Class of 2018/2019

Accuracy of Free-Handed, Pilot-Drilled, and Fully
Guided Implant Surgery in partially Edentulous Patients (click to view report)

Published on: December 17th, 2018

By: Shawn Robinson

Report Summary: The present study looks at the differences in accuracy of three treatment options in implant placement: free-handed, pilot-guided, and fully-guided surgery, in patients that are partially edentulous. It has shown that fully guided surgeries do return the best results in respect to accuracy according to implant planning, and those of free-handed surgery return the worst. More studies should be performed, comparing the accuracy, long-term viability, and cost-effectiveness of each surgical technique.

Bioactive-Glass in Periodontal Surgery and Implant Dentistry (click to view report)

Published on: March 5th, 2019

By: Shawn Robinson

Report Summary: B-Gs are an important consideration when choosing the optimal biomaterial to be used as a bone substitute in periodontal and implant therapy. B-G is a versatile replacement material, since it is available in multiple forms and can be
moulded into desired shapes. Its unique bioactive properties allow for an osteoproductive environment in which the bonebiomaterial interface is uniquely stronger than it would be with other forms of alloplasts. B-G represents an important and exciting field of study.

Bleeding Disorders of Importance in Dental Care (click to view report)

Published on: April 14th, 2019

By: Sina Moshiri

Report Summary: Bleeding disorders may impact planned dental treatment, depending on the severity of the disorder and the type of procedure planned. Consultation with the patients physician and hematologist is recommended prior to treatment or drug dose
adjustments.

Botulinum Toxin (click to view report)

Published on: August 19th, 2018

By: Kimberly Hawrylyshyn

Report Summary: Botulinum toxin has shown promising results to correct facial esthetics and for therapeutic purposes in the orofacial region. The effect is temporary and not curative, with repeated administration required. Botulinum toxin has a good safety profile, but should be used at recommended doses to minimize spread of toxin effect

Burning Mouth Syndrome (click to view report)

Published on: October 14th, 2018

By: Lillian Han

Report Summary: BMS is a poorly understood, idiopathic chronic pain disorder that can be characterized by a burning sensation of the oral cavity in the absence of any identified organic disease. One of the most important things for a practitioner can do is to listen to the patients, reassure through education, and make them aware that this syndrome is likely of multifactorial etiology. Patients should understand that there is no cure for BMS and current therapies are more for symptom control. It is very important that the symptom management process starts with a comprehensive diagnostic work-up. Using a multidisciplinary approach, a combination of medical and psychosocial therapy, provides the best management of symptoms in patients with BMS.

Characteristics of Dental Patients Determining Their Compliance Level in Dentistry (click to view report)

Published on: March 11th, 2019

By: Shawn Robinson

Report Summary: By degree of compliance with doctor’s recommendations, patients were divided into two groups: 1. patients with good oral care and lack of periodontal inflammation; 2. patients swith poor oral care and periodontal. Inflammation, complying and noncomplying with advice.

Comparison of Hospital Mortality and Readmission Rates for Medicare Patients (click to view report)

Published on: December 3rd, 2018

By: Maral Aghourian

Report Summary: Patients who receive care from female general internists have lower 30-day mortality and readmission rates compared to male internists. As seen in other studies, these findings suggest that the differences in practice patterns may have important clinical implications for patient outcomes. Understanding why these differences exist can help improve quality of care for all patients, irrespective of who provides their care.

Cognitive Decline and Periodontitis (click to view report)

Published on: January 20th, 2019

By: Sandra Ghobrial

Report Summary: Periodontal health problems are a modifiable risk factor of cognitive impairment and dementia. Early treatment of periodontitis may slow the profession of the inflammatory process on the brain.

Common Cardiac Arrhythmias (click to view report)

Published on: September 4th, 2018

By: Shawn Robinson

Report Summary: Cardiac arrhythmias are quite complex and difficult to understand, but breaking down the anatomy, physiology, and electrical conduction of the heart, allows us to understand them better. A good understanding of the cardiac arrhythmias and the ability to recognize these rhythms on a monitor can increase the efficiency to which we treat such problems. As dental professionals, it is important that we understand the rhythms and their characteristics in order to identify these quickly and be able to inform the attending team upon arrival

Conscious Intravenous Sedation (click to view report)

Published on: July 15th, 2018

By: Sandra Ghobrial

Report Summary: Sedation is an integral part in providing high-quality dental care. Goals should be to maximize comfort, decrease pain by providing sedation, amnesia and analgesia. Careful patient pre-operative assessment, intra-operative monitoring, and post-operative care is extremely important to decrease the risk during procedures where sedation will be used.

Dental Management of Patients with Renal Failures (click to view report)

Published on: July 29th, 2018

By: Sina Moshiri

Report Summary: Approximately 90% of patients with chronic renal failure present with oral manifestations. Treatment of CRF ranges from conservative management such as life-style changes to invasive procedures such as dialysis or kidney transplantation. Dental management requires prior consultation with patient’s nephrologist to determine status of the disease, timing for dental care, as well as procedural and pharmacologic modifications. Modification include timing dental care on non-dialysis days, obtaining CBC prior to invasive treatment and considering antibiotic prophylaxis for patients with central lines. Drug modifications include avoidance of tetracycline and aminoglycosides, and dosing interval of penicillin, clindamycin and cephalosporin. Multidisciplinary approach to patient’s health care is critical to ensure patients safety and prevent complications in the dental chair.

Diphenhydramine as Alternative to
Local Anesthetics for Patients with Known Drug Allergy (click to view report)

Published on: December 10th, 2018

By: Sandra Ghobrial

Report Summary: Results showed that onset of anesthesia was considerably longer with diphenhydramine than with 2% lidocaine-epinephrine, and a larger quantity of DPH was needed for satisfactory anesthesia.

Diagnostic Tests for Oral Cancer (click to view report)

Published on: November 5th, 2018

By: Kimberly Hawrylyshyn

Report Summary: None of the adjunctive tests are recommended to replace the current standard of biopsy and histological assessment. Cytology shows promise as an adjunctive procedure to compliment conventional oral examination; requires adequate training to correctly harvest cells. Patients should be referred to specialists in the management of premalignant disease appropriately. No evidence exists for use of adjunctive tests in primary care.

Effects of Temperature on Sodium Hypochlorite (click to view report)

Published on: September 25th, 2018

By: Kimberly Hawrylyshyn

Report Summary: Preheating NaOCl increases tissue dissolution and efficacy against E. faecalis. NaOCl can be heated chair side from stock solution relatively quickly using warming devices. NaOCl remains chemically stable at temperatures up to 60°C.

Electronic Cigarettes & their Growing Impact on Oral Health (click to view report)

Published on: August 26th, 2018

By: Sandra Ghobrial

Report Summary: According to some studies, ECs are less harmful than conventional cigarettes. Because they are relatively novel devices when compared to conventional smoking, little evidence is available about their long term effects on general and overall health. Electronic cigarettes carry their own range of health risks that have not yet been fully understood.

Electronic Cigarettes & their Growing Impact on Oral Health (click to view report)

Published on: August 26th, 2018

By: Sandra Ghobrial

Report Summary: According to some studies, ECs are less harmful than conventional cigarettes. Because they are relatively novel devices when compared to conventional smoking, little evidence is available about their long term effects on general and overall health. Electronic cigarettes carry their own range of health risks that have not yet been fully understood.

Green Dentistry (click to view report)

Published on: February 26th, 2019

By: Maral Aghourian

Report Summary: To be sustainable, dental practice can adopt several simple changes in their clinic. Though it may require money and effort, dentists are together doing their best to practice green dentistry.

Intranasal Tetracaine and Oxymetazoline (click to view report)

Published on: November 19th, 2018

By: Sina Moshiri

Report Summary: Studies reveal 3% tetracaine and 0.05% oxymetazoline produced a success rate of 83-90% in sufficiently anaesthetizing the maxillary jpremolars, canines, and incisors to allow dental restoration. Most common side effects include nasal runniness, stuffiness and stinging. Cardiovascular effects were observed in only two individuals out of 186 subjects and can be attributed to the oxymetazoline component.

Liposomal Bupivacaine (click to view report)

Published on: November 26th, 2018

By: Sina Moshiri

Report Summary: A novel method of encapsulating local anesthetic within carrier molecules has been developed in order to increase the duration of anesthesia.

Low Level Laser Therapy for the Treatment of Acute Necrotizing Ulcerative Gingivitis (click to view report)

Published on: February 4th, 2019

By: Sandra Ghobrial

Report Summary: Treatment includes alleviation of the acute inflammation by performing gross debridement and necrotic tissue. The use of low level laser therapy in the treatment of several diseases, especially in dentistry has increased in recent years. It has been shown in literature that LLLT stimulates wound healing.

Manifestations of Ehlers-Danlos Syndrome (click to view report)

Published on: January 6th, 2019

By: Lillian Han

Report Summary: EDS is a broad term for a number of inheritable connective tissue disorders, which are linked to mutations in one of the genes encoding for fibrillar collagen proteins or enzymes involved in post-translational modification of these proteins. Patients with EDS-HT suffer from joint hypermobility, chronic pain, chronic gastrointestinal discomfort/IBS, and chronic recurrent headaches.

Microbiome Associated with Severe Caries in Canadian First Nations Children (click to view report)

Published on: January 28th, 2019

By: Sandra Ghobrial

Report Summary: First study to use advanced microbial analyses to investigate the roal microbiome of Indigenous children affected by S-ECC. Indigenous children suffer considerable oral health disparities when compared with other children of the same age. Stems from the historical and ongoing effects of colonialism and racism that have resulted in major socioeconomic and health care inequities.

Nano-Silver Fluoride Toothpaste (click to view report)

Published on: August 7th, 2018

By: Maral Aghourian

Report Summary: Toothpaste with NSF (Nano-Silver Fluoride) seems to have significant antiadherence and antiacidogenicity when compared to toothpaste that has fluoride alone. Similarly, to NaF, NSF also prevents mineral loss on the enamel and has the advantage of not staining the teeth black like with silver diamine fluoride. Ultimately, I believe that a better oral hygiene regimen may actually triumph the use of NaF vs NSF, but for patients who are not able to have good oral hygiene due to various reasons, toothpaste containing NSF can have potential benefits.

Non-restorative Treatment Options for Carious Lesions (click to view report)

Published on: October 25th, 2018

By: Lillian Han

Report Summary: Arresting the cariogenic process should be at combination of patient and lesion level management. Patient level intervention: diet counselling (reducing sugar consumption) and oral hygiene instructions and reinforcement (tooth brushing, flossing, fluoridate tooth paste use).

Occlusal Dysesthesia (click to view report)

Published on: November 12th, 2018

By: Sina Moshiri

Report Summary: OD refers to a perception of uncomfortable or altered bite with no obvious physical occlusal discrepancy. Often results following a dental procedure (restorative, orthodontic, prosthodontic) and subsequent attempts as resolving the complaint through additional treatments invariably fail or exacerbate the issue.

Oral Manifestations of Lymphoma (click to view report)

Published on: April 22nd, 2019

By: Lillian Han

Report Summary: Lymphomas occurring in the oral cavity are often misdiagnosed, delaying proper treatments. A good medical and dental history, detailed clinical examination, radiographic evaluations, and any necessary biopsies are crucial in arriving at the correct diagnosis and guiding the patient to the appropriate treatment.

Partial Extraction Therapies (click to view report)

Published on: July 22nd, 2018

By: Shawn Robinson

Report Summary: PETs have shown promise for development of immediate implant placement or pontic site development, both histologically and clinically. Although promise is there, PETs do not yet supersede that of traditional, established ridge preservation techniques. Other than Root Submergence, PETs, collectively, are in their infancy. Further research and studies are required to evaluate the effectiveness of these techniques.

Periopatch (click to view report)

Published on: March 19th, 2019

By: Kimberly Hawrylyshyn

Report Summary: Periopatch acts as a barrier to protect tissue, absorb exudate and reduce inflammation. Based on the results of this study periopatch can decrease in inflammation as well as affect clinical and bacterial parameters of peri-implant mucosal inflammation and peri-implantitis.

Platelet Rich Fibrin (click to view report)

Published on: October 2nd, 2018

PRF improves wound healing when used in surgical procedures. Promising material to enhance alveolar cleft reconstruction and reduce peri-implant marginal bone resorption. Currently limited evidence available.

Postoperative Bleeding after Dental Extraction in Liver Pretransplant Patients (click to view report)

Published on: September 16th, 2018

By: Lillian Han

Report Summary: No statistically significant differences were found to support the use of tranexemaic acid solution for local pressure. With the support of other studies, local hemostatic measures without tranexamic acid appear to be an acceptable approach and lower the cost of the procedure. Local hemostatic measures using absorbable collagen sponge, cross sutures, and local pressure with gauze were effective for achieving hemostasis after tooth extraction in candidates for liver transplantation. This study showed the possibility of extracting teeth with local hemostatic in patients with liver cirrhosis, with INR of 2.50 or less and platelet counts of 30,000/mm3 or greater, without the need for blood transfusion.

Recent Advances in Orthognathic Surgery (click to view report)

Published on: October 29th, 2018

By: Kimberly Hawrylyshyn

Report Summary: Surgery-first approach has the advantage of shortened treatment time, and early correction of facial deformity, early response to patient’s needs. There are limitations including proper case selection. Proper diagnoses, treatment planning and simulation of correction is required. Experienced surgeon and orthodontist is important to apply the appropriate treatment method to meet the patient’s needs and goals.

Respiratory Anesthetic Emergencies in Oral and Maxillofacial Surgery (click to view report)

Published on: August 12th, 2018

By: Lillian Han

Report Summary: Respiratory emergencies are the most common complications during administration of anesthesia in the office. Diseases that present many challenges are asthma, COPD, and respiratory infections - take a thorough history of patients and be prepared with the protocols in case of encountering respiratory emergencies.

Resveratrol and Curcumin for potential treatment of Periodontitis (click to view report)

Published on: April 2nd, 2019

By: Sandra Ghobrial

Report Summary: Administration of resveratrol and curcumin, alone or in combination, appeared to enhance the levels of IL- 4. Resveratrol alone reduced the levels of IFN- c. It is noteworthy that although no significant difference was found in the amounts of IL-1b when resveratrol and curcumin were used alone, a trend toward lower levels of IL-1b in these groups was observed when compared with the control group.

Risk of General Anesthesia for the Special Needs Dental Patient (click to view report)

Published on: September 10th, 2018

By: Sina Moshiri

Report Summary: The relative risk versus benefit of dental treatment under general anesthesia for the special needs population is a common dilemma practioners face, yet very little research has been dedicated towards this subject. Further research is required in order to stratify the risk of general sedation in these populations and convey these risks to the patients and guardians during the decision making process. Special needs patients are at greater risk of oversedation and often present with physical impairments or medical comorbidities that further increase the anesthetic risks. Geriatric patients must be managed with caution, especially concerning medical comorbidities and drug dose modifications. Children are not little adults. Knowledge of pediatric physiology and common emergencies and their management is necessary for safe provision of general anesthesia.

Surgical Considerations of Marijuana use in Elective Procedures (click to view report)

Published on: October 8th, 2018

By: Lillian Han

Report Summary: - In acute settings, marijuana’s effects peaks at approximately 1 hour post initiation, lasting 2-4 hours. Marijuana increases cardiac workload, myocardial infarctions and strokes in young, chronic users. Cannabis causes similar pulmonary complications to those of a tobacco smoker. Marijuana causes airway obstruction and increases anesthetic dosages needed to place laryngeal effects. Marijuana use is problematic for surgeons, who are left without much evidence-based guidelines. Further research is needed to provide information to guide elective procedures.

Staging and Grading of Periodontitis (click to view report)

Published on: July 3rd, 2018

By: Kimberly Hawrylyshyn

Report Summary: The staging and grading classification of periodontitis was developed as a multidimensional approach to periodontal diagnosis that can incorporate all current evidence. Stage of periodontitis conveys information about the severity and extent of disease as well as complexity of managing the patient. Grade of periodontitis conveys information rate of periodontal progression, response to standard therapy and potential influence of systemic health. The matrix of stage and grade can appropriately describe periodontal disease and can be readily communicated among practitioners. The classification system can be reviewed and modified as new evidence emerges.

Staging of HPV and non-HPV OPSCC (click to view report)

Published on: February 18th, 2019

By: Maral Aghourian

Report Summary: Changes in staging of OPSCC based on HPV association o Determined by p16 positivity or negativity. New guidelines recognize the biologic and epidemiologic diversity in behavior of HPV-associated (p16-positive) and non–HPV-associated OPSCC. New staging groups to provide improved hazard consistency, discrimination, and predictive ability.

Stress Dose Steroids (click to view report)

Published on: January 14th, 2019

By: Sina Moshiri

Report Summary: Supplemental steroid dosing in the context of surgery is a treatment paradigm that remains unchallenged despite the lack of convincing evidence.  Spurred primarily by a few case reports and supported by a feasible pathophysiology, this practice has persisted for over 60 years.

Class of 2017/2018

Alveolar Osteitis (click to view report)

Published on: March 15th, 2018

By: Michael Martins

Report Summary: Dry socket is a complicated process in which we still don’t fully comprehend. The full aetiology has yet to be established despite are numerous theories. One thing that we can take away from all this is that we should be minimizing risk as much as possible. No single method is available to eliminated dry sockets from happening. As we look to improve our post-operative care for the prevention of dry sockets, we look back to the first rule of medicine which is to do no harm. Following these principles, the best treatment in reducing dry socket would be the use of a chlorhexidine mouth rinse post operatively for all extractions. This is due to the reported prophylactic benefit and lack of adverse effects that make it justified in the use of post-operative care and for the prevention of dry socket.

Anesthesia Awareness (click to view report)

Published on: May 21st, 2018

By: Ivan Boras

Report Summary: Anesthetic awareness is an uncommon intraoperative event that is commonly a result of under dosage of various anesthetic mediations and could lead to significant post-operative trauma to the patient, including PTSD. 

Anesthetic Management of the Obese Patient (click to view report)

Published on: April 10th, 2018

By: Ivan Boras

Report Summary: Obesity has several anesthetic complications that arise from physiological and pharmacokinetic factors. Airway anatomy and altered lung capacity make intubation and ventilation difficult. Increased gastric acidity increases aspiration risk in this population. Medication dosage must be considered depending on the lipid solubility and clearance rates for those medications. Finally, obese patients have an increase propensity for OSA, postoperative atelectasis and thromboembolism.

Anticoagulation and Antiplatelet (click to view report)

Published on: January 30th, 2018

By: Michael Martins

Report Summary: Don’t discontinue anticoagulation or antiplatelet drugs for your patients and work around the dosing schedule, especially when it comes to novel oral anticoagulants. As new drugs continue to flood the market our techniques and protocols will have to evolve with them. 

Avulsed Permament Teeth (click to view report)

Published on: March 27th, 2018

By: James Kim

Report Summary: Avulsion refers to an injury where the complete tooth structure is displaced from its socket after trauma. Prognosis of avulsed tooth depends heavily on the type and timing of the treatment. The best management of avulsion is replantation of tooth immediately or within 60 minutes after avulsion. It is very important to receive professional help from a dentist as soon as possible. Never replant primary teeth, only permanent teeth. 

Carbamazepine (click to view report)

Published on: January 30th, 2018

By: Matthew Venditelli

Report Summary: The HLA-B*1502 allele, commonly found in Asian populations, is highly associated with carbamazepine-induced Stevens-Johnson syndrome and toxic epidermal necrolysis; life threatening cutaneous disorders. Prior to implementing carbamazepine treatment in patients of Asian descent it is recommended that genotyping of these patients is performed to identify the presence of the HLA-B*1502 allele. Pre-treatment and regular hematological testing is also recommended to identify significant blood dyscrasias that can result due to carbamazepine treatment. 

Cocaine and Oral Health (click to view report)

Published on: March 27th, 2018

By: James Kim

Report Summary: Cocaine is an illicit drug with high addictive potential that can cause many adverse effects such as hallucinations, aggressive behavior, dizziness, and disorientation. Cocaine also increases peripheral vasoconstriction and heart rate, resulting in increased blood pressure. Thus, administration of local anaesthetic with epinephrine shortly after cocaine use can trigger acute increase in blood pressure resulting in heart attack. As a precaution, local anesthetics with epinephrine and epinephrine-impregnated retraction cords should not be used if the patient abused cocaine recently. Dental treatment should be postponed for 6 to 24 hours after the use of cocaine to allow for drug to leave the body system.

Comprehensive Care Physician Model (click to view report)

Published on: June 25th, 2018

By: Joo Kim

Report Summary: Cost reduction and improvement of patient outcome is a key for a successful healthcare system. Patient outcomes are better when hospitalized patients are treated by primary care physicians, however it is not economically attractive for physicians. Multiple care coordination attempts to reduce costs have failed in the past. CCP model aims to improve coordination of inpatient and outpatient care while lower the cost by focusing on patients at high risk of hospitalization. Further research is required to evaluate the effectiveness of CCP model in improving patient care while reducing costs.

Diabetes and Periodontal Diseases (click to view report)

Published on: March 28th, 2018

By: James Kim

Report Summary: Periodontitis is a chronic inflammatory disease resulting in destruction of supporting tissues around teeth. Patients with diabetes are at a higher risk of developing periodontal diseases. Diabetic patients with severe periodontal diseases appear to be at a higher risk of diabetes complications. There is low quality evidence supporting that periodontal therapy improves glycemic control in patients with diabetes. In clinical practice, careful follow-ups and ongoing professional treatments beyond 6 months are required to maintain clinical improvements. Further investigation is needed to confirm this finding.

E-Cigarettes and Oral Health (click to view report)

Published on: May 8th, 2018

By: Joo Kim

Report Summary: E-cigarettes may be less harmful than traditional smoking, however e-cigarettes can still contribute to the pathogenesis of periodontal diseases by inflammation, cell injury, and impaired repair ability. Chemicals in e-cigarette vapor is known to cause DNA damage and cellular senescence. There is insufficient evidence for clinicians to promote e-cigarettes as a smoking cessation aid. Further research is needed to establish the risk of using e-cigarette.

Facial Emphysema (click to view report)

Published on: March 15th, 2018

By: Andrew DeMarco 

Report Summary: Subcutaneous emphysema is not a common occurrence during dental procedures. Due to the promptness of swelling directly related to certain events (such as: blowing air directly into the canals during root canal treatment, surgical extractions with an improper hand piece, restorative therapy, crown preparations and the use of air abrasion) the appearance of the swelling can be alarming for both the patient and the clinician. It is important to differentiate subcutaneous emphysema between other similar conditions such as hematoma formation, allergic reactions, angioedema or facial swelling due to dental infection. Treatment usually consists of a course of antibiotics and a wait and see approach for the swelling to decrease.

Facial Palsy (click to view report)

Published on: April 24th, 2018

By: Michael Martins

Report Summary: We informed the patient that she must keep her eye well hydrated and her eye was covered, and she was told that it should resolve within a few hours and she had the option of staying so we could monitor or go home. She ultimately decided to head home that night and when she was called in the morning the palsy had resolved. Although neurologic occurrences are rare, dentists should keep in mind that certain procedures like the IAN can initiate facial palsy. Attention should be paid during the administration of the anesthetic solution and continuous monitoring of the patient could minimize possible side effects. 

Hypodontia and Ovarian Cancer (click to view report)

Published on: March 15th, 2018

By: Matthew Venditelli

Report Summary: Ovarian cancer is the most fatal malignancy of the female genital tract, and has no known early diagnostic markers, often diagnosed in women over 55 years of age and without effective treatments. The same genetic mutations in genes involved in embryonic development that cause hypodontia, one or two missing permanent adult teeth, are possibly involved with the development of epithelial ovarian cancer. In one case-control study, it concluded that women with epithelial ovarian cancer are 8.1 times more likely to have hypodontia than women without epithelial ovarian cancer. This study suggests hypodontia, which can be seen early in one’s life, as possible risk marker of future epithelial ovarian cancer development. The association isstronger when familial history of EOC is present.

Liver Disease (click to view report)

Published on: March 13th, 2018

By: Michael Martins

Report Summary: Hepatitis is a very common disease that doesn't require really any dental modifications until the disease has really progressed and has become advanced. With proper history taking and ordering the correct blood work, no complications should occur when treating this patient population.

Malignant Hyperthermia (click to view report)

Published on: March 15th, 2018

By: Ivan Boras

Report Summary: Malignant Hyperthermia remains a serious risk factor for susceptible individuals undergoing general anesthesia using volatile agents. Symptoms include an elevation of end tidal CO2, muscle rigidity, hyperthermia, tachycardia, hyperkalemia, acidosis and rhabdomyolysis. Early recognition is vital to proper treatment, which includes administration of dantrolene, discontinuation of trigger agents, cooling, and hyperkalemia management.

Microbiome and Disease (click to view report)

Published on: January 30th, 2018

By: Andrew DeMarco

Report Summary: Our microbiome influences our health and ultimately how well we age. There is evidence linking the oral bacteria to Alzheimer's disease (AD) in the context of aging. Aging may favour the proliferation of anaerobes in the mouth eliciting a TNF-alpha response from the oral epithelium - compromising the integrity of the Blood-Brain Barrier. This theory hypothesizes that bacteria can then enter the brain through the depleted, or less active BBB, allowing these bacteria to spread and create some sort of chronic inflammatory response (such as in cases of atherosclerosis). It is these inflammatory responses which has been long associated with AD.

Pregnancy (click to view report)

Published on: March 29th, 2018 

Report Summary: Improving the oral hygiene of our patients who are thinking of becoming pregnant is an important step to ensure a healthy pregnancy for both fetus and mother. Identifying those at risk for periodontal disease and treating these patients prior to pregnancy should be incorporated into our treatment plans. Emergency treatment for pregnant patients should not be turned down at any stage of pregnancy, as there has been no significance behind stress related to dental procedures and adverse pregnancy events. Elective dental procedures can be postponed to the second trimester ideally, however there have been no studies showing adverse pregnancy events related to dental procedures in any trimester. Dental radiographs pose no significant risk to the fetus, however should be properly prescribed following charting and clinical examination. Local anesthesia with lidocaine and citanest can be administered safely throughout pregnancy. Antibiotics such as penicillin, amoxicillin, cephalexin, clindamycin and erythromycin are all safe choices. Pain management modality should be selected on a patient to patient basis, but can be safely achieved with acetaminophen, and ibuprofen or opioids in the first and second trimesters.

Prevora (click to view report)

Published on: March 25th, 2018

By: James Kim

Report Summary: Prevora is a 10% Chlorhexidine varnish applied on the full dentition for prevention of root caries. It significantly reduces Streptococcus Mutans (bacterial etiology for dental caries) in adults, thereby reducing the risk of future caries development. Prevora is indicated for patients at high risk of dental caries. Lastly, it appears to also help improve periodontal health as well. Further study is needed to confirm this finding.

Probiotics (click to view report)

Published on: March 28th, 2018

By: Aman Bhojani

Report Summary: The consumption of probiotics to help live a healthy life is a well-accepted concept. Certain strains have been shown to reduce the cariogenicity of S. Mutans and neutralize P. gingivalis – hallmark pathogens in caries and periodontal disease. There is limited scientific evidence to back the use of oral probiotics as acceptable ways to reduce dental caries and serve the needs for periodontal health prophylaxis. Current products are trying to increase exposure time in the oral cavity through the form of lozenge or chewing gum tablets. Controlled clinical trials and long term studies are required to investigate the concentration of probiotic bacteria in the specific means of administration being proposed in the market today.

Resveratrol (click to view report)

Published on: April 10th, 2018

By: Andrew DeMarco

Report Summary: Resveratrol, a natural phenol found in different foods from grapes to blueberries and raspberries, it is thought to initially improve cardiovascular health. While Resveratrol's use in dentistry still needs to undergo multiple studies involving human trials the initial results (from rat studies) are impressive. Resveratrol shows clear benefits when studied in rats with experimentally induced periodontitis. The results include not only preventing inflammation and bone loss but more importantly, reversing previous bone loss that had occurred.

Salivary Biomarkers (click to view report)

Published on: June 11th, 2018

By: Aman Bhojani

Report Summary: Salivary tests offer an accurate, effective, easy-to-use, and cost-effective alternative to identifying biomarkers indicative of systemic diseases. These tests offer the potential of screening entire populations for specific diseases in a timely manner. As patients visit their dentists more than their physicians, salivary tests can pave the way for chair-side diagnoses and follow up for inquiry of potential systemic disease.

Silver Diamine Fluoride (click to view report)

Published on: March 29th, 2018

Report Summary: SDF has been shown to be an effective cariostatic agent. There are other agents, such as CR, SiF, and APF, which have all been shown to aid in remineralization of dentin and enamel. Future in vivo comparative studies are required to evaluate the efficacy of the above agents, specifically in arresting caries progression, relative to each other over a long-term period.

Smoking (click to view report)

Published on: March 15th, 2018

Report Summary: Cigarette smoking is correlated with increased gingival levels of pathogenic bacteria. It decreases gingival vasculature, increases immediate gingival blood flow and alters host response to gingival inflammation due to reduced neutrophil chemotaxis and oxidative burst. Smoking adversely affects the result of periodontal therapy, non-surgical and surgical alike. Although the improvements in smokers are less than those for non- smokers, it is important to recognize that smokers still benefit from both non- surgical and surgical therapy. 
Advancement in implant surface modifications and treatments have reduced implant failures in smokers vs. non-smokers to a level that is statistically insignificant.

Stainless Steel Crowns (click to view report)

Published on: March 29th, 2018

By: Aman Bhojani

Report Summary: For patients where reducing chair side time is an important consideration i.e. patients with disability, pregnancy, or geriatric population; SSCs have shown to less technique sensitive and used to treat severe enamel defects or teeth with gross caries. In Ontario, public insurance compensates for SSC; hence, for patients with financial concerns, SSCs can offer patients a viable semi-permanent restoration. Despite the challenges of having poor aesthetics, experiencing recurrent decay, and their ongoing maintenance, SSC continue to offer the advantage of full-coverage restorations. SSCs should be considered as an alternative to more precise crown fabrication techniques until further research can comment on the prognosis of such restorations in the permanent dentition 

Temporomandibular Disorders (click to view report)

Published on: March 28th, 2018

By: Aman Bhojani

Report Summary: TMD is a multifactorial condition that has various etiologies. Along with a detailed history and physical examination, multiple diagnostic imaging modalities to help diagnose TMD. Initial treatment should include conservative, reversible, and evidence based modalities. Invasive therapies should be initiated only after noninvasive options have been exercised. Cochrane review of NSAIDs, benzodiazepines, anti-convulsants, and muscle relaxants concluded that there was insufficient evident to support or refute the effectiveness of any drug for the treatment of TMD. Only naproxen, gabapentin, and diazepam had evidence to support a reduction of pain associated with TMD. There are many treatments indicated for TMD; however, there is not one that is uniformly superior for the treatment of pain and oral dysfunction.Quality of life can be affected by TMD. Referrals to specialists are necessary when cases fail to respond to conservative measures.

TMJ Arthralgia (click to view report)

Published on: May 14th, 2018

By: Matthew Venditelli

Report Summary: Around half of the patients that present with TMJ arthralgia have a component of refractory, chronic myofascial pain that goes untreated when patients are treated with arthroscopy alone. Adjuvant Botox administered via injection to symptomatic muscles of mastication presents a possible way to target refractory myofascial pain and decrease pain experience, in a relatively safe manner, when patients are non-responsive to first-line TMD therapies. 

Vital Pulp Therapy (click to view report)

Published on: April 30th, 2018

By: Aman Bhojani

Report Summary: Indirect pulp capping is the favorable technique for treating primary teeth with deep caries and no exposure of inflamed pulp tissue. It has a lower cost, long-term higher success rate and better exfoliation pattern. DPC is not recommended for primary teeth until recently where new biomaterials can over a desirable result, these require longer term evaluation. MTA is the most successful material for pulpotomies in primary molars; FC was considered to gold standard but MTA offers improved long-term success rates and with further supportive evidence, may replace FC in many dental practices.