Wednesday, May 24, 2017

Recreational cannabis, used often, increases risk of gum disease


Columbia University dental researchers have found that frequent recreational use of cannabis--including marijuana, hashish, and hash oil--increases the risk of gum disease.
The study was published in the March issue of the Journal of Periodontology.
Periodontal (gum) disease is an inflammatory reaction to a bacterial infection below the gum line. Left untreated, gum disease can lead to receding gums and tooth loss. Longstanding periodontal disease has also been associated with a number of non-oral health issues, from preterm labor during pregnancy to heart disease.
Jaffer Shariff, DDS, MPH, a postdoctoral resident in periodontology at Columbia University School of Dental Medicine (CDM) and lead author, noticed a possible link between frequent recreational cannabis use and gum disease during his residency at a community-based dental clinic in Manhattan.
"It is well known that frequent tobacco use can increase the risk of periodontal disease, but it was surprising to see that recreational cannabis users may also be at risk," said Dr. Shariff. "The recent spate of new recreational and medical marijuana laws could spell the beginning of a growing oral public health problem."
Dr. Shariff and colleagues from CDM analyzed data from 1,938 U.S. adults who participated in the Centers for Disease Control's 2011-2012 National Health and Nutrition Examination Survey, administered in collaboration with the American Academy of Periodontology. Approximately 27 percent of the participants reported using cannabis one or more times for at least 12 months.
Periodontal exams focus on a patient's gum tissue and connection to the teeth. Among other assessments, periodontists look for plaque, inflammation, bleeding, and gum recession. The clinician uses a probe to measure the space between teeth and their surrounding gum tissue. 
Healthy gums fit a tooth snugly, with no more than one to three millimeters of space, known as pocket depth, between the tooth and surrounding gum tissue. Deeper pockets usually indicate presence of periodontitis. 
Among the study participants, frequent recreational cannabis users had more sites with pocket depths indicative of moderate to severe periodontal disease than less frequent users.
"Even controlling for other factors linked to gum disease, such as cigarette smoking, frequent recreational cannabis smokers are twice as likely as non-frequent users to have signs of periodontal disease," said Dr. Shariff. "While more research is needed to determine if medical marijuana has a similar impact on oral health, our study findings suggest that dental care providers should ask their patients about cannabis habits."
Commenting on the study, Dr. Terrence J. Griffin, president of the American Academy of Periodontology, said, "At a time when the legalization of recreational and medical marijuana is increasing its use in the United States, users should be made aware of the impact that any form of cannabis can have on the health of their gums."

Tuesday, May 23, 2017

Dentists in good compliance with American Heart Association guidelines, according to Rochester epidemiology project



In the first study examining dental records in the Rochester Epidemiology Project, results show that dentists and oral surgeons are in good compliance with guidelines issued by the American Heart Association (AHA) in 2007, describing prophylactic antibiotic use prior to invasive dental procedures.

The Rochester Epidemiology Project is a collaboration of medical and dental care providers in Minnesota and Wisconsin. With patient agreement, the organizations link medical, dental, surgical procedures, prescriptions, and other health care data for medical research.

Prior to 2007, the AHA guidelines recommended prophylactic antibiotics for patients with cardiac conditions who were at moderate or high risk of developing infective endocarditis -- a potentially deadly infection of the heart valve. After 2007, AHA recommended that only high-risk patients receive the antibiotics. This group represents a very small fraction of the individuals receiving antibiotics before 2007, says Daniel DeSimone, M.D., study lead author and infectious diseases and hospital internal medicine physician at Mayo Clinic. The study will be released May 23 online in Mayo Clinic Proceedings.

Earlier studies by Dr. DeSimone's team determined the incidence of infective endocarditis in Olmsted County before and after 2007, using Rochester Epidemiology Project data. They found no significant increase in cases of infective endocarditis following the introduction of updated AHA guidelines.

However, "the major limitation of these studies was the lack of access to dental records," says Dr. DeSimone.

"The inclusion of dental records in the Rochester Epidemiology Project provides a unique opportunity unlike any population health database in the United States," he says.

"The primary criticism of the earlier studies was, 'Are dentists actually following the 2007 AHA guidelines, or do patients continue to receive antibiotics when no longer indicated?'" reports Dr. DeSimone. "How could we prove that dentists were actually following the guidelines, rather than assuming they were? Now we can."

Dr. DeSimone also says, there are a number of health risks for patients when taking antibiotics. "Plus overuse of antibiotics can result in increased bacterial resistance, which is a widespread public health problem," he says.

In addition, while the cost to patients might only be a few dollars a dose, Dr. DeSimone says that when added up, this group of moderate-risk patients could spend well over $100 million per year.

"Using the Rochester Epidemiology Project, we have shown that the new guidelines were very helpful in reducing unnecessary antibiotic use and related issues, without an increase in new cases of infective endocarditis."

Although this was the first study using the newly linked dental records, it was just one of more than 2,600 medical research publications using the Rochester Epidemiology Project. Using medical and dental records, researchers can identify what causes diseases and how patients with certain diseases respond to surgery, medication or other interventions. They also can determine what the future holds for patients with specific diseases or medical conditions.


Friday, May 19, 2017

Extra weight may increase dental risks


Being overweight or obese was linked with an increased likelihood of having poor oral health in a recent study.

In the study of 160 participants, those with BMI ?23 had generally more severe periodontitis, total inflammatory dental diseases, and leukocyte counts than normal weight individuals. Patients who were obese (BMI ?25) had almost a 6-times increased risk for severe periodontitis compared with normal weight participants. Altered inflammatory molecules that are associated with obesity may play a role.

The results are published in Oral Diseases.

Wednesday, May 10, 2017

Grape seed extract could extend life of resin fillings


A natural compound found in grape seed extract could be used to strengthen dentin -- the tissue beneath a tooth's enamel -- and increase the life of resin fillings, according to new research at the University of Illinois at Chicago College of Dentistry.

No filling lasts forever, whether it's composite-resin or amalgam. But dentists find amalgam -- a combination of mercury, silver, tin or other materials -- easier to use and less costly. Plus, it can last 10 to 15 years or more. Composite-resin fillings are more aesthetically pleasing because the mixture of plastic and fine glass particles can be colored to match a patient's teeth. However, the fillings typically last only five to seven years.

In research published in the Journal of Dental Research, Ana Bedran-Russo, associate professor of restorative dentistry, describes how grape seed extract can make composite-resin fillings stronger, allowing them to last longer. The extract, Bedran-Russo said, can increase the strength of the dentin, which comprises the majority of the calcified extracellular tissue of teeth, forming the layer just beneath the hard external enamel.

Dentin is mostly made of collagen, the main structural protein in skin and other connective tissues. Resins have to bind to the dentin, but the area between the two, or the interface, is a weak point, causing restorations to breakdown, Bedran-Russo said.

"When fillings fail, decay forms around it and the seal is lost. We want to reinforce the interface, which will make the resin bond better to the dentin," she said. "The interface can be changed through the use of new natural materials."

More than 90 percent of adults between the ages of 20 and 64 have cavities, according to a federal report. A cavity is a hole that forms in the tooth when acid produced by bacteria erodes the minerals faster than the tooth can repair itself. The dentist removes the decay, or caries, with a drill and seals the hole with a filling.

Secondary caries and margin breakdown are the most frequent causes of failed adhesive restorations, Bedran-Russo said. Despite numerous advances in dental restorative materials, degradation of the adhesive interface still occurs.

Bedran-Russo has discovered that damaged collagen can repair itself with a combination of plant-based oligomeric proanthocyanidins -- flavonoids found in most foods and vegetables -- and extracts from grape seeds. Interlocking the resin and collagen-rich dentin provides better adhesion and does not rely on moisture.

"The stability of the interface is key for the durability of such adhesive joints, and hence, the life of the restoration and minimizing tooth loss," Bedran-Russo said.

One of the possible benefits of using grape seed extract is that it prevents tooth decay, she said. She and Guido Pauli, professor of medicinal chemistry and pharmacognosy in the UIC College of Pharmacy, recently collaborated on another study that showed extract from the root bark of Chinese red pine trees has similar properties to the grape seed extract.

Wednesday, March 29, 2017

Gum disease, tooth loss may increase postmenopausal women's risk of death


Gum disease and tooth loss may be associated with a higher risk of death in postmenopausal women but not increased cardiovascular disease risk, according to new research in Journal of the American Heart Association, the open access journal of the American Heart Association/American Stroke Association.
Loss of all natural teeth also was linked with an increased risk of death in postmenopausal women, according to the study led by researchers at the University at Buffalo.
Periodontal disease, a chronic inflammatory disease of the gum and connective tissue surrounding the teeth, affects nearly two-thirds of U.S. adults 60 and older. The loss of all one's teeth, called edentulism, impacts about one-third of U.S. adults 60 and older and often results from periodontal disease.
"Beside their negative impact on oral function and dietary habits, these conditions are also thought to be related to chronic diseases of aging," said Michael J. LaMonte, PhD, study author and research associate professor of epidemiology and environmental health in UB's School of Public Health and Health Professions.
Researchers analyzed the health information from the Women's Health Initiative program -- a study of 57,001 women, 55 years and older.
"Previous studies included smaller sample sizes or had limited numbers of cardiovascular disease events for analysis. Ours is among the largest and focuses exclusively on postmenopausal women in whom periodontitis, total tooth loss and cardiovascular disease is high nationally," LaMonte said.
In 6.7-year follow up of postmenopausal women studied, they found:
  • There were 3,589 cardiovascular disease events and 3,816 deaths.
  • History of periodontal disease was associated with a 12 percent higher risk of death from any cause. 
  • Loss of all natural teeth was associated with a 17 percent higher risk of death from any cause. The risk of death associated with periodontal disease was comparable regardless of how often women saw their dentists.
  • Women who had lost their teeth were older, had more CVD risk factors, less education and visited the dentist less frequently compared to women with their teeth.
"Our findings suggest that older women may be at higher risk for death because of their periodontal condition and may benefit from more intensive oral screening measures," LaMonte said.
"However, studies of interventions aimed at improving periodontal health are needed to determine whether risk of death is lowered among those receiving the intervention compared to those who do not. Our study was not able to establish a direct cause and effect."

New research comes to terms with old ideas about canker sores


A burning pain sensation - and treatments that do not work. This is what daily life is like for many of those who suffer from recurrent aphthous stomatitis. Research from the Sahlgrenska Academy now sheds new light on the reasons behind this condition found in the mouth.
"There are many misconceptions regarding the reasons for the ulcers and the care of this patient category is hugely neglected despite the fact that many suffer a great deal from their symptoms. Patients may experience a general feeling of illness, and they have difficulties in eating and speaking and may not be able to go to school or work for several days due to the lesions," says Maria Bankvall, dentist and postdoctoral researcher in Odontology.
Mouth blisters, cold sores or apthae are words that are normally used to describe this specific type of lesion, which in medical terms is called recurrent aphthous stomatitis (RAS). The condition is considered one of the most common lesions of the oral mucosa found in the world today.
The lesions have a typical appearance with a red halo surrounding a whitish area, and they can appear anywhere in the non-keratinized mucosa, i.e., on the inside of the cheeks and lips, at the floor of the mouth, on the sides of the tongue and in the throat.
Lots of different causes
The lesions smart and burn and can be greatly disabling for anyone affected. Today there is no cure, instead treatment strategies are aimed at relieving the symptoms using none prescription and/or prescription drugs. 
"For a long time, it was believed that this condition was due to a virus, in the same way as mouth herpes, and many physicians and dentists treat aphthous stomatitis and herpes in the same way, also because it can be difficult to clinically distinguish the two conditions. The patient is often given anti-viral medication, which is a suitable treatment for herpes, but does not relieve aphthous stomatitis," says Maria Bankvall.
"RAS should probably not be regarded as a specific disease but as a general symptom of the body due to an imbalance similar to a headache or a fever," says Maria Bankvall. Her research points to the fact that there is great complexity and multiple interacting factors. 
Hereditary is an important factor as well as the bacterial flora in the mouth, our immune system and environmental factors. The thesis presents a theoretic frame for causality based on existing research and their own patient studies.
Genes and bacterial flora
A number of different genes have been identified as being of importance. The research also shows that the bacterial flora in the healthy oral mucosa seems to differ in people with RAS compared to healthy control subjects.
A certain sub-group of patients may also suffer from a food allergy, but we do not know that much about tolerance mechanisms in the mouth. The importance of the immune system in the oral cavity has also been studied in the thesis, initially with experiments on mice. 
"Today there is a great deal of knowledge regarding the two major conditions in the oral cavity, i.e., caries and periodontitis. However, there are still large information gaps when it comes to different types of oral mucosal lesions. Hopefully, our conclusions can contribute to increasing the knowledge regarding the most common lesions that affect this part of the mouth," says Maria Bankvall.

Friday, March 24, 2017

New study identifies successful method to reduce dental implant failure


UNIVERSITY OF PLYMOUTH
IMAGE
IMAGE: NEW NANOCOATING SHOWS PROMISE IN DENTAL IMPLANT PROTECTION. view more 
CREDIT: UNIVERSITY OF PLYMOUTH
According to the American Academy of Implant Dentistry (AAID), 15 million Americans have crown or bridge replacements and three million have dental implants -- with this latter number rising by 500,000 a year. The AAID estimates that the value of the American and European market for dental implants will rise to $4.2 billion by 2022.
Dental implants are a successful form of treatment for patients, yet according to a study published in 2005, five to 10 per cent of all dental implants fail.
The reasons for this failure are several-fold - mechanical problems, poor connection to the bones in which they are implanted, infection or rejection. When failure occurs the dental implant must be removed.
The main reason for dental implant failure is peri-implantitis. This is the destructive inflammatory process affecting the soft and hard tissues surrounding dental implants. This occurs when pathogenic microbes in the mouth and oral cavity develop into biofilms, which protects them and encourages growth. Peri-implantitis is caused when the biofilms develop on dental implants.
A research team comprising scientists from the School of Biological Sciences, Peninsula Schools of Medicine and Dentistry and the School of Engineering at the University of Plymouth, have joined forces to develop and evaluate the effectiveness of a new nanocoating for dental implants to reduce the risk of peri-implantitis.
The results of their work are published in the journal Nanotoxicology.
In the study, the research team created a new approach using a combination of silver, titanium oxide and hydroxyapatite nanocoatings.
The application of the combination to the surface of titanium alloy implants successfully inhibited bacterial growth and reduced the formation of bacterial biofilm on the surface of the implants by 97.5 per cent.
Not only did the combination result in the effective eradication of infection, it created a surface with anti-biofilm properties which supported successful integration into surrounding bone and accelerated bone healing.
Professor Christopher Tredwin, Head of Plymouth University Peninsula School of Dentistry, commented: "In this cross-Faculty study we have identified the means to protect dental implants against the most common cause of their failure. The potential of our work for increased patient comfort and satisfaction, and reduced costs, is great and we look forward to translating our findings into clinical practice."
The University of Plymouth was the first university in the UK to secure Research Council Funding in Nanoscience and this project is the latest in a long line of projects investigating nanotechnology and human health.
Nanoscience activity at the University of Plymouth is led by Professor Richard Handy, who has represented the UK on matters relating to the Environmental Safety and Human Health of Nanomaterials at the Organisation for Economic Cooperation and Development (OECD). He commented: "As yet there are no nano-specific guidelines in dental or medical implant legislation and we are, with colleagues elsewhere, guiding the way in this area. The EU recognises that medical devices and implants must: perform as expected for its intended use, and be better than similar items in the market; be safe for the intended use or safer than an existing item, and; be biocompatible or have negligible toxicity."
He added: "Our work has been about proving these criteria which we have done in vitro. The next step would be to demonstrate the effectiveness of our discovery, perhaps with animal models and then human volunteers."
Dr Alexandros Besinis Lecturer in Mechanical Engineering at the School of Engineering, University of Plymouth, led the research team. He commented: "Current strategies to render the surface of dental implants antibacterial with the aim to prevent infection and peri-implantitis development, include application of antimicrobial coatings loaded with antibiotics or chlorhexidine. However, such approaches are usually effective only in the short-term, and the use of chlorhexidine has also been reported to be toxic to human cells. The significance of our new study is that we have successfully applied a dual-layered silver-hydroxyapatite nanocoating to titanium alloy medical implants which helps to overcome these risks."