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Dental problems of Teenagers – Five Most Common Causes

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Teenagers have a lot of issues to think about and deal with everyday. School pressures, navigating social issues, and trying to figure out just where they fit in the grand scheme of things is enough for anyone to worry about. In light of this, one of the things that tends to get overlooked during this time of growth and change is that of dental health and oral hygiene. There are several factors to consider when talking about teens and oral health. Below is some information about the five most common dental problems facing teenagers.

Smoking and Drug Use

Along with all of the other pressures kids are facing, smoking and drug use are high on the list of things that can affect dental health. Aside from staining your teeth, smoking leads to gum disease and gingivitis as well as many other problems. It can inhibit healing of tissues in case of accident or tooth loss, and it is also one of the leading causes of oral cancers. Other drugs, such as methamphetamines, are known for causing severe periodontal disease including tooth and bone loss in the jaw.

Eating Disorders

Unfortunately, with the uptick in eating disorders in teens, there has been an increase in oral health problems as well. Common eating disorders such as bulimia can quickly erode the surface of  teeth as stomach acids from induced vomiting can destroy  tooth enamel. Additionally, other eating disorders can lead to malnourishment, causing bone and jaw problems. Proper nutrition is as important to oral health as it is to all other aspects of growth and development.

Wisdom Teeth

There’s not much to do to prevent  wisdom teeth from coming in; they’ll come in when they’re ready. You can be on the lookout for signs and symptoms and take steps to deal with them when they do. Many people never get wisdom teeth, but some teens and young adults have trouble with crowding, pain, and even impaction. Talk to your dentist about monitoring the teeth before they erupt; they can often tell you what to expect based on your x-rays and have a plan. If you wear or have worn braces, you’ll want to play close attention. If your wisdom teeth come in and you don’t have the space for them, they can quickly undo years’ worth of orthodontic work.

Soda and Excess Sugar

Sports drinks, sodas, and other sugary treats can wreak havoc on your teeth, even if you’re brushing regularly. Sugar feeds bacteria in your mouth that produce acids, which in turn attack the enamel on your teeth, weakening the enamel and leading to tooth decay and cavities. Teenagers are notorious for snacking and consuming large quantities of soft drinks. If you’re going to indulge, make sure that you are at the very least rinsing your mouth with water frequently, and try to increase brushing and flossing to help get rid of the excess sugar.

Injuries

You’d be surprised how many active teens involved in sports programs suffer from dental injuries. Chipped or broken teeth commonly occur from falls or from a blow to the face with a ball, bat or other sports equipment. While many sports require players to wear mouth guards for just that reason, there are plenty of activities that don’t stress the importance of taking care of your teeth. Consider these risks when deciding whether or not to invest in safety equipment for your mouth. In small children, it’s not as big a problem as deciduous teeth will be replaced, but once your permanent teeth are in, you’ll want to start taking steps to protect them.

This is a guest post by Kate Thora who works at BizSet.com as a Senior Content Specialist.  She enjoys writing about the newest trends in the field of medicine. 

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Your Dentist Can Help Protect You From Diabetes

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Diabetes is a condition affecting up to 100 million Americans, making it one of the biggest health concerns facing the U.S.. While it can be managed with a change in diet and prescription medication, there is also a role for your dental practitioner. They will be able to tell from examining your mouth whether you are at risk and can perform procedures to stabilize blood sugar levels. Poor dental health can tell you so much more about your health than just the condition of your teeth and has been linked not just to physical conditions but also to poor mental health. Don’t be afraid to ask your dentist if they see any other health concerns during a dental checkup, particularly having to do with diabetes.

The Link Between Diabetes and Dental Diseases

Even if a doctor hasn’t diagnosed you with diabetes, you should ask your dentist if they think you’re at risk. Some of the main symptoms and earliest signs of diabetes show up in the mouth. You may have a dry mouth and feel a constant thirst, which your dentist should be able to pick up on during a check up. This lack of saliva in your mouth will make you vulnerable to cavities, so needing fillings could also be a sign of diabetes.

If you regularly experience cuts or bleeding gums, this could be a sign of a health condition. This is especially true if they take a long time to heal. Diabetes slows down the ability of your body to heal from wounds, so a dentist might be able to recommend a doctor’s appointment if you keep returning with mouth injuries.

Treating Gum Disease

Receiving treatment for diabetes ultimately comes from a medical doctor and in some cases such treatment can lead to increased cardiovascular problems. Even so dentists have an active role, as effectively treating gum disease can improve your body’s ability to control the production of sugar in the blood. Those living with diabetes have a significantly increased chance of developing periodontal disease. This is because a blood sugar imbalance makes it difficult for the body to fight off the bacteria living in the gums.

Healthy gums are essential to the management of blood sugar levels. If you can regularly go to the dentist, then they can treat gum disease and improve your oral health. This can prevent diabetes occurring and help you to manage the condition if it arises.

Dentist Chair Equipment

Between Dental Appointments

Every time you visit your dentist, you will receive a deep clean to help prevent diabetes. However, you have a responsibility between dental appointments. Make sure you brush properly at least twice a day and floss regularly to keep your gums healthy and protected from bacteria.

Diabetes in an extremely common condition, so it is useful to take in as much information around the subject as possible. Many of the symptoms start in the mouth, which is also where the condition can be managed. Brush regularly and get dental check ups often to look out for warning signs of diabetes and keep the body protected.

Image from https://unsplash.com/photos/kdoaOFGE9QM

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Reducing mental distress in patients undergoing dental procedures including hypnosis, relaxation, and counseling

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An interesting article titled “Non-pharmacological interventions for reducing mental distress in patients undergoing dental procedures: Systematic review and meta-analysis” by Sophia Burghardt  et al., appears in the Journal of Dentistry in 2018 (vol. 68, pp. 22 – 31). The article seeks to determine the effects of hypnosis, enhanced information, relaxation, music, or cognitive-behavioral approaches on adults undergoing dental procedures. The researchers explored 29 randomized controlled trials and found through random effects meta-analyses significant reduction of mental distress when patients underwent a non-pharmacological intervention. In particular the largest effect was shown for hypnosis.

People experience anxiety and fear of going to a dentist and some even have a diagnosable condition of dental phobia. Research shows a general dentist is capable of treating adults with mild or moderate forms of dental anxiety but those with severe dental anxiety or even dental phobia often requires more specialized care such as psychotherapy. There are several different approaches that can be used in dental care in order to assist anxious patients. Hypnosis is the induction of a state of consciousness in which a person apparently loses the power of voluntary action and is highly responsive to suggestions.Hypnosis is suggested to work by reducing distress and targeting patients with suggestions for positive outcomes. All studies included by the researchers applied hypnosis using pre-recorded audio files which might be a more economic approach. Enhanced information draws on the patient’s cognitive level to transmit sensory and/or procedural information before, during and after a dental procedure. Cognitive-behavioral strategies focus on the reduction of dental anxiety through cognitive restructuring, distraction, sensory focusing, positive reinforcement, or systematic desensitization. Many often think of cognitive-behavioral therapy as a form of counseling. Counselors can help one become more aware of feelings and help work through difficulties. Relaxation techniques are described as teaching or instructing patients in breath control, muscle relaxation, guided imaginary, or autogenic training. Music interventions are known to influence physiological and psycho-emotional responses in patients by arousing memory and association, stimulating imagery, evoking emotions, and promoting relaxation and distraction.

The researchers also note that they found a negative effect on a study of showing patients the details of an operative procedure by using a video and it is believed this could have lead to additional anxiety. Based on the results the researchers feel that non-pharmacological interventions may be beneficial for reducing mental distress in patients undergoing dental procedures. They believe that additional high quality studies are needed to strengthen the evidence of non-pharmacological interventions.

woman thinking

Image from https://unsplash.com/photos/P9rQn2qcEV0 

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Tooth Decay Higher in Children Who do not Drink Tap Water, But Blood Lead Levels Lower

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A new study appearing in the American Journal of Preventive Medicine has shown that American children who do not drink tap water are much more likely to have tooth decay than those who do, but also less likely to have elevated levels of lead in their blood. Due to some dangers reported from drinking tap water which includes fluoride and potentially other contaminants, some parents have opted to not give it to their child and instead have opted for bottled or filtered water for drinking. See http://blog.teethremoval.com/large-amounts-of-fluoride-consumed-by-young-children-leads-to-fluorosis/ for more information on the dangerous of fluoride for young children.

According to the Centers for Disease Control and Prevention (CDC), adding fluoride to the water supply has dramatically reduced the prevalence of tooth decay over the past 70 years. Even so tooth decay is still a large problem affecting the primary teeth of over 20% of U.S. preschoolers in 2011 to 2012.

Researchers from the Department of Dental Ecology, University of North Carolina at Chapel Hill, analyzed a nationally representative sample of nearly 16,000 children and adolescents aged two to 19 years who participated in the National Health and Nutrition Examination Survey (NHANES) from 2005 to 2014. The researchers found more than 12,000 records included data on blood lead level and about 5,600 records had data on dental caries. NHANES is the U.S. benchmark for national surveillance of blood lead levels and is the sole national source of dental examination data. Several studies using data from NHANES has been cited on the risks of keeping wisdom teeth page located at http://www.teethremoval.com/risks_of_keeping_wisdom_teeth.html.

In the NHANES study, individuals visited a mobile examination center where they completed a dietary interview, donated a blood sample, and received a dental examination. About 15% of the children involved said that they did not drink tap water. According to the results of the study, children and adolescents who did not drink tap water were more likely than tap water drinkers to have tooth decay. Those who drank tap water had significantly higher prevalence of elevated blood lead levels than children who did not drink tap water. Overall, almost 3% of children and adolescents had elevated blood lead levels and 49.8% had tooth decay. An elevated blood lead level was defined as having at least three micrograms of lead per deciliter of blood. Tooth decay was defined as the presence of one of more tooth surfaces affected by dental caries as determined on the dental examination. The study used a statistical analysis which took into account other factors that could account for the relationship between drinking tap water and tooth decay and blood lead levels .

One limitation of the study was that the fluoridation status of participants’ tap water was unknown. Tooth decay in children can cause pain and problems and be costly to treat. Even though elevated blood levels only affects a small amount of children, the effects can be permanent. The researchers feel their study shows a trade-off between drinking tap water and not drinking tap water. The researchers feel that water fluoridation is beneficial and having parents decide that their water is harmful and not give it to their children is to their detriment.

Source: Anne E. Sanders and Gary D. Slade, Blood Lead Levels and Dental Caries in U.S. Children Who Do Not Drink Tap Water, American Journal of Preventive Medicine, 2017.

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Household Environment Shapes Saliva Microorganisms

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Researchers from UCL in the United Kingdom have discovered that the mix of microorganisms in a person’s saliva are largely determined by the household they live in. The study showed that early environmental influences play a far larger role than human genetics in shaping the salivary microbiome. The microbiome are organisms that play an important role in oral and overall health. The oral cavity is colonized by hundreds of bacterial species, which stop external pathogens but they also can cause oral disease. The researchers were interested in exploring how the salivary microbiome becomes established and which factors are most responsible.

The researchers used DNA and saliva from an extended Ashkenazi Jewish family living in various households spread across four cities on three continents. The family members are believed to have shared cultural diets and lifestyles that control for many confounding factors. The DNA had already been sequenced to the level of single changes in the DNA code which provided insights into their genetic relatedness. The researchers also sequenced the DNA  present in saliva samples from 157 family members and 27 unrelated Ashkenazi Jewish controls. They found the core salivary microbiome made up of bacteria from the genera Rothia, Neisseria, Streptococcus, and Prevotella.

The researchers used statistical methods to determine which factors are responsible for the most variation. When comparing factors such as city, age, household, and genetic relatedness, the factor that determined who shared the most similar saliva microbes was household. Spouses and parents and children younger than 10 living in a household together had the most similar saliva microbiomes. The researchers believe that contact played a role but it did not have to be intimate. Children younger than 10 were found to have more similar bacteria to their parents than to their older siblings.

The researchers also explored whether genetic relatedness drove the makeup of the saliva microbiome. They used a measure of relatedness based on family tree relationships alone and saw a small, statistically significant effect. When they looked at the genetic sequence information the effect disappeared. Essentially this means that a person’s genetics played almost no role in shaping their saliva microbes. This study shows shared environments play a major role in determining what bacteria becomes established.  The researchers feel that knowing that the environment drives the microbiome may one day allow for behavior to shift which can lead to a more favorable microbiome. It is known that periodontitis (gum disease) is associated with an altered microbiome. So potentially making subtle changes in the environment you live in may affect if you develop periodontitis or not at a later age.

Source: Liam Shaw and et. al., The Human Salivary Microbiome Is Shaped by Shared Environment Rather than Genetics: Evidence from a Large Family of Closely Related Individuals, mBio, vol. 8, issue 5, 2017.

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Preventing Tooth Cavities with an Inhibitor

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Researchers at the University of Alabama at Birmingham have created a small molecule that prevents tooth cavities in a preclinical model. The inhibitor blocks the function of an enzyme in an oral bacterium and prevents it from forming biofilms. Specifically the inhibitor causes Streptococcus mutans (S. mutans) which is the prime bacterium that causes tooth decay and dental cavities, to not make the sticky bioflim that has it glue to a tooth surface. The selective inhibition of the sticky biofilm acts against S. mutans reduced dental caries in rats fed a diet intended to promote cavities.

The glucan biofilm is made by three S. mutans glucosyltransferase (Gtf) enzymes. It is know what the crystal structure of the GtfC glucosyltransferase is, and the researchers used the structure to run numerous computer simulations for drug-like compounds for binding at the enzyme’s active site. Ninety compounds with diverse scaffolds that showed promise in the computer simulations were purchased and tested for their ability to block biofilm formation by S. mutans. Seven were found to show the most promise. The researchers further narrowed their candidate to #G43 which inhibited the activity of enzymes GtfB and GtfC. #G43 did not inhibit the expression of the gtfC gene, and did not affect growth of S. mutans and other oral bacteria. #G43 also was found to not inhibit biofilm production by several oral streptococcal species.

The researchers fed rats a low-sucrose diet and infected them with S. mutans. The rats teeth were treated topically with #G43 twice a day for four weeks. The #G43 treatment was found to cause large  reductions in tooth enamel and cavities. The researchers feel that their compound can be developed into drugs that prevent and treat dental cavities.  Development of the inhibitor in the dental setting offers a proof of concept that selective targeting of key bacteria may help with new treatment approaches. This may serve to be more beneficial to many than the common approach today of tooth brushing and flossing to remove oral bacteria.

Source: Qiong Zhang and et. al., Structure-Based Discovery of Small Molecule Inhibitors of Cariogenic Virulence. Scientific Reports, vol. 7, issue 1, 2017.

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Will Dental School Debt Lead to Future Counseling?

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Future dentists these days are being subjected to large amount of loans that are necessary as a part of dental school. This topic has been covered a bit before on this site, see for example http://blog.teethremoval.com/medical-school-student-costs-in-the-u-s-are-affecting-mental-health/ and http://blog.teethremoval.com/medical-students-are-at-risk-for-suicide/. This topic has also been recently discussed on the American Dental Association (ADA) Viewpoint and Letters to the Editor. In an April 18, 2016, letter titled “Dental student loan debt” Dr. Sparkman from Texas said

If most dental students today are borrowing over $200,000 to get out of dental school then I have part of the solution in three words.

Get a job.

Dr. LeMert a 2009 dental school graduate from the state of Washington took issue with this position and found Dr. Sparkman’s position laughable.  He said in a May 16, 2016 letter titled “Dental school reality

Dental school itself was a 60 hour/week endeavor that not only left you physically tired but often mentally spent… Students today might be able to work … but at what personal cost? Physical and mental health, as well as preservation of marriage and family, if that applies, needs to be important to our students if they are to graduate as well rounded individuals ready to take on the challenges of entering the work force.

Essentially Dr. LeMert argues that dental school is just too demanding each week to really be able to work much and make up this money without sacrificing other aspects of their life. Perhaps a dental student wants to have some time to workout and exercise and to have some downtime where they can rest and recuperate. They may also want to date and perhaps get married and start a family. Many people these days get into deep and meaningfully relationships during the time dental school occurs. A spouse or a future spouse may not be able to really commit to a relationship with a dental student who was in school all day and then also trying to work to make back up some of their money to reduce their future student loan burden. Furthermore, if a dental student manages their time such that they are in school and work nearly all the time, this may set up a bad habit in their future lives once they graduate.  These individuals may go on to have problems in their lives and even may require marriage counseling or relationship counseling to try to save their relationships with friends and family. Clearly dental education is in need of some reform so that once dental students graduate they are not overwhelmed with huge amounts of loans and debt as this may affect their ability to be the most ethical dentist that everyone wants.

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Dentists Should be Prepared to Refer to a Counselor, Psychologist or Psychiatrist

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In recent years more and more dentists have had to deal with patients with substance use disorders. Wisdom teeth extractions are sometimes said to be a potential cause of a later substance use disorder, see for example http://blog.teethremoval.com/painkiller-overdose-in-michigan-are-wisdom-teeth-extractions-contributing/. Even though dentists and oral surgeons have taken steps in recent years to reduce the amount of drugs they prescribe to their patients that would possibly be used for non-medical purposes this may not entirely solve the problem. If through the course of a patient evaluation, a dentist becomes aware of a possible drug or alcohol problem, they should be prepared to refer their patient to a counselor, psychologist or psychiatrist. As such they should have several possibilities available for the referral. The American Dental Association (ADA) had a webinar series several years ago titled “Interviewing and Counseling of patients with substance use disorders and drug seeking behaviors” that provides useful information for dentists to review.

The webinar slides suggest dentists use The Screening, Brief Intervention, and Referral to Treatment (SBIRT) model, the Drug Abuse Screening Test (DAST), and the Alcohol use disorders identification test (AUDIT). The slides suggest that less than than 5% of all patients are likely to have a positive screen. Numerous red flags a patient may show that could indicate a drug problem are presented including

  • Unusual behavior in the waiting room
  • Unusual appearance
  • Assertive personality, often demanding immediate attention
  • Unusual knowledge of controlled substances
  • Reluctant or unwilling to provide reference information
  • Request of a specific controlled substance
  • No interest in diagnosis
  • Exaggerate medical problems
  • Signs of drug abuse such as skin tracks and scars
  • Comes in after regular office hours
  • States only a certain drug works
  • Threatens dentist or staff

It also suggested dentists use a Prescription Drug Monitor Program (PDMP) to help them initiate a conversation with a patient. By using such a tool a dentist can determine if the patient has had any prescription medications for pain prescribed recently for pain or anxiety. A dentist can also determine if the patient is actively taking any prescription medications.

While a dentist may not typically encounter a patient with drug-seeking behavior, they should be educated in ways to determine this and what to do when it occurs. For some dentists in more rural areas or even in large cities with heavy traffic it may be more convenient for their patients to be referred to a online psychiatrist or other form of a counselor that does not require an in person office visit. Of course at some point an in person visit may be preferred, but the potential benefit with a virtual visit is the convenience which may allow for intervention sooner.

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How Does Cavity Causing Bacteria Survive?

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Researchers from the University of Basel’s Preventative Dentistry and Oral Microbiology Clinic and Department of Biomedical Engineering have found that extracellular polysaccharides play a central role in the survival capabilities of cavity causing bacteria in dental plaque. These bacteria live in biofilm and cause cavities by attacking dental enamel by converting sugar and starch into acids that dissolve out calcium from the enamel. The dissolution of calcium increases the concentration of calcium locally which creates an environment hostile to bacterial life.

The researchers investigated how bacteria manage to survive in dental plaque despite conditions of hostility. They suggested that extracellular polysaccharides (EPS) support the bacteria’s survival capabilities. EPS are substances that build extracellular cariogenic bacteria from sugar residue. These substances create biofilm’s scaffolding and ensure bacteria are able to anchor themselves in  dental plaque. The researchers showed the more that calcium cariogenic bacteria dissolve, the greater their calcium tolerance and survival capability in the biofilm. The team demonstrated that cariogenic bacteria develop mechanisms to help them survive the high concentrations of calcium.

The team showed that extracellular polysaccharides possess a high number of calcium binding sites which can integrate the free calcium into the biofilm. This neutralizes the toxic substance and strengthens the EPS structure of the biofilm. The EPS’ integration of calcium causes cavities in addition to helping cariogenic bacteria to survive in dental enamel. EPS integration of calcium inhibits the remineralization of the enamel since there is not enough free calcium present in the plaque. The researchers feel that this work is important to improve understanding of how calcium regulation occurs in cavities.

Source: Monika Astasov-Frauenhoffer and et. al., Exopolysaccharides regulate calcium flow in cariogenic biofilms, PLOS ONE, vol. 12, issue 10, 2017.

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Dental X-rays Show Vitamin D Deficiency

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McMaster anthropologists have found that human teeth hold important information about Vitamin D deficiency which can be identified by a dental X-ray. The researchers had previously discovered that human teeth hold a detailed and permanent record of Vitamin D deficiency. The teeth show microscopic deformities in dentin. This is preserved by enamel which protect teeth from breaking down. Vitamin D deficiency often occurs when a human does not get enough exposure to sunlight.

This work is useful for examining the teeth of people who lived years ago to see if they were ever deprived of sunlight and had Vitamin D deficiency. An issue when looking for teeth deformities currently is that that a tooth must be cut open and there are limited teeth the researchers had access to. To avoid wasting specimens, the researchers tried to find a way to isolate teeth for further study. Using X-rays to study the pulp horns, the dark shadow at the center of the image of a tooth, the researchers found a consistent and recognizable pattern.

The pulp shape in a healthy person’s tooth resembles an arch topped by two cat ears. The pulp shape of a person who has had a deficiency of Vitamin D is asymmetrical and constricted, and looks like the profile of a hard-backed chair.  Vitamin D deficiency can have adverse health implications and being able to know who has had a deficiency can help identify people who may have ongoing issues to prevent worse damage. The researchers feel that if a dental X-rays shows there might be a Vitamin D deficiency then a later blood test can be used to confirm it.  Detecting a problem early in a person’s life could prevent future problems with Vitamin-D related bone deficiency. Knowing about Vitamin D deficiency can determine what is the best balance between protecting people from harmful sunlight and making sure they get enough sun.

It is interesting that even though this work started off exploring ancient humans who have been did for a number of years, it is still applicable today. Vitamin D deficiency has been linked to increased chronic headaches, see http://blog.teethremoval.com/vitamin-d-deficiency-and-increased-chronic-headaches/. Making sure you have enough Vitamin D can also help prevent future gum infections, see http://blog.teethremoval.com/vitamin-d-can-help-prevent-gum-infections/. Even though blood tests can currently detect if someone has a Vitamin D deficiency, these are not always performed and having readily available dental x-rays may allow a dentist to play a role in telling patients if they need additional Vitamin D supplements and/or exposure to natural sunlight.

Source: Lori D’Ortenzio and et. al., The rachitic tooth: The use of radiographs as a screening technique, International Journal of Paleopathology, 2017.

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Microbes to Modify Nitrates in Migraine Headache Sufferers

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Researchers at the University of California San Diego have found that the mouths of those who suffer from migraine headaches have significantly more microbes with the ability to modify nitrates than people who do not have headaches. Many of the millions of Americans who suffer from migraines report an association between consuming foods with nitrates and the intensity of their headaches. The researchers were interested in exploring the idea that foods can trigger migraines and in particular exploring the microbiome connection with migraines. In addition, four in five cardiac patients who take nitrate-containing drugs often report headaches as a side effect.

Nitrates are found in foods including processed meats and green leafy vegetables. Nitrite reducing bacteria found in the mouth can reduce the nitrates to nitrites. These nitrites can then be converted to nitric oxide when circulating in blood. Nitric oxide can help improve cardiovascular health by reducing blood pressure.

Using publicly available data from the American Gut Project, the researchers sequenced bacteria found in 172 oral samples and 1,996 fecal samples from healthy study participants. The people who the samples were obtained from had filled out surveys indicating whether they suffered from migraine headaches. The bacterial gene sequencing found that bacterial species were found in different abundances between people who have migraines when compared to those who don’t.

The team then used a bioinformatic tool called PICRUSt to analyze which genes were likely to be present in the two different sets of samples, given the bacterial species present. In fecal samples, they found a small statistically significant increase in the abundance of genes that encode nitrate, nitrite and nitric oxide-related enzymes in those who suffer from migraines. In oral samples, these genes were significantly more abundant in those who suffer from migraines.

The researchers feel that the conversion from nitrates to nitrites in the mouth is advantageous to cardiovascular health. However, now they know that more of this going on can result in migraine headaches or may be a cause of migraine headaches occurring. The researchers have plans to look at more patients and group by different types of migraines. The researchers can then better find out if oral microbes really do have nitrate-reducing genes and measure their levels of circulating nitric oxide allowing them to gain insight into migraine headaches.

This is interesting work and helps solidify the experience that many migraine sufferers have, that their diet can play a role in their headaches. See for example a prior blog post at http://blog.teethremoval.com/a-healthy-headache-diet/.

Source: Antonio Gonzalez and et al., Migraines Are Correlated with Higher Levels of Nitrate-, Nitrite-, and Nitric Oxide-Reducing Oral Microbes in the American Gut Project Cohort, mSystems, October 2016.

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Having diabetes can lead to periodontitis

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Those with diabetes may end up with periodontitis, a gum infection which causes tooth loss. University of Pennsylvania researchers has found diabetes triggers changes in oral microbiome which increases inflammation and increases the risk of bone loss. Prior studies before this work did not show any evidence that diabetes affects the oral microbiome. In addition over four years ago, the European Federation of Periodontology and the American Academy of Periodontology issued a report describing how there is evidence that diabetes is linked to changes in the oral microbiome.

The University of Pennsylvania researchers collaborated with Peking University, the University of São Paulo, Sichuan University, the Federal University of Minas Gerais, and the University of Capinas. The authors consulted with the Penn Center for Musculoskeletal Diseases.

The researchers first explored the oral microbiome of diabetic mice compared to healthy mice. It was found that diabetic mice had a similar oral microbiome to healthy ones when sampled prior to developing high blood sugar levels known as hyperglycemia. Once the diabetic mice became hyperglycemic, their microbiome became different from normal mice and had a less diverse set of bacteria. The diabetic mice had periodontitis and increased levels of IL-17, a signaling molecule which plays a role in immune response and inflammation.

The results showed an association between changes in the oral microbiome and periodontitis but to better understand, the researchers transferred microorganisms from diabetic mice to normal germ-free mice that were never exposed to any microbes. These mice developed bone loss. A micro-CT scan showed 42% less bone than mice whom had received a microbial transfer from normal mice.  Thus the researchers demonstrated that they were able to induce rapid bone loss characteristic of the diabetic group into a normal group of mice simply transferring the oral microbiome.

The researchers hypothesized that inflammatory cytokines, such as IL-17, played a role, and thus repeated the microbiome transfer experiments, but instead also injected the diabetic donors with an anti-IL-17 antibody prior to transfer. The mice that received microbiomes from the treated diabetic mice had much less severe bone loss compared to mice that received a microbiome transfer from mice not treated with the antibody.

The researchers feel these results show that diabetes-induced changes in the oral microbiome drive inflammatory changes that enhance bone loss in periodontitis. They also do not feel that IL-17 treatment can be effective at reducing bone loss in humans. This study underscores the importance of those suffering from diabetes to practice good glycemic control and good oral hygiene.

Reference: E Xiao and et al., Diabetes Enhances IL-17 Expression and Alters the Oral Microbiome to Increase Its Pathogenicity, Cell Host & Microbe, issue 1, vol. 22, 2017.

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Nanodiamonds to Help With Root Canal Recovery

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Researchers at UCLA found in a clinical trial that nanodiamonds protected disinfected root canals after the nerve and pulp were removed. This result may help people who undergo root canals as it could help prevent infection after treatment. Specifically combining nanodiamonds with gutta percha, a material used to fill disinfected root canals, may enhance the gutta percha’s protective properties.

Nanodiamonds are tiny particles made of carbon and are very very small. Nanodiamonds have previously been explored to deliver drugs and serve as imaging agents. Protecting disinfected root canals is a delicate process. Dentists use gutta percha to block bacteria from infiltrating the tooth, but it can break during the procedure or create pockets of space for bacteria to infiltrate. The researchers tested nanodiamond-embedded gutta percha (NDGP) in three people who undergoing root canal procedures. These tests demonstrated the implanted material NDGP was more resistant to buckling and breaking than conventional gutta percha. All three patients healed without experiencing much pain and with no infections.

Using NDGP for the procedures did not require changes to any of the standard procedures for root canals. The researchers believe nanodiamonds could help with drug resistance in cancer, improve the efficiency of magnetic resonance imaging, and address many other clinical challenges.

Source: Dong-Keun Lee and et. al., Clinical validation of a nanodiamond-embedded thermoplastic biomaterial. Proceedings of the National Academy of Sciences, 2017.

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Terror Attack Survivors More Prone to Headaches

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Researchers have shown that survivors of a terror attack have an increased risk of frequent migraine and tension headaches developing after the attack. Therefore there are potential physical effects of violent incidents in addition to the better known psychological effects.

The researchers studied the responses teenage survivors of the largest mass killing in Norway that occurred in 2011. In the attack, a lone gunman opened fire at a youth summer camp on Utøya Island, killing 69 people and severely wounding 33. All survivors experienced terror, some lost friends, and some risked drowning as they tried to escape the island. The study shows that a single highly stressful event such as a terror attack may lead to ongoing suffering with frequent migraines and other headaches.

All 358 teenage survivors of the incident were invited to participate in the study. A total of 213 survivors participated, with an average age of 18 and 6% being severely injured in the attack. Participants were interviewed about their headache type and frequency four to five months after the attack. These responses about their headache were compared to the responses of 1,704 young people of the same sex and age who had not experienced any terror.

The teens who had been exposed to the terror attack were four times more likely to have migraines and three times more likely to have frequent tension headaches than those who were not exposed to any terror. These findings remained the same after adjusting for sex, injury, prior exposure to violence, and psychological distress. Among the female respondents, 80 of the 109 (73%) who were exposed to the attack had recurrent headaches, compared to 325 of the 872 (37%)  who were not exposed. Among the male respondents, 43 of the 104 (41%) who were exposed to the attack had recurrent headaches, compared to 158 of the 832 (19%) who were not exposed. The terror attack survivors were more likely to have daily or weekly headaches than those who were not involved in such an incident.

The researchers feel that people right after terror attacks can be helped to help reduce the potential of frequent and disabling headaches occurring thereafter. In many cases with severe headaches, treatments can be most helpful early on before the headaches progresses to become chronic.  The researchers note that a limitation of the study was that they received a lower response rate from survivors with high symptom levels, which could have led to an underestimation of the risk of headaches occurring in the group. This is an interesting study and perhaps other research teams can look at other terror attack incidents and see if similar results where headaches increase also occur.

Source: Synne Øien Stensland, John-Anker Zwart, Tore Wentzel-Larsen, and Grete Dyb, The headache of terror, Neurology, 2017.

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Gum to Test for Inflammation in Mouth

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Researchers from the University of Würzburg in Germany have developed a chewing gum that is capable of detecting inflammation in the mouth. The research was motivated by the fact that 6% to 15% of patients who receive dental implants develop an inflammatory response in in the years that follow. This is caused by bacteria destroying the soft tissue and the bone around the dental implant.

The researchers provided proof of a principle by using studies of the saliva of patients at Merli Dental Clinic in Rimini. They showed that in the presence of inflammatory conditions, specific protein-degrading enzymes are activated in the mouth. These same enzymes break down a special ingredient of chewing gum within five minutes to release a bittering agent that could not be tasted before. In the future, patients will benefit from this method using a chewing gum diagnostic test to assess whether they carry any bacteria that leads to mouth inflammation.

If there is an inflammation in the oral cavity, a bittering agent is released while chewing the gum. Patients then visit their dentist who confirms the diagnosis and treats the disease. This is a quick and affordable diagnostic approach. This type of early detection aims at preventing serious complications such as bone loss. This test it easy in that it can be used anywhere and without any special costly equipment.

The invention and work was described in the the journal “Nature Communication” in 2017.

Right now the chewing gum that detects mouth inflammation is not commercially available. The researchers plan to set up a company to produce it but it may take several years before someone can buy this chewing gum. It is also important to note that a chewing gum test for other medical applications is currently being developed. It would certainly be interesting if patients could just chew a piece of gum and be able to diagnose diseases that their doctors could then readily treat. This would help prevent future problems and preserve patients health in a faster and more efficient way than what one can do today.

Source: J. Ritzer and etl al., Diagnosing peri-implant disease using the tongue as a 24/7 detector, Nature Communications, vol.8, issue 1, 2017.

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Opioids Overused For Migraine Headache Treatment

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A new study that attempted to find racial disparities in the treatment of migraine headaches found no differences and instead found that opioids are often overused for migraine headache treatment. As has been discussed on this blog and site before, the prescribing habits of opioids are under scrutiny for wisdom teeth surgery. See for example the article http://blog.teethremoval.com/what-can-a-surgeon-do-to-prevent-opioid-abuse/ and the article http://blog.teethremoval.com/painkiller-overdose-in-michigan-are-wisdom-teeth-extractions-contributing/. Now it appears that the prescribing habits of opiods for migraines should also be under scrutiny.

Existing research shows that African-Americans experience more frequent and severe migraine headaches than non-Hispanic whites. Researchers at the University of Michigan set out to explore if there was any evidence of racial disparities in treatment practices for migraines. However, instead of finding any disparities, they found opioids were being prescribed as frequently as medications that are more effective for migraine headaches.

In the study, results from 2,860 migraine visits in the U.S. between 2006 and 2013 were explored. A total of 65% of patients were non-Hispanic whites, while 10% were African-American, and another 10% Hispanic. African-Americans were 4% less likely to receive high-quality abortive agents and Hispanics were 5% less likely to receive high-quality prophylactic agents when compared with non-Hispanic whites (without any statistical significance).  A total of 15.3% of African-Americans, 19.4% of non-Hispanic whites, and 17.7% of Hispanics received a Level A abortive, an evidence-based medication intended for acute migraine treatment, such as dihydroergotamine or triptan. Overall, 38.9% of patients were not prescribed any abortive medication. Also 27% of patients being given an abortive medication were given a low-quality one instead of a high-quality one.

Roughly just over 40% of patients for each of the three groups received no prophylactic treatment or preventive medication. For all three groups, 15.2% of patients studied received a prescription for an opioid, with no significant difference among groups of patients. Other medications have been show to be more effective for treating migraine headaches than opioods so the researchers were a bit surprised by the results. Futher, opioids carry additional problems including association with medication overuse headache and comorbidities such as anxiety and depression.

The research was designed to investigate disparities in migraine occurrence and severity. The study was not able to determine the reasons for racial disparities in migraine headaches so the researchers feel that future studies are needed to help better explore this. Even so the study had an interesting result that may help doctors keep a closer eye on their prescribing habits for their patients who suffer for migraine headaches.

Source: Larry Charleston IV and James Francis Burke, Do racial/ethnic disparities exist in recommended migraine treatments in US ambulatory care? Cephalalgia, 2017.

 

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Prevent cavities in sensitive teeth

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People with sensitive teeth know that taking a sip of an ice cold drink can cause a painful jolt in the mouth. There are different approaches to treat this condition but the treatment usually does not last very long. Research appearing in ACS Applied Materials & Interfaces shows the development of a new material with an extract from green tea that can help treat sensitive teeth and even help prevent cavities.

Tooth sensitivity occurs when the protective layers of teeth are worn away and exposing the bony tissue called dentin. Dentin contains microscopic hollow tubes which allow hot and cold liquids and food to contact the underlying nerve endings in the teeth leading to pain. Unprotected dentin is vulnerable to having cavities form around it. Placing a mineral called nanohydroxyapatite in these tubes has often been used to treat sensitive teeth. However the material does not hold up well to brushing and  grinding and erosion or acid produced by bacteria that causes cavities.

The researchers encapsulated nanohydroxyapatite and a green tea polyphenol, epigallocatechin-3-gallate (EGCG), in silica nanoparticles. This material can stand up to wear and tear and acid from cavity bacteria. EGCG has been shown in previous studies to fight Streptococcus mutans, which forms biofilms that cause cavities. The researchers tested their approach on extracted wisdom teeth. This showed the material plugged the dentin tubules, released EGCG for at least 96 hours, stood up to tooth erosion, the effects of brushing, had low toxicity, and prevented biofilm formation. Based on their research and results, the researchers feel that encapsulated nanohydroxyapatite with EGCG could help prevent tooth sensitivity and cavities. Of course it seems the researchers only tested their approach on wisdom teeth that were already removed, so it will require some additional studies and testing with real teeth still in the mouth to verify their approach.

Reference: Jian Yu and et al, Development of Epigallocatechin-3-gallate-Encapsulated Nanohydroxyapatite/Mesoporous Silica for Therapeutic Management of Dentin Surface, ACS Applied Materials & Interfaces, 2017.

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Hyperbaric oxygen therapy may help with Alzheimer’s disease

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A study by researchers at Tel Aviv University shows that hyperbaric oxygen treatments may help improve symptoms by patients who have Alzheimer’s disease. Putting someone in a hyperbaric oxygen chamber has been shown in the past to be extremely effective in treating wounds slow to heal. Professional sports athletes, including even Lebron James, have used hyperbaric oxygen chambers to help them better perform in their respective sports. See http://www.slamonline.com/media/slam-tv/lebron-james-recharges-hyperbaric-chamber/.

The researchers have shown for the first time that hyperbaric oxygen therapy can actually improve the pathology of Alzheimer’s disease and even correct behavioral deficits associated with the disease. Patients who undergo hyperbaric oxygen therapy breathe in pure oxygen in a pressurized room or chamber. In the chamber, the air pressure is increased to twice that of normal air. When this occurs, oxygen solubility in the blood increases and is transported by blood vessels throughout the body. The added oxygen stimulates the release of stem cells and growth factors which promote healing.

The researchers used a mouse model of Alzheimer’s disease and built a custom-made hyperbaric oxygen chamber for them. Over the course of 14 days for one hour per day, the team administered hyperbaric oxygen treatment to the mice. After the 14 days were over, the mice underwent a series of behavioral tests and tissue biochemical tests to understand how hyperbaric oxygen treatment affects the pathological hallmarks associated with Alzheimer’s disease. The treatment was found to reduce behavioral deficiencies when compared to control mice, reduced neuroinflammation by roughly 40%, and reduced plaque pathology by 40%.

Hyperbaric oxygen treatment is a safe therapy used in various clinics around the world for many medical conditions.  In this study, the beneficial physiological effects of hyperbaric oxygen therapy were directly demonstrated on Alzheimer-affected brain tissue. The researchers speculate that a challenge in human use of hyperbaric oxygen treatments will be to start the treatment at the early stages of disease before any significant amount of brain tissue is lost. The researchers are conducting an additional study on the effectiveness of hyperbaric oxygen treatment on a mouse model of Alzheimer’s disease to investigate the mechanisms underlying the disease. The researchers hope that by better understanding the mechanisms of the therapy and better evaluating the potential beneficial effects, that hyperbaric oxygen treatments may have benefits for those with Alzheimer’s disease.

Source: Ronit Shapira and et al., Hyperbaric oxygen therapy ameliorates pathophysiology of 3xTg-AD mouse model by attenuating neuroinflammation, Neurobiology of Aging, vol. 62, issue 105, 2018.

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Why is Pain in the Face and Head Worse than the Rest of the Body?

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Researchers have found why pain from the head and face can be more disruptive, and emotionally draining than pain in other parts of the body. The researchers found that sensory neurons from the head and face are wired directly into the brain’s principal emotional signaling hubs, while sensory neurons from elsewhere in the body are connected only indirectly to this hub. People consistently rate pain of the head and face as more disruptive and emotionally draining than pain in other parts of the body. The results may help lead toward more effective treatments for pain mediated by the craniofacial nerve, including chronic headaches and neuropathic face pain.

Usually doctors focus on treating the sensation of pain, but this work demonstrates that doctors need to also treat the emotional aspects of pain. Pain signals from the head and face compared to those from the body are carried to the brain through two different groups of sensory neurons, and it is possible that neurons from the head are simply more sensitive to pain than neurons from the body. Even so, differences in sensitivity would not explain the greater fear and emotional suffering that patients experience in response to head and face pain than pain in other parts of the body. Functional Magnetic Resonance Imaging (fMRI) shows greater activity in the amygdala, a region of the brain involved in emotional experiences, in response to head pain than in response to body pain. It has been observed in human studies that pain in the head and face seems to activate the emotional system more extensively.

To examine the neural circuitry underlying the two different types of pain, the researchers tracked brain activity in mice after irritating either the face or a paw.  Irritating the face led to higher activity in the brain’s parabrachial nucleus (PBL), a region directly wired into the brain’s instinctive and emotional centers. The researchers used methods based on a novel technology, called CANE, to pinpoint the sources of neurons that caused this elevated PBL activity. Further experiments showed that activating this pathway prompted face pain, while silencing the pathway reduced it.

The researchers feel the results of this study can help lead to a more profound understanding of chronic head and face pain and translating this insight into treatments that will provide benefit. Chronic head-face pain from headaches and trigeminal neuralgia is often very severe and sometimes led patients to seek surgical solutions such as severing the known neural pathways that carry pain signals from the head and face to the hindbrain. These surgeries do not always stop the pain though.  The discovery of this direct pain pathway might provide an explanation why facial pain is more severe and more unpleasant than other types of pain. The researchers feel that targeting the neural pathway identified in the work can be used toward developing innovative treatments for head and face pain.

This work should help people undergoing wisdom teeth removal understand that if complications occur they can be potentially be very painful and long lasting, such as the chronic headaches experienced by the author of this site and blog.

Source: Erica Rodriguez and et al., A craniofacial-specific monosynaptic circuit enables heightened affective pain, Nature Neuroscience, 2017.

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Opioid pain relievers to reduce overdose risk

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Researchers at the The Scripps Research Institute (TSRI) in Florida have developed opioid pain relievers that do not slow or stop breathing which is the cause of overdose. According to the U.S. Centers for Disease Control and Prevention, 91 Americans die every day from opioid overdoses when opiates like heroin, oxycontin, and fentanyl slow and later stop a person’s breathing.

The research shows that a range of compounds can deliver pain-blocking potency without affecting respiration. The study builds on two decades of research, where the researchres have long explored whether the painkilling pathway, the G protein pathway, could be unlinked from the breathing suppression pathway, the beta-arrestin pathway. The researchers had their doubts about being able to separate out the pathways and also wanted to know how much separation was needed to see analgesia without respiratory suppression.

For the study, the researchers worked to develop new potential drug molecules. Later the researchers tweaked their chemical structures to systematically vary the “bias” between G protein signaling and beta-arrestin recruitment. The group has developed more than 500 compounds in the past 6 years, and found more than 60 with bias between signaling assays. The researchers selected six compounds to represent a wide range in the degree of bias (from those that preferred barrestin2 recruitment to those that preferred G protein signaling) and determined their overall potency for inducing analgesia and respiratory suppression in mouse models. The researchers found the new compounds could indeed enter the brain. All of the compounds were as potent, and in some cases more, than morphine.

The compounds that were less able to promote barrestin2 associations in cells were less likely to induce respiratory suppression in mice. The painkiller fentanyl was shown to prefer receptor-barrestin2 associations and also had a narrower safety margin. The fentanyl dose needed to alleviate the perception of pain was closer to the dose that suppressed breathing, which may be why fentanyl is more likely to trigger respiratory suppression at low doses. Fentanyl is a powerful pain killer, but has a narrow therapeutic window and a history of overdoses. Separating the receptor’s ability to engage in the two pathways can provide a way to separate desired drug effects from side effects. This work suggests an opportunity to expand the “therapeutic window,” or the range of doses at which a drug may be administered safely.

It is important to see new pain relievers like the ones developed in this work to better help prevent dental deaths. Fentanyl has contributed to several dental deaths over the years see http://www.teethremoval.com/dental_deaths.html.

Source: Cullen L. Schmid, and et al., Bias Factor and Therapeutic Window Correlate to Predict Safer Opioid Analgesics. vol. 171, issue 5, Cell, 2017.

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