See Your Dentist for Sleep Apnea and Snoring

According to the American Dental Association, sleep apnea is a common and serious sleeping disorder that happens when your regular breathing is interrupted during sleep.

Snoring is common among patients with sleep apnea but not all snorers have sleep apnea.

There are two main types of sleep apnea:

Obstructive Sleep Apnea. The more common form, it is the result of blocked airflow during sleep, usually when the soft tissue in the back of the throat collapses while you sleep. Health factors, such as obesity may contribute.

Central Sleep Apnea. Results from a problem with how the brain signals the breathing muscles. The airway is not blocked. Instead the brain fails to signal the muscles to breathe. This type of sleep apnea can occur with conditions such as heart failure, brain infections and stroke.

Sleep apnea can affect any one at any age, although men are more likely to develop the disorder. The risk is also greater for those:

· Over 40

· Overweight

· With large tonsils, large tongue, or small jaw

· With a family history of sleep apnea

· With a nasal obstruction due to a deviated septum, allergies, or sinus problem

If left untreated, sleep apnea can result in several health problems including:

· high blood pressure

· stroke

· heart failure, irregular heartbeat, and heart attack

· diabetes

· depression

· worsening of ADHD

Sleep apnea can be treated. There are several options:

Adjusting sleeping habits. This may mean simply not sleeping on your back.

Continuous Positive Air Pressure (CPAP). This is a device which improves breathing while you sleep. The device supplies air through the nasal passages and the air pressure keeps the airway open while sleeping.

Oral Appliances. Certain oral devices can shift and support the jaw to prevent the airway from collapsing. Research shows that oral appliances can successfully prevent sleep apnea in some mild to moderate cases.

Surgery. Upper airway surgery may be recommended when other treatment options are unsuccessful in eliminating the symptoms of sleep apnea. Depending on the location and nature of the airway obstruction, the procedure may be minimally invasive or more complex. It may be necessary to remove the tonsils or other parts of the soft palate or throat.

If you think you may have sleep apnea, make sure to speak with your dentist for more information and possible evaluation.


Frequent Recreational Use of Cannabis Is Associated with Gum Disease

Recreational use of Cannabis is permissible in some states, including California. Anecdotal and observational reports have pointed to Cannabis use being involved with receding gums and gum disease. An analysis of the data from the National Health and Nutritional Examination indicated the following:

Periodontal (Gum) disease, one of the most common chronic conditions in the United States, is a major cause of tooth loss among adults. Although periodontitis has a genetic component, factors such as increased age, gender, chronic conditions such as diabetes, exposure to tobacco, and oral hygiene may also increase the risk or severity of the disease.

Researchers examined data from the 2011-2012 cycle of the National Health and Nutritional Examination (NHANES) survey to evaluate whether cannabis use (i.e., marijuana or hashish) may also be a risk factor for periodontitis prevalence and severity.

NHANES is designed to be representative of the noninstitutionalized civilian population of the United States aged 30 years or older and includes both a demographic and behavioral questionnaire, as well as a full-mouth periodontal examination conducted at 6 sites per tooth.

This analysis was restricted to the 1,938 adults who received a complete periodontal examination and answered questions on substance use. Those who reported they used marijuana or hashish once or more every month for the last 12 months were categorized as frequent cannabis users, while those who reported using marijuana or hashish less than once per month were categorized as non-frequent cannabis users.

Frequent cannabis users had significantly greater clinical attachment loss than non-frequent, and significantly higher mean number of sites with pocket depths of 4 mm or more and attachment loss of 3 mm or more. Confounding factors for age, gender, race/ethnicity, family income, diabetes, alcohol and smoking, and treatment for gum disease within the past year were accounted for in the study. The odds of severe periodontitis were 1.4 higher for frequent cannabis users than those who never or rarely used cannabis.

This analysis demonstrates the effect of cannabis as a potential risk factor for periodontal disease.

Check with your dentist about the possible effect of cannabis use on your dental health.

(Portions of this article was excerpted from ADA News.)

Health Oral

Colorectal Cancer May be Started and Accelerated by Oral Bacteria

Two recent studies suggest that a type of gut bacteria found in the mouth may trigger colorectal cancer by influencing the immune response and switching on cancer genes.

The researchers believe their findings may lead to more timely and improved ways of diagnosing, preventing and treating colorectal cancer, the second leading cause of death from cancer among Americans. The culprit is called Fusobacteria, a type of bacteria in the mouth that is associated with periodontitis, more commonly called “gum disease.” This gum condition is the leading cause of tooth loss among adults.

These two studies were recently published in the Journal of Cell Host and Microbe. In the first study the researchers determined the oral bacteria, called Fusobacterium, were found in benign tumors that later turned cancerous. Furthermore in the mice model they found that Fusobacterium sped up tumor formation through the release of a type of immune cell called “myeloid cells.” The latter cells penetrate tumors and trigger inflammations that can lead to cancer. The researchers, Wendy S. Garrett, MD, PhD from the Dana-Farber/Harvard Cancer Center stated that, “Fusobacteria may provide not only a new way to group or describe colon cancers but also, more importantly, a new perspective on how to target pathways to halt tumor growth and spread.”

In the second study another group of researchers found that Fusobacterium uses a molecule that lives on the surface of the bacterial cells. This molecule allows the bacteria to stick to the human cells and facilitates the invasion of the normal human cell. The molecule called Fusobacterium adhesion A (FadA) switches on genes that spur cancer growth, triggers inflammation in the human cancer cells. The end result may be cancer. The researchers also found that the FadA is much lower in normal patients. This report also said that they identified a compound that can stop the effects of FadA on cancer cells. Even better news is that FadA, according to author Yiping Han of Western Reserve University of School of Medicine, FadA is a “marker that can be used for the early diagnosis of colorectal cancer. Furthermore, FadA can be used to find “therapeutic targets to treat or prevent this common and debilitating disease.”

The conclusion to be drawn from these two studies, as far as dentistry is concerned, is the importance of dental hygiene and regular professional dental care. Keeping the mouth as clean as possible, following common sense instructions and seeing the dentist and the dental hygienist on a regular basis is the best way to prevent abnormal growth of “bad” bacteria,” including the latest villain Fusobacterium. Thus it can be said that you have a lessened risk of colorectal cancer as well as other cancers if you keep your oral health in the optimal condition.

Also remember increased inflammation in the mouth may increase the inflammation index for the whole body. Abnormal inflammation in the body is associated with many diseases, such as Alzheimer’s, rheumatoid arthritis, heart ailments and diabetes, to name just a few.

As the eyes are windows to the soul, the mouth is the same to the body.


Flu Season is Coming: See your dentist to prevent bacterial pneumonia

Gum disease (periodontitis) is the number one cause of tooth loss in adults.

If you follow this column, you probably already know that periodontitis is caused by microorganisms and the toxic enzymes they secrete. Interaction of the host’s immune system with these organisms leads to the destruction of the gum and underlying bone that support the teeth. You probably also have heard that once these microscopic creatures make inroads into your gums and then invade your vascular system, they will continue to infiltrate your body through these blood vessels and impact different organ systems.

Cardiovascular disease, cancer, rheumatoid arthritis, pancreatic and other types of cancer and even Alzheimer’s have been linked to the presence of these “germs” in the affected organs.

With the “flu season” coming, you should know that respiratory infectious diseases such as bacterial pneumonia and bronchitis are common in the flu season, especially in institutionalized and elderly inpatients. It is believed that respiratory infection relies in part on the swallowing (aspiration) of oral bacteria into the lower respiratory tract and failure of host (patient) defense mechanisms to eliminate the contaminating bacteria, which then multiply to cause infection. Dental plaque, which accumulates between your dental visits, is the reservoir for these nasty microorganisms.

So, whether you decide to take the flu shot or not, do take time to see your dentist and have the plaque removed, at least.

Prevent gum disease. Prevent pneumonia.

Have a great holiday season!


High Blood Pressure Hard to Control? It May be Your Gums!

It is currently estimated that one in three U.S. adults is living with high blood pressure, yet less than half have their condition under control, according to the American College of Cardiology.

A recent study confirmed the link between gum disease and high blood pressure.

This study, published in the American Heart Associated journal Hypertension, included more than 11, 750 U.S. adults who were examined between 2009 and 2014. The goal of the study was to see if gum disease has any impact on blood pressure control.

After analysis, researchers found that among those with high blood pressure, those with gum disease had 2.3 – 3 mm Hg higher systolic blood pressure than those with healthy gums. Furthermore, patients with gum disease were also less likely to have their blood pressure under control with medication than those with good oral health.

The authors of this study suggest that gum disease may impact outcomes in patients with high blood pressure. Since these results indicated treatments for high blood pressure may not be as effective in patients with gum disease as it would in patients with good oral health. Hence, taking care of the teeth and gums may be an important way to help promote a healthy blood pressure.

Although the investigators cannot state, yet, there is a cause and effect between the two diseases, they point out that their findings add to a body of evidence linking gum disease to poorer heart health.

Gum disease, also referred to as periodontal disease, causes chronic inflammation of the gums. It currently affects nearly half of Americans over 30. Experts believe that inflammation from gum disease may trigger or worsen inflammation in other parts of the body, including blood vessels and arteries.

The best way to prevent gum disease is to see your dentist regularly and follow home card instructions, especially as to minimizing sugar intake.

So, if your follow your dentist’s advice, your dentist not only can save your teeth, but also your life.

Dental Health

Microorganisms on the tongue could help diagnose heart failure, according to research presented

Normal tongues are pale red with a pale white coating. Heart failure patients have a redder tongue with a yellow coating and the appearance changes as the disease becomes more advanced, the tongue coating differ between heart failure patients and healthy people, according to the research presented by author Dr. Tianhui Yuan, No.1 Hospital of Guangzhou University of Chinese Medicine.

This study investigated the composition of the tongue microbiome in participants with and without chronic heart failure. The study enrolled 42 patients in the hospital with chronic heart failure and 28 healthy controls.

The researchers found that heart failure patients shared the same types of microorganisms in their tongue coating. Healthy people also shared the same microbes. There was no overlap in bacterial content between the two groups.

Five categories of bacteria distinguished heart failure patients from healthy people, with decreases in levels of Eubacterium and Solobacterium, bacteria found in normal mouths.

The author suggested that more research is needed, but our results suggest that tongue microbes, which are easy to obtain, could assist with wide-scale screening, diagnosis, and long-term monitoring of heart failure. The underlying mechanisms connecting microorganisms in the tongue coating with heart function deserve further study.

It is interesting to note that tongue color, configuration and texture have been the hallmark diagnosis in Chinese Medicine, dating back thousands of years.

Perhaps the confluence of Western and Chinese Medicine in this regard portends more interesting developments in the future.


New Study Further Confirms How Diabetes Leads to Gum Disease

A new study led by University of Pennsylvania researchers has found that the oral microbiome affected by diabetes causes a shift in the likelihood of disease.

The microbiome is the microorganisms that coexist with our own cells. We depend on a vast army of microbes to stay alive. Microbiome protects us against germs, breaks down food to release energy, and produces vitamins.” Hence, when microbiome is affected by diseases such as diabetes, it has been hypothesized that we are more likely to succumb to diseases. This study proves that microbiome affected by diabetes causes gum disease (periodontitis) and explains how this happens.

The research, published in the journal Cell Host & Microbe this week, not only showed that the oral microbiome of mice with diabetes shifted but also change was associated with increased inflammation and bone loss around the teeth.

“Up until now, there had been no concrete evidence that diabetes affects the oral microbiome,” said Dana Graves, senior author on the new study and vice dean of scholarship and research at Penn’s School of Dental Medicine. “But the studies that had been done were not rigorous.”

Just four years ago, the European Federation of Periodontology and the American Academy of Periodontology issued a report stating there is no compelling evidence that diabetes is directly linked to changes in the oral microbiome. But Graves and colleagues were skeptical and decided to pursue the question, using a mouse model that mimics Type 2 diabetes.

“My argument was that the appropriate studies just hadn’t been done, so I decided, we’ll do the appropriate study,” Graves said.

The researchers began by characterizing the oral microbiome of diabetic mice compared to healthy mice. They found that the diabetic mice had a similar oral microbiome to their healthy counterparts when they were sampled prior to developing high blood sugar levels, or hyperglycemia. But, once the diabetic mice were hyperglycemic, their microbiome became distinct from their normal littermates, with a less diverse community of bacteria.

The findings underscored an association between changes in the oral microbiome and periodontitis but didn’t prove that the microbial changes were responsible for the disease. To drill in on the connection, the researchers transferred microorganisms from the diabetic mice to normal germ-free mice, animals that have been raised without being exposed to any microbes.

These recipient mice also developed bone loss. A micro-CT scan revealed they had 42 percent less bone than mice that had received a microbial transfer from normal mice. Markers of inflammation also went up in the recipients of the diabetic oral microbiome.


“We were able to induce the rapid bone loss characteristic of the diabetic group into a normal group of animals simply by transferring the oral microbiome,” said Graves.

With the microbiome now implicated in causing the periodontitis, Graves and colleagues wanted to know how. Suspecting that inflammatory cytokines, and specifically IL-17, played a role, the researchers repeated the microbiome transfer experiments, this time injecting the diabetic donors with an anti-IL-17 antibody prior to the transfer. Mice that received microbiomes from the treated diabetic mice had much less severe bone loss compared to mice that received a microbiome transfer from untreated mice. The findings “demonstrate unequivocally” that diabetes-induced changes in the oral microbiome drive inflammatory changes that enhance bone loss in periodontitis, the authors wrote.

Though IL-17 treatment was effective at reducing bone loss in the mice, it is unlikely to be a reasonable therapeutic strategy in humans due to its key role in immune protection. But Graves noted that the study highlights the importance for people with diabetes of controlling blood sugar and practicing good oral hygiene.

“Diabetes is one of the systemic diseases that is most closely linked to periodontal disease, but the risk is substantially ameliorated by good glycemic control,” he said. “And good oral hygiene can take the risk even further down.”

In conclusion, if you have diabetes, not only should you brush, brush, floss and see your dentist regularly, but also strictly control sugar intake. Even if the sugar you ingest doesn’t cause decay right off, the “good germs” (microbiome) will change so that you get gum disease.

So cut down the sugar, folks!


Oral Bacteria In Brain Clots

As published recently in the Journal of the American Heart Association, researchers from Tampere University in Finland analyzed blood clot samples from 74 subjects who received emergency treatment for ischemic stroke and found that 79% contained DNA from a common oral bacteria, called Streptococci mitis.

Simply put, oral bacteria likely grew in the brain clots.

Oral bacteria can stimulate endothelial cells, or cells that line the blood vessels, to secrete inflammatory signals from the immune system. This, in turn, contributes to the establishment of plaque in the blood vessels.

Inflammation caused by these oral bacteria can exacerbate atherosclerosis, a buildup of plaque on artery walls. When enough plaque builds up, strokes become more likely.

It appears logical that if oral pathogens (bacteria that cause inflammation) could be minimized, then the risk of strokes could be lowered. In fact, a study confirmed that regular dental care lowers the risk for this kind of medical emergency.

Another study published in this journal also determined that oral hygiene should be emphasized in the primary prevention of acute ischemic stroke. Periodontitis, gum disease leading to loss of bone around the teeth, involved uncontrolled inflammation of the gums caused by pathogens. This disease, which is the number one cause of adult tooth loss, were identified in this study as an independent risk for the occurrence of strokes.

How can you tell whether you have periodontitis? Here are some of the symptoms:

(1) Your gums bleed when you brush or floss your teeth.

(2) You notice your gums are receding and you can see bare roots.

(3) Dark holes (triangles) or spaces are seen between your front teeth.

(4) You notice bad breath or bad taste.

(5) Teeth are shifting or growing long, called getting “long in the tooth.”

(6) Your teeth are getting loose.

(7) Your bite is changing.

If you notice any of the above symptoms, see your dentist for rule out gum disease.

Save your teeth. Save your life.


Sugar Eats Away Your Teeth and Your Brain

According to the American Dental Association, Americans consume sugar, particularly in the form of sugar-sweetened beverages (SSBs), at an alarming rate.

SSBs are a leading cause of dental cavities, obesity, and type II diabetes. SSBs are sports drinks, energy drinks, fruit drinks, flavored milk, and other beverages that contain added caloric sweeteners.

Sadly, new evidence indicates SSBs are also associated brain shrinkage. So, it can be said that SSBs can eat away your teeth as well as your brain.

In the United States, SSB consumption has reached epidemic proportions. The average American is now consuming a whopping 50 gallons per person per year! This is the second highest consumption rate in the world (after Mexico). This consumption is equivalent to approximately 1.5 cans of soda per person per day. SSBs are the leading source of added sugar in the American diet and is strongly associated with the high rate of dental caries in the U.S. Obesity is associated with diabetes. The United States is amid an obesity epidemic fueled in great part by SSBs. Americans are among the most overweight and obese population in the world. Today, over two-thirds (69%) of all Americans older than 20 years are overweight, and just over one-third (35%) are obese. It is no wonder that the Center for Disease Control (CDC) reported that in 2017 more than 100 million adults in the United States have diabetes or pre-diabetes. This is estimated to be over 30% of the entire U.S. population.

What is not well known is, according to the Framingham Heart Study, one or more sugary drinks per day resulted in lower total brain volume, lower hippocampus volume. Hippocampus is an important part of the brain for memory and is also where the process of Alzheimer’s disease starts. In other words, normal shrinking of the brain due to aging is accelerated by consuming sugary drinks.

This study reported that those people who consumed one or two sugary drinks per day experienced the equivalent of 1.6 years of accelerated brain aging per year. Those subjects in the Framingham study taking in more than two sugary drinks per day showed an astounding 11.0 years of brain aging.

The Framingham Heart Study is a long-term, ongoing cardiovascular cohort study on residents of the city of Framingham, Massachusetts.The study began in 1948 with 5,209 adult subjects from Framingham and is now on its third generation of participants.

So, the next time you are tempted to drink a soda or other sugary drink, remember it’s not just your teeth but your brain that is also at stake. Don’t let these beverages eat away your brain!

Dental Health

Bite Guards Used to Treat Tourette Syndrome

Tourette syndrome is a neurological disorder characterized by vocal and motor tics, which can contribute to anxiety, depression, and low self-esteem. Researchers in Japan have developed a removable dental appliance (bite guard) that can reduce these tics in both children and adults with Tourette syndrome. The ability to ameliorate tics could positively impact the everyday lives of individuals with Tourette syndrome.

While there is no cure for Tourette syndrome, there are several available options to treat severe tics. These include behavioral (e.g. psychotherapy and cognitive behavioral therapy), pharmacological (e.g. medications that block dopamine in the brain), and more intrusive surgical interventions (e.g. deep brain stimulation, whereby motor areas of the brain receive electrical stimulation). However, the efficacy of these treatments can vary, and patients still frequently suffer from physical, mental, and social disabilities.

As an alternative treatment option, researchers at Osaka University have developed a custom-made oral splint. These are typically used for unconscious teeth clenching and grinding, and for temporomandibular disorders such as misalignment of the teeth or jaw. The oral splint is applied to the molars to increase the occlusal vertical dimension, which essentially means that the alignment of the nose, lips, and chin is altered. The study was recently published in Movement Disorders.

“Biting down on the device immediately improved both motor and vocal tics in 10 of the 14 children and 6 of the 8 adults that participated in the study,” says Jumpei Murakami, joint first author of the study. “What’s more, these effects were long-lasting. Long-term improvements in motor tics after more than 100 days were especially evident in patients who were younger when their tics first started.”

While it isn’t yet clear how the oral splint exerts these effects, the action of biting down could serve as a sensory trick. Sensory tricks are voluntary maneuvers that usually involve touching parts of the face and head and can alleviate involuntary movements. Sensory tricks have been well documented to temporarily improve dystonia, which is a movement disorder that is, like Tourette syndrome, characterized by uncontrollable tics.

“Considering previous findings on sensory tricks in patients with cervical dystonia, it seems possible that the oral splint modulates proprioceptive, or ‘touch’ signals,” explains Yoshihisa Tachibana, co-first author of the study. “These ‘touch’ signals might be modified by the muscles involved in jaw-closing before being relayed to the brain.”

Unlike Las Vegas, nothing happens in the mouth just stays in the mouth. Whatever happens to the mouth invariably spreads to the rest of the body, for good or bad. In this case, it’s potentially very good news, indeed. Dentists may be able to help patients with Tourette’s disorder.

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