Chronic sinusitis linked to head and neck cancers in elderly

Author: Anna Azvolinsky

Chronic sinusitis is associated with three rare types of head and neck cancer, including nasopharyngeal cancer, human papillomavirus (HPV)-related oropharyngeal cancer, and nasal cavity and paranasal sinus cancers, according to a new study published in JAMA Otolaryngology–Head & Neck Surgery.

Chronic sinusitis is local inflammation caused by either a virus or bacteria that lasts for longer than 12 weeks.

Either the chronic inflammation from the sinusitis, the immunodeficiency that can accompany chronic sinusitis, or both may contribute to the development of these head and neck cancers. The effect is modest, however, wrote the study authors.

“There are currently no general US guidelines for head and neck cancer screening, but given the low absolute risk, our findings do not support a need for head and neck cancer screening in individuals with chronic sinusitis,” wrote study authors Daniel C. Beachler, PhD, MHS, and Eric A. Engels, MD, MPH, of the infections and immunoepidemiology branch of the National Cancer Institute in Bethesda, Maryland.

The absolute risk of these cancer types was low. At 8 years after a chronic sinusitis diagnosis, they had a cumulative incidence of less than 0.07%.

The authors conducted a case-cohort study using the Surveillance, Epidemiology, and End Results (SEER)–Medicare database to assess this link among elderly individuals in the United States.

The authors included 483,546 Medicare beneficiaries and an additional 826,436 individuals from the database who developed cancer, including 21,716 individuals who developed head and neck cancer.

The mean age of individuals in the cohort was 72.6 years and the majority were women (57.7%). About 83% percent of the individuals in the cohort were white.

Among the 483,546 Individuals, those with chronic sinusitis were more likely to be younger, female, white, and to have other upper airway conditions compared with individuals who did not receive a chronic sinusitis diagnosis (P < .001).

Chronic sinusitis was associated with a risk of developing head and neck cancer (adjusted hazard ratio [aHR], 1.37). The risk was highest for nasopharyngeal cancer (aHR, 3.71), HPV-related oropharyngeal cancer (aHR, 1.33), and nasal cavity and paranasal sinus cancer (aHR, 5.49).

This increased risk was weakened over time, the study authors found. Most of the increased risk was limited to within a year of a chronic sinusitis diagnosis. After 1 year or more, the associations decreased (aHRs of 1.60 for nasopharyngeal cancer, 1.07 for HPV–related oropharyngeal cancer, and 2.47 for nasal cavity and paranasal sinus cancer).

Overall, the risk of any cancer type was 8% higher among individuals diagnosed with chronic sinusitis compared to those with no chronic sinusitis (aHR, 1.08).

In an editorial accompanying the study, Elisabeth H. Ference, MD, MPH, and Jeffrey D. Suh, MD, of the department of head and neck surgery at the University of California–Los Angeles, noted that the current study may underestimate the link between chronic sinusitis and cancer risk because the authors analyzed an older age cohort while most inflammatory and infection-related cancers tend to occur at a younger age. “Future studies are necessary to consider whether inflammation in patients with sinusitis contributes to tumorigenesis, especially in middle-aged adults,” concluded the editorial authors.

September, 2016|Oral Cancer News|

Smoking with a hookah is linked to serious oral problems

Author: staff

Many people who use a hookah to smoke tobacco think it is a safer way to smoke and that they are reducing their risk. Not so. A new study suggests that using a hookah is associated with serious conditions of the mouth, head, and neck.


Researchers from Rutgers University in New Jersey analyzed 20 published studies that focused on the use of a hookah or water pipe. Ten of the articles pertained to the problems in the mouth, seven to head and neck cancer, and three to problems with the larynx and middle ear.

They found that using a hookah is associated with greater amounts of inflammation, gum diseases, a dental condition called dry socket, premalignant lesions, oral cancer, and cancer of the head, neck, and esophagus. It was also associated with a greater incidence of oral infections by the organism Candida, with swelling of the vocal cords, and a lower vocal pitch.

The number of people who use a hookah or water pipe-also called an argilah or hubbly-bubbly-has risen worldwide in the past few years. To use these devices, people place tobacco into a bowl on the top of the pipe and light it. The tobacco smoke is passed through a container of water before it is inhaled. Often, the tobacco used in a hookah is heavily flavored with sweeteners such as molasses or honey and other favors.

According to the World Health Organization, a typical session of smoking using a hookah lasts up to an hour, during which a smoker inhales 100 to 200 times the amount of smoke inhaled from one cigarette. Despite this, many people believe that filtering the smoke through water somehow makes it less harmful than cigarettes.

The study appeared in the Journal of the American Dental Association. “This study sheds light on the common misconception that smoking from a water pipe is somehow safer than smoking a cigarette,” said journal editor Michael Glick, DMD in a statement. “Whether you are smoking a cigarette, an e-cigarette, a cigar, or tobacco from a water pipe, smoking is dangerous not only to your oral health but to your overall health.”

November, 2015|Oral Cancer News|

B.C. detection test being used to catch oral cancer in early stages

Author: staff

Doctor says oral cancer is among the deadlier diseases yet rarely talked about.


The Canadian Cancer Society estimates 4,400 people will be diagnosed with oral cancer this year. The deadly disease can often go undiagnosed because it is tough to screen for dormant symptoms. But now, researchers at the University of British Columbia (UBC)  are developing a new test that will be able to detect oral cancer at a much earlier stage.

Dr. Catherine Poh, an oral pathologist who also teaches dentistry at UBC, spoke with the Early Edition’s Rick Cluff about the latest developments.

What can you tell us about this new brushing test you’re working on?
We are a proposing a non-invasive approach to analyse genetic material collected from patients mouths using a simple brush. This can be done by a dentist or at a family doctor’s office.

This test would detect genetic change that happens in human genomes from the cells collected from the mouth. We have shown that it has prediction value for the risk for oral cancer development.

How does your test compare to how oral cancer is detected right now?
Right now the majority of oral cancer has been screened by dentists because many of the oral cancer [diagnosis] come with no pain or no symptoms. Through the dental regular checkups it can be detected early, otherwise patients come with a sore in their mouths that is essentially a delay in the diagnosis.

What symptoms should people look out for?
Many people know your mouth can be sore and that’s not a sign of oral cancer. I’m suggesting people look for a mouth sore that doesn’t heal within three to four weeks or there’s colour change with white or red bumps that don’t get resolved. [This warrants a] checkup from your family dentist or doctors.

Who does oral cancer affect?
Traditionally 75 per cent are smokers and drinkers, however we’re aware there are a number of rising incidents within the younger non-smoker, non-drinker group. Studies show increasing risks of tongue cancer for women aged 18 – 44.

We don’t know [the exact reason] yet. There are people talking about chronic inflammation and infection so we are looking for more details into that aspect.

If it is caught early on, what does that mean for someone’s chances of beating cancer?
Right now, 1 in 2 patients will die in five years so it’s a deadly disease. If caught early…the chance for easier treatment increases. Early detection is the key to really improve a better outcome.

We promote that patients over 80 should have a regular check up for the disease with their family doctor.

Study finds how T cells cause inflammation with oral candidiasis

Author: Donna Domino, Features Editor

Ohio dental researchers have found a method to study how T cells cause inflammation during oral candidiasis infections, according to a new study in the Journal of Visualized Experiments (February 18, 2015). The discovery could lead to new therapies or drugs that may improve the functioning of weakened immune systems.

Pushpa Pandiyan, PhD, an assistant professor at Case Western Reserve School of Dental Medicine, and colleagues worked on mice to find a new way to model how T cells, the white blood cells critical for the body’s immune system, cause inflammation.

Pandiyan’s previous work focused on isolating different types of oral T cells for study. In the latest study, the researchers injected T cells into genetically engineered immunodeficient mice to test how the cells function when fighting Candida albicans, a fungus found in about 60% of the population but controlled by a functioning immune system.

The infection becomes a particular health problem for people with the HIV/AIDS infection, cancer patients with immune systems weakened by chemotherapy, or those born with no immune defenses.

The researchers investigated how IL-17a (T helper 17, or Th17 cells, a type of T cells that secrete a cytokine) and T regulatory cells (Tregs) controlled the fungal infection and inflammation, respectively.

“Although Th17 cells are required for antifungal immunity, uncontrolled Th17 cells have been implicated with such illnesses as multiple sclerosis, lupus, psoriasis, cancers, and irritable bowel disease,” Pandiyan said in a statement.

The immunodeficient mice were infected with the fungus and injected with Th17 cells. One group of mice was also injected with Tregs.

The group of mice that received both Th17 and Tregs fared better in stopping the infection and thriving during inflammation, the researchers found. The other group of mice that did not receive Tregs lost weight and began to waste away.

The researchers also found the immune system doesn’t work well when the Th17 cells malfunction without appropriate control. “They can set into action a series of immune responses that develop into inflammation and greater health issues,” Pandiyan said.

While Pandiyan studied Th17’s role in fighting C. albicans, other researchers could use the method to study Th17 cell functions in other areas of the body, she noted.

Pandiyan believes the process could lead to identifying and testing new drugs to replace antifungal medicines that have become ineffective as the fungi develop a resistance to them.

March, 2015|Oral Cancer News|

Study links gum disease, HPV-status of head and neck cancer

Author: Sara R. Saldi

Human Papilloma Virus (HPV), once almost exclusively associated with cancer of the cervix, is now linked to head and neck cancer. Furthermore, according to a new UB study just published in the Archives of Otolaryngology—Head & Neck Surgery, a JAMA publication, gum disease is associated with increased odds of tumors being HPV-positive.

Primary investigator Mine Tezal, assistant professor of oral biology in the School of Dental Medicine, and a team of scientists from UB evaluated data from 124 patients diagnosed with primary head and neck squamous cell carcinoma (HNSCC) between 1999 and 2007.

“The aim of the study was to test the presence of periodontitis, a persistent inflammatory process and HPV-status of HNSCC,” Tezal says.

Of the 124 tumor samples Tezal and her team studied, 50 were positive for HPV-16 DNA and that subjects with HPV-positive tumors had a significantly higher severity of periodontitis when compared to subjects with HPV-negative tumors.

According to the National Cancer Institute, there has been a steady increase in the prevalence of oropharyngeal cancers in the U.S. since 1973. This is despite the significant decline in tobacco use since 1965, a year after the U.S. Surgeon General issued the landmark Report on Smoking and Health. Tezal notes that this increase has mainly been attributed to oral HPV infection.

Understanding the natural history of the oral HPV infection and targeting factors associated not only with its acquisition but also with its persistence, says Tezal, will lead to more effective strategies, not only for prevention, but also for treatment.

“While there is an effective vaccine for cervical HPV infection if given prior to the exposure of the virus (females 9-26; males 9-21), oral HPV infection can be transmitted at or any time after birth, and the target population for a vaccine to prevent oral HPV infection has not yet been defined,” says Tezal.

Tezal pointed out that though many previous studies combined periodontitis and dental decay as indicators of poor oral health, dental decay was not significantly linked to tumor-HPV status in the present study.

“The fact that only periodontitis was associated with tumor HPV status points to the potential association of [this] inflammation with tumor HPV status,” she says.

When Tezal and colleagues started their research about eight years ago they were looking at the potential association between chronic inflammation and head and neck cancers because the importance of the local oral environment for malignant tumor growth was widely accepted. However there wasn’t research evaluating the role of local oral factors in the natural history of HNSCC, Tezal says.

“The next step in this research will be intervention studies to test whether treating the sources of inflammation, like gum disease, can reduce the acquisition and/or persistence of oral HPV infection and improve the prognosis of HPV-related diseases,” she says.

Berry Nutrition

Author: Marie Spano, M.S., R.D., Contributing Editor

Nutritionally speaking, good things come in sweet—and tart—little packages. Research is discovering berries pack a nutritional punch due to their vitamin, fiber and antioxidant content.

Botanically speaking, berries are indehiscent fruits (they don’t need to be opened to release their seeds) that ripen through the ovary wall. However, any small, edible fruit with multiple seeds is typically considered a berry.

In addition to lending flavor and brilliant colors to a wide variety of dishes, all berries are packed with an array of antioxidants, nutrients and potential health benefits. Berries that are especially antioxidant-rich include fresh crowberries, bilberries, black currants, wild strawberries, blackberries, blueberries, goji berries, sea buckthorn, blueberries and cranberries. However, the antioxidant content of berries varies based on the geographical growing condition. And, while fresh berries are an excellent source of antioxidants, total phenol content drops during processing. In fact, processed berry jams and syrup contain approximately half the antioxidant capacity of fresh berries, and juices show the greatest loss of anthocyanins and tannins due to the removal of seeds and skin (Nutrition Journal, 2010; 9:3; Journal of Agricultural and Food Chemistry, Jan 13, 2012).

Botanical berries
Shiny, scarlet-colored cranberries are rich in vitamin C, loaded with antioxidants, including flavonoids, and score higher in their ORAC score than many other fruits (“Oxygen Radical Absorbance Capacity (ORAC) of Selected Foods—2007”, USDA ARS). Cranberries are perhaps best known for the role their juice plays in the prevention of urinary tract infections (UTI) in women, particularly those with recurrent UTIs (Cochrane Database Systems Review, 2008; 23:CD001321). However, cranberries may also inhibit the growth and proliferation of some types of cancer cells (Journal of Nutrition, 2007; 137:186S-193S), reduce low-density lipoprotein (LDL) oxidation and platelet aggregation, and improve vascular function (Nutrition Reviews, 2010; 68:168-177; Nutrition Reviews, 2007; 65:490-502). In addition, polyphenols isolated from cranberries appear to inhibit the formation of cariogenic bacteria and reduce both inflammation and the production of enzymes that contribute to the destruction of the extracellular matrix in periodontal disease, making them beneficial for oral health (Journal of the Canadian Dental Association, 2010; 76:a130).

Processing and storage affects the phytochemicals found in cranberries. Anthocyanins are present at much higher levels than flavonols in cranberries, but the reverse is true for cranberry juice, due, in part, to the instability of anthocyanins. Some flavonols are also degraded during processing but to a lesser extent than anthocyanins (Critical Reviews in Food Science and Nutrition, 2009; 49:741-781).

Also leading the nutritional way is the tiny blueberry. According to the U.S. Highbush Blueberry Council, Folsom, CA, blueberries are packed with vitamin C, dietary fiber, potassium and antioxidants, with a total of 6,552 ORAC units per 100 grams. Further, many studies have indicated blueberry supplementation can help mitigate age-related neurodegenerative diseases. In one study, for example, rats fed 18.6 grams of dried blueberry extract per kilogram of diet for eight weeks showed a reversal of age-related deficits in brain and behavioral function (The Journal of Neuroscience, 1999; 19:8,114-8,121). The phytochemicals in blueberries also may help protect against some cancers. A study that identified blueberry anthocyanins also determined their ability to inhibit the growth of colon, breast, oral and, especially, prostate cancer cell lines. The same study showed blueberries were effective in inducing cell death of colon-cancer cells (Journal of Agricultural and Food Chemistry, 2006; 54:9,329-9,339).

Other less commonly consumed berries show promising health benefits. Though relatively few health-related studies have been conducted using black, white and red currants, one study using mixed berries, including currants, found that consumption of two portions of berries daily (including black currant purée on alternating days) resulted in favorable changes in high-density lipoprotein (HDL) cholesterol, blood pressure and platelet functioning (American Journal of Clinical Nutrition, 2008; 87:323-331). Red and black currants are an excellent source of vitamin C, and black currants are also an excellent source of fiber and good source of manganese and potassium.

Wolfberries, otherwise known as goji berries, contain several antioxidants, notably zeaxanthin, one of the two antioxidants found in the retina of the eye. One double-blind, placebo-controlled study in healthy elderly subjects found that, compared to placebo, daily supplementation with goji berry (13.7 grams per day) for 90 days increased plasma zeaxanthin and antioxidant levels while protecting from hypopigmentation and soft drusen accumulation (yellow deposits under the retina) in the macula of the eye (Optometry & Vision Science, 2011; 88:257-262). Additional studies have found that goji berry juice improves antioxidant biomarkers in healthy humans (Nutrition Research, 2009; 29:19-25), subjective feelings of well-being, neurologic and psychologic performance and gastrointestinal functioning (Journal of Alternative and Complementary Medicine, 2008; 14:403-412).

More research needs to be done on the health benefits of gooseberries and muscadine grape berries, but they, too, have a great nutrition profile. Gooseberries are an excellent source of vitamins A and C, and a good source of potassium and fiber. Muscadine grape berries are an excellent source of manganese, a good source of fiber and contain reseveratrol (American Journal of Enology and Viticulture, 1996; 47:57-62).

Non-botanical berries
In addition to the nutrition attributes for botanical berries, non-botanical berries, including strawberries, chokeberries, blackberries and raspberries, are also loaded with nutrients and antioxidants.

Strawberries are an excellent source of vitamin C and also contain fiber, vitamins, potassium and phytonutrients. Animal research has shown that strawberries improve indices of memory and cognitive functioning (Current Opinion in Clinical & Metabolic Care, 2009; 12:91-94), while human intervention studies indicate that strawberries (in addition to chokeberries, cranberries and blueberries; fresh, as juice or freeze-dried) lead to significant improvements in LDL oxidation, lipid peroxidation, dyslipidemia and glucose metabolism (Nutrition Reviews, 2010;6 8:168-177).

Chokeberries (Aronia melanocarpa) contain a mix of many antioxidants, including procyanidins, anthocyanins and phenolic acids. A review of studies to date on chokeberries indicate they may be a promising functional food for diseases related to oxidative stress, but more rigorous scientific research is necessary (Phytotherapy Research, 2010; 24:1,107-1,114).

Blackberries are an excellent source of vitamin C and fiber. Studies show anthocyanin-rich fractions of blackberry extracts reduce UV-induced free radical damage to skin cells (Phytotherapy Research, 2012; 26:106-112), and freeze-dried blackberries reduce esophagus and colon cancer development in rodents (Nutrition and Cancer, 2006; 54:69-78).

Raspberries are an excellent source of vitamin C, manganese and dietary fiber, and a good source of vitamin K. However, much of the interest in raspberries stems from their anthocyanin and ellagic acid content. In vitro studies show ellagic acid is protective against cancer (Journal of Nutrition and Biochemistry, 2004; 15:672-678). And this antioxidant, as well as the overall antioxidant capacity of raspberries, is similar in fresh commercial, freshly picked and frozen raspberries (Journal of Agricultural and Food Chemistry, 2002; 50:5,197-5,201).

All berries are full of antioxidants and nutrients. And, the various colors, textures and different forms of berries, including frozen, fresh, dried and pulp, make berries a versatile, nutritious, eye-appealing and tasty addition to a variety of foods and beverages.

About the author:
Marie Spano, M.S., R.D., CSCS, is a nutrition communications expert whose work has appeared in popular press magazines, e-zines and nutrition-industry trade publications. She has been an expert guest on NBC, ABC and CBS affiliates on the East Coast.

February, 2012|Oral Cancer News|

Emerging indications: antioxidants for periodontal disease

Author: Edward P. Allen, DDS, PhD

Since approximately 10 to 15 percent of adults worldwide suffer from periodontitis at one time or another(1), oral health professionals are constantly challenged with treating patients for existing conditions and helping them prevent future occurrences. Root planing, scaling, and in severe cases, surgical intervention are part of the standard treatment for periodontitis, and antibiotics are used for infection control.

However, in recent years, dental health professionals have honed in on the inflammation that accompanies periodontitis. Research shows that inflammation in the oral tissues—especially that associated with periodontitis—can be a factor in chronic illness such as heart and vascular disease, diabetes, arthritis, Alzheimer’s, pregnancy complications, and a growing list of other conditions.

The real culprit with inflammation is oxidative stress, a disturbance in the balance of oxidants and antioxidants. Oxidative stress is the result of overproduction of free radicals, unstable molecules that attack tissue cells by “stealing” electrons from other molecules.

Although infection is a major trigger for inflammation and oxidative stress, there are numerous other causes, such as poor diet, alcohol consumption and nicotine use or chemical pollutants. In oral tissues oxidative stress can result from dental procedures and from materials used for bleaching, composite fillings, implants, crowns, veneers, and so on.

Antibiotics control the micro-organisms that contribute to periodontitis and other infection, but they do not necessarily address the free radicals and oxidative stress that accompany inflammation.

Innate defense through natural salivary antibiotics and antioxidants
The human body has an innate defense system that combats oral inflammation: saliva. Saliva contains natural antibacterial compounds that defend against bacteria and other micro-organisms. Saliva also contains natural antioxidants that have been shown to neutralize free radicals contributing to oxidative stress and inflammation.

Several recent scientific articles have explored salivary antioxidants and their role in oral health, including periodontal disease, OLP, and even cancer.(2,3,4,5) There is a growing consensus that administration of local therapeutic agents (i.e., antioxidants) to the oral cavity should be considered.(6)

Topical antioxidants for inflammation control
Many dental health professionals have begun to augment the natural salivary antioxidants with topical application of antioxidants. A suite of products, AO ProVantage, from Dallas-based PerioSciences, LLC (, contain antioxidants, including phloretin and ferulic acid, that are applied directly to the gums. The products are distributed through professional dental offices and are best used as part of a comprehensive oral hygiene program.

In the early 1990s, compounds of phloretin and ferulic acid were clinically proven to counteract free radicals that caused damage in skin cells. More recently, scientists at Texas A&M University Baylor College of Dentistry have shown that specific concentrations and combinations of phloretin and ferulic acid are highly effective at neutralizing free radicals in oral cells that are caused by nicotine, alcohol, and hydrogen peroxide—some of the most common toxins introduced to the oral cavity. Additional studies indicate that combinations of phloretin and ferulic acid may actually promote cell proliferation and healing in oral cells.(7)

Treating periodontal disease will continue to depend on antibiotics for micro-organisms. And now, augmenting natural salivary antioxidants with topical antioxidants on oral tissues shows promise in reducing free radicals, oxidative stress and oral inflammation. In the fight against periodontitis and other oral inflammation, topical antioxidants are taking their place next to antibiotics.

1. Brown, L.J., and Loe, H. Prevalence, extent, severity and progression of periodontal disease. Periodontology 2000; 2, 57-71.

2. Sculley DV, et al. Salivary antioxidants and periodontal disease status, Proceedings of the Nutrition Society 2002; 6:137-143.

3. Battino M, et al. The antioxidant capacity of saliva. Journal of Clinical Periodontology 2002; 29:189-194.

4. Miricescu D, et al. The antioxidant potential of saliva: Clinical significance in oral diseases. Therapeutics, Pharmacology and Clinical Toxicology 2011; 15 2:1-5.

5. Gupta A, et al. Lipid peroxidation and antioxidant status in head and neck squamous cell carcinoma patients. Oxidative Medicine and Cellular Longevity, April-June 2009.

6. Hershkovich O, et al. Age-related changes in salivary antioxidant profile: Possible implications for oral cancer. The Journals of Gerontology 2007; 62A 4:361-366.

7. San Miguel SM, et al. Bioactive antioxidant mixtures promote proliferation and migration on human oral fibroblasts. Archives of Oral Biology 2011; doi:10.1015/jarchoralbil.2011.01.001.

January, 2012|Oral Cancer News|

If teeth could talk…

Author: Melinda Beck

The eyes may be the window to the soul, but the mouth provides an even better view of the body as a whole.

Some of the earliest signs of diabetes, cancer, pregnancy, immune disorders, hormone imbalances and drug issues show up in the gums, teeth and tongue — sometimes long before a patient knows anything is wrong.

There is also growing evidence that oral health problems, particularly gum disease, can harm a patient’s general health as well, raising the risk of diabetes, heart disease, stroke, pneumonia and pregnancy complications.

“We have lots of data showing a direct correlation between inflammation in the mouth and inflammation in the body,” said Anthony Iacopino, director of the International Centre for Oral-Systemic Health, which opened at the University of Manitoba Faculty of Dentistry in Canada in 2008.

Recent studies also show that treating gum disease improves circulation, reduces inflammation and can even reduce the need for insulin in people with diabetes.

Such findings are fueling a push for dentists to play a greater role in patients’ overall health. Some 20 million Americans — including six percent of children and nine percent of adults — saw a dentist but not a doctor in 2008, according to a study in the American Journal of Public Health this month.

“It’s an opportunity to tell a patient, ‘You know, I’m concerned. I think you really need to see a primary care provider,’ so you are moving in the direction of better health,” said the study’s lead researcher Shiela Strauss, co-director of statistics and data management for New York University’s Colleges of Nursing and Dentistry.

George Kivowitz, a restorative dentist with offices in Manhattan and Newtown, Pa., said he has spotted seven cases of cancer in 32 years of practice, as well as cases of bulimia, due to the telltale erosion of enamel on the back of the upper front teeth — as well as methamphetamine addiction. “We call it ‘meth mouth,'” he said. “The outer surface of teeth just rot in a way that’s like nothing else.”

Some of the most distinctive problems come from uncontrolled diabetes, Dr. Kivowitz adds. “The gum tissue has a glistening, shiny look where it meets the teeth. It bleeds easily and pulls away from the bone—and it’s all throughout the mouth.”

An estimated six million Americans have diabetes but don’t know it—and several studies suggest that dentists could help alert them. A 2009 study from New York University found that 93% of people who have periodontal disease are at risk for diabetes, according to the criteria established by American Diabetes Association.

It’s not just that the same lifestyle habits contribute to both gum disease and high blood sugar; the two conditions exacerbate each other, experts say. Inflammation from infected gums makes it more difficult for people with diabetes to control their blood-sugar level, and high blood sugar accelerates tooth decay and gum disease, creating more inflammation.

Diabetes also complicates dental-implant surgery, because it interferes with blood vessel formation and bone growth. “When you put a dental implant in, you rely on the healing process to cement it to the jaw, so you get a higher failure rate with diabetes,” says Ed Marcus, a periodontist in Yardley, Pa., who teaches at the University of Pennsylvania and Temple University dental schools.

Dr. Marcus notes that about 50% of periodontal disease is genetic—and even young patients can have significant bone loss if they have an unusually high immune response to a small number of bacteria. Giving such patients a low dose of doxycycline daily can help modify the immune response. “It doesn’t really control the bacteria, but it helps reduce the body’s reaction,” he says.

There’s also growing evidence that the link between periodontal disease and cardiovascular problems isn’t a coincidence either. Inflammation in the gums raises C-reactive protein, thought to be a culprit in heart disease.

“They’ve found oral bacteria in the plaques that block arteries. It’s moved from a casual relationship to a risk factor,” says Mark Wolff, chairman of the Department of Cariology and Comprehensive Care at NYU College of Dentistry.

Bacteria from the mouth can travel through the bloodstream and cause problems elsewhere, which is why people contemplating elective surgery are advised to have any needed dental work performed first.

The American Heart Association no longer recommends that people with mitral valve prolapse (in which heart values close abnormally between beats) routinely take antibiotics before dental procedures, since it’s now believed that oral bacteria enter the bloodstream all the time, from routine washing, brushing and chewing food.

But the American Heart Association, the American Medical Association and the American Orthopedic Association all urge people who have had a full joint replacement to take an antibiotic one hour before any dental visit for the rest of their lives to reduce the risk of post-surgical infections. “I have my guidelines taped to the door in my hygienists’ room,” Dr. Kivowitz says.

Dentists say they also need to stay up to date with all medications, supplements and over-the-counter drugs their patients are taking. Blood thinners can create excess bleeding in the mouth. Bisphosphonates, often prescribed for osteoporosis, can severely weaken jaw bones. Both should be stopped temporarily before oral surgery.

Antihypertensive drugs, calcium-channel blockers and some anti-inflammatory drugs can cause painful ulcerations of the gums. Many medications, from antidepressants to chemotherapy drugs, cause dry mouth, which can cause cavities to skyrocket, since saliva typically acts as a protective coating for teeth. Additional fluoride treatments can help.

Some proactive dentists have glucose monitors for another check on blood-sugar levels if they suspect diabetes. Some also take patients’ blood pressure and hold off on invasive procedures if it’s extremely high.

The Centers for Disease Control and Prevention recommends that dentists offer HIV testing, because some of the first symptoms appear in the mouth, including fungal infections and lesions. Dentists can do the HIV test with a simple mouth swab and get results in 20 minutes.

Breaking the bad news is often more difficult. “I went into oral surgery because I didn’t think I would have to deliver that kind of news to patients,” says Clifford Salm, an oral and maxillofacial surgeon in Manhattan who has found leukemia, lymphoma, AIDS and metastatic breast cancer after performing biopsies on suspicious spots. “It can be a difficult conversation,” he says, “but most patients are very grateful.”

Don’t Be Fooled by White, Shiny Teeth
A gleaming, white smile is a sign of a healthy mouth, right? Not necessarily.

“Whiteness and the health of your teeth are totally unrelated,” says Mark Wolff, an associate dean at New York University College of Dentistry.

In fact, many dentists worry that people who whiten their teeth may have a false sense of complacency, since their teeth can still be harboring tooth decay and serious gum disease.

Even people who have no cavities can still have inflamed and infected gums. It could be that their saliva is particularly protective of their tooth enamel, while their brushing and flossing habits, needed to keep gum tissues healthy, could be lax.

“I get these patients in their mid-30s who don’t have cavities, so they haven’t been to a dentist in 10 years. But they have full-blown periodontal disease,” says George Kivowitz, a restorative dentist in Manhattan. “They are losing all the supporting structure, and I have to tell them that these gorgeous teeth will fall out of your head if we don’t turn this around.”

Using whitening products more often than recommended can erode some of the enamel and cause teeth to appear translucent. But whether that actually harms teeth is controversial. “No one has really shown that it’s damaging, but no one knows the long-term results,” says Dr. Marcus, the periodontist in Yardley, Pa.

January, 2012|Oral Cancer News|

CU Med School prof seeing red over wine benefit study

Author: Sara Castellanos

There’s a reason Robert Sclafani always chooses red wine over white wine, and it’s not just because he thinks it tastes better.

Sclafani, a professor of biochemistry and molecular genetics at the University of Colorado’s School of Medicine, prefers the darker of the two wines because of its health benefits.

Red wine contains much more of a compound called resveratrol, found in the skin of grapes and also in peanuts and leeks.

Sclafani and his colleagues are currently testing the effects of resveratrol on mice, and this month he received encouraging news from overseas that resveratrol can have health benefits for obese humans.

“There are a number of studies in animals where you can take an animal like a mouse and give it cancer by treating it with carcinogens or manipulating the genes in mice so they’ll get cancer,” Sclafani said. “If you treat the animal with resveratrol, it blunts the effect; they either get less cancers, cancers never develop or they never go anywhere.”

Here’s how it works: resveratrol causes damage to the DNA in cancer cells, he said.

“We think that’s the Achilles heel,” he said.

The compound has been known to have positive effects for more than a decade, but on Nov. 2, a group of scientists in the Netherlands showed for the first time that it can have health benefits in obese humans.

Eleven obese but healthy men had taken a relatively low dose of the compound daily for a month, which lowered their metabolic rate, cut the accumulation of fat in the liver, reduced blood sugar, blood pressure, triglycerides and inflammation, and boosted the efficiency of muscles, according to the Washington Post.

That news solidified Sclafani’s research on resveratrol.

“We’ve shown in our studies that moderate amounts of resveratrol, much lower than they’re using in these individuals, can have anti-cancer effects in mice and cell-culture studies,” he said.

The researchers in the Netherlands did say, however, that a person would have to drink at least 2 gallons of red wine a day to get the equivalent amount of resveratrol as the dosage used in the study, according to the Post.

But their research and Sclafani’s could help explain the “French paradox.”

Sclafani said French people eat fatty diets (foie gras, steak and fries) and drink a lot of red wine but have much less cancer and heart disease than one would expect.

“It’s still not understood, but that’s always been the idea, that there must be something in red wine that allows them to have this unhealthy diet and still have reduced disease,” he said.

Sclafani and, Rajesh Agarwal, a professor in the Department of Pharmaceutical Studies at the School of Medicine, also found recently that resveratrol is successful in preventing a specific type of cancer in mice.

“As recently as last month, we are in the position that we can have more convincing data in the mice showing that … resveratrol is extremely effective in preventing the appearance of oral cancer,” he said.

In a couple of years, they hope to test the effects of resveratrol in humans with oral cancer, which is a common affliction among people in countries like India. Agarwal said high quantities of concentrated resveratrol could be given to patients with oral cancer in the form of a mouth wash or a gel.

And the best part, he said, is there are no known side effects to resveratrol.

But just because the compound is found in red wine doesn’t mean that Agarwal encourages people to drink as much as they want, as often as they want, in hopes of living a cancer-free life.

“Anything in excess is not good,” he said. “People will say, ‘OK, so resveratrol is good, and it’s in the red wine’ so they’ll start drinking more red wine. But before they die of cancer, they’ll die of liver failure. It’s kind of a fine balance, and that needs to be taken into account.”

But consuming moderate amounts of foods that contain resveratrol certainly can’t hurt, he said.

“As my good friend Bob Sclafani says, he eats a lot of Thai food and drinks red wine so he can be healthier for a longer time,” Agarwal said.

November, 2011|Oral Cancer News|

Scientific website features research on inflammation, oral and systemic disease, and antioxidants

Author: staff

Inflammation, oral disease and systemic disease. The popular press—newspapers, magazines, TV, and the Internet— as well as professional medical and dental publications are tracking the subject and the number of articles is increasing with each passing day. To keep up with the proliferation of research studies and publications, a new website, provides background information and current research.

In response to the heightened interest in the high-potential topic, the American Academy for Oral Systemic Health (AAOSH) was recently organized. Declaring 2011 as “The Year of the Mouth,” the AAOSH writes on its website, “In recent years the studies have been piling up connecting poor oral health to the deadliest of diseases including heart disease, stroke, cancer and diabetes. Oral health problems have also been shown to have close connections to many other serious health concerns like Alzheimer’s, arthritis, pneumonia and pregnancy complications.”

The role of antioxidants
A primary focus of is the role of antioxidants in controlling inflammation and oral disease. The sections within the website include: The Oral/Systemic Link, Oxidative Stress and Oral Health, Free Radicals in the Oral Cavity, and Antioxidants and Oral Health. Specific areas of interest on the site include the relationships between oral and systemic health, between infection and chronic inflammatory disease, and between cardiovascular disease and inflammation, as well as the specific connection between periodontal disease and cardiovascular disease. The site will also feature research in biochemistry regarding the sources and uses of antioxidants, their reactivity with other organic compounds, and their effects on organic systems including oral cells.

Distinguished advisory board
The principal supervisor for the website is Kathy Svoboda, PhD, Regents Professor, Department of Biomedical Sciences at Texas A&M Health Science Center, Baylor College of Dentistry. “Our ongoing objective,” says Dr. Svoboda, “is to ensure that we identify and evaluate as much of the emerging research as possible and make it available on this site.” She notes that other scientists and scholars at Baylor College of Dentistry are involved in the massive project of reviewing all the possibly relevant research.

Some of the nation’s most prominent practitioners in dentistry and medicine have agreed to serve on the advisory board. These thought leaders will act as advisors and be involved in writing and in article review. “We are grateful to have such an esteemed group of scientists and practitioners serving on the advisory board,” says Dr. Svoboda. “Their willingness to serve underscores the importance of antioxidant research.”

Presently, the advisory board includes:
Edward Allen, DDS, PhD, Adjunct Professor in the Department of Periodontics at Baylor College of Dentistry and is in full-time private practice in Dallas. Dr. Allen has served as President of the American Academy of Esthetic Dentistry, the American Academy of Restorative Dentistry and the American Academy of Periodontology Foundation.

Bruce Bowers, MD, FACC, an interventional cardiologist. He is Co-Director, Vascular Clinical Research Division and Principal Investigator, Peripheral Vascular Clinical Trials at The Heart Hospital/Baylor Regional Medical Center. In addition, he is a Co-Investigator for the PARTNER trial (Transcatheter Aortic Valve Replacement) at Medical City Dallas Hospital.

Karen Davis, RDH, BSDH, founder of Cutting Edge Concepts®, an international continuing education company. She has served on numerous advisory boards in the profession and has been recognized as one of the “Leaders in Continuing Education” in Dentistry Today for several years.

Casey Hein, BSDH, MBA, Assistant Clinical Professor in the Department of Periodontics, and Director of Education of the International Centre for Oral-Systemic Health, in the Faculty of Dentistry; and Assistant Professor in the Office of Continued Professional Development, and Director of Interprofessional Development, in the Faculty of Medicine, University of Manitoba. In these positions, she is developing the first comprehensive, multi-media curriculum specifically related to oral-systemic relationships for non-dental healthcare providers.

Harald O. Heymann, DDS, MEd, is the past Chairman and Graduate Program Director of the Department of Operative Dentistry and currently is Professor of Operative Dentistry at the University of North Carolina School of Dentistry.

John C. Kois, DMD, MSD, maintains a private practice limited to Prosthodontics in Tacoma and Seattle and is an Affiliate Professor in the Graduate Restorative Program at the University of Washington. He lectures nationally and internationally, is a reviewer for many journals and is the Editor in Chief for The Compendium of Continuing Education in Dentistry.

Samuel B. Low, DDS, MS, MEd, Professor Emeritus, University of Florida, College of Dentistry; and associate faculty member of the Pankey with 30 years of private practice experience in periodontics and implant placement. He is also a Diplomat of the American Board of Periodontology and President of the American Academy of Periodontology. He is a Past President of the Florida Dental Association and presently 17th district ADA Trustee.

Salvador Nares, DDS, PhD, Graduate Program Director of the Department of Periodontology at the University of North Carolina at Chapel Hill, School of Dentistry. His research has been supported by NIH, UNC, and the American Academy of Implant Dentistry among others.

Trisha E. O’Hehir, RDH, MS, has more than 30 years experience as a clinical hygienist and educator in private practices in the United States and Zurich, Switzerland, and has held faculty positions at the University of Minnesota, University of Washington, and University of Arizona. She is an international lecturer, , Editorial Director of Hygienetown magazine/online community, editor of Perio Reports Newsletter, co-founder of Perio-Data Company, and former consulting editor for RDH magazine.

Rebecca Wilder, RDH, MS, Professor and Director of Faculty Development at The University of North Carolina at Chapel Hill School of Dentistry. She also serves as Director of the Master of Science Degree Program in Dental Hygiene Education and she is the Interim Director of the undergraduate dental hygiene programs. She has served as chair of the ADHA Institute for Oral Health Research Grant Review Committee, the ADHA Council on Research and president of the Oral Health Research Group of the International Association of Dental Research.

Dr. Kathy Svoboda has an extensive background in developmental and cell biology, with specific training and expertise in signal transduction. Her own research has focused on an especially promising area of investigation—the formation of free radicals in oral cells and the effectiveness of specific combinations of antioxidants to neutralize the free radicals. As the principal investigator on several previous university and privately funded grants, she designed experiments to determine effective antioxidant combinations that counteract the effects of oral stressors (nicotine, ethanol, H2O2, or dental materials) in a variety of cell based and animal assays. One study was recently published in the Journal of Periodontology titled “Antioxidants counteract nicotine and promote migration via RacGTP in oral fibroblast cells.” Her research has been supported by NIH, NSF, March of Dimes, and the Baylor Oral Health Foundation.

Emerging research on topical antioxidants
Antioxidants are a promising technology for addressing inflammation in the oral tissues, and several research studies are underway. Two scholarly review articles published in 2011, have surveyed the field of research studies regarding antioxidants and oral tissues. Both articles, “Reactive Oxygen Species and Antioxidant Defense Mechanisms in the Oral Cavity: A Literature Review” and “Use of Antioxidants in Oral Healthcare,” can be accessed on the website:

Within the body of research on antioxidants, a recent development is topical application of antioxidant compounds. This new technology, which is based on natural compounds, is part of a growing consumer demand for natural products for oral care. It is expected that several new oral care products based on advanced topical antioxidant technology will be brought to market in the coming months.

April, 2011|Oral Cancer News|