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
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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