Growing Link Between Diabetes And Periodontal Disease Focus Of National Gathering For Health Care Leaders
9/25/2007
Source: Institute for Oral Health
The Institute for Oral Health is sponsoring its second national conference for health care leaders, turning its focus on the growing link between periodontal disease and diabetes. The gathering on November 26-27 in Seattle will bring together academia, clinical practice and public health leaders to expand upon the current state of evidence and opportunities to improve treatment for these two related conditions.
"New ground is being broken on the diabetes and periodontal disease connection that could bring an improved quality of life to millions of people," said the Institute for Oral Health Director Dr. Ron Inge. "By exploring this relationship, there is tremendous potential for improving lives and impacting skyrocketing health care costs."
The Centers for Disease Control and Prevention estimates there are 20.8 million diabetics in the United States, making up 7 percent of the U.S. population. Of that, 14.6 million have been diagnosed, while 6.2 million have the disease but do not know it yet. Add to that another 54 million people who are pre-diabetic. Diabetes is suggested to represent 10 percent of the two trillion dollar health care cost in the U.S.
"Diabetes creates greater susceptibility to infections, a key factor in diabetes. Controlling periodontal disease may improve diabetic patients' response to insulin, increasing their chances for controlling this devastating condition -- improving their well being and reducing health care costs," said Dr. Inge.
Conference presenters will provide the current state of evidence supporting the association between diabetes and periodontal disease. They will also discuss the advantages patients have gained through treatment of both conditions and recommend coordinated treatment to improve the overall health of diabetic patients.
Conference on Periodontal Disease and Diabetes November 26 - 27, 2007 Grand Hyatt Seattle - Seattle, Washington
Tooth loss in elderly linked to mental impairment
9/18/2007
NEW YORK (Reuters Health) - Older people who have lost their teeth are at more than three-fold greater risk of memory problems and dementia, UK researchers report. "This study essentially raises questions rather than answering them," Dr. Robert Stewart of Kings College London, the study's lead author, told Reuters Health. "The measurements were taken at the same time, so we are not able to say what caused what."
It's possible that people with cognitive impairment simply take worse care of their teeth, he added, but there are also mechanisms by which poor dental health itself could harm the brain. "One message still stands regardless of what caused what," he said. "Particular attention may need to be paid to the health and nutrition of people with cognitive impairment because they may also have dental problems."
Stewart and his colleague Vasant Hirani at University College London looked at 2,463 men and women 65 and older who were living independently, as well as 1,569 elderly people residing in nursing homes. Among people living independently, 40 percent had no teeth, compared to 68 percent of those in nursing homes, the investigators report in the Journal of the American Geriatrics Society.
The researchers calculated that people with no teeth were at 3.57 times greater risk of having cognitive impairment than those who had some or all of their teeth. The relationship was only significant for people who lived independently, while there was no similar association among nursing home residents.
There are two possible ways that poor dental health might boost the risk of cognitive problems, Stewart noted.
"Firstly, dental disease often causes prolonged inflammation and infection in the mouth; both of these may alter some factors in the blood which might possibly cause problems in the brain," he explained.
"Secondly, people who lose a lot of teeth tend to alter their diet. There is a lot of interest at the moment in the association between diet and some forms of dementia, like Alzheimer's disease. If people move towards a less-balanced diet as a result of their loss of teeth, then this could result in vitamin deficiencies and other problems which might affect the brain."
More research is needed, Stewart and Hirani conclude, before a causative relationship can be proven or disproven. "However it is certainly a good idea for all sorts of reasons to take care of your teeth as you get older and to make sure that any problems are dealt with promptly by an appropriate specialist," Stewart said. "If you do lose teeth, you may find that you have to change your diet but it is important to make sure that it stays balanced. Your family doctor, dentist or a dietitian can advise on this."
SOURCE: Journal of the American Geriatrics Society, September 2007.
NYUCD study finds humans and their oral bacteria evolved from a common African ancestor.
3/24/2007
A New York University College of Dentistry (NYUCD) research team has found the first oral bacterial evidence supporting the dispersal of modern Homo sapiens out of Africa to Asia.
The team, led by Page Caufield, a professor of Cariology and Comprehensive Care at NYUCD, discovered that Streptoccocus mutans, a bacterium associated with dental caries, has evolved along with its human hosts in a clear line that can be traced back to a single common ancestor who lived in Africa between 100,000 and 200,000 years ago.
S. mutans is transmitted from mothers to infants, and first appears in an infant’s mouth at about two years of age. Caufield’s findings are reported in an article in the February issue of the Journal of Bacteriology.
In his analysis of the bacterium, Caufield used DNA fingerprints and other biomarkers that scientists have also employed to trace human evolution back to a single common African ancestor, known as “ancestral Eve.”
“As humans migrated around the world and evolved into the different races and ethnicities we know today,” Caufield said, “this oral bacterium evolved with them in a simultaneous process called coevolution.”
“It is relatively easy to trace the evolution of S. mutans, since it reproduces through simple cell division,” says Caufield, who gathered over 600 samples of the bacterium on six continents over the past two decades. His final analysis focused on over 60 strains of S. mutans collected from Chinese and Japanese; Africans; African-Americans and Hispanics in the United States; Caucasians in the United States, Sweden, and Australia; and Amazon Indians in Brazil and Guyana.
“By tracing the DNA lineages of these strains,” Caufield said, “We have constructed an evolutionary family tree with its roots in Africa and its main branch extending to Asia. A second branch, extending from Asia back to Europe, traces the migration of a small group of Asians who founded at least one group of modern-day Caucasians.”
Additional branches, tracing the coevolution of humans and bacteria from Asia into North and South America, will be drawn in the next phase of Caufield’s analysis.
Further Applications of the PDx Test®
Current research has indicated a link between periodontal diseases and systemic conditions, such as heart disease, diabetes, respiratory diseases and pre-term low-birth-weight babies - which is of great concern to all health professionals. The pharmacist needs to counsel individuals on the importance of controlling their disease state (cardiovascular, diabetes, respiratory). It is evident that pharmacists, physicians and dentists should improve their collaboration for the benefit of improving patient care.
This new concept of periodontal medicine influences the examination procedures, diagnosis, and the treatment of oral problems.
Periodontal diseases and the overall health of the patient may change the manner in which pharmacists, physicians and dentists are educated and interact.
 Cardiovascular Disease (CVD) is one of the most common medical conditions in patients with periodontitis. Patients with periodontitis have been documented to have a one-and-a-half to two times increased risk of coronary heart disease and are three times more likely to suffer a stroke than are those with minimal periodontal disease.
Also, there is a greater incidence of CVD in men under 50 years of age with periodontal diseases than those over 50. There is a one-and-a-half to two-fold greater risk of having a fatal heart attack in patients with periodontal disease than in patients without a periodontal infection.
Several theories have been proposed for these data, including the effect of bacteria on the cells involved in atherosclerosis. Oral bacteria such as Porphyromonas gingivalis induce aggregation of platelets through the binding of a specific surface protein.
Periodontal disease may soon be included in the list of risk factors for CVD, along with smoking, hypertension and high cholesterol.
Respiratory Disease: The course of bacterial pneumonia involves the aspiration of bacteria in the oral cavity, specifically the oropharyngeal area, into the lower respiratory tract. Pulmonary infection results when the host’s immune system cannot get rid of the colonizing bacteria. Certain Gram-negative bacteria found in pneumonia patients have also been cultivated in periodontal pockets.
Pneumonia is more prone to occur in hospitalized patients, alcoholics, smokers, the elderly, or patients with other health problems that suppress the immune system. These patients may have poor oral hygiene, and often harbor respiratory pathogens in their dental plaque.
Chronic obstructive pulmonary disease (COPD) occurs when there is an obstruction of airflow due to bronchitis or emphysema. One study has found that patients with periodontitis characterized by alveolar bone loss had an increased risk for COPD.
Premature Birth: Periodontal infections may be a risk factor for pre-term low-birth-weight (PLBW) babies. Considering periodontal diseases are, for the most part, preventable and treatable, the literature supports the importance of addressing periodontal problems promptly in women of childbearing age.
Mothers with periodontal disease have about an 8-fold greater chance of having PLBW babies than do mothers without periodontal diseases.
A proposed mechanism suggests a concentration-dependent relationship between increased maternal levels of prostaglandin E2 in the gingival fluid found in the pocket and PLBW. More research is needed to confirm how periodontal diseases may affect pregnancy outcomes. If it can be definitely determined that periodontal disease is a risk factor for PLBW babies, this may help to reduce the mortality associated with premature birth.
Diabetes Mellitus: Patients with diabetes mellitus (DM) are more at risk for periodontal diseases than are individuals without diabetes. Recent studies suggest that the relationship between periodontal diseases and DM goes both ways; periodontal disease may make it more difficult for people with diabetes to control their blood sugar. This puts the diabetic at increased risk for diabetic complications. Controlling periodontal disease may help patients control their diabetes.
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