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Heart disease risk higher with latent tooth infection

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if you missed your last dental checkup, a new study might encourage you to book that appointment right away; researchers have identified a higher risk of heart disease for individuals who have hidden tooth infections.

women in the United States, responsible for around 610,000 deaths every year.

Coronary artery disease (CAD) is the most common form of heart disease, caused by a buildup of plaque in the coronary arteries, reducing blood flow to the heart.

Common risk factors for heart disease include obesity, physical inactivity, smoking, high blood pressure, high cholesterol, anddiabetes. However, researchers are increasingly suggesting poor dental health should be added to the list.

Last year, for example, a study published in Infection and Immunity suggested that the bacterium involved in gum diseasemay also raise the risk of heart disease.

Now, researchers from the University of Helsinki in Finland have uncovered a link between dental root tip infection, known as apical periodontitis, and greater risk for acute coronary syndrome (ACS) - an umbrella term for conditions that involve blocked blood flow to the coronary arteries.

Study co-author John Liljestrand, of the Department of Oral and Maxillofacial Diseases at the University of Helsinki, and colleagues publish their findings in the Journal of Dental Research.

Apical periodontitis is a condition characterized by inflammatory lesions of the pulp in the center of the tooth, most commonly triggered by infection. Dental caries, or tooth decay, are the most common cause of apical periodontitis.

While the condition can cause pain, this may not present until later on in the infection, meaning some people who have apical periodontitis are unaware they have it; most cases are uncovered unexpectedly through X-rays.

 

Apical periodontitis 'independently associated' with CAD, ACS

The research involved 508 individuals of a mean age of 62 years who were part of The Finnish Parogene study and who were experiencing some heart problems.

All patients underwent angiography - an X-ray of the blood vessels. This revealed that 36 percent of the patients had stable CAD, 33 percent had ACS, and 31 percent had no significant CAD.

Using panoramic tomography, the researchers assessed the patients' teeth and jaws. They found that up to 58 percent of the patients had at least one inflammatory lesion, a sign of apical periodontitis.

The results revealed that patients with apical periodontitis were more likely to have CAD or ACS; this association was strongest for patients whose apical periodontitis was untreated and required a root canal, with a 2.7-times greater risk of ACS.

These results remained after accounting for a number of possible confounding factors, including patients' age, sex, smoking,type 2 diabetes, body mass index (BMI), and number of teeth.

Based on their findings, the researchers believe apical periodontitis can be considered a risk factor for heart disease:

 

'Concern' over GPs prescribing 'unnecessary' antibiotics for toothache

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Over half of all patients who visited their GP with a dental problem in the last 10 years were not offered a long-term treatment for their pain and were instead prescribed antibiotics, often unnecessarily, new research has found.

In a 10 year retrospective study published in the British Journal of General Practice a team of experts from Cardiff University and Cardiff and Vale University Health Board examined dental consultations in UK general practice and the resultant number of antibiotics prescriptions.

The study found many patients are visiting their GP rather than their dentist, and that over half of these consultations resulted in antibiotic prescribing, which is likely to be unhelpful, and potentially harmful.

"Our study found that many people visit their GP rather than their dentist when experiencing dental problems," said Dr Anwen Cope, a qualified dentist and speciality trainee in Dental Public Health at Cardiff and Vale University Health Board, who completed the research alongside colleagues from the Schools of Dentistry and Medicine at Cardiff University.

"Most dental problems cannot be comprehensively managed by a GP. This places an additional burden on already busy GPs when patients should be visiting a dentist.

"The best treatment for severe toothache remains an operative intervention like an extraction or root canal treatment. These treatments can only be undertaken by a dentist. Therefore, we would always encourage patients to see a dentist, rather than a GP, when experiencing dental problems."

The most alarming finding was the number of unnecessary prescriptions of antibiotics over the last ten years.

The study found over half of patients in the study who consulted their GP with a dental problem were prescribed an antibiotic. This raises serious concerns about the UK's long-term dental health and the potential contribution to antibiotic resistance.

Antibiotic drug resistance, which occurs when bacterial infections no longer respond to antibiotics, is a serious problem, and the use of antibiotics is the single most important factor leading to resistance.

Dr Cope added: "The widespread use of antibiotics in the management of tooth-related complaints in general practice is concerning.

"Despite antibiotics not providing a definitive treatment for dental problems we found over half of consultations for dental problems resulted in prescription of an antibiotic.

"This presents a number of problems. It means patients are not getting a long-term resolution for their dental problem, and they may even remain in pain for longer.

"Prescribing antibiotics also carries a risk of adverse reaction and is likely to increase the number of medical consultations for dental conditions further down the line.

"More worryingly is the potential impact on the rates of antibacterial resistance. Antibiotics save lives, and therefore it's important we use them carefully and only when they are really required.

"Improving antibiotic prescribing for dental problems is an important step in ensuring antibiotics will still be available in the years to come."

This research did not identify the reasons why patients were consulting with a GP rather than a dentist, and it may be that GPs are sometimes treating patients who report being unable to get a timely appointment with a dentist.

Nevertheless, the team hope the study will promote more appropriate consulting for dental problems, and a reduction in antibiotic prescribing by GPs for patients with dental problems.

Dr Cope added: "The messages from our study are simple: GPs should avoid routinely prescribing antibiotics when patients present with dental problems, and more work is needed to identify how patients experiencing dental problems can be best directed to emergency dental services."

 

How bioceramics could help fight gum disease

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Severe gum disease known as periodontitis can lead to tooth loss, and treating it remains a challenge. But new approaches involving silicon nitride, a ceramic material used in spinal implants, could be on the way. The surface of silicon nitride has a lethal effect on the bacteria that commonly cause periodontitis. Now scientists, reporting in ACS' journalLangmuir, are examining why this happens. Their findings could help inform future efforts to treat the disease.

About half of American adults have some form of gum disease. It's caused by bacteria that infect the tissue around teeth, resulting in gum inflammation. If the condition progresses, the bacteria can damage the bone that supports the teeth. In addition to tooth loss, periodontitis can increase a person's risk of heart attack or stroke. Options for treatment include scaling and root planing, topical antibiotics and surgery. Giuseppe Pezzotti and colleagues wanted to find a new alternative by studying the reactions of bacteria to antimicrobial silicon nitride.

The researchers investigated how the ceramic material changes the metabolism of Porphyromonas gingivalis - the bacteria species primarily responsible for periodontitis. They found that chemical reactions at the surface cause the bacteria's nucleic acids to degrade and drastically reduce the amounts of certain proteins and fats. While further studies are needed, the results show silicon nitride holds promise as a therapeutic aid for treating severe gum disease.

 
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