NIH grant to fund oral-health computer game

NIH grant to fund oral-health computer game

Firsthand Technology has received a $3.4 million Small Business Initiative Research grant from the National Institutes of Health (NIH) to research the effectiveness of interactive computer games to change the oral health habits of children, according to the company.

Firsthand and the department of dental public health sciences at the University of Washington School of Dentistry in Seattle are developing a multiplayer, stereoscopic 3D action game to engage children ages 8-12 in the world of bacteria and biofilms with the goal of improving oral health habits. The game will be offered in both English and Spanish.

"There is a whole world in kids' mouths that they know almost nothing about," said Ari Hollander, CEO, technical director, and principal investigator at Firsthand, in a press release. "We have new information and new and exciting science on the dynamics of tooth decay and its prevention. But we're not just trying to teach kids about this -- we believe our immersive game will change their behavior. We are using our experience in virtual reality and game design to create a game that meshes the physicality of the Wii with the engagement of stereoscopic 3D movies."

The game will be the centerpiece of a hands-on, interactive museum exhibit with its public debut at the Pacific Science Center in Seattle in early 2010, according to Firsthand. Later, the exhibit will be converted into a traveling exhibit for science centers across the U.S., as well as around the world.

On behalf of the American Dental Education Association (ADEA), James Swift, D.D.S., will testify on March 18 in support of dental education and research programs before the U.S. House Appropriations Subcommittee on Labor, Health and Human Services, Education, and Related Agencies.

Dr. Swift, currently the immediate past president of the ADEA and the director of the division of oral and maxillofacial surgery at the University of Minnesota School of Dentistry, will present the association's fiscal year 2010 budget recommendations for the Title VII health professions education and training programs, the National Institutes of Health (NIH) and the National Institute of Dental and Craniofacial Research (NIDCR), the Dental Health Improvement Act, the Oral Health Program at the Centers for Disease Control and Prevention (CDC), the National Health Service Corps (NHSC), and the Ryan White CARE Act.

According to an ADEA press release, Dr. Swift will urge Congress to provide $16 million for general dentistry and pediatric dentistry residency training grants; $33.2 billion for NIH, including $440.9 million for the NIDCR; $117 million for the Title VII diversity programs; $235 million for the National Health Service Corps; $10 million for the Dental Health Improvement Act; $17.5 million for CDC's Oral Health Program; and $19 million for the dental programs included in the Ryan White CARE Act.

Can caries detection devices prompt overtreatment

Can caries detection devices prompt overtreatment

A group of international researchers set out to evaluate whether having results from multiple detection methods influences dental treatment decisions for incipient caries lesions on occlusal surfaces. Led by Dr. Antonio Carlos Pereira of the Piracicaba School of Dentistry in São Paulo, Brazil, the team compared visual assessment of 96 extracted permanent molars to data obtained using four additional caries detection methods -- bitewing radiographs, electric conductance measurement (ECM), quantitative light fluorescence (QLF), and laser fluorescence (LF, specifically Diagnodent by KaVo Dental) -- on the same teeth.

Three examiners were used -- all university teachers with up to four years of experience in clinical practice. Prior to participating in the study, they underwent six hours of training: two hours of theoretical training and four hours of practice on extracted teeth.

They first examined the teeth using ECM, then performed a visual exam (without an explorer) and made a treatment decision during the same session. One week later, they performed the radiographic, LF, and QLF examinations. Three weeks after that, they were asked to re-evaluate the teeth and their original treatment recommendations using the additional data obtained with the caries detection devices.

While only slight improvement in the percentage of correct diagnoses was seen when the additional detection methods were used, "a drastic effect" on treatment choice was observed, the researchers stated. In particular, by having results available from multiple detection methods, the choice of invasive treatment -- versus no treatment or preventive/noninvasive treatment such as applying a sealant -- increased "substantially," they noted.

Overtreatment existed at two levels, they added: applying noninvasive treatment to sound teeth and applying invasive treatment to teeth with enamel lesions.

"The former is 'harmless' although costly, and the second is disastrous," the researchers wrote.

In the long run, they concluded, having data from multiple methods did not improve the accuracy of the examiners in detecting early occlusal caries lesions, but it had a "great influence" on the number of surfaces indicated for operative treatment.

The study has other implications as well, according to Dr. Pereira.

"In my opinion, this study shows that each diagnostic method has different characteristics," Dr. Pereira stated in an e-mail interview with zetadental.com.au "Diagnodent has a high sensitivity for initial caries, but also a high level of false positives. ECM is great for dentin caries but fails at the enamel level. Professionals are [encouraged] to understand the new knowledge of caries diagnostic methods and use them, keeping in mind that most caries are at the incipient level and thus prone to preventive treatment."

Douglas Young, D.D.S., M.S., M.B.A., an associate professor at the University of the Pacific School of Dentistry, agrees.

"This study showed that all the different technologies tested didn't necessarily increase correct diagnoses but did prompt them to treat sooner and more aggressively," he said. "It is my understanding that this study was done before the ICDAS [International Caries Detection and Assessment System] ... came out, and it would be interesting to include the ICDAS coding system in a similar study and compare results. The technologies are getting more specific, and each different technology looks for different things; for example, some look for changes in light refraction while others measure fluorescence signals coming off the teeth."

One real problem, Dr. Young added, is that aggressive marketing literature often uses the term "caries" improperly, which makes the clinician think the caries detection device is picking up "decay" earlier so they should restore earlier. "But that is not necessarily true," he said.

Rather, because the devices might be detecting demineralization rather than true decay or infected dentin, clinicians need to fully understand the particular technology they are using and realize that it is only an adjunct in decision-making. Sometimes a more conservative preventive approach could be considered first, Dr. Young suggested.

"The question then becomes, that given that the morphology of the pits and fissures make cleaning them problematic, what is the most minimally invasive way to help prevent cavitation?" he said. "The caries risk of the patient and the extent and activity of the lesion often determine if treatment is optional or elective. It is important to understand that prevention is up to the patient and that, in many cases, we should be giving them options, not dictating treatment. In many cases, all we need to do is to clean out these fissures and seal them so they don't pick up decay. But too many dentists are overly aggressive when it comes to deep restorations and aggressive prepping for sealants."

One option is to rethink the sealant procedure and place a conventional (no resin) glass ionomer as a long-term, fluoride-releasing surface protectant, Dr. Young said.

"Seal and fluoride release prevent decay, which may be more important than retention, bond strength, or even longevity for some patients," he said. "Just tell patients when the fluoride (the glass ionomer) is gone you will put some more on." This approach especially makes sense for newly erupted teeth where you do not want to prep or place a resin-based sealant that will inhibit further maturation (mineralization) of the occlusal surface, he added.

"Dr. Hien Ngo and others have shown that glass ionomers are semipermeable to some ions and have properties very similar to remineralization underneath them. To me, this is the best answer for many people, but it requires re-educating clinicians and patients alike about the treatment objective," Dr. Young concluded.

The 3 (unexpected) keys to successful e-mail marketing

The 3 (unexpected) keys to successful e-mail marketing

Isn't it hard to keep writing all these e-mails? And can you have someone else do it for you?

Let me use this column to talk about some of the objections to what I suggested in a previous column -- that is, to e-mail as often as once a day if possible, to be very informal, to bring up and deal with anxiety and negatives, and to close every e-mail with an offer.

First, the matter of frequency. It is a fact that some people hate getting an e-mail from you every day. In fact, they will unsubscribe from your list if you mail them every day.

Yet, mailing every day is the single most effective thing most dentists can do with their list.

Why?

First, people build a relationship with you because they hear from you so often.

Second, they remember when they subscribed. They are not likely to complain about your e-mail to their e-mail provider, so you are less likely to be blocked.

Third, and most important, your buyers are people who will like and trust you. By turning off some people through frequent e-mail, you will turn on others, who will like you a lot.

Frequency is a fantastic tool for effective e-mails.

Now, about how hard it is to write these e-mails. I suggest you dictate into a USB recording device. Or use a service like zetadental.com.au that lets you dictate into your cell phone, then they transcribe and e-mail for you. So easy!

In fact, you should write like you talk. People will love you. Or they'll hate you and unsubscribe. Big deal. You want to be polarizing so you get those rabid fans. And you can only do that by being really, really you.

Dental patients see you as their friend (or not). It's a relationship to them and to you. If they like you through your e-mails, they will like you in person. And you will like them. The only way to have this honest mutual like is for you to really project your personality. And that means some people off will be turned off.

Take my articles. Some people hate them. They think I am a big promoter and that I encourage doctors to oversell to their patients. These folks hate selling. But other folks like my articles, and they like doing business with me.

I polarize and that way I have passionate customers. I also turn off some people, and they stay away, which is fine with me.

Get it?

This leads to the third question: Do you have to do this all yourself?

I have figured out a way for you to subcontract the whole kit and caboodle, this matter of list building and e-mail marketing and all. But you really should do it all yourself.

I'm going to put on a free webinar soon in which I will share everything I know about advertising and e-mail marketing. Then you really can do it yourself.