Safe Practices in Dentistry: Out with the Old in with the New

Having recently published a post regarding the dangers of amalgam fillings, I was eager to further explore the web for related topics in dental medicine. In particular, I decided to search the blogosphere for topics that focus on the alternative and more efficient techniques that professionals are using to ensure quality care and safety for their patients. As a dentist in the making, it is critical to gain a comprehensive understanding of the current trends in all areas of dentistry so that I am able to effectively employ them with my own patients in the future.

The first post I came across was within The Endo Blog entitled Research Update: Direct Pulp Capping with MTA. The blog was created by Dr. Edward Carlson D.D.S and Dr. Jason Hales D.D.S., M.S., two endodontists with training from West Virginia University. Apparently, endodontists are now using a Mineral Trioxide Aggregate as a direct pulp capping agent (see picture to above), which appears to be a safer and more successful material. It was refreshing to see that the experts in the specialty fields of dentistry are not the only ones starting to engage in new and improved technological advances; general dentists are also getting involved. The other post that interested me was within Glen Ellyn’s blog, Smile. Dr. Ellyn, pictured below, is a high tech dentist with more than 27 years of experience in cosmetic, sedation, and implant dentistry. On a more general level, his post entitled Dentists Using Dangerous Dental Labs, appropriately warns consumers to inquire about the origin of their fillings, dentures, and veneers due to a recent discovery of dangerous levels of lead found in porcelain dental crowns. I have offered a few comments to both posts, and have also placed them below for your convenience.Comment: (Research Update: Direct Pulp Capping with MTA)

Although I am naïve to the field of endodontics, I found your post intriguing because, on the other hand, I am very aware of the issue involving the health hazards of certain materials used in dental work. It was only recently brought to my attention that harmful substances are found not only in fillings, but in dentures, veneers, and in capping agents as well. From my understanding, MTA is a type of cement that is easy to use, more predictable than traditional materials used for capping, and more importantly, safe for the patient. As I am sure you are aware, many practitioners are unfortunately reluctant to incorporate the use of newer and safer material in their practices, so the inclusion of the data that supports the use of MTA as a direct pulp capping agent is appropriate and necessary in your post. You state that, “Over a 9 year period of observation, the authors found that 49 of 53 teeth had a favorable outcome on the basis of radiographic appearance, subjective symptoms & cold testing,” which seems remarkable. Since practitioners are trained to rely solely on evidence based dentistry and medicine, it might be beneficial to include additional cases similar to the study in your post to sell other dentists on this new product. Regrettably, the fact that it can do wonders for the patient, by inducing cell proliferation, cytokine release, and hard tissue formation, is still not enough to convince all professionals to use MTA. As you have mentioned, it can also potentially be used by a wide variety of specialists and general dentists, which should also add to the benefits of MTA and encourage its use. My question to you is, how can other specialists besides endodontists employ this material? I am curious to know because, although I do not expect to enter the field of endodontia, I want to integrate the best and safest materials in my own practice in the future. By informing dentists of all types about the applications of MTA, perhaps more MTA will be put to use, making the dentist’s job easier, which could ultimately yield more successful and safer outcomes.

Comment: (Dentists Using Dangerous Dental Labs)

First, I want to say that I think it is excellent that you are making the public aware of the potential harmful consequences resulting from toxins that may be found in their dental repair components. Your brief post regarding this topic was the only one I encountered in my exploration throughout the blogosphere. It is unfortunate that other professionals are not showing as much concern for their patients’ safety. This issue was brought to my attention after recently publishing my own post regarding the health hazards of amalgam fillings. Reading the research on the subject of the consequences of mercury within these restorations and how some dentists are reluctant to discontinue their use was disturbing. It was even more appalling to read in your piece that this is not only an issue with fillings, but that there are also dangerous materials within caps, crowns, dentures and veneers. The fact that millions of dental prostheses are actually made in labs in China, India, the Philippines, Mexico, Eastern Europe, and Costa Rica is also new to me. There is no question that the United States is one of, if not the most, technologically advanced countries in medicine and research. Do you agree that dental products and supplies could be made safer if manufactured under the eye of the prestigious professionals within our nation, or even under the scrutiny of the FDA? The inclusion of more stories in future posts, similar to the account of the woman being sickened by lead-tainted dental work from China, may sway more experts and dentists into adopting some method of policing the dental components utilized in this country. I certainly concur with you when you state, “It is unfortunate that many dentists who have felt the pressures of managed care and rising costs are reducing the standard of care by using dental laboratories that may not meet the standard of professional care that patients deserve.” I enjoyed reading your post, and hope you find a moment to respond to my comments. Thanks for your time.

Amalgam Fillings: Danger to those in the Dentist Chair and Behind it

Despite the fact that the World Health Organization declared that a safe level of mercury exposure has never been established, dentists are still giving patients mercury-containing amalgam fillings. Although amalgam fillings are durable and strong, the potential harmful side effects that can result from the mercury within these dental restorations should be a sufficient reason to band these fillings from all dental practices.

Several government and medical studies have concluded that amalgam fillings (see picture to below), which contain 50% Mercury, are the number one source of human exposure to this toxic substance. Mercury has been proven to damage DNA, impair kidney function, and induce autoimmune and neurological diseases, like Multiple Sclerosis and Parkinson’s disease. Dr. Kourosh Maddahi, a Beverly Hills biological dentist claims that, “A wide range of problems have been associated with mercury poisoning such as chronic tiredness, digestive problems, muscle and joint aches, and stiffness and sinus troubles,” Other signs and symptoms associated with mercury poisoning include tension and migraine headaches, hair loss, asthma, allergies, and eczema. There are several stories posted on the web that cover patients’ experiences with overcoming these side effects. Daniel Lewis, a former varsity athlete in Portland Oregon, said that two weeks after the removal of his amalgam restorations, his nose bleeds, neurological moods swings, and paranoid thoughts immediately ceased. Chuck Balzer of Lincroft, New Jersey, was misdiagnosed with fibromyalgia because he suffered complaints of lower leg pain, exacerbating arthritis, and fatigue. Once he took the advice of the right general practitioner who recommended he remove his amalgam fillings, he noticed that his overall health dramatically improved.

It is quite disturbing that these types of fillings are still in use, especially after the publishing of over 100 scientific papers linking mercury poisoning with amalgam fillings. What is even more appalling is the fact that the well-known and respected American Dental Association recently published an article that labels any dentist who removes amalgam restorations unethical. The European Union scientific committee recently stated in a similar bulletin that, "No risks of adverse systemic effects exist and the current use of dental amalgam does not pose a risk of systemic disease.” Unfortunately, comments from certain “trustworthy” organizations appear to be persuading practitioners that these fillings are safe.

If the risk to the patient’s safety is not enough to completely dissuade dentists from amalgam fillings, perhaps the consequences mercury can have on the practitioner’s health will be sufficient. Scientific data has revealed that dentists who use these restorations have double the number of brain tumors and perform less well with respect to neurological function tests than dentists who do not use fillings containing mercury. It would be beneficial for dentists to take advantage of the several technological advancements in dental medicine, and become more adamant about promoting the use of alternative methods and materials, for both their own safety and the patient’s. Some new techniques are not only safer, but more efficient and less painful. Using a dental laser instead of a drill to fill cavities is a less invasive technique. Gold fillings, although not aesthetically pleasing, are very durable like amalgam, but less dangerous. White fillings, otherwise known as composite fillings, are smaller than amalgam fillings and require less tooth preparation. They also make the tooth stronger, and less sensitive to temperature changes in the mouth. Resin ionomers is another option. They offer a more natural appearance and contain fluoride, which protects the tooth from future decay. According to Dr. Maddahi, “It is impossible for dentists to say who or who will not manifest overt symptoms of chronic mercury poisoning,” similar to how physicians cannot always determine which patients may react defectively with certain medications. This should further encourage dentists to use these other types of fillings that are guaranteed to fix dental caries and simultaneously maintain the wellbeing of the patients. .

Regrettably, the extensive evidence on the dangers of amalgam fillings and the emergence of new technology is still not enough to completely discontinue their use. Furthermore, since there is also a lack of regulation from the government and other health organizations, it seems as though the only other source that could possibly provide a solution to this recurring issue may be the patient. While some are more prone to cavities than others, like smokers, chemotherapy patients, sufferers of Sjogren Syndrome, and those who have dysfunctional salivary glands, there are still ways to prevent the development of caries (see picture to right). Simply by avoiding sugary foods, and brushing and flossing three times a day, individuals can maintain good oral hygiene, which may save a trip to the dentist, a few hundred dollars, and allow an individual to steer clear of receiving fillings altogether. Nevertheless, it is still unfortunate that patients may need to guard their safety solely by themselves, instead of being able to entirely rely on their practitioner.

The harmful side effects of amalgam fillings, which have been recognized for several years, should make their use unacceptable. More dentists and organizations need to take a stance like the American Academy of Head, Neck and Facial Pain, who feels that, “The evidence is too overwhelming to continue to practice in ignorance and avoidance of the facts.” Though some dentists have taken the appropriate actions and attitude towards these mercury-containing restorations, some is not enough.

Helpful Hints from the Web: The "Ins and Outs" for Dental School Admission

Having recently been accepted to a few very prestigious dental schools, I thought it might be helpful to provide my readers with valuable tips on how to achieve positive results from the dental school application process. Provided within my linkroll (left) are ten websites, which I have appropriately evaluated below according to the Webby Awards Criteria, that may offer advice to future dental school applicants. The Webby Awards evaluate resources based on content, structure and navigation, visual design, functionality, interactivity, and overall experience. Some of the websites listed may be stronger in some areas than in others. Depending upon the future dentist’s area of interest within the application process, a few or several of these sites may offer some assistance.

From personal experience, one of the best ways to begin the dental school application procedure is to first seek advice from those who have already applied and “suffered” through the process. Even though Predental.com has poor visual design, with minimal colors and no pictures, it does offer an excellent way to become interactive via its discussion group. By simply entering an email address, browsers can contact professionals and other students with questions and comments. FAFSA is another website that permits easy interaction. It is no surprise that the cost of dental school is prohibitive. Because this site utilizes exceptional structure and navigation techniques, applying for financial aid online is made easier for the applicant. Having just submitted my own FAFSA, I found the site map and main links at the top of the page useful for locating particular portions of the application. Similarly, the Ultimate Dental School Admission Guide provides an opportunity for readers to effortlessly subscribe to its newsletter on the main page, which offers tips from an actual dental medical doctor, Dr. Aly Kanani DMD. The site also offers a test preparation package (see to the right), which appears to be a great alternative way to practice for the DAT, for those who do not desire or cannot afford to enroll in a Kaplan course. Unfortunately, that portion of the site is cumbersome. Even if one is able to dredge through the site, with intentions of making a purchase, the site is not currently accepting any orders online. If a DAT preparation package is of little interest, Education Index offers several links within the site that offer alternative ways for preparing for the DAT. Although the overall visual appearance is plain with very little textual variety, its brightly colored links offer tips for the admission test. Nonetheless, most dental schools do place a great emphasis on board scores regarding acceptance.

Often, the next step immediately following the completion of the DAT, is to begin filling out the application itself, which is done online through AADSAS. The site is structured in a manner to make the application process significantly simpler, so that a student only needs to fill out one application for all designated schools. During the 2007-2008 application cycle, I found that the site was frequently under construction or inaccessible. It would be helpful in the future to make the site more functional, as the application process is long and tedious. To provide guidance as to which schools may be most suitable for an individual, The Dental Site contains a page within it that provides links to all the 54 dental schools within the United States. To alleviate some of the stressors of the application process, it also provides easily located links to personal stories involving admission, professional accounts, and online archives.

Several of the other resources provide adequate content for dental school preparation and other aspects of dentistry. A link within the US Department of labor presents easily navigable information on the nature of dentistry, earnings, and job outlooks. This link, however, could be more visually attractive. It is easy to access the information being sought because it neatly arranges the topics of interest at the top of the screen, which prevents the browser from having to scroll through the entire page. Choosing the right dental school may be difficult, so it may be wise to base a decision on a school’s residency programs, especially if the candidate is interested in post graduate studies. Dental Resources not only is appealing, through its videos on cosmetic dentistry and several pictures, but it also provides excellent links to information on other branches of dentistry like endodontics, orthodontics, periodontics, and other specialty programs. This, as well as the Academy of General Dentistry, may also be of some assistance to current dental students and dentists. The Academy of General Dentistry is the most well constructed site, as it is updated frequently, contains appropriate and appealing images, provides detailed descriptions of the benefits of becoming a member, and also offers opportunities for readers to interact through its blog, “The Daily Grind.”

I thought it would also be beneficial to include a site for those who may be interested in pursuing other careers in the dental field other than the doctor of dental surgery or dental medical doctor programs. All Allied Health Schools provides links with easy access and functionality to schools for training in areas like dental hygiene and dental assistance, for example. Links to career centers, recent articles, and top programs and schools are also available on the home page. Since it is common to enter programs such as these for extra experience before applying to dental school, this resource may be very informative, even for the future dentist.

Through first hand experience, there is no doubt that the application process for dental school admission is extensive and challenging. I certainly hope that at the very least, a few of the websites enlisted can ease the process and answer several questions regarding the course of action that is necessary to take in order to be a prime candidate for a career in dental medicine.

Counterfeit Colgate: A Wake up Call for the FDA

The U.S. Food and Drug Administration aggressively regulates products such as food, veterinary products, cosmetics, and medical devices in order to advance and protect the public health. As a result of some of the lethal side effects of medications, the FDA has focused its attention on the safety standards of prescription drugs. Although the FDA has demonstrated adequate surveillance of pharmaceutical drugs, they have failed to sufficiently regulate nutraceuticals and other consumer products, like toothpaste. Recently, counterfeit “Colgate” toothpaste was found in discount stores in several states across the country. It was detected to contain a toxic chemical known as diethylene glycol (DEG), which is illegally used as an artificial sweetener, thickening agent or solvent, and is commonly found in antifreeze. Dr. Nestor Sosa M.D., shown to the right, is a University of Miami trained physician who discovered DEG in other consumer products like cough syrup. He claims that DEG may result in weakness and tingling in the legs, kidney failure, neurological degeneration, and possibly death. Unfortunately, it was only after customers experienced these harmful side effects that the FDA recognized the situation. Even after the toxic side effects were exposed, the FDA continued to take a passive role in regulation. Since the discovery, the company has only pulled the product from shelves in Massachusetts. It still remains in stores in Pennsylvania, New York, Maryland, Florida and New Jersey, and customers in other areas have only received a warning to stay away from the item. Douglas Arbesfeld, a spokesman for the FDA, seemed to take a nonchalant stance on the situation when he stated, “It's (DEG) a low health risk but the bottom line is, it doesn't belong in toothpaste.” It is irresponsible for Arbesfeld to minimize the significance of the side effects of [DEG], particularly after medical doctors from prestigious universities claim that the toxin may be extremely risky and unsafe.

Regulatory agencies, especially the FDA, should have taken a more active role in regulation prior to the public experiencing these toxic consequences. Perhaps their inability to do so may be because of the larger mood of deregulation in Washington. Medical device field inspection and enforcement programs took a 12.2% cut in the FDA’s 1998 budget, as James G. Dickenson claims. Lillian Gill suggested, “The cut would mean fewer and shorter inspections, new risk-based enforcement strategies, elimination of field-headquarters overlaps in processing product recalls, less travel, and more use of satellite- and videoconferencing to get her office's message out.” Nevertheless, the FDA failed to take action, as they overlooked the several misspelled words on the product carton. Other distinguishing characteristics of the imitation product include its origin. Colgate has never imported toothpaste from South Africa, and the FDA neglected to recognize the phrase “Manufactured in South Africa” within the labeling on the container. Fortunately, the Colgate-Palmolive company has made additional developments and taken action to protect consumers against possible risks from the counterfeit toothpaste. For instance, they have clarified to consumers how to distinctly identify the product, and are currently working with the American Dental Association and the American Dental Hygienists Association to provide information to dental professionals in hopes to assist them in answering patient questions. They have also ensured the public that their authentic product is safe by stating that, "Diethylene Glycol is not used in any Colgate toothpaste in the United States or anywhere else in the world and Colgate does not import toothpaste from South Africa into America." Furthermore, by supplying additional representatives on its consumer information line and extending their hours of operation, Colgate Palmolive has made itself more readily available to answer any questions about the counterfeit product.

It is disturbing that the only reason consumers are truly aware of the issues with the counterfeit Colgate is through the Colgate-Palmolive company itself (see toothpaste to left). The Federal Drug Administration is one of the largest regulatory entities in the world, and the public should be reassured that the company will not only meticulously inspect prescription drugs, but also carefully examine everyday household products. There have been recent claims that counterfeit toothpaste is not only being imported from South Africa, but from China as well. Although the FDA claims that, “All Chinese toothpaste is stopped and tested at the border, and very little, if any is coming into the United States,” it is difficult to believe such a statement following the issues with the counterfeit Colgate. The FDA should assure customers of their safety by assessing and evaluating over-the counter products of all origins, including other brands of toothpaste and dental hygienic products, which could potentially contain toxic substances. It should be a requirement for the FDA to examine items that are ingested and also topically applied, because topically applied products have significant systemic absorption.

Failure by the FDA to properly regulate certain materials may not only take a toll on consumers and patients, but could hurt dentists and physicians as well. Dr. Michael Pelekanos M.D. of Forbes Regional Hospital, a qualified obstetrician and gynecologist from the University of Pennsylvania said, “There’s less control on generic drugs. A patient who was on Dilantin for seizure activity for ten years promptly seized two days after starting the generic version. Fortunately the patient was home, but had she’d been driving, it could have jeopardized her life, passangers’ in other cars, and potentially cost me my job.” Inevitably, the system of policing consumer products will never be perfect, even with added regulation to non-prescriptions items. Toxicities of certain compounds may not manifest until repetitive use. However, taking a step towards making the inspection process better is what our governmental agencies must do.

Cybermouth: A Closer Look

This week I decided to explore the Web for sources that are relevant to my blog’s emphasis in dentistry. In the course of my search, I found ten sites, which have been posted in my link roll to the left, that may be valuable to those who share an interest in my field of study. As a tool for those browsing my blog, I have critiqued the websites according to the Webby Awards criteria, and have offered a few comments as to how these sites may be improved in order to make a viewer’s experience more enjoyable.

The first and foremost significant aspect of a credible website is having trustworthy text, visual, and musical content. The American Association of Orthodontics offers educational videos, detailed advice for patients, and updated press releases. These areas of interest are easy to navigate, structurally appealing, and engaging. I found my overall experience at this particular site to be excellent, as it functioned well and provided a wide variety of topics that could be valuable to dentists and patients.

Since cosmetic dentistry involves meticulous attention to detail, it is no surprise that the American Academy of Cosmetic Dentistry appropriately contains superb visuals and audio. The Kaplan Test Prep and Admissions suitably offers exceptional material for students with intentions of pursuing a career in dental medicine. From personal experience, I can ensure that it contains easily accessible links that can offer a student all the necessary advice to properly prepare for the DAT. The American Dental Association also offers suggestions for the DAT exam, in addition to a variety of subject matter concerning oral health. It arranges all of its topics in alphabetical order, which makes browsing the page more efficient.

The American Association of Women Dentists is an appealing site because more and more women are entering the field of dentistry and need power for networking and representation. The site also offers easy access to affiliate organizations. The content is intriguing, however the way the material is presented needs to be done so more creatively. Web Dentistry encounters a similar problem. Although it contains high-quality, frequently updated content relevant to current issues in dentistry, the structure of the site is very repetitive and boring. For these sites, it may be beneficial to add supplements that are visually pleasing to the viewer, like video clips, audio, and photos.

With new breakthroughs in medicine and health care everyday, it is important for professionals and patients to be able to share experiences and thoughts on the web. Oral Health America actively portrays to the public the importance of the mouth on general health, and encourages viewers to donate to charities and sign up for news letters. Dental Fear Central allows patients to easily and promptly discuss their fears involved with seeing the dentist. There is abundant opportunity for students to interact within the American Student Dental Association. It encourages student dentists to obtain a membership, make a profile, and to participate in discussion forums. Although ADS Practice Transitions Made Perfect offers interactivity for those professionals with questions about their practices and questions about dental economics, it is unfortunately not very functional. It is slow to load its blog page, which may drive away browsers. It is crucial that websites not only have easy access to areas within the page, but it must allow viewers to retrieve information in a timely manner.

Although these websites do need some corrections and updates, they do contain very useful information that may be beneficial to patients, practitioners, and students. I hope my critiques may be valuable to others when exploring these links.

The Good Dentist: Accommodating all Patients

Visiting the dentist on a regular basis is not always easy for a majority of people. For some it is too costly, others do not have time, many fear going to the dentist all together, and some are simply unreliable. As I get closer and closer to entering my profession as a dentist, I have realized that it is not only important to be technically proficient and knowledgeable about multiple disease states, but it is also imperative to acquire a knack in order to cater to a broad spectrum of patients. After entering the blogosphere for the first time, it was refreshing to see that several dentists and organizations are now attempting to accommodate all of their patients through a variety of ways. Richmond Dental Implants was the first blog I came across, and I examined the post, “Sedation Dentistry in Richmond,” published by Dr. Scott Gore D.D.S. He is a graduate of the Medical College of Virginia, School of Dentistry, and is a proud advocate of sedation dentistry. Sedation dentistry (see picture to right) appears to allow the busy patient to receive the type of treatment they need in a time efficient manner, and may make a visit more pleasant for patients with dental phobia. The other post that interested me was found within a blog written by a USC student, Melody Chiu. Her entry entitled, “USC School of Dentistry Students Check Local Children’s Oral Hygiene,” discusses how USC is assisting patients and families with low incomes by providing them with a trip to the dentist and exposure to proper oral hygiene, as seen in the picture below. I have offered my comments on both posts below and directly on the authors’ blog page.

Comment (Sedation Dentistry in Richmond):
It seems to me that whenever I mention my aspirations of becoming a dentist to those who ask about my future career plans, the majority cringe. At least at some point in your career, I am sure you have also experienced family, friends, and even patients telling you, “I hate going to the dentist!” or something along those lines. As you mention in your post, people avoid the dentist for a number of reasons: some are too busy to get to the dentist regularly, others get physically sick, some people have severe back and neck pain that make sitting in a chair uncomfortable, and several get claustrophobic or anxious, to name a few. Although my father is not a dentist, he is a very successful gynecologist, and has demonstrated to me over the years how very important it is to find a way to accommodate all types of patients. What is intriguing to me about your article is that sedation dentistry seems to be a technique that can help patients who dread a trip to the dentist for a variety of reasons. Being naïve in the field of dentistry at this point, I have very little knowledge about sedation dentistry. You do mention it involves taking pills, that the patient is not asleep, and that it promotes relaxation. Having an interest in medicine as well, and to ensure a patient’s well being, I would like to know more about the composition of these pills, side effects, and who specifically may or may not benefit from this new technique. As you have probably experienced in your practice, children especially tend to have a difficult time at the dentist. With this in mind, I am interested in knowing if sedation dentistry is safe for the younger patient, and if this technique may affect them differently than it would affect adults. Finally, you mention it allows you to do several procedures in one sitting and may shorten recovery time for the patient. Fewer trips to the dentist and a less painful and shorter recovery time are aspects of sedation dentistry that would clearly be appealing to all people. With the significance of being able to accommodate a wide variety of patients, do you feel that sedation dentistry may be the way of the future in dental medicine for everyone? Thank you for your time.

Comment (USC School of Dentistry Student’s Check Local Children’s Hygiene):
Recently, I published a post that discusses how the mouth may be used as a diagnostic tool for diagnosing other systemic diseases. When I came across your post, I found it quite interesting that the number one reason why kids from the Los Angeles Unified School District are missing school is because of tooth-related problems that ultimately affect the rest of the body. It was fulfilling to find facts within your post that relate to a previous post of mine. However, what truly caught my attention within your entry was the idea of USC dental school students taking action to help less fortunate children from low income families solve these tooth-related problems. As you probably can agree, a necessary ingredient to becoming a successful practitioner is being capable of accommodating a variety of patients and their needs. You mention that a lot of kids end up with infections because their parents cannot afford to take them to the dentist. It is very uplifting to see, through exposure to proper oral hygiene, that USC students are helping children get the treatment they need while eliminating some of the expenses. I think it is great that USC is teaming up with the American Dental Association to provide basic screenings and required sealants for children, but I believe disease prevention and reduction of tooth decay starts with knowing how to eat and brush properly. With intentions of becoming an orthodontist, I completely agree with Dr. Holtzman when she states in your post that, “Teeth are very important in the way we feel about ourselves.” To be able to enhance a patient’s confidence by providing them with appropriate care and a beautiful smile will be very rewarding. Accommodating my patients’ needs, whether it be cutting costs, or making their experience more pleasant, while providing care at the same time will be even more rewarding. Your post was very engaging. Thanks for your time.

The Mouth: A Diagnostic Tool

It is no surprise that certain systemic diseases, like cancer, osteoporosis, coronary artery disease and certain viral infections are becoming more prevalent amongst the general population. Whether this is due to unhealthy diet, genetics, age, or environmental factors like smoke and pollution, more are being diagnosed with these and other lethal infections. Regardless of the source, many individuals are reluctant to see their doctors on a regular basis, which may not only prevent diseases, but allow them to be treated in an earlier and more curable stage. People are failing to turn to their physicians, so perhaps a visit to the dentist could be an alternative. Recent evidence shows that there may be new screening technology for the oral cavity that could possibly predict which patients are at risk for developing these diseases. Minimally invasive, inexpensive, and painless screening techniques, that are currently demonstrating promising results in clinical studies, may be the diagnostic tool of the future.

According to the American Cancer Society, the second leading cause of death among American women today is breast cancer. In order to detect cysts, calcifications and tumors within the breast, typically women over the age of 35 make a trip to their OBGYN to receive a yearly mammogram. However, Chyke A. Doubeni, M.D., M.P.H., of the University of Massachusetts Medical Center claims that, "Despite their [women] significant risk for development of a new breast tumor, even women who comply with a recommended yearly mammogram gradually fall by the wayside over the years." On the other hand, in a recent experiment at the University of Texas, Dr. Charles F. Streckfus D.D.S., may have discovered an alternative method for diagnosis. He simply examined a swab of saliva for salivary protein levels, which he claims have the potential to assist in diagnosis of breast cancer, and the ability to monitor tumor response during treatment. The study revealed that breast cancer patients tend to have higher levels of salivary proteins than healthy patients, that ultimately decrease once chemotherapy is initiated. Though this method has not yet been approved by the FDA, it is still an easier process for the patient and the practitioner. Until this new technology receives approval, in collaboration with mammography and blood work, salivary protein analysis may enhance the diagnostic acumen of the medical provider.

An analysis of the saliva may eventually help gynecologists to also detect other disease states. A study conducted at the University of Buffalo concluded that the prevalence of gum-disease causing oral bacteria has been linked to oral bone loss. In a controlled setting, postmenopausal women that were part of a larger investigation involving risk factors for osteoporosis and oral bone loss (see picture to left), were examined for specific periodontal pathogens, mainly P. gigivalis and T. forsynthesis. These two pathogens were found to infect 15.1 percent and 37.9 percent of these women. In addition, two other pathogens, P. intermedia and C. rectus, were found in 43.4 percent and 17.4 percent of women. If indeed these oral pathogens are related to bone loss in the mouth, it is conceivable that this may prove to be an easy, reasonably priced, and risk free test that may help in the diagnosis of systemic osteoporosis. It is well known that obese women compared to women with normal BMIs have a lower risk of developing osteoporosis due to effects of estrogen and weight bearing on bone preservation. However, this study also found that the greatest risk for oral bone loss was found in overweight women, supported by a three-fold increase. These seemingly contradicting discoveries only support the fact that further research needs to be done to elucidate the seemingly conflicting results. Since the cost of the current bone density test used by gynecologists is so significant, if further investigation of this new diagnostic tool could prove to help predict systemic osteoporosis, health care costs could be decreased dramatically.

Salivary analysis could also help infectious disease specialists diagnose viral infections. Although typically these viruses are found through examination of blood samples, Farmer, Clewley, Griffiths, and Johnson of the U.S. National Institute of Health claim that, "The sensitivity of the saliva Murex GACELISA is the same as the routine serum testing assay." For example, salivary IgA levels tend to decline as an HIV patient becomes symptomatic. Therefore, it may be that the detection of IgA antibody to HIV (see picture to right) in saliva may indicate the progression of the HIV infection. Similar studies have used saliva samples as a successful tool for diagnosis of hepatitis A and hepatitis B, based on the levels of IgM antibodies in saliva. In particular, it has been found that low levels of IgM are associated with vaccine-induced immunity. Just as the comparison of serum and saliva levels of antibody to HIV have been directly correlated, so have the levels of antibody for hepatitis (sensitivity = 98.7% and specificity = 99.6%). Since it has been discovered that in certain cases saliva and serum analysis are equally effective in the diagnoses of some diseases, this new technique may be advantageous. This needle-less method of analysis is not only simple and cost effective, but it is also beneficial to those patients, like hemophiliacs and drug users, who have difficulty in accessing peripheral blood.

Saliva samples are also being used to predict and monitor drug and hormone levels, certain autoimmune diseases, and hereditary diseases like cystic fibrosis. Still, many physicians are hesitant to believe that it could ever truly be considered a valid method for accurately predicting systemic diseases. For instance, Irwin Mandel, a professor emeritus of Columbia University, believes that, "Saliva doesn't have the drama of blood and the salivary glands are only lowly excretory organs." Although plenty of further research is necessary to make this new diagnostic tool legitimate, it is still very encouraging to believe that in the very near future, health care providers may have a painless, efficient, and cost effective way for detecting several of today’s most common diseases. After all, swabs of certain body surfaces that were at one point thought to be unreliable have proven to save lives, and the classic example is George Papanicolaou’s Pap Smear.