Friday, November 2, 2018

Oral Cancer and HPV

In our efforts to provide the highest standard of care our team routinely attends continuing education courses.  Our hygienists recently attended an update in Oral Cancer. The presentation was given by the surgeons from Washington University School of Medicine, Department of Head and Neck Surgical Oncology. Dr. Jose P. Zevallos, the Division Chief  started the morning with  an update on oropharyngeal cancer.

Dr. Zevallos recounted the rise in orophoharyngeal cancer began to be noticed in the 1980's and 1990's. It wasn't until the early 2000's it was discovered that this rise in cancer was being caused by  HPV (Human papillomavirus). The scary thing about this cancer is that it's demographic is across all age ranges, in smokers and non-smokers, with an increase noted in all races. Another troubling thing about HPV related cancers is that it has a 30 year legacy period between infection and onset of cancer. The infection generally occurs in the patients 20's and then lays dormant until the 50's to 60's. People with autoimmune diseases or people taking immunosuppressants are at a higher risk for developing HPV related cancers.

Another issue associated with HPV oropharyngeal cancers is our lack of ability to reliably screen for them. There are some saliva tests for oral HPV infection, however there is a high rate of false positives with these tests. This is because 2-8% of the population will have the infection but only a tiny percent of those get cancer. Once a tumor is present there will be very high levels of HPV in the saliva. The current saliva tests do not screen for the levels of HPV present in the saliva. Secondly, these tumors form deep in the base of the tonsillar crypt and the base of the tongue, making them very hard to see in a visual oral exam.

The Gardisil vaccine now cover 9 of the high risk forms of HPV. This vaccine is our best chance at preventing cancers. However, much of the population is still at risk for developing an HPV related cancer of the head, neck and mouth. This is why it is critical to have regular dental checkups and ensure your provider is competently evaluating your oral and oropharyngeal cavities for any early signs of cancer.




Possible signs and symptoms of oral cavity and oropharyngeal cancers include:
  • A sore in the mouth that doesn't heal (the most common symptom)
  • Pain in the mouth that doesn’t go away (also very common)
  • A lump or thickening in the cheek
  • A white or red patch on the gums, tongue, tonsil, or lining of the mouth
  • A sore throat or a feeling that something is caught in the throat that doesn’t go away
  • Trouble chewing or swallowing
  • Trouble moving the jaw or tongue
  • Numbness of the tongue or other area of the mouth
  • Swelling of the jaw that causes dentures to fit poorly or become uncomfortable
  • Loosening of the teeth or pain around the teeth or jaw
  • Voice changes
  • A lump or mass in the neck
  • Weight loss
  • Constant bad breath
Many of these signs and symptoms can also be caused by things other than cancer, or even by other cancers. Still, it's very important to see a doctor or dentist if any of these conditions lasts more than 2 weeks so that the cause can be found and treated, if needed.

Friday, October 12, 2018

Oral Bacteria Use Your Bloodstream As Highway To Your Body

PERIODONTAL PATHOGENS AREN'T JUST IN YOUR MOUTH



The concept of sterile blood no longer exists. Bacteremia occurs when pathogens enter the bloodstream. Many microbes simply enter the bloodstream transiently. They are shed from the primary biofilm found in the mouth by chewing or routine dental hygiene at home.
Higher concentrations of pathogens enter the blood by invasive dental procedures, including mechanical debridement, extractions, and endodontic procedures. It requires only 60 seconds for a pathogen to travel anywhere in the body as a result of an invasive dental procedure. 
Bacteremia results in “seeding” bacteria at potentially new systemic locations. These new sites are typically under stress and have become susceptible to invasion. 
Translocation is a pathogen’s arrival at a new systemic site from its point of origin. New biofilms or microbiomes of pathogens emerge at sites where these species are not normally found. The impact of these pathogens is the same wherever they colonize: cellular destruction.
Co-Occurrence
In the past several years, much evidence has shown a prevalence of periodontal pathogens in arterial biofilms and microbiomes. Recently, the term “co-occurrence” has become relevant as it describes the existence of two similar biofilms in the same patient at the same time.
study published in February 2017 found that a large group of patients who had both the symptoms of periodontitis and of heart disease had a similar profile of periodontal high-risk pathogens at the two independent locations. For three pathogens, the co-occurrence was at the 95% confidence level. Eight other pathogens were simply determined to have a very high incidence of correlation. 
In a dental practice, a simple salivary test can be performed to determine the specific bacteria that are present in the mouth, understanding that the very same bacteria that are found in high concentrations in the mouth also are found on the lining of the patient’s arterial walls.
The goal of periodontal therapy should be to eliminate the bacterial etiology. Successful periodontal therapy must include antimicrobials and or antibiotics specific to the pathogens present in a given individual’s oral bacterial flora or biofilm. 
If periodontal therapy is only delivered with a local focus, what will become of the already translocated and in-place biofilms and pathogens in hosts who are medically or genetically compromised and incapable of mounting an effective immune response? Does a systemic disease warrant a systemic response? These questions need to be considered when periodontal therapy is warranted.
Looking at periodontal disease as a bacterial infection that travels throughout the body is much different than looking at periodontal disease as a localized bacterial infection of the oral cavity only. Systemic mitigation of pathogens requires a total body wellness approach. Periodontal disease treatment must be considered a part of the preventive armamentarium for chronic disease management in the human body, which is a complex ecosystem. 
This article excerpted from:
Dentistry Today
08 Oct 2018  Traci Warner, RDH  Today's Dental News

Friday, October 5, 2018

New Research: Smoking Can Damage Your Tooth's Nerve


Smoker's have been cautioned about lung disease, gum disease and other deleterious affects of smoking, but a new study has shown that smoking can affect the pulp (nerve and blood supply inside your tooth) of your tooth.
Researchers at the Case Western Reserve University School of Dental Medicine found that smoking weakens the ability for pulp in teeth to fight illness and disease.
In other words, smokers have fewer defense mechanisms on the inside of their teeth.
"That might explain why smokers have poorer endodontic(root canal treatment) outcomes and delayed healing than non-smokers," said Anita Aminoshariae, associate professor of endodontics and director of predoctoral endodontics. "Imagine TNF-? and hBD-2 are among the soldiers in a last line of defense fortifying a castle. Smoking kills these soldiers before they even have a chance at mounting a solid defense."
The results of the study were published in the Journal of Endodontics.
Aminoshariae said that, previously, there was little research into the endodontic effects of smoking -- the inside of teeth. Smokers had worse outcomes than nonsmokers, with greater chances of developing gum disease and nearly two times more likely to require a root canal.
This new preliminary research set out to explain the possible contributing factors.
Thirty-two smokers and 37 nonsmokers with endodontic pulpitis -- more commonly known as dental-tissue inflammation -- were included in the study.
"We began with a look at the dental pulp of smokers compared with nonsmokers," she said. "We hypothesized that the natural defenses would be reduced in smokers; we didn't expect them to have them completely depleted."
One interesting find, Aminoshariae noted, was that for two patients who quit smoking, those defenses returned.
Joining Aminoshariae in the study were former students Caroline Ghattas Ayoub and Mohammed Bakkar; faculty members Tracey Bonfield, Catherine Demko, Thomas A. Montagnese and Andre K. Mickel; and research Santosh Ghosh -- all from the School of Dental Medicine.

Case Western Reserve University. (2018, September 26). Dental research shows that smoking weakens immune systems. ScienceDaily. Retrieved October 5, 2018 from www.sciencedaily.com/releases/2018/09/180926110940.htm

Friday, August 17, 2018

Plaque: The invisible enemy of teeth

The CONSTANT BATTLE WITH BACTERIA


We come into the world without teeth. Too often we exit in the same condition.
That’s an odd outcome, given that enamel, the white part of the tooth, is the hardest substance in the body. Human teeth are actually as hard as sharks’ teeth, a group of scientists from Germany discovered. Sharks have advantages over us, though. Rows of sharks’ teeth are replaced throughout life, while loss of a permanent human tooth requires a prosthesis in the form of a bridge, crown, implant or dentures.
If our teeth are so strong, why then are 19 percent of the population 65 years old and older completely edentulous, or toothless?
Sharks again provide part of the answer. They don’t get cavities — and with good reason. Sharks don’t eat sugar, but we do, and apparently, plenty of it. Added sugar, such as table sugar, honey and high fructose corn syrup, are the major culprits here, but all sugars and starches play a role. The World Health Organization recommends no more than 25 grams of added sugar a day, which amounts to 20 pounds a year. Yet, the average American consumes 82 grams a day, or 66 pounds a year.
illustration: Caleb Olson
illustration: Caleb Olson

Plaque — step one to cavities

The teeth are covered by plaque a soft, invisible sticky film teeming with bacteria – some good, some bad. Plaque is always in the mouth even after you brush. That’s because bacteria are hardy creatures and multiply very rapidly. The problem begins when you start to eat. When you eat sugars or any carbohydrate or starch, like rice and bread, the bad bacteria start eating too. They feed off sugars, and that combination of sugar and bacteria is not a good thing. It produces an acid which starts the destructive process of tooth decay called caries or cavities.
The problem is that plaque will not remain soft and sticky. If not brushed away after a period of time, it turns into a hard yellowish substance called tartar, which can be removed only by a dentist or dental hygienist.
Dental caries is very common in this country. Approximately 91 percent of U.S. adults aged 20 to 64 had dental caries in permanent teeth, according to a 2015 data brief by the National Center for Health Statistics. Apparently, this process starts at an early stage. More than 43 percent of youth between the ages of two and 19 had both treated and untreated cavities in primary or permanent teeth.
Minorities are hardest hit. Blacks, Hispanics and Native Americans have the poorest oral health of any racial and ethnic groups in the United States. In addition, less educated adults experience untreated tooth decay nearly three times that of adults with at least some college education

Gum disease

Plaque is not confined to the teeth. It can also initiate an infection of your gum tissue and bone surrounding your teeth. The initial stage of gum disease  is called gingivitis, which is characterized by redness and bleeding gums particularly when brushing or flossing. With good oral care, this stage is reversible. It can progress, however, to periodontitis, which is irreversible and can result in permanent tooth loss.
Image: courtesy of Mayo Clinic
Image: courtesy of Mayo Clinic
What’s worse is that the inflammation can have an impact on chronic diseases, such as diabetes and heart disease. “The mouth is part of the body,” said Dr. Susana Tejada, a dentist at The Dimock Center. “Bacteria that affect the mouth can travel to the rest of the body. It’s all connected.”
Research has found that plaque builds up in people with diabetes that is poorly controlled. “People with diabetes are three to four times more likely to have gum disease,” she explained. The reverse is also true. Gum inflammation makes it harder to control diabetes.
It’s not just diabetes that’s affected by poor oral health. The heart may suffer as well. Some studies suggest that clogged arteries that contribute to heart disease and stroke may have a connection to gum inflammation, according to the Mayo Clinic. Women with periodontitis have a higher risk of premature birth and low birth weight.

Dry mouth

Saliva — known more familiarly as spit — does not have the best reputation. Your mother taught you not to spit. Several states — including Massachusetts — have laws on the books forbidding residents to spit on a public sidewalk. In the Commonwealth, that antiquated law carries a whopping $20 fine. These laws and your mother’s admonition give the impression that there’s something sinister about spit. Yet, saliva is nourishing to the mouth. “It washes away food particles and moistens the mouth,” explained Tejada. “It prevents tooth decay by neutralizing the acids produced by bacteria.”
Low production of saliva results in a condition known as dry mouth. Patients complain that it feels like “cotton balls in the mouth,” or “everything seems to stick.” Dry mouth is often a side effect of certain medications, such as those to treat depression, high blood pressure, and mental health disorders anxiety and pain. Even over-the-counter drugs, including antihistamines and decongestants can cause the condition. It is more common in older people, but more probably a factor of increased use of medication than passing years. Therapy for head and neck cancers, tobacco, alcohol and marijuana use are other possible causes.

Types of dentists

General dentist
General dentists are your primary dental providers who manage your overall dental health. They provide cleanings and x-rays, diagnose dental conditions and perform several dental procedures, including fillings and extractions. At times, however, a specialist is required.
Endodontistspecializes in root canals
Oral surgeonperforms complex extractions and surgeries on the mouth and jaw
Orthodontistdevelops braces or other devices to straighten teeth
Pedodontist or pediatric dentistspecializes in the prevention, diagnosis and treatment of diseases that affect the gums, such as gingivitis and periodontitis
Prosthodontistresponsible for replacement of missing teeth and the repair of a person’s natural teeth by means of bridges, crowns, implants and dentures

Dry mouth is more than just annoying. A more serious complication is its link to increased plaque and tooth decay. There’s no moisture to wash away the food, and therefore no protection of the teeth from acid formation. Roughly 30 percent of all tooth decay in older adults is caused by dry mouth, according to the Oral Cancer Foundation.
Over-the-counter remedies such as mouth sprays and sugar-free gum, are available to reduce the symptoms. Tejada offers an easier and free solution. “Drink a lot of water” she advised. “Sip it frequently throughout the day.”

Prevention

Yet, tooth decay and gum disease are largely preventable. You need a toothbrush, floss and fluoride toothpaste … and you have to use them. It’s easy on the budget. All together that can set you back roughly $10 every three months. Check-ups with the dentist can help spot a problem before it balloons into a more serious condition. In spite of this relatively low cost at-home treatment, cavities remain one of the most common chronic diseases in the U.S.
More than 70 percent of the residents in Massachusetts receive fluoridated water. Studies have shown that people who drink fluoridated water have a lower incidence of tooth decay. Fluoride replaces minerals in the teeth that are lost due to acid formation by bacteria.
We can drink the water, but it is necessary to do more than just imbibe and brush. Other habits do their fair share of damage. Smoking decreases the production of saliva, which leads to dry mouth, and in turn the risk of gum disease. But it’s the diet that causes the most problems, and two of the biggest offenders are soda and coffee. Roughly half of the U.S population drinks an average of three glasses of sodas every day. In addition, the average coffee drinker sips two to three cups a day, but coffee is very acidic. That means we are constantly coating our teeth with both sugar and acid, an ill-fated duo.
By age 21 we have 32 teeth. At 81 we should still have 32 teeth. Although, due to evolutionary changes, many people never develop their 3rd molars (wisdom teeth) or their jaws are too small to accommodate them and they are extracted, making the total tooth count 28 teeth. Tooth loss is not inevitable with age, warned Tejada. “They do not have to go hand in hand.”
 Article from The Bay State Banner; Be Healthy  by Karen Miller 7-20-18

Friday, August 10, 2018

Oral Hygiene and Type 2 Diabetes

Better Dental Hygiene Linked to Improved Type 2 Diabetes Glycemic Levels


A study published in The Journal of Clinical Periodontology revealed a potential link between Type 2 diabetes and dental hygiene. The results of the study will have a significant impact in the medical community, especially because Type 2 diabetes accounts for approximately 90% of all diabetes cases and impacts over 30 million Americans according to the Center for Disease Control.
A randomized clinical study conducted by researchers at the Faculty of Medicine and Health Sciences of the University of Buffalo demonstrated that patients who follow proper dental hygiene routines might experience an improvement in their Type 2 diabetes. The lead researcher, Miquel Viñas, is a professor of Microbiology at the University of Buffalo. Professors Elisabet Mauri Obradors, Albert Estrugo and Enric Jané from the university’s Department of Odonto-Stomatology also contributed to the study. Additional research participants included Alexandra Merlos from the Department of Pathology and Experimental Therapy and José López López, a lecturer and medical director at the Dental Hospital of the University of Buffalo.

Type 2 Diabetes Causes and Symptoms 

Insulin is a naturally occurring hormone secreted by the pancreas. Type 2 diabetes is a chronic condition which occurs when the body cannot metabolize blood sugar and becomes resistant to insulin. As a result, blood sugar levels can rise higher than normal. This can lead to serious health problems such as kidney and heart disease and other medical complications. People who are obese, and not physically active, may be at risk for developing Type 2 diabetes. Common symptoms include fatigue, frequent urination (polyuria), weight loss, increased thirst (polydipsia) and hunger (polyphagia), blurry vision and thick darkened skin. However, some patients may never experience noticeable symptoms and do not discover they have the disease until their blood sugars are tested, and a physician diagnoses them.
Although Type 2 diabetes is incurable, it can go into remission when patients begin to eat healthy and work out to maintain their blood sugar levels. Some patients may need to take prescribed oral medications or receive insulin injections to help keep their target blood glucose at healthy levels.

The University of Buffalo Study

The researchers decided to evaluate the effect of non‐surgical periodontal treatment on serum HbA1c (hemoglobin A1c or glycated hemoglobin) levels in patients who were diagnosed with Type 2 diabetes. Although previous research had shown a correlation between diabetes and periodontal diseases, the researchers noted there were limited studies about how periodontal disease can affect patients with diabetes.
Ninety patients with Type 2 diabetes participated in the single‐masked, randomized clinical study. Over the duration of six months, patients received oral treatments and underwent a control of glycated hemoglobin. The researchers also evaluated the patients for certain types of oral bacteria that are linked to periodontitis. The treatment group received oral hygiene instructions and non-surgical periodontal therapy/SRP using both ultrasonic and hand instrumentation. Meanwhile, the study’s control group received just oral hygiene instructions and had biofilm and calculus removed with only ultrasonic instrumentation. The researchers measured and analyzed the patient’s plaque index, pocket depth, and gingival index at the beginning, middle, and end of the study.

The Results of the Study

Based on their findings, non‐surgical periodontal treatment resulted in a better glycemic status for patients with type 2 diabetes. “The main conclusion of the study,” José López López shared, “is that the non-surgical treatment of periodontitis improves the glycemic status and levels of glycated hemoglobin, and therefore proves the great importance of oral health in these patients.” There was no noticeable improvement in the control group. In conclusion, the study revealed just how much oral health is closely tied to a patient’s overall health.

Published by Today's RDH August 3, 2018

Friday, July 27, 2018

HAPPY SUMMER

Summer Vacation is Here, Yeah!



We are off for the one week when the entire staff takes a summer vacation.  The staff is off to many different areas of the country with family and friends. 

We will return on Monday August 6th!

Happy Summer To You All

Monday, July 16, 2018

Periodontal Disease Just May Be Causing Rheumatoid Arthritis


BACTERIA THAT CAUSES ADVANCED GUM DISEASE FOUND IN LARGE AMOUNTS IN PATIENTS WITH RHEUMATOID ARTHRITIS


Individuals at risk of rheumatoid arthritis (RA) have increased levels of gum disease and disease-causing bacteria, according to a study presented at the Annual European Congress of Rheumatology (EULAR 2018).
“It has been shown that RA-associated antibodies, such as anti-citrullinated protein antibodies, are present well before any evidence of joint disease. This suggests they original from a site outside of the joints,” said lead author Kulveer Mankia, MD, of the Leeds Institute of Rheumatic and Muscoskeletal Medicine and the Leeds Biomedical Research Centre. 
“Our study is the first to describe clinical periodontal disease and the relative abundance of periodontal bacterial in these at-risk individuals. Our results support the hypothesis that local inflammation at mucosal surfaces, such as the gums in this case, may provide the primary trigger for the systemic autoimmunity seen in RA,” Mankia said.
RA is a chronic inflammatory disease that affects the joints, causing pain and disability. It also can affect internal organs. While it is more common in older people, there also is a high prevalence in young adults, adolescents, and even children, and it affects women more frequently than men. 
Porphyromonas gingivalis
The prevalence of gum disease is increased in patients with RA and could be a key initiator of RA-related autoimmunity. This is because autoimmunity in RA is characterized by an antibody response to citrullinated proteins, and the oral bacterium Porphyromonas gingivalis (Pg) is the only human pathogen known to express an enzyme that can generate citrullinated proteins.
“We welcome these data in presenting concepts that may enhance clinical understanding of the key initiators of rheumatoid arthritis,” said Robert Landewé, MD, PhD, chair of the Scientific Programme Committee with EULAR. “This is an essential step towards the ultimate goal of disease prevention.” 
In the study, dentists diagnosed clinical gum disease in significantly more at-risk individuals than in healthy controls (73% versus 38%). Also, the percentage of sites with clinical attachment level of ≥2 mm, pocket depth of ≥4 mm, bleeding on probing, periodontal disease (PDD), and active periodontal disease were all significantly greater in the at-risk individuals compared to controls. In non-smokers, PDD and active PDD were more prevalent in at-risk individuals compared to controls.
DNA was isolated from the subgingival plaque, next to the gums, of each participant and used to measure the levels of three types of bacteria, PgAggregatibacter actinomycetemcomitans (Aa), and Filifactor Alocis. Results showed that there was increased abundance of both Pg and Aa in at-risk individuals. But in at-risk individuals, only Pg was significantly increased at healthy dental sites and was associated with the overall extent of gum disease.
The study included 48 at-risk individuals (positive test for anti-citrullinated protein antibodies, musculoskeletal symptoms but no clinical synovitis), 26 patients with RA, and 32 healthy controls. The three groups were balanced for age, gender, and smoking. At-risk individuals underwent ultrasound assessment to assess for subclinical synovitis. Only two were found to have ultrasound synovitis. Dentists examined six sites per tooth in each participant, and a clinical consensus was reached in each by three dentists.

02 Jul 2018  Dentistry Today Industry News