DENTAL TRIBUNE The World’s Dental Newspaper · South Asia Edition Published in India www.dental-tribune.in 2/18 Stop unauthorized courses or face strict action, warns Dental Council of India ” Page 02 Treating Incipient Dental Caries In Children, A New Method Developed ” Page 04 Nonsteroidal anti-inflam- matory drugs provide more effective dental pain relief ” Page 06 Ten essential aspects for implementing magnification in your practice ” Page 08 ‘World No Tobacco Day’ focuses on the heart of the problem the enters directly system through the oral cavity. Whereas with smoking, only 20 percent of the harmful chemicals reach the lungs and 80 percent is exhaled.” According to him all is not lost with those addicted to tobacco. There is a solution. He believes that nicotine dependency is a by DT SEA, Niranjan Prabhakar Every year, the 31st of May is observed as the World No Tobacco Day around the world to educate people about the ill effects of tobacco and to help them kick the habit. The theme for this year is Tobacco Breaks Hearts. Cardiovascular diseases (CVD) including stroke, are considered the world’s leading causes of death. Incidentally statistics show that tobacco use is the second leading cause of CVDs, after high blood pressure. In simple words, tobacco affects the heart in more ways than you can imagine. The World Health Organization (WHO) states that CVDs kill more people than any other cause of death worldwide. Tobacco use and second-hand greater challenge in the control of this menace. lethal substance Sadly, India features among the top four users of tobacco and this is responsible for more than 1 in 10 fatalities globally. It’s comes as no surprise that about 11.2 percent smokers worldwide are Indian. A Global Adult Tobacco Survey (GATS-2) report shows that India is the second largest consumer of tobacco products with nearly 28 percent of the population addicted to it in any form. Of this, 10.7 percent smoke and 21.4 percent use smokeless tobacco (SLT). Interestingly, of the 346 million SLT consumers globally, India alone has over 150 million consumers with a substantial increase across all age groups. Senior Psychiatrist and de- addiction specialist Dr.Roshan difficult habit to overcome, but with help, it’s possible for a fresh start. “Quitting tobacco may be the best decision of your life. If you don’t succeed at first, then revisit, review and rework the plan. Never quit on quitting ”, he advices. Offering solutions to this problem, Dr. Roshan lists out many practical tips on quitting this habit in his blog. (Source: http://roshanjain. c o m / m i n d - b l o g /g u t k a - s m o k e l e s s - t o b a c c o - p i n c h - poison/) Ad – regular e-news delivered to your inbox – individualized content according to your specialty & region – latest industry developments – event specials – exclusive interviews with key opinion leaders – product information – clinical cases – job adverts World No Tobacco Day theme for 2018 is Tobacco Breaks Hearts. Each year tobacco kills millions of addicts around the world. Picture courtesy: Dr.Niranjan Prabhakar Sign up smoke exposure contribute to approximately 17 percent of all cardiovascular deaths globally. It is a known fact in the WHO European Region, that CVDs cause around half of all deaths. Of the six WHO regions, the highest overall prevalence for smoking in 2017 was estimated to be in the European Region, at nearly 28 percent. In India, the additional problem of a smokeless or chewable form of tobacco is a cause for concern, posing a Jain says, “Many live under the myth that chewing gutka or smokeless tobacco is less harmful than smoking. Most are not aware that gutka is literally, ‘a pinch of poison’ and an ingredient for severe ailments and slow death. Specialists especially oncologists say consumption of gutka is more harmful than any other form of tobacco.” Reflecting on the disastrous effects of SLT, Dr. Roshan adds, “Smokeless is more hazardous than smoking because the chewed mixture tobacco to the ﬁ nest e-read in dentistry www.dental-tribune.com
2 News 2/18 Stop unauthorized courses or face strict action, warns Dental Council of India by DT SEA, Niranjan Prabhakar New Delhi: India; In its notice dated 12th April 2018, Dental Council of India (DCI) has recognized that several dental courses conducted by certain the country are wrong on moral, ethical and legal grounds. institutions in Asserting that dental courses conducted by unauthorized institutions pose a huge hazard to patient’s general and oral health as they could be technically wrong and ineffective. Moreover, the competence of the dentists conducting such courses is a cause for concern. persons, In the executive committee meeting that concluded on 6 April 2018, facts regarding authority certain or the dental qualification without any prior and valid permission as contemplated under the Dentists Act, 1948 were noted. institution imparting in run It was noticed that many the institutes or doctors country these month- long certificate courses. The candidates then mislead patients by mentioning these courses on their letterheads and boards. DCI is now in the process of streamlining the practices and also making strict guidelines for the courses, which will be released in the coming two months. The doctors providing these courses may also get barred according to sources. courses/training Such an act of conducting illegal to dentists may attract the relevant provisions (Section 51 and Section 52) of Dentists Act,1948, which provides for punishment to such authorities/institutions conducting courses/ training to dentists. illegal This notice from the DCI has brought about mixed reactions from the Dental fraternity. Trending now, on social media platforms, is opinion from senior members of the fraternity who feel that DCI has no such powers to curtail the improvement or renewal of knowledge and skills from qualified persons. They feel that such a memorandum will only retard the quest for knowledge and skills essential for improvement. On the flip side some other senior members of the fraternity feel that this is a good move by DCI to curb the mushrooming of dental courses conducted by ill trained personnel. However they do not approve of the blanket ban. Dr. Priya Titus, practitioner in Mumbai, reflects upon the notice and says, ”After my BDS I needed to enhance my skills as a clinician. I attended various skill enhancement courses in Periodontics, Pedodontics, Oral surgery, Implants etc. This has helped me become a better clinician. How else could one learn the latest in the field? ” to “We need regularize courses because of the sheer number of them today. This is to ensure standards of dental education in India”, emphasizes Dr. Deepil Mehta who conducts smile courses designing and is a mentor to many. He adds, “A lot of courses are wrongly rewarding Fellowships and Diplomas to participants. So a regulatory act is important and I feel that it’s a good move by the DCI”. aesthetic in Senior dental practitioner and an international speaker, Dr. Sandeep Singh adds an interesting view. “I’m happy that DCI has finally decided to regulate this aspect of dental education in India.”, he says. “There are several courses in the country today which are being conducted by dentists who have very little experience in the field and this is detrimental Dental council of India (DCI) has recognized that several dental courses conducted by certain institutions in the country are wrong on moral, ethical and legal grounds. Picture courtesy: Dr. Niranjan Prabhakar the all. Nevertheless, we to must understand that there are so many dental colleges in the country and yet there are dental courses cropping up everyday. This is to meet the demand. BDS and MDS graduates today do not get an opportunity to learn many things during their course. And once they pass out they feel the need to learn and upgrade their seriously lacking clinical skills”, he opines. Another senior dentist says, “We conduct dental courses of high standards. Most of us in the team have trained for many years both in India and abroad. Every year we attend at least two international conferences to keep ourselves updated. We then share our experience gained over the years with our participants through our courses. I feel the DCI must ensure that the dentists conducting the courses should be well trained, experienced and updated.” The notice has brought out some important questions such as, Who can or cannot conduct courses? What is the criteria to be able to conduct or organize courses? How can one upgrade their clinical skills? and, can DCI prevent or ban anyone from conducting such courses? Ad
3 News 2/18 3-D printed and drug filled dentures can now keep infections away Arany, DDS, PhD, the study’s senior author and an assistant professor in the Department of Oral Biology in the UB School of Dental Medicine. “The clinicians technology to rapidly allows create susceptible those highly to infection, such as the elderly, hospitalized or disabled patients,” he says. The biomaterials market – worth more than $66 billion in 2015 – is expected to dental material could effectively release antifungal medication. To test the strength of the teeth, researchers used a flexural strength testing machine to bend the dentures and discover their breaking points. A conventional lab-fabricated denture was used as a control. Although the flexural strength of the 3-D printed dentures was 35 percent less than that of the conventional pair, the printed teeth never fractured. fibers and carbon nanotubes, and focus on denture relining – the readjustment of dentures to maintain proper fit. lead authors Chinnici, Investigators include Arany, Alexander Sikora and Malvika Nagrath, and graduate students in the School of Dental Medicine; Jacob Graca, undergraduate student in the UB College of Arts and Sciences; Jennifer research technician in the UB Microbiome Center; Sasikumar Ponnusamy, PhD, and Saeed Ur Rahman, PhD, postdoctoral fellows in the Department of Oral Biology; Sharaschandra Reddy, graduate student in the School of Dental Medicine; and Abhiram Maddi, DDS, PhD, assistant professor in the UB Department of Periodontics and Endodontics. To the examine team agent release in the printed of medication filled the dentures, into the antifungal biodegradable, permeable microspheres. The microspheres protect the drug during the heat printing process, and allow the release of medication as they gradually degrade. by DT SEA, Niranjan Prabhakar BUFFALO, N.Y. – Statistically speaking, nearly two-thirds of the U.S. denture-wearing population frequent fungal infections leading to denture stomatitis. Seen with typical inflammation, redness and swelling in the mouth. suffer To better treat these infections, called denture-related stomatitis, University at Buffalo researchers have turned to 3-D printers, using the machines to build dentures filled with microscopic capsules that periodically release Amphotericin B, an antifungal medication. A study describing the work, recently published in Materials Today Communications, found that the drug-filled dentures can reduce fungal growth. Unlike current treatment options, such as antiseptic mouthwashes, baking soda and microwave disinfection, the new development can also help prevent infection while the dentures are in use. “The major impact of this innovative 3-D printing system is its potential impact on saving cost and time,” says Praveen The 3-D printed dentures, made of acrylamide, can help fight off denture related infections. Picture courtesy: University at Buffalo, New York dentures customized chair- side, a vast improvement over conventional manufacturing that can vary from a few days to weeks”, says Arany. from Applications this research, says Arany, could be applied to various other clinical therapies, splints, stents, casts and prosthesis. including “The antifungal application could prove invaluable among grow 14 percent by 2020. A large part of the industry is focused on dental polymers, particularly the fabrication of dentures. UB researchers printed their dentures with acrylamide, the current go-to material for denture fabrication. The study sought to determine if these dentures maintained strength of conventional dentures and if the the Source : University at Buffalo http://www.buffalo.edu/news/ releases/2018/04/041.html The investigation involved the development of an innovative form of acrylamide designed to carry antifungal payloads and a novel syringe pump system to combine the dental polymer and microspheres during the printing process. Future research aims to reinforce the mechanical strength of 3-D printed dentures with glass Fluoride varnish application aids in the prevention and progression of caries in children by Dental Tribune International in caries COLOGNE, Germany: Whereas adults and adolescents in Germany is declining, research has found that about 14 percent of 3-year-olds in the country have cavities in their primary dentition. According to a report by the Institute for Quality and Efficiency in Health Care (IQWiG), fluoride varnish is remineralisation effective of the surface and prevents the development and progression of caries. in tooth Permanent teeth may be affected by caries at an early stage in the case of caries-affected primary teeth, as the enamel has not yet fully hardened. Because oral hygiene and caries prevention can be challenging application in young children, the use of fluoride varnish can be beneficial. For this reason, the IQWiG researchers investigated whether the of fluoride varnish to primary dentition has advantages in comparison with standard care without fluoride application by comparing the findings of randomised controlled trials. In these, a total of 5,002 children were treated with fluoride varnish, and 4,705 children received no such treatment, being the control group. Children aged up to 6 years with or without caries of their primary teeth were included in the research. 15 In several of the studies, further measures for caries prevention in addition to the application of fluoride varnish were offered. These training on oral hygiene, instruction on the included correct tooth brushing technique, and the provision of toothbrushes and fluoridated toothpaste. The follow-up observation period was mostly two years. further The development of caries was investigated in all 15 studies; side-effects were investigated in nearly all of the studies. However, owing to a lack of conclusive data, it is unclear whether fluoride application also has advantages regarding patient- relevant outcomes, such as tooth preservation, toothache or dental abscesses. There was no data on oral health-related quality of life. A clear advantage of fluoride varnish was determined despite the very heterogeneous study the application results. After of fluoride varnish, caries in primary teeth was less frequent. the fluoride More precisely, treatment completely could prevent caries in approximately every tenth child and would at least reduce progression of caries in further children. Apparently, whether the children already had caries or whether their teeth were completely intact made no difference regarding the benefit of fluoride varnish application. The report titled, “Assessment of the application of fluoride varnish on milk teeth to prevent the development and progression of initial caries or new carious lesions”, was published online by IQWiG on 26 April 2018. Fluoride varnish application prevents the development and progression of caries, according to a study. Picture Courtesy: Dr. Niranjan Prabhakar
4 News 2/18 Treating incipient dental caries in children, a new method developed Engineering and Department of Oral Health Sciences at the University of Washington, said: “Remineralization guided by peptides is a healthy alternative to current dental health care.” Researchers believed that this could benefit some lower socio economic groups who have suffered from oral disease despite the past centenary seeing an improvement in global oral health. They quoted a recent report from the Centers for Disease Control and Prevention on the prevalence of dental cavities in Americans indicated that caries is again on the rise—suggesting a regression in the progress of previous years. The study, titled “Biomimetic tooth repair: Amelogenin- derived peptide enables in vitro human remineralization enamel,” was published in ACS Biomaterials Science and Engineering on March 9, 2018. of created lesion on their teeth. The remineralization ability of the peptides was tested against variations of fluoride alone or combined with peptides, among others. The results showed that, participants who received the peptides alone showed a 10 μm remineralization thick layer. This, the researchers believe, that the peptides could rebuild and strengthen enamel on a daily basis, when part of a well planned preventive dental care routine. Once fully developed, the technology could then be used in both private and public health settings. It could find its applications in biomimetic toothpaste, gels, solutions and composites as a safe alternative to existing dental procedures and treatments. head Commenting on their new researcher discovery, Sarikaya, Professor Mehmet of Materials and Engineering and adjunct professor at the Department of Chemical Science Researchers from the University of Washington have developed a new method to remineralize tooth enamel to treat incipient caries using proteins. (Photograph courtesy: Dr.Niranjan Prabhakar) by Dental Tribune International WASHINGTON, U.S.: Prevention of dental caries in children is the best way to improve their oral health. However, many patients would be to have access to an alternative if their thrilled teeth did develop caries and needed restorative work. In new research, scientists from the University of Washington have developed a method that uses proteins to remineralize tooth enamel to treat white spot lesions and incipient caries. derived is crucial is used by from Peptides amelogenin the researchers. This is the protein which forming enamel, that biomineralize as the key active ingredient in the new technology. In order to assess the effect of peptides, a group of participants received artificially to Tooth loss in middle-aged is linked to increased coronary heart disease risk by Dental Tribune International NEW ORLEANS, U.S.: Losing two or more teeth in middle age is associated with increased cardiovascular disease risk, according to preliminary research. The findings were the American presented at Heart 2018 Epidemiology and Prevention Lifestyle and Cardiometabolic Health Scientific Sessions, a premier global exchange of the latest advances in population- based cardiovascular science for researchers and clinicians. Association’s between In a collaborative research effort the Tulane University School of Public Health and Tropical Medicine in New Orleans and Harvard T.H. Chan School of Public Health in Boston, U.S., a team of researchers analyzed the impact of tooth loss in two large studies of adults. In the studies, the participants, aged 45–69 years, were asked to report on the numbers of natural teeth they had, then in a follow-up questionnaire, report on any recent cases of tooth loss. The adults in this analysis did not have cardiovascular disease when the studies began. The researchers prospectively studied the occurrence of tooth loss during an eight-year period and followed an incidence of cardiovascular disease among people with no tooth loss, one tooth lost and two or more teeth lost over 12–18 years. It was found that, among the adults with 25–32 natural teeth at the respective study’s start, those who lost two or more teeth had a 23 percent increased risk of cardiovascular disease, compared with those with no tooth loss. increased risk occurred The regardless of reported diet quality, physical activity, body weight and other cardiovascular risk factors, such as high blood pressure, high cholesterol and diabetes. There was not a notable increase cardiovascular disease risk among those who reported tooth respective study during period. Cardiovascular disease risk among all the participants (regardless of the number of natural teeth at the respective study’s start) increased 16 percent among those who lost two or more teeth during the respective study period, compared with those who did not lose any teeth. Adults with less than 17 natural teeth, compared with 25–32 at the respective study’s start, were losing one in the Many studies have shown that dental health problems, such as periodontal disease and tooth loss, are related to inflammation, diabetes, smoking and following less-healthy diets. Picture courtesy: Dr. Niranjan Prabhakar. 25 percent more likely to have cardiovascular disease. Study author and Professor of Epidemiology at Tulane University Dr. Lu Qi added: “Previous research has also found that dental health issues are associated with elevated risk of cardiovascular disease. However, most of that research looked at cumulative tooth loss over a lifetime, which often includes teeth lost in childhood due to cavities, trauma and orthodontics. Tooth loss in middle age is more likely related to inflammation, but it hasn’t been clear how this later-in-life loss might influence cardiovascular disease risk.” tooth to “In addition other established associations between dental health and risk of disease, our findings suggest that middle- aged adults who have lost two or more teeth in the recent past could be at increased risk for cardiovascular disease. That’s regardless of the number of natural teeth a person has as a middle-aged adult, or whether they have traditional risk factors for disease, such as poor diet or high blood pressure,” Qi said. cardiovascular The findings have not yet been published as a peer- reviewed paper. The abstract, titled “Changes in dental health and coronary heart disease risk: Two prospective cohort studies in men and women,” was published in the Circulation journal on March 20, 2018.
2/18 Ad 6 News Poor dental health may indicate diabetes risk by Dental Tribune International by and U.S.: CHICAGO, An interaction between diabetes and oral health has been investigated numerous studies, and according to U.S. link between researchers, a diabetes periodontal disease and dental caries was suggested as far back as the 1930s. In a poster presented at the recent Endocrine Society annual meeting, the researchers presented the results of their study on the impact of glucose tolerance on dental health in a representative population in the U.S. They recorded the numbers of missing teeth due to caries and periodontal disease for individual patients. They also determined the relationship between glucose tolerance and dental condition in relation to age, sex, racial and ethnic group, family history of diabetes, smoking status, alcohol consumption, and poverty index. education in as The glucose increase researchers found a progressive the number of patients with missing teeth tolerance declined, from 45.57 percent in the group with normal glucose tolerance to 67.61 percent in the group with abnormal glucose tolerance and to 82.87 percent in the group with diabetes. Except for sex, all other covariates had significant impact on the number of missing teeth. U.S. researchers have found that poor dental health can be observed before the development of diabetes. (Photograph courtesy: Dr. Niranjan Prabhakar) The main finding was that dental diseases may precede the development of diabetes. For the study, they reviewed the records of 9,670 adults 20 years of age and above enrolled in the 2009–2014 National Health Examination and Nutrition Survey. They analyzed the participants’ reported body mass index and glucose tolerance states by fasting plasma glucose, 2-hour postchallenge plasma glucose, established hemoglobin A1c, diabetes, the condition was treated with oral agents or insulin. and whether The health of your teeth may be a sign of your risk for diabetes. Our findings suggest that dental exams may provide a way to identify someone at risk for developing diabetes. We found a progressive positive relationship between worsening glucose tolerance and the number of missing teeth. Although a causal relationship cannot be inferred from this cross-sectional study, it demonstrates that poor dental outcome can be observed before the onset of overt diabetes,” said lead author Dr. Raynald Samoa, assistant professor in the Department of Clinical Diabetes, Endocrinology and Metabolism at City of Hope National Medical Center in Duarte, California, U.S. The results were presented in a poster on March 19 at ENDO 2018, the 100th annual meeting of the Endocrine Society in Chicago. Dental Tribune International ESSENTIAL DENTAL MEDIA www.dental-tribune.com Nonsteroidal anti-inflammatory drugs provide more effective dental pain relief. by Dental Tribune International CLEVELAND, U.S.: Effective pain management is of utmost importance to dental practitioners. Opioid and nonopioid analgesic agents are among the commonly prescribed medications to manage patients with dental pain. However, according to a new examination of the results of 460 published studies, opioids are not among the most effective or longest- lasting options for relief from acute dental pain. Recently at the Case Western Reserve University School of Dental Medicine in the U.S. researchers found that ibuprofen and other nonsteroidal anti- inflammatory drugs alone or in combination with acetaminophen are more effective than opioids in reducing dental pain. The study sought to summarize the available evidence on the safety and efficacy of analgesic agents for the relief of acute pain in dentistry, obtained through pre-existing systematic reviews. The researchers found that, for adults, a combination of 400 mg of ibuprofen and 1 g of acetaminophen was superior opioid-containing to medications included the studies reviewed. any in In addition, it was shown that opioids or drug combinations that included opioids accounted for the most adverse side effects, including drowsiness, respiratory depression, nausea/vomiting and constipation, in both children and adults. as a to use “Our aim was to create a compendium detailing both the benefits and harms of these resource medications for dentists in their clinical decision-making. The best available data suggests that the use of nonsteroidal medications, with or without acetaminophen, offers the most favorable between benefits and harms, optimizing efficacy while minimizing acute adverse events,” said co-author balance Dr. Anita Aminoshariae, an associate professor in the school’s Department of Endodontics. Furthermore, Dr. Aminoshariae cited the national opioid epidemic as one of many reasons that healthcare providers should take note of the findings. Each day, more than 115 Americans die as a result of opioid overdose, according to the National Institutes of Health. “No patient should go home in pain. That means that opioids are sometimes the best option, but certainly should not be the first option,” she stated. The study, titled “Benefits and harms associated with analgesic medications used in According to a recent study, Non-Opioids are more effective in dental pain management. Picture courtesy: Dr.Niranjan Prabhakar the management of acute dental pain,” was published in the April 2018 issue of the Journal of the American Dental Association.
7 Interview 2/18 Latest classification of periodontal disease presented at Europerio9 by Dental Tribune International After almost 19 years, the latest classification of periodontal diseases was presented on 22 June 2018 at the EuroPerio9 in Amsterdam. is The presentation an outcome of last November’s World Workshop of American Academy of Periodontology (AAP) and European Federation (EFP) on of Periodontology Classification of Periodontal and Peri-implant diseases and conditions. It aims in Chicago The new classification was reviewed by nearly 110 experts from around the world at the workshop last incorporate year. peri-implant and address the challenging issue of between chronic and aggressive forms of periodontal disease. to diseases differentiation Dental Tribune South Asia spoke to senior eminent Periodontists, Dr.Neel Bhatavadekar and Dr.Tarun Kumar, in India about the latest buzz in the world of Periodontics and presents some of their views on the same. DT The SEA: latest classification of Periodontal and Peri-implant diseases is here. What are your first thoughts about it? Dr. Neel Bhatavadekar: A new way of looking at Peri-implant and periodontal diseases was needed. This publication is a step in the right direction. The different working groups who are a part of this publication are clinicians who represent years of clinical and research experience. Bringing them all together is no mean feat. Kudos to the AAP (American Academy of Periodontology) and the EFP (European Federation of Periodontology). Dr. Tarun Kumar: It is a very exhaustive overview that covers all the drawbacks of the 1999 classification. I believe it is quite comprehensive with the introduction of the concept of clinical gingival health. What‘s exciting what‘s not about Classification? and latest the evidence Dr. Neel: The new classification summarizes from the last 20 years in an attempt to provide an evidence based approach to treatment planning and prognosis. The end objectives are obviously how this relates to actual patient care. Some terms have also been changed, such as replacing “biologic width“ with “supracrestal tissue attachment“. This brings more emphasis to the biologic components in each term (supracrestal attachment refers to connective tissue fibers and tissue). Given the information at hand, it does prompt the clinician to approach peri-implant and periodontal diseases as multifactorial, but since the evidence regarding some translational aspects is still lacking, it may not address all the questions that currently persist. junctional the Dr. Tarun: Exciting factor here is the introduction of the concept of clinical health, the need for which has been felt for long now. The new classification of recession which overcomes shortcomings of Millers classification. The concept of gingivitis in reduced periodontium treated periodontitis patients provides a framework which will be path breaking in the way we diagnose as well as assess post treatment patients. and Not exciting factors are firstly, removal of the term aggressive periodontitis(AgP) saying that Chronic Periodontitis (CP) and AgP have a common endpoint and only different phenotype is not justified. The need for a more aggressive treatment plan required for AgP is diluted by removal of this term. Second aspect is that certain terminology changes seemed to have been made just for sake of it. For example, biologic width to supracrestal tissue attachment or Occlusal trauma in place of trauma from occlusion. The previous classification was termed an Encyclopedia by many. Is the current system different from it and how? Dr. Neel: The current system acknowledges that the definitions of periodontal and peri-implant diseases might differ from a clinical standpoint and from an epidemiological standpoint. Thus, they provide practice Will the inclusion of model based staging and grading make our diagnosis simpler? Dr. Neel: The model based staging and grading promises to enhance the ability of the clinician to make evidence based decisions. Dr. Tarun: The aim of an ideal classification should be to present a guide to the etiology, prognosis and treatment plan. It’s unclear as to how the exclusion of Aggressive Periodontitis (AgP) and the inclusion of staging and grading will contribute to that. of aggressive periodontitis has chiefly differed from chronic in the use of antibiotics (sometimes combination antibiotics). I don’t think the new classification would influence treatment philosophies for this segment greatly, but it might help clinicians get a broader outlook for treatment. Dr. Tarun: The last 20 years of research says that there is a difference in etiology, progression, clinical presentation, prognosis and treatment planning of AgP and CP. Ignoring this just to make a classification simpler is not justified. If not anything, it may lead to misdiagnosis. How helpful will this system be for clinicians to treat periodontal disease? based Dr. Neel: Clinicians will be able to utilize this system to segregate patients from an evidence standpoint. For instance, a novel system of classifying mucogingival defects has been introduced. The new system also highlights the fact that predisposing or contributory factors such as diabetes and smoking need to be closely considered, but that there is no separate disease entity called “diabetes induced periodontitis“. Overall, this new classification and system provides the much knowledge needed updated compared the 1999 classification, and is a definite step in the right direction. to : Among Dr. Tarun the positives of this classification is the inclusion of the concept of gingival health, which makes many things clear as far as diagnosis and treatment planning is considered. However, removal of AgP may end up negating that step. Thank you for the interview. The latest classification on Periodontal Diseases was presented at the EuroPerio9 in June this year. (Photograph DTI) the ‚new‘ definitions which will be beneficial to clinicians. In my opinion, a key presentation in this manuscript is that a treated and stable periodontitis patient with current gingival health remains at an increased risk of recurrent periodontitis. An extrapolation can also be made for the “treated“ peri-implantitis patient. Dr. Tarun: This If is definitely different. the previous classification was an encyclopaedia, this one is an encyclopaedia on each lesion. The need to be exhaustive is essential, however, it should be kept in mind that it should be simple enough for day to day usage. This addresses certain issues which are mainly for research purpose and may descend into clinical practice quite slowly. classification Rather than simpler, I would say that this classification may make our diagnosis more accurate. However only time will tell us about how effective it is. and Chronic aggressive forms of the disease have always posed a dilemma. Does the classification provide the essentials solutions to simpler diagnosis? Dr. Neel : Any disease classification poses two problems. If it‘s made too complex, then clinical implementation becomes a problem and if it gets too simple then one risks losing out on important diagnostic and prognostic information. This new classification walks this fine line quite well. Conventionally, in my private practice setting, the treatment Graduated from Nair Hospital Dental College, Bombay and completed Masters in Periodontology at the University of North Carolina at Chapel Hill. In addition, he has a Masters in Biomedical Engineering from the University of Florida and a Masters in Public Health. He is the first Diplomate of the prestigious American Board of Periodontology to be practicing in India, and he holds adjunct faculty appointments in the Department of Periodontology at the University of Texas Health Science Center, Houston, the Department of Bioengineering at Rice University, and at the University of North Carolina at Chapel Hill. He maintains a private practice Clarus Dental Specialities in Pune. Dr. Neel Bhatavadekar Dr. Baron Tarun Kumar A. Dr. Baron Tarun Kumar A. is a Professor the in Periodontics, and presently Heads Department of Implantology, Bapuji Dental College and Hospital. He has numerous national and International publications to his name. He is also the reviewer for several reputed international and national journals. He is a Diplomate of the International Congress of Oral Implantologists (ICOI). He pursues a keen interest in the field of Periodontal Plastic surgery , Microsurgery and Implantology.
8 Clinical 2/18 Ten essential aspects for implementing magnification in your practice This is very important to apply for DOM in clinical practice. It takes time and practice to develop an understanding of the Indirect vision. 8. Integrated Camera / / Video for External Camera Magnification should be below the elbows. There are different steps of A dental surgeon can use Image of root canal orifices as seen under a microscope. Picture courtesy: Dr.Hetal Buch In case of external camera attachments, it has to be decided prior, as the camera optics need to fit the microscope optics with adapters provided by the manufacturers . These cameras exert extra weight on the scope as compared to integrated cameras. Extra cables are required if live procedures are shown but Wi-Fi this enabled problem. cameras provide ease of maneuverability, as there is no extra weight on the scope and no extra cables. Integrated cameras solves by Dr. Hetal Buch dentistry Today magnification has all revolutionized the world. Higher around magnification with a dental operating microscope (DOM) is clearly an asset, improving the operator’s visibility and thereby the ability to diagnose and provide predictable dental care in day to day dental practice. This article will discuss ten essential aspects implementing magnification in your practice: for 1.Ergonomics Ergonomics is the ideal position of the operator in relation to the patient. With a Microscope, the ergonomics position is excellent which improves the posture of the operator. This fact alone can add years to your career as a dentist, by reducing strain on your neck and back. Neutral Body Position with support to forearms is the key for great ergonomics. Position of Operator 2. Magnification allows you to work with great comfort and relaxation between 9 o’ clock to 12 o’clock position. Shoulders should be relaxed and forearms supported for refined precise movements without trembling of hands with postural symmetry. Position of Patient 3. Position of patient is always supine and chair position headrest When working on Maxillary posteriors, the maxilla should be perpendicular to the ground. Neck hypertension is required when neck has to be turned for working on posterior teeth in maxilla and mandible. Thus, the scope can be maneuvered depending on the area of work. Position of DOM 4. The body of DOM should be perpendicular to the ground. An imaginary line drawn through both eyepieces should be parallel to ground. 5. Magnification Changer magnification. According to the area of working and need for magnification these fields are negotiated during the routine workflow. for e.g. Higher magnification needed re-treatment is Endodontics or for locating the elusive MB2, whereas, in cases of crown preps and periodontal treatment lower magnification will suffice. Steps of magnification varies according to the type of microscope and components used by the company. 6. Documentation their magnification as an excellent communication tool as they can explain diagnosis to the patient, present treatment plans and show the final layout of the treatment. Cracked tooth cases can be easily diagnosed and a live procedure can be shown to patients and dentists for education purposes by video recording. I do all my cases under microscope and document each so I can compare them and become better than I was yesterday by doing this. Indirect Vision 7. Ad register for FREE – education everywhere – no time away from and anytime the practice – live and interactive – interaction with webinars colleagues and experts – more than 1,000 archived across the globe courses – a focused discussion forum – a growing database of scientiﬁ c articles and case reports – free membership – ADA CERP-recognized no travel costs credit administration Dental Tribune Study Club Join the largest educational network in dentistry! www.DTStudyClub.com ADA CERP is a service of the American Dental Association to assist dental professionals in identifying quality providers of continuing dental education. ADA CERP does not approve or endorse individual courses or instructors, nor does it imply acceptance of credit hours by boards of dentistry. of 9. In Excellent Light Source cases Endodontic treatment, to get maximum advantage of the light source be it halogen, xenon or LED, Rubber Dam is a must. In addition to other advantages that are innumerable it allows amazing visibility and admission of light to the areas which are difficult to see and access. E.g. deep interproximal areas. A very good tip here is to first isolate the rubber dam and then go towards magnification as it will be a lot easier to implement microscope for all cases. 10. Challenges Cost of the scope, training of the staff, steep learning curve, inconvenience to take it in the flow of practice, cannot charge accordingly, back is good- no need, eyes will be tired due to magnification, it will reduce my speed of work etc.. The reality is once you start using dental operating and experience its benefits as I have done in my clinical practice, you will never want to go back to your old way of practice. My clinical world has changed totally once I have incorporated DOM into my practice. microscope Conclusion DOM has already started a revolution with regards to diagnosis, treatment and quality control in dentistry and it’s the need of the hour for a practitioner to implement magnification in day to day practice. You cannot treat what you cannot see. When you visualize the hidden detail, that is the moment where magnification works.