The Problems With Outdated Oral Care

Some regions in the world, especially in low and middle class communities, receive no oral care or primitive versions of it. One of the most common examples of this issue is dental amalgam restorations. Dental amalgam restorations are a compound of mercury and sliver-based alloys. Mercury had been widely used in dental restorations for about 150 years, until recently in the few past decades when mercury was deemed a toxic material for humans and a contaminant for the environment. However, there are efforts to at least "phase out" the use of this out-dated material and replace it with another material that is as effective and inexpensive. Parts of the body mercury can damage include: kidney, central nervous system and cardiovascular system. Some countries like Norway, Denmark and Sweden have banned mercury amalgam due to its danger to the human body. The European Union plans to ban dental amalgam for children and pregnant women in 2018. The alternative to dental amalgam is composite resin. It is and composed of an acrylic resin reinforced with powered glass filler. Not only is it safe to human health, it is also white and resembles natural tooth color well.

Sources: WHO Oral Health Report, 2003

Oral Cancer

Oral cancer is the eighth most common caner for men in the world. In south-central Asia it ranks among the top three most common caners. Denmark, Germany, Scotland, and central and eastern Europe have all reported sharp inclines in the amount of oral/pharyngeal cancers. Austria, New Zealand, Japan and the US have reported inclines, but to a lesser extent. The graph below shows common cancers for males world wide. By studying the graph, pharyngeal and oral cancers are much more frequent in less developed countries.

Comparison of the most common cancers in males in more and less developed countries in 2000

As I stated in my last post, most of the time the culprit is smoking. However, use of smokeless tobacco and alcohol consumption can also lead to a higher risk of oral/pharyngeal cancers. In Thailand, per 100,000 people, the incident rate of oral cancer is 4.6. This number directly correlates with the amount of people that smoke, chew and drink alcohol. About 60% of people in Thailand smoke, 15% chew betal nut and 35% consume alcohol. India has an even higher incidence rate of 12.6.

Sources:

WHO International Agency for Research on Cancer, 2003

WHO Oral Health Report, 2003

Edentulousness and Periodontal Health for Adults Around the World

My last post focused on statistics about dental health for children, but adults especially elderly individuals can suffer from dental issues too. In most cases the solution to a problem tooth is extraction because proper dental care is not available. While one or two teeth may not seem like that big of a difference, loosing teeth can severely diminish an individuals quality of life due to inability to eat basic foods.

Edentulous means lacking teeth or toothless. Below is a table of the edentulous elderly in countries across the world.

Prevalence of edentulousness (%) of elderly reported for selected countries throughout the world 

Some industrialized countries have seen a decrease in tooth loss among adult populations. However, in some cases percentages of edentulous adults, ages 65 and older, are still very high. Countries above 50% edentulous adults 65 and older include Canada, Albania, Bosnia, Herzegovina, and Malaysia.

Periodontal diseases are also common among adults. 5-15% of some populations suffer from severe periodontitis, which can result in tooth loss. The graph below shows the average percentages of 34-44 year-olds using the Community Periodontal Index. This index has five different degrees of severeness; 0  represents healthy, uninflammed gingiva and periodontium, while 4 represents non-funtional teeth and the most severe form of periodontitis.

Mean percentages of 35-44-year-olds by maximum Community Periodontal Index scores according to WHO regional offices 

More than half of the periodontitis cases in this age group are a result of smoking. In industrialized continues smoking poses as a major threat to periodontal health. Studies have shown that countries with decreased tobacco use have also seen a decrease in periodontal disease cases. When smokes quit the risk of periodontal disease lessens as well.

Sources:

WHO Global Orla Health Data Bank

WHO Oral Health Country/Area Profile Programme, 2000

Dental Health for Children Around the World

Access to oral care is something most of us take for granted. In many developed and undeveloped countries large percentages of citizens go without proper dental care. Major oral issues include dental caries (cavities) and periodontal diseases. Cavities impact anywhere from 60-90% of children and most adults. The figure below shows cavities amongst 12-year olds from around the world using the DMFT (Decayed, Missing and Filled Teeth) Index. AFRO is African countries, AMRO is American countries, EMRO is Eastern Mediterranean countries, EURO is European countries, SEARO stands for South Eastern Asian countries and WPRO stands for Western Pacific countries.

Dental caries experience (DMFT) of 12-year-old children according to WHO

The graph shows that African and Western Pacific countries have a smaller DMFT index, than American countries with the highest DMFT index. A higher index can be a result of increased consumption of sugar and a lack of exposure to fluorides. 

More serious oral conditions that plagues children around the world include noma (cancrum oris), ANUG (acute necrotizing ulcerative gingivitis), oral pre-cancer and cancer. Noma is a gangrene of the face typically caused by bacterial infections. It most commonly occurs in young children who are malnourished or suffering from another disease. The figure below shows cases of noma around the world.

Cases of noma involving children ages 3-5 were reported in Africa, Latin America and Asia, 90% of whom died without ever receiving any treatment. Tomorrow I will post about global statistics on oral disease for adults. Stay tuned. 

Sources: 

WHO Oral Health Programme, Geneva, Switzerland

WHO Global Oral Health Data Bank and WHO Oral Health Country/Area Profile Programme, 2000 

Final Paper and Presentation

This week I started to write the introduction to my research paper about cementation methods of zirconia. I will be sending drafts to Dr. Kramer to revise. I am using the sample papers as well as other dental journals as a guide for content and langue. I also made all of the slides that I will use for my final presentation on May 6th. Going through everything I have learned has been really exciting. I am really looking forward to sharing all of my knowledge about dental restorations with the audience. I think once I begin to practice my whole presentation I will have to cut parts out in order to stay within the time limits, which will be so difficult because I think all of it is so interesting and deserves to be mentioned in detail! Looking back, I have had so much fun with this project and am anticipating the outcome of all my hard work.

3D Printing in Dentistry

Last week Dr. Kramer went to a dental convention and bought back a couple neat sources talking about how 3D printing is being utilized to make restorations. This is an extremely new field that does not have much research behind it. However, here is a little bit about how 3D printing is emerging in dentistry.

Ceramic 3D printing uses resin-based systems mainly for small, high quality elements. The printed material is a sinterable ceramic powder mixed with photo curable resin. Small portions of this technology, like the alumnia parts, helped make the parts on Mars rover Curiosity. Below is a picture of the kinds of restorations 3D printers can make.

Models of 3D printed restorations

3D printing is in fact different than CAD/CAM technology that I have talked about before. In CAD/CAM technology you begin with making the lithium disilicate or zirconia into blocks, then the material is milled and crystallized. 3D printing begins with making the resin material, printing the restoration then crystallizing it.

3D print (bottom) vs CAD/CAM (top) technology

3D printed restorations will certainly grow and have more research conducted on their effectiveness in the field, especially as restorations move away from metal and into a ceramic dominated industry.

Final Weeks of Senior Projects

Now that it is April I will be beginning to compile all of my data from the dental journals into the final format for my paper. I will also be beginning my paper, with the guidance of Dr. Kramer and possibly the new chemistry teacher at BASIS who has a background in dentistry. I am excited to start the process and continue learning about dentistry and how higher level research is completed as well as communicated with the community. I might have a few more shadow days with Dr. Shelley of Dr. Folson, however I want to keep focused on writing my final research paper. Some of my time will also be spent making my tri-fold poster, and power point presentation that I will be using to present my senior project on May 6th, as well as practicing. I cannot wait to write my final research paper. It will be so exciting to see the finished product! Stay tuned!

Shadow Day with Dr. Folson

On Thursday I had the privilege to shadow Dr. Folson at his private practice. He specializes in periodontics and dental implant surgery. The concentration of periodontics focuses on the surrounding framework of the teeth. Before I begin describing the steps of the surgery, I must say that I had a fantastic day watching Dr. Folson work. He answered all of my questions very throughly and made sure that I was able to learn as much as I could. All of the staff were extremely welcoming and encouraging which I appreciated immensely. 

To begin the surgery Dr. Folson took preliminary X-rays to map out how he was going to approach the problem tooth. Next, the patient was administered local anesthetic to numb the right side of the mouth. Once the patient was completely numb, Dr. Folson began to extract the lower right bicuspid. The crown of this tooth was broken and the integrity of the tooth was compromised, so putting in a dental implant was the best solution. To achieve a better angle, for the whole surgery, Dr. Folson cut a flap of gum from the front to the lower right bicuspid. Most of the time he would not have to cut such a long layer, but the right lower molar had weak gum tissue and he did not want to disturb the area. After the tooth came out, he began preparing the tooth socket for drilling. He explained that you want to start off with a much more narrow drill and gradually get larger as you fit the screw into the socket. If you drill too shallow then the implant will stick out too much, but if you drill too far into the jaw bone then you can hit the nerve located in the jaw bone, causing a permanent tingling sensation in the patient. To avoid both of these problems, Dr. Folson uses the X-rays and computer software to measure exactly how far he needs to drill as well as which drill head to use.

Dental Drill

Various Drill Heads

Then Dr. Folson inserted the screw into the drilled socket shown in the image below. 

Screw, abutment and crown

Once he ensured that the fit was correct, he put a temporary cap on the screw while the implant heals. Implants can take months at a time to recover. Dr. Folson then used a bone graft in the surrounding portion of the implant before suturing the flap of gum he cut back into place. For the bone graft he used LifeNet mineralized bone granules shown below. 

Mineralized Bone Granules

For the sutures, Dr. Folson used PTFE sutures instead of black silk sutures because the surrounding tissue responds well and deters bacterial growth. These sutures can stay in a patients mouth for longer periods of time as well due to their biocompatibily.

PTFE suture

Dr. Folson gave me a copy of the before and after X-rays of the implant. 

Before is on the left
After is on the right 

I learned so much observing the procedure and I had so much fun. Below is a picture of Dr. Folson, the patient and myself after the surgery.

A special thanks to Liz!