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Laboratory-grown gingival cells treated with vitamin D boosted their production of an endogenous antibiotic, and killed more bacteria than untreated cells, according to a paper in the June 2011 issue of the journal Infection and Immunity. The research suggests that vitamin D can help protect the gums from bacterial infections that lead to gingivitis and periodontitis. Periodontitis affects up to 50 percent of the US population, is a major cause of tooth loss, and can also contribute to heart disease. Most Americans are deficient in vitamin D.
His interest piqued by another laboratory's discovery that vitamin D could stimulate white blood cells to produce natural proteins that have antibiotic activity, Gill Diamond of the UMDNJ -- New Jersey Dental School, Newark, showed that vitamin D could stimulate lung cells to produce LL-37, a natural antibiotic protein, and kill more bacteria. That suggested that , vitamin D might help cystic fibrosis patients. Next, in the new research, he showed that vitamin D has the same effct on gingival cells.
Then, Diamond found that vitamin D also stimulates gingival cells to produce another protein, called TREM-1, which had not been well-studied, but which was thought to be made by white blood cells. He found that it boosts production of pro-inflammatory cytokines.
The new research also showed that vitamin D coordinates expression of a number of genes not previously considered to be part of the vitamin D pathway. Those genes may be involved in additional infection-fighting pathways. A more comprehensive understanding of how vitamin D carries out this regulation at the molecular level -- something Diamond hopes to investigate -- will enable targeted therapies using vitamin D, he says.
Interestingly, Diamond also found that lung and gum cells appear to have the ability to activate inactive forms of vitamin D, says Diamond. "This means that we may even be able to use vitamin D therapy topically, if that proves true."
Vitamin D has become a hot area of research in recent years. In addition to infectious diseases, studies suggest that it has protective effects against autoimmune diseases, and certain cancers.
Diamond says that after he began conducting research on vitamin D, he began taking it as a supplement. Since then, "I have had only one cold in four years, and that one lasted only three days," he says. "Other people I've met who have done the same have seen similar results. We are trying to figure out how it's working, and what other infectious diseases can be mitigated by it."
Monday, June 20, 2011
Tuesday, June 14, 2011
Healing times for dental implants could be cut
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The technology used to replace lost teeth with titanium dental implants could be improved. By studying the surface structure of dental implants not only at micro level but also at nano level, researchers at the University of Gothenburg; Sweden, have come up with a method that could shorten the healing time for patients.
"Increasing the active surface at nano level and changing the conductivity of the implant allows us to affect the body's own biomechanics and speed up the healing of the implant," says Johanna Löberg at the University of Gothenburg's Department of Chemistry. "This would reduce the discomfort for patients and makes for a better quality of life during the healing process."
Dental implants have been used to replace lost teeth for more than 40 years now. Per-Ingvar Brånemark, who was recently awarded the prestigious European Inventor Award, was the first person to realise that titanium was very body-friendly and could be implanted into bone without being rejected. Titanium is covered with a thin layer of naturally formed oxide and it is this oxide's properties that determine how well an implant fuses with the bone.
It became clear at an early point that a rough surface was better than a smooth one, and the surface of today's implants is often characterised by different levels of roughness, from the thread to the superimposed nanostructures. Anchoring the implant in the bone exerts a mechanical influence on the bone tissue known as biomechanical stimulation, and this facilitates the formation of new bone. As the topography (roughness) of the surface is important for the formation of new bone, it is essential to be able to measure and describe the surface appearance in detail. But roughness is not the only property that affects healing.
Johanna Löberg has come up with a method that describes the implant's topography from micrometre to nanometre scale and allows theoretical estimations of anchoring in the bone by different surface topographies. The method can be used in the development of new dental implants to optimise the properties for increased bone formation and healing. She has also studied the oxide's conductivity, and the results show that a slightly higher conductivity results in a better cell response and earlier deposition of minerals that are important for bone formation.
The results are in line with animal studies and clinical trials of the commercial implant OsseoSpeed (Astra Tech AB), which show a slightly higher conductivity for the oxide and also an exchange between hydroxide and fluoride on the surface of the oxide. Surfaces with a well-defined nanostructure have a larger active area and respond quickly to the deposition of bone-forming minerals.
The technology used to replace lost teeth with titanium dental implants could be improved. By studying the surface structure of dental implants not only at micro level but also at nano level, researchers at the University of Gothenburg; Sweden, have come up with a method that could shorten the healing time for patients.
"Increasing the active surface at nano level and changing the conductivity of the implant allows us to affect the body's own biomechanics and speed up the healing of the implant," says Johanna Löberg at the University of Gothenburg's Department of Chemistry. "This would reduce the discomfort for patients and makes for a better quality of life during the healing process."
Dental implants have been used to replace lost teeth for more than 40 years now. Per-Ingvar Brånemark, who was recently awarded the prestigious European Inventor Award, was the first person to realise that titanium was very body-friendly and could be implanted into bone without being rejected. Titanium is covered with a thin layer of naturally formed oxide and it is this oxide's properties that determine how well an implant fuses with the bone.
It became clear at an early point that a rough surface was better than a smooth one, and the surface of today's implants is often characterised by different levels of roughness, from the thread to the superimposed nanostructures. Anchoring the implant in the bone exerts a mechanical influence on the bone tissue known as biomechanical stimulation, and this facilitates the formation of new bone. As the topography (roughness) of the surface is important for the formation of new bone, it is essential to be able to measure and describe the surface appearance in detail. But roughness is not the only property that affects healing.
Johanna Löberg has come up with a method that describes the implant's topography from micrometre to nanometre scale and allows theoretical estimations of anchoring in the bone by different surface topographies. The method can be used in the development of new dental implants to optimise the properties for increased bone formation and healing. She has also studied the oxide's conductivity, and the results show that a slightly higher conductivity results in a better cell response and earlier deposition of minerals that are important for bone formation.
The results are in line with animal studies and clinical trials of the commercial implant OsseoSpeed (Astra Tech AB), which show a slightly higher conductivity for the oxide and also an exchange between hydroxide and fluoride on the surface of the oxide. Surfaces with a well-defined nanostructure have a larger active area and respond quickly to the deposition of bone-forming minerals.
Thursday, May 5, 2011
Should dentists provide dental care to pregnant women through the second trimester?
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Every day, dentists across the country decide whether or not to provide dental care to a patient who is pregnant. On the one hand, they realize the patient needs to maintain her good oral health, especially if she has periodontal disease, a relatively common and destructive problem during pregnancy. On the other hand, dentists traditionally have lacked the scientific evidence to make informed decisions about the possible effects of dental care, if any, to the developing child. The lack of data has caused many dentists to err strongly on the side of caution, especially during the second trimester when the child’s development accelerates and, in theory, exposure to infectious oral bacteria or dental products could have adverse effects. But the fundamental questions remain: Should dentists provide dental care to pregnant women through the second trimester? If so, which types of treatment are safe to provide?
Over the last five years, newer scientific evidence has provided answers to these important questions. The data so far indicate that mothers who receive dental care through the second trimester - both general and periodontal treatment – do not appear to increase their risk of adverse events during pregnancy.
Some of the most scientifically rigorous data come from the NIDCR-supported Obstetrics and Periodontal Therapy Trial (OPT). In 2006, the OPT reported in the New England Journal of Medicine that pregnant women, most with early-to-moderate periodontitis, benefitted from general and periodontal care without an increase in preterm births or other negative pregnancy outcomes. All mothers had been randomly assigned to receive either: (1) scaling and root planing of the teeth prior to the 21st week of pregnancy, then monthly tooth polishings or (2) scaling and root planing after delivery, meaning women in this control group did not have their periodontal disease treated during their pregnancies. All women were 16 years or older and between 13 and 17 weeks pregnant upon entry into the study.
Now, as published online in the journal Pediatrics on April 11, the investigators report findings from a follow-up study of the OPT patients and their children born during the original trial. The researchers evaluated the neurodevelopment of 411 children, including 32 preterm infants, two years after the study. They tested the children using the Bayley Scales of Infant and Toddler Development (Third Edition) and the Preschool Language Scale (Fourth Edition). The former is a well-recognized assessment instrument for cognitive and motor functions in young children; the latter is frequently used to assess language skills in this age group.
The scientists found no difference in the neurodevelopment of children from mothers previously assigned to the treatment or control group. They also report slight associations between improvements in a mother’s periodontal attachment loss during the original study and higher cognitive and motor skills in their children. But both the associations are so weak, the scientists considered them “to be of little or no clinical significance.”
* Michalowicz BS, Hodges JS, Lussky RC, Bada H, Rawson T, Buttross LS, Chiriboga C, Diangelis AJ, Novak MJ, Buchanan W, Mitchell DA, and Papapanou PN. Maternal Periodontitis Treatment and Child Neurodevelopment at 24 to 28 months of Age, Pediatrics 2011 April 11 [Epub ahead of print]
Every day, dentists across the country decide whether or not to provide dental care to a patient who is pregnant. On the one hand, they realize the patient needs to maintain her good oral health, especially if she has periodontal disease, a relatively common and destructive problem during pregnancy. On the other hand, dentists traditionally have lacked the scientific evidence to make informed decisions about the possible effects of dental care, if any, to the developing child. The lack of data has caused many dentists to err strongly on the side of caution, especially during the second trimester when the child’s development accelerates and, in theory, exposure to infectious oral bacteria or dental products could have adverse effects. But the fundamental questions remain: Should dentists provide dental care to pregnant women through the second trimester? If so, which types of treatment are safe to provide?
Over the last five years, newer scientific evidence has provided answers to these important questions. The data so far indicate that mothers who receive dental care through the second trimester - both general and periodontal treatment – do not appear to increase their risk of adverse events during pregnancy.
Some of the most scientifically rigorous data come from the NIDCR-supported Obstetrics and Periodontal Therapy Trial (OPT). In 2006, the OPT reported in the New England Journal of Medicine that pregnant women, most with early-to-moderate periodontitis, benefitted from general and periodontal care without an increase in preterm births or other negative pregnancy outcomes. All mothers had been randomly assigned to receive either: (1) scaling and root planing of the teeth prior to the 21st week of pregnancy, then monthly tooth polishings or (2) scaling and root planing after delivery, meaning women in this control group did not have their periodontal disease treated during their pregnancies. All women were 16 years or older and between 13 and 17 weeks pregnant upon entry into the study.
Now, as published online in the journal Pediatrics on April 11, the investigators report findings from a follow-up study of the OPT patients and their children born during the original trial. The researchers evaluated the neurodevelopment of 411 children, including 32 preterm infants, two years after the study. They tested the children using the Bayley Scales of Infant and Toddler Development (Third Edition) and the Preschool Language Scale (Fourth Edition). The former is a well-recognized assessment instrument for cognitive and motor functions in young children; the latter is frequently used to assess language skills in this age group.
The scientists found no difference in the neurodevelopment of children from mothers previously assigned to the treatment or control group. They also report slight associations between improvements in a mother’s periodontal attachment loss during the original study and higher cognitive and motor skills in their children. But both the associations are so weak, the scientists considered them “to be of little or no clinical significance.”
* Michalowicz BS, Hodges JS, Lussky RC, Bada H, Rawson T, Buttross LS, Chiriboga C, Diangelis AJ, Novak MJ, Buchanan W, Mitchell DA, and Papapanou PN. Maternal Periodontitis Treatment and Child Neurodevelopment at 24 to 28 months of Age, Pediatrics 2011 April 11 [Epub ahead of print]
Thursday, March 24, 2011
Orthodontic researchers ask: Where's your retainer?
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Have you been wearing your retainer? It's a question countless parents ask of their children post-braces. Now Case Western Reserve University School of Dental Medicine researchers are getting serious about the question.
"We found little written about the kinds of retainers prescribed and how compliant patients are in using them," said Case Western Reserve's Manish Valiathan, an assistant professor of orthodontics and a member of the American Board of Orthodontics. He notes that there is a dearth of information despite the devices being common in orthodontics practice.
Consequently Valiathan and fellow researchers embarked on three studies that examined how people are using retainers, which types are prescribed and what happens when patients don't follow up orthodontic work with a retainer.
After randomly sending 2,000 surveys to orthodontists throughout the country, researchers received responses from 658 practitioners regarding the kinds of retainers they prescribe. The majority (58.2 percent) prescribed removable retainers; about 40 percent opted for fixed lingual retainers that, once in place, are worn for life.
Post-braces, the majority of orthodontists said they required wearing removable retainers full-time for the first nine months and then part-time after that. They also encouraged part-time retainer use throughout life.
Valiathan said that without retainers specific prior conditions may return but that definitive research does not exist as to what conditions require ongoing retainer use. More evidence is needed, he said.
Another survey study of 1,200 patients from four practices focused on patient compliance two years after prescribing retainers. Patients self-reported and 36 percent responded to the researchers' questions regarding type of retainer used, age, gender, length of time since braces were removed, and hours per day and night retainer is worn.
The overall responses showed that 60 percent wore retainers more than 10 hours a day in the first three months and 69 percent wore them every night. By the time retainer users reached 19 to 24 months, 19 percent were not wearing retainers but 81 percent were—even if it was only one night a week. About 4 percent never wore their retainer at all.
Research indicated that many patients were still using their original retainers two years later—a sign that teeth had not moved, Valiathan said. Additionally, researchers found that age, gender and the type of retainer did not impact compliance.
The third study was a pilot research project. It examined the ramifications of no retainer use within the first four weeks after braces removal. Researchers measured patients' teeth before and after for spacing issues, overbites, under bites and tooth crowding.
Thirty patients had the wires removed from their braces but kept the appliances affixed to the teeth to monitor any changes without a retainer. Nearly half of the participants showed no movement, and many showed positive settling of the back teeth including the molars. Some did require additional orthodontic treatment at the end of the four weeks.
"Further studies with a larger study population will let us know if some patients can go without using retainers," Valiathan said.
He added that orthodontic researchers need to study what kinds of conditions require long-term retainer use.
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For more detailed information, consult the studies mentioned in this report:
"Retainer wear and compliance in the first 2 years after active orthodontic treatment," in the American Journal of Orthodontics and Dentofacial Orthopedics (Volume 138, Number 5) was conducted by Case Western Reserve University School of Dental Medicine researchers—Kurtis A. Kacer, Manish Valiathan, Sena Narendran and Mark G. Hans.
"Results of a survey-based study to identify common retention practices in the United States," in the American Journal of Orthodontics and Dentofacial Orthopedics (Volume 137, Number 2) by Manish Valiathan from Case Western Reserve University School of Dental Medicine and Eric Hughes, a private practice dentist from Tuscaloosa, Ala.
"Short-term postorthodontic changes in the absence of retention" in Angle Orthodontist (Volume 80, Number 6) by Nadia Lyotard, private practice dentist from Houston, Texas; and Case Western Reserve University dental researchers Mark Hans, Suchitra Nelson and Manish Valiathan.
Have you been wearing your retainer? It's a question countless parents ask of their children post-braces. Now Case Western Reserve University School of Dental Medicine researchers are getting serious about the question.
"We found little written about the kinds of retainers prescribed and how compliant patients are in using them," said Case Western Reserve's Manish Valiathan, an assistant professor of orthodontics and a member of the American Board of Orthodontics. He notes that there is a dearth of information despite the devices being common in orthodontics practice.
Consequently Valiathan and fellow researchers embarked on three studies that examined how people are using retainers, which types are prescribed and what happens when patients don't follow up orthodontic work with a retainer.
After randomly sending 2,000 surveys to orthodontists throughout the country, researchers received responses from 658 practitioners regarding the kinds of retainers they prescribe. The majority (58.2 percent) prescribed removable retainers; about 40 percent opted for fixed lingual retainers that, once in place, are worn for life.
Post-braces, the majority of orthodontists said they required wearing removable retainers full-time for the first nine months and then part-time after that. They also encouraged part-time retainer use throughout life.
Valiathan said that without retainers specific prior conditions may return but that definitive research does not exist as to what conditions require ongoing retainer use. More evidence is needed, he said.
Another survey study of 1,200 patients from four practices focused on patient compliance two years after prescribing retainers. Patients self-reported and 36 percent responded to the researchers' questions regarding type of retainer used, age, gender, length of time since braces were removed, and hours per day and night retainer is worn.
The overall responses showed that 60 percent wore retainers more than 10 hours a day in the first three months and 69 percent wore them every night. By the time retainer users reached 19 to 24 months, 19 percent were not wearing retainers but 81 percent were—even if it was only one night a week. About 4 percent never wore their retainer at all.
Research indicated that many patients were still using their original retainers two years later—a sign that teeth had not moved, Valiathan said. Additionally, researchers found that age, gender and the type of retainer did not impact compliance.
The third study was a pilot research project. It examined the ramifications of no retainer use within the first four weeks after braces removal. Researchers measured patients' teeth before and after for spacing issues, overbites, under bites and tooth crowding.
Thirty patients had the wires removed from their braces but kept the appliances affixed to the teeth to monitor any changes without a retainer. Nearly half of the participants showed no movement, and many showed positive settling of the back teeth including the molars. Some did require additional orthodontic treatment at the end of the four weeks.
"Further studies with a larger study population will let us know if some patients can go without using retainers," Valiathan said.
He added that orthodontic researchers need to study what kinds of conditions require long-term retainer use.
###
For more detailed information, consult the studies mentioned in this report:
"Retainer wear and compliance in the first 2 years after active orthodontic treatment," in the American Journal of Orthodontics and Dentofacial Orthopedics (Volume 138, Number 5) was conducted by Case Western Reserve University School of Dental Medicine researchers—Kurtis A. Kacer, Manish Valiathan, Sena Narendran and Mark G. Hans.
"Results of a survey-based study to identify common retention practices in the United States," in the American Journal of Orthodontics and Dentofacial Orthopedics (Volume 137, Number 2) by Manish Valiathan from Case Western Reserve University School of Dental Medicine and Eric Hughes, a private practice dentist from Tuscaloosa, Ala.
"Short-term postorthodontic changes in the absence of retention" in Angle Orthodontist (Volume 80, Number 6) by Nadia Lyotard, private practice dentist from Houston, Texas; and Case Western Reserve University dental researchers Mark Hans, Suchitra Nelson and Manish Valiathan.
Thursday, March 17, 2011
Sealing manifest occlusal caries in permanent teeth
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Today, during the 89th General Session & Exhibition of the International Association for Dental Research, held in conjunction with the 40th Annual Meeting of the American Association for Dental Research and the 35th Annual Meeting of the Canadian Association for Dental Research, lead researcher V. Qvist will hold an oral presentation on a research study titled "Sealing Manifest Occlusal Caries in Permanent Teeth - 2½-year Results."
This research was performed under the objective of investigating the possibility of non-operative sealing of manifest occlusal caries lesions which otherwise would have been treated with conventional restoration. This prospective, randomized study was performed in the young permanent dentition with two parallel treatment arms. The material includes 523 occlusal caries lesions in 523 patients aged 6-17 years. All lesions were assessed to be in need of operative treatment and were limited to the outer half of the dentin. Informed consent was obtained from the patients/parents.
After randomization in the ratio of 2:1, 370 resin sealants and 153 resin restorations were carried out by 72 public dentists from August 2006 to November 2009. The treatments were followed by annual clinical and radiographic control examinations. Chi-square tests were applied for statistical comparisons between sealants and restorations.
After an average observation period of 2½ years, the dropout rate was 3 percent. Of the sealants 76 percent were well-functioning, 10 percent were repaired or renewed, and 15 percent were replaced by restorations. Of the restorations, 96 percent were well-functioning and 4 percent were extended or replaced, which was significantly different compared with the sealant group (p<0.001). The radiographic assessment showed caries progression in 11 percent of the sealed teeth and 1 percent of the restored teeth (p<0.001).
The majority of the sealed lesions were successfully arrested during the first 2½ years. Thus, the results indicate the possibility of extending the criteria for non-operative sealing of occlusal caries lesions in the young permanent dentition. However, a longer observation period is needed for final conclusion, and treatments will be followed for at least 5 years.
Today, during the 89th General Session & Exhibition of the International Association for Dental Research, held in conjunction with the 40th Annual Meeting of the American Association for Dental Research and the 35th Annual Meeting of the Canadian Association for Dental Research, lead researcher V. Qvist will hold an oral presentation on a research study titled "Sealing Manifest Occlusal Caries in Permanent Teeth - 2½-year Results."
This research was performed under the objective of investigating the possibility of non-operative sealing of manifest occlusal caries lesions which otherwise would have been treated with conventional restoration. This prospective, randomized study was performed in the young permanent dentition with two parallel treatment arms. The material includes 523 occlusal caries lesions in 523 patients aged 6-17 years. All lesions were assessed to be in need of operative treatment and were limited to the outer half of the dentin. Informed consent was obtained from the patients/parents.
After randomization in the ratio of 2:1, 370 resin sealants and 153 resin restorations were carried out by 72 public dentists from August 2006 to November 2009. The treatments were followed by annual clinical and radiographic control examinations. Chi-square tests were applied for statistical comparisons between sealants and restorations.
After an average observation period of 2½ years, the dropout rate was 3 percent. Of the sealants 76 percent were well-functioning, 10 percent were repaired or renewed, and 15 percent were replaced by restorations. Of the restorations, 96 percent were well-functioning and 4 percent were extended or replaced, which was significantly different compared with the sealant group (p<0.001). The radiographic assessment showed caries progression in 11 percent of the sealed teeth and 1 percent of the restored teeth (p<0.001).
The majority of the sealed lesions were successfully arrested during the first 2½ years. Thus, the results indicate the possibility of extending the criteria for non-operative sealing of occlusal caries lesions in the young permanent dentition. However, a longer observation period is needed for final conclusion, and treatments will be followed for at least 5 years.
Tuesday, March 15, 2011
Does Treating Periodontitis Improve Diabetes Control?
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The Stony Brook University School of Dental Medicine is leading a multicenter national clinical trial to evaluate whether treatment of chronic periodontitis will help improve diabetes control. Sponsored by the National Institutes of Health (NIH), the Diabetes and Periodontal Therapy Trial (DPTT) monitors blood sugar levels of those with Type 2 diabetes after periodontal therapy. The trial is the first of its kind in the United States.
The American Diabetes Association reports that Type 2 diabetes is the fifth leading cause of death in the U.S., affecting nearly 24 million Americans. Chronic Periodontitis affects roughly half of all Americans over the age of 55, but it is 2-to-4 times more likely to occur among people with diabetes, according to the American Academy of Periodontology.
“We hope the results of this clinical trial will support the research that clearly shows an association between chronic periodontitis and Type 2 diabetes and evidence that treating periodontal infection and inflammation can improve glycemic control,” says Steven Engebretson, D.M.D., M.S., M.S., Principal Investigator for the trial and Assistant Professor of Periodontics and Implantology at the SBU School of Dental Medicine.
In 2008, Dr. Engebretson and colleagues within the School of Dental Medicine and School of Medicine received a $12.5 million five-year grant from the NIH to develop the format and research plan for a multicenter trial investigating the effectiveness of periodontal therapy in improving blood sugar levels in Type 2 diabetes – now named the DPTT.
In 2011, a supplemental NIH grant for the DPTT to Stony Brook will provide an additional $1.4 million for the trial, bringing the total award to $13.9 million. This two-year grant supplement will be used to further develop a clinical site for ongoing recruitment of study participants through May 2012.
Participants for the trial must be 35 years or older and have Type 2 Diabetes and gum disease. Those who are eligible will receive at no cost: a dental cleaning by a hygienist and a professional evaluation by a dentist; 6-8 office visits, which include periodontal treatment for 6 months; oral hygiene products and diabetic counseling, as well as compensation for time and travel.
The periodontal treatment involves an in-depth cleaning called scaling and root planing (SRP). SRP is a careful cleaning of the tooth root surfaces to remove plaque from pockets and remove bacteria and toxins from tooth root. Dr. Engebretson points out that research has consistently shown that SRP reduces the amount of bacteria associated with periodontal disease. Due to this finding, SRP is usually the first mode of treatment recommended for most patients. Some people do not require any further active treatment after SRP.
The entire trial will span 30 months and include four clinical sites. Stony Brook is the coordinating clinical center, and the other clinical sites are the University of Alabama in Birmingham, the University of Minnesota in Minneapolis, and the University of Texas Health Science Center in San Antonio. The NIH’s National Institute of Dental and Craniofacial Research sponsors the trial.
The shared goal of the four clinical centers is to recruit a total of 600 adults who also have untreated moderate to severe chronic periodontitis. Subjects will be recruited from the diabetes clinics, dental clinics and communities near each center.
Dr. Engebretson believes that in the long-run the study results have the potential to provide a scientific basis for an improvement in the standard of care for patients with diabetes, thus addressing one of the Public Health Service's Healthy People 2010 goals. The trial is also carrying out a mandate from the 2000 Surgeon General’s Report on Oral Health, which identified the relationship between improvement in periodontal health and glycemic control as an area in need of further investigation.
Ω
The Stony Brook University School of Dental Medicine is leading a multicenter national clinical trial to evaluate whether treatment of chronic periodontitis will help improve diabetes control. Sponsored by the National Institutes of Health (NIH), the Diabetes and Periodontal Therapy Trial (DPTT) monitors blood sugar levels of those with Type 2 diabetes after periodontal therapy. The trial is the first of its kind in the United States.
The American Diabetes Association reports that Type 2 diabetes is the fifth leading cause of death in the U.S., affecting nearly 24 million Americans. Chronic Periodontitis affects roughly half of all Americans over the age of 55, but it is 2-to-4 times more likely to occur among people with diabetes, according to the American Academy of Periodontology.
“We hope the results of this clinical trial will support the research that clearly shows an association between chronic periodontitis and Type 2 diabetes and evidence that treating periodontal infection and inflammation can improve glycemic control,” says Steven Engebretson, D.M.D., M.S., M.S., Principal Investigator for the trial and Assistant Professor of Periodontics and Implantology at the SBU School of Dental Medicine.
In 2008, Dr. Engebretson and colleagues within the School of Dental Medicine and School of Medicine received a $12.5 million five-year grant from the NIH to develop the format and research plan for a multicenter trial investigating the effectiveness of periodontal therapy in improving blood sugar levels in Type 2 diabetes – now named the DPTT.
In 2011, a supplemental NIH grant for the DPTT to Stony Brook will provide an additional $1.4 million for the trial, bringing the total award to $13.9 million. This two-year grant supplement will be used to further develop a clinical site for ongoing recruitment of study participants through May 2012.
Participants for the trial must be 35 years or older and have Type 2 Diabetes and gum disease. Those who are eligible will receive at no cost: a dental cleaning by a hygienist and a professional evaluation by a dentist; 6-8 office visits, which include periodontal treatment for 6 months; oral hygiene products and diabetic counseling, as well as compensation for time and travel.
The periodontal treatment involves an in-depth cleaning called scaling and root planing (SRP). SRP is a careful cleaning of the tooth root surfaces to remove plaque from pockets and remove bacteria and toxins from tooth root. Dr. Engebretson points out that research has consistently shown that SRP reduces the amount of bacteria associated with periodontal disease. Due to this finding, SRP is usually the first mode of treatment recommended for most patients. Some people do not require any further active treatment after SRP.
The entire trial will span 30 months and include four clinical sites. Stony Brook is the coordinating clinical center, and the other clinical sites are the University of Alabama in Birmingham, the University of Minnesota in Minneapolis, and the University of Texas Health Science Center in San Antonio. The NIH’s National Institute of Dental and Craniofacial Research sponsors the trial.
The shared goal of the four clinical centers is to recruit a total of 600 adults who also have untreated moderate to severe chronic periodontitis. Subjects will be recruited from the diabetes clinics, dental clinics and communities near each center.
Dr. Engebretson believes that in the long-run the study results have the potential to provide a scientific basis for an improvement in the standard of care for patients with diabetes, thus addressing one of the Public Health Service's Healthy People 2010 goals. The trial is also carrying out a mandate from the 2000 Surgeon General’s Report on Oral Health, which identified the relationship between improvement in periodontal health and glycemic control as an area in need of further investigation.
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Could there be more than lunch lurking on your retainer?
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Insufficient cleaning could allow build-up of microbes on orthodontic retainers, researchers at the UCL Eastman Dental Institute have found. Dr Jonathan Pratten and colleagues looked at the types of microbes which live on retainers. This study, which found potentially pathogenic microbes growing on at least 50% of the retainers, is published today in the Society for Applied Microbiology's journal Letters in Applied Microbiology and could indicate a need for the development of improved cleaning products for orthodontic retainers.
Dr Pratten and his team took samples from the mouths of people without retainers and those wearing either of the two most widely used types. As retainers are frequently removed and then replaced in the mouth, the potential for transmission of microbes is high.
Our mouths are full of different types of bacteria, some of which promote oral health. However, the researchers were looking for microbes which are not normally found in the oral cavity. They were particularly interested in two species of microbes; Candida, a type of yeast, and Staphylococcus including MRSA. Dr Pratten and his team found that species of these microorganisms were present on 66.7% and 50% of retainers respectively regardless of the retainer type. These microbes were also present on the interior cheeks and tongue of retainer wearers.
Candida and Staphylococcus rarely cause problems in healthy individuals but are potentially highly problematic in people with a compromised immune system. The bacteria on the retainers live in biofilms, which are communities of bacteria living together covered in a layer of slime. Once these biofilms form they are very difficult to remove and often have high levels of resistance to antimicrobials.
Dr Pratten says: "With the growing awareness the public has of hospital-acquired infections it is important to be aware of other potential 'hidden reservoirs' of harmful bacteria which could be introduced to environments where we know they can cause problems."
Whilst the researchers are now looking at developing effective methods of cleaning, for now hygiene is the key to reducing the transmission of these bugs. Anyone handling a retainer should wash their hands before and after use. Careful tooth brushing and mouthwash may also help to keep the retainer clean.
Insufficient cleaning could allow build-up of microbes on orthodontic retainers, researchers at the UCL Eastman Dental Institute have found. Dr Jonathan Pratten and colleagues looked at the types of microbes which live on retainers. This study, which found potentially pathogenic microbes growing on at least 50% of the retainers, is published today in the Society for Applied Microbiology's journal Letters in Applied Microbiology and could indicate a need for the development of improved cleaning products for orthodontic retainers.
Dr Pratten and his team took samples from the mouths of people without retainers and those wearing either of the two most widely used types. As retainers are frequently removed and then replaced in the mouth, the potential for transmission of microbes is high.
Our mouths are full of different types of bacteria, some of which promote oral health. However, the researchers were looking for microbes which are not normally found in the oral cavity. They were particularly interested in two species of microbes; Candida, a type of yeast, and Staphylococcus including MRSA. Dr Pratten and his team found that species of these microorganisms were present on 66.7% and 50% of retainers respectively regardless of the retainer type. These microbes were also present on the interior cheeks and tongue of retainer wearers.
Candida and Staphylococcus rarely cause problems in healthy individuals but are potentially highly problematic in people with a compromised immune system. The bacteria on the retainers live in biofilms, which are communities of bacteria living together covered in a layer of slime. Once these biofilms form they are very difficult to remove and often have high levels of resistance to antimicrobials.
Dr Pratten says: "With the growing awareness the public has of hospital-acquired infections it is important to be aware of other potential 'hidden reservoirs' of harmful bacteria which could be introduced to environments where we know they can cause problems."
Whilst the researchers are now looking at developing effective methods of cleaning, for now hygiene is the key to reducing the transmission of these bugs. Anyone handling a retainer should wash their hands before and after use. Careful tooth brushing and mouthwash may also help to keep the retainer clean.
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