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
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INTRODUCTION
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.

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.