Anti-inflammatory drugs commonly taken by children can cause alterations to dental enamel, study shows

The authors investigated the effects of celecoxib and indomethacin, non-steroidal anti-inflammatory drugs (NSAIDs) classified by the World Health Organization (WHO) as the first step on the analgesic ladder, alongside paracetamol.

Peer-Reviewed Publication

FUNDAÇÃO DE AMPARO À PESQUISA DO ESTADO DE SÃO PAULO

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A study conducted at the University of São Paulo (USP) in Brazil and described in an article published in the journal Scientific Reports shows that anti-inflammatory drugs commonly taken by children may be associated with dental enamel defects (DEDs), currently seen in about 20% of children worldwide.

The authors, who are affiliated with the Ribeirão Preto Dental School (FORP-USP) and School of Pharmaceutical Sciences (FCFRP-USP), investigated the effects of celecoxib and indomethacin, non-steroidal anti-inflammatory drugs (NSAIDs) classified by the World Health Organization (WHO) as the first step on the analgesic ladder, alongside paracetamol.

In recent years, dentists at FORP-USP’s Dental Enamel Clinic, who research and deal with the problem on a daily basis, have observed a sharp rise in the number of children seeking treatment for pain, white or yellow tooth spots, and dental sensitivity and fragility. In some cases, simple chewing can fracture the children’s teeth. All these are classical symptoms of DEDs of the type known as enamel hypomineralization, whose causes are poorly understood.

As a result of this disorder, dental decay in the form of carious lesions appears sooner and more frequently in these patients, whose restorations are less adhesive and tend to fail more. Studies have shown they may have to replace restorations ten times more often over a lifetime than people with healthy teeth.

A coincidence aroused the researchers’ curiosity most of all: the patients’ ages. The first years of life, when DEDs form, are a period in which sickness is frequent, often with high fever. “These diseases are typically treated with NSAIDs, which inhibit the activity of cyclooxygenase [COX, a key inflammatory enzyme] and reduce production of prostaglandin [which also promotes inflammation],” said Francisco de Paula-Silva, a professor in FORP-USP’s Pediatric Department and last author of the article. “However, COX and prostaglandin are known to be physiological for dental enamel, and we therefore wondered whether these drugs interfered in the normal formation of this structure.”

The study was supported by FAPESP via three projects (10/17611-4, 14/07125-6 and 21/09272-0). 

The researchers used rats to study the problem, as these animals have incisors that grow continuously, which facilitates analysis. The rats were treated with celecoxib and indomethacin for 28 days, after which practically no differences were visible to the naked eye in their teeth. However, when the researchers began extracting, they found that the teeth fractured more easily.

Analysis based on imaging and chemical composition suggested that dental mineralization had been affected. The teeth contained below-normal levels of calcium and phosphate, which are important to dental enamel formation, and mineral density was low. 

When the researchers looked for the reasons for this, they found alterations in proteins required for mineralization and cellular differentiation, showing that the drugs had indeed affected the composition of the dental enamel. 

Next steps

“Right now, the study at least offers us a clue to the identity of a new player that may be involved in the development of DEDs. Hitherto we’ve been totally in the dark,” said Paula-Silva. “We only achieved these important findings thanks to the efforts of FORP-USP’s Dental Enamel Clinic and collaboration with Lúcia Helena Faccioli, a professor at FCFRP-USP. She made a crucial contribution to our understanding of the role played by lipidic mediators related to inflammatory diseases that affect teeth.”

The group plan to conduct a clinical study with the aim of confirming the results of the research in the animal model. “We’re going to analyze the medical history of the children with DEDs and their use of these drugs, and we’ll set up a clinical study that will correlate the two datasets to see if the same thing happens to humans. If so, we can make recommendations on which drugs shouldn’t be used for which patients. We can also help work out an appropriate treatment protocol in future,” said Paula-Silva, comparing this situation with that of tetracycline, an antibiotic not recommended for children because it causes tooth discoloration.

Another important point to be addressed is indiscriminate use of over-the-counter drugs, a problem that appears to have worsened as pediatric care has become more common, although concrete information on this is not yet available. 

Study identifies potential link between oral bacteria and brain abscesses

Peer-Reviewed Publication

UNIVERSITY OF PLYMOUTH

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Bacteria known to cause oral infections may also be a contributory factor in patients developing potentially life-threatening abscesses on the brain, new research has shown.

The study, published in the Journal of Dentistry, investigated brain abscesses and their association with bacteria that occur in the oral cavity. While this type of abscess is relatively uncommon, it can result in significant mortality and morbidity.

Researchers examined the records of 87 patients admitted to hospital with brain abscesses, and used microbiological data obtained from abscess sampling and peripheral cultures.

This allowed them to investigate the presence of oral bacteria in patients’ brain abscesses where a cause of the abscess had either been found, as was the case in just 35 patients, or not found.

Their results showed that the 52 patients where no cause had been found were about three times as likely to have oral bacteria present in their samples.

Those patients also carried significantly higher counts of Streptococcus anginosus, a bacteria that can lead to pharyngitis, bacteremia, and infections in internal organs such as the brain, lung, and liver. This bacteria is often found in dental abscesses.

Writing in the study, researchers say the findings suggest that the oral cavity could be considered a source of infection in cases of brain abscess where no clear cause has been identified.

The research was led by the University of Plymouth and University Hospitals Plymouth NHS Trust.

Dr Holly Roy, an NIHR Clinical Lecturer in Neurosurgery based at the University of Plymouth and University Hospitals Plymouth NHS Trust, is the study’s lead author.

She said: “While many potential causes of brain abscesses are recognised, the origin of infection often remains clinically unidentified. However, it was still surprising to frequently find orally occurring bacteria in brain abscesses of unexplained origin. It highlights the importance of using more sensitive techniques to assess the oral cavity as a potential bacterial source in brain abscess patients. It also highlights the importance of improving dental care and oral hygiene more generally.”

The study forms part of ongoing research taking place within the University’s Oral Microbiome Research Group, led by Dr Raul Bescos and Dr Zoe Brookes, to explore the links between the oral microbiome and a range of cardiovascular and neurological conditions.

Other clinical trials are underway investigating the links between gum health and Alzheimer’s disease and identifying patients under high cardiovascular risk in primary care dental clinics, as an altered balance of oral bacteria (microbiome) during gum disease can lead to high blood pressure and strokes.

These clinical studies are being carried out in primary care dental facilities run by Peninsula Dental Social Enterprise, where the focus of the research is very much on improving clinical outcomes for patients.

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JOURNAL

Journal of Dentistry

DOI

10.1016/j.jdent.2022.104366 

Tooth decay: New study explores the impact of increasing dental health programs in middle schools

 

Kennesaw State University researcher Christina Scherrer’s studies on school-based dental health programs have shown how effective they can be in reducing tooth decay in elementary-aged children. Now, through a grant from the National Institutes of Health (NIH), Scherrer is expanding her research to see if similar programs can also help children in middle school.

“Dental problems are a significant contributor to children being out of school for pain and discomfort,” said Scherrer, professor and department chair of industrial and systems engineering in the Southern Polytechnic College of Engineering and Engineering Technology. “Data also shows that children who do not receive good oral healthcare can have diminished health later in life.”

According to Scherrer, who is working with Shillpa Naavaal, associate professor in Virginia Commonwealth University’s School of Dentistry, school-based dental programs are important, especially in low-income areas where parents may not have the means to take their children to a dentist. The researchers will use the more than $400,000 NIH grant to survey school sealant program directors and state oral health directors around the United States to determine how they are using school-based sealant programs and then dive into data on children’s teeth.

“We know sealants work, and we know that school-based sealant programs work,” Scherrer said. “However, most of these programs are in elementary schools and what we don’t know is how it looks different in a middle school. Our hypothesis is that perhaps children’s first molars are in better shape because they’re more likely to get sealed in these school-based programs and the second molars, those that typically come in between the ages of 11 and 13, are not.”

Scherrer and Naavaal will use data from the Centers for Disease Control and Prevention (CDC), which details children’s teeth including those that have sealants, have decay, and that are missing, in addition to demographic data. Once the research team has analyzed the CDC data and survey results, they will build a simulation model to see what the likely benefit would be of increasing school-based sealant programs for middle schoolers.  

Once the simulation model is built, the team will be able to estimate the impact of increasing the number of middle-school-based sealant programs on children’s teeth. If their results support the belief that more school-based sealant programs will improve children’s oral health in a cost-effective way, the goal is to apply for funding to help implement more programs.

“Dr. Scherrer continues to impress us with her community-focused and impactful research,” said KSU's Engineering College Dean Ian Ferguson. “It is an incredible honor to receive three NIH grants within the past year. It is clear that she and her research teams are making a difference in children’s lives. We look forward to continuing to follow her projects over the next several years.”

Earlier this year, Scherrer started work on her first NIH grant for a project aimed at assessing and reducing barriers associated with primary care doctors applying fluoride varnish on children’s teeth. She has been researching children’s oral health for more than a decade.

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Medicare coverage of medically necessary oral and dental health therapies in physician fee schedule

The Gerontological Society of America (GSA) — the nation’s largest interdisciplinary organization devoted to the field of aging — commends the Biden-Harris Administration for finalizing regulatory policy that will have a direct and meaningful impact in the lives of many Medicare beneficiaries. The Medicare program is taking an important step towards much-needed coverage of medically necessary oral and dental care.

Specifically, the final Physician Fee Schedule for 2023 codifies Medicare coverage for dental services that are inextricably linked and substantially related and integral to organ transplant surgery, cardiac valve replacement, valvuloplasty procedures, and head and neck cancers. The final rule also creates the opportunity for further coverage expansion by establishing “a process to identify for [the Medicare program’s] consideration and review submissions of additional dental services that are inextricably linked and substantially related and integral to the clinical success of other covered medical services.” Finally, the rule codifies Medicare coverage for the wiring of teeth related to covered medical services, the reduction of jaw fractures, the extraction of teeth in preparation for radiation treatment of neoplastic disease, dental splints for covered treatment of certain medical conditions, and oral or dental examinations relating to renal transplant surgery.

GSA members contribute to the evidence base as it relates to the importance of oral health as an essential element of healthy aging. The Society has a long-standing commitment to oral health, which includes multiple collaborations over several years. Guided by its Oral Health Workgroup, GSA works to increase awareness of appropriate oral care and strengthen the impact that all members of health care and caregiver teams have to ensure good oral care for older people. Additionally, GSA’s Oral Health Interest Group is an interdisciplinary network that provides an active opportunity for persons interested in the issue of oral health to meet and exchange information and resources.

Starting in 2016, GSA has developed and actively disseminated several relevant publications. Among them are a white paper from an interprofessional convening that included more than 20 national aging and oral health organizations titled “Interprofessional Solutions for Improving Oral Health in Older Adults: Addressing Access Barriers, Creating Oral Health Champions,” and two issues of GSA’s What’s Hot newsletter, “Oral Health: An Essential Element of Healthy Aging” in 2017 and “Interrelationships Between Nutrition and Oral Health in Older Adults” in 2020.

GSA has been a strong advocate for the inclusion of coverage of medically necessary oral and dental care in Medicare and has worked as a member of the Consortium for Medically Necessary Oral Health Coverage to advocate for Medicare coverage of medically necessary oral and dental treatment. GSA has joined roughly 240 colleagues in signing the consortium’s Community Statement to urge Congress and the Administration to explore options for extending evidence-based coverage to all Medicare beneficiaries. As a member of the consortium, GSA will now turn to the important process of expanding coverage of medically necessary oral and dental services to all medical conditions for which such services are documented to be of clinical, fiscal, and human value.

GSA thanks the administration for recognizing these facts and taking this important step to extend Medicare coverage to dental services that are integral to the delivery of covered medical services. By broadening coverage of medically necessary dental services and opening an important opportunity for stakeholders to suggest clinical scenarios to which medically necessary oral and dental services should be extended in the future, the Physician Fee Schedule makes meaningful progress to improve the clinical success of covered medical services.

Study finds no adverse effects of early fluoride exposure on childhood development

An Australian nation-wide population-based follow-up study published in the Journal of Dental Research (JDR) has provided evidence that exposure to fluoridated water by young children was not negatively associated with child emotional, behavioral development and executive functioning in their adolescent years.

The study by Professor Loc Do of the University of Queensland Faculty of Health and Behavioural Sciences, School of Dentistry and colleagues examined the effect of early childhood exposures to water fluoridation on measures of school-age executive functioning and emotional and behavioral development in a population-based sample. This longitudinal follow-up study used information from Australia’s National Child Oral Health Study of 2012-14. Children aged 5-10 years at the baseline were contacted again after 7–8 years, before they had turned 18 years of age.  

Percent lifetime exposed to fluoridated water (%LEFW) from birth to the age of five years was estimated from residential history and postcode-level fluoride levels in public tap water. Measures of children’s emotional and behavioral development were assessed by the Strength and Difficulties Questionnaire (SDQ), and executive functioning was measured by the Behavior Inventory of Executive Functioning (BRIEF). Multivariable regression models were generated to compare the associations between the exposure and the primary outcomes, controlled for covariates. An equivalence test was also conducted to compare the primary outcomes of those who had 100%LEFW against those with 0%LEFW.  

Sensitivity analysis was also conducted. A total of 2,682 children completed SDQ and BRIEF, with mean scores of 7.0 (95%CI: 6.6, 7.4) and 45.3 (44.7, 45.8), respectively. Those with lower %LEFW tended to have poorer scores on the SDQ and BRIEF. Multivariable regression models reported no association between exposure to fluoridated water and the SDQ and BRIEF scores. Low household income, identifying as Indigenous, and having a neurodevelopmental diagnosis were associated with poorer SDQ/BRIEF scores.

 The study concluded that exposure to fluoridated water during the first five years of life was not associated with altered measures of child emotional and behavioral development and executive functioning. Children who had been exposed to fluoridated water for their whole early childhood had their measures of emotional, behavioral development and executive functioning at least equivalent to that of children who had no exposure to fluoridated water.

 “Water fluoridation is unquestionably effective in preventing dental caries, and this study is an important addition to the body of literature documenting the safety of water fluoridation,” said IADR President Brian O’Connell, Dean of the Faculty of Health Sciences, Trinity College Dublin, Ireland. “The IADR recently reaffirmed its support for water fluoridation as this public health measure has a high benefit/cost ratio and benefits deprived communities the most, thus reducing health inequalities.”  

Diabetes and oral diseases affect each other and hinder treatment

Research shows that common chronic diseases and problems associated with oral health have a detrimental and long-term reciprocal effect on each other. To achieve the best possible treatment outcomes, the general and oral health of patients should be considered as a whole.

In a study conducted at the University of Helsinki, the predictive value of oral health for the onset of various chronic diseases was investigated through a 10-year follow-up. A key finding was that periodontitis (a disease of the connective tissue of teeth) has a particular link with diabetes.

“We know from prior studies that periodontitis has a connection to many chronic diseases. Thanks to our exceptionally long-term dataset, we were able to analyse causalities and bidirectional effects between these factors,” says University Lecturer Pia Heikkilä.

“The research dataset was unusually extensive, encompassing some 70,000 study subjects, which increases the reliability and weight of the study,” she adds. 

The results of the study show that periodontitis, a common disease of public health importance in Finland, and apical periodontitis, inflammation of the apex of the tooth root, are associated with common metabolic diseases, such as metabolic syndrome, type 1 and 2 diabetes, and gestational diabetes, which require treatment. 

No similar association with other common chronic diseases, such as connective tissue diseases, rheumatoid arthritis, inflammatory intestinal diseases or serious mental diseases, was observed in the study.

The results have been published in the scholarly Frontiers in Oral Health journal.

A two-way effect – Severalfold costs

Based on the findings, a two-way effect exists between diabetes and other metabolic diseases, and periodontitis. Diabetes accelerates the progression of periodontitis and complicates its diagnosis and treatment, especially if diabetes has not been diagnosed or the disease is poorly controlled. 

Correspondingly, incipient or latent periodontitis makes diabetes chronic as well as hinders its diagnosis, control and maintenance therapy. 

The mutual effect of these diseases also results in increased costs, significant both in terms of public health and the economy.

“Based on our findings, successful treatment of periodontitis has a positive effect on the treatment outcomes for diabetes and reduces the cost of care. Similarly, the successful treatment of diabetes slows down the progression of periodontitis while reducing medical costs,” Professor Timo Sorsa notes. 

Health is the sum of several parts

The researchers estimate that more such bidirectional effects between diseases are likely to be identified in the future.

“The general and oral health of patients should be considered as a whole in healthcare, as our research demonstrates that even latent diseases have a harmful and long-term effect on one another,” Sorsa stresses.

“Hopefully, the training of professionals in the field and the healthcare service system in line with the health and social services reform in Finland will enable the collaboration needed for this. It’s in the interest of patients and taxpayers,” he concludes. 

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JOURNAL

Frontiers in Oral Health

DOI

10.3389/froh.2022.956072 

Gel treats gum disease by fighting inflammation

 

IMAGE: A TOPICAL GEL THAT BLOCKS THE RECEPTOR FOR A METABOLIC BYPRODUCT CALLED SUCCINATE TREATS GUM DISEASE BY SUPPRESSING INFLAMMATION AND CHANGING THE MAKEUP OF BACTERIA IN THE MOUTH. view more 

CREDIT: YUQI GUO

A topical gel that blocks the receptor for a metabolic byproduct called succinate treats gum disease by suppressing inflammation and changing the makeup of bacteria in the mouth, according to a new study led by researchers at NYU College of Dentistry and published in Cell Reports.

 

The research, conducted in mice and using human cells and plaque samples, lays the groundwork for a non-invasive treatment for gum disease that people could apply to the gums at home to prevent or treat gum disease.

 

Gum disease (also known as periodontitis or periodontal disease) is one of the most prevalent inflammatory diseases, affecting nearly half of adults 30 and older. It is marked by three components: inflammation, an imbalance of unhealthy and healthy bacteria in the mouth, and destruction of the bones and structures that support the teeth. Uncontrolled gum disease can lead to painful and bleeding gums, difficulty chewing, and tooth loss. 

 

“No current treatment for gum disease simultaneously reduces inflammation, limits disruption to the oral microbiome, and prevents bone loss. There is an urgent public health need for more targeted and effective treatments for this common disease,” said Yuqi Guo, an associate research scientist in the Department of Molecular Pathobiology at NYU Dentistry and the study’s co-first author.

 

Past research has linked increased succinate—a molecule produced during metabolism—to gum disease, with higher succinate levels associated with higher levels of inflammation. Guo and her colleagues at NYU Dentistry also discovered in 2017 that elevated levels of succinate activate the succinate receptor and stimulate bone loss. These findings made the succinate receptor an appealing target for countering inflammation and bone loss—and potentially stopping gum disease in its tracks. 

 

Strengthening the link between succinate and gum disease

The researchers started by examining dental plaque samples from humans and blood samples from mice. Using metabolomic analyses, they found higher succinate levels in people and mice with gum disease compared to those with healthy gums, confirming what previous studies have found. 

 

They also saw that the succinate receptor was expressed in human and mouse gums. To test the connection between the succinate receptor and the components of gum disease, they genetically altered mice to inactivate, or “knock out,” the succinate receptor. 

 

In “knockout” mice with gum disease, the researchers measured lower levels of inflammation in both the gum tissue and blood, as well as less bone loss. They also found different bacteria in their mouths: mice with gum disease had a greater imbalance of bacteria than did “knockout” mice.

 

This held true when the researchers administered extra succinate to both types of mice, which worsened gum disease in normal mice; however, “knockout” mice were protected against inflammation, increases in unhealthy bacteria, and bone loss.

 

“Mice without active succinate receptors were more resilient to disease,” said Fangxi Xu, an assistant research scientist in the Department of Molecular Pathobiology at NYU Dentistry and the study’s co-first author. “While we already knew that there was some connection between succinate and gum disease, we now have stronger evidence that elevated succinate and the succinate receptor are major drivers of the disease.”

 

A novel treatment

To see if blocking the succinate receptor could ameliorate gum disease, the researchers developed a gel formulation of a small compound that targets the succinate receptor and prevents it from being activated. In laboratory studies of human gum cells, the compound reduced inflammation and processes that lead to bone loss. 

 

The compound was then applied as a topical gel to the gums of mice with gum disease, which reduced local and systemic inflammation and bone loss in a matter of days. In one test, the researchers applied the gel to the gums of mice with gum disease every other day for four weeks, which cut their bone loss in half compared to mice who did not receive the gel.

 

Mice treated with the gel also had significant changes to the community of bacteria in their mouths. Notably, bacteria in the Bacteroidetes family—which include pathogens that are known to be dominant in gum disease—were depleted in those treated with the gel.

 

“We conducted additional tests to see if the compound itself acted as an antibiotic, and found that it does not directly affect the growth of bacteria. This suggests that the gel changes the community of bacteria through regulating inflammation,” said Deepak Saxena, professor of molecular pathobiology at NYU Dentistry and the study’s co-senior author. 

 

The researchers are continuing to study the gel in animal models to find the appropriate dosage and timing for application, as well as determine any toxicity. Their long-term goal is to develop a gel and oral strip that can be used at home by people with or at risk for gum disease, as well as a stronger, slow-release formulation that dentists can apply to pockets that form in the gums during gum disease. 

 

“Current treatments for severe gum disease can be invasive and painful. In the case of antibiotics, which may help temporarily, they kill both good and bad bacteria, disrupting the oral microbiome. This new compound that blocks the succinate receptor has clear therapeutic value for treating gum disease using more targeted and convenient processes,” said Xin Li, professor of molecular pathobiology at NYU Dentistry and the study’s lead author.  

 

Improved mineralized material can restore tooth enamel

 

 

IMAGE: SCIENTISTS TESTED THE EFFECTIVENESS OF THE NEW ENAMEL COATING ON REAL HEALTHY TEETH. view more 

CREDIT: ANASTASIA KURSHPEL / URFU

Scientists have perfected hydroxyapatite, a material for mineralizing bones and teeth. By adding a complex of amino acids to hydroxyapatite, they were able to form a dental coating that replicates the composition and microstructure of natural enamel. Improved composition of the material repeats the features of the surface of the tooth at the molecular and structural level, and in terms of strength surpasses the natural tissue. The new method of dental restoration can be used to reduce the sensitivity of teeth in case of abrasion of enamel or to restore it after erosion or improper diet. The study and experimental results are published in Results in Engineering.

"Tooth enamel has a protective function, but unfortunately, its integrity can be destroyed by, for example, abrasion, erosion or microfractures. If the surface of the tissue is not repaired in time, the enamel lesion will affect the dentin and then the pulp of the tooth. Therefore, it is necessary to restore the enamel surface to a healthy level or build up additional layers on the surface if it has become very thin. We have created a biomimetic (i.e., mimicking natural) mineralized layer whose nanocrystals replicate the ordering of apatite nanocrystals of tooth enamel. We also found out that the designed layer of hydroxyapatite has increased nanohardness that exceeds that of native enamel," says Pavel Seredin, Leading Specialist at UrFU Center "Nanomaterials and Nanotechnologies", Head of the Department of Solid State Physics and Nanostructures at Voronezh State University.

Hydroxyapatite is a compound that is a major component of human bones and teeth. Scientists selected a complex of polyfunctional organic and polar amino acids, including, for example, lysine, arginine, and histidine, which are important for the formation and repair of bone and muscle structures. The chosen amino acids made it possible to obtain hydroxyapatite, which is morphologically completely similar to apatite (the main component of tissues) of dental enamel. The researchers also described the conditions of the environment in which the processes of binding of hydroxyapatite to the dental tissue should occur. Only if these conditions are met it is possible to fully reproduce the structure of natural enamel.

"Traditionally in dentistry, composite restorative materials are used in enamel restoration. To increase the bonding efficiency of enamel and composite, the restoration technique involves acid etching of the enamel beforehand. The etching products left behind may not always have a positive effect on the bonding of enamel and synthetic materials. To reproduce the enamel layers with biomimetic techniques, we neutralized the media and removed the etching products using calcium alkali. In this way we improved the binding of the new hydroxyapatite layers," explains Pavel Seredin.

The formation of a mineralized layer with properties resembling those of natural hard tissue was confirmed by field emission electron and atomic force microscopy as well as by chemical imaging of surface areas using Raman microspectroscopy. The study was conducted on healthy teeth to eliminate the influence of extraneous factors on the resulting layer and to be able to compare the results with healthy teeth. Next, the researchers will tackle the challenge of repairing larger defects, which can be of varying nature from the initial stages of caries to cracks and volumetric fractures.

The joint research was conducted by scientists from the Research and Education Center "Nanomaterials and Nanotechnologies" of Ural Federal University, Voronezh State University, Voronezh State Medical University, Al-Azhar University, and the National Research Center (Egypt).

Reference

Tooth enamel consists mainly of an inorganic substance (biological apatite, about 95% by weight), an organic component (collagen fibers, 1-1.5%) and water (4%). Dental composite materials do not have the ability to bind physically and chemically to the dental tissues on their own. Therefore, additional materials must be used to create a strong bond between the composite and the tooth tissue. To increase the bonding effectiveness of enamel and composite, dental restoration technique involves acidic enamel pretreatment with a liquid or gel based on phosphoric acid (10-37%) or maleic acid (10%).

Hydroxyapatite is the main inorganic component of bone tissue, mineralized tissues of humans and animals, due to which it is widely used in various fields of medicine such as cosmetology, orthopedics, dentistry. Hydroxyapatite produced chemically, with the participation of a secondary source of calcium that is the egg shells of birds on the microelement composition, structure and size factor is similar to the apatite of dental enamel. This method of synthesizing hydroxyapatite is easy to use and economically feasible.

People who receive periodontal care have better outcomes after heart attack

The conventional wisdom is that medical and dental care are related, but less is known about how dental care relates to health outcomes after acute incidents like heart attacks.

 

To that end, University of Michigan researchers studied patients receiving periodontal care, dental cleanings or no dental care during 2016-2018 and who had acute myocardial infarction (heart attack) in 2017. 

 

They found that patients who had heart attacks and received periodontal maintenance care had the shortest length of stay in the hospital, and more follow-up visits. The longest length of stay was experienced by the no-dental-care group. 

 

"After controlling for several factors, the periodontal care group had higher odds of having post-hospital visits," said study co-author Romesh Nalliah, associate dean for patient services at the U-M School of Dentistry.  

 

There was no statistically significant difference between the other groups (active periodontal care and regular care) compared to the no-care group. 

 

The study, published in the Journal of the American Dental Association, did not establish a causal relationship between periodontal disease and heart disease, but research like this adds weight to the understanding that there is an association between oral health and overall health, Nalliah said.

 

There are 800,000 myocardial infarctions in the United States annually, and those with periodontal disease are at increased risk for hospitalization after a heart attack, he said. 

 

Nalliah and colleagues wanted to examine the association between periodontal care and heart attack hospitalization, and follow-up visits in the 30 days after acute care. Using the MarketScan database, they found 2,370 patients who fit the study criteria. Of those, 47% percent received regular or other oral health care, 7% received active periodontal care (root planing and periodontal scaling) and 10% received controlled periodontal care (maintenance). More than 36% did not have oral health care before they were hospitalized after a heart attack. 

 

"Dentistry is often practiced in isolation from overall health care," Nalliah said. "Our results add weight to the evidence that medical and dental health are closely interrelated. More and more studies like ours are showing that it is a mistake to practice medicine without the thoughtful consideration of the patient’s oral health."

 

Nalliah said improved communication between medical and dental teams could help with early intervention to ensure stable periodontal health in patients who have risk factors for heart disease. 

 

"It is important to include dental care in routine medical care and this means insurances must facilitate this connection rather than offer dental insurance as a separate add-on coverage," he said. 

 

Can good dental health help protect against cognitive decline and dementia?

 

An analysis of all relevant studies published in the medical literature indicates that poor periodontal health and tooth loss may increase the risk of both cognitive decline and dementia.

The analysis, which is published in the Journal of the American Geriatrics Society, included 47 studies. Poor periodontal health (reflected by having periodontitis, tooth loss, deep periodontal pockets, or alveolar bone loss) was associated with a 23% higher odds of cognitive decline and a 21% higher risk of dementia. Tooth loss alone was linked to a 23% higher odds of cognitive decline and a 13% higher risk of dementia. The overall quality of evidence was low, however.

“From a clinical perspective, our findings emphasize the importance of monitoring and management of periodontal health in the context of dementia prevention, although available evidence is not yet sufficient to point out clear ways for early identification of at-risk individuals, and the most efficient measures to prevent cognitive deterioration,” the authors wrote.

URL Upon Publication: https://onlinelibrary.wiley.com/doi/10.1111/jgs.17978