Wednesday, February 24, 2010

Oral hygiene curbs pneumonia risk in elderly

NEW YORK (Reuters Health) - Among nursing home residents, having a nursing aide help them maintain good oral hygiene lowers the odds of them dying from pneumonia, a study suggests.

Pneumonia is the leading cause of death in elderly nursing home residents, Dr. Carol W. Bassim and colleagues point out in the Journal of the American Geriatrics Society. "Several studies have shown that poor oral hygiene or inadequate oral care are also associated with pneumonia," they add.

Bassim, now at the National Institute of Dental and Craniofacial Research in Bethesda, Maryland, and her associates studied the impact of enhanced oral hygiene care for residents in two wards at a Florida nursing home compared with residents in two other wards.

Initially, there was no difference in the mortality rate from pneumonia between the two groups. However, patients in the oral care group were older and more disabled than those who did not receive oral care, and once this was taken into account the risk of dying from pneumonia was more than three times higher in patients who did not receive oral care.

Pneumonia in the elderly is often triggered by aspirating saliva or food. It is likely that the risk of pneumonia "depends on the quality and the quantity of the oropharyngeal contents of a patient at the time of respiratory inoculation or introduction," Bassim and colleagues explain.

"The quantity of saliva inhaled and a predisposition to gross aspiration events may not be modified through oral care," they add, "but this study indicates that oral care may be involved in significantly reducing the harmful quality of the intra-oral environment, reducing the risk of a patient dying from pneumonia."

SOURCE: Journal of the American Geriatrics Society.

Stomach Ulcer Bug Causes Bad Breath

Stomach Ulcer Bug Causes Bad Breath

acteria that cause stomach ulcers and cancer could also be giving us bad breath, according to new research. For the first time, scientists have found Helicobacter pylori living in the mouths of people who are not showing signs of stomach disease.

The mouth is home to over 600 different species of bacteria, some of which can cause disease. Helicobacter pylori has recently been shown to cause stomach ulcers and is also responsible for a large proportion of gastric cancers. Scientists estimate that between 20 and 80 % of people in the developed world and over 90 % of people in the developing world carry the bacterium.

"Recently, scientists discovered that H. pylori can live in the mouth," said Dr Nao Suzuki from Fukuoka Dental College in Fukuoka, Japan. "We wanted to determine whether the bacteria can cause bad breath, so we tested patients complaining of halitosis for the presence of H. pylori."

The researchers found the bacteria in the mouths of 21 out of 326 Japanese people with halitosis (6.4%). In these people, the concentration of a bad breath gas and the level of oral disease was significantly higher. In patients with periodontal (gum) disease, 16 of 102 people (15.7%) had H. pylori in their mouths.

"Halitosis is a common problem in humans, and bad breath is largely caused by periodonitis, tongue debris, poor oral hygiene and badly fitted fillings," said Dr. Suzuki. "Bacteria produce volatile compounds that smell unpleasant, including hydrogen sulphide, methyl mercaptan and dimethyl sulphide. Doctors often measure the levels of these compounds to diagnose the problem. Gastrointestinal diseases are also generally believed to cause halitosis."

Patients who were carrying H. pylori had more blood in their saliva and were also carrying Prevotella intermedia, which is one of the major periodontal bacteria.

"Although the presence of H. pylori in the mouth does not directly cause bad breath, it is associated with periodontal disease, which does cause bad breath," said Dr. Suzuki. "We now need to look into the relationship between H. pylori in the mouth and in the stomach. We hope to discover the role of the mouth in transmitting H. pylori stomach infections in the near future."

Suzuki et al. Detection of Helicobacter pylori DNA in the saliva of patients complaining of halitosis. Journal of Medical Microbiology, 2008; 57 (12): 1553 DOI:

Adding flossing to your hygiene regimen can add 10 years to your life

Sometimes senior Kelsey Stein flosses three times a day.

"I floss twice a day; once at night before I go to bed and then in the morning when I wake up," Stein said. "Sometimes I floss in between, too, if I need to."

Stein's habit of flossing often will not only benefit her oral health, but can also benefit her body's overall health. In fact, that little piece of string that Stein keeps in her purse has the ability to add up to 10 years to her life span.

Flossing has its dental benefits preventing gingivitis and other gum diseases, but a recent study published in "Circulation: Journal of the American Heart Association" looked at the link between the mouth and chronic diseases.

Faith Yingling, director of Wellness, said the study found people with higher blood levels of specific disease-causing bacteria in the mouth were more likely to experience hardening of the arteries in the carotid artery in the neck.

"Atherosclerosis, also called 'hardening of the arteries,' develops when deposits of fats and other substances in your blood begin to stick to the sides of your arteries. These deposits, called plaques, can build up and narrow your arteries, clogging them like a plugged-up drain," Yingling said. "If these plaques ever block theblood flow completely, you could have a heart attack or stroke, depending on the location of the blockage."

Bacteria from the mouth can enter the bloodstream through the gums and this has been found among artery plaque, which directly contributes to arterial blockage.

Lee Meserve, a biology professor and pre-dentistry adviser at the University, said when it comes to the spaces between the teeth where plaque hides, brushing vigorously won't be enough to remove it.

"Plaque is essentially a collection of microorganisms that like it where it's dark and moist," Meserve said. "Some of those mircoorganisms could potentially spread to the rest of the body."

When people floss they are removing that plaque and harmful bacteria from between the teeth, which in turn helps prevent gum inflammation -- another way in which mouth infections can affect the rest of the body.

"One of the body's natural responses to infection is inflammation (swelling)," Yingling said. "It's possible that as these oral bacteria travel through your body, they trigger a similar response, causing the blood cells to swell. This swelling could then narrow an artery and increase the risk of clots."

Health professionals agree on the benefits of flossing, but disagree when it comes to how many years flossing can add to a person's life span.

Dr. Michael Roizen, chief wellness officer at the Cleveland Clinic, believes that flossing ranks in the top five healthy habits for a long life and believes it can add up to 6.4 years to a person's life. But Dr. Thomas Perls, associate professor at the Boston University School of Medicine, allots a year and a half addition to a life span for daily flossing.

No matter how many years flossing can add to a person's life, it can still help prevent heart disease while also preventing bad breath moments.

"[Flossing] can also help prevent cavities, gingivitis, and tooth loss," Yingling said. "In the short-term, flossing can help reduce tartar build-up, remove food particles and plaque, and improve the smell of breath."

Floss Facts:

The proper way to floss according to the American Dental Hygienists' Association (provided by Dr. Faith Yingling):

  • Wind 18" of floss around middle fingers of each hand. Pinch floss between thumbs and index fingers, leaving a 1"- 2" length in between. Use thumbs to direct floss between upper teeth.
  • Keep a 1" - 2" length of floss taut between fingers. Use index fingers to guide floss between contacts of the lower teeth.
  • Gently guide floss between the teeth by using a zig-zag motion. Do not snap floss between your teeth. Contour floss around the side of the tooth.

Gum Disease and your Health

As this body of research surrounding the Oral-Systemic Connection has grown scientists from all directions have discovered that they are all looking at the same thing. Systemic inflammation is now considered to be one of the dominant common denominators in many of today’s major illnesses. We now know that increased pro-inflammatory proteins in the body (i.e. cytokines and chemokines) has profound life and death consequences.

Pregnancy complications soar by a factor of 255% for women with gum disease. (Ask any physician about the oxytocic effects of increased PGE2 levels during pregnancy!)

For diabetics, mortality in adults without gum disease rises from 3% to almost 28% when gum disease is present.

C-reactive protein is now recognized as a more significant risk factor for heart disease and strokes than is high cholesterol levels.

Cancers of inflammatory origin (colon), Alzheimer’s disease, osteoporosis, kidney disease, and other diseases and conditions related to systemic inflammation are now entering this arena.

Suddenly, dentistry is beginning to take a more central role in the quest to identify and remove sites of chronic infection and inflammation within the body. This sudden increase in scientific literature and research is destined to continue to grow, no doubt snowballing its way onto the front stage of modern dentistry and medicine. Indeed, many physicians and medical specialists are aware of these changes, but many are as yet unsure what to do about it.

Physicians now find themselves in a particularly vulnerable spot. They will be held accountable by malpractice attorneys and the new standards-of-care, for people with gum infections – especially if they have heart attacks, strokes or have pregnancy complications or diabetes.