We have an enormous influence on children’s overall health / Combination of breast milk and babies’ saliva shapes healthy oral microbiome, study suggests / Researchers develop new method for identifying oral cancer / Dental Hygienst Seminar Impressions
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DTMEA_No.6. Vol.8_HT.indd
www.dental-tribune.me
Published in Dubai
November-December| No. 6, Vol. 8
We have an enormous influence
on children’s overall health
By Dental Tribune International
Parents of children with systemic
disease often wonder in the dentist’s office what oral health problems they can expect for their child.
Depending on the type of systemic
disease, there can be complications
in terms of the child’s oral health. In
this context, Dr Karolin Höfer, senior
physician at the University Hospital
of Cologne, studies oral disease in
children with chronic renal insufficiency or congenital heart defects.
In her presentation at the Oral-B
Up-to-Date event, she spoke about
the typical oral health problems of
paediatric kidney and heart patients
based on her own research and compared these with current systematic
reviews. She then, in a very personal
interview gave helpful suggestions
for the support and treatment of
these children in everyday life.
Dr Höfer, why do you like working
with children?
Dr Karolin Höfer: My passion lies
in working with children and young
people; that’s why I specialised in
paediatric dentistry, with a special
focus on children with systemic disease. In dentistry, we say: one either
loves it or leaves it.
With every one of my young patients, whether they have a medical
history or are healthy, I have to gain
their confidence on an emotional
level first, aside from the dentistry
challenge. Working with children
who are traumatised and have medical histories in particular requires
sensitive handling in order to build
trust, which is the foundation of successful treatment. Intuition, taking
sufficient time, patience and empathy are essential here.
Successful treatment of children
with cancer or severe heart problems
or others at high risk is achievable
by using special techniques, such as
ritualised behaviour management.
After a difficult treatment, having a
child smile and ask when he or she
can come back is the best endorsement in daily practice.
What patients do you work with?
Most of my patients have a systemic
disease and are with me from birth
up to age 25. The period between
ages 18 and 25 is considered a transition phase; from child to adult.
After careful paediatric treatment,
a deterioration of the condition is
frequently reported during the transition phase. For example, we treat
patients with cystic fibrosis, congenital heart defects, chronic kidney
disease and immunosuppression,
for example, after a transplant or
during cancer treatment. Every day,
we ask ourselves: Are there correla-
Dr Karolin Höfer, Germany
tions between these systemic diseases and oral disease and/or disease
that affects tooth development? As
dentists, we should know how these
systemic disease can affect oral
health. We are already aware of the
well-known interactions with some
chronic diseases, such as congenital heart disease, diabetes mellitus,
arthritis and chronic diseases of the
bowel and kidney.
What questions do dentists have to
ask when treating these patients?
First of all, it is important to identify
the child’s dental problem. Secondly,
it should be determined whether
the child has certain diseases and
whether there are interactions with
oral disease. And thirdly, which specialists in other disciplines should be
consulted before dental work commences must be established.
How do you see your position as a
dentist within the holistic therapy
of these children?
I am not responsible for the patient’s
entire medical recovery. However, I
see myself as a physician, mediator
and member of a team of paediatric
specialists. When we treat patients
with systemic disease, we need to be
in contact with specialists from all
disciplines. As experts in oral health,
we have an enormous influence on
children’s overall health. Every den-
tist should consult with the treating
paediatricians of children with preexisting conditions. It’s about the
overall well-being of the child. Even
a tooth cleaning can take on another
meaning for these children. Healthy
people associate it with health, wellbeing and aesthetics. For children
with systemic disease, however,
an intensive prophylaxis can have
major implications for their general
health, for example, should pathogenic bacteria enter the bloodstream
of a child, say, with immunosuppression.
You work with children who have
congenital disease. You have conducted interesting studies on the
prevalence of caries and gingivitis.
What have your results been?
If one considers the tooth decay process of healthy children in Germany
20 years ago, about five teeth were
affected by tooth decay, while today,
only one tooth on average is affected. Up to 85 per cent of 3-year-olds
have no caries; however, the remainder may have up to four carious
teeth. As I said, these figures involve
healthy children.
For children with systemic disease,
the situation is different. Children
with heart disease have a demonstrably higher prevalence of caries.
On average, four to seven teeth are
affected. Children with kidney disease have a risk of caries comparable
to that of healthy children; however,
this group presents a much higher
risk of developing gingivitis. Gingivitis could thus be understood as
enabling bacteria to enter the bloodstream. Children with cystic fibrosis
also have a very low caries prevalence, but owing to the frequent intake of antibiotics, the composition
of their saliva is altered, so in this
patient group, frequent enamel hypoplasia has been determined.
Why should paediatric dentistry be
interested in such interactions?
If there are potentially about 700
different species of bacteria in the
mouth, and children with heart disease have an increased risk of caries,
the danger actually exists that these
bacteria will reach the bloodstream
via the mouth. We are speaking here
of bacteraemia. Bacteraemia is not a
disease in itself and is not a risk for a
healthy patient; the immune system
automatically fights the invading
bacteria. For patients with systemic
disease, the starting point is different. It is therefore not surprising
that, with bacteraemia, oral streptococci, in particular the viridans
streptococci, can be detected. Blood
cultures reveal, for example, that viridans streptococci, as part of the oral
cavity, are also responsible for 50 per
cent of infectious endocarditis cases.
Of course, bacteraemia does not automatically lead to endocarditis. As
I said, a healthy body can normally
deal with such bacteria. Patients with
pre-existing conditions like heart
disease, however, have a higher risk
of endocarditis. Ideally, children with
a serious heart disease should have
their teeth cleaned prior to upcoming heart surgery.
How frequently does bacteraemia
develop after dental procedures?
Occult bacteraemia can result from
routine activities such as toothbrushing, but of course also through
different dental procedures. Bacteraemia develops most frequently
after surgeries like tooth extractions. Here, the frequency is usually
100 per cent. These bacteria can be
released during periodontal procedures, such as scaling and root planing, and even during professional
tooth cleaning, bacteria enter the
bloodstream in around 40 per cent
of patients. It is very interesting that,
even after brushing and interdental
care, the frequency of bacteraemia is
about 68 per cent. As I said, a healthy
body normally deals with such bacteria, but the picture is different for patients with systemic disease, particu-
ÿPage C2
[2] =>
DTMEA_No.6. Vol.8_HT.indd
C2
hygiene tribune
Dental Tribune Middle East & Africa Edition | 6/2018
◊Page C1
this genetic defect and a patient’s
dental status?
Patients with cystic fibrosis often
have an accumulation of viruses,
fungi and bacteria in their airways,
which can in turn lead to pneumonia. These patients are under constant drug therapy. As dentists, we
should comply with special hygiene
regulations. We should be aware that
the particulate matter that normally
develops during dental treatment
is to be avoided. One danger, for example, is lung infections, which can
be triggered by bacteria like Pseudomonas aeruginosa. This risk can
be prevented by using an external
water supply.
larly children with congenital heart
disease. If we find a carious lesion in
these children, we would treat this
immediately in consultation with
the paediatric cardiologist in order
to avoid further infections. For our
paediatric colleagues, it is more difficult to diagnose carious lesions. We
do, however, have an excellent working relationship with our colleagues
from the paediatric clinic. They are
well trained and refer patients to us
promptly and regularly for checkups before surgical procedures.
You also mentioned cystic fibrosis, a congenital metabolic disease
that leads to the formation of thick
mucus, for example in the lungs,
intestine and liver. What interactions have you observed between
Dr Karolin Höfer, Germany
AD
What measures do you recommend to reduce the risk of bacteraemia for these risk groups?
We are currently conducting an intervention study in collaboration
with the paediatric nephrology division at the University of Cologne.
In addition to treating gingivitis
through intensive prophylaxis, the
goal of the clinical trial is to determine the bacterial risk after toothbrushing. For bacteria identification,
blood cultures and oral microbiomes
are examined. We want to examine
the influence of a patient-centred
intensive prophylaxis programme
and improved oral hygiene on the
change in the oral microbiome. We
hope in the long term to improve
oral hygiene through regular checkups and instructions, and to implement an interdisciplinary prevention programme for children with
chronic kidney disease.
Furthermore, we hope to achieve
a substantial improvement in oral
health with targeted tooth cleaning
and intensive prophylaxis, and to
eliminate the daily bacteraemia risk
in children at risk, as well as carious
lesions and gingivitis. This includes a
regular recall system for these highrisk patients adapted to their individual needs.
What are your recommendations
for parents?
I would like children to look forward
to their dental appointment with
me. Through a very intensive relationship with the children and their
relatives, I replace the cliché of an uncomfortable and angst-ridden dental
visit with trust in dental treatment.
We should give today’s generation
of children a new perception about
dentists. Of course, for many parents
who have a child with a systemic disease, oral hygiene is not their top priority. However, all the results of my
clinical trials to date have shown that
oral health has only a positive effect
on the overall health of children with
systemic disease, but besides that,
the quality of life and self-confidence
of my young patients are enormously strengthened.
What is your appeal to your peers
in practice?
It is enormously important to take
children in dental treatment in hand,
accompany, explain and find a way
to bring dentistry goals in line with
the systemic disease.
We must achieve oral health in children as quickly as possible and maintain it for the long term through individual prevention programmes. The
treatment of children with systemic
disease should always take place in
consultation with the treating paediatrician. Every practice staff member
should contribute to paediatric dentistry being perceived by parents as
a specialist field in interdisciplinary
cooperation with paediatricians and
serving the well-being of their children.
[3] =>
DTMEA_No.6. Vol.8_HT.indd
Dental Tribune Middle East & Africa Edition | 6/2018
C3
hygiene tribune
Combination of breast milk and babies’
saliva shapes healthy oral microbiome,
study suggests
By Dental Tribune International
BRISBANE, Australia: There is much
debate of the pros and cons of breastand bottle-feeding. A research team
from the Queensland University of
Technology (QUT), in collaboration
with the University of Queensland,
both in Australia, has found that
breastfeeding, at least in terms of
oral health of the baby, is beneficial.
According to lead author Dr Emma
Sweeney, from the Institute of
Health and Biomedical Innovation
at QUT, the team’s earlier studies
had found significant differences in
the prevalence of key bacteria in the
mouths of breastfed and formulafed babies and that breastmilk and
saliva interactions boost innate immunity by acting in synergy to regulate the oral microbiome of newborn
babies.
For the recent study, a variety of
microorganisms were exposed to
breastmilk and saliva mixtures.
The results showed that inhibited
growth of the microorganisms took
place immediately and for up to one
day regardless of whether the microorganisms were considered pathogenic or commensal in an infant’s
mouth.
“Our findings suggest that breastmilk is more than a simple source
of nutrition for babies because it
plays an important role in shaping
a healthy oral microbiome,” said
Sweeney. “Our previous research
found that the interaction of neo-
natal saliva and breast milk releases
antibacterial compounds, including
hydrogen peroxide. The release of
this chemical compound also activates the lactoperoxidase system,
which produces additional compounds that also have antibacterial
activity, and these compounds are
capable of regulating the growth of
microorganisms,” she added.
health and well-being and also has
an impact on infections and diseases
in babies’ early lives.
The study, titled “The effect of breastmilk and saliva combinations on the
in vitro growth of oral pathogenic
and commensal microorganisms”,
was published online in Scientific Reports on 11 October 2018.
According to the research team, the
composition of a baby’s mouth microbiota has an important role in its
Researchers develop new method for
identifying oral cancer
By Dental Tribune International
SÃO PAULO, Brazil: In a discovery
that may help the early identification of oral squamous cell carcinoma
(OSCC), researchers in Brazil have
found a correlation between the cancer’s progression and the abundance
of specific proteins present in tumor
tissue and saliva. The discovery offers parameters for predicting the
progression of the disease and may
help in overcoming the limitations
of clinical and imaging exams.
“We worked on the study for five
years until we achieved this breakthrough,” said contributing author
Adriana Franco Paes Leme, a researcher at the Brazilian National
Bioscience Laboratory—part of National Energy and Materials Research
Center (CNPEM) in São Paulo.
During the first phase of the study,
researchers used laser microdissection and proteomics to map the
proteins in mouth cancer tissue and
correlate them with the clinical characteristics of the patients. This analysis enabled the identification of several proteins, such as CSTB, NDRG1,
LTA4H, PGK1, COL6A1, ITGAV and
MB—with differing levels of abundance depending on the tumor
area—and link them to key clinical
outcomes.
After identifying and quantifying
proteins in about 120 tumor tissue
samples, the second phase of the
study saw researchers deploy two
protein verification strategies. “One
strategy consisted of gauging the
abundance of the selected proteins
in independent tissue samples using immunohistochemistry with
antibodies. The other consisted of
monitoring the same preselected
targets in patients’ saliva,” explained
Paes Leme.
“Saliva is a promising source of
markers, as well as being a fluid obtained by noninvasive collection,”
she explained. “We verified the
proteins in saliva from 40 patients.
Technical triplicates were analysed
to achieve the highest possible con-
fidence level for the results in this
phase of the study.”
sity, as well as other institutions in
and outside of Brazil. It was funded
by the São Paulo Research Foundation, with the research conducted at
the National Energy and Materials
Research Centre.
AD
After analysing the saliva samples,
researchers used bio-informatics
and machine learning techniques to
obtain prognostic signatures. From
here, they were able to verify which
of the proteins or peptides were
selected during the first phase and
could thereby distinguish between
patients who had or did not have cervical lymph node metastasis.
According to the study’s results, it
was possible to identify three specific
peptides—LTA4H, COL6A1 and CSTB
—that can be used as a signature to
classify patients with and without
cervical lymph node metastasis.
Researchers believe that this could
potentially help doctors overcome
the limitations of clinical exams and
guide personalized treatment strategies.
“The data led to robust results that
are highly promising as guides to defining the severity of the disease. We
suggested potential markers of the
disease in the first phase of the study
and verified these markers in the
second phase, enhancing the reliability of the findings and showing that
these markers are effective in classifying patients with cervical lymph
node metastasis,” said Paes Leme.
Scientists are now working on a new
study designed to use translational
techniques to build affordable biosensors that are capable of detecting
prognostic signatures in patients’
saliva.
save the date
08 NOVEMBER 2019
InterContinental Hotel
Dubai Festival City
DUBAI, UAE
Part of 11th Dental Facial Cosmetic Conference & Exhibition
The study, titled “Combining discovery and targeted proteomics reveals
a prognostic signature in oral cancer”, was published on September 5
in Nature Communications.
Partners of the study included the
São Paulo State Cancer Institute, the
University of Campinas’s Piracicaba
Dental School and Institute of Computing, the University of São Paulo’s
Mathematics and Computer Science
Institute in São Carlos, the Dental
School of the West Paraná Univer-
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[4] =>
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hygiene tribune
Dental Tribune Middle East & Africa Edition | 6/2018
Dental Hygienst Seminar Impressions
Part of the 10th Dental Facial Cosmetic Conference & Exhibition, Dubai, UAE
312 dental hygienists attended the Dental Hygienist Seminar
Dr Mohammad Kashif Shafiq Khot – Seminar chairman
Dental hygienists attending the Dental Hygienst Seminar
Dental hygienists listening to the lectures
Robyn Watson, Australia lecturing on Periodontal Therapy
Prof Andrea Mombelli, Switzerland presented during the Dental Hygienist Seminar
Amanda Gallie, UK lecturing on salivary dysfunction
Mary Mowbray, New Zealand lecturing on management and prevention
of Peri Implant disease
Dental hygienists listening to the lectures
Dr Penelope Jones, Australia lecturing on sitting posture
Dr Nadia Mohd Saleh lecturing on Oro Facial Pain
Sawsan Jaffer AlThaqafi, Bahrain presenting during the Dental Hygienist
Seminar
Sitting posture lecture exercise
Hands-on training with Dr Penelope Jones
Dental hygienists listening to the lectures
Hands-on training with Amanda Gallie
Hands-on training with Amanda Gallie
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[toc_titles] => We have an enormous influence on children’s overall health
/ Combination of breast milk and babies’ saliva shapes healthy oral microbiome, study suggests
/ Researchers develop new method for identifying oral cancer
/ Dental Hygienst Seminar Impressions
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