RxPG News : Dental

Fluoride acts on plaque-causing bugs: Study

Sat, 24 Dec 2011 14:10:27 PST

( from http://www.rxpgnews.com ) Washington, Dec 23 - Regular use of fluoride toothpaste and mouthwash, known to toughen teeth enamel, also acts on plaque-causing bugs. Conversely, these bugs try to fend off fluoride as a toxic substance, according to a new study led by Ronald Breaker, a researcher at the Howard Hughes Medical Institute -.

The bacterial response indicates that fluoride itself has antimicrobial properties, Breaker said.

'Our data not only help explain how cells fight the toxicity of fluoride, but it also gives us a sense of how we might be able to enhance the antimicrobial properties of fluoride,' says Breaker.

'In the future we might be able to use this knowledge to make fluoride even more toxic to bacteria,' he adds.

Blocking the fluoride channel, for example, makes cells 200 times more sensitive to fluoride, the researchers showed.

CBT is highly effective in Dental Phobia

Fri, 02 Sep 2011 23:37:56 PST

( from http://www.rxpgnews.com ) People with severe dental phobia may be able to overcome their anxieties with a single session of cognitive behavioural therapy (CBT), research published in the latest issue of the British Dental Journal (BDJ) suggests.

The authors of the study, based on an initial pilot of 60 patients who relied on having intravenous sedation before they could undergo dental treatment, concluded that the benefits were of such significance that they advise dental providers to implement this approach now rather than wait to pursue further research. They point out that patients benefit from not being exposed to the health risks associated with repeated intravenous sedation; and this approach saves money for the NHS.

The initial cohort of 60 patients had all attended a specialist dental clinic in Sheffield for people with severe dental phobia. Half the group were offered CBT, with 21 patients accepting the treatment. Twenty of these went on to have dental treatment without having to be sedated. An audit of these patients a decade later found that of the 19 patients located who had had CBT, none had returned to sedation in the intervening 10-year period.

The benefits of having CBT for severe dental phobia appear to endure over time, the authors of A joint approach to treating dental phobia: A re-evaluation of a collaboration between community dental services and specialist psychotherapy services ten years on, conclude.

The latest 10-yearly survey on adult dental health published earlier this year by the NHS Information Centre suggests that as many as 12 per cent of people may experience extreme dental anxiety.

Professor Damien Walmsley, the BDA’s scientific adviser, said:

“Dental phobia is a serious problem because it deters some people from ever going to the dentist, except when they are in severe pain. At this stage, they may require more invasive treatment than might be the case if they went to the dentist regularly. Sadly, this cycle of anxiety, non-attendance and pain is often repeated in the children of those with dental phobia, perpetuating the problem and feeding another generation of oral health problems.

“CBT is one of a range of techniques than can be used to make the experience comfortable for patients who feel especially anxious about having dental treatment, and the results of this study look promising for those who experience severe dental phobia.

“All dentists are highly-skilled, caring health professionals who are trained to put patients at ease. Many also undertake additional training in techniques, such as hypnosis, and acupuncture, and of course, CBT.”

Fewer heart patients need antibiotics before dental procedures

Tue, 15 May 2007 04:56:05 PST

( from http://www.rxpgnews.com ) Based on a review of new and existing scientific evidence, most dental patients with heart disease do not need antibiotics before dental procedures to prevent infective endocarditis (IE), a rare, but life-threatening heart infection.

According to revised guidelines from the American Heart Association (AHA) with input from the American Dental Association (ADA), antibiotics are now only recommended for patients at greatest risk of negative outcomes from IE including those with artificial heart valves or certain congenital heart conditions, heart transplant recipients who develop cardiac valve problems, recipients of an artificial patch to repair a congenital heart defect within the past six months and patients with a history of IE.

The AHAâs latest guidelines were published in its scientific journal, Circulation, in April. The Guidelines apply to a range of medical and dental procedures. The ADA is publishing those portions of the new guidelines relevant to dentistry on its Web site today and in the June issue of the Journal of the American Dental Association (JADA).

For decades, the AHA recommended that patients with certain heart conditions take antibiotics shortly before dental treatment. This was done with the belief that antibiotics would prevent IE, previously referred to as bacterial endocarditis. IE is an infection of the heartâs inner lining or valves, which results when bacteria enter the bloodstream and travel to the heart. Bacteria are normally found in various sites of the body including on the skin and in the mouth.

The ADA participated in the development of the new guidelines and has approved those portions relevant to dentistry. The guidelines are also endorsed by the Infectious Diseases Society of America and by the Pediatric Infectious Diseases Society.

The new guidelines are based on a growing body of scientific evidence that shows the risks of taking preventive antibiotics outweigh the benefits for most patients. The risks include adverse reactions to antibiotics that range from mild to potentially severe and, in rare cases, death. Inappropriate use of antibiotics can also lead to the development of drug-resistant bacteria.

Scientists also found no compelling evidence that taking antibiotics prior to a dental procedure prevents IE in patients who are at risk of developing a heart infection. Their hearts are already often exposed to bacteria from the mouth, which can enter their bloodstream during basic daily activities such as brushing or flossing. The new guidelines are based on a comprehensive review of published studies that suggests IE is more likely to occur as a result of these everyday activities than from a dental procedure.

The guidelines say patients who have taken prophylactic antibiotics routinely in the past but no longer need them include people with mitral valve prolapse, rheumatic heart disease, bicuspid valve disease, calcified aortic stenosis, or congenital heart conditions such as ventricular septal defect, atrial septal defect and hypertrophic cardiomyopathy.

The new recommendations apply to many dental procedures, including teeth cleaning and extractions. The guidelines emphasize that maintaining optimal oral health and practicing daily oral hygiene are more important in reducing the risk of IE than taking preventive antibiotics before a dental visit.

Secondhand smoke proves to be no 'joke' on oral health

Fri, 13 Apr 2007 13:52:27 PST

( from http://www.rxpgnews.com ) A study published in this monthâs issue of the Journal of Periodontology found that subjects with periodontitis who were exposed to secondhand smoke were more likely to develop bone loss, the number one cause of tooth loss.

Researchers studied rats that were induced with periodontal disease. One group was not exposed to cigarette smoke while the other two groups were exposed to either 30 days of smoke inhalation produced by non-light cigarettes (cigarettes containing higher tar, nicotine and carbon monoxide levels) or light cigarettes (cigarettes containing lower tar, nicotine and carbon monoxide levels). Results showed that bone loss was greater in the subjects exposed to secondhand smoke regardless of if it was smoke from light or non-light cigarettes than those who were exposed to no smoke at all.

"Previous clinical research has proven a strong positive correlation between smoking and gum disease. However, this study is unique in that it evaluated the impact of secondhand smoke on periodontitis," explained study author Getulio da R. Nogueira-Filho, DDS.

"This study really drives home the fact that even if you donât smoke the effects of secondhand smoke can be devastating. Part of maintaining a healthy lifestyle should include avoiding smoke filled places such as nightclubs, bars and even some restaurants," said Preston D. Miller, Jr., DDS and AAP president. "The Academy applauds the cities that are taking steps to make their hospitality industries smoke free so all patrons can enjoy not only a good time but also good overall health."

Bacteria from patient's dental plaque causes ventilator-associated pneumonia

Tue, 03 Apr 2007 15:08:16 PST

( from http://www.rxpgnews.com ) Patients admitted to a hospital's intensive care unit (ICU) already are seriously ill, so the last thing they need is a new infection. Unfortunately, statistics show that as many as 25 percent of all patients admitted to the ICU and placed on ventilators develop pneumonia, which can be fatal.

Ventilator-associated pneumonia is a major cause of infection in the hospital, and studies have shown that this infection can add $40,000 to costs and double the length of stay of the patient in the hospital.

Ironically, it turns out that the patientâs own dental plaque is a major source of germs that cause ventilator-associated pneumonia.

In results to be presented today (March 23, 2007) at the International Association of Dental Research (IADR), researchers from the University at Buffalo School of Dental Medicine show that the same bacteria identified in dental plaque of patients when they were admitted to the ICU and placed on ventilators were found later in the lungs from those who subsequently developed pneumonia.

"Our study shows that a strong relationship exists between oral and respiratory pathogens in patients with ventilator-associated pneumonia," said Paul Heo, D.D.S., a doctoral student in the UB dental schoolâs Department of Oral Biology and first author on the study.

"We are saying that if the patientsâ mouths and teeth arenât cleaned while they are in the hospital, they may easily develop lung disease."

The presentation is part of a three-year longitudinal, double-blind study funded by the National Institute of Dental and Craniofacial Research and headed by Frank A. Scannapieco, D.D.S., Ph.D., professor and chair of the Department of Oral Biology.

The trial aims to determine if swabbing ventilated ICU patientsâ mouths with a bactericide protects them from developing pneumonia.

In this component, Heo and colleagues concentrated on three strains of suspected pathogens that are responsible for most hospital-acquired pneumonia: Staphylococcus aureus, Escherichia coli and Pseudomonas aeruginosa. Samples of plaque from teeth and of secretions from the trachea were obtained from ICU patients on the day of admission and every third day thereafter, up to 21 days. Bronchial alveolar lavage samples also were collected from those suspected of having developed pneumonia.

Samples from nine patients who were found to have the pathogens of interest in their plaque and were suspected of having pneumonia were selected for analysis. Protein and DNA profiles of pathogens in plaque and in bronchial alveolar lavage samples were identified using a process called pulsed-field gel electrophoresis.

Results showed that genetic profiles of bacteria from tracheal and bronchial samples of the nine patients with pneumonia were identical to profiles of bacteria from their dental plaque.

"These results suggest that the teeth likely serve as an important reservoir of infection in these patients," said Heo. "To prevent opportunistic, hospital-acquired disease, taking care of teeth and gums while hospitalized might be especially important."

Root Beer May Be "Safest" Soft Drink for Teeth

Tue, 27 Mar 2007 12:58:11 PST

( from http://www.rxpgnews.com ) Exposing teeth to soft drinks, even for a short period of time, causes dental erosionâand prolonged exposure can lead to significant enamel loss. Root beer products, however, are non-carbonated and do not contain the acids that harm teeth, according to a study in the March/April 2007 issue of General Dentistry, the AGDâs clinical, peer-reviewed journal. That might be something to consider during the next visit to the grocery store.

Consumers often consider soft drinks to be harmless, believing that the only concern is sugar content. Most choose to consume âdietâ drinks to alleviate this concern. However, diet drinks contain phosphoric acid and/or citric acid and still cause dental erosionâthough considerably less than their sugared counterparts.

âDrinking any type of soft drink poses risk to the health of your teeth,â says AGD spokesperson Kenton Ross, DMD, FAGD. Dr. Ross recommends that patients consume fewer soft drinks by limiting their intake to meals. He also advises patients to drink with a straw, which will reduce sodaâs contact with teeth.

âMy patients are shocked to hear that many of the soft drinks they consume contain nine to twelve teaspoons of sugar and have an acidity that approaches the level of battery acid,â Dr. Ross explains. For example, one type of cola ranked 2.39 on the acid scale, compared to battery acid which is 1.0.

Researchers concluded that non-colas cause a greater amount of erosion than colas. Citric acid is the predominant acid in non-cola drinks and is a major factor in why non-cola drinks are especially erosive. There is a significant difference between sugared and diet colas.

âThe bottom line,â Dr. Ross stresses, âis that the acidity in all soft drinks is enough to damage your teeth and should be avoided.â

Xylitol reduces risk of cavities

Thu, 15 Feb 2007 10:26:36 PST

( from http://www.rxpgnews.com )

The sugar substitute xylitol affects the bacterial composition of the oral cavity even in low doses.

The sugar substitute xylitol affects the bacterial composition of the oral cavity even in low doses. On the other hand, a relatively high intake is needed to counteract the production of acid between the teeth, according to Pernilla Lif Holgerson in the dissertation she will defend at Umeå University in Sweden on February 23.

Xylitol is a sugar alcohol that is produced by reduction of the sugar xylose, or wood sugar. Xylitol occurs naturally in fruits and berries, such as pears and strawberries. It is used in sugarless sweets, above all in chewing gum and lozenges. The dissertation studies what effects the substance has on the ecology of the oral cavity and its role in preventing tooth decay (caries). In a series of studies on children and adolescents, samples of saliva and plaque were examined. Among other findings, it was determined that a daily intake of 3.4 grams of xylitol was sufficient to change the consistency of the bacteria, but this did not lead to a lower production of lactic acid in plaque. In another study it was shown that a single higher intake of xylitol for a limited time reduced the degree of acidity in plaque between teeth.

In a field study involving 128 children aged 712, the subjects were asked to chew gum three times a day, with a total daily dose of 6.0 grams of xylitol. The amount of plaque and the production of lactic acid declined dramatically during the trial period. After four weeks, the proportion of caries-producing bacteria was down by a third, but six months afterward the values had returned to the original levels. Despite the relatively high dose of xylitol used, no negative effects were reported, such as stomach troubles.

Products with xylitol as the sole sweetener are uncommon on the Swedish market today. In the most common sugarless products, xylitol accounts for roughly a third of the sweetening.

The studies nevertheless warrant the following recommendations:

A daily intake of xylitol is recommended as a supplement for patients at high risk for tooth decay.

Xylitol products that actively stimulate the secretion of saliva should be the first choice, such as chewing gum.

About 6 g of xylitol per day is needed to counteract the production of acid and thereby reduce the risk of cavities.

The daily intake should be distributed over at least three occasions.

The products should contain as much xylitol as possible and not be mixed with other sweeteners.

Researchers Use Stem Cells to Regenerate Parts of Teeth

Sun, 24 Dec 2006 19:18:56 PST

( from http://www.rxpgnews.com ) A multi-national research team headed by USC School of Dentistry researcher Songtao Shi, DDS, PhD, has successfully regenerated tooth root and supporting periodontal ligaments to restore tooth function in a swine (an animal) model. The breakthrough holds significant promise for clinical application in human patients.

The study appears December 20 in the inaugural issue of PLoS ONE.

Utilizing stem cells harvested from the extracted wisdom teeth of 18- to 20-year olds, Shi and colleagues have created sufficient root and ligament structure to support a crown restoration in their mini-pig (animal) model. The resulting tooth restoration closely resembled the original tooth in function and strength.

The technique relies on stem cells harvested from the root apical papilla, which is responsible for the development of a tooth's root and periodontal ligament. Previous studies conducted by Shi and collaborator Stan Gronthos at the National Institutes of Health had utilized dental pulp stem cells. Shi found the new technique to be superior.

"The apical papilla provides better stem cells for root structure regeneration. With this technique, the strength of the tooth restoration is not quite as strong as the original tooth, but we believe it is sufficient to withstand normal wear and tear," says Shi.

He hopes to move the technique to clinical trials within the next several years, a potential boon for dental patients who are not appropriate candidates for dental implant therapy or would prefer living tissue derived from their own teeth.

"Implant patients must have sufficient bone in the jaw to support the implant. For those who don't, this therapy would be a great alternative," says Shi.

According to Shi, the not-so-distant future may be one in which not only wisdom teeth, but those baby teeth once left to the tooth fairy for a pittance, will become valuable therapeutic tools.

"We will be able to provide not only this technique, but other new therapies utilizing a patient's own stem cells harvested from their preserved teeth. This is a very exciting discovery and one that I hope to see in wide-spread clinical use in the near future," says Shi.

Common Antacids Could Help Keep Gingivitis at Bay

Tue, 07 Nov 2006 22:07:00 PST

( from http://www.rxpgnews.com ) Chemicals commonly used to treat heartburn also display fighting power against the oral bacteria linked with gum disease, according to researchers at the University of Rochester Medical Center and Göteborg University in Sweden.

A study published in Novembers Archives of Oral Biology explores how the active ingredients in popular antacids could help fend off gingivitis. If the work holds up in subsequent studies in people, the compounds could one day find themselves widely available in oral care products like toothpaste and mouthwashes.

The American diet and the constant drip of sugar allows little time for the natural repair of teeth. All day, its a cycle of acidic erosion and repair or at least, it should be but our constant sucking on hard candy and guzzling sodas with high fructose syrups leaves little time for repair, said Robert Marquis, Ph.D., of the University of Rochester Medical Center. Marquis, an internationally recognized expert on the bacteria that inhabit our mouths, is the studys lead author.

The team studied a compound known as lansoprazole, part of a family of compounds known as benzimidazoles that already have a range of uses, primarily controlling stomach hyperacidity and killing Helicobacter pylori (the bacteria responsible for stomach ulcers). Now, the compounds are brandishing potent antimicrobial actions that interfere with the dirty work of other types of bacteria that cause plaque buildup and gingivitis.

Such bacteria make their home on unbrushed teeth, which become coated with plaque, a filmy substance that, under a microscope, appears as a teeming sea of hundreds of bacteria. Among these are gingivitis-causing bacteria that break down sugars and amino acids into toxins that are harmful to our gums.

Unchecked, an accumulation of plaque and an overgrowth of these ravenous, toxin-oozing bacteria leads to one of the bodys natural immune responses, inflammation, where bacteria-fighting cells are recruited to the gums to fight off the infection. Unfortunately, instead of just fending off the bacteria, the immune response also inflicts damage to the healthy gums. In the case of an intense infection, the battle drags out and results in more devastation to the gums, or gingivitis.

Since gingivitis can be a preamble for periodontal disease an oral inflammation so persistent that it destroys the bone where the teeth anchor, causing them to fall out researchers at the University of Rochester and Göteborg University in Sweden decided to focus on Fusobacterium nucleatum, an especially hardy bacterial troublemaker that plays a crucial role in setting the stage for gum disease.

When its not secreting irritating chemicals itself, F. nucleatum acts as a binding site for other dangerous oral bacteria that cannot directly attach to tooth surfaces on their own. These bacteria, dubbed secondary colonizers, rely on the help of F. nucleatum, which serves almost like an aircraft landing strip atop an aircraft carrier, allowing planes (or in this case, bacteria) to set down. With the help of F.nucleatum, these dangerous bacteria now have a place to land and create the damage that causes periodontal disease and tooth decay.

It acts as a transitional organism, welcoming the bacteria which couldnt survive there on their own, and moving the infection from above the gum line to below it, said Marquis, professor of both Microbiology & Immunology and Oral Biology.

Thats where lansoprazole comes in. When the oral environment becomes acidic a telltale sign of bacteria at work lansoprazole is chemically modified to kick into action, disabling F. nucleatum and preventing it from producing toxins or serving as a landing site. Once the oral environment returns to normal, the lansoprazole simply switches off.

Benzimidazoles arent just for acid-reflux anymore, said Marquis, whose research project was supported by the National Institute of Dental and Craniofacial Research. Weve shown their promise for preventing cavities in previous research, and now, perhaps even some protective benefits to guard against gingivitis. Its not unthinkable that one day these compounds might be more broadly used to promote dental health in toothpastes and mouthwashes.

Tetracycline plus teeth equal gray smile

Tue, 01 Aug 2006 14:52:00 PST

( from http://www.rxpgnews.com ) Many adults over age 35 cover their mouth to avoid smiling in public in order to hide their teeth darkened by tetracycline stains. Typically, invasive as well as costly treatment options, such as veneers, crowns and bonding, served as the only treatment options to help these individuals hide such stains and boost their self-esteem.

However, Kim L. Capehart, DDS, MBA, AGD member and clinician, will explain how a new tooth whitening procedure he used on a patient helped significantly lighten these tough-to-remove stains and saved his patient more than $10,000 in dental restorative fees. He'll share this information during his discussion titled "Treating Tetracycline Staining in the Adult Dentition" to be presented at the Academy of General Dentistry's (AGD) 54th Annual Meeting & Exposition in Denver, August 2-6, 2006. For patients, this means that AGD members that attend this course will offer them the latest in dental health technology, knowledge and treatment.

Tetracycline is a powerful antibiotic that kills a wide array of bacteria. Many women, prior to 1980, may have take this antibiotic during their pregnancy. When teeth are forming in utero, the drug becomes calcified in the dental and enamel of the child's teeth and creates a permanent dark and deep gray or brown stain over the entire tooth. Other stains appear in a pattern of horizontal stripes of varying intensity. Also, during the same time period (before1980) many children may have been given the drug and had the same stains. Often dentists can tell if a child had a high fever, just by looking at the stain pattern on their patient's teeth. In the 1950s, tetracycline stains reached widespread levels because so many doctors prescribed this drug.

Since the stain is embedded deep into the tooth, different restorative materials have to be used to completely cover up the effects of tetracycline. These materials, such as veneers and crowns, have to be placed across all the teeth that show when smiling (typically 8 upper and 8 lower teeth). To place veneers or crowns on all teeth can cost in range from $1,000 to $2,000 per tooth. "The cost deters many people from seeking treatment," says Dr. Capehart.

However, Dr. Capehart developed a special treatment plan for a patient who was embarrassed by his tetracycline-stained smile, but who could not afford such costly treatment. He developed a personalized treatment plan for the patient, which allowed him to significantly alter the shade of his patient's teeth, without the costly procedures.

Dr. Capehart's new tooth whitening treatment protocol involves placing the patient on a prescription dose of fluoride toothpaste for two weeks in order to minimize tooth sensitivity from the whitening solutions. Then, the patient comes in for a one-hour tooth whitening session, where the enamel is painted with the whitening solution and "cured" under a UV light. Then, for every night for three weeks, the patient uses customized trays that deliver the whitening solution to the teeth. During this time period, the patient maintained a meticulous home oral hygiene care and took potassium nitrate, which also decreases sensitivity after bleaching. Then, after the three week time period, the patient uses the trays for another three weeks.

"The results significantly boosted my patient's self-esteem and he was thoroughly pleased with the results," says Dr. Capehart. He now comes back every six months for a regular cleaning and then uses the whitening trays once a year to maintain their new color. "Although tetracycline is no longer widely prescribed today, parents need to be aware that other drugs can stain their children's teeth, such as chlortetracycline, oxytetracycline, tetracycline and minocycline."

Periodontal bacteria may be linked to acute coronary syndrome (ACS)

Thu, 20 Jul 2006 20:34:00 PST

( from http://www.rxpgnews.com ) The presence of specific bacteria and combinations of bacteria in periodontal pockets might be an explanation for the relationship between periodontal disease and acute coronary syndrome (ACS), according to a new study published in the Journal of Periodontology.

The amount of oral bacteria was two times higher in the ACS group for the combination of the bacteria streptococci spp, P. gingivalis, T. forsythia and T. denticola. Specifically, the findings suggest that T. denticola, T. forsythia and streptococci spp are bacteria in a shared infectious etiology for periodontitis and ACS.

"This might be one of several explanations as to why elevated bacteria and the combination of specific pathogens in periodontal pockets can be linked to a history of ACS," said Stefan Renvert, DDS, PhD and Department of Health Sciences, Kristianstad University. "We also found that the amount of periodontal bacteria results in an inflammatory response that elevates the white blood cell counts and high sensitivity C-reactive protein levels, which has also been linked in past studies to heart disease."

It was also found that the extent of alveolar bone loss was significantly greater among subjects with ACS. Seventy-seven percent of the participants in the ACS group and 42 percent in the control group demonstrated evidence of periodontitis. The extent of bone loss was more severe in the ACS group than in the non-ACS group.

Another reason people diagnosed with ACS may have higher oral bacteria could be due to their infectious susceptibility and lack of an adequate host inflammatory response, which may induce other systemic vascular effects participating in the onset of ACS.

"Although this study supports past findings, further research is needed to evaluate the effects of reducing specific bacteria such as T. forsythia and T. denticola on reducing the risk for ACS," said Kenneth A. Krebs, DMD and AAP president. "This data highlights the importance of routine periodontal examinations and at-home dental care."

Ultrasound may help regrow teeth

Fri, 30 Jun 2006 02:28:00 PST

( from http://www.rxpgnews.com ) Hockey players, rejoice! A team of University of Alberta researchers has created technology to regrow teeth--the first time scientists have been able to reform human dental tissue.

Using low-intensity pulsed ultrasound (LIPUS), Dr. Tarak El-Bialy from the Faculty of Medicine and Dentistry and Dr. Jie Chen and Dr. Ying Tsui from the Faculty of Engineering have created a miniaturized system-on-a-chip that offers a non-invasive and novel way to stimulate jaw growth and dental tissue healing.

"It's very exciting because we have shown the results and actually have something you can touch and feel that will impact the health of people in Canada and throughout the world," said Chen, who works out of the Department of Electrical and Computer Engineering and the National Institute for Nanotechnology.

The wireless design of the ultrasound transducer means the miniscule device will be able to fit comfortably inside a patient's mouth while packed in biocompatible materials. The unit will be easily mounted on an orthodontic or "braces" bracket or even a plastic removable crown. The team also designed an energy sensor that will ensure the LIPUS power is reaching the target area of the teeth roots within the bone. TEC Edmonton, the U of A's exclusive tech transfer service provider, filed the first patent recently in the U.S. Currently, the research team is finishing the system-on-a-chip and hopes to complete the miniaturized device by next year.

"If the root is broken, it can now be fixed," said El-Bialy. "And because we can regrow the teeth root, a patient could have his own tooth rather than foreign objects in his mouth."

The device is aimed at those experiencing dental root resorption, a common effect of mechanical or chemical injury to dental tissue caused by diseases and endocrine disturbances. Mechanical injury from wearing orthodontic braces causes progressive root resorption, limiting the duration that braces can be worn. This new device will work to counteract the destructive resorptive process while allowing for the continued wearing of corrective braces. With approximately five million people in North America presently wearing orthodontic braces, the market size for the device would be 1.4 million users.

In a true tale of interdisciplinary work, El-Bialy met Chen at the U of A's new staff orientation. After hearing about Chen's expertise in nanoscale circuit design and nano-biotechnology, El-Bialy explained his own research and asked if Chen might be able to help produce a tiny ultrasound device to fit in a patient's mouth. The two collaborated and eventually along with Tsui received a grant from NSERC's "Idea to Innovation," program to expand on their prototype.

Dr. El-Bialy first discovered new dental tissue was being formed after using ultrasound on rabbits. In one study, published in the American Journal of Orthodontics and Dentofacial Orthopedics, El Bialy used ultrasound on one rabbit incisor and left the other incisor alone. After seeing the surprising positive results, he moved onto humans and found similar results. He has also shown that LIPUS can improve jaw growth in cases with hemifacial microsomia, a congenital syndrome where one side of the child's jaw or face is underdeveloped compared to the other, normal, side. These patients usually undergo many surgeries to improve their facial appearance. This work on human patients was presented at the World Federation of Orthodontics in Paris, September 2005.

"After proving it worked, we looked at creating a smaller ultrasound carrier where we can take the patient out as a variable," said El-Bialy. "Before this, a patient has to hold the ultrasound for 20 minutes a day for a year and that is a lot to ask."

The researchers are currently working on turning their prototype into a market-ready model and expect the device to be ready for the public within next two years.

Effects of stress, depression and cortisol on periodontal disease

Thu, 01 Jun 2006 12:51:00 PST

( from http://www.rxpgnews.com ) Caregivers of people under psychological or physical stress, as well as those with the conditions themselves, should not overlook their oral health, according to a new study printed in the Journal of Periodontology.

The results from the study suggest that being a caregiver to relatives with dementia, hypercortisolemia (overproduction of cortisol) or stress were associated with elevated plaque levels and increased gingival bleeding in a study that examined adults aged 50 years and older.

"We found that short term psychological stress was a risk indicator to elevated plaque levels and long term physical stress was a risk indicator to gingivitis," said Fernando N. Hugo, DDS and Faculty of Dentistry of Piracicaba, Brazil. "These findings support the health impact of psychosocial risk factors from chronic stress, which may lead to malfunction of some biological functions."

The study indicates that the demanding task of caregiving, usually associated with increased stress, may also be a risk factor for poor oral hygiene. These findings point out that stress may contribute to a disinterest in performing oral hygiene.

"Flossing and brushing the teeth and gums had a protective effect against plaque and gingivitis," said Kenneth A. Krebs, DMD and AAP president. "That said, future research is needed to explore the relationship between stress and oral hygiene negligence."

In this study, 230 individuals were evaluated, and almost 52 percent were caregivers. Caregivers of patients with dementia were examined because they represent a well-known group suffering from the impacts of chronic stress on human health and immune functions. The results are among the first in literature to suggest that caregivers of relatives with dementia are at risk of having more plaque and gingivitis than non-caregivers.

Roasted vegetables could cause dental erosion

Sun, 07 May 2006 18:43:00 PST

( from http://www.rxpgnews.com ) Eating leafy green vegetables may be good for health, but if roasted they may cause dental erosion, according to scientists in Scotland.

Fruits and vegetables tend to be quite acidic in nature and when they are roasted, they become more acidic like fizzy drinks, the online edition of the Daily Mail reported.

The study by researchers at the University of Dundee, Scotland, found that oven-roasting aubergines, green peppers, courgettes and ratatouille - a traditional French stewed vegetable dish - significantly increased its acidity as compared to stewing.

The study, published in the current edition of the European Journal of Prosthodontics and Restorative Dentistry, also says that the acidity caused by oven-roasting these vegetables amounts to the acidity resulting from certain carbonated drinks, when consumed in excess, and is believed to cause dental erosion.

However, they found the cooking method had no impact on the acidity of tomatoes or onions.

Periodontal therapy may help diabetic patients improve sugar control

Tue, 18 Apr 2006 01:24:00 PST

( from http://www.rxpgnews.com ) Results of a new study support the hypothesis that periodontal therapy may improve metabolic control (lower HbA1c) in diabetic patients.

The results suggest that periodontal therapy may reduce a diabetic patient's HbA1c count by as much as 20 percent at three and six months following treatment. According to the American Diabetes Association, HbA1c provides patients with a picture of their average blood sugar changes in the past two to three months and gives them a good idea of how well their diabetes treatment plan is working. A healthy HbA1c count is between the ranges of 4.0 to 6.0.

"We found that conventional treatment for chronic moderate generalized periodontitis, which included a simple, non-surgical procedure called Scaling and Root Planing (SRP) lowered the study group's HbA1c count from 7.2 to 5.7," said study authors Prof. Antonio Bascones and Dr.Ricardo Faria- Almeida from Department of Medicine and Buccofacial Surgery of the Complutense University in Madrid Spain.

"This could significantly put diabetic patients who are just above the normal HbA1c range into the healthy range and reduce their risk of serious complications from diabetes."

Bascones cautioned that these findings should not be considered definitive or universally generalizable because of the study sample size. In addition, this study compared the response to conventional periodontal treatment between type 2 diabetic and non-diabetic patients with chronic moderate generalized periodontitis and did not include a group of diabetics that was not undergoing periodontal treatment. The absence of this information is a limitation because it is not known how diabetic patients who were not undergoing periodontal treatment would have progressed.

"For a long time we've know that diabetic patients have a higher risk of developing periodontal disease compared to non-diabetics," said Kenneth A. Krebs, DMD and AAP president. "The results of this study provide additional evidence about the other side of the equation: that periodontal treatment may affect metabolic control in diabetic patients who have periodontal disease. While we can't say periodontal treatment will definitively help, to date no reports indicate a harmful effect of periodontal treatment on a diabetic patient's metabolic control."

Archaea Identified As Possible Human Pathogen

Sat, 15 Apr 2006 18:43:00 PST

( from http://www.rxpgnews.com ) For the first time German researchers have linked Archaea to infectious diseases in humans by identifying it as a possible cause of endodontic infections. They report their findings in the April 2006 issue of the Journal of Clinical Microbiology.

Archaea, one of the three domains of life, has previously been recognized as a component of human microbiota, but not as a cause of human disease. High numbers of methane-producing archaea (methanogens) have been found in the gastrointestinal tract, vagina, and oral cavity but are often ignored in routine laboratory diagnostics despite the diversity of pathogens identified in the other two domains, Bacteria and Eukarya.

In attempt to gather more evidence for the existence of pathogenic methanogens researchers focused on their possible role in primary endodontic infections. A tooth's root canal is devoid of microbes in a healthy state, emphasizing that endodontic microbes must gain access while evading host defense mechanisms, both of which are features displayed by pathogens. In the study researchers analyzed samples from 20 different endodontic patients that had not undergone prior treatment, but had been previously screened for bacteria. Of those 20 samples, five returned positive results for the presence of methanogenic archaea.

"Here we report for the first time the detection, identification, and quantification of a defined phylotype of archaea in infected root canals," say the researchers. "This finding may contribute to an emerging view of archaea as potential human pathogens."

Cimetidine Inhibits Gum Disease in Rabbits

Sat, 15 Apr 2006 18:39:00 PST

( from http://www.rxpgnews.com ) Researchers from Boston University School of Medicine have discovered that topical application of an ulcer drug to teeth may help prevent gum disease. Their findings appear in the April 2006 issue of the journal Infection and Immunity.

Periodontitis (gum disease) occurs when the bacterium Porphyromonas gingivalis accumulates on the tooth's surface causing inflammatory disease which leads to loss of connective tissue and bone. This disease affects tens of millions of people in the U.S. alone, emphasizing the importance of effective preventative care and treatment method.

Cimetidine is a powerful H2 receptor antagonist originally designed to treat ulcers by blocking the acid producing cells in the stomach. In the study three groups of rabbits were simultaneously induced with experimental periodontitis using P. gingivalis and treated with varying levels of topically applied cimetidine three times a week over a six-week period. Results showed that topical application of cimetidine at all concentrations inhibited inflammation and bone loss by approximately 90%.

"The findings of this study provide morphological and histological evidence that topically active cimetidine is a potent inhibitor of P. gingivalis-elicited periodontal inflammation, arresting and/or preventing tissue destruction and influencing cell populations present in the inflammatory cell infiltrate," say the researchers.

Dentistry in vogue 9,000 years ago in Balochistan

Fri, 14 Apr 2006 22:23:00 PST

( from http://www.rxpgnews.com ) Dentistry may have been practised in what is now western Pakistan as far back as 7,000 BC, say researchers who have found some Neolithic skulls with holes drilled into their molars.

According to the British journal Nature, at least nine people living in a Neolithic village in Mehrgarh, near the Bolan river in Balochistan, had holes drilled into their molars and appeared to have survived the procedure, the Daily Times said.

The findings push back the practice of dentistry by 4,000 years. The earliest known evidence of dental work was a drilled molar found in a Neolithic graveyard in Denmark dating from about 3,000 BC. The Pakistani graves are from about 7,000 BC.

The drilled molars, 11 in all, come from a sample of 300 individuals buried in graves at the Mehrgarh site, said to be the oldest Stone Age complex in the Indus River valley.

The excavation of 300 individuals was begun by a French team in the 1980s. International groups followed until 2001, when it became too dangerous to work in Balochistan.

None of the individuals with drilled teeth appear to have come from a special tomb or sanctuary, indicating that the oral care they received was available to all, says a report in the International Herald Tribune, quoting the British journal.

According to Kansas University's Prof David W. Frayer, "This is certainly the first case of drilling a person's teeth. But even more significant, this practice lasted some 1,500 years and was a tradition at this site. It wasn't just a sporadic event."

All nine of the Mehrgarh patients were adults, ranging in age from about 20 to over 40 - four men, two women and three whose sex could not be determined. Most of the dental work was done on the chewing surfaces of their molars, in both the upper and lower jaws, probably using a flint point attached to a bow that made a Stone Age version of a high-speed drill, the researchers said.

First link of oral bacteria and preterm birth found in human

Wed, 12 Apr 2006 01:09:00 PST

( from http://www.rxpgnews.com ) A 37-year-old-mother, who gave birth to a low-weight preemie at 24 weeks, exhibited the first-found link in a human between bacteria found in the mouth and the amniotic fluid of a woman in preterm labor.
Using new DNA finger-printing techniques to find bacteria that cannot be cultured and grown in the lab, researchers from Case Western Reserve University School of Dental Medicine and the Department of Obstetrics and Gynecology at MetroHealth Medical Center in Cleveland made the discovery.

Yiping Han, the lead researcher and a Case microbiologist in the Department of Biological Sciences at the Case School of Dental Medicine, has spent approximately three years searching for this link.

Assisting in her investigation were Akihiko Ikegami, Nabil Bissada and Raymond Redline from Case and Graham Ashmead and Melissa Herbst from the Department of Obstetrics at Case School of Medicine and MetroHealth Medical Center.

The researchers report that they found the link during a pilot study of 34 women undergoing amniocentesis at MetroHealth.

The women in their second or last trimester had sought testing for genetics, fetal development or suspected infections.

Six of the women delivered before 30 weeks and had a higher risk for possible infections. Only the one mother had an infection.

But Han points out that in this small study it was one in six of the mothers under 30 weeks and in the overall population could mean many more women with infections that bring on early labor or the need to induce labor to protect the baby from an infection during the pregnancy.

Women can contract intrauterine infections vaginally while pregnant. Another pathway of infection has been suspected through the mouth in pregnant mothers where the oral bacteria enter the blood through bleeding gums.

Hans said the infections play a bigger role in premature deliveries prior to 30 weeks than those that happen later in pregnancy and can result in babies born with many health challenges and who struggle to thrive at their low-birth weights.

Finding why mothers give birth prematurely is important for the health of the baby and mother and to drive down medical costs, said Han.

The mother, who had the presence of Bergeyella, came to MetroHealth when in preterm labor and dilated at 24 weeks. She was induced after it was determined by low glucose levels and elevated white blood cell counts in her amniotic fluid that she had an infection. An examination of the placenta, fetal lining and umbilical cord following the birth supported the infection.

Han's tests of the amniotic fluid found the Bergeyella bacteria.

This study continues Han's research into the suspicion that oral bacteria, once entering the blood, can cause a host of health problems including preterm labor.

She confirmed the harm oral bacteria can cause in a mice study in April 2004 when she injected the common oral bacteria of Fusobacterium nucleatum into the blood of pregnant mice. It resulted in premature delivery for the mouse mothers and fetal death for some of their fetuses.

The pilot study is one of the first studies done on humans.

The mother, who had the presence of Bergeyella, regularly visits the dentist and showed no signs of post-partum periodontal disease--a suspected facilitating condition for bacteria to enter the bloodstream.

"If periodontal disease is not present, then this raises more questions about how the bacteria got into the amniotic fluid," said Han.

Bergeyella is one of the 700 bacteria found in the mouth. It is also one of approximately 60% of the bacteria that cannot be grown in a culture, and until now, could not be studied. Since new techniques like PCR (polymerase chain reaction) became available to track the DNA of the bacteria, it now allows for the study of those other bacteria.

Salivary Biomarkers as Diagnostic Tools in Existing Periodontal Disease

Fri, 07 Apr 2006 13:48:00 PST

( from http://www.rxpgnews.com ) A University of Kentucky research study featured on the cover of the March issue of the Journal of American Dental Association could help change the diagnosis and treatment of periodontal disease.

The article, Salivary Biomarkers of Existing Periodontal Disease, discusses the importance of saliva and its potential to be a diagnostic tool.

The study was conducted by a team of UK researchers to determine if saliva could be tested for signs of periodontal disease, a chronic bacterial infection affecting millions of Americans characterized by persistent inflammation, connective tissue breakdown and alveolar bone destruction. Results showed that saliva could be a significant component in diagnosing and monitoring periodontal disease.

"Our research team has been working on methods and point-of-care devices that could allow saliva to be used as a diagnostic fluid, said Craig Miller, primary investigator and professor of oral medicine at UK. Our initial emphasis is on the identification of biomarkers in saliva that will allow us to diagnose periodontal disease. We have made great strides in doing just that, as evident by our recent data published in JADA.

This could impact the practice of dentistry and medicine in the very near future, as health care practitioners use saliva, possibly instead of blood, to diagnose and monitor oral and systemic health. With time and continued research funding, we are hoping to realize portable devices that can diagnose a wide variety of disease conditions using saliva."

In this issue of JADA, which was devoted to studies on the salivary glands, two feature stories and two editorials evaluated the future of saliva as a diagnostics tool. The second feature story was a study from the University of California Los Angeles, which examines markers in saliva of patients that are correlated with oral cancer.

Point of Care diagnostics is the holy grail for the health care in the 21st century, said Daniel Malamud, professor at New York University, in his guest editorial, Salivary Diagnostics: the Future is Now, also appearing in the March issue of JADA. Within the discipline of POC diagnostics the use of saliva and other oral samples as the source of biomarkers is particularly appealing since their collection is relatively noninvasive and well-tolerated by the patient.

Kids with Carries Overweight, Not Underweight

Thu, 06 Apr 2006 02:34:00 PST

( from http://www.rxpgnews.com ) New evidence from pediatric dentists at the University at Buffalo has shown that, contrary to previous findings, most young children with decayed "baby" teeth are not underweight, and actually may be overweight or at risk of being overweight.

A study of children ages 2-5 who underwent aggressive dental treatment under general anesthesia in the operating room by UB's pediatric dentists at the Women and Children's Hospital of Buffalo found that at least a quarter of the patients were over the recommended weight for their age or close to it, unlike their peers who had good teeth
"Prior studies in the 1990s found that children with rampant tooth decay appeared to be underweight, and this was attributed to a failure to thrive," said Hiran Perinpanayagam, D.D.S., Ph.D., an endodontist and assistant professor in UB's School of Dental Medicine and senior author on the study.

"In contrast, a more recent study found that the children with tooth decay did not have reduced bodyweight. Given these conflicting results, we thought a more definitive study was needed."

Sandra McDougal, D.D.S., pediatric dental resident was first author on the study.

The researchers analyzed all complete records of children 2-5 years old who were treated for early childhood cavities at the pediatric clinic in 2000 and between January and April 2005. The analysis included gender, age, height and bodyweight at the time of treatment. In young boys and girls, bodyweight is assessed using a measure called body-mass-index (BMI) for age, which takes into account childhood growth patterns.

A total of 407 records of children with cavities were reviewed -- 170 from 2000 and 237 from 2005 -- as well as records of 79 children seen in May 2005 who were cavity free.

Results showed that very few of the children with cavities were underweight: 8.2 percent and 7.2 percent in 2000 and 2005 respectively. In contrast, 16.5 percent were at risk of being overweight and 10.6 percent were overweight in 2000. In 2005, 10.5 percent of the children with cavities were nearly overweight and 15.6 percent were already overweight.

Although the average age-adjusted body mass index was higher in the children with cavities in 2005 than in the children with cavities in 2000, or those that were free of cavities, these differences were not significant, Perinpanayagam noted.

"Our study has confirmed that the children with dental decay are not underweight in comparison to their peers," he said. "Furthermore, their BMI-for-age appears to be significantly higher than the 50th percentile.

"The significance of these findings is that there may be a connection between a poor diet that causes tooth decay and one that leads to childhood overweight and obesity. Our next step will be to see if those children that improve their diet to stop a recurrence of cavities also are able to maintain healthy bodyweight."

Red wine components modulate tissue damage in gums

Sat, 11 Mar 2006 00:55:00 PST

( from http://www.rxpgnews.com ) Researchers are finding that components found in red wine can help in preventing and treating inflammatory periodontal diseases. Periodontitis is a progressive infectious disease affecting the gums and bone that surround and support teeth, often causing tooth movement and leading to permanent tooth loss. About 15% of adults between 21 and 50 years of age and 65% of adults over 50 are affected by this disease.

In recent years, the benefits of consuming fresh fruits and yellow-green vegetables and beverages, particularly green tea and red wine, have been reported to reduce human cancer incidence and mortality. The potential health benefits of those products are attributed to a broad range of compounds called polyphenols. Recent studies have also shown that red wine, and particularly grape seeds, possesses anti-inflammatory and anti-tumor activities and prevent heart disease. Mechanisms by which these phenolic compounds exert their protective effects include their anti-oxidant properties.

Scientists from Université Laval (Québec, Canada), reporting today at the 35th Annual Meeting of the American Association for Dental Research, conducted a study to investigate the role of polyphenols, including those from red wine, in scavenging free radicals released by immune cells stimulated with components of bacteria causing periodontal diseases. Because free radicals are generated by immune cells during periodontitis, it is critical to keep them at low levels to maintain healthy gums.

Their results indicated that red wine polyphenols significantly modulate several inflammatory components released by macrophages (a population of host immune cells) in response to bacterial stimuli. Specifically, polyphenols efficiently scavenged and inhibited free-radical generation by host immune cells by controlling intracellular proteins involved in their release. These anti-oxidant properties of red wine polyphenols could be useful in the prevention and treatment of inflammatory periodontal diseases as well as other disorders involving free radicals.

PDT Kills Drug-Resistant Bacteria of oral cavity

Fri, 10 Mar 2006 21:17:00 PST

( from http://www.rxpgnews.com ) Photodynamic therapy may be an effective treatment for fungal infections and certain bacterial infections of the oral cavity, including some that are resistant to antibiotics, research from the University at Buffalo's School of Dental Medicine has shown.

Researchers found that the bacteria S. mutans, as well as fungal organisms of the genus Candida, cultured from HIV patients, were highly susceptible to killing with minimal doses of PDT, both in laboratory dishes and on biofilms grown on denture material.

Results of the research were presented today (March 10, 2006) at the International Association of Dental Research meeting in Orlando, Fla.

"The results of the studies so far, while not completed, may have important implications in the treatment of oral infectious diseases currently confounding the medical and dental community," said Thomas S. Mang, Ph.D., associate professor of oral and maxillofacial surgery and senior author on the study.

"PDT may provide an adjunct to current antibiotic treatment or an alternative where antibiotics no longer are working. This may be vital for patients undergoing cancer therapy, HIV patients who demonstrate resistance to antibiotics and the elderly with persistent oral infections."

Photodynamic therapy is based on the propensity of certain types of cells or organisms to absorb light-sensitive drugs. This selective retention allows researchers to direct a laser beam into the organism, which activates the drug and kills the organism but does not damage surrounding tissue.

PDT has been shown to be effective against certain types of cancer, particularly Kaposi's sarcoma, cancer of the esophagus and breast cancer that has metastasized to the chest wall. The drug Photofrin® has been approved by the FDA as a sensitizer for PDT in the treatment of early and late stage endobronchial and esophageal cancers, as well as high-grade abnormal tissues associated with Barrett's esophagus, a peptic ulcer of the lower esophagus caused by the presence of cells that normally stay in the stomach lining.

In the current research, after adding the light-sensitive drug Photofrin® to the cultured samples and biofilm, the samples were exposed to various intensities of light.

Results showed that the photosensitizer accumulated in the samples within 15 minutes. Very low doses of light killed nearly all the S. mutans bacteria, reducing its concentration to less than 0.1 percent.

PDT also demonstrated significant killing of three types of Candida: C. albicans, which causes thrush, and C. glabrata and C. krusei, in samples harvested from immunocompromised (HIV) patients.

Resolvin E1 protects against inflammation and bone loss

Fri, 10 Mar 2006 21:15:00 PST

( from http://www.rxpgnews.com ) Gum disease is initiated by bacteria populating dental plaque and may eventually result in tissue and tooth loss. Gum disease is similar to other chronic inflammatory diseases such as arthritis, where inflammation causes tissue damage and is responsible for the disease. To date, the prevention of gum disease is limited to successful oral hygiene and regular professional care. However, despite these preventive actions, plaque control is not enough to prevent disease in susceptible individuals with a high inflammatory response.

Researchers presenting their findings today during the 35th Annual Meeting of the American Association for Dental Research are introducing Resolvins, a new family of biologically active products of omega-3 fatty acids. They are natural endogenous regulators of the inflammatory response. Since it is now known that inflammation plays a critical role in many diseases, including heart diseases and asthma, experiments were carried out to test the actions of the newly described EPA (eicosapentanoic acid)-derived Resolvin E1 (RvE1) in regulating tissue destruction and resolving inflammation in gum disease. Experimental gum disease characterized by tissue inflammation and bone loss was stimulated in rabbits by the application of specific bacteria that cause human gum disease.

The results of this study showed that topical application of RvE1 in experimental gum disease provided remarkable protection against soft tissue and bone loss associated with gum disease (periodontitis). Analysis of these data supports the concept that inflammation is a good therapeutic target in the treatment of periodontal disease.

Dentists in research network do not discriminate

Wed, 08 Mar 2006 21:42:00 PST

( from http://www.rxpgnews.com ) Regardless of race, private practice dentists do not discriminate in services they provide their patients, according to a new study from Case Western Reserve University's School of Dental Medicine.

The findings are from the first analyses of observational data from a major study, funded by the National Institute of Health and the National Institute of Dental and Craniofacial Research, to discover what happens in dental practices and how private practice dentists and dental hygienists counsel patients in ways to prevent dental diseases.

Other dental schools working with similar networks are New York University, the University of Washington (Seattle) and the University of Alabama at Birmingham.

Dentists, who primarily work in isolation from each other, receive little or no feedback from their peers.

One aspect of this study provides information to help dentists see how their individual practices compare to other dental professionals in the study.

Examining information gathered through observations, patient charts and insurance billings, Case researchers confirm that the people visiting private dentists are generally middle class and have attained some higher education.

In the study, more African Americans have dental insurance, but all dental patients end up paying "out of the pocket" for approximately 50 percent of the dental costs, according to Dr. Stephen Wotman, Case professor of dentistry and the lead investigator on $2.5 million study. Approximately 8% of the patients from Ohio Dental Practice Research Network study are African American.

The Case researchers visited and collected data from 120 practices in a dental research network established by the Case dental school in 1998 to have access to what dentists actually do in their practices. Researchers reviewed the practices of 124 dentists and 128 hygienists during 3,400 patient visits. The data was collected between June 2004 and September 2005.

"Preventive counseling is the major method by which people learn self care and self care can prevent the majority of dental disease," said Wotman.

According to a 2000 U.S. Surgeon General Report, some 70 percent of dental disease can be prevented through an individual's efforts to brush, floss, conduct self examinations for oral cancers and stop using tobacco products.

How this information reaches the patient is a concern for the profession.

"We believe that at the high end of preventive counseling there is a 'champion' in the office," said Wotman.

He added that from observations it usually is the hygienist, but when the hygienist and dentist battle dental disease together, the patient wins.

One of the nine studies found that a prevention procedure was performed in 78.1% of the hygienist visits compared to 14.4% of the dentist visits and prevention counseling was done in 87.7% of hygiene visits compared to 28.7% of dentists' visits.

Many people find visiting the dentist stressful, with 65% of the patients feeling some level of anxiety.

One study examined how dentists and hygienists make their patients comfortable. Some of those strategies include distractions in the office environment, verbal reassurances and relaxation techniques. The researchers reported that all dentists use some form of comfort-giving with their patients.

Oral and cardiovascular health are related - Study

Thu, 23 Feb 2006 11:29:00 PST

( from http://www.rxpgnews.com ) New research is reinforcing the longstanding belief that a connection exists between periodontal disease, or severe gum inflammation, and cardiovascular disease. But according to Moise Desvarieux, MD, PhD, infectious disease epidemiologist in the Department of Epidemiology at Columbia University's Mailman School of Public Health, the nature of the relationship is still unclear and patients cannot rely only on good oral hygiene as a way to reduce their risk for heart disease--they must manage other risk factors for the disease as well.

"It appears a relationship exists, but we don't know exactly what it is and if it is a causal relationship.Therefore, we can't make recommendations for people with periodontal disease in respect to cardiovascular disease," said Dr. Desvarieux, whose team studies periodontal disease in relation to atherosclerosis, or hardening of the arteries, "To reduce their risk for cardiovascular disease, patients must manage all their risk factors, including smoking, diabetes, and weight."

Dr. Desvarieux, who coordinates the INVEST study, an NIH-funded study in Northern Manhattan, as well as the international network investigating the oral health-cardiovascular disease relationship, spoke today at the American Medical Association and American Dental Association media briefing, Oral and Systemic Health: Exploring the Connection, in New York City.

Most research to date has been specifically on the clinical level, explained Dr. Desvarieux. Using a manual probe, dentists measure for signs of periodontal disease, including gum inflammation, gum pocket depth, or spacing around each tooth and tooth-bone attachment loss and compare these data to ultrasound measurements of the carotid artery. If cholesterol or fatty buildup is detected on the wall of the artery, there's a good chance the patient has atherosclerosis, a direct link to future stroke and cardiovascular disease.

Dr. Desvarieux and a collaborative team including researchers from the Mailman School of Public Health, the College of Dental Medicine and neurologists at the College of Physicians & Surgeons at Columbia University Medical Center, took this research one step farther.

"Our research brings in the microbiological factors that may connect the two diseases," explained Dr. Desvarieux. "We analyzed bacterial samples from the oral cavity, three of which are specifically associated with periodontal disease. We found that those patients with one or any combination of these three bacteria also had atherosclerosis."

He hypothesizes that the atherosclerosis may be a result of bacteria from gum infection entering the bloodstream, creating inflammation in other parts of the body. However, he cautions "Because both pieces of the puzzle were being measured simultaneously, we don't know which came first and we can't say whether the relationship is causal."

He continued "Further research is needed. We need to follow these patients over the course of their lives and see whether those with the highest levels of the gum disease bacteria end up having more heart attacks and strokes than the others."

"If we determine that there is a causal relationship between periodontal disease and cardiovascular disease, patients at risk will have to manage their oral health in addition to their other risk factors. The periodontal disease-cardiovascular disease connection won't negate their diabetes, weight or smoking habit. Individually, each contributes to the disease and the more risk factors, the more likely that one will have an episode."

But Dr. Desvarieux stressed that even though the exact relationship has not been discovered, it doesn't mean patients should neglect their oral health. "It is hard for anyone to be against good oral health" he said. "If a causal relationship is found, you'll already be ahead of the game in regards to your heart health. If there is no relationship, you'll have a healthy mouth that will benefit your overall well-being."

NHANES III Study - Obesity is a significant predictor of periodontal disease

Wed, 22 Feb 2006 16:17:00 PST

( from http://www.rxpgnews.com ) People have a new reason to stick to their New Year's resolution to lose excess weight besides fitting into the latest fashion trends. Researchers from University at Buffalo found that obesity is a significant predictor for periodontal disease, independent of age, gender, race, ethnicity, and smoking.

Furthermore, analysis of this national sample suggests that insulin resistance mediates the relationship between obesity and periodontal disease. It was found that the severity of periodontal attachment loss increased proportionally with increasing insulin resistance. In addition, the number of teeth lost increased significantly with increasing levels of insulin resistance. Individuals in the highest insulin resistance category lost 1.1 more teeth compared to individuals in the lowest category.

"People who have a higher body mass index produce cytokines (hormone-like proteins), that lead to systemic inflammation and insulin resistance," said Robert J. Genco, vice provost at the University at Buffalo and editor of the JOP. We propose that chronic stimulation and secretion of proinflammatory cytokines associated with periodontal infection also occurs, contributing to insulin resistance, which may further predispose to diabetes mellitus."

Genco and his research team recently showed that diabetics with periodontal disease may have greater mortality from diabetic complications such as cardiovascular disease and kidney complications than diabetics with little or no periodontal disease.

"The presence of periodontal infection combined with obesity may contribute to type 2 diabetes and its complications, such as coronary heart disease," said Kenneth A. Krebs, DMD and AAP president. "Although further studies are needed, people should remember that living a healthy lifestyle along with daily brushing and flossing and visiting your oral health care provider is always in fashion."

Fluoride varnish helps prevent tooth decay

Sat, 28 Jan 2006 12:52:00 PST

( from http://www.rxpgnews.com ) Fluoride varnish, a dental preventive treatment, reduces the incidence of early childhood tooth decay in combination with dental health counseling for parents, according to a study by investigators at the UCSF School of Dentistry.

The investigators examined cavity-free infants and young children, primarily from low-income Chinese or Hispanic families in San Francisco. All families received counseling on dental health, and children were randomized into three groups: those receiving fluoride varnish twice per year, those receiving it once per year, and those not receiving it at all. Of the initial 376 children enrolled, 280 completed the study.

According to study findings, children who did not receive any fluoride varnish were more than twice as likely to develop tooth decay as the children who were assigned to the annual fluoride varnish group. Children who did not receive fluoride varnish were nearly four times more likely to develop tooth decay than those assigned to receive it twice per year (four treatments over two years).

There are two important points that parents should be aware of as a result of this study, said Jane Weintraub, DDS, MPH, Lee Hysan Professor at the UCSF School of Dentistry and principal investigator of the study. "First, the results support the use of fluoride varnish to prevent tooth decay in very young children. Second, the results support parents bringing children for their first dental visit at age one when they are getting their first teeth."

"Fluoride varnish is relatively inexpensive, easy to brush onto a child's teeth, and can be part of a positive first dental visit to help prevent tooth decay," Weintraub said. "In contrast, when very young children get cavities, it is difficult for them to sit still for dental treatment. Often, young children needing many fillings receive care in the operating room, at great expense to their family and with the additional risks posed by general anesthesia. We now have an easy, low-cost way to keep teeth healthy."

Fluoride varnish is a resin containing concentrate fluoride that is brushed on teeth the same way that nail polish is painted onto nails. "Nail polish makes nails look good; fluoride varnish helps keep teeth looking good by preventing cavities," Weintraub said. It is meant to enhance the potential therapeutic benefit of fluoride by keeping the tooth enamel in contact with it.

Previously it has been shown to help prevent tooth decay for older school-age children who have their permanent teeth. According to the investigators, this was the first randomized study of children as young as six months of age, and it shows the efficacy of fluoride varnish to prevent tooth decay in young children's primary (baby) teeth.

The study was conducted at the San Francisco General Hospital Family Dental Center and the San Francisco Department of Public Health's Chinatown Public Health Center. The average age of the children enrolled in the study was 1.8 years old, with ages ranging from six months to 44 months at the start of the study. In addition to dental-health counseling, treatment with fluoride varnish and examinations for tooth decay, at each visit the children's parents were asked about adverse events or safety concerns; none associated with the fluoride varnish treatment were discovered.

The children who participated in the study were primarily from low-income, dentally underserved backgrounds. This made them well suited as participants for the study, according to Weintraub. "Statewide studies have shown that children from low-income Hispanic and Asian populations in California are at high risk for tooth decay," Weintraub said.

Licorice compounds may help fight tooth decay

Tue, 24 Jan 2006 16:02:00 PST

( from http://www.rxpgnews.com ) Compounds isolated from licorice root may help prevent cavities, according to researchers at the University of California, Los Angeles. In test tube studies, the scientists showed that an extract from a plant root that is used to make licorice candy and other products contains at least two compounds that appear to be potent inhibitors of Streptococcus mutans, a major cause of dental caries. Their study is scheduled to appear in the Feb. 24 print version of the Journal of Natural Products, a monthly peer-reviewed joint publication of the American Chemical Society and the American Society of Pharmacognosy.

More studies are needed before it is proven that the compounds effectively fight cavities in humans, caution Qing-Yi Lu, Ph.D., a chemist at UCLA's School of Medicine, and Wenyuan Shi, Ph.D, a microbiologist at UCLA's School of Dentistry. If further studies show promise, the licorice compounds could eventually be used as cavity-fighting components in mouthwash or toothpaste, they say.

Licorice has been an important herb in Chinese medicine for many years and is now being rediscovered by Western medicine as a rich source of potentially beneficial compounds. In addition to being used as flavoring and sweetening agents in candy, tobaccos and beverages, compounds derived from licorice root have been shown to help fight inflammation, viruses, ulcers and even cancer, according to the researchers.

Removing gaps depends on overall health

Sun, 22 Jan 2006 22:01:00 PST

( from http://www.rxpgnews.com ) Dental implants, an artificial tooth root surgically anchored into a jaw to hold a replacement tooth or several teeth in place, offer a permanent solution to replace lost or extracted teeth. Implants have become a treatment of choice for some patients to eliminate the need for removable partial or complete dentures. Other patients choose implants for esthetic purposes or to conserve tooth structure in an otherwise cavity-free mouth.

However, according to a recent report in the November/December issue of General Dentistry, the Academy of General Dentistrys (AGD) clinical, peer-reviewed journal, the success or failure of an implant relies on a number of factors, including the quality of the patients overall health.

The success rate for implants decreases in patients that suffer from chronic problems, such as tooth grinding and clenching or systemic diseases, such as uncontrolled diabetes. Also, individuals who smoke heavily or abuse alcohol may not be ideal candidates for the procedure.

You must have good bone quality and a lack of chronic periodontal disease for the implant to stay in place, says report lead author Judith A. Porter, DDS, MA EdD. Patients are unaware that bone loss in their jaw will often follow the loss of a tooth. When that happens, over time, bone loss can cause facial changes and diet changes.

Successfully placed dental implants allow the bone to grow around the artificial tooth root and to firmly hold it in place. Implants also help patients regain everyday functions, such as normal eating and speaking abilities.

Implants are a good solution to tooth loss because they look and feel like natural teeth, says Kenton Ross, DMD, FAGD, an AGD spokesperson. They can enhance a patients quality of life and self-image.

Severe periodontal disease frequent among socioeconomically disadvantaged

Sun, 22 Jan 2006 21:57:00 PST

( from http://www.rxpgnews.com ) Socioeconomic disadvantage at the individual and neighborhood level is associated with severe periodontitis among African-Americans and Whites, according to research conducted at the Mailman School of Public Health and reported in the American Journal of Public Health.

The study was based on a sample of individuals aged 45 to 64 years, who participated in the Dental Atherosclerosis Risk in Communities Study, selected from four U.S. communities in North Carolina, Mississippi, Minnesota, and Maryland. Findings confirmed the associations between individual socioeconomic indicators and the prevalence of severe periodontitis among African Americans and Whites. Low income was associated with the prevalence of severe periodontitis among Whites, and both low education and income levels were associated with severe periodontitis among African-Americans.

"These associations remained significant after adjustment for age, gender, recruitment center, and neighborhood socioeconomic conditions," according to Luisa N. Borrell, DDS, PhD, MPH, lead author, and assistant professor of Epidemiology at the Mailman School of Public Health and assistant professor of Dentistry, School of Dental and Oral Surgery, Columbia University. "Specifically, the odds of having severe periodontitis were twice as high among African Americans without a high-school diploma than among their peers with a college degree or postgraduate education. Moreover, low income African Americans and Whites were at least 50% more likely to have severe periodontitis than their high-income counterparts," observed Dr. Borrell.

Although there was no association between neighborhood socioeconomic conditions and severe periodontitis, the study shows that low-income Whites residing in disadvantaged neighborhoods had almost twice the odds of experiencing severe periodontitis than high-income Whites living in high-socioeconomic status neighborhoods.

This is the first study of its kind to investigate neighborhood effects on periodontal disease, although it had been postulated that area of residence influences an individual's health behaviors and health-related norms. "In the case of periodontal disease, social contexts could promote or prevent behaviors that may affect periodontal health such as smoking, regardless of individual socioeconomic status," notes Dr. Borrell.

"Our study confirms that individual income and education are important factors in periodontal health independent of neighborhood socioeconomic circumstances for African Americans and Whites. Most importantly, this study shows that being poor and living in a disadvantaged neighborhood increases the odds of periodontal disease among Whites only" says Dr. Borrell.

Treating gum disease may reduce the risk of cardiovascular disease

Sun, 22 Jan 2006 21:32:00 PST

( from http://www.rxpgnews.com ) The Journal of Dental Research has just published the results of a study showing that treatment of gum disease may reduce the risk of cardiovascular disease.

Researchers from Australia (Sydney Dental Hospital and Royal North Shore Hospital) and Norway (University of Oslo) collaborated in the PERICAR clinical trial, providing strong evidence linking periodontal (gum) disease to an increased risk of developing blood clots, which could lead to the onset of heart attack and stroke.

In recent years, many studies throughout the world have linked periodontal disease to increased cardiovascular risk, although the reasons for this link have not been fully explained, nor has it been proven that the link is a direct causal one. One explanation is that inflammation and infection have also been related to increased atherosclerosis and cardiovascular risk. Periodontal disease is the most common chronic infection in humans, and symptoms include bleeding, swollen or receding gums, and bad breath. In severe cases, the teeth become loose and may eventually fall out.

Individual participants who were involved in the trial had blood tests before and after treatment of gum disease that was so severe that all their teeth had to be extracted. The blood tests were for blood-clot risk factors and signs of inflammation.

The average level of factors fell when the gum infection was eradicated, suggesting that the risk of heart attacks and clots in the future had reduced. This also indicates that inflammation in the mouth has a measurable effect in the bloodstream, and therefore the rest of the body.

Although these results are exciting they do not yet provide proof of a direct link and more research is needed. With grants from the National Health and Medical Research Council of Australia and the Ramaciotti Foundation, the researchers are currently studying the relationship between gum and heart disease in people with less severe periodontal disease who do not need to have all their teeth extracted.

Dental disease impacts on people's general health and well-being. Periodontal disease is common, preventable, and treatable. This study suggests that improving periodontal health could significantly reduce the risk of cardiovascular disease.

New Link Between Severe Periodontitis and Cardiovascular Disease

Sun, 04 Dec 2005 10:18:00 PST

( from http://www.rxpgnews.com ) Virginia Commonwealth University researchers have found that changes in the plasma lipoprotein profile of patients with severe periodontitis a condition characterized by chronic infection and inflammation of the gums - may contribute to these patients elevated risk for heart disease and stroke.

The findings suggest that it may be beneficial to test periodontitis patients for changes in their plasma lipoprotein profiles, so that available medication can be taken if necessary.

In the December issue of the Journal of Lipid Research, researchers found that patients with generalized aggressive periodontitis generally had elevated plasma levels of a particularly bad subclass of the low density lipoprotein (LDL) called small-dense LDL.

Previous research has shown that people who have predominantly small-dense LDL in their blood are at a three- to six-fold increased risk of heart disease and stroke, said lead author Rik van Antwerpen, Ph.D., an assistant professor of biochemistry at VCU. A person may have predominantly small-dense LDL without having alarmingly high blood levels of cholesterol. Therefore, unhealthy levels of small-dense LDL are not always detected in regular cholesterol tests.

According to the study, a second factor influencing the cardiovascular risk of patients with severe periodontitis may be platelet activating factor acetylhydrolase (PAF-AH), an enzyme that is associated with small-dense LDL. PAF-AH is able to break down some of the inflammatory, atherogenic components of LDL. Van Antwerpen said that the enzyme may lower the atherogenic effects of LDL, and that the observed decrease of LDL-associated PAF-AH activity in patients with severe periodontitis may increase the cardiovascular risk of these patients.

Our results indicate that these differences may in part be responsible for the enhanced plaque build up in the arteries of patients with severe periodontitis, said van Antwerpen.

In this study, a limited number of participants were enrolled 12 patients with generalized aggressive periodontitis and 12 control subjects without periodontal disease. Currently, van Antwerpen and his colleagues are evaluating a greater number of patients with varying degrees of periodontal infection and inflammation as they work toward establishing testing guidelines for periodontitis patients.

Cranberry juice acts like Teflon for teeth

Fri, 25 Nov 2005 06:13:00 PST

( from http://www.rxpgnews.com ) A team led by oral biologist Hyun (Michel) Koo, D.D.S., Ph.D., at the University of Rochester Medical Center has discovered that the same traits that make cranberry juice a powerful weapon against bladder infections also hold promise for protecting teeth against cavities. Koo found that cranberry juice acts like Teflon® for teeth, making it difficult for the bacteria that causes cavities to cling to tooth surfaces. Stickiness is everything for the microbe Streptococcus mutans, which creates most cavities by eating sugars and then excreting acids that cause dental decay.

"Scientists believe that one of the main ways that cranberries prevent urinary tract infections is by inhibiting the adherence of pathogens on the surface of the bladder. Perhaps the same is true in the mouth, where bacteria use adhesion molecules to hold onto teeth," Koo said.

Koo's team also found evidence that cranberry juice disrupts the formation of the building block of plaque, known as a glucan. Like a mason using cement to build a wall brick by brick, bacteria use enzymes known as glucosyltransferases to build dental plaque piece by piece, quickly forming a gunky fortress that covers the tooth and gives bacteria a safe haven to munch on sugar, thrive, and churn out acid. Koo's team found that cranberry juice prevents bacteria from forming plaque by inhibiting those enzymes and by stopping additional bacteria from glomming on to the ever-growing goo.

"Something in the cranberry juice disarms the pathogens that cause tooth decay," Koo said.

But don't even think about running to the juice aisle in the grocery store to prevent tooth decay, Koo said. The sugar that is usually added to cranberry juice can cause cavities, and the natural acidity of the substance may contribute directly to tooth decay.

Instead of advocating mass consumption of cranberry juice, Koo hopes to isolate the compounds within the juice that pack an anti-cavity punch. The substances could then be added to toothpaste or mouth rinse directly. He is working closely with Nicholi Vorsa, Ph.D., a plant pathologist and director of the Blueberry and Cranberry Research and Extension Center at Rutgers, to isolate the compounds in juice that are most protective.

A food scientist turned dentist, Koo became fascinated with research and is an expert on natural substances that can improve oral health. Currently, as an assistant professor in the Eastman Department of Dentistry and a researcher in the Center for Oral Biology, he is focusing on ways to stop the bacteria that ultimately causes cavities. Such research, if successful, would improve the oral health of millions of people worldwide.

Koo's work with cranberry juice is one of nine projects funded through a special program by the National Institutes of Health to test the berry's reputed health-enhancing effects. The other projects focus on topics such as urinary tract infections and how the body processes cranberry juice.

"There is a massive number of publications about the effect of cranberries on urinary tract infections," said Koo, "but there are only few studies on the dental side."

The cranberry research will be published in the January 2006 issue of Caries Research. Other authors include dentist Patricia Nino de Guzman, dental student Brian Schobel, and microbiologist Anne Vacca Smith, Ph.D., and dental researcher William Bowen, D.D.S., Ph.D.

As Thanksgiving approaches, Koo said that only cranberry juice is under study, so diners shouldn't reach for the cranberry sauce just to stop the tooth decay brought on by carbohydrate-laden foods like mashed potatoes, rolls, and pumpkin pie. He recommends traditional measures to avoid cavities: Brush your teeth after dinner, don't snack often, stay away from sugary foods, use a mouth rinse, and get regular dental checkups.

Sunlight help prevent periodontal disease

Thu, 13 Oct 2005 15:11:00 PST

( from http://www.rxpgnews.com ) As the days get shorter and colder, it gets harder to spend time in the sun, and that's probably bad for your teeth. According to an article in the Journal of Periodontology from a researcher at Washington University School of Medicine in St. Louis, our teeth may be light-sensitive, at least indirectly.

"Calcium and vitamin D are important to oral health," says Charles F. Hildebolt, D.D.S., Ph.D., associate professor of radiology at Washington University's Mallinckrodt Institute of Radiology and author of the paper. "The best way to get calcium is through the diet, but we need vitamin D to regulate calcium, and it's hard to eat enough foods rich in vitamin D to meet that need. The best source of vitamin D is sunshine."

Vitamin D is important in regulating absorption of calcium in the body. Even if people took in adequate calcium, the body still needs vitamin D to maintain proper calcium levels, both in the bones and in the bloodstream.

"If our systems can't maintain calcium at particular levels, then the calcium in our bones can be resorbed to maintain serum calcium levels," Hildebolt says. "That causes problems. We know that 21 percent of Caucasian women over age 50 have osteoporosis and 38 percent have osteopenia, which is a milder form of bone weakening. Half of all Caucasian women over the age of 50 will suffer an osteoporotic fracture at some point before they die."

These women also will be at risk for periodontal disease, as will men who don't get enough calcium and vitamin D. That's because in addition to its role in regulating calcium, vitamin D also has a role in regulating inflammation. In the face of low vitamin D levels, cells produce more cytokines proteins that contribute to inflammation.

"Periodontal disease is an inflammatory process in which cytokine levels are increased," he says. "You can actually think of the disease as an overreaction to bacteria in the mouth that causes damage to the bone and the soft tissues that support the teeth."

A way to lower that risk, he says, is to boost vitamin D levels, and the best way to do that is to increase sun exposure. Hildebolt doesn't advocate sunbathing or spending time in a tanning bed. He says it takes just a few minutes of exposure on the hands, arms, face and neck to boost vitamin D to the necessary levels. In most parts of the country, about 10 to 15 minutes a couple of times a week is sufficient to provide the body with adequate stores of vitamin D.

"A limited amount of sunshine is good," Hildebolt says. "It's like many other things. Food is good, but too much of it is harmful. Too much sunshine isn't good either. But sunshine remains the best way for our bodies to make vitamin D, so we need to get enough sunshine to generate the vitamin D that our systems require."

The problem is that older people have the highest risk, and many get little or no sunshine, especially during the cold, dark winter months. Even those who get outside tend to wear hats, coats and gloves to keep the skin covered. Plus, winter sunlight isn't as effective at manufacturing vitamin D in the body as the "warmer" sunlight of spring, summer and fall, which delivers more ultraviolet radiation that the body uses to manufacture vitamin D.

"During the wintertime in a city like Boston, one needs more than five hours of exposure to sunshine to generate any vitamin D at all," he says. "That makes it hard to get adequate vitamin D from sunshine."

Because some vitamin D can be stored in body fat, Hildebolt says it is possible to "save up" some sun exposure "for a rainy day." But it's unlikely that a person would store up enough vitamin D to make it through the winter without supplementation.

Getting enough sun exposure in the winter months may get slightly easier soon when Daylight Savings Time is extended in much of the country, but Hildebolt says it still will be necessary for people over 50 to take vitamin D supplements during the winter months. He says many calcium pills also contain vitamin D, making those supplements a good way to maintain levels of both key substances.

And he says maintaining adequate calcium and vitamin D has benefits beyond a beautiful smile. Calcium and vitamin D not only lower risk of periodontal disease, but they help keep bones strong and may lower the risk for rheumatoid arthritis, cardiovascular disease and diabetes. Spending some time in the sun seems to be an important part of lowering those risks.

Amoxicillin use in infancy may be linked to tooth enamel defects

Thu, 06 Oct 2005 21:10:00 PST

( from http://www.rxpgnews.com ) Use of the antibiotic amoxicillin during infancy appears to be linked to tooth enamel defects in permanent teeth, according to a study in the October issue of the Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals.

Dental fluorosis, a result of exposure to excessive fluoride during enamel formation, is one of the most common developmental enamel defects, according to background information in the article. The clinical signs range from barely noticeable white flecks, to pits and brown stains. Amoxicillin is one of the most common antibiotics used among pediatric patients, mainly for treatment of otitis media-infection and inflammation of the middle ear. There has been some evidence that amoxicillin use could be associated with dental enamel defects, and, the authors suggest, even a small effect on dental enamel could have a significant effect on the public's dental health because of the widespread use of amoxicillin.

Liang Hong, D.D.S., M.S., Ph.D., of the University of Iowa, Iowa City, and colleagues assessed the association between dental fluorosis and amoxicillin use during early childhood. (Dr. Hong is now with the Department of Dental Public Health and Behavioral Science, University of Missouri - Kansas City.) The researchers analyzed data from the Iowa Fluoride Study, a prospective study investigating fluoride exposures, biological and behavioral factors, and children's dental health. They followed 579 participants from birth to 32 months, using questionnaires every three to four months to gather information on fluoride intake and amoxicillin use.

"The results show that amoxicillin use during early infancy seems to be linked to dental fluorosis on both permanent first molars and maxillary central incisors," the authors report. "Duration of amoxicillin use was related to the number of early-erupting permanent teeth with fluorosis."

By the age of one year, three-quarters of the subjects had used amoxicillin. By 32 months, 91 percent of participants had used amoxicillin. "Overall, 24 percent had fluorosis on both maxillary central incisors," the authors write.

Amoxicillin use from three to six months doubled the risk of dental fluorosis. "The significantly elevated risk for dental fluorosis associated with amoxicillin use during early infancy was found at all levels of statistical analyses, even after controlling for other potential risk factors, such as fluoride intake, otitis media infections, and breastfeeding," the authors report.

The authors emphasize that additional laboratory and clinical studies-including controlled animal studies with specified amoxicillin dosages, chemical analysis and histological examination of affected teeth, and additional well-designed epidemiological studies-are needed to confirm the results.

"The findings suggest that amoxicillin use in infancy could carry some heretofore undocumented risk to the developing teeth," they conclude. "While the results of this one study do not warrant recommendations to cease use of amoxicillin early in life, they do further highlight the need to use antibiotics judiciously, particularly during infancy."

In an editorial accompanying the article, Paul S. Casamassimo, D.D.S., M.S., of the Ohio State University College of Dentistry and Columbus Children's Hospital, writes that pediatricians have already reduced their use of amoxicillin to treat ear infections. "Looking back through decades on the repeated dental cautions about tetracycline, it took years and alternative drug choices to reshape clinical practice to reduce what was a far more obvious, generalized, and more difficult-to-treat cosmetic problem. If the choice is hearing loss and its sequelae or the possible risk of minor cosmetic disappointment, there is little doubt of what will happen. Frankly, at this point, the association between amoxicillin use and fluorosis needs further study, as Hong et al have suggested. Until that time, the best course of action may be what both the medical and dental communities have advocated for a long time-careful, thoughtful, and appropriate use of both fluoride and antibiotics."

Research Finds it Wise to Remove Wisdom Teeth

Fri, 23 Sep 2005 17:46:00 PST

( from http://www.rxpgnews.com ) Keeping wisdom teeth intact has long been the traditional approach of dentists, but research is now showing even unproblematic wisdom teeth may need to come out to avoid snags later in life.

Richard Haug, DDS, UK College of Dentistry Executive Associate Dean and professor of oral and maxillofacial surgery, is a lead researcher in the landmark Third Molar Clinical Trials, led by the American Association of Oral and Maxillofacial Surgeons and the Oral and Maxillofacial Surgery Foundation. Yesterday the AAOMS released its research findings to date and gave evidence supporting the removal of wisdom teeth in young adults.

The researchers agree that keeping wisdom teeth intact, even if they are not showing serious problems, isnt the best idea. Dentists have long thought that periodontal disease, a common chronic oral infection caused by bacteria that starts around the wisdom teeth, doesnt show up until most people are in their mid-30s. However, this research clearly shows young adults are at risk for the disease much earlier than previously thought. It was once thought that three to five percent of young people had the beginnings of periodontal disease, but this research shows upward of thirty percent of young people may have the disease.

Most people have their wisdom teeth removed so they dont crowd other teeth and move them out of place. But wisdom teeth can also cause cysts, tumors, infection and chronic inflammation problems that are more common than previously thought. Those with deep pockets around their wisdom teeth have the most troubles. Once bacteria gather in the pockets it is very hard to get it out. Its hard even for a dentist to reach and effectively clean bacteria from the back of the mouth.

But the problems reach further than just the mouth these bacteria can enter the bloodstream and cause a variety of systemic consequences, such as coronary artery disease, stroke, renal vascular disease, diabetes and obstetric complications.

Levels of C-reactive protein, used to measure acute inflammation and infection in the body, and isoprostanes, indicators of oxidative stress levels, also were found to be increased in patients with deep pockets around their wisdom teeth.

Another important finding shows pregnant women with these types of deep pockets and bacteria are at increased risk for pre-term babies, low birth weight babies and preeclampsia (high blood pressure). So whats a young person with wisdom teeth to do? Right now the researchers recommend good personal oral care, along with yearly dentist evaluations of the area surrounding the wisdom teeth to check for pockets. Talk with your dentist if you have pockets to discuss their size and risk factors.

Implant-placed overdentures lock the denture in place

Thu, 22 Sep 2005 04:57:00 PST

( from http://www.rxpgnews.com ) The enticing aroma of a thick, juicy steak was a temptation Marvin Goodwin oftentimes avoided because his dentures made the meat difficult to chew. Now that he's had implants placed to support his denture, he is no longer cautious of the foods he eats.

In a new study that printed in the Journal of Periodontology, researchers found that the cumulative survival rate of implant-placed overdentures was 95.4 percent for 10 years. The success rate for the maxilla (upper jaw) implant supporting overdentures was 87.3 percent and the mandible (lower jaw) was 99.5 percent.

"My implant-placed overdentures have made my life more pleasurable, I felt practically no pain in having them placed, and am very glad that I did it," said Marvin Goodwin of Buena Park, Calif. "Now I can eat caramel at a party and not have to worry about my dentures sticking together and prying them apart."

An implant-supported overdenture requires that implants are placed into the jaw. The implants bond to the jawbone forming an anchor. Full bridges or dentures are created to attach to the implants, literally locking the teeth replacement into place. "Even though my partials fit, they were often uncomfortable and had a tendency to move when I talked or ate," explained Goodwin. "I can now enjoy eating food especially steak because my teeth do not move."

"One of the advantages of implant-supported full bridges and dentures is that it replaces some of the tooth roots, which will better preserve the jawbone," explains Vincent J. Iacono, DMD and president of the American Academy of Periodontology. "Dental implants integrate with the jawbone helping to keep the bone healthy and intact."

The overall rate of edentulism for adults 18 and older is nearly 10 percent. This rate increases with age so that about 33 percent of those 65 and older are without teeth according to the Surgeon General's Report on Oral Health.

The good news is periodontists have the special knowledge, training and facilities to give people teeth that look and feel just like their own. This procedure is a team effort between the patient, dentist and periodontist. Depending on the specific condition, the periodontist will create a treatment plan tailored to meet the patients' needs.

Nanospheres could help dentists fill tiny holes in teeth

Tue, 06 Sep 2005 00:17:00 PST

( from http://www.rxpgnews.com ) Nanospheres could help dentists fill the tiny holes in our teeth that make them incredibly sensitive, and that cause severe pain for millions of adults and children worldwide.

Sensitive teeth or dental hypersensitivity is a condition that arises when the dentine of the tooth is exposed. The dentine is made up of thousands of tiny fluid-filled channels which radiate outwards from the nerve endings at the centre of the tooth. Heat, some chemicals, and physical contact can cause the fluid in these channels to move in or out triggering the nerve endings and causing sharp pain.

If these channels (or tubules) are fully or partially blocked, the flow can be reduced and the pain stopped or significantly reduced. Currently, the only way to treat this condition is through good dental hygiene using special toothpastes and fluorine mouthwashes which encourage re-mineralization of the dentine coating.

Jonathan Earl, David Wood and Steve Milne from the institute of materials research at the University of Leeds have found that the most successful particle shape for filling these channels is a nanosphere and are now trying to synthesize nanospheres of hydroxyapatite. Hydroxyapatite is a ceramic material which is highly compatible with teeth and bone and so is widely used by medics for bone grafts or dental coatings (because it binds strongly with the bone material).

Earl and his colleagues grew hydroxyapatite at various pH levels to vary the size of the particles it is made up of. At normal pH, it is composed of long rod-like structures but at high pH levels the particles of hydroxyapatite become smaller and more rounded, better for fitting inside the tiny channels in teeth.

To see whether nanospheres would be successful at filling the channels they used commercially available silica nanospheres of around 40nm in diameter.

Earl said: "We found these tiny spheres are really good at filling the channels in teeth, packing inside them quite evenly and going down the holes to a good depth. They'd be the perfect shape of particle for filling these channels and reducing or preventing the pain caused by sensitive teeth".

The next stage of their research will be to work out how to synthesize nanospheres of hydroyapatite or a combination of hydroxyapatite and fluorine which would fill the holes and encourage re-mineralization at the same time and so be an incredibly powerful repair tool for dentists.

Dental problems can be bone marrow transplant risk

Tue, 30 Aug 2005 19:12:00 PST

( from http://www.rxpgnews.com ) Many children who undergo bone marrow transplantation (BMT) as part of cancer treatment already have dental abnormalities that leave them vulnerable to potentially life-threatening bacterial infections, according to investigators at St. Jude Children's Research Hospital. A report on this study appears in the prepublication online edition of Bone Marrow Transplantation.

The investigators found that the most common dental problem in children about to undergo BMT was tooth decay, often resulting from neglected oral hygiene and poor nutrition. Tooth decay is especially dangerous in children undergoing BMTs because physicians must first suppress their immune systems to reduce the chance of transplant rejection. Therefore, children about to undergo immunosuppression as part of BMTs should have dental checkups, said Sue C. Kaste, D.O., a member of St. Jude Radiological Sciences. "It's important to make sure they do not have cavities that could act as doorways to the bloodstream for disease-causing bacteria," she said.

The St. Jude investigators made their findings during a retrospective study of the medical records and X-rays of the entire set of teeth in 259 children (age range 3.2 to 25.9 years) who underwent BMT. The most common diagnosis among these children was leukemia (63 percent); while the other children were found to have solid tumors (14 percent), anemia (8 percent), or brain tumors (3 percent). In addition, one child had retinoblastoma (eye cancer) and one had severe combined immunodeficiency. One hundred fifty of these patients were male, 203 were Caucasians and 38 were African-American.

The St. Jude team found that, before BMT, 150 (57.9 percent) of the 259 patients had dental abnormalities. Among patients who still had their "first" teeth before BMT, 36.4 percent had dental abnormalities; among patients with permanent teeth, 66.7 percent had dental abnormalities; and among patients with both first and permanent teeth, 52.3 percent had abnormalities. There was no difference in frequency of abnormalities in permanent teeth between males (65.5 percent) and females (67.5 percent), nor was there a difference between Caucasians (69 percent) and African-Americans (70 percent).

The most common dental abnormality identified in the study was caries (tooth decay), which was seen in 133 (51 percent) patients. Among other dental problems were abnormal clumps of enamel on the tooth and calcification (hardening) of the tooth pulp (the soft inner matter in teeth containing nerves and blood vessels).

A variety of factors can cause tooth decay in pediatric patients who later undergo BMTs. For example, previous studies by other researchers have found that children receiving chemotherapy and radiation are at increased risk of tooth damage that causes decay. Radiation can also reduce the amount of saliva released by the mouth's salivary glands, which in turn can lead to growth of decay-causing bacteria.

Some children undergoing cancer treatment also develop ulcers in the lining of their mouths, which discourage them from eating certain foods. Instead, these children prefer sweet foods, which don't sting, but do promote tooth decay. In addition, some children undergoing cancer treatments must consume high levels of carbohydrates to ensure they get enough calories, which also encourages the growth of decay-causing bacteria.

Since small cuts in the tissue around teeth caused by brushing could become serious sources of blood loss, children are sometimes forbidden to brush their teeth if they suffer from severely reduced levels of platelets--blood cells that trigger clot formation. Finally, young children often cannot brush their own teeth properly, and their parents might fail to brush their children's teeth.

"Our findings clearly show that children about to undergo bone marrow transplantation should be examined for dental problems that might promote infections," said Christopher C. Rowland, D.D.S., the dentist in the Department of Surgery at St. Jude and a co-author of the paper. "This is also an opportune time to educate patients and parents about proper oral hygiene. Meticulous dental care can minimize the development of therapy-related caries. Follow-up examinations after transplantation and immunosuppression will also help to minimize sources of potential infection."

Dental consequences of anticancer therapy preceding stem cell transplantation

Mon, 29 Aug 2005 21:39:00 PST

( from http://www.rxpgnews.com ) Research published by the University of Helsinki, Finland, indicates that cytostatic and radiation therapies administered before stem cell transplantation often damage children's permanent teeth.

Detrimental effects of cytostatic and radiation therapies on dental development have been known for a long time, but knowledge about the dental consequences of high-dose anticancer therapy preceding stem cell transplantation has so far been scarce. Päivi Hölttä, Licentiate in Dentistry, from the Institute of Dentistry, University of Helsinki, has studied the effects of high-dose anticancer chemotherapy and total body irradiation on the development of permanent teeth.

Tooth development is a genetically controlled chain of events that can be disturbed by various environmental factors. The development of permanent teeth begins as early as the 20th week of gestation and continues until the age of 14 to 15 years with the exception of wisdom teeth, which still continue their development for several years. All this time teeth are vulnerable to developmental aberrations.

The children examined in the current study, treated for cancer or aplastic anemia, had received stem cell transplantation at the age from 1 to 9.4 years, preceded with a high-dose anticancer chemotherapy and, in most cases, with total body irradiation. In her research, Hölttä studied how many of the treated children lacked permanent teeth or had unusually small teeth, and how often dental roots were poorly developed.

The results indicated that 31% of the treated children lacked permanent teeth (as opposed to 8% of the Finnish population), when wisdom teeth were excluded. Lack of permanent teeth was most frequent (77%) among children who had been less than three years old at stem cell transplantation. The highest number of missing teeth was 12. Those who had been over five years of age at stem cell transplantation lacked only wisdom teeth. A significant finding was that a high-dose anticancer chemotherapy alone caused a lack of permanent teeth nearly as often as when combined with total body irradiation, which, however, slightly increased the number of missing teeth.

The children also had a high frequency of microdontia, teeth smaller than normal (44% as opposed to 2% of the Finnish population). Microdontia was common among children under five years of age at stem cell transplantation and rare among others. Surprisingly, high-dose anticancer chemotherapy caused microdontia in all those who had been treated when under three years old. Total body irradiation did not increase the number of microdontia patients or microdontic teeth.

Developmental aberrations in dental roots were found in all the children in the study. Some of them had minor changes visible in a few teeth only, while others had severe damage in all their teeth. Total body irradiation increased the number of damaged roots. The children who had only received high-dose anticancer chemotherapy had root damage in over half of their teeth, but the damage was not as severe as with those who had also received total body irradiation.

The lack of several permanent teeth and their small size affect the development of occlusion and the growth of the jaws. Short and sometimes almost non-existent roots may not endure masticatory forces, and periodontal infections may result in an early loss of short-rooted teeth. "We still don't know about the long-term consequences of the treatments, which is why the monitoring of the patients should be continuous and centralised. Cooperation between specialists in children's haematology and oncology and specialists in various fields of dentistry is of fundamental importance in providing for these children the best possible dental care in the future," Päivi Hölttä says.

C-section delivery linked with higher risk of cavities in newborns

Thu, 25 Aug 2005 04:39:00 PST

( from http://www.rxpgnews.com ) A new study by NYU dental researchers suggests that women with dental caries (cavities) who deliver Caesarean-section babies should pay special attention to their newborns' oral health.

The NYU researchers focused on a caries-causing bacterium that mothers with caries transmit to their newborns. Known as Streptococcus mutans, the bacterium grows on tooth surfaces and in crannies between teeth just above the gum line, where it multiplies and converts foods, especially those containing sugar and starch, into acids that break into the tooth surface.

C-section deliveries were infected by the bacterium almost a year earlier than vaginally-delivered infants in the four-year study of 156 mother-infant pairs published in the September issue of the Journal of Dental Research. The first signs of the bacterium appeared at an average of 17.1 months of age in C-section babies, compared to 28.8 months in vaginally-delivered infants, a significant finding since previous studies have linked earlier bacterial infection with a higher rate of dental caries in children.

NYU's study is the first to distinguish between bacterial infection in C-section and vaginally-delivered babies. The findings suggest that mothers who have dental caries should inform their family dentists if they had a C-section delivery because of the potentially higher risk that the child will also develop caries, said the study's principal investigator, Dr. Yihong Li, an Associate Professor of Basic Science and Craniofacial Biology at NYU College of Dentistry.

"Vaginally-delivered infants offer oral bacteria a less hospitable environment," Dr. Li explained. "They develop more resistance to these bacteria in their first year of life, in part because of exposure to a greater variety and intensity of bacteria from their mothers and the surrounding environment at birth. C-section babies have less bacterial exposure at birth, and therefore less resistance."

Mothers in Dr. Li's study who delivered C-section babies had high levels of Streptococcus mutans infection, and caries on an average of one-third of their teeth. A majority had an annual family income of $10,000 or less -- a potential barrier to accessing dental care and a history of sexually transmitted disease. These cofactors contributed to an earlier onset of bacterial infection, Dr. Li said.

The study followed a predominantly African-American group of women from an inner-city area of Birmingham, Alabama, beginning in their third trimester of pregnancy. There were 127 vaginal and 29 C-section births.

Further study is needed to determine if C-section births can be linked to earlier acquisition of this and other oral bacteria in a broader cross-section of the population, and if a higher incidence of caries follows. The results of Dr. Li's study add to a growing body of knowledge about a possible link between a mother's level of tooth decay and her newborn's health that was identified by NYU dental researchers in an earlier study of predominantly low-income African-American women in Birmingham, which found that pregnant women with high levels of oral bacteria associated with dental caries are at risk for delivering preterm low birth weight babies. Published last February in the Journal of Periodontology, that study was led by Dr. Ananda P. Dasanayake, an Associate Professor of Epidemiology & Health Promotion. Dr. Dasanayake is among a group of researchers in the U.S. and abroad who also have reported that periodontal diseases in pregnant women may be a risk factor for delivering preterm low birth weight babies.

Periodontitis and Three Health-Enhancing Behaviors

Tue, 23 Aug 2005 21:11:00 PST

( from http://www.rxpgnews.com ) Heart healthy habits are good for oral health, too, according to a new study published in the current issue of the Journal of Periodontology, the official publication of the American Academy of Periodontology.

Researchers from Case Western Reserve University examined data from 12,110 individuals who participated in the third National Health and Nutrition Examination Survey (NHANES III) and found that individuals who exercised, had healthy eating habits and maintained a normal weight were 40 percent less likely to develop periodontitis, a gum infection that can result in loss of teeth.

The findings were reported in the article, "Periodontitis and Three Health-Enhancing Behaviors: Maintaining Normal Weight, Engaging in Recommended Level of Exercise and Consuming a High-Quality Diet." Beside healthy brushing and flossing habits, prior to this study other healthy behaviors that contribute to the prevention of the disease were unknown, according to the researchers.

The prevalence of periodontitis was reduced by 29 percent for those individual who only met two of the healthy behaviors and 16 percent in those that met at least one, according to Mohammad S. Al-Zahrani from the division of periodontitics at King Abdulaziz University in Jeddah, Saudi Arabia (and alumnus of Case Western Reserve University's School of Dental Medicine and Case School of Medicine).

He conducted the study for his doctoral dissertation work in epidemiology at Case in collaboration with Elaine A. Borawski from Case's department of epidemiology and statistics at the Case medical school and Nabil F. Bissada, chair of the department of periodontics at the Case School of Dental Medicine.

Advances in dental medicine have permitted more people to keep their teeth as they grow older. Understanding the underlying ways to prevent gum diseases have become increasingly important, according to the researchers. More than 30 percent of the population suffers from periodontitis, an infection of the gums that can lead to heart disease, diabetes and pre-term labor.

Curious whether the same factors that can prevent heart disease and lower the risks for diabetes might also impact oral health, the researchers examined the cumulative relationship between weight, exercise and a high-quality diet and dental disease in the United States population.

NHANES III is a cross-section survey conducted by the National Center for Health Statistics. It includes comprehensive systemic and dental components.

Information about weight, eating and exercise were collected during the survey. Participants were monitored for 24 hours on their food intake and also questioned about nine leisure-time physical activities (walking a mile or more at a time without stopping, jogging or running, bike riding, aerobic dancing or exercise, dancing, swimming, calisthenics, garden or yard work, and weight lifting). If individuals reported five or more moderate physical activities or three intensive activity sessions a week, it was considered healthy. Weight was considered within normal range if it fell within the body mass index (BMI) of 18.5 to 24.9 kg/m² (obesity was considered at 25 kg/m²).

The researchers concluded that the healthy behaviors such as exercise and diet that lower the risks of diabetes also can lower the risk factors for periodontitis. Exercise--also known to reduce the C-reactive protein in the blood associated with inflammation in the heart and periodontal disease. Healthy eating habits, which builds the body's defenses against disease, also reduce the production of plaque biofilm, which is the primary epidemiological factor associated with periodontal disease.

Conquering periodontal disease, according to the researchers, may mean more than just targeting the disease but addressing multiple risk behaviors, too.

"Since oral health professionals may see their patients two or four times a year, it gives them several opportunities to promote these healthy behaviors," report the researchers.

Reducing postmenopausal tooth loss by controlling periodontal disease

Fri, 22 Jul 2005 00:49:00 PST

( from http://www.rxpgnews.com ) Postmenopausal women may significantly reduce tooth loss by controlling their periodontal disease, according to a study in the Journal of Periodontology.

Researchers from the University at Buffalo, School of Dental Medicine did a follow-up evaluation on 106 postmenopausal women and found that during an average of 11.7 years follow-up, 57.5 percent of the participants lost at least one tooth.

"We found that alveolar bone loss (the bone that holds the tooth in the mouth) is the strongest independent predictor of tooth loss in the postmenopausal population," explained Mine Tezal, DDS and study author. "Each millimeter of alveolar bone loss increased the risk of tooth loss 3 times, and the risk of tooth loss increased 2.5 times for each millimeter of clinical attachment loss, or soft tissue attachment between the tooth and alveolar bone." (This is also known as loss of gums and bone.)

The health of teeth depends upon the integrity of the alveolar bone holding them in the mouth. Periodontal disease is the major cause of alveolar bone loss and tooth loss in patients over 35.

"The long follow-up period is an advantage of this study since researchers were able to evaluate the same people more than 10 years later," said Vincent J. Iacono, DMD and president of the American Academy of Periodontology. "Since alveolar bone loss has been shown to be a significant factor for tooth loss in postmenopausal women, studies will be needed to determine possible aggravating effects of post menopause on the severity of periodontal disease. Until we know more, postmenopausal women will want to control periodontal disease to significantly reduce their risk of alveolar bone loss and tooth loss."

Estrogen deficiency after menopause and consequent loss of bone mineral density have been shown to be associated with increased rate of tooth loss. These relationships may be explained by increased severity of periodontal disease in estrogen deficiency.

The participants of this study had participated in a past study in 1989 and 1991. The average follow-up time was 11.7 years. The age ranged from 45 to 73 and all subjects had reached menopause with the average age at 48.8 years.

Quitting smoking could save your teeth, study shows

Wed, 20 Jul 2005 00:26:00 PST

( from http://www.rxpgnews.com ) Smokers who give up are much less likely to lose their teeth prematurely than those who dont kick the habit, pioneering research has shown.

Dental researchers at the University of Newcastle upon Tyne, UK, observed a group of cigarette smokers with chronic gum disease over one year and found some symptoms were more likely to improve in the people who quit during the study period.

Chronic gum disease, which is characterised by inflamed gums that increasingly recede from the teeth, can lead to tooth loss in its advanced stages if preventive action is not taken.

The researchers findings, revealed today in the academic publication, the Journal of Clinical Periodontology, therefore provide yet another reason for the 12 million UK adult smokers (just over one-quarter of the adult population) and smokers worldwide to quit their habit for the good of their health.

Statistics show that smokers are still up to six times more likely to develop gum disease than non-smokers, because the detrimental effect the habit has on their bodys immune system makes them less well-equipped to fight back.

The study, which is the first of its kind, followed 49 smokers with chronic gum disease over one year. All were encouraged to stop smoking through counselling and, in some cases, using nicotine replacement therapy and/or medication. All of the patients also received treatment for their gum disease.

One-fifth of the patients quit smoking, and in those patients, gum health was significantly improved compared to those who continued to smoke over the 12 months

Gum disease is initiated by a build up of bacteria in plaque, the sticky white substance that accumulates on the teeth if they are not properly cleaned. The bacteria cause the gums to become inflamed, and they begin to recede from the teeth. At the same time, the bone that holds the teeth in place is gradually destroyed so that over a number of years, teeth may start to become loose and may fall out, or need to be extracted.

The disease is usually painless and thus only discovered when people visit their dentist. The progression of chronic gum disease can often be prevented by a good, daily oral health routine, together with preventive care by a dentist and dental hygienist.

Dr Philip Preshaw (pictured above, left), a clinical lecturer in periodontology (the specialists term for gum disease) with Newcastle Universitys School of Dental Sciences, led the research. He said: Our study shows that people should stop smoking now if they want to increase their chances of keeping their teeth into old age.

Often the dentist is in the best position to help them stop smoking, because most people, if they are going for regular dental appointments, have more contact with him or her than with their doctor.

Dentists have known for some time that smokers have worse oral and gum health than non-smokers but for the first time we have shown that quitting smoking together with routine gum treatment results in healthier gums.

Dr Preshaw added: It is very important to look after your teeth, because losing them will have a huge influence on your life. Not only will this affect your appearance, it can also impact on your confidence, lifestyle, and so much more.

For example, losing teeth could prevent you from eating a healthy diet. You are less likely to chose to eat something like an apple if your teeth are loose, because it would be difficult to bite and chew it.

The UK Governments Department of Health has promoted the idea of smoking cessation counselling by dentists, and dental students at Newcastle University are now taught how to counsel patients on this issue as part of their degree. Newcastle Dental Hospital has a full-time smoking cessation counsellor to whom patients can be referred.

Professor Raman Bedi, the Governments Chief Dental Officer, welcomed this research, stating: Cigarette smoking is a major risk factor for periodontitis, which affects the support structures of the tooth and is an important cause of tooth loss.

All members of the dental team, just like any health professional, can play an important role in helping people stop smoking.

Newcastle Universitys Dental School is a shining example by ensuring dental students are now taught how to counsel patients on this issue as part of their dental degree.

Amanda Sandford, Research Manager for ASH, commented: "As gum disease is often painless, smokers may be completely unaware of the impact their smoking can have on oral health.

But the increased risk of tooth loss may be enough to persuade many to quit smoking. Dentists must do all they can to inform patients of the risks and to assist patients who smoke to stop before the disease takes hold."

Orthodontics takes first step toward biological control of tooth movement

Wed, 06 Jul 2005 13:20:00 PST

( from http://www.rxpgnews.com ) In the first study of its kind, University of Florida researchers are testing the power of a natural human hormone to biochemically move teeth faster and less painfully during orthodontic treatment.

"Most of orthodontics has traditionally dealt with physics, the biomechanics of applying a force against a tooth to move it," said study investigator Timothy Wheeler, D.M.D., Ph.D., a professor and chairman of orthodontics at UF's College of Dentistry. "Ours is the first study to use a naturally occurring hormone, recombinant human relaxin, to biochemically augment tooth movement and retention."

Relaxin is best known as the hormone that helps women's pelvic ligaments stretch in preparation for giving birth. It does this by softening collagen and elastin in the tissues, loosening strong, cord-like fibers until they have the consistency of limp spaghetti noodles.

That ability prompted researchers to consider relaxin a possible way to accelerate tooth movement and prevent relapse, a condition where the tooth migrates back to its original position after braces are removed.

"You can imagine normal collagen and elastin fibers to be like rubber bands that attach to the tooth to hold it in place," said Wheeler. "Those tissue fibers resist the force of the orthodontic treatment applied to move the tooth, and, when that force is removed, say when the braces are taken off, the elasticity of the tissues springs the tooth back into position."

UF researchers will evaluate whether injecting relaxin into the gums will loosen the collagen and elastin fibers and reorganize them so teeth can move more freely into orthodontic alignment. Once the teeth have been moved, researchers will administer another injection of relaxin under the premise that it will further soften gum tissue fibers, preventing them from pulling teeth back into their original position.

The study will be the first of many to test the hormone as an orthodontic therapy, and it is hoped the drug could cut treatment time in half and eliminate the need for retainers after braces have been removed.

This may not help the more than 5 million Americans and Canadians the American Association of Orthodontists estimates currently wear braces, but if it's shown to work it could bring a sigh of relief from those anticipating future tooth-torqueing orthodontic treatment and the aching teeth and throbbing gums that often go along with it.

The patent for the drug, which received the green light from the Food and Drug Administration last April for testing in human subjects, is owned by BAS Medical, a California-based company. BAS Medical is the sponsor of the UF study, which will establish safety and proof of principle on 40 people before a series of multicenter studies could begin testing the drug on hundreds worldwide.

Researchers won't know which of the 40 subjects receive relaxin and which receive a placebo. One tooth in each subject will be targeted for movement, and, subjects will wear Invisalign braces for eight weeks to move the targeted tooth. At week eight, the aligners will be removed and the teeth evaluated for relapse every four weeks for six months. As a safety measure, the week four outcomes of the first 12 patients entered into the study will be evaluated before the remaining 28 begin treatment. All 40 subjects will have completed the protocol by early October.

Wheeler said researchers hope to determine whether the treatment could eliminate the need for patients to wear retainers to hold teeth in place after braces are removed. The issue of retention - a term used to indicate the tooth remains in the position to which it has been moved without relapse - is a crucial aspect of the study.

"Right now, retention is the biggest problem we have in orthodontics," Wheeler said. "I want to get completely away from retainers, which for most patients right now are a lifetime commitment."

When patients don't wear retainers as prescribed, teeth gradually relapse, nullifying years of orthodontic treatment and expense. It is this lack of patient compliance that frustrates orthodontists worldwide.

"If the results of this study demonstrate enhancement of the rate of orthodontic tooth movement and better stability after treatment, it could be an exciting new method of increasing treatment acceptability while decreasing the need for compliance," said Robert Boyd, D.D.S., a professor and chairman of orthodontics at the University of the Pacific School of Dentistry. "Finishing orthodontic treatment without the usual regimen of lifetime use of retainers would greatly enhance the effectiveness and efficiency of current orthodontic treatment."

An important goal of future studies is to determine dosage and timing of drug delivery as well as delivery methods other than injection.

"This is the first step orthodontics has taken to deal with the biologic control of tooth movement, and what the final product will be is hard to tell at this point. Obviously, we want to make it easily available, easily delivered and as pain-free as possible," Wheeler said. "This initial proof of principle trial will help us define how to accomplish that."

Raisins Fight Bacteria in Mouth that Cause Cavities

Wed, 08 Jun 2005 19:51:00 PST

( from http://www.rxpgnews.com ) Compounds found in raisins fight bacteria in the mouth that cause cavities and gum disease, according to researchers at the University of Illinois at Chicago.

"Our laboratory analyses showed that phytochemicals in this popular snack food suppressed the growth of oral bacteria associated with caries and gum disease," said Christine Wu, professor and associate dean for research at the UIC College of Dentistry and lead author of the study. Phytochemicals are compounds found in higher plants.

Wu and her co-workers performed routine chemical analyses to identify five phytochemicals in Thompson seedless raisins: oleanolic acid, oleanolic aldehyde, betulin, betulinic acid and 5-(hydroxymethyl)-2-furfural.

Oleanolic acid, oleanolic aldehyde, and 5-(hydroxymethyl)-2-furfural inhibited the growth of two species of oral bacteria: Streptococcus mutans, which causes cavities, and Porphyromonas gingivalis, which causes periodontal disease. The compounds were effective against the bacteria at concentrations ranging from about 200 to 1,000 micrograms per milliliter.

Betulin and betulinic acid were less effective, requiring much higher concentrations for similar antimicrobial activity.

At a concentration of 31 micrograms per milliliter, oleanolic acid also blocked S. mutans adherence to surfaces. Adherence is crucial for the bacteria to form dental plaque, the sticky biofilm that accumulates on teeth. After a sugary meal, these bacteria release acids that erode the tooth enamel.

Wu said that the findings counter a longstanding public perception that raisins promote cavities.

"Raisins are perceived as sweet and sticky, and any food that contains sugar and is sticky is assumed to cause cavities," Wu said. "But our study suggests the contrary. Phytochemicals in raisins may benefit oral health by fighting bacteria that cause cavities and gum disease."

"Moreover, raisins contain mainly fructose and glucose, not sucrose, the main culprit in oral disease."

In an earlier unpublished study, Wu's collaborator Shahrbanoo Fadavi, a pediatric dentist at UIC, found that adding raisins alone to bran cereal did not increase the acidity of dental plaque. Raisin bran cereal with added sugar, however, did raise acidity levels.

"Foods that are sticky do not necessarily cause tooth decay. It is mainly the added sugar, the sucrose, that contributes to the problem," Wu said.

Don't let your Mouth Pollute your Clean Heart

Fri, 20 May 2005 13:03:00 PST

( from http://www.rxpgnews.com ) Researchers have found evidence that the amount of bacteria in subgingival plaques, the deep plaques in periodontal pockets and around the teeth, may contribute to an individual's risk of a heart attack, according to two studies appearing the Journal of Periodontology. These studies further researchers understanding that periodontal bacteria may increase the risk for heart disease.

In one study researchers looked at 150 individuals with periodontal diseases and found that the total number of periodontal bacteria in subgingival plaques was higher in individuals that have suffered from an acute myocardial infarction (heart attack). The second study found that the same DNA from different kinds of periodontal bacteria in plaque was also in the patients' heart arteries. Researchers believe that these findings may help substantiate what they have long known; if there is a sterile pathway, such as a bloodstream, near a periodontally infected area that the bacteria from this infected area cause inflammation in the gums that opens up pores in the surrounding blood vessels, which enables the bacteria to enter the bloodstream and travel to other parts of the body and cause great harm.

"It is like setting up a garbage dump on the edge of a river. You wouldn't be surprised if the lake downstream ended up polluted with the garbage from the dump," said Vincent J. Iacono, DMD and president of the American Academy of Periodontology. "A patient's bloodstream acts very much like the river in this analogy, in that it carries the bacteria from the periodontal plaques, possibly 'polluting' the arteries of the heart with periodontal bacteria, causing inflammation of the arteries which may lead to a heart attack. This potential effect of periodontal bacteria further supports the need for periodic deep cleanings to enhance overall health and wellbeing."

These studies represent two in a large body of research that investigates the possible link between periodontal diseases and other systemic conditions such as heart disease. "Intervention data is not available to prove a causal relationship between the two. Right now we are currently advising patients that maintaining good periodontal health can only help not hurt," said Iacono.

Another study published in the Journal of the American Geriatrics Society said that elderly persons with active root caries, a type of tooth decay, have an increased risk of having irregular heart beats.

A total of 125 generally healthy individuals over the age of 80, living in urban, community-based populations were examined. Researchers discovered that persons with three or more active root caries had more than twice the odds of cardiac arrhythmias of those without. Researchers indicate that root caries may be a marker of general physical decline in the elderly and specifically underscore the mouth as an integral part of the body.

"The findings make a strong case for the active assessment of and attention to oral problems for the older community-dwelling population," states Poul Holm-Pedersen, lead author of the study. Because arrhythmias can signify other possibly undiagnosed diseases in older people, researchers stress the importance of taking dental diseases seriously.

The advanced age of those who participated in the study may have been a factor in determining an association between overall periodontal disease and arrhythmia since those who might have been strong examples of this association may not have survived to age 80.

Two-thirds of patients brush off their dentist's advice

Fri, 13 May 2005 19:55:00 PST

( from http://www.rxpgnews.com ) The best efforts of dentists don't always mean people will look after their teeth, British researchers have found.

A study by a team at the University of Newcastle upon Tyne discovered that only up to one-third of gum disease patients, who received advice on how long to brush their teeth, followed it to the letter.

Yet the same people perceived their brushing habits to be better than they were a finding which has major implications for dentists wishing to change their patients' behaviour.

Gum disease can eventually lead to multiple tooth loss, but in many cases damage can be stabilised or reversed if treatment is combined with a good home toothcare regime. For the study, patients were given advice on a regime which in particular said they should brush their teeth twice a day for two minutes each time.

Each of the 17 study participants used an electronic 'data logger' powered toothbrush that recorded brushing time. The brush had a light on the handle that flashed when two minutes had elapsed. They were also asked to fill in diaries detailing their brushing habits. The experiment recorded brushing times for two periods of four weeks.

When researchers analysed the data, the data logger toothbrushes showed approximately one-third of people followed the advice whereas the diaries suggested that more than half of patients thought they had been compliant.

The results of the study are published in the British Dental Journal.

Lead researcher, Dr Giles McCracken, a lecturer with Newcastle University's School of Dental Sciences, said: "Research has shown that brushing for two minutes is the optimum time for most people to remove the plaque from your teeth. If you brush for less time, you aren't removing enough, and if you brush for longer the benefits may not be much greater.

"The fact that many participants in our experiment said they had followed the dentist's advice when our records proved they had not, has implications for the profession, especially in our increasingly litigious society."

"Patients must understand their health is mainly their responsibility, and if they are not going to comply with the advice of health providers like dentists who have their best interests at heart, they must accept the consequences."

The Newcastle researchers are carrying out further research into how advice is given in the dental chair, and whether this can be specially adapted for each individual receiving treatment.

Co-researcher, Prof Peter Heasman, said: "I think that many dentists and dental hygienists are fully aware that their patients do not always follow their professional advice. Nevertheless, we were surprised to find so many of our patients who were unable to follow instructions accurately, even in the short term."

Oral bacteria may predict Preterm Delivery and Low Birthweight

Thu, 24 Mar 2005 19:28:00 PST

( from http://www.rxpgnews.com ) Researchers from New York University found that certain bacteria from the mouth may be related to preterm delivery and low birthweight according to a study in the Journal of Periodontology (JOP).

It's been reported in the past that periodontal disease may be a factor in the occurrence of preterm low birthweight babies. Now it is believed that bacteria commonly found in dental plaque biofilms may also be related.

Researchers evaluated bacterial levels in the saliva of 297 women in their third trimester of pregnancy. They found that a higher salivary level of the bacteria called Actinomyces naeslundii Genospecies2 (A. naeslundii gsp2) is associated with low birth weight and preterm delivery, while higher levels of the bacteria Lactobacillus casei (L. casei) during pregnancy positively affected the birthweight."

"Our observation that A.naeslundii gsp2 reduced birthweight and preterm delivery fits well with the theory that oral bacteria and the molecules the body produces against them can enter the uterine environment through the blood stream and may influence the delivery process," explained Dr. Ananda P. Dasanayake, Department of Epidemiology and Health Promotion, New York University College of Dentistry. "Whereas the bacteria L.casei secretes acids that maintain the vaginal pH level below 4.5. This pH level has a protective effect and prevents the overgrowth of more bacteria, including those associated with bacterial vaginosis (a condition associated with preterm labor and deliver)."

"What's interesting is that the research shows that for each ten-fold increase in A. naeslundii gsp 2 levels, there was a 60 gram (0.13 pound) decline in birthweight and a 0.17 week decrease in gestational age. On the other hand, for one unit increase of L. casei levels there was a 42 gram increase (0.9 pounds) in birth weight and a 0.13 week increase in gestational age," said Vincent J. Iacono, DMD and president of the American Academy of Periodontology. "Future studies should evaluate both oral bacteria and bacteria that are not related to periodontal diseases to better understand this potential important link between periodontal status and prematurity."

Aloe vera can treat Canker, HSV, Lichen Planus, Gingivitis and Cold Sores

Tue, 22 Mar 2005 20:27:00 PST

( from http://www.rxpgnews.com ) New reports prove that the aloe vera plant, which has been used to heal skin for more than 2,000 years, can also treat many oral health problems including canker sores, cold sores, herpes simplex viruses, lichen planus and gingivitis according to the January/February issue of General Dentistry, the Academy of General Dentistry's (AGD) clinical, peer-reviewed journal.

"There is good evidence to support using aloe vera for oral health problems," says AGD spokesperson Kenton A. Ross, DMD, FAGD. "I believe a number of patients will be interested in this inexpensive alternative."

Aloe vera accelerates healing and reduces pain associated with canker sores, which are blisters on the lips or mouth. Aloe vera does not have a bad taste or sting when applied.

The journal article, written by Richard L. Wynn, PhD, mentions a study done on a patient with lichen planus, a disease affecting the skin and oral mucus membranes. The patient drank 2.0 ounces of aloe vera juice daily and topical applied aloe vera lip balm. The oral lesions cleared up in four weeks and complete success was achieved.

Dr. Wynn cited the study as showing that oral health problems can be treated with aloe vera. "Aloe vera can be taken both as the aloe vera juice and aloe vera gel. These are the two modes of delivery recognized by the FDA," says Dr. Wynn.

Orthodontists must brace against back pain

Fri, 04 Mar 2005 21:14:00 PST

( from http://www.rxpgnews.com ) A study of graduate orthodontic students at the university and a practising orthodontist--who'd been working for 18 years--showed that long hours of bending low and working in patients' mouths put heavy strain on the lower back and neck--burdens that translated into weights of up to 138 kilograms in males and 93 kg in females. The total duration of daily work would amount to an hour's continuous load on the spine of 450 kg for men and 275 kg for women.

Results of the study appear in the February issue of Clinical Biomechanics. The subjects, aged 27 to 36, (the practicing professional was 48) were videotaped performing their regular duties and the recorded postures were analysed frame by frame for top to bottom compression load, side to side shearing load and exposure time.

"Musculoskeletal disorders of the back and neck among orthodontists, and likely other similar professions are prevalent, but because they don't necessarily do heavy lifting or tasks that put an instant load on the back, these disorders have not been investigated," said Dr. Shrawan Kumar, a professor of physical therapy at the University of Alberta.

"Although the tasks appear to be light and harmless, by virtue of the frequency and duration of their performance, they are rendered hazardous."

In reviewing the records of private clinics, the study showed that orthodontists treat an average 70 patients per day with the help of up to five assistants. The body stress was induced by long periods of sitting (about 70 per cent of their workday), with 90 per cent of the strain coming from the tasks of applying, removing or adjusting braces.

The research also showed that males bore heavier loads than their female counterparts because of their heavier body weights.

Dr. Kumar would like to see future research lead to better layout of work and equipment for orthodontists and all other dental workers

A simple saliva test can predict dental cavities in children

Sat, 19 Feb 2005 17:08:00 PST

( from http://www.rxpgnews.com ) A simple saliva test can predict for the first time whether children will get cavities, how many cavities they will get and even which teeth are most vulnerable, University of Southern California researchers say.

Developed by a USC School of Dentistry team led by professor Paul Denny, the test quantifies the genetic component of tooth decay (caries).

Dentists have long known that even in areas with fluoridation and good oral hygiene education, some people just have bad teeth. The USC test spots the risk early, when something can be done about it.

"When we apply this to young children, it allows us to predict what might be their future caries history - the number of cavities that they'll get by, say, their late twenties or early thirties," Denny said.

The Caries Assessment and Risk Evaluation (CARE) test measures the relative proportions in saliva of different types of sugar chains, known as oligosaccharides. The same sugar chains are present on tooth surfaces.

The effect of sugar chains on the tooth's ability to resist disease is analogous to the effect of "good" and "bad" cholesterol on blood vessels. "Good" sugar chains tend to repel the bacteria that cause cavities, while "bad" sugar chains allow the bacteria to bond to a tooth and start the decay process.

Unlike cholesterol, humans' sugar chain makeup is 100 percent genetically determined and cannot be changed. The USC researchers found that the sugar chain makeup in saliva can predict a child's future cavity history to plus or minus one cavity with greater than 98 percent confidence.

Children at the far ends of the spectrum - those with exceptionally weak or strong oral hygiene and nutritional habits - may develop more or fewer cavities than the test predicts. Bad habits may cause tooth decay, but researchers caution against extreme measures: completely eliminating sugar has not been shown to prevent cavities, and over-brushing can cause enamel erosion.

The USC test suggests that genes play a greater role in tooth decay now than at any time in the past. Gross malnutrition and negligent oral hygiene are rare in developed societies: That leaves a child's genes as the prime determinant of his or her dental future.

A different version of the test identifies the particular teeth at risk, Denny said. And the test's specificity may reduce the cost and increase the effectiveness of prevention.

"It's possible that in the future - even though a kid might be at very high risk for getting a large number of caries - with the proper preventive dental care he [or she] can arrive at adulthood without any," Denny said.

A further version of the test can identify children with active tooth decay. This test has important public health implications in areas where families cannot afford routine dental exams.

"This is going to help people who are not dental professionals," said Mahvash Navazesh, associate professor in the USC School of Dentistry and co-inventor of the CARE test with USC research scientist Patricia Denny.

School nurses could administer the test, Navazesh said, though she stressed any test would not be a substitute for proper dental care.

"This is not a test to diagnose caries. This is a test that can be used to evaluate susceptibility and risk," she said. "If we can identify those people that are at risk and put in place preventive measures, it is going to prevent them from suffering."

The physical and financial burden of caries increases with age, researchers said. The cost of dental care can be prohibitive and is not covered by Medicare.

Fillings deteriorate and need to be replaced with larger fillings, often leading to root canals, crowns and even tooth loss.

That is why stopping the formation of cavities is so important, Denny said.

"It's the initial cavity or caries that we're worried about," he said. "If we can prevent that, then we prevent this whole lifelong process from occurring."

Treating mouth wounds by engineering tissue grafts

Tue, 05 Oct 2004 15:14:00 PST

( from http://www.rxpgnews.com ) University of Michigan researchers are testing a new procedure in which they can take a tiny piece of a person's mouth lining, grow it into a dollar-bill sized piece of tissue and graft that expanded piece into the donor's mouth to heal a wound.

Dr. Stephen Feinberg is leading a team that is currently working with five patients to treat small mouth wounds with the grafts. These five patients are part of what is called a proof of concept study for the Food and Drug Administration.

Feinberg, a professor of both dentistry and surgery, is collaborating with Kenji Izumi, a scientist and surgeon who already has seen success with the method in about 80 patients in Japan. Izumi is a visiting assistant research scientist at U-M and a long-time colleague of Feinberg's.

Many types of people have trouble with mouth wounds that do not heal well on their own---patients going through cancer chemotherapy, for example, or people with diabetes. Those who have been involved in accidents are candidates, as well.

Existing treatments include taking a skin graft from a site such as a leg and stitching it into the mouth. Skin works for covering the wound, but is not as pliable as the mucosal lining of the mouth, and if it is too thick, it might even grow hair inside the mouth. A large skin graft also leaves the patient in pain with lengthy healing time.

Feinberg said tissue engineering has many advantages, including a smaller donor site that heals faster and a graft that is mucosal cells, more like the mouth lining, not skin. After a short healing period, the patient feels mouth lining as it is supposed to feel.

In their research, Feinberg and Izumi took thin pieces of mucosa from the roof of the patients' mouths, about as big around as the end of a pencil eraser. They worked with Cynthia Marcelo, a research professor of surgery with nearly a decade of expertise in cell growth, to use a system she developed that encourages the cells to reproduce more rapidly in a well-defined system acceptable to the FDA. This special environment helps a tiny piece of mucosal mouth lining grow to the size of a quarter within a few weeks, and a dollar bill within about a month.

The team attaches the expanded cells to a piece of AlloDerm, a specially prepared piece of human dermis made by LifeCell Corp. The composite of cells and AlloDerm is then immersed in a Petri dish with a liquid Izumi casually compares to plant food. The liquid

contains proteins and vitamins, the nutrients that encourage the cells to grow faster and increase in numbers.

Feinberg and Isumi use the U-M Human Application Lab in University Hospital, an ultra-clean facility that follows the FDA's strict regulations for keeping out potential contaminants. Everyone who enters must wear elaborate protective gear, and before Izumi works with growing tissue samples, he must sterilize the work area and his gloves. Every precaution protects the tissue cultures from exposure to dirt, skin cells or anything else that might cause a problem once the cells are implanted in a human.

The team is working with five patients to demonstrate proof of concept. That is the precursor to moving into the trials that inform an FDA decision to approve a new medical treatment. Following successful completion of the preliminary studies, Feinberg plans to seek FDA approval for a larger clinical trial involving 50 patients.

Feinberg is working with U-M Technology Transfer to identify companies that might have an interest in commercializing the treatment so it can be easily put into practice by others.

Eventually, Feinberg hopes to see the treatment used not only for small mouth wounds but for major reconstructive surgery where the patient cannot physically donate enough tissue for repairs.

Though this treatment is still in the early stages of approval, Feinberg already is looking down the road. He has begun to separate the stem cells from the harvested piece of tissue, because stem cells divide more rapidly and can live longer, aiming to eventually produce grafts solely from stem cells. He is also interested in modifying the approach to infuse the piece of tissue with gene therapy compounds, meaning the implanted tissue might help a person with such chronic conditions as diabetes or systemic illnesses like diabetes or hemophilia.

Feinberg and his team are among dozens of researchers at U-M working on tissue engineering techniques and applications. Some aim to generate tooth or bone to aid in healing, others focus on softer tissues like skin, but all are looking at the next generation treatment that involves having a patient's own body provide the building blocks for healing itself.

Study will provide basis for targeted therapies for leading cause of adult tooth loss

Fri, 10 Sep 2004 15:16:00 PST

( from http://www.rxpgnews.com ) Scientists at Columbia University Medical Center (CUMC) are looking into the genetic reasons why individuals experience periodontal disease so differently, and why some respond to treatment more successfully than others. Even with treatment, some patients continue to see deterioration of gum condition and eventual loss of teeth.

The research is part of an effort at CUMC to eradicate periodontitis in these patients and better understand how the gum disease develops, and will allow the development of pharmacologic therapies targeted specifically to a person's own genetic predisposition for response.

A new three-year, $1.8 million grant from the National Institute of Dental & Craniofacial Research will support research to determine whether different forms of periodontitis can be classified based on gene expression in inflamed gums.

Periodontitis occurs when infection of the gums goes untreated and inflammation spreads to ligaments and bone that support the teeth. The disease is the leading cause of tooth loss in adults.

Currently, periodontitis is classified into two groups chronic and aggressive that are categorized based on clinical signs after consideration of medical and oral health history. However, distinguishing these two disease categories can be difficult because the clinical signs of both can be quite similar, while response to standard therapeutic procedures may vary considerably. Both types of disease are characterized by swollen gums and deep periodontal pockets. Therapy usually consists of cleaning of the periodontal pockets and root surfaces, accompanied by gum surgery and adjunctive antibiotics.

"The current system for classifying periodontal disease does not have a solid, pathobiology-based foundation," said Panos N. Papapanou, D.D.S., Ph.D., the principal investigator on the project, who is also professor and chair of the Section of Oral and Diagnostic Sciences and director of the Division of Periodontics, Columbia University School of Dental & Oral Surgery. "We intend to identify the molecular basis of the wide spectrum of responses to periodontal bacteria, and use this information to reduce the risk of periodontitis and develop new, more targeted therapies."

The patient's individual immuno-inflammatory response to the bacterial challenge is believed to determine the type, extent and severity of periodontitis, and this response is believed to have a strong genetic component. Dr. Papapanou and his team will examine gene expression signatures to define different subtypes of the disease in order to understand the molecular processes involved in each subtype.

The research will take advantage of contemporary gene expression profiling technology, similar to that used to study the behavior and prognosis of certain cancers. Dr. Papapanou and his team will study 120 patients 60 with chronic and 60 with aggressive periodontitis. Samples of inflamed gingival tissue from the patients will be analyzed to identify local patterns of gene expression in inflamed gums, and will be used to develop a novel classification scheme based on similarities in gene expression signatures.

"In addition to providing insights into the pathobiology of periodontitis, this research will provide a wealth of data on the basic host responses to infection," said Paul Pavlidis, Ph.D., co-principal investigator of the study and assistant professor in the Columbia University department of Biomedical Informatics and the Columbia Genome Center.

A new way of making a detailed 3D picture of a diseased area of a tooth

Tue, 07 Sep 2004 15:18:00 PST

( from http://www.rxpgnews.com ) A team of scientists from Glasgow today revealed a new technique that will allow dentists to detect and study the tell-tale signs of tooth decay before too much damage is done.

Speaking at one of the opening sessions at the Institute of Physics conference Photon 04 in Glasgow, Simon Poland outlined a new way of making a detailed 3D picture of a diseased area of a tooth, which could be done while a patient waits.

Simon Poland, from the Institute of Photonics at the University of Strathclyde, working with colleagues at the Glasgow Dental Hospital, and the University of Dundee, has used an existing imaging technique which creates optical sections (individual images or slices through a 3D object) using structured light (a beam of light in a grid pattern). They applied this technique to human teeth for the first time and succeeded in producing a 3D image a diseased area of a tooth.

The scientists took a tooth with an area of known decay and shone a beam of structured infra-red light (of around 880nm) using a halogen lamp. They took sets of 3 images at different spatial phases and combined them using standard image processing techniques. This produces an optically sectioned image - many image 'slices,' which are put together to form a whole 3D image.

Speaking at Photon 04, the UK's premier conference for photonics and optics, Simon Poland said: "We've successfully produced a 3D image of a region of tooth decay which will allow dentists to study the process of decay, caused by food and drink, in great detail and in real time, as the disease occurs, rather than after the fact."

He continued: "The technique is fast and simple and we could attach an endoscope to our kit to allow dentists to use the device in the surgery. They would shine the endoscope at the tooth they wanted to examine, and by using high-speed CCD camera, the image could be delivered very quickly, in around twenty minutes or so."

"Dentists usually detect disease by scraping and looking, or by taking X-rays but these methods only catch decay once it's already quite serious. Some of the more complex techniques currently available only give dentists data readings. The advantage of a detailed 3D image like the one we've created is that it can reveal decay in its earliest stages, and lets the dentist take measures to stop or repair the damage before it gets too bad. It gives them a powerful diagnostic tool, and tells them about the size and shape of the disease, and its progression."

Tooth decay is caused by acid produced when the sugar in plaque (bits of food and drink mixed with bacteria) breaks down. Fizzy drinks are particularly bad for teeth because they contain acid which begins to cause decay straight away. This leads to the break-down of the enamel (the protective surface coating) and mineral loss occurs. At this stage, re-mineralization is possible and is helped by good dental hygiene ¡V regular cleaning with toothpaste and fluorine mouthwash. The technique developed by Simon Poland and his colleagues could help dentists catch disease early in the process, before too much mineral loss occurs, when the possibility of re-mineralisation still exists. If mineral loss continues unchecked, cavities begin to form and grow, then fillings are needed.

The team now intend to use the technique to study teeth in different stages of tooth decay and to devise an easy to use kit for use in dental practices.

Treatments for depression have dental side effects

Mon, 06 Sep 2004 15:45:00 PST

( from http://www.rxpgnews.com ) Up to 37 percent of adults experience mood disorders at some point in their lives; and many receiving treatments may undergo adverse dental side effects according to a study that appears in the September/October 2004 issue of General Dentistry, the Academy of General Dentistry's (AGD) clinical peer-reviewed journal.

Mood disorders are a group of mental conditions, including depression and bipolar disorder, which are common among adults and early diagnosis and treatment can greatly reduce the risk of suicide.

Medications prescribed as treatments for mood disorders can result in dry mouth (xerostomia), an increased rate of dental caries and periodontal (gum) disease. "Many patients who are taking antidepressants will have dry mouth," says David F. Halpern, DMD, FAGD and AGD spokesperson. "In an effort to curtail any tooth decay, we stress with patients the importance of maintaining an extremely high level of oral hygiene care by brushing, flossing and daily fluoride therapy."

Because of these medical interactions, it is typical for dentists to ask about:

# Lifestyle (smoking or involvement in high-risk sports)
# Family medical history
# Health, even if it doesn't relate to the mouth
# Surgeries or major illnesses
# Medications being taken

Dry mouth can be treated by sipping water during the day and chewing sugarless gum. Dr. Halpern also suggests artificial saliva substitutes such as gels, liquids or sprays. Individuals with dry mouth should contact a dentist for an evaluation and appropriate solution.

Periodontal (gum) disease can be prevented by removing plaque through daily brushing, flossing and professional cleaning.

Major depression usually lasts eight to nine months if the individual is not treated. James W. Little, DMD, lead author, says, "If treated it will take about 1-3 weeks to begin to feel better and get rid of thoughts of suicide."

Antidepressants and psychotherapy are common for treatment of depression. Bipolar disorder is treated with an antidepressant and a mood stabilizer to prevent manic episodes. When medication and psychotherapy are coupled together more than sixty percent of individuals will begin to notice improvements.

Obstructions due to chronically congested nasal passages or enlarged tonsils may affect the growth of the face

Sun, 05 Sep 2004 15:43:00 PST

( from http://www.rxpgnews.com ) Obstructions due to chronically congested nasal passages or enlarged tonsils may affect the growth of the face. "Long face syndrome" is a term describing the longer, narrow face of children who suffer from uncontrolled allergies or, an obstruction of the upper airway which creates an inability to breathe through the nose, reports an article in the July/August 2004 issue of General Dentistry, the Academy of General Dentistry's (AGD) clinical, peer-reviewed journal.

"Narrow nostrils, shadows beneath the eyes and constantly open lips may also be associated with blockage of the upper airway or allergies," explains Jane A. Soxman, DDS, lead author of the report.

If the child is unable to breathe through the nose, mouthbreathing results, which may affect overall health since important nasal functions are bypassed. As air passes through the nose, it is warmed, humidified and cleansed of foreign particles, pollen and bacteria. "In addition, dry air carries less oxygen than moist air to the lungs, causing these children to fatigue more rapidly," explains Dr. Soxman.

The child's bite may change too. Unbalanced muscle forces compress the upper jaw and the tongue may protrude through the front teeth, forcing them outward. If the constriction of the upper jaw repositions the molars, a dentist may recommend expansion of the upper jaw with an appliance, which also often improves breathing.

In some children, a severe upper airway blockage can cause breathing to stop during sleep or sleep apnea. According to Dr. Soxman, these children may not grow normally because of the energy they expend trying to breathe during the night. Also, these children may be hyperactive and experience poor concentration, headaches, nightmares and bedwetting. Use the BEARS acronym to determine if sleep apnea is a possibility:

# Bedtime problems, such as snoring, sleep apnea or nightmares
# Excessive daytime sleepiness
# Awakenings at night
# Regularity and duration of sleep
# Snoring

Parents may use an audio or video to tape documentation of the child's sleep disturbances. A physician may recommend removal of the adenoids if sleep apnea is due to obstruction of the upper airway.

If allergies are the source of the problem, the causes need to be determined and removed. Dr. Soxman encourages parents to minimize dust. "Use a damp cloth to dust, remove carpet, stuffed animals, down pillows and down comforters. Buy hypoallergenic pillows and cover mattresses and pillows with dust mite barrier covers." The child's doctor may recommend drugs or allergy shots to reduce allergic responses.

"Knowing what a nose knows may help to improve the quality of life," says Dr. Soxman.

Dentists provide laser treatments and avoid using a scalpel

Sat, 04 Sep 2004 15:40:00 PST

( from http://www.rxpgnews.com ) Periodontal disease affects more than fifty percent of adults. Until recently, the only way for dentists to treat this condition involved use of a scalpel to remove diseased tissue. An article in the September/October 2004 issue of General Dentistry, the Academy of General Dentistry's (AGD) clinical, peer-reviewed journal describes a new procedure on how lasers are being used to treat diseased gums.

Laser-assisted new attachment procedure (LANAP) offers a scalpel-free way for patients to take care of diseased gums. The LANAP procedure works by using the lasers to zap away diseased tissue. These lasers are able to seek out only the diseased tissue and leave the healthy gum tissue behind.

Then, lasers are used again to heat the area until a clot (similar to a scab) is created. This clot protects the gum tissue wound by keeping it closed. Once the clot heals, new gum tissue is left behind.

"This is the first ever stand alone procedure for the laser to replace surgical methods," says Robert H. Gregg, DDS, co-author of the study. "The data shows you can treat periodontal disease without using sutures (stitches) or amputating the gums."

Dr. Gregg reminds patients that even though stitches are not needed with this new procedure, patients still must receive a local anesthetic. The LANAP procedure may also mean fewer trips to the office for follow-up care.

Other benefits of laser dentistry include:

* Faster healing time

* Reduced risk of infection

* Less time in the dental chair

* Less post-procedure pain

"These findings are very interesting," says Eugene Antenucci, DDS, AGD spokesperson. "Lasers have been proven to be extremely effective for many purposes in the dental office. As additional research is done on this procedure and similar procedures, we'll learn more about how lasers can improve periodontal health."