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Reduce Tooth Decay Effectively By This Cavity Prevention Approach

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A scientifically based approach that includes a tooth-decay risk assessment, aggressive preventive measures, and conservative restorations can dramatically reduce decay in community dental practices, according to a study by researchers at UC San Francisco.

The findings, which support earlier research demonstrating positive results of the assessment and treatment method in a university setting, have the potential to transform dental care for high-risk patients at a lower cost to both patients and dental clinics and practices. Results appear online Jan. 22, 2018, in Advances in Dental Research.

“We put the 2012 UCSF clinical study into the real world and showed it works,” said lead author Peter Rechmann, DMD, Ph.D., professor of preventive and restorative dental sciences in the UCSF School of Dentistry.

“The patients at high caries risk who used prescription products went down significantly over time in their risk level. Those in the control group also reduced their risk to a lesser degree, simply by using over-the-counter products that also protect teeth and affect the bacteria.”

Treating Tooth Decay at Its Earliest Stages

Dental caries (tooth decay) is caused by bacteria on the tooth surface feeding on carbohydrates, then making acids as waste. These acids destroy the protective tooth enamel and the dentin layer beneath it. If not halted or reversed, this leads to a cavity.

Caries Management By Risk Assessment (CAMBRA®) is an evidence-based approach to preventing or treating dental caries at its earliest stages. It was launched in 2003 through the UCSF School of Dentistry by the paper’s senior author, John Featherstone, Ph.D., MSc, former dean of the school and distinguished professor of preventive and restorative dental sciences.

A dentist who uses CAMBRA obtains the patient’s dental and medical history and conducts a clinical exam to assess caries early enough to reverse or halt progression and to determine caries risk factors. These factors include, among other things, acid-producing bacteria, frequent eating and drinking of fermentable carbohydrates (“snacking”), and abnormally low saliva flow and function.

From this assessment, the dentist utilizes behavioral approaches and chemical treatments to optimize protective factors. The treatment plan typically incorporates remineralization through the use of fluoride and/or antibacterial therapies such as chlorhexidine and xylitol, minimally invasive restorative procedures to conserve tooth structure, and regular patient follow-up.

The authors published their initial validation of CAMBRA for ages 6 through adult in 2006, followed by several additional years of data published in 2011, 2012, 2015 and 2016. Since then, more than half of the U.S. schools and colleges of dentistry have adopted CAMBRA in one form or another as part of their standard curriculum. The authors said now that this has been shown to be effective in a non-academic clinical setting, there also is potential for insurance companies to reimburse CAMBRA and other preventive therapies for adults, thereby lowering patient costs while increasing profits for dental practices.

Treatment Effective Even Without Prescription Products

In the Advances in Dental Research study, Rechmann and his colleagues recruited 20 dentists – 17 in private practice, three in community clinics – to participate in a two-year CAMBRA trial of 460 patients ages 12-65 years old, with 239 in a CAMBRA group and 221 in a control group.

In the CAMBRA group, high-risk patients received prescription fluoride toothpaste, chlorhexidine antibacterial rinse, xylitol mints and fluoride varnish. The control group received regular fluoride toothpaste, an assumed inactive mouth rinse, sorbitol candies and a non-fluoride varnish.

Follow-up visits occurred at six, 12, 18 and 24 months, in which new caries lesions or changes in caries risk level were recorded. Overall, the researchers found that a significantly greater percentage of high-risk participants were classified at lower risk after receiving CAMBRA preventive therapies. Dental decay was low in both groups.

Among 242 patients (137 intervention, 105 control) initially identified as high risk for caries, only a quarter of the patients remained at high risk in the CAMBRA group at 24 months, while just over half (54 percent) of the control group did. Of the 192 low-risk participants (93 intervention, 99 control), most participants remained low risk, indicating that the assessment correctly identifies who is at risk for caries.

The researchers said the risk reduction among the control group may have been caused by the fluoride toothpaste enhancing tooth repair, as well as the mouth rinse enhancing saliva flow and having bactericidal effects. While not as significant as the CAMBRA group in this study, the risk level of these patients dropped more dramatically over time than for those in the 2012 UCSF CAMBRA study.

“It was surprising to see the benefits gained by the control group,” Rechmann said.

“More research is needed to see if the products and treatment administered to this group function in the way we speculate, and if so, they might be made easily available to dental patients. Doing so can change the whole picture of caries control.”

Among the study limitations, the researchers noted a high study attrition (65 percent), which partly may have contributed to observed declines in risk level at each subsequent recall visit.

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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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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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