Tuesday, February 10, 2009

Men, Women Differ in Oral Health Care Habits

Survey Finds Smile Is “Most Attractive” Physical Feature

Valentine’s Day is around the corner, and what do people find most attractive in others? The smile. A national survey from the American Dental Association and Crest® and Oral B® finds that the smile outranked eyes, hair and the body as the most attractive physical feature.

Yet men and women differ when it comes to taking care of their teeth and gums. The nationally representative survey of 1,000 Americans ages 18 and older found 86 percent of women brush their teeth twice or more a day, yet only 66 percent of men do so.

The survey also found that women say they change their toothbrush or power toothbrush head every 3-4 months on average, yet men hang on to theirs an average of 5 months. The ADA recommends replacing toothbrushes every 3-4 months or when the bristles become frayed since frayed and worn bristles decrease cleaning effectiveness.

Sadly, all Americans need to do a better job of flossing their teeth. Only half of those surveyed (49 percent) say they floss their teeth once a day or more often. And 1 out of 3 people surveyed think a little blood in the sink after brushing their teeth is normal, yet it’s not—it could signal gum disease or another health problem.

Oral health is an important part of overall health. Regular dental check-ups are important not only to diagnose and treat gum disease and tooth decay, but also because some diseases or medical conditions, such as oral cancer, have symptoms that can appear in the mouth.

Growing research indicates there may be an association between oral health and serious health conditions such as cardiovascular disease and diabetes, underscoring the importance of good oral hygiene habits.

“We need to constantly get the word out how important it is to stay on top of your oral health,” says Dr. Ada Cooper, an ADA consumer advisor and practicing dentist in New York City. “Brushing twice a day with fluoride toothpaste, flossing daily, eating a balanced diet, and visiting your dentist regularly can help keep your smile healthy.”

For more information on the survey findings and other oral health information, visit the American Dental Association’s Web site at: www.ada.org

Saturday, February 7, 2009

Maintaining Healthy Teeth and Gums

Maintaining Healthy Teeth and Gums Is a Wise Investment

Reducing stress can positively affect your oral health, and potentially your bottom line.

Faced with plummeting investments and an unsteady job market, many Americans are feeling the effects of the recent economic crisis. In fact, a recent study by the American Psychological Association found that over 80 percent of Americans rank money and the economy as significant causes of stress. And while chronic stress can lead to a host of health problems, including a weakened immune system and increased blood pressure, it can also take its toll on periodontal health. If left untreated, periodontal disease may result in even more serious, and potentially expensive, overall health complications.

Stress and Your Smile
According to David Cochran, DDS, PhD, President of the American Academy of Periodontology and Chair of the Department of Periodontics at the University of Texas Health Science Center at San Antonio, stress can make an individual more susceptible to harmful habits that negatively impact oral health. “Stress may lead an individual to abuse tobacco or alcohol, and to possibly even neglect his or her oral hygiene. These lifestyle choices are known risk factors for the development of periodontal disease, which has been connected to several other chronic diseases, including heart disease and diabetes.”
A study published in the February 2009 Journal of Periodontology (JOP) confirmed that stress may interfere with oral hygiene. In the study, 56 percent of participants self-reported that stress led them to neglect regular brushing and flossing. In addition, the hormone cortisol may also play a role in the connection between stress and gum disease. Chronic stress is associated with higher and more prolonged levels of cortisol; previous research has found that increased amounts of cortisol in the bloodstream can lead to a more destructive form of periodontal disease.

“During periods of high stress such as what we are currently experiencing in this economic climate, individuals should seek healthy sources of relief such as regular exercise, eating a balanced diet, and getting adequate sleep,” says Dr. Cochran. “Doing so can help maintain a healthy mouth, and potentially help ward off other negative health concerns.”

Preserve Your Gum Line, Improve Your Bottom Line

Reducing stress in an effort to avoid gum disease may not only help sustain overall health, but it might also help your pocketbook as well. A study published in the November 2007 Journal of Periodontology found that preventing periodontal disease may be one way to help lower your total health care expenses. In the study, patients with severe periodontal disease had 21 percent higher health care costs as compared to those with no periodontal disease. Severe periodontal disease (periodontitis) involves bone loss and diminished tissue attachment around the teeth. And since past research has shown that periodontal disease may lead to other serious health conditions, striving to maintain oral health may help diminish the need to incur additional health care expenses, and ultimately help reduce overall health care spending.

“In these stressful times I encourage my patients to pay even more attention to their teeth and gums,” says Dr. Cochran. “And in turn, since preventing gum disease may help reduce overall health care expenses, maintaining a healthy mouth may actually be a stress reliever in itself.”

Wednesday, February 4, 2009

Periodontal treatment during pregnancy

The American Academy of Periodontology issues statement on periodontal treatment during pregnancy

Research recently presented at the annual meeting of the Society for Maternal-Fetal Medicine found that routine periodontal treatment in pregnant women did not reduce the risk of preterm deliveries. Some previous studies in this area have suggested that periodontal therapy during pregnancy can lessen the chance of adverse pregnancy outcomes.

While the American Academy of Periodontology (AAP) has not yet received the opportunity to review the complete study findings, it continues to urge women to care for their periodontal health while pregnant, through regular tooth brushing and flossing, and routine visits to a dental professional, such as a periodontist, to screen for periodontal disease.

These study results demonstrate the need for additional research to clarify the potential impact that periodontal disease has on the risk of preterm births; and if needed, what periodontal treatment modalities are most effective in helping to prevent premature deliveries.

As the organization representing over 8,000 dentists specially trained in the diagnosis, treatment and prevention of periodontal disease, the AAP is eager to analyze the complete study results, and provide women with accurate and effective recommendations on the management of periodontal disease during pregnancy.

Thursday, January 29, 2009

Periodontal treatment doesn't cut preterm births

New data show periodontal treatment doesn't reduce preterm birth risk

The study, involving researchers from Duke University Medical Center and the University of North Carolina at Chapel Hill, is one of the largest randomized trials to date to look at the link between the two conditions.

Previous research had suggested that gum disease was associated with very preterm deliveries (defined as less than 32 weeks gestation). That led insurance policies and healthcare providers to recommend scaling and root planing, sometimes referred to as "deep cleaning," in pregnant women. It was thought that such care had the potential to reduce preterm delivery risk.

These new findings, based on a randomized trial of 1,800 pregnant women with periodontal disease, indicate that routine gum treatments do not reduce the risk of early delivery.

"I'm always asked whether we should mandate dental treatment for all pregnant women," said Amy Murtha, MD, director of obstetrics research at Duke University Medical Center in Durham, NC, who presented the findings at the annual meeting of the Society for Maternal-Fetal Medicine in San Diego. "The biggest implication of this study is that this level of standard periodontal care will not affect the birth outcome."

That's not to say pregnant women should not get dental exams and treatment as needed; they should, Murtha added. "Our study emphasizes that treating periodontal disease during pregnancy is safe, but that standard periodontal care is not enough."

Progression, or worsening of periodontal disease occurs in about 25 percent of pregnancies, said Steven Offenbacher, DDS, PhD, the study's lead investigator and director of the UNC-Chapel Hill School of Dentistry-based Center for Oral and Systemic Diseases. The bacterial infection attacks the teeth-supporting tissues below the gum line. Left untreated, it can lead to tooth loss as well as a host of other problems.

This study, conducted at Duke, the University of Alabama at Birmingham and the University of Texas at San Antonio, was overseen by the UNC-Chapel Hill School of Dentistry. Pregnant women with periodontal disease were randomly assigned to two groups: one received periodontal treatment before 23 weeks gestation; the other did not. Overall, no significant differences were reported regarding obstetric or neonatal outcomes when the two groups were compared.

Despite the findings, Murtha said much remains unknown about the relationship between the two conditions. "Periodontal disease and poor pregnancy outcomes travel together, but we don't know why."

Nor do researchers understand how or why pregnancy appears to jumpstart the onset and progression of the disease. Murtha said it may be that preterm birth and periodontal disease share a common underlying trait, such as an exaggerated inflammatory response, but more studies are needed to fully explain the connection.

Additional research is also needed to determine whether more intensive periodontal care during pregnancy might make a difference. "Although we did not reduce the risk of preterm births, the level of periodontal care provided in this study was not as effective as compared to earlier studies," Offenbacher said. It may be that a more aggressive approach to periodontal disease management could have a different outcome, he added.

UV Light Bad Approach to Bleaching

UV light-enhanced tooth bleaching is not only a con, but is dangerous to your eyes and skin, says a Royal Society of Chemistry journal.

The light treatment gives absolutely no benefit over bleaching without UV, and damages skin and eyes up to four times as much as sunbathing, reports a study in Photochemical & Photobiological Sciences.

Those looking to match Tom Cruise's glittering pearly-whites would be better off ignoring claims of better bleaching with UV light treatment.

The treatment is at least as damaging to skin and eyes as sunbathing in Hyde Park for a midsummer's afternoon – one lamp actually gave four times that level of radiation exposure.

And as with sunbathing, fair-skinned or light-sensitive people are at even greater risk, said lead author Ellen Bruzell of the Nordic Institute of Dental Materials.

Bruzell also found that bleaching damaged teeth. She saw more exposed grooves on the enamel surface of bleached teeth than on unbleached teeth. These grooves make the teeth more vulnerable to mechanical stress.

Tooth bleaching is one of the most popular cosmetic dental treatments available. It uses a bleaching agent – usually hydrogen peroxide – to remove stains such as those from red wine, tea and coffee, and smoking.

UV light is claimed to further activate the oxidation process, improving bleaching efficiency. The authors of this Photochemical & Photobiological Sciences article say there is very little substantive evidence to support this claim, and their new study finds no benefit to using UV light.

Cures for TMJD?

For millions of people with mysterious pain of the jaw region, there may be help on the way.

Researchers at the University of Maryland Dental School hope their new seven-year, $17 million study of 3,400 study subjects will finally identify the cause and effect, and point to possible cures for temporomandibular joint and muscle disorders (TMJD).

For most people, the discomfort from the commonly called "TMJ" group of disorders will eventually go away with little or no treatment says the National Institute of Dental and Craniofacial Research (NIDCR) in Bethesda. However, many TMJD patients develop significant, long-term problems that cause chronic pain and dysfunction in the jaw joint and muscles that control jaw movement.

As much as 2 percent of the U.S. population suffers from TMJD, with more women than men appearing to have the condition, but doctors and scientists know little about the causes, and so there are few effective treatments.

Joel Greenspan, PhD, a professor and chair of the Department of Neural and Pain Sciences at the Dental School, says that most people know someone with the disorder or have heard their doctor suggest that a pain may be TMJD. "But, there is often little or nothing physically wrong that can be identified. And, frequently the pain is not specifically focused or limited to the jaw," he says.

Common characteristics of TMJD include pain, limitations in mobility and function, and jaw joint noises─clicks, pops, catches, or locks when the mouth is opened. TMJD is the second leading cause of pain for people who report facial or head pain.

Greenspan is one of the principle investigators in the $17 million “Orofacial Pain: Prospective Evaluation and Risk Assessment” (OPPERA) study, funded by the, NIDCR, which is part of the National Institutes of Health. OPPERA is being conducted at four sites, the University of Maryland Dental School, and the universities of Buffalo, North Carolina, and Florida dental schools. It is headed by William Maixner, DDS, PhD, Center for Neurosensory Disorders, School of Dentistry, University of North Carolina.

In some cases, the disorder can be brought on by trauma. Greenspan said some dental procedures can bring it on, but that is uncommon. It can also be brought on by misalignment of teeth, which is most often hereditary. Overuse of the jaw is another possible cause. Excessive gum chewing, nail biting, and gnawing on items like plastic straws can overtax the muscles of this joint.

"The main purpose of our OPPERA study is to identify the precursors in a prospective way, thus allowing us to more formally determine cause and effect, rather than just associations”, said Greenspan. He said there have been very few studies that address the cause of the disorder in a prospective manner, and none of the size and comprehension of OPPERA. Almost all of the clinical literature studies on TMJD are either observations on TMJD patients, or case-control studies.

Historically, doctors routinely recommended surgery to try to correct TMJD, but surgery is no longer a leading recommendation. Dental treatments include filing teeth down to make them fit better in the bite, or using dental appliances to even out the bite, like a match box under a table leg. "But, sometimes grinding makes things worse and may not be the answer. Noninvasive techniques are better recommended, such as appliances or reduced stress through exercise," said Greenspan.

TMJD occurs at least two times more frequently in women than in men, and often with more severe symptoms in women, perhaps because women are more pain sensitive, he said. "Several studies conducted here and elsewhere have shown that under controlled test conditions, women report standard test stimuli as more painful than men. Recent testing we have completed indicates that the brain’s processing of pain is amplified more in women than men, and even more so in women suffering with TMJD.”

In an NIDCR survey of 42,370 adults, (ages 18 to 75 and older) over a six-month period prior to Dec. 20, 2008, 3.5 percent of males and 6.9 percent of females reported pain in the jaw joint or in front of the ear more than once. The average for participants ages 75 and older of both sexes combined was 3.9 percent, but the average for those in the 18 to 34 year old group was 6.5 percent.

One mystery of the disorder is that the pain is not necessarily directly focused on the jaw, while another is that the pain is not related to the extent of tissue injury. This doesn’t surprise Greenspan because, he says, pain is the result of multiple system changes. "This is a complex area," he says, involving the three factors underlying pain: genetics, psychology, and physiology.

Friday, January 9, 2009

Mechanism for dental pain discovered

Researchers at Oregon Health & Science University's School of Dentistry (www.ohsu.edu/sod) have discovered a novel function of the peptide known as Nerve Growth Factor (NGF) in the development of the trigeminal nerve. The trigeminal nerve provides the signaling pathway for periodontal pain, dental surgical pain, and pain associated with temporomandibular disorder, trigeminal neuralgia, migraine, and other neuropathic and inflammatory conditions.

The study is posted online (www.neuropeptidesjournal.com/article/S0143-4179(08)00110-8/abstract) in the journal Neuropeptides and will appear in print issues of that journal in early 2009.

Working with researchers in the dental school departments of Endodontology and Integrative Biosciences, second-year endodontology resident and lead author of the study, Leila Tarsa, D.D.S., M.S., found a new mechanism involved in establishing junctions – known as synapses – between trigeminal nerve cells. Nerve cells communicate with one another through chemicals called transmitters that are released at synapses. The transmitter release from nerve cells endings is possible only if aided by several molecules that are critical for proper function of the synapse. Tarsa's research shows that NGF promotes transport of one of the molecules (called synaptophysin) from the nerve cell body to its ending.

"The data indicate that NGF participates in formation of neuronal connections in the trigeminal system," said Agnieszka Balkowiec, M.D., Ph.D., OHSU School of Dentistry assistant professor of integrative biosciences and OHSU School of Medicine adjunct assistant professor of physiology and pharmacology, who is the senior author of the study and whose lab hosted the research. "This study has broad implications for trigeminal nerve regeneration."