Dr. Mark J. Weingarden

Internal Medicine News

By Richard M. Kirkner, Internal Medicine News Digital Network  5/25/11

Recent laboratory findings from Australia have shown a strong correlation between gum disease and worsening signs and symptoms of rheumatoid arthritis, one of the lead investigators reported May 25.

During his presentation at the annual European Congress of Rheumatology, Mark Bartold, Ph.D., who is a periodontist and the director of the Colgate Dental Research Centre at the University of Adelaide (South Australia), discussed his group’s recently published study of laboratory mice with preexisting periodontitis and worsening RA. “Emerging evidence now suggests a strong relationship between the extent and severity of periodontal disease and rheumatoid arthritis,” Dr. Bartold said in an interview.

The experiments showed that mice with coexisting periodontitis and RA exhibited more severe joint inflammation than did the mice with just RA, he said.  Also, mice with both periodontitis and RA were more likely to demonstrate signs of arthritis in their rear paws, compared with mice with arthritis only.  The progress of RA in mice with both conditions followed a more rapid course than it did in mice with just RA or just periodontitis, he reported.

Gum disease and RA could be related through common underlying dysfunction of fundamental inflammatory mechanisms.  The nature of the dysfunction remains unknown, but recent scientific studies have suggested a link between the two, he said.

Although this relationship is unlikely to be casual, it is clear that individuals with advanced RA are more likely to have significant periodontal problems, compared with their nonrheumatoid counterparts.  Likewise, people with severe gingivitis are more likely to have severe RA.  Data from earlier studies have shown that individuals with RA had a 3.6-fold greater risk of moderate to severe periodontitis, and those with gum disease had a 2.2-fold greater risk of RA than did the general population.

To read the complete article, visit www.internalmedicinenews.com

A Seattle Study Club Organization

Dr. Mark J. Weingarden has been director of the Pittsburgh branch of the Seattle Study Club since he formulated the club in 1993.  What does that mean to you, the patient?  It means that your dental professional has made a commitment to lifelong learning, to provide you with the best care and newest techniques currently available in dentistry.

As director of the Pittsburgh Dental Network, Dr. Weingarden spends time outside the office at monthly meetings and at a national symposium each year to keep abreast of the latest developments and treatment options available to patients.

The Pittsburgh Dental Network is often referred to as a “university without walls”.  It is recognized as one of the most advanced continuing education groups for dental professionals in the nation.  Members participate in hands-on demonstrations, problem-solving workshops, panel discussions and clinical treatment planning sessions.  PDN invites internationally known speakers to share information at local meetings, keeping Pittsburgh in the forefront of dental technology.

The Seattle Study Club is the originator and leader of the international network of over 250 affiliated clubs, including the Pittsburgh Dental Network, with a combined membership of 6,700 dentists.  For more information, visit www.seattlestudyclub.com.

If your dentist is a member of this prestigious group, you’re in good hands.

by ANAHAD O’CONNOR
New York Times. Published March 28, 2011

Everyone knows you can catch a cold or the flu.  But can you catch a cavity? Researchers have found that not only is it possible, but it occurs all the time.

While candy and sugar get all the blame, cavities are caused primarily by bacteria that cling to teeth and feast on particles of food from your last meal.  One of the byproducts they create is acid, which destroys teeth.

Just as a cold virus can be passed from one person to the next, so can these cavity-causing bacteria.  One of the most common is Streptococcus mutans.  Infants and children are particularly vulnerable to it, and studies have shown that most pick it up from their caregivers – for example, when a mother tastes a child’s food to make sure it’s not too hot, said Dr. Margaret Mitchell, a cosmetic dentist in Chicago.

A number of studies have also shown that transmission can occur between couples, too.  Dr. Mitchell has seen it in her own practice.  In one instance a patient in her 40’s who had never had a cavity suddenly developed two cavities and was starting to get some gum disease,” she said.  She learned the woman had started dating a man who hadn’t been to a dentist in 18 years and had gum disease. 

To reduce risk, Dr. Mitchell recommends frequent flossing and brushing, and chewing sugar-free gum, which promotes saliva and washes away plaque and bacteria.

The bottom line, cavities can be transmitted from one person to another.

You may have heard recent reports about bisphosphonate drugs and their potential effect on periodontal health.  These reports can be alarming and even misleading, especially for those taking bisphosphonates.  The information below explains what bisphosphonates are, how they are related to periodontal health, and how bisphosphonates may impact your periodontal treatment.

Bisphosphonates, also known as bone-sparing drugs, are used to treat and prevent osteoporosis, and are also prescribed to patients diagnosed with certain bone cancers.  Bisphosphonates can be administered in two ways: orally and intravenously (IV).  Oral, or tablet, bisphosphonates (common names include Fosamax, Boniva, and Actonel) are usually prescribed for osteoporosis, while IV bisphosponates (common names include Aredia and Zometa) are typically prescribed for patients with advanced bone cancers to help decrease pain and fractures.

In rare instances, some people that have been treated with bisphosphonates, especially the intravenous form, develop a rare condition called osteonecrosis of the jaw (ONJ), which can cause severe and irreversible, and often debilitating damage to the jaw.  ONJ can be worsened by invasive dental procedures such as tooth extractions or dental implants.  People may not have symptoms in the early stages of ONJ, but pain can gradually develop as the condition progresses. 

Symptoms of ONJ include:

• Loose teeth
• Numbness or a feeling of heaviness in the jaw
• Pain, swelling, or infection of the gums or jaw
• Gums that do not heal
• Exposed bone

 Currently, there is no treatment that definitely cures ONJ.  However, antibiotics and anti-inflammatory drugs may help relieve some of the pain associated with ONJ.  Most people diagnosed with ONJ will also need surgical treatment.

If your physician prescribes a bisphosphonate, especially IV bisphosphonates, it is very important to tell your dental professional, because your dental treatment plan may be affected.  There have been other risk factors associated with ONJ including age, gender, and other medical conditions, so it is important to share all health information with your dental professional.

It is also important to maintain your oral health if you are taking bisphosphonates.  Even though the risk of developing ONJ while taking a bisphosphonate remains very small, if you need periodontal surgery, your dental professional may recommend that you interrupt your bisphosphonate therapy prior to, during, and/or after your procedure.  Be assured that both the medical and dental communities are studying ways to ensure the safest outcomes for patients taking bisphosphonates who require invasive dental procedures.

Sustained or controlled release local delivery antimicrobial agents (LDAs) are available for use as adjuncts to scaling and root planing (SRP) in the treatment of periodontitis.  These products are placed into periodontal pockets in order to reduce subgingival bacterial flora and clinical signs of periodontitis.  This therapy cannot correct anatomical deformities caused by the disease process.  Use of LDAs can deposit a high level of the active agent in the periodontal pocket, and the delivery vehicle facilitates prolonged drug delivery.

Recent systematic reviews report that modest additional probing depth (PD) reductions in the range of 0.25mm to 0.5mm were achieved when LDAs were used as an adjunct to SRP in pockets > 5mm.  However, even when the differences were statistically significant, the additional improvement in PD was a fraction of the reported mean 1.45mm PD reduction achieved by SRP alone.  Effects on clinical attachment level gains were smaller and statistical significance less common.  In many studies, repeated LDA applications were compared to a single episode of SRP.  It should be noted that these reviews included a number of antimicrobial agents not currently sold in the United States.  Antimicrobial agents for local delivery currently sold in the United States include: Arestin (1 mg minocycline microspheres), Atridox (10% doxycycline hyclate in a bioabsorbable polymer), and PerioChip (2.5mg chlorhexidine in a gelatin matrix).

The existing data appear insufficient to conclude that adjunctive sustained or controlled release LDA treatment can either reduce the need for surgery or improve long-term tooth retention, or is cost effective.  Additional studies are needed to support the use of LDAs in special sites (e.g. periodontal abscesses, furcations, peri-implantitis) and special populations (e.g. smokers, patients with aggressive periodontitis, or who are medically compromised).  Additional studies are also needed to further define the therapeutic value of LDAs in different phases of treatment (active versus maintenance).  The long-term benefits are unknown because most studies are limited to 9 months.

Thorough SRP is highly effective in the treatment of chronic periodontitis and is the standard approach to non-surgical therapy.  Clinicians may consider the use of LDAs in chronic periodontitis patients as an adjunct to SRP:

• When localized recurrent and/or residual PD > 5mm with inflammation is still present following conventional therapies.

Therapies other than LDAs should be considered when:

• Multiple sites with PD > 5mm exist in the same quadrant.
• The use of LDAs has failed to control periodontitis (e.g. reduction of PD).
• Anatomical defects are present (e.g. intrabony defects).

The clinician’s decision to use LDAs should be based upon a consideration of clinical findings, the patient’s dental and medical history, scientific evidence, patient preferences, and the advantages and disadvantages of alternative therapies.

For patients that have residual, excessive pocketing and inflammation following root planing, (especially in areas with complex root anatomy such as maxillary first bicuspids and maxillary molars), there is no better instrument to treat these sites than the Perioscope.  These complex areas rarely respond adequately to root planing, since calculus removal is essentially done as a “blind” procedure.  

Why not the conventional surgical approach to address these areas?  Surgery is not a wrong approach, since is does give us access to see the calculus and therefore improves our ability to remove it.   Surgery also allows for regeneration of bone and periodontal attachment when possible.  However, the Perioscope is far more conservative and actually provides 48x magnification; better visibility than surgery with loupes.  

Some vendors will suggest using topical antimicrobials in areas that have not responded to root planing.  However, Perioscope research and our experience shows that when there is residual inflammation in these sites, calculus is still present 100% of the time.  The benefit of antimicrobials is limited and short-term if calculus remains.  Using antimicrobials when calculus remains is comparable to painting over rust. 

Consider the benefits of the Perioscope for your patients’ periodontal needs: 

• The Perioscope provides 48x magnification.  There is nothing better to remove subgingival calculus. (Surgical loupes provides only 3.8x magnification which is often inadequate).
• The Perioscope is nonsurgical and conservative – there are no incisions.
• The Perioscope costs less than conventional surgery and is often more effective.
• Unlike the laser, which has never been assessed for complex root anatomy, the Perioscope is effective for early furcations.
• The Perioscope gives your patient the best chance of avoiding periodontal surgery. 

If you have questions or would like to observe the Perioscope in action, please call Jodi @ 412-487-8288.

 www.pittsburghimplantsandperio.com