Vaccine for Tooth Decay
For most of the twentieth century, the only way dentists could treat cavities was to "drill and fill." But what if cavities never formed to begin with, thanks to a vaccine painlessly squirted into the nostrils in the first few years of a child's life?
Harvard Medical School faculty members working at the Forsyth Institute in Boston, an independent research and educational organization focused on oral and craniofacial science, have discovered the basis for a vaccine that could someday end tooth decay in children. Professor of oral biology Martin Taubman, who heads Forsyth's immunology department, and associate clinical professor of oral biology and pathophysiology Daniel Smith, a senior member of the Forsyth immunology department, say their vaccine could prevent decay-causing bacteria from gaining a foothold in the mouth.
Although it has been common knowledge among dental scientists since the 1950s, most people are still startled to learn that tooth decay is merely a symptom of a chronic infectious disease called dental caries (Latin for "rot"). The germs that cause caries, a group of bacteria called the mutans streptococci, amass in significant numbers in the presence of sugar-sucrose, specifically. As mutans break down sugar, they manufacture lactic acid, which strips away tooth enamel and eventually produces cavities.
Rotting teeth are now nearly epidemic around the world, caused in part by the spread of sugary Western foods, including infant formula. In China, 75 percent of five-year-olds have tooth decay. And in the United States, dental caries affects permanent teeth in almost half of all children between the ages of five and 17, most of them poor. Lacking the money to drill and fill, poor children are more likely to see their cavities progress to excruciating tooth infections and to have decaying teeth extracted rather than undergo costly treatments like root canals or crowns.
The Forsyth team aims to pull the rug out from under the cavity-causing mutans germs by making it impossible for them to stick to teeth to begin with. Like other active vaccines, theirs works by introducing a foreign substance, called an antigen, into the body. Antigens trigger the immune system to produce antibodies, which attack the antigens and stay in the system indefinitely, providing long-term immunity.
The new caries vaccine uses an antigen called glucosyltransferase, or GTF-an enzyme that allows decay-causing bacteria to accumulate on teeth and, Taubman says, arouses a greater immune response than other previously tested antigens. By stimulating immunity to the enzyme, the vaccine makes it impossible for the decay-producing microorganisms to cling to the teeth.
Unlike many vaccines that work through the bloodstream, this one triggers immunity in saliva and mucous tissues-hence it could be squirted or swabbed into the nostrils. The researchers believe the best way to provide long-term protection against caries is to vaccinate children at about the age of one, after baby teeth have begun to emerge, but before the mutans bacteria have started to amass in destructive numbers. At this age, Taubman explains, children's immune systems are developed enough to produce the needed antibodies. (Once the bacteria have begun to build up, usually when a child is between 18 and 36 months of age, antibodies still form, but are powerless to interfere with mutans streptococci that have already established themselves on teeth; in high-sucrose conditions, these bacteria can still cause decay.) Since antibodies remain in the saliva-and can be "boosted"-they could conceivably provide lifelong immunity, although this has yet to be proven.
That is the next step: human clinical trials. Taubman and Smith have successfully tested the new vaccine on rats (which, like humans, love to gobble sweets) and also showed positive effects and safety with an orally administered form of the vaccine tested 10 years ago in a Phase I trial involving young men. The researchers are now seeking to partner with institutions that could provide the initial financial support (perhaps $400,000 to $500,000, Taubman estimates) and/or research facilities to help make enough vaccine to test in wider controlled studies.
Alternatively, we could simply give up our love affair with sugar.
By: Jane Roy Brown
Sports drinks linked to tooth damage
Sipping on sports drinks can damage your teeth because of the high levels of acid in them, dentists have warned.
Dental experts placed teeth in sports drinks and in water to compare the effects and found the citric acid in the sports drinks caused corrosion and could result in severe tooth damage if left untreated.
The results of the experiment were presented at the annual meeting of the International Association for Dental Research in Miami.
Researchers at the New York University College of Dentistry cut calves' teeth in half and immersed each half in either a sports drink or water and compared the results after 75 to 90 minutes.
"This is the first time that the citric acid in sports drinks has been linked to erosive tooth wear," said Dr Mark Wolff, Professor and Chairman of the Department of Cariology and Comprehensive Care at the college, who led the study.
The erosion on the half placed in the sports drink was clearly visible because dozens of tiny holes had appeared while there was no damage on the half which was immersed in water
Brushing teeth immediately after the drinks would compound the problem, Dr Wolff said, because the acid in the drink softens tooth enamel leaving it vulnerable to the the abrasive brushing with toothpaste.
In another study in the American Journal of Clinical Nutrition, scientists found cutting out one serving of sugared soft drink led to weight loss of just over one pound after six months and 1lb 4oz after 18 months. Cutting out other drinks did not have the same effect, the researchers said.
A spokesman for the British Soft Drinks Association said: "This study does not replicate real life as the teeth were studied outside of the mouth. A real-life study conducted by Ohio State University, which is the most comprehensive study to date, found that there is no relationship between the consumption of sports drinks and dental erosion. Anyone concerned about this issue should consult their dentist for advice on how to minimise the effects of dietary acids from all sources in the diet."
By, Rebecca Smith
Top 10 Myths About Root Canals
People seem to cringe when they hear the words root canal. I know that I used to. But reading the truth about these 10 root canal myths can help you get a better sense of what having a root canal really is all about.
1. Root Canals Hurt
According to the American Association of Endodontists, the perception of root canals being painful began decades ago when root canal treatments were painful. Today, with modern technology and better anesthetics, root canal treatments are no more painful than having a filling. Knowing what to expect while having a root canal can help ease a lot of anxiety.
2. Root Canals Require a lot of Visits to the Dentist
With today’s cutting edge technology, most root canals can be performed in one or two office visits.
3. Crowns Cause Teeth to Need Root Canals
Many people believe that having a crown on a tooth means that the tooth will eventually need a root canal. Crowns do not cause the need for root canal therapy. If a crowned tooth does require a root canal, it could be that the tooth has abscessed or that decay has gotten underneath the crown and reached the pulp of the tooth.
4. Root Canals Cause Illness
There is no evidence to support that root canals cause illness. However, there is evidence to support the fact that people who have had root canals are no more at risk for developing illness than people who have never had root canals.
5. Root Canals Involve Removing the Roots of the Tooth
When the dentist or endodontist performs a root canal treatment, he or she remove the pulp from inside of the tooth. The roots of the tooth are not removed.
6. Pregnant Women Can't Have Root Canals
Pregnant women can and do have root canals. Having a root canal does require a small x-ray, but the radiation exposure is very minimal and the x-ray is aimed at the mouth, not the abdomen area. If you are pregnant and your dentist needs to give you an x-ray, he will use a lead apron to cover your belly. The anesthetics that dentists use are also safe for pregnant women.Be sure to let your dentist know beforehand if you are pregnant.
7. Even With A Root Canal, The Tooth Will Come Out Eventually
If you have your tooth properly restored, maintain good oral hygiene and visit your dentist for regular checkups, your natural tooth could last for the rest of your life.
8. If the Tooth Doesn't Hurt, There is no Need for a Root Canal
While a throbbing toothache usually results in the need for root canal treatment, many times a tooth can require root canal treatment when there is no pain present. Dentists and endodontists are specially trained to test a tooth to see if the pulp has been infected or damaged. If this is the case, a root canal would be necessary to save the tooth.
9. Pulling the Tooth is Better than Getting a Root Canal
Keeping your natural teeth for as long as possible is very important for proper eating and chewing functions. There are several options available for missing teeth, such as dentures, partial dentures, dental implants and fixed dental bridges, however, these alternatives can be much more expensive than saving your tooth with a root canal treatment.
10. After Having a Root Canal, My Tooth is Completely Restored
After having a root canal, it is extremely important to make a follow-up appointment with your dentist to have the tooth permanently restored. After the pulp of the tooth has been removed, the tooth can become very dry and brittle. Having a permanent restoration will help protect your tooth from fracturing.
By: Tammy Davenport
When Stress Takes a Toll on Your Teeth
WITH economic pressures affecting millions of Americans, dentists may have noticed a drop in patients opting for a brighter smile, but they are seeing another phenomenon: a rise in the number of teeth grinders.
"I'm seeing a lot more people that are anxious, stressed out and very concerned about their financial futures and they're taking it out on their teeth," said Dr. Steven Butensky, a dentist with a specialty in prosthodontics (aesthetic, implant and reconstructive dentistry) in Manhattan.
One of his patients lost hundreds of thousands of dollars invested with Bernard L. Madoff. Another reported that he had lost a job with a seven-figure salary. A third, a single mother with a floral design business on Long Island, said she was working twice as hard for half as much.
"All three are grinders, directly affected by what's going on out there," Dr. Butensky said, gesturing outside his Midtown office window.
Dr. Robert Rawdin, another Manhattan dentist with a specialty in prosthodontics, said he had seen 20 to 25 percent more patients with teeth grinding symptoms in the last year. And in San Diego, Dr. Gerald McCracken said that over the last 18 months his number of cases had more than doubled. They, along with other dentists interviewed for this article, chalk it up to the economy.
"We're finding in a lot of double-income families, we have the people who have lost jobs and are worried, and then we have the spouse, who still has the job, with the added pressure and uncertainty," Dr. McCracken said. "This can cause some real grinding at night."
With or without economic hardship, 10 to 15 percent of adult Americans moderately to severely grind their teeth, according to Dr. Matthew Messina, a dentist in Cleveland and a consumer adviser for the American Dental Association.
Because it is a subconscious muscle activity, most grinders grind without realizing it, until a symptom such as a fragmented tooth or facial soreness occurs.
While many experts believe that genetics may play a role in bruxism (or teeth grinding), stress has long been known to set off clenching and grinding in some people, Dr. Messina said. "Recession breeds stress and our body responds to stressful events so in times like these, the incidence of bruxism goes up," he said, adding that over the last year or so he had heard from dentists around the country who had seen an uptick in patients with bruxism while also complaining about financial stress. In his own practice, he said he had treated twice as many cases in the last year than in the year before.
"Stress, whether it's real or perceived, causes flight-or-fight hormones to release in the body," he said. "Those released stress hormones mobilize energy, causing isometric activity, which is muscle movement, because that built-up energy has to be released in some way."
The most expensive option for rebuilding teeth damaged by grinding is with veneers, but this year, dentists say that many of their bruxism patients are requesting one of the least costly treatments: a night guard, also known as an occlusal splint. Manufacturers said sales of these devices had gone up. "Our night guard sales have increased 15 percent over the prior year," said Greg Pelissier, a manager at Glidewell Laboratories, a maker of custom restorative, reconstructive and cosmetic dental products based in Newport Beach, Calif.
vNew drugstore products have also come to market, including a disposable night guard, Grind-No-More (about $30 for 14 guards). Its makers hope it will appeal to on-again-off-again grinders.
Stan Goff, executive editor of Dental Products Report, a monthly publication, wrote in an e-mail message that all this teeth grinding "may be playing a role in the introduction of several new products designed to not only prevent bruxism, but to help fight against tooth sensitivity" and other conditions that are aggravated by grinding.
While experts believe bruxism is not a dental disorder per se, but rather originates in the central nervous system, the condition can greatly affect the teeth and the entire craniofacial structure.
"Normally, we exert about 20 to 30 pounds per square inch on our back molars when we chew," Dr. Rawdin said. "But teeth grinders, especially at night without restraint, can exert up to as much as 200 pounds per square inch on their teeth."
Some nocturnal grinders will grind up to 40 minutes of every hour of sleep. The relentless wear and tear can quickly erode enamel (10 times faster than that of nongrinders), fracture teeth, affect bite and damage the temporomandibular joint at the hinge of the jaw, and the masseter muscle, which controls the jaws. Jaw and face pain, as well as earaches and headaches, may also occur.
"I kind of thought I was going crazy," said Adrienne Lee Kornstein, 48, a patient of Dr. Butensky, whose floral design business in Jericho, N.Y., has suffered because of the economy. "A tooth broke for what seemed like no reason, and by the time I got to Dr. Butensky, I'd been to my physician, other dentists, even a dermatologist to try to get relief from migraines and facial pain I was taking painkillers for. I had no idea I was grinding or that grinding your teeth could even lead to all that."
The most common treatment for the disorder is to wear a night guard, which may not only alleviate grinding but, in some cases, train someone to stop grinding altogether.
Fitted in the dentist's office, a custom guard is usually a clear, hard plastic device that runs over the top or lower teeth from front to back and prevents the top and bottom molars from making contact. Although not cheap (the price can range from $350 to $1,000), most dentists prefer a custom guard to over-the-counter guards, which are usually made of softer material and can encourage chewing and exacerbate masseter muscle activity.
There are also smaller prefabricated splints that a dentist can customize. These are generally cheaper than the fitted full arch guards and require fewer adjustments. But some dentists argue they are not as effective as the full arch guards.
Many teeth grinders interviewed said they would not go to bed without their night guards.
"Sometimes I wake up in the middle of the night and having my guard in makes me more aware if I'm tensing my body or gripping my jaw, and I can just take a moment to relax," said Alisa Fastenberg, 50, a graphic designer in Manhattan.
Other treatments for teeth grinding include acupuncture, medical massage, hypnosis and Botox injections into the masseter muscle to relax the muscle enough to stop it from going into spasms without changing one's chewing function.
"Grinding is like body building," said Dr. Alexander Rivkin, a head and neck surgeon at Westside Aesthetics in Los Angeles, who has also seen an increase in grinding-related cases this past year. "The constant workout of the masseter muscle, the largest in the head, builds up that muscle and that can cause a lot of pain, not to mention make the face appear more square."
He added, "For, I'd say, 85 percent of the people who come to me complaining about headaches, jaw soreness and pain, Botox injections into the masseter muscle on both sides of the face is the answer."
But even something as simple as taking time before bed to de-stress has been known to help.
"Good sleep hygiene goes a long way to keeping the mind relaxed and the jaws from starting to smack together," said Dr. McCracken, who has studied the relation of sleep to teeth grinding. "We know that the stress center of the brain is directly next to the part of the brain that controls teeth grinding. We're not sure how it relates to the disorder, but it's intriguing. Lately, I even tell my patients, before they go to bed, not to watch the news."
By: CAMILLE SWEENEY