Dentists Can Identify People With Undiagnosed Diabetes

In a study, Identification of unrecognized diabetes and pre-diabetes in a dental setting, published in the July 2011 issue of the Journal of Dental Research, researchers at Columbia University College of Dental Medicine found that dental visits represented a chance to intervene in the diabetes epidemic by identifying individuals with diabetes or pre-diabetes who are unaware of their condition. The study sought to develop and evaluate an identification protocol for high blood sugar levels in dental patients and was supported by a research grant from Colgate-Palmolive. The authors report no potential financial or other conflicts.

"Periodontal disease is an early complication of diabetes, and about 70 percent of U.S. adults see a dentist at least once a year," says Dr. Ira Lamster, dean of the College of Dental Medicine, and senior author on the paper. "Prior research focused on identification strategies relevant to medical settings. Oral healthcare settings have not been evaluated before, nor have the contributions of oral findings ever been tested prospectively."
For this study, researchers recruited approximately 600 individuals visiting a dental clinic in Northern Manhattan who were 40-years-old or older (if non-Hispanic white) and 30-years-old or older (if Hispanic or non-white), and had never been told they have diabetes or pre-diabetes.
Approximately 530 patients with at least one additional self-reported diabetes risk factor (family history of diabetes, high cholesterol, hypertension, or overweight/obesity) received a periodontal examination and a fingerstick, point-of-care hemoglobin A1c test. In order for the investigators to assess and compare the performance of several potential identification protocols, patients returned for a fasting plasma glucose test, which indicates whether an individual has diabetes or pre-diabetes.
Researchers found that, in this at-risk dental population, a simple algorithm composed of only two dental parameters (number of missing teeth and percentage of deep periodontal pockets) was effective in identifying patients with unrecognized pre-diabetes or diabetes. The addition of the point-of-care A1c test was of significant value, further improving the performance of this algorithm.
"Early recognition of diabetes has been the focus of efforts from medical and public health colleagues for years, as early treatment of affected individuals can limit the development of many serious complications," says Dr. Evanthia Lalla, an associate professor at the College of Dental Medicine, and the lead author on the paper. "Relatively simple lifestyle changes in pre-diabetic individuals can prevent progression to frank diabetes, so identifying this group of individuals is also important," she adds. "Our findings provide a simple approach that can be easily used in all dental-care settings."

Source: Columbia University Medical Center

Fully Functional Bioengineered Mature Tooth Unit

Donor organ transplantation is currently an essential therapeutic approach to the replacement of a dysfunctional organ as a result of disease, injury or aging in vivo. Recent progress in the area of regenerative therapy has the potential to lead to bioengineered mature organ replacement in the future. A research group led by Professor Takashi Tsuji (Professor in the Research Institute for Science and Technology, Tokyo University of Science, and Director of Organ Technologies Inc.) has provided a proof-of-concept for bioengineered mature organ replacement as a future regenerative therapy.

The research group, M. Oshima et al., reports a further development in this regard in which a bioengineered tooth unit comprising mature tooth, periodontal ligament and alveolar bone, was successfully transplanted into a properly-sized bony hole in the alveolar bone through bone integration by recipient bone remodeling in a murine transplantation model system. The bioengineered tooth unit restored enough the alveolar bone in a vertical direction into an extensive bone defect of murine lower jaw. The engrafted bioengineered tooth displayed physiological tooth functions such as mastication, periodontal ligament function for bone remodeling and responsiveness to noxious stimulations. This study thus represents a substantial advance and demonstrates the real potential for bioengineered mature organ replacement as a next generation regenerative therapy.
Professor Tsuji is a research team member in "Health Labor Sciences Research Grant: Research on Regenerative Medicine for Clinical Application (Domain Leader: Professor Akira Yamaguchi of Tokyo Medical and Dental University)". This research was collaborated research with Professor Teruko Takano-Yamamoto (Division of Orthodontics and Dentofacial Orthopedics, Graduate School of Dentistry, Tohoku University, Japan) and Professor Shohei Kasugai (Oral Implantology and Regenerative Dental Medicine Graduate School, Tokyo Medical and Dental University, Japan).

The Mystery Of Burning Mouth Syndrome

Most people can relate to the uncomfortable feeling that occurs after scalding their mouth on hot soup or coffee. It's a relief when that burnt feeling subsides after several days. But imagine experiencing that burning sensation all day, every day. The condition is called burning mouth syndrome (BMS), and damage to the nervous system during menopause may be to blame, according to an article published in the May/June 2011 issue of General Dentistry, the peer-reviewed clinical journal of the Academy of General Dentistry (AGD).
BMS affects nearly 5 percent of Americans and causes a constant burning sensation, most commonly on the top of the tongue, lower lip, and roof of the mouth.

"The cause of BMS is currently unknown, but our findings support the theory that this is a neuropathic condition," says lead study author Gary D. Klasser, DMD. "For reasons unknown, it seems that the BMS patient's nerves are not sending and/or processing information correctl there's a short circuit in the nervous system and the brain can't turn off the pain receptors."
Although BMS can affect both sexes, the study confirms by a 7:1 ratio that women in their menopausal and post-menopausal years are more likely to be affected by BMS.
"For a small percentage of women, it is these hormonal changes that may alter taste and the way in which a person interprets pain," says Dr. Klasser. "The alterations may be enough to start the cascade of events that lead to BMS."
With no physical signs, it is very difficult for many health practitioners to recognize, diagnose, and manage BMS. As with most BMS sufferers, the patients in this study experienced oral burning symptoms for several years and visited multiple health practitioners prior to receiving a definitive diagnosis of BMS.
"Besides reporting oral burning, patients describe experiencing a dry, gritty feeling in the mouth, as well as alterations in taste," says AGD Spokesperson Eugene Antenucci, DDS, FAGD. "But because many health practitioners are not familiar with BMS and cannot see any physical symptoms, patients often leave the doctor's office frustrated and untreated."
Although no cure currently exists, health practitioners who have an understanding of the syndrome can help patients manage their symptoms.
"BMS is not a matter of life or death, but it is a matter of quality of life," says Dr. Antenucci. "Patients who believe they suffer from any of these symptoms should speak with their general dentist and seek out a health practitioner who has experience with this condition."
Medications, both topical and systemic, are available to treat BMS. Patients should consult their doctor to determine the medication that is best for them.

Some helpful ways for patients to alleviate the symptoms of BMS without taking medication are to drink water regularly to keep the mouth lubricated; avoid spicy, hot, acidic foods that can amplify symptoms; chew sugarless gum to increase saliva flow; and avoid tobacco and alcohol products that can cause irritation to the oral tissue.

Women's Fertility Linked To Oral Health

Women who want to have a baby should look after their oral health, a fertility expert told a meeting in Sweden yesterday. During the meeting, delegates heard about preliminary research that found for the first time, from when she starts trying to conceive, a woman's chances of falling pregnant can depend on how well she looks after her teeth and gums.
Roger Hart, a professor at the University of Western Australia in Perth, told the annual meeting of the European Society of Human Reproduction and Embryology in Stockholm, that the effect of gum disease on conception is about the same order of magnitude as the effect of obesity.
Hart, who is Professor of Reproductive Medicine at the University and Medical Director of Fertility Specialists of Western Australia, said their study was the first to be published that investigates links between gum disease and women's chances of getting pregnant, so it is the:
"... first report to suggest that gum disease might be one of several factors that could be modified to improve the chances of a pregnancy."
He says women who want to become pregnant should visit their dentist and brush their teeth regularly.
For their research, Hart and colleagues analyzed data on over 3,400 pregnant women from Western Australia who were taking part in a study called SMILE that was investigating how treatment for gum disease affects pregnancy outcomes.
They found that women with gum disease took on average two months longer to conceive than women without gum disease (seven months instead of five).
Non-Caucasian women appeared to be the group most affected: they were likely to take more than 12 months to become pregnant if they had gum disease.
Gum disease, also known as periodontal disease, is where the gums and supporting tissue are chronically infected and inflamed.
Our mouths are full of bacteria, which stick to mucus and bits of food and form a sticky "plaque" on our teeth. Brushing and flossing gets rid of plaque, but if this is not done regularly, then the plaque goes hard and turns into "tartar", that is much harder to get rid of. You should then visit the dentist or hygienist to have it removed properly.
If you leave it too long before removing plaque and tartar, the bacteria causes an inflammation called "gingivitis", where the gums appear red and swollen, and bleed. At this stage, daily brushing and flossing and visits to the dentist can restore oral health. But eventually, if not attended to, the disease moves to a stage where tissue and bone are affected: this is periodontitis, which literally means "inflammation around the tooth".
In periodontitis the gums pull away from the teeth and little pockets develop that become infected. The bacteria and plaque starts to grow below the gum line, causing the immune system to respond. Toxins from the bacteria and immune system activity start to attack the tissue and bone that hold teeth in place, and they become loose.
But these destructive agents also get into the bloodstream, which may explain why gum disease is linked to increased risk of a number of chronic diseases such as type 2 diabetes, heart disease, respiratory and kidney disease, and also, miscarriage and premature birth.
About one in ten people is thought to have severe periodontal disease. The best way to prevent it is to brush and floss your teeth regularly.
Hart suggests the reason the non-Caucasian women were the most affected was because they appeared to have the highest level of inflammatory response when suffering from gum disease.
He also said that receiving treatment for gum disease while pregnant does not affect the health of the foetus or the mother.

New Method may Help Cut Healing Process for Dental Implants

Replacing the lost teeth with titanium dental implants could shorten the healing time for patients. "Increasing the active surface at nano level and changing the conductivity of the implant allows us to affect the body's own biomechanics and speed up the healing of the implant," says Johanna L'berg at the University of Gothenburg's Department of Chemistry. "This would reduce the discomfort for patients and makes for a better quality of life during the healing process."

Dental implants have been used to replace lost teeth for more than 40 years now. Per-Ingvar Br'nemark, who was recently awarded the prestigious European Inventor Award, was the first person to realise that titanium was very body-friendly and could be implanted into bone without being rejected. Titanium is covered with a thin layer of naturally formed oxide and it is this oxide's properties that determine how well an implant fuses with the bone.
It became clear at an early point that a rough surface was better than a smooth one, and the surface of today's implants is often characterised by different levels of roughness, from the thread to the superimposed nanostructures. Anchoring the implant in the bone exerts a mechanical influence on the bone tissue known as biomechanical stimulation, and this facilitates the formation of new bone. As the topography (roughness) of the surface is important for the formation of new bone, it is essential to be able to measure and describe the surface appearance in detail. But roughness is not the only property that affects healing.
Johanna L'berg has come up with a method that describes the implant's topography from micrometre to nanometre scale and allows theoretical estimations of anchoring in the bone by different surface topographies. The method can be used in the development of new dental implants to optimise the properties for increased bone formation and healing. She has also studied the oxide's conductivity, and the results show that a slightly higher conductivity results in a better cell response and earlier deposition of minerals that are important for bone formation.
The results are in line with animal studies and clinical trials of the commercial implant OsseoSpeed (Astra Tech AB), which show a slightly higher conductivity for the oxide and also an exchange between hydroxide and fluoride on the surface of the oxide. Surfaces with a well-defined nanostructure have a larger active area and respond quickly to the deposition of bone-forming minerals.
The project is a collaboration between the University of Gothenburg and Astra Tech AB in M'lndal, and will be further evaluated in follow-up studies.

The top 7 best and worst foods for teeth

** The top 7 best foods and drinks for teeh:

1- High fibre fruits and vegetables
High-fibre foods work like a detergent in the mouth, not only physically 'scrubbing' the teeth, but also stimulating saliva flow by requiring longer chewing times.
Saliva is the mouth's first line of defense, because it neutralises tooth-damaging acids, and contains calcium and phosphates that help rebuild minerals leached away by bacterial acids. Crunchy, juicy fruits and vegetables also have high water content that helps offset their sugar content. High-fibre foods are also a key foundation of an overall healthy diet, so they offer a double benefit.

2- Water
When it comes to oral health, water is indispensable. It's the primary component of saliva, and is important to both tooth and gum health. Water is valuable as the final rinsing agent for foods and sugary drinks, and, if fluoridated, works to prevent tooth decay by strengthening tooth enamel.

3- Dairy products
Dairy products without added sugar help teeth in a number of ways. Cheese helps stimulate saliva, while its calcium helps replace minerals leached from the teeth. Other dairy products, such as milk, yogurt and similar products also provide calcium and phosphates; enriched milk also provides vitamin D, which helps the body use calcium.

4- Xylitol
Sugarless gums of any kind can help boost dental health, because they stimulate saliva production and can help 'scrub' teeth. But those sweetened with xylitol – a type of sugar extracted from a variety of plants – can actually battle tooth decay, because xylitol works against mutans streptococci, the bacteria that causes tooth decay. Xylitol is available as a general sweetener at health stores.

5- A hot cup of cavity-fighter
Green and black teas contain compounds called polyphenols that interact with the bacteria that causes plaque. These polyphenols either kill or suppress bacteria, preventing them from growing or producing tooth-attacking acid. The polyphenols in coffee also have cavity-fighting properties. Studies have also shown cocoa to have strong anti-mutans streptococci properties, although chomping sugary chocolate bars isn't tooth-friendly.

6- Go nuts
Many nuts provide vitamins and minerals that help your teeth. These include peanuts (calcium and vitamin D), almonds (high levels of calcium that helps both teeth and gums), cashews (stimulates saliva and helps clean teeth) and walnuts (fiber, folic acid, iron, thiamine, magnesium, iron, niacin, vitamin E, vitamin B6, potassium and zinc).

7- Mining for minerals
Foods that provide vitamins A, C and D as well as calcium and phosphorus, are especially good for the teeth. These foods can be part of an overall healthy diet, as well. These include beef, eggs, fish, potatoes, spinach, fortified cereals, tofu, leafy green vegetables, beans, whole grains and poultry.


** Top 7 Worst Foods and Drinks for Teeth

1- Carbonated beverages and other drinks
Soft drinks are a perennial target of nutrition police, because they add so much sugar to the national diet. The sugar content – as much as a king-sized candy bar – is bad for both body and teeth. But teeth aren't safe even for those who stick to diet drinks! Like their sugar-loaded versions, artificially sweetened soft drinks contain tooth-eroding acids, such as phosphoric and citric. Even canned iced teas, which normally might be good for teeth, contain flavor-enhancing organic acids that can erode tooth enamel.

2- Not-so-healthy vitamins
Even so-called health drinks are brimming with danger for your teeth. Sports drinks are notoriously acidic and full of sugar. And vitamin waters can contain as much sugar as a candy bar. Chewable vitamins – from multivitamins to large chewable vitamin C tablets – are especially bad, because they contain a concentrated acid that tends to cling to and between teeth.

3- Mouth-drying consumables
Whether it's last night's margaritas that are leaving one cotton-mouthed, or one of the medications that affect salivation, a dry mouth is danger to teeth and gums. Psychiatric medications, Dr Moore says, are among the worst culprits in causing dry mouth. One must to take extra care to keep the mouth hydrated, from deliberately washing with water or fluoridated rinses, to mouth hydration solutions.

4- Long-lasting and sticky sweets
It's not news that caramels and other gooey, sugary sweets are bad for teeth. It's not just the sugar, though; it's how long the teeth are exposed to sugar. So while those caramels stick and cling tenaciously to tooth surfaces and crevices, hard candies and lollipops are also very bad; they're designed for a long, leisurely suck.
This principle applies to any sweets, from candy to sweet drinks – sugar should stay in the mouth as briefly as possible.

5- Dried fruits
While fresh grapes and plums are considered 'good' foods, if they are dried, they go from hero to villain. Although often touted as healthy snacks, dried fruits like raisins, prunes and apricots, are similar to caramels.
Already sweet when fresh, their sugars are highly concentrated as the water is dried away, and their gummy texture can cling to teeth as much as gooey candy. And worse, the fruit is packed with non-soluble cellulose fiber, which can bind and trap sugars on and around the tooth, making it worse than sweets.

6- Starchy foods
Many starchy foods, including white bread, potato chips and French fries and al dente pasta, can easily become lodged between teeth and in crevices.
While they may not necessarily taste sweet, the starches can begin converting to sugar almost immediately, not only by the bacteria, but also by the pre-digestive process that begins in the mouth through the enzymes in saliva.

7- High-acid foods and drinks
Citrus fruits and drinks contain powerful citric acid – in fact, such juice is often used as a cleaning agent. While oranges, lemons and grapefruit can be a healthy part of the diet, they should be consumed quickly, preferably as part of a meal, and the teeth should be rinsed afterward. Sucking on citrus fruits should be avoided; this especially applies to the home remedy practise sucking lemon wedges for tooth-whitening.

## Some tooth-healthy dos and don'ts

Crunching ice and popcorn
Teeth are tough and made to last a lifetime eating a normal diet, but they do have a breaking point. Ice is tough – tough enough that glaciers carve mountains and an iceberg could peel open the Titanic. Chewing ice is a common habit; but even if this doesn't cause a major break, it can lead to a network of tiny cracks that can develop serious problems as time goes on. Popcorn has its own dental danger, from husks that can easily become wedged between teeth to uncooked kernels that can damage teeth.

Use a straw/don't swish
The impact of sweet and/or acidic drinks can be cushioned by getting into the habit of drinking through a straw aimed toward the back of the mouth. Swishing a drink through the teeth, however, intensifies the effect of both sugars and acids.

Use water as a mouthwash
Water makes the perfect rinse to clear sugars and acids after eating or drinking.

Be careful brushing
Brushing is recommended after every meal. However there's an exception; if one has just eaten or drunk an acidic food or beverage, they should rinse with plain water to clear the mouth, and then wait at least a half-hour before brushing. After the acid bath, tooth enamel is more vulnerable to damage. Waiting a while gives saliva a chance to remineralise the teeth so the brushing doesn't worsen damage.

Workshops of The Conference