Marketing Manager at Eschmann, David Gibson, considers dentistry in space.

 Have you ever wondered what astronauts do if they experience dental complications while in space? Well, in shorter missions it would usually be the case that the individual waits for their return to Earth before receiving appropriate dental treatment. But in long-term or exploration class missions, dental emergencies that require urgent attention can be treated in-flight, believe it or not. Granted, it may not be a common occurrence, but we know from a NASA publication that it has happened at least once; Dr John Hatcher reported in 2011 that an astronaut’s crown displacement was temporarily repaired by another crewmember without any complications.[i]

It’s because of situations like the one that took place in 2011 that all crewmembers of any NASA mission receive pre-flight medical training, and why two astronauts of each expedition crew undergo additional training to become Crew Medical Officers (CMO). According to the NASA Medical Checklist,[ii]there’s also a range of equipment and tools available to be able to deal with crown replacement, total avulsion, exposed pulp, tooth extraction and toothache, and to place a temporary filling.

As it stands, dental emergencies aren’t too much of a concern for space agencies, but as the duration of missions continues to lengthen and humans’ time in space continues to increase, it is quite possible that dental risks could rise significantly. This, in turn, could result in the need for more treatments to be carried out in-flight. As such, any future explorations – including any potential visits to Mars and deep space – will need to consider the potential dental risks within preparations and how dentistry could be delivered safely and effectively.  

In particular, NASA and other agencies will need to give thought to the infection control risks associated with carrying out dental treatment in-flight. As well as the usual risk of cross-infection due to inadequate decontamination, astronauts would be faced with additional infection prevention and control hazards as a result of gravity, environment and physiological changes.

The first of which is that an astronaut’s immune system is compromised during space flight. As it is thought that a range of opportunistic pathogens such as bacteria, fungi and viruses that rely on reduced immune function to cause serious infectious diseases can be present in the spacecraft/space station, crew are at serious risk of contamination.[iii]

This is made worse by the fact that bacteria have been shown to demonstrate enhanced growth patterns in microgravity alongside an increased virulence.[iv]^,[v]Plus, because microgravity affects the aerobiology of the aerosols that are created from a cough, sneeze or during talking, particles remain airborne in space until they are either swallowed, removed by an air filtration system or come into contact with an absorbable surface. The presence of these aerosols therefore affects the risk of person-to-person transmission and would present a huge problem during the provision of any dental treatment in-flight.

Naturally, there are a number of infection control measures already in place by NASA to minimise cross-contamination during space flight. For instance, we know that germicidal wipes are used to clean high-touch, inanimate objects and disposable gloves and gowns are worn for all contact with potentially infectious materials.[vi]

However, there is no evidence available to indicate how dental equipment would be processed after use, so it remains unclear what – if any – specific infection prevention and control measures are in place for the delivery of dental treatment. Though it is almost guaranteed that whatever protocols are in place are far removed from those implemented within the dental practice, particularly as the use of a washer disinfector and autoclave would be an impossible task.

The question is then if dentistry in space becomes a common occurrence in the future during longer missions, how will space agencies prevent cross-contamination and ensure infection control compliance is achieved? Ultimately only time will tell for us to find out, but one thing is for sure, and that is that agencies will need to give lengthy consideration to infection control moving forward.

Meanwhile, back on Earth, dentists need to ensure that the utmost care is taken with decontamination when treating astronauts – the select few that treat expedition crews anyway! Infection control is critical to eliminate the spread of dangerous pathogens in any dental environment, be it in a dental practice on Earth or on a shuttle or space station.

For more information on the highly effective and affordable range of decontamination equipment and products from EschmannDirect, please visit www.eschmann.co.uk or call 01903 753322

[i]NASA [Dental Emergencies]. 2012. Review of Spaceflight Dental Emergencies. Anil Menon, The University of Texas Medical Branch, NASA Johnson Space Center Bioastronautics Contract, NASA/TM-2012-217368. Accessed online April 2018 at https://humanresearchroadmap.nasa.gov/gaps/closureDocumentation/2-Menon-A_TM-2012-217368.pdf?rnd=0.255094678259964

[ii]NASA [Medical Checklist] 2001. International Space Station Integrated Medical Group (IMG) Medical Checklist, ISS – All Expeditions. Mission Operations Directorate, 12 November 2001, NASA, Lyndon B. Johnson

Space Center, Houston, Texas, JSC-48522-E4. Accessed online April 2018 at https://www.nasa.gov/centers/johnson/pdf/163533main_ISS_Med_CL.pdf

[iii]Taylor PW. Impact of space flight on bacterial virulence and antibiotic susceptibility. Infect Drug Resist. 2015; 8: 249-262. Accessed online April 2018 at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4524529/

[iv]Mauclaire L, Egli M. Effect of simulated microgravity on growth and production of exopolymeric substances of Micrococcus luteus space and earth isolates, FEMS Immunol Med Microbiol, 2010; 59: 350- 6. Accessed online April 2018 at https://www.ncbi.nlm.nih.gov/pubmed/20482631

[v]Wilson JW, Ott C, Hönerzu Bentrup K, et al. Spaceflight alters bacterial gene expression and virulence and reveals a role for global regulator Hfq, Proc Natl Acad Sci. 2007; 104 (41):16299-304. Accessed online April 2018 at https://www.ncbi.nlm.nih.gov/pubmed/17901201

[vi]Mermel LA. Infection Prevention and Control During Prolonged Human Space Travel. Clinical Infectious Diseases. 2013; 56 (1): 123-130. Accessed online April 2018 at https://academic.oup.com/cid/article/56/1/123/419033

It’s not something that will have crossed the mind of many people, but when you look at the sort of activities that take place at the gym it’s surprising how risky some of them are.

The problem is that the majority of people think mouth guards should only be used during contact sports and other high impact scenarios, but the truth remains that a number of activities at the gym could be putting people’s teeth in danger. This is something that professionals should bear in mind when discussing the lifestyle habits of patients who visit the gym regularly.

A fitness revolution

Regardless of whether it’s down to societal pressures to look good or a growing interest in personal health, the fact remains that gym membership among UK residents is higher than ever. Recent reports indicate that as many as 1 in 7 people are now members of a gym, and this equates to 9.7 million of us who are now heading to gyms on a regular basis.[i]One news story even stated that gym membership rose by a shocking 44% between 2014 and 2015 alone,[ii]indicating how fast interest in the gym is growing.

Whilst this is good news for personal health, it does also mean that more people could be putting themselves at risk of dental injury.

What are the risks for people who go to the gym?

Of course, the risk factors for people attending the gym will greatly vary depending on which equipment and activities they regularly use. Those who predominantly stick to running machines or the swimming pool are unlikely to be at a risk high enough to entail the need for dental protection, however other gym activities carry risks that are worth detailing to patients to ensure they are aware of the damage they may cause.

The main risk to the dentition of people to visit the gym is weight lifting. Research has found that it is common for those lifting heavy weights to clench their jaws[iii]and this could be causing a number of negative effects on their teeth.

Effectively a form of awake bruxism, constant clenching and grinding of the jaw during exercise can lead to serious dental injury. The force exerted during clenching can chip and fracture teeth over time or wear them down, leading to the need for restorative work that can be expensive for the patient.

Furthermore, this constant force can cause even more catastrophic results. Robert Herbst, a power-lifting champion from the US, even detailed during an interview how his right molar “exploded” under the extreme pressure he was exerting on it during weight lifting, consequently requiring him to undergo dental implant surgery.[iv]

Many gyms in the UK are also leisure centres and have courts and fields attached where members can play sports such as football, squash and other activities that may present risks of dental trauma. Squash, in particular, is a sport where dental injury can easily occur. Due to the high velocity of gameplay, close contact and use of racquets, injuries to the maxillofacial area are surprisingly common and one survey found that out of 650 squash-playing participants, 20.4% of them had witnessed a dental injury occurring during gameplay.[v]Most worryingly, this study revealed that although such a high proportion had seen dental trauma first-hand, only one person wore a mouth guard when playing.

Protect them with a mouth guard

As with many sporting activities, the best way to protect your patients from harm is to prescribe a mouth guard.

Saber Protect mouth guards from CosTech Dental Laboratory are a particularly good choice as they are custom-fabricated to provide a comfortable fit for patients. They also have different levels of shock absorbency tailored towards the sport or activity the patient partakes in, offering an extra level of protection against impacts and jaw clenching.

Make them aware

A mouth guard may not be necessary for all patients who visit the gym, but prevention is always better than treatment. By making them aware that certain activities at the gym could put them at risk, you’re giving them the option to protect themselves and prevent the need for future treatment should an accident occur.

For more information about CosTech Dental Laboratory, please visit www.costech.co.ukor call 01474 320076

[i]The 2017 State of the UK Fitness Report 2017. Leisure DB. Link: http://www.leisuredb.com/blog/2017/5/5/2017-state-of-the-uk-fitness-industry-report-out-now[Last Accessed June 18].

[ii]The Guardian. UK Gym Membership Spending up by 44%. Link: https://www.theguardian.com/lifeandstyle/2015/aug/18/uk-gym-membership-spending-up-by-44-per-cent[Last accessed June 18].

[iii]Huang, D., Chou, S., Chen, Y., Chiou, W. Frowning and Jaw Clenching Muscle Activity Reflects the Perception of Effort During Incremental Workload Cycling. J Sports Sci Med. 2014; 13(4): 921–928.

[iv]The Independent. Could the Gym be Ruining Your Teeth?

[v]Persic, R., Pohl, Y., Filippi, A. Dental Squash Injuries – A Survey Among Players and Coaches in Switzerland, Germany and France. Dent Traumatol. 2006; 22(5): 231-6.

Occlusion is one of the most controversial subjects in dentistry. As practitioners will know, a “bad bite” is one of the leading causes of tooth loss and can be as detrimental to a patient’s teeth as dental caries and periodontal disease.

Until recently, dental schools have spent very little time teaching occlusal concepts, leaving a huge gap in practitioners’ knowledge of this important subject. Outside of university, many sources of occlusal education teach the topic in a manner that can confuse learners and these approaches often make the process of treating occlusion appear far more complicated than it should be. That is why experts such as Dr John Kois have dedicated a lot of their time to educating dental professionals on the current challenges of occlusion.

After receiving his DMD (Doctor of Dental Medicine) degree from the School of Dental Medicine at the University of Pennsylvania, Dr Kois was awarded the Certificate in Periodontal Prosthodontics with an MSD (Master of Science in Dentistry) degree from the School of Dentistry at the University of Washington. He currently maintains private practices limited to prosthodontics in Tacoma and Seattle. As the Past President of both the American Academy of Restorative Dentistry and American Academy of Esthetic Dentistry, Dr Kois is also the founder and director of the Kois Centre – a didactic clinical teaching programme.

Featuring a curriculum that is taught almost exclusively by Dr Kois himself, the Centre is the only continuing education programme in America that conducts and publishes independent research. Through evidence-based dentistry, Dr Kois is committed to “Enabling motivated dentists to achieve extraordinary levels, expanding knowledge and application skills in restorative dentistry”. Since its inception in 1995, the Kois Centre has grown to become one of the world’s most prestigious dental institutions.

As ever, Dr Kois remains passionate about teaching and helping practitioners both within and outside of the Kois Centre. For the first time in several years, he will be joining many other leading experts at the British Academy of Cosmetic Dentistry (BACD) Annual Conference 2018, where he will provide his professional insight as he presents a lecture entitled, “Functional Occlusion: Current Challenges”.

“Occlusion and occlusal function has always proved to be a difficult topic within the dental profession,” says Dr Kois. “This is because we, as practitioners, have learned how to avoid problems by ensuring single unit crowns ‘do not touch too much’, which is a risk management solution that works. However, this is not a concept that works occlusally in more involved cases, because the requirement is that teeth need to touch ‘just right’. In reality, this is actually more difficult to achieve.”

Dr Kois believes that understanding the role occlusion plays is important for the long-term success of restorative dentistry. He says: “Our knowledge about occlusion has been based on gnathologic principles. These concepts are the basis of a mechanical system with focus on posterior determinants and mutual protection. If it is that simple, why can’t we predict when or why occlusal pathology develops and why can’t we always create a therapeutic occlusion?”

In order to answer these questions, Dr Kois’ lecture at the BACD Annual Conference will focus on biologic principles necessary for developing a functional occlusion. He will present new paradigms to inform delegates’ understanding of occlusal dysfunction. Practitioners will be armed with the knowledge to predict more successful restorative results and will be able to recognise when complex treatment is not necessary.

“I will teach delegates five functional diagnoses that help establish functional risk and prognosis,” Dr Kois explains. “By the end of the session, delegates should also have a comprehensive knowledge of the factors that contribute to tooth wear. My lecture will build a concept of occlusion, based on available science, which will close the gap between ‘laboratory generated occlusion’ and ‘operatory required therapeutic occlusion’.

“If delegates take one thing away, I hope that it is the importance of pathway versus guidance. Delegates will not go back to practice on Monday morning as the same dentist.” 

Dr Kois will be one of many internationally-renowned dental professionals at the BACD Annual Conference. He adds: “As an organisation, the BACD has great vision and equally brilliant members supporting that vision. The Academy is always trying to help practitioners improve the delivery of oral health care, and I’m delighted to be part of its 2018 Annual Conference.”

This three-day event will offer the chance for delegates to take part in various lectures and hands-on workshops. Delegates will also have the opportunity to explore the latest equipment and materials at an exclusive trade show. To make sure you don’t miss out, visit the BACD website today to book your ticket!

The BACD Fifteenth Annual Conference 2018

‘The Functional Smile: Start With Why…’

8^th– 10^thNovember 2018

Millennium Gloucester Hotel

Kensington, London

For further enquiries about the British Academy of Cosmetic Dentistry, visit www.bacd.com

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