Repost: CDC includes periodontal disease in annual health report

This article from the Dental Tribune International notes that The Centers for Disease Control and Prevention has included for the first time in its annual report statistics on the prevalence of periodontitis among U.S. adults.

According to the report, more than 47 percent of adults aged 30 and over (approximately 65 million adults) had periodontitis during 2009–2010. While an estimated 8.7 percent had mild periodontitis, the prevalence of moderate periodontitis was 30 percent. Severe periodontitis was estimated to occur in 8.5 percent.

A new report has shown that periodontal disease is a
significant public health concern. (Photo: botazsolti/Shutterstock)
Image Source: dental-tribune.com

Among other aspects, the survey found that periodontitis was directly associated with lower levels of education and higher levels of poverty, both of which influence the use of dental services by adults. Rates of periodontitis were highest among adults with less than a high school education (66.9 percent). More than 16 percent of adults in poor families had severe periodontitis.

The prevalence of periodontitis was significantly higher in non-Hispanic blacks (58.6 percent) and Mexican-Americans (59.7 percent) compared with non-Hispanic whites (42.6 percent). Among all ethnic groups, the prevalence of periodontitis increased with age (24.4–70.1 percent). The prevalence of periodontitis was significantly higher among men (56.4 percent) than among women (38.4 percent).

The purpose of the report was to discuss and raise awareness of the differences in the characteristics of people with periodontal disease and to prompt action to reduce these disparities, the CDC stated.

Data for the report was obtained from the 2009–2010 National Health and Nutrition Examination Survey, a program of studies designed to assess the health and nutritional status of adults and children in the U.S. The survey examines a nationally representative sample of about 5,000 people each year.

The report, titled "CDC Health Disparities and Inequalities Report — United States, 2013," was published as a supplement to the November issue of CDC's Morbidity and Mortality Weekly Report and can be accessed on the organization's website.

Oral health practitioners like Dr. Domenick Coletti would agree with CDC that periodontal disease is an important public health issue. Subscribe to this Twitter account to receive regular updates on oral health.

REPOST: Olympic Athletes Bomb on Oral Hygiene

Olympians undergo a constant series of stringent physical exams to ensure their readiness for competition. An article on TIME suggests that the focus on their bodies may actually be leaving their teeth neglected.

Japan's Fumiyuki Beppu leads the breakaway during the Men's Road Race Road Cycling on day 1 of the London 2012 Olympic Games on July 28, 2012 in London, England. | Image source: TIME

Olympic athletes are at the top of their game when it comes to their physique, but not so much for oral hygiene. New research from the British Journal of Sports Medicine reveals that elite athletes tend to have more cavities, tooth erosion and gum disease than others of a similar age.

Surveying athletes who attended the dental clinic at the 2012 Olympic Games in London for free check-ups and mouth guards, researchers at the University College London (UCL) found a fifth of visitors said that oral health affected training and performance and more than 40 percent were “bothered” by their oral health. Of the 302 athletes surveyed (with data available for 278) from Africa, the Americas and Europe, more than half of respondents had cavities, including 45 percent with dental erosion and 76 percent showed signs of gingivitis.

Though the data is confined to only those visiting the Olympic Village clinic, the researchers assert that the findings are consistent with previous studies. Olympic athlete’s high intensity performance includes consuming large amounts of carbohydrates as well as sugary drinks. Ian Needleman, a professor at UCL who spearheaded the study, said that extreme training places stress on the immune system leaving athletes at high risk of oral disease, the BBC reports. The study also notes that half of the athletes examined had not had a dental examination the year before.

Previous research found that inflammation elsewhere in the body can affect the likelihood of injury as well as recovery time. Researchers have even linked a higher risk of heart attacks among people who do not brush their teeth twice a day (which results in inflamed gums).

As an experienced dental surgeon, Dr. Domenick Coletti would recognize the signs of gum and tooth decay early on and educate patients on better oral hygiene. Click 'Like' on this Facebook page for more updates about dental care.

REPOST: Chin advancements: The oral surgery perspective

Is it possible that some of today’s gadgets can cause diseases that can compromise “our work, activities of daily living, and perhaps even our appearance?” Dr. Tim Sands, Dr. Claudio Tocchio, and Dr. Robert Givelas take a look at some of these new ailments like “smartphone face” which can lead to more people seeking treatment for the affected body part. Read their Oral Health Group report below.

Mucosal incision (Image source: oralhealthgoup.com)

There is no argument that recent innovations in the diagnosis and management of disease involve the application of technology. However, can some of the complementary technological advancements and gadgets that have become lifestyle necessities actually cause disease themselves? Blackberry thumb, iPad finger, and tech neck are becoming the common new ailments compromising our work, activities of daily living, and perhaps even our appearance.

Smartphone face1 is the phenomenon that describes how sitting for hours with your head tipped forward staring at a smartphone, laptop or computer screen, will shorten the neck muscles and increase gravitational pull on the lower face and chin. This leads to submental fullness, double chin (buccula), facial sagging (jowls) and a recessive chin profile (microgenia). The development of the symptoms characterizing smartphone face can be attributed to genetics, the natural aging process and weight fluctuation; nevertheless, the explosion in the use of electronic gadgets has mirrored the rise in individuals seeking treatment of the chin.

According to the American Society of Plastic Surgeons the number of chin augmentation surgeries performed in the United States increased over 70 percent in 2011.2 This increase is more than breast augmentation, botox and liposuction. With equal numbers of both men and women opting for the procedure, it makes chin augmentation the fastest growing plastic surgery trend.3 A trend that is expected to continue as facial aging may first appear in the chin and jaw line. The posting of pictures on Facebook and Instagram and the increasing prevalence of video chat technology, like Skype and FaceTime where perceived flaws are instantly captured for all to see, may be driving force behind the escalating numbers.4 Many people are seeking ways to improve their appearance, boost self-confidence and provide themselves any competitive advantage in the workplace.

THE COSMETIC SURGERY PERSPECTIVE - AUGMENTATION
The chin forms an integral part of the total facial esthetic and profile. A visual treatment objective is developed from a lateral cephalometric tracing and a systematic clinical patient evaluation.5 Esthetic considerations of the lower facial third requires attention to vertical dimension, symmetry and profile to achieve facial balance with the forehead, cheeks, paranasal area, lips and neck.6 Many patients that present for nasal surgery, only after consultation, realize that adding a chin augmentation can improve their overall facial balance and appearance in profile.2

Cosmetic chin augmentations, whether performed by an otolaryngologist or a plastic surgeon, most frequently incorporate the use of an alloplastic implant. Chin implants can be silicone, polymethacrylate, polyethylene or expanded polytetraflourethylene.7 The procedure is performed by an extraoral submental approach as the chin implant is often combined with cervicofacial liposuction, platysma plication (necklift) or rhytidectomy (facelift) through the same skin access incision.6 The implants can be biocompatible, easy to contour, place and remove if necessary.

Injectable facial volumizing fillers including hyaluronic acid (Restylane, Juvederm) and calcium hydroxylapatite (Radiesse) are being used to temporarily augment the chin. The effects can last up to a year and allow an idea of what a chin implant may more permanently provide.2
The use of chin implants is low risk but is not without complication. Alloplastic materials may result in unpredictable soft tissue contours, resorption of bone and sometimes underlying tooth roots, palpable mobility, infection and inflammatory foreign body reactions.5

Preoperative radiograph (Image source: oralhealthgroup.com)

THE ORAL SURGERY PERSPECTIVE - ADVANCEMENT
Chin augmentations performed by an oral and maxillofacial surgeon most frequently involve a sliding bony advancement by genioplasty. The genioplasty is a horizontal osteotomy of the mandibular symphysis. Originally described from an extraoral approach,8 it is almost exclusively performed today by intraoral access.9 Although a genioplasty can be an isolated procedure, an oral surgeons participation is usually to complement other orthognathic surgical procedures required to correct a malocclusion. Unlike cosmetic implant augmentation, the bony chin advancement not only affords an esthetic change but can provide functional objectives. Genioplasty advancement of the genial tubercle and genioglossus muscle is used to treat sleep apnea.6 Lip competency can be improved by incorporating a vertical chin reduction with the horizontal advancement. In variation, the genioplasty can be used to improve almost every skeletal abnormality of the chin. An excellent review on the preoperative radiographic assessment and clinical patient evaluation was previously published in Oral Health.5 Since this article is on chin augmentation; we are limiting the discussion to our genioplasty advancement technique. Potential complications are addressed at each step to minimize their development.

GENIOPLASTY ADVANCEMENT TECHNIQUE
In the oral surgery environment, since chin advancement is often combined with a LeFort I or a mandibular bilateral sagittal split osteotomy, a general anesthetic is used. However, it can be performed independently on an outpatient basis under sedation and local anesthesia.10 A local anesthetic with vasoconstrictor is injected submucosally along the symphysis to the gonial notch bilaterally. The lower lip is retracted and a superficial mucosal incision is made 1 cm anterior to the depth of the labial vestibule from cuspid to cuspid (Fig. 1). This incision may allow identification of the mental nerve branches.6 An incision placed too close to the vestibule can result in scar bands and unaesthetic mucosal webbing. The incision is then angled directly to the labial cortical bone through the mentalis muscle and periosteum. The soft tissue is reflected superiorly and inferiorly to expose the intended level of the osteotomy. Lateral dissection identifies the mental foramina bilaterally and then extends posteriorly to the inferior aspect of the mandibular body.

A midline vertical line is marked into the labial cortex perpendicular to the planned horizontal osteotomy (Fig. 2). A failure to preoperatively assess and mark the facial and dental midline can lead to transverse malposition and asymmetry. The horizontal osteotomy is made approximately 5 mm inferior to the mental foramen with a reciprocating saw cutting cross-table from the posterior to the midline, through both labial and medial cortices (Fig. 3). The mental nerves are carefully protected as the osteotomy is performed. Poor exposure, excessive retraction or inadequate protection are the most common causes of nerve injury.11 In one study,12 although postoperative sensory loss was found temporarily in all patients, normal sensation returned within 12 months. The posteromedial aspect is the most problematic area to cut. A retractor is placed under the inferior border of the mandible to protect the facial artery and vein. If the posterior osteotomy is not confirmed, an unfavorable fracture of the inferior border of the mandible distally may occur.11 Mobilization of the inferior free chin segment is accomplished (Fig. 4) and is anteriorly repositioned to the predetermined advancement.

Posoperative radiograph (Image source: oralhealthgroup.com)

Stabilization can be made with cortical or circumferential stainless steel wires, titanium miniplates or screws. Our preferred stabilization method involves rigid fixation using two interosseous titanium screws and a lag screw technique. A 1.5 mm hole is drilled in a superior and posterior direction, engaging both the labial cortex of the inferior free chin fragment and the medial cortex of the superior tooth-bearing segment. The labial cortex is countersunk to reduce postsurgical screw palpation and enlarged to the same 2.0 mm diameter of the fixation screw itself. The screw threads do not engage the chin fragment as the screw is placed and tightened (Fig. 5). This technique provides rigid fixation with mild compression (Fig. 6). Titanium screws osseointegrate and rarely need removal. Inadequate stabilization of the mobilized chin fragment may lead to malposition, asymmetry or bony nonunion. Rigid internal fixation promotes maintenance of the advancement and minimal relapse is reported.10 The ratio of soft tissue change to amount of bony movement associated with a surgical genioplasty advancement is predictable and close to 1:1. There is a bony remodeling or rounding of the posterior wings and osteotomy step of the advanced segment that occurs with time.

Initial soft tissue closure involves the mentalis muscles bilaterally and the mucosal midline is identified and a resorbable suture is placed to coordinate symmetry. The mucosal layer is then closed in a running fashion (Fig. 7). A layered closure, midline identification and muscle reapproximation helps to obtain optimal chin and lip position.11 An Elastoplast chin pressure dressing is applied for 48 hours to minimize hematoma formation and to help support the suture line. A comparison of the preoperative and postoperative radiographs confirms the bony and soft tissue advancement and improved lip competency provided by genioplasty (Figs. 8, 9).

Chin augmentation can be performed competently by a number of specialties, each of which employs their preferred technique. It appears the patterns for referral may be based on whether a patient’s evaluation determines the need for primarily an esthetic change or there are also functional objectives. The desired treatment goals can be achieved and complications minimized with systematic clinical and radiographic evaluation, careful surgical technique and consideration of the anatomy of the area.

Dr. Domenick Coletti, a Maryland-based surgeon, performs a number of maxillofacial and oral surgical procedures, including chin surgery. Visit this website for more information.

REPOST: Stem Cells Found in Gum Tissue Can Fight Inflammatory Disease

A new research suggests that stem cells (gingiva) found in gum tissues may be the best healers for inflammatory diseases as they have much less inflammatory reaction and heal much faster when compared to skin.

Stem cells found in mouth tissue can not only become other types of cells but can also relieve inflammatory disease, according to a new Ostrow School of Dentistry of USC study in the Journal of Dental Research.

The cells featured in the study are gingival mesenchymal stem cells (GMSC), which are found in the gingiva, or gum tissue, within the mouth. GMSC, like other stem cells, have the ability to develop into different types of cells as well as affect the immune system.

“Gingiva is very unique in our body,” says Professor Songtao Shi, the study’s senior author. “It has much less inflammatory reaction and heals much faster when compared to skin.”


Professor Songtao Shi
Image source: dentistry.usc.edu

Previously, the developmental origins and abilities of GMSC hadn’t been fully illustrated. This study shows that there are two types of GMSC: those that arise from the mesoderm layer of cells during embryonic development (M-GMSC) and those that come from cranial neural crest cells (N-GMSC). The cranial neural crest cells develop into many important structures of the head and face, and 90 percent of the gingival stem cells were found to be N-GMSC.

The two types of stem cells vary dramatically in their abilities. N-GMSC were not only easier to change into other types of cells, including neural and cartilage-producing cells; they also had much more of a healing effect on inflammatory disease than their counterparts. When the N-GMSC were transplanted into mice with dextrate sulfate sodium-induced colitis – an inflamed condition of the colon – the inflammation was significantly reduced.

The study indicates that the stem cells in the gingiva – obtained via a simple biopsy of the gums – may have important medical applications in the future.


Specialized Laboratory Technician Xingtian Xu
Image source: dentistry.usc.edu

“We will further work on dissecting the details of the gingiva stem cells, especially their notable immunoregulatory property,” says first author Xingtian Xu, specialized lab technician at the Ostrow School of Dentistry Center for Craniofacial Molecular Biology.

“Through the study of this unique oral tissue, we want to shed the light on the translational applications for improving skin wound healing and reducing scar formation.”

Dr. Domenick Coletti is a partner at Central Maryland Oral and Maxillofacial Surgery. Follow this Twitter page for select news about oral health.

All in the bite: Corrective jaw surgery and you

Bite is an important function of the jaw. If the dental arch contains one or more misaligned teeth, it could make chewing and other functions such as speaking extremely difficult. Jaw malformations are even more serious, and can range from minor cosmetic defects to severe bite misalignments that cannot be corrected through conventional orthodontia.

Image source: health.com

These malformations are not only vanity affairs; they could cause chronic headaches and other problems that interfere with normal functioning. Whether for cosmetic or therapeutic purposes, jaw surgery is the most viable solution where orthodontia finds limits. The results are often dramatic, with patients reporting their life-changing aesthetic improvements and easier time chewing.

Image source: esic.co.uk

Bite correction prior to corrective jaw surgery is often done through orthodontia to bring the teeth closer to their future position post-surgery. While patients are likely to feel that this worsens their current bite, it is a necessary step to prevent malocclusions once the surgery is complete.

Jaw surgery can help align the jaw and teeth in a more natural, healthier, and more comfortable manner. People can seek the advice of their dentist or orthodontist for the merits of jaw surgery.

Image source: todaysparent.com

Dr. Domenick Coletti, a Maryland-based surgeon, offers a number of maxillofacial and oral surgical procedures, including jaw surgery. Visit this website for more information.

Why visiting the dentist matters

It has been said time and again that regular dental check-up is a must for everyone. However, a report recently published in the Journal of Dental Research revealed that nearly 4 billion people—or almost half of the world’s population have oral health conditions that can lead to other issues, like the inability to eat properly or sleep at night. And individuals who suffer from untreated conditions such as tooth decay or cavities in permanent teeth make up 35 percent of the global population. Of all the 291 major ailments identified in the report titled Global Burden of Oral Conditions in 1990-2010: A Systematic Analysis, cavities were the most common.

Image source: psychologie.uzh.ch

In the U.S., the latest statistics from the Centers for Disease Control and Prevention (CDC) show that about 16 percent of children from ages 6 to 19 suffer from untreated dental caries. As for the percentage of adults (ages 20 to 64) with untreated dental caries, CDC estimates it around 24 percent.

Image source: libertydentist.wordpress.com

Visiting the dentist twice a year for cleaning and general check-up is not only a good oral health practice, but it can be a lifesaver, too, as studies have shown that there are several diseases and health conditions that can be influenced by the cleanliness of the mouth. Thus, it is important for people to visit their dentist on a regular basis as a salute to good health.

Image source: excelfitnessct.com

  
Domenick Coletti DDS, MD, is a partner at Central Maryland Oral and Maxillofacial Surgery. Subscribe to this Twitter account for select news about oral health.

REPOST: UAB School of Dentistry ranks No. 1 in research funding

AL.com reports that the UAB School of Dentistry received the highest amount of dental research funding last year. More about the story below:

BIRMINGHAM, Alabama -- The $12.5 million given to the UAB School of Dentistry by the primary federal sponsor of dental research is tops in the nation for 2012.
Riding a huge grant $67 million, multi-year grant award last year, the dentistry school went from No. 15 in funding to No. 1 in money received by the National Institute of Dental and Craniofacial Researcher (NICDR), the dental arm of the National Institutes of Health, according to a UAB news release.

"These rankings illustrate UAB's and the school's leadership position in dental research," said Michael Reddy, dean of the school, in the release. "We have some of the top minds in dental research in the United States and the world at UAB, and this is a testament to our hard work and dedication to the nation's oral health."

Dr. Priya Gulati (left) and Patty McCurry work on Quinton Jones teeth at The UAB School of Dentistry. FILE: Wed., April. 11, 2012 in Birmingham,Ala. (image source: blog.al.com)

The highest rank UAB School of Dentistry has achieved previously was No. 4, Reddy said. In 2011, the school received $4.25 million.

The jump in funding rides mainly on one UAB-led national project.
UAB announced last year it was receiving from NIDCR a seven-year, $67 million grant for the National Dental Practice-Based Research Network, which consolidates the institute's three regional research networks into a nationally coordinated effort to research best practices in dental care. The effort received $9.9 million in 2012.

TOP 5 FUNDED DENTAL SCHOOLS BY NIDCR IN 2012
1) University of Alabama at Birmingham -- $12,456,763
2) Forsyth Institute -- $9,841,103
3) University of Michigan at Ann Arbor -- $9,761,343
4) University of California San Francisco -- $8,520,201
5) University of North Carolina Chapel Hill -- $8,352,978

Read about the latest in dentistry on this Facebook page for Dr. Domenick Coletti.

From barbers to doctors: A brief history of dentistry

The concern over dental hygiene is not a modern issue. In fact, today’s dentists are practitioners of an ancient discipline that began way before Moses supposedly crossed the Red Sea.

Though dentistry may have begun earlier, the earliest evidence of dental procedures were found in Egypt. Skulls dated from circa 2,900 BC have been excavated with small holes in the jaws near the teeth’s roots. These holes may have been used for draining abscesses. Meanwhile, the earliest dentist may have been Hesi-Re (ca 3,000 BC), whose burial chamber was inscribed with “the greatest of those who deal with teeth [chief toother], and of the physicians.” By 1,500 BC, Egyptian dentists were creating false teeth made from teeth connected by a gold wire around the gum line.

Image source: citizenscientistsleague.com

In the Western world, Aristotle was among the first to have made a comparative study of teeth. Meanwhile, the Romans adapted the use of a “chewstick” from the Chinese and the Babylonians for cleaning teeth. The Roman physician Celsus was noted as the first to have used fillings for cavities in 30 AD.

Image source: rompedas.blogspot.com

The Early Middle Ages saw dentistry-related duties fall to the monks who were the most learned in science and medicine at the time. But following a series of Papal edicts that forbid monks from performing any kind of surgery, barbers assumed the monks’ surgical responsibilities. 

Dentistry became separated from general surgery in the 1700s when Pierre Fauchard published Le Chirurgien Dentiste, or The Surgeon Dentist. In it, he discussed all that was known of dentistry at the time, as well as the dental conditions and treatments for each. In doing so, he began to lay down the framework of modern dentistry, earning him the recognition as the “Father of Modern Dentistry.”

Image source: wikipedia.org

Developments in science and technology went hand in hand with dentistry in developing procedures and techniques that were safer and more effective than those previously employed. Today, dentists continue the legacy of their ancient predecessors, and use advanced machines and equipment for various procedures that ensure that patients have strong and healthy teeth.


Dr. Domenick Coletti of Central Maryland Oral and Maxillofacial Surgery is an expert in a variety of dental procedures, such as pre-prosthetic surgery and wisdom teeth extraction. Follow this Twitter page for links to dentistry news and other information.

REPOST: Two Important Lessons from My Much-Procrastinated Trip to the Dentist

Many people have an aversion to visiting the dentist.  But the experience has its perks, and can teach a thing or two about teeth and more.  In her Forbes article, writer Gretchen Rubin shared the epiphany she had during a trip to the dentist.

Yesterday, I finally went to the dentist. I was due for a check-up in July, and for the last eight months, I’ve been moving the reminder card around my office and coming up with new excuses about why I couldn’t make an appointment.

I made the appointment last Thursday, went in, and the whole process took thirty-eight minutes from the time I picked up a magazine in the waiting room to the time I walked out the door holding my bag with freebie toothbrush and floss. I walked the twenty-five blocks to get there, too, on this beautiful spring afternoon, so even half of my travel time was well-spent.

From this experience, I draw two lessons for myself — both of which were quite apparent to me, although I neglected to act on them:

•  Procrastination is itself draining. That reminder card cluttered up my office and cluttered up my brain. Repeatedly thinking “I should…no, I’ll wait…but I really should…but not now…I’ll do it later…” etc. just weighs me down. Just do it! Or decide when I’ll do it, and then do it when that time comes.  

• I have plenty of time for the things that are important to me. I kept telling myself, “I don’t have time to go to the dentist.” Really? For eight months? During that time, I went on vacation, got my hair cut, met friends for coffee, and went on kindergarten field trips, so clearly I’m not so pressed for time that I can do nothing but work. The fact is, it wasn’t a priority — which is fine. But I should be honest with myself.

I’ve found that saying “I’m too busy” makes me feel harried and distracted. Now, instead, I tell myself, “I have plenty of time for the things that are important to me.” It’s more important to me to go to the bread factory with the kindergarten class than to go to the dentist. That’s my choice. But telling myself that I “don’t have time” makes me feel out of control.

Do you find that procrastinating makes you feel drained and overwhelmed? And yet it’s so hard just to do those things which ought to be done, without delay. Two of my Twelve Personal Commandments are Do it now and Do what ought to be done, and yet I struggle with this mightily.

* I keep thinking about this post from Love That Max — “a blog about kids with special needs (and the parents who adore them).” In Helping kids with special needs fit in: I did not buy the purple Crocs, Ellen wrote about deciding not to buy the purple Crocs that she knew her son would love like crazy, to help him in a way that he couldn’t see. I think this is an issue for all parents — resisting the delight of doing something that will make our children very happy, in the present, out of love.

Based in Maryland, Dr. Domenick Coletti is an expert in many surgical procedures, including placement of dental implants and corrective jaw surgery.  This Twitter page contains more details about his work.

On corrective jaw surgery

Image Source: chibuttidallatorre.skyrock.com


The entertainment industry has dictated the world that to have a jaw like Johnny Depp’s or Brad Pitt’s is bliss, which is why many people think that corrective jaw surgery is only for those who want to be as handsome as the aforementioned celebrities and, needless to say, for those who have money to afford it.

But for oral and maxillofacial experts, like Dr. Domenick Coletti and Dr. Dennis G. Smiler, turning a person’s physiognomy, at times, is a matter of death and life, for they are chiefly doing this kind of surgery not just to change one’s appearance, but also to help patients who are suffering from different illnesses, like sleep apnea, and deformities, like TMJ disorders and malocclusion problems.



Image Source: worldsbestinformation.org


On the surgeons

However, many people also think that oral and maxillofacial surgeons are nothing but dentists who happen to have better pay. Indeed, they are dentists, too. The only thing difference is that they are trained to operate the human mouth, jaw, and face—a very technical method that requires a high level of preparation and training.



Image Source: faceandjawsurgeryblog.com


Talking about the price

The price of corrective jaw surgery is not that cheap, but it is not that costly either. In addition, the total cost for this procedure depends on several factors, including the severity of the injury and the patient’s insurance plan. For patients who suffered from an appearance-rescinding accident, the procedure is surely worth the price.


Dr. Domenick Coletti is a partner at Central Maryland Oral and Maxillofacial Surgery, P.A. Learn more about the dental surgeries he performs by visiting this website.

Sleep apnea: Searching for the best treatment

More than 18 million American adults are suffering from sleep apnea, a potentially serious sleep disorder in which breathing repeatedly stops and starts. This condition, which starves the body of oxygen, can lead to heart conditions, high blood pressure, and mood and memory problems. The most common form of the condition is obstructive sleep apnea, in which the airway collapses or becomes blocked during sleep, causing shallow or interrupted breathing.

Image source: parkcities.bubblelife.com

It is important for people with this life-threatening disorder to seek medical attention immediately. For those with mild sleep apnea, lifestyle changes such as losing weight, quitting smoking, and not drinking alcohol before bedtime can reduce the occurrence of the condition. Some are advised to wear dental appliances, like a mouth guard, which repositions the mandible (lower jaw) and keeps the airway open.

Image source: flplahore.blogspot.com

Others, particularly those with severe apnea, turn to surgery for relief. A recent ABC Action News report featured how Susan Yeats of Florida turned to surgery to treat her sleep apnea. Yeats noted that the surgery, which is originally performed to correct jaw relationship problems, improved her breathing and reduced the occurrence of her sleep apnea.

Image source:cbc.ca

Called maxillomandibular advancement or MMA, the surgery is deemed a “radical procedure” for it moves the mouth, tongue, and chin forward permanently to enlarge the airway. The surgery, isn’t for everyone with sleep apnea, especially those doing well with continuous positive airway pressure or CPAP, the gold standard of treatment for mild to severe apnea. But for Yeats and others who are desperate to get a permanent fix to their sleep apnea, the surgery seems like a viable alternative.

This website provides information on the various treatment options for sleep apnea offered at Central Maryland Oral and Maxillofacial Surgery, P.A.

REPOST: A New Strategy To Prevent Or Halt Periodontal Disease Suggested By Research

Periodontitis, in its most severe form, can severely impact systemic health. Now, scientists from the University of Pennsylvania have demonstrated ability in a mouse model to prevent periodontitis from developing and halt its progression, according to this news article from Medical News Today.

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."

Based in Columbia, MD, Dr. Domenick Coletti specializes in oral and maxillofacial surgery. Check out this Facebook page to learn more about Dr. Coletti’s expertise.