The NobleDentist Blog

Dr Jayant Gokani of J G Dental is becoming a participating dentist.

This should take place by Monday, 12 March 2007. Contact details will be in Dentists Sydney.

Dr Jayant Gokani is located at 56 Old Castle Hill Road, Castle Hill, New South Wales.

This is an article by Mark Horstman that appeared recently in ABC Science Online.

People with missing or damaged teeth may one day buy implants of new living teeth grown from their own cells, says a U.K. researcher.

Scientists are using a biological approach to ‘regenerative dentistry’ in mice. But one scientist claims it could offer an alternative to dentures or synthetic implants in people in as little as two years.

Professor Paul Sharpe, who runs the craniofacial department at the Dental Institute in King’s College London, says researchers know how to initiate tooth development in stem cells of mice and grow them into mature teeth.

He was speaking recently at the American Association for the Advancement of Science meeting in Seattle, after Korean scientists announced the cloning of human stem cells, potentially for creating new organs or tissues.

Sharpe’s team bioengineers the two types of tissue in the embryo that form a tooth: the epithelium (the outer layer) and mesenchyme (connective tissue and blood vessels).

“We have a long way to go. But by understanding how to put those two together, and the important key genes, we can stimulate them to form a tooth, as opposed to forming any other organ,” he said.

Stem cells can become a range of tissues when given certain signals. The researchers grow stem cells from adult mice in culture and use them to replace the mesenchyme. The adult stem cells are combined with embryonic epithelium.

“For this we’ve concentrated on adult stem cells, because eventually for human patients, we don’t want to be extracting embryonic stem cells,” said Sharpe.

An advantage of using adult stem cells to treat patients is that they are autologous (come from the person being treated), and are found in many parts of the body: nerves, bone, marrow, hair, skin and intestine.

“We take the artificial tissues out of the culture dish and put them into the kidneys of adult mice, because they provide a good supply of blood and oxygen for teeth to develop. From there we can get a completely normal tooth organ, including the bone surrounding it.”

Problems with whole organs

Sharpe said they are currently experimenting on adult stem cells to recreate both types of tooth-making tissue, the epithelium as well as the mesenchymal tissue, from the embryo.

“But at this point we hit a problem, and it’s a problem with all regenerative medicine for complete organ replacement,” he said. “The embryo and the adult are completely different environments with different tissues and blood supplies.”

“I don’t know of any cases where a rudimentary organ from an early embryo transplanted into the appropriate spot in an adult gives rise to an adult organ.”

But Sharpe is confident that teeth are an exception, pointing to a teratoma as a naturally occurring example. A teratoma is a type of germ cell tumour that may contain hair, muscle or bone. In these strange tumours, teeth can develop inside cysts on ovaries.

“This is an example were the embryonic process has proceeded normally in an adult environment, albeit a pathological one.

“With this in mind, we’ve removed the early tooth rudiments from an embryo, and transplanted them into the mouth of an adult mouse between the incisors and molars where there are no teeth,” he said.

“We find that a tooth of normal size develops and cells differentiate to attach it to the underlying bone. What we’re not sure of yet is how to control the shape.”

“We don’t want the patient waking up from the treatment to find we’ve grown a molar in the front of their mouth where an incisor should be.”

“If we can do it in a mouse, and prove up the principles, it should be much easier in humans because of the size, basically,” he told ABC Science Online.

“We know we can do many of the bits. We’ve yet to do them all together. But in about two years, we should be ready to start on human patients.”

In 2002 Sharpe founded a start-up company, Odontis, to commercialise the new technology. Odontis holds the patents for using stem cells to grow teeth.

This is an article by Sue Dunlevy that appeared recently on www.news.com.au.

When a group of Thai Buddhist dentists feels compelled to come here to provide charity dental care for Australians, the true shame of our nation’s appalling public dental program is revealed.

We live in a nation sporting a $10 billion Budget surplus but there are 650,000 Australians living in pain, many unable to get a job or eat normally because they can not afford to see a dentist.

The state of our teeth is so bad we’ve been adopted as a charity cause by our Asian neighbours.

I was embarrassed when I learned on a trip to outback Australia that the highlight of the year in the tiny desert-bound town of Bedourie in Queensland was a visit by five Thai dentists.

With their saffron-robed cooks in tow, the dentists travelled from Thailand to spend a few weeks providing free dental care to the residents of this town to fulfil their religious obligation to perform charity work.

No disrespect to the burghers of Bedourie but you could see why they came when you saw the blackened, rotting and disappearing teeth of some of the people who lived in the area.

Sadly, the town’s publican informed me this week the Thai dentists had stopped their visits and there was now no dental care at all for the people who live around Bedourie.

The residents of Bedourie are not alone in their dental pain.

The Health Services Union this week produced three people who had been waiting 10 years for treatment on public dental waiting lists.

In Sydney single mother Sue Gandy said she was unable to get a job or attend her daughter’s parent teacher interviews because her missing and broken teeth and rotting gums were ruining her life.

The NSW public dental service had offered to pull out all her teeth but told her she would have to wait two years before they could supply her with dentures to take their place.

Anyone who has overcome their phobia of the dentist chair to have some dental work done will know why low-income earners can’t afford it.

A simple filling will set you back more than $300 and a capped tooth will cost $1300.

You will be after a second mortgage on your home if your child needs braces.

The appalling state of this nation’s teeth is matched only by the shameless reaction of our politicians to the problem.

The Iemma Government contributes the lowest amount of money per head to public dental care of any state in the country – just $18 a year, compared with about $36 in other states.

Federal Health Minister Tony Abbott this week washed his hands of the problem, claiming public dental care was a state responsibility and they should fix it.

Yet his Government spends more than $368 million a year paying 30 per cent of the cost of dental care for those rich enough to have private health insurance through the private health insurance tax rebate.

And his Government made the public dental waiting lists worse when it axed a $100 million a year contribution to public dental health programs in 1996.

The Australian Council of Social Services and the Health Services Union point out that poor public dental care has ramifications beyond the disfigurement and pain it causes the individuals who suffer from it.

In the end it means many of these people are unemployable.

It means they are left living off welfare and pain-killers and antibiotics paid for by the taxpayer.

ACOSS says with a $10 billion Budget surplus, the Federal Government should at the very least be able to spare $160million a year to cover the cost of a comprehensive oral health check or the cost of a course of basic treatment every two years for families earning less than $48,000.

The Health Services Union says Medicare should cover the cost of dental treatment for children aged under 18 and those aged over 65 as well as low-income earners.

Fifty per cent of marginal-seat voters surveyed by the union say they had put off dental care because they couldn’t afford it.

Three out of four of them said the Federal Government should have a role in providing public dental care and they want Medicare to cover it.

Two of our politicians are offering some hope for the dentally challenged.

Opposition Leader Peter Debnam says he will spend $208.5 million on public dental care if he wins next month’s state election.

Labor’s health spokeswoman Nicola Roxon says a federal Labor government will provide a means-tested program of free dental care for the nation’s working families.

Until then it seems the only road to dental nirvana may be to meditate and hope that the Buddhists resume their charity work in Australia.

This is an article that appeared recently on ABC News Online.

Federal Health Minister Tony Abbott says the Federal Government cannot be blamed for the long dental waiting lists.

He told Parliament state dental funding fell by $47 million between 2000 and 2004.

He noted the case of a pensioner from the Gold Coast who waited three years to have teeth removed in 1994, when Kevin Rudd worked for the Queensland Government.

And Mr Abbott says state governments are still failing to provide enough funding for dental services.

“It is true that state-run public dental services are failing, unfortunately Mr Speaker there are now some 650,000 people on state public dental waiting lists right around Australia and Mr Speaker this is fairly and squarely the fault of the state Labor governments,” he said.

This is an article that recently appeared in ABC News Online.

A Liberal backbencher says the Federal Government should consider paying for dental checks for people in aged care facilities.

Labor has been attacking the Government over dental health and has promised to fund a national dental program if it wins government.

Several Coalition MPs are pushing for the Federal Government to put more money into dental care, and the issue was raised in today’s Coalition party room meeting.

Western Australian Liberal MP Mal Washer says preventive dental care for the elderly is a cost-effective way of avoiding medical complications.

“We traditionally do care for people in aged care facilities, that is our responsibility,” he said.

“If we’re going to do that, let’s set a damn good example by proving that if you take care of good dental health, then it’s a very good investment.”

One suggestion raised by Coalition MPs is for basic dental care to be covered by Medicare and tied funding to be paid from the Commonwealth to the states.

Dr Washer says the states have dropped the ball on dental health.

“Whichever way, I think the it’s a bit like mental health, that eventually the Federal Government’s going to have to have a bigger part to play in this and greater responsibility,” he said.

“I think we’ve got to go and sit down in a cooperative manner, say ‘look, you folk are not pulling your weight here, how can we help to get good dental health for our communities in general?’”

This is an article by Melissa Healy that appeared recently in the Los Angeles Times.

Getting a mouthful of hardware designed to straighten the teeth is a rite of passage for nearly three in 10 American children. But a new study suggests that these kids do not come out happier for it once they grow into adulthood.

Parents and patients often hear orthodontists tout the improved confidence and self-esteem that will come from correcting misalignments of the teeth and jaw. But a 20-year study conducted by British psychologists and dentists has found that by the time they reach 31, children who were identified as needing some orthodontia – and who didn’t get it – were no more likely to have psychological difficulties than those who needed – and got – their smiles straightened.

The study, which tracked the psychological well-being of more than 1,000 children, focused on a smaller subset of kids whose orthodontic needs were not extreme, but considered to be “borderline,” and who did not have them treated.

“Orthodontic treatment, in the form of braces placed on children’s teeth in childhood, had little positive impact on their psychological health and quality of life in adulthood,” said Dr. William Shaw, an orthodontist from the University of Manchester and one of the authors of the study, published in the British Journal of Health Psychology. “This runs contrary to the widespread belief among dentists that orthodontic treatment improves psychological well-being, for which there is very little evidence.” That belief is due to be dealt a further blow by a study set for presentation to the International Association for Dental Research at its March 21 to 24 conference. A comprehensive review of all studies addressing the impact of orthodontia on self-esteem has come up empty.

Dr. David Locker, chairman of the University of Toronto’s Community Dentistry department, and co-author Shoroog Agou, a dentist in the program, found a “lack of self-esteem gain following early orthodontic treatment.” Dr. Clarice Law, an orthodontist and pediatric dentist at the University of California, Los Angeles’ School of Dentistry, said studies such as this help fill in a key part of the puzzle that orthodontists and patients – and their paying parents – need to consider when a child’s teeth are just a little uneven.

“It’s interesting to me to hear that for most kids, it doesn’t seem to have that great an impact,” Law said.

But James E. Richeson Jr., past president of the Academy of General Dentistry, said doing a 20-year study on the psychological impact of orthodontia misses the point.

Getting teeth straightened and aligned is about preserving the teeth and making the mouth jaw work better as a unit, he said, adding that any increase in self-confidence is a byproduct of that treatment. “I would say that preserving oral health is by far the most common motivator for patients,” said Richeson.

This is an article by Anne-Marie Tobin that appeared recently in The Canadian Press (www.canada.com).

TORONTO - Some people go under the knife or have injections every few months to smooth their skin, while others depend on wrinkle creams and lotions or just allow nature to take its course.

Whatever the approach, anti-aging products are a multibillion-dollar industry in North America, and now some dentists are getting into the act too.

A removable device called Angellift, manufactured in California, is worn inside the mouth and “gives patients another option to help them remain looking younger,” said Dr. Bruno Paliani, a London, Ont., dentist who’s among the first in Canada to start fitting patients.

Including visits, he charges less than $500 for an upper, and the same for a lower; some people take only one, some take both.

“It fits above the gum lines, and it lifts and supports the tissues around the face, so what it does is it removes wrinkles and it prevents further deepening of the wrinkles as the patients age,” Paliani said.

So far, he’s just in the early days of fitting a handful of patients. A spokesman for Medical Matrix, the U.S.-based company that developed and markets the device, said about 500 North American dentists are trained, but the company could not provide a list of other Canadians who have signed on.

Lisa Berk, a mother of three-year-old twins in San Diego, Calif., has been wearing one for about a year now—even though she’s only 39 years old, and not quite into wrinkle territory yet.

“I just don’t want to be wrinkled, and I know I don’t want to have to do plastic surgery or I don’t want injections, or anything like that,” Berk said.

“So I figure if I can just take care of my skin then hopefully I won’t have to worry about that down the line.”

Berk decided to get one after seeing a “dramatic” difference in her mother’s appearance after she got the device.

“With her, you can just see all of those lines filling out,” Berk said on the telephone from California.

“She’s not a smoker, but they kind of look like those vertical smoker’s lines, and you can just see how it fills that area.”

Dr. Wayne Halstrom, president of the Canadian Dental Association, said that fitting patients with the device “wouldn’t fall into something that I would participate in.”

He noted the association doesn’t take an official position on cosmetic procedures.

“When we talk about cosmetics in dentistry, our position on that would be yes, when it involves … replacement of teeth with bridges or dentures for cosmetic reasons. They also would have a dental reason for doing that,” he said from Vancouver. “In the case of the lift, there is no dental reason for doing it.”

But if someone decides to place such a device “near and at and around oral tissues both hard and soft, if I made that decision, I would quite likely go to my dentist, and say ‘Look can you do this for me, and make sure I don’t put myself in harm’s way?’ ”

There would also be issues of cleanliness and bacteria buildup, he noted.

“You’re introducing some new entity into the mouth and because it’s not related to the oral environment necessarily in the person’s mind, the question is, how clean do they keep them between wearings?” he said. “That’s a consistent concern for dentists who are treating patients with removable appliances.”

Aaron Bruce, an official with Medical Matrix in San Diego, said the lift can be worn all the time, but users are advised to remove it before eating.

A patient study that followed 170 people found that after 30 days, they wore the device for an overall average of three hours a day. Thirty-two patients reported discomfort and all 170 saw facial improvement.

After a year, it was worn for an overall average of 1.2 hours a day. Sixteen of the original 170 people could not be reached, but of the 154 who were contacted, 12 patients had discomfort and 143 reported facial improvement.

The Angellift came about when Medical Matrix was building a prototype insert for a California surgeon who wanted to give patients a “preview” of their appearance before putting implants under their lips.

The device has gone through some new engineering to include a type of wax that adheres to resin.

“We can actually allow the patient, with this wax, to be able to reduce, move, add to the lift any time they want,” Bruce said.

He acknowledged that dentists are heading into new territory, and said it has created “some conflict” with the medical community in the United States.

“There are certain people in the industry who do not believe the product should be handled by dentists,” Bruce said. “They want dermatologists and surgeons to handle the product.”

Dentists, he said, welcome it because it’s their only tool to fight wrinkles.

“And in the U.S., and in Canada, wrinkle fighting is a big business.”

I have not been to the dentist for many years because of a previous bad experience. Now, I need some dental work done, and I’m terrified. What can I do to get through it?

Mayo Clinic dental care specialist Alan Carr, D.M.D. and colleagues answer select questions.

Answer

Many people experience some level of trepidation about dental procedures. This is normal — especially if you’ve had a prior bad experience. Talk to your dentist about your concerns and ask him or her about the possibility of using dental sedation.

Sedation dentistry involves the use of medications to allow you to relax and feel sleepy during a dental visit or procedure. This is referred to as conscious sedation. However, sedation is not pain medication, so you will still require local anesthesia, such as Novocain, during treatment.

There are a variety of sedation dentistry methods. The most common types are inhaled sedation, which involves breathing in a mixture of nitrous oxide (laughing gas) and oxygen; and oral sedatives, which are medications taken by mouth. Another type of dental sedation is intravenous (IV) sedation, which is provided by dentists with specialized training in IV sedation. The major advantage of IV sedation is the ability to adjust the level of sedation when needed.

With conscious sedation, you breathe on your own. You’re also responsive to vocal commands and sensory stimulation. You may feel so relaxed that you fall asleep during the procedure. Afterwards, you may feel groggy and disoriented and may require help getting home. In addition, you may not remember what happened during the time you were sedated.

Conscious sedation is safe when administered by dentists trained in its use. However, as with any medication, sedation involves a certain amount of risk. It is important to talk to your dentist about these risks.

This is an article by Jill Stark that appeared recently in The Age – Melbourne, Victoria.

The shocking state of children’s dental health is revealed in new figures showing a 42 per cent rise in under-12s being treated in private hospitals for tooth decay.

The Australian Dental Association has called for a government health campaign after a major private health insurance company found the number of children being admitted to hospital for rotting teeth had increased from 436 in 2000 to 619 in 2005.

Claims for hospital treatment for children’s fillings rose 66 per cent and preventive dental care claims are up 72 per cent.

Six-year-olds emerged as most at risk of rotting teeth, with a 95 per cent increase in hospital admissions, prompting calls for children to have dental check-ups from their first birthday.

The figures, compiled from insurance claims made by MBF members, mirror a recent study by the Australian Research Centre for Population Oral Health that revealed the rate of children under nine having general anaesthetics for dental work has tripled.

Soft drinks and sugar-laden juices are blamed for the rise in tooth decay and experts have urged parents to encourage children to drink fluoridated tap water.

Prime Minister John Howard recently described the tooth-decay crisis as a national tragedy and called for children to drink a glass of tap water a day.

But Australian Dental Association president John Matthews said the figures showed public awareness of oral health had to be a priority.

“It sheets home a certain level of complacency about a very common disease, dental decay,” he said. “One of the things we’ve asked the Government to do in this election year is to look at how you can translate some of the successes they’ve had with health promotion with Quit and Slip Slop Slap and get-fit messages, and whether it’s time to start looking back at dentistry for similar campaigns.”

Dental cavities rank fourth in the top 10 reasons for admission to private hospitals.

The president of the Australian and New Zealand Society of Pediatric Dentistry, Dr John Winters, said the rise in child tooth decay in the past 15 years was almost certainly due to the amount of fruit juice and soft drinks being consumed.

But he said hospital treatment was often the most effective method of treatment for dental cavities.

“Under general anaesthetic we have the optimal work environment — the kids are still, they keep their mouth open, they don’t get frightened, they don’t start to get upset when you’re halfway through.”

A spokeswoman for State Health Minister Bronwyn Pike said more than $130 million for dental services was allocated in the last budget. Waiting lists for general dental care fell about 60 per cent in the past 18 months.

This is a piece that appeared recently in the ABC News Online.

The Australian Dental Association (ADA) has accused the Queensland Premier Peter Beattie of “political buck-passing” over the issue of fluoridating water.

ADA state president Martin Webb says the Government’s introduction of recycled water provides the perfect opportunity to fluoridate supplies in south-east Queensland.

Mr Beattie says there are no plans at this stage to go beyond the incentives offered to councils to voluntarily fluoridate water.

But Dr Webb says that is a “cop-out”.

“We think it’s typical political buck-passing,” he said.

“It’s a State Government issue, it really is a health issue and for the State Government to flick it to local government and say they that have the responsibility to introduce this when there’s no real local government benefit.

“It’s really a community public health benefit which really comes under the category of a State Government issue.”