While dentistry is far afield from psychiatry, we all have teeth. Hence, my interest in dentistry. I recommend brushing twice a day with a toothbrush with fairly soft bristles. Eat breakfast, eat a healthy diet, avoid sweets at night after brushing, and take folic acid 800 mcg or more and selenium 200 mcg per day (see Healthy Living). Visiting the dentist every 12 months for cleaning is a very good idea. I am not a fan of dental x-rays, although I am not up on the research in that area of dentistry. Over 5,000 cases of cancer each year in the U.S. come from x-ray exposure when all types are added together. And children are more sensitive than adults. While the medical and dental communities pooh-pooh worrying over such a small number, I would rather get lose all my teeth many times over than get one case of cancer. Besides, avoiding dental x-rays saves money, something I really enjoy doing.
Gum disease or gingivitis and periodontitis are risk factors for stroke. Stannous fluoride toothpaste appears superior to other fluoride toothpastes for gingivitis, but it is no longer available. For older adults, one-third of whom have some gingivitis, using Colgate Total or Crest Pro-Health and Listerine type or the new Crest Pro-Health alcohol-free mouthwash seems the best first line strategy along with using a toothpick or dental floss and seeing the dentist. There are still more interventions for gingivitis mentioned below. Doxycycline also helps gingivitis.
I do like using a rounded toothpick daily, although dental floss is probably just about as good. I personally find toothpicks both more effective and more gentle. However, care must be taken not to swallow the toothpick as there are numerous reports of people being injured by accidental ingestion. Toothpick injuries to eyes and ears are very common among children under age five, so care should be taken to keep toothpicks out of their reach.
I was able to find very little research on the advantages and disadvantages of using toothpicks despite toothpicks being more popular than dental floss in Europe and South America and fairly popular in the U.S. Like the field of medicine, dentistry does research for the companies who provide the money. Since there is not much profit in toothpicks, little or no research is done. Ten times as many reports on dental floss are available, but even there, only a few useful studies exist. Several studies show benefit from use of floss, but a couple find no benefit. Floss is never compared to the toothpick except in a very small, very short study from 1976 in which toothpicks did as well or better. Of course, the floss manufacturers don't want to take a chance that toothpicks will prove better, so comparative studies are never done.
Teeth Getting Healthier: From 1991 to 2001, cavities or fillings in children's permanent teeth fell from 57% to 42% (ages 6-19) filling in their permanent teeth when examined between 1999 and 2002, a 15-percent decrease from the 1988-1994 period. Tooth decay among adults fell 5%, with 20% fewer over the age of 60 reporting they had lost all their teeth. The reduction was attributed to flouride in water systems and in toothpaste. Dental sealants, thin plastic coatings applied to the chewing surfaces of back teeth to prevent pit and fissure decay, also helped children. Smokers were 3 times more likely to have lost all their teeth and lower-income adults were about twice as likely to have untreated tooth decay. William Maas, CDC. Atlanta (Reuters) 8/25/05.
Twice Daily Brushing More Important: Study of 1450 British children ages 1-5 found social class, tooth brushing and sugar intake important in determining the number of cavies but sugar intake didn’t matter when brushing teeth twice daily. Gibson, UK, Caries Res ‘99’33:101
Bone Loss: Tooth Loss Linked to Bone Loss in Elderly: In a 7-year follow-up study of 189 healthy women, for each 1% per year decrement in bone mineral density, relative risks (RR) of losing a tooth were significantly elevated at the whole body (RR = 4.83), femoral neck (RR = 1.50), and spine (RR = 1.45). These results provide support for a role of systemic bone loss in the development of tooth loss among postmenopausal women. Tufts. Increased risk of tooth loss is related to bone loss at the whole body, hip, and spine. Krall EA, Garcia RI, Dawson-Hughes B. Calcif Tissue Int. 1996 Dec;59(6):433-7. Ed: This might be a vitamin D deficiency effect.
Electric Toothbrushes No Advantage: In a study, electric toothbrushes removed only 65-80% of the plaque that manual toothbrushes removed when used for the same amount of time. In the study, adults brushed as long as they thought necessary and actually brushed longer with the electric toothbrushes, but still didn't do as well. What matters most is your technique and how long you brush. However, some people tend to brush longer with an electric toothbrush, which could actually make the electric toothbrush better than a manual one used for shorter periods of time. The most effective electrics for the money were the Colgate Actibrush ($10) and Crest SpinBrush PRO ($7), both of which did better than the Oral-B. Consumer Reports 12/2003.
Toothpick Use Associated with Keeping Teeth: In Denmark, 28% use toothpicks daily vs. 11% flossing. Toothpick use was associated with having more teeth suggesting a possible beneficial effect, although those using toothpicks also were more likely to have other good dental habits like regular dental visits. Univ. Copenhagen. Self-reported oral hygiene practices among adults in Denmark. Christensen LB, Petersen PE, Krustrup U, Kjoller M. Community Dent Health. 2003 Dec; 20(4): 229-35
Flossing and Toothbrushing Didn't Help Periodontitis: One third of adults have some periodontitis. A study of 553 health professionals including dentists found that neither brushing twice a day and nor using floss regularly helped decrease the incidence of periodontitis. Harvard. Oral hygiene practices and periodontitis in health care professionals. Merchant A, Pitiphat W, Douglass CW, Crohin C, Joshipura K. J Periodontol. 2002 May; 73(5): 531-5
Flossing and Brushing Helped Periodontitis: In a Detroit study of 319 adults in regression analyses, brushing thoroughness, flossing ability and frequency, and dental visit frequency were predictors of lower plaque, gingivitis, and calculus scores. In turn, these scores were predictors of shallower pocket depths and less attachment loss. Preventive behaviors as correlates of periodontal health status. Lang WP, Ronis DL, Farghaly MM. J Public Health Dent. 1995 Winter; 55(1): 10-7. Ed: This is not controlled research. It could well be that people who brush and floss regularly are also more careful in choosing their diets or have better dental genetics.
Flossing Associated with Worse Teeth in Brazil, But Not Pittsburgh: In a study of Brazilians without cavities and a matched control group, not using dental floss was associated with fewer cavities with a risk factor of OR 0.73. Adults without caries: a case-control study about knowledge, attitudes and preventive practices. Cad Saude Publica. 2000 Jan-Mar; 16(1): 145-53; The opposite association with less periodontal disease was reported in 406 Pittsburgh diabetics. J Public Health Dent. 1998 Spring; 58(2): 135-42
Fluoride Gel by Dentist Not Worth It for Most Children: In a DB PC study of 594 children ages 9-12 using fluoride toothpaste, professionally applied fluoride gel showed no statistically significant effect on permanent teeth score in low-caries children. J Dent Res. 2005 May;84(5):418-21.
Folic Acid Reduced Gingivitis: In a DB PC study of 30 adults with half receiving 2 mg folic acid twice a day for thirty days, those on the folic acid showed less plaque and gingivitis. The effect of folic acid on gingival health. Vogel RI, Fink RA, Schneider LC, Frank O, Baker H. J Periodontol. 1976 Nov; 47(11): 667-8.
Folate Mouthwash Reduced Gingivitis: In a DB PC study of 60 patients, 5 mg folate/5ml water was swished in the mouth for 1 minute and expectorated. Folate helped by local action. Pack, J Clin Peridontal, ’84;11:619. Another study showed folate mouthwash helped phenytoin (Dilantin) gingivitis more than oral folate or placebo. Ed: While spitting out the folate is important for determining whether swished or swallowed folate makes the difference, in real life it is silly to spit out the folate. If you have gingivitis, it makes more sense to crush up the folate you were going to swallow, mix it with a teaspoon of fluid, then swish for 1 minute and swallow.
Folate Mouthwash, Not Swallowed, Helped Pregnancy Gingivitis: 30 patients in 8th month of pregnancy were treated for 4 weeks with placebo or oral folate or folate mouthwash twice a day as above. Only the mouthwash showed benefit which was highly significant. Thomson, J Clin Peridontal ’82;9:275; Also ’80;7:402 same result with 14 days in 4th and 8th months by Pack and Thomson.
Bad Bacteria From Mother: A study by Emanuelsson of Lund U in Sweden in Oral Microbiol Immunol 10/98 13:271 found that of 11 of 25 kids with mutan streptococcus, six had the same genotype as the mother’s streptococcus but none the same as the fathers suggesting that mothers are one source of decay producing streptococcus but that father rarely are.
Cetylpyridinium (Crest Pro-Health) Better than Flossing for Plaque, Gingivitis: In an 8-week random-assignment study of 156 healthy volunteers of 1) toothbrushing and rinsing (0.06% chlorhexidine and 0.025% fluoride); 2) toothbrushing and rinsing (0.1% cetylpyridiniumchloride and 0.025% fluoride); 3) toothbrushing and flossing; and 4) toothbrushing only, the modified proximal plaque index improved more for the mouthrinse groups than the control and floss groups: 1) 0.73; 2) 0.82; 3) 0.40; and 4) 0.32 (P <0.05). The papillary bleeding index showed no statistically significant difference between groups, but a definite favorable trend: 1) 0.46; 2); 0.50; 3); 0.42; and 4) 0.37. Clinical efficacy of flossing versus use of antimicrobial rinses. Zimmer S, et al. Heinrich-Heine-University, Dusseldorf, Germany. . J Periodont 2006 Aug;77(8):1380-5.
Cetylpyridinium as Good as Scope: In a 6-month randomized single-blind study of Crest Pro-Health alcohol-free, 0.07% cetylpyridinium chloride vs. Scope, an alcohol-based mouthwash similar to Listerine, subject evaluations were generally positive with respect to both rinses. Side effects were minimal, with no between-group differences in hygienist-rated calculus or stain accumulation, or prophylaxis time. Practice implications with an alcohol-free, 0.07% cetylpyridinium chloride mouthrinse. Blenman TV, et al. Procter and Gamble Company. Am J Dent 2005 Jul;18 Spec No:29A-34A.
Cetylpryidinium Helped in 6-month study: In a 6-month DB PC study of 366 adults, cetylpyridinium chloride mouthrinses containing 0.075% and 0.10% CPC had significantly (P< 0.0001) less gingivitis, gingival bleeding, and plaque, on average, than those on placebo. The 6-month mean reductions in gingivitis, gingival bleeding, and plaque for the 0.075% and 0.10% CPC rinses versus placebo were 23%, 30% and 17% for 0.075%, and 20%, 27% and 19% for 0.1%. A 6-month clinical study assessing the safety and efficacy of two cetylpyridinium chloride mouthrinses. Stookey GK, et al. Indiana University. . Am J Dent 2005 Jul;18 Spec No:24A-28A.
Cetylpryidinium did As Well As Listerine: In a 4-week randomized DB study of 78 adults, alcohol-free 0.07% cetylpyridinium chloride (Crest Pro-Health Rinse) did as well as a positive control rinse containing essential oils (EO) and 21.6% ethyl alcohol (Cool Mint Listerine) when both were combined with brushing twice daily using the Modified Gingival Index, Gingival Bleeding Index, and Modified Quigley-Hein Plaque Index. Comparative clinical trial of two antigingivitis mouthrinses. Witt JJ, et al. Procter and Gamble. . Am J Dent 2005 Jul;18 Spec No:15A-17A.
Chlorhexidine Strongest, Cetylpyridinium was Moderate and Miswak Low in Anti-bacterial Test: Eght commercially available mouthrinses (Corsodyl, Alprox, Oral-B advantage, Florosept, Sensodyne, Aquafresh Mint, Betadine and Emoform) and a 50% aqueous extract of miswak (Salvadora persica) were compared against Streptococcus faecalis, Streptococcus pyogenis, Streptococcus mutans, Candida albicans, Staphylococcus aureus and Staphylococcus epidermidis with the ditch plate method. Mouthrinses containing chlorhexidine was with maximum antibacterial activity, while cetylpyridinium chloride mouthrinses were with moderate and miswak extract was with low antibacterial activity.An in vitro antimicrobial comparison of miswak extract with commercially available non-alcohol mouthrinses. Almas K, et al. New York University. . Int J Dent Hygiene 2005 Feb;3(1):18-24. Ed: I have read that there is a problem with side-effects with chlorhexidine.
Doxycycline Helps Gingivitis and Periodontal Disease: 82 patients with a recent history of periodontal abscesses and/or loss of gingival attachment despite active periodontal therapy were given subgingival scaling every 2 months. If any site exhibited greater than or equal to 2 mm loss of GAL or a periodontal abscess, patients were given either 100 mg Doxycycline per day for 3 weeks or placebo. During 12 months of monitoring, 55 patients exhibited recurrent active disease and were then randomly assigned to either the Doxycycline or placebo groups. Within 7 months, 15 out of 19 patients on placebo exhibited recurrent disease compared to 13 out of 29 patients on Doxycycline, a relative risk reduction of 43% (p< 0.05). Randomized controlled trial of doxycycline in prevention of recurrent periodontitis in high-risk patients: antimicrobial activity and collagenase inhibition. McCullouch CA, et al. University of Toronto, Ontario, Canada. J Clin Periodontol 1990 Oct;17(9):616-22. Ed: Several other studies have found similar results, although the issue needs more study. Doxycycline without scaling is probably also useful, but has not been studied.
Halitosis Defeated by New Colgate: In a Chinese DB study comparing Colgate Total Advanced Fresh (a triclosan/copolymer/sodium-fluoride toothpaste) vs. Colgate Cavity Protection Winterfresh Gel (a just fluoride toothpaste), with each toothpaste used twice a day, researchers found Total Advanced to have 3.2 units on a 9 point scale less halitosis and in the pleasant breath range during both morning and evening tests 12 hours after the last brushing. Clinical effectiveness of a triclosan/copolymer/sodium-fluoride dentifrice in controlling oral malodor: a three-week clinical trial. Hu D, Zhang YP, Petrone M, Volpe AR, DeVizio W, Proskin HM. Compend Contin Educ Dent. 2003 Sep;24(9 Suppl):34-41; A 32-adult New Jersey study found the same result.
Crest Pro-Health Helped Those Unresponsive to Colgate: In a 12-week examiner blind study of the antigingivitis efficacy of twice daily (60 seconds) 0.454% stannous fluoride/sodium hexametaphosphate Crest Pro-Health among 41 adults who were nonresponsive or minimally responsive to 6 months of a sodium fluoride/triclosan/copolymer Colgate Total, participants had 54% less gingivitis and 55% less bleeding compared to baseline. No adverse oral soft tissue effects were reported. Antigingivitis efficacy of a stabilized stannous fluoride/sodium hexametaphosphate dentifrice in subjects previously nonresponsive to a triclosan/copolymer dentifrice. Archila L, et al. University of Texas, San Antonio. Compend Continue Ed Dent 2005 Sep;26(9 Suppl 1):12-8.
Hydrogen Peroxide Reduces Gingivitis, Whitens Teeth: In a 5 month DB PC study of 99 adults with gingivitis, the Eastman bleeding index, modified gingival index, intensity of stain, and extent of stain were significantly reduced in the test group at 5 months compared to baseline (P < 0.05). In contrast, only the Eastman bleeding index was significantly reduced in the control group (P < 0.05). The reduction in the index of gingival inflammation for the test group was significantly greater than for the control group (P = 0.004). Subjects using the test rinse were also six times more likely to exhibit an improvement in tooth color (P = 0.002). Efficacy of a fluoridated hydrogen peroxide-based mouthrinse for the treatment of gingivitis: a randomized clinical trial. Hasturk H, et al. Boston University. J Periodont 2004 Jan;75(1):57-65.
Hydrogen Peroxide Reduces Gingivitis with Braces: Comparing 2 groups of adolescents undergoing orthodontic treatment with fixed appliances, once daily use of 1.5% H2O2 mouthwash along with toothbrushing was better than toothbrushing alone in maintaining their periodontal health. The H2O2 group had significantly fewer study sites with gingival indes or bleeding tendency scores greater than 1 than the control group from the 1-month through the 18-month examinations (P < 0.01), and significantly fewer sites with plaque index greater than 1 and bleeding tendency scores of 2 or more from the 3-month through the 18-month examinations (P< 0.02 and 0.01). Effects on gingivitis of daily rinsing with 1.5% H2O2. Boyd RL. University of California, San Francisco. J Clin Periodont 1989 Oct;16(9):557-62.
Triclosan/copolymer Toothpaste Reduced Gingivitis: In a DB PC study of 118 adults for 14 weeks, the experimental toothpaste reduced gingivitis by 50% vs. the control toothpaste. The effect of a dentifrice containing triclosan and a copolymer on plaque formation and gingivitis: a 14-week clinical study. Palomo F, Wantland L, Sanchez A, DeVizio W, Carter W, Baines E. Am J Dent. 1989 Sep; 2 Spec No: 231-7; Similar results in 7 month study with an 87% reduction with 0.3% triclosan and 2% of a copolymer of methoxyethylene and maleic acid on plaque formation and gingivitis. Am J Dent. 1990 Sep; 3 Spec No: S15-26; Many similar studies.
Triclosan/Zinc Better than Triclosan/Copolymer Toothpaste: A British Unilever study found a triclosan 0.3% plus zinc 2% (Unilever) toothpaste did better than triclosan 0.3% plus copolymer (Colgate Total) toothpaste. The effect of a toothpaste containing 2% zinc citrate and 0.3% Triclosan on bacterial viability and plaque growth in vivo compared to a toothpaste containing 0.3% Triclosan and 2% copolymer. Adams SE, Theobald AJ, Jones NM, Brading MG, Cox TF, Mendez A, Chesters DM, Gillam DG, Hall C, Holt J. Int Dent J. 2003 Dec;53(6 Suppl 1):398-403. Ed: I don't think that this toothpaste is available. Colgate Total is the best available.
Amine Fluoride/Stannous Fluoride Better Against Cavities: In a DB study vs. sodium fluoride, using both mouthwash and toothpaste, the amine fluoride/stannous fluoride (Meridol), the root caries index (RCl, Katz) had decreased by the end of the experiment by 10% in the NaF group and by 47.4% in the AmF/SnF2 group. Effect of amine fluoride (AmF)/stannous fluoride (SnF2) toothpaste and mouthwashes on dental plaque accumulation, gingivitis and root-surface caries. Banoczy J, Nemes J. Proc Finn Dent Soc. 1991; 87(4): 555-9; Several other studies have similar results including benefits for plaque and gingivitis.
Lead Causes 10% of Cavities: Analysis of National Health and Nutrition Examination Survey (NHANES III) data on 24,901 children shows 10% of cavities linked to increased lead in the body even though the levels are still below current fed guideline of 10 microg/dl. (Mark Moss, U Rochester, JAMA 6/23/99). Lead mostly comes from lead based paint in older houses which is best painted over to keep sealed out of the environment and contaminated soil, a remnant of leaded gasoline exhaust. Calcium may reduce lead absorption and 800mg/d is recommended. Vitamin C was also linked to lower lead levels. Fruits, vegetables, and a supplement may help. Sci News 155:405, 6/26/99
Listerine Reduced Plaque and Gingivitis: In a 9 month DB PC study with patients continuing tooth brushing, those using Listerine showed significantly reduced plaque and gingivitis. Efficacy of Listerine antiseptic in inhibiting the development of plaque and gingivitis. Gordon JM, Lamster IB, Seiger MC. J Clin Periodontol. 1985 Sep; 12(8): 697-704; Similar results in J Clin Periodontol. 1987 May; 14(5): 285-8; Peridex did as well as Listerine in J Clin Periodontol. 1990 Sep; 17(8): 575-9
Plax Mouthrinse of Little Value: A meta-analysis of studies of a commercial mouthrinse promoted for gingivitis concludes that it is a minor value. A couple studies have found it no better than placebo. Evaluation of the effectiveness of a pre-brushing rinse in plaque removal: a meta-analysis. Angelillo IF, Nobile CG, Pavia M. J Clin Periodontol. 2002 Apr; 29(4): 301-9
Chlorhexidine Mouthwash Reduced Gingivitis: In a DB PC study of 109 Mexican children using their regular dental hygiene, those using a chlorhexidine mouthwash twice a day did better. The use of chlorhexidine in the management of gingivitis in children. de la Rosa M, Sturzenberger OP, Moore DJ. J Periodontol. 1988 Jun; 59(6): 387-9.; Similar in DB of 40 diabetic adults. J Parodontol. 1989 Sep; 8(3): 299-310; Alcohol adds no benefit. J Periodontol. 2002 Mar; 73(3): 317-21
Chlorhexidine, Fluoride Varnish, Xylitol Chewing Gum: Gen Dent 1/98;46:34. Anusavice at U Florida says these prevention strategies are underutilized. Bedtime chlorhexidine is his first strategy. A Swedish study by Peterson found a 22% decrease in caries in kids with fluoride varnish.
Plaque Removal Just as Good with Older Toothbrush: An actual random assignment study of students using a new toothbrush every month vs. using the same toothbrush for four months found no difference in plaque removal. Univ. Bologna. Plaque removal by worn toothbrush. Sforza NM, Rimondini L, di Menna F, Camorali C. J Clin Periodontol. 2000 Mar; 27(3): 212-6
Selenium: Increased Selenium May Have Helped: Finland is low in selenium in its foods. Since the 1960s, supplementation of Finnish food with selenium has doubled the intake. This report provides evidence of better teeth since then. The author gives reasons why selenium may be responsible for the dental improvement. Parko, Proc Finn Den Soc ’92.
Sea Cucumber Toothpaste Helped Chronic Gingivitis and Periodontitis: A DB PC study of Gamadent toothpaste by Univ of Malaya for 3 months found steady improvement with significant advantages in Plaque Index, Gingival Index, Papilla Bleeding Index and Probing Pocket Depth (p<.001). Efficacy of 'Gamadent' toothpaste on the healing of gingival tissues: a preliminary report. Taiyeb-Ali TB, Zainuddin SL, Swaminathan D, Yaacob H. J Oral Sci. 2003 Sep;45(3):153-9. Ed: I don't think this is on the market yet.
Stannous Fluoride Toothpaste Best for Gingivitis: In a DB study by the Indiana University, a stabilized stannous fluoride dentifrice (Crest Plus Gum Care), baking soda and peroxide (NaF) dentifrice (Mentadent), and essential oil mouthrinse (Listerine) to a conventional NaF dentifrice (Crest) for the control of plaque, gingivitis and gingival bleeding over six months were compared. The stannous fluoride clearly did best with little difference between the others. The comparative efficacy of stabilized stannous fluoride dentifrice, peroxide/baking soda dentifrice and essential oil mouthrinse for the prevention of gingivitis. Beiswanger BB, McClanahan SF, Bartizek RD, Lanzalaco AC, Bacca LA, White DJ. J Clin Dent. 1997; 8(2 Spec No): 46-53. Ed: I have been unable to find Crest Plus Gum Care for sale anywhere. It is probably no longer in production. Colgate has a much more expensive product named Gel-Kam for sale, but even it is hard to find. Colgate Total seems to be the best toothpaste readily available against gingivitis and can be used in combination with Listerine at least 30 minutes after toothbrushing. This disappearance of stannous fluoride is odd, since stannous fluoride was the first fluoride on the market and patented by Crest. The other companies came out to the other types of fluoride in order to compete. I haven't been able to find out why Crest has abandoned stannous fluoride.
Stannous Fluoride Did Better than than Triclosan/coploymer for Gingivitis: In a DB PC 6-month study, a stabilized stannous fluoride formulation (Crest Plus Gum Care-currently marketed in U.S.) comprised of 0.454% SnF2 in a stabilized silica abrasive base; and a formulation containing triclosan (Colgate Total) comprised of 0.30% triclosan. 2.0% Gantrez co-polymer and 0.243% NaF in a silica abrasive base. The control dentifrice was a conventional fluoride dentifrice comprised of 0.243% NaF in a silica abrasive base. Proctor and Gamble. A comparison of stabilized stannous fluoride dentifrice and triclosan/copolymer dentifrice for efficacy in the reduction of gingivitis and gingival bleeding: six-month clinical results. McClanahan SF, Beiswanger BB, Bartizek RD, Lanzalaco AC, Bacca L, White DJ. J Clin Dent. 1997; 8(2 Spec No): 39-45; A number of other studies also favor stannous fluoride.
Tetracycline Helped Gingivitis: A 50 week DB PC study of 14 patients with included scaling of two of four quadrants of each patient found in patients with advanced periodontal disease long-term tetracycline therapy in the absence of scaling resulted in the establishment of a subgingival microbiota almost devoid of motile bacteria and in markedly reduced signs of gingivitis, probing depth and attachment loss. In fact, the alterations observed as a result of tetracycline administration to patients with excellent self-performed plaque control were similar to those obtained by conventional scaling and root planing in the control group. Effect of long-term tetracycline therapy on human periodontal disease. Lindhe J, Liljenberg B, Adielsson B. J Clin Periodontol. 1983 Nov; 10(6): 590-601
Vitamin D: Higher Levels Linked to Lower Gingivitis: In 6700 never smokers ages 13-90 from the third National Health and Nutrition Examination Survey, when adjusted for subject- and site-specific covariates included age, sex, race-ethnicity, income, body mass index, diabetes, use of oral contraceptives and hormone replacement therapy among women, intake of vitamin C, missing teeth, full crown coverage, presence of calculus, frequency of dental visits, and dental examiner and survey phase, compared to those in the lowest 25(OH)D quintile, the highest 25(OH)D quintile were 20% less likely to bleed on gingival probing (P< 0.001). The association appeared to be linear over the entire 25(OH)D range, was consistent across racial or ethnic groups, and was similar among men and women as well as among users and nonusers of vitamin and mineral supplements. Association between serum concentrations of 25-hydroxyvitamin D and gingival inflammation. Dietrich T, et al. Boston University. . Am J Clin Nutr 2005 Sep;82(3):575-80.
Vitamin D: Lower Blood Levels Linked to Increased Periodontal Disease: Using serum 25-hydroxyvitamin D(3) [25(OH)D(3)] levels from 11,202 adults in the third National Health and Nutrition Examination Survey, adjusted for age within age groups, race or ethnicity, smoking, diabetes, poverty income ratio, body mass index, estrogen use, and gingival bleeding, 25(OH)D(3) was significantly and inversely associated with attachment loss (AL) in men and women over age 49. Compared with men in the highest 25(OH)D(3) quintile, those in the lowest quintile had a mean AL that was 0.39 mm higher; in women, the difference in AL between the lowest and highest quintiles was 0.26 mm. In younger men and women, there was no significant association between 25(OH)D(3) and AL. Association between serum concentrations of 25-hydroxyvitamin D3 and periodontal disease in the US population. Dietrich T, et al. Humboldt University of Berlin, Germany. . Am J Clin Nutr 2004 Jul;80(1):108-13.
Vitamin D: Tooth Loss and Osteoporosis Reduced by Vitamin D and Calcium Supplements: In a 3-year DB PC study of 145 men over age 64 with an additional 2 years of follow-up, participants took placebo or vitamin D plus calcium 1000 mg. Of the supplement group, 13% lost at least one tooth vs. 27% with placebo. OR = 0.4. Calcium and vitamin D supplements reduce tooth loss in the elderly. Krall EA, Wehler C, Garcia RI, Harris SS, Dawson-Hughes B. Am J Med 2001 Oct 15;111(6):452-6; Boston U
Vitamin D: Tooth Decay: Sunshine Lacking North Has More Multiple Sclerosis, Tooth Decay, Prostate and other Cancers: Mortality rates from multiple sclerosis have a well-proven north-south pattern, both within the United States and internationally. Mortality rates from prostate cancer show a similar pattern as does colon cancer, dental caries, and Parkinson's disease. Vitamin deficiencies caused by a lack of sunshine exposure may be the cause. Multiple sclerosis and prostate cancer: what do their similar geographies suggest? Schwartz GG. Neuroepidemiology. 1992;11(4-6):244-54
Wisdom Teeth: Leave Disease-Free Impacted Ones Alone: No reliable studies exist to support removal of trouble-free impacted wisdom teeth, according to a systematic review of evidence. Despite this surprising lack of data, extraction of third molars has long been considered appropriate care in most developed countries. “Watchful monitoring” of asymptomatic wisdom teeth may avoid 60% of operations. Dirk Mettes, et al. Radboud University, Nijmegen, Netherlands. Cochrane 4/29/05.
An excellent site for an in depth review of dental research is http://wellness.ucdavis.edu/wellconnected/peridontal24.html from Harvard.
Stroke & Heart Disease
Gingivitis Associated with Increased Early Mortality: A 25 year follow-up study found gingivitis as strongly associated with death as smoking and independent of smoking. In the study, 804 healthy men were followed with 160 dying in the 25 year period. For each 20% increase in alveolar bone loss on X-ray, the increased risk of death was RR 1.51. For smoking, the risk was RR 1.52. Highest quintile in gingivitis (ABL loss) vs. the lowest had a risk of RR 1.85. Garcia, Ann Periodon 7/98;3:339
Periodontitis and Gingivitis Stroke Factors for Men: 303 ischemic stroke and TIA patients compared to 300 population controls, and 168 hospital controls with non-vascular and non-inflammatory neurological diseases found that after adjustment for age, sex, number of teeth, and other factors, the risk of cerebral ischemia increased with increasing severity of periodontitis. Subjects with severe periodontitis had a 4.3-fold increased risk of cerebral ischemia than those with mild or no periodontitis. Men, but not women, were the ones affected.
Periodontitis Extremely Common in Middle Age: Of 108 patients with CAD with a mean age of 59.2 vs. a similar group of 62 people without CAD found moderate to severe periodontitis in 91% of cardiac patients vs. 66% of non-cardiac patients. E.H. Rompen, Liege, Belgium. Journal of Periodontology October 26, 2004. Ed: I don’t know which is the cause and which the effect. However, I was impressed by how common periodontitis is. Use Colgate Total toothpaste with triclosan and a generic Listerine type mouthwash.
Gum Disease May Increase Strokes: State University of New York at Buffalo are saying after finding people who suffer from severe gum disease face twice the risk of an ischemic stroke. 10,000 people -- age 25 to 75 -- who took part in the first National Health and Nutrition Examination Survey from 1972 to 1974, and its successor, which concluded in 1992. Oct. 9, Arch Intern Med
Gum Disease, Tooth Loss Stroke Factors: Harvard male Health Professionals Study 41,000+ men. 12 years of follow-up, stroke incidence was assessed and subclassified by use of medical history, medical records, and imaging reports. Hazard ratios (HRs) were adjusted for age, amount smoked, obesity, alcohol, exercise, family history of cardiovascular disease, multivitamin use, vitamin E use, profession, baseline reported hypertension, and hypercholesterolemia. <25 teeth HR 1.57 for stroke. recent tooth loss no more important. Periodontal disease more modest association HR 1.33. Periodontal disease, tooth loss, and incidence of ischemic stroke. Joshipura KJ, Hung HC, Rimm EB, Willett WC, Ascherio A. Stroke 2003 Jan;34(1):47-52
Heart Disease: Fewer Teeth, Gingivitis Much More Common in Heart Patients: A study comparing 256 NYHA class II-IV heart disease patients and 250 matched controls found many more heart disease patients without teeth (35% vs. 15%) and many fewer teeth in those who had them (8.6 vs. 17). Gingivitis was 237% more common in heart patients. Dental infections and serum inflammatory markers in patients with and without severe heart disease. Meurman JH, Janket SJ, Qvarnstrom M, Nuutinen P. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2003 Dec;96(6):695-700; However, among patients who already have heart disease, having gingivitis or periodontitis did not increase the risk of another heart attack. J Dent Res. 2002 Mar;81(3):186-91
Gingivitis, Periodontitis Not Heart Risk Factor in U.S. Study: In the 9 year follow-up of 8032 dentate adults ages 25 to 74 in the NHNESE study with no reported history of cardiovascular disease, including 1859 individuals with periodontitis, 2421 with gingivitis, and 3752 with healthy periodontal tissues, 1265 individuals developed heart disease, including 468 heart disease deaths. After adjustment for known cardiovascular risk factors, gingivitis was not associated with coronary heart disease (hazard ratio, 1.05), while periodontitis was associated with a nonsignificant increased risk (hazard ratio, 1.14). JAMA. 2000;284:1406-1410.
Gingivitis, Periodontitis Are Heart Risk Factors in Canadian Study: In a 22 year follow-up of over 11,000 Canadian adults initially without heart disease, adjusted for age, sex, diabetes status, serum total cholesterol, smoking, hypertensive status, and province, there was a statistically significant association between periodontal disease and risk of fatal coronary heart disease. Rate ratios (RR) of 2.15 and 1.90 were observed for severe gingivitis and edentulous status, respectively. Non-statistically significantly increased RRs of 1.81 and 1.63 were observed for severe gingivitis and edentulous status for cerebrovascular disease. Periodontal disease and risk of fatal coronary heart and cerebrovascular diseases. Morrison HI, Ellison LF, Taylor GW. J Cardiovasc Risk. 1999 Feb;6(1):7-11
Periodontal Disease Increases Heart Disease: J Periodontol ’98;69:841-50; Clin Infect Dis ’98;26:719; Ann Periodontol ’98;3:127
Poor Dental Hygiene and Pneumonia, Diabetes, Pregnancy Complications:
Dental Plaque Linked to Pneumonia in Elderly: Poor oral hygiene with extensive plaque promotes oral colonization by potential respiratory bacteria and increases the risk for serious lower respiratory tract infections. Fourteen of 49 patients (29 percent) who needed mechanical assistance to breathe had evidence of hospital-acquired pneumonia about 12 days after assisted respiration began. Oral hygiene was poor in patients who did and those who did not develop pneumonia. Patients with bacteria in their dental plaques were at increased risk for developing pneumonia and had a poorer functional status than their peers without bacteria. All nine microbes isolated from eight patients with pneumonia matched those recovered from their dental plaque. El-Solh et al. University of Buffalo, Chest, November 2004.
Periodontal Disease Increases Diabetes: Ann Periodont ’98;3:51; J Periodon ’97;68:713;
Periodontal Disease Increases Pregnancy Complications: Ann Periodont ’98;3:233; J Periodont ’96;67:1103
Thomas E. Radecki, M.D., J.D.