Recent Studies You Should Be Aware Of
May 22, 2012
I have preached for years, based on the information available, that there was a direct relationship between gum disease, heart disease, stroke and other health issues. This morning I received an email from the American Dental Association (ADA) about the newest report on this subject.
A report published recently in Circulation, the journal of the American Heart Association (AHA), states that current scientific evidence does not establish a direct cause and effect relationship between gum disease and heart disease or stroke. Additionally, the evidence does not establish that gum disease increases the rate of heart disease or stroke.
The report was developed by an AHA expert committee comprised of dentists, cardiologists and infectious disease specialists. The ADA’s Council on Scientific Affairs appointed a representative to the committee that examined 537 peer-reviewed studies on the subject in order to develop the report. The CSA then reviewed the report and agreed with its conclusions.
The report acknowledges the value of good oral hygiene to maintain good overall health but noted that current scientific data does not indicate whether regular brushing and flossing or treatment of gum disease can decrease the incidence of atherosclerosis, which is the narrowing of the arteries that can lead to heart attacks and stroke.
Last week, in typical media-slanted coverage, was a study published in Cancer, a scientific journal of the American Cancer Society, associating yearly or more frequent dental X-rays with an increased risk of developing meningioma, the most commonly diagnosed brain tumor. This type of tumor is usually not malignant. The study has received widespread media coverage, and a number of the stories cite the ADA’s dental x-ray recommendations that help dentists determine how to keep radiation exposure as low as reasonably achievable.
Study participants averaged 57 years old and were asked to remember how many x-rays they received as kids before age 10. That’s a stretch for believability – remembering details from 47 or more years ago? That long ago, x-ray technology was vastly different from today. When I was a kid, I probably got 100 times more harmful radiation from x-rays than kids (or adults) today.
Statistics show about 5,000 of this type tumor diagnosed each year in the U.S. In a country of over 310 million people, 5,000 is less than .001%. And, there are almost certainly many other causes other than dental x-rays. Granted, every brain tumor is serious, particularly to the person with the tumor and his/her loved ones, and the topic must be approached appropriately.
So, what do these two recent studies mean to you as patients and “us” as dentists? To be honest, not much for most of us. The fact remains that if you have untreated or uncontrolled gum disease, which has a strong genetic component, you will lose your teeth but apparently won’t die from it. And, if you don’t go to the dentist regularly and/or refuse dental x-rays at appropriate intervals, you put yourself and your dentist at significant risk.
Studies like these are important for the progression in any area of our society. However, it is important to look at the big picture. Teeth are important and good dental health greatly increases the quality of life. Just ask the patient I saw last Sunday for an emergency extraction after days of excruciating pain having not been to a dentist in a few years.
Dr. St. Clair maintains a private dental practice in Rowley and Newburyport dedicated to health-centered family dentistry. If there are certain topics you would like to see written about or questions you have please email them to him at jpstclair@dentalhealthforlife.com. You can view all previously written columns at www.dentalhealthforlife.com.
What Your Mouth Says
February 2, 2012
A few weeks ago there was a large article in The Wall Street Journal entitled, “If Your Teeth Could Talk.” It was a basic review of some of the connections between oral and systemic health and also offered some newer research that I was unaware of.
I have written many times on the growing evidence linking periodontal (gum) disease with many systemic issues. The fact of the matter is the mouth is truly the gateway to the rest of the body. While some early signs of diabetes, cancer, pregnancy, immune disorders, hormone imbalance and drug issues can show up in the mouth long before the person discovers that there is a “problem”, an unhealthy mouth also puts you at greater risk for things like heart disease, stroke, diabetes, and pregnancy complications.
A study done at New York University in 2009 reported that 93% of people who have periodontal disease are at risk for diabetes. The issue is inflammation and the fact that periodontal disease and diabetes exacerbate each other. Inflammation from periodontal disease, a chronic non-symptomatic disease, makes it more difficult for people with diabetes to control blood sugar levels. High blood sugar accelerates tooth decay and gum disease, which elevates inflammation. It is a vicious cycle.
However, more recent studies show that treating gum disease improves circulation, reduces inflammation and can even reduce the need for insulin in people with diabetes. The estimates are that six million Americans have diabetes and don’t know it. The risk of not treating either disease can have irreversible consequences.
If you have ever had a planned surgery you probably were asked about your dental health, how often you visit a dentist and asked to get “clearance” from your dentist prior to surgery. The reason for that is because the type and quantity of bacteria present in uncontrolled gum disease is much higher than in periodontally healthy individuals. Bacteria from the mouth can travel through the bloodstream and cause problems elsewhere. Far too often patients come to me a month before surgery and say they need to get their mouth in shape prior to their procedure….an often impossible task.
There are also an increasing number of people on medication and the number of medications they are taking. Many drugs, including but not limited to blood thinners, bisphosphonates (ex. Fosamax), blood pressure medications, antidepressants and chemotherapy drugs can all have effects on the mouth that can be devastating if not closely monitored.
This is all “real” stuff. I deal with these issues in the office every day. I use this analogy a lot, “Periodontal disease is like diabetes, it is not curable, but in most cases it is controllable.” For most patients, good home care combined with good professional care can control this disease. Just as in the lottery, “you can’t win if you don’t play”. However, the consequences for not playing the dental game are more risky.
If you didn’t take the survey last week that I discussed, go to the Facebook page below to take it. I will be reporting the results in the next couple of weeks. So far, not one respondent would give up their teeth for a million dollars. Would you?
The Silent Epidemic – Part 2
September 21, 2011
Last week we discussed the role and effect that diabetes has on oral health. It is not something that should be taken lightly. If you missed this column, please visit the website at the end of this column or e-mail me directly and I will send you a copy.
After reading last week’s column, it may seem frightening that there is no way out of the partnership of horrors between diabetes and severe gum disease. There are solutions. Just as poor oral health can compound a diabetic’s plight, proper oral health can come to the rescue.
Clinical studies confirm that treatment of gum disease reduces oral inflammation, which removes the factor that triggers the body’s inflammatory response which, in turn, plays a major role in compounding the effects of diabetes.
Dental treatments that fight gum infections also help improve control of blood sugar levels in diabetics.
If you are pre-diabetic, your dentist may actually be able to help prevent diabetes. If you already have diabetes, your dentist may be able to help you keep it under control, improve your quality of life and reduce the risk of premature death.
There’s even better news. It’s never too late to improve oral health care. Even if you already have severe gum disease or other dental problems, proper treatment can help stop it in its tracks. In many cases, dentists can even reverse the damage done to your teeth and gums as well as manage the metabolic elements of diabetes. And, if you haven’t yet developed any symptoms of diabetes-related oral health problems, your dentist can start a prevention program that will help you stay in control of your diabetes, maintain better health and enjoy a preferred quality of life.
Perhaps the best news is that this is something that doesn’t require exercise, taking a pill, giving yourself a shot of insulin, or sticking to a special diet. However, some or all of these things may be necessary to also help control diabetes. From an oral health perspective all you need to do is to start seeing your dentist and talking to him or her about your particular situation.
In the dental world there are going to be varying degrees of participation from dentists, depending on their knowledge or “philosophy” of care, when it comes to partnering with you to manage the oral health issues in regards to diabetes or pre-diabetes. Different dentists just practice differently. The best team approach is between the doctor, the patient and the dentist. If one of these team members does not participate, the battle cannot be won. Often times it is the patient who is not doing the things that he or she needs to do to properly manage the problem. If the dentist does not seem too concerned about your diabetes, you have the desire to have your oral health properly managed and are willing to do your part, find a new dentist.
The point is that this is a serious issue and if you, the patient, wants to take control of it, a team effort is needed.
The Silent Epidemic
February 8, 2011
With more than 24 million diabetics and 57 million pre-diabetics in the United States, nearly a quarter of the nation’s population, there are a lot of people affected by diabetes. The most up to date research shows the connection between dental health and diabetes has never been more critical.
As an indication of our general health, the rapidly rising rate of diabetes should be ringing alarm bells everywhere. The litany of health implications from diabetes is a long and grisly list. It is the sixth leading cause of death in the U.S. That is probably vastly understated because as many as 65% of deaths from diabetes are attributed to heart attack and stroke. People with diabetes have about twice the overall risk of death as those who don’t have the disease.
Complications from diabetes cuts years off productive lives and interfere with the quality of those lives through a host of debilitating health effects. Heart disease and stroke rates are as much as four times higher among diabetics. Nearly three-quarters of diabetics have high blood pressure. Each year, diabetes causes blindness in as many as 24,000 Americans. It is the leading cause of kidney failure, nervous system disease, amputations – the list goes on.
This isn’t meant to be a scare tactic. These are simply the facts and, yes, they are sobering. But if you have diabetes or are pre-diabetic, you may want to brace yourself. Because we are going to talk straight about oral health and diabetes, two diseases that can twist each other into a tight downward spiral of amplifying negative health effects. Unless they are halted by your physician and your dentist working in tandem as a health care team, together with your commitment to hold up your end of the bargain, these effects can continue to compound.
The facts about the connections between oral health and diabetes are even more alarming than those about diabetes alone. Here are just a few:
Diabetics are twice as likely to develop gum disease. This is especially true if your diabetes is not under control. The gum disease then worsens your diabetes through an automatic response that your uses to fight the infection.
People with gum disease are 270% more likely to suffer a heart attack than those with healthy gums.
People who have diabetes and sever gum disease have a premature death rate nearly eight times higher than those who do not have periodontal disease.
Those who have gum disease and diabetes together are more than three time likely to die of combined heart and kidney failure.
In people who have type 2 diabetes, gum disease is a predictor of end-stage kidney disease.
In people who have pre-diabetes – blood glucose levels that are higher than normal but not in the diabetic range – gum disease makes it more likely that they will become diabetic.
Once established in a person who has diabetes, the chronic infection that causes gum disease makes it more difficult to control diabetes, and increases damage and complications in blood vessel disease.
It’s Just a Cleaning
October 28, 2010
This is a phrase we hear far too frequently when patients call to cancel their hygiene appointments at the last minute or just do not show up. When the patient is told that there are no open hygiene appointments for 4-6 months the response if often, “Oh, that’s okay, it’s just a cleaning.” However, this lack of concern for urgency is only partly to blame on the patient; most of the accountability falls in the lap of the dental staff, including the dentist.
If you read this column with any frequency, I am sure you are sick of hearing that 75% of the population has some form of periodontal (gum) disease. I am sure you are sick of hearing that periodontal disease has been linked to heart disease, stroke, pre-term, low birth-weight babies, diabetes, and possibly even some types of cancer. The problem is the dental staff is not discussing this enough with their patients.
Based on your level of periodontal health, there are different levels of frequency recommended for hygiene visits. Many people, and the bare minimum, should be seen every 6 months. For others, every 3 or 4 months is recommended. We have some patients where even more frequency is recommended. Regardless, if you put off your routine care by 1, 2 or even 6 months, that is a lot of time to have bacterial growth accumulate and put your body into a defensive mode due to increased inflammation.
Remember, gum disease is not only bad because it makes your breathe stink and your teeth fall out; it is bad for you systemically because of chronic inflammation. You may very well not notice an increase in inflammation, but your body does. There are measureable indicators of this.
If your goal is health, routine maintenance is essential. I tell my staff this all the time – without being a nag, educate, educate, educate. Believe me, if you only knew how bad chronic inflammation really was for you, you would most likely want to be seen more frequently than you are. Personally, I have a good family history when it comes to periodontal disease and I have good home care (although I am told there is room for improvement). My maintenance frequency is every 4 months.
The other, and understandably more selfish issue with regards to changes in your hygiene appointments, is what it does to the office schedule. Most dental offices have a 48-hour policy for changing appointments. This allows enough time to fill the schedule with people on a wait list. There are obviously good reasons why patients need to change an appointment. I do not consider many of the reasons that my staff report to me very good reasons to change a time that has been reserved for you for months. This goes back to the understanding of how important it is to stay on schedule with maintenance.
Some offices charge a fee for not cancelling an appointment within a certain period of time due to lost production and the need to pay staff for their time.
The goal of your dental office is to help you in keeping your teeth and aiding in a healthy body. Help yourself with regular and frequent visits.
Dr. St. Clair maintains a private dental practice in Rowley and Newburyport dedicated to health-centered family dentistry.
