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Sunday, November 24, 2013

Stem Cells and the Future of Dentistry



Embryonic Stem Cells
Stem cells have the ability to transform into different types of cells.  Stems cell hold the key to cell development and cell renewal and repair. Stem cells are derived from two sources.


First, embryonic stem cells can be isolated from the inner mass of the blastocyst. These stem cells are considered pluripontential because they are undifferentiated, therefore have unlimited ability to transform into multiple cell lines which form multiple types of tissues.



Somatic (Adult) Stem Cells
Second type are called adult stem cells or somatic stem cells.  These are the stem cells found embedded within all tissues of the body. They have the important function of healing, repair or development of cell lines (bone marrow stem cells developing into multiple types of blood cells).  They are different from embrylogic stem cells in that they are found within the tissues of the body and have some differentiation toward those tissues.

Stem cells hold the promise of treating damaged, diseased or lost tissues.  Because stem cells have the unique ability of proliferation and self renewal, there is hope that stem cell therapy may have answers for the treatment of many chronic diseases and potential organ replacement.

Cell based stem cell therapy may include the growth of needed cells and strategic placement to repair damaged tissues (nerve, muscle, immune etc.) and diseases such as Parkinson's disease, diabetes, spinal cord injuries, muscular dystrophy, heart disease, vision loss etc.).

Stem cells also hold the promise of organ replacement.  This would be the ability to re-create and replace an organ that has been damaged.  Organ replacement is the biological solution to the problem of many diseases.  For example, a patient in kidney failure is currently required to have dialysis to stay alive.  If a new kidney could be developed, using the patient's own stem cells, we now have a biological solution to this problem.

Stem cell therapy provides hope for biological solution to chronic disease and organ replacement .

Organ replacement therapy using stem cells require three essential components.
1. Proper Stem Cells
2. Scaffold (matrix for the cells to grow into the shape of the organ)
3. Growth Factors - proper growth factors orchestrated the complex development of the stem cells

Research and trials in this area of organ replacement are underway. The following examples show the current research in the area of organ replacement.

An international team of stem cell researchers have recently reported growing human liver tissue in a mouse.  This is a step toward organ replacement therapy.

A replacement ear was recently grown on a mouse by scientists in Massachusetts. click here


Japanese scientists claim they are ready to begin growing human organs in animals within the next year. click here

 
Scientists have recently grown a functioning rat kidney in the lab.

 

How do these concepts apply to dentistry?

Applications of stem cells or regenerative therapy in dentistry would completely change the way we practice dentistry.  Rather than removing damaged tissue and replacing it with a non-biologic material (filling, bridge, implant), we would replace damaged tissues with biologic materials.

Dr. Peter Murray, of Nova Southeastern dental school, says that in the future, the standard of care for dentistry will be to use stem cells to regrow parts of teeth or replacement teeth.



In dentistry we have unwittingly benefited from stem cell repair.  Anytime we lay a surgical flap, replace an avulsed tooth, extract a tooth or do some deep root scaling, we are triggering stem cell repair.  We have been performing or attempting to perform regenerative bone procedures and tissue regenerative procedures - both of which are most likely successful due to native stem cell activity.  However, we have been oblivious to the presence of these stem cells and the "behind the scenes" benefit they have provided to our dental procedures.

While stem cell or regenerative therapy may seem far off, progress is being made.

A recent article in the Wall Street Journal discusses potential application of stem cell therapies in dentistry including the repair of pulpal tissue and regenerate new teeth.


2009 Successfully bioengineered and implanted a tooth.
U. of Michigan student studies the method for preserving stem cells from extracted wisdom teeth. click here

USC researchers studying American alligators ability to renew teeth. click here

Chinese researchers dental mesenchymal stem cells to regenerate a tooth root on scaffold. click here

Nova Southeastern University is actively working on stem cell research. click here

Reseachers at Toyko University report a fully functional, stem cell produced tooth implanted into a mouse (see image). click here

The endodontics is leading the way in "regenerative-type" therapy.  Recent research has identified important stem cells associated with the tooth. The SCAP cell (Stem Cell of the Apical Papilla), DPSC (Dental Pulp Stem Cell), SHED cell (Stem cell from Human Exfoliated Deciduous teeth) have been the topic of recent research studies. The SCAP cells appear to the be the stem cells responsible for the development of human dentin. The stem cells of the dental pulp, while being a somatic stem cell,  have been identified to have the capability to differentiate into multiple cell lines including hepatic cells.  Our understanding of stem cells is radically changing.  The chronic periapical lesions  that we routinely excised during periapical surgery have recently been shown to contain 400 times the concentration of stem cells found normally in the circulation.  Our understanding and appreciation of dental related stem cells and their regenerative ability is changing.

Current clinical application of pulpal regenerative therapy is being performed on immature teeth with pulpal necrosis. This new treatment protocol provides several benefits over traditional treatment regimen for immature roots (Ca(OH) apexification or MTA apexification.

For more information regarding the current status of endodontic regenerative therapy, please review the recent "Colleagues for Excellence" published by the American Association of Endodontists. 

Regenerative dentistry is the future of dentistry and endodontists are leading the way in this new concept of dentistry.  Replacement of tooth structure with non-biological materials (gutta percha, titanium, resin, amalgam, non-biologic grafting materials etc.) will someday be replaced with natural, biological materials.  

The doctors at Superstition Springs Endodontics are leaders in endodontic regenerative therapy.  They have been performing endodontic regenerative procedures since 2003.  Stay tuned to TheEndoBlog for future case reports of endodontic pulpal regenerative procedures.

Source: http://www.theendoblog.com/2013/07/stem-cells-and-future-of-dentistry.html



Thursday, August 15, 2013

Stop the Excuses! Go to the Dentist

By


Oh, you don't love spending time and money as a stranger picks, buffs, scrapes, fills or pulls your teeth? Join the club. No one says you ought to enjoy dental appointments, but that doesn't mean you should skip them. It's through the mouth that we breathe, eat, communicate and kiss, so it's usually worth 45 minutes of discomfort to keep your mouth healthy. If you're not convinced, we've debunked three popular excuses for skipping appointments.
Dental work is too expensive. Many of us have dropped a swollen, drool-soaked jaw upon leaving a dental appointment and hearing the cost of the procedure. In fact, more than one in three Americans delays dental care because of their financial situation, according to a 2013 survey by ORC International and Aspen Dental, which also shows that 61 percent of workers making less than $35,000 per year don't have dental insurance. A study from Harris Interactive and the American Dental Association elaborates on the dental divide: There are those who can afford dental care, go to the dentist and have good oral health, and then there are those who can't afford dental care, avoid the dentist and thus land with poor oral health, which is quite expensive to treat.
Yes, shelling out for fillings and cleanings can be frustrating and flat-out difficult to afford if you're broke. But putting off these necessary appointments can cost much more in the long run. Nathan Laughrey, owner of several Aspen Dental practices in western Pennsylvania, sees many patients with decay, broken teeth and lost fillings. "If they came in right away or had routine maintenance, we could have covered them with crowns and replaced fillings – a couple hundred dollars worth of work," he says. "But it turns into thousands of dollars worth of extractions and root canals."
Laughrey also has patients who have had gum disease for years but didn't recognize the warning signs – persistent bad breath and receding gums that may be red, swollen and tender, among others. So by the time they pay him a visit, he often needs to pull all their teeth. Indeed, the ADA survey shows that adults making less than $30,000 per year are more than twice as likely than those earning $30,000 or more to have had all their teeth removed.
Tooth decay and gum disease are slow, progressive problems; you don't wake up one morning and suddenly need all your teeth pulled. At regular appointments, professionals can detect warning signs, help you prevent the diseases if you're at risk and catch them in their early stages – before they do major damage to your mouth and wallet. "They're easily prevented and controlled diseases," says William Kohn, vice president of dental science and policy at Delta Dental Plans Association, and a former director of the Division of Oral Health at the Centers for Disease Control and Prevention. "But once they start, they're hard to reverse. Prevention is key to dental success."
The most obvious way to save money on dentistry, Kohn says, is to regularly spend a few bucks at the drugstore on fluoride toothpaste and floss, use the products regularly and get checkups twice a year to avoid costly dental ailments from the get-go. But if the classic "brush and floss" bit is too little too late, and you need to foot an intense bill for dental work, ask your health care provider for financing options, which may allow you to stretch payments across several months, Laughrey suggests. He also says, acknowledging that this advice could be filed under "easier said than done," to try budgeting money specifically for dentistry, just as you would for primary care checkups.
Dental appointments are uncomfortable. Well, yeah. Health care is personal, and lying back with machinery in your mouth can make you feel vulnerable. But it is what it is, and dentistry has improved vastly in the last couple decades. "A lot of people base their fears on what they had when they were kids," Laughrey says, "but modern dentistry is a whole lot different than it was in 1960." Think about what specific part of dental appointments makes you cringe, and communicate that fear to your dentist, Laughrey says. If it's the sound of the drill that curdles your blood, the dentist may suggest you bring in an iPod. If it's a needle you fear, the dentist may try an oral sedative or topical anesthetic. "We get lumped into this big pile, like we're sadists and enjoy inflicting pain, but it's much easier to work on a patient who is calm," Laughrey says. "And if you have a dentist that doesn't cater to your whims, find another one."


source :http://health.usnews.com/health-news/articles/2013/05/23/stop-the-excuses-go-to-the-dentist

Tuesday, April 9, 2013

Part Of Brain Removed From The Boy Who Was Having Uncontrolled Seizures

1. How Did It Start?

Spike Parrent had led a completely normal life until he was four years of age. One day in January 2011 Spike Parrent told his father, Tom Parrent, that he was tired and wanted to go to sleep. Tom Parrent watched him falling asleep, and then went upstairs to do some work. Minutes later, senior Parrent said he heard an animal-like scream, and when he rushed downstairs, his son was having a seizure. I ran to him; and was thinking, ‘Can I get to the ER before the paramedics?’ On the way to ER, he was conscious, but not really aware of anything.

2. What The Doctors Thought At First?


The doctors at the emergency room ran some tests and concluded that these most likely were febrile fits, which are caused by fever and five percent of children suffer from these at some point during their childhood. Tom Parrent was assured another seizure would never happen again.
Later that night, Spike had another seizure, so Parrent and his wife, JoJo, took him back to the ER, where doctors told them that half of the five percent of kids who suffer from febrile fits, end up having a second attack. But, that would be it.

3. What It Actually Turned Out To Be?


One week later, Spike was having multiple seizures a day and was diagnosed with epilepsy, a chronic disorder characterized by recurrent seizures. This can be very frustrating for the parents because it is a lifelong illness and requires 24/7 monitoring of the child.
Medication can control epileptic seizures only in about 45 percent of patients. After trying multiple medications, it became clear that Spike would not be one of them.

4. Any Reason Behind This Catastrophe?


Doctors tried every test possible – cancer and autoimmune diseases were ruled out. A brain biopsy was performed, and while doctors saw some unusual material in the brain’s lining, they were never able to determine what it was.

5. Any Way Out Of It?


Spike also tried alternative treatments – including the ketogenic diet, which is low in carbohydrates and high in fat. This diet has to be so precise that every ingredient has to be measured to a tenth of a gram. At just 4 years of age, a typical meal for Spike included heavy cream, heavy butter, a tiny piece of meat and a couple of blueberries.
For a while, the diet seemed to work and he went without seizures – until August of that same year when the fits returned with a vengeance.

6. No Relief? How About Taking Out The Part Of Brain That Is Causing These Seizures?


That’s when Spike was sent to the Cleveland Clinic where doctors decided that he was a good candidate for brain surgery. Essentially, Spike would have his right frontal lobe removed – the part of the brain responsible for attention span and executive function.
Research has found that epileptic patients who opt to have frontal lobe surgery have an 80 percent chance of living seizure-free for the rest of their lives but if they wait for more than five years then these chances can be cut down by at least three times.

7. How The Surgery Turned Out To Be?

Spike had his last seizure on November 9, 2011 right before his surgery. To date, he has not had another one – and he’s reducing his medications and living a happy and healthy life. He iss learning to read and you can just see the acceleration of growth, He can play football, kickbox, he’s a regular little boy who enjoys hiking practically he can do anything.

8. Any Concerns About This Surgery?

Main concerns of this surgery include change in personality, chance of having temporary paralysis and/or attention deficit issues, or being slower to learn things – but in the end, all functions recover.


source:http://researchonmedical.com/2013/03/part-of-brain-removed-from-the-boy-who-was-having-uncontrolled-seizures/

Friday, March 15, 2013

Top 10 Innovations Of 2013 In The Medical Field

Since the dawn of the 20th century rapid and remarkable changes have been occurring in the field of science. Few of these simple changes have made deep impression in our lives because of the solutions that these scientific innovations provide for the difficult problems that have not been addressed for a long period of time. It is very much possible that the things which are inevitable to us would be obsolete in the new generations to come. New developments will always be there, we don’t need to wonder and be in awe because the majestic curtains will always be open to unveil innovative ideas which are not current, but would be used for future advantages. Few days ago, the Cleveland Clinic made an announcement about the top 10 medical innovations in 2013. How it would affect and the impact it would leave in some of the unresolved medical human conditions will be found out during the coming months and years.

10. Health Care Programs and Its Incentives:
The Bipartisan Medicare Better Health Rewards Program Act of 2012 will privilege the people to maintain stable health conditions with reduced medical expenditures at the same time. It has been tied up with rewards (such as money) for being watchful about their health by alleviating or avoiding complex illnesses and diseases, which can be potential threat to life. Based on this program, financial incentives have been given to improve health at personal level and  wellness is assessed by six essential parts of human health including body mass index, blood pressure, cholesterol, diabetes indicators, status of vaccination and use of tobacco products. There are progressive measurements, which will allow recipients to keep themselves healthy and be able to receive monetary rewards up to $400 during second and third year of the program.

9. Tomosynthesis Of Breast:

Breast Cancer is one of the leading cause of mortality and morbidity among women. Early detection and treatment can significantly reduce the mortality and morbidity in these patients.  Breast Tomosynthesis is the new technology that will be used in 2013, it is a 3D mammography that will be helpful in early diagnosis and has been approved already by Food and Drug Administration in 2011 in order to have a clearer and refined view of breast. 2D mammography will not become obsolete, it will still be used in combination with this new innovation. Tomosynthesis is also expected to reduce the rate of repetition of mammography due to lack of clarity.
8. Complex Aneurysm Treatment:
This is good news for patients with complex aneurysm, which is the 13th leading cause of mortality in the United States. This problem can lead to internal bleeding, loss of consciousness, shock and even death. At present this condition is being treated with endografts but the gap of waiting time is to be bridged with a fabric graft, thus making it very painful for the patient in a way that he/she has not only to wait but also has to undergo the procedure twice.  FDA has approved a new treatment known as modular stent device  which will be available in 2013 and will pass through the aneurysm to strengthen the weak walls of the blood vessels. This treatment is expected to save many lives and prevent a lot of disability.

7. Ex Vivo Lung Perfusion:

Lung transplantation is the treatment of choice for nonmalignant end-stage lung disease in case of failure of all other medical and surgical treatment options. However, the demand for donor lungs exceeds the number of available organs by far, resulting in substantial waiting list mortality. The lung is especially susceptible to damage in donors not only due to its direct external contact, but also due to the development of neurogenic edema and proinflammatory changes caused by brain death. As a consequence of that, lungs are currently used from only 15% of all reported donors. One approach to overcome the scarcity of donor organs is the use of marginal donor lungs. However, there is evidence suggesting an increased incidence of primary graft dysfunction (PGD) in recipients of such marginal organs. The most recent approach to expand the available pool of donor lungs is ex vivo lung perfusion (EVLP). This procedure is performed by perfusing the donor lung outside the body (ex-vivo organ perfusion) on a closed loop circuit simulating the in-vivo scenario, utilizing a specially developed protective perfusion solution (Steen Solution™). It helps the marginal donor lungs to be ready for transplant and eliminate rejection.

6. Femtosecond Laser Cataract Surgery:


This is the fastest method of cataract surgery and causes less inflammation , which uses laser application rather than relying on traditional surgical blade, which is not accurate enough to give a precise incision in the eye. The Femtosecond Laser separates the tissues by ablation and cleavage. The advantage of this laser is the higher level of accuracy and precision  in giving a smaller incision. This new technology has proven to be very effective and has resulted in clearer visions without undergoing the surgery.
 
 
 

5. Handheld Optical Scan for Melanoma:


More than 76,000 people have been diagnosed with melanoma, a type of skin cancer, which is attributed to exposure to ultraviolet (UV) radiation. Hand-held optical scan is a noninvasive method of diagnosis of melanoma. The US government has allocated $3 billion for the treatment of melanoma. Early and noninvasive diagnosis with this device will not only reduce the costs of treatment but also morbidity and mortality.

4. Novel Medications for Advanced Prostate Cancer:

Prostate cancer is a common type of malignancy among men in their senior years. This cancer has a rapid spread both locally and by metastasis to remote tissues like bones, and other parts of the body. Hence  it is one of the leading causes of death among older men.  Over the past two years various research groups have introduced five new drugs, which have been approved by the DFA, for the treatment of advanced prostate cancers in men. These drugs include abiraterone, cabazitaxel, denosumab,  enzalutamide, and sipuleucel-T, which  increase cancer survival rate among men. Another drug which is not yet included in Novel New medicines for prostate cancer is radium-223 dichloride, which is expected to be approved this year.

3. Mass Spectrometry for Bacterial Identification:


A new technology known as mass spectrometry has been developed for quick identification for recognition of bacteria that infect and cause disease among human beings. Identification of bacteria takes days to be done under presently available technology thus making both doctors and patients to wait until definite results are available for definite treatment to be started. This new technology will revolutionize the diagnosis and treatment of bacterial infections.

2. Neuromodulation To Relieve Cluster and Migraine Headaches:

Headache is a very common complaint among people in all parts of the world. Most of the time there is no definite underlying cause. Headache can be divided into tension headache, cluster headache, migrain etc. Most of the people suffering from headache take any pain killer and get through this. A new therapy technique known as Neuromodulation has been developed which relieves headache within 10 minutes in about 70% of patients suffering from headaches.

1. Bariatric Surgery To Control Diabetes:


Bariatric surgery is done to reduce the volume of stomach so that the treated person eats less at a time. The main principle behind dietary management of diabetes is to have 6 small snacks during the day instead of having 3 large meals. Because large meals result in sudden rise and then fall in blood sugar level while small frequent snacks result in relatively steady blood sugar levels. This surgery not only results in weight reduction but also prevents the sudden spikes of blood sugar level that result from single large meals.

Source :
http://researchonmedical.com/2013/02/top-10-innovations-of-2013-in-the-medical-field/2/
   

Monday, February 4, 2013

PERIODONTAL DISEASE, LEFT UNTREATED, CAN LEAD TO TOOTH LOSS AND OTHER DISEASES


Nearly half of the people over age 30 in the U.S. have periodontal disease according to the Center for Disease Control (CDC). It occurs more frequently in men than women, is more likely to occur in current smokers and is most prevalent in Mexican-Americans. In those 65 and older, the rate increases to over 70%. Men with this gum disease are 49% more likely to develop kidney cancer, 54% more likely to develop pancreatic cancer and 30% more likely to develop blood cancers according to the American Academy of Periodontology (AAP).
The common factor in all of these diseases is inflammation, which is the body's response to insult. According to Dr. Greg Fauth, “Our immune system that produces inflammation is like a well-functioning army.” He explains that, “When it becomes necessary for the army to go in too many directions, fighting too many battles, the army's ability to effectively control each insult is compromised and disease will occur in the weakest link in an individual's body. Periodontal disease is one of the inflammation points that will compromise the immune system.”
According to the AAP, people with diabetes are more likely to develop periodontal disease, probably because they are more susceptible to contracting infections. Those who don't have their diabetes under control are especially at risk. Severe periodontal disease can lead to increased blood sugar levels. These periods of time when the body functions with a high blood sugar level put people with diabetes at increased risk for diabetic complications.
While no cause and effect relationship has been proven between periodontal disease and heart disease, scientists believe that inflammation caused by periodontal disease may be responsible for an association between the two. In addition, periodontal disease can also cause existing heart conditions to worsen.
Additional studies have pointed to a relationship between periodontal disease and stroke. In one study, people diagnosed with acute cerebrovascular ischemia (stroke) were more likely to have a periodontal infection than those who did not have an infection.
The good news is that your general dentist, dental hygienist or a periodontist can perform a comprehensive periodontal evaluation at your regular yearly dental check-up. The evaluation is relatively painless and non-invasive. It consists of examining each tooth above and below the gum line. An instrument called a ‘periodontal probe’ is passed gently along the side of the tooth beyond the gum line. The probe will stop at about the level of the bone attachment to the tooth. It allows the dental professional to measure the distance from the gum line to the bone level, feel the texture of the tooth (rough or smooth) and see if the gum bleeds when the probing is done. Bleeding on probing is a good indicator of inflammation in the gums. Rough texture of the root indicates dental plaque hardened on the tooth that makes it impossible to clean the root surface effectively. Probing depth greater than 3-4 mm indicates an area that cannot be predictably cleaned with home care instrumentation.
The warning signs of gum disease include the following:
• Red, swollen or tender gums or other pain in your mouth
• Bleeding while brushing, flossing or eating hard food
• Gums that are receding or pulling away from the teeth, causing the teeth to look longer than before
• Loose or separating teeth
• Pus between your gums and teeth
• Sores in your mouth
• Persistent bad breath
• A change in the way your teeth fit together when you bite
• A change in the fit of partial dentures
Periodontal disease is known as a silent disease and the onset of the disease may be present without the symptoms. Therefore, it is very important to have a yearly exam that allows your dental professional check for any warning signs that you may not notice, but may be present. As more evidence unfolds indicating the association between periodontal disease and an individual’s well being, it becomes more important for each of us to establish a regimen of evaluation and care.
If you would like to take an assessment, click on http://service.previser.com/aap/default.aspx.
WHAT IS A PERIODONTIST AND WHAT DOES HE DO?
A periodontist is a dentist who specializes in the prevention, diagnosis and treatment of periodontal disease and the placement of dental implants. Periodontists are also experts in the treatment of oral inflammation. Periodontists receive extensive training in these areas, including three additional years of education beyond dental school. They are familiar with the latest techniques for diagnosing and treating periodontal disease and are also trained in performing cosmetic periodontal procedures.
Periodontists often treat more problematic periodontal cases, such as those with severe gum disease or a complex medical history. Periodontists offer a wide range of treatments, such as scaling and root planing (in which the infected surface of the root is cleaned) or root surface debridement (in which damaged tissue is removed). They can also treat patients with severe gum problems using a range of surgical procedures. In addition, periodontists are specially trained in the placement and repair of dental implants.
During the first visit, the periodontist usually reviews the patient’s complete medical and dental histories. It is extremely important for the periodontist to know if any medications are being taken or if the patient is being treated for any condition that can affect periodontal care, such as heart disease, diabetes, or pregnancy.
The periodontist examines the gums, checks to see if there is any gum line recession, assesses how the teeth fit together when biting, and checks the teeth to see if any are loose. The periodontist will also take a small measuring instrument called a probe and place it between the teeth and gums to determine the depth of those spaces, known as periodontal pockets; this helps the periodontist assess the health of the gums. X-rays may also be taken to observe the health of the bone below the gum line.
Who Should See a Periodontist?
Some periodontal needs can be managed by the general dentist. However, as more and more patients are exhibiting signs of periodontal disease, coupled with research that suggests a relationship between periodontal disease and other chronic diseases of aging, periodontal treatment may necessitate a greater understanding and increased level of expertise by a trained specialist. Patients who present with moderate or severe levels of periodontal disease, or patients with more complex cases, will be best managed by a partnership between the dentist and periodontist.
This information comes from the American Academy of Periodontology and can be seen at http://www.perio.org/consumer/periodontist2.htm.

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