Friday, May 29, 2009

Dentists Suffer from Noise-Induced Hearing Loss

Noise-induced hearing loss (NIHL) is an occupational hazard to dentists exposed to the noise from high speed drills. This is the conclusion of a study presented at the 101st Annual Meeting of the American Academy of Otolaryngology--Head and Neck Surgery Foundation.

The study, "Noise-Induced Hearing Loss," was prepared by Renata C. Di Francesco, MD, Fabiana Arajuo Sperandio, MD, Tanit Ganz Sanchez, MD, and Marco Aurelio Bottino, MD, otolaryngologists (ear, nose, and throat specialists) from San Paulo, Brazil. The purpose of the study was to evaluate (1) the incidence of NIHL in dentists; (2) the relationship between duration of exposure and severity of hearing loss; and (3) the relation of risk factors (ambient amplified music) and severity of loss.

The research conducted is significant because dentists are daily exposed to drills, which reach 85 to 95 dB most of the time. Moreover, dentists generally do not wear ear protection or undergo periodic audiometric examinations.

Methodology: The team of medical specialists evaluated 896 dentists attending the Seventeenth International Meeting of Odontology (Dentistry) in San Paulo. All the test subjects were evaluated by a questionnaire, ear examination, and tonal audiometry.

Results: Forty percent of the dentists presented some hearing loss, and 87% of the affected ears presented a demonstrable loss in 6,000 Hz. The incidence of hearing loss was related directly to duration of exposure to noise from dental equipment.

Thursday, May 28, 2009

Treating gum disease helps rheumatoid arthritis

Treating gum disease helps rheumatoid arthritis sufferers

Here's one more reason to keep your teeth healthy.

People, who suffer from gum disease and also have a severe form of rheumatoid arthritis, reduced their arthritic pain, number of swollen joints and the degree of morning stiffness when they cured their dental problems. Researchers from the Case Western Reserve University School of Dental Medicine and University Hospitals of Cleveland reported on this new intervention for arthritis in the Journal of Periodontology.

"It was exciting to find that if we eliminated the infection and inflammation in the gums, then patients with a severe kind of active rheumatoid arthritis reported improvement on the signs and symptoms of that disease," said Nabil Bissada, D.D.S., chair of the department of periodontics at the dental school. "It gives us a new intervention," adds Bissada.

This is not the first time that gum disease and rheumatoid arthritis have been linked. According to another researcher in the study, Ali Askari, M.D., chair of the department of rheumatology at University Hospitals, "From way back, rheumatologists and other clinicians have been perplexed by the myth that gum disease may have a big role in causing systematic disease."

He added that historically teeth were pulled or antibiotics given for treatment of rheumatoid arthritis, which actually treated the periodontitis. The patients got better.

Askari and Bissada are part of a team of researchers that studied 40 patients with moderate to severe periodontal disease and a severe form of rheumatoid arthritis.

The study results should prompt rheumatologists to encourage their patients to be aware of the link between periodontal disease and rheumatoid arthritis, says Askari.

Bissada notes that gum disease tends to be prevalent in rheumatoid arthritis patients.

Both inflammatory diseases share similarities in the progression of the disease over time. In both diseases, the soft and hard tissues are destroyed from inflammation caused by toxins from bacterial infection.

One toxin from the inflamed areas called tumor neurosis factor-alpha (TNF-α) is a marker present in the blood when inflammation is present in the body. TNF-α can initiate new infections or aggravate sites where inflammation already exists.

The study's participants were divided into four groups. Two groups of patients were receiving a new group of anti-TNF-α drugs that block the production of TNF-α at inflamed rheumatoid arthritis sites. Two groups were not on this new medication. Half of group of the participant on the medication and half not receiving the new drug received a standard nonsurgical form of periodontal treatment to clean and remove the infection from the bones and tissues in the gum areas. The other half of those studied did not receive the treatment until after completion of the study.

After receiving treatment for the gum disease, improvement in rheumatoid arthritis symptoms was seen in patients who did and did not receive the anti-TNF-α medications, which block the production of TNF-α that aggravate or can cause inflammation. Patients on the TNF- α inhibitors showed even greater improvements over those not receiving the drugs.

"I'm optimistic that someday the biologic agents that we use successfully in treatment of rheumatoid arthritis will lead to improvement of periodontitis and would be available for use and treatment of this perplexing problem," says Askari.

"Again we are seeing another link where good oral health improves the overall health of an individual," says Bissada, who adds that studies have linked gum disease to premature births, heart disease and diabetes.

Tuesday, May 12, 2009

Dental Implants Result in Minimal Bone Loss

Dental implants are frequently used as a replacement for missing teeth in order to restore the patient’s tooth function and appearance. Previous research demonstrates that the placement of a dental implant disrupts the host tissue in the area of the implant, so practitioners often focus their treatment planning to carefully maintain the patient’s bone and gum tissue surrounding the implant. A recent study published in the Journal of Periodontology found that the majority of bone remodeling occurred in the time between the implant placement and final prosthesis placement. Study Abstract*

Subsequently, little mean bone change was observed in the five years following the implant placement, independent of type of restoration or implant length. The study, conducted at the University of Texas Health Science Center at San Antonio, evaluated 596 dental implants placed in 192 patients over the age of 18. Patients were screened for adequate oral hygiene and bone volume. Exclusion criteria included heavy smoking, chewing tobacco use, drug abuse, and untreated periodontal disease, amongst others.

Study author Dr. David Cochran, DDS, PhD, Chair of the Department of Periodontics at the University of Texas Health Science Center at San Antonio, and President of the American Academy of Periodontology (AAP), believes that this study provides additional support for the use of dental implants to replace missing teeth. “As a periodontist, I am committed to saving my patients’ natural dentition whenever possible. However, the results of this study help further indicate that a dental implant is an effective and dependable tooth replacement option. Since the patient’s host tissue surrounding the dental implant largely remains unchanged in the five years following placement, the dental team can now focus on periodic assessment and treatment of other areas in the mouth as needed, and know that the implant is doing its job as a viable substitute solution.”

Saturday, May 9, 2009

X-rays help predict permanent bone damage

X-rays help predict permanent bone damage from bisphosphonates

Breast cancer patients, individuals at risk for osteoporosis and those undergoing certain types of bone cancer therapies often take drugs containing bisphosphonates. These drugs have been found to place people at risk for developing osteonecrosis of the jaws (a rotting of the jaw bones). Dentists, as well as oncologists, are now using X-rays to detect "ghost sockets" in patients that take these drugs and when these sockets are found, it signals that the jawbone is not healing the right way. Early detection of these ghost sockets can help the patient avoid permanent damage to their jawbone, according to an article in the March/April 2009 issue of General Dentistry, the Academy of General Dentistry's (AGD) clinical, peer-reviewed journal.

A ghost socket occurs when the jawbone is not healing and repairing itself the right way. "The good news is that even though these ghost sockets may occur, by using radiographic techniques we can see that the soft tissue above these sockets can still heal," according to Kishore Shetty, DDS, MS, MRCS, lead author of the report. Dr. Shetty states these findings are important news to learn about because early prevention and detection can halt permanent damage from happening to a patient's jawbone.

In 2006, about 191 million prescriptions of oral bisphosphonates worldwide were written. The National Osteoporosis Foundation estimates that nearly 44 million people in the United States are at risk for developing osteoporosis. Currently, approximately 10 million Americans suffer from the disease.

Bisphosphonates are a family of drugs used to prevent and treat osteoporosis, multiple myeloma, Paget's disease (bone cancers), and bone metastasis from other cancers. These drugs can bond to bone surfaces and prevent osteoclasts (cells that break down bone) from doing their job. Other cells are still working trying to form bone, but it may turn out to be less healthy bone leading to the ghost-like appearance on X-rays.

"Healthy bones can easily regenerate," says Dr. Shetty. "But, because jawbones have rapid cell turnover, they can fail to heal properly in patients taking any of the bisphosphonate drugs. It's very important for patients to know about complications from dental surgery or extractions. Since these drugs linger in the bone indefinitely, they may upset the cell balance in how the jaws regenerate and remove unhealthy bone."

According to AGD spokesperson Carolyn Taggart-Burns, DDS, FAGD, patients who are taking bisphosphonates should inform their dentist to prevent complications from dental surgical procedures.

"Widespread use of bisphosphonates to prevent or treat early osteoporosis in relatively young women and the likelihood of long-term use is a cause for concern," says Dr. Taggart-Burns.

Drs. Shetty and Taggart-Burns agree that, "how bisphosphonates interfere with healing after dental surgery is still unclear and further research will be needed. It is imperative that the public understands there is no present treatment or cure for this problem."