Research – Page 2

Future “drug” for dental phobics

April 12, 2013 By Trish Walraven 2 Comments

It looks like virtual reality may actually be almost Matrix-quality in a few short years, and our patients will be able to immerse themselves fully in another world while they’re getting their dental work done. But because there’s a lot more money to be made in gaming (and there’s a MUCH wider customer base) don’t expect that this technology will have a dental application any time soon. Here’s a decent introduction to the concept featuring Palmer Luckey, the originator of the Oculus Rift headset:

These sorts of glasses have been intriguing to me for years, but all the previous versions mentioned here on DentalBuzz basically make it seem like you’re watching a TV screen from a distance. Oculus Rift is different. Users have described the feeling as being totally disconnected from reality. And isn’t that what recreational drugs do? Isn’t that what dental sedatives do?

Imagine a dental appointment where a fearful patient is allowed to slip into a virtual playground where they don’t even need to move their head much in order to initiate the immersive feeling of being elsewhere while they hold their totally oblivious mouths open. Patients’ ears will hear the sounds of their “other world,” letting them slip away from their bodies for a little while so that you can manage all the dental unpleasantries for them.

Here’s another preview of Oculus Rift:

There are many software developers in dentistry that are in search of the next big thing. The 3-D milling technology is pretty awesome these days, but indirect dental software such as patient education, practice management and the like are also looking for the leg-up. Oculus Rift is looking for developers right now, and my guess is that they haven’t even imagined its application in dentistry.

But that’s because you haven’t yet picked up their development kit to make it happen.

Here ya go, and good luck:

Why your fingers shouldn’t be in the picture

March 15, 2013 By Trish Walraven 6 Comments

“Just this once; it’s okay.”

Does that sound like your practice? You know, you have a gaggy, bouncy kid who’s just about to tongue-thrust their way out of having those radiographs taken, but here comes Amazing Assistant to help you get a diagnostically acceptable image. SCORE!

The problem is that this never happens “just once.” I’ve seen the same person holding sensors in patients’ mouths dozens of times, and that’s when it becomes a problem. Yes, radiation is safer now that we’ve dialed it down and collimators make sure that there’s nothing scattering beyond the focused beam, but that doesn’t mean that we should be flippant about limiting exposure to our patients and most importantly, ourselves.

My best friend from high school could tell you not to hold those films in people’s mouths, too. She was a dental technician in the Navy and also worked for years in pediatric dental offices and orthodontics as an assistant, calming nervous children, helping them to have good dental experiences, and when she was exposing radiographs, sometimes she admits that she would make it easier on everyone if she would stay with the child while the x-rays were beaming through her hand.

She doesn’t have to tell you not to hold the films, though. She can just show you why you shouldn’t:

This is her right hand. Several years ago when she was doing laundry her finger caught on the dryer and “snapped.” This is important, sort of like when your patient tells you exactly what they were eating when their tooth broke – don’t you pay that the most attention of all? Because it was the darn dryer that was the problem….(!) Let’s be serious, though. Like you, her doctor really didn’t care what broke her finger, he wanted to know why it broke.

Turns out that she had developed a giant cell tumor in the first (proximal) phalange of her ring finger that had eaten everything except a small sliver of bone and that was what had snapped. These are very, very rare in small bones like those found in our fingers; most osteoclastomas happen in the larger bones like femurs and such. Hmmm.

Even though the tumor was benign, because of the damage done, the possibility of regrowth and other factors, the decision was made for my friend to have her ring finger amputated. I would have had her flip you the bird for effect but she no longer has a middle finger either…! (think about it…!)

So she was fortunate enough to stay in dentistry as a patient care coordinator for a few more years as she recovered but is now working towards her master’s degree for speech pathology. While she doesn’t seem totally convinced that excessive radiation exposure caused her to lose her finger, she doesn’t count it out for even a second.

And neither do I.

Losing a finger may be anecdotal evidence about the dangers of radiation, but it’s enough for me to feel like enforcing what we already know to be true.

Please share this story with those you care about, even if it makes you feel like the Radiation Nazi.

Open, sesame!

March 5, 2012 By Trish Walraven 3 Comments

I wish they would have named it “Strangle Me Elmo.” Because that’s how I feel about that particular character.

Sesame Street was my babysitter growing up, especially since the show and I are practically the same age. So when the news comes that Sesame Workshop is launching an educational oral health initiative geared towards two year olds and up, I get it. They’re about modeling good habits with jingles and images that kids will remember when it’s their time to “do what they saw on TV.”

This is especially helpful for the kids from low-income families, because parents may not realize that their own belief systems about primary teeth can prevent children from getting appropriate care. When a kid sees Elmo brushing his teeth and eating healthy “crunch” foods, studies show that they’re very likely to have positive changes in their own nutrition and hygiene habits, and so even if they’re not going to the dentist, they just might have healthier teeth.

Elmo’s annoying voice was not part of my childhood, so I don’t “connect” with him. But I would, oh, I SO would connect with him, if someone wanted to put him in my hygiene chair and let me spin a prophy cup at his fur.

Learn more about Sesame Workshop and their “Healthy Mouth, Healthy Me” series here, and you also may enjoy reading this interview with Dr. James Crall, Sesame Workshop advisor and professor of pediatric dentistry and public health & community dentistry at UCLA.

Suction supermod

April 4, 2011 By Trish Walraven 4 Comments

by Trish Walraven

Rubber dams, meet silicone simplicity! Awkward assistants, take your cheek retraction and spit-sucking attempts elsewhere. You have both been banned from the operatories where isolation mouthpieces rule supreme.

First brought to market in 2005, Isolite™ Systems originated the idea of combining dryfield illumination and isolation in a patented product called the Isolite, which costs about $1700 per operatory to set up. Whoa, steeeeep. The tubing and LED Smart Stick sure isn’t their loss leader, now, is it? Then you still have to buy a $2.50 mouthpiece for each patient because they’re not sterilizable. All of it together is still easier and less expensive than your assistant.

But what if you want to keep your assistant, even though she kicks you under the chair all those times you say something stupid to a patient or start getting all OCD over a procedure? You’ve already ditched your overhead lamp for loupe-mounted headlights, so maybe you don’t even need the Lite part of the Isolite.

About a year ago, Isolite™ Systems indroduced a non-illuminating version called the IsoDry that runs a little less than half the cost of the original product. Both systems come with extra tubing. Tooobing. Makes me want to laze down the Guadalupe River with a six-pack in a styrofoam cooler. Don’t we have enough tubes and hoses to twist around each other already?

This brings us to the essence, the soul, the very magic of what makes the Isolite System the game-changer that it has become. It’s all about the mouthpiece. This transparent, comfortable, easy-to-insert soft piece of silicone not only attaches to high-speed suction to create a dry field, it replaces bite blocks, throat packs, cotton rolls, drying angles, and everything else that you used to cram in your patient’s mouth to create a perfect restorative environment.

But in order to use the mouthpiece, the rule is, you have to buy an Isolite or an Isodry. You can’t just stick it onto your high-speed suction and use it solo.

Or can you?

Mark Frias, RDH, can hook you up to go commando. Literally. He’s invented a hook-up mod for the Isolite mouthpieces that must have been driven by the frustration of trying to keep a squirmy six year old’s teeth dry for sealants with traditional isolation. You can see the differences between his design and the original Isolite on the left. It’s not sleek and sexy, but from a cost perspective this little adapter is a no-brainer. Mark calls it the Kona Adapter. Why? Is he an Ironman Triathlete from Hawaii? Actually, I think he named it after his dog.

Whatever the case, the ingenuity here is striking at a great moment. Mark is having difficulty keeping Kona Adapters in stock if that’s any indication of its demand.

For those who are concerned about taking business away from Isolite, Mark suggests purchasing a single system for one of your operatories and fitting the rest with Kona Adapters. This will give you the privilege of being an official Isolite customer so that you can be assured that you aren’t buying mouthpieces on the down low.

And everyone really wins here. Isolite could give the system away like Gillette gave away razor handles to sell you the blades for the rest of your life, or use the printer model: sell the hardware cheaply to lock you into high-priced ink refills. It’s not like Isolite Systems is exactly losing money on the mouthpieces. With this new adapter, Isolite can now make money from the dental practices that may have not been able to justify a whole-office use of their product.

So slippery-gripped assistants everywhere: Ding! You are now free to move about the office. Your hands have finally been relieved without a significant lightening of your employers’ bank accounts.

Release the (S.) mutants

February 9, 2011 By Trish Walraven 2 Comments

by Trish Walraven

The Dramatization:

At first it was small. The outbreak began in Florida’s Tampa Bay Area as local hospitals noticed an influx of patients with complaints of turquoise discolorations of their lips and aversion to simple carbohydrates. Once case histories were correlated it was noticed that all those who were affected had either recently received an inoculation of a mutant version of Streptococcus mutans at their dentist’s office or had been in close contact with someone who had.

Initially the culprit was thought to be excessive consumption of blue raspberry slushies, but by the time the CDC discovered that an organism was responsible for these symptoms and that it was bacterial in origin and highly contagious the disease had spread far beyond Florida and had affected millions throughout the US and abroad.

There have been no reports of mortality, save the demise of the soft drink and candy industries. Sugar consumption has plummeted as more of the population becomes infected by this new strain of bacteria which was originally created to cure the problem of dental decay. Because persons who are affected display a noticeable change in their appearance, blue lips have become a strong signal of exclusion due to the fear surrounding this epidemic. However, as more evidence points to the positive outcomes of having been infected, the “blue look” is currently trendy in the larger cities. Blue-lipped patrons that had been banned from public venues such as restaurants and arena events are slowly trickling in, thanks to the assurances from the World Health Organization that this current situation has actually caused more good than harm. The long-term effects will be felt by dentists, who, in the next 30 years, will see an attrition of their necessity as caries becomes extinct, and possibly within the cosmetics industry with a shift in lip color preferences.

The Reality

Um, Yay? It’s been like, since the early 70’s that everyone’s been asking for a caries vaccine. And wouldn’t you know it? A company in the United States is already so ON this. Oragenics first initiated their first Phase 1 Clinical trials in 2005 but were halted by the FDA because of the fear of something happening like the above scenario. Think I’m kidding? Okay, maybe I was being sensational. But there can be genuine risks when you fiddle with a few genes, and the FDA seemed to be mainly concerned with the lack of a plan to eradicate attenuated strains in the test subjects’ children. AHHHHH!

It starts to get interesting when you look at the solution that Oragenics came up with to begin their second Phase 1 testing announced last week: The trial subjects will be inoculated with a strain of S. mutans that cannot survive without the amino acid D-alanine, which is not found in a normal human diet. This means that the subjects will have to feed their germs daily with a mouthwash to keep them from dying.

Are you excited yet? Well, you’d better hold those horses back for a while. A long while. It’s going to take a bunch of time and a lot more money to get this to the market.

The inoculation is designed to be a painless 5-minute treatment with a cotton-tipped swab to deliver the suspension of Oragenics’ patented bacterial strain into a patient’s mouth during routine dental visits. But this one won’t die without feeding. It will live forever.

And what is it supposed to do once it goes viral? Err… bacterial? Oragenics calls this treatment SMaRT Replacement Therapy™ and it promises to:

• Offer lifelong protection against tooth decay caused by S. mutans

• Eliminate the creation of lactic acid by oral bacteria

• Dramatically reduce the ability of S. mutans to cause tooth decay

• Be genetically stable

• Grow at a rate similar to non-genetically-altered S. mutans

• Aggressively displace the native, decay-causing strains of S. mutans and preemptive colonization of its niche

• Not cause any acute or chronic adverse side effects

I think it’s a foregone conclusion that this sort of genetic manipulation is probably the only way we’ll and break caries’ hold on humanity and the loss of teeth caused by decay. We can’t just kill all the bugs in our gut – all the Jamie Lee Curtis Activia commercials have given us TMI about probiotics lately – so it makes sense that this same premise is true in our mouths.

And the raspberry slushie is still your best bet for getting blue lips. Sorry, Oragenics will probably not be helping you there.

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