Laser Shown to Prevent Caries

Even though the laser has been shown over the years to be useful in a variety of medical and dental applications, certain laser dental procedures have been unpredictable. But a recent pilot study shows that a laser is well suited for preparation of pits and fissures.

The study, presented at the Jan. 22-28 annual meeting of the International Society for Optical Engineering in San Jose, Calif., showed that occlusal pits and fissures can be conservatively prepared, cleaned, and etched, and can receive caries preventive effects all in one laser procedure.

"We killed three birds with one stone, rather than using multiple procedures with conventional techniques," says Douglas A. Young, DDS, associate professor at the University of the Pacific School of Dentistry. "Many may argue that this as an improvement over the dental drill."

The almost two-year-long study, titled "Treating Occlusal Pit and Fissure Surfaces by IR Laser Irradiation," was performed by Young; Daniel Fried, PhD; and John D.B. Featherstone, DDS, of the University of California at San Francisco School of Dentistry. The study involved irradiating occlusal pits and fissures of extracted human teeth with noncommercially available Er:YAG, Er:YSGG, and CO2 lasers. A control group of teeth was treated with a dental bur. After treatment, artificial caries-like lesions were created that mimicked the biological process occurring in the mouth. The laser ablation groups resulted in a 50 percent inhibition of caries progression for both the CO2 and Er:YAG, and 72 percent caries inhibition for the Er:YSGG laser when compared to the bur control group.

Young believes that the deep morphology of the pits and fissures combined with the currently available crude caries detection techniques make conventional treatment of the occlusal surfaces grossly inadequate.

"What makes this technology so exciting is that it is available to clinical dentists now to conservatively treat occlusal lesions even before they can be detected, and, based on this study, may also have the potential to prevent cares development."

Featherstone, an expert in the use of lasers in dentistry with almost 20 years of experience, says that this study is a significant step forward from previous laser research.

"One of the differences here is that it brought the caries prevention and caries removal research, previously on separate tracks, into one study," he says. "This was the first attempt to do a study that’s closer to clinical reality."

Fried, who has worked closely with Featherstone for eight years on caries prevention with lasers, has also worked for the past five years on the caries removal research track. He says the question in his mind was when dentists drill through the enamel, is an acid-resistant layer being created as a side effect due to the heat buildup?

"We wanted to see if a laser could do it," says Fried, an associate professor in UCSF’s Department of Restorative Dentistry. "Doug Young found he got caries inhibition with all three laser types, with no significant difference between them, but they did require markedly different radiation intensities."

The caries inhibition effect was achieved in the laboratory without the use of cooling water spray. Fried cautioned dentists using lasers to leave their water sprays turned on until further studies are done.

"We know from our study’s results that without using a water spray during ablation with these systems, we actually created resistance to acid dissolution," Fried says. "That doesn’t mean that people using lasers should turn off the cooling water, because that may create heat problems (such as) cooking the pulp."

Young said that a follow-up study would aim at more clearly defining the parameters for water spray use with lasers that will still achieve caries inhibition.

"If we can get the caries inhibition effect with the water spray, we won’t need to turn it off," Young says. "But we have to attempt to show that this is possible with commercially available lasers."

Featherstone said the follow-up study would seek to find a compromise between energy delivery and water cooling impact to maintain a level of caries inhibition.

"My concept here is that we should use a laser with water spray to ablate the caries and a little of the enamel, then reduce the water spray to do the caries prevention," he says. "We’re studying this concept in the progression of the idea toward clinical utilization."

Roger Rempfer, DMD, a laser expert and member of CDA’s Council on Dental Care, says that some other laser procedures have been shown to be less than predictable, but in this area there is an effort at good science.

"In this particular area there is good reason to be optimistic that they will be able to modulate the heat and address incipient or pit and fissure caries," Rempfer says. "There’s reason to be hopeful that they will at some juncture have this science dialed in so this will be a viable application."

Featherstone says that this use of lasers will be a future tool for caries intervention.

"This will be one of several tools used for intervention at an early stage, much better than having to do massive restorations at a later stage," he says. "Early caries identification, detection, and prevention will be a key part of this new paradigm as we move yet another step on the path from G.V. Black’s research a century ago to the future."

Putting Your Home in the Balance

By Marios P. Gregoriou

Measured by several factors, a home can be a good investment. But how good?

In a strong economy, a home’s value can appreciate, and additional physical improvements will usually help increase the value.

Two other factors support consideration of a home as a solid investment. Specifically, traditional home ownership has a "forced savings" component that offers advantages. When a homeowner holds an amortizing mortgage, the monthly loan payments include principal pay-down as well as an interest payment. The principal portion of the loan increases with each loan payment made so that over several years homeowners can build up additional equity in the home.

Federal income tax also treats mortgage interest favorably: If a homeowner has taxable income, he or she may enjoy the effective return of between 15 percent and 39 percent of the mortgage interest payments.

Also attractive is the fact that home ownership involves predictable, steady monthly payments.

But how good an investment is a home compared to other liquid-asset class investments? As a measured investment, historical U.S. growth in property values has lagged behind long-term historical growth of stocks and bonds.

Also, steady payment of a mortgage may have certain drawbacks. Principal growth can be relatively low in the initial years of loan payback unless additional principal payments can be made without penalty. Compared with other investment options, equity growth can be relatively modest. And except for the deductibility of mortgage interest, the two other significant components -- forced savings and growth potential -- may deliver lower rates of return relative to other investment vehicles.

Those potential lower returns might be acceptable to people who consider a mortgage a debt to be completely repaid on or ahead of schedule. That thinking represents a traditional view of the role of a mortgage loan. But home ownership patterns have changed dramatically -- families move and refinance more frequently than ever. As a result, financial planners have developed alternative ways to view home ownership, evaluating the investment in the context of a homeowner’s overall financial profile and long-term wealth creation goals.

The concept that all debt, including a home mortgage, should be evaluated and managed as part of an individual’s overall financial plan is called Total Balance Sheet Management, through which people manage their liabilities with a goal of increasing their assets.

The key is that smart management of liabilities can ultimately reduce the cost of debt, preserve assets, and free liquidity to help long-term net worth growth. Homeowners can continue to pay down mortgage principal, invest, or use the additional liquidity elsewhere.

Lenders have produced hybrid mortgage loans with that benefit in mind. One popular product is an adjustable rate mortgage, with an initial fixed-rate period. During the initial five-, seven- or 10-year period, borrowers make interest-only payments, thus generating excess liquidity. The hybrid mortgage offers additional flexibility by allowing principal pay-down at any time, without penalty.

Even if the interest-only mortgage has a higher rate than the fully amortizing mortgage, the required monthly payments could be lower and the goal of generating additional liquidity for investment or other purposes can be achieved.

Upon conclusion of the initial period, the borrower has the option to refinance the mortgage, without prepayment penalty, into another hybrid adjustable-rate mortgage to once again leverage the liquidity derived from the fixed-rate interest-only period.

Incorporating one’s home into a total financial picture can enhance the opportunity for long-term wealth accumulation.

Marios Gregoriou is an associate vice president and financial adviser with Morgan Stanley Dean Witter in Sacramento. He can be reached at (800) 755-8041.

Navigating the Scientific Session

You’ve arrived in Anaheim for the Scientific Session. You’ve checked into your hotel, unpacked your bags, and made your way to the Convention Center. What do you do now?

* Grab a program -- First, grab an on-site program. They are located throughout the registration area and have important information on classes and exhibitors.

* If you have a badge -- If you have preregistered and received a badge (a small piece of paper with your name and the Session logo on it), go to the booth labeled "Badge-Holder Pickup." This will be a quick line. A nice staff member there will take your badge, tear off the perforated half (which CDA uses to count attendees), and hand you a badgeholder. Your badge must be in this holder for you to gain entrance to the Session.

If you have a badge, but there is an error on it, you may have it corrected at the "Badge Correction" booth in the registration area.

* If you DO NOT have a badge -- If you did not preregister or did not receive a badge in the mail, proceed to one of the kiosks with applications. Fill out the application and get in the line leading toward the booths labeled "On-Site Registration." There will be a fee for registering staff and guests at this time.

If you need to register for the Session and need renew your CDA membership, are a nonmember, or are from out of state or out of country, go to the "Special Registration" booth.

* To attend exhibits -- To attend the exhibit, display your badge and enter the exhibit area. A badge is required for entrance.

* To attend classes -- Continuing education lectures and symposia are free and are filled first-come, first -served. Go to the appropriate room. Your badge will be scanned on your way in. Take a seat and enjoy the class. Be sure to get the C.E. form that is handed out toward the end of class. It is still the primary source of receiving C.E. credits, because the scanning equipment is still in test mode. Fill out the form, keep the bottom part for your records, and drop it in one of the C.E. drop boxes located throughout the registration and classroom areas. If you are from out of state, you will need to mail the form in to CDA.

* To attend workshops -- Tickets to fee workshops must be purchased in advanced. Go to the booth labeled "Ticketing Booth" in the registration area to sign up if you haven’t already. If you have signed up, the room monitors will have your name on the class list.

*Enjoy the Session -- Don’t forget to get tickets for Disneyland and the Membership Celebration. They can be purchased at the Ticketing Booth in the registration area.

See you in Anaheim.



Health Web Sites Aren't Private Clubs

Visitors to health Web sites are not anonymous, even if they think they are, and personal information shared with health Web sites is highly vulnerable, according to a report released by the California HealthCare Foundation.

The report conducted by Janlori Goldman and Zoe Hudson of the Health Privacy Project at Georgetown University, and Richard Smith, an Internet security expert, looked at the privacy policies and practices of 21 of the most heavily trafficked health sites on the Internet.

The privacy concerns related to those health Web sites don't stem from a concern about vulnerability to hackers, but from the fact that the sites are sharing the personal health information they collect from visitors with advertisers and others, without the visitors’ knowledge or permission.

"We found that third-party ad networks receive access to information that would allow them to build detailed, personally identified profiles of individuals’ health conditions and patterns of Internet use," Smith said.

Among the report's findings:

* Health Web sites recognize consumers’ concerns about the privacy of their personal health information and have made efforts to establish privacy policies; however, the policies fall short of truly safeguarding consumers.

* There is inconsistency between the privacy policies and the actual practices of health Web sites.

* Health Web sites with privacy policies that disclaim liability for the actions of third parties on the site negate those very policies.

The full report can be accessed at http://ehealth.chcf.org/priv_pol3/index_show.cfm?doc_id=33.



Dental Spending is Projected to Rise

The government is expecting a 50 percent increase in dental spending by 2008, for an annual total of $93.1 billion, despite slower projected growth in private sector health spending.

The study by the Health Care Financing Administration Office of the Actuary appeared in the July/August 1999 issue of Health Affairs.

Americans spent an estimated $50.6 billion for dental care in 1997 and were expected to come close to $57 billion in 1999.

The dental economy will continue expanding at more than twice the rate of overall economic growth project by the Congressional Budget Office through 2009, an average of 2.4 percent per year.

In overall health, government actuaries expect spending to double from $1.1 trillion in 1997 to $2.2 trillion in 2008. From 2001-2008, private and public health spending will slow because the number of uninsured Americans is rising faster than expected.



Antidepressants Can Cause Bruxism

The family of antidepressant medications that includes Prozac, Paxil, and Zoloft may cause bruxism and associated headaches, researchers report, adding that the antidepressant drug Buspar appears to provide relief.

Dr. John Michael Bostwick of the Mayo Clinic in Rochester, N.Y., and colleague Dr. Michael Jaffee published their findings in the December 1999 issue of the Journal of Clinical Psychiatry.

The researchers point out that the selective serotonin reuptake inhibitor family of medications can all suppress activity of the brain chemical dopamine. One of dopamine’s important functions is the control of muscular or motor activity.

Bostwick and Jaffee described the case of a 61-year-old woman who reported severe nighttime bruxism soon after starting on Zoloft (setraline). The clenching cracked two of her crowns. In another case, a 35-year-old man reported constant jaw clenching and severe headaches connected with Zoloft use.

Symptoms were relieved in both cases after doctors added another type of antidepressant different from the selective serotonin reuptake inhibitors -- Buspar.



Web Watch: Southern California Attractions

The following are Web pages to help you plan family fun during your trip to Anaheim for CDA’s Spring Scientific Session.

http://www.anaheimoc.org/

Site for the Anaheim/Orange County Visitor & Convention Bureau, which describes many of the attractions in the Anaheim area.

http://disney.go.com/Disneyland/

You can plan your trip to Disneyland on this page.

http://www.knotts.com/

This page has information on the Knott’s Berry Farm theme park.

http://www.angelsbaseball.com/

Official Web site of the Anaheim Angels. The Angels will be playing at home in Edison Field through April 12.

http://www.dodgers.com/index_dhtml.html

Official site of the Los Angeles Dodgers. The Dodgers will be playing at home during the Scientific Session.




Upcoming Meetings

2000

April 5-9 American Society for Laser Medicine and Surgery annual meeting, Reno, Nev., (715) 845-9283

April 6-8 Dentistry 2000 -- British Dental Association Annual Conference and British Dental Trade Association Dental Showcase Exhibition, Birmingham, England, 01934 844408

April 11-15 American Academy of Oral Medicine Annual Scientific Session, Las Vegas, (410) 602-8585

April 13-16 CDA Scientific Session, Anaheim, Calif., (916) 443-3382, Ext. 4470

April 29-May 1 Star of the North Meeting, St. Paul, Minn., (651) 646-7454, www.mndental.org.

May 5-7 Periodontal Medicine: Clinical and Practical Implications, Washington, D.C., (312) 573-3213, www.perio.org.

May 15-20 World Biomaterials Congress and Exposition, Kamuela, Hawaii, (612) 543-0908

June 12-13 "The Face of a Child" -- Surgeon General’s Conference on Children and Oral Health, Washington, D.C., (301) 588-6000, www.nidcr.nih.gov/sgr/children/children.htm

July 30-Aug. 2 Congress of the International Society for Lasers in Dentistry, Brussels, Belgium, +32 2 648 80 59.

Sept. 15-17 CDA Scientific Session, San Francisco, (916) 443-3382, Ext. 4470

Sept. 17-20 American Academy of Periodontology Annual Meeting, Honolulu, www.perio.org

Oct. 14-18 ADA Annual Session, Chicago, (312) 440-2500

Nov. 29-Dec. 2 Le Mondial du Dentaire, Paris, http://www.fdi.org.uk/calender/index.htm

2001

May 4-8 Australian Dental Congress, Brisbane, +61 (0) 7 3369 0477

To have a meeting included on this list, please send the information to Upcoming Meetings, CDA Journal, P.O. Box 13749, Sacramento, CA 95853 or fax the information to (916) 443-2943.