Diabetes may weaken teeth and promote tooth decay

 

People with either type 1 or Type 2 diabetes are prone to tooth decay, and a new study from Rutgers may explain why: reduced strength and durability of enamel and dentin, the hard substance under enamel that gives structure to teeth.

Researchers induced Type 1 diabetes in 35 mice and used a Vickers microhardness tester to compare their teeth with those of 35 healthy controls over 28 weeks. Although the two groups started with comparable teeth, enamel grew significantly softer in the diabetic mice after 12 weeks, and the gap continued to widen throughout the study. Significant differences in dentin microhardness arose by week 28.

“We’ve long seen elevated rates of cavity formation and tooth loss in patients with diabetes, and we’ve long known that treatments such as fillings do not last as long in such patients, but we did not know exactly why,” said Mohammad Ali Saghiri, an assistant professor of restorative dentistry at the Rutgers School of Dental Medicine.

The study advances a multiyear effort by Saghiri and other researchers to understand how diabetes affects dental health and to develop treatments that counter its negative impact. Previous studies have established that people with both types of diabetes have significantly elevated rates of most oral health issues, both in the teeth and the soft tissues that surround them. Saghiri and other researchers also have demonstrated that diabetes can interfere with the ongoing process of adding minerals to teeth as they wear away from normal usage.

“This is a particular focus of mine because the population of people with diabetes continues to grow rapidly,” Saghiri said. “There is a great need for treatments that will allow patients to keep their teeth healthy, but it has not been a major area for research.”

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JOURNAL

Archives of Oral Biology

DOI

10.1016/j.archoralbio.2022.105434 

Crisis in dental care for people with severe mental illness

 

People with severe mental illnesses are falling through the cracks when it comes to oral health care, according to new research.

The study explores the reasons why people with severe mental illness – such as Schizophrenia and bipolar disorder – struggle to maintain good oral health and access dental care, leaving them three times more likely than the general population to lose all their teeth.

The research found a lack of integration of oral, mental and physical health care services and lack of tailored support for accessing dental care to be contributing factors. 

The study highlights the need for mental health care staff to provide support for good oral health. Dental care providers would also benefit from training to increase their knowledge of the needs of people with severe mental illness, the research suggests.

Availability of care was flagged by the study as a major issue with recent reports suggesting as many as nine out of ten NHS dental practices in England are now closed to new routine patients. 

Lead author of the study Dr Masuma Mishu from the Department of Health Sciences at the University of York, said: “People with severe mental illness have poorer oral health compared to those without mental illness and untreated tooth decay is a common cause of non-psychiatric hospital admissions for this group. Our study addresses the urgent need to understand the reasons behind these oral health inequalities.” 

Co-author of the study, Professor Lina Gega from the Department of Health Sciences at the University of York, added: “During a mental health crisis, physical health can be overshadowed; this includes oral health which can lead to long-term dental problems, pain and oral disease. 

“We are calling for oral health to be incorporated into care planning for those experiencing severe mental health problems. Offering support such as organised accompanied visits to the dentist can help alleviate anxieties and overcome practical barriers around dental check-ups and treatment.”

The qualitative study involved seven participants with severe mental health conditions. A further ten participants were healthcare professionals including dentists, carers, mental health nurses and doctors. 

Participants in the study also identified costs as a key barrier to accessing dental care. 

One participant with a diagnosis of bipolar disorder said: “Because it’s having access to quality dental care and if it’s costing you 45 quid to go now and a bit of a squirt and clean 45 quid is, you know well that’s Monday, Tuesday, Wednesday, Thursday’s benefits for me well what shall we not pay? Shall we not pay my rent, shall we not pay my council tax; so I am not going to see my kids, yeah; no, I am okay with brown teeth and a bit of plaque. You know you’re asking people to make those sort of choices.”

The researchers are now seeking further funding inorder to trial interventions. 

Dr Mishu added: “Working closely with service users, carers, public health researchers and partners in the NHS, we want to co-design a system level intervention for people with severe mental illness. This will be designed to encourage training and the provision of collaborative support from both mental and dental health care staff. We aim to provide comprehensive tailored support - from encouraging personal oral health care to arranging accompanied dental visits and help with paperwork allowing patients to access additional funding. 

“Overall this will promote a culture of discussing oral health care in mental health care settings and will enable people with severe mental illness to engage and learn about good oral health”.

A Qualitative Study Exploring the Barriers and Facilitators for Maintaining Oral Health and Using Dental Service in People with Severe Mental Illness: Perspectives from Service Users and Service Providers is published in the International Journal of Environmental Research and Public Health. The study was led by researchers at the University of York and was funded by Closing the Gap Network. 

 

First U.S. study analyzing tooth survival after root canal in general population

 Teeth survive about 11 years after a root canal, according to new research from Regenstrief Institute and Indiana University School of Dentistry. The groundbreaking study is the first to analyze records from community dental practices, where most Americans receive dental care.

“The findings of this study give deeper insight into the longevity of dental procedures because it provides real-world data on a wider range of patients, not just those receiving care in large health systems or those who are insured,” said first author Thankam Thyvalikakath, DMD, MDS, PhD, director of the Regenstrief-IU School of Dentistry dental informatics program. “This information can be used to inform dental practice, and help patients and dentists make better care decisions.”

Root canals are an important treatment to maintain natural teeth affected by disease. However, over time, the treated tooth eventually becomes brittle and dies. Understanding the outcomes of the procedure is essential to improving dental treatments. 

For this study, the research team gathered deidentified electronic dental records from the National Dental Practice-Based Research Network, consisting of 99 small group and solo dentistry practices from around the country. The data covered more than 46,000 patients who received root canals. 

Breaking down the root canal data 

Data analysis revealed that the median survival time of a tooth after a root canal is 11.1 years. However, several factors can impact that, including follow-up treatments.

• Teeth that receive a root canal, and a subsequent filling and crown last about 20 years. 
• Teeth that receive either a filling or a crown after a root canal last around 11 years. 
• Teeth that receive no restorative work after a root canal only last about 6.5 years.  

There were also wide disparities in longevity among geographic regions. 

• Northeast -- 20.5 years 
• Midwest – 11.2 years 
• Southwest – 11.2 years 
• South Atlantic – 9.1 years 
• South Central – 9.0 years 
• Western – 8.7 years  

Insurance status also played a significant role in tooth survival time.   

“This data could also inform dental insurance coverage by demonstrating the value of crowns and permanent restoration options,” said Dr. Thyvalikakath. “Oral health is a public health issue that significantly affects people’s overall health. Leveraging dental records can help us better understand ways to improve treatment, identify causal relationships and maintain the health of teeth and gums.”

This study provides more representative data of the overall population than previous studies. It also demonstrates that meaningful insights can be gained through analysis of existing data from routine dental care. 

“Root canal treatment survival analysis in National Dental PBRN practices,” is published in the Journal of Dental Research. This work was supported by National Institutes of Health grants U19-DE-28717 and U19-DE-22516.

In addition to Dr. Thyvalikakath, authors on the paper are Michelle LaPradd, M.S., IU School of Medicine at the time of the study; Zasim Siddiqui, BDS, M.S., IU School of Dentistry at the time of the study; William D. Duncan, PhD, M.S., Biomedical Data Science and Shared Resource, Roswell Park Cancer Center at the time of the study; George Eckert, M.S., IU School of Medicine; Jayanth Kumar Medam, M.S., IU School of Dentistry; D. Brad Rindal, DDS, and Mark Jurkovich, DDS, both of HealthPartners Institute; and Gregg H. Gilbert, DDS, MBA, the National Dental Practice-Based Research Network.