Study Suggests Dentists Can Identify Patients At Risk For Fatal Cardiovascular Event

A new study indicates dentists can play a potentially life-saving role in health care by identifying patients at risk of fatal heart attacks and referring them to physicians for further evaluation.


Published in the November issue of the Journal of the American Dental Association, the study followed 200 patients (101 women and 99 men) in private dental practices in Sweden whose dentists used a computerized system, "HeartScore," to calculate the risk of a patient dying from a cardiovascular event within a 10-year period.


Designed by the European Society of Cardiology, HeartScore measures cardiovascular disease risk in persons aged 40-65 by factoring the person's age, sex, total cholesterol level, systolic blood pressure and smoking status.


Patients with HeartScores of 10 percent or higher, meaning they had a 10 percent or higher risk of having a fatal heart attack or stroke within a 10-year period, were told by dentists to seek medical advice regarding their condition.


Twelve patients in the study, all of them men, had HeartScores of 10 percent or higher. All women participating in the study had HeartScores of 5 percent or less.


Of the 12 male patients with HeartScores of 10 percent or higher, nine sought further evaluation by a medical care provider who decided that intervention was indicated for six of the patients. Two patients did not follow the dentist's recommendation to seek further medical evaluation and one patient was only encouraged by his dentist to discontinue smoking. Physicians for three patients were not able to confirm their risk for cardiovascular disease.


All 200 patients enrolled in the study were 45 years of age or older with no history of cardiovascular disease, medications for high blood pressure, high cholesterol or diabetes and had not visited a physician during the previous year to assess their glucose, cholesterol or blood pressure levels.


The study's authors conclude that oral health care professionals can identify patients who are unaware of their risk of developing serious complications as a result of cardiovascular disease and who are in need of medical interventions.


According to the authors, "With emerging data suggesting an association between oral and non-oral diseases, and with the possibility of performing chairside screening tests for diseases such as cardiovascular disease and diabetes, oral health care professionals may find themselves in an opportune position to enhance the overall health and well-being of their patients."


Source

American Dental Association

Link Between Gum Inflammation And Alzheimer's Disease Supported By New Evidence From NYUCD

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.



Dr. Kamer's latest findings are based on an analysis of data on periodontal inflammation and cognitive function in 152 subjects in the Glostrop Aging Study, which has been gathering medical, psychological, oral health, and social data on Danish men and women. Dr. Kamer examined data spanning a 20-year period ending in 1984, when the subjects were all 70 years of age. The findings were presented by Dr. Kamer at the 2010 annual meeting of the International Association for Dental Research July 16, in Barcelona, Spain.



Dr. Kamer's team compared cognitive function at ages 50 and 70, using the Digit Symbol Test, or DST, a part of the standard measurement of adult IQ. The DST assesses how quickly subjects can link a series of digits, such as 2, 3, 4, to a corresponding list of digit-symbol pairs, such as 1/-,2/- ... 7/?›,8/X,9/=.



Dr. Kamer found that periodontal inflammation at age 70 was strongly associated with lower DST scores at age 70. Subjects with periodontal inflammation were nine times more likely to test in the lower range of the DST compared to subjects with little or no periodontal inflammation.



This strong association held true even in those subjects who had other risk factors linked to lower DST scores, including obesity, cigarette smoking, and tooth loss unrelated to gum inflammation. The strong association also held true in those subjects who already had a low DST score at age 50.



Dr. Kamer plans to conduct a follow-up study involving a larger, more ethnically diverse group of subjects, to further examine the connection between periodontal disease and low cognition.



In addition to Dr. Morse, Dr. Kamer's coinvestigators included Dr. Poul Holm-Pedersen, Professor and Director of the Gerontology & Oral Health Research Center; Dr. Erik Lykke Mortensen, Professor of Psychology; and Dr. Birita Ellefsen, Assistant Professor of Gerontology & Oral Health, all at Copenhagen University in Denmark; and Dr. Kirsten Avlund, Professor of Social Medicine at the Institute of Public Health in Copenhagen.

New Dental Registration Plan Against Patients' Interests, Say UK Dentists

Plans to change NHS dental registration in Scotland could harm patient care, according to a survey of high street dentists. Dentists are worried that proposals to introduce continuous registration, a scheme which would sweep away the need for patients to visit their dentist in order to remain registered with them, sends the wrong message about the value of regular check-ups.



In a survey of general dental practitioners from across Scotland, 87 per cent of respondents said they were opposed to the introduction of continuous registration. Concerns articulated by respondents include it undermining the importance of regular check-ups, failing to promote a strong dentist-patient relationship, and increasing the chances of serious conditions such as mouth cancer going undetected.



Concerns were also expressed about the strain on NHS services that would be caused by patients who chose to attend less regularly. Irregular attendance often results in more complex and time-consuming treatment being required. Catering for a greater number of emergency appointments would also increase waiting times for patients attending regular appointments.



Colin Crawford, Chair of the BDA's Scottish Dental Practice Committee, said:



"This survey is an overwhelming vote of no confidence in the proposed change to continuous registration. The profession has worked hard to improve Scotland's unenviable oral health record by promoting the value of preventive dental care. The proposed change threatens to undermine that work.



"Continuous registration may be politically expedient - it will create an illusion of growing numbers of patients accessing dentistry - but it doesn't genuinely improve patient care. We urge the Scottish Government to think again on this plan. Massaging figures isn't the way to improve the oral health of Scotland; ensuring there are adequate numbers of dentists, encouraging patients to visit them regularly and working with the profession is."



The BDA has communicated the results of the survey, and reiterated its concerns about continuous registration, in a letter to the Scottish Government.



Under the current arrangements, patients who attend at the interval agreed with their dentist maintain their registered status, effectively enjoying open-ended registration anyway.



Source
British Dental Association

Dentists, Pediatricians Urge Mouthguard Use as Kids Head Back to School

Each year, more than three and a half million children, aged 14 and under are injured while playing sports or participating in recreational activities (USA).


As part of the American Dental Association (ADA) and the American Academy of Pediatrics (AAP) annual back-to-school health promotion, when some 6 million high school students plan their participation in team sports, both health organizations remind parents that the use of mouthguards can help protect children from mouth injuries.


Mouthguards help cushion blows that might otherwise cause broken teeth, and injuries to the lips, tongue, face or jaw. They also may reduce the severity and incidence of concussions. If a child wears braces or another fixed dental appliance on their lower jaw, the dentist may suggest a mouth protector for those teeth as well.


Facial injuries and protective equipment


Kids suffer thousands of injuries each year on the playing field, the basketball court or while skateboarding, biking or during other activities.


"Injuries to the face from participating in a sport or other recreational activity can harm your child's teeth, lips, cheeks and tongue, but a properly fitted mouthguard can help protect your child's smile," says Edmond Hewlett, D.D.S., an ADA consumer advisor and associate professor at UCLA's School of Dentistry.


"In addition to mouthguards, be sure your child wears all the appropriate protective equipment made for their sport, such as shin pads, wrist guards, eye protection, and helmet, adds AAP President Carol Berkowitz, M.D., FAAP. Always consult your pediatrician on the sport that is right for your child's age and abilities."


"In the past few years, since high schools and colleges began to require mouthguards and facemasks for football, about 200,000 injuries to the mouth and face have been prevented each year," says Dr. Hewlett.


Completion of health, dental exams and immunizations


ADA and AAP also encourage parents to make dental exams a regular part of their children's back-to-school routine, including completion of all health examinations and necessary immunizations in time for the new school year.


About the American Dental Association


The not-for-profit ADA is the nation's largest dental association, representing more than 152,000 members. The premier source of oral health information, the ADA has advocated for the public's health and promoted the art and science of dentistry since 1859. The ADA's state-of-the-art research facilities develop and test dental products and materials that have advanced the practice of dentistry and made the patient experience more positive. The ADA Seal of Acceptance long has been a valuable and respected guide to consumer and professional products. For more information about the ADA, visit the Association's Web site at ada.


About the American Academy of Pediatrics


The American Academy of Pediatrics is an organization of 60,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults. For more information about the AAP, visit aap


American Dental Association (ADA)

211 E. Chicago Ave.

Chicago, IL 60611

United States

ada

IDF Guideline On Oral Health For People With Diabetes Supported By AAP

New clinical guidelines released by the International Diabetes Foundation (IDF) emphasize the importance of periodontal health for people with diabetes. Diabetes affects approximately 246 million people worldwide, and this number is only expected to increase. The IDF is an organization of 200 national diabetes associations from 160 countries.



The new IDF oral health clinical guideline supports what research has already suggested: that management of periodontal disease - which affects the gums and other supporting tissues around the teeth - can help reduce the risk of developing diabetes; and can also help people with diabetes control their blood sugar levels. Studies have suggested there is a two-way relationship between diabetes and periodontal disease, and the IDF guideline outlines helpful guidance for health professionals who treat people living with and at risk for diabetes.



The IDF guideline contains clinical recommendations on periodontal care, written in collaboration with the World Dental Federation (FDI), that encourage health professionals to conduct annual inquiries for symptoms of periodontal disease such as swollen or red gums, or bleeding during tooth brushing; and to educate their patients with diabetes about the implications of the condition on oral health, and especially periodontal health.



"Everyone should maintain healthy teeth and gums to avoid periodontal disease, but people with diabetes should pay extra attention," said Samuel Low, DDS, MS, Associate Dean and professor of periodontology at the University of Florida College of Dentistry, and President of the American Academy of Periodontology (AAP). "Periodontal disease triggers the body's inflammatory response which can affect insulin sensitivity and ultimately lead to unhealthy blood sugar levels. Establishing routine periodontal care is one way to help keep diabetes under control."



In recognition of American Diabetes Month, the American Academy of Periodontology commends the International Diabetes Foundation on the release of the Guideline on Oral Health for People with Diabetes, and supports its encouragement of continued collaboration and communication between diabetes and oral healthcare professionals.



In addition to helping increase awareness about the importance of oral care for people with diabetes, Dr. Low believes the guideline presents more opportunities for medicine and dentistry to work together. "I know that these clinical recommendations will be helpful for those professionals who work with and treat people with diabetes. I also encourage the medical and dental communities to work together to provide the best possible care for our patients."

Discovery Of New Proteins May Lead To More Effective Treatment Of Endocarditis And Infections Associated With Implants

A research team at the Faculty of Odontology at Malmo University in Sweden has discovered two new proteins that are of importance to the survival of bacteria and their colonization of the human body. Besides enhancing our knowledge of the ability of bacteria to spread, the findings may also lead to more effective treatment of endocarditis and infections associated with implants.


Each year some 500 people in Sweden develop endocarditis, inflammation of the heart valves. The condition can be life-threatening, and one of the bacteria that cause the disease is Streptococcus gordonii, a bacterium that exists in the mouth.


"It's part of the natural flora of bacteria there, but sometimes it gets into the bloodstream, and then it can lead to infective endocarditis. The bacteria have also been found in infections surrounding various kinds of implants," says Associate Professor Julia Davies, who directed the research team at the Faculty of Odontology.


To survive in the oral cavity the bacteria must be able to attach to a surface, such as the mucous membrane. This is done with the help of proteins. In the mid 1990s one of these proteins from the bacterium S. gordonii was identified by a research team in England.


Julia Davies and her colleagues have now discovered two more. These scientists have thereby taken a step toward an understanding of how these bacteria get a grip on a surface, on heart valves, for instance. The two new proteins, SGO 0707 and SGO 1487, are found in the cell wall of the bacterium S. gordonii. The proteins are produced by the bacterium, and without them the bacterium cannot fasten to a surface, which is a precondition for it to be able to survive.


If bacteria wind up in the bloodstream, they can bind to the heart valves, where they produce a so-called biofilm and encapsulate themselves. Once the bacteria are encapsulated, it is extremely difficult to get rid of them. But with enhanced knowledge of how bacteria fasten to surfaces, it will be easier to find effective new strategies to treat biofilms-induced diseases.


"If we can block this binding with the help of drugs, treatment will be more effective," says Julia Davies.


It was previously known that bacteria that grow in so-called biofilms alter their properties when they settle on a surface. For example, they become more resistant to antibiotics and antibacterial compounds.


These researchers are now moving on to find out how this resistance arises.


"We want to understand in what ways bacteria alter their properties when they settle on a surface," says Julia Davies.

Periodontal Disease: How To Protect Your Teeth And Gums

Millions of people
have periodontal (gum) disease and many don't even know they have it. Are
you one of them?



Periodontal disease is an infection of the tissues that support your
teeth. It is caused by the plaque-forming bacteria in your mouth. While
brushing and flossing removes most plaque, it is impossible to remove all
of it. The remaining plaque hardens into tartar. When this tartar forms
under the gumline, it can irritate and infect the gums, leading to gum
disease.



The good news is that periodontal disease is easily preventable. The
Pennsylvania Dental Association (PDA) reminds the public about the
importance of maintaining healthy teeth and gums.



Periodontal disease has two stages: gingivitis and periodontitis. The
first stage, gingivitis, is the early stage of periodontal disease, where
the bacteria get in between the tooth and gum, causing inflammation. During
this early stage, daily brushing and flossing can likely reverse
periodontal disease.



If left untreated, periodontitis, the more advanced stage of
periodontal disease, can develop, causing irreversible damage to the gums,
teeth and surrounding bones. Periodontitis is more serious because the
tissue that holds the teeth to the bone is destroyed, causing tooth roots
to be exposed and increasing decay, inflammation and receding gums,
resulting in possible tooth loss.



There are several factors that can increase your risk of developing
periodontal disease, including the use of tobacco; certain systematic
diseases, such as diabetes; some types of medication, including steroids
and various anti-epilepsy drugs, cancer therapy drugs, calcium channel
blockers and oral contraceptives; bridges that no longer fit properly;
crooked teeth; fillings that have become defective and pregnancy.



"Researchers have found that people with gum disease are almost twice
as likely to suffer from coronary artery disease," said Dr. David Shemo, a
PDA member and general dentist from Wilkes-Barre. "Their theory is that
oral bacteria can affect the heart when it enters the blood stream,
attaching to fatty plaques in the heart's blood vessels and contributing to
clot formation."



PDA offers the following tips to maintain optimal dental health and
prevent periodontal disease:


-- Brush your teeth twice a day and floss daily. Brushing and flossing
helps to remove the plaque and food particles from the surface of the
teeth and between the teeth where a toothbrush can't reach. Replace
your toothbrush every few months or when the bristles become frayed or
worn. Using a fluoride toothpaste and antibacterial mouthrinse is
another way to help keep tooth decay at bay.


-- Eat a nutritious and well-balanced diet. Choose a variety of nutritious
foods from the five main food groups: grain, dairy, fruits, vegetables
and meat/poultry.


-- Visit the dentist at least every six months for oral health checkups and
professional cleaning.


-- Contact your dentist immediately if you notice any symptoms of
periodontal disease, as early detection is key. Symptoms of periodontal
disease include red, swollen or tender gums or gums that bleed easily or
are pulling away from the teeth; chronic bad breath or bad taste in the
mouth; permanent teeth that are loose or separating; pus appearing
between the teeth and gums when gums are pressed; changes in teeth
alignment when you bite and changes in the fit of partial dentures.



For more information on other oral health topics, visit PDA's website
at padental.


Pennsylvania Dental Association

padental