New 'tooth-on-a-chip' could lead to more personalized dentistry M

A so-called "tooth-on-a-chip" could one day enable more personalized dentistry, giving dentists the ability to identify dental filling materials that work better and last longer based on a patient's own teeth and oral microbiome.
The miniaturized tooth system is a thin slice of a human molar placed in between transparent rubber slides that are etched with tiny channels, through which fluids flow. The research device mimics a real tooth with a cavity, which allows fluids and bacteria to move between the cavity opening and the inner tooth. Scientists use a microscope to observe the tooth as it interacts with materials and bacteria.
While other mini organs such as livers and lungs have been placed on chips like this for research purposes, this is the first time an organ-on-a-chip system has been created for dental research, reports a paper published in the Royal Society of Chemistry journal Lab on a Chip.
"Today's cavity fillings don't work as well as they should. They last for five, seven years on average, and then they break off," said the paper's corresponding author, Luiz E. Bertassoni, D.D.S., Ph.D., associate professor of restorative dentistry in the OHSU School of Dentistry and biomedical engineering in the OHSU School of Medicine.
"They don't work because we haven't been able to figure out what's happening at the interface of the tooth and the filling," Bertassoni continued. "This device can help address that by giving us a close-up view of what's happening there in real time. Years from now, dentists could extract a tooth from a patient, load it into this device, observe how a dental filling material interacts with the tooth, and pick a material that's best for that particular patient."
The device is designed to help scientists better understand the innerworkings of dental cells in their natural environment. For example, researchers could use the tooth-on-a-chip to better understand how teeth form and how they respond biologically to all sorts of injuries and treatments.
"It opens up a new window into the complexity of dental care that could change the way we do dentistry quite significantly," Bertassoni said.

Saliva test shows promise for earlier and easier detection of mouth and throat cancer

A novel noninvasive technique may detect human papilloma virus-16, the strain associated with oropharyngeal cancer, in saliva samples, reports The Journal of Molecular Diagnostics

Elsevier

IMAGE: Acoustofluidic exosome isolation chip for salivary exosome isolation. The microfluidic channel is shown by red dye solution and the coin demonstrates the size of the chip. Two pairs of gold... view more 

Credit: The Journal of Molecular Diagnostics

Philadelphia, December 13, 2019 - Unfortunately, cancers that occur in the back of the mouth and upper throat are often not diagnosed until they become advanced, partly because their location makes them difficult to see during routine clinical exams. A report in the Journal of Molecular Diagnostics, published by Elsevier, describes the use of acoustofluidics, a new non-invasive method that analyzes saliva for the presence of human papilloma virus (HPV)-16, the pathogenic strain associated with oropharyngeal cancers (OPCs). This novel technique detected OPC in whole saliva in 40 percent of patients tested and 80 percent of confirmed OPC patients.
"OPC has an approximate incidence of 115,000 cases per year worldwide and is one of the fastest-rising cancers in Western countries due to increasing HPV-related incidence, especially in younger patients. It is paramount that surveillance methods are developed to improve early detection and outcomes," explained co-lead investigator Tony Jun Huang, PhD, Department of Mechanical Engineering and Materials Science, Duke University, Durham, NC, USA.
"Considering these factors, the successful detection of HPV from salivary exosomes isolated by our acoustofluidic platform offers distinct advantages, including early detection, risk assessment, and screening," added Dr. Huang. This technique may also help physicians predict which patients will respond well to radiation therapy or achieve longer progression-free survival.
Exosomes are tiny microvesicles originating within cells that are secreted into body fluids. They are believed to play a role in intercellular communication and their numbers are elevated in association with several types of cancers. Acoustofluidics is an advanced technology that fuses acoustics and microfluidics. Fluid samples are analyzed using a tiny acoustofluidic chip developed to isolate salivary exosomes by removing unwanted particles based on size, leaving exosome-rich concentrated samples that make it easier to detect tumor-specific biomarkers.
In this study investigators analyzed saliva samples from 10 patients diagnosed with HPV-OPC using traditional methods. They found that the technique identified the tumor biomarker HPV-16 DNA in 80 percent of the cases when coupled with droplet digit PCR. Since this method is independent of sample variability that arises due to changes in saliva viscosity and collection methods used, it may prove ideal for use in clinical settings.
Dr. Huang highlighted some of the technique's features, including automated and fast exosome isolation (less than five minutes of processing time compared to approximately eight hours of processing time using benchmark technologies). Analyses can be performed at relatively low cost and at points of care. Also, it is suitable for repeated and continuous monitoring of tumor progression and treatment, unlike traditional biopsy.
"With these features, the acoustofluidic technology has the potential to significantly exceed current industry standards, address unmet needs in the field, help expedite exosome-related biomedical research, and aid in the discovery of new exosomal biomarkers," commented Dr. Huang.
"The saliva exosome liquid biopsy is an effective early detection and risk assessment approach for OPC," said co-lead investigator David T.W. Wong, DMD, DMSc, of the Center for Oral/Head and Neck Oncology Research, School of Dentistry at the University of California Los Angeles, CA, USA. "The acoustofluidic separation technique provides a fast, biocompatible, high-yield, high-purity, label-free method for exosome isolation from saliva." According to the researchers, this technology can also be used to analyze other biofluids such as blood, urine, and plasma.

No evidence to suggest that conventional fillings are more successful than sealing decay into teeth, or using preventive methods alone.

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A dentist's drill might not be the best way to tackle tooth decay in children's teeth, a new study has concluded.

Findings from a major dental trial suggest that preventing tooth decay from occurring in the first place is the most effective way for parents to help avoid pain and infection from decay in their children's teeth.
A three-year study comparing three different treatment options for tooth decay in children's teeth, led by dentists from the Universities of Dundee, Newcastle, Sheffield, Cardiff, Queen Mary University of London and Leeds, has found no evidence to suggest that conventional fillings are more effective than sealing decay into teeth, or using prevention techniques alone, in stopping pain and infection from tooth decay in primary teeth.
The FiCTION trial, the largest of its kind to date, also found that 450 children who took part in the study experienced tooth decay and pain, regardless of which kind of dental treatment they received.
Professor Nicola Innes, Chair of Paediatric Dentistry at the University of Dundee and lead author on the paper published today, said, "Our study shows that each way of treating decay worked to a similar level but that children who get tooth decay at a young age have a high chance of experiencing toothache and abscesses regardless of the way the dentist manages the decay.
"What is absolutely clear from our trial is that the best way to manage tooth decay is not by drilling it out or sealing it in -- it's by preventing it in the first place."
During the study, more than 1,140 children between the ages of three and seven with visible tooth decay were recruited by dentists working in one of 72 dental clinics throughout the country. One of three treatment approaches was then chosen randomly for each child's dental care for the duration of the trial, which was up to three years.
The first approach avoided placing any fillings and aimed to prevent new decay by reducing sugar intake, ensuring twice-daily brushing with fluoridated toothpaste, application of fluoride varnish and placing of fissure sealants on the first permanent molar (back) teeth.
The second option involved drilling out tooth decay, which was based upon what has been considered the standard "drill and fill" practice for more than 50 years together with preventive treatments. The third treatment strategy was a minimally invasive approach where tooth decay was sealed in under a metal crown or a filling to stop it progressing together with preventive treatments.
The main trial findings, published in the Journal of Dental Research found no evidence to suggest that any of the treatment strategies were better than another in terms of making a difference in children's experience of pain or infection, quality of life or dental anxiety between groups.
All three different ways of treating decay were acceptable to children, parents and dental professionals.
Sealing-in with preventive treatment was most likely to be considered the best way of managing children's decay if society are willing to pay a minimum of £130 to avoid an episode of pain or infection.
Professor Anne Maguire, Chair of Preventive Dentistry at Newcastle University and one of the co-chief investigators said, "The FiCTION findings have focused attention again on the need to prevent dental decay before it begins but also provided some reassurance that if decay does develop in a child's mouth, there are a number of treatment options available which can be tailored to the clinical and behavioural needs of an individual child."
Professor Gail Douglas, Chair of Dental Public Health at the University of Leeds and one of the chief investigators, said, "All of the children in our study were chosen to take part because they already had tooth decay and unfortunately even with lots of care and attention from the dentist once children have decay, there's quite a chance that it will cause further problems.
"The good news however is that tooth decay can be prevented. Brushing your teeth with fluoride toothpaste, especially last thing before bedtime, avoiding sugary drinks and snacks between meals and seeing a dentist regularly are all small habits that can help boost the overall health of your teeth."
Scotland's Chief Dental Officer, Tom Ferris, said, "FiCTION highlights the importance of preventing tooth decay in our youngest children. I believe the key to success in prevention lies within families and communities; for this reason Scottish Government launched the Oral Health Community Challenge Fund for Third Sector organisations working alongside families living in our most disadvantaged areas. The activities from these projects complement our mainstream Childsmile work in education and health settings."
The FICTION study was funded by the Health Technology Assessment (HTA) programme of the National Instit11/26/2019ute for Health Research (NIHR).

New study explores the link between obesity and gum disease

Obesity and gum (periodontal) disease are among the most common non-communicable diseases in the United States--and studies show these chronic conditions may be related. This new study explores the effect of obesity on non-surgical periodontal care and evaluates potential pathways that may illustrate the connection between the two conditions.
The connection between obesity and gum disease isn't as simple as cause-and-effect, said Andres Pinto, professor of oral and maxillofacial medicine and diagnostic sciences at the Case Western Reserve University School of Dental Medicine and co-author of the study published in the British Dental Journal.
Instead, the relationship centers on what both diseases have in common: inflammation.
Examining a plethora of existing studies, researchers found that data showing increased body mass index, waist circumference and percentage of body fat to be associated with an increased risk to develop gum disease, also known as periodontitis. Most studies analyzed data from population subsets at one point in time, as opposed to studying the same population over a longer period.
They concluded that changes in body chemistry affect metabolism, which, in turn causes inflammation--something present in both maladies.
"Periodontal disease occurs in patients more susceptible to inflammation--who are also more susceptible to obesity," Pinto said.
This information can inform how health-care professionals plan treatments for patients suffering from obesity and/or gum disease, Pinto said.
"Oral health-care professionals need to be aware of the complexity of obesity to counsel their patients about the importance of an appropriate body weight and maintaining good oral hygiene," he said.
Pinto said further research on the relationship between gum disease and obesity is needed, noting there is, at this point, limited evidence to recommend changes in treatment planning.
"There is a thought, from the clinical perspective, that if you treat one of the issues, it may impact the other," he said. "This is the big question. For example, if we treat obesity successfully, will this impact periodontal disease to the point of being of clinical relevance compared to control population. The jury is still out given the paucity of controlled, well designed, clinical trials on this issue."

Brush your teeth to protect the heart

Brushing teeth frequently is linked with lower risks of atrial fibrillation and heart failure, according to a study published today in the European Journal of Preventive Cardiology, a journal of the European Society of Cardiology (ESC).1
Previous research suggests that poor oral hygiene leads to bacteria in the blood, causing inflammation in the body. Inflammation increases the risks of atrial fibrillation (irregular heartbeat) and heart failure (the heart's ability to pump blood or relax and fill with blood is impaired). This study examined the connection between oral hygiene and occurrence of these two conditions.
The retrospective cohort study enrolled 161,286 participants of the Korean National Health Insurance System aged 40 to 79 with no history of atrial fibrillation or heart failure. Participants underwent a routine medical examination between 2003 and 2004. Information was collected on height, weight, laboratory tests, illnesses, lifestyle, oral health, and oral hygiene behaviours.
During a median follow-up of 10.5 years, 4,911 (3.0%) participants developed atrial fibrillation and 7,971 (4.9%) developed heart failure.
Tooth brushing three or more times a day was associated with a 10% lower risk of atrial fibrillation and a 12% lower risk of heart failure during 10.5-year follow up. The findings were independent of a number of factors including age, sex, socioeconomic status, regular exercise, alcohol consumption, body mass index, and comorbidities such as hypertension.
While the study did not investigate mechanisms, one possibility is that frequent tooth brushing reduces bacteria in the subgingival biofilm (bacteria living in the pocket between the teeth and gums), thereby preventing translocation to the bloodstream.
Senior author Dr. Tae-Jin Song of Ewha Womans University, Seoul, Korea noted that the analysis was limited to one country and as an observational study does not prove causation. But he added: "We studied a large group over a long period, which adds strength to our findings."
An accompanying editorial states: "It is certainly too early to recommend tooth brushing for the prevention of atrial fibrillation and congestive heart failure". It adds: "While the role of inflammation in the occurrence of cardiovascular disease is becoming more and more evident, intervention studies are needed to define strategies of public health importance."2

References
1Chang Y, Woo HG, Park J, et al. Improved oral hygiene care is associated with decreased risk of occurrence for atrial fibrillation and heart failure: A nationwide population-based cohort study. Eur J Prev Cardiol. 2019. doi:10.1177/2047487319886018.
2Meyre P, Conen D. Does tooth brushing protect from atrial fibrillation and heart failure? Eur J Prev Cardiol. 2019. doi:10.1177/2047487319886413.

Soft drinks found to be the crucial link between obesity and tooth wear=

A new study published today in the journal Clinical Oral Investigations, has found that sugar-sweetened acidic drinks, such as soft drinks, is the common factor between obesity and tooth wear among adults.
Scientists from King's College London found that being overweight or obese was undoubtedly associated with having tooth wear. Significantly, they also found that the increased consumption of sugary soft drinks may be a leading cause of the erosion of tooth enamel and dentine in obese patients.
Drawing on data from the National Health and Nutrition Examination Survey 2003-2004, they analysed a representative sample of survey participants of 3,541 patients in the United States. Patient BMI and the level of tooth wear were the exposure and outcome measurements in the analysis. The intake of sugar-sweetened acidic drinks was recorded through two non-consecutive 24-hour recall interviews where the patients were asked to provide details of diet intake across these two days.
"It is the acidic nature of some drinks such as carbonated drinks and acidic fruit juices that leads to tooth wear," said lead author Dr Saoirse O'Toole from King's College London.
Tooth wear is ranked as the third most important dental condition, after cavities and gum disease and the consumption of acidic food and drink is a leading cause of this. Obese patients also have other risk factors such as increased likelihood of gastric reflux disease (heartburn) which was controlled for in this study.
"This is an important message for obese patients who are consuming calories through acidic sugar sweetened drinks. These drinks may be doing damage to their body and their teeth. There is also an important message for dentists. We should be asking our patients who are obese and have tooth wear what calories they are drinking as this may be having an effect on their full bodies - not just their teeth," Dr O'Toole added.
Previous research from King's has found that tooth wear affects up to 30% of European adults. It is the premature wearing of teeth due to the softening of the dental enamel from dietary or gastric acids, combined with wear and tear. It occurs when the outer layer (enamel) of the tooth slowly dissolves. This can lead to changes in the shape or appearance of teeth, and they can become sensitive when eating or drinking cold food and drinks. At its worst, the tooth structure can gradually wear away. Severe Erosive Tooth Wear reduces quality of life and can mean complex and costly procedures, costing up to £30,000 per patient. Tooth wear is preventable and changes to consumption habits can help stop people from getting it or making it worse.

Antibiotics not necessary for most toothaches, according to new ADA guideline

American Dental Association

The American Dental Association (ADA) announced today a new guideline indicating that in most cases, antibiotics are not recommended for toothaches. This guidance, published in the November issue of the Journal of the American Dental Association, aligns with the ADA's longstanding antibiotic stewardship efforts and its pledged commitment to the U.S. government's Antimicrobial Resistance Challenge.
Patients with toothaches are often prescribed antibiotics by physicians and dentists to help relieve signs and symptoms and prevent progression to a more serious condition. However, the new guideline and accompanying systematic review find that healthy adults experiencing a toothache are best served not by antibiotics but by dental treatment and, if needed, over-the-counter pain relievers such as acetaminophen and ibuprofen.
"Antibiotics are, of course, tremendously important medications," said Peter Lockhart, D.D.S., chair of the ADA expert panel that developed the guideline and research professor at Carolinas Medical Center - Atrium Health. "However, it's vital that we use them wisely so that they continue to be effective when absolutely needed."
Studies have shown that antibiotics, which are designed to stop or slow the growth of bacterial infections, don't necessarily help patients experiencing a toothache. In addition, antibiotics can cause serious side effects, and overuse has resulted in bacterial strains that are resistant to antibiotics.
The guideline offers example scenarios when antibiotics may be prescribed for a toothache. "When dental treatment is not immediately available and the patient has signs and symptoms such as fever, swollen lymph nodes, or extreme tiredness, antibiotics may need to be prescribed," said Dr. Lockhart. "But in most cases when adults have a toothache and access to dental treatment, antibiotics may actually do more harm than good."

Advances in precision oral health research proceedings published in Advances in Dental Research

International & American Associations for Dental Research

Alexandria, VA, USA - On November 8-9, 2018 the American Association for Dental Research (AADR) held the "9^th AADR Fall Focused Symposium: Advances in Precision Oral Health Research" meeting on the National Institutes of Health (NIH) campus in Bethesda, Maryland, USA. The papers resulting from this symposium are published in the latest issue of Advances in Dental Research, an e-Supplement to the Journal of Dental Research (JDR).
Unprecedented advances in genomics, data science and biotechnology have ushered in a new era of healthcare in which interventions are increasingly tailored to individual patients and  extended to population precision-based approaches which can be applied oral health. Harnessing the full potential of precision oral health will depend on research to more fully understand the factors that underlie health and contribute to disease -- including the human genome, microbiome, epigenome, proteome and others.
This two-day symposium addressed the current state of precision oral health research and its clinical application, the future of personalized oral health and the research gaps that need to be filled to realize the full potential of personalized oral care. The symposium, summarized in these proceedings, was organized into sessions on the topics of: an introduction to precision oral health research, oral health in the context of overall health, precision reengineering of the oral microbiome for caries management, the molecular basis of dental caries and periodontitis, the integration of studies for diagnostic and therapeutic precision in head and neck cancer and the rehabilitation of patients sustaining orofacial injuries.
"Precision medicine continues to revolutionize healthcare. Oral health professionals and insurers will need to work with the research community and industry to develop new strategies to achieve optimal oral and overall health based on advances in precision oral health research that utilizes genomics, proteomics, metabolomics, bioinformatics and systems biology," said AADR Immediate Past President Maria Ryan, Colgate-Palmolive Company. "Clearly implementing precision health care into clinical practice is not without challenges. Precision healthcare will require human capital, infrastructure and education of the healthcare workforce, as well as empowering the general public with accurate information to facilitate adoption of new preventive and therapeutic strategies. Various ethical and social issues should be addressed, such as privacy, protection of genomic data and access to care."
Funding for this conference was made possible (in part) by the Task Force on Design & Analysis in Oral Health Research and a conference grant R13DE027882 from the National Institute of Dental and Craniofacial Research (NIDCR). The views expressed in written conference materials or publications and by speakers and moderators do not necessarily reflect the official policies of the Department of Health and Human Services; nor does mention by trade names, commercial practices, or organizations imply endorsement by the U.S. Government.

Oral implants -- The paradigm shift in restorative dentistry

International & American Associations for Dental Research

Alexandria, VA, USA – 2019 marks the Centennial of the Journal of Dental Research (JDR). Over the last century the JDR has been dedicated to the dissemination of new knowledge and information on all sciences relevant to dentistry and to the oral cavity and associated structures in health and disease.
To celebrate, the JDR is featuring a yearlong, commemorative article and podcast series that highlights topics that have transformed dental, oral and craniofacial research over the past 100 years.
The discovery of the phenomenon osseointegration has led to the development of oral implants with high clinical performance. In the JDR Centennial article “Oral Implants — The Paradigm Shift in Restorative Dentistry,” Niklaus P. Lang, Professor Emeritus, University of Berne, Switzerland, reviews history and progression of dental implants but emphasizes the importance of advocating for treatment philosophies that help retain more teeth.
“While the osseointegration facilitates the use of implants as prosthetic abutments, it must be kept in mind that the peri-implant soft tissue may be subject to biological complications and, in turn, this may result in an infectious process that will jeopardize the osseointegration,” said Lang. “Consequently, the monitoring of the peri-implant tissues is an important aspect and early intervention in situations with peri-implant mucositis is mandatory for the prevention of peri-implantitis. In the light of these facts, it would appear to be logical to advocate that treatment philosophies should change to retain more teeth.”
The November 2019 issue of the JDR also includes a JDR Centennial podcast “Oral Implants — The Paradigm Shift in Restorative Dentistry,” which features a conversation between Lang and Lisa Heitz-Mayfield, University of Western Australia, Perth, moderated by JDR Editor-in-Chief William Giannobile, University of Michigan, Ann Arbor, USA, and Historical Highlight 12 on the cause of mottled enamel by JDR Associate Editor, Nicholas Jakubovics, Newcastle University, England.
The legacy of the JDR was honored during a celebration at the 97^th General Session of the IADR, held in conjunction with the 48^th Annual Meeting of the AADR and the 43^rdAnnual Meeting of the Canadian Association for Dental Research, in Vancouver, British Columbia, Canada on June 19-22, 2019. For more information on the JDR Centennial, please visit: www.iadr.org/JDRcentennial.
Click here to view a PDF of this press release.
About the Journal of Dental Research
The IADR/AADR Journal of Dental Research (JDR) is a multidisciplinary journal dedicated to the dissemination of new knowledge in all sciences relevant to dentistry and the oral cavity and associated structures in health and disease. The JDR continues to rank #1 of 90 journals in Eigenfactor with a score of 0.021290, ranks #2 in Impact Factor of 90 journals in the “Dentistry, Oral Surgery & Medicine” category at 5.125 and ranks #2 of 90 in Article Influence with a score of 1.643.The JDR’s 5-year Impact Factor has remained above 5 for the fourth year at 5.722, ranking #2 of 91 journals. With over 20,000 citations, the JDR also boasts the most citations in the “Dentistry, Oral Surgery & Medicine” category — 4,500 citations above the second ranked journal in the field.
International Association for Dental Research
The International Association for Dental Research (IADR) is a nonprofit organization with over 11,400 individual members worldwide, with a Mission to drive dental, oral and craniofacial research to advance health and well-being worldwide. To learn more, visit www.iadr.org. The American Association for Dental Research (AADR) is the largest Division of IADR with 3,300 members in the United States. To learn more, visit www.iadr.org/aadr.

Disclaimer: AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert system.

Evolution of aesthetic dentistry

International & American Associations for Dental Research

Alexandria, VA, USA - 2019 marks the Centennial of the Journal of Dental Research (JDR). Over the last century the JDR has been dedicated to the dissemination of new knowledge and information on all sciences relevant to dentistry and to the oral cavity and associated structures in health and disease. To celebrate, the JDR is featuring a yearlong, commemorative article and podcast series that highlights topics that have transformed dental, oral and craniofacial research over the past 100 years.
One of the main goals of dental treatment is to mimic teeth and design smiles in the most natural and esthetic manner, based on the individual and specific needs of the patient. The JDR Centennial article "Evolution of Esthetic Dentistry," by Markus B. Blatz, University of Pennsylvania, Philadelphia, USA, Gerald Chiche, Augusta University Dental College of Georgia, USA, Oded Bahat, Beverly Hills, California, USA, Richard Roblee, Roblee Orthodontics, Fayetteville, Arkansas, USA, Christian Coachman, University of Pennsylvania, Philadelphia, USA and Harald Heymann, University of North Carolina at Chapel Hill, USA, provides a historical review of the evolution of esthetic dentistry over the past 100 years and highlights advances in the development of dental research and clinical interventions that have contributed to the science and art of esthetic dentistry.
"There is strong scientific evidence that the appearance of a person's face and teeth has a profound impact on the perception and judgment by others," said Blatz. "The options to reach the goal of mimicking the most natural esthetics have significantly improved over the last decade. In the future, artificial intelligence and machine learning will likely lead to automation of esthetic evaluation, smile design and treatment planning processes."
"Among the most noteworthy advancements in esthetic dentistry over the past decade are the establishment of universal esthetic rules and guidelines, the development of tooth whitening and advanced restorative and prosthetic materials, progress in orthodontics and periodontal and oral and maxillofacial surgery," said Chiche. "And most recently, the implementation of digital technologies in the 3D planning and realization of truly natural and individual smiles."

Tooth loss associated with higher risk of heart disease

Adults missing one or more teeth from nontraumatic events more prone to heart attack, stroke

American College of Cardiology

Adults who have lost teeth due to nontraumatic reasons may have a higher risk of developing cardiovascular disease according to a presentation at the American College of Cardiology Middle East Conference 2019 together with the 10th Emirates Cardiac Society Congress. The conference is Oct. 3-5 in Dubai, United Arab Emirates.
Cardiovascular disease is the No. 1 cause of death of men and women in the United States, and previous studies have linked cardiovascular disease with oral disease. Oral disease is an inflammatory disease that frequently causes tooth loss due to the breakdown of periodontal tissue.
The causal association between oral disease and cardiovascular disease is not well known, so researchers in this study conducted a secondary analysis of the 2014 Behavior Risk Factor Surveillance System that looked at tooth loss not caused by trauma, as well as cardiovascular disease, including heart attack, angina and/or stroke.
The study included 316,588 participants from the United States and territories between the ages of 40-79. Overall 8 percent were edentulous (had no teeth) and 13 percent had cardiovascular disease. The percentage of people who had cardiovascular disease and were edentulous was 28 percent, compared to only 7 percent who had cardiovascular disease but did not have missing teeth.
In addition to edentulous participants, those who reported having one to five missing teeth or six or more, but not all, missing teeth were also more likely to develop cardiovascular disease, even after adjusting for other factors such as body mass index, age, race, alcohol consumption, smoking, diabetes and dental visits.
"Our results support that there is a relationship between dental health and cardiovascular health," said Hamad Mohammed Qabha, MBBS, lead author of the study and Chief Medical and Surgical Intern at Imam Muhammad Ibn Saud Islamic University. "If a person's teeth fall out, there may be other underlying health concerns. Clinicians should be recommending that people in this age group receive adequate oral health care to prevent the diseases that lead to tooth loss in the first place and as potentially another way of reducing risk of future cardiovascular disease."

As we age, oral health plays increasing role in overall health A

Oral health is a critical component to overall health for all ages, but according to dental and medical experts from UConn Health, vigilance is especially critical for the elderly.
In a review article recently published in the Journal of the American Geriatrics Society, the authors outline the potential complications that can arise from poor oral hygiene in older adults and cite the  role of all health care professionals in working to promote good oral hygiene in this population.
"All health care professionals should work to promote good oral hygiene for their older patients," said Dr. Patrick Coll, professor of family medicine and medicine at the UConn School of Medicine and lead author of the review article. They "should consider an oral examination during an annual wellness visit, especially for those patients who are not receiving regular dental care."
The need is evident, say the authors. Data from the National Center for Health Statistics indicates that the prevalence of cavities is more than twice as high in older adults than younger adults. The prevalence of periodontitis -- a serious gum infection that damages the soft tissue and destroys the bone that supports your teeth -- also increases with age. As many as 64% of older adults in the U.S. have periodontitis.
Periodontitis is associated with a variety of medical conditions including cardiovascular disease and diabetes. Patients with replacement heart valves and prosthetic joints should be particularly careful regarding their oral hygiene, according to the authors.
It is well recognized that manipulation of teeth and their support structures can result in bacteria present in the oral cavity being released into the bloodstream, which may lead to infections in parts of the body far removed from the oral cavity, they write.
"Even tooth brushing for those who have poor oral hygiene can cause bacteria to be released into the blood stream and these bacteria can potentially cause joint infections and heart valve infections," says Coll.
Without good oral hygiene, the use of fluoride, and regular dental care, older adults are more prone to damage to the oral cavity and the extension of infection into surrounding tissues.
Tooth loss, for instance, can affect a person's ability to chew, which can lead to malnutrition. Chronic oral infection is a recognized risk factor for heart disease, and can also lead to the spread of infection to artificial joints and endocardial implants.
Researchers noted several populations of older adults who are at increased risk for oral health problems, including patients with diabetes, patients with dementia, and those in long-term care settings.
Patients with dementia--particularly those with advanced dementia--may neglect their oral health and may be reluctant to see a dental hygienist.
And, many residents in nursing homes also do not receive adequate dental care, despite federal requirements for nursing homes to provide both routine and emergency dental care. Nursing home facilities, the experts say, should adopt risk assessment tools to identify patients at high risk for poor oral hygiene and educate staff on the importance of good oral hygiene and how to provide it.
The experts recommend that all older adults should have biannual dental cleaning performed by a hygientist and a biannual oral health assessment by their dentist.
"Your mouth is a mirror to your body," says  Dr. Sree Raghavendra, co-author of the article and assistant professor in the Department of Craniofacial Sciences at the UConn School of Dental Medicine.
"This article is a prime example of true interprofessional collaboration that emphasizes the importance of the entire health care team coming together to take care of all of our patients and especially our geriatric population."

Gum disease linked with higher risk of hypertension

People with gum disease (periodontitis) have a greater likelihood of high blood pressure (hypertension), according to a study published today in Cardiovascular Research, a journal of the European Society of Cardiology (ESC).¹
Senior author Professor Francesco D'Aiuto of UCL Eastman Dental Institute, UK, said: "We observed a linear association - the more severe periodontitis is, the higher the probability of hypertension. The findings suggest that patients with gum disease should be informed of their risk and given advice on lifestyle changes to prevent high blood pressure such as exercise and a healthy diet."
High blood pressure affects 30-45% of adults and is the leading global cause of premature death,² while periodontitis affects more than 50% of the world's population. Hypertension is the main preventable cause of cardiovascular disease, and periodontitis has been linked with increased risk of heart attack and stroke.
"Hypertension could be the driver of heart attack and stroke in patients with periodontitis," said Professor D'Aiuto. "Previous research suggests a connection between periodontitis and hypertension and that dental treatment might improve blood pressure, but to date the findings are inconclusive."
This study compiled the best available evidence to examine the odds of high blood pressure in patients with moderate and severe gum disease. A total of 81 studies from 26 countries were included in the meta-analysis.
Moderate-to-severe periodontitis was associated with a 22% raised risk for hypertension, while severe periodontitis was linked with 49% higher odds of hypertension. Lead author Dr Eva Munoz Aguilera of UCL Eastman Dental Institute said: "We observed a positive linear relationship, with the hazard of high blood pressure rising as gum disease became more severe."
Average arterial blood pressure was higher in patients with periodontitis compared to those without. This amounted to 4.5 mmHg higher systolic and 2 mmHg higher diastolic blood pressures. "The differences are not negligible," said Dr Munoz Aguilera. "An average 5 mmHg blood pressure rise would be linked to a 25% increased risk of death from heart attack or stroke."
Just 5 out of 12 interventional studies included in the review showed a reduction in blood pressure following gum treatment. The changes occurred even in people with healthy blood pressure levels.
Professor D'Aiuto said: "There seems to be a continuum between oral health and blood pressure which exists in healthy and diseased states. The evidence suggesting periodontal therapy could reduce blood pressure remains inconclusive. In nearly all intervention studies, blood pressure was not the primary outcome. Randomised trials are needed to determine the impact of periodontal therapy on blood pressure."
Regarding potential reasons for the connection between the conditions, gum disease and the associated oral bacteria lead to inflammation throughout the body, which affects blood vessel function. Common genetic susceptibility could also play a role, along with shared risk factors such as smoking and obesity.
Professor D'Aiuto said: "In many countries throughout the world, oral health is not checked regularly, and gum disease remains untreated for many years. The hypothesis is that this situation of oral and systemic inflammation and response to bacteria accumulates on top of existing risk factors."
He noted that the study investigated gum disease as a potential risk factor for hypertension, but the reverse could also be true. "Further research is needed to examine whether patients with high blood pressure have a raised likelihood of gum disease. It seems prudent to provide oral health advice to those with hypertension," he said.

New study questions value of fluoride varnish

Fluoride varnish has become a popular anti-cavity treatment for children, and it isn't hard to see why. It's relatively easy to apply, and not just for dentists or dental hygienists. Pediatricians can do it as well, with minimal instruction. The sticky varnish goes on with a brush and then dries in a few hours. There's little risk of children swallowing the fluoride, as they might with other topical treatments such as gels.
Nor is it very expensive, with treatment costs generally ranging from about $25 to $55. That doesn't seem to be a prohibitive price to pay to guard a child against tooth decay.
Yet a new study by two University of Washington researchers and their colleagues questions the cost-effectiveness of fluoride varnish for preschoolers and calls its anti-cavity effects "modest and uncertain" in this age group.
Dr. Joana Cunha-Cruz and Dr. Philippe Hujoel of the UW School of Dentistry and four research colleagues came up with their conclusion after reviewing 20 clinical trials of fluoride varnish in 13 countries. They examined trials in which fluoride varnish was used by itself or in an oral health program, and also checked the results of using fluoride varnish compared with placebo, usual care, or no treatment.
"As much as we want fluoride varnish to be effective, the current evidence doesn't support a huge benefit for its use in young children," Dr. Cunha-Cruz said.
In their new study, which was recently published in the journal Caries Research, she and her colleagues noted that fluoride varnish applications are aimed especially at children with a high risk of caries, or tooth decay. It's not considered a primary form of treatment, but rather a complement to other fluoride treatments such as toothpaste or fluoridated water.
Nonetheless, the researchers reported that more recent clinical trials in both low-risk and high-risk groups "failed to show a protective effect of fluoride varnish applications."
"Cost-effectiveness analyses are needed to assess whether fluoride varnish should be adopted or abandoned by dental services," they said in their study.
The researchers don't assert that fluoride varnish doesn't work. Their analysis showed that the risk of developing new cavities declined by 12 percent among the children who received fluoride varnish, compared with those who did not. And they added that fluoride varnish could still be a cost-effective alternative in some cases. However, they also stated, "This was a rather modest benefit, as a large number of the children developed new dentine caries lesions, regardless of fluoride varnish use."
Concentrations of fluoride can also vary among different varnishes, Dr. Cunha-Cruz said.
That's not to say that there aren't highly effective topical treatment alternatives. Sealants do a good job of protecting the teeth, especially those hard-to-reach ones in the rear of the mouth, Dr. Cunha-Cruz said. Even better are sealants with glass ionomer, which releases fluoride, as opposed to resin-based sealants, which don't have it.
Sealants are more difficult to apply than varnish, but Dr. Cunha-Cruz said that they remain effective for two to three years. Silver diamine fluoride has also been growing in popularity and is very effective in stopping decay, she said, but more research is needed on its preventive effect. It can also discolor teeth, but that isn't as much of a concern for preschoolers who still haven't lost their primary teeth.
"The evidence still supports the use of fluoride toothpaste, which is easy and low-cost," Dr. Cunha-Cruz said. "The value of toothpaste lies in how it creates a daily presence of fluoride in the mouth." Fluoride rinse is also effective in this way, she said.
For now, she and her research colleagues are calling for more studies of fluoride varnish's cost-effectiveness among different populations and application settings. She suggests caregivers discuss the pros, cons and alternatives to fluoride varnish to prevent cavities with a child's dentist.
Meanwhile, aside from using fluoride toothpaste and rinses each day, Dr. Cunha-Cruz suggests another approach: "Reducing sugar intake is an even more cost-effective strategy."

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Acute periodontal disease bacteria love colon and dirt microbes

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True or false? Bacteria living in the same space, like the mouth, have evolved collaborations so generous that they are not possible with outside bacteria. That was long held to be true, but in a new, large-scale study of microbial interactions, the resounding answer was "false."

Research led by the Georgia Institute of Technology found that common mouth bacteria responsible for acute periodontitis fared better overall when paired with bacteria and other microbes that live anywhere but the mouth, including some commonly found in the colon or in dirt. Bacteria from the oral microbiome, by contrast, generally shared food and assistance more stingily with gum infector Aggregatibacter actinomycetemcomitans, or Aa for short.
Like many bacteria known for infections they can cause -- like Strep -- Aa often live peacefully in the mouth, and certain circumstances turn them into infectors. The researchers and their sponsors at the National Institutes of Health would like to know more about how Aa interacts with other microbes to gain insights that may eventually help fight acute periodontitis and other ailments.
"Periodontitis is the most prevalent human infection on the planet after cavities," said Marvin Whiteley, a professor in Georgia Tech's School of Biological Sciences and the study's principal investigator. "Those bugs get into your bloodstream every day, and there has been a long, noted correlation between poor oral hygiene and prevalence of heart disease."
Unnatural pairing
The findings are surprising because bacteria in a microbiome have indeed evolved intricate interactions making it seem logical that those interactions would stand out as uniquely generous. Some mouth microbes even have special docking sites to bind to their partners, and much previous research has tightly focused on their cooperations. The new study went broad.
"We asked a bigger question: How do microbes interact with bugs they co-evolved with as opposed to how they would interact with microbes they had hardly ever seen. We thought they would not interact well with the other bugs, but it was the opposite," Whiteley said.
The study's scale was massive. Researchers manipulated and tracked nearly all of Aa's roughly 2,100 genes using an emergent gene tagging technology while pairing Aa with 25 other microbes -- about half from the mouth and half from other body areas or the environment.
They did not examine the mouth microbiome as a whole because multi-microbial synergies would have made interactions incalculable. Instead, the researchers paired Aa with one other bug at a time -- Aa plus mouth bacterium X, Aa plus colon bacterium Y, Aa plus dirt fungus Z, and so on.
"We wanted to see specifically which genes Aa needed to survive in each partnership and which ones it could do without because it was getting help from the partner," said Gina Lewin, a postdoctoral researcher in Whiteley's lab and the study's first author. They published their results in the Proceedings of the National Academy of Sciences.
Q & A
How could they tell that Aa was doing well or poorly with another microbe?
The researchers looked at each of Aa's genes necessary for survival while it infected a mouse -- when Aa was the sole infector, when it partnered with a fellow mouth bacterium and when paired with a microbe from colon, dirt, or skin.
"When Aa was by itself, it needed a certain set of genes to survive -- like for breathing oxygen," Lewin said. "It was striking that when Aa was with this or that microbe that it normally didn't live around, it no longer needed a lot of its own genes. The other microbe was giving Aa things that it needed, so it didn't have to make them itself."
"Interactions between usual neighbors -- other mouth bacteria -- looked more frugal," Whiteley said. "Aa needed a lot more of its own genes to survive around them, sometimes more than when it was by itself."
How did the emerging genetic marking method work?
To understand "transposon sequencing," picture a transposon as a DNA brick that cracks a gene, breaking its function. The brick also sticks to the gene and can be detected by DNA sequencing, thus tagging that malfunction.
Every Aa bacterium in a pile of 10,000 had a brick in a random gene. If Aa's partner bacterium, say, E. coli, picked up the slack for a broken function, Aa survived and multiplied even with the damaged gene, and researchers detected a higher number of bacteria containing the gene.
Aa surviving with more broken genes meant a partner microbe was giving it more assistance. Aa bacteria with broken genes that a partner could not compensate for were more likely to die, reducing their count.
Does this mean the mouth microbiome does not have unique relationships?
It very likely does have them, but the study's results point to not all relationships being cooperative. Some microbiomes could have high fences and share sparsely.
"One friend or enemy may be driving your behavior, and other microbes may just be standing around," Lewin said.
Smoking, poor hygiene, or diabetes -- all associated with gum disease -- might be damaging defensive microbiomes and allowing outside bacteria to help Aa attack gum tissue. It's too early to know that, but Whiteley's lab wants to dig deeper, and the research could have implications for other microbiomes.

Poor oral health linked to cognitive decline, perceived stress

Oral health is an essential part of psychological well-being and overall health in older adults. Poor oral health is associated with decreased quality of life, depression, hypertension, and cognitive decline. Two Rutgers studies, co-authored by Darina Petrovsky, Bei Wu, and Weiyu Mao, and published in the Journal of the American Geriatrics Society, explored the relationship between poor oral health and cognitive decline and the effects of perceived stress and social support on dry mouth among older Chinese Americans.
Researchers interviewed more than 2,700 Chinese Americans aged 60 and older and found that nearly 50 percent of study participants reported experiencing tooth symptoms, 25.5 percent reported dry mouth. In the first study, those who reported tooth symptoms experienced declines in cognition and episodic memory, often precursors to dementia. In the second study, the researchers found that stress increased symptoms of dry mouth, leading to poorer overall oral health.
"Racial and ethnic minorities are particularly vulnerable to the negative consequences of poor oral health," said XinQi Dong, director of Rutgers University's Institute for Health, Health Care Policy and Aging Research. "Minorities have less access to preventive dental care that is further exacerbated by language barriers and low socioeconomic status. Older Chinese Americans are at particular risk for experiencing oral health symptoms due to lack of dental insurance or not visiting a dental clinic regularly."
According to Dong, the increasing oral health disease burdens among older Chinese immigrants point to the need for investigations of psychosocial factors due to the current emphasis on physical diseases and health behaviors in oral health.
"Efforts must be made to increase social support to alleviate stress and the resulting dry mouth issues reported by our study participants," Dong continued. "These efforts can help preserve older adults' health and well-being and limit cognitive decline."
Key findings:

• 47.8 percent of older Chinese Americans reported having teeth symptoms; participants who reported teeth symptoms at baseline experienced their global cognition and episodic memory decline
• 18.9 percent of older Chinese Americans reported gum symptoms.
• 15.6 percent of older Chinese Americans reported teeth and gum symptoms.
• 25.5 percent of older Chinese Americans reported dry mouth.
• More perceived stress was associated with higher odds of dry mouth.

"These studies demonstrate the importance of examining immigrant oral health outcomes later in life to understand the specific type of outcomes of different cultural groups," said Dong. "The studies further serve as a call to action for policymakers to develop programs aimed at improving oral health preventative and dental care services in this high-risk population. Darina Petrovsky, first author, added, "Examining current oral health practices among older Chinese Americans is crucial for developing culturally-tailored interventions to promote oral health and ultimately mitigate cognitive decline."
"Poor oral health is a top concern among older Chinese Americans. In our study, the prevalence rate of dry mouth is followed by diabetes and heart disease. Our findings demonstrate the importance of studying the linkage between stress and dry mouth in this vulnerable population." said author Weiyu Mao, Assistant Professor, School of Social Work, University of Nevada, Reno.
"Support from family and friends could be protective against dry mouth symptoms in relation to stress; however, the potential overload of such support could be detrimental to oral health outcomes among older Chinese Americans." Mao continued. "Intervention strategies need to expand beyond the common risk factors, such as health conditions and health behaviors, and account for the psychosocial determinants, including stress and social support, to better promote oral health and reduce oral health disparities in this population."
"Our research raises critical awareness for dental and healthcare providers of the role of perceived stress in dry mouth symptoms," added Dong. "Working collaboratively, dental, and healthcare providers can better identify oral health symptoms as risk factors of cognitive decline in this fast-growing vulnerable population. The primary focus should include promoting optimal oral health and improving the quality of life."

Mouthwash use could inhibit benefits of exercise

Exercise is known to reduce blood pressure - but the activity of bacteria in our mouths may determine whether we experience this benefit, according to new research.
An international team of scientists has shown that the blood pressure-lowering effect of exercise is significantly reduced when people rinse their mouths with antibacterial mouthwash, rather than water - showing the importance of oral bacteria in cardiovascular health.
The researchers now suggest that health professionals should pay attention to the oral environment when recommending interventions involving physical activity for high blood pressure.
The study was led by the University of Plymouth in collaboration with the Centre of Genomic Regulation in Barcelona (Gabaldon's lab), Spain, and was published in the journal Free Radical Biology and Medicine.
Why did the research take place? Lead author Dr Raul Bescos, Lecturer in Dietetics and Physiology at the University of Plymouth, said: "Scientists already know that blood vessels open up during exercise, as the production of nitric oxide increases the diameter of the blood vessels (known as vasodilation), increasing blood flow circulation to active muscles.
"What has remained a mystery is how blood circulation remains higher after exercise, in turn triggering a blood-pressure lowering response known as post-exercise hypotension.
"Previous research has suggested that nitric oxide was not involved in this post-exercise response - and only involved during exercise - but the new study challenges these views.
"It's all to do with nitric oxide degrading into a compound called nitrate, which for years was thought to have no function in the body. But research over the last decade has shown that nitrate can be absorbed in the salivary glands and excreted with saliva in the mouth.
"Some species of bacteria in the mouth can use nitrate and convert into nitrite - a very important molecule that can enhance the production of nitric oxide in the body. And when nitrite in saliva is swallowed, part of this molecule is rapidly absorbed into the circulation and reduced back to nitric oxide. This helps to maintain a widening of blood vessels which leads to a sustained lowering of blood pressure after exercise.
"We wanted to see whether blocking nitrate's ability to convert into nitrite by inhibiting oral bacteria would have any effect on post-exercise hypotension."
What did the study involve? Twenty-three healthy adults were asked to run on a treadmill for a total of 30 minutes on two separate occasions, after which they were monitored for two hours.
On each occasion at one, 30, 60 and 90 minutes after exercise they were asked to rinse their mouths with a liquid - either antibacterial mouthwash (0.2% chlorhexidine) or a placebo of mint-flavoured water. Neither the researchers nor the participants knew which liquid they were rinsing with.
Their blood pressure was measured and saliva and blood samples were taken before exercise and at 120 minutes after exercise. No food or drink except water was allowed during exercise and the recovery period, and none of the study participants had any oral health conditions.
What did the science show?
The study found that when participants rinsed with the placebo, the average reduction in systolic blood pressure was -5.2 mmHg at one hour after exercise. However when participants rinsed with the antibacterial mouthwash, the average systolic blood pressure was -2.0 mmHg at the same time point.
*Systolic blood pressure refers to the highest blood pressure level when the heart is squeezing and pushing the blood round the body.
These results show that the blood pressure-lowering effect of exercise was diminished by more than 60% over the first hour of recovery, and totally abolished two hours after exercise when participants were given the antibacterial mouthwash.
Previous views also suggested that the main source of nitrite in the circulation after exercise was nitric oxide formed during exercise in the endothelial cells (cells that line the blood vessels). However, the new study challenges this. When antibacterial mouthwash was given to the participants, their blood nitrite levels did not increase after exercise. It was only when participants used the placebo that nitrite levels in blood raised, indicating that oral bacteria are a key source of this molecule in the circulation at least over the first period of recovery after exercise.
What the authors say
Craig Cutler, study co-author who conducted the research as part of his PhD at the University of Plymouth, said: "These findings show that nitrite synthesis by oral bacteria is hugely important in kick-starting how our bodies react to exercise over the first period of recovery, promoting lower blood pressure and greater muscle oxygenation.
"In effect, it's like oral bacteria are the 'key' to opening up the blood vessels. If they are removed, nitrite can't be produced and the vessels remain in their current state.
"Existing studies show that, exercise aside, antibacterial mouthwash can actually raise blood pressure under resting conditions, so this study followed up and showed the mouthwash impact on the effects of exercise.
"The next step is to investigate in more detail the effect of exercise on the activity of oral bacteria and the composition of oral bacteria in individuals under high cardiovascular risk. Long-term, research in this area may improve our knowledge for treating hypertension - or high blood pressure - more efficiently."

Elite athletes have poor oral health despite brushing twice daily

Elite athletes have high rates of oral disease despite brushing their teeth more frequently than most people, finds a new UCL study.
The findings, published in the British Dental Journal, highlight potential for improvement as most of the athletes expressed an interest in changing their oral hygiene behaviour to improve their oral health.
The UCL Eastman Dental Institute research team surveyed 352 Olympic and professional athletes across 11 sports, including cycling, swimming, rugby, football, rowing, hockey, sailing and athletics, when they provided dental check-ups for male and female athletes measuring tooth decay, gum health and acid erosion.
The researchers also asked athletes what they did to keep their mouth, teeth and gums healthy.
The dental check-ups revealed substantial amounts of oral disease as reported in a 2018 paper, finding that nearly half (49.1%) had untreated tooth decay, the large majority showed early signs of gum inflammation, and almost a third (32%) reported that their oral health had a negative impact on their training and performance.*
Elite athletes have poor oral health despite their efforts to care for their teeth: this new study found that 94% reported brushing their teeth at least twice a day, and 44% reported regularly cleaning between their teeth (flossing) - substantially higher figures than for the general population (75% for twice-daily brushing and 21% for flossing**).
The researchers found that the athletes regularly use sports drinks (87%), energy bars (59%) and energy gels (70%), which are known to damage teeth.
"We found that a majority of the athletes in our survey already have good oral health related habits in as much as they brush their teeth twice a day, visit the dentist regularly, don't smoke and have a healthy general diet," said researcher Dr Julie Gallagher (UCL Eastman Dental Institute Centre for Oral Health and Performance).
"However, they use sports drinks, energy gels and bars frequently during training and competition; the sugar in these products increases the risk of tooth decay and the acidity of them increases the risk of erosion. This could be contributing to the high levels of tooth decay and acid erosion we saw during the dental check-ups."
The study builds on research carried out by the Centre since the London 2012 Olympics, led by Professor Ian Needleman. Previous findings have suggested that elite athletes may also face an elevated risk of oral disease from a dry mouth during intensive training.
Encouragingly, the surveyed athletes said they would consider adopting even better oral hygiene habits to tackle this and an intervention study has already been piloted.***
Dr Gallagher said: "Athletes were willing to consider behaviour changes such as additional fluoride use from mouthwash, more frequent dental visits, and reducing their intake of sports drinks, to improve oral health."
"We subsequently asked some of them and support team members to help us design an oral health intervention study, based on contemporary behaviour change theory and we will publish the results soon."

Gastroesophageal reflux associated with chronic pain in temporomandibular joint

Gastroesophageal reflux (GERD) is associated with chronic, painful temporomandibular disorder -- pain in the temporomandibular joint -- and anxiety and poor sleep contribute to this association, according to a study in CMAJ (Canadian Medical Association Journal) http://www.cmaj.ca/lookup/doi/10.1503/cmaj.181535.
Pain from temporomandibular disorder (TMD) affects about 13% of Canada's population. Reflux is an uncomfortable condition in which stomach contents are regurgitated into the throat. Evidence indicates that anxiety, somatization and depression are linked to GERD.
Researchers from China and the United States looked at data on 1522 patients with chronic TMD, of whom 69% (1048) were women, to understand the relationship between chronic TMD and GERD and to determine if anxiety, somatization and depression influence the association. They found symptomatic GERD was a risk factor for TMD, and people with a longer history of GERD had a higher risk of TMD than those with a shorter history.
"The interactions between chronic musculoskeletal diseases, gastrointestinal diseases, mental disorders and sleep problems are complicated," writes Dr. Jihua Chen, The Dental College of Georgia, Augusta, Georgia, and The Fourth Military Medical University, Xi'an, China, with coauthors. "There is evidence to support the bidirectional nature of the associations among these comorbidities, and patients may be stuck in a cycle in which undermined sleep, somatization and anxiety exacerbate the pain, with the pain also leading to sleep problems and mental disorders."
The authors suggest physicians need to be aware of the association and consider multidisciplinary management programs to help patients with TMD and chronic pain.
"Physicians and patients may overlook the association between chronic musculoskeletal disease and gastrointestinal symptoms," write the authors. "Patients with both chronic TMD and reflux symptoms may be underdiagnosed, resulting in deferred effective treatment and a prolonged disease course."
"Associations among gastroesophageal reflux disease, mental disorders, sleep and chronic temporomandibular disorder: a case-control study" is published August 19, 2019.

Remove false teeth before general anesthetic, doctors warn

False teeth need to be taken out before a general anaesthetic, doctors warn in the journal BMJ Case Reports after a 72 year old's dentures got stuck in his throat during surgery to remove a harmless lump in his abdominal wall, and weren't discovered for eight days.
Aside from experiencing considerable pain, bleeding, and swallowing difficulties, the oversight led to repeated hospital visits, additional invasive tests, blood transfusions, and eventually more surgery for the man.
The doctors describe how six days after abdominal surgery, the man turned up at A&E complaining of blood in the mouth and swallowing difficulties and pain, which had prevented him from eating solid food ever since.
Nothing in his test results prompted doctors to consider anything other than a respiratory infection and the side effects of having had a tube down his throat during his operation.He was therefore prescribed mouthwash, antibiotics and steroids, and sent home.
Two days later he returned with worsening symptoms. He had been unable to swallow any of the medicine he had been prescribed. He was admitted to hospital with suspected aspiration pneumonia--a severe chest infection usually caused by inhaling food or stomach acid or saliva into the lungs.
During this hospital stay, a diagnostic procedure to look at his throat and voice box revealed a semi-circular object lying across his vocal cords, which had clearly caused internal swelling and blistering.
When this was explained to him, the man revealed that his dentures, which consisted of a metal roof plate and three false teeth, had been lost during his previous hospital stay.
He then had emergency surgery to remove the dentures and was discharged after six days. But six days later a bout of bleeding prompted his return. As tests revealed the bleeding had stopped, he was sent home, only to reappear 10 days later with the same problem.
After a couple of days he was again discharged, but returned six days later because of further bleeding. Tests revealed that he had internal wound tissue around the site of the blistering which was cauterised to prevent further bleeding. Because he had lost so much blood, he also required a blood transfusion.
He was discharged after two days, but returned again nine days later with further bleeding, which required emergency surgery as the source of the bleed was a torn artery in the wound.
A check-up a week after this procedure showed that the tissue was healing well, and six weeks later he had not needed further emergency care and his blood count was back to normal.
The authors note that this isn't the first documented case of dentures being inhaled while anaesthetic is being infused.
"There are no set national guidelines on how dentures should be managed during anaesthesia, but it is known that leaving dentures in during bag-mask ventilation allows for a better seal during induction [when the anaesthetic is being infused], and therefore many hospitals allow dentures to be removed immediately before intubation [when a tube is inserted into the airway to assist breathing]," write the authors.
The presence of any false teeth or dental plates should be clearly documented before and after any surgical procedure, with all members of the surgical team made aware of what is to be done with them, they add.

New method of tooth repair? Scientists uncover mechanisms that could help dental treatment

Researchers from TU Dresden's Biotechnology Center teamed up with international scientists that led to the discovery of a new stem cell population in the front teeth of mice

Technische Universität Dresden

IMAGE: The image shows a group of mesenchymal (green) stem cells migrating in a tooth to further regenerate tissues. view more 

Credit: Source: Media and Communications | University of Plymouth

Stem cells hold the key for tissue engineering, as they develop into specialised cell types throughout the body including in teeth. An international team of researchers, including scientists from the Biotechnology Center of the TU Dresden (BIOTEC), has found a new mechanism that could offer a potential new solution to tooth repair. They discovered a new population of mesenchymal stromal cells in a continuously growing mouse incisor model. They have shown that these cells contribute to the formation of dentin, the hard tissue that covers the main body of a tooth. Importantly, the work showed that when these stem cells are activated, they send signals back to the mother cells of the tissue to control the number of cells produced, through a molecular gene called Dlk1. This study is the first to show that Dlk1 is vital for this process to work. In the same study, the researchers also demonstrated that Dlk1 can enhance stem cell activation and tissue regeneration in a wound healing model. This mechanism could provide an innovative solution for tooth repair, addressing problems such as tooth decay, crumbling and trauma treatment. Further studies are needed to validate the results for clinical applications to determine the appropriate duration and dose of treatment.
The study was led by Dr Bing Hu of the Peninsula Dental School of the University of Plymouth, UK. Co-authors were research group leader Dr. Denis Corbeil and his colleague Dr. Jana Karbanová from BIOTEC. "The discovery of this new population of stromal cells was very exciting and has enormous potential in regenerative medicine," says Dr. Denis Corbeil.

Visits to the dentist decline in old age, especially among minorities

Visits to the dentist drop significantly after adults turn 80, finds a new study by researchers at NYU Rory Meyers College of Nursing and the University of Hawai'i at Mānoa.
The study, published online in the journal Research on Aging, also highlights disparities in dental visits for U.S. adults by race and country of birth, with immigrants and racial and ethnic minorities less likely to access care.
Oral health is increasingly recognized as an essential part of healthy aging. It is closely related to overall health status and quality of life, and regular dental checkups can prevent oral diseases and maintain good oral health.
However, regularly seeing a dentist is a challenge for many Americans, especially older adults, racial and ethnic minorities, and immigrant populations. Older adults face barriers such as a lack of access to quality dental care, awareness of the importance of oral health, and dental insurance coverage. Medicare does not cover most dental care, and only 12 percent of Medicare beneficiaries report having at least some dental insurance from another source to help pay dental expenses. These roadblocks to dental care increase for racial and ethnic minorities and immigrants, who may experience racial discrimination and language barriers in healthcare settings.
"To promote oral health and close racial and ethnic gaps in oral health disparities, seeing a dentist regularly is critical," said Wei Zhang, PhD, professor and chair of the Department of Sociology at the University of Hawai'i at Mānoa and the study's first author. "Failure to engage in preventive dental care may lead to serious consequences such as tooth decay, pain, tooth loss, and inflammation."
In this study, the researchers examined how often people see a dentist as they age, focusing on U.S. adults 51 years and older, and explored variations by race and country of birth. While previous studies have looked at recent trends of dental care utilization among adults in the U.S., this study extends these efforts by using longitudinal data to focus on middle-aged and older adults across an extended period of time.
The researchers used data from the Health and Retirement Study (HRS), a longitudinal study from the University of Michigan that conducts interviews with a national sample of middle-aged and older adults. They analyzed rates of dental care utilization--measured by whether someone had seen a dentist in the past two years--for 20,488 study participants of different races and ethnicities, including 17,661 U.S.-born and 2,827 foreign-born individuals.
Seventy percent of adults had visited a dentist in the past two years, but this rate decreased significantly beginning around age 80. U.S.-born adults of all races and ethnicities were more likely to see a dentist (71 percent) than immigrants (62 percent). Interestingly, the gap in care between U.S.-born adults and immigrants shrunk as people aged, suggesting that age and acculturation may play a role in decreasing oral health disparities over time.
The researchers also found that White adults had higher rates of service utilization than Black and Hispanic adults, and while the rates of service utilization decreased with age for all groups, the rates of decline for Whites were slower than others.
"Our study went beyond prior research by confirming that racial and ethnic disparities were substantial and persistent as people became older, regardless of their birthplace and while adjusting for a wide range of factors. This finding is alarming as it indicates that some unmeasured factors beyond the scope of this study, such as oral health literacy, perception of need, barriers to access, and dissatisfaction with dental care, could play important roles in explaining the disparities in dental care as people age," said Bei Wu, PhD, Dean's Professor in Global Health at NYU Rory Meyers College of Nursing and co-director of the NYU Aging Incubator, as well as the study's senior author.

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The study's findings highlight the importance of identifying racial and ethnic barriers to dental care for aging adults and developing culturally competent programs to meet the dental needs of the increasingly diverse U.S. population.

Big Sugar and neglect by global health community fuel oral health crisis

Oral diseases present a major global public health burden, affecting 3.5 billion people worldwide, yet oral health has been largely ignored by the global health community, according to a new Lancet Series on Oral Health.

The Lancet

• Oral diseases present a major global public health burden, affecting 3.5 billion people worldwide, yet oral health has been largely ignored by the global health community, according to a new Lancet Series on Oral Health.
• With a treat-over-prevent model, modern dentistry has failed to combat the global challenge of oral diseases, giving rise to calls for the radical reform of dental care
• The burden of oral diseases is on course to rise as more people are exposed to the underlying risk factors of oral diseases, including sugar, tobacco and alcohol
• Emerging evidence of the food, beverage, and sugar industry's influence on dental research and professional bodies raises fresh concern

Oral health has been isolated from traditional healthcare and health policy for too long, despite the major global public health burden of oral diseases, according to a Lancet Series on Oral Health, published today in The Lancet. Failure of the global health community to prioritise the global burden of oral health has led to calls from Lancet Series authors for the radical reform of dental care, tightened regulation of the sugar industry, and greater transparency around conflict of interests in dental research.
Oral diseases, including tooth decay, gum disease and oral cancers, affect almost half of the global population, with untreated dental decay the most common health condition worldwide. Lip and oral cavity cancers are among the top 15 most common cancers in the world. In addition to lower quality of life, oral diseases have a major economic impact on both individuals and the wider health care system.
Accessing dental care continues to present the highest cost barrier compared to any other healthcare service in the United States (U.S.) and the highest dental expenditures globally were found for the U.S. ($129.1 billion). [1]
The Lancet Series on Oral Health led by University College London (UCL) researchers brought together 13 academic and clinical experts from 10 countries, including the US, to better understand why oral diseases have persisted globally over the last three decades, despite scientific advancements in the field, and why prevalence has increased in low- and middle- income countries (LMIC), and among socially disadvantaged and vulnerable people, no matter where they live. [2]
A tipping point for global oral health "Dentistry is in a state of crisis," said Professor Richard Watt, Chair and Honorary Consultant in Dental Public Health at UCL and lead author of the Series. "Current dental care and public health responses have been largely inadequate, inequitable, and costly, leaving billions of people without access to even basic oral health care. While this breakdown in the delivery of oral healthcare is not the fault of individual dental clinicians committed to caring for their patients, a fundamentally different approach is required to effectively tackle to the global burden of oral diseases." [3]
In high-income countries (HIC), dentistry is increasingly technology-focused and trapped in a treatment-over-prevention cycle, failing to tackle the underlying causes of oral diseases. Oral health conditions share many of the same underlying risk factors as non-communicable diseases, such as sugar consumption, tobacco use and harmful alcohol consumption.
Professor Robert J. Weyant, DMD, DrPH Professor and Chair, University of Pittsburgh, Department of Dental Public Health, said: "The U.S. continues to struggle with how to best ensure access to affordable dental care for many individuals. This has led to ongoing suffering for many with oral disease and significant disparities in oral health for vulnerable populations such as poor families, ethnic minorities, and the elderly. The Affordable Care Act helped to expand access to dental care for millions but many still remain unable receive needed care, highlighting an urgent need for improvements in dental health policy." [4]
In middle-income countries the burden of oral diseases is considerable, but oral care systems are often underdeveloped and unaffordable to the majority. In low-income countries the current situation is most bleak, with even basic dental care unavailable and most disease remaining untreated.
Coverage for oral health care in LMIC is vastly lower than in HIC with median estimations ranging from 35% in low-, 60% in lower-middle, 75% in upper middle, and 82% in high income countries.
Sugar, alcohol and tobacco industries fuel global burden The burden of oral diseases is on course to rise, as more people are exposed to the main risk factors of oral diseases. Sugar consumption, the underlying cause of tooth decay, is rising rapidly across many LMIC. While sugary drinks consumption is highest in HIC, the growth in sales of sugary drinks in many LMIC is substantial. By 2020, Coca-Cola intend to spend US$12 billion on marketing their products across Africa [5] in contrast to WHO's total annual budget of $4.4 billion (2017).
"The use of clinical preventive interventions such as topical fluorides to control tooth decay is proven to be highly effective, yet because it is seen as a 'panacea', it can lead to many losing sight of the fact that sugar consumption remains the primary cause of disease development." said Watt. "We need tighter regulation and legislation to restrict marketing and influence of the sugar, tobacco and alcohol industries, if we are to tackle the root causes of oral conditions."
Writing in a linked commentary, Cristin E Kearns of the University of California and Lisa A Bero of the University of Sydney raise additional concerns with the financial links between dental research organisations and the industries responsible for many of these risk factors.
"Emerging evidence of industry influence on research agendas contributes to the plausibility that major food and beverage brands could view financial relationships with dental research organisations as an opportunity to ensure a focus on commercial applications for dental caries interventions--eg, xylitol, oral hygiene instruction, fluoridated toothpaste, and sugar-free chewing gum--while deflecting attention from harm caused by their sugary products."
Lancet Series authors argue a pressing need exists to develop clearer and more transparent conflict of interest policies and procedures, and to restrict and clarify the influence of the sugar industry on dental research and oral health policy.
Radical reform of dentistry needed Lancet Series authors have called for wholesale reform of the dental care model in five key areas:

1. Close the divide between dental and general healthcare 2. Educate and train the future dental workforce with an emphasis on prevention
3. Tackle oral health inequalities through a focus on inclusivity and accessibility
4. Take a stronger policy approach to address the underlying causes of oral diseases
5. Redefine the oral health research agenda to address gaps in LMIC knowledge

Dr Jocalyn Clark, an Executive Editor at The Lancet, said: "Dentistry is rarely thought of as a mainstream part of healthcare practice and policy, despite the centrality of the mouth and oral cavity to people's well-being and identity. A clear need exists for broader accessibility and integration of dental services into healthcare systems, especially primary care, and for oral health to have more prominence within universal health coverage commitments. Everyone who cares about global health should advocate to end the neglect of oral health."
APPENDIX OF KEY FACTS & STATISTICS Oral disease: types and causes

• The key oral health conditions include: dental caries (tooth decay) [localised destruction of dental hard tissues (enamel and dentine) by acidic by-products from the bacterial fermentation of free sugars]; periodontal (gum) disease [chronic inflammatory conditions that affect the tissues surrounding and supporting the teeth]; and oral cancer [squamous cell carcinoma is the most common type of oral cancer].
• The main cause of periodontal disease is poor oral hygiene leading to an accumulation of pathogenic microbial biofilm (plaque) at and below the gingival margin. Tobacco use is also an important independent risk factor for periodontal disease.
• The major risk factors for oral cancers are tobacco use, alcohol consumption, and areca nut (betel quid) chewing. In many high-income countries (HIC), human papilloma virus (HPV) infection is responsible for a steep rise in the incidence of oropharyngeal cancers among young people.
• Oral diseases can lower quality of life in many ways, including pain, infections, problems with eating and speaking, diminished confidence, and disruption to social, work, and school activities.

The global burden of oral disease

• The most recent data from 2015 confirm that untreated caries in the permanent dentition remain the most common health condition globally (34·1%).
• A 4% decrease in the number of prevalent cases of untreated dental caries occurred globally from 1990 (31,407 cases per 100 000) to 2017 (30,129 cases per 100 000).
• The global burden of untreated dental caries for primary and permanent dentition has remained relatively unchanged over the past 30 years.
• Epidemiological evidence indicates that lifetime prevalence of dental caries has decreased in the past four decades, but this is mainly in HIC, with the most substantial decrease seen in 12-year-old children.
• Data from 2018 show that oral cancer has the highest incidence among all cancers in Melanesia and south Asia among males, and is the leading cause of cancer-related mortality among males in India and Sri Lanka.

Inequalities in oral disease

• Case-control studies showed a consistent association between low socioeconomic status and oral cancer in both LMIC and HIC, even after adjustment for behavioural confounders.
• Extreme oral health inequalities exist for the most marginalised and socially excluded groups in societies, such as homeless people, prisoners, those with long term disabilities, refugees, and indigenous groups, which serves as a classic example of a so-called cliff edge of inequality
• Indigenous children, even in HIC (Australia, Canada, New Zealand, and USA), are particularly vulnerable, with the prevalence of early childhood caries ranging from 68% to 90%.

Prevention

• WHO recommends that free sugars intake should be restricted to less than 10% of total energy highlighting that for further benefits, restriction in sugar consumption should be now more than 5% of total energy; however, many countries do not meet these guidelines.
• While topical fluorides are proven clinical preventive agents, caries will still develop in the presence of free sugars above 10% of total energy intake. Even where exposure to fluoride is optimal, evidence suggests that free sugars exposure as low as of total energy may still carry a risk of caries.

Commentary: Sugar industry ties to professional dental organizations must be addressed

Oral diseases, such as tooth decay, gum disease and oral cancers, are a major health burden affecting 3.5 billion people worldwide, but are largely ignored by the global health community, according to a series on oral health in Oral diseases, such as tooth decay, gum disease and oral cancers, are a major health burden affecting 3.5 billion people worldwide, but are largely ignored by the global health community, according to a series on oral health in The Lancet that publishes July 20, 2019.
In a commentary accompanying the series, Cristin Kearns, DDS, MBA, of UCSF, and Lisa Bero, PhD, of the University of Sydney, express growing concern that the dental profession will not make meaningful progress in combatting the oral health epidemic until it addresses the sugar industry's influence on dental research and professional bodies.
"Dental research organizations have only recently woken up to the fact that their research activities haven't focused on sugars for many years, and very few people realize that these organizations have financial relationships with global candy, ice cream, sugary beverage and snack companies," said Kearns, an assistant professor in the UCSF School of Dentistry and Philip R. Lee Institute for Health Policy Studies. "While these relationships may be slightly less shocking when one considers these companies also sell oral health products, we can't lose sight of the fact that in many cases, these are the same companies that are opposing sugar reduction policies, such as sugary beverage taxes."
The commentary lists the corporate members of the European Organisation for Caries Research (ORCA), which include Cloetta, a Nordic confectionary company; Unilever, a global consumer goods company selling ice cream and sugary beverages; and Mars Wrigley Confectionary, a leader in production of chewing gum, chocolate mints and fruity confections. International Association for Dental Research (IADR) corporate members include Unilever and Mondel?z International, one of the world's largest snack companies.
The authors note that industry funding presents a conflict of interest (COI) and a risk of bias in how research is designed, conducted and published. It can drive research agendas away from studying product harms or towards topics that may distract from these harms, such as dental caries interventions with commercial applications (e.g., xylitol, oral hygiene instruction, fluoridated toothpaste and sugar-free chewing gum), rather than prevention.
"Dental research organizations have made inconsistent progress towards the disclosure and management of COI," wrote Kearns and Bero, who also is a prominent researcher in the field of pharmaceutical COI. "The extent of undisclosed financial ties with the sugary food and beverage industry is uncertain because existing transparency databases focus mainly on pharmaceutical industry payments. Furthermore, disclosure alone does not manage COI."
The authors advise adding dentistry to the key recommendations spelled out in a 2009 report by the U.S. Institute of Medicine (now National Academy of Medicine) on conflicts of interest in medical research, education, and practice for pharmaceutical, medical device and biotechnology companies.
To specifically manage financial conflicts within the sugary food and beverage industry, Kearns and Bero recommend dental research organizations take the following actions:

Adopt COI policies consistent with the 2009 Institute of Medicine Report for the organization and any related entities (e.g., dental journals). Publicly report industry payments to dentists, researchers, health care institutions, professional societies and continuing dental education providers.
Bar researchers with a COI from doing research with human participants, except when the investigators' expertise is essential to the safe and rigorous conduct of the research.
Prohibit or end relationships with industry that present unacceptable risks of undue influence over professional decision-making or a loss of public trust.
Reduce industry influence in the development of clinical practice guidelines by requiring the majority of guideline committee members and committee chair be free of financial COI.
Establish policies at the board level to identify, limit and manage institution-level COI.
Develop incentives to promote the institutional adoption and implementation of policies recommended by the Institute of Medicine report for medical research, education and practice.

The Lancet Oral Health Series includes two papers and two commentaries from 13 academic researchers from 10 countries. The series provides an analysis of the health and economic burdens of dental decay, which disproportionately affect low- and middle-income countries, and issues a call for action on oral health within the global agendas for non-communicable diseases and universal health coverage.
The two Lancet studies, on which Kearns is also a co-author, advocate for widespread dental reform. The researchers encourage closing the divide between dental and general health care; educating and training the future dental workforce to focus on prevention; tackling oral health inequalities through inclusivity and accessibility; strengthening policy to address the underlying causes of oral diseases; and redefining the oral health research agenda to address knowledge gaps in lower- and middle-income countries.
Untreated dental decay is the most common health condition worldwide, and lip and oral cavity cancers are among the top 15 most common cancers. Sugar consumption, the underlying cause of tooth decay and a common risk factor for obesity and associated diseases, is rising rapidly across many low- and middle-income countries. The papers emphasize that prevention of tooth decay requires global implementation of the World Health Organization's guideline recommending individuals consume less than 10 percent of total energy from free sugars, preferably below 5 percent.