DENTAL TRIBUNE The World’s Dental Newspaper · Asia Paciﬁc Edition PUBLISHED IN HONG KONG www.dental-tribune.asia GIANT PANDA TEETH Scientists from China and US have discovered what is the key to pan- das’ teeth lasting a lifetime. Their obsevations inspire the design of artificial durable ceramics. ” Page 02 SUBSIDISE DENTAL WORK Lower sio-economic groups in New Zealand cannot afford dental treat- ments. Government should be loo- king for more ways to better sub- sidise dental care for adults. ” Page 04 VOL. 18, NO. 02 INTERVIEW Dr Jongho Choi, Brush Monster co- founder and CEO of Kitten Planet, talks about an interactive mobile app that teaches children healthy brushing habits. ” Page 11 Scientists discover oral cancer biomarkers associated with patient survival By DTI DUNEDIN, New Zealand/KOLKATA, India: In a recent study, researchers have discovered epigenetic mark- ers that are markedly different in oral cancer tissue compared with the adjacent healthy tissue in pa- tients. This study is one of the first to identify epigenetic markers in oral cancer. Identifying these mark- ers could help detect early signs of cancer and significantly improve patient survival rates. The study was conducted by re- searchers from the University of Otago in New Zealand and the Indian Statis- tical Institute (ISI) in Kolkata. The re- search team recruited 16 oral cancer patients in India who either smoked or chewed tobacco or had mixed hab- its, and took samples of their tumours and adjacent tissue. After isolating the DNA in the samples, the research- ers discovered regions with altered epigenetic profiles in tumour cells compared with adjacent cells. The findings of a new study could help decrease high oral cancer mortality in developing countries. (Photograph: Matej Kastelic/Shutterstock) Epigenetics can alter gene ex- pression in cancer cells without changes to the DNA sequence and can cause tumour progression. “This phenomenon is relatively new and understudied, particularly in oral cancer. This study is one of the first to identify epigenetic markers Green light for XIVIA Xylitol dental health claims By DTI in oral cancer, using cutting-edge approaches,” said co-author Dr An- iruddha Chatterjee, Senior Research Fellow and Rutherford Discovery Fellow in the Department of Pathol- ogy at the Dunedin School of Med- icine at the University of Otago. The findings showed that the arrange- ment of a certain epigenetic mech- anism, called DNA methylation, might be responsible for dictating gene expression and the spread of abnormal cells. “By validating in a larger cancer cohort, we have shown that a subset of these biomarkers is significantly associated with poor prognosis of patients,” Chatterjee said. The age-adjusted incidence of oral cancer in the world is estimated at four cases per 100,000 people, according to the World Health Or- ganization. This oral disease is more common in men and in older people, and varies considerably by socio-economic condition. Accord- ing to the 2019 report of “India Against Cancer”, of the 300,000 cases of tobacco-associated oral cancer detected globally, 86 per cent are from India. Additionally, late diagnosis and poor prognosis are key problems associated with the high mortality rate of this cancer in developing countries. The re- search group was surprised to find such broad differences in the oral cancer tissue compared with adja- cent healthy tissue in the same pa- tients. “We were also surprised to see that small molecules, called microRNA, were methylated or de- methylated in the tumours from smokers or chewers or mixed habits, suggesting that therapeutic inter- vention might be different in pa- tients depending on the way the tobacco was abused,” said lead author Dr Roshni Roy, professor in the Department of Pathology at the University of Otago. AD at an effective daily dosage adjusted from 10–25 g down to 5–10 g, a sim- ilar amount to that of international dental association standards. In South Korea, functional ingre- dients that have received a health claim approval undergo a mandatory re-evaluation every ten years. With the latest re-approval, DuPont Nutri- tion & Health continues to work with manufacturers to create sugar-free products with oral health in mind. XIVIA Xylitol is claimed to de- liver sweetness at 50 per cent of the calorie level of sugar. In addition, it is preferred for its relatively low glycaemic index, which makes it suitable for diabetic and health-con- scious consumers. In addition to replacing sugar in chewing gum and other confectionery applica- tions, xylitol is commonly incor- porated into oral hygiene products, including toothpaste, mouthwash and teething gels. Distinguished by innovation Healthy teeth produce a radiant smile. We strive to achieve this goal on a daily basis. It inspires us to search for innovative, economic and esthetic solutions for direct ﬁlling procedures and the fabrication of indirect, ﬁxed or removable restorations, so that you have quality products at your disposal to help people regain a beautiful smile. www.ivoclarvivadent.com Ivoclar Vivadent AG Bendererstr. 2 | 9494 Schaan | Liechtenstein Tel. +423 235 35 35 | Fax +423 235 33 60 DuPont Nutrition & Health is the first company in South Korea to receive re- approval for xylitol health claims. (Photograph: morisfoto/Shutterstock) IHEONGJU, South Korea: South Ko- rea’s Ministry of Food and Drug Safety has issued a re-approval of the health claim that consumers from 3 to 80 years old of the sweet- ener XIVIA Xylitol have a reduced risk of dental caries. The manufac- turer, DuPont Nutrition & Health, is the first company in the country to receive such re-approval. In the re-evaluation of the sweet- ener, the ministry reviewed 146 re- search reports, including 94 clinical trials, and concluded that XIVIA Xy- litol helps reduce the risk of caries
02 ASIA PACIFIC NEWS Dental Tribune Asia Paciﬁc Edition | 02/2019 Scientists draw inspiration from giant panda teeth By DTI SHENYANG/HEFEI/LANZHOU, Ihina/ BERKELEY, Ialif., US: Tooth enamel protects teeth over the lifetime of an organism by providing a hard surface resistant to wear and tear and by withstanding impacts with- out breaking. According to research- ers, the giant panda has particularly resistant tooth enamel, which can recover its structure and geometry to counteract the early stages of damage. The team which investigated the tooth structure of the panda was made up of researchers from the Institute of Metal Research of the Chinese Academy of Sciences in Shenyang, the University of Sci- ence and Technology of China in Hefei, Lanzhou University of Tech- nology in Lanzhou and the Univer- sity of California, Berkeley in the US. They believe their observations could be replicated in the tooth enamel of all vertebrates, including humans, and inspire the design of artificial durable ceramics. “Tooth enamel possesses an ex- ceptional durability and plays a critical role in the function of teeth, however, [it] exhibits a remarkably low resistance to the initiation of large-scale cracks comparable to geological minerals,” said Prof. Rob- ert O. Ritchie, who led the study. The ingenious design of the pan- da’s tooth enamel, which has to with- stand a daily diet of bamboo—a ma- Hydration plays a key role in the process. The viscoelasticity of the organic-rich matrix surround- ing the mineral prisms and fibres facilitates self-recovery, while the presence of water decreases the width of any cracks that do form, with only a minor cost in terms of hardness. “Our findings identify a novel means by which the tooth enamel of vertebrates develops an excep- tional durability to accomplish its functionality,” added Liu. “The self-recovery process represents a new source of durability that dif- fers markedly from the conventional protocol of fracture mechanics.” As the architecture of the pan- da’s tooth enamel is essentially sim- ilar to that of other vertebrates, the researchers believe that this self-re- covery behaviour is likely to occur in tooth enamel in general. “Our findings also offer inspiration for the development of artificial, dura- ble, self-recoverable ceramic mate- rials,” said Ritchie. The team is hop- ing to develop tooth enamel-inspired self-recoverable durable materials by introducing shape memory poly- mers at the interface of ceramics. The study, titled “Hydration- induced nano - to micro -scale self-recovery of the tooth enamel of the giant panda”, was published in the November 2018 issue of Acta Biomaterialia. Scientists from China and the US have discovered that hydration is the key to pandas’ teeth lasting a lifetime. (Photograph: Hung Chung Chih/Shutterstock) terial of remarkable strength and toughness—comprises parallel mi- cro-scale prisms made up of verti- cally aligned nanoscale fibres of the mineral hydroxyapatite embedded in an organic-rich matrix. When there is an impact on the enamel, a variety of different deformation mechanisms take place to mitigate the growth of small cracks and pre- vent the formation of large cracks. “The tooth enamel is capable of partially recovering its geometry and structure at nano- to micro-scale di- mensions autonomously after defor- mation to counteract the early stage of damage,” explained first author Zengqian Liu. “[This] property results from the unique architecture of tooth enamel, specifically the vertical align- ment of nanoscale mineral fibres and micro-scale prisms within a water-re- sponsive organic-rich matrix.” New oral appliance could help manage sleep apnoea By DTI went mandibular advancement ap- pliance (MAA) therapy. The research- ers used multi-slice computed to- mography in order to measure the regional effects of the appliance on the upper airway. “This is like when you have to use glasses. You have to wear them every time you want to see prop- erly so [patients] have to wear this appliance every time [they] want to sleep better,” said study co-au- thor Dr Hiroshi Ueda, an associate professor in the Graduate School of Biomedical and Health Sciences at Hiroshima University. Previous research typically mea- sured patients standing up, a tech- nique that does not simulate sleep- ing conditions. The current study measured the change in airway space of patients lying flat. It demonstrated that the proportional size of the soft-tissue volume, that is, the soft palate and tongue in the oro-hypo- pharyngeal region, significantly de- creased when the patient was wear- ing an MAA. This forward displace- ment of the soft tissue thereby in- creased the retro-glossal airway space, except the nasopharynx, three-dimensionally and therefore allowed for easier breathing. According to the researchers, further investigations that focus on 3-D airway enlargement analy- sis of various sites affected by MAA therapy are required in a larger number of patients with OSA. This would help scientists understand the pathogenesis of OSA and the clinical applicability of MAA fully. The study, titled “Multislice computed tomography assessment of airway patency changes associ- ated with mandibular advancement appliance therapy in supine pa- tients with obstructive sleep apnea”, was published online on 3 March 2019 in Sleep Disorders. Scientists from China and the US have discovered that hydration is the key to pandas’ teeth lasting a lifetime. (Photograph: Hung Chung Chih/Shutterstock) HIROSHIMA, Japan: Researchers have recently developed a novel treat- ment to improve the quality of sleep for patients who suffer from mild to moderate obstructive sleep ap- noea (OSA). Using 3-D imaging of the airways with the patients su- pine to simulate sleeping condi- tions, the study confirmed that the treatment is effective at opening the airways and warrants further collaboration between dentists and doctors in the treatment of sleep apnoea. The treatment was developed by researchers from the Depart- ment of Orthodontics at Hiroshima University Hospital. The partici- pants included eight men and five women who were diagnosed with mild to moderate OSA and under-
Dental Tribune Asia Paciﬁc Edition | 02/2019 ASIA PACIFIC NEWS 03 State government bans advertising of junk food on publicly owned space By DTI BRISBANE, Australia: An unhealthy diet can be a contributing factor to poor oral and general health, and advertising plays a key role in this regard. Seeking to curb this, the Queensland government has an- nounced a ban on the promotion of unhealthy food and drinks on the advertisement spaces it owns. The move is the first of its kind by an Australian state. increased availability of free water, in schools, government institutions, children’s sports and places fre- quented by children. In addition, Rethink Sugary Drink suggested the creation of state and local gov- ernment policies that reduce the availability of sugary drinks in workplaces, government institu- tions, healthcare settings, sports and recreation facilities, and other public places. AD Tetric® N-Line High-quality composites for esthetic anterior and posterior restorations High-quality composites for esthetic anterior and posterior restorations In a move that is the first of its kind in Australia, the Queensland government has announced a ban on the promotion of unhealthy food and drinks on the advertisement spaces it owns. (Photograph: beats1/ Shutterstock) Rethink Sugary Drink, a part- nership of 19 leading health and community organisations, includ- ing the Australian Dental Associa- tion, praised the decision. In a state- ment, Craig Sinclair, head of the prevention division at Cancer Coun- cil Victoria, a partner of Rethink Sugary Drink, placed particular focus on the need to provide sup- portive, healthy environments for children where the considerable negative impact on sugary drinks can be tackled. “Whether that is on their walks to school, while waiting for the bus or even when visiting sports and community centres, the presence of sugary drink marketing is over- whelming, making messages about healthier options more difficult to hear,” noted Sinclair. In addition to praising the de- cision by the Queensland govern- ment, Rethink Sugary Drink rec- ommended a public education cam- paign supported by government that highlights the health impacts of consuming drinks high in sugar. The group also proposed compre- hensive mandatory restrictions by state governments on the sale of sugar-sweetened drinks, as well as One efficient solution for all cavity classes MORE THAN MIO . s e r u g ﬁ l s e a s n o d e s a B * RESTORATIONS PLACED* Ivoclar Vivadent AG Bendererstr. 2 | 9494 Schaan | | Tel. +423 235 35 35 | Fax +423 235 33 60
04 ASIA PACIFIC NEWS Dental Tribune Asia Paciﬁc Edition | 02/2019 Lower socio-economic groups in New Zealand cannot afford urgently needed dental procedures By DTI AUIKLAND, New Zealand: Socially disadvantaged adults in New Zea- land cannot afford dental treat- ments, even if in great pain, result- ing in dangerous do-it-yourself procedures. Consequently, various representatives of the health sector are calling for the government to take action. In a recent statement, the New Zealand Dental Association (NZDA) called for better government fund- AD PRINT EVENTS EDUCATION DIGITAL SERVICES Dental Tribune International The World's Dental Marketplace www.dental-tribune.com ing to enable low-income adults to access dental care. Even though New Zealand adults have experienced great improvements in oral health since the 1980s, still many patients only visit a dentist when a dental problem occurs, and in particular, low-income adults see the cost as a significant barrier. “Some truly cannot afford care, and for these groups we must do better, and that involves working with government on a better deal,” said Dr Bill O’Connor, President of the NZDA. The New Zealand Dental Association is urging the government to provide affordable dental care for adults. (Photograph: Andrey_Popov/ Shutterstock) Mike Naera, health advocate in Rotorua, commented: “Maori are over-represented in the lower so- cio-economic demographic and they sacrifice everything so they can live day-to-day. A lot of [them] can’t afford dental work so their options are to remain in pain or extract their teeth themselves. The consequences of paying for dental care would be sacrificing food on the table. The government should be looking for more ways to better subsidise dental work so our fami- lies don’t have to keep suffering.” According to Dr Sherry Sembhy, from Rotorua Dentists, self-den- tistry is dangerous, as people do not know what they are doing, do not understand the anatomy of their teeth and use unsterile tools, which make the condition only worse. Infections, abscesses, swell- ing and broken teeth and jaws were some of the possible outcomes of the home procedures which Sem- bhy said could end up costing even more in repairs.
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08 ASIA PACIFIC NEWS Dental Tribune Asia Paciﬁc Edition | 02/2019 New research provides faster cheaper method to treat periodontitis By DTI SENDAI, Japan: Periodontitis affects many people and can have serious effects on oral health. In new re- search originating from Japan, sci- entists have developed a cell-based regenerative therapy approach. The proposed therapy design promises to address periodontitis without some of the shortcomings and lim- itations of regenerative therapies to date. According to the researchers from Tohoku University in Sendai, the therapy will be faster and cheaper. “The use of cell-based ther- apies is a promising approach to treat human disease. This kind of treatment paradigm is important because commercially available stem cells that represent a cell-based therapy specifically developed to treat periodontal tissue regenera- tion will reduce time and cost while improving quality assurance,” said lead author Prof. Masahiro Saito, from the Department of Restorative Dentistry at Tohoku University Graduate School of Dentistry. In a new approach to the treat- ment of periodontitis, the research- ers transplanted stem cells from healthy mini pigs to those who had periodontal defects and, by doing so successfully, overcome the short- comings that can be associated with autologous stem cell treatments. By using this mini pig periodontal Researchers in Japan have developed a new method to treat periodontitis that they believe will be faster, cheaper and more effective than anything available today. (Photograph: Sergii Kuchugurnyi/Shutterstock) defect model, they demonstrated that allogeneic adipose-derived mesenchymal progenitor stem cells (ADMPCs)—mesenchymal stem cells (MSCs) derived from fat tis- sue—are safe and effective for the treatment of periodontitis. “Our study demonstrates that ADMPCs appear to be safe and not triggering an immune response in allogeneic settings, and as such it ex- plores the potential use of allogeneic MSCs for tissue regeneration. The study is a powerful first step towards further development of stem cell- based therapy for the treatment of periodontal disease,” explained Saito. The study, titled “Periodontal regeneration by allogeneic trans- plantation of adipose tissue derived multi-lineage progenitor stem cells in vivo”, was published on 29 Janu- ary 2019 in Scientiﬁc Reports. The study was conducted in collabora- tion with researchers from Osaka University in Osaka and Fujita Health University in Toyoake. Study links frailty to poor oral health By DTI MELBOURNE, Australia/LONDON, UK: It is widely known that poor nutri- tion is a risk factor for frailty. Simi- larly, the link between nutrition and oral health status has been estab- lished in numerous studies. New research has bridged the gap between these two relationships, however, and found that poor oral health is independently associated with frailty. The study, conducted by re- searchers at the Monash Aging Re- search Centre at Monash University in Melbourne, assessed the oral health, nutrition and frailty of 168 New research shows that elderly people who suffer from frailty are substantially more prone to issues with their oral health. (Photograph: Lisa S./Shutterstock) hospitalised geriatric patients over six months using previously vali- dated tools. create a series of challenges for how we care for the population’s oral health,” he said. The results show that elderly people who suffer from frailty are substantially more prone to issues with their oral health. Frailty is linked to a reduced ability to bite and chew food, as well as sensitiv- ity to hot and cold food and drink. The study also revealed that frail adults are more likely to feel self-con- scious about their teeth, gingivae or dentures and are less likely to access dental care. Previously, experts have iden- tified a relationship between frailty and difficulties with speech and with taking medication for oral pain. Dr Nigel Carter, OBE, Chief Ex- ecutive of the Oral Health Founda- tion, a UK-based charity, stated in a press release regarding the study that the oral health of older people remains an ongoing issue. “In the UK, people are living longer than ever before. This will increase the amount of poor health, frailty and disability. In turn, it will “The first problems to occur are often because of a loss of dex- terity. Limited mobility, no mat- ter how small, can have an ex- tremely large effect on our ability to care for our own health. In terms of oral health, this means effec- tive toothbrushing becomes much harder. Balanced nutrition also becomes more difficult,” he con- tinued. Carter called on the UK gov- ernment to provide greater access to dental services for frail adults in hospitals, as well as for those in nursing homes, and to provide better oral health training for car- ers. “The government must find such proactive solutions if they are to address the health needs of an ageing population,” Car ter stated. The study, titled “Frailty, oral health and nutrition in geriatrics inpatients: A cross¯sectional study”, was published online in Gerodon- tology on 12 March 2019 ahead of inclusion in an issue.
Dental Tribune Asia Paciﬁc Edition | 02/2019 WORLD NEWS 09 Survey shows fear of being sued often leads to stress and anxiety for dentists By DTUK LONDON, UK: Often, dentistry-re- lated stress is only looked at through the lens of the patients’ experience and their fear of dental procedures. A recent survey, however, has found that there is an entirely different source of stress and anxiety for dental professionals in the UK: the fear of being sued, receiving a claim or complaint, or being the subject of an investigation by the General Dental Council. The survey was conducted by Dental Protection, part of the not- for-profit Medical Protection Soci- ety for doctors, dentists and health- care professionals. It asked more than 1,100 UK-based dentists for feedback regarding the sources of their work-related stress, and 77 per cent responded that the fear of being sued by an unsatisfied pa- tient had caused them to become stressed and anxious. A recent survey of more than 1,100 UK-based dentists found that the fear of being sued by an unsatisfied patient is a primary source of work- related stress. (Photograph: VH- studio/Shutterstock) The results of the survey come just months after the findings of an analysis published in the British Dental Journal showed that general dental practitioners exhibit the highest levels of stress and burn- out among UK dentists. The find- ings of this research suggested that, while practice ownership could possibly reduce burn-out due to regulatory stress, it does not posi- tively influence patient-led stress for dentists. Remarking upon the findings of the survey, Dr Raj Rattan, MBE, Dental Director at Dental Protec- tion, said: “Stress can impact on a dentist’s health and practice in a number of ways. It can affect con- fidence, clinical judgement, morale and even lead to performance is- sues. Research confirms that high stress levels affect performance and increase the potential for ad- verse outcomes of error. These may in turn spark patient complaints and claims and a self-perpetuating vicious circle is established.” “Modern life is full of challenges, stressors and pressures—and the dental profession is no exception. Dental Protection would like to en- courage dentists to seek help and advice to manage the condition be- fore it causes irreversible changes to health and well-being,” he con- cluded. AD SIGN UP NOW! The world's dental e-newsletter Stay informed on the latest news in dentistry! www.dental-tribune.com
10 WORLD NEWS Dental Tribune Asia Paciﬁc Edition | 02/2019 Case report presents rare incidence of retained tooth in nasal cavity By DTI AARHUS, Denmark: Besides everyday diagnoses, there are some real rari- ties to be found in the world of med- icine. This was true for a patient at the Department of Otorhinolaryn- gology, Head and Neck Surgery of the Aarhus University Hospital. After two years of a stuffy and runny nos- tril and the loss of his ability to smell, doctors discovered that a retained tooth growing in his nasal cavity was the reason for his symptoms. AD A CT scan of the 59-year-old pa- tient revealed a mucus-covered mass on the floor of his nasal cavity. As a result, the doctors suspected that the patient had either a dermoid cyst—a growth that some people are born with that contains struc- tures such as hair, teeth, fluid or skin glands—or an impacted tooth. The medical team decided to use an endoscope to perform a surgical extraction. The examination of the extracted mass revealed the retained tooth, which was covered with in- flamed nasal tissue. Usually, a condition like this is caused by trauma, infections from a cyst, or developmental disturbances such as cleft lip or cleft palate, but the doctors had no obvious expla- nation for this particular case, as stated in their report. “Our patient most likely had the intranasal retained tooth most of his life, but had late onset of symp- toms,” stated co-author Dr Milos Fuglsang, who had carried out the tooth extraction. According to the BMJ, only 23 patients have been identified as ex- periencing similar incidents over a period from 1959 to 2008. It is most common in males and more com- mon among adults than children. For Fuglsang, this was the first case of its kind in his medical career. The case report, titled “Retained tooth in the nasal cavity: A rare cause of nasal congestion”, was published on 21 February 2019 in BMJ Case Reports. The retained tooth shortly after it was removed from the patient’s nose. (Photograph: 2019 BMJ Case Reports)
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