Diabetes Leads to Gum Disease; Gum Disease leads to Diabetes | Alhambra Dentist

Poorly controlled diabetic patients are at risk for numerous oral complications, such as periodontal disease, salivary gland dysfunction, infection, neuropathy, and poor healing.

Diabetes mellitus (diabetes) is a common chronic disease of abnormal carbohydrate, fat, and protein metabolism that affects an estimated 20 million people in the United States, of whom about one third are undiagnosed. There are two major forms recognized, type-1 and type-2. Both are characterized by inappropriately high blood sugar levels (hyperglycemia). In type-1 diabetes, the patient cannot produce the hormone insulin, while in type-2 diabetes the patient produces insulin, but it is not used properly. An estimated 90% of diabetic patients suffer from type-2 disease. The causes of diabetes are multiple and both genetic and environmental factors contribute to its development. The genetic predisposition for type-2 diabetes is very strong and numerous environmental factors such as diet, lack of exercise, and being overweight are known to also increase one’s risk for diabetes. Diabetes is a dangerous disease which affects the entire body and diabetic patients are at increased risk for heart disease, hypertension, stroke, kidney failure, blindness, neuropathy, and infection when compared to nondiabetic patients. Diabetic patients also have impaired healing when compared to healthy individuals. This is in part due to the dysfunction of certain white blood cells that fight infection.

The most common test used to diagnose diabetes is the fasting blood glucose. This test measures the glucose levels at a specific moment in time (normal is 80-110 mg/dl). In managing diabetes, the goal is to normalize blood glucose levels. It is generally accepted that by maintaining normalized blood glucose levels, one may delay or even prevent some of the complications associated with diabetes. Measures to manage diabetes include behavioral modification (proper diet, exercise) and drug therapies (oral hypoglycemic, insulin replacement). The choice of therapy prescribed takes into consideration the type and severity of the disease present and patient compliance. The physician may request the patient to keep a log of their daily blood glucose measurements to better assess therapeutic success. Another commonly obtained test is the hemoglobin A1c (HbA1c), which is a surrogate marker used to assess blood glucose levels over an extended period (2-3 months). This test provides the physician with a good picture of the patient’s glucose levels over time.

Oral changes are evident in poorly managed diabetics. These patients are at risk for numerous oral complications, such as periodontal disease, salivary gland dysfunction, infection, neuropathy, and poor healing. None of these complications are unique to diabetes. However, their presence may serve as an early clue to the possible presence of diabetes, prompting your dentist to perform or request further testing.

Periodontal disease is a commonly observed dental problem for patients with diabetes. It is similar to the periodontal disease encountered among nondiabetic patients. However, as a consequence of the impaired immunity and healing associated with diabetes, it may be more severe and progress more rapidly. The potential for these changes points to the need for periodic professional evaluation and treatment.

In conclusion, we can summarize the above by citing the American Dental Association, which states that those with diabetes are more at risk for getting periodontal disease; and those with periodontal disease are more likely to contract diabetes. Good hygiene and regular visits to the dentist will lower our risk for gum disease, as well as diabetes and other diseases. Keeping your blood sugar level within the normal range by proper diet and exercise will keep your body healthy and lower the risk of gum disease.

(This column is partly based on statements of the American Academy of Oral Medicine.)

If you would like more information about diabetes, call Dr. Chao in Alhambra, CA at (626) 308-9104 or visit www.alhambradental.com.

Dr. Chao proudly serves Alhambra and all surrounding areas.

Abscessed Teeth Increases Risk of Heart Attacks | Alhambra Dentist

In a study carried out at the University of Helsinki, in cooperation with the Heart and Lung Centre of the university and published in the Journal of Dental Research, a dental abscess (infection at the root tip of a tooth) increases the risk of coronary artery disease, even if there no pain. The study states, “Acute coronary syndrome (heart attack) is 2.7 times more common among patients with untreated teeth in need of root canal treatment than among patients without this issue.” In short, this study suggests a substantially higher risk of heart attacks among those with untreated abscessed (dead) teeth.

A dental abscess is a reaction of the body to microbial infection of the dental pulp, the nerve and blood vessels in the canals of the root. Dental caries (cavities) is the most common cause of abscesses.

Gum infections have been found to be associated with many common chronic diseases. Low grade inflammation generated by oral infections is postulated to be an independent risk factor for coronary artery disease and diabetes. This is the first study to link a need for root canal treatment to heart disease.

In this study of 508 Finnish patients with a mean age of 62 years who were experiencing heart symptoms, 58 percent were found to be suffering from one or more dental abscesses. Furthermore, these dental abscesses were connected with a high level of serum antibodies related to common bacteria. Thus, a dental abscess, whether painful or not, can affect other parts of the body as well.

Cardiovascular diseases cause more than 30 percent of deaths globally. They can be prevented by a healthy diet, weight control, exercise and not smoking. With regard to the health of the heart, measures should be taken to prevent or treat oral infections, as they are very common and often asymptomatic. Root canal treatment of an infected tooth may eliminate an unnecessary risk of heart disease. In other words, root canal treatment can save lives.

If you would like more information about cardiovascular disease, call Dr. Chao in Alhambra, CA at (626) 308-9104 or visit www.alhambradental.com.

Dr. Chao proudly serves Alhambra and all surrounding areas.

Gum Treatment Reduces Pain of Rheumatoid Arthritis | Alhambra Dentist

“After gum treatment my arthritis pain is at least 65% better.” Mary, age 36, has been suffering from rheumatoid arthritis (RA) for five years. Her suffering has been particularly from pain and swelling in the joints of the wrists, hands and toes. Because of the severity of the symptoms, her rheumatologist insisted that she see the dentist for treatment of noticeable oral infections. Her rheumatologist told her that removing sources of infection from the oral cavity may very well lessen the severity of her condition. Having been a reader of my columns for many years, she chose to come to this office for treatment. After uneventful non-surgical gum treatment, she was thrilled that pain had subsided by so much. Mary also said that she felt more energetic and definitely more enthusiastic about life. Even her complexion cleared up. Although we cannot predict the exact effect of gum treatment in every case involving rheumatoid arthritis, Mary’s experience is not uncommon in my practice. We have seen many cases just like Mary’s. In fact, this association between rheumatoid arthritis and gum treatment has been reported in various medical and dental journals for at least the past ten years. But what is the science behind this improvement?

A recent study published by the American Rheumatism Association compared the dental health of 44 patients with rheumatoid arthritis (RA) with 44 healthy patients. With 95% confidence level, the study concluded that RA patients are more at risk for gum disease (periodontitis), thus being more susceptible to gum disease. It came as no surprise, since a previous study also showed that patients with rheumatoid arthritis may have a higher risk for gum disease (periodontitis). In an article published in January 2008 in the Journal of Rheumatoid Arthritis, called Association of Periodontal Disease and Tooth Loss with Rheumatoid Arthritis in the US Population it was concluded that “RA (rheumatoid arthritis) may be associated with tooth loss and periodontitis”. This study involved 4,461 patients.

What is interesting is that a third study published June 2009 in an issue of the Journal of Periodontology titled Periodontal Therapy Reduces the Severity of Active Rheumatoid Arthritis in Patients Treated with or without Tumor Necrosis Factor Inhibitors showed that non-surgical treatment of gum disease “had a beneficial effect on signs and symptoms of RA”. The latter study was a collaborative project between the Division of Rheumatology, University Hospital Case Medical Center in Cleveland, Ohio and the Department of Periodontology, School of Dentistry of Case Western Reserve University. This study involved forty rheumatoid arthritis patients who also had been diagnosed for moderate or severe gum disease. Twenty received non-surgical gum treatment and the other twenty received no gum treatment. Six weeks of objective observation by rheumatologists and blood tests were done.

The story that these three studies tell is that RA patients tend to get periodontitis which if treated, may likely reduce symptoms of RA.

How are these two disorders related?  According to the summary of the literature, as reported in this article, rheumatoid arthritis and periodontitis (gum disease) share some common characteristics. Rheumatoid arthritis is an inflammatory disease wherein the autoimmune system attacks the hard and soft tissue of the joints. Periodontitis is a bacterially-incited inflammatory disease wherein the autoimmune system attacks and hard (bony) and soft (gum) tissue around the teeth. Bacteria that cause gum disease have been found in the joints of patients with rheumatoid arthritis. Patients with rheumatoid arthritis have been shown to have more antibodies against bacteria that cause gum disease than those patients without rheumatoid arthritis. Artificially-induced rheumatoid arthritis has been associated with development of gum disease in some laboratory experiments.

Hence it appears that studies reported in both medical and dental journals acknowledge the association between rheumatoid arthritis and periodontitis. Although there is no scientific basis to definitively conclude that there is a “causal” relationship as yet, there is no downside risk in having one’s gum disease treated, no matter whether you have rheumatoid arthritis or not. Furthermore, there is no dispute that removing infection from the gums and the mouth will not only save teeth, but also certainly improve one’s general health. In conclusion, for the rheumatoid arthritis patient who has gum disease or without, only good can come out of seeing the dentist. See your dentist regularly. You can’t lose.

If you would like more information about gum treatment, call Dr. Chao in Alhambra, CA at (626) 308-9104 or visit www.alhambradental.com.

Dr. Chao proudly serves Alhambra and all surrounding areas.

No More Root Canals! | Alhambra Dentist

What if there was no more need for root canal treatment to be done in order save a “dead” tooth? Researchers at the University of Nottingham and the Wyss Institute at Harvard University have developed new regenerative dental fillings that use stem cells inside our teeth to repair tissue. This can potentially make conventional root canal treatment a choice, but not the only alternative when you have an “abscessed” tooth, or a tooth which has a dead nerve.

This new regenerative filling contains “pluri-potent” cells, which have the biological potential of becoming whatever cells are needed to regenerate the nerves, blood vessels and other tissue in the canals of the tooth. This source of cells can actually be recruited by this innovative filling material.

During a root canal procedure, the pulp of the tooth and the nerve are removed. If the new treatment becomes available, fillings made of synthetic biomaterials would be inserted, stimulating dental stem cells to repair and regenerate dentin, which is the hard, organic substance that accounts for the root and inner structure of the crown of the tooth.

Stem cells can serve many different functions in the body, including repairs, according to the U.S. Food and Drug Administration. For example, stem cells are currently used to help treat spinal injuries, arthritis and diabetes.

Stem cells are already being used in dentistry to regenerate bone and gums through a process called Platelet Rich Plasma (PRP). In this application of stem cell regeneration, platelets from the patient’s drawn blood is concentrated through a centrifuging process. This process causes the plasma to be infused with high amounts of growth factors (stem cells). The enriched plasma is then reintroduced into the appropriate site to assist in the regeneration of bone and gum.  

Thus, stem cell research is now in the throes of revolutionizing the field of endodontics, the specialty concerned with saving teeth through root canal treatment. In the new era, endodontists, and perhaps general practitioners, will administer the regenerative filling material using the proper clinical protocol to regenerate the nerves of the tooth in a similar manner that dentists are now regenerating bone and gum with stem cell technology.

It is not expected that this regenerative filling material will be less costly than doing a regular root canal. Therefore, on the basis of cost alone, the public is advised to observe proper dental hygiene, as well as dietary recommendation to avoid developing cavities that can lead to abscessed teeth.  

It is, of course, important to see your dentist regularly for check ups and cleanings in order to avoid expensive, and possibly uncomfortable, root canals.

If you would like more information about root canal treatment options, call Dr. Chao in Alhambra, CA at (626) 308-9104 or visit www.alhambradental.com.

Dr. Chao proudly serves Alhambra and all surrounding areas.