Thursday, November 29, 2012

Brighten Your Smile for the Holidays

We have decided to continue our Whitening Special for Existing and New Patients.
Call or email us for an appointment. 

Wednesday, April 4, 2012

New Swedish Study links Periodontitis to Breast Cancer

New Swedish Study links periodontitis to breast cancer

Recently, signs of past and present oral infections have been linked to an increased incidence of breast cancer
Since the early 1990’s, a number of systemic maladies have been associated with chronic periodontitis.  Initially, these reports were greeted skeptically.  Many suspected no pathophysiological relationships, and questioned if the correlations were just coincidence or were indicative of etiologically unrelated co-morbidities.  Such doubts were sensible given the possibility that data mining may have biased early reports.  Nevertheless, others were spurred to perform additional studies that uncovered additional associations, etiologic explanations and assessed the effects of periodontal interventions on systemic conditions.
Years later, it’s now thought the systemic inflammatory burden incurred by those with periodontitis, along with the seeding of oral pathogens via the circulation to other sites, represent plausible pathophysiological explanations underscoring the potential for periodontitis to aggravate or even help induce certain systemic conditions.[i]
Yet, the most definitive question for practitioners remains the same now as it was fifteen years ago, namely does periodontal therapy beneficially affect those systemic diseases to which periodontitis has been linked? Unfortunately, the effects of periodontal therapy on various systemic maladies have not been well-elucidated, partly because clinical studies are expensive.  In this context, two prospective clinical trials funded by the (U.S.) National Institutes of Health failed to uncover statistically significant improvements in birth outcomes when pregnant women treated for periodontitis were compared with untreated controls.[ii] [iii] Yet, similar controlled trials have detected benefits, including one published in early 2010.[iv] Why such discrepancies?  It’s my opinion that NIH-funded studies were underpowered because they compared the effects of only one episode of scaling and root planing with non-treated controls.  In contrast, periodontal care in the 2010 study was provided to test subjects throughout their pregnancies.  As someone who spends much of his professional life assessing the design, quality and clinical meaningfulness of published evidence, many prospective controlled studies and even some systematic reviews come up short.  On the other hand, it’s clear from the science that those with Type II diabetes are better able to control their blood glucose if they optimize their periodontal health.  Moreover, those with diabetes who better control their serum glucose improve their periodontal health, thereby confirming the central role that inflammation – acting both locally and remotely – plays in both groups of diseases.[v]
Recently signs of past and present oral infections were linked to an increased incidence of breast cancer in a Swedish study.1 Yet many questions remain yet to be answered regarding what may turn out to be a new perio-systemic link.  For now, I believe that it’s reasonable to inform patients that:
A new study has reported that breast cancer incidence may be increased in patients with chronic periodontitis.  We don’t know yet if treating periodontitis will have a beneficial effect in this context.  More studies are needed.  However, when one compares the costs of being wrong on either side of this question, getting treatment that one already needs for a host of other reasons seems to make good sense.
Readers of this blog know from other entries and the published literature that the adjunctive use of PeriowaveTM can improve periodontal parameters beyond that which is obtained without its use.  To me, PeriowaveTM seems especially useful at sites that don’t respond well to mechanical therapy alone.

[i] Rethman, M.P., 2010. Inflammation in chronic periodontitis and significant systemic diseases. Journal of the California Dental Association, 38(4), pp.247-257. [ii] Michalowicz, B.S. et al., 2006. Treatment of periodontal disease and the risk of preterm birth. The New England Journal of Medicine, 355(18), pp.1885-1894.
[iii] Offenbacher, S. et al., 2009. Effects of periodontal therapy on rate of preterm delivery: a randomized controlled trial. Obstetrics and Gynecology, 114(3), pp.551-559.
[iv] Cruz, S.S. et al., 2010. Periodontal therapy for pregnant women and cases of low birthweight: an intervention study. Pediatrics International: Official Journal of the Japan Pediatric Society, 52(1), pp.57-64.
[v] Mealey, B.L. & Rethman, M.P., 2003. Periodontal disease and diabetes mellitus. Bidirectional relationship. Dentistry Today, 22(4), pp.107-113.

Wednesday, March 28, 2012

Occlusion Seminar with Dr. R. Kerstein

On Friday March 23, 2012, Dr. Baksh attended a seminar in Toronto presented by Dr. Robert Kerstein, dealing with occlusion: how the lower teeth fit against the upper teeth.
     A more specific method of evaluating the occlusion of a patient using a computer scanning device called a T-scan was described.  Uses for this method of evaluation include preventing tooth wear as well as preventing muscle and ligament damage to the head and neck area.  The constant disturbances caused by poor occlusion can often result in muscle pain which can be confused with tooth pain. Correcting the occlusion can help to prevent the use of grinding and clenching guards while sleeping.
     Dr. Baksh was impressed with the T-scan and the information it provides.  He has had a number of patients he's had to treat with problems related to their malocclusion. He feels this technology would be very helpful in assisting him in providing alternative solutions for our patients who have experienced problems because their occlusion needs adjusting.

Oral Tongue Cancer in White Females

Dentists Beware: Oral Tongue Cancer in White Females Jumps 111%

Oral Tongue Cancer in White Females Jump 111%April is oral cancer awareness month. Of course, dentists are on the lookout for oral tongue squamous cell carcinoma 12 months a year.
In an online report published March 7 in the Journal of Clinical Oncology, the authors found an alarming trend: incidences of oral tongue cancer climbed 111% in young white females.
For the past thirty years, occurrences of oral cancer have increased in both white men and white women, ages 18 to 44, but the trend is most noticeably advancing in young white women at an alarming rate.
Lead author of the report Bhisham Chera, MD, is the assistant professor in the Department of Radiation Oncology at the University of North Carolina School of Medicine.
Dr. Chera was quoted in Medscape Medical News stating, “Lately, we have been seeing more oral tongue cancer in young white women in our clinic. So we looked at the literature, which reported an increase in oral tongue squamous cell carcinoma in young white individuals, but couldn’t find any information about gender-specific incidence rates, so we decided we should take a look at the Surveillance, Epidemiology, and End Results data.”
For the past three decades, oral cavity squamous cell carcinoma has been on the decline, while oropharyngeal squamous cell cancer has been on the rise. The authors of the report felt these changes were most likely due to the decreased use of tobacco and the association between the carcinogenic strains of HPV and cancer of the oral cavity.
Dr. Chera and the other authors reviewed the HPV status of their young white female patients with oral tongue tumors.
They did not find an association between HPV and the 111 percent rise in oral tongue cancer cases.
Due to the fact that oral tongue squamous cell carcinoma is not usually associated with HPV, the doctors are searching for the possible root cause for the stark increase in cases.
According to Medscape Medical News, the authors of the report noted that oral tongue squamous cell carcinoma in young white women “may be an emerging and distinct clinical entity, although future research is necessary before broad conclusions can be drawn.”
Dentists and primary care physicians should be more cognizant of oral tongue squamous cell carcinoma in this group of patients,” said Dr. Chera. “At this point, the incidence is very small, and widespread screening may not be cost effective.”
“I would say that if a young white person has complaints of a persistent sore on their tongue, cancer should be moved up higher on the differential, based on our study,” he added. Dentists should not only examine dental health but also examine the tongue. They are in a position to provide effective screening.”
To read the complete article, visit Medscape Medical News.
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