Expectant mothers' periodontal health vital to health of her baby

When a woman becomes pregnant, she knows it is important to maintain a healthy lifestyle to ensure both the health of herself and the health of her baby. New clinical recommendations from the American Academy of Periodontology (AAP) and the Eurpean Federation of Periodontology (EFP) urge pregnant women to maintain periodontal health as well. Research has indicated that women with periodontal disease may be at risk of adverse pregnancy outcomes, such giving birth to a pre-term or low-birth weight baby, reports the AAP and EFP.

Periodontal disease is a chronic, bacteria-induced, inflammatory condition that attacks the gum tissue and in more severe cases, the bone supporting the teeth. If left untreated, periodontal disease, also known as gum disease, can lead to tooth loss and has been associated with other systemic diseases, such as diabetes and cardiovascular disease.

"Tenderness, redness, or swollen gums are a few indications of periodontonal disease," warns Dr. Nancy L. Newhouse, DDS, MS, President of the AAP and a practicing periodontist in Independence, Missouri. "Other symptoms include gums that bleed with toothbrushing or eating, gums that are pulling away from the teeth, bad breath, and loose teeth. These signs, especially during pregnancy, should not be ignored and may require treatment from a dental professional."

Several research studies have suggested that women with periodontal disease may be more likely to deliver babies prematurely or with low-birth weight than mothers with healthy gums. According to the Center for Disease Control and Prevention (CDC), babies with a birth weight of less than 5.5 pounds may be at risk of long-term health problems such as delayed motor skills, social growth, or learning disabilities. Similar complications are true for babies born at least three weeks earlier than its due date. Other issues associated with pre-term birth include respiratory problems, vision and hearing loss, or feeding and digestive problems.

The medical and dental communities concur that maintaining periodontal health is an important part of a healthy pregnancy. The clinical recommendations released by the AAP and the EFP state that non-surgical periodontal therapy is safe for pregnant women, and can result in improved periodontal health. Published concurrently in the Journal of Periodontology and Journal of Clinical Periodontology, the report provides guidelines for both dental and medical professionals to use in diagnosing and treating periodontal disease in pregnant women. In addition, the American College of Obstetricians and Gynecologists recently released a statement encouraging pregnant women to sustain their oral health and recommended regular dental cleanings during pregnancy.

"Routine brushing and flossing, and seeing a periodontist, dentist, or dental hygienist for a comprehensive periodontal evaluation during pregnancy may decrease the chance of adverse pregnancy complications," says Dr. Newhouse. "It is important for expectant mothers to monitor their periodontal health and to have a conversation with their periodontist or dentist about the most appropriate care. By maintaining your periodontal health, you are not only supporting your overall health, but also helping to ensure a safe pregnancy and a healthy baby," says Dr. Newhouse.

Poor oral health linked to cancer-causing oral HPV infection

Poor oral health, including gum disease and dental problems, was found to be associated with oral human papillomavirus (HPV) infection, which causes about 40 percent to 80 percent of oropharyngeal cancers, according to a study published in Cancer Prevention Research, a journal of the American Association for Cancer Research.

"Poor oral health is a new independent risk factor for oral HPV infection and, to our knowledge, this is the first study to examine this association," said Thanh Cong Bui, Dr.P.H., postdoctoral research fellow in the School of Public Health at the University of Texas Health Sciences Center in Houston. "The good news is, this risk factor is modifiable — by maintaining good oral hygiene and good oral health, one can prevent HPV infection and subsequent HPV-related cancers."

The researchers found that among the study participants, those who reported poor oral health had a 56 percent higher prevalence of oral HPV infection, and those who had gum disease and dental problems had a 51 percent and 28 percent higher prevalence of oral HPV infection, respectively. In addition, the researchers were able to associate oral HPV infections with number of teeth lost.

Similar to genital HPV infection, oral HPV infection can be of two kinds: infection with low-risk HPV types that do not cause cancer, but can cause a variety of benign tumors or warts in the oral cavity, and infection with high-risk HPV types that can cause oropharyngeal cancers.

Bui, Christine Markham, Ph.D., and colleagues used data from the 2009-2010 National Health and Nutrition Examination Survey (NHANES) conducted by the National Center for Health Statistics of the Centers for Disease Control and Prevention. This survey consisted of a nationally representative sample of about 5,000 people recruited each year, located in counties across the United States.

The researchers identified 3,439 participants aged 30 to 69 years from NHANES, for whom data on oral health and the presence or absence of 19 low-risk HPV types and 18 high-risk HPV types in the oral cavity were available. Oral health data included four measures of oral health: self-rating of overall oral health, presence of gum disease, use of mouthwash to treat dental problems within past seven days of the survey, and number of teeth lost. They examined data on age, gender, marital status, marijuana use, cigarette smoking, and oral sex habits, among others, which influence HPV infection.

The researchers found that being male, smoking cigarettes, using marijuana, and oral sex habits increased the likelihood of oral HPV infection. They also found that self-rated overall oral health was an independent risk factor for oral HPV infection, because this association did not change regardless of whether or not the participants smoked or had multiple oral sex partners.

Because HPV needs wounds in the mouth to enter and infect the oral cavity, poor oral health, which may include ulcers, mucosal disruption, or chronic inflammation, may create an entry portal for HPV, said Bui. There is, however, currently not enough evidence to support this, and further research is needed to understand this relationship, he said.

"Although more research is needed to confirm the causal relationship between oral health and oral HPV infection, people may want to maintain good oral health for a variety of health benefits," said Bui. "Oral hygiene is fundamental for oral health, so good oral hygiene practices should become a personal habit."

A Glass of Milk After Eating Sugary Cereals May Prevent Cavities

Washing down sugary breakfast cereal with milk after eating reduces plaque acid levels and may prevent damage to tooth enamel that leads to cavities, according to new research at the University of Illinois at Chicago College of Dentistry.

Dry ready-to-eat, sugar-added cereals combine refined sugar and starch. When those carbohydrates are consumed, bacteria in the dental plaque on tooth surfaces produce acids, says Christine Wu, professor of pediatric dentistry and director of cariology, who served as principal investigator of the study.

The research is published in the July issue of the Journal of the American Dental Association.

Reports have shown that eating carbohydrates four times daily, or in quantities greater than 60 grams per person per day, increases the risk of cavities.

The new study, performed by Wu's former graduate student Shilpa Naval, involved 20 adults eating 20 grams of dry Froot Loops cereal, then drinking different beverages -- whole milk, 100 percent apple juice, or tap water.

Plaque pH, or acidity, was measured with a touch microelectrode between the premolar teeth before eating; at two and five minutes after eating; and then two to 30 minutes after drinking a liquid.

The pH in plaque dropped rapidly after consuming cereal alone, and remained acidic at pH 5.83 at 30 minutes. A pH below 7 is acidic; a pH greater than 7 is basic. Pure water has a pH close to 7.

Participants who drank milk after eating sugary cereal showed the highest pH rise, from 5.75 to 6.48 at 30 minutes. Those who drank apple juice remained at pH 5.84 at 30 minutes, while water raised the pH to 6.02.

Fruit juices are considered healthy food choices, but the added sugar can be a risk to dental health, Wu said.

"Our study results show that only milk was able to reduce acidity of dental plaque resulting from consuming sugary Froot Loops," said Naval, who is currently a fellow at the Centers for Disease Control and Prevention in Atlanta. "We believe that milk helped mitigate the damaging effect of fermentable carbohydrate and overcome the previously lowered plaque pH."

Milk, with a pH ranging from 6.4 to 6.7, is considered to be a functional food that fights cavities because it promotes tooth remineralization and inhibits the growth of plaque, Wu said.

Wu says most consumers think that since milk is considered to be cavity-fighting, acid production by plaque bacteria can be minimized by mixing it with cereal. However, in an unpublished study in her lab, it was discovered that the combination of Froot Loops and milk became syrupy. Eating cereal combined with milk lowered plaque pH to levels similar to that obtained after rinsing with a 10 percent sugar solution.

Eating sugar-added cereal with milk, followed by drinking fruit juice is thus a highly cavity-causing combination, Wu said.

Diet plays an important role in oral health, Wu said. Studies of food intake and cavities have focused mainly on the sugar, or carbohydrate, content. Fewer studies have looked at how combinations of food, and the order in which they are eaten, may help fight cavities.

"Results from a previous study suggested that the last food item consumed exerts the greatest influence on subsequent plaque pH," she said. For example, eating cheese after a sugary meal reduces acid production, and consumers can modify their diet in such a way as to prevent the cavity-causing effects of sugary foods."

"If understood and implemented properly, food sequencing can be used as a public health educational tool to maintain and preserve good oral health," said Naval.

Bacterium that causes gum disease packs a 1-2 punch to the jaw

The newly discovered bacterium that causes gum disease delivers a one-two punch by also triggering normally protective proteins in the mouth to actually destroy more bone, a University of Michigan study found.

Scientists and oral health care providers have known for decades that bacteria are responsible for periodontitis, or gum disease. Until now, however, they hadn't identified the bacterium.

"Identifying the mechanism that is responsible for periodontitis is a major discovery," said Yizu Jiao, a postdoctoral fellow at the U-M Health System, and lead author of the study appearing in the recent issue of the journal Cell Host and Microbe.

Jiao and Noahiro Inohara, research associate professor at the U-M Health System, worked with William Giannobile, professor of dentistry, and Julie Marchesan, formerly of Giannobile's lab.

The study yielded yet another significant finding: the bacterium that causes gum disease, called NI1060, also triggers a normally protective protein in the oral cavity, called Nod1, to turn traitorous and actually trigger bone-destroying cells. Under normal circumstances, Nod1 fights harmful bacterium in the body.

"Nod1 is a part of our protective mechanisms against bacterial infection. It helps us to fight infection by recruiting neutrophils, blood cells that act as bacterial killers," Inohara said. "It also removes harmful bacteria during infection. However, in the case of periodontitis, accumulation of NI1060 stimulates Nod1 to trigger neutrophils and osteoclasts, which are cells that destroy bone in the oral cavity."

Giannobile, who also chairs the Department of Periodontics and Oral Medicine at the U-M School of Dentistry, said understanding what causes gum disease at the molecular level could help develop personalized therapy for dental patients.

"The findings from this study underscore the connection between beneficial and harmful bacteria that normally reside in the oral cavity, how a harmful bacterium causes the disease, and how an at-risk patient might respond to such bacteria," Giannobile said.

Consuming cheese may help protect teeth against cavities

Consuming dairy products is vital to maintaining good overall health, and it's especially important to bone health. But there has been little research about how dairy products affect oral health in particular. However, according to a new study published in the May/June 2013 issue of General Dentistry, the peer-reviewed clinical journal of the Academy of General Dentistry (AGD), consuming cheese may help protect teeth against cavities.

The study sampled 68 subjects ranging in age from 12 to 15, and the authors looked at the dental plaque pH in the subjects' mouths before and after they consumed cheese, milk, or sugar-free yogurt. A pH level lower than 5.5 puts a person at risk for tooth erosion, which is a process that wears away the enamel (or protective outside layer) of teeth. "The higher the pH level is above 5.5, the lower the chance of developing cavities," explains Vipul Yadav, MDS, lead author of the study.

The subjects were assigned into groups randomly. Researchers instructed the first group to eat cheddar cheese, the second group to drink milk, and the third group to eat sugar-free yogurt. Each group consumed their product for three minutes and then swished with water. Researchers measured the pH level of each subject's mouth at 10, 20, and 30 minutes after consumption.

The groups who consumed milk and sugar-free yogurt experienced no changes in the pH levels in their mouths. Subjects who ate cheese, however, showed a rapid increase in pH levels at each time interval, suggesting that cheese has anti-cavity properties.

The study indicated that the rising pH levels from eating cheese may have occurred due to increased saliva production (the mouth's natural way to maintain a baseline acidity level), which could be caused by the action of chewing. Additionally, various compounds found in cheese may adhere to tooth enamel and help further protect teeth from acid.

"It looks like dairy does the mouth good," says AGD spokesperson Seung-Hee Rhee, DDS, FAGD. "Not only are dairy products a healthy alternative to carb- or sugar-filled snacks, they also may be considered as a preventive measure against cavities."

Soda and illegal drugs cause similar damage to teeth

Addicted to soda? You may be shocked to learn that drinking large quantities of your favorite carbonated soda could be as damaging to your teeth as methamphetamine and crack cocaine use. The consumption of illegal drugs and abusive intake of soda can cause similar damage to your mouth through the process of tooth erosion, according to a case study published in the March/April 2013 issue of General Dentistry, the peer-reviewed clinical journal of the Academy of General Dentistry (AGD).

Tooth erosion occurs when acid wears away tooth enamel, which is the glossy, protective outside layer of the tooth. Without the protection of enamel, teeth are more susceptible to developing cavities, as well as becoming sensitive, cracked, and discolored.

The General Dentistry case study compared the damage in three individuals' mouths—an admitted user of methamphetamine, a previous longtime user of cocaine, and an excessive diet soda drinker. Each participant admitted to having poor oral hygiene and not visiting a dentist on a regular basis. Researchers found the same type and severity of damage from tooth erosion in each participant's mouth.

"Each person experienced severe tooth erosion caused by the high acid levels present in their 'drug' of choice—meth, crack, or soda," says Mohamed A. Bassiouny, DMD, MSc, PhD, lead author of the study.

"The citric acid present in both regular and diet soda is known to have a high potential for causing tooth erosion," says Dr. Bassiouny.

Similar to citric acid, the ingredients used in preparing methamphetamine can include extremely corrosive materials, such as battery acid, lantern fuel, and drain cleaner. Crack cocaine is highly acidic in nature, as well.

The individual who abused soda consumed 2 liters of diet soda daily for three to five years. Says Dr. Bassiouny, "The striking similarities found in this study should be a wake-up call to consumers who think that soda—even diet soda—is not harmful to their oral health."

AGD Spokesperson Eugene Antenucci, DDS, FAGD, recommends that his patients minimize their intake of soda and drink more water. Additionally, he advises them to either chew sugar-free gum or rinse the mouth with water following consumption of soda. "Both tactics increase saliva flow, which naturally helps to return the acidity levels in the mouth to normal," he says.

New evidence on how fluoride fights tooth decay

In an advance toward solving a 50-year-old mystery, scientists are reporting new evidence on how the fluoride in drinking water, toothpastes, mouth rinses and other oral-care products prevents tooth decay. Their report appears in the ACS journal Langumir.

Karin Jacobs and colleagues explain that despite a half-century of scientific research, controversy still exists over exactly how fluoride compounds reduce the risk of tooth decay. That research established long ago that fluoride helps to harden the enamel coating that protects teeth from the acid produced by decay-causing bacteria. Newer studies already found that fluoride penetrates into and hardens a much thinner layer of enamel than previously believed, lending credence to other theories about how fluoride works.

The report describes new evidence that fluoride also works by impacting the adhesion force of bacteria that stick to the teeth and produce the acid that causes cavities. The experiments — performed on artificial teeth (hydroxyapatite pellets) to enable high-precision analysis techniques — revealed that fluoride reduces the ability of decay-causing bacteria to stick, so that also on teeth, it is easier to wash away the bacteria by saliva, brushing and other activity.