As baby boomers head to the dentist in increasing numbers for implants, crowns, and other smile-preserving surgeries, many are encountering a new and unsettling twist on periodontal work--the use of material from cows, pigs, and human cadavers to keep their teeth intact.
If you have a long-festering dental abscess, for example, it may be treated with Emdogain--a protein derived from the teeth of piglets that stimulates growth of the tooth and surrounding bone. Another technique, called guided tissue regeneration, uses membranes rendered from the Achilles tendons of cows. It provides sturdy barricades that keep gum cells at bay, giving teeth and bone a fighting chance to reclaim their rightful place.
These procedures are expensive--usually requiring an outlay of at least $1,200--and are rarely covered completely by dental insurance. Periodontists who use them, though, laud them as worthy investments in one's dental health.
"It really has been a
revolution," says periodontist Daniel Lippiner, DDS, of New York
University. "Until the advent of these materials, many, many teeth were
The type of biomaterial a periodontist will use depends on the problem being fixed as well as how big it is and where it is in your mouth. It will also depend on your practitioner's preference and training. But such surgeries are undeniably on the rise.
As recently as 5 years ago, three-quarters of the grafting materials used in this type of surgery were taken from other parts of the patient's mouth, says Michael Jeffries of Osteotech, Inc., the largest US supplier of cadaver bone. Now, he says, human and cow bone share the market for half of all such procedures.
While no one can give an ironclad guarantee that the biomaterials used in dentistry will ever result in an unintended complication, experts generally praise their safety.
A review published in the September 1999 Journal of Periodontology concluded that the risk of contracting a fatal brain illness from a cow bone graft "is several orders of magnitude less than that posed by the risk of death related to lightning, tornados, or similarly remote events." There have been no confirmed cases of human mad cow infection in the United States, which bans the importation of any bovine products from countries where the disease has appeared.
There have been no reports of any disease transmission with any of the more than 2 million human bone grafts of all types done in the past 7 years, according to Bob Rigney of the American Association of Tissue Banks. And Jeffries, of Osteotech, says that not only are donor-screening tests for viruses like HIV and hepatitis more sensitive than ever before, but the dozens of steps involved in processing the bone eradicate any disease-causing cells for which tests exist. (After being harvested from arm and leg bones of cadavers, it is demineralized and freeze-dried.) "You can never say 'never,' but the risk is minimal," says Jeffries.
How likely is it that implanted animal or human tissue will save a tooth, staunch an abscess, or securely anchor a crown or implant?
Collectively, such procedures "work 70 to 75% of the time," says Murray Schwartz, DDS, of the Columbia University Dental School. "It's more a risk of time and finances than a health risk," he says.
Autologous bone, which is taken from the patient's own chin or mouth, "is always the best," says Schwartz. Sometimes, though, a patient needs more bone than can be safely and comfortably harvested. Also, the pain, risk, and complications of opening a second surgical site may prompt a surgeon to opt for a foreign graft.
Emdogain, the pig protein manufactured by Biora, a Swedish company, is praised by many practitioners for enhancing healing and triggering bone growth; and some studies have shown remarkably positive results. It is undeniably useful, Grbic concedes, but "the people who do these studies have done the procedure thousands of times," and are experts at them. He also notes that certain defects are easier to correct than others are, and young, healthy patients heal better than those who are not.
But a far bigger
problem, says Grbic, is access to biomaterials by those who most need them.
"The people who tend to have more periodontal disease are typically the
ones who can't afford treatment," he says.
While a failure to fix a defect or abscess may not be the fault of the surgeon, the success of an operation involving biomaterials derived from human or animal tissue depends a lot on the skill and experience of the person who performs it, according to Dr. John Grbic of Columbia University.
Before having a procedure, ask the surgeon how many times he or she has performed it and what the chances are of success. No surgery is a 100% sure thing. Operations are more likely to fail if you are a smoker, have diabetes, or have a weakened immune system.
Some patients recoil when told that their periodontist wants to plant a piece of another person or animal inside them. They may have visions of Rob Schneider in Animal or Jeff Goldblum in The Fly. Synthetic fillers exist that can be used in place of bone, but they generally don't work as well in procedures where biomaterials are called for.
Still, it's worth
asking about your options, and whether you're a candidate for a simpler,
less expensive procedure. "With periodontal disease, things aren't
always black and white. There are sometimes other things you can do to
smooth out a pocket. You can sometimes take a burr and smooth out the bone
and eliminate a hole just by doing that," says Grbic.
Electronic Dental Anesthesia- Acceptable Alternative To Injected Anesthesia
ATLANTA, GA -- October 24, 2001-- Electronic dental anesthesia (EDA) appears to be a more effective anesthetic than a local anesthetic administered by injection. Additionally, almost all patients found the procedure acceptable, according to new study findings.
Lisa Fleck with Minnesota State University, in Mankato, United States, and colleagues presented the research today at the 2001 American Public Health Association (APHA) 129th Annual Meeting, in Atlanta, Georgia.
Although the US Food and Drug Administration (FDA) has approved EDA for use in the United States, a manufacturer of the product, 3M, pulled the product off the market, "not because it wasn't working, but because the marketability wasn't there.
The EDA procedure employs electrodes, which are placed on the patients' face. As a current is administered, the patient turns a knob to control the flow.
A total of 12 patients used the device to see how its ability as an anesthetic compared to that of an injection.
One half of each patient's mouth was treated with an injection of local anesthesia and scaled and root planed. The other half of the patient's mouth was treated with EDA and the same procedure was performed.
The researchers measured the patients' blood pressure at 5 intervals during the treatment, and patients filled out a pain scale before and after each side of the mouth was completed.
According to Ms Fleck, the patients' blood pressure spiked immediately following the injection. In contrast, blood pressure remained level throughout the procedure with the EDA. In addition, fewer patients receiving EDA reported experiencing moderate pain or discomfort compared to those receiving an injection.
Eleven of the 12 patients found
the procedure acceptable. "One patient did not like having to control the
level of current and would have preferred to rely on the dentist," she
"The main reason people would choose this method is that they are needle phobic," Ms Fleck said.
According to Ms Fleck, a major benefit is that there is no residual numbness or slurred speech after use. "Another advantage is that the blood flow to the area is increased with the use of the EDA, and this may hasten recovery and improve healing, especially for more invasive procedures," Ms Fleck said.
Ms Fleck advised that EDA is contraindicated for certain patients, such as if the patient cannot follow direction, has a pacemaker, heart disease, epilepsy, or is pregnant.
SUNDAY, Oct. 28 (HealthScoutNews) -- Dry mouth, an increasingly common condition for adults taking medications, undergoing chemotherapy or suffering from auto-immune diseases, can be more than just uncomfortable. It heightens the risk of cavities, say dentists.
And one way of reducing cavities can be taken from a chapter to prevent tooth decay in children -- using dental sealants to protect teeth.
"Sealants have been around for years and were geared to children as a way to prevent cavities by keeping germs and acids from attaching to the tops of back teeth," says Dr. Barbara A. Rich, a Cherry Hill, N.J., dentist. "It should be a common procedure in dental offices to prevent dental disease [in adults with dry mouth]."
Rich says that dry mouth, when the mouth glands don't produce enough saliva, is increasingly common among older adults who are taking drugs, as well as those who are undergoing chemotherapy, or who are suffering from diseases like Parkinson's.
According to the Academy of General Dentistry, studies show that up to 400 medications, prescriptions and over-the-counter drugs can contribute to symptoms associated with dry mouth. The most common troublemakers are anti-depressants, painkillers, tranquilizers, diuretics, and antihistamines. The result is that a lot of people can suffer from this disorder.
"It could be as much as a third of the population that suffers from dry mouth," Rich says.
Without enough saliva in your mouth to cleanse it, plaque adheres more readily to the teeth and gums and there is an increased incidence of cavities, Rich says.
The sealants, applied in liquid or gel form, adhere to the tops of the teeth and protect the grooves in the teeth from germs and acids that could collect there.
However, the procedure does not offer complete protection. "It prevents cavities on the tops of teeth, the biting surface, but not in between," Rich says.
Also, many older people no longer have the pits and grooves in the tops of the teeth.
"Some people get through life with no cavities, but many have had fillings and the grooves were smoothed out then," says Minnesota dentist Dr. Kimberly Harms. "Also, most of their decay is on root surfaces, near the gumline, and between the teeth, and the sealants only take care of the top of the teeth."
For those people, she emphasizes dental hygiene.
"The cavities can form very quickly [without enough saliva], and you need to keep the plaque away. So I recommend meticulous oral hygiene -- brushing at least twice a day with fluoridated toothpaste, and floss, floss, floss," says Harms, who is also a consumer advisor for the American Dental Association.
"But that being said, sealants are a wonderful thing for treatment of dry mouth if you have exposed grooves," she says.
What To Do
If you have started a new medication and find that your mouth is drier, you should visit your dentist, says Rich, because cavities can develop quickly without enough saliva.
Other suggestions she makes for reducing the effects of dry mouth: Avoid caffeine, alcohol and overly salty foods, which dry out the mouth; brush and floss regularly; and chew sugarless gum, which can triple the amount of saliva in your mouth.