THE D3 GROUP ISSUE #13 MARCH 2020 D3G DISPATCH News about Developmental Dental Defects (D3s), The D3 Group, and the Chalky Teeth Campaign. COMMENT FROM THE CUSP: Going viral Commiserations to everyone disrupted by the pandemic crisis, and hallelujah to science and technology for providing humanity an unprecedentedly strong path to recovery. Just 3 weeks ago, a colleague praised D3G's recent progress as "going viral"– not knowing the next day we'd be in the midst of a COVID-19 scare that has consumed life down under since. With D3G now affected by the bad connotation of improvement") emerge, usually directed at authors "going viral", this first issue of 2020 relays a mixture of and/or reviewing. It seems appropriate that D3G use ups, downs and uncertainties – unfortunately the April CE it's clinico-scientific strengths to improve both ends event in Toronto has been postponed and the October of the system and that this will be a great topic for Symposium remains on track but uncertainly so. On the our upcoming symposium. bright side we share some wonderful examples of "D3 Take care, and do the world a favour by communicating love", provide further reasons to "think beyond MIH" the importance of science! and to communicate translationally, and dip a cautious toe into the murky waters of research publication quality. Unsurprisingly the latter is frequently discussed amongst D3-Mike | Mike Hubbard D3ers and diverse grumbles (aka "opportunities for D3G Founder-Director NEWS: Feel the D3 love :-) Given growing tensions with COVID-19, we're thrilled the first 3 months of 2020 delivered a wonderful triad of "feel the D3 love" moments that'll surely help us through this challenge and beyond. In an amazing D3-world-first, thePacific Smiles Group (PSG) ran a fundraiser at their annual practitioner conference (aptly dubbed "Inspire") and produced a stunning $10,000 donation for D3G!! Could this be any timelier given the financial strain D3G will face this year (like everyone else)? Spurring the giving, an artist wowed all by producing 3 artworks for auction – each within the 3 minutes taken to play a song of its famous subject. PSG is a pace-setting dental service organisation with over 90 practices across eastern Australia, all of which have Sam's Storybook to hand. This emergent educational collaboration is unique for the sector and traces back to a GC Australasia function where D3-Mike met D3er Caroline Townsend, a PSG regional leader with first-hand concerns about Molar Hypomin. Mutual admiration has since grown around several shared values including the spectacular "family spirit" evident at the conference. A special thanks to PSG practitioners and exhibiting companies for their generosity, and to PSG leadership (including D3ers Alison Hughes and Melissa Dorn, and pivots Walter Reid, Alex Abrahams and Phil McKenzie) for their ongoing "love of D3G". We hope others will feel inspired to follow your lead! continued on pg 2 > D3G DISPATCH ISSUE #13 PG1 > continued from pg 1 Second, D3G endorsers NZDOHTA kindly invited Teeth” that not only addresses top-down management D3-Mike to present at a CE event for community oral but also uses clinical data to improve policy. We thank health practitioners held in Christchurch. As outlined NZDOHTA president Arish Naresh for this initiative and recently (Dispatch 10-12), dental & oral health therapists generous support (donation plus Sam sponsorship), and manage the D3 frontline of New Zealand's school dental Kim Heslop for local organisation. service, backed in Christchurch by the nation's first Third, long-term D3 supporters ANZSPD again shouted "Hypomin Clinic". A popular Q&A session contributed D3G a table at their conference held this year in Hobart – by clinic manager & D3er, Tule Misa, helped make the capital of Australia's spectacular island state, Tasmania. this an engaging experience where was learned heaps D3-Mike valued exchanging ideas with existing and new by presenters and audience alike! Pleasingly, Sam's D3ers, particularly about the Toronto symposium and allied Storybook was provided to all attendees plus every developments. A COVID-19 scare at the conference other community dental practitioner in the Canterbury venue provided an unexpected sequel but fortunately & regions. Discussions with West Coast Martin Lee it transpired that all attendees were spared. Our thanks (regional clinical director and prized D3 recruit) bolstered to ANZSPD president Sue Taji and the organisers who the idea of a national plan for "Kiwi Kids with Chalky managed the event and viral bombshell with aplomb. WEB UPDATES: ""1-in-5 kids have MH" In a long-awaited development that bolsters our "think beyond MIH" philosophy (see Dispatch 12), we're now saying "1-in-5 kids have chalky molars" instead of "1-in-6 kids have Molar Hypomin" (e.g. here and here). Referring to hypomineralised "6-year molars", the original "1-in-6" tagline was introduced in 2013 to launch 1-in-5 D3G's website and Chalky Teeth Campaign (media release). Translationally, this public health message was "cutting edge" because it reduced prevalence data schoolchildren (then averaging 15.9% across 42 studies) and a complex HAVE clinical concept (Molar-Incisor Hypomineralisation) into CHALKY TEETH simple terms with scientific advantage. Recent introduction enabled inclusion of "2 year molars" alongside 6-year of "chalky molars" as a conversational bridge from molars, the "1-in-5 kids" claim is now well-justified – "chalky teeth" added further traction – scientists and recognising an offset for those who have both their 2-year practitioners alike can now talk logically about "chalky and 6-year molars affected, and an increment for those enamel" for example. And as increased prevalence data with hypomin 12-year molars. ROAD TO TORONTO: Great progress despite bump! Oh the irony of having "attacking key questions" as postponed? We're starting to think perhaps not realising our symposium theme – now we're being (self-) attacked some "global projects" under consideration could benefit with an array of unexpected questions, many of which from longer pre-incubation. Conversely, given widespread you'll certainly share. Foremost, will the event go ahead excitement about this event, it's clear the sooner it gets in October as planned? – we simply don't know at this underway the better. Please let us know your thoughts stage but work continues on the presumption it will. and concerns, and we'll strive to keep you informed of Realistically however, October may be too soon for some ours (contact Ben and/or Mike). still rebuilding their post-crisis lives – yet for others it might Meanwhile, from the "great news department", we're be the brain-stirring jolt of fresh air needed for return to pleased to report two fabulous keynote speakers are normal. Can the event still be organised in time given locked in (both are translational scientists working in current turmoil, and will depressed economics curtail healthcare) and a growing variety of organisations the sponsorship needed to swing this paradigm-shifting engaged including IAPD, NIDCR, NCATS, Forsyth event? And actually, would the event suffer by being Institute, ASO and NZAO. The symposium design continued on pg 3 > D3G DISPATCH ISSUE #13 PG2 > continued from pg 2 is shaping up nicely around the idea of a “cross-sector experience for all (not just the organisers!). Despite conversation about better management and prevention the new uncertainties, it remains likely this event will of chalky teeth”. We’ll keep updating the symposium be oversubscribed as numbers will be capped for quality's webpage as plans evolve (e.g. see new concept chart), sake. Consequently, pre-bookings will be opened for D3G hoping to make “the road to Toronto" a learning members (only) soon. ROLE MODEL: UK's genetic testing for AI In our past 3 issues (Dispatch 10-12) we've outlined how pioneering innovations within New Zealand's public health system – i.e. management plans, clinics and virtual orthodontic consultations for kids with Molar Hypomin (MH) – are spurring thoughts of a nationalised healthcare strategy for D3s. Besides MH, such a "D3 track" should include the genetic disorder amelogenesis imperfecta (AI) which, although quite rare, is often hugely troublesome for affected families and dentists alike. Asking how AI might best be managed within today's genomics revolution, a pioneer can be found in the UK's NHS which has made genetic testing for AI available since 2016. Their test covers 21 "AI genes" (i.e. involved in AI and downstream liabilities including general anaesthesia. allied syndromes) and can be "free" subject to referral Alan Mighell, an oral medicine specialist and D3G friend by a specialist paedodontist with informed consent from at University of Leeds, continues to play a central role the affected family. The genetic test is valuable because, in developing the service not least through his ongoing although AI often can be diagnosed from the extreme discovery of AI genes. Alan says the response has been disruption to all teeth, this isn't always so. A definitive highly positive despite some tests being negative due diagnosis can also reassure families at risk of psychological to undiscovered genes. With his focus now shifting from harm (guilt/blame) and help dentists to intervene early engaging the profession towards improving translation and optimise their management. Scientific understanding to patient care (e.g. via clinical management networks and researchers are other beneficiaries, particularly given & public education), he agrees there's exciting potential evidence that some types of AI may become preventable for cross-leveraging between AI, MH and other D3s as before long. The test's cost (≈US$1,000) is offset by the proposed for NZ. For more information, see here and potential for better clinical care and to ameliorate major here or contact Alan.