Agenda

July 03, 2007

PERIODONTAL BACTERIA FOUND IN AMNIOTIC FLUID

Study evaluates women at risk for premature labor and finds

periodontal bacteria in amniotic fluid

CHICAGO – A study appearing in the July issue of the Journal of Periodontology found bacteria commonly found in the mouth and associated with periodontal diseases in the amniotic fluid of some pregnant women.

The study, which evaluated 26 pregnant women with a diagnosis of threatened premature labor, found the presence of periodontal bacteria, P. Gingivalis, in both the oral cavity and amniotic fluid in 30% of the women. Amniotic fluid is a liquid that surrounds an unborn baby during pregnancy. Any disruptions in the amniotic fluid, such as a bacterial infection, could potentially be dangerous to both the mother and baby.

“We evaluated women who were at risk of premature labor,” said study author Gorge Gamonal, Faculty of Dentistry, University of Chile. “We know that there are many reasons a woman can be diagnosed with threatened premature labor, including bacterial infection. Past research has shown a relationship between adverse pregnancy outcomes and periodontal disease, a chronic bacterial infection.”

“While this study’s findings do not show a direct causal relationship between periodontal diseases and adverse pregnancy outcomes, it is still important for women to pay special attention to their oral health during pregnancy,” explained Preston D. Miller, Jr., DDS, President of the American Academy of Periodontology. “Woman who are pregnant or considering becoming pregnant should speak with their dental and health care professionals about their oral health during pregnancy.”

To find out if you are at risk for periodontal diseases take the Academy’s risk assessment test. A referral to a periodontist, additional information, and brochure samples are available online at www.perio.org, or by calling toll-free (800) FLOSS-EM ((800) 356-7736).

Be sure to also keep in mind your “pocket size” guide to periodontal health; periodontal pockets of one to two millimeters with no bleeding are not a concern but pockets of three and four millimeters may need a more in depth cleaning called scaling and root planing.

The American Academy of Periodontology is an 8,000-member association of dental professionals specializing in the prevention, diagnosis and treatment of diseases affecting the gums and supporting structures of the teeth and in the placement and maintenance of dental implants. Periodontics is one of nine dental specialties recognized by the American Dental Association.

Study identifies lifestyle factors that have the biggest impact on periodontal health

CHICAGO – There are many lifestyle factors that can impact a person’s health, such as nutrition, amount of sleep, mental stress, tobacco use, and exercise. A study in the May issue of the Journal of Periodontology identifies lifestyle factors that have the most impact on periodontal health.

The study followed a group of 219 factory workers in Japan from 1999 to 2003 in an attempt to evaluate the effect of different lifestyle factors on the progression of periodontal diseases. Each worker was evaluated on a list of the following lifestyle factors: physical exercise, alcohol consumption, tobacco use, hours of sleep, nutritional balance, mental stress, hours worked and eating breakfast. The study found that the number one lifestyle factor that independently impacted the progression of periodontal disease was smoking; hours of sleep closely followed. Over 41% of study participants who showed periodontal disease progression from 1999 to 2003 were current smokers. In addition, lack of sleep was identified as a significant lifestyle factor that may play a role in the progression of periodontal disease. The participants who received seven to eight hours of sleep exhibited less periodontal disease progression than those who received six hours of sleep or less. High stress levels and daily alcohol consumption also demonstrated a significant impact on periodontal disease progression.

“Our findings are in line with other studies that have identified smoking as a strong lifestyle factor affecting oral health,” said study author Muneo Tanaka, DDS. “However, studies that have looked at hours of sleep as an independent factor affecting periodontal health are limited. From this study, we can speculate that shortage of sleep can impair the body’s immune response which may lead to the progression of diseases such as periodontal disease.”

“This study points out to patients that there are lifestyle factors other than brushing and flossing that may affect their oral health. Simple lifestyle changes, such as getting more sleep, may help patients improve or protect their oral health,” explained Preston D. Miller, Jr., DDS, President of the American Academy of Periodontology. “It is also important to keep these in mind as the body of evidence linking oral disease with systemic diseases continues to grow because ultimately these lifestyle factors might impact a patient’s overall health.”

CHICAGO- Periodontal diseases may contribute to the progression to pre-diabetes, according to a new study that appears in the March issue of the Journal of Periodontology.

Pre-diabetes is a condition in which blood glucose levels are higher than normal, but not high enough to be diagnosed as diabetes. The American Diabetes Association estimates 54 million people in the United States have pre-diabetes, and a significant portion of those people will develop Type 2 diabetes within 10 years.

Researchers from Denmark investigated if having periodontal diseases can influence pre-diabetes and contribute to the progression of diabetes. They found that having periodontal disease can cause someone to develop pre-diabetic characteristics, and probably disturb the glucose regulation of a non-diabetic who has pre-diabetic characteristics, contributing to the progression of Type 2 diabetes. The study, conducted with rat models known to exhibit pre-diabetes characteristics, is believed to be the first to evaluate the relationship between periodontitis and pre-diabetes.

“This study found that having periodontal diseases can alter the metabolic conditions which would probably lead to the progression to pre-diabetic characteristics and Type 2 diabetes,” said Dr. Carla Pontes Andersen, Department of Periodontology at the University of Copenhagen.

“We have known that people with diabetes are more susceptible to periodontal diseases and have more severe disease,” said Dr. Preston D. Miller, Jr., President of the American Academy of Periodontology. “This breakthrough research shows having periodontal disease may aggravate pre-diabetes which is a precursor for diabetes. These findings underscore the importance of taking good care of your teeth and gums: it may be a simple way to prevent diabetes, or to prevent the progression of diabetes.”

To asses your periodontal health visit www.perio.org and click on “Assess your gum disease risk”. To check if you may be at risk of developing diabetes, visit http://www.diabetes.org/risk-test.jsp.

Visit the AAP website, www.perio.org for a referral to a periodontist and free brochure titled Diabetes & Periodontal Diseases.

Secondhand smoke may be associated with bone loss in subjects with periodontitis

CHICAGO – A study published in this month’s issue of the Journal of Periodontology found that subjects with periodontitis who were exposed to secondhand smoke were more likely to develop bone loss, the number one cause of tooth loss.

Researchers studied rats that were induced with periodontal disease. One group was not exposed to cigarette smoke while the other two groups were exposed to either 30 days of smoke inhalation produced by non-light cigarettes (cigarettes containing higher tar, nicotine and carbon monoxide levels) or light cigarettes (cigarettes containing lower tar, nicotine and carbon monoxide levels). Results showed that bone loss was greater in the subjects exposed to secondhand smoke regardless of if it was smoke from light or non-light cigarettes than those who were exposed to no smoke at all.

“Previous clinical research has proven a strong positive correlation between smoking and gum disease. However, this study is unique in that it evaluated the impact of secondhand smoke on periodontitis,” explained study author Getulio da R. Nogueira-Filho, DDS.

“This study really drives home the fact that even if you don’t smoke the effects of secondhand smoke can be devastating. Part of maintaining a healthy lifestyle should include avoiding smoke filled places such as nightclubs, bars and even some restaurants,” said Preston D. Miller, Jr., DDS and AAP president. “The Academy applauds the cities that are taking steps to make their hospitality industries smoke free so all patrons can enjoy not only a good time but also good overall health.”

November 14, 2006

PERIODONTAL DISEASE MAY NEGATIVELY

EFFECT THE SUCCESS OF ORGAN TRANSPLANT SURVIVAL

Given the association between transplant rejection and levels of interleukin-6,a molecule also found in high levels in periodontal inflammation, researchers explore the possible association between chronic periodontitis and transplant rejection.

CHICAGO – Researchers from the University of Connecticut Health Center are the first to report an interrelationship between periodontal and systemic inflammation in solid organ transplant recipients. This study appears in this month’s issue of the Journal of Periodontology.

For a long time researchers have known that inflammation plays a pivotal role in organ transplant rejection and that levels of serum interleukin-6 (IL-6) can identify individuals who are at greater risk for transplant rejection. IL-6 is a protein that is secreted to stimulate the immune response to trauma, foreign antigens, or infections, such as periodontal infection. Once secreted, IL-6 can enter the bloodstream and circulate in an active form long enough to mediate distal effects in other tissues and organs.

“Our goal was to assess the periodontal status of solid organ transplant patients to quantify the IL-6 levels in bloodstream and gingival tissues and explore their possible association with chronic periodontitis,” explains Principal Investigator Anna Dongari-Bagtzoglou, DDS, MS, PhD, Associate Professor and Chair of the Division of Periodontology at University of Connecticut Health Center. “We found that in transplant patients with chronic periodontitis, bloodstream IL-6 levels were elevated compared to those with no periodontitis, and were positively association with locally synthesized levels of IL-6 within periodontal tissue. This suggests that periodontal infections have the potential to affect systemic levels of IL-6 in this population.”

In support of this, it was also found that clinical periodontal parameters such as probing depth and clinical attachment loss were independent predictors of the body’s IL-6 levels.

“With research and science advancing every day, the life expectancy after organ transplantation is on a steady rise,” said Preston D. Miller, DDS and AAP president. “Further studies monitoring periodontal disease, IL-6 and transplant tissues are needed to provide conclusive evidence that periodontal inflammation may have negative effects on long-term transplant survival.”

STUDY BACKGROUND

Forty-seven kidney and cardiac transplant patients were recruited for this study. Patients had to be clinically stable, at least one-year post transplant, absent of additional systemic conditions that might elevate the systemic inflammatory status and no history of periodontal treatment within the last year. A group of 18 systemically healthy individuals that matched the age and sex were also recruited.

All individuals received a complete clinical periodontal examination, medical records of the transplant subjects were reviewed and a blood and gingival sample were taken to quantify levels of IL-6. This study was supported by the National Institute of Dental and Craniofacial Research (NIH).

A referral to a periodontist and a free brochure titled Periodontal Diseases: What You Need to Know is available by visiting the AAP website at www.perio.org or calling toll-free at 800/FLOSS-EM (800.356-7736).

Research presented in a recent paper by Michalowicz et al published in the New England Journal of Medicine (NEJM) suggests that treatment of periodontitis in pregnant women improves periodontal health and is safe but does not significantly alter rates of preterm birth, low birth weight, or fetal growth restriction. This outcome is at variance with findings of other studies, which have suggested that periodontal treatment positively affects birth outcomes.

There may be several explanations for the differences in research findings to date including timing of the treatment intervention, as well as the pregnancy outcomes studied. For example, the Michalowicz research did not study the effect of periodontal treatment on early adverse outcomes, such as late miscarriage, stillbirth, and early spontaneous preterm birth, which previous observational studies have linked with periodontal disease.

According to the March of Dimes, the rate of infants born preterm increased nearly 14% from 1994 to 2004. And while the specific causes of spontaneous preterm labor and delivery are largely unknown, the March of Dimes believes they are likely due to a complex interplay of multiple risk factors, as opposed to any single isolated risk factors. The intriguing findings of the study by Michalowicz study support the need for additional research to clarify the potential effect of periodontal disease on adverse pregnancy outcomes, given the potential impact of the increasing problem of prematurity. Other trials are underway that should provide additional insight on this important topic. In the meantime, the recent NEJM study confirms that treatment of periodontitis in pregnant women improves oral health and is safe, which is an important message for the dental and medical communities and all patients.

Japanese researchers find oxidative stress levels lower to those of nondiabetic patients

CHICAGO- Patients with Type 2 diabetes and periodontal disease who receive periodontal therapy see levels of oxidative stress, a condition in which antioxidant levels are lower than normal, reduced to the same levels as nondiabetic patients, according to a new study that appeared in the November issue of the Journal of Periodontology (JOP).

Researchers from Kyushu Dental College in Kitakyushu, Japan investigated the impact of periodontal therapy on patients with Type 2 diabetes, as compared to nondiabetic patients. They found that periodontal therapy decreased lipid peroxide (LPO), an oxidative stress index, in diabetic patients.

“Our research emphasized one of the benefits of having periodontal therapy for patients with diabetes,” said Dr. Kazuo Sonoki, M.D. PhD at Kyushu Dental College, one of the study authors. “However, this was just a preliminary study and more research should be conducted to evaluate how periodontal disease affects both people with and without diabetes.”

It has been found that diabetes and periodontal disease can lead to atherosclerosis, which occurs when deposits of fatty substances, cholesterol, and other substances build up in the inner lining of an artery. This buildup is called plaque. It has been thought that oxidative stress is linked to heart disease because oxidation of LDL (low-density lipoprotein) in the endothelium is a precursor to plaque formation. Recently, oxidative stress has emerged as an important factor for atherosclerosis in patients with diabetes.

“We hear every day about how more and more people are being diagnosed with diabetes,” said Preston D. Miller, DDS and AAP President. “This research confirms that patients with diabetes should be especially conscious of their periodontal health. While more research needs to be done to evaluate the relationship between periodontal disease and diabetes, we do know that treating periodontal diseases can save teeth, and can promote overall health.”

Periodontal disease and coronary heart disease are widespread conditions; therefore, an association between the two is an important scientific subject from a preventive outlook

CHICAGO – Researchers found an increased risk of coronary heart disease for people below the age of 60 who have more than four millimeters of alveolar bone loss (the bone that holds the teeth in the mouth) from periodontal disease, according to a new study that is printed in the Journal of Periodontology.

It was found that participants with coronary heart disease had an increase of periodontal disease indicators, including alveolar bone loss, clinical attachment loss and bleeding compared to the group without coronary heart disease.

“This study is distinctive because to our knowledge, it is the first to include both the alveolar bone loss and full mouth recording of clinical attachment loss as measurements of periodontal disease,” explains Dr. Karen Geismar, Department of Periodontology, School of Dentistry, Faculty of Health Science, University of Copenhagen, Denmark. “Alveolar bone loss was recently found to be the periodontal variable that had the strongest association to coronary heart disease.”

The association between periodontal disease and coronary heart disease has been that chronic infections and the inflammatory response from diseases such as periodontal disease may be involved in the initiation and progression of atherosclerosis.

“A number of pathways are suspected to be involved,” said Geismar. “One way is that periodontal bacteria directly invade the arterial wall and another way is that bacterial products from the periodontal pocket exert a systemic effect on atherosclerosis development based on the immune system.”

“This is one of many studies suggesting that the spread of bacteria and bacterial products from the periodontal lesion to the bloodstream may contribute to coronary heart disease,” said Preston D. Miller, DDS and AAP President. “However, it is still uncertain whether or not the association between periodontal disease and coronary heart disease is causal. Until we know more, it is very important that people talk to their dentist or periodontist about their periodontal health.”

This study included 110 patients with coronary heart disease and 140 people without coronary heart disease. The mean age was 65 years and 70 percent of the participants were male. All 250 participants received a medical and dental examination. Researchers found a significantly higher odds ration of 6.6 for individuals below age 60 having being a patient with coronary heart disease when having a mean alveolar bone loss of more than four millimeters.

For more information including a referral to a periodontist or a free brochure entitled Ask Your Periodontist About Periodontal Disease and Heart Disease, visit the” AAP website at www.perio.org or call toll-free at 800/FLOSS-EM (800.356-7736).