Gum disease raises death risk in diabetics: study

NEW YORK (Reuters Health) - Severe gum disease may hasten death in people with diabetes, new study findings suggest.

"Diabetic people with periodontal disease had increased death rates due to cardiovascular disease and renal (kidney) failure, which are two major complications of type 2 diabetes," said study author Dr. William C. Knowler.

The findings underscore the need for good oral hygiene in diabetics, who are particularly prone to periodontitis, or gum disease, Knowler said in an interview with Reuters Health.

Gum disease, characterized by red, swollen gums, is caused by a bacterial infection. And studies have indicated that infections and inflammation can promote blood-vessel damage in the heart and kidneys, said Knowler, chief of the diabetes and arthritis epidemiology section of the National Institute of Diabetes and Digestive and Kidney Diseases in Phoenix.

While gum disease might not be diagnosed until mid-life or later, infection with the bacteria that cause it can occur decades earlier. Combined with years of inadequate oral hygiene, infection can result in gingivitis, an early form of gum disease characterized by inflamed gums that often bleed easily. This form of the disease can usually be reversed with more careful brushing and flossing.

But as the more aggressive periodontitis develops, the gums and bone surrounding the teeth can become seriously damaged, and teeth may loosen or fall out.

The new study involved 549 Pima Indians ages 45 or older with type 2 diabetes, the most common form of the disease. At the beginning of the study, the prevalence of severe gum disease, marked by the loss of bone and often teeth, was roughly 60 percent.

During a follow-up period of about 10 years, 172 participants died of natural causes, according to findings presented at a recent meeting of the American Diabetes Association in New Orleans.

Overall, the rate of death from natural causes was 42 per 1,000 people per year among participants with severe gum disease, compared with 26.6 per 1,000 people per year among those who did not.

The extra deaths among those with severe gum disease were due to heart disease and diabetic nephropathy, and not to other causes such as cancer or liver disease, Knowler and colleagues concluded.

Diabetic nephropathy is a condition in which diabetes damages the kidneys, which then progressively lose their ability to function normally and eventually fail.

After adjusting for factors such as age, sex, duration of diabetes, obesity and cholesterol levels, the researchers found that diabetics with severe gum disease were twice as likely as those without it to die from either heart disease or kidney failure.

Snoring can kill

WASHINGTON (Reuters) -- Dental surgeons said Saturday they have discovered why snoring can kill sometimes: It can actually cause damage to the arteries.

Snoring is usually harmless, if annoying, unless a person has a particular disorder known as sleep apnea.

Sleep apnea is marked by irregular breathing and snorting. Sufferers often stop breathing completely for up to several seconds. It usually affects overweight, middle-aged men and has been linked with stroke and heart disease.

A team at the University of California at Los Angeles School of Dentistry set out to see what the physical mechanism is.

Writing in the Journal of Oral and Maxillofacial Surgery, they said X-rays showed it is more complicated than seems immediately obvious.

"When persons with sleep apnea fall asleep, their tongue falls back into their throat, blocking their airway. As they struggle for breath, their blood pressure soars," Dr. Arthur Friedlander, an oral surgeon who worked on the study, said in a statement.

"We believe that this rise in blood pressure damages the inner walls of the carotid arteries lining the sides of the neck," he added.

"Cholesterol and calcium stick to the injury sites and amass into calcified plaques, which block blood flow to the brain. The result is often a massive stroke."

Two-minute brush helps achieve cleaner teeth: study

NEW YORK (Reuters Health) - Although hard work tends to pay off in other areas of life, forceful toothbrushing appears to be no better at ridding the mouth of plaque than a medium effort.

A group of European researchers discovered that the most efficient means of reducing plaque appears to be brushing for about two minutes at a medium force.

More vigorous teeth cleaning may actually do more harm than good, said Dr. Peter A. Heasman of the University of Newcastle upon Tyne, UK. Research suggests that heavy brushing can damage gums and wear down teeth, both potentially serious oral health problems, he said.

"Although we found that you have to brush your teeth reasonably long and hard to get rid of the harmful plaque which causes dental diseases, our research shows that once you go beyond a certain point you aren't being any more effective," Heasman said in a statement.

"You could actually be harming your gums and possibly your teeth," he added.

Heasman and his colleagues designed the study, published in the Journal of Clinical Periodontology, to determine the most efficient way to brush away plaque. Plaque is a sticky substance that can contain more than 300 species of bacteria, which adhere to tooth surfaces and produce cavity-causing acid. Plaque is a leading cause of gum disease.

During the study, Heasman and his colleagues measured plaque levels in the mouths of 12 people after they brushed their teeth using four different forces and for four periods of time -- 30 seconds, 60 seconds, 120 seconds, and 180 seconds.

The study participants brushed using a power toothbrush, which exerted set forces of between 75 grams and 300 grams. All spent 24 hours without cleaning their teeth before testing how well each technique stripped their mouths of plaque.

Heasman said that a force of 75 grams feels much lighter than one of 300 grams. However, he recommended that people visit their dentist to determine how different brushing forces feel.

"It is very difficult for a lay person to differentiate between brushing forces," Heasman told Reuters Health.

Longer brushing generally appeared better, but the researchers found that 120 seconds of brushing was roughly just as effective at removing plaque as longer brushing. And during those longer sessions, people removed about the same amount of plaque using a force of 150 grams as when they employed forces of 225 and 300 grams.

Although different people may require more or less time to get at all the plaque-ridden nooks and crannies in their mouth, spending around two minutes brushing your teeth seems "about right", Heasman said.

And applying a force beyond 150 grams -- somewhere in between light and forceful brushing -- "offered little benefit to plaque removal," Heasman added.

Furthermore, in toothbrushing, it is possible to have too much of a good thing, the researcher said.

"In the short term, gum changes may become apparent, but in the longer term, tooth wear or toothbrush abrasion is likely with too abrasive a technique, toothpaste, brush or force," Heasman said.

SOURCE: Journal of Clinical Periodontology 2003;30:409-413.

Tooth Loss Linked to Pancreatic Cancer in Smokers

NEW YORK (Reuters Health) - The more teeth a smoker loses, the higher the risk that he will develop pancreatic cancer, according to a new study.

The risk of developing pancreatic cancer was 63 percent higher in smokers who had lost all their teeth, compared with those who had lost fewer than 10 teeth, researchers reported in the American Journal of Clinical Nutrition. Overall, the risk of pancreatic cancer in the group was about 6 in 1000.

The study doesn't show that tooth loss causes pancreatic cancer, the study's lead author Rachel Z. Stolzenberg-Solomon said in an interview with Reuters Health.

Tooth loss could simply be a marker for some other factor that leads to cancer, said Stolzenberg-Solomon, an investigator in the Nutritional Epidemiology Branch at the National Cancer Institute. For example, she said, tooth loss could simply be a marker for an unhealthy lifestyle.

On the other hand, Stolzenberg-Solomon said, smokers who have lost all their teeth may have more bacteria in their mouths. And this higher level of bacteria in the mouth may lead to higher levels of bacteria in the gut.

"There is a hypothesis that connects bacterial load with pancreatic cancer," Stolzenberg-Solomon said. "Bacteria in the stomach convert nitrates and nitrites into nitrosamines. And nitrosamines are carcinogens."

For the new study, Stolzenberg-Solomon and her colleagues examined the medical records of 29,104 male smokers. The men, who were aged 50 to 69 at the start of the study, were followed from 1985 to 1997. They were asked about their dental health at the beginning of the study. By the end of the study, 174 men had developed pancreatic cancer.

After taking age, education, and whether the men lived in a rural or urban environment into account, the researchers found that men were 63 percent more likely to develop pancreatic cancer if they had lost all their teeth.

While the new study doesn't prove that the conditions that promote tooth loss lead to an elevated cancer risk, it does underscore the importance of good dental hygiene, Stolzenberg-Solomon said.

Studies have shown that the use of dental floss and toothpaste are linked with lower risk of cancers of the mouth and esophagus, she said.

Source: American Journal of Clinical Nutrition 2003;78:176-181

New cavity-fighting agent shows promise

New cavity-fighting agent shows promise

NEW YORK (Reuters Health) - An experimental cavity-fighting toothpaste may be better at preventing tooth decay and cavities than traditional fluoride toothpaste, according to a study.

The new agent does not contain any fluoride, which has been the cornerstone of cavity prevention for decades.

The product, called CaviStat, contains the amino acid arginine as well as calcium carbonate. The toothpaste may help fight cavities by promoting a higher pH in the mouth, according to Mitchell Goldberg, president of Ortek Therapeutics Inc., the company granted the licensing rights to the product by the Research Foundation of the State University of New York.

After eating food, the bacteria trapped in sticky plaque inside the mouth metabolize sugars and release acid. Over time, this process can eat away at the enamel of the tooth and promote decay.

The study, which is due to be presented at the International Association of Dental Research in Sweden later this week, suggests the calcium carbonate portion of the CaviStat might also remineralize teeth at a higher rate than fluoride, explained Goldberg in an interview.

Dr. Dan Meyer, director of science at the American Dental Association characterized his reaction to the study as "guardedly optimistic." He said he hasn't actually evaluated the product.

"Normally, you like to have several studies that find similar results," he said, adding that the current study "shows promise," but more research is needed to validate the anti-cavity findings.

In the study, Dr. Israel Kleinberg, of Stony Brook University in New York, and colleagues evaluated the efficacy of CaviStat among 726 Venezuelan children who were between 10 and 11 years old.

Half of the youngsters were instructed to brush their teeth three times a day for one minute with CaviStat toothpaste, and the other used traditional fluoride toothpaste.

After one year, CaviStat appeared to reduce the signs of early tooth decay, according to Goldberg.

At the end of two years, kids who used CaviStat had fewer cavities compared to the ones in the fluoride group, said Goldberg.

Although this is the first large clinical trial of the product to be conducted, Goldberg said he is confident that future trials will show similar results.