Routine oral care to treat gum disease (periodontitis) may play a role in reducing inflammation and toxins in the blood (endotoxemia) and improving cognitive function in people with liver cirrhosis. The study is published ahead of print in the American Journal of Physiology -- Gastrointestinal and Liver Physiology.
Cirrhosis, which is a growing epidemic in the U.S., is the presence of scar tissue on the liver. When severe, it can lead to liver failure. Complications of cirrhosis can include infections throughout the body and hepatic encephalopathy, a buildup of toxins in the brain caused by advanced liver disease. Symptoms of hepatic encephalopathy include confusion, mood changes and impaired cognitive function.
Previous research shows that people with cirrhosis have changes in gut and salivary microbiota -- bacteria that populate the gastrointestinal tract and mouth -- which can lead to gum disease and a higher risk of cirrhosis-related complications. In addition, studies have found that people with cirrhosis have increased levels of inflammation throughout the body, which is associated with hepatic encephalopathy.
Researchers studied two groups of volunteers that had cirrhosis and mild-to-moderate periodontitis. One group received periodontal care ("treated"), including teeth cleaning and removal of bacteria toxins from the teeth and gums. The other group was not treated for gum disease ("untreated"). The research team collected blood, saliva and stool samples before and 30 days after treatment. Each volunteer took standardized tests to measure cognitive function before and after treatment.
The treated group, especially those with hepatic encephalopathy, had increased levels of beneficial gut bacteria that could reduce inflammation, as well as lower levels of endotoxin-producing bacteria in the saliva when compared to the untreated group. The untreated group, on the other hand, demonstrated an increase in endotoxin levels in the blood over the same time period. The improvement in the treated group "could be related to a reduction in oral inflammation leading to lower systemic inflammation, or due to [less harmful bacteria] being swallowed and affecting the gut microbiota," the research team wrote.
Cognitive function also improved in the treated group, suggesting that the reduced inflammation levels in the body may minimize some of the symptoms of hepatic encephalopathy in people who are already receiving standard-of-care therapies for the condition. This finding is relevant because there are no further therapies approved by the U.S. Food and Drug Administration to alleviate cognition problems in this population, the researchers said. "The oral cavity could represent a treatment target to reduce inflammation and endotoxemia in patients with cirrhosis to improve clinical outcomes."

Story Source:
Materials provided by American Physiological Society. Note: Content may be edited for style and length.

Journal Reference:

1. Jasmohan Singh Bajaj, Payam Matin, Melanie B. White, Andrew Fagan, Janina Golob Deeb, Chathur Acharya, Swati s Dalmet, Masoumeh Sikaroodi, Patrick M Gillevet, Sinem Esra Sahingur. Periodontal Therapy Favorably Modulates the Oral-Gut-Hepatic Axis in Cirrhosis. American Journal of Physiology-Gastrointestinal and Liver Physiology, 2018; DOI: 10.1152/ajpgi.00230.2018

Information retreived from: American Physiological Society. "Gum disease treatment may improve symptoms in cirrhosis patients: Study finds routine oral care alters gut bacteria and reduces inflammation and cognitive problems." ScienceDaily. ScienceDaily, 29 August 2018. <www.sciencedaily.com/releases/2018/08/180829081323.htm>.

By Lori Roniger, DrBicuspid.com contributing writer
​​
August 20, 2018 -- How can you get adolescents to brush longer and more effectively? Using an interactive power toothbrush connected to a smartphone could improve oral health habits and reduce plaque levels in this finicky population, according to a new study.
Researchers compared plaque levels in adolescents instructed to brush as usual, with additional time in areas needing more care, using either a manual or an interactive power toothbrush that connects to a smartphone. They found that plaque levels dropped and brushing time increased with the use of an interactive power toothbrush compared with a manual toothbrush.
"An interactive power toothbrush with Bluetooth technology appears to appeal to technology-savvy adolescents, producing increases in brushing efficacy, duration, and compliance among this vulnerable population," wrote the authors, led by Dr. Christina Erbe, an orthodontist at the Johannes Gutenberg University University Medical Center in Mainz, Germany (BMC Oral Health, August 3, 2018).

Maintaining their interest
Many adolescents don't follow toothbrushing recommendations, previous studies have found. Additionally, this demographic may experience higher levels of plaque formation due to their consumption of carbohydrate-dense snacks and sugar-containing drinks, as well as the difficulty of removing plaque when undergoing fixed orthodontic treatment.
Since power toothbrushes have demonstrated better plaque removal than manual toothbrushes, the current study examined whether brushing with an interactive power toothbrush with Bluetooth connectivity to a smartphone mobile app would improve plaque removal and increase brushing duration compared with using a manual toothbrush in adolescents, who interact frequently with technology and cellphones.
The power toothbrush used in the study (Oral-B Professional Care 6000, Procter & Gamble) allows immediate feedback on brushing force and duration, and it provides reminders and guidance regarding focusing additional time and effort on areas that clinical exams have found to have excessive plaque or gingivitis.
Potential study participants underwent a screening visit that involved identifying these focus care areas and a plaque evaluation using the Turesky Modified Quigley-Hein Plaque Index (TMQHPI) (minimum mean score of 1.75 on a scale of 0 to 5). The investigators also asked participants to brush as usual using their regular toothbrush and discreetly observed and recorded brushing time.
At a baseline visit, the investigators randomly assigned 60 participants ages 13 to 17 to two groups: Half of them used the power toothbrush with an Oral-B Precision Clean brush head, and the other half used a soft manual toothbrush (Oral-B Indicator 35, Procter & Gamble). All participants also received the Blend-a-Med Classic dentrifice (Procter & Gamble). The power toothbrush group also received a charger and Samsung Galaxy S3 smartphone loaded with the Oral-B Application v2.1, OB2 phone app.
The investigators instructed participants in the manual group to brush twice daily for two minutes in their usual way and those in the power brush group to follow the manufacturer's instructions. They told them to brush in each of their focus care areas for an additional 10 seconds, which was communicated via verbal instructions in the manual group and via the Oral-B app in the power group.
Two weeks later, the participants underwent another oral exam, and the investigators asked them to brush as they had during the study. One subject in the power group did not complete the study.
The researchers reported similar baseline data between the groups. However, plaque levels in the power group dropped 34% (p < 0.001), with an adjusted mean whole mouth TMQHPI score reduction of 0.865, but it lessened just 0.044 or 1.7% (p = 0.231) in the manual group, a difference that was highly statistically significant (p < 0.0001).
Plaque in focus care areas as measured by mean TMQHPI scores dropped significantly in both groups (p ≤ 0.0001), but this difference was significantly greater in the power group compared with the manual group, according to the researchers.
Mean brushing time increased significantly in the power group but remained essentially unchanged in the manual group, and this change was significantly different between the groups (p < 0.001).

            Mean brushing times of power vs. manual brush groups
Toothbrush                                                               Baseline            After 2 weeks
Manual brush (n = 30)                                            119.2 sec                118.4 sec
Interactive power brush (n = 29)                         108.6 sec               143.5 sec

“These results demonstrate striking oral health benefits when patients are motivated by advanced oral hygiene products and technologies to brush longer and more thoroughly.”
— Dr. Christina Erbe and colleagues

Brushing a long time
A study limitation is that the brushing time at baseline of 113.9 seconds was much greater than the typical average brushing time of one minute or less, which may have been due to subjects modifying their behavior since they knew they were participating in a study, the authors wrote.
Overall, brushing time still increased by a statistically significant amount in the power brush group.
"These results demonstrate striking oral health benefits when patients are motivated by advanced oral hygiene products and technologies to brush longer and more thoroughly," the authors concluded.

Study disclosures
Procter & Gamble, which manufactures the toothbrushes used in the study, funded the research, participated in its design, and provided statistical analysis and data interpretation.
Link: https://www.drbicuspid.com/index.aspx?sec=sup&sub=hyg&pag=dis&ItemID=323488

The Holidays are upon us and we would like to wish a happy new year filled with health, happiness, and spectacular success.

Our favorite Holiday Carol 
Brush enough to glow,
In an angled-brush open way,
All the Smiles will grow,
Flossing all the way!
Ho - ho - ho!
Happy Holidays from your Belmont Family Dentistry!

​Our ​2017 Holiday Hours
We will be closed December 25 until January 2 to celebrate the holidays with our families.
Our office will be closed at 3 p.m. on December 21, 2017.
We will resume normal business hours January 3, 2018.
BELMONT FAMILY DENTISTRY

Did you know there are five distinct stages of tooth decay? And, that in the first stage of decay, you can actually take steps to reverse the progression of the disease? Indeed, it’s true. In the first stage of decay, whether you’re a child or an adult, the application of fluoride via fluoride treatments, your toothpaste and even the local water supply can stop a cavity from penetrating through the enamel and reaching its second stage. Even the saliva in your mouth and the foods you eat help to re-mineralize a tooth in jeopardy. But that’s just the first stage! What about the rest? Understanding how a cavity progresses can assist you in preventing each successive stage from occurring in your children. There’s always a lot going on in that little mouth!

Stage One: White Spots
In stage one, the tooth begins to show signs of strain from the attack of sugars and acids, and white spots will begin to materialize just below the surface of the enamel. These white spots are representative of the demineralization of the tooth and can be easy to miss because they’re likely to occur on your child’s molars. A dental exam, of course, is designed to catch such cavities! Can you see why regular visits to the dentist are recommended? As mentioned previously, at this stage, the cavity can be repaired without the need to excavate the tooth.  Call us at (617) 484-1760 to make an appointment! 

Stage Two: Enamel Decay
Stage two marks the beginning of the end for the surface enamel that is being attacked. Initially, the tooth erodes from the underside outward, so the outer enamel will still be intact for the first half of this second stage. Once the cavity breaks through the surface of the enamel, there is no turning back, and your child will need to have the cavity corrected with a filling. 

Stage Three: Dentin Decay
If a cavity in your child’s mouth were to progress beyond stage two without you knowing, you’d tend become aware of it when it started to hit stage three because it would probably start to cause some pain. At this level, the cavity begins to eat away at the second level of tooth material that lies beneath the enamel: the dentin. A filling can still be used to stop the onslaught of bacteria assaulting the tooth in order to prevent the cavity from reaching the tooth’s most critical component: the pulp.

Stage Four: Involvement of The Pulp
Once the cavity reaches the pulp, it’s going to hurt. A lot. So if you’ve unfortunately missed all the signs to this point, a screaming child or moaning teenager will certainly let you know there is a big problem. Stage four is serious, and a root canal is the only option of treatment at this stage, save for a complete extraction. Should you have a tooth that has reached this stage, we would work with our endodontist partners to help treat bring you back to good health.

Stage Five: Abscess Formation
In the fifth and final stage of a cavity, the infection has reached the tip of the root and exited the tip of the tooth’s structure. This in turn infects the surrounding tissues and possibly the bone structure. Swelling would be commonplace and pain severe. In children (as well as adults) an abscess can be fatal if not dealt with immediately. Root canal or extraction would be the order of the day should decay reach this stage. Need to see us? Give a call at (617) 484-1760! 

​As you can see, cavities don’t happen overnight. In the early stages, regular visits can stall and reverse the progression of these dastardly little devils, so it really does pay to visit the dentist at pre-selected intervals. You can keep your kids far from stage five their whole lives, and if a little bit of prodding to get them to the dentist accomplishes that, you can rest easy despite the griping.

Summer is coming to an end. Labor day is around the corner and before you know it, winter will be here! I know this is the last thing you want to hear but imagine it’s winter … you’re standing at the door, ready to brave the cold. You’re layered-up with three shirts and a sweatshirt, your heavy winter coat, and two layers of socks underneath your waterproof winter boots. Then you’ve got those awesome jeans with the flannel on the inside, your comfy hat, scarf, and gloves. You’re set! But wait. As you step toward the door, you suddenly realize you have an itch … and it’s deep down … buried beneath all those layers. And, try as you may, every attempt to reach that bugger-of-an-itch fails. Defeated, you realize the only relief you’re ever gonna’ get is to remove each one of those layers. Where are we going with this?!

The Tongue
We’re going inside your mouth, of course, to your tongue – this is a dental article, after all! Because whether you know it or not, like you in the wintertime, your tongue is also “all covered up” – buried beneath layers of bacteria, fungi, and food residue that can inhibit your ability to taste, let alone cause your tongue to appear various shades of yellow, white, or green! Remove the bacteria, though, and your food will once again directly interact with those taste buds, and return to its natural hue. So how does one do that? With a tongue scraper, of course!

WHAT is a tongue scraper?
A tongue scraper is a U-shaped device designed to “scrape” the top layer of scum from your tongue. They have been in use since ancient times, and have been made of everything from wood to whalebone. Nowadays, they are made of more hygienic material, and come in a variety of shapes, sizes, designs and colors.

WHY use a tongue scraper?
The residue on your tongue includes things like the cavity-inducing Streptococcus mutans bacterium, fungi, rotting food (that’s not good), and what’s referred to as “volatile sulfur compounds.” In other words, sulfur – that “rotting egg smell.” Talk about ew! So, as you can see, there are several reasons why you’d want to get rid of this gunk in your mouth. Let’s tackle them one by one:
• Reduce bad breath: ‘nuff said! 
• Reduce your risk of periodontal disease and cavities: Bad bacteria contribute to plaque and tartar on teeth, making them more susceptible to cavities. Bacteria build-up can also lead to inflammation of gum tissue (gingivitis). If left untreated, gingivitis can lead to periodontal disease, which means a more expensive dental visit (plus other unwanted consequences!). Speaking of avoiding an expensive dental visit, when was the last time you came in to see us? Come see us now if it’s been awhile, by calling in at (617) 484-1760.
• Make room for good bacteria: see our article here on probiotics for your mouth.
• Prevent heart disease? While the debate is still up in the air, some studies suggest there could be a correlation between gum disease and heart disease.

HOW does one use a tongue scraper?
In general, make sure to rinse your tongue scraper before and after use. Apply the tongue scraper to the back of your tongue and drag it forward. Then, rinse and repeat. Make sure to get the sides of your tongue as well, not just the center! Make sure not to press too hard or you can cause yourself to bleed. And, if you’re wondering if you should scrape your tongue while recovering from a dental procedure, that’s a good question … ask your dentist for the best advice particular to your situation. Still not sure how this thing really works? The next time you’re in ask us for a quick tutorial!

WHERE do I buy one?
Tongue scrapers are relatively inexpensive, and can also be found at any local drugstore. It doesn’t matter the material, color, or brand – just find the one you like and get scraping!