Daniel M. Meyer

The Challenge for Innovation in Direct Restorative Materials

During the past 50 years, a series of key UN conferences have established a framework to minimize human health risks from environmental exposures to key chemicals. In January 2013, more than 140 countries agreed to the text of new treaty to minimize Hg effects on the environment (the Minamata Convention). Dental caries is omnipresent around the globe, affecting 60% to 90% of school children and most adults, and producing discomfort that affects quality of life. Dental amalgam is frequently used to treat carious lesions and its use releases mercury into the environment. The best way to avoid the use of dental amalgam is to emphasize caries prevention. Alternatives to amalgam are suitable in some applications, but no replacement for amalgam has been found for large posterior restorations. For any restorative material, safety and environmental impacts are part of clinical risk assessment. Safety is freedom from unacceptable risks. Risk is a combination of probability of exposure and severity of harm. Best management practices are crucial to manage dental amalgam, but these impose additional that are disproportionately more for developing countries. The Minamata Convention seeks a phase-out of all mercury-based products except dental amalgam, where a phase-down is the present goal. For dentistry, the most important focus is the promotion of caries prevention and research on new materials.

Low-level mercury exposure and peripheral nerve function

BACKGROUND Mercury is known to be neurotoxic at high levels. There have been few studies of potential peripheral neurotoxicity among persons with exposure to elemental mercury at or near background levels. OBJECTIVES The present study sought to examine the association between urinary mercury concentration and peripheral nerve function as assessed by sensory nerve conduction studies in a large group of dental professionals. METHODS From 1997 through 2006 urine mercury measurements and sensory nerve conduction of the median and ulnar nerves in the dominant hand were performed, and questionnaires were completed, on the same day in a convenience sample of dental professionals who attended annual conventions of the American Dental Association. Linear regression models, including repeated measures models, were used to assess the association of urine mercury with measured nerve function. RESULTS 3594 observations from 2656 subjects were available for analyses. Urine mercury levels in our study population were higher than, but substantially overlap with, the general population. The only stable significant positive association involved median (not ulnar) sensory peak latency, and only for the model that was based on initial observations and exclusion of subjects with imputed BMI. The present study found no significant association between median or ulnar amplitudes and urine mercury concentration. CONCLUSIONS At levels of urine mercury that overlap with the general population we found no consistent effect of urine mercury concentration on objectively measured sensory nerve function.

The evidence-based dentistry champions: a grassroots approach to the implementation of EBD.

In order for evidence-based dentistry (EBD) to become part of decision making in practice, the most current and comprehensive research findings must be translated into practice. The use of Champions, influential individuals to support the transfer of knowledge among their peers, is one effective approach used by others in the health care field to successfully implement science research into clinical care. With the success of Champions in other health care areas, the American Dental Association (ADA) and the Journal of Evidence-Based Dental Practice, through an educational grant from Procter and Gamble, have launched a novel program to develop Evidence-Based Dentistry Champions. The EBD Champion program is developing a network of oral health care workers who will disseminate information about the application of an evidence-based approach to dental care and will serve as resources and mentors to their colleagues. The primary mechanism for developing the network of EBD Champions is through 3 annual EBD Champion Conferences, the first of which will be held at the ADA Headquarters in Chicago, IL, on May 2 and 3, 2008. The EBD Champion will serve as a resource to the practitioners in their communities, providing a grassroots approach to facilitating the implementation of an evidence-based approach to providing dental care.

Defining oral health: A prerequisite for any health policy

I would like to applaud Dr. Michael Glick and Dr. Daniel Meyer’s June JADA commentary, “Defining Oral Health: A Prerequisite for Any Health Policy” (JADA 2014;145[6]:519-520). How do we define oral health objectively? My objective list would include the following items: decayed, missing or filled teeth; bone loss around the teeth; issues with salivary flow and composition; problems with occlusion (lack of anterior guidance) and presence of tooth mobility; the presence of any airway restriction that could be improved by jaw repositioning; pain; pathology of soft tissues; problems with speech, swallowing or chewing; unusual wear, chipping or positioning of the teeth; any issues with overall facial appearance and smile; radiographic findings; and mouth odor. The problem comes in objectively defining periodontal disease and gingivitis. Bone loss is not periodontal disease. Is gingivitis a disease or a symptom? How can gingivitis be defined objectively? How do we define periodontal disease objectively? These are important questions that would help define oral health. Good epidemiology requires objective data. With objective data we then can know if oral health influences general health, and if general health influences oral health. We know general health improves with cigarette smoking cessation, but how do we document it with oral health?

Latex allergy and filaggrin null mutations

OBJECTIVES Natural rubber latex (NRL) contains over 200 proteins of which 13 have been identified as allergens and the cause of type I latex allergy. Health care workers share a high occupational risk for developing latex allergy. Filaggrin null mutations increase the risk of type I sensitizations to aeroallergens and it is possible that filaggrin null mutations also increase the risk of latex allergy. The aim of this paper was to examine the association between filaggrin null mutations and type I latex allergy. METHODS Twenty latex allergic and 24 non-latex allergic dentists and dental assistants, occupationally exposed to latex, were genotyped for filaggrin null mutations R501X and 2282del4. Latex allergy was determined by a positive reaction or a historical positive reaction to a skin prick test with NRL. RESULTS 41 individuals were successfully genotyped. Three individuals were filaggrin mutation carriers. One (2.4%) was a 2282del4 heterozygote and two (4.9%) were R501X heterozygote. No homozygote or compound heterozygote carriers were detected. No association between filaggrin null mutations and type I latex allergy was found (p=0.24). Patients with type I latex allergy more often reported contact dermatitis. CONCLUSIONS This is the first study to examine a highly plausible association between filaggrin null mutations and type I latex allergy. The study subjects were occupationally exposed to latex but no association between latex allergy and filaggrin mutations were detected. Sensitization to latex in the cases in this study may not have occurred through direct skin contact but through the respiratory organs via latex proteins that are absorbed in glove powder and aerosolized.

Policy Development Fosters Collaborative Practice: The Example of the Minamata Convention on Mercury

This article provides an example of interprofessional collaboration for policy development regarding environmental global health vis-à-vis the Minamata Convention on Mercury. It presents an overview of mercury and mercury-related environmental health issues; public policy processes and stakeholders; and specifics including organized dentistrys efforts to create global policy to restrict environmental contamination by mercury. Dentistry must participate in interprofessional collaborations and build on such experiences to be optimally placed for ongoing interprofessional policy development. Current areas requiring dental engagement for interprofessional policy development include education, disaster response, HPV vaccination, pain management, research priorities, and antibiotic resistance.

Providing clarity on evidence-based prophylactic guidelines for prosthetic joint infections.

Daniel M. Meyer, DDS T he notion of biological plausibility—that is, the likelihood of whether an outcome could occur as a result of a causal association—is frequently a premise for clinical research as well as a basis for clinical decision making. However, what do we as clinicians do when the scientific evidence indicates that a risk factor for a condition, preventive regimen, or treatment is not probable or likely, despite being conceivable? Do we follow precedence, inference, or conflicting professional standards of care, or do we rely on clinical guidelines supported by relevant, scientific evidence from systematic reviews in the peer-reviewed literature? Should we as health care providers discontinue providing conventional care when new scientific evidence from clinical studies indicates a particular therapy or a traditional antibiotic regimen is not necessary, especially if the risk of potential harms outweigh the benefits? Such appears to be the case in regard to the results of systematic reviews in the scientific literature on the use of prophylactic antibiotics to prevent prosthetic joint infections (PJI). The concept of providing prophylactic antibiotics to prevent PJI has been based on a logical premise and biological plausibility. Dental procedures that involve soft-tissue manipulation or bleeding have the potential to introduce oral bacteria into the blood stream, leading to bacteremia. It has generally been accepted that bacteremia resulting from dental invasive procedures could lead to infection of prosthetic joint implant areas. The common practice, thus far, has been to have patients premedicate with oral antibiotics before dental treatment to prevent bacteremia and postsurgical infections of prosthetic joint implant areas. More recent scientific information published in the peer-reviewed literature is contributing to a greater understanding of the risks versus benefits resulting from the widespread use of antibiotics. Consequently, attitudes regarding the indications and contraindications for antibiotic usage are changing. The overprescribing and overuse of oral antibiotics are now considered to be a significant public health threat. Providers, their patients, and the public need to be aware of widespread antibiotic resistance, adverse drug reactions such as hypersensitivity reactions, anaphylaxis, opportunistic infections, and Clostridium difficile infection. In 2013, the American Association of Orthopedic Surgeons (AAOS), in collaboration with the American Dental Association (ADA), published the