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Losing Teeth During Middle Age Linked To An Increased Risk Of Cardiovascular Disease

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Losing two or more teeth in middle age is associated with increased cardiovascular disease risk, according to preliminary research presented at the American Heart Association’s Epidemiology and Prevention | Lifestyle and Cardiometabolic Health Scientific Sessions 2018, a premier global exchange of the latest advances in population-based cardiovascular science for researchers and clinicians.

Studies have shown that dental health problems, such as periodontal disease and tooth loss, are related to inflammation, diabetes, smoking and consuming less healthy diets, according to study author Lu Qi, M.D., Ph.D., professor of epidemiology at Tulane University in New Orleans.

“Previous research has also found that dental health issues are associated with elevated risk of cardiovascular disease,” Qi said.

“However, most of that research looked at cumulative tooth loss over a lifetime, which often includes teeth lost in childhood due to cavities, trauma and orthodontics. Tooth loss in middle age is more likely related to inflammation, but it hasn’t been clear how this later-in-life tooth loss might influence cardiovascular disease risk.”

In a collaborative research effort between Tulane University School of Public Health and Tropical Medicine and Harvard T.H. Chan School of Public Health, Qi and colleagues analyzed the impact of tooth loss in large studies of adults, aged 45 to 69 years, in which participants had reported on the numbers of natural teeth they had, then in a follow-up questionnaire, reported recent tooth loss. Adults in this analysis didn’t have cardiovascular disease when the studies began. The researchers prospectively studied the occurrence of tooth loss during an eight-year period and followed an incidence of cardiovascular disease among people with no tooth loss, one tooth lost and two or more teeth lost over 12-18 years.

They found:

  • Among the adults with 25 to 32 natural teeth at the study’s start, those who lost two or more teeth had a 23 percent increased risk of cardiovascular disease, compared to those with no tooth loss.
  • The increased risk occurred regardless of reported diet quality, physical activity, body weight and other cardiovascular risk factors, such as high blood pressure, high cholesterol and diabetes.
  • There wasn’t a notable increase in cardiovascular disease risk among those who reported losing one tooth during the study period.
  • Cardiovascular disease risk among all the participants (regardless of the number of natural teeth at the study’s start) increased 16 percent among those losing two or more teeth during the study period, compared to those who didn’t lose any teeth.
  • Adults with less than 17 natural teeth, versus 25 to 32, at the study’s start, were 25 percent more likely to have cardiovascular disease.

“In addition to other established associations between dental health and risk of disease, our findings suggest that middle-aged adults who have lost two or more teeth in recent past could be at increased risk for cardiovascular disease,” Qi said.

“That’s regardless of the number of natural teeth a person has as a middle-aged adult, or whether they have traditional risk factors for cardiovascular disease, such as poor diet or high blood pressure.”

Armed with the knowledge that tooth loss in middle age can signal elevated cardiovascular disease risk, adults can take steps to reduce the increased risk early on, he said.

A limitation of the study was that participants self-reported tooth loss, which could lead to misclassification in the study, according to Qi.

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Can These Proteins Cure Cavities?

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Researchers at the University of Washington have designed a convenient and natural product that uses proteins to rebuild tooth enamel and treat dental cavities.

The research finding was first published in ACS Biomaterials Science and Engineering.

“Remineralization guided by peptides is a healthy alternative to current dental health care,” said lead author Mehmet Sarikaya, professor of materials science and engineering and adjunct professor in the Department of Chemical Engineering and Department of Oral Health Sciences.

The new biogenic dental products can — in theory — rebuild teeth and cure cavities without today’s costly and uncomfortable treatments.

“Peptide-enabled formulations will be simple and would be implemented in over-the-counter or clinical products,” Sarikaya said.

Cavities are more than just a nuisance. According to the World Health Organization, dental cavities affect nearly every age group and they are accompanied by serious health concerns. Additionally, direct and indirect costs of treating dental cavities and related diseases have been a huge economic burden for individuals and health care systems.

“Bacteria metabolize sugar and other fermentable carbohydrates in oral environments and acid, as a by-product, will demineralize the dental enamel,” said co-author Sami Dogan, associate professor in the Department of Restorative Dentistry at the UW School of Dentistry.

Although tooth decay is relatively harmless in its earliest stages, once the cavity progresses through the tooth’s enamel, serious health concerns arise. If left untreated, tooth decay can lead to tooth loss. This can present adverse consequences on the remaining teeth and supporting tissues and on the patient’s general health, including life-threatening conditions.

Good oral hygiene is the best prevention, and over the past half-century, brushing and flossing have reduced significantly the impact of cavities for many Americans. Still, some socio-economic groups suffer disproportionately from this disease, the researchers said. And, according to recent reports from the Centers for Disease Control and Prevention, the prevalence of dental cavities in Americans is again on the rise, suggesting a regression in the progress of combating this disease.

Taking inspiration from the body’s own natural tooth-forming proteins, the UW team has come up with a way to repair the tooth enamel. The researchers accomplished this by capturing the essence of amelogenin — a protein crucial to forming the hard crown enamel — to design amelogenin-derived peptides that biomineralize and are the key active ingredient in the new technology. The bioinspired repair process restores the mineral structure found in native tooth enamel.

“These peptides are proven to bind onto tooth surfaces and recruit calcium and phosphate ions,” said Deniz Yucesoy, a co-author and a doctoral student at the UW.

The peptide-enabled technology allows the deposition of 10 to 50 micrometers of new enamel on the teeth after each use. Once fully developed, the technology can be used in both private and public health settings, in biomimetic toothpaste, gels, solutions and composites as a safe alternative to existing dental procedures and treatments. The technology enables people to rebuild and strengthen tooth enamel on a daily basis as part of a preventive dental care routine. It is expected to be safe for use by adults and children.

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Is the Sweet Tooth Gene Connected With Having Less Body Fat?

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People with a gene variation of FGF21 have a predisposition to less body fat than others, new research conducted at the University of Copenhagen, among others, shows.

It comes as a bit of a surprise to the researchers, who last year discovered that precisely this genetic variation could be one of the reasons why some people have a particular craving for sweet things. People with this variation eat more sugar than others.

‘It sort of contradicts common intuition that people who eat more sugar should have less body fat. But it is important to remember that we are only studying this specific genetic variation and trying to find connections to the rest of the body. This is just a small piece of the puzzle describing the connection between diet and sugar intake and the risk of obesity and diabetes’, says one of the researchers behind the study, Associate Professor Niels Grarup from the Novo Nordisk Foundation Center for Basic Metabolic Research.

Higher Blood Pressure and More ‘Apple Shape’

But the effects associated with the genetic variation are not all positive, the new study shows. The genetic variation is connected with slightly increased blood pressure and more fat around the waist than the hips — that is, more ‘apple shape’.

The study is an international collaboration headed by researchers at the University of Exeter Medical School and has just been published in the scientific journal Cell Reports.

The researchers’ conclusions are based on large amounts of data. They have studied health information from more than 450,000 individuals who have allowed their data to be recorded in the UK Biobank. It includes blood samples, questionnaires on diet and genetic data, among other things.

‘Now that so many people are involved in the study, it gives our conclusions a certain robustness. Even though the difference in the amount of body fat or blood pressure level is only minor depending on whether or not the person has this genetic variation or not, we are very confident that the results are accurate. Around 20 per cent of the European population has this genetic predisposition’, says Niels Grarup.

Potential Drug Target

This new knowledge about people with a ‘genetic sweet tooth’ is mainly important in connection with the development of drugs and future research. Because researchers are currently trying to determine whether it is possible to target or replace FGF21 using drugs in order to treat for obesity and diabetes.

‘Due to its connection with sugar, FGF21 constitutes a potential target in the treatment of for example obesity and diabetes. This research helps us to understand the underlying mechanisms of the hormone and to predict its effects and side effects’, says Niels Grarup.

The study is funded by the European Research Council (ERC), the National Institute of Health (NIH) and the Novo Nordisk Foundation, among others.

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Children’s Use of Non-Dental Services for Oral Pain Costing The NHS £2.3m a year

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The study of more than half of all of the pharmacies in London and nearly 7,000 parents finds that most pharmacy visits for children’s pain medications in London are to treat oral pain.

Lead researcher Dr Vanessa Muirhead from Queen Mary’s Institute of Dentistry said: “The fact that only 30 per cent of children with oral pain had seen a dentist before going to a pharmacy highlights a concerning underuse of dental services.

“Children with oral pain need to see a dentist for a definitive diagnosis and to treat any tooth decay. Not treating a decayed tooth can result in more pain, abscesses and possible damage to children’s permanent teeth.

“These children had not only failed to see a dentist before their pharmacy visit; they had seen GPs and a range of other health professionals outside dentistry. This inappropriate and overuse of multiple health services including A&E is costing the NHS a substantial amount of money at a time when reducing waste is a government priority.”

Nearly one in ten children had signs of a dental emergency
Previous research has found that the main cause of planned hospital admissions for children aged 5-9 years is to have their decayed teeth extracted under general anaesthesia. Meanwhile, a quarter of five-year-olds in England still have tooth decay in their baby teeth and approximately one in five 12-year-olds have tooth decay in their adult teeth.

Only 58 per cent of children in England and 49 per cent of children in London had visited a dentist in 2016, even though dental care is free in the UK for under 18s and national guidelines recommend dental visits at least every year for children.

  • In this latest study, published in BMJ Open and jointly funded by Healthy London Partnership and NHS England London Region, 951 pharmacies collected information from 6,915 parents seeking pain medications for their children in November 2016 – January 2017, and found that:Nearly two-thirds (65 per cent) of parents seeking pain medications for their children were doing so to relieve their children’s oral pain.
  • Only 30 per cent of children with oral pain had seen a dentist before the pharmacy visit while 28 per cent had seen between one and four different health professionals (including GPs, health visitors, school nurses and A&E departments – GPs being the most common).
  • Nearly one in ten children had signs and symptoms indicating a dental emergency and community pharmacy staff signposted them to emergency services.
  • The cost to the NHS of children contacting health professionals outside dentistry over the period was £36,573 (an annual cost of £373,288). Replicating these findings across all pharmacies in England could mean that the NHS spends an estimated £2.3 million annually when children with oral pain inappropriately use multiple health services.
  • 41 per cent of the children had toothache; 20 per cent had pain from a newly erupting tooth and 15 per cent had a painful mouth ulcer.
  • Saturdays and Sundays were the peak days for parents to visit pharmacies for pain medication for children’s oral pain. This could partly explain why some parents had not seen a dentist due to limited urgent dental care services over the weekend.

GPs, pharmacists and dentists need to talk to each other
Dr Muirhead added:

“We need to develop integrated systems and referral processes where GPs, community pharmacists and dentists talk to each other to make sure that children with toothache see a dentist as soon as possible for treatment. We also need better training for community pharmacy staff giving parents advice and look at how dentists manage children who have toothache.”

The researchers also highlight the need to work towards preventing tooth decay from occurring in the first place. This includes rolling out Scotland’s Childsmile programme more widely, where fluoride toothpaste is distributed to all pre-school children, all nurseries have supervised toothbrushing every day and early years’ settings have healthy low sugar meals and snacks.

The study limitations include the extrapolation of cost estimations which contained several assumptions. The researchers also possibly underestimated the number of children with oral pain in London because only community pharmacies were used as a means of identifying children and parents.

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