Monday, July 16, 2018

Periodontal Disease Just May Be Causing 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

Friday, June 29, 2018

The Dangers of Oral Piercings

Today's article is from studies that were recently presented at the European Federation of Periodontology’s EuroPerio9 conference, June 20 to June 23 in Amsterdam.  
Though considered trendy and fashionable in some circles, tongue piercings may affect nearby gums and teeth.  We have seen multiple cases in our practice of  severe damage to the periodontium from these fashion statements. In some cases the damage occurred very quickly, within the first months of the piercing.  
“My interest in piercings began when a young female patient presenting unusually severe periodontal destruction was referred to my clinic,” said Clemens Walter, DMD, of the Department of Periodontology, Endodontology, and Cariology at the University of Basel in Switzerland and author of the first study.
“The patient was periodontally healthy with the exception of the lower incisor teeth. We could not identify any known risk factors. The patient had a tongue piercing. Nonsurgical and advanced surgical treatment was performed and was not successful. The patient lost teeth. Since then, I have been curious about this association and started to collect cases,” Walter said.
The 18 subjects in Walter’s study, including 14 females, were drawn from a database of more than 1,400 patients treated at the university. The mean age was 28.3 years, ±7.7 years. Three of the patients wore both a lip and a tongue piercing, for a total of 14 tongue piercings and seven lip piercings.
Clinical parameters and the maximum wearing time of the lip and/or tongue piercing were recorded. Periodontal findings in the teeth close to the piercing were compared to teeth not affected by the piercing.
“Due to ethical considerations, it seems impossible to conduct a prospective study. Therefore, the suitable design to answer our question was a retrospective study/case series,” said Walter.
“We found an association between oral piercings and increased periodontal inflammation, as evident by increased bleeding on probing and increased probing depth and/or attachment loss. The closer teeth were to a tongue piercing, the more affected they were,” said Walter. 
recession and bone loss caused by a lip piercing
“Acknowledging the growing data from all over the world, we now try to create awareness about the consequences of piercings for oral health, and we counsel our patients to remove piercings in order to decrease the risk for dental and periodontal complications,” said Walter.
Dr. Bernard Loir of Brussels found repeated gum damage due to the chronic pressure of metal against teeth and gums during tongue movements in speaking, eating, or swallowing in a pair of female patients, age 27 and 32. 
This gum damage also was associated with gum bleeding and infection, causing deep lingual infrabony lesions and periodontitis. The tongue piercings were used for eight to 10 years and finally removed after abscesses, teeth mobility, and migration.
“The lesions were localized on the lower incisor’s lingual side, close to a tongue piercing (the most frequent oral localization of these devices, followed by the lip),” said Loir.
“Periodontal complications occurred in a location hardly visible for the patient, and as these teeth have very short roots, tooth mobility and tooth loss in the aesthetic area may be quickly encountered, an uncomfortable situation for such young and mostly female patients,” said Loir. 
“For both patients, time consuming and costly surgical treatment and antibiotics were needed, and complete regeneration of the lost tissue could not be achieved,” Loir said.
“Young patients with oral piercings should be made aware of the local and global health risks they take by wearing these useless devices, especially if they compound the risk by smoking and a lack of proper dental hygiene. Piercings interfere daily with chewing, swallowing, and speaking, and the rate of complications is very high in the available literature,” said Loir. 
“Early complication is usually infection due to lack of hygiene in the piercing saloon or when done by the patients themselves with nonsterile material. Bleeding and swelling of the tongue is also very common and may represent a danger for a patient with cardiovascular disease, but late complications also occur, such as swallowing the jewelry, teeth chipping, and gum recession with lip piercings,” Loir said. 
“Other complications occur in a more silent mode, such as lingual gum recession and bone loss, causing tooth mobility, migration, and loss. Other life-threatening diseases such as viral contamination (hepatitis, papilloma virus), endocarditis, and cerebral abscesses have also been registered,” said Loir.
“While awareness with respect to oral complications associated with piercings seems to be slowly increasing, there is yet much to be done,” said Walter. “We are continuing with our research and hope to recruit more patients in order to increase our database.”

My advice to all people considering a perioral or tongue piercing is very simple, just don't do it. And for all those who have already taken the leap and had the piercing done, your best bet it to promptly remove it. If you've noticed any changes in the condition of your gum near your piecing make an appointment with a periodontist to get the damaged treated, it might not be too late to save the affected teeth.

Friday, June 22, 2018

Possible Gene found which controls periodontal disease

Study pinpoints genetic connections to perio and coronary artery disease in addition to lifestyle factors

Results of a meta-analysis presented at the European Federation of Periodontology-EuroPerio9 meeting reported that periodontal disease and coronary artery disease (CAD) share a common genetic basis. 
“Knowledge of the shared genetic basis helps to understand the molecular mechanisms that underlie and predispose to the disease,” explained lead author, Dr. Arne S Schäfer, a professor at the department of periodontology and synoptic dentistry based at Charité University Medicine in Berlin, Germany. “This knowledge will guide strategies for therapy but also allow the identification of risk groups for preventive care, before the disease manifests itself.”
Strong evidence of association between CAD and periodontal disease (PD) has already been established. Both are among the most common diseases: CAD affects 110 million people worldwide and is the first cause of death, while PD affects 538 million people.(2) Both diseases are frequently diagnosed together and have common risk factors, such as smoking and diabetes. Both are characterised by a chronic inflammatory process but, independent of those shared risk factors, previous studies(3,4) had suggested a few shared genetic variants.
Dr. Schäfer said, “Our aim in undertaking this study was to further explore the joint genetic basis of CAD and PD. The identification of the shared genetic susceptibility factors will pinpoint relevant molecular pathways for the disease. This knowledge will yield very specific therapeutical targets for precision medicine. We believed that, given the localized nature of periodontitis which is confined to the oral cavity, there would be a small variety of different pathways that had the potential to contribute to both diseases.”
He added that the 10-year study examined every common variant in the entire DNA sequence. “These are alternative building blocks called alleles, which are in the millions. We counted if a variant was more common in both CAD and periodontitis cases, compared to healthy controls,” he said. To rule out chance findings, which can be caused by random differences of natural variation, we counted all these variants in all patients of CAD and periodontitis that were available to us. This high number of analyzed individuals and a replication of the results in an independent sample of cases and controls, allows to generalize our findings.”
Researchers identified a variant in the promoter region of the gene VAMP8 (a promoter regulates the activity of a gene in response to other stimuli) to be significantly more frequent in CAD and periodontitis cases than in healthy controls, indicating the involvement of this gene in the etiology of both diseases.
“VAMP8 is of special interest, because it is involved in the import and export of molecules and other substances into and out of the cells (acting as a sort of door),” Dr. Schäfer said. “It is strongly expressed in the epidermis of cellular interfaces of barrier organs of the gastrointestinal tract, which includes the gingiva. We are now looking in detail at which direction the transport is affected in the disease processes and what substances are involved, for example microbial substances that get in or antimicrobial substances that get out of the gut.”
Asked for a “take home” message, Dr. Schäfer said that it is important to retain that coronary artery disease and gum disease are not linked to lifestyle factors alone. “There are probably risk groups which have a genetic predisposition in response to certain factors,” he replied. “This also means that periodontitis does not increase the risk for CAD in general or vice versa. Nevertheless, a group of individuals may share a genetic predisposition, involving the VAMP8 function, which increases the risk for both diseases. While it is possible that one disease precedes the onset of the other, that does not necessarily mean that the manifestation of one causes the manifestation of the second disease.”
The European Federation of Periodontology is an umbrella organization of 30 national scientific societies devoted to promoting research and education for periodontal science and practice. EuroPerio9 will hosted June 20- 23 at the RAI in Amsterdam.

Article originally published by Dentistry IQ 6-15-18

Friday, June 15, 2018

Home Grown Research Team develops early detection for gum disease!

“Smart Tooth” Detects Periodontitis

Researchers from the Washington University School of Medicine in St. Louis and the School of Engineering & Applied Science are developing “smart tooth” technology that could be used to detect the early signs of certain diseases such as periodontitis and diabetes in high-risk patients by analyzing saliva or gingival crevicular fluid. 
“Salivary-based biosensors have generated a lot of interest because of their potential for wide applications in medicine,” said Erica Lynn Scheller, DDS, PhD, assistant professor of medicine, cell biology, and physiology at the School of Medicine. “We’re initially working to develop a biological sensor that measures specific peptides active in periodontal disease, and that would be used in combination with a wireless device to retrieve that data.” 
“It’s like an electronic tooth,” said Shantanu Chakrabartty, MS, PhD, professor of electrical and systems engineering in the School of Engineering & Applied Science and a partner on the project, currently funded by a four-year, $1.5 million grant from the National Institutes of Health.
The “smart tooth” is a tiny sensor and electronic chip that’s about a few millimeters cubed in volume. Designed to be inserted inside the gumline or as part of a dental appliance, it features bio-recognition elements that measure disease-specific peptides, which are natural or synthetic groups of amino acids. 
As a first attempt, the researchers will work toward monitoring peptides related to bone breakdown in periodontitis. A wireless ultrasound device would then read the peptide levels and connect to the medical data cloud. However, chemistry remains one of the project’s biggest challenges.
“You only have a finite number of bio-recognition elements conjugated to the transducer if you are using an antibody that is specific to these peptides,” said Srikanth Singamaneni, MS, PhD, associate professor of mechanical engineering and materials science. “They get saturated fairy quickly. The question is, how do you refresh those sensors? That’s one of the aspects we are working to address with this project.” 
The researchers say that developing a new, minimally invasive system that can detect and monitor gum disease and the effectiveness of treatment would be beneficial to the 64 million United States residents with periodontal disease and to their dentists. Also, the researchers are interested in developing other applications for the technology that, while likely years away, could go well beyond the dentist’s chair.
“We’re developing this sensing platform that can be expanded to include additional tracking for inflammatory markers, stress markers, and diabetes monitoring,” said Scheller. “Really, anything you can think of that you’d want to track in the oral cavity, we’re developing both the platform and the specific application.”

Friday, May 18, 2018


Receding gums are also known as gingival recession. The pink gum tissue normally covers the root of the tooth. This can become exposed when the gum is pushed back or if the tooth is in an abnormal position.
Receding gums are common and often unnoticed at an early stage. There are many risk factors, but age is a main one - 88 percent of people older than 65 have receding gums in at least one tooth. However, recession can be seen developing as early as the teen years.
The main concern with receding gums is that when the roots of the teeth become exposed, they are at risk for decay, infection, and loss. Treatment can stop or reverse the process of gum recession if begun at an early stage.
If the recession is severe and the patient has symptoms such as tooth sensitivity, pain, or infection, a variety of treatment options are available. These include deep cleaning, medicine to fight infections, and even tissue grafts.  In fact, tissue grafts done by your periodontist are the most natural way of treating lost gum/gingiva.

What is gum recession?

[teeth and gums up close]
The gums protect the fragile tooth roots from bacteria, plaque, and other forms of decay.
Gingival recession is the exposure of the roots of teeth after experiencing a loss of tissue in the gum.
The gums are also known as the gingivae. The gingiva is the moist pink tissue in the mouth that meets the base of the teeth. There are two such gums - one for the upper, and one for the lower set of teeth.
The gingiva is a dense tissue with a good supply of blood vessels beneath a moist surface. The surface is called mucous membrane. It is joined to the rest of the mouth lining but is pink instead of shiny red.
The gums tightly surround the teeth up to the neck of each one and are firmly attached to the jaw bone. The gums usually cover the roots of the teeth, protecting them as they are more fragile than the rest of the teeth.
Gingival recession  causes a loss of the tight firm gum tissue at the neck of the teeth which exposes the fragile mucous membrane to the harsh environment that the gingiva is designed to protect. Thus  allowing the tooth roots to be directly exposed to bacteria, plaque, and food making the tooth more susceptible to decay of the root. Bone loss occurs as the recessions progresses and the end result can be the loss of tooth or teeth.


Poor oral hygiene and periodontal disease are linked to gingival recession. But 
receding gums can happen in people with good standards of oral hygiene, too.
Broadly, there are two causes of receding gums:
  • Physical wear of the gums
  • Inflammation of the gum tissues - this is a reaction of the immune system
Some people are more prone to receding gums because of inherited factors. These factors include their tooth position and gum thickness.
Physical wear of the gums by vigorous tooth brushing or use of hard bristles is a     common cause of receding gums.
[teeth and gums examined]
The two main causes of receding gums are physical wear and inflammation of the gum tissue.
People with this problem otherwise have good oral hygiene. The teeth and gums otherwise appear healthy when receding gums are caused by over-brushing.
This type of recession often affects the left side more. This is because most people use a toothbrush in their right hand and so put more pressure on the left gums. The pattern also tends to affect the side gums more than the front.
Other physical factors that push the gums back include lip piercings, misaligned teeth, and damage caused by dental treatment.
Some people are more prone to the inflammatory causes of receding gums. Thinner gum tissue makes inflammation caused by plaque more likely. The gums are more delicate in some people.
Periodontal disease is a common cause of gum recession. Periodontal disease causes the loss of the supporting bone around a tooth through an inflammatory reaction. The gum recession tends to affect all the teeth in a similar way.
Periodontal disease is caused by plaque buildup. Plaque is a sticky film that forms on the teeth. Bacteria, mucus, cells, and other particles are involved in the formation of plaque.
When plaque builds up on teeth, it causes:
  • Inflamed gums known as gingivitis. This condition can lead to periodontitis
  • Periodontitis results in spaces between the gums and teeth and loss of connective fibers and bone around the tooth roots. This leads to receding gums
Tartar is hardened plaque and cannot be removed by tooth brushing. Instead, it must be removed at a dentist's office.


Many people with receding gums have no concern about them early on. Many others are unaware that they have recession.
For some, though, the concern may be about:
  • Appearance
  • Fear of tooth loss
  • Sensitivity due to exposed tooth roots
Assessing concerns about the way gums look may include checking how much of the gums are on show.
For some people, the gums show when talking and smiling. Others have a different lip line that does not expose the gums to view.


Most cases of mild gum recession do not need treatment. Dentists may simply give advice about prevention and offer to monitor the gums. Teaching people how to brush gently but effectively is a good early intervention. It is always advisable to visit a periodontist to evaluate your recession. This is because the periodontist can intervene with minor surgical treatments that can stop further recession and may be able to replace lost gum tissue if the reccession is treated early enough.
For people who do need treatment, a number of options are available:
[teeth with braces]
Orthodontics are one method of treatment for receding gums.
  • Desensitizing agents, varnishes, and dentine bonding agents: These aim to reduce any sensitivity that may develop in the exposed tooth root. This treats the nerve symptoms and helps to keep normal oral hygiene by allowing brushing of sensitive teeth to continue. However, when the sensitivity does not respond to these treatments a periodontist may be able to recover the exposed root with specialized gum grafting techniques.
  • Composite restoration: Tooth-colored composite resins are used to cover the root surface. They can also close black gaps between teeth.
  • Pink porcelain or composite: This is the same pink color of the gums. This is done when the recession is so severe that root coverage can not be achieved with grafting procedures.
  • Orthodontics: Treatments designed to move the position of teeth can correct the gum margin.
  • Surgery: Tissue is grafted from elsewhere in the mouth and heals over the gum recession. This is the most natural method of replacing the lost biologic tissue. You simply replace what was lost with what nature intended to be there in the first place.

How to prevent receding gums

Some of the causes of gingival recession are preventable.
The most obvious preventable cause is brushing the teeth too harshly or by using hard-bristle toothbrushes. People should avoid doing this to prevent receding gums
Plaque buildup leads to periodontal disease, so careful oral hygiene can also help prevent receding gums.

Friday, April 20, 2018

Dr. Duello Advancing Dental Education in Our Community


This was the subject of the Open House and mini CE course at our office this past Wednesday night. Dr. Duello continues to work hard to bring the best of the growing digital technologies to his practice and share the benefits of these technologies with the St. Louis dental community.

The X-Guide by X-Nav Technologies was the darling of the night.  This GPS guided surgery technology has made "perfect" implant placement a reality. X-Guide allows for the transfer of the 3D treatment plan direct to the patient's mouth for the surgical procedure utilizing GPS technology to precisely place dental implants. Basically, it creates a virtual surgical guide rather than a physical one, thus reducing the margin of error to .222microns.
Dr. Duello demonstrating X-Guide 
Dr. Duello in our teaching facility with a group local dentists

Dr. Duello continues to embrace the burgeoning growth of the digital world in dentistry because it ultimately allows the dental practitioner to give patients what they truly want: less time in the dental chair and a  very predictable outcome.

Friday, April 6, 2018

Periodontal Disease and Age-Related Macular Degeneration

Gum Disease May Cause Blindness

We've been reporting that periodontal disease is associated with many systemic inflammatory diseases, but now there is emerging evidence that a specific bacteria may contribute to age-related macular degeneration.

The anaerobic gram-negative bacteria Porphyromonas gingivalis (Pg) is the root of this evil. If you or a loved one have symptoms of gum disease then you need to act. Gum treatments are a relatively easy way to prevent devastating systemic diseases that can threaten your eyesight and even your life. Below is a synopsis of the new research into the age-related macular degenration that is associated with Pg.

Many clinical studies link Chronic Periodontitis (CP) to various systemic disorders and lately age-related macular degeneration (AMD), a leading cause of irreversible vision loss in elderly, is found to be associated with periodontal disease. The keystone oral-pathobiont and one of the major causative organism for CP, Porphyromonas gingivalis (Pg), has been identified with the ability to invade epithelial, fibroblasts and dendritic cells. "Our study was designed with an objective to interrogate the role of Pg and its fimbriae-mediated infection of human retinal-pigment epithelial cells and retro-orbitally injected mice retina, thus revealing possible molecular links between CP and AMD," said Hyun Hong (Predoctoral dental student, Summer Research Program, Dental College of Georgia) and Dr. Pachiappan Arjunan, the Principal Investigator, who directed this study (Assistant Professor, Department of Periodontics, Dental College of Georgia, Augusta University).
Human retinal-pigment epithelial cells were infected with Pg and its isogenic mutant strains and genes were analyzed by qPCR.
The results showed that human retinal-pigment epithelial cells take up Pg381 and that qPCR shows a significant increase in expression levels of genes, important in immunosuppression and angiogenesis/neo-vascularization markers compared with uninfected control.
Certain complement regulatory-related genes were upregulated, while others were downregulated. In a mouse model, AMD-related effects on mouse retinae were induced by Pg-injection compared to control group.
Dr. Arjunan states that, "This is the first study to demonstrate the link between oral pathobiont infection and AMD pathogenesis and that Pg can invade human retinal-pigment epithelial cells & elevate AMD-related genes which might be the target molecules for both diseases."
Further, successive ongoing studies in Dr. Arjunan's laboratory in collaboration with Dr. Christopher W Cutler (Professor and Chair, Department of Periodontics, Dental collage of Georgia, Augusta University), could distinguish specific causal role of Pg in AMD pathogenesis. The first part of this work will be published very soon, he added.
This work was funded by the Department of Periodontics, Dental College of Georgia, Augusta University and seeks additional funding support from National Institutes of Health (NIH) to accomplish the objective of this innovative study.
At the 47th Annual Meeting of the American Association for Dental Research (AADR), held in conjunction with the 42nd Annual Meeting of the Canadian Association for Dental Research (CADR), Hyun Hong, The Dental College of Georgia at Augusta University, presented a poster titled "Investigating the Enigmatic Link Between Periodontal Inflammation and Retinal Degeneration."
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