnosis and risk assessment: a review of preventive strategies and management. J Am Dent Assoc 126(Suppl), 1995. | |||
Give a Hand to the Basics
It’s the most basic infection control measure in the health professional’s arsenal, but that probably makes hand washing one of the easiest to overlook.
Hands have long been recognized as one of the most important carriers of microorganisms in the spread of disease, but proper hand washing techniques can significantly reduce this risk, according to the Organization for Safety & Asepsis Procedures publication Focus, No. 3, 1998.
OSAP offers the following reminders on properly washing hands:
· Wash hands before and after donning gloves.
· Consider skin sensitivities and allergies when selecting a hand washing agent.
· Use a thorough surgical scrub at the beginning of the clinic day.
· For subsequent washing, lather for about 15 seconds.
· Don’t wear jewelry, and keep nails short.
· Clean under nails.
· Direct particular attention to the thumb and fingertips.
· Rinse with cool to lukewarm water.
· Use disposable paper towels to dry hands.
· Use the towel to turn off the faucet.
· Dry hands completely before donning gloves.
· Maintain epithelial integrity. Dry, chapped hands can make a person more susceptible to infection.
Lead Linked to Increased Caries
Environmental lead exposure is associated with an increased prevalence of dental caries in the U.S. population, especially among poor and disadvantaged children, according to a study in the June 23/30 issue of the Journal of the American Medical Association.
Mark E. Moss, DDS, PhD, of the University of Rochester School of Medicine and Dentistry in Rochester, N.Y., and colleagues studied 24,901 people age 2 and older who participated in the Third National Health and Nutrition Examination Survey to examine the relationship between blood lead levels and dental caries.
The researchers report that the blood lead level was significantly associated with the number of affected surfaces (decayed, missing, or filled) for both deciduous teeth and permanent teeth in all age groups, even after adjusting for sociodemographic characteristics, diet, and dental care. Among children aged 5 to 17 years, a 0.24-µmol/L (5-µg/dL) change in blood lead level was associated with an 80 percent elevated risk of tooth decay. The researchers estimate that for the general population, 13.5 percent of the tooth decay among 5- to 17-year-olds is attributable to high levels of lead exposure and 9.6 percent of the tooth decay is attributable to moderate levels of lead exposure.
The researchers note that a recent study showed that family income level was particularly linked with the proportion of children having decayed teeth.
"The results of the present analyses suggest that environmental lead exposure may explain, at least in part, the disproportionately high rate of dental caries among disadvantaged children and adolescents," the authors write.
But this study suggests that the association between poverty and tooth decay is only partially explained by lead exposure. The authors add that they cannot demonstrate conclusively that environmental lead exposure is causally linked to dental caries on the basis of observational data alone.
Study Shows Discrepancy in Level of HMO Care
Investor-owned health maintenance organization plans had lower rates for all 14 quality-of-care indicators studied when compared with not-for-profit HMO plans, according to an article in the July 14 issue of the Journal of the American Medical Association.
David U. Himmelstein, MD, from Cambridge Hospital/Harvard Medical School in Cambridge, Mass., and colleagues reported on quality-of-care data from the National Committee for Quality Assurance’s Quality Compass 1997, which included the Health Plan Employer Data and Information Set and HMO accreditation surveys. These data reflect 1996 plan characteristics and performance for 329 HMO plans (248 investor-owned and 81 not-for-profit) in 45 states, representing 56 percent of the HMO enrollment in the United States. The authors examined all 14 of the NCQA’s "Effectiveness of Care" variables and found that investor-owned HMO plans had lower rates for all 14 indicators. The largest differences in quality-of-care rates were in two indicators for patients with serious medical illnesses, namely treatment following hospitalization for myocardial infarction and diabetes mellitus.
The cost per HMO member per month averaged $128 in investor-based owned plans as opposed to $127.50 in not-for-profit plans, according to the authors. The percentage of revenues spent on medical and hospital services averaged 80.6 percent in investor-owned plans and 86.9 percent in not-for-profit plans.
"Hence, spending on profit and administrative overhead was about 48 percent higher in investor-owned plans (19.4 percent versus 13.1 percent for non-profit plans)," according to the authors.
The data showed that investor-owned HMOs reported lower rates than not-for-profit HMOs for all 14 quality-of-care indicators. Among them were:
* Beta-blocker use by patients discharged from the hospital after myocardial infarction with no evidence of contraindications to beta-blocker agents: 59.2 percent of members in investor-owned HMOs and 70.6 percent of members in not-for-profit HMOs.
* Of patients with diabetes who are receiving insulin or an oral hypoglycemic agent: 35.1 percent of members in investor-owned HMOs had annual eye exams and 47.9 percent of members in not-for-profit HMOs had annual eye exams.
* Overall immunization completion rate for 2-year-olds (includes diphtheria pertussis tetanus, oral poliovirus, mumps measles rubella, Haemophilus influenza type B and hepatitis B immunizations): 63.9 percent of members in investor-owned HMOs and 72.3 percent of members in not-for-profit HMOs.
* Mammography performed within two years for women aged 52- through 69-years-old: 69.4 percent of members in investor-owned HMOs and 75.1 percent of members in not-for-profit HMOs.
* First trimester prenatal care rate: 83.1 percent of members in investor-owned HMOs and 88.5 percent of members in not-for-profit HMOs.
Teaming Up Works
While no two dental practices are exactly alike, they can all benefit from following team-building principles as suggested by Sandy Roth, dental communications consultant and guest columnist in Focus on Ohio Dentistry, April 1999.
Roth writes that some predictors of success are easily overlooked because they seem too small to be of interest. However, it is difficult to be successful if these areas are disregarded, Roth writes. These areas of teamwork include:
No secrets. Everyone should know what is going on at all times with the practice, including long-term plans and performance expectations.
No whining. Each team member must accept his or her role in every interaction and participate in solving problems.
No politics. Everyone is entitled to the same level of respect and opportunity. The days of playing one group against another are gone.
No surprises. The staff should be involved in budgeting, production goals, and cost controls.
No distractions. Personal problems and issues should be left at the door, and heart-to-heart discussions should be saved until after clinical hours.
No confusion. The whole staff should be familiar with equipment operations, financial procedures and anything else important to the practice. Internal processes should be documented and training frequently reinforced.
No waste. Everyone must be careful with the business’s resources, including time. Little things add up.
Misery Times 2: Money Worries, Dental Caries
High levels of financial stress and poor coping abilities increase twofold the likelihood of developing periodontal disease, according to a study in the July 1999 issue of the Journal of Periodontology.After accounting for other risk factors -- such as age, gender, smoking, poor dental care and diabetes -- those who reported high levels of financial strain and poor coping behaviors had higher levels of attachment loss and alveolar bone loss than those with low levels of financial strain.
"Financial strain is a long-term, constant pressure," said Dr. Robert Genco, chair of the Oral Biology Department at the State University of New York at Buffalo and behavioral scientist Dr. Lisa Tedesco, of the University of Michigan. "Our studies indicate that this ever-present stress and a lack of adequate coping skills could lead to altered habits, such as reduced oral hygiene or teeth grinding, as well as salivary changes and a weakening of the body’s ability to fight infection."
However, people who dealt with their financial strain in an active and practical way (problem-focused) rather than with avoidance techniques (emotion-focused) had no more risk of severe periodontal disease than those without money problems.
Venerable Customer Shows Satisfaction with UOP -- $1 million
The estate of Nada Konrad recently donated $1 million to the University of the Pacific School of Dentistry.
Konrad met her future husband when she was his patient at the College of Physicians and Surgeons (now UOP) in the 1920s. In the 1990s, she returned to the school as a patient in the dental clinic.
"She had the financial means to go to any dentist in the city," said Dr. Ronald Borer, associate dean for Clinical Services. "Nada chose to come back to the dental college’ (as she referred to it) because she loved the idea of being cared for by a student dentist."
Konrad made the donation in the name of her late husband and son. Earnings from the Dr. and Mrs. Arthur C. Konrad and Mr. Vernon R. Liewald Scholarship Endowment will fund scholarships for dental school students.
Nada Konrad died in 1995 at the age of 92. Her bequest was given to the school in May 1999 after the death of her only living relative, her twin sister Vada.
Honors
Judith R. Babcock, director of Dental Affairs for the California Dental Association, has been honored with the 1999 Allied Service Award from the Northern California Section of the Pierre Fauchard Academy. She is the first recipient of the award.
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Web Watch Pages of interest to dentistry. http://www.ncbi.nlm.nih.gov/PubMed/ Free searches of Medline. http://www.cdc.gov/ The web site for the Centers for Disease Control and Prevention. A search for "dental" will bring up hundreds of documents, including infection control guidelines. http://www.dir.ca.gov/DIR/OS&H/occupational_safety.html Cal/OSHA’s site. Clicking on "Publications" will lead to the Bloodborne Pathogens Regulatory Update. http://www.nidr.nih.gov/ Web site for the National Institute of Dental and Craniofacial Research. http://www.toothfairy.org/ Basic consumer information on dental hygiene, plus an e-mail link so kids can write to the Tooth Fairy. A listing here does not constitute endorsement by the California Dental Association. As is the case with all web sites, content is subject to frequent change. |
Upcoming Meetings 1999
Sept. 1-4 Surfaces in Biomaterials ’99, Scottsdale, Ariz., (612) 512-9103Sept. 2-4 Academy of Surgical Research Annual Meeting, Scottsdale, Ariz., (612) 545-1919
Sept. 16-18 CDA Scientific Session, San Francisco, (916) 443-3382, Ext. 4470
Sept. 17-18 Society for Advanced Dentistry Annual Meeting, New Orleans, (317) 290-2613
Sept. 25-29 American Academy of Periodontology Annual Meeting, San Antonio, Texas, www.perio.org
Oct. 9-13 ADA Annual Session, Honolulu, (312) 440-2500
Oct. 21-23 Forensic Dentistry Seminar and Laboratory, Travis Air Force Base, Calif., (707) 423-7720
Oct. 21-23 American Society for Dental Aesthetics International Conference on Aesthetic Dentistry, Bal Harbour, Fla., (800) 454-2732
Oct. 28-Nov. 1 FDI Annual World Dental Congress, Mexico City, +44 171 935 7852
2000
Jan. 27-29 Miami Winter Meeting & Dental Expo, (800) 344-5660.
April 6-8 Dentistry 2000 -- British Dental Association Annual Conference and British Dental Trade Association Dental Showcase Exhibition, Birmingham, England, 01934 844408
April 13-16 CDA Scientific Session, Anaheim, Calif., (916) 443-3382, Ext. 4470
Sept. 17-20 American Academy of Periodontology Annual Meeting, Honolulu, www.perio.org
Oct. 28-Nov. 1 ADA Annual Session, Chicago, (312) 440-2500
To have a meeting included on this list, please send the information to Upcoming Meetings, CDA Journal, P.O. Box 13749, Sacramento, CA 95853 or fax the information to (916) 443-2943.
