S2 EP8: The Science Shaping Dentistry’s Future

In this episode of Dental Sound Bites, we get an inside look at cutting-edge dental testing and inventions from the ADA Science and Research Institute (ADASRI).

ADA Dental Sound Bites - Dr. Mia Geisinger - The Science Shaping Dentistry’s Future

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Episode notes

The Science Shaping Dentistry’s Future

Where do you go for answers when you have a tough clinical question? We’re getting an inside look at cutting-edge testing, new recommendations and inventions from the ADA Science and Research Institute (ADASRI) that will change the way you practice.

Plus, we’ll hear the answers to the questions dentists ask the ADA’s science team most frequently – about pregnancy, antibiotics, teledentistry and more. We’ll also talk about how you – yes, you! – can join in on the work they’re doing, from the comfort of your own home, by participating in ACE Panels.

Special Guest: Dr. Mia Geisinger

Featured Guest: Dr. Scott Howell

“One of the best things, one of the most unsung things that the ADASRI and all of the scientists at the ADA do, are work on standards that are global standards, that establish what the federal government requires, and what the global community requires, for dental materials.”

-Dr. Mia Geisinger

Dr. Mia Geisinger
Dr. Mia Geisinger

Show Notes

  • Special guest, Dr. Mia Geisenger, shares insights into the work of the ADA Science and Research Institute and addresses frequently asked questions from dentists.
  • Dr. Geisinger is a professor and the Director of Advanced Education and Periodontology at the University of Alabama at Birmingham, UAB, and Vice President of the American Academy of Periodontology. She focuses on clinical research applications in the periodontology field on preventative care and periodontal and systemic interactions. Dr. Geisinger is also a board member of  ADASRI.
  • One of the most frequently asked science questions is about how to properly care for a pregnant patient, when it comes to x-rays and procedures. Dr. Geisinger shares the proper protocol and what all dentists should know.
  • Dr. Ioannidou talks about the paradigm shift in clinical trials for pregnant women.
  • Dr. Geinsinger tells dentists "Don't be afraid of treating pregnant patients. View it as an opportunity, a teaching opportunity, and an opportunity to make a difference, not just for that patient, but for their entire family."
  • Another one of our most frequently asked clinical questions is about receiving antibiotic prophylaxis. Who should receive it and when? Dr. Geisinger shares what dentists should be doing in their practices.
  • Dr. Effie and Geisinger share their take on the future of providing patient precision care.
  • Dr. Wright asks about the ADA Seal of Acceptance and who can get a seal on their product. Dr. Geisinger says, "It protects our patients that they can feel confident that we are using materials and, and we are adhering to recommendations that are not only not gonna be harmful to them but that they are gonna see a benefit from."
  • Dr. Scott Howel, Associate Professor and the Director of Public Health Dentistry and Teledentistry at A.T. Still University, Arizona School of Dentistry and Oral Health, shares the uses, capabilities, and benefits of teledentistry and its place in the future of dentistry.
  • We learn about science surveys through the ADA Clinical Evaluators, the ACE panel, which is a group of licensed ADA member dentists that volunteer to share their perspectives on existing and emerging dental topics, treatments, and different products. Dr. Geisinger shares how dentists can sign up to join upcoming ACE Panels, and its benefits.
  • What’s ADASRI working on next? take a listen and learn about the most up-to-date work.

Resources

 

View episode transcript

Transcript

Wright: [00:00:00] Ever wonder how our dental tools work? And who are the people making recommendations for how we practice? Hey. Hey, I'm Dr. ArNell Wright.

Ioannidou: [00:00:07] And I'm Dr. Effie Ioannidou. And today we are taking an inside look at how the work at the ADA Science Research Institute, makes dentist lives better and easier. Plus, we are getting answers to the questions dentists ask the ADA science team most frequently.

Announcer: [00:00:27] From the American Dental Association, this is Dental Sound Bites. Created for dentists by dentists. Ready? Let's dive right in to real talk on dentistry's daily wins and sticky situations.

Wright: [00:00:43] I'll admit it. I really love science. I'm always trying to learn a little bit more about how things work and how the work being done in the ADA Science Research Institute, or ADASRI as it's sometimes called.

Ioannidou: [00:00:55] Yes. Being in academia and being a researcher, I have been awfully curious in my life. 

Today we get answers to the questions that the ADA science team gets asked most frequently. We will talk about dentistry's next frontier, and find out how you, yes you, can join in on the work ADASRI is doing, from the comfort of your own home.

Wright: [00:01:18] Well, let's go. I wanna welcome our guest, Dr. Mia Geisinger. Hi, Dr. Geisinger.

Geisinger: [00:01:23] Hello, hello! It is. So good to be here with y'all.

Ioannidou: [00:01:28] Hello, hello!

Wright: [00:01:29] Yes, you say y'all. I love it already. That's that UAB,  right?

Geisinger: [00:01:34] Yes, ma'am.

Wright: [00:01:34] Tell us a little bit about yourself, the work that you do. Tell all of our listeners just who Dr. Geisinger is.

Geisinger: [00:01:41] I am a professor and the Director of Advanced Education in Periodontology at the University of Alabama at Birmingham, UAB, Go Blazers! I am a clinician scientist here. Most of my work focuses on downstream clinical research applications and in the periodontology field really focusing on preventative care and periodontal and systemic interaction. Ooh, fancy. And I've been involved with ADASRI or the ADA Science and Research Institute as a board member for the past two years.

And prior to that I was the chair of the ADA's Council on Scientific Affairs.

Ioannidou: [00:02:22] And this is where we worked together actually. Mia was one of the people that recruited me to become a member at the Council for Scientific Affairs. So it was great.

Wright: [00:02:3 Yes. Recruitment. Ok. I see it. I like it.

Ioannidou: [00:02:36] But of course we know each other forever. Yeah. More than this.

Geisinger: [00:02:40] Perio is a small world, so if you're a lady in Perio who likes lipstick, we probably know you.

Ioannidou: [00:02:46] That's right.

Wright: [00:02:47] Listen, y'all both have the lipstick popping today. We all have our glasses on. Look, I think that I can, I can join the team you got just put on a little bit. Got it. Lipstick, you know.

Ioannidou: [00:02:58] Mia is a powerhouse in periodontology. She has a leadership position also at the American Academy of Periodontology. Speak about this too.

Geisinger: [00:03:06] Oh, I'm currently the Vice President of the American Academy of Periodontology, and so we have a, a chair system there, so in a few years I'll be the the president and it's really an honor to be involved with that organization. I've served on the board of trustees. I've been the president of the AAP Foundation, and I really enjoy working with my fellow periodontist and my fellow dentist, and especially love talking nerdy. So, let's do it, girls. Yes. Yes.

Wright: [00:03:35] Let's do it. Oh, I love it. Ok. See, this is about to be a fun episode already. Look, let's jump in. Why don't we?

Ioannidou: [00:03:42] The staff at the ADASRI and our membership call center serve the top two most asked science questions that they get from dentists. So pregnancy. First question, dentist call in is about how to properly care for a pregnant patient, when it comes to x-ray, when it comes to procedures. So, Mia, what's the proper protocol and what should we be aware of when we are treating pregnant patients?

Geisinger: [00:04:07] The biggest thing is that dentistry is safe and effective during pregnancy. Number one. And it is necessary, maybe even more necessary during pregnancy than it is for the rest of our patients, which we know is critical for them as well.

So the American College of Obstetrics and Gynecology actually recommends that for women who are pregnant or who are planning to become pregnant in the next six months, that if they haven't seen their dentist in six months, they should get a dental visit and establishing dental health during pregnancy is critically important, because there are things that can affect the dental health that go on during pregnancy.

Nausea and vomiting, increase in carbohydrate intake can alter the oral microbiome, the oral pH, and cause an increase in erosion and or dental caries. And we know that gingival diseases, particularly periodontitis, may have an impact on adverse pregnancy outcomes, in particular, low birth weight. So it's critically important for both mom and baby that our pregnant patients are seen in the dental office.

And you know, this really has been a paradigm shift since I've been in dentistry since last century.

Ioannidou: [00:05:21] indeed. Literally, literally.

Geisinger: [00:05:26] Where, you know, we used to say when a patient came in and told us that they were pregnant, we would say, okay, well we'll see you in nine months. Good luck. And we would avoid everything but the most emergent care.

But now we know that delivering preventative care and ongoing care for issues that come up during pregnancy is critically important. Obviously with radiographs, we have to think about the ALARA principle for all of our patients. Particularly for pregnant patients, and there are some alterations to those protocols which may involve using additional lead, trying to minimize the number of X-rays.

But the truth of the matter is if we need a radiograph to see what we need to do, whether that is a root canal, an extraction, or other treatment, we need to get that radiograph so that we can best treat the patient. Because what we don't wanna do is neglect dental care and have a smaller problem, become a bigger problem during the pregnancy.

Ioannidou: [00:06:21] So well said Mia, because there has been a paradigm shift. Whenever I'm invited to talk about sex and gender in biomedical sciences, I always give a little bit of historical perspective, and I think this is very relevant here. I think the culture of protectionism after the second World War, the fact that all women were excluded from clinical trials, hence there were no enough studies on pregnant women, affected dentistry directly.

That's why this stop of “nine months, hey, hold everything. We don't, we, it's the unknown, right? We cannot touch a pregnant woman”. So I think this is really important, this paradigm shift. I think it's really critical and really to the benefit of the oral health and systemic health of pregnant women.

Geisinger: [00:07:03] And Effie, you and I both know that sex steroid hormones can modify gingival diseases, right?

And for a long time we talked about pregnancy gingivitis or pyogenic granulomas as being sort of a natural outcome of pregnancy. Yes. But what we now know is, while it may take more meticulous oral hygiene, those conditions can be prevented with preventative care and good daily home care. And that's another reason why pregnancy is a great time to get treatment in dentistry.

And the last reason I would say, and I always use myself as an example of. You know, when I was pregnant, I gave up wine. And if you know me, you know that I would never do that on my own. Right? But for baby, I was willing to, you know, put down my glass of wine for a year. And, you know, moms will do things for baby that they're not willing to do themselves, but if they do them over a nine month period, it becomes a habit.

And so we know that maternal increases in dental IQ, maternal increases in understanding about the importance of oral hygiene and visiting the dentist also has an impact on early childhood caries rates in their offspring. So it's really a great time to educate our patients, to set a role, a model in the household who understands dentistry and is gonna be a dental advocate for the family and to make those changes and to establish habits. 

So I say to dentists, don't be afraid to treat pregnant patients. View it as an opportunity, a teaching opportunity, and an opportunity to make a difference, not just for that patient, but for their entire family.

Ioannidou: [00:08:50] So well said.

Wright: [00:08:51] Oh, that was so good.

Another one of our most frequently asked clinical questions is about receiving antibiotic prophylaxis. Who should receive it and when? So, can you talk a little bit about what we should be aware of, what our listeners should, should be doing in their practices? tell us, tell us about that.

Geisinger: [00:09:08] Yeah, so this is another thing that has drastically changed over, the last two decades. You know, now since the 2014 recommendation from our orthopedic colleagues and dental colleagues together. For most instances of total joint replacement, we don't recommend antibiotic prophylaxis. Further, there's really a very small subset of individuals for whom we would recommend antibiotic prophylaxis in a cardiovascular setting.

No more mitral valve prolapse. Every patient gets polls with antibiotics. It's really patients who have. Severe valvular disease or a past history of infective endocarditis, who would be the most likely to need antibiotic prophylaxis, and those guidelines were actually just updated in 2021. So I encourage everyone to go to the ADA website and look up the updates for their practice because what we don't wanna do is over utilize some of these antibiotics.

In addition for penicillin allergic patients, we've switched away from clindamycin to azithromycin for prophylaxis. And so I think all of that is really critical for all of us to know because we do want to be cognizant of these things and we're learning more about microbiome, not just oral microbiome, but gut microbiome and how it can be affected by some of the antibiotics that we use, and we want to promote overall wellness as well as oral wellness.

Wright: [00:10:44] That was a great explanation and guideline for our practitioners. We have our own questions that we're gonna ask. I'm gonna let Dr. Effie go first.

Ioannidou: [00:10:52] Sure. Following what we just discussed about pregnant women and antibiotic prophylaxis. I would like to ask Mia, how close do you think we are in really, really providing precision care? like really tailored to the needs of the patient sitting in front of you.

Geisinger: [00:11:10] Yeah, so we talk a lot about this, right? We talk a lot about patient-centered care and precision care. I think that we are at a point now where we can deliver patient-centered care. I think we are getting there. With precision medicine and precision care, but it probably takes some more clinical investigations that include outliers.

So, you know, one of the things that is always a little bit challenging for me as a clinician and as a scientist, is many of the things that we base our decision making on are systematic reviews and meta-analyses. And when you look across the board, those things all regress to the mean, right? But for me, what's a lot more interesting is the outliers.

Why do these people behave like this? And these people behave like this, right? What is different and special about those people? That they really respond to a certain treatment modality or that they have a negative response or don't respond at all? And I think that. Figuring those things out is gonna be critical to us being able to deliver precision care, and we can take antibiotics in periodontal treatment as an example.

So in periodontal treatment, particularly for more aggressive forms of periodontitis, what we would now call stage three or four, grade C molar incisor pattern periodontitis, that usually shows up in younger age groups, progresses rapidly. We have shown that utilizing antibiotics during non-surgical therapy can improve outcomes.

We have also shown that in the broader case of periodontitis on the whole, there is a marginal or, or maybe slightly more than marginal, just statistically significant difference. If we use antibiotics with non-surgical periodontal therapy. But the truth of the matter is when you look at that spectrum of people, you see that some people really respond very well and some people don't at all.

And I know that this is an interest of yours, Effie, to look at how do we drill down on why some people respond and some people don't. And I think that that is something that we will see much more clearly, certainly within our practice lifetimes, but I would say within the next five to ten years, we'll have a lot more information about how to deliver that care precisely.

And part of our ability to do that is really more inclusivity when we think about the subjects that we're looking at, across the age range, across the gender spectrum, across, racial and ethnic backgrounds. But also across, you know, disease severity and genotypes and history. And so I think that all of those things together are gonna be pieces of a puzzle that we can put together for our individual patients.

And I am also hopeful that artificial intelligence will be able to help us click those boxes and say, okay, if our patient looks like this and they have this phenotype and this genotype, here are some strategies that may be most effective for those patients.

Ioannidou: [00:14:35] You're absolutely right. In the past we used to run completely sterile trials of non-diabetic, non-smokers, no women, because God forbid you have hormonal fluctuations, right? This will mess up your trial.  This is true story, ArNelle, before your time. So you exclude all these people and then you have clean with very, very low variability trial. And then you take the results of this trial and you generalize them to the whole population.

Geisinger: [00:15:05] Yeah. Another example in periodontology was the I-O one genotype, and you know, those studies were done in a male, Northern European population. And when we tried to repeat the outcomes in like, let's say an Asian population didn't work, cuz the incidence of that particular genotype was so low that it didn't have the same influence as it did in other populations. So, I think we're getting there. I think we have the right idea, the outliers are where it's interesting. Nobody wants to be average. That means that you're boring. Right. The outliers are what's interesting.

Wright: [00:15:42] Sure. Speaking of outliers, Is it Malcolm Gladwell? The book Outliers.. There we go. That's right. There we go. Right through there. Outliers are interesting. Well, okay. Can I ask you a question now?

Ioannidou: [00:15:55] Yes.

Wright: [00:15:55] Yeah. Okay, good, good, good, please. So, all right, I'm gonna put a little spin on it. So, on TikTok right now what's trending these days is things that get the ADA Seal of Acceptance. Like you can go viral if you know the ADA seal is there. So can you talk to us about how the Seal of Acceptance happened? Can any size company attempt to achieve it? Like what's the big thing with the ADA Seal?

Geisinger: [00:16:21] This is a great question, Dr. Wright, because, for my first three years on the Council on Scientific Affairs, I was on the Seal Subcommittee and I chaired it for two. And, it's really an interesting process. And I think before I was, So intimately involved in the process, I had no idea what went into it. So there is an application process for the individual categories that we have the seal for, and companies apply for approval. Each of the categories has a monograph that says, okay, for this particular category, you're gonna need, I'll use, gingivitis and dentifrice as an example.

So, toothpaste that you're gonna say treats, gingivitis, right? So you have to have clinical studies that are at least three months long. You need at least two studies. And then those data are reviewed by content experts within the ADA and content expert volunteers to make sure that the studies are valid. And then those can be used to support your claim of gingivitis on a toothpaste. 

For other categories like let's say a manual toothbrush, there are also tests that are done by the company and submitted to the ADA, but also tests that are done at the ADA laboratories themselves. So we test bristle hardness, we test abrasiveness, we test, pull out strength to make sure it's not a choking hazard.

So your ADA, staff scientists are working hard to make sure that if something has the ADA Seal that as a dentist, or a dental healthcare provider, you can really feel confident in recommending that for your patient. The ADA Seal is not something that says one product that, that has the seal is superior to another product that has the seal, but they all meet a standard.

Now the companies may have additional data that they may wanna use in marketing claims, but we are really looking at, do they meet the standard to be able to say, this is a product that, that we in dentistry, can stand behind. And there's a lot that goes on behind the scenes. 

Even as far as if they change a flavoring in the product, it needs a secondary application to make sure that there's not something that's unsafe within the product. And the staff and volunteers at the ADA continually go through, look at product categories, revise the application process, the requirements for each category, and also can add categories.

So when I was on the Seal subcommittee, we added some categories for tobacco cessation, and we added some categories, or some additional bullets. So if you have a toothpaste or a mouth rinse and you wanna claim it works for halitosis, that bullet underneath the ADA Seal tells you what the ADA Seal is for.

Wright: [00:19:38] I just wanna say, like you said, one word that I love, which is standard, like in some of my council meetings that I recently went to, like this word was just all around and I just got super duper excited and I just want all of our listeners to know that like standards are being met, upheld, achieved.

Like it's all about the standards. So I just love that word. And you can say a few comments on it if you want.

Geisinger: [00:20:00] And one of the best things, one of the most unsung things that the ADASRI and all of the scientists at the ADA do, are work on standards that are  global standard, that establish what the federal government requires, and what the global community requires for dental materials.

Like all of the zirconium that you're gonna use in your practice, is it gonna crush, you know, after so many rounds of bite force, or does it meet a standard? And I think that's really important because that protects us as healthcare providers and it protects our patients. Most importantly, it protects our patients that they can feel confident that we are using materials and, and we are adhering to recommendations that are not only not gonna be harmful to them, but that they are gonna see a benefit from.

Wright: [00:20:56] There we go.

Ioannidou: [00:20:58] I also want to point out on top of what Mia just mentioned is that all those standards and principles are evolving based on new evidence, based on critical approach that the ADA scientists have. So it's not like something written in stone in a sense that if science evolves, standards evolve with it.

I mean, I sat on the Seal Approval Committee and there is no doubt that there is a lot of critical approach to those applications and to the actual standards. As you said, Mia, we add, we adapt, we evolve.

Geisinger: [00:21:35] I think that's very, very good to point out. This is not, we do it once in 1965 and we never, we put it in the drawer and never look at it again. We have to keep moving forward as science moves forward.

Wright: [00:21:48] Mm-hmm.

Ioannidou: [00:21:49] That's right.

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Wright: [00:22:24] We all know that new scientific developments can help us take our patient treatment to the next level, and Teledentistry is in the spotlight.

Dr. Scott Howell is gonna dive into teledentistry and the place that it has in the future of dentistry.

Howell: [00:22:38] Hi, I'm Scott Howell. I'm an associate professor and the director of public health Dentistry and tele at Dentistry at A.T. Still University, Arizona School of Dentistry and Oral Health. Teledentistry is a great way for us to connect with our patients over short or long distances.

While it is an emerging technology, it has actually been around since the late 1980s when the US military started using it, but because so many more people are getting familiar with it now as a result of COVID, we need to better understand all of its uses, its capabilities and how it benefits our clinics, our offices, our providers, and our patients.

Since the COVID-19 pandemic, a lot more providers in oral health started learning about teledentistry, but because of this boom, there was a bit of a misconception that it was only needed during COVID, with so many cases of it being used prior to and now continuing after, what we know is that there are numerous ways we can use technology to connect with our patients.

What we need to do now is get the word out there, so every dentist, every hygienist, dental assistant, dental therapist, anyone that might want to use teledentistry, knows its full capability. With COVID, as I mentioned, some of the concerns are that, oh, this is just a fad. But, did you know that there are new technologies coming out in the last few years that allow you to monitor your patient's home care and all they have to do is put a small little device on their toothbrush?

And when they pick up their toothbrush, it'll start tracking their home care. This is an amazing opportunity for us to monitor our patients, to see how they're doing when they're brushing, so that when they come and see us, we can actually tailor our advice and our oral hygiene instructions to meet the patient's needs.

Not every patient is brushing two minutes, but we know, they tell us they do. However, with these technologies, we can really get a sense of what our patients are doing and how we can help them be better caretakers of their own oral health. What's really neat about Teledentistry is the benefits that come with it.

Having worked with it over the last eight years at the Arizona School of Dentistry and Oral Health, I've been able to see various ways that our patients have benefited from teledentistry. One way that I really didn't expect is that those living close to the clinic really appreciated meeting over video conference with their providers.

This was a situation where the patient had difficulty getting outta the house. They were maybe taking care of a loved one, or they were taking care of children that day, but they just needed a quick five minute post-op visit just to check in and see how they were doing. By meeting with their provider on camera, they told them how grateful they were that they didn't have to drive, so that they didn't lose that time with their family.

There was a really cool project in Brazil that used telehealth technologies to connect general dentists and general physicians with oral medicine specialists. Prior to using technology to connect the different providers, patients would sometimes have to wait up to a year to get in to see the specialist, but by using the technology, the general dentist, the general physicians connecting with the oral medicine doctors, were able to converse and talk about what does the patient need.

Do they really need to see the specialist? And by using the technology, the patient's wait time went down from a year to one month, just by using technology to connect the providers. So sometimes we use technology not to connect just our patients and us, but also provider to provider. 

Teledentistry allows us to work on teams. Teams that allow the team members to work at the top of their scope. A lot of people think that Teledentistry is just meeting on camera with your patient, but the thing is, so many examples of it are working with teams where a hygienist, as an example, might be in a clinical site or a community site, and the dentist is in the clinical office, the dental office.

This allows them to work together so the hygienist can screen patients, take intraoral photos, take the necessary radiographs, and forward those asynchronously to the dentist. Alternatively, the dentist and the hygienist could be meeting on camera live or synchronously, and the hygienist could be moving the camera around the patient's mouth so the dentist can get a really good view of what's going on.

At our dental clinic, at the Arizona School of Dentistry and Oral Health, we've used this form of teledentistry to reach out and to connect with kids in juvenile detention centers. Due to numerous situations that result in very difficult access to care for these kids by sending a hygienist out, I can screen those kids and know exactly what kind of treatment they need before they come over to the dental school for their dental treatment.

This saves time, it saves money, and it allows us to get some very needed care to some very important patients so that they don't continue to have pain or infection. One thing I want everyone to remember about Teledentistry and how we use it is that it's so important that the patient knows who their provider is.

There are situations where someone, a patient might be talking to someone over video or over phone, or they're sending their information into an office, but they never actually know who the dentist is. If the patient either A, can't easily connect with the dentist, or B doesn't know who the dentist is, it's not teledentistry. 

There's so many ways we can use the technology, but it's really important that we continue to meet standards of care. And those standards of care are probably gonna change a little bit as we learn how technology can help our patients. But again, the patient has to know who their dentist is, and they have to know how to contact them and be able to talk to them if it's necessary.

Wright: [00:28:17] Nice. I thought it was really good to see how teledentistry has evolved and the fact that it's been around for so long. I will admit, I did not know that it's been around for as long as it has been. It kind of surprised me a lot, and I did have some questions about just how you know, like liability wise, the part where he discussed not knowing who the provider was. That was like the first thing that was on my list. So what about you all?

Geisinger: [00:28:48] I really liked his take on the opportunity to use it as a tool for screening and public health. In my research, in my practice, one of the things that we've been working on is using asynchronous teledentistry and intraoral cameras. In the evaluation and coaching of medical providers to deliver oral care to individuals who are in a residential nursing home setting. 

So shocking numbers of individuals with dementia in residential nursing homes do not get daily oral hygiene. In fact, over 90% of nursing assistants say that they either do not perform or truncate oral hygiene in patients with dementia in those settings.

But here's the thing, if you give a patient with dementia a toothbrush to hold before you deliver their oral hygiene, their care resistant behavior goes down by about 50%

Wright: just by holding the toothbrush. 

Geisinger: Just by holding the toothbrush because it triggers like a memory for them. If you stand them up in front of the mirror, instead of standing over them in bed. Wow. and like coming at them with something that looks like a stick. So there are ways to coach people to be able to deliver that type of care in a way that reduces care resistant behavior. And because of that, using teledentistry can be really, really helpful when having a dental practice in a nursing home, or having a dental hygienist or, or a, a dentist going in and doing oral hygiene care for those patients is not feasible. So I think that the public health aspect of some of these technologies is really exciting. I don't think, and maybe I'm wrong, maybe I'm wrong, but I don't think that it will replace the one-on-one connection and the in-person access with patients.

But I do think that there are mechanisms that really are available to help us with patients. You know, when he talked about the sensors to allow us to determine how patients are delivering oral hygiene. That's something that we use in research. Right now there are toothbrushes that allow us to see not only how long patients brushed, but where did they brush?

Was it only the buccal surfaces? For me, that information as a dentist is really critical and you know, we know that patients. May not be intending to mislead us, but they may be poor historians or they may really believe they brush for two minutes, but actually they brush for 52 seconds.

Ioannidou: [00:31:42] You mean 52 seconds or five seconds?

Geisinger: [00:31:48] But you know that hard data can really help us coach patients up to get them to be. Better co-practitioners with us, and realistically, that makes our restorative and prosthodontic work better. It makes my job as a periodontist better. So anytime we can use technology to be able to help our patients like that, I think, I think it's great.

I do think there are still some questions about it. I think that the dental practice acts in quite a few states are based upon potentially older technology, and we need to revisit based upon newer information. We also need better science to say, here are the limitations and here are the strengths of these technologies.

Wright: [00:32:38] Yeah. Yeah.

Ioannidou: [00:32:39] Mia, given that this study was a survey through the ADA Clinical Evaluators, the ACE panel, which is a group of dentists that volunteer to share their perspectives on existing and emerging dental topics, treatments, and different products. Tell us a little bit about this panel. Who can join? How does this work and where can people sign up?

Geisinger: [00:33:00] The ACE panels are panels that anyone who is a licensed dentist and an ADA member can sign up to join. And I think we're gonna put the link in the show notes, right?

Wright: [00:33:13] Yes.

Geisinger: [00:33:13] Perfect. So if you're interested, go to the link in the show notes and sign up.

Ioannidou: [00:33:17] Yes.

Geisinger: [00:33:18] And it does involve a little bit of your time. The ADA and ADASRI are very interested in how our member dentists are using technology, are using techniques and materials in their practices. And so on a quarterly basis, you may have seen it in your JADA. There is usually some very cool infographics in there that talk about the report and how dentists responded.

And it gives you a lot of insight into where dentistry is on a particular topic at the moment. So I know that there have been ones in the past on tobacco cessation. On vaccine administration, on methods for light-curing composites. And I think all of these give us a lot of information about where the community standard is, but also potentially where it's going.

And I encourage everyone if they're interested, to consider becoming a member of the ACE panel and let your voice be heard. If you feel like you want to be a part of science, and you're in your practice, you're not in an ivory tower in a university like Dr. Effie and myself, it's a great way to be a part of pushing the science of dentistry forward just from sharing what you are doing in your practice every day.

Ioannidou: [00:34:43] I can tell you for sure it's an ivory tower. Definitely. But, so the, the, the link is ada.org/ace, A.C.E.

Wright: [00:34:52] Perfect. Perfect. Well, Dr. Geisinger, before we wrap up, I do wanna ask, what is ADASRI working on next? If you can share a few things with us.

Geisinger: [00:35:02] One of the things that we see with ADASRI is that we really have three individual umbrellas of the science that we're working on. So we have ESTER, which is really the translational portion. They're the group that works on some of our clinical practice guidelines, best practices, and also some of the larger projects that take the data that are already out there and collate it, so that it becomes digestible for the clinician in his or her practice.

And I think that those are some of the most downloaded papers and information that we have. They also are in charge of the oral health topics and working on those with some of the volunteers to make sure that those things, like the questions about pregnancy or antibiotic prophylaxis are the most up to date on the ADA website.

Yeah. In the ADA labs in Chicago we have work that's going on on dental materials, on standards like we talked about before, but also some of the work about the biofilm models and in particular biofilm models as they relate to peri-implantitis. Which is, you know, a really difficult and intransigent condition that we're seeing. 

And I read a wonderful systematic review not too, too long ago that was titled “The Breaking Wave Of Periimplantitis”, you know, it's a tsunami that's coming at us, and I think the fact that the ADA is trying to get ahead of that for us in dentistry and our patients is really, really critically important.

And then we have other scientists and clinicians. That are working on some of this precision medicine that we talked about, the cell atlas , and some of the work that they're doing in combination with NIST at the NIH, to really think about how do we make sure that the biology of the oral and craniofacial region is best understood so that we can work towards a more precision and personalized medicine base. 

And you know, that's gonna include things like scaffolds and delivery of, you know, signaling molecules at the right time in the right doses, you know, but we have to have the basic biology first. And understand that first before we can think about, okay, how do we regrow a tooth and a test tube?

How do we regenerate pulp inside a tooth that has had irreversible pulpitis? How do we predictably regenerate a periodontal defect all the way up to the top, not 70% like I can do right now, right? So, you know, all of these things are dependent, not just on whatever materials we're gonna put in there.

So, But also on the patient's biology and harnessing that biology for the best outcomes for our patients.

Wright: [00:38:18] This was so good. Oh my gosh.

Announcer: [00:38:20] On the next Dental Sound Bites.

Ioannidou: [00:38:22] We get to ask a lot of questions on this show, but now the tables have turned and we are the ones in the hot seat.

Wright: [00:38:29] In our last episode of season two, we are answering listener questions about ourselves, the show dentistry, the ADA, and more.

Wright: This was so good. Well, we wanna thank you so much for coming on the show, for spending some time with us, sharing all of your knowledge and so much fun.

Geisinger: [00:38:49] It was fun.

Wright: [00:38:50] Yay. I'm glad.

Ioannidou: [00:38:51] It was great. Thank you. So

Wright: [00:38:54] it's like a little reunion. I can tell y'all have been reunited over there.

Geisinger: [00:38:57] Well, so, so Dr. Wright, here's the thing though. That just means that we're not as good of friends yet. Oh. So we'll see each other at SmileCon and then the next time it'll be a reunion for all three of us.

Ioannidou: [00:39:13] That's right. That's right. I love it.

Wright: [00:39:15] So, so I, we, we do have to wrap up the show because we wanna be respectful of your time. But I will say, if I can have a point of personal privilege, I already asked my producers.I went and got my lipstick, Just briefly I did. So I wanna make sure once we wrap the show, I wanna, you know, take a picture so we can be cute with our lipstick and our glasses.

Geisinger: [00:39:35] Well, you know that one of my favorite hashtags is #scientistswithlipstick. Well, we'll use it. I know. Use it. One of our favorite periodontist, who is the chair of perio at Harvard, started a hashtag called Scientists with Lipstick just to talk about what does a scientist look like. And sometimes. You know, she's got her lipstick on.

Wright: [00:39:57] I love it.

Ioannidou: [00:39:58] Mia, thank you so much for being here. This was a great show. We had a great dialogue. I really, really enjoyed it. Thank you.

Geisinger: [00:40:04] Thank you so much for having me. I love talking to you both and I always appreciate the ADA's investment in science and all of our dental colleagues' interest in science, so it's awesome.

Wright: [00:40:16] Aw, thank you so much. If you like this episode, go ahead and share it with a friend or a colleague. Then subscribe to this podcast wherever you are listening so you can get the latest episodes.

Ioannidou: [00:40:26] You can also rate and write a review and follow us on social media.

Wright: [00:40:30] And don't forget the conversation continues on the ADA member app. This episode's bonus content: learning about 3D printing in dental offices.

Announcer: [00:40:42] Thank you for joining us. Dental Sound Bites is an American Dental Association podcast. You can also find this show resources and more on the ADA member app and online at ada.org/podcast.