Link found between history of periodontitis and cerebrovascular disease in men
Research news from Annals of Neurology
The potential role of periodontitis, an inflammatory disease of the gums, in the risk of cardiovascular disease, particularly ischemic stroke, has received growing attention during the last decade. A new study is the first prospective cohort study to use clinical measures of periodontitis to evaluate the association between this disease and the risk of cerebrovascular disease. The study is published in Annals of Neurology, the official journal of the American Neurological Association
Led by Thomas Dietrich of the University of Birmingham School of Dentistry, and Elizabeth Krall of the Boston VA and the Boston University School of Dental Medicine, the study analyzed data from 1,137 men in the VA Normative Aging and Dental Longitudinal Study, an ongoing study begun in the 1960s with healthy male volunteers from the greater Boston area. A trained periodontist conducted dental exams every three years that included full mouth X-rays and periodontal probing at each tooth. Cerebrovascular disease was defined as a stroke or transient ischemic attack (TIA) and follow-up lasted an average of 24 years.
The results showed a significant association between periodontal bone loss and the incidence of stroke or TIA, independent of cardiovascular risk factors. This association was much stronger among men younger than 65 years old.
There are several possible pathways that could explain the association found in the study. There could be direct or indirect effects of the periodontal infection and the inflammatory response, or some people may have an increased pro-inflammatory susceptibility that could contribute to both cerebrovascular disease and periodontal disease.
The study found that only periodontal bone loss, which would indicate a history of periodontal disease, not probing depth, which would indicate current inflammation, was associated with the incidence of cerebrovascular disease. Also, the stronger association in younger men seen in this and other studies may indicate a pro-inflammatory susceptibility in some men that is reflected in periodontal destruction at a younger age.
The authors note that if periodontitis caused cerebrovascular disease, it could be an important risk factor, given its relatively high prevalence and the strength of the association in younger men. It is also possible that people with periodontitis may pay less attention to health in general (e.g., they may not take medications as regularly). The authors conclude: "Large epidemiologic studies using molecular and genetic approaches in various populations are necessary to determine the strength of the association between periodontitis and cerebrovascular disease and to elucidate its biologic basis."
Tuesday, June 30, 2009
Friday, June 26, 2009
Preventing Gum Disease Fights Memory Loss
Keeping your teeth brushed and flossed can cut down on gum disease, drastically reducing risk of heart attack and stroke, dentists have warned for years. Now researchers at West Virginia University have found a clean mouth may also help preserve memory.
The National Institutes of Health (NIH) has awarded a $1.3 million grant over four years to further build on studies linking gum disease and mild to moderate memory loss.
“Older people might want to know there’s more reason to keep their mouths clean – to brush and floss – than ever,” said Richard Crout, D.M.D., Ph.D., an expert on gum disease and associate dean for research in the WVU School of Dentistry. “You’ll not only be more likely to keep your teeth, but you’ll also reduce your risk of heart attack, stroke and memory loss.”
Crout will share the grant with gerontologist Bei Wu, Ph.D., formerly of WVU and now a researcher at the University of North Carolina; Brenda L. Plassman, Ph.D., of Duke University, a nationally recognized scientist in the field of memory research, and Jersey Liang, Ph.D., a professor at the University of Michigan. Wu is the principal investigator.
The team will look at health records over many years of several thousand Americans.
“This could have great implications for health of our aging populations,” Crout said. “With rates of Alzheimer’s skyrocketing, imagine the benefits of knowing that keeping the mouth free of infection could cut down on cases of dementia.”
The research builds on an ongoing study of West Virginians aged 70 and older. Working with the WVU School of Medicine, School of Dentistry researchers have given oral exams and memory tests to 270 elderly people in more than a dozen West Virginia counties.
Funded by a $419,000 two-year grant, they’ve discovered that about 23 percent of the group suffers from mild to moderate memory loss.
A blood draw is also part of the study for research subjects who agree.
“If you have a gum infection, you’ll have an increased level of inflammatory byproducts, Crout explained. “We’re looking for markers in the blood that show inflammation to see if there is a link to memory problems. We’d like to go full circle and do an intervention – to clean up some of the problems in the mouth and then see if the inflammatory markers go down.”
Researchers don’t yet understand whether microorganisms in the mouth create health problems or whether the body’s inflammatory response is to blame. It may be a combination of both.
Researchers also don’t know much about mild to moderate memory loss, even though the connection between severe dementia and gum disease is well known, Crout said.
In the future, dentists may routinely administer memory tests to their older patients, he said.
“A dentist may see a longtime, older patient with an area of the mouth that’s showing signs of inflammation because of not being properly cleaned daily,” Crout said. “Many times we as clinicians, however, don’t think of this as due to a memory problem. The patient may not be flossing or brushing properly as we have instructed they should. But this research indicates that the problem may be due to memory loss as opposed to noncompliance.”
The National Institutes of Health (NIH) has awarded a $1.3 million grant over four years to further build on studies linking gum disease and mild to moderate memory loss.
“Older people might want to know there’s more reason to keep their mouths clean – to brush and floss – than ever,” said Richard Crout, D.M.D., Ph.D., an expert on gum disease and associate dean for research in the WVU School of Dentistry. “You’ll not only be more likely to keep your teeth, but you’ll also reduce your risk of heart attack, stroke and memory loss.”
Crout will share the grant with gerontologist Bei Wu, Ph.D., formerly of WVU and now a researcher at the University of North Carolina; Brenda L. Plassman, Ph.D., of Duke University, a nationally recognized scientist in the field of memory research, and Jersey Liang, Ph.D., a professor at the University of Michigan. Wu is the principal investigator.
The team will look at health records over many years of several thousand Americans.
“This could have great implications for health of our aging populations,” Crout said. “With rates of Alzheimer’s skyrocketing, imagine the benefits of knowing that keeping the mouth free of infection could cut down on cases of dementia.”
The research builds on an ongoing study of West Virginians aged 70 and older. Working with the WVU School of Medicine, School of Dentistry researchers have given oral exams and memory tests to 270 elderly people in more than a dozen West Virginia counties.
Funded by a $419,000 two-year grant, they’ve discovered that about 23 percent of the group suffers from mild to moderate memory loss.
A blood draw is also part of the study for research subjects who agree.
“If you have a gum infection, you’ll have an increased level of inflammatory byproducts, Crout explained. “We’re looking for markers in the blood that show inflammation to see if there is a link to memory problems. We’d like to go full circle and do an intervention – to clean up some of the problems in the mouth and then see if the inflammatory markers go down.”
Researchers don’t yet understand whether microorganisms in the mouth create health problems or whether the body’s inflammatory response is to blame. It may be a combination of both.
Researchers also don’t know much about mild to moderate memory loss, even though the connection between severe dementia and gum disease is well known, Crout said.
In the future, dentists may routinely administer memory tests to their older patients, he said.
“A dentist may see a longtime, older patient with an area of the mouth that’s showing signs of inflammation because of not being properly cleaned daily,” Crout said. “Many times we as clinicians, however, don’t think of this as due to a memory problem. The patient may not be flossing or brushing properly as we have instructed they should. But this research indicates that the problem may be due to memory loss as opposed to noncompliance.”
Friday, June 12, 2009
56% with rheumatoid arthritis have periodontitis
Anti-TNF therapy can improve periodontal status after 6 months
Over half (56%) of people with rheumatoid arthritis (RA) also have periodontitis (a chronic inflammatory disease of the gum and surrounding ligaments and bones that hold the teeth in place), displaying fewer teeth than healthy matched controls, high prevalence of oral sites presenting dental plaque and advanced attachment loss (the extent of periodontal support that has been destroyed around a tooth) (chi square p<0.05), according to the results of a new study presented today at EULAR 2009, the Annual Congress of the European League Against Rheumatism in Copenhagen, Denmark. In addition, these patients were found to have significantly higher RA disease activity and anti-CCP (cyclic citrullinated peptide) antibody levels than others with RA who did not exhibit periodontitis (r=0.84, p<0.05; r=0.78, p<0.05).
The study also showed that, after six months of anti-TNF therapy (prescribed to control RA inflammation and destruction), a statistically significant improvement in periodontal status was seen in 20 (80%) of the 25 participants (mean age 41.5+3.7 years; mean disease duration 7.2+4.8 years), suggesting that the biological therapy may also be able to modulate the inflammatory process in the periodontium (the tissues investing and supporting the teeth, including the cementum, periodontal ligament, alveolar bone, and gingival / gums).
Dr Codrina Ancuta of the Grigore T Popa University of Medicine and Pharmacy, Rehabilitation Hospital, Iasi, Romania, who led the study, said: "There is a growing body of evidence to demonstrate an association between periodontal disease and systemic conditions involving inflammatory rheumatic disease (especially RA), cardiovascular disease and diabetes. However, further cross-disciplinary research among rheumatologists and periodontologists is required to fully understand the underlying mechanisms that link RA and periodontitis, and to explore how patients can be managed more holistically using treatments such as anti-TNFs and some lifestyle approached that may simultaneously address both conditions."
The prospective observational study compared 25 consecutive RA patients receiving anti-TNFs with 25 systemically healthy individuals matched for age, gender and periodontal status at baseline and six months, assessing both groups for periodontal status (visible plaque scores, marginal bleeding scores, attachment loss, number of present teeth), and the RA patient group in terms of RA parameters (erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), anti-CCP antibodies, disease activity and disability scores). Statistical analysis was conducted in SPSS-14 (a statistical analysis computer programme) p<0.05.
Moderate to Severe Periodontitis may be a Risk Factor for Developing RA in Non-Smokers
A second study presented at EULAR 2009 showed that, although smoking is an established risk factor for both RA and periodontitis, non-smoking individuals with moderate to severe periodontitis may also be at a greater risk for the development of RA. Those with RA who had moderate to severe periodontitis also developed significantly higher Anti-Citrullinated Peptide Antibody (ACPA) levels than those with no-mild periodontitis.
The retrospective study identified 45 RA patients based on their hospital discharge diagnostic codes from a cohort of 6,661 participants of the Atherosclerosis Risk in Communities (ARIC) study, from whom serum was obtained at the time of a detailed periodontal assessment during the period 1996-1998. RA participant sera were assessed for ACPA and rheumatoid factor (RF) positivity using ELISA (enzyme-linked immunosorbent assay). Participants were classified as having incident RA (n=33) if their first hospital discharge code occurred after periodontitis classification.
The hazard ratio (HR) of developing RA in subjects with moderate to severe periodontitis (n=27) was found to be 2.6 (95% CI=1.0-6.4, p=0.04), compared to those with no / mild periodontitis (n=6). Among lifetime non-smokers who developed RA, the Hazard Ratio was 8.8 (95% CI=1.1-68.9, p=0.04). Periodontitis severity was not shown to be independently associated with RA incidence among current and former smokers. ACPA levels were significantly higher in participants with moderate to severe periodontitis than in those with no / mild periodontitis (222.5 Units vs. 8.4 Units, p=0.04). These findings indicate that periodontitis may be a risk factor both for the development of RA, and for the development of more severe ACPA-positive disease.
Over half (56%) of people with rheumatoid arthritis (RA) also have periodontitis (a chronic inflammatory disease of the gum and surrounding ligaments and bones that hold the teeth in place), displaying fewer teeth than healthy matched controls, high prevalence of oral sites presenting dental plaque and advanced attachment loss (the extent of periodontal support that has been destroyed around a tooth) (chi square p<0.05), according to the results of a new study presented today at EULAR 2009, the Annual Congress of the European League Against Rheumatism in Copenhagen, Denmark. In addition, these patients were found to have significantly higher RA disease activity and anti-CCP (cyclic citrullinated peptide) antibody levels than others with RA who did not exhibit periodontitis (r=0.84, p<0.05; r=0.78, p<0.05).
The study also showed that, after six months of anti-TNF therapy (prescribed to control RA inflammation and destruction), a statistically significant improvement in periodontal status was seen in 20 (80%) of the 25 participants (mean age 41.5+3.7 years; mean disease duration 7.2+4.8 years), suggesting that the biological therapy may also be able to modulate the inflammatory process in the periodontium (the tissues investing and supporting the teeth, including the cementum, periodontal ligament, alveolar bone, and gingival / gums).
Dr Codrina Ancuta of the Grigore T Popa University of Medicine and Pharmacy, Rehabilitation Hospital, Iasi, Romania, who led the study, said: "There is a growing body of evidence to demonstrate an association between periodontal disease and systemic conditions involving inflammatory rheumatic disease (especially RA), cardiovascular disease and diabetes. However, further cross-disciplinary research among rheumatologists and periodontologists is required to fully understand the underlying mechanisms that link RA and periodontitis, and to explore how patients can be managed more holistically using treatments such as anti-TNFs and some lifestyle approached that may simultaneously address both conditions."
The prospective observational study compared 25 consecutive RA patients receiving anti-TNFs with 25 systemically healthy individuals matched for age, gender and periodontal status at baseline and six months, assessing both groups for periodontal status (visible plaque scores, marginal bleeding scores, attachment loss, number of present teeth), and the RA patient group in terms of RA parameters (erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), anti-CCP antibodies, disease activity and disability scores). Statistical analysis was conducted in SPSS-14 (a statistical analysis computer programme) p<0.05.
Moderate to Severe Periodontitis may be a Risk Factor for Developing RA in Non-Smokers
A second study presented at EULAR 2009 showed that, although smoking is an established risk factor for both RA and periodontitis, non-smoking individuals with moderate to severe periodontitis may also be at a greater risk for the development of RA. Those with RA who had moderate to severe periodontitis also developed significantly higher Anti-Citrullinated Peptide Antibody (ACPA) levels than those with no-mild periodontitis.
The retrospective study identified 45 RA patients based on their hospital discharge diagnostic codes from a cohort of 6,661 participants of the Atherosclerosis Risk in Communities (ARIC) study, from whom serum was obtained at the time of a detailed periodontal assessment during the period 1996-1998. RA participant sera were assessed for ACPA and rheumatoid factor (RF) positivity using ELISA (enzyme-linked immunosorbent assay). Participants were classified as having incident RA (n=33) if their first hospital discharge code occurred after periodontitis classification.
The hazard ratio (HR) of developing RA in subjects with moderate to severe periodontitis (n=27) was found to be 2.6 (95% CI=1.0-6.4, p=0.04), compared to those with no / mild periodontitis (n=6). Among lifetime non-smokers who developed RA, the Hazard Ratio was 8.8 (95% CI=1.1-68.9, p=0.04). Periodontitis severity was not shown to be independently associated with RA incidence among current and former smokers. ACPA levels were significantly higher in participants with moderate to severe periodontitis than in those with no / mild periodontitis (222.5 Units vs. 8.4 Units, p=0.04). These findings indicate that periodontitis may be a risk factor both for the development of RA, and for the development of more severe ACPA-positive disease.
Tuesday, June 2, 2009
Periodontology+Cardiology= joint recommendations
Recently published consensus paper encourages periodontists and cardiologists to join together to promote patient health
Cardiovascular disease (CVD), the leading killer in the United States, is a major public health issue contributing to 2,400 deaths each day. Periodontal disease, a chronic inflammatory disease that destroys the bone and tissues that support the teeth affects nearly 75 percent of Americans and is the major cause of adult tooth loss. While the prevalence rates of these disease states seem grim, research suggests that managing one disease may reduce the risk for the other.
A consensus paper on the relationship between heart disease and gum disease was recently developed by the American Academy of Periodontology (AAP) and The American Journal of Cardiology (AJC). The paper is published concurrently in the online versions of the AJC, a peer-reviewed journal circulated to 30,000 cardiologists, and the Journal of Periodontology (JOP), the official publication of the AAP. Developed in concert by cardiologists and periodontists, the paper includes clinical recommendations for both medical and dental professionals to use in managing patients living with, or who are at risk for, either disease. As a result of the paper, cardiologists may now examine a patient's mouth, and periodontists may begin asking questions about heart health and family history of heart disease.
Specific clinical recommendations include:
Patients with periodontitis who have 1 known major atherosclerotic CVD risk factor such as smoking, immediate family history for CVD, or history of dyslipidemia should consider a medical evaluation if they have not done so within the past 12 months.
A periodontal evaluation should be considered in patients with atherosclerotic CVD who have: signs or symptoms of gingival disease; significant tooth loss, and unexplained elevation of hs-CRP or other inflammatory biomarkers.
A periodontal evaluation of patients with atherosclerotic CVD should include a comprehensive examination of periodontal tissues, as assessed by visual signs of inflammation and bleeding on probing; loss of connective tissue attachment detected by periodontal probing measurements; and bone loss assessed radiographically. If patients have untreated or uncontrolled periodontitis, they should be treated with a focus on reducing and controlling the bacterial accumulations and eliminating inflammation.
When periodontitis is newly diagnosed in patients with atherosclerotic CVD, periodontists and physicians managing patients' CVD should closely collaborate in order to optimize CVD risk reduction and periodontal care.
The clinical recommendations were developed at a meeting held in early 2009 of top opinion-leaders in both cardiology and periodontology. The consensus paper also summarizes the scientific evidence that links periodontal disease and cardiovascular disease and explains the underlying biologic and inflammatory mechanisms that may be the basis for the connection.
According to Kenneth Kornman, DDS, PhD, Editor of the Journal of Periodontology and a co-author of the consensus report, the cooperation between the cardiology and periodontal communities is an important first step in helping patients reduce their risk of these associated diseases. "Inflammation is a major risk factor for heart disease, and periodontal disease may increase the inflammation level throughout the body. Since several studies have shown that patients with periodontal disease have an increased risk for cardiovascular disease, we felt it was important to develop clinical recommendations for our respective specialties. Therefore, you will now see cardiologists and periodontists joining forces to help our patients."
While additional research will help identify the precise relationship between periodontal disease and cardiovascular disease, recent emphasis has been placed on the role of inflammation - the body's reaction to fight off infection, guard against injury or shield against irritation. While inflammation initially intends to have a protective effect, untreated chronic inflammation can lead to dysfunction of the affected tissues, and therefore to more severe health complications.
"Both periodontal disease and cardiovascular disease are inflammatory diseases, and inflammation is the common mechanism that connects them," 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. "The clinical recommendations included in the consensus paper will help periodontists and cardiologists control the inflammatory burden in the body as a result of gum disease or heart disease, thereby helping to reduce further disease progression, and ultimately to improve our patients' overall health. That is our common goal."
Cardiovascular disease (CVD), the leading killer in the United States, is a major public health issue contributing to 2,400 deaths each day. Periodontal disease, a chronic inflammatory disease that destroys the bone and tissues that support the teeth affects nearly 75 percent of Americans and is the major cause of adult tooth loss. While the prevalence rates of these disease states seem grim, research suggests that managing one disease may reduce the risk for the other.
A consensus paper on the relationship between heart disease and gum disease was recently developed by the American Academy of Periodontology (AAP) and The American Journal of Cardiology (AJC). The paper is published concurrently in the online versions of the AJC, a peer-reviewed journal circulated to 30,000 cardiologists, and the Journal of Periodontology (JOP), the official publication of the AAP. Developed in concert by cardiologists and periodontists, the paper includes clinical recommendations for both medical and dental professionals to use in managing patients living with, or who are at risk for, either disease. As a result of the paper, cardiologists may now examine a patient's mouth, and periodontists may begin asking questions about heart health and family history of heart disease.
Specific clinical recommendations include:
Patients with periodontitis who have 1 known major atherosclerotic CVD risk factor such as smoking, immediate family history for CVD, or history of dyslipidemia should consider a medical evaluation if they have not done so within the past 12 months.
A periodontal evaluation should be considered in patients with atherosclerotic CVD who have: signs or symptoms of gingival disease; significant tooth loss, and unexplained elevation of hs-CRP or other inflammatory biomarkers.
A periodontal evaluation of patients with atherosclerotic CVD should include a comprehensive examination of periodontal tissues, as assessed by visual signs of inflammation and bleeding on probing; loss of connective tissue attachment detected by periodontal probing measurements; and bone loss assessed radiographically. If patients have untreated or uncontrolled periodontitis, they should be treated with a focus on reducing and controlling the bacterial accumulations and eliminating inflammation.
When periodontitis is newly diagnosed in patients with atherosclerotic CVD, periodontists and physicians managing patients' CVD should closely collaborate in order to optimize CVD risk reduction and periodontal care.
The clinical recommendations were developed at a meeting held in early 2009 of top opinion-leaders in both cardiology and periodontology. The consensus paper also summarizes the scientific evidence that links periodontal disease and cardiovascular disease and explains the underlying biologic and inflammatory mechanisms that may be the basis for the connection.
According to Kenneth Kornman, DDS, PhD, Editor of the Journal of Periodontology and a co-author of the consensus report, the cooperation between the cardiology and periodontal communities is an important first step in helping patients reduce their risk of these associated diseases. "Inflammation is a major risk factor for heart disease, and periodontal disease may increase the inflammation level throughout the body. Since several studies have shown that patients with periodontal disease have an increased risk for cardiovascular disease, we felt it was important to develop clinical recommendations for our respective specialties. Therefore, you will now see cardiologists and periodontists joining forces to help our patients."
While additional research will help identify the precise relationship between periodontal disease and cardiovascular disease, recent emphasis has been placed on the role of inflammation - the body's reaction to fight off infection, guard against injury or shield against irritation. While inflammation initially intends to have a protective effect, untreated chronic inflammation can lead to dysfunction of the affected tissues, and therefore to more severe health complications.
"Both periodontal disease and cardiovascular disease are inflammatory diseases, and inflammation is the common mechanism that connects them," 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. "The clinical recommendations included in the consensus paper will help periodontists and cardiologists control the inflammatory burden in the body as a result of gum disease or heart disease, thereby helping to reduce further disease progression, and ultimately to improve our patients' overall health. That is our common goal."
Friday, May 29, 2009
Dentists Suffer from Noise-Induced Hearing Loss
Noise-induced hearing loss (NIHL) is an occupational hazard to dentists exposed to the noise from high speed drills. This is the conclusion of a study presented at the 101st Annual Meeting of the American Academy of Otolaryngology--Head and Neck Surgery Foundation.
The study, "Noise-Induced Hearing Loss," was prepared by Renata C. Di Francesco, MD, Fabiana Arajuo Sperandio, MD, Tanit Ganz Sanchez, MD, and Marco Aurelio Bottino, MD, otolaryngologists (ear, nose, and throat specialists) from San Paulo, Brazil. The purpose of the study was to evaluate (1) the incidence of NIHL in dentists; (2) the relationship between duration of exposure and severity of hearing loss; and (3) the relation of risk factors (ambient amplified music) and severity of loss.
The research conducted is significant because dentists are daily exposed to drills, which reach 85 to 95 dB most of the time. Moreover, dentists generally do not wear ear protection or undergo periodic audiometric examinations.
Methodology: The team of medical specialists evaluated 896 dentists attending the Seventeenth International Meeting of Odontology (Dentistry) in San Paulo. All the test subjects were evaluated by a questionnaire, ear examination, and tonal audiometry.
Results: Forty percent of the dentists presented some hearing loss, and 87% of the affected ears presented a demonstrable loss in 6,000 Hz. The incidence of hearing loss was related directly to duration of exposure to noise from dental equipment.
The study, "Noise-Induced Hearing Loss," was prepared by Renata C. Di Francesco, MD, Fabiana Arajuo Sperandio, MD, Tanit Ganz Sanchez, MD, and Marco Aurelio Bottino, MD, otolaryngologists (ear, nose, and throat specialists) from San Paulo, Brazil. The purpose of the study was to evaluate (1) the incidence of NIHL in dentists; (2) the relationship between duration of exposure and severity of hearing loss; and (3) the relation of risk factors (ambient amplified music) and severity of loss.
The research conducted is significant because dentists are daily exposed to drills, which reach 85 to 95 dB most of the time. Moreover, dentists generally do not wear ear protection or undergo periodic audiometric examinations.
Methodology: The team of medical specialists evaluated 896 dentists attending the Seventeenth International Meeting of Odontology (Dentistry) in San Paulo. All the test subjects were evaluated by a questionnaire, ear examination, and tonal audiometry.
Results: Forty percent of the dentists presented some hearing loss, and 87% of the affected ears presented a demonstrable loss in 6,000 Hz. The incidence of hearing loss was related directly to duration of exposure to noise from dental equipment.
Thursday, May 28, 2009
Treating gum disease helps rheumatoid arthritis
Treating gum disease helps rheumatoid arthritis sufferers
Here's one more reason to keep your teeth healthy.
People, who suffer from gum disease and also have a severe form of rheumatoid arthritis, reduced their arthritic pain, number of swollen joints and the degree of morning stiffness when they cured their dental problems. Researchers from the Case Western Reserve University School of Dental Medicine and University Hospitals of Cleveland reported on this new intervention for arthritis in the Journal of Periodontology.
"It was exciting to find that if we eliminated the infection and inflammation in the gums, then patients with a severe kind of active rheumatoid arthritis reported improvement on the signs and symptoms of that disease," said Nabil Bissada, D.D.S., chair of the department of periodontics at the dental school. "It gives us a new intervention," adds Bissada.
This is not the first time that gum disease and rheumatoid arthritis have been linked. According to another researcher in the study, Ali Askari, M.D., chair of the department of rheumatology at University Hospitals, "From way back, rheumatologists and other clinicians have been perplexed by the myth that gum disease may have a big role in causing systematic disease."
He added that historically teeth were pulled or antibiotics given for treatment of rheumatoid arthritis, which actually treated the periodontitis. The patients got better.
Askari and Bissada are part of a team of researchers that studied 40 patients with moderate to severe periodontal disease and a severe form of rheumatoid arthritis.
The study results should prompt rheumatologists to encourage their patients to be aware of the link between periodontal disease and rheumatoid arthritis, says Askari.
Bissada notes that gum disease tends to be prevalent in rheumatoid arthritis patients.
Both inflammatory diseases share similarities in the progression of the disease over time. In both diseases, the soft and hard tissues are destroyed from inflammation caused by toxins from bacterial infection.
One toxin from the inflamed areas called tumor neurosis factor-alpha (TNF-α) is a marker present in the blood when inflammation is present in the body. TNF-α can initiate new infections or aggravate sites where inflammation already exists.
The study's participants were divided into four groups. Two groups of patients were receiving a new group of anti-TNF-α drugs that block the production of TNF-α at inflamed rheumatoid arthritis sites. Two groups were not on this new medication. Half of group of the participant on the medication and half not receiving the new drug received a standard nonsurgical form of periodontal treatment to clean and remove the infection from the bones and tissues in the gum areas. The other half of those studied did not receive the treatment until after completion of the study.
After receiving treatment for the gum disease, improvement in rheumatoid arthritis symptoms was seen in patients who did and did not receive the anti-TNF-α medications, which block the production of TNF-α that aggravate or can cause inflammation. Patients on the TNF- α inhibitors showed even greater improvements over those not receiving the drugs.
"I'm optimistic that someday the biologic agents that we use successfully in treatment of rheumatoid arthritis will lead to improvement of periodontitis and would be available for use and treatment of this perplexing problem," says Askari.
"Again we are seeing another link where good oral health improves the overall health of an individual," says Bissada, who adds that studies have linked gum disease to premature births, heart disease and diabetes.
Here's one more reason to keep your teeth healthy.
People, who suffer from gum disease and also have a severe form of rheumatoid arthritis, reduced their arthritic pain, number of swollen joints and the degree of morning stiffness when they cured their dental problems. Researchers from the Case Western Reserve University School of Dental Medicine and University Hospitals of Cleveland reported on this new intervention for arthritis in the Journal of Periodontology.
"It was exciting to find that if we eliminated the infection and inflammation in the gums, then patients with a severe kind of active rheumatoid arthritis reported improvement on the signs and symptoms of that disease," said Nabil Bissada, D.D.S., chair of the department of periodontics at the dental school. "It gives us a new intervention," adds Bissada.
This is not the first time that gum disease and rheumatoid arthritis have been linked. According to another researcher in the study, Ali Askari, M.D., chair of the department of rheumatology at University Hospitals, "From way back, rheumatologists and other clinicians have been perplexed by the myth that gum disease may have a big role in causing systematic disease."
He added that historically teeth were pulled or antibiotics given for treatment of rheumatoid arthritis, which actually treated the periodontitis. The patients got better.
Askari and Bissada are part of a team of researchers that studied 40 patients with moderate to severe periodontal disease and a severe form of rheumatoid arthritis.
The study results should prompt rheumatologists to encourage their patients to be aware of the link between periodontal disease and rheumatoid arthritis, says Askari.
Bissada notes that gum disease tends to be prevalent in rheumatoid arthritis patients.
Both inflammatory diseases share similarities in the progression of the disease over time. In both diseases, the soft and hard tissues are destroyed from inflammation caused by toxins from bacterial infection.
One toxin from the inflamed areas called tumor neurosis factor-alpha (TNF-α) is a marker present in the blood when inflammation is present in the body. TNF-α can initiate new infections or aggravate sites where inflammation already exists.
The study's participants were divided into four groups. Two groups of patients were receiving a new group of anti-TNF-α drugs that block the production of TNF-α at inflamed rheumatoid arthritis sites. Two groups were not on this new medication. Half of group of the participant on the medication and half not receiving the new drug received a standard nonsurgical form of periodontal treatment to clean and remove the infection from the bones and tissues in the gum areas. The other half of those studied did not receive the treatment until after completion of the study.
After receiving treatment for the gum disease, improvement in rheumatoid arthritis symptoms was seen in patients who did and did not receive the anti-TNF-α medications, which block the production of TNF-α that aggravate or can cause inflammation. Patients on the TNF- α inhibitors showed even greater improvements over those not receiving the drugs.
"I'm optimistic that someday the biologic agents that we use successfully in treatment of rheumatoid arthritis will lead to improvement of periodontitis and would be available for use and treatment of this perplexing problem," says Askari.
"Again we are seeing another link where good oral health improves the overall health of an individual," says Bissada, who adds that studies have linked gum disease to premature births, heart disease and diabetes.
Tuesday, May 12, 2009
Dental Implants Result in Minimal Bone Loss
Dental implants are frequently used as a replacement for missing teeth in order to restore the patient’s tooth function and appearance. Previous research demonstrates that the placement of a dental implant disrupts the host tissue in the area of the implant, so practitioners often focus their treatment planning to carefully maintain the patient’s bone and gum tissue surrounding the implant. A recent study published in the Journal of Periodontology found that the majority of bone remodeling occurred in the time between the implant placement and final prosthesis placement. Study Abstract*
Subsequently, little mean bone change was observed in the five years following the implant placement, independent of type of restoration or implant length. The study, conducted at the University of Texas Health Science Center at San Antonio, evaluated 596 dental implants placed in 192 patients over the age of 18. Patients were screened for adequate oral hygiene and bone volume. Exclusion criteria included heavy smoking, chewing tobacco use, drug abuse, and untreated periodontal disease, amongst others.
Study author Dr. David Cochran, DDS, PhD, Chair of the Department of Periodontics at the University of Texas Health Science Center at San Antonio, and President of the American Academy of Periodontology (AAP), believes that this study provides additional support for the use of dental implants to replace missing teeth. “As a periodontist, I am committed to saving my patients’ natural dentition whenever possible. However, the results of this study help further indicate that a dental implant is an effective and dependable tooth replacement option. Since the patient’s host tissue surrounding the dental implant largely remains unchanged in the five years following placement, the dental team can now focus on periodic assessment and treatment of other areas in the mouth as needed, and know that the implant is doing its job as a viable substitute solution.”
Subsequently, little mean bone change was observed in the five years following the implant placement, independent of type of restoration or implant length. The study, conducted at the University of Texas Health Science Center at San Antonio, evaluated 596 dental implants placed in 192 patients over the age of 18. Patients were screened for adequate oral hygiene and bone volume. Exclusion criteria included heavy smoking, chewing tobacco use, drug abuse, and untreated periodontal disease, amongst others.
Study author Dr. David Cochran, DDS, PhD, Chair of the Department of Periodontics at the University of Texas Health Science Center at San Antonio, and President of the American Academy of Periodontology (AAP), believes that this study provides additional support for the use of dental implants to replace missing teeth. “As a periodontist, I am committed to saving my patients’ natural dentition whenever possible. However, the results of this study help further indicate that a dental implant is an effective and dependable tooth replacement option. Since the patient’s host tissue surrounding the dental implant largely remains unchanged in the five years following placement, the dental team can now focus on periodic assessment and treatment of other areas in the mouth as needed, and know that the implant is doing its job as a viable substitute solution.”
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