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Smile and Say “Healthy” With NobleDentist

NobleDentist offers a dental plan so everyone can afford to get quality dental care. With the cost of dental treatment rising all the time, visits to the dentist often get pushed to the bottom of the budget list. Unfortunately, that can not only lead to teeth and gum problems but it can literally affect your general health including the immune system.

People tend to separate taking care of their body and taking care of their teeth and that can be a big mistake. You can exercise and try to eat a balanced diet, but if your mouth has become a breeding ground for bacteria then you stand a good chance of becoming sick in some way.

It may not sound pleasant to call your mouth a “breeding ground” but just think of other areas where moisture is constant. There’s mould in bathrooms and fungus in dark damp caves growing all the time. Your mouth is actually facing similar conditions, except every time you eat the bacteria breeding in your mouth are fed. No wonder they thrive!

Linking Healthy Teeth And Gums To A Healthy Body

Research has confirmed a link between the health of your teeth and gums and the general health of your body. That’s why NobleDentist created a dental plan for Australians that makes ongoing and regular dental care more affordable. Keeping your teeth clean and your gums healthy can prevent problems in two major areas:

• Systemic health
• General health

Clean teeth, healthy gums and a great smile are all important components in a plan to protect your health in all ways. There’s a direct connection between your teeth and gums and your heart, lungs, immune system and cardiovascular system. Bacteria that build up in your mouth don’t stay there. They travel throughout the body like unwanted passengers on a river trip using the bloodstream as transportation. When they reach their destination, the damage they can cause covers the spectrum from mild to severe.

1. Systemic Health

It is known that bacteria in the mouth can cause poor systemic health. Systemic health is a term that means exactly what it sounds like – the health of the systems in the body. These systems include the cardiovascular, respiratory and reproductive systems. Research has linked periodontitis which involves progressive loss of the alveolar bone around the teeth (i.e. if left untreated, can lead to the loosening and subsequent loss of teeth) with the development of certain systemic diseases such as cardiovascular and pulmonary diseases. The bacteria enter the bloodstream and are carried to the heart, lungs and other organs where they proceed to create or aggravate a number of health problems:

• Cardiovascular disease
• Chronic inflammation
• Diabetes
• Pulmonary Disease

People who have periodontitis are at a much higher risk of developing cardiovascular disease because the bacteria build-up in the bloodstream leads to excessive inflammatory responses. The low-grade chronic inflammation impacts the body’s organs including the heart and arteries over time. Bacteria also play a part in the development of the plaque that is associated with hardening of the arteries and other circulatory diseases.

Though studies have not yet identified the specific cause-and-effect relationship, almost all results show there is an association between periodontitis and diseases such as atherosclerosis and the presence of periodontitis. But it’s not just the heart that can be negatively impacted by the presence of too many bacteria in the mouth.

There is ongoing research to determine the relationship between diabetes and periodontitis. People with diabetes are more likely to develop severe periodontitis than the non-diabetic. The studies are focusing on the relationship of mouth bacteria and glycemic control which is an important element in the control of diabetes.

Periodontitis is also being investigated as having a relationship to the development of pulmonary disease. The bacteria travel the bloodstream to the lungs where it then causes severe problems like Chronic Obstructive Pulmonary Disease (COPD) as micro-organisms damage the lung tissue.

Also included in the studies is the relationship of diseases that involve inflammation such as rheumatoid arthritis and periodontitis. Even if periodontitis does not have a direct relationship as a cause of these types of diseases it is probable that periodontitis will always complicate the management of the disease by impacting the inflammatory system in the body.

2. General Health

In a nutshell, if you have periodontitis there is a good chance you are overworking your immune system by keeping the inflammatory response active on a continual basis. This can lead to the inability of the body to use the appropriate immune response to normal day-to-day threats. Lipid (i.e. fats) levels remain high leading to a weakened immune system and an increased probability of developing cardiovascular or other systemic diseases.

Studies are also looking at the relationship of oral health to cancer. It is thought that periodontitis can lead to open sores in the mouth or on the gums that eventually become cancerous. This is due to constant exposure to mouth bacteria and other elements found in foods and the environment.

Periodontitis can also impact the reproductive systems of women. Studies are showing that women with periodontitis have a higher probability of an early delivery or delivering a baby that is underweight.

Clearly the impact on systemic and general health can be severe when oral health is poor. You can think of it this way: how can you possibly be in great health if your body is constantly battling unhealthy bacteria levels? Even if you don’t develop a systemic disease, advanced periodontitis left untreated will eventually decay the bone holding your teeth.

Fortunately, maintaining good oral health is not difficult. You need to:

• Brush your teeth daily
• Use fluoride fortified mouthwash and/or toothpaste
• Floss each time you brush
• Eat a nutritionally balanced diet
• Visit the dentist regularly for teeth cleaning and care

NobleDentist has developed a dental plan (i.e. dental cover) in Australia. It ensures that for an affordable membership fee you have access to exceptional dentists at reduced dental fees. This can help you and your family maintain great health.

This is a paper by Williams, R C Barnett, A H; Claffey, N; Davis, M; Gadsby, R; Kellett, M; Lip, G Y H; Thackray, S that was published recently on the RedOrbit website.

Background: Evidence for a link between periodontal disease and several systemic diseases is growing rapidly. The infectious and inflammatory burden of chronic periodontitis is thought to have an important systemic impact. Current evidence suggests that periodontitis is associated with an increased likelihood of coronary heart disease and may influence the severity of diabetes.

Scope: This paper represents a UK and Ireland cross-specialty consensus review, undertaken by a group of physicians and dentists. The consensus group reviewed published evidence (PubMed search for review and original articles), focusing on the past 5 years, on the contributory role of periodontal disease to overall health. In particular, evidence relating to a role for periodontal disease in cardiovascular disease and in diabetes was considered.

Findings: Initial studies of large epidemlological data sets have sought to find links between periodontitis and systemic disease outcomes, but a causal relationship still needs to be demonstrated between perlodontal disease, cardiovascular disease and diabetes through prospective studies. There is a need for prospective studies assessing the association between periodontal disease and patients at particular risk of cardiovascular events which will allow assessment of both cardiovascular disease clinical endpoints and surrogate markers of cardiovascular risk. Of note, periodontal disease is also often more severe in subjects with diabetes mellitus, a group at already increased risk for cardiovascular events.

Conclusions: While further research is needed to define the population-attributable risk of periodontal disease to both cardiovascular diseases and to diabetes control and progression, health education to encourage better oral health should be considered as part of current healthy lifestyle messages designed to reduce the increasing health burden of obesity, cardiovascular disease and diabetes.

Introduction

Physicians and dentists are being drawn together by emerging evidence that suggests an association between oral disease and a number of clinically important diseases and conditions. Specifically, periodontitis, a chronic infectious and inflammatory disease of the gums and supporting tissues, has attracted much interest as a potential risk factor for cardiovascular diseases and type 2 diabetes, and also for its association with adverse pregnancy outcomes, respiratory disease, kidney disease and certain cancers1- 7. These associations between periodontal disease and certain systemic diseases highlight an urgent need for dentists and physicians to work more closely together in understanding and improving patient health.

This report summarises an overview of the current peer-reviewed literature made by an expert consensus group. The group, comprising both physicians and dentists, mainly drawn from the UK, met in London in January 2008 to review and debate the current and emerging evidence linking periodontal disease to cardiovascular disease and diabetes mellitus, and what this evidence currently reveals about the contributory role of periodontal disease to overall health. A literature search spanning the past 5 years was performed for PubMed cited articles (reviews and original articles) using key words relating to periodontal disease terms, cardiovascular disease and diabetes mellitus. Members of the consensus group were asked to review selected articles and supplement the reading list with any additional papers they felt relevant to the overview and consensus discussions. The article aims to highlight ongoing, contemporary discussion of periodontal disease to medical practitioners. The consensus represents one of the first attempts to bring together practising UK clinicians and dentists to discuss contemporary views on periodontal disease. The resulting consensus group article details concepts and ideas, for both clinical research and for daily practice, that recognise the complementary roles of the oral health and medical care teams in contributing to disease control and prevention.

The contribution of oral health to overall health

Current interest in the importance of periodontal disease to general health was rekindled in the late 1980s following reports of an association between dental health and acute myocardial infarction (MI)8. In a case-control study, subjects with acute MI had significantly more dental problems, such as periodontal disease, than subjects without MI, even after adjustment for age, social class, smoking, serum lipid concentrations and presence of diabetes8. Since then, research in the past two decades has sought to determine and define relationships between periodontal disease and the aetiology of other diseases with inflammatory or infectious components.

Defining periodontal disease

Periodontal disease is a general term used to describe diseases that affect the gingiva and cause damage to the supporting connective tissue and bone which anchor the teeth to the jaws9. Periodontal disease is caused by specific bacteria from the biofilm within the periodontal pocket (Figure 1). As anaerobic infection takes hold, a complex cascade of tissue-destructive pathways is set in motion, triggered by bacterial products and fuelled by inflammatory mediators. The surface area of the mouth affected by periodontal disease can be large, equivalent to the surface area of one to two hand-spans (~300cm^{sup 2})10. From the periodontal pocket, there are at least two potential pathways by which the apparently localised infection and inflammation can have an effect on systemic health. One is by passage of periodontal pathogens, and their products, through ulcerated epithelium into the circulation, leading to bacteraemia and/or provocation of systemic immune and inflammatory responses. The second is the passage of locally produced inflammatory mediators from the periodontal pocket into the systemic circulation11 (Figure 2). These biological mediators and pathological mechanisms through which periodontitis may contribute to systemic inflammatory diseases are currently the subject of intensive study, but will not be discussed further in this report, which focuses more on the clinical associations between oral infection and cardiovascular diseases as well as diabetes. Importantly, the publications reviewed and the research concepts defined within this article focus on periodontal disease characterised by periodontitis rather than gingivitis.

This overview considers four broad questions in reviewing the available published literature in the field:

• Is there evidence to suggest that subjects with periodontal disease have an increased risk of cardiovascular disease and events?

• Is there evidence that suggests treatment of periodontal disease can reduce the risk of secondary or primary cardiovascular diseases and events?

Figure 1. Penodontitis: in some subjects, for reasons that remain unknown, the chronic inflammation of established gingivitis spreads to provoke periodontal ligament and alveolar bone destruction. (Reproduced from Gaffar and Volpe12, with permission)

Figure 2. Theoretical pathways by which the gingival inflammatory response may impact systemic inflammation and systemic processes such as atherosclerosis. (Reproduced from Gaffar and Volpe12 (p. 22), with permission)

• Is there evidence to suggest that the relationship between diabetes mellitus and periodontal disease is two-way?

Is there evidence that treatment of periodontal disease may improve outcomes in diabetes mellitus?

These questions were posed to form the framework for consensus, commentary and research-generating hypotheses on the role of periodontal disease in both cardiovascular diseases and in diabetes.

Periodontal disease and cardiovascular disease – evidence for an association

The literature suggests that burden of pathogens, antigens, endotoxins and inflammatory cytokines of periodontitis might contribute to atherogenesis and thrombosis11-15. Common periodontal pathogens such as Porphyromonas gingivalis and Streptococcus sanguis have been found in arterial plaques from carotid endarterectomy samples and, furthermore, periodontal disease has been associated with elevated levels of inflammatory markers such as C-reactive protein1,14,16,17. There is growing evidence to support a role for C- reactive protein as a predictive, pathogenic factor for vascular risk and interest in therapies and interventions that may modify C- reactive protein. However, it is recognised that more research is needed as to the true clinical relevance of C-reactive protein at this time18. The literature also contains reference to studies indicating that periodontal pathogens themselves may cause platelet aggregation and thromboembolic events1.

Periodontal disease is thought to cause changes in both traditional and novel cardiovascular risk factors16,17,19-22. For example, severe periodontitis has been associated with adverse changes in blood pressure and in serum cholesterol levels16. A number of studies have also suggested an association between periodontal disease and carotid intimamedia thickening, the latter being a surrogate index of atherosclerosis19,20.

Our review of the current evidence base derived from large epidemiological datasets designed for other reasons and from small- scale longitudinal studies and periodontal intervention studies suggests an association between periodontal disease and an increased risk of cardiovascular disease. For example, in a meta-analysis of studies relating to the prevalence and incidence of coronary heart disease (CHD), it was found that the risk of developing CHD was significantly higher in subjects with periodontal disease compared with controls1 (Figure 3). In this systematic review of the literature, five prospective cohort studies that involved a total of 86092 patients, followed up for at least 6 years, found that subjects with periodontal disease had a 1.14-fold (95% CI 1.074- 1.213, p<0.001) greater risk of developing CHD than controls1. According to this recently published meta-analysis, both the incidence and prevalence of CHD were increased in subjects with periodontal disease after adjustment for variables known to increase risk for CHD. The authors of the meta-analysis considered that three of the five prospective studies were of good quality and they noted that cardiovascular assessments in these studies included the accepted measures of coronary artery disease and clinically defined CHD. This same review identified five case-control studies (1423 patients) and five cross-sectional studies (17724 patients) that were eligible for meta-analysis and these again supported a significant relationship between periodontal disease and CHD1. Figure 3. The relative risk of coronary heart duease in penodontitis – a meta-anatysis of data from prospective studies (adapted from Bahekar et al. 2007(1))

Nonetheless, our consensus is that there remains a lack of prospective studies at this time. Well-designed, prospective studies are needed to validate the assumption that risk of developing CHD is increased in subjects with periodontal disease.

Need for prospective studies

In planning prospective studies, it will be important to bear in mind the difficulties in isolating risk factors for cardiovascular disease within observational and epidemiological study designs. Strong confounding factors associated with cardiovascular diseases include age, gender, smoking, family history and diabetes mellitus. In epidemiological and observational studies, controlling for such confounding factors requires large numbers of subjects to be enrolled, and the subjects need to be followed over a long period of time. To date, the mining of large-scale cardiovascular disease epidemiological datasets – such as the National Health And Nutrition Examination Surveys I23 and III24 (NHANES I and III), the Framingham Heart Study25 (www.framinghamheartstudy.org) and the VA Normative Aging cohort26 – has not been fully utilised in the search for associations between periodontal disease and cardiovascular disease, possibly because of multiple confounders. One large-scale, ongoing observational study – the Atherosclerosis Risk in Communities (ARIC) study has reported studies involving periodontal disease13,17. While such sub-studies of observational datasets have methodological problems, the ARIC data do suggest that the host response to oral bacteria appears to be relevant to systemic atherothrombotic coronary events13. In this study, periodontal status and serum IgG antibody levels against 17 periodontal organisms were compared against prevalent CHD. Although clinical signs of periodontal disease were not associated with CHD, the systemic antibody response and the quality and quantity of host responses to periodontal infection did appear to relate to systemic atherothrombotic events13. Systemic exposure to more than one oral organism was related to an increased risk for CHD, particularly in subjects who had never smoked. For example, high antibody levels to Prevotella nigrescens and to Actinobacillus actinomycetemcomitans were each linked with an odds ratio of 1.7 (95% CI 1.1-2.6 and 1.2-2.7, respectively) and antibodies to Capnocytophaga ochracea to an odds ratio of 2.0 (95% CI 1.3-3.0) in non-smokers.

Another substudy of ARIC has reported that extensive periodontal disease and body mass index were jointly associated with increased C- reactive protein levels in otherwise healthy middle-aged adults17. While it is uncertain whether C-reactive protein contributes to atherosclerosis or is a marker of atherosclerosis and vascular damage, this marker is increasingly studied as a potential surrogate indicating potential elevated risk for cardiovascular diseases.

Associations and causality

Our consensus is that prospective studies are needed to clarify whether periodontal disease and cardiovascular diseases simply share risk factors in common or whether there is a true causal relationship. Further research is required to both establish causality and to determine the population-attributable risk of periodontal disease to cardiovascular disease. It will be important to account for potential confounding factors and shared risk factors in patient populations, most notably obesity and smoking. There is also a need for intervention studies that address both primary prevention and secondary prevention of clinical disease. We also note that in cardiovascular medicine, ‘hard’ clinical endpoints, such as death, fatal and non-fatal myocardial infarction and other coronary or cerebrovascular events are usually required to support a causal relationship. Reductions in risk factors such as hypertension and dyslipidaemia are viewed as acceptable surrogate study endpoints but these must then be shown to equate with a subsequent reduction in clinical event endpoints. Our view and the prevailing view in contemporary literature is that research into the pathophysiological drivers of cardiovascular risk associated with periodontal disease – such as C-reactive protein and other inflammatory or thrombotic markers – should be conducted in parallel with clinical-endpoint studies, to provide additional plausibility to clinical associations18.

Periodontal disease – a potentially modifiable cardiovascular disease risk factor?

Our review of the available literature suggests the need for further interventional studies into the effect of periodontal disease treatment on cardiovascular risk and outcomes27-28. Both primary prevention and secondary prevention studies are needed. Many of the published intervention studies to date have suggested that successful treatment of periodontal disease may alter or modify inflammatory markers. For example, one study in 94 otherwise healthy subjects with generalised periodontitis assessed levels of C- reactive protein and interleukin-6 (IL-6) before and after periodontal therapy and showed significant reductions in C-reactive protein and serum IL-6 following treatment27. In another intervention study in 120 patients with severe periodontitis, intensive periodontal treatment resulted, 6 months after therapy, in improvement in endothelial function, as measured by reductions in soluble E-selectin and greater flow-mediated dilatation, at 6 months33.

Although a review of available literature and evidence suggests there may be an effect of periodontal treatment on surrogate markers, this consensus group considers that, like the PAVE study (Periodontitis and Vascular Events), any treatment studies must determine the effects of periodontal intervention on established clinical endpoints. Acceptable clinical endpoints in cardiovascular studies include major adverse cardiovascular and cerebrovascular events, often assessed within a combined endpoint. Nonetheless, there is merit in intervention studies that demonstrate reductions in surrogates and known risk factors for clinical events, such as blood pressure, LDL cholesterol and alterations in endothelial function.

To date, plans for large-scale studies of periodontal intervention, with sufficient power to detect a treatment effect on cardiovascular endpoints, remain at the pilot stage. Very recently, first data from the pilot PAVE study – a randomised secondary prevention trial comparing periodontal therapy to community dental care and their impact on cardiovascular disease risk – have been published34. This study, in patients with established coronary heart disease, hopes to assess the effect of periodontal intervention and treatment on outcomes such as hospitalisation for myocardial infarction (MI), cardiac revascularisation, fatal coronary heart disease, unstable angina, and hospitalisation for ischaemic stroke.

Interventions for periodontal disease

Between 8 and 10% of the population are prone to very severe periodontal disease35. Although the consequences of periodontal infection may extend to including an increased risk for systemic disease, the oral condition itself is very treatable. Indeed, mechanical debridement of the subgingival biofilm can lead to improvement in periodontal status. In addition to treatment of established disease, prevention of periodontal disease is possible with good oral hygiene and good dental care.

If causality between periodontal disease and cardiovascular disease is confirmed, periodontal disease could be viewed as a potentially modifiable cardiovascular risk factor. Interventions to prevent periodontal disease, beginning in childhood, could be studied for long-term effects on health and disease. Although there are currently no appropriately powered intervention studies to link successful treatment of periodontal disease with a reduction in cardiovascular events, there is still a rationale for promoting the public health message that good oral health could contribute to good general health. Indeed, our consensus view is that physicians should be encouraged to consider poor oral health as a possible marker of an unhealthy lifestyle or poor levels of disease control. Furthermore, referral to a dental professional should be considered for patients who have poor oral health. Health education to encourage better oral health care needs to be seen as a natural extension of current healthy lifestyle messages, such as diet and exercise that are encouraged and promoted in a bid to reduce obesity, cardiovascular disease and diabetes. Identifying at-risk patient groups in which to study the impact of periodontal disease

Our consensus view is that it should be possible to identify select patient groups, who have had previous cardiovascular events and in whom periodontal disease is likely to represent an additional risk factor. These high-risk patient groups offer an opportunity for prospective study of the effect of periodontal disease on risk and the impact of periodontal intervention on events and pathophysiological mechanisms.

Inflammatory factors may be important in affecting plaque rupture in patients with coronary artery disease. This being so, a study of periodontal disease and its inflammatory load in these patients could be enlightening. Patients with unstable plaques could represent a cohort in which to study the influence of periodontal disease and the impact of periodontal treatment on cardiovascular clinical events. Diabetic patients represent another high-risk subgroup in which to study periodontal disease and its role in increasing cardiovascular risk.

As discussed earlier, intervention and secondary prevention studies in such patient groups need to be run prospectively, with patients randomised to receive standard treatment for periodontal disease versus community care/usual standard of oral care. Such studies should assess the impact of intervention on cardiovascular treatment goals and targets. These include currently accepted targets for blood pressure, plasma lipid levels and HbAj0 in patients with diabetes (see later also). These short-term but clinically acceptable surrogate endpoints may allow an assessment of the impact of periodontal intervention on established cardiovascular risk factors. In addition, there is the need to show the impact of intervention, longer-term, on clinical events such as coronary and cerebrovascular events, both fatal and non-fatal. This group considers that the ability to demonstrate that clinical interventions can impact on hard clinical endpoints is essential to effect real changes in clinical practice and influence preventive medicine practices. As part of such prospective research and study, the impact of periodontal intervention on surrogate markers could also be undertaken.

The possible two-way relationship in diabetes

Closer attention to oral health in patients with diabetes is a goal for both dentists and physicians. Undiagnosed diabetes may be suggested by poor oral health unresponsive to ‘usual1 cleaning measures. Physicians managing patients with type 2 diabetes need to encourage attention to good oral health as part of overall lifestyle management and to reduce the risk of periodontal disease.

The available literature highlights the importance of oral health in subjects with diabetes3’36”41.

Our review identified small-scale studies in patients with type 2 diabetes which suggest that improved oral hygiene can reduce dental plaque scores and may assist in diabetes control as assessed by overall decreases in fasting blood glucose levels36. When diabetes (both type 1 and type 2) is poorly controlled or there are diabetic complications, patients are more likely to have periodontal disease37. Indeed, one meta-analysis of 18 comparative, cross- sectional studies found that subjects with diabetes have significantly more severe periodontal disease as compared with healthy subjects3.

Nonetheless, our consensus view is that the current evidence- base does not really support a causal relationship between periodontal disease and risk for type 2 diabetes, although there may be a significant two-way association between the two diseases. As discussed earlier, diabetic subjects represent a patient group known to be at heightened risk for cardiovascular disease. It therefore follows that periodontal disease may aggravate existing cardiovascular risk factors in patients with diabetes. In addition, the link between chronic infection and adverse effects on patient health is an established association in diabetes42. Of note, severe periodontitis has been associated with systemic inflammation and a dysmetabolic status in otherwise healthy individuals43.

Once again, we identify that well-designed and conducted studies are therefore needed to further examine the effect of periodontal treatment on glycaemic control and clinical outcomes in patients with diabetes. Initial interventional studies have shown a reduction in HbA^{sub 1c} levels in patients with diabetes following periodontal disease treatment. However, the power of these early studies does not permit direct associations to be made4’5’39’44’45. In a study involving 44 patients with type 2 diabetes, an association could be made between periodontal treatment and improved glycaemic control44, and one study of an 11-year follow-up of over 600 patients with type 2 diabetes suggests a link between periodontal disease and cardiovascular mortality or diabetic nephropathy4 consistent with other observational studies . The small patient numbers and confounding factors in such studies make definitive connections difficult, but not impossible, to draw.

Figure 4. The effects of periodontal treatment on HbA^{sub 1c} – data from ten intervention studies and from combined study data (adapted from Janket et al. 2005(46)

In a meta-analysis of ten intervention studies that included 456 patients, it was noted that periodontal treatment resulted in a 0.66% reduction in absolute HbA^{sub 1c} levels among patients with type 2 diabetes46 (Figure 4). Such a reduction would be of clinical relevance and our group consider that an update to this meta- analysis, to include more recent studies, would strengthen the evidence base. In diabetes research it is sometimes acceptable to evaluate the effects of an intervention on HbA^{sub 1c} levels as a marker of glycaemic control and regulatory bodies may accept 0.6% reductions in HbA^{sub 1c} as clinically significant when reviewing drug-efficacy appraisals (www.fda.gov). An advantage of studying changes in HbA^{sub 1c} levels in prospective clinical studies is that changes in this endpoint should be evident within a year of any successful intervention. Thereafter, patient follow-up to around 5 years would provide data on the impact of treatment on clinical events. It is our consensus view that both micro- and macrovascular endpoints could be assessed during prospective studies in diabetic subjects. As in cardiovascular research, confirmation of the benefits of HbA^{sub 1c} reduction, in terms of an impact on clinical events, can be considered a worthy goal.

The potential importance of periodontal disease in diabetes is highlighted by emerging evidence to suggest that periodontitis predicts the development of overt nephropathy and end-stage renal disease in patients with type 2 diabetes5. In a study involving over 500 patients with type 2 diabetes, 38% of whom had moderate periodontitis and 22% of whom had severe periodontitis, over a 22- year follow-up period, subjects with periodontitis had between 2.3 and 3.5 times increased risk for end-stage renal disease5. Although the effects of oral treatment on this endpoint have not yet been studied, we consider that the findings of studies showing associations between periodontitis and macrovascular disease, provide a rationale for further investigation of the connections between oral health and diabetic progression.

Our consensus view is that, once again, clinical research in specific at-risk groups may hold the key to unlocking associations between periodontitis and diabetes-associated events. For example, studies in Asian and other ethnic subgroups with high-risk profiles might provide more immediate answers to research questions relating to periodontal disease than studies within the more heterogeneous diabetic population.

The growing interest and potential clinical importance of good oral hygiene in patients with diabetes has been demonstrated in the US, where health-insurance providers are actively encouraging dental check-ups and regular cleanings in an effort to reduce the overall costs of health events associated with diabetes care.

Conclusions

Our consensus group of physicians and dentists consider that good oral health is an integral component of good general health. Evidence for a link between periodontal disease and several systemic diseases is growing and periodontitis is associated with an increased risk for CHD and diabetes. However, a causal relationship needs to be demonstrated in prospective studies, including controlled intervention studies. Periodontal disease is often more severe in subjects with diabetes, a group already at increased risk for cardiovascular events. Research into the inflammatory pathophysiology of periodontitis, cardiovascular disease and diabetes is already identifying potential links between these conditions. Crossdiscipline communication and research endeavours between dentists and physicians are important to improve understanding of the risks associated with periodontitis and the contributory role of oral health and disease to patient health and disease control. The promotion of good oral health, as part of better overall health care, can be seen as a natural extension of current healthy lifestyle messages around diet, exercise and the cessation of smoking, which are designed to help reduce the burden of cardiovascular disease and diabetes.

This is a press release for a New Harvard Medical School Report.

For some people, the fear of visiting a dentist outweighs the pain of a toothache. But putting off that visit almost invariably leads to more advanced oral health problems and lengthier, more complex procedures. What many people don’t realize is that they can work with their dentists to learn about and implement anxiety – relieving strategies, according to Dental Health for Adults: A Guide to Protecting Your Teeth and Gums, a new report from Harvard Medical School.

The most direct approach is to be straightforward with your dentist and
explore various strategies for pain reduction together. Improvements in
techniques, medications, and equipment over the past 30 years mean much
more comfortable visits than those you might recall from childhood.

Dental Health for Adults describes in detail both standard and novel
treatments available for pain management, such as local and general
anesthesia, anti-anxiety medications, and conscious sedation. The report
also includes a lengthy discussion of alternative approaches to dealing
with dental anxiety. These are some of the tips in the report:
—Have your dentist agree on a “stop” signal so you can take a time-out
from the procedure.—Avoid caffeinated beverages before your visit, as they may make you
jittery.—Listen to music on a portable music player before and during treatment.—Practice relaxation exercises and guided imagery techniques.—Get regular dental checkups, which help you build a good rapport with
your dentist and enable your dentist to catch problems early.

Edited by Hans-Peter Weber, D.M.D., Head of the Department of
Restorative Dentistry at the Harvard School of Dental Medicine, the 48-page
Dental Health for Adults: A Guide to Protecting Your Teeth and Gums also
covers:
—dental basics—the relationship between oral health and general health—taking care of your teeth at home—dealing with emergencies—tooth replacements—braces for adults—cosmetic dentistry.

Dental Health for Adults: A Guide to Protecting Your Teeth and Gums is
available for $16 from Harvard Health Publications, the publishing division
of Harvard Medical School. Order it online at
http://www.health.harvard.edu/DHA or by calling 1-877-649-9457 (toll free).

This is an article that recently appeared in Best Syndication – Pinon Hills, CA, USA.

All aspects of your appearance are important but without a doubt your face is the one physical feature that will be noticed more than others. Your face identifies you and each part is so unique that often they can become the main focus of attention. For instance, you may have heard people describe themselves as having a “pug” nose or “sleepy eyes.”

But perhaps even more than the eyes, the mouth draws attention when you speak, laugh or cry, and throughout all of these actions your teeth are on display for the world to see. As you progress through life and the different the stages of development, it is natural for your body to change. In addition, every person has experienced physical trauma which sometimes involved the face and resulted in damage to or the loss of teeth.

The solution for many people who have had their teeth chip or break has been to have crown and bridge restorations made to repair the damage. On the other hand, if the physical trauma was severe and teeth were lost, until as recently as ten years ago, your only option was to be fitted with either removable or fixed dentures.

Traditional dentures continue to be chosen by many people, but they have their limitations; removable dentures can be difficult to manage, sometimes they do not fit properly which causes problems speaking and eating. Wearers of fixed dentures which are attached directly to the jawbone and can only be removed by a dentist experience the same problem of achieving a comfortable fit that plagues the removable type of denture as well.

These problems led to the development of dental implants, which like fixed dentures are attached to the jawbone, with the difference found in the techniques used to secure them in the mouth. Rather than feeling like foreign objects in your mouth, dental implants quickly become one of the “pearls” in your mouth.

One of the main reasons why dental implants are the better choice today is because they are made of titanium, an exceptionally strong but lightweight material that is impervious to damage from the acids used to digest food in the mouth. Especially in the case where a person has lost a tooth which has created a gap between their teeth, dental implants are the ideal solution to restore the curvature of the face to its original position.

Dental implants are designed to become part of your natural array of teeth. You do not experience the problems encountered with this traditional dentures such as slipping or discomfort. The main reason why dental implants are growing in popularity is because they free you from the anxiety caused by improper fitting dentures and they allow you to have a beautifully confident smile.

The cost of quality dentistry, especially cosmetic dentistry is best considered as an investment in your health. When you have experienced physical trauma and need to have teeth replaced, keep in mind that the cost of dental implants is based on their prominent function. Teeth play a role in your ability to speak clearly, prepare your food for digestion by your body and support your facial features. Your mouth is the gateway to your body and oral hygiene or the lack of it can be a contributing factor to the support or the deterioration of your health as a whole. The most important thing is for you to discuss with your dentist whether cosmetic dentures or dental implants are the best choice for you.

I have not been to the dentist for many years because of a previous bad experience. Now, I need some dental work done, and I’m terrified. What can I do to get through it?

Mayo Clinic dental care specialist Alan Carr, D.M.D. and colleagues answer select questions.

Answer

Many people experience some level of trepidation about dental procedures. This is normal — especially if you’ve had a prior bad experience. Talk to your dentist about your concerns and ask him or her about the possibility of using dental sedation.

Sedation dentistry involves the use of medications to allow you to relax and feel sleepy during a dental visit or procedure. This is referred to as conscious sedation. However, sedation is not pain medication, so you will still require local anesthesia, such as Novocain, during treatment.

There are a variety of sedation dentistry methods. The most common types are inhaled sedation, which involves breathing in a mixture of nitrous oxide (laughing gas) and oxygen; and oral sedatives, which are medications taken by mouth. Another type of dental sedation is intravenous (IV) sedation, which is provided by dentists with specialized training in IV sedation. The major advantage of IV sedation is the ability to adjust the level of sedation when needed.

With conscious sedation, you breathe on your own. You’re also responsive to vocal commands and sensory stimulation. You may feel so relaxed that you fall asleep during the procedure. Afterwards, you may feel groggy and disoriented and may require help getting home. In addition, you may not remember what happened during the time you were sedated.

Conscious sedation is safe when administered by dentists trained in its use. However, as with any medication, sedation involves a certain amount of risk. It is important to talk to your dentist about these risks.

This is an article that was recently published within the Your Oral Health section of the NobleDentist website.

Routine physical examinations including hearing and vision tests help ensure that students are in good health before school begins. When scheduling health care appointments, don’t overlook a dental check up for your child. A dental examination should be a regular part of back-to-school preparations. Children need to see a dentist at intervals recommended by their dentist. Many parents and caregivers don’t realise that serious tooth decay is an infectious disease for which there is no immunisation.

Children and Oral Health

More than one-half of all children aged 5 to 9 years have at least one cavity or filling. A painful tooth or chronic dental problem can lead to difficulty in eating, speaking and concentrating. Children with chronic dental pain may not always voice their dental problem. They may appear anxious, depressed or tired but teachers may not recognise their pain. Dental problems also cause many children to miss school.

Children and Dentists

Regular dental check ups and preventive dental care such as cleanings and fluoride treatment provide children with “smile” insurance. Routine dental examinations uncover problems that can be treated in the early stages when damage is minimal and restorations may be small. This helps prevent painful, chronic conditions and saves money.

When necessary, radiographs (commonly called “x-rays”) are taken to see how the teeth are developing and to spot hidden decay. Every child should have an orthodontic evaluation by age 7. Early examination and treatment may prevent or reduce the severity of malocclusions (or “bad bite”) in the permanent teeth.

Because children’s needs differ, our participating dentists are best able to suggest a schedule of visits for your child. The frequency of dental visits will depend partly on the child’s eating habits, how clean the teeth are kept, past treatment needs, whether the child drinks fluoridated water and other factors that can affect the likelihood of dental diseases.

Protecting a Healthy Smile

Dental sealants are another option for keeping teeth healthy. A sealant is a plastic material that our participating dentists apply to the chewing surfaces of the back teeth (the premolars and molars). Sealants form a barrier that protects teeth from plaque, a sticky film of acid-producing bacteria. Sealants hold up well under the force of normal chewing and usually last several years before a reapplication is needed.

Besides a dental check up, your child may be due for a new toothbrush. The ADA recommends replacing toothbrushes every three to four months or sooner if bristles are worn. A worn toothbrush can’t do a thorough job of cleaning teeth. Select a child-sized toothbrush for ease of use.

Children may be able to brush their teeth by the age of 7 years but may need supervision brushing until about age 10 or 11 years. Flossing removes plaque from between the teeth where a toothbrush can’t reach. However, flossing is a more difficult skill to master. Floss your child’s teeth until about age 10 years after which he or she should be able to floss under adult supervision.

Many injuries that occur on the playground or even while skateboarding can be prevented or minimised if the child is wearing a mouthguard. A mouthguard can be purchased at a sporting goods store or can be custom made by our participating dentists to fit your child’s mouth.

This is an article that was recently published in the ‘Your Oral Health’ section of the NobleDentist website.

Advances in modern dental materials and techniques increasingly offer new ways to create more pleasing, natural looking smiles. Researchers are continuing their often decades-long work developing esthetically attractive materials such as ceramic and plastic compounds that mimic the appearance of natural teeth.

Today, more patients ask participating dentists about white fillings because they want their teeth to look natural when they laugh, talk and smile.

White fillings, also called composite fillings, are made from tooth-coloured materials that restore the natural appearance of a decayed or previously filled tooth. Because they blend well with tooth enamel and don’t look like fillings, a participating dentist may recommend them if the teeth to be restored are near the front of your mouth.

A composite filling usually requires only one visit, during which the tooth is prepared and restored. An advantage of composite fillings, as with other dental restorations, is that they require less of the healthy part of a tooth to be removed to hold the filling in place. This is due to composite materials’ ability to bond to teeth adhesively.

The procedure for a composite filling may take a little longer than those for other types of fillings because after the decay is removed, the tooth must be kept totally isolated from saliva. A participating dentist carefully applies an adhesive followed by several thin layers of the tooth-coloured composite. Once the filling is in place, it is chemically hardened, or cured, for less than a minute with a special light.

Composites are preferable for obvious cosmetic reasons but if the decayed area is large or is subject to heavy chewing pressure, a participating dentist may recommend another type of material or restoration. Some people may experience some sensitivity to hold or cold temperatures in the newly filled tooth for a few days or as long as a week. If the sensitivity continues beyond that time, contact a participating dentist.

Other types of white fillings include composite inlays and porcelain inlays and onlays. Inlays and onlays are used to restore teeth that are badly damaged by decay or wear. They may be applied to the chewing surfaces of the back teeth when esthetics is of concern.

Some white fillings may be more expensive than other dental materials but most patients find these natural-looking restorations well worth the additional cost. White fillings, like other dental materials, may require periodic replacement. If the edge of the filling eventually pulls away from the tooth, bacteria can get between the filling and the enamel and eventually may cause decay. Tooth decay over time may develop elsewhere on the tooth. Regular dental check-ups are important because they allow a participating dentist to detect a problem in the early stage.

This is an article recently published in the ‘Your Oral Health’ section of the NobleDentist website.

Many patients are discovering the benefits of dental veneers. Unlike a crown which covers the entire tooth, a veneer is a thin covering that is placed over the front (visible) part of the tooth. A participating dentist applies veneers in a simple, comfortable procedure that takes just a few visits.

Veneers are a popular treatment option for several reasons. They generally are placed on upper front teeth that are severely discoloured, poorly shaped or slightly crooked. Veneers may be used to lighten front that are naturally yellow or have a gray cast and can not be whitened by bleaching. Veneers are sometimes used to correct teeth that are chipped or worn. They also may be used to correct uneven spaces or a diastema (a large, noticeable gap between the upper front teeth).

Types of Veneers

There are two types of veneers: ceramic veneers (sometimes called laminates) and resin-based composite veneers.

Ceramic veneers. Ceramic veneers are extremely thin shells made of a strong and durable dental ceramic. A participating dentist removes a small amount of enamel from the front and sides of the tooth. This makes room for the veneer and prevents the restored tooth from feeling or looking bulky or unnatural.

Next, the participating dentist makes an impression of the prepared teeth so that the shape of the preparations and surrounding teeth can be replicated in the dental laboratory. The participating dentist also looks for the shade that will best match or blend with the other teeth. The impressions are sent to a dental laboratory that makes the ceramic veneers to fit your individual teeth. This may take several days.

At the next visit, the participating dentist places the veneers on the teeth to check the fit and shape. After any adjustments, the teeth are cleaned and the ceramic veneers are bonded to the teeth with dental cement. Further adjustments may be done at a subsequent appointment.

Resin-based composite veneers. Resin-based composite veneers generally are placed in one appointment. After the tooth is prepared or reshaped, the participating dentist carefully bonds and sculpts the composite material in a colour that matches your other teeth. A special light is used to harden the composite. The veneer is smoothed and polished to look like a natural tooth.

Choosing Veneers: Considerations

Teeth must be healthy and free of decay and active periodontal disease. Veneers typically require less removal of tooth enamel than do crowns. However, the process is not reversible once the enamel is removed.

Patients who clench or grind their teeth are not good candidates for veneers because the thin veneers may chip, break or peel. Avoid biting your fingernails and chewing on hard objects such as pencils or ice. Like any dental restoration, veneers can be dislodged over time and with wear. In that case, new ones might be needed. As with all your dental care, discuss your expectations and treatment options thoroughly with a participating dentist.

No special maintenance is needed other than good oral hygiene each day. Brush twice a day with fluoride toothpaste and clean between your teeth once a day with floss or another interdental cleaner. Regular dental visits are a must for maintaining healthy teeth.

This is an article recently published within the ‘Your Oral Health’ section of the NobleDentist website.

If you are self-conscious about missing teeth or wearing dentures, there’s an alternative that may be right for you: dental implants. Dental implants are one option for replacing missing or badly diseased teeth. A dental implant offers comfort and stability and, by virtue of the artificial tooth it supports, is a restoration that is the closest thing to a natural tooth.

What is a dental implant?

Implants are manufactured anchors that look like cylinders or screws. They are artificial replacements for natural tooth roots. Implants are used in upper and lower jaws. They are made of titanium and other material that are well suited to the human body. They attach to the jawbone and gum tissue to become a stable base for one or more custom artificial replacement teeth, called dental crowns.

Dental implants have been used for several decades. Patients of all ages have chosen dental implants to replace a single tooth or several teeth or to support partial or full dentures. It’s no surprise. Dental implants and their crowns help restore the ability to chew food. They help fill out a face that otherwise could look sunken because of missing teeth. Unlike dentures, implants and crowns are not removed for overnight soaking and cleaning. No adhesives are needed.

The Dental Implant Process

Treatment generally is a three part process that takes several months.

In the first step, a participating dentist surgically places the implant in the jaw with the top of the implant slightly above the top of the bone. A screw is inserted into the implant to prevent gum tissue and other debris from entering. The gum then is secured over the implant. The implant will remain covered for approximately three to six months while it fuses with the bone, a process called osseointegration. There may be some swelling, tenderness or both for a few days after the surgery, so pain medication usually is prescribed to alleviate the discomfort. A diet of soft foods, cold foods and warm soup often is recommended during the healing process.

In the second step, the implant is uncovered and a participating dentist attaches an extension called a post, to the implant. The gum tissue is allowed to heal around the post. Some implants require a second surgical procedure in which a post is attached to connect the replacement teeth. With other implants, the implant and post is a single unit placed in the mouth during the initial surgery. Once healed, the implant and post can serve as the foundation for the new tooth.

In the third and final step, a participating dentist makes a crown which has a size, shape, colour, and fit that will blend with your teeth. Once completed, the crown is attached to the implant post.
Are dental implants right for you?

Who’s a good candidate for implant treatment?

You are, if you’re in good health and have healthy gums and adequate bone to support an implant. You must be committed to thorough oral hygiene to keep your mouth healthy and to scheduling regular dental visits. Ask a participating dentist if implants are an option for you.

NobleDentist recently added several new oral health articles to assist you.

Simply click on any of the links below to peruse that article.

1. Oral Cancer – How to Protect Yourself


2. Oral Care for Cancer Patients


3. Oral Health and Piercing


4. Periodontal Disease and Prevention


5. Periodontal Disease – Treatment for Prevention


6. Pregnancy and Oral Health


7. Sensitive Teeth – Causes and Treatment


8. Smoking and Oral Health


9. Toothbrush – Care, Cleaning, and Replacement

To learn how to save hundreds and even thousands of dollars at the dentist, click on NobleDentist.