Postmenopausal women have a new health message to hear. Two annual dental checkups aren’t enough. Older women need more, according to research findings from the Case Western Reserve University School of Dental Medicine and the Cleveland Clinic. That message comes from a comparison study of women on and off bone-strengthening bisphosphonate therapies for osteoporosis. Leena Palomo, assistant professor of periodontics from the dental school, and Maria Clarinda Beunocamino-Francisco from the Center for Specialized Women’s Health at the clinic, set out to study the long-term effects of bisphosphonate therapies on the jawbone, but came up with this new finding that impacts all women after undergoing menopause.
Twenty-eight postmenopausal women with normal bones were compared with 28 women on bisphosphonate therapies for at least two years or more. The participants (all between the ages of 51 and 80) received conebeam CT scans of their jaws and a complete periodontal check for dental plaque, bleeding, and loss of bone attachment and of the alveolar bone socket. Both groups of women had followed the recommended American Dental Association oral health standards to brush twice daily, floss and have at least two dental checkups a year.
The findings for bone strength and other markers for osteoporosis were similar for both groups. But the researchers found both groups had abnormally increased dental plaque levels, which could endanger the jawbone of normal postmenopausal women and reverse any benefits gained in bone mass. Bacterial dental plaque is the primary cause of gum disease and associated bone loss in the jaw. The findings suggest that post-menopausal women may have an increased risk for periodontal disease. If that bone loss isn’t stopped, Palomo said, a woman could potentially lose her teeth. “Women also have to realize that bone disease and gum disease are two separate diseases,” Palomo said. The bisphosphonate therapy isn’t enough to keep jawbones strong and healthy, she added. That means it is very important to eliminate or reduce the dental plaque. Dr. Palomo advised that women may need to see the dentist as many as four times a year to control dental plaque by deep periodontal cleanings.
The research findings were announced in the article, “Is long-term bisphosphonate therapy associated with benefits to the periodontium in postmenopausal women?” that was published in the February issue of Menopause.
Source: Science Daily
Case Western Reserve University (2011, March 21). Message to postmenopausal women: ‘Increase yearly dental checkups,’ researcher urges. ScienceDaily. Retrieved March 24, 2011, from http://www.sciencedaily.com /releases/2011/03/110310173210.htm
Journal Reference:
- Leena Palomo, Maria Clarinda A. Buencamino-Francisco, John J. Carey, Mala Sivanandy, Holly Thacker. Is long-term bisphosphonate therapy associated with benefits to the periodontium in postmenopausal women? Menopause, 2011; 18 (2): 164-170 DOI: 10.1097/gme.0b013e3181e8e2a2
Photo: sodahead.com
Using a bone-creating protein to augment the maxillary sinus could improve dental implant success, according to Georgia Health Sciences University researchers. Dental implants, screws that anchor permanent prosthetic teeth, won’t work if the bone in which they are anchored is too thin. Bone-thinning is a common cause and consequence following tooth loss. The current favored solution is to supplement the area with bone grafts to stabilize the implant base. But that technique is problematic “primarily because it involves additional surgeries to harvest the bone,” said Dr. Ulf M.E. Wikesjö, Interim Associate Dean for Research and Enterprise in the GHSU College of Dental Medicine. In animal studies, he and his team at the GHSU Laboratory for Applied Periodontal & Craniofacial Regeneration found that implanting bone morphogenetic protein in the sinus more new bone will form within four weeks than using conventional bone grafting at the same site. “We found that BMP induced superior bone quality over that following bone grafts, which improves the chances for successful implants,” Wikesjö said. “BMP is phenomenal, because it’s a true, off-the-shelf product with ease of use that can produce real results, and it could be the new gold standard for this procedure.”
According to the American Association of Oral and Maxillofacial Surgeons, 69 percent of adults ages 35-44 have lost at least one tooth due to decay, disease or trauma, and 26 percent of adults have lost all permanent teeth by age 74. Before dental implants were available, the only options for replacing these missing teeth were dentures and dental bridges, both of which could lead to further bone loss. Implants provide patients with numerous benefits, including improved oral health, appearance, speech, convenience, durability and ability to eat.
The findings of his team’s pilot study were presented March 4 at the Academy of Osseointegration annual meeting in Washington, D.C. Wikesjö’s GHSU co-investigators include Drs. Jaebum Lee, Cristiano Susin, Nancy Rodriguez and Jamie de Stefano.
Kudos to the these researchers who continue to look for ways to improve our surgical outcomes and improve the quality of life for our patients! Your comments are appreciated.
Source: Science Daily
Georgia Health Sciences University (2011, March 6). Bone-creating protein could improve dental implant success. ScienceDaily. Retrieved March 24, 2011, from https://www.sciencedaily.com /releases/2011/03/110304151018.htm
Photo: Bone Morphogenetic Protein
I came across a very interesting study the other day which has important implications for the dental profession. Forteo, a drug marketed to grow bone in osteoporosis patients, also works to heal bone wounds in gum disease patients, a University of Michigan study suggests. “This new approach for the treatment of periodontal disease could allow us to rebuild some of the bone that is lost due to periodontal disease, which until this point has been very difficult to achieve,” said Jill Bashutski, clinical assistant professor at the U-M School of Dentistry and first author on the study. “Current treatments to re-grow bone around teeth affected with gum disease have limited success rates.” The findings are significant because gum disease is the leading cause of tooth loss in adults and is associated with a host of other health problems. Periodontal disease results in loss of teeth and can be devastating because it compromises speaking as well as eating, which can in turn contribute to poor nutrition.
The generic name of the drug is teriparatide and it is marketed by Eli Lilly and Co. under the trade name Forteo. It’s a type of parathyroid hormone and the only anabolic (meaning it grows bone) osteoporosis drug approved on the market in the United States. Typically, other types of osteoporosis drugs such as bisphosphonates work by preventing bone loss. With bisphosphonates, there is a risk that long term use may lead to ONJ, osteonecrosis of the jawbone.
“There was speculation that the bone that forms in a wound like a fracture or inflammatory disease condition might be more responsive to being built back than other bone,” said McCauley, who noted that this proved true in the experimental group.McCauley said the next step is for U-M researchers to test whether the treatment could be delivered locally to target site-specific bone healing. Forteo is not FDA approved for uses other than osteoporosis, but another possible application could be to help grow bone around dental implants.
The study appeared online in the New England Journal of Medicine Oct. 16 and in the print edition Oct. 28. The study was presented Oct. 16 in Toronto at the annual meeting of the American Society for Bone and Mineral Research.
In our periodontal practice, we have used Forteo, prescribed and supervised by the patient’s medical doctor, with great success to aid in bone regeneration in severely osteoporotic patients prior to dental implant surgery. Although anecdotal, the outcomes are quite remarkable. Has anyone else had similar experiences? Your comments are appreciated.
Source: Science Daily
Journal Reference:
Jill D. Bashutski, Robert M. Eber, Janet S. Kinney, Erika Benavides, Samopriyo Maitra, Thomas M. Braun, William V. Giannobile, Laurie K. McCauley. Teriparatide and Osseous Regeneration in the Oral Cavity. New England Journal of Medicine, 2010; 101016083039040 DOI: 10.1056/NEJMoa1005361
The other day, the New York Times featured an article entitled “Radiation Worries for Children in Dentist’s Chairs”. The article mainly centers around the increasing use of Cone Beam CT Scans by dentists, including oral surgeons and orthodontists, to aid in the diagnosis and treatment of a variety of common dental problems in children such as malocclusion and impacted teeth. The main issue is that these children are being exposed to much higher doses of radiation as compared to those children who are being evaluated with more traditional diagnostic tools such as conventional panoramic and periapical dental Xrays (both digital and film), photographs, and study casts of the dentition.
The article states that many experts in dental radiation have raised alarms about what they see as their indiscriminate use. They worry that with few guidelines or regulations, well-meaning orthodontists and other specialists are turning to a new technology they do not fully understand, putting patients at risk, particularly younger ones. Some orthodontists now use Cone Beam CT scans to screen all patients, even though a number of dental groups in this country and in Europe have questioned whether the benefit of routine use justifies the added risk. The ADA has already responded and advises that dentists follow the ALARA principle (As Low As is Reasonably Achievable) to determine which diagnostic tools are best for each particular case.
There is no question that Cone Beam CT scans can help dentists and surgeons deal with complex cases involving dental implants, TMJ disorders, jawbone pathology, and other serious dental and medical problems. As a periodontist who has been placing dental implants for over 23 years, we have been using CT scans since the early 1990s to aid in diagnosis and treatment planning for complicated cases. The technology is an extremely valuable tool which helps us to provide our patients with a safe, predictable surgical outcome. But the vast majority of our smaller cases do not require the use of this technology, especially when we have extracted the teeth and repaired the bone with bone graft and guided bone regeneration procedures. These cases may be evaluated by more conventional means outlined above.
With the increasing prevalence of in-office CBCT scanners, usually at a cost of around $140,000, I sometimes wonder if they are being overused by some clinicians just to help pay for the cost of the machines. I would like to believe that this technology would only be used when absolutely necessary to justify the extra radiation exposure, but I have seen instances with patients referred for second opinions where conventional dental Xrays would have been adequate for proper diagnosis and treatment. On the other hand, I completely understand the concept that dentists and surgeons would like to have the best and most complete information available to them prior to treating their patients. In this litigious society, implant surgeons have oftentimes been told that utilizing CT scans in the diagnostic phase is actually the standard of care. So, therein lies a “Catch 22”. In the end, we must rely on the judgment, skill and expertise of the treating dentist and surgeon to determine how best to evaluate cases. But, patients do need to be informed of the risks and benefits, especially when concerning children.
Do you think the NY Times article is valid? What are your experiences? Your comments are appreciated.
Cary Feuerman, DMD
Periodontal Associates
Photo Credit: New York Times
It is well known that oral infection progressively destroys periodontal tissues and is the leading cause of tooth loss in adults. A major goal of periodontal treatment is regeneration of the tissues lost to periodontitis. Unfortunately, most current therapies cannot predictably promote repair of tooth-supporting defects. A variety of regenerative approaches for repair of diseased teeth are currently available which use bone grafts and guided tissue membranes. Unfortunately, around many periodontally diseased teeth, successful outcomes are varied and limited.
In a new article published in the International and American Associations for Dental Research’s Journal of Dental Research,
M. Kitamura, from Osaka University Graduate School of Dentistry, Japan, and a team of researchers conducted a human clinical trial to determine the safety and effectiveness of fibroblast growth factor-2 (FGF-2) for clinical application. This is the largest study to date in the field of periodontal regenerative therapy. A randomized, double-masked, placebo-controlled clinical trial was conducted in 253 adults afflicted with periodontitis. Periodontal surgery was performed, during which one of three different doses of FGF-2 was randomly administered to localized bone defects. Each dose of FGF-2 showed significant superiority over the standard of care (vehicle alone (p < 0.01)) for the percentage of bone fill at 36 wks after administration, and the percentage peaked in the mid-dose FGF-2 group. These results strongly support the topical application of FGF-2 can be efficacious in the regeneration of human periodontal tissue that has been destroyed by periodontitis.
“This study represents the largest multi-center human clinical trial
using growth factor therapy to repair tooth-supporting osseous defects,” said JDR Editor-in-Chief William Giannobile. “The tissue engineering technology has important ramifications in the treating of localized bone defects around teeth resulting from periodontal disease.”
In an accompanying editorial, author Martha Somerman, University of
Washington, Seattle, states “for periodontal regeneration to continue as an attractive approach for restoring tissues lost to disease versus the
choice for extraction and implant placement, we must focus our efforts on developing predictable therapies that include substantial restoration of tissues to physiological health with positive outcomes over the long term (e.g., greater than 10 years), as well as containing costs for our patients.”
In a time when many clinicians are quick to condemn teeth in favor of implant-supported replacements, it is encouraging to see that the work continues to discover treatment modalities that may help our patients save their own natural teeth. The challenge remains to develop treatment protocols that provide predictable success.
Your thoughts and comments are appreciated.
SOURCE: Science Daily
PHOTO: FutureTimeline.net
Halloween can present a very scary time of year for any parent concerned about their child’s oral health, since your kids will probably come home with that big haul of candy from trick or treating. But should you let them immediately gorge themselves on the candy and get it out of their system? Temple University pediatric dentist Mark Helpin thinks that might not be such a bad idea. “The frequency of eating candy, and other refined carbohydrates, and their stickiness, are big factors in creating the risk of caries (cavities),” he said.
Eating carbohydrates can change the pH balance of the mouth, making it more acidic, which can increase the risk of cavities. Each time candy is eaten, the acid environment in the mouth can take up to an hour to dissipate.
“If I eat a piece of candy now, the pH in my mouth will become acidic, and it will take 30-60 minutes for it to become normal,” said Helpin. “If I eat 2 or 3 pieces of candy when I eat that first one, my mouth stays acid the same length of time that it would if I ate just that single piece. It’s still 30-60 minutes. If I keep eating candy throughout the day, there is acid in my mouth for a much longer period of time. The longer teeth are in an acid environment, the greater the risk they will become decayed.”
Helpin, the acting chair of pediatric dentistry at Temple’s Maurice H. Kornberg School of Dentistry, says that there are a number of ways parents can minimize this risk while still letting their children enjoy the holiday. “Parents can let kids eat a bunch [of candy] now and a bunch later. But don’t let them have one piece now, then an hour later let them have another piece,” he said, adding that candy can also be dispensed as a dessert or snack.
Meals are a good time at which to have treats as dessert because the production of saliva increases, which helps to wash away acidity in the mouth. Helpin also recommends that parents have their children brush their teeth after eating candy, or if that’s not possible, tell their children to rinse their mouth with water three or four times after eating, which will help reduce acidity in the mouth.
Helpin warns that substituting small bags of chips or pretzels for candy doesn’t solve the cavity problem, either. “Chips and pretzels are also carbohydrates and they also will create an acid environment that can create cavities,” he says. “These treats and snacks get stuck on your teeth, and that’s the stickiness factor,” he said.
When trick-or-treaters come to his door, Helpin likes to give out sugar-free candies, and avoids the sticky, gummy candies, which stick to the teeth promote cavities because they allow bacteria “to feed” for a longer time. Ultimately, “it’s not realistic to think you can tell your child you can’t have candy, cookies, cakes, or other treats,” says Helpin. “Those are the things most people enjoy — and we want our kids to enjoy life.”
Source: Science Daily
Photo: Twilight Earth
A new approach to anchor teeth back in the jaw using stem cells has been developed and successfully tested in the laboratory for the first time by researchers at the University of Illinois at Chicago. Researchers in UIC’s Brodie Laboratory for Craniofacial Genetics used stem cells obtained from the periodontal ligament of molars extracted from mice, expanded them in an incubator, and then seeded them on barren rat molars. The stem cell-treated molars were reinserted into the tooth sockets of rats. After two and four months, the stem cells aligned and formed new fibrous attachments between the tooth and bone, firmly attaching the replanted tooth into the animal’s mouth, said Smit Dangaria, a bioengineering doctoral candidate who conducted the research. Tissue sections showed that the replanted tooth was surrounded by newly formed, functional periodontal ligament fibers and new cementum, the essential ingredients of a healthy tooth attachment. In contrast, tooth molars that were replanted without new stem/progenitor cells were either lost or loosely attached and were resorbed, Dangaria said.
The study, published in an online issue of the journal Tissue Engineering, was funded through a grant by the National Institutes of Health.
According to Tom Diekwisch, director of the Brodie Laboratory, who is senior author on the paper, this is the first progenitor cell-based regeneration of a complete periodontal ligament in which a functional tooth was attached. “Our strategy could be used for replanting teeth that were lost due to trauma or as a novel approach for tooth replacement using tooth-shaped replicas,” said Diekwisch, who is also professor and head of oral biology.
Quite remarkable! Comments are appreciated.
Source: Science Daily
Journal Reference:
Smit Jayant Dangaria, Yoshihiro Ito, LeiLei Yin, Giovanni Valdre, Xianghong Luan, Thomas Diekwisch. Apatite Microtopographies Instruct Signaling Tapestries for Progenitor-driven New Attachment of Teeth. Tissue Engineering Part A, 2010; 100826193646026 DOI: 10.1089/ten.TEA.2010.0264
Scientists say they have established one reason why gum disease may increase the risk of heart disease. The link between gum and heart problems has long been recognized, but it is unclear if poor oral health is simply a marker of a person’s general well-being. U.K. and Irish experts now say bacteria enter the bloodstream via sore gums and deposit a clot-forming protein. The findings are being presented at a meeting of the Society for General Microbiology. Earlier this year a Scottish study of more than 11,000 people found people who did not brush their teeth twice a day were at increased risk of heart disease.
BBC News 5 September, 2010.
The benefits of fluoridated water for the prevention of tooth decay in children have been well-documented for decades. An interesting new study also suggests that use of fluoride as a child is related to a lower incidence of tooth loss in the adult years. In an article appearing in the October issue of the American Journal of Public Health, Matthew Neidell reports a strong relationship between fluoride levels in a resident’s county at the time of their birth with tooth loss as an adult. “Your fluoridation exposure at birth is affecting your tooth loss in your 40s and 50s, regardless of what your fluoridation exposure was like when you were 20 and 30 years old,” said Neidell, a health policy professor at the Mailman School of Public Health at Columbia University. Dr. Neidell combined data from a recent Centers for Disease Control and Prevention community health study and a water census to see the impact of drinking fluoridated water in the 1950s and 1960s on tooth loss in the 1990s.
The researchers write that respondents who did not live in the same county their entire lives received differing amounts of fluoride in their water, which complicated study findings. The study, which focused on tooth loss as an indication of overall oral health, could not adjust for factors such as use of toothpaste, which also provides a dose of fluoride.
The American Dental Association, which has supported fluoridation of community water since 1950, says scientists continue to show adding the mineral to water is safe and aids tooth health. One 2007 study of Kaiser Permanente HMO members found that adults benefited from community fluoridation more than children. A study of Medicaid dental patients in Louisiana, which showed that for every $1 invested in water fluoridation, the state saw $38 in reduced dental costs.
The use of fluoride is still controversial for some people. Yet, this is another study which suggests that early fluoride use has long term benefits.
Comments are welcome!
Source: Science Daily
Photo Credit: CrossFit Oakland
NYU dental researchers have found the first long-term evidence that periodontal (gum) disease may increase the risk of cognitive dysfunction associated with Alzheimer’s disease in healthy individuals as well as in those who already are cognitively impaired. The NYU study offers fresh evidence that gum inflammation may contribute to brain inflammation, neurodegeneration, and Alzheimer’s disease. The research team, led by Dr. Angela Kamer, Assistant Professor of Periodontology & Implant Dentistry, examined 20 years of data that support the hypothesis of a possible causal link between periodontal disease and Alzheimer’s disease. “The research suggests that cognitively normal subjects with periodontal inflammation are at an increased risk of lower cognitive function compared to cognitively normal subjects with little or no periodontal inflammation,” Dr. Kamer said. Dr. Kamer’s study, conducted in collaboration with Dr. Douglas E. Morse, Associate Professor of Epidemiology & Health Promotion at NYU College of Dentistry, and a team of researchers in Denmark, builds upon a 2008 study by Dr. Kamer which found that subjects with Alzheimer’s disease had a significantly higher level of antibodies and inflammatory molecules associated with periodontal disease in their plasma compared to healthy people.
This is just another example of the important link between dental and periodontal diseases and general medical health. Your comments are appreciated.
Source: Science Daily