Dental Implants

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It's been less than 10 years since Alaska's dental health aide initiative was launched to train and place dental health aide therapists (DHAT) in rural Alaska, and three years since the program graduated its first students. It was an innovative project, the nation's first attempt at developing a dental therapist program of this kind. According to a recent study conducted by Research Triangle Institute, Alaska's dental therapists are now providing safe, competent and appropriate care in their scope of practice.

Nearly two dozen DHATs are currently working around Alaska. They impact 35,000 people in rural Alaska who now have access to a dedicated oral health provider. That's critical care for Alaska Natives, who have long struggled with dental disease; in fact, Alaska Native children still have more than two times the national rate of tooth decay. Communities that once relied on itinerant dental care or had none at all now receive routine restorative and preventive services by local providers.

The initiative spearheaded by the Alaska Native Tribal Health Consortium (ANTHC) is leading Alaska's rural communities toward better oral health, while also making a significant socio-economic impact because of the new health care provider jobs it's produced.

The two-year academic and hands-on education includes training in dental disease prevention and basic dental treatment skills. When finished, many DHATs return to serve their home villages. That kind of familiarity helps bring cultural competence to the dental care provided.

"The patients showed appreciation for all the work we'd provided, which gave me a boost of confidence as a provider of my people," explained Trisha Patton, a second-year DHAT student from Napakiak, who recently completed a week of work and training in a Yukon Delta village.

After training, most dental therapists work in regional and sub-regional clinics providing local care, as well as making regular trips to surrounding communities. That means a crucial part of DHAT training includes several weeks of village travel. In these weeks, students like Patton work with a dentist to treat residents in pain, while also providing preventive services and measures to stem the tide of decay. Patton's recent village-based work was with fellow student Shannon Hardy and dentist instructor Dr. Anthony Brusca.

"Our week started pretty slowly, but as we began the process of unpacking gear, it suddenly felt like it was never going to end," Patton said. "We instantly had two pages of patients we were expected to see."

In fact, demand was so high that the team worked from 9 a.m. to 10 p.m. for nearly a week.

"Shannon and I wrote notes probably until 11:30 p.m., ate dinner, went to sleep and repeated that schedule all week," Patton said. "While we were overwhelmed with all the dental work that needed to be completed, I felt comfort — the village made us feel at home.

"And as I was providing care, I realized that I love making a difference in the lives of the Yup'ik people and helping many feel free of pain," Patton added.

The DHAT program is even inspiring groups outside Alaska, with Lower 48 states looking at Alaska's training as a model for improving access to dental care for people in their areas. The American Association of Public Health Dentistry recently released a special supplement to their journal dedicated to exploring midlevel dental providers including dental therapists, including a curriculum outline based on the DHAT training curriculum and an article co-authored by Dr. Mary Williard, DHAT training director for ANTHC, on DHAT supervision.

Four more Alaska-trained dental therapists will graduate at the end of 2011, while seven new students are entering class this month at the ANTHC/University of Washington DENTEX Training Center in Anchorage.

[News source : thearcticsounder.com]

A team of scientists from Boston has confirmed that the bacterium Streptococcus mutans is a primary culprit in early childhood caries (EEC) cavities on the first set of teeth, and has identified a new species of bacterium, Scardovia wiggsiae, which they suspect is also a major contributor. They report their findings in the Journal of Clinical Microbiology.

The study's ultimate goal was to determine which bacterial species should be suppressed "to prevent cavity formation," says Anne Tanner, of the Forsyth Institute, Cambridge, MA. EEC is the most common chronic infectious disease of childhood in the US. It afflicts one quarter of the relevant population, and more than one half among certain disadvantaged socioeconomic groups.

In this study, the researchers compared the bacterial populations in samples of dental plaque taken from deep cavities in afflicted children, with plaque from matched sites in cavity-free children. They identified species using 16S ribosomal RNA (16S rRNA). Ribosomes are the machinery that translate the genetic code into protein, and 16S rRNA differs among species. Since high acidity causes caries, and since only acid tolerant bacteria can survive in levels of acidity associated with active caries, they cultured bacteria under acidic conditions to select for species likely to play important roles in cariogenesis.

"We detected the major caries pathogen of childhood caries, S. mutans, in many of the children with advanced caries," says Tanner. In addition, they the found the new species, S. wiggsiae, in a high proportion of plaque samples from cavities, including in several such samples from which S. mutans was absent. S. wiggsiae can tolerate the level of acidity in active caries, leading the team to speculate that it causes cavities.

Over and above normal dental care, measures to suppress cariogenic bacteria include mouth rinses such as chlorhexidine, Povodine iodine, fluoride, and the use of sugar substitutes, says Tanner. "By removing a primary sugar carbohydrate from the diet, the more cariogenic bacteria would make less acid, and might no longer be able to outcompete non-cariogenic plaque bacteria." Managing very young children for severe caries is difficult, and they are often treated under general anaesthesia. [News Source - www.sciencedaily.com]