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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the perfect lecture, in multiple takes, meaning that they only have to re-do parts of it when the information becomes outdated, instead of presenting the same lecture, over and over.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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Can These Proteins Cure Cavities?

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Researchers at the University of Washington have designed a convenient and natural product that uses proteins to rebuild tooth enamel and treat dental cavities.

The research finding was first published in ACS Biomaterials Science and Engineering.

“Remineralization guided by peptides is a healthy alternative to current dental health care,” said lead author Mehmet Sarikaya, professor of materials science and engineering and adjunct professor in the Department of Chemical Engineering and Department of Oral Health Sciences.

The new biogenic dental products can — in theory — rebuild teeth and cure cavities without today’s costly and uncomfortable treatments.

“Peptide-enabled formulations will be simple and would be implemented in over-the-counter or clinical products,” Sarikaya said.

Cavities are more than just a nuisance. According to the World Health Organization, dental cavities affect nearly every age group and they are accompanied by serious health concerns. Additionally, direct and indirect costs of treating dental cavities and related diseases have been a huge economic burden for individuals and health care systems.

“Bacteria metabolize sugar and other fermentable carbohydrates in oral environments and acid, as a by-product, will demineralize the dental enamel,” said co-author Sami Dogan, associate professor in the Department of Restorative Dentistry at the UW School of Dentistry.

Although tooth decay is relatively harmless in its earliest stages, once the cavity progresses through the tooth’s enamel, serious health concerns arise. If left untreated, tooth decay can lead to tooth loss. This can present adverse consequences on the remaining teeth and supporting tissues and on the patient’s general health, including life-threatening conditions.

Good oral hygiene is the best prevention, and over the past half-century, brushing and flossing have reduced significantly the impact of cavities for many Americans. Still, some socio-economic groups suffer disproportionately from this disease, the researchers said. And, according to recent reports from the Centers for Disease Control and Prevention, the prevalence of dental cavities in Americans is again on the rise, suggesting a regression in the progress of combating this disease.

Taking inspiration from the body’s own natural tooth-forming proteins, the UW team has come up with a way to repair the tooth enamel. The researchers accomplished this by capturing the essence of amelogenin — a protein crucial to forming the hard crown enamel — to design amelogenin-derived peptides that biomineralize and are the key active ingredient in the new technology. The bioinspired repair process restores the mineral structure found in native tooth enamel.

“These peptides are proven to bind onto tooth surfaces and recruit calcium and phosphate ions,” said Deniz Yucesoy, a co-author and a doctoral student at the UW.

The peptide-enabled technology allows the deposition of 10 to 50 micrometers of new enamel on the teeth after each use. Once fully developed, the technology can be used in both private and public health settings, in biomimetic toothpaste, gels, solutions and composites as a safe alternative to existing dental procedures and treatments. The technology enables people to rebuild and strengthen tooth enamel on a daily basis as part of a preventive dental care routine. It is expected to be safe for use by adults and children.

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Is the Sweet Tooth Gene Connected With Having Less Body Fat?

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People with a gene variation of FGF21 have a predisposition to less body fat than others, new research conducted at the University of Copenhagen, among others, shows.

It comes as a bit of a surprise to the researchers, who last year discovered that precisely this genetic variation could be one of the reasons why some people have a particular craving for sweet things. People with this variation eat more sugar than others.

‘It sort of contradicts common intuition that people who eat more sugar should have less body fat. But it is important to remember that we are only studying this specific genetic variation and trying to find connections to the rest of the body. This is just a small piece of the puzzle describing the connection between diet and sugar intake and the risk of obesity and diabetes’, says one of the researchers behind the study, Associate Professor Niels Grarup from the Novo Nordisk Foundation Center for Basic Metabolic Research.

Higher Blood Pressure and More ‘Apple Shape’

But the effects associated with the genetic variation are not all positive, the new study shows. The genetic variation is connected with slightly increased blood pressure and more fat around the waist than the hips — that is, more ‘apple shape’.

The study is an international collaboration headed by researchers at the University of Exeter Medical School and has just been published in the scientific journal Cell Reports.

The researchers’ conclusions are based on large amounts of data. They have studied health information from more than 450,000 individuals who have allowed their data to be recorded in the UK Biobank. It includes blood samples, questionnaires on diet and genetic data, among other things.

‘Now that so many people are involved in the study, it gives our conclusions a certain robustness. Even though the difference in the amount of body fat or blood pressure level is only minor depending on whether or not the person has this genetic variation or not, we are very confident that the results are accurate. Around 20 per cent of the European population has this genetic predisposition’, says Niels Grarup.

Potential Drug Target

This new knowledge about people with a ‘genetic sweet tooth’ is mainly important in connection with the development of drugs and future research. Because researchers are currently trying to determine whether it is possible to target or replace FGF21 using drugs in order to treat for obesity and diabetes.

‘Due to its connection with sugar, FGF21 constitutes a potential target in the treatment of for example obesity and diabetes. This research helps us to understand the underlying mechanisms of the hormone and to predict its effects and side effects’, says Niels Grarup.

The study is funded by the European Research Council (ERC), the National Institute of Health (NIH) and the Novo Nordisk Foundation, among others.

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Losing Teeth During Middle Age Linked To An Increased Risk Of Cardiovascular Disease

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Losing two or more teeth in middle age is associated with increased cardiovascular disease risk, according to preliminary research presented at the American Heart Association’s Epidemiology and Prevention | Lifestyle and Cardiometabolic Health Scientific Sessions 2018, a premier global exchange of the latest advances in population-based cardiovascular science for researchers and clinicians.

Studies have shown that dental health problems, such as periodontal disease and tooth loss, are related to inflammation, diabetes, smoking and consuming less healthy diets, according to study author Lu Qi, M.D., Ph.D., professor of epidemiology at Tulane University in New Orleans.

“Previous research has also found that dental health issues are associated with elevated risk of cardiovascular disease,” Qi said.

“However, most of that research looked at cumulative tooth loss over a lifetime, which often includes teeth lost in childhood due to cavities, trauma and orthodontics. Tooth loss in middle age is more likely related to inflammation, but it hasn’t been clear how this later-in-life tooth loss might influence cardiovascular disease risk.”

In a collaborative research effort between Tulane University School of Public Health and Tropical Medicine and Harvard T.H. Chan School of Public Health, Qi and colleagues analyzed the impact of tooth loss in large studies of adults, aged 45 to 69 years, in which participants had reported on the numbers of natural teeth they had, then in a follow-up questionnaire, reported recent tooth loss. Adults in this analysis didn’t have cardiovascular disease when the studies began. The researchers prospectively studied the occurrence of tooth loss during an eight-year period and followed an incidence of cardiovascular disease among people with no tooth loss, one tooth lost and two or more teeth lost over 12-18 years.

They found:

  • Among the adults with 25 to 32 natural teeth at the study’s start, those who lost two or more teeth had a 23 percent increased risk of cardiovascular disease, compared to those with no tooth loss.
  • The increased risk occurred regardless of reported diet quality, physical activity, body weight and other cardiovascular risk factors, such as high blood pressure, high cholesterol and diabetes.
  • There wasn’t a notable increase in cardiovascular disease risk among those who reported losing one tooth during the study period.
  • Cardiovascular disease risk among all the participants (regardless of the number of natural teeth at the study’s start) increased 16 percent among those losing two or more teeth during the study period, compared to those who didn’t lose any teeth.
  • Adults with less than 17 natural teeth, versus 25 to 32, at the study’s start, were 25 percent more likely to have cardiovascular disease.

“In addition to other established associations between dental health and risk of disease, our findings suggest that middle-aged adults who have lost two or more teeth in recent past could be at increased risk for cardiovascular disease,” Qi said.

“That’s regardless of the number of natural teeth a person has as a middle-aged adult, or whether they have traditional risk factors for cardiovascular disease, such as poor diet or high blood pressure.”

Armed with the knowledge that tooth loss in middle age can signal elevated cardiovascular disease risk, adults can take steps to reduce the increased risk early on, he said.

A limitation of the study was that participants self-reported tooth loss, which could lead to misclassification in the study, according to Qi.

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