Obesity and Periodontal Disease

Obese patients at higher risk of perio disease

By Rabia Mughal, Associate Editor

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February 24, 2011 -- A recent study conducted by researchers from the University of North Carolina found that dentists are interested in helping patients with serious weight issues but are afraid of offending them and appearing judgmental.

A large number of dentists would be more willing to have such discussions if obesity were definitively linked to oral disease, the study authors noted.
Now researchers from the University of Pittsburgh have found a positive association between periodontal disease and obesity, according to data from a study to be presented next month at the International Association for Dental Research (IADR) conference in San Diego.
"The prevalence of obesity is the public health challenge of our time as it can damage quality of life, boost medical costs, and is recognized as a predisposing factor to major chronic diseases ranging from cardiovascular disease to cancer," the study authors noted.
They hypothesized that the prevalence of periodontal disease would be greater in obese individuals and used electronic health records from the University of Pittsburgh School of Dental Medicine to retrospectively identify 4,537 unique individuals (2,445 female, 2,092 male, average age 54). The patient records documented weight, height, age, sex, type 2 diabetes status, and periodontal evaluation.
Periodontal disease was classified as periodontal pocketing of 4 mm or greater. Body mass index (BMI) was calculated, and patients with a BMI of 30 or higher were classified as obese, while those with a BMI below 30 were classified as nonobese.
"Statistical analysis of the retrospective data collected established that periodontal disease is more prevalent in obese individuals," the authors noted.
Systemic condition?
Obesity might represent a systemic condition influencing onset and progression of periodontal disease through the gateway of metabolic syndrome, the proinflammatory state characterized by insulin resistance and oxidative stress, in a bidirectional relationship, the researchers added.
"Obesity is an obvious national problem and is increasingly a global problem as well, affecting societies that never before were necessarily affected by obesity," study author Pouran Famili, DMD, a professor and chair of the department of periodontics and preventive dentistry at the University of Pittsburgh School of Dental Medicine, told DrBicuspid.com. "Not much has been done about it and its relation to dental issues."
While not surprising, the findings do indicate that more research regarding the relationship between obesity and periodontal disease needs to be conducted, she added.
Positive associations are repeatedly demonstrated between prevalent periodontal disease and obesity, but establishing any physiological mechanism behind this relationship will require well-designed prospective research, Dr. Famili and her colleagues concluded.
Other studies have come to similar conclusions.
Dentists in clinical practice can expect a higher prevalence of periodontal disease among obese adults, although the evidence pointing to a direct link between obesity and periodontal disease is limited, according to a recent study in the Journal of Periodontology (December 2010, Vol. 81:12, pp. 1708-1724).
"This positive association was consistent and coherent with a biologically plausible role for obesity in the development of periodontal disease," the authors of that study concluded. "However, with few quality longitudinal studies, there is an inability to distinguish the temporal ordering of events, thus limiting the evidence that obesity is a risk factor for periodontal disease or that periodontitis might increase the risk of weight gain."
Robert Genco, DDS, PhD, a distinguished professor of oral biology and microbiology at the State University of New York at Buffalo School of Dental Medicine, has conducted similar research (Journal of Periodontology, November 2005, Vol. 76:11-s, pp. 2075-2084). He noted that while there is no new information in this new study, the findings are "confirmatory."
In addition, he said, it is possible that inflammatory cytokines produced by adipose tissue could increase the inflammatory response to periodontal bacteria.
"The dentist can better understand why obese individuals may be at greater risk for periodontal disease, let the patient know this, and encourage weight loss as part of management of periodontal disease," he concluded.

For more information about periodontal disease and its treatment www.scottsdalelanap.com or www.drjamesmiller.com/lanap.html

Is Europe Preparing to Ban Amalgam?

Is Europe looking to ban dental amalgam?

By Rob Goszkowski, Assistant Editor
At present, the EC's position is that dental amalgams and various alternative materials are considered effective and safe to use, based on a 2008 assessment by the Scientific Committees on Emerging and Newly Identified Health Risks (SCENIHR) and the Scientific Committee on Health and Environmental Risks (SCHER).
February 14, 2011 -- Fresh challenges to the use of dental amalgam in Europe may arise following the release next month of a new European Commission report that is expected to recommend a phase out of amalgam. Some countries are already moving in that direction.

But in a preliminary report published online in July, Bio Intelligence Service (BIOIS) -- the French environmental and health consulting firm tasked with producing the EC report to be released in March -- recommended phasing out mercury amalgam dental restorations throughout Europe.

“There is no project aimed at banning dental amalgams so far.”
— Julie Aurnaud, European
     Commission press officer

Even so, "There is no project aiming at banning dental amalgams at the European level so far," Julie Aurnaud, press officer for the French representation of the EC, told DrBicuspid.com in an e-mail. "The commission will take a position on dental amalgams once the results are analyzed."
Currently in the EU, Denmark and Sweden have banned dental amalgam altogether, and Germany and Norway have restricted its use. The U.K. and France have done neither, although the new EC report could change France's position on the restorative material since it is already viewed unfavorably by many there, according to a recent article in the Guardian.
"France's 40,000 dentists use it less and less for two reasons: The fuss about mercury has made them cautious, but also for reasons of appearance," Michel Goldberg, spokesman for the French Dental Association, told the Guardian.
Mercury phase down
The EC has been working to reduce mercury exposure to humans since the completion of a 2005 Extended Impact Assessment by the EC's Directorate-General Environment of the Commission Services. That report contained a 20-point plan for limiting emissions, reducing supply and demand, protecting people from exposure, developing a better understanding of the problems mercury poses, and promoting international action.
More recent reports on the matter call for greater use of amalgam separators and more research into the impact of amalgam on health. BIOIS' preliminary report does acknowledge SCENIHR/SCHER's opinion that amalgam is safe. However, BIOIS also proposes a ban as a potential action and suggests that the conclusions of the SCENIHR/SCHER report could be revised and reassessed to support such a ban. It also notes the importance of taking into account information gaps highlighted in the 2008 assessment.
In its preliminary report, BIOIS weighed the potential impact of legislation banning dental amalgam on providers and patients, including costs, the life span of alternative restoratives, and environmental concerns. Ultimately, it sees caries prevention as a key strategy going forward.
BIOIS also referenced a December 2008 EC study, Options for reducing mercury use in products and applications, and the fate of mercury already circulating in society, conducted by Consultancy within Engineering, Environmental Science and Economics (COWI). According to BIOIS, COWI concluded that there is "sound basis for concluding that dental amalgam ... should be seriously considered for further restrictions."
BIOIS also believes that changing the guidelines for the exportation of elemental mercury should be considered. The EU is the world's largest exporter of mercury, and although a ban on exportation begins on March 15, 2011, an exception for medical usage exists for amalgam. There is concern that in some countries it is purchased under the guise of medical use and diverted to small-scale mining, BIOIS noted. Extending the ban to medical usage is suggested as an option, the organization concluded.

Dr. James Miller is a Family and Cosmetic Dentist located in Scottsdale, AZ.  His website is located at www.drjamesmiller.com or www.scottsdalelanap.com