Mouthwash may reveal risk of cardiovascular disease / “Maintaining good dental and oral health is crucial for lifelong quality of life” / The future of dentistry: What will oral care look like in 2040? / New remineralisation product may provide a long-term solution for dentine hypersensitivity
Mouthwash may reveal risk of cardiovascular disease
1 - 1 view“Maintaining good dental and oral health is crucial for lifelong quality of life”
2 - 2 viewThe future of dentistry: What will oral care look like in 2040?
4 - 4 viewNew remineralisation product may provide a long-term solution for dentine hypersensitivity
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DTMEA_No.5. Vol.13_HT.indd
PUBLISHED IN DUBAI
www.dental-tribune.me
Vol. 13, No. 5
Mouthwash may reveal risk of
cardiovascular disease
By Franziska Beier, Dental
Tribune International
HAMILTON, Ontario, Canada:
The link between periodontitis and
cardiovascular disease is well established. However, most research in this
area concerns older patients, and little is known about whether mild oral
inflammation—which occurs commonly in young and apparently
healthy individuals—has an impact
on cardiovascular health. Using a
simple saliva test, a team consisting
of researchers from different institutions in Canada set out to determine
whether lower levels of oral inflammation can be clinically relevant to
cardiovascular function.
Previous research on oral inflammation that precedes periodontitis
has found that higher inflammation,
reflected in a higher concentration of
white blood cells in saliva, is associated with fewer healthy arteries and
a potentially higher risk of cardiovascular disease.
“Even in young healthy adults,
low levels of oral inflammatory load
may have an impact on cardiovascular health—one of the leading causes
of death in North America,” said
AD
In the future, a simple mouthrinse test at a patient’s annual dental check-up could provide insight into whether the patient is at
increased risk of cardiovascular disease. (Image: freepik/Freepik)
co-author Dr Trevor King from McMaster University in Hamilton and
Mount Royal University in Calgary in
Alberta.
For their study, the researchers
worked with 28 individuals aged between 18 and 30 who were
non-smokers, showed no risk factors
for cardiovascular health and had no
reported history of periodontal disease. The team used a simple oral
mouthwash to determine whether
the concentration of white blood
cells in the saliva could be associated
with a higher risk of cardiovascular
disease. As key indicators of cardiovascular risk, the team chose
flow-mediated dilation, a measure of
how well arteries can dilate to allow
more blood flow, and pulse wave velocity, which measures arterial stiffness.
The researchers found that oral
inflammation is a predictor of reduced flow-mediated dilation, which
is an indication of a possible risk of
developing cardiovascular disease.
They suggested that inflammation
that reaches the vascular system
from the mouth might have an impact on the ability of arteries to produce the nitric oxide that allows them
to respond to changes in blood flow.
However, they observed no link
between oral inflammation and pulse
wave velocity, indicating that a longterm impact of oral inflammation on
the artery structure had not occurred. This observation is in line with
findings of previous studies that included older individuals.
“We are starting to see more relationships between oral health and
risk of cardiovascular disease,” said
lead author Ker-Yung Hong from
McMaster University. “If we are seeing that oral health may have an impact on the risk of developing cardiovascular disease even in young
healthy individuals, this holistic approach can be implemented earlier
on.”
“The mouthrinse test could be
used at your annual check-up at the
family doctors or the dentist,” said
co-author Dr Michael Glogauer from
the University of Toronto. “It is easy
to implement as an oral inflammation
measuring tool in any clinic.”
The researchers concluded that
their study provides evidence that
oral health may impact cardiovascular disease, even in young and
healthy individuals. According to Dr
King, the researchers hope to conduct further studies with larger study
populations and more individuals
with gingivitis and periodontitis that
is more advanced in order to better
understand the connection between
different levels of oral inflammation
and cardiovascular status.
The study, titled “Oral inflammatory load predicts vascular function
in a young adult population: A pilot
study”, was published online on 18
August 2023 in Frontiers in Oral
Health.
[2] =>
DTMEA_No.5. Vol.13_HT.indd
HYGIENE TRIBUNE
E2
Hygiene Tribune Middle East & Africa Edition | 05/2023
“Maintaining good dental and oral health
is crucial for lifelong quality of life”
By Iveta Ramonaite, Dental
Tribune International
As the elderly population continues to grow exponentially, it is now
more important than ever to address
certain challenges related to the oral
and overall health of older adults to
ensure healthy longevity. In this interview, Dental Tribune International
spoke with Dr Kakuhiro Fukai, director of the Fukai Institute of Health
Science in Japan and chair of FDI’s
Oral Health for an Ageing Population
(OHAP) task team. Drawing on his
decades-long experience of global
oral health, Dr Fukai discussed some
pressing issues related to the oral
healthcare needs of older adults and
shared some wisdom on how to best
address them.
Dr Fukai, how does ageing affect oral health, and how can main-
What role do dental professionals play in managing the oral
healthcare needs of an ageing population?
Dental professionals contribute
not only to oral health maintenance
but also to the prevention of
non-communicable diseases and
frailty as well as the promotion of social participation. They do so by delivering quality preventive care, including education, and dental treatment via the life course approach,
that is, by preventing and controlling
caries, periodontal disease, tooth
loss and a decline in oral function. It
is also crucial that dental professionals work on improving the early detection of oral cancer in an ageing
population. Owing to the complex
interrelatedness of oral and systemic
health, dental professionals should
work in close cooperation with a variety of other healthcare professionals.
Dr Kakuhiro Fukai’s research activities have focused on global oral health, the link between oral and systemic health and healthy
longevity. He has published over 300 research articles and 50 books on oral health promotion. (Image: Kakuhiro Fukai)
“When assessing, diagnosing and treating older adult
patients, dental professionals first need to be aware of patients’
multi-morbidity and medication regimens.”
taining good oral hygiene improve
the oral and overall health of older
adults?
Ageing leads to a decline in the
physical and mental functions
needed for daily functioning, increasing vulnerability to disease. In
the oral cavity, the loss of teeth, a decline in chewing ability and swallowing function, and a reduction in saliva
production also often occur. The systemic health effects and oral health
effects of ageing also have a reciprocal relationship, affecting each other
in a vicious cycle. This is particularly
observable when it comes to chewing function, malnutrition and sarcopenia. Another good example is oral
health-related quality of life and reduced social participation.
Maintaining good oral health is
crucial for lifelong quality of life, and
it has been shown to contribute to
the prevention of non-communicable diseases, cognitive decline and
frailty. Research also shows that oral
healthcare maintenance helps to
prevent dental caries, periodontal
disease, tooth loss and a decline in
oral function, thereby contributing to
healthy longevity.
When assessing, diagnosing and
treating older adult patients, dental
professionals first need to be aware
of patients’ multi-morbidity and
medication regimens. They must assess the physical and mental status of
patients, for example robust, frail or
dependent, and then proceed to the
objective assessment of gradual
changes in oral function owing to
ageing.
To detect oral function decline as
early as possible, it is not enough to
perform these assessments in the
isolated context of outpatient dental
services.
Regional
community
healthcare networks need to establish collaborative assessment and/or
information-sharing systems that integrate the efforts of dental clinics,
nursing homes and perhaps even
families and companies.
In 2015, FDI launched the
OHAP project to strengthen the
role of the oral health community
in achieving healthy longevity for
patients. What are the overarching
goals of the initiative, and how has
it helped spread awareness of the
topic?
The Japan Dental Association
and the World Health Organization
organised the 2015 World Congress,
during which the Tokyo Declaration
was issued. This declaration emphasised that lifelong oral health is a fundamental human right, called for the
inclusion of oral healthcare in all
healthcare policies and recognised
the essential role of oral healthcare in
maintaining quality of life.
Based on the Tokyo Declaration,
FDI established the OHAP project to
raise the awareness of national dental
associations of oral healthcare for an
ageing population, to assess national
or regional oral healthcare policies
and share that information globally,
to identify solutions and to address
these issues at the global and national
level. Season I (2016–2019) of the
OHAP project produced a guide for
managing the dental treatment of
older adults, an oral healthcare pathway for older people and a road map
for healthy ageing, all of which are on
FDI’s website.
Building on the resources produced during Season I, Season II
(2021–2023) of the OHAP project
seeks to further promote clinical and
community initiatives to achieve optimal oral health in older adults. The
focus of Season II is on clinical issues
such as oral functional decline. Sea-
son II aims to promote widespread
dissemination and use of the Season I
resources and to adapt them for use
in different settings and groups, to
promote awareness of the role of oral
function in elderly oral health and to
provide practical tools for patients
and oral health professionals to prevent functional decline. To achieve
these objectives, the OHAP team has
surveyed national dental associations, published supplementary issues of the International Dental Journal, organised symposia at World
Dental Congresses and held various
webinars.
What resources are available to
help guide dental professionals in
their journey to better address the
oral health-related challenges of
older dental patients?
One of the products of OHAP
Season I was the Managing Older
Adults: Chairside Guide. This document provides a wealth of prevention-oriented advice for dental professionals according to each patient’s
level of dependency. In OHAP Season II, the guide has been further revised, made more user-friendly for
dentists and developed as a web app.
In addition to the level of depen-
dency, the guide now includes oral
frailty as a preliminary assessment for
older patients.
Validated scales were used for
these assessments. Additionally, clear
and concise infographics are provided for patients and caregivers
based on these assessments. These
tools increase dentists’ basic knowledge of and competence in dealing
with older people. We also believe
that they will enable interactive and
shared decision-making between
dentists and older patients, ensuring
a more people-centred and function-focused approach.
Editorial note:
Dr. Kakuhiro Fukai was one of the speakers
at the symposium, titled "Oral health for an
ageing population," which was held during
the 2023 FDI World Dental Congress on 25
September.
[3] =>
DTMEA_No.5. Vol.13_HT.indd
ENJOY
STEAMING
HOT
YOUR DENTIST OR
HYGIENIST HAS RECOMMENDED
WHAT IS SENSITIVITY AND HOW COULD IT BE AFFECTING YOU?
Sensitivity is often described as a short, sharp pain in
the teeth.
Sensitive teeth develop when the inner layer of your teeth
(called dentin) becomes exposed and is no longer protected
by the hard enamel or gums. This means that triggers such
as cold and hot drinks can activate nerves, deep inside the
tooth, causing pain.
HOW CAN I LOOK AFTER MY SENSITIVE TEETH?
Triggers of sensitivity
Cold foods/
drinks
Cold
weather
Hot foods/
drinks
Sweet or sour
Touch (from
foods/drinks your toothbrush)
SENSODYNE Advanced REPAIR & PROTECT DEEP REPAIR
Brush with Sensodyne Advanced Repair & Protect Deep
Repair twice a day, every day, instead of a regular
toothpaste
Clinically proven relief from the pain of sensitivity, and
long-lasting protection so you can enjoy life without the
worry of sensitivity
Maintain good oral hygiene – brush twice a day, every
day
Scientifically proven to go deep
Avoid brushing aggressively*
Creates a robust reparative layer over and within
exposed dentin for strong repair
Use a soft toothbrush
If your sensitivity pain continues, contact your dentist.
* Ask your dentist or hygienist for advice on the most appropriate brushing technique for you.
PM-BH-SENO-22-00011 prepared on March 221
[4] =>
DTMEA_No.5. Vol.13_HT.indd
HYGIENE TRIBUNE
E4
Hygiene Tribune Middle East & Africa Edition | 05/2023
(Image: Freepik)
The future of dentistry:
What will oral care look like in 2040?
By Dr Anne Mette Stougaard,
Denmark
Smart toothbrushes and intra-oral sensors that continually
monitor biomarkers in the oral cavity,
efficient and free dental services
based on preventive and collaborative care strategies, a mobile app that
provides patients with preliminary
triage and dental care guidance—a
new way of doing dentistry may be
just around the corner. Let us gaze
into the crystal ball and see what
might be possible if we dare to imagine it.
Screening on the playground
The calendar reads 2040. Fiveyear-old Ava is at the playground
with her mother after her afternoon
snack. Suddenly, Ava holds her cheek
and says: “Ouch, my tooth hurts!”
Her mother asks: “Which tooth is it,
honey?” and Ava points and says:
“Right there by my finger.” Her
mother responds: “Okay, sweetie.
Let’s take a picture and send it to
tooth chat for help.”
Ava opens her mouth, and her
mother takes out her phone and
opens tooth chat in her dental app,
where she is greeted by the app’s
chatbot, which is powered by artificial intelligence (AI) and guides her in
taking a perfect photograph of the
area. Using augmented reality, she
can see what the photograph should
look like before she takes it. Once
happy with the photograph, she
sends it off in the app. The chatbot
asks her a few follow-up questions,
which she answers either in text or
verbally.
A few seconds later, Ava’s mother
receives an answer from the chatbot:
it looks like food impaction in the interdental space between the molars.
The chatbot sends some advice and
short videos with instructions on how
Ava and her mother could try to
clean the space between the teeth
and thus solve the problem by themselves at home without having to go
to the dental clinic.
To be sure of the preliminary diagnosis, the chatbot recommends
that Ava’s mother take a better intra-oral photograph with Ava’s smart
toothbrush when they get home. The
whole family has electric toothbrushes with built-in intra-oral cameras, making it easy to monitor the
health of their teeth and mouths
from home.
Ava and her mother walk home
to join the rest of the family for dinner. When it is time to brush their
teeth before bed, Ava’s mother scans
Ava’s teeth with the smart toothbrush, which automatically sends the
scan via the dental app. While Ava is
sleeping, her mother can check the
response from the app, which always
gives a preliminary diagnosis and
some home care advice.
The final diagnosis can only be
made at the clinic. If further remote
assessment is needed, or if Ava’s
mother has any follow-up questions,
an on-call dentist or dental hygienist
is always available for a remote
tele-consultation via chat or voice or
video call.
Biohacking and dental care
on subscription
Ava’s mother is a biohacker and
has gone one step further, having
had an intra-oral sensor attached to
the buccal side of one of her own
mandibular molars. The sensor is a
bit like an orthodontic bracket and
can constantly monitor the condition
of the oral cavity via various biomarkers in the saliva. This means that most
dental diseases and imbalances in
the oral microbiome can be detected
early, allowing disease development
to be discovered and reversed before requiring treatment. The electronic dental equipment is obviously
expensive to acquire, but its cost is
covered by the compulsory dental
insurance package that all citizens
now have.
Of course, the dental care package also includes a fixed quarterly
subscription to all the oral care products that have been prescribed by
the dental practitioner. Each quarter,
a new pack of oral care products is
provided, and the old products can
be returned in the same box for sustainable recycling.
Healthcare turned upside
down
The healthcare system long ago
reoriented to care focused on prevention first. Anything else could no
longer be justified. When you look
back at the system in the 2020s, you
shake your head. Back then, dentistry
was predominantly geared towards
treatment, which made it both extremely expensive and inefficient.
Dental staff were perpetually treating
oral conditions in patients and were
consequently stressed and suffering
burn-out, having to take time off
work frequently or leaving the profession early owing to the subsequent effects on their mental and
physical health.
Fortunately, in 2025, a few farsighted health professionals, financial
experts and politicians reached a
broad policy agreement that reshaped the financing of dental care.
Under the agreement, basic dental
care for all citizens is funded by income tax and additional oral care is
financed through a combination of
compulsory dental insurance and
treatment fees.
Central specialist clinics and
local prophylaxis clinics
Celina, a dentist, is resting in the
staffroom wearing virtual reality
glasses for engaging in a few minutes
of guided mini-meditation before
she sees her next patient. She is
pregnant and needs a little break in
which she can put her feet up and
take calming deep breaths in a nature-based setting.
She is a specialist in oral–systemic medicine, having completed a
relatively new multidisciplinary master’s degree programme that is offered by a collaboration between
dental faculties and hospitals. She
works at the specialist clinic for com-
plicated oral–systemic co-morbidities, where patients from all over the
country can have complicated oral
diseases treated and monitored and
major reconstructions done. Patient
capacity at the specialist clinic has
been reached, and satellite specialist
clinics are set to open in other major
cities.
The clinics will collaborate closely,
the specialist clinic acting as a
mini-hospital and providing the
complicated treatments, and the
local satellite clinics providing the important basic dental treatments and
regular check-ups, prophylaxis and
health promotion, as well as the
often overlooked trust-creating social interaction between the patient
and the dental staff.
The clinics will communicate with
each other via a cloud-based dental
and medical record system, enabling
data sharing and remote monitoring
on the basis of extra-oral images, intra-oral scans and AI-assisted radiographs, among others. The system
communicates with the common
dental app, through which the entire
population has access to their own
dental records.
The work environment is the
strongest currency
Anton, chief of staff at the specialist clinic, is extremely focused on
creating the best workplace in the
country, where employees want to
stay on, take on responsibility and
develop their professional skills. Indeed, Anton knows that recruiting
great staff is now an advanced art
form, as there is an extreme shortage
of competent staff in all sectors.
He has taken the prevention first
model one step further by adopting
a well-known simple but extremely
important approach that prioritises
employees. Simply put, if employees
are happy, patients and employers
are happy too.
At the specialist clinic, the team
no longer works with a schedule of
fixed appointment times; rather, time
intervals are provided. Patients can
check in at a fixed time in the local
area and then stay within a maximum
of 5 minutes’ walking distance to the
clinic until they receive a notification
that the team is ready to receive
them for treatment.
Rounding up
This look into the crystal ball
shows us that the future of dentistry
offers many fascinating new possibilities. However, these possibilities will
only become reality if someone takes
the lead and dares to try out new
methods and workflows. The saying
“If you are not evolving, you are
dying” can be aptly applied to the recruitment (and retention!) of good
staff who look forward to each workday and experience a deep sense of
purpose and joy in their work.
I hope you have enjoyed this little
sketch of how I think the future of
dentistry may look. It is meant solely
as inspiration for dental professionals
and is based on dental innovation
that is happening around the world,
futuristic trends, scientific research
and current scientific projects. Indeed, some of the technologies
mentioned are already being implemented in several countries, and others are still in the developmental
stage.
Editorial note: This article was published in
Dental Tribune Nordic 2/2023.
Dr Anne
Mette
Stougaard is
a dentist, futurist and entrepreneur
based in Denmark. Readers can
follow her on social media (@annemettestougaard), subscribe to her
newsletter at https://dentalinsights.
substack.com/.
[5] =>
DTMEA_No.5. Vol.13_HT.indd
[6] =>
DTMEA_No.5. Vol.13_HT.indd
HYGIENE TRIBUNE
E6
Hygiene Tribune Middle East & Africa Edition | 05/2023
New remineralisation product may
provide a long-term solution for dentine
hypersensitivity
By Franziska Beier, Dental
Tribune International
SEATTLE, US: Existing treatments for dentine hypersensitivity,
including desensitisers and dentinal
tubule blockers, offer only temporary
relief for patients. A permanent solution would be one that provides lasting occlusion of the exposed dentinal
tubules and mineralisation of the
peritubular dentine. A team of researchers from the University of
Washington in Seattle has developed
a means of achieving just that. Their
solution has shown promising results
and can be used in various oral care
applications.
“We see patients with hypersensitive teeth, but we can’t really help
them,” said co-researcher Dr Sami
Dogan, associate professor of restorative dentistry at the university, in a
press release. “We have all these repair options available in the market,
but they’re all transient. They focus
on treating the symptoms and not
addressing the root cause. I see my
patients after a couple of weeks, several months, again coming to my
practice complaining about the same
issue,” he explained.
To address the issue of dentine
hypersensitivity, the researchers
used a specifically tailored amelogenin-derived peptide which binds
to calcium and phosphate ions, foun-
dational components of tooth mineral, to construct new mineral micro-layers on the exposed dentine.
This process was designed to be biomimetic, resembling the process by
means of which teeth are developed
in the body.
When testing the mineral layers,
the researchers observed that the
peptide bonded well to the dentine
surface by attracting calcium and
phosphate ions, forming a hydroxyapatite mineral layer. The resulting
layer not only occluded the dentinal
tubules but also promoted dentine
repair by remineralising the surface,
resulting in a well-integrated and
long-lasting layer.
Furthermore, the mineral layer
displayed notable hardness, and the
researchers suggested that the layers
are capable of enduring the mechanical and thermal stresses typical of
the oral environment.
Different design and delivery
methods
Commenting on how the peptide
might be applied, co-researcher
Dr Hanson Fong, an assistant teaching professor of materials science
and engineering at the university,
said: “There are lots of different design and delivery methods.” In preclinical trials, participants were given
a dental lozenge composed of a core
of calcium and phosphate enveloped
(Image: Freepik)
in a peptide-infused flavouring. In
addition, the team designed peptide-based formulas for products
such as mouthwashes, dental gels,
tooth whiteners and toothpastes.
The researchers concluded that
their peptide-based remineralisation
procedure “could provide a foundation for the development of highly
effective oral care products leading
to novel biomimetic treatments for a
wide range of demineralisation-related ailments and, in particular, offers a potent long-term solution for
dentine hypersensitivity”.
The study, titled “Biomimetic
dentin repair: Amelogenin-derived
peptide guides occlusion and peritu-
bular mineralization of human teeth”,
was published on 13 March 2023 in
ACS Biomaterials Science and Engineering.
Vaping jeopardises oral health as much
as smoking does, states EFP
By Iveta Ramonaite, Dental
Tribune International
BRUSSELS, Belgium: Besides
crippling health effects, smoking can
cause serious damage to oral health,
putting smokers at an increased risk
of periodontal disease, tooth loss
and even oral cancer. A trendy alternative to smoking favoured by the
younger generation is vaping, which
is often seen as the lesser of the two
evils. However, research on its oral
health effects is limited, and its claims
to be a safer option than smoking
conventional cigarettes have been
oversold.
Nicotine, an ingredient commonly found in both cigarettes and
e-cigarettes, restricts the blood flow
to the gingival tissue. Other chemicals contained in the e-cigarette vapour, including formaldehyde, pro-
pylene glycol and benzene, may lead
to serious dental damage and cause
progressive destruction of the periodontium.
According to the European Federation of Periodontology (EFP), tobacco-smokers have a heightened
awareness of the risks of smoking for
general and oral health. However, it
stated that e-cigarette users are
often misled into thinking that vaping
is a less harmful option than smoking.
According to the World Health
Organization, around 1.3 billion people worldwide are tobacco users, and
tobacco kills over eight million people each year, including 1.3 million
non-smokers who are exposed to
second-hand smoke. Regular warnings against vaping often only highlight the damage it causes to the
heart and lungs, but do not refer to
oral health, although as the EFP
noted, evidence shows a clear and
undisputable link between e-cigarettes and poor oral health.
“Damage on the gums and the
tissues supporting the teeth, often to
an irreversible state, is a likely adverse effect of vaping,” stated Prof.
Andreas Stavropoulos, EFP’s immediate past president and chair of the
EFP’s scientific affairs committee.
“This damage includes permanent
resorption of the gums and the bone
that keep the teeth in function and in
the mouth. Treatment of these problems, depending on the extent, is
often cumbersome, and expensive,”
he added.
The EFP encourages oral healthcare professionals to refrain from
recommending vaping as a means of
transitioning from tobacco use. Instead, health experts should priori-
tise offering smoking cessation guidance to individuals who use either
cigarettes or e-cigarettes. Additionally, the EFP believes that dental professionals should provide patients
with information concerning the potential adverse effects of vaping on
oral health.
Other oral health-related side effects of vaping include halitosis,
mouth and throat irritation, paratracheal oedema, laryngitis, black hairy
tongue, nicotine stomatitis, toothache, tooth discoloration, caries,
tooth sensitivity, tooth loss, reduced
enamel hardness and an increased
risk of cancer.
Growing health concerns in the
UK
According to research conducted
by not-for-profit organisation Material Focus, a staggering five million
single-use vapes are being disposed
of in the UK every week—four times
more than in 2022. Owing to growing
fears about the health and environmental risks of disposable vapes, the
government is reportedly planning
to ban their sale in the country.
Scott Butler, the executive director of Material Focus, stated that single-use vapes are one of the most
environmentally wasteful, damaging
and dangerous consumer products
ever made. However, according to
The Guardian, the UK Vaping Industry Association is concerned that the
ban would only lead to further harm,
since the vapes would eventually be
sold on the black market.
[7] =>
DTMEA_No.5. Vol.13_HT.indd
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DTMEA_No.5. Vol.13_HT.indd
30-DAY
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