Treating gum disease reduces prostate symptoms

Treating gum disease reduced symptoms of prostate inflammation, called prostatitis, report researchers from Case Western Reserve University School of Dental Medicine and the Departments of Urology and Pathology at University Hospitals Case Medical Center.

Previous studies have found a link between gum disease and prostatitis, a disease that inflames the gland that produces semen. Inflammation can make urination difficult.

"This study shows that if we treat the gum disease, it can improve the symptoms of prostatitis and the quality of life for those who have the disease," said Nabil Bissada, chair of Case Western Reserve's Department of Periodontics and the new study's corresponding author.

The researchers reported their findings in the Dentistry article, "Periodontal Treatment Improves Prostate Symptoms and Lowers Serum PSA in Men with High PSA and Chronic Periodontitis." Naif Alwithanani, a graduate student in the dental school, led the investigation as part of his residency in periodontics.

Bissada explained that gum disease not only affects the mouth, but is a system-wide condition that can cause inflammation in various parts of the body. The dental school has previously found a link between gum disease and fetal deaths, rheumatoid arthritis and heart disease.

The new prostate study

Researchers studied 27 men, 21 years old and older. Each had had a needle biopsy within the past year that confirmed inflammation of the prostate gland, and a blood test that showed elevated prostate specific antigen (PSA) levels--possible signs of inflammation and cancer.

The men were assessed for symptoms of prostate disease by answering questions on the International-Prostate Symptom Score (IPSS) test about their quality of life and possible urination issues.

Researchers found 21 of the 27 participants had no or mild inflammation, but 15 had biopsy-confirmed malignancies. Two had both inflammation and a malignancy.

The men also had to have at least 18 teeth and were examined for signs of gum disease, such as increased levels of inflammation and bleeding and/or loose teeth due to attachment and bone loss.

All the men had moderate to severe gum disease, for which they received treatment. They were tested again for periodontal disease four to eight weeks later and showed significant improvement.

During the periodontal care, the men received no treatment for their prostate conditions. But even without prostate treatment, 21 of the 27 men showed decreased levels of PSA. Those with the highest levels of inflammation benefited the most from the periodontal treatment. Six participants showed no changes.

Symptom scores on the IPSS test also showed improvement.

Bissada is now conducting follow-up research to support the first study's findings. He hopes to make periodontal treatment a standard part of treating prostate disease, much like cardiac patients are often encouraged to visit their dentist before undergoing heart procedures and a dental checkup is advised for women who are pregnant or considering pregnancy.

The connection between mouth bacteria and inflammation in heart disease

Oral infections are the most common diseases of mankind and are also a key risk factor for heart disease, which is the leading cause of death worldwide. In a review article published in Trends in Endocrinology and Metabolism on April 16, researchers summarize the latest clinical evidence supporting a link between oral infections, which are caused by the bacteria in our mouth, and heart disease, and they emphasize the important role of inflammation in both of these conditions.

"Given the high prevalence of oral infections, any risk they contribute to future cardiovascular disease is important to public health," says senior author Thomas Van Dyke of the Forsyth Institute. "Unravelling the role of the oral microbiome and inflammation in cardiovascular disease will likely lead to new preventive and treatment approaches." The (oral) microbiome refers to the totality of microorganisms in a body part-in this case the mouth--that we all co-exist with.

The most common oral infections are cavities and periodontal diseases such as gingivitis and periodontitis, which are chronic inflammatory diseases that slowly and steadily destroy the supporting structures of multiple teeth. Significant epidemiological evidence supports an association between oral infections, particularly periodontitis, and stroke, especially among men and younger individuals.

Inflammation plays a major role both in oral infections such as periodontitis and in cardiovascular disease. However, over-the-counter nonsteroidal anti-inflammatory drugs such as ibuprofen can produce significant cardiovascular side effects, which means it is crucial that we consider alternative therapies. A high dose of a commonly prescribed cholesterol-lowering medication, atorvastatin, which boosts blood levels of anti-inflammatory molecules called lipoxins and resolvins, prevents both periodontal and cardiovascular inflammation and reverses existing disease in humans. This is exciting and promising because lipoxins and resolvins also have the advantage of naturally controlling inflammation without suppressing the immune system.

"New discoveries of natural pathways that resolve inflammation have offered many opportunities for revealing insights into disease pathogenesis and for developing new pharmacologic targets for the treatment of both oral infections and cardiovascular disease," Van Dyke says.

In future studies, it will be important to compare the effectiveness of these inflammation-reducing molecules, which we produce naturally, and other interventions that could potentially prevent or reverse periodontitis and cardiovascular disease. Another open question is whether there is a reverse relationship between these conditions: what if the onset of cardiovascular disease influences the presence or progression of periodontal disease? Or what are some of the common genetic mechanisms underlying periodontitis and cardiovascular disease?

In the meantime, Van Dyke recommends that people take better care of their teeth to potentially lower their risk of cardiovascular disease and other health problems. "The majority of diseases and conditions of aging, including obesity and type 2 diabetes, have a major inflammatory component that can be made worse by the presence of periodontitis," he says. "Periodontitis is not just a dental disease, and it should not be ignored, as it is a modifiable risk factor."

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Trends in Endocrinology & Metabolism, Kholy et al.:"Oral infections and cardiovascular disease" http://dx.doi.org/10.1016/j.tem.2015.03.001

How gum disease treatment can prevent heart disease

A new study from the Forsyth Institute is helping to shed more light on the important connection between the mouth and heart. According to research recently published online by the American Heart Association, scientists at Forsyth and Boston University have demonstrated that using an oral topical remedy to reduce inflammation associated with periodontitis, more commonly known as gum disease, also results in the prevention of vascular inflammation and can lower the risk of heart attack.

This study is the first time researchers anywhere have demonstrated the ability of an oral treatment for gum disease to also reduce inflammation in the artery wall. The active ingredient is an inflammation resolving molecule, known as Resolvin E1. This discovery further underscores the increasing body of evidence showcasing how problems in the mouth - and how they are treated - can have life changing influences on other key systems in the body, such as the heart in this case.

"Our research is helping to underscore the very real link between oral health and heart disease," said Lead Investigator Hatice Hasturk, DDS, PhD, an associate member of Forsyth's Department of Applied Oral Sciences and director of Forsyth's Center for Clinical and Translational Research. "The general public understands the connection between heart health and overall wellness, and often takes appropriate steps to prevent heart disease. More education is needed to elevate oral wellness into the same category in light of proven connections to major health conditions."

According to the CDC, heart disease accounts for one in four deaths in the United States, and the rate continues to rise. Forsyth's findings suggest a need to expand the public's understanding of risk factors beyond cholesterol, smoking, hypertension and diabetes to include a focus on oral health. With support from the scientific community, Forsyth aims to generate greater awareness of gum disease (affecting 64.7 million American adults according to the CDC) as a critical risk factor for heart disease, independent from diet and lifestyle.

The study, titled, "Resolvin E1 Prevents Atheromatous Plaque Formation," will be published in print in the May issue of Arteriosclerosis, Thrombosis, and Vascular Biology (ATVB), a journal of the American Heart Association. It is the first paper to show a rabbit model of accelerated heart disease, demonstrating a range of atherosclerotic plaque stages that more closely resemble those in humans without genetic modification of the animal. This research is authored by Hatice Hasturk, Rima Abdallah, Alpdogan Kantarci, Daniel Nguyen, Nicholas Giordano, James Hamilton and Thomas E. Van Dyke.

A novel way to apply drugs to dental plaque

Therapeutic agents intended to reduce dental plaque and prevent tooth decay are often removed by saliva and the act of swallowing before they can take effect. But a team of researchers has developed a way to keep the drugs from being washed away.

Dental plaque is made up of bacteria enmeshed in a sticky matrix of polymers--a polymeric matrix--that is firmly attached to teeth. The researchers, led by Danielle Benoit at the University of Rochester and Hyun Koo at the University of Pennsylvania's School of Dental Medicine, found a new way to deliver an antibacterial agent within the plaque, despite the presence of saliva.

Their findings have been published in the journal ACS Nano.

"We had two specific challenges," said Benoit, an assistant professor of biomedical engineering. "We had to figure out how to deliver the anti-bacterial agent to the teeth and keep it there, and also how to release the agent into the targeted sites."

To deliver the agent--known as farnesol--to the targeted sites, the researchers created a spherical mass of particles, referred to as a nanoparticle carrier. They constructed the outer layer out of cationic--or positively charged--segments of the polymers. For inside the carrier, they secured the drug with hydrophobic and pH-responsive polymers.

The positively-charged outer layer of the carrier is able to stay in place at the surface of the teeth because the enamel is made up, in part, of HA (hydroxyapatite), which is negatively charged. Just as oppositely charged magnets are attracted to each other, the same is true of the nanoparticles and HA. Because teeth are coated with saliva, the researchers weren't certain the nanoparticles would adhere. But not only did the particles stay in place, they were also able to bind with the polymeric matrix and stick to dental plaque.

Since the nanoparticles could bind both to saliva-coated teeth and within plaque, Benoit and colleagues used them to carry an anti-bacterial agent to the targeted sites. The researchers then needed to figure out how to effectively release the agent into the plaque.

A key trait of the inner carrier material is that it destabilizes at acidic--or low pH--levels, such as 4.5, allowing the drug to escape more rapidly. And that's exactly what happens to the pH level in plaque when it's exposed to glucose, sucrose, starch, and other food products that cause tooth decay. In other words, the nanoparticles release the drug when exposed to cavity-causing eating habits--precisely when it is most needed to quickly stop acid-producing bacteria.

The researchers tested the product in rats that were infected with Streptococcus mutans--a microbe that causes tooth decay. "We applied the test solutions to rats' mouths twice daily for 30 seconds, simulating what a person might do using a mouth rinse morning and night," said Hyun Koo, a professor in the Department of Orthodontics and co-senior author of the work. "When the drug was administered without the nanoparticle carriers, there was no effect on the number of cavities and only a very small reduction in their severity. But when it was delivered by the nanoparticle carriers, both the number and severity of the cavities were reduced."

Plaque formation and tooth decay are chronic conditions that need to be monitored through regular visits to the dental office. The researchers hope their results will someday lead to better--and perhaps permanent--treatments for dental plaque and tooth decay, as well as other biofilm-related diseases.

Inflammation in mouth, joints in rheumatoid arthritis

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At the 93rd General Session and Exhibition of the International Association for Dental Research, researcher Sheila Arvikar, Massachusetts General Hospital, Boston, USA, will present a study titled "Inflammation in the Mouth and Joints in Rheumatoid Arthritis." The IADR General Session is being held in conjunction with the 44th Annual Meeting of the American Association for Dental Research and the 39th Annual Meeting of the Canadian Association for Dental Research.

Periodontitis shares pathogenic mechanisms with rheumatoid arthritis (RA) and may trigger its onset. In this study, researchers performed joint and dental examinations, determined Porphyromonas gingivalis (P. gingivalis) antibodies, and examined inflammatory microenvironments in early and chronic RA patients.

Twenty-three RA patients, (15 new-onset disease, eight chronic) and 20 age/gender-matched healthy subjects (HS) without periodontitis/RA were enrolled in this study. Serum P. gingivalis IgG antibodies were measured by ELISA. Twenty inflammatory mediators were measured in serum, saliva, gingival crevicular fluid (GCF), and joint fluid by Luminex.

The 23 patients (87% female) received routine dental care, except for one; none currently smoked. Of the 23 RA patients, 10 had gingivitis and nine had periodontitis. RA patients exhibited increased pocket depth, clinical attachment loss, bleeding on probing and GCF volume compared with HS. Six of 23 patients had P. gingivalis antibodies, and all six had periodontitis.
RA patients showed a marked inflammatory profile in all microenvironments, including oral, despite routine dental care. P. gingivalis antibodies can be considered as biomarkers for rheumatologists in identifying those who may benefit from periodontal treatment.

Graphene: A new tool for fighting cavities and gum disease?

Dental diseases, which are caused by the overgrowth of certain bacteria in the mouth, are among the most common health problems in the world. Now scientists have discovered that a material called graphene oxide is effective at eliminating these bacteria, some of which have developed antibiotic resistance. They report the findings in the journal ACS Applied Materials & Interfaces.

Zisheng Tang and colleagues point out that dentists often prescribe traditional antibiotics to get rid of bacteria that cause tooth decay or gum disease. But with the rise in antibiotic resistance, new approaches are needed to address these problems, which can lead to tooth loss. Previous studies have demonstrated that graphene oxide -- carbon nanosheets studded with oxygen groups -- is a promising material in biomedical applications. It can inhibit the growth of some bacterial strains with minimal harm to mammalian cells. Tang's team wanted to see if the nanosheets would also stop the specific bacteria that cause dental diseases.

In the lab, the researchers tested the material against three different species of bacteria that are linked to tooth decay and gum disease. By destroying the bacterial cell walls and membranes, graphene oxide effectively slowed the growth of the pathogens. The researchers conclude that the nanosheets could have potential uses in dental care.

Periodontal disease linked to increased risk of kidney disease

 In a study of blacks with normal kidney function, those with severe periodontal disease developed chronic kidney disease (CKD) at 4 times the rate of those without severe periodontal disease. The study that will be presented at ASN Kidney Week 2014 November 11¬-16 at the Pennsylvania Convention Center in Philadelphia, PA.

Periodontal disease is a chronic bacterial infection of the oral cavity, and it disproportionately affects African Americans. It's also been implicated as a potential risk factor for CKD. To investigate this potential link, researchers led by Vanessa Grubbs, MD (University of California, San Francisco) analyzed 699 African American adults who underwent complete dental examinations.

During an average follow-up of 4.8 years, there were 21 (3.0%) new CKD cases. Participants with severe periodontal disease had a 4.2-fold greater incidence of CKD after adjusting for various factors (age, sex, diabetes, hypertension, smoking, and income) compared with those without severe periodontal disease.

"Because periodontal disease is common and can be prevented and treated, targeting it may be an important path towards reducing existing racial and ethnic disparities in chronic and end-stage kidney disease," said Dr. Grubbs.