ORAL CARE REPORT
Technological Advances in
Oral Healthcare
O ver the last century, major technolog-
ical breakthroughs were achieved leading to
innovations in healthcare. Early issues of the
Oral Care Report (OCR) provided a brief
overview of technological advances that were
relevant to the dental profession. In 1998
(OCR 8.4), the use of lasers in dentistry for
both soft and hard tissue applications was
reviewed, highlighting the need for further
development of laser technology and for stud-
ies assessing its clinical benefits compared to
those of standard approaches. The article iden-
tified the high cost of new devices as an obsta-
cle to their widespread acceptance among den-
tists. Following this first article, a number of
topics were covered, including
• the use of laser fluorescence for early
caries detection (OCR 9.1, 1999);
• advances in endodontic therapy (OCR
10.3, 2000; OCR 12.1, 2002);
• detection of oral cancer using com-
puter-assisted brush biopsy and chemi-
luminescent-assisted visualization of
the oral mucosa (OCR 19.1, 2009);
• teledentistry or the use of telecommu-
nications in dental care, specifically in
relation to interceptive orthodontics
(OCR 19.3, 2009);
• the paradox of technological advances
in healthcare with regard to the high
cost of new technologies that provide
benefits only to a limited number of
patients (OCR 22.1, 2012); and
• salivary diagnostics of oral and systemic
diseases (OCR 23.1, 2013).
The current article reviews three relatively
new technologies which are collectively known
as “digital dental practice”: computer guided
implant placement, intraoral scanning for dig-
ital impressions of teeth and other intraoral
tissues, and computer-assisted design/com-
puter-assisted manufacturing (CAD/CAM).
Volume 25, Number 3, 2015
Providing Continuing Education as a Service to Dentistry Worldwide
Computer-Guided Implant
Placement
Development of computer-guided sur-
gery has helped improve and simplify the
process of dental implant placement. Using
three-dimensional imaging and tomography
scanning of bone and soft tissue structures,
this digital technology allows dental profes-
sionals to visualize the most suitable site for
implant placement and to plan for safe and
accurate tooth replacement.1,2
A number of studies have shown the
advantages of computer-guided implant place-
ment over conventional methods. In terms
of accuracy, it is believed to improve preci-
sion within one millimeter for implant posi-
tion and five degrees for inclination.1 As a
result, fewer positioning errors are likely to
occur. When computer-assisted implant treat-
ment was compared to conventional freehand
treatment in a clinical study, the latter method
was associated with higher error rates (see
figure on next page).3 Inaccurate position-
ing resulted in improper interproximal emer-
gence, insufficient inter-implant distance,
improper parallelism, offset position, exces-
sive subcrestal placement, implant shoulder
exposure, and improper location of the screw
access hole.3 The digital method was also
shown to shorten the duration of dental pro-
cedures by approximately 50% (33 min vs.
63 min),4 thereby reducing labor costs. In addi-
tion, computer-guided implant placement
demonstrated reduced incidence of surgery-
related bacteremia compared to the freehand
method (12% vs. 62%).4
Over recent years, many software prod-
ucts became available that facilitated the
expanded application of computer-guided
technologies. For example, generation of
three-dimensional templates allows for the
Click here to continue to next page
In This Issue
Technological Advances in
Oral Healthcare 1
In Practice 4
Periodontal Page 5
Hygiene Page 6
Healthcare Trends 7
Earn 3 credits online through
this issue of the Oral Care Report
at www.colgateprofessional.com.
Educational
Objectives
After reading this issue of the Colgate
Oral Care Report and correctly answer-
ing the questions in the Continuing
Education Quiz, you will
1. better understand the application
of digital technologies to dental
practice;
2. know the applications of intraosseous
anesthesia and identify the patients
for whom it will be most beneficial;
3. learn why in addition to antirheumat-
ic pharmacotherapy, both smoking
cessation and periodontal treatment
have the potential to reduce the sever-
ity of RA; and
4. see the important role community
pharmacists play in providing oral
healthcare information to patients.
2 ORAL CARE REPORT
identification of bone and prosthetic needs
of the patient and planning for implant surgery.2
Successful outcomes, however, can only be
obtained if the dental staff has received appro-
priate training in the use of the technology.1
Interdisciplinary cooperation via teledentistry
could help overcome limitations with availabil-
ity to all dentists.1
Despite the progress achieved in this
domain, some technical limitations still need
to be resolved. These include overheating of
the implant site by the surgical drill, uncertain-
ty around the accuracy of surgical guide tem-
plates, and the need for a minimum distance
from adjacent structures.1 The most recent con-
sensus report regarding the use of computer-
guided implant therapy urged caution. The
report emphasized that use of computer-guid-
ed approaches for implant surgery is not a guar-
antee of ideal implant placement, that system
errors of 0.5 to 1.2 mm can be expected to occur
with use of these systems, and to reduce errors
the use of a single template is preferred over
the use of multiple templates.5
Computer-guided implant placement
improves accuracy and time efficiency
compared to conventional freehand
methods. Nevertheless, caution is
urged with the use of this technique.
Digital Dental Impressions
Digital dental impressions have emerged
as an alternative to conventional impression
models. Using lasers and digital scanners, den-
tists can create virtual replicas of the oral soft
and hard tissues, thereby eliminating the need
to use impression material. This results in
reduced procedural costs through savings in
material cost and technician time.6 A study
showed that use of intraoral scanners to design
digital models for dental prosthetics shortened
impression time by up to 23 minutes compared
to conventional methods.7 This may result in
improvement of work flow, which may have a
positive impact on patient satisfaction.
Digital impression models may help
reduce the cost of dental treatment
through savings in material cost
and technician time.
In terms of accuracy, digital models were
shown to be at least equivalent to traditional
impression models. Compared to gypsum mod-
els created from a physical impression, digi-
tally created models had similar accuracy, except
for secondary anatomical areas such as grooves
and fossae where they performed less well than
traditional methods.8 In another study com-
paring design using digital versus convention-
al impression models, it was shown that the
crowns’ marginal fit was better (significantly
reduced vertical gap) with the digital impres-
sion.6 Similarly, the marginal gap of digitally
designed all-ceramic crowns for posterior teeth
was smaller than for crowns designed using
conventional silicone impressions.9
While it is possible to create digital den-
tal impressions via scanning casts made from
conventional models (indirect method), vir-
tual images obtained through direct intraoral
scanning has gained increasing interest.10,11
Several intraoral impression systems based on
different technologies are currently available
on the market (see table on next page).
Computer Assisted
Design/Computer Assisted
Manufacturing (CAD/CAM)
CAD/CAM systems are being used to
improve the design and manufacturing of den-
tal restorations. They consist of a data acquisi-
tion unit which converts data to a digital impres-
sion, virtual design software, and a milling
device to produce the restoration, using a vari-
ety of materials.11 Successful outcomes have
been demonstrated when CAD/CAM was
applied to implant dentistry, showing high suc-
cess rates (> 95%) for crowns, abutments, and
frameworks.12
Concomitant with the emergence of
improved materials for restorations, the spec-
Click here to continue to next page
 ORAL CARE REPORT
trum of CAD/CAM applications in dental prac-
tice is widening to support implant impressions
and crown and bridge restorations, in addition
to its traditional role in scanning and prosthe-
sis milling.8,13 The restorative material has evolved
to meet patients’ needs for improved durabili-
ty, safety, and esthetics.13 Currently available
CAD/CAM restorative material options include
esthetic ceramics, high-strength ceramics, and
composite materials for definitive and tempo-
rary restorations.14 Esthetic ceramics offer mod-
erate strength and ensure long-term retention
and durability of restorations. High-strength
ceramics (lithium-disilicate) offer higher flex-
ural strength. CAD/CAM technology facilitat-
ed the use of feldspathic glass ceramic, glass infil-
trated ceramic, and polycrystalline ceramics for
restorative purposes.15 Composite resin provides
high resistance to fracture and durability for
permanent and temporary restorations and for
bridge frameworks.13,14 Composite resin also
offers different shade and color options.
Use of newly synthesized ceramics
and composite materials in
CAD/CAM has improved
durability, safety, and esthetics.
Conclusion
Application of digital technologies to den-
tal practice is an evolving field, with other new
technologies in development. Although more
research is required to overcome the limita-
tions, computer-assisted techniques are expect-
ed to replace conventional methods of dental
restorative treatment.16 Widespread integra-
tion of these new technologies into dental prac-
tice would require appropriate training of den-
tal professionals. O C
References
1. Nickenig HJ, Eitner S, Rothamel D,
Wichmann M, Zoller JE. Possibilities and
limitations of implant placement by virtu-
al planning data and surgical guide tem-
plates. Int J Comput Dent 2012;15(1):9-21.
2. Stachulla G. Potential of 3D guided implan-
tology. Int J Comput Dent 2012;15(1):67-72.
3. Arisan V, Karabuda CZ, Mumcu E, Ozdemir
T. Implant positioning errors in freehand
and computer-aided placement methods:
a single-blind clinical comparative study.
Int J Oral Maxillofac Implants 2013;28(1):
190-204.
4. Arisan V, Bolukbasi N, Oksuz L. Computer-
assisted flapless implant placement reduces
the incidence of surgery-related bacteremia.
3
Clin Oral Investig 2013;17(9):1985-93.
5. Sicilia A, Botticelli D. Computer-guided
implant therapy and soft- and hard-tissue
aspects. The Third EAO Consensus
Conference 2012. Clin Oral Implants Res
2012;23(Suppl 6):157-61.
6. Ng J, Ruse D, Wyatt C. A comparison of the
marginal fit of crowns fabricated with dig-
ital and conventional methods. J Prosthet
Dent 2014;112(3):555-60.
7. Patzelt SB, Lamprinos C, Stampf S, Att W.
The time efficiency of intraoral scanners:
an in vitro comparative study. J Am Dent Assoc
2014;145(6):542-51.
8. Lee SJ, Betensky RA, Gianneschi GE,
Gallucci GO. Accuracy of digital versus con-
ventional implant impressions. Clin Oral
Implants Res 2015;26(6):715-9.
9. Pradies G, Zarauz C, Valverde A, Ferreiroa
A, Martinez-Rus F. Clinical evaluation com-
paring the fit of all-ceramic crowns obtained
from silicone and digital intraoral impres-
sions based on wavefront sampling tech-
nology. J Dent 2015;43(2):201-8.
10. Galhano GA, Pellizzer EP, Mazaro JV.
Optical impression systems for CAD-CAM
restorations. J Craniofac Surg 2012;23(6):
e575-9.
11. Ting-Shu S, Jian S. Intraoral digital impres-
sion technique: a review. J Prosthodont
2015;24(4):313-21.
12. Kapos T, Evans C. CAD/CAM technology
for implant abutments, crowns, and super-
structures. Int J Oral Maxillofac Implants
2014;29(Suppl):117-36.
13. Miyazaki T, Hotta Y. CAD/CAM systems
available for the fabrication of crown and
bridge restorations. Aust Dent J 2011;56
(Suppl 1):97-106.
14. Fasbinder DJ. Materials for chairside
CAD/CAM restorations. Compend Contin
Educ Dent 2010;31(9):702-9.
15. Li RW, Chow TW, Matinlinna JP. Ceramic
dental biomaterials and CAD/CAM tech-
nology: state of the art. J Prosthodont Res
2014;58(4):208-16.
16. Patel N. Contemporary dental CAD/CAM:
modern chairside/lab applications and the
future of computerized dentistry. Compend
Contin Educ Dent 2014;35(10):739-46.
4 ORAL CARE REPORT

Intraosseous Dental
Anesthesia
Safe and effective local anesthesia is a
vital component of dental care, controlling
and preventing both patient discomfort as well
as operator stress.1,2 However, there are cir-
cumstances under which conventional local
anesthetic approaches may be inadequate, as
is often the case following a conventional
mandibular nerve block.1,2 The thick cortical
bone of the mandible can limit diffusion of
the anesthetic, preventing adequate anesthe-
sia.1 The effectiveness of conventional local
anesthetics can also be impaired by soft tissue
inflammation.1 Reported failure rates for intra-
alveolar nerve blocks range from 44-81% in
patients with irreversible pulpitis, compared
to only a 15% failure rate of dental anesthesia
in other endodontic patients.1
Benefits and Place in Therapy
Intraosseous anesthesia (IA) techniques
have been developed to address some of the
limitations of conventional oral anesthesia
approaches. Intraosseous techniques allow
for the delivery of anesthetics directly into
the cancellous medullary bone surrounding
the tooth, either via high-pressure injection
through the periodontal ligament (the PDL
technique) or by mechanically puncturing
the cortical bone (intraosseous injection).2
Both of these methods allow for delivery of
the anesthetic around the tooth socket, anes-
thetizing the dental pulp.
In cases where conventional
mandibular or intra-alveolar
nerve blocks have failed,
intraosseous anesthesia techniques
represent a safe and effective
means of providing local
anesthetics to patients.
IN PRACTICE
Compared to conventional nerve block tech-
niques, less anesthetic can be used, and the
effects are more targeted as anesthesia begins
immediately and without affecting the sur-
rounding soft tissue.2-4 Since there is little or
no soft tissue anesthesia, IA also allows for bilat-
eral mandibular anesthesia, as the lip and
tongue are not anesthetized. In addition, IA
provides a benefit for pediatric patients, for
whom soft tissue injuries (i.e., self-biting due
to numbness) are a major side effect of con-
ventional nerve block techniques.5
Potential Concerns
Despite the advantages of IA, there are
potential risks and adverse effects. For instance,
patients with acute periapical infections or
severe periodontal disease may not be good
candidates for IA, as there is a risk of fistula
formation at the injection site. Also, clinicians
generally prefer to use a vasoconstrictor with
local anesthetics (i.e., both nerve block and
IA), since vasoconstrictors can improve the
quality and duration of anesthesia and can
reduce the minimum concentration of anes-
thetic needed for the block.3 However, due to
the rapid absorption associated with IA, vaso-
constrictors can also lead to an elevation in
heart rate. In one study where patients were
treated with lidocaine and epinephrine
(1:100,000), 67% of participants were report-
ed to have experienced a mean increase in
heart rate of 28 beats per minute.4 For healthy
individuals the risk is minimal, but for those
with moderate to severe cardiovascular disease
or patients treated with contraindicated med-
ications such as non-selective beta blockers and
tricyclic antidepressants, caution should be
exercised.2,4 Patients also report other adverse
effects, such as pain at the injection site, pres-
sure discomfort, and post-operative tender-
ness.2 While these adverse events may be more
likely to occur with IA, others associated with
conventional anesthesia, such as trismus and
post-anesthetic biting, may be avoided alto-
gether (table).4
Conclusions
IA techniques represent an important
means of providing anesthesia to patients for
whom a conventional local anesthetic may not
be effective, either due to the location of the
targeted tooth (e.g., mandible) or the level of
inflammation in the soft tissue surrounding the
tooth. While IA poses potential risks for certain
patient groups (e.g., patients with cardiovascu-
lar or severe periodontal disease), for other-
wise healthy patients, side effects are minimal
and, in fact, certain side effects associated with
conventional anesthesia may be avoided. O C
References
1. Idris M, Sakkir N, Naik KG, et al. Intraosseous
injection as an adjunct to conventional local
anesthetic techniques: A clinical study. J Conserv
Dent 2014;17(5):432-5.
2. Moore PA, Cuddy MA, Cooke MR, et al.
Periodontal ligament and intraosseous anes-
thetic injection techniques: alternatives to
mandibular nerve blocks. J Am Dent Assoc
2011;142(Suppl 3):13S-8.
3. Ozer S, Yaltirik M, Kirli I, et al. A comparative
evaluation of pain and anxiety levels in 2 dif-
ferent anesthesia techniques: locoregional anes-
thesia using conventional syringe versus
intraosseous anesthesia using a computer-con-
trolled system (Quicksleeper). Oral Surg Oral
Med Oral Pathol Oral Radiol 2012;114(5
Suppl):S132-9.
4. Peñarrocha-Oltra D, Ata-Ali J, Oltra-Moscardo
MJ, et al. Side effects and complications of
intraosseous anesthesia and conventional oral
anesthesia. Med Oral Patol Oral Cir Bucal
2012;17(3):e430-4.
5. Sixou JL, Barbosa-Rogier ME. Efficacy of
intraosseous injections of anesthetic in chil-
dren and adolescents. Oral Surg Oral Med Oral
Pathol Oral Radiol Endod 2008;106(2):173-8.

With IA, the duration of anesthetization

may vary between 30 to 60 minutes, depend-
ing on the amount of anesthetic administered
and whether or not the anesthetic has been
paired with a vasoconstrictor.1,2 Pulpal anes-
thesia has been found to have a duration of
15–30 minutes without a vasoconstrictor com-
pared to 60 minutes with vasoconstrictor.1,2
 ORAL CARE REPORT
PERIODONTAL PAGE
Are Periodontitis and
Rheumatoid Arthritis
Related?
R heumatoid arthritis (RA) and peri-
odontitis are both chronic inflammatory dis-
eases affecting joints and the oral cavity, respec-
tively. Both diseases are characterized by bone
destruction mediated by inflammatory
cytokines.1 Recent evidence suggested an asso-
ciation between periodontitis and RA, although
its nature has not been elucidated.
Citrullination of proteins (conversion of amino
acid arginine into citrulline) happens in both
diseases, and the existence of a latent asymp-
tomatic phase of RA detected by anti-citrulli-
nated peptide immunoreactivity has led to the
hypothesis that periodontitis could constitute
a “primary hit” prior to the secondary event
which is characterized by the manifestation of
symptomatic clinical arthritis.1,2 According to
this hypothesis, it may be possible that the treat-
ment of periodontitis could lead to improve-
ment of RA. Recent studies shed light on the
association between periodontitis and RA, tak-
ing into account specific bacterial species
involved in periodontitis and confounders such
as tobacco smoking, which is an established
risk factor for both periodontitis and RA.
Association between Periodontitis
and Rheumatoid Arthritis
In a recent case-control study, prevalence
of periodontitis was shown to be higher in sub-
jects with RA regardless of immunoreactivity
status with anticyclic citrullinated peptide
(CCP)-2 compared with control subjects with-
out RA.3 However, only positive anti-CCP-2 RA
was shown to be significantly associated with
periodontitis after adjusting for multiple vari-
ables.3 Higher RA activity, as assessed by 28-
joint Disease Activity Score and the C-reactive
protein level (DAS28-CRP) was observed in
patients with concomitant periodontitis and
RA compared to patients with RA alone.3 The
DAS28 includes the assessment of tenderness
and swelling in 28 joints most commonly affect-
ed in RA, complemented by measurement of
an important acute-phase reactant, CRP or the
erythrocyte sedimentation rate (ESR), and
patients’ global measure of health using a visu-
al analog scale.1 In another study of patients
with RA, there were no differences in DAS28-
ESR scores between patients with moderate
and severe periodontitis.4 Thus, recent evidence
points to an association between periodonti-
tis and RA, especially among patients that are
seropositive for anti-CCP-2.
Effect of Periodontal Treatment on
Rheumatoid Arthritis
In a meta-analysis including five studies
of patients with RA, non-surgical periodontal
treatment (i.e., oral hygiene instruction and
subgingival debridement) during regular vis-
its was associated with a reduction of RA activ-
ity as assessed by the ESR, a surrogate marker
for the presence of systemic inflammation.1
However, non-significant reductions were
observed for other markers of RA activity, i.e.,
DAS28 scores and tumor necrosis factor-alpha,
and no effect was reported specifically for CRP.1
Since the data reported did not specifically cap-
ture the asymptomatic CCP-2 immunoreac-
tive phase of the disease, these discrepancies
may be linked to the multifactorial nature of
symptomatic RA and its associated comorbidi-
ties, masking in some way the effect of peri-
odontal treatment on observable RA activity.
Use of disease-modifying anti-rheumatic drugs
by patients may contribute to the lack of effect
of periodontitis treatment on some RA activi-
ty parameters.1
Involvement of Tobacco Smoking and
Periodontitis in Rheumatoid Arthritis
It is worthwhile to assess the impact of
tobacco smoking, which is an established com-
mon risk factor for periodontal diseases and
RA development, on the association between
these two chronic diseases (see figure).2
Smoking can enhance the prevalence of spe-
cific periodontal pathogens such as
Porphyromonas gingivalis, which carries an
enzyme that citrullinates protein and has been
implicated in the association between peri-
odontitis and CCP-2 positive RA cases.2,3,5
However, the association between periodonti-
tis and anti-CCP-2 positive RA was reported to
be independent of cigarette smoking in a recent
study.3 Although smoking cessation can stop,
at least partially, the development of peri-
odontitis, much less is known about its effects
5
on the risk of RA. Additional studies are
required.
In addition to antirheumatic
pharmacotherapy, both smoking
cessation and periodontal
treatment have the potential to
reduce the severity of RA.
Recent studies have shed more light on
the association between periodontitis and RA,
independent of smoking status, and on the
effect of periodontal treatment on the pre-
vention of RA, and more specifically, of CCP-
2 positive RA.3 Thus, in addition to antirheumat-
ic pharmacotherapy, both smoking cessation
and periodontal treatment (including non-
surgical options) have the potential to reduce
the severity of RA. More evidence is required
to define these interrelationships. O C
References
1. Kaur S, Bright R, Proudman SM, Bartold PM. Does
periodontal treatment influence clinical and bio-
chemical measures for rheumatoid arthritis? A sys-
tematic review and meta-analysis. Semin Arthritis
Rheum 2014;44(2):113-22.
2. Scher JU, Bretz WA, Abramson SB. Periodontal dis-
ease and subgingival microbiota as contributors
for rheumatoid arthritis pathogenesis: modifiable
risk factors? Curr Opin Rheumatol 2014;26(4):424-9.
3. Mikuls TR, Payne JB, Yu F, Thiele GM,
Reynolds RJ, Cannon GW, et al. Periodontitis and
Porphyromonas gingivalis in patients with rheuma-
toid arthritis. Arthritis Rheumatol 2014;66(5):
1090-100.
4. Khantisopon N, Louthrenoo W, Kasitanon N,
Sivasomboon C, Wangkaew S, Sang-In S, et al.
Periodontal disease in Thai patients with rheuma-
toid arthritis. Int J Rheum Dis 2014;17(5):511-8.
5. Abdullah SN, Farmer EA, Spargo L, Logan R, Gully
N. Porphyromonas gingivalis peptidylarginine deim-
inase substrate specificity. Anaerobe 2013;23:102-8.
6 ORAL CARE REPORT
The Role of
Community
Pharmacists in Oral
Healthcare
C ommunity pharmacists play an impor-
tant role in primary healthcare. In the con-
text of oral health, pharmacists are well placed
to offer recommendations about oral hygiene
products, provide oral healthcare advice, and
inform patients of potential oral side effects
of medications. Pharmacists may also refer
patients to other healthcare professionals for
oral health complaints.1
Counseling Patients on Oral
Healthcare Issues
Pharmacists are often consulted for symp-
toms of oral and dental disease. In a question-
naire of 17 pharmacies in the United Kingdom,2
pharmacists reported the frequency of requests
and types of oral health advice sought by mem-
bers of the public. The majority of pharma-
cies (67.4%) reported more than 11 requests
for oral health advice per week. The most com-
mon requests were for information concern-
ing ulcers, toothaches, or pain relief (figure).
The least frequent advice sought was about
toothbrushes and tooth whitening systems
(figure). Similarly, a survey of 141 community
pharmacists in Riyadh, Saudi Arabia,3 found
that toothache and mouth ulcers were the most
common dental problems for which their
clients sought advice. These findings indicate
that pharmacists represent an important front-
line source of healthcare advice for patients
experiencing acute oral problems.
According to the UK study described
above,2 when advice for painful oral health
problems was requested, pharmacists coun-
selled their clients to consult a dentist in 94.1%
of cases, and to consult a physician in 23.5%
of cases. Pharmacists reported that they also
provided short-term pain relief in 100% of cases
and oral hygiene advice in 42% of cases.
In the UK study, most community phar-
macists stated that they were confident giving
oral healthcare advice.2 However, almost a third
(29%) said that they sometimes lacked confi-
dence. Recommendations for oral healthcare
products were most often based on personal
experience, but in certain cases they were based
on training courses the pharmacists had attend-
HYGIENE PAGE
ed.2 In surveys of professional pharmacists and
undergraduate pharmacy students, most
expressed a positive attitude toward dental care
and were keen to improve their knowledge of
oral health.2,4 Thus, most pharmacists look favor-
ably upon providing oral healthcare advice,
and oral healthcare education is likely to
improve their potential to address oral health-
related problems.1
Oral Hygiene and Medications
Pharmacists are ideally placed to inform
patients of potential oral health implications
of their current medications. For example,
many medications can cause dry mouth, a con-
dition associated with a higher risk of dental
caries.5 An investigation of the 72 most fre-
quently prescribed pharmaceutical products
in Canada in 2010 found that 61% can cause
dry mouth.6 Pharmacists can advise potential-
ly affected patients of the importance of oral
hygiene and dental visits. In addition, they can
act to promote oral health by providing infor-
mation regarding the range of products avail-
able for oral care.1,5
Community pharmacists are
ideally placed to inform patients of
the potential oral health effects of
their specific medicines.
Conclusions
Pharmacists represent an important source
of information on health matters for patients
and their caregivers. Recent studies indicate
that community pharmacists are commonly
consulted for information related to oral health.
Given this significant role, oral health-related
training is recommended for pharmacists.
Additionally, dental professionals can provide
information to pharmacists on the available
dental services in their communities, includ-
ing a list of key contacts in the vicinity. O
C
References
1. Cohen LA. Enhancing pharmacists’ role as oral
health advisors. J Am Pharm Assoc 2013;53(3):
316-21.
2. Maunder PE, Landes DP. An evaluation of the
role played by community pharmacies in oral
healthcare situated in a primary care trust in the
north of England. Br Dent J 2005;199(4):219-23,
discussion.
3. Bawazir OA. Knowledge and attitudes of phar-
macists regarding oral healthcare and oral
hygiene products in Riyadh, Saudi Arabia. J Int
Oral Health 2014;6(6):10-3.
4. Rajiah K, Ving CJ. An assessment of pharmacy stu-
dents’ knowledge, attitude, and practice toward
oral health: An exploratory study. J Int Soc Prev
Community Dent 2014;4(Suppl 1):S56-62.
5. Su N, Marek CL, Ching V, Grushka M. Caries
prevention for patients with dry mouth. J Can
Dent Assoc 2011;77:b85.
6. Nguyen CT, MacEntee MI, Mintzes B, Perry TL.
Information for physicians and pharmacists about
drugs that might cause dry mouth: a study of
monographs and published literature. Drugs
Aging 2014;31(1):55-65.
 ORAL CARE REPORT
HEALTHCARE TRENDS
Editor-in-Chief
Ira B. Lamster, DDS, MMSc
Professor of Health Policy &
Management,
Mailman School of Public Health
Dean Emeritus,
Columbia University College of
Dental Medicine
International Editorial Board
P. Mark Bartold, BDS, BScDent
(Hons), PhD, DDSc, FRACDS
(Perio); Australia
John J. Clarkson, BDS, PhD; Ireland
Kevin Roach, BSc, DDS, FACD;
Canada
Prof. Cassiano K. Rösing; Brazil
Mariano Sanz, DDS, MD; Spain
Ann Spolarich, RDH, PhD; USA
Xing Wang, MD, PhD; China
Rebecca S. Wilder, RDH, MS; USA
David T.W. Wong, DMD, DMSc; USA
© 2015 Colgate-Palmolive Company.
All rights reserved.
The Oral Care Report
(ISSN 1520-0167) is supported by
the Colgate-Palmolive Company for
oral care professionals. Medical
writing by LASER Analytica,
Montréal, QC (Canada).
Published by Professional Audience
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(USA).
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7
The Challenge of New Technology
in Dental Practice
T his issue of the Oral Care Report examines the emergence of new technology in dental practice. Technology
has the potential to dramatically improve the delivery of dental services. Imaging is moving beyond traditional
plain films to cone beam computed tomography, which offers a far more robust visualization of the oral anatomy.
When linked to implant placement, the increased precision will improve implant outcomes and avoid compli-
cations. Computer-assisted design/computer-assisted manufacturing (CAD/CAM) can improve efficiency and
patient satisfaction, eliminating a delay in completion of the restoration. CAD/CAM is linked to the use of an
optical scanner to obtain impressions of hard and soft tissues in the oral cavity, which traditionally was accomplished
with the use of intraoral trays loaded with an impression compound. Taking traditional impressions can be
difficult for patients and is subject to error. The optical scanner will capture an image and create a virtual
impression to allow the restoration to be fabricated.
The challenge with any new technology is the balance between the additional cost and advantages to the
patient and provider. In dentistry, perhaps the best example of this balance is the clinical application of laser
technology in dental practice. Examples include non-surgical treatment of periodontal disease 1 and caries
removal.2 The primary questions are around patient comfort, effectiveness of the procedures relative to the con-
ventional means of accomplishing the task, and cost of the technology, again relative to conventional treatment.
Further, the introduction of new technologies is occurring at a time when the profession is challenged to
find resources to meet the needs of so many individuals who do not have access to care. The utilization of resources
is a major focus of healthcare, especially for procedures considered to be elective. Availability often depends
upon one’s ability to pay directly for services. In the case when a procedure is not considered elective, there may
be different solutions to a particular clinical problem and technology will invariably increase cost. An interesting
paradox is that in most fields, new technology tends to reduce costs. The opposite is true in healthcare, where
new technology drives up the cost of care.3
New technology will also offer improved opportunities for collaboration among oral healthcare professionals,
and between healthcare professions. Two examples are telemedicine/teledentistry, and the availability of new
surveillance systems for emerging infections. Teledentistry is now being discussed more widely, primarily as a
means of improving access to care. 4 For example, dental hygienists can provide care at a remote site, with a tele-
dentistry link to a dentist at a different location. This technology could also be used to link dental and medical
offices. Further, new digital technology is available to identify microbial pathogens. With infectious diseases a
great concern in both the developing and developed world, new technologies can offer a means to identify
emerging threats. The focus of the use of this technology is now large gatherings, including religious pilgrimages
and national/international athletic events.5 This technology could also be employed at dental clinics, especially
those that see large numbers of patients (hospital dental services, dental schools, etc.). New opportunities and
synergies will emerge as new health technology is introduced.
The role of new technology in dentistry will continue to be broadly discussed. The introduction of new
technology will help establish new standards of care. The profession is challenged to develop algorithms that
allow this technology to be used for the greatest good for the largest number of patients. O C
References
1. Sanz I, Alonso B, Carasol M, Herrera D, Sanz M. Nonsurgical treatment of periodontitis. J Evid Based Dent Pract
2012;12(3 Suppl):76-86.
2. Jacobsen T, Norlund A, Englund GS, Tranaeus S. Application of laser technology for removal of caries: a systematic
review of controlled clinical trials. Acta Odontol Scand 2011;69(2):65-74.
3. Skinner JS. The costly paradox of health-care technology. On MIT Technology Review website [updated 2013 Jun
5; cited 2015 Jul 6]. Available from: http://www.technologyreview.com/news/518876/the-costly-paradox-of-health-
care-technology/.
4. Daniel SJ, Kumar S. Teledentistry: a key component in access to care. J Evid Based Dent Pract 2014;14(Suppl):201-8.
5. Nsoesie EO, Kluberg SA, Mekaru SR, Majumder MS, Khan K, Hay SI, et al. New digital technologies for the
surveillance of infectious diseases at mass gathering events. Clin Microbiol Infect 2015;21(2):134-40.