From cavities to sleep apnea: dentists can assume new role in saving lives

A patient dozes off in a dental chair despite the anxiety of an impending procedure. A seemingly unremarkable act but — for dentists versed in the latest sleep research — this red flag hints at a life-threatening condition.

In a research review published in the Journal of the American Dental Association, Rutgers Health researchers identified dentists as an unexpected player in the battle against life-threatening sleep disorders.

The review suggests dental professionals have unique opportunities to screen for conditions such as obstructive sleep apnea, a disorder that affects millions of Americans and is linked to serious health risks, including cardiovascular disease and neurodegeneration.

It also challenges dentists to look beyond teeth and gums to the broader landscape of patient health.

"We have a great opportunity to change lives for the better," said Davis Thomas, a clinical associate professor at the Rutgers School of Dental Medicine and senior author of the review. "Dentists can be the first line of defense in identifying sleep disorders. They often see symptoms long before physicians. Indicators like tooth grinding, tongue scalloping or even a patient dozing off in the chair can be early signs that something more is going on."

Sleep disorders such as obstructive sleep apnea affect more than half of Americans at some point in their lives. Many cases go undiagnosed, but dentists can play an important role in reducing those numbers.

The review outlines several key indicators that dental clinicians should look for during examinations, including enlarged jaw muscles, scalloped tongue edges, white lines on the cheeks, restricted visibility of the throat, dental wear patterns and tiny cracks on teeth.

These physical signs, combined with patient history and simple screening tools, can help dentists identify at-risk patients with up to 80 percent accuracy.

"It's not just about looking at teeth anymore," Thomas said. "We need to observe the whole patient, from their behavior in the waiting room to the subtle signs in their oral cavity."

Another sign of concern, according to the review authors, is bruxism, commonly known as teeth grinding. Contrary to long-held beliefs, the studies suggest teeth griding is often a symptom of underlying sleep issues rather than a standalone problem caused by dental misalignment.

"We've been treating the symptoms without addressing the root cause for far too long," Thomas said. "By understanding the neuroscience behind sleep disorders, we can provide more comprehensive care and potentially prevent serious health complications."

This shift in perspective could have far-reaching implications. By identifying patients at risk for sleep disorders, dentists can facilitate early intervention, potentially preventing complications such as hypertension, heart disease and stroke.

To implement these findings, Thomas and his team propose a simple protocol for dental practices: Incorporate sleep-related questions into patient history forms. Other recommendations include training dental staff to recognize physical signs of sleep disorders and using validated screening tools like the STOP-BANG (snoring, tiredness, observed apnea, blood pressure, body mass index, age, neck size, gender) questionnaire, which screens for obstructive sleep apnea and establish referral networks with sleep medicine specialists.

"We're not asking dentists to diagnose sleep disorders," Thomas said. "We're asking them to recognize the signs and make appropriate referrals. This simple act can be lifesaving."

Thomas recommends that dentists looking to incorporate sleep screening into their practices start with education.

"Attend sleep medicine conferences, take continuing education courses, and stay up-to-date with the latest research," he said. "The more we learn, the more we realize how much we don't know – and how much we can do to help our patients."

Protect your teeth with fruit: antimicrobial effects found in biomass compounds

 

A nonirritant, antibacterial solution to prevent oral inflammation may lie in citrus and coconut chemical compounds

Peer-Reviewed Publication

Osaka Metropolitan University

 

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Compounds found in citrus and coconut could be the solution to oral disease in children and the elderly.

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Credit: Osaka Metropolitan University

Periodontal disease is an inflammatory disease caused by a periodontal pathogenic bacteria infection that affects oral and internal health. Good oral care is essential for prevention, but most over-the-counter oral hygiene products are disinfectants that can be highly irritating. This makes them unsuitable for use by young children and the elderly, who are susceptible to periodontal disease.

To find an antibacterial that is easy to use and effective in preventing periodontal disease at all ages, Professor Shigeki Kamitani of Osaka Metropolitan University’s Graduate School of Human Life and Ecology led a research team in verifying the antibacterial effect of seven different compounds. Prunin laurate (Pru-C12) and its analogs were tested against the periodontal pathogenic bacteria, Porphyromonas gingivalis.

The results showed that while several of the compounds inhibited bacterial growth, Pru-C12, which can be derived from biomass such as that of citrus plants and coconut-derived components, had the highest antimicrobial effect.

“Pru-C12 is tasteless and hypoallergenic,” Professor Kamitani stated. “If its safety in humans is confirmed in the future, it could be an inexpensive antimicrobial solution.”

The findings were published in Foods.

Oral cancer screening:programs for improved early detection

Cancer is a complex disease characterized by uncontrolled cell growth, significantly impacting global health. Head and neck cancers rank as the sixth most prevalent cancers worldwide, with a higher incidence in South-central Asia. Oral squamous cell carcinoma (OSCC) is the predominant malignancy in this category, posing a significant health concern due to its high mortality and often late-stage diagnosis. The significance of early detection and appropriate screening measures cannot be overstated, as they play a pivotal role in improving survival rates and reducing the disease burden.

Overview of Oral Cancer

Oral cancer involves the malignant growth of cells in the mouth's tissues, including the lips, tongue, gums, cheeks, and throat. The five-year survival rate is discouragingly low, between 50% and 60%, largely due to late diagnosis. Early detection is crucial for improving prognosis and survival rates. However, diagnostic delays are common, often attributed to patient-related issues like lack of awareness and delayed consultation, as well as healthcare provider factors such as misdiagnosis or inadequate suspicion of malignancy.

Epidemiology

The global burden of oral cancer is substantial, with approximately 377,713 new cases and 177,757 deaths in 2020, predominantly in Asia. India faces a particularly high incidence due to cultural and behavioral factors like tobacco use. Oral cancer is the most diagnosed cancer among men and the third among women in India, with significant regional variations in incidence and mortality rates. The high prevalence in South-central Asia can be linked to specific risk behaviors and socioeconomic factors that necessitate targeted public health interventions.

Characteristics

Over 90% of oral cancers are OSCCs, often located in the tongue and floor of the mouth. Early-stage carcinomas typically go unnoticed due to the absence of symptoms, leading to late-stage diagnoses characterized by pain, bleeding, and other severe symptoms. The prognosis is poor once the disease progresses to advanced stages. Early detection relies heavily on clinical examination and biopsy. Recognizing the subtle clinical signs in the early stages can significantly alter the treatment outcomes and improve survival rates.

Risk Factors

Major risk factors for oral cancer include tobacco use, alcohol consumption, betel quid chewing, and HPV infection. These factors contribute to the majority of oral cancer cases, with synergistic effects observed when multiple risk factors are present. Other factors include the oral microbiome, chronic mucosal inflammation, and trauma from dental prosthetics. Ultraviolet radiation is a significant risk for lip cancer, while genetic conditions like Xeroderma pigmentosum increase susceptibility. Public health efforts aimed at reducing these risk factors can lead to a significant decrease in oral cancer incidence.

Prevention and Detection

Prevention strategies focus on reducing risk factors such as tobacco and alcohol use. Public health campaigns and policy measures targeting these behaviors are crucial for primary prevention. Secondary prevention involves screening high-risk populations to detect oral cancer early. Clinical trials in India have shown that reducing tobacco and betel quid use can lower the risk of malignancy. Nutritional interventions with vitamins C, A, and E may also reduce cancer risk. Regular clinical examinations and biopsies are crucial for early detection, particularly in high-risk areas like the floor of the mouth and the tongue. Implementing community-based screening programs can facilitate early diagnosis and treatment, improving patient outcomes.

Screening Techniques

Conventional screening methods include visual and tactile examinations, but these have limitations such as sampling bias. Visual inspection alone may miss early or subtle lesions. Advanced techniques like imaging and artificial intelligence (AI) are being explored to improve accuracy. Imaging technologies such as autofluorescence, narrow-band imaging, and optical coherence tomography enhance the visualization of suspicious lesions. AI, in particular, shows promise in integrating with conventional methods to enhance early detection and intervention strategies. AI algorithms can analyze large datasets, identify patterns, and assist clinicians in making more accurate diagnoses.

Conclusions

Early detection of oral cancer is critical for improving patient outcomes and reducing mortality. By integrating advanced technologies like imaging and AI with traditional screening methods, the accuracy and effectiveness of early detection can be significantly improved. This approach is particularly vital for underdeveloped and developing nations, where the burden of oral cancer is highest. Effective screening and prevention strategies can lead to earlier detection, more successful interventions, and ultimately, better prognosis for patients. Public health policies focusing on education, risk factor modification, and accessible screening programs are essential for combating the high incidence of oral cancer and improving global health outcomes.

 

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https://www.xiahepublishing.com/2835-3315/CSP-2023-00029S

 

The study was recently published in the Cancer Screening and Prevention.

Children living in deprived areas 3 times more likely to need dental extractions

Researchers at Queen Mary University of London have found that children living in areas with high levels of deprivation are three times more likely to have severe tooth decay that requires a dental extraction in hospital, compared with children living in more affluent areas. The findings highlight an urgent need for equitable access to preventive dentistry.

In the study, published today (16 July 2024) in BMJ Public Health, researchers analysed de-identified GP and hospital records for 600,000 children between the ages of five and 16 living in North East London. During the five-year study period, one in 200 children had at least one tooth removed under a general anaesthetic, which must be done in a hospital setting. Most of those children had multiple teeth extracted.

The study findings demonstrate major socioeconomic and ethnic inequalities in severe tooth decay in children, which is preventable through access to NHS dentists, and policies such as toothbrushing in schools and control of sugar in food and drinks.

• Children living in areas with the highest proportion of low-income households were three times more likely to require a dental extraction, compared with those living in areas with the lowest proportion of low-income households.
• Children from some ethnic groups were more likely to need a dental extraction, compared with children from White British ethnic groups:
  • White Irish: twice as likely;
  • Bangladeshi: 1.5 times more likely;
  • Pakistani: 1.4 times more likely.
• Children living with obesity were less likely to require a dental extraction than children with healthy weight. More research is needed to replicate and understand this finding.

The researchers also examined the data by North East London borough, comparing rates of children’s dental extractions with access to NHS general dental practitioners. After adjusting for deprivation and ethnic group, the highest risk of hospital dental extraction was for children in Tower Hamlets, which also has the lowest general dental practitioner attendance in North East London. Conversely, children living in Redbridge, Havering, and Barking & Dagenham had the lowest risk of hospital dental extraction - these areas have the highest proportion of five-year-olds accessing general dental practitioner services. Additionally, the 2022 National Dental Epidemiology Programme (NDEP) oral health survey found that only 13% of decayed teeth in five-year-old children in London had been filled.

This study is the first to analyse inequalities in children’s tooth extractions under general anaesthesia by ethnic group in such granular detail, revealing a difference in outcomes between White Irish and White British groups, and between Bangladeshi, Pakistani and Indian groups. By linking hospital data to GP records, which include 16 categories for ethnic group, researchers were able to reveal ethnic inequalities that are less apparent when using the broader ethnicity categories used in previous research.   

This research was funded by a grant from Barts Charity (ref: MGU0419).

Vanessa Muirhead, Co-author and Reader and Honorary Consultant in Dental Public Health at Queen Mary, said:

“Sadly, our findings demonstrate wide socioeconomic and ethnic inequalities related to access to dental care and outcomes.

“Tooth extraction is a last resort, but when families have difficulty accessing timely preventive and treatment services, dental problems can progress until children need more serious and costly interventions such as multiple tooth extractions under general anaesthesia.”

Nicola Firman, lead author and Health Data Scientist at Queen Mary, said:

“Linking health data from different settings has allowed us to see inequalities in the dental care system more clearly.

“Our findings point to an urgent need for equitable access to preventive general dental services, and interventions that are targeted at the wider determinants of dental health.”

Christopher Tredwin, Dean and Director of the Institute of Dentistry at Queen Mar, said:

“This research highlights clear oral health inequalities, which we are also acutely aware of through our longstanding service of the local community.

“In partnership with Barts Health NHS Trust, the Queen Mary Institute of Dentistry opened a new dental outreach clinic in Kenworthy Road, Homerton, earlier this year. It is now providing quicker and easier access to dental care in the local area, while our dental and therapy students learn to treat children in these primary care settings. Through the outstanding work of our students at these clinics, we hope to mitigate the effects of unequal access to general dentistry in North East London and help to provide care for those who need it most.”

Victoria King, Director of Funding and Impact at Barts Charity, said:

“This important work, supported by Barts Charity, has demonstrated that there are major inequalities linked to severe tooth decay for children in East London, which could be preventable. Supporting research to understand these health inequalities is key to making better healthcare possible for our diverse East London population."

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JOURNAL

BMJ Public Health

DOI

10.1136/bmjph-2023-000622 

Kidney function is associated with tooth loss in postmenopausal women

Kidneys play a critical role in overall health by removing waste products from the blood. When they fail to sufficiently filter out foreign elements, several serious, lifethreatening, medical conditions can result. A new study suggests that chronic kidney disease may also be linked with tooth loss. Results of the survey are published online today in Menopause, the journal of The Menopause Society.

A woman’s glomerular filtration rate shows how well her kidneys are functioning. Kidney function decreases with time after menopause and is associated with declining reproductive hormone levels. These hormone changes during menopause also often lead to abdominal obesity, which is an independent risk factor for the development of chronic kidney disease and also linked with a higher risk of tooth loss.

The consequences of kidney disease are numerous, including an increased probability of experiencing problems with bone and cardiovascular health. Tooth loss, which reflects oral health status, is also associated with systemic diseases, such as diabetes, thyroid disease, and osteoporosis, and is independently associated with an increased risk of stroke. Excessive tooth loss can also impair chewing and speech.

Previous studies have identified an association between kidney function and tooth count. This newest study involving nearly 65,000 participants, however, is the first known to evaluate the association between chronic kidney disease and tooth loss in postmenopausal women across the ages. It concluded that the glomerular filtration rate, a measure of kidney function, is significantly associated with having at least 20 (of a total of 28) adult teeth, suggesting that chronic kidney disease and tooth loss are significantly associated, especially in postmenopausal women aged 66 to 79 years.

These findings suggest that preventing and managing mineral and bone metabolism disorders in postmenopausal women with chronic kidney disease are crucial to prevent tooth loss. It is also important to address kidney disease progression, as the consequences affect multiple body systems beyond just oral health.

Survey results are published in the article “Chronic kidney disease in postmenopausal women is associated with tooth loss.”

“This study highlights the known link between chronic kidney disease and bone metabolism. Increased attention to oral and bone health is warranted in postmenopausal women with chronic kidney disease, in addition to meticulous efforts aimed at preserving kidney function. Conversely, oral health is a window to overall health, and good oral hygiene is important for women of all ages,” says Dr. Stephanie Faubion, medical director for The Menopause Society. 

Hidden challenges of tooth loss and dentures revealed in new study

 

The hidden challenges faced by people with tooth loss and dentures has been identified by new research from the University of Sheffield

Peer-Reviewed Publication

UNIVERSITY OF SHEFFIELD

 

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IMAGE COPYRIGHT GINA ALLEN 2024

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CREDIT: IMAGE COPYRIGHT GINA ALLEN 2024

The hidden challenges faced by people with tooth loss and dentures has been identified by new research from the University of Sheffield.

 

Improvements in dental care, more people living longer and the social value placed on having a healthy smile has led to people keeping their own teeth longer, but it has also led to an increasing number of people needing some kind of restoration work including crowns, bridges and implants. 

 

Many of these treatments remain unobtainable for most people due to the availability of NHS dentists and the high cost of private dental work. Removable dentures are often the only viable option for anyone experiencing tooth loss with an estimated 10 to 15 percent of the population wearing them.

 

A new study by researchers at the University of Sheffield’s Healthy Life Span Institute and the School of Clinical Dentistry has highlighted the emotional struggles and hidden challenges patients experience when having dentures fitted. This is the first study to map out the patient journey and how this experience can affect the overall success of the treatment.

 

The study found that patients think about their denture journey in four stages:

 

• Tooth Loss: This is the initial stage where patients experience the physical loss of teeth.

 

• The Emotional Tunnel: This stage focuses on the emotional rollercoaster of tooth loss. Patients experience self-consciousness, depression, and struggle with dentures. They may feel shame, anger, or fear, but also hope.

 

• Prosthetic Hope: This stage represents the hope and optimism patients feel when getting dentures. They might anticipate regaining their smile and ability to eat normally.

 

• Prosthetic Compromise leading to managing disclosure: This final stage acknowledges that dentures take some getting used to. Patients might need to adjust their expectations and learn how to manage talking and eating with dentures. They might also develop strategies to feel comfortable disclosing their denture use to others.

 

These feelings and how dentists understand and manage them can influence the patient outcomes. A dentist's empathy during this adjustment period is crucial for successful denture use and better patient outcomes.

 

The study also identified that wearing removable dentures can be a hidden disability for many. People with dentures feel they have to hide them due to feeling embarrassed or worrying they will fall out. Some patients also avoided social situations 

 

Lead researcher Barry Gibson, Professor in Medical Sociology at the University of Sheffield said “Tooth loss can be hugely traumatic and this study has uncovered just how challenging it is for people needing partial dentures. Feelings such as embarrassment or shame can significantly affect the process of having dentures made and fitted. On top of this if they don’t fit properly this can make everyday activities such as speaking, eating and drinking very difficult which affects a person’s quality of life. The impact can be so dramatic that it can impact their confidence to leave the house. This can have a devastating and lasting impact.

 

“Understanding the emotional difficulties identified in the study will help dentists to improve the care given to denture patients and lead to a more successful and better experience for everyone”

 

The research team partnered with local Sheffield artist Gina Allen to create an art piece reflecting the diverse emotional journeys of denture wearers. 

 

The picture is a collage that illustrates the type of journeys patients go through from tooth loss to life with a denture. It uses colour to depict the emotional nature of the journey and demonstrates that all patients have a unique journey and outcome from the experience.  One patient, a young woman, has a successful outcome; a middle-aged man is OK but a bit 'Meh!' An older woman continues to struggle to cope with some aspects of adapting to her denture.

 

Artist Gina Allen said  “I’m a visual artist with a science background and a particular interest in how art can help to explore and interpret data, often around social and environmental themes. It seemed to me that there was such a depth and variety of individual experiences captured by the research team on this project, so it was a really interesting challenge to be involved in, trying to use the visual parameters of an artwork to convey some of that in an engaging and meaningful way.”

 

This collaboration has influenced the development of a new patient questionnaire designed to:

• Identify Individual Needs: Tailor care based on specific patient experiences.
• Improve Communication: Enable dentists and patients to have open conversations about dentures.
• Trigger Follow-Up: Identify patients who may need additional support.

 

In addition to identifying the emotional challenges faced by patients, the study also highlights the need for a clinical care pathway to improve patient support, focus on improving denture fit, educate patients about denture care, and combat the shame and stigma associated with wearing dentures.

 

Mr Bilal El-Dhuwaib, Clinical Teacher in Restorative Dentistry at the University of Sheffield, said: “This study is important because it goes beyond the typical numbers-driven approach to dentistry by looking at crucial aspects of patients' emotions and lived experiences. By understanding the psychological and social impact of tooth loss and replacement, the research provides a valuable toolkit for myself and fellow dentists to better understand and address the emotional rollercoaster patients navigate during this process. By equipping dentists with the tools to understand these challenges, we can create a more compassionate and effective approach to tooth replacement."

 

Alcohol-based mouthwash brand disrupts the balance of your oral microbiome

Peer-Reviewed Publication

MICROBIOLOGY SOCIETY

SUMMARY

• Researchers have identified a significant change in composition and abundance of bacteria in study participants’ oral microbiomes after using a popular brand of alcohol-based mouthwash.
• The oral microbiome is the community of bacteria that live in the mouth, they help us digest our food and keep our mouth healthy.
• Researchers found that two species of opportunistic bacteria were significantly more abundant in the mouth after daily use of the alcohol-based mouthwash, Fusobacterium nucleatum and Streptococcus anginosus.
• These two bacteria have been previously linked to several diseases including gum disease and oesophageal and colorectal cancers.
• Although results show potentially damaging alterations to the microbiome, researchers urge that the study results do not mean that the general public should no longer use mouthwash.

The oral microbiome is the community of bacteria that live in the mouth, they help us digest our food and keep our mouth healthy. Changes to the composition of the oral microbiome have been linked to periodontal diseases and some cancers.

The research, published in Journal of Medical Microbiology found that two species of opportunistic bacteria were significantly more abundant in the mouth after three months of daily use of the alcohol-based mouthwash, Fusobacterium nucleatum and Streptococcus anginosus. These two bacteria have been previously linked to gum disease, esophageal and colorectal cancers. Researchers also saw a decrease in a group of bacteria called Actinobacteria which are crucial contributors to the regulation of blood pressure.

Dr Jolein Laumen, first author of the study and researcher at ITM’s Unit of Sexually Transmitted Infections said:

“Alcohol-based mouthwashes are widely available. The public may use them daily to tackle bad breath or prevent periodontitis, but they should be aware of the potential implications. Ideally, long-term usage should be guided by healthcare professionals”.