PUBLISHED IN DUBAI www.dental-tribune.me 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 den- tist’s ofﬁce what oral health prob- lems 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 insuf- ﬁciency 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 com- pared 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 dis- ease. In dentistry, we say: one either loves it or leaves it. With every one of my young pa- tients, 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 medi- cal histories in particular requires sensitive handling in order to build trust, which is the foundation of suc- cessful treatment. Intuition, taking sufﬁcient time, patience and empa- thy 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 endorse- ment 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 tran- sition phase; from child to adult. After careful paediatric treatment, a deterioration of the condition is frequently reported during the tran- sition phase. For example, we treat patients with cystic ﬁbrosis, con- genital 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 dis- eases 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 congeni- tal 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 spe- cialists in other disciplines should be consulted before dental work com- mences 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 pre- existing 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, well- being and aesthetics. For children with systemic disease, however, an intensive prophylaxis can have major implications for their general health, for example, should patho- genic bacteria enter the bloodstream of a child, say, with immunosuppres- sion. You work with children who have congenital disease. You have con- ducted interesting studies on the prevalence of caries and gingivitis. What have your results been? If one considers the tooth decay pro- cess of healthy children in Germany 20 years ago, about ﬁve teeth were affected by tooth decay, while today, only one tooth on average is affect- ed. Up to 85 per cent of 3-year-olds have no caries; however, the remain- der 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 demon- strably higher prevalence of caries. On average, four to seven teeth are affected. Children with kidney dis- ease have a risk of caries comparable to that of healthy children; however, this group presents a much higher risk of developing gingivitis. Gingi- vitis could thus be understood as enabling bacteria to enter the blood- stream. Children with cystic ﬁbrosis also have a very low caries preva- lence, but owing to the frequent in- take of antibiotics, the composition of their saliva is altered, so in this patient group, frequent enamel hy- poplasia 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 dis- ease 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 differ- ent. It is therefore not surprising that, with bacteraemia, oral strep- tococci, in particular the viridans streptococci, can be detected. Blood cultures reveal, for example, that vir- idans streptococci, as part of the oral cavity, are also responsible for 50 per cent of infectious endocarditis cases. Of course, bacteraemia does not au- tomatically 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 upcom- ing heart surgery. How frequently does bacteraemia develop after dental procedures? Occult bacteraemia can result from routine activities such as tooth- brushing, but of course also through different dental procedures. Bacte- raemia develops most frequently after surgeries like tooth extrac- tions. Here, the frequency is usually 100 per cent. These bacteria can be released during periodontal proce- dures, such as scaling and root plan- ing, 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 bacte- ria, but the picture is different for pa- tients with systemic disease, particu- ÿPage C2
C2 ◊Page C1 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 dif- ﬁcult to diagnose carious lesions. We do, however, have an excellent work- ing relationship with our colleagues from the paediatric clinic. They are well trained and refer patients to us promptly and regularly for check- ups before surgical procedures. You also mentioned cystic ﬁbro- sis, a congenital metabolic disease that leads to the formation of thick mucus, for example in the lungs, intestine and liver. What interac- tions have you observed between HYGIENE TRIBUNE Dental Tribune Middle East & Africa Edition | 6/2018 Dr Karolin Höfer, Germany AD 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 pneumo- nia. These patients are under con- stant 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 ex- ample, is lung infections, which can be triggered by bacteria like Pseu- domonas aeruginosa. This risk can be prevented by using an external water supply. What measures do you recom- mend to reduce the risk of bacte- raemia for these risk groups? We are currently conducting an in- tervention study in collaboration with the paediatric nephrology di- vision at the University of Cologne. In addition to treating gingivitis through intensive prophylaxis, the goal of the clinical trial is to deter- mine the bacterial risk after tooth- brushing. 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 check- ups and instructions, and to imple- ment an interdisciplinary preven- tion 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 high- risk patients adapted to their indi- vidual needs. What are your recommendations for parents? I would like children to look forward to their dental appointment with me. Through a very intensive rela- tionship with the children and their relatives, I replace the cliché of an un- comfortable 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 dis- ease, oral hygiene is not their top pri- ority. 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 enormous- ly 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 chil- dren as quickly as possible and main- tain it for the long term through indi- vidual prevention programmes. The treatment of children with systemic disease should always take place in consultation with the treating paedi- atrician. Every practice staff member should contribute to paediatric den- tistry being perceived by parents as a specialist ﬁeld in interdisciplinary cooperation with paediatricians and serving the well-being of their chil- dren.
Dental Tribune Middle East & Africa Edition | 6/2018 HYGIENE TRIBUNE C3 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 breast- and 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 formula- fed babies and that breastmilk and saliva interactions boost innate im- munity by acting in synergy to regu- late 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 micro- organisms were considered patho- genic or commensal in an infant’s mouth. “Our ﬁndings suggest that breast- milk 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 acti- vates the lactoperoxidase system, which produces additional com- pounds 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 breast- milk and saliva combinations on the in vitro growth of oral pathogenic and commensal microorganisms”, was published online in Scientiﬁc Re- ports on 11 October 2018. According to the research team, the composition of a baby’s mouth mi- crobiota 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 identiﬁca- tion of oral squamous cell carcinoma (OSCC), researchers in Brazil have found a correlation between the can- cer’s progression and the abundance of speciﬁc proteins present in tumor tissue and saliva. The discovery of- fers 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 break- through,” said contributing author Adriana Franco Paes Leme, a re- searcher at the Brazilian National Bioscience Laboratory—part of Na- tional Energy and Materials Research Center (CNPEM) in São Paulo. During the ﬁrst phase of the study, researchers used laser microdis- section and proteomics to map the proteins in mouth cancer tissue and correlate them with the clinical char- acteristics of the patients. This analy- sis enabled the identiﬁcation of sev- eral proteins, such as CSTB, NDRG1, LTA4H, PGK1, COL6A1, ITGAV and MB—with differing levels of abun- dance 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 us- ing 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 ob- tained 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 Founda- tion, with the research conducted at the National Energy and Materials Research Centre. 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 cer- vical 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 strate- gies. “The data led to robust results that are highly promising as guides to de- ﬁning 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 reliabil- ity of the ﬁndings and showing that these markers are effective in clas- sifying 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 bio- sensors that are capable of detecting prognostic signatures in patients’ saliva. The study, titled “Combining discov- ery and targeted proteomics reveals a prognostic signature in oral can- cer”, 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 Com- puting, the University of São Paulo’s Mathematics and Computer Science Institute in São Carlos, the Dental School of the West Paraná Univer- AD save the date 08 NOVEMBER 2019 InterContinental Hotel Dubai Festival City DUBAI, UAE Part of 11th Dental Facial Cosmetic Conference & Exhibition Contact Us Mobile: +971502793711 Telephone: +971 4 347 6747 E-mail: email@example.com www.cappmea.com/aesthetic www.facebook.com/CAPPDHS ORGANISED BY
4 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 Hygien- ist 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