Interprofessional Collaboration in the Assessment and Management of Substance Use Risk.

Substance use disorder assessment strategies are increasingly being employed by dentistry, while adequate evaluation requires reaching out to other cotreating providers and collaborating on patient care. The field of dentistry has a range of barriers often not experienced in other professions, including limitations on e-record communication and clinical practice setting often isolated from the patient's general medical care. Barriers can be overcome if the dentist facilitates communication.

Massachusetts Dental Schools Respond to the Prescription Opioid Crisis: A Statewide Collaboration.

The prescription opioid crisis has involved all sectors of U.S. society, affecting every community, socioeconomic group, and age group. While federal and state agencies are actively working to deal with the epidemic, medical and dental providers have been tasked to increase their awareness of the issues and consider ways to safely prescribe opioids and, at the same time, effectively treat their patients' pain. The Commonwealth of Massachusetts, under the leadership of Governor Charles D. Baker and his administration, challenged the state's four medical schools and three dental schools to improve their curricula to prepare the next generation of clinicians to deal with this crisis in an evidence-based, effective, and sympathetic way. This Perspectives article outlines the national prescription opioid crisis, details its effects in Massachusetts, and describes the interdisciplinary collaboration among the Commonwealth, the three dental schools, the Massachusetts Dental Society, and a concerned student group. The article also describes the efforts each dental school is undertaking as well as an assessment of the challenges and limitations in implementing the initiative. The authors hope that the Massachusetts model will be a useful resource for dental schools in other states.

VDR deficiency affects alveolar bone and cementum apposition in mice.

OBJECTIVE: To compare the mineralisation density (MD), morphology and histology of alveolar bone and cementum amongst VDR +/+, VDR -/-, and VDR -/- groups supplemented with a diet TD 96348, containing 20% lactose, 2.0% calcium and 1.25% phosphorous. METHODS: Four groups of mice (6 mice/group) were identified by genotyping: VDR +/+ mice (VDR wild type), VDR -/- mice (VDR deficient), VDR -/- offsprings derived from VDR -/- parents receiving a supplemental diet (early rescued), and VDR -/- mice fed with a supplemental diet beginning at age one month (late rescued). All mice were sacrificed at age 70.5 days. Micro-CT was used to compare MD and morphology of alveolar bone and cementum. H-E and Toluidine blue staining was used to examine the ultrastructure of the alveolar bone and cementum at matched locations. RESULTS: In VDR -/- group, alveolar bone and cementum failed to mineralise normally. Early rescue increased MD of alveolar bone in VDR -/- mice with excessive alveolar bone formation, but which not observed in late rescue group. MD and morphology of cementum-dentine complex in both early and late rescue groups were comparable with VDR +/+ group when feeding with high-calcium rescue diet. CONCLUSIONS: VDR affects alveolar bone mineralisation and formation systemically and locally. However, cementum apposition and mineralisation is mainly regulated by calcium concentrations in serum.

Regulation of enamel and dentin mineralization by vitamin D receptor.

BACKGROUND: Vitamin D plays an important role in bone mineralization. Enamel and dentin are two mineralized tissues of different origins that are part of the tooth structure, but the mechanism by which vitamin D regulates the mineralization of these tissues remains unclear. We examined the mineral deposition pattern of enamel and dentin in continuously erupting incisors in a vitamin D receptor (VDR) deficient mouse model to determine the effect of vitamin D receptor pathway on enamel and dentin mineralization. METHODS: VDR wild-type mice (VDR+/+) and VDR-deficient (VDR--/--) littermates were sacrificed at 70.5 days of age, and their mandibles were dissected. Immunostaining of biglycan and decorin was used to evaluate the dentin maturation. Micro-computerized tomography (micro-CT) was used to compare the mineral density (MD) of enamel and dentin of the two groups at different regions along the axis of the mandibular incisors. Scanning electronic microscopy (SEM) was employed to examine the ultrastructure of enamel and dentin at the levels corresponding to those examined in the micro-CT studies. Furthermore, an accelerated eruption procedure was performed to exclude the effect of delayed eruption on enamel and dentin mineralization. RESULTS: Different mineral deposition patterns of enamel and dentin were observed at different levels of the incisors in the VDR+/+ and VDR--/-- groups. Early enamel maturation and mineralization, and dentin hypomineralization were observed in the VDR--/-- group. CONCLUSION: Vitamin D affects enamel and dentin mineralization through different mechanisms. It may affect the mineralization of dentin systemically while enamel mineralization may be regulated locally.

Normalisation of calcium status reverses the phenotype in dentin, but not in enamel of VDR-deficient mice.

OBJECTIVE: To determine the effects of vitamin D receptor (VDR) deficiency on mouse dentin and enamel mineralisation, and how normalisation of serum calcium level affects dentin and enamel phenotypes in VDR knockout mice. MATERIALS AND METHODS: Groups of VDR wild-type (VDR+/+), VDR deficient (VDR-/-) and VDR-/- rescued mice were sacrificed at 70.5 days of life. The rescued group was established by a high-calcium diet feeding the VDR-/- mice from postnatal 19 days. Micro-CT was used to compare enamel and dentin mineralisation density (MD) at different levels of mandibular incisors among the groups. The scanning electron microscope (SEM) was used to examine the ultrastructure of the enamel and dentin in the corresponding levels and of surface enamel after acidic treatment. RESULTS: Micro-CT showed that in VDR-/- rescued group, dentin phenotype was reversed and dentin MD was reversed to normal; however, enamel mineralisation was not reversible, and remained as hypermineralisation in molar region and apical region of the incisors. SEM also revealed enamel hypermineralisation in the VDR-/- rescued group. This early enamel hypermineralisation was more susceptible to acidic erosion. CONCLUSION: Vitamin D affects dentin mineralisation systemically, and it regulates enamel mineralisation locally.

Different enamel and dentin mineralization observed in VDR deficient mouse model.

UNLABELLED: Vitamin D plays an important role in the bone mineralization process. Enamel and dentin are two mineralized tissues of different origins that combine to form teeth, but the mechanism by which vitamin D regulates these tissues remains unclear. We hypothesized that vitamin D affects enamel and dentin mineralization through different mechanisms. OBJECTIVE: To examine enamel and dentin mineralization in a vitamin D receptor (VDR) deficient mouse model by micro-computerized tomography (micro-CT) and scanning electronic microscopy (SEM). METHODS: VDR wild type mice (VDR+/+) and VDR deficient (VDR-/-) littermates were sacrificed at 70.5 days old, and their mandibles were dissected. Micro-CT was used to compare mineral density (MD) of enamel and dentin of the two groups at different levels along the axis of mandibular incisors. SEM was employed to examine the ultrastructure of incisors at the levels corresponding to the levels used for the micro-CT studies. Furthermore, an accelerated eruption procedure was performed to exclude the effect of delayed eruption on enamel and dentin mineralization. RESULTS: Different distribution patterns of enamel and dentin MD were observed between VDR+/+ and VDR-/- groups. Early enamel maturation, mineralization, and hypomineralization in dentin were observed in the VDR deficient mice. CONCLUSION: Vitamin D may affect the mineralization of dentin systemically, and enamel mineralization may be regulated locally.

What the ADEA CCI series of articles means to me: reflections of a dental school dean.

In this reflection article, Dr. Huw F. Thomas, a U.S. dental school dean, identifies important messages and insights he gained from a series of twenty-one articles about the future of dental education published in the Journal of Dental Education from October 2005 to February 2009. This article addresses three questions: 1) What influence have these articles had on a dental school dean's perspectives about his role and priorities? 2) What important messages are contained within these articles for fellow deans? and 3) What messages do these articles send to dental education in general? The American Dental Education Association's Commission on Change and Innovation in Dental Education (ADEA CCI) was established to facilitate change and innovation in dental education. Through the ADEA CCI, ADEA brought together stakeholders in academic dentistry: dental schools, the American Dental Association (ADA) Board of Trustees, the Commission on Dental Accreditation (CODA), the ADA Council on Dental Education and Licensure (CDEL), the Joint Commission on National Dental Examinations (JCNDE), the dental licensure community, the ADA Foundation, and advanced dental education programs. The goal of the ADEA CCI is to provide a forum to build consensus within the dental community for innovative changes in the education of general dentists. As part of the consensus-building process, the ADEA CCI commissioned a series of articles, published in the Journal of Dental Education, to raise awareness and stimulate dialogue about issues and forces shaping the future of dental education and propose strategies to achieve desired enhancements. Collectively, this series of articles is known as the Perspectives and Reflections in Dental Education (PRIDE) series to acknowledge the commitment of the academic dental community to reflect on current practices and future directions and also to represent the pride of dental school faculty members in their educational responsibilities and accomplishments.

Comparison of demineralisation rates in pre- and postnatal enamel and at the neonatal line.

AIMS: The neonatal line, which is an exaggerated incremental layer line, separates pre- and postnatal enamel. It has been suggested that this layer may be a barrier to the progress of a carious lesions. The objective was to measure the rate of demineralisation in pre- and postnatal enamel and within the neonatal layer using scanning microradiography (SMR). Permanent enamel and compressed permeable hydroxyapatite samples were used as controls. METHODS AND RESULTS: Enamel specimens from deciduous incisors were cut into mesiodistal blocks of 2mm thickness without altering the labial surface and located within SMR cells. Permanent enamel and hydroxyapatite specimens were similarly prepared. Artificial caries-like lesions were created by exposing the specimens to 0.1 mol l(-1) acetic acid (pH 4.0) within the SMR cells. SMR was used to measure the rate of mineral loss at 10 points either side of and at the neonatal line in the deciduous enamel, and 20 points across in the control specimens. The rate of demineralisation was almost the same in pre- and postnatal enamel ((6.0-8.0) x 10(-4)gcm(-2)h(-1)), but much lower in the vicinity of the neonatal line (2.0 x 10(-4)gcm(-2)h(-1)). The rate of demineralisation was lower in permanent (5.0 x 10(-4)gcm(-2)h(-1)) than in deciduous enamel, and even lower in the permeable hydroxyapatite specimen (2.5 x 10(-4)gcm(-2)h(-1)). CONCLUSIONS: This study showed no difference in the rate of demineralisation between pre- and postnatal enamel, but a reduced rate within the region that contained the plane of the neonatal line. This supports the hypothesis that the neonatal line may act as a barrier to the propagation of carious lesions.

Vitamin D receptor deficiency affects dentin maturation in mice.

Mutation of vitamin D receptors (vdr) results in resistance to the vitamin's normal effects which may compromise dentin formation. The objective of this study was to investigate the effect of vdr deficiency on post-natal dentin maturation in mice. The dentin in mandibular incisors of 70.5-day-old vdr wild-type and vdr knockout mice was compared at different levels along the long axis. Expression of biglycan and decorin was detected by immunolocalisation. Scanning electron microscopy was used to observe the ultrastructure of the dentin, and micro-computerised tomography was used to determine the degree of dentin mineralisation density. In the vdr knockout mice, the pulp chamber was larger and the dentin wall was thinner compared with the wild-type mice. In addition, the pre-dentin layer was thickened with an irregular front line and diffuse expression of biglycan and decorin. Fewer tubules, lower mineralisation density and pore-like defects were observed in the dentin at the eruptive region and level with the first molar. In conclusion, vdr deficiency compromises dentin maturation.