Thursday, February 16, 2017

Mavrik Dental Systems Working to Make In-Office Tooth Whitening Better

Mavrik Delivery Unit.jpg
 
For years dentistry has been trying hard to come up with some type system that will deliver the same beautiful results from in-office bleaching that we are capable of producing with take home bleaching.  Up to this point in dental history what we’ve had are high strength solutions that can whiten quickly, but also leave the very sensitive.  Many times this has created a situation that mimics the old medical joke of “the cure is worse than the disease”.  Dentistry has put up with enough over the years when it comes to patients being frightened, but simply adding to the problem is ludicrous.

However, we are also faced with the fact of people being unhappy with their smiles and wanting to change them for the better.  To the rescue of this problem comes a company called Maverick with their brand new device called the Thera-Smile.  In the early 2000s, a trend spread across dentistry.  That trend was to use a high powered light that would warm the bleaching solution and help accelerate the chemistry.

There were several attempts along these lines.  Companies tried high powered ARC lights, very bright and powerful LED’s, and even lasers.  These devices were always very expensive for the office to purchase and were marketed to patients on television and in women’s magazines.  Often, due to the advertising, women knew about the lights before the industry even got word to the dentists.  Due to the expense of the lighting systems, doctors had no choice but to charge high fees for the procedure.

Then, the science would come along and word would quickly spread that the light did little, if anything, to aid the whitening process.

Well, Mavrik is a different animal in the tooth whitening jungle.  First of all, the device does not use a light at all!!  Instead it uses a process to warm the chemistry (no light needed) and it has a unique intraoral mouthpiece that connects to a an on-board vacuum pump.  The vacuum pulls air out of the mouthpiece causing it to be suction form fitted to the ideal fit.  In my opinion, the biggest marketing hurdle the company faces is the fact that machines have been tried in the in-office bleaching space before… without much success.  Even though the device is completely different from lights, that is still something to overcome.

Then there is the cost.  I’m not sure of the cost of the device, but I can assure you that something this sophisticated will not be inexpensive.  Many offices are now used to advocating take home tray based whitening, so it will be interesting to see where this all goes.

In closing out this post, l’m very enthused about the science Mavrik is using.  It’s approaching in-office whitening from a completely different angle and looks to make an interesting move into the market.  How this all shakes out, only time will tell.

Wednesday, February 15, 2017

The Music of Prince is Now on Streaming Services

Prince.jpg
 
As a guy who came of age in the 80’s and wasn’t much younger than His Royal Purpleness, I was greatly saddened last spring when Prince passed away at his home in Minnesota.
 
The man, who at one time changed his name to an unpronounceable symbol, truly was an artist in every sense of the word.  While I didn’t love ALL his stuff, I loved a good portion of it and the artist known as Prince made a tremendous impact on my generation.
 
When he passed away, one of the things I was really bummed about was that I couldn’t stream his music.  I ended up just looping my Prince collection for about 96 hours until I could finally deal with the fact that he was gone.
 
But now comes word that his music is finally going to be on streaming services.  Supposedly his catalogue will be available on Amazon Music, iHeartRadio, Spotify, and Apple Music.  While some of the services are speculation, the fact that the catalogue will be streamed is NOT speculation.  The announcement was made on NPR.  If you’d like to view the page, here is the link.  Otherwise here is the story:
 

After months of well-sourced rumors, the streaming service Napster (formerly known as Rhapsody) and another source have confirmed to NPR that Prince's records under Warner Bros. — which include the epochal classics 1999Purple RainDirty Mind, and Sign o' the Times — will be available to stream this Sunday, the day of the 59th Grammy Awards.

As the company wrote: "The rumors are true ... music fans rejoice!"

That Napster broke the news is a very strong indication that other streaming services, like Spotify, will also have the catalog. (Spotify and Apple declined to comment.) Amazon Music, iHeartRadio and Apple Music, that last according to an anonymous source, will also have the catalog available.

Many have noted Prince's aversion to streaming (apart from signing a strict deal with Tidal, he removed his music from most other streaming services) without considering his forward-thinking approach to both business and technology. For that, you could do much worse than the comprehensive accounting of the Purple One's technological and business history that Billboard's Jem Aswad laid out last year or Hasit Shah's essay on this site about the ways in which his attitude toward technology was misunderstood.

 

Even without his most famous recordings held off Apple Music and Spotify, Prince was the ninth-most successful recording artist of 2016 — so now we wait and see what, if any, digital records he'll break. Again.

Tuesday, February 14, 2017

Gemini Laser Testing is Done

Ultradent Gemini.jpg
 
After a couple of months of clinical usage, I’m ready to make my opinions know on the Ultradent Gemini Laser.
 
The Gemini is the first entry into the soft tissue laser market for Ultradent.  Company insiders tell me that the reason they hadn’t come to market before this is that they were wanting a product that set them apart.  something new and different that properly reflected their dedication having better products.
 
The Gemini is a dual wavelength diode laser.  You can use it in 810nm mode or in 980nm mode.  Both wavelengths are very effective on soft tissue and provide very good hemostasis.  However, it’s truly groundbreaking function is its “dual wavelength” feature.  This means that you can select to use both 810 *and* 980 simultaneously.  This allows for fast and smooth removal of soft tissue.  Over the years, the major complaint against diode lasers has been their tendency to leave small tissue tags.  This usually is not a problem clinically, but for offices using digital impression systems, the presence of tissue tags can sometimes complicate the scanning process.  By utilizing the dual wavelength feature, the Gemini increases clinical speed while greatly decreasing tissue tags.
 
The device is cordless with a rechargeable battery.  This makes it completely portable in the office.  It is very light and easy to take from room to room.  I’ve also been *very* impressed with the “Heads-Up Display” on the Gemini.  The flat piece of glass in the photo above is completely clear until you turn the Gemini on.  At that point, the image appears on the glass.  I always make it a point to start the laser in front of the patient and it has never failed to get an impressed reaction.  Patients are blown away at how beautiful and high tech the Gemini is.
 
The foot pedal is wireless and makes it much easier to use as you can place the foot pedal anywhere you would like.  As anyone practicing today knows, we have way too many cords to deal with.  Adding cords to foot pedals just increases the “sphagetti” we are dealing with.  Any chance a manufacturer has to eliminate cords is *greatly* appreciated!
 
The device utilizes unidose tips which screw onto the handpiece.  I’ve found these tips to be sturdy and easy to use clinically.  Each box of tips also comes with a small plastic piece that allows the user to bend the tip canola in a variety of angles.  This makes reaching all areas of the mouth much easier.  Also, in the picture above, you can see the tip showing just behind the display screen.  The white area of the tip contains a very high intensity white LED that creates surprisingly bright illumination of the field.  Since I mentioned the position of the handpiece in the picture above, I should also mention that it is being held in that spot by a magnet that keeps the handpiece in the small cradle behind the screen.
 
The Gemini comes preprogrammed with a variety of procedures and has plenty of power for all procedures.  There are 2 tip lengths available; 7mm uninitiated and 5mm initiated.  In my testing I preferred the 5mm initiated tip as initiating is just one more step to do.
 
The device also has voice controls that can be turned off if you prefer.
 
Overall, this laser has performed extremely well.  It is ergonomic and easy to use.  The aesthetics impress patients and it truly is a “next generation” product.  The Gemini is highly recommended!!!

Monday, February 13, 2017

ADA Says No Evidence to Support Pre-Med for Joint Prosthetics

ADA Logo.png
 
 
 
 
 

For as long as Ive been in dentistry (even including my training) dentistry has been advocating prescribing antibiotics for patients with prosthetic joints.  At first the rationale was that any procedure that caused the gums to bleed could introduce oral bacteria into the bloodstream and those bacteria could attach to the prosthesis and cause an infection.  That would then lead to a hospital visit with copious doses of IV antibiotics to stop the infection.  It could also potentially lead to failure of the joint which could lead to surgery with all of its potential complications or perhaps even death.

Over time, the opinion of the experts changed.  It was then thought that the risk was only to recently placed prosthetics.  The opinion then shifted again to the point that maybe there was no risk at all or a minimal risk, but no one was quite sure.

To minimize the risk of this infection, the patient was given a dose of antibiotics before blood producing dental procedures so that any bacteria introduced into the bloodstream would be killed.  Now, to lay people this may not seem like a big deal, but to those of us in healthcare, there were potential problems with this.  Namely they were:

  • The cost of the antibiotics.  While this was usually minimal, it was more cost and the “hassle factor” of getting the prescription.
  • Potential allergic reactions.  Anytime a patient takes a medication, there is a chance of them developing an allergy and having a reaction.  While this is fairly rare, it does exist, and when it happens, has the potential to be a serious consequence.
  • The potential to contribute to the development of resistant strains of bacteria.
Now comes word from the ADA as of Friday February 10, 2017, that antibiotics are no longer needed for any patients that have prosthetic joints.  The statement from the ADA is below, published in its entirety.  I’ve got the link if you would like to view the ADA webpage on this subject that includes all of the reference papers and other info.   


Approximately 332,000 primary total hip arthroplasties and 719,000 primary total knee arthroplasties were performed in the United States in 201096% of hip replacement and 98% of knee replacement 1surgeries were performed on patients 45 years and older. Reported infection rates for such operations range from 0.8% to 2.2%.2-Infections can be caused by introduction of microorganisms at the time of surgery, hematogenous seeding, or contiguous spread of infection from an adjacent site.2,Infections of total joint replacements can result in failure of the initial surgical procedure and the need for extensive revision, prolonged antibiotic treatment, functional impairment, considerable cost of care, and even death. 

In 2014, the American Dental Association (ADA) Council on Scien- tific Affairs (CSA) assembled an expert panel to update and clarify the clinical recommendations found in a 2012 joint ADA and American Academy of Orthopaedic Surgeons (AAOS) evidence report and guide- line.4,5 In accord with the 2012 ADA/AAOS evidence report, the updated ADA systematic review (published in the January 2015 issue of The Journal of the American Dental Association) found no statistically sig- nificant association between dental procedures and prosthetic joint in- fections (PJI). On the basis of the review of the evidence, the 2015 ADA Clinical Practice Guideline stated, In general, for patients with pros- thetic joint implants, prophylactic antibiotics are not recommended prior to dental procedures to prevent prosthetic joint infection.5

The ADA panel found no association between dental procedures and PJIs and no scientifically based efficacy for using antibiotics to prevent PJIs.5 The panel did acknowledge that there may be special circumstances in which a clinician may consider antibiotic prophylaxis despite the lack of scientific evidence. However, the guidelines did not list any special circumstances.

DEVELOPMENT OF APPROPRIATE USE CRITERIA FOR THE MANAGEMENT OF THE CARE OF PATIENTS WITH ORTHOPEDIC IMPLANTS UNDERGOING DENTAL PROCEDURES

Because there is weak evidence that some patients with certain medical conditions, diseases, and disorders may be at higher risk of experi- encing PJI independent of dental procedures, the AAOS contacted the ADA to participate in the develop- ment of appropriate use criteria (AUC) to assist orthopedic surgeons and dentists in managing the care of these patients. (Note: The AAOS began developing AUC in 2011 as a tool to implement evidence-based clinical practice guidelines. AUC are created to inform clinicians for whom a procedure should be per- formed. This involves using clini- cian expertise and experience, in conjunction with the relevant evi- dence, to rate the appropriateness of various treatments in a set of hy- pothetical, but clinically realistic, patient scenarios. For more informa- tion, visit http://www.orthoguidelines. org/go/auc/.) Although dental treat- ment is not considered a risk factor for PJI, the AAOS and ADA convened a group of subject matter experts to consider if antibiotic prophylaxis might be appropriate in any of these higher-risk patients.

To create the AUC, the AAOS used the RAND/University of Cali- fornia Los Angeles Appropriateness Method (RAM).6 The process involved reviewing the available evi- dence, compiling a list of potential clinical indications or scenarios,

and convening an expert panel comprised of representatives from multiple stakeholders to determine the appropriateness of each of the proposed clinical indications for treatment as appropriate,” “may be appropriate,or rarely appropriate.The literature reviewed for the AUC was derived primarily from the sci- entific articles used to develop the 2012 AAOS/ADA guidelines4 and 2015 ADA clinical practice guidelines.5

With the AUC,6 subject matter experts attempted to define clinical situations in which antibiotic pro- phylaxis in defined potentially at-risk patients might reduce the theoretical risk of experiencing post- surgical PJI. A writing panel comprised of AAOS and ADA rep- resentatives developed clinical sce- narios of situations in which dental treatment might theoretically create a higher risk of experiencing PJI. The following medically complex patient populations and related issues were used to develop a matrix to gain consensus on any potential benefit from antibiotic prophylaxis until more definitive scientific data be- comes available:

- planned dental procedure;
- an immunocompromised status; - glycemic control;
- history of periprosthetic or deep PJI of the hip or knee that required an operation;

- time since hip or knee joint replacement procedure.

Once approved by the writing panel, the theoretical risk scenarios were presented to a separate expert voting panel (made up of ADA and AAOS representatives) to determine the appropriateness of antibiotic prophylaxis for each scenario (that is, when antibiotic prophylaxis

is rarely appropriate,” “may be appropriate,or is appropriate). The voting panel identified relatively few patient subpopulations for whom antibiotic prophylaxis might be indicated before certain dental procedures. Of 64 total prophylactic antibiotic voting items, 8 (12%) items were rated as appropriate,17 (27%) items were rated as may be appro- priate,and 39 (61%) were rated as rarely appropriate.A Web-based application of the AUC is available at www.orthoguidelines.org/go/auc.

TAKE-HOME MESSAGES

There is no evidence to support
an association between dental pro- cedures and risk of experiencing PJIs.
The parameters that were used as potential scenarios for the AUC, in which antibiotic prophylaxis may be appropriate, do not indicate an increased risk of experiencing PJI due to hematogenous spread (bacteremia) from dental procedures or possibly other daily, oral healthrelated hygiene behaviors.7 These scenarios may indeed have some added risk of developing PJI in a small number of patients, but they are independent of dental treatment.

The AUC is a decision-support tool to supplement clinicians in their judgment regarding anti- biotic prophylaxis for patients with a prosthetic joint who are under- going dental procedures. It is not intended as the standard of care or as a substitute for clinical judgment. As developed, the AUC could facilitate the treatment of defined high riskand immune compromisedpa- tients. It affects a narrow cohort of patients for whom antibiotic pro- phylaxis might be considered. Although there was not complete consensus on all aspects of the AUC development process or outcomes,

a consensus of ADA-appointed expert panel members and CSA members agreed that this tool could benefit dentists, physicians, and patients by reducing antibiotic prescriptions.

Discussion of available treat- ment options applicable to each patient relies on communication between the patient, dentist, and orthopedic surgeon, weighing the potential risks and benefits for that patient. Prophylactic antibiotics before any clinical procedure that may cause bacteremia are chosen based on the nature and suscepti- bility of microflora at the treatment site, as well as the possible economic and health impact to patients
and populations. Any perceived po- tential bene
fit of antibiotic prophy- laxis must be weighed against the known risks of antibiotic use, including Clostridium difficile infec- tion, allergic reaction, and the development, selection, and trans- mission of antimicrobial resistance factors.8

It is appropriate for the dentist to make the final judgment to use antibiotic prophylaxis for patients potentially at higher risk of expe- riencing PJI (independent of dental treatment) using the AUC as a guide, without consulting the orthopedic surgeon. However, if the orthopedic surgeon recommends antibiotic prophylaxis or the patient prefers it, despite the dentists recommendation against premed- ication, the prescription should be provided by the surgeon.

The 2015 ADA clinical practice guideline is valid and should continue to inform clinical de- cisions for dental patients in ambulatory settings. The guideline

states clearly that the [e]vidence fails to demonstrate an association between dental procedures and PJI or any effectiveness for antibiotic prophylaxis. Given this information in conjunction with the potential harm from antibiotic use, using an- tibiotics before dental procedures is not recommended to prevent PJI.The CSA and ADA-appointed expert panel members encourage dental health care professionals to continue to use the 2015 ADA clinical practice guideline, consult the AUC as needed, and respect the patients specific needs and preferences when considering antibiotic prophylaxis before dental treatment.

CONCLUSIONS

In general, for patients with prosthetic joint implants, prophylactic antibiotics are not recommended prior to dental procedures to prevent prosthetic joint infection.5 n http://dx.doi.org/10.1016/j.adaj.2016.12.002 

In 2014, the American Dental Association (ADA) Council on Scien- tific Affairs (CSA) assembled an expert panel to update and clarify the clinical recommendations found in a 2012 joint ADA and American Academy of Orthopaedic Surgeons (AAOS) evidence report and guide- line.4,5 In accord with the 2012 ADA/AAOS evidence report, the updated ADA systematic review (published in the January 2015 issue of The Journal of the American Dental Association) found no statistically sig- nificant association between dental procedures and prosthetic joint in- fections (PJI). On the basis of the review of the evidence, the 2015 ADA Clinical Practice Guideline stated, In general, for patients with pros- thetic joint implants, prophylactic antibiotics are not recommended prior to dental procedures to prevent prosthetic joint infection.5

The ADA panel found no association between dental procedures and PJIs and no scientifically based efficacy for using antibiotics to prevent PJIs.5 The panel did acknowledge that there may be special circumstances in which a clinician may consider antibiotic prophylaxis despite the lack 

Thursday, February 9, 2017

Kerr™ Endodontics Launches Endovac Pure™

EV Pure.jpg


This revolutionary system is the only one of its kind to leverage the apical negative pressure technique

 

January 18, 2017 – Kerr Endodontics, a global leader in endodontic equipmentand consumables, is proud to announce the launch of Endovac Pure, an irrigationsystem that combines a portable base unit with a sterile packed cartridge and anergonomically designed, single handheld controller for ease of use. It is the onlysystem of its kind to leverage the apical negative pressure technique, a methodsupported by more than 200 independent studies.

With a single handheld controller, dentists can achieve complete three-dimensional and apical cleaning of a root canal. Endovac Pure removes debris and bacteria from the apical third and provides a continuous flow of irrigants to the canal while minimizing the risk of extrusion past the apex. Endovac Pure’s Apex cartridge is sterile packed and fully integrates the MacroPure and MicroPure cannulas for greater ease of use. Endovac Pure offers best in class canal debridement when compared to other leading irrigation techniques.

 

“Endovac Pure is a great example of how we approach innovation at Kerr — with a focus on efficiency, results and cutting edge clinical technique,” said Phil Prentice, Vice President of North America for KaVo Kerr. “We believe that general practitioners and specialists deserve a partner who is committed to their success at every level.”

 

For more information on Endovac Pure and for the entire Kerr Endodontics family of products, go to KerrDental.com or call 800-KERR123.

--

 

About Kerr Corporation

 

For nearly 125 years, Kerr has been serving the comprehensive needs of the entire dental care community in pursuit of enhancing oral health. Individual Kerr brands are encompassed within the Kerr Restoratives, Kerr Endodontics, Kerr Rotary, and Kerr TotalCare platforms. By providing best-in-class, patient-based solutions, we believe that in partnership with those we serve - “Together we’re more.”

Wednesday, February 8, 2017

Yale Study Reports 1 in 4 Teens that use E-cigarettes Have Tried "Dripping"

Vape Drip.jpeg
 
It seems that e-cigarettes have been making the news a lot lately.  One of the most recent things I’ve read about was a user who’s device exploded as he was using it.  He lost some teeth, fractured his jaw, and had to have a decent amount of plastic surgery to give him a “normal” appearance again.
 
It seems that many folks look upon e-cigarettes as a safer alternative to the real thing.  The problem is, they are not without their problems.  E-cigs can deliver lots of nicotine and there are also some other chemicals released that can cause harm to the body.

Now comes word from Yale about the potential problems of “dripping” with e-cigs.  Dripping is done by taking the device apart and putting “drips” of the liquid directly onto the battery-powered coil (the part that heats the liquid and vaporizes it).  Supposedly this provides better flavor as well as stronger hit.

I’ve got several concerns about this but I’ll just discuss a couple here.
  1. The dripping process creates a higher temperature to vaporize the liquid.  This has the potential to heat the liquid higher than manufacturers intended.  This can lead to potential exposure to acetaldehyde and formaldehyde among other chemicals.  Other research has indicated this is possible.
  2. E-cigarette usage coms with some inherent risk.  There are actual documented and substantiated cases of these devices exploding and causing severe personal injuries.  Many of those injured have admitted to altering their devices in some way.  It seems that often times, users are DIYing their devices in an attempt to increase the potency of their vaping medium.  With the explosion potential that exists, taking your device apart and holding your face very close to the coil just seems like a really, really bad idea.

The study is pretty darn interesting.  You can read the article here.  

Tuesday, February 7, 2017

Presidential Order from President Trump Freezes Amalgam Separator Rule

Amalgam Separator.jpeg
 
 
Late in 2016 the Environmental Protection Agency passed a rule that required dental practices to install amalgam separators.  I did a post on it in December.  
 
Now comes word, as of February 6, 2017, that the rule has been frozen by President Trump.  This is intended to all his administration time for executive review of the regulations.
 
So… long story short, the Amalgam Separator rule is now on hold.
 
We have had an amalgam separator in our office for about 5 years.  We did it as we thought doing so would be “the right thing to do” and it fit with our philosophy of always trying to do the right thing.
 
However, I will be the first to say that amalgam separators are one more expense placed on healthcare providers that will ultimately be passed along to the patient.  As we all know, government intervention and regulation is a frequent cause of increasing fees.  In some states the devices have been required for some time, but for the ones that did have that requirement (like Missouri, where I practice) the federal rule would have required it of *every* office.
 
I’m interested to see where the rule goes from here.