Sarah Handzel, BSN, RN

Even though periodontitis is a fairly common problem, it’s largely preventable. Usually resulting from poor oral hygiene, it can cause damage to the gingiva and underlying bone that support teeth. While dentists in the past were largely concerned with preventing this common gum disease for the sake of a patient’s oral health, there’s now more reason to be concerned. Two new studies appear to strengthen the case that there’s a link between periodontitis and heart disease.

 examined 508 Finnish patients with an average age of 62 years. All participating patients were experiencing cardiac symptoms at the time of the study. Upon examination of coronary arteries by angiography, 36% of the study patients were suffering from stable coronary artery disease — they had an established, regular pattern of chest pain, a history of heart attack, or coronary plaques that had been previously discovered. One-third (33%) of the patients had acute coronary syndrome, an umbrella diagnosis that describes many situations where blood flow to the heart is blocked. Finally, 31% of participants did not have any significant degree of coronary artery disease. 

In addition to the angiography, all patients participating in the study also had their teeth examined. It was found that as many as 58% of the patients had one or more inflammatory oral lesions. Also, researchers discovered that many patients had dental root tip infections, which are commonly detected by accident on X-ray and are correlated with a high level of serum antibodies related to the infectious bacteria. This finding suggested that oral infections can affect other parts of the body, such as the heart.

, more than 60,000 patient records were reviewed to examine the link between chronic gum disease and heart disease. Each patient was at least 35 years old. The results of the study were clear: patients with periodontitis were twice as likely to also have heart disease or other coronary symptoms. 4.7% of patients with periodontitis were also reported to have atherosclerotic cardiovascular disease, compared to only 1.9% of patients without periodontitis. 

Other factors influencing heart disease were also taken into account. Even accounting for comorbidities like hypertension, high cholesterol, diabetes, and smoking, researchers found that patients with periodontal disease were still 59% more likely to have a history of heart-related issues. The researchers in the second study hypothesized that gum disease might develop first and could promote heart disease through bacterial infection in the cardiovascular system. 

Articles

A pair of new studies appear to bolster the case that periodontitis and heart disease are connected.

New Studies Strengthen Link Between Chronic Gum Disease and Cardiovascular Disease

A new, free mobile app has been released to help improve patients’ healthcare insurance literacy in the State of Connecticut. The company releasing the app, 

, says their goal is to provide more transparency in both dental and medical costs, and to increase Connecticut residents’ engagement in their own healthcare. 

FAIR Health is a non-profit corporation that aims to boost patient understanding of the costs associated with healthcare.

 allows users to estimate the region-specific costs of dental and medical services to make better informed decisions on where they choose to receive healthcare services. Patients are able to use the app regardless of whether they have dental or medical insurance, and it’s available for use in both English and Spanish. In addition to Connecticut, patients are able to look up estimated costs of office visits and procedures in New York, Massachusetts, and Rhode Island. 

FAIR Health gathers their estimated costs based on a database of over 21 billion claims for privately billed dental and medical procedures going back to the year 2002. The company receives its data from insurance payers that collectively insure more than 150 million consumers in the state’s private healthcare system. 

In addition to price estimates for dental work and other medical procedures and office visits, FAIR Health provides consumers with glossaries of common healthcare terms that often appear on healthcare documents and bills. Healthcare resources, such as provider locator services and assistance for filing insurance appeals are also available through the company’s website. Educational articles on topics ranging from the fundamentals of insurance coverage to healthcare issues specific to Connecticut are also available at no cost. 

The creation of the app was funded by the Connecticut Heath Foundation (CT Health), the state’s largest health philanthropic organization. FAIR Health is promoting its use through community-based organizations, health centers and health exchange navigators. There are also plans to develop targeted partnerships with Hispanic community organizations.

As Tiffany Donelson, Vice President of Program at CT Health, noted

, “having access to basic health information and pricing data is absolutely critical to advancing health equity in Connecticut. Now more than ever, it is essential to equip consumers with cost and other educational health resources so that they can make better healthcare decisions.” 

A new mobile phone app by a Connecticut nonprofit uses more than a decade of billing data to give consumers an idea of potential treatment costs.

New App Aims to Bring Price Transparency to Medical, Dental Procedures

Plaque, otherwise known as dental biofilm, is usually made up of an extracellular matrix that encapsulates bacteria in a protective barrier, making it difficult to remove the bacteria effectively. The bacteria in the biofilm can create highly acidic microenvironments, leading to the acid-dissolution of enamel on teeth. Now, a new method of targeting these bacteria could help to reduce the onset and severity of tooth decay.

It’s a novel approach to fighting decay. Researchers at Penn Dental Medicine decided to forgo applying an antimicrobial treatment in favor of using 

. Unfortunately, current antimicrobial agents are not able to penetrate the dental biofilm itself, and therefore cannot kill the bacteria that are contained inside. 

The new strategy to fight tooth decay is an extension of earlier findings, which showed that nanoparticles could possess enzyme-like properties that are dependent on surrounding pH levels. The earlier research showed that, at a neutral or near-neutral pH, nanoparticles had no catalytic activity at all. However, when the pH became acidic, the nanoparticles became very active and could quickly produce free radicals.

, researchers used the enzyme-like properties of pH-sensitive, iron-containing nanoparticles to jump-start the activity of hydrogen peroxide, itself a natural antiseptic. When hydrogen peroxide was activated by the nanoparticles, it produced free radicals. Scientists first studied the effects of the free radicals in in vitro applications and later moved on to animal studies. 

The animal studies were performed using rats, an animal that can develop the same kind of tooth decay observed in humans when infected with the bacterium Streptococcus mutans. Nanoparticles and hydrogen peroxide were both applied to the rat’s teeth for one minute, twice daily. The experiment was performed over the course of three weeks.  

Using the animal model, scientists were able to show that the free radicals produced by activated hydrogen peroxide broke down the dental biofilm and killed the bacteria contained inside it. This significantly reduced the amount of plaque present and prevented further tooth decay. There were also no adverse effects observed in the oral soft tissues of any of the rats.

The study’s senior author, Hyun (Michel) Koo, DDS, MS, PhD, said that “adding nanoparticles increased the efficiency of bacterial killing more than 5,000-fold”, according to the same study published in Biomaterials. Koo also said that “it’s very promising…the efficacy and toxicity need to be validated in clinical studies, but I think the potential is there.”

A study out of the University of Pennsylvania looked at whether nanoparticles could penetrate the dental biofilm surrounding bacteria.

Study Suggests Nanoparticles Could Prevent Tooth Decay

We see them every day: people using smartphones to take “selfies” they can share with their social networks. But instead of taking these pictures to show off a new haircut or capture a visit to their favorite vacation spot, what if people used selfies to evaluate their own dental care techniques? In a small 

, researchers in India used smartphone video selfies to see if tooth brushing techniques could be improved in a volunteer patient population.

Tooth brushing is the most widely used form of oral hygiene. Since tooth brushing techniques are usually taught from a very early age, any problems people have with their brushing methods can be hard to correct. Even if patients are re-educated on technique during visits to their dentist, it’s likely that they will fall back into the same poor patterns of tooth brushing once they’re home.

Since almost everyone has a smartphone now, researchers wanted to study whether they could be used to help patients identify and correct improper tooth brushing techniques once they were away from their dentists. Four dental student intern volunteers were chosen to participate in the study. Each volunteer was trained to use their own smartphone to capture video selfies while brushing their teeth, making sure to include in the video their brushing hand, mouth, toothbrush, and toothbrush bristles. Participants were asked to record their entire tooth brushing routine as they’d regularly perform it.

At the start of the study, one baseline video selfies was recorded for each patient on-site at the research facility. For each study volunteer, a total of five videos were analyzed. The research team noted a modest increase in the accuracy of tooth brush strokes for each volunteer, and there was an increase in the number of strokes overall. However, the length of time that each person spent brushing their teeth did not increase at all.

Since the effectiveness of tooth brushing has previously only been measured by patients’ self-reported behavior, indirect measures such as tooth wear, and clinical outcomes, the study researchers hope that new approaches to dental care — like selfie videos – could be used by dentists to promote more active patient participation in their own oral health care.

Using selfie videos to actively involve patients could increase patient motivation to do a good job brushing and might help patients stick with new tooth brushing techniques their dentists recommend. Patients might also be more aware of the techniques they’re using and choose to correct those techniques after viewing the videos of themselves. The study researchers hope that dental selfies could be used as a tool to help dentists reinforce proper tooth brushing methods and while also evaluating improvements provided to patients.

A small study in India looked at whether the camera feature on smartphones could be used to help people improve their tooth-brushing technique.

'Selfies' May Help Patients Improve Their Oral Health Care Techniques

The Internal Revenue Service (IRS) has filed for a 

 to the Affordable Care Act (ACA) that would help expand dental coverage to millions of pediatric patients by helping to reduce the financial challenges their families face when purchasing dental coverage. Currently, the ACA offers both healthcare and dental plans separately through some exchanges, allowing families to purchase one type of plan without also purchasing the other.

Only about one-third of presently offered healthcare plans also include dental coverage for children. As a part of the passage of the ACA in 2010, pediatric dental coverage was listed among 10 “essential healthcare benefits” all Americans are entitled to receive when purchasing a healthcare plan.

Since dental benefits are typically sold separately from other healthcare benefits, many families have to deal with the financial burden of purchasing stand-alone dental plans that usually don’t benefit from any kind of tax credit. Under the existing law, qualified health plans that don’t offer any kind of pediatric dental benefit are usually cheaper than plans that do. The existing tax credits typically don’t offset the cost of purchasing separate, stand-alone dental coverage for children, and many families choose to forgo this coverage because of the expense.

In the proposed rule change, the IRS would adjust how tax credits are actually calculated to help more of the credits apply to stand-alone pediatric dental plans. The new rule would take effect in 2019 — families who purchase both a health plan that doesn’t include pediatric dental coverage 

 a stand-alone dental plan for their children would be eligible for a tax credit based on the premiums paid for both the health plan and the stand-alone dental plan. 

Several groups have been lobbying for such a tax rule change since 2012, when information outlining the calculations of tax credits was made publicly available. The United States Treasury was petitioned in 2013 by the American Dental Association, the National Association of Dental Plans, the Delta Dental Plans Association and the Children’s Dental Health Project to help make coverage more affordable. According to their 

 sent in September 2013, changing the tax credit on purchase of stand-alone dental plans would help to “provide oral health services to vulnerable children who need them” by helping to “act as an incentive to purchase coverage.”

By changing the tax rule, the IRS could help to remove some of the financial difficulty families face when purchasing dental coverage for their children. No matter how pediatric dental plans are purchased, families could get the maximum amount of tax credits to which they are entitled.

The Internal Revenue Service wants to create a tax incentive to help families purchase dental coverage.

IRS Tax Credit Proposal Could Make Dental Care More Affordable for Children

A lot of people are scared of going to the dentist, but for one group of patients, this fear can negatively affect their oral health for years to come. Children are usually most scared of the dentist, and this fear is often reinforced by their own adult family members who are also wary of receiving dental care.

Pediatric dentists know that children’s dental phobias can often lead to disruptive behavior during visits, impacting the quality of care received. In fact, many dental practices use television in examination rooms as a way to distract patients from procedures that are taking place. In a new 

, researchers sought to measure the effectiveness of audiovisual (AV) distraction during pediatric dental procedures to see whether such distraction influenced patient anxiety and fear.

In the study, 56 children, all between 7 and 9 years old, were separated into two groups. One group wore special eyeglasses displaying cartoons as an AV distraction. A control group received treatment with no distractions. Each patient received three dental treatments, and the amount of time for each treatment was 30 minutes or less.

To measure each child’s stress response during the visit, a combination of measures was utilized. First, children were asked to pick out a facial expression on a facial expression scale (FIS) that best matched the way they felt about being at the dentist. Next, providers were asked to rate the children’s cooperation during treatment on a scale of 0 to 5: 0 being most relaxed and 5 being completely out of control. Finally, all patients had multiple vital sign readings, specifically blood pressure and pulse rate, taken at intervals during the procedures. The readings were then averaged to generate a mean value for each visit.

When researchers analyzed the results of the study, they found that children in the group exposed to AV distraction were much less anxious and were more cooperative during procedures compared to children who had no distraction.

Vital sign results also demonstrated that children exposed to AV distraction had a reduction in clinical anxiety during injection with local anesthetics. There was significant elevation in pulse rate in the control group of children during anesthetic injections compared to the AV distraction group, who did not show pulse rate elevations both during and after any dental treatments. For both groups, there were no significant changes in blood pressure throughout any procedures.

While further research is necessary, this study indicates that AV distraction in children undergoing dental procedures seems to be an effective method of reducing anxiety and increasing cooperative behavior during treatment. There also seems to be evidence that AV distraction could be correlated with a more positive response after injection with local anesthetic. To reduce fear and anxiety during dental treatment, AV distraction seems to be a useful tool.

Many dentists use videos or other audiovisual entertainment in hopes of calming pediatric patients during procedures. A new study aimed to figure out whether such techniques actually work.

New Study Measures Audiovisual Distraction During Pediatric Dental Procedures

You might be seeing more patients in your practice who’ve ditched traditional cigarettes in favor of electronic cigarettes (e-cigarettes). Companies making e-cigarettes have touted them as less harmful than other forms of tobacco, and some argue that e-cigarettes can actually help smokers quit smoking. But recent research is showing these devices might not be as safe as people think.

E-cigarettes are made up of a battery-powered heating element that vaporizes a liquid containing nicotine, propylene glycol or glycerin and flavorings. The user then inhales this vaporized liquid through the device.

It’s no secret that experts can’t agree on whether e-cigarettes do more harm than good. The debate continues in part because public health agencies around the world have promoted these products as a healthier way of consuming tobacco than traditional cigarettes. In fact, one independent review board in the United Kingdom determined that e-cigarettes were around 

It should be noted that e-cigarettes are also viewed as an alternative product to help consumers stop smoking traditional cigarettes, but the FDA has not approved them for this use.

A recent study from the University of California suggests that the long-term health effects that come from using these products are anything but harmless. In 

 performed by Diana Messadi, DDS, and her colleagues tested the aerosols in e-cigarettes and their effects on normal human oral keratinocytes. They compared the results observed in cells exposed to aerosols with cells that were not exposed.

The results were clear. Significantly fewer cells exposed to aerosols from e-cigarettes were viable compared to cells that were not exposed. The researchers also observed that in exposed cells, intracellular glutathione levels were decreased — this molecule helps to protect cells from oxidative stress that may cause cancer in traditional tobacco smokers. Also, the aerosolized cells expressed higher levels of heme oxygenase, an enzyme that might be associated with the inflammatory response. The findings seem to indicate that using e-cigarettes may increase the risk for periodontal disease and cancer.

Researchers involved in the study plan to test their results in animal studies, and other scientists at the University of Minnesota are performing similar studies with similar results. Messadi cautioned clinicians to educate their patients on the potential harmful effects of using e-cigarettes, just as they would caution them against smoking tobacco. She recommends discouraging young adults form ever starting to use these products, and says if adults are using these devices to stop smoking traditional cigarettes, they should only use e-cigarettes for a brief period of time.

E-cigarettes are becoming a popular trend as many believe them to be a safer alternative to smoking. But recent research calls that into question.

Long-Term Effects of E-Cigarettes Unclear

A North Carolina oral surgeon has lost his dental license after state regulators say he routinely over-booked his surgery schedule, leaving little or no time to properly evaluate patients before procedures or ensure procedures were completed in accordance with patient safety standards. Such practices ultimately contributed to the death of a tooth extraction patient in 2010, the state dental board said.

John S. Won, DDS, MD, an oral surgeon working at a clinic in Cary, NC, had his dental license revoked by the North Carolina State Board of Dental Examiners in late July after the board found him guilty of misconduct and acting unethically in the treatment of an unidentified male patient who died after having teeth pulled. The patient saw Won in February 2010 and died within 48 hours after having the surgical procedure as a result of cardiac arrest secondary to hemorrhagic shock.

, the patient was scheduled for tooth extraction at 10 a.m. Before seeing the patient in question, Won had no fewer than nine surgeries scheduled on other patients. The board also found that, between the patient’s appointment at 10 a.m. and noon the same day, Won was booked for several patient consultations and six other oral surgeries.

Information from the clinic’s anesthesia and treatment records showed that Won had only five minutes at most before finishing the surgery prior to the patient’s appointment at 10 a.m. and the start of the patient’s tooth extraction procedure. Further, the board found that Won failed to adequately assess any of his patients before the start of any procedures, including the patient in question. The board said treatment records for multiple patients were identical—records were not completed or changed to reflect individual patients’ circumstances, including the record of the patient that died.

Won was also found to have scheduled his practice differently for patients, depending on if they had private insurance or Medicaid. Office staff were apparently instructed to book all five of the time slots per hour for every hour of the day the practice was open, but only on days that Won was seeing Medicaid patients. Also, almost none of the Medicaid patients were assessed, consulted, or examined prior to their procedures.

In addition, the dental board found that the clinic fraudulently billed Medicaid for surgeries, oral evaluations, CT scans, and other procedures that were not performed, as well as for medications that were never administered. 

The News & Observer reported that Won’s attorney has said

 Won has already reimbursed the government for approximately half of the overbillings. 

The dental board stated that Won “was negligent in the practice of dentistry…(and) committed acts constituting malpractice in the practice of dentistry.” The board’s findings noted that Dr. Won’s “misconduct involved such serious, numerous violations of the Dental Practice Act and the rule of ethics governing professionals that revocation is the only discipline sufficient to protect the public.”  

Officials say a North Carolina dentist over-scheduled his practice to such an extent that he had little time to evaluate patients before or after oral surgeries.