Periodontal Disease is Associated with Higher Risk of Cancer in Postmenopausal Women

MedicalResearch.com Interview with:

Jean Wactawski-Wende, PhD Dean, SUNY Distinguished Professor Professor, Department of Epidemiology and Environmental Health School of Public Health and Health Professions University of Buffalo

Dr. Wactawski-Wende

Jean Wactawski-Wende, PhD
Dean, SUNY Distinguished Professor
Professor, Department of Epidemiology and Environmental Health
School of Public Health and Health Professions
University of Buffalo

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: There has been a growing interest in the role of periodontal disease in system chronic diseases, including cancer. We explored the association of periodontal disease history and incident cancer in the women’s health initiative study of postmenopausal women. We found that women reporting periodontal disease history were at increased risk of developing cancer overall. In addition they were found to have significant increased risk of specific cancers including cancers of the lung, breast, esophagus, gallbladder and melanoma. The risk persisted after control for many other factors. In addition, the risk was seen in women regardless of their smoking history. Both ever smokers and never smokers were found to have increased risk of cancer associated with periodontal disease history.

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Diabetes Alters Oral Microbiome Leading to Periodontal Disease

MedicalResearch.com Interview with:

Dana T. Graves DDS Department of Periodontics School of Dental Medicine University of Pennsylvania Philadelphia, PA

Dr. Graves

Dana T. Graves DDS
Department of Periodontics
School of Dental Medicine
University of Pennsylvania
Philadelphia, PA

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: It was previously thought that diabetes did not have a significant effect on oral bacteria. We found that diabetes caused a change in the composition of the oral bacteria. This change caused resulted in a bacterial composition that was more pathogenic and stimulated more inflammation in the gums and greater loss of bone around the teeth.

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Engineering New Vasculature Could Revolutionize Root Canal Surgery

MedicalResearch.com Interview with:
Avathamsa Athirasala, MSE and
Luiz E. Bertassoni, DDS PhD

Biomaterials and Biomechanics, School of Dentistry
Center for Regenerative Medicine, School of Medicine
Biomedical Engineering, School of Medicine
Portland OR 97201 USA

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Current clinical practices for root canal treatment involve replacing the damaged tissue with inert, synthetic materials. While these procedures are able to arrest infection and decay in the tooth, they do not restore its biological function causing it to become weaker and more prone to fractures.

We are focused on the regeneration of pulp tissue instead and in this study, we have developed a strategy to apply tissue-engineering concepts to engineer dental pulp-like tissue constructs, complete with blood vessels, which can, in principle, integrate with existing vasculature when introduced at the site of injury and form healthy pulp tissue. Continue reading

In Accordance With Guidelines, Fewer Low Risk Patients Receiving Antibiotics Before Dental Procedures

MedicalResearch.com Interview with:

Daniel C. DeSimone, M.D.</strong> Infectious Diseases Fellowship, Year 2 Mayo Clinic

Dr. DeSimone

Daniel C. DeSimone, M.D.
Infectious Diseases Fellowship, Year 2
Mayo Clinic

MedicalResearch.com: What is the background for this study?

Response: For over 50 years, the American Heart Association (AHA) has recommended antibiotics to be given to patients with certain cardiac conditions prior to invasive dental procedures (dental cleanings, extractions, root canals) with the hope to prevent infective endocarditis–a potentially deadly infection of the heart valves. Prevention of this infection was preferred to treatment of an established infection due to its high morbidity and mortality rates. However, in 2007, experts found that there was very little, if any, evidence that showed antibiotics prophylaxis prevented infective endocarditis prior to invasive dental procedures. Given this, the AHA revised its guidelines, significant reducing the number of patients where antibiotic prophylaxis would be given–as routine daily activities such as chewing food, tooth brushing, and flossing were much more likely to cause infective endocarditis than a single dental procedure.

For over 50 years, patients with cardiac conditions that placed them at “moderate risk” and/or “high risk” were to receive antibiotics prior to dental procedures. In 2007, the “moderate risk” group were to no longer receive antibiotic prophylaxis. This is a significantly large proportion of patients–approximately 90% of all patients who would have received antibiotic prophylaxis. Given the drastic changes made in 2007, there was concern among the medical and dental communities about whether we were leaving patients “unprotected” and at risk for infective endocarditis. Thankfully, several population based studies from our group and others across the United States have not shown an increase in the rate of infective endocarditis. However, the question remained, “Are providers following the 2007 AHA guidelines?” and “Are patients still receiving antibiotics prior to dental procedures when its no longer indicated by the guidelines?”.

This was the main focus of our paper. We were able to go into the local dental offices and at the same time, have full access to their medical records. Every dental visit between 2005 and 2015 at their dental office was reviewed; the type of dental visit, whether they received antibiotic prophylaxis or not. In addition, we could confirm their cardiac conditions that would place them at “moderate risk” or “high risk” compared to the general population.

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Oral Bacteria Linked to Cardiovascular Disease

MedicalResearch.com Interview with:
Bradley F. Bale, M.D.

Texas Tech Health Science Center
School of Nursing, Lubbock, Texas
1002 Montrose Drive
Gallatin, TN 37066

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: It has been known for some time that periodontal disease is associated with higher risk for arterial disease.  It was shown decades ago that the germs in the mouth frequently seed into our blood stream with simple activities such as chewing and brushing our teeth.  During the last decade, it was discovered certain high risk periodontal pathogens are associated with various cardiovascular (CV) risk factors such as blood pressure, lipid levels, insulin resistance and endothelial dysfunction.  These studies elucidated that the CV risk stems from the bacteria involved in the periodontal disease and not the clinical signs such as pocket depth, bleeding of gums and loose teeth.

The above knowledge demonstrated that high risk periodontal pathogens can adversely influence two of the three elements in the atherogenic triad.  Those factors are concentration of apoB and endothelial inflammation and dysfunction.  Then approximately two years ago it was published that the high risk pathogen Porphyromonas  gingivalis (P.g.) can enhance the third element.  This portion is the transformation of contractile smooth muscle cells (SMCs) in the medial layer of artery into migratory secretory SMCs.  These morphed cells enter the deep layer of the intima and enrich it with proteoglycans which are the ‘velcro’ that traps cholesterol particles in the arterial wall and initiates the formation of arterial disease.  At that point, there was solid evidence that the high risk pathogens boost every element in the triad to create atherosclerosis.  With that knowledge these pathogens must be considered a contributory cause of arterial disease.  When a condition is causal it demands diagnosis and management to reduce the disease risk.

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Gum Disease Linked to Autoimmunity in Rheumatoid Arthritis

MedicalResearch.com Interview with:

Maximilian F. Konig, MD Department of Medicine Massachusetts General Hospital Harvard Medical School

Dr. Maximilian F. Konig

Maximilian F. Konig, MD
Division of Rheumatology,
Johns Hopkins University School of Medicine
Current affiliation:
Department of Medicine
Massachusetts General Hospital
Harvard Medical School

MedicalResearch.com: What is the background for this study?

Response:The idea that rheumatoid arthritis (RA), an autoimmune disease that leads to chronic joint inflammation and destruction, may be initiated by a bacterial infection is not novel, but has been posited for more than a century. Based on the clinical observation that patients with RA frequently have severe periodontal disease (gum disease), gum inflammation has long been thought to contribute to disease development in RA. However, limited understanding of the mechanisms that fuel and sustain the autoimmune attack in RA made it difficult to pinpoint a specific bacterial trigger.

In recent years, our understanding of the abnormal immune response that attacks the joints in patients with RA has grown exponentially, and we now know that disease-specific autoantibodies (ACPAs) target modified self-proteins (this modification is known as citrullination). It is this abnormal immune response against citrullinated proteins that appears to drive the joint (and sometimes lung) inflammation seen in rheumatoid arthritis. Recent studies from our laboratory at The Johns Hopkins University (led by principle investigator Felipe Andrade, MD, PhD) suggested that an immune cell called the neutrophil, which normally protects us from infection at sites like the oral cavity or anywhere else in the body, also appears to be the source of the proteins attacked in RA. We were therefore interested to understand what drives the association of gum disease, an inflammation commonly triggered by bacteria, with RA.

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Dental Occlusion Affects Standing Balance in Unstable Conditions

MedicalResearch.com Interview with:
Sonia Julià-Sánchez, Ph.D
.
Departament de Fisiologia i Immunologia
Universitat de Barcelona

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Contradictory results are still reported on the influence of dental occlusion on the balance control. While most literature have evaluated this relationship in static conditions with inconclusive results, the topic is still a matter of debate. However, less research has focused on the correlation of dental occlusion and balance control in unstable surfaces, even though the higher sensitivity of the unstable platforms to examine individual responses to translational and angular perturbations.

Moreover, when we talk about the influence of dental occlusion on the body balance, the study of the specific malocclusal traits influencing balance control should be of extremely importance to apply the proper treatment.

Our study was focused on the influence of dental occlusion and specific malocclusal traits on the body balance control at extreme levels of stability. We found that body balance was significantly influenced by dental occlusion in unstable conditions.
Moreover, specific occlusal traits significantly influencing postural control were: Angle Class, crowding, midline deviation, crossbite, anterior open bite and overjet.

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Regular Dental Check Ups Linked To Lower Risk of Pneumonia

MedicalResearch.com Interview with:
Michelle E. Doll, M.D., M.P.H.

Assistant Professor
Associate Hospital Epidemiologist
Department of Internal Medicine
Division of Infectious Diseases
North Hospital
Richmond, VA 23298-0019

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: There are many studies that show that poor oral health is associated with systemic conditions including bacterial pneumonias. Many find this link surprising, but considering that the airways are a direct conduit between the oral cavity and the lungs, saliva containing oral bacteria is able to track down into the lungs via aspiration. Previous studies have found that good oral health seems to prevent pneumonias in people susceptible to lung infections, possibly because the types and quantities of bacteria residing in the mouth are different in people with healthy versus unhealthy teeth.

In my infectious disease clinical practice, I am often frustrated by my inability to assist patients with dental problems. Many of my patients are immunosuppressed, and when they have tooth decay for which they are unable to get timely dental care, I worry about consequences of untreated dental disease; lack of access to dental care is common in the United States. For these reasons, we decided to use data from the Medical Expenditure Panel Survey (MEPS) to determine whether dental care is preventive for bacterial pneumonia. The MEPS database is a large, nationwide survey administered by the Agency for Healthcare Research and Quality (AHRQ), with comprehensive insurance data including dental insurance and access. We found that those who never see the dentist were 86% more likely to get pneumonia in a year, compared to those who visit the dentist for routine check-ups twice a year or more. Furthermore, even those who visit the dentist less than once yearly were at smaller but still significantly increased risk of pneumonia compared to those who see the dentist more frequently.

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Community Dental Program May Reduce Emergency Dental Admissions

MedicalResearch.com Interview with:
Jonathon P. Leider, PhD
Department of Health Policy and Management
Johns Hopkins University
Baltimore, MD

MedicalResearch.com: What is the background for this study?

Response: The increasing utilization of Emergency Departments (ED) for the treatment of non-urgent and non-traumatic dental conditions among adults in the United States is an increasing policy issue. Research shows that seeking dental care in an ED is often more expensive and less effective when compared to a traditional dental office. Seeking care in the ED for non-traumatic dental conditions is more frequent among low income individuals and people in rural areas, who must often overcome insufficient dental coverage and access to receive office-based care.

Under the Affordable Care Act, there has been considerable expansion in state Medicaid dental coverage for adults. However, not all states are participating in the expansion or extension of dental benefits and dental professional shortage areas are fairly common– over 4,900 exist in the United States. Innovative programs are needed to effectively address the challenges low income individuals in rural areas encounter accessing care. Our study examined the expansion of a Community Dental Program (CDP) in rural Western Maryland and its impact on dental-related visits at a regional ED.

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Dental Occlusion Can Influence Standing Balance

MedicalResearch.com Interview with:
Sonia Julià-Sánchez, PhD
Universitat de Barcelona

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Over the last few years, a growing interest has focused on the potential correlation between the stomatognathic system and the body balance. While this relationship is still a subject for debate, it is well known that sensory information contributes differently on the postural control regulation depending on the conditions of the surface area. Therefore, we hypothesized that dental occlusion may contribute differently on the body balance control depending on the stability condition (stable versus unstable) and that influence might be more evident in fatigue conditions due to reorganization of the sensory information sources.

In the current study we aimed to determine whether:

(i) dental occlusion influences body balance in stable and unstable surfaces, and

(ii) the influence of dental occlusion on the balance control comes strongly into effect under fatigue conditions.

Our results showed that dental occlusion influenced balance control, at unstable level, both at rest and fatigue condition. However, when measuring at stable level, the influence of dental occlusion only reached significance in fatigue condition.

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