Dentists and Prosthodontics Annual Meeting June 27-28, 2016 New Orleans, USA

James L Ratcliff is the Chairman of the Board and CEO of Rowpar Pharmaceuticals, Inc., Scottsdale, AZ, maker of the Dentists Choice and ClōSYS brands of oral care products. In 2014, Rowpar received the US Small Business Administration’s Exporter of the Year Award. From 1989 to 2000, he served as a Senior Research, Scientist, Professor and Director, Center for the Study of Higher Education at the Pennsylvania State University. From 1979 to 1989, he was professor and program head for higher education at Iowa State University. He is the author of 120 articles, books, book chapters, is co-inventor on over 24 patents. He is an active member of the Arizona Biotechnology Assn., American Academy of Oral and Systemic Health, American Education Research Assn., and the International Association for Dental Research. He holds a PhD degree in Higher Education from Washington State University, a MA degree in History from Washington State University, and a BA degree from Utah State University.

There is a chicken and egg question in oral health: Which is the cause of oral disease, the inflammatory response of the host (us) to the insult (invading pathogens, chemicals and treatments), or the pathogens, chemicals and treatments themselves? We know that different people have different inflammatory responses to the same pathogens and chemicals, and we know that systemic diseases, such as adult diabetes, may heighten the inflammatory response to insult. In this presentation, we consider the insult and inflammatory response of certain disease conditions: osteonecrosis of the jaw (BRONJ), lichen planus, and mucositis related to head and neck cancer radiation treatment. So, is it the host’s inflammatory response that is a trigger to disease? And is it the host’s inability to contain microbial overgrowth in the oral microbiome that is a trigger to disease? In short, have we met the enemy, and is it us? Proper home oral care and regular professional visits can overcome our own inability to fully resist disease. Requirements for effective home oral care are reviewed in light of emerging research on sources on insult and inflammatory response.

John D Petkanas has completed his graduation from NewYork University College of Dentistry in 1992 with full academic honours, and then completed his hospital training with clinical affiliates of the Albert Einstein College of Medicine, as Housestaff Chair. He entered private practice in New York City immediately upon completion, and has been practicing in New Jersey since 1998. He has been in clinical practice for over 20 years, and is a Diplomate to both the American Academy of Pain Management and the American Board of Forensic Dentistry. He is a Fellow of the American Academy of Craniofacial Pain, and the American College of Forensic Examiners. His fellowship examination has also been certified by the International College of Craniomandibular Orthopaedics.

Victims of motor vehicle accidents frequently develop cranio mandibular/cranio-cervical dysfunction secondary to their trauma. This should hardly be surprising, as we have reviewed the relevant anatomy and biomechanics involved. Seldom, however, do clinicians such as ER staffers, EMS and first-responders adequately evaluate the temporo-mandibular apparatus for any signs of dysfunction in the immediate post-trauma setting of CAD, unless dislocation is present or fracture suspected. This is not unexpected, as their rightful primary concern is that the patient, our patient, is not going to expire. They are more emergently concerned with cardiovascular stability, integrity of the central nervous system and airway patency. These functions, after all, are primary, central, and essential for life. Neck pains, jaw clicks and low-back strains are secondary, or even tertiary concerns in a trauma setting. This is particularly unfortunate for us because functionally the temporo-mandibular joint, cervical spine and interdental articulations are intimately related, and frequently, problems with these structures may not manifest until sometime has lapsed, status post-MVA. Any alteration in one component must affect the others. Insufficient or delayed diagnosis can allow a long-standing TMD to develop and fulminate into advanced, degenerative temporo-mandibular arthrosis, with devastating results. In light of the above, effective clinical management of all patients suffering cervical hyperextension/hyperflexion injury should include evaluation and treatment of TMJ and masticatory systems function. Clearly then, prompt, aggressive assessment and management of CAD and related craniofacial and temporo-mandibular injuries is vital in order to minimize the effects of said trauma, and to restore the patient to normalcy. To do otherwise is at best negligent and at worst incompetent, as the ramifications can be severe.