Periodontal DiseaseJanet M. Torpy, MD, Writer; Alison E. Burke, MA, Illustrator; Richard M. Glass, MD, Editor
KEYWORDS: PERIODONTAL DISEASES.
Periodontal disease (unhealthy gums and teeth) often reflects serious health risks. Mild inflammation of the gums (gingivitis) can be prevented by regularly brushing and flossing teeth to remove plaque (buildup of a film on the teeth). This stops the development of tartar (hardened accumulation of plaque at the gum line), which can only be removed by dental cleaning. More serious infection, called periodontitis, can cause not only disease of the gums, but loss of teeth and the bone structures that support the teeth. Periodontitis may be associated with heart disease, stroke, and systemic (whole body) infections. There is also evidence that premature births happen more often to women who have gum disease before or during their pregnancies. The February 6, 2008, issue of JAMA includes an article about an association between periodontal disease and smoking marijuana.
Next SectionCAUSES•Poor dental hygiene—not brushing your teeth or using dental floss regularly—allows the buildup of plaque and tartar, making the gum tissue unhealthy.
•Smoking causes decreased oxygen delivery to the gum tissue and makes it easier for bacteria to invade the gums.
•Some medications may cause gingival hyperplasia (overgrowth of gum tissue) or receding gums.
•Viral or fungal infection
•Poor nutrition, especially vitamin and mineral deficiencies, may cause gum disease or loss of teeth.
•Chronic medical conditions, including diabetes, may lead to greater risk of infections or poor healing in the gums as well as in other body tissues.
Previous SectionNext SectionSIGNS AND SYMPTOMS
•Receding or puffy, swollen gums
•Painful gums
•Bleeding when you brush your teeth
•Tooth loss or loose teeth in adults
•Pus draining from the gums
•Bad breath that is not related to food and does not go away
Previous SectionNext Section
PREVENTION AND TREATMENT•Brush your teeth at least twice a day.
•Use dental floss daily.
•Periodontitis does not cause symptoms initially, so it is important to have regular dental checkups.
•Maintain good nutrition by eating fruits, vegetables, and whole grains and making sure your diet contains plenty of calcium.
•Do not smoke
•Control chronic medical problems, especially diabetes (maintaining normal blood sugar levels decreases your risk of infection).
•In severe cases of periodontitis, advanced dental treatments may be offered, including gum surgery, bone grafts, or placement of antibiotics into the gum tissue itself.
Previous SectionNext SectionFOR MORE INFORMATION•American Dental Association
http://www.ada.org/
•National Institute of Dental and Craniofacial Research
http://www.nidcr.nih.gov/
•American Heart Association
http://www.americanheart.org/
Previous Section INFORM YOURSELFTo find this and previous JAMA Patient Pages, go to the Patient Page link on JAMA's Web site at http://www.jama.com. Many are available in English and Spanish.
Sources: National Institute of Dental and Craniofacial Research, American Dental Association, American Heart Association
The JAMA Patient Page is a public service of JAMA. The information and recommendations appearing on this page are appropriate in most instances, but they are not a substitute for medical diagnosis. For specific information concerning your personal medical condition, JAMA suggests that you consult your physician. This page may be photocopied noncommercially by physicians and other health care professionals to share with patients. To purchase bulk reprints, call 203/259-8724.
Dr. James Miller is a Scottsdale, Arizona general dentist who uses the LANAP procedure utilizing the Periolase MVP-7 laser to treat gum disease. For more information www.drjamesmiller.com/lanap.html
Thursday, January 13, 2011
Thursday, December 30, 2010
The Mouth-Body Connection: 6 Ways Oral Hygiene Helps Keep You Well
Taking good care of your mouth -- teeth and gums -- does more than help ensure you have a bright, white smile.
A healthy mouth and healthy body go hand in hand. Good oral hygiene and oral health can improve your overall health, reducing the risk of serious disease and perhaps even preserving your memory in your golden years. The phrase "healthy mouth, healthy you" really is true -- and backed by growing scientific evidence.
Recommended Related to Oral Health
Posttransplantation Dental Treatment
Caution should be given relative to oral treatment for transplant patients for at least the first year posttransplant. Even though hematologic parameters including complete blood count and differential may be documented as within normal limits, functional abnormalities may still be present. Patients should not resume routine dental treatment, including dental scaling and polishing, until adequate immunologic reconstitution has occurred; this includes recovery from graft-versus-host disease. The...
It's never too early to start teaching your children to take care of teeth and gums -- healthy habits learned in childhood can pay off in adulthood. And, if you're tempted to shrug off your good oral hygiene habits -- brushing, flossing, and seeing your dentist regularly -- remember that you're a role model for your kids. Keep in mind these six ways having healthy teeth and gums helps boost overall health.
Boosts Your Self-esteem and Confidence
Decayed teeth and gum disease are often associated not only with an unsightly mouth but very bad breath -- so bad it can affect your confidence, self-image, and self-esteem. With a healthy mouth that's free of gum disease and cavities, your quality of life is also bound to be better -- you can eat properly, sleep better, and concentrate with no aching teeth or mouth infections to distract you.
May Lower Risk of Heart Disease
Chronic inflammation from gum disease has been associated with the development of cardiovascular problems such as heart disease, blockages of blood vessels, and strokes.
Experts stop short of saying there is a cause-and-effect between gum disease and these other serious health problems, but the link has shown up in numerous studies. The findings of these studies may suggest that maintaining oral health can help protect overall health.
Preserves Your Memory
Adults with gingivitis (swollen, bleeding gums) performed worse on tests of memory and other cognitive skills than did those with healthier gums and mouths, according to a report in the Journal of Neurology, Neurosurgery & Psychiatry.
Those with gingivitis were more likely to perform poorly on two tests: delayed verbal recall and subtraction -- both skills used in everyday life.
Reduces Risks of Infection and Inflammation in Your Body
Poor oral health has been linked with the development of infection in other parts of the body. In one study, poor oral hygiene and periodontal disease was associated with the development of pneumonia in older people. Bacteria in the mouth can travel into the lungs, causing infection or worsening of lung conditions.
Other research has found an association between gum disease and rheumatoid arthritis, an autoimmune disease that causes inflammation of the joints. Experts say the mechanism of destruction of connective tissues in both gum disease and RA is similar. Eating a balanced diet, seeing your dentist regularly, and good oral hygiene helps reduce your risks of tooth decay and gum disease. Make sure you brush twice a day and floss once a day. Using an antibacterial mouthwash or toothpaste can help reduce bacteria in the mouth that can cause gingivitis.
Helps Keep Blood Sugar Stable if You Have Diabetes
People with uncontrolled diabetes often have gum disease. Having diabetes can make you less able to fight off infection, including gum infections that can lead to serious gum disease.
And some experts have found that if you have diabetes, you are more likely to develop more severe gum problems than someone without diabetes.
That, in turn, may make it more difficult to control blood sugar levels.
Reducing your risk of gingivitis by protecting your oral health may help with blood sugar control if you have been diagnosed with diabetes.
Helps Pregnant Women Carry a Baby to Term
Women may experience increased gingivitis during pregnancy. Some research suggests a relationship between gum disease and preterm, low-birth-weight infants.
Not all studies have found a solid link, but maintaining good oral health is still the best goal. If you're pregnant, visit your dentist or periodontist as part of your prenatal care. Consider it good practice for the role modeling that lies ahead for all new parents.
Dr. James Miller is a Scottsdale AZ Family dentist http://www.drjamesmiller.com/lanap.html
Taking good care of your mouth -- teeth and gums -- does more than help ensure you have a bright, white smile.
A healthy mouth and healthy body go hand in hand. Good oral hygiene and oral health can improve your overall health, reducing the risk of serious disease and perhaps even preserving your memory in your golden years. The phrase "healthy mouth, healthy you" really is true -- and backed by growing scientific evidence.
Recommended Related to Oral Health
Posttransplantation Dental Treatment
Caution should be given relative to oral treatment for transplant patients for at least the first year posttransplant. Even though hematologic parameters including complete blood count and differential may be documented as within normal limits, functional abnormalities may still be present. Patients should not resume routine dental treatment, including dental scaling and polishing, until adequate immunologic reconstitution has occurred; this includes recovery from graft-versus-host disease. The...
It's never too early to start teaching your children to take care of teeth and gums -- healthy habits learned in childhood can pay off in adulthood. And, if you're tempted to shrug off your good oral hygiene habits -- brushing, flossing, and seeing your dentist regularly -- remember that you're a role model for your kids. Keep in mind these six ways having healthy teeth and gums helps boost overall health.
Boosts Your Self-esteem and Confidence
Decayed teeth and gum disease are often associated not only with an unsightly mouth but very bad breath -- so bad it can affect your confidence, self-image, and self-esteem. With a healthy mouth that's free of gum disease and cavities, your quality of life is also bound to be better -- you can eat properly, sleep better, and concentrate with no aching teeth or mouth infections to distract you.
May Lower Risk of Heart Disease
Chronic inflammation from gum disease has been associated with the development of cardiovascular problems such as heart disease, blockages of blood vessels, and strokes.
Experts stop short of saying there is a cause-and-effect between gum disease and these other serious health problems, but the link has shown up in numerous studies. The findings of these studies may suggest that maintaining oral health can help protect overall health.
Preserves Your Memory
Adults with gingivitis (swollen, bleeding gums) performed worse on tests of memory and other cognitive skills than did those with healthier gums and mouths, according to a report in the Journal of Neurology, Neurosurgery & Psychiatry.
Those with gingivitis were more likely to perform poorly on two tests: delayed verbal recall and subtraction -- both skills used in everyday life.
Reduces Risks of Infection and Inflammation in Your Body
Poor oral health has been linked with the development of infection in other parts of the body. In one study, poor oral hygiene and periodontal disease was associated with the development of pneumonia in older people. Bacteria in the mouth can travel into the lungs, causing infection or worsening of lung conditions.
Other research has found an association between gum disease and rheumatoid arthritis, an autoimmune disease that causes inflammation of the joints. Experts say the mechanism of destruction of connective tissues in both gum disease and RA is similar. Eating a balanced diet, seeing your dentist regularly, and good oral hygiene helps reduce your risks of tooth decay and gum disease. Make sure you brush twice a day and floss once a day. Using an antibacterial mouthwash or toothpaste can help reduce bacteria in the mouth that can cause gingivitis.
Helps Keep Blood Sugar Stable if You Have Diabetes
People with uncontrolled diabetes often have gum disease. Having diabetes can make you less able to fight off infection, including gum infections that can lead to serious gum disease.
And some experts have found that if you have diabetes, you are more likely to develop more severe gum problems than someone without diabetes.
That, in turn, may make it more difficult to control blood sugar levels.
Reducing your risk of gingivitis by protecting your oral health may help with blood sugar control if you have been diagnosed with diabetes.
Helps Pregnant Women Carry a Baby to Term
Women may experience increased gingivitis during pregnancy. Some research suggests a relationship between gum disease and preterm, low-birth-weight infants.
Not all studies have found a solid link, but maintaining good oral health is still the best goal. If you're pregnant, visit your dentist or periodontist as part of your prenatal care. Consider it good practice for the role modeling that lies ahead for all new parents.
Dr. James Miller is a Scottsdale AZ Family dentist http://www.drjamesmiller.com/lanap.html
Wednesday, December 29, 2010
Sex Hormones May Explain Higher Incidence of Periodontal Disease in Men
Science News Share Blog Cite Print Bookmark Email
Sex Hormones May Explain Higher Risk of Gum Disease in Men
ScienceDaily (Nov. 1, 2010) — Sex hormones may be the biological reason why men are at greater risk than women for destructive periodontitis, an infection of the gums, according to researchers at the University of Maryland Dental School.
--------------------------------------------------------------------------------
See Also:
Health & Medicine
•Dentistry
•Chronic Illness
•Diseases and Conditions
•Parkinson's Research
•Alzheimer's Research
•Joint Pain
Reference
•Periodontal disease
•Hormone replacement therapy
•Human skeleton
•Hysterectomy
To establish better management and risk assessment models for periodontal disease, Harlan Shiau, DDS, DMedSc, assistant professor, and Mark Reynolds, DDS, PhD, MA, professor at the Dental School, have published the first comprehensive review of gender differences in the development and progression of the destructive periodontal disease.
In a review paper in the Journal of Periodontology, the authors examine evidence for a biologic basis for a sexual dimorphism, or the differences in susceptibility, to periodontal disease between men and women. They conclude that sex steroids exert effects on multiple ways on the immune system regulation of inflammation. They also conclude that the root of the difference may be genetic.
"Differential gene regulation, particularly in sex steroid-responsive genes, could likely play a part in the observed sexual dimorphism of destructive periodontal disease," said Shiau.
"We think it is a plausible explanation," he added. The observation of men "having worse gum disease than women" was generally accepted by dental clinicians previously, says Shiau, "but we wondered if the traditional explanations were adequate. This study provides health care professionals with important comparative data for estimating gender-related differences in risk for destructive periodontal disease."
Prior to the current review paper, the researchers conducted a systematic review of published population studies on the prevalence of periodontal disease. In their analysis they established that men, indeed, have a greater prevalence of periodontal disease than women globally.
Shiau and Reynolds explored potential biologic explanations by drawing from the extensive body of literature in autoimmune disease research, where there also exists sexual dimorphism in disease prevalence.
"Also, we considered the competing hypothesis that the environment explains the dimorphism, such as the observation that men have worse oral hygiene and compliance than women. However, there exist population studies, which control for potential co-variants, like these, and have still yielded significant gender effects." Shiau explains.
"The innate immune response plays a considerable role in the pathogenesis of periodontal disease. The literature seems to indicate that a heightened innate immune response in men compared to women, as well as potential differences in regulation of amplification and termination of inflammation, provide a sound biologic basis for sex differences in periodontal disease progression," says Shiau.
Email or share this story:
More
--------------------------------------------------------------------------------
Story Source:
The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by University of Maryland Baltimore.
--------------------------------------------------------------------------------
Journal Reference:
1.Harlan J. Shiau, Mark A. Reynolds. Sex Differences in Destructive Periodontal Disease: Exploring the Biological Basis. Journal of Periodontology, 2010; : 100701094910009 DOI: 10.1902/jop.2010.100045
For more information on gum disease and it treatment www.drjamesmiller.com/lanap.html
Sex Hormones May Explain Higher Risk of Gum Disease in Men
ScienceDaily (Nov. 1, 2010) — Sex hormones may be the biological reason why men are at greater risk than women for destructive periodontitis, an infection of the gums, according to researchers at the University of Maryland Dental School.
--------------------------------------------------------------------------------
See Also:
Health & Medicine
•Dentistry
•Chronic Illness
•Diseases and Conditions
•Parkinson's Research
•Alzheimer's Research
•Joint Pain
Reference
•Periodontal disease
•Hormone replacement therapy
•Human skeleton
•Hysterectomy
To establish better management and risk assessment models for periodontal disease, Harlan Shiau, DDS, DMedSc, assistant professor, and Mark Reynolds, DDS, PhD, MA, professor at the Dental School, have published the first comprehensive review of gender differences in the development and progression of the destructive periodontal disease.
In a review paper in the Journal of Periodontology, the authors examine evidence for a biologic basis for a sexual dimorphism, or the differences in susceptibility, to periodontal disease between men and women. They conclude that sex steroids exert effects on multiple ways on the immune system regulation of inflammation. They also conclude that the root of the difference may be genetic.
"Differential gene regulation, particularly in sex steroid-responsive genes, could likely play a part in the observed sexual dimorphism of destructive periodontal disease," said Shiau.
"We think it is a plausible explanation," he added. The observation of men "having worse gum disease than women" was generally accepted by dental clinicians previously, says Shiau, "but we wondered if the traditional explanations were adequate. This study provides health care professionals with important comparative data for estimating gender-related differences in risk for destructive periodontal disease."
Prior to the current review paper, the researchers conducted a systematic review of published population studies on the prevalence of periodontal disease. In their analysis they established that men, indeed, have a greater prevalence of periodontal disease than women globally.
Shiau and Reynolds explored potential biologic explanations by drawing from the extensive body of literature in autoimmune disease research, where there also exists sexual dimorphism in disease prevalence.
"Also, we considered the competing hypothesis that the environment explains the dimorphism, such as the observation that men have worse oral hygiene and compliance than women. However, there exist population studies, which control for potential co-variants, like these, and have still yielded significant gender effects." Shiau explains.
"The innate immune response plays a considerable role in the pathogenesis of periodontal disease. The literature seems to indicate that a heightened innate immune response in men compared to women, as well as potential differences in regulation of amplification and termination of inflammation, provide a sound biologic basis for sex differences in periodontal disease progression," says Shiau.
Email or share this story:
More
--------------------------------------------------------------------------------
Story Source:
The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by University of Maryland Baltimore.
--------------------------------------------------------------------------------
Journal Reference:
1.Harlan J. Shiau, Mark A. Reynolds. Sex Differences in Destructive Periodontal Disease: Exploring the Biological Basis. Journal of Periodontology, 2010; : 100701094910009 DOI: 10.1902/jop.2010.100045
For more information on gum disease and it treatment www.drjamesmiller.com/lanap.html
Monday, December 27, 2010
Gum Disease and Heart Health
Font SizeA A A 1 2
Next »
Periodontal Disease and Heart Health
Heart Disease (Coronary Artery Disease) Slideshow Pictures
Dental Dangers: Plaque and Your Heart
Heart-Healthy Foods Slideshow Pictures
Brushing and flossing may actually save your life.
WebMD Feature
Reviewed By Charlotte Grayson
If you're worried about heart disease, you can easily spend thousands of dollars each year trying to prevent it, paying hand over fist for prescription medicines, shelves of healthy cookbooks, fitness machines for your home, and a gym membership.
Or maybe not. A number of recent studies suggest that you may already have a cheap and powerful weapon against heart attacks, strokes, and other heart disease conditions. It costs less than $2 and is sitting on your bathroom counter. It is none other than the humble toothbrush.
"There are a lot of studies that suggest that oral health, and gum disease in particular, are related to serious conditions like heart disease," says periodontist Sally Cram, DDS, a spokeswoman for the American Dental Association.
So can preventing periodontal disease, a disease of the gums and bone that support the teeth, with brushing and flossing prevent heart disease?
The evidence isn't clear yet, experts say, but it's intriguing. According to the American Academy of Periodontology, people with periodontal disease are almost twice as likely to have coronary artery disease (also called heart disease). And one study found that the presence of common problems in the mouth, including gum disease (gingivitis), cavities, and missing teeth, were as good at predicting heart disease as cholesterol levels.
Evidence Links Periodontal Disease and Heart Health
When it comes to the connection between periodontal disease and heart disease, epidemiologist Moise Desvarieux, MD, PhD, is used to dealing with skeptics.
"One of the talks I give is called, 'Investigating the Links Between Periodontal Infection and Vascular Disease: Are We Nuts?'" says Desvarieux, from Columbia University's Mailman School of Public Health. "It's not a connection that people naturally think of."
Desvarieux was the lead author of a recent study published in Circulation: Journal of the American Heart Association that studied 657 people without known heart disease. He and his co-authors found that people who had higher blood levels of certain disease-causing bacteria in the mouth were more likely to have atherosclerosis in the carotid artery in the neck. Clogging of the carotid arteries can lead to stroke.
Atherosclerosis, also called "hardening of the arteries," develops when deposits of fats and other substances in your blood begin to stick to the sides of your arteries. These deposits, called plaques, can build up and narrow your arteries, clogging them like a plugged-up drain. If these plaques ever block the blood flow completely, you could have a heart attack or stroke, depending on the location of the blockage.
(Note: Not all plaque is alike. The plaques in your arteries have nothing to do with dental plaque your dental hygienist scrapes off your teeth. Dental plaque is a sticky residue of bacteria, acid, and food particles that can irritate your gums and eat away at tooth enamel.)
So what might hardening of the arteries have to do with gingivitis, that minor villain of toothpaste and mouthwash commercials?
No one is sure yet. Experts know that bacteria from the mouth can enter the bloodstream through the gums. These same bacteria have been found clumped in artery plaques. So one theory is that these bacteria stick to the fatty plaques in the bloodstream, directly contributing to blockages.
Other possibilities lie in the body's own defense mechanisms against bacteria. One of the body's natural responses to infection is inflammation (swelling). It's possible that as these oral bacteria travel through your body, they trigger a similar response, causing the blood cells to swell. This swelling could then narrow an artery and increase the risk of clots.
For more information please go to www.drjamesmiller.com/lanap.html
Next »
Periodontal Disease and Heart Health
Heart Disease (Coronary Artery Disease) Slideshow Pictures
Dental Dangers: Plaque and Your Heart
Heart-Healthy Foods Slideshow Pictures
Brushing and flossing may actually save your life.
WebMD Feature
Reviewed By Charlotte Grayson
If you're worried about heart disease, you can easily spend thousands of dollars each year trying to prevent it, paying hand over fist for prescription medicines, shelves of healthy cookbooks, fitness machines for your home, and a gym membership.
Or maybe not. A number of recent studies suggest that you may already have a cheap and powerful weapon against heart attacks, strokes, and other heart disease conditions. It costs less than $2 and is sitting on your bathroom counter. It is none other than the humble toothbrush.
"There are a lot of studies that suggest that oral health, and gum disease in particular, are related to serious conditions like heart disease," says periodontist Sally Cram, DDS, a spokeswoman for the American Dental Association.
So can preventing periodontal disease, a disease of the gums and bone that support the teeth, with brushing and flossing prevent heart disease?
The evidence isn't clear yet, experts say, but it's intriguing. According to the American Academy of Periodontology, people with periodontal disease are almost twice as likely to have coronary artery disease (also called heart disease). And one study found that the presence of common problems in the mouth, including gum disease (gingivitis), cavities, and missing teeth, were as good at predicting heart disease as cholesterol levels.
Evidence Links Periodontal Disease and Heart Health
When it comes to the connection between periodontal disease and heart disease, epidemiologist Moise Desvarieux, MD, PhD, is used to dealing with skeptics.
"One of the talks I give is called, 'Investigating the Links Between Periodontal Infection and Vascular Disease: Are We Nuts?'" says Desvarieux, from Columbia University's Mailman School of Public Health. "It's not a connection that people naturally think of."
Desvarieux was the lead author of a recent study published in Circulation: Journal of the American Heart Association that studied 657 people without known heart disease. He and his co-authors found that people who had higher blood levels of certain disease-causing bacteria in the mouth were more likely to have atherosclerosis in the carotid artery in the neck. Clogging of the carotid arteries can lead to stroke.
Atherosclerosis, also called "hardening of the arteries," develops when deposits of fats and other substances in your blood begin to stick to the sides of your arteries. These deposits, called plaques, can build up and narrow your arteries, clogging them like a plugged-up drain. If these plaques ever block the blood flow completely, you could have a heart attack or stroke, depending on the location of the blockage.
(Note: Not all plaque is alike. The plaques in your arteries have nothing to do with dental plaque your dental hygienist scrapes off your teeth. Dental plaque is a sticky residue of bacteria, acid, and food particles that can irritate your gums and eat away at tooth enamel.)
So what might hardening of the arteries have to do with gingivitis, that minor villain of toothpaste and mouthwash commercials?
No one is sure yet. Experts know that bacteria from the mouth can enter the bloodstream through the gums. These same bacteria have been found clumped in artery plaques. So one theory is that these bacteria stick to the fatty plaques in the bloodstream, directly contributing to blockages.
Other possibilities lie in the body's own defense mechanisms against bacteria. One of the body's natural responses to infection is inflammation (swelling). It's possible that as these oral bacteria travel through your body, they trigger a similar response, causing the blood cells to swell. This swelling could then narrow an artery and increase the risk of clots.
For more information please go to www.drjamesmiller.com/lanap.html
Vitamin D and Periodontal Health
Does vitamin D enhance periodontal health?
December 1, 2010 -- Vitamin D supplements can play a positive role in supporting and improving periodontal health in older adults and pregnant women, according to two new studies in the Journal of Periodontology (JOP, September 1, 2010).
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In 2009, researchers from Saint Louis University, Southern Illinois University, and Washington University found that patients in periodontal maintenance programs taking vitamin D and calcium supplementation trended toward better periodontal health compared with patients not taking supplementation (JOP, September 2009, Vol. 80:9, pp. 1433-1439).
And this is just one of many cross-sectional studies and secondary data analyses in the last few years that reached similar conclusions, according to Charles Hildebolt, DDS, PhD, study co-author and director of radiology at the Mallinckrodt Institute of Radiology at Washington University.
Vitamin D stimulates the production of natural antibiotics -- antimicrobial peptides -- and bacteria and viruses have a hard time developing a resistance to them, he told DrBicuspid.com.
“It is very difficult to get too much vitamin D.”
— Charles Hildebolt, DDS, PhD,
Mallinckrodt Institute of Radiology "Periodontal disease is largely an immune response to bacteria in the biofilm, so if vitamin D stimulates production of natural antibiotics, this might be good in preventing periodontal disease," he said.
Dr. Hildebolt and his colleagues acknowledge, however, that the effects of vitamin D and calcium supplementation on periodontal disease have not been completely clarified in the scientific literature.
"Although a number of early studies suggested that vitamin D and calcium supplementation reduced tooth loss and alveolar ridge resorption, most of these studies included heterogeneous populations or did not directly measure periodontal diseases status," they wrote. More recently, however, analyses of the Third National Health and Nutrition Examination Survey, which included 12,000 adults, revealed significant associations between periodontal health and and calcium intake, they noted (JOP, July 2000, Vol. 71:7, pp. 1057-1066).
Even so, the National Institute of Dental and Craniofacial Research (NIDCR) wants more evidence on the effects of vitamin D on periodontitis before it will fund randomized clinical trials on this topic, according to Dr. Hildebolt. And on November 30, the Institute of Medicine (IOM) released a report that, while increasing the recommended daily intake of vitamin D and calcium, said that the current body of research does not offer the evidence needed to confirm that vitamin D has the larger positive health effects its proponents claim it does.
The IOM's report is a move in the right direction, Dr. Hildbebolt said. But he also believes there is enough evidence to support research into the effects that higher levels of vitamin D may have on periodontal disease.
"There have been many, many randomized clinical trials that have shown the benefits of vitamin D and calcium in preventing bone loss below the head, and everyone agrees that you need an adequate intake of vitamin D to promote calcium absorption," he told DrBicuspid.com. "So it seems reasonable that bone in the head is not too much different from bone in the rest of the body. If it is beneficial to those bones, it is probably also beneficial to the alveolar bone."
One-year findings
In an effort to convince the NIDCR of this, Dr. Hildebolt and colleagues went back to the same patient group from the 2009 JOP study to see if the trends they had initially found in the relationship between periodontal health and vitamin D and calcium supplements persisted after one year.
Their latest JOP study followed the original 51 patients (men and women age 50-80), who had moderate to severe chronic periodontal disease (at least two interproximal sites with at least 3 mm of clinical attachment loss) and were enrolled in maintenance programs at two dental clinics.
The patients were divided into two groups: 23 had been taking vitamin D (at least 400 international units [IU] per day) and calcium (at least 1,000 mg per day) supplements for more than 18 months at the time of their baseline visits, while the other group (28) had been taking no supplements and had daily dietary intakes of calcium and vitamin D below 1,000 mg and 400 IU, respectively.
All patients were clinically assessed using probing and CEJ-GM (cemento-enamel junction - gingival margin) measurements at baseline, six months, and one year. Clinical measurements were taken at six sites (buccal, lingual, me = 0.049), siolingual, mesiobuccal, distolingual, and distobuccal) for each mandibular posterior tooth. In addition, bitewing radiographs of the mandibular posterior teeth were taken at baseline, six months, and one year.
All subjects from both groups received periodontal maintenance therapy at three-month intervals. Treatment consisted of scaling and root planing, polishing, reinforcement of oral hygiene procedures, and a general dental exam.
For subjects who did not take oral supplements, the mean daily calcium intake was 642 mg and the mean daily vitamin D intake was 156 IU. For subjects who did take oral supplements, the mean daily calcium intake was 1,769 mg and the mean daily vitamin D intake was 1,049 IU.
Clinical parameters of periodontal health improved with time in both groups (p < 0.001). When clinical measures were considered collectively, the differences between supplement takers and nontakers had the following p values: baseline (p = 0.061), six months (p = 0.049), and 12 months (p = 0.114).
"This study suggests that periodontal health improves in patients attending regular periodontal care programs, regardless of their dietary calcium or vitamin D supplements," the authors wrote. "However, taking calcium and vitamin D supplementation is associated with better periodontal health relative to taking no such supplements."
The researchers observed less bleeding on probing and less inflammation in supplement takers, a difference that was evident at baseline and remained significant for one year while subjects underwent periodontal maintenance therapy.
"Our findings do not deny the possibility that vitamin D supplements may reduce the severity of periodontal disease if used at doses higher than 800-1,000 IU daily, thus supporting the rationale for testing the potential beneficial role of vitamin D on periodontal disease in more powerful, randomized clinical trials," they concluded.
Good for pregnant women too
Lack of vitamin D is also associated with maternal periodontal disease during pregnancy, according to researchers from the University of North Carolina at Chapel Hill and Harvard Medical School (JOP, September 1, 2010). In fact, maternal periodontal disease is found in up to 40% of pregnant women and is associated with adverse pregnancy outcomes, including preterm birth, preeclampsia, and late miscarriage, the authors noted.
In their case-control study, 117 cases of pregnant women with moderate to severe periodontal disease (15 or more tooth sites with 4 mm or more of gingival pocket depth) were compared with 118 pregnant women who were periodontally healthy. All the women had been prescribed a prenatal vitamin containing 400 IU of vitamin D.
Their serum 25-hydroxyvitamin D (25[OH]D) levels were measured and compared between the case and control groups to determine the prevalence of vitamin D insufficiency (defined as < 75 nanomoles per liter [nmol/L]). A serum concentration of 75 nmol/L or greater appears to support bone mineral density and dental health, the authors noted, and 90-100 nmol/L has been suggested as the optimal vitamin D level (American Journal of Clinical Nutrition, July 2006, Vol. 84:1, pp. 18-28).
The researchers found that the case group had lower median 25(OH)D levels than the control group (59 versus 100 nmol/L, p < 0.001) and were more likely to have vitamin D insufficiency (65% versus 29%, p < 0.001).
"The relationship between maternal vitamin D status, periodontal disease, and adverse pregnancy outcomes requires more study before definitive conclusions can be made," they wrote. "However, our data provide evidence that improvement of vitamin D status is a potential intervention to improve oral health among a vulnerable group of pregnant women."
Given the role of vitamin D in inflammatory responses and integrity of the innate immune response, vitamin D supplementation could improve maternal oral health, the researchers concluded.
Dr. Hildebolt believes that the best way to determine if patients are getting enough vitamin D from sunshine and diet is to test their blood for serum 25(OH)D levels. If less than 75 nmol/L of serum 25(OH)D is present, then a supplement may be warranted.
"There is a lot of hype about vitamin D right now," Dr. Hildebolt said. "It's not the magic bullet that will cure all forms of cancer, but it is much better to have too much than not enough. And it is very difficult to get too much vitamin D, and to get enough just from diet alone."
Copyright © 2010 DrBicuspid.com
By: Kathy Kincade, Editor in Chief
For more information on Gum Disease and it treatment options please go to www.drjamesmiller.com/lanap.html
December 1, 2010 -- Vitamin D supplements can play a positive role in supporting and improving periodontal health in older adults and pregnant women, according to two new studies in the Journal of Periodontology (JOP, September 1, 2010).
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In 2009, researchers from Saint Louis University, Southern Illinois University, and Washington University found that patients in periodontal maintenance programs taking vitamin D and calcium supplementation trended toward better periodontal health compared with patients not taking supplementation (JOP, September 2009, Vol. 80:9, pp. 1433-1439).
And this is just one of many cross-sectional studies and secondary data analyses in the last few years that reached similar conclusions, according to Charles Hildebolt, DDS, PhD, study co-author and director of radiology at the Mallinckrodt Institute of Radiology at Washington University.
Vitamin D stimulates the production of natural antibiotics -- antimicrobial peptides -- and bacteria and viruses have a hard time developing a resistance to them, he told DrBicuspid.com.
“It is very difficult to get too much vitamin D.”
— Charles Hildebolt, DDS, PhD,
Mallinckrodt Institute of Radiology "Periodontal disease is largely an immune response to bacteria in the biofilm, so if vitamin D stimulates production of natural antibiotics, this might be good in preventing periodontal disease," he said.
Dr. Hildebolt and his colleagues acknowledge, however, that the effects of vitamin D and calcium supplementation on periodontal disease have not been completely clarified in the scientific literature.
"Although a number of early studies suggested that vitamin D and calcium supplementation reduced tooth loss and alveolar ridge resorption, most of these studies included heterogeneous populations or did not directly measure periodontal diseases status," they wrote. More recently, however, analyses of the Third National Health and Nutrition Examination Survey, which included 12,000 adults, revealed significant associations between periodontal health and and calcium intake, they noted (JOP, July 2000, Vol. 71:7, pp. 1057-1066).
Even so, the National Institute of Dental and Craniofacial Research (NIDCR) wants more evidence on the effects of vitamin D on periodontitis before it will fund randomized clinical trials on this topic, according to Dr. Hildebolt. And on November 30, the Institute of Medicine (IOM) released a report that, while increasing the recommended daily intake of vitamin D and calcium, said that the current body of research does not offer the evidence needed to confirm that vitamin D has the larger positive health effects its proponents claim it does.
The IOM's report is a move in the right direction, Dr. Hildbebolt said. But he also believes there is enough evidence to support research into the effects that higher levels of vitamin D may have on periodontal disease.
"There have been many, many randomized clinical trials that have shown the benefits of vitamin D and calcium in preventing bone loss below the head, and everyone agrees that you need an adequate intake of vitamin D to promote calcium absorption," he told DrBicuspid.com. "So it seems reasonable that bone in the head is not too much different from bone in the rest of the body. If it is beneficial to those bones, it is probably also beneficial to the alveolar bone."
One-year findings
In an effort to convince the NIDCR of this, Dr. Hildebolt and colleagues went back to the same patient group from the 2009 JOP study to see if the trends they had initially found in the relationship between periodontal health and vitamin D and calcium supplements persisted after one year.
Their latest JOP study followed the original 51 patients (men and women age 50-80), who had moderate to severe chronic periodontal disease (at least two interproximal sites with at least 3 mm of clinical attachment loss) and were enrolled in maintenance programs at two dental clinics.
The patients were divided into two groups: 23 had been taking vitamin D (at least 400 international units [IU] per day) and calcium (at least 1,000 mg per day) supplements for more than 18 months at the time of their baseline visits, while the other group (28) had been taking no supplements and had daily dietary intakes of calcium and vitamin D below 1,000 mg and 400 IU, respectively.
All patients were clinically assessed using probing and CEJ-GM (cemento-enamel junction - gingival margin) measurements at baseline, six months, and one year. Clinical measurements were taken at six sites (buccal, lingual, me = 0.049), siolingual, mesiobuccal, distolingual, and distobuccal) for each mandibular posterior tooth. In addition, bitewing radiographs of the mandibular posterior teeth were taken at baseline, six months, and one year.
All subjects from both groups received periodontal maintenance therapy at three-month intervals. Treatment consisted of scaling and root planing, polishing, reinforcement of oral hygiene procedures, and a general dental exam.
For subjects who did not take oral supplements, the mean daily calcium intake was 642 mg and the mean daily vitamin D intake was 156 IU. For subjects who did take oral supplements, the mean daily calcium intake was 1,769 mg and the mean daily vitamin D intake was 1,049 IU.
Clinical parameters of periodontal health improved with time in both groups (p < 0.001). When clinical measures were considered collectively, the differences between supplement takers and nontakers had the following p values: baseline (p = 0.061), six months (p = 0.049), and 12 months (p = 0.114).
"This study suggests that periodontal health improves in patients attending regular periodontal care programs, regardless of their dietary calcium or vitamin D supplements," the authors wrote. "However, taking calcium and vitamin D supplementation is associated with better periodontal health relative to taking no such supplements."
The researchers observed less bleeding on probing and less inflammation in supplement takers, a difference that was evident at baseline and remained significant for one year while subjects underwent periodontal maintenance therapy.
"Our findings do not deny the possibility that vitamin D supplements may reduce the severity of periodontal disease if used at doses higher than 800-1,000 IU daily, thus supporting the rationale for testing the potential beneficial role of vitamin D on periodontal disease in more powerful, randomized clinical trials," they concluded.
Good for pregnant women too
Lack of vitamin D is also associated with maternal periodontal disease during pregnancy, according to researchers from the University of North Carolina at Chapel Hill and Harvard Medical School (JOP, September 1, 2010). In fact, maternal periodontal disease is found in up to 40% of pregnant women and is associated with adverse pregnancy outcomes, including preterm birth, preeclampsia, and late miscarriage, the authors noted.
In their case-control study, 117 cases of pregnant women with moderate to severe periodontal disease (15 or more tooth sites with 4 mm or more of gingival pocket depth) were compared with 118 pregnant women who were periodontally healthy. All the women had been prescribed a prenatal vitamin containing 400 IU of vitamin D.
Their serum 25-hydroxyvitamin D (25[OH]D) levels were measured and compared between the case and control groups to determine the prevalence of vitamin D insufficiency (defined as < 75 nanomoles per liter [nmol/L]). A serum concentration of 75 nmol/L or greater appears to support bone mineral density and dental health, the authors noted, and 90-100 nmol/L has been suggested as the optimal vitamin D level (American Journal of Clinical Nutrition, July 2006, Vol. 84:1, pp. 18-28).
The researchers found that the case group had lower median 25(OH)D levels than the control group (59 versus 100 nmol/L, p < 0.001) and were more likely to have vitamin D insufficiency (65% versus 29%, p < 0.001).
"The relationship between maternal vitamin D status, periodontal disease, and adverse pregnancy outcomes requires more study before definitive conclusions can be made," they wrote. "However, our data provide evidence that improvement of vitamin D status is a potential intervention to improve oral health among a vulnerable group of pregnant women."
Given the role of vitamin D in inflammatory responses and integrity of the innate immune response, vitamin D supplementation could improve maternal oral health, the researchers concluded.
Dr. Hildebolt believes that the best way to determine if patients are getting enough vitamin D from sunshine and diet is to test their blood for serum 25(OH)D levels. If less than 75 nmol/L of serum 25(OH)D is present, then a supplement may be warranted.
"There is a lot of hype about vitamin D right now," Dr. Hildebolt said. "It's not the magic bullet that will cure all forms of cancer, but it is much better to have too much than not enough. And it is very difficult to get too much vitamin D, and to get enough just from diet alone."
Copyright © 2010 DrBicuspid.com
By: Kathy Kincade, Editor in Chief
For more information on Gum Disease and it treatment options please go to www.drjamesmiller.com/lanap.html
Monday, November 22, 2010
Breast Cancer and Gum Disease Link
Breast cancer linked to perio disease and tooth loss
November 18, 2010 -- As the body of research linking periodontitis with a host of other disease states -- including diabetes, cardiovascular disease, rheumatoid arthritis, surgical complications, and risk of fetal death -- a new study has added yet another to the list: breast cancer (Breast Cancer Research and Treatment, October 19, 2010).
"To our knowledge, this is the first study on the association between periodontitis and breast cancer," Birgitta Söder, DrMedSc, PhD, Lic Odont Sc, RDH, a professor emeritus at Karolinska Institute, told DrBicuspid.com
The American Cancer Society estimates 209,060 cases of invasive breast cancer in 2010, with more than 40,000 deaths. Breast cancer is rarer in men than women, accounting for less than 1% of breast cancer diagnoses, but both men and women should report any changes in breast tissue to their doctors.
“This is the first study on the association between periodontitis and breast cancer.”
— Birgitta Söder, DrMedSc, PhD,
Karolinska Institute Periodontal disease affects 15% to 35% of adults in industrialized countries. Most often caused by poor hygiene and bacterial infection, disease-active periodontitis also seems to be closely associated with human cytomegalovirus and Epstein-Barr virus co-infection. It is believed that these viruses act together to suppress immune response to bacterial challenges. Herpes viruses may also contribute to chronic periodontitis, leading the authors to conclude that these viruses and bacteria act together to lead to low-degree chronic inflammation and carcinogenesis.
"In severe periodontitis, probably there will be co-infection closely associated with a virus," Dr. Söder said.
The prospective study by Dr. Söder and colleagues followed 3,273 randomly selected subjects from 1985 to 2001 who were 30-40 years of age at baseline. At baseline, 1,676 individuals underwent a clinical oral examination (group A); 1,597 subjects were not clinically examined but were registered (group B).
In total, 26 subjects in group A and 15 subjects in group B had breast cancer. The incidence of breast cancer was 1.75% in subjects who had periodontal disease and/or any missing molars, and 0 in subjects who had periodontal disease but had no missing molars. For periodontally healthy subjects with no missing teeth, the breast cancer incidence was 1%. For group B, the incidence was 0.94%.
Of the subjects with periodontal disease and any missing molars in the mandible, 5.5% had breast cancer, compared with 0.5% of the subjects who had periodontal disease but no missing molars in the mandible (p < 0.02). Chronic periodontal disease indicated by missing molars seemed to associate statistically with breast cancer, the researchers concluded.
Smoking a risk factor?
The link between smoking and cancer has not been fully accounted for in many studies relating periodontal disease to cancer, according to Suellan Go Yao, DMD, and James Burke Fine, DMD, of Columbia University (Compendium of Continuing Education in Dentistry, July/August 2010, Vol. 31:6, pp. 436-444).
"Smoking is a known risk factor for many cancers as well as for periodontal disease and tooth loss," they wrote.
In the Karolinska study, the researchers controlled for smoking as a confounding variable by using multiple logistic regression and dichotomizing smokers into ever smokers (current and former smokers) and never smokers, and found no statistical difference between the two groups. Of the subjects with breast cancer, 42.8% were smokers, 17.9% were former smokers, and 39.3% had never smoked. These numbers were similar to the group with no breast cancer.
Similarly, a study by the American Association for Cancer Research also showed smoking to be a less significant variable than periodontal disease with head and neck squamous cell carcinomas (Cancer Epidemiology, Biomarkers, and Prevention, September 2009, Vol. 18:9, pp. 2406-2412).
And in 2007, researchers from the Harvard School of Public Health found periodontal disease to be independently associated with an increased risk of pancreatic cancer overall, including in people who had never smoked (Journal of the National Cancer Institute, January 17, 2007, Vol. 99:2, pp. 171-175).
"Periodontitis in its advanced form can be viewed as a hyperinflammatory response to bacteria," Dr. Fine told DrBicuspid.com. "The byproducts of this oral inflammation enter the bloodstream and can create problems at distant sites. Inflammation may enhance cellular proliferation and mutagenesis, allowing for the development and spread of cancer."
Copyright © 2010 DrBicuspid.com
By: Erin Archer, R.N., DrBicuspid.com contributing writer
For more information on gum disease and its treatment please go to www.drjamesmiller.com/lanap.html
November 18, 2010 -- As the body of research linking periodontitis with a host of other disease states -- including diabetes, cardiovascular disease, rheumatoid arthritis, surgical complications, and risk of fetal death -- a new study has added yet another to the list: breast cancer (Breast Cancer Research and Treatment, October 19, 2010).
"To our knowledge, this is the first study on the association between periodontitis and breast cancer," Birgitta Söder, DrMedSc, PhD, Lic Odont Sc, RDH, a professor emeritus at Karolinska Institute, told DrBicuspid.com
The American Cancer Society estimates 209,060 cases of invasive breast cancer in 2010, with more than 40,000 deaths. Breast cancer is rarer in men than women, accounting for less than 1% of breast cancer diagnoses, but both men and women should report any changes in breast tissue to their doctors.
“This is the first study on the association between periodontitis and breast cancer.”
— Birgitta Söder, DrMedSc, PhD,
Karolinska Institute Periodontal disease affects 15% to 35% of adults in industrialized countries. Most often caused by poor hygiene and bacterial infection, disease-active periodontitis also seems to be closely associated with human cytomegalovirus and Epstein-Barr virus co-infection. It is believed that these viruses act together to suppress immune response to bacterial challenges. Herpes viruses may also contribute to chronic periodontitis, leading the authors to conclude that these viruses and bacteria act together to lead to low-degree chronic inflammation and carcinogenesis.
"In severe periodontitis, probably there will be co-infection closely associated with a virus," Dr. Söder said.
The prospective study by Dr. Söder and colleagues followed 3,273 randomly selected subjects from 1985 to 2001 who were 30-40 years of age at baseline. At baseline, 1,676 individuals underwent a clinical oral examination (group A); 1,597 subjects were not clinically examined but were registered (group B).
In total, 26 subjects in group A and 15 subjects in group B had breast cancer. The incidence of breast cancer was 1.75% in subjects who had periodontal disease and/or any missing molars, and 0 in subjects who had periodontal disease but had no missing molars. For periodontally healthy subjects with no missing teeth, the breast cancer incidence was 1%. For group B, the incidence was 0.94%.
Of the subjects with periodontal disease and any missing molars in the mandible, 5.5% had breast cancer, compared with 0.5% of the subjects who had periodontal disease but no missing molars in the mandible (p < 0.02). Chronic periodontal disease indicated by missing molars seemed to associate statistically with breast cancer, the researchers concluded.
Smoking a risk factor?
The link between smoking and cancer has not been fully accounted for in many studies relating periodontal disease to cancer, according to Suellan Go Yao, DMD, and James Burke Fine, DMD, of Columbia University (Compendium of Continuing Education in Dentistry, July/August 2010, Vol. 31:6, pp. 436-444).
"Smoking is a known risk factor for many cancers as well as for periodontal disease and tooth loss," they wrote.
In the Karolinska study, the researchers controlled for smoking as a confounding variable by using multiple logistic regression and dichotomizing smokers into ever smokers (current and former smokers) and never smokers, and found no statistical difference between the two groups. Of the subjects with breast cancer, 42.8% were smokers, 17.9% were former smokers, and 39.3% had never smoked. These numbers were similar to the group with no breast cancer.
Similarly, a study by the American Association for Cancer Research also showed smoking to be a less significant variable than periodontal disease with head and neck squamous cell carcinomas (Cancer Epidemiology, Biomarkers, and Prevention, September 2009, Vol. 18:9, pp. 2406-2412).
And in 2007, researchers from the Harvard School of Public Health found periodontal disease to be independently associated with an increased risk of pancreatic cancer overall, including in people who had never smoked (Journal of the National Cancer Institute, January 17, 2007, Vol. 99:2, pp. 171-175).
"Periodontitis in its advanced form can be viewed as a hyperinflammatory response to bacteria," Dr. Fine told DrBicuspid.com. "The byproducts of this oral inflammation enter the bloodstream and can create problems at distant sites. Inflammation may enhance cellular proliferation and mutagenesis, allowing for the development and spread of cancer."
Copyright © 2010 DrBicuspid.com
By: Erin Archer, R.N., DrBicuspid.com contributing writer
For more information on gum disease and its treatment please go to www.drjamesmiller.com/lanap.html
Monday, November 15, 2010
Periodontal Disease and Sex Hormones
'Landmark' Study Points to Role of Sex Hormones in Higher Risk of Gum Disease in Men
TEXT SIZE By: University of Maryland Baltimore
--------------------------------------------------------------------------------
Newswise - Sex hormones may be the biological reason why men are at greater risk than women for destructive periodontitis, an infection of the gums, according to researchers at the University of Maryland Dental School.
To establish better management and risk assessment models for periodontal disease, Harlan Shiau, DDS, DMedSc, assistant professor, and Mark Reynolds, DDS, PhD, MA, professor at the Dental School, have published the first comprehensive review of gender differences in the development and progression of the destructive periodontal disease.
In a review paper in the Journal of Periodontology, the authors examine evidence for a biologic basis for a sexual dimorphism, or the differences in susceptibility, to periodontal disease between men and women. They conclude that sex steroids exert effects on multiple ways on the immune system regulation of inflammation. They also conclude that the root of the difference may be genetic.
"Differential gene regulation, particularly in sex steroid-responsive genes, could likely play a part in the observed sexual dimorphism of destructive periodontal disease," said Shiau.
"We think it is a plausible explanation," he added. The observation of men "having worse gum disease than women" was generally accepted by dental clinicians previously, says Shiau, "but we wondered if the traditional explanations were adequate. This study provides health care professionals with important comparative data for estimating gender-related differences in risk for destructive periodontal disease."
Prior to the current review paper, the researchers conducted a systematic review of published population studies on the prevalence of periodontal disease. In their analysis they established that men, indeed, have a greater prevalence of periodontal disease than women globally.
Shiau and Reynolds explored potential biologic explanations by drawing from the extensive body of literature in autoimmune disease research, where there also exists sexual dimorphism in disease prevalence.
"Also, we considered the competing hypothesis that the environment explains the dimorphism, such as the observation that men have worse oral hygiene and compliance than women. However, there exist population studies, which control for potential co-variants, like these, and have still yielded significant gender effects." Shiau explains.
"The innate immune response plays a considerable role in the pathogenesis of periodontal disease. The literature seems to indicate that a heightened innate immune response in men compared to women, as well as potential differences in regulation of amplification and termination of inflammation, provide a sound biologic basis for sex differences in periodontal disease progression," says Shiau.
Mark Reynolds is chair of the Dental School's Department of Periodontics.
For more information contact
www.drjamesmiller.com/lanap.html
TEXT SIZE By: University of Maryland Baltimore
--------------------------------------------------------------------------------
Newswise - Sex hormones may be the biological reason why men are at greater risk than women for destructive periodontitis, an infection of the gums, according to researchers at the University of Maryland Dental School.
To establish better management and risk assessment models for periodontal disease, Harlan Shiau, DDS, DMedSc, assistant professor, and Mark Reynolds, DDS, PhD, MA, professor at the Dental School, have published the first comprehensive review of gender differences in the development and progression of the destructive periodontal disease.
In a review paper in the Journal of Periodontology, the authors examine evidence for a biologic basis for a sexual dimorphism, or the differences in susceptibility, to periodontal disease between men and women. They conclude that sex steroids exert effects on multiple ways on the immune system regulation of inflammation. They also conclude that the root of the difference may be genetic.
"Differential gene regulation, particularly in sex steroid-responsive genes, could likely play a part in the observed sexual dimorphism of destructive periodontal disease," said Shiau.
"We think it is a plausible explanation," he added. The observation of men "having worse gum disease than women" was generally accepted by dental clinicians previously, says Shiau, "but we wondered if the traditional explanations were adequate. This study provides health care professionals with important comparative data for estimating gender-related differences in risk for destructive periodontal disease."
Prior to the current review paper, the researchers conducted a systematic review of published population studies on the prevalence of periodontal disease. In their analysis they established that men, indeed, have a greater prevalence of periodontal disease than women globally.
Shiau and Reynolds explored potential biologic explanations by drawing from the extensive body of literature in autoimmune disease research, where there also exists sexual dimorphism in disease prevalence.
"Also, we considered the competing hypothesis that the environment explains the dimorphism, such as the observation that men have worse oral hygiene and compliance than women. However, there exist population studies, which control for potential co-variants, like these, and have still yielded significant gender effects." Shiau explains.
"The innate immune response plays a considerable role in the pathogenesis of periodontal disease. The literature seems to indicate that a heightened innate immune response in men compared to women, as well as potential differences in regulation of amplification and termination of inflammation, provide a sound biologic basis for sex differences in periodontal disease progression," says Shiau.
Mark Reynolds is chair of the Dental School's Department of Periodontics.
For more information contact
www.drjamesmiller.com/lanap.html
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