Wednesday, April 18, 2018

Statins save lives of people with high levels of LDL cholesterol

Cholesterol-lowering drugs are more likely to save thousands of additional lives when used in people with higher levels of LDL cholesterol, or "bad" cholesterol, according to a new study from the University of Iowa, published in the Journal of the American Medical Association (JAMA).

Jennifer Robinson, a physician, professor of epidemiology in the UI College of Public Health, and study coauthor, says the findings show that doctors should more aggressively treat patients who have high levels of LDL cholesterol with statins, and patients should feel safe using them.

"Statins are the safest drugs we have to reduce the risk of heart attacks, strokes, and death in a wide range of patients," says Robinson. "Patients with higher LDL cholesterol levels are likely to experience even greater health benefits from taking statins and some of the newer cholesterol drugs."

The study analyzed 34 previous studies that involved more than 270,000 participants. The analysis found that statins were more likely to reduce the risk of death when LDL cholesterol levels were 100 milligrams per deciliter (mg/dl) or greater, whether or not they were used with other LDL-lowering drugs.

Robinson says the study found the lives of an additional 4.3 in 1,000 people were saved every year when treated with LDL cholesterol lowering therapy. The greatest benefit--and the greatest reduction in death rates--came to those with the highest levels of LDL cholesterol, she says.

LDL cholesterol causes fat and plaque to build up in arteries, increasing the risk for heart attacks and strokes. Levels below 100 mg/dl are considered optimal, as people with that reading are less likely to develop cholesterol plaques as they age. Readings above 100 mg/dl are considered unhealthy.

Given that 12.4 percent of American adults--or about 30 million people--have LDL levels above 160 mg/dl, Robinson says the findings show statins save tens of thousands of lives annually.

"Unfortunately, most Americans with higher cholesterol levels are not treated, and lives are unnecessarily being lost," she says.

Those with excess LDL can reduce their levels through an improved diet, increased exercise, and by taking medications such as statins. People who already have cardiovascular disease or genetic causes of high cholesterol also may benefit from adding other LDL-lowering drugs to statin therapy.

The study shows that LDL-lowering drugs can be effective for preventing heart attacks and stroke in people with risk factors even when LDL cholesterol levels are low, but even more heart attacks and death are prevented when people have LDL levels above 100 mg/dl.

The study, "Lipid lowering and mortality and cardiovascular outcomes," was published in the April 3, 2018, issue of JAMA





Ibuprofen, acetaminophen more effective than opioids in treating dental pain




Opioids are not among the most effective--or longest lasting--options available for relief from acute dental pain, a new examination of the results from more than 460 published studies has found.

Ibuprofen and other nonsteroidal anti-inflammatory drugs (NSAIDs) alone or in combination with acetaminophen are better at easing dental pain, according to new research conducted with the School of Dental Medicine at Case Western Reserve University.

The study examining relief of acute pain in dentistry--recently featured on the cover of The Journal of the American Dental Association--evaluated the safety and efficacy of dozens of pain-relief options.
"What we know is that prescribing narcotics should be a last resort," said Anita Aminoshariae, an associate professor in the dental school's Department of Endodontics and one of the study's authors.

Each day, more than 115 Americans die as a result of an opioid overdose, according to the National Institutes of Health.

"No patient should go home in pain," Aminoshariae said. "That means that opioids are sometimes the best option, but certainly should not be the first option."

Aminoshariae said the goal of the systematic review was to summarize data--using five in- depth studies--of the effectiveness of oral-pain medications.

"The best available data suggests that the use of nonsteroidal medications, with or without acetaminophen, offers the most favorable balance between benefits and harms, optimizing efficacy while minimizing acute adverse events," she said.
She cited the national opioid epidemic as one of many reasons why health-care providers should take note of the findings.

The research found that, for adults, a combination of 400 milligrams of ibuprofen and 1,000 milligrams of acetaminophen was superior to any opioid-containing medications studied.

"Our aim was to create a compendium detailing both the benefits and harms of these medications as a resource for dentists to use in their clinical decision-making," Aminoshariae added.

The study also found that opioids or drug combinations that included opioids accounted for the most adverse side effects--including drowsiness, respiratory depression, nausea/vomiting and constipation--in both children and adults.

Peptide-based biogenic dental product may cure cavities



Researchers at the University of Washington have designed a convenient and natural product that uses proteins to rebuild tooth enamel and treat dental cavities.

The research finding was first published in ACS Biomaterials Science and Engineering.

"Remineralization guided by peptides is a healthy alternative to current dental health care," said lead author Mehmet Sarikaya, professor of materials science and engineering and adjunct professor in the Department of Chemical Engineering and Department of Oral Health Sciences.

The new biogenic dental products can -- in theory -- rebuild teeth and cure cavities without today's costly and uncomfortable treatments.

"Peptide-enabled formulations will be simple and would be implemented in over-the-counter or clinical products," Sarikaya said.

Cavities are more than just a nuisance. According to the World Health Organization, dental cavities affect nearly every age group and they are accompanied by serious health concerns. Additionally, direct and indirect costs of treating dental cavities and related diseases have been a huge economic burden for individuals and health care systems.

"Bacteria metabolize sugar and other fermentable carbohydrates in oral environments and acid, as a by-product, will demineralize the dental enamel," said co-author Sami Dogan, associate professor in the Department of Restorative Dentistry at the UW School of Dentistry.

Although tooth decay is relatively harmless in its earliest stages, once the cavity progresses through the tooth's enamel, serious health concerns arise. If left untreated, tooth decay can lead to tooth loss. This can present adverse consequences on the remaining teeth and supporting tissues and on the patient's general health, including life-threatening conditions.

Good oral hygiene is the best prevention, and over the past half-century, brushing and flossing have reduced significantly the impact of cavities for many Americans. Still, some socio-economic groups suffer disproportionately from this disease, the researchers said. And, according to recent reports from the Centers for Disease Control and Prevention, the prevalence of dental cavities in Americans is again on the rise, suggesting a regression in the progress of combating this disease.

Taking inspiration from the body's own natural tooth-forming proteins, the UW team has come up with a way to repair the tooth enamel. The researchers accomplished this by capturing the essence of amelogenin -- a protein crucial to forming the hard crown enamel -- to design amelogenin-derived peptides that biomineralize and are the key active ingredient in the new technology. The bioinspired repair process restores the mineral structure found in native tooth enamel.

"These peptides are proven to bind onto tooth surfaces and recruit calcium and phosphate ions," said Deniz Yucesoy, a co-author and a doctoral student at the UW.

The peptide-enabled technology allows the deposition of 10 to 50 micrometers of new enamel on the teeth after each use. Once fully developed, the technology can be used in both private and public health settings, in biomimetic toothpaste, gels, solutions and composites as a safe alternative to existing dental procedures and treatments.

The technology enables people to rebuild and strengthen tooth enamel on a daily basis as part of a preventive dental care routine. It is expected to be safe for use by adults and children.

Monday, April 16, 2018

Effective school-based cavity prevention program


School-based prevention programs can substantially reduce children's cavities - but what type of treatment should be delivered in schools to best prevent tooth decay?
A new study by researchers at NYU College of Dentistry, published in the journal BMC Oral Health, suggests that cavity prevention programs with a combination of prevention strategies may be more effective than one alone for reducing tooth decay.
Dental cavities are the world's most prevalent childhood disease, affecting nearly 30 percent of school-age children and 50 percent of rural, minority, or Medicaid-receiving children in the United States.
School-based cavity prevention programs have emerged as an important way to improve access to dental services. In medically underserved areas, these programs often serve as the sole source of dental care for children. While the American Dental Association supports the use of school-based cavity prevention programs, questions remain on the optimal mix of treatment services, intensity, and frequency of care.
"Given the high variability in school-based programs to prevent cavities, comparing the effectiveness of different prevention agents, frequency of care, or intensity of treatment can lead to optimal program design," said Ryan Richard Ruff, MPH, PhD, assistant professor of Epidemiology & Health Promotion at NYU Dentistry and the study's lead author.
In this study, NYU Dentistry researchers compared two cavity prevention programs in elementary schools serving more than 8,200 students over 10 years (2004-2014). Both programs provided school-based care twice a year to children ages 5 to 12.
One program provided sealants on molars (primary prevention) while the other provided sealants on all teeth and interim therapeutic restorations (primary and secondary prevention). Interim therapeutic restorations are a minimally-invasive method for controlling tooth decay by filling a cavity with a fluoride?releasing agent. Interim therapeutic restorations are intended to bridge the gap between identifying a cavity, particularly in a nontraditional setting or in a very young child, and having the cavity filled or crowned in a more permanent procedure.
Both school-based cavity prevention programs reduced the risk of untreated decay over time. While the total number of all decayed or filled teeth observed over the course of the study increased across both programs, the comprehensive program that provided primary and secondary prevention significantly lowered the rate of new and untreated cavities when compared to only sealants on molars.
"A comprehensive cavity prevention program, particularly for children without regular access to dental care, can be significantly better than the traditional molar sealant programs," said Richard Niederman, DMD, professor and chair of the Department Epidemiology & Health Promotion at NYU Dentistry and the study's coauthor.
Ruff and Niederman are continuing to study how to optimize school-based cavity prevention. They are currently leading two large studies - a PCORI-funded study in the Bronx and an NIH-funded study in New Hampshire - to compare two cavity prevention techniques in school-based dental programs. One technique is a more complex treatment similar to the combined primary and secondary prevention, but the Bronx and New Hampshire studies will also introduce the use of silver diamine fluoride, a non-invasive, cavity-fighting liquid that is painted onto teeth to halt the progression of tooth decay. The cavity prevention programs will begin in schools in the fall of 2018.

Monday, April 2, 2018

People with diabetes visit the dentist less frequently despite link between diabetes, oral health


Adults with diabetes are less likely to visit the dentist than people with prediabetes or without diabetes, finds a new study led by researchers at NYU Rory Meyers College of Nursing and East Carolina University's Brody School of Medicine.

The study, published in The Journal of the American Dental Association, showed an overall decline in dental visits among adults with and without diabetes, but people with diabetes were consistently the least likely to obtain oral healthcare.

Research has shown a two-way relationship between diabetes and oral health. People with diabetes are at an increased risk for periodontal disease, a chronic inflammation of the gums and surrounding tissue and bone, while periodontal disease has an adverse effect on blood glucose control - which can contribute to the progression of diabetes. In fact, periodontal disease has been called the "sixth complication" of diabetes after issues like kidney disease, damage to the retina, and heart disease.

"For people living with diabetes, regular dental check-ups - paired with proactive dental and diabetes self-care - are important for maintaining good oral health. Regular dental visits provide opportunities for prevention, early detection, and treatment of periodontal disease, which can potentially help with blood glucose control and preventing complications from diabetes," said Bei Wu, PhD, Dean's Professor in Global Health and director of Global Health & Aging Research at NYU Meyers and the study's senior author.

Older studies have shown that individuals with diabetes had fewer dental visits than those without diabetes. In order to have an updated understanding of dental visits among people with diabetes, this study assessed the trends of annual dental visits from 2004 to 2014 in adults with diabetes, prediabetes, and without diabetes, and assessed racial and ethnic disparities in dental visits.

The researchers used data from the Behavioral Risk Factor Surveillance System, an annual telephone survey of U.S. adults during which respondents are asked whether or not they had a dental visit in the past 12 months and whether they were ever diagnosed with diabetes or prediabetes. The study sample included 2.5 million adults age 21 years and older, including 248,203 people with diabetes, 30,520 with prediabetes, and 2,221,534 without diabetes.

The researchers found that people with diabetes were the least likely to visit the dentist, followed by people with prediabetes. From 2004 to 2014, the proportion of annual dental visits declined from 66.1 percent to 61.4 percent among people with diabetes, 66 percent to 64.9 percent among people with prediabetes, and 71.9 percent to 66.5 percent among people without diabetes.

"This pattern is concerning, given that timely dental care is essential for good oral health, especially in individuals with diabetes. Those who need dental care the most seem to be the least likely to have it," said study author Huabin Luo, PhD, of East Carolina University.

Several factors may account for the underutilization of dental services by people with diabetes, according to the researchers. People may not be aware of the impact of diabetes on their oral health and vice versa. In addition, in a previous study, individuals with diabetes more frequently reported the cost of dental care as a reason for avoiding routine visits.

The researchers also observed racial and ethnic disparities in dental care. Black and Hispanic individuals were less likely to visit the dentist than were white people, and these disparities persisted over the decade studied. Males and single people were also less likely to regularly visit the dentist than females and married people.

While the study did not measure whether individuals had dental insurance, the researchers found substantial financial barriers to dental services for people with diabetes based comparing dental visits and income levels. The researchers assert that reducing these barriers and improving access to dental providers is needed, especially among people with diabetes and prediabetes.

"Healthcare providers and public health professionals should promote oral health in diabetes management and encourage people with diabetes to visit a dentist at least annually. Increasing access to dental services is vital to achieving this goal," said Wu, who is also co-director of the NYU Aging Incubator.

Monday, March 26, 2018

Associations between longitudinal beverage intakes and adolescent caries

At the 47th Annual Meeting of the American Association for Dental Research (AADR), held in conjunction with the 42nd Annual Meeting of the Canadian Association for Dental Research (CADR), Teresa A. Marshall, University of Iowa College of Dentistry, Iowa City, presented an oral session titled "Associations Between Longitudinal Beverage Intakes and Adolescent Caries." The AADR/CADR Annual Meeting is in Fort Lauderdale, Fla., USA from March 21-24, 2018. "Sugar-sweetened beverages (SSB) are the most relevant dietary risk factor for caries in young children, but there has not been as much research done on adolescent caries. Our objective was to assess associations between longitudinal beverage intakes and adolescent caries experience, adjusting for known caries-preventive factors," said Marshall.
Area-under-the-curve daily beverage and fluoride intakes of Iowa Fluoride Study participants were calculated for ages 0.5-17 years from questionnaire-reported intakes of milk, 100% juice, sugar-sweetened beverages (SSB) and water-based sugar-free beverages. Dental exams were completed when the participant reached 17 years old.
The results show that higher SSB intake and lower brushing frequency were significant predictors of the caries. In multivariable models including all beverages, higher SSB and lower juice intakes were also significant predictors of caries.
"The observed associations of sugar-sweetened beverages and juice with caries are consistent with previous studies. The relationship between SSB and caries was reduced by tooth brushing and fluoride intake, and suggests an association between beverage intakes and oral health behaviors. To accurately estimate the effect of SSB on caries, future studies should adjust for preventive factors including brushing frequency and fluoride intake," said Marshall.

Thursday, March 22, 2018

Middle-aged tooth loss linked to increased coronary heart disease risk Amer


Losing two or more teeth in middle age is associated with increased cardiovascular disease risk, according to preliminary research presented at the American Heart Association's Epidemiology and Prevention | Lifestyle and Cardiometabolic Health Scientific Sessions 2018, a premier global exchange of the latest advances in population based cardiovascular science for researchers and clinicians.

Studies have shown that dental health problems, such as periodontal disease and tooth loss, are related to inflammation, diabetes, smoking and consuming less healthy diets, according to study author Lu Qi, M.D., Ph.D., professor of epidemiology at Tulane University in New Orleans.

"Previous research has also found that dental health issues are associated with elevated risk of cardiovascular disease," Qi said. "However, most of that research looked at cumulative tooth loss over a lifetime, which often includes teeth lost in childhood due to cavities, trauma and orthodontics. Tooth loss in middle age is more likely related to inflammation, but it hasn't been clear how this later-in-life tooth loss might influence cardiovascular disease risk."

In a collaborative research effort between Tulane University School of Public Health and Tropical Medicine and Harvard T.H. Chan School of Public Health, Qi and colleagues analyzed the impact of tooth loss in large studies of adults, aged 45 to 69 years, in which participants had reported on the numbers of natural teeth they had, then in a follow-up questionnaire, reported recent tooth loss.

Adults in this analysis didn't have cardiovascular disease when the studies began. The researchers prospectively studied the occurrence of tooth loss during an eight-year period and followed an incidence of cardiovascular disease among people with no tooth loss, one tooth lost and two or more teeth lost over 12-18 years.

They found:
  • Among the adults with 25 to 32 natural teeth at the study's start, those who lost two or more teeth had a 23 percent increased risk of cardiovascular disease, compared to those with no tooth loss.
  • The increased risk occurred regardless of reported diet quality, physical activity, body weight and other cardiovascular risk factors, such as high blood pressure, high cholesterol and diabetes.
  • There wasn't a notable increase in cardiovascular disease risk among those who reported losing one tooth during the study period.
  • Cardiovascular disease risk among all the participants (regardless of the number of natural teeth at the study's start) increased 16 percent among those losing two or more teeth during the study period, compared to those who didn't lose any teeth.
  • Adults with less than 17 natural teeth, versus 25 to 32, at the study's start, were 25 percent more likely to have cardiovascular disease.
"In addition to other established associations between dental health and risk of disease, our findings suggest that middle-aged adults who have lost two or more teeth in recent past could be at increased risk for cardiovascular disease," Qi said. "That's regardless of the number of natural teeth a person has as a middle-aged adult, or whether they have traditional risk factors for cardiovascular disease, such as poor diet or high blood pressure."

Armed with the knowledge that tooth loss in middle age can signal elevated cardiovascular disease risk, adults can take steps to reduce the increased risk early on, he said.

A limitation of the study was that participants self-reported tooth loss, which could lead to misclassification in the study, according to Qi.