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.

Evolving areas in oral and maxillofacial surgery

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There are a vast number of accidents that happen in the world on a given time. Surgeons like Dr. Domenick Coletti suggest that as facial and neck injuries associated with interpersonal violence increase, the demand for high-quality medical service also escalates. Medical specialties, such as oral and maxillofacial surgery, are continuously being improved to avoid prolonged physical disabilities and reduce death tolls.

Key areas in oral and maxillofacial surgery that are currently evolving include the following:

Osteo-distraction
This procedure aims to make cuts in the bone without actually moving it at the time of surgery. To achieve this, distracters are applied and the bone is lengthened slowly over several weeks. Slowing the bone’s growth means that there is also enough time for soft tissues to grow, thus minimizing the movements of the bones.

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Navigational technology
This technique uses computer and CT modeling to precisely position bones or prosthetic implants of the facial skeleton during the time of surgery. The use of this procedure can optimize the final result and lessen the complications or the need for further procedures.

Microvascular surgery
This procedure involves a highly advanced way of removing tissue from one part of the body and transferring it to another. Although this technique is already well-established, many factors are still being considered to ensure it efficacy and safety.

Implantology
Now approaching more than four decades of availability, facial prostheses and bone-anchored hearing aids are some of today’s most readily used procedures in oral and maxillofacial surgery. Optimization of the functional and cosmetic results from these procedures is currently developing fast and reliable.

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Visit this website for more information on oral and maxillofacial surgery.

ScienceLine: Why Do We Have Wisdom Teeth?

By ScienceLine's Rachele Cooper. 2007.

Not just a year ago my wisdom was tucked tightly away in my mouth, just below the surface of my gums, bothering no one. And then, last fall, it decided to emerge in the shape of three large, impacted teeth that had to come out. As I lay under the dental surgeon’s tools over the holidays, slowly coming out of my anesthesia, I wondered to myself: where did these teeth come from?

Anthropologists believe wisdom teeth, or the third set of molars, were the evolutionary answer to our ancestor’s early diet of coarse, rough food – like leaves, roots, nuts and meats – which required more chewing power and resulted in excessive wear of the teeth. The modern diet with its softer foods, along with marvels of modern technologies such as forks, spoons and knives, has made the need for wisdom teeth nonexistent. As a result, evolutionary biologists now classify wisdom teeth as vestigial organs, or body parts that have become functionless due to evolution.

Why do wisdom teeth wait to erupt long after the tooth fairy has stopped leaving change under your pillow? Tooth development, from baby primary teeth to permanent teeth, takes place in an organized fashion, over a course of years, with the first molar erupting around the age of six and the second molar erupting around the age of 12. Wisdom teeth, which begin forming around your tenth birthday, are the last set of molars on the tooth-development timeline, so they usually don’t erupt until you are between the ages of 17 and 25. Because this is the age that people are said to become wiser, the set of third molars has been nicknamed “wisdom teeth.”

Some people never get wisdom teeth, but for those who do, the number may be anywhere from one to four – and, on very rare occasions, more than four, according to a study published in the Journal of the Canadian Dental Association. Scientific literature has yet to be able to explain why the number of teeth per individual varies, but for those who do get these extraneous, or supernumerary, teeth, it can lead to all sorts of problems.

Because human jaws have become smaller throughout evolutionary history, when wisdom teeth form they often become impacted, or blocked, by the other teeth around them. Also, if the tooth partially erupts, food can get trapped in the gum tissue surrounding it, which can lead to bacteria growth and, possibly, a serious infection.

Wisdom teeth that do not erupt but remain tucked away can also lead to oral problems, such as crowding or displacement of permanent teeth. On very rare occasions, a cyst (fluid filled sac) can form in the soft tissue surrounding the impacted wisdom tooth. These cysts can lead to bone destruction, jaw expansion, or damage to the surrounding teeth. Even more uncommonly, tumors can develop in the cysts, which can lead to the jaw spontaneously breaking if the tumor or cyst grows too much.

There are patients that develop wisdom teeth that function just as well as every other tooth in the mouth, and as a result they do not need to go under the knife. But no one can predict when third molar complications will occur, and the American Association of Oral and Maxillofacial Surgeons estimates that about 85 percent of wisdom teeth will eventually need to be removed.

If you do have wisdom teeth that you are thinking of having taken out, the association strongly recommends that patients remove wisdom teeth when they are young adults, in order to “prevent future problems and to ensure optimal healing.” People who have oral surgery after the age of 35 have higher risks for complications, harder surgeries, and longer healing times than those who get them removed in their late teens or early 20’s. The best time to get those suckers out is when the roots are about two-thirds formed, which is generally between the ages of 15 to 18. Though I was…well, a lady never tells her age, but suffice it to say that for me, a weeks long lack of locution and a diet of soup and applesauce was worth no longer having pain in my jaw and food in my teeth.

Domenick Coletti: Healing through platelet rich growth factor

Platelets are irregularly shaped cell fragments that are a vital part of the blood clotting process. Dental surgeons like Dr. Domenick Coletti apply platelet rich growth factor (PRGF) in many dental operation procedures. The substance, relatively available and inexpensive, is fast becoming a valuable part in assisting the healing process post op.

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Also known as thrombocytes, platelets are one of the three principal cells found in blood. These are colorless cells that lack nuclei and are a source of growth factors. During the clotting process, these cells become more rounded and mesh together, trapping the blood in place. In addition, they release chemicals that cause surrounding cells to release fibroblasts, which facilitate healing.

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This important role in wound repair is what makes PRGF desirable. To create PRGF, dentists like Dr. Domenick Coletti would extract 20 to 40 cc of the patient’s own blood to get the platelets.

Using PRGF is advantageous in many ways. First, it accelerates the body’s own healing processes. In addition, because it is extracted from the patient, it is devoid of any potentially harmful pathogens and would have no issues on compatibility. Finally, it is easy to make, taking at most 15 minutes, and cost-effective as it is created in a centrifuge machine in the clinic and not taken from a hospital or blood bank.

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More information on PRGF and its applications can be accessed from Dr. Domenick Coletti’s website.

Central Maryland Oral Maxillofacial Surgery, PA: Treating nerve injuries

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Central Maryland Oral Maxillofacial Surgery, PA offers a full scope of oral and maxillofacial surgery procedures performed by its team of physicians led by Domenick Coletti, DDS, MD.

Nerve injuries can be caused by trauma, surgery, and sometimes dental procedures such as root canal fillings, wisdom teeth removal, and insertion of implants. Soft tissue lacerations and facial bone fractures can cause significant nerve injuries, too. Moreover, local anesthetics can trigger nerve injury.

A person with nerve injury experiences a variety of unpleasant sensations. Some of the symptoms include:

• Numbness
• Tingling
• Crawling sensation
• Burning sensation
• Hypersensitivity of the affected area
• Electric shock sensation

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These sensations, according to doctors like those at Central Maryland Oral Maxillofacial Surgery, PA, can interfere with normal activities such as chewing, speaking, and drinking. If these symptoms persist longer than a month following surgery, the nerve injury will likely not resolve on its own without other treatments or surgical intervention.

Treatment options Depending on the type and severity of injury, one or more of the following procedures can be done:

• Decompression -- The nerve is relieved of any material or tissue pressuring it.
• Nerve grafting -- The lost portion of the nerve is replaced by a sensory nerve graft taken from either the posterior portion of the lower leg or the neck.
• Neurolysis -- The removal of the scar tissue inside the nerve.
• Suturing – The two ends of the nerve that are severed are held in place with precise stitches.

• Removal – Taking out of any abnormal nerve tissue or a neuroma.
Chances of recovery are high if the injury is treated immediately. Central Maryland Oral Maxillofacial Surgery, PA offers treatments for nerve injuries.

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More information can be accessed at this website.

Domenick Colletti: When to get dental implants

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On occasion, some people might find the teeth in their jaws to ultimately be lacking—literally. When done by professionals such as Dr. Domenick Coletti, “death” or the atrophy of the surrounding jawbone and a myriad of other problems can be avoided through the use of dental implants. Today, implants can offer the necessary structural support sought by people affected by tooth loss and can support not only replacement teeth but also dentures.

While many assume dental implants to be a purely cosmetic affair, the complications that arise from an insufficient set of teeth can have adverse effects on both a person’s wellbeing and the overall integrity of the jawbones. Among the complications include the jaw’s tendency to fill in the space with new teeth, which can cause problems regarding dental hygiene. In addition, people affected by tooth loss may find it difficult to chew, which may lead to dietary defects.

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Moreover, specialists like Dr. Domenick Coletti say that death of the surrounding bone cells may result due to lack of use, causing atrophy of the jawbone. By the time action is taken, there might not be enough bone material for future implants to take place, thus necessitating a bone graft.

Seeking dental implants early on is a wise decision because it can prevent further complications. Bone grafts, on the other hand, can be sought to first reverse the effects of atrophy.

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More information on implants from Dr. Domenick Coletti and how death of the surrounding bone and other conditions can be avoided through them can be accessed on his practice’s website.

Dr. Domenick Coletti: What is teeth grinding?

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Most people don’t realize that they might be putting their teeth in harm even while they sleep. Dentists, like Dr. Domenick Coletti, agree that it is important to understand the causes and effects of teeth grinding before complications develop.

Medically known as bruxism, teeth grinding usually occurs while a person is asleep. This condition is believed to be caused by having crooked or missing teeth or an abnormal bite, and is often associated with stress and anxiety. Since people usually experience this condition while they are asleep, most of them are unaware that they grind their teeth and only realize it when other people hear the grinding or when they wake up with a sore jaw or headache.

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Although teeth grinding may appear to be harmless, dentists, like Dr. Domenick Coletti, agree that it can be harmful once it becomes chronic. Those who grind their teeth constantly may suffer from fractured or loose teeth, tooth loss, hearing loss, temporomandibular disorders, and even a change in facial appearance.

To stop teeth grinding, patients may ask their dentist for a mouth guard which they can wear while they are asleep. They can also seek help in stress management if their condition is caused by stress or anxiety. Cutting back on caffeinated and alcoholic drinks can also help ease their anxiety.

Domenick Coletti image credit: centralmarylandoms.com

Based in Columbia, MD, Dr. Domenick Coletti specializes in oral and maxillofacial surgery. To learn more, visit www.centralmarylandoms.com.