CHICAGO—April 18, 2012—The American Academy of Periodontology (AAP) supports the American Heart Association’s (AHA) scientific statement “Periodontal Disease and Atherosclerotic Vascular Disease: Does the Evidence Support an Independent Association?” recently published in Circulation. The statement concludes that observational studies to date support an association between periodontal disease and cardiovascular disease, independent of shared risk factors. The AHA’s statement confirms the conclusions of the statements published by the AAP and the American Journal of Cardiology in 2009 and the U.S. Preventive Services Task Force in 2008.
While current research does not yet provide evidence of a causal relationship between the two diseases, scientists have identified biologic factors, such as chronic inflammation, that independently link periodontal disease to the development or progression of cardiovascular disease in some patients.
The lack of causal evidence should not diminish concern about the impact of periodontal status on cardiovascular health. According to Pamela McClain, DDS, president of the American Academy of Periodontology and a practicing periodontist in Aurora, Colorado, “Periodontal disease and cardiovascular disease are both complex, multi-factorial diseases that develop over time. It may be overly simplistic to expect a direct causal link. The relationship between the diseases is more likely to be mediated by numerous other factors, mechanisms, and circumstances that we have yet to uncover. However, as the AHA statement points out, the association is real and independent of shared risk factors. Patients and healthcare providers should not ignore the increased risk of heart disease associated with gum disease just because we do not have all the answers yet.”
The AAP believes additional long-term interventional studies are needed to better understand the specific nature of the relationship between periodontal disease and cardiovascular disease. Patients’ periodontal status should also be added to future longitudinal studies of cardiovascular disease. The AAP hopes that the American Heart Association’s statement brings attention to the association between the two diseases and the need for additional research in this area.
Dr. McClain encourages physicians and dentists to communicate the association between cardiovascular disease and periodontal disease to patients. “It is not as simple as telling a patient that brushing and flossing will ward off a heart attack,” says Dr. McClain. “Patients should be aware that by maintaining periodontal health, they are helping to reduce harmful inflammation in the body, which has been shown to reduce the risk of cardiovascular disease.”
Patients should expect to receive a comprehensive periodontal evaluation from their dental professional at least once a year, adds Dr. McClain. This includes a detailed examination of the teeth and gums, and an assessment of risk factors such as smoking, age, and overall health status. In addition, patients diagnosed with periodontal disease should be sure to inform their general health care provider and/or cardiologist to encourage better integration of their care.
“There is no compelling evidence to support that treating periodontal disease will reduce cardiovascular disease at this time,” says Dr. McClain, “but we do know that periodontal care will improve your oral health status, reduce systemic inflammation, and might be good for your heart as well.”
Twin study published in the Journal of Periodontology demonstrates that flossing can decrease the occurrence of gum disease-causing bacteria.
CHICAGO—August 5, 2008—In dental offices all over the world, patients are often told they are not flossing enough or instructed to floss more. As the old saying goes, you only need to floss the teeth you want to keep. After all, not flossing regularly can lead to tooth decay and to periodontal disease, the leading cause of tooth loss in adults.
A study published in the Journal of Periodontology (JOP), the official publication of theAmericanAcademy of Periodontology (AAP) demonstrates that including flossing as part of one’s routine oral care can actually help reduce the amount of gum disease-causing bacteria found in the mouth, therefore contributing to healthy teeth and gums.
The study, conducted atNew YorkUniversity, examined 51 sets of twins between the ages of 12 and 21. Each set was randomly assigned a two-week treatment regimen with one twin brushing with a manual toothbrush and toothpaste and the other twin brushing with a manual toothbrush and toothpaste and flossing. At the end of the two-week trial, samples were taken from both pairs of twins and compared for levels of bacteria commonly associated with periodontal disease.
The study findings indicated that those twins who did not floss had significantly more of the bacteria associated with periodontal disease when compared to the matching twin who flossed in addition to tooth-brushing with toothpaste.
“This study illustrates the impact flossing can have on oral health. The twins experimental model is a powerful tool to help sort out genetic and environmental factors that often confound the interpretation of treatment studies. This study demonstrates that flossing can have an important and favorable impact on an individual, as compared to that of a non-flossing individual with similar genetics and possibly similar habits,” explains Dr. Kenneth Kornman, editor or the Journal of Periodontology. “Twins tend to share the same or similar environmental factors such as dietary habits, health and life practices, as well as genetics. In this case, the only difference was flossing, and the outcome was significant. Flossing may significantly reduce the amount of bad bacteria in the mouth.”
The study results support that old saying, and show that including flossing as an integral part of your regular oral care can help reduce the amount of periodontal disease-causing bacteria in the mouth, thereby helping you keep your teeth. Periodontal disease is an infection caused by a build-up of bacterial plaque, a sticky, colorless film that constantly forms on your teeth. Flossing, or using interdental cleaners, helps clean the bacterial plaque from between your teeth that regular brushing can’t reach.
“As a practicing periodontist, I am constantly telling my patients to clean between their teeth more using dental floss or interdental cleaners,” says Dr. Susan Karabin, President of the AAP. “Patients tend to think that flossing can’t possibly make that much of a difference. But this study demonstrates that the addition of flossing to your dental hygiene routine can significantly reduce the amount of periodontal disease causing bacteria. Even after just two weeks!”
CHICAGO—December 12, 2011—Routine tooth brushing and flossing and regular check-ups by a dental professional remain the cornerstone of a healthy mouth. However, according to the American Academy of Periodontology (AAP), pairing a few well-known healthy-lifestyle habits with your daily oral health regimen may also help reduce your risk for periodontal disease.
Periodontal disease is a chronic inflammatory disease that affects the gum tissue and other structures supporting the teeth. According to Dr. Pamela McClain, President of the American Academy of Periodontology and a practicing periodontist in Aurora, Colorado, “If left untreated, periodontal disease can lead to tooth loss and may also interfere with other systems of the body. Several research studies have indicated that one’s periodontal health may be related to overall health. Therefore, it is crucial that you do everything you can to establish good periodontal health.”
According to the AAP, the following tips may help sustain healthy teeth and gums while also helping you live an overall healthy lifestyle:
- Eat and drink up. It is well known that eating a balanced diet leads to proper nutrition and helps keep the body running effectively. Studies published in the Journal of Periodontology (JOP) have also shown that certain foods can promote teeth and gum health. Foods containing omega-3, calcium, vitamin D and even honey have all been shown to reduce the incidence or severity of periodontal disease.
- Hit the gym. Frequent exercise is a recognized way to avoid being overweight, and it may ultimately reduce your risk of periodontal disease. In a study published in the Journal of Periodontology, researchers found that subjects who maintained a healthy weight and had high levels of physical fitness had a lower incidence of severe periodontitis than those that did not exercise.
- Stress less. Stress can lead to a variety of health complications, including periodontal disease. Research published in the JOP showed a relationship between stress and periodontal disease. Increased levels of cortisol, which the body releases when experiencing stress, can intensify the destruction of the gums and bone due to periodontal disease. In addition, another JOP study indicated that people experiencing stress are more likely to neglect their oral hygiene.
- Kick the habit. Smoking is not only a leading cause of respiratory and cardiovascular disease in the United States, it is also a major risk factor for periodontal disease. Several research studies have shown that smoking not only increases the chance of developing periodontal disease, but it can also affect the success of treatments for existing periodontal disease.
- See the doctor. Regular check-ups by a physician can help with early diagnosis of several health issues, including periodontal disease. A large body of research associates gum disease with other chronic inflammatory diseases such as diabetes, cardiovascular disease, and rheumatoid arthritis. Therefore, by screening for systemic disease early and receiving any needed treatment, you may also benefit your periodontal health.
Dr. McClain stresses that while these tips may contribute to healthy teeth and gums, the benefit of routine oral care cannot be discounted. “Taking good care of your periodontal health starts with daily tooth brushing and flossing. You should also expect to get a comprehensive periodontal evaluation, or CPE, every year,” she advises. A dental professional, such as a periodontist, a specialist in the diagnosis, treatment and prevention of gum disease, can conduct a comprehensive exam to assess your periodontal health.
A study published in the Journal of Periodontology found that current and past users of the contraceptive depot medroxyprogesterone acetate (DMPA) had increased markers of poor periodontal health compared to women who have never used it.
CHICAGO—February 6, 2012—Injectable progesterone contraceptives may be associated with poor periodontal health, according to research in the Journal of Periodontology. The study found that women who are currently taking depot medroxyprogesterone acetate (DMPA) injectable contraceptive, or have taken DMPA in the past, are more likely to have indicators of poor periodontal health, including gingivitis and periodontitis, than women who have never taken the injectable contraceptive. DMPA is a long-lasting progestin-only injectable contraceptive administered intermuscularly every three months.
Periodontal disease is a chronic inflammatory disease that affects the gum tissue and bone that supports the teeth. Gingivitis, the mildest form of gum disease, causes the gums to become red, swollen, and bleed easily. Periodontitis is the most severe form of gum disease and can lead to tooth loss. Additionally, research has associated gum disease with other chronic inflammatory diseases such as diabetes, cardiovascular disease, and rheumatoid arthritis.
The data for this study were obtained from the NHANES 1999-2004 public use datasets. The participants chosen were non-pregnant, premenopausal women aged 15-44 who had provided complete DMPA usage data, indicating current usage of DMPA, past usage of DMPA, or no usage of DMPA at all. All participants received a dental examination that noted clinical attachment (CA) loss, periodontal pocket assessment at two or three sites per tooth, and presence of gingival bleeding.
After adjusting for age, race, education, poverty income level, and smoking status, the study found that current and past DMPA users had significantly increased periodontal pockets, gingival bleeding, and CA loss than women who have never used DMPA. Current DMPA users were more likely to have gingivitis, while past DMPA users were more likely to have periodontitis.
According to Dr. Pamela McClain, President of the American Academy of Periodontology (AAP) and a practicing periodontist in Aurora, Colorado, women currently taking DMPA or that have used DMPA in the past should pay careful attention to their teeth and gums. “Hormones can play a role in woman’s periodontal health. These findings suggest that women that use, or have used, a hormone-based injectable contraception such as DMPA may have increased odds of poor periodontal health. I would encourage women that use or previously used this form of contraception to maintain excellent oral care, and to be sure to see a dental professional for a comprehensive periodontal evaluation on an annual basis.”
More than 500 medications can contribute to oral dryness, including antihistamines (for allergy or asthma), antihypertensive medications (for blood pressure), decongestants, pain medications, diuretics and antidepressants.
CHICAGO—August 11, 2011—Leading dental and pharmacy organizations are teaming up to promote oral health and raise public awareness of dry mouth, a side effect commonly caused by taking prescription and over-the-counter medications. More than 500 medications can contribute to oral dryness, including antihistamines (for allergy or asthma), antihypertensive medications (for blood pressure), decongestants, pain medications, diuretics and antidepressants. In its most severe form, dry mouth can lead to extensive tooth decay, mouth sores and oral infections, particularly among the elderly. Nearly half of all Americans regularly take at least one prescription medication daily, including many that produce dry mouth, and more than 90 percent of adults over age 65 do the same. Because older adults frequently use one or more of these medications, they are considered at significantly higher risk of experiencing dry mouth.
The American Dental Association (ADA), Academy of General Dentistry (AGD), American Academy of Periodontology (AAP) and the American Pharmacists Association (APhA) are collaborating to expand awareness of the impact of medications on dry mouth, a condition known to health professionals as xerostomia.
With regular saliva production, your teeth are constantly bathed in a mineral-rich solution that helps keep your teeth strong and resistant to decay. While saliva is essential for maintaining oral health and quality of life, at least 25 million Americans have inadequate salivary flow or composition, and lack the cleansing and protective functions provided by this important fluid. “Each day, a healthy adult normally produces around one-and-a-half liters of saliva, making it easier to talk, swallow, taste, digest food and perform other important functions that often go unnoticed,” notes Dr. Fares Elias, immediate past president, Academy of General Dentistry. “Those not producing adequate saliva may experience some common symptoms of dry mouth.”
Five-year follow-up study observed marginal bone remodeling occurs between implant placement and prosthesis placement.
CHICAGO—May 11, 2009—Dental implants are frequently used as a replacement for missing teeth in order to restore the patient’s tooth function and appearance. Previous research demonstrates that the placement of a dental implant disrupts the host tissue in the area of the implant, so practitioners often focus their treatment planning to carefully maintain the patient’s bone and gum tissue surrounding the implant. A study published in the Journal of Periodontology found that the majority of bone remodeling occurred in the time between the implant placement and final prosthesis placement.
Subsequently, little mean bone change was observed in the five years following the implant placement, independent of type of restoration or implant length. The study, conducted at the University of Texas Health Science Center at San Antonio, evaluated 596 dental implants placed in 192 patients over the age of 18. Patients were screened for adequate oral hygiene and bone volume. Exclusion criteria included heavy smoking, chewing tobacco use, drug abuse, and untreated periodontal disease, amongst others.
Study author Dr. David Cochran, DDS, PhD, Chair of the Department of Periodontics at the University of Texas Health Science Center at San Antonio, and President of the American Academy of Periodontology (AAP), believes that this study provides additional support for the use of dental implants to replace missing teeth. “As a periodontist, I am committed to saving my patients’ natural dentition whenever possible. However, the results of this study help further indicate that a dental implant is an effective and dependable tooth replacement option. Since the patient’s host tissue surrounding the dental implant largely remains unchanged in the five years following placement, the dental team can now focus on periodic assessment and treatment of other areas in the mouth as needed, and know that the implant is doing its job as a viable substitute solution.”
A low-calcium diet can harm the supporting structures around teeth and gums, especially for nursing mothers
CHICAGO – January 9, 2007 – Mothers who breastfeed should be sure to have enough calcium in their diet, or they may risk bone loss around their teeth and gums, according to a study that appears in the January 2007 issue of the Journal of Periodontology (JOP).
Researchers from Tohoku University in Japan investigated if lactation affects alveolar bone loss, the bone surrounding the roots of teeth, in rat models of experimental periodontitis. They found mothers who are lactating could put the bone structures around their teeth at risk, especially when there was not enough calcium in their diet.
“Our research emphasized the importance of having a high-calcium diet while breast-feeding,” said Dr. Kanako Shoji, Division of Periodontology and Endodontology at Tohoku University. “While our study was on a rat population, the evidence confirmed that breastfeeding can cause increased bone loss in the mother, especially when the mother has insufficient calcium intake. But additional studies in human populations are necessary to confirm these findings.”
The study showed that all groups with insufficient Calcium intake saw an acute inflammatory reaction in periodontal tissues and disruption of the gingival epithelium, the tissues surrounding the teeth, in addition to increased attachment loss, and increased alveolar bone loss. Those groups which were lactating saw even greater attachment loss and bone loss.
“We know a high-Calcium diet can promote healthy teeth and gums,” said Dr. Preston D. Miller, DDS, President of the American Academy of Periodontology, “But this research indicates that nursing mothers should be especially conscious of having enough Calcium in their diet. While breast milk is critical to their baby’s bone development, mothers should be sure to have enough calcium, or risk bone loss in her mouth, which can worsen periodontal diseases. Given that a thorough periodontal evaluation should be done as soon as a woman finds out that she is pregnant, monitoring periodontal tissues, including more frequent cleanings during pregnancy and continuing until 3 months after delivery, will help assure periodontal health.”
Smokers with dental implants saw implants fail at higher rate than nonsmokers
CHICAGO —February 6, 2007—Smoking can harm the integrity of dental implants and cause them to fail more often than in a nonsmoker, according to a study in the February 2007 issue of the Journal of Periodontology (JOP).
Researchers from University of Murcia in Spain investigated if smoking impacts the ability of a dental implant to succeed. They found that smoking is a risk factor with regard to tooth loss and dental implant failure.
“People who smoke are at a greater risk of infection following surgery, and may heal more slowly,” said Dr. Arturo Sanchez Perez, Department of Periodontology at the University of Murcia. “When an implant is placed in a smoker, it is more likely to fail. This means a patient’s smile may be negatively affected, and the potential for more bone loss in the areas surrounding the gums and teeth.”
Smoking negatively affects blood flow to the bone and tissues surrounding the gums and teeth, which impairs bone healing. Implants fail because of a failure to integrate with the surrounding bone tissues. The study followed 66 patients over 5 years, who received 165 implants. They found that 15.8% of implants failed in smokers, versus 1.4% of implants in non-smokers.
“Tobacco use has been shown to be a risk factor for periodontal diseases, which is the main cause of tooth loss in adults,” said Dr. Preston D. Miller, DDS, President of the American Academy of Periodontology, “This research shows that if you want your dental implant to last, you should not smoke. Also, the treating dentist should make sure their patients are aware of this before placing an implant, and emphasize the importance of quitting smoking.”
Research findings link secondhand smoke with bone loss in subjects with periodontitis.
CHICAGO –April 3, 2007 –A study published in 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 any 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, D.D.S.
“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 night clubs, bars and even some restaurants,” said Dr. Preston D. Miller, 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.”
Cigarette smoking may well be the major preventable risk factor for periodontal disease.
CHICAGO—August 2, 2010—The health complications of being overweight, such as increased risk of heart disease, Type 2 diabetes and certain cancers, have long been reported. Health care professionals often urge patients to manage their weight and strive to get physical exercise each day to achieve and maintain overall health. And now, researchers have now uncovered another benefit of maintaining a fit lifestyle: healthy teeth and gums.
In a study published in the August issue of the Journal of Periodontology, researchers found that subjects who maintained a healthy weight and had high levels of physical fitness had a lower incidence of severe periodontitis. Using body mass index (BMI) and percent body fat as a measure of weight control, and maximal oxygen consumption (VO2max) as a measure of physical fitness, researchers compared subjects’ weight and fitness variables with the results of a periodontal examination. Those with the lowest BMI and highest levels of fitness had significantly lower rates of severe periodontitis.
Periodontitis, or gum disease, is a chronic inflammatory disease that affects the supporting bone and tissues around the teeth. Gum disease is a major cause of tooth loss in adults, and research has suggested gum disease is associated with other diseases, such as heart disease, diabetes, and rheumatoid arthritis.
Samuel Low, DDS, MS, Associate Dean and professor of periodontology at the University of Florida College of Dentistry, and President of the American Academy of Periodontology (AAP), says that research connecting overall health and periodontal health should motivate people to maintain a healthy weight and get enough physical fitness.
“Research continues to demonstrate that our overall health and oral health are connected,” says Dr. Low. “Weight management and physical fitness both contribute to overall health; and now we believe staying in shape may help lower your risk of developing gum disease. Since gum disease is related to other diseases, such as cardiovascular disease and diabetes,” continues Dr. Low, “There is even more reason to take care of yourself through diet and exercise.”
Dr. Low also encourages comprehensive periodontal care through daily tooth brushing and flossing, and routine visits to a dental professional, such as a periodontist, a specialist in the diagnosis, treatment and prevention of gum disease.