Friday, November 17, 2017

Methodologies in orthodontic pain management: A review

                     


Patients experience pain and discomfort during active orthodontic treatment with fixed appliances. It can vary from person to person and is influenced by certain factors such as age, gender, previous pain experiences, stress or anxiety, and type of appliance.

The objective of this literature review was to discuss conventional versus recently introduced treatment modalities used in pain management for orthodontic patients.

According to the reviewed articles, both pharmacological and non-pharmacological methods were introduced in orthodontic pain management. However, orthodontists must use their best professional judgment to assess each case individually and select an appropriate treatment modality based on pain threshold level of an individual.

Research Key Points
  • Effective orthodontist-patient communication and targeted nutritional guidance may help in preventing pain and discomfort experienced by the patients to some extent.
  • However, based on the available literature, analgesics remained the effective and routine methodology of pain management.
  • Some clinicians supported that NSAIDs such as Ibuprofen had no impact on tooth movements as they were administered in lower doses and for a shorter duration. Hence, Ibuprofen was considered a safe and effective drug compared to other NSAIDs. On the contrary, other authors declared a delay in orthodontic tooth movements as a result of NSAID intake.
  • Another investigation supported that paracetamol (acetaminophen) was considered the safest NSAID that had no influence on the range of tooth movements as well as root resorption. However, much of what has been published on this subject is still controversial.
  • Moreover, while prescribing analgesics, orthodontists must be aware of the pharmacological action as well as the pros and cons related to each drug.
  • Nevertheless, pain management is a complex phenomenon. Therefore, further investigations combining different methods of orthodontic pain control with appropriate study designs and large sample sizes are required to improve the quality of evidence.

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For more information about the article, please visit https://benthamopen.com/ABSTRACT/TODENTJ-11-492
  • Reference: Hussain AS, et al. Methodologies in Orthodontic Pain Management: A Review. The Open Dentistry Journal, 2017, Vol 11, DOI: 10.2174/1874210601711010492

Tooth cavities can be fought 'naturally'


A new discovery may one day lead to natural anti­cavity products, researchers report.

The scientists from West China School of Stomatology and Academic Centre for Dentistry Amsterdam have figured out the main active ingredient of Galla Chinensis, a natural herb, and further improved its anti-caries efficacy. The finding is published in The Open Dentistry Journal.

To maintain a healthy mouth, the oral environment must be relatively neutral. When the environment in the mouth becomes more acidic, dental cavities or other disorders may develop. Galla Chinensis was revealed to inhibit the acid production of caries-associated bacteria as well as make teeth more resistant to acidic attack.

The research team of West China School of Stomatology has tested hundreds of Chinese herbs and identified that Galla Chinensis has a strong potential to prevent dental caries due to its antibacterial capacity and tooth mineralization benefit. Galla Chinensis also possesses substantial antiviral, anticancer, hepatoprotective, antidiarrheal and antioxidant activities. However, the main active ingredient of Galla Chinensis is unknown, which restricts the application in dentistry.

In the present study, several Galla Chinensis extracts with different main ingredients were obtained and determined by liquid chromatography-mass spectrometry (LC-MS) analysis. The antibacterial capacity was determined using the polymicrobial biofilms model, which can generate reproducible plaque-like biofilms that occur in vivo. The effect of inhibiting tooth demineralization was tested using an in vitro pH-cycling regime, which mimicked the periodic pH change in mouth.

"Medium molecular weight gallotannins are the most active constituent in terms of caries prevention" concluded Xuelian Huang, PhD, DDS, the lead author.

In dental caries, significant reductions in caries prevalence and incidence have been made by the introduction of fluoride. It is not a total cure, however, and there is still a need to seek products complementary to fluoride. With these new findings, the research team is working with the industry to develop new oral care products.
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For more information about the article, please visit https://benthamopen.com/ABSTRACT/TODENTJ-11-447
Reference: Zhou X, et al. Comparison of Composition and Anticaries Effect of Galla Chinensis Extracts with Different Isolation Methods. The Open Dentistry Journal, 2017, Vol 11, DOI: 10.2174/1874210601711010447

Naturally occurring molecule may help prevent and treat atherosclerosis and gum disease

                    

Resolvin E1, a molecule produced naturally in the body from an omega -3 fish oil, topically applied on gum tissues not only prevents and treats gum disease as previously shown (Hasturk et al 2006 and 2007), but also decreases the likelihood for advanced arterial atherosclerotic plaques to rupture and form a dangerous thrombus or blood clot.

The findings, which appear in the journal Current Atherosclerosis Reports, could lead to effective preventive and therapeutic treatments in people with heart disease and/or gum disease without unwanted side effects.

Inflammation is a key pathology of atherosclerosis and may be a major driving force for heart attacks and stroke. There is increasing evidence from numerous research groups that chronic inflammatory diseases including, diabetes, heart disease, rheumatoid arthritis, colitis, pulmonary and kidney diseases, cancer and Alzheimer's disease can benefit by the use of the pro-resolving lipid mediators, resolvins and lipoxins.

To test the effectiveness of lipid mediators on advanced atherosclerosis, researchers from Boston University School of Medicine (BUSM) and The Forsyth Institute used two groups of an experimental model that possessed highly inflamed advanced atherosclerosis.

The first group was treated with a solution applied on gum tissues that contained Resolvin E1 while the second group was treated with salt water as a control.

The group treated with the inflammation-lowering lipid mediator (Resolvin E1) had minimal atherosclerosis and reduced plaque rupture in their aortic artery, while atherosclerosis advanced to more severe form of the disease in the control (salt water) group.

"Current therapies for advanced atherosclerosis are inadequate and often carry high risks, and the Resolvin E1 therapy could provide a very effective and safe therapy that can be taken daily, which would also serve as a preventive approach for plaque inflammation and acute clinical events of heart attack and stroke," explained corresponding author James A. Hamilton, PhD, professor of physiology and biophysics and research professor of medicine at BUSM.

The researchers believe these findings support a paradigm shift in the treatment of both localized and systematic inflammatory conditions that are increasingly prevalent in type 2 diabetes and obesity and may be applicable to other chronic inflammatory diseases.


Wednesday, November 15, 2017

Treating gum disease may help lower blood pressure

                     

Treatment for gum disease, or periodontitis, significantly lowered blood pressure among Chinese patients at risk for developing high blood pressure, according to preliminary research presented at the American Heart Association's Scientific Sessions 2017, a premier global exchange of the latest advances in cardiovascular science for researchers and clinicians.

This small study compared blood pressure levels after standard and intensive treatment for gum disease. The standard treatment included basic oral hygiene instructions and teeth cleaning with plaque removal above the gum line. The intensive treatment included the standard treatment along with cleaning down to the roots with local anesthesia, antibiotic treatment and dental extractions, if necessary.

Researchers found:

  • One month after treatment, systolic blood pressure was nearly 3 points lower in participants receiving intensive treatment, but no significant difference was observed in diastolic blood pressure.
  • Three months after treatment, systolic blood pressure was nearly 8 points lower and diastolic pressure was nearly 4 points lower in patients receiving intensive treatment.
  • Six months after treatment, systolic blood pressure was nearly 13 points and diastolic blood pressure was almost 10 points lower in patients receiving intensive treatment.
"The present study demonstrates for the first time that intensive periodontal intervention alone can reduce blood pressure levels, inhibit inflammation and improve endothelial function," said study lead author Jun Tao, M.D., Ph.D., chief of the department of Hypertension and Vascular Disease and director of the Institute of Geriatrics Research at The First Affiliated Hospital of Sun Yat-sen University in Guangzhou, China.

Study participants included 107 Chinese women and men age 18 years and over with prehypertension and moderate to severe gum disease. Through random assignment, half of the participants received standard treatment and half received intensive treatment for gum disease.

Researchers noted additional research with patients from diverse backgrounds is needed.
In the United States, high blood pressure affects 29.1 percent of adults aged 18 and over in 2011 - 2012. High blood pressure is a major risk factor for heart and blood vessel disease. Fortunately, most people can manage the disease through diet and lifestyle changes, such as quitting smoking, maintaining a healthy weight, being physically active, limiting alcohol and taking prescribed medications properly.

Thursday, November 9, 2017

A focus on dental health can protect children from developing overweight

                    


Talking about dental health with children and parents - about what is healthy and unhealthy for your teeth - can be one way to prevent children from developing overweight. This is suggested in a thesis from Sahlgrenska Academy, Sweden, on children's diet, BMI and well-being.
"Weight can be a sensitive subject, but if you talk about eating behaviors alongside dental health, you're looking at the issue from a different angle," confirms Louise Arvidsson, registered dietitian and PhD student at the Institute of Medicine.
In one of her sub-studies, she reviewed eating behavior, BMI and dental health of 271 pre-school and primary school children in Sweden. The children's height, weight, and food intake over one day were compared with the prevalence of cariogenic microorganisms in saliva - and the link was clear: The children who had higher amount of caries bacteria also had significantly higher BMI and worse eating habits. They ate more frequently and consumed more foods rich in sugar.
"There is absolutely a possibility to catch these children and talk about food habits, specifically in Sweden where the dentists meets with them at an early age, but this needs a good level of collaboration between the general dentistry, the child health care and schools," says Louise Arvidsson.
With good food comes increased self-esteem, better relationships with friends and fewer emotional problems, Louise confirms in a different sub-study. Children that to a higher extent followed general dietary recommendations - wholegrain products, 400-500 grams of fruit and vegetables per day, fish two to three times a week and a low intake of sugar and saturated fat - reported better mental well-being.
The effects were achieved regardless of socio-economic background, and regardless of the children's weight. Her research further shows that good self-esteem could be linked to the healthier eating habits, two years later. A healthy diet and mental well-being might therefore be considered to interact, in a positive spiral.
"We know that adults with depression feel better if, in addition to other treatment, they also meet with a dietitian. The question is whether a healthy diet can have effect also in young children. There has been a lot of focus on physical activity and mental health in children, but diet is an increasingly recognized aspect," says Louise Arvidsson.
The entire thesis is based on data from a large European study, Idefics (with the University of Gothenburg having primary responsibility for Sweden's participation), the aim of which is to document and prevent childhood obesity.
In her thesis, Louise has also highlighted what does not work in protecting children from becoming overweight. Children between the age of 2-10 who were stopped from eating by their parents were generally overweight 5-6 years later.
"It clearly doesn't work, stopping your child from eating too much, or putting them on a diet, as some people were convinced. You really have to look at other methods to control a child's eating habits," says Arvidsson.
"Are you offering carrots as snacks, or both carrots and biscuits? What you eat at home is a very important question, and that you yourself try to make healthy choices. Children do as we do, not as we say."
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Title: Diets of European children, with focus on BMI, well-being, and families

Tuesday, November 7, 2017

Dental X-rays reveal Vitamin D deficiency



Human teeth hold vital information about Vitamin D deficiency, a serious but often hidden condition that can now be identified by a simple dental X-ray, McMaster anthropologists Lori D'Ortenzio and Megan Brickley have found.

Their research appears today in the International Journal of Paleopathology.

The researchers and their colleagues had previously discovered that human teeth hold a detailed and permanent record of serious Vitamin D deficiency, or rickets. That record takes the form of microscopic deformities in dentin, the material that makes up the mass of the tooth, and can be extremely valuable for understanding precisely when people, even those who lived centuries ago, were deprived of sunlight, the main source of Vitamin D.

The record is preserved by enamel, which protects teeth from breaking down, unlike bones, which are subject to decay.

The problem with looking for such deformities is that a tooth must be cut open to read the patterns that form a lifetime's Vitamin D record, and the supply of post-mortem teeth available for study is limited.

To avoid wasting precious specimens, the researchers went looking for a way to isolate teeth for further study. By using X-rays to study the readily observable shapes of the "pulp horns" -- the dark shadow at the centre of the image of a tooth -- they found a consistent, recognizable pattern that could prove helpful not only to their studies of archaeological teeth, but to living people who may not realize they are suffering from Vitamin D deficiency.

"We were looking for a non-destructive method so we wouldn't need to destroy precious archaeological material to see if there had been a deficiency," says D'Ortenzio, a PhD candidate in anthropology and lead author of the paper. "Now we know which teeth to look at."

The pulp shape in a healthy person's tooth resembles an arch topped by two cat ears, while the pulp shape of a person who has had a severe deficiency of Vitamin D is asymmetrical and constricted, and typically looks like the profile of a hard-backed chair.

D'Ortenzio and Brickley's previous research had suggested such a recognizable pattern, and their examination of both historic and current teeth proved that X-ray images are consistent and reliable indicators of prior deficiency.

"It was a real Eureka! It wasn't just that it looked different. It was different," says Brickley, a Professor of Anthropology who holds the Canada Research Chair in the Bioarchaeology of Human Disease. "I think it's really important. It was a piece of work that aimed to look more at past individuals, but it has the potential to contribute to modern health care as well."

Since the consequences of Vitamin D deficiency can be severe - especially in terms of bone health - knowing who has had a deficiency can help identify people who may have ongoing issues in time to prevent worse damage, the researchers say. If regular dental X-rays show a problem, blood tests can confirm whether there is an ongoing deficiency.

Such evidence could be particularly valuable in the case of children whose bones are still growing, the researchers say, and spotting a problem early could head off future problems with Vitamin-D related bone deficiency.

Knowing more about ongoing Vitamin D deficiency can also help to determine what is the best balance between protecting people from harmful UV rays and making sure they get enough sun to maintain a healthy level of the vital nutrient.

Monday, November 6, 2017

Dental filling failure linked to smoking, drinking and genetics

                     


New research shows that people who drink alcohol or men who smoke are more likely to suffer a failed dental filling. Strikingly, the research team also found that a genetic difference in some patients is associated with increased filling failure rates. The study, published today in open-access journal Frontiers in Medicine, also shows no major difference in filling failure rates between traditional amalgam and newer composite resin fillings. The results suggest that genetic analysis might help dentists to personalize treatments for their patients, which could lead to improved outcomes.

Fillings can fail for a variety of reasons, including reemergence of the initial tooth decay or the filling becoming detached. Until now, the jury has been out on whether newer composite resin fillings are as durable as traditional amalgam fillings, which have been in use for more than 150 years but which contain mercury, a toxic metal.

To investigate this, researchers from America and Brazil accessed a large repository of dental records from a dental school in Pittsburgh, which contained information on patient fillings and rates of failure up to five years after the filling procedure.

The researchers found that overall, there were no major differences between patients receiving amalgam or composite fillings in terms of filling failure rates. This suggests that composite fillings are at least as durable as amalgam fillings, and offer a viable alternative with no toxic ingredients.

The repository also contained information about patient lifestyles, including smoking and drinking habits, and a DNA sample from each patient -- allowing the team to investigate whether patient lifestyle and genetic factors could affect the failure rate of composite fillings.

The team found that within two years of the procedure, fillings failed more often in patients who drank alcohol, and the overall filling failure rate was higher in men who smoked. Furthermore, a difference in the gene for matrix metalloproteinase (MMP2), an enzyme found in teeth, was linked to increased filling failure.

The researchers hypothesize that MMP2 might be able to degrade the bond between the filling and the tooth surface, potentially leading to failure. While this link and preliminary hypothesis are intriguing, the researchers have not yet confirmed whether differences in the MMP2 gene are responsible for failed fillings, and will need to investigate this further. However, the results suggest that personal factors for each patient appear to influence their chance of filling failure, rather than the filling material their dentist used.

"A better understanding of individual susceptibility to dental disease and variation in treatment outcomes will allow the dental field to move forward," says Alexandre Vieira, a researcher involved in the study. "In the future, genetic information may be used to personalize dental treatments and enhance treatment outcomes."