When Pro-Fluoridation “Evidence” Falls Apart

Once upon a time – a bit more than a year and a half ago – some scientists published a study in which they looked at the rates of tooth decay in two large Canadian cities: Edmonton, where the water had been consistently fluoridated since 1967, and Calgary, which stopped its fluoridation program in 2011.

Both cities showed more primary (baby) tooth decay, but the increase was greater in non-fluoridated Calgary, said the scientists.

Their study received a lot of media coverage and a whole lot of hoopla over what seemed like a confirmation of fluoride’s effectiveness. Yet, as a recent column in the Calgary Herald noted,

What was not widely published is that according to the very same study, the number of cavities in permanent teeth actually decreased in Calgary since fluoridation ended. You read that correctly. “For all tooth surfaces among permanent teeth, there was a statistically significant decrease in Calgary . . . which was not observed in Edmonton.” Interesting, isn’t it, that this juicy morsel from the report was never quoted? [emphasis added]

And that wasn’t the only funny thing about the study. Now, a new paper in Community Dentistry and Oral Epidemiology shows that it also had some significant “shortcomings in study design and interpretation of results, and did not include important pertinent data.” Include that data, and you get something far different from what the original team found.

When this third data set is considered, the rate of increase of decay in Calgary is found to be the same before and after cessation of fluoridation, thus contradicting the main conclusion of the paper that cessation was associated with an adverse effect on oral health.

Other problems included a failure to account for variables among risk factors for caries between the two cities and a low participation rate that may have resulted in selection bias, further distorting the results.

“Owing to these weaknesses,” assert the authors of the new evaluation,

the study has limited ability to assess whether fluoridation cessation caused an increase in decay. The study’s findings, when considered with the additional information from the third Calgary survey, more strongly support the conclusion that cessation of fluoridation had no effect on decay rate.

More, fluoridation is just bad policy. For 10 reasons why (plus a link to 50 more), visit IAOMT.org.

Originally posted 2017-10-19 07:09:30.

The post When Pro-Fluoridation “Evidence” Falls Apart appeared first on Dr. Judson Wall.

Be Kind to Your Gums: Exercise! (Yes, Really)

As we mentioned last week, though diet and hygiene are the foundation for good oral health, other factors have an impact, too – factors most people just don’t think about.

Exercise, for instance.

Now, a new study in the Journal of Clinical Periodontology offers some of the latest evidence of the difference a little regular physical activity can make.

For the study, researchers used rats to observe how physical activity affected inflammation and behavior in the presence of gum disease. This progressive infection starts with inflammation. The gums grow red, tender, and puffy. They may bleed when you brush and floss.

If not treated, this gingivitis progresses to a more severe infection known as periodontitis. At this point, the infection starts to damage the bone that supports your teeth. Your teeth become loose. Your dentist may recommend extracting them before they pop out on their own, having so little support.

Tooth loss is the ultimate consequence of periodontal disease.

One thing that makes it especially pernicious is that it develops in hard-to-clean areas of the mouth. It develops under the gumline, in the sulci – “pockets” between the teeth and gums. Those pockets are perfect harbors for harmful bacteria: dark, moist, remote, and low oxygen.

(Oral pathogens tend to be anaerobic, meaning they thrive in low oxygen environments. This is one reason why ozone is such a powerful disinfectant: it saturates the bacteria with the oxygen they hate.)

Most Americans – up to 75% – have some degree of gum disease. The good news? In its early stages, it’s reversible. And it’s largely preventable.

So back to those rats.

For their study, the research team split the rats into groups: with and without gum disease; with and without exercise. At the end of the study period, those that underwent physical training showed less bone and attachment loss and less inflammation.

In other words, their gums were healthier than those of the rats that weren’t regularly exercised.

Earlier studies have also shown a relationship between physical activity and periodontal health. For instance, one 2005 study identified exercise as one of three “health-enhancing behaviors” that decreased risk of periodontitis. The others? Maintaining a normal weight and having a high quality diet.

Those who did all three “were 40% less likely to have periodontitis compared to individuals who maintained none of these health-enhancing behaviors.”

For the rest, each additional behavior was linked to “a 16% reduction in the prevalence of periodontitis….”

Another study by the same lead author and drawing from the same NHANES-III data likewise showed less prevalence of severe gum disease. In this case, they focused on adult participants who’d had a perio exam and reported similar physical activity or inactivity over at least 10 years.

These results suggest that engaging in the recommended level of exercise is associated with lower periodontitis prevalence, especially among never and former smokers.

In fact, for former smokers, disease rates were 74% lower among those who were physically active. Among never-smokers, the decrease was about 54%.

A later study of 1160 Japanese adults likewise found that gum disease was least likely among those who were the most physically fit and those who were least obese.

This study suggests that obesity and physical fitness may have some interactive effect on periodontal health status.

That obesity plays a role here is no surprise. We’ve long observed that perio problems tend to be more common among the obese, as well as those who are diabetic. Notably, like gum disease, both of these conditions are marked by chronic inflammation – as are all of the other chronic diseases that science has linked to gum health, from heart disease to Alzheimer’s, rheumatoid arthritis to cancer.

Exercise has been known to lower the risk of those conditions, too. Just sayin’.

Originally posted 2017-10-05 07:01:09.

The post Be Kind to Your Gums: Exercise! (Yes, Really) appeared first on Dr. Judson Wall.

Why Sleep Apnea Is a Very Big Deal – and How Your Dentist Can Help

Sleep is when your body does its maintenance work. Toxins are swept from your brain. Tissues rebuild. Memories are consolidated. Energy is restored.

It should be no surprise, then, that lack of sleep can interfere with your health. This maintenance work can’t be done while you’re up and active. If it doesn’t all happen during sleep, it doesn’t happen at all.

And the effects can be profound.

Just recently, for instance, a study in Neurology provided more evidence of the link between a lack of REM sleep and dementia. (REM is the deepest phase of sleep. It’s when your brain gets rejuvenated.) As Reuters reported, an analysis of sleep study data from more than 300 older adults showed that

Each percentage reduction in the time people spent in REM sleep was associated with a 9% increase in the risk of dementia.

There are lots of things that can keep you from getting a good night’s sleep: the neighbor’s noisy dog; stress; chronic insomnia. One of the most common, though, is obstructive sleep apnea (OSA).

Having sleep apnea means you periodically stop breathing during sleep. It happens when the airway becomes blocked by the tongue or soft tissues relaxing and falling backward. When air is forced past the blockage, the result is a snore – which is at least a sign that a person is getting some air.

It’s hard to overstate the importance of oxygen. While you can live days without water and weeks without food, you can only last a couple minutes without oxygen before brain cells start to die.

The lack of oxygen that triggers apneic events is thus a real emergency. The body goes into red alert and does all it can to get the oxygen it needs to go on living. You’re startled awake, often with choking or gasping. And this happens again and again throughout the night.

And you don’t get the sleep you need.

This impacts far more than just the brain. According to new research in the Journal of Clinical Endocrinology & Metabolism, untreated sleep apnea can raise blood sugar and fat levels, blood pressure, and stress hormones.

To see the impact of OSA, researchers took blood draws repeatedly through two nights of observing middle aged individuals with severe apnea sleep with CPAP and without. As MedicalXpress reported,

[Senior author Jonathan] Jun and colleagues found that CPAP withdrawal caused recurrence of OSA associated with sleep disruption, elevated heart rate and reduced blood oxygen. CPAP withdrawal also increased levels of free fatty acids, glucose, cortisol and blood pressure during sleep. The more severe the OSA, the more these parameters increased. In addition, glucose increased the most in patients with diabetes. Increases in fatty acids, glucose and cortisol have all been linked to diabetes. The Johns Hopkins team also found that blood pressure increased and the arteries showed signs of stiffness in the morning without CPAP. Over time, increased blood pressure and vascular stiffness can contribute to cardiovascular disease.

Jun added “that the study provides further evidence that sleep apnea isn’t just a manifestation of obesity, diabetes and cardiovascular disease—it can directly aggravate these conditions.”

Indeed, there’s a substantial body of evidence linking sleep apnea to a wide range of systemic health problems , including diabetes, heart disease, stroke, high blood pressure, cognitive issues, and even possibly some cancers. Some, such as Dr. Felix Liao in his book Six-Foot Tiger, Three-Foot Cage, have suggested that a blocked airway and sleep apnea may contribute to many dental problems, as well.

Fortunately, CPAP isn’t the only option for dealing with apnea. More and more evidence shows that oral appliance therapy can be just as effective and much more tolerable. (Who wants to sleep with a CPAP mask covering their face, really?) Many of these devices work by gently holding the lower jaw in a more forward position, keeping the tongue from falling into the airway. Others, such as the Full Breath appliance we provide in our office, work by gently depressing the tongue, keeping it out of the airway.

Yet another option is NightLase – a laser treatment that actually widens the airway by renaturing and restructuring collagen. Research shows that NightLase can help reduce snoring 74%, and is an effective, non-invasive treatment for mild to moderate obstructive sleep apnea.

Yes, there are dental solutions to sleep apnea.

Save

Originally posted 2017-09-14 07:01:06.

The post Why Sleep Apnea Is a Very Big Deal – and How Your Dentist Can Help appeared first on Dr. Judson Wall.

When It Comes to Dental Implants, Metal-Free Is Your Best Bet. Here’s Why

When you need to replace teeth, you’ve got three options: a bridge, dentures (partial or full), or implants.

Bridges look great and work well, but they’re not exactly ideal. Most types require the dentist to cut down perfectly healthy teeth on either side of the gap to be bridged so the prosthetic can be attached.

Dentures are a better option: aesthetic, functional, and reasonably priced. And with the lightweight, thermodynamic materials available today, even one-tooth partials or “pop-ins” are a possibility. But there’s no bond between the denture and gums, which can cause problems like slippage or constantly trapped food. And if it doesn’t fit right, it can cause discomfort and even make it hard to speak normally. Additionally, with full dentures, you can expect bone loss over time, which affects the appearance of your lower face and mouth.

By far, implants are your best option. They look and work just like natural teeth. They integrate with your jawbone.

But not all implants are created equal. In fact, recent research has begun to highlight the problems with titanium implants in particular.

Currently, titanium is the norm for implants, largely because the metal has been considered stable, durable, and nonreactive. This is turning out not to be the case.

For one, they’re seldom made only with titanium. Other metals such as nickel and aluminum may be used – metals that are both highly toxic and prone to cause galvanic currents in the mouth when other metal restorations are present. Allergic reactions are also a possibility.

Other research has suggested that titanium itself “can induce toxicity” or allergic responses, especially in patients who already have sensitivity to metals.

Another issue is the fact that the metal itself can corrode, releasing metals into the body. This corrosion may be caused by bacteria around the implant, as well as exposure to substances such as fluoride and hydrogen peroxide.

That there may be harmful bacteria around an implant is no surprise, really. Most extractions happen due to infection, usually gum disease. If that infection isn’t controlled or if the bone at the extraction site isn’t properly cleaned, it’s bound to proliferate once the gums have healed.

Corrosion of the titanium simply aggravates inflammation around the implant, which can result in a condition known as “peri-implantitis.”. Only now are researchers beginning to understand just how big of a concern this is. Research recently presented at the California Dental Association’s CDA Presents 2017 meeting suggests the scope of the problem.

Peri-implant mucositis is found in 43% of implants and peri-implantitis in 22%,

* * *

However, about 10% of implants will have peri-implantitis after five to 10 years in 19% of patients, according to another systematic review and meta-analysis (Journal of Periodontology, November 2013, Vol. 84:11, pp. 1586-1598). Dr. [Mark] Reynolds discussed. Mucositis was found in 31% of implants and 63% of patients.

Peri-implant mucositis indicates inflammation without the loss of bone you see with peri-implantitis. Often, that loss of bone means ultimate loss of the implant.

Ten years ago, professionals said the condition didn’t exist. But now it is on the rise, as increasing numbers of people have replacement porcelain crowns with titanium roots. Half-a-million adults have at least one dental implant, according to the latest Adult Dental Health Survey.

Studies have suggested that one third of patients will be infected. “We’re sitting on a time bomb,” says Dr Stephen Jacobs, a past president of the Association of Dental Implantology and well-respected implant surgeon. “We are going to be seeing more and more cases.”

One of the first treatments a dentist might recommend for this condition is ultrasonic scaling – a very deep cleaning using a device that creates tiny bubbles that help disinfect areas below the gumline. According to research in Scientific Reports, this scaling may actually make the peri-implantitis worse.

How? By releasing yet more metal from the implants, increasing inflammation and triggering bone loss. That loss, noted the authors, “is unlikely to be reversible.”

Because of such problems, we use only biocompatible ceramic (zirconium) implants. They’re entirely metal-free and less likely to encourage the kind of bacterial growth that leads to peri-implantits.

Not only are they the safer option, they’re more aesthetic, too. In patients with thin or receding gums, the gray titanium can become visible. White ceramic retains a far more natural look.

Are ceramic implants for everyone? Of course not. No treatment is. But when it comes to replacing teeth and retaining normal mouth functions, they certainly can’t be beat.

Corrosion image Dr. Sammy Noumbissi

Originally posted 2017-09-21 07:12:44.

The post When It Comes to Dental Implants, Metal-Free Is Your Best Bet. Here’s Why appeared first on Dr. Judson Wall.

Stress Is Your Friend – Until It Isn’t (with Tips for Managing It Before It Gets Out of Control)

Although you might think of stress as something oppressive and unwanted, it’s actually an important survival mechanism. It’s your body’s automatic response in the face of a threat. All systems go into fight-or-flight mode, marshalling resources to help you either eliminate the threat or get away from it as quickly as possible.

As Hans Selye, the doctor who first identified the stress response, once wrote, “To eliminate stress completely would mean to destroy life itself.”

Trouble is, we live in a world in which the stressors we face are more numerous and far different than those our ancestors faced. An angry boss, a dangerous driver on your commute, financial pressures, social media flame wars – these kinds of things are far less lethal than, say, meeting up with a hungry mountain lion or facing an enemy in battle.

Yet our physiological response is just the same.

And it’s often constant in our 24/7, always “on” culture, where we can be treated to incessant streams of bad, frightening, or difficult news just by glancing at our phone. Chronic stress means the body is always on red alert, always ready to react.

This has major consequences for your health. For one, it fuels chronic inflammation. Under normal circumstances, like stress, inflammation is a good thing. It’s a sign that your body is fending off a threat, such as an infection, or healing from a wound. But if it keeps on keeping on even when there’s no threat present, it lays a foundation for a wide range of health problems, including heart disease, stroke, diabetes, and cancer.

Research has shown that chronic stress actually causes the body to lose its ability to regulate the inflammatory response.

“Inflammation is partly regulated by the hormone cortisol and when cortisol is not allowed to serve this function, inflammation can get out of control,” said Cohen, the Robert E. Doherty Professor of Psychology within CMU’s Dietrich College of Humanities and Social Sciences.

Cohen argued that prolonged stress alters the effectiveness of cortisol to regulate the inflammatory response because it decreases tissue sensitivity to the hormone. Specifically, immune cells become insensitive to cortisol’s regulatory effect. In turn, runaway inflammation is thought to promote the development and progression of many diseases.

And that includes gum disease.

Indeed, over the years, science has delineated a clear relationship between chronic psychological stress and gum disease. In fact, chronic stress is one of the major risk factors for periodontitis. (The others include exercise, as we saw last week, diet/nutrition, sleep loss, and, above all, smoking/tobacco use.)

And like all other risk factors, it’s a behavior you can change – and, by changing it, lower your risk. Here are some tips to get you started:

• Practice mindfulness – focusing on what’s going on right now, without judgment. Research has consistently shown that it can do wonders for lowering stress and anxiety (not to mention improving your general health).

• Exercise. Practices such as yoga and tai chi are especially well-suited for lowering stress, but any kind of exercise you like can help reduce both stress and inflammation.

• Include prayer or meditation in your day. Not only can it enrich your spiritual life; it’s been scientifically shown to offset the negative health effects of stress.

• Schedule time for yourself to regularly do something relaxing and fun. Making it part of your schedule gives it more priority than just doing something relaxing when you’ve got the time.

• Spend time with your pets – or if you don’t already have one, contact an animal rescue to foster or adopt. Pets are fantastic for helping us chill, bringing us to calm.

• Develop tools and strategies for grappling with stress right now, in the moment.

• In a pinch, herbal remedies such as Valerian root, Kava Kava, lemon balm, and lavender can be used for quick calming. Homeopathics such as Calms Forte or Rescue Remedy can also be helpful.

For more tips on reducing stress naturally, see this and this and this.

Image by Andrew Imanaka, via Flickr

Originally posted 2017-10-12 07:01:59.

The post Stress Is Your Friend – Until It Isn’t (with Tips for Managing It Before It Gets Out of Control) appeared first on Dr. Judson Wall.

Our Teeth Are Making Us Sick

A patient at the New York University College of Dentistry’s Urgent Care unit gets treatment. One hundred and fourteen million Americans don’t have insurance coverage for their teeth.Credit Sam Hodgson for The New York Times

The left side of Jacquelyn Garcia’s face throbbed fiercely. She had tried taking Tylenol and Excedrin for the pain, but threw them up. On a Monday morning straight after working the night shift as a custodian, she rushed to the N.Y.U. emergency dental clinic. Here a student delivered the verdict: decay so deep it had reached the nerve. The tooth needed to be pulled.

Paradoxically, this could make her mouth worse off. Dentists say pulling a tooth can lead to a cascade of other problems: the teeth start shifting, the bone diminishes, the skin sags and the risk of gum disease increases. But Ms. Garcia didn’t have any choice. Her tooth had been rotting from the inside out for more than a year. She didn’t have dental insurance and didn’t want to pay the high fees until the pain had surged and she couldn’t stand it anymore.

As Americans debate medical coverage, the problem of our teeth has remained almost entirely unaddressed. About 114 million Americans don’t have insurance coverage for their teeth – more than twice the number of people who didn’t have health insurance before the Affordable Care Act.

“Oral health is a neglected issue nationally,” said Julia Paradise, an associate director of the program on Medicaid and the Uninsured at the Kaiser Family Foundation. “This is a big problem. The mouth and the head – mental health and dental health – somehow remain outside of what people think of as general health.”

Lots of people (including politicians) think of dental care as a luxury – pleasant, sure, but not vital. But that’s just not true, experts say. Gum disease can increase the risk of heart disease and diabetes, and among pregnant women it is correlated with lower birth weights for their babies. 

Read More: https://kristof.blogs.nytimes.com/2017/05/23/our-teeth-are-making-us-sick

Related Article: Reaffirming our commitment to oral health in rural America