Gum Disease Can Raise Your Blood Sugar Level

According to the American Diabetic Association, roughly 10% of the U.S. population have diabetes and about 30% (84 million) have prediabetes. 1.5 million Americans are diagnosed with diabetes. It is the 7th leading cause of death in the U.S.

Now for the good news.

It has been known for a long time that people with diabetes, especially uncontrolled diabetes, have more gum disease than those without diabetes. According to the American Dental Association, scientists are finding that gum disease may raise blood sugar levels in people with and without diabetes. Conversely, the good news is that in people with type 2 diabetes, treatment of severe gum disease can lead to a drop in blood sugar levels. The benefit is about the same as you might find if you add another drug to your usual diabetes medicine.

For the 84 million Americans who have prediabetes, there is also good news. The American Dental Association has reported a study in Denmark that showed periodontitis accelerates the progression of prediabetes into diabetes. Hence treating and controlling periodontitis is a way to lower the risk onset of diabetes for these 84 million American who are pre-diabetic.

How would one know whether or not one is already pre-diabetic? When you see your physician on a regular basis for routine blood tests, screening for diabetes will reveal your status. One of the clues to whether you have additional risk factors for diabetes is a family history of diabetes. And incidentally one of the risk factors for gum disease is family history of gum disease and loss of teeth.

How does gum disease make blood sugar levels go up? Scientists think that some of the germs in infected gums lead into the bloodstream after normal activities such as chewing or tooth brushing. This starts a reaction from your body’s defense system, which in turn produces some powerful molecules (biochemicals, such as cytokines) that have harmful effects all over your body. One of the things these molecules do is to raise blood sugar levels.

Since fully 40% of the population has issues with diabetes or prediabetes, and half of the population have periodontitis, it is essential that everyone visit the physician and the dentist regularly. It will save your life and your teeth.

Healthy teeth mean a healthy life. A healthy life means healthy teeth.


Gum Treatment Reduces Pain of Rheumatoid Arthritis

“After gum treatment my arthritis pain is at least 65% better.”

Mary, age 63, 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 4461 patients.

What is interesting is that a third study published in 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, 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 tells is that RA patients tend to get gum 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 and everybody else, only good can come out of seeing the dentist. So see your dentist regularly.

You can’t lose.


Is Brushing Your Teeth in the Shower Good or Bad for You?

Should you brush your teeth in the shower? Is it estimated that about 4% of Americans routinely brush their teeth in the shower according to a recent survey by the Delta Dental Plans Association, a dental-insurance provider. That’s about 13 million people.

What are the pros and cons? Some say that it saves time and water. As to saving time, it’s debatable. To save time, one would have to multi-task by scrubbing the body and brushing the teeth at the same time. But if you are loitering in the shower, it would make sense that by brushing your teeth there you are saving time.

As to saving water, according to the American Water Works Association, a nonprofit founded to improve water quality and supply, modern shower heads use 2½ to 3½ gallons a minute, versus 1 to 3 for sinks. Especially if you are turning off the water while you are brushing over the sink, it appears that you would be saving some water.

Some folks even brush their teeth in the bath. They would have to not spit out the toothpaste nor rinse out the mouth until they get out of the bath tub. What if you swallow the toothpaste? You might be ingesting the fluoride, which is a poison in high doses.

The American Dental Association (ADA) says there isn’t any harm in shower brushing, as long as it gets done twice a day and that the toothbrush doesn’t stay in there. A moist environment is more conducive to bacteria growth, and if the shower doesn’t completely dry between uses, the toothbrush can be susceptible to bacterial growth, the ADA says. This may be somewhat inconvenient for some folks. You’d have to take out the toothbrush each time to let it dry between showers. But if you can do it, the ADA would have no objection.

But the ADA does recommend flossing your teeth regularly. Wrapping your wet fingers around a floss and trying to floss your teeth without the aid of a mirror would be somewhat challenging for most people. You can use disposable plastic flossers that come in various shapes and sizes. They have small handles with a fork strung with a floss. They might be less difficult in some way.

For those folks with food traps between teeth, flossing is a must and is not optional. So, if you need to floss regularly, it would make sense for you to brush and floss over the sink, rather than brush your teeth in the shower, then floss your teeth over the sink.

If you think about it, flossing in the bath tub may not be something you’d want to do.

My recommendation is that since you should brush and floss your teeth regularly you should do both over the sink.

If you still have questions, ask your dentist.


Jowl Lines May Be Caused by Grinding Your Teeth (Bruxism)

There is a muscle that attaches the corners of our mouth to the border of the lower jaw. It is called the “depressor anguli oris.” It is also called the “triangularis”. Triangularis is a muscle of facial expression. Specifically it allows us to frown. It stands to reason if we frown a lot, we are likely to over-develop this muscle.

The consequence is “jowl lines” that go at an angle from the corners of the mouth to the bottom of the lower jaw.

The bad news is that you don’t have to frown a lot to get jowl lines. You can get jowl lines just from unconsciously clenching and grinding your teeth. You would be doing something a lot of people do unconsciously during sleep, and even during the awake hours. This unconscious habit is called bruxism. According to the American Sleep Disorders Association, the prevalence of bruxism varies from 5 to 20 percent.

The wide range is due to reporting something you are not, by definition, aware of. Your dentist can with some confidence diagnose you as having bruxism if you have obvious signs of excessive wear on your teeth that cannot be attributed to what you eat and chew. If you are told you have bruxism, don’t fight it. Excessive wear of your teeth is forensic evidence you are unconsciously doing it during the daytime, or you are doing it while you are in certain stages of sleep.

So what do you do with habit? It needs to be changed. How? Your dentist can make you a specially designed and calibrated oral appliance that gives you an ideal bite. This ideal bite will lessen the tendency to clench and grind. But to change the habit, you will need to wear this appliance 24 hours per day for at least 6 months and often as long as two years. While you wear the appliance, you must remember to use it as a “biofeedback appliance” that will train your muscles not to clench and grind.

Every time you bite into it, you will be able to tell you are doing so. After a period of time, the muscles will learn not to clench or grind. This is just like training your muscles to golf or play tennis. It takes practice.

The bite appliances are not obtrusive nor obviously visible, especially if your dentist makes it to fit over your lower teeth. The benefits would be that you won’t wear your teeth down and you won’t get “frown” or “jowl” lines in your face.

Seeing the dentist can give you good dental health, as well as save you from facelifts, botox injections or dermal fillers. Don’t forget your regular checkups.


Long in the Tooth May Mean Shorter Life

The number of teeth you keep as you get older could indicate just how long you will keep getting older. The main reason for loss of teeth in adulthood is gum disease, called periodontitis.

This disease causes bone loss, which leads to loosening and drifting of the front teeth. This leads to the phrase, “long in the tooth,” which implies old age.

Aside from periodontitis, recent research has closely related tooth loss to “stress” during a person’s life, including specific social, emotional, economic, and educational experiences as well as health issues like chronic disease, genetic conditions, nutritional intake, and lifestyle choices. According to studies cited by the Oral Health Foundation, smoking or just continued poor oral health leads to premature loss of teeth.

No matter the cause of tooth loss, people who had lost 5 or more teeth by the age of 65 years were more likely to suffer from cardiovascular disease, diabetes, and osteoporosis, all of which could severely limit life expectancy, according to the Oral Health Foundation.

Another study concludes that the number of teeth in aging humans can affect longevity and life expectancy. Also, tooth loss is a predictor of shortened longevity.

The Oral Health Foundation is encouraging people to pay close attention to their mouth and to visit their dental team regularly to check for any signs of disease that could lead to tooth loss. The organization also notes that a similar study found that people who have a full set of teeth when they are 74 years old are significantly more likely to reach the age of 100.

“It is very evident that what is going on in our mouths can really be a useful window to our overall health. It is therefore vital that we take proper care of our mouth and pay close attention to what is happening, as it could be a sign of something more serious,” according to the Oral Health Foundation.

So, if you don’t want to get “long in the tooth,” visit your dentist regularly and reduce sugar intake. And do not smoke.


Maintaining Good Health by Taking Care of Your Toothbrush

Most dentists agree you should change your toothbrush at least every two to three months.

According to a recent report, “20 Things You Should Throw Away For Better Health”, by TIME (1/30, Jones) a toothbrush is one of these things. The American Dental Association (ADA) spokesman, Ruchi Sohota, was quoted to say, “Toothbrush bristles start to fray after two months and should be replaced by three months”.

After daily wear, a toothbrush can get worn and become less effective in cleaning teeth and gums. Bacteria, germs, and fungus can flourish in between the bristles. Putting a wet toothbrush in an enclosed case can cause mold to grow on it. Let your toothbrush dry before putting it a case.

It is very important to change your toothbrush after you have had a cold, flu, mouth Infections, cold sores, and sore throat. This will help you from re-infecting yourself and others. Even if you are not sick, bacteria and fungus can still grow on your toothbrush.

Always rinse, shake any excess moisture, and air dry your toothbrush after you brush your teeth. Also try to keep your toothbrush away from any flushing commode because of germs that may travel with any aerosols.

Taking care of your tooth brush can help you have a healthier 2015!

Micro-Robots: Treat Gum Disease, Dental Decay and Implant Infection

A swarm of micro-robots, directed by magnets, can break apart and remove dental biofilm, or plaque, from a tooth and potentially treat gum disease, infected implants and prevent tooth decay, according to a report published in Science Robotics at the School of Dental Medicine and the Edward Steager School of Engineering and Applied Science.

A team of engineers, dentists, and biologists from the University of Pennsylvania developed a microscopic robotic cleaning crew. With two types of robotic systems — one designed to work on surfaces and the other to operate inside confined spaces — the scientists showed that robots with catalytic activity could ably destroy biofilms, sticky amalgamations of bacteria enmeshed in a protective scaffolding. Such robotic biofilm-removal systems could be valuable in a wide range of potential applications, from keeping water pipes and catheters clean to reducing the risk of tooth decay, endodontic infections, and implant contamination.

Presently “teeth cleaning” and “deep cleaning” is basically manual removal of biofilm and its end products. These dental procedures are labor intensive and costly. Micro-robotics may be a means of providing the same essential service in a cost effective and minimally invasive manner.

Using the robotic technology, the dentist can use magnets to direct “iron-oxide-containing nanoparticles” to breakdown plaque (biofilm) under the gums better than with using instruments. This method, called catalytic antimicrobial robotics (CAR), can more effectively kill bacteria than the traditional techniques and, also remove the debris with precision. CAR may be able to reach areas on tooth surfaces that are hard to reach, such as dead spaces between multi-rooted teeth, such as molars. The capacity of CAR to expeditiously remove the leftover debris would be an additional improvement over the manual method.

Changes in dental treatment are coming, but don’t hold your breath. It may be some time yet before CAR becomes widely available.

So, continue to see your dentist for routine checkups and treatment


No More Root Canals?

What if there is 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 has developed new regenerative dental fillings that use stems cells inside our teeth to repair tissue. This potentially can 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 has the biologic 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 actually can 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 stems cells to repair and regenerate dentin, which is the hard, organic substance that accounts for root and inner structure of the crown of the tooth.

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

Stems 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 blood drawn from the patient is concentrated through a centrifuging process. This process causes the plasma to be infused with high amount of growth factors (stems cells). The enriched plasma is then reintroduced into the appropriate site to assist in the regeneration of bone and gum.

Thus, stems 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 the similar manner that dentists are now regenerating bone and gum with stems cell technology.

It is not expected that this regenerative filling material will be less costly than doing 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 regular for check ups and cleaning in order to avoid expensive and possibly uncomfortable root canals.


Obesity and Gum Disease

There is a connection between obesity and gum disease, says a study conducted at the Case Western University School of Dental Medicine and published in the British Dental Journal recently.

This study showed that increased body mass, waist circumference and percentage body fat may be associated with increased risk to gum disease. However, there is, yet, not enough concrete evidence to establish a cause and effect connection.

Nevertheless, this study showed that changes caused by obesity or gum disease create changes in body chemistry which leads to inflammation. The more the inflammatory burden in the body, the more likelihood for diseases of an inflammatory nature, such as diabetes, heart disease and pulmonary disorders to develop.

On the other hand, the more we can reduce inflammation in the body, the healthier we are, the longer and healthier our lives. This column has previously discussed the statistical connection between gum disease (periodontitis) and variety of systemic diseases, such as Alzheimer’s, cardiovascular disorders, pancreatic cancer, ulcers and pulmonary diseases, all of which involved abnormality in the level of chronic inflammation. Therefore, resolving gum disease just may reduce the risk of developing the above conditions. And perhaps keeping the gum healthy will also lessen the risk of obesity.

The new “thought” of the researchers is that perhaps effectively treating obesity may also reduce the risk of periodontal disease as well as other inflammatory disease of the body.

It is entirely possible that eliminating obesity may also make the treatment of periodontal disease more effective and long lasting.

See your dentist regularly. Keep your teeth and your health all the same time!


Getting Teeth Cleaned Reduced “Bad” Cholesterol by 30%

A study of 273 aboriginal Australians showed that treatment of gum disease with “deep cleaning” was so able to reduce the thickness of the carotid artery that this change can be equated to having reduced “bad cholesterol” by 30%.

This study was conducted by the University of Sydney and published in Hypertension online June 23, 2014. The author, Michael Skilton, BSc, PhD, said that,” The study shows that the non-surgical periodontal therapy significantly reduced the progression of thickening of the carotid artery over a one-year period”. He further explained, “The effect is comparable to a 30 percent [decrease] in low-density lipoprotein cholesterol [levels]—commonly referred to as ‘bad’ cholesterol—which is associated with a decreased risk of heart disease”.

Dr. Skilton led a team of researchers from The University of Sydney and other Australian and U.S. institutions. They enrolled 273 aboriginal Australians who had periodontitis in a parallel-group, open-label, randomized clinical trial. Participants in the intervention group received full-mouth periodontal scaling during a single visit. Those in the control group received no treatment.

Follow-up data were available for 169 participants at three months and 168 participants at 12 months.

After 12 months, participants in the intervention group had experienced a significant decrease in intima-media thickness—an indicator of arterial structure—but those in the control group did not, the authors reported. In contrast, there were no significant differences between the groups in pulse wave velocity, an indicator of arterial function.

“Future studies may tell us whether a more intensive approach to periodontal therapy, including regular periodontal maintenance schedules, can produce more marked improvements in vascular structure,” Dr. Skilton said.

So don’t wait when you have gum disease.

See your dentist and save your life.

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