The NobleDentist Blog

This is anrticle by Michael Riley that appeared recently in the Asbury Park Press.

Dr. Robert Hersh, a periodontist and newly elected president of the New Jersey Dental Association, opened up and said “Ahhh!” about various cavity-filling techniques and the controversary surrounding at least one of those fillings.

“There are,” says Hersh, of The Center for Oral Health in Freehold, “two types of dental restorations — direct and indirect.”

Direct restorations are fillings placed immediately into a prepared cavity. They include dental amalgam, glass ionomers, resin ionomers and some resin composite fillings.

Indirect restorations include inlays, crowns and bridges.

The controversary that has gotten some people down in the mouth concerns the stuff that amalgam fillings are made of.

One of the typical ingredients in amalgam fillings is mercury.

“Mercury is a toxic element,” Hersh says. “Everybody knows it. Some people have come to believe that silver-colored amalgam fillings can cause harm, either by mercury vapor being inhaled or mercury being swallowed through chewing.”

The problem with that theory, Hersh says, is that The Centers for Disease Control, the National Institutes of Health, The Food and Drug Administration, and the World Health Organization have all concluded that there is an absense of evidence that the mercury in filling material poses a threat to the individual with the fillings. There are, he says, a small number of people who have an allergic reaction to amalgam fillings.

“As the years go by, this will become less of an issue,” Hersh says.

Flouridation of water and increased dental hygiene, he says, have resulted in smaller cavities more able to be filled by non-almagam materials.

Still, there are dentists so concerned about the issue that their offices, and the mouths of their patients are “mercury-free.”

According to her office staff, Dr. Elizabeth Piela of Lakewood is a dentists who will not use mercury fillings.

But, even if one believes that the mercury in cavity-filling material is safe, because its combination with other materials renders it stable and harmless in your mouth, the environmental threat from all that mecury in dentists’ offices and spit sinks is something that needs to be reckoned with, Hersh says. “Dentistry contributes about 1 percent of all the scrap mercury which makes its way into the water system,” he says.

Theoretically, dental waste is caught with other waste in water treatment plants and burned. But, according to Hersh, the New Jersey legislature is going to require dental offices to use new technology to trap the mercury and have it picked up by a specialized agency or company.

“Dentists want to do their part for the environment we all share,” says Dr. James B.Bramson, executive director of the American Dental Association.

This is an article that appeared recently on SooToday.com.

WINNIPEG, MANITOBA – (October 10, 2006) – A team of National Research Council (NRC) scientists and their collaborators are developing cost-effective tools that will help dentists diagnose and manage patients’ dental health.

The studies will support clinical implementation of the technology for early detection, preventing and reversing early dental decay, thus avoiding drilling and filling!

The NRC Institute for Biodiagnostics (NRC-IBD) researchers, working in collaboration with dental clinicians at the University of Manitoba (Winnipeg) and Dalhousie University (Halifax), believe the fusion of various techniques, such as Raman spectroscopy and optical coherence tomography, will help overcome the limitations and shortcomings often encountered when using only a single technique like x-rays.

The significance of this collaborative research initiative has been recognized by the U.S. National Institutes of Health’s National Institute of Dental and Craniofacial Research (NIH-NIDCR), which has awarded the NRC researchers and their clinical collaborators a US$1 million grant to tackle the problem of early assessment of dental caries.

The grant will fund the project over four years.

The project proposes to develop intra-oral probes based on the combined technology and to validate the methods for clinical use. The NRC technology is in line with a new dental care focus on prevention and tooth preservation rather than restoration.

“The results of this research could have a major impact on dental practice and we are proud to be part of the innovative team. It is very satisfying to see Canadians taking the lead in this important field,” says Dr. Ian Smith, Director General of NRC in Manitoba.

“The partnership between NRC-IBD and the University of Manitoba was initiated almost five years ago and has progressively grown stronger. Our colleagues at the NRC-IBD were very innovative in recognizing early, the opportunity to apply their expertise to a widespread age old oral health problem that is now a major leading area of dental research,” says Dr. Cecilia Dong, Faculty of Dentistry, University of Manitoba.

Recognized globally for research and innovation, Canada’s National Research Council (NRC) is a leader in the development of an innovative, knowledge-based economy for Canada through science and technology.

The NRC Institute for Biodiagnostics, located in Winnipeg, develops and commercializes innovative medical devices for the non-invasive diagnosis of diseases, with research focused in optical and magnetic resonance imaging and spectroscopy, device prototyping, bioinformatics, and medical software.

This is an article by Shari Rudavsky that recently appeared in the Indianapolis Star.

Gum disease can contribute to heart problems, diabetes and other illnesses, studies indicate.

The periodontal disease that’s giving you a toothache might not only be hurting your gums; it could also be affecting other aspects of your health, from your heart to your blood sugar, a growing body of research suggests.

In recent years, studies have shown links between gum disease and other maladies. Experts stop short of calling periodontal disease a causal factor in conditions like diabetes or low birth-weight babies, but they do suspect it could be a potent risk factor.

“The basic message that we want to get across is that periodontal disease and oral infection is a risk factor,” says Dr. Preston D. Miller, president of the American Academy of Periodontology. ” A direct link has not been established, but all the studies I know of indicate that there is a connection.”

One of the strongest links has been drawn between diabetes and gum disease. Diabetics generally respond poorly to infections; infection in the mouth is no exception. Treating periodontal disease may decrease a patient’s dependence on insulin, experts say, though it won’t end it altogether.

Conversely, diabetics—even those who are undiagnosed—are more likely to develop periodontal disease. Sometimes periodontists even sound the first alarm about diabetes after seeing a rapid decline in a person’s oral health, says Dr. Howard Tenenbaum, a professor of periodontology at the University of Toronto.

But it’s not just diabetics who should worry about gum disease, experts say. Studies show people with periodontal disease are almost twice as likely to suffer heart disease as those whose gums are healthy.

Nobody knows exactly why that is, but some speculate that oral bacteria may travel through the bloodstream to the heart, where they attach to fatty plaques in the arteries and contribute to the formation of clots.

While much of the research has focused on the role full-blown periodontal disease plays, an Indiana University School of Dentistry professor is asking whether the process starts years before, with gingivitis, a local inflammation of the gums that may affect as much as 80 percent of the population.

A three-year federal grant for $1.3 million will help Dr. Michael Kowolik and colleagues test the hypothesis that even small amounts of dental plaque can stimulate the body to produce a reaction that over time would increase a person’s risk of a heart attack.

Dental plaque already is a suspect in other illnesses. Research on patients in long-term care facilities and intensive care units who do not receive regular dental care or even brushing suggests that as plaque builds up, so does the risk of aspirational pneumonia, says Toronto’s Tenenbaum.

Now Kowolik and colleagues at IU’s Oral Health Research Institute want to see if plaque has an impact on healthy individuals.

The grant calls for inducing gingivitis in 128 participants with healthy gums who agree not to brush their teeth for 21 days. The plan is to compare levels of plaque and gum inflammation as well as markers for heart disease at the beginning of the study and after 21 days of negligence.

Higher risk predicted

Even if the study shows these markers do increase with gum inflammation, it will not prove a direct correlation between heart disease and periodontal disease, Kowolik cautions. It will, however, confirm the importance of good oral hygiene.

“If I’m right and the amount of plaque that builds up on teeth does produce a systemic reaction, it doesn’t prove that it will cause a heart attack but simply that it will produce some of the risk factors,” he says. “In the end, what we might show, if we can reduce insult to the body by practicing good oral hygiene, then dentists and dental hygienists could be more significant to society for general hygiene.”

That significance could extend beyond heart disease. Periodontal disease might also have a hand in preterm births, many experts believe. Infections in other parts of the body, such as the urinary tract, have been known to travel to the placenta and cause inflammation, which could play a role in low birth weight and early labor, notes Ray White, a professor of oral and maxillofacial surgery at the University of North Carolina.

So it seemed equally plausible that bacteria in the gums could also travel through the bloodstream and have a similarly detrimental effect.

Effect on pregnancy?

The Oral Conditions and Pregnancy study has already suggested that indeed a correlation exists between poor obstetric outcomes and periodontal disease.

More recently, White looked at wisdom teeth’s contribution. His work has shown that many periodontal problems start around these teeth, even in people who don’t realize they have a problem.

“The message is, if you’re planning on getting pregnant, you better go and make sure you don’t have gum disease,” White says. “What we’re showing is that, at least for some young people, periodontal problems start in the lower teeth.”

To help get that word out, the American Academy of Periodontology is promoting a campaign to encourage patients and obstetricians to discuss oral health, Miller says.

Check ‘probing depth’

The academy also urges people to take greater control of their periodontal health and ask dentists about their teeth’s “probing depth,” measured on a level of one to seven. The higher the number, the worse the disease.
“Patients should understand that a five is as important to periodontal disease as a 200 is to cholesterol,” says Miller, a periodontist in private practice in Memphis. “The layman has to look after himself.”

Still, at least one IU dentist believes that the layman could use a little help. Dr. Gerardo Maupome, a professor at the Oral Health Research Institute at the IU School of Dentistry, wants to explore the possibility of using health educators in the Hispanic community to teach their patients, who typically have poor access to medical or dental care, about preventing periodontal disease.

Maupome is hoping to find funding to start a pilot project in East Chicago that will teach this population, many of whom also are diabetic, about proper dental hygiene.

If this plan comes to fruition, Maupome says, the program could wind up preventing not just dental disease but also problems with diabetes.

Are you at risk?

There’s no great secret to preventing periodontal disease. Just practice standard good preventive dental care, says the Academy of General Dentistry.

Brush and floss daily and see your dentist for regular professional cleanings.

Here are some signs and symptoms that you might have periodontal disease, according to the American Academy of Periodontology:

• Pain in your mouth.
• Bleeding gums when you brush or eat hard food.
• Spaces developing between your teeth.
• Swollen or tender gums.
• Receding gums.
• Persistent bad breath.
• Pus between your teeth and gums.
• Sores in your mouth.
• Changes in the way your teeth fit together.

This is an article by Peter Weekes that appeared recently in The Age.

A NATIONAL advertising campaign similar to the successful Slip, Slop, Slap push against skin cancer is needed to stop the nation’s teeth from rotting, says the Australian Dental Association.

The association wants the Federal Government to take overriding responsibility for promoting dental health as figures reveal that Australia has the highest tooth extraction rate in the developed world.

The average Australian will suffer serious decay in at least 10 teeth by their late 30s.

And our overall dental health is second-lowest among developed nations.

“We have the second-worst health for adults and there are disturbing trends with kids at the moment,” the association’s president, Bill O’Reilly, said.

“Dental disease is completely preventable. If you have a good brushing and flossing routine, you shouldn’t have a problem.”

Dental experts say people with poor teeth endure ongoing pain, difficulty in eating and talking, gum disease and bad breath.

Decayed teeth have also been linked to premature, low- weight babies, heart disease, brain damage, diabetes and obesity.

Professor John Spencer of Adelaide University, who is conducting a new national audit of the country’s teeth, has published two major reports on the state of the nation’s teeth.

“Since the 1990s we have had some deterioration in oral health, which we think is due to lack of exposure to fluoride or due to increased exposure to dietary-rich factors,” he said.

“The jury is out on which of those played a more significant role.”

After fluoride was added to tap water in the 1960s and ‘70s, the rate of tooth decay plummeted. Many now think society’s newfound love of bottled water and filtered tap water may be eating away at our teeth.

Sports drinks and fizzy drinks are likely to be even worse, Dr O’Reilly said.

The results of the audit will not be known for about 18 months.

However, a 2004 study by Professor Spencer found dental health was deteriorating, with a widening gap between the “haves and have-nots”.

“There is nothing to suggest this has changed, only accelerated,” he said.

Typically, low and middle-income earners have the poorest teeth and availability of care “either because of the inadequacies of the torn and tattered safety net of public dental services or their inability to purchase an adequate scope of private dental care”, he said.

There are an estimated 650,000 pensioners and other healthcard holders on the national waiting list.

This is a program transcript of a recent segment (12.09.06) of the 7.30 Report – ABC.

KERRY O’BRIEN: Welcome to the program. It’s only days since the Federal Government announced it would sell off Medibank Private, obviously hoping it would be quite a straightforward proposition after the traumas of Telstra. But today they called a retreat, not on the principle of the sale but certainly on its timing. The Government health fund float will now be put off until after the next election. The Government says it’s taken the decision for financial reasons. There’s the next tranche of Telstra to put on the market in what’s left of this year. Next year doesn’t seem to be too attractive a proposition either. There will after all be an election. Political editor, Michael Brissenden reports.

MICHAEL BRISSENDEN: Whether it was children or insurance, health was the issue of the day here in Canberra. Harry Kewell, the soccer star, lent his name to the campaign to fight childhood obesity. It was a good move. He is a great footballing role model and as everyone knows nothing draws a crowd quite like a sporting hero. Certainly the politicians know it. Harry Kewell has a deft touch on the field. He can sidestep and feint, dummy pass and run rings around many of the best. The other two with him aren’t bad at the fancy footwork either. The field might be different but they’re masters at the game. They know when to strike and they know when to pass. Which is what they’ve done today with Medibank Private. Having run hard for weeks, the privatisation has now been put on the bench till after the next election.

TONY ABBOTT, HEALTH MINISTER: Let everyone be in no doubt, Mr Speaker, if this Government is returned, there will be a sale of Medibank Private early in 2008. Let there be no doubt whatsoever.

MICHAEL BRISSENDEN: The Government says the reason is simple: financial advice shows that with T3 about to be offered to the market, floating public entities is becoming a little crowded toward the end of this year.

JOHN HOWARD, PRIME MINISTER: Our financial advisers have suggested clearly that the two should not be run together. That stands to reason. I would’ve thought even those on the Opposition frontbench who don’t study these matters very closely would immediately acknowledge that to try and run the two of them together would be unwise and we’re plainly not going to do that.

MICHAEL BRISSENDEN: Some in the Government, though, think the market’s more than big enough to cope with two floats at the same time.

JOE HOCKEY, HUMAN SERVICES MINISTER: I think we should be selling…look, they’re two..don’t be ridiculous. I mean, the stock market is deep enough and liquid enough to cope with Medibank Private, Telstra and a range of other listings this year. The Australian stock market’s in great shape.

MICHAEL BRISSENDEN: No doubt Joe Hockey’s changed his mind since he made that confident prediction as he came to work this morning. Labor of course says the market is taking a back seat to politics.

JULIA GILLARD, OPPOSITION HEALTH SPOKESWOMAN: Minister, isn’t the real reason the Government has deferred the sale of Medibank Private that Australians are opposed to it?

TONY ABBOTT: Mr Speaker, if the Government was scared by today’s opinion poll result, we would’ve entirely abandoned the sale of Medibank Private. We have not. We support the sale of Medibank Private. We think it will be good for policyholders. It will be good for taxpayers. It will be good for the health sector. And we will proceed with the sale of Medibank Private as announced in 2008.

MICHAEL BRISSENDEN: Privatisations are never popular of course. They are the cod liver oil of politics. Some say it’s good for you, others say it just tastes bad. And it seems the privatisation of Medibank Private has been particularly difficult to swallow. Ever since it was first put on the table back in May, the Government ran into problems with it. First, there were very serious questions raised about whether it was in fact theirs to sell. The Parliamentary library even concluded that the Government may have some problems in that regard because as it was the health fund the members might actually have an interest. Then some economists and commentators and even the AMA disagreed publicly with the Government’s line that the sale would push down insurance premiums. And today, newspaper polls suggested that more than 60 per cent of the voters were opposed to it as well but it seems the opposition and perhaps those voters polled by the newspapers have been listening to different experts than the Government. Tony Abbott named a few today who agreed that privatisation would bring down premiums and reminded Kim Beazley of Labor’s track record of privatisations along the way.

TONY ABBOTT: Mr Speaker, let’s make it absolutely clear: privatisation of Medibank Private will no more raise health insurance premiums than the privatisation of the Commonwealth Bank raised interest rates and the privatisation of Qantas caused air fares to rise.

MICHAEL BRISSENDEN: Well, the one thing this has done is ensure that the privatisation of Medibank Private at least will be an election issue next year. But Tony Abbott also hinted today that further and wider health industry privatisations might also be on the cards. The privatisation of public hospitals, for instance. The Federal Government doesn’t own them. But Mr Abbott has floated the idea nonetheless. Still, the premier of one state who has already tried that route has given it short shrift already.

MORRIS IEMMA, NSW PREMIER: With the example of Port Macquarie Hospital, where a public hospital was privatised and as the auditor-general showed, it was virtually given away and paid for twice over by the taxpayer and recently bought back by us. I would be fighting Mr Abbott’s proposal to privatise public hospitals.

MICHAEL BRISSENDEN: Still that’s probably just the fight the Feds would welcome, but the free market zeal is also creating a few difficulties internally as well. The Coalition is under considerable strain at the moment, with the Nationals unhappy on a number of fronts. First, Barnaby Joyce crossed the floor and voted with a Democrat motion last night on a Bill he believes will threaten independent petrol retailers.

SENATOR BARNABY JOYCE, QUEENSLAND NATIONALS: What this is actually doing is quarantine the section of the market that’s currently being used for that section that we want to protect. Now, we hear that BP and Caltex and Shell, they say, “Look, we’ve got…” – they put their hand on their heart and say, “Look we’ve got no intention to ever remove those families from those businesses. We’ve got no intention to go into their area.” Well, if that’s the case, then this won’t worry them.

MICHAEL BRISSENDEN: Senator Joyce has put his own amendment forward as well and the final vote will come on that later tonight. The Nationals are also revolting over media laws, in particular, the cross-media ownership proposals for regional areas. Two Nationals senators, Barnaby Joyce, there he is again, and Fiona Nash from New South Wales, told today’s joint party room they’ll reserve their right to cross the floor on that issue, too. And then there’s concern about the failure to implement an election promise for a mandatory code of practice for the horticultural industry. If we don’t get a win on this one, one National Party member said, then there will be more than two of us crossing the floor. But then, this was the party that opposed the sale of Telstra as well. And that’s one privatisation that will hit the market before the next election.

KERRY O’BRIEN: Political editor, Michael Brissenden.

This is an article by Andrew Bridges that was released recently by The Associated Press.

WASHINGTON - Government health advisers have questioned a federal report concluding that the mercury-laden amalgam dentists use to fill cavities is safe.

Meanwhile, consumer activists pressed for at least a partial ban on the silver dental fillings, as they expose patients to toxic mercury.

The Food and Drug Administration asked a joint panel of outside advisers to decide whether the study – a review of 34 recent research studies – reflects current knowledge about the risks associated with the fillings.

Meeting Thursday, panel members and consultants didn’t discuss a potential ban, but did say the report fell short of expectations.

“Just by looking at this paper, we are in a sense really limiting ourselves. I am not convinced we are doing justice to the topic at hand,” said Michael Aschner, a professor of pediatrics and pharmacology at Vanderbilt University and a panel consultant.

The study found “no significant new information” that would change the FDA’s earlier determination that mercury-based fillings don’t harm patients, except in rare cases where they have allergic reactions.

Mississippi dentists, reached on Thursday, said they normally use amalgam fillings containing mercury and find no cause for alarm.

“It’s a good, economical filling,” said Dr. Sherry Gwin, who has been practicing in Pearl for 20 years and is familiar with the debate. “I have never read a reputable study that found it toxic in the amounts we use.”

Gwin estimated that she had placed about 12,000 amalgam fillings in her career while also offering alternatives.

Dr. Jennifer Ray, a Biloxi dentist who has been seeing patients for five years, said she follows the American Dental Association’s guidelines, which have been repeatedly tested for safety.

“It becomes a personal choice for the patient,” she said. “I use composite and amalgam. I discuss it with patients and let them decide.”

Consumer groups opposed to the use of mercury in dentistry dispute the conclusion that amalgam does not harm patients. The groups petitioned the FDA earlier in the week for an immediate ban on the cavity-filler in pregnant women.

“Do the right, decent, honorable and God-loving thing: There needs to be an immediate embargo on mercury fillings for everyone, or at least pregnant women and children, because they are our future,” said Michael Burke, who blamed mercury fillings for the early onset of Alzheimer’s disease in his wife, Phyllis, in 2004.

The FDA review falls short because it doesn’t lay out what questions about the safety of mercury fillings remain to be answered, said panel member Dr. Larry Goldstein, a Duke University professor of medicine.

Amalgam fillings, also called silver fillings, by weight are about 50 percent mercury, joined with silver, copper and tin. Dentists have used amalgam to fill cavities since the 1800s.

Today, tens of millions of Americans receive mercury fillings each year. Amalgam use has begun to taper off, though, with many doctors switching to resin composite fillings that blend better with the natural coloring of teeth.

However, such “cosmetic” fillings can’t always be substituted for amalgam, including in cases where dentists have to place large fillings in the back teeth, Dr. Ronald Zentz, of the ADA, said in a recent interview.

Dentist Howard Bailit said he and his colleagues at the University of Connecticut studied the impact of a ban on mercury fillings and found it would increase costs, reduce the number of cavities filled and have an overall negative effect on oral health.

“Our recommendation is, do not ban the use of dental amalgams,” Bailit said.

With amalgam fillings, mercury vapor is released when patients chew and brush their teeth. Significant levels of mercury exposure can cause permanent damage to the brain and kidneys. Fetuses and children are especially sensitive to its harmful effects.

Scientists have found that mercury levels in the blood, urine and body tissues rise the more mercury fillings a person has. However, even among people with numerous fillings, exposure levels are well below those known to be harmful, the FDA report said.

Dr. Roger Porter, an industry representative on one of the two panels, called the study “very deficient” because it didn’t address how the human body absorbs, distributes, processes and eliminates mercury.

This is the transcript of a segment that appeared recently on the 7.30 Report – ABC.

Reporter: Clayton Bloom

MAXINE MCKEW: Welcome to the program. And coming up tonight we’ll hear from John Clarke and Bryan Dawe. They’ve got some tips this week about the T3 sale. But first, the crisis in Australian dental care. A nationwide shortage of dentists, coupled with lengthy public waiting lists, is being described by some in the profession as a national disaster in the making. In some country areas, dentists are becoming as rare as the proverbial hen’s teeth. As older members of the profession reach retirement, they are fining they can’t find anyone to take over their practices, forcing some to simply close their doors. Suffering the most are those with limited means and few choices. Nick Grimm reports.

VALERIE SHORTER: I had to wait a week and a half. They told me that and then I thought half an hour of pain is probably better than going for two weeks. So I pulled my tooth.

NICK GRIMM: Valerie Shorter isn’t one to suffer in silence. When she came down with an excruciating toothache and lost hope of seeing a dentist, she took matters into her own hands.

VALERIE SHORTER: I knew I had to go through another night of no sleeping, so that’s when I decided that I was going the pull the tooth.

VALERIE SHORTER: Yes, this is where it all happened on the night.

NICK GRIMM: So how did you do it?

VALERIE SHORTER: The tooth was so bad at the time, I put the pliers in the kettle to sterilise them. I then had a couple of glasses of wine, to steady my nerves.

NICK GRIMM: Just a couple?

VALERIE SHORTER: Yes.

NICK GRIMM: With the help of a bottle of wine she had won from her local bowling club and a pair of pinch nosed pliers, the 65 year old great grandmother attacked the root of her problem quite literally.

VALERIE SHORTER: I put it on the tooth firmly, knees hit the floor, pliers hit the floor and the tooth hit the cupboard and the pain bang, it had gone.

NICK GRIMM: That must have taken nerves of steel?

VALERIE SHORTER: I think there would be a lot more people out there that would have to have done it. They don’t get heard.

DR CHRIS COLE, DENTIST: To have that happening, to me is quite disgusting and the governments that are allowing that to happen should be ashamed of themselves.

DR PETER PULLINGER, DENTIST: It’s a national disaster in the making. It’s a crisis.

NICK GRIMM: As a widowed pensioner, Valerie Shorter should be entitled to see a public dentist, but she’s just one of an estimated 650,000 Australians languishing on waiting lists, while State and Federal Governments argue over who should fix the problem.

JOHN HATZISTERGOS, NSW HEALTH MINISTER: We’re doing much better than what the Commonwealth has put into dental care. We’ve significantly boosted our expenditure at the same time that the Commonwealth took away $350 million in 1996 and never replaced it.

NICK GRIMM: The Federal Health Minister, Tony Abbott, said recently he has no plans to relieve the States of their responsibility. But critically, it’s not just the public dental system failing to keep up with the demand. Across Australia, even though whose can afford to pay to see a dentist are having trouble finding one.

CHRIS COLE: How are you today?

NICK GRIMM: Chris Cole owns a dental practice in Armidale in northern NSW, but he’s been working alone since his partner retired two years ago.

CHRIS COLE: The workload certainly is increasing; there is always a patient, as soon as you turn around, there is another patient ready to come into the chair.

NICK GRIMM: Try as he might, Chris Cole can’t find a dentist anywhere in Australia to join his practice. In large part, he says, because the baby boomer generation of dentists is now approaching retirement age. Meanwhile, the number of dentists graduating from universities today is about a third of what it was in the 1970s.

CHRIS COLE: In those 30 years population has well and truly doubled and people are keeping their teeth longer. There is more teeth to work with and I can’t fathom why the system has been run down so much.

NICK GRIMM: So the dentists just aren’t getting trained, they’re not coming out of the universities?

CHRIS COLE: The universities aren’t making the places available to train the dentists.

NICK GRIMM: The Australian Dental Association says it was education funding cutbacks that caused the rot to set in. Dentistry is an expensive course to teach, so it’s been particularly hard hit, even though there are plenty of students trying to get in. Go to some smaller towns, like Tenterfield north of Armidale, and the shortages mean that locals have no dentist at all. Tenterfield’s last remaining dental surgery is now a pizza shop, forced to close when the town’s elderly dentist found he couldn’t sell his practice for love nor money.

TREVOR MCFEETERS: We used to have three dentists here in town. When the town was only half the size we had three dentists and now we are double the size, we have no dentist.

NICK GRIMM: It’s a situation which troubles everyone in the town, like George Patch, who is proud to have reached his late 60s still in possession of two of his own teeth.

GEORGE PATCH: One of these days I’ll wake up and they’ll be aching and then there is problems then, mate.

MEALS ON WHEELS VOLUNTEER: Grilled fish today.

NICK GRIMM: There are problems already for the town’s community services. The local Meals on Wheels service has to provide special softer meals for those who can’t chew their food. Robert Grogan lives in Tenterfield on a carer’s pension, looking after his elderly father who has Parkinson’s disease. 72-year-old John Grogan also has no teeth. He’s been waiting for dentures for at least six years, according to his son, though the elder Grogan himself reckons it’s been more like 15 years.

NICK GRIMM: What would it mean to you to get a new set of teeth?

JOHN GROGAN: Well, providing they fit and do everything they should do, it would mean a lot.

NICK GRIMM: It would make a big difference to your life?

JOHN GROGAN: It would, yeah. I would look a bit prettier.

NICK GRIMM: Meanwhile, 38-year-old Robert Grogan recently had 12 teeth removed himself. They had rotted away since he first went on the dental waiting list with a toothache.

ROBERT GROGAN: I had to wait a couple of years on the waiting list and in that time they got worse and worse and then I got an infection up the side of me face and had to get on antibiotics because me face get poisoned from the bad teeth.

NICK GRIMM: Dentists say Robert Grogan is typical of many public patients who go on to the waiting list in need of a filling, but can’t get in to see a dentist until one or more teeth have become so badly decayed they have to be removed.

ROBERT GROGAN: Well, that is what was my case. I reckon they could have filled them and fixed them up, but because I had to wait so long, they just got that bad they were past fixable. So you’ve got to get them all taken out and get false teeth like me.

NICK GRIMM: And for Robert Grogan, that means going on another waiting list and, well, waiting. But with Australia gripped by a national skills shortage, State and Federal Governments are arguing over who should fix the dentist crisis. Now, Federal Health Minister Tony Abbott wasn’t available to be interviewed for this story, but his spokeswoman told us that public waiting lists have been the sole responsibility of the States and Territories ever since the coalition scrapped the Commonwealth dental scheme when it came to power 10 years ago. The States aren’t very happy about that arrangement. For example, NSW says it’s had to increase its spending by 75 per cent over the past decade and it can do little more unless the Commonwealth now kicks in with more funds for university training facilities like this to teach new dentists.

JOHN HATZISTERGOS: There’s a shortage of work force overall and what we need to do is increase the total supply of the number of people who are working in the system so that they will be able to service the public, irrespective of whether it’s in the private sector or public sector.

NICK GRIMM: The Federal Government’s response? It points out that this year it announced 60 new places at universities. But the Australian Dental Association says that’s still not enough, and that an additional $25 million is urgently needed. But like a lot of Australians suffering toothache, Armidale dentist Chris Cole is sick of waiting for help while governments argue. His growing desperation to find a colleague has pushed him to travel halfway around the world to London.

CHRIS COLE: I think it’s a ridiculous situation that we’ve allowed the system to run down so badly that you’ve got to go to the measures of travelling overseas to get overseas dentists, where we should be training our own people.

NICK GRIMM: But instead, Australia is becoming increasingly reliant on overseas trained dentists coming here to fill some of the gaps, like Dr Imogen Foster who moved from Britain to Burnie in Tasmania.

DR IMOGEN FOSTER, DENTIST: I’m surprised by the state of dental health here. I’m doing more extractions, for example, than I would previously have done.

NICK GRIMM: Imogen Foster’s new boss, Dr Peter Pullinger, spent two years sorting through immigration red tape so he could get another dentist working in his practice in regional Tasmania.

PETER PULLINGER: We’re in a third world crisis situation and that’s getting worse and worse and worse. No one seems to be listening.

NICK GRIMM: So, regardless of whether it’s patients pulling teeth with pliers or dentists travelling far and wide touting for help, individual Australians are taking matters into their own hands, as governments watch a national crisis get steadily worse.

CHRIS COLE: It’s reasonably immoral to go over and find, pinch staff from a country where they are needed anyway.

VALERIE SHORTER: I know I’m never going to live it down. I know that.

NICK GRIMM: And as Valerie Shorter knows, sometimes doing nothing is simply not an option.

VALERIE SHORTER: Yes. Start a dental clinic, backyard dental clinic myself. It doesn’t take a rocket scientist to pull a tooth, I can tell you.

NICK GRIMM: Have you had any customers yet?

VALERIE SHORTER: Not yet.

This is a public release made recently by Germaine Reinhardt of the University of Rochester Medical Centre.

Study shows new screening program effectively roots out toddlers’ cavities.

Dental researchers are combining the ease of digital photography with the internet to develop a new and inexpensive way to screen for a common childhood oral disease that predominantly plagues America’s inner city toddlers – early childhood dental caries (ECC), or as it is commonly called, “baby bottle tooth decay.” The cavities are caused by prolonged exposure to sweetened juices, often from sleeping with a bottle, and tend to be overlooked by parents until the pain becomes so severe, and the teeth so decayed, that the only option for these toddlers – often under the age of four – is sedation and extraction.

A specially outfitted digital camera is used to take photos of children’s teeth by a child care center health assistant. The photos are then sent electronically across town to pediatric dentists, who review the files in batches, identifying those toddlers with ECC. Dentists believe that this new screening system is the first of its kind, and will pave the way for earlier identification of the cavities before they become a painful problem for young toddlers – and a costly one for states across the country footing the bill for Medicaid. Estimates in the community of Rochester alone put treatment of ECC at $1 million annually, a tab picked up almost exclusively by Medicaid.

In a recent study published in the June issue of the Journal of Telemedicine & Telecare, University of Rochester Medical Center dentists documented how the new system showed that nearly 40 percent of 162 toddlers were suffering from baby bottle tooth decay. Most averaged about two cavities, but one child had as many as 20 decayed teeth.

“We have identified a very simple, cost-effective method to screen for this common childhood disease before it becomes a much larger problem,” said Dorota Kopycka-Kedzierawski, D.D.S., assistant professor of Dentistry at the University of Rochester Medical Center, and author of the study. “By catching ECC at its earliest stage, we will effectively save the patient and parent toothache and heartache, decrease use of emergency room services, and increase the usage of dentists by this underserved population.”

Typically found in children aged five and under, the practice of putting a baby to bed with a bottle, which the baby can suck on for hours, is the major cause of ECC. The sugary liquid flows over the baby’s upper front teeth and dissolves the enamel, causing decay that can lead to infection and cavities. ECC is rampant in minority communities, where access to dental care is uncommon. National estimates put up to 25 percent of minority children aged 1-5 suffering with the painful and often disfiguring condition.

If caught early on, parental education, fluoride treatments and sealants can slow down the decay, allowing teeth to naturally fall out as the child ages. But when the disease progresses unchecked, invasive treatment is the only choice, including sedation and extraction of the tooth.

One key to addressing this oral disease lies in the development of a cost-effective screening process, yet dentists have long struggled to find a balance point at which a large-scale screening program would be successful without generating exorbitant labor costs.

“Unfortunately, early childhood dental caries tends to occur in children who are not yet under the care of dentists, so there is no existing system of care that we can simply insert a screening exam into,” Kopycka-Kedzierawski said. “When we saw the success being experienced by the Health-e-Access telemedicine network here in Rochester, we knew we had the potential for a very cost-effective and successful solution.”

Health-e-Access is one the nation’s largest telemedicine networks, using customized computer and other medical equipment to connect sick children in child care centers and schools with their physicians to facilitate virtual sick visits. Researchers tapped into this infrastructure to conduct a pilot program, where digital photographs of childrens’ mouths were taken by Health-e-Access assistants. These digital files were then electronically delivered to Eastman Dental Center, where they were reviewed by pediatric dentists.

The pilot project proved two important things. First, the on-site health assistant at the child care center could be trained to take accurate photos of teeth, and second, the images were clear enough to diagnose ECC. In fact, the photos were better than “clear enough.”

“The quality of the images was such that we could spot decay that was not visible to the human eye,” Kopycka-Kedzierawski said. “And, we could use the photos to help educate the parents about the disease, and in some cases, gently prod them into seeking the care of a dentist.”

These results helped pave the wave for the larger screening program, the subject of the article published in Journal of Telemedicine & Telecare. In total, 162 children from 1 to 5 years old in six Rochester inner-city child care centers were screened, with almost 40 percent shown to have ECC. Once identified, parents received a letter alerting them to their child’s oral disease, and were provided with a referral so the problem could be treated.

Three months later, all children were rescreened to determine how many actually had actually seen a dentist to correct the problem. About 25 percent of children did receive dental services, though the sample size in this study is too small to make generalized conclusions. Now, researchers are focused on finding grants to help support follow-up efforts so that all toddlers identified with ECC will receive the much needed dental care.

This is an article that recently appeared in the Peterborough Evening Telegraph – Peterborough,England,UK.

An intrepid dentist is set to swap his leafy state-of-the-art practice for a makeshift clinic in the wilds of rugged Tanzania.

When Amit Mehta volunteered to treat villagers living in mountainous pockets of Peru two years ago, he was shocked by the sight of countless adults and children who had been forced to suffer agonising pain simply because they had never had access to a dentist before.

It made such an unforgettable impact that he vowed he would do more to help and put a smile back on the faces of hundreds of people.

And next February, after the region’s rainy season, the 25-year-old, who lives in Redbridge, Werrington, Peterborough, will fulfil that promise when he heads out to north-west Tanzania with Bridge2Aid’s UK Dental Volunteer Programme.

The charity works to improve oral health in the developing country and also provides vital training.

Although the sparse facilities – where extracting teeth in the open air is the norm – will be a world away from the comfortable dental practice in Brighton where Amit is due to start a new job next month, he is determined to make the most of the experience.

The former Ken Stimpson School pupil said: “Millions of people suffer dental pain with no way of getting even basic dental care.

“I chose this project, because as well as carrying out treatment, it allows you to train locals so they can gain the skills and become self-sufficient.

“When you think that there is about one dentist to every 2,100 people in the UK and compare it to one to every 300,000 in Tanzania, it hits you how big the problem is.”

He added that while dentistry here is largely preventative as people have access to check-ups, fluoride toothpaste and education, in the East African country, 70 to 90 per cent of the population live in rural areas with no hope of being seen by a trained dental professional.

Recalling his time with Dental Project Peru in the Apurimac region situated high in the Andes of Peru – where a population of 50,000 has access to just two dentists – Amit explained how it was the spur for his latest mission.

He said: “It was a totally different environment to work in, very remote and cut off from the Western world. It improved my clinical skills and it made me feel like I was making a difference.

“In terms of their dental health, the people had grossly decayed teeth because of their sugar-rich diet, but despite their pain, they were so welcoming and grateful to see us.

“Some of them had travelled 10 miles on foot when they heard we would be there.

He added: “I remember seeing the huge smile on the face of one little girl after I had removed a row of rotten teeth – it was really rewarding and I’ll never forget it.”

This is an article by Amy Norton that was published recently by Reuters.

Some of us are ‘extreme dreaders’ whose brains register more than simple fear.

Anyone who has ever waited in dread for the dentist may find some comfort in the findings of a new brain study.

For some people, researchers say, the waiting is indeed the hardest part, and finding a distraction might help.

Their study, published in the journal Science, used the brain-imaging technique of functional MRI to investigate the neural mechanisms underlying dread.

The researchers looked specifically at the agony of waiting to have a painful procedure among 32 volunteers who agreed to have a series of electric shocks to the foot.

Some of them dreaded each shock so much that they repeatedly opted to have a higher-voltage jolt just so they could get it over with more quickly.

These individuals, dubbed ‘extreme dreaders’, showed greater activity in a brain region related to both pain and attention.

The findings, say the researchers, indicate that dread arises not from simple fear, but from the brain’s attention to the unpleasant event.

“The dread is often worse than the event itself,” says lead study author Dr Gregory Berns, a professor of psychiatry and behavioural sciences at Emory University School of Medicine in Atlanta.

He says the brain-imaging results are good news because they indicate that extreme dreaders can do something to alleviate the problem.

They can find a distraction – such as meditation, exercise or some other activity – to take the focus off the anticipated event.

Shocking results

For the study, Berns and his colleagues took brain images of volunteers who agreed to endure electrical shocks to their feet.

First, each jolt was preceded by a cue that told participants how intense it would be, for instance 60% of their maximum pain tolerance, and how long they would have to wait for it.

In a second go, participants were presented with choices on how each shock should be delivered, with the voltage and timing of the jolt as the variables.

For example, they could choose between having a shock at 90% of their maximum pain tolerance delivered in the next 3 seconds, or one at 60% intensity in 27 seconds.

Extreme dreaders

Of the 32 volunteers, nine (the extreme dreaders) consistently opted for the stronger shock to avoid the longer wait.

This may seem illogical to many people, Berns says, but for extreme dreaders avoiding the anguished wait makes sense.

And it was the extreme dreaders who showed particularly high activity in the brain’s so-called pain matrix during the build-up to their electrical shocks.

Activity was specifically high in areas related to attention, but not in those associated with fear and anxiety.

In other words, extreme dreaders were giving more attention to their foot than ‘mild dreaders’ were.