December 2004

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The clinical course of chronic periodontitis

The purpose of this study was to assess the long-term influence of gingival inflammation on tooth loss.

The data originated from a 26-year longitudinal study of Norwegian males, who practiced adequate daily oral home care and received "state-of-the-art" dental care. The initial examination in1969 included 565 individuals aged between 16 and 34 years. Subsequent examinations took place in 1971, 1973, 1975, 1981, 1988 and 1995. Thus, the study covers the age range of 16–59 years.  At baseline (1969), out of possible 15,820 teeth (565 × 28), 15,383 teeth were present. Four hundred and thirty-seven teeth had already been missing for unknown reasons. Teeth with Severity Group yielded an odds ratio for tooth loss that was 46 times higher

Teeth surrounded with inflammation-free gingival tissues were maintained for a tooth age of 51 years, while teeth consistently surrounded with inflamed gingivae yielded a 46-times higher risk to be lost. Only two-thirds of such teeth were maintained throughout the 26-year observation period. This documents the role of gingival inflammation as a risk factor for future tooth loss.

J Clinical Perio Volume 31: Issue 12 article Type: Original Article Page range: 1122 - 1127

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Does Tooth Loss Affect Dietary Intake?

Since the primary function of teeth is mastication, tooth loss can reduce chewing ability that leads to detrimental changes in food selection. This, in turn, may increase the risk of particular systemic diseases since diet and certain health states, such as cardiovascular health, are linked. For example, an increase in dietary cholesterol and saturated fat, and a decrease in fiber have been shown to elevate the risk of heart disease. Since a large portion of the population has missing teeth, the effect on health risks due to tooth loss may have a significant impact.

In what is, no doubt, one of the largest studies investigating a relationship between tooth loss and diet, data were collected on dental status, and food and nutrient intake from over 49,000 male professionals.  After adjusting for age, smoking, exercise and profession, it was found that intake of vegetables, dietary fiber , crude fiber, and carotene was significantly lower, while intake of total calories, cholesterol  and fat  was significantly higher  in edentulous participants compared to participants with 25 teeth or more.

In a follow-up study with the same cohort of professional men, longitudinal analyses between tooth loss and consumption of specific foods and nutrients were performed. It was found that over an eight-year period, participants without any tooth loss had greater reductions in daily intake of saturated fat, cholesterol and vitamin B12, and greater increases in daily intake of fiber, carotene and fruits compared to participants with tooth loss. In addition, subjects who lost five or more teeth were significantly more likely to stop eating apples, pears and carrots compared to subjects who lost four teeth or less. These studies provide the best evidence to date for an association between tooth loss and a change in food intake, and suggest that it is advisable to incorporate dietary evaluation and nutrition recommendations into dental visits for patients with tooth loss to avoid the health risks of a poor diet.

References

1. Hung HC, Willett W, Ascherio A, Rosner BA, Rimm E, Joshipura KJ.
Tooth loss and dietary intake. JADA 2003;134(9):1185-1192.

2. Joshipura KJ, Willett WC, Douglass CW. The impact of
edentulousness on food and nutrient intake. JADA 1996;127(4):459-467.

3. Willett WC. Diet and health: What should we eat? Science 1994;264
(5158):532-537.

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December 5-11: National Hand Washing Awareness Week To help "spread the word, not the germs," sponsored by "Henry the Hand" . http://www.henrythehand.com

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Urgent product removal:
Oral-B CrossAction Power and PowerMax toothbrushes and refills

Important safety information regarding a recall of Oral-B CrossAction Power and PowerMAX toothbrushes and brush refills in Canada and the United States. It is advised that consumers exercise caution when using these products due to a choking hazard. Further advise is given to caregivers who brush the teeth of people with special needs, such as
cerebral palsy or autism, to contact Oral-B to return the recalled products.
www.hc-sc.gc.ca/english/media/releases/2004/oralbbk1.html

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November 2004

Great American Smokeout

Help patients quit smoking by participating in the American Cancer Society's GreatAmerican Smokeout on November 18th. The idea for the event came from Arthur P. Mullaney, a Massachusetts resident who asked people to give up smoking for a day in 1971 and donate the money they would have spent on tobacco to a local high school. In 1977, the ACS introduced the event nationwide. Today an estimated 46 million US adults smoke and a multitude of illnesses are impacted by tobacco use. To help raise awareness about effective ways to quit smoking and get involved, call 1-800-ACS-2345to find a quitline or other science-based support in your area.

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Further Evidence of the Association Between Periodontal Conditions and Coronary

There is increasing evidence that chronic infections, such as periodontal diseases, could play a role in the initiation and development of coronary artery disease (CAD). population.

Periodontitis was significantly more frequent in CAD patients than in controls (CAD patients: 91%; controls: 66%). Furthermore, proportions of mobile teeth, bleeding sites, periodontal pockets, and involved furcations were
significantly higher in CAD patients than in controls. In addition, the extent of the periodontal disease present was also greater in cases than in controls.
In the present study, periodontitis was revealed to be a significantrisk factor for CAD after adjusting for other confounding factors, with the level of association increasing with the individual extent of
the periodontal lesions.

[Sabine O, et al., Further evidence of the association between periodontal conditions and coronary artery disease  Sabine O. Geerts, Victor Legrand, Joseph Charpentier, Adelin Albert,and Eric H. Rompen J Periodontol 2004;75(9):1274-1280.]

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Pediatric patient fears

A study of more than 400 children in Washington state found that 20% of pediatric patients fear dental treatment. The proportion of children who displayed negative behavior during treatment was 21%. Researchers found that children with dental fear had a greater propensity toward exhibiting negative behavior during a visit than children with no dental fear. Pediatric Dentistry, July/August 2004

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Dental caries: a transmissible bacterial infection

According to Kathy Phipps, PhD, under normal circumstances of diet and challenge, children become permanently colonized with mutans streptococci between the middle of the second year and the end of the third year of life, during a  window of infectivity. Despite a long-held belief that mutans streptococci require teeth for persistent oral colonization, recent studies have demonstrated that the bacteria can colonize the mouths of predentate infants, particularly in the furrows of the tongue. The primary sources of caries-causing bacteria in infants are their mothers. The higher the level of maternal mutans streptococcal infection, the higher the percentage of children who become infected.  By shifting the focus to the bacterial nature of the disease, we will be able to more effectively prevent and treat dental caries, says Phipps. UDA Action, newsletter of the Utah Dental Association, May/June 2004

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Periodontal Changes in Patients Undergoing Radiotherapy

The purpose of this study was to evaluate changes in the periodontiumin patients who received head and neck radiation therapy.

Periodontal clinical parameters (probing depth, clinical attachment level, gingival recession, plaque index, and bleeding on probing) were assessed on 27 patients before and 6 to 8 months following radiationtherapy in the head and neck area.

The greatest changes occurred in clinical attachment level: overall, 70.3% of the patients showed a loss, with 92% evincing loss in the mandible. Attachment loss was directly related to the field of radiation and was greater when the jaws were actually included in theirradiated area.

Periodontal status should be evaluated prior to and following radiation therapy in the oral-maxillary-facial region to help ensure that periodontal health is maintained in oncology patients.

[Alvarez M, Marques C,  Dib  L   Periodontal Changes in PatientsUndergoing Radiotherapy  J Periodontol 2004;75(9):1178-1187.]

October 2004

MedWatch - The FDA Safety Information Alert for Osteonecrosis

FDA and Novartis notified healthcare professionals of revisions the PRECAUTIONS and ADVERSE REACTIONS sections of labeling, describing spontaneous reports of osteonecrosis of the jaw mainly in cancer patients, who have received bisphosphonates as a component of their therapy. A dental examination with appropriate preventive dentistry should be considered prior to treatment with bisphosphonates in patients with concomitant risk factors (e.g. cancer, chemotherapy, corticosteroids, poor oral hygiene). Read the MedWatch 2004 safety summary, including links to: http://www.fda.gov/medwatch/SAFETY/2004/safety04.htm#zometa

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Infertility and Oral Health

Journal of Periodontology researchers have determined that women undergoing ovulation induction for infertility treatment for more than 3 menstrual cycles experience higher gingival inflammation, bleeding and gingival crevicular fluid.

The gingival inflammation levels of women under going infertility treatment and ovulation induction were investigated and found that due to the medications these women were taking for more than 3 months they had higher levels of gingival inflammation, bleeding and fluid that contains enzymes and tissue breakdown products that have been examined as potential markets for the progression of gum disease.  Thus the presence of infection in the gum tissue is associated with unsuccessful embryo development and implantation failure invirtro fertilization patients.

Impact 10/04 pg 9

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Novartis has warned that patients taking Aredia or Zometa (for metastatic bone disease) should avoid invasive dentistry.  They can get osteonecrosis as a complication. IDF 10/05/04

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Loss of Teeth and Coronary Heart Disease

This study found there was a significant hazard ratio for total mortality, but only for edentulousness. When examined by stepwise regression of the coronary heart disease risk factors, all significance of risk from the three oral parameters was lost, smoking having the largest effect of all risk factors.

Number of remaining teeth, edentulousness, and number of years of edentulism were not independent risk factors for total or coronary heart disease mortality, but they were surrogate markers for the risk from smoking. 
[Ragnarsson E, Eliasson ST, / Gudnason V Loss of Teeth and Coronary Heart Disease International Journal of Prosthodontics  2004;17(4): 441-446.]

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Hypertension

Hypertension has few discernable symptoms before events like strokes or heart attacks. Most individuals are often unaware of the symptoms associated with hypertension and tend to be unaware of theircondition  if they do not receive regular blood pressure screenings.

Blood pressure checks are easy to incorporate into routine hygiene examinations.  Through hypertension specific organs are targeted for damage, such as heart, brain, kidneys, peripheral arteries and the eyes.  Anti-hypertension therapy typically involves referral, medication, lifestyle changes and monitoring. Treatment is effective.

Hormone changes in women, especially during pregnancy and while taking birth control can increase blood pressure and the risk of hypertension. Hypertension is also becoming a problem with the increasing prevalence of overweight children.

So what is normal? A systolic pressure of less than 120 and a diastolic pressure of less than 80. The research has shown that the systolic blood pressure number is the better indicator of decreased risk.

Berger EK  Contemporary Oral Hygiene 2004;4(6)10-11

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Inflammatory Response to Acute Coronary Syndrome in Patients With  Coexistent Periodontal Disease

Conclusions: The periodontal health of patients admitted to the Coronary Care Unit due to acute coronary syndrome is unacceptable. The mean values for CAL and probing depth, as well as extensive bleeding on probing sites indicate the presence of active periodontal disease, which may affect the incidence of cardiovascular disease.  We observed that patients with acute coronary syndrome had more advanced periodontal disease. Patients with less advanced periodontal disease were characterized by a faster diminution of the inflammatoryresponse in comparison to the groups with more advanced periodontal disease.

[J Periodontol 2004;75:1020-1026.] July 2004 (Vol. 75, No. 7) Inflammatory Response to Acute Coronary Syndrome in Patients With 
Coexistent Periodontal Disease Maciej R. Czerniuk, Renata Górska, Krzysztof J. Filipiak, andGrzegorz Opolski
 

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September 2004

Today's Tip:  Smoking Did you know that smoking affects all parts of the digestive system,and contributes to ulcers and heartburn?  According to the National Digestive Diseases Information Clearinghouse, smoking can also affect the makeup of stomach acid, making it more harmful.
And - with reflux - that could harm the teeth!

hearts@work Tip of the Week courtesy of your Healthy Heart Society ofBritish Columbia
 

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Vitamin C (ascorbic acid) is responsible for the formation and preservation of collagen in the body. "Collagen is a proteinfound in teeth, bones, tendons, blood vessels, skin, joints, and muscles. As a maintainer of collagen, vitamin C helps to heal wounds like periodontal pockets."

While the current recommended daily allowance (RDA) for vitamin C in adults over eighteen years of age is 90 mg for men and 75 mg for non pregnant, non lactating women, research suggests the body's tissue absorbs up to 200mg of vitamin C in one day - any more is excreted in the urine.

"A study at Loma Linda University in California compared using a multivitamin or a placebo and the subsequent effect on patients with Type II periodontal disease who are not currently undergoing active periodontal therapy. They were looking at quantifiable improvements in soft-tissue health - gingival index, bleeding index, periodontal pocket depth and attachment level over a period of 60 days.""At the  end of the study, there was clinical reduction in the gingival index, bleeding index and pocket depth for the experimental group. No significant changes for attachment levels were found in the experimental or control group." Simply adding nutritional supplements to the therapy improved gingival health more than not taking the supplement.

Vitamin C is a readily available and affordable adjunct that can be used safely and effectively to treat active and maintenance periodontal patients.

Berger EK The efficacy of vitamin C in conjunction with periodontal therapy  Contemporary Oral Hygiene 2004;4(4):31

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Don't stick those lips near me!
 

It will examine the air in the immediate vicinity for anything from bad breath and alcohol to atmospheric gas levels. She didn't say what the phone would do if it found you too smelly, it might ring you or send out a high pitched scream that shouts bad breath to anyone who might want to get close to you.

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Doctors grow new jaw in man's back

LONDON, England (AP) -- A German who had his lower jaw cut out because of cancer has enjoyed his first meal in nine years after surgeons grew a new jaw bone in his back muscle and transplanted it to his mouth in what experts call an "ambitious'' experiment.

According to this week's issue of The Lancet medical journal, the German doctors used a mesh cage, a growth chemical and the patient's own bone marrow, containing stem cells, to create a new jaw bone that fit exactly into the gap left by the cancer surgery. Tests have not been done yet to verify whether the bone was created by the blank-slate stem cells and it is too early to tell whether the jaw will function normally in the long term.

But the operation is the first published report of a whole bone being engineered and incubated inside a patient's body and transplanted. Stem cells are the master cells of the body that go on to become every tissue in the body. They are a hot area of research with scientists trying to find ways to prompt them to make desired tissues, and perhaps organs.
A patient who had previously lost his mandible (lower jaw) through the result of a destructive tumor can now sit down and chew his first solid meals in nine years ... resulting in an improved quality of life.

The operation was done by Dr. Patrick Warnke, a reconstructive facial surgeon at the University of Kiel in Germany. The patient, a
56-year-old man, had his lower jaw and half his tongue cut out almost a decade ago after getting mouth cancer. Since then, he had only been able to slurp soft food or soup from a spoon...

For the rest of the story go here.
http://cnn.space.printthis.clickability.com/pt/cpt?action=cpt&title=CNN.com+

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August 2004

Tooth Decay Different for Boys and Girls

A new study from Australia suggests that young boys and girls exhibit different tooth decay patterns. While boys have more decay in their baby teeth, the study indicated that girls had more tooth decay as adults.

The study, conducted by the Australian Institute for Health and Welfare (AIHW), also found that boys tend to develop more baby teeth than girls at any age, and girl's permanent teeth arrive earlier than a boy's. The study didn't see any significant differences between the consumption of sugary foods from one gender to the next, which leads them to additionally conclude that cultural factors may account for the noted differences.

"Certainly ... boys, in relation to their oral hygiene, start brushing later in life and brush their teeth less often thangirls,"
researcher Jason Armfield told Australia's Herald Sun paper. Additional findings suggested a strong link between childhood decay and later tooth troubles. The Herald Sun quoted Armfield as noting that "one of the best predictors of having decay in permanentteeth is having decay in baby teeth."adha website
 

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The Liquid Effect

Liquid toothpaste is 35 percent more effective in preventing cavities that form between teeth than traditional toothpaste, according to new research published in the current issue of Journal of the American Dental Association (JADA).

They found that enamel exposed to the liquid toothpaste had 13 percent more fluoride uptake, which ultimately resulted in surfaces that were 35 percent stronger compared to the similar tooth enamel exposed to traditional toothpaste.

Dr Giniger said, `The reason why liquid dentifrice works better than thicker toothpastes is because thinner fluids can more easily penetrate into narrow spaces. Thus liquid toothpaste works like fluoridated mouth rinses in that they can flow into areas that toothbrush bristles are too big to fit into.

`We have found without any question that liquid toothpaste formats outperform  pastes. Anyone who has ever watched how the toothpaste stands on top of the toothbrush can clearly see that the pastes are too thick to penetrate between the tiny spaces between the bristles. Even when diluted with water while brushing, toothpastes remain too gummy to really do an effective job. Dr Giniger added that liquid products have different foaming properties that give it better plaque removal ability, especially in hard to reach areas that are more prone to cavities.
JADA 8/04

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A Comparative Clinical Trial Of Tongue Cleaning with a Toothbrush v.s. Tongue Scrapper.
 It is estimated that approximately 85% of all halitosis (bad breath) cases have their origin within the mouth; of these, 50% are caused by tongue residues. Previous studies have established that hydrogen sulfide and mercaptans are the primary components of halitosis. Thus, tongue cleaning gains importance as a means of halitosis management. This investigation compared the efficacy of two mechanical methods for tongue cleaning through a handheld sulfide monitor. The baseline measurements were compared with those of the end of each week . The tongue scraper showed a 75% reduction in VSCs, while the toothbrush only achieved a 45% reduction in VSCs. Although the tongue coating was removed by both methods, the tongue scraper performed better in reducing the production of volatile sulfur compounds.

Vinícius Pedrazzi, Sandra Sato, Maria da Glória Chiarello de Mattos, Elza Helena Guimarães Lara, and Heitor Panzeri Tongue-Cleaning Methods: A Comparative Clinical Trial Employing a Toothbrush and a Tongue Scraper  J Periodontol 2004;75(7):1009-1012

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July 2004

The Associated Press

AUGUSTA — A new dress code for Richmond County students lacks teeth —gold teeth. The Richmond County Board of Education on Tuesday unanimously passed the code to ban gold teeth, large belts and clothing that appears to be gang-related. Gang hand signals, symbols, uniforms and meeting also were prohibited. You have the Eminem look and the Vanilla Ice look. Basically, it is a total distraction. The students are wearing the metallic caps on their teeth, also called grilles. Jeff Padgett, the school board president, put the group’s decision in plain terms. ‘‘I think we have to decide that it’s about grades and not grilles.
It’s about tests and not teeth,’’ Padgett said.
 

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Given the high risk of bias in the available studies and lack of consistency between different outcome measures, there is no reliable evidence that application of ozone gas to the surface of decayed teeth stops or reverses the decay process. There is a fundamental need for more evidence of appropriate rigour and quality before the use of ozone can be accepted into mainstream primary dental care or can be considered a viable alternative to current methods for the management and treatment of dental caries.

Citation: Rickard GD, Richardson R, Johnson T, McColl D, Hooper L. Ozone therapy for the treatment of dental caries (Cochrane Review). In: The Cochrane Library, Issue 3, 2004. Chichester, UK: John Wiley & Sons, Ltd

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No Smoke Without Films

Teenage girls who have never even puffed on a cigarette are far more likely to start smoking if their favourite film star smokes in films, according to a recent US study.

Published in the July issue of the American Journal of Public Health, researchers from the Cancer Center's Cancer Prevention and Control Program concluded that on-screen smoking by popular actors undermine
public health efforts to keep children from smoking.

We've heard for years that big-screen movies influence kids to smoke. Our results were very strong, showing that if the movie stars smoke, especially in romance films, they are effectively encouraging young girls to smoke.

Approximately 3,000 12 – 15 year olds who had never smoked were randomly called and asked to name their favorite male and female screen actors over a three-year period. One-third of those surveyed named actors and actresses who smoked in films.

Girls whose favorite star smoked on-screen were 80 percent more likely to smoke by the time of the follow-up interview than their counterparts whose favorite star did not smoke on-screen. This finding was reached after researchers accounted for other independent predictors such as peer smoking, tobacco advertising and promotions, and parental disapproval of smoking.

After similar analyses to identify independent predictors among boys, the researchers found little change attributable to on-screen smoking.

The lack of this effect among boys, we believe, is associated with movie genre preferences. Girls tend to like romance movies, where smoking is common. Boys prefer action films, which contain lower levels of star smoking.

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Do Circumstances in Early Life Contribute to Tooth Retention in Middle Age?

The relative contributions of factors operating in fetal life,  childhood, and adulthood to risk of disease in middle age have become
an important research issue, though oral health has rarely been considered.

This study investigated the relative impacts of risk factors operating at different stages throughout life on the number of teeth retained
at ages 49-51 yrs based on data from the Newcastle Thousand Families cohort. Very little variation in tooth retention in middle age was explained by factors operating at earlier stages in life. The previously noted relationship between childhood socio-economic status and oral health in adulthood appears, with respect to tooth retention, to diminish with increasing age as adult socio-economic position and  lifestyle factors have an increasing effect.

Promotion of a healthier adult lifestyle and continued improvementsin oral hygiene would appear to be the public health interventions most  likely to increase tooth retention in middle age.
[J Dent Res 83(6): 448-453, 2004]

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Got Floss?

Here are some new uses for floss:

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June 2004

Topacal Remineralisation Product
A new product to hit the US may be the start of a new trend in oral care products.

Australia firm NSI Dental Party Ltd has developed a product to help prevent the increasing problem of dental erosion. Its product Topacal has been on sale in Australia for four years, but has only recently hit the US market. The product is available in the UK though it has not yet been officially launched.

While the product does not contain fluoride, it is made from milk-protein and promises to aid remineralisation. Its makers claim, `Topacal helps buffer plaque acids and forms a barrier at the tooth surface which helps minimize the adhesion of bacteria. At low pH the calcium phosphate is released and boosts the ability of saliva to prevent demineralization and promote remineralisation by natural means.' The manufacturers recommend use twice daily.

An enamel care toothpaste has also recently been developed. Its makers, Arm & Hammer, say the toothpaste is the only one with `liquid calcium' and that it `fills tooth surface and restores luster'.

http://www.topacal.com/
http://www.nynewsday.com/ny-dssupp3816791may25,0,7564161,print.story?

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 Licensed To Chew

While it has been reported that the 12-year chewing gum ban in Singapore has finally been lifted, it would appear that it is not that easy to purchase it.

If you want to buy chewing gum, you will have to pay a visit to a pharmacist, who is the only person permitted to sell it. You will then need to prove that you are a registered gum chewer by submitting our name and ID card number. Pharmacists who fail to screen potential buyers could be fined up to 1,600 GBP and risk a two-year jail term.

The chewing gum ban was reviewed after it became an issue in Singapore's trade talks with a US representative who shares his home state with gum giant Wrigley.

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Cigarette smoke undermines protective properties of saliva 

Once exposed to cigarette smoke, our normally healthy saliva not only loses its beneficial qualities but it turns traitor and actually aids in destroying the cells of the mouth and oral cavity. Cigarette smoke is not only damaging on its own, it can turn the body against itself. Cigarette smoke can destroy the antioxidants found in saliva, leaving behind a mixture of compounds that can accelerate the development of oropharyngeal cancer  [www.ada.org News Today June 2004]

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Virtually all Americans (99.7%) believe:

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Parents look out for the fizzy erosion

“LONDON (Reuters) – Fizzy drinks are the major cause of tooth erosion in British teenagers, researchers said (recently).  The sodas and pop drunk by up to 92% of UK 14-year-olds wear away the enamel protective coating on the teeth.  Dental erosion weakens teeth and can cause thinning or chipping of the tooth edges.  This research identifies fizzy drink as by far the biggest factor in causing dental erosion among teenagers. 

Drinking four or more glasses of fizzy drinks a day raises a 12-year-old’s chances of suffering tooth erosion by 252%.  Heavy consumption in 14-year-olds increased the risk to 513%, according to research published in the British Dental Journal.

Unlike tooth decay, which results from high levels of sugar, erosion is caused by acidic substances in the drinks.  Even diet versions are harmful.  Drinking milk (or) water instead reduces the risk. 

‘Erosion is a growing problem  yet many parents don’t understand the difference between decay and erosion, parents need to understand…it is the acidity of certain products that cause erosion.

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College smoking habit hard to break for most

 According to a study published in the current issue of Health Psychology, almost 90 percent of college students who were daily smokers and 50 percent of occasional smokers were still smoking four years later. The stude also found that some college smokers did move between categories - 14 percent of occasional smokers became daily smokers, and 11 percent of nonsmokers took up smoking.   Progression from occasional smoking to daily smoking seems to be gender-related. More men than women make that progression. The strongest predictor for continued smoking among occasional smokers related to expectations about smoking. The students more likely to continue smoking were those with the strongest beliefs that smoking provides positive emotional experiences, lessens negative ones and helps control weight. Nonsmokers were more likely to believe other activities would produce the same results. "Helping students to develop realistic expectations about smoking and to find other ways to cope with negative feelings may be helpful in reducing dependence upon smoking. Smoking status of college students seems more changeable than adults, college students may be more receptive to smoking cessation. 

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The association of gingivitis and periodontitis with ischemic stroke 

The aim of this study was to assess the associations of different periodontal conditions with cerebral ischemia.  Patients were examined on average 3 days after ischemia. The individual mean clinical attachment loss measured at four sites per tooth was used as indicator variable for periodontitis. Patients had higher clinical attachment loss than the generalnpopulation . After adjustment a mean clinical attachment loss >6 mm had a 7.4 times greater,  a gingival index >1.2 = a 18.3 times greater and a radiographic bone loss a 3.6 times higher risk of cerebral ischemia(stroke) than subjects without periodontitis or gingivitis. Periodontitis is an independent risk factor for stroke and acute exacerbation of inflammatory processes in the periodontium might be a trigger for the event of stroke.
 [Dörfer CE et al.,. The association of gingivitis and periodontitis with is chemic stroke J Clin Periodontol 2004;31(5):396 - 401.]

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May 2004

An oral appliance has been developed in the US to help people eat more slowly so that they will avoid over eating. The device, called the DDS System, has been developed by Scientific Intake in Atlanta, It forces users to take smaller bites, giving the natural `satiety response' - the feeling of being full - a chance to kick in. The DDS has to be initially fitted by a dentist who has taken a DDS System certification course. While it cannot be seen once it is in the mouth, it substantially reduces the open space in the roof of the mouth, helping the user to take smaller bites. The problem with overeating starts with the mouth - and dentists are responsible for caring for the mouth. 

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Soft Drink Cancer Link  The consumption of fizzy drinks isn't just bad for your teeth,  research suggests a link between the rise in the consumption of carbonated drinks and the rise in oesophageal cancer  The numbers of those suffering from cancer of the oesophagus has risen by 66 percent in the UK over the past 30 years, whereas in countries like China and Japan, where not as many fizzy drinks are consumed, there has been no rise. Dr John Toy, Cancer Research UK's Medical Director, is more open to the research. He said, `The increase in incidence of oesophageal cancer in recent years in alarming and somewhat puzzling. `Reflux of the acidic gastric juices from the stomach into the oesophagus is a suspected culprit. `People who are obese are more prone to this reflux and they have an increased risk of cancer. Carbonated drinks cause burping and some reflux. These drinks are also acidic and will bathe the lining of the oesophagus as they are swallowed.

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April 2004

April is National Facial Protection Month

5 million teeth are knocked out a year
200,000 number of injuries mouthguards prevent in high school and college football
70 times morel likely an athlete is to sustain damage to teeth when not wearing a mouthguard
1 in 10 chances athletes have of suffering a facial or dental injury in a season
60% of organized sports related injuries occur during practice rather than during games
150,000 number of emergency room visits from bike related head injuries
$15,000 cost of total rehabilitation of a single avulsed tooth
$5.00-$150.00 range of cost for mouthguards!
AGD Impact pg 7 4/04

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The Effect of Menstrual Cycle on Periodontal Health  

Many women report an increase in gum tissue inflammation or swelling and discomfort associated with their menstrual cycle. It was found that several women reported considerable oral symptoms prior to menses. The symptoms included:

Researchers compared the gingival and periodontal status premenopausal women between the ages of 20 to 50 years at different time points of their menstrual cycles.  The time points were ovulation, premenstruation and menstruation.  During the examination, researchers measured plaque index, gingival index, probing depth, gingival recession and clinical attachment level. Gingival inflammation was lower during menstruation than during ovulation and premenstruation.  This may be attributed to the hormone known as serum estradiol, which is a natural form of estrogen that peaks and drops during ovulation and premenstruation.            

Patients should remember the importance of telling their dental professionals about what is going on in their bodies including any prescription or over-the-counter medications they are taking.  This way dental professionals can explain any effects it has on periodontal health.”        The Effect of Menstrual Cycle on Periodontal Health Eli E. Machtei, Dan Mahler, Hana Sanduri, and Micha PeledJ Periodontol 2004;75:408- 412.

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March 2004

Tobacco use on the rise among military personnel

 The cigarette pack is back in the military and smokeless tobacco is gaining favor with older service men. Military officials expressed concern March 8 with tobacco and alcohol trends reported in the 2002 Survey of Health Related Behaviors Among Military ..This survey showed the first increase in 20 years in smoking among Department of Defense personnel. This study also showed  that 90 percent of military personnel had received a dental checkup in the 12 months preceding the survey . We are concerned with the increase in smoking and heavy alcohol use. These findings, along with indicators of stress and other similar mental health indicators, obtained in this survey, are not entirely surprising given the military's role in worldwide events during the past two years. Cigarette smoking remains a common behavior in one-third of military personnel. The statistically significant increase from 1998 to 2002 in the prevalence of cigarette smoking marks the first increase since 1980 and is of concern in that it signals a change in the pattern of declines that has prevailed for the past two decades. More than one in ten, or 12.2 percent of all military personnel, reported smokeless tobacco use in the past 30 days, and nearly one in five had used this type of tobacco in the past 12 months. Among males aged 35 or older, smokeless tobacco use increased significantly from 5.3 percent in 1998 to 9.5 percent in 2002. The high rate of smoking is of concern to the defense department for the physical toll it exacts on troop readiness, the legacy of smoking- related disease, higher absenteeism, diminished motor and perceptual skills and poorer endurance and the sheer cost of feeding the habit, Each year, the DoD spends an estimated $875 million on smoking- related health care and productivity loss, the report noted.

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Oral sex can lead to oral tumors, according to a US study published in the New Scientist. The human papilloma virus (HPV) is an extremely common sexually transmitted infection that has been known to cause cervical cancers. However, studies have suggested it also plays a role in other cancers, including oral cancer.  Out of those, 1,670 people had oral cancer, the people with oral cancers containing the HPV16 strain the most commonly seen strain in cervical cancer were three times as likely to report having had oral sex . We have known for some time that there is a small but significant group of people with oral cancer whose disease cannot be blamed on decades of smoking and drinking, because they're too young. In this group there must be another factor, and HPV and oral sex seems to be one likely explanation. 

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WHO: 5 Billion People Have Tooth Decay

 Five billion people — or nearly 80 percent of the world's population — suffer from tooth decay, the U.N. health agency said. Tooth decay, gum disease as well as oral and throat cancers are a global health problem . Also, the loss of teeth usually leads to malnutrition — with people being unable to chew many foods vital to their health — and subsequently a host of other problems. Poor oral health can have a profound effect on general health and the quality of life. The experience of pain, endurance or dental abscesses, problems with eating, chewing and missing, discolored or damaged teeth, has a major impact on people's daily lives and well being. Losing teeth, often seen as a natural consequence of aging, can be prevented and most children show signs of gingivitis (bleeding gums)  Severe gum disease, which can result in tooth loss, is found in 5-15 percent of most populations. Studies show that smoking is a key factor for gum disease in industrialized countries. Other risk factors include chewing tobacco and betel nuts, using snuff, brushing and flossing inadequately, consuming too little calcium and other micro-nutrients and consuming alcohol. Oral cancer is the eighth most common cancer of men worldwide because globally men tend to smoke more than women. In south central Asia, where the habit of chewing highly carcinogenic betel nuts is prevalent, oral cancer ranks among the three most common types of cancer. But WHO was also concerned about a sharp increase of oral and throat cancers, this was likely because these populations tend to consume more alcohol and there is an amplifying effect between liquor and tobacco, increasing the risk of oral cancer.  By ERICA BULMAN GENEVA - 

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Scorpion Venom Good for Gum Disease!

The Forsyth Institute, kaliotoxin a compound in the venom harvested by the arachnid, inhibits the bone loss associated with advanced gum disease.  One fourth of the Americans over age 30 have gum disease involving loss of bone or teeth.  It is hopeful that this compound will help allay the effects of bone related disease.  AGD Impact pg 7 3/04

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Brush before eating  ...Back to the question: Do you brush to remove plaque or food? The equation for caries is "plaque bacteria plus a fermentable carbohydrate equals acid." We can break the equation by removing either the plaque or the carbohydrate. Removing the plaque thoroughly before introducing the carbohydrate prevents acid production. If you brush after eating to remove the food instead, it's after the fact and, therefore, not prevention. Brushing before eating, brushing after the acid is produced is no longer preventive. Preventive means intervention before the event — in this case, prevention would occur before acid production, not after. Plaque bacteria produce acid right away. Acid production occurs within seconds of bacteria's exposure to sucrose, and salivary pH drops from a neutral of 7 to acidic 4.5 within just five minutes. It then takes 30 minutes to return to 7; so waiting till the meal is over to brush allows the bacteria ample time to produce acid. Need more convincing? Here's another reason to brush before meals, especially when consuming acidic beverages like orange juice or soda. Enamel erosion caused by orange juice increases the susceptibility of enamel to toothpaste abrasion. The acid softens the tooth surface. Dentin is even more susceptible to erosion from acid drinks and toothpaste abrasion. Even brushing without toothpaste after ingesting orange juice resulted in loss of enamel and dentin. These researchers conclude that brushing immediately after consuming acidic beverages should be avoided. Better to brush before. ... read the rest at http://rdh.pennnet.com/Articles/Article_Display.cfm? By Trisha E. O'Hehir [get the full story at RDH.net February 2004issue]

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The incident last month on Capitol Hill involving a bag of highly poisonous ricin sent to the office of Senate Majority Leader Bill Frist (R-TN), and the testing of those who may have been exposed to it, highlights the importance of saliva diagnostic research by the Navy Dental Research Facility at the Great Lakes Navy Base. Researchers there have developed a prototype device that can detect poisonous agents in humans in as little as 90 seconds. Current methods of detection take up to 48 hours. We're lobbying to get more money for the research facility and hope to secure at least $4 million for FY 2005.

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February 2004

The low carb diet Atkins, the Zone, the Low-Carb diet solution; they all restrict carbohydrate consumption while encouraging dieters to eat as much fat and protein as they desire. From a dental respective being on these diets for any period of time will cause vitamin and mineral deficiencies if proper supplements are not in place. Vitamin D and calcium are often deficient and are required for bone and tooth formation. Folate is also deficient and is essential for women considering pregnancy. A lack of vitamin C can lead to gum problems. The lack of fiber can also be detrimental. Constipation, headaches, nausea and dehydration are common side-effects of the low-carb diet. Chen C Adolescent diets and oral health - high-protein, low-carbohydrate diet Probe 2004; 38(1):16-20.]

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A visit to the doctor's surgery for a routine blood test could reveal a lot more than you had in mind.  The blood of 7,452 men and women for 37 common ailments were analyzed.  The results revealed that the blood tests with generally healthy results matched up with good oral health, while those tests which showed positive results for particular ailments were generally linked with evidence of periodontal disease.  More serious symptoms of periodontal disease were generally found in the men. Published in the Journal of Periodontology

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Study shows smokers should quit before dental procedures 

Smokers may want to quit using tobacco before undergoing oral surgery in order to encourage a prompt recovery.  Researchers investigated the relationship between tobacco smoking and the inflammatory response in smokers who consumed 10 to 20 cigarettes a day.   The researchers found that the body's defense mechanism was weakened in smokers, while the defense mechanism in nonsmokers promoted a more favorable healing response. Smoking interferes with the treatment response, noting that the findings also might explain the clinical evidence of inferior treatment outcomes in smokers.  October 2003 issue of the Journal of Periodontology.

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Dental caries experience in older people over time.

 The only caries risk factor common to all four studies was the wearing of a partial denture (for root surface caries only). Conclusions Older people are a caries-active group, experiencing new disease at a rate which is at least as great as that of adolescents. Dentate older people should be the target of intensive monitoring and preventive efforts at both the clinical practice and public health levels. There is no easily identifiable 'magic bullet' for preventing caries in that age group, but the use of evidence-based preventive interventions (such as fluoride) should suffice.Dental caries experience in older people over time: what can the large cohort studies tell us? W. M. Thomson British Dental Journal (2004); 196, 89–92

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January 2004

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