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Periodontal Disease May be Linked to Esophageal Cancer According to this Decade-long Study

Esophageal cancer is one of the most common cancers worldwide – eighth to be exact. Not only that but it is also the sixth most common cancer caused deaths.


Only 15-20% of all patients survive in 5 years.


Dr. Jiyoung Ahn is an associate professor and associate director for population science and the Laura and Isaac Perlmutter Center at New York University. She conducted a study, lasting a decade, that was focused on how oral bacteria can lead to periodontal disease and increase a patient’s chance of developing esophageal cancer.


What is Esophageal Cancer?

The esophagus is the long hollow tube within the body that connects the throat and mouth to the stomach.


Esophageal cancer is 3 times more likely to be found in men than women.


Esophageal cancer develops from malignant cells that form inside the esophagus, typically becoming a large tumor or mass that continues to grow.


There are two major types of esophageal cancer that develops in different ways and areas.

  1. Squamous cell carcinoma – cancer is formed inside the lining of the esophagus in thin flat cell. Usually it is found in the upper and middle part of the esophagus.
  2. Adenocarcinoma – within the glandular tissue is where a tumor forms. Typically, it forms in the lower section of the esophagus, near the stomach.

Those who have esophageal cancer may experience the following:

  • Chest pain
  • Heartburn
  • Difficulty swallowing
  • Coughing
  • Vomiting
  • Weight loss
  • Pain behind breastbone or throat region

The reason it has such a low survival rate is because it is caught in the late stages. When it is too far along. If left untreated, it can eventually spread to nearby organs such as lymph nodes, stomach, liver and lungs.


Periodontal Disease

Periodontal disease is an advanced form of gum disease. It stems from gingivitis, or inflammation of the gingival.


Healthy gums should be pale pink and tightly fitted around your teeth. With periodontal disease your gums become swollen or puffy, bleed when brushing or flossing and the gums are receding.


This occurs because of trapped bacteria under patient’s gums causes irritation. When plaque builds up to tartar, it requires professional care to remove.


While gingivitis is reversible, advanced periodontal disease is not. It leads to tooth decay and tooth loss.


With the leading cause of periodontal disease being poor oral health, make sure you have good oral habits. This includes brushing twice and flossing daily and regular dental checkups.


Dr. Ahn's Study

This study was based on prior research on how periodontal disease was associated with cancers in the mouth, head and neck. The study was primarily based specifically on the oral microbiota found as a result of periodontal disease.


Dr. Ahn’s goal was to identify whether the oral microbiota increased the chances of developing either adenocarcinoma or squamous cell carcinoma later.


The study was conducted using 122 000 different samples from patients who participated in the American Cancer Society Cancer Prevention Study II Nutrition and the Nation Cancer Institute Prostate, Lung, Colorectal and Ovarian Cancer Screen Trial.


Dr. Ahn found that after a decade, 106 patients developed esophageal cancer. They extracted their oral DNA and compared to the previous test.


Certain types of bacteria were linked to higher rates of esophageal cancer. Porphyromonas gingivalis connected to squamous cell carcinoma and Tannerella forsythia caused a higher risk of adenocarcinoma.


Both of these bacteria are linked to periodontal disease.


However, there was an interesting discovery regarding other types of bacteria. Several bacteria actually helped lower the chances of patients being diagnosed in the future.


Dr Ahn hopes to conduct more research in the future. She believes that learning more about the different bacteria will allow doctors to identify the disease predictively. It will help diagnose patients earlier and prevent the later stages of the cancer from occurring.

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The Importance of Discussing Health with Patients

It’s important to keep an open conversation with your patients.


Nutrition is the process of providing or obtaining the food necessary for health and growth. But not everyone is the same. You can’t give the same diet to every person. Based on their existing health and genetics requires varying compositions of healthy diets.


As dental hygienists, we can often see early signs of several different makeups. Because we can see these things, it is up to us to start a discussion with patients and highlight details that otherwise may not have considered from you.


Enamel Erosion Signs and Causes

For example, patients often are found with enamel erosion. On the surface of teeth, the hypoplastic enamel could be slick or smoother-looking. This is a result of your enamel being worn down from several dietary related causes like:

  • GERD
  • Alcoholism
  • Eating Disorders
  • Drug Abuse
  • Highly Acidic diets

Teeth may appear discoloured or even transparent, or they are overly sensitive. If this occurs, it is important to have open up a conversation with your dentist for potential causes or solutions.


Recommendations for Enamel Erosion

The problem with the enamel is that is it not a living tissue, so it cannot be regenerated naturally. It can’t be regrown artificially either actually.


Once enamel is gone, it’s gone.


There are however a few things that doctors will suggest minimizing further damage:


1. Use straws

By using straws, patients minimize the contact of liquid to teeth. This helps with sensitive teeth for particularly cold beverages too.


2. Wait 30+ minutes to brush your teeth after eating or drinking

When eating or drinking something, especially something particularly acidic, the tooth enamel softens from the foods. Brushing too soon after eating or drinking can damage the enamel when it is already in a sensitive or weak state.


3. Use a toothpaste without whitening or tartar control

Fluoride toothpaste is the best option because it is known to strengthen teeth and prevent tooth decay.


4. Chew gum with xylitol or fluoride mouthwash

Since xylitol is a natural sweetener and have shown signs that it reduces the amount of bacteria in your mouth that causes cavities. This is because xylitol cannot provide suitable nutrition for the organisms to flourish. The less cavity-causing bacteria in your mouth, the better environment for healthy teeth.


Similarly, fluoride mouthwash is great for protecting your teeth from acids and cavities. It is especially important for children with developing teeth because it can be a preventative.


5. Adapt to a carbohydrate-free or highly hypoglycidal diet

A study investigated the correlation with diet and enamel erosion and found an interesting correspondence. Patients with a carbohydrate-free diet (sugars, starches) reduce acid reflux and clinical manifestations were almost eliminated.


Tooth Decay Signs and Causes

The second example found commonly that dictates a conversation about diet with the dentist is signs of caries.


A high caries rate is related to a diet high in sugar and 51% of Americans have a sweet tooth.


Some signs of tooth decay:

  • Tooth aches or sensitivities
  • Visible holes in teeth
  • Staining on teeth (black, brown or white in colour)
  • Pain when biting

When dental hygienists notice signs of tooth decay, it is time to discuss the patient’s diet. This could lead to further discussions on daily foods consumed.


It’s important to gain insight into when the most sugar is being consumed. Even having one meal high in sugar will increase the likelihood of tooth decay.


Some foods that increase your likelihood of caries are:

  • Soda, juice and sports drinks
  • Candy
  • Fruit snacks
  • Frequent intake of starchy foods
  • Sugar in coffee

In 2014, the World Health Organization reduced the recommended daily sugar intake to 5%. The average adult should be consuming approximately 25 grams or 6 teaspoons of sugar per day. This not only helps prevent caries but also the risk of heart disease and diabetes.


Starting the Conversation

There are countless resources to open up the conversation about the importance of sugar or acidic free diets.

  • Contacting public health and nutrition department for local resources and pamphlets
  • Utilizing to evaluate a patient’s needs

For most patients, they just don’t know what to look for or where to start. So, it is up to dental hygienists to educate and work with the patients so they can have a happier and healthier smile.


It can’t just be one conversation either. Working closely with patients is the key to ensuring they have a well-balanced diet fit for their needs.


The more we communicate with patients the more comfortable they will be. By opening up, it may also alleviate stress and anxiety that often is associated with the dentist.


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Can Chewing Xylitol Gum be Good for Your Teeth?


Most of us chew gum, and we chew it for a variety of reasons. Whether it’s a piece before a first date, or after a particularly strong cup of coffee, many of us use the chewy stuff to keep our mouths smelling clean and fresh as we go about our day.


We see gum promoted in advertisements as something you can use not only to keep your breath smelling fresh; but to whiten and clean your teeth, improving your oral health.


Exaggerated marketing, or bona-fide fact? The answer lies in the ingredients of the gum you choose to chew.


The Potential Benefits


It comes as no surprise that if you’re chewing gum with a lot of sugar in it, it’s going to be bad for your teeth. Sugar promotes the growth of plaque bacteria, which in turn promotes the development of cavities, the decay of enamel, and other issues.


It’s because of this that many companies, such as Wrigley’s, have begun to use both aspartame and a substance known as Xylitol as a substitute for sugar in their products.


A naturally occurring compound that has been shown to prevent tooth decay, the National Centre for Biotechnology Information writes that Xylitol, “reduces the levels of mutans streptococci … in plaque and saliva by disrupting their energy production processes, leading to futile energy cycle and cell death … Consumption of xylitol chewing gum for >3 weeks leads to both long-term and short-term reduction in salivary and plaque S. mutans levels.


Sounds pretty good, doesn’t it? Less bacteria on your teeth means less enamel-eating acid created, which means a healthier mouth. Brands like Confadent advertise and discuss their use of Xylitol as a safe alternative to aspartame, and a plaque reducer.


According to Delta Dental of California, “With xylitol use over a period of time, the types of bacteria in the mouth change and fewer decay-causing bacteria survive on tooth surfaces.


Potential Drawbacks


This sounds like a big-time benefit for your pearly whites, but how do the results compare to projection? Some research shows that the evidence regarding the long term benefits of Xylitol as a dental hygiene product is still unclear.


According to a review published by the American Dental Association in 2015, while there is some evidence that Xylitol may reduce tooth decay over a period of years, the evidence is low quality.


Research published by the Cochrane Library website suggests that there just isn’t enough high quality evidence to confirm that Xylitol prevents tooth decay.


Philip Riley, M.P.H., of the School of Dentistry at the University of Manchester in the UK, is quoted as writing, “More well-conducted, randomized placebo-controlled trials that are large enough (in terms of number of randomized participants) to show a difference, if one exists, are needed.


The Cochrane Library review stresses in its conclusions, “We found some low quality evidence to suggest that fluoride toothpaste containing xylitol may be more effective than fluoride-only toothpaste … The effect estimate should be interpreted with caution due to high risk of bias and the fact that it results from two studies that were carried out by the same authors in the same population.


So, What to Do?


In the end, the conclusions are yours to draw based on the evidence given, but it’s safe to say that chewing gum with Xylitol is better for your teeth than its sugary counterparts. While there needs to be some more research done to better reinforce this conclusion, Xylitol has indeed been shown to reduce cavity causing bacteria in the mouth.


Still, if you want to keep your teeth healthy, at the end of the day no gum is a substitute for regular brushing and flossing. For more information on Xylitol, its benefits and drawbacks, you can check out this article from Access Dental, or this one from Delta Dental.

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Fluoride – What You Should Know


Almost everyone concerned about the health of their teeth brushes regularly, but they may not know exactly why toothpaste performs the cleansing magic it does. They may not even know they also receive fluoride every day in their community’s drinking water.


There are various cleaning components in toothpaste and one of the primary ones is fluoride. The discovery of fluoride's cleaning abilities was a boon in preserving dental health. Toothpaste and tap water then became convenient fluoride delivery systems to aid in the fight against tooth decay.


A Natural Cavity Fighter


The discovery of fluoride’s ability to keep our teeth healthy dates back to the early 20th century. A pair of dentists in Colorado discovered that people in the area had teeth unusually resistant to decay. This was due to the high degree of natural fluoride deposits in the area, which had found their way into the local drinking water. Fluoride became a regular part of toothpaste beginning in 1914.


In the 1940s, a multi-year study began with the goal of determining whether adding fluoride to drinking water made a notable difference for dental health. The results showed a 60-65% decrease in tooth decay in children born after the experiment began. As a result, a number of states in America began water fluoridation programs to improve their citizens’ oral health.


How Flouride Works


The enamel of your teeth is the natural coating that helps to protect them. When children’s teeth are first forming, fluoride combines with the enamel to help stave off decay during a time of life when teeth are particularly vulnerable to cavities. Fluoride remains valuable throughout the life of your teeth by helping protect them against the ravages of sugar and plaque.


Rare Health Risks


As mentioned, almost everyone’s teeth come into regular contact with fluoride through exposure to drinking water and toothpaste. There are additional fluoride supplements in the form of drops or tablets, and it is also an ingredient in mouthwash. The degree of fluoride in the latter is quite high, so do not swallow it.

High doses of fluoride in water can be bad for you, but this would require ingesting a volume of water with fluoride going well beyond what the normal person drinks.


Excessive fluoride can cause conditions known as dental fluorosis and skeletal fluorosis. You can only come down with dental fluorosis as a child, as ingesting too much fluoride at a young age can lead to white spots appearing on your permanent teeth. Fortunately, degrees of this condition ranking above very mild are almost non-existent.


You can also acquire skeletal fluorosis by taking in too much fluoride. However, you would have to have a very high amount on a daily basis for a very long period. As with dental fluorosis, the odds of contracting this problem are extremely rare.


Government oversight helps to ensure the level of fluoride in drinking water does not exceed safe rates. In Ontario, municipalities follow the guidelines laid out in the Safe Drinking Water Act managed by the Ministry of the Environment.

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10 Tips for Oral Health Care


Tooth Care


You know the basics of oral health care: brush twice a day, floss your teeth, avoid sugary snacks, and visit your dentist at least twice a year. Here are 10 tips for oral health care you may not know (and a good refresher if you do!)


1) Brush Smarter


Which is better: a humble manual toothbrush or a fancy electric one? They can be equally effective, but what really matters is your brushing technique.


Don’t just brush up and down or back and forth. Hold the brush at a 45-degree angle and use a gentle, circular motion to clean each surface of the teeth, including the chewing side and the side facing your tongue, for at least two minutes. Brushing harder or faster doesn’t do you any good. In fact, it can actually lead to tooth and gum damage! 


2) Don't Forget to Floss


People often think flossing is secondary to brushing, but they are both essential to good oral health. If you aren’t flossing, you’re leaving a third of the surface of the teeth unclean.


The ideal flossing technique is a forward or backward motion, with the floss forming a curved ‘C’ shape around the tooth. Use a fresh part of the floss for each tooth so you aren’t re-inserting the bacteria you just removed.


3) Pay Attention to Sensitive Teeth


Sensitivity to heat and cold is a common dental complaint, and it’s often a sign of an underlying issue like tooth decay, gum disease, or tooth grinding. It’s important to find and treat the source of tooth sensitivity, even if the pain is mild. See your dentist at the first signs of sensitive teeth.


4) Eat Well and Brush Often


You’ve heard it since you were a kid: sugar causes cavities. True, a diet high in sugar can lead to cavities, but the real cause is plaque, produced by bacteria in your mouth that eats the carbohydrates left on teeth after a meal.


While sugar is the biggest cavity culprit, even healthy food leads to some plaque formation. This is why you should brush after every meal, not just after dessert, and avoid eating or drinking anything, aside from water, after you have brushed your teeth at night.


5) Watch Your Fillings


Do you have fillings? If so, you can usually expect them to last for eight to 10 years. However, some fillings break down earlier than that. When a filling starts to chip and break apart, food and bacteria can get caught underneath, causing decay deep in the tooth. Be sure to make a dental appointment if your tooth filling is not holding up.


6) Wear a Mouth Guard


Mouth guards are standard equipment for contact sports like hockey and football. However, less confrontational sports—such as baseball, skiing, and skateboarding—can also pose a risk of injury to your teeth. Even minor dental injuries can lead to long-term consequences, so a mouth guard is a good investment for anyone who participates in a sport on a regular basis.


7) Read the Ingredients on Toothpaste


What’s in your toothpaste? Different kinds of toothpaste—those for desensitizing, tartar control, whitening, et cetera—consist of different active ingredients. Understanding how these ingredients work will help you choose the right toothpaste for you. You should always choose a toothpaste containing fluoride, even if your tap water is already fluoridated. 


8) Beat Bad Breath


There are many possible causes of bad breath, but poor oral hygiene is a common source. When you don’t brush and floss regularly, odor-causing bacteria can accumulate between teeth and in the back of your throat. However, bad breath can also be a sign of a medical problem, so have a dentist rule out any oral hygiene issues first.


9) Use Mouthwash as Directed


Mouthwash cannot replace proper brushing and flossing, but it can help boost your oral hygiene and control issues like bad breath, plaque, and oral sores. Be sure to read the instructions on the bottle before using it. Depending on the ingredients, the manufacturer may recommend using it either before or after brushing or flossing for the best results.


10) Make Regular Dental Appointments


Do not wait until you have a problem to see your dentist! Even if your teeth and gums seem fine, the dentist might notice things you can’t feel or see. Scheduling regular dental exams will help you detect and treat cavities, tooth decay, gingivitis, and other oral health issues before they become painful and/or expensive to fix.

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First Data On New Dental Fillings To Repair Tooth Decay Revealed


Amalgam Fillings


This might be a shock, but its true: data indicates that over 80 percent of the population in the United Kingdom has at least one filling in their teeth, seven fillings being the average. In addition to this, dentists fill eight million cavities with amalgams each year.


There are many mercury-based amalgams, but thanks to new data released by Professor Robert Hill, this may not need to be the case much longer. This data, regarding new bioactive glass composites, indicates a prolonged composite life and a lessened need for amalgams with mercury. This is major progress in restorative materials for everyone’s teeth.


The bioactive glass composites, according to Professor Hill, possess a unique ability to release fluoride. Fluoride, as you know, is an essential component in oral health. It is a mineral often found in soil, water, and some food. It improves teeth’s resistance to decay, and may even reverse tooth decay that has already started. The bioactive composites can also release high quantities of phosphate and calcium, two other elements needed to form strong tooth mineral.


The bioactive glass composites, according to Professor Hill, possess a unique ability to release fluoride. Fluoride, as you know, is an essential component in oral health. It is a mineral often found in soil, water, and some food. It improves teeth’s resistance to decay, and may even reverse tooth decay that has already started. The bioactive composites can also release high quantities of phosphate and calcium, two other elements needed to form strong tooth mineral.


The benefits of the new bioactive glass composite have caught the attention of the dental community. It is definitely clear these fillings can provide significant improvements in oral health when patients require dental fillings. BioMin Technologies has even licensed the technology of the bioactive glass and hopes to find a use for the remineralizing in dental products with restorative properties.


In recent developments in the dental industry, there is significant pressure to reduce and hopefully eliminate the use of amalgams with mercury by the year 2020. In fact, Richard Whatley, who happens to be the CEO of BioMin Technologies, indicates this is actually included in a number of international agreements. The good news is this new bioactive glass composite is a great help in the reduction of mercury-based amalgams. The fillings, as described previously, do not simply put teeth into stasis. They actually help to reverse the effects of tooth decay and return your teeth to their optimum health.


These new dental fillings, along with proper oral hygiene practices like regular brushing (twice a day) and flossing (most recommend once a day, or at least with meals where food often gets caught in your teeth), are sure to help the overall oral health of everyone, particularly with the scourge of tooth decay.



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Can Chemicals in Food Packaging Damage Children’s Teeth?


In recent years, there has been increased concern about the harmful effects of chemicals found in everyday products. Endocrine disruptors such as BPA are known to increase the risk of cancer, birth defects, and other conditions.


Now, research has linked these chemicals to MIH – a condition that irreversibly damages children’s teeth. The study found that early exposure to chemicals found in food packaging and fungicides may interfere with the growth of dental enamel.


Molar incisor hypermineralisation (MIH) is a condition that causes defects in a child’s tooth enamel. MIH weakens the enamel of permanent molars and incisors, causing the teeth to be cavity-prone and sensitive to hot and cold. The condition affects up to 18% of children aged six to nine.


Molar incisor hypermineralisation (MIH) is a condition that causes defects in a child’s tooth enamel. MIH weakens the enamel of permanent molars and incisors, causing the teeth to be cavity-prone and sensitive to hot and cold. The condition affects up to 18% of children aged six to nine.


To study the effects of endocrine disruptors on enamel, Dr. Katia Jedeon and his colleagues experimented on rats. They gave the rats daily doses of endocrine disruptors, in an amount equivalent to the average dose a human would experience daily. The exposure started in utero and continuing for a month after birth – the period when tooth enamel develops. 


After 30 days, they collected cells from the surface of the rats’ teeth and analyzed them. The chemicals had a clear effect. Two genes that control the creation of tooth enamel, Klk4 and SLC5A8, were expressed differently.


The study also revealed a potential cause of this effect.


In the second part of the experiment, the researchers collected ameloblast cells, which play a key role in forming tooth enamel. They found that sex hormones, like estrogen and testosterone, boost the expression of the genes that make tooth enamel. Endocrine disruptors can block the effect of male sex hormones. This indicates the chemicals may lead to MIH by blocking the hormones needed for development of tooth enamel.


Unlike bone, tooth enamel does not have living cells. This means it cannot regrow, so any damage to the enamel is permanent. However, parents can protect children by reducing their exposure to endocrine disruptors.


"Tooth enamel starts at the third trimester of pregnancy and ends at the age of 5, so minimizing exposure to endocrine disruptors at this stage in life as a precautionary measure would be one way of reducing the risk of enamel weakening,” says Dr. Jedeon. 

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