Dr Mark O'Donnell B.D.S
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News - March 2017
Oestrogen therapy reduces oral diseases in postmenopausal women
Oestrogen therapy has already been credited with helping women manage an array of menopause-related issues. Now a new study suggests that the oestrogen therapy used to treat osteoporosis can lead to healthier teeth and gums. The study outcomes are being published in Menopause.
As oestrogen levels fall during menopause, women become more vulnerable to numerous health issues. Changes in oral health are also common as teeth and gums become more susceptible to disease, which can lead to inflammation, pain, bleeding, and eventually loose or missing teeth.
In the study, 492 postmenopausal Brazilian women aged 50 to 87 years, 113 in osteoporosis treatment and 379 not in treatment, were evaluated to determine whether osteoporosis treatment could help increase the bone mineral density in their jaws and, subsequently, improve overall oral health.
The study found that the rate of occurrence of severe periodontitis was 44% lower in the osteoporosis treatment group than in the untreated group. Treatment consisted of systemic oestrogen alone or oestrogen plus progestin, as well as calcium and vitamin D supplements.
"Osteoporosis can occur throughout the body, including the jaw, and lead to an increased risk of periodontal disease”, says Dr JoAnn Pinkerton, North American Menopause Society Executive Director: "This study demonstrates that oestrogen therapy, which has proven to be effective in preventing bone loss, may also prevent the worsening of tooth and gum disease. All women, but especially those with low oestrogen or on bisphosphonate treatment for osteoporosis, should make good dental care a part of their healthy lifestyles”.
Gum disease may be an early sign of diabetes
New research published in BMJ Open Diabetes Research & Care suggests severe gum disease, or periodontitis, might be an early sign of diabetes. The authors also suggest a simple finger stick diabetes screening procedure could be carried out in the dental surgery to help avoid the adverse effects of leaving diabetes untreated.
Researchers from the University of Amsterdam in the Netherlands assessed a total of 313 participants from a dental clinic at the university. Of these, 126 patients had mild-to-moderate gum disease, 78 patients had severe periodontitis, and 198 individuals did not have signs of gum disease.
Participants with periodontitis had a higher body mass index (BMI) than the rest, with an average BMI of 27. Other diabetes risk factors – such as high blood pressure or high cholesterol – were similar across all three groups.
The researchers analysed higher glycated haemoglobin (HbA1c) values in dry blood spots, and evaluated the differences in mean HbA1c values, as well as the prevalence of diabetes and prediabetes between the two groups.
HbA1c values measure the average level of blood sugar in the last two to three months. The dry blood spots were obtained by sampling participants' blood using a finger pin-prick test.
The analysis revealed that those with the most severe form of periodontitis were also the most likely to have prediabetes.
Additionally, the researchers found a high percentage of people with suspected diabetes and prediabetes among participants with mild-to-moderate and severe gum disease.
Enamel defects conducive to cavities
Why do some people develop cavities even though they always brush their teeth carefully, while others are less stringent yet do not have any holes? Both have bacteria on the surface of their teeth which can attack the enamel. Enamel forms via the mineralisation of specific enamel proteins. If the enamel is defective, tooth decay can strike.
Researchers from the University of Zurich have pinpointed a gene that is responsible for the formation of tooth enamel. Two teams used mice with varying mutations of the enamel proteins involved in the so-called Wnt signalling pathway. Thanks to this transmission route, human and animal cells respond to external signals and specifically activate selected genes.
"All mice with mutations in these proteins exhibit teeth with enamel defects", explained Pierfrancesco Pagella, one of the study's authors: "Therefore, we demonstrated that there is a direct link between mutations in the genetic blueprints for these proteins and the development of tooth enamel defects”.
This genetic discovery goes a long way towards improving our understanding of the production of tooth enamel. The hardness and composition of the tooth enamel can affect the progression of cavities.
"We revealed that tooth decay isn't just linked to bacteria, but also the tooth's resistance", says Thimios Mitsiadis, Professor of Oral Biology. Bacteria and their toxic products can easily penetrate enamel with a less stable structure.
Understanding the molecular-biological connections of tooth enamel development and the impact of mutations that lead to defects opens up new possibilities for the prevention of cavities.