Thursday, April 2, 2009

Salivary diagnostics comes of age

Salivary diagnostics has come of age. In a mere six years, research supported by the National Institute of Dental and Craniofacial Research (NIDCR) has sprung to the forefront of basic, translational, and clinical research. In a scientific session on "Oral Fluid Diagnostics", to be held during the 87th General Session of the International Association for Dental Research, convening today at the Miami Beach Convention Center, researchers will showcase a remarkable spectrum of research outcomes that expands the clinical applications of saliva based on 'diagnostic toolboxes', as well as establishing foundational mechanistic insights into salivary diagnostics.

Three papers will highlight the scientific and translational values of three diagnostic toolboxes (proteins, DNA, and RNA) in saliva. One research team identified 36 novel phosphoproteins in parotid saliva. This elegantly established the systemic phosphoproteome documentation technology, providing a powerful tool to evaluate health vs. disease states of oral and systemic disease. Another group explores the methylation status of genomic DNA contents of 807 cancer-associated genes in the saliva of oral cancer patients. Subpanels of these differentially methylated genes were able to discriminate oral cancer subjects with a specificity of 83-100% and a sensitivity of 62-77%, providing proof-of-concept data that differential methylation analysis of specific cellular genes in saliva can be used to detect oral cancer. A third diagnostic alphabet, the salivary transcriptome, was discovered to exist in saliva encapsulated in a lipid bilayer entity known as the exosome. This is a significant finding, since it provides the long-missing scientific rationale as to why endogenous salivary mRNA is unusually stable, firmly providing the scientific rationale for the translational utilization of the salivary transcriptome for biomarker studies.

This session will also feature a paper that highlights a translational and clinical application of salivary biomarkers for detecting patients with acute coronary syndrome (ACS). Of interest is that discriminatory salivary biomarkers for ACS are gender- and fluid-specific (stimulated vs. unstimulated). The potential use of saliva, rather than blood, for ACS detection presents clear clinical advantages.

Last, there will be a paper demonstrating the mechanistic insights into the value of salivary diagnostics for systemic disease detection. In rodent tumor transplantation models of melanoma and lung cancer, tumor-associative saliva biomarker profiles were observed. A systemic disease-induced salivary biomarker fingerprint is therefore validated. The working model proposed is that tumors, like endocrine organs, produce hormones, lymphokines, and cytokines, which will traverse through the vasculature and reach a distal organ to exert biological actions. When reaching the salivary glands, these hormones/lymphokines/cytokines will lead to transcriptional profile changes and ectopic protein translation, which will be secreted into saliva as tumor-associated surrogate biomarkers. This is the first mechanistic demonstration of a profile connection between systemic disease and salivary biomarkers.

Amalgam fillings are safe, but controversial

Amalgam fillings are safe, but skeptics still claim controversy, researcher says

Dental amalgam has been proven safe and effective for years, yet unfounded controversy still surrounds it, a Medical College of Georgia researcher says.

Dentists have used amalgam, an alloy of mercury with at least one other metal, in fillings for over 200 years. Amalgam fillings don’t contain enough mercury to cause potential health problems associated with larger doses, says Dr. Rod Mackert, professor of dental materials in the MCG School of Dentistry Department of Oral Rehabilitation.

"The dose makes the poison,” he says, quoting 16th century Swiss physician Paracelsus. A person would need between 265 and 310 amalgam fillings before even slight symptoms of mercury toxicity could be felt. A person with seven fillings, which is average, absorbs only about one microgram of mercury daily. About six micrograms are absorbed daily from food, water and air, according to the Environmental Protection Agency.

To create a dental filling, liquid mercury dissolves and reacts with a powder of silver, tin and copper, forming a compound that contains no free mercury. "Anti-amalgam activists say mercury is soaked into metal powder, like water into a sponge, and can come back out of the fillings, but that's not at all true," Dr. Mackert says. In fact, the evaporation rate of mercury from amalgam is a million times lower than from pure mercury.

Anti-amalgam activists also say dental mercury pollutes the environment. However, dental mercury accounts for less than a quarter of a percent of mercury re-entering the environment.

Dr. Mackert presented an overview of amalgam, its controversy and its alternatives today at the 87th General Session of the International Association for Dental Research in Miami.

The amalgam controversy began in the 1970s. Awareness that dental fillings contained mercury was heightened and people were concerned by a couple of mercury-related health scares. In Japan, the release of methyl mercury into industrial wastewater caused a mercury buildup in shellfish and fish, leading to severe mercury poisoning and Minamata disease. Also, a grain covered in mercury fungicide was baked into bread and consumed in Iraq, killing hundreds. "Mercury poisoning was on people's minds and in the press," he says.

Urban legends abounded, including erroneous reports linking vapors from amalgam fillings to kidney damage and degenerative diseases such as Alzheimer's disease, multiple sclerosis and Parkinson's disease. The only documented health effects of amalgam fillings are rare allergic reactions, Dr. Mackert says, but the controversy led many people to have their fillings removed in the misguided hope of curing neurological diseases.

That controversy continues today. "It's mystifying that people persist in saying there is cause for concern with amalgam fillings when there's no evidence that they cause adverse health effects," Dr. Mackert says.

He also disputes claims that ulterior motives have influenced the American Dental Association position attesting to the safety and effectiveness of amalgam fillings. Anti-amalgam activists link the position to patent interests, but the association had only two amalgam patents, now expired, and neither was licensed, according to the U.S. Patent and Trademark Office. Most of the association’s 78 patents are for white filling materials, including composite resin, an alternative to amalgam.

But composite fillings have their own problems. They cost more than amalgam and often are not covered by insurance. Numerous studies have shown that amalgam significantly outlasts composite, while composite causes more secondary cavities and may contribute to plaque formation, Dr. Mackert says.

"The bottom line is people don't need to be concerned with adverse health effects from any type of fillings – amalgam or composites," Dr. Mackert says. Since beginning his studies of amalgam in the early 1980s, his position has never changed. In fact, he has amalgam fillings himself.

Wednesday, April 1, 2009

White wine can make tooth stains darker

NYU College of Dentistry researchers found that drinking white wine can also increase the potential for teeth to take on dark stains

It has long been known that red wine causes teeth to stain. But white wine? A recent study by NYU dental researchers found that drinking white wine can also increase the potential for teeth to take on dark stains.

The researchers compared two sets of six cow teeth, whose surface closely resembles that of human teeth, and used a spectrophotometer, an instrument that measures color intensities, to evaluate staining levels.

They found that teeth soaked for one hour in white wine before being immersed in black tea had significantly darker stains than teeth immersed for one hour in water before exposure to the tea.

"Dipping teeth in white wine for one hour is similar to the effect of sipping the wine with dinner," said Dr. Mark Wolff, Professor and Chairman of the Department of Cariology & Comprehensive Care at New York University College of Dentistry, who oversaw the study, which was led by Ms. Cristina M. Dobrescu, a third-year student at New York University College of Dentistry. The findings were presented today at the annual meeting of the International Association for Dental Research in Miami.

"The acids in wine create rough spots and grooves that enable chemicals in other beverages that cause staining, such as coffee and tea, to penetrate deeper into the tooth," Dr. Wolff explained.

Still, red wine continues to beat out white wine when it comes to staining teeth. When the researchers repeated the experiment with red wine, the resulting stains were significantly darker than those in the white wine group. "Red wine, unlike white, contains a highly-pigmented substance known as chromogen," explained Dr. Wolff.

But he added that connoisseurs concerned about staining need not cut back on their consumption. "The best way to prevent staining caused by wine, as well as other beverages, is to use a toothpaste containing a whitening agent," advised Dr. Wolff.

More Oral Bacteria = Higher Risk of Heart Attack

Several studies have suggested there is a connection between organisms that cause gum disease, known scientifically as periodontal disease, and the development of heart disease, but few studies have tested this theory.

A study conducted at the University at Buffalo, where the gum disease/heart disease connection was uncovered, now has shown that two oral pathogens in the mouth were associated with an increased risk of having a heart attack, but that the total number of germs, regardless of type, was more important to heart health.

Results of the study will be presented during a poster session at the International Association of Dental Research (IADR) General Session being held in Miami, Fla., from April 1-4.

Oelisoa M. Andriankaja, D.D.S., Ph.D., conducted the study in UB's Department of Oral Biology in the School of Dental Medicine, as a postdoctoral researcher. She currently is an adjunct professor at the University of Puerto Rico's School of Dental Medicine.

"The message here," said Andriankaja, "is that even though some specific periodontal pathogens have been found to be associated with an increased risk of coronary heart disease, the total bacterial pathogenic burden is more important than the type of bacteria.

"In other words, the total number of 'bugs' is more important than one single organism," she said.

The study involved 386 men and women between the ages of 35 and 69 who had suffered a heart attack and 840 people free of heart trouble who served as controls. Samples of dental plaque, where germs adhere, were collected from 12 sites in the gums of all participants.

The samples were analyzed for the presence of the six common types of periodontal bacteria, as well as the total number of bacteria.

The patients harbored more of each type of bacteria than the controls, the analysis showed. However, only two species, known as Tannerella Forsynthesis and Preventella Intermedia, had a statistically significant association with an increased risk of heart attack.

An increase in the number of different periodontal bacteria also increased the odds of having a heart attack, results showed.

Prospective studies -- those that measure oral bacteria in participants who have had no heart problems when they enter the study, and again when a heart attack occurs in a participant -- are needed to better assess this potential association, noted Andriankaja.

Tuesday, March 10, 2009

Evidence-Based Dentistry Web Site

Initial Database Features Over 1300 Systematic Reviews

The American Dental Association (ADA) announces the launching of EBD.ada.org (http://www.ebd.ada.org), the Web site dedicated to evidenced-based dentistry (EBD). EBD.ada.org allows easy and quick access to a database of systematic reviews of oral health clinical information from one centralized location.

EBD, according to the ADA, is an approach to oral health care that requires the judicious integration of systematic assessments of clinically relevant scientific evidence, relating to the patient's oral and medical condition and history, with the dentist's clinical expertise and the patient's treatment needs and preferences.

Supported by a grant from the National Library of Medicine and the National Institute for Dental and Craniofacial Research (grant number G08 LM008956), EBD.ada.org also features critical summaries of systematic reviews that assess information within systematic reviews in a concise format so that health care workers can incorporate scientific evidence in clinical decision making.

Key features of the EBD Web site include:

o A database of systematic reviews-- The database features over 1300 systematic reviews, with quarterly updating.

o Critical Summaries of systematic reviews -- One-page synopses of the key elements of a systematic review that a member of the dental team needs to know when making treatment decisions. Authors of the summaries are practicing dentists trained in critical assessment of published studies.

o Clinical Recommendations -- These provide evidence-based guidance on the application of current scientific evidence to patient care.

o Suggest Clinical Ideas-- A section where dentists can let the ADA know the clinical questions they encounter in trying to provide the best care to their patients.

o Links to other useful resources-- This central resource for EBD information will include links to many outside resources, including tutorials, glossaries, and databases.

"This is just a first step for EBD.ada.org," explains John S. Findley, D.D.S., ADA president. "We will continue to gather feedback to make sure the Web site provides the most clinically relevant and current information in a concise and user-friendly manner for dental and health care professionals."

Friday, March 6, 2009

Gene Responsible For Formation Of Enamel

"Subjects afflicted by DiGeorge syndrome exhibit teeth with enamel defects. We have demonstrated that a direct link between impaired Tbx1 function and enamel defects exists. Enamel forms via the mineralization of specific enamel proteins that are secreted by dental epithelial cells called ameloblasts. Our results clearly show that teeth of Tbx1 null mice lacked enamel and ameloblasts," explains Prof Mitsiadis.

Dentistry Of Future? Gene Responsible For Formation Of Enamel Discovered

A team of researchers lead by Professor Dr Thimios Mitsiadis at the University of Zurich, Switzerland, has identified a gene responsible for the formation of enamel, which is the key component of the teeth. The experiments were accomplished in mice carrying a deletion of the transcription factor Tbx1, a gene that plays a principal role in several human malformations (heart, thymus, parathyroid, face, and teeth) associated to the DiGeorge syndrome.

These findings, just published in Development Biology, represent a major contribution to the understanding of the production of enamel, the "hardest organic tissue" found in nature.

An American group of researchers from the University of Oregon have also shown a relationship between another transcription factor (Ctip2) and the production of enamel, but in the words of Prof Mitsiadis "our investigations better demonstrate the lack of enamel in teeth. Because of the early lethality of the Tbx1 mutant mice, we have used long-term culture techniques that allow the unharmed growth of teeth until their full maturity. No such studies were performed from our American colleagues."

Could dental treatment benefit in the future from this revolutionary study? The answer is definitively "yes." "The understanding of the genetic code controlling tooth development and repair will permit us to imagine and generate new products and replacement tissues for injured and unhealthy teeth. However the requirements for functional tooth repair and/or formation are complex. Yet, a single approach has not allowed an effective clinical therapy," says Prof Mitsiadis.

Is it possible to use dental stem cells to stimulate the growth of new enamel? This represents the biggest challenge in the discipline of tooth engineering. "Our results show that Tbx1 is involved in the maintenance of dental epithelial stem cells that are responsible for ameloblast formation. In some cases of genetic tooth anomalies, regeneration and repair of teeth could be treated by stem cells. Aggregates of dental stem cells could be used in the future for local transplantation in the dental tissues," explains Prof Mitsiadis

Thursday, March 5, 2009

Green tea for healthy teeth and gums

Recent study suggests that antioxidants in green tea may help reduce periodontal disease.

With origins dating back over 4,000 years, green tea has long been a popular beverage in Asian culture, and is increasingly gaining popularity in the United States. And while ancient Chinese and Japanese medicine believed green tea consumption could cure disease and heal wounds, recent scientific studies are beginning to establish the potential health benefits of drinking green tea, especially in weight loss, heart health, and cancer prevention. A study recently published in the Journal of Periodontology, the official publication of the American Academy of Periodontology (AAP), uncovered yet another benefit of green tea consumption. Researchers found that routine intake of green tea may also help promote healthy teeth and gums. The study analyzed the periodontal health of 940 men, and found that those who regularly drank green tea had superior periodontal health than subjects that consumed less green tea.

"It has been long speculated that green tea possesses a host of health benefits," said study author Dr. Yoshihiro Shimazaki of Kyushu University in Fukuoka, Japan. "And since many of us enjoy green tea on a regular basis, my colleagues and I were eager to investigate the impact of green tea consumption on periodontal health, especially considering the escalating emphasis on the connection between periodontal health and overall health."

Male participants aged 49 through 59 were examined on three indicators of periodontal disease: periodontal pocket depth (PD), clinical attachment loss (CAL) of gum tissue, and bleeding on probing (BOP) of the gum tissue. Researchers observed that for every one cup of green tea consumed per day, there was a decrease in all three indicators, therefore signifying a lower instance of periodontal disease in those subjects who regularly drank green tea.

Green tea's ability to help reduce symptoms of periodontal disease may be due to the presence of the antioxidant catechin. Previous research has demonstrated antioxidants' ability to reduce inflammation in the body, and the indicators of periodontal disease measured in this study, PD, CAL and BOP, suggest the existence of an inflammatory response to periodontal bacteria in the mouth. By interfering with the body's inflammatory response to periodontal bacteria, green tea may actually help promote periodontal health, and ward off further disease. Periodontal disease is a chronic inflammatory disease that affects the gums and bone supporting the teeth, and has been associated with the progression of other diseases such as cardiovascular disease and diabetes.

"Periodontists believe that maintaining healthy gums is absolutely critical to maintaining a healthy body," says Dr. David Cochran, DDS, PhD, President of the AAP and Chair of the Department of Periodontics at the University of Texas Health Science Center at San Antonio. "That is why it is so important to find simple ways to boost periodontal health, such as regularly drinking green tea – something already known to possess certain health-related benefits."