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New National Poll Finds Lack Of Guidance May Delay A Child’s First Dentist Trip

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Less than half of parents received guidance about starting dental visits from a doctor or dentist, worse among low-income parents.

Without a doctor or dentist’s guidance, some parents don’t follow national recommendations for early dental care for their children, a new national poll finds.

One in 6 parents who did not receive advice from a health care provider believed children should delay dentist visits until age 4 or older – years later than what experts recommend – according to this month’s C.S. Mott Children’s Hospital National Poll on Children’s Health. (link is external)

The American Academy of Pediatrics and the American Dental Association both recommend starting dental visits around age one when baby teeth emerge.

“Visiting the dentist at an early age is an essential part of children’s health care,” says Mott poll co-director Sarah Clark.

“These visits are important for the detection and treatment of early childhood tooth decay and also a valuable opportunity to educate parents on key aspects of oral health.”

“Our poll finds that when parents get clear guidance from their child’s doctor or dentist, they understand the first dental visit should take place at an early age. Without such guidance, some parents turn to family or friends for advice. As recommendations change, they may be hearing outdated information and not getting their kids to the dentist early enough.”

The nationally representative poll is based on responses from 790 parents with at least one child aged 0-5

More than half of parents did not receive guidance from their child’s doctor or a dentist about when to start dentist visits. Among parents who were not prompted by a doctor or dentist, only 35 percent believed dentist visits should start when children are a year or younger as is recommended.

Over half of parents (60 percent) reported their child has had a dental visit with most parents (79 percent) believing the dentist visit was worthwhile.

Among the 40 percent of parents whose child has not had a dental visit, common reasons for not going were that the child is not old enough (42 percent), the child’s teeth are healthy (25 percent), and the child would be scared of the dentist (15 percent).

Experts say starting dental visits early helps set children up for healthy oral hygiene, with parents learning about correct brushing techniques, the importance of limiting sugary drinks, and the need to avoid putting children to bed with a bottle.

Early childhood caries (dental decay in baby teeth) may also be detected at young ages, allowing for treatment of decay to avoid more serious problems. In young children with healthy teeth, dentists may apply fluoride varnish to prevent future decay.

A quarter of parents who had delayed dental visits said their child’s teeth are healthy but Clark notes it is unlikely that a parent could detect early tooth decay.

“Parents may not notice decay until there’s discolouration, and by then the problem has likely become significant,” she says.

“Immediate dental treatment at the first sign of decay can prevent more significant dental problems down the road, which is why having regular dentist visits throughout early childhood is so important.”

Another factor that may delay dental care is that health care recommendations for early childhood are often focused on well-child visits with medical providers, Clark notes.

“Parents hear clear guidelines on when they should begin well-child visits for their child’s health and often schedule the first visit before they even bring their baby home from the hospital. Doctors typically prompt parents to stick to a standard schedule for immunizations and other preventive care,” she says.

“Parents get much less guidance, however, on when to start taking their child to the dentist, with less than half saying they have received professional advice. This lack of guidance may mean many parents delay the start of dental visits past the recommended age.”

Parents with higher income and education and those with private dental insurance were more likely to report that a doctor or dentist provided guidance on when to start dental visits.

“Our poll suggests that families who are low-income, less educated, and on Medicaid are less likely to receive professional guidance on dental care. This is particularly problematic because low-income children have higher rates of early childhood tooth decay and would benefit from early dental care,” Clark says.

“Providers who care for at-risk populations should dedicate time to focus on the importance of dental visits. Parents should also ask their child’s doctor or their own dentist about when to start dentist visits and how to keep their child’s teeth healthy.”

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The Effectiveness Of Chlorhexidine Is Limited In Preventing Infections In Oral Procedures

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The human oral cavity is colonised by a huge variety of bacteria. When surgical procedures such as a tooth extraction are carried out, the bacteria can pass into the bloodstream causing bacteraemia that is generally transient. What is not yet clear is how significant this presence of bacteria in the blood is in terms of the origin and evolution of infectious processes such as endocarditis of the heart valves, prosthetic valves, hip and knee joint replacements generally, and in local infection.

Numerous studies have shown that a mouthwash containing chlorhexidine has a powerful antimicrobial effect on saliva microflora and bacterial plaque.

“On the basis of this hypothesis we can assume that antimicrobial mouthwashes used before the dental procedure should reduce the number of micro-organisms that pass into the patient’s bloodstream, yet this is a hotly debated issue,” said the members of the UPV/EHU’s research group.

In 1997 the American Heart Association (AHA) suggested that patients at risk of infectious endocarditis should use an antimicrobial mouthwash before a dental procedure. In 2006, the British Society for Antimicrobial Chemotherapy (BSAC) recommended a single mouthwash with 0.2% chlorhexidine (CHX) (10 ml for 1 minute) before the carrying out of dental procedures associated with bacteraemia in patients at risk. Yet in 2007 the AHA recommended against adopting any antiseptic prophylaxis protocol.

In an effort to shed scientific light on this issue, the UPV/EHU research group comprising Iciar Arteagoitia, Carlos Rodriguez-Andrés and Eva Ramos decided to conduct a systematic review and meta-analysis of random controlled trials (RCT), following the PRISMA Statement. The aim was to assess the effectiveness of chlorhexidine in preventing bacteraemia following a tooth extraction. The research was conducted in collaboration with the UPV/EHU’s Department of Epidemiology and was published in Plos One.

In the study that included 8 clinical trials with 523 patients there were 267 in the group treated with chlorhexidine, in which 145 cases of bacteraemia were recorded, and 256 in the control group, in which there were 156 cases of bacteraemia. The results of the research therefore indicate that the percentage of cases of bacteraemia that can be prevented if a population undergoes chlorhexidine-based prevention is 12%. The NNT, the number of patients that need to be treated to prevent bacteraemia, is 16.

The results point to the relative and not particularly significant effectiveness of the use of chlorhexidine when it comes to preventing the bacteria present in the mouth from passing into the bloodstream when dental extraction is carried out.

“Yet, given its low cost and the absence of adverse reactions and complications, we would recommend a mouthwash with chlorhexidine before a procedure of this type is carried out,” concluded the UPV/EHU’s research group.

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Effective Diagnosis Of Persistent Facial Pain Will Benefit Patients And Save Money

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Patients with persistent facial pain are costing the economy more than £3,000 each per year, new research has revealed.

Experts at Newcastle University, UK, say introducing an electronic referral system to speed up diagnosis and treatment is likely to improve quality of life and save money.

The team has assessed the hidden costs of people suffering from long-term face and mouth pain that wasn’t caused by toothache.

Findings, published today in the Journal of Dental Research, show patients’ out-of-pocket costs are more than £650 a year, including prescription charges and travel expenses to and from appointments.

Meanwhile, costs to employers can be almost £2,500 every 12 months, due to aspects such as absenteeism and workers’ loss of productivity as a result of dealing with pain.

Screening patients

This research adds weight to growing evidence that there is a need to screen patients with a Graded Chronic Pain Scale (GCPS) to ensure those most severely affected receive specialist care quickly.

A previous study, by the same team at Newcastle University, showed that a well-established graded pain scale could help reduce costs by providing a better structured system of care.

Justin Durham, Professor of Orofacial Pain and Deputy Dean of Clinical Medicine, at Newcastle University, led the two-year study which was funded by the National Institute for Health Research.

He said: “Our research shows that people have to go around the proverbial ‘mulberry bush’, visiting lots of different healthcare professionals to even get close to obtaining a diagnosis never mind beginning treatment for their condition.

“A better and more defined care pathway would improve care for those with persistent facial pain and help reduce their costs and those to the economy.”

It is estimated that 7% of the population have Persistent Orofacial Pain (POFP), including temporomandibular disorders, phantom tooth pain, burning mouth syndrome, trigeminal neuralgia and atypical facial pain.

This research has revealed how patients attend a large number of appointments with different healthcare professionals but fail to obtain effective diagnosis or treatment plan quickly.

Professor Durham added: “Persistent facial pain is like having toothache every day of the week and, therefore, understandably has a profound and debilitating impact on people’s lives, and our research has highlighted the hidden costs of this condition.”

Data collected

Experts asked 200 patients suffering long-term face and or mouth pain to complete questionnaires every six months for two years to assess how individuals used the NHS for their pain.

The team collected the costs of the care patients received, such as what the NHS paid to provide medication, surgery or other treatments, how much patients paid out of their own pockets and how their condition affected their ability to work.

Within a six month period, participants reported an average of nine healthcare appointments, and those employed reported missing almost two days off work. This absenteeism equates to an average employer cost of £174 per person per six-months.

While the findings suggest that most study participants were unlikely to have a large number of days off work because of their pain, they did report experiencing pain while working for nearly 35 days in a six-month period, during which they noted a decrease in their productivity whilst at work that could cost employers more than £1,000.

Professor Durham said: “We’re calling for the introduction of an electronic referral system which uses a Graded Chronic Pain Scale — a simple seven item questionnaire.

“This scale would be a reliable way to determine who to fast-track to specialists and who should begin care immediately at their dentists or GP, meaning direct referrals would be made electronically to the best service local to the patient rather than relying on healthcare professionals’ knowledge of who manages persistent facial pain in their locality.”

Further research is expected to focus on how care pathways can be designed to better meet the needs of patients.

In partnership with the British Dental Association, the Newcastle University team is helping dentists and GPs manage persistent facial pain by setting up study days for next year.

Peter Dyer, Chair of the British Dental Association’s Central Committee for Hospital Dental Staff, said: “Dentists working in hospitals will have seen patients who have failed to get priority, some on the verge of suicide in the face of unmanageable pain.

“This important research is a timely reminder that facial pain carries a huge personal and financial cost, and patients need not face barriers securing care.

“When so many people have been laid low by this condition GPs and high street dentists need a clear pathway to ensure patients can get the right treatment, when they need it.”

Patient’s story

Father-of-two Joe Buckham’s life was turned upside down when he began to get severe facial pain a decade ago.

The extraction of a wisdom tooth left the former school teacher in agony as he suffered a fractured jaw during the procedure and a subsequent bone infection.

Mr Buckham was pushed from pillar to post as healthcare professionals struggled to identify the problem despite extensive tests, scans and investigations.

He spent a lot of money on hospital trips, including return train fares to a specialist in Oldham up to eight times, and private treatment, such as acupuncture and sports massage therapy.

It was not until he was referred to Professor Justin Durham, an Honorary Consultant Oral Surgeon at Newcastle upon Tyne Hospitals NHS Foundation Trust, that his problem was unearthed.

The 52-year-old has received treatment at Newcastle Hospitals’ orofacial pain referral service and is on medication to help him deal with the pain.

The foster carer, of Rowlands Gill, Gateshead, said: “I believe had I been given the correct treatment quicker than I was, then I would have continued to work as a teacher.

“Sadly I had to retire because I couldn’t do the job due to the seriousness of the pain — even things such as heat and antibiotics make it much worse.

“The pain I get in my face is severe and it can be very debilitating, sometimes it’s so bad I just want to lie in a darkened room.

“Persistent facial pain is a hidden condition as no-one can see the problem and people don’t understand it’s so serious that it can ruin lives and you’re stuck with it forever.

“The specialist service in Newcastle is fantastic and the research being done into facial pain is very much welcomed to help raise awareness of the condition.

“I feel that if medical healthcare professionals were able to use a Graded Chronic Pain Scale it would help ensure patients like me got the best treatment as soon as possible.”

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Researchers Are First To Sequence Rare Bacteria That Causes Rampant Tooth Decay

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The most prevalent chronic disease in both children and adults, tooth decay occurs when the good and bad bacteria in our mouth become imbalanced. The bad bacteria, Streptococcus mutans, forms a biofilm (aka tartar), then takes the sugars we eat and ferments them into acid, which decalcifies our teeth and causes cavities.

Scientists know, though, that there is a second harmful bacteria called Streptococcus sobrinus that accelerates tooth decay in some people, but very little is known about this microbe. This will soon change because a team of Illinois Bioengineering researchers led by Assistant Professor Paul Jensen has successfully sequenced the complete genomes of three strains of S. sobrinus.

According to Jensen, S. sobrinus is difficult to work with in the lab and it is not present in all people, so researchers have instead focused their efforts over the years on understanding the more stable and prevalent S. mutans, which was sequenced in 2002.

“Although it is rare, S. sobrinus produces acid more quickly and is associated with the poorest clinical outcomes, especially among children,” noted Jensen, a researcher at the Carl R. Woese Institute for Genomic Biology on campus.

“If S. sobrinus is present along with S. mutans, you’re at risk for rampant tooth decay, which means there’s some level of communication or synergy between the two that we don’t understand yet.”

Now that the S. sobrinus sequencing is complete, Jensen and his students are building computational models to better understand how the two bacteria interact and why S. sobrinus can cause such potent tooth decay when combined with S. mutans.

Already they have confirmed, for example, that S. sobrinus lacks complete pathways for quorum sensing, which is the ability bacteria have to sense and react to nearby bacteria, and ultimately proliferate.

According to Jensen, S. mutans bacteria send out feelers in the form of a peptide to find out how many other S. mutans cells are nearby. Once the S. mutans cells reach a certain threshold, they attack and create an imbalance in a person’s mouth between good and bad bacteria, which leads to rapid cavity formation.

S. sobrinus doesn’t have a complete system to do this,” said Jensen.

“We’re really curious to explore this further and find out what is missing and why.”

Interestingly, the entire S. sobrinus genome sequencing was completed by a team of Bioengineering undergraduates and students enrolled in the one-year Master of Engineering (M.Eng.) program, rather than doctoral candidates who typically conduct this type of research over several years.

“For the S. sobrinus field, this is groundbreaking work because the field was plagued by a lack of information,” said Jensen.

“In 2018, it is surprising that we had a whole species [of bacteria] that causes disease and no complete genome of it. Yet, an ambitious team of undergrads and M.Eng. students completed the sequencing in a year.”

Mia Sales, who graduated with her bachelor’s degree this past May, completed the assemblies of two of the species of S. sobrinus. Sales also built the computer that other team members used to do the initial genome assemblies.

Fellow undergraduate Will Herbert worked on the annotation part of the project, finding genes in the strings of approximately 2 million adenine (A), cytosine (C), guanine (G), and thymine (T) nucleotides that make up the S. sobrinus genomes.

Other contributors to the research include M.Eng. students Yuting Du, Amitha Sandur, and Naaman Stanley.

“This work exemplifies the students’ ability to synthesize their learning experience with a completely new insight, resulting in an original research publication,” said Professor Dipanjan Pan, director of the M.Eng. program.

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