News

Herbal toothpastes effective in reducing inflammatory markers, study finds

FCIP News

When it comes to harmful ingredients, herbal oral care products, which usually do not contain artificial substances such as sweeteners, colourants or preservatives, are considered a safer alternative to most conventional dentifrices. However, to date, sufficient research on the efficiency of plant-derived oral care products has been sparse. Aiming to change that, researchers from India have now compared the effect of three different herbal toothpastes on salivary enzymes that are important for Read More Here

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Regular dental visits may help prevent pneumonia, study shows

FCIP News

Nearly one million Americans become ill with the infection every year and 50,000 die. While it is more common among older people and those with conditions such as AIDS or lung disease, anyone can get pneumonia. Based on an analysis of a national database of more than 26,000 people, the new research found that people who never get dental checkups had an 86 percent greater risk of pneumonia than to those who… Read More Here

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Prevention-oriented approach to dentistry helps patients avoid the drill

FCIP News

Several years ago, Peter Rechmann, DMD, PhD, professor of Preventive & Restorative Dental Science at UC San Francisco’s School of Dentistry, saw a patient who was convinced that she needed a new set of dental crowns.

He was using what was then a new approach to dentistry known as Caries Management by Risk Assessment (CAMBRA), which emphasizes prevention and risk assessment rather than Read More Here

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Protecting the oral cavity and mind of type II diabetics: The comorbidity of type II diabetes, Alzheimer’s, and periodontitis

FCIP News

Those with diabetes and forms of dementia face their own oral health challenges. There has long been a connection between type II diabetes and Alzheimer’s; recent research suggests that Alzheimer’s may actually be a form of diabetes itself. In this article, learn about the mechanisms of periodontitis in those with diabetes and Alzheimer’s, as well as useful patient care considerations. Read More Here

 

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Toss the Floss?

FCIP News

Who expected to wake up last week to the “news” that flossing doesn’t matter? In case you missed it – and you can be sure that your patients will enlighten you if you did – here is a link to one of the many media reports: http://www.latimes.com/science/sciencenow/la-sci-floss-benefits-unproven-20160802-snap-story,amp.html

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So, what is going on?

The answer lies in understanding the process and logic of medical/dental science, and also in deciphering what current research can and cannot tell us. This can be complicated, and the mass media has oversimplified the reasoning of the Department of Health and Human Services. Since we have experienced the thrill of reading the voluminous research literature, including systematic reviews and meta-analyses, on flossing for preventing decay or periodontal disease, we thought we would try to provide some clarity.

First, periodontitis. This is caused by bacteria. So no bacterial plaque, no periodontitis. However, periodontitis only occurs in people who are susceptible, which is governed by genetics. Approximately 50% of periodontitis risk is due to genetic factors. In addition, many fortunate people never acquire the complex pathogenic bacterial populations responsible for causing periodontitis, even if they have poor oral hygiene. By contrast, in the case of simple gingivitis, genetics and personal microbiota are much less determinative. Poor oral hygiene leads to gingivitis in essentially all people. But many of these people will never go on to develop periodontitis, with deepening pockets and bone loss. So the correlation between poor oral hygiene and gingivitis is strong, but the correlation between poor oral hygiene and periodontitis is weaker. Failure to floss does not inexorably lead to periodontitis. But it might. Currently we are not able to accurately predict who is at high or low risk for periodontitis. So people with poor oral hygiene are rolling the dice on periodontitis and leaving themselves at the mercy of their unknown genetic susceptibility and oral microflora.

Second, decay. Like periodontitis, caries is caused by bacteria. So no bacterial plaque, no decay. However, a significant proportion of caries risk is related to each individual’s historic and current fluoride exposure. Therefore oral hygiene is more likely to have an effect in people who have no past and/or present fluoride protection. The effect of differing bacterial species among different people is less significant for caries than for periodontitis, since most people carry the simple cariogenic flora responsible for decay. This means that poor oral hygiene will more predictably cause decay than periodontitis. But people with a life history of fluoridated water and toothpaste will be relatively immune, even if they do not floss. In addition, dietary sugar plays a significant role in decay risk, so patients with high or low sugar exposure will have higher or lower decay rates, regardless of their hygiene efforts.

Third, the research. Many studies on the relationship between flossing (or oral hygiene in general) and caries or periodontitis are outdated, or were short-term, or had small numbers of subjects. Periodontitis takes years or decades to develop, so prospective studies assessing the risks of poor oral hygiene are difficult to sustain and therefore rare. To a lesser extent this is also true for caries. And the literature groups high- and low-risk people together, which can obscure the effects of oral hygiene. Nevertheless, there are reasonable conclusions we can make with the available data. First, clean teeth do not get disease. There is strong evidence that patients who have been treated for periodontitis have a much better prognosis if they maintain good oral hygiene and a regular preventive maintenance schedule. Second, the heterogeneity among patients means that oral hygiene will be more important for some people than for others. Since we can’t know each individual’s risk, we have to assume that everyone is at risk and therefore should practice effective oral hygiene. Many smokers will never develop lung cancer. Does this mean smoking is risk-free? The same logic holds for oral hygiene.

Fourth, oral hygiene. Isolating flossing from hygiene is misleading. There are many ways to achieve clean teeth. Although flossing is ideal, most people do not floss regularly, and many of those who do floss perform it incorrectly. Reasonably effective interdental cleaning can be accomplished with WaterFlossers, electric toothbrushes such as Oral-B or Sonicare, and interdental aids such as Stimudents, proxabrushes, or rubber tip stimulators. Our favorites for many patients are proxabrushes and Oral-B electric toothbrushes. The lead investigator behind the current flossing controversy uses Stimudents. Even manual toothbrushing, performed meticulously, can remove the majority of interproximal plaque. Our challenge is to tailor oral hygiene regimens to individual patients that they will perform properly once daily for life. If you plan to toss the floss, replace it with something equivalent.

Most problems in life result from risk factors that do not cause the problem 100% of the time. This is true for driving too fast, or drunk, or without a seatbelt, or eating a diet high in saturated or trans fats, or smoking, or not exercising, among many examples. So if you plan to reduce or curtail oral hygiene procedures, why not also live on french fries, smoke, drink a six-pack and go out for a drive? Maybe you’ll get lucky.

Decades of research and experience with decay and periodontal disease can be summarized in four words: no plaque, no disease.

 

Drs David and Amy Rosania

Portsmouth, New Hampshire


Dental Fillings Heal Teeth With Stem Cells

FCIP News

Regenerative dental fillings that allow teeth to heal themselves have been developed by researchers, potentially eliminating the need for root canals.

The treatment, developed by scientists from the University of Nottingham and Harvard University, earned a prize from the Royal Society of Chemistry after judges described it as a “new paradigm for dental treatments.”

The tooth filling works by stimulating stem cells to encourage the growth of dentin—the bony material that makes up the majority of the tooth—allowing patients to effectively regrow teeth that are damaged through dental disease.

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Tobacco Smoke Makes Oral Bacteria More Resilient

FCIP News

The mouth is home to more than 700 different bacteria species. Tobacco smoke, though, promotes the colonization and fortification of harmful species like Porphyromonas gingivalis. The immune system, then, has a much harder time fighting them off as biofilms begin to develop.

“Once a pathogen establishes itself within a biofilm, it can be difficult to eradicate as biofilms provide a physical barrier against the host immune response,” said David A. Scott, PhD, a researcher at the University of Louisville School of Dentistry.

The chemicals in tobacco smoke stress the oral environment and alter the expression of multiple genes and proteins in the bacteria there, promoting colonization and…

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Diabetes Patients Have Higher Odds of Dental Loss

FCIP News

People with diabetes are 1.46 times more likely to lose their teeth than healthy patients.   Diabetes patients are also more likely to lose their teeth earlier in life than people without diabetes of the same age. Furthermore, diabetics suffer more severely and more frequently from periodontal disease and dental caries, which probably increases…

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Gum diseases could open the body to a swarm of infections

FCIP News

Dental care has been disconnected from general health care for many years now, but the more you start to think about it, the stranger it seems. After all, you don’t really separate any other branch of medicine so… why teeth? It all started in the 19th century, following conflicts between surgeons and dentists in England. The conflict was carried on in the United States, after medicine became linked to employer insurance and Medicare. The fissure between medicine and dentistry widened, until it was…

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Cancer Patients Require Managed Oral Healthcare

FCIP News

Approximately every 3 minutes, someone in the United States is diagnosed with cancer. Oral complications resulting from anticancer therapies like chemotherapy and radiation can significantly affect morbidity, the patients’ tolerance, and their overall quality of life. Is your office prepared to handle the unique oral care needs of these patients?

In 1989, The National Institutes of Health had a Consensus Development Conference entitled “The Oral Complications of Cancer Therapies: Diagnosis, Treatment and Prevention.” The number one recommendation of the conference was…
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