Dr Mark O'Donnell B.D.S
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Space maintainers require extra oral hygiene
Without special attention to oral hygiene, orthodontic space maintainers can affect oral health, say the authors of a recent study published in the journal Medical Principles and Practice.
The Turkish study included 38 children, aged four to 10 years, each of whom was given a space maintainer.
A space maintainer is a device that is placed in a child's mouth when the child has lost a baby molar too soon. It holds the space open so that the permanent tooth can come into the mouth in a normal position. The device is usually made of metal, although it sometimes includes plastic parts. A fixed space maintainer is cemented in the mouth for several months. A removable one can be taken out and put back in.
The children in the study were examined just before their space maintainers were put in, and after one, three and six months.
By the six-month visit, children with fixed space maintainers had poorer gum health around the space maintainer. The gums in that area were puffier and more likely to bleed when probed with a dental tool.
All of the children had more Candida yeast species in their mouths at the six-month visit, compared with before the space maintainer was put in. They also had more Enterococcus faecalis bacteria. This is a normal part of the human digestive system, but it can cause infection, including urinary tract infections, wound infections and bacterial meningitis.
The authors conclude that any patient given a space maintainer should be told that it can lead to increased bacteria and yeast in the mouth. These patients should give special attention to oral hygiene.
American Dental Association releases guideline on gum disease treatment
Dentists treating patients with chronic periodontitis, a severe form of gum disease that can lead to tooth loss, are advised to use scaling and root planing (SRP), which is a deep cleaning of the teeth, as initial treatment, according to new guidelines from the American Dental Association (ADA). The guidelines were published recently in the Journal of the American Dental Association (JADA).
"This is the first time the various treatments of periodontitis have been compared side by side," said ADA President and periodontist Maxine Feinberg DDS. "Dentists are often challenged with managing gum disease of varying severity; these guidelines will assist practitioners in their decision-making and ultimately help patients receive the right treatment at the right time."
According to the authors, chronic periodontitis is a prevalent condition, and a major cause of tooth loss in adults. According to the Centers for Disease Control and Prevention and the American Academy of Periodontology, the prevalence of moderate periodontitis among adults is estimated at 30% and that of severe periodontitis is 8.5%.
In 2011, the ADA resolved to develop a clinical practice guideline on non-surgical treatments, including SRP. SRP is the process by which dentists remove tartar and plaque that attach to the tooth surfaces. Based on a review of the evidence, the ADA concluded that clinicians should consider SRP as the initial treatment for patients with chronic periodontitis.
Missing teeth may predict future cardiovascular events
Advanced tooth loss can often indicate that a person has a history of inflammatory oral diseases. In a study carried out by the University of Helsinki (Finland) in collaboration with The National Institute for Health and Welfare (THL), an association was found between tooth loss and future cardiovascular events, diabetes and death.
The researchers suggests that the number of missing teeth could be a useful additional indicator for general medical practitioners, when individual risk factors for chronic diseases are assessed.
The National FINRISK 1997 Study is a Finnish population-based survey of 8,446 subjects, aged 25-75, who filled in a comprehensive questionnaire and participated in clinical examinations. The number of missing teeth was recorded at baseline and information on incident disease events and deaths was obtained via national registers in a 13-year follow-up.
The results showed:
• more than five missing teeth increased the risk for coronary heart disease events and myocardial infarctions by as much as 140%; and,
• more than nine missing teeth indicated an increased risk for cardiovascular diseases (51%), diabetes (31%) and death (37%).
Non-communicable diseases such as cardiovascular diseases and diabetes are the most common cause of death worldwide. They are known to associate with inflammatory oral diseases, such as periodontitis. Periodontitis is a chronic inflammatory disease in the gums, which appears as gingival bleeding, increased tooth mobility and deepened periodontal pockets. It may result in the loss of teeth if left untreated, and is the most common cause of tooth loss in the middle aged and elderly.