The University Record, January 10, 2000 By Nancy Ross-Flanigan
News and Information Services
One hundred years ago, half of all American adults had no teeth. Today, fewer than 10 percent of people over age 65 are totally toothless—just one example of how dental health, and demands on the dental profession, have changed over the years. A national conference hosted by the School of Dentistry and held at the University last week, “Scientific Frontiers in Clinical Dentistry,” offered a glimpse at how far the profession has come and where it’s headed.
Researchers and clinicians discussed the latest advances in dentistry, from pain prevention to tissue regeneration at the conference, sponsored by Delta Dental Fund and the National Institute of Dental and Craniofacial Research (NIDCR). The conference was part of the School of Dentistry’s Continuing Dental Education program.
Until this year, NIDCR’s annual “Scientific Frontiers” program had always been held at the institute in Bethesda, Md., noted NIDCR director Harold Slavkin. “This is the first time it’s been held at a university campus, the first time it’s been held in partnership with a major health insurance company, and the first time that it has been strategically done to communicate with a whole state of health professionals.”
The state of Michigan has “a special place in the heart and mind of the NIDCR,” Slavkin added, because the first clinical trial of fluoridated drinking water was conducted in Grand Rapids in the 1940s and 1950s. “Fluoridation is considered one of the greatest public health interventions of the 20th century and was made possible by the people of Michigan. This is a way of saying thank you.”
Other speakers included leading clinicians and researchers from around the nation, including three from the U-M. Here are highlights of some of the presentations:
Repairs and replacements: Finding the critical factors
Back in the really early days, around the first to second centuries, the options for fixing dental defects were limited, but inventive—seashells and bits of iron and wood were used to replace missing teeth. Thank goodness the science has advanced. Now, with a technique called guided tissue regeneration (GTR), synthetic bone powders and membranes are being used to rebuild oral tissues lost to disease.
But success with these new materials is unpredictable, says Martha Somerman, professor and chair of the Department of Periodontics/Prevention/Geriatrics. “The current procedures are often expensive, and it bothers me that I can’t guarantee patients that they’ll be successful,” she said. Hoping to develop a more predictable system, Somerman and her research team are isolating cells that naturally function to repair damaged tissues surrounding and supporting the teeth. They’re also tracking down the specific molecules that regulate these cells. The next step is to outfit cells with those crucial regulators and to implant the engineered cells into diseased tissue.
“By first understanding what factors trigger the cells and then adding those factors back in, it provides a more biological, and therefore more rational approach,” Somerman explained. So far, her group has tried the technique on rats with gum disease, and results have been encouraging. Eventually, the method may be used not only for repairing tissues in the mouth, but also for replacing other body parts, she believes.
Boomers and beyond—changing needs for dental services
With better hygiene, increasing emphasis on healthy lifestyles and the use of fluoridated water and toothpastes, the oral health of Americans has steadily improved over the years. How is that improvement affecting their current and future dental care needs?
To find out, Stephen Eklund, associate professor at the School of Public Health and adjunct professor at the School of Dentistry, studied trends in treatment provided to insured Michigan patients over the past two decades. Baby boomers, he found, have been and will continue to be major consumers of dental services. As kids, they got their first fillings before “Look, Ma! No cavities!” was a common cry. Now that they’re hitting their 50s, they’re back in the dentist’s chair, having old fillings replaced and receding gums treated.
But for the generations just behind them, such services may be needed much less often, Eklund said. People in their 20s, 30s and 40s are reaching adulthood with more of their teeth intact, so they’ll be less likely to need fillings replaced. And because some dentists suspect a link between large fillings and periodontal disease, the post-boomer generations may also have fewer gum problems.
“The insurance data show we’re at the beginning of a major sea change,” Eklund said. As oral health continues to improve, patterns of people’s dentistry needs also will keep changing, he predicted. One possible result is that individual dentists will be able to serve many more patients than in the past. Another possibility is that specialists will handle some of the care that general practice dentists now provide. Whatever changes occur, said Eklund, they’re sure to trigger discussions in the dental profession and beyond of how dentists should be trained, what services dentists should provide and how often patients should be seen.
Taking pains to ease the aches
The picture of pain is changing, said Christian Stohler, professor and chair of the Department of Biologic and Materials Sciences. And so are notions of how it should be managed.
“In the past, we treated all pain as one condition. Now, we’re discovering that there are actually two kinds of pain—acute pain and chronic pain.” Acute pain, like the “ouch!” you feel when you burn yourself, “is a helpful warning signal,” Stohler says. “It tells the person that something is wrong; that the person needs to seek care.” Chronic pain, like the persistent facial pain that plagues some patients for years, serves no useful purpose and often is difficult to pin down to specific causes.
“We have evidence that the biology of the two types of pain is very, very different, as is the brain’s response to each type,” Stohler said. “And the recognition of those differences is leading to treatments targeted to sites in the brain that are involved in processing each type.” In his own work, Stohler has studied brain images of people voluntarily exposed to pain. He finds evidence that certain areas of the brain regulate the sensation of pain, while others are involved in the emotional response to discomfort.
Pain researchers also are learning that factors such as gender and genetics affect a person’s susceptibility to pain, Stohler said. For example, “pain in general is worse in women, and more than 90 percent of patients with persistent craniofacial pain are women.” It’s not a matter of pain tolerance, he said. Women actually process pain differently than men. While patients with chronic pain have many options for treatment, they often are dissatisfied with the results, Stohler’s research shows. A study of 206 patients referred to the U-M Facial Pain Clinic showed they had previously consulted health professionals in 43 different specialties or areas of expertise, ranging from general dentist and family physician to acupuncturist and massage therapist. But nearly half the patients felt “barely satisfied,” “dissatisfied” or “very dissatisfied” with the care and treatment they had received.
In treating persistent craniofacial pain, such as temporomandibular disorders, the best approach is a prudent, low-tech one, Stohler believes. Extreme measures, such as temporomandibular implants, have not been shown to help patients significantly and may leave them in worse shape than before the treatment, he said.
Teaming up for total health
At the start of the new century, health care professionals face a changing world that presents new challenges, said Harold Slavkin, director of the National Institute of Dental and Craniofacial Research. For example, scientists know more than ever about human genes and how they interact with the environment, but the environment in which we live is constantly changing. With jets crisscrossing the globe, people—and their diseases—are no longer confined to their own little corners of the Earth. “Somebody can get up in the morning with a severe viral infection in New Delhi and transmit it to New York in 12 hours,” Slavkin observed.
In addition, the U.S. population is becoming more diverse than ever before, and more people are living into their 70s and beyond. To provide the best care for all segments of the population, health care professionals must understand how gender, ethnicity and age affect health needs.
Finally, Slavkin said, with increasing emphasis on treating the whole body, there’s a need for health professionals to expand their knowledge base, share information with one another and learn to work together. “We now know that oral infections lead to systemic diseases and that systemic diseases have oral complications. We need to make sure that all dentists have a medical foundation of the whole body, and not a diluted or watered-down version.
“A number of dental schools in the United States and Canada—including the University of Michigan—are trying to integrate dental education with the rest of the health center,” Slavkin noted. “Dentistry, medical, pharmacy and nursing students take courses together and learn to work together as a team. I believe that is a wonderful idea. At the same time, some other dental schools are going it alone. I think that’s a mistake.”
About the School of Dentistry
The School of Dentistry is one of the nation’s leading dental schools engaged in oral health care education, research and patient care. General dental care clinics and specialty clinics providing advanced treatment enable the school to offer dental services and programs to patients throughout Michigan. Classroom and clinic instruction train future dentists, dental specialists and dental hygienists for practice in private offices, hospitals, academia and public agencies. Research seeks to discover and apply new knowledge that can help patients worldwide. More information is available on the Web at www.dent.umich.edu.
