02 << Page 1 NEWS Dental Tribune Asia Pacific Edition | Autumn 2020 “Everyone is thinking about how to implement the necessary precautionary measures and change or modify treatment procedures while not compromising on quality and results” There are many webinars and articles on standard precautions and transmission-based precau- tions. But what does one do once you have put all the precautionary measures in place? How do you start the treatment? What are changes in protocol that you need to make with SARS-CoV-2 now em- bedded in our environment? Do we change the treatment standard operating procedures or products or delivery systems? While most of us have de- ferred elective procedures to a later date, no one knows when that will be. Just empirical treatment may not be enough sometimes. We need to know what the exact changes are, that we need, in order to make sure that we follow infec- tion prevention protocols com- pletely but without compromis- ing on the final treatment out- come. We want to continue doing quality work, so we need to adapt to the new rules of the same game which we have been playing for a long time now. You have been very active in con- ducting on-site workshops and lec- turing at conferences and institu- tions. How did you experience lec- turing online for IDEM 2020? Being part of the IDEM 2020 digital conference was an honour. I have been actively lecturing and conducting workshops on various platforms. The digital shift is quite recent. In India, I have been ac- tively doing those for some time now. But this is the first time I was part of such a huge international platform. My session was planned way in advance, and that gave me enough time to prepare. The back- end logistics were conducted smoothly. The team was very knowledgeable and focused, and made me feel very comfortable. The entire thing was seamlessly done. My sincere thanks to the Koelnmesse team and the 3M Sin- gapore team for their uncondi- tional support. How has the SARS-CoV-2 pandemic affected the dental industry in India and your day-to-day work? As with every other country, this pandemic has rocked the den- tal industry in India too. No mat- ter which part of world you are in, there’s no one who isn’t affected by this crisis. India is a highly pop- ulated country. In accordance with the seriousness of the rapid spread of SARS-CoV-2, India was under complete lockdown from mid-March to mid-July. Too many unknown factors were involved, leading to panic and fear. The government of India was very prompt and efficient in con- trolling the situation and imple- menting treatment and precau- tionary measures. There has been a huge uproar about dental work- place dangers, and the scare cre- ated because of aerosol-generat- ing procedures has taken its toll on the overall footfall of patients. Recently, we have been getting back to our routine clinical prac- tice with great caution. We are still deferring elective procedures, but most routine work has started. The Indian Dental Association and Dental Council of India moved quickly and took control of the sit- uation and implemented rules and guidelines. The infection pre- vention protocol is now strin- gently followed, and dentists are adapting to the new normal. The dental industry in India is slowly but steadily getting back on its feet. Do you think that the SARS-CoV-2 pandemic will have a long-term im- pact on dentistry and the way den- tal professionals work? I firmly believe so, but not neces- sarily only in a bad way. Of course, financially it has been a huge de- bacle, but hopefully, that is a short-term result. However, I think every situation—good or bad—can change you. I now see that awareness of infection pre- vention both in medical profes- sionals and patients has increased. That’s a collective good. Dentists today are thinking of newer and better ways to work. Everyone is thinking about how to implement the necessary precautionary mea- sures and change or modify treat- ment procedures while not com- promising on quality and results. Of course, we’ll not come out of this situation unscathed—the sooner we understand and adapt to it, the faster we’ll be on top of our game again. Poor oral hygiene could affect accuracy of SARS-CoV-2 tests Researchers assess effects of oral care on prolonged viral shedding in COVID-19 patients. By Jeremy Booth, Dental Tribune International TOKYO, Japan: A study conducted at a hospital in Tokyo has found that poor oral hygiene could lead to prolonged viral shedding in pa- tients with COVID-19. In the study, it was observed that patients with inadequate oral health regimes re- turned positive results in poly- merase chain reaction (PCR) tests for the virus long after their clini- cal recovery, leading the research- ers to believe that oral hygiene could affect the accuracy of test- ing for the virus. The researchers evaluated the course of treatment of eight COVID-19 patients who were ad- mitted to the Department of Neu- rology at Tokyo Metropolitan Neurological Hospital between 30 April and 14 May. The patients had passed the acute phase of the dis- ease, but were admitted to the dedicated medical facility for in- fectious diseases owing to per- sistent positive PCR test results for SARS-CoV-2. The study found that, among the patients, the viral shedding period—the period during which the virus was still detectable after clinical recovery—ranged from one to 40 days. The average viral shedding period was found to be 15.1 days, but for two patients, Pa- tient 1 and Patient 2, it continued for 53.0 days and 44.0 days, re- spectively. For Patients 3–8, two consecutive negative PCR test re- sults were confirmed within 18 days of clinical recovery. The researchers sought to es- tablish why Patients 1 and 2 con- tinued to test positive for the ex- tended period. They noted that Pa- tients 3–8 had kept up their per- sonal hygiene routines, which included regular toothbrushing, while hospitalised in isolation in private rooms in the hospital. Pa- tients 1 and 2, however, who had mental and/or psychiatric disor- ders, had not voluntarily brushed their teeth while hospitalised. After being instructed by the re- searchers regular toothbrushing and gargling, the PCR tests of Patients 1 and 2 re- turned a negative result within four to nine days. to practise “Patient 1 had schizophrenia and was unable to voluntarily keep herself clean during isolated hospitalised life,” the study reads. “She brushed her teeth for the first time on the 18th day of hospital- isation, but after that, she did not brush her teeth at all. Her virus shedding period reached 46 days, with consistently positive PCR test results. We speculated that her in- appropriate oral care might have caused the persistence of PCR test positivity. In collaboration with the nurse, we repeatedly encour- aged Patient 1 to brush her teeth and gargle. Two days after the start of this instruction, on the 49th day after the patient’s onset of symptoms, the patient’s PCR test result was negative for the first time.” Patient 2, who had the under- lying diseases of dissociative dis- order and mild mental retarda- tion, returned a negative PCR test result 26 days after being admit- ted to the medical facility; how- ever, the viral shedding period reached 43 days before two con- secutive negative PCR test results could be obtained. “At that time, we found that Patient 2 rarely brushed her teeth. Since then, we repeatedly instructed her to brush her teeth. With four days of inten- sive toothbrushing with only water, Patient 2 had two consecu- tive negative PCR test results on Days 44 and 47, so she was dis- charged,” the researchers wrote. They acknowledged that the low number of patients who were Researchers in Japan have proposed that effective toothbrushing and gargling could improve the accuracy of COVID-19 testing and reduce the duration of hos- pital stays. (Image: Alexey Broslavets/Shutterstock) followed in the study made it dif- ficult to draw statistical conclu- sions from the research, but noted that it was significant that the two patients with poor oral health re- gimes had displayed significantly longer than average viral shed- ding periods. “In such prolonged viral shedding cases, non-infec- tious viral nucleic acid may accu- mulate in an uncleaned oral cav- ity and may continue to be de- tected by PCR. We propose tooth- brushing and gargling to remove accumulated non-infectious viral nucleic acid, leading to consis- tently negative PCR test results and thus avoiding unnecessarily long hospital stays,” the research- ers concluded. The study, titled “Effects of oral care on prolonged viral shed- ding in coronavirus disease 2019 (COVID-19)”, was published online on 24 July 2020 in Special Care in Dentistry, ahead of inclusion in an issue.

Dental Tribune Asia Pacific Edition | Autumn 2020 ADVERTORIAL 04 BISCO DENTAL PRODUCTS The science of restorative dentistry calcium-releasing hydrophilic matrix. It offers immediate place- ment directly into the pulp cham- ber, followed by a 10-second light- cure. The THERA family of prod- ucts continues to expand, with more products currently in devel- opment that are poised to protect the remaining dental structure. “These new materials— whether they are intended to be used as pulp capping agents, lin- ers, bases, or cements—will have an impact on the clinical ap- proach of restorative dentistry and our patients,” said Dr Nuñez. “The age of drill and fill is over.” BISCO’s search for new mate- rials that are more compatible with tooth structure is far from over. And in the process of this ongoing research and develop- ment, the search will undoubt- edly unearth new science and technology—leading to ground- breaking products that simplify life in the operatory for clinicians everywhere. “BISCO has some smart peo- ple working in their kitchens,” said Dr Peifer. “I have been wowed by every BISCO product that I have used.” Support documents available at www.bisco.com *Data on file. BISCO, Inc. Groundbreaking calcium-releasing technology opens a new door for expanding the THERA family of products. Trioxide BISCO is no stranger to devel- oping groundbreaking materials. So, after witnessing the success of Mineral Aggregate (MTA) as a revolutionary end- odontic material when it came to perforation repairs, apexifica- tions, polpotomies, and pulp cap- ping, the company’s research and development team looked to the lab in an effort to apply the same science to restorative dentistry. The result was TheraCal LC. This resin-modified calcium sili- cate pulp protectant and liner sig- naled the use of a new resin and filler technology. Behind the scenes of TheraCal LC’s success and growing popularity among clinicians is a unique hydrophilic resin that allows calcium ions1 to be exchanged between the mate-rial and dentin structure— encouraging hydroxyapatite for- mation and a secondary dentin bridge.2,3 “I like TheraCal LC because it is light-cured, sets up very hard, induces secondary dentin forma- tion, and allows me to etch and rinse cavosurfaces without fear of washing it out,” said Dr Darrell Lyvers. “It also helps minimise postop sensitivity in deep carious lesions where irreversible pulpi- tis would otherwise be sequela.” A peace of mind material TheraCal LC offers precise and immediate placement through its syringe delivery, thixotropic properties, and light-cured set. In fact, simple placement is the fa- vorite feature of Dr. Jeff Peifer, who uses the material as a liner while performing direct com- pos-ite restorations and core buildups. “From the first time I used TheraCal LC, I was sold,” he said. Not unlike his peers, Dr Peifer, who practices in Gilbert, AZ, re- members the days of mixing a calcium hydroxide liner with a fluoride-releasing glass ionomer and placing it in small areas, which he said was a nightmare to keep from slumping or getting on the box prep walls. “Because of its syringe delivery, TheraCal LC is very easy to place and manipu- late in small areas,” he said. Dr Peifer also appreciates that TheraCal LC is calcium-releasing* with an alkaline pH, which pro- motes healing and apatite forma- tion2,4 while insulating the pulp.5,6 “This product gives me peace of mind when I have a deep cavity preparation,” he shared. Opening new doors The breakthrough success of TheraCal LC and its unique hydro- philic resin and filler technology led BISCO to dig even deeper into the science of restorative den- tistry and, in the process, solve even more clinical challenges. “This new filler technology opened up a new door for product development,” shared Dr Rolando Nuñez, Clinical Research Man- ager at BISCO. “Now it has become possible to develop materials that contain calcium and fluoride, which can be released via an ion exchange.” TheraCem, the second mem- ber of a growing THERA family, is a unique self-adhesive resin ce- ment that not only bonds to den-tin and various substrates— including zirconia, metal, and composite—without etching or priming, it also releases calcium and fluoride.7 After 30 minutes of polymerisation, transitions from an acidic pH, which is needed for an initial bond, to a preferred alkaline pH.8 it “I like TheraCem better than other cement products because of its ease of use, release of calcium and fluoride, and easy cleanup,” said Frisco, TX, clinician Dr. Rob- ert Beatty, adding that TheraCem allows him to cement crowns with a simplified procedure while being confident he’s creating a great seal. A Growing Family The THERA family recently added pulpotomy treatment to its list of indications with the re- lease of TheraCal PT—a dualcured resin-modified calcium silicate. After partial or full removal of the coronal pulp, it’s used to treat exposed dentin and create a pro- tective barrier around the pulpal complex. TheraCal PT is chemically for- mulated with synthetic Portland Cement silicate particles in a 5 UNIQUE BENEFITS OF USING THERACAL LC 1. Unique hydrophilic matrix facilitates calcium release* 2. Alkaline pH promotes healing and apatite formation2,4 3. Syringe delivery allows for simple and precise placement — even in small areas 4. High radiopacity allows for easy identification and differ-entiation from recurrent decay and other restorative materials — which leads to faster diagnoses 5. Moisture tolerance results in low water solubility* This article was printed with permisson of Dental Product Shopper. It was first published in Dental Product Shopper Vol. 13, No. 06.

Dental Tribune Asia Pacific Edition | Autumn 2020 NEWS 06 How dentists and pharmacists can col- laborate and improve patients health An interview with Dr Meng-Wong Taing, University of Queensland. “There is [...] a need for growing partnerships and collaborations between national professional dental and pharmacy organisations” school dental check-ups and also later in life. Growing up, I developed poor oral hygiene habits and, in hind- sight, didn’t brush my teeth prop- erly. It wasn’t until I found a proac- tive dentist who educated me on identifying plaque that I devel- oped a greater self-interest and in- creased confidence about the bet- ter management of my oral health. By following simple oral hygiene recommendations, I have been filling-free for over six years— that’s a record for me! I wish What I realised was how sim- ple it is to prevent cavities and promote good oral health. All I needed to do was make subtle changes in how I looked after my teeth—something I’d known much earlier in life. Being better educated in oral healthcare, I now feel empowered and confi- dent about maintaining my oral health and would like to promote better oral hygiene practices for everyone, particularly for the dis- advantaged, who are at a much greater risk of having poor oral health. What are the benefits of getting pharmacists more involved in pro- viding advice and services regard- ing oral healthcare? Pharmacists have great access to patients within the commu- nity, which provides them with ample opportunity to promote oral healthcare and offer advice. The average Australian visits his or her community pharmacy ap- proximately 14 times a year, and we also know from various studies that pharmacy staff express a strong interest in promoting bet- ter oral healthcare within their communities. Specifically, pharmacists may be more involved in: • identifying patients at risk of poor oral health; • implementing oral health pre- vention initiatives and providing advice on good oral hygiene and minor oral health problems; • supplying oral health products and providing evidence-based ad- vice; • informing patients about medi- cations which may affect oral health, including medicines that increase the risk of dental caries; • implementing assessment and referral pathways; • carrying out oral health promo- tion activities and events; and • addressing common risk factors in chronic diseases. What can dental professionals do to make this collaborative ap- proach a reality? I believe that the principles underpinning good collaborative working relationships are trust, open communication pathways and professionalism. The advice I give to my pharmacist colleagues that can be reciprocated by den- tists for promoting good collabo- rative working relationships in- cludes: • Get to know your local pharma- cist if you’re a dentist, and vice versa. Reach out to each other, share ideas and support each other in your clinical practices so that you aren’t isolated and feel- ing alone. • Make yourselves available for each other whenever there is need. In your busy schedules, please make sure to provide a timely re- sponse if a call is missed or a mes- sage is left. • Find ways in which you can assist each other. By talking openly about your respective needs, try to identify where you can best support each other’s practices and work hard towards achieving these goals with the aim of im- proving patient outcomes. To make this collaborative ap- proach a reality, there is also a need for growing partnerships and collaborations between na- tional professional dental and pharmacy organisations. These partnerships could support the development and implementa- tion of mutually appropriate pharmacy practice guidelines, de- cision support pathways and in- terprofessional re- sources. education Is your model specific to Australia and its approach to oral health? Is it influenced, for example, by the fact that only 53% of Australians pos- sess dental coverage? Currently, there are no established oral healthcare models within Australian community pharma- cies. What is needed is the develop- ment and evaluation of innova- tive and collaborative pharmacy- based models to address poor oral health in rural and metropolitan regions. We need to show evidence that implementation of any pro- posed model is feasible, effective and mutually acceptable by both professions. I am working with Australian dentists, university dental schools and government health departments in order to ob- tain funding for the development and testing of collaborative oral healthcare models. Dr Meng-Wong Taing. (Image: Meng-Wong Taing) By Brendan Day, Dental Tribune International A lecturer at the University of Queensland’s School of Pharmacy, Dr Meng-Wong Taing is passionate about expanding the role phar- macists play in improving their patients’ health through a collabo- rative approach. Naturally, this approach includes giving advice regarding appropriate oral health- care. In this interview, Taing dis- cusses why oral health promotion means so much to him and shows how dentists and pharmacists can work together in order to optimise patient health outcomes. Dr Taing, as someone with a back- ground in pharmacy, what first made you interested in maintain- ing oral health? Since my youth, I have had a predisposition for cavities. My parents made us brush our teeth, so I was surprised that I constantly needed fillings at my annual Dental researcher is developing more aesthetic crowns for children More aesthetically pleasing and more cost-effective alternatives to metal crowns. By Brendan Day, Dental Tribune International DUNEDIN, New Zealand: In New Zealand, one of most common methods for treating dental caries in primary teeth is the Hall tech- nique. The non-invasive method involves placing metal crowns over teeth that are only moder- ately decayed, and is relatively quick and inexpensive to per- form. Numerous issues have been reported with the type of crown used in Kiwi dental practices, however, leading a local dental re- searcher to begin developing her own restorative technology. Dr Joanne Choi, a lecturer at the University of Otago’s Faculty of Dentistry and a dental technol- ogy and materials researcher, told International Dental Tribune (DTI) that her research into the topic “began almost by chance” in 2017, when her colleague Dr Lyn- die Foster Page conducted a pre- sentation on the implementation of the Hall technique in New Zea- land. “She mentioned how parents had said that the metal Hall crowns don’t look nice,” Choi said. >> Page 07 Dr Joanne Choi, a dental technology and materials researcher, is currently de- veloping a tooth-coloured crown to be used with the Hall technique. (Image: University of Otago)

08 NEWS Dental Tribune Asia Pacific Edition | Autumn 2020 COVID-19 and the potential for dental reform An interview with Professor Richards Watt, University College London. By Brendan Day, Dental Tribune International Though the spread of SARS-CoV-2 has had an undeniably deleterious effect on many elements of the dental world, it has also opened up new possibilities for imagining how dentistry should be deliv- ered. That is the contention of Dr Richard Watt, professor of dental public health in the Department of Epidemiology and Public Health at University College Lon- don, in a recent letter to The Lan- cet. Watt spoke with Dental Tri- bune International about how points of emphasis in dentistry may change in a post-pandemic world. Prof. Watt, could you please ex- plain how the current pandemic has helped to highlight opportuni- ties for reform in dentistry? The COVID-19 pandemic has highlighted some of the underly- ing problems that dentistry is fac- ing globally. As many of us are aware, dentistry is recovering slowly, and in different countries, various issues have cropped up, but there are some common agen- das that we really need to begin to tackle. One of these issues is the lack of an emphasis on prevention in dentistry, either delivered within clinical settings or across community and public health are- nas. This was one of the main points I was trying to get across in my letter. What kinds of steps can, or should, be taken to implement these re- forms? I think the first thing to stress when dealing with such issues is that it’s not just simple reform; it’s not a straightforward issue. For many, many years, the dental pro- fession has recognised that pre- vention is important, and changes have been made in some coun- tries to address this. Largely, how- ever, dentistry remains a treat- ment-centred service, and that ap- proach is something that needs system-level reform. It’s not about the individual dental practitioner or the dental team, but instead it is the system of the delivery of den- tistry that needs to change. Sys- tem reform requires discussions to take place at the local and na- tional level between practitioners, policymakers and funding agen- cies in order to figure out how pre- vention can be strengthened in the dental practice, as there’s no one system that fits all circum- stances. creasingly implemented during the pandemic, can work to help reduce inequalities in dental access in the long term? identify opportunities that are beyond what has been done his- torically in terms of promotional materials and equipment. Yes, I think that is the case. In parts of the world such as Austra- lia, you have rural communities that are very isolated geographi- cally, and so, rather than expect- ing them to travel to a city for treatment, a notion like teleden- tistry should be explored for its potential to improve access for them. During this pandemic, are there any countries that you think have provided examples for how reform can be introduced into dentistry at a systemic level? It’s a bit too soon to say for sure, since we’re still very much in the middle of the pandemic. How- ever, if we consider the UK as an example, we can see how the role of many dental professionals has changed during this time owing to their redeployment. When den- tal services were shut down in the UK—as they were in many coun- tries—thousands of dental per- sonnel were redeployed to other areas of the healthcare system, ei- ther to support efforts to combat the pandemic or to provide other forms of healthcare beyond den- tistry. And that’s quite an amazing shift, because it changed the pro- fessional boundaries of what den- tists can do. Over the last few months, these kinds of changes have shown how radical shifts can happen quickly, even at a systemic level. Many major dental companies have experienced massive losses throughout this pandemic. Do you think this could have an impact on the provision of dental services and will this potential impact be posi- tive or negative? I think that’s an important point. I think very few people are very confident in their predic- tions of how the pandemic is going to pan out economically, but we know that there are already increased unemployment num- bers. If people are unemployed, they’re unlikely to go to the den- tist to get new crowns, bridgework or other forms of expensive treat- ment. So the effects on dentistry, and the wider dental industry, are potentially massive. It is hard to know at this stage how much of an economic bounce- back there will be and how long that will take. If I were working in the dental industry, I would be looking at trying to diversify and IMPRINT PUBLISHER AND CHIEF EXECUTIVE OFFICER Torsten R. Oemus CHIEF CONTENT OFFICER Claudia Duschek MANAGING EDITOR Franziska Beier ASSISTANT EDITORS Jeremy Booth, Brendan Day, Monique Mehler, Iveta Ramonaite COPY EDITORS Sabrina Raaff, Ann-Katrin Paulick AD PRODUCTION Marius Mezger DESIGNER Maria Macedo Dental Tribune International GmbH Holbeinstr. 29, 04229, Leipzig, Germany Tel.: +49 341 48474-302 Fax: +49 341 48474-173 GENERAL REQUESTS: info@dental-tribune.com SALES REQUESTS: mediasales@dental-tribune.com www.dental-tribune.com Material from Dental Tribune International GmbH that has been reprinted or translated and reprinted in this issue is copyrighted by Dental Tribune International GmbH. Such material must be published with the permission of Den- tal Tribune International GmbH. Dental Tribune is a trademark of Dental Tribune International GmbH. All rights reserved. © 2020 Dental Tribune In- ternational GmbH. Reproduction in any manner in any language, in whole or in part, without the prior written permission of Dental Tribune Inter- national GmbH is expressly prohibited. Dental Tribune International GmbH makes every effort to report clinical information and manu- facturers’ product news accurately but cannot assume responsibility for the validity of product claims or for typographical errors. The publisher also does not assume responsibility for product names, claims or statements made by advertisers. Opi- nions expressed by authors are their own and may not reflect those of Dental Tribu- ne International GmbH. AD www.dental-tribune.com Prof. Richard Watt. (Image: Richard Watt) “The pandemic has [...] had the most effect on those populations that are the most vulnerable and disadvantaged” To be fair, these are big issues that don’t have any quick, easy an- swers. But I think it’s important that, as a profession, we debate and discuss these bigger issues be- cause, at a time of crisis, there is an opportunity for us to really think through what the future holds. Do you think that the fact that SARS-CoV-2 has affected every- one’s lives, not just those who suf- fer from oral health inequalities, will have an impact on the poten- tial for reform in an area like den- tistry? In broader discussions taking place in the media, in academia, and so on, almost all sectors are taking stock of where they are and what this pandemic has meant to them. And overall, there seems to be a shared view that we don’t nec- essarily want to go back to how things were pre-COVID-19, not least of all because certain things are unlikely to ever be re-estab- lished. In a lot of countries—certainly across Europe—the pandemic has disrupted daily life for many, but it has, however, had the most ef- fect on those populations that are the most vulnerable and disad- vantaged. This was already a prob- lem in dentistry, since it often hasn’t managed to provide care for disadvantaged groups to the same extent as it has for other groups. So providing access to dental care for those groups who suffer from inequalities remains a challenge that we need to address. Do you think that a measure such as teledentistry, which has been in-