Health

COVID-19 Patients with Severe Gum Disease are 3x More Likely to Experience Complications

November 26, 2022 No Comments
A new study of 568 COVID-19 diagnoses with severe gum disease (periodontitis) were at least three times more likely to experience complications including death, ICU admission and need for assisted ventilation, according to an article published in the Journal of the American Academy of Periodontology (AAP).

Additionally, COVID-19 patients with periodontitis showed increased levels of biomarkers associated with worsened disease outcomes including white blood cell levels, D-dimer, and reactive protein.

Conducted using the national electronic health records of the State of Qatar between February and July 2020, this study analyzed patient cases with severe COVID-19 complications (death, ICU admissions or assisted ventilation). The control group was comprised of COVID‐19 patients discharged without major complications. Periodontal conditions in the two groups were analyzed using dental radiographs from the same database.

Periodontal disease, commonly known as gum disease, can cause bleeding gums, bad breath, and if left untreated lead to tooth loss. Research from the AAP and the Centers for Disease Control and Prevention suggests up to half of US adults aged 30 and older have some form of periodontal disease. Periodontal disease has been linked to several other serious conditions in addition to COVID-19, including diabetes, heart disease, and Alzheimer’s.

According to the AAP, systemic inflammation is not only a symptom of COVID-19 but can also be a symptom of periodontal disease. Gum disease experts (periodontologists) are alerting the medical profession and the public to maintain healthy teeth and gums to avoid developing periodontal disease amid a global pandemic like COVID-19.

In other words, those COVID-19 diagnoses with gum disease should take care of their teeth and gums and seek treatment to optimize gum health. Those without COVID-19 should maintain good gum health to avoid gum disease to minimize the risk of being more vulnerable to coming down with COVID-19 and contract severe complications if they do come down with COVID-19.

Health

Gum Disease (Periodontitis) May Predispose You to COVID-19

November 26, 2022 No Comments
Gum Disease (Periodontitis) has long been known to possess the ability to incite an inflammatory response in gum tissue just like how COVID-19 similarly incites a much more severe, often lethal, inflammatory phenomenon in the body through chemicals called “cytokines.”

In COVID-19, these cytokines bring about the severe inflammatory responses called a “cytokine storm.” One such cytokine, called IL17, is also found in gum disease as well as the blood stream of the patient with periodontitis. In other words, one of the lethal cytokines (IL17) is found in periodontitis when the patient does not have COVID-19. The question then is, does periodontitis bring about a higher risk for COVID-19?

According to an article to be published in the November 2020 issue of the “Medical Hypothesis, “This common pathway of inflammatory response points towards a possible association between Periodontitis and COVID-19 related adverse outcomes. Understanding of this association underscores the importance of keeping periodontal disease under check and the value of maintaining meticulous oral hygiene in the COVID-19 era. It also points towards the possibility of the presence of periodontal disease as predisposing towards COVID-19 related adverse outcomes,”

In other words, periodontitis may predispose you to COVID-19.

So, how prevalent is periodontitis? According to the CDC one out of every two American adults aged 30 and over has periodontal disease. A study published in the Journal of Dental Research estimates that 47.2 percent, or 64.7 million American adults, have mild, moderate, or severe periodontitis. In adults 65 and older, prevalence rate is 70.1 percent.

So, what is periodontitis? It is a chronic inflammatory disease that affects the gum tissue and bone supporting the teeth, according to the American Academy of Periodontology. If left untreated periodontal disease can lead to tooth loss and other chronic inflammatory disease, such as diabetes, cardiovascular disease and even obesity.

Therefore, use your mask, practice social distancing, and keep your teeth and gums as healthy as possible.

Seeing your dentist can not only save your teeth, but also your life.

Health

Cotton Candy was invented by a Dentist…

November 26, 2022 No Comments
It is not known whether Dr. William J. Morrison (1860-1926) had an ulterior motive for inventing the soft confection, but the dentist no doubt helped ensure others in his profession continued drawing in plenty of customers.

In 1897, he partnered with confectioner, John C. Wharton to develop the “Electric Candy Machine” that spun sugar into candy (which at the time was known as “Fairy Floss”), and its been bringing kids cavities ever since.

In 1921, another dentist, Josef Lascaux attempted to improve the design and trademarked the name “Cotton Candy.” Dr. Lascaux sold the cotton candy to his patients.

When cotton candy is spun, the sugar can create up to a 4-mile-long string of sugar! One sticky, sweet cloud of cotton candy has less sugar than a can of soda, no fat, no cholesterol, no sodium and only has about 105 calories for a standard one ounce serving.

The basic cotton candy invented in 1897 is still the same today and is sold worldwide. It is still one of the most popular treats at carnivals, fairs, and festivals. Chewing Gum was first patented by a Dentist….

On December 28, 1869, William F. Semple (1834-1922) filed the first chewing gum patent. It was not the sweet candy that it is today. Dr. Semple hoped it would clean the teeth. His ingredients included chalk and powdered licorice root. Charcoal was also considered a suitable ingredient.

Although chewing gum can be traced back to civilizations around the world, modernization and commercialization took place in the USA.

Humans are the only animals that chew gum. If you give a piece of gum to a monkey, he will chew it for a minute and then stick it in his hair.

In the USA alone, the amount of gum sold in one year would make a stick 3.5 million miles long. Over 100,000 tons of gum is chewed each year, with consumers spending a half-billion dollars!

If you are one of the many who enjoy delicious Cotton Candy and chewing gum, be sure to visit your dentist regularly.

Health

Alzheimer’s and Dental Care

November 26, 2022 No Comments
Those with high levels of tooth plaque have a great risk of cognitive decline, although cause and effect is not clear, according to the December 15 issue of the British Dental Journal.  The link of gum disease and Alzheimer’s (AD) may be oral bacteria.

Oral bacteria invade the brain, promote inflammation, increase permeability of blood brain barrier, and have been found in the brains of those with AD and blood clots in cerebrovascular disease.

A USC study of 10,000 people showed twins with AD four times more likely to have periodontal disease in middle age, and a 7 year study of 100,000 found the dental cleanings reduced stroke risk by 13%.

For those with AD, appropriate preventive/treatment should be instigated to minimize dental disease as soon as possible.

Schedule AD patients at times of best alertness, which is late morning and early afternoon. Ensure dentures are labelled, cleaned professionally on a regular basis, and relined and renewed as necessary.

AD patients should be seen by the dentist regularly to maintain status quo, avoid pain and minimize further interventions.

Ensure that fear, stress and embarrassment for the caregiver and the person with AD are minimized.

Feel free to consult your dentist if you have any questions regarding a loved one with AD.

Health

Fight the Flu by Keeping Your Mouth Healthy and Free of Infection

November 26, 2022 No Comments
A healthy mouth is positively linked with reduced rates of heart disease and other chronic illnesses. How harmful bacteria in the oral cavity can increase susceptibility to harmful systemic viruses having been received more and more attention from researchers.

Many common oral bacteria associated with gum disease also have an immune-suppression effect that increases susceptibility to cold and flu viruses like influenza and rhinovirus, according to researchers at North Carolina State University in collaboration with the CDC and reported in the RDH Journal. According to the RDH Journal, two of the most virulent bacteria are: Porphyromonas gingivalis. P. gingivalis is found in the oral cavity. While it is generally present in low numbers, it has many ways of suppressing the immune system to evade immune responses. P. ginivalis has been linked to chronic immune conditions, rheumatoid arthritis, and viruses like HIV and herpes.

Streptococcus pneumoniae. S. pneumoniae is a bacteria generally found in the respiratory tract, sinuses, and nasal cavity. It becomes pathogenic when the host immune system is suppressed and colonizes the air sacs of the lungs. S. pneumoniae has a powerful ability to repair its own DNA when damaged by the host immune response, continuing to transfer itself to non-infected cells. While most frequently associated with pneumonia and meningitis, it is also positively associated with periodontitis and oral plaque and increases the risk of death when comorbid with the influenza virus.

Illness-causing viruses and bacteria interact in two ways:

● Direct interactions, in which a virus exploits a bacterial component to penetrate a host cell, leading to viral infestation, such as the flu.

● Indirect interactions, in which a viral infection causes increased spread of bacterial infections.

In short, a review of the literature suggests that heightened oral care may be an under-utilized avenue for prevention of disease and mitigation of lethality during cold and flu season. In addition to conventional flu prevention methods such as handwashing, avoiding exposure, and getting a flu shot, additional preventive methods specifically targeting oral health may be beneficial. Here are some additional ways patients can take care of themselves during the flu season:

● Get regular dental checkups and dental cleanings

● Brush and clean in between teeth regularly

● Wash your hands before flossing to prevent bacteria from entering the mouth

● Replace toothbrushes every 3-4 months, and discard a toothbrush if it was used while suffering from the cold or flu

● Thoroughly rinse toothbrushes after use and allow them to air-dry in an upright position between uses.

So see your dentist to keep your immune system operating at an optimal level.

Teeth

A Lasting Impression: A Great Smile

November 26, 2022 No Comments

It is accepted that a great smile is a great social asset and you are remembered for the great smile you have. So it is not surprising that a survey of adults found the following results:

* 92% agree that an attractive smile is an important social asset.

* 88% say that they always remember someone with an especially attractive smile.

* 85% find that an unattractive smile is less appealing to the opposite sex.

* 74% agree that an unattractive smile will negatively impact career success.

* Only 50% of respondents are satisfied with their smiles.

Some of the most common complaints people have with their smiles are those that they have had since childhood, such as discolored, gapped or crooked teeth. Other problems may be those that developed in adulthood, such as cracked or worn down teeth. Then there are teeth, which have had fillings that have discolored the front teeth, or crowns that no longer match the color of the natural teeth, which turned a darker color.

Whitening your teeth would generally be the first consideration. Very often when your teeth are whiter, minor discrepancies such as slight crowding of your front teeth will almost disappear. Your dentist may advise that all that you need may be the use of a home-bleaching product available over the counter. Failing that, you may ask your dentist to make home-bleaching trays that use a higher concentration of bleaching gel. Over a period of weeks you should see dramatic improvement. For those who want a whiter and even more dramatic result, in-office bleaching procedures that will whiten your teeth within one hour are available.

For gapped front teeth, bonding is generally the initial consideration. Cosmetic bonding calls for the dentist to incrementally build up spaces between the teeth with various shades of composite materials and then “paint” surfaces with additional composites of different hues, chroma and translucency to match the adjacent teeth. Techniques employing “optical illusion” in shaping the composites give the teeth the appearance of normal-sized teeth, without the gaps. This can be done without reducing the teeth. With some precautions and proper care cosmetic bonding can last many years without chipping or breakage.

In the case where the patient desires veneers, because of the strength and durability of enhanced porcelain, this procedure calls for reducing a slight amount of tooth structure to accommodate the thin layer of porcelain that will cover the surface of the teeth. The shell of thin porcelain is bonded over the tooth. Veneers do not change color or shine over time, and allow the dentist to do a complete makeover of the smile. Stunning results are achieved with this technique.

For crooked teeth, orthodontics is always a good alternative. Where bands and braces are impractical, veneering can bring changes in a matter of weeks. Transparent plastic “retainers” to move teeth also may be an alternative in some cases.

Where teeth are worn down, previously filled or capped, veneers or porcelain crowns may be a good solution. However, in the case where teeth have been worn down due to involuntary nighttime clenching or grinding, a bite guard should be worn so that new crowns or veneers would not be worn down again.

If you are among the 50% who are not satisfied with your smile, see your dentist for the solution that will work best for you. And if you are among the fortunate 50%, who are satisfied with your smile, see your dentist regularly so that you can maintain that great smile for a lifetime.

Children Health

Baby Teeth Showed Autism Associated with Lead and Other Heavy Metals

November 26, 2022 No Comments
According to the Centers for Disease Control and Prevention, as many as 1 in 68 children in the United Sates have autism spectrum disorder (ASD).

Researchers have shown that autism may be caused by a complex reaction between environmental factors and genetics. Separating these causative factors has been particularly challenging. A new study by Manish Arora, Ph.D., a dentist and environmental scientist at the Icahn School of Medicine at Mount Sinai in New York, has shown a way to isolate genetics from environmental factors, using baby teeth of ASD children. This was published in the journal Nature Communications.

Previous studies that have investigated the relationship between toxic metals, essential nutrients, and the risk of having ASD; but these studies showed only metal concentrations in the blood stream after ASD has developed. Information as to the level of toxic metal before ASD was diagnosed was left to guesswork. This study reasoned that if pre-ASD toxic levels can be determined, then environmental exposure toxic metals may be statistically separated from genetic factors.

The method used in this new study, however, manages to bypass many of these limitations. By looking at naturally shed baby teeth, the researchers explain, they have access to information that goes as far back as a baby’s prenatal life. And by studying twins, Dr. Arora and colleagues were able to separate genetic influences from environmental ones.

To determine how much metal the babies’ bodies contained before and after birth, the researchers used lasers to analyze the growth rings on the dentine (root structure) of the baby teeth. Much like looking at the age of a tree by examining the rings on its trunk, scientists can determine the amount of lead in dentine layers during different stages of development of the tooth bud. By this means, the scientists were able to ascertain the level of exposure to lead at different stages of fetal development prior to birth.

Laser technology allowed the scientists to accurately extract specific layers of dentine, which is the substance that lies beneath the tooth enamel.

Cindy Lawler, Ph.D., head of the National Institute of Environmental Health Sciences (NIEHS) Genes, Environment, and Health Branch, explains the importance of using this scientific method for studying autism:

“We think autism begins very early, most likely in the womb, and research suggests that our environment can increase a child’s risk. But by the time children are diagnosed at age 3 or 4, it’s hard to go back and know what the moms were exposed to. With baby teeth, we can actually do that.”

To isolate genetic factors causing ASD, the scientists recruited 32 pairs of twins. The scientists were able to compare the twin that developed ASD to the twin that has not. The study showed that the difference between the ASD twin and the normal twin was only the level of lead in the blood stream. Hence the conclusion is that heavy metals, or the body’s ability to process them, may affect ASD and that children with ASD had much higher levels of lead throughout their development.

Finally, manganese and zinc were found to correlate with ASD as well. Children with ASD seemed to have less manganese and less zinc than children without, both pre- and postnatally.

Overall, the study suggests that either prenatal exposure to heavy metals, or the body’s ability to process them, may influence the chances of developing autism.

Dr. Arora called the method “a window into our fetal life.” More extensive studies based on using baby teeth to look through this window are recommended by Dr. Arora.

Dr. Arora‘s study represents one of the numerous ways dental science impacts medical research. Dentists are working side by side with physicians and scientists to generate solutions to health problems.

Health

Bad Bite & Bad Posture Related? Can a Better Bite Give You Better Athletic Performance?

November 26, 2022 No Comments
Dental occlusion or “your bite” could be defined as contact between the top and bottom teeth when closing the mouth. Correction of the bite through orthodontic and other treatments leads to better dental health. It’s been known in the field of occlusion that malocclusion (bad bite) may be associated with neck, back and other postural problems.

Lately, two new studies appear to further confirm this clinical hypothesis.

Two new studies, carried out in collaboration between the Department of Physiology at the University of Barcelona (Spain) and the University of Innsbruck (Austria), indicate a connection between bad bite and poor posture.

“When there is a malocclusion, it is classified according to scientifically established criteria. What is relevant in the study is that malocclusions have also been associated with different motor and physiological alterations,” explains Sonia Julià-Sánchez to Sinc, the main author of the studies and a researcher at the Catalan University.

Both studies, whose results have been published in Motor Control and Neuroscience Letters, provide conclusive data which show that postural control is improved -both in static and dynamic equilibrium- when different malocclusions are corrected by positioning the jaw in a neutral position.

It has been known that athletic performance can be enhanced through bite guards as well as other means of bite correction. These studies further emphasize the role occlusion plays in the prevention of injuries such as sprains, strains and fractures caused by unexpected instability as fatigue increases and motor control capacity decreases.

“Therefore, it would be helpful for both the general population and athletes to consider correcting dental occlusions to improve postural control and thus prevent possible falls and instability due to a lack of motor system response,” adds Julià-Sánchez.

“Postural control is the result of a complex system that includes different sensory and motor elements arising from visual, somatosensory and vestibular information,” explains the expert.

Dr. Julià-Sánchez explains neurophysiological aspects of the phenomenon. There is a reciprocal influence between the trigeminal nerve and the vestibular nucleus ‑which are responsible for the masticatory function and balance control, respectively‑ as well as between the muscles of mastication and of the neck.

This influence would explain why dental malocclusions negatively affect postural control. Up until now, however, there was no conclusive research.

“The main problem stems from the fact that the majority of these studies had statically assessed balance under conditions of total stability, which in practice has little actual application in the control of posture while in action,” points out Julià-Sánchez.

The first study took into account the type of dental occlusion as well as whether there had been previous orthodontic treatment. The results showed that alterations in alignment of the teeth were related to poorer control of static balance.

The second study assessed the type of dental occlusion, control of posture and physical fatigue in order to analyze a possible relationship among these factors. The analysis demonstrated that balance improved when malocclusions were corrected, and that the latter had a greater impact on postural control when subjects were fatigued than when they were rested.

The take home lesson from these studies is that, no matter what age or occupation, malocclusion should be corrected. This could at the least prevent falls and accidents.

So see your dentist regularly and ask about your “bite.”

Teeth

Bleachorexia: Excessive Teeth Whitening

November 26, 2022 No Comments
Excessive, unsupervised teeth whitening, dubbed “Bleachorexia,” may lead to receding gums and oversensivity, according to a news segment on Good Morning America.

This TV program cited Dr. Laurence Rifkin who treated five-time World Boxing Council champion Mia St. John for “bleachorexia.” St. John “constantly” bleached her teeth to the point her dentist warned her that her teeth might turn to “mush.” A good thing can become a bad thing, if overdone, said Dr. Rifkin. For that reason some dentists have coined a new term, “Bleachorexia,” to describe excessive, or obsessive preoccupation with teeth whitening.

Also interviewed on this show was Dr. Jen Ashton who quoted the position of the American Dental Association (ADA) with regard to teeth whitening. Dr. Ashton stated that teeth whitening should only be done after consultation and examination with your dentist. Especially if you already have crowns, fillings or veneers on your teeth, you should be treated under the supervision of your dentist. The ADA warned that there is not enough evidence to support long-term, unsupervised and/or repeated use of bleaching products.

When consulting with your dentist, it would be important to have the front teeth examined to determine whether there are fillings, crowns or veneers and their relative condition. Should “leaky fillings” be replaced first to prevent bleaching agents from leaking through to the nerve? Would dark fillings be bleached as white as the teeth? Would these darker fillings be even more obvious when the teeth become whiter? Crowns and fillings do not whiten. Would there be a contrast problem? Are the gums in good shape? If not, can inflamed gums be irritated and can they become painful if exposed to bleaching agents? These are the many questions to ask your dentist before you allow bleaching agents to be applied to your teeth.

The following is the ADA statement on teeth whitening:

“The ADA recommends that if you choose to use a bleaching product, you should only do so after consultation with a dentist. This is especially important for patients with many fillings, crowns, and extremely dark stains. A thorough oral examination, performed by a licensed dentist, is essential to determine if bleaching is an appropriate course of treatment. The dentist and patient together can determine the most appropriate treatment. The dentist may then advise the patient and supervise the use of bleaching agents within the context of a comprehensive, appropriately sequenced treatment plan … Patients should be cautioned that not enough information is available to support unsupervised long-term and/or repeated use of bleaching products.”

Nothing can be gained by bypassing your dentist and hygienist when you consider improving your teeth and your dental health by means not recommended by the ADA.

Health

Diabetes Leads to Gum Disease; Gum Disease leads to Diabetes

November 26, 2022 No Comments
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 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.)

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