Tuesday, November 25, 2008

Gum disease = risk for cardiovascular disease

Presence of gum disease may help dentists and physicians identify risk for cardiovascular disease

NEW YORK (Nov. 25, 2008) -- Individuals reporting a history of periodontal disease were more likely to have increased levels of inflammation, a risk factor for heart disease, compared to those who reported no history of periodontal disease, according to an American Journal of Cardiology report available online today. Led by investigators from Columbia University Medical Center and NewYork-Presbyterian Hospital, the findings suggest persons with increased levels of inflammatory markers associated with a higher risk of cardiovascular disease might be identified by asking about oral health history. This group might not be detected by traditional cardiovascular risk screening.

Inflammation has been associated with cardiovascular disease and has been suggested to be a potential link between periodontal disease and cardiovascular disease. To examine whether oral health history and inflammatory markers associated with cardiovascular disease were linked, the investigators followed participants in the National Heart, Lung and Blood Institute (NHLBI) Family Intervention Trial for Heart Health (F.I.T. Heart), an ongoing national trial led by principal investigator Lori Mosca, M.D., M.P.H., Ph.D., professor of medicine at Columbia University College of Physicians and Surgeons and director of preventive cardiology at NewYork-Presbyterian Hospital/Columbia University Medical Center.

The NHLBI Family Intervention Trial for Heart Health aims to study family members of patients hospitalized with heart disease because they may be at increased risk themselves due to shared genetic and/or lifestyle factors. Dr. Mosca and her research team recruited family members or co-habitants of patients hospitalized for such cardiac events as a heart attack or narrowed arteries that required bypass surgery or an angioplasty procedure. Previous research has shown that family members of cardiovascular disease patients may be at increased risk for the disease due to the genes and lifestyle habits they share.

In this study, 421 individuals who were blood related to and/or living with a person recently hospitalized due to cardiovascular disease were screened for traditional cardiovascular risk factors (such as elevated blood pressure and abnormal cholesterol levels), inflammatory markers associated with disease risk (high-sensitivity c-reactive protein (hsCRP) and lipoprotein-associated phospholipase A2 (Lp-PLA2)). They were also asked standardized questions about their oral health status, including whether they had ever been diagnosed with periodontal (gum) disease, whether they had ever been treated for periodontal disease, whether they used partial or complete removable dentures, and the date of their last teeth cleaning. The oral health history was then correlated with standard markers of inflammation.

Results found that among participants who did not have traditional cardiovascular disease risk factors (such as high blood pressure, high cholesterol, and overweight/obese status), almost one in four were found to have a personal history of periodontal disease and higher levels of Lp-PLA2, an inflammatory marker which has been found present in inflamed rupture prone plaque in heart arteries/valves.

It is important to note that it is not possible to determine from this study that poor oral health causes cardiovascular disease risk or that any therapy based on oral health status would be effective in preventing cardiovascular disease. However, Dr. Mosca says, "Our finding is novel because it suggests the dentist and oral health exam may be the latest weapon in identifying persons at risk of cardiovascular disease, our nation's number one killer."

"Many people don't realize how oral health is often a predictor of one's overall health," says co-author John T. Grbic, DMD, MS, MMSc, professor of clinical dental medicine at the Columbia University College of Dental Medicine. "Symptoms for many life-threatening illnesses, such as diabetes and heart disease, first appear in the mouth. For this reason, it's vitally important for people to have routine dental check-ups and have an ongoing dialogue with their dentist about their oral health. Patients may also benefit from seeing dentists affiliated with an academic medical center, where they are tapped into deep referral networks to appropriate clinicians."

Drink brewed tea to avoid tooth erosion

Low erosive effect on teeth and antioxidants provide health benefits

Today, the average size soft drink is 20 ounces and contains 17 teaspoons of sugar. More startling is that some citric acids found in fruit drinks are more erosive than hydrochloric or sulfuric acid—which is also known as battery acid. These refined sugars and acids found in soda and citrus juice promote tooth erosion, which wears away the hard part of the teeth, or the enamel. Once tooth enamel is lost, it's gone forever. There is a beverage that does not produce such irreversible results. When deciding between the many options available, the best thing to drink is brewed tea, according to a study in the July/August issue of General Dentistry, the clinical, peer-reviewed journal of the Academy of General Dentistry (AGD).

Apart from tasting good, brewed tea has many health benefits. Tea is loaded with natural antioxidants, which are thought to decrease incidence of cancer, cardiovascular disease, and diabetes.

Mohamed A. Bassiouny, DMD, BDS, MSc, PhD, the lead author of the study, compared green and black tea to soda and orange juice in terms of their short- and long-term erosive effect on human teeth. The study found that the erosive effect of tea was similar to that of water, which has no erosive effect. And, when comparing green versus black, he discovered that there is a better option among those as well.

Dr. Bassiouny says that "when we look at tea and read about the benefits, it's amazing—not because green tea is 'the in thing'—but because there are advantages." He adds that much research done overseas, in countries such as Japan and Europe, found that green tea was identified to being superior over black due to its natural flavonoids (plant nutrients) and antioxidants.

But, if you do drink tea, experts suggest avoiding additives such as milk, lemon, or sugar because they combine with tea's natural flavonoids and decrease the benefits. In addition, stay away from prepackaged iced teas because they contain citric acid and high amounts of sugars. It does not matter whether the tea is warm or cold—as long as it is home brewed without additives.

Kenton Ross, DMD, FAGD, AGD spokesperson, sees patients' erosion problems on a daily basis in his practice. "Severe cases of erosion occur monthly and are frequently associated with high rates of soft drink consumption," he says. "This study clearly shows that brewed teas resulted in dramatically less enamel loss than soft drinks and acidic juices," says Dr. Ross. "I would highly recommend patients choose tea as an alternative to more erosive drinks like soda and fruit juice."

Lightheadedness at the dentist could prove serious

Vasovagal syncope affects patients of all ages

You see it in movies or while viewing your favorite sitcom; a scene at the doctor's office where the character inevitably gets a little woozy which leads to a fainting spell. It may seem funny when watching it all unfold on television, but according to a study in the May/June 2008 issue of General Dentistry, the Academy of General Dentistry's (AGD) clinical, peer-reviewed journal, this type of reaction, in real life settings, these breath-holding scenarios are the most common emergency situation in the dental office.

This condition is known as vasovagal syncope and lead author of the study, Rubia Kapusta, DDS, MS, explains that both dentists and patients should be aware of the signs and be prepared in case it occurs. Vasovagal syncope is characterized by a loss of consciousness and muscle tone, which typically are preceded by non-specific symptoms that last anywhere from a few seconds to a minute. These symptoms result from alterations in the nervous system that can include dizziness, lightheadedness, paleness, palpitations, nausea, sweating, hyperventilation and changes in vision.

According to Dr. Kapusta, "Any patient who experiences a syncope reaction may have an underlying cause that can predispose him or her to a life-threatening situation."

It is considered the most common clinical problem that occurs among patients of all ages, affecting 3.5 percent of the general population. Emotional stress, anxiety, pain, fatigue and being in a hot and crowded environment can lead to vasovagal syncope.

"It is not uncommon for patients to experience some anxiety when visiting their general dentist," says AGD spokesperson, Melvin Pierson, DDS. "Yet, there are ways to lessen the possibility of an anxiety-related incident." Dr. Pierson encourages patients to discuss with their general dentist any fears they may have, and when seeing a dentist for the first time, schedule a preliminary visit.

"Asking questions and requesting informational materials can help you get a better understanding of your dental service or treatment," says Dr. Pierson. "General dentists are trained to answer questions and tell you what to expect to help you feel comfortable."

If the signs and symptoms of vasovagal syncope do occur, the dental procedure will be immediately stopped and treatment provided as soon as possible.

Wednesday, November 12, 2008

1/4 of children have had no dental care in a year+

A University of South Carolina study of children’s dental health has found that nearly one-fourth of the nation’s children have had no dental care in at least a year.

Conducted by researchers at the S.C. Rural Health Research Center at the Arnold School of Public Health, the study found that nearly 32 percent of Hispanic children in rural areas had no dental care in the past year. Twenty-six percent of rural black children had no dental care, followed by 23 percent of “other” children and 22 percent of white children.

“Our nation has a group of children suffering dental disease severe enough to constitute a public health problem,” said Dr. Amy Brock Martin, the lead author of “Dental Health and Access to Care among Rural Children: A National and State Report.”

Data for the report came from the 2003 National Survey of Children’s Health, which used parents’ reports to measure the health and well-being of children from birth to age 17. The survey asked parents in urban and rural areas about the condition of their children’s teeth, utilization of dental care and dental insurance coverage.
The University of South Carolina report looks at dental health from a national perspective and also provides state and regional analyses.

More than 47 percent of all children 5 and younger had not seen a dentist in the previous year. Among rural children, the percentage was more than 48 percent. More than 33 percent of rural children had no dental insurance.

“Dental care is critical for children, even preschoolers,” she said. “A thorough dental exam not only helps children have healthy teeth, but also can detect nutritional deficiencies, injuries and some diseases and infections.

“This report gives us a better understanding of children’s oral health and the challenges faced by healthcare providers. It also gives us information specific to rural children, particularly rural minority children.”

Among the report’s other findings:
* Hispanic children in rural and urban areas are the least likely to receive preventive dental care. Vermont led the nation in the percentage of its children receiving preventive dental care (84 percent); Florida, with nearly 61 percent, had the lowest.

* Hispanic children in rural and urban areas were the least likely to have dental insurance. Hawaii, with nearly 89 percent of children having dental insurance, was No. 1. Montana had the lowest number (nearly 61 percent) of children with dental insurance.

* Rural counties throughout the nation are likely to have Dental Health Professional Shortage Areas (HPSA), a federal designation. Of all rural counties, nearly 60 percent had a dental HPSA designation between 2000 and 2004. The areas with the greatest shortages are in Northwest and Southwest states, followed by those in the Midwest and Southeast.

* More than 68 percent of parents in the United States consider their children’s teeth to be in very good or excellent condition. Urban white, black and Hispanic parents were more likely to describe their children’s teeth as “excellent” than those in rural areas. Among states with a large number of rural people responding to the study, New Hampshire, with nearly 54 percent, had the highest proportion of children with excellent teeth.

Brock Martin said the study provides a foundation for future studies on children’s dental health and provides data for policymakers and healthcare providers who make decisions on children’s health needs.

“This report provides state-by-state information on children living in urban and rural areas,” she said. “Dental care has been designated as the most prevalent unmet health need in U.S. children, and this report underscores that the problem is particularly acute among rural children.”

Visit http://rhr.sph.sc.edu/index.php for more information on the report.