Vital Record » Dentistry Your source for health news from the Texas A&M Health Science Center Tue, 26 Aug 2014 21:44:17 +0000 en-US hourly 1 Operation Lone Star 2014 Thu, 21 Aug 2014 18:37:57 +0000 Students from Texas A&M University Baylor College of Dentistry joined the ranks of military and medical personnel to serve thousands in this full-scale emergency response exercise]]>

02connections-ols.jpgIn the waning weeks of summer break, disaster loomed along the Texas-Mexico border. Sort of. A massive cohort of military, medical and volunteer personnel descended upon the Rio Grande Valley Aug. 4 to 8, where they responded to a simulated bioterrorism threat with a medical countermeasure dispensing operation.

Created as a full-scale emergency response exercise, Operation Lone Star provides free health services to local residents at five sites located in four different counties in South Texas. Students and faculty from Texas A&M University Baylor College of Dentistry were a part of the event, now in its 16th year.

A vast collaborative effort of Texas county and state public health professionals, the operation is comprised of Texas Military Forces, U.S. military personnel, the Remote Area Medical Volunteer Corps and hundreds of volunteers, including faculty and 36 dental and dental hygiene students from Texas A&M Baylor College of Dentistry.

The experience is not for the faint of heart. Hopeful patients arrive in the middle of the night, waiting until dawn in lines that snake around the building. By 10 a.m. on Aug. 4, the first day of the weeklong event, the Palmview High School site in Mission, Texas, where TAMBCD students worked had already accepted 537 patients for medical, dental or vision appointments that day.

In total, volunteer dentists and dental students saw an estimated 737 patients at the high school throughout the week. A total of 2,948 patients received health care services at that single site.

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Healthy teeth for kids: 3 pointers every parent should know Wed, 20 Aug 2014 16:12:19 +0000 Make sure your child's dental health is as sparkling as his or her new school supplies in this back-to-school season]]>

BacktoSchool1resizedBack-to-school activities are in full swing. Amid shopping for supplies, selecting new clothes and ensuring immunizations are current, it can be easy for the condition of your kids’ pearly whites to get lost in the shuffle. Yet oral health has the potential to impact their success in school more than nearly any other health concern.

Parents can start with some simple preventive steps — fluoride toothpaste, fluoridated water and allowing fewer sodas and sticky, sugary snacks — so children are less likely to experience the pain or disruption of cavities. But dental health doesn’t stop at cavity prevention. With the hustle and bustle of the new school year often comes participation in contact sports, and protecting your child’s teeth is vital. Additionally, parents can do their part by being prepared for the unexpected dental emergency. A little bit of knowledge can go a long way in ensuring the best possible outcome when a child’s tooth gets knocked out or injured.

Consider the following pointers from faculty members at Texas A&M University Baylor College of Dentistry to make sure your child’s dental health is front and center this new school year.

1. Consider sealants

For long-lasting protection on the cavity-prone permanent molars and premolars, dental sealants are a great option. These thin, plastic coatings are painted on the chewing surfaces of the back teeth to shield their natural grooves and fissures from the bacteria that can cause cavities. Toothbrush bristles cannot fully reach inside these deep pits. Sealants should be applied as soon as the permanent molars fully emerge from the gums: between the ages of 5 and 7 and then between 11 and 14.

“Sealants are a cost-effective, noninvasive way to protect children while they are developing good oral health habits,” says Dr. Kathleen Pace, assistant professor of pediatric dentistry at Texas A&M Baylor College of Dentistry. “Many children even have access to sealants through their school’s partnership with a dental public health provider. When this is available, it’s a wonderful service.”

Texas A&M Baylor College of Dentistry offers such care through its school-based dental sealant program. Each year the college provides sealants for more than 10,000 Dallas schoolchildren.

Getting sealants is a simple, painless procedure. The American Dental Association’s MouthHealthy site advises that as long as the sealant remains intact, the tooth surface will be protected from decay. Sealants hold up well under the force of normal chewing and may last several years before reapplication is needed. Pace reassures parents that sealants are easily repaired if they become chipped or cracked.

According to the National Institutes of Health, however, less than one-third of children in the U.S. have sealants on their teeth.

2.  Sports safety counts

Mouthguards are indispensable for sports players of all ages. Dr. Danette McNew, clinical assistant professor of general dentistry at the Texas A&M Baylor College of Dentistry, asserts they are important even for solo sports like bike riding and waterskiing. As an Olympic Team USA dental provider and sports dentistry veteran, McNew knows a thing or two about the protection that mouthguards offer.

“Custom mouthguards can be adapted for different sports because each calls for different protection,” McNew explains. “In football, linebackers clench down on their teeth because they are prepping to take blows, so you need thickness in the posterior chewing region. With basketball, it needs to be thicker in the front because those athletes are taking elbows to the face.

“That’s why a custom mouthguard made by your dentist is better than an over-the-counter version or one that you boil and then bite to fit around your teeth.”

3.  Be prepared for a dental emergency

If your child’s permanent tooth gets knocked out, knowing in advance what to do can reduce stress for parents and children while allowing dentists to save the tooth. It is critical to act quickly and keep the tooth moist at all times.

When possible, Pace advises patients to try placing the tooth back in the socket without touching the root or scrubbing the surface. Biting on a cloth or towel can help keep the reinserted tooth in place.

“However, I caution parents to first be aware of where the tooth landed when it fell out,” Pace says. “You certainly don’t want to put it in your mouth if it’s covered with gravel or something like that.” The tooth can be rinsed gently under cold water for 10 seconds if needed.

Other options exist for keeping the tooth from drying out if it can’t be reinserted in the socket.

“A glass of milk, a special preservation solution such as Save-A-Tooth or your child’s own saliva in a cup can help save the permanent tooth, but in every case, it is important to get to the dentist’s office right away.”

Do not place a child’s baby tooth back into the socket because it might hurt a permanent tooth. Do make an immediate visit to the dentist whether the knocked out or damaged tooth was a baby tooth or a permanent one. Baby teeth are important not only for chewing but for saving space in the jaws for permanent teeth.

“Tooth trauma can be scary, but your child’s dentist will help see you through any dental emergency. Make sure your family members know who to call, whether it’s routine care or urgent,” Pace says.


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Dental students serve in Jamaica over summer break Mon, 11 Aug 2014 20:00:28 +0000 As summer clinic drew to a close, nine dental students boarded a flight bound for Jamaica, where many of their patients were treated in dental chairs unlike any the students had ever seen]]>

The dental chairs at the Hopewell clinic set it apart in more ways than one. In the main clinic, eight fully-functional, modern dental chairs allow dentists to perform restorative work in addition to extractions. They’re not too different from what one would find in the Third Floor Clinic at Texas A&M University Baylor College of Dentistry. This can be a welcome yet uncommon surprise at a far-flung dental mission staffed by volunteers. Five more dental chairs are housed in a smaller clinic tucked around the back of the building. Some are obviously beach chairs. The others are handmade. They can’t partially recline. Instead, they have only one setting: horizontal.

TAMBCD students provide dental care in Jamaica.

TAMBCD students provide dental care in Jamaica.

“They were made out of cardboard,” says Paul Jang, a fourth-year dental student. “Those chairs were used only for cleanings and extractions.”

From July 19 to 26, the nine Texas A&M Baylor College of Dentistry students — many of whom are members of the Christian Medical & Dental Association — stayed in Treasure Beach to provide extractions, cleanings and operative treatment for residents of the rural area along Jamaica’s southern coast. They teamed up with 16 dental students from Howard University College of Dentistry, as well as five supervising dentists and three dental assistants.

“Going into it I didn’t know what to expect. I felt like all of us walked away with more appreciation for the profession we’re entering, as well as humility to see the impact we had on that community,” third-year dental student Heena Gupta says of the trip, an initiative of the Christian Dental Society, a nonprofit that coordinates dental missions around the globe.

The four days spent in the clinic often stretched until 8 p.m. Electricity could be intermittent, and there wasn’t always time for lunch. During the trip, the volunteers cared for 500 adult and pediatric patients.

That number was reached because both schools worked together, Jang says.

“We shared a common goal; volunteers came for different reasons, wanting to get different things out of it,” says Jang. “But essentially it came down to serving the people.

“If someone didn’t like doing extractions, didn’t like doing cleanings, it didn’t matter. We just wanted to see more people.”

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Closing a gap in oral health care Wed, 06 Aug 2014 21:01:50 +0000 A partnership between Texas A&M University Baylor College of Dentistry and one local nonprofit will result in free dental care for thousands of low-income residents in northwest Dallas]]>
Elsa Helton receives dental care at North Dallas Shared Ministries.

A partnership through TAMBCD allows more patients to receive dental care at North Dallas Shared Ministries.

Elsa Helton was elated when she discovered that students from Texas A&M University Baylor College of Dentistry would provide her with some overdue dental care at North Dallas Shared Ministries. She had seen the fliers at the center and knew that the nonprofit would begin seeing patients daily on a first-come, first-served basis starting June 11.

Helton had prior experience with TAMBCD from the late ’90s, when she selected the college’s orthodontic program for her daughter’s needed braces.

“They were phenomenal,” says Helton of the faculty and residents who oversaw her daughter’s treatment. “Knowing my care would be under A&M Baylor College of Dentistry made me feel so comfortable and even more grateful.”

Since losing her job at a Dallas publishing company in January, it has been tough for Helton to pay grocery bills, much less afford dental care without insurance. So Helton, who had for years contributed to North Dallas Shared Ministries through food and money offerings collected at her synagogue, turned to the nonprofit for its free services.

“I felt like I was in the most capable hands,” says Helton, who received a filling for a cavity left untreated for several years — a temporary measure, dental students cautioned her. “If I’m still in the same position next year and need a root canal, I will sign up to have it done at North Dallas Shared Ministries.”

The nonprofit — backed by 52 Metroplex congregations — provides social and health care services to more than 65,000 low-income residents within 20 ZIP codes. Through this new partnership with A&M Baylor College of Dentistry, made possible by the 1115 Healthcare Transformation waiver, North Dallas Shared Ministries has expanded the oral health care services it can provide to uninsured northwest Dallas residents.

Texas A&M Baylor College of Dentistry’s Department of Public Health Sciences now sends fourth-year dental students to the location as part of a recent expansion to the college’s community-based clinical training program. Now each of the North Dallas Shared Ministries’ four dental operatories will be filled Monday through Friday, 10 a.m. to 6 p.m. Previously, the clinic’s hours were limited to four days a month, during which time dental students could shadow volunteer dentists as part of the college’s preceptor program.

“This is a good way to expand access to an underserved population and to enhance our training base for our predoctoral program,” says Paul Hoffmann, administrative director for extramural clinics at TAMBCD. “This will teach our students about the total needs of the patient. It’s not just their mouths. And it’s not just health. It’s social services; it’s education; it’s behavioral health; it’s the whole gamut of services these patients need. It’s going to be a really good experience.”

With faculty supervision and the help of dental assistants, dental students will treat approximately 25 patients a day at the clinic, performing extractions and fillings for adults. There are plans to expand services to children and transition to comprehensive care with dental hygiene, education, and fixed and removable prosthodontics. Right now patients are seen on a walk-in basis, but appointments will be introduced, he adds.

To further beef up the workforce at North Dallas Shared Ministries, a separate A&M Baylor College of Dentistry student-run program began June 16, catering to special-needs patients on a volunteer, biweekly basis Monday evenings.

The college’s increased presence at North Dallas Shared Ministries is something executive director Judy Rorrie welcomes with open arms.

“This is going to allow us to expand the dental clinic exponentially,” says Rorrie. “To be able to have our clinic open for eight hours a day, five days a week, for 40 weeks a year is going to provide dental care for a population that is sorely in need of its services.”

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Adolescents most at risk with e-cigarettes, yet teen usage soars Mon, 04 Aug 2014 19:13:02 +0000 Teenagers are among the fastest growing groups of electronic cigarette consumers in the U.S. They may also be the most vulnerable to the devices’ physical and psychological side effects, according to experts from Texas A&M University Baylor College of Dentistry’s Tobacco Treatment Services]]>

Teenagers are among the fastest growing groups of electronic cigarette consumers in the U.S., with usage among middle and high school students more than doubling from 2011 to 2012, according to data from the Centers for Disease Control and Prevention (CDC). Making this information even more troubling are recent studies showing that teens may also be the most vulnerable to the devices’ physical and psychological side effects.

Even though e-cigarettes don’t contain tobacco, the battery-powered devices do deliver nicotine in aerosol form. “Nicotine’s addictive properties are a risk for any age group, but with adolescents, the stakes are even higher,” says Dr. K. Vendrell Rankin, a professor and associate chair in public health sciences who is director of Texas A&M University Baylor College of Dentistry’s Tobacco Treatment Services.

05experts-ecigarette-2For teens, mental health as well as key emotional and cognitive systems are at stake.

“Major cognitive functions and attention performance are still in the process of developing during adolescence,” Rankin says. “Nicotine increases the risk of developing psychiatric disorders and lasting cognitive impairment and is associated with disturbances in working memory and attention. Reliance on nicotine to manage negative emotions and situations impairs the development of coping skills.”

In addition to affecting the emotional and cognitive development of teens, nicotine is highly addictive. In fact, the younger a person is when they begin using nicotine, the more likely they are to become addicted and the stronger the addiction may become. According to the American Lung Association, of adults who smoke, 68 percent began smoking at age 18 or younger.

Nicotine use very quickly escalates into addiction, even when dealing with tobacco-free, odorless “vaping” associated with e-cigarettes. That’s because nicotine in any form triggers the release of neurotransmitters such as adrenaline and dopamine, which dramatically impacts a number of body systems. Dopamine floods the brain, and nicotine cravings increase.

“Everybody has a certain amount of nicotine receptors in the brain,” Rankin says. “When you start smoking, vaping or supplying nicotine to them, they multiply. If you stop smoking or vaping, the receptors don’t go away.”

In other words, the younger users are when they try or start using nicotine, the more receptors they will have and the more they may struggle with nicotine cravings throughout  their lives. It’s concerning news for the 1.78 million teens who tried e-cigarettes in 2012, according to the CDC.

E-cigarette companies currently advertise their products to a broad audience that includes 24 million youths, and proposed U.S. Food and Drug Administration regulations would not limit e-cigarette marketing. Bold marketing tactics, celebrity endorsements, endless flavor choices and a plethora of online videos instructing users on how to mix their own e-cigarette liquid, or “e-juice,” have only added fuel to the fire. There currently are no federal laws in place to restrict minors from purchasing e-cigarettes.

There is a glimmer of hope on the horizon. In April, the FDA released the details of a proposal to extend its tobacco authority to e-cigarettes, including minimum age and identification restrictions intended to prevent sales to minors. A final ruling is slated for summer 2015.

In the meantime, many Texas cities have set their own regulations and ordinances banning the sale of e-cigarettes to minors. Any e-cigarette regulation in Texas will have to occur city by city, Rankin says, since the state doesn’t have comprehensive smoke-free laws.

“I don’t think e-cigarettes are going to drop off,” Rankin says. “It’s the newest — or most popular — kid on the block right now.”

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Tobacco cessation training helps dental students coach patients to quit Thu, 31 Jul 2014 22:43:07 +0000 A multi-year tobacco cessation curriculum means dental students gain knowledge in behavioral intervention, the use of pharmacotherapy and motivational interviewing. This promotes the confidence for them to actively motivate and assist patients who want to quit tobacco use]]>

Numerous products can help patients quit tobacco use.

Dental professionals hold a front-line position for motivating patient behaviors that influence health. One faculty member at Texas A&M University Baylor College of Dentistry is using that opportunity to help encourage cessation of tobacco use.

Dr. Kathleen V. Rankin, professor and associate chair of public health sciences, empowers students to broach this sometimes sensitive subject with patients who stand to benefit from tobacco cessation counseling, support and any needed medication. Students can refer patients to Tobacco Treatment Services at TAMBCD.

During the first, second and third years of dental school, students gain knowledge in behavioral intervention, the use of pharmacotherapy and motivational interviewing to promote tobacco cessation.

This curriculum component was first introduced 12 years ago with second-year dental students. Rankin conducted a grant-funded study in those early years to evaluate changes in dental students’ behavior, knowledge and attitudes in addressing tobacco cessation with patients. This study provided the information needed to determine the number of lecture hours and what specific tobacco topics to include in the dental school’s curriculum.

The training has proven beneficial for students, including third-year dental student Ryan Packard, who says he wasn’t that familiar with any tobacco cessation techniques before dental school, except for the daunting task of quitting cold turkey.

“More than anything I have come to understand the prevalence of tobacco-related illnesses and how tobacco affects specific parts of the body, especially the oral cavity,” Packard says.

Being exposed to tobacco cessation education changed Packard’s attitude and comfort level about bringing up this conversation with patients who use tobacco.

“I feel obligated, as the doctor of the oral cavity, to make sure that patients are properly educated to make the best choice as it relates to tobacco and its use,” he said. Tobacco causes oral cancer as well as bone loss within the jaw, gum disease, increase build up of plaque and tartar on the teeth and delayed healing following an extraction or oral surgery.  “In general, the adverse effects of tobacco are known, but perhaps the methods and opportunities for cessation are less well known.”

Packard says tobacco cessation can be a hard battle to fight, even when an individual is ready to quit. He believes one of the most effective counterattacks is education.

“We need to know the facts about tobacco and appropriate cessation methods, so we can help our patients know,” Packard says.

Rankin believes awareness of the facts is key to motivating behavioral changes in patients. That’s why she stays abreast of the latest trends in tobacco use.

“I update the curriculum on a yearly basis, as so much literature is currently being published in the field and new forms of tobacco such as kretek, bidis, hookah, e-cigarettes and snus, among other products, become popular alternatives to traditional cigarettes, especially among youth,” Rankin said.

A tobacco history is integrated within the electronic patient record. This guides students on how to ask tobacco-related questions. According to Rankin, third-year dental students are expected to use motivational interviewing in the course of patient evaluation in the clinic. These open-ended questions create dialogue between the dental student and the patient.

“This helps us know if the patient is ready to quit tobacco, how we can help them develop the behaviors and confidence essential to success and recommend or prescribe medications to reduce withdrawal symptoms,” Rankin said. “If the patient is not ready to quit, the objective is to enhance their motivation to quit. Three prongs must be present for success: Patients must be ready, motivated and confident.”

Packard sees his tobacco cessation training as a benefit for himself as well as his patients.

“There may be hundreds of patients who say no to quitting tobacco for every one patient that accepts our offer for tobacco cessation,” Packard says. “I think it is important that we understand tobacco cessation for that one patient. Everyone makes his or her own choices regarding personal habits, but when a patient chooses it’s time to quit, we will be ready.”


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Tao brings $1.25 million in funding to research stress and chronic pain Wed, 30 Jul 2014 22:41:30 +0000 Just what is the role of stress when it comes to healing? What if there were ways to identify, pre-surgery, what patients are most inclined to suffer from chronic pain as a result of their procedure and then to manage that pain? ]]>

Just what is the role of stress when it comes to healing? What if there were ways to identify, pre-surgery, what patients are most inclined to suffer from chronic pain as a result of their procedure and then to manage that pain?

05experts-progress-notes-tao-resizedDr. Feng Tao brings these questions and $1.25 million in funding from the National Institute of Dental and Craniofacial Research in his new role as associate professor in biomedical sciences at Texas A&M University Baylor College of Dentistry. Tao had been rooted to Johns Hopkins University in Baltimore since 2000; in May he moved west for the opportunity to apply his research to the dental environment.

With renovations to his fourth-floor now complete, Tao talks about what remains to be discovered about stress and its role in chronic pain, the motivation behind his work and opportunities for synergy with the world-class team of researchers at Texas A&M Baylor College of Dentistry.

Is there a driving force behind the focus of your research? What unknowns do you hope your work will reveal regarding the role of stress in inducing chronic pain?

Pain is a hallmark of tissue damage and inflammation that promotes tissue protection and thereby contributes to repair. Transient acute pain is an important feature of the adaptive response to damage, however, pain can persist for months to years after surgery even though the surgical incision that originally caused the pain has recovered. Such chronic neuropathic pain is maladaptive because it no longer serves as a protective reaction. Chronic pain, especially chronic neuropathic pain, is debilitating, both physiologically and psychologically, and treatments to provide relief from chronic pain are often ineffective. To date, the neurobiological mechanisms that underlie the transition from adaptive acute pain to maladaptive chronic pain are not fully understood. The transition from acute pain to chronic pain is a complex and poorly understood developmental process that involves biological, psychological, and socio-environmental factors.

In our ongoing project, we will demonstrate the molecular mechanism by which stress induces pain transition after surgery. Our data will help physicians predict which patients are at greater risk for developing chronic pain after surgical procedures. Eventually, monitoring of stress hormone levels in the blood may improve pain management in high-risk patients.

Today’s fast-paced world contains more conveniences — and perhaps more stressors — than ever before. Because stress can affect the body’s ability to heal after surgical procedures and medical treatments, an environment that causes constant tension becomes a very real concern. What do we know at this point about stress and its role in causing acute, adaptive pain to transition into chronic, maladaptive pain?

Previous studies have demonstrated that exposure to stressful events induces the release of stress hormones. These stress hormones can regulate glutamate receptor-mediated cellular communication in the central nervous system, including regulating activities of AMPA (α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid) receptor (one type of glutamate receptor that mediates fast communication between neural cells). In short, stress hormones affect synaptic trafficking and phosphorylation of AMPA receptors in the central nervous system. The effect of these events is the buildup of pain in the brain in response to peripheral stimulation in the body. In our study, we found that stress significantly impacts the function and activity of AMPA receptors, resulting in prolonged, incision-induced pain. We also found that targeted mutation of AMPA receptors significantly inhibits stress-produced incisional pain prolongation.

After 14 years at Johns Hopkins University, you decided to make the switch to Texas A&M Baylor College of Dentistry. What resources and people made the dental school an attractive option? How do you envision synergy with other researchers here at at the dental school?

My current R01 grant is funded by the National Institute of Dental and Craniofacial Research. Besides the stress-induced pain transition project, I am also interested in dissecting neural circuits related to orofacial pain transmission by using optogenetic manipulation and multichannel electrophysiological recording.

The Department of Biomedical Sciences and the Center for Craniofacial Research and Diagnosis at Texas A&M Baylor College of Dentistry is a perfect platform to conduct such research. Drs. Phillip Kramer and Larry Bellinger in our department are senior investigators who have studied orofacial pain for many years. We have complementary expertise in pain research, and our laboratories are fully equipped for different experimental requirements.

Recently, I wrote a research proposal, and they provided their critical comments. In this proposal, we will use combined optical neuromodulation and large-scale neuronal recording to investigate nociceptive signaling with high spatiotemporal resolution. The overall goal of this project is to unravel nociception-related neural circuits by using above-mentioned cutting-edge techniques. I believe that we can develop a new research project in the near future.


This story originally appeared in TAMBCD’s NewsStand.

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Texas dental schools team up to create a standardized course for treatment of sleep-related breathing disorders Fri, 18 Jul 2014 22:33:30 +0000 As the number of Americans with sleep-related breathing disorders continues to grow, so does the need for dentists to have access to continued training to best serve this patient population. ]]>

On June 11, after more than two years of hearings, proposals and discussions, a new rule regarding how Texas dentists may diagnose and treat sleep-related breathing disorders went into effect.

The Texas State Board of Dental Examiners recently approved the rule, making it a part of Texas Administrative Code. It allows dentists to independently diagnose, treat and monitor any dental condition related to benign snoring or obstructive sleep apnea. With this responsibility comes the mandate for dentists to complete 12 hours of education in sleep-disordered breathing the first year of treating patients for such conditions and three hours in subsequent years.

Hand holding dental retainersTo make this process as seamless as possible, alumni and faculty at Texas A&M University Baylor College of Dentistry have teamed up with dentists at the UT Health Science Center dental schools in San Antonio and Houston to create a standardized, statewide course on the discipline.

At the helm is Dr. Keith Thornton, who graduated from Texas A&M Baylor College of Dentistry in 1969 and owns SleepWell Solutions, a Dallas dental practice dedicated entirely to sleep-related breathing disorders.

“This course will include everything that is necessary for a dentist to start treating their patients in his or her office,” says Thornton. “It will be comprehensive and developed by Texas dentists who are experts in the field of sleep-disordered breathing plus representatives from each of the Texas dental schools.”

The program will cover the basics of sleep and sleep-disordered breathing through lecture and hands-on instruction. The goal is for dentists to become comfortable with the technical aspects of fitting patients for and fabricating oral appliances, which are designed to protrude the jaw, preventing the tongue and soft tissues of the throat from collapsing into the airway.

Dr. Amerian Sones, director of continuing education at Texas A&M Baylor College of Dentistry, says she anticipates the college will host the first standardized program by fall 2015. An annual two-day course covering snoring and sleep apnea has already been in place at the dental school for several years, but the need for training within this dental niche continues to grow.

“There is a very big interest in treating these problems,” Sones says. “Sleep-related breathing disorders affect such a big percentage of our population, and those who suffer from it deal with a lack of sleep and really can’t function. They can’t work, drive or be productive because they don’t get the rest that they need.

“We in dentistry are jumping on board because this is a problem that in most cases can be managed, prevented, or treated using dental technology, and so we must be a part of diagnosis and treatment planning.”

The program, which may be structured as a symposium, could include the opportunity for interprofessional collaboration with physicians and ear-nose-and-throat specialists.

In his role as president of the Texas State Board of Dental Examiners, Dr. Rudy Ramos has worked on the rule for the past two years.

“I meet with state board examiners across the country. No one really addresses sleep-disordered breathing,” Ramos says. “Texas is the first to embark on a sleep dentistry rule. It will set the bar across the country.

“A lot of dental schools now are going to have to make this a part of their curriculum. This is going to be a big change for dentistry as a whole.”

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It’s not just about the waistline Tue, 15 Jul 2014 22:04:25 +0000 Juice1

Liquid diets impact your body and your teeth.

Americans are becoming increasingly health conscious, and that’s a good thing. According to a U.S. Department of Agriculture study released earlier this year, the average person’s daily caloric intake dropped by 78 calories from 2005 to 2010. But what is considered healthy eating — including dietary choices trending toward high-protein, low-carb selections, liquid cleanses, vegan lifestyles and raw diets — may not always be good for the mouth. Each diet carries its own set of pros and cons.

“Eating begins in the mouth,” says Lisa Mallonee, a registered dietitian and associate professor in dental hygiene at Texas A&M University Baylor College of Dentistry. “The foods and beverages we consume, the methods and timing in which we consume them, and the frequency of consumption can all impact oral disease risk.”

Packing the protein

One of the most notorious diets for a tendency to produce unintended side effects is a high-protein, carb-curbing lifestyle reminiscent of the Atkins diet, which peaked in popularity a decade ago.

That’s because when a high-protein diet works as intended, the body burns fat at a higher rate, producing ketones. When they accumulate in the saliva, ketones are a culprit for bad breath. Mallonee likens the smell to rotting fruit and suggests some time-tested remedies: alcohol-free mouthwash, xylitol chewing gum, adequate hydration and, of course, diet modification.

“In the oral cavity, ketones are otherwise benign, but from an overall health perspective, individuals can experience light-headedness, headaches and irritability,” says Mallonee.

Not quite so harmless is xerostomia, or dry mouth, associated with water loss from a high-protein diet. In its mildest form, it begins as a sticky, dry feeling in the mouth but can lead to burning, tingling and increased risk for gum disease and tooth decay.

Then there’s blood.

“I’ve heard comments from practitioners that they notice more bleeding in patients on a high-protein diet,” Mallonee says. “This is likely due to the fact they are not eating crunchy fresh fruits and vegetables — since they are avoiding carbohydrates — so there is a higher level of plaque accumulation because a high-protein diet is typically a ‘softer’ diet.”

Vegetarian versus vegan

The major difference in oral health impact between a vegetarian versus a vegan diet boils down to the absence of three nutrients: vitamin B12, vitamin D and calcium. Deficiencies in these can present as soreness in the mouth and tongue, altered taste sensation, increased risk of periodontal disease and weak enamel.

While a lacto-vegetarian diet includes dairy such as butter and cheese, a vegan diet that includes no animal products may put patients at a heightened risk of oral health problems. Mallonee advises it may be necessary to add dietary supplements to include vitamin D, calcium and vitamin B12, the last of which can only be found in animal products.

Duration also plays a role.

“For the otherwise healthy individual, months of exclusion as a result of a vegan diet is not typically as big of a concern,” Mallonee says. “It is more of a concern for those individuals who have committed to a vegan lifestyle for numerous years. Individuals must make a conscious effort to include nutrients in their diet that can only be found in animal products.”

Food in the raw

A raw diet — one consisting of fruits, vegetables, nuts, seeds and grains — lends itself to a high daily intake of vitamins, fiber and minerals. Because a raw diet precludes heating food to more than 118 degrees, it doesn’t bode well for eating much meat, fish and eggs unless you opt to eat them raw.

“A raw food diet can be lacking in protein, iron, calcium and B12,” says Mallonee. “If lots of acidic raw fruits and vegetables are consumed — think grapefruit, oranges, tomatoes and corn — dental erosion could be a problem.”

When acid from these foods attacks the surface of the teeth too often, saliva cannot balance out the oral environment, and the end result is weakened enamel and exposed dentin.

Matters of liquidity

Cleanses come in varied forms: three-day, five-day, seven-day, cheap, expensive. Dieters sip on concoctions composed of ingredients such as tea, lemons, cayenne pepper, even freshly juiced fruits and vegetables.

No solid food is eaten for the duration, and the all-natural ingredients purport to flush out the body, cease cravings, and improve kidney and liver function. Advocates claim it’s like hitting the reset button on myriad bodily processes.

Liquid detoxes can impact the mouth, though.

“The issue with not eating solid food for several days at a time is that chewing is limited,” says Mallonee. Chewing bilaterally minimizes plaque accumulation and ultimately calculus on the tooth surface.”

Diets that mandate juicing or even low calorie, highly caffeinated beverages coupled with herbal supplements have a different effect.

“Juicing is a very healthy dietary trend,” Mallonee says. “However, juicing is acidic and doing so several times a day can lead to dental erosion; patients should be educated to drink water afterwards and to avoid brushing immediately following consumption.”

Discussing diet

Regardless of what patients eat, asking questions about food choices is recommended for every new or recall appointment. Telltale signs of possible diet-related oral health issues may include recurring or new areas of decay and demineralization.

Timing matters.

“We typically ask after the extraoral and intraoral soft tissue exam, periodontal assessment and dental charting has been completed so we can fully relate the importance of the patient’s nutrition habits to oral health and disease risk,” Mallonee says.

Preparations for nonsurgical periodontal treatment also offer a prime opportunity to review a patient’s food choices.

“Although a poor diet doesn’t cause periodontal disease,” Mallonee says, “lack of essential nutrients in the diet may impact immune function, resulting in decreased healing, and resolution of pocket depths and bleeding points.”

“As dental professionals, we need to be comfortable asking our patients about their diet, determining if it might impact their oral health and integrating this information into preventive patient education.”


This story originally appeared in TAMBCD’s NewsStand.

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