Inflamed gums caused by severe periodontal disease could lead to erection problems

Men in their thirties who had inflamed gums caused by severe periodontal disease were three times more likely to suffer from erection problems, according to a study published in the Journal of Sexual Medicine. Turkish researchers compared 80 men aged 30 to 40 with erectile dysfunction with a control group of 82 men without erection problems. This showed that 53 per cent of the men with erectile dysfunction had inflamed gums compared with 23 per cent in the control group. When the results were adjusted for other factors, such as age, body mass index, household income and education level, the men with severe periodontal disease were 3.29 times more likely to suffer from erection problems than men with healthy gums. "Erectile dysfunction is a major public health problem that affects the quality of life of some 150 million men, and their partners, worldwide," says lead author Dr. Faith Oguz from Inonu University in Malatya, Turkey. "Physical factors cause nearly two-thirds of cases, mainly because of problems with the blood vessels, with psychological issues like emotional stress and depression accounting for the remainder. "Chronic periodontitis (CP) is a group of infectious diseases caused predominantly by bacteria that most commonly occur with inflammation of the gums. "Many studies have reported that CP may induce systemic vascular diseases, such as coronary heart disease, which have been linked with erection problems." The average age of the men in both groups was just under 36 and there were no significant differences when it came to body mass index, household income and education. Their sexual function was assessed using the International Index of Erectile Function and their gum health using the plaque index, bleeding on probing, probing depth and clinical attachment level. "To our knowledge, erectile dysfunction and CP in humans are caused by similar risk factors, such as ageing, smoking, diabetes mellitus and coronary artery disease," says Dr. Oguz. "We therefore excluded men who had systemic disease and who were smokers from this study. "We particularly selected men aged between 30 and 40 to assess the impact of CP on erectile dysfunction without the results being influenced by the effects of ageing. "The result of our study support the theory that CP is present more often in patients with erectile dysfunction than those without and should be considered as a factor by clinicians treating men with erection problems."

Vitamin D = lower rates of tooth decay

A new review of existing studies points toward a potential role for vitamin D in helping to prevent dental caries, or tooth decay. The review, published in the December issue of Nutrition Reviews, encompassed 24 controlled clinical trials, spanning the 1920s to the 1980s, on approximately 3,000 children in several countries. These trials showed that vitamin D was associated with an approximately 50 percent reduction in the incidence of tooth decay. "My main goal was to summarize the clinical trial database so that we could take a fresh look at this vitamin D question," said Dr. Philippe Hujoel of the University of Washington, who conducted the review. While vitamin D's role in supporting bone health has not been disputed, significant disagreement has historically existed over its role in preventing caries, Hujoel noted. The American Medical Association and the U.S. National Research Council concluded around 1950 that vitamin D was beneficial in managing dental caries. The American Dental Association said otherwise – based on the same evidence. In 1989, the National Research Council, despite new evidence supporting vitamin D's caries-fighting benefits, called the issue "unresolved." Current reviews by the Institute of Medicine, the U.S. Department of Human Health and Service and the American Dental Association draw no conclusions on the vitamin D evidence as it relates to dental caries. "Such inconsistent conclusions by different organizations do not make much sense from an evidence-based perspective," Hujoel said. The trials he reviewed increased vitamin D levels in children through the use of supplemental UV radiation or by supplementing the children's diet with cod-liver oil or other products containing the vitamin. The clinical trials he reviewed were conducted in the United States, Great Britain, Canada, Austria, New Zealand and Sweden. Trials were conducted in institutional settings, schools, medical and dental practices, or hospitals. The subjects were children or young adults between the ages of 2 and 16 years, with a weighted mean age of 10 years. Hujoel's findings come as no surprise to researchers familiar with past vitamin D studies. According to Dr. Michael Hollick, professor of medicine at the Boston University Medical Center, "the findings from the University of Washington reaffirm the importance of vitamin D for dental health." He said that "children who are vitamin D deficient have poor and delayed teeth eruption and are prone to dental caries." The vitamin D question takes on greater importance in the light of current public health trends. Vitamin D levels in many populations are decreasing while dental caries levels in young children are increasing. "Whether this is more than just a coincidence is open to debate," Hujoel said. "In the meantime, pregnant women or young mothers can do little harm by realizing that vitamin D is essential to their offspring's health. Vitamin D does lead to teeth and bones that are better mineralized." Hujoel added a note of caution to his findings: "One has to be careful with the interpretation of this systematic review. The trials had weaknesses which could have biased the result, and most of the trial participants lived in an era that differs profoundly from today's environment. " Hujoel has joint appointments as a professor in the University of Washington School of Dentistry's Department of Oral Health Sciences and as an adjunct professor of epidemiology in the UW School of Public Health. His research has concentrated on nutrition with a focus on low-carbohydrate diets, harmful effects of diagnostic radiation, and evidence-based methodology and applications. His research has also covered sugar substitutes, the use of antibiotics in the treatment of periodontal disease, and cleft lip and cleft palate. He has also studied the link between dental disease and systemic disease, as well as trends in disease prevalence.

Fear of the dentist is passed on to children by their parents

The father acts as an intermediary for dentist fear between both mother and children Fear of visiting the dentist is a frequent problem in paediatric dentistry. A new study confirms the emotional transmission of dentist fear among family members and analyses the different roles that mothers and fathers might play. A new study conducted by scientists at the Rey Juan Carlos University of Madrid highlights the important role that parents play in the transmission of dentist fear in their family. Previous studies had already identified the association between the fear levels of parents and their children, but they never explored the different roles that the father and the mother play in this phenomenon. América Lara Sacido, one of the authors of the study explains that "along with the presence of emotional transmission of dentist fear amongst family members, we have identified the relevant role that fathers play in transmission of this phobia in comparison to the mother." Published in the "International Journal of Paediatric Dentistry", the study analysed 183 children between 7 and 12 years and their parents in the Autonomous Community of Madrid. The results were in line with previous studies which found that fear levels amongst fathers, mothers and children are interlinked. A key factor: the father The authors confirmed that the higher the level of dentist fear or anxiety in one family member, the higher the level in the rest of the family. The study also reveals that fathers play a key role in the transmission of dentist fear from mothers to their children as they act as a mediating variable. "Although the results should be interpreted with due caution, children seem to mainly pay attention to the emotional reactions of the fathers when deciding if situations at the dentist are potentially stressful," states Lara Sacido. Consequently, transmission of fear from the mother to the child, whether it be an increase or reduction of anxiety, could be influenced by the reactions that the father displays in the dentist. Positive emotional contagion Amongst the possible implications of these results, the authors outline the two most salient: the need to involve mothers and especially fathers in dentist fear prevention campaigns; and to make fathers to attend the dentist and display no signs of fear or anxiety. "With regard to assistance in the dental clinic, the work with parents is key. They should appear relaxed as a way of directly ensuring that the child is relaxed too," notes the author. "Through the positive emotional contagion route in the family, the right attitude can be achieved in the child so that attending the dentist is not a problem," she concludes.

Gum Disease Bacteria Linked To Pancreatic Cancer Risk

The British Dental Health Foundation believes new scientific research presented is a further indication of a possible link between pancreatic cancer and gum disease. The latest research, presented in the journal Gut, found one of the bacterium key in the development of gum disease was associated with a two-fold increase in risk for pancreatic cancer. The study also discovered those with non-harmful oral bacteria had a 45 per cent lower risk of pancreatic cancer. Although researchers cannot confirm whether gum disease contributes towards a higher risk of developing pancreatic cancer, the research is a further indication of a potential link between the two diseases. Previous research has also drawn an association between bacteria responsible for gum disease and pancreatic cancer, although in both cases it remains unclear whether the presence of particular types of bacteria are a cause or effect of pancreatic cancer. The paper's corresponding author Dominique Michaud, epidemiologist at Brown University, commented: "This is not an established risk factor. But I feel more confident that something is going on. It's something we need to understand better." Co-lead author Jacques Izard, of the Forsyth Institute and Harvard University concurred. He said: "We need to further investigate the importance of bacteria in pancreatic cancer beyond the associated risk." Pancreatic cancer accounted for 7,901 deaths in 20104, while only four per cent of people in England survived the disease for more than five years. Given these statistics, Chief Executive of the British Dental Health Foundation, Dr Nigel Carter OBE, believes any link between the two diseases should provide a timely reminder about the importance of good oral health. Dr Carter said: "This research provides further ammunition to the growing belief these two diseases could be related. "There is no escaping the fact poor oral health has some role to play, as a number of studies are now starting to show. What we must remember is oral health is relatively simple to maintain. The Foundation's three key messages - brushing your teeth for two minutes twice a day using a fluoride toothpaste, cutting down on how often you have sugary foods and drinks and visiting the dentist regularly, as often as they recommend - are a great starting point for maintaining good oral health. "If you have swollen gums that bleed regularly when brushing, bad breath, loose teeth or regular mouth infections appear, it is likely you have gum disease. If any of these symptoms persist, your dentist may be able to help you."

New discovery related to gum disease

A University of Louisville scientist has found a way to prevent inflammation and bone loss surrounding the teeth by blocking a natural signaling pathway of the enzyme GSK3b, which plays an important role in directing the immune response.

The discovery of UofL School of Dentistry researcher David Scott, PhD, and his team recently published on-line first in the journal Molecular Medicine. The finding not only has implications in preventing periodontal disease, a chronic inflammatory disease that causes tooth loss, but also may have relevance to other chronic inflammatory diseases. Since GSK3b is involved in multiple inflammatory signaling pathways, it is associated with a number of diseases and also is being tested by scientists for its impact in Alzheimer's disease, Type II diabetes and some forms of cancer, to name a few.

"The traditional approach to dealing with periodontal disease is to prevent plaque from forming at the gum-line or prevent the consequences of periodontal disease progression," Scott said. "Our approach manipulates a natural mechanism within our bodies to prevent inflammation and subsequent degradation when exposed to the bacterium P. gingivalis."

GSK3b is known to facilitate the inflammation that occurs during bacterial infections, so blocking this enzyme from completing its normal function by using the GSK3-specific inhibitor, SB216763 stopped the inflammation process and subsequent bone loss induced by the key periodontal pathogen, P. gingivalis, Scott said.

The next step is for Scott and his team to determine whether SB216763 has any side-effects or whether they need to search for a different inhibitor of GSK3b.

Progression of oral lesions to cancer

A group of molecular markers have been identified that can help clinicians determine which patients with low-grade oral premalignant lesions are at high risk for progression to oral cancer, according to data from the Oral Cancer Prediction Longitudinal Study published in Cancer Prevention Research, a journal of the American Association for Cancer Research.

"The results of our study should help to build awareness that not everyone with a low-grade oral premalignant lesion will progress to cancer," said Miriam Rosin, Ph.D., director of the Oral Cancer Prevention Program at the BC Cancer Agency in Vancouver, British Columbia, Canada. "However, they should also begin to give clinicians a better idea of which patients need closer follow-up."

Oral cancers are a global public health problem with close to 300,000 new cases identified worldwide each year. Many of these cancers are preceded by premalignant lesions. Severe lesions are associated with a high progression risk and should be treated definitively. However, the challenge within the field has been to distinguish which low-grade lesions are the most likely to progress to cancer.

In 2000, Rosin and colleagues used samples of oral premalignant lesions where progression to cancer was known to have subsequently occurred in order to develop a method for grouping patients into low-risk or high-risk categories based on differences in their DNA. In their current population-based study, they confirmed that this approach was able to correctly categorize patients as less or more likely to progress to cancer.

They analyzed samples from 296 patients with mild or moderate oral dysplasia identified and followed over years by the BC Oral Biopsy Service, which receives biopsies from dentists and ENT surgeons across the province. Patients classified as high-risk had an almost 23-fold increased risk for progression.

Next, two additional DNA molecular risk markers called loss of heterozygosity were added to the analysis in an attempt to better differentiate patients' risks. They used the disease samples from the prospective study, and categorized patients into low-, intermediate- and high-risk groups.

"Compared with the low-risk group, intermediate-risk patients had an 11-fold increased risk for progression and the high-risk group had a 52-fold increase in risk for progression," Rosin said.

Of patients categorized as low-risk, only 3.1 percent had disease that progressed to cancer within five years. In contrast, intermediate-risk patients had a 16.3 percent five-year progression rate and high-risk patients had a 63.1 percent five-year progression rate.

"That means that two out of every three high-risk cases are progressing," Rosin said. "Identifying which early lesions are more likely to progress may give clinicians a chance to intervene in high-risk cases, and may help to prevent unnecessary treatment in low-risk cases."

Moms linked to teen oral health, says CWRU dental study

A mother’s emotional health and education level during her child’s earliest years influence oral health at age 14, according to a new study from Case Western Reserve University’s School of Dental Medicine.

Researchers started with the oral health of the teens and worked backwards to age 3 to find out what factors in their past influenced their oral health outcomes._While mothers were interviewed, lead investigator Suchitra Nelson, professor in the dental school, believes it can apply to whoever is the child’s primary caregiver.

Nelson’s team examined the teeth of 224 adolescent participants in a longitudinal study that followed very low birth weight and normal birth weight children. Over the years, researchers gathered health and medical information from the children and their mothers to assess the child’s wellbeing at age 3, 8 and now 14. _The researchers analyzed the teen’s oral health by counting the number of decayed, filled or missing permanent teeth and assessed the level of dental plaque, a symptom for poor oral hygiene.

Mothers completed a questionnaire about preventative treatments from sealants to mouthwashes, sugary juice or soft drink consumption and access to dental care and frequency of dental visits.

The data revealed that even with access to dental insurance, fluoride treatments and sealants as young children, it did not always prevent cavities by the age of 14, said Nelson, professor of community dentistry at Case Western Reserve dental school.

She is lead investigator on the Journal of Dental Research article, “Early Maternal Psychosocial Factors are Predictors for Adolescent Caries.”

What did prevent cavities in teens?

Using a statistical modeling program that tracked pathways from the teen’s dental assessments back to the source of where the oral health originated led researchers right to mothers and their overall emotional health, education level and knowledge when children were at ages 3 and 8.

The researchers found if mothers struggled in any of the three areas, the oral health of the teens at age 14 resulted in higher numbers of oral health problems.

“We can’t ignore the environments of these children,” Nelson said. “It isn’t enough to tell children to brush and floss, they need more—and particularly from their caregivers.”

The oral health boost comes from mothers, who muster coping skills to handle everyday stresses and develop social networks to provide for their children’s needs.

It was found that mothers with more education beyond high school, with healthy emotional states and knowledge about eating right had children with healthier teeth.

“We cannot ignore these environmental influences and need interventions to help some moms get on track early in their children’s lives,” Nelson concludes.

Nelson says moms need to care for themselves to help their children. She likens it to the emergency instructions on an airplane that mothers put on the mask first and then their children. “How can a mother help her child if she passes out,” asks Nelson. “It’s all common sense, but some mothers may need help.”

Poor Oral Health Can Mean Missed School, Lower Grades

Poor oral health, dental disease, and tooth pain can put kids at a serious disadvantage in school, according to a new Ostrow School of Dentistry of USC study.

“The Impact of Oral Health on the Academic Performance of Disadvantaged Children,” appearing in the September 2012 issue of the American Journal of Public Health, examined nearly 1500 socioeconomically disadvantaged elementary and high school children in the Los Angeles Unified School District, matching their oral health status to their academic achievement and attendance records.

Ostrow researchers had previously documented that 73 percent of disadvantaged kids in Los Angeles have dental caries, the disease responsible for cavities in teeth. The new study shines light on the specific connection between oral health and performance in school for this population, said Roseann Mulligan, chair of the school’s Division of Dental Public Health and Pediatric Dentistry and corresponding author of the study.

Children who reported having recent tooth pain were four times more likely to have a low grade point average—below the median GPA of 2.8—when compared to children without oral pain, according to study results.

Poor oral health doesn’t just appear to be connected to lower grades, Mulligan said, adding that dental problems also seem to cause more absences from school for kids and more missed work for parents.

“On average, elementary children missed a total of 6 days per year, and high school children missed 2.6 days. For elementary students, 2.1 days of missed school were due to dental problems, and high school students missed 2.3 days due to dental issues,” she said. “That shows oral health problems are a very significant factor in school absences. Also, parents missed an average of 2.5 days of work per year to care for children with dental problems.”

A factor in whether children miss school due to dental health issues was the accessibility of dental care. Eleven percent of children who had limited access to dental care—whether due to lack of insurance, lack of transportation, or other barriers—missed school due to their poor oral health, as opposed to only four percent of children who had easier access to dental care.

“Our data indicates that for disadvantaged children there is an impact on students’ academic performance due to dental problems. We recommend that oral health programs must be more integrated into other health, educational and social programs, especially those that are school-based,” Mulligan said. “Furthermore, widespread population studies are needed to demonstrate the enormous personal, societal and financial burdens that this epidemic of oral disease is causing on a national level. ”

BPA in Dental Fillings Might Affect Children's Behavior

Children who receive dental fillings made from the controversial plastics chemical bisphenol-A (BPA) could undergo small but long-term changes in their behavior, a new study suggests.

Researchers looked at 534 children who had fillings for at least two cavities and examined their social skills before and five years after getting fillings.

The fillings were made of either a silver blend called amalgam, which has been phased out because it contains mercury, or plastic composites, some of which are based on bisGMA, a material made from BPA.

The children who got the highest number of bisGMA-based fillings had more emotional problems five years later than the children who got fewer of these fillings. But no such change occurred with other types of fillings.

The study appeared online July 16 and will be published in the August print issue of Pediatrics.

"It was actually kind of a surprise that instead of seeing any possible adverse associations with amalgam, that the trends seem to go the other way and the children in the composite group seemed to have more problems," said study author Nancy Maserejian, an epidemiologist at New England Research Institutes in Watertown, Mass.

"On average, the difference in social behavior scores were very small and would probably not be noticed for each individual child," Maserejian said. "But imagine a huge group of children around the country; you'd probably notice a difference."

Although it remains controversial whether BPA affects human health, previous research has linked BPA exposure to hyperactivity and aggressive behavior in young children.

Composite fillings, including the kind made from BPA, became the mainstay for treating children's cavities in the mid-90s because they were thought to be safer than mercury-containing amalgam fillings and they looked more natural, said Dr. Burton Edelstein, a pediatric dentist and professor of dentistry at Columbia University, in New York City.

"This study raises enough concern about the alternative of amalgam to revisit the value of amalgam," Edelstein said. There is no reason at this point to be concerned about the health effects of amalgam, or the stainless steel crowns that are sometimes placed on top of a tooth with a cavity, he added.

The study included 543 children between the ages of 6 and 10 who received two or more fillings in their back teeth made of amalgam or a composite based on either bisGMA or urethane. The data were part of a New England-based study that was designed to look at the long-term effects of amalgam fillings on psychological scores and kidney function.

Children who had the most bisGMA-based fillings were more likely four or five years later to score poorly on tests that asked the children and their parents questions like whether they had trouble making friends or felt anxious or depressed.

Overall, the researchers found that 16 percent of the children in the top third for their number of bisGMA-based fillings were at risk for having a behavior problem, based on a combination of children's self-reports and parents' descriptions, compared with only 6 percent of children in the bottom two-thirds.

But no difference existed in emotional problems when looking at children who had more vs. fewer amalgam or urethane-based composite fillings.

"This study is a call for more research," said Dr. Mary Hayes, a pediatric dentist in Chicago and a spokeswoman for the American Dental Association.

Hayes chooses between composite fillings or amalgams depending on the tooth and where it is in the mouth and if parents want a white-colored composite filling for their children instead of a silver filling. "Most composites that I am aware of have BPA," she said.

Study author Maserejian said, "We are really not sure if BPA or another material released from the resin could be causing these effects." She and her colleagues are currently measuring BPA levels in children's systems.

Children could be exposed to materials in their fillings both when the dentist applies them and over time, because the fillings wear down and release chemicals that children swallow, Columbia's Edelstein said.

"If you've got to have a filling, you're better to go with one that does not have BPA, but that is not a panacea," Edelstein said. Parents can also reduce exposure by making sure their dentist takes standard steps, like vacuuming around the tooth after applying the filling, he added.

"The only real solution is to realize that no material is better than the material that Mother Nature gave us and to do a better job of [cavity] prevention," Edelstein said.

Parents can help prevent cavities by helping their children brush their teeth, giving them water instead of sugary drinks and visiting the dentist twice a year.

If your child does have a cavity, "talk to the dentist about where the cavity came from and how to prevent the next one," Edelstein said. "This study was clear that [higher] doses of fillings were associated with a health impact."

The study also made it explicitly clear that you should not have your amalgam fillings replaced with composites, which some dental practices will do, Edelstein said. "If you've got a sound filling, leave it in place."

While the study found an association between materials in fillings and behavior, it did not prove a cause-and-effect relationship.

Gum Disease Linked To Oral Cancer Virus

Scientists have discovered that severe gum disease could be linked to an increased risk of head and neck cancer cases caused by the Human Papilloma Virus (HPV).

The study found patients with HPV-positive tumours had significantly higher bone loss, a key factor in the development of severe gum disease, compared with patients with HPV-negative tumours.

Latest figures suggest more than 6,000 people in the UK suffer from oral cancer, while almost 2,000 lives are lost to the disease. HPV is a growing cause of the disease, with experts suggesting it may rival tobacco use as the main cause of oral cancer within 10 years. Other risk factors for developing the disease include tobacco use, drinking to excess and poor diet.

The significance of the research is compounded by the fact more teeth are lost through periodontal (gum) disease than through tooth decay.

Although further research is required to determine the exact relationship of the link between severe gum disease and an increased risk of HPV-related oral cancer, it is not the first time poor oral health and cancer have been linked. Recent research carried out at the Karolinska Institute in Sweden suggested failure to brush your teeth properly could increase the chance of premature death resulting from cancer. They found a link between high levels of dental plaque - the cause of gum disease - and dying from cancer up to 13 years earlier than previously expected.

The findings of both studies present even greater evidence of the need to ensure good oral health, according to Chief Executive of the British Dental Health Foundation, Dr Nigel Carter OBE.

Dr Carter said: "A greater understanding of how we can tackle this potentially life-threatening disease could lead to many lives being saved.

"Most of us suffer from gum disease at some point in our lives, yet it is entirely preventable. By developing and keeping a good oral health routine it lowers the risk of gum disease and any possible links to more serious diseases. We should all take time to reflect on how we can make that a reality.

"Brushing your teeth for two minutes twice a day using a fluoride toothpaste, cleaning in between teeth daily with interdental brushes or floss, cutting down on how often you have sugary foods and drinks and visiting the dentist regularly, as often as they recommend will be a great starting point.

"If you have swollen gums that bleed regularly when brushing, bad breath, loose teeth or regular mouth infections appear, it is likely you have gum disease.

"It is also vital to check regularly for early warning signs of mouth cancer. These include ulcers which do not heal within three weeks, red and white patches in the mouth and unusual lumps or swellings in the mouth. If you are in any doubt, please get checked out."

The study, published in the Archives of Otolaryngology, sampled 124 patients suffering from oral cancer, 50 of which were as a result of HPV. Lead author Mine Tezal, D.D.S., Ph.D., of the University at Buffalo commented: "Periodontitis is easy to detect and may represent a clinical high-risk profile for oral HPV infection.

"Prevention or treatment of sources of inflammation in the oral cavity may be a simple yet effective way to reduce the acquisition and persistence of oral HPV infection."

Oral Health - Americans Score Badly

A new survey from the American Dental Association (ADA) shows that Americans seriously need to clean up their act when it comes to oral health. The ADA's newly launched website, MouthHealth.org that aims to improve oral health reveals that Americans' average score was a 'D' in the survey's range of 'true or false' questions, which included questions like how often should teeth be cleaned, what causes cavities and the age of a child's first dentist visit.



William R. Calnon, D.D.S., ADA president and a practicing dentist in Rochester, N.Y. stated: "The results of the survey were quite shocking and really show how important it is for people to become more involved in their own oral health."



Nine in ten adults aged between 20-64 years have had cavities in their permanent teeth, according to the National Institute of Dental and Craniofacial Research (NIDCR), and almost half of children between the ages from 2 to 11 years have already had cavities in their baby teeth. It is therefore not surprising that the most common chronic disease in children is dental disease.



ADA's new consumer website, www.MouthHealthy.org, which was launched on June 25, provides information on prevention, care and treatments to improve and maintain dental care in addition to the dental IQ test so that visitors to the site can test their own knowledge.



Dr. Calnon pointed out: "Oral health is a critical part of overall health. MouthHealthy.org will help empower people to take charge of their oral health." ADA's national survey, conducted in May 2012, which involved a nationally representative sample of almost 1,500 adults revealed:

•

90% of people believe they should clean their teeth after every meal, whilst ADA recommends cleaning twice a day •

81% of people believe that cavities are caused by sugar. However, it is not the actual sugar that causes cavities, but germs in the mouth that feed on sugar and produce acid that attacks the teeth enamel, which over time wear down the enamel to such an extent that cavities form •

75% have no idea at what age they should take a child to the dentist for the first time. According to ADA recommendations, a child's first dentist visit should be within six months after the first tooth appears or before the child's first birthday •

65% of people think their toothbrush should be replaced twice a year, when it should be replaced every three months •

59% of people are unaware that germs that can cause cavities can be passed from person to person



(The survey included a margin of error of + or - 2.6 points.)

OK to limit pre-dental procedure antibiotics to high risk heart patients

The incidence of infective endocarditis among dental patients in Olmsted County, Minn. did not increase after new guidelines called for giving preventive antibiotics before dental procedures only to those at greatest risk of complications, according to independent research published in Circulation, an American Heart Association journal.

Infective endocarditis is a bacterial infection of the heart lining, heart valve or blood vessel. Although rare, it can occur when bacteria enter the bloodstream through breaks in the gums during invasive dental procedures or oral surgery. It can cause death if untreated. A common group of bacteria that cause this infection is viridans group streptococci (VGS).

Patients with a heart weakened by certain congenital defects and acquired conditions, including those with prosthetic heart valves, can be more susceptible to the infection. People with normal heart valves develop the infection less often.

In 2007, the American Heart Association changed its guidelines, recommending patients take antibiotics before invasive dental procedures only if they are at risk of complications from infective endocarditis. This includes patients with artificial heart valves, transplanted hearts with abnormal heart valve function, previous infective endocarditis and people born with specific heart defects.

Before 2007, antibiotics were given to many more people, including those with many types of congenital heart defect or acquired cardiac condition. Antibiotics also were given for a wider range of procedures, including operations involving the mouth, throat, gastrointestinal, genital or urinary tract.

"We were giving preventive antibiotics like we were treating an entire iceberg, when we only needed to treat the very tip of that iceberg," said Daniel C. DeSimone, M.D., study lead author and an internal medicine resident at the Mayo Clinic in Rochester, Minn. "Millions of people once getting antibiotics now are not."

In the first U.S. study examining VGS-related infective endocarditis rates after the guidelines changed, investigators found a slight decline in the number of patients diagnosed.

To compare infective endocarditis rates, researchers analyzed local hospital discharge records in the Rochester Epidemiology Project and national rates using the Nationwide Inpatient Sample. Olmstead County was used because of its unique medical records-linkage system that encompasses all residents of the county.

From Jan. 1, 1999 to Dec. 31, 2010, 22 patients in Olmsted County, Minn., were diagnosed with the heart infection. These patients represent two to three of every 100,000 people in the United States before updated guidelines, and one of every 100,000 after the updated guidelines.

The percentage of Olmsted county dentists following the new association guidelines represented the percentage of dentists using them nationally, researchers said.

The national annual infective endocarditis diagnosis rates showed no increase, ranging from:
•
15,300-17,400 in 1999-2006 (before the updated guideline) •
•
14,700-15,500 in 2007-09 (after the updated guideline) •

"These findings are reassuring, but additional studies are needed to further support our findings," DeSimone said.

"There's still a concern among many healthcare providers over whether we are leaving certain people at risk of getting a potentially lethal infection just from a dental cleaning or tooth extraction," he said. "This study should reduce some fears. It will allow dentists to become more comfortable when they tell a patient, 'You've been getting this antibiotic for years. Now, it's not recommended anymore, and here is data showing you why.'"

Among other limitation, the lack of diversity in Olmstead means these results may not hold true for non-Caucasian populations.

Connections between preventive dentistry and public health

The dental profession needs to build a stronger connection between oral health and general health—not only for individual patients, but also at the community level, according to the special June issue of The Journal of Evidence-Based Dental Practice (JEBDP), the foremost publication of information about evidence-based dental practice, published by Elsevier.

The special issue follows the usual format of JEBDP, comprising expert reviews and analyses of the scientific evidence on specific dental procedures. "Yet the coverage goes beyond a review of specific clinical interventions to broader ones that address prevention on a community basis," according to an introductory guest editorial by Robert J. Collins, DMD, MPH, of University of Pennsylvania.

Dr. Collins highlights the role of evidence-based innovations such as home dental care, community water fluoridation, and dental sealants in shifting public perceptions of dental care from replacement or repair of missing or damaged teeth to protection against oral diseases. In his editorial, he calls on dentists to recognize the value of collaboration in addressing the problems of the public and the dental profession: "As professionals, clinicians have a responsibility to care for their patients as individuals and a community."

The goal of the special issue is to forge a closer link between the research-proven clinical care provided to individuals and the larger public health goals of improving health in the community. "The oral health status of individuals, families, and communities can be greatly improved when patient-centered, evidence-based care intersects with focused, larger community prevention efforts," states the CDC's William Bailey, DDS, MPH, Assistant Surgeon General and Chief Dental Officer, U.S. Public Health Service, highlighting the link between clinical care and public health.

The issue includes review and article analyses and evaluations on a wide range of topics related to prevention in dental care. The focus is on techniques that not only prevent dental diseases, but also reflect a growing appreciation of the connections between dental health and general health. Topics illustrating these areas of crossover include:
-1.
"Rubber cup" dental prophylaxis—there's little evidence of a health benefit for this familiar "preventive" technique, but it continues to be widely used. -1.
-1.
Prophylactic surgical extraction of wisdom teeth—a growing body of evidence questions the need for this common procedure, although controversy continues. -1.
-1.
Chlorhexidine mouthwash to reduce the risk of ventilator-associated pneumonia—an example of how better oral health can help prevent a serious medical condition, with important implications for dental care in nursing home residents. -1.



A highlight of the issue is an invited commentary by American Dental Association (ADA) President William R. Calnon, DDS. In contrast to its historical emphasis on surgical treatment of dental diseases after they have occurred—"drilling and filling"— Dr. Calnon believes the ADA and the dental profession at large need to develop a new framework for prevention of oral disease. He writes, "Perhaps it is time to think about prevention as the management of oral health risks, including the identification, assessment, and prioritization of these risks, and to take actions designed to mitigate the risks of oral disease or dysfunction."

The special issue also includes opinion pieces on key issues related to prevention and dental public health. Invited editorials highlight the need for private dental practitioners to take on increased responsibility for carrying out essential public health functions; and the impact of financial incentives on the provision of evidence-based preventive services in clinical dentistry.

"Our focus is on collaboration between dental professionals involved in community health and clinical health," Dr. Collins commented. "The issue is extremely important, particularly in looking at what we can do about the 25 to 30 percent of the population who don't have regular access to dental care."

###

The JEBDP special issue on prevention is supported by educational grants from Colgate and the American Association of Public Health Dentistry. Every dental school and all dental public health residents in the United States will receive copies of the special Issue of JEBDP.

Gum disease associated with women’s hormones

Women, keep those toothbrushes and dental floss handy. A comprehensive review of women’s health studies by Charlene Krejci, associate clinical professor at the Case Western Reserve University School of Dental Medicine, has shown a link between women’s health issues and gum disease.

Across the ages, hormonal changes take place during puberty, menstruation, pregnancy and menopause. Krejci found female hormones that fluctuate throughout women’s lives can change conditions in the mouth that allow bacteria to grow, enter the blood, and exacerbate certain health issues like bone loss, fetal death and pre-term births.

Her overview of the literature was reported in the article, “Women’s Health: Periodontitis and its Relation to Hormonal Changes, Adverse Pregnancy Outcomes and Osteoporosis” in the May issue of Oral Health and Preventive Dentistry.

The Case Western Reserve University periodontist reviewed 61 journal articles with nearly 100 studies for a collective answer on whether hormones have a relationship to gum disease and specific women’s health issues like preterm labor, bone loss, and the side effect of hormonal replacement therapy.

“There’s definitely a gender-specific connection between women’s hormones, gum disease, and specific health issues impacting women,” Krejci said.__“Although women tend to take better care of their oral health than men, the main message is women need to be even more vigilant about maintaining healthy teeth and gums to prevent or lessen the severity of some of women-specific health issues,” Krejci said.

In addition to the brushing and flossing daily regimen, Krejci recommends visiting the dentist at least every six months, and more if there are any gum problems found or women suffer from bone loss or are pregnant.

She added that it is widely known that hormones cause some women gum problems during pregnancy. Women already susceptible to gum disease before being pregnant, she advises, need to make sure that these oral problems are treated.

Although women were once discouraged from seeing the dentist while pregnant, she said that scaling and planing of the roots of teeth to eliminate some gum disease is now recommended during pregnancy for women. Severe gum disease requiring surgery is still generally postponed until after the baby’s birth.

Gum disease begins with the build up of bacterial plaque on the teeth and under the gums. Untreated it can cause irritation and inflammation during which harmful and toxic byproducts are released. These toxins erode the bone that anchors teeth and cause breaks and bleeding in the gums.

Collaborating with Krejci on the study was Nabil Bissada, professor and chair of the Department of Periodontology at Case Western Reserve University School of Dental Medicine.

Two-step tooth implantation and built-up bone can be longer lasting

Periodontists routinely grow bone in the mouth to guarantee a stable environment for teeth and tooth implants. But whether it's better to build up bone before placing the implant, or to simply place the implant and allow bone to grow around it, has been a subject of considerable medical debate.

Now Prof. Zvi Artzi of Tel Aviv University's Maurice and Gabriela Goldschleger School of Dentistry at the Sackler Faculty of Medicine has completed a study that concludes the two-step method is the more effective alternative — building bone first, then implanting and allowing further bone growth. Currently, many dental professionals prefer a one-step process to save their patients from an additional surgical procedure.

Published in the Journal of Clinical Periodontology, Prof. Artzi's study shows that a one-step implant will show more wear and tear over time than one implanted through the more cautious two-step procedure. While both are clinically effective methods, he concludes, implant placement procedures done with the one-step method show greater bone resorption around the implant neck — a process by which the bone is broken down. Bonding of the bone around the implant was also shown to be inferior.

Testing proven procedures

The successful placement of a tooth implant is based on the biocompatibility of titanium, the main component of most dental and orthopedic implants. Both animal and human tissues readily accept the implant and grow around it. But in many cases, the amount of bone is also crucial to the success of the implant. Building bone to stabilize a titanium fixture is a long-standing procedure in dentistry.

Periodontists typically choose either the one-step or two-step procedure based on their preference alone. So Prof. Artzi and his fellow researchers set out to determine which procedure was scientifically superior in the long-term, well past the time when periodontists would typically monitor a patient's progress. In their study, they compared both methods of implantation in lab animals, and followed the progress of the implants over a course of two years.

The one-step procedure is based on the idea that a bone graft will simply attract the surrounding tissue to build up bone around the titanium implant — a process called conduction. The benefit of this procedure is that patients are only subjected to one surgery. But the study shows a difference in long-term efficacy, Prof. Artzi says. Ultimately, the bone recedes less in the more cautious two-step procedure. The quality of the resulting bone itself is similar.

A judgement call

Though the study proves that the two-step method is more advantageous in most cases, each case is different, says Prof. Artzi. For example, dental professionals also take into account the already existing bone – which determines how stable a future implant will be – before deciding which route to take with each individual patient. Clinically, both methods remain sound, and periodontists should still rely on their own judgement as to what is best for the patient.

Sports and Energy Drinks Responsible for Irreversible Damage to Teeth

Energy drinks found twice as likely to destroy enamel than sports drinks

A recent study published in the May/June 2012 issue of General Dentistry, the peer-reviewed clinical journal of the Academy of General Dentistry, found that an alarming increase in the consumption of sports and energy drinks, especially among adolescents, is causing irreversible damage to teeth—specifically, the high acidity levels in the drinks erode tooth enamel, the glossy outer layer of the tooth.

“Young adults consume these drinks assuming that they will improve their sports performance and energy levels and that they are ‘better’ for them than soda,” says Poonam Jain, BDS, MS, MPH, lead author of the study. “Most of these patients are shocked to learn that these drinks are essentially bathing their teeth with acid.”

Researchers examined the acidity levels in 13 sports drinks and nine energy drinks. They found that the acidity levels can vary between brands of beverages and flavors of the same brand. To test the effect of the acidity levels, the researchers immersed samples of human tooth enamel in each beverage for 15 minutes, followed by immersion in artificial saliva for two hours. This cycle was repeated four times a day for five days, and the samples were stored in fresh artificial saliva at all other times.

“This type of testing simulates the same exposure that a large proportion of American teens and young adults are subjecting their teeth to on a regular basis when they drink one of these beverages every few hours,” says Dr. Jain.

The researchers found that damage to enamel was evident after only five days of exposure to sports or energy drinks, although energy drinks showed a significantly greater potential to damage teeth than sports drinks. In fact, the authors found that energy drinks caused twice as much damage to teeth as sports drinks.

With a reported 30 to 50 percent of U.S. teens consuming energy drinks, and as many as 62 percent consuming at least one sports drink per day, it is important to educate parents and young adults about the downside of these drinks. Damage caused to tooth enamel is irreversible, and without the protection of enamel, teeth become overly sensitive, prone to cavities, and more likely to decay.

“Teens regularly come into my office with these types of symptoms, but they don’t know why,” says AGD spokesperson Jennifer Bone, DDS, MAGD. “We review their diet and snacking habits and then we discuss their consumption of these beverages. They don’t realize that something as seemingly harmless as a sports or energy drink can do a lot of damage to their teeth.”

Dr. Bone recommends that her patients minimize their intake of sports and energy drinks. She also advises them to chew sugar-free gum or rinse the mouth with water following consumption of the drinks. “Both tactics increase saliva flow, which naturally helps to return the acidity levels in the mouth to normal,” she says.

Also, patients should wait at least an hour to brush their teeth after consuming sports and energy drinks. Otherwise, says Dr. Bone, they will be spreading acid onto the tooth surfaces, increasing the erosive action.

Fish Oil Could Be Therapy for Periodontal Disease

Periodontitis, inflammation of the tissue surrounding the teeth, affects more than half of adults and is linked to an increased risk of stroke and other heart problems. To evaluate whether fish oil supplementation could be an adjunct therapy for periodontitis, Dr. Alison Coates from the University of South Australia and colleagues from the School of Dentistry at University of Adelaide in Australia reviewed evidence from eight unique studies that involved humans.

Their review of these studies showed that improvements in clinical measures were common in all studies, but were scientifically significant in two that used a combination of fish oil and aspirin. Although this is not conclusive evidence, intake of fish oil is recommended for health benefits beyond the teeth.

"I would recommend that people ensure they have a sufficient intake of long chain omega-3 fatty acids in their diet for general health," said Coates. "In Australia, these types of fatty acids are considered to be essential with ~500 mg recommended as the suggested dietary target. This equates to approximately 2 fatty fish meals per week."

There are no serious dangers to consuming fish oil. At high levels of fish oil above the GRAS limit, people may experience a delayed clotting time and at very high doses potential gastric upset. If people are taking blood thinning medication, then they should consult with a doctor.

The group reports that the evidence for fish oil being effective in reducing periodontal symptoms is building but there is a need for more well designed studies that evaluate the supplement both alone and in combination with aspirin to be able to tease out whether fish oil by itself is effective. It is important that compliance to treatment is considered and that the dose and length of supplementation is appropriate. A clinical trial is underway in Australia that is investigating the effects of fish oil as adjunct therapy for periodontitis.

IADR/AADR publish studies on severe early childhood caries

New classification proposed

The International and American Associations for Dental Research have published two studies about dental caries in children. These articles, titled "Hypoplasia-Associated Severe Early Childhood Caries – A Proposed Definition" (lead author Page Caufield, New York University College of Dentistry) and "Deciduous Molar Hypomineralization and Molar Incisor Hypomineralization" (lead author M.E.C. Elfrink, Academic Centre for Dentistry, Amsterdam) discuss the definitions of dental caries susceptibility to the hypomineralization and hypoplasia.

The study by Caufield et al proposes a new classification of severe early childhood caries (S-ECC) called hypoplasia-associated severe early childhood caries (HAS-ECC). This form of caries affects mostly young children living at or below poverty, characterized by structurally damaged primary teeth that are particularly vulnerable to dental caries. These predisposing developmental dental defects are mainly permutations of enamel hypoplasia (EHP). Anthropologists and dental researchers consider EHP an indicator for infant and maternal stresses including malnutrition, a variety of illnesses and adverse birthing conditions. Differentiation of HAS-ECC from other forms of early childhood caries is warranted due to its distinct etiology, clinical presentation and eventual management.

According to the study, defining HAS-ECC has important clinical implications: therapies that control or prevent other types of caries are likely to be less effective with HAS-ECC because the structural integrity of the teeth is compromised prior to their emergence into the oral cavity. The study suggests that to prevent HAS-ECC, dentists must partner with other health providers to develop interventions that begin with pregnant mothers with the aim of eliminating or ameliorating the covariates accompanying poverty, including better pre- and postnatal care and nutrition.

The study by Elfrink et al was embedded in the Generation R Study, a population-based prospective cohort study from fetal life until young adulthood. This study focused on the relationship between deciduous molar hypomineralization (DMH) and permanent molar incisor hypomineralization (MIH). First permanent molars develop during a period similar to that of second primary molars, with possible comparable risk factors for hypomineralization. Children with DMH have a greater risk of developing MIH. In this study, clinical photographs of clean, moist teeth were taken with an intra-oral camera in 6,161 children (49.8% girls; mean age 74.3 mos, SD ± 5.8). First permanent molars and second primary molars were scored with respect to DMH or MIH. The prevalence of DMH and MIH was 9.0% and 8.7% at child level, and 4.0% and 5.4% at tooth level. The odds ratio for MIH based on DMH was 4.4 (95% CI, 3.1-6.4). The relationship between the occurrence of DMH and MIH suggests a shared cause and indicates that, clinically, DMH can be used as a predictor for MIH.

"Data from over 6,000 children show that children with hypomineralization in the deciduous dentition (DMH: prevalence 9.0%) have a greater risk of developing hypomineralization in the permanent dentition (MIH; prevalence 8.7%)," said J.M. ten Cate, professor at Academisch Centrum Tandheelkunde Amsterdam and co-author of the study titled "Deciduous Molar Hypomineralization and Molar Incisor Hypomineralization". "Therefore, in clinical practice, extra attention needs to be paid to children with DMH in the period when their permanent molars and incisors are erupting, given their increased risk of having MIH."

Satu Alaluusua, University of Helsinki, Institute of Dentistry, Finland, wrote a corresponding perspective article entitled "Defining Developmental Enamel Defect-Associated Caries: Where are we now?" In it, she states that it would be of value to distinguish hypoplasia associated severe early childhood careers as a subgroup of S-ECC and she emphasizes that developmental enamel defects whether hypoplasia, hypomineralization or in combination can increase caries risk.

Saliva test could dramatically increase detection of oral cancer

A Michigan State University surgeon is teaming up with a Lansing-area dental benefits firm on a clinical trial to create a simple, cost-effective saliva test to detect oral cancer, a breakthrough that would drastically improve screening and result in fewer people dying of the world's sixth most common cancer.

Barry Wenig, a professor in the College of Human Medicine's Department of Surgery and lead investigator on the project, is working with Delta Dental of Michigan's Research and Data Institute to compile study data and recruit dentists. The study will enroll 100-120 patients with white lesions or growths in their mouths and tonsil areas to test as part of the clinical trial.

Wenig and his team will be looking for certain biomarkers previously identified by researchers at UCLA; the biomarkers have been shown in studies to confirm the presence of oral cancer. By creating a simple saliva test which could identify the biomarker's presence, physicians and dentists would know which patients need treatment and which ones could avoid needless and invasive biopsies.

"Most white lesions are benign, so a majority of people who develop them are getting biopsies that are not needed," Wenig said. "Conversely, a simple test would allow us to identify those patients with malignant lesions and get them into treatment quicker."

Oral cancer has a poor survival rate linked to late detection, Wenig said: Only 60 percent of patients live beyond five years after diagnosis. Among black males, the survival rate is less than 38 percent.

"The key challenge to reduce the mortality and morbidity of oral cancer is to develop strategies to identify and detect the disease when it is at a very early stage," he said.

In addition to Delta Dental's Research and Data Institute, which works with researchers from leading universities to monitor advances in science, Wenig is collaborating with PeriRx, a Pennsylvania company that will sponsor upcoming trials with the Food and Drug Administration.

"The results of this trial could be life changing for many people," said Jed Jacobson, chief science officer at Delta Dental and a licensed dentist. "It is a tremendous opportunity for the dental community to participate in what could be a groundbreaking research project."

Wenig and members of his team recently returned from southern California, where they met with UCLA colleagues, who are working to develop saliva diagnostic tests for other cancers as well.

"These tests are as noninvasive as it gets; patients simply need to spit into a cup," Wenig said. "The ease of the test will greatly expand our ability to effectively screen for the cancerous lesions.

"Right now, there are no early screenings available for most head and neck cancers."

The test also has the potential to accelerate health care savings, he added, since the number of biopsies can be dramatically reduced.

Anyone seeking more information on the trial can call the Department of Surgery at (517) 267-2042.

###

Study hints at why gums suffer with age

New research from Queen Mary, University of London in collaboration with research groups in the USA sheds light on why gum disease can become more common with old age.

The study, published in Nature Immunology, reveals that the deterioration in gum health which often occurs with increasing age is associated with a drop in the level of a chemical called Del-1.

The researchers say that understanding more about Del-1 and its effects on the body’s immune system could help in the treatment or prevention of serious gum disease.

Periodontitis is a disease of the gums which causes bleeding and bone loss which can, over time, lead to loss of teeth. It affects about 20 per cent of the UK population and is caused by an over-active immune response to bacteria that grow in the mouth.

As people age they are more likely to suffer from inflammatory diseases, including gum disease.

The new research investigated gum disease in young and old mice and found that an increase in gum disease in the older animals was accompanied by a drop in the level of Del-1. This protein is known to restrain the immune system by stopping white blood cells from sticking to and attacking mouth tissue.

Mice that had no Del-1 developed severe gum disease and elevated bone loss and researchers found unusually high levels of white blood cells in the gum tissue.

When they treated the gums of the mice with Del-1, the number of white blood cells dropped, and gum disease and bone loss were reduced.

The researchers say their findings could be the basis for a new treatment or prevention of gum disease.

Mike Curtis is Professor of Microbiology at Queen Mary, University of London, Director of the Blizard Institute and the lead on the microbiological studies in the research. He said: “Periodontitis is an extremely common problem and we know that the disease tends to be more common as we get older.

“This research sheds some light on why ageing makes us more susceptible and understanding this mechanism is the first step to an effective treatment.”

Dental X-rays Should be Used Sparingly To Reduce Radiation Risk

Ω


Dental X-rays linked to common brain tumor

The American Dental Association (ADA) says that it is aware of a recent study that associates yearly or more frequent dental X-rays to an increased risk of developing meningioma, the most commonly diagnosed brain tumor. The ADA’s long-standing position is that dentists should order dental X-rays for patients only when necessary for diagnosis and treatment. Since 1989, the ADA has published recommendations to help dentists ensure that radiation exposure is as low as reasonably achievable.

Meningioma, the most common primary brain tumor in the United States, accounts for about 33 percent of all primary brain tumors. The most consistently identified environmental risk factor for meningioma is exposure to ionizing radiation. In the largest study of its kind, researchers from Brigham and Women's Hospital (BWH), Yale University School of Medicine, Duke University, UCSF and Baylor College of Medicine have found a correlation between past frequent dental x-rays, which are the most common source of exposure to ionizing radiation in the U.S, and an increased risk of developing meningioma. These findings are published in the April 10, 2012 issue of Cancer.

"The findings suggest that dental x-rays obtained in the past at increased frequently and at a young age, may be associated with increased risk of developing this common type of brain tumor," said Elizabeth Claus, MD, PhD, a neurosurgeon at BWH and Yale University School of Medicine at New Haven. "This research suggests that although dental x-rays are an important tool in maintaining good oral health, efforts to moderate exposure to this form of imaging may be of benefit to some patients."

Claus and her colleagues studied data from 1,433 patients diagnosed with meningioma between 20 and 79 years of age between May 2006 and April 2011 and compared the information to a control group of 1350 participants with similar characteristics. They found that patients with meningioma were twice as likely to report having a specific type of dental x-ray called a bitewing exam, and that those who reported having them yearly or more frequently were 1.4 to 1.9 times as likely to develop a meningioma when compared to the control group. Additionally, researchers report that there was an even greater increased risk of meningioma in patients who reported having a panorex x-ray exam. Those who reported having this exam taken under the age of 10, were 4.9 times more likely to develop a meningioma compared to controls. Those who reported having the exam yearly or more frequently than once a year were nearly 3 times as likely to develop meningioma when compared to the control group.

"It is important to note that the dental x-rays performed today use a much lower dose of radiation than in the past," said Claus.

According to background information in the study, The American Dental Association's statement on the use of dental radiographs emphasizes the need for dentists to examine the risks and benefits of dental x-rays and confirms that there is little evidence to support the use of dental x-rays in healthy patients at preset intervals.

The ADA has reviewed the study and notes that the results rely on the individuals’ memories of having dental X-rays taken years earlier. Studies have shown that the ability to recall information is often imperfect. Therefore, the results of studies that use this design can be unreliable because they are affected by what scientists call “recall bias.” Also, the study acknowledges that some of the subjects received dental x-rays decades ago when radiation exposure was greater. Radiation rates were higher in the past due to the use of old x-ray technology and slower speed film. The ADA encourages further research in the interest of patient safety.

As part of the ADA’s recommendations to minimize radiation exposure, the ADA encourages the use of abdominal shielding (e.g., protective aprons) and thyroid collars on all patients. In addition, the ADA recommends that dentists use E or F speed film, the two fastest film speeds available, or a digital x -ray.
In addition to the X-ray recommendations, the ADA’s Council on Scientific Affairs will publish clinical guidance on the use of cone-beam computed tomography in an upcoming issue of The Journal of the American Dental Association. The ADA will share these recommendations as soon as they are available.

Dental X-rays are valuable in helping dentists detect and treat oral health problems at an early stage. Many oral diseases can’t be detected on the basis of a visual and physical examination alone, and dental X-rays are valuable in providing information about a patient’s oral health such as early-stage cavities, gum diseases, infections or some types of tumors. How often dental X-rays should be taken depends on the patient’s oral health condition, age, risk for disease and any signs and symptoms of oral disease that the patient might be experiencing.

The ADA encourages patients to talk to their dentists if they have questions about their dental treatment. As a science-based organization, the ADA fully supports continuing research that helps dentists deliver high-quality oral health care safely and effectively.

Screening For Alcohol Abuse At The Dentist's

In a report published in the April edition of the Royal College of Surgeon's Dental Journal, health experts warn that excessive alcohol consumption causes mouth cancer and dental disease. According to the experts, in order to tackle this as fast as possible, screening and treatment for alcohol abuse is critical.

The paper is entitled "Alcohol misuse: screening and treatment in primary dental care."

According to the paper, individuals do not visit their GP unless they are ill, whereas the majority of people visit their dentist for a routine check-up, as a result dentists have the chance to identify alcohol abuse.

Given that questioning patients with regard to their alcohol consumption is a routine component of understanding their overall health, making standard questions about alcohol consumption more explicit under the new policy proposals could provide a new opportunity to help people in their fight against drinking problems, which has so far been left untouched.

Lead author of the paper, Jonathan Shepherd, Professor of Oral and Maxillofacial Surgery, explained:

"Excessive alcohol consumption can lead to cancer of the mouth, larynx and oesophagus and dentists may be the first to notice these conditions. So we need to introduce an alcohol screening tool that reliably detects hazardous and harmful drinking alongside effective treatment."



According to the paper, approximately 1 in 5 men in the UK and 1 in 7 women often drink excessive amounts of alcohol - costing the UK economy around £25 billion every year. Encouraging moderation in alcohol consumption in primary dental settings could help to lower the social, economic and health burdens linked to excessive alcohol consumption.

The authors state that identifying and tackling alcohol abuse at the dentist would significantly contribute towards the Government's health priorities.

Shepherd concluded:

"The dental team has a responsibility to promote overall health and not just dental health. Dentists and the Government must work together to develop and deliver screening and treatment by intervening early."

Dental plaque bacteria may trigger blood clots

Ω

Oral bacteria that escape into the bloodstream are able to cause blood clots and trigger life-threatening endocarditis. Further research could lead to new drugs to tackle infective heart disease, say scientists presenting their work at the Society for General Microbiology's Spring Conference in Dublin this week.

Streptococcus gordonii is a normal inhabitant of the mouth and contributes to plaque that forms on the surface of teeth. If these bacteria enter into the blood stream through bleeding gums they can start to wreak havoc by masquerading as human proteins.

Researchers from the Royal College of Surgeons in Ireland (RCSI) and the University of Bristol have discovered that S. gordonii is able to produce a molecule on its surface that lets it mimic the human protein fibrinogen – a blood-clotting factor. This activates the platelets, causing them to clump inside blood vessels. These unwanted blood clots encase the bacteria, protecting them from the immune system and from antibiotics that might be used to treat infection. Platelet clumping can lead to growths on the heart valves (endocarditis), or inflammation of blood vessels that can block the blood supply to the heart or brain.

Dr Helen Petersen who is presenting the work said that better understanding of the relationship between bacteria and platelets could ultimately lead to new treatments for infective endocarditis. "In the development of infective endocarditis, a crucial step is the bacteria sticking to the heart valve and then activating platelets to form a clot. We are now looking at the mechanism behind this sequence of events in the hope that we can develop new drugs which are needed to prevent blood clots and also infective endocarditis," she said.

Infective endocarditis is treated with surgery or by strong antibiotics – which is becoming more difficult with growing antibiotic resistance. "About 30% of people with infective endocarditis die and most will require surgery for replacement of the infected heart valve with a metal or animal valve," said Dr Petersen. "Our team has now identified the critical components of the S. gordonii molecule that mimics fibrinogen, so we are getting closer to being able to design new compounds to inhibit it. This would prevent the stimulation of unwanted blood clots," said Dr Steve Kerrigan from the RCSI.

The team are also looking more widely at other dental plaque bacteria that may have similar effects to S. gordonii. "We are also trying to determine how widespread this phenomenon is by studying other bacteria related to S. gordonii. What our work clearly shows is how important it is to keep your mouth healthy through regular brushing and flossing, to keep these bacteria in check," stressed Dr Petersen.

Ω

New 'massage method' quadruples protection against tooth decay

Ω


Do you really want to avoid cavities in your teeth? Try massaging them with a high-fluoride toothpaste after lunch. "Rubbing toothpaste onto your teeth increases the fluoride protection by 400%," says Anna Nordström, dentist, PhD and researcher at the Sahlgrenska Academy at the University of Gothenburg, Sweden.

Eight years ago a new brand of toothpaste was launched in Sweden with more than three times as much fluoride as standard toothpaste. Available without prescription, it is aimed primarily at those with high caries risk.

First scientific evaluation

Researchers at the University of Gothenburg's Sahlgrenska Academy have now performed the first scientific evaluation of the effect of this so called "high-fluoride toothpaste". The study has resulted in a new method that quadruples the level of protection from fluoride.

Four times better protection

In the study, 16 volunteers tested a variety of brushing techniques, using either high-fluoride or standard toothpaste, and brushing either two or three times a day. "The study revealed that those who used a high-fluoride toothpaste three times a day had four times better fluoride protection in the mouth than those who used standard toothpaste twice a day," says researcher Anna Nordström from the Institute of Odontology at the Sahlgrenska Academy.

Rub your teeth after lunch

Also tested was a new method developed in collaboration with professor Dowen Birkhed, which involves rubbing toothpaste onto your teeth with a finger. "This 'massage' method proved to be at least as effective as a third brushing in increasing the amount of fluoride in the mouth," Anna Nordström explains. "Rubbing the front of your teeth with toothpaste can be an easy way of giving your teeth a third "shot" of fluoride during the day, after lunch for example. But this should not replace brushing with a fluoride toothpaste morning and evening – it's an extra."

Daily use is essential

Brushing with fluoride toothpaste has played – and continues to play – a major role in combating tooth decay, and there is strong scientific evidence that daily use of fluoride toothpaste has a pronounced preventive effect.

###
The study Effect of a third application of toothpaste (1450 and 5000 ppm F), including a "massage" method, on fluoride retention and pH drop in plaque was published in Acta Odontologica Scandinavia.

Link to article: http://www.ncbi.nlm.nih.gov/pubmed/22320714

Periodontal therapy reduces hospitalizations and medical care costs in diabetics

Ω

Today, during the 41st Annual Meeting & Exhibition of the American Association for Dental Research (AADR), held in conjunction with the 36th Annual Meeting of the Canadian Association for Dental Research, an abstract titled "Periodontal Therapy Reduces Hospitalizations and Medical Care Costs in Diabetics" to determine if periodontal treatment was associated with the number of hospitalizations and cost of medical care among diabetics with periodontal disease.

A longitudinal study compared medical costs for diabetic subjects with periodontal disease who received periodontal treatment versus periodontally untreated controls over a three year period. Subjects were enrolled in Highmark (Blue Cross) medical and United Concordia Companies, Inc. dental plans, and received medical and dental services. The periodontal treatment group was treated in the first year and maintained thereafter. The control group had received incomplete periodontal therapy prior to baseline and did not receive regular maintenance during the study.

"There have been emerging links between oral infections and systemic diseases such as diabetes, which is increasingly prevalent in our population," said lead researcher Marjorie Jeffcoat, professor and dean emeritus of the University of Pennsylvania School of Dental Medicine. "My research team and I had looked at other datasets and we knew that health care costs could be reduced, but we wanted to look at the hospitalizations and see how those could be reduced. This study provided direct insight as to how lower hospitalizations could be achieved through periodontal therapy, and we will further this study by analyzing other chronic diseases and conditions such as heart attacks, strokes and pregnancy with pre-term birth."

Periodontal treatment was associated with a significant decrease in hospital admissions, physician visits and overall cost of medical care in diabetics. Savings averaged $1,814 per patient in a single year. A 33% decrease in hospital admissions was observed.

Ω

Poor dental hygiene puts congenital heart disease patients at risk of further heart damage

Poor dental hygiene behaviours in patients with congenital heart disease are increasing their risk of endocarditis. Teens with congenital heart disease floss, brush and visit the dentist less than their peers. But they have healthier behaviours when it comes to alcohol, cigarettes and illicit drugs. Adults with single ventricle physiology (a type of congenital heart disease) also have poorer dental hygiene practices than their peers despite having better health behaviours overall.

The findings were presented in two studies at the 12th Annual Spring Meeting on Cardiovascular Nursing, 16-17 March, in Copenhagen, Denmark.

"Patients with congenital heart disease are diagnosed and receive their initial treatment in childhood but this does not mean that they are cured," says the supervisor of both studies, Professor Philip Moons, professor in nursing science at the University of Leuven, Belgium, and guest professor at Copenhagen University Hospital, Denmark. "They remain vulnerable for developing complications – for instance we know that in patients with congenital heart disease, binge drinking can trigger life-threatening arrhythmias and good dental hygiene helps prevent endocarditis."

For the first study (FPN 34) 1, lifestyle information was collected from 429 adolescents with congenital heart disease aged 14-19 years from the longitudinal study i-DETACH (Information technology Devices and Education programme for Transitioning Adolescents with Congenital Heart disease). Of these, 401 were matched with a control of the same age and gender without congenital heart disease. All participants completed a questionnaire, developed by the research group of Professor Moons, which measures the use of alcohol, cigarettes and illicit drugs, dental care and physical activity. These behaviours are particularly important to the health of patients with congenital heart disease.

Using results from the questionnaire, the researchers calculated risk scores for 'substance use' (binge drinking; smoking; illicit drug use) and 'dental hygiene' (no dental visits; not brushing; not flossing) ranging from 0𔃁. An 'overall health risk score' (range 0𔃅) was calculated using the substance use risk score, dental hygiene risk score, and the absence of physical activity. The 3 risk scores were transformed to a scale ranging from 0 (no risk) to 100 (maximum risk). Scores were compared across different age groups.

In adolescents with congenital heart disease, substance use increased with age (p<0.001). Compared with matched controls, adolescents with congenital heart disease had significantly lower substance use (p<0.001) and health risk (p<0.001) scores, and significantly higher dental hygiene risk scores (p=0.04).

The results reveal that health risk behaviours are prevalent in adolescents with congenital heart disease and they increase with age. They also show that in general, the health behaviour of adolescents with congenital heart disease is better than their peers except for dental hygiene.

Professor Moons says: "The fact that adolescents with congenital heart disease have better health behaviour overall than the general population is understandable given the amount of input they have had from healthcare professionals over their lives. But we need to do more to understand why their dental hygiene is not as good as expected."

For the second study (FPN 158)², the same questionnaire was used to collect lifestyle information from adults aged 16-48 years (average age 24 years) with a type of congenital heart disease called single ventricle physiology. "This is a very complex congenital heart condition and we know that these patients are more at risk for endocarditis and arrhythmias than the larger population of congenital heart disease patients," says Professor Moons. "This means that their health behaviour is even more important."

A cross sectional, case control study was conducted in 59 patients who were matched on age and gender to 172 healthy controls.

In patients with single ventricle physiology, 85% drank alcohol; 26% were binge drinkers; 20% smoked cigarettes; 12% used cannabis over the past year; 20% had not visited the dentist during the last year; 46% were not flossing teeth; and 39% were not physically active.

Compared to healthy controls, patients with single ventricle physiology had better health behaviours overall. But patients exercised less and their dental hygiene practices (mainly flossing) was poorer.

The only statistically significant differences between patients and controls were for binge drinking and physical activity. A significantly lower proportion of binge drinking was found in patients compared to controls (24% vs 41%). And patients exercised less than controls (61% vs 76%).

"Patients with complex conditions can have physical restrictions so the fact that they are less physically active is perhaps not surprising," says Professor Moons. "But the reasons behind the poorer dental hygiene practices of patients in both studies need to be investigated further."

In the past, efforts to prevent endocarditis in patients with congenital heart disease focused on taking antibiotics one hour before a dental procedure. This prevented bacteria released into the blood from damaged gums travelling to the heart and causing an infection (endocarditis).

But researchers have since discovered that daily dental hygiene is more important for preventing endocarditis than antibiotics before a procedure. Professor Moons says: "This was a change in the American Heart Association 2007 guidelines but not all physicians have switched to that new paradigm. And of course if you switch to that paradigm you also need to educate patients in a systematic way, but a lot of centres are not doing that yet."

He adds: "Systematic structured patient education on the importance of dental hygiene is critical for preventing endocarditis in patients with congenital heart disease."

Successful Dental Implants for Patients Taking Biphosphonates for Osteoporosis

Ω

Reducing a patient’s treatment time and simplifying the treatment can increase patient acceptance and reduce the risk of complications. For dental implants, this means moving away from the traditional two-stage surgical approach toward a one-stage procedure. The success of this concept when combined with another complication—that of patients receiving drug therapy for osteoporosis—was studied to determine the best method of treatment in this situation.

The current issue of the Journal of Oral Implantology reports on adult patients, all taking oral biphosphonates for osteoporotic disease, who received fixed full-arch dental prostheses supported by six implants. Immediate loading procedures were performed, installing the implants in a one-stage surgery.

Osteoporosis is a well-known disease that weakens bone and increases the risk of fracture, particularly among postmenopausal women. Biphosphonates, an inhibitor of bone resorption, are widely used as a drug therapy for those with osteoporosis. Prolonged used of biphosphonates, however, can lead to a painful refractory bone exposure in the jaws, known as “biphosphonate-induced osteonecrosis of the jaw” (BONJ).

This condition usually develops after dental treatment, indicating that oral surgery and implants placed into the jaw bone can precipitate BONJ. Although the process is not fully understood, it appears that prolonged use of biphosphonates may suppress the bone’s repair function, interfering with healing after implants.

In the current study, a total of 54 implants were installed for nine osteoporotic patients, 45 to 68 years old, eight of them female. All had been taking oral biphosphonates for less than three years; a significant increase in risk of developing BONJ is associated with more than three years of biphosphonate therapy.

Immediate occlusal loading procedures were used, which require that motion at the bone-implant interface be kept below a certain threshold during healing. This study demonstrated a 100 percent success rate, with all patients rehabilitated with a full-arch prosthesis supported by implants. Two years of follow-up found no adverse events of infection, tissue swelling, or lesions, showing this to be a viable one-stage treatment.

Full text of the article, “Immediate Loading in Mandible Full-Arch: Pilot Study in Patients With Osteoporosis in Biphosphonate Therapy ,” Journal of Oral Implantology, Vol. 38, No. 1, 2012, is available at http://www.joionline.org/
###

Wash Your Mouth out With Silver, to Treat Hard-To-Treat Mouth Infections?

Ω

Yeasts which cause hard-to-treat mouth infections are killed using silver nanoparticles in the laboratory, scientists have found. These yeast infections, caused by Candida albicans and Candida glabrata target the young, old and immuno-compromised. Professor Mariana Henriques, University of Minho, and her colleagues hope to test silver nanoparticles in mouthwash and dentures as a potential preventative measure against these infections.

Professor Henriques and her team, who recently published their research in the Society for Applied Microbiology's journal Letters in Applied Microbiology, looked at the use of different sizes of silver nanoparticles to determine their anti-fungal properties against Candida albicans and Candida glabrata. These two yeasts cause infections including oral thrush and dental stomatitis, a painful infection affecting around seven out of ten denture wearers. Infections like these are particularly difficult to treat because the microorganisms involved form biofilms.

The scientists used artificial biofilms in conditions which mimic those of saliva as closely as possible. They then added different sizes and concentrations of silver nanoparticles and found that different sizes of nanoparticles were equally effective at killing the yeasts. Due to the diversity of the sizes of nanoparticles demonstrating anti-fungal properties the researchers hope this will enable the nanoparticles to be used in many different applications.

Some researchers have expressed concerns around the safety of nanoparticle use but the authors stress this research is at an early stage and extensive safety trials will be carried out before any product reaches the market.

Professor Henriques comments: With the emergence of Candida infections which are frequently resistant to the traditional antifungal therapies, there is an increasing need for alternative approaches. So, silver nanoparticles appear to be a new potential strategy to combat these infections. As the nanoparticles are relatively stable in liquid medium they could be developed into a mouthwash solution in the near future.

Moving forward Professor Henriques hopes to integrate silver nanoparticles into dentures which could prevent infections from taking hold.

Gum Healing Promoted Around Exposed Roots

Ω

Receding gums often result in tooth sensitivity and can lead to decay of the root and persistent inflammation of the gum. New research published in BioMed Central's open access journal Head & Face Medicine demonstrates that a novel method using bovine collagen is able to enhance gum healing. This resulted in thicker margins around the tooth and, in over half the cases, complete coverage of exposed roots.

Researchers across Germany and Switzerland led by Dr Shahram Ghanaati and the dentist Dr Markus Schlee investigated the possibility of using collagen, extracted from bovine pericardium, to form a support for mending receding gums and exposed roots. The collagen was extracted by a process involving osmotic, oxidative and alkaline treatment. This ensured that the cell walls were broken down, proteins and fats dissolved, and that bacteria, viruses and other pathogens were inactivated and removed.

The study followed 14 otherwise healthy patients with over 60 'recessions' between them. Their damaged teeth were cleaned before surgery and the collagen implants held in place with loops of surgical thread around the affected tooth. Two weeks later the sutures were removed. None of the patients needed antibiotics.

The patients were re-examined after six months to see how well they had recovered. Dr Schlee described the results, "In all cases the healed-over implant improved the look and severity of the recession, and, in over half of all treatments, resulted in total coverage of the exposed root. We would not have expected any of these patients to get better without surgery."

The collagen seems to be able to act as a scaffold for the body's own cells to repair the damage leading to results on a level comparable to that of connective tissue grafts. Bovine collagen is a possible solution for patients with little available donor tissue or for whom multiple surgeries are not an option.

Ω

An Unlikely Bond: Prenatal Health and Dental Hygiene

Ω

Oral health doesn’t always top the list of concerns that expectant mothers may have, but it certainly should. Proper dental health and control of oral disease can safeguard a mother’s health before and during pregnancy and reduces the transmission of bacteria from women to their children. According to numerous studies by the American Congress of Obstetricians and Gynecologists, many women do not seek, nor are instructed to seek, proper oral healthcare as part of their routine prenatal care.

“Caring for a pregnant mother’s teeth and gums should start before she becomes pregnant,” said Doron Kochman, DDS and Associate Clinical Professor of Pediatric Dentistry in the Department of Clinical Dentistry, at the University of Rochester Strong Memorial Hospital, and Eastman Dental Center in Rochester, NY. “Ideally, women who are planning to get pregnant should visit their dentists and have any necessary work done before the pregnancy. Mothers should continue to visit their dentists for routine prevention visits during their pregnancies.”

Due to the natural hormonal fluctuations during pregnancy, gums are more susceptible to swelling and inflammation. Because of this, bacteria can accumulate causing gum disease and further medical complications for both mother and baby. “We now know that the bacteria responsible for gum disease can also cause problems in places other than the mother’s mouth,” said Kochman. Periodontal disease increases the risk that bacteria will enter the bloodstream, causing potential infections in either mother or baby.

Studies have shown a link between periodontal disease in mothers and an increased chance of delivering premature or low birth weight babies. Because many pregnant women routinely experience swollen and bleeding gums after they brush, they may not recognize a true problem if it exists. Regular check-ups before and during pregnancy are highly recommended.

In addition to prematurity and low birth weight, other problems can result from oral health issues. Studies have suggested that periodontal disease can increase the risk for preeclampsia, a life-threatening disorder caused by high blood pressure which usually occurs mid-to-late pregnancy.

People with diabetes are also more likely to have periodontal disease. Diabetic mothers need to be vigilant about their blood glucose levels to protect their unborn children from fetal obesity, high blood insulin levels and blood disorders, among other conditions.

Furthermore, there is growing evidence that if a mother’s oral hygiene is less than optimal, her baby’s oral health can suffer. “An expectant mother’s diet and oral hygiene can affect her baby's teeth,” said Kochman. “The baby’s teeth start developing in the 5th or 6th week after conception. A mother's balanced diet during pregnancy provides the calcium, phosphorous, other minerals and vitamins needed for the baby’s teeth to form properly.”

Most dentists recommend the following tips for expectant moms:
• Brush at least twice a day to remove plaque buildup
• Floss regularly
• Avoid sugary snacks
• Eat a healthy, balanced diet
• Get regular dental exams (speak to your dentist to see what is right for you)

New method for stronger dental implants

Millions of people have bad teeth replaced with implants. Often following the procedure, they are unable to chew food for up to six months, until the implant has become fixated in the bone. Now, for the first time, a drug coating that has been tested on humans allows titanium screws to adhere to the bone better and faster. The Linköping researchers behind the method report that the results are good.

The study, led by Per Aspenberg, professor of orthopaedic surgery at Linköping University, is published in the journal Bone and was highlighted in this week's edition of the British Medical Journal (BMJ).

The implants are screwed into the jawbone and provide purchase for artificial teeth. Using current technology, it may take four to six months before the bone surrounding the screw has healed and is strong enough so the patient can begin to benefit from surgery.

The coating, developed at Linköping University in Sweden, consists of a nanometre-thin layer of protein that attaches to the metal surface. Attached to the protein is a drug belonging to the bisphosphonates, usually used to treat osteoporosis. Several animal studies have shown that this method allows the bone surrounding the implant to rapidly become denser and stronger.

Now, for the first time, this method has been tested on humans. 16 patients each received two implants; one normal and a similar surface-treated implant as described above. Neither the patient nor the dental surgeon knew which was which. After six months it was noted that for 15 of the 16 patients the treated screw was markedly much better established. Already after two months X-ray images showed positive changes adjacent to the treated screws. No complications occurred.

“It is the first time ever anyone has succeeded in reinforcing the bone around an implant with localised medication”, says Per Aspenberg, professor of orthopaedics, who devised the method of using bisphosphonates in this way.

Pentti Tengvall, professor of biomaterials, developed the method of adhering the drug to the screw and the study was conducted by Jahan Abtahi, specialist MD and PhD, supported by Per Aspenberg. Addbio AB is a Linköping based company now working on commercializing the surface treatment for different types of implants in bone.

Article:
A bisphosphonate-coating improves the fixation of metal implants in human bone. A randomized trial of dental implants by Jahan Abtahi, Pentti Tengvall and Per Aspenberg. The journal ‘Bone’ (in press), published online 10 February 2012.

Dental pulp stem cells transformed by 'bad breath' chemical

Ω

Japanese scientists have found that the odorous compound responsible for halitosis – otherwise known as bad breath – is ideal for harvesting stem cells taken from human dental pulp.

In a study published today, Monday 27 February, in IOP Publishing's Journal of Breath Research, researchers showed that hydrogen sulphide (H2S) increased the ability of adult stem cells to differentiate into hepatic (liver) cells, furthering their reputation as a reliable source for future liver-cell therapy.

This is the first time that liver cells have been produced from human dental pulp and, even more impressively, have been produced in high numbers of high purity.

"High purity means there are less 'wrong cells' that are being differentiated to other tissues, or remaining as stem cells. Moreover, these facts suggest that patients undergoing transplantation with the hepatic cells may have almost no possibility of developing teratomas or cancers, as can be the case when using bone marrow stem cells," said lead author of the study Dr. Ken Yaegaki.

The remarkable transforming ability of stem cells has led to significant focus from research groups around the world and given rise to expectations of cures for numerable diseases, including Parkinson's and Alzheimer's.

In this study, Dr. Ken Yaegaki and his group, from Nippon Dental University, Japan, used stem cells from dental pulp – the central part of the tooth made up of connective tissue and cells – which were obtained from the teeth of dental patients who were undergoing routine tooth extractions.

Once the cells were sufficiently prepared, they were separated into two batches (a test and a control) and the test cells incubated in a H2S chamber. They were harvested and analysed after 3, 6 and 9 days to see if the cells had successfully transformed into liver cells.

To test if the cells successfully differentiated under the influence of H2S, the researchers carried out a series of tests looking at features that were characteristic of liver cells. In addition to physical observations under the microscope, the researchers investigated the cell's ability to store glycogen and then recorded the amount of urea contained in the cell.

"Until now, nobody has produced the protocol to regenerate such a huge number of hepatic cells for human transplantation. Compared to the traditional method of using fetal bovine serum to produce the cells, our method is productive and, most importantly, safe" continued Dr. Yaegaki.

Hydrogen sulphide (H2S) has the characteristic smell of rotten eggs and is produced throughout the body in the tissues. Although its exact function is unknown, researchers have been led to believe that it plays a key role in many physiological processes and disease states.

Ω