Cbite Dental Products

The impossible’s now possible with new gel that can rebuild enamel

lynn — Mon, 10 Nov 2025 22:22:58 +0000

A new protein-based gel can regenerate lost enamel—something once considered impossible—and may offer a fluoride-free solution for repairing erosion and sensitivity.

Meg Kaiser

Key Highlights

New gel seeps into tiny cracks and holes, capturing calcium and phosphate ions from saliva to rebuild enamel.
The treatment is safe, easy to apply, and designed with both clinicians and patients in mind.
Regenerated enamel exhibits properties similar to healthy natural enamel, even after exposure to typical oral stresses.
This technology could significantly reduce the need for temporary treatments and improve long-term dental health.

New protein-based gel can repair eroded or demineralized tooth enamel.

An unprecedented advancement in dental technology has emerged through a new protein-based gel that can repair eroded or demineralized tooth enamel. The new gel could be available commercially as early as next year.

Scientists at the University of Nottingham’s School of Pharmacy and Department of Chemical and Environmental Engineering created the compound that’s designed to restore eroded or demineralized enamel. Their innovative process mimics the natural growth processes of tooth enamel and is made from proteins that imitate those responsible for natural enamel formation early in life. Their findings were published in Nature Communications on November 4.

Why this matters: Current enamel loss treatments only offer temporary protection

Because enamel cannot regenerate, dentistry has long focused on prevention and temporary protection. Current fluoride varnishes and remineralization products offer temporary relief but have never been able to rebuild lost enamel.

In their tests, the scientists applied the fluoride-free gel in a thin layer over teeth to form a protective coat that repairs and regenerates damaged tooth enamel. This is something that, until now, has been impossible. Scientists say the gel can help prevent cavities, repair exposed dentine, reduce sensitivity, and improve how restorations bond to the tooth surface.

Applied like fluoride treatments, the gel forms a coating by seeping into teeth’s tiny cracks and holes and filling them in. It then captures phosphate ions and calcium from saliva, which form into new enamel through a process called epitaxial mineralization.

How the gel works: Mimicking natural enamel formation to rebuild tooth structure

“Dental enamel has a unique structure, which gives it its remarkable properties that protect teeth throughout life against physical, chemical, and thermal insults,” Dr. Abshar Hasan, a lead author of the study, explained to Science Daily. “When our material is applied to demineralized or eroded enamel, or exposed dentine, the material promotes the growth of crystals in an integrated and organized manner, recovering the architecture of our natural healthy enamel. We have tested the mechanical properties of these regenerated tissues under conditions simulating ‘real-life situations’ such as tooth brushing, chewing, and exposure to acidic foods, and found that the regenerated enamel behaves just like healthy enamel.”

“We are very excited because the technology has been designed with the clinician and patient in mind. It is safe, can be easily and rapidly applied, and it is scalable,” explained Professor Alvaro Mata, lead investigator on the project, to Science Daily. “Also, the technology is versatile, which opens the opportunity to be translated into multiple types of products to help patients of all ages suffering from a variety of dental problems associated with loss of enamel and exposed dentine. We have started this process with our start-up company Mintech-Bio, and we hope to have a first product out by next year.”

Their ultimate goal? To help patients increase the longevity of their own healthy teeth and redefine modern dentistry while they’re at it. We now know—think oral-systemic link—that a healthy mouth ultimately leads to fewer health problems in the population overall. There’s not a much better outcome than that.

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Tooth-in-eye surgery performed successfully in Canada for the first time

lynn — Thu, 02 Oct 2025 01:08:44 +0000

A rare surgery called osteo-odonto-keratoprosthesis, also known as “tooth-in-eye” surgery, was recently performed in Canada for the first time. Dr. Jason Auerbach comments.

Sarah Butkovic, MA, BA, DentistryIQ Editors

Ian Tibbetts lived without his sight for 16 years due to a freak accident involving flying scrap metal in 1997. But in 2013, he was able to see his 4-year-old twins for the first time, thanks to a little-known operation that restored his sight with the use of his tooth called osteo-odonto-keratoprosthesis (OOKP).¹

What is tooth-in-eye surgery?

OOKP, also known as “tooth-in-eye” surgery, is a medical procedure that can restore vision in the most severe cases of corneal and ocular surface patients. It includes removal of a tooth from the patient or a donor. After this, a lamina of tissue cut from the tooth is drilled and the hole is fitted with optics. The lamina is grown in the patient’s cheek for a period of months and then is implanted upon the eye.¹

Canada’s first OOKP surgery

In Tibbetts’s case, Dr. Christopher Liu at the Sussex Eye Hospital in Brighton, UK, inserted the lens into a hole drilled through the tooth, which was then implanted in Tibbetts’s eye. Recently, however, Providence Health Care ophthalmologist Greg Moloney successfully performed this procedure on three patients in Canada, making their cases the first in the country.²

The procedure was performed on Canadian woman, Gail Lane, at Mount Saint Joseph Hospital.

“I haven’t seen myself for 10 years,” She said. “If I’m fortunate enough to get some sight back, there will be wonderful things to see.”²

As for Tibbetts, he was also grateful to regain his vision, but it went beyond just that.

“I have my independence back now and I can start looking after the kids while my wife is out at work.” He said. “Before, the kids were just shapes. I couldn’t make them out. I had to actually learn to tell them apart by their voices … I would do anything to get some sight back. I had to try something.”¹

How this procedure works

OOKP was pioneered by the Italian ophthalmic surgeon Professor Benedetto Strampelli in Rome in the early 1960s. By mostly relying on the body’s own biological material, this procedure is intended to minimize the risk of a patient’s body rejecting a foreign implant.

According to Dr. Liu: “Patients who have the surgery are often able to see immediately and the quality of sight can be extraordinarily good. However, it is only suitable for certain types of blindness, specifically patients who have severe and irreversible corneal damage.”¹

The risks involved in this procedure limit surgeons from performing it in only one of each patient’s eyes. Even still, it has been performed in 10 countries with a relatively high success rate; a 2022 study from Italy determined roughly 94 percent of implant recipients could still see even 27 years after having the procedure. Not only that, but recipients from previous studies were reported to be able to drive cars after recovery.²

Photos from the surgery can be viewed here.

Response from Dr. Jason Auerbach, DDS

Dr. Auerbach, practicting dentist and Dental Economics contributor known as @bloodytoothguy on Instagram, believes this type of surgery is both genius and extremely risky—one that should only be performed by a highly-skilled team under very specific circumstances. He has agreed to share his thoughts on OOKP following the success of the most recent procedure in Canada.

Do you think this procedure will ever become popular?

“I do not think this is mainstream and nor will it become mainstream. It’s reserved for extreme cases that are typically patients with severe corneal damage and no other options. That’s what makes it so special at the same time. It’s the kind of last-resort miracle that pushes the boundaries of medicine and shows what’s possible when surgical disciplines collaborate without ego or limitations.”

With so many risks involved, is OOKP worth it?

“When done in the right hands and for the right patient, it’s definitely worth it. OOKP is reserved for where basically no other options exist. For patients who are otherwise permanently blind due to severe corneal disease or chemical burns, this is sometimes the only shot they’ve got at seeing again. That makes the risk not just acceptable. It makes it sometimes necessary.”

Would you recommend it to the right patient?

“100%. If I had a patient whose ophthalmology team determined they were a viable candidate, psychologically prepared, medically stable, and committed to the process, I would absolutely advocate for it. The idea that we can take a tooth and restore vision with it? That’s the kind of cross-disciplinary brilliance and creativity that I love.”

What does the future hold for OOKP, in your opinion?

“Do I think it’ll become more common? Probably not widely. It may evolve though. Because it’s so complex, and the indications are too rare, OOKP isn’t likely to replace LASIK or corneal transplants. But it’s a surgical option that can open doors. And as tech evolves, particularly in biomaterials and regenerative medicine, one could see some of its principles being adapted and scaled. The idea of using living tissue as a scaffold for long-term ocular implants is not so farfetched. Overall, it’s a testament to what can happen when we stop seeing disciplines in silos and start seeing the human body and surgical possibility, as one integrated creative system.”

References

Man regains sight after doctors replace his eye with a tooth. GMA News Online. October 7, 2013. https://www.gmanetwork.com/news/scitech/science/329791/man-regains-sight-after-doctors-replace-his-eye-with-a-tooth/story/
Paul A. Surgeon implants teeth in patients’ eye to restore vision. Popular Science. March 4, 2025. https://www.popsci.com/science/eye-in-tooth-surgery/

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Want a better toothpaste? Just add wool

lynn — Wed, 20 Aug 2025 02:54:22 +0000

Andrew Paul

Researchers hope to have their new additive available to the public in the next 2-3 years. Credit: Deposit Photos

A protein found in hair and fingernails may help restore enamel.

A new, sustainably sourced toothpaste additive may soon transform how we strengthen—and even restore—weakened or lost tooth enamel. However, this potential game changing dentistry ingredient isn’t harvested from rare or complex sources. Instead, the protein can be found in everyone’s hair, skin, and fingernails.

Tooth enamel doesn’t replenish itself, and retaining it isn’t easy. The natural protective barrier lining our chompers inevitably erodes over your lifetime, but highly acidic diets and poor dental hygiene often also exacerbates the deterioration. Losing the exterior layer frequently results in tooth sensitivity, acute pain, and ultimately tooth loss. Fluoride remains one of the safest treatments to prevent deterioration, but it’s not capable of fostering enamel regrowth or replacing what has already disappeared.

“Unlike bones and hair, enamel loss does not regenerate,” King’s College London prosthodontics consultant Sherif Elsharkawy said in a statement. “Once it is lost, it’s gone forever.”

Recently, Elsharkawy and colleagues wondered if a very resilient protein called keratin could somehow help reinforce teeth. After extracting keratin from sheep’s wool, the team added it into a composite mixture that they then applied to the surfaces of human molars. They soon realized that the protein quickly combined with saliva’s naturally present minerals to form a well-organized, crystalline scaffolding structure that shares a remarkable similarity to enamel. Once adhered to a tooth, the layer kept attracting phosphate and calcium ions to continue growing a new, protective coating—effectively regenerating lost enamel. Their results were recently published in the journal Advanced Healthcare Materials.

“Not only is it sustainably sourced from biological waste materials like hair and skin, it also eliminates the need for traditional plastic resins, commonly used in restorative dentistry, which are toxic and less durable,” explained study first author and restorative dentistry clinician Sara Gamea.

Gamea added that unlike plastic resins, keratin simply looks more natural and can be altered to more closely match an original tooth’s color.

Elsharkawy and Gamea believe that their groundbreaking solution to the nearly ubiquitous dental concern may only be 2 to 3 years away from becoming publicly available. They anticipate the keratin-based mixture could be added to over-the-counter toothpaste like fluoride, or used in targeted repairs at a dentist’s by applying it like nail polish.

“With further development and the right industry partnerships, we may soon be growing stronger, healthier smiles from something as simple as a haircut,” Elsharkawy said.

The keratin-infused enamel repair is one of the latest in the growing waste-to-health industry, which aims to repurpose discarded materials for medical solutions.

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Using thyroid collars during radiographic exams no longer recommended by ADA

lynn — Tue, 09 Apr 2024 15:03:42 +0000

by: Mary Beth Versaci

Expert panel updates imaging safety guidance

The American Dental Association no longer recommends using thyroid collars on patients during radiographic exams.

Before taking radiographs, dentists should also consider what diagnostic information they need from the images to benefit patient care or substantially improve clinical outcomes, according to updated recommendations developed by an expert panel established by the ADA Council on Scientific Affairs.

The recommendations, published online Feb. 1 by The Journal of the American Dental Association, aim to improve radiation protection in dental radiography and cone-beam computed tomography. Medical physicists with the U.S. Food and Drug Administration supported the development of the recommendations, which are also aligned with recent guidance from the American Academy of Oral and Maxillofacial Radiology. The recommendations are the first on dental imaging safety and radiation protection from the council since 2012.

After reviewing nearly 100 articles, guidance documents and regulations related to radiography, the expert panel determined thyroid and abdominal shielding during dental imaging is no longer recommended, and the use of these forms of protective shielding should be discontinued as routine practice. Evidence indicates modern digital radiography equipment and restricting the beam size only to the area that needs to be imaged better protect patients against radiation exposure to other parts of their body. Lead aprons and thyroid collars can also block the primary X-ray beam, preventing dentists from capturing the image they need.

“When this happens, more radiographs need to be taken, and unnecessary X-rays are what we want to avoid,” said Purnima Kumar, D.D.S., Ph.D., professor of dentistry and chair of the department of periodontology and oral medicine at the University of Michigan School of Dentistry and chair of the ADA Council on Scientific Affairs. “The central point of these recommendations is that clinicians should order radiographs in moderation to minimize both patients’ and dental professionals’ exposure to ionizing radiation.”

The recommendations — which apply to all patients, regardless of age or health status, such as pregnancy — also advise dentists to safeguard patients against unnecessary radiation exposure by:

• Ordering radiographs to optimize diagnostic information and enhance patient care outcomes and making every effort to use images acquired at previous dental exams.
• Using digital instead of conventional radiographic film for imaging.
• Restricting the beam size during a radiography exam to the area that needs to be assessed.
• Properly positioning patients so the best image can be taken.
• Incorporating CBCT only when lower-exposure options will not provide the necessary diagnostic information.
• Adhering to all applicable federal, state and local regulations on radiation safety.

“We encourage dentists and their teams to review these best-practice recommendations, comply with radiation protection regulations and talk with their patients about any questions or concerns before ordering dental imaging,” Dr. Kumar said.

There may be state laws or regulations mandating continued use of certain equipment. Dentists should abide by the laws and regulations where they practice.

To view the complete recommendations, visit JADA.ADA.org. They will appear in the April issue of JADA.

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Gingival recession: Causes, effects, and ways to reduce dentinal hypersensitivity

lynn — Mon, 26 Feb 2024 19:18:40 +0000

Dentinal hypersensitivity due to gingival recession requires routine in-office dental care along with supportive home care. Here are some tools to help patients minimize their risk of recession-related concerns.

Masooma Rizvi, RDH

Gingival recession, the apical shift of the gingival margins,^1,2 is the process in which the margin of the gingiva that surrounds the teeth wears away or pulls back, exposing surfaces of the tooth or the tooth’s root.^3-5 This common finding in clinical practice can lead to dentinal hypersensitivity among patients during dental hygiene visits.² To ensure patient compliance with their dental care and recare interval maintenance, it becomes imperative for practitioners to use desensitizing agents on patients to reduce dentinal hypersensitivity due to gingival recession. Various preventive measures can be taken during hygiene visits and at home for patients experiencing dentinal hypersensitivity associated to gingival recession.

Gingival recession is the result of a shift of the gingiva, positioned 0.5–2.0 mm coronal to the cementoenamel junction (CEJ) in a healthy periodontium, beyond the CEJ.⁶ Recession is a prevalent dental issue because of its gradual nature⁴ that affects most middle-aged and older people.^4,7

According to the US National Survey, 88% of seniors age 65 and over and 50% of adults ages 18–64 present with gingival recession in one or more sites.^4,7 Moreover, progressive increase in the frequency and extent of gingival recession is observed with an increase in age.⁷ When gingival recession occurs, disease-causing bacteria start to form as gaps and pockets between the teeth and the gingival lining appear.^3,4 If left untreated, supporting tissue and bone structures of the teeth can be severely damaged, ultimately resulting in tooth loss.⁴

What causes gingival recession?

Gingival recession is multifactorial. Its causes include:

Periodontal disease
Supragingival and subgingival calculus accumulation
Gingival inflammation
Improper flossing
Aggressive toothbrushing and use of a hard-bristled toothbrush
High frenal attachment (which may impede plaque removal by causing pull on gingival margins)
Tooth movement by orthodontic forces via proclination of incisors and arch expansion¹
Improperly designed partial dentures and restorations^7,8

Subgingival restoration margins increase plaque accumulation, gingival inflammation, and alveolar bone loss.^7,8 Further, the use of chemicals, such as topical cocaine application, causes gingival ulcerations and erosions as does smoking.⁷ Recession sites due to smoking have been found particularly on buccal surfaces of maxillary molars, premolars, and mandibular central incisors.⁷ These factors must be considered when classifying periodontal disease status as part of patient care.

Dental treatment methods for dentinal hypersensitivity

Gingival recession is assessed by a long clinical tooth and varied proportion when compared to adjacent teeth.⁷ It can manifest as localized or generalized and occur with or without loss of attached tissue.⁷When a patient with gingival recession is in for hygiene therapy, dentinal hypersensitivity must be addressed first before proceeding with the appointment. Periodontal gels can be a solution for treating dentinal hypersensitivity problems in-office.⁹

A research study conducted in six dental schools investigated the ability of a thermosetting gel containing 25mg/g prilocaine and 25mg/g lidocaine as active agents to produce analgesia in periodontal pockets.¹⁰This randomized, double-blind, placebo-controlled study used pain as measurement on a 100 mm Visual Analogue Scale (VAS) and a Verbal Rating Scale (VRS).^6,10 Results using the VAS pain score showed that 5% anesthetic gel was statistically more effective than the placebo in reducing pain and sensitivity during periodontal debridement.¹⁰

Use of local anesthetics can be cost effective and save time for dental practitioners.⁴ In accordance with evidence-based research, a local anesthetic injection combined with a periodontal gel saved approximately 20 minutes per session.

Home-care products for patients with dentinal hypersensitivity

As part of the recall visit, review the oral hygiene regimen with patients who have gingival recession.¹¹Studies have indicated that improper toothbrushing can harm gingival tissue due to brushing pressure and bristle type, which serve as the most important determinants of gingival recession.¹¹ Dentinal hypersensitivity is an issue for many patients who use hard-bristled toothbrushes.¹¹ Recall visits are an ideal time to discuss ways to prevent dentinal hypersensitivity, and recommending a soft- or ultrasoft-bristled toothbrush or a power toothbrush with a pressure sensor can help these patients.¹¹ Evidence indicates that such tools help minimize aggressive toothbrushing patterns. Technique and angulation affect plaque removal despite the toothbrush type.¹¹

Likewise, selecting proper dentifrice is a must in patients with dentinal hypersensitivity.¹¹ The relative dentin abrasivity (RDA) value measures abrasiveness of toothpaste on dentin.¹¹ RDA is directly related to dentin loss, which contributes to teeth sensitivity.¹¹ Using a toothpaste with low RDA can help minimize the symptoms of dentinal hypersensitivity and its progression due to gingival recession.¹¹ Toothpastes with a RDA value of 0–70 are categorized as “low abrasion” and should be recommended to patients with existing hypersensitivity.¹¹

Apart from the RDA of dentifrices, patients should consider a toothpaste with ingredients that help with dentinal hypersensitivity—calcium sodium phosphosilicate, arginine and calcium carbonate, strontium, or potassium nitrate.¹¹ These ingredients depolarize the nerves or block dentinal tubules to prevent fluid movement, thereby decreasing nerve conduction and dentinal hypersensitivity.¹¹ Since sensitivity-relief toothpastes work by different mechanisms, patients may need to try several different toothpastes and use them for a few weeks to find the one that alleviates their symptoms.¹¹ Toothpaste with a high-fluoride concentration may also be beneficial.¹¹

Dental procedures for dentinal hypersensitivity

Besides noninvasive ways of preventing and treating dentinal hypersensitivity due to gingival recession, invasive procedures such as periodontal surgery can be pursued to establish regular recare intervals for patients in addition to the recommended postoperative follow-up visits with their specialist.¹¹ Evidence suggests that patients who have undergone periodontal surgery benefit from an alternating maintenance schedule between their general dentist and periodontist.¹¹ At each scheduled periodontal maintenance visit, a periodontal exam, prophylaxis, and evaluation by the dentist should be performed.¹¹

Reinforcing healthy habits

With these tools dental professionals can support oral health through routine in-office maintenance and regular home care. Proper oral hygiene is essential to long-term treatment success for dental hypersensitivity due to gingival recession.¹¹ In-office periodontal gels can reduce hypersensitivity. Following a routine oral regimen using recommended products can help prevent gingival recession and minimize patients’ risk of clinical concerns in future. Addressing periodontal disease is vital for the longevity of a healthy periodontium and successful surgical outcomes.

Editor’s note: This article first appeared in Clinical Insights newsletter, a publication of the Endeavor Business Media Dental Group. Read more articles and subscribe.

References

Zini A, Mazor S, Timm H, et al. Effects of an oral hygiene regimen on progression of gingivitis/early periodontitis: a randomized controlled trial. Can J Dent Hyg. 2021;55(2):85-94.
Imber JC, Kasaj A. Treatment of gingival recession: when and how? Int Dent J. 2021;71(3):178-187. doi:10.1111/idj.12617
Chambrone L, Ortega MAS, Sukekava F, et al. Root coverage procedures for treating localised and multiple recession‐type defects. Cochrane Database Syst Rev. 2018;10(10):CD007161. doi:10.1002/14651858.CD007161.pub3
Marconcini S, Goulding M, Oldoini G, Attanasio C, Giammarinaro E, Genovesi A. Clinical and patient-centered outcomes post non-surgical periodontal therapy with the use of a non-injectable anesthetic product: a randomized clinical study. J Investig Clin Dent. 2019;10(4):e12446. doi:10.1111/jicd.12446
Merijohn GK. Management and prevention of gingival recession. Periodontol 2000. 2016;71(1): 228-242. doi:10.1111/prd.12115
Fageeh HN, Meshni AA, Jamal HA, Preethanath RS, Halboub E. The accuracy and reliability of digital measurements of gingival recession versus conventional methods. BMC Oral Health. 2019;19(1):154. doi:10.1186/s12903-019-0851-0
Pradeep K, Rajababu P, Satyanarayana D, Sagar V. Gingival recession: review and strategies in treatment of recession. Case Rep Dent. 2012;2012:563421. doi:10.1155/2012/563421
Jati AS, Furquim LZ, Consolaro A. Gingival recession: its causes and types, and the importance of orthodontic treatment. Dental Press J Orthod. 2016;21(3):18-29. doi:10.1590/2177-6709.21.3.018-029.oin
Mayor-Subirana G, Yagüe-García J, Valmaseda-Castellón E, Arnabat-Domínguez J, Berini-Aytés L, Gay-Escoda C. Anesthetic efficacy of Oraqix versus Hurricaine and placebo for pain control during non-surgical periodontal treatment. Med Oral Patol Oral Cir Bucal. 2014;19(2):e192-e201. doi:10.4317/medoral.19202
Donaldson D, Gelskey SC, Landry RG, Matthews DC, Sandhu HS. A placebo-controlled multi-centred evaluation of an anaesthetic gel (Oraqix) for periodontal therapy. J Clin Periodontol. 2003;30(3):171-175. doi:10.1034/j.1600-051x.2003.00017.x
Saltz AE, Sirois V. The dental hygienist’s role in treating gingival recession. Proper prevention, treatment, and maintenance strategies are integral to achieving positive patient outcomes. Dimensions of Dental Hygiene. May 17, 2022. https://dimensionsofdentalhygiene.com/article/dental-hygienists-role-treating-gingival-recession/

Masooma Rizvi, RDH, has been practicing clinical dental hygiene for five-and-a-half years in general practices across Halifax Regional Municipality in Nova Scotia, Canada. Her professional expertise caters to patients’ dental concerns relating to periodontal disease and orthodontic needs. Outside of work she likes to travel, read, and spend time with family and friends.

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Emerging Autoimmune Syndrome Disrupts the Formation of Tooth Enamel

lynn — Fri, 05 Jan 2024 20:28:26 +0000

Weizmann Institute of Science

The latest research from the Weizmann Institute of Science unveils a newly identified autoimmune disorder affecting tooth enamel development, providing valuable insights into the mysteries surrounding enamel irregularities. Headed by Professor Jakub Abramson, the study investigates a rare genetic syndrome named APS-1 and its correlation with impaired enamel production. Significantly, this disorder is also prevalent in children diagnosed with celiac disease, suggesting a broader link between autoimmune conditions and dental health.

Tooth enamel, acknowledged as the toughest and most mineral-rich substance in the human body, plays a vital role in safeguarding teeth. However, the study reveals that one in ten individuals and a third of children with celiac disease exhibit defective enamel, heightening sensitivity to temperature changes and accelerating decay. Despite the widespread occurrence of enamel issues, the specific causative factors remain elusive in many cases.

Published recently in Nature, the study delves into the autoimmune nature of enamel defects observed in APS-1 individuals. Given that APS-1 patients grapple with various autoimmune diseases, the researchers theorize that the enamel abnormalities may be autoimmune-related, indicating a potential immune system assault on proteins or cells crucial for enamel formation.

The investigation identifies a mutation in the autoimmune regulator (Aire) gene during the exploration of this mechanism. A key player in educating T cells, essential for averting autoimmune responses, the Aire gene mutation disrupts the critical process of instructing T cells to distinguish between the body’s own proteins and external substances. Consequently, T cells lacking proper education are released from the thymus gland, leading to the production of antibodies targeting enamel proteins.

The study intriguingly draws parallels between APS-1 and celiac disease, a prevalent autoimmune disorder affecting approximately 1% of the Western population. Significant numbers of celiac patients were found to possess autoantibodies targeting enamel proteins, akin to APS-1 cases. To comprehend this link, the study explores potential shared proteins between the intestine and dental tissue.

A noteworthy discovery arises from the focus on k-casein, a major component of dairy products. The study reveals that antibodies against k-casein, generated in response to specific food antigens in the intestines of celiac patients, may inflict collateral damage on enamel development. Considering the widespread use of k-casein in dairy products, the study’s implications extend to the food industry.

Professor Abramson underscores the common occurrence of impaired tooth enamel development for unknown reasons among individuals. The study not only enhances our understanding of this phenomenon but also suggests the potential for diagnosing this newfound disorder through blood or saliva tests. Early diagnosis, especially in children, holds the promise of enabling preventive treatment for tooth enamel issues, potentially revolutionizing dental healthcare practices.

In summary, this comprehensive study not only unravels the intricate connection between autoimmune disorders and tooth enamel defects but also carries implications for medical diagnosis and the broader food industry.

The study, “Autoimmune amelogenesis imperfecta in patients with APS-1 and coeliac disease,” was published November 2023 in Nature.

FEATURED IMAGE CREDIT: Markus Winkler on Unsplash.

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How to Deal with a Difficult Patient

lynn — Tue, 05 Sep 2023 20:04:06 +0000

Roger P. Levin, DDS

Even if you have a practice with 5-star customer service, you’ll still encounter patients who are deemed difficult—individuals who simply don’t cooperate in some way, shape, or form. Dealing with difficult patients can upset the staff, send negative reverberations throughout the practice, cause stress and frustration, and even lead to a loss of revenue due to their behaviors and the time needed to address them.

Here are 4 steps for effectively dealing with difficult patients:

Maintain Your Composure: The first step in handling a difficult patient is not to let it bother you. While this may sound easier said than done, it’s essential not to internalize the difficult patient’s behavior or comments. Instead of being shocked or surprised, expect occasional encounters with challenging patients. Try viewing it as a challenge or game to be won – find ways to relieve stress and possibly satisfy the patient.
Seek Understanding: Be curious enough to try to figure out why the patient is being difficult. Initially, it’s natural to perceive the patient as unfair, ridiculous, or annoying. However, there is usually an underlying reason that triggers the difficult behavior. It could be a minor inconvenience, financial concerns, personal preferences, or discomfort with a team member. Taking a moment to understand the root cause of their behavior can help you find a solution.
Ask for Feedback: Engage the patient by asking how you can make their experience better. This approach often disarms difficult patients because they may not expect someone to genuinely listen to their concerns. By simply asking what could enhance their appointment’s comfort, convenience, or enjoyment, you demonstrate a willingness to address their needs. This can help move the patient back into rational and logical behavior.
Offer Reasonable Solutions: Determine if the patient’s request or concern can be reasonably addressed. In some situations, offering a simple solution can alleviate the patient’s dissatisfaction. For instance, a restaurant might offer a free dessert to appease a customer unhappy with service. Similarly, in a dental setting, finding a practical solution, such as scheduling the patient for the first appointment of the day to avoid delays, can resolve their issue. Often, acknowledging the problem and taking steps to rectify it can significantly improve the patient’s attitude.

Dealing with difficult patients can be disruptive and challenging. They can create stress, tension, conflict, financial losses, and disrupt the practice’s daily operations. Following the general guidelines mentioned above can help you manage and satisfy most difficult patients effectively. However, in rare cases, you may need to consider whether it’s in the practice’s best interest to continue serving an extremely challenging patient.

Ultimately, the goal is to equip your team with the tools and principles to handle difficult patients professionally and skillfully, ensuring the best possible experience for both the patient and the practice.

ABOUT THE AUTHOR

Roger P. Levin, DDS, is the CEO and founder of Levin Group, a leading practice management consulting firm that has worked with over 30,000 clients to increase production. A recognized expert on dental practice management and marketing, he has written more than 60 books and over 4,000 articles and regularly presents seminars in the U.S. and around the world.

To contact Dr. Levin or to join the 40,000 dental professionals who receive his Practice Production Tip of the Day, visit www.levingroup.com or email rlevin@levingroup.com.

FEATURED IMAGE CREDIT: Vitalii Vodolazskyi/Shutterstock.com.

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EU Commission Bans Use of Dental Amalgam from 2025

lynn — Mon, 17 Jul 2023 19:19:12 +0000

The European Commission

The European Commission has published draft legislation to phase out dental amalgam in 2025. The revision of the EU Mercury Regulation has been expected since December 2022 and includes a ban on mercury-containing light bulbs and lamps.

Since there are viable mercury-free alternatives, dental amalgam shall no longer be used for dental treatments of any member of the population from January 1, 2025. The proposal also includes a ban on its manufacture and export, making an important contribution to reducing mercury emissions internationally.

The use of dental amalgam for children under the age of 15, as well as breastfeeding and pregnant women, has already been banned in the EU since 2018.

Amalgam consists of 50% mercury, one of the world’s most toxic substances. Despite all precautions taken in dentistry, mercury inevitably enters the environment, where it transforms into the even more toxic form methylmercury and contributes to mercury accumulation in the fish we eat.

Before the Commission’s proposal can take effect, it must be approved by the European Parliament and the Council. Given the delay, however, the Parliament will have to move fast to complete all the formalities before the 2024 parliamentary elections.

“This is a milestone. Finally, we get a regulation for dental amalgam, the largest remaining use of mercury in Europe and a serious threat to health and the environment,” says Florian Schulze, director of the European Network for Environmental Medicine, who has been pushing for the phase-out for years.

“Numerous countries, such as Sweden, Norway, Moldova, Lithuania, Switzerland, Bolivia, Ecuador, Indonesia, the Philippines, or Zambia, have already phased out the use of amalgam. Most recently, Poland had replaced amalgam with alternatives in the statutory health insurance,” explains Schulze.

FURTHER INFORMATION

Proposal for a REGULATION OF THE EUROPEAN PARLIAMENT AND OF THE COUNCIL amending Regulation (EU) 2017/852 of the European Parliament and of the Council of May 17, 2017, on mercury as regards dental amalgam and other mercury-added products subject to manufacturing, import, and export restrictions: https://ec.europa.eu/transparency/documents-register/detail?ref=SEC(2023)395&lang=en.

Global Overview of Countries Phasing Out Dental Amalgam: https://environmentalmedicine.eu/mercury-free-dentistry-for-planet-earth/.

FEATURED IMAGE CREDIT: Tobias Blad-Stahl/Shutterstock.com.

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Occlusion and caries: Ongoing zirconia challenges

lynn — Mon, 27 Feb 2023 16:29:25 +0000

Zirconia crowns are well known as the most-used ceramic restoration in dentistry. Dr. Gordon Christensen provides some potential solutions for a few of their most important challenges.

Gordon J. Christensen, DDS, PhD, MSD

“I have been practicing for many years, and most of the indirect restorations I have placed in the past could be cemented with correct occlusion as they came from the laboratory. However, in recent years, I am seeing some crowns that are not even close to touching the opposing arch of teeth, and others are too high. These crowns come from my usual laboratory that has had near-optimal occlusion on the crowns in the past. Additionally, I still have some zirconia crowns coming off in service. What can I do about these challenges?”

Dr. Christensen: Both you and I are seeing the same problems, and I have several potential reasons and solutions to share.

Labs are making crowns out of contact with the opposing arch (figure 1). Some labs are making crowns up to 0.5 mm too low (500 microns or the thickness of at least 10 human hairs) as measured by Clinicians Report (CR) scientists. This reduction in crown height reduces the completed restoration occlusal thickness, potentially compromising crown strength and causing tooth extrusion of both the tooth being crowned and the opposing tooth, as well as stress on adjacent teeth.

Figure 1: Note the significant lack of occlusal contact on this zirconia crown example as sent from a large dental laboratory.

Why would technicians do this? Currently, the most popular crown types—zirconia and lithium disilicate—are very difficult to reduce in height and difficult to finish and polish smooth in the mouth, taking clinical time and frustrating the dentist and patient. The technician and the dentist would like to have the patient say the crown feels just right when closing the two arches together. Making the crown shorter with no occlusal contact avoids removal of ceramic on the occlusal/incisal surface when seating.

Most zirconia and lithium disilicate crowns are initially one color without significant translucence. Thus, most ceramic crowns have a layer of low-fusing ceramic fired over them to provide individual characterization of color and translucence on the crown. If the occlusal/incisal crown surface is adjusted, removing the superficial layer of low-fusing ceramic, the underlying zirconia or lithium disilicate is exposed and the restoration’s color and translucence are compromised.

In discussions with CR scientists and clinicians, they disagree with placement of superficial low-fusing ceramic. They have proven that the superficial glaze and stain wear off over time and wear the opposing teeth until worn off (personal communication, Rella Christensen, PhD).

Successful cementing of zirconia crowns: Still a problem

Zirconia crowns in dentistry: Uses, clinical challenges, and solutions

Some labs are spacing the intaglio (internal) surfaces of crowns to reduce seating difficulty as measured by the CR science team (figure 2). You have probably noticed that many current zirconia crowns do not have a definitive seating location and tend to be mobile on the tooth until cemented. This unfortunate situation is directly related to internal spacing. So, how much internal spacing is necessary for optimum seating?

Figure 2: This crown came off in service and is from one of CR’s in vivo zirconia studies. It was placed only a short time before the photo was taken. Note the thickness of the resin cements as observed in the void area on the occlusal intaglio surface of the crown and the staining on the margins that occurred after a very short time.

You may remember when stone dies were the norm. A layer of lacquer was painted on the dies to allow space for the cement and reduce hydraulic resistance caused by the cement during seating. That layer was about 25 microns thick, which is probably enough even for the digital needs of today. However, if there are undercuts on the prep, those undercuts need to be filled with some material to avoid the digital directed milling device automatically overspacing the digital prep model. CR scientists have measured up to 500 microns (one-half mm) of internal spacing.

Consider the combination of up to one-half mm occlusal spacing and one-half mm internal spacing totaling one full mm thickness reduction on the occlusal surface of the crown. Is there any question as to why some crowns don’t have stability on the tooth until they are cemented?

I strongly suggest dentists should communicate with their lab technicians to minimize the external and internal spacing of zirconia crowns.

Open margins are a problem. When the crown internal is spaced digitally, the margin is also spaced. Are dentists using cariostatic cement to fill those open margins? Thankfully, most dentists (from CR survey data) are using resin-modified glass ionomer (RMGI). Popular and proven examples are 3M RelyX Luting Plus and GC FujiCEM Evolve, which release significant fluoride for potential reduction of future caries involvement on the margins. However, many dentists are using resin cements for zirconia crown cementation, which have at least 2% polymerization shrinkage, resultant microscopically open margins, and no cariostatic properties.

Assuming you have followed the narrative above, most zirconia crowns cemented with the resin cement technique are essentially a strong zirconia roof on a potentially cariogenic composite resin cement. Logic says future marginal caries will be present on zirconia crowns cemented with resin cement (figure 3).

Use resin-modified resin cement until additional long-term research is completed on my suggestion below.

Figure 3: Open margin on a crown with caries that almost exposed the pulp when removed was seated with resin cement.

A possible solution for the cement challenge with zirconia crowns. In the 1970s and 1980s, conventional glass ionomer (GI) cements were used routinely. Later, about 20% resin was added to modifications of these cements, resulting in RMGI cements as discussed above.

Why aren’t conventional GI cements popular in North America? Infrequently and without any supported research reason, significant postoperative tooth sensitivity was observed, which led most dentists to choose other cements. Can that be overcome today? Yes!

Clinicians Report Foundation scientists have accomplished long-term research on glutaraldehyde-containing materials such as Zest Dental Solutions MicroPrime G, Kulzer Gluma, and several others. This data has been published in Clinicians Report.¹ These liquids contain 5% glutaraldehyde and 35% HEMA. When applied to tooth preparations for two one-minute applications just before cementing a crown, they coagulate the tooth collagen, closing the dentinal tubules and effectively eliminating postoperative tooth sensitivity. Another major reason for their use is that the application technique also effectively disinfects the tooth preparation.

Proven conventional GI cements are available. Two well-known brands are 3M Ketac Cem and GC Fuji I. Such cements do not have the undesirable polymerization shrinkage of resin or the slightly less shrinkage of resin-modified cements. They have natural chemical chelation (bonding) to tooth structure, and they have proven preventive properties related to fluoride release.

Here’s a personal empirical observation from my long-term practice experience. Remember Dr. David Sackett’s classic statement about evidence-based medicine (EBM)? He is the person often credited with initiating and supporting evidence-based practice. This is a direct quote from Dr. Sackett: “EBM is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. The practice of EBM means integrating individual clinical experience with the best available clinical evidence from systematic research.”²

During the 1970s and 1980s, I accomplished many full-mouth restorative rehabilitations. The cements used were conventional GI and later polycarboxylate, which was popular as a cement having less postoperative tooth sensitivity than conventional GI but was not an adequate long-term cement. Some of these rehabilitations have failed over the years due to restoration failure, caries, or periodontal problems and have required re-treatment. When taking the GI-cemented crowns off, caries is almost never observed even though the crowns have served up to 40 years or more in the mouth.

Combine my empirical statement with the proven cariostatic properties of GI cement, the obvious microscopically open margins of milled zirconia crowns, and it appears we have a mandate to revisit glass ionomer cements.

Summary

Zirconia crowns are now well known as the most-used ceramic restoration in dentistry. However, there are continuing challenges with them. This article provides some potential solutions for a few of the most important challenges. Zirconia crowns are here to stay. They can be esthetically and functionally excellent if their physical characteristics are known and proper cements are used (figure 4).

Figure 4: The current generation of zirconia crowns can be both beautiful and functional.

Editor’s note: This article appeared in the February 2023 print edition of Dental Economics magazine. Dentists in North America are eligible for a complimentary print subscription. Sign up here.

References

How to predictably reduce post-op tooth sensitivity and caries. Clinicians Report. 2020;13(10).
Sackett DL, Rosenberg WMC, Gray JAM, Haynes RB, Richardson WS. Evidence based medicine: what it is and what it isn’t. BMJ. 1996;312(7023):71-72. doi:10.1136/bmj.312.7023.71

Author’s note: The following educational materials from Practical Clinical Courses offer further resources on this topic.

One-hour videos:

Strong, Comfortable, Esthetic Rehabilitations with Zirconia (Item #V1942)
Cementing Restorations—Proven and Successful (Item #V1921)

Three-hour virtual course:

Christensen’s Most Frequent Failures and How to Avoid Them (Item #X4740)
Making Occlusion Work for Your Practice (Item #X3515)

For more information, visit our website at pccdental.com or contact Practical Clinical Courses at (800) 223-6569.

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A new method for restoring enamel has “huge potential for applicaton” in dentistry

lynn — Thu, 12 Jan 2023 15:43:27 +0000

Learn about a new strategy for restoring tooth enamel by adding a complex of amino acids to hydroxyapatite that researchers say could have a widespread impact in dentistry.

Elizabeth S. Leaver

Researchers have developed a method of restoring tooth enamel by adding a complex of amino acids to hydroxyapatite, a strategy they say has “huge potential for application” in dental practices.

Hydroxyapatite is a naturally occurring component of teeth and bones, comprising 97% of tooth enamel and 70% of tooth dentin, and mixing it with amino acids can create coating that replicates the composition and microstructure of natural tooth enamel.

According to the study, Engineering of biomimetic mineralized layer formed on the surface of natural dental enamel engineering, a biomimetic mineralized layer on the surface of native dental tissue (bio-template) was key to that replication. They achieved that mineralized layer with nanocrystalline carbonate-substituted calcium hydroxyapatite (HAp), calcium alkali, and a complex of polyfunctional organic and polar amino acids.

“By applying the set of structural and spectroscopic methods of analysis we have confirmed the formation of a mineralized biomimetic HAp layer on the surface of bio-template with properties resembling those of natural hard tissue … our work aimed to develop a concept for the engineering of a biomimetic mineralized layer on the surface of natural dental tissue as well as the study of its structural-spectroscopic features.”

Current restorative techniques involve acid etching of the enamel to increase the bonding effect, which sometimes leaves behind products that aren’t conducive to the bonding of enamel and synthetic materials.

The new method of using HAp can be used to reduce the sensitivity of teeth in case of enamel abrasion or to restore it after erosion. Overall, researchers said their strategy for biomimetic engineering and technique for enamel surface pre-treatment to provide tissue mineralization has a “huge potential for application in dental clinic practices.”

A growing cohort of dental professionals espouse HAp for its usefulness as a natural means of remineralization: “HAp should be a no-brainer when it comes to substances able to remineralize our teeth,” wrote Jacqueline Carcaramo in “Hydroxyapatite: A way to brush your teeth with their natural components?“ “The benefits of this ingredient being biomimetic are that once we place it on the teeth, the body knows what to do with it as it is already a familiar component. The small particles adhere to the tooth structure and fill in the weaker, demineralized areas, binding to the tooth and creating a stronger surface. This can also decrease sensitivity and give a whiter appearance to the teeth.”

Download the PDF: Engineering of biomimetic mineralized layer formed on the surface of natural dental enamel

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