Sarah Handzel, BSN, RN

Periodontal disease has had many mentions in the news recently due to its links to other, more chronic diseases like heart disease and Alzheimer’s. Now, researchers at Columbia University College of Dental Medicine (CDM) have identified 41 master regulator genes that may be responsible for the development of this common dental problem.

 at CDM was the first of its kind. Dental researchers used genome-wide reverse engineering to identify specific genetic pathways that lead to periodontitis. In genetic studies up until this point, scientists have only been able to identify genes that are commonly expressed in either healthy or diseased tissue. However, such studies can’t pinpoint a causal relationship between genes and the disease being studied. Further, many genes that affect large numbers of pathways in the development of the disease are often missed.

The dental researchers were able to use an algorithm previously used for the reconstruction of accurate cellular networks to analyze large gene expression profile data sets. The data sets were obtained from healthy individuals and patients that already had a diagnosis of periodontitis. The researchers specifically focused on RNA from tissue samples referenced in the data sets.

Analysis of the data sets identified the 41 master regulator genes, which all activated or were a part of pathways regulating immune response signaling processes. These findings confirmed laboratory and clinical observations of the development of periodontal disease.

Panos N. Papapanou, DDS, PhD, who is a professor and Chair of Oral, Diagnostic, and Rehabilitation Sciences at CDM said in a 

 that “this allows us to focus on the handful of genes that represent the most important players in the process rather than the whole transcriptome."

Since these 41 master regulator genes have been identified, it’s now up to researchers to develop and test medications and compounds that disrupt their action, thereby developing treatment options to stop periodontitis at its source. Treatment is vitally important before or in the early stages of the disease, before teeth are lost and supporting bone is also destroyed.

As Papapanou says, "Now it's important to do the downstream work of validating these master regulators in the lab before we can test these genes in experimental models."

Articles

Researchers at Columbia University College of Dental Medicine (CDM) have identified 41 master regulator genes that may be responsible for the development of periodontal disease.

Periodontal Disease Genes Identified

Time and again, smoking has been condemned as one of the worst habits a person can have. As a dentist, you might have had numerous conversations with your patients about the risks of smoking and the damage it causes not only to the lungs, but also to the mouth and teeth. Now, there’s new information you can put in your anti-smoking arsenal.

, researchers have actually identified smoking’s effects within the body and how those effects are related to increased inflammation. The research has been able to show that nicotine, the addictive ingredient in both traditional cigarettes and newer e-cigarettes, causes an inflammatory response in the body by activating certain white bloods cells called neutrophils.

Once activated, neutrophils release specific cellular signals that begin to regulate the body’s immune response. In the early part of the immune response, inflammation occurs. In this study, researchers used isolated neutrophils from humans and mice. They stimulated the neutrophils in order to measure dose-dependent releases of certain inflammatory molecules. Ultimately, the researchers were able to identify essential receptor and signaling pathways that have been shown to be involved in the nicotine-mediated activation of the neutrophils.

As E. John Wherry, PhD and Deputy Editor of the 

 said in a statement, “The cancer-causing effects of smoking have been known for decades, but how smoking is related to immune changes has been less clear. Because of the direct link between nicotine itself and inflammation, this study has important implications including that alternative forms of nicotine inhalation, such as vaping that lacks other chemicals from cigarette smoke, may nonetheless still have detrimental immunological effects.”

, several companies have portrayed e-cigarettes as a safer, less addictive way for people to smoke, with some going so far as to say that these products can actually help people stop smoking altogether. Patient education is critically important regarding these products, and this new research, together with previous studies related to e-cigarettes, is one more tool you can use to have open, honest conversations in your practice about the risks of using nicotine and nicotine-related products.

Researchers have identified how smoking leads to an immune response and increased inflammation.

Link Between Smoking and Inflammation Identified

Caries continue to be one of the most prevalent dental health issues in adults and children worldwide. Part of the problem with this common oral malady is the difficulty of making the initial diagnosis, which currently relies on one of two diagnostic methods: simple visual inspection by a dentist, or x-ray imaging. 

Both current methods of diagnosis are flawed. Dentists usually are unable to see caries until they are advanced. X-rays cannot be used to detect early occlusal caries on the biting surface of the tooth.

Now, a new tool is being developed to help dentists identify and diagnose dental caries much earlier than usual. Scientists in the department of mechanical engineering at York University in Toronto are 

working to further develop an imaging system

 that incorporates intensity-modulated laser light together with a low-cost, long-wavelength infrared camera. Put simply, the imaging system detects small amounts of thermal infrared radiation that is given off from dental caries after exposure to a light source.

The new tool, known as a thermophotonic lock-in imaging (TPLI) tool, would allow dentists to detect developing caries much earlier than traditional diagnostic methods allow for.

While not in clinical practice at the present time, test results involving the TPLI tool are encouraging. The effectiveness of the imaging system has already been demonstrated in an 

 comparing its accuracy to that of a trained dental practitioner. The scientists working to develop the system artificially induced early demineralization on an extracted human molar by submerging it in an acid solution. The molar was held in the solution for 2, 4, 6, 8, and 10 days at a time. A TPLI image of the tooth was taken after two days, and there was clear evidence of a dental lesion in the tooth. However, a dental practitioner was unable to spot the lesion visually, even after the tooth had been submerged in the acid solution for 10 days.

The scientists involved with further development of the imaging system say that it is very suitable for integration into clinical practice. In addition to being low cost, the tool is also low weight, making it easy for trained dentists to use. It is also a non-invasive, non-contact apparatus, giving it great potential to become a commercially viable part of the dental industry in years to come.

A new tool is being developed to help dentists identify and diagnose dental caries much earlier than usual.

Dentists Could Use New Imaging Method to Detect Cavities Earlier

The American Dental Association (ADA) has again endorsed CareCredit as a recommended patient financing option for members of the ADA. The new endorsement agreement spans the next 7 years.

Endorsements are managed through the ADA Business Resources program. CareCredit, a health, wellness, and personal care credit card, was previously endorsed as a recommended product for ADA member dentists since 2001. The new agreement was put in place to continue to help patients and their families manage the out-of-pocket expenses that so commonly occur with dental treatments and procedures.

, the magnitude of out-of-pocket expenses can make the difference between a patient receiving or forgoing dental treatment. A study performed by CareCredit showed that 67% of dental patients research how much a procedure will cost, and other financing options, while only 58% of patients research the actual proposed procedure or treatment. According to the same study, almost half of patients, 49%, were likely to apply for or use the CareCredit credit card if the option was available and if the procedure or treatment was estimated to cost at least $1000.

CareCredit provides credit services to patients seeking assistance with healthcare expenses. The credit card is accepted at more than 200,000 healthcare providers and retailers nationwide. In order for CareCredit to have received the ADA Business Resources endorsement, 5 criteria must have been met by the company:

·         They must solve a proven ADA member need

·         They must be an industry leader

·         They must hold a higher customer service standard than other companies in the industry

·         They must offer ADA members preferred pricing options

·         The company must support the ADA’s mission and goals

The endorsement signifies the long-term relationship between ADA Business Resources and CareCredit. The goal of the relationship has always been to bring more financing options to dental patients.

Dr. James E. Mercer, Chairman of the Board of Directors for ADA Business Resources notes that “for over 15 years, CareCredit has continuously served our members with extraordinary customer service, a product that helps to further treatment acceptance and a deep, long-term involvement in our community.”

In response, Doug Hammond, Senior Vice President and General Manager of CareCredit said “we are honored to have had the privilege to serve ADA members for over 15 years. Research shows that dental patients want and need financing options, and it is our ongoing commitment to assist members and their teams by helping patients access care.”

The American Dental Association (ADA) has again endorsed CareCredit as a recommended patient financing option for members of the ADA.

ADA Re-Endorses CareCredit as Patient Financing Option

To combat exponentially rising rates of tooth decay, obesity, and diabetes, the World Health Organization (WHO) is urging governments across the world to consider placing heavier taxes on sugary drinks like soda.

According to statements from Dr. Douglas Bettcher in a 

 provided by the WHO, the “consumption of free sugars, including products like sugary drinks, is a major factor in the global increase of people suffering from obesity and diabetes.” Free sugars refer to monosaccharides like glucose and fructose. The term also refers to disaccharides, like table sugar, that are added to foods and drinks. They also include natural sugars like those present in honey and fruit juices.

Worldwide, rates of obesity have more than doubled since 1980—in 2014, more than 600 million adults globally were classified as obese. The WHO defines obesity as a body mass index (BMI) of greater than or equal to 30, while overweight is defined as a BMI of 25 or greater. According to a WHO 

 on obesity, most of the world’s population live in countries where being overweight or obese was more likely to be a cause of death than being underweight. Also, the WHO noted that 41 million children under 5 years old were overweight or obese in 2014.

Previous information published by the WHO states that sugar is not a necessary part of anyone’s diet. The WHO recommends that free sugar intake should be kept below 10% of a person’s total daily energy needs. Consumption should be reduced to less than 5% for additional health benefits.

The news release notes that a 20% increase in the retail price of sugary drinks, accomplished through increased taxation, would result in dramatically reduced consumption of these types of products. The WHO says that countries should use increased taxation to target foods and drinks that have healthier alternatives.

Some countries have already taken action against unhealthy foods and drinks. For example, Mexico has already implemented a tax on non-alcoholic drinks that contain added sugar, and Hungary has implemented a tax on prepackaged products containing high levels of sugar, caffeine, or salt. Several other countries have already announced plans to increase taxation on sugary drinks, including South Africa, the Philippines, Great Britain, and Northern Ireland. 

WHO Urges Higher Global Taxes on Sugary Drinks

As many as 38 million Americans suffer from migraine headaches, and there’s new evidence that the bacteria in these people’s mouths may be a contributing factor to their headaches. A research team at 

the University of California San Diego School of Medicine

 that many people with migraines, which might be a significant number of your patients, have many more microbes in their mouths that can actually modify nitrates.

Nitrates trigger headaches for many people. These compounds are commonly found in drugs, like cardiac medications, and in a variety of foods including processed meats and green, leafy vegetables. The microbes in the mouth modify these nitrates into nitrites, which then circulate in the blood and, during circulation, can be converted into nitric oxide under a specific set of circumstances. Nitric oxide helps cardiovascular symptoms by reducing blood pressure and improving blood flow, but severe headaches are often reported as a side effect of this process.

The research team knew that certain foods were said to trigger migraines, and hypothesized that there was a link between the food, the microbiomes of the affected patients’ mouths, and the patients’ individual experiences with migraines.

Their study used data made available from the 

. The team was able to gene sequence bacteria collected from 172 oral samples. Bacteria for the study was also sequenced from 1,996 fecal samples provided by healthy study participants. All participants in the study were asked, prior to beginning, whether they suffered from migraines.

After sequencing the bacterial genes, the team noted that certain types of bacteria were found in different quantities in people who suffered from migraines and those that did not. In the fecal samples, the researchers found slightly more genes that encode nitrate, nitrite and nitric oxide-related enzymes present in people who developed migraines. Also, the same genes were more plentiful in people who suffer from migraines in the oral bacterial samples.

At this point, it is still unclear whether these oral bacteria are the actual cause of migraines, or if they are somehow the result of those types of headaches. They could be indirectly linked in a way not yet understood by scientists. The research team plans to next investigate more defined groups of patients which will be separated into distinct groups by the type of migraine each patient experiences. Then, it might be easier to determine how exactly oral microbes correlate to a patient’s experience with migraines.

There is new evidence that the bacteria in the mouths of migraine sufferers may be a contributing factor to their headaches.

Bacteria in Your Patient's Mouth Could Be Causing Their Migraines

Dental occlusion, the contact made between the teeth when closing the mouth, has recently been shown to influence more than just your oral health. Recent research is showing that dental occlusion is also tied to your posture and balance.

Two new studies examined the correlation between posture, balance, and teeth that don’t fit perfectly together. 

According to a news release highlighting both studies

, the results show conclusively that posture control is improved when different malocclusions are corrected by positioning the jaw in a neutral position.

Researchers believe that there may be a neurophysiological explanation. A reciprocal relationship between the trigeminal nerve in the face and the vestibular nucleus in the brainstem has already been shown to exist. The nerve and nucleus are responsible for both the masticatory function of the jaw and balance control. This would explain why dental malocclusions negatively influence posture and balance.

The first of the two studies examined the type of dental occlusion and whether the patient had received any previous dental or orthodontic treatments. The results of this study showed that alterations in alignment of the teeth were related to poorer control of static balance.

The second study again examined the type of dental occlusion but also looked at posture control and physical fatigue to try to analyze a relationship among these factors. The researcher’s analysis indicated that balance improved in patients when their malocclusions were corrected. It was also noted that correction of malocclusions had a greater impact on posture and balance when the patients were fatigued verses when they were well rested.

The relationship between dental malocclusion and posture control is not as obvious in everyday life, but the relationship does grow stronger when a patient is fatigued or when other instabilities are factored in. For example, pathologies like obesity, which worsen the body’s instability, significantly decreases postural control independently of dental malocclusion.

The results are especially relevant to those invested in athletic pursuits. According to this research, the correlation between malocclusion and posture and balance can have a dramatic impact on performance. Just as better posture and balance increases performance in athletic individuals, it’s also important in reducing the number of injuries that can occur, like sprains, strains, and fractures. These types of injuries are usually the result of unexpected instability of posture, due in part to increases in fatigue and a decreased motor control capacity.

Recent research is showing that dental occlusion is also tied to your posture and balance.

New Research Shows Relationship Between a Bad Bite and Poor Posture

According to psychology researchers at West Virginia University, there’s an actual genetic basis for the fear of receiving dental treatment, a common concern among many people. Since fear of going to the dentist is a prevalent problem preventing large numbers of people from seeking dental care when they need it, the researchers hope that this new information about the possible causes of that fear can be used to develop new interventions to reduce patient distress and anxiety.

 used a novel approach to gathering information from a large, family-based cohort of study participants. Participants ranged from 11 — 74 years old. The research team initially hypothesized that dental fear was due, in part, to genetic influences inherited from family members. Both heritability and genetic relationships to dental fear were estimated using likelihood-based methods.

Different measures of dental fear and fear of pain were identified, since the fear of pain is often a predictor and critical component of dental fear. Assessment of the heritability of dental fear and fear of pain was a part of the attempt to explain the role genetics play in both situations.

It was shown that dental fear was 30% heritable, while fear of pain was 34% heritable. It was also shown that there was a major correlation between fear of pain and dental fear. This suggests that both fears are genetically related, even though they are likely distinct genetic phenotypes. However, this could provide more insight as to how the fear of pain actually contributes to the development of fear of dental procedures.

Cameron Randall, one of the scientists working on the study, 

 that “the most important conclusion of this study is that our genes may predispose us to be more susceptible to developing dental fear, perhaps through pain-related variables. This information, along with a well-documented understanding of the important role of prior experiences and environment in causing dental fear, may help us develop new ways to treat dental fear and phobia.”

Since a relationship between dental fear and anxiety and the fear of pain were shown to exist, it’s now hoped that these conclusions can pave the way for future studies. It’s important to continue to examine these genetic factors as influencers of patients’ oral and overall health since dental-care related fear is common and can cause delays in treatment or avoidance of treatment altogether.

According to psychology researchers at West Virginia University, there's an actual genetic basis for the fear of receiving dental treatment, a common concern among many people.

Genes Might Be to Blame for Fear of the Dentist

traditional dental amalgam can increase mercury levels

 in the body, Professor Robert Hill of the Institute of Dentistry at Queen Mary University of London has presented the 

 examining a new type of dental filling that can be used to repair tooth decay.

The new data could be the first step toward permanent tooth restorative materials. The findings involve a new filling material composed of bioactive glass composite. This new material interacts with the body and provides minerals that replace those that are lost in the process of tooth decay. The bioactive glass composite actually releases fluoride, calcium and phosphate to the tooth into which they are placed, providing minerals necessary for repair.

Current dental amalgam fillings contain inert materials that do not help repair the actual tooth decay once they are inserted. The new bioactive glass composite does so while also filling in the cavity within the tooth, preventing any new decay from forming. Researchers hope that this new material will reduce the need for mercury-based amalgams, especially after recent research has placed tremendous pressure to do so on the dental industry.

As Hill explained, “not only did this bioactive glass composite remineralize the partially decayed teeth, but it also creates an alkaline environment that discourages the bacteria that caused the initial decay. The new bioactive glass also fills in the gaps with tooth mineral thus preventing the oral bacteria which cause tooth decay from establishing themselves. Research in the US suggests this will potentially prolong the life of fillings and slow secondary tooth decay because the depth of bacterial penetration with bioactive glass fillings was significantly smaller than for inert fillings."

The CEO of BioMin Technologies, Mr. Richard Whatley, said that his company has recently licensed the technology behind the new glass composite. The company’s goal is to take the remineralizing technology, formerly seen only in a type of toothpaste they produce, and develop it into restorative dental products. As he noted, “using this type of bioactive glass composite to fill cavities eliminates the need to use mercury based amalgam by offering aesthetic white fillings which help heal the tooth."

In the United Kingdom, where this research was conducted, over 80% of the population have at least one dental filling. The average number of fillings is seven per person, with eight million cavities being filled with amalgam every year.

Professor Robert Hill of the Institute of Dentistry at Queen Mary University of London has presented the first scientific data examining a new type of dental filling that can be used to actively repair tooth decay.

New Dental Filling Could Replace Traditional Dental Amalgams

, the United States Food and Drug Administration (FDA) has warned consumers to stop using homeopathic teething tablets and gels because they might cause harm to infants and children. According to the FDA, homeopathic teething products have not been evaluated by the agency and are not approved for use based on their safety or efficacy. The FDA is currently not aware of any proven health benefit these types of products provide.

The FDA also warns parents to seek immediate medical attention for their child if the child experiences seizures, difficulty breathing, lethargy, excessive sleepiness, muscle weakness, skin flushing, constipation, difficulty urinating, or agitation after using any homeopathic products.

Currently, the agency is analyzing reports of adverse events submitted to the FDA since a 2010 safety alert was issued regarding homeopathic teething tablets. Some of the reports submitted to the FDA since the initial safety alert include information about seizures in infants and children who were given homeopathic products. The FDA is currently testing product samples and will provide further information about the results of such testing, and any other relevant information, as more information becomes available.

Homeopathic teething tablets and gels are touted as a natural solution providing fast and effective pain relief due to teething. They are designed to be used temporarily to relieve restlessness, irritability, and gingiva redness in children. These products are distributed in several locations, including CVS, Hyland’s, Amazon, and others.

According to Janet Woodcock, M.D. and Director of the FDA’s Center for Drug Evaluation and Research, “Teething can be managed without prescription or over-the-counter remedies. We recommend parents and caregivers not give homeopathic teething tablets and gels to children and seek advice from their health care professional for safe alternatives.”

The FDA advises consumers to dispose of these products immediately. Also, both consumers and healthcare providers are encouraged to report any adverse events or other problems experienced by children after the use of any homeopathic teething tablets or gels. Reports can be made through the 

FDA’s Medwatch Adverse Event Reporting system

The FDA is responsible for regulating the safety and security of America’s food supply, cosmetics, dietary supplements, tobacco products, and any products that give off electronic radiation. The agency also provides for the public’s safety through regulation of human and veterinary medications, vaccines, other biological products, and medical devices.

According to the United States Food and Drug Administration, homeopathic teething products have not been evaluated by the agency and are not approved for use based on their safety or efficacy.