Improving the treatment of periodontitis

For the first time, researchers from Charité -- Universitätsmedizin Berlin have shown that a unicellular parasite commonly found in the mouth plays a role in both severe tissue inflammation and tissue destruction. Most patients with severe and recurrent periodontitis (gum disease) showed an increased presence of the amoeba Entamoeba gingivalis inside their oral cavities. The effect of this amoeba is similar to that of Entamoeba histolytica, the parasite responsible for causing amebiasis. Once the parasite has invaded the gingival tissue, it feeds on its cells and causes tissue destruction. According to the researchers' findings, which have been published in the Journal of Dental Research, the two amoebae show similar mechanisms of tissue invasion and elicit a similar immune response in the host.

Periodontitis, or gum disease, is an inflammation of the gums and supporting structures of the teeth. It is one of the most common chronic diseases in the world. In Germany, approximately 15 percent of people are affected by a particularly severe form of this disease. If left untreated, periodontitis will lead to tooth loss. The disease also increases the risk of arthritis, cardiovascular disease and cancer. In patients with periodontitis, a decrease in the diversity of the oral flora coincides with an increase in the frequency of E. gingivalis. A team of researchers, led by Prof. Dr. Arne Schäfer, Head of the Periodontology Research Unit at Charité's Institute of Dental and Craniofacial Sciences, was able to show that oral inflammation is associated with colonization by the oral parasite E. gingivalis.

Scientists have long been aware of the virulence potential of this genus of amoebae. The gastrointestinal parasite E. histolytica, for instance, causes a disease known as amebiasis, one of the most common causes of death from parasitic diseases worldwide. "We have shown that an amoeba like E. gingivalis, which colonizes the oral cavity, will invade the oral mucosa and destroy gingival tissue. This enables increased numbers of bacteria to invade the host tissue, which further exacerbates inflammation and tissue destruction," says Prof. Schäfer. The international team of researchers was the first to describe precise roles of E. gingivalis in the pathogenesis of inflammation. During their analysis of inflamed periodontal pockets, the researchers detected evidence of the amoeba in approximately 80 percent of patients with periodontitis, but in only 15 percent of healthy subjects. Their observations revealed that, after invading the gums, the parasites move within the tissue, feeding on and killing host cells. Cell culture experiments showed that infection with E. gingivalis slows the rate at which cells grow, eventually leading to cell death.

The researchers concluded that the amoeba's role in inflammation shows distinct parallels to the pathogenesis of amebiasis. "E. gingivalis actively contributes to cell destruction inside the gingival tissue and stimulates the same host immune response mechanisms as E. histolytica during its invasion of the intestinal mucosa," explains Prof. Schäfer. "This parasite, which is transmitted by simple droplet infection, is one potential cause of severe oral inflammation."

Treatment success is often short-lived in patients with periodontitis. This might be due to the high virulence potential of this previously unnoticed, yet extremely common amoeba. Summing up the results of the research, Prof. Schäfer says: "We identified one infectious parasite whose elimination could improve treatment effectiveness and long-term outcomes in patients with gum disease." He adds: "Current treatment concepts for periodontitis fail to consider the possibility of infection by this parasite or its successful elimination." A clinical trial is underway to determine the extent to which the elimination of this amoeba might improve treatment outcomes in patients with periodontitis.

Ouch: Patients prescribed opioids after tooth extraction report worse pain

The use of opioids to soothe the pain of a pulled tooth could be drastically reduced or eliminated altogether from dentistry, say University of Michigan researchers.

More than 325 dental patients who had teeth pulled were asked to rate their pain and satisfaction within six months of extraction. Roughly half of the study's patients who had surgical extraction and 39% who had routine extraction were prescribed opioids.

The U-M researchers compared the pain and satisfaction of those who used opioids to those who didn't.

"I feel like the most important finding is that patient satisfaction with pain management was no different between the opioid group and non-opioid group, and it didn't make a difference whether it was surgical or routine extraction," said study co-author Romesh Nalliah, clinical professor and associate dean for patient services at the U-M School of Dentistry.

Surprisingly, patients in the opioid group actually reported worse pain than the non-opioid group for both types of extractions, Nalliah said.

The researchers also found that roughly half of the opioids prescribed remained unused in both surgical and nonsurgical extractions. This could put patients or their loved ones at risk of future misuse of opioids if leftover pills are not disposed of properly.

The findings are scheduled to appear March 13 in JAMA Network Open.

"The real-world data from this study reinforces the previously published randomized-controlled trials showing opioids are no better than acetaminophen and nonsteroidal anti-inflammatory drugs for pain after dental extraction," said study co-author Chad Brummett, director of the Division of Pain Research and of Clinical Research in the Department of Anesthesiology at Michigan Medicine, U-M's academic medical center.

Brummett co-directs the Michigan Opioid Prescribing Engagement Network, or Michigan OPEN, which has developed, tested and shared guidelines for the use of opioids in patients with acute pain from surgery and medical procedures.

"These data support the Michigan OPEN prescribing recommendations calling for no opioids for the majority of patients after dental extractions, including wisdom teeth extraction," he said.

The results have big implications for both patients and dentists, and suggest prescribing practices need an overhaul, Brummett and Nalliah said.

The American Dental Association suggests limiting opioid prescribing to seven days' supply, but Nalliah believes that's too high.

"I think we can almost eliminate opioid prescribing from dental practice. Of course, there are going to be some exceptions, like patients who can't tolerate nonsteroidal anti-inflammatories," he said. "I would estimate we can reduce opioid prescribing to about 10% of what we currently prescribe as a profession."

For dentists, many of whom are sole proprietors, this new information means they needn't worry so much about unhappy patients changing practices if they aren't prescribed strong opioids. Alternatives such as nonsteroidal anti-inflammatory drugs or acetaminophen appear to control pain better, and patient satisfaction remains high.

Nalliah gives two possible reasons for this. First, dentists may have prescribed opioids in only the toughest cases, which would have resulted in more pain regardless.

"Or alternatively, and this is the reason I tend to accept, is that our study concurs with previous studies that suggest opioids are not the most effective analgesic for acute dental pain," Nalliah said.

"Dentists are torn between wanting to satisfy patients and grow business and limiting their opioid prescribing in light of the current crisis. I think it's an extremely liberating finding for dentists who can worry more about the most effective pain relief rather than overprescribing for opioids."

Dentists account for about 6% to 6.5% of U.S. opioid prescriptions -- a relatively small amount. But the study notes that dentists are among the most common prescribers for minors, and for many patients, dental opioid prescriptions are their first exposure.

Could the cure for IBD be inside your mouth?

A new collaborative study from the U-M Medical and Dental Schools reveals that inflammatory bowel disease (IBD), which included Crohn's disease and ulcerative colitis and afflicts an estimated 3 million adults in the U.S., may be the latest condition made worse by poor oral health.

Nobuhiko Kamada, Ph.D., assistant professor of internal medicine in the division of gastroenterology, has been studying the gut microbiome -- the collection of bacteria that are normally present in the gut -- for years. He noted an emerging link in research literature between an overgrowth of foreign bacterial species in the guts of people with IBD -- bacteria that are normally found in the mouth. "I decided to approach the dental school to ask the question, does oral disease affect the severity of gastrointestinal diseases?" says Kamada.

The new mouse study, published in Cell, shows two pathways by which oral bacteria appear to worsen gut inflammation.

In the first pathway, periodontitis, the scientific name for gum disease, leads to an imbalance in the normal healthy microbiome found in the mouth, with an increase of bacteria that cause inflammation. These disease-causing bacteria then travel to the gut.

However, this alone may not be enough to set off gut inflammation. The team demonstrated that oral bacteria may aggravate gut inflammation by looking at microbiome changes in mice with inflamed colons.

"The normal gut microbiome resists colonization by exogenous, or foreign, bacteria," says Kamada. "However, in mice with IBD, the healthy gut bacteria are disrupted, weakening their ability to resist disease-causing bacteria from the mouth." The team found that mice with both oral and gut inflammation had significantly increased weight loss and more disease activity.

In the second proposed pathway, periodontitis activates the immune system's T cells in the mouth. These mouth T cells travel to the gut where they, too, exacerbate inflammation. The gut's normal microbiome is held in balance by the action of inflammatory and regulatory T cells that are fine-tuned to tolerate the resident bacteria. But, says Kamada, oral inflammation generates mostly inflammatory T cells that migrate to the gut, where they, removed from their normal environment, end up triggering the gut's immune response, worsening disease.

"This exacerbation of gut inflammation driven by oral organisms that migrate to the gut has important ramifications in emphasizing to patients the critical need to promote oral health as a part of total body health and wellbeing," says co-author William Giannobile, DDS, the William K and Mary Anne Najjar professor of dentistry and chair of the department of periodontics and oral medicine at the U-M School of Dentistry.

The study has implications for novel treatments for IBD, necessary because "far too many patients still fail medications, leading to reduced quality of life and eventual surgery," says study co-author Shrinivas Bishu, M.D., assistant professor of gastroenterology. "This study importantly implies that clinical outcomes in IBD may be improved by monitoring oral inflammation -- an intriguing concept."

Harnessing pickle power to promote dental health

Can a probiotic derived from Chinese pickles prevent cavities? That seems to be the case, according to a study by researchers at Ben-Gurion University of the Negev and Chengdu University in China.

Pickles are an integral part of the diet in the southwest of China. When fruits and vegetables are fermented, healthy bacteria break down the natural sugars. These bacteria, also known as probiotics, not only preserve foods but offer numerous benefits, including immune system regulation, stabilization of the intestinal microbiota, reducing cholesterol levels, and now inhibiting tooth decay.

According to the study published in Frontiers in Microbiology, a strain of Lactobacilli (L. plantarum K41) found in Sichuan pickles reduced S. mutans by 98.4%. Dental caries (cavities) are caused by Streptococcus mutans, (S. mutans) commonly found in the human oral cavity as plaque and is a significant contributor to tooth decay.

Prof. Ariel Kushmaro of the BGU Avram and Stella Goldstein-Goren Department of Biotechnology Engineering and the Chinese research team evaluated 14 different types of Sichuan pickles from southwest China. They extracted 54 different strains of Lactobacilli and found that one, L. plantarum K41, significantly reduced the incidence and severity of cavities. K41 was also highly tolerant of acids and salts, an additional benefit as a probiotic for harsh oral conditions. It also could have potential commercial value when added to dairy products.

According to Doug Seserman, chief executive officer of American Associates, Ben-Gurion University of the Negev based in New York City, "the researchers currently have no plans to evaluate Jewish deli pickles."

How Seniors Can Prevent Tooth Loss?

Sadly, about 27% of seniors over the age of 65 have no remaining teeth, as per the NIDCR. A study by CW Douglas indicated that in 2000, 35.4 million people in the US wore dentures, and the number will increase to 37.9 million by 2020. The Silberg Center for Dental Science advises that loss of tooth among seniors has a lot of effects including affecting their social life adversely. Therefore, in your senior years, it is better to use natural and non-invasive ways to strengthen your teeth. Just like there are various ways to ensure that kids brush their teeth, there are specific constraints that seniors should heed to improve their dental health and more importantly, to beat tooth loss. Below are some natural and lifestyle tips that can help you in curbing the loss of teeth as you age.

What to know about dental veneers

Dental veneers help improve the appearance of a person’s teeth. They may be beneficial for people who want a long-term solution to persistent cosmetic concerns — particularly those that do not respond to other dental treatments, such as teeth whitening, braces, or retainers.

During the placement process, a dentist will typically remove a small amount of enamel, which is the thin protective outer covering of the teeth. Because of this, once the dentist places the veneers, a person cannot remove them or choose not to use them.

Dental veneers, crowns, and implants can all improve the cosmetic appearance of the teeth. However, there are differences between them.

One difference between veneers, crowns, and implants is the area of the tooth that each option covers.

Dental veneers mainly cover the front of a tooth. By contrast, crowns cover the entire tooth, including the front, back, and all the sides. As a result, dentists use crowns to repair broken teeth, including teeth that have little structure left. Crowns can also help strengthen the teeth they cover.

Implants, meanwhile, are bolt-like structures that attach to the jawbone to replace missing teeth.

When necessary, a dentist may use an implant to secure a crown in the mouth. This may be the case if a person is missing a tooth or a tooth is irreparable because it is too badly broken down and requires removal.

Essentially, dentists use crowns to build up teeth that are badly damaged, whereas implants replace missing teeth. Veneers improve the appearance of teeth that are mostly still intact.

What to know about sticking the tongue out

Sticking the tongue out can have many meanings. Children may use it as a sign of silliness, while people might do it to express disgust. A person may also stick their tongue out if they need to concentrate.

A baby who sticks their tongue out could be learning about their body, or it may indicate an underlying issue.

Some conditions have symptoms that can cause someone to stick their tongue out. These signs tend to accompany other symptoms, depending on the underlying issue.

Tongue microbes provide window to heart health

Microorganisms on the tongue could help diagnose heart failure, according to research presented today on HFA Discoveries, a scientific platform of the European Society of Cardiology (ESC).1

"The tongues of patients with chronic heart failure look totally different to those of healthy people," said study author Dr. Tianhui Yuan, No.1 Hospital of Guangzhou University of Chinese Medicine. "Normal tongues are pale red with a pale white coating. Heart failure patients have a redder tongue with a yellow coating and the appearance changes as the disease becomes more advanced."

"Our study found that the composition, quantity and dominant bacteria of the tongue coating differ between heart failure patients and healthy people," she said.

Previous research has shown that microorganisms in the tongue coating could distinguish patients with pancreatic cancer from healthy people.2 The authors of that study proposed this as an early marker to diagnose pancreatic cancer. And, since certain bacteria are linked with immunity, they suggested that the microbial imbalance could stimulate inflammation and disease. Inflammation and the immune response also play a role in heart failure.

Materials scientists drill down to vulnerabilities involved in human tooth decay

Researchers have cracked one of the secrets of tooth decay. The materials scientists are the first to identify a small number of impurity atoms in human enamel that may contribute to the material's strength but also make it more soluble. They also are the first to determine the spatial distribution of the impurities with atomic-scale resolution. The discovery could lead to a better understanding of human tooth decay as well as genetic conditions that affect enamel formation.

What Is Beauty?

This is the “golden ratio,”a.k.a. the “golden mean,”the “golden section,” and the “divine proportion.” It is a proportional relation obtained by dividing a line, or a plane figure, so that the shorter part is to the longer part as the longer part is to the whole. If you take a “golden rectangle” — one whose length-to-breadth is in the golden ratio — and snip out a square, what remains is another, smaller golden rectangle. What makes the golden ratio special to mathematicians is the number of properties it possesses. But what makes it extraordinary to the world is its relation to beauty. The golden ratio has been evoked through the ages to express perfection.

Examples abound. The Egyptians called it the “sacred ratio,” and applied it to the building of the pyramids.

The Greeks used it in the construction of the Parthenon. It is said that daVinci painted the face of the Mona Lisa to fit inside a golden rectangle. People like the architect Corbusier and the composer Bartók have consciously embodied it in their work. And daily in art and science classrooms students discover that geometric forms expressing the golden ratio are simply the most appealing to the eye.