Wednesday, December 22, 2010
A New Method Is Developed For Predicting Shade Improvement After Teeth Bleaching
This is the first time that scientists manage to predict the outcome of bleaching treatments, which will certainly have an important impact on these treatments, which are becoming frequent
Researchers at the University of Granada have developed a new method for predicting the precise shade that a bleaching treatment will bring about for a patient’s teeth. What is innovative about this method is that it allows researchers to successfully predict the outcome of a bleaching treatment, which will have a significant impact on such treatments, which are becoming more frequent.
At present, dental offices routinely employ carbomide peroxide bleaching agents for tooth discoloration. As bleaching treatments have soft side effects –all of them temporary and mild– and are relatively cost-effective, they have become very popular.
While bleaching treatments have been long applied, one of its main problems has been the inability to predict the outcome of the process. This means that, so far, dentists have been unable to predict the results for patients’ teeth. This means that dental physicians could not inform their patients on the shade improvement that the treatment would bring about, which was a limitation to the therapy.
The study was conducted by Janiley Santana Díaz, at the Department of Stomatology of the University of Granada and was coordinated by professors Rosa Mª Pulgar Encinas, Mª Del Mar Pérez Gómez and Luis Javier Herrera Maldonado. Using a fuzzy rule system, scientists had a first approach to the shade improvement that teeth can get after undergoing a 20% carbamide peroxide treatment (Opalescence® PF 20%, Ultradent) two hours a day for two weeks.
Participants
For the purpose of this study, authors took a sample of 53 subjects that subsequently underwent a teeth bleaching treatment. Before the bleaching treatment, participants answered a questionnaire on their eating habits so that scientists analyzed whether such habits had any impact on the prediction models. The researchers found that eating habits are not relevant to such models, so these factors where not considered in the study.
To illustrate the shade change expected after the teeth bleaching treatment, the University of Granada researchers designed a fuzzy system that allows to associate these instrumental measures to the commercial shade guides typically used at dental offices to identify the before-and-after tooth color.
Such association allows to establish a series of objective guidelines that, once the before-tooth color is identified with the closest shade of the guide, will allow both dentist and patient to predict the color that the teeth will get after the treatment.
All in all, researchers warn that, in the long term and given the limitation of any clinical trial, a wider range of patients and initial tooth colors would be required to obtain a more precise fuzzy system.
Thursday, December 16, 2010
The protective shield fluoride forms on teeth is up to 100 times thinner than previously believed
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In a study that the authors describe as lending credence to the idiom, "by the skin of your teeth," scientists are reporting that the protective shield fluoride forms on teeth is up to 100 times thinner than previously believed. It raises questions about how this renowned cavity-fighter really works and could lead to better ways of protecting teeth from decay, the scientists suggest. Their study appears in ACS' journal Langmuir.
Frank Müller and colleagues point out that tooth decay is a major public health problem worldwide. In the United States alone, consumers spend more than $50 billion each year on the treatment of cavities. The fluoride in some toothpaste, mouthwash and municipal drinking water is one of the most effective ways to prevent decay. Scientists long have known that fluoride makes enamel — the hard white substance covering the surface of teeth — more resistant to decay. Some thought that fluoride simply changed the main mineral in enamel, hydroxyapatite, into a more-decay resistant material called fluorapatite.
The new research found that the fluorapatite layer formed in this way is only 6 nanometers thick. It would take almost 10,000 such layers to span the width of a human hair. That's at least 10 times thinner than previous studies indicated. The scientists question whether a layer so thin, which is quickly worn away by ordinary chewing, really can shield teeth from decay, or whether fluoride has some other unrecognized effect on tooth enamel. They are launching a new study in search of an answer.
ARTICLE: "Elemental Depth Profiling of Fluoridated Hydroxyapatite: Saving Your Dentition by the Skin of Your Teeth?"
In a study that the authors describe as lending credence to the idiom, "by the skin of your teeth," scientists are reporting that the protective shield fluoride forms on teeth is up to 100 times thinner than previously believed. It raises questions about how this renowned cavity-fighter really works and could lead to better ways of protecting teeth from decay, the scientists suggest. Their study appears in ACS' journal Langmuir.
Frank Müller and colleagues point out that tooth decay is a major public health problem worldwide. In the United States alone, consumers spend more than $50 billion each year on the treatment of cavities. The fluoride in some toothpaste, mouthwash and municipal drinking water is one of the most effective ways to prevent decay. Scientists long have known that fluoride makes enamel — the hard white substance covering the surface of teeth — more resistant to decay. Some thought that fluoride simply changed the main mineral in enamel, hydroxyapatite, into a more-decay resistant material called fluorapatite.
The new research found that the fluorapatite layer formed in this way is only 6 nanometers thick. It would take almost 10,000 such layers to span the width of a human hair. That's at least 10 times thinner than previous studies indicated. The scientists question whether a layer so thin, which is quickly worn away by ordinary chewing, really can shield teeth from decay, or whether fluoride has some other unrecognized effect on tooth enamel. They are launching a new study in search of an answer.
ARTICLE: "Elemental Depth Profiling of Fluoridated Hydroxyapatite: Saving Your Dentition by the Skin of Your Teeth?"
Tuesday, December 14, 2010
University of Maryland Dental School Stepping Up Ergonomics Instruction
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In response to a high prevalence of neck and back pain among working dentists and dental hygienists, the dean of the University of Maryland Dental School Christian S. Stohler, DMD, DrMedDent, has launched an initiative to bring renewed attention to ergonomics into dental education.
Starting with the current semester, every incoming student must take the School’s course “Ergonomics in Dentistry,” before he or she can practice simulations or live-patient dental work. The School wants to be the place where dentists and dental hygienists learn to practice ergonomically correct practices, says Stohler.
“Three out of every five dentists live with the pain,” due to years of practicing with poor posture and other unwise positioning, guest lecturer Lance Rucker, DDS, director of clinical ergonomics and simulation at the University of British Columbia, told this year’s incoming class.
Stohler recruited Rucker as the world’s leading authority on dentistry ergonomics to kick off its course with a lecture and workshops. He greeted the new students with, “If you want to be a healthy, well-postured individual, statistically you have chosen the wrong profession. However, you do have a choice.”
Studies in the U.S. and in Canada over the past 37 years have underscored the need for dentists to adopt more ergonomically correct equipment and positioning, Rucker explained. He said that two-thirds of dentists lose days of practice each year by avoidable muscular skeletal pain.
Retired professor Michael Belenky, DDS, MPH, has taught what he refers to as human center ergonomics at the School for many years,” We first ask a student to identify how he or she would like to stand or sit for optimal visual and physical comfort and effectiveness,” says Belenky “Many dentists eventually need years of physical therapy, go to a chiropractor or even have surgery, but seldom do you hear about the need for preventive solutions, the etiology of the problem.”
Norman Bartner, DDS, a clinical assistant professor who leads the upgraded course, (above with students) says, “We are widely recognized as the no. 1 dental school in the country. Now we want to be known as the School that graduates students with the longest careers, greatest earning capacity, and enjoy the most leisure time because they are healthy.” He added, “This should increase alumni financial support for the School as well.”
Bartner and Belenky have created an instructional video that begins with dentists who have been forced from the profession with musculo-skeletal problems, due to poor ergonomic working conditions.
Bartner says, “I don’t want students developing musculo-skeletal problems from chronic stress on the neck, shoulder, high back, and low back. We start all the dental students off with knowing the proper posture as a dentist for avoiding such career-limiting problems.”
In response to a high prevalence of neck and back pain among working dentists and dental hygienists, the dean of the University of Maryland Dental School Christian S. Stohler, DMD, DrMedDent, has launched an initiative to bring renewed attention to ergonomics into dental education.
Starting with the current semester, every incoming student must take the School’s course “Ergonomics in Dentistry,” before he or she can practice simulations or live-patient dental work. The School wants to be the place where dentists and dental hygienists learn to practice ergonomically correct practices, says Stohler.
“Three out of every five dentists live with the pain,” due to years of practicing with poor posture and other unwise positioning, guest lecturer Lance Rucker, DDS, director of clinical ergonomics and simulation at the University of British Columbia, told this year’s incoming class.
Stohler recruited Rucker as the world’s leading authority on dentistry ergonomics to kick off its course with a lecture and workshops. He greeted the new students with, “If you want to be a healthy, well-postured individual, statistically you have chosen the wrong profession. However, you do have a choice.”
Studies in the U.S. and in Canada over the past 37 years have underscored the need for dentists to adopt more ergonomically correct equipment and positioning, Rucker explained. He said that two-thirds of dentists lose days of practice each year by avoidable muscular skeletal pain.
Retired professor Michael Belenky, DDS, MPH, has taught what he refers to as human center ergonomics at the School for many years,” We first ask a student to identify how he or she would like to stand or sit for optimal visual and physical comfort and effectiveness,” says Belenky “Many dentists eventually need years of physical therapy, go to a chiropractor or even have surgery, but seldom do you hear about the need for preventive solutions, the etiology of the problem.”
Norman Bartner, DDS, a clinical assistant professor who leads the upgraded course, (above with students) says, “We are widely recognized as the no. 1 dental school in the country. Now we want to be known as the School that graduates students with the longest careers, greatest earning capacity, and enjoy the most leisure time because they are healthy.” He added, “This should increase alumni financial support for the School as well.”
Bartner and Belenky have created an instructional video that begins with dentists who have been forced from the profession with musculo-skeletal problems, due to poor ergonomic working conditions.
Bartner says, “I don’t want students developing musculo-skeletal problems from chronic stress on the neck, shoulder, high back, and low back. We start all the dental students off with knowing the proper posture as a dentist for avoiding such career-limiting problems.”
Monday, December 13, 2010
For Your Teeth, Thanksgiving Dinner Is a Real Food Fight
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If you're lucky, it will all be kisses and hugs around the Thanksgiving dinner table, with friends and family near and dear gathered about, and puppies at your feet waiting for table scraps.
But peace won't reign within the confines of the oral cavity, where Streptococcus mutans and other harmful bacteria will await their own holiday feast. Your meal will enable S. mutans to launch one of its biggest assaults of the year on your tooth enamel.
New work by dental researchers at the University of Rochester Medical Center brings both good and bad news. While bacterial forces in your mouth will exploit your delectables in newly discovered ways, some foods common at the holiday dinner table -- like the cranberry and even wine -- offer new leads in the effort to stop tooth decay.
The Thanksgiving Day battle for oral health hinges on microbes like S. mutans. Most cookies, pies and the like contain mountains of sugar, but it's not the sugar itself that causes tooth decay. Rather, S. mutans and other bacteria in our mouths -- billions of individual microbes all waiting for their next snack -- feast on the sugars, stick on your teeth and then churn out acid that eats away at tooth enamel.
At the front lines is Hyun "Michel" Koo, D.D.S, Ph.D., a dentist turned food scientist and microbiologist who is both exploring the destructive power of S. mutans and scouring foods and natural substances to harness their ability to prevent cavities. With every portion of bad news he delivers about cavities comes good news about compounds that may help prevent tooth decay.
"Natural substances offer tremendous possibilities for stopping tooth decay," said Koo, who earlier this year received a $1.6 million from the National Institute of Dental and Craniofacial Research to conduct his research. "Our time spent in the laboratory is aimed at harnessing the potential of some of these compounds, perhaps eventually incorporating them into a toothpaste or mouth rinse to stop dental decay."
Good news at the dinner table
Koo is hot on the trail of the cranberry as a potential ally in the fight against S. mutans, which is a threat to our teeth primarily because of its ability to form plaque. What appears to us as sticky white gunk along our teeth is actually a formidable fortress of molecules known as glucans -- building blocks of plaque, stacked like bricks in a wall, rife with bacteria. It's a gunky fortress that covers the tooth and gives bacteria a safe haven to munch on sugar, thrive, and churn out acid.
Koo has discovered that compounds within the cranberry disrupt enzymes known as glucosyltransferases that bacteria use to build glucans. Without its glucans, S. mutans and other bad bacteria in plaque becomes vulnerable.
Together with Nicholi Vorsa, Ph.D., director of the Philip E. Marucci Center for Blueberry and Cranberry Research and Extension at Rutgers University, Koo is working to isolate the compounds within the cranberry that are most protective. The pair has identified molecules known as A-type proanthocyanidins as having potential to reduce cavities dramatically. Earlier this year in the journal Caries Research, the team reported that when the molecules were applied, glucan and acid production by S. mutans was reduced by up to 70 percent, and cavity formation in rats was slashed by up to 45 percent.
"Maintaining the natural balance of resident flora in the oral cavity is important for keeping opportunistic pathogens in check," said Koo, a researcher in the Center for Oral Biology and an associate professor in the Eastman Institute for Oral Health and the Department of Microbiology and Immunology. "These molecules don't outright kill S. mutans. Instead, they disrupt the two most harmful actions of this pathogenic organism, acid production and glucan production."
More good news
More good news comes from that delicious glass of wine, or at least the waste in its wake. With funding from the U.S. Department of Agriculture, Koo began a research project with Olga I. Padilla-Zakour, Ph.D., associate professor of Food Processing at the New York Agricultural Experiment Station of Cornell University. They found that the abundant waste from the red-wine-making process -- materials such as fermented seeds and skins collectively known as pomace that are cast away after grapes are pressed -- contains compounds that fight S. mutans. In particular, some polyphenols can inhibit the activity of S. mutans' crucial enzymes by as much as 85 percent and also reduce the amount of acid the bacteria produce.
And the bad news
Last month in PloS One, Koo showed that S. mutans is even more powerful than scientists have realized, responding readily to changing environmental conditions in the presence of starch and sucrose to thrive in the mouth.
In work led by Marlise Klein, D.D.S., Ph.D., research assistant professor, Koo's team analyzed the activity of more than 300 genes in S. mutans under changing conditions. The team found that certain key proteins boost their activity dramatically in the presence not only of sugar but also complex carbohydrates derived from starch digestion. Once the body's own amylase enzymes naturally present in saliva break down starches, S. mutans kicks its glucan-forming machinery into high gear.
"The new research shows how two pillars of the modern diet, starch and sugar, can work cooperatively to bring about tooth decay," said Koo. "A cookie, sugar-covered doughnut, or a piece of pie filled with both sugar and starch provide the perfect recipe for the bacteria that destroy teeth."
Even when the amount of sugar was slashed in half, certain genes central to the ability of S. mutans to create its formidable glucan fortress boosted their activity five-fold in the presence of starch-derived carbohydrates. That enabled the bacteria to create plaque that is hardier, stickier, and capable of producing more acid than plaque created without significant starch present.
On Thanksgiving Day ……
Koo notes people shouldn't simply eat more cranberry sauce or drink more wine to try to prevent cavities. His work is aimed at identifying and then exploiting specific compounds that give the benefit without, for instance, the high levels of acidity or the added sugar that cranberry products might include. Rather, at this point, everything your dentist keeps telling you remains the best advice to prevent cavities.
"On Thanksgiving Day, like any day, brush your teeth, avoid foods filled with sugars as best you can, and don't snack often -- and if you do, brush your teeth again," said Koo. "Consider using a mouth rinse, get some fluoride in there -- and be sure to see a dentist regularly."
If you're lucky, it will all be kisses and hugs around the Thanksgiving dinner table, with friends and family near and dear gathered about, and puppies at your feet waiting for table scraps.
But peace won't reign within the confines of the oral cavity, where Streptococcus mutans and other harmful bacteria will await their own holiday feast. Your meal will enable S. mutans to launch one of its biggest assaults of the year on your tooth enamel.
New work by dental researchers at the University of Rochester Medical Center brings both good and bad news. While bacterial forces in your mouth will exploit your delectables in newly discovered ways, some foods common at the holiday dinner table -- like the cranberry and even wine -- offer new leads in the effort to stop tooth decay.
The Thanksgiving Day battle for oral health hinges on microbes like S. mutans. Most cookies, pies and the like contain mountains of sugar, but it's not the sugar itself that causes tooth decay. Rather, S. mutans and other bacteria in our mouths -- billions of individual microbes all waiting for their next snack -- feast on the sugars, stick on your teeth and then churn out acid that eats away at tooth enamel.
At the front lines is Hyun "Michel" Koo, D.D.S, Ph.D., a dentist turned food scientist and microbiologist who is both exploring the destructive power of S. mutans and scouring foods and natural substances to harness their ability to prevent cavities. With every portion of bad news he delivers about cavities comes good news about compounds that may help prevent tooth decay.
"Natural substances offer tremendous possibilities for stopping tooth decay," said Koo, who earlier this year received a $1.6 million from the National Institute of Dental and Craniofacial Research to conduct his research. "Our time spent in the laboratory is aimed at harnessing the potential of some of these compounds, perhaps eventually incorporating them into a toothpaste or mouth rinse to stop dental decay."
Good news at the dinner table
Koo is hot on the trail of the cranberry as a potential ally in the fight against S. mutans, which is a threat to our teeth primarily because of its ability to form plaque. What appears to us as sticky white gunk along our teeth is actually a formidable fortress of molecules known as glucans -- building blocks of plaque, stacked like bricks in a wall, rife with bacteria. It's a gunky fortress that covers the tooth and gives bacteria a safe haven to munch on sugar, thrive, and churn out acid.
Koo has discovered that compounds within the cranberry disrupt enzymes known as glucosyltransferases that bacteria use to build glucans. Without its glucans, S. mutans and other bad bacteria in plaque becomes vulnerable.
Together with Nicholi Vorsa, Ph.D., director of the Philip E. Marucci Center for Blueberry and Cranberry Research and Extension at Rutgers University, Koo is working to isolate the compounds within the cranberry that are most protective. The pair has identified molecules known as A-type proanthocyanidins as having potential to reduce cavities dramatically. Earlier this year in the journal Caries Research, the team reported that when the molecules were applied, glucan and acid production by S. mutans was reduced by up to 70 percent, and cavity formation in rats was slashed by up to 45 percent.
"Maintaining the natural balance of resident flora in the oral cavity is important for keeping opportunistic pathogens in check," said Koo, a researcher in the Center for Oral Biology and an associate professor in the Eastman Institute for Oral Health and the Department of Microbiology and Immunology. "These molecules don't outright kill S. mutans. Instead, they disrupt the two most harmful actions of this pathogenic organism, acid production and glucan production."
More good news
More good news comes from that delicious glass of wine, or at least the waste in its wake. With funding from the U.S. Department of Agriculture, Koo began a research project with Olga I. Padilla-Zakour, Ph.D., associate professor of Food Processing at the New York Agricultural Experiment Station of Cornell University. They found that the abundant waste from the red-wine-making process -- materials such as fermented seeds and skins collectively known as pomace that are cast away after grapes are pressed -- contains compounds that fight S. mutans. In particular, some polyphenols can inhibit the activity of S. mutans' crucial enzymes by as much as 85 percent and also reduce the amount of acid the bacteria produce.
And the bad news
Last month in PloS One, Koo showed that S. mutans is even more powerful than scientists have realized, responding readily to changing environmental conditions in the presence of starch and sucrose to thrive in the mouth.
In work led by Marlise Klein, D.D.S., Ph.D., research assistant professor, Koo's team analyzed the activity of more than 300 genes in S. mutans under changing conditions. The team found that certain key proteins boost their activity dramatically in the presence not only of sugar but also complex carbohydrates derived from starch digestion. Once the body's own amylase enzymes naturally present in saliva break down starches, S. mutans kicks its glucan-forming machinery into high gear.
"The new research shows how two pillars of the modern diet, starch and sugar, can work cooperatively to bring about tooth decay," said Koo. "A cookie, sugar-covered doughnut, or a piece of pie filled with both sugar and starch provide the perfect recipe for the bacteria that destroy teeth."
Even when the amount of sugar was slashed in half, certain genes central to the ability of S. mutans to create its formidable glucan fortress boosted their activity five-fold in the presence of starch-derived carbohydrates. That enabled the bacteria to create plaque that is hardier, stickier, and capable of producing more acid than plaque created without significant starch present.
On Thanksgiving Day ……
Koo notes people shouldn't simply eat more cranberry sauce or drink more wine to try to prevent cavities. His work is aimed at identifying and then exploiting specific compounds that give the benefit without, for instance, the high levels of acidity or the added sugar that cranberry products might include. Rather, at this point, everything your dentist keeps telling you remains the best advice to prevent cavities.
"On Thanksgiving Day, like any day, brush your teeth, avoid foods filled with sugars as best you can, and don't snack often -- and if you do, brush your teeth again," said Koo. "Consider using a mouth rinse, get some fluoride in there -- and be sure to see a dentist regularly."
Friday, December 10, 2010
Scientists and Citizens Opposed to Mercury Fillings Urge FDA Panel to Restrict Amalgam PR Newswire
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FDA Device Division, still concerned about mercury toxicity in American dentistry, is convening yet another professional panel review regarding safety issues. A nationwide convergence of scientists, dental and medical professionals, lead by the International Academy of Oral Medicine and Toxicology (IAOMT) are provoking new challenges to the Food and Drug Administration's (FDA) July'09 "no risk" classification of mercury fillings . The Holiday Inn, Gaithersburg MD is the site of FDA's Dental Products Panel meeting December 14 & 15 where scientific and public testimony will be presented.
The use of mercury fillings, deceptively called "silver" by the dental profession, has been controversial since introduced more than 150 years ago, simply because they contain 50% mercury, a known poison which is neurotoxic. A 2006 Zogby poll indicated that 76% of Americans were not aware that their silver fillings contained mercury, and would have chosen non-mercury fillings had they been advised of the mercury content known to be poisonous to every living cell.
Denmark, Sweden and Norway have already banned dental amalgam use, while other countries, including Canada, Germany, France and Italy, have restricted the use of dental amalgam for children, pregnant women, mothers who are breast feeding, people with kidney problems, and/or individuals with mercury sensitivity.
In 2006 FDA convened a joint meeting of its dental and neurology panels asking approval of the FDA "White Paper" which declared mercury fillings were not a danger. In an unlikely turn of events, the Joint Panel voted13 to 7 rejecting the FDA's contention. Despite the fact that FDA had no scientific support of their claim, three years later in July 2009 the FDA strongly endorsed the safety of mercury fillings, still with no credible scientific evidence that the general or vulnerable populations were not at risk.
The FDA's nearly unprecedented hearing next week on the claims of safety versus danger was prompted by a Petition for Reconsideration prepared by the IAOMT's attorneys Jim Love and Bob Reeves, which pointed out that FDA's past reporting of dental mercury disregarded the harm of mercury dosages on the vulnerable population of smaller size and lighter weight children, relying on improper assumptions and outdated reviews of scientific literature.
A new risk assessment by Dr. Mark Richardson and his colleagues at SNC-Lavalin Environmental sent to FDA by Love last month concludes that the mercury vapor from fillings is absorbed and distributed into every tissue and organ in the body including the brain, resulting in excessive exposure of this poison to 122 million Americans. The risk assessment proves that mercury from all sources such as fillings, vaccines, and fish is cumulative and compounded by other toxins particularly lead.
Matthew Young DDS, President of the IAOMT emphasized: "The cumulative dose and health effects of mercury from all sources will eventually force a ban on all optional use of this toxic metal. Mercury based fillings are the greatest contributor to mercury exposure in humans according to this recent risk assessment and the World Health Organization's Mercury Policy Report." Young calls for a ban now instead of years from now, stating "the elimination of mercury fillings will be the greatest health benefit to humankind."
FDA Device Division, still concerned about mercury toxicity in American dentistry, is convening yet another professional panel review regarding safety issues. A nationwide convergence of scientists, dental and medical professionals, lead by the International Academy of Oral Medicine and Toxicology (IAOMT) are provoking new challenges to the Food and Drug Administration's (FDA) July'09 "no risk" classification of mercury fillings . The Holiday Inn, Gaithersburg MD is the site of FDA's Dental Products Panel meeting December 14 & 15 where scientific and public testimony will be presented.
The use of mercury fillings, deceptively called "silver" by the dental profession, has been controversial since introduced more than 150 years ago, simply because they contain 50% mercury, a known poison which is neurotoxic. A 2006 Zogby poll indicated that 76% of Americans were not aware that their silver fillings contained mercury, and would have chosen non-mercury fillings had they been advised of the mercury content known to be poisonous to every living cell.
Denmark, Sweden and Norway have already banned dental amalgam use, while other countries, including Canada, Germany, France and Italy, have restricted the use of dental amalgam for children, pregnant women, mothers who are breast feeding, people with kidney problems, and/or individuals with mercury sensitivity.
In 2006 FDA convened a joint meeting of its dental and neurology panels asking approval of the FDA "White Paper" which declared mercury fillings were not a danger. In an unlikely turn of events, the Joint Panel voted13 to 7 rejecting the FDA's contention. Despite the fact that FDA had no scientific support of their claim, three years later in July 2009 the FDA strongly endorsed the safety of mercury fillings, still with no credible scientific evidence that the general or vulnerable populations were not at risk.
The FDA's nearly unprecedented hearing next week on the claims of safety versus danger was prompted by a Petition for Reconsideration prepared by the IAOMT's attorneys Jim Love and Bob Reeves, which pointed out that FDA's past reporting of dental mercury disregarded the harm of mercury dosages on the vulnerable population of smaller size and lighter weight children, relying on improper assumptions and outdated reviews of scientific literature.
A new risk assessment by Dr. Mark Richardson and his colleagues at SNC-Lavalin Environmental sent to FDA by Love last month concludes that the mercury vapor from fillings is absorbed and distributed into every tissue and organ in the body including the brain, resulting in excessive exposure of this poison to 122 million Americans. The risk assessment proves that mercury from all sources such as fillings, vaccines, and fish is cumulative and compounded by other toxins particularly lead.
Matthew Young DDS, President of the IAOMT emphasized: "The cumulative dose and health effects of mercury from all sources will eventually force a ban on all optional use of this toxic metal. Mercury based fillings are the greatest contributor to mercury exposure in humans according to this recent risk assessment and the World Health Organization's Mercury Policy Report." Young calls for a ban now instead of years from now, stating "the elimination of mercury fillings will be the greatest health benefit to humankind."
Wednesday, November 24, 2010
Expecting? Don’t Neglect Your Teeth
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The effects of pregnancy on oral health
Even though most people are aware that good oral health is essential for the overall health of both mother and child, misunderstandings about the safety of dental care during pregnancy may cause pregnant women to avoid seeing their dentist. The fact is that dentists can create a treatment plan that is safe, effective, and essential for combating the adverse effects of oral disease during pregnancy.
During the course of pregnancy, a woman’s oral health can undergo significant changes. According to an article published in the November/December 2010 issue of General Dentistry, the peer-reviewed clinical journal of the Academy of General Dentistry (AGD), pregnant women can experience gingivitis, pregnancy tumors, and mild to severe gingival enlargement.
Clinically, pregnancy gingivitis is no different than non-pregnancy gingivitis. Patients will experience redness and inflammation of the gums, bleeding on probing, and increased tooth mobility. Between 30 and 100 percent of pregnant women will experience varying degrees of gingivitis.
“Although bleeding and inflammation of the gums has been noted in all trimesters of pregnancy, it typically disappears three to six months after delivery, provided that proper oral hygiene measures are implemented,” says Crystal L. McIntosh, DDS, MS, lead author of the article. “Good oral hygiene and visits to a dentist can help to alleviate gum inflammation.”
Pregnancy tumors are reported by 10 percent of pregnant women. These tumors, which are not cancerous, appear as a growth in the mouth and usually disappear after the child is born. They typically are painless and purple or red in color, but they can exhibit spontaneous bleeding.
“If a pregnancy tumor is painful, bleeds severely, or interferes with eating, surgical removal is the treatment of choice,” says AGD spokesperson Robert Roesch, DDS, MAGD.
Gingival enlargement, which is an overgrowth or an increase in the size of the gums, occurs less frequently than gingivitis and pregnancy tumors. In severe cases, the gums can “grow” to cover the teeth completely.
“Pregnancy gingivitis and gingival enlargement are thought to be the result of a heightened response to bacteria in the mouth,” says Dr. Roesch. “That’s why it is extremely important to educate and motivate patients to maintain good oral hygiene during pregnancy.”
If proper oral hygiene is not initiated prior to or during pregnancy, conditions such as gingivitis, pregnancy tumors, and gingival enlargement can worsen as the pregnancy progresses. Pregnant women should maintain their regular, semi-annual checkups and consult a dentist if they notice any changes in their oral health.Expecting? Don’t Neglect Your Teeth
The effects of pregnancy on oral health
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CHICAGO (November 23, 2010) – Even though most people are aware that good oral health is essential for the overall health of both mother and child, misunderstandings about the safety of dental care during pregnancy may cause pregnant women to avoid seeing their dentist. The fact is that dentists can create a treatment plan that is safe, effective, and essential for combating the adverse effects of oral disease during pregnancy.
During the course of pregnancy, a woman’s oral health can undergo significant changes. According to an article published in the November/December 2010 issue of General Dentistry, the peer-reviewed clinical journal of the Academy of General Dentistry (AGD), pregnant women can experience gingivitis, pregnancy tumors, and mild to severe gingival enlargement.
Clinically, pregnancy gingivitis is no different than non-pregnancy gingivitis. Patients will experience redness and inflammation of the gums, bleeding on probing, and increased tooth mobility. Between 30 and 100 percent of pregnant women will experience varying degrees of gingivitis.
“Although bleeding and inflammation of the gums has been noted in all trimesters of pregnancy, it typically disappears three to six months after delivery, provided that proper oral hygiene measures are implemented,” says Crystal L. McIntosh, DDS, MS, lead author of the article. “Good oral hygiene and visits to a dentist can help to alleviate gum inflammation.”
Pregnancy tumors are reported by 10 percent of pregnant women. These tumors, which are not cancerous, appear as a growth in the mouth and usually disappear after the child is born. They typically are painless and purple or red in color, but they can exhibit spontaneous bleeding.
“If a pregnancy tumor is painful, bleeds severely, or interferes with eating, surgical removal is the treatment of choice,” says AGD spokesperson Robert Roesch, DDS, MAGD.
Gingival enlargement, which is an overgrowth or an increase in the size of the gums, occurs less frequently than gingivitis and pregnancy tumors. In severe cases, the gums can “grow” to cover the teeth completely.
“Pregnancy gingivitis and gingival enlargement are thought to be the result of a heightened response to bacteria in the mouth,” says Dr. Roesch. “That’s why it is extremely important to educate and motivate patients to maintain good oral hygiene during pregnancy.”
If proper oral hygiene is not initiated prior to or during pregnancy, conditions such as gingivitis, pregnancy tumors, and gingival enlargement can worsen as the pregnancy progresses. Pregnant women should maintain their regular, semi-annual checkups and consult a dentist if they notice any changes in their oral health.
The effects of pregnancy on oral health
Even though most people are aware that good oral health is essential for the overall health of both mother and child, misunderstandings about the safety of dental care during pregnancy may cause pregnant women to avoid seeing their dentist. The fact is that dentists can create a treatment plan that is safe, effective, and essential for combating the adverse effects of oral disease during pregnancy.
During the course of pregnancy, a woman’s oral health can undergo significant changes. According to an article published in the November/December 2010 issue of General Dentistry, the peer-reviewed clinical journal of the Academy of General Dentistry (AGD), pregnant women can experience gingivitis, pregnancy tumors, and mild to severe gingival enlargement.
Clinically, pregnancy gingivitis is no different than non-pregnancy gingivitis. Patients will experience redness and inflammation of the gums, bleeding on probing, and increased tooth mobility. Between 30 and 100 percent of pregnant women will experience varying degrees of gingivitis.
“Although bleeding and inflammation of the gums has been noted in all trimesters of pregnancy, it typically disappears three to six months after delivery, provided that proper oral hygiene measures are implemented,” says Crystal L. McIntosh, DDS, MS, lead author of the article. “Good oral hygiene and visits to a dentist can help to alleviate gum inflammation.”
Pregnancy tumors are reported by 10 percent of pregnant women. These tumors, which are not cancerous, appear as a growth in the mouth and usually disappear after the child is born. They typically are painless and purple or red in color, but they can exhibit spontaneous bleeding.
“If a pregnancy tumor is painful, bleeds severely, or interferes with eating, surgical removal is the treatment of choice,” says AGD spokesperson Robert Roesch, DDS, MAGD.
Gingival enlargement, which is an overgrowth or an increase in the size of the gums, occurs less frequently than gingivitis and pregnancy tumors. In severe cases, the gums can “grow” to cover the teeth completely.
“Pregnancy gingivitis and gingival enlargement are thought to be the result of a heightened response to bacteria in the mouth,” says Dr. Roesch. “That’s why it is extremely important to educate and motivate patients to maintain good oral hygiene during pregnancy.”
If proper oral hygiene is not initiated prior to or during pregnancy, conditions such as gingivitis, pregnancy tumors, and gingival enlargement can worsen as the pregnancy progresses. Pregnant women should maintain their regular, semi-annual checkups and consult a dentist if they notice any changes in their oral health.Expecting? Don’t Neglect Your Teeth
The effects of pregnancy on oral health
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CHICAGO (November 23, 2010) – Even though most people are aware that good oral health is essential for the overall health of both mother and child, misunderstandings about the safety of dental care during pregnancy may cause pregnant women to avoid seeing their dentist. The fact is that dentists can create a treatment plan that is safe, effective, and essential for combating the adverse effects of oral disease during pregnancy.
During the course of pregnancy, a woman’s oral health can undergo significant changes. According to an article published in the November/December 2010 issue of General Dentistry, the peer-reviewed clinical journal of the Academy of General Dentistry (AGD), pregnant women can experience gingivitis, pregnancy tumors, and mild to severe gingival enlargement.
Clinically, pregnancy gingivitis is no different than non-pregnancy gingivitis. Patients will experience redness and inflammation of the gums, bleeding on probing, and increased tooth mobility. Between 30 and 100 percent of pregnant women will experience varying degrees of gingivitis.
“Although bleeding and inflammation of the gums has been noted in all trimesters of pregnancy, it typically disappears three to six months after delivery, provided that proper oral hygiene measures are implemented,” says Crystal L. McIntosh, DDS, MS, lead author of the article. “Good oral hygiene and visits to a dentist can help to alleviate gum inflammation.”
Pregnancy tumors are reported by 10 percent of pregnant women. These tumors, which are not cancerous, appear as a growth in the mouth and usually disappear after the child is born. They typically are painless and purple or red in color, but they can exhibit spontaneous bleeding.
“If a pregnancy tumor is painful, bleeds severely, or interferes with eating, surgical removal is the treatment of choice,” says AGD spokesperson Robert Roesch, DDS, MAGD.
Gingival enlargement, which is an overgrowth or an increase in the size of the gums, occurs less frequently than gingivitis and pregnancy tumors. In severe cases, the gums can “grow” to cover the teeth completely.
“Pregnancy gingivitis and gingival enlargement are thought to be the result of a heightened response to bacteria in the mouth,” says Dr. Roesch. “That’s why it is extremely important to educate and motivate patients to maintain good oral hygiene during pregnancy.”
If proper oral hygiene is not initiated prior to or during pregnancy, conditions such as gingivitis, pregnancy tumors, and gingival enlargement can worsen as the pregnancy progresses. Pregnant women should maintain their regular, semi-annual checkups and consult a dentist if they notice any changes in their oral health.
Osteoporosis Drug Builds Bone in Patients With Gum Disease
Science News
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A drug marketed to grow bone in osteoporosis patients also works to heal bone wounds in gum disease patients, a University of Michigan study suggests.
"This new approach for the treatment of periodontal disease could allow us to rebuild some of the bone that is lost due to periodontal disease, which until this point has been very difficult to achieve," said Jill Bashutski, clinical assistant professor at the U-M School of Dentistry and first author on the study. "Current treatments to re-grow bone around teeth affected with gum disease have limited success rates."
The findings are significant because gum disease is the leading cause of tooth loss in adults and is associated with a host of other health problems. Periodontal disease results in loss of teeth and can be devastating because it compromises speaking as well as eating, which can in turn contribute to poor nutrition.
The generic name of the drug is teriparatide and it is marketed by Eli Lilly and Co. under the trade name Forteo. It's a type of parathyroid hormone and the only anabolic (meaning it grows bone) osteoporosis drug approved on the market in the United States. Typically, osteoporosis drugs work by preventing bone loss.
The study appears online in the New England Journal of Medicine Oct. 16 and in the print edition Oct. 28. The study was presented Oct. 16 in Toronto at the annual meeting of the American Society for Bone and Mineral Research.
The study took place at the School of Dentistry's Michigan Center for Oral Health Research, where patients with severe chronic gum disease received the traditional treatment for gum disease, which is periodontal surgery on one-quarter of the mouth. Half of the patients took a six-week course of teriparatide by injection into the skin over the abdomen or stomach, plus calcium and vitamin D supplements, while the other half received a placebo.
After one year, researchers saw a 29 percent improvement in bone-level measurements on x-rays in the teriparatide group, versus a 3 percent improvement in the placebo group, a 10-fold increase.
"I think one really interesting aspect of this study is that even a short dosing of this drug had benefits that lasted a year," said Laurie McCauley, U-M professor and chair of periodontics and oral medicine, and principal investigator on the study.
McCauley's research lab has spent nearly two decades studying how parathyroid hormone works. Animal models suggest that it works even better in certain bone wound-healing situations, such as those that involve surgery, than in osteoporosis, which is a diminishing of the bone rather than a wound.
"There was speculation that the bone that forms in a wound like a fracture or inflammatory disease condition might be more responsive to being built back than other bone," said McCauley, who noted that this proved true in the experimental group.
McCauley said the next step is for U-M researchers to test whether the treatment could be delivered locally to target site-specific bone healing. Forteo is not FDA approved for uses other than osteoporosis, but another possible application could be to help grow bone around dental implants.
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A drug marketed to grow bone in osteoporosis patients also works to heal bone wounds in gum disease patients, a University of Michigan study suggests.
"This new approach for the treatment of periodontal disease could allow us to rebuild some of the bone that is lost due to periodontal disease, which until this point has been very difficult to achieve," said Jill Bashutski, clinical assistant professor at the U-M School of Dentistry and first author on the study. "Current treatments to re-grow bone around teeth affected with gum disease have limited success rates."
The findings are significant because gum disease is the leading cause of tooth loss in adults and is associated with a host of other health problems. Periodontal disease results in loss of teeth and can be devastating because it compromises speaking as well as eating, which can in turn contribute to poor nutrition.
The generic name of the drug is teriparatide and it is marketed by Eli Lilly and Co. under the trade name Forteo. It's a type of parathyroid hormone and the only anabolic (meaning it grows bone) osteoporosis drug approved on the market in the United States. Typically, osteoporosis drugs work by preventing bone loss.
The study appears online in the New England Journal of Medicine Oct. 16 and in the print edition Oct. 28. The study was presented Oct. 16 in Toronto at the annual meeting of the American Society for Bone and Mineral Research.
The study took place at the School of Dentistry's Michigan Center for Oral Health Research, where patients with severe chronic gum disease received the traditional treatment for gum disease, which is periodontal surgery on one-quarter of the mouth. Half of the patients took a six-week course of teriparatide by injection into the skin over the abdomen or stomach, plus calcium and vitamin D supplements, while the other half received a placebo.
After one year, researchers saw a 29 percent improvement in bone-level measurements on x-rays in the teriparatide group, versus a 3 percent improvement in the placebo group, a 10-fold increase.
"I think one really interesting aspect of this study is that even a short dosing of this drug had benefits that lasted a year," said Laurie McCauley, U-M professor and chair of periodontics and oral medicine, and principal investigator on the study.
McCauley's research lab has spent nearly two decades studying how parathyroid hormone works. Animal models suggest that it works even better in certain bone wound-healing situations, such as those that involve surgery, than in osteoporosis, which is a diminishing of the bone rather than a wound.
"There was speculation that the bone that forms in a wound like a fracture or inflammatory disease condition might be more responsive to being built back than other bone," said McCauley, who noted that this proved true in the experimental group.
McCauley said the next step is for U-M researchers to test whether the treatment could be delivered locally to target site-specific bone healing. Forteo is not FDA approved for uses other than osteoporosis, but another possible application could be to help grow bone around dental implants.
Taking a Closer Look at Plaque
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A team of University of Rochester scientists is using the technique of Raman spectroscopy to study two common dental plaque bacteria, Streptococcus sanguis and mutans. The relative balance of the two may be an indicator of a patient's oral health and risk for tooth decay -- Streptococcus sanguis is associated with "healthy" plaque, while mutans is associated with tooth decay.
Raman spectroscopy offers the potential to analyze samples of the bacterium in a simple, rapid and quantitative manner as compared to microbiology techniques, including the ability to study spatial distributions of bacterial species, living or dead, within samples.
"We're using Raman spectroscopy to study these oral bacterial biofilms, essentially observing how two species scatter light into shifted wavelengths in a unique way. We can then use these characteristic spectra to identify 'unknown' samples of these species," says Brooke Beier, a Ph.D. candidate at the University of Rochester's Institute of Optics. "Studying the spatial distributions of the good vs. bad bacteria under various growth conditions may help scientists determine more effective treatments to prevent tooth decay."
With the ability to identify biofilm samples by species, the researchers can now move on to the study of biofilms grown from a mixture of liquid cultures, where the two species may interact as they grow together.
A team of University of Rochester scientists is using the technique of Raman spectroscopy to study two common dental plaque bacteria, Streptococcus sanguis and mutans. The relative balance of the two may be an indicator of a patient's oral health and risk for tooth decay -- Streptococcus sanguis is associated with "healthy" plaque, while mutans is associated with tooth decay.
Raman spectroscopy offers the potential to analyze samples of the bacterium in a simple, rapid and quantitative manner as compared to microbiology techniques, including the ability to study spatial distributions of bacterial species, living or dead, within samples.
"We're using Raman spectroscopy to study these oral bacterial biofilms, essentially observing how two species scatter light into shifted wavelengths in a unique way. We can then use these characteristic spectra to identify 'unknown' samples of these species," says Brooke Beier, a Ph.D. candidate at the University of Rochester's Institute of Optics. "Studying the spatial distributions of the good vs. bad bacteria under various growth conditions may help scientists determine more effective treatments to prevent tooth decay."
With the ability to identify biofilm samples by species, the researchers can now move on to the study of biofilms grown from a mixture of liquid cultures, where the two species may interact as they grow together.
Substantial Consumption of Fluoride Increases Chance of Mild Fluorosis
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Young children who consume substantial amounts of fluoride through infant formula and other beverages mixed with fluoridated water or by swallowing fluoride toothpaste have an increased chance of developing mild enamel fluorosis, according to research published in the October issue of The Journal of the American Dental Association and supported by the National Institute of Dental and Craniofacial Research. However, experts say, children can continue using fluoridated water and fluoride toothpaste because fluoride has been proven to prevent tooth decay, and mild fluorosis does not negatively affect dental health or quality of life.
"Nearly all of the fluorosis in our study participants was mild. A recent review of the effects of mild dental fluorosis on oral health-related quality of life concluded that the effect of mild fluorosis was not adverse and could even be favorable," according to the study. "This suggests that concerns about mild dental fluorosis may be exaggerated. Therefore, no general recommendations to avoid use of fluoridated water in reconstituting infant formula are warranted. "
According to the American Dental Association, mild enamel fluorosis appears as barely noticeable faint white lines or streaks on tooth enamel that may occur when children ingest excess fluoride while their teeth are developing.
Researchers concluded that substantial fluoride consumption from beverages with fluoridated water, including infant formula, by children between the ages of 3 to 9 months, elevates a child's prospect of developing mild enamel fluorosis. Substantial fluoride consumption from beverages with fluoridated water and from fluoride toothpaste by children between the ages of 16 to 36 months also elevates a child's probability of developing mild enamel fluorosis.
The American Academy of Pediatrics recommends breastfeeding for infants. If parents are concerned about reducing the chances of their infants developing mild fluorosis through consuming substantial amounts of infant formula mixed with fluoridated water, the researchers suggest that they consult with their family dentist or physician. The researchers also encourage parents to follow recommendations to use small (smear or pea-sized) amounts of fluoridated toothpaste and ensure proper supervision of the child's tooth brushing.
Researchers recruited mothers of newborn infants from eight Iowa hospital postpartum wards between 1992 and 1995 for their children's participation in what would become known as the Iowa Fluoride Study, an investigation of dietary and non-dietary fluoride exposures, dental fluorosis and dental cavities. Researchers sent questionnaires to the parents at regular intervals and 630 children underwent visual dental examinations using standardized techniques and portable equipment. The leader of the research team was Steven M. Levy, D.D.S., M.P.H., the Wright-Bush-Shreves Endowed Professor of Research in the Department of Preventive and Community Dentistry at the University of Iowa's College of Dentistry and Professor of Epidemiology at the College of Public Health.
Young children who consume substantial amounts of fluoride through infant formula and other beverages mixed with fluoridated water or by swallowing fluoride toothpaste have an increased chance of developing mild enamel fluorosis, according to research published in the October issue of The Journal of the American Dental Association and supported by the National Institute of Dental and Craniofacial Research. However, experts say, children can continue using fluoridated water and fluoride toothpaste because fluoride has been proven to prevent tooth decay, and mild fluorosis does not negatively affect dental health or quality of life.
"Nearly all of the fluorosis in our study participants was mild. A recent review of the effects of mild dental fluorosis on oral health-related quality of life concluded that the effect of mild fluorosis was not adverse and could even be favorable," according to the study. "This suggests that concerns about mild dental fluorosis may be exaggerated. Therefore, no general recommendations to avoid use of fluoridated water in reconstituting infant formula are warranted. "
According to the American Dental Association, mild enamel fluorosis appears as barely noticeable faint white lines or streaks on tooth enamel that may occur when children ingest excess fluoride while their teeth are developing.
Researchers concluded that substantial fluoride consumption from beverages with fluoridated water, including infant formula, by children between the ages of 3 to 9 months, elevates a child's prospect of developing mild enamel fluorosis. Substantial fluoride consumption from beverages with fluoridated water and from fluoride toothpaste by children between the ages of 16 to 36 months also elevates a child's probability of developing mild enamel fluorosis.
The American Academy of Pediatrics recommends breastfeeding for infants. If parents are concerned about reducing the chances of their infants developing mild fluorosis through consuming substantial amounts of infant formula mixed with fluoridated water, the researchers suggest that they consult with their family dentist or physician. The researchers also encourage parents to follow recommendations to use small (smear or pea-sized) amounts of fluoridated toothpaste and ensure proper supervision of the child's tooth brushing.
Researchers recruited mothers of newborn infants from eight Iowa hospital postpartum wards between 1992 and 1995 for their children's participation in what would become known as the Iowa Fluoride Study, an investigation of dietary and non-dietary fluoride exposures, dental fluorosis and dental cavities. Researchers sent questionnaires to the parents at regular intervals and 630 children underwent visual dental examinations using standardized techniques and portable equipment. The leader of the research team was Steven M. Levy, D.D.S., M.P.H., the Wright-Bush-Shreves Endowed Professor of Research in the Department of Preventive and Community Dentistry at the University of Iowa's College of Dentistry and Professor of Epidemiology at the College of Public Health.
Tuesday, October 5, 2010
Women who get dental care have lower risk of heart disease, says study
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A new study led by a University of California, Berkeley, researcher could give women a little extra motivation to visit their dentist more regularly. The study suggests that women who get dental care reduce their risk of heart attacks, stroke and other cardiovascular problems by at least one-third.
The analysis, which used data from nearly 7,000 people ages 44-88 enrolled in the Health and Retirement Study, did not find a similar benefit for men.
Published online Sept. 29 in the journal Health Economics, the study compared people who went to the dentist during the previous two years with those who did not.
"Many studies have found associations between dental care and cardiovascular disease, but our study is the first to show that general dental care leads to fewer heart attacks, strokes, and other adverse cardiovascular outcomes in a causal way," said study lead author Timothy Brown, assistant adjunct professor of health policy and management at UC Berkeley's School of Public Health.
In the world of health and medical studies, causality is typically determined through randomized controlled trials in which two or more groups of people are essentially equal, except for the receipt of a treatment or intervention, such as a new drug, a periodontal procedure or a health education class. The group that did not receive the treatment – the control group – is compared with the group that did. Differences in outcomes between the groups are attributed to the treatment.
But randomized controlled trials are not always possible, so researchers sometimes turn to a statistical approach called the method of instrumental variables to rule out other potential factors that could account for different outcomes between groups. The use of instrumental variables is common among economists to evaluate the effects of economic policies, but it is less well-known in the clinical setting.
"While relatively short randomized controlled trials of specific types of dental treatment are possible, we can't run long-term randomized controlled trials of whether general dental care reduces cardiovascular disease events like heart attacks and strokes," said Brown, a health economist. "Individuals randomized to the treatment group would enjoy general dental care and those randomized to the control group would get no dental care at all. Many, if not most, people in the control group would simply get dental care on their own, destroying the experimental design, and making the results of the experiment worthless. The method of instrumental variables allows us to avoid this problem."
The method helped researchers rule out self-selection bias, or the possibility that people who seek out dental care are different – perhaps healthier in general – than those who don't.
Data from the Health and Retirement Study had been collected every two years from 1996 to 2004. This longitudinal study followed the same individuals over time, and each biennial survey included questions on whether subjects had visited the dentist and whether they had experienced a heart attack, stroke, angina or congestive heart failure during the prior two years. Deaths from heart attacks or strokes were also included in the analysis. The study took into account other risk factors, such as alcohol and tobacco use, high blood pressure and body mass index.
The fact that men and women did not benefit equally from dental care did not completely surprise the researchers. "To my knowledge, previous studies in this area have found that the relationship between poor oral health and cardiovascular disease markers varies by gender, but none have examined differences between men and women with regard to actual cardiovascular disease events," said Brown, who is also associate director of research at UC Berkeley's Nicholas C. Petris Center on Health Care Markets & Consumer Welfare.
"We think the findings reflect differences in how men and women develop cardiovascular disease," said study co-author Dr. Stephen Brown, a first-year obstetrician/gynecologist resident at the West Virginia University Charleston Division School of Medicine. "Other studies suggest that estrogen has a protective effect against heart disease because it helps prevent the development of atherosclerosis. It's not until women hit menopause around age 50 to 55 that they start catching up with men."
The study authors suggest that for dental care to have a protective effect, it should occur early in the development of cardiovascular disease.
The researchers did not have data on the type of procedures used during the dental visit, but they pointed to other studies that indicated three-fourths of older adult dental visits involved preventive services, such as cleaning, fluoride and sealant treatments.
Oral health experts recommend twice-yearly visits to the dentist, as well as brushing and flossing at least twice a day. Those wearing dentures should make sure they stay clean to prevent the growth and buildup of plaque and bacteria.
A new study led by a University of California, Berkeley, researcher could give women a little extra motivation to visit their dentist more regularly. The study suggests that women who get dental care reduce their risk of heart attacks, stroke and other cardiovascular problems by at least one-third.
The analysis, which used data from nearly 7,000 people ages 44-88 enrolled in the Health and Retirement Study, did not find a similar benefit for men.
Published online Sept. 29 in the journal Health Economics, the study compared people who went to the dentist during the previous two years with those who did not.
"Many studies have found associations between dental care and cardiovascular disease, but our study is the first to show that general dental care leads to fewer heart attacks, strokes, and other adverse cardiovascular outcomes in a causal way," said study lead author Timothy Brown, assistant adjunct professor of health policy and management at UC Berkeley's School of Public Health.
In the world of health and medical studies, causality is typically determined through randomized controlled trials in which two or more groups of people are essentially equal, except for the receipt of a treatment or intervention, such as a new drug, a periodontal procedure or a health education class. The group that did not receive the treatment – the control group – is compared with the group that did. Differences in outcomes between the groups are attributed to the treatment.
But randomized controlled trials are not always possible, so researchers sometimes turn to a statistical approach called the method of instrumental variables to rule out other potential factors that could account for different outcomes between groups. The use of instrumental variables is common among economists to evaluate the effects of economic policies, but it is less well-known in the clinical setting.
"While relatively short randomized controlled trials of specific types of dental treatment are possible, we can't run long-term randomized controlled trials of whether general dental care reduces cardiovascular disease events like heart attacks and strokes," said Brown, a health economist. "Individuals randomized to the treatment group would enjoy general dental care and those randomized to the control group would get no dental care at all. Many, if not most, people in the control group would simply get dental care on their own, destroying the experimental design, and making the results of the experiment worthless. The method of instrumental variables allows us to avoid this problem."
The method helped researchers rule out self-selection bias, or the possibility that people who seek out dental care are different – perhaps healthier in general – than those who don't.
Data from the Health and Retirement Study had been collected every two years from 1996 to 2004. This longitudinal study followed the same individuals over time, and each biennial survey included questions on whether subjects had visited the dentist and whether they had experienced a heart attack, stroke, angina or congestive heart failure during the prior two years. Deaths from heart attacks or strokes were also included in the analysis. The study took into account other risk factors, such as alcohol and tobacco use, high blood pressure and body mass index.
The fact that men and women did not benefit equally from dental care did not completely surprise the researchers. "To my knowledge, previous studies in this area have found that the relationship between poor oral health and cardiovascular disease markers varies by gender, but none have examined differences between men and women with regard to actual cardiovascular disease events," said Brown, who is also associate director of research at UC Berkeley's Nicholas C. Petris Center on Health Care Markets & Consumer Welfare.
"We think the findings reflect differences in how men and women develop cardiovascular disease," said study co-author Dr. Stephen Brown, a first-year obstetrician/gynecologist resident at the West Virginia University Charleston Division School of Medicine. "Other studies suggest that estrogen has a protective effect against heart disease because it helps prevent the development of atherosclerosis. It's not until women hit menopause around age 50 to 55 that they start catching up with men."
The study authors suggest that for dental care to have a protective effect, it should occur early in the development of cardiovascular disease.
The researchers did not have data on the type of procedures used during the dental visit, but they pointed to other studies that indicated three-fourths of older adult dental visits involved preventive services, such as cleaning, fluoride and sealant treatments.
Oral health experts recommend twice-yearly visits to the dentist, as well as brushing and flossing at least twice a day. Those wearing dentures should make sure they stay clean to prevent the growth and buildup of plaque and bacteria.
New approach for treating dry mouth
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A newly published study in the October 2010 issue of The Journal of the American Dental Association (JADA), conducted at New York University's College of Dentistry, confirms the safety and efficacy of a new novel method for controlling xerostomia, or dry mouth. The double masked, randomized controlled crossover study concludes that use of a unique mucoadhesive patch, affixed to the hard palate inside the mouth, provides statistically significant and sustainable improvements in salivary flow rates and subjective moistness for dry mouth sufferers. An estimated 30 million Americans deal with this uncomfortable oral health condition.
This latest study comes on the heels of another published study (March 2010 issue of Quintessence International) that showed these patches provided better performance for dry mouth sufferers than a leading over-the-counter dry mouth spray.
Chronic dry mouth is an under-diagnosed condition that can have a detrimental effect on oral health by contributing to tooth decay, gum disease and chronic bad breath. It can be a symptom of other medical conditions, such as diabetes or Sjogren's Syndrome, and is also the result of radiation treatment for head and neck cancer, but it is most often a side effect of many prescription and over-the-counter medications taken daily by millions of Americans (34% of people on three or more medications will likely have this condition).
The mucoadhesive patches tested in the study are available to consumers under the brand name OraMoist™ and sold over-the-counter at retailers, such as Rite-Aid and Walgreen's, nationwide. Approximately one centimeter in diameter, the patches can adhere to any oral mucosal surface, such as the roof of the mouth or inside the cheek, and the study confirmed can yield a "statistically significant improvement in baseline subjective and objective measures of dry mouth for up to 60 minutes – and possibly longer – after application."
The JADA study also found that after two weeks of daily use, participants experienced a statistically significant improvement in baseline subjective and objective measures of salivary flow. This, according to the researchers, suggests a sustained effect.
"One of the results was that after two weeks of use of the patch, the amount of saliva in the mouth had increased even during times when there was no patch in the mouth," says the study's lead author A. Ross Kerr, DDS, MSD, clinical associate professor at New York University College of Dentistry. "In other words, the patch would seem to have a cumulative beneficial effect."
According to Dr. Kerr, OraMoist provides an appealing and convenient alternative to other dry mouth treatments, which are usually in spray, rinse or gel form and require the user to replenish when necessary – which can be up to every 20 minutes. Overnight, the sustained effect is of particular benefit.
"The OraMoist patches offer pleasant tasting and longer-lasting option for the management of dry mouth, which becomes a quality of life issue for sufferers," says Dr. Kerr. In this and the Quintessence International study, approximately 70% of participants stated they would use the patch again.
OraMoist Dry Mouth Patch is a time-released mucoadhesive patch that moistens and lubricates the mouth, while simultaneously stimulating saliva production, day or night. . The patch can last for up to four hours and is the only such sustained release dry mouth product available over-the-counter.
The placebo mucoadhesive patches used in this study were made using the same unique, patented technology as the OraMoist patches. Unlike the unloaded placebo patch, the loaded patch, OraMoist, is enhanced by natural ingredients including natural lipids, oral enzymes, citrus oil, sea salt, calcium carbonate, natural lemon and xylitol. According to the company, the researchers behind the patch believe that these additional ingredients also play a role in inhibiting bacterial growth and promoting oral health. Based on the results of this study, further investigation of these benefits is warranted.
The patented mucoadhesive patch technology was developed by Professor Abraham J. Domb, PhD, Institute of Drug Research, School of Pharmacy, Faculty of Medicine at the Hebrew University. Dr. Domb is a leading worldwide authority on mucoadhesive technology/bio-degradable polymer research. The same patch technology has also been successfully adapted for the treatment of aphtous ulcers, or canker sores.
JADA Study Findings Summary: Use of Mucoadhesive Patch for Relief of Chronic Dry Mouth
Significant increase in objectively-measured salivary flow rates in those using OraMoist
A "sustained effect" for OraMoist – the patients using it benefited more on their 4th and 5th weeks than on their 3rd; increased baseline of improvement
96% of patients said OraMoist was easy to use; 82% said OraMoist did not interfere with eating or talking; 74% said the flavor was pleasant.
OraMoist is safe. There were no adverse events reported in the study.
A newly published study in the October 2010 issue of The Journal of the American Dental Association (JADA), conducted at New York University's College of Dentistry, confirms the safety and efficacy of a new novel method for controlling xerostomia, or dry mouth. The double masked, randomized controlled crossover study concludes that use of a unique mucoadhesive patch, affixed to the hard palate inside the mouth, provides statistically significant and sustainable improvements in salivary flow rates and subjective moistness for dry mouth sufferers. An estimated 30 million Americans deal with this uncomfortable oral health condition.
This latest study comes on the heels of another published study (March 2010 issue of Quintessence International) that showed these patches provided better performance for dry mouth sufferers than a leading over-the-counter dry mouth spray.
Chronic dry mouth is an under-diagnosed condition that can have a detrimental effect on oral health by contributing to tooth decay, gum disease and chronic bad breath. It can be a symptom of other medical conditions, such as diabetes or Sjogren's Syndrome, and is also the result of radiation treatment for head and neck cancer, but it is most often a side effect of many prescription and over-the-counter medications taken daily by millions of Americans (34% of people on three or more medications will likely have this condition).
The mucoadhesive patches tested in the study are available to consumers under the brand name OraMoist™ and sold over-the-counter at retailers, such as Rite-Aid and Walgreen's, nationwide. Approximately one centimeter in diameter, the patches can adhere to any oral mucosal surface, such as the roof of the mouth or inside the cheek, and the study confirmed can yield a "statistically significant improvement in baseline subjective and objective measures of dry mouth for up to 60 minutes – and possibly longer – after application."
The JADA study also found that after two weeks of daily use, participants experienced a statistically significant improvement in baseline subjective and objective measures of salivary flow. This, according to the researchers, suggests a sustained effect.
"One of the results was that after two weeks of use of the patch, the amount of saliva in the mouth had increased even during times when there was no patch in the mouth," says the study's lead author A. Ross Kerr, DDS, MSD, clinical associate professor at New York University College of Dentistry. "In other words, the patch would seem to have a cumulative beneficial effect."
According to Dr. Kerr, OraMoist provides an appealing and convenient alternative to other dry mouth treatments, which are usually in spray, rinse or gel form and require the user to replenish when necessary – which can be up to every 20 minutes. Overnight, the sustained effect is of particular benefit.
"The OraMoist patches offer pleasant tasting and longer-lasting option for the management of dry mouth, which becomes a quality of life issue for sufferers," says Dr. Kerr. In this and the Quintessence International study, approximately 70% of participants stated they would use the patch again.
OraMoist Dry Mouth Patch is a time-released mucoadhesive patch that moistens and lubricates the mouth, while simultaneously stimulating saliva production, day or night. . The patch can last for up to four hours and is the only such sustained release dry mouth product available over-the-counter.
The placebo mucoadhesive patches used in this study were made using the same unique, patented technology as the OraMoist patches. Unlike the unloaded placebo patch, the loaded patch, OraMoist, is enhanced by natural ingredients including natural lipids, oral enzymes, citrus oil, sea salt, calcium carbonate, natural lemon and xylitol. According to the company, the researchers behind the patch believe that these additional ingredients also play a role in inhibiting bacterial growth and promoting oral health. Based on the results of this study, further investigation of these benefits is warranted.
The patented mucoadhesive patch technology was developed by Professor Abraham J. Domb, PhD, Institute of Drug Research, School of Pharmacy, Faculty of Medicine at the Hebrew University. Dr. Domb is a leading worldwide authority on mucoadhesive technology/bio-degradable polymer research. The same patch technology has also been successfully adapted for the treatment of aphtous ulcers, or canker sores.
JADA Study Findings Summary: Use of Mucoadhesive Patch for Relief of Chronic Dry Mouth
Significant increase in objectively-measured salivary flow rates in those using OraMoist
A "sustained effect" for OraMoist – the patients using it benefited more on their 4th and 5th weeks than on their 3rd; increased baseline of improvement
96% of patients said OraMoist was easy to use; 82% said OraMoist did not interfere with eating or talking; 74% said the flavor was pleasant.
OraMoist is safe. There were no adverse events reported in the study.
Friday, October 1, 2010
FDA warns three companies to stop making unproven claims on mouth rinses
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The FDA has issued warning letters to three companies that manufacture and market mouth rinse products with claims that they remove plaque above the gum line or promote healthy gums. These claims suggest the products are effective in preventing gum disease when no such benefit has been demonstrated.
The FDA has issued warning letters to three companies that manufacture and market mouth rinse products with claims that they remove plaque above the gum line or promote healthy gums. These claims suggest the products are effective in preventing gum disease when no such benefit has been demonstrated.
Warning letters were sent to, Johnson & Johnson (Listerine Total Care Anticavity Mouthwash), CVS Corporation (CVS Complete Care Anticavity Mouthwash), and Walgreen Company (Walgreen Mouth Rinse Full Action).
These mouth rinse products contain the active ingredient sodium fluoride. The FDA has determined that sodium fluoride is effective in preventing cavities but has not found this ingredient to be effective in removing plaque or preventing gum disease.
“It is important for the FDA to take appropriate enforcement action when companies make false or unproven product claims to ensure that consumers are not misinformed or misled,” said Deborah Autor, director of the Office of Compliance in FDA’s Center for Drug Evaluation and Research.
Under federal law, a company cannot claim its product is effective in treating a disease unless those claims have been reviewed and approved by the FDA in a new drug application or the active ingredient has been generally recognized as safe and effective for these claims in an over-the-counter (OTC) drug monograph.
The FDA actions are part of the agency’s effort to curtail an increasing number of Federal Food Drug and Cosmetic Act (FFDCA) violations among the makers/marketers of mouthwashes concerning unproven claims of therapeutic benefits.
To date, the FDA is unaware of any injuries or adverse health effects related to the use of these mouth rinse products. Consumers who have these products may continue to use the products for cavity prevention without risk of injury but should be aware that the FDA has no data to show that these products can prevent gum disease.
Companies that received FDA warning letters are required to take appropriate action to correct these violations within 15 days. Failure to do so may result in seizure of the product, or other civil or criminal penalties.
For more information:
EPA Will Propose Rule to Protect Waterways by Reducing Mercury from Dental Offices
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The U.S. Environmental Protection Agency (EPA) today announced it intends to propose a rule to reduce mercury waste from dental offices. Dental amalgams, or fillings containing mercury, account for 3.7 tons of mercury discharged from dental offices each year. The mercury waste results when old mercury fillings are replaced with new ones. The mercury in dental fillings is flushed into chair-side drains and enters the wastewater systems, making its way into the environment through discharges to rivers and lakes, incineration or land application of sewage sludge. Mercury released through amalgam discharges can be easily managed and prevented.
EPA expects to propose a rule next year and finalize it in 2012. Dental offices will be able to use existing technology to meet the proposed requirements. Amalgam separators can separate out 95 percent of the mercury normally discharged to the local waste treatment plant. The separator captures the mercury, which is then recycled and reused.
Until the rule is final, EPA encourages dental offices to voluntarily install amalgam separators. Twelve states and several municipalities already require the installation of amalgam separators in dental offices.
Approximately 50 percent of mercury entering local waste treatment plants comes from dental amalgam waste. Once deposited, certain microorganisms can change elemental mercury into methylmercury, a highly toxic form that builds up in fish, shellfish and animals that eat fish.
Fish and shellfish are the main sources of methylmercury exposure to humans. Methylmercury can damage children’s developing brains and nervous systems even before they are born.
More information on mercury from dental offices
More information on mercury and the environment
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The U.S. Environmental Protection Agency (EPA) today announced it intends to propose a rule to reduce mercury waste from dental offices. Dental amalgams, or fillings containing mercury, account for 3.7 tons of mercury discharged from dental offices each year. The mercury waste results when old mercury fillings are replaced with new ones. The mercury in dental fillings is flushed into chair-side drains and enters the wastewater systems, making its way into the environment through discharges to rivers and lakes, incineration or land application of sewage sludge. Mercury released through amalgam discharges can be easily managed and prevented.
EPA expects to propose a rule next year and finalize it in 2012. Dental offices will be able to use existing technology to meet the proposed requirements. Amalgam separators can separate out 95 percent of the mercury normally discharged to the local waste treatment plant. The separator captures the mercury, which is then recycled and reused.
Until the rule is final, EPA encourages dental offices to voluntarily install amalgam separators. Twelve states and several municipalities already require the installation of amalgam separators in dental offices.
Approximately 50 percent of mercury entering local waste treatment plants comes from dental amalgam waste. Once deposited, certain microorganisms can change elemental mercury into methylmercury, a highly toxic form that builds up in fish, shellfish and animals that eat fish.
Fish and shellfish are the main sources of methylmercury exposure to humans. Methylmercury can damage children’s developing brains and nervous systems even before they are born.
More information on mercury from dental offices
More information on mercury and the environment
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Thursday, September 30, 2010
New technique to reattach teeth using stem cells
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A new approach to anchor teeth back in the jaw using stem cells has been developed and successfully tested in the laboratory for the first time by researchers at the University of Illinois at Chicago.
The new strategy represents a potential major advance in the battle against gum disease, a serious infection that eventually leads to tooth loss. About 80 percent of U.S. adults suffer from gum disease, according to the National Institute of Dental and Craniofacial Research.
Researchers in UIC's Brodie Laboratory for Craniofacial Genetics used stem cells obtained from the periodontal ligament of molars extracted from mice, expanded them in an incubator, and then seeded them on barren rat molars. The stem cell-treated molars were reinserted into the tooth sockets of rats.
After two and four months, the stem cells aligned and formed new fibrous attachments between the tooth and bone, firmly attaching the replanted tooth into the animal's mouth, said Smit Dangaria, a bioengineering doctoral candidate who conducted the research. Tissue sections showed that the replanted tooth was surrounded by newly formed, functional periodontal ligament fibers and new cementum, the essential ingredients of a healthy tooth attachment.
In contrast, tooth molars that were replanted without new stem/progenitor cells were either lost or loosely attached and were resorbed, Dangaria said.
The study, published in an online issue of the journal Tissue Engineering, was funded through a grant by the National Institutes of Health.
Dangaria said the natural surface of the tooth played an essential role in the study.
"Our research uncovered the code required to reattach teeth -- a combination of natural tooth root surface structure together with periodontal progenitor cells," he said.
To verify that the ligament was formed by the transplanted stem cells and not by the animal's own cells, stem cells were labeled with green fluorescent protein prior to seeding them on the molars and re-inserting the teeth into the animal's mouth, Dangaria said.
According to Tom Diekwisch, director of the Brodie Laboratory, who is senior author on the paper, this is the first progenitor cell-based regeneration of a complete periodontal ligament in which a functional tooth was attached.
"Our strategy could be used for replanting teeth that were lost due to trauma or as a novel approach for tooth replacement using tooth-shaped replicas," said Diekwisch, who is also professor and head of oral biology.
A new approach to anchor teeth back in the jaw using stem cells has been developed and successfully tested in the laboratory for the first time by researchers at the University of Illinois at Chicago.
The new strategy represents a potential major advance in the battle against gum disease, a serious infection that eventually leads to tooth loss. About 80 percent of U.S. adults suffer from gum disease, according to the National Institute of Dental and Craniofacial Research.
Researchers in UIC's Brodie Laboratory for Craniofacial Genetics used stem cells obtained from the periodontal ligament of molars extracted from mice, expanded them in an incubator, and then seeded them on barren rat molars. The stem cell-treated molars were reinserted into the tooth sockets of rats.
After two and four months, the stem cells aligned and formed new fibrous attachments between the tooth and bone, firmly attaching the replanted tooth into the animal's mouth, said Smit Dangaria, a bioengineering doctoral candidate who conducted the research. Tissue sections showed that the replanted tooth was surrounded by newly formed, functional periodontal ligament fibers and new cementum, the essential ingredients of a healthy tooth attachment.
In contrast, tooth molars that were replanted without new stem/progenitor cells were either lost or loosely attached and were resorbed, Dangaria said.
The study, published in an online issue of the journal Tissue Engineering, was funded through a grant by the National Institutes of Health.
Dangaria said the natural surface of the tooth played an essential role in the study.
"Our research uncovered the code required to reattach teeth -- a combination of natural tooth root surface structure together with periodontal progenitor cells," he said.
To verify that the ligament was formed by the transplanted stem cells and not by the animal's own cells, stem cells were labeled with green fluorescent protein prior to seeding them on the molars and re-inserting the teeth into the animal's mouth, Dangaria said.
According to Tom Diekwisch, director of the Brodie Laboratory, who is senior author on the paper, this is the first progenitor cell-based regeneration of a complete periodontal ligament in which a functional tooth was attached.
"Our strategy could be used for replanting teeth that were lost due to trauma or as a novel approach for tooth replacement using tooth-shaped replicas," said Diekwisch, who is also professor and head of oral biology.
Thursday, September 23, 2010
Gum Disease Found to Be Significant Public Health Concern
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Centers for Disease Control and Prevention and American Academy of Periodontology suggest more American adults may have gum disease; previous estimates underestimate periodontal disease in the US population.
CHICAGO—September 21, 2010—The prevalence of periodontal disease in the United States may be significantly higher than originally estimated. Research published in the Journal of Dental Research from the Centers for Disease Control and Prevention (CDC) and the American Academy of Periodontology (AAP) suggests that the prevalence of periodontal disease may have been underestimated by as much as 50 percent. The implication is that more American adults may suffer from moderate to severe gum disease than previously thought.
In a National Health and Nutrition Examination Survey (NHANES) pilot study, funded by the CDC’s Division of Oral Health, a full-mouth, comprehensive periodontal examination was conducted on over 450 adults over the age of 35. Periodontal disease was classified according to definitions determined by the CDC in collaboration with the AAP. The prevalence rates were then compared against the results of previous NHANES studies which used a partial-mouth periodontal examination. Historically, NHANES has served as the main source for determining prevalence of periodontal disease in US adults. The pilot study finds that the original partial-mouth study methodology may have underestimated true disease prevalence by up to 50 percent.
Periodontal disease is a chronic inflammatory disease that affects the gum tissue and other structures supporting the teeth. If left untreated, it can lead to tooth loss, and may also interfere with other systems of the body. Several research studies have associated gum disease with other chronic inflammatory diseases such as diabetes, cardiovascular disease, and rheumatoid arthritis.
“This study shows that periodontal disease is a bigger problem than we all thought. It is a call to action for anyone who cares about his or her oral health.” said Samuel Low, DDS, MS, associate dean and professor of periodontology at the University of Florida College of Dentistry, and president of the American Academy of Periodontology. “Given what we know about the relationship between gum disease and other diseases, taking care of your oral health isn’t just about a pretty smile. It has bigger implications for overall health, and is therefore a more significant public health problem.”
Dr. Low explained that the increased prevalence of periodontal disease makes it essential to maintain healthy teeth and gums. “Not only should you take good care of your periodontal health with daily tooth brushing and flossing, you should expect to get a comprehensive periodontal evaluation every year,” he advised. A dental professional, such as a periodontist, a specialist in the diagnosis, treatment and prevention of gum disease, will conduct the comprehensive exam to assess your periodontal disease status.
According to Paul Eke, MPH, PhD, epidemiologist at the CDC and lead author of the study, the findings have significant public health implications. “The study suggests we have likely underestimated the prevalence of periodontal disease in the adult US population,” he said. “We are currently utilizing a full-mouth periodontal examination in the 2009/10 NHANES to better understand the full extent and characteristics of periodontal disease in our adult population.” Dr. Eke added, “Research suggests a connection between periodontal health and systemic health. In light of these findings, understanding the relationships between periodontal disease and other systemic diseases in the adult U.S population is more crucial than ever.”
Centers for Disease Control and Prevention and American Academy of Periodontology suggest more American adults may have gum disease; previous estimates underestimate periodontal disease in the US population.
CHICAGO—September 21, 2010—The prevalence of periodontal disease in the United States may be significantly higher than originally estimated. Research published in the Journal of Dental Research from the Centers for Disease Control and Prevention (CDC) and the American Academy of Periodontology (AAP) suggests that the prevalence of periodontal disease may have been underestimated by as much as 50 percent. The implication is that more American adults may suffer from moderate to severe gum disease than previously thought.
In a National Health and Nutrition Examination Survey (NHANES) pilot study, funded by the CDC’s Division of Oral Health, a full-mouth, comprehensive periodontal examination was conducted on over 450 adults over the age of 35. Periodontal disease was classified according to definitions determined by the CDC in collaboration with the AAP. The prevalence rates were then compared against the results of previous NHANES studies which used a partial-mouth periodontal examination. Historically, NHANES has served as the main source for determining prevalence of periodontal disease in US adults. The pilot study finds that the original partial-mouth study methodology may have underestimated true disease prevalence by up to 50 percent.
Periodontal disease is a chronic inflammatory disease that affects the gum tissue and other structures supporting the teeth. If left untreated, it can lead to tooth loss, and may also interfere with other systems of the body. Several research studies have associated gum disease with other chronic inflammatory diseases such as diabetes, cardiovascular disease, and rheumatoid arthritis.
“This study shows that periodontal disease is a bigger problem than we all thought. It is a call to action for anyone who cares about his or her oral health.” said Samuel Low, DDS, MS, associate dean and professor of periodontology at the University of Florida College of Dentistry, and president of the American Academy of Periodontology. “Given what we know about the relationship between gum disease and other diseases, taking care of your oral health isn’t just about a pretty smile. It has bigger implications for overall health, and is therefore a more significant public health problem.”
Dr. Low explained that the increased prevalence of periodontal disease makes it essential to maintain healthy teeth and gums. “Not only should you take good care of your periodontal health with daily tooth brushing and flossing, you should expect to get a comprehensive periodontal evaluation every year,” he advised. A dental professional, such as a periodontist, a specialist in the diagnosis, treatment and prevention of gum disease, will conduct the comprehensive exam to assess your periodontal disease status.
According to Paul Eke, MPH, PhD, epidemiologist at the CDC and lead author of the study, the findings have significant public health implications. “The study suggests we have likely underestimated the prevalence of periodontal disease in the adult US population,” he said. “We are currently utilizing a full-mouth periodontal examination in the 2009/10 NHANES to better understand the full extent and characteristics of periodontal disease in our adult population.” Dr. Eke added, “Research suggests a connection between periodontal health and systemic health. In light of these findings, understanding the relationships between periodontal disease and other systemic diseases in the adult U.S population is more crucial than ever.”
Thursday, September 16, 2010
Periodontal therapy may reduce the risk of preterm birth
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A collaboration led by a periodontal researcher from the University of Pennsylvania School of Dental Medicine has found a possible link between the success of gum-disease treatment and the likelihood of giving birth prematurely, according to a study published in the journal BJOG: An International Journal of Obstetrics and Gynaecology.
While a number of factors are associated with an increased rate of preterm birth, such as low body-mass index, alcohol consumption and smoking, the study adds to the body of research that suggests oral infection may also be associated with such an increase.
The study looked at 322 pregnant women, all with gum disease. Half the group was given oral-hygiene instruction and treated with scaling and root planning, which consists of cleaning above and below the gum line. The second half received only oral-hygiene instruction.
The incidence of preterm birth was high in both the treatment group and the untreated group: 52.4 percent of the women in the untreated control group had a preterm baby compared with 45.6 percent in the treatment group. These differences were not statistically significant.
However, researchers then looked at whether the success of periodontal treatment was associated with the rate of preterm birth. Participants were examined 20 weeks after the initial treatment, and success was characterized by reduced inflammation, no increase in probing depth and loosening of the teeth.
Within the treatment group of 160 women, 49 were classified as having successful gum treatment and only four, or 8 percent, had a preterm baby. In comparison, 111 women had unsuccessful treatment and 69, or 62 percent, had preterm babies.
The results show that pregnant women who were resistant to the effects of scaling and root planning were significantly more likely to deliver preterm babies than those for whom it was successful.
The mean age of the women in the study was 23.7 years; 87.5 percent were African-American, and 90 percent had not seen a dentist for tooth cleaning.
"First and foremost, this study shows that pregnant women can receive periodontal treatment safely in order to improve their oral health," said Marjorie Jeffcoat, professor of periodontics at Penn Dental Medicine and lead author of the paper. "Second, in a high risk group of pregnant women, such as those patients who participated in this study, successful periodontal treatment when rendered as an adjunct to conventional obstetric care may reduce the incidence of preterm birth."
Future papers will address the role of antimicrobial mouth rinses in reducing the incidence of preterm birth.
"Researchers have previously suggested that severe gum infections cause an increase in the production of prostaglandin and tumour necrosis factor, chemicals which are associated with preterm labor," Philip Steer, editor-in-chief of BJOG, said. "This new study shows a strong link between unsuccessful gum-disease treatment and preterm birth; however, we need to bear in mind that 69 percent of women failed to respond to the dental treatment given. Therefore, more effective treatment will need to be devised before we can be sure that successful treatment improves outcome, rather than simply being a marker of pregnancies with a lower background level of inflammation that will go to term anyway."
A collaboration led by a periodontal researcher from the University of Pennsylvania School of Dental Medicine has found a possible link between the success of gum-disease treatment and the likelihood of giving birth prematurely, according to a study published in the journal BJOG: An International Journal of Obstetrics and Gynaecology.
While a number of factors are associated with an increased rate of preterm birth, such as low body-mass index, alcohol consumption and smoking, the study adds to the body of research that suggests oral infection may also be associated with such an increase.
The study looked at 322 pregnant women, all with gum disease. Half the group was given oral-hygiene instruction and treated with scaling and root planning, which consists of cleaning above and below the gum line. The second half received only oral-hygiene instruction.
The incidence of preterm birth was high in both the treatment group and the untreated group: 52.4 percent of the women in the untreated control group had a preterm baby compared with 45.6 percent in the treatment group. These differences were not statistically significant.
However, researchers then looked at whether the success of periodontal treatment was associated with the rate of preterm birth. Participants were examined 20 weeks after the initial treatment, and success was characterized by reduced inflammation, no increase in probing depth and loosening of the teeth.
Within the treatment group of 160 women, 49 were classified as having successful gum treatment and only four, or 8 percent, had a preterm baby. In comparison, 111 women had unsuccessful treatment and 69, or 62 percent, had preterm babies.
The results show that pregnant women who were resistant to the effects of scaling and root planning were significantly more likely to deliver preterm babies than those for whom it was successful.
The mean age of the women in the study was 23.7 years; 87.5 percent were African-American, and 90 percent had not seen a dentist for tooth cleaning.
"First and foremost, this study shows that pregnant women can receive periodontal treatment safely in order to improve their oral health," said Marjorie Jeffcoat, professor of periodontics at Penn Dental Medicine and lead author of the paper. "Second, in a high risk group of pregnant women, such as those patients who participated in this study, successful periodontal treatment when rendered as an adjunct to conventional obstetric care may reduce the incidence of preterm birth."
Future papers will address the role of antimicrobial mouth rinses in reducing the incidence of preterm birth.
"Researchers have previously suggested that severe gum infections cause an increase in the production of prostaglandin and tumour necrosis factor, chemicals which are associated with preterm labor," Philip Steer, editor-in-chief of BJOG, said. "This new study shows a strong link between unsuccessful gum-disease treatment and preterm birth; however, we need to bear in mind that 69 percent of women failed to respond to the dental treatment given. Therefore, more effective treatment will need to be devised before we can be sure that successful treatment improves outcome, rather than simply being a marker of pregnancies with a lower background level of inflammation that will go to term anyway."
Asthma and cavities in kids but not linked
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There is no apparent link between asthma and tooth decay, according to a study published in the September 2010 issue of the Journal of the American Dental Association.
"Is There a Relationship between Asthma and Dental Caries?: A Critical Review of the Literature" examined the 27 separate studies which looked for a link between asthma and cavities that were reported in 29 papers published between 1976 and March 2010.
"The notion that there is a link between asthma and tooth decay may have its origin in anecdotal statements by emergency room workers who see children with poorly managed asthma. These children could also be more likely to have poorly managed dental conditions, and therefore tooth decay. It's reasonable to believe that poor clinical management may be associated with both conditions, not the asthma that is causing the cavities," said Gerardo Maupomé, B.D.S., M.Sc., Ph.D., professor of preventive and community dentistry at the Indiana University School of Dentistry and a Regenstrief Institute affiliated scientist, who is the first author of the new JADA study.
"We found little evidence to suggest that asthma causes tooth decay. In fact, the two largest studies we reviewed found that children with asthma appear to have fewer cavities than others. This may be because their parents are used to taking them to health-care providers, and routinely bring them to the dentist," said Dr. Maupomé.
The large number of variables involved, including severity of asthma symptoms and the variety of types of treatment for the disease, has made it difficult to unequivocally determine whether there is a causal link between the two.
While not apparently associated, tooth decay and asthma are the two most prevalent chronic childhood diseases in the United States.
Routine home and professional dental care are critical for all children. Parents of children with asthma do not need to be concerned about an increased risk of tooth decay but Dr. Maupomé points out that children who use nebulizers to control their asthma may be inadvertently increasing their frequency of exposure to sugars because these nebulizers use fructose to deliver therapy. The frequency and the amount of certain sugars consumed are major factors leading to cavities.
He also recommends that children who are mouth breathers or who have mouth dryness be checked periodically by their dentists. These conditions may be associated with asthma but they are also found in children who do not have asthma. Many medications used for the long term (such as asthma medications) have been found to reduce the amount of saliva, which is the first protection of teeth.
There is no apparent link between asthma and tooth decay, according to a study published in the September 2010 issue of the Journal of the American Dental Association.
"Is There a Relationship between Asthma and Dental Caries?: A Critical Review of the Literature" examined the 27 separate studies which looked for a link between asthma and cavities that were reported in 29 papers published between 1976 and March 2010.
"The notion that there is a link between asthma and tooth decay may have its origin in anecdotal statements by emergency room workers who see children with poorly managed asthma. These children could also be more likely to have poorly managed dental conditions, and therefore tooth decay. It's reasonable to believe that poor clinical management may be associated with both conditions, not the asthma that is causing the cavities," said Gerardo Maupomé, B.D.S., M.Sc., Ph.D., professor of preventive and community dentistry at the Indiana University School of Dentistry and a Regenstrief Institute affiliated scientist, who is the first author of the new JADA study.
"We found little evidence to suggest that asthma causes tooth decay. In fact, the two largest studies we reviewed found that children with asthma appear to have fewer cavities than others. This may be because their parents are used to taking them to health-care providers, and routinely bring them to the dentist," said Dr. Maupomé.
The large number of variables involved, including severity of asthma symptoms and the variety of types of treatment for the disease, has made it difficult to unequivocally determine whether there is a causal link between the two.
While not apparently associated, tooth decay and asthma are the two most prevalent chronic childhood diseases in the United States.
Routine home and professional dental care are critical for all children. Parents of children with asthma do not need to be concerned about an increased risk of tooth decay but Dr. Maupomé points out that children who use nebulizers to control their asthma may be inadvertently increasing their frequency of exposure to sugars because these nebulizers use fructose to deliver therapy. The frequency and the amount of certain sugars consumed are major factors leading to cavities.
He also recommends that children who are mouth breathers or who have mouth dryness be checked periodically by their dentists. These conditions may be associated with asthma but they are also found in children who do not have asthma. Many medications used for the long term (such as asthma medications) have been found to reduce the amount of saliva, which is the first protection of teeth.
Friday, September 10, 2010
Impact of chemical BPA in dental sealants used in children
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Researchers from Mount Sinai School of Medicine have found that bisphenol A (BPA) released from some plastic resins used in pediatric dentistry is detectable in the saliva after placement in children's mouths. BPA is a widely used synthetic chemical that has been associated with changes in behavior, prostate and urinary tract development, and early onset of puberty. The findings are published in the current issue of Pediatrics.
Reins containing BPA are commonly used in preventive and restorative oral care. Children often have their teeth sealed with a dental resin containing BPA to prevent cavities, and it is often used for fillings. Led by Philip Landrigan, MD, Dean for Global Health, Professor and Chair of Preventive Medicine, and Director of the Children's Environmental Health Center at Mount Sinai School of Medicine, the research team conducted a literature review and found that BPA was detectable in saliva for up to three hours after the dental work was completed.
"BPA is commonly used in dental products, and while exposure from dental materials is much less common than from food storage products, we are still concerned," said Dr. Landrigan. "These dental products are still safe and an effective way to promote good oral health, but dentists should take precautions to reduce potential absorption of this chemical and the negative side effects associated with it."
Dr. Landrigan's team reviewed toxicology data over the last 10 years to examine the benefits and potential childhood health risks of using dental materials containing BPA. They determined that dental products contain different derivatives of BPA, and that saliva breaks down the derivative into BPA during the dental procedure and for three hours following it. As a further precaution the authors urge that resins containing BPA not be applied in women during pregnancy.
The authors caution that these results are preliminary, and that data on the absorption of BPA in the body were not available. "Further research is needed to fully grasp the impact of BPA in dental products, and to analyze all dental products that use this chemical," continued Dr. Landrigan. "However, the overwhelming benefit of these dental resins in oral health outweighs the brief exposure to BPA. Dentists should continue to use these products, but manufacturers should disclose specific information about the chemical structures of these products and search for alternatives."
To reduce exposure, the authors recommend the use of one BPA derivative called bis-GMA over another, bis-DMA, as bis-GMA seems to pose less risk. They also recommend that dentists rub the surface of the materials with pumice to remove the top liquefied layer of the sealant. Another preventive measure would be to encourage the patient to rinse for 30 seconds immediately following the procedure to prevent saliva from breaking the chemical down into BPA.
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Researchers from Mount Sinai School of Medicine have found that bisphenol A (BPA) released from some plastic resins used in pediatric dentistry is detectable in the saliva after placement in children's mouths. BPA is a widely used synthetic chemical that has been associated with changes in behavior, prostate and urinary tract development, and early onset of puberty. The findings are published in the current issue of Pediatrics.
Reins containing BPA are commonly used in preventive and restorative oral care. Children often have their teeth sealed with a dental resin containing BPA to prevent cavities, and it is often used for fillings. Led by Philip Landrigan, MD, Dean for Global Health, Professor and Chair of Preventive Medicine, and Director of the Children's Environmental Health Center at Mount Sinai School of Medicine, the research team conducted a literature review and found that BPA was detectable in saliva for up to three hours after the dental work was completed.
"BPA is commonly used in dental products, and while exposure from dental materials is much less common than from food storage products, we are still concerned," said Dr. Landrigan. "These dental products are still safe and an effective way to promote good oral health, but dentists should take precautions to reduce potential absorption of this chemical and the negative side effects associated with it."
Dr. Landrigan's team reviewed toxicology data over the last 10 years to examine the benefits and potential childhood health risks of using dental materials containing BPA. They determined that dental products contain different derivatives of BPA, and that saliva breaks down the derivative into BPA during the dental procedure and for three hours following it. As a further precaution the authors urge that resins containing BPA not be applied in women during pregnancy.
The authors caution that these results are preliminary, and that data on the absorption of BPA in the body were not available. "Further research is needed to fully grasp the impact of BPA in dental products, and to analyze all dental products that use this chemical," continued Dr. Landrigan. "However, the overwhelming benefit of these dental resins in oral health outweighs the brief exposure to BPA. Dentists should continue to use these products, but manufacturers should disclose specific information about the chemical structures of these products and search for alternatives."
To reduce exposure, the authors recommend the use of one BPA derivative called bis-GMA over another, bis-DMA, as bis-GMA seems to pose less risk. They also recommend that dentists rub the surface of the materials with pumice to remove the top liquefied layer of the sealant. Another preventive measure would be to encourage the patient to rinse for 30 seconds immediately following the procedure to prevent saliva from breaking the chemical down into BPA.
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A smart use for wisdom teeth: Making stem cells
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For most people, wisdom teeth are not much more than an annoyance that eventually needs to be removed. However, a new study appearing in the September 17 Journal of Biological Chemistry shows that wisdom teeth contain a valuable reservoir of tissue for the creation of stem cells; thus, everyone might be carrying around his or her own personal stem-cell repository should he or she ever need some.
Groundbreaking research back in 2006 revealed that inducing the activity of four genes in adult cells could "reprogram" them back into a stem-cell-like state; biologically, these induced-pluripotent stem cells are virtually identical to embryonic stem cells, opening up a new potential avenue for stem-cell therapy whereby patients could be treated with their own stem cells.
However, despite their promise, making iPS cells is not easy; the reprogramming efficiencies are very low and vary among the cells that can be used for iPS generation and thus require good amount of "starter" cells - which might involve difficult extraction from body tissue (unfortunately skin cells, the easiest to acquire, show very low reprogramming efficiency).
Now, a team of scientists at Japan's National Institute of Advanced Industrial Science and Technology may have found an ideal source: third molars, commonly known as wisdom teeth.
The soft pulp inside of teeth contains a population of cells known as mesenchymal stromal cells that are similar to cells found in bone marrow, a common stem-cell source. However, unlike bone marrow, tooth pulp is more easily obtained, especially in wisdom teeth, which most individuals have removed anyway.
The researchers, led by Hajime Ohgushi, collected tooth samples from three donors and managed to generate a series of iPS cell lines following the similar procedure of activating three key genes (however, in another beneficial change they did not have activate the c-MYC gene which might lead the cells to become cancerous).
The different cell lines displayed varying degrees of robustness but in some cases proliferated quite well, up to 100 times more efficiently than typical skin-cell-derived iPS cells. The molar-derived cells also could differentiate into many other cell types including beating cardiomyocytes (see an attached movie), as expected.
The presence of a supply of MSCs in wisdom teeth could have meaningful therapeutic ramifications. As noted by the researchers and others, wisdom tooth extraction is a common medical procedure in developed nations and, thus, creates a perfect opportunity to remove biological material in a sterilized setting; the teeth subsequently can be frozen and stored for many years until needed. In the meantime, that also provides time for researchers to better understand the details of iPS creation to further increase the efficiency for clinical use.
For most people, wisdom teeth are not much more than an annoyance that eventually needs to be removed. However, a new study appearing in the September 17 Journal of Biological Chemistry shows that wisdom teeth contain a valuable reservoir of tissue for the creation of stem cells; thus, everyone might be carrying around his or her own personal stem-cell repository should he or she ever need some.
Groundbreaking research back in 2006 revealed that inducing the activity of four genes in adult cells could "reprogram" them back into a stem-cell-like state; biologically, these induced-pluripotent stem cells are virtually identical to embryonic stem cells, opening up a new potential avenue for stem-cell therapy whereby patients could be treated with their own stem cells.
However, despite their promise, making iPS cells is not easy; the reprogramming efficiencies are very low and vary among the cells that can be used for iPS generation and thus require good amount of "starter" cells - which might involve difficult extraction from body tissue (unfortunately skin cells, the easiest to acquire, show very low reprogramming efficiency).
Now, a team of scientists at Japan's National Institute of Advanced Industrial Science and Technology may have found an ideal source: third molars, commonly known as wisdom teeth.
The soft pulp inside of teeth contains a population of cells known as mesenchymal stromal cells that are similar to cells found in bone marrow, a common stem-cell source. However, unlike bone marrow, tooth pulp is more easily obtained, especially in wisdom teeth, which most individuals have removed anyway.
The researchers, led by Hajime Ohgushi, collected tooth samples from three donors and managed to generate a series of iPS cell lines following the similar procedure of activating three key genes (however, in another beneficial change they did not have activate the c-MYC gene which might lead the cells to become cancerous).
The different cell lines displayed varying degrees of robustness but in some cases proliferated quite well, up to 100 times more efficiently than typical skin-cell-derived iPS cells. The molar-derived cells also could differentiate into many other cell types including beating cardiomyocytes (see an attached movie), as expected.
The presence of a supply of MSCs in wisdom teeth could have meaningful therapeutic ramifications. As noted by the researchers and others, wisdom tooth extraction is a common medical procedure in developed nations and, thus, creates a perfect opportunity to remove biological material in a sterilized setting; the teeth subsequently can be frozen and stored for many years until needed. In the meantime, that also provides time for researchers to better understand the details of iPS creation to further increase the efficiency for clinical use.
Friday, September 3, 2010
Tray Bleaching May Improve Oral Health of Elderly, Special-Needs Patients
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A tooth-bleaching agent may improve the oral health of elderly and special-needs patients, say dentists at the Medical College of Georgia and Western University of Health Sciences.
Standard oral hygiene, such as brushing and flossing, can be difficult or impossible for patients with mental challenges or impaired manual dexterity. Additionally, when health problems or medications cause xerostomia, or dry mouth, the lack of saliva reduces the mouth's natural protective mechanisms. These problems lead to plaque accumulation, cavities and periodontal disease, and could further impact the patient's health.
A report featured on the cover of this month's Journal of the American Dental Association noted that applying the tooth whitener carbamide peroxide through a custom-fit mouth tray might combat those problems. The report was based on a literature review and the authors' clinical experiences with special-needs patients and tooth bleaching.
"What we've noticed through whitening patients' teeth over the years is that as they bleached, their teeth got squeaky clean and their gingival health improved," said Dr. Van Haywood, professor in the Medical College of Georgia School of Dentistry and co-author of the report.
Dentists have used carbamide peroxide, or urea peroxide, for decades to whiten teeth, but its original use was as an oral antiseptic. It removes plaque, kills bacteria and elevates the mouth's pH above the point at which enamel and dentin begin to dissolve, which results in fewer cavities.
"All these benefits lead us to believe that tray bleaching can be a very effective supplemental method of oral hygiene for patients facing greater challenges keeping their mouths clean," said Dr. David Lazarchik, associate professor in the Western University of Health Sciences College of Dental Medicine and the report's co-author.
The trick is in the tray, Haywood said. After a complete dental exam, the dentist can make the custom-fit tray that the patient can wear comfortably at night or for several hours during the day. The carbamide peroxide gel can be prescribed or purchased over-the-counter.
Lazarchik said further research is needed to determine a specific protocol for using tray-applied carbamide peroxide specifically to improve oral health.
Haywood will lecture on the topic in October at the American Dental Association's 151st Annual Session and World Marketplace Exhibition in Orlando, Fla.
A tooth-bleaching agent may improve the oral health of elderly and special-needs patients, say dentists at the Medical College of Georgia and Western University of Health Sciences.
Standard oral hygiene, such as brushing and flossing, can be difficult or impossible for patients with mental challenges or impaired manual dexterity. Additionally, when health problems or medications cause xerostomia, or dry mouth, the lack of saliva reduces the mouth's natural protective mechanisms. These problems lead to plaque accumulation, cavities and periodontal disease, and could further impact the patient's health.
A report featured on the cover of this month's Journal of the American Dental Association noted that applying the tooth whitener carbamide peroxide through a custom-fit mouth tray might combat those problems. The report was based on a literature review and the authors' clinical experiences with special-needs patients and tooth bleaching.
"What we've noticed through whitening patients' teeth over the years is that as they bleached, their teeth got squeaky clean and their gingival health improved," said Dr. Van Haywood, professor in the Medical College of Georgia School of Dentistry and co-author of the report.
Dentists have used carbamide peroxide, or urea peroxide, for decades to whiten teeth, but its original use was as an oral antiseptic. It removes plaque, kills bacteria and elevates the mouth's pH above the point at which enamel and dentin begin to dissolve, which results in fewer cavities.
"All these benefits lead us to believe that tray bleaching can be a very effective supplemental method of oral hygiene for patients facing greater challenges keeping their mouths clean," said Dr. David Lazarchik, associate professor in the Western University of Health Sciences College of Dental Medicine and the report's co-author.
The trick is in the tray, Haywood said. After a complete dental exam, the dentist can make the custom-fit tray that the patient can wear comfortably at night or for several hours during the day. The carbamide peroxide gel can be prescribed or purchased over-the-counter.
Lazarchik said further research is needed to determine a specific protocol for using tray-applied carbamide peroxide specifically to improve oral health.
Haywood will lecture on the topic in October at the American Dental Association's 151st Annual Session and World Marketplace Exhibition in Orlando, Fla.
Wednesday, August 25, 2010
Fluoride in Water Prevents Adult Tooth Loss
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Children drinking water with added fluoride helps dental health in adulthood decades later, a new study finds.
In an article appearing in the October issue of the American Journal of Public Health, Matthew Neidell reports a strong relationship between fluoride levels in a resident’s county at the time of their birth with tooth loss as an adult.
“Your fluoridation exposure at birth is affecting your tooth loss in your 40s and 50s, regardless of what your fluoridation exposure was like when you were 20 and 30 years old,” said Neidell, a health policy professor at the Mailman School of Public Health at Columbia University.
He combined data from a recent Centers for Disease Control and Prevention community health study and a water census to see the affects of drinking fluoridated water in the 1950s and 1960s on tooth loss in the 1990s.
“We know that the benefits of fluoridation are greatest from birth,” said Howard Pollick, a professor of clinical dentistry at the University of California, San Francisco. “This recent study adds credence to that.”
For children whose adult teeth have not shown yet, fluoride still improves tooth enamel, the highly mineralized tissue on teeth’s surface. Fluoride also helps teeth damaged from the decay process and breaks down bacteria on teeth.
The researchers write that respondents who did not live in the same county their entire lives received differing amounts of fluoride in their water, which complicated study findings. The study, which focused on tooth loss as an indication of overall oral health, could not adjust for factors such as use of toothpaste, which also provides a dose of fluoride.
Pollick said that roughly 75 percent of people served by public water systems have fluoride added. The process uses small amounts of the naturally occurring mineral to increase concentrations to no more than one part per million typically.
The American Dental Association, which has supported fluoridation of community water since 1950, says scientists continue to show adding the mineral to water is safe and aids tooth health. One 2007 study of Kaiser Permanente HMO members found that adults benefitted from community fluoridation more than children.
Pollick pointed to a study of Medicaid dental patients in Louisiana, which showed that for every $1 invested in water fluoridation, the state saw $38 in reduced dental costs.
To prevent tooth decay, Pollick recommends also brushing twice a day with fluoride toothpaste and reducing sugar levels in diet.
Children drinking water with added fluoride helps dental health in adulthood decades later, a new study finds.
In an article appearing in the October issue of the American Journal of Public Health, Matthew Neidell reports a strong relationship between fluoride levels in a resident’s county at the time of their birth with tooth loss as an adult.
“Your fluoridation exposure at birth is affecting your tooth loss in your 40s and 50s, regardless of what your fluoridation exposure was like when you were 20 and 30 years old,” said Neidell, a health policy professor at the Mailman School of Public Health at Columbia University.
He combined data from a recent Centers for Disease Control and Prevention community health study and a water census to see the affects of drinking fluoridated water in the 1950s and 1960s on tooth loss in the 1990s.
“We know that the benefits of fluoridation are greatest from birth,” said Howard Pollick, a professor of clinical dentistry at the University of California, San Francisco. “This recent study adds credence to that.”
For children whose adult teeth have not shown yet, fluoride still improves tooth enamel, the highly mineralized tissue on teeth’s surface. Fluoride also helps teeth damaged from the decay process and breaks down bacteria on teeth.
The researchers write that respondents who did not live in the same county their entire lives received differing amounts of fluoride in their water, which complicated study findings. The study, which focused on tooth loss as an indication of overall oral health, could not adjust for factors such as use of toothpaste, which also provides a dose of fluoride.
Pollick said that roughly 75 percent of people served by public water systems have fluoride added. The process uses small amounts of the naturally occurring mineral to increase concentrations to no more than one part per million typically.
The American Dental Association, which has supported fluoridation of community water since 1950, says scientists continue to show adding the mineral to water is safe and aids tooth health. One 2007 study of Kaiser Permanente HMO members found that adults benefitted from community fluoridation more than children.
Pollick pointed to a study of Medicaid dental patients in Louisiana, which showed that for every $1 invested in water fluoridation, the state saw $38 in reduced dental costs.
To prevent tooth decay, Pollick recommends also brushing twice a day with fluoride toothpaste and reducing sugar levels in diet.
Tuesday, August 10, 2010
New Process Could Improve Dental Restoration Procedures
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Oral surgeons may one day have an easier, less costly approach to one important aspect of dental restoration, thanks to a newly patented process developed by researchers at Missouri University of Science and Technology (Missouri S&T).
The process computerizes the method for creating a dental bar, also called an over-denture. For dental restoration procedures, the device is the bridge connecting dental implants to dentures.
The computerized approach was developed by Dr. Ming Leu, the Keith and Pat Bailey Missouri Distinguished Professor of Integrated Product Manufacturing at Missouri S&T, and one of Leu’s former students, Amit Gawate, who received a master’s degree in mechanical engineering from Missouri S&T in 2005. Leu and Gawate were recently awarded a patent for their process.
Typically, a dental technician creates the device through a laborious manual process that involves molding and casting. But Leu’s approach is entirely digital and automated.
“This method can reduce the cost as well as the time involved” in fabricating dental bars, Leu says.
The conventional approach involves first making an impression of the area of the mouth where a denture would be placed, then casting a model of the gums and implants. From there, technicians design and fabricate the dental bar from a metal material.
Rather than making a physical model, Leu’s process uses digital imaging technology to take a picture of a patient’s mouth. From there, computer algorithms – developed by Leu and Gawate – crunch the image data to create a computer-aided design model of the actual dental bar. That model can then be fabricated using either an “additive manufacturing” or a computer-numerically controlled (CNC) machining process.
“Additive manufacturing is a way of making a part by adding material, one layer at a time, rather than removing material, as you would do with machining,” he says. The process uses less material than machining or other processes and can be easily tailored to individualized parts of different geometries, Leu adds.
An expert in manufacturing, Leu first became interested in dental surgery after a prosthodontist contacted Leu about some previous research with additive manufacturing. In 2000, Leu developed a way to create prototypes of manufactured parts out of ice, a method he called “rapid freeze prototyping,” and the prosthodontist thought the approach would be a cost-effective way to make models for dental surgery. Together, they obtained funding from the National Science Foundation to investigate the approach. From there, Leu developed the computer-aided method for dental bar design.
Oral surgeons may one day have an easier, less costly approach to one important aspect of dental restoration, thanks to a newly patented process developed by researchers at Missouri University of Science and Technology (Missouri S&T).
The process computerizes the method for creating a dental bar, also called an over-denture. For dental restoration procedures, the device is the bridge connecting dental implants to dentures.
The computerized approach was developed by Dr. Ming Leu, the Keith and Pat Bailey Missouri Distinguished Professor of Integrated Product Manufacturing at Missouri S&T, and one of Leu’s former students, Amit Gawate, who received a master’s degree in mechanical engineering from Missouri S&T in 2005. Leu and Gawate were recently awarded a patent for their process.
Typically, a dental technician creates the device through a laborious manual process that involves molding and casting. But Leu’s approach is entirely digital and automated.
“This method can reduce the cost as well as the time involved” in fabricating dental bars, Leu says.
The conventional approach involves first making an impression of the area of the mouth where a denture would be placed, then casting a model of the gums and implants. From there, technicians design and fabricate the dental bar from a metal material.
Rather than making a physical model, Leu’s process uses digital imaging technology to take a picture of a patient’s mouth. From there, computer algorithms – developed by Leu and Gawate – crunch the image data to create a computer-aided design model of the actual dental bar. That model can then be fabricated using either an “additive manufacturing” or a computer-numerically controlled (CNC) machining process.
“Additive manufacturing is a way of making a part by adding material, one layer at a time, rather than removing material, as you would do with machining,” he says. The process uses less material than machining or other processes and can be easily tailored to individualized parts of different geometries, Leu adds.
An expert in manufacturing, Leu first became interested in dental surgery after a prosthodontist contacted Leu about some previous research with additive manufacturing. In 2000, Leu developed a way to create prototypes of manufactured parts out of ice, a method he called “rapid freeze prototyping,” and the prosthodontist thought the approach would be a cost-effective way to make models for dental surgery. Together, they obtained funding from the National Science Foundation to investigate the approach. From there, Leu developed the computer-aided method for dental bar design.
Friday, August 6, 2010
Six Dental Myths Debunked
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Brushing, flossing, and twice-yearly dental check-ups are standard for oral health care, but there are more health benefits to taking care of your pearly whites than most of us know. In a review article, a faculty member at Tufts University School of Dental Medicine (TUSDM) debunks common dental myths and outlines how diet and nutrition affects oral health in children, teenagers, expectant mothers, adults and elders.
Myth 1: The consequences of poor oral health are restricted to the mouth
Expectant mothers may not know that what they eat affects the tooth development of the fetus. Poor nutrition during pregnancy may make the unborn child more likely to have tooth decay later in life. “Between the ages of 14 weeks to four months, deficiencies in calcium, vitamin D, vitamin A, protein and calories could result in oral defects,” says Carole Palmer, EdD, RD, professor at TUSDM and head of the division of nutrition and oral health promotion in the department of public health and community service. Some data also suggest that lack of adequate vitamin B6 or B12 could be a risk factor for cleft lip and cleft palate formation.
In children, tooth decay is the most prevalent disease, about five times more common than childhood asthma. “If a child’s mouth hurts due to tooth decay, he/she is less likely to be able to concentrate at school and is more likely to be eating foods that are easier to chew but that are less nutritious. Foods such as donuts and pastries are often lower in nutritional quality and higher in sugar content than more nutritious foods that require chewing, like fruits and vegetables,” says Palmer. “Oral complications combined with poor diet can also contribute to cognitive and growth problems and can contribute to obesity.”
Myth 2: More sugar means more tooth decay
It isn’t the amount of sugar you eat; it is the amount of time that the sugar has contact with the teeth. “Foods such as slowly-dissolving candies and soda are in the mouth for longer periods of time. This increases the amount of time teeth are exposed to the acids formed by oral bacteria from the sugars,” says Palmer.
Some research shows that teens obtain about 40 percent of their carbohydrate intake from soft drinks. This constant beverage use increases the risk of tooth decay. Sugar-free carbonated drinks and acidic beverages, such as lemonade, are often considered safer for teeth than sugared beverages but can also contribute to demineralization of tooth enamel if consumed regularly.
Myth 3: Losing baby teeth to tooth decay is okay
It is a common myth that losing baby teeth due to tooth decay is insignificant because baby teeth fall out anyway. Palmer notes that tooth decay in baby teeth can result in damage to the developing crowns of the permanent teeth developing below them. If baby teeth are lost prematurely, the permanent teeth may erupt malpositioned and require orthodontics later on.
Myth 4: Osteoporosis only affects the spine and hips
Osteoporosis may also lead to tooth loss. Teeth are held in the jaw by the face bone, which can also be affected by osteoporosis. “So, the jaw can also suffer the consequences of a diet lacking essential nutrients such as calcium and vitamins D and K,” says Palmer.
“The jawbone, gums, lips, and soft and hard palates are constantly replenishing themselves throughout life. A good diet is required to keep the mouth and supporting structures in optimal shape.”
Myth 5: Dentures improve a person’s diet
If dentures don’t fit well, older adults are apt to eat foods that are easy to chew and low in nutritional quality, such as cakes or pastries. “First, denture wearers should make sure that dentures are fitted properly. In the meantime, if they are having difficulty chewing or have mouth discomfort, they can still eat nutritious foods by having cooked vegetables instead of raw, canned fruits instead of raw, and ground beef instead of steak. Also, they should drink plenty of fluids or chew sugar-free gum to prevent dry mouth,” says Palmer.
Myth 6: Dental decay is only a young person’s problem
In adults and elders, receding gums can result in root decay (decay along the roots of teeth). Commonly used drugs such as antidepressants, diuretics, antihistamines and sedatives increase the risk of tooth decay by reducing saliva production. “Lack of saliva means that the mouth is cleansed more slowly. This increases the risk of oral problems,” says Palmer. “In this case, drinking water frequently can help cleanse the mouth.”
Adults and elders are more likely to have chronic health conditions, like diabetes, which are risk factors for periodontal disease (which begins with an inflammation of the gums and can lead to tooth loss). “Type 2 diabetes patients have twice the risk of developing periodontal disease of people without diabetes. Furthermore, periodontal disease exacerbates diabetes mellitus, so meticulous oral hygiene can help improve diabetes control,” says Palmer.
This article appears in the July/August issue of Nutrition Today.
Palmer CA, Burnett DJ, Dean B. July/August 2010. Nutrition Today. 45(4): 154-164. “It’s More than Just Candy: Important Relationships between Nutrition and Oral Health.” doi: 10.1097/NT.0b013e3181e98969
Brushing, flossing, and twice-yearly dental check-ups are standard for oral health care, but there are more health benefits to taking care of your pearly whites than most of us know. In a review article, a faculty member at Tufts University School of Dental Medicine (TUSDM) debunks common dental myths and outlines how diet and nutrition affects oral health in children, teenagers, expectant mothers, adults and elders.
Myth 1: The consequences of poor oral health are restricted to the mouth
Expectant mothers may not know that what they eat affects the tooth development of the fetus. Poor nutrition during pregnancy may make the unborn child more likely to have tooth decay later in life. “Between the ages of 14 weeks to four months, deficiencies in calcium, vitamin D, vitamin A, protein and calories could result in oral defects,” says Carole Palmer, EdD, RD, professor at TUSDM and head of the division of nutrition and oral health promotion in the department of public health and community service. Some data also suggest that lack of adequate vitamin B6 or B12 could be a risk factor for cleft lip and cleft palate formation.
In children, tooth decay is the most prevalent disease, about five times more common than childhood asthma. “If a child’s mouth hurts due to tooth decay, he/she is less likely to be able to concentrate at school and is more likely to be eating foods that are easier to chew but that are less nutritious. Foods such as donuts and pastries are often lower in nutritional quality and higher in sugar content than more nutritious foods that require chewing, like fruits and vegetables,” says Palmer. “Oral complications combined with poor diet can also contribute to cognitive and growth problems and can contribute to obesity.”
Myth 2: More sugar means more tooth decay
It isn’t the amount of sugar you eat; it is the amount of time that the sugar has contact with the teeth. “Foods such as slowly-dissolving candies and soda are in the mouth for longer periods of time. This increases the amount of time teeth are exposed to the acids formed by oral bacteria from the sugars,” says Palmer.
Some research shows that teens obtain about 40 percent of their carbohydrate intake from soft drinks. This constant beverage use increases the risk of tooth decay. Sugar-free carbonated drinks and acidic beverages, such as lemonade, are often considered safer for teeth than sugared beverages but can also contribute to demineralization of tooth enamel if consumed regularly.
Myth 3: Losing baby teeth to tooth decay is okay
It is a common myth that losing baby teeth due to tooth decay is insignificant because baby teeth fall out anyway. Palmer notes that tooth decay in baby teeth can result in damage to the developing crowns of the permanent teeth developing below them. If baby teeth are lost prematurely, the permanent teeth may erupt malpositioned and require orthodontics later on.
Myth 4: Osteoporosis only affects the spine and hips
Osteoporosis may also lead to tooth loss. Teeth are held in the jaw by the face bone, which can also be affected by osteoporosis. “So, the jaw can also suffer the consequences of a diet lacking essential nutrients such as calcium and vitamins D and K,” says Palmer.
“The jawbone, gums, lips, and soft and hard palates are constantly replenishing themselves throughout life. A good diet is required to keep the mouth and supporting structures in optimal shape.”
Myth 5: Dentures improve a person’s diet
If dentures don’t fit well, older adults are apt to eat foods that are easy to chew and low in nutritional quality, such as cakes or pastries. “First, denture wearers should make sure that dentures are fitted properly. In the meantime, if they are having difficulty chewing or have mouth discomfort, they can still eat nutritious foods by having cooked vegetables instead of raw, canned fruits instead of raw, and ground beef instead of steak. Also, they should drink plenty of fluids or chew sugar-free gum to prevent dry mouth,” says Palmer.
Myth 6: Dental decay is only a young person’s problem
In adults and elders, receding gums can result in root decay (decay along the roots of teeth). Commonly used drugs such as antidepressants, diuretics, antihistamines and sedatives increase the risk of tooth decay by reducing saliva production. “Lack of saliva means that the mouth is cleansed more slowly. This increases the risk of oral problems,” says Palmer. “In this case, drinking water frequently can help cleanse the mouth.”
Adults and elders are more likely to have chronic health conditions, like diabetes, which are risk factors for periodontal disease (which begins with an inflammation of the gums and can lead to tooth loss). “Type 2 diabetes patients have twice the risk of developing periodontal disease of people without diabetes. Furthermore, periodontal disease exacerbates diabetes mellitus, so meticulous oral hygiene can help improve diabetes control,” says Palmer.
This article appears in the July/August issue of Nutrition Today.
Palmer CA, Burnett DJ, Dean B. July/August 2010. Nutrition Today. 45(4): 154-164. “It’s More than Just Candy: Important Relationships between Nutrition and Oral Health.” doi: 10.1097/NT.0b013e3181e98969
Tuesday, August 3, 2010
Tongue Piercing May Cause Gapped Teeth
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Could cost thousands of dollars in orthodontic repairs
Mark this one down as a parental nightmare.
First, your child gets her tongue pierced. Then, as if you needed something else, she starts "playing" with the tiny barbell-shaped stud, pushing it against her upper front teeth. And before you know it, she forces a gap between those teeth -- a fraction-of-an-inch gap that may cost thousands of dollars in orthodontic bills to straighten.
How and why this happens has been documented in a case study by University at Buffalo researchers published in the July issue of the Journal of Clinical Orthodontics.
"It is a basic tenet of orthodontic that force, over time, moves teeth," explains the study's primary investigator, Sawsan Tabbaa, DDS, MS, assistant professor of orthodontics at the UB School of Dental Medicine.
Tabbaa notes that a previous UB dental school survey study of Buffalo high school students revealed that the presence of a barbell implant/stud caused a damaging habit whereby subjects pushed the metal stud up against and between their upper front teeth, a habit commonly referred to among the students as "playing."
"And it happened in very high percent of the cases," said Tabbaa.
That repeated "playing" with the stud may result in a gap as is demonstrated in Tabbaa's current case study.
The study involved a 26- year-old female patient examined at UB's orthodontic clinic who complained that a large space had developed between her upper central incisors or upper front teeth. The patient also had a tongue piercing that held a barbell-shaped tongue stud.
The tongue was pierced seven years earlier and every day for seven years she had pushed the stud between her upper front teeth, creating the space between them and, subsequently, habitually placing it in the space. The patient did not have a space between her upper front teeth prior to the tongue piercing.
"The barbell is never removed because the tongue is so vascular that leaving the stud out can result in healing of the opening in the tongue, said Tabbaa, "so it makes perfect sense that constant pushing of the stud against the teeth -- every day with no break -- will move them or drive them apart."
The patient provided the research team with photos that demonstrated she had no diastema, or space, prior to having her tongue pierced. For the purposes of treating this patient's space, it was assumed that positioning of the tongue stud between the maxillary central incisors or "playing" caused the midline space.
Her treatment involved a fixed braces appliance to push the front teeth back together.
Tongue piercing can result in serious injury not just to teeth but has also been associated with hemorrhage, infection, chipped and fractured teeth, trauma to the gums and, in the worst cases, brain abscess, said Tabbaa.
"The best way to protect your health, your teeth and your money is to avoid tongue piercing."
Could cost thousands of dollars in orthodontic repairs
Mark this one down as a parental nightmare.
First, your child gets her tongue pierced. Then, as if you needed something else, she starts "playing" with the tiny barbell-shaped stud, pushing it against her upper front teeth. And before you know it, she forces a gap between those teeth -- a fraction-of-an-inch gap that may cost thousands of dollars in orthodontic bills to straighten.
How and why this happens has been documented in a case study by University at Buffalo researchers published in the July issue of the Journal of Clinical Orthodontics.
"It is a basic tenet of orthodontic that force, over time, moves teeth," explains the study's primary investigator, Sawsan Tabbaa, DDS, MS, assistant professor of orthodontics at the UB School of Dental Medicine.
Tabbaa notes that a previous UB dental school survey study of Buffalo high school students revealed that the presence of a barbell implant/stud caused a damaging habit whereby subjects pushed the metal stud up against and between their upper front teeth, a habit commonly referred to among the students as "playing."
"And it happened in very high percent of the cases," said Tabbaa.
That repeated "playing" with the stud may result in a gap as is demonstrated in Tabbaa's current case study.
The study involved a 26- year-old female patient examined at UB's orthodontic clinic who complained that a large space had developed between her upper central incisors or upper front teeth. The patient also had a tongue piercing that held a barbell-shaped tongue stud.
The tongue was pierced seven years earlier and every day for seven years she had pushed the stud between her upper front teeth, creating the space between them and, subsequently, habitually placing it in the space. The patient did not have a space between her upper front teeth prior to the tongue piercing.
"The barbell is never removed because the tongue is so vascular that leaving the stud out can result in healing of the opening in the tongue, said Tabbaa, "so it makes perfect sense that constant pushing of the stud against the teeth -- every day with no break -- will move them or drive them apart."
The patient provided the research team with photos that demonstrated she had no diastema, or space, prior to having her tongue pierced. For the purposes of treating this patient's space, it was assumed that positioning of the tongue stud between the maxillary central incisors or "playing" caused the midline space.
Her treatment involved a fixed braces appliance to push the front teeth back together.
Tongue piercing can result in serious injury not just to teeth but has also been associated with hemorrhage, infection, chipped and fractured teeth, trauma to the gums and, in the worst cases, brain abscess, said Tabbaa.
"The best way to protect your health, your teeth and your money is to avoid tongue piercing."
Pilot safety protocol could help dentists reduce errors
Ω
Pilots and dentists have more in common than one might think: Both jobs are highly technical and require teamwork. Both are subject to human error where small, individual mistakes may lead to catastrophe if not addressed early.
A dental professor at the University of Michigan and two pilot-dentists believe that implementing a checklist of safety procedures in dental offices similar to procedures used in airlines would drastically reduce human errors.
Illustration by Maria Gunnes Sibbel
Crew Resource Management empowers team members to actively participate to enhance safety using forward thinking strategies, said Russell Taichman, U-M dentistry professor and director of the Scholars Program in Dental Leadership. Taichman co-authored the study, "Adaptation of airline crew resource management (CRM) principles to dentistry," which will appear in the August issue of the Journal of the American Dental Association.
Airlines implemented CRM about 30 years ago after recognizing that most accidents resulted from human error, said co-author Harold Pinsky, a full-time airline pilot and practicing general dentist who did additional training at U-M dental school.
"Using checklists makes for a safer, more standardized routine of dental surgery in my practice," said David Sarment, a third co-author on the paper. Sarment was on the U-M dental faculty full-time before leaving for private practice. He is also a pilot and was taught to fly by Pinsky.
CRM checklists in the dentist's office represent a major culture shift that will be slow to catch on, but Pinsky thinks it's inevitable.
"It's about communication," Pinsky said. "If I'm doing a restoration and my assistant sees saliva leaking, in the old days the assistant would think to themselves, 'The doctor is king, he or she must know what's going on.'" But if all team members have a CRM checklist, the assistant is empowered to tell the doctor if there is a problem. "Instead of the doctor saying, 'Don't ever embarrass me in front of a patient again,' they'll say, 'Thanks for telling me.'"
At each of the five stages of the dental visit, the dental team is responsible for checking safety items off a codified list before proceeding. Pinsky said that while he expects each checklist to look different for each office, the important thing is to have the standards in place.
Studies show that CRM works. Six government studies of airlines using CRM suggest safety improvements as high as 46 percent. Another study involving six large corporate and military entities showed accidents decreased between 36-81 percent after implementing CRM. In surgical settings, use of checklists has reduced complications and deaths by 36 percent.
Many other industries: hospitals; emergency rooms; and nuclear plants look to the airline industry to help craft CRM programs, but dentistry hasn't adopted CRM, said Pinsky.
For the next step, the co-authors hope to design a small clinical trial in the dental school to test CRM, Taichman said
Pilots and dentists have more in common than one might think: Both jobs are highly technical and require teamwork. Both are subject to human error where small, individual mistakes may lead to catastrophe if not addressed early.
A dental professor at the University of Michigan and two pilot-dentists believe that implementing a checklist of safety procedures in dental offices similar to procedures used in airlines would drastically reduce human errors.
Illustration by Maria Gunnes Sibbel
Crew Resource Management empowers team members to actively participate to enhance safety using forward thinking strategies, said Russell Taichman, U-M dentistry professor and director of the Scholars Program in Dental Leadership. Taichman co-authored the study, "Adaptation of airline crew resource management (CRM) principles to dentistry," which will appear in the August issue of the Journal of the American Dental Association.
Airlines implemented CRM about 30 years ago after recognizing that most accidents resulted from human error, said co-author Harold Pinsky, a full-time airline pilot and practicing general dentist who did additional training at U-M dental school.
"Using checklists makes for a safer, more standardized routine of dental surgery in my practice," said David Sarment, a third co-author on the paper. Sarment was on the U-M dental faculty full-time before leaving for private practice. He is also a pilot and was taught to fly by Pinsky.
CRM checklists in the dentist's office represent a major culture shift that will be slow to catch on, but Pinsky thinks it's inevitable.
"It's about communication," Pinsky said. "If I'm doing a restoration and my assistant sees saliva leaking, in the old days the assistant would think to themselves, 'The doctor is king, he or she must know what's going on.'" But if all team members have a CRM checklist, the assistant is empowered to tell the doctor if there is a problem. "Instead of the doctor saying, 'Don't ever embarrass me in front of a patient again,' they'll say, 'Thanks for telling me.'"
At each of the five stages of the dental visit, the dental team is responsible for checking safety items off a codified list before proceeding. Pinsky said that while he expects each checklist to look different for each office, the important thing is to have the standards in place.
Studies show that CRM works. Six government studies of airlines using CRM suggest safety improvements as high as 46 percent. Another study involving six large corporate and military entities showed accidents decreased between 36-81 percent after implementing CRM. In surgical settings, use of checklists has reduced complications and deaths by 36 percent.
Many other industries: hospitals; emergency rooms; and nuclear plants look to the airline industry to help craft CRM programs, but dentistry hasn't adopted CRM, said Pinsky.
For the next step, the co-authors hope to design a small clinical trial in the dental school to test CRM, Taichman said
Link between gum inflammation and Alzheimer's disease
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NYU dental researchers have found the first long-term evidence that periodontal (gum) disease may increase the risk of cognitive dysfunction associated with Alzheimer's disease in healthy individuals as well as in those who already are cognitively impaired.
The NYU study offers fresh evidence that gum inflammation may contribute to brain inflammation, neurodegeneration, and Alzheimer's disease.
The research team, led by Dr. Angela Kamer, Assistant Professor of Periodontology & Implant Dentistry, examined 20 years of data that support the hypothesis of a possible causal link between periodontal disease and Alzheimer's disease.
"The research suggests that cognitively normal subjects with periodontal inflammation are at an increased risk of lower cognitive function compared to cognitively normal subjects with little or no periodontal inflammation," Dr. Kamer said.
Dr. Kamer's study, conducted in collaboration with Dr. Douglas E. Morse, Associate Professor of Epidemiology & Health Promotion at NYU College of Dentistry, and a team of researchers in Denmark, builds upon a 2008 study by Dr. Kamer which found that subjects with Alzheimer's disease had a significantly higher level of antibodies and inflammatory molecules associated with periodontal disease in their plasma compared to healthy people.
Dr. Kamer's latest findings are based on an analysis of data on periodontal inflammation and cognitive function in 152 subjects in the Glostrop Aging Study, which has been gathering medical, psychological, oral health, and social data on Danish men and women. Dr. Kamer examined data spanning a 20-year period ending in 1984, when the subjects were all 70 years of age. The findings were presented by Dr. Kamer at the 2010 annual meeting of the International Association for Dental Research July 16, in Barcelona, Spain.
Dr. Kamer's team compared cognitive function at ages 50 and 70, using the Digit Symbol Test, or DST, a part of the standard measurement of adult IQ. The DST assesses how quickly subjects can link a series of digits, such as 2, 3, 4, to a corresponding list of digit-symbol pairs, such as 1/-,2/┴ ... 7/Λ,8/X,9/=.
Dr. Kamer found that periodontal inflammation at age 70 was strongly associated with lower DST scores at age 70. Subjects with periodontal inflammation were nine times more likely to test in the lower range of the DST compared to subjects with little or no periodontal inflammation.
This strong association held true even in those subjects who had other risk factors linked to lower DST scores, including obesity, cigarette smoking, and tooth loss unrelated to gum inflammation. The strong association also held true in those subjects who already had a low DST score at age 50.
Dr. Kamer plans to conduct a follow-up study involving a larger, more ethnically diverse group of subjects, to further examine the connection between periodontal disease and low cognition.
NYU dental researchers have found the first long-term evidence that periodontal (gum) disease may increase the risk of cognitive dysfunction associated with Alzheimer's disease in healthy individuals as well as in those who already are cognitively impaired.
The NYU study offers fresh evidence that gum inflammation may contribute to brain inflammation, neurodegeneration, and Alzheimer's disease.
The research team, led by Dr. Angela Kamer, Assistant Professor of Periodontology & Implant Dentistry, examined 20 years of data that support the hypothesis of a possible causal link between periodontal disease and Alzheimer's disease.
"The research suggests that cognitively normal subjects with periodontal inflammation are at an increased risk of lower cognitive function compared to cognitively normal subjects with little or no periodontal inflammation," Dr. Kamer said.
Dr. Kamer's study, conducted in collaboration with Dr. Douglas E. Morse, Associate Professor of Epidemiology & Health Promotion at NYU College of Dentistry, and a team of researchers in Denmark, builds upon a 2008 study by Dr. Kamer which found that subjects with Alzheimer's disease had a significantly higher level of antibodies and inflammatory molecules associated with periodontal disease in their plasma compared to healthy people.
Dr. Kamer's latest findings are based on an analysis of data on periodontal inflammation and cognitive function in 152 subjects in the Glostrop Aging Study, which has been gathering medical, psychological, oral health, and social data on Danish men and women. Dr. Kamer examined data spanning a 20-year period ending in 1984, when the subjects were all 70 years of age. The findings were presented by Dr. Kamer at the 2010 annual meeting of the International Association for Dental Research July 16, in Barcelona, Spain.
Dr. Kamer's team compared cognitive function at ages 50 and 70, using the Digit Symbol Test, or DST, a part of the standard measurement of adult IQ. The DST assesses how quickly subjects can link a series of digits, such as 2, 3, 4, to a corresponding list of digit-symbol pairs, such as 1/-,2/┴ ... 7/Λ,8/X,9/=.
Dr. Kamer found that periodontal inflammation at age 70 was strongly associated with lower DST scores at age 70. Subjects with periodontal inflammation were nine times more likely to test in the lower range of the DST compared to subjects with little or no periodontal inflammation.
This strong association held true even in those subjects who had other risk factors linked to lower DST scores, including obesity, cigarette smoking, and tooth loss unrelated to gum inflammation. The strong association also held true in those subjects who already had a low DST score at age 50.
Dr. Kamer plans to conduct a follow-up study involving a larger, more ethnically diverse group of subjects, to further examine the connection between periodontal disease and low cognition.
Wednesday, July 7, 2010
1 in 4 Californian children have never seen a dentist, study finds
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Lack of dental care continues to be a significant problem for American children, who miss about 1.6 million school days each year due to dental disease.
A new study published in the July issue of the journal Health Affairs reveals that in California, nearly 25 percent of children have never seen a dentist and that disparities exist across race, ethnicity and type of insurance when it comes to the duration between dental care visits.
The study, "Racial and Ethnic Disparities in Dental Care for Publicly Insured Children," examines barriers to dental care among California children age 11 and under, using data from the 2005 California Health Interview Survey. The study contains data on nearly 11,000 children.
Researchers Nadereh Pourat, of the UCLA Center for Health Policy Research, and Len Finocchio, of the California HealthCare Foundation, found that Latino and African American children with all types of insurance were less likely than Asian American and white children to have visited the dentist in the previous six months — or even in their entire lifetime.
Similarly, researchers found that Latino and African American children in public insurance programs, including Medicaid and the Children's Health Insurance Program (CHIP), went to the dentist less often than white and Asian American children with the same insurance coverage. Overall, children with private insurance saw a dentist more often than those with Medicaid or CHIP.
"The findings suggest that having insurance isn't always enough," said Pourat, Ph.D., director of research planning at the UCLA Center for Health Policy Research. "We need to address the other barriers that keep children from getting the help they need."
The authors note the findings raise concerns about Medicaid's ability to address disparities in dental care access. Ultimately, they observe, more strategic efforts are necessary to overcome systemic barriers to care, including raising reimbursement rates paid to dentists who serve the Medicaid population and increasing the number of participating Medicaid providers.
"These findings indicate that many poor children in California do not make routine dental visits or simply never receive any dental care," said Finocchio, Dr.P.H., senior program officer at the California HealthCare Foundation. "Even with Medicaid coverage, there are tremendous barriers to getting services."
Despite the disparities, the authors say, having any form of dental insurance significantly increases the odds of seeing a dentist on a regular basis. The studied showed that 54 percent of privately insured children and 27 percent of publicly insured children had seen the dentist during the previous six months, compared with 12 percent of children without dental coverage.
"The data tell us that Medicaid and CHIP have improved children's ability to get dental care," Pourat said. "However, both programs need to do more to reduce disparities."
Lack of dental care continues to be a significant problem for American children, who miss about 1.6 million school days each year due to dental disease.
A new study published in the July issue of the journal Health Affairs reveals that in California, nearly 25 percent of children have never seen a dentist and that disparities exist across race, ethnicity and type of insurance when it comes to the duration between dental care visits.
The study, "Racial and Ethnic Disparities in Dental Care for Publicly Insured Children," examines barriers to dental care among California children age 11 and under, using data from the 2005 California Health Interview Survey. The study contains data on nearly 11,000 children.
Researchers Nadereh Pourat, of the UCLA Center for Health Policy Research, and Len Finocchio, of the California HealthCare Foundation, found that Latino and African American children with all types of insurance were less likely than Asian American and white children to have visited the dentist in the previous six months — or even in their entire lifetime.
Similarly, researchers found that Latino and African American children in public insurance programs, including Medicaid and the Children's Health Insurance Program (CHIP), went to the dentist less often than white and Asian American children with the same insurance coverage. Overall, children with private insurance saw a dentist more often than those with Medicaid or CHIP.
"The findings suggest that having insurance isn't always enough," said Pourat, Ph.D., director of research planning at the UCLA Center for Health Policy Research. "We need to address the other barriers that keep children from getting the help they need."
The authors note the findings raise concerns about Medicaid's ability to address disparities in dental care access. Ultimately, they observe, more strategic efforts are necessary to overcome systemic barriers to care, including raising reimbursement rates paid to dentists who serve the Medicaid population and increasing the number of participating Medicaid providers.
"These findings indicate that many poor children in California do not make routine dental visits or simply never receive any dental care," said Finocchio, Dr.P.H., senior program officer at the California HealthCare Foundation. "Even with Medicaid coverage, there are tremendous barriers to getting services."
Despite the disparities, the authors say, having any form of dental insurance significantly increases the odds of seeing a dentist on a regular basis. The studied showed that 54 percent of privately insured children and 27 percent of publicly insured children had seen the dentist during the previous six months, compared with 12 percent of children without dental coverage.
"The data tell us that Medicaid and CHIP have improved children's ability to get dental care," Pourat said. "However, both programs need to do more to reduce disparities."
Friday, July 2, 2010
Rapily Assess Children's Tooth Decay Risk
Researchers at the Oregon Health & Science University School of Dentistry have determined that ATP-driven (adenosine triphosphate-driven) bioluminescence -- a way of measuring visible light generated from ATP contained in bacteria -- is an innovative tool for rapidly assessing in children at the chair-side the number of oral bacteria and amount of plaque that can ultimately lead to tooth decay.
The study is published online in the May-June 2010 issue of Pediatric Dentistry.
Caries (microbial disease) prevention is one of the most important aspects of modern dental practice. Untreated, large numbers of cariogenic bacteria adhere to teeth and break down the protective enamel covering, resulting in lesions and cavities. There is a critical need in dentistry to develop better quantitative assessment methods for oral hygiene and to determine patient risk for dental caries, because disease as well as restorative treatment results in the irreversible loss of tooth structure. Previous caries risk assessments have focused on social, behavioral, microbiologic, environmental and clinical variables.
The goal of the OHSU study was to examine the use of microbiological testing, specifically ATP-driven bioluminescence, for quantifying oral bacteria, including plaque streptococci, and assessment of oral hygiene and caries risk. Thirty-three randomly selected OHSU pediatric patients, ages 7 to 12, were examined, and plaque specimens, in addition to saliva, were collected from one tooth in each of the four quadrants of the mouth. The oral specimens were then assessed to count total bacteria and streptococci and subjected to ATP-driven bioluminescence.
The OHSU team found statistical correlations, linking ATP to the numbers of total bacteria and oral streptococci. Their data indicated that ATP measurements have a strong statistical association with bacterial numbers in plaque and saliva specimens, including numbers for oral streptococci, and may be used as a potential assessment tool for oral hygiene and caries risk in children.
"The use of ATP-driven bioluminescence has broad implications in dentistry and medicine and can be used translationally in the clinic to determine the efficacy of interventional therapies, including the use of mouth rinses and perhaps in the detection of bacterial infections in periodontal and other infectious diseases," noted Curt Machida, Ph.D., principal investigator and OHSU professor of integrative biosciences and pediatric dentistry.
The OHSU team included Machida; Shahram Fazilat, D.D.S., a 2008 pediatric dentistry graduate; Rebecca Sauerwein, research assistant in integrative biosciences; Jennifer McLeod, a fourth-year dental student who recently graduated; Tyler Finlayson, second-year dental student; Emilia Adam, D.D.S., M.P.H., a second-year pediatric dentistry resident who recently graduated; John Engle, D.D.S., interim chair of the Department of Pediatric Dentistry; Prashant Gagneja, D.D.S., associate professor of pediatric dentistry; Tom Maier, Ph.D., assistant professor of integrative biosciences and oral pathology and radiology.
The research was funded by Oral BioTech, the OHSU School of Dentistry, and the Oregon Clinical and Translational Research Institute, which is funded by a grant from the National Center for Research Resources (NCRR), a component of the National Institutes of Health (NIH). Established in September 2006 through the NIH's Clinical and Translational Science Award (CTSA) program, OCTRI is a unique partnership between OHSU and Kaiser Permanente Center for Health Research -- bringing together an academic medical center and an innovative managed care organization. OCTRI's mission is to improve human health by enhancing clinical and translational research. OCTRI works with institutional partners, community organizations, and industry to engage communities in clinical research efforts and to reduce the time it takes for laboratory discoveries to become treatments for patients.
The study is published online in the May-June 2010 issue of Pediatric Dentistry.
Caries (microbial disease) prevention is one of the most important aspects of modern dental practice. Untreated, large numbers of cariogenic bacteria adhere to teeth and break down the protective enamel covering, resulting in lesions and cavities. There is a critical need in dentistry to develop better quantitative assessment methods for oral hygiene and to determine patient risk for dental caries, because disease as well as restorative treatment results in the irreversible loss of tooth structure. Previous caries risk assessments have focused on social, behavioral, microbiologic, environmental and clinical variables.
The goal of the OHSU study was to examine the use of microbiological testing, specifically ATP-driven bioluminescence, for quantifying oral bacteria, including plaque streptococci, and assessment of oral hygiene and caries risk. Thirty-three randomly selected OHSU pediatric patients, ages 7 to 12, were examined, and plaque specimens, in addition to saliva, were collected from one tooth in each of the four quadrants of the mouth. The oral specimens were then assessed to count total bacteria and streptococci and subjected to ATP-driven bioluminescence.
The OHSU team found statistical correlations, linking ATP to the numbers of total bacteria and oral streptococci. Their data indicated that ATP measurements have a strong statistical association with bacterial numbers in plaque and saliva specimens, including numbers for oral streptococci, and may be used as a potential assessment tool for oral hygiene and caries risk in children.
"The use of ATP-driven bioluminescence has broad implications in dentistry and medicine and can be used translationally in the clinic to determine the efficacy of interventional therapies, including the use of mouth rinses and perhaps in the detection of bacterial infections in periodontal and other infectious diseases," noted Curt Machida, Ph.D., principal investigator and OHSU professor of integrative biosciences and pediatric dentistry.
The OHSU team included Machida; Shahram Fazilat, D.D.S., a 2008 pediatric dentistry graduate; Rebecca Sauerwein, research assistant in integrative biosciences; Jennifer McLeod, a fourth-year dental student who recently graduated; Tyler Finlayson, second-year dental student; Emilia Adam, D.D.S., M.P.H., a second-year pediatric dentistry resident who recently graduated; John Engle, D.D.S., interim chair of the Department of Pediatric Dentistry; Prashant Gagneja, D.D.S., associate professor of pediatric dentistry; Tom Maier, Ph.D., assistant professor of integrative biosciences and oral pathology and radiology.
The research was funded by Oral BioTech, the OHSU School of Dentistry, and the Oregon Clinical and Translational Research Institute, which is funded by a grant from the National Center for Research Resources (NCRR), a component of the National Institutes of Health (NIH). Established in September 2006 through the NIH's Clinical and Translational Science Award (CTSA) program, OCTRI is a unique partnership between OHSU and Kaiser Permanente Center for Health Research -- bringing together an academic medical center and an innovative managed care organization. OCTRI's mission is to improve human health by enhancing clinical and translational research. OCTRI works with institutional partners, community organizations, and industry to engage communities in clinical research efforts and to reduce the time it takes for laboratory discoveries to become treatments for patients.
Wednesday, June 30, 2010
Tray bleaching may improve oral health of elderly, special-needs patients
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A tooth-bleaching agent may improve the oral health of elderly and special-needs patients, say dentists at the Medical College of Georgia and Western University of Health Sciences.
Standard oral hygiene, such as brushing and flossing, can be difficult or impossible for patients with mental challenges or impaired manual dexterity. Additionally, when health problems or medications cause xerostomia, or dry mouth, the lack of saliva reduces the mouth's natural protective mechanisms. These problems lead to plaque accumulation, cavities and periodontal disease, and could further impact the patient's health.
A report featured on the cover of this month's Journal of the American Dental Association noted that applying the tooth whitener carbamide peroxide through a custom-fit mouth tray might combat those problems. The report was based on a literature review and the authors' clinical experiences with special-needs patients and tooth bleaching.
"What we've noticed through whitening patients' teeth over the years is that as they bleached, their teeth got squeaky clean and their gingival health improved," said Dr. Van Haywood, professor in the Medical College of Georgia School of Dentistry and co-author of the report.
Dentists have used carbamide peroxide, or urea peroxide, for decades to whiten teeth, but its original use was as an oral antiseptic. It removes plaque, kills bacteria and elevates the mouth's pH above the point at which enamel and dentin begin to dissolve, which results in fewer cavities.
"All these benefits lead us to believe that tray bleaching can be a very effective supplemental method of oral hygiene for patients facing greater challenges keeping their mouths clean," said Dr. David Lazarchik, associate professor in the Western University of Health Sciences College of Dental Medicine and the report's co-author.
The trick is in the tray, Haywood said. After a complete dental exam, the dentist can make the custom-fit tray that the patient can wear comfortably at night or for several hours during the day. The carbamide peroxide gel can be prescribed or purchased over-the-counter.
Lazarchik said further research is needed to determine a specific protocol for using tray-applied carbamide peroxide specifically to improve oral health.
A tooth-bleaching agent may improve the oral health of elderly and special-needs patients, say dentists at the Medical College of Georgia and Western University of Health Sciences.
Standard oral hygiene, such as brushing and flossing, can be difficult or impossible for patients with mental challenges or impaired manual dexterity. Additionally, when health problems or medications cause xerostomia, or dry mouth, the lack of saliva reduces the mouth's natural protective mechanisms. These problems lead to plaque accumulation, cavities and periodontal disease, and could further impact the patient's health.
A report featured on the cover of this month's Journal of the American Dental Association noted that applying the tooth whitener carbamide peroxide through a custom-fit mouth tray might combat those problems. The report was based on a literature review and the authors' clinical experiences with special-needs patients and tooth bleaching.
"What we've noticed through whitening patients' teeth over the years is that as they bleached, their teeth got squeaky clean and their gingival health improved," said Dr. Van Haywood, professor in the Medical College of Georgia School of Dentistry and co-author of the report.
Dentists have used carbamide peroxide, or urea peroxide, for decades to whiten teeth, but its original use was as an oral antiseptic. It removes plaque, kills bacteria and elevates the mouth's pH above the point at which enamel and dentin begin to dissolve, which results in fewer cavities.
"All these benefits lead us to believe that tray bleaching can be a very effective supplemental method of oral hygiene for patients facing greater challenges keeping their mouths clean," said Dr. David Lazarchik, associate professor in the Western University of Health Sciences College of Dental Medicine and the report's co-author.
The trick is in the tray, Haywood said. After a complete dental exam, the dentist can make the custom-fit tray that the patient can wear comfortably at night or for several hours during the day. The carbamide peroxide gel can be prescribed or purchased over-the-counter.
Lazarchik said further research is needed to determine a specific protocol for using tray-applied carbamide peroxide specifically to improve oral health.
Wednesday, June 23, 2010
Decay of baby teeth may be linked to obesity, poor food choices, study suggests
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A preliminary study of young children undergoing treatment for cavities in their baby teeth found that nearly 28 percent had a body mass index (BMI) above the 85th percentile, indicating overweight or obesity.
That percentage is more than 5 percent higher than the estimated national average, adding more fuel to the growing concern that poor food choices, including those sugary drinks and fruit juices so popular and convenient, likely are contributing to both obesity and tooth decay in very young children.
The findings will be presented today (June 22) at the 2010 annual meeting of the Endocrine Society being held in San Diego, Calif. The study is one of 38 abstracts (out of 2,000 accepted) selected for inclusion in the society's Research Summaries Book, which is provided to the media for future reference.
Kathleen Bethin, MD, associate professor of pediatrics at the University at Buffalo and director of the pediatric endocrinology and diabetes fellowship program at Women and Children's Hospital of Buffalo, is first author.
Dental cavities are the most common chronic disease of childhood, according to Healthy People 2010 -- 5-10 percent of young children have early childhood cavities -- and childhood obesity has more than tripled in the past 30 years, reaching nearly 20 percent by 2008.
"We hypothesized that poor nutritional choices may link obesity and dental decay in young children, but there is very little published data associating these two health issues," says Bethin.
"The aim of our study was to obtain preliminary data on BMI, energy intake and metabolic profiles in young children with tooth decay."
The study involved 65 children ages 2-5 who were treated in the operating room at Women and Children's Hospital. All children required anesthesia due to the severity of their dental problems or other issues.
The children, who had been fasting for 8-12 hours, were weighed and measured for height. After the patients were anesthetized, researchers measured waist circumference and drew blood. Parents completed a food questionnaire while their children were in surgery.
The data showed that:
Eighteen of the 65 children, approximately 28 percent, had a BMI above the 85th percentile, which Bethin noted might be higher if the children hadn't been fasting.
Waist circumference compared to height was significantly higher in the overweight and obese children compared to the children of normal weight, measurements showed.
Approximately 71 percent of the children had a calorie intake higher than the normal 1,200 per day for their age group.
"The main point of our findings is that poor nutrition may link obesity to tooth decay," says Bethin. "Thus the dental office, or 'dental home,' may be an ideal place to educate families about nutrition and the risks of obesity and dental decay.
"Our results found no difference in total calories consumed by the overweight and healthy-weight kids," noted Bethin, "so the problem isn't overeating, per se, just making the wrong food choices."
Bethin and colleagues now are analyzing whether the overweight children eat more processed sugar, drink more juice and have other unhealthy eating habits compared to the healthy-weight children.
A preliminary study of young children undergoing treatment for cavities in their baby teeth found that nearly 28 percent had a body mass index (BMI) above the 85th percentile, indicating overweight or obesity.
That percentage is more than 5 percent higher than the estimated national average, adding more fuel to the growing concern that poor food choices, including those sugary drinks and fruit juices so popular and convenient, likely are contributing to both obesity and tooth decay in very young children.
The findings will be presented today (June 22) at the 2010 annual meeting of the Endocrine Society being held in San Diego, Calif. The study is one of 38 abstracts (out of 2,000 accepted) selected for inclusion in the society's Research Summaries Book, which is provided to the media for future reference.
Kathleen Bethin, MD, associate professor of pediatrics at the University at Buffalo and director of the pediatric endocrinology and diabetes fellowship program at Women and Children's Hospital of Buffalo, is first author.
Dental cavities are the most common chronic disease of childhood, according to Healthy People 2010 -- 5-10 percent of young children have early childhood cavities -- and childhood obesity has more than tripled in the past 30 years, reaching nearly 20 percent by 2008.
"We hypothesized that poor nutritional choices may link obesity and dental decay in young children, but there is very little published data associating these two health issues," says Bethin.
"The aim of our study was to obtain preliminary data on BMI, energy intake and metabolic profiles in young children with tooth decay."
The study involved 65 children ages 2-5 who were treated in the operating room at Women and Children's Hospital. All children required anesthesia due to the severity of their dental problems or other issues.
The children, who had been fasting for 8-12 hours, were weighed and measured for height. After the patients were anesthetized, researchers measured waist circumference and drew blood. Parents completed a food questionnaire while their children were in surgery.
The data showed that:
Eighteen of the 65 children, approximately 28 percent, had a BMI above the 85th percentile, which Bethin noted might be higher if the children hadn't been fasting.
Waist circumference compared to height was significantly higher in the overweight and obese children compared to the children of normal weight, measurements showed.
Approximately 71 percent of the children had a calorie intake higher than the normal 1,200 per day for their age group.
"The main point of our findings is that poor nutrition may link obesity to tooth decay," says Bethin. "Thus the dental office, or 'dental home,' may be an ideal place to educate families about nutrition and the risks of obesity and dental decay.
"Our results found no difference in total calories consumed by the overweight and healthy-weight kids," noted Bethin, "so the problem isn't overeating, per se, just making the wrong food choices."
Bethin and colleagues now are analyzing whether the overweight children eat more processed sugar, drink more juice and have other unhealthy eating habits compared to the healthy-weight children.
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