Case Western Reserve University School of Dental Medicine and the Cleveland Clinic say that menopausal women may need to see the dentist as many as four times a year to control dental plaque.
Leena Palomo, an assistant professor of periodontics, and Maria Clarinda Beunocamino-Francisco from the Center for Specialized Women’s Health at the clinic completed a comparison study of women on and off bone-strengthening bisphosphonate therapies for osteoporosis.
In the women they studied, they found a marked increase in dental plaque levels, which could endanger the jawbones of postmenopausal women. (Dental plaque is a biofilm that develops naturally on our teeth. If the plaque is left on teeth too long, it triggers gum disease.)
“Menopausal women at risk for osteoporosis also are at risk for periodontal disease, which affects bone that anchors teeth,” says Palomo. “To keep jawbones strong and healthy,” she added, “means getting rid of the dental plaque by seeing the dentist as many as four times a year for deep periodontal cleanings.”
Article by Jim Du Molin
Dental Practice Marketing & Mangement Blog
Electronic cigarettes (e-cigarettes) alter oral health and may contribute to gum disease, according to a study published in Bio on February 22. People who vaped e-cigarettes in the study had a less healthy oral microbiome than nonsmokers did -- but could still be healthier than cigarette smokers.
Researchers from New York University College of Dentistry studied 84 adults ages 30 and older across three groups: people who had never smoked, cigarette smokers, and e-cigarette users. The study demonstrated the long-term consequences of using e-cigarettes.
"To our knowledge, this is the first longitudinal study of oral health and e-cigarette use," stated lead author Deepak Saxena, PhD, a professor of molecular pathology, in a press release. "We are now beginning to understand how e-cigarettes and the chemicals they contain are changing the oral microbiome and disrupting the balance of bacteria."
Researchers have known about the oral and overall health consequences of traditional cigarettes for decades, but little is known about how e-cigarettes affect gum health. The authors conducted the study in the hope of learning more.
Using plaque samples from dental exams, they analyzed the bacteria present to assess gum diseases. Samples were taken six months apart to allow more time for disease progression. In total, 168 samples from 84 subjects were analyzed in the final study.
All participants had some gum disease at the start of the study. After six months, gum disease had worsened for some participants in each smoking status group.
E-cigarette users had a different oral microbiome than traditional cigarette smokers and nonsmokers, and their distinct microbiome had a strong correlation with some measures of gum disease. Both Fusobacterium and Bacteroidales, which are linked to gum disease, were more dominant in the mouths of e-cigarette users than the other two groups.
The bacterial composition for e-cigarette users was also much more similar to that of cigarette smokers than nonsmokers. E-cigarette and traditional cigarette users had higher levels of Selenomas, Leptotrichia, and Saccharibacteria than nonsmokers.
"Vaping appears to be driving unique patterns in bacteria and influencing the growth of some bacteria in a manner akin to cigarette smoking, but with its own profile and risks to oral health," stated Fangxi Xu, a junior research scientist in Saxena's lab and the study's co-first author.
More so, the use of e-cigarettes was tied to changes in the immune environment. People who vaped e-cigarettes had different levels of immune regulating cytokines.
In particular, e-cigarette users had higher levels of tumor necrosis factor-alpha (TNF-alpha), a cytokine related to inflammation, and lower levels of interleukin-4 (IL-4) and IL-1-beta, cytokines that tend to be reduced in people with untreated gum diseases. The findings suggest the oral bacteria in e-cigarette users may be actively suppressing the immune system, the authors noted.
The authors did not discuss limitations or next steps; however, they pointed to the lack of research on vaping's long-term effects on gum health, something they hoped future studies could look into.
"Unlike smoking, which has been studied extensively for decades, we know little about the health consequences of e-cigarette use and are just starting to understand how the unique microbiome promoted by vaping impacts oral health and disease," stated co-first author Scott Thomas, an assistant research scientist in Saxena's lab.
By Hannah Welk, DrBicuspid.com contributing writer
Periodontitis is a common multifactorial disease characterized by clinical attachment loss and bone loss and may result in tooth loss, if not treated effectively.1 Periodontitis occurs in most age groups, but it is most prevalent among adults over the age of 30, affecting 42% of the US adult population, of which 7% have severe periodontitis.2 Over the last 40-years, numerous studies have demonstrated an association between periodontal disease and several chronic diseases.3-5 These studies have reported an association among periodontal disease and diabetes mellitus, osteoporosis, rheumatoid arthritis, chronic obstructive pulmonary disease, and cardiovascular diseases (CVDs).6,-8 Several case-control and cross-sectional studies have discussed the relationship between periodontal diseases and coronary heart disease (CHD).9,-11 These studies indicated that patients with periodontitis have a 1.14 times higher relative risk of developing coronary heart disease and a 25% increased risk compared with control subjects.11, 12 In addition, several studies have suggested that atherosclerosis may be exacerbated by periodontitis. 13-15
Chronic periodontal infections may stimulate endothelial dysfunction through systemic inflammation that is exacerbated by elevated levels of interleukin-6 and fibrinogen. Moreover, bacterial products from Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans, including gingipains and soluble bacterial components, can induce endothelial dysfunction.16 Inflammation plays a role in the entire pathogenesis with atherosclerosis, starting from the expression of the endothelial adhesion molecules, including intercellular adhesion molecule I and vascular cell adhesion molecule I. These molecules are expressed in response to soluble inflammatory mediators, such as interleukin 1 and 6, in the bloodstream, leading to endothelial permeability, leukocyte migration, and adhesion. Fatty streaks and calcifications become phagocytosed within macrophages, resulting in the increasing release of pro-inflammatory cytokines (e.g., interleukin-1, interleukin-6 and tumor necrosis factor alpha). The disintegrated endothelial layer leads to the production of thrombin from prothrombin and the formation of fibrin to fibrinogen that can result in thrombosis and, consequently, to cerebrovascular accidents or myocardial infarction.7, 17 According to a polymerase chain reaction study on samples taken from carotid endarterectomies, 44% of atheromas were found positive for at least one periodontal bacteria and P. gingivalis and Tannerella forsythia were observed in 26% and 30%, respectively, of the surgical specimens. These periodontal pathogens are strongly related to bleeding on probing and deep pocket depths.10, 18 Extracranial carotid artery calcifications (ECACs) may be visualized in panoramic radiographs beneath the mandibular angle proximal to the cervical vertebrae at the C3 and C4 levels. These calcifications were detected among 10% to 12% of male patients and 10% to 16% of female patients, either unilaterally or bilaterally.19 Regarding the accuracy of panoramic radiographs for detection of ECACs, one study compared ultrasonography with conventional panoramic radiographs. The authors found that the panoramic radiographs had a sensitivity of 66.6%, and a positive predictive value of 45% was found for the detection of carotid artery calcifications in patients whose angiograms confirmed the presence of coronary artery disease and a sensitivity of 50% in patients with a normal angiogram.20 However, the sensitivity and specificity reached 76% and 98% in digital panoramic X-rays, respectively, in the portrayal of carotid artery calcifications.21 In addition, a statistically significant association was found between the presence of ECACs in panoramic radiographs and the percentage of alveolar bone loss in patients with periodontitis.19
Intracranial carotid artery calcifications (ICACs) are one type of calcification that may be detected as incidental findings in cone-beam computed tomography (CBCT). A cross-sectional study by Khosropanah and co-workers compared the prevalence of intracranial and extracranial artery calcifications in 705 CBCT scans. They reported that more than 60% of the scans were positive for ICACs and 39.9% were positive for ECACs. The findings also showed that there was a correlation between ICACs and ECACs 22 and another study by de Weert reported that ICACs were independently associated with smoking, hypercholesterolemia, and history of cardiac and/or ischemic cerebrovascular diseases.23 A dental practitioner who prescribes CBCT imaging is responsible for the interpretation of the entire scanned volume. This interpretation is based on a thorough knowledge of the anatomical structures, variations, and abnormalities on radiographic images. It is crucial to examine the entire volume systematically, which may include paranasal sinuses, airway spaces, the base of the skull, the cervical spine, and temporomandibular joints. To the best of the current authors’ knowledge, no research has examined the association between internal carotid artery calcifications and periodontitis. Therefore, this retrospective study aimed to examine the prevalence of ICACs on CBCT images and their associations among age, gender, chronic periodontitis, and patient-reported CVDs.
From an article published in the Journal of Periodontology.
Practicing good oral hygiene does more than maintain a beautiful smile. Unhealthy gums can exacerbate health issues throughout the body through the oral-systemic link, explains Sam Low, DDS, MS, a past president of the American Academy of Periodontology, a specialty of dentistry that focuses on the supporting structures of teeth, like the gums. For example, research has shown a link between cardiovascular disease and periodontitis (gum disease).
"We never want to suggest that just because you have gum disease, you're going to have a heart attack," says Dr. Low, who is a spokesperson for Philips, a brand with a major oral-care catalog. "But what we have been able to establish is that the chronic inflammatory reactions that occur with gum disease parallel what you see in other major chronic inflammatory diseases, especially cardiovascular disease, diabetes, respiratory diseases, rheumatoid arthritis, recent data with Alzheimer's."
According to 2012 data from the Centers for Disease Control and Prevention, about 47 percent of adults age 30 and older have some form of periodontal disease. Gum disease, which can cause serious gum and jawbone damage, costs Americans $54 billion per year in lost wages. Severe gum disease is the sixth most prevalent disease in the world. Symptoms of gum disease, like swollen gums and painful chewing, are easy to miss or brush off, says Dr. Low. So getting your regular checkups is imperative, as gum disease can lead to other issues in the body.
Untreated infections from gum disease can cause blood sugar to rise, making it more difficult to manage diabetes. "I would imagine that there are patients that are having difficulty controlling their diabetes and have not put two and two together," says Dr. Low. Additionally, gum disease can worsen lung diseases by increasing inflammation and passing bacteria into already compromised lungs. "If the bacteria are in the mouth and you're breathing these bacteria 24 hours a day, then they're going into the lungs," he says. "We can show that relationship with the COVID-19 scenario." Research has shown that COVID-19 patients with oral health issues like painful or bleeding gums were more likely to die than those who did not.
"It wasn't a surprise to us because if you're aware of COVID, no one actually dies from the virus, you die from the body's reaction to the virus," says Dr. Low. COVID-19 can start a cytokine storm in the body, which is when the immune system overacts and floods your bloodstream with cytokines, which are inflammatory proteins that can kill tissue and damage organs. "And that generally destroys the lung material to where it's not receptive to the intake of oxygen. That is exactly the way perio works. Perio is not about bacteria. Perio is about a patient's susceptibility to overreacting to the bacteria."
Dr. Low shares this information not to scare you into the dentist's chair. "We don't want people to have to be motivated to come see us because they may die," he says. But if you are already dealing with or are predisposed to other health issues, staying on top of oral health should be among your priorities. "If you're susceptible already to a complicated pregnancy, if you're already hypertensive, if you already have stints, if you already have a familiar history of cardiovascular disease, if you're a diabetic and you're uncontrolled and you are also genetically susceptible to perio, then one creates almost a synergistic effect to make it worse."
The most important thing you can do is visit a dentist every six months for a checkup and when you see a dentist, you should tell them about your medical history. While there is some collaboration between dentists and physicians (many cardiologists require a clearance from a dentist before performing heart surgery), Dr. Low hopes to see it continue to increase. "You are starting to see, and I think COVID started this, more and more, there are folks starting to talk about putting dental clinics in medical clinics, putting medical clinics in dental clinics."
Additionally, Dr. Low says it's important to stay on top of your at-home oral care. "It would be extremely naive to think that what we do in a dental office is enough. The bacteria will come back very quickly because the mouth is just a great vessel to grow those bacteria," he says. Brush your teeth for two minutes twice a day, preferably, with an electric toothbrush. "I don't want to belittle our manual toothbrushing, but my goodness, this morning, you did not get up and make a call on a rotary or push-button phone?" And be sure to floss. "Periodontal disease is not on the out and in of teeth, it's in between teeth." Keep in mind that good oral health has implications far beyond the mouth and that staying on top of it can help you live a longer, happier life.
EXPERTS REFERENCED: Sam Low, DDS, MS, Periodontist
Article by Kara Jillian Brown・Well + Good | July 26, 2021
By Lauren Kent, CNN
Thu July 8, 2021
Maintaining good oral health habits, such as brushing and flossing, may help prevent cognitive impairment and dementia.
(CNN)Flossing your teeth isn't just important for keeping your dentist happy -- it may also protect against cognitive decline.
Good oral health habits like brushing and flossing may prevent cognitive impairment and dementia, according to a new analysis led by researchers at NYU Rory Meyers College of Nursing.
"Given the staggering number of people diagnosed with Alzheimer's disease and dementia each year, and the opportunity to improve oral health across the life span, it's important to gain a deeper understanding of the connection between poor oral health and cognitive decline," said Bei Wu, a professor in global health at NYU Rory Meyers College of Nursing and the senior study author, in a statement.Researchers analyzed 14 studies on tooth loss and cognitive impairment conducted over an extended period of time, which involved a total of 34,074 adults and 4,689 cases of people with diminished cognitive function.The results showed that adults with more tooth loss had a 1.48 times higher risk of cognitive impairment and 1.28 times higher risk of dementia, even when other factors were controlled.And with each additional missing tooth, the risk of cognitive impairment grows, according to the analysis published in JAMDA: The Journal of Post-Acute and Long-Term Care Medicine.
Lisa, one of Dr. Nordland's staff members, shows how to use yarn for flossing.
Adults who experienced tooth loss were more likely to have cognitive decline if they did not have dentures, the new research also revealed.
"We need to think about increasing awareness of the importance of oral health, and we also need to think about preventive treatment and dentures," Wu told CNN.
Dentures are important because they allow patients to maintain a healthy diet, as well as provide "the confidence to smile naturally," according to Dr. James Wilson, president of the American Academy of Periodontology, who was not affiliated with the study.
"Being able to eat a normal diet is extremely important to a person's physical health," Wilson said via email. "The positive self-image that dentures provide a patient works to improve their mental health as well."
Article by Bite Magazine Editor, July 5, 2021
US dental researchers have found the combined use of a high-volume evacuator (HVE) with an intraoral suction device significantly reduces the amount of microbial aerosols generated during a dental cleaning procedure.
The study, conducted by a team from Loma Linda University School of Dentistry, reported that the combination of the two devices improves patients’ and dental professionals’ safety from potentially harmful airborne microbes.
Researchers found a three-fold reduction in microbial aerosols with the simultaneous use of an HVE plus an additional suction device placed in a patient’s mouth when compared to using the HVE only—and published their findings in The Journal of the American Dental Association
“Once organisations like the WHO and CDC released reports describing the virus’s modes of transmission, we quickly understood how dentistry would be affected because a number of dental procedures generate aerosols,” principal investigator Associate Professor Montry Suprono said.
“So, we wanted to figure out ways to minimise the risks by decreasing the amount of aerosols that are generated during dental procedures.”
The team commenced with a clinical trial involving over 90 dental student participants who would enact roles like operator or patient at the LLU dental clinic. Researchers collected aerosol samples by placing blood agar plates in various zones throughout the clinic, like shelves or patients’ chests, for intervals of time before, during and after the dental cleaning procedures.
The procedures themselves were conducted using a split-mouth design whereby operators used both the HVE instrument and intraoral suction device on one side of the patient’s mouth during one round of the cleaning procedure and used only the HVE on the other side of the patient’s mouth for the other round of the procedure.
Having collected the aerosols in the various agar plates that were incubated for two days, the team then measured the microbial levels of each sample.
Compared to using the HVE alone, the combination of HVE and an intraoral suction device significantly reduced the amount of microbial aerosols generated.
In addition, microbial levels before procedures were similar to the microbial levels after the procedures, indicating a 30-minute time interval for air change and for the aerosols to settle down on surfaces post-procedure appears to be adequate.
by Perelman School of Medicine at the University of Pennsylvania
Article from Medical Xpress
June 29, 2021
Patients who had their wisdom teeth extracted had improved tasting abilities decades after having the surgery, a new Penn Medicine study published in the journal Chemical Senses found. The findings challenge the notion that removal of wisdom teeth, known as third molars, only has the potential for negative effects on taste, and represent one of the first studies to analyze the long-term effects of extraction on taste.
"Prior studies have only pointed to adverse effects on taste after extraction and it has been generally believed that those effects dissipate over time," said senior author Richard L. Doty, Ph.D., director of the Smell and Taste Center at the University of Pennsylvania. "This new study shows us that taste function can actually slightly improve between the time patients have surgery and up to 20 years later. It's a surprising but fascinating finding that deserves further investigation to better understand why it's enhanced and what it may mean clinically."
Doty and co-author Dane Kim, a third-year student in the University of Pennsylvania School of Dental Medicine, evaluated data from 1,255 patients who had undergone a chemosensory evaluation at Penn's Smell and Taste Center over the course of 20 years. Among that group, 891 patients had received third molar extractions and 364 had not.
The "whole-mouth identification" test incorporates five different concentrations of sucrose, sodium chloride, citric acid, and caffeine. Each solution is sipped, swished in the mouth, and then spit out. Subjects then indicate whether the solution tastes sweet, salty, sour, or bitter.
The extraction group outperformed the control group for each of the four tastes, and in all cases, women outperformed men. The study suggests, for the first time, that people who have received extractions in the distant past experience, on average, an enhancement (typically a three to 10 percent improvement) in their ability to taste.
"The study strongly suggests that extraction of the third molar has a positive long-term, albeit subtle, effect on the function of the lingual taste pathways of some people," Kim said.
Two possibilities, the authors said, could explain the enhancement. First, extraction damage to the nerves that innervate the taste buds on the front of the mouth can release inhibition on nerves that supply the taste buds at the rear of the mouth, increasing whole-mouth sensitivity. Second, hypersensitivity after peripheral nerve injury from a surgery like an extraction has been well documented in other contexts. There is evidence, for example, from animal studies that repetitive light touch, which might occur during chewing, gradually accentuates neural responses from irritated tissue that can lead to progressive long-term tactile hypersensitivity. Whether this occurs for taste, however, is not known.
"Further studies are needed to determine the mechanism or mechanisms behind the extraction-related improvement in taste function," Doty said. "The effects are subtle but may provide insight into how long-term improvement in neural function can result from altering the environment in which nerves propagate."
Article from Dentistry Today
June 3, 2021
Poor oral hygiene has a negative impact on athletic training and performance, according to Sunstar, which notes that maintaining a healthy mouth should be an essential part of athletes’ training programs and has partnered with the FDI World Dental Federation to launch Sports Dentistry Guidelines.
In a study of 302 athletes, 40% said they were bothered by their oral health, while 28% reported an impact on their quality of life, and 18% reported an effect on their training and performance. Also, 55% of the athletes had cavities, 45% had dental erosion, and 76% had periodontal disease.
Athletes are at high risk of developing oral diseases for several reasons, Sunstar said. For example, they require a lot of calories, which often are consumed via sugary protein sports bars. Also, athletes consumer a lot of sports drinks, which are mostly acidic and have high sugar content. Training leads to increased mouth breathing and reduced saliva flow, causing dry mouth and creating ideal conditions for bacteria to grow as well.
Sports-related stress is another risk factor that can cause gum disease, tooth erosion, cavities, and teeth grinding. In aquatic sports, low pH in swimming pool water can cause tooth erosion.
Just as athletics can impact oral health, oral health can impact athletic performance, Sunstar said. Poor oral health overall affects quality of life and well-being, which are key for optimal athletic performance, the company said.
Periodontal experts stress the importance of gum health in older adults and other at-risk groups
Press Release from the American Academy of Periodontology
CHICAGO – JANUARY 28, 2019 – A recent study has periodontists, experts in the treatment, diagnosis, and prevention of periodontal disease, encouraging patients to maintain gum health in an effort to reduce their Alzheimer’s disease risk.
The study, published in the journal Science Advances, uncovered a potential link between P. gingivalis, the bacteria associated with periodontal disease (commonly known as gum disease) and Alzheimer’s. Researchers analyzed brain tissue, spinal fluid, and saliva from Alzheimer’s patients—both living and deceased—and found evidence of P. gingivalis. Gingipains, the toxic enzyme secreted by P. gingivalis, were found in 96 percent of the 53 brain tissue samples examined, with higher levels detected in those with the pathology and symptoms of Alzheimer’s disease.
Additionally, researchers including co-author Mark I. Ryder DMD, Professor of Periodontology at the University of California, San Francisco, noted that the presence of P. gingivalis increased the production of amyloid beta, a component of the amyloid plaques whose accumulation contributes to Alzheimer’s. The study confirmed via animal testing that P. gingivalis can travel from the mouth to the brain and that the related gingipains can destroy brain neurons. These findings are noteworthy in that they suggest a biological mechanism for how periodontal disease bacteria may play a role in the development and progression of Alzheimer’s.
According to Richard Kao, DDS, PhD, president of the American Academy of Periodontology (AAP), the professional society representing more than 8,000 periodontists, this study underscores the important role of gum health on overall wellness. “Periodontists have long known that a healthy mouth contributes to a healthy body, and research has suggested an association between periodontal disease and dementia conditions, such as Alzheimer’s,” Dr. Kao said. “These recent findings present strong evidence on how periodontal disease can impact the pathogenesis of Alzheimer’s disease and should highlight how crucial it is to manage periodontal disease, especially in older adults or individuals who have increased risk for dementia.”
Although the study results add to the evidence supporting a link between gum disease and Alzheimer’s, additional research is needed to better understand the etiology of Alzheimer’s and how periodontal disease bacteria can exacerbate progression. An upcoming FDA Phase II clinical trial will assess the benefits of using a novel small molecule inhibitor of these P. gingivalis gingipains in hindering the development and progression of Alzheimer’s. This clinical trial may add further insight to the link between gum disease and Alzheimer’s.
Dr. Kao encourages older adults and other at-risk individuals to maintain diligent oral care and promptly treat periodontal disease to help mitigate Alzheimer’s risk. “More than half of the U.S. population age 30 and older has some form of periodontal disease. Prevalence increases to 68 percent for those age 65 and older. Routine brushing, flossing once a day, and visiting a periodontist can help identify any disease and treat as needed, potentially diminishing the risk of developing Alzheimer’s.”
To learn more about periodontal disease, visit perio.org.
About the American Academy of Periodontology
The American Academy of Periodontology (AAP) represents over 8,000 periodontists—specialists in the prevention, diagnosis, and treatment of inflammatory diseases affecting the gums and supporting structures of the teeth, and in the placement of dental implants. Periodontics is one of the nine dental specialties recognized by the American Dental Association.