Gum Disease Linked To Oral Cancer Virus

Scientists have discovered that severe gum disease could be linked to an increased risk of head and neck cancer cases caused by the Human Papilloma Virus (HPV).

The study found patients with HPV-positive tumours had significantly higher bone loss, a key factor in the development of severe gum disease, compared with patients with HPV-negative tumours.

Latest figures suggest more than 6,000 people in the UK suffer from oral cancer, while almost 2,000 lives are lost to the disease. HPV is a growing cause of the disease, with experts suggesting it may rival tobacco use as the main cause of oral cancer within 10 years. Other risk factors for developing the disease include tobacco use, drinking to excess and poor diet.

The significance of the research is compounded by the fact more teeth are lost through periodontal (gum) disease than through tooth decay.

Although further research is required to determine the exact relationship of the link between severe gum disease and an increased risk of HPV-related oral cancer, it is not the first time poor oral health and cancer have been linked. Recent research carried out at the Karolinska Institute in Sweden suggested failure to brush your teeth properly could increase the chance of premature death resulting from cancer. They found a link between high levels of dental plaque - the cause of gum disease - and dying from cancer up to 13 years earlier than previously expected.

The findings of both studies present even greater evidence of the need to ensure good oral health, according to Chief Executive of the British Dental Health Foundation, Dr Nigel Carter OBE.

Dr Carter said: "A greater understanding of how we can tackle this potentially life-threatening disease could lead to many lives being saved.

"Most of us suffer from gum disease at some point in our lives, yet it is entirely preventable. By developing and keeping a good oral health routine it lowers the risk of gum disease and any possible links to more serious diseases. We should all take time to reflect on how we can make that a reality.

"Brushing your teeth for two minutes twice a day using a fluoride toothpaste, cleaning in between teeth daily with interdental brushes or floss, cutting down on how often you have sugary foods and drinks and visiting the dentist regularly, as often as they recommend will be a great starting point.

"If you have swollen gums that bleed regularly when brushing, bad breath, loose teeth or regular mouth infections appear, it is likely you have gum disease.

"It is also vital to check regularly for early warning signs of mouth cancer. These include ulcers which do not heal within three weeks, red and white patches in the mouth and unusual lumps or swellings in the mouth. If you are in any doubt, please get checked out."

The study, published in the Archives of Otolaryngology, sampled 124 patients suffering from oral cancer, 50 of which were as a result of HPV. Lead author Mine Tezal, D.D.S., Ph.D., of the University at Buffalo commented: "Periodontitis is easy to detect and may represent a clinical high-risk profile for oral HPV infection.

"Prevention or treatment of sources of inflammation in the oral cavity may be a simple yet effective way to reduce the acquisition and persistence of oral HPV infection."

Oral Health - Americans Score Badly

A new survey from the American Dental Association (ADA) shows that Americans seriously need to clean up their act when it comes to oral health. The ADA's newly launched website, MouthHealth.org that aims to improve oral health reveals that Americans' average score was a 'D' in the survey's range of 'true or false' questions, which included questions like how often should teeth be cleaned, what causes cavities and the age of a child's first dentist visit.



William R. Calnon, D.D.S., ADA president and a practicing dentist in Rochester, N.Y. stated: "The results of the survey were quite shocking and really show how important it is for people to become more involved in their own oral health."



Nine in ten adults aged between 20-64 years have had cavities in their permanent teeth, according to the National Institute of Dental and Craniofacial Research (NIDCR), and almost half of children between the ages from 2 to 11 years have already had cavities in their baby teeth. It is therefore not surprising that the most common chronic disease in children is dental disease.



ADA's new consumer website, www.MouthHealthy.org, which was launched on June 25, provides information on prevention, care and treatments to improve and maintain dental care in addition to the dental IQ test so that visitors to the site can test their own knowledge.



Dr. Calnon pointed out: "Oral health is a critical part of overall health. MouthHealthy.org will help empower people to take charge of their oral health." ADA's national survey, conducted in May 2012, which involved a nationally representative sample of almost 1,500 adults revealed:

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90% of people believe they should clean their teeth after every meal, whilst ADA recommends cleaning twice a day •

81% of people believe that cavities are caused by sugar. However, it is not the actual sugar that causes cavities, but germs in the mouth that feed on sugar and produce acid that attacks the teeth enamel, which over time wear down the enamel to such an extent that cavities form •

75% have no idea at what age they should take a child to the dentist for the first time. According to ADA recommendations, a child's first dentist visit should be within six months after the first tooth appears or before the child's first birthday •

65% of people think their toothbrush should be replaced twice a year, when it should be replaced every three months •

59% of people are unaware that germs that can cause cavities can be passed from person to person



(The survey included a margin of error of + or - 2.6 points.)

OK to limit pre-dental procedure antibiotics to high risk heart patients

The incidence of infective endocarditis among dental patients in Olmsted County, Minn. did not increase after new guidelines called for giving preventive antibiotics before dental procedures only to those at greatest risk of complications, according to independent research published in Circulation, an American Heart Association journal.

Infective endocarditis is a bacterial infection of the heart lining, heart valve or blood vessel. Although rare, it can occur when bacteria enter the bloodstream through breaks in the gums during invasive dental procedures or oral surgery. It can cause death if untreated. A common group of bacteria that cause this infection is viridans group streptococci (VGS).

Patients with a heart weakened by certain congenital defects and acquired conditions, including those with prosthetic heart valves, can be more susceptible to the infection. People with normal heart valves develop the infection less often.

In 2007, the American Heart Association changed its guidelines, recommending patients take antibiotics before invasive dental procedures only if they are at risk of complications from infective endocarditis. This includes patients with artificial heart valves, transplanted hearts with abnormal heart valve function, previous infective endocarditis and people born with specific heart defects.

Before 2007, antibiotics were given to many more people, including those with many types of congenital heart defect or acquired cardiac condition. Antibiotics also were given for a wider range of procedures, including operations involving the mouth, throat, gastrointestinal, genital or urinary tract.

"We were giving preventive antibiotics like we were treating an entire iceberg, when we only needed to treat the very tip of that iceberg," said Daniel C. DeSimone, M.D., study lead author and an internal medicine resident at the Mayo Clinic in Rochester, Minn. "Millions of people once getting antibiotics now are not."

In the first U.S. study examining VGS-related infective endocarditis rates after the guidelines changed, investigators found a slight decline in the number of patients diagnosed.

To compare infective endocarditis rates, researchers analyzed local hospital discharge records in the Rochester Epidemiology Project and national rates using the Nationwide Inpatient Sample. Olmstead County was used because of its unique medical records-linkage system that encompasses all residents of the county.

From Jan. 1, 1999 to Dec. 31, 2010, 22 patients in Olmsted County, Minn., were diagnosed with the heart infection. These patients represent two to three of every 100,000 people in the United States before updated guidelines, and one of every 100,000 after the updated guidelines.

The percentage of Olmsted county dentists following the new association guidelines represented the percentage of dentists using them nationally, researchers said.

The national annual infective endocarditis diagnosis rates showed no increase, ranging from:
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15,300-17,400 in 1999-2006 (before the updated guideline) •
•
14,700-15,500 in 2007-09 (after the updated guideline) •

"These findings are reassuring, but additional studies are needed to further support our findings," DeSimone said.

"There's still a concern among many healthcare providers over whether we are leaving certain people at risk of getting a potentially lethal infection just from a dental cleaning or tooth extraction," he said. "This study should reduce some fears. It will allow dentists to become more comfortable when they tell a patient, 'You've been getting this antibiotic for years. Now, it's not recommended anymore, and here is data showing you why.'"

Among other limitation, the lack of diversity in Olmstead means these results may not hold true for non-Caucasian populations.

Connections between preventive dentistry and public health

The dental profession needs to build a stronger connection between oral health and general health—not only for individual patients, but also at the community level, according to the special June issue of The Journal of Evidence-Based Dental Practice (JEBDP), the foremost publication of information about evidence-based dental practice, published by Elsevier.

The special issue follows the usual format of JEBDP, comprising expert reviews and analyses of the scientific evidence on specific dental procedures. "Yet the coverage goes beyond a review of specific clinical interventions to broader ones that address prevention on a community basis," according to an introductory guest editorial by Robert J. Collins, DMD, MPH, of University of Pennsylvania.

Dr. Collins highlights the role of evidence-based innovations such as home dental care, community water fluoridation, and dental sealants in shifting public perceptions of dental care from replacement or repair of missing or damaged teeth to protection against oral diseases. In his editorial, he calls on dentists to recognize the value of collaboration in addressing the problems of the public and the dental profession: "As professionals, clinicians have a responsibility to care for their patients as individuals and a community."

The goal of the special issue is to forge a closer link between the research-proven clinical care provided to individuals and the larger public health goals of improving health in the community. "The oral health status of individuals, families, and communities can be greatly improved when patient-centered, evidence-based care intersects with focused, larger community prevention efforts," states the CDC's William Bailey, DDS, MPH, Assistant Surgeon General and Chief Dental Officer, U.S. Public Health Service, highlighting the link between clinical care and public health.

The issue includes review and article analyses and evaluations on a wide range of topics related to prevention in dental care. The focus is on techniques that not only prevent dental diseases, but also reflect a growing appreciation of the connections between dental health and general health. Topics illustrating these areas of crossover include:
-1.
"Rubber cup" dental prophylaxis—there's little evidence of a health benefit for this familiar "preventive" technique, but it continues to be widely used. -1.
-1.
Prophylactic surgical extraction of wisdom teeth—a growing body of evidence questions the need for this common procedure, although controversy continues. -1.
-1.
Chlorhexidine mouthwash to reduce the risk of ventilator-associated pneumonia—an example of how better oral health can help prevent a serious medical condition, with important implications for dental care in nursing home residents. -1.



A highlight of the issue is an invited commentary by American Dental Association (ADA) President William R. Calnon, DDS. In contrast to its historical emphasis on surgical treatment of dental diseases after they have occurred—"drilling and filling"— Dr. Calnon believes the ADA and the dental profession at large need to develop a new framework for prevention of oral disease. He writes, "Perhaps it is time to think about prevention as the management of oral health risks, including the identification, assessment, and prioritization of these risks, and to take actions designed to mitigate the risks of oral disease or dysfunction."

The special issue also includes opinion pieces on key issues related to prevention and dental public health. Invited editorials highlight the need for private dental practitioners to take on increased responsibility for carrying out essential public health functions; and the impact of financial incentives on the provision of evidence-based preventive services in clinical dentistry.

"Our focus is on collaboration between dental professionals involved in community health and clinical health," Dr. Collins commented. "The issue is extremely important, particularly in looking at what we can do about the 25 to 30 percent of the population who don't have regular access to dental care."

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The JEBDP special issue on prevention is supported by educational grants from Colgate and the American Association of Public Health Dentistry. Every dental school and all dental public health residents in the United States will receive copies of the special Issue of JEBDP.

Gum disease associated with women’s hormones

Women, keep those toothbrushes and dental floss handy. A comprehensive review of women’s health studies by Charlene Krejci, associate clinical professor at the Case Western Reserve University School of Dental Medicine, has shown a link between women’s health issues and gum disease.

Across the ages, hormonal changes take place during puberty, menstruation, pregnancy and menopause. Krejci found female hormones that fluctuate throughout women’s lives can change conditions in the mouth that allow bacteria to grow, enter the blood, and exacerbate certain health issues like bone loss, fetal death and pre-term births.

Her overview of the literature was reported in the article, “Women’s Health: Periodontitis and its Relation to Hormonal Changes, Adverse Pregnancy Outcomes and Osteoporosis” in the May issue of Oral Health and Preventive Dentistry.

The Case Western Reserve University periodontist reviewed 61 journal articles with nearly 100 studies for a collective answer on whether hormones have a relationship to gum disease and specific women’s health issues like preterm labor, bone loss, and the side effect of hormonal replacement therapy.

“There’s definitely a gender-specific connection between women’s hormones, gum disease, and specific health issues impacting women,” Krejci said.__“Although women tend to take better care of their oral health than men, the main message is women need to be even more vigilant about maintaining healthy teeth and gums to prevent or lessen the severity of some of women-specific health issues,” Krejci said.

In addition to the brushing and flossing daily regimen, Krejci recommends visiting the dentist at least every six months, and more if there are any gum problems found or women suffer from bone loss or are pregnant.

She added that it is widely known that hormones cause some women gum problems during pregnancy. Women already susceptible to gum disease before being pregnant, she advises, need to make sure that these oral problems are treated.

Although women were once discouraged from seeing the dentist while pregnant, she said that scaling and planing of the roots of teeth to eliminate some gum disease is now recommended during pregnancy for women. Severe gum disease requiring surgery is still generally postponed until after the baby’s birth.

Gum disease begins with the build up of bacterial plaque on the teeth and under the gums. Untreated it can cause irritation and inflammation during which harmful and toxic byproducts are released. These toxins erode the bone that anchors teeth and cause breaks and bleeding in the gums.

Collaborating with Krejci on the study was Nabil Bissada, professor and chair of the Department of Periodontology at Case Western Reserve University School of Dental Medicine.

Two-step tooth implantation and built-up bone can be longer lasting

Periodontists routinely grow bone in the mouth to guarantee a stable environment for teeth and tooth implants. But whether it's better to build up bone before placing the implant, or to simply place the implant and allow bone to grow around it, has been a subject of considerable medical debate.

Now Prof. Zvi Artzi of Tel Aviv University's Maurice and Gabriela Goldschleger School of Dentistry at the Sackler Faculty of Medicine has completed a study that concludes the two-step method is the more effective alternative — building bone first, then implanting and allowing further bone growth. Currently, many dental professionals prefer a one-step process to save their patients from an additional surgical procedure.

Published in the Journal of Clinical Periodontology, Prof. Artzi's study shows that a one-step implant will show more wear and tear over time than one implanted through the more cautious two-step procedure. While both are clinically effective methods, he concludes, implant placement procedures done with the one-step method show greater bone resorption around the implant neck — a process by which the bone is broken down. Bonding of the bone around the implant was also shown to be inferior.

Testing proven procedures

The successful placement of a tooth implant is based on the biocompatibility of titanium, the main component of most dental and orthopedic implants. Both animal and human tissues readily accept the implant and grow around it. But in many cases, the amount of bone is also crucial to the success of the implant. Building bone to stabilize a titanium fixture is a long-standing procedure in dentistry.

Periodontists typically choose either the one-step or two-step procedure based on their preference alone. So Prof. Artzi and his fellow researchers set out to determine which procedure was scientifically superior in the long-term, well past the time when periodontists would typically monitor a patient's progress. In their study, they compared both methods of implantation in lab animals, and followed the progress of the implants over a course of two years.

The one-step procedure is based on the idea that a bone graft will simply attract the surrounding tissue to build up bone around the titanium implant — a process called conduction. The benefit of this procedure is that patients are only subjected to one surgery. But the study shows a difference in long-term efficacy, Prof. Artzi says. Ultimately, the bone recedes less in the more cautious two-step procedure. The quality of the resulting bone itself is similar.

A judgement call

Though the study proves that the two-step method is more advantageous in most cases, each case is different, says Prof. Artzi. For example, dental professionals also take into account the already existing bone – which determines how stable a future implant will be – before deciding which route to take with each individual patient. Clinically, both methods remain sound, and periodontists should still rely on their own judgement as to what is best for the patient.

Sports and Energy Drinks Responsible for Irreversible Damage to Teeth

Energy drinks found twice as likely to destroy enamel than sports drinks

A recent study published in the May/June 2012 issue of General Dentistry, the peer-reviewed clinical journal of the Academy of General Dentistry, found that an alarming increase in the consumption of sports and energy drinks, especially among adolescents, is causing irreversible damage to teeth—specifically, the high acidity levels in the drinks erode tooth enamel, the glossy outer layer of the tooth.

“Young adults consume these drinks assuming that they will improve their sports performance and energy levels and that they are ‘better’ for them than soda,” says Poonam Jain, BDS, MS, MPH, lead author of the study. “Most of these patients are shocked to learn that these drinks are essentially bathing their teeth with acid.”

Researchers examined the acidity levels in 13 sports drinks and nine energy drinks. They found that the acidity levels can vary between brands of beverages and flavors of the same brand. To test the effect of the acidity levels, the researchers immersed samples of human tooth enamel in each beverage for 15 minutes, followed by immersion in artificial saliva for two hours. This cycle was repeated four times a day for five days, and the samples were stored in fresh artificial saliva at all other times.

“This type of testing simulates the same exposure that a large proportion of American teens and young adults are subjecting their teeth to on a regular basis when they drink one of these beverages every few hours,” says Dr. Jain.

The researchers found that damage to enamel was evident after only five days of exposure to sports or energy drinks, although energy drinks showed a significantly greater potential to damage teeth than sports drinks. In fact, the authors found that energy drinks caused twice as much damage to teeth as sports drinks.

With a reported 30 to 50 percent of U.S. teens consuming energy drinks, and as many as 62 percent consuming at least one sports drink per day, it is important to educate parents and young adults about the downside of these drinks. Damage caused to tooth enamel is irreversible, and without the protection of enamel, teeth become overly sensitive, prone to cavities, and more likely to decay.

“Teens regularly come into my office with these types of symptoms, but they don’t know why,” says AGD spokesperson Jennifer Bone, DDS, MAGD. “We review their diet and snacking habits and then we discuss their consumption of these beverages. They don’t realize that something as seemingly harmless as a sports or energy drink can do a lot of damage to their teeth.”

Dr. Bone recommends that her patients minimize their intake of sports and energy drinks. She also advises them to chew sugar-free gum or rinse the mouth with water following consumption of the drinks. “Both tactics increase saliva flow, which naturally helps to return the acidity levels in the mouth to normal,” she says.

Also, patients should wait at least an hour to brush their teeth after consuming sports and energy drinks. Otherwise, says Dr. Bone, they will be spreading acid onto the tooth surfaces, increasing the erosive action.