Expectant mothers' periodontal health vital to health of her baby

When a woman becomes pregnant, she knows it is important to maintain a healthy lifestyle to ensure both the health of herself and the health of her baby. New clinical recommendations from the American Academy of Periodontology (AAP) and the Eurpean Federation of Periodontology (EFP) urge pregnant women to maintain periodontal health as well. Research has indicated that women with periodontal disease may be at risk of adverse pregnancy outcomes, such giving birth to a pre-term or low-birth weight baby, reports the AAP and EFP.

Periodontal disease is a chronic, bacteria-induced, inflammatory condition that attacks the gum tissue and in more severe cases, the bone supporting the teeth. If left untreated, periodontal disease, also known as gum disease, can lead to tooth loss and has been associated with other systemic diseases, such as diabetes and cardiovascular disease.

"Tenderness, redness, or swollen gums are a few indications of periodontonal disease," warns Dr. Nancy L. Newhouse, DDS, MS, President of the AAP and a practicing periodontist in Independence, Missouri. "Other symptoms include gums that bleed with toothbrushing or eating, gums that are pulling away from the teeth, bad breath, and loose teeth. These signs, especially during pregnancy, should not be ignored and may require treatment from a dental professional."

Several research studies have suggested that women with periodontal disease may be more likely to deliver babies prematurely or with low-birth weight than mothers with healthy gums. According to the Center for Disease Control and Prevention (CDC), babies with a birth weight of less than 5.5 pounds may be at risk of long-term health problems such as delayed motor skills, social growth, or learning disabilities. Similar complications are true for babies born at least three weeks earlier than its due date. Other issues associated with pre-term birth include respiratory problems, vision and hearing loss, or feeding and digestive problems.

The medical and dental communities concur that maintaining periodontal health is an important part of a healthy pregnancy. The clinical recommendations released by the AAP and the EFP state that non-surgical periodontal therapy is safe for pregnant women, and can result in improved periodontal health. Published concurrently in the Journal of Periodontology and Journal of Clinical Periodontology, the report provides guidelines for both dental and medical professionals to use in diagnosing and treating periodontal disease in pregnant women. In addition, the American College of Obstetricians and Gynecologists recently released a statement encouraging pregnant women to sustain their oral health and recommended regular dental cleanings during pregnancy.

"Routine brushing and flossing, and seeing a periodontist, dentist, or dental hygienist for a comprehensive periodontal evaluation during pregnancy may decrease the chance of adverse pregnancy complications," says Dr. Newhouse. "It is important for expectant mothers to monitor their periodontal health and to have a conversation with their periodontist or dentist about the most appropriate care. By maintaining your periodontal health, you are not only supporting your overall health, but also helping to ensure a safe pregnancy and a healthy baby," says Dr. Newhouse.

Poor oral health linked to cancer-causing oral HPV infection

Poor oral health, including gum disease and dental problems, was found to be associated with oral human papillomavirus (HPV) infection, which causes about 40 percent to 80 percent of oropharyngeal cancers, according to a study published in Cancer Prevention Research, a journal of the American Association for Cancer Research.

"Poor oral health is a new independent risk factor for oral HPV infection and, to our knowledge, this is the first study to examine this association," said Thanh Cong Bui, Dr.P.H., postdoctoral research fellow in the School of Public Health at the University of Texas Health Sciences Center in Houston. "The good news is, this risk factor is modifiable — by maintaining good oral hygiene and good oral health, one can prevent HPV infection and subsequent HPV-related cancers."

The researchers found that among the study participants, those who reported poor oral health had a 56 percent higher prevalence of oral HPV infection, and those who had gum disease and dental problems had a 51 percent and 28 percent higher prevalence of oral HPV infection, respectively. In addition, the researchers were able to associate oral HPV infections with number of teeth lost.

Similar to genital HPV infection, oral HPV infection can be of two kinds: infection with low-risk HPV types that do not cause cancer, but can cause a variety of benign tumors or warts in the oral cavity, and infection with high-risk HPV types that can cause oropharyngeal cancers.

Bui, Christine Markham, Ph.D., and colleagues used data from the 2009-2010 National Health and Nutrition Examination Survey (NHANES) conducted by the National Center for Health Statistics of the Centers for Disease Control and Prevention. This survey consisted of a nationally representative sample of about 5,000 people recruited each year, located in counties across the United States.

The researchers identified 3,439 participants aged 30 to 69 years from NHANES, for whom data on oral health and the presence or absence of 19 low-risk HPV types and 18 high-risk HPV types in the oral cavity were available. Oral health data included four measures of oral health: self-rating of overall oral health, presence of gum disease, use of mouthwash to treat dental problems within past seven days of the survey, and number of teeth lost. They examined data on age, gender, marital status, marijuana use, cigarette smoking, and oral sex habits, among others, which influence HPV infection.

The researchers found that being male, smoking cigarettes, using marijuana, and oral sex habits increased the likelihood of oral HPV infection. They also found that self-rated overall oral health was an independent risk factor for oral HPV infection, because this association did not change regardless of whether or not the participants smoked or had multiple oral sex partners.

Because HPV needs wounds in the mouth to enter and infect the oral cavity, poor oral health, which may include ulcers, mucosal disruption, or chronic inflammation, may create an entry portal for HPV, said Bui. There is, however, currently not enough evidence to support this, and further research is needed to understand this relationship, he said.

"Although more research is needed to confirm the causal relationship between oral health and oral HPV infection, people may want to maintain good oral health for a variety of health benefits," said Bui. "Oral hygiene is fundamental for oral health, so good oral hygiene practices should become a personal habit."

A Glass of Milk After Eating Sugary Cereals May Prevent Cavities

Washing down sugary breakfast cereal with milk after eating reduces plaque acid levels and may prevent damage to tooth enamel that leads to cavities, according to new research at the University of Illinois at Chicago College of Dentistry.

Dry ready-to-eat, sugar-added cereals combine refined sugar and starch. When those carbohydrates are consumed, bacteria in the dental plaque on tooth surfaces produce acids, says Christine Wu, professor of pediatric dentistry and director of cariology, who served as principal investigator of the study.

The research is published in the July issue of the Journal of the American Dental Association.

Reports have shown that eating carbohydrates four times daily, or in quantities greater than 60 grams per person per day, increases the risk of cavities.

The new study, performed by Wu's former graduate student Shilpa Naval, involved 20 adults eating 20 grams of dry Froot Loops cereal, then drinking different beverages -- whole milk, 100 percent apple juice, or tap water.

Plaque pH, or acidity, was measured with a touch microelectrode between the premolar teeth before eating; at two and five minutes after eating; and then two to 30 minutes after drinking a liquid.

The pH in plaque dropped rapidly after consuming cereal alone, and remained acidic at pH 5.83 at 30 minutes. A pH below 7 is acidic; a pH greater than 7 is basic. Pure water has a pH close to 7.

Participants who drank milk after eating sugary cereal showed the highest pH rise, from 5.75 to 6.48 at 30 minutes. Those who drank apple juice remained at pH 5.84 at 30 minutes, while water raised the pH to 6.02.

Fruit juices are considered healthy food choices, but the added sugar can be a risk to dental health, Wu said.

"Our study results show that only milk was able to reduce acidity of dental plaque resulting from consuming sugary Froot Loops," said Naval, who is currently a fellow at the Centers for Disease Control and Prevention in Atlanta. "We believe that milk helped mitigate the damaging effect of fermentable carbohydrate and overcome the previously lowered plaque pH."

Milk, with a pH ranging from 6.4 to 6.7, is considered to be a functional food that fights cavities because it promotes tooth remineralization and inhibits the growth of plaque, Wu said.

Wu says most consumers think that since milk is considered to be cavity-fighting, acid production by plaque bacteria can be minimized by mixing it with cereal. However, in an unpublished study in her lab, it was discovered that the combination of Froot Loops and milk became syrupy. Eating cereal combined with milk lowered plaque pH to levels similar to that obtained after rinsing with a 10 percent sugar solution.

Eating sugar-added cereal with milk, followed by drinking fruit juice is thus a highly cavity-causing combination, Wu said.

Diet plays an important role in oral health, Wu said. Studies of food intake and cavities have focused mainly on the sugar, or carbohydrate, content. Fewer studies have looked at how combinations of food, and the order in which they are eaten, may help fight cavities.

"Results from a previous study suggested that the last food item consumed exerts the greatest influence on subsequent plaque pH," she said. For example, eating cheese after a sugary meal reduces acid production, and consumers can modify their diet in such a way as to prevent the cavity-causing effects of sugary foods."

"If understood and implemented properly, food sequencing can be used as a public health educational tool to maintain and preserve good oral health," said Naval.