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.”

The study, “Deletion of Interleukin 1 Receptor-Associated Kinase 1 (Irak1) Improves Glucose Tolerance Primarily by Increasing Insulin Sensitivity in Skeletal Muscle,” was published by the Journal of Biological Chemistry.

This was  originally published by Dentistry Today, Sept 15, 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! 

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!

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

Activated Charcoal: The Next Great Thing for Teeth Whitening, Or Is It?

You brush your teeth and floss on the reg. You’ve tried everything from the latest toothpaste to whitening strips, gels and trays but nothing seems to give you that brite-white smile. So what’s the best way to get gleaming pearly whites?

According to Pinterest and YouTube, the path to whiter teeth is covered in a pitch-black paste. Bloggers and vloggers claim that brushing with activated charcoal is an all-natural way to remove surface stains caused by coffee, tea or red wine without bleach or abrasives. To prove it, they’re flaunting soot-covered teeth straight out of a horror movie. The result? Fluorescent white teeth after as few as one use, proponents say.

While you may have used charcoal in your skincare and juice routine, should you replace your toothpaste with the powdery black substance? We checked in with dental professionals to find out whether activated charcoal is a safe and effective way to whiten your teeth — or if it will just leave your mouth full of dust.

Activated Charcoal: The Whitening Promise

“Activated charcoal has been used for many things. It’s a purifying agent that absorbs impurities,” says Dr. Mark Wolff, DDS, Professor and Chair of the Department of Cariology and Comprehensive Care at the New York University College of Dentistry. While you’ll find activated charcoal in air filters, traditionally, hospitals and poison control centers use it to treat accidental poisoning or a drug overdose. Unlike the bricks you use for your backyard barbecue, activated charcoal’s enormous surface area is dotted with the numerous nooks and crannies that draw in and trap toxic substances in your gut like a sponge, preventing them from being absorbed by the body by approximately 47 percent. The bad stuff is then carried out with your next bowel movement.

Is Black the New White? More recently, though, the superfine powder has made its way to the health and beauty market, popping up in everything from face masks to cleaners to detox regimens. And the latest body part to get the black magic treatment is your smile. After all, if activated charcoal can remove toxins from our body and skin, can’t it remove those pesky stains from your teeth and get them squeaky clean?

Proponents say yes. And the prescription is simple: First, break open capsules of activated charcoal, mix the powder with water, then brush the thick black paste directly onto your teeth. Others recommend swishing the powder around in your mouth or using a special toothpaste containing charcoal. After three to five minutes, rinse away the charcoal (and stains) and voilà! Whiter teeth. In theory, at least…

Your teeth may become discolored due to a variety of factors from poor dental hygiene to the food you eat to just getting older. “If you eat a blueberry, it could stain it blue,” says Dr. Wolff. “Those are the types of stains that they think if you brush with charcoal, you can clean off.”

But Minneapolis-based dentist and spokesperson for the American Dental Association Dr. Kim Harms, DDS says to hold off. “There’s no evidence at all that activated charcoal does any good for your teeth,” says Dr. Harms. She worries about the potential damage the grainy substance can do to your teeth and gums. “Like any abrasive, we’re worried about the effects on the gums and enamel on the teeth. We don’t know about the safety and effectiveness of it,” she says. And according to Dr. Wolff, attempts to use charcoal in toothpaste haven’t been met with tremendous success.

Dr. Harms also notes that activated charcoal shouldn’t replace everyday teeth cleaning and regular visits to the dentist. “The important part of brushing and flossing is the physical removal of plaque. The toothpaste you’re using, from a dentist’s point of view, delivers fluoride to teeth,” she says. “We’re concerned about practices where people are using products without fluoride. Fluoride is nature’s cavity fighter and can cut tooth decay by up to 40 percent.”

Charcoal Toothpaste: The Gritty Truth 

“There’s no scientific indication that [activated charcoal] actually works and there are better options out there that do work,” says Dr. Harms. If you want a gleaming white smile, both Dr. Harms and Dr. Wolff recommend talking to your dentist about using traditional whitening toothpaste for surface stains or over-the-counter treatments for deeper stains.

“Remember, if it sounds too good to be true, it probably is,” says Dr. Wolff. “I still recommend any of the mainstream whitening toothpastes or seeing the dentist. The mainstream whitening toothpastes are going to be safe. There are a number of products on the market that can be too abrasive.” If you do go the DIY charcoal-route, he advises using it sparingly and discontinuing its use if your teeth become sensitive.

Originally published March 2016. Updated July 20, 2017.  Dailyburn.com

Pain In Your Mouth? What Might Be Causing It?

It might be surprising for some people but even in the modern day, many are not aware of why oral hygiene is important. You might be thinking that people who brush their teeth regularly do not fall into this category.

Brushing teeth in the morning is a healthy habit and should be taught and practiced by everyone for good dental condition. However, this is not a sign that you know how to maintain your oral hygiene or will prevent any problems.

According to the statistics, most of the people who are prone to gum pain and toothache do brush their teeth every morning. Upon a medical check by a dentist, these people still tend to have oral problems, especially the ones related to gums.

Do you brush your teeth and still have pain in the gums? Do not worry, it does not mean that your dental condition is extremely poor. In fact, pain in the gums is fairly common and sometimes can be caused due to reasons other than hygiene.
Sore or painful gums are taken lightly by the majority. You might even hear a person blaming it on their fast brushing or the hard bristles of their toothbrush. That does happen, but not every other day and continuously.

Healthy gums have a light pink hue and do not bleed easily. Brushing too hard with a poor quality toothbrush causes bleeding or pain only after a prolonged usage or if you suddenly change your toothbrush.

Not all the problems related to gums will make a trip to the dentist necessary such as the hard brush problems. If you have braces and dentures, they can also irritate the skin and occasionally cause bleeding and swelling.

While the pain in the gums should not be ignored if it is perpetual or severe, make sure if it’s not related to any of your habits or anything else that might be causing the pain.

What can Cause Gum Pain?

Gum pain can happen due to a variety of conditions ranging from easily treatable to dangerous if neglected for a long time. Most of the time, problems related to gums are complicated which results in anyone not being able to figure out what is the exact problem.

Some of the most prevalent gum pain causes include:

Yeast Infection

By far, the most common cause of pain in the gums that confuses people is a yeast infection. Where fungal infections generally are harder to get rid of especially if diagnosed in a later stage, yeast infection in the mouth is comparatively easily treatable.

The biggest signs of a yeast infection or what is known as thrush in medical language is hurtful gums along with a pale white coating on the tongue and teeth. Many people feel that the covering is due to them not brushing hard enough.

Brushing hardly in this scenario is the worst thing you can do. Usually, the problem can be treated by consuming yogurt with live cultures and maintaining oral hygiene.However, if your condition has gone past the stage you should probably see a doctor.

Canker Sores

Gum pain and white covering is sometimes accompanied by something even more painful. If you having white mouth ulcers with red borders in your mouth along with symptoms like thrush, you are suffering from canker sores.

Cankers sores tend to be confused with blisters in the mouth till the time they turn painful. At the beginning of getting sores, you might feel mild or no pain at all but you can tell if you are having them due to their distinctive red borders.
Small canker sores in the mouth might appear after consuming foods loaded with spices or salt. Acidic food can also lead to sores in the mouth.
Sores such as these clear up in 1-4 weeks time and might not be that painful. However, sores larger in size especially the ones bigger than half an inch can be extremely hurtful. See the dentist immediately if you have such sores in the mouth.

Secondly, you can lessen the pain of sores by avoiding spicy, salty and acidic food which will lead to more sores forming in your mouth along with gum pain.

Gingivitis

The serious problems with the gums that can cause continuous gum swelling and pain are gum diseases. Your gums also grow more sensitive and bleed easily while brushing and consuming food or even drinking really cold or hot drinks.

According to American Dental Association, more than three-quarters of the people over the age of 35 alone in the United States suffer from gum diseases from less to severe stages. Gingivitis is one of such diseases.

If your teeth and gums bleed easily without any reason, there is a big possibility that you are suffering from gingivitis. Because this specific condition only causes bleeding and no pain, many people tend to ignore it until it reaches a severe stage.

Prolonged negligence of the disease can cause serious problems in the gum tissue. Treatment in those stages can be painful, taking a long time, and expensive. Many times you might even need surgeries for getting the old appearance of your gums and teeth.

Periodontitis

While many people have minor dental problems, 5-15% of the adults can suffer from a more serious problem known as periodontitis which can be a result of neglected gingivitis.
When gingivitis is left untreated, the inflammation from bacteria that caused it in the first place can worsen leading to periodontitis, a condition in which the bone holding the teeth in place is considerably weakened.

The bacteria at this stage, start releasing harmful substances that damage the gums and lead to infections. The inflammation and further bacteria attacks can result in degradation of the gums and the bone in the jaw even more.

You can have exceptionally painful and sensitive teeth at this point which can start bleeding anytime. If left further untreated, the condition can cause damage to the jaw bone as well as lead to permanent tooth loss.

Tobacco and Smoking

Smoking and tobacco usage are not only bad for your respiratory system but can greatly damage your gums and teeth. People who do either of the two are more prone to getting gum diseases or develop gum sensitivities.

Hormonal Changes

Pain in the gums is one of the problems faced by women during puberty, pregnancy, menstruation, and menopause. The rise in hormones during these situations can lead to excess blood flow into the gums, leaving them swollen, red, and painful.

Some women can have a condition called menstrual gingivitis which causes red, sore gums that bleed every time before the menstrual period. Pregnancy gingivitis starts in the third or the fourth month of pregnancy and continues throughout the eighth month causing painful gums.

According to some researchers, oral birth control can sometimes result in similar issues. Secondly, some women may even have dry and sensitive gums during their menopause which leaves them sore and painful.

Chemotherapy

Chemotherapy has a lot of unwelcomed side effects including pain in the gums and bleeding along with swelling. People undergoing this treatment develop a condition called stomatitis which causes painful sores and ulcers in the mouth.

Heart Disease

Many people do not know that problems in the mouth can also be linked to problems of the heart. If you have random and sudden gum swelling with a severe toothache, it can also be a sign of a potential heart attack.

Should you see the Dentist?

If your pain and swelling last for longer than a week, make sure to visit a dentist as soon as you can. Gingivitis has become common. Swollen, red, and painful gums are mostly the signs of this disease. So, it is better to get rid of it at its early stages.

In addition, you should see your dentist if you are seeing the following:

• Red gums
• Swelling
• Bleeding
• Pain during chewing
• Gums that are pulling back from teeth
• Increased sensitivity
• Dentures that no longer fit
• Loose teeth
• White coating on teeth and tongue

Reports Healthcare, Ashley Miller 10-16-17

Did you know your periods can give you gum disease or lead to menstrual gingivitis?

There is more to menstrual problems than

 just the cramps.

  

Menstruation brings with it a host of problems – period pains, nausea, heavy bleeding and what not. Seldom do we think that the problems can go beyond these regular ones. With time we get used to dealing with the same and living with the debilitating pain. But women, listen up, menstruation is not all about cramps and bleeding, the hormonal upheavals that happen during this period can set you up for dental problems too, precisely gingivitis (gum disease) or menstrual gingivitis. Hormonal changes and oral health are just two sides of the same coin. 

What is menstrual gingivitis?

Menstruation gingivitis is a common oral problem that women go through but hardly know about it. This happens due to hormonal fluctuations during the course of menstruation or days before you get your period. Gingival tissues or gum tissues have lots of estrogenic receptors, it’s response to the hormonal changes is rapid. During the start of your periods estrogen is at its rock-bottom, but then it starts to increase and its levels go up. As this happens, the hormones can act with the estrogen receptors in the gums and erode them.

However, not everyone suffers from this oral condition, but for people with poor dental hygiene should be wary. The bacteria which is already present in the mouth multiplies rapidly due to hormonal surges and paves the way for gum diseases, if ignored it can further lead to periodontitis (tooth mobility). 

What causes menstruation gingivitis?

During menstruation, there is a surge in the production of the two hormones estrogen and progesterone that increases the blood flow to the gums. In this process, the gum tissues become red, soft, swollen and tender leading to conditions like bad breath, bleeding gums, bleeding while brushing, gingival pain and discomfort while chewing hard foods. If you don’t take care of your gums the right way they become weak and this leads to gum diseases. The weak gums can also cause pockets to form between the teeth and gums, due to which plaque and food debris get deposited and the situation further worsens. This condition is experienced one or two days before the onset of the menstrual cycle and gradually decreases with the start of menstruation. 

If you don’t care enough for your gums during your cycles, it can lead to gingivitis and later to periodontitis where you can lose your teeth at a younger age.

How can gingivitis be prevented?

You need to maintain proper routine oral care to avoid these dental problems. Below mentioned are guidelines that will help in dealing with the problem:

• Brushing daily: Regularly brushing your teeth using a soft nylon-bristle toothbrush, at least twice daily in a circular motion or a straight downward motion is the best way to clean your teeth. With that, a back-and-forth scrub may be needed to focus on the gum line.
• Tongue cleaning: This is a mandatory step which helps to collect and clean the bacteria that sticks to our tongue.
• Floss your teeth: Make sure to floss every time, after you done with brushing your teeth. This helps to reduce plaque built-up between your teeth.
• Use a mouthwash: Rinsing with mouthwash, it helps in curing gum inflammation as anti-bacterial mouthwashes contain the ingredient chlorhexidine which helps to kill dental bacteria’s and cavities.
• Use an interdental brush: Further techniques like Oral prophylaxis (ultrasonic scaling) or use of interdental brush, a plaque removal device or an irrigation device can help. However, first do consult a dentist before investing in one. Professional scaling is also extremely vital because once the plaque has hardened and built-up or become tartar, only a dentist or dental hygienist can eradicate it. Advanced technologies like gingivectomy, flap surgery, root planning is of greater help in the chronic conditions.

Are women prone to gum diseases only during menstruation?

Pregnancy, menopause, and intake of birth control pills other than menstruation are the few causes of hormonal fluctuation leading to gingivitis. It can also occur due to certain long-term consumption of medicines like anti-epileptic drugs and certain anti-hypertensive drugs. Later it may result into periodontitis. This can also turn out as one of the biggest threats to our heart and can lead to severe heart diseases. 

Debjani Arora: 10-3-2017, The Health Site