Thursday, October 19, 2017

American Academy of Pediatric Dentistry Issues SDF Guidelines

aapdlogo pediatric.jpg
For the last couple of years, dental professionals have been hearing more and more about SDF (38% Silver Diamine Fluoride) to help treat caries in susceptible patients.  Applying SDF  can arrest carious lesions.  However, the drawback is that the areas treated are rapidly stained dark brown or black.  While not a miracle cure for dental disease, SDF shows great promise to help many people, especially children in impoverished areas or those with special needs.  
Recently, the American Academy of Pediatric Dentistry released a paper containing guidelines for SDF use in clinical practice.  The full paper can be accessed here in pdf format.  The abstract appears below:

Background:  This manuscript presents evidence-based guidance on the use of 38 percent silver diamine fluoride (SDF) for dental caries management in children and adolescents, including those with special health care needs. A guideline workgroup formed by the American Academy of Pediatric Dentistry developed guidance and an evidence-based recommendation regarding the application of 38 percent SDF to arrest cavitated caries lesions in primary teeth.
Types of studies reviewed: The basis of the guideline’s recommendation is evidence from an existing systematic review "Clinical trials of silver diamine fluoride in arresting caries among children: A systematic review." (JDR Clin Transl Res 2016;1[3]:201-10). A systematic search was conducted in PubMed®/MEDLINE, Embase®, Cochrane Central Register of Controlled Trials, and gray literature databases to identify randomized controlled trials and systematic reviews reporting on the effect of silver diamine fluoride and address peripheral issues such as adverse effects and cost. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was used to assess the quality of the evidence and the evidenceto-decision framework was employed to formulate a recommendation.
Results: The panel made a conditional recommendation regarding the use of 38 percent SDF for the arrest of cavitated caries lesions in primary teeth as part of a comprehensive caries management program. After taking into consideration the low cost of the treatment and the disease burden of caries, panel members were confident that the benefits of SDF application in the target populations outweigh its possible undesirable effects. Per GRADE, this is a conditional recommendation based on low-quality evidence. Conclusions and practical implications: The guideline intends to inform the clinical practices involving the application of 38 percent SDF to enhance dental caries management outcomes in children and adolescents, including those with special health care needs. These recommended practices are based upon the best available evidence to-date. A 38 percent SDF protocol is included in Appendix II.

Wednesday, October 18, 2017

Taking Alexa for a Drive

Foval 300W.jpg
Like a lot of you, I have become a big fan of Amazon’s Echo Devices with the built in Alexa personal assistant.  I have become such a diehard, in fact, that I even went so far as to get an Echo Dot for my office.  It’s nice to have the device connected to my Bose Bluetooth speaker and simply tell Alexa what to play.
Lately though, I got to thinking that the place it would really make sense to have Alexa was in my vehicle.  I mean, it’s the ultimate hands-free device, right?
The problem was, my Chevy Tahoe is a 2009.  It has Bluetooth for a handsfree phone experience, but no Wifi like the newer models now have.  The workaround for that was my old Netgear hotspot that I used to use a lot while traveling.  Now with Wifi so ubiquitous, I don’t use it nearly as much as I used to.  So I configured Alexa to access the Netgear device and presto!  Alexa is online!
The second problem I faced was actually getting the Echo Dot running in the Tahoe.  The Echo Dot is pretty picky about its power needs and would not run via a USB micro cable connected to a power port in the vehicle.  No, I needed a full blown AC connection for that.  The workaround for that was this device pictured above.  This is the Foval 300W Power Inverter DC 12V to 110V AC Converter with 4.8A Dual USB Car Charger.    This nifty device plugs into a power port and then provides the AC power needed to power the Echo.
The Tahoe has a fairly good sized and deep console which even has a power port inside of it.  The electronics are all inside the console and the Alexa power cord snakes out of the lid.  The Dot itself sits on the console and is held in place with adhesive backed velcro so I can take it off the console when necessary.
I also paired Alexa with a Bluetooth converter I have plugged into the Aux port.  Since my Bluetooth in the Tahoe is fairly limited and will work for handsfree phone calls but does not work as Bluetooth headphones for my iPhone 6 Plus.  Hence the need for the Bluetooth converter.  The good news is now I just have to say, “Alexa, play Jimmy Page and the Black Crowes” and it all happens just like at my desk.
Just a little geeky DIY that I thought might be of interest for some of you.  If you have a newer vehicle with builtin Wifi and a 4G signal, you can forgo the hotspot & the Bluetooth converter as both of those items are making up for my out of date vehicle technology.  All you would need was the Focal unit above & a place to hide the Echo Dot.  The ultimate in handsfree is not that hard to create!

Tuesday, October 17, 2017

Activated Charcoal: Teeth-Whitening Secret or Total Scam?

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Since my post yesterday was on the scientific aspects of a literature review on charcoal toothpastes, my thinking today is to look at the information from a more “mainstream” point of view.  I mean all of that science stuff is fine, but what are concerns with this subject from the court of public opinion?  In short, it’s pretty much the same.
Here are a couple of paragraphs from an article I located on The Daily Beast:

You brush your teeth and floss on the reg. You’ve tried everything from the latest toothpaste to whitening strips, gels, and trays but nothing seems to give you that 100-watt smile. So what’s the best way to get gleaming pearly whites?

According to Pinterest and YouTube, the path to whiter teeth is covered in a pitch-black paste. Bloggers and vloggers claim that brushing with activated charcoal is an all-natural way to remove surface stains caused by coffee, tea, or red wine without bleach or abrasives. To prove it, they’re flaunting soot-covered teeth straight out of a horror movie. The result? Fluorescent white teeth after as few as one use, proponents say.

The article is well written and doesn’t, in my opinion, show signs of bias.  It just wants people to know the facts.  Those facts are that this stuff doesn’t seem to work and could even be harmful.
Of course, don’t just take my word for it.  Go to The Daily Beast and read for yourself.  It’s a great article about the newest fad.  

Monday, October 16, 2017

Literature Review: No Scientific Evidence To Support Oral Health Claims Of Charcoal Toothpastes

ADA Logo.jpg
For a while now, we’ve all been seeing some pretty outrageous claims about toothpastes containing charcoal and how much of a benefit they have.  Usually these appear in ads that say something like “the toothpaste your dentist will never tell you about” implying some conspiracy or the fact that they work so well, they will put dentistry in a pine box.  Unfortunately, neither of these are the truth.  The reason you don’t hear much about charcoal from your dentist is because there is no proof that it works.
JADA (Journal of the American Dental Association) recently published a literature review that showed no scientific evidence.  The review states:


The results of this literature review showed insufficient clinical and laboratory data to substantiate the safety and efficacy claims of charcoal and charcoal-based dentifrices. Larger-scale and well-designed studies are needed to establish conclusive evidence.

Practical Implications

Dental clinicians should advise their patients to be cautious when using charcoal and charcoal-based dentifrices with unproven claims of efficacy and safety.

Note that they are not saying it does not work as advertised.  They are simply saying there is no PROOF.  More scientific studies need to be done.
That being said, I’m not using or recommending anything in this category for the foreseeable future.

Thursday, October 12, 2017

Bluephase Style Curing Light - Polywave AND Pink!!!

Pink Bluephase Style.jpg
 Curing is perhaps the most important part of adhesive dentistry and yet it is the part that most dentists pay the least attention to.  The prevailing thought tends to be, “if it’s blue, we’re good!”.  Yet nothing could be further from the truth.
A good curing light is just as important to your clinical success as good materials and good technique.  That’s why I’m so passionate about curing.
I’m also passionate about breast cancer awareness and the fight against this terrible disease.  My sister is a tremendous fighter and a survivor!!!  during her treatment, I truly learned what it means to “fight like a girl”.  Because of my sister’s brave fight and her ultimately prevailing I’ve become very in touch with my inner pink and I support companies that support the fight.
Because of that, I want you to be aware of the Bluephase Style from Ivoclar,  It’s a broadband light that cures everything that uses a photoinitiator, and has several other nice features such as (direct from the company website):

Bluephase® Style

Bluephase® Style is on an ergonomic mission. Whilst it is grounded in the proven technologies of the Bluephase® range, it incorporates optimized features.

It offers a light output of 1,100 mW/cm2, which is comparable to that of the existing Bluephase® light. Additionally, the new Bluephase Style features a compact and ergonomic shape that fits the hands of women and men even more comfortably than its predecessor.


  • Comfortable to fit every woman’s and man’s hand
  • Polywave LED with halogen-like broadband spectrum of 385 to 515 nm
  • Suitable for all materials
  • Large treatment field due to 10-mm light probe
  • Shortened light probe, enabling access to all tooth surfaces without extreme opening of the mouth
  • Click & Cure for battery-independent emergency corded operation
  • Available in 3 colors (grey, pink and blue)

For all the pertinent info, check out the Bluephase Style page on the Ivoclar Vivadent webpageo  

Wednesday, October 11, 2017

FDA Looking Into Faster Generic Drug Development to Help with Rx Prices

The only way you wouldn’t know that prescription drug prices are spiraling into the stratosphere is if you haven’t needed a prescription in the last 5 years.  Many patients are faced with financial dilemmas such as “food or medicine” simply because their monthly prescription prices are so high.  Of course, the one way to fight that problem is with generic medications.  Generics are frequently many orders of magnitude less than their name brand counterparts.
What has always been the case in the world of pharmaceuticals is that big pharma spends a huge amount in developing a new drug.  The costs associated with this are astronomical.  There is research and development, FDA approval, and clinical testing, just to name a few.  Due to these huge expenditures, the big pharma companies have been able to recoup their costs by having a patent lasting about 7 years.  During that time, only the original name brand drug is available and the price is high to give the company a return on their huge investment.  Once the patent expires, generics come on the market and profitability for the drug’s developer drops accordingly.
Now comes word from the FDA that they are working to expedite the development of generics on a faster track than ever before.
In a FDA blog post last week, FDA Chairman Dr. Scott Gottlieb made the following statement:
Our plan has a number of different domains. Among them is a compilation of efforts to improve the efficiency of the generic drug approval process; and another is a group of policies aimed at closing loopholes that allow branded drug companies to game our rules in ways that forestall the generic competition that Congress intended. One important group of policies is aimed at making it easier to bring generic competition to a category of branded drugs known as complex drugs. Today we’re announcing a major new set of policies to advance these goals.
The full blog post can be seen here, but you need to scroll down to the post from October 2 titled “Reducing the Hurdles for Complex Generic Drug Development”.

Tuesday, October 10, 2017

GC Announces MI Paste One

One of things that dentistry considers a founding principle is prevention.  Since I use several advanced caries detection devices in my practice like CamX Spectra, CariVu, Sopro LIFE, and Sopro CARE, I’m able to find decay at its earliest stages.  Even if you aren’t yet using those types of devices, all practices still see patients who experience accelerated enamel breakdown whether it’s from a diagnosable problem or not.  For small reversible lesions and/or for patients who are caries prone, we’ve been recommending GC’s MI Paste for years now.  From an acceptance point of view, the only problem with MI Paste is getting people to remember to use it as they should.  However, almost everyone remembers to brush their teeth!!!  Hence I was pretty excited to hear about GC’s newest product MI Paste ONE.  Now the benefits of MI Paste are available in a toothpaste.  Here are all the details:

MI Paste ONE is the newest member of the MI Paste® Family as a two-in-one application (toothpaste and MI Paste Plus®) containing RECALDENT™ (CPP-ACP) and fluoride, in a cool mint flavor. This product presents another way to treat sensitivity, remineralize tooth enamel and prevent white spot lesions. Imagine a simple, single step for treatment and cleaning. As a replacement for your current toothpaste, it gives you the same power of MI Paste Plus®, but in a single application. Now, rather than brushing first then applying MI Paste® and/or MI Paste Plus®, you'll simply brush with MI Paste ONE.

  • Use MI Paste ONE:
    • For hypersensitivity
    • For remineralization
    • For tooth erosion and wear
    • For sensitivity from whitening
    • For preventing caries and white spot lesions