Dental Tribune South Asia No. 8, 2023

Oral resistome-an emerging concept in antibiotic-resistance genes / “Dental schools should consider incorporating haptic VR simulation devices” / 3D printing is not the perfect answer to periodontal regeneration, but it is getting close / Cambodian study indicates improving oral health in children with HIV/Aids could help lower viral load / EFP releases peer-reviewed guideline on peri-implant disease prevention and treatment / VR, AR, AI and the future of tobacco cessation counselling

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The World‘s Dental Newspaper
South Asia Edition
Published in India

www.dental-tribune.com

HAPTIC VR

Vol. 1, No. 8

HIV/AIDS

DIGITAL TECHNOLOGIES

According to Dr Szabolcs Felszeghy
from Finland, dental schools should
consider incorporating haptic VR
simulation devices.

Cambodian study indicates improving oral health in children
with HIV/Aids could help lower viral load.

Virtual reality, augmented reality,
artificial intelligence & the future of tobacco cessation counselling.

Page 03

Page 05

Page 07

Oral resistome-an emerging concept in
antibiotic-resistance genes
common resistant strains by recognizing the antibiotic resistance
genes dominant in an individual.
This individualized strategy can
improve treatment results, lower
the risk of antibiotic resistance,
and cut down on the overuse of
antibiotics.
●
More efficient antimicrobial prophylaxis: Invasive dental treatment in high-risk patients
needs prior antibiotic prophylaxis.
Understanding the oral resistome
can guide the development of evidence-based guidelines for resistome-specific antimicrobial prophylaxis. This will ensure that appropriate antibiotics are prescribed while minimizing the risk
of promoting further resistance.
Understanding the oral microbiome changes with age: The milestones
The article explores the role of early-age oral resistome in screening dental diseases. (Photo: Canva)
By Dr. Satabdi Saha,
Dental Tribune South Asia
The last decade has witnessed
a global rise in antibiotic resistance, creating substantial challenges for healthcare systems
worldwide. While the primary
focus has traditionally been on
comprehending the impact of antibiotic usage on resistance development, a novel concept in microbial ecology is unveiling the potential role of the human oral microbiome in the spread of
antibiotic-resistance genes. This
concept, termed the “Oral Resistome” delves into the complex in-

terplay between the oral microbiota and the acquisition and transfer of resistance genes. In this article, we explore the world of oral
resistomes, their connection to
dental diseases, and antibiotic
profiling.
Oral resistome: An emerging
concept
The oral microbiome is the
second-largest microbial community in the body, after the gut.1
The oral resistome refers to
the collection of antibiotic-resistance genes (ARGs) present in the
microbial community of the oral
cavity. It encompasses the genetic
material that can confer resistance
to antibiotics and is carried by various microorganisms inhabiting
the oral environment.1
Oral resistome can provide
valuable insights into screening
and managing dental diseases.
Here’s how.

www.dental-tribune.com

●
Early resistance detection: Screening the oral resistome
may enable for the early discovery
of antibiotic resistance in oral infections. Dentists can spot rising
resistance patterns and alter treatment methods by tracking the
prevalence of resistance genes
over time.
●
Screening
high-risk
populations: The oral resistome
analysis can aid in the identification
of certain patient populations or
subgroups who are more likely to
harbor antibiotic-resistant oral
bacteria. This information can help
prioritize screening efforts and
execute preventative measures in
people who are at higher risk, such
as those with impaired immune
systems, chronic diseases, or a
history of antibiotic usage.
●
Personalized therapy:
Antibiotic therapy for dental disorders can be improved by having a
better understanding of the oral
resistome. Clinicians can choose
medicines that are more likely to
be successful against the most

Oral resistomes, a crucial part
of the oral human microbiome, include a reserve of ARGs that are
directly linked to the ever-growing
threat of global antimicrobial resistance (AMR).1
Given the fact that the oral resistome builds upon the oral microbiome, we must take a look into
the age-wise evolution of the oral
microbiome.
The age-old belief is that oral
microbial colonization occurs after
birth (the sterile womb concept).
However, current research has
confirmed that the human microbiome begins to develop before
birth. The oral bacterial diversity
continues to evolve through
time. 2,3 Diet, genes, the eruption of
teeth, habits, and environmental
factors bring about these alterations. Here is an age-wise mapping of the oral microbiome in
newborns, during the first year of
their lives.
●
Prenatal: Interestingly,
amniotic fluid from up to 70% of
pregnant women includes several
oral microorganisms, such as

Streptococcus,
Fusobacterium,
Neisseria, Prevotella, and Porphyromonas. Instead of the gut microbiome, the placental microbiome
is more similar to the pregnant
mother’s mouth microbiome. 3
Simply put, the maternal oral microbiome directly influences the
newborn oral microbiome.
●
0-6 months: Just after
birth, a newborn is exposed to a
broad variety of microorganisms,
via diverse contact routes. The
early colonizers include bacteria,
fungi, parasites, and viruses. The
majority of these are Gram-positive facultative, followed by
Gram-negative anaerobes. Among
the oral fungi, Candida remains
abundant from the first day, and
throughout the first year. 2
●
6 months to 1 year: The
oral
ecosystem
undergoes
changes when the first primary
tooth emerges- there is a decrease
in the presence of Gram-positive
facultative bacteria and an increase in Gram-negative facultative bacteria. One specific example
is Streptococcus mutans, which
rapidly colonizes the oral cavity
during this stage with the newly
erupted teeth as their preferred
surface for adhesion. With the
emergence of teeth, plaque microbiota also comes into existence
and forms a distinct oral community. By this time, Veillonella, Streptococcus, Actinomyces, Selenomonas, and Leptotrichia make up the
most abundant genera. 2
●
1 to 5 years: Pediatric
oral resistome is an inherent feature of the oral microbiome from
infancy, which develops throughout childhood. As the child grows,
crucial changes like the transition
from primary to mixed to permanent detentions, diet changes,
hormonal changes during adolescence, and changes in host immunity add up to create a more diverse oral microbiota. This diversity increases in the first few years
of life before it is stabilized at
around age five. 2

[2] =>

NEWS

Dental Tribune South Asia Edition | 08/2023

These milestones are the stepping stones for characterizing the
AMR potential of the human oral
microbiota.
Is oral resistome a mirror of
health and disease?
Accumulating evidenc e now
highlight that the oral resistome
has the potential to mirror the
state of health and disease. 3 Taking a step ahead, studies are acknowledging oral resistome as a
novel screening tool for dental
diseases.
Let’s look at some groundbreaking studies.
A first-of-its-kind study aimed
to determine whether the oral microbiota represents a source of
ARGs and how the resistome differs in healthy (H) individuals as
compared to caries active (C) individuals and chronic periodontitis
(P) patients. The shotgun metagenomics sequencing combined
with the culture technique was
used to generate comprehensive
data on the microbiome and resistome.
4

The team found 64 ARGs conveying resistance to 36 common
antibiotics, particularly to tetracy-

cline, macrolide - lincosamide streptogramin, and beta-lactam
antibiotics. Interestingly, based on
the microbiota composition, these
ARGs cluster in different resistotypes, and a higher prevalence is
found in healthy and caries active
than in periodontally diseased individuals. The ARGs with the highest prevalence in healthy and caries-active individuals were mefA,
msrD, cfxA, and ermF, and tetQ,
pgpB, and tet32 in periodontitis.
The species that most commonly
possessed ARGs were Streptococcus mitis, P. gingivalis (20.9%), P.intermedia (15.8%), L. wadei (11.3%),
and Gemella oral taxon 928 (6.2%).
The experts concluded that
“Interestingly, significantly fewer
ARGs were detected in P than in H
and C, which can be explained by
the lower diversity and differing
microbial composition in periodontitis. The oral microbiome is a
rich reservoir for multiple ARGs
which can be clustered into different resistotypes based on the specific differences in the microbiota
composition and also depending
on the respective condition of the
individuals, i.e. health, caries, or
periodontitis.”
Keeping in mind the potential
implications of this study, the re-

searchers quoted that given these
findings and the proof that antibiotics are frequently prescribed in
dentistry without an appropriate
indication, prudent antibiotic use
is highly advised, and additional
study is required to clarify any potential horizontal gene transfer
and spread of resistance through
oral bacteria.
Another recent study investigated if the resistome composition changes in a disease condition (caries). The team looked at
variations in overall resistome
abundance and diversity between
the caries-free (CF) and caries-active (CA) groups. Results showed
discrepancies at the ARG level. The
CF resistome has 83 ARGs compared to 57 ARGs in the CA resistome, with 15 common ARGs.
In all groups, the most abundant AMR gene class was macrolide resistance followed by beta-lactams. The severe category
(ICDAS Classification) had the
highest compositional change in
microbiome, resistome, and insertion sequences. Interestingly, the
team highlighted that BlaOXA-85,
associated with health, was significantly more abundant in resistomes of children who had restorations-suggesting that the place-

ment of a restoration favors a return to microbial homeostasis.1

Takeaway
Throughout human history,
antimicrobial resistance genes
have been identified in the oral microbiome and have been detected
in people of all ages, from neonates to adults. However, their potential effect on dental diseases
and how to treat them is, is gaining
traction only recently. Deciphering
these oral resistomes holds immense potential to transform the
way we screen, diagnose, and
manage dental diseases. Resistomes can be the stepping stone
towards personalized dental treatments, effective infection control
strategies, and a future where antibiotic resistance is tamed!

References

141.
https://doi.org/10.1111/
prd.12366
3.
Xiao, J., Fiscella, K.A. &
Gill, S.R. Oral microbiome: possible
harbinger er for children’s health.
Int J Oral Sci 12, 12 (2020). https://
d oi .o r g /10.1038/s 4136 8 - 020 0082-x
4.
Anderson AC, von Ohle
C, Frese C, Boutin S, Bridson C,
Schoilew K, Peikert SA, Hellwig E,
Pelz K, Wittmer A, Wolff D, Al-Ahmad A. The oral microbiota is a
reservoir for antimicrobial resistance: resistome and phenotypic
resistance characteristics of oral
biofilm in health, caries, and periodontitis. Ann Clin Microbiol Antimicrob. 2023 May 13;22(1):37. doi:
10.118 6/s129 41- 023- 0 0585 -z .
PMID:
37179329;
PMCID:
PMC10183135.

1.
Sukumar, S., Wang, F.,
Simpson, C.A. et al. Development
of the oral resistome during the
first decade of life. Nat Commun
14, 1291 (2023). https://doi.
org/10.1038/s41467-023-36781-w
2.
Kahharova, D., & Zaura,
E. (2021). Acquisition and establishment of the oral microbiota.
Periodontology 2000, 86(1), 123-

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NEWS

Dental Tribune South Asia Edition | 08/2023

“Dental schools should consider
incorporating haptic VR simulation devices”
By Iveta Ramonaite,
Dental Tribune International
As haptic technology slowly
makes its way into dentistry, dental students are increasingly using
haptic virtual reality (VR) simulation in their training. Combined
with traditional phantom head
practice, the technology may help
improve students’ tooth preparation and offers benefits such as increased manual dexterity. Dental
Tribune International spoke with
Dr Szabolcs Felszeghy, a senior researcher at the University of Eastern Finland who has conducted
several studies on haptics in dentistry, about dental students’ experience with using haptic VR simulation in preclinical training and
the benefits it offers compared
with phantom head simulation
and discussed how haptic technology may evolve in the future.
Dr Felszeghy, why should dental students use haptic VR simulation?
Learning tooth preparation
techniques and the finesse required is an important part of preclinical dental education. The traditional phantom head simulation
laboratory learning is really important to mimic clinical dental
procedures in preclinical dental
education. In our experience at the
Institute of Dentistry at the University of Eastern Finland’s School
of Medicine, combining haptic VR
with conventional tooth preparation exercises in dental education
allows us to improve dental students’ learning outcomes, improving their manual dexterity, increasing their efficiency and improving work performance.
What other benefits does haptics-enhanced VR offer to dental
students?
Haptic VR training is a great
method for achieving the required
level of skill for tooth preparation.
The benefits of haptic VR practice
especially include its relative informality, the ability to repeat the exercise as many times as necessary
and the possibility of training at a
time suitable for each student. In
addition, students may feel more
self-confident after practising in
the haptic VR environment using a
dental trainer. Another advantage
compared with traditional methods is consistency of scoring.
Haptics-enhanced VR has become increasingly popular in the
recent decade. However, fewer
than 150 dental institutions worldwide have had haptic VR equipment installed. How might this
slow adoption rate be explained?
Haptic feedback technology
has received increasing attention
in dental schools, and there are no
questions about the effectiveness

With its cutting-edge technology, haptic virtual reality simulation is slowly transforming dental education. (Image: Damir Khabirov/Shutterstock)
of haptic VR dental trainers in preclinical operative dentistry courses
as an adjunct to conventional
phantom head training. I believe
that the major reason for the slow
adoption rate is not based on the
benefits of a haptic VR dental
trainer, such as Simodont (Nissin
Dental Products), but rather on the
financial aspect. It costs over €1
million for complete installation of
15 haptic VR training units ready
for use.
The University of Eastern Finland was the first university in the
country to install VR dental trainers in 2021. Have more universities in Finland followed suit since
then?
Yes, three more haptic VR Simodont dental trainers were installed in the dental faculty of the
University of Turku this spring.
From your experience, what do
students value the most when
using VR to enhance their manual
skills?
In general, our undergraduate
dental students viewed our de
novo training module positively
and felt that they had learned new
skills and gained new clinical information in a relaxed scenario.

You have recently worked on a
study that examined dental practice that combined VR haptics and
frasaco plastic tooth model preparation exercises. What were the
most significant results?
The combination of haptic VR
technology provided by the Simodont dental trainer with frasaco
simulation can successfully meet
the learning and teaching needs
for tooth preparation.
What is the future of haptic
technology in dentistry?
The future of haptic technology looks bright, as it has the potential to revolutionise a wide
range of dental training. In the recent past, haptics helped make
things perceptible, for example
phone vibration and Rumble Paks
in gaming controllers. We now
have haptic VR dental trainers, and
the use of artificial intelligence (AI)
in dental training is just around the
corner. The combination of AI with
haptic VR devices would definitely
enhance training and engagement, and this could potentially
reduce the risk of surgical errors
and improve patient outcomes.

“The future of haptic
technology looks bright,
as it has the potential to
revolutionise a wide
range of dental training.”
However, further development and evidence-based
clinical validation of haptic
VR dental trainers are
needed to improve engagement and learning
outcomes for more dental students around the
world. I am convinced
that, as the technology
continues to advance, it is
likely that dental educators
will see even more innovative
and exciting dental applications of
haptic VR technology in the coming years.

Editorial note:
The study has been accepted
for publication in the International
Journal of Computerized Dentistry.

Dr Szabolcs Felszeghy, a senior
researcher at the University of
Eastern Finland working on
haptics in dentistry. (Image:
Szabolcs Felszeghy)

Can haptic training replace
using phantom head simulation,
or do you think that the two types
of training methods should complement each other?
Phantom head simulation
training for invasive dental procedures must be a core component
of the preclinical dental curriculum. However, besides the conventional training methods, dental
schools should consider incorporating haptic VR simulation devices to facilitate the transition of
preclinical students from the simulated dental learning environment to the clinical setting.
A haptic virtual reality Simodont dental trainer. (Image: Szabolcs Felszeghy)

[4] =>

NEWS

Dental Tribune South Asia Edition | 08/2022

3D printing is not the perfect
answer to periodontal regeneration,
but it is getting close

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3D-printing technology is rapidly catching up to provide treatment alternatives for nearly every issue facing periodontists today.
(Image: Kasama Kanpittaya/Shutterstock)

By Anisha Hall Hoppe,
Dental Tribune International
The prevalence of periodontitis is estimated to be around 19%
in the global adult population, according to the World Health Organization. The need for regenerative therapy for severe disease and
the potential benefits of 3D printing in this regard cannot be overemphasised. A recent review by
researchers at the Department of
Periodontology at KSR Institute of
Dental Science and Research in
Tiruchengode provides an excellent guide for clinicians on the
emerging role of 3D printing in the
field of periodontal regenerative
therapy.
Because the main objective of
periodontal therapy is to reconstruct or regenerate the lost periodontium, various regenerative
modalities have been explored
over the years, including bone
grafts, guided tissue membranes,
growth factors and stem cell technology. However, 3D printing has
recently gained prominence as a
novel approach that facilitates optimal cell interactions and promotes the regeneration of biological tissue in periodontal defects.
The review covers some of the
currently available 3D-printing
technologies, such as inkjet printing, extrusion printing, fused
deposition modelling, light-assisted printing and electrospinning. For periodontal regenera-

tion specifically, 3D printing includes indirect 3D printing and 3D
printing with live cells. Each
method offers unique advantages
for tissue engineering and scaffold
fabrication.
However, it is the 3D-printed
scaffolds that play a crucial role in
periodontal regeneration, as they
provide a framework for cell attachment, migration, proliferation
and differentiation. To achieve
successful periodontal regeneration, these scaffolds must meet
certain requirements to ensure
optimal cell interactions and tissue
growth. The ideal requirements
for 3D-printed scaffolds in periodontal regeneration include biocompatibility, porosity and mechanical strength.
As periodontal regeneration
has a myriad of related medical
goals, 3D printing has also evolved
to address them. These aims include socket preservation, treatment of fenestration and peri-osseous defects, sinus and ridge
augmentation, and peri-implant
regeneration.
Although
3Dprinted options are showing exceptional results, there are still
some areas where the technology
is lagging behind. In the case of
socket preservation, the researchers cited a study that found that a
custom scaffold 3D-printed from
the biodegradable polymer polycaprolactone provided sufficient
structure and integrity of the alveolar ridge, but caused soft-tissue

dehiscence with minimal bone repair.
Newer studies which used
3D-printed scaffolds made of hydroxyapatite and beta-tricalcium
phosphate have shown positive
results for treating bony defects.
Because the scaffold should promote the formation and integration of bone and periodontal tissue, it should ensure proper attachment of the regenerated
structures to the existing natural
tissue. The review cited several experimental studies that have
demonstrated promising results in
using 3D-printed scaffolds for tissue regeneration in these areas.
The authors noted that 3D
printing is far from perfected in
terms of periodontal regenerative
therapy, mainly owing to high
costs, biocompatibility concerns
and the need for suitable biomaterials. The authors also highlighted
the necessity for further human
clinical trials to establish robust
evidence and support the efficacy
of 3D printing in this domain.
Overall, this comprehensive
review sheds light on the immense
potential of 3D-printing technology in revolutionising the field of
periodontal regenerative therapy
and addresses the need for further
research to establish its efficacy
and practicality in clinical settings.
The study, titled “Quintessential commence of three-dimen-

sional printing in periodontal regeneration—a review”, was published online on 6 July 2023 in the
Saudi Dental Journal, ahead of inclusion in an issue.

Editorial note:
Tissue engineering is a way of
helping the body grow back its
lost or damaged tissues and organs. It’s like giving the body a little boost to fix itself. Scientists are
working on techniques to replace
or regenerate human cells, tissues,
or organs so they can work normally again.
In regenerative periodontal
therapy, there’s a challenge in
making structures that look like
the complex shape of periodontal
tissues. To help with this, scientists
use special materials, like ceramic
biomaterials and synthetic polymers.
One commonly used option is
a mix of polycaprolactone (PCL)
with other polymers or ceramics
like calcium phosphate and bioactive glasses. They use 3D printing
to create these structures and help
the periodontal tissues to grow
back.

Dental Tribune International GmbH
makes every effort to report clinical
information and manufacturers’ product news accurately but cannot assume responsibility for the validity of
product claims or for typographical
errors. The publisher also does not
assume responsibility for product
names, claims or statements made
by advertisers. Opinions expressed
by authors are their own and may
not reflect those of Dental Tribune
International GmbH

DENTAL TRIBUNE SOUTH ASIA
EDITION

PUBLISHER
Ruumi J. DARUWALLA
CHIEF EDITOR
Dr. Meera VERMA

CLINICAL EDITOR
Dr. Dilip DESHPANDE

RESEARCH EDITOR
Dr. Shobha DESHPANDE

ASSOCIATE EDITOR
Dr. GN ANANDAKRISHNA
EXECUTIVE EDITOR
Dr. Rajeev CHITGUPPI

ASSISTANT EXECUTIVE EDITOR
Dr. Riddhi D. TELISARA
DESIGNER
Anil LAHANE

PRINTER
Mehernosh MISTRY
Burzin MISTRY
Ampersand, Mumbai, India

[5] =>

NEWS

Dental Tribune South Asia Edition | 08/2023

Cambodian study indicates improving oral
health in children with HIV/Aids could help
lower viral load
viral load and BMI in children with
HIV/Aids. A decrease in caries and
plaque and an increase in salivary
pH were associated with increased
BMI. Increased salivary flow rate
was associated with improved
quality of life. These findings suggest that poor oral hygiene might
lead to health issues and stress the
importance of effective oral
healthcare interventions for children with HIV/Aids.
The study, titled, “Impact of
oral intervention on the oral and
overall health of children living
with HIV in Cambodia: A randomized controlled trial”, was published on 28 April 2023 in BMC
Medicine.

Improving oral health in children with HIV/Aids may have further-reaching positive effects on general health than previously realised.
(Image: Alexxndr/Shutterstock)

By Anisha Hall Hoppe,
Dental Tribune International

age, BMI for age and overall
health-related quality of life.

PHILADELPHIA, US: It was previPHNOM PENH, Cambodia: Antiretroviral therapy (ART) has increased the life expectancy of children with HIV/Aids, leading to a
focus on helping these children
have healthy lives, for which oral
health has been identified as key.
A research team in Cambodia and
Japan sought to evaluate to what
extent oral health interventions in
children with HIV/Aids and receiving ART would impact their health.
Their randomised controlled trial
determined that oral health education and support provides critical benefit, particularly in poorer
settings, and that when oral hygiene outcomes are improved,
other aspects of health improve.

The intervention improved the
oral healthcare behaviours of children with HIV/Aids, particularly
toothbrushing duration and frequency. However, there were no
significant differences in oral hygiene outcomes. The researchers
said that the study duration might
not have been sufficient to evaluate changes in oral hygiene, considering that previous research
suggests that interventions of less
than two years are unlikely to significantly improve oral hygiene.

The two-year intervention involved oral health education sessions and the provision of toothbrushes, toothpaste and dental
floss to support daily home-based
oral care. Through a structured
questionnaire, medical records
and oral examination, the researchers compared the effects
between children with HIV/Aids
who received the intervention and
those who did not and between
children with HIV/Aids who received the intervention and those
without HIV/Aids who did not.
The researchers assessed the
oral health effects according to
changes in caries scores, salivary
pH, salivary flow rate, debris index,
oral health-related quality of life
and oral care behaviours. They
tracked overall health outcomes
through HIV viral load, height for

The study revealed longitudinal associations of the intervention between changes in oral hygiene and overall health. Particularly, dental caries changes in permanent teeth correlated with viral
load detection, salivary flow rate
was associated with overall quality
of life, and changes in caries, salivary pH and debris index had negative interaction effects on BMI. At
the end of the study, 16.2% and
14.4% of the children with HIV/
Aids who received and did not receive the intervention, respectively, had a detectable viral load.
Additionally, HIV/Aids appeared to have a negative impact
on the oral health of children, as
children without HIV/Aids exhibited better oral hygiene than those
with HIV/Aids. This suggests that
HIV-positive children might require a more intensive oral healthcare approach than children without HIV/Aids. The study also found
that changes in oral hygiene outcomes due to the intervention
were associated with changes in

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NEWS

Dental Tribune South Asia Edition | 08/2023

EFP releases peer-reviewed guideline
on peri-implant disease prevention and
treatment
desired. From assessment to intervention, the guideline includes relevant data for a select number of
co-morbid conditions such as diabetes and for specific implant-related conditions. The guidance
covers surgical interventions as
well as the non-surgical management of peri-implantitis.

By Iveta Ramonaite,
Dental Tribune International
MADRID, Spain: The global
dental implant market was worth
US$4.6 billion (about ₹ 36,000
Crores) in 2022 and is expected to
grow annually by 10% until 2030,
according to market analysis. Considering that recent research indicates that the rates of peri-implantitis exceed 19%, clinicians have
valid reason to be concerned with
its prevention. The European Federation of Periodontology (EFP)
has therefore published the highest-quality level (S3) clinical practice guideline for the prevention
and treatment of peri-implant mucositis and peri-implantitis. The
guideline promotes an interdisciplinary approach and is targeted
at oral health clinicians, health systems decision makers, other medical professionals and the public.
According to the guideline, clinicians should be strategising prevention from the moment the decision to pursue implant treatment
has been made. Utilising a patient-centred and evidence-based
decision-making process, the new
guideline outlines specific inter-

Because the EFP specifically
commissioned the thirteen mentioned reviews, undertook additional information gathering, debate and consensus in various forums, the guideline is a very powerful resource for improved case
management and prevention of
peri-implant disease.

A large study in children has demonstrated a highly complex microbial interaction in dental plaque.
(Image: Evgeniy Kalinovskiy/Shutterstock)
ventions that can be undertaken
for both prevention and treatment
of peri-implant disease. The guideline also offers a handy evaluation
of the available scientific information for a number of popular implant processes and methods.
These evidence-based recommendations are provided with the
aim of helping clinicians maintain

the health of peri-implant tissue
and increase implant longevity.
By gathering and synthesising
relevant data from research globally and additionally evaluating
the strength of existing recommendations, the guideline disseminates a vast amount of knowledge
in an easy-to-digest form. In sec-

tions devoted to preoperative,
perioperative and postoperative
interventions as well as diagnostic
classifications, the guideline emphasises specific care pathways for
appropriate treatment.

The study titled, “Prevention
and treatment of peri-implant diseases—the EFP S3 level clinical
practice guideline”, was published
online on 4 June 2023 in the Journal of Clinical Periodontology,
ahead of inclusion in an issue.

It is even possible to break the
recommendations down into sections should group instruction be

Skipping evening toothbrushing may
heighten cardiovascular disease risk
By Dental Tribune International

tively affecting general health and
leading to cardiovascular events.
However, the authors recommended undertaking a multicentre study with a longer observation period to generalise the
study results and explore the
mechanism behind the observed
relationship between toothbrushing timing and cardiovascular disease risk.

SUITA, Japan: The World
Health Organization reports that
cardiovascular disease is the leading cause of death globally, and
there are proven links between
cardiovascular disease and periodontal disease. A recent study by
a team at Osaka University Hospital has investigated whether the
timing of toothbrushing affects
the risk of developing cardiovascular disease. It turns out that the
importance of brushing at night
expands beyond the benefits of
tooth retention.
For the study, researchers enrolled 1,583 patients aged 20 years
and older who were hospitalised
for surgery, other medical treatment or examination. They found
that participants who brushed
their teeth both in the morning
and at night and those who
brushed only at night had significantly higher survival estimates
for cardiovascular events compared with those who did not
brush their teeth at all. Addition-

A study in Japan has suggested a connection between cardiovascular events and not brushing one’s teeth in
the evening. (Image: Elizaveta Galitckaia/Shutterstock)
ally, smokers who did not brush
had a worse prognosis for cardiovascular onset events than did
smokers who brushed only in the
morning, only at night or both,
and non-smokers who did not
brush or who brushed only in the

morning also showed worse prognosis on hospitalisation.
The researchers concluded
that brushing teeth at night is important for reducing the risk of
cardiovascular disease. They sug-

gested that increased intra-oral
bacterial load during sleep owing
to reduced salivary flow may cause
periodontal disease or dental caries, impairing mastication and
spreading oral bacteria to the intestines and blood, thereby nega-

While the study’s findings are
limited to hospitalised patients
and cannot be generalised to
healthy populations, they highlight the significance of proper
toothbrushing habits for maintaining good oral and systemic
health. The study emphasises the
importance of increasing awareness about appropriate toothbrushing timing in the general
population to potentially prevent
cardiovascular disease.
The study, titled “Not brushing
teeth at night may increase the risk
of cardiovascular disease”, was
published on 28 June 2023 in Scientific Reports.

[7] =>

NEWS

Dental Tribune South Asia Edition | 08/2023

VR, AR, AI and the future of tobacco
cessation counselling

Virtual reality, augmented reality, artificial intelligence and mobile applications can improve the outcome of tobacco cessation counseling efforts.
(Photo: Canva)

By Drs. Rewant Chauhan &
Saumya Tiwari
Tobacco use continues to be a
global health concern, with devastating effects on individuals and
societies. Tobacco kills more than
8 million people each year. More
than 7 million of those deaths are
the result of direct tobacco use
while around 1.2 million are the result of non-smokers being exposed to second-hand smoke. In
India, the prevalence of tobacco
use is alarmingly high, leading to
millions of deaths annually. The future of tobacco cessation counseling holds great potential for addressing significant tobacco-related health issues, such as those
seen in India. While traditional
methods, such as the 5A’s framework and behavioral coping strategies, have shown success in helping individuals quit tobacco,
emerging technologies and approaches can further enhance the
effectiveness of counseling efforts. This article explores the potential role of Virtual reality, augmented reality, artificial intelligence and mobile applications in
enhancing tobacco cessation
counseling efforts.
The role of VR and AR in tobacco cessation counseling

VR and AR offer new possibilities for immersive and engaging
tobacco cessation counseling experiences. VR can create simulated
environments that showcase the
detrimental effects of smoking,
motivating individuals to quit. AR
and VR can also facilitate virtual
support groups, provide mindfulness and relaxation experiences,
gamify the quitting process, offer
personalized coaching, deliver real-time behavioral feedback, and
provide interactive educational resources. These technologies have
the potential to revolutionize tobacco cessation counseling by
providing innovative and impactful interventions.
1.
Virtual environments:
VR can create simulated environments that expose individuals to
the negative effects of smoking.
Users can experience firsthand the
damage caused by smoking, such
as lung diseases or other health
complications. This immersive experience can enhance motivation
and reinforce the desire to quit.
2.
Virtual support groups:
Users can connect with others who
are going through a similar journey, providing a sense of community and support. These virtual interactions can offer encouragement, share success stories, and
provide coping strategies to over-

come cravings and withdrawal
symptoms.
3.
Mindfulness and relaxation: Users can engage with
calming virtual environments,
guided meditation sessions, and
breathing exercises designed to
alleviate the anxiety and tension
associated with smoking cessation.
4.
Gamification of quitting: This works by incorporating
elements such as challenges, rewards, and progress tracking, individuals can feel a sense of accomplishment as they reach milestones and overcome hurdles on
their journey to quitting smoking.
5.
Personalized coaching:
Virtual coaches can offer tailored
advice, strategies, and motivational messages based on the user’s progress, triggers, and preferences. This personalized support
can be available at any time, empowering users to stay on track
with their quit plan.
6.
Real-time
behavioral
feedback: AR can overlay real-time information on the user’s
surroundings, helping them become more aware of their smoking-related behaviors. For example, it can provide visual cues when
they are about to reach for a cigarette or remind them of their com-

mitment to quit. This instant feedback can assist in breaking habitual patterns and promoting
self-awareness.
7.
Education and information: AR and VR can provide interactive educational experiences to
inform individuals about the dangers of smoking, the benefits of
quitting, and available cessation
resources. Virtual simulations can
demonstrate the impact of smoking on the body and highlight the
positive health outcomes associated with quitting.
The role of AI in tobacco cessation counseling
AI can play a significant role in
personalizing tobacco cessation
efforts. AI algorithms can analyze
individual smoking patterns, triggers, and behaviors to create customized quit plans. Chatbots and
virtual assistants powered by AI
can provide round-the-clock support, track, and monitor smoking
behavior, offer evidence-based information, and deliver personalized motivational messages. AI
can also utilize predictive analytics
to identify individuals at higher
risk of relapse and tailor interventions accordingly. It is important to
emphasize that AI should complement human interaction, ensuring
a comprehensive and personalized approach to counseling.

1.
Personalized quit plans:
AI algorithms can analyze individual smoking patterns, triggers,
and behaviors to create personalized quit plans. By incorporating
data from various sources, such as
self-reports, wearable devices,
and social media, AI can tailor cessation strategies to the unique
needs and preferences of everyone, increasing the chances of successfully quitting.
2.
Chatbots and virtual Assistants: AI-powered chatbots and
virtual assistants can provide 24/7
support to individuals seeking to
quit smoking. Chatbots can adapt
their responses based on user interactions and continuously improve their effectiveness through
machine learning algorithms.
3.
Behavioral tracking and
monitoring: AI can analyze data
from wearable devices, smartphone apps, or sensors to track an
individual’s smoking behavior in
real-time. This monitoring can
provide insights into triggers, patterns, and contexts associated
with smoking, enabling personalized interventions and timely support to manage cravings and prevent relapse.
4.
Natural language processing (NLP): NLP techniques can
analyze text data, such as social
media posts or online forums, to

[8] =>

NEWS

identify individuals expressing a
desire to quit smoking or seeking
support. AI-powered systems can
automatically detect and engage
with these individuals, offering resources, and counseling information, and connecting them with
appropriate cessation services.
5.
Predictive analytics: AI
algorithms can leverage predictive
analytics to identify individuals at
higher risk of relapse or those who
may benefit from additional support. By analyzing various factors,
including past quit attempts, emotional states, environmental cues,
and social interactions, AI can provide early warning signs and trigger targeted interventions to prevent relapse.
6.
Gamification and incentives: AI can incorporate gamification elements to make the quitting
process more engaging and rewarding.
Virtual
challenges,
achievements, and rewards systems can motivate individuals to
stay committed to their quit plans.
AI algorithms can track progress,
provide feedback, and offer personalized incentives to reinforce
positive behaviors.
7.
Data-driven
insights
and research: AI can analyze large
datasets to uncover patterns and
insights regarding smoking behavior, cessation methods, and
outcomes. This data-driven approach can contribute to evidence-based
decision-making,
identify effective intervention
strategies, and inform the development of future tobacco cessation programs.
The role of mobile applications
in tobacco cessation
Mobile applications have
gained popularity as effective
tools in tobacco cessation. There
are many apps available on the
play store like Quit Now, My quit
buddy, Smoke-free, etc, to assist
through the journey of tobacco
cessation. These apps provide
convenient, accessible, and personalized platforms for individuals
seeking to quit smoking. They
offer features such as quit tracking
and monitoring, personalized quit
plans, daily support and reminders, coping strategies and tools,
educational resources, social support and community engagement,
gamification elements, and progress tracking. By leveraging these
mobile apps, individuals can receive continuous support and motivation throughout their quit
journey.
1.
Quit tracking and monitoring: Mobile apps provide features to track and monitor smoking behavior, including the number of cigarettes smoked, cravings
experienced, triggers identified,
and money saved since quitting.
This tracking functionality helps
individuals gain insight into their
smoking patterns, progress, and

Dental Tribune South Asia Edition | 08 /2023

milestones, fostering self-awareness and motivation.
2.
Personalized quit plans:
Mobile apps can generate personalized quit plans based on the individual’s smoking history, goals,
and preferences. These plans provide step-by-step guidance, set
target quit dates, and offer tailored strategies for managing
cravings and withdrawal symptoms. The customization of the
plans enhances engagement and
adherence to the quitting process.
3.
Daily support and reminders: Mobile apps deliver daily
support and reminders to individuals attempting to quit smoking.
They send motivational messages,
tips for dealing with cravings, and
encouragement to stay committed to the quit plan. These reminders help individuals stay focused,
reinforce their motivation, and
provide a sense of accountability.
4.
Coping strategies and
tools: Mobile apps offer a range of
coping strategies and tools to assist individuals in dealing with
cravings, stress, and withdrawal
symptoms. These may include
breathing exercises, guided meditation, distraction techniques, and
interactive activities to divert attention from smoking urges. The
availability of coping tools promotes self-regulation and reduces
reliance on tobacco.
5.
Education and information: Mobile apps provide access
to comprehensive information
about the health effects of smoking, the benefits of quitting, and
various tobacco cessation methods. They offer evidence-based
content, interactive quizzes, and
videos to educate users and reinforce their motivation to quit.
Clear and accurate information
empowers individuals to make informed decisions about their
smoking habits.
6.
Social support and community: Mobile apps facilitate social support and connection with
others on a similar quit journey.
Users can join virtual communities, share experiences, provide
mutual support, and celebrate
milestones together. Peer support
and encouragement foster a sense
of belonging, reduce feelings of
isolation, and increase the likelihood of successful quitting.
7.
Gamification and incentives: Mobile apps often incorporate gamification elements to
make the quitting process more
engaging and enjoyable. They
offer challenges, achievements,
and virtual rewards that motivate
individuals to progress and stay
smoke-free. Gamification can enhance motivation, provide a sense
of accomplishment, and create a
positive quitting experience.
8.
Progress tracking and
motivational statistics: Mobile
apps provide visual representa-

tions of progress and achievements. They display statistics such
as the number of smoke-free days,
money saved, and health improvements. These visual reminders of
progress can boost motivation, reinforce the benefits of quitting,
and provide a sense of pride in the
journey.

Conclusion:
The future of tobacco cessation counseling is filled with opportunities for leveraging technology and innovative approaches.
Smoking prevalence has declined
by 27.2% (26.0% to 28.3%) for men
since 1990, and by 37.9% (35.3% to
40.1%) for women. VR, AR, AI, and
mobile applications can further
enhance counseling outcomes
and support individuals in their
journey to quit smoking. These advancements offer immersive experiences, personalized interventions, data-driven support, and
convenient access to resources.
However, it is crucial to remember
that human guidance and counseling remain vital in tobacco ces-

sation efforts. By combining these
technological advancements with
traditional counseling methods,
we can strive toward a tobacco-free future and improve public
health outcomes globally. Continued research, evaluation, and adaptation of these technologies will
be essential to ensure their longterm efficacy and impact in tobacco cessation counseling.

ness of dental treatments, which
could lead to better patient outcomes.
Dr. Saumya Tiwari, BDS from
Govt Dental College & Hospital,
Mumbai is a professional contentwriter with a strong interest in
business and marketing.

About:
Dr. Rewant Chauhan, BDS from
Govt Dental College & Hospital,
Mumbai, is well-versed in avariety
of computer platforms and advanced software packages that
can assist dental practitioners.
He has experience in digital
dentistry
workflows
and
CAD-CAM software, which he uses
to improve the accuracy and efficiency of dental treatments.
Dr. Rewant holds a patent
foran AI model in dentistry. This
innovation has the potential to enhance the precision and effective-

View details of the programme
on our website and register now.

world-dental-congress.org

WORLD
DENTAL
CONGRESS
SYDNEY 2023
SUN 24 - WED 27 SEPTEMBER
Register now for the premier dental event of 2023.
Enjoy a 4-day scientific programme with leading
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[cover] => Dental Tribune South Asia No. 8, 2023

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Table of contents

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