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Sunday, January 20, 2013

Congressional hearing on amalgam wastewater gets personal

July 9, 2008 -- Representatives from the American Dental Association got a less-than-friendly reception from members of Congress on Tuesday during a hearing on environmental concerns related to amalgam wastewater.

In what news reports described as emotional and at times heated testimony before the House Committee on Oversight and Government Reform's Subcommittee on Domestic Policy, ADA consultant William J. Walsh came under fire early on when two of the subcommittee members aired "deeply personal diatribes" about their experiences with mercury-based amalgam fillings.

According to a story by the Associated Press, Rep. Dan Burton (R-IN) -- who has held several hearings on mercury in the past -- expressed concerns over some dental work he'd recently had and what impact the removal of a filling might have on the environment. He also talked about one of his grandchildren, who became autistic shortly after receiving several vaccinations, many containing mercury.

Rep. Diane Watson (D-CA) discussed her issues with mercury fillings she received as a child, saying they are responsible for allergies, headaches, and splotchy skin she has suffered from ever since.

Walsh was reportedly "taken aback" by their comments and their emphasis on mercury poisoning, according to the AP. He tried to focus the hearing on the recommendations the ADA had made on proper handling of waste amalgam.

"The ADA has issued and continually updates as appropriate its best management practices [BMPs] for handling waste amalgam," said Walsh, a lawyer who has represented the ADA on amalgam wastewater issues since 2001, to the committee. "These BMPs call for the use of standard control methods, recycling of collected amalgam, and, since last fall, the use of amalgam separators. Dentistry's goals comport exactly with those of government -- to minimize dentistry's discharge of amalgam waste."

Walsh told the subcommittee that dentistry contributes a very small amount of the mercury in wastewater, and that the ADA and its members are taking "every reasonable step" to further minimize that impact, according to a statement by the ADA. However, he also reiterated the ADA's opposition to requiring all dentists to install amalgam separators in their offices.

"Even without separators, dentists capture in their offices approximately 80% of the waste amalgam, with almost all of the remaining 20% captured by water treatment plants before the wastewater is discharged to surface water," he stated. "In other words, 99% of the amalgam is already captured prior to discharge from the POTW [publicly owned treatment works]."

According to a 1997 report to Congress by the Environmental Protection Agency, dentistry contributes less than 1% of the total mercury found in U.S. lakes and streams, Walsh added. Even so, the ADA says it has devoted substantial time and resources to working with government agencies and educating the dental community about amalgam wastewater management.

"Despite the very small share of mercury in surface waters from dental amalgam, America's dentists want to do the right thing and minimize even further impact on the environment," Walsh said. "[They] drink and fish and swim in the same waters as everyone else in their communities and believe that ongoing efforts to encourage the use of BMPs and separators are succeeding and will continue increasingly to succeed."

Lie to the dentist? Not me. Never.

By Rochelle Sharpe, DrBicuspid.com contributing writer

July 9, 2008 -- When dentists and their staff ask their patients simple questions, they shouldn't expect truthful answers. That's the take-home message of a recent survey, in which more than four in 10 adults admitted they would tell their dentists they always brushed for the recommended time -- even if it weren't true.

One in four, meanwhile, said they would fib about flossing, too, according to a Harris Interactive poll of 1,001 U.S. adults. The survey was commissioned by Philips Sonicare and the nonprofit group Oral Health America. (Harris declined to provide a margin of error.)

While those numbers might seem high to the straight shooters of the world, experts on lying suspect that the percentage of dental patients who embellish the truth is a lot higher than that. And it illustrates why asking direct questions may not prove the best means of helping patients improve their oral health.

"People lie all the time," said Michael Lewis, Ph.D., a psychiatry professor at the Robert Wood Johnson Medical School in New Jersey, who contends that lying is just as common as truth telling. "I would lie if the dentist asked me about flossing."

Why patients lie

“You've got to be really stupid not to lie.”
— Michael Lewis, Ph.D.

Patients tell white lies for many reasons, ranging from wanting to please authority figures to avoiding shame and punishment. No one wants to admit their slothful ways, let alone get a lecture on hygiene. And who wants to aggravate a dentist wielding a syringe?

In such vulnerable situations, lying is "almost a reflex," said Marian Stuart, Ph.D., also a professor at the Robert Wood Johnson Medical School.

"You've got to be really stupid not to lie," said Lewis, citing a study that found children who don't lie have lower IQs. "People lie because they don't want to be scolded."

People lie especially frequently to dental receptionists, said Gary Kadi, who heads NextLevel Practice, a dental management consulting firm in Scottsdale, AZ. In one of his surveys, only 15% of patients told receptionists why they were really canceling appointments, said Kadi, whose clients can have cancellation rates as high as 50%.

When patients finally make it to the dentists' chair and are asked about their oral health habits, they often aren't thinking about brushing or flossing at all, said Dorothea Lack, Ph.D., a former hygienist who's now a psychologist in San Francisco. "They want the doctor to like them," she said. Some patients believe that if dentists and hygienists approve of their patients, the patients will get better care.

On one hand, patients visiting new dentists or hygienists may be embarrassed to admit that they don't brush properly, said Timothy Smith, Ph.D., a behavioral science professor at the University of Kentucky College of Dentistry. "They aren't going to tell a stranger intimate things, even if it's just about dentistry," he said.

On the other hand, those who consider their dentists or hygienists old friends, meanwhile, may tell white lies to spare their feelings. "They don't want to let them down," Smith said.

Then there are the people who lie to themselves. Some may really believe that they have acceptable hygiene habits, while others can't bear to admit to themselves that they are neglecting their oral health.

More concerning than patients who fib about hygiene are those who don't mention that they suffer from debilitating diseases -- a crucial omission that could lead to serious medical complications. For example, a patient who lies about having had endocarditis might not receive the antibiotics recommended before dentistry.

Of course, dentists also want to know if patients carry contagious diseases, such as hepatitis or AIDS. When patients don't reveal the information, they are not necessarily being malicious, Smith said. "People like to forget they have these problems."

Finding the truth

So how can dentists get patients to be more truthful? The first step: forget the yes and no questions. After all, dentists don't really need patients to plead guilty to poor hygiene. Teeth don't lie.

In the Japanese culture, people rarely ask questions, yet they achieve a lot, according to Lewis. Avoiding questions "turns out to be a useful strategy," he said.

While it would be nice for patients to talk openly about their hygiene habits, remember that finding out the truth is not the ultimate goal. It's far more important for dentists to build strong relationships with their patients -- and convince them to become more compliant, Kadi said.

"You can accomplish anything in the context of a good relationship," Lack agreed.

One way to build good relationships: active listening. Dentists should get in the habit of repeating patients' answers to questions, so they can be sure that they are hearing them correctly, Smith said.

Using nonverbal behavior is important, too. Dentists can encourage patients to open up by leaning forward, maintaining eye contact, and nodding often, Smith said.

Ask open-ended questions and listen for offhand remarks -- comments that don't sound quite right, or what Smith calls "zingers." For instance, a dentist talking to a patient about health problems may conclude a conversation with "Anything else?" If the patient responds with "Nothing important," that's when it's important to follow-up, Smith said. Ask "Nothing important?" and the answer may be "Well, I have these problems in my heart."

Dentists should not be satisfied with a patient's first answer, psychologists say. It's often helpful to ask the same question in different ways and move from general, open-ended questions to extremely specific ones. Dentists can ask patients directly if they are on specific medications, and explain why they need to know.

Creating a nonthreatening environment is key, psychologists say, with some suggesting that dentists go so far as to normalize undesirable behavior. Stuart advises that dentists say something such as "Most people don't floss every day. They don't brush every day. Tell me what you do." Ask patients what makes it hard to have better hygiene habits, and look with them at what the barriers are, she said.

Loving the liar

Look for teachable moments, psychologists say. If patients have bleeding gums, they may be more interested in learning how to properly floss.

To convince patients to take better care of their teeth, praise something, Lack suggested. "They're probably doing something right," she said. "Whatever you praise, you get more of that."

Patients are "expecting to be beat up," said Kadi, the management consultant. Surprise them and tell them something good, he said, even if it's just "you've got good bone structure."

Too many dentists focus on the means such as tooth brushing, rather than the patients' ends: the desire to have a sexy smile or live long enough to watch their children grow up.

"Look beyond the soft and hard tissues, and get to the emotional issues of the patient," he said. With this philosophy, he said, his clients have not only been able to convince their patients to be more compliant, but the dentists have also reaped big financial rewards. He said his more than 600 clients saw their collections grow an average of 37% from May 2007 to May 2008, despite the poor economy. And appointment cancellations are down. "People buy for emotional reasons," he said.

Finally, don't take patients' behavior personally, Lack said. Don't be annoyed if patients lie or even if they don't comply with your instructions. "Patients don't feel well. They may be afraid," she said. "Healthcare workers forget: It isn't about the doctor."

Honestly.

Dentists ignoring high-risk patients' needs, survey finds

By Laird Harrison, Senior Editor

July 9, 2008 -- Dentists know that some patients need more care than others, yet most aren't following professional guidelines for these patients. So say San Francisco Bay Area researchers who presented a survey of 410 dentists last week at the International Association for Dental Research (IADR) meeting in Toronto.

"Knowledge doesn't necessarily transfer to behavior," said Nathaniel Kaufman, D.D.S., a private practice dentist in Berkeley, CA.

Dr. Kaufman and researchers from the University of California, San Francisco drew data from a larger survey of dentists who were Delta Dental Providers in California, Pennsylvania, and West Virginia. Of the 265 who responded to the survey, most were white males who had practiced at least 15 years.

Almost all of the dentists (94%) agreed that dentists should take special care of patients at high risk of caries. And they reported such basic steps as advising these patients that they're at risk (96%) and recommending fluoride toothpaste (98%).

At the same time, however, only 82% of the surveyed dentists recommend home fluoride rinse, 58% provide dietary counseling, 50% recommend antimicrobials, and 34% apply in-office fluoride varnish.

The low percentage of dentists applying fluoride varnish is particularly striking because the ADA has made a very clear recommendation in favor of this procedure. "Higher-risk patients should receive fluoride varnish or gel applications at three- to six-month intervals," reads a 2006 guideline published in the Journal of the American Dental Association (August 2006, Vol. 137:8, pp. 1151-1159).

The ADA hasn't made as clear an endorsement of antimicrobials or rinses, but in November 2007 the Journal of the California Dental Association published a consensus statement signed by most of the leading experts on caries in the U.S. that includes this statement: "Topical antibacterial therapy should be used whenever a high cariogenic bacterial challenge is identified and patients should be informed it could require repeated treatments" (JCDA, November 2007, Vol. 35:11, pp. 799-805).

The ADA is also less specific on dietary counseling and fluoride rinses, but the JCDA statement includes 0.05% sodium fluoride rinses among the possible sources of fluoride to be recommended.

So why would so many dentists fail to carry out recommendations by the leading authorities in their field? You might think that financial incentives would help; if you reimbursed dentists more for applying fluoride varnishes, maybe they'd do it more often. But studies aimed at addressing that question have showed a big change in reimbursement only makes a small change in behavior, said James Bader, D.D.S., M.P.H, a research professor of operative dentistry at the University of North Carolina who has published similar research.

"It's human nature," he said. "It's more difficult to change than not to change."

The problem isn't limited to dentists. Dr. Bader cited other research on medical doctors finding a lag of about 17 years between the time a new procedure is identified as effective and the time it is widely adopted.

One clue to the reason for dentists' inertia may be a lack of confidence in their ability to prevent caries. In the survey, 70% of those dentists who felt effective in addressing high caries activity used some sort of topical fluoride (varnishes, gels, foams, etc.) versus only 47% of those who felt ineffective, a statistically significant difference.

In other words, said Dr. Kaufman, the dentists had to believe these added measures would really make a difference. "To say 'I've been wrong for 25 years' -- that's hard to swallow."

World's poorest can't afford fluoride toothpaste

By Rabia Mughal, Contributing Editor

July 7, 2008 -- What if you had to pay $4.75 a day for toothpaste? That would be the approximate cost to U.S. consumers if they had to spend as much of their income on this common drugstore item as the world's poorest people do. This cost poses one of the biggest challenges to oral health in the developing world, according to a new report in BioMed Central'sGlobalization and Health journal (June 13, 2008, Vol. 4:7).

Rapid globalization has led to a change in people's eating habits, and developing countries are now embracing a Westernized diet high in refined carbohydrates. Along with this diet comes dental caries, which in some developing countries contribute to a poor quality of life and malnutrition, the study authors noted.

Fluoride toothpaste has helped many developed countries respond to this problem. Now most developing countries are trying to follow suit.

"Available data suggest that the change in diet in most developing countries is very much toward a more Western diet with its associated health problems," wrote Ann S. Goldman, M.P.H., corresponding author and research instructor at George Washington University, in an e-mail to DrBicuspid.com. "So, having access to appropriate amounts of fluoride and good oral hygiene is essential."

But the cost of the toothpaste may prove prohibitive for some, according to the report.

Another popular form of caries prevention is water fluoridation, but that has its limitations also. The study authors give the example of the U.K. where optimally fluoridated water reaches only 9% of the population. Developing countries simply cannot afford to fluoridate water because of poor infrastructure and limited financial and technological resources.

Fluoride can also be applied in a topical form as a varnish or gel, but trained personnel are required to apply it on an individual basis and treatment becomes prohibitively expensive, the authors noted.

"Although a whole range of fluoride vehicles are available for fluoride use (drinking water, salt, milk, varnish, etc.), the most widely used method for maintaining a constant low level of fluoride in the oral environment is fluoride toothpaste," they wrote. "The widespread use of fluoride toothpaste has been recognized as the single most important reason for the decline of dental caries in developed countries during the 1970s and 1980s."

For countries that can only afford the bare minimum in dental care, fluoride toothpaste is absolutely the best option, confirmed Poul Erik Petersen, D.D.S., chief of the World Health Organization's oral health program, in an interview withDrBicuspid.com.

Who can afford fluoride toothpaste?

For the study, dental associations, nongovernment oral health organizations, and individuals in 45 countries filled out a survey about the cost of fluoride toothpaste between December 2005 and March 2006.

The researchers collected information about several brands of fluoride toothpaste, including local and international brands, and then analyzed whether people could afford the least expensive brand of toothpaste available, Goldman said. They found a similar range in prices among developed and developing countries, regardless of income.

The following are some price ranges in U.S. dollars for 189 g of fluoride toothpaste:

Country	Price
Benin	$3.07 to $8.58
Zambia	$1.70 to $8.48
Senegal	$2
U.K.	$0.88 to $8.48

The researchers calculated the cost of a year's worth of toothpaste for one person, both as a proportion of household expenditure and in terms of the number of days of work needed to cover the cost.

Not surprisingly, they found that people in poorer countries would have to spend a higher proportion of their income to buy fluoride toothpaste.

For example, the poorest 30% of the population in Kenya would have to work 9.34 days to pay for one annual dose of toothpaste per person, the researchers found.

For an average U.S. household, this would be equal to spending approximately $1,731 a year on toothpaste.

"The real issue is whether people in these countries can afford to buy toothpaste at these prices given their income," Goldman explained. "The cost of even the equivalent of one dollar a day is expensive for many people, but certainly the poorest people in developing countries."

Toothpaste for all

The authors offered different ways that fluoride toothpaste might be made more affordable in developing countries.

First, toothpaste companies could lower their prices in the developing world and increase their market there. "Manufacturers may want to balance the benefits of expanding their market versus a certain level of profits at current levels of consumption of toothpaste," Goldman stated.

The researchers also suggested that governments could tax fluoride toothpaste at a lower rate.

Finally, poor countries should focus on producing fluoride toothpaste locally and avoid expensive imported brands, they stated. Less expensive ingredients and packaging can also lower the cost.

"In view of the current extremely inequitable use of fluoride throughout countries and regions, all efforts to make fluoride and fluoride toothpaste affordable and accessible must be intensified," the authors concluded. "As a first step to addressing the issue of affordability of fluoride toothpaste in the poorer countries, in-depth country studies should be undertaken to analyze the price of toothpaste in the context of the country economies."

Prenatal vitamin D linked to kids' dental health

By Reuters Health

July 7, 2008 -- NEW YORK (Reuters Health), Jul 7 - By maintaining adequate vitamin D levels during pregnancy, mothers may be protecting their babies against early tooth decay in childhood, according a study reported Friday at the International Association for Dental Research (IADR) meeting in Toronto, Canada.

Dr. Robert Schroth from the University of Manitoba reported that mothers of children who developed cavities at an early age had significantly lower vitamin D levels during pregnancy than those whose children were cavity-free.

The study team enrolled 206 women during the second trimester of pregnancy "as that is when primary teeth begin to develop and calcify," Schroth explained in comments to Reuters Health. They measured vitamin D levels in the women's blood at enrollment and then followed them until their infants were around 1 year old.

Only 21 women (10.5%) were found to have adequate vitamin D levels. The average vitamin D level was about half what is considered adequate, the investigators found.

Among 135 infants who had their teeth checked by the team, roughly 22% had noticeable enamel defects and about 34% had early childhood tooth decay.

Mothers of children with enamel defects in their primary teeth had lower average vitamin D levels than those of children without enamel defects, but the difference was not significant from a statistical standpoint.

However, mothers of children with early tooth decay had significantly lower vitamin D levels during pregnancy than mothers whose children did not develop early tooth decay.

"Considering that 90% of this study group was comprised of urban Aboriginal women, the results may not be completely generalizable to the public at large," Schroth noted.

"However, this is the first known study that has attempted to link blood levels of vitamin D and infant oral health, particularly caries (tooth decay) and suggesting a significant association," Schroth said.

By Megan Rauscher

Last Updated: 2008-07-07 10:50:18 -0400 (Reuters Health)

Copyright © 2008 Reuters Limited. All rights reserved. Republication or redistribution of Reuters content, including by framing or similar means, is expressly prohibited without the prior written consent of Reuters. Reuters shall not be liable for any errors or delays in the content, or for any actions taken in reliance thereon. Reuters and the Reuters sphere logo are registered trademarks and trademarks of the Reuters group of companies around the world.

Sirona Teneo optimizes workflow and communication

By DrBicuspid Staff

July 7, 2008 -- The new Teneo Treatment Center from Sirona Dental Systems integrates patient communications, optimized workflow, and implant and endondontic systems.

Teneo also features computer networking capabilities with standard USB and Ethernet interfaces that facilitate complete practice integration and the remote installation of software updates, service, and diagnostics.

Teneo will be exhibited at European dental shows starting this fall.

Glass ionomers get vote of confidence at IADR

By Kathy Kincade, Editor in Chief

July 3, 2008 -- TORONTO - Speakers at the International Association for Dental Research (IADR) meeting on Thursday called for wider adoption of glass ionomers for restorations, linings, and bases.

First developed in the U.K. in the 1970s, glass ionomers have long been used in Europe, Asia, and developing countries for restorative and lining purposes, offering a readily available, cost-effective alternative for caries treatment, particularly in children. But their use in the U.S. has been limited.

"The United States has had a glass ionomer barrier for many years," said Martin Tyas, B.D.S., Ph.D. (Birm), D.D.Sc., professor and director of the biomaterials evaluation unit in the School of Dental Science at the University of Melbourne and moderator of the IADR session on glass-ionomer cementers. "Over the years, it has been used very little in the United States, and that use has been disappointing. I think this is primarily an issue of lack of training and understanding."

What are glass ionomers?

Glass ionomer cements are available in two forms, both of which contain fluoride: conventional and resin-modified. The first glass-ionomer cements comprised a liquid acid mixed with a glass powder, creating an acid-base reaction. Early release of calcium ions is responsible for the initial setting of these cements; the subsequent release of aluminium ions significantly improves the strength over the next several days. Initial commercial glass-ionomer cements included the Fuji I and Shofu I.

Resin-modified glass ionomer cements such as the Fuji Plus and Vitremer Luting were first developed in the early 1980s. These are glass-ionomer cements that contain a small quantity of a water-soluble, polymerizable resin component. These combine an acid-base reaction of the traditional glass ionomer with a self-cure amine-peroxide polymerization reaction. These light-cured systems have been developed by adding polymerizable functional methacrylate groups with a photoinitiator to the formulation.

According to a 1999 study (Journal of the Canadian Dental Association, October 1999, Vol. 65:9, pp. 491-495), the main limitation of glass-ionomer cements is their relative lack of strength and low resistance to abrasion and wear. Resin-modified glass-ionomer cements have been shown to be stronger and more flexible, although their wear resistance needs further clinical study. In addition, while it has been hypothesized that release of fluoride from glass ionomers may contribute to caries prevention, this clinical effect has not been well-established in the literature (Journal of the American Dental Association, March 2008, Vol. 139:3, pp. 257-268).

For example, according to Sharan Sidhu, B.D.S., M.Sc., Ph.D., of the Institute of Dentistry at Barts and The London School of Medicine and Dentistry, there is much documented evidence that glass ionomers are a viable alternative to conventional materials for fillings, linings, and bases. Her review of several multiyear clinical evaluations of resin-based glass ionomers (RMGICs) compared retention, marginal characteristics, material deterioration, secondary caries, color stability, and pulpal and biological effects. She found that, with the exception of color stability, RMGICs consistently performed well.

Results from several studies -- including Abdalla and Alhadainy (American Journal of Dentistry, February 1997, Vol. 10:1, pp. 18-20) and Loguercio et al (Journal of Adhesive Dentistry, 2003, Vol. 5:4, pp. 323-332) -- show retention rates of 93% to 100%, according to Dr. Sidhu. Similarly, two studies -- the 1997 Abdalla and Alhadainy study and another by van Dijken et al (Swedish Dental Journal, 1999, Vol. 23:1, pp. 1-9) -- found no secondary caries development following the use of RMGIC over two years and only one (in an open sandwich restoration) over three years. A third study (Loguercio et al, 2003) found no secondary caries over five years.

Promise for developing world

Ionomers are particularly well-adapted to atraumatic restorative treatment (ART), a technique being used in conditions where minimal equipment and supplies are available. In this technique, dentists use hand tools to remove decayed tissue without anesthesia, then restore the tooth using only the glass ionomer.

"Most patients [in developing countries] present themselves when the pain is unbearable, and extraction is the treatment of choice," said Joseph Frencken, D.D.S., Ph.D., associate professor in minimal intervention dentistry at Radboud University in the Netherlands. "But this can have serious consequences, especially in children."

Research has shown that lack of proper oral health care and the resulting illness and pain it can cause is one of the leading reasons for school absenteeism for children in developing countries, he added.

Research teams are working to introduce ART in Mexico, South Africa, and Tanzania, Dr. Frencken said. While they have so far had mixed results, Dr. Frencken attributes this to lack of sufficient training, an inadequate supply of instruments and materials, and high patient loads. "High-viscosity glass ionomer is an essential element in oral healthcare systems worldwide, together with hand instruments, and both need to be readily available when ART is introduced into a system," he concluded.

Despite the evidence presented at the IADR meeting, convincing dentists in the U.S. that glass ionomers are safe and practical remains as much a challenge as convincing their counterparts in developing countries.

In fact, too many dentists in the U.S. think glass ionomers are only fit for developing countries, according to one audience member at the IADR session who asked not to be identified. "Some of the rhetoric is that this is Third World dentistry -- even though this [approach] is saving teeth and keeping kids in the classroom," she said.

Acupuncture for anxiety looks promising but unproven

By Rosemary Frei, MSc, DrBicuspid.com contributing writer

July 3, 2008 -- TORONTO - Acupuncture might calm patients who fear their dentists, but there isn't enough evidence yet to recommend this approach. So said researchers from King's College in the U.K. at the annual meeting of the International Association for Dental Research (IADR) on Wednesday.

The researchers headed by Nora Donaldson, Ph.D., M.Sc., searched Medline, EMBASE, the Cochrane database, and several complementary medicine databases for studies on acupuncture for dental anxiety. Discarding several smaller studies, they focused on three randomized controlled trials, added up the data, and found only weak evidence for the treatment.

The most promising study, published in Anesthesia & Analgesia in 2007 (February 2007, Vol. 104:2, pp. 295-300) included 67 subjects. Nineteen were randomized to auricular acupuncture that focused on the relaxation points, another 19 were randomized to sham acupuncture, 19 received nasal midazolam, and 10 received no treatment for dental anxiety.

After 30 minutes, investigators found that the Spielberger State-Trait Anxiety Inventory (STAI) scores decreased by 6.9 points in the acupuncture group, 14.4 in the midazolam group, and 4.11 in the sham acupuncture group. The differences among the three groups were statistically significant.

Another study the King's College researchers analyzed was published in the same journal in 2001 (February 2001, Vol. 92:2, pp. 548-553). In this study, 22 subjects were randomized to auricular acupuncture by the traditional Chinese medicine approach, 15 received auricular acupuncture focusing on the relaxation points, and the remaining 18 subjects received sham acupuncture. There was no statistically significant difference in the STAI score reduction after 30 minutes among the three groups, at -1.6, -5.85 and -1.68 points, respectively.

The final study analyzed, conducted by the same research team and published in the same journal (November 2001, Vol. 93:5, pp. 1178-1180), also found no significant difference in the STAI score reduction among the three groups, despite slightly more subjects in each group (at 31, 32, and 27 subjects, respectively).

Donaldson's team found significant flaws in all three studies. The 2007 paper did not justify the sample size that was used, and the two 2001 papers neither justified the sample size nor discussed the withdrawals and dropouts. The team determined that the studies were sufficiently homogeneous to group together, and found that the overall effect on STAI scores of auricular acupuncture was a significant reduction, of 4.47 points (95% confidence interval -8.09 to -0.84, p = 0.02). Still, they said, more study was needed before they could recommend acupuncture for anxiety.

The chair of the IADR session, Zakaria Messieha, D.D.S., an anesthesiologist at the University of Illinois at Chicago, also called for more research, in particular because researchers had used needles in different ways in the three studies. "The question is what the differences in technique are between auricular acupuncture using the traditional Chinese medicine approach and using relaxation points," he said.

Quantum touts new early caries detection system

By DrBicuspid Staff

July 3, 2008 -- TORONTO - Quantum Dental Technologies, a Canadian diagnostic device company, introduced a laser-based dental caries detection system prototype at the annual meeting of the International Association for Dental Research (IADR).

The Canary system uses a handheld laser that emits a low-power light to examine tooth surfaces, according to the company. The system measures the level of glow (luminescence) and heat released from the tooth to identify the extent of decay as deep as 5 mm from the tooth surface and as small as 50 microns in size. It can scan for caries on smooth enamel surfaces, root surfaces, biting surfaces, between teeth, and around existing fillings.

"Dentists are limited in their abilities to detect and monitor the early stages of tooth decay with traditional diagnostic tools such as the x-ray and visual examination," said Stephen Abrams, D.D.S., CEO of Quantum Dental Technologies, in a press release. "Now, with this innovative new system that is pain-free, noninvasive and provides early caries detection, we can finally move away from intervention, or the filling of cavities, to focus on prevention and actual remineralization or healing of small areas of tooth decay."

The Canary system will be in clinical trials for the next 18-24 months and will be released into the market in 2010.

Sunday, January 20, 2013

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