LEADING PERIODONTISTS–NEW RESEARCH

[drmithila]

More Human Histologic Research, This Time on ‘Hopeless’ Teeth! Research Sponsored in Part by Millennium Dental Technologies, Inc. and the Institute for Advanced Laser Dentistry.

CERRITOS, Calif. (November 30, 2011)-New research unveiled to a standing-room-only assembly of the leading periodontists across the globe shows regeneration of bone in teeth affected by periodontal disease when treated with the LANAP protocol. These results have not been previously documented in any dental research worldwide.
The preliminary report for the independent nine-month en-bloc human histological study of the LANAP® protocol was revealed by its principal investigator, Marc L. Nevins, DMD, MMSc at the 2011 American Academy of Periodontology Annual Session in Miami Beach, Florida.

The study researches the effect of the LANAP protocol on the most extreme cases of periodontitis. Preliminary results positively support the LANAP protocol as an effective treatment for periodontitis, also known as gum disease. Human histology slides indicate new connective tissue attachment (CTA) and regeneration of root surface (cementum), both positive signs of the reversal of bone loss, a hallmark effect of gum disease. All 12 treated teeth returned to health, and 50% of teeth analyzed showed evidence of bone regeneration. Full study results are expected to be published in early 2012″The periodontists in the AAP are world-class,” said Robert Gregg II, DDS, Program Director for the Institute for Advanced Laser Dentistry (IALD). “Their excitement about the research results was palpable, and underscores how important this research is to the dental community. The LANAP protocol is consistently producing results previously thought to be impossible.”

The current study contributes to the body of evidence supporting the LANAP protocol. Previous Human Histology on more moderately involved teeth was published in the International Journal of Periodontics and Restorative Dentistry by Raymond Yukna, DMD, MS.

“Human histology reports indicate bone regeneration can be an expected outcome, even in extreme periodontally challenged teeth. This supports the fact that the LANAP protocol is effective in obtaining regeneration,” said Delwin McCarthy, DDS, Institute for Advanced Laser Dentistry Executive Director. “Ultimately, this means more patients can save their natural teeth and improve their oral health.”

Gum disease is a chronic bacterial infection that, left untreated, can lead to tooth loss and has been closely linked to major health problems including heart disease, strokes, pre-term, and stillborn births, as well as certain cancers. It is often painless and can go undetected or ignored until severe gum and bone destruction catches the individual’s attention. Even when detected, patients often choose not to undergo traditional surgery due to fear, poor esthetic outcomes and associated pain.

The LANAP protocol, a patient-friendly, laser gum disease surgery, was developed by clinicians for clinicians as a treatment patients would accept. The protocol’s strict operating parameters ensure consistent, reproducible, positive results.

Dawn Bloore, DDS, Director of Training for the IALD states, “The most recent research findings support the successful treatments reported by LANAP-trained clinicians worldwide.” The LANAP protocol continues to be adopted by specialists as the preferred laser gum surgery, on the basis of its clinical results and treatment acceptance rates.

Additional university-based, prospective studies continue. More information on ongoing research is available athttp://clinicaltrials.gov/ct2/show/NCT01282229?term=lanap&rank=1.

        

[drmithila]

 ABOUT THE INSTITUTE FOR ADVANCED LASER DENTISTRY (IALD): The Institute for Advanced Laser Dentistry is a non-profit educational and research center dedicated to providing evidence-based clinical training in advanced laser dentistry therapies. Formed in 1999 by dentists Robert H. Gregg II and Delwin K. McCarthy, the IALD is both ADA CERP and AGD PACE accredited, and is nationally recognized for its continuing education (CE) programs. With more than 20 certified instructors who train dental professionals in laser dentistry techniques including the LANAP® protocol, the IALD aims to reach more underserved patients with gum disease who have avoided therapy out of fear. To that end, the organization provides free treatment to qualified patients who can benefit from the no-cut, no-sew, no-fear LANAP® protocol-providing about $750,000 in free dental services each year. The IALD’s ultimate goal is for the percentage of patients seeking treatment for periodontitis to reach the percentage of patients seeking general dental care. For more information, please visit http://www.theiald.com.

ABOUT MILLENNIUM DENTAL TECHNOLOGIES, INC. Headquartered in Cerritos, Calif., Millennium Dental Technologies, Inc. is the developer of the LANAP® protocol for the treatment of gum disease and the manufacturer of the PerioLase® MVP-7TM digital dental laser. By providing a simple and comfortable experience with unique bone-building clinical results, MDT’s FDA-cleared LANAP protocol removes the fear from gum disease treatment, offering a vastly less painful and less invasive regenerative treatment alternative to conventional scalpel/suture flap surgery; its PerioLase® MVP-7TM is a 6-watt free-running variable pulsed Nd:YAG dental laser featuring digital technology and 7 pulse durations-the most available on the market-giving it the power and versatility to perform a wide range of soft- and hard-tissue laser procedures. Established in 1990, the company’s founding clinicians, Robert H. Gregg, II, D.D.S. and Delwin K. McCarthy, D.D.S., continue to operate the company with a shared vision and purpose: To create better clinical outcomes in periodontal disease patients-and to remain true to the guiding principle-"It’s all about the patient." For more information, visit http://www.LANAP.com.

        

[Drsumitra]

In 2009, researchers from Saint Louis University, Southern Illinois University, and Washington University found that patients in periodontal maintenance programs taking vitamin D and calcium supplementation trended toward better periodontal health compared with patients not taking supplementation (JOP, September 2009, Vol. 80:9, pp. 1433-1439).

And this is just one of many cross-sectional studies and secondary data analyses in the last few years that reached similar conclusions, according to Charles Hildebolt, DDS, PhD, study co-author and director of radiology at the Mallinckrodt Institute of Radiology at Washington University.

Vitamin D stimulates the production of natural antibiotics — antimicrobial peptides — and bacteria and viruses have a hard time developing a resistance to them, he told DrBicuspid.com.

“It is very difficult to get too much vitamin D.”
— Charles Hildebolt, DDS, PhD,
Mallinckrodt Institute of Radiology
"Periodontal disease is largely an immune response to bacteria in the biofilm, so if vitamin D stimulates production of natural antibiotics, this might be good in preventing periodontal disease," he said.

Dr. Hildebolt and his colleagues acknowledge, however, that the effects of vitamin D and calcium supplementation on periodontal disease have not been completely clarified in the scientific literature.

"Although a number of early studies suggested that vitamin D and calcium supplementation reduced tooth loss and alveolar ridge resorption, most of these studies included heterogeneous populations or did not directly measure periodontal diseases status," they wrote. More recently, however, analyses of the Third National Health and Nutrition Examination Survey, which included 12,000 adults, revealed significant associations between periodontal health and and calcium intake, they noted (JOP, July 2000, Vol. 71:7, pp. 1057-1066).

Even so, the National Institute of Dental and Craniofacial Research (NIDCR) wants more evidence on the effects of vitamin D on periodontitis before it will fund randomized clinical trials on this topic, according to Dr. Hildebolt. And on November 30, the Institute of Medicine (IOM) released a report that, while increasing the recommended daily intake of vitamin D and calcium, said that the current body of research does not offer the evidence needed to confirm that vitamin D has the larger positive health effects its proponents claim it does.

The IOM’s report is a move in the right direction, Dr. Hildbebolt said. But he also believes there is enough evidence to support research into the effects that higher levels of vitamin D may have on periodontal disease.

"There have been many, many randomized clinical trials that have shown the benefits of vitamin D and calcium in preventing bone loss below the head, and everyone agrees that you need an adequate intake of vitamin D to promote calcium absorption," he told DrBicuspid.com. "So it seems reasonable that bone in the head is not too much different from bone in the rest of the body. If it is beneficial to those bones, it is probably also beneficial to the alveolar bone."

One-year findings

In an effort to convince the NIDCR of this, Dr. Hildebolt and colleagues went back to the same patient group from the 2009 JOP study to see if the trends they had initially found in the relationship between periodontal health and vitamin D and calcium supplements persisted after one year.

Their latest JOP study followed the original 51 patients (men and women age 50-80), who had moderate to severe chronic periodontal disease (at least two interproximal sites with at least 3 mm of clinical attachment loss) and were enrolled in maintenance programs at two dental clinics.

The patients were divided into two groups: 23 had been taking vitamin D (at least 400 international units [IU] per day) and calcium (at least 1,000 mg per day) supplements for more than 18 months at the time of their baseline visits, while the other group (28) had been taking no supplements and had daily dietary intakes of calcium and vitamin D below 1,000 mg and 400 IU, respectively.

All patients were clinically assessed using probing and CEJ-GM (cemento-enamel junction – gingival margin) measurements at baseline, six months, and one year. Clinical measurements were taken at six sites (buccal, lingual, me = 0.049), siolingual, mesiobuccal, distolingual, and distobuccal) for each mandibular posterior tooth. In addition, bitewing radiographs of the mandibular posterior teeth were taken at baseline, six months, and one year.

All subjects from both groups received periodontal maintenance therapy at three-month intervals. Treatment consisted of scaling and root planing, polishing, reinforcement of oral hygiene procedures, and a general dental exam.

For subjects who did not take oral supplements, the mean daily calcium intake was 642 mg and the mean daily vitamin D intake was 156 IU. For subjects who did take oral supplements, the mean daily calcium intake was 1,769 mg and the mean daily vitamin D intake was 1,049 IU.

Clinical parameters of periodontal health improved with time in both groups (p < 0.001). When clinical measures were considered collectively, the differences between supplement takers and nontakers had the following p values: baseline (p = 0.061), six months (p = 0.049), and 12 months (p = 0.114).

"This study suggests that periodontal health improves in patients attending regular periodontal care programs, regardless of their dietary calcium or vitamin D supplements," the authors wrote. "However, taking calcium and vitamin D supplementation is associated with better periodontal health relative to taking no such supplements."

The researchers observed less bleeding on probing and less inflammation in supplement takers, a difference that was evident at baseline and remained significant for one year while subjects underwent periodontal maintenance therapy.

"Our findings do not deny the possibility that vitamin D supplements may reduce the severity of periodontal disease if used at doses higher than 800-1,000 IU daily, thus supporting the rationale for testing the potential beneficial role of vitamin D on periodontal disease in more powerful, randomized clinical trials," they concluded.

Good for pregnant women too

Lack of vitamin D is also associated with maternal periodontal disease during pregnancy, according to researchers from the University of North Carolina at Chapel Hill and Harvard Medical School (JOP, September 1, 2010). In fact, maternal periodontal disease is found in up to 40% of pregnant women and is associated with adverse pregnancy outcomes, including preterm birth, preeclampsia, and late miscarriage, the authors noted.

In their case-control study, 117 cases of pregnant women with moderate to severe periodontal disease (15 or more tooth sites with 4 mm or more of gingival pocket depth) were compared with 118 pregnant women who were periodontally healthy. All the women had been prescribed a prenatal vitamin containing 400 IU of vitamin D.

Their serum 25-hydroxyvitamin D (25[OH]D) levels were measured and compared between the case and control groups to determine the prevalence of vitamin D insufficiency (defined as < 75 nanomoles per liter [nmol/L]). A serum concentration of 75 nmol/L or greater appears to support bone mineral density and dental health, the authors noted, and 90-100 nmol/L has been suggested as the optimal vitamin D level (American Journal of Clinical Nutrition, July 2006, Vol. 84:1, pp. 18-28).

The researchers found that the case group had lower median 25(OH)D levels than the control group (59 versus 100 nmol/L, p < 0.001) and were more likely to have vitamin D insufficiency (65% versus 29%, p < 0.001).

"The relationship between maternal vitamin D status, periodontal disease, and adverse pregnancy outcomes requires more study before definitive conclusions can be made," they wrote. "However, our data provide evidence that improvement of vitamin D status is a potential intervention to improve oral health among a vulnerable group of pregnant women."

Given the role of vitamin D in inflammatory responses and integrity of the innate immune response, vitamin D supplementation could improve maternal oral health, the researchers concluded.

Dr. Hildebolt believes that the best way to determine if patients are getting enough vitamin D from sunshine and diet is to test their blood for serum 25(OH)D levels. If less than 75 nmol/L of serum 25(OH)D is present, then a supplement may be warranted.

"There is a lot of hype about vitamin D right now," Dr. Hildebolt said. "It’s not the magic bullet that will cure all forms of cancer, but it is much better to have too much than not enough. And it is very difficult to get too much vitamin D, and to get enough just from diet alone."

 

        

[drmithila]

Periodontitis, a form of chronic gum disease that affects nearly half of the U.S. adult population, results when the bacterial community in the mouth becomes unbalanced, leading to inflammation and eventually bone loss. In its most severe form, which affects 8.5 percent of U.S. adults, periodontitis can impact systemic health.
By blocking a molecular receptor that bacteria normally target to cause the disease, scientists from the University of Pennsylvania have now demonstrated an ability in a mouse model to both prevent periodontitis from developing and halt the progression of the disease once it has already developed.
The study, published in the Journal of Immunology, was led by Toshiharu Abe, a postdoctoral researcher in the Department of Microbiology in Penn’s School of Dental Medicine. Abe works in the lab of George Hajishengallis, a professor in the department who was a senior author on the paper. The co-senior author was John D. Lambris, the Dr. Ralph and Sallie Weaver Professor of Research Medicine in the Department of Pathology and Laboratory Medicine in Penn’s Perelman School of Medicine. Kavita B. Hosur and Evlambia Hajishengallis from Penn Dental Medicine also contributed to the research, as did Penn Medicine’s Edimara S. Reis and Daniel Ricklin.
In previous research, Hajishengallis, Lambris and colleagues showed that Porphyromonas gingivalis, the bacterium responsible for many cases of periodontitis, acts to “hijack” a receptor on white blood cells called C5aR. The receptor is part of the complement system, a component of the immune system that helps clear infection but can trigger damaging inflammation if improperly controlled.
By hijacking C5aR, P. gingivalis subverts the complement system and handicaps immune cells, rendering them less able to clear infection from the gum tissue. As a result, numbers of P. gingivalis and other microbes rise and create severe inflammation. According to a study published last year by the Penn researchers, mice bred to lack C5aR did not develop periodontitis.
Meanwhile, other studies by the Penn group and others have shown that Toll-like receptors, or TLRs — a set of proteins that also activate immune cell responses — may act in concert with the complement system. In addition, mice lacking one form of TLR called TLR2 do not develop bone loss associated with periodontitis, just like the C5aR-deficient mice.
In the new study, the Penn team wanted to determine if the synergism seen by other scientists between the complement system and TLRs was also at play in this inflammatory gum disease.
To find out, they injected two types of molecules, one that activated C5aR and another that activated TLR2, into the gums of mice. When only one type of molecule was administered, a moderate inflammatory response was apparent a day later, but when both were injected together, inflammatory molecules increased dramatically — soaring to levels higher than would have been expected if the effect of activating both receptors was merely additive.
This finding suggested to the scientists that the Toll-like receptor signaling was somehow involved in “crosstalk” with the complement system, serving to augment the inflammatory response. Turning that implication on its head, they wondered whether blocking just one of these receptors could effectively halt the inflammation that allows P. gingivalis and other bacteria to thrive and cause disease.
Testing this hypothesis, the researchers synthesized and administered a molecule that blocks the activity of C5aR, to see if it could prevent periodontitis from developing. They gave this receptor “antagonist,” known as C5aRA, to mice that were then infected with P. gingivalis. The C5aRA injections were able to stave off inflammation to a large extent, reducing inflammatory molecules by 80 percent compared to a control, and completely stopping bone loss.
And when the mice were given the antagonist two weeks after being infected with P. gingivalis, the treatment was still effective, reducing signs of inflammation by 70 percent and inhibiting nearly 70 percent of periodontal bone loss.
“Regardless of whether we administered the C5a receptor antagonist before the development of the disease or after it was already in progress, our results showed that we could inhibit the disease either in a preventive or a therapeutic mode,” Hajishengallis said. This is significant for extending these findings to a potential human treatment, as treatments would most likely be offered to those patients already suffering from gum disease.
Because not all cases of periodontitis are caused by P. gingivalis, the research team also wanted to see whether C5aRA could effectively prevent or treat the disease when it arose due to other factors. To do so, they placed a silk ligature around a single molar tooth in a group of mice. The obstruction not only blocked the natural cleaning action of saliva, but also enabled bacteria to stick to the ligature itself, resulting in a massive accumulation of bacteria. This microbial build-up rapidly leads to periodontitis and bone loss, within just five days in the mice.
The researchers then injected the gum tissue adjacent to the ligated molar tooth with C5aRA in some of the mice, and gave the other mice a control.
“These mice that got the C5a receptor antagonist developed at least 50 percent less inflammation and bone loss compared to an analog of C5a receptor antagonist which is not active,” Hajishengallis said.
This result gives the researchers greater confidence that the C5aRA treatment could be effective against periodontitis in general, not just those cases caused by P. gingivalis bacteria.
The team is now working to replicate their success in mice in other animal models, an important step toward extending this kind of treatment to humans with gum disease.
“Our ultimate goal is to bring complement therapeutics to the clinic to treat periodontal diseases,” Lambris said. “The complement inhibitors, some of which are in clinical trials, developed by my group are now tested in various periodontal disease animal models and we hope soon to initiate clinical trials in human patients.”

        

[drmithila]

Texas Biomed scientists in San Antonio have found that moderate gum disease in an animal model exposed to an AIDS- like virus had more viral variants causing infection and greater inflammation. Both of these features have potential negative implications in long term disease progression, including other kinds of infections, the researchers say in a new report.
The public health message from the study is that even mild inflammation in the mouth needs to be controlled because it can lead to more serious consequences, said Luis Giavedoni, Ph. D, a Texas Biomed virologist and first author of the study.
“This is important because moderate gum disease is present in more than 50 percent of the world population. It is known that severe gum disease leads to generalized inflammation and a number of other health complications, but the conditions that we created were moderate and they were mainly localized in the mouth,” he added.
“After infection with the simian AIDS virus, the generalized acute inflammation induced by the virus was exacerbated in the animals with gingivitis, indicating that even mild localized inflammation can lead to a more severe systemic inflammation,” he added.
The study, funded by the National Institutes of Health (NIH) and conducted at Texas Biomed’s Southwest National Primate Research Center (SNPRC), appears in the February 2013 issue of the Journal of Virology. Collaborators included scientists at the Dental School at UT Health Science Center San Antonio and at Seattle Biomed in Washington State.
Giavedoni and his colleagues studied whether inflammation of the mouth would increase the susceptibility of the monkeys to becoming infected with the monkey AIDS virus. This was based on epidemiological evidence that shows that infection and inflammation of the genital mucosa increases the chances of becoming infected with HIV by the sexual route.
The scientists induced moderate gum inflammation in a group of monkeys, while a second group without gum inflammation served as a control. After exposing both groups of macaques to infectious SIV, a monkey virus similar to AIDS, in the mouth they did not observe differences in the rate of infection, indicating the moderate gum disease did not increase the chances of getting infected with the AIDS virus.
“However, we did observe that the animals that had gum inflammation and got infected had more viral variants causing infection and they also showed augmented systemic inflammation after infection; both of these findings may negatively affect the progression of the viral infection.” Giavedoni said.

        

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