Monday, March 5, 2012

Gum Healing Promoted Around Exposed Roots

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Receding gums often result in tooth sensitivity and can lead to decay of the root and persistent inflammation of the gum. New research published in BioMed Central's open access journal Head & Face Medicine demonstrates that a novel method using bovine collagen is able to enhance gum healing. This resulted in thicker margins around the tooth and, in over half the cases, complete coverage of exposed roots.

Researchers across Germany and Switzerland led by Dr Shahram Ghanaati and the dentist Dr Markus Schlee investigated the possibility of using collagen, extracted from bovine pericardium, to form a support for mending receding gums and exposed roots. The collagen was extracted by a process involving osmotic, oxidative and alkaline treatment. This ensured that the cell walls were broken down, proteins and fats dissolved, and that bacteria, viruses and other pathogens were inactivated and removed.

The study followed 14 otherwise healthy patients with over 60 'recessions' between them. Their damaged teeth were cleaned before surgery and the collagen implants held in place with loops of surgical thread around the affected tooth. Two weeks later the sutures were removed. None of the patients needed antibiotics.

The patients were re-examined after six months to see how well they had recovered. Dr Schlee described the results, "In all cases the healed-over implant improved the look and severity of the recession, and, in over half of all treatments, resulted in total coverage of the exposed root. We would not have expected any of these patients to get better without surgery."

The collagen seems to be able to act as a scaffold for the body's own cells to repair the damage leading to results on a level comparable to that of connective tissue grafts. Bovine collagen is a possible solution for patients with little available donor tissue or for whom multiple surgeries are not an option.

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Friday, March 2, 2012

An Unlikely Bond: Prenatal Health and Dental Hygiene

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Oral health doesn’t always top the list of concerns that expectant mothers may have, but it certainly should. Proper dental health and control of oral disease can safeguard a mother’s health before and during pregnancy and reduces the transmission of bacteria from women to their children. According to numerous studies by the American Congress of Obstetricians and Gynecologists, many women do not seek, nor are instructed to seek, proper oral healthcare as part of their routine prenatal care.

“Caring for a pregnant mother’s teeth and gums should start before she becomes pregnant,” said Doron Kochman, DDS and Associate Clinical Professor of Pediatric Dentistry in the Department of Clinical Dentistry, at the University of Rochester Strong Memorial Hospital, and Eastman Dental Center in Rochester, NY. “Ideally, women who are planning to get pregnant should visit their dentists and have any necessary work done before the pregnancy. Mothers should continue to visit their dentists for routine prevention visits during their pregnancies.”

Due to the natural hormonal fluctuations during pregnancy, gums are more susceptible to swelling and inflammation. Because of this, bacteria can accumulate causing gum disease and further medical complications for both mother and baby. “We now know that the bacteria responsible for gum disease can also cause problems in places other than the mother’s mouth,” said Kochman. Periodontal disease increases the risk that bacteria will enter the bloodstream, causing potential infections in either mother or baby.

Studies have shown a link between periodontal disease in mothers and an increased chance of delivering premature or low birth weight babies. Because many pregnant women routinely experience swollen and bleeding gums after they brush, they may not recognize a true problem if it exists. Regular check-ups before and during pregnancy are highly recommended.

In addition to prematurity and low birth weight, other problems can result from oral health issues. Studies have suggested that periodontal disease can increase the risk for preeclampsia, a life-threatening disorder caused by high blood pressure which usually occurs mid-to-late pregnancy.

People with diabetes are also more likely to have periodontal disease. Diabetic mothers need to be vigilant about their blood glucose levels to protect their unborn children from fetal obesity, high blood insulin levels and blood disorders, among other conditions.

Furthermore, there is growing evidence that if a mother’s oral hygiene is less than optimal, her baby’s oral health can suffer. “An expectant mother’s diet and oral hygiene can affect her baby's teeth,” said Kochman. “The baby’s teeth start developing in the 5th or 6th week after conception. A mother's balanced diet during pregnancy provides the calcium, phosphorous, other minerals and vitamins needed for the baby’s teeth to form properly.”

Most dentists recommend the following tips for expectant moms:
• Brush at least twice a day to remove plaque buildup
• Floss regularly
• Avoid sugary snacks
• Eat a healthy, balanced diet
• Get regular dental exams (speak to your dentist to see what is right for you)

Thursday, March 1, 2012

New method for stronger dental implants

Millions of people have bad teeth replaced with implants. Often following the procedure, they are unable to chew food for up to six months, until the implant has become fixated in the bone. Now, for the first time, a drug coating that has been tested on humans allows titanium screws to adhere to the bone better and faster. The Linköping researchers behind the method report that the results are good.

The study, led by Per Aspenberg, professor of orthopaedic surgery at Linköping University, is published in the journal Bone and was highlighted in this week's edition of the British Medical Journal (BMJ).

The implants are screwed into the jawbone and provide purchase for artificial teeth. Using current technology, it may take four to six months before the bone surrounding the screw has healed and is strong enough so the patient can begin to benefit from surgery.

The coating, developed at Linköping University in Sweden, consists of a nanometre-thin layer of protein that attaches to the metal surface. Attached to the protein is a drug belonging to the bisphosphonates, usually used to treat osteoporosis. Several animal studies have shown that this method allows the bone surrounding the implant to rapidly become denser and stronger.

Now, for the first time, this method has been tested on humans. 16 patients each received two implants; one normal and a similar surface-treated implant as described above. Neither the patient nor the dental surgeon knew which was which. After six months it was noted that for 15 of the 16 patients the treated screw was markedly much better established. Already after two months X-ray images showed positive changes adjacent to the treated screws. No complications occurred.

“It is the first time ever anyone has succeeded in reinforcing the bone around an implant with localised medication”, says Per Aspenberg, professor of orthopaedics, who devised the method of using bisphosphonates in this way.

Pentti Tengvall, professor of biomaterials, developed the method of adhering the drug to the screw and the study was conducted by Jahan Abtahi, specialist MD and PhD, supported by Per Aspenberg. Addbio AB is a Linköping based company now working on commercializing the surface treatment for different types of implants in bone.

Article:
A bisphosphonate-coating improves the fixation of metal implants in human bone. A randomized trial of dental implants by Jahan Abtahi, Pentti Tengvall and Per Aspenberg. The journal ‘Bone’ (in press), published online 10 February 2012.

Monday, February 27, 2012

Dental pulp stem cells transformed by 'bad breath' chemical

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Japanese scientists have found that the odorous compound responsible for halitosis – otherwise known as bad breath – is ideal for harvesting stem cells taken from human dental pulp.

In a study published today, Monday 27 February, in IOP Publishing's Journal of Breath Research, researchers showed that hydrogen sulphide (H2S) increased the ability of adult stem cells to differentiate into hepatic (liver) cells, furthering their reputation as a reliable source for future liver-cell therapy.

This is the first time that liver cells have been produced from human dental pulp and, even more impressively, have been produced in high numbers of high purity.

"High purity means there are less 'wrong cells' that are being differentiated to other tissues, or remaining as stem cells. Moreover, these facts suggest that patients undergoing transplantation with the hepatic cells may have almost no possibility of developing teratomas or cancers, as can be the case when using bone marrow stem cells," said lead author of the study Dr. Ken Yaegaki.

The remarkable transforming ability of stem cells has led to significant focus from research groups around the world and given rise to expectations of cures for numerable diseases, including Parkinson's and Alzheimer's.

In this study, Dr. Ken Yaegaki and his group, from Nippon Dental University, Japan, used stem cells from dental pulp – the central part of the tooth made up of connective tissue and cells – which were obtained from the teeth of dental patients who were undergoing routine tooth extractions.

Once the cells were sufficiently prepared, they were separated into two batches (a test and a control) and the test cells incubated in a H2S chamber. They were harvested and analysed after 3, 6 and 9 days to see if the cells had successfully transformed into liver cells.

To test if the cells successfully differentiated under the influence of H2S, the researchers carried out a series of tests looking at features that were characteristic of liver cells. In addition to physical observations under the microscope, the researchers investigated the cell's ability to store glycogen and then recorded the amount of urea contained in the cell.

"Until now, nobody has produced the protocol to regenerate such a huge number of hepatic cells for human transplantation. Compared to the traditional method of using fetal bovine serum to produce the cells, our method is productive and, most importantly, safe" continued Dr. Yaegaki.

Hydrogen sulphide (H2S) has the characteristic smell of rotten eggs and is produced throughout the body in the tissues. Although its exact function is unknown, researchers have been led to believe that it plays a key role in many physiological processes and disease states.

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Monday, February 6, 2012

Injectable progesterone contraceptives may be associated with poor periodontal health

Injectable progesterone contraceptives may be associated with poor periodontal health, according to research in the Journal of Periodontology. The study found that women who are currently taking depotmedroxyprogesterone acetate (DMPA) injectable contraceptive, or have taken DMPA in the past, are more likely to have indicators of poor periodontal health, including gingivitis and periodontitis, than women who have never taken the injectable contraceptive. DMPA is a long-lasting progestin-only injectable contraceptive administered intermuscularly every three months.

Periodontal disease is a chronic inflammatory disease that affects the gum tissue and bone that supports the teeth. Gingivitis, the mildest form of gum disease, causes the gums to become red, swollen, and bleed easily. Periodontitis is the most severe form of gum disease and can lead to tooth loss. Additionally, research has associated gum disease with other chronic inflammatory diseases such as diabetes, cardiovascular disease, and rheumatoid arthritis.

The data for this study were obtained from the NHANES 1999-2004 public use datasets. The participants chosen were non-pregnant, premenopausal women aged 15-44 who had provided complete DMPA usage data, indicating current usage of DMPA, past usage of DMPA, or no usage of DMPA at all. All participants received a dental examination that noted clinical attachment (CA) loss, periodontal pocket assessment at two or three sites per tooth, and presence of gingival bleeding.

After adjusting for age, race, education, poverty income level, and smoking status, the study found that current and past DMPA users had significantly increased periodontal pockets, gingival bleeding, and CA loss than women who have never used DMPA. Current DMPA users were more likely to have gingivitis, while past DMPA users were more likely to have periodontitis.

According to Dr. Pamela McClain, President of the American Academy of Periodontology (AAP) and a practicing periodontist in Aurora, Colorado, women currently taking DMPA or that have used DMPA in the past should pay careful attention to their teeth and gums. "Hormones can play a role in woman's periodontal health. These findings suggest that women that use, or have used, a hormone-based injectable contraception such as DMPA may have increased odds of poor periodontal health. I would encourage women that use or previously used this form of contraception to maintain excellent oral care, and to be sure to see a dental professional for a comprehensive periodontal evaluation on an annual basis."

Friday, January 27, 2012

Study Pinpoints Genetic Variation that Raises Risk of Serious Complication Linked to Osteoporosis Drugs

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Researchers at the Columbia University College of Dental Medicine have identified a genetic variation that raises the risk of developing serious necrotic jaw bone lesions in patients who take bisphosphonates, a common class of osteoclastic inhibitors. The discovery paves the way for a genetic screening test to determine who can safely take these drugs. The study appears in the online version of the journal The Oncologist.

Oral bisphosphonates are currently taken by some 3 million women in the United States for the prevention or treatment of osteoporosis. In addition, intravenous bisphosphonates are given to thousands of cancer patients each year to control the spread of bone cancer and prevent excess calcium (hypercalcemia) from accumulating in the blood. Bisphosphonates work by binding to calcium in the bone and inhibiting osteoclasts, bone cells that break down the bone’s mineral structure.

“These drugs have been widely used for years and are generally considered safe and effective,” said study leader Athanasios I. Zavras, DMD, MS, DMSc, associate professor of Dentistry and Epidemiology and Director of the Division of Oral Epidemiology & Biostatistics at the Columbia University College of Dental Medicine. “But the popular literature and blogs are filled with stories of patients on prolonged bisphosphonate therapy who were trying to control osteoporosis or hypercalcemia only to develop osteonecrosis of the jaw.”

Osteonecrosis of the jaw, or ONJ, often leads to painful and hard-to-treat bone lesions, which can eventually lead to loss of the entire jaw. Among people taking bisphosphonates, ONJ tends to occur in those with dental disease or those who undergo invasive dental procedures.

There are no reliable figures on the incidence of ONJ in patients taking oral bisphosphonates. Estimates range from 1 in 1,000 to 1 in 100,000 patients for each year of exposure to the medication, according to the American College of Rheumatology. ONJ is more common among cancer patients taking the intravenous form of the drug, affecting about 5 to 10 percent of these individuals, noted Dr. Zavras.
Studies have suggested that genetic factors play a major role in predisposing patients to ONJ.

Delving deeper into this question, Dr. Zavras and his colleagues performed genome-wide analyses of 30 patients who were taking bisphosphonates and had developed ONJ and compared them with several bisphosphonate users who were disease free.

The researchers found that patients who had a small variation in the RBMS3 gene were 5.8 times more likely to develop ONJ than those without the variation. The study also identified small variations in two other genes, IGFBP7 and ABCC4, that may contribute to ONJ risk.

“Our ultimate goal is to develop a pharmacogenetic test that personalizes risk assessment for ONJ, a test that you could give to people before they start to use bisphosphonates,” said Dr. Zavras. “Those who are positive for this genetic variation would select some other treatment, while those who are negative could take these medications with little fear of developing ONJ.”

“At the moment, many women discontinue or avoid treatment for serious osteoporosis because they are afraid of losing their jaw bones,” added Dr. Zavras. “There even are reports of dentists who have refused to perform certain invasive procedures in patients taking bisphosphonates. So there is a great need for a pharmacogenetic screening test to determine which patients are really at risk for ONJ.”

The current study looked only at Caucasians. Further studies are needed to determine whether the RBMS3 gene variation is seen in other racial groups, according to the researchers.

The paper is entitled, “Genome-wide pharmacogenetics of bisphosphonate-induced osteonecrosis of the jaw: the role of RBMS3.”

Wednesday, January 4, 2012

Dried licorice root fights the bacteria that cause tooth decay and gum disease

Scientists are reporting identification of two substances in licorice — used extensively in Chinese traditional medicine — that kill the major bacteria responsible for tooth decay and gum disease, the leading causes of tooth loss in children and adults. In a study in ACS' Journal of Natural Products, they say that these substances could have a role in treating and preventing tooth decay and gum disease.

Stefan Gafner and colleagues explain that the dried root of the licorice plant is a common treatment in Chinese traditional medicine, especially as a way to enhance the activity of other herbal ingredients or as a flavoring. Despite the popularity of licorice candy in the U.S., licorice root has been replaced in domestic candy with anise oil, which has a similar flavor. Traditional medical practitioners use dried licorice root to treat various ailments, such as respiratory and digestive problems, but few modern scientific studies address whether licorice really works. (Consumers should check with their health care provider before taking licorice root because it can have undesirable effects and interactions with prescription drugs.) To test whether the sweet root could combat the bacteria that cause gum disease and cavities, the researchers took a closer look at various substances in licorice.

They found that two of the licorice compounds, licoricidin and licorisoflavan A, were the most effective antibacterial substances. These substances killed two of the major bacteria responsible for dental cavities and two of the bacteria that promote gum disease. One of the compounds — licoricidin — also killed a third gum disease bacterium. The researchers say that these substances could treat or even prevent oral infections.