Good Oral Hygiene May Protect Against Heart Infections
(BlackDoctor.org) — Taking good care of teeth and gums may be crucial in preventing heart valve infection, a U.S. study finds.
Researchers examined whether daily dental activities such as brushing were as likely as major dental procedures such as tooth extraction to cause infective endocarditis (IE), a dangerous infection of the lining of the heart or heart valve that can occur when bacteria enter the bloodstream.
In the study of 290 dental patients, researchers analyzed the amount of bacteria released into the bloodstream (bacteremia) during tooth brushing and tooth extraction, with and without antibiotics. Blood samples were taken from the patients before, during and after these activities, and analyzed for bacterial species associated with IE.
The researchers found the incidence of IE-related bacteremia from tooth brushing (23 percent) was closer to that of extraction than expected — 33 percent for extraction with antibiotics and 60 percent for extraction without antibiotics.
“This suggests that bacteria get into the bloodstream hundreds of times a year, not only from tooth brushing, but also from other routine activities like chewing food,” study author Peter Lockhart, chairman of the department of oral medicine at the Carolinas Medical Center in Charlotte, N.C., said in a prepared statement.
“While the likelihood of bacteremia is lower with brushing, these routine daily activities likely pose a greater risk for IE simply due to frequency: that is, bacteremia from brushing twice a day for 365 days a year versus once or twice a year for dental office visits involving teeth cleaning, or fillings or other procedures,” Lockhart said.
“For people who are not at risk for infections such as IE, the short-term bacteremia is nothing to worry about,” he noted.
“If you stop oral hygiene measures, the amount of disease in your mouth goes up considerably and progressively, and you’ll have far worse oral disease. It’s the gingival [gum] disease and dental caries [decay] that lead to chronic and acute infections such as abscesses. It’s that sort of thing that puts you at risk for frequent bacteremia, and presumably endocarditis if you have a heart or other medical condition that puts you at risk.”
Gum Care Helps Control Type 2 Diabetes and Its Complications
(BlackDoctor.org) — People with type 2 diabetes can help control the disease by taking better care of their teeth and gums.
That’s the case dentists were expected to make at the American Diabetes Association’s annual meeting in San Francisco this weekend.
“Several recent studies have shown that having periodontal disease makes those with type 2 diabetes more likely to develop worsened glycemic control, and puts them at much greater risk of end-stage kidney disease and death,” George W. Taylor, an associate professor of dentistry at the University of Michigan schools of Dentistry and Public Health, said in a prepared statement. “Given the numerous medical studies showing that good glycemic control results in reduced development and progression of diabetes complications, we believe there is the potential that periodontal treatment can provide an increment in diabetes control and subsequently a reduction in the risk for diabetes complications,” he said.
Intensive periodontitis intervention, for example, can significantly lower one’s levels of A1C, a measure of long-term glucose control.
“We have found evidence that the severity of periodontal disease is associated with higher levels of insulin resistance, often a precursor of type 2 diabetes, as well as with higher levels of A1C,” dentist Maria E. Ryan, director of clinical research at the Stony Brook University School of Dental Medicine in New York, said in a prepared statement.
Periodontal, or gum, disease is an infection and chronic inflammatory disease of the tissues surrounding and supporting the teeth. As it is painless, most people don’t know they have it, yet it is a major cause of tooth loss in adults.
Among the studies to be discussed linking gum disease and diabetes are:
A 1988-1994 U.S. population data study that found having periodontal disease put a person at twice the risk of having insulin resistance as those without such disease.
An unpublished Stony Brook University study of people displaying pre-diabetic insulin resistance that links the severity of a periodontal disease with their degree of insulin resistance. “We think periodontitis may adversely affect glycemic control, because the pro-inflammatory chemicals produced by the infection — such as IL-1 beta, IL-6 and TNF-alpha — could transfer from the gum tissue into the bloodstream and stimulate cells to become resistant to insulin,” Taylor said. “Then insulin resistance prevents cells in the body from removing glucose from the bloodstream for energy production.”
A set of studies of the Pima Indians in the Southwest, a population with a very high rate of type 2 diabetes. One found those with periodontitis were more than four times as likely to develop worsened glycemic control; another showed that those with severe gum disease had more than triple the risk of dying from diabetic nephropathy or ischemic heart disease than those with less severe periodontal disease.
A study, funded by the National Institutes of Health, that found a “statistically significant reduction” in A1C levels in people with type 2 diabetes after 15 months after routine periodontal treatment, Taylor said.
“When glycemia has been difficult to control, the physician might consider asking patients when they last saw their dentist, whether periodontitis has been diagnosed and, if so, whether treatment has been completed,” Ryan said. “A consultation with the dentist may be appropriate, to discuss whether periodontal treatment has been successful or whether a more intensive approach with oral or sub-antimicrobial antibiotics is in order because, just as it is difficult to control diabetes while the patient has an infected leg ulcer, the same applies when there’s infection and inflammation of the gums.”