Olympians say poor oral health is impairing performance

Many of the elite sportsmen and women who competed at the London 2012 Olympic Games had poor levels of oral health similar to those experienced by the most disadvantaged populations. 18 per cent of athletes surveyed said their oral health was having a negative impact on their performance.

The research, which was led by Professor Ian Needleman at the UCL Eastman Dental Institute, is published in the British Journal of Sports Medicine.

The researchers recruited 302 athletes to take part in the study at the Dental Clinic in the London 2012 athletes' village. The athletes represented 25 different sports, with 95 (34.9 per cent) competing in track and field, 38 (14 per cent) boxing and 31 (11.4 per cent) playing hockey. The athletes were given a systematic oral health check-up before being asked to give a personal assessment of the impact of oral health on their quality of life and athletic training/performance.

Overall, the research team found high levels of poor oral health with 55 per cent of athletes suffering from dental caries (tooth decay), of which 41 per cent was into the dentine (and therefore irreversible). More than three quarters of the participants had gingivitis (early stage gum disease) with 15 per cent showing signs of periodontitis, an irreversible gum infection in the soft tissue around the teeth.

42 per cent of athletes taking part in the study said that they were, "bothered by oral health" issues, with 28 per cent saying that it affected their quality of life. Almost one in five (18 per cent) athletes said that they believed poor oral health was negatively affecting their training or performance levels.

Nearly half of participants (46.5 per cent) had not attended for a dental examination or hygiene care in the previous year, while 8.7 per cent said they had never been to the dentist.

Professor Ian Needleman, lead author of the paper at the UCL Eastman Dental Institute, said: "Oral health is important for wellbeing and successful elite sporting performance. It is amazing that many professional athletes – people who dedicate a huge amount of time and energy to honing their physical abilities – do not have sufficient support for their oral health needs, even though this negatively impacts on their training and performance.

"Oral health assessment should be part of every athlete's routine medical care," continues Professor Needleman. "If we are going to help them optimise their level of performance we need to concentrate on oral health promotion and disease prevention strategies to facilitate the health and wellbeing of all our elite athletes."

In the report the authors speculate that the associations between oral health, wellbeing and performance might be explained by oral disease causing pain, systemic inflammation and a reduction in self-confidence and quality of life.

Previous studies have repeatedly found athletes to have poor oral health, something which might result from frequent carbohydrate intake, a reduced immune function through intensive training and a lack of awareness about the links between oral health and elite performance.

Are nanodiamond-encrusted teeth the future of dental implants?

UCLA researchers have discovered that diamonds on a much, much smaller scale than those used in jewelry could be used to promote bone growth and the durability of dental implants.

Nanodiamonds, which are created as byproducts of conventional mining and refining operations, are approximately four to five nanometers in diameter and are shaped like tiny soccer balls. Scientists from the UCLA School of Dentistry, the UCLA Department of Bioengineering and Northwestern University, along with collaborators at the NanoCarbon Research Institute in Japan, may have found a way to use them to improve bone growth and combat osteonecrosis, a potentially debilitating disease in which bones break down due to reduced blood flow.

When osteonecrosis affects the jaw, it can prevent people from eating and speaking; when it occurs near joints, it can restrict or preclude movement. Bone loss also occurs next to implants such as prosthetic joints or teeth, which leads to the implants becoming loose — or failing.

Implant failures necessitate additional procedures, which can be painful and expensive, and can jeopardize the function the patient had gained with an implant. These challenges are exacerbated when the disease occurs in the mouth, where there is a limited supply of local bone that can be used to secure the prosthetic tooth, a key consideration for both functional and aesthetic reasons.

The study, led by Dr. Dean Ho, professor of oral biology and medicine and co-director of the Jane and Jerry Weintraub Center for Reconstructive Biotechnology at the UCLA School of Dentistry, appears online in the peer-reviewed Journal of Dental Research.

During bone repair operations, which are typically costly and time-consuming, doctors insert a sponge through invasive surgery to locally administer proteins that promote bone growth, such as bone morphogenic protein.

Ho's team discovered that using nanodiamonds to deliver these proteins has the potential to be more effective than the conventional approaches. The study found that nanodiamonds, which are invisible to the human eye, bind rapidly to both bone morphogenetic protein and fibroblast growth factor, demonstrating that the proteins can be simultaneously delivered using one vehicle. The unique surface of the diamonds allows the proteins to be delivered more slowly, which may allow the affected area to be treated for a longer period of time. Furthermore, the nanodiamonds can be administered non-invasively, such as by an injection or an oral rinse.

"We've conducted several comprehensive studies, in both cells and animal models, looking at the safety of the nanodiamond particles," said Laura Moore, the first author of the study and an M.D.-Ph.D. student at Northwestern University under the mentorship of Dr. Ho. "Initial studies indicate that they are well tolerated, which further increases their potential in dental and bone repair applications."

"Nanodiamonds are versatile platforms," said Ho, who is also professor of bioengineering and a member of the Jonsson Comprehensive Cancer Center and the California NanoSystems Institute. "Because they are useful for delivering such a broad range of therapies, nanodiamonds have the potential to impact several other facets of oral, maxillofacial and orthopedic surgery, as well as regenerative medicine."

Ho's team previously showed that nanodiamonds in preclinical models were effective at treating multiple forms of cancer. Because osteonecrosis can be a side effect of chemotherapy, the group decided to examine whether nanodiamonds might help treat the bone loss as well. Results from the new study could open the door for this versatile material to be used to address multiple challenges in drug delivery, regenerative medicine and other fields.

"This discovery serves as a foundation for the future of nanotechnology in dentistry, orthopedics and other domains in medicine," said Dr. No-Hee Park, dean of the School of Dentistry. "Dr. Ho and his team have demonstrated the enormous potential of the nanodiamonds toward improving patient care. He is a pioneer in his field."

Bacteria responsible for gum disease facilitates development and progression of rheumatoid arthritis

Does gum disease indicate future joint problems? Although researchers and clinicians have long known about an association between two prevalent chronic inflammatory diseases - periodontal disease and rheumatoid arthritis (RA) - the microbiological mechanisms have remained unclear.

In an article published today in PLoS Pathogens, University of Louisville School of Dentistry Oral Health and Systemic Diseases group researcher Jan Potempa, PhD, DSc, and an international team of scientists from the European Union’s Gums and Joints project have uncovered how the bacterium responsible for periodontal disease, Porphyromonas gingivalis worsens RA by leading to earlier onset, faster progression and greater severity of the disease, including increased bone and cartilage destruction.

The scientists found that P. gingivalis produces a unique enzyme, peptidylarginine deiminanse (PAD) which then enhances collagen-induced arthritis (CIA), a form of arthritis similar to RA produced in the lab. PAD changes residues of certain proteins into citrulline, and the body recognizes citullinated proteins as intruders, leading to an immune attack. In RA patients, the subsequent result is chronic inflammation responsible for bone and cartilage destruction within the joints.

Potempa and his team studied another oral bacterium, Prevotella intermedia for the same affect, but learned it did not produce PAD, and did not affect CIA.

“Taken together, our results suggest that bacterial PAD may constitute the mechanistic link between P. gingivalis periodontal infection and rheumatoid arthritis, but this ground-breaking conclusion will need to be verified with further research,” he said.

Potempa said he is hopeful these findings will shed new light on the treatment and prevention of RA.

Studies indicate that compared to the general population, people with periodontal disease have an increased prevalence of RA and, periodontal disease is at least two times more prevalent in RA patients. Other research has shown that a P. gingivalis infection in the mouth will precede RA, and the bacterium is the likely culprit for onset and continuation of the autoimmune inflammatory responses that occur in the disease.