Better oral health can help prevent and control diabetes

Better oral health can help prevent and control diabetes

June 9, 2008 -- The American Diabetes Association feels so strongly about the link between periodontal disease and type 2 diabetes that the group invited a number of dentists to share their thoughts on this growing problem during a special symposium at the 68th annual meeting of the American Diabetes Association this week in San Francisco.

According to the American Dental Association, nearly 10% (21 million) of the U.S. population has diabetes, which means U.S. dentists can expect to have more than 120 diabetic patient visits per year. Some 5% of diabetic patients are type 1, while the other 95% are type 2 -- the form that develops in adulthood and is linked to excess weight and a sedentary lifestyle.

Dental disease and the associated inflammation is an early warning sign of diabetes and its complications. In addition, diabetics with periodontal disease have a harder time controlling blood sugar levels.

"One of the many complications of diabetes is a greater risk for periodontal disease," said Maria E. Ryan, D.D.S., Ph.D., a professor of oral biology and pathology at Stony Brook University, New York, at the diabetes association dental symposium. "If you have this oral infection and inflammation, as with any infection, it's much more difficult to control blood glucose levels."

A key finding to be reported at the diabetes meeting was the fact that in prediabetic patients -- those who are insulin-resistant but are not yet presenting with the disease -- the level of oral disease seems to correlate with the insulin resistance, she added.

"We have found evidence that the severity of periodontal disease is associated with higher levels of insulin resistance, often a precursor of type 2 diabetes, as well as with higher levels of A1C, a measure of poor glycemic control of diabetes," Dr. Ryan said at the meeting.

Recent studies have also shown that having periodontal disease makes those with type 2 diabetes more likely to develop worsened glycemic control and puts them at much greater risk of end-stage kidney disease and death, according to George W. Taylor, Dr.P.H., D.M.D., an associate professor of dentistry at the University of Michigan.

He pointed to an analysis of the National Health and Nutrition Examination Survey of the U.S. population data between 1988 and 1994, in which he and his colleagues found that people with periodontal disease were twice as likely to be insulin-resistant than those without such disease. This result was found after controlling for other characteristics that would be associated with insulin resistance, such as obesity, lipids, exercise, and other markers of inflammation, and whether they had diabetes.

Dr. Taylor also reported on studies at the University of Michigan and elsewhere that further demonstrate the association between periodontitis and the complications of type 2 diabetes.

"Given the numerous medical studies showing that good glycemic control results in reduced development and progression of diabetes complications, we believe there is the potential that periodontal treatment can provide an increment in diabetes control and subsequently a reduction in the risk for diabetes complications," Dr. Taylor said.

For example, a recent set of observational studies of southwestern U.S. Pima Indians, a population with a very high rate of type 2 diabetes, investigated whether those with periodontitis are more likely to develop poorer glycemic control. Dr. Taylor noted that those with periodontitis were more than four times as likely to develop worsened glycemic control after two years of follow-up.

Dr. Ryan recommends that the medical and dental communities work together to play a more proactive and preventive role in treating diabetic patients. In addition to checking for bleeding gums and other signs of gingivitis, if a patient's glycemia has been difficult to control, the physician should ask when the patient last visited a dentist, whether periodontitis has been diagnosed, and, if so, whether treatment has been completed. A consultation with the dentist might then be appropriate to discuss whether periodontal treatment has been successful or if a more intensive approach with oral or subantimicrobial antibiotics is in order.

"Just as it is difficult to control diabetes while the patient has an infected leg ulcer, the same applies when there's infection and inflammation of the gums," she said. "Diabetes educators and healthcare providers need to be informed of this and refer their patients to dentists for evaluation," she noted in an interview with DrBicuspid.com.

In addition to helping diabetic patients manage their disease through better oral health and regular checkups, dental care providers can also play an important role in helping to diagnose patients whose diabetes has not yet been detected, Dr. Ryan added.

"The Centers for Disease Control estimates that 40% of people with diabetes don't know they have it," she said. "And certainly dental care providers are in a position to help identify people at risk of diabetes. We know that periodontal disease leads to heightened levels of C-reactive proteins, and studies are now showing that people with elevated C-reactive protein levels are the most likely to convert to diabetes within five years. But if you treat the periodontal disease, you can reduce the levels of A1C. Now we need to find out if treating periodontal disease will delay the onset of diabetes, and this we don't know yet."

Cosmetic dentist invents forceps that speed restorations

Cosmetic dentist invents forceps that speed restorations

June 6, 2008 -- Christian W. Hahn, D.D.S., a cosmetic dentist in Louisville, KY, has invented forceps that will allow dentists to adjust the bite and deliver indirect restorations such as caps and veneers with better accuracy and in less time.

The Hahn Twin Forceps will be launched in August through a dental distributor.

"Any product that helps me deliver higher-quality dentistry in less time is a winner in my practice," Dr. Hahn said. "Those are the type of inventions I focus on."

Delta Dental gives $340,000 to Louisiana dental school

Delta Dental gives $340,000 to Louisiana dental school

June 6, 2008 -- Delta Dental Insurance is donating $340,000 to Louisiana's only dental school to help renovate an auditorium damaged by Hurricane Katrina.

Nearly three years ago, Hurricane Katrina devastated the LSU Health Sciences Center (LSUHSC) campus in New Orleans, which houses the only dental school in the state. Students and faculty were subsequently relocated to a temporary campus some 80 miles away in Baton Rouge, where they remained for two years, returning to the New Orleans campus last August.

In the immediate aftermath of Hurricane Katrina, Delta Dental spearheaded contributions totaling $380,000 to LSUHSC and its students, including a $25,000 grant to the dental school, a $35,000 unrestricted educational grant, and a check for $1,000 given to each of the 312 LSUHSC students after the hurricane devastated the campus. With this most recent contribution, the company has now pledged close to $750,000 dollars to help LSUHSC in its continuing recovery.

The auditorium renovation is expected to begin in October.

Patients with certain antibodies at lower risk for periodontal disease

Patients with certain antibodies at lower risk for periodontal disease

June 5, 2008 -- New research at the University of Michigan found that people with certain antibodies are at a lower risk for periodontal disease, the ADA reported in a news article.

"The antibody is to a protein called HtpG, of the bug Porphyromonas gingivalis, [which is] an important pathogen in periodontal disease," the ADA stated.

"Anti-P. gingivalis HtpG antibodies are protective and ... may augment the host defence to periodontitis," the researchers wrote. They also noted that "a unique peptide of P. gingivalis HtpG offers significant potential as an effective diagnostic target and vaccine candidate."

According to the ADA, the researchers found that the HtpG antibodies were present at lower levels in people with chronic and aggressive periodontal disease and at higher levels in healthy subjects. Also, periodontal therapy was more successful in subjects with higher levels of HtpG antibodies before periodontal treatment.

Price makes teeth whitening more attractive at the mall

Price makes teeth whitening more attractive at the mall

June 5, 2008 -- Many patients are obsessed with obtaining the perfect Hollywood smile. But these days, instead of heading to their dentist's office, some are heading to the mall.

Teeth-whitening kiosks and centers run by nondentists are popping up in malls across the U.S. and are attracting attention because they offer a less expensive alternative to having the work done by a dentist. Procedures that might cost $400 to $500 at a dentist's office will run patients only about $100 to $140 at these centers.

But are they safe?

ADA consumer advisor Matthew Messina, D.D.S., who practices in Cleveland, has several concerns. First, the centers are not run by dentists. In fact, the personnel are not required to have any kind of dental training.

"Even though it looks like a dentist's office, it's not," he said. "When a patient sees a dental chair and people wearing scrubs, they assume the kiosk is using approved materials, has infection control standards, and is equipped with all the facilities of a dental office."

The reality is there is no way of knowing exactly what materials these centers are using for the procedure, Dr. Messina added. A flawed procedure could lead to allergic reactions, gum irritation, gum recession, and other problems.

In addition, teeth whitening should only be done on a healthy mouth, and staff at the mall-based centers cannot do a physical examination to determine that. They are also unequipped to deal with dental emergencies.

"Patients expect them to be prepared in case there is a problem," Dr. Messina said. "When they can't handle an emergency, they make the dental profession look bad."

Fortunately, safety margins in whitening procedures are so large that these problems rarely occur.

"But on the flip side, these procedures are then not particularly effective," he said.

Apart from patients' safety, another area of concern is the legality of the mall-based whitening centers. The North Carolina and Ohio state dental boards have taken the strongest measures of any states to regulate these centers, said Barb Palmucci, an investigative assistant with the Ohio State Dental Board.

Every state has its own definition for what constitutes the practice of dentistry. In North Carolina, for example, only a licensed practitioner can remove stains, accretions, or deposits from human teeth. As a result, the North Carolina State Board of Dental Examiners currently has lawsuits pending against two teeth-whitening centers, Signature Spas and Carmel Spa, that it has accused of performing dentistry without a license.

Many of these facilities provide patients with gel trays that the patients handle themselves, then they "loan" them the lights. This approach allows the centers to claim that they did not touch the patient, thereby avoiding prosecution by staying on the right side of the state's dental practice acts, Palmucci explained.

Also, since bleaching products fall into FDA's cosmetic category, there is no restriction on who can hand them out. Palmucci said she has heard that some of these centers use as much 44% carbamide peroxide in their delivery systems. Crest whitening strips have 10%, while dentists typically use 10% to 22%.

Palmucci also echoed Dr. Messina's concern that the staff at these centers are not adequately equipped to judge if the mouth they are whitening is healthy. Even though patients are asked to fill out forms that inquire about their dental health at some of the facilities, the risk remains.

"People don't know if they have conditions like decay or periodontitis that are mentioned in these forms," Palmucci, said.

Bottom line: "If [whitening centers] are putting chemical agents in a person's mouth without a dental exam, that's a risk," said Bobby D. White, chief operations officer of the North Carolina State Board of Dental Examiners.

Angela Sieving, president of BleachBright of Illinois and owner of a teeth-whitening center at Eastland Mall in Bloomington, IL, has nothing but satisfied customers to report. Sieving's center uses BleachBrite's prepackaged gel trays for procedures.

"Everything is customer-applied," Sieving said. "The mouth piece with the gel (which contains 6% hydrogen peroxide) is prepackaged. You hand it to the patient, put a light on them, and it takes 20 minutes."

Sieving said 95% of her customers are happy with the treatment, and since they use such a low level of hydrogen peroxide, it doesn't cause problems. The company guarantees a three- to five-shade difference in teeth color.

"There is not a patient who comes in here that we don't see results with," Sieving said.

Dental professionals in North Carolina and elsewhere are very concerned about this trend, according to Palmucci. But "people just think about white teeth and a shiny smile," she said.