October is Dental Hygiene Month in the US

October 21, 2010 by  
Filed under HEALTHCARE, HEART AND STROKE

I am not one of those who are scared of dentists. In fact, I was more scared of the cost. You see, unlike in many European countries, dental care, even the most basic, is not covered by health insurance in Switzerland where I now live.

Thus, since we moved to Switzerland 4 years ago, I had my dental services done in Asia when every time I visit my family there. Asia, in fact, is very popular among “medical tourists” in terms of dental care.

Then a couple of weeks ago, I had pain in my teeth and gums that barely allowed me to eat. I hoped that the pain will go away but after 2 weeks on pain and discomfort, I finally decided to visit the dentist.

Now, let me tell you, dental care in Switzerland is the most expensive in the world. But it is also arguably the best in the world.

So I went to the dentist and I was told that the problem is not my teeth – no holes or caries anywhere – but my gums. Specifically the tartar or calculus that accumulated under my gums caused the problem.

MedicineNet defines tartar as:

“… is the hardened product of longstanding plaque accumulating minerals from the saliva and foods. Plaque is the soft accumulation of food debris and bacteria around teeth. These bacteria feed on left over food in the mouth to excrete toxins that irritate the gums and dissolve the bone. Plaque can be removed by proper brushing and flossing at home. Tartar can become as hard as a rock and then can require a dentist or dental hygienist with special tools to remove it. Dental plaque and tartar cause inflammation of the bone surrounding the teeth referred to as “periodontia.”

So what I had was gingivitis, inflammation or infection of the gums. And I am not careful, it can progress to periodontitis when the infection spreads from the gums to the ligaments and bone that support the teeth.

So I did a bit of research into the topic, well-timed since it is Dental Hygiene Month in the US.

And here are some reasons why we should take dental hygiene seriously:

  • Periodontitis can cause tooth loss, especially among adults.
  • Periodontitis increase the risk for heart disease and other serious health problems.

According to Mayo Clinic experts:

“…bacteria may travel to the arteries in your heart. There, they can trigger a cycle of inflammation and arterial narrowing that contributes to heart attacks.”

Tartar may  accumulate on the tooth crown (supra-gingival) and on the root of the tooth under the gums (sub-gingival calculus). Mine were most the latter, which is the most difficult to remove.

So how is tartar removed?

Treatment options are:

A non surgical approach is when access to the root surfaces is via the sulci or periodontal pockets.

A surgical approach is when full thickness tissue flaps are reflected to expose the root surfaces and gain direct access to them.

The efficacy of subgingival plaque and calculus removal utilizing a non surgical approach is limited. Pockets up to 5mm may be adequately debrided using a closed approach, but deeper pockets often will require an open or surgical approach.

I am scheduled next week for a periodontal debridement.

And I have learned my lesson: don’t go for cheap dental hygiene options.

Good dental hygiene slows down aging

June 24, 2010 by  
Filed under AGING

There is a better and cheaper alternative to botox or plastic surgery in trying to keep the years away. It’s good dental hygiene, according to some experts. Simply speaking, “gum disease makes you look ‘long in the tooth’”, according to an msnbc article.

Here is how poor dental hygiene ages your looks:

  • Yellowing and staining between and around the teeth occurs.
  • Gum tissue bleeds, becomes inflamed, leading to gum disease
  • Gum disease can lead to gum recession that creates gaps, spaces and uneven gum tissue makes you look older.
  • Gum disease leads to bone loss and bone loss can lead to changes in facial structures.

Gum diseases, also known as periodontitis range from “simple gum inflammation [gingivitis] to serious disease that results in major damage to the soft tissue and bone that support the teeth. In the worst cases, teeth are lost.”

According to Dr. Donald S. Clem, president-elect of the American Academy of Periodontology Foundation

“When gum disease begins to eat away at the bone, there are changes in facial appearance. Once a tooth is lost the bone has no reason to be there. In later stages of periodontal disease we would see disfigurement in terms of caving in of the lips and cheek and wrinkles around the lips and cheeks.”

What can be done?

Plastic surgery may be an option but it is a procedure that only works on the skin. Recent studies have shown that aging is more than just skin deep – the bones and the muscles also play a very important role in facial looks (see previous post). Bone loss is not as easy to fix as wrinkles.

Tooth implants or replacements would all depend on how far bone loss has progressed and whether there is still space for implants to attach in “the most aesthetically desirable place.”

Unfortunately, many people do not put too much worth on their teeth as well as they would, for example, their skin, their hair and especially in women, their nails. However, beauty is not just about flawless smooth skin or perfect hairstyle.

Dental hygienists recommends regular flossing – everyday, in fact. A large part of our teeth’s surfaces may not be accessible by a toothbrush. Flossing cleans the food, sticky plaques and bacteria between the teeth. Visiting a dental hygienist every 6 months is also recommended.

Aside from making you look old, poor dental hygiene has also been linked to other health problems – including heart disease and atherosclerosis.

Connecting the dots: your gums, your arteries, and your heart

January 8, 2009 by  
Filed under HEART AND STROKE

Here is another lifestyle tip for 2009: To prevent heart disease, visit your dentist.

Now, you’d ask what does your dental hygiene have to do with your cardiovascular health? Well, it has something to do with two seeming different but apparently related health conditions: periodontal or gum disease and atherosclerosis.

Periodontal or gum diseases, also known as periodontitis range from “simple gum inflammation [gingivitis] to serious disease that results in major damage to the soft tissue and bone that support the teeth. In the worst cases, teeth are lost.”

Atherosclerosis is defined as “the progressive narrowing and hardening of the arteries over time.” When this happens to the coronary arteries supplying the heart, it leads to coronary artery disease (CAD). CAD causes angina (chest pains) and heart attacks when blood clots form in the narrowed arteries, thereby blocking blood supply to the heart. CAD can also weaken the heart muscles and can cause abnormal hearth rhythms (arrhythmias) and heart failure.

Atherosclerosis can also lead to blockage of arteries supplying the brain, causing stroke.

So where is the link?

The link is in the systematic inflammation that is characteristic of the two diseases. In particular, the bacteria Porphyromonas gingivalis that cause gum lesions are also associated with the development of atherosclerotic plaques.

A recent study by Italian researchers showed that a simple dental workup could lead to lower risk for atherosclerosis, and thus cardiovascular diseases. The researchers enrolled 35 healthy adults with mild to moderate periodontal disease. They underwent periodontal treatment which involved “removal of tartar and cleaning the gums, and that’s it-no surgery and no antibiotics-just your basic dental hygiene.” The intima media thickness (IMT) of the carotid artery was regularly checked as well as inflammation biomarkers for cardiovascular risk. The results of the study can be summarized as:

  • Periodontal treatment resulted in a significant decrease in the total oral bacterial load.
  • The treatment also led to decreased levels of inflammation biomarkers as well as adhesion and activation proteins.
  • The carotid IMT was significantly reduced starting 6 months after periodontal treatment and persisted even up to 12 months or longer.

This is the first study to demonstrate that dental hygiene can actually prevent, even reverse atherosclerosis. However, a more comprehensive study involving more participants is on the way to confirm the results.

The authors give us the following take-home message:

By taking good care of your teeth and gums, you can not only prevent the development of atherosclerosis, you can also reduce your risk of developing cardiovascular disease.”

 

Photo credit: stock.xchng

Keep your teeth clean, keep your heart healthy

July 9, 2008 by  
Filed under HEART AND STROKE

The purpose of toothbrushing is to clean our teeth. And we do achieve this goal when we perform this routine task 2 to 3 times a day. But what we don’t know is that during toothbrushing, we are also introducing bacteria into our bloodstream, probably through breaks and cuts in our gums.

A recent article in the journal Circulation reported that good dental hygiene is important in the prevention of heart valve infection.

The researchers studied 290 dental patients and measured bacteremia, which is the number of bacteria released into the bloodstream during performance of 3 different dental activities, as follows:

  • Toothbrushing
  • Single tooth extraction plus antibiotic (amoxicillin)
  • Single tooth extraction plus placebo.

 

The results showed that bacteremia is highest in the patients who underwent extraction plus placebo. This is really not surprising. What is surprising – and troubling – is the high incidence of bacteremia during tooth brushing – with values which are too close to extraction measurements for comfort. In addition, the bacteria can persist in the blood for as long as an hour after the extraction or tooth brushing.

“This suggests that bacteria get into the bloodstream hundreds of times a year, not only from tooth brushing, but also from other routine daily activities like chewing food,”

according to Peter Lockhart, lead author of the study.

In additional to bacteremia measurements, the researchers also looked for the presence of bacterial species which are linked to infective endocarditis (IE) which is “a rare but life-threatening infection of the lining of the heart or heart valve that can occur when bacteria enter the bloodstream.” It has been previously reported that introduction of bacteria during dental procedures is linked to the development of IE.

From the blood samples of the dental patients analyzed, the incidence of IE-related bacteremia is as follows:

  • 23% in the tooth-brushing group
  • 33% in the extraction plus antibiotic group
  • 60% for the extraction-placebo group

Now this doesn’t mean to say that we should stop brushing our teeth altogether. In fact, poor oral hygiene can actually increase the risks because it can cause chronic mouth infections such as gum disease and tooth decay. These infections in turn heighten the risk for IE. What we should probably do is to make sure that our toothbrushes are cleaned properly and cleaned regularly.

The antibiotic amoxicillin used in the study seems to have a prophylactic effect but did not fully prevent bacteremia.

The American Heart Association recommends the use of preventive antibiotics during dental procedures for patients at the highest risk for IE, namely patients described below:

 

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NOTE: The contents in this blog are for informational purposes only, and should not be construed as medical advice, diagnosis, treatment or a substitute for professional care. Always seek the advice of your physician or other qualified health professional before making changes to any existing treatment or program. Some of the information presented in this blog may already be out of date.