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Jet 'to replace dentist's drill' / New health initiatives for Dubai / Oral cancer: Early detection saves lives / News & Opinions / Industry News

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DTME01-02-10_ME 2/13/2010 10:53 PM Page 1

DENTAL TRIBUNE
The World’s Dental Newspaper · Middle East & Africa Edition
PUBLISHED IN DUBAI
2
Hours

FEBRUARY 2010

Media CME
Oral cancer: Early
detection saves lives

NO. 1+2 VOL. 8

Trends & Applications
Emergency dental
implant procedures

4Page

6

4Page

News & Opinions
FDI, FOLA and DTI
launch campaign for
Haitian dentists 4Page 10

8

Jet 'to replace dentist's drill' Baby death linked to
mum’s gum disease

A futuristic "plasma jet" that
eradicates tooth decay without
fillings could be replacing the
hated dentist's drill in as little
as three years, it was claimed.

The first-ever documented
link between foetal death and a
mother's pregnancy-related
gum disease has been reported.

The space-age device fires a
beam of electrically-charged
oxygen atoms into tooth cavities
to obliterate decay-causing bacteria. Traditionally, the same job
is done by drilling holes into the
tooth that has to be filled.
Unlike the dentist's drill, the
plasma jet is non-invasive and
 DT page 2

First Emirati professor joins Masdar
ABU DHABI // An academic
who has received numerous
awards for her scholastic
achievements has become the
first Emirati faculty member at
Masdar Institute of Science and
Technology.
Dr Amal al Ghaferi will be an
assistant professor at the institute, which is the research arm of

the US$22 billion (Dh80.8bn)
carbon-neutral Masdar City
project. She will teach materials
science and engineering and
carry out research in nanotechnology and energy.
“I believe my position at Masdar Institute will open doors to
pursuing my research in nanotechnology and related fields,”
said Dr al Ghaferi. “I am looking

forward to this challenging mission and hope to become a role
model for all UAE nationals.”
She graduated in physics
from UAE University, where her
grade-point average was 3.98 on
a 4.0 scale. She later earned a
PhD in materials science and en DT page 2

A 35-year-old woman delivered a full-term stillborn baby
who, during pregnancy, experienced severe gum bleeding, a
symptom of pregnancy-related
gingivitis.
Approximately 75% of pregnant women experience gum
bleeding due to the hormonal
changes during pregnancy.
These findings – by Yiping
Han, a researcher from Department of Periodontics at Case
Western Reserve University
School of Dental Medicine – are
discussed in an article in the February issue of Obstetrics & Gynecology.
The article explains that
bleeding in the gums allows bacteria in the mouth to enter the
bloodstream and potentially infect a foetus – but can be stopped
by the immune system.
However, in this case, the
mother also experienced an upper respiratory infection like a
cold and low-grade fever just a
few days before the stillbirth.

Lead author, Yiping Han, said:
‘There is an old wives' tale that
you lose a tooth for each baby,
and this is due to the underlying
changes during pregnancy..
‘But if there is another underlying condition in the background, then you may lose more
than a tooth.'
Even though the amniotic
fluid was not available for testing, Han suspects from work with
animal models that the bacteria
entered the immune-free amniotic fluid and eventually ingested
by the baby.
‘The timing is important here
because it fits the timeframe of
haematogenous (through the
blood) spreading we observed in
animals,' Han said.
Post-mortem microbial studies of the baby found the presence of F. nucleatum in the lungs
and stomach. The baby had died
from a septic infection and inflammation caused by bacteria.
After questioning the mother
about her health during the pregnancy, Han arranged for her to
visit a periodontist, who col DT page 2

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[2] => ME

DTME01-02-10_ME 2/13/2010 10:54 PM Page 2

DENTAL TRIBUNE Middle East & Africa Edition

News

Countries in Asia less than
average in health care spending
LEIPZIG, Germany: Asian countries have been found to spend
less of their GDP’s for health care
than most other countries in Europe and the US. According to
a new health care report
by the Organisation for Economic Co-operation and Devel-

opment (OECD) in Paris, only
New Zealand provided more
money for health care than the
average of all observed countries. Japan, Korea and Australia,
however, spent less than the
OECD average of 8.9 per cent of
GDP.
The US currently spends more
on health care than any other

Jet 'to replace dentist's drill'
DT Page 1

pain-free. Fear of fillings is a genuine phobia for some people,
causing them to avoid visits to the
dentist.
A new study has shown that
firing low-temperature plasma
beams at dentine - the fibrous
tooth structure below the enamel
- can reduce bacteria levels by up
to 10,000 times.
Researchers in Germany
tested the effectiveness of the
plasma jet against common dental bugs including Streptococcus
mutans and Lactobacillus casei.
Both form films on the surface
of teeth and are responsible for
the erosion of tooth enamel and
dentine that causes cavities.

The scientists infected dentine from extracted human molars with four strains of bacteria
and exposed it to plasma for between six and 18 seconds. The
longer the treatment continued,
the greater the amount of bacteria that was eliminated.
Lead researcher Dr Stefan
Rupf, from Saarland University
in Homburg, said: "The low temperature means they can kill the
microbes while preserving the
tooth. The dental pulp at the centre of the tooth, underneath the
dentine, is linked to the blood
supply and nerves and heat damage to it must be avoided at all
costs." DT

Baby death linked to mum’s
gum disease
DT Page 1

lected plaque samples from her
teeth.
Using DNA cloning technologies, Han found a match in the
bacterium in the mother's mouth
with the bacterium in the baby's
infected lungs and stomach.
'The testing strongly suggested the bacteria were delivered through the blood,' Han
said. With preventive periodontal treatment and oral health

care, the mother has since given
birth to a healthy baby.
Han says this points again to
the growing importance of good
oral health care. Collaborating
with Han on the case study were
Yann Fardini, Casey Chen, Karla
G. Iacampo, Victoria A. Peraino,
Jaime Shamonki and Raymond
W. Redline.
The study had support from
the National Institute of Dental
and Craniofacial Research in the
US DT

First Emirati professor joins
Masdar
DT Page 1

gineering from the University of
Pittsburgh.
Dr al Ghaferi has won two
Sheikh Rashid Awards for Academic Excellence for her undergraduate and postgraduate
work. The prize is typically conferred upon several hundred
Emiratis per year who have excelled in their studies.
She has also received a fellowship from the US State Department and earned one of six
British government research

grants from a Dh1.1 million fund
while she was employed at UAE
University.
Dr John Perkins, the institute’s provost, said Dr al Ghaferi
would make “a significant contribution” in both her research
and teaching.
“She is also an excellent role
model for young people interested in pursuing a career in science and technology,” he said.
There are now 22 faculty
members at the institute recruited from universities around
the world. DT

country—almost two and a half
times greater than the OECD
average of US$2,984, adjusted for
purchasing power parity. Luxembourg, France and Switzerland
also spend far more than the
OECD average. At the other end of

cluding the growing rates of child
and adult obesity, which are
likely to drive higher health
spending in the coming decades.
Based on new data on access
to care, the report demonstrates
that all OECD countries provide
universal or near-universal
coverage for a core set of health
services, except the US, Mexico
and Turkey. DT

Editorial Board
Dr. Talal Al-Harbi, Orthodontist, Qatar
Dr. Mohammed H. Al Jishi, Bahrain
Dr. Lara Bakaeen, Prosthodontist , Jordan
Dr. Aisha Sultan, Periodontist, UAE
Dr. Kamal Balaghi Mobin Aesthetics, Iran

Prof. Abdullah Al-Shammary, Restorative Dentistry, KSA
Prof. Hussain F. Al Huwaizi, Endodontics, Iraq
Prof. Samar Burgan, Oral Medicine, Jordan
Dr. Abdel Salam Al Askary, Implantology, Egypt

DENTAL TRIBUNE
The World’s Dental Newspaper · Middle East & Africa Edition

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Yasir Allawi
y.allawi@dental-tribune.ae

Director mCME:

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info@cappmea.com

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Khawla Najib
khawla@dental-tribune.ae

Production manager

Hussain Alvi
dentalme@dental-tribune.ae

Published by Education Zone
in licence of Dental Tribune International GmbH
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validity of product claims, or for typographical errors. The publishers also do
not assume responsibility for product names or claims, or statements made
by advertisers. Opinions expressed by authors are their own and may not reflect those of Dental Tribune International.

PO Box 214592, Dubai, UAE, Tel + 971 4 391 0257
Fax + 971 4 366 4512 www.dental-tribune.com
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[3] => ME

DTME01-02-10_ME 2/13/2010 10:55 PM Page 3

[4] => ME

DTME01-02-10_ME 2/13/2010 10:56 PM Page 4

[5] => ME

DTME01-02-10_ME 2/13/2010 10:58 PM Page 5

DENTAL TRIBUNE Middle East & Africa Edition

Local News

New health initiatives for Dubai
Representatives of Dubai
Healthcare City (DHCC) have
announced the launch of new
initiatives to address a number of
issues in the Middle East’s growing health-care sector. Speaking
at a press conference at Arab

fessionals further, the Dubai
Harvard Foundation for Medical
Research is offering a Science
Writers and Journalists Fellowship Program in 2009 for the second consecutive year and postdoctoral research fellowships to
train scientists and researchers.
The foundation is also offering
annual grants for two research

teams under the Collaborative
Research Center Programme.
Dr Ayesha added that one of
DHCC’s many achievements in
the last two years has been the region’s first health-care licensing
examination centre, established
to help develop and administer
comprehensive examinations

for health-care professionals.
Doctors in Dubai and other countries in the Middle East usually
choose to advance their specialist training credentials through
the postgraduate examinations
of the British Royal Colleges,
such as the Membership of the
Royal College of Physicians,
which is hosted in Dubai, or the

5

Membership of the Royal College
of Surgeons.
Postgraduate programmes in
dentistry are offered by the
DHCC’s Boston University Institute for Dental Research and Education. The only private postgraduate dental institute in the
Middle East received accreditation by the UAE government last
year. Its programmes include
endodontics, orthodontics, paediatrics, periodontology, and
prosthodontics. DT
AD

Health, an annual event for the
health-care industry in Dubai in
the UAE, senior vice-president
Dr Ayesha Abdullah said that the
DHCC’s programmes in 2009 will
include a CME session on diabetes by the Harvard Medical
School Dubai Center, as well as
a variety of mobile, simulationbased courses for various levels
of health-care professionals including dentists.
To support the training of regional and local health-care pro-

Fizzy Phone:
Mobile Runs On
Coca-Cola
Bulky mobile phone chargers
could soon be a thing of the past
with handsets running on soft
drinks instead
Daizi Zheng designed the
'greenphone', which is powered
by Coca-Cola, as part of her final
university project. The Central
Saint Martins graduate came up
with the concept for Finnish mobile phone manufacturer Nokia.
Ms Zheng said the prototype
could run up to four times longer
than a traditional lithium ion battery and has the potential to be
fully biodegradable.
The greenphone's bio battery
generates electricity using enzymes to catalyse sugar in the
drink. As the battery dies out,
only water and oxygen are left
behind.
Unfortunately, Nokia will not
be developing the greenphone
prototype further in the near future. Ms Zheng told Sky News:
"At the time they wanted something to bring out within the next
two years and thought my design
was too futuristic."
But she added that bio batteries are being developed by large
electronics companies and may
be on the market in the next five
years

[6] => ME

DTME01-02-10_ME 2/13/2010 10:58 PM Page 6

DENTAL TRIBUNE Middle East & Africa Edition

Media CME

Oral cancer:

Early detection saves lives

Hours

The article has been accredited by Health Authority - Abu Dhabi as having educational content and is acceptable for up to 2
(Category 1) credit hours. Credit may be claimed for one year from the date of subscription.
By Arlene Guagliano, RDH, MS

Cancer of the mouth or oral
cavity is one of the most preventable cancers in the United
States today. According to the
Journal of the National Cancer
Institute, more than 35,000
Americans will be diagnosed
with oral or pharyngeal cancer
this year.
It will cause more than
8,000 deaths, killing roughly
one person per hour, 24 hours
per day. Of those 35,000 newly
diagnosed individuals, only
half will be alive in five years.
This is a number that has not
significantly improved in
w
decades.1
Although the overall incidence of oral cancer has remained stable with numbers
only slightly increasing each
year2, currently this is the second year in a row in which
thereÊ has been
anÊ increase in
Ê
Ê
the rate of occurrence, about
11 percent over last year.
The death rate for oral cancer is higher than that of other
cancers that we hear about
routinely, such as cervical cancer, Hodgkin’s lymphoma, laryngeal cancer, cancer of the
testes and endocrine system
cancers such as thyroid
or skin cancer (malignant
melanoma).1
Oral squamous-cell carcinomas (OSCCs) are the eighth
most common cancer among
men and the 14th most common among women in the
United States.3
It includes many parts of the
mouth: the lips, the buccal mucosa of the lips and cheeks, the
gingiva and the area behind
the wisdom teeth, the floor of
the mouth, the hard palate, the
soft palate and the uvula, the
tonsils and the tongue.4
The ratio of men to women
diagnosed with oral cancer is
2:1 over a lifetime, although
the ratio comes closer to 1:1
with advancing age. Approximately 96 percent of oral cancer is diagnosed in persons
older than 40, and the average
age at the time of diagnosis is
63 years.
However, recent evidence
has emerged indicating that
oral cancers are occurring
more frequently in younger
persons, those under 40 years
old.2

Common symptoms of oral
cancer include:
•

A sore or lesion in the
mouth that does not heal
within two weeks.

Ê Ê
Ê

Ê
Ê

•

A lump or thickening in
Ê
Ê
the cheek.
• A white or red patch on the
gingiva, tongue, tonsil or
e
lining of the mouth.
• A sore throat or a feeling
that something is caught
n
in the throat.
d
• Difficulty chewing or
s
swallowing.
• Difficulty moving the jaw
or tongue
n
• Numbness of the tonguee
or other area of the mouth.
• Swelling of the jaw that
causes dentures to fit
poorly.1

diagnosis. Early detection is
the key.4
The best defense against
oral cancer is early discovery.
Early detection is complicated by the fact that many lesions in their earlier stages
may be completely asymptomatic. Historically, unaided
visual examination, palpation and radiographs were
the only methods available
for oral cancer screening. In
recent years, screening technologies have become available to supplement the visual
examination and help the clinician identify suspicious lesions that require further investigation.6

Fig. 1: The ViziLight Plus.

e
Oral cancer is caused bye
damage to the DNA of cells in
the mouth. There are two distinct
pathways
throughe
which most people come tof
have oral cancer. Many yearsr
ago, the most prevalent pathway was through the use ofs
Fig. 2: The VELscope.
tobacco and alcohol, but to-s
day the growing pathway is
through exposure to the huÊ
Ê
Ê Ê
man papilloma virus (HPV),
the same one that is responsiÊ
Ê
Ê
Ê
ble for the vast majority of cerÊ
Ê Ê
Ê
vical cancers in women.

Adjunctive screening aids
ViziLight Plus. Technology such as light-based detection systems increases a clinician’s ability to see tissue
changes that the naked eye

Ê
Ê

Whichever the pathway,
damage to the cells occurs and
they malfunction, mutating
into cancer cells. The anatomical malignancy sites associated with each pathway appear
to also be different from each
other.
In the broadest terms, they
can be differentiated into the
following areas: HPV-related
appear to occur on the tonsillar
area, the base of the tongue and
the oropharynx while non-HPV
positive tumors tend to involve
the anterior tongue, floor of the
mouth, the mucosa that covers
the inside of the cheeks and
alveolar ridges.
It is now confirmed that
HPV is the most common virus
Ê
Ê
Ê Ê
group in the world today, affecting
theÊ skin and
mucosal
Ê
Ê
Ê
Ê Ê
areas of the body. More than
100
Ê differentÊ types/versions
Ê
Ê
Ê ofÊ
have
DifÊ HPV
Ê
Ê Ê been Êidentified.
Ê
Ê
Ê
ferent
types
human
pa-Ê
Ê
Ê Ê of the
Ê
Ê
Ê
Ê pilloma
Ê
Ê virus
Ê are known
Ê Êto inÊ
fect different parts of the body.
Ê
Ê are
Ê Ê
Ê forms
Ê
Ê
Ê
Ê There
Ê
Ê Ê certain
Ê
Ê Ê ofÊ HPV
that are sexually transmitted
and are a serious problem.
Ê Ê
Ê
Ê Ê Ê
Ê
Ê
Today, in the younger age
group, including those who
have never used tobacco products, there are those who have
oral cancer, which is HPV-viral
based.
Ê
Ê Ê
Ê
Ê Ê
Two types of genital tract
HPV in particular, HPV 16 and
HPV 18, are known to be linked
to oral cancer and have been
conclusively implicated in the
increasing incidence of young,
non-smoking, oral cancer pa-

Ê
Ê

Ê
Fig. 3a: Normal
tongue in normal
light.

Fig. 3b:
Normal tongue
viewed
with the
VELscope.

tients. The HPV group is the
might miss. One such technolfastest
growing
Ê
Ê
Ê segment
Ê of the Ê ogy is ViziLite Plus, a simple
oral cancer population to
screening tool that helps visudate.1
alize suspect tissues in the oral
Oral cancer is among the
cavity (Fig. 1).
most debilitating and disfigurLesions that may have gone
ing disorders seen in today’s
unnoticed to the naked eye will
oral health environment. Tube more visible using Toluimors affecting a patient’s
dine blue (T-Blue) tissue dye
mouth, tongue and soft palate
and chemiluminescent light,
can prohibit proper swallowwhich marks and identifies
ing and speech.5
oral lesions.
In addition, the cancer can
spread to other parts of the
body, causing disability and
even death. The survival of patients and the quality of life after treatment depend on early
diagnosis. Eighty-one percent
of patients with oral cancer
survive at least one year after

The patient rinses with a dilute acetic acid solution, and
abnormal squamous epithelium tissue will appear acetowhite when viewed under
ViziLite’s diffuse low-energy
wavelength light.
Normal epithelium will absorb the light and appear dark.

ViziLite can assist a dentist or
hygienist in identifying an abnormality in the oral cavity that
may need further testing, such
as a biopsy.
It has been difficult to determine which tissues in the
mouth are cause for concern. It
is with continued research that
technology has forged forward
and developed adjuncts for the
oral health care professional
to
F
intervene when early signs are
unclear.
VELScope. The VELscope
integrates four key elements:
illumination, sophisticated filtering, natural tissue fluorophores and the power of human optical and neural physiology (Fig. 2).
Next to public awareness,
which is essential regarding
the risk factors in oral cancer,
the role of the dental professional is the first line of defense
in early detection of the disease.
The VELscope illuminates
Ê
tissue
with specific wavelengths that interact with and
provide metabolic and biochemical information about
the cells at and just beneath the
surface.
This gives clinicians the
ability to see early biochemical
changes before they present
more obviously, and therefore
to detect lesions earlier in the
disease process.7
Figue 3a is an image of a
normal tongue in normal light,
and Figure 3b is an image of a
normal tongue with the use of
the VELscope (images courtesy LED Dental).
Figure 4a shows a tongue
with an area that appears normal under white light. However, Figure 4b shows the area
as seen under the VELscope.
The dark area is VEL-scope
positive, which was confirmed
by biopsy as carcinoma in situ
(images courtesy of LED Dental).

In-office tissue test
OralCDx BrushTest. An essential tool for early detection
of oral cancer is the OralCDx
BrushTest, or oral brush biopsy
(Fig. 5). This is the only painless test for oral dysplasia (precancer) and cancer.
The BrushTest was found to
be at least as sensitive as a
scalpel in ruling out dysplasia
and cancer in every study in
which the same tissue was simultaneously tested by both
OralCDx
and
a
scalpel
biopsy.8,9

[7] => ME

DTME01-02-10_ME 2/13/2010 10:58 PM Page 7

DENTAL TRIBUNE Middle East & Africa Edition

Media CME

such as dysplasia or full malignancy.
Ê Ê

A pathologist examines the
cells to determine the final diagnosis. A lab report is then
sent to the dentist, and experts
from the pathology department provide patient-specific
follow-up guidance by telephone for every abnormal
Ê
Ê
OralCDx
report.
Fig. 4a: Close-up of
the tongue in
normal light.

The American Dental Association states that 60 percent of
the U.S. population sees a denÊ
Ê Ê
Ê
tist every
year.
One only has to look at the
impact of the annual PAP smear
for cervical cancer, the mamÊmogram
Ê
Ê
Ê
Ê
to check
for Êbreast
cancer, or PSA and digital rectal exam for prostate cancer to
see how effectively an aware
and involved public can contribute to early detection, when
coupled with a motivated medical community.
Ê

Ê Ê
Ê
Ê
Ê
The Ê dental
Ê

Ê
Ê

Ê Ê

Firm pressure with a circular brush is applied to the suspicious area. The brush is then
rotated five to 10 times, causing some pinpoint bleeding or
light abrasion. The cellular

Ê
Ê
Ê upÊ by the
material
picked
brush is transferred to a glass
Ê
Ê
slide,Ê preservedÊ and dried.
Ê

The
isÊ thenÊ mailed
Ê slide
Ê
Ê toÊ a
laboratory along with written
documentation about the patient and a detailed description
of the questionable area of the
mouth. At the laboratory, the
sample will be examined for
cells that show signs of change,

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and requires no topical or local
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Fig. 5:
The OralCDx
BrushTest.

ticle. After the payment, participants will receive their membership number and will be able to
attend to the program.
How to earn CME credits?
Once the reader attends the distance-learning program, he/she
can earn credits in three easy
steps:
1.
Read the articles.
2.
Take the exercises
3.
Fill in the Questionnaire and Submit the answers by
Fax (+971 4 36868883) or
Email :info@cappmea.com
After submission of the answers, (name and membership
number must be included for
processing) they will receive the
Certificate with unique ID Number within 48 to 72hours.
Articles and Questionnaires
will be available in the website
after the publication.
www.cappmea.com

References

1
2

community
Ê Ê
Ê
needs to incorporate adjuncÊ
Ê to theÊ screenÊ
tive technology
ing process and assume the
same leadership role as the

A final word

Fig. 4b:
Tongue
close-up
with the
VELscope
showing
in situ
carcinoma
that was
confirmed
by biopsy.

medical community if oral cancer is to be brought down in the
future from its undeserved
high ranking as a killer.1 DT

The Oral Cancer Foundation
2007; www.oralcancerfounda
tion.org.
Inside Dentistry—The Forgotten
Disease “Oral Cancer: Early Detection and Prevention” Nelson
L. Rhodus, DMD, MPH; January
2007; Vol 3, No 1.
Chaturvedi, Anil K., Engels, Eric
A., Anderson, William F., Gillison, Maura L.; Incidence Trends
for Human Papillomavirus — Related and Unrelated Oral Squamous Cell Carcinomas in the
United States; Journal of Clinical
Oncology; February 1, 2008; Vol.
26, No. 4.
University of Texas Cancer Center; Oral Cancer M.D. Anderson
Cancer Center; www.mdander
son.org/diseases/oralcancer.
Baker, Gerry I.: Radiation Therapy to Head and Neck, Dental Hygiene News, Fall 1991, Vol. 4 No.
4, p 1, 2.
Oral Cancer Risk and Detection:
The Importance of Screening
Technology; Lynch, Denis P. DDS
Ph.D;
www.ineedce.com/
pathology.html.
John C. Kois, DMD, MSD, and Edmond Truelove, DDS, MSD; DeÊ
Ê
Ê Techtecting
Oral Cancer:
A New
nique and Case Reports, Dentistry Today, 2006, Oct; 25(10):94,
96–7.

“Oral cytology revisited”; R.
Mehrotra, M. Hullmann, R.
Smeets, T. E. Reichert, O.
Driemel; Journal of Oral Pathology & Medicine Volume 38, Issue
2, Date: February 2009, Pages:
161–166.
“Improving Detection of Precancerous and Cancerous Oral Lesions: Computer-Assisted Analysis of the Oral Brush Biopsy”;
James J. Sciubba, D.M.D., PH.D.;
and for the U.S. Collaborative
OralCDx Study Group (JAMA)
Journal of the American Dental
Association 1999;130:1445–1457.

About the author
Arlene Guagliano, RDH, MS, is
an associate professor at Farmingdale State College in the department of dental hygiene and
an assistant professor at Hostos
Community College in the dental hygiene unit. Her professional experience includes 29
years in clinical practice specializing in geriatric dental care,
oral cancer screening for early
detection, dental hygiene education, caries management and periodontics. She can be reached at
arlene.guagliano@farmingdale.
edu, or via phone at (516)
6800231.

[8] => ME

DTME01-02-10_ME 2/13/2010 10:58 PM Page 8

Trends & Applications

DENTAL TRIBUNE Middle East & Africa Edition

Emergency dental implant procedures
Drs. Nicholas Caplanis and Jaime
Lozada

Patients often present to the office with unscheduled emergency conditions that require
immediate tooth removal.

therapy was performed, specifically, endodontic treatment, post
and core buildup and a toothsupported crown.2 Immediate implant placement following an
emergency extraction should
therefore be an integral part of
emergency treatment.

These situations have become increasingly complex to
deal with given the myriad available treatment options, which
impact the treatment approach
and methodology of both tooth
extraction as well as provisionalization.1

A oneyear prospective study
reported a 100 percent implant
success rate and also suggested
improved esthetic outcomes are
achieved following this approach when compared to extraction alone without implant
placement.5 The ability to
quickly and effectively treat
Unrestorable crown and root
these emergency scenarios imfractures are often ideal clinical
proves patient satisfaction, facilscenarios for immediate implant
itates patient management and is
placement given the frequent
a tremendous clinical service.
lack of overt infection and alveoTherefore, the dental office
lar bone damage, which is often
and team should be welleassociated with other emergency
quipped, or referral guidelines
conditions such as endodontic
be effectively
established, to
allow for efficient and predictable dental
implant
placement
during these
types of emergency
appointments.
The following
two clinical
case reports
describe
a
simple
and
efFig. 1a: Emergency presentation of unrestorable crown
fective process
and root fracture of tooth #8.
to treat hopelessly
fractured teeth using dental implants
and periodontal abscesses. Failand either a bonded restoration
ure to perform immediate imas a provisional or a provisional
plant placement or site preservaplaced immediately on the imtion during the emergency visit
plant.
often leads to a loss of alveolar
bone, which greatly impacts dental implant treatment success.
Patient 1
When comparing the excellent
longterm success rates of imA 65yearold Asian female
plants with the guarded
presents for a new patient emerlongterm prognosis of a badly
gency exam, with an oblique
fractured tooth requiring encrown and root fracture affecting
dodontic treatment, crown
her maxillary right central incilengthening surgery, and a post
sor. The fracture occurred sponand core buildup, extraction and
taneously while eating, involved
site preservation or immediate
the entire facial surface of the
implant placement is frequently
tooth and extended
the ideal treatment approach.
to
the
alveolar
crest
A clinical study of 534 frac(Figs.1a,1b). The clinical crown
tured teeth reported a 20 percent
exhibited severe mobility and
failure rate when conventional

Fig.1b:Radiographofobliquecrownandrootfracturetooth#8.

Fig.1e:Radiographofimmediateimplantinplacewithbondedprovisional.

was painful upon
palpation and percussion.
The prognosis
was poor and extraction was advised.
Treatment options to replace the
tooth were discussed and included a fixed partial denture as well Fig.1c:Intactclinicalcrowntobeusedas- Fig.1d:Fracturedcrownbondedtoadjacentdentitionservingasprimaryprovisional.
as an implant sup- bondedprovisional.
ported
crown.
Given the excellent
condition of the adjacent teeth as
central incisor was
well as the patient’s prior history
partially fractured at
of having successful dental immid root and exhibplantsupported restorations, she
ited grade III mobility
elected to have an implant
(Fig. 2a). The left latplaced.
eral incisor was tenThe crown portion of the
der to percussion and
tooth was easily removed and,
exhibited grade 1
given its excellent condition, was
mobility,
but
it
retained to be used as a bonded
recorded a negative
provisional (Fig. 1c). The tooth
response with ethyl
root was extracted atraumatichloride and elecFig.2a:Traumatothemaxillaryleftcentralincisorcally without flap elevation and
tronic pulp testing.
withhorizontalrootfracture.
the socket debrided, irrigated
The patient was
and evaluated with a periodontal
then scheduled to unprobe. The extraction defect had
dergo an emergency
minor horizontal bone loss assoprocedure at the
ciated with a reduced periodonclinic consisting of
tium secondary to a prior history
atraumatic extracof periodontitis, but the adjacent
tion of the affected
socket walls including the buccal
tooth and immediate
crest were otherwise intact.
implant placement
Therefore the defect appeared
with immediate proamenable for immediate implant
visionalization. The
placement. A 4.3 x 16 mm Refractured tooth was
place® Select implant (Nobel
extracted and the reBiocare™) was placed and utimaining root fraclized the entire length of the alveture was removed
olus and engaged the nasal floor,
utilizing a periotome Fig.2b:Periotomeandforceptextractionoffracturedroot.
in order to achieve effective priinstrument (Fig. 2b).
mary stability (Fig. 1e). After imThe alveolus was
plant placement, the residual
curetted and no bone
socket defect was grafted with a
fenestration
was
composite anorganic bovine
noted. A Nobel Active
bone matrix (BioOss® Osteodental implant was
health®) and a demineralized
used to replace the
cortical bone allograft (Oraextracted tooth (Fig.
Graft® LifeNet®). Composite
2c). The osteotomy
was bonded to the fractured surwas
performed
face of the clinical crown in order
palatal to the alveoto develop an ovate surface to
lus in order to obtain
maintain soft tissue esthetics.
maximum stabilizaThe modified clinical crown was
tion for the implant.
then bonded to the adjacent teeth
The implant was
and served as a primary proviseated at 35 nc stabil- Fig.2c:Immediateimplantisplacedachievingexcelsional restoration (Fig. 1d). The
ity, which made the lentprimarystability.
patient was then referred back to
clinical situation viher restorative dentist the next
able for immediate
day to fabricate an immediate
provisionalization. A
provisional supported by the
prefabricated abutimplant. The emergency apment was placed and
pointment including the exhand torqued to protraction, placement of the imvide the support for
plant, grafting of the residual
the acrylic resin
socket defect and bonding of
restoration. The prothe primary provisional
visional crown was
restoration took approxithen relieved from all
mately one hour of clinical
occlusal
contacts
time.
(Fig. 2d). Intraoperative radiographs rePatient 2
vealed adequate po- Fig.2d:Animmediateacrylicrestorationisusedasaprovisional.
sition of the implant
A 35yearold female prein relation to the adjasented at the emergency
tion or bonding of the fractured
cent dentition and bone implant
clinic of Loma Linda Univercrown can be used as a provilevel.
sity School of Dentistry and
sional restoration.
The emergency dental imwas immediately referred to
plant procedure should be conthe Center for Implant DenReferences
sidered a viable and often prefertistry. She complained of
1 Iasella JM et.al. Ridge preservaable treatment approach to treat
trauma to her maxillary antetion with freezedried bone alloemergency situations that ultirior dentition after an alleged
graft and a collagen membrane
mately lead to tooth loss such as
assault, a “blow to the face,”
compared to extraction alone for
implant site development: A clinroot fractures. When appropritwo days previously. Upon exical and histologic study in huate, immediate provisionalizaamination, the maxillary left

[9] => ME

DTME01-02-10_ME 2/13/2010 10:58 PM Page 9

DENTAL TRIBUNE Middle East & Africa Edition

About the authors

Low fluoride toothpaste
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Dr. Nick Caplanis
Dr. Nick Caplanis is an assistant
professor and part-time faculty
member within the graduate program in implant dentistry at Loma
Linda University School of Dentistry. Caplanis has a unique background with formal residency
training in the inter-related fields
of implant surgery, prosthodontics
and periodontics. He is board certified and a diplomate of both the
American Board of Periodontology
and the American Board of Oral
Implantology and is a fellow of the
American Academy of Implant
Dentistry. He was also the general
meeting chairman for the 57th annual meeting of the AAID, which
was held in San Diego from Oct.
29–Nov. 1. Caplanis maintains a
full-time private practice limited to
periodontics and dental implant
surgery, in Mission Viejo, Calif.

3399 E

mans. J. Periodontol 2003 74(7):
990—9.
Cvek M, Tsilingaridis G, Andreasen JO. Survival of 534 incisors after intraalveolar root fracture in patients aged 7—17 years.
Dent Traumatol. 2008 Aug;
24(4):379—87.
Caplanis N, Kan J, Lozada JL. Extraction defect assessment, classification and management.
Journal of the California Dental
Association. 2005; 33(11): 853—
863.
Wöhrle PS. Singletooth replacement in the aesthetic zone with
immediate provisionalization:
fourteen consecutive case reports. Pract Periodont Aesthet
Dent.
1998
Nov—Dec.;
10(9):1107—14.
Kan JY, Rungcharassaeng K,
Lozada J. Immediate placement
and provisionalization of maxillary anterior single implants:
1year prospective study. Int J
Oral Maxillofac Implants. 2003
JanFeb; 18(1):31—9.

Trends & Applications

Dr. Jaime Lozada
Dr. Jaime Lozada is the director of
the graduate program in implant
dentistry and a professor at Loma
Linda University School of Dentistry. Lozada has been involved
with implant dentistry for more
than 20 years. He completed his
residency in implant dentistry in
1987 and his graduate prosthodontics certificate in 1997. Lozada has
trained hundreds of residents and
fellows in the latest techniques in
oral implant surgery and prosthodontics. Lozada is a fellow and past
president of the American Academy of Implant Dentistry and a
diplomate of the American Board
of Implant Dentistry. He is wellpublished and lectures nationally
and internationally on implant
dentistry and maintains a faculty
practice limited to implant dentistry and prosthodontics at the
Loma Linda University School of
Dentistry.

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[10] => ME

DTME01-02-10_ME 2/13/2010 10:59 PM Page 10

DENTAL TRIBUNE Middle East & Africa Edition

10 News & Opinions

FDI, FOLA and DTI launch
campaign for Haitian dentists
Javier M. de Bison
DT Latin America

PANAMA CITY, Panama: The
president of the Haitian Dental
Association
Dr.
Samuel
Prophet has told Dental Tribune Latin America that he and

several colleagues he was able
to contact in Port-au-Prince
were fine after the devastating
earthquake in his country. "So
far, we only have reports of two
missing dentists", Prophet
wrote in an email.

The recent earthquake not
only devastated Haiti’s meager
health resources, but also most
dental practices. In a country
were there were only 500 dentists
for nine million people before
AD

FOLA president Adolfo Rodríguez,
center, asking for help for Haiti at a
meeting in Panama. In the image, he's
surrounded by the president, right,
and vicepresident of the Panama Dental Association.

January 12th, the extent of the
devastation has affected regular
people and dental professionals
alike.

New Ga
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Organizer

The president of the Latin
American Dental Federation
(FOLA), Dr. Adolfo Rodríguez,
launched a campaign immediately after the quake to help both
the general population and dental professionals in Haiti. Dr. Rodríguez, who's also the president
of the Dominican Dental Association (AOP), is asking companies
and dental professionals to donate dental instruments, materials, and equipment. He's organising the campaign for Haiti with
the help of FDI World Dental Federation, and Dental Tribune International.
In addition, Dr. Rodríguez is
putting together teams of dental
volunteers to travel to Haiti once
the major health and humanitarian crisis are under control or at
least manageable, to attend to the
dental needs of the population.
The hub for this effort would be
the headquarters of AOP in Santo
Domingo.
"We also need to show our
support for our colleagues in
Haiti, most of whom have lost
everything," Rodriguez said. "We
need to get them back on their
feet by helping them to rebuild
their practices."
Lost Practices
Dr Prophet said in his email
that "many of our colleagues
have lost their practices and we
were thinking about how to help
them. It's very good news to know
that FOLA, FDI and Dental Tribune are trying to help Haitian
dentists." If dentists know "that
help is on the way they can have
hope!" Dental Tribune will publicize in its worldwide print and
online editions the campaign for
Haiti.
At a meeting in Panama, Dr
Rodríguez of FOLA received the
support of the presidents of Central American dental associations, and made an emotional appeal to dental manufacturers to
donate much needed supplies.
He said Colgate has already
agreed to donate brushes and
toothpaste, and that he intended
to meet with KaVo do Brasil in the
DT page 11

[11] => ME

DTME01-02-10_ME 2/13/2010 10:59 PM Page 11

DENTAL TRIBUNE Middle East & Africa Edition

News & Opinions 11

Survey finds hygienist among best jobs in 2010
By Daniel Zimmermann
Group Editor DTI

Dental hygienists are in position No. 10 among the top 10
jobs in 2010, a new survey has
found. According to CareerCast.com, a job search site
based in Carlsbad, Calif., hiring
outlooks for dental assistants

were even better than those for
other jobs in the top 10 list, including accountants or computer analysts. Dental technicians ranked 72 in the survey,
while orthodontists ranked 94.
The report analyzed 200 jobs
in North America based on a set of
criteria, such as work environ-

ment, income, outlook, stress
and physical demands. According to Tony Lee, publisher of the
CareerCast.com 2010 Jobs Rated
Report, the jobs that ranked near
the top not only pay well, but also
have the greatest potential for
growth as the economy rebounds. “Conversely, [the job of]
roustabout is a difficult and dan-

gerous job working on an oil rig
with a salary of about $31,000 per
year, high unemployment and a
negative outlook for growth,
which is why it’s ranked as the
nation’s worst job,” explained
Lee.
He added that some whitecollar jobs didn’t make the top of

the list once other aspects of the
position were factored in. “Surgeon, which is the highest-paying job, ranked toward the bottom of the list when you evaluate
the profession’s stress levels,
physical demands and work environment,” he said. To view the
entire top 10 list, please visit,
www.CareerCast.com. HT DT
AD

DT Page 10

upcoming CIOPS meeting in Sao
Paulo to ask for donations of new
and used dental units.
Dr. Rodríguez added that it
was moving to witness dental
professionals from countries
with little resources such as Honduras, Nicaragua or El Salvador,
say that they will collect funds
from their members, second
hand equipment and dental supplies to help their Haitian colleagues.
Some prominent Latin American dental professionals from
Brazil, Uruguay and Costa Rica
among others have already expressed their interest in participating in dental teams to help the
most urgent needs of the Haitian
population. Conditions on the
ground seem to indicate that
these teams would operate in
mobile units at the DominicanHaiti border, once the most
pressing health emergencies
and needs are somewhat controlled.
The reason for this is that
most of Port-au-Prince is in ruins,
and the Dominican government
has moved the majority of its mobile health resources to the border in an effort to treat Haitians,
and avoid a migratory exodus.

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The president of FOLA said
that this tragedy "is also an opportunity to build a public health
service that includes dental care.
We have asked the Pan American
Health Organization (PAHO),
FDI, all Latin American dental
associations, companies and
other institutions for help in putting together teams of dental professionals to travel to Haiti and
start working there, and leave in
place basic dental treatment centers."
Dr. Rodríguez said that this
will be a long-term programme
that includes rebuilding the dental school at the university, as
well as private practices. It also
will take some time to start, and
he said that the priorities would
be treating children and pregnant women.
The Latin American dental
leader said he has also asked for
funding from the government of
Dominican Republic. Companies and dentists interested in
helping Haiti should contact Dr.
Rodriguez at arn@codetel.net.do
or by phone at +809 519-0789. DT

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[12] => ME

DTME01-02-10_ME 2/13/2010 10:59 PM Page 12

12 Industry News

DENTAL TRIBUNE Middle East & Africa Edition

Don’t tax health benefits, dental groups say
By Fred Michmershuizen,

Online Editor
As lawmakers in Washington
hash out the details of proposed reform to the nation’s health care
system, a number of dental associations — including the American
Dental Association (ADA), the
Academy of General Dentistry
(AGD) and others — are crying foul
over a key sticking point: a pro-

posed tax on employer-sponsored
health coverage.
The provision, as written, is
“the opposite of health care reform,” said ADA President Ron
Tankersley, DDS. “It would compel many employers to drop critical dental and other coverage to
avoid the tax. It dismantles exactly
the type of preventive, primary

care that everyone agrees this
country needs more of.”
Democrats from the House and
Senate have been in discussions to
resolve numerous differences in
the health care reform bills passed
by the two chambers to expand
coverage to millions of Americans
who lack any coverage and to rein
in the costs of health care.

Under the Senate’s version of
the bill, the federal government
would impose a 40 percent tax on
the value of employer-sponsored
health coverage that exceeds
$8,500 a year for individuals and
$23,000 for families.
The Senate bill would make
certain allowances for plans covering retirees 55 and older and
AD

workers in high-risk occupations.
The Congres
the tax would raise $149 billion
over 10 years. The House version
of the bill would not tax health
benefits.
President Barack Obama, who
has indicated that he is in favor of
the tax, is pushing for Congress to
reconcile the bills so he can sign
the legislation into law before his
State of the Union address on Jan.
27.
But the proposed tax has unleashed a fury of opposition. Many
argue that to avoid the tax, many
employers would simply drop supplemental dental and vision coverage for their employees.
In addition to the ADA and
AGD, a number of other dental associations are also opposed to the
tax. They include the American
College of Prosthodontists, the
American Academy of Pediatric
Dentistry, the American Association of Oral and Maxillofacial Surgeons, the American Association
of Orthodontists and the Hispanic
Dental Association.
All of these associations sent a
joint letter to Congress asking
leaders of the House and Senate to
eliminate or substantially modify
the excise tax on health benefits,
including flexible spending
accounts (FSAs), to ensure the
final health care reform legislation
does not adversely impact key and
important goals of health reform,
like primary and prevention-oriented care.
“Many employer-sponsored
plans exceed or will exceed the
PPACA excise tax threshold simply
because the plans include many
older workers or retirees with
higher cost health care needs, or
are concentrated in locations with
high health costs,” the letter states.
“For example, the standard option BCBS Federal Employees
Health Benefit plan, a basic plan
that covers 3.8 million Americans
today, will exceed the PPACA
excise threshold in the first year of
the tax (2013) for single coverage
and in the third year of the tax
(2016) for family coverage.”
The letter continues, “As a result, the excise tax could lead
many employers to reduce
benefits by eliminating limited
service supplemental benefits and
FSAs that fund much-needed and
prevention-ori-ented dental and
vision care in order to avoid the
tax.
“Cuts in these crucial benefits
will lead to a decline in access to
necessary care. Patients rely on
the preventive services covered by
the dental, vision and limited service supplemental plans to prevent
infections, slow the progress of
chronic disease and facilitate early
treatment of preventable conditions.”
The coalition is proposing alternatives to the tax, including the
following:
• Excluding FSAs as well as
managed and limited service
dental, vision and stand-alone
plans, from the calculation of
health plan costs.
 DT page 13

[13] => ME

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DENTAL TRIBUNE Middle East & Africa Edition

Industry News 13

Mobile phones may halt, reverse Alzheimer's: study
WASHINGTON - Long suspected
of causing brain tumors, mobile
phones are now being eyed as key
allies in the fight against
Alzheimer's disease, US researchers said in a study.
Researchers at the University of
South Florida (USF) found, to their
surprise, that 96 mice they zapped
twice daily for an hour each time
with electromagnetic waves similar to those generated by US mobile
(cellular) phones benefited from
the exposure.
Older mice saw deposits of betaamyloid -- a protein fragment that
accumulates in the brain of
Alzheimer's sufferers to form the
disease's signature plaques -wiped out and their memories improved after long-term exposure to
mobile phones, the study published in the Journal of Alzheimer's
Disease showed.
Young adult mice with no apparent
signs of memory impairment were
protected against Alzheimer's disease after several months' exposure to the phone waves, and the
memories of normal mice with no
genetic
predisposition
for
Alzheimer's disease were boosted
after exposure to the electromagnetic waves.
No one was more surprised by the
results than the researchers themselves, who had embarked on the
tests several years ago, convinced
they would show "that the electromagnetic fields from a cell phone
would
be
deleterious
to
Alzheimer's mice," lead author
Gary Arendash, a USF professor,
told AFP.

DT Page 12

•

Raising the threshold and indexing the threshold to
medical inflation.
• Replacing the single family
coverage thresholds with a
per-covered-person threshold, a fairer approach to plan
cost allocation.
Many House Democrats are
opposed to any health care
benefits tax, and at least 190 representatives signed a letter opposing
such a tax.
“The view of many progressives is that the tax is unacceptable,” Rep. Jerrold Nadler, Democrat of New York, told The New
York Times. “It would affect a lot of
middle-income people.”
“The health care reform debate has never centered on dental,
vision and other supplemental
benefits,” said James A. Klein,
president of the American Benefits
Council.
“Those valuable benefits have
only been included in the calculation of the excise tax to raise
revenue. Several modifications
are needed to improve the excise
tax provision, including not applying the tax to these important
supplemental benefits.”
“For millions of patients and
consumers, most of whom are
middle-and low-income working
Americans, the excise tax is unfair
and punitive, leading to reduced
health care services,” said Louise
Novotny, research director at
Communications Workers of
America. DT

"When we got our initial results
showing a beneficial effect, I
thought, 'Give it a few more months
and it will get bad for them.'
"It never got bad. We just kept getting these beneficial effects in both
the Alzheimer's and normal mice,"
Arendash said. It took several
months of exposure before the
benefits were seen in mice, and
that would be the equivalent of
many years in humans, Arendash
said. But William Thies, chief med-

ical and scientific officer of the
Alzheimer's Association, said the
study was "very preliminary" and
warned against self-medicating by
over-using a cell phone.
"No one should feel they are being
protected from Alzheimer's, dementia, cognitive decline by using
their cell phones based on this
study," Thies said in a statement.
The study "needs to be replicated in
animals before we begin to even
consider trying it in people, as ani-

mal models of Alzheimer's and
people with the disease are very
different," he said.
Arenbach called the Alzheimer’s
Association reaction disappointing
and "so negative about a new research area of neuroscience that
could offer real benefits against the
disease in the future -- especially
since a new therapeutic approach
is desperately needed and long
overdue."

"If we can determine the best set of
electromagnetic parameters to effectively prevent beta-amyloid aggregation and remove pre-existing
beta amyloid deposits from the
brain, this technology could be
quickly translated to human benefit against Alzheimer's disease,"
said USF professor Chuanhai Cao.
Around 36 million people will be
living with dementia this year, according to international umbrella
group Alzheimer's Disease International. DT

AD

[14] => ME

DTME01-02-10_ME 2/13/2010 10:59 PM Page 14

DENTAL TRIBUNE Middle East & Africa Edition

14 Industry News

ADA, other groups petition
against FTC ‘red flags’ rule
by Fred Michmershuizen, DTA

Following a recent federal
court decision, the American
Dental Association (ADA) has
joined with three other national organizations representing professional health care
providers calling on the Fed-

eral Trade Commission (FTC)
to exclude health professionals
from controversial new regulation intended to combat identity theft.

(AMA), the American Osteopathic
Association (AOA) and the American Veterinary Medical Association (AVMA) is the latest challenge
to the so-called “red flags” rule.

A letter sent to FTC Chairman Jon
Leibowitz by leaders of the ADA,
the American Medical Association

According to the associations, the
FTC’s interpretation of the regulation imposes an unjustified, unAD

funded mandate on health professionals for detecting and responding to identity theft.
“Congress did not intend the original red flags legislation to apply to
small businesses, but rather it was
intended to encourage large businesses like banks, credit firms and
national retailers to implement
best practices to protect customers’
from identity theft,” said ADA President Ronald Tankersley, DDS.

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4HYJO

+\IHP0U[LYUH[PVUHS*VU]LU[PVU
 ,_OPIP[PVU*LU[YL

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In their petition, the organizations
asked the FTC to make it clear that
the rule will not apply to their members given the result of recent litigation brought by the American
Bar Association against the FTC. In
that case, the U.S. District Court for
the District of Columbia ruled that
lawyers should be excluded from
the requirements imposed by the
red flags rule.
The court decision follows wide
criticism that the FTC’s overly
broad interpretation of the Fair and
Accurate Credit Transactions Act
of 2003 (FACT) led the commission
to create a rule that oversteps its
authority. In response to these concerns, the FTC postponed the rule’s
effective date to June 1, but it has
never changed the position that the
rule will apply to health professionals.
In its ruling against the FTC, the
court said that the application of
this rule to attorneys “is both
plainly erroneous and inconsistent
with the purpose underlying enactment of the FACT Act.” The
court also stated that the FTC “not
only seeks to extend its regulatory
power beyond that authorized by
Congress,” but also “arbitrarily selects monthly invoice billing as the
activity it seeks to regulate.”
“The court ruling sends a clear signal that the FTC needs to re-evaluate the broad application of the red
flags rule,” said AMA President J.
James Rohack, M.D. “Our four organizations firmly believe that applying the rule to health professionals, but not to lawyers, would
be unfair.”
“Postponement of the rule’s effective date is inadequate,” said AOA
President Larry A. Wickless, D.O.
“Our four organizations need a
commitment from the FTC that it
will not apply the red flags rules to
health professionals if it is not applied to lawyers.”
“The burdens of complying with
this rule outweigh the benefits,”
said AVMA President Larry R.
Corry, D.V.M. “The FTC’s interpretation of the FACT Act should be redefined to exclude health professionals.” DT

[15] => ME

DTME01-02-10_ME 2/13/2010 10:59 PM Page 15

Time to talk about dry mouth?
Dry mouth is an increasingly common condition, primarily
related to disease and medication use.
In fact more than 400 medicines can cause dry mouth1 and
the prevalence is directly related to the total number of
drugs taken.2

Ask your patient
Some patients develop advanced coping strategies for dealing with
dry mouth, unaware that there are products available that can help
to alleviate the symptoms, like the biotène system.
Diagnosis may also be complicated by the fact physical symptoms
of dry mouth may not occur until salivary flow has been reduced by
50%.3

Diagnosing dry mouth
Four key questions have been validated to help determine the
subjective evaluation of a patient’s dry mouth:4
1
2
3
4

Do you have any difficulty swallowing?
Does your mouth feel dry when eating a meal?
Do you sip liquids to aid in swallowing dry food?
Does the amount of saliva in your mouth seem to be too little, too
much or you do not notice?

Clinical evaluations can also help to pick up on the condition, in
particular:
s USE OF THE MIRROR @STICK TEST PLACE THE MIRROR AGAINST THE BUCCAL
mucosa and tongue. If it adheres to the tissues, then salivary
secretion may be reduced
s CHECKING FOR SALIVA POOLING IS THERE SALIVA POOLING IN THE FLOOR OF
the mouth? If no, salivary rates may be abnormal
s DETERMINING CHANGES IN CARIES RATES AND PRESENTATION LOOKING FOR
unusual sites, e.g. incisal, cuspal and cervical caries.

Consequences of unmanaged dry mouth include caries,
halitosis and oral infections.

Saliva’s natural defences
Saliva’s natural defences contain a mixture of proteins and enzymes,
each of which plays a specific role:5

Protein:
s LACTOFERRIN n CHELATES IRON $EPRIVES BACTERIA OF IRON WHICH IS
essential for bacterial growth.

Enzymes:
s LYSOZYME n DISRUPTS CELL WALLS OF BACTERIA RESULTING IN CELL DEATH
s LACTOPEROXIDASE n SYNTHESIS OF HYPOTHIOCYANITE A POTENT
antimicrobial agent.

The biotène patented salivary LP3 enzyme
system
The biotène formulation supplements natural saliva, providing
some of the missing salivary enzymes and proteins in patients
with xerostomia and hyposalivation to replenish dry mouths.
The biotène system allows patients to choose the right product
to fit in with their lifestyles:
s RELIEF PRODUCTS /RAL "ALANCE GEL
s HYGIENE PRODUCTS TOOTHPASTE AND MOUTHWASH
The range is specifically formulated for the sensitive mucosa of
the dry mouth patient:
s ALCOHOL FREE

s 3,3 FREE

s MILD FLAVOUR

The biotène formulation:
s HELPS MAINTAIN THE ORAL ENVIRONMENT AND PROVIDE PROTECTION
against dry mouth
s HELPS SUPPLEMENT SALIVAS NATURAL DEFENCES
s HELPS SUPPLEMENT SALIVAS NATURAL ANTIBACTERIAL SYSTEM
weakened in a dry mouth.

GSK welcomes
biotène to its oral
care family

leaders in dry mouth treatment
1. %VESON *7 @8EROSTOMIA 0ERIODONTOLOGY 2. 3REEBNY ,- 3CHWARTZ 33 @! REFERENCE GUIDE TO DRUGS AND DRY MOUTH n ND EDITION 'ERODONTOLOGY 3. $AWES # @(OW MUCH
3ALIVA )S %NOUGH FOR !VOIDANCE OF 8EROSTOMIA #ARIES 2ES 4. &OX 0# "USCH +! "AUM "* @3UBJECTIVE REPORTS OF XEROSTOMIA AND OBJECTIVE MEASURES OF SALIVARY GLAND PERFORMANCE *!$!
5. 4ENUVUO * @#LINICAL APPLICATIONS OF ANTIMICROBIAL HOST PROTEINS LACTOPEROXIDASE LYSOZYME AND LACTOFERRIN IN XEROSTOMIA EFFICACY AND SAFETY /RAL $ISEASE

[16] => ME

DTME0110-new_ME 1/30/2010 9:29 PM Page 12

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) [page_count] => 16 [pdf_ping_data] => Array ( [page_count] => 16 [format] => PDF [width] => 888 [height] => 1237 [colorspace] => COLORSPACE_UNDEFINED ) [linked_companies] => Array ( [ids] => Array ( ) ) [cover_url] => [cover_three] =>

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