Beyond tooth decay: why good dental hygiene is important

In this spotlight feature, to coincide with National Dental Hygiene Month, we peer beneath the plaque to investigate what other - perhaps unexpected - health conditions are affected by poor dental health.

Alzheimer's disease
In 2010, researchers from New York University (NYU) concluded that there is a link between gum inflammation and Alzheimer's disease, after reviewing 20 years of data on the association.

However, the number of participants in the NYU study was fairly small. The researchers analyzed data from 152 subjects enrolled in the Glostrop Aging Study - a study looking at psychological, medical and oral health in Danish men and women. The study spanned a 20-year period and ended in 1984, when the subjects were all over the age of 70.

Comparing cognitive function at ages 50 and 70, the NYU team found that gum disease at the age of 70 was strongly associated with low scores for cognitive function.

Study participants were nine times more likely to have a score in the lower range of the cognitive test - the "digit symbol test" (DST) - if they had inflammation of the gums.

Although this study took into account potentially confounding factors like obesity, cigarette smoking and tooth loss unrelated to gum inflammation, there was still a strong association between low DST score and gum inflammation.

In 2013, UK-based researchers from the University of Central Lancashire (UCLan) built on the findings of this study, by comparing brain samples from 10 living patients with Alzheimer's with 10 brain samples from people who did not have the disease.

Analysis showed that a bacterium - Porphyromonas gingivalis - was present in the Alzheimer's brain samples but not in the samples from the brains of people who did not have Alzheimer's. What was interesting was that P. gingivalis is usually associated with chronic gum disease.

The team followed up this research in 2014 with a new mouse study, the results of which were published in the Journal of Alzheimer's Disease. Medical News Today spoke to co-author Dr. Sim K. Singhrao regarding the findings.

Dr. Singhrao says that there is sufficient scientific evidence to show that two of the three gum disease-causing bacteria are capable of motion (or "motile") and have been consistently found in brain tissue.

"These motile bacteria can leave the mouth and enter the brain via two main routes," he explains. "They can use their movement capability to directly enter the brain. One of the paths taken is to crawl up the nerves that connect the brain and the roots of teeth. The other path is indirect entry into the brain via the blood circulation system."

In a patient who has bleeding gums, says Dr. Singharo, the gum disease-causing bacteria will enter the blood stream every time they clean their mouth and even when they eat food.

He continues:

"P. gingivalis is particularly interesting as it has found ways to hitch a lift from red blood cells when in the blood stream and instead of getting 'off the red blood cell bus' in the spleen, they choose to get off in the brain at an area where there are no immune checkpoints. From there, they spread to the brain at their will. In addition, in older individuals, the blood vessels tend to enlarge and become leaky."

"The published work confirmed P. gingivalis placed in the mouths of mice finds its way to the brain once gum disease becomes established first," Dr. Singhrao concludes. "Furthermore, our hypothesis is strengthened by the recent results demonstrating that the chemicals released by the brain's immune system in response to P. gingivalis reaching the brain 'inadvertently' damage functional neurons in the area of the brain related to memory."

Pancreatic cancer
A research team from Harvard School of Public Health in Boston, MA, were the first to report strong evidence on a link between gum disease and pancreatic cancer, back in 2007.

The type of gum inflammation associated with pancreatic cancer in the study was periodontitis, which affects the tissue that support the teeth and can cause loss of bone around the base of the teeth.

The other main kind of gum disease - gingivitis; where the tissue around the teeth becomes inflamed - was not linked to increased cancer risk. However, gingivitis can lead to periodontitis if persistent. Gingivitis happens when bacteria in the plaque around the base of the teeth build up due to bad dental hygiene.

Examining data on gum disease from the Health Professionals Follow-Up Study, which involved a cohort of more than 51,000 men and began collecting data in 1986, the Harvard researchers found that men with a history of gum disease had a 64% increased risk of pancreatic cancer compared with men who had never had gum disease.

The greatest risk for pancreatic cancer among this group was in men with recent tooth loss. However, the study was unable to find links between other types of oral health problems - such as tooth decay - and pancreatic cancer.

The researchers suggest that there may be a link between high levels of carcinogenic compounds found in the mouths of people with gum disease and pancreatic cancer risk. They argue that these compounds - called nitrosamines - may react to the digestive chemicals in the gut in a way that creates an environment favorable to the development of pancreatic cancer.

However, a follow-up study from the team in 2012 was unable to prove whether the periodontitis bacteria are a cause or result of pancreatic cancer - the study could only prove that the two were linked.

"This is not an established risk factor," admitted author Dominique Michaud. "But I feel more confident that something is going on. It's something we need to understand better."

Heart disease
Perhaps more well established is the association between dental hygiene and heart disease.

In 2008, MNT reported on research from joint teams at the University of Bristol in the UK and the Royal College of Surgeons in Dublin, Ireland, who found that people with bleeding gums from poor dental hygiene could be increasing their risk of heart disease.

The researchers found that heart disease risk increased because - in people who have bleeding gums - bacteria from the mouth is able to enter the bloodstream and stick to platelets, which can then form blood clots, interrupting the flow of blood to the heart and triggering a heart attack.

"The mouth is probably the dirtiest place in the human body," said Dr. Steve Kerrigan from the Royal College of Surgeons, explaining that there are up to 700 different types of bacteria co-existing in our mouths.

Prof. Howard Jenkinson, from the University of Bristol, added:

"Cardiovascular disease is currently the biggest killer in the western world. Oral bacteria such as Streptococcus gordonii and Streptococcus sanguinis are common infecting agents, and we now recognise that bacterial infections are an independent risk factor for heart diseases."

The Bristol University researchers investigated how the bacteria interact with platelets by mimicking the pressure inside the blood vessels and the heart. Prof. Jenkinson's team found that the bacteria use the platelets as a defense mechanism.

By clumping the platelets together, the bacteria are able to completely surround themselves. This platelet armor shields the bacteria from attack by immune cells and makes them less detectable to antibiotics.

Although some of the associations we have looked at in this spotlight feature are still under investigation, good dental hygiene remains important for lowering risk of a variety of conditions.

The American Dental Hygienists' Association (ADHA) recommend that we should brush for 2 minutes, twice daily. The ADHA guidelines also stress the importance of flossing daily and rinsing with mouthwash. You can read the full recommendations on the ADHA website.

Written by David McNamee

ADA Recommends Earlier Fluoride Distribution for Children

It may be beneficial for children to be given fluoride even earlier than they receive it now, according to the American Dental Association.

Previous information suggested children receive fluoride by the time they were 6. This new information, however, suggests that children be administered fluoride even earlier. The new ADA recommendation states that children should be given fluoride as soon as their first teeth develop.

When children use fluoride toothpaste at an early age, it can lower the rate of decay. Research suggests that around one quarter of children develop a cavity before reaching kindergarten but more children using fluoride at an earlier age can lower that number.

The change in position on when a child should start using fluoride comes after a study from the Journal of the American Dental Association.

The study also indicated that pea-sized quantities of toothpaste can lead to a higher risk of fluorosis when toothpaste is ingested. Children younger than 3 should use smaller amounts of toothpaste. The ADA recommends parents watch their children clean their teeth to make certain the children spit out the toothpaste as opposed to swallowing it.

More studies on fluoride will be conducted to determine when is the exact time children should initially use it. There are many different opinions regarding how people feel about fluoride and this information won’t change those beliefs.

-DentistryToday

We drink milk because it is good for us, but we rarely stop to think "Why?"

Archaeologists and geneticists have been puzzling this question since it was revealed that the mutations which enable adults to drink milk are under the strongest selection of any in the human genome.

These mutations cause the intestinal enzyme lactase -- which digests lactose milk sugar during infancy -- to continue to be produced long after weaning. This lactase persistence is prevalent only in some populations around the world such as in Northern Europe. In most other people of the world, the lactose cannot be properly digested and can cause diarrhea, or other symptoms of lactose intolerance resulting from the gases produced by fermentation by the gut bacteria.

Some dairy products such as yoghurt and cheese have had their lactose content reduced or removed through processing. In the case of cheese, the lactose ends up in the whey, where it is often fed to pigs and other animals. If it is so easy to remove milk sugars, and the mutation is only required for drinking raw milk or whey -- why is it under such strong selection?

An international team of researchers involving the Universities of York, Oklahoma and Copenhagen, and University College London (UCL) has shed new light on this puzzling question through an unusual source -- investigations of calcified dental plaque on ancient human teeth.

To understand how, where and when humans consumed milk products, it is necessary to link evidence of consumption directly to individuals and their livestock. Previous research by archaeologists has used indirect lines of evidence, such a high frequency of adult females in animal herds or milk lipids present on pots, to identify evidence of dairying.

Now a breakthrough by the international team, reported in the journalScientific Reports, provides the first direct evidence of milk drinking from an increasingly important archaeological reservoir -- human dental calculus, a mineralized form of dental plaque. Using the latest mass spectrometry-based techniques for ancient protein sequencing, the team detected a milk protein, beta-lactoglobulin (which they had previously reported from a modern dental plaque sample) in ancient remains.

Lead author Jessica Hendy, from the University of York's BioArCh research facility, said: "It seemed too good to be true; beta-lactoglobulin is the dominant whey protein -- the one used by bodybuilders to build muscle mass -- and therefore the ideal marker for milk consumption. We kept finding sequences of beta-lactoglobulin and at first we thought it could be modern contamination. But we repeated the analysis several times, at three different laboratories in three different countries, each time finding the same results."

Lead author Dr Christina Warinner, from the Department of Anthropology, University of Oklahoma, said: "The study has far-reaching implications for understanding the relationship between human diet and evolution. Dairy products are a very recent, post-Neolithic dietary innovation, and most of the world's population is unable to digest lactose, often developing the symptoms of lactose intolerance."

Professor Dallas Swallow, from the Research Department of Genetics, Evolution and Environment at UCL, added: "It is only within the last several thousand years that genetic mutations arose in Europe, East Africa, and the Arabian Peninsula that allowed lactase to persist into adulthood, a genetic trait that enables lifelong milk consumption."

The new research provides direct protein evidence that cattle, sheep, and goat whey has been consumed by human populations for at least 5,000 years. This corroborates previous isotopic evidence for milk fats identified on pottery and cooking utensils in early farming communities. Until now it has been difficult to investigate both human genetic milk adaptations and direct evidence of milk consumption at the same time, in part because milk preserves so poorly in the archaeological record.

"The discovery of milk proteins in human dental calculus will allow scientists to unite these lines of evidence and compare the genetic traits and cultural behaviors of specific individuals who lived thousands of years ago," says Dr Warinner.The team found direct evidence of milk consumption preserved in human dental plaque from the Bronze Age to the present day.

Professor Matthew Collins, of BioArCh in York's Department of Archaeology, said: "Some of the findings were as we expected. For example, we did not find any evidence of milk protein in 19th century West African individuals from regions where dairying was uncommon. But we found widespread evidence for milk consumption at European sites spanning a period of 5,000 years."

Dr Camilla Speller, from York's BioArCh research facility, said: "Most of the molecular evidence for milk consumption has previously come from residues on ceramics. While pot residues can tell you that people are using dairy products, it can't tell you which individuals in the group are actually consuming the milk. This study is very exciting, because for the first time, we can link milk consumption to specific skeletons, and figure out who has access to this important nutritional resource."

Dr Enrico Cappellini, from the Centre for GeoGenetics, Natural History Museum of Denmark, University of Copenhagen, says the milk protein beta-lactoglobulin is also an important find because it contains sequence variants that allow different milk-producing livestock to be distinguished.

"We found widespread evidence of cows' and sheep milk consumption as early as the Bronze Age, whereas evidence for goat milk consumption was limited to Bronze Age northern Italy," he said.

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Story Source:

The above post is reprinted from materials provided by University of York.Note: Materials may be edited for content and length.

-ScienceDaily

Sugar-Free Drinks could cause dental problems

A recent study by researchers at the University of Melbourne's Oral Health Cooperative Research Centre suggests that sugar free products can cause measurable damage to the tooth enamel, NDTV reports.

"Many people are not aware that while reducing your sugar intake does reduce your risk of dental decay, the chemical mix of acids in some foods and drinks can cause the equally damaging condition of dental erosion," said Eric Reynolds, CEO of the Oral Health CRC.

"Dental erosion occurs when acid dissolves the hard tissues of the tooth. In its early stages erosion strips away the surface layers of tooth enamel. If it progresses to an advanced stage it can expose the soft pulp inside the tooth," said Reynolds.

For the study, the researchers tested 23 different types of drink. They found that drinks that contain acidic additives and with low pH levels cause significant damage to dental enamel, even if the drink is sugar-free.

The researchers also measured dental enamel softening and tooth surface loss due to the consuming the range of drinks. They found that majority of soft drinks and sports drinks caused softening of dental enamel by 30-50 per cent.

The study concluded that both sugar-containing and sugar-free soft drinks produced measurable loss of the tooth surface, with no significant difference between the two groups of drinks.

Reynolds also pointed out that 'sugar-free' labelling does not mean a product is safe for teeth.

"We have even found sugar-free confectionery products that are labelled 'tooth-friendly' and which when tested were found to be erosive," said Reynolds.

-UniversityHerald

Root Canal Myths

If you’ve ever heard someone talk about getting a root canal, you get the feeling that this endodontic procedure is a nightmare. However, a root canal is a tooth-saving dental treatment that can dramatically improve your oral health if you have severely damaged teeth, or even a tooth infection. Don’t let anxiety over a dental treatment prevent you from getting the care you need. We bust some popular myths about root canals below:

• Root Canals are Complicated Oral Surgery – A root canal is a dental procedure that requires the use of special instruments, controlled by skilled dentist or endodontist, but it is not a complicated surgical procedure, like some might think. In order to treat a damaged tooth with a root canal, Dr. Moscattini will remove infected tooth pulp (the material inside the tooth) by creating a small opening in the dental crown. This process is not much more invasive than getting a filling, crown, or other treatment that requires modification of dental enamel.

• Root Canals are Extraordinarily Painful – This is likely the biggest lie told about root canal treatment. While some may think that root canals are complex and uncomfortable, many patients report that it feels no different than receiving a filling. Dr. Moscattini will apply a local anesthetic before beginning treatment, so you remain comfortable and relaxed.

• Root Canals Damage your Teeth – Quite the opposite, a root canal is specifically intended to save teeth and does not “kill” a live tooth. Before root canal treatment was honed, the standard course of action for an infected or damaged tooth was extraction. But extracting teeth creates a host of other oral health problems that root canals can prevent. By removing affected material from inside your tooth, Dr. Moscattini can save your tooth’s structure and further protect your oral health by capping off your treatment with a dental crown.

• If You Get Another Tooth Infection, It’s Better Have the Tooth Extracted – Extraction is always a worst-case scenario. Dr. Moscattini takes every tooth-saving measure possible to ensure that you get to keep your natural teeth as long as possible. If you’ve previously had a root canal and experience another infection at the same site, your tooth can be successfully re-treated with root canal therapy.

Root canal therapy is a great way to save teeth and prevent the need for tooth extraction, or other, more extensive oral health treatment. Patients in need of root canals can trust their oral health to the Duluth, GA dental office of Dr. Roy Moscattini. Dr. Moscattini takes the time to go over your treatment plan and answer any questions you may have about getting a root canal. For more information, contact our dental office to set up your consultation.