Vitamin D = lower rates of tooth decay

A new review of existing studies points toward a potential role for vitamin D in helping to prevent dental caries, or tooth decay. The review, published in the December issue of Nutrition Reviews, encompassed 24 controlled clinical trials, spanning the 1920s to the 1980s, on approximately 3,000 children in several countries. These trials showed that vitamin D was associated with an approximately 50 percent reduction in the incidence of tooth decay. "My main goal was to summarize the clinical trial database so that we could take a fresh look at this vitamin D question," said Dr. Philippe Hujoel of the University of Washington, who conducted the review. While vitamin D's role in supporting bone health has not been disputed, significant disagreement has historically existed over its role in preventing caries, Hujoel noted. The American Medical Association and the U.S. National Research Council concluded around 1950 that vitamin D was beneficial in managing dental caries. The American Dental Association said otherwise – based on the same evidence. In 1989, the National Research Council, despite new evidence supporting vitamin D's caries-fighting benefits, called the issue "unresolved." Current reviews by the Institute of Medicine, the U.S. Department of Human Health and Service and the American Dental Association draw no conclusions on the vitamin D evidence as it relates to dental caries. "Such inconsistent conclusions by different organizations do not make much sense from an evidence-based perspective," Hujoel said. The trials he reviewed increased vitamin D levels in children through the use of supplemental UV radiation or by supplementing the children's diet with cod-liver oil or other products containing the vitamin. The clinical trials he reviewed were conducted in the United States, Great Britain, Canada, Austria, New Zealand and Sweden. Trials were conducted in institutional settings, schools, medical and dental practices, or hospitals. The subjects were children or young adults between the ages of 2 and 16 years, with a weighted mean age of 10 years. Hujoel's findings come as no surprise to researchers familiar with past vitamin D studies. According to Dr. Michael Hollick, professor of medicine at the Boston University Medical Center, "the findings from the University of Washington reaffirm the importance of vitamin D for dental health." He said that "children who are vitamin D deficient have poor and delayed teeth eruption and are prone to dental caries." The vitamin D question takes on greater importance in the light of current public health trends. Vitamin D levels in many populations are decreasing while dental caries levels in young children are increasing. "Whether this is more than just a coincidence is open to debate," Hujoel said. "In the meantime, pregnant women or young mothers can do little harm by realizing that vitamin D is essential to their offspring's health. Vitamin D does lead to teeth and bones that are better mineralized." Hujoel added a note of caution to his findings: "One has to be careful with the interpretation of this systematic review. The trials had weaknesses which could have biased the result, and most of the trial participants lived in an era that differs profoundly from today's environment. " Hujoel has joint appointments as a professor in the University of Washington School of Dentistry's Department of Oral Health Sciences and as an adjunct professor of epidemiology in the UW School of Public Health. His research has concentrated on nutrition with a focus on low-carbohydrate diets, harmful effects of diagnostic radiation, and evidence-based methodology and applications. His research has also covered sugar substitutes, the use of antibiotics in the treatment of periodontal disease, and cleft lip and cleft palate. He has also studied the link between dental disease and systemic disease, as well as trends in disease prevalence.

Fear of the dentist is passed on to children by their parents

The father acts as an intermediary for dentist fear between both mother and children Fear of visiting the dentist is a frequent problem in paediatric dentistry. A new study confirms the emotional transmission of dentist fear among family members and analyses the different roles that mothers and fathers might play. A new study conducted by scientists at the Rey Juan Carlos University of Madrid highlights the important role that parents play in the transmission of dentist fear in their family. Previous studies had already identified the association between the fear levels of parents and their children, but they never explored the different roles that the father and the mother play in this phenomenon. América Lara Sacido, one of the authors of the study explains that "along with the presence of emotional transmission of dentist fear amongst family members, we have identified the relevant role that fathers play in transmission of this phobia in comparison to the mother." Published in the "International Journal of Paediatric Dentistry", the study analysed 183 children between 7 and 12 years and their parents in the Autonomous Community of Madrid. The results were in line with previous studies which found that fear levels amongst fathers, mothers and children are interlinked. A key factor: the father The authors confirmed that the higher the level of dentist fear or anxiety in one family member, the higher the level in the rest of the family. The study also reveals that fathers play a key role in the transmission of dentist fear from mothers to their children as they act as a mediating variable. "Although the results should be interpreted with due caution, children seem to mainly pay attention to the emotional reactions of the fathers when deciding if situations at the dentist are potentially stressful," states Lara Sacido. Consequently, transmission of fear from the mother to the child, whether it be an increase or reduction of anxiety, could be influenced by the reactions that the father displays in the dentist. Positive emotional contagion Amongst the possible implications of these results, the authors outline the two most salient: the need to involve mothers and especially fathers in dentist fear prevention campaigns; and to make fathers to attend the dentist and display no signs of fear or anxiety. "With regard to assistance in the dental clinic, the work with parents is key. They should appear relaxed as a way of directly ensuring that the child is relaxed too," notes the author. "Through the positive emotional contagion route in the family, the right attitude can be achieved in the child so that attending the dentist is not a problem," she concludes.

Gum Disease Bacteria Linked To Pancreatic Cancer Risk

The British Dental Health Foundation believes new scientific research presented is a further indication of a possible link between pancreatic cancer and gum disease. The latest research, presented in the journal Gut, found one of the bacterium key in the development of gum disease was associated with a two-fold increase in risk for pancreatic cancer. The study also discovered those with non-harmful oral bacteria had a 45 per cent lower risk of pancreatic cancer. Although researchers cannot confirm whether gum disease contributes towards a higher risk of developing pancreatic cancer, the research is a further indication of a potential link between the two diseases. Previous research has also drawn an association between bacteria responsible for gum disease and pancreatic cancer, although in both cases it remains unclear whether the presence of particular types of bacteria are a cause or effect of pancreatic cancer. The paper's corresponding author Dominique Michaud, epidemiologist at Brown University, commented: "This is not an established risk factor. But I feel more confident that something is going on. It's something we need to understand better." Co-lead author Jacques Izard, of the Forsyth Institute and Harvard University concurred. He said: "We need to further investigate the importance of bacteria in pancreatic cancer beyond the associated risk." Pancreatic cancer accounted for 7,901 deaths in 20104, while only four per cent of people in England survived the disease for more than five years. Given these statistics, Chief Executive of the British Dental Health Foundation, Dr Nigel Carter OBE, believes any link between the two diseases should provide a timely reminder about the importance of good oral health. Dr Carter said: "This research provides further ammunition to the growing belief these two diseases could be related. "There is no escaping the fact poor oral health has some role to play, as a number of studies are now starting to show. What we must remember is oral health is relatively simple to maintain. The Foundation's three key messages - brushing your teeth for two minutes twice a day using a fluoride toothpaste, cutting down on how often you have sugary foods and drinks and visiting the dentist regularly, as often as they recommend - are a great starting point for maintaining good oral health. "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. If any of these symptoms persist, your dentist may be able to help you."

New discovery related to gum disease

A University of Louisville scientist has found a way to prevent inflammation and bone loss surrounding the teeth by blocking a natural signaling pathway of the enzyme GSK3b, which plays an important role in directing the immune response.

The discovery of UofL School of Dentistry researcher David Scott, PhD, and his team recently published on-line first in the journal Molecular Medicine. The finding not only has implications in preventing periodontal disease, a chronic inflammatory disease that causes tooth loss, but also may have relevance to other chronic inflammatory diseases. Since GSK3b is involved in multiple inflammatory signaling pathways, it is associated with a number of diseases and also is being tested by scientists for its impact in Alzheimer's disease, Type II diabetes and some forms of cancer, to name a few.

"The traditional approach to dealing with periodontal disease is to prevent plaque from forming at the gum-line or prevent the consequences of periodontal disease progression," Scott said. "Our approach manipulates a natural mechanism within our bodies to prevent inflammation and subsequent degradation when exposed to the bacterium P. gingivalis."

GSK3b is known to facilitate the inflammation that occurs during bacterial infections, so blocking this enzyme from completing its normal function by using the GSK3-specific inhibitor, SB216763 stopped the inflammation process and subsequent bone loss induced by the key periodontal pathogen, P. gingivalis, Scott said.

The next step is for Scott and his team to determine whether SB216763 has any side-effects or whether they need to search for a different inhibitor of GSK3b.

Progression of oral lesions to cancer

A group of molecular markers have been identified that can help clinicians determine which patients with low-grade oral premalignant lesions are at high risk for progression to oral cancer, according to data from the Oral Cancer Prediction Longitudinal Study published in Cancer Prevention Research, a journal of the American Association for Cancer Research.

"The results of our study should help to build awareness that not everyone with a low-grade oral premalignant lesion will progress to cancer," said Miriam Rosin, Ph.D., director of the Oral Cancer Prevention Program at the BC Cancer Agency in Vancouver, British Columbia, Canada. "However, they should also begin to give clinicians a better idea of which patients need closer follow-up."

Oral cancers are a global public health problem with close to 300,000 new cases identified worldwide each year. Many of these cancers are preceded by premalignant lesions. Severe lesions are associated with a high progression risk and should be treated definitively. However, the challenge within the field has been to distinguish which low-grade lesions are the most likely to progress to cancer.

In 2000, Rosin and colleagues used samples of oral premalignant lesions where progression to cancer was known to have subsequently occurred in order to develop a method for grouping patients into low-risk or high-risk categories based on differences in their DNA. In their current population-based study, they confirmed that this approach was able to correctly categorize patients as less or more likely to progress to cancer.

They analyzed samples from 296 patients with mild or moderate oral dysplasia identified and followed over years by the BC Oral Biopsy Service, which receives biopsies from dentists and ENT surgeons across the province. Patients classified as high-risk had an almost 23-fold increased risk for progression.

Next, two additional DNA molecular risk markers called loss of heterozygosity were added to the analysis in an attempt to better differentiate patients' risks. They used the disease samples from the prospective study, and categorized patients into low-, intermediate- and high-risk groups.

"Compared with the low-risk group, intermediate-risk patients had an 11-fold increased risk for progression and the high-risk group had a 52-fold increase in risk for progression," Rosin said.

Of patients categorized as low-risk, only 3.1 percent had disease that progressed to cancer within five years. In contrast, intermediate-risk patients had a 16.3 percent five-year progression rate and high-risk patients had a 63.1 percent five-year progression rate.

"That means that two out of every three high-risk cases are progressing," Rosin said. "Identifying which early lesions are more likely to progress may give clinicians a chance to intervene in high-risk cases, and may help to prevent unnecessary treatment in low-risk cases."

Moms linked to teen oral health, says CWRU dental study

A mother’s emotional health and education level during her child’s earliest years influence oral health at age 14, according to a new study from Case Western Reserve University’s School of Dental Medicine.

Researchers started with the oral health of the teens and worked backwards to age 3 to find out what factors in their past influenced their oral health outcomes._While mothers were interviewed, lead investigator Suchitra Nelson, professor in the dental school, believes it can apply to whoever is the child’s primary caregiver.

Nelson’s team examined the teeth of 224 adolescent participants in a longitudinal study that followed very low birth weight and normal birth weight children. Over the years, researchers gathered health and medical information from the children and their mothers to assess the child’s wellbeing at age 3, 8 and now 14. _The researchers analyzed the teen’s oral health by counting the number of decayed, filled or missing permanent teeth and assessed the level of dental plaque, a symptom for poor oral hygiene.

Mothers completed a questionnaire about preventative treatments from sealants to mouthwashes, sugary juice or soft drink consumption and access to dental care and frequency of dental visits.

The data revealed that even with access to dental insurance, fluoride treatments and sealants as young children, it did not always prevent cavities by the age of 14, said Nelson, professor of community dentistry at Case Western Reserve dental school.

She is lead investigator on the Journal of Dental Research article, “Early Maternal Psychosocial Factors are Predictors for Adolescent Caries.”

What did prevent cavities in teens?

Using a statistical modeling program that tracked pathways from the teen’s dental assessments back to the source of where the oral health originated led researchers right to mothers and their overall emotional health, education level and knowledge when children were at ages 3 and 8.

The researchers found if mothers struggled in any of the three areas, the oral health of the teens at age 14 resulted in higher numbers of oral health problems.

“We can’t ignore the environments of these children,” Nelson said. “It isn’t enough to tell children to brush and floss, they need more—and particularly from their caregivers.”

The oral health boost comes from mothers, who muster coping skills to handle everyday stresses and develop social networks to provide for their children’s needs.

It was found that mothers with more education beyond high school, with healthy emotional states and knowledge about eating right had children with healthier teeth.

“We cannot ignore these environmental influences and need interventions to help some moms get on track early in their children’s lives,” Nelson concludes.

Nelson says moms need to care for themselves to help their children. She likens it to the emergency instructions on an airplane that mothers put on the mask first and then their children. “How can a mother help her child if she passes out,” asks Nelson. “It’s all common sense, but some mothers may need help.”

Poor Oral Health Can Mean Missed School, Lower Grades

Poor oral health, dental disease, and tooth pain can put kids at a serious disadvantage in school, according to a new Ostrow School of Dentistry of USC study.

“The Impact of Oral Health on the Academic Performance of Disadvantaged Children,” appearing in the September 2012 issue of the American Journal of Public Health, examined nearly 1500 socioeconomically disadvantaged elementary and high school children in the Los Angeles Unified School District, matching their oral health status to their academic achievement and attendance records.

Ostrow researchers had previously documented that 73 percent of disadvantaged kids in Los Angeles have dental caries, the disease responsible for cavities in teeth. The new study shines light on the specific connection between oral health and performance in school for this population, said Roseann Mulligan, chair of the school’s Division of Dental Public Health and Pediatric Dentistry and corresponding author of the study.

Children who reported having recent tooth pain were four times more likely to have a low grade point average—below the median GPA of 2.8—when compared to children without oral pain, according to study results.

Poor oral health doesn’t just appear to be connected to lower grades, Mulligan said, adding that dental problems also seem to cause more absences from school for kids and more missed work for parents.

“On average, elementary children missed a total of 6 days per year, and high school children missed 2.6 days. For elementary students, 2.1 days of missed school were due to dental problems, and high school students missed 2.3 days due to dental issues,” she said. “That shows oral health problems are a very significant factor in school absences. Also, parents missed an average of 2.5 days of work per year to care for children with dental problems.”

A factor in whether children miss school due to dental health issues was the accessibility of dental care. Eleven percent of children who had limited access to dental care—whether due to lack of insurance, lack of transportation, or other barriers—missed school due to their poor oral health, as opposed to only four percent of children who had easier access to dental care.

“Our data indicates that for disadvantaged children there is an impact on students’ academic performance due to dental problems. We recommend that oral health programs must be more integrated into other health, educational and social programs, especially those that are school-based,” Mulligan said. “Furthermore, widespread population studies are needed to demonstrate the enormous personal, societal and financial burdens that this epidemic of oral disease is causing on a national level. ”