Source; The Dentist, Mark Allen Group, England. 04 February 2023

Taking care of your teeth and gums may offer benefits beyond oral health, such as improving brain health, according to preliminary research to be presented at the American Stroke Association’s International Stroke Conference 2023.

Studies have shown that gum disease, missing teeth and other signs of poor oral health, as well as poor brushing habits and lack of plaque removal, increase stroke risk. According to NICE, “Stroke is a leading cause of death and disability, causing around 38,000 deaths each year in the UK.” Previous research has also found that gum disease and other oral health concerns are linked to heart disease risk factors and other conditions like high blood pressure.

Cyprien Rivier, study author and a postdoctoral fellow in neurology at the Yale School of Medicine, said, “What hasn’t been clear is whether poor oral health affected brain health, meaning the functional status of a person’s brain, which we are now able to understand better using neuroimaging tools such as magnetic resonance imaging or MRI. Studying oral health is especially important because poor oral health happens frequently and is an easily modifiable risk factor – everyone can effectively improve their oral health with minimal time and financial investment.”

Just as healthy lifestyle choices impact the risk of heart disease and stroke, they also affect brain health, including one’s ability to remember things, think clearly and function.

Between 2014 and 2021, researchers in this study analysed the potential link between oral health and brain health among about 40,000 adults (46 per cent men, average age 57 years) without a history of stroke enrolled in the U.K. Biobank. Participants were screened for 105 genetic variants known to predispose persons to have cavities, dentures and missing teeth later in life. The relationship between the burden of these genetic risk factors for poor oral health and brain health was evaluated.

Signs of poor brain health were screened via MRI images of the participants’ brains: white matter hyperintensities, defined as accumulated damage in the brain’s white matter, which may impair memory, balance and mobility; and microstructural damage, which is the degree to which the fine architecture of the brain has changed in comparison to images for a normal brain scan of a healthy adult of similar age.

The analysis found:

People genetically prone to cavities, missing teeth or needing dentures had a higher burden of silent cerebrovascular disease, as represented by a 24 per cent increase in the amount of white matter hyperintensities visible on the MRI images.

Those with overall genetically poor oral health had increased damage to the fine architecture of the brain, as represented by a 43 per cent change in microstructural damage scores visible on the MRI scans. Microstructural damage scores are whole-brain summaries of the damage sustained by the fine architecture of each brain region.

Cyprien said, “Poor oral health may cause declines in brain health, so we need to be extra careful with our oral hygiene because it has implications far beyond the mouth. However, this study is preliminary, and more evidence needs to be gathered – ideally through clinical trials – to confirm improving oral health in the population will lead to brain health benefits.”

The analysis was limited by the fact that the UK Biobank includes only people who reside in the U.K., and they are predominantly of European ancestry (94 per cent of the U.K. Biobank participants reported their race as white vs 6 per cent reported as mixed, Black British, Asian British or other). In addition, more research among people from diverse racial and ethnic backgrounds is needed.

Joseph P. Broderick, a professor at the University of Cincinnati department of neurology and rehabilitation medicine, said, “Environmental factors such as smoking and health conditions such as diabetes are much stronger risk factors for poor oral health than any genetic marker – except for rare genetic conditions associated with poor oral health, such as defective or missing enamel.

“It is still good advice to pay attention to oral hygiene and health. However, since people with poor brain health are likely to be less attentive to good oral health compared to those with normal brain health, it is impossible to prove cause and effect. Also, genetic profiles for increased risk of oral health may overlap with genetic risk factors for other chronic health conditions like diabetes, hypertension, stroke, infections, etc., that are known to be related to brain imaging markers.“

For the main source of the article:

Michele Vano, DDS, PhD1/Giacomo Derchi, DDS, PhD, MSc2/Antonio Barone, DDS, PhD1/Ugo Covani, DMD3

Dentin hypersensitivity is a common dental clinical condition in permanent teeth and has been defined as acute pain for a short duration arising from the exposed dentin in response to thermal, evaporative, tactile, osmotic, or chemical stimuli, which cannot be  ascribed to any other form of dental defect or pathol- ogy by the presence of open dentinal tubules on an exposed dentinal surface.

Several theories have been used to explain the mechanisms of dentin hypersensitivity. The most widely accepted is the “hydrodynamic theory” proposed by Brännström in 1963.

According to this theory, open tubules of exposed dentin allow the movement of dentinal fluid within the dentinal tubules indirectly stimulating the pulp nerves. In support of this theory, individuals with dentin hypersensitivity show open dentinal tubules that are wider and more numerous than nonsensitive surfaces, which are mainly covered by a smear layer.

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FEASIBLE, TEACHABLE AND REPEATABLE

Style Italiano recipe for successful dental procedures

The Style Italiano movement emerged from a simple idea of two friends – Walter Devoto and Angelo Putignano. The recognized experts in conservative and aesthetic dentistry had observed that materials allowing for the creation of beautiful direct restorations were available, but there was a lack of appropriate concepts for their successful use.

Anyone who wanted to imitate natural teeth in a perfect way needed artistic skills, creativity, and lots of time to practice.

• Since time is a scarce resource in every dental office, the two friends decided to develop simplified techniques that enable every dentist to obtain impressive results with direct composite materials.
• Their practical suggestions are based on clear and precise ideas that help dentists face their own daily challenges in their dental office.

All concepts have three things in common:

FEASIBLE

With the materials available on the market as INGREDIENTS and the Style Italiano techniques as RECIPES, it becomes easy for dental practitioners to obtain the desired results. Every step in the procedure is described in a detailed way in order to make sure that it is copied and implemented easily.

Instead of suggesting materials of a specific manufacturer, Style Italiano offers an independent perspective and understanding of the materials’ use – based on scientific research and personal experience.

TEACHABLE

We share our knowledge and spread our ideas with passion – both as lecturers teaching around the world and as authors on our online platforms. Apart from this website, we run facebook pages for restorative dentistry and endodontics and a facebook community.

As we believe that our techniques can only be used successfully by our colleagues if they are easily comprehensible, we develop teaching content that is transparent and understood without effort. In this context, we leverage our more than 20 years of experience in teaching dentistry to create a unique learning experience.

REPEATABLE

The techniques, ideas and suggestions we develop must be useful to and replicable for any dental practitioner, independent of his or her individual skills. Based on this insight, it became clear to us that we needed the feedback of our community and – even more daring – wanted to encourage our members to share their own ideas. Hence, we started to establish platforms that allow for multidirectional communication and knowledge sharing. This experiment turned out to be extremely engaging and exciting!

Style Italiano became a team of professionals who support each other and help others improve, always showing them that “YOU can do what WE do”. News, articles and cases are published by our members every week. Non-members are invited to submit their own case for publication at the community page of this website.

For more information you can visit the official website https://www.styleitaliano.org

The history of oral hygiene products: how far have we come in 6000 years?
Stuart Fischman

The Fluoride Debate: The Pros and Cons of Fluoridation
Antoine Aoun, corresponding author Farah Darwiche, Sibelle Al Hayek, and Jacqueline Doumit.

Fluoride is the ionic form of fluorine, the thirteenth most abundant element in the earth’s crust. It is released into the environment naturally in both water and air. Its concentration in water is variable. Water is the major dietary source of fluoride. The variability in water content explains much of the variability in total fluoride intake. Other important sources of fluoride are tea, seafood that contains edible bones or shells, medicinal supplements, and fluoridated toothpastes.

Fluoride compounds are also produced by some industrial processes that use the mineral apatite, a mixture of calcium phosphate compounds. Dietary fluoride is absorbed rapidly in the stomach and small intestine.

Fluoride works to control early dental caries in several ways. Due to its anticariogenic and antimicrobial properties, the fluoride ion (F−) has been widely used in the treatment of dental caries. The antibacterial action of fluoride is due to the acidification of the bacterial cytoplasm through the formation of hydrogen ion (H+) and F− from hydrogen fluoride and the disruption of the bacterial metabolism by inhibiting vital bacterial enzymes such as proton releasing adenosine triphosphatase and enolase.

Moreover, the use of fluoride lowers the pH. Bacteria will thus use more energy to maintain a neutral pH. Therefore, they will have less energy left to grow, reproduce and generate acid and polysaccharides.

The mechanisms of fluoride oral action suggested by Ullah et al. include the following:

• reduction in de-mineralization of sound enamel by inhibiting microbial growth and metabolism,
• enhancement of the remineralization and the recovery of demineralized enamel, and the formation of the fluorapatite mineral phase that provides more resistance to demineralization and acid dissolution following acid production by bacteria,
• inhibition of enzymes such as reduction of immunoglobulin A protease synthesis; reduction in extracellular polysaccharide production which helps in decreasing bacterial adherence to dental hard tissues.

As fluoride concentrates in dental plaque, it inhibits the process by which cariogenic bacteria metabolize carbohydrates to produce acid and adhesive polysaccharides.

Dental caries is an infectious and multifactorial disease afflicting most people in industrialized and developing countries. Fluoride reduces the incidence of dental caries and slows or reverses the progression of existing lesions. Although pit and fissure sealants, meticulous oral hygiene, and appropriate dietary practices contribute to caries prevention and control, the most effective and widely used approaches include fluoride use.

Dental treatments are expensive throughout the world. The cost of dentistry has hardly been reduced, even in countries where the decline in caries began 30 years ago. Thus, extension of preventive dentistry is still indispensable for improving oral health. The absence of dental care and poor hygiene are still considered the main causes of dental decay.

Although multifactorial in origin, caries is a preventable disease, with fluoride as a preventive agent used worldwide. Several modes of fluoride use have evolved, each with its own recommended concentration, frequency of use, and dosage schedule. Concurrently, recent opposition has been growing worldwide against fluoridation, emphasizing the potential and serious risk of toxicity. Since the fluoride benefit is mainly topical, perhaps it is better to deliver fluoride directly to the tooth instead of ingesting it. Fluoride toothpaste, rinses and varnish applications have proven their effectiveness in some countries, but they are still not universally affordable.

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