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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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Lifestyle Choices Increase Mouth Cancer Risks

New research has shown that young adults are increasing their risks of oral cancer through the lifestyle choices they make.

The number of young people being diagnosed with mouth, throat and food pipe cancer has doubled, and researchers believe this is due to excessive smoking, drinking and unhealthy diets among the young.

These cancers – known as upper aero-digestive tract cancers – are responsible for 10,000 deaths in the UK alone.

Researchers at Aberdeen University conducted a five year study, which examined 350 patients under the age of 50 with UADT cancers and compared the results to 400 people who did not have the disease. It was discovered that nine in 10 of the cancers had been caused by smoking, drinking and a lack of fruit and vegetables in the diet.

Professor Macfarlane, who led the study, said, “Our study aimed to determine whether smoking, alcohol consumption and low fruit and vegetable intake remained the most significant risk factors for UADT cancers in this age group, or whether other ‘novel’ factors, including genetics and infection, could be relatively more important.

“The results of our study further emphasize that the message we need to be communicating to the public remains the same – that smoking, drinking and diet are the major triggers of these diseases at all ages.”

Tobacco is considered to be the leading cause of mouth cancer, and those who drink alcohol and smoke to excess are up to 30 times more likely to develop the condition. Alcohol aids the absorption of tobacco in the mouth, which transforms saliva into a deadly cocktail that damages cells and can turn them cancerous.

Around a third of cases are thought to be linked to an unhealthy diet. Increasing evidence suggests that Omega 3, found in fish and eggs, can help to lower risks, as can high-fiber foods such as nuts, seeds, whole wheat pasta and brown rice.

Another key risk factor for mouth cancer is the Human Papilloma Virus (HPV). US studies have linked more than 20,000 cancer cases to the virus in the last five years. Transmitted via oral sex, people with multiple sexual partners are more at risk. Oral health experts suggest HPV may rival tobacco and alcohol as the most common risk factor.

Mouth cancer is twice more common in men than in women, though an increasing number of women are being diagnosed with the disease. Previously, the disease has been five times more common in men than women. Initial signs of the disease include a non–healing mouth ulcer, a red or white patch in the mouth, or unusual lumps or swelling in the mouth.

 

From a British Dental Health Foundation media release

Image: ndanger/Flickr

 

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Gum Disease & Cancer, Cancer & Smoking, Smoking & Tooth Loss

Over the past year or so, there’s been a lot more talk in conventional dental circles about the relationship between oral health and physical health, much of it focusing on the demonstrated links between periodontal (gum) disease and inflammatory conditions such as heart disease, diabetes and Alzheimer’s. One of the links we’ve heard less about – at least in the popular media – is that between oral health and cancer.

A little over a year ago, a study published in Cancer Epidemiology, Biomarkers & Prevention cast some light on this relationship, looking to the effect of chronic periodontitis on head and neck squamous cell carcinoma (HNSCC). As gum disease in its most severe form leads to bone loss in the jaw, researchers measured the amount of alveolar bone loss. (This is the bone that secures the teeth in their sockets.) Even after adjusting for factors such as smoking, alcohol use and missing teeth, they found that for each additional millimeter of bone loss, an individual’s risk of developing HNSCC increased by more than four fold, with the strongest association occurring in the oral cavity. The scientists concluded that chronic gum disease may well be an independent risk factor for HNSCC. Smoking may raise the risk even more, considering that it aggravates alveolar bone loss.

Because the alveolar bone is the fundamental structure that keeps teeth in the mouth, as it erodes, the individual becomes more susceptible to losing their teeth. There’s simply not enough bone to hold them in place. This is something we’ve known about for some time, but there’s continued interest in understanding the progress of gum disease, as well as the impact of risk factors such as smoking even after the the person has quit.

Along these lines, a sobering study was just published in the Journal of the American Dental Association, in which researchers looked at the long term effects of smoking and tooth loss among older adults. Unsurprisingly, current and former smokers both showed a much higher rate of tooth loss than those who had never smoked. Surprisingly, though risk declined significantly once individuals quit smoking, their risk remained elevated even after 30 smoke-free years.

For those who still think smoking makes you look cool or sexy, you might want to think about how cool you’d look without teeth or how sexy when taking out dentures each night before going to bed.

Yet another reason to quit the smokes – or never start in the first place.

 

Image via foldedspace

 

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Understanding How Cigarette Smoke Destroys Your Gums

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A couple weeks ago, I wrote about the effects of secondhand smoke on children’s dental health. In passing, I also mentioned how smoking affects the smoker’s oral health, as well – especially the strongly increased risk of periodontal disease and associated bone and tooth loss.

We’ve known about this link for quite a while, but we still don’t entirely understand the mechanism – how tobacco does the damage it does to the periodontal tissues and underlying bone. Answers continue to emerge, though, including some from a new study I learned of shortly after publishing that post.

This study, published in the Journal of Dental Research, considered the effects of cigarette smoke condensate (CSC) – the particulate matter of smoke – and a microbe called P. gingivalis, which is one of the main players in the development of gum disease. Specifically, they wanted to see the effect of these combined factors on the collagen-degrading capability of human gingival fibroblasts – connective tissue cells found in the gingival crevice (the small space between a tooth and surrounding gum tissue).

Three groups of cells were tested. One was exposed just to CSC, one just to P. gingivalis and one to both factors. Looking at the effects of each exposure, the researchers found that the combination of CSC and the pathogenic microbe was more destructive than either component alone and did so by destroying specific secreted proteins in the extracellular matrix.

This is the kind of tissue destruction that ultimately progresses and manifests as receding gums. It’s also entirely preventable, potentially reversible through proper treatment and care, and offers just one more reason to quit smoking now.

 

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Secondhand Smoke Hurts Kids’ Teeth & Gums

When we think about the health effects of smoking, the first things that come to mind are usually diseases such as cancer and emphysema. But smoking does a number on a person’s dental health, too – and far beyond simple bad breath and stained teeth. For instance, smokers are four times more likely than non-smokers to develop periodontal disease, even if their home hygiene is exemplary. Gum health deteriorates, often leading to bone and tooth loss. Some periodontists – dentists who specialize in treating the gums – refuse reparative treatments to smokers if they continue to use, such is the ongoing damage.

More than half of all cases of periodontal disease can be attributed to smoking.

 

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If you smoke, you might think, “Fine, but it’s my body. I can do what I want to it,” and that’s certainly your choice – though I would argue it’s far from the best you can make. But you’re not the only one exposed to the toxins in cigarette smoke. Just as secondhand smoke can cause cancer, emphysema and other diseases in non-smokers, so can it cause dental problems for a very vulnerable population: young children.

Two studies published over the past couple years have demonstrated that “passive smoking” (exposure to secondhand smoke) considerably raises young people’s risk of dental problems. The first, published in 2008 in the Archives of Oral Biology showed quite plainly that children exposed to cigarette smoke had more caries (cavities). They also showed higher counts of pathogenic oral bacteria, more acidic saliva and a lower rate of salivary flow – all factors contributing to the formation of caries.

The second study, published earlier this year in the Journal of Clinical Periodontology, found that children exposed to cigarette smoke also show deterioration of their gum tissues. Here, the researchers measured levels of continine – a primary metabolite of nicotine – in the children’s saliva, urine and gingival crevicular fluid (found in the small space between each tooth and the surrounding gum tissue), as well as conducted periodontal exams. Those children with higher continine levels showed lower clinical attachment levels (the attachment of gum tissues to the alveolar bone and tooth structure) – a marker of gum disease. Though it’s not clear why, this effect was more pronounced in children whose fathers smoked compared to those whose mothers smoked.

The moral of the story? If you choose to continue to smoke, avoid doing so around others, especially children. But best of all – for kids’ health as well as your own – is to quit tobacco use altogether. For those of you ready to take that step, here are some resources from the CDC and info on a few natural remedies to help you get started stopping.

 

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