Important info for people with diabebtes! See my office facebook page ( https://www.facebook.com/MastersInstitute/?ref=bookmarks ) to read more about tooth loss and diabetes

Diabetes and Periodontal Disease: A Two-Way Relationship

The American Diabetes Association defines diabetes as a serious disease in which the body does not produce or properly use insulin, a hormone that is needed to convert sugar, starches, and other food into energy needed for daily life. Approximately 23.6 million Americans have diabetes;
however, 5.7 million of them have not yet been diagnosed.

If you or someone you know has diabetes, you already understand the importance of keeping the disease under control. However, you may not know that good oral health not only keeps the mouth and gums free from periodontal disease, but also might have a significant impact on the control of diabetes. Periodontal disease is an inflammatory response to a bacterial infection that, if left
untreated, may cause damage to the tissues and bone surrounding the teeth and may even lead to tooth loss. People with diabetes are three to four times more likely to develop periodontal disease, which, like any other infection in the body, can impair their ability to process and/or utilize
insulin. Additionally, people with diabetes tend to have more severe levels of bone loss, and often
experience more aggressive disease activity. This can ultimately lead to tooth loss, which can make chewing and digesting food difficult. For people with diabetes, this can have a devastating impact on the ability to maintain proper nutrition and control blood sugar levels.

Just as diabetes can increase a patient’s chance of developing periodontal disease, research
suggests that periodontal disease may make it more difficult for people who have diabetes to control their blood sugar. Periodontal disease increases the body’s systemic inflammatory signals that serve to increase blood sugar. This contributes to increased periods of time when the body functions with an unhealthy blood sugar level. Consequently, it is important for people with diabetes to treat periodontal disease to eliminate the infection for optimal metabolic control.

Periodontal disease is a leading complication of diabetes; therefore, it is important for people with diabetes to know their treatment options. If detected early, a periodontist can provide treatment that can stop the gum disease and bring the gums back  to a state of health, preventing additional bone or tooth loss. In fact, periodontal treatment has been shown to improve blood sugar levels in people with diabetes, suggesting that treating patients’ periodontal disease could decrease insulin requirements.

If diabetes is well controlled, treatment will be similar to the treatment of someone who doesn’t
have diabetes. In the early stages of gum disease, treatment usually includes scaling and root planning, a procedure in which plaque and calculus are removed from the pockets around the tooth and near the gums. People with diabetes may want to schedule their dental appointments early in the morning after they have eaten a normal breakfast in order to stabilize and prevent a severe or sudden drop in blood sugar levels. Upon determining a treatment plan, your periodontist and physician will work together to help you control both your diabetes and gum disease.

DR. DUELLO  at the AAP

Dr. Duello returned from the American Academy of  Periodontology  meeting on Wednesday. he lectured on "Transitioning the Full Arch Terminal Dentition, to a Fixed Implant Solution". Dr. Duello invited his colleague James Mace, DDS  to co-lecture with him. 

Dr. Mace, a general dentist in Washington, MO has collaborated with Dr. Duello on many cases in the past 15+ years. They have become close friends over the years and that relationship hit the "Big Stage" at the AAP meeting. Congratulations to both on a well prepared and well received presentation.

While at the meeting Dr. Duello attended many seminars and mini lectures, providing him with the latest information in the Periodontic field. Dr. Duello was so involved in the learning experience at the AAP meeting that he didn't even have an opportunity to enjoy any extracurricular activities in Florida!!!!


He presented three hands-on live demonstrations focusing on the All-on-4 treatment concept at the Nobel Biocare booth. The All-on-4 treatment concept is an innovative technique that allows for an immediate-function, full-arc, implant-supported prosthesis without the need for any bone grafting procedures even when bone atrpohy exists. Dr. Duello is privileged to be a contributing consultant to Nobel Biocare the largest and most innovative implant company in the world.                                                                                                                                                                                                                        

Continuation of our discussion about Nutrition & Oral Health

Nutrition plays an important role in overall wellness, including oral health. Eating well and maintaining a healthy diet can help reduce the risk of developing problems in your mouth, including
periodontal disease. In fact, including certain foods as part of a nutritious diet has actually been shown to play a role in the prevention of  periodontal disease.

Lactic Acid & Calcium

Most people know that dairy products can help build strong bones. What some may not know is that consuming dairy products may also reduce your risk for developing periodontal
disease. A recent study determined that individuals who regularly consume 55 or more grams of foods containing lactic acid, commonly found in dairy products such as yogurt, have a lower instance of gum disease. Dairy products are also a good source of
calcium which has been shown to lower the risk of severe periodontal disease. The American Dietetic Association advises that adults should consume at least three servings of calcium each day to help keep your jaw bone strong and your teeth in place.

Vitamin C

When a cold is coming on, many people reach for the vitamin C. But this vitamin may do more than just fend off the sniffles; it may reduce the risk of periodontal disease. According to a study, consuming less than 60 mg of vitamin C each day can put you at slightly higher risk for developing certain types of periodontal disease. And this isn’t recent news! In fact, in the late 18th century, sailors away at sea would eat limes to prevent their gums
from bleeding! According to the Institute of Medicine, the recommended dietary allowance for vitamin C is 60 mg per day – or about 1 orange.

Vitamin D

Sometimes known as the “sunshine vitamin”, vitamin D can help lessen inflammation associated with periodontal disease. Research shows that foods fortified with vitamin D such as milk, eggs, sardines, and tuna fish, as well as moderate exposure to sunlight, can provide you with the amount of vitamin D required to stay healthy.

Healthy Diet

There may be more reasons to watch what you eat other than maintaining a healthy weight. Studies indicate that obesity may be linked to periodontal disease. Obesity can be the
result of an unbalanced diet, which may lack the nutrients known to help prevent gum disease. Also, excessive consumption of sugary drinks such as soft drinks and foods high in sugars, trans-fats, and sodium are often associated with increased tooth decay and can have a negative impact on periodontal health. Without the proper nutrients from a healthy diet, the body can have a  hard time fighting off infections such as periodontal diseases. And routinely including such things as lactic acid, calcium, and vitamins C and D in your diet have been shown to possibly reduce the occurrence of gum disease. So next time you go to the grocery store or sit down for a meal, remember: eat right to smile bright!

Eat Well and Brush Well

While nutrients such as lactic acid, calcium, and vitamins C

and D have been shown to have a possible effect on periodontal

diseases, patients should  be aware that a well-balanced

diet alone is not a substitute for periodontal care. It is important

to follow up every healthy meal with proper brushing and flossing!

Read to post to LEARN MORE about how your DIET/NUTRITION can affect your ORAL HEALTH!!!!

NUTRITION AND ORAL HEALTH

Milk does a mouth good

Adults who consume at least three servings of calcium each day have another reason to smile. A new study published in the July, 2000 issue of the Journal of  Periodontology found that people who get enough calcium have significantly lower rates of periodontal disease, a leading cause of tooth loss.

Researchers found that men and women who had calcium intakes of fewer than 500 milligrams, or about half the recommended dietary allowance, were almost twice as likely to have periodontal disease, as measured by the loss of attachment of the gums from the teeth. The association was particularly evident for young adults in their 20s and 30s.

The relationship between calcium intake and periodontal disease is likely due to calcium’s role in building density in the alveolar bone that supports the teeth. Periodontal disease is an infection caused by bacteria that accumulate in pockets between the teeth and gums. Eventually, the infection can break down and destroy the tissues and bone that support the teeth. But, if the jaw bone is kept strong with enough calcium, it may be better able to withstand the bacterial onslaught.

Calcium is necessary for healthy bones, teeth, muscle contractions and other body functions. However, according to the American Dietetic Association, about three out of four people do not meet their daily need. Good sources of calcium include dairy foods such as milk, yogurt and cheese, dark green veggies, fortified orange juice, as well as rice and beans.

A relationship between calcium intake and periodontal disease makes sense in light of other new
research linking osteoporosis with tooth loss. However, people need to keep in mind that several other important risk factors exist for periodontal disease, including tobacco use, oral hygiene habits, genetics, diabetes, certain medications and stress. In addition to drinking milk, ask your dentist or periodontist about the state of your periodontal health to help prevent tooth loss. He or she can help you identify and control the risk factors for periodontal disease

Nourish your smile

A diet low in important nutrients can make it harder for the body’s immune system to fight
off infection. Because periodontal disease is an infection, a well-balanced diet benefits your
oral health.

In addition to calcium, research has shown that not getting enough vitamin C may put
you at increased risk for periodontal disease, especially if you smoke. Good sources of
vitamin C include dark colored fruits and vegetables, such as oranges, green and red peppers, broccoli and strawberries.

Here’s some other nutritional recommendations to help keep you smiling:

• Keep your mouth moist by drinking lots of water. Saliva is important in warding off tooth decay and periodontal disease because it washes away food and neutralizes plaque. If you have dry mouth, your dentist or periodontist can recommend various methods to restore moisture, including sugarless gum, oral rinses or artificial saliva products. 
• Foods that are sticky, such as raisins, fruit rolls and candy, can cling to the teeth and promote tooth decay. Brush and floss after eating sticky foods. 
• Good nutrition plays an important role in protecting the oral health of diabetics. Research shows increased serum triglyceride levels in uncontrolled diabetics seems to be related to greater attachment loss and probing depths, measures of periodontal disease. Reducing cholesterol and serum triglyceride levels, preferably through diet and exercise, may be the most important change that diabetics can make to improve their quality of life, as well as their oral health.
• Research shows that a diet high in wide variety of plant based foods helps to provide the antioxidants needed to fight diseases that are caused by high levels of free radicals (metabolic toxins) in the blood stream. 

Dr. Duello will be Lecturing at the American Dental Association & the American Academy of Periodontology this November

Dr. Duello at the ADA

Dr. Duello returned to his practice on Monday, November 9, 2015 after attending the American Dental Association 2015 Annual Meeting in Washington, DC. Approximately 21,000 dentist and staff were in attendance at this meeting.   This is one of the largest dental meetings in the world.   After many years of lecturing, Dr. Duello was honored to be invited to speak for the first time at the ADA Annual Meeting.  Despite some rain on Saturday, it was a very pleasant experience for Dr. Duello.

He gave two lectures over the weekend while in attendance. The first lecture was in cooperation with the American Academy of Periodontology on "Implant Treatment in the Esthetic Zone" .                                                                                                                                                                                                                                                                  Photo was taken just before the lecture began          




The second program was a panel discussion involving 5 specialties entitled " Myth vs. Realities: Dental Implant vs Root Canal Therapy.  Both programs were well attended and excellent audience participation occurred.   Dr. Duello was especially pleased with the caliber of presenters at the round table discussion.

In addition to Dr. Duello, panelists for this course were:
Dr. Michael Glick, professor and William M. Feagans Chair, School of Dental Medicine, University at Buffalo, The State University of New York, Buffalo, NY; editor of The Journal of the American Dental Association; and a diplomate of the American Board of Oral Medicine.
Dr. Stuart Lieblich, clinical professor at the University of Connecticut; in private practice of oral and maxillofacial surgery; and a co-principal investigator on a national study on the use of antibiotics for oral surgical procedures.
Dr. David Little, adjunct clinical professor at the University of Texas Health Science Center at San Antonio Dental School; maintains a private dental practice in San Antonio, Texas.
Dr. Jaime Lozada, professor and director of the Advanced Education Program in Implant Dentistry at Loma Linda University; past president of the American Academy of Implant Dentistry; and a member of the editorial board of the Journal of Oral Implantology.
Dr. Daniel Meyer, an endodontist and the ADA chief science officer.
Dr. Alan Gluskin, a course panelist and professor and co-chair of the department of endodontics at the University of the Pacific.

 Dr. Duello and the other panelists took a moment to pose for a photo op.

Following his lecture, Dr. Duello was able to take in some of the famous sites in Washington, DC.  After lecturing on Saturday morning, he visited the Smithsonian Aerospace Museum, the National Gallery, and the News Museum.   To complete his visit, Dr. Duello viewed the White House from the South Lawn and the front of the White House from the North View.   

Dr. Duello at AAP

Dr. Duello will be presenting two lectures at the American Academy of Periodontology's (AAP) international meeting in Orlando FL November 13-16, 2015. He will be presenting on implant treatment. The first presentation is entitled" Transitioning the Full Arch Terminal Dentition to a Fixed Implant Solution". His second presentation will be a live hands on demonstration titled "Surgical & Restorative Procedures for the Edentulous Patient Using the All-on-4 treatment concept.More to follow when Dr. Duello returns.....

this post regarding MEDICATIONS AND ORAL HEALTH is a MUST READ, if your are among the millions of Americans on Rx Meds

That pill might be making your mouth ill

Your medicine cabinet may hold the answer to some of your oral  health problems. Drugs that improve the health of one part of your body may have a detrimental affect on your mouth.
     
For example, over 400 medications produce dry mouth or xerostomia, which can be damaging to the gum tissue. Other drugs may cause gingival enlargement, which means the gums become swollen and “grow over” the teeth. Medications with sugar as a main ingredient, such as over-the-counter
cough drops and syrups, may increase plaque as well as enhance the ability of plaque to be more adherent to your teeth. In addition, medications which have a depressant effect may make people  negligent with their oral hygiene habits.

Drugs that induce dry mouth include those for high blood pressure, spastic bladder syndrome,
pain relief, anxiety and allergies. People with dry mouth have a tendency to accumulate more plaque
and experience changes in their gum tissue that can make them more susceptible to periodontal disease and tooth decay. Your dental professional can recommend various methods to restore moisture, including sugarless gum, oral rinses or artificial saliva products.

A number of medications also may cause gingival enlargement or overgrowth, such as
calcium channel blockers, phenytoin used for seizure prevention and cyclosporine, which
is widely used following organ transplants to control rejection. Gingivitis may act as a predisposing factor to this condition, so meticulous oral care and routine dental visits are very important for people who use these medications.

Many liquid or chewable medications, especially children’s medications, are made palatable by the
addition of sucrose, glucose or fructose as sweeteners. These may significantly alter plaque and increase the risk of cavities and possibly periodontal disease. When purchasing lozenges, chewable tablets and syrups, look for those that are sugar-free.

Just as you tell your physician about the drugs your taking, be sure to tell your periodontist about all
the medications that your are taking, including herbal remedies and over-the-counter medications.
Your dental professional can talk to you about what effects, if any, these may be having on your
periodontal health. Your dental professionals can work with you and your physician to minimize negative effects.

Dental care may ward off gingival overgrowth

If you use a calcium channel blocker, you can add another important reason to go to the dentist to the list. These drugs commonly cause gingival overgrowth. And, nifedipine a commonly prescribed medication for high blood pressure, is the calcium channel
blocker most frequently associated with this condition.

However, a recent study in the Journal of Periodontology suggests that frequent dental visits
following initial periodontal treatment may significantly reduce gingival overgrowth in patients taking nifedipine. This is good news for the 20 to 40 percent of patients taking nifedipine who experience discomfort from recurring gingival overgrowth and rely on nifedipine to control their high blood pressure. Swollen gums can be painful, unsightly and interfere with speech, eating, and everyday brushing and flossing.

The study found that gingival overgrowth recurrence was eliminated in more than half of patients with a combination of initial periodontal therapy, including surgical and non-surgical treatments, followed by more frequent dental visits (every three months). This regimen
appeared to affect recurrence more than previously known risk factors, such as gender, drug type, and duration of drug therapy.

Overgrown gums make it easierfor bacteria to accumulate and attack supporting structures of the teeth, which can lead to severe periodontal infection. These study findings are a significant advancement to earlier research, which concluded that the development and recurrence of gingival overgrowth could be minimized, but not prevented, with periodontal
therapy and frequent dental visits.

Some people also may be able to substitute the calcium channel blocker they take with a different type if it is causing oral problems. Talk with your physician and periodontist.,

Bad Breath, Gum Disease & Oral Bacteria

Bacteria are the culprit in periodontal disease

Imagine you’re in a jungle. It’s warm and moist and there is plenty of food to feed on.  It is also crawling with hundreds of diverse species of living beings. Many are harmless and some are even beneficial to the environment. However, one group can be described as predators, attacking their immediate environment and wreaking havoc far and wide. To stop the wild beasts, you need weapons. What should you grab? A toothbrush and floss. Okay, we’re not talking about the Amazon Rain Forest, we’re talking about your mouth, but it really is a jungle in there. 

More than 500 species of microorganisms have been identified in the mouth. Approximately 15 of these bacterial species have been implicated for playing a role in periodontal disease. Whether or not you get periodontal disease depends on the bacterial makeup, your response mechanism and environmental factors, such as smoking. Your saliva includes proteins and anti-fungal agents, which help get rid of oral bacteria. 

The bacteria in plaque cause the gums to become red and swollen and to bleed easily. Eventually, gums separate from the teeth forming pockets. The pockets fill with even more plaque and infection and eventually deepen. Over time, tissue and bone are destroyed and the teeth loosen.

To stop this process, it is necessary to eliminate the infection-causing bacteria that accumulate below the gumline, dental professionals often use simple procedures such as scaling and root planing. These are nonsurgical procedures to remove plaque and tartar from below the gum line. Tooth root surfaces are cleaned and smoothed as the rough surfaces of tartar make it easier for bacteria to get a foothold. 

In addition, your periodontist may recommend antibiotic treatments to enhance traditional
therapies. These are designed to kill a wide variety of oral bacteria. 

Someday, researchers may discover a vaccine to eliminate harmful bacteria from the mouth. Until then, arm yourself with a toothbrush, floss and regular dental visits.

Don't be a yuck mouth, tame that beastly breath

With all the bacteria proliferating in the human mouth, it is no wonder that about one in four
people believe they have halitosis. Bad breath originates from certain oral bacteria producing an abundance of volatile sulfur compounds. Bad breath can be caused by several things, including certain foods, periodontal disease, dry mouth, tobacco use or a medical disorder. Here are some breath freshening tips:

• First, determine if you have bad breath. One method is to take a piece of unwaxed, unflavored dental floss and floss between your upper and lower back molars. Or, use a dry cloth and wipe it across the back part of your tongue for about five seconds. Wait about a half a minute and then smell it. Asking a friend or family member works too.
• Mouthwashes, breath sprays and mints mask the problem temporarily. In fact, mouthwashes with alcohol may further the problem as, over time, they can dry out the mouth. If you have chronic bad breath, you will want to get to the source of the problem. 
• Be aware of foods that trigger bad breath such as garlic, onions and coffee. And, brush your teeth after consuming milk products, fish and meat. 
• Keep your mouth moist by drinking plenty of fluids, chewing sugar free gum or sucking on sugarless candy. 
• Floss, and brush your teeth, gums and tongue daily. Do not forget to clean behind the back teeth in each row. 
• Denture wearers need to avoid plaque buildup under the dentures. Thoroughly clean dentures daily and remove dentures at night to avoid bacterial growth. Denture wearers should continue to see a dental professional regularly. 
• Talk with your dentist or periodontist about oral problems that may be the cause. Your dental professional can also tell you about the latest techniques to treat bad breath. 
• If you determine that chronic bad breath is not from an oral source, see your physician. 

View this blog post for information about Aging & Tooth Loss

A Lifetime of Healthy Teeth and Gums

People are now living longer and healthier lives, and older adults are more likely than ever before to keep their teeth for a lifetime. However, research has shown that older people also have the highest rates of periodontal disease. In fact, at least half of people over age 55 have some form of periodontal disease, and almost one out of four people over 65 have lost all their teeth.

No matter what your age, it is important to keep your teeth and gums healthy. If you’ve
succeeded in avoiding periodontal disease as you age, it is especially important to continue
to maintain your oral care routine. Be sure to brush and floss daily, and see a dental
professional, such as a periodontist, regularly. You should also receive a comprehensive 
periodontal exam each year. This will ensure that your oral health (and possibly even your overall health) stays at its best. If you have dexterity problems or a physical disability and are finding it difficult to properly brush or floss your teeth, your dentist or periodontist can suggest options such as an electric toothbrush or floss holder. 

Research has shown that periodontal disease is a chronic inflammatory disease that may put you at a higher risk for other diseases including cardiovascular disease, diabetes, and Alzheimer’s disease. During your regular visits with your dentist or periodontist, be sure to let him or her know if you have any of  these medical conditions or if you have a family history of disease. Likewise, if you have been diagnosed with periodontal disease, it’s a good idea to share this information with your physician to ensure that you’re receiving appropriate care. 

You should also tell your dentist or periodontist about any medications you are taking, because many medications can impact your oral health and therefore affect your dental treatment. Hundreds of common medications - including antihistamines and high blood pressure medications - can cause side effects such as soft tissue changes, taste changes, and gum overgrowth. Another possible side effect of some medications is dry mouth, a condition that leaves the mouth without enough saliva to wash away food from your teeth. This may leave you more susceptible to tooth decay and periodontal disease, and can cause sore throat, problems with speaking, and difficulty swallowing. 

Maintaining your oral health should be a priority at any age. As you get older, be sure to continue to take care of your teeth and gums to ensure that they’ll stay healthy and strong for life.

Special Concerns For Women

Women who are menopausal or post-menopausal may experience changes in their mouth including
dry mouth, pain or burning sensations in the gum tissue, and altered taste due to hormonal
changes. Additionally, menopausal women should be concerned about osteoporosis, which can
lead to tooth loss if the density of the bone that supports the teeth has decreased. Talk to your doctor
about hormone replacement therapy or estrogen supplements, which may help symptoms of
menopause.

DENTAL FEAR & ANXIETY

Don'’t let your fear keep you out of the chair

If your palms start sweating and your heart starts pounding at the thought of visiting the
dentist, you are not alone. The vast majority of individuals experience some anxiety toward
dentistry. However, about 10 to 15 percent of the population suffers from high dental anxiety,
which has been associated with avoidance behaviors and adverse outcomes to dental health. It’s important to find ways to “unlearn” this dental fear because when dental professionals can catch a
problem in your mouth early, it minimizes expense, time and discomfort.

Here are some ideas:

• The first step is to identify where your fear came from. According to a recent AAP survey,periodontists report that the two most common origins for patient fear are family and friends or personal bad experience more than 10 years ago. Discuss your fear with family members, friends and your dental professionals. In many cases, the fears are no                       longer realistic because of advances in dentistry. 
• Next, find ways to feel more in control of your experience. Ask your periodontist                     to explain any procedures being considered. Knowledge can be empowering. Your periodontist can also explain your options for techniques to control pain and stress, such as medications, anesthesia, sedation and relaxation techniques that can make your treatment virtually painfree. And, you and your periodontist can agree on a signal, such as a raised hand, that will stop the procedure and allow you the opportunity to deal with your anxiety. 
• Choose times for your appointments when you won’t be rushed or stressed by other issues. If you feel tense when you get into the dental chair, try relaxation techniques such as rhythmic breathing or visualizing calming scenarios, such as relaxing on a beach. Or, distract yourself with a Walkman or by focusing on something in the room. 
•  Once the dental visit is over, congratulate yourself for your courage and treat yourself to a special reward.   
• Most importantly, remember that your dental professionals are your allies. Enlist their help in overcoming your fear by not being embarrassed to talk with them about it and by asking any questions you may have.

Many periodontal procedures can be pain-free

        It’s been “drilled” into our minds by family members and friends and experiences from

long ago: our fear of dental treatments. However, according to a recent online poll of periodontists conducted by the AAP, many more patients indicate they have a fear about receiving periodontal treatment prior to treatment than say they felt extreme discomfort or pain following treatment.

       Of the 164 periodontists polled, almost half said that more than 50 percent of their patients indicate they are fearful about receiving periodontal treatment. However, more than three-quarters said less than 10 percent of their patients say periodontal treatments actually cause them any extreme discomfort or pain. Many respondents said establishing trust with patients goes a long way in alleviating fear. 

       Periodontists report that it’s men and middle-aged adults who are most likely to fear periodontal procedures. While 47 percent of those surveyed said that male patients

are more often fearful, only 11 percent find their female patients to be the more fearful gender. And, more than half chose adults in their 40s and 50s as the most fearful age group, compared to younger and older age groups. Specifically, they said their patients are most likely to be afraid of feeling pain and needles. 

        The survey also revealed that the top origins of fear are family and friends or a personal bad experience more than 10 years ago. 

        The vast majority (84 percent) of respondents said that they have implemented specific procedures to help patients deal with their fear during treatment, and 59 percent said they’d implemented procedures in the past three years that actually make periodontal treatment more comfortable. In addition, some periodontists mentioned that improvements in local anesthesia, pain and anxiety medications, and in some cases, conscious sedation, have made many procedures performed at the periodontist's office virtually painfree. 

FAMILIES AND PERIODONTAL DISEASE

Achieve optimal oral health in your family

Researchers suggest periodontal disease can pass through saliva. This means that the common contact of saliva in families may put children and couples at risk for contracting the periodontal disease of another family member.

Based on this research, The American Academy of Periodontology
(AAP) recognizes that treatment of gum disease may involve entire families. If one family member has periodontal disease, the AAP recommends that all family members see a dental professional
for a periodontal disease screening.

Parents should also be aware that periodontal disease is not just
an adult health problem. In fact, studies indicate that gingivitis is nearly a universal finding in children and adolescents. Gingivitis is the first level of periodontal disease. Periodontal disease is a bacterial gum infection that progresses over time and can become more advanced with age.

To ensure healthy teeth as an adult, good oral health habits should be established as a child. Parents can encourage good at home oral health habits in children. For example, parents may want to reward children with visits from the tooth fairy not just when a tooth is lost, but also when a child receives a clean bill of health from the dentist.

 Evidence shows that periodontal disease may increase during adolescence due to lack of motivation to practice oral hygiene. Children who maintain good oral health habits through the teen years are more likely to continue brushing and flossing than children who were not taught proper oral care.

Periodontal disease is a leading cause of tooth loss in adults. In addition, research has linked it to more serious health threats such as diabetes, cardiovascular and respiratory disease, and pre-term low-birthweight babies.

Periodontists recommend remembering the basics. Replace toothbrushes every few months or
when the bristles begin to look frayed. Floss daily to break up the bacterial colonies between teeth
that can cause periodontal disease. And, seek dental care for professional cleanings, as well as screenings for periodontal disease.

Free brochures entitled
Caring For Your Child’s Teeth and
Gums and Periodontal Diseases:
What You Need To Know are available
by calling 1-800-FLOSS-EM
or by using the AAP’s online
request form at www.perio.org.

Simple tips help ensure healthy smiles

Your periodontist and his or her staff can give you tips for improving the oral health of your
family, including demonstrating proper home care techniques.
Here's some additional tips:

•  Know what medications family members are taking and let your dental professionals know about these. Many medications can dry out the mouth, which can cause bad breath and eventually periodontal disease.
• If you’re thinking about becoming pregnant, see a periodontist. About a quarter of women of childbearing age have periodontitis, which can put their unborn babies at risk. In fact, they may be as much as seven times more likely to deliver a premature and underweight baby.
• Monitor your family to see if anyone has the habit of teeth grinding. Grinding can cause cracked or chipped teeth and can increase the risk of developing periodontal disease. Dentists can make custom-fitted night bite guards to prevent teeth grinding at night.
•  Up to 30% of the population may be genetically susceptible to developing severe periodontal disease. Genetic testing could result in the early identification and treatment of at-risk patients. 
• Be aware that if your family drinks a lot of bottled water, they may be missing out on the fluoridation that has been added to public water systems for several decades. Children who drink adequately fluoridated water have up to 50 percent fewer cavities than children who do not.

More Tips to Keep Your Teeth and Gums Healthy

Most people recognize how important it is to keep your teeth and gums healthy, but over time,
different lifestyle factors can negatively impact your periodontal health. To help
maintain healthy teeth and gums, keep these tips in mind

Strive to be stress free
Minimize the stress in your life. Research has shown that people who are having a difficult time
coping with stress can neglect their oral hygiene.1 Additionally, researchers have also associated
the hormone cortisol with periodontal disease.2 Chronic stress has been shown to increase levels of cortisol, and these increased levels can be a factor in developing periodontal disease.

Kick the tobacco habit
Tobacco use is one of the most significant risk factors in the development and progression of
periodontal disease. Tobacco’s negative effects on oral health are well documented. Most
people that have recurrent periodontal disease are smokers, and smoking is also associated
with complications after oral surgery.

Drink alcohol in moderation
Drinking the occasional glass of red wine has been shown to have positive effects on the body;
however, heavy drinking can negatively impact your oral health. Alcohol can irritate your
gums, tongue, and other oral tissues. It can also contribute to poor healing after surgery and
can halt your oral hygiene routine. In addition, heavy drinkers often suffer from tooth
decay as a result of the increased exposure to sugars and acids that are often found in alcoholic
drinks.

Stock up on healthy foods
You know that a healthy diet is important for your overall health, but it’s also very important for
your oral health! A good diet will help your immune system be at its best to help fight infections,
including periodontal disease. In addition to eating a well-balanced, nutritious diet, research has shown that both yogurt3 and green tea4 may add an extra boost to your periodontal health.

Genetics can affect oral health, too!

Family history may make a difference in your overall health, including periodontal disease.

Periodontal disease is multi-factorial, which means you can be susceptible due to

genetics as well as environmental factors such as diet and smoking. Your genes play a 

major role in the onset and severity of periodontal disease.

1. Peruzzo, DC et al. A systematic review of
stress and psychological factors as possible
risk factors for periodontal disease. J
Periodontol. 2007 Aug;78(8):1491-504.
2. Cury PR et al. Hydrocortisone Affects the
Expression of Matrix Metalloproteinases
(MMP-1, -2, -3, -7, and -11) and Tissue
Inhibitor of Matrix Metalloproteinases
(TIMP-1) in Human Gingival Fibroblasts. J
Periodontol. 2007 Jul;78(7):1309-15.
3. Shimazaki Y et al. Intake of Dairy
Products and Periodontal Disease: The
Hisayama Study. J Periodontol. 2008 Jan;79
(1):131-7.
4. Kushiyama M et al. Relationship Between
Intake of Green Tea and Periodontal
Disease. J Periodontol. 2009 Mar;80(3):
372-7.

Choose Tried-and-True Methods to Treat Gum Disease

CHOOSING PROVEN TREATMENTS FOR YOUR DENTAL CARE

Miracle cures, or quick fixes, have been around for centuries; certain foods, ointments, or potions have claimed to cure everything from hair loss to cancer. Marketed as quick, easy, and painless, these
miracle cures often are not backed by science or approved by the Food and Drug Administration
(FDA), which means that they may do more harm than good. Similar quick fixes that claim to treat
periodontal disease are no different. Though elements of these quick and easy periodontal
“cures” may be FDA approved, there may be little or no scientific proof that they are effective in the
prevention and treatment of periodontal diseases. In fact, periodontal “miracle cures” may
actually harm your oral health. Periodontal disease is a chronic inflammatory disease that affects
the gums and bone supporting the teeth, and has been associated with the progression of other
diseases such as cardiovascular disease and diabetes. If you opt for a treatment for periodontal disease that has not been backed by scientific evidence, it’s possible that the treatment won’t effectively treat (or could even worsen) your condition. Just because a treatment is deemed “new” or
“innovative” doesn’t mean that it works properly or better than more traditional treatments. By choosing the quick fix route first, your oral health may remain in poor condition and you may require additional treatment. Instead, a better idea is to schedule an appointment with a periodontist when you notice signs of periodontal disease (red, swollen or tender gums; bleeding while brushing or flossing; gums that are receding or pulling away from the  teeth; loose or separating teeth). A
periodontist is a dentist who specializes in the prevention, diagnosis and treatment of
periodontal disease and in the placement of dental implants. Periodontists receive extensive
training in these areas, including three additional years of education  beyond dental school. They are
familiar with the latest techniques for diagnosing and treating periodontal disease, and their
education and experience allow them to effectively treat periodontal disease using clinically
proven treatments such as scaling and root planing, soft tissue grafts and regenerative procedures. A
periodontist will evaluate your unique condition, and offer the treatment that is best for you; one
that is supported by both science and experience. Your periodontist can also answer any questions that you may have about alternate treatment options. Your oral health is invaluable. While quick fixes for periodontal disease may seem like a good option, it’s a better idea to research treatment options and discuss them with a periodontist first. The discussion has the possibility of saving you time and
money in the long-run!
If you or someone you know is considering periodontal therapy, you may visit us at www.perioltd.com and www.stlouisdentalimplants.com. Further information is available at www.perio.org

Osteoporosis and Bisphosphonates

Osteoporosis and Tooth Loss

Osteoporosis is a condition that causes low or decreasing bone mass. Untreated osteoporosis can often lead to tooth loss, mainly because the disease diminishes the density of  the bone supporting the teeth. Since both osteoporosis and periodontal disease have shared risk factors such as tobacco use and age, and because both can result in bone loss, an association between the two diseases has been difficult to prove. However, if you are at risk for or being treated for osteoporosis, it is still important to keep your oral health at its best. Be sure to brush your teeth at least twice every day, floss at least once every day, and see a dental professional, such as a periodontist, every six months.

What You Need to Know about Bisphosphonates

You may have heard recent reports about bisphosphonate drugs and their potential effect on periodontal health. These reports can be alarming and even misleading, especially for those taking

bisphosphonates. The information below explains what bisphosphonates are, how they are
related to periodontal health, and how bisphosphonates may impact your periodontal treatment. Bisphosphonates, also known as bone-sparing drugs, are used to treat and prevent osteoporosis, and
are also prescribed to patients diagnosed with certain bone cancers. Bisphosphonates can be
administered in two ways: orally and intravenously (IV). Oral, or tablet, bisphosphonates (common names include Fosamax, Boniva, and Actonel) are usually prescribed for osteoporosis, while IV
bisphosphonates (common names include Aredia and Zometa) are typically prescribed for patients with advanced bone cancers to help decrease pain and fractures. In rare instances, some people that
have been treated with bisphosphonates, especially the intravenous form, develop a rare condition called osteonecrosis of the jaw (ONJ), which can cause severe, irreversible, and often debilitating
damage to the jaw. ONJ can be worsened by invasive dental procedures such as tooth extractions
or dental implants. People may not have symptoms in the early stages of ONJ, but pain can gradually
develop as the condition progresses.
Symptoms of ONJ include:
• Loose teeth
• Numbness or a feeling of
heaviness in the jaw
• Pain, swelling, or infection of the
gums or jaw
• Gums that do not heal
• Exposed bone
Currently, there is no treatment that  definitely cures ONJ. However, antibiotics and anti-inflammatory drugs may help relieve some of the pain associated with ONJ. Most people diagnosed with ONJ will also need surgical treatment. If your physician prescribes a bisphosphonate, especially IV bisphosphonates, it is very important to tell your dental professional, because your dental treatment plan may be affected. There have been other risk factors associated with
ONJ including age, gender, and other medical conditions, so it is important to share all health
information with your dental professional. It is also important to maintain your oral health if you are taking bisphosphonates. Even though the risk of developing ONJ while taking a bisphosphonate remains very small, if you need periodontal surgery, your dental professional may recommend
that you interrupt your bisphosphonate therapy prior to, during, and/or after your procedure.
Be assured that both the medical and dental communities are studying ways to ensure the safest outcomes  for patients taking bisphosphonates who require invasive dental procedures.

The American Academy of Periodontology Patient Page is a public service of the AAP and should
not be used as a substitute for the care and advice of your personal periodontist. There may be
variations in treatment that your periodontist will recommend based on individual facts and circumstances.
Visit perio.org to assess your risk and for more information on periodontal disease.