Category Archives: Periodontal health

Gum Disease & ED

Find any list of qualities to cultivate for sex appeal, and you’ll find it includes an attractive smile. People consistently rate it as the most captivating physical feature – more than eyes, hair or even physique.

smileJust because a smile looks good, however, doesn’t necessarily mean it’s healthy. And according to a new study, a particular kind of unhealthy one could be putting a damper on your sex life.

For a while now, we’ve known about the links between periodontal disease and inflammatory conditions such as heart disease, diabetes and stroke. All those are known to be physical causes of erectile dysfunction, and there appears to be a relationship between ED and gum disease, as well.

According to Wiley’s press release on research just published in the Journal of Sexual Medicine,

Turkish researchers compared 80 men aged 30 to 40 with erectile dysfunction with a control group of 82 men without erection problems.

This showed that 53 per cent of the men with erectile dysfunction had inflamed gums compared with 23 per cent in the control group.

When the results were adjusted for other factors, such as age, body mass index, household income and education level, the men with severe periodontal disease were 3.29 times more likely to suffer from erection problems than men with healthy gums.

Smokers, older men and those with systemic illness were excluded from the study, as all are already at elevated risk for both ED and periodontal disease.

As ever, correlation doesn’t equal causation; it only shows that two things occur together. It’s where things stand with the gum disease/heart disease link, as well. We know that they’re often present together; that oral bacteria are often found in the heart; that improving gum health may improve heart health. If you’ve been diagnosed with one condition, it’s worthwhile to get the other checked and do what you can to improve your health.

The good news with gum disease is that, unless severe or advanced, it’s usually reversible through a combination of improved home care and diet, frequent professional cleanings and sometimes surgery. Granted, it takes a time and money, but it’s certainly cheaper than replacing the teeth you’re sure to lose if gum disease goes unchecked.

Consider the results of a study published earlier this year in the Journal of Periodontology. Its authors found that those who had only baseline treatment could replace just 3 teeth with bridgework – or 2 with implants – before they’d be spending more than for a lifetime of perio care.

Those who had no treatment at all could buy 4.

Image by practicalowl, via Flickr

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Fighting Gum Disease with Food

We’ve long known that periodontal (gum) disease is a major problem here in the US, but now a study just published in the Journal of Dental Research puts it into numbers.

And they’re not pretty.

One of every two adults over 30 has some form of gum disease.

Among seniors, it’s about 7 in 10.

Rates are highest for Mexican-Americans, current smokers, those living below the federal poverty line and those with less than a high school education. And more men are affected by it than women (56.4% vs. 38.4%).

According to Dr. Bicuspid’s summary, this data came from the 2009-2010 National Health and Nutrition Examination Survey (NHANES), which for the first time included a full mouth perio exam. Before, only partial mouth exams were done. But “because periodontal disease is not evenly distributed in the mouth, prevalence estimates from surveys…may have underestimated the severity of the disease.”

Consequently, the new findings are considered the most accurate to date.

Of course, one of the things that makes such numbers so troubling is that gum disease, like tooth decay, is almost entirely preventable. Good oral hygiene, of course, is part of it. So is good nutrition. Not only can it help lower your risk; it can help manage or reverse the course of perio disease if it does occur.

Because it inovlves inflammation – a major factor in its link with heart disease, stroke, diabetes and other conditions – a good, broad and basic approach to getting the best of perio problems can be an anti-inflammatory diet such as this one from Dr. Weil.

And there are specific nutrients that offer great help, as well.

For instance, one study published about a year ago in the Journal of Clinical Periodontology confirmed the significant impact of vitamin D, calcium and antioxidants on gum health. Reviewing “the evidence for nutritional exposures in the etiology and therapeutic management of periodontitis” – that is, the cause and treatment of advanced gum disease – the authors concluded that

For prevention and treatment of periodontitis daily nutrition should include sufficient antioxidants, vitamin D, and calcium. Inadequate antioxidant levels may be managed by higher intake of vegetables, berries, and fruits (e.g. kiwi fruit), or by phytonutrient supplementation.

But while supplementation can help, whole, natural foods should be your first and best source of all essential nutrients (along with, in the case of Vitamin D, sunshine). Here are a couple of references to help you make your “perio happy” shopping list:

Image by Dr Parveen Chopra, via Flickr

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HPV, Oral Cancer & Gum Disease

According to the CDC, more than 36,500 new cases of mouth and throat cancer are diagnosed every year. The 5 year survival rate is only about 50%.

But that rate is a whole lot better in cases where the cancer is detected early. That’s why, in my office, oral cancer screening – using VelScope – is included in every adult patient’s exam at least once a year.

A recent paper underscores why this matters.

Published last month in Head & Neck Oncology, the study confirms that

oral sex with multiple partners is one of the significant risk factors for oral cancer and oropharyngeal cancer. Young people, who increasingly practice oral sex especially with many partners, may be driving the increase in these cancers.

The culprit, as we’ve discussed before, is HPV (human papillomavirus). More known for causing cervical cancer, HPV is also a major cause of oral cancer. In fact, it’s surpassed tobacco as the leading risk factor: While smoking rates have plummetted, oral cancer rates have soared. And that risk increases along with sexual activity. According to the current research,

HPV infection is likely to be sexually acquired with increased risk of oropharyngeal cancer with either many (more than 26) lifetime vaginal-sex partners or six or more lifetime oral-sex partners.

Why is the mouth so vulnerable to HPV transmission?

It must be remembered that the oral cavity is a battlefield of healing mucosal micro abrasions which could in the right circumstances of altered local host defenses allow viral inculcation, infection and entrenchment leading to somatic genetic change. Changes in immuno-tolerance at these “special” immuno-modulating sites…combined with further environmental triggers then lead to cancerous changes. Basically, viral “genes load the gun and environment pulls the trigger.”

So maybe it’s no surprise that earlier research has suggested a connection between gum disease and oral cancer. The initial study found that precancerous lesions were twice as prevalent – and tumors, four times as prevalent – in those with periodontal disease than those with healthy gums. Inflammation appears to be the key factor, as lead author Dr. Mine Tezal recently discussed in an interview with Dr. Bicuspid about her ongoing research:

The results of our recent study suggested an association between chronic local inflammation and tumor HPV status of head and neck cancers. HPV infects only basal cells of the epithelium and gains access through breaks in the mucosa….

In this inflammatory environment, HPV is also shed in greater amounts leading to increased risk of viral transmission. If prospective studies in cancer-free populations confirm that chronic inflammation is a significant factor in the natural history of oral HPV infection, the public health implications would be important.

Thus, another cancer-preventive measure, she suggests, is to control inflammation in the mouth. And she likewise confirms what the Head & Neck Oconology paper showed: frequency of exposure to the virus matters. A lot.

HPV is a commonly transmitted virus and the majority of the infections are cleared rapidly by the immune system without causing disease. Rather than the mere presence of the virus at one time point, its persistence is critical for the development of HPV-related diseases. [emphasis added]

Learn more steps you can take to lower your risk of oral cancer from my earlier post “The Oral Cancer Pandemic & How You Can Keep Yourself Safe.”

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Raspberries, Piercings & Smoking – Oh, My!

So back to blogging, following up on a few older posts with more recent items I ran across during the hiatus…

Nontoxic Oral Cancer Treatments

We’ve looked at causes and early detection of oral cancer, but then what? Well, if a pair of recent studies holds up, we just might wind up treating precancerous lesions with raspberries.

“Part of the biggest clinical challenge,” says Dr. Susan Mallery in DrBicuspid’s report on her work, “is that we cannot currently identify which lesions will progress to oral cancer. Having nontoxic and effective treatment options available would be a great benefit to both patients and healthcare practitioners.”

In a 2010 study in Pharmaceutical Research, Dr. Mallery’s team found that applying a black raspberry gel directly to the lesions kept precancerous cells from becoming cancerous.

Based on the known mechanisms by which berry compounds function at the cellular levels, researchers speculate that the promising gel trial results reflect activation of two related pathways – apoptosis and terminal differentiation – in the premalignant cells. The ultimate benefit is that damaged cells don’t continue to divide and are therefore not retained.

A new study by the team, published in Molecular Pharmaceutics, showed similar efficacy of patch-delivered fenretinide, a synthetic vitamin A compound. The authors suggest that these “chemopreventives” could be used alone or in rotation, though the raspberry gel was enough for many.

“We’re getting a pretty good handle on what enzymes you need and how you metabolize the compounds, which will give a predictive indicator if you’re going to be a good responder to the raspberry gel alone,” Dr. Mallery said.

How Body Piercing Can Go Wrong

A while back, we looked at a few of the problems oral piercings can cause for your teeth and gums – from infection to pushing teeth out of alignment. But there are others.

Last month, the American Journal of Clinical Dermatology published a comprehensive review of “the medical consequences of body piercing.” First, there are those that can crop up regardless of where the piercing is.

Localized infections are common. Systemic infections such as viral hepatitis and toxic shock syndrome and distant infections such as endocarditis and brain abscesses have been reported. Other general complications include allergic contact dermatitis (e.g. from nickel or latex), bleeding, scarring and keloid formation, nerve damage, and interference with medical procedures such as intubation and blood/organ donation.

Then there are “site-specific” problems. Of concern to dentists:

Oral piercings may lead to difficulty speaking and eating, excessive salivation, and dental problems. Oral and nasal piercings may be aspirated or become embedded, requiring surgical removal.

What the report doesn’t go into, though, are concerns of biological, holistic or integrative practitioners over punching through acupuncture points and housing metal in the body. These can block and disturb energy along the meridians, which can damage health over time. You can learn more about the issue in this helpful overview.

Smokers Avoid the Dentist

Not long after we looked at why smokers need to kick their habit before getting treatment for gum disease – a disease that affects tobacco-users disproportionately – the CDC released some new and sad data on smokers, dental problems and dental care.

The CDC looked at 2008 survey responses from more than 16,000 adults ages 18 through 64.

More than a third of smokers reported having three or more dental problems, ranging from stained teeth to jaw pain, toothaches or infected gums. That was more than twice as much as people who never smoked.

But 20 percent of the smokers said they had not been to a dentist in at least five years. Only 10 percent of non-smokers and former smokers had stayed away that long, the study found.

Smokers seem to be aware their dental health is worse “but they’re not doing anything about it,” said Robin Cohen, a CDC statistician who co-authored the new report.

Why not?

Half said they couldn’t afford it, which makes sense: Smoking rates are higher among lower income groups, it’s an expensive habit and the amount and type of damage it causes can quickly inflate a dental bill. I suspect fear plays a role, too – fear of The Lecture, as noted before, and fear of finding out just how bad the problems are.

Unfortunately, the avoidance tactic usually ends up costing much more. According to a study in the Journal of Periodontology, patients with gum disease who did without periodontal treatment could only replace 4 teeth before they were spending more than they would have for a lifetime of periodontal care.

A lifetime!

“Feasible”?

Last, a headline – from a story about recent UK debates on the use of mercury amalgam in dentistry:

Well, amalgam fillings are sure as heck not feasible in any term!

Images by Lottery Monkey, jpmatth and Savannah Roberts, via Flickr

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Gum Disease? Smoker? Why You Need to Kick the Habit Before Getting Treatment

According to a recent poll, 1 in 10 smokers try to hide the fact from their physician. Most say they do this to avoid getting get lectured about their habit. And that’s understandable. After all, most smokers know they should quit. Many have tried. But the pleasures, rituals and effects (physical and mental) – and so, the addiction – often win out.

Since so much of tobacco’s damage isn’t readily visible in a routine medical visit, hiding the habit may be fairly easy – especially if you’re a light smoker, as the poll says many hiders are. Hiding it from a dentist, though, is tougher. Yes, you can mask bad breath for a while. Yes, you can diligently whiten your teeth. But you can’t mask things like bleeding gums, bone and tooth loss or cancerous lesions.

While most Americans have some degree of gum disease, the problem, as noted before, is much worse among smokers. According to research published in the Journal of Periodontology, over half of all cases may be due to smoking, and smokers are four times more likely to develop it. Why? Among other reasons, they “may be more than 10 times more likely than nonsmokers to harbor the bacteria that cause periodontal disease and are also more likely to have advanced periodontal disease.”

And no, it’s not just about cigarettes. You don’t get a free pass just because you smoke cigars or a pipe. The effect is similar. And the more you smoke, the greater the risk. Chewing tobacco carries its own oral health risks.

While gum disease can lead to bone and tooth loss, it’s not a necessary cause. Smoking alone is enough of a trigger, and its effects persist even after decades of living smoke-free. While we can try to spur new bone growth or at least slow the rate of loss, there’s currently no sure-fire fix.

Because of tobacco’s pernicious effects on both the hard and soft oral tissues, an increasing number of periodontists refuse to treat smokers until they kick the habit. Smokers may be surprised, frustrated, hurt or even offended by this. Obviously, they care enough about their oral health to consult with a specialist. But that care needs to motivate a successful quit, as well. After all, would you start repairing a flooded home while water was still gushing in? Or a fire-damaged home while flames are still raging?

For while periodontal treatment may help in the short term, long-term prognosis for smokers is poor. This is borne out both clinically and through research.

Among the latest research is a study just published in the American Journal of Medical Sciences. For it, the authors reviewed over 40 years of research on the impact of smoking on perio surgery outcomes. Of the two dozen studies that met their criteria, 2/3

showed that reductions in probing depth and gains in clinical attachment levels were compromised in smokers in comparison with nonsmokers. Three studies showed residual recession after periodontal surgical interventions to be significantly higher in smokers compared with nonsmokers. Three case reports showed periodontal healing to be uneventful in smokers.

But this can be new incentive to quit. No one wants to waste money on treatments not likely to help much or last long. So the choice becomes one of continued tobacco use and worsening oral health or quitting and getting help to regain periodontal health and keep as many natural teeth as long as possible. (After all, replacing teeth isn’t cheap either: a single implant can cost several thousand dollars!) For the good news is that although the risk of tooth loss persists, the effects of smoking on gum tissue are reversible. You can undo a lot of damage.

You just have to quit the cigs first.

Some natural, drug-free tips for quitting smoking

Abstracts on the tobacco-perio health link

 

Image by Marko Miloševic, via Flickr

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Bleeding Gums Are NOT Normal!

A lot of people think that it’s perfectly normal if their gums bleed a little bit when they brush or floss.

You imagine they’d think so if, say, their scalp bled a little while they washed their hair? Their hands during scrubbing?

Blood is a sign that something is wrong. Bleeding gums are a sign of disease. If left untreated, the result is lost bone and, ultimately, lost teeth.

 

 

But it’s not just the mouth that suffers. Periodontal (gum) disease has been linked with many other inflammatory conditions, including heart disease, diabetes and stroke. For what happens in the mouth can and does affect the rest of the body. How could it be otherwise? Your mouth is connected to your body; your body is connected to your mouth.

Whoopi Goldberg, for one, found out about the oral/systemic link the hard way – and spoke of it quite powerfully on The View:

 

 

If you’re not taking care of your mouth, you’re not taking care of your body!

That’s plain, hard truth; wisdom that comes from, as Whoopi says, “paying the price” for neglecting her oral health for so long (and this despite the fact that she had insurance and far more than enough money to get regular, top-notch care).

Indeed, no one is immune from gum disease, though some are more susceptible than others. (Click here for a list of contributing factors.) Still, there are three important things we can do to lower our risk: 1) Don’t use tobacco; 2) Brush, floss and see your dentist regularly; and 3) Eat well, including lots of fresh vegetables and few sugary drinks and highly processed carbs.

Want to learn more about the connections between periodontal disease and systemic health? I recommend ZT4BG – Zero Tolerance for Bleeding Gums – a site maintained by dentist William C. Domb, DMD.

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Stopping Gum Disease Naturally – New Study Shows Key Role for Fatty Acids from Fish, Nuts

A diet full of fish and nuts – foods rich in polyunsaturated fatty acids (PUFAs) – goes a long way to keeping people’s smiles healthy, according to a new study.

Looking at the diets of 182 adults, researchers found that those who consumed the highest amount of n-3 fatty acids were 30% less likely to develop gum disease and 20% less likely to develop periodontitis (severe gum disease).

Lead author Dr Asghar Z. Naqvi of Boston’s Beth Israel Deaconess Medical Center says, “We found that n-3 fatty acid intake, particularly docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) are inversely associated with periodontitis in the US population.

“To date, the treatment of periodontitis has primarily involved mechanical cleaning and local antibiotic application. A dietary therapy, if effective, might be a less expensive and safer method for the prevention and treatment of periodontitis.”

Commenting on the study, Chief Executive of the British Dental Health Foundation, Dr Nigel Carter, said, “Most people suffer from gum disease at some point in their life. What people tend not to realize is that it can actually lead to tooth loss if left untreated, and in this day and age, most people should be able to keep all their teeth for life.

“This study shows that a small and relatively easy change in people’s diet can massively improve the condition of their teeth and gums, which in turn can improve their overall well being.”

The study was published in the November issue of the Journal of the American Dietetic Association.

“n-3 Fatty Acids and Periodontitis in US Adults” (Abstract)

Adapted from a British Dental Health Foundation media release.

Images by cobalt123 and s58y via Flickr

 

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