Study points to dental X-ray as tool in stroke prevention

Researchers in the UB School of Dental Medicine are the first to show, in a general population, that a standard dental X-ray taken on new patients to establish a baseline picture of dental health also can detect potentially dangerous calcium deposits in the carotid arteries.

In a review of dental X-rays, they detected calcifications in the carotid arteries ­ the large vessels on both sides of the neck that supply blood to the brain ­ in 5 percent of the dental X-rays of more than 2,700 new patients in UB's dental clinics. Such calcifications are a sign of advanced atherosclerosis, a major cause of stroke. All of the patients were told of the findings and referred to their personal physician for follow-up.

Results of the research were presented by Laurie Carter, a radiologist and associate professor of oral diagnostic sciences, Friday, March 21, at the annual meeting of the International Association of Dental Research in Orlando, Fla. The study was one of several from UB presented at the meeting. (For results of three of the other studies, see page 5).

Calcifications found in 5 percent
The UB investigation involved reviewing the screening panoramic radiographs of 2,752 new patients at the UB dental clinics. A panoramic radiograph is a wide-angle frontal X-ray taken during a patient's first visit to establish the initial condition of the teeth and surrounding bone and at periodic intervals thereafter as needed.

Calcifications in the carotid arteries were detected in 143 patients, or about 5 percent of the sample. Two thirds of this group were women, with a mean age of 65 years. Findings showed that 40 percent of patients with calcification had the finding in both carotid arteries.

While most of the patients had no stroke symptoms and only three had a history of transient ischemic attacks, or mini-strokes, many had several risk factors for atherosclerosis.

Individuals should not consider it strange that their dentist would be the first to warn them about stroke, Carter said.

"Many systemic diseases make their presence known first in the oral cavity," she added. "Dentists are really physicians of the head and neck areas; that is their training. We are responsible for everything on a panoramic dental film, not just the teeth."

To read more about this study, go to http://www.buffalo.edu/news/Latest/CarterStrokeDental_Lois.html.

Gum disease increases risk of future heart disease
Persons with gum disease are at high risk of developing heart disease in the future, particularly if they also are diabetic, UB researchers have found.

Results of the study, conducted among Native Americans from the Gila River Indian community in Mesa, Ariz., 40 percent of whom have diabetes, showed that periodontal disease was a stronger risk factor in this population than other conditions traditionally associated with heart disease risk, including hypertension, high cholesterol, age and gender.

Robert J. Genco, SUNY Distinguished Professor and chair of the Department of Oral Biology, said, "We have always suspected that periodontal disease was a true risk factor for cardiovascular disease, but our studies have been confounded by the presence of smoking.

"Smoking is rare in this community of Pima Indians, so it was not a factor," he added. "We found a powerful association between the existence of periodontal disease at the study baseline and the development of cardiovascular disease in the succeeding 10 years." Diabetes was the only factor that showed a stronger association.

New dental research being conducted at UB and other institutions is showing a strong relationship between conditions in the oral cavity and many systemic diseases. In this case, bacteria present in periodontal disease is thought to be the culprit, Genco said. He explained that oral bacteria that enter the bloodstream via small ulcers in the gum tissue cause platelets to aggregate and form clumps, or thrombi, that accumulate on damaged tissue, such as lesions in the blood vessel or a heart-valve replacement.

To read more about this study, go to http://www.buffalo.edu/news/Latest/GencoNativeAmer_Lois.html

Antibiotic puts periodontal disease in "holding pattern"
A multi-center study has shown that daily low doses of a common antibiotic can halt the progression of adult periodontal disease.

Sebastian G. Ciancio, professor and chair of the Department of Periodontology, said the 12-month clinical trial showed that 20 milligrams of the antibiotic doxycycline taken twice a day can stop bone loss, gum detachment and bleeding of the gums in adults with periodontal disease.

"We found that we can induce the disease to go into a holding pattern," said Ciancio. "The significance of this finding is that people who have no dental insurance or lose their dental insurance temporarily can keep their periodontal disease in check until they can afford treatment." The low dose of antibiotic did not induce bacterial resistance, he said.

In addition to the UB School of Dental Medicine, the trial involved researchers at Eastman Dental College, University of Oregon, West Virginia University, University of Florida, University of Missouri, UCLA, University of Michigan, University of Texas-San Antonio, University of California-San Francisco and State University of New York at Stony Brook.

To read more about this study, go to http://www.buffalo.edu/news/Latest/CiancioAntibiotic_Lois.html

Smoking implicated in new cases of gum disease
People who have healthy gums are highly likely to develop gum disease within two to five years if they smoke cigarettes, dental researchers from the University at Buffalo have found.

The study is the first to show a direct association between smoking and the development of gum detachment and loss of bone in the jaw-symptoms of periodontal disease-in healthy persons.

Sara Grossi, clinical director of the UB Periodontal Disease Research Center and director of the new study, has reported previously that smoking increases the severity of existing gum disease, that gum disease is more prevalent in smokers than non smokers, and that smoking slows the healing process after treatment, but had not yet implicated smoking in the initiation of the disease process.

"This is a definitive step in establishing smoking as a true risk factor," Grossi said. "We now can show, not only that people who have the disease have more, but that people who were free of disease now have the disease."

The study involved 181 men and 230 women who initially showed little or no evidence of gums pulling away from the teeth or deterioration of the bone in which the teeth are embedded. In those who subsequently developed periodontal disease, only a history of smoking was associated with both gum detachment and bone loss, results showed.

"Of the individuals who did not have the disease and then developed it, significantly more had a smoking history than those who didn't develop the disease," Grossi said. "Some developed disease as early as two years into the study.

To read more about this study, go to http://www.buffalo.edu/news/Latest/GrossiSmokingPerio_Lois.html