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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the perfect lecture, in multiple takes, meaning that they only have to re-do parts of it when the information becomes outdated, instead of presenting the same lecture, over and over.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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Novel Nanoparticle-Based Approach Detects And Treats Oral Plaque Without Drugs

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When the good and bad bacteria in our mouth become imbalanced, the bad bacteria form a biofilm (aka plaque), which can cause cavities, and if left untreated over time, can lead to cardiovascular and other inflammatory diseases like diabetes and bacterial pneumonia.

A team of researchers from the University of Illinois has recently devised a practical nanotechnology-based method for detecting and treating the harmful bacteria that cause plaque and lead to tooth decay and other detrimental conditions.

Bioengineering Associate Professor Dipanjan Pan (seated) and doctoral student Fatemeh Ostadhossein have demonstrated a drug-free, nanotechnology-based method for detecting and destroying the bacteria that causes dental plaque.

Oral plaque is invisible to the eye so dentists currently visualize it with disclosing agents, which they administer to patients in the form of a dissolvable tablet or brush-on swab. While useful in helping patients see the extent of their plaque, these methods are unable to identify the difference between good and bad bacteria.

“Presently in the clinic, detection of dental plaque is highly subjective and only depends on the dentist’s visual evaluation,” said Bioengineering Associate Professor Dipanjan Pan, head of the research team.

“We have demonstrated for the first time that early detection of dental plaque in the clinic is possible using the regular intraoral X-ray machine which can seek out harmful bacteria populations.”

In order to accomplish this, Fatemeh Ostadhossein, a Bioengineering graduate student in Pan’s group, developed a plaque detection probe that works in conjunction with common X-ray technology and which is capable of finding specific harmful bacteria known as Streptococcus mutans (S. mutans) in a complex biofilm network. Additionally, they also demonstrated that by tweaking the chemical composition of the probe, it can be used to target and destroy the S. mutans bacteria.

The probe is made up of nanoparticles made of hafnium oxide (HfO2), a non-toxic metal that is currently under clinical trial for internal use in humans. In their study, the team demonstrated the efficacy of the probe to identify biochemical markers present at the surface of the bacterial biofilm and simultaneously destroy S. mutans. They conducted their study on Sprague Dawley rats.

In practice, Pan envisions a dentist applying the probe on the patient’s teeth and using the X-ray machine to accurately visualize the extent of the biofilm plaque. If the plaque is deemed severe, then the dentist would follow up with the administering of the therapeutic HfO2 nanoparticles in the form of a dental paste.

In their study, the team compared the therapeutic ability of their nanoparticles with Chlorhexidine, a chemical currently used by dentists to eradicate biofilm. “Our HfO2 nanoparticles are far more efficient at killing the bacteria and reducing the biofilm burden both in cell cultures of bacteria and in [infected] rats,” said Ostadhossein, noting that their new technology is also much safer than conventional treatment.

The nanoparticles’ therapeutic effect is due, said Pan, to their unique surface chemistry, which provides a latch and kill mechanism.

“This mechanism sets our work apart from previously pursued nanoparticle-based approaches where the medicinal effect comes from anti-biotics encapsulated in the particles,” said Pan, also a faculty member of the Carle Illinois College of Medicine and the Beckman Institute for Advanced Science and Technology.

“This is good because our approach avoids anti-biotic resistance issues and it’s safe and highly scalable, making it well-suited for eventual clinical translation.”

In addition to Pan and Ostadhossein, other members of the research team include bioengineering post-doctoral researcher Santosh Misra, visiting scholar Indu Tripathi, undergraduate Valeriya Kravchuk, visiting scholar Gururaja Vulugundam; and Veterinary Medicine clinical assistant professor Denae LoBato and adjunct assistant professor Laura Selmic.

Their work is described in the paper, “Dual purpose hafnium oxide nanoparticles offer imaging Streptococcus mutans dental biofilm and fight it In vivo via a drug free approach,” published online on July 30, 2018, in the journal Biomaterials. The research was funded by the University of Illinois at Urbana-Champaign Children’s Discovery Institute and the American Heart Association.

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Unwise Opioids For Wisdom Teeth: Study Shows Link To Long-Term Use In Teens And Young Adults

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Getting wisdom teeth removed may be a rite of passage for many teens and young adults, but the opioid painkiller prescriptions that many of them receive could set them on a path to long-term opioid use, a new study finds.

Young people ages 13 to 30 who filled an opioid prescription immediately before or after they had their wisdom teeth out were nearly 2.7 times as likely as their peers to still be filling opioid prescriptions weeks or months later, according to new research from a University of Michigan team.

Those in their late teens and twenties had the highest odds of persistent opioid use, compared with those of middle school and high school age, the researchers report in a research letter in the new issue of JAMA.

Led by Calista Harbaugh, M.D., a U-M research fellow and surgical resident, the researchers used insurance data to focus on young people who were ‘opioid naïve’ — who hadn’t had an opioid prescription in the six months before their wisdom teeth came out, and who didn’t have any other procedures requiring anesthesia in the following year.

“Wisdom tooth extraction is performed 3.5 million times a year in the United States, and many dentists routinely prescribe opioids in case patients need it for post-procedure pain,” says Harbaugh, a National Clinician Scholar at the U-M Institute for Healthcare Policy and Innovation.

“Until now, we haven’t had data on the long-term risks of opioid use after wisdom tooth extraction. We now see that a sizable number go on to fill opioid prescriptions long after we would expect they would need for recovery, and the main predictor of persistent use is whether or not they fill that initial prescription.”

Other factors also predicted risk of long-term opioid use. Teens and young adults who had a history of mental health issues such as depression and anxiety, or chronic pain conditions, were more than others to go on to persistent use after filling their initial wisdom tooth-related prescription.

More about the study

In all, 1.3 percent of 56,686 wisdom tooth patients who filled their opioid prescription between 2009 and 2015 went on to persistent opioid use, defined as two or more prescriptions filled in the next year written by any provider for any reason. That’s compared with 0.5 percent of the 14,256 wisdom tooth patients who didn’t fill a prescription.

Though those numbers may seem small, the high number of wisdom teeth procedures every year mean a large number of young people are at risk, notes Harbaugh, a research fellow with the Michigan Opioid Prescribing and Engagement Network, or Michigan OPEN.

The team used data from employer-based insurance plans, available through the Truven MarketScan database purchased for researchers’ use by IHPI. Chad Brummett, M.D., co-director of Michigan OPEN, is senior author of the new research, and the team includes U-M School of Dentistry professor Romesh Nalliah, D.D.S., MHCM.

The data show opioid prescriptions filled, but not actual use of opioid pills by patients. Leftover opioids pose a risk of their own, because they can be misused by the individual who received the prescription, or by a member of their household or a visitor. The researchers also couldn’t tell the reason for the later opioid prescription fills by those who went on to persistent use.

The authors suggest that dentists and oral surgeons should consider prescribing non-opioid painkillers before opioids to their wisdom tooth patients. If pain is acute, they should prescribe less than the seven-day opioid supply recently recommended by the American Dental Association for any acute dental pain.

“There are no prescribing recommendations specifically for wisdom tooth extraction,” says Harbaugh.

“With evidence that nonsteroidal anti-inflammatories may just as, if not more, effective, a seven-day opioid recommendation may still be too much.”

Brummett adds:

“These are some of the first data to the show long-term ill effects of routine opioid prescribing after tooth extractions. When taken together with the previous studies showing that opioids are not helpful in these cases, dentists and oral surgeons should stop routinely prescribing opioids for wisdom tooth extractions and likely other common dental procedures.”

Importance for patients and parents

Getting a prescription for an opioid painkiller around the time of a wisdom tooth procedure comes with many decision points, Harbaugh says.

“Patients must decide whether to fill the prescription and take the medication, and where to store and dispose of the unused pills. All of these decision points need to be discussed with patients,” she says.

“Patients should talk to their dentists about how to control pain without opioids first. If needed, opioids should only be used for breakthrough pain, as backup if the pain’s not controlled with other medications.”

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Tongue Microbiome Research Underscores Importance Of Dental Health

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Elderly individuals with fewer teeth, poor dental hygiene, and more cavities constantly ingest more dysbiotic microbiota, which could be harmful to their respiratory health, according to new research published in the journal mSphere. The findings come from a large, population-based study that identified variations in the tongue microbiota among community-dwelling elderly adults in Japan.

“Fewer teeth, poorer dental hygiene, and more dental caries (cavities) experience are closely related to dysbiotic shift in the tongue microbiota composition, which might be harmful to the respiratory health of elderly adults with swallowing problems,” said corresponding author Yoshihisa Yamashita, PhD, DDS, Section of Preventive and Public Health Dentistry, Division of Oral Health, Growth, and Development, Faculty of Dental Science, Kyushu University, Fukuoka.

Prior to this study, researchers knew that constant aspiration of saliva can lead to pneumonia, a major cause of death among elderly adults with swallowing impairments, and that tongue microbiota are a dominant source of oral microbial populations that are ingested with saliva. Previous research has also shown that in institutionalized frail elderly adults, the dysbiotic shift of indigenous tongue microbiota is associated with an increased risk of death from pneumonia.

In the new study, Dr. Yamashita and colleagues set out to understand the variations in tongue microbiota composition related to oral health conditions among community-dwelling elderly adults and to identify factors associated with the dysbiotic shift in the tongue microbiota. They investigated the tongue microbiota status and dental conditions of 506 adults aged 70 to 80 years living in the town of Hisayama, Japan who received a dental examination during a health examination of the town’s residents performed in 2016. The scientists collected the tongue microbiota from the center area of the tongue dorsum using a modified electric toothbrush as a sampling device, and used next-generation sequencing approaches to analyze the samples.

The researchers found that the total bacterial density was independent of the conditions of teeth surrounding the tongue, whereas the microbiota composition, especially the relative abundances of predominant commensals, showed an association with tooth conditions.

“Commensal microbiota composition, especially the relative abundances of predominant commensals, showed an association with tooth conditions,” said Dr. Yamashita.

“Two cohabiting groups of predominant commensals exist in the tongue microbiota; one of which was primarily composed of Prevotella histicola, Veillonella atypica, Streptococcus salivarius, and Streptococcus parasanguinis, which have been previously associated with an increased risk of mortality due to pneumonia in the frail elderly. This bacterial group was more predominant in the elderly with fewer teeth, a higher plaque index, and more dental caries-experienced teeth.”

The study highlights the importance of dental health.

“Careful attention should be given to the tongue microbiota status in elderly adults with poorer dental conditions,” said Dr. Yamashita.

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