The teeth and gums are a gateway to overall good health

It seems there’s a way to lower our risk for type 2 diabetes (T2D), cardiovascular disease (CVD), coronary artery disease (CAD) and high-risk pregnancies: Practice good oral hygiene.

Researchers looked at the records of nearly 339,000 people who had periodontal (gum) disease to see if those who were treated for it went on to have better overall health than those that didn’t. They found that people who had at least one gum disease treatment went on to have lower medical costs and fewer hospitalizations for the 4 above-mentioned conditions. They conclude:

This study shows lower medical costs and hospitalizations in the time period following periodontal treatment in patients in four of the five conditions examined (T2D, CVD, CAD, and pregnancy), when compared to untreated controls. In each case, the difference is both statistically significant and substantial in magnitude (11%–74% lower in the treated group).

The interesting question is why. In general terms they think the “deep pockets” of bacteria and bacterial toxins present in gum disease will, if left untreated, be swallowed, or enter the bloodstream via ulcerated and inflamed tissues. Once there, the body will counter with an immune/inflammatory response that can become chronic and eventually lead to systemic disease.

Although the oral–systemic disease link is complex and is still being investigated, the researchers nevertheless recommend that periodontal treatment “be considered part of the preventive armamentarium for chronic disease management.”

What do pathogenic bacteria in your mouth have to do with cancers in your GI tract?

‘Regular brushing and flossing of your teeth will help prevent cancers of the GI tract,’ is not a statement fully supported by the evidence—yet—but it seems only a matter of time before we get there.

A large-scale study conducted by the New York University School of Medicine and reported in JAMA last week, found that the presence of two oral bacterial pathogens increase your risk for cancer of the pancreas by a whopping 59 percent in the case of one of the bugs (Porphyromonas gingivalis), and by “at least” 50 percent in the case of the other (Aggregatibacter actionomycetemcomitans).

Pancreatic cancer is serious business because it’s typically discovered after it’s too late to do anything about it. In the US for example, less than 10% of those diagnosed will still be alive in 5 years, hence its high death toll of about 50,000 people annually.

Significantly, this JAMA-reported research does not stand alone. It builds on a growing body of evidence that links these periodontal disease-causing pathogens to pancreatic cancer. For example, JAMA also cites:

1) A European study that found P gingivalis associated with “a 2-fold greater risk of developing pancreatic cancer.”

2) A US study of 50,000 male health professionals that found “a history of periodontitis was associated with a 64% increased risk of developing pancreatic cancer.”

Notice a couple of things here:

One, why just the pancreas? To get to it, the bad bacteria in the mouth have to travel down the throat into the stomach then behind it to where the pancreas is attached, from where it secretes digestive enzymes into the stomach. So if the pancreas is affected by the bugs, shouldn’t the path leading to it from the mouth also be vulnerable to cancer? And what about the rest of the GI tract?

In short, the entire length of the GI tract, beginning with your mouth, has a periodontitis-driven elevated risk for cancer, according to a review of worldwide studies, published by PubMed 2 ½ years ago and available online here. Specifically, the review study found that cancers of the mouth, tongue, esophagus, digestive tract, colon, and prostate, are significantly elevated in those people with periodontal disease (a chronic inflammation of the gums) which, remember, is in turn driven by those bad bugs.

Two, bacteria (and viruses) are indeed linked to cancer as a causative agent and have been for years. For example, as the review study points out, Helicobacter pylori infection is linked with gastric cancer, Chlamydia pneumonia infection with lung cancer, Streptococcus bovis infection with colon cancer, and Salmonella Typhi to gall bladder cancer.

The big question, of course, is how: how do bad bugs drive cancer? Since we haven’t quite figured that out, these association studies (A is associated with B; the more A that you have, the more B you have) use carefully crafted words of non-causation such as “linked” to, and so on.

But don’t underestimate the power of these association studies, warns oncologist Sid Mukherjee MD, in his Pulitzer-prize winning book on cancer, The Emperor of all Maladies. Wherein he reminds us that for decades we had tobacco smoke “linked” to, “associated” with, and “correlated” with, various cancers. But it wasn’t until we were able to demonstrate how cancers are caused by tobacco smoke (by damaging our genes) that science began to use the c-word — causation — to describe the relationship between the two.

In fact, the PubMed review study suggests that bacteria also drive cancer by damaging our genes. They do so directly, and indirectly — via the chronic inflammation that is periodontitis — with the result that “Microorganisms [bacteria] and their products … may … induce mutations in the tumor-suppressor genes and proto-oncogenes,” thereby giving rise to cancers.

But we’re not quite there yet. In the meantime, the JAMA report observes, “although the NYU … study results are intriguing, it’s too soon to recommend that people step up their brushing and flossing as a preventive measure.” Maybe so, but until the verdict is in we might be cautioned to take our cue from Pascal’s Wager. The 17th C French philosopher Blaise Pascal argued that it’s best to live your life as if God exists because if you’re right, the reward is tremendous — you go to heaven; but if you’re wrong, there’s really no downside. Similarly, by living your life as if good oral hygiene can avoid a multitude of GI tract  cancers, the reward is also tremendous — a healthy life; but even if you’re wrong, what’s the downside?







In Praise of Coffee

This is good for your teeth

Good news for coffee, red wine, and beer drinkers – have more!

Researchers at Boston University wanted to know if coffee consumption contributed to tooth & gum disease. To their surprise they found that not only did it not contribute to it, they found that drinking coffee reduced bone loss in teeth due to tooth and gum disease.

It was an impressive study. These top-of-the-line researchers followed 1,152 men at the U.S. Dept. of Veteran’s Affairs over a 30 year period. They were careful to control for other risk factors such as education, diabetes status, body mass index, smoking, frequency of brushing and flossing, and recent periodontal treatment or dental cleanings.

The reason for the coffee effect? Antioxidants – a complicated term but all we have to understand is that they’re a good thing. Coffee is a major dietary source of antioxidants as well as of other anti-inflammatory factors. And this is where red wine and lager beer come in – they too are loaded with antioxidants.

And so are these guys!

Another study published this year found further good effects of coffee on your teeth. Apparently black coffee will protect your teeth from decay by fighting plaque. It works by breaking up the bacteria around your teeth and by promoting the release of calcium. Coffee, it turns out, works just like an antibiotic.

And that’s important because we’re learning that antibiotics are not who we thought they were – they have huge costs associated with them. Antibiotics will knock out your good bacteria that help you fight disease; they will increase your risk of contracting clostridium difficile which causes severe diarrhea and death; and antibiotic use drives the increase in bacteria that are resistant to antibiotics in both you and the population at large.

One more thing – go easy on the sugar. The researchers who found that coffee reduced dental plaque used black, strong, and unsweetened Coffea canephora. They caution that milk, cream, (these are sugar-based products), and especially sugar itself, will have a counterproductive effect. Hmm, I get the pure sugar thing, but I thought milk built strong bones and teeth?

Well, perhaps we will just have to compensate with more red wine & beer – I mean, antioxidants.

Canada’s McGill Dental Team Shines in Mexico

There are no words to express my pride for the extraordinary work of my fellow Canadians in Yucatan Mexico. Dr. Veronique Benhamou and her team of Canadians volunteer their time and the resources to help Mayan- speaking people from a remote part of Mexico receive the dental care they need.  In a matter of ten days more than 750 treatments were performed, generating more goodwill between Canadians and Mexicans than a bevy of international trade delegates.

The experience for all involved was beyond description and will rank as one of the highlights of our careers. The simple act of kindness and sharing of one’s time and skills can only be seen as generosity of spirit and has a far greater value than just the relieving of pain and the fixing of teeth.  The work is hard work…very hard work day after day, and represents respect and personal commitment to the well-being others.

The fact that our worlds are so different and our lives are filled with so much privilege and abundance gives meaning to those receiving the care. The people of Espita Mexico were very touched by the kindness in action of Dr. Benhamou’s team and are already counting on the return of the McGill team next year.

2014 Dental Mission to Yucatan Mexico – 755 Patient Treatments

Led by the spirited Dr. Veronique Benhamou, Head of Periodontology of McGill University, the Canadian dental team completed another successful dental mission in the Yucatan. This 2014 trip was the team’s second time in Mexico providing Mayans living in remote parts of the Yucatan, with access to world class dentistry. More than 750 patients were treated during this ten day “Kindness in Action” mission. The team of 22 consisted of McGill dental students, volunteering dentists largely from the Montreal area, and volunteers from companies in the dental industry including 3 from Periowave Dental Technologies Inc.

This mission was facilitated by support from Mexicans from the Yucatan, Guadalajara and Mexico City. Captain Carlos Erosa, mayor of Espita and local businessmen including Professor Montforte, Alfonso Salazar and Gabriel Domenzain provided help with logistics, equipment as well as the provision of local facilities. The joint effort produced a great experience for all involved and most importantly, resulted in a very large number of under-privileged people in the remote area of Espita Yucatan obtaining the dental care that they urgently needed. Dr. Miguel de la Isla, Guadalajara-based President of the Mexican Periodontology Association (AMP) participated in this year’s dental mission, volunteering his time and dental supplies to assist alongside the Canadian team.

It was a real privilege to participate in this dental mission as a volunteer and as a sponsor. I was extremely proud of the professionalism as well as the technical talents of our dedicated Canadian team. Under the right leadership, extraordinary things are possible. It truly was “kindness in action” with a palpable impact on the community, reaching far beyond those that were treated.

Can Oral Infections be Life Threatening?

If we know anything about a toothache it’s that as painful as it might be (can we say ‘root canal’) at least it’s not life threatening.

At least that’s what most people think. The truth, however, is that not only are tons of people running to the ER every year for treatment for their dental infections, but these infections can also turn lethal.

A case in point is 24 year-old Cincinnati father Kyle Willis and his wisdom tooth that started hurting. When dentists told him it needed to be pulled, he decided to forgo the procedure for financial reasons. The tooth infection spread, causing his brain to swell and then he died within weeks of his toothache first appearing.

12-year-old Deamonte Driver

In Maryland, 12-year-old Deamonte Driver also died of what began as a toothache. By the time Deamonte’s aching tooth got any attention, the bacteria from the abscess had spread to his brain, doctors said. After two operations and more than six weeks of hospital care, he died. The picture of the boy included in this piece, shows the long scar across the top of his head from his brain surgery that ultimately failed in an effort to save his life.

Kyle Willis and Deamonte Driver aren’t alone. Death from tooth infection while low in numbers is nonetheless more common than we think. A study conducted by researchers in Boston found that between 2000 and 2008 a total of 66 patients died in hospitals as a result of oral infections.

One problem is that the brain is only about three inches from the tooth roots and a dental infection caused by a tooth abscess can spread to the brain through the veins in the head.

The heart and lung can also implicated in life threatening situations. Inflammation of the inside of the heart can be caused by bacteria from a tooth abscess. As bacteria attach to the inside of the heart, they grow and can damage the heart permanently. If the bacteria enter the lungs, they can cause pneumonia.

Far more common, however, are the huge numbers of people hospitalized every year because of dental infections. A study conducted by the Pew Charitable Trusts estimates that preventable dental conditions were the primary reason for 830,590 ER visits by Americans in 2009 – a 16 percent increase from 2006.

Shelly Gehshan, director of the Pew Children’s Dental Campaign, warns us about having tooth problems treated at a hospital: “The care provided in an ER … generally doesn’t solve dental problems. Most hospital ERs are not staffed with dentists, and the medical personnel who work there are not trained to treat the underlying problems of patients with untreated dental issues.”

Commenting on the large and growing number of people using the hospital (instead of their dentist) for their oral infections, Dr. Mark Wong, the chairman of oral surgery at the University of Texas Health Science Center at Houston, says “To call this an epidemic of dental infections we are seeing in major hospital environments and in our emergency rooms — it’s not an overstatement.”

The good news is that the ER visits and even the deaths are avoidable if we act in a timely manner. “It’s better to have it treated when it’s treatable than to wait until it gets out of hand and is possibly life-threatening,” says Dr. Gary R. Hartwell, the president of the American Association of Endodontists

Given that tooth decay is the single most common chronic childhood disease—5 times more common than asthma – Dr. Hartwell’s warning is especially important for all parents.

Dental Students are at Risk for Increased Exposure to MRSA: What does this mean for their Patients?

Dental student are at a much greater risk of being exposed to methicillin-resistant Staphylococcus aureus (MRSA), the potentially lethal bacteria often found in hospitals and now increasingly in the general community. Known as one of the superbugs due to its ability to resist multiple antibiotics, the mortality rate for a MRSA bloodstream infection is about 20-30%.1 The findings of a recently published study in The Journal of Hospital Infection entitled “Higher prevalence of methicillin-resistant Staphylococcus aureus among dental students lead to the inevitable conclusion that greater consideration for infection control and prevention is needed for both dental clinicians and their patients.

The study undertaken in Mexico City comparing 100 dental students (exposed to patients for 5-6 years) with 81 non-dental students found that the dental students had a significantly higher rate of carriage of MRSA. The study found that 20% of the dental students versus 6% of non-dental students were colonized with MRSA (odds ratio: 4.04; 95% confidence interval: 1.6–12.6; P = 0.0033). The conclusion of the study is that the dental students were occupationally threatened by exposure to this highly antibiotic resistant pathogen with implications that greater steps are needed to try to address this potential risk to their health. The other worrisome implication of this study is that these dental clinicians are also likely to be vectors for MRSA transmission to their patients if the proper precautions are not undertaken.

A key observation from this Mexican study underscores how widespread MRSA is in Mexico. If our data is to be trusted, North American and UK rates of MRSA colonization are significantly lower than in Mexico…. 2-3% versus the 6% found in the study’s non-dental student population. People colonized with MRSA are at a greater risk of self-infection, especially when immunocompromised as in the case of a surgery or major illness. 20-60% of patients identified as being colonized with MRSA in hospital subsequently develop an MRSA infection 2

Until recently, most antibiotics in Mexico were available over the counter and not by prescription. The ability of patients to self-prescribe (not matching the appropriate antibiotic to the prevailing infection) combined with standard non-compliance practices (taking sub-lethal doses) led to the emergence of high antibiotic resistance rates as evidenced by the finding of this study. Fortunately, there are greater controls over how antibiotics are now dispensed in Mexico which should help to lower antibiotic resistance rates in the Mexican public in the future. A reduction of the overuse and abuse of antibiotics in Mexico should, in the future, contribute to lowering the risk of MRSA colonization in the dental clinician population. In the meantime, however, the results of this study are shocking and must be taken as sign that more must be done to protect the dental clinician and their patients from this potentially deadly superbug.


Periowave: A Unique Anti-Inflammation Therapy that Yields Superior Patient Outcomes

It is widely understood that chronic periodontitis is due to the presence of subgingival Gram-negative bacterial biofilms proliferating at the junctional epithelium, in periodontal pockets deep beneath the gumline. Mechanical debridement (scaling) and root planing (SRP) is standard therapy for chronic periodontitis. While SRP is useful for the removal of the calculus, SRP unfortunately leaves the majority of the Gram-native biofilm in the periodontal pocket resulting in the need for retreatment every 3 months to control the disease. SRP alone is often inadequate for very deep pockets, for instance pockets that are 10-13 millimetres deep. Patients with deep periodontal pockets typically are referred to specialists for surgical intervention, especially when bone loss is evident. Photodisinfection is a non-antibiotic, light based therapy that offers a non-invasive alternative to surgery. Photodisinfection has been shown to instantly inactivate the Gram-negative bacteria associated with periodontal diseases, as well as the bacterial virulence factors responsible for triggering inflammation.  The key virulence factors of P. gingivalis (a primary perio-pathogen) include the cytotoxin lipopolysaccharide (“bacterial endotoxin or LPS”), proteolytic enzymes and many toxic low-molecular weight compounds such as hydrogen sulfide and ammonia.  The proteases in particular are thought to be responsible for the majority of periodontal tissue damage.  Photodisinfection destroys the LPS and other virulence factors, a significant advantage over conventional antibiotics and antiseptics. Periowave Photodisinfection, more importantly, offers a key advantage over other therapies as it was able to demonstrate direct and immediate inactivation pro-inflammatory cytokines. The Periowave Photodisinfection approach can directly inhibit LPS, reducing the risk of cytotoxic shock, and can substantially reduce protease activity, minimizing the risk of further tissue damage. Periodontal (gum) disease is a chronic disease affecting about half the adult population.  It is the leading cause of tooth loss, responsible for about two thirds of lost teeth.  Pain and cost factors result in the majority of diagnosed patients neglecting to address their gum disease. Periowave Photodisinfection technology, with its unique ability to simultaneously eliminate the underlying bacteria causing chronic gum disease as well as reduce inflammation, is an important stress free therapy benefitting both the patient and the dental clinician.  Periowave is a cost effective and pain-free approach to the treatment of gum disease, whether as a prevention therapy in early stages of the disease or as a possible alternative to surgery in later stages of the disease. Irrigate Illuminate To learn more about Periowave Photodisinfection, please visit

Periowave Photodisinfection- The Unique 3 Prong Attack on Periodontal (Gum) Disease

The most common of human infections is gum (or periodontal) disease, affecting up to 80% of the population at some point in their lives. The primary issue is that teeth are non-shedding surfaces and so bacteria, in the form of biofilms, can easily establish themselves on the surface of a tooth where tooth-brushing or other mechanical debridement is lacking.

Gum disease is caused by the presence of gram-negative bacterial biofilms growing in the periodontal pockets underneath the gum line. These gram- negative pathogens associated with gum disease are largely anaerobic, thriving in environments with little to no oxygen. Bacteria, and their associated virulence factors, cause an immune response by the body. Gram negative pathogens associated with gum disease are not “good” bugs (commensals), that is, they are not part of the body’s natural flora. One pathogen, Porphyromonas  gingivalis, according to Dr. Richard Darveau, Dean  of the University of Washington’s Dental School, has demonstrated an ability to modify the behaviour of oral commensals, turning bacteria that are normally ‘good’ bacteria into ‘bad’.  Perio-pathogens,  such as Porphyromonas  gingivalis, up-regulate the body’s production of proteolytic enzymes, cytokines and other pro-inflammatory factors in order to sustain their continued growth. The result is inflammation with widespread impact on the local as well as systemic physiology.

Gum disease has been associated with a number of serious systemic conditions including heart disease, stroke, diabetes, pre-diabetes, cancer, Alzheimer’s and pre-term births. The most notable local symptoms of the effects of these perio-pathogens  are red inflamed gums and the loss of alveolar bone supporting the teeth. Gum disease is responsible for about two thirds of tooth loss. Scaling and root planing (SRP), the historic standard of care leaves as much as 60% of the perio-pathogens behind to continue the disease process, which is why the SRP protocol requires a 3 month retreatment recall program. Photodisinfection, however, has been able to double the outcomes of SRP in clinical trials.

Effective gum disease eradication requires 3 components which only Periowave Photodisinfection provides: the instantaneous elimination of virtually all of the gram negative anaerobic perio-pathogens, the destruction of their associated virulence factors, and the inactivation of the host inflammatory factors. When removing both the biofilm and the inflammation simultaneously, the body is then able to repair itself through soft and hard tissue regeneration.  Periowave Photodisinfection has been proven to rapidly and effectively kill the micro-organisms located in periodontal biofilms and to destroy the virulence factors produced by these pathogens. Most importantly, Periowave has a unique advantage, an ability to rapidly and substantially reduce protease activity, providing a high-level suppression of pro-inflammatory cytokines needed to restore oral health.

How does Photodisinfection Work?

Photodisinfection is a topical, non-antibiotic antimicrobial therapy that destroys a broad spectrum of pathogens including fungi, bacteria and virus without damaging human tissue. Unlike antibiotics, Photodisinfection selectively kills virulence factors such as the endotoxins and exotoxins produced by pathogens, leading to a clinically observable anti-inflammatory effect. The treatment process takes only minutes, making it over 1,000 times more effective at biofilm killing than antibiotics.

Photodisinfection is a minimally invasive non-thermal therapy involving the light activation of a photosensitizer to eliminate topical infections in a highly targeted approach. Photodisinfection has been proven to be safe and effective in other applications such as for the dental, sinusitis and hospital acquired infection prevention markets. In dentistry, Photodisinfection has been proven to be highly effective for the treatment of caries, endodontics, restorative dentistry, periodontitis, peri-implantitis and halitosis. Many new applications of Photodisinfection are now under development.

The Photodisinfection Process: Instant Antimicrobial Therapy

Apply Photosensitizer to Infection Site & Illuminate with Appropriate Wavelength for Several Minutes

A photosensitizing solution is applied to the treatment site where the photosensitizer molecules preferentially bind to the targeted microbes.  The photosensitizer molecules are inactive at this stage.  A light of a specific wavelength and intensity illuminates the treatment site and a photocatalytic reaction occurs.  The wavelength is carefully chosen to maximize absorption of light energy by the photosensitizer.

This 2 step procedure results in the destruction of the targeted microbes and their virulence factors without damaging host cells.  This reaction involves the formation of short-lived, highly reactive free-radical oxygen species.  These radicals cause a physical disruption of the microbial cell membrane through oxidative reactions, resulting in immediate rupture and destruction of the cell.  This process occurs in seconds with total kills completed in minutes.

The Photodisinfection process has also been shown to eliminate a multitude of virulence factors, unlike antibiotics. When the light isremoved, the photocatalytic reaction ceases along with all antimicrobial action. Photodisinfection does not promote the development of resistance.

The Photodisinfection process is both pain-free and stress-free due to lack of side-effects or damage to human tissue.

Source: Eastman Dental Institute, UK

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