Monday, May 11, 2015
For children with autism, adjusting the environment to be more soothing could eliminate the need for general anesthesia to cope with routine dental cleanings
Going to the dentist might have just gotten a little less scary for the estimated 1 in 68 U.S. children with autism spectrum disorder as well as children with dental anxiety, thanks to new research from USC.
In an article published on May 1 by the Journal of Autism and Developmental Disorders, researchers from USC and Children's Hospital Los Angeles (CHLA) examined the feasibility of adapting dental environments to be more calming for children with autism spectrum disorder.
"The regular dental environment can be quite frightening for children with autism who, not knowing how to react, tend to be completely averse to whatever we're trying to do," said one of the study's authors, José Polido DDS, head of dentistry at CHLA and assistant professor at the Herman Ostrow School of Dentistry of USC.
Children with autism spectrum disorders -- as well as some typically developing children -- often show heightened responses to sensory input and find these sensations uncomfortable. As such, the dental office, with its bright lights, loud sounds from the dental equipment, and touch of children in and around the mouth, present particular challenges for such children.
In the study, 44 CHLA patients -- 22 with autism and 22 "typically developing" (defined as children not on the autism spectrum)--underwent two professional dental cleanings. One cleaning took place in a regular dental environment, the other in a sensory adapted dental environment. During each session, the child's physiological anxiety, behavioral distress and pain intensity were measured.
"I've talked to several parents who have said, 'We really put off taking our child to the dentist because we know how hard it is and we know he's going to scream and cry,'" said Sharon Cermak, the study's lead author and professor at the USC Mrs. T.H. Chan Division of Occupational Science and Occupational Therapy, as well as professor of pediatrics at the Keck School of Medicine of USC.
To help combat that reaction, researchers adapted the dental environments by turning off overhead office lights and headlamps, projecting slow-moving visual effects onto the ceiling and playing soothing music.
Instead of using traditional means to secure the child in the dental chair, practitioners used a seat cover that looked like a gigantic butterfly whose wings wrapped around the child and provided a comforting, deep-pressure hug.
The research team found that both children who are typically developing as well as those with autism spectrum disorders exhibited decreased psychological anxiety and reported lower pain and sensory discomfort in the sensory-adapted dental environment.
The study -- which represents a unique collaboration between pediatric dentists and occupational therapists--could help improve oral health care for children with autism -- a group reported to suffer from poor oral health, research shows.
The findings could also represent a cost savings to the health care system, with fewer insurance reimbursements paid to dental offices for the additional staff members and general anesthesia often necessary for children with autism.
Next up for the researchers is to increase their sample size -- they'll be using 110 children in each group -- to determine which factors (e.g. age, anxiety, sensory over-responsitivity) best predict which children respond best to the intervention.
"One of our long-term goals with this study is to help dentists develop protocols for their own dental clinics to see how sensory components are contributing to behavioral issues," Cermak said. "I think these protocols can then be translated across the globe."
Thursday, May 7, 2015
Arginine, a common amino acid found naturally in foods, breaks down dental plaque, which could help millions of people avoid cavities and gum disease, researchers at the University of Michigan and Newcastle University have discovered.
Alexander Rickard, assistant professor of epidemiology at the U-M School of Public Health, and colleagues, discovered that in the lab L-arginine -- found in red meat, poultry, fish and dairy products, and is already used in dental products for tooth sensitivity--stopped the formation of dental plaque.
"This is important as bacteria like to aggregate on surfaces to form biofilms. Dental plaque is a biofilm," Rickard said. "Biofilms account for more than 50 percent of all hospital infections. Dental plaque biofilms contribute to the billions of dollars of dental treatments and office visits every year in the United States."
Dental biofilms are the culprits in the formation of dental caries (cavities), gingivitis and periodontal disease. Surveys indicate that nearly 24 percent of adults in the United States have untreated dental caries, and about 39 percent have moderate-to-severe periodontitis, a number that rises to 64 percent for those over age 65.
Most methods for dental plaque control involve use of antimicrobial agents, such as chlorhexidine, which are chemicals aimed at killing plaque bacteria, but they can affect sense of taste and stain teeth. Antimicrobial treatments have been the subject of debate about overuse in recent years.
Pending further clinical trials to verify their lab findings, the researchers said L-arginine could take the place of the current plaque-controlling biocide substances including chlorhexidine and other antimicrobials.
"At present, around 10-to-15 percent of adults in the Western world have advanced periodontitis, which can lead to loose teeth and even the loss of teeth. Therefore, there is a clear need for better methods to control dental plaque," said Nick Jakubovics, a lecturer at Newcastle University's School of Dental Sciences.
Their findings are reported in the current issue of PLOS ONE.
The mechanism for how L-arginine causes the disintegration of the biofilms needs further study, the researchers said. It appears arginine can change how cells stick together, and can trigger bacteria within biofilms to alter how they behave so that they no longer stick to surfaces, they said.
In conducting their research, team members used a model system they introduced in 2013 that mimics the oral cavity. The researchers were able to grow together the numerous bacterial species found in dental plaque in the laboratory, using natural human saliva.
"Other laboratory model systems use one or a small panel of species," Rickard said. "Dental plaque biofilms can contain tens to hundreds of species, hence our model better mimics what occurs in the mouth, giving us great research insight."
Tuesday, May 5, 2015
Treating gum disease reduced symptoms of prostate inflammation, called prostatitis, report researchers from Case Western Reserve University School of Dental Medicine and the Departments of Urology and Pathology at University Hospitals Case Medical Center.
Previous studies have found a link between gum disease and prostatitis, a disease that inflames the gland that produces semen. Inflammation can make urination difficult.
"This study shows that if we treat the gum disease, it can improve the symptoms of prostatitis and the quality of life for those who have the disease," said Nabil Bissada, chair of Case Western Reserve's Department of Periodontics and the new study's corresponding author.
The researchers reported their findings in the Dentistry article, "Periodontal Treatment Improves Prostate Symptoms and Lowers Serum PSA in Men with High PSA and Chronic Periodontitis." Naif Alwithanani, a graduate student in the dental school, led the investigation as part of his residency in periodontics.
Bissada explained that gum disease not only affects the mouth, but is a system-wide condition that can cause inflammation in various parts of the body. The dental school has previously found a link between gum disease and fetal deaths, rheumatoid arthritis and heart disease.
The new prostate study
Researchers studied 27 men, 21 years old and older. Each had had a needle biopsy within the past year that confirmed inflammation of the prostate gland, and a blood test that showed elevated prostate specific antigen (PSA) levels--possible signs of inflammation and cancer.
The men were assessed for symptoms of prostate disease by answering questions on the International-Prostate Symptom Score (IPSS) test about their quality of life and possible urination issues.
Researchers found 21 of the 27 participants had no or mild inflammation, but 15 had biopsy-confirmed malignancies. Two had both inflammation and a malignancy.
The men also had to have at least 18 teeth and were examined for signs of gum disease, such as increased levels of inflammation and bleeding and/or loose teeth due to attachment and bone loss.
All the men had moderate to severe gum disease, for which they received treatment. They were tested again for periodontal disease four to eight weeks later and showed significant improvement.
During the periodontal care, the men received no treatment for their prostate conditions. But even without prostate treatment, 21 of the 27 men showed decreased levels of PSA. Those with the highest levels of inflammation benefited the most from the periodontal treatment. Six participants showed no changes.
Symptom scores on the IPSS test also showed improvement.
Bissada is now conducting follow-up research to support the first study's findings. He hopes to make periodontal treatment a standard part of treating prostate disease, much like cardiac patients are often encouraged to visit their dentist before undergoing heart procedures and a dental checkup is advised for women who are pregnant or considering pregnancy.