Heraeus Kulzer to relocate headquarters

Heraeus Kulzer to relocate headquarters

May 7, 2008 -- Dental esthetics firm Heraeus Kulzer recently announced that it will relocate its North American headquarters to its current manufacturing and distribution facility in South Bend, Ind., by December 2008.

All business functions, including sales, customer service, finance, accounting, technical services, and marketing, will be centralized at the South Bend facility, according to the company.

"This is a time of unprecedented innovation in esthetic dentistry ... and in the history of Heraeus," said Bernard Bolka, chief financial officer of Heraeus Kulzer, in a press release. "Just as we relentlessly improve our products and materials, we want to continually evolve our company to be in the best position to accelerate new technologies and to better serve our customers."

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AGD applauds proposed U.S. oral health initiative

AGD applauds proposed U.S. oral health initiative

May 29, 2008 -- The Academy of General Dentistry (AGD) is giving two thumbs up to the recent introduction of the Oral Health Initiative Act of 2008 by Sen. Benjamin Cardin (D-MD) and Sen. Susan Collins (R-ME). The bill, S. 3064, proposes the establishment of a multifaceted approach to oral healthcare through the creation of an expert oral health working group to assess existing U.S. oral health programs and recommend improvements.

"Dental disease presents a very serious problem for our children, particularly those from lower-income families," said AGD president Vincent Mayher, D.M.D, M.A.G.D. "This working group should look closely at all federal oral healthcare programs and make recommendations for improvement to ensure that no child is without dental care." The working group would also develop programs to improve the oral health of and prevent dental disease in children, Medicaid-eligible adults, and other vulnerable populations who are among those Americans at highest risk of dental disease.

The AGD will be issuing an action alert this week to its members, urging them to send letters to their senators asking them to support this measure, according to Janet Kopenhaver, AGD's Washington lobbyist. Cosponsorship of the bill will be a component of the AGD Scorecard of the 110th Congress, to be issued at this session's adjournment, she added.



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Saliva provides early warning signs of cancer

Saliva provides early warning signs of cancer

May 29, 2008 -- Looking inside someone's mouth may one day involve more than dental care. It could enable early diagnosis of various cancers, leading to more effective treatment outcomes and better survival rates.

According to research presented at the 2008 American Association for Cancer Research (AACR) meeting in San Diego, analyzing the DNA in saliva can provide clues about the molecular damage that can lead to cancer. In particular, the investigators found that analyzing this DNA may help detect the early signs of head and neck squamous cell cancer (HNSCC).

While this research is still in its infancy, the researchers say sampling cells in saliva could become a cancer screening method for large populations, and dentists might play an important role in such testing.

"The test is a very noninvasive one and very patient-friendly," said Seema Sethi, M.D., of Henry Ford Hospital in Detroit, the lead researcher of the study. "At the same time, it was very good at differentiating those with cancer from healthy people without the disease."

At present, more than 40,000 Americans are affected by HNSCC, and approximately 12,000 die from it each year. The development of HNSCC in people at risk, such as smokers, takes many years, and most cases are diagnosed at an advanced stage when prognosis is poor. Often, the treatment is surgery that can lead to significant disfigurement.

"Patients are sometimes unable to eat and speak afterward," Dr. Sethi said. It would be much better if clinicians could diagnose this cancer before such drastic surgery is needed, she added.

In her study, Dr. Sethi and fellow researchers took saliva samples from 27 patients with HNSCC and 10 healthy participants and extracted DNA from the samples. They then examined 82 genes with known associations to HNSCC. Eleven genes were found to have some ability to predict the presence of HNSCC in the cancer patients. Upon further assessment, the researchers found that increases in a gene called PMAIP1 alone or together with a gene called PTPN1 identified all patients with HNSCC with 96% sensitivity and 90% specificity.

While emphasizing that this research is in its early stages, Dr. Sethi hopes that it could one day be used to screen for HNSCC on a widespread basis. The noninvasive test that Dr. Sethi and fellow researchers developed could be administered by dentists, she added. So just as dentists screen for oral cancer today, they may one day screen for more pervasive cancers such as HNSCC.


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Most U.S. dental faculty like their jobs, study finds

Most U.S. dental faculty like their jobs, study finds

May 28, 2008 -- A recent study that surveyed 17% of the dental faculty in U.S. dental schools found that an overwhelming 71% are satisfied with their jobs.

Areas of high satisfaction included nature of teaching assignments and interaction with colleagues. Areas where participants showed less satisfaction included amount of time for research and the extent and quality of the faculty practice program.

"It is extremely positive to see how many current faculty are enjoying their academic careers, which sends a good message to individuals exploring academic dentistry," said ADEA President Charles N. Bertolami, D.D.S., D.Med.Sc.

However, "tenured associate professors expressed the greatest level of dissatisfaction," the study authors noted. "Opportunities for and support of professional development emerged as an area requiring substantially more attention from dental schools."

The study took into account 1,748 responses from 49 U.S. dental schools. Other findings included the following:

While 71% of the respondents were satisfied with their job, 8% expressed dissatisfaction.
73% said they were satisfied with the intellectual challenges associated with their teaching responsibilities, while 7% were dissatisfied.
18% were satisfied with the extent and quality of the intramural private practice program, while 25% were dissatisfied.
23% felt satisfied with the amount of time they have for research, while 31% were dissatisfied.
The study, "The Quality of Dental Faculty Work-Life: Report on the 2007 Dental School Faculty Work Environment Survey," was conducted through a survey developed by the Academy for Academic Leadership on behalf of the American Dental Education Association Commission on Change and Innovation in Dental Education (ADEA CCI). The results were published in the latest issue of the Journal of Dental Education (JDE, May 2008, Vol. 72:5, pp. 514-531).



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Making early detection of oral cancer a priority

Making early detection of oral cancer a priority

May 28, 2008 -- Oral cancer has a five-year survival rate of only 50%. A patient's best chance of surviving is early detection. While a number of methods and new technologies are now available to enhance early detection, the panel is still out on whether there is any one best approach for detecting oral cancer.

As we report this week, questions have been raised about the ADA's heavily promoted oral cancer campaign, which prominently features the BrushTest made by OralCDx Laboratories. Mark Lingen, D.D.S., Ph.D., a University of Chicago associate professor of pathology, has been among the most prominent critics of the campaign. So when he outlined his approach to detecting oral cancer at a recent meeting of the California Dental Association, an avid crowd showed up to listen.

"About 10% of all patients have some sort of oral mucosal abnormality," Dr. Lingen noted. Because it is extremely difficult to tell premalignant lesions apart from the harmless ones, the deadly disease often goes unnoticed until it is advanced and thus much harder to treat.


A crater-form ulcerated lesion with rolling borders that turned out to be squamous cell carcinoma.
Oral cancer is indicated through two kinds of tumors: leukoplakia (white lesions) and erythroplakia (red lesions). Five percent to 25% of leukoplakias and 90% of erythroplakias have histological evidence of premalignancy when dentists see them.

It is important to keep in mind that not all white and red lesions are premalignant, Dr. Lingen explained. And the size of the lesion won't give you a significant clue.

His take-home message: If your patient has a white or red patch and you cannot figure out why it's there, it could be precancerous or cancerous. After seeing this lesion in a patient's mouth, a dentist usually has a 10 to 14-day window to check if it has subsided. If it hasn't subsided in that time, he said, do a scalpel biopsy.

Some common areas to look for lesions are:

Floor of mouth
Ventral surface of tongue
Retromolar trigone region
Soft palate
Less common areas include:

Gingiva
Buccal mucosa
Hard palate
"I don't care how you get there -- tongue depressors, mirrors. The floor of the mouth is a very common place to get oral cancer. Examine it thoroughly," Dr. Lingen said.

Another area to check is the ventral surface of the tongue. Dr. Lingen showed a picture of a clinician using a piece of wet gauze to extend the patient's tongue.

"The most common location for oral cancer of the tongue is the posterior aspect of the anterior tongue," he said. "To get a good look at this region, you have to pull the patient's tongue out."

Another compelling reason to conduct a thorough exam is that dental-related malpractice suits associated with oral cancer are on the rise. Here are a few scenarios in which the cases are deemed indefensible:

Failure to biopsy.
Failure to re-examine a lesion. If you have a patient with a lesion, you need the patient to come back in 10 to 14 days to make sure the lesion is healing. If he or she comes back and the lesion is still there or has become worse, you need to biopsy.
Failure to follow up on diagnostic report.
Diagnostic devices

A number of devices now on the market are designed to enhance early detection of oral cancer, including:

The BrushTest (OralCDx)
Toluidine blue staining
ViziLite Plus (Zila)
Microlux (AdDent)
VELscope (LED Dental)
Here are the key advantages and disadvantages of each, according to Dr. Lingen:

The BrushTest

Dentists can use the BrushTest to collect cells from white or red lesions and send them to a lab for diagnosis. If the cells are abnormal, a biopsy will determine if the spot is potentially cancerous. You can get back three possible results: positive, negative, and atypical. If the result is atypical or positive, a scalpel biopsy is mandatory.

If the results are negative (and nothing else causes concern), then simple follow-up is probably sufficient.

Advantages:

FDA-approved.
Useful in cases in which a patient has multiple lesions throughout the oral cavity because it's painful to have multiple scalpel biopsies.
Useful for a noncompliant patient. If you see suspicious lesions and want to refer a patient for a scalpel biopsy, but are quite certain he or she won't comply, do the brush biopsy to check for positive or atypical results.
Disadvantages:

Often used inappropriately by the dentist. For example, some use it on papillomas.
Cells are seen out of context, which can result in misinterpretation. For example, if the BrushTest is used to collect cells from a patient who has lichen planus and the cells are spread out on a slide, they will be out of context and will be read as atypical.
"Don't brush biopsy everything that looks atypical," Dr. Lingen said. "You do that, and you will get back a lot of atypical results which you will then be obligated to scalpel biopsy."

Toluidine blue staining

This technology is not yet approved for use in the U.S. and is more common in Canada and the U.K. It is a liquid dye composed of tolonium chloride. Practitioners swab the blue dye onto suspicious oral lesions and look for ones that retain the blue dye, as they can be cancerous.

Advantages:

May help to better define gross extent of areas of lesions. These fields can be as large as 6 cm in diameter. If you have a patient with a field that large, but only a centimeter is clinically evident, and you excise it, you will still be left with 5.5 cm of molecularly altered tissue that has the potential to become cancerous.
Disadvantages:

Not FDA-approved.
High rates of false positives and false negatives.
Works well on erythroplakias but not on leukoplakias, which is where clinicians need more help.
May be better than visual acuity but does not identify the true margins of the field.
ViziLite Plus and Microlux

These competing technologies are similar. For the ViziLite Plus test, the patient rinses for 30 to 60 seconds with a solution that contains 1% acetic acid, and then the dentist uses a disposable light device to examine the oral mucosa. Any abnormalities will appear acetowhite. They can then be marked using the TBlue marking system.

Microlux is the same technology, except that the light device used in this system is not disposable.

Advantages:

FDA-approved.
May be better to define areas with increased amounts of DNA.
High degree of sensitivity.
Disadvantages:

Low degree of specificity. It will light up things that are not premalignant.
May be better than visual acuity but does not identify the true margins of the field.
VELscope

The VELscope is a handheld device that shines a light into the oral cavity, which excites the tissue and causes it to fluoresce. The clinician can view the different fluorescence responses to help differentiate between normal and abnormal tissue. Healthy tissue fluoresces green, while abnormal tissue does not fluoresce and may appear dark.

Advantages:

May help to better define surgical margins.
FDA-approved.
Disadvantages:

Low specificity as described for ViziLite Plus and Microlux.
May be better than visual acuity but does not identify the true margins of the field.

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