Gum infection may be a risk factor for heart arrhythmia, researchers find

Periodontitis, a gum disease, can lead to a litany of dental issues from bad breath to bleeding and lost teeth. Now, researchers at Hiroshima University have found that it could be connected to even more severe problems elsewhere in the body — the heart. 

In a study published on Oct. 31 in JACC: Clinical Electrophysiology, the team found a significant correlation between periodontitis and fibrosis — scarring to an appendage of the heart’s left atrium that can lead to an irregular heartbeat called atrial fibrillation — in a sample of 76 patients with cardiac disease. 

“Periodontitis is associated with a long-standing inflammation, and inflammation plays a key role in atrial fibrosis progression and atrial fibrillation pathogenesis,” said first author Shunsuke Miyauchi, assistant professor with the Hiroshima University’s Health Service Center. He is also affiliated with the university’s Graduate School of Biomedical and Health Sciences. “We hypothesized that periodontitis exacerbates atrial fibrosis. This histological study of left atrial appendages aimed to clarify the relationship between clinical periodontitis status and degree of atrial fibrosis.”

The left atrial appendages were surgically removed from the patients, and the researchers analyzed the tissue to establish the correlation between severity of the atrial fibrosis and severity of the gum disease. They found that the worse the periodontitis, the worse the fibrosis, suggesting that the inflammation of gums may intensify inflammation and disease in the heart. 

“This study provides basic evidence that periodontitis can aggravate atrial fibrosis and can be a novel modifiable risk factor for atrial fibrillation,” said corresponding author Yukiko Nakano, professor of cardiovascular medicine in Hiroshima University’s Graduate School of Biomedical and Health Sciences. 

According to Nakano, in addition to improving other risk factors such as weight, activity levels, tobacco and alcohol use, periodontal care could aid in comprehensive atrial fibrillation management. However, she cautioned that this study did not establish a causal relationship, meaning that while gum disease and atrial fibrosis degrees of severity appear connected, researchers have not found that one definitively leads to the other. 

“Further evidence is required for establishing that periodontitis contributes to the atrial fibrosis in a causal manner and that periodontal care can alter fibrosis,” Nakano said. “One of our goals is to confirm that periodontitis is a modifiable risk factor for atrial fibrillation and to promote dental specialists’ participation in comprehensive atrial fibrillation management. Periodontitis is an easy modifiable target with lower cost among known atrial fibrillation risk factors. Thus, the achievement of this study series may bring benefits for many people worldwide.”

Heavy smokers with severe periodontitis receive no benefit from treatment

 

IMAGE: HEAVY SMOKERS SHOULD BE OFFERED HELP TO QUIT SMOKING IF THEY SUFFER FROM SEVERE PERIODONTITIS, SAYS JULIE PAJANIAYE, RESEARCHER AND DENTAL HYGIENIST. view more 

CREDIT: AU HEALTH

Smoking can have a serious impact on the effect of the treatment of periodontitis – a widespread condition that leads to degradation of the teeth’s supportive tissue and, in serious cases, to loss of the teeth.

This is shown by a new study from Aarhus University which has just been published in the Journal of Dental Research.

The researchers studied the effect of different levels of smoking on the clinical results of the treatment of more or less advanced cases of periodontitis.

The study shows that heavy smokers with the most severe forms of inflammation obtained no benefit from the treatment, while heavy smokers with moderate periodontitis only had a 50 percent effect from the treatment, compared to smokers with less tobacco consumption.

“To our surprise, we could see that the disease had actually grown worse in some parameters in the hardest-hit group, despite the fact that this particular group had received the most extensive, individually-designed treatment,” says Julie Pajaniaye MHH, a dental hygienist and one of the authors behind the study.

Should be offered help to quit smoking

It is estimated that around 40 per cent of the population is affected by periodontitis, but there is a great deal of variation in how severely the disease develops in each individual patient. Around 18 percent of Danes smoke on a daily basis, or occasionally.

The treatment of the disease is adapted to the individual patient, including deep cleansings of the affected teeth, information about the harmful effects of smoking and, in some cases, surgery.

According to Julie Pajaniaye, the study illustrates the need for politicians and decision-makers to better incorporate referrals to smoking cessation courses in the treatment of periodontitis when developing new clinical guidelines and performance descriptions.

“This is completely new knowledge for the country’s dental clinics, and it should be taken into account when treatment is being planned for the individual patients,” she says.

Crucial knowledge in treatment

Dentists and dental hygienists currently refer patients to quit-smoking courses only to a limited extent as part of the treatment of periodontitis.

This should be changed, according to Julie Pajaniaye – not least because, for the first time, the study shows that in the case of heavy smokers, a worsening of the disease may occur during a period of active treatment.

“As a heavy smoker with periodontitis, it is very important to understand that working towards stopping smoking is a crucial step in the effective treatment of the disease,” says Julie Pajaniaye.

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Behind the research results

• Type of study: Prospective clinical cohort study which included 80 smokers with periodontitis resident in the city of Aarhus
• Funding: Health, AU and the Danish Dental Association
• Partners: Aarhus Municipality - Public Health Aarhus
• Potential conflicts of interest: None
• Link to the scientific article: https://pubmed.ncbi.nlm.nih.gov/36333874/

Contact: 

Dental hygienist and Master of Humanities and Health Studies (MHH), Julie Pajaniaye
Department of Dentistry and Oral Health, Aarhus University.
Mail: jp@dent.au.dk
Phone: +45 87168263

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JOURNAL

Journal of Dental Research

METHOD OF RESEARCH

Observational study

Towards better dental cavity diagnosis with nondestructive infrared imaging

Researchers test and compare different imaging-based methods to accurately detect active dental cavities

Peer-Reviewed Publication

SPIE--INTERNATIONAL SOCIETY FOR OPTICS AND PHOTONICS

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IMAGE: WHEN COMBINED WITH AIR DRYING, SHORTWAVE-INFRARED CAN BE USED TO DETECT ACTIVE DENTAL CAVITIES. THIS IS POSSIBLE BECAUSE ACTIVE CAVITIES ARE POROUS AND HOLD MORE WATER, WHICH AFFECTS THE INFRARED MEASUREMENTS AROUND THE AFFECTED AREA AS THE TOOTH DRIES. view more 

CREDIT: CHANG ET AL., DOI 10.1117/1.JBO.28.9.094801.

Dental caries, also called “cavities” or “tooth decay,” can be debilitating. Modern dentistry has tried-and-tested solutions for treating caries of many shapes and sizes without needing to remove the tooth altogether. Dental restorations, also known as “fillings,” are commonplace and yet—while modern restorative materials have many advantages such as improved biocompatibility and better aesthetics—they can still fail over time.

Restorative materials do not always bond well to the surrounding healthy tooth structure. Microscopic leaks may form, allowing fluids and bacterial acids to penetrate beneath the restoration. This can lead to the formation of a secondary caries that appears and grows around a previously restored cavity. “Dentists now spend more time replacing failed restorations than placing new ones due to the maladaptation of bonding materials to tooth structure,” comments Dr. Nai-Yuan N. Chang from the Fried Group in the Department of Preventive and Restorative Dental Sciences at University of California, San Francisco (UCSF).

Directed by UCSF Professor Daniel Fried, the Fried Group develops new diagnostic techniques to detect active dental lesions. In a recent study published in Journal of Biomedical Optics (JBO), Chang’s research team evaluated emerging imaging modalities for discerning active tooth decay. “The traditional methods relying on tactile sensation via a dental explorer and visual inspection based on texture and color are highly subjective and unreliable,” explains Chang. “However, there is currently no established dental imaging technology that can provide diagnostic information with high specificity and sensitivity when assessing dental decay activity.”

To address this issue, the researchers focused on whether shortwave-infrared (SWIR) and thermal imaging could be combined with air drying to accurately diagnose the activity of a secondary caries lesion. The idea underlying both these methods is that active lesions are more porous than healthy tooth, and these pores hold water. In the SWIR-based approach, one can indirectly detect active lesions by observing changes in the SWIR reflectivity as the tooth dries out. On the other hand, the thermal imaging-based approach relies on the fact that the temperature changes in active lesions during air drying are different from that in healthy tooth, owing to the water trapped in the pores of the lesion. 

In their work, the team acquired 63 human tooth samples from oral surgeons and analyzed 109 suspected secondary lesions in them using both SWIR and thermal imaging. In addition to these methods, the researchers also observed the samples using optical coherence tomography (OCT), a more sophisticated technique that uses near-infrared light to create high resolution 3D images. To determine whether SWIR and thermal imaging were indeed useful for detecting active lesions, the results of these methods were compared with those obtained via OCT.

Overall, SWIR proved superior to thermal imaging and performed better in most circumstances. The SWIR permeability measurements were well correlated with the thickness of the transparent surface layer (TSL) of lesions measured via OCT. The team found that the highly mineralized TSL was thickest when a lesion had been fully arrested and needed no further intervention. According to the OCT results, a TSL thicker than 70 µm was a potential indication that a lesion was no longer active.

The findings of this study could help pave the way to a new era of diagnostic imaging in dentistry. Excited about the results, Chang concludes: “Our work provides further developmental milestones towards meeting the need for better diagnostic and easily operable clinical devices.”

Let us hope these new methods make active cavities easier to detect, allowing us all to preserve our dental health better.

Read the Gold Open Access article by Chang et al., “Assessment of the activity of secondary caries lesions with short-wavelength infrared, thermal, and optical coherence tomographic imaging,” J. Biomed. Opt. 28(9), 094801 (2023), doi 10.1117/1.JBO.28.9.094801.

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JOURNAL

Journal of Biomedical Optics

DOI

10.1117/1.JBO.28.9.094801 

Anti-inflammatory drugs commonly taken by children can cause alterations to dental enamel, study shows

The authors investigated the effects of celecoxib and indomethacin, non-steroidal anti-inflammatory drugs (NSAIDs) classified by the World Health Organization (WHO) as the first step on the analgesic ladder, alongside paracetamol.

Peer-Reviewed Publication

FUNDAÇÃO DE AMPARO À PESQUISA DO ESTADO DE SÃO PAULO

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A study conducted at the University of São Paulo (USP) in Brazil and described in an article published in the journal Scientific Reports shows that anti-inflammatory drugs commonly taken by children may be associated with dental enamel defects (DEDs), currently seen in about 20% of children worldwide.

The authors, who are affiliated with the Ribeirão Preto Dental School (FORP-USP) and School of Pharmaceutical Sciences (FCFRP-USP), investigated the effects of celecoxib and indomethacin, non-steroidal anti-inflammatory drugs (NSAIDs) classified by the World Health Organization (WHO) as the first step on the analgesic ladder, alongside paracetamol.

In recent years, dentists at FORP-USP’s Dental Enamel Clinic, who research and deal with the problem on a daily basis, have observed a sharp rise in the number of children seeking treatment for pain, white or yellow tooth spots, and dental sensitivity and fragility. In some cases, simple chewing can fracture the children’s teeth. All these are classical symptoms of DEDs of the type known as enamel hypomineralization, whose causes are poorly understood.

As a result of this disorder, dental decay in the form of carious lesions appears sooner and more frequently in these patients, whose restorations are less adhesive and tend to fail more. Studies have shown they may have to replace restorations ten times more often over a lifetime than people with healthy teeth.

A coincidence aroused the researchers’ curiosity most of all: the patients’ ages. The first years of life, when DEDs form, are a period in which sickness is frequent, often with high fever. “These diseases are typically treated with NSAIDs, which inhibit the activity of cyclooxygenase [COX, a key inflammatory enzyme] and reduce production of prostaglandin [which also promotes inflammation],” said Francisco de Paula-Silva, a professor in FORP-USP’s Pediatric Department and last author of the article. “However, COX and prostaglandin are known to be physiological for dental enamel, and we therefore wondered whether these drugs interfered in the normal formation of this structure.”

The study was supported by FAPESP via three projects (10/17611-4, 14/07125-6 and 21/09272-0). 

The researchers used rats to study the problem, as these animals have incisors that grow continuously, which facilitates analysis. The rats were treated with celecoxib and indomethacin for 28 days, after which practically no differences were visible to the naked eye in their teeth. However, when the researchers began extracting, they found that the teeth fractured more easily.

Analysis based on imaging and chemical composition suggested that dental mineralization had been affected. The teeth contained below-normal levels of calcium and phosphate, which are important to dental enamel formation, and mineral density was low. 

When the researchers looked for the reasons for this, they found alterations in proteins required for mineralization and cellular differentiation, showing that the drugs had indeed affected the composition of the dental enamel. 

Next steps

“Right now, the study at least offers us a clue to the identity of a new player that may be involved in the development of DEDs. Hitherto we’ve been totally in the dark,” said Paula-Silva. “We only achieved these important findings thanks to the efforts of FORP-USP’s Dental Enamel Clinic and collaboration with Lúcia Helena Faccioli, a professor at FCFRP-USP. She made a crucial contribution to our understanding of the role played by lipidic mediators related to inflammatory diseases that affect teeth.”

The group plan to conduct a clinical study with the aim of confirming the results of the research in the animal model. “We’re going to analyze the medical history of the children with DEDs and their use of these drugs, and we’ll set up a clinical study that will correlate the two datasets to see if the same thing happens to humans. If so, we can make recommendations on which drugs shouldn’t be used for which patients. We can also help work out an appropriate treatment protocol in future,” said Paula-Silva, comparing this situation with that of tetracycline, an antibiotic not recommended for children because it causes tooth discoloration.

Another important point to be addressed is indiscriminate use of over-the-counter drugs, a problem that appears to have worsened as pediatric care has become more common, although concrete information on this is not yet available. 

Study identifies potential link between oral bacteria and brain abscesses

Peer-Reviewed Publication

UNIVERSITY OF PLYMOUTH

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Bacteria known to cause oral infections may also be a contributory factor in patients developing potentially life-threatening abscesses on the brain, new research has shown.

The study, published in the Journal of Dentistry, investigated brain abscesses and their association with bacteria that occur in the oral cavity. While this type of abscess is relatively uncommon, it can result in significant mortality and morbidity.

Researchers examined the records of 87 patients admitted to hospital with brain abscesses, and used microbiological data obtained from abscess sampling and peripheral cultures.

This allowed them to investigate the presence of oral bacteria in patients’ brain abscesses where a cause of the abscess had either been found, as was the case in just 35 patients, or not found.

Their results showed that the 52 patients where no cause had been found were about three times as likely to have oral bacteria present in their samples.

Those patients also carried significantly higher counts of Streptococcus anginosus, a bacteria that can lead to pharyngitis, bacteremia, and infections in internal organs such as the brain, lung, and liver. This bacteria is often found in dental abscesses.

Writing in the study, researchers say the findings suggest that the oral cavity could be considered a source of infection in cases of brain abscess where no clear cause has been identified.

The research was led by the University of Plymouth and University Hospitals Plymouth NHS Trust.

Dr Holly Roy, an NIHR Clinical Lecturer in Neurosurgery based at the University of Plymouth and University Hospitals Plymouth NHS Trust, is the study’s lead author.

She said: “While many potential causes of brain abscesses are recognised, the origin of infection often remains clinically unidentified. However, it was still surprising to frequently find orally occurring bacteria in brain abscesses of unexplained origin. It highlights the importance of using more sensitive techniques to assess the oral cavity as a potential bacterial source in brain abscess patients. It also highlights the importance of improving dental care and oral hygiene more generally.”

The study forms part of ongoing research taking place within the University’s Oral Microbiome Research Group, led by Dr Raul Bescos and Dr Zoe Brookes, to explore the links between the oral microbiome and a range of cardiovascular and neurological conditions.

Other clinical trials are underway investigating the links between gum health and Alzheimer’s disease and identifying patients under high cardiovascular risk in primary care dental clinics, as an altered balance of oral bacteria (microbiome) during gum disease can lead to high blood pressure and strokes.

These clinical studies are being carried out in primary care dental facilities run by Peninsula Dental Social Enterprise, where the focus of the research is very much on improving clinical outcomes for patients.

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JOURNAL

Journal of Dentistry

DOI

10.1016/j.jdent.2022.104366 

Tooth decay: New study explores the impact of increasing dental health programs in middle schools

 

Kennesaw State University researcher Christina Scherrer’s studies on school-based dental health programs have shown how effective they can be in reducing tooth decay in elementary-aged children. Now, through a grant from the National Institutes of Health (NIH), Scherrer is expanding her research to see if similar programs can also help children in middle school.

“Dental problems are a significant contributor to children being out of school for pain and discomfort,” said Scherrer, professor and department chair of industrial and systems engineering in the Southern Polytechnic College of Engineering and Engineering Technology. “Data also shows that children who do not receive good oral healthcare can have diminished health later in life.”

According to Scherrer, who is working with Shillpa Naavaal, associate professor in Virginia Commonwealth University’s School of Dentistry, school-based dental programs are important, especially in low-income areas where parents may not have the means to take their children to a dentist. The researchers will use the more than $400,000 NIH grant to survey school sealant program directors and state oral health directors around the United States to determine how they are using school-based sealant programs and then dive into data on children’s teeth.

“We know sealants work, and we know that school-based sealant programs work,” Scherrer said. “However, most of these programs are in elementary schools and what we don’t know is how it looks different in a middle school. Our hypothesis is that perhaps children’s first molars are in better shape because they’re more likely to get sealed in these school-based programs and the second molars, those that typically come in between the ages of 11 and 13, are not.”

Scherrer and Naavaal will use data from the Centers for Disease Control and Prevention (CDC), which details children’s teeth including those that have sealants, have decay, and that are missing, in addition to demographic data. Once the research team has analyzed the CDC data and survey results, they will build a simulation model to see what the likely benefit would be of increasing school-based sealant programs for middle schoolers.  

Once the simulation model is built, the team will be able to estimate the impact of increasing the number of middle-school-based sealant programs on children’s teeth. If their results support the belief that more school-based sealant programs will improve children’s oral health in a cost-effective way, the goal is to apply for funding to help implement more programs.

“Dr. Scherrer continues to impress us with her community-focused and impactful research,” said KSU's Engineering College Dean Ian Ferguson. “It is an incredible honor to receive three NIH grants within the past year. It is clear that she and her research teams are making a difference in children’s lives. We look forward to continuing to follow her projects over the next several years.”

Earlier this year, Scherrer started work on her first NIH grant for a project aimed at assessing and reducing barriers associated with primary care doctors applying fluoride varnish on children’s teeth. She has been researching children’s oral health for more than a decade.

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Medicare coverage of medically necessary oral and dental health therapies in physician fee schedule

The Gerontological Society of America (GSA) — the nation’s largest interdisciplinary organization devoted to the field of aging — commends the Biden-Harris Administration for finalizing regulatory policy that will have a direct and meaningful impact in the lives of many Medicare beneficiaries. The Medicare program is taking an important step towards much-needed coverage of medically necessary oral and dental care.

Specifically, the final Physician Fee Schedule for 2023 codifies Medicare coverage for dental services that are inextricably linked and substantially related and integral to organ transplant surgery, cardiac valve replacement, valvuloplasty procedures, and head and neck cancers. The final rule also creates the opportunity for further coverage expansion by establishing “a process to identify for [the Medicare program’s] consideration and review submissions of additional dental services that are inextricably linked and substantially related and integral to the clinical success of other covered medical services.” Finally, the rule codifies Medicare coverage for the wiring of teeth related to covered medical services, the reduction of jaw fractures, the extraction of teeth in preparation for radiation treatment of neoplastic disease, dental splints for covered treatment of certain medical conditions, and oral or dental examinations relating to renal transplant surgery.

GSA members contribute to the evidence base as it relates to the importance of oral health as an essential element of healthy aging. The Society has a long-standing commitment to oral health, which includes multiple collaborations over several years. Guided by its Oral Health Workgroup, GSA works to increase awareness of appropriate oral care and strengthen the impact that all members of health care and caregiver teams have to ensure good oral care for older people. Additionally, GSA’s Oral Health Interest Group is an interdisciplinary network that provides an active opportunity for persons interested in the issue of oral health to meet and exchange information and resources.

Starting in 2016, GSA has developed and actively disseminated several relevant publications. Among them are a white paper from an interprofessional convening that included more than 20 national aging and oral health organizations titled “Interprofessional Solutions for Improving Oral Health in Older Adults: Addressing Access Barriers, Creating Oral Health Champions,” and two issues of GSA’s What’s Hot newsletter, “Oral Health: An Essential Element of Healthy Aging” in 2017 and “Interrelationships Between Nutrition and Oral Health in Older Adults” in 2020.

GSA has been a strong advocate for the inclusion of coverage of medically necessary oral and dental care in Medicare and has worked as a member of the Consortium for Medically Necessary Oral Health Coverage to advocate for Medicare coverage of medically necessary oral and dental treatment. GSA has joined roughly 240 colleagues in signing the consortium’s Community Statement to urge Congress and the Administration to explore options for extending evidence-based coverage to all Medicare beneficiaries. As a member of the consortium, GSA will now turn to the important process of expanding coverage of medically necessary oral and dental services to all medical conditions for which such services are documented to be of clinical, fiscal, and human value.

GSA thanks the administration for recognizing these facts and taking this important step to extend Medicare coverage to dental services that are integral to the delivery of covered medical services. By broadening coverage of medically necessary dental services and opening an important opportunity for stakeholders to suggest clinical scenarios to which medically necessary oral and dental services should be extended in the future, the Physician Fee Schedule makes meaningful progress to improve the clinical success of covered medical services.