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

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.

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.

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.

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.

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

Chicago, Sept. 21/PRNewswire-USNewswire – The prevalence of periodontal disease in the United States may be significantly higher than originally estimated.  Research published in the Journal of Dental Research from the Centers for Disease Control and Prevention (CDC) and the American Academy of Periodontology (AAP) suggests that the prevalence of periodontal disease may have been underestimated by as much as 50 percent.  The implication is that more American adults may suffer from moderate to severe gum disease than previously thought. 

In a National Health and Nutrition Examination Survey (NHANES) pilot study, funded by the CDC’s Division of Oral Health, a full-mouth, comprehensive periodontal examination was conducted on over 450 adults over the age of 35.  Periodontal disease was classified according to definitions determined by the CDC in collaboration with the AAP.  The prevalence rates were then compared against the results of previous NHANES studies which used a partial-mouth periodontal examination.  Historically, NHANES has served as the main source for determining prevalence of periodontal disease in U.S. adults.  The pilot study finds that the original partial-mouth study methodology may have underestimated true disease prevalence by up to 50 percent. 

Periodontal disease is a chronic inflammatory disease that affects the gum tissue and other structures supporting the teeth.  If left untreated, it can lead to tooth loss, and may also interfere with other systems of the body.  Several research studies have associated gum disease with other chronic inflammatory diseases such as diabetes, cardiovascular disease, and rheumatoid arthritis. 

“This study shows that periodontal disease is a bigger problem than we all thought.  It is a call to action for anyone who cares about his or her oral health,” said Samuel Low, DDS, MS, associate dean and professor of periodontology at the University of Florida College of Dentistry, and president of the American Academy of Periodontology.  “Given what we know about the relationship between gum disease and other diseases, taking care of your oral health isn’t just about a pretty smile.  It has bigger implications for overall health, and is therefore a more significant public health problem.” 

Dr. Low explained that the increased prevalence of periodontal disease makes it essential to maintain healthy teeth and gums.  “Not only should you take good care of your periodontal health with daily tooth brushing and flossing, you should expect to get a comprehensive periodontal evaluation every year,” he advised.   A dental professional, such as a periodontist , a specialist in the diagnosis, treatment and prevention of gum disease, will conduct the comprehensive exam to assess your periodontal disease status. 

According to Paul Eke, MPH, PhD, epidemiologist at the CDC and lead author of the study, the findings have significant public health implications.  “The study suggests we have likely underestimated the prevalence of periodontal disease in the adult U.S. population,” he said.  “We are currently utilizing full-mouth periodontal examination in the 2009/10 NHANES to better understand the full extent and characteristics of periodontal disease in our adult population.”  Dr. Eke added, “Research suggests a connection between periodontal health and systemic health.  In light of these findings, understanding the relationships between periodontal disease and other systemic diseases in the U.S. population is more crucial than ever”. 

To assess your risk for periodontal disease and learn more, visit perio.org

Chicago-August 2, 2010-The health complications of being overweight, such as increased risk of heart disease, Type 2 diabetes  and certain cancers, have long been reported.  Healthcare professionals often urge patients to manage their weight and strive to get physical exercise each day to achieve and maintain overall health.  And now, researchers have uncovered another benefit of maintaining a fit lifestyle: healthy teeth and gums. 

In a study published in the August issue of the Journal of Periodontology, researchers found that subjects who maintained a healthy weight and had high levels of physical fitness had a lower incidence of severe periodontitis.  Using body mass index (BMI) and percent body fat as a measure of weight control, and maximal oxygen consumption (VO2max) as a measure of physical fitness, researchers compare subjects’ weight and fitness variables with the results of a periodontal examination.  Those with the lowest BMI and highest levels of fitness had significantly lower rates of severe periodontitis. 

Periodontitis, or gum disease, is a chronic inflammatory disease that affects the supporting bone and tissues around the teeth.  Gum disease is a major cause of tooth loss in adults, and research has suggested gum disease is associated with other diseases, such as heart disease, diabetes, and rheumatoid arthritis. 

Samuel Low, DDS,MS, Associate Dean and Professor of periodontology at the University of Florida College of Dentistry, and President of the American Academy of Periodontology (AAP), says that research connecting overall health and periodontal health should motivate people to maintain a healthy weight and get enough physical fitness. 

“Research continues to demonstrate that our overall health and oral health are connected,” says Dr. Low.  “Weight management and physical fitness both contribute to overall health; and now we believe that staying in shape may help lower your risk of developing gum disease and diabetes,” continues Dr. Low, “There is even more reason to take care of yourself through diet and exercise.” 

Dr. Low also encourages comprehensive periodontal care through daily tooth brushing and flossing, and routine visits to a dental professional, such as a periodontist, a specialist in the diagnosis, treatment and prevention of gum disease. 

PERIO.ORG 

Visit our website at www.pittsburghimplantsandperio.com

When dental insurance came into existence, a treatment code system was implemented to communicate between the provider (a dentist) and the insurer as to what procedures were completed for a patient.  The insurer would then, according to a “fee schedule” reimburse for that treatment code.   This system made sense…at least at the time it was initiated in the 1970’s.

As years go by, dental procedures change and ideally, as new technology and new and improved procedures are introduced, the insurance company’s fee schedule would change to include the new procedures.  However, this is usually not the case.  Insurance companies are resistant to changes in their coding system – it can take more than several decades to add a new procedure code to the list.  Why?  Because adding codes means additional claims are eligible for payment, and insurance companies would pay out more money.    

The out-of-date fee schedule is what I call the “insurance magnet”.  Periodontal providers, limited by a signed contract with an insurance company, are drawn toward rendering treatment within the confines of what has been included on the fee schedule.   If a procedure is not on the schedule, it is often not even considered as an option for that patient, even though it may be the appropriate treatment.  In essence, the coding system controls what treatment is rendered, as opposed to what providers diagnose or what patients might prefer. 

In short, the coding system, rather than the diagnosis, too frequently dictates the care.  Isn’t this a case of the tail wagging the dog? 

How can patients be sure they are given every option available?  By asking their provider, “ARE THERE ANY OTHER TREATMENT OPTIONS?  I WOULD LIKE TO KNOW – EVEN IF THEY ARE NOT COVERED BY MY INSURANCE”.  

If a periodontal provider does not offer to do alternative treatments, it may be time to seek a second opinion.

A recent article printed in the New York Times discusses relief from the misery of dentures with dental implants.

For Most, Implants Beat Dentures, but at a Price

“They fell out when I talked,” Mr. Panko, 56, a small-business owner in Woodridge, Ill., recalled.  “I couldn’t taste my food – in fact, I could hardly chew.  It was the most miserable time of my entire life.”

Mr. Panko, who lost his teeth in his early 50’s because of a hereditary form of periodontal disease, eventually replaced his dentures with something better: dental implants.  While many people wear dentures without discomfort, implants are now considered the preferred treatment for replacing lost teeth, said Dr. Robert Pick, an associate professor of surgery at the Feinberg School of Dental Medicine at Northwestern University.

The procedure is straightforward.  A surgeon places a titanium screw in the jaw bone, and prosthetic teeth are secured to the implant.  They don’t wiggle or slip, as dentures can, and are healthier for the gum and bone.  Most patients find implants easier to maintain than dentures.

“Best decision I ever made,” Mr. Panko said of his implants.  I could chew beer cans now”.

For all their advantages, implants are expensive.  Insurance coverage is usually minimal, and patients are often surprised by high out-of-pocket costs….Why so much?  Implants typically involve the work of both a surgeon and a dentist.  Several office visits may be needed to put in the screws and to add the prosthetic teeth.  More dental insurance plans are covering the costs, but the annual reimbursement limit is typically $1500, an amount that hasn’t changed in four decades….Still many patients find it a worthwhile investment.  Implants typically last a lifetime, with a failure rate of less than 5 percent.

Let’s say you lose one tooth.  If you opt for a bridge, which costs almost as much as an implant but is more often covered by insurance, the dentist will grind down the two adjacent teeth to create a structure that secures the replacement tooth.

The ground teeth become more vulnerable to decay and nerve damage, and there’s a good chance you will require a root canal in the future, said Dr. Karl Gruendl, a dentist in Fenton, Mo., who advises insurance plans.

A study done for Washington Dental Service, the largest insurance carrier in Washington State, found that over a five-year period the maintenance costs for people with bridges were higher than for those who had implants.

“For a single tooth replacement, over the long run we think it’s more beneficial to get the implant”, said Dr. Ron Inge, dental director for Washington Dental Service.  And that’s an insurance executive talking….

Implants also will help protect your bones over time.  “The screw in your jawbone will trick the body into thinking you still have teeth,” said Dr. Ira Cheifetz, president of the American Association of Maxillofacial Surgeon.  “The bone continues to grow and thrive.”

There is good news for the patients in Dr. Weingarden’s practice.  Dental implants generally cost less in Pittsburgh than other major cities across the country.

Dr. Weingarden also offers interest-free payment options.  Through dental implant technology, patients can rid themselves of the misery of dentures and regain the look, feel and function of their natural teeth.

For more information regarding dental implants, visit our website at

www.pittsburghimplantsandperio.com

For this article in its entirety visit www.nytimes.com