Friday, June 20, 2008

Teeth and Jewelry = Bad Mix

Skin piercings might be the rage among teens, but researchers from Tel Aviv University have found good reasons to think twice about piercing one’s tongue or lip.

Dr. Liran Levin, a dentist from the Department of Oral Rehabilitation, School of Dental Medicine at Tel Aviv University has found that about 15 to 20 percent of teens with oral piercings are at high risk for both tooth fractures and gum disease. Resulting tooth fractures as well as periodontal problems, he says, can lead to anterior (front) tooth loss later in life.

High rates of fractures due to piercings are not found in other age groups, and cases of severe periodontal damage in teens without oral piercings are similarly rare, says Dr. Levin, who conducted the study with partners Dr. Yehuda Zadik and Dr. Tal Becker, both dentists in the Israeli Army.

Their initial study was done on 400 young adults aged 18-19, and the results were published in the well-known peer-reviewed journal Dental Traumatology in 2005. A new review by Drs. Levin and Zadik published in the American Dental Journal in late 2007 is the first and largest of its kind to document the risks and complications of oral piercings, drawing on research from multiple centers in America and across the world.

Ten percent of all New York teenagers have some kind of oral piercings, compared to about 20 percent in Israel and 3.4 percent in Finland. Dr. Levin warns teens to think twice before getting an oral piercing, as it can lead to easily preventable health complications and, in some (rare) cases, even death.

Premature Frontal Tooth Loss

“There are short-term complications to piercings in low percentages of teens, and in rare cases a piercing to the oral cavity can cause death,” Dr. Levin says. “Swelling and inflammation of the area can cause edema, which disturbs the respiratory tract.” He warns that the most common concerns ― tooth fracture and periodontal complications ― are long-term.

“There is a repeated trauma to the area of the gum,” says Dr. Levin. “You can see these young men and women playing with the piercing on their tongue or lip. This act prolongs the trauma to the mouth and in many cases is a precursor to anterior tooth loss.”

During the Israel-based study, the researchers surveyed teens both with piercings and without, asking them a number of questions about their oral health, their knowledge of the risk factors associated with piercings, and about their piercing history, before conducting the clinical oral exams.

Ironically, Dr. Levin notes, those youngsters who opted for oral piercing were very concerned about body image, but seemed to be unaware of the future risks such piercings can cause.

The Doctor’s Practical Advice to Teens and Parents

Bottom line, the best advice for teens is to “try and avoid getting your mouth pierced,” says Dr. Zadik. If your teen is insistent, he says, then it’s essential that piercing tools are disposable, and that all other equipment is cleaned in an on-site autoclave to help reduce infection.

After the procedure, the area should be rinsed regularly with a chloroxidine-based mouthwash for two weeks. Thereafter, avoid playing with the piercing and clean it on a regular basis. Calculus deposits on the piercing may form over time and should be removed by a dentist. Checkups should be made regularly.

“Teenagers are not easy to manage,” Dr. Levin commiserates, but his advice to parents is simple: “Try where possible to dissuade your teen from getting a piercing. They will thank you when they are older.”

Monday, June 16, 2008

New technique can correct a smile in half the time

USC School of Dentistry researchers use a patient's own bone to accelerate orthodontics

Researchers at the University of Southern California School of Dentistry say they have improved upon a surgical procedure developed by periodontist Tom Wilcko that rapidly straightens teeth, delivering a healthy bite and attractive smile in months instead of years.

Led by Hessam Nowzari DDS, PhD, Director of the USC School of Dentistry and Advanced Education in Periodontology program, the researchers have published the first case study of the successful use of a patient's own bone material for the grafting necessary in the accelerated orthodontic surgical procedure. The report appears in the May 2008 issue of the Compendium of Continuing Education in Dentistry.

Accelerated orthodontics is gaining popularity as a way for patients, particularly adults with mature bones, to speed up the time it takes to straighten misaligned bites and fix crowded teeth. Wilcko, who operates a practice in Erie, Penn., offers courses in the procedure, trademarked as "Wilckodontics."

USC dentists used a procedure known as PAOO, short for Periodontally Accelerated Osteogenic Orthodontics. With this technique, a periodontist or oral surgeon uses special instruments to score the bone that holds the teeth in place and then applies bone graft material over the grooves. The procedure is done under local anesthetic in the dental office operatory.

As the bone begins to heal, it softens slightly, allowing teeth to be moved into alignment with dental braces in a matter of months, rather than the years required with traditional orthodontics. The cost for accelerated orthodontics typically ranges from $10,000 to $15,000, depending on the course of treatment.

Prior to the USC study, the bone graft material used for this procedure was bovine bone and bioactive glass particles to help the bone strengthen as it healed.

Nowzari says that his team believed they could improve the technique by using the patient's own bone instead of the artificial or bovine graft.

"Given a choice for grafts, nothing is better than a patient's own tissue," Nowzari explains. "It encourages new, healthy bone formation in the grafted area. It's very safe and eliminates the risk of any disease transmission."

Tuesday, June 10, 2008

Dental Treatment Safe for Pregnant Women

Essential Dental Treatment Safe for Pregnant Women,
Says New Study in ADA Journal


Pregnant women can safely undergo essential dental treatment and receive topical and local anesthetics at 13 to 21 weeks gestation, says a study published in the June issue of The Journal of the American Dental Association.

Although obstetricians generally consider dental care safe for pregnant women, supporting clinical trial evidence has been lacking. To address this issue, researchers compared safety outcomes from the Obstetrics and Periodontal Therapy Trial in which pregnant women received scaling and root planing (deep cleaning) and essential dental treatment (defined as treatment of moderate-to-severe cavities or fractured or abscessed teeth).

The researchers randomly assigned 823 pregnant women with periodontitis to receive scaling and root planing, either at 13 to 21 weeks’ gestation or up to three months after delivery. (Experts recommend that pregnant women defer elective care before eight weeks’ gestation and during late pregnancy.) The researchers determined that 483 of these women also needed essential dental treatment. Three hundred fifty-one of the women completed all recommended treatment.

Throughout the trial, obstetric nurses reviewed medical records to monitor subjects for serious adverse events. The authors defined these events as pregnancies that ended in a nonlive birth and other adverse events that did not result in pregnancy termination (including hospitalizations for more than 24 hours because of labor pains, hospitalizations for any other reason, fetal or congenital anomalies and neonatal deaths).

The results of the study showed that “periodontal treatment and essential dental treatment, administered at a time between 13 and 21 weeks’ gestation, did not significantly increase the risk of any adverse outcome evaluated,” the authors write. “Use of topical and local anesthetics for scaling and root planing also was not associated with an increased risk of experiencing these adverse events and outcomes.”

Monday, June 9, 2008

Good dental hygiene helps prevent heart infection

Good dental hygiene and health may be crucial in preventing heart valve infection, according to research reported in Circulation: Journal of the American Heart Association.

In a study of 290 dental patients, researchers investigated several measures of bacteremia (bacteria released into the bloodstream) during three different dental activities – tooth brushing, a single tooth extraction with a preventive antibiotic and a single tooth extraction with a placebo.

As expected, researchers found bacteria in the blood more often with the two extraction groups than with the brushing group. However, the incidence of bacteremia from brushing was closer to an extraction than expected. "This suggests that bacteria get into the bloodstream hundreds of times a year, not only from tooth brushing, but also from other routine daily activities like chewing food," said the study's lead author Peter Lockhart, D.D.S.

In 2007, the American Heart Association modified its recommendation that preventive antibiotics be used prior to most dental procedures for the great majority of those at risk for infective endocarditis (IE) – a rare but life-threatening infection of the lining of the heart or heart valve that can occur when bacteria enter the bloodstream. The association now recommends preventive antibiotics only for patients at the highest risk for a bad outcome from IE.

In this double-blind, placebo-controlled study, researchers sought to determine if daily dental activities like tooth brushing posed as much risk for IE as major dental procedures (e.g., tooth extractions) for which preventive antibiotics might be prescribed. Researchers drew blood from each patient a total of six times – before, during and after these interventions – and analyzed the samples for bacterial species that are associated with IE.

They found that bacteria enter the bloodstream in most patients early on during a dental extraction or tooth brushing, and that bacteria can still be found in the blood as long as an hour after these procedures in a small number of cases.

"While the likelihood of bacteremia is lower with brushing, these routine daily activities likely pose a greater risk for IE simply due to frequency: that is, bacteremia from brushing twice a day for 365 days a year versus once or twice a year for dental office visits involving teeth cleaning, or fillings and other procedures," said Lockhart, chair of the Department of Oral Medicine at the Carolinas Medical Center, Charlotte, N.C.

"For people who are not at risk for infections such as IE, the short-term bacteremia is nothing to worry about," he said.

"If you stop oral hygiene measures, the amount of disease in your mouth goes up considerably and progressively and you'll have far worse oral disease," Lockhart said. "It's the gingival (gum) disease and dental caries (decay), that lead to chronic and acute infections such as abscesses. It's that sort of thing that puts you at risk for frequent bacteremia and presumably endocarditis if you have a heart or other medical condition that puts you at risk."

"The incidence of IE-related bacteremia from all blood draws was 23 percent in the tooth-brushing group, 33 percent in the extraction plus antibiotic group, and 60 percent for the extraction-placebo group," Lockhart said. The researchers therefore found that amoxicillin significantly decreased the incidence of bacteremia from an extraction but did not eliminate it altogether.

The highest incidence of positive IE-related bacterial cultures occurred within five minutes of all three procedures, with the majority (93 percent) of patients with bacteria in the blood experiencing the condition for less than 20 minutes after the procedures. Only 5 percent of the extraction-placebo group and 2 percent of the brushing group still had bacteria in the blood at one hour.

"The human mouth is colonized by a larger variety of bacteria than any other body area, and many of the bacterial species in the mouth that cause disease are found in the periodontal pocket (below the gum line) adjacent to the teeth," said Lockhart, adding that some of those species have been associated with IE. "Bacteria commonly gain entrance to the circulation through ulcerated gingival (gum) tissue surrounding the teeth, but oral hygiene reduces gingival disease and reduces that risk."

Patients in this study came to an urgent care clinic in need of tooth extractions. So it's likely they had a higher level of dental disease and poorer oral hygiene than the general population.

The researchers are analyzing additional data from this study to determine if there is a direct correlation between the level of dental disease and the likelihood of IE bacteria getting into the bloodstream.

According to the American Heart Association, those at highest risk for adverse outcomes from IE are 1) patients with a prosthetic cardiac valve or prosthetic material used for cardiac valve repair; 2) previous endocarditis; 3) cardiac transplantation recipients who develop cardiac valve abnormalities; and 4) congenital heart disease for unrepaired cyanotic congenital heart disease, including palliative shunts and conduits; completely repaired congenital heart defect with prosthetic material or device, during the first six months after the procedure; or repaired congenital heart disease with persisting leaks or abnormal flow at the site or adjacent to the site of a prosthetic patch or prosthetic device.

Friday, June 6, 2008

ADA on FDA Settlement of Dental Amalgam Lawsuit

American Dental Association Comments on FDA's Settlement of Dental Amalgam Lawsuit

The American Dental Association (ADA) believes the recent settlement between the U.S. Food and Drug Administration (FDA) and the group Moms Against Mercury simply sets a definite deadline (July 28, 2009) for the FDA to complete what it began in 2002 - a reclassification process for dental amalgam, a commonly used cavity filling material. As far as the ADA is aware, the FDA has in no way changed its approach to, or position on, dental amalgam.

Contrary to some assertions, the FDA's current reclassification proposal does not call for restrictions on the use of amalgam in any particular population group. It merely restates FDA's ongoing call for public comments on that issue, as well as the findings of the most current scientific studies on amalgam.

"People depend on the FDA and other government health agencies to help protect their health. It's critically important that public health recommendations are based on sound scientific evidence," states ADA President Mark J. Feldman, DMD. "The ADA will continue to advocate for the best oral health of the public as part of the FDA regulatory process."

Presently, FDA has different classifications for encapsulated amalgam and its component parts, dental mercury and amalgam alloy. The FDA's proposed reclassification, which the ADA has supported since 2002, would place encapsulated amalgam and its components under one classification.

Based on extensive studies and scientific reviews of dental amalgam by government and independent organizations worldwide, the ADA believes that dental amalgam remains a safe, affordable and durable cavity filling choice for dental patients

Wednesday, June 4, 2008

Saving teeth: periodontal ligament regeneration

Teeth may fall out as a result of inflammation and subsequent destruction of the tissues supporting the teeth. Dutch researcher Agnes Berendsen has investigated a possible solution to this problem. At the Academic Centre for Dentistry Amsterdam (ACTA), she has studied the regeneration of the periodontal ligament by use of tissue engineering. The 3D in vitro model she has developed appears to be promising for regenerating periodontal ligament and may also prove valuable for restoring tendons and ligaments elsewhere in the body.

The periodontal ligament forms a flexible connection between the tooth root and the surrounding jaw bone. Trauma or inflammation can cause destruction of the periodontal ligament. Berendsen chose tissue engineering to tackle this problem. Research in tissue engineering uses cells placed in a 3D model, after which signals are applied to activate the cells. Berendsen developed a new 3D model in which cells isolated from periodontal ligament were implanted in a collagen network suspended between an artificial root and artificial bone. She wanted to see if viable periodontal ligament could be generated in this way.

The composition of the collagen network in which the cells are located has a considerable influence on the contractile properties of the cells. Contraction of the cells creates internal tension in the network which keeps the cells active. The network must be well attached to the surrounding solid surfaces to prevent its detachment. Berendsen managed to attach the network to these artificial root and bone surfaces present in the model by creating an enzyme-mediated mineral deposition on the surfaces. By subsequently applying loading to the tooth root (mimicking the process of chewing) in the 3D model, she was able to deform the mineral-anchored network containing the cells. The subsequent response of the cells was dependent on the magnitude of the loading.

Follow-up research will investigate whether the cell-culture results can be translated to an animal model to obtain more accurate insights concerning the potential use of this method in humans.