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4 Huge Changes to Dental Education

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In June 2016, I started a summer KCL’s iTEL Hub. iTEL is short for, “Informatics and Technology Enhanced Learning”. The aim of the department is to enhance learning and teaching using technology, which gave me a unique insight into the future of how learning in dentistry might look like.

One of the highlights of the job was helping to develop resources for the King’s College London Dental Institute collaboration with BYBO, one of China’s largest dental providers. This collaboration meant creating an online virtual learning environment for dentists in China, working for the BYBO Dental Group.

 

Utilising Technology

Textbooks have historically been viewed as the bread & butter of self-study at university, however, the age-old traditions of reading chunky library textbooks are slowly being challenged and replaced with a simple web search.

Over the last decade, many universities in the UK, have been investing in e-learning environments. The popularity of resources such as Khan Academy’s lectures & e-learning courses over traditional lectures has proven that online lectures are slowly but surely superseding live lectures. The advantages of this are numerous – for students, you can listen to lectures at will, at any time, with the simple ability to pause, rewind & speed up the recording helping students learn at their own pace. For institutes, this saves time & money, allowing lecturers to pre-record the perfect lecture, in multiple takes, meaning that they only have to re-do parts of it when the information becomes outdated, instead of presenting the same lecture, over and over.

Within dentistry, the success of movements such as Tooth Wise for dental news & Dentinal Tubules for webinars shows that the next generation is moving away from textbooks. Instead, they are searching for a more streamlined way to learn. Webinars & online courses geared towards dentists are becoming increasingly prevalent.

 

More Simulation-Based Learning

First came the radio, then the TV, then 3D technology. Now, Virtual Reality headsets have become a reality, with augmented reality poised to revolutionise industries such as the games industry & even military training.

“Phantom heads” have been used since 1894 and are an established tool for clinical training. In 2009 a technology called HapTEL was developed at KCL, allowing dental students to practice using fast handpieces on a computer simulation. Other universities such as the University of Leeds & the University of Sheffield have developed similar devices, meaning that students can practice dentistry in simulations before they see patients. In 2015 the University of Sydney acquired 6 dental local anaesthesia simulators, allowing students to practice potentially hundreds of times before actually injecting a patient!

In 2015 the University of Sydney acquired 6 dental local anaesthesia simulators, allowing students to practice potentially hundreds of times before actually injecting a patient!

Applications such as Essential Anatomy 5 & BoneBox are being utilised by students in order to provide an active & engaging kinaesthetic learning environment, where anatomical structures can be spun in every direction, isolated & manipulated to the users liking.

 

More Discussions & Forums

Traditional teaching & learning methods are being increasingly challenged. While students cannot avoid having to put in the hours to rote learn topics such as anatomy or materials, it is the way in which this information is conveyed to them which matters more.

I believe that social networking & online forums will have an ever-growing role in every educational field – especially dentistry. Dentistry is a vast world. Mediums such as Facebook enable dentists who have never met to share case presentations, ask each other for advice & engage in healthy debate regarding the best way to approach any situation, whether clinical or purely academic. As previously discussed, universities & institutions are catching on. Distance learning platforms allow for discussion forums between academics & clinicians, as well as between clinicians themselves.

The UK-based Facebook group Dental Roots has accumulated over 10,000 members, with daily posts, videos, queries & replies from every facet of the dental community. The ease of access to technology enables anyone to watch clinical videos recorded by dentists all around the world, such as from the Middle East, India, Australia or the USA. This ease of access to information provided by social media has the potential to have a domino effect on every part of dentistry & promote a globalisation of dental academia. Dentinal Tubules is another example of a community centred approach to education, with online resources coupled with in person lectures.

From a patient perspective, online tools such as Dental Chat allow those in dire need of a dentist to instantly message them from the comfort of their homes. Large forums such as Reddit boast 36 million members, with a small but active Dental community of just under 14,000 members.

 

Self-Education

Within the world of dental higher education, more & more emphasis is being laid on “self-education”. Many dental institutes, such as those in Manchester, Liverpool & Hong Kong, base their undergraduate dental curriculum on Problem Based Learning (also called Enquiry Based Learning). These systems aim to foster students to develop “learner independence” whereby students work in groups & learn in a more auto-didactic fashion rather than operating using the traditional methods of lectures & textbooks.

Another prime example of this trend of “self-education” is when dental professionals speak about the importance of business acumen with regards to dental practices & corporations. Something we often hear from dentists who run practices is things like,

“No-one teaches you business at dental school even though a large proportion of dental graduates go on to run or work within what is essentially a business”.

This has led to the growth in the field of dental economics, with internet discussions & courses to aid dentists to manage their practice finances.

 

Conclusion

All in all, change is inescapable, for better or for worse. Traditional teaching & learning methods are being challenged ferociously by dental students and institutes alike. I sincerely hope that the next 25 years results in the world which enables education to be more streamlined, discussion-based & easy to access.

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New Smart Material Developed To Stop Bacteria From Causing Cavities Under Fillings

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When patients go to the dentist to fill a cavity, they’re trying to solve a problem — not create a new one. But many dental patients get some bad news: bacteria can dig under their tooth-coloured fillings and cause new cavities, called recurrent caries. This recurrent caries affects 100 million patients every year and costs an additional US$34 billion to treat.

Now, a research collaboration between the Department of Materials Science & Engineering (MSE), Faculty of Dentistry, and the Institute of Biomaterials and Biomedical Engineering (IBBME) at the University of Toronto has resulted in a novel way to minimize recurrent caries.

In a recent paper published in the journal Scientific Reports, professors Benjamin Hatton (MSE), Yoav Finer (Dentistry) and PhD student Cameron Stewart (IBBME) tackled the issue and proposed a novel solution: a filling material with tiny particles made by self-assembly of antimicrobial drugs, designed to stop bacteria in its tracks. These particles may solve one of the biggest problems with antibacterial filling materials: how do you store enough drug within the material to be effective for someone’s entire life?

“Adding particles packed with antimicrobial drugs to a filling creates a line of defense against cavity-causing bacteria,” says Hatton. “But traditionally there’s only been enough drug to last a few weeks. Through this research, we discovered a combination of drugs and silica glass that organize themselves on a molecule-by-molecule basis to maximize drug density, with enough supply to last years.”

This discovery of using antimicrobials which self-assemble means the team can pack 50 times as much of the bacteria-fighting drugs into the particles.

“We know very well that bacteria specifically attack the margins between fillings and the remaining tooth to create cavities,” says Finer.

“Giving these materials an antimicrobial supply that will last for years could greatly reduce this problem.”

Looking ahead, the research team plans on testing these new drug-storing particles in dental fillings, monitoring their performance when attacked by bacteria and saliva in the complex environment in the mouth. With some fine-tuning, this new ‘smart’ material could create a stronger filling and fewer trips to the dentist.

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Who Has Stronger Teeth: Girls or Boys?

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Dentists and scientists often find it difficult to determine why some people’s teeth are affected by dental erosion and others not, despite similar drinking and eating habits. Many studies show more severe dental erosion in men than in women. Studies have been carried out on dental erosion in wine tasters and people suffering from eating disorders with vomiting. These people frequently expose their teeth to acid and therefore have a high risk of developing dental erosion. However, research shows that not all of these patients at risk have dental erosion. Researchers at the Faculty of Dentistry, University of Oslo, are now attempting to find an explanation for this.

Not just acid

How do we explain that some individuals may have no signs of dental erosion despite frequently exposing their teeth to acid, while certain individuals who seem to do everything right, still develop dental erosion? Ph.D. candidate Marte-Mari Uhlen has been taking a closer look at this in her doctoral work.

“As dentists and researchers, we are often facing cases of dental erosion that we have difficulties explaining, and we meet patients who don’t have dental erosion although their lifestyle indicates that they should. It is also a general assumption that boys tend to have more erosion and more severe erosive lesions than girls. We believe that this disparity is due to something more than just the acidic effect,” explains Uhlen.

Clinical study

Uhlen and her colleagues conducted a clinical study on 66 patients with eating disorders and vomiting. The study consisted of a clinical examination and a questionnaire-based survey in which the patients were interviewed about their illness. The questionnaire included questions about the duration of the eating disorder and frequency of vomiting as well as the participants’ general health, oral hygiene habits and eating and drinking habits.

“The results from the study showed that 70 percent of the patients had dental erosion and that those who had been ill the longest had more dental erosion and more severe lesions than the ones with a shorter duration of disease. This finding confirms our assumptions that dental erosion is a common problem in patients with eating disorders and vomiting. Nevertheless, we were surprised to find that a third of the patients had no sign of dental erosion at all, even patients who had vomited regularly for up to 32 years”, explains Uhlen.

The researchers also examined the oral environment and the tooth enamel. The oral environment includes the volume of saliva, the contents of the saliva as well as the dental pellicle, which is a protein film that covers the surface of the teeth. All these elements are important factors in protecting the teeth against acid attacks. Dental enamel consists mainly of minerals, and the formation and structure of enamel are controlled by genes.

Simulating vomiting episodes in the laboratory

In their next study, the scientists collected teeth from eight people and placed samples of enamel from these teeth on a plate in the mouth of six other volunteers.

The plates with the enamel samples were subjected to simulated vomiting episodes: The plates were removed from the mouth and washed in hydrochloric acid twice a day for a total of nine days.

“We hoped to see how the teeth would respond to being exposed to acid in a different mouth than the one they came from,” explains Uhlen. “In this way, we could examine the protecting effect of both the oral environment and of the enamel itself”

The results revealed that susceptibility to dental erosion seems to be influenced both by the quality of the dental enamel and the oral environment: While in some subjects the degree of protection by the oral environment appeared to be most important, in others, the strength or weakness of their dental enamel was more significant.

Association with enamel formation genes

Then, the attention was aimed at genetics. Could a strong or weak enamel be inheritable? The hypothesis was that the genes responsible for enamel formation may give us more information about why a person develops dental erosion or not. Results from previous studies suggest that variations in these enamel formation genes could influence the susceptibility to dental caries and dental erosion.

The researchers then collected a tooth and a saliva sample from 90 people. Samples of enamel from these teeth were then mounted on a plate and exposed to acid. The amount of enamel loss was then measured using an advanced microscope.

The scientists extracted DNA from the saliva samples to investigate whether enamel formation genes might play a role in the susceptibility to dental erosion. Seven genes were selected.

“We selected these particular genes because they are important in different phases in the formation of the enamel”, says Uhlen.

Genetic variation affects susceptibility

Comparing the amount of enamel loss and the variation in the selected genes, the scientists discovered that some gene variations involved in the formation of the enamel seem to influence the susceptibility to dental erosion. The results from the genetic analyses also indicated that enamel from female donors is more protected against dental erosion than enamel from male donors. This supported the results from the eating disorder study, namely that the enamel in girls are genetically more protected against dental erosion than the enamel in boys.

“Our findings indicate that the susceptibility to dental erosion varies from individual to individual. Factors related to both the oral environment and the quality of the enamel seem to influence the susceptibility. In addition, the susceptibility to dental erosion appears to be affected by genetic variation”, Uhlen explains.

Furthermore, the findings confirm an assumption long held by clinicians and researchers that men are more prone to dental erosion than women.

Clinical significance

The results from these studies indicate that what is generally considered a normal intake of acidic food and beverages may cause dental erosion in subjects at risk. It is important that clinicians and researchers recognize this difference in susceptibility and inform their patients.

“Recognition of the fact that some people are more vulnerable or susceptible to dental erosion as well as an awareness of males possibly being particularly susceptible, dental professionals can distribute their resources better and devote more time to the patients who need it the most,” concludes Uhlen.

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Removing Dental Plaque with Micro-bubbles

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Whether through an accident or a disease, teeth loss can cause many inconveniences. Dental implants such as crowns, however, have allowed people to overcome most of these and live a better quality of life.

But just like normal teeth, these dental implants require proper care and oral hygiene to prevent further complications, such as the inflammation of the tissues surrounding the implants. While the buildup of dental plaque sticks mainly to the crown, it also adheres to the exposed parts of the screw that holds the dental fixture in place, and these are much harder to clean because they contain microgrooves that make them fit better into the upper or lower jaw bones.

Hitoshi Soyama from Tohoku University and his team from Showa University in Japan conducted a study to look for better ways for dentists to remove this plaque and prevent complications. The team wanted to study the efficiency of a cavitating jet, where a high-speed fluid is injected by a nozzle through the water to create very tiny bubbles of vapour. When these bubbles collapse, they produce strong shockwaves that are able to remove contaminants.

The researchers used a certain type of nozzle to create the cavitation bubbles which removed the plaque when they collapsed.

The team compared the cleaning effect of a cavitating jet to that of a water jet, which has been used for a long time to remove plaque from dental implants to keep them clean. They grew a biofilm over three days within the mouths of four volunteers, then proceeded to clean that with the two different methods, measuring the amount of plaque remaining at several time intervals.

While there was little difference between the amounts of dental plaque removed by both methods after one minute of cleaning, that changed after longer exposure. After three minutes, the cavitating jet had removed about a third more plaque than the water jet did, leaving little plaque stuck to the implant at the end of the experiment. The cavitating jet was also able to remove the plaque not only from the root section of the screws but also from the harder-to-reach crest section, though to a lesser extent.

“Conventional methods cannot clean plaques on the surface of dental implants very well, so this new method could give dentists a new tool to better manage these fixtures which are becoming more common,” says Soyama.

Previous research has shown that water flow exerts shear stress to remove the biofilm. In addition to this shear effect, the cavitating jet also produces a considerable force when the bubbles collapse that is able to remove particles from the biofilm and carry them away. The researchers suggest that the two processes probably work in synergy to make the cavitating jet superior to the water jet when cleaning the plaque off the irregular surface of dental implants.

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