Dr. Wally Renne is a Professor of Dental Medicine and Assistant Dean of Innovation in Digital Dentistry in the James B. Edwards College of Dental Medicine at MUSC. Wally was recently recognized as the world's best digital dentist from the International Digital Dental Academy, and was the recipient of the COVID-19 Innovation Award for 3D printing face mask designs to be used as PPE during the COVID-19 pandemic. The face mask became an international success. The South Carolina state museum will feature the mask as part of a COVID-19 display.

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Hello, everyone, and welcome to this edition

of MUSC's Science Never Sleeps Podcast.

I am your host, Loretta Lynch-Reichert.

Today we have a truly innovative and creative individual

speaking with us.

Dr. Wally Renne is a Professor of Dental Medicine

and Assistant Dean of Innovation in Digital Dentistry

in the James B. Edwards College of Dental Medicine at MUSC.

Wally was recently recognized

as the world's best digital dentist

from the International Digital Dental Academy,

and was the recipient of the COVID-19 Innovation Award

for 3D printing face mask designs

to be used as PPE during the COVID-19 pandemic.

The face mask became an international success,

and received an outpouring of support

from the local Charleston community.

The state museum will feature the mask

as part of a COVID-19 display.

Welcome, Dr. Renne.

Thank you so much for having me.

I'm really excited to be here.

We're happy to have you.

I'll do a little disclosure with my audience,

and say Dr. Renne is my dentist,

and he is a renowned dentist

here at MUSC.

Patients adore him, so just to put a little plug in there.

-Thank you for that. -So, let's begin

by congratulating on these accolades,

and then ask: What is digital dentistry?

That's a really good question, because digital dentistry

means many different things to many different people.

It could be as simple as upgrading your radiographs

-from film to digital. -Mhm.

Believe it or not, there are still film radiographs

being taken around the country,

and one first step to go digital

in your journey to digital dentistry

would be to go to digital radiographs.

We know that that has lower radiation to our patients,

better clarity, and many other benefits,

including not needing to have a dark room

in your office.

So, that's kind of what we used to think of

as digital dentistry maybe 15 years ago.

-Okay. -Then, we started to evolve

past just digital radiographs

to now including 3D digital radiographs

as in the form of cone-beam CT.

We have pioneered ultra-low-dose protocols

where we're able to take a 3D scan of your skull,

including all your teeth, at a lower dose

than a traditional 2D pantograph.

-Wow. -A pantograph, as you know,

are those things that rotate around your head

and have those 2D things show up on the screen.

But, with the latest technology, we're able to do a 3D scan,

so it's really cool, and that helps with all sorts of things,

like implant placement, and making sure we're safe

and not hitting things that we don't want to hit

when we place implants, and also diagnosing pathology.

So, then evolving past radiography,

we're also transitioning into the world of 3D scanning

using no radiation.

So, we're able to use white-light imaging

and laser imaging to scan teeth,

and make restorations on the computer,

so we're able to design fillings, and crowns,

and veneers, and all sorts of beautiful things,

and then 3D print or mill them for our patients,

and that is what's really exciting.

Is that part of what students in dentistry right now

are dealing with rather than the old stuff,

or is it a combination of both types.

I feel bad for them because it's both.

-Oh. -So, it used to be,

if you look at kind of the evolution

of dental education,

typically and historically it was behind the times,

where you learned antiquated techniques,

and then when you graduated you had to scramble

to figure out, "Okay, how do I use modern technology?

How do I figure this out?"

MUSC was one of the first schools

to actually be forward thinking

and say, "Okay, we want to teach the future of dentistry now,

but we also don't want to lose those old techniques

that have been tried and true

and proven in the literature with evidence-based dentistry."

So, we have this perfect synergistic blend here

between these kind of traditional techniques

that have really been proven in the literature,

and we blend that very carefully

with the most modern techniques in existence,

and so our students have to learn both.

That's a lot, but at the same time

I can see where, you know, if you're going to be a dentist

in a rural area that probably doesn't have

that kind of high tech, that it's perfect

for the patients in that area.

-100 percent, sure. -That's really awesome.

I love that MUSC considered that when they were moving into

the new curriculum, so that's great.

-It's really cool. -So, I mean,

what you do now, how does that affect,

like, I know forensic dentistry,

when you're looking at,

you know, trying to identify a body,

does that affect that at all?

Sure, so there are some new advancements

in forensic dentistry as well as it relates to 3D imaging,

where, as before, when you had a bite mark,

say, on a body, you had to take a mold

of that bite mark, and that mold would deform,

because you're pressing down onto the skin.

With new technology you're able to use

touch-free scanning and get a 3D mold,

and then you're instantly able to try to match that

using some really sophisticated

iterative closest point algorithms

to 3D molds of patients, and so you can kind of have

this artificial intelligence matching.

I mean, it has come a long way, hasn't it?

-It's so exciting. -It really is,

and hopefully when we're done with this podcast,

folks will reconsider going to the dentist,

which is, for a lot of people, a very scary thing to do,

and it sounds like the new technology

and the new materials might make that

a bit more of a comfortable opportunity.

It's more efficient and it's definitely safer.

I mean, because if you think about the way

that we used to, for example, place implants,

we used to kind of just put them in the bone.

It'd almost be kind of like

when you hang a picture on a wall

and you want to hit a stud, but you don't have

a stud finder, and you kind of just drill,

and you hope that you got it, but half the time you miss.

Well, before guided implant surgery

and computer-aided design and manufacturing,

we had to kind of do that.

Now, we're able to precision guide things,

super safe,

ensuring that we don't hit vital structures,

like nerves and arteries, and it's lower stress

for the patient and the doc.

-That's incredible. -Yeah.

That is wonderful.

So, maybe we could take our listeners

back a little ways, so.

Tell me about what the first materials

that were used just to do fillings,

which were, I believe,

not carcinogenic, but at least some biohazard.

Yeah, I mean, so,

amalgam fillings

contain silver, tin, mercury,

and they have a little bit of copper in them.

These restorations, though, have been around

for a long time, and have served the profession really well.

There's concerns how we're more environmental

that, specifically with the mercury

being released into the waste water,

or if you include all the dental offices

around the world.

So, the primary drive to remove these restorations

from practice is more of an environmental concern

-than a physiologic concern. -Okay.

There's been some really good randomized control

clinical trials, one done by a colleague,

Dr. DeRouen out of University of Washington,

in conjunction with Lisbon, Portugal.

What they did is they took around 715 kids

in Portugal, and randomly divided them.

Half of them were to receive silver fillings with mercury.

The other half were to receive the new generation

of tooth-colored fillings,

and they followed urinary levels of mercury

and all sorts of things out of that

over a course of five to seven years.

What they found was that

the children who received all these silver fillings

had no significant consequential issues

that were related to the mercury.

There was also the New England amalgam trial,

which did the same thing in New England,

and this was also a very well-done study,

randomized control trial.

Interestingly, though, as people go back

and mine the data, they're finding that

even with the new generation of fillings

that contain bisphenol A glycidyl dimethacrylate,

which is almost a bis-GMA base, and you know, bis-GMA is

the plastic material that people don't like.

They're finding that that leads to an increase

in behavioral issues.

Get out, really?

Yeah, so maybe the old silver stuff's better.

That is really interesting.

Do they have any inkling why?

-I mean-- -You know,

and I almost am tempted to be scared to even say anything,

but, you know, because the new tooth-colored materials,

the bisphenol A glycidyl dimethacrylate that's found

is slowly being replaced with other compounds

like triethylene glycol dimethacrylate

and other things that don't contain

that bis-GMA component.

But nevertheless, people are trying to do

more bio-compatible materials using bioceramics and glasses

and things like that, but interestingly,

the mainstream filling material

had been shown--and correlation does not mean causation--

but there is a strong trend

that the individuals who had more tooth-colored fillings,

children, had more likely to have

behavioral issues,

including attention deficit and other things like that.

-Fascinating. -Yeah, interesting.

More research needs to be done, it sounds like.

-It definitely does. -Yeah, that's really cool.

So, how do you see

dentistry moving forward in the next 10, 15 years?

For someone who might consider wanting to be a dentist,

and that's a rigorous program of study actually,

and it's a very challenging profession.

-Yes. -What would you advise someone

as they're considering that,

and what you see as the future of dentistry?

There has never been a better time

to be a dentist than now.

I mean, we are leading...

...other professions in technology.

So, for example, let me explain.

We are one of the first medical professions

to routinely 3D print in office

and implant 3D-printed devices on patients on a daily basis.

-Wow. -That prosthetic could be

a denture, it could be an implant hybrid prosthetic.

But, 3D printing in dentistry has propelled the profession

into the future, and it's mainstream.

So, roughly around 20 percent of dentists

have 3D printers, isn't that incredible?

That's incredible, it truly, truly is,

because I believe that, from a topical point of view,

people just started hearing about 3D

over the last few years.

-Yeah. -So, you guys have been

-way ahead of the game. -We have been doing it

for almost a decade, and now it's finally getting to be

where dentists are learning it,

and they're doing it in schools.

It's not only that, it's just the technology

and the artificial intelligence, not that it's not

going on everywhere, but in dentistry specifically

it's propelling us

to basically to be in the future now.

You know, when you think about what would the future

of dentistry be, is it, like, robots doing things?

Well, we're really living that right now.

The first dental implant had been placed in China

by a robot, completely human free.

In America now there's FDA-approved robots

-placing implants. -Get out of here.

I'm not kidding, and we have augmented reality

surgical guides, so what does that mean?

So, as the dentist is placing the implant--

the implant, by the way, if you don't know,

is a titanium screw essentially,

and I'm not going to say it's a hardware screw,

but if you think of that in your mind,

it's like a hardware screw.

They are hollow on the inside so they can accept crowns

and things to be screwed into them,

so it's a screw within a screw.

But, that gets drilled into your jawbone,

and we have machines now where, as you're drilling,

you could see live

on the 3D X-ray exactly where you are.

-Wow. -Instantly.

I mean, that is just incredible.

Augmented reality, it shows you your depth and everything.

So, we're just excited to be where we are right now.

Does this new technology

offer a little bit of a cost benefit

for the patient?

Going to the dentist is actually quite expensive,

not that it's not worth it, and we'll speak about that

a little bit in a little bit, but that's

a very expensive proposition.

So, out of all the technologies that are out there,

the only thing that really is lower in cost for patients

is 3D printing, and let me tell you why.

So, if you talk about the augmented reality systems,

or if you talk about 3D radiograph,

all those machines are hundreds of thousands of dollars.

So, if you think about a dentist who wants to get into this,

they're going to have to get a huge loan

on top of an already big loan,

and they just cannot transfer that cost to the patient

without having to increase fees

or keep their fees the same and just be more efficient.

Now, 3D printing,

you could get a 3D printer for $250,

and use FDA-approved materials on it.

Of course, the best dental printers

are up there around 15 to 20 grand,

but even that is just peanuts compared to

these other machines, and we're able to manufacture

things like a denture for all-in cost to the dentist

-of $10. -Wow.

-Incredible. -So now, you could start to see,

okay, well if a dentist buys a 3D printer,

and is printing dentures for $10 material cost,

yes, it does take time to learn how to do it all,

but maybe we don't have to charge $1,500 for a denture.

-Yeah. -That is occurring,

and it is really good, because it's those individuals

that need help the most typically.

Well, that's an interesting segue for me,

because I was reading an article in the New York Times,

and I have spoken with one of your colleagues,

Dr. Amy Martin, and she is

an incredible advocate for oral health.

She's been to the statehouse, she's been to rural areas.

It is funny that this New York Times article

suggested that, even in the MDs,

they don't see the mouth as part of the body.

People just don't think of their mouth

as a part of their overall health.

-Sure. -But, in fact, oral health

is one of the most significant indicators

of overall health,

and that's where health really starts, is in your mouth.

Can you talk about that a little bit?

Sure, first of all, Amy is just on a whole other level

of fantastic, she's above and beyond

what I know on the topic, but I will be happy to chime in.

We know, we have significant evidence

in the literature to support the notion

that oral health is directly related

to cardiac health, and also mental health,

so it's interesting.

So, organisms

that exist in the mouth,

like treponema denticola, which is a spirochete,

-have been shown to-- -What's a spirochete?

Spirochete is a nasty little bug

that could penetrate the blood-brain barrier,

and autopsies show that

in people who have Alzheimer's,

there's more likely to be spirochetes in their brain.

-So, oral spirochetes. -Wow.

These are the same spirochetes that cause periodontal disease,

-by the way. -Wow.

Then, we have other evidence to support that.

Porphyromonas gingivalis gets into the bloodstream.

That's a bug that lives in your mouth

that goes into your bloodstream and causes inflammation,

and if said inflammation goes into an area of your artery

or where you have a plaque, your body will attack that area,

you could have a stroke,

or have heart failure and heart disease.

That little bug releases

some certain inflammatory elements

that could also get into the brain

and cause mental health degradation.

So, it's insane that we're finding that

how clean your mouth is is a window

-to the rest of your body. -Outside of brushing,

and flossing, and gargling,

how do you keep your mouth clean?

Well, let's start with that.

The most important thing as it relates to oral health

is consistency.

So, like, you can't skip

a few days of oral healthcare,

and then just all of a sudden start back

and expect to erase the damage that had been done.

You're going to have gingivitis,

you're going to have bleeding gums.

I hear it all the time, "When I floss it bleeds."

Well, that's a sign of inflammation,

and when you have puffy, red, bleeding gums,

the bacteria's entering into your bloodstream,

and it's spreading throughout your whole entire body,

and so you're going to have inflammation

in areas that you wouldn't expect.

So, the main thing is to maintain

almost a religious cycle

of oral healthcare.

It is important to go, and I'm not just saying this

because I'm a dentist, but it is really important

to go see a qualified hygienist

every six months at least

for them to do a really good deep cleaning on you,

because there's areas you just can't get with a toothbrush.

-Right. -Below your gums

where stuff accumulates.

So, that's the main thing, it's consistency.

I used to think there was, like, a magic bullet,

like, before becoming a dentist,

I would say to myself, "Surely they know something

that I don't know," because you might not know

that I have pretty much a filling in every tooth

in my mouth, because I was a naughty boy.

(chuckling)

-I would get can-- -Was there candy?

There was candy, so I would get--

Mhm, I would get 2 bucks a week for allowance,

and I would ride my bike to the candy store

and get a bag, a brown paper bag full of candy,

and every time I went to the dentist

it's 8 cavities, it's 10 cavities.

I'm like, "Are you running out of teeth?"

(laughing)

It was a nightmare, and I thought that, like,

you know, surely somebody else has some secret,

-and the secret is consistency. -Yeah.

-That's it. -Wow, yeah,

but just like with a lot of things, if it's not a habit

that just becomes part of your routine,

and especially younger people.

I think that most of us

who, you know, adults are pretty good about it.

I would suggest to you that the younger people

-and elderly... -Huge.

...would be problematic.

-Huge problem. -Yeah.

Then, the dexterity of young.

For example, I have three kids.

We brush their teeth until they're 8...

-Wow. -...for them.

That might sound a little crazy, like, you know,

helicopter parents, but if you look at, like,

the AAP guidelines, the American Academy of Pediatric Dentistry

and the ADA, children do not

have the dexterity to properly brush their teeth.

So, you know, it's like,

just you have to put them in a headlock sometimes,

they're screaming at you, "I don't want to

brush my teeth!" but you just do it,

and you teach them good habits, and when usually,

if you look at the guidelines, dexterity around 8

will be such that they can properly clean their mouth.

I remember when I was in school

that the dentists came to do a little presentation,

and they gave us these little blue things to chew on

after we brushed to see where we missed.

-Yes, that's a good idea. -I don't know

-if they still do that. -They still do that.

It was an eye opener, and we were little kids,

so we were like, "Oh, my God, how did I miss that?"

You know, it becomes a game to play, so.

That is a super good teaching tool.

We still do that in certain schools

and teach, that the disclosing agent

that highlights the biofilm.

-Yeah. -It's really cool.

Yeah, it is, and it's a simple way for a kid

to engage in their own oral health.

Again, it's so important not only for the total body,

but also your physical presentation.

People look at you right away to say--

They make judgments on a person based on their teeth

and their mouth, so I mean, that's important stuff.

It's really important.

You know, they say that you could be missing an eyebrow,

and it's less noticeable than missing a front tooth.

-Yeah, I would imagine. -We've seen that meme

floating around, yeah.

So, let's get into something

I'm sure you're really excited about,

and I want to know more about, is how did you get into

this whole thing of deciding to develop the masks

and become the digital dentist?

Can you tell us that story?

It's a little bit of just serendipity.

I mean, if you look at the beginning

of the COVID-19 pandemic, we really didn't know

how SARS-CoV-2 was spread.

We had a hypothesis that it might've been

aerosol related.

So, we rushed early on to develop

an open-source mask, working with the Yost Lab,

-who, by the way, is just-- -Michael Yost, Dr. Michael Yost

-in surgery, just a wonderful-- -Incredible resource,

and just a professional guy.

That's the kind of stuff on MUSC campus

that I think people need to realize

is that we have resources that you can tap into,

and it's human resources, like people.

-Right. -It's the people here.

-It's their intelligence. -Their wealth of knowledge.

-Yeah. -He's on another level,

so I mean, immediately it was natural for me

to reach out and to collaborate with him

and his son John, who's also just a brilliant kid.

We decided to design, using computer-aided design,

a mask that could be printed on any printer.

So, even your $100 high school printer

that you see in, like, high schools and libraries,

and stuff like that.

We did some testing to show a few things.

One was that the printed mask, using the settings

that we recommend, is indeed airtight.

Right, because you don't want to 3D print something,

and then have the false idea that it's stopping...

-Right. -...microbes from entering.

Then, we developed kind of a way to develop

your own filters for it,

and we had tutorials on how to put it together.

You have to remember, this is at a time when people had nothing.

People were using a scarf, tissue paper.

I mean, we literally had no masks anywhere.

This was at a time of true crisis,

and so people started printing these masks

all around the world,

and it's quite remarkable, and I'm proud to be

-a part of that team. -So, just to step back,

MUSC, you, and your team

were the ones to first start all this.

-Sure. -Then, it went to

the rest of the world, so MUSC is where it really began.

Yeah, I mean, we released our design

open source, so we worked with

the Foundation of Research and Development here

to create license where people could just

download and modify as needed that design,

which I know for sure in several countries

and other areas of America,

people were using that design as their only mask.

-Wow. -Which is really cool,

and we hope that it maybe early on saved some lives,

and prevented some people from getting COVID-19.

-Absolutely. -Yeah.

Oh, gosh, yeah.

That was a very challenging time for all of us,

and in fact, in the article that I was reading

from the New York Times, they noted that

after COVID-19 really became an issue,

and as people were finally able to go back

into the dental office, what you all saw,

as practitioners, was pretty horrific.

Everything from people,

you know, ate comfort food and junk,

and just kind of gave up on health habits,

or they were so anxious they were grinding their teeth.

So, a whole lot of fallout, if you will, from COVID

-just for oral health. -We're still catching up.

-Really? -I mean,

a whole year essentially

of not having professional dental care,

we're still catching up from all the issues

that have come out of that.

A lot of people were stressed.

They were at home, they weren't doing their normal routine,

and they, for better or for worse,

they maybe forgot about their teeth just a little bit,

because, you know, you got a lot of stuff going on.

-Yeah. -So, we see, what happened was

we have a lot of gingivitis,

some new diagnoses of periodontitis,

but a lot of broken teeth.

It's strange, the stress, the clenching, the grinding.

People were probably eating things that they shouldn't,

very hard things, crunching on who knows what,

ice cubes, and things like that

could wreak havoc on the teeth.

-Yeah, amazing. -When I think about how MUSC

is leading the nation with oral healthcare,

it's a proud moment for me,

because it's not just about the technology.

I mean, there's schools that have technology,

but it sits in the corner, it doesn't get used,

there's nobody to drive it.

We're innovating not only oral healthcare,

but oral health research.

We have a really fantastic team of individuals

who are pushing the boundaries

of dental oral health research,

and it's just really cool to see the innovations

occurring on that end, so it's not just technology

that's really making us stand apart

from the rest of the nation, it's also the team

that we've assembled, and the amount of research

that we're doing, it's really, really inspiring.

It is inspiring, and also, I think the public

ought to know what kind of really beautiful people

inhabit the dental school, because you also do a lot

of outreach, the dental school,

to communities where they don't have access

-to good dentistry. -Yep.

I think that is, again, as we said earlier,

oral health is the beginning of really good health,

so the fact that you guys spend your time

getting out there with the public

and trying to make a difference in their lives

I think is a very important part.

I think that's a part of the legacy

of when the dental school started,

and it continues on, even under today's current leadership,

it's really a wonderful thing to see.

It is, and our students have such a heart to help.

I mean, they're the ones begging for more help.

I mean, they want to go out there and be involved

in the community.

They're volunteering

at the Echo Clinic in Mount Pleasant,

and Our Lady of Mercy in Johns Island,

and you name free clinic X,

they're there in the morning when it opens,

they're there on the weekends, they're there at nights,

and they're really wanting to help people

who do not have an avenue for oral healthcare.

I think that's a wonderful thing, absolutely, and I think

that our community should support that.

As a final thought, as a dentist,

when you have a patient coming in to your clinic,

what would you like them to know

about what they're about ready to go through?

How do you ease their mind about

the work that's going to be done?

So, typically you have to understand that

you're in control as the patient.

-Okay. -How so?

Well, so, it's not like it used to be.

A lot of people tell me stories, and I have these same stories.

You're in the dentist as a child,

and you're getting your tooth drilled on,

and you're screaming because it hurts,

and the dentist is like, "Just a little more,

just a little further," and you're clenching,

and you're screaming, and you're in, like,

you know, strapped down essentially.

That is not the dentistry of today.

Okay, we are there essentially for your benefit,

and we are going to use the latest technologies

and techniques, and synergistically combine that

with new hands-on skills

that we've learned, that we've picked up on

how to numb with less pain.

How do we drill more conservatively?

So, instead of cutting a big hole in your tooth,

we're doing a tiny microscopic hole.

These things is where the profession's heading.

We're more conservative.

We do not want to have to pick up that hand piece

and drill on your tooth unnecessarily.

Whereas 10 years ago, 15 years ago,

the philosophy was, "Drill more."

Yep, and we've completely departed from that.

So, less is more, we're more conservative,

we're watching out for you, and of course we always say,

"What would I have done on my tooth?"

Or, "What would I do to my family member?"

That's what you're going to get these days.

That's great, that's a wonderful way

to finish this podcast is to say

it's not something you need to be afraid of anymore,

and when you're in the capable hands

of our dentists at MUSC and Dr. Renne,

you can feel good about what's happening.

So, thank you so very much.

This was fun, it was informative.

It was thoughtful.

I hope that people take away from this

important and mindful ideas about how to take care

of their health, even the smallest thing,

just I guess gargling.

You know, if you're not in a place

where you have a toothbrush and floss,

gargle or something, just to clean your mouth out,

that will help you tremendously.

-Absolutely. -Yeah, thank you so much,

Dr. Renne, I really appreciate it.

It was really fun, I am so delighted that you had me on.

Thank you, sir, and to our listeners,

join us next time for another edition

of Science Never Sleeps Podcast

here at the Medical University of South Carolina.

Everyone, take care, stay healthy,

go to the dentist.

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