Friday, February 9, 2018

Can Your Ethnicity and Your Genetics Affect Gum Disease?

Race Plays a Role in Periodontal Health

Not everyone is equally susceptible to periodontal disease. For example, men have higher rates of periodontal disease than women. In addition, people of different races and ethnicities also differ in terms of their oral health.

A study published in the Journal of Periodontology reports that while 25 percent of non-Hispanic
whites age 30 to 54 in the United States have periodontitis, 35 percent of Mexican Americans and
42 percent of African Americans in this same age group have the disease. The trend continues as
the groups age, with 47 percent of whites age 55 to 90 having periodontitis, compared with 59 percent of Mexican Americans and 70 percent of blacks.

The reasons for the significant differences between racial groups remain a mystery. It may be a compilation of reasons, such as less use of dental services and different inflammatory
responses. For example, 53 percent of Hispanics report having annual dental visits,
compared with 68 percent of non-Hispanic whites.

The Human Genome Project, a major initiative to map the genetic components of humans, has declared that genetic factors contribute to virtually every human disease, increasing susceptibility or
resistance or influencing the interaction with the environment. The project has also determined that racial/ethnic groups are more alike than different. However, clusters of the population may have
a greater prevalence of certain diseases. In addition to higher rates of periodontal disease, Mexican Americans and blacks have higher rates of diabetes. Diabetics are at a higher risk of developing
periodontal disease, likely due to an increased susceptibility to contracting infection.

No matter how susceptible you may be to periodontal disease, if the bacteria responsible for the disease are kept under control with good oral hygiene and frequent dental visits, you are not sentenced to a life with periodontal disease. Recognizing your risk factors may help you control for them, so talk to your periodontist about them.

Genetic Markers Differ in Some Populations

A genetic marker strongly associated with periodontal disease does not play a role in the high prevalence of periodontal disease in people of Chinese heritage, according to a study in the Journal of Periodontology.

The Interleukin-1 (IL-1) genotype that puts more than 30 percent of people of European heritage at increased risk for periodontal disease is barely existent in Chinese populations. The study tested 300 people of Chinese heritage, and only about 2 percent carried the IL-1 genotype.  Periodontal disease is a multifactorial disease, and it is still unclear whether oral hygiene, genetics
or any other risk factor is most important in explaining why periodontal disease is widespread in
Chinese populations.

A separate study confirmed that people of Northern European origin who have the IL-1 genotype are more than five times as likely to develop periodontal disease, making oral hygiene habits, smoking and genetics among the top risk factors for periodontal disease.

The study concluded that giving dental patients a genetic test, which can be performed through a saliva sample, before they even show signs of periodontal disease and getting them into early interventive treatment might help them keep their teeth for a lifetime.

The test may be most useful for specific cases, such as for patients with advanced periodontal disease who seem to lack other major risk factors, for adults considering orthodontic treatment that could make them more susceptible to bone loss around the teeth, and for patients considering extensive treatment to save teeth jeopardized by periodontal disease.

However, the study questions the usefulness of genetic testing for Chinese patients until further research is done. Future studies may determine if other gene candidates contribute to periodontal disease in Asians.

Friday, February 2, 2018

Healthy Mouth, Healthy Body

The Disease in Your Mouth Can KILL You!

Here it is again....another article tying your health to the health of your mouth!!! Folks, it's for real, the disease in your mouth can KILL you! If you haven't seen your dentist or have been putting off treating your gum  disease....NOW is the TIME!

 This article provided by Roberta Codemo is a freelance health journalist. She opened Codemo Writing Services in 2012. A Springfield resident, she can be reached at

The mouth serves as a gateway to the body. There is a connection between oral health and general health. Our mouth can tell us whether we’re at risk for developing chronic inflammatory health conditions, such as cardiovascular disease and diabetes. 

More than 300 different kinds of bacteria live in the mouth. While some bacteria are beneficial and help protect us from disease, other bacteria can cause infection in the gum tissue that leads to inflammation and over time to gingivitis which, if left untreated, progresses to periodontal disease. 

Periodontal disease is the most common chronic infection in this country, writes Bradley Bale, M.D., and Amy Doneen, ARNP, in their 2014 book, Beat The Heart Attack Gene. A recent study by the American Academy of Periodontology found that 50 percent of adults age 30 and older have periodontal disease and 70 percent of adults age 65 and older have periodontitis. 

Most people aren’t aware that they have gum disease. In the early stages, gum disease is painless. It begins as gingivitis, which is characterized by bleeding gums when you brush and floss. “There is no such thing as normal bleeding in the mouth,” said Dr. Edward Segal, a periodontist in Northbrook and past president of the Illinois State Dental Society. 

As the disease progresses, it’s known as periodontal disease, and is characterized by inflammation of the gum tissue, presence of disease-causing bacteria and infection below the gum line. Signs of periodontal disease include bad breath, puffy or receding gums, loose teeth, pockets of pus between teeth and gums and changes in bite. 

“Periodontal disease is a root cause for heart attack and stroke,” said Dr. Craig Backs of Springfield, who operates the Center for Prevention of Heart Attack and Stroke. Recent research shows that people with periodontal disease have triple the risk of heart disease and stroke. 

“We’ve known for a long time that bacteria in the mouth can increase the risk of arteriosclerosis,” said Backs. Studies have analyzed the plaque material removed from the arteries in the heart and compared this bacteria to the bacteria in the mouth. It matches. 

Periodontal disease is an inflammatory condition. As the disease progresses, it triggers an immune response in the body. To fight it the body produces cytokines, which are proteins made by our immune system that act as chemical messengers. This inflammatory response can exacerbate chronic inflammatory diseases in other parts of the body. 

When oral bacteria enters the bloodstream, it travels throughout the body and can attach to the fatty plaque inside the coronary arteries, causing inflammation in the wall of the artery. The inflammation further causes plaque to build up inside the arterial wall, leading to a condition called atheroscelerosis, or hardening of the arteries, that can lead to blockage and eventually a heart attack.

“It’s a cascading event,” said Backs. “It’s important to detect the disease early to avoid consequences.” Treating and preventing periodontal disease can lower the risk of heart attack and stroke. 

Research shows a strong correlation between periodontal disease and Type 2 diabetes. People with diabetes are more likely than non-diabetics to develop periodontal disease. Periodontal disease is more severe in diabetics with insufficient blood sugar control. 

This occurs for a variety of reasons. First, diabetes sufferers are more prone to infections, and diabetes reduces the body’s resistance to infection. Second, periodontal disease elevates blood sugar levels in the body. Diabetics with periodontitis are more likely to suffer from high blood sugar levels, making it difficult to keep their blood sugar under control. Lastly, high glucose levels promote the growth of gum disease-causing bacteria. 

“When these patients undergo treatment for their periodontal disease, their diabetes status significantly improves,” said Backs. 

The challenge for the most part, however, is getting medical practitioners and the dental community to work together. “They need to share information and collaborate on patient care,” said Backs, who is working to build relationships within the dental community. Both sides need to recognize the role that oral health plays and work together to improve patient outcomes. 

In the meantime, people need to raise their level of personal dental hygiene by brushing, flossing and making regular visits to their dentist. By taking preventative measures, you can reverse your risk of developing these diseases.

“Taking care of yourself is the best you can do for the ones that you love,” said Backs.

Friday, January 12, 2018

HPV and It's Risk Factors for Orophyarngeal Cancer and

Human papillomavirus (HPV) infection

Human papillomavirus (HPV) is a group of more than 150 types of viruses. They are called papillomaviruses because some of them cause a type of growth called a papilloma. Papillomas are not cancers, and are more commonly called warts.
Infection with certain types of HPV can also cause some forms of cancer, including cancers of the penis, cervix, vulva, vagina, anus, and throat. Other types of HPV cause warts in different parts of the body.
HPV can be passed from one person to another during skin-to-skin contact. One way HPV is spread is through sexual activity, including vaginal and anal intercourse and even oral sex.
HPV types are given numbers. The type linked to throat cancer (including cancer of the oropharynx) is HPV16.
Most people with HPV infections of the mouth and throat have no symptoms, and only a very small percentage develop oropharyngeal cancer. Oral HPV infection is more common in men than in women. In some studies, the risk of oral HPV infection was linked to certain sexual activities, such as open mouth kissing and oral-genital contact (oral sex). Smoking also increases the risk of oral HPV infection . At this time the US Food and Drug Administration has not approved a test for HPV infection of the mouth and throat.
The number of oropharyngeal cancers linked to HPV has risen dramatically over the past few decades. HPV DNA (a sign of HPV infection) is now found in about 2 out of 3 oropharyngeal cancers and in a much smaller fraction of oral cavity cancers. The reason for the rising rate of HPV-linked cancers is unclear, although some think that it could be because of changes in sexual practices in recent decades, in particular an increase in oral sex.
Oropharyngeal cancers that contain HPV DNA tend to have a better outlook than those without HPV.

From the American Cancer Society website.

Friday, January 5, 2018

Link Between Diabetes and Inflammation Identified

Study Identifies the Metabolic Relationship Between Inflammation and Diabetes
More than 30 million Americans have diabetes, according to the University of Maryland School of Medicine (UM SOM), a disease with significant links to oral health. Now, researchers at the school have uncovered how inflammation contributes to diabetics’ inability to metabolize glucose, a condition known as insulin resistance.
“Until now, we didn’t really understand how insulin resistance occurred,” said Xiao-Jian Sun, PhD, an assistant professor in the Department of Medicine at UM SOM. “Our study has done something new. It has identified a new molecule involved in the development of insulin resistance.” 
Sun began his research by focusing on Insulin Receptor Substrate-1 (IRS-1) and Insulin Receptor Substrate-2 (IRS-2). These signaling molecules allow insulin to do its work, such as synthesizing fat, promoting muscle growth, and breaking down glucose. Since the hormone plays many such roles, diabetics have multiple problems, often including gum disease.
“Poor blood glucose control could lead to thick blood vessels, leading to gum disease because it prevents the normal blood supply from maintaining healthy gums. It also could provide glucose for the bacteria to thrive, which sets the stage for gum disease,” said Sun. “Severe gum disease also could induce inflammation, which escapes into the bloodstream and upsets the body’s defense system, which in turn affects blood sugar control.”  
Researchers have noted that many patients suffer from both type 2 diabetes and chronic inflammation, which can be caused by factors such as aging, obesity, and high sugar consumption. These factors also increase the risk of diabetes. A gene called Interleukin-1 receptor-associated kinase 1 (IRAK1) plays a key role in this process.
Inflammation activates IRAK1. Sun and his team discovered that this enzyme blocks insulin signaling in muscle by blocking IRS-1, reducing insulin’s ability to metabolize glucose in muscle. Research showed that mice that had been genetically modified to lack IRAK1 had significantly higher insulin sensitivity in muscle than regular mice.
“What we suspect is that high IRAK1 activity is bad in humans,” Sun said. “It increases insulin resistance, particularly in muscle. This gives us insight into how to improve insulin resistance in patients with diabetes.”
Sun said that in the future, it may be possible to test diabetes patients to see what version of IRAK1 they have. Some may have a more active version of the gene, while others may have a less active version. With testing, clinicians may be able to predict how much insulin resistance might be possible with weight loss or other preventive measures. Also, drugs that inhibit IRAK1 activity may be developed.
“Diabetes remains one of our country’s most urgent public health challenges,” said UM SOM dean E. Albert Reece, MD, PhD, MBA. “Especially because it is a chronic illness, it causes enormous suffering not only for patients but for their families. Dr. Sun’s new paper opens up a new avenue that has the potential to eventually help millions of patients with the disease.”
This was  originally published by Dentistry Today, Sept 15, 2017

Friday, December 22, 2017

During the holiday season as we reflect on the past year, our thoughts turn gratefully to those who make our practice possible. 

It is in this spirit that we say to our patients, referring doctors, family and friends, Thank You and Best Wishes for the holiday season and Happy New Year! 

Monday, December 11, 2017

Dr. Duello to receive the 2018 Gold Medal Award

The Greater St Louis Dental Society 2018 Gold Medal Award

The Gold Medal Award is presented to an dentist who has acheived outstanding professional accomplishments and is recognized as an individual who has devoted essentially an entire career to the advancement of the profession of dentistry.

We are proud to announce that our very own Dr. George Duello has been chosen to be honored with the presitgous Gold Medal Award at the Greater St. Louis Dental Society 2018 Installation and Award Dinner on January 27th at the Moto Museum.

We'd like to share just a small peek into Dr. Duello's journey through his career with the following photos.

Dr. Duello is an accomplished speaker. He has lectured extensively across the United States and in Europe. He has been invited to be a speaker at both the American Academy of Periodontics and the American Dental Association's National Meetings. He has been privileged to be invited to speak at many Study Clubs throughout the country.
Teaching the art of Dental Implants at a hands on course

Keynote Speaker at the AAP National Meeting
In Germany filming an implant surgery for a large audience

Dr. Duello has volunteered at many community events. Such as Give Kids a Smile, a St. Louis event where underserved children are treated.

 Dr. Duello has been published in several professional journals. He is most proud of his chapter in Dr. Michael Cohen's, Interdisciplinary Treatment Planning, Vol II Comprehensive Case Studies

Showing off his chapter, A Path to Interdisciplinary Care for the Dental Team, at the Quintessence booth on the exhibit floor

Dr. Duello has spent countless hours giving back to the St. Louis dental community. In fact one of his career goals has been "to raise the standard of dentistry in St. Louis". To that end he was the Director of the Gateway Study Club, a chapter of the Seattle Study Club, for 16 years. The concept of the club is a university without walls.  Eventually he created the New Horizons Hygiene Study Club as a sub group to the Gateway Study Club.
Lecturing a group of 70 hygienists about mucogingival defects
Lecturing in our teaching room to a group of doctors
about new technologies in dental implants

Dr. Duello's passion ultimately lies with helping his patients acheive a healthy smile. As a specialist he works with many general dentists and other dental specialities to provide the best treatments possible for each patient he sees.

Dr Duello pictured with Mr Wells who will be 101 years young in January!

Friday, November 17, 2017

Exposing the Periodontal Pathogen: The Culprit Causing Gum Disease

Define Periodontal Disease by Its Pathogens

Periodontal disease by definition is an infectious, contagious, inflammatory, polymicrobial disease with systemic and genetic expression.
Polymicrobial means many strains of pathogens are present. Each strain presents with different sensitivities to different antimicrobials or antibiotics. It becomes relevant to treating pathogenic infections to know what strains are present to become aware of how best to plan a treatment remedy.
The strains present as well as their concentrations can be determined by a simple saliva test. The prescribing dentist determines the appropriate periodontal therapy depending on the results of the saliva test. The patient’s dental and medical history also will be considered when evaluating the use of antibiotic medications to treat the periodontal condition. There are different antibiotic options depending on which pathogens are present and on the concentration of those pathogens.
Know the Types 
Of the more than 800 oral bacteria, at least 11 pathogens are also found systemically and can be identified routinely by both their individual strain and their concentration via a simple bacterial DNA test.
Four of the most virulent and destructive periodontal pathogens are Aa, Pf, Tf, and Td. In salivary pathogen testing and much literature, they are referred to as the red complex, high-risk, or late colonizing pathogens. The high-risk pathogens are initiators of intracellular damage wherever they are found.
There are six moderate-risk pathogens: En, Fn, Pi, Cr, Pm, and Ec. This group is known as the orange complex or middle colonizing pathogens, and they are usually collaborative once a red complex organism has entered a cell. Many recent studies are finding that Fn and Cr can be found alone and are seemingly solely responsible for an inflammatory response. 
The last pathogen is Cs, a low-risk, early colonizing or “green complex” bacteria. It also is collaborative and has been found to be of far less threat systemically than the others.
Their Effect on Oral Health
All of the systemically virulent pathogens from periodontal disease are pathogenic, relative to their individual or collective concentrations or to their total numbers. Certainly, there are times for all individuals when each of the strains is present 100% of the time. It is only when genetics, low immunity, low resistance, or chronically uninterrupted colonies are allowed to proliferate that total counts elevate to encourage systemic infection.
The systemic impact of periodontal pathogens is profound. Periodontal pathogens are associated with or linked to 16 systemic diseases to date, including cardiovascular disease, diabetes, respiratory disease, chronic obstructive pulmonary disease, rheumatoid arthritis, gastrointestinal disorders, Alzheimer’s disease, osteoporosis, kidney disease, preterm birth, preterm birth weight, and cancer. Periodontal disease treatment, then, must be considered a part of the preventive armamentarium for chronic disease management. 
Perhaps looking at dentists as doctors of oral medicine, hygienists as oral medicine therapists, dental assistants as oral medicine technicians, and the administrative team members as oral medicine facilitators will bring into focus exactly what dental professionals are responsible for. Dentistry is moving beyond saving a tooth and moving closer to saving and extending lives.

Traci Warner, RDH  Todays Dental News