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Hidden Tooth Infections Boost Heart Disease Risk

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Could an undetected infection at the root of a tooth be putting you at risk of heart disease? A Finnish study suggests it may.

“Acute coronary syndrome is 2.7 times more common among patients with untreated teeth in need of root canal treatment than among patients without this issue,” says researcher John Liljestrand.

Infection of the root of a tooth is most often caused by tooth decay.

The study included 508 Finnish patients with a mean age of 62 who were experiencing heart symptoms at the time of the study.

The coronary arteries of the patients were examined using angiography, and 36 percent of them were found to be suffering from stable coronary artery disease, 33 percent were undergoing acute coronary syndrome, and 31 percent did not suffer from coronary artery disease to a significant degree.

Their teeth were examined using panoramic tomography of the teeth and jaws. As many as 58 percent were found to be suffering from one or more inflammatory lesions.

The researchers also discovered that dental root tip infections were connected with a high level of serum antibodies related to the bacteria that cause such infections. This shows that oral infections affect other parts of the body as well.

Gum disease, such as periodontitis, is regarded as an independent risk factor for coronary artery disease and diabetes. Infections of root tips have been studied relatively little in this context, even though they appear to be connected with low-grade inflammation 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 reduce the risk of heart disease, but the researchers note that more research is needed.

Sealants are a Proven and Effective Therapy for Preventing Cavities in Children and Teens

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Study: Sealants may reduce caries by up to 80%

By Tony Edwards, Editor in Chief, www.drbicuspid.com

August 5, 2016 — Sealants may reduce carious lesions on the occlusal surfaces of permanent molars by up to 80%, according to a study jointly published by the ADA and the American Academy of Pediatric Dentistry (AAPD).

The authors of the review, hailing from multiple dental schools, organizations, and institutes, sought to summarize the available evidence regarding the effectiveness of dental sealants for preventing pit-and-fissure occlusal caries in primary and permanent molars on children, adolescents, and adults to develop a joint evidence-based clinical practice guideline (Journal of the American Dental Association, August 2016, Vol. 147:8, pp. 631-645).

“Sealants are a proven and effective therapy for preventing cavities in children and teens,” stated lead author Timothy Wright, DDS, in a release from the ADA and AAPD. “The joint report reaffirms that sealants should be a routine part of cavity prevention, as children with sealants are up to 80% less prone to cavities compared to those without them.”

Caries prevalence

In the U.S., nearly a quarter of children and more than half of adolescents have caries in their permanent teeth, according to data from the National Health and Nutrition Examination Survey 2011-2012. Pits and fissures on occlusal surfaces, especially those on permanent molars, increase the risk of these patients developing carious lesions, the authors noted.

“The joint report reaffirms that sealants should be a routine part of cavity prevention.”
— Timothy Wright, DDS, lead study author

The researchers started with more than 2,800 published studies from 1976 through 2016 for their systemic review and reduced the number to 24, including only parallel and split-mouth randomized controlled trials with at least two years of follow-up. They included studies whose authors reported sealant-effectiveness data compared with a control without sealants, fluoride varnishes, or other head-to-head comparisons.

In comparing sealant use versus nonuse, the researchers reviewed nine studies with a total of 3,542 participants. They found that those who received sealants reduced their risk of developing new carious lesions by 76% (95% confidence interval [CI]: 0.19-0.30; p < 0.00001) compared with participants who did not receive sealants.

The researchers also compared sealant use versus fluoride varnishes by reviewing three studies with a total of 1,715 participants. They found that those who received sealants had a 73% reduction in the risk of developing new carious lesions (95% CI: 0.11-0.69; p = 0.006) compared with participants who received fluoride varnishes.

Age of studies

The authors acknowledged several limitations with the review, including an inability to contact primary authors of the studies if there were issues related to risk of bias, as some of the trials were more than 20 years old. They also noted an inability to assess publication bias by means of using a funnel plot owing to the limited number of included studies per outcome.

More research is needed to provide more data about the merits of the different types of sealant materials, the authors noted.

“Available evidence suggests that sealants are effective and safe to prevent or arrest the progression of noncavitated carious lesions compared with a control without sealants or fluoride varnishes,” they concluded.

Survey: More pregnant women in U.S. visiting a dentist

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May 16, 2016
By Michelle Manchir

The number of pregnant women in the U.S. going to the dentist has increased 5.5 percent over the last year, according to survey data released in May from Delta Dental Plans Association.

In 2015, 57.5 percent of mothers in the United States reported they visited the dentist during their pregnancy, Delta Dental Plans Association said. The 2016 survey results show that number has increased to 63 percent.

“This is positive news and we’re glad expectant mothers are increasingly visiting the dentist. Oral health issues have a heightened risk of occurring during pregnancy, so being aware and on top of these is crucial,” said Dr. Bill Kohn, Delta Dental Plans Association’s vice president of dental science and policy, in a news release.

Most women who reported seeing a dentist during pregnancy — 37 percent — said it was a routine checkup, while 13 percent said they wanted to address a particular oral health issue and six percent said they wanted to discuss what to expect when it came to oral health while pregnant.

The survey was conducted between Dec. 16, 2015, and Jan. 14, 2016, among a nationally representative group of 1,307 parents of children ages 6-12.

Dental professionals can use ADA’s consumer website, MouthHealthy.org, to help inform patients about what’s safe and healthy for them during pregnancy.

For more information, visit MouthHealthy.org/pregnancy.

In 2015, The Journal of the American Dental Association published research that showed it’s safe for pregnant women to undergo dental treatment with local anesthetics.

The researchers compared the pregnancy outcomes between a group of women exposed to dental treatment with anesthetics and a control group that did not have treatment. The study showed that exposure to dental care and local anesthetics during pregnancy is not associated with increased risk for major medical problems in newborns.

Drinking Alcohol May Worsen Periodontal Disease

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canstockphoto27614364

The more alcohol people drink, the worse their periodontal condition may be, according to a new study in the Journal of Periodontology. The findings show that men and women who consume at least four alcoholic drinks per week have worse periodontal status than those who drink less than that amount monthly, or who do not drink alcohol at all.

The Brazilian researchers wanted to find out how alcohol usage affected the severity of periodontitis. After dividing patients into groups based on their alcohol consumption, they found that those who were alcohol-dependent had more plaque and higher clinical attachment levels than patients who drank less frequently.

“A higher severity of periodontitis has been reported among alcohol users with incremental odds for occurrence of the disease proportional to the frequency of alcohol consumption, as well as a higher need for periodontal treatment,” the authors wrote (J Periodontol, June 11, 2015). “Therefore, it is important to highlight that in the present study, alcohol-dependent users presented a higher plaque index and a higher severity of periodontitis.”

Link between alcohol and periodontitis

While many studies have linked alcohol consumption to other diseases, few have looked at its effects on periodontal disease. Since excessive alcohol intake can contribute to faster biofilm formation and alcohol users are more likely to have poor oral hygiene, the researchers wanted to see if alcohol consumption was associated with periodontitis.

“Alcohol-dependent users presented a higher plaque index and a higher severity of periodontitis.”

Alcohol-consumption questionnaires were given to men and women on the waiting list for medical and dental treatment from three health centers in Brazil. The patients were divided into four categories based on how much alcohol they consumed. Patients who consumed alcohol at least four times per week were categorized as alcohol-dependent, while those who did not use alcohol or used it less than monthly were deemed as nonusers or occasional alcohol users.

In the end, the researchers looked at 88 patients ages 35 to 55. The sample was divided into four groups of 22 people each based on their periodontal status and alcohol consumption levels:

  • ADP: alcohol-dependent with periodontitis
  • ADNP: alcohol-dependent without periodontitis
  • NAP: nonusers or occasional alcohol users with periodontitis
  • NANP: nonusers or occasional alcohol users without periodontitis

Despite the four groups having homogenous smoking status, educational levels, and body mass index, the alcohol-dependent groups tended to have worse periodontal status than the nonusers or occasional alcohol users.

“In the present study, the ADP group presented worse periodontal status and higher frequency of some periodontal pathogens,” the authors wrote. “The microbial analysis revealed significant differences in bacterial counts among the four groups, demonstrating higher counts associated with periodontitis and alcohol dependence.”

 

Periodontal condition by alcohol consumption and periodontal status
ADP NAP ADNP NANP
Plaque index 1.5 1.2 1.3 0.9
Site percentage PD 4-6 mm 15.3% 6.5% 0.31% 0.22%
Site percentage PD ≥ 7 mm 3.7% 2.3% N/A N/A
Site percentage CAL ≥ 4mm 16.4% 7.2% 5.4% 2.9%

PD = probing depth; CAL = clinical attachment level. Data from “Alcohol Consumption and Periodontitis: Quantification of Periodontal Pathogens and Cytokines,” Journal of Periodontology, June 11, 2015.

 

“Individuals without periodontitis showed significantly lower bacterial levels when compared to those with periodontitis, although with no significant difference in relation to alcohol consumption was observed,” the authors noted.

Alcohol users without periodontitis also had more plaque than their nondrinking counterparts. Alcohol’s drying effect on the mouth may contribute to plaque formation, triggering an inflammatory response in the gums, the researchers explained.

Encourage patients to be honest

While the study did present some significant findings, it consisted of a relatively small sample size, and the authors called for other researchers to look at larger samples and different populations. They also note that finding alcohol-dependent patients may be difficult.

“Although the topic of alcohol use and its effect on periodontal health requires further research, this report offers valuable insight on why our patients should care for their gums and teeth, especially if they enjoy the occasional drink,” stated Joan Otomo-Corgel, DDS, MPH, president of the American Academy of Periodontology, in a press release. “For patients who are diagnosed with periodontal disease, it’s imperative that they are encouraged to be completely honest about their drinking habits. This information can guide in determining appropriate treatment and next steps.”

 

Study: Half of oral cancer deaths due to cigarettes

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OralCancer

June 15, 2015 — Almost half of the deaths caused by cancers of the oral cavity and pharynx in U.S. adults 35 and older in 2011 were attributable to cigarette smoking, according to a multi-institution research letter published in JAMA Internal Medicine

Overall, almost 346,000 people died of one of 11 cancers in 2011 in the U.S. (see list below), including about 150,000 women and more than 197,000 men. Of these deaths, 48.5% were attributable to cigarette smoking.
“Cigarette smoking continues to cause numerous deaths from multiple cancers despite a half century of decreasing prevalence,” the authors noted (JAMA Intern Med, June 15, 2015).
There were more than 8,500 deaths in the U.S. from cancers of the oral cavity and pharynx in 2011. Researchers attributed 47% of these deaths to cigarette smoking. In comparison, more than 80% of deaths from lung, bronchial, and tracheal cancers and more than 76% of deaths from cancer of the larynx were attributed to smoking in the research letter (see chart below). Source: JAMA Intern Med (June 15, 2015).

chart

By gender, these deaths from oral and pharynx cancers broke down to more than 6,000 men and slightly more than 2,500 women. Just under half of these deaths (2,955) in men were attributed to smoking. In women, 43% (1,077) of deaths from cancers of the oral cavity and pharynx were attributed to smoking.

The authors noted that the 2014 U.S. surgeon general’s report provided an estimation of the annual number of smoke-attributable deaths from 2005 to 2009 from cancer overall and from lung cancer, but not from the 11 other cancers found to be caused by smoking.

“Updated estimates are needed because smoking patterns and the magnitude of the association between smoking and cancer death have changed in the past decade,” they noted.
The researchers, from the American Cancer Society, Harvard Medical School, the National Cancer Institute, and the Fred Hutchison Cancer Research Center, reported that while smoking prevalence dropped more than 5% (23.2% to 18.1%) from 2000 to 2012, the “risk of cancer death” among smokers increased over the same period.

The researchers noted one limitation of their study was the cohort populations, which were “less racially diverse” and “more educated” than the U.S. population in general. Also, exposure to secondhand smoke was not included in their analysis. Exposure to secondhand smoke is estimated to cause an additional 5% of lung cancer deaths, according to the 2014 U.S. surgeon general’s report.

The cancers in the study included colorectal; esophageal; kidney and renal pelvis; larynx; liver and intrahepatic bile duct; lung, bronchial, and tracheal; myeloid leukemia; pancreal; stomach; urinary bladder; and uterine cervix; and cancers of the oral cavity and pharynx.

“Continued progress in reducing cancer mortality, as well as deaths from many other serious diseases, will require more comprehensive tobacco control, including targeted cessation support,” the authors concluded.