Gum infection may be a risk factor for heart arrhythmia, researchers find

Periodontitis, a gum disease, can lead to a litany of dental issues from bad breath to bleeding and lost teeth. Now, researchers at Hiroshima University have found that it could be connected to even more severe problems elsewhere in the body — the heart. 

In a study published on Oct. 31 in JACC: Clinical Electrophysiology, the team found a significant correlation between periodontitis and fibrosis — scarring to an appendage of the heart’s left atrium that can lead to an irregular heartbeat called atrial fibrillation — in a sample of 76 patients with cardiac disease. 

“Periodontitis is associated with a long-standing inflammation, and inflammation plays a key role in atrial fibrosis progression and atrial fibrillation pathogenesis,” said first author Shunsuke Miyauchi, assistant professor with the Hiroshima University’s Health Service Center. He is also affiliated with the university’s Graduate School of Biomedical and Health Sciences. “We hypothesized that periodontitis exacerbates atrial fibrosis. This histological study of left atrial appendages aimed to clarify the relationship between clinical periodontitis status and degree of atrial fibrosis.”

The left atrial appendages were surgically removed from the patients, and the researchers analyzed the tissue to establish the correlation between severity of the atrial fibrosis and severity of the gum disease. They found that the worse the periodontitis, the worse the fibrosis, suggesting that the inflammation of gums may intensify inflammation and disease in the heart. 

“This study provides basic evidence that periodontitis can aggravate atrial fibrosis and can be a novel modifiable risk factor for atrial fibrillation,” said corresponding author Yukiko Nakano, professor of cardiovascular medicine in Hiroshima University’s Graduate School of Biomedical and Health Sciences. 

According to Nakano, in addition to improving other risk factors such as weight, activity levels, tobacco and alcohol use, periodontal care could aid in comprehensive atrial fibrillation management. However, she cautioned that this study did not establish a causal relationship, meaning that while gum disease and atrial fibrosis degrees of severity appear connected, researchers have not found that one definitively leads to the other. 

“Further evidence is required for establishing that periodontitis contributes to the atrial fibrosis in a causal manner and that periodontal care can alter fibrosis,” Nakano said. “One of our goals is to confirm that periodontitis is a modifiable risk factor for atrial fibrillation and to promote dental specialists’ participation in comprehensive atrial fibrillation management. Periodontitis is an easy modifiable target with lower cost among known atrial fibrillation risk factors. Thus, the achievement of this study series may bring benefits for many people worldwide.”

Heavy smokers with severe periodontitis receive no benefit from treatment

 

IMAGE: HEAVY SMOKERS SHOULD BE OFFERED HELP TO QUIT SMOKING IF THEY SUFFER FROM SEVERE PERIODONTITIS, SAYS JULIE PAJANIAYE, RESEARCHER AND DENTAL HYGIENIST. view more 

CREDIT: AU HEALTH

Smoking can have a serious impact on the effect of the treatment of periodontitis – a widespread condition that leads to degradation of the teeth’s supportive tissue and, in serious cases, to loss of the teeth.

This is shown by a new study from Aarhus University which has just been published in the Journal of Dental Research.

The researchers studied the effect of different levels of smoking on the clinical results of the treatment of more or less advanced cases of periodontitis.

The study shows that heavy smokers with the most severe forms of inflammation obtained no benefit from the treatment, while heavy smokers with moderate periodontitis only had a 50 percent effect from the treatment, compared to smokers with less tobacco consumption.

“To our surprise, we could see that the disease had actually grown worse in some parameters in the hardest-hit group, despite the fact that this particular group had received the most extensive, individually-designed treatment,” says Julie Pajaniaye MHH, a dental hygienist and one of the authors behind the study.

Should be offered help to quit smoking

It is estimated that around 40 per cent of the population is affected by periodontitis, but there is a great deal of variation in how severely the disease develops in each individual patient. Around 18 percent of Danes smoke on a daily basis, or occasionally.

The treatment of the disease is adapted to the individual patient, including deep cleansings of the affected teeth, information about the harmful effects of smoking and, in some cases, surgery.

According to Julie Pajaniaye, the study illustrates the need for politicians and decision-makers to better incorporate referrals to smoking cessation courses in the treatment of periodontitis when developing new clinical guidelines and performance descriptions.

“This is completely new knowledge for the country’s dental clinics, and it should be taken into account when treatment is being planned for the individual patients,” she says.

Crucial knowledge in treatment

Dentists and dental hygienists currently refer patients to quit-smoking courses only to a limited extent as part of the treatment of periodontitis.

This should be changed, according to Julie Pajaniaye – not least because, for the first time, the study shows that in the case of heavy smokers, a worsening of the disease may occur during a period of active treatment.

“As a heavy smoker with periodontitis, it is very important to understand that working towards stopping smoking is a crucial step in the effective treatment of the disease,” says Julie Pajaniaye.

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Behind the research results

• Type of study: Prospective clinical cohort study which included 80 smokers with periodontitis resident in the city of Aarhus
• Funding: Health, AU and the Danish Dental Association
• Partners: Aarhus Municipality - Public Health Aarhus
• Potential conflicts of interest: None
• Link to the scientific article: https://pubmed.ncbi.nlm.nih.gov/36333874/

Contact: 

Dental hygienist and Master of Humanities and Health Studies (MHH), Julie Pajaniaye
Department of Dentistry and Oral Health, Aarhus University.
Mail: jp@dent.au.dk
Phone: +45 87168263

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JOURNAL

Journal of Dental Research

METHOD OF RESEARCH

Observational study

Towards better dental cavity diagnosis with nondestructive infrared imaging

Researchers test and compare different imaging-based methods to accurately detect active dental cavities

Peer-Reviewed Publication

SPIE--INTERNATIONAL SOCIETY FOR OPTICS AND PHOTONICS

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IMAGE: WHEN COMBINED WITH AIR DRYING, SHORTWAVE-INFRARED CAN BE USED TO DETECT ACTIVE DENTAL CAVITIES. THIS IS POSSIBLE BECAUSE ACTIVE CAVITIES ARE POROUS AND HOLD MORE WATER, WHICH AFFECTS THE INFRARED MEASUREMENTS AROUND THE AFFECTED AREA AS THE TOOTH DRIES. view more 

CREDIT: CHANG ET AL., DOI 10.1117/1.JBO.28.9.094801.

Dental caries, also called “cavities” or “tooth decay,” can be debilitating. Modern dentistry has tried-and-tested solutions for treating caries of many shapes and sizes without needing to remove the tooth altogether. Dental restorations, also known as “fillings,” are commonplace and yet—while modern restorative materials have many advantages such as improved biocompatibility and better aesthetics—they can still fail over time.

Restorative materials do not always bond well to the surrounding healthy tooth structure. Microscopic leaks may form, allowing fluids and bacterial acids to penetrate beneath the restoration. This can lead to the formation of a secondary caries that appears and grows around a previously restored cavity. “Dentists now spend more time replacing failed restorations than placing new ones due to the maladaptation of bonding materials to tooth structure,” comments Dr. Nai-Yuan N. Chang from the Fried Group in the Department of Preventive and Restorative Dental Sciences at University of California, San Francisco (UCSF).

Directed by UCSF Professor Daniel Fried, the Fried Group develops new diagnostic techniques to detect active dental lesions. In a recent study published in Journal of Biomedical Optics (JBO), Chang’s research team evaluated emerging imaging modalities for discerning active tooth decay. “The traditional methods relying on tactile sensation via a dental explorer and visual inspection based on texture and color are highly subjective and unreliable,” explains Chang. “However, there is currently no established dental imaging technology that can provide diagnostic information with high specificity and sensitivity when assessing dental decay activity.”

To address this issue, the researchers focused on whether shortwave-infrared (SWIR) and thermal imaging could be combined with air drying to accurately diagnose the activity of a secondary caries lesion. The idea underlying both these methods is that active lesions are more porous than healthy tooth, and these pores hold water. In the SWIR-based approach, one can indirectly detect active lesions by observing changes in the SWIR reflectivity as the tooth dries out. On the other hand, the thermal imaging-based approach relies on the fact that the temperature changes in active lesions during air drying are different from that in healthy tooth, owing to the water trapped in the pores of the lesion. 

In their work, the team acquired 63 human tooth samples from oral surgeons and analyzed 109 suspected secondary lesions in them using both SWIR and thermal imaging. In addition to these methods, the researchers also observed the samples using optical coherence tomography (OCT), a more sophisticated technique that uses near-infrared light to create high resolution 3D images. To determine whether SWIR and thermal imaging were indeed useful for detecting active lesions, the results of these methods were compared with those obtained via OCT.

Overall, SWIR proved superior to thermal imaging and performed better in most circumstances. The SWIR permeability measurements were well correlated with the thickness of the transparent surface layer (TSL) of lesions measured via OCT. The team found that the highly mineralized TSL was thickest when a lesion had been fully arrested and needed no further intervention. According to the OCT results, a TSL thicker than 70 µm was a potential indication that a lesion was no longer active.

The findings of this study could help pave the way to a new era of diagnostic imaging in dentistry. Excited about the results, Chang concludes: “Our work provides further developmental milestones towards meeting the need for better diagnostic and easily operable clinical devices.”

Let us hope these new methods make active cavities easier to detect, allowing us all to preserve our dental health better.

Read the Gold Open Access article by Chang et al., “Assessment of the activity of secondary caries lesions with short-wavelength infrared, thermal, and optical coherence tomographic imaging,” J. Biomed. Opt. 28(9), 094801 (2023), doi 10.1117/1.JBO.28.9.094801.

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JOURNAL

Journal of Biomedical Optics

DOI

10.1117/1.JBO.28.9.094801