Gap ExMC 4.11: Limited dental care capabilities (Closed)
Last Published:  07/30/21 01:05:31 PM (Central)
Responsible Element: Exploration Medical Capability (ExMC)
Status: Closed
Closure Rationale
Gap Closure Synopsis
Dental care for spaceflight faces challenges of limited crew training, medical resources, evidence-based guidelines and extensive mission duration.  There have been two incidences of US pre- and postflight pulpitis and three Russian in-flight dental events--one of which had no reported contingency plan.  These events underscore the need for enhancing preventive, diagnostic, and treatment methods for the dental conditions on the Exploration Medical Conditions List (EMCL).  A review of Skylab’s oral health data, as well as standard terrestrial treatment of dental conditions reviewed at the 2012 Dental Working Group meeting, provided an operational concept and requirements for an exploration medical system.  The recommendations for this system include methods and technologies that currently exist and no areas for technology development were identified to be able to treat the dental conditions on the EMCL.  Evidence from the working group and the recommended dental technologies for the exploration medical system has been documented in the white paper “Review of Spaceflight Dental Emergencies” (Menon, 2012) and in the “Dental Working Group Meeting Summary Report” (Menon et al., 2012), which provide sufficient closure to this gap and are summarized below.


Current ISS mission requirements involve routine preflight exams, but only address expected dental health issues over a one-year timeframe.  In-flight screening is not performed but can be instituted through periodic hygiene and examination requirements.  The inclusion of portable dentistry equipment as is used for remote military and civilian patients can be used to prevent dental pathology.  Additionally, use of resin sealants, fluoride toothpaste and Xylitol gum all have potential benefit in preventing dental caries.


Current preflight dental diagnostic methods are similar to private practice.  Digital radiography continues to be the standard of care for detection of dental caries; handheld radiography may be implemented in future spaceflight.  In addition, other diagnostic technology such as Alternating Current Impedance Spectroscopy (ACIST), Quantitative Light Induced Fluorescence (QLF), Laser Fluorescence (LF), Frequency Domain Photothermal Radiometry (FD-PTR), Modulated Luminescence (LUM) and Cone Beam CT (CBCT) can detect tooth decay and other dental pathology using various modes of energy. Such technologies would likely be implemented on the ground to reduce in-flight incidence of disease. 


Current dental treatment aims at symptomatic treatment and filling caries.  Topical and systemic analgesics can be used until underlying pathology is definitively treated.  Infiltrating resins and glass isomer restorations can both attenuate early caries, though the latter is weak and the former does not promote remineralization.  Transition metals and composites provide definitive cavity treatment while fast-drying materials such as CavitTM, flown on ISS, offer temporary fillings. Novel filling materials, used in private practice to fill caries, may help regenerate teeth in the future. Microwave radiation may treat caries and pulpitis via portable instruments if clinical trials prove successful.  Ozone can also be used to treat infections, caries, endodontal and periodontal disease, and to promote remineralization; although its use in spaceflight must be discerned.

 

Rationale for Closure

A review of the prevention, diagnosis, and treatment of dental conditions suggests that the dental capabilities needed for future exploration missions are available and do not require further development, thus warranting closure of this gap. As the technologies for the pre-flight and inflight screening, prevention, diagnosis, and treatment of dental conditions evolve, ExMC will identify new advancements in care via the gap for technology watch, Gaps 1.01 and 3.03. Dental suction capabilities will be addressed in the gap for medical suction, Gap 4.09.

 

Tasks and Supporting Reports Completed
1. Anil Menon, Kristina Barsten, Sharmila D. Watkins, Dental Working Group Meeting Summary Report,
9/1/2012,  NASA Technical Reports Server.

2. Anil Menon, Review of Spaceflight Dental Emergencies. 9/1/2012, NASA Technical Reports Server.


Description

Development of methods/technologies for dental conditions; technology development effort to provide dental care technology.

Target for Closure
No Target for Closure available.
Mappings
Risk Risk of Adverse Health Outcomes and Decrements in Performance Due to Medical Conditions that occur in Mission, as well as Long Term Health Outcomes Due to Mission Exposures
You are here! Gap ExMC 4.11: Limited dental care capabilities (Closed)
Completed

Multi-Disciplinary Research Plans

Documentation:
No Documentation Available