The research, conducted in mice and using human cells and plaque samples, lays the groundwork for a non-invasive treatment for gum disease that people could apply to the gums at home to prevent or treat gum disease.

Gum disease (also known as periodontitis or periodontal disease) is one of the most prevalent inflammatory diseases, affecting nearly half of adults 30 and older. It is marked by three components: inflammation, an imbalance of unhealthy and healthy bacteria in the mouth, and destruction of the bones and structures that support the teeth. Uncontrolled gum disease can lead to painful and bleeding gums, difficulty chewing, and tooth loss.

“No current treatment for gum disease simultaneously reduces inflammation, limits disruption to the oral microbiome, and prevents bone loss. There is an urgent public health need for more targeted and effective treatments for this common disease,” said Yuqi Guo, an associate research scientist in the Department of Molecular Pathobiology at NYU Dentistry and the study’s co-first author.

Past research has linked increased succinate—a molecule produced during metabolism—to gum disease, with higher succinate levels associated with higher levels of inflammation. Guo and her colleagues at NYU College of Dentistry also discovered in 2017 that elevated levels of succinate activate the succinate receptor and stimulate bone loss. These findings made the succinate receptor an appealing target for countering inflammation and bone loss—and potentially stopping gum disease in its tracks.

Strengthening the link between succinate and gum disease

The researchers started by examining dental plaque samples from humans and plasma samples from mice. Using metabolomic analyses, they found higher succinate levels in people and mice with gum disease compared to those with healthy gums, confirming what previous studies have found.

They also saw that the succinate receptor was expressed in human and mouse gums. To test the connection between the succinate receptor and the components of gum disease, they genetically altered mice to inactivate, or “knock out,” the succinate receptor.

In “knockout” mice with gum disease, the researchers measured lower levels of inflammation in both the gum tissue and blood, as well as less bone loss. They also found different bacteria in their mouths: mice with gum disease had a greater imbalance of bacteria than did “knockout” mice.

This held true when the researchers administered extra succinate to both types of mice, which worsened gum disease in normal mice; however, “knockout” mice were protected against inflammation, increases in unhealthy bacteria, and bone loss.

“Mice without active succinate receptors were more resilient to disease,” said Fangxi Xu, an assistant research scientist in the Department of Molecular Pathobiology at NYU Dentistry and the study’s co-first author. “While we already knew that there was some connection between succinate and gum disease, we now have stronger evidence that elevated succinate and the succinate receptor are major drivers of the disease.”

A novel treatment

To see if blocking the succinate receptor could ameliorate gum disease, the researchers developed a gel formulation of a small compound that targets the succinate receptor and prevents it from being activated. In laboratory studies of human gum cells, the compound reduced inflammation and processes that lead to bone loss.

The compound was then applied as a topical gel to the gums of mice with gum disease, which reduced local and systemic inflammation and bone loss in a matter of days. In one test, the researchers applied the gel to the gums of mice with gum disease every other day for four weeks, which cut their bone loss in half compared to mice who did not receive the gel.

Mice treated with the gel also had significant changes to the community of bacteria in their mouths. Notably, bacteria in the Bacteroidetes family—which include pathogens that are known to be dominant in gum disease—were depleted in those treated with the gel.

“We conducted additional tests to see if the compound itself acted as an antibiotic, and found that it does not directly affect the growth of bacteria. This suggests that the gel changes the community of bacteria through regulating inflammation,” said Deepak Saxena, professor at NYU Dentistry and the study’s co-senior author.

The researchers are continuing to study the gel in animal models to find the appropriate dosage and timing for application, as well as determine any toxicity. Their long-term goal is to develop a gel and oral strip that can be used at home by people with or at risk for gum disease, as well as a stronger, slow-release formulation that dentists can apply to pockets that form in the gums during gum disease.

“Current treatments for severe gum disease can be invasive and painful. In the case of antibiotics, which may help temporarily, they kill both good and bad bacteria, disrupting the oral microbiome. This new compound that blocks the succinate receptor has clear therapeutic value for treating gum disease using more targeted and convenient processes,” said Xin Li, professor at NYU Dentistry and the study’s lead author.

Additional study authors include Scott Thomas, Yanli Zhang, Bidisha Paul, Sungpil Chae, Patty Li, Caleb Almeter, and Angela Kamer of NYU College of Dentistry; Satish Sakilam and Paramjit Arora of NYU Department of Chemistry; and Dana Graves of the University of Pennsylvania School of Dental Medicine.

The research was supported by the National Institutes of Health (DE027074, DE028212, AG068857, and R01DE017732); the development of the gel and oral strip is funded by the National Institute of Dental and Craniofacial Research (R41DE028212). Li and Saxena are the co-founders of Periomics Care, an early-stage biotechnology company within NYU Dentistry.

About NYU College of Dentistry

Founded in 1865, New York University College of Dentistry (NYU Dentistry) is the third oldest and the largest dental school in the US, educating nearly 10 percent of the nation’s dentists. NYU Dentistry has a significant global reach with a highly diverse student body.

Visit dental.nyu.edu for more.

Drawing blood in the dental office is a regular occurrence. It’s unavoidable, really. Gums bleed when we nick them, floss them, and move them around during procedures. Occasionally, the tongue will bleed when it’s pinched by a suction, or a cheek will bleed when it’s scraped by a dry angle. But now, it’s becoming common practice for blood to be drawn at the dental office intentionally! Enter PRP, PRF, and PRGF.

Platelet-rich plasma is PRP.

Platelet-rich growth factor is PRGF.

Platelet-rich fibrin is PRF.

If these acronyms “promote and accelerate wound healing, regulate inflammation, and improve soft and hard tissue regeneration,” then, which one might be the best option? Let’s look at how they are the same, how they are different, which one is used for what, and which is the best option depending on one’s need.

How Are They the Same?

PRP, PRGF, and PRF all require the obtaining of an autologous blood sample to extract the platelet-rich layer used for accelerated healing in oral surgical procedures. In other words, they all require taking a blood sample from the patient to aid in their healing.

The samples in each case are spun in a centrifuge to separate the blood into three layers. The heaviest red blood cells sink to the bottom. The middle platelet-rich layer is suspended above that. The very light platelet-sparse layer is at the top.

The speed at which a blood sample is spun will yield a different concentration of certain blood components in these layers. The gel-like layer of platelets suspended in plasma in the middle is collected and injected or applied into the site of injury (surgery) to accelerate the patient’s healing following a surgical procedure.

How Are They Different?

With so many acronyms, it’s easy to feel lost. Many times, the terms might be used synonymously when in fact they’re each a little different.

In simplest terms, PRP and PRGF can be thought of as more of a gel-like product and PRF as a more clot-like product. But just for fun, lets dive in a little deeper.

PRP, the older approach, hails from the “dark ages” of 1997. (I kid—sort of.) It is primarily used for soft-tissue regeneration rather than osteogenesis and requires more blood than PRF. PRP is spun at a higher speed, making all the heavy white blood cells and stem cells sink to the bottom of the tube, where they are not collected in the sample.

Additional research resulted in the discovery that a higher concentration of platelets with the inclusion of white blood cells and stem cells in the sample would be even more therapeutic. Enter PRF. It turns out the inclusion of white blood cells aided in avoiding postoperative infection, and the presence of stem cells had obvious regenerative capacity.

Since PRF is spun at a lower speed, a higher concentration of white blood cells, stem cells, and platelets remains in the middle plasma layer, protected from the mechanical damage that happens when spun at a higher speed (like PRP) along with a higher platelet concentration.

PRF ends up producing about twice as many platelets as found in the body compared to PRP. This fact is important to point out since platelets are responsible for releasing growth factors that repair and help regrow tissue and, combined with fibrin, clot the blood, forming a plug that seals up blood vessels to prevent the loss of blood.

It makes sense that a higher platelet concentration results in a greater yield of growth factor. The growth factor in PRF is slowly released over about seven to 10 days due to its fibrin network, whereas PRP releases growth factor immediately in the absence of a dense fibrin network. 

Unlike PRF, PRP sometimes requires the initial addition of an anticoagulant to prevent the blood sample from clotting too much and too quickly. The most commonly used anticoagulant in PRP is acid citrtate dextrose (ACD), which “binds calcium and prevents the coagulation proteins from initiating the clotting cascade.” PRF doesn’t need an anticoagulant.

After being spun, PRP is collected and usually mixed with bovine thrombin or calcium chloride. Both are coagulants that activate a PRP sample, prompting fibrinogen to convert to fibrin, resulting in a more gel-like product. Centrifugation for PRF results in a clot that is plucked out of the test tube after it is spun.

Finally, PRGF offers growth factor and blood clotting at the site of wound healing, but it is the most costly and does not yield a lot of fibrin. PRGF is very similar to PRP in the way that it is collected and prepared but does not require animal thrombin for coagulation. However, it still requires the addition of calcium chloride as a post centrifugation fibrinogen activator (coagulator) like PRP and is also a more gel-like product.

Which One Is Used for What?

All in all, PRP and PRF overlap all over the place in their applications. But again, it’s hard to avoid the fun of diving in a little deeper.

As mentioned, after collection, PRP is mixed with a coagulating activator, prompting fibrinogen to convert to fibrin, resulting in a gel-like product. The PRP can then be used at extraction sites and is often used in cases where the surgical site can be reapproximated or covered easily with the patient’s own gum tissue since it is not as dense as PRF. Sometimes, it is used to hydrate bone graft or coat implants.

PRGF, like PRP, is a liquid product that requires an activator coagulant (calcium chloride) to elicit the conversion of fibrinogen to fibrin to achieve a gel-like consistency and is then used commonly in the same way that PRP is without the addition of an anticoagulant at the start. PRGF is not the superior option for hard-tissue healing since it lacks the stem cells found in PRF but is still good for coating an implant before it is placed.

PRF, a clot product, is most often used for guided tissue and bone (both hard and soft tissue) regeneration. Because PRF can be used as a membrane or plug, it is often used in root coverage procedures, socket and soft-tissue grafting procedures, bone grafting and management around implants, and recession cases. It can even be used in cosmetic facial surgeries and in the form of “I-PRF” in the case of temporomandibular joint (TMJ) pain.

Wait… There Are Sub-Acronyms, Too?

Oh yes.

Let’s close this out with a note on three slight variations of PRF used depending on the application:

• L-PRF: leukocyte and platelet-rich fibrin
• A-PRF: advanced platelet-rich fibrin
• I-PRF: injectable platelet-rich fibrin

First, to simplify, these slight variations of PRF are really just the result of different speed and time of spin in the centrifuge, yielding a higher percentage of different cell types over the others. A-PRF and L-PRF are both clot-like results, and I-PRF is a liquid gel.

L-PRF is great for decreasing the chances of postoperative infection, given it is rich in white blood cells, leukocytes to be more specific, which helps decrease inflammation. It is great for extraction sites by minimizing bone loss, and it can even be used to revitalize the pulp of a tooth to avoid the need for root canal or extraction in some cases.

A-PRF is spun for the same amount of time as the traditional PRF sample but at a slower speed, lending a more uniform spread of growth factor in the clot. It also is used for the same applications as PRF. The slow spin generally yields a greater red blood cell inclusion, as you can imagine.

I-PRF is the injectable form of PRF. It can be used as treatment for TMJ pain by being injected directly into the joint! It makes delivering stem cells directly into the joint possible because it is liquid as it is being injected and clots after the fact. It helps enhance vascularity. It’s useful in bone grafting where it can hydrate the bone initially. As it firms up, the graft is easier to place because the tiny bone particles can no longer flake out.

So, Which Is the Best Option?

PRF results in a greater concentration of platelets. With that comes a greater concentration of growth factor and fibrin and, therefore, more efficacious healing—not to mention the growth factor is released more slowly in PRF, so the product keeps working well beyond the time of surgery. Stacked up against PRP and PRGF, PRF appears to be winning.

Looking at the brief overview of which one is used for what, we can see a lot of overlap between applications. PRF is easier to collect and prepare. It also does not require as much blood or any additives. Plus, it can be used to heal of both hard and soft tissue while stimulating new bone and new blood vessel formation.

So, PRF appears to reign supreme when it comes to autologous platelet-rich therapies in dentistry. It is simply a choice between using the everyday PRF form or the L-PRF, A-PRF, or I-PRF applications, depending on the procedure.

All in all, it appears that drawing blood at the dental office isn’t going away and, in fact, may be beneficial for optimal healing!

References

1. Giannini S; Cielo A; Bonanome L; Rastelli C; Derla C; Corpaci F; Falisi G, European review for medical and pharmacological sciences [Eur Rev Med Pharmacol Sci], ISSN: 2284-0729, 2015; Vol. 19 (6), pp. 927-30; Publisher: Verduci; PMID: 25855914, Database: MEDLINE Complete PubMed(2)
2. The International Cellular Medical Society. (n.d.). Guidelines for the Use of Platelet Rich Plasma. The International Cellular Medical Society. http://www.cellmedicinesociety.org/attachments/206_ICMS%20-%20Guidelines%20for%20the%20use%20of%20Platelet%20Rich%20Plasma%20-%20Draft.pdf. (3)
3. Kobayashi E;Flückiger L;Fujioka-Kobayashi M;Sawada K;Sculean A;Schaller B;Miron RJ; (2016). Comparative release of growth factors from PRP, PRF, and advanced-PRF. Clinical oral investigations. https://pubmed.ncbi.nlm.nih.gov/26809431/. (6)
4. PRF vs PRP: PRF stands out as superior compared TO PRP. (2020, August 09). Retrieved April 05, 2021, from https://www.dentaliceberg.com/prf-prp-prgf-which-one-is-the-best/#:~:text=PRF%20stands%20out%20as%20a,the%20blood%20into%20distinct%20layers. (1)
5. Rehan, K. (2020, April 20). A Quicker Way to Heal? PRP and PRF in Dentistry. constituent. https://www.agd.org/constituent/news/2020/04/20/a-quicker-way-to-heal-prp-and-prf-in-dentistry. (5)
6. Team, I. P. (n.d.). The benefits and limitations of using platelet-rich fibrin for implants: Implant Practice US. Implant Practice US – Dental Publication. https://implantpracticeus.com/ce-articles/a-comprehensive-clinical-review-of-platelet-rich-fibrin-prf-and-its-role-in-promoting-tissue-healing-and-regeneration-part-2/. (4)

Dr. Schneider is the dental director at Delta Dental of Arizona and has more than 19 years of experience in dental administration, dental education, and clinical dentistry.

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Despite the remarkable progress of vaccination in the United States and other countries such as the United Kingdom, the COVID-19 pandemic is unfortunately far from over. The catastrophic situation in India and Brazil highlights the tragic consequences of the sidelining of science.  

Meanwhile, healthcare professionals still face several challenges given the threat of new variants, the lack of biomarkers to identify those at risk for severe complications and death, the lack of predictable treatment, and the scarcity of knowledge on the duration of the immunity conferred by the vaccines. It has become clear that hidden sources of infection may play a crucial role in the pathogenesis of severe COVID-19.

The Role of Oral Health

Last year, after reading about the importance of inflammatory markers in the progression of COVID-19 lung disease, particularly IL-6, my research partner Carla Cruvinel Pontes, DDS, MsC, PhD, and I wrote an article suggesting a link between periodontal disease and its potential to contribute to elevated local and systemic IL-6 levels.

Since then, our findings have been corroborated by clinical studies suggesting high IL-6 levels to be a strong predictor of severe acute respiratory syndrome in COVID-19 patients and periodontitis to be a risk factor for complications. Notably, the study from Marouf et al. (2021) showed that periodontitis resulted in 8.8 times higher risk for death, 4.6 times higher risk for needing mechanical ventilation, and 3.5 times higher risk for ICU admission after accounting for significant confounders, such as age, comorbidities, and smoking.

At the beginning of 2021, I was contacted by an experienced radiologist and medical educator from the UK, Dr. Graham Lloyd-Jones. He had also been in contact with a professor from Birmingham and former president of the European Academy of Periodontology, Iain Chapple. Together, Dr. Cruvinel Pontes, Dr. Lloyd-Jones, Prof. Chapple, and I decided to expand our understanding of the role that oral health, particularly periodontitis, can play in the pandemic.

Our collaboration resulted in the development of a solid medical hypothesis, recently published in the Journal of Oral Medicine and Dental Research, which has been in the spotlight on more than 200 websites worldwide, live radio, and TV. Here, we explain the reasons behind the vast public interest in our study and why it has the potential to change the course of the pandemic.

When a Hypothesis Is More Than a Concept

Many hypotheses are born from scientific exploration. It is crucial to mention that our hypothesis study was born from radiologic lung image findings from COVID-19 patients, and not simply from scientific curiosity. Simply put, Dr. Lloyd-Jones noticed that the disease pattern seen radiographically in COVID-19 lung disease did not match other viral lung infections.

COVID-19 lung disease develops in the base of the lung, as opposed to the mid- and upper areas, as typically seen with infections caused by inhaled pathogens. Vascular changes in small lung vessels are evident early in the disease process in computed tomography (CT) images, including peripheral vasodilation, immunothrombosis, and small filling defects (clots). Microangiopathy and pulmonary infarcts, characterizing thrombosis on both sides of the capillary bed (in both venules and arterioles), have been confirmed in lung autopsies.

Based on the radiological findings, COVID-19 initial lung disease seems to be vascular in nature, as opposed to a primary disease of the trachea and airways. But how does it reach the lung vessels?

With the knowledge that saliva is a reservoir for the virus and that salivary viral levels are strong predictors of poor outcome and disease severity, as well as findings suggesting that SARS-CoV-2 does not reach the lungs through inhalation, we propose that the virus enters the blood circulation in the mouth, from where it reaches the lungs.

The oral cavity biological foundation for this model includes:

• Many oral and gingival cells express ACE-2 receptors, including cells from the gingival sulcus.
• SARS-CoV-2 RNA has been found in saliva and gingival crevicular fluid. The virus can invade salivary glands and mucosal and gingival cells.
• The periodontal environment can favor viral replication and passage through the permeable sulcular or pocket epithelium. Poor oral hygiene, periodontal inflammation, and viral-bacterial synergy can potentially mediate SARS-CoV-2 entrance to the mucosal or gingival blood circulation.
• Higher severity of COVID-19 and risk of death have been linked to periodontitis.
• Other respiratory conditions have been linked to periodontal disease and poor oral hygiene.

COVID-19 and periodontitis have multiple common risk factors, such as aging, specific ethnic groups, male sex, type A blood group, obesity, cardiovascular disease, diabetes, chronic kidney disease, chronic obstructive pulmonary disease, dementia, Down syndrome, learning difficulty, and physical disability (see the figure).

What Does It Mean If This Model Is Correct?

If the hypothesis is proven correct, decreasing the viral load in saliva can mitigate transmission and decrease the risk for lung complications and death. Simple measures can prevent the virus from entering the blood circulation in the oral cavity.

For example, maintenance of optimal daily oral hygiene can fight infection, including toothbrushing twice daily for at least 2 minutes with a fluoridated toothpaste, along with daily interdental cleaning. Periodontitis patients are likely to need longer brushing times.

Also, the use of commercial mouthwash products can inactivate the virus in vitro, whether it’s 15 ml of 0.05% to 0.1% cetylpyridinium chloride (CPC) for 30 seconds twice a day, or 20 ml of 0.147% ethyl lauroyl arginate (ELA) for 30 seconds twice a day. However, daily oral hygiene cannot be replaced by the use of oral rinses.

Regular dental visits are essential to preventing infection as well.

Can Oral Rinses Prevent COVID-19 Lung Disease?

Currently, there is a scarcity of clinical studies on the effect of oral rinses in COVID-19. However, because these over-the-counter products are widely available and have been proven to be safe for unsupervised home use, we suggest the use of CPC and ELA mouthwashes before and after social interactions.

This simple measure can potentially lower the risk for viral entrance to the blood circulation and COVID-19 lung disease while we wait for clinical studies to confirm their efficacy. In places where oral rinses may not be available, studies on pulmonary conditions indicate that even boiled water that has cooled down or a saline solution can be used as an oral rinse to decrease the salivary viral load.

Simple Preventive Measures Can Make a Difference

The reason why health authorities worldwide are not implementing non-invasive, inexpensive, and preventive measures is obscure. In countries such as Brazil and India, the devastating situation has been linked to the overlooking of science. In fact, scientific opinions have been ignored in multiple countries.

As healthcare professionals, we have strong reasons to believe that the mouth plays a crucial role in the pandemic. We urge health authorities and professionals to recommend preventive measures in private and public contexts, especially CPC and ELA oral rinses. Due to their availability, general safety, and potential to decrease COVID-19 lung disease, need for mechanical ventilation, and death, we believe that this recommendation can truly make a difference.

Results from ongoing studies will certainly shed more light on the efficacy of mouthwash products against COVID-19. Meanwhile, let’s do our part and listen to what science is telling us. It strongly suggests that COVID-19 lung complications can start in the mouth, so this is also where preventive measures should begin.

Reference

Lloyd-Jones G, Molayem S, Pontes CC, Chapple I. (2021) The COVID-19 Pathway: A Proposed Oral-Vascular-Pulmonary Route of SARS-CoV-2 Infection and the Importance of Oral Healthcare Measures. J Oral Med and Dent Res. 2(1):1-25.

Dr. Molayem received both his bachelor of arts in history and DDS at UCLA. Thereafter, he completed a specialty program in periodontics at the Herman Ostrow USC School of Dentistry. He is the founder of both the UCLA and USC Journals of Dental Research, which have been going on for 13 and 11 years, respectively. He has lectured and has published in dental implants and periodontics and is the co-founder of Synergy Specialists, the largest agency for traveling dental specialists in the United States. Dr. Molayem has been practicing periodontics in a private practice setting in Southern California for the past 10 years. More recently, he has been conducting research and has published the most comprehensive connection to date between the mouth and COVID-19 in the Journal of the California Dental Association. He can be reached at smolayem@gmail.com.

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Today’s Dental Practices Need On-Point Messaging to Improve Oral and Systemic Health

Dentistry can be confusing and overwhelming for patients who are dealing with pain or anxiety about procedures—even regular cleanings, if they haven’t been that regular.

As part of a field in the medical industry that is commonly misunderstood, the best thing dental professionals can do is help our patients maintain excellent oral health while remaining relaxed and confident in the longevity and effectiveness of quality care that we work hard to provide.

Embracing transparency with new technologies, clarifying concerns for customers, and providing an extra touch of comfort has grown our practice at Brio Dental into a thriving community invested in the wealth of holistic health.

More Bang For Your Brush

There’s no need to squeeze a million patients into your already busy schedule, especially when that stress from feeling rushed can be exchanged in shared spaces, including with your associates and by the patient in the chair.

Investing in creating an inviting, anxiety-reducing environment, scheduling enough time, and having a passionate staff will allow your patients to feel more at ease while you do your job.

Making the time to transparently, clearly, and visually explain treatments and the need for procedures at Brio Dental, we focus on giving the patients time to ask questions, thoroughly considering their overall health and lifestyle habits as guidance for crafting their best solution.

Utilizing my certification in holistic health and lifestyle coaching, along with the knowledge acquired from years of studying how to holistically and naturally manage my autoimmune illness, I have developed a particular fascination with how the mouth’s health can reflect the comprehensive bodily system.

We check each patient for any dietary oversights, the repercussions of autoimmune diseases in the oral environment, systemic inflammation and its underlying causes, and signs of stomach malfunction while providing guidance on healthy habit formation to add more “happy” to our patients’ lives by determining what we can do differently to improve and elevate their lifestyle.

Without compromising effectiveness, we also provide natural treatments backed by science to give patients options that might not be afforded at other clinics or practices. For example, Brio is a metal-free clinic. We don’t place any mercury fillings, and we safely excavate them during their replacement. We also don’t use crowns with any metallic components. We use metal-free, thermoplastic polymer partial dentures and all-zirconium implants as well.

Although there might be more cost-effective methods for the clinic, the adoption of new findings and research gives patients the option to collaborate on deciding the best, healthiest, and longest-lasting solutions for their oral health.

Patient Priority Floss-ophy

Other adjustments we’ve made regarding personalized treatment for improved patient-centered service include little pampering practices to reduce patient anxiety and add an extra element of comfort.

When new customers come in, we like to introduce alternatives to traditional oral care while they are in the chair at Brio! They include oil pulling instead of common over-the-counter mouthwashes to improve gum health, resolve dry mouth symptoms, and whiten teeth without harsh chemicals.

We also provide a complimentary, educational massage for facial musculature and the temporomandibular Joint (TMJ), using our favorite CBD ointment from Blue Sky Oregon CBD with arnica to reduce pain and inflammation, which works wonders during lengthy procedures as well as an at-home, natural remedy for myofascial pain due to bruxism.

We advocate natural products and solutions, fully backed by science and research, that are just as effective as mainstream brands while minimizing toxicity and long-term side effects.

Furthermore, we carefully remove mercury fillings and reduce the vapor release for more direct restorations, highlighting the latest research that prefers zirconium and ceramic implants, which have shown better body compatibility, and polymer-based dentures that have some flexibility and usually have a more comfortable fit.

Prioritizing holistic patient care by investing in the latest technology elevates the practice as a whole, such as with our ozonator unit. By ozonating water, we combine an oxygen molecule (O₂) with singlet oxygen (O₁), forming ozone (O₃).

Ozone is a powerful oxidant that reacts and destroys pathogens such as bacteria, fungi, and viruses that do not have anti-oxidative enzymes in their cell membranes, unlike our own healthy cells. The best part of this updated and effective technique is the water and oxygen-based byproducts that are entirely safe for your body.

Getting to the Root of the Situation

After graduating in 2017 from dental school and building experience working in seven different clinic environments during a span of two years, I found that I was disappointed working in spaces that supported practices that lacked patient understanding. Experiencing the full range of dental clinics and comparing practices led me to be a better dentist and recognize a void in the industry for holistic approaches, which I began with Brio.

On a more personal level, I was diagnosed with an autoimmune illness in 2013, immediately after my acceptance to dental school. I experienced such debilitating side effects from medications meant to manage my condition that staying focused on my studies in dental school became the biggest mountain to climb in my life.

Knowing I didn’t want to live a life constantly putting patches on symptoms rather than addressing the root cause, I thoroughly studied, researched, and trial-and-errored holistic healing methods, including adjusting my diet and lifestyle habits.

This has allowed me to live without medication and achieve remission for more than two years now, despite doctors and specialists rebuking me in my journey, reiterating their dissent of holistic methods to manage and alleviate my symptoms.

In my strong opinion, dentistry needs to challenge its traditional approach to treatment and patient care in the same way. Exploring and being open to new scientifically backed and holistic routes has shown me that success could come more authentically when patients are treated and seen as a whole instead of just a mouth.

Back to Business

Understanding that dentistry is an intricate practice custom to every dentist’s personal treatment philosophy, I encourage all practitioners to be open to and reconsider their methods and recognize that there are more options available to provide solutions for patients.

Truly putting the patient’s care and comfort first has brought in more word-of-mouth referrals than deemed imaginable, keeps clients coming back, and gives us all the time to listen to concerns and provide the best care possible.

As crucial as profit is for businesses to stay afloat, Brio Dental is proof that prioritizing whole patient care will positively benefit everyone involved.

Dr. Jahan has a bachelor’s degree in public health with a minor in Spanish from Penn State University and holds a DMD from Oregon Health & Science University. She also recently completed Botox administration and dermal filler implantation certifications to better serve her patients. She is a certified holistic health and lifestyle coach as well, helping her clients achieve their healthy mind and body goals, leading to happier and healthier lives.

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Researchers at the University of Iowa College of Dentistry and Dental Clinics are developing techniques for using the body’s own internal repair processes to tailor specific bone regeneration strategies to the specific causes of bone damage.

Deferoxamine, which treats iron poisoning, can be used to activate hypoxia-induced factor-1, which promotes angiogenesis and bone regeneration. But there have been safety concerns in this research as well as complicating factors such as chronic inflammation that are common among older individuals.

However, the researchers are using a small molecule known as phenamil to reduce inflammation and promote endogenous bone regeneration. They also have engineered a novel nanomaterial scaffold that mimics the bone collagen structure and delivers deferoxamine and phenamil locally and controllably.

“The drugs themselves are not new, and people have been using them. But we are developing a new method for controlled release of the drugs that can be delivered at a specific location,” said Dr. Hongli Sun, associate professor in the Department of Oral and Maxillofacial Surgery at the Iowa Institute for Oral Health Research.

These innovations could pave the way for treatments to rejuvenate and repair significant bone damage, even for older adults, the school said. Sun and his colleagues recently received a five-year National Institutes of Health grant for more than $1.7 million to support this research.

The researchers also are developing a specific bone regeneration strategy tailored to the specific needs associated with periodontitis-induced bone and tooth loss. The strategy treats the bacteria that causes periodontitis while continuously and effectively directing the body’s own repair processes to the site of the damage, the researchers said.

Although Sun has only been at the College of Dentistry since 2018, the school said, he has had remarkable success in developing his own research and securing grant funding for his projects.

From developmental biologists like Dr. Brad Amendt to research design and biostatistical support from Dr. Xian Jin Xie to mechanics support from the College of Engineering to clinical expertise from oral surgeons and periodontists, the school said, Sun has found a range of collaborators who make his work better.

“For any major research like this, we really need a well-rounded team, with a lot of different experts from different areas,” Sun said. “And I came to Iowa because I knew I would get strong support from other researchers, support staff, and the administration.”

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Poor oral hygiene has a negative impact on athletic training and performance, according to Sunstar, which notes that maintaining a healthy mouth should be an essential part of athletes’ training programs and has partnered with the FDI World Dental Federation to launch Sports Dentistry Guidelines.

In a study of 302 athletes, 40% said they were bothered by their oral health, while 28% reported an impact on their quality of life, and 18% reported an effect on their training and performance. Also, 55% of the athletes had cavities, 45% had dental erosion, and 76% had periodontal disease.

Athletes are at high risk of developing oral diseases for several reasons, Sunstar said. For example, they require a lot of calories, which often are consumed via sugary protein sports bars. Also, athletes consumer a lot of sports drinks, which are mostly acidic and have high sugar content. Training leads to increased mouth breathing and reduced saliva flow, causing dry mouth and creating ideal conditions for bacteria to grow as well.

Sports-related stress is another risk factor that can cause gum disease, tooth erosion, cavities, and teeth grinding. In aquatic sports, low pH in swimming pool water can cause tooth erosion.

Just as athletics can impact oral health, oral health can impact athletic performance, Sunstar said. Poor oral health overall affects quality of life and well-being, which are key for optimal athletic performance, the company said.

Also, tooth decay and gum disease can cause and maintain inflammation in the body, which can negatively impact athletic performance. And athletes who have an infected tooth, mouth abscess, or some other painful condition could possibly perform badly or even withdraw from competition or training.

Sunstar offers advice for athletes:

• Make your oral health a priority, just like other parts of your training program, and include it as part of your daily routine like training, nutrition, and physio.
• Brush your teeth twice a day for at least two minutes with a fluoride toothpaste, ideally 30 minutes after eating, and clean between your teeth using interdental brushes, picks, or floss.
• Chew sugar-free gum or rinse with water after meals and snacks when brushing isn’t an option.
• Ensure you visit your dentist at least twice a year for a complete oral health checkup.

“We are striving to raise awareness of the importance of good oral hygiene to athletes and to their overall performance,” said Dr. Marzia Massignani, PhD, senior manager of scientific affairs at Sunstar. 

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Researchers at the University Medical Center Greifswald have confirmed the results of a previous study that found an association between inflammatory gum disease due to periodontitis and Alzheimer’s disease.

“It is very difficult to conduct meaningful methodological studies of the effects of periodontal disease, a common severe form of gum disease,” said Dr. Christian Schwahn of the university’s Polyclinic for Dental Prosthetics, Geriatric Dentistry, and Medical Materials Science.

“Statistical models that have only recently been developed make it possible to simulate a controlled clinical study by combining available data from treated patients and untreated patients,” said Schwahn.

The long-term Study of Health in Pomerania/Life and Health in Western Pomerania (SHIP) has been examining the influence of dental diseases on the general health of people since 1997, finding that inflammatory gum disease affects 15% to 45% of people depending on age.

“For the first time, the connection between the treatment of gum disease and the onset of Alzheimer’s disease in a quasi-experimental model of 177 patients treated periodontally in the Greifswald GANI-MED study and 409 untreated participants from the SHIP study will be analyzed,” said Schwahn.

The researchers used magnetic resonance imaging (MRI) data as an indicator for the onset of Alzheimer’s disease and compared it with MRI data from the US Alzheimer’s Disease Neuroimaging Initiative so they it be used as an individual measure of the loss of brain substance typical of Alzheimer’s disease.

Periodontitis treatment carried out by a dentist specializing in gum disease showed a positive effect on the loss of brain matter, which could be assessed as moderate to severe.

The researchers said that the results were remarkable because the periodontitis patients were younger than the age of 60 at the time of the MRI examination, and the observation time between the dental treatment and the MRI exam was 7.3 years on average for the patients. 

“Our approach clearly lies in the prevention and timely treatment of gum disease, which can be triggered by a large number of germs, in order to prevent such possible consequential damage in advance,” said Thomas Kocher, director of the Polyclinic for Dental Conservation, Periodontology, Endodontology, Pediatric Dentistry, and Preventive Dentistry.

“We will continue to have to rely on observational studies that simulate a controlled clinical study in this area,” said Schwahn. “A clinical study with a placebo treatment in a patient group, i.e., with patients who have intentionally not been treated by the dentist, is not feasible for ethical and medical reasons.”

The study, “Effect of Periodontal Treatment on Preclinical Alzheimer’s Disease—Results of a Trial Emulation Approach,” was published by Alzheimer’s & Dementia.

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Oral health during pregnancy can greatly impact the mother and the fetus. While the physiological changes during pregnancy can certainly cause oral health issues, pre-existing oral health conditions can have an effect on the well-being of the mother and her unborn child.¹

Dental practitioners can help their patients by educating them about the potential impact of pre-existing dental conditions, as well as diagnose and treat dental conditions that can develop with or during pregnancy.

Pre-Existing Disease

Several pre-existing conditions can negatively impact pregnancy. When examining oral health, studies support that pregnant women with pre-existing periodontal disease are at higher risk for compromised pregnancy outcomes including preterm birth, delivery of low-birth-weight babies, and development of pre-eclampsia.²

In fact, women with periodontitis have double the risk of pre-term birth.³ Complications of pre-term birth may include developmental delays, growth reduction, and hearing impairment.⁴ But why does periodontitis cause this to happen?

The gram-negative bacteria in the gingival biofilm leads to inflammatory markers in the bloodstream. These inflammatory markers cause an immune inflammatory response in the fetal-placental unit as well as suppression of local growth factors. This response can generate uterine contractions that may result in pre-term labor and/or babies with low birth weight.^3,5

Oral Health Issues During Pregnancy

During pregnancy, the placenta produces higher levels of estrogen and progesterone. These hormonal changes may lead to increased gingivitis, gingival sensitivity to irritants, and pyogenic granulomas. This is partially due to progesterone increasing the vascular permeability.⁶

Pregnant and/or postpartum women also may neglect their own oral care to focus on the health and well-being of their baby.⁶ This leads to toxic plaque remaining on the teeth and gums long term. Not surprisingly, approximately 60% to 75% of pregnant women have gingivitis.¹

In addition, the vomiting that may occur during pregnancy causes an acidic environment in the oral cavity. The acidity may lead to erosion and decay of the tooth structure.

Lastly, many women are hesitant to visit the dentist during pregnancy. This may be because there is a lack of perceived need, or they may mistakenly believe it is unsafe to visit the dentist during pregnancy.¹

However, research supports that professional dental care during pregnancy is integral to improving oral health.⁶ Additionally, when appropriate pregnancy guidelines are followed, dental care is safe during pregnancy.¹ If possible, a full oral examination is recommended prior to pregnancy to achieve optimum oral health and encourage proper oral care habits at home.⁶

Patient Communication

Dental professionals must effectively communicate the risks of pre-existing disease, such as periodontitis, to their patients who are pregnant or wish to become pregnant. Recommended conversation starters may include:

• The bacteria in your mouth impacts the rest of your body and can actually lead to pre-term labor. Let’s work together to treat your periodontal disease so you can have a healthier pregnancy and baby.
• I know you are planning to have children soon. Did you know that the bacteria that causes your periodontal disease can negatively impact your pregnancy? With proper treatment and home care, we can work together to manage your periodontal disease

For pregnancy gingivitis, dental professionals may say something like:

• During pregnancy, your hormones may cause your gums to be more susceptible to swelling and irritation. It’s really important that you keep plaque under control. Try by brushing with an oscillating-rotating toothbrush such as the Oral-B iO and an antimicrobial paste like Crest Gum Detoxify.

The patient and dental professional must work together to stop this cycle before it begins with diligent daily oral hygiene: brushing and interdental cleaning, getting regular oral health checkups, and properly treating periodontal disease early. Oral hygiene in pregnant women can be improved by amplifying their oral care routine at home with the proper oral care products.

The primary factor for gingivitis in pregnant women, toxic plaque, can likely be ameliorated by improved hygiene including the use of antimicrobial pastes such as Crest Gum Detoxify, antimicrobial rinse like Crest Pro-Health Multi-Protection Clean Mint, and optimal mechanical plaque control via an electric rechargeable toothbrush with a round head, like the Oral-B iO.

Moreover, pastes that include stannous fluoride such as Crest Gum Detoxify can prevent the erosion that may be caused by the acidic oral environment during pregnancy. Helping your patients to take good care of their mouth, teeth, and gums during pregnancy can help them to have a healthy pregnancy and a healthy baby.

References

1. Hartnett E, Haber J, Krainovich-Miller B, Bella A, Vasilyeva A, Lange Kessler J. Oral Health in Pregnancy. J Obstet Gynecol Neonatal Nurs. 2016 Jul-Aug;45(4):565-73. doi: 10.1016/j.jogn.2016.04.005. Epub 2016 Jun 6. PMID: 27281467.
2. Daalderop LD,Wieland BV, Tomsin K, Reyes L, Kramer BW, Vanterpool SF. Periodontal disease and pregnancy outcomes: Overview of systematic reviews. JDR Clinical & Translational Research 3:10-27.
3. Manrique-Corredor EJ, Orozco-Beltran D, Lopez-Pineda A, Quesada JA, Gil-Guillen VF, Carratala-Munuera C. Maternal periodontitis and preterm birth: Systematic review and meta-analysis. Community Dent Oral Epidemiol 2019; 47:243-251.
4. Ward RM, Beachy JC. Neonatal complications following preterm birth. BJOG. 2003 Apr;110 Suppl 20:8-16. doi: 10.1016/s1470-0328(03)00012-0. PMID: 12763105.
5. Puertas A, Magan-Fernandez A, Blanc V, Revelles L, O’Valle F, Pozo E, León R, Mesa F. Association of periodontitis with preterm birth and low birth weight: a comprehensive review. J Matern Fetal Neonatal Med. 2018 Mar;31(5):597-602. doi: 10.1080/14767058.2017.1293023. Epub 2017 Feb 28. PMID: 28282773.
6. Yenen Z, Ataçağ T. Oral care in pregnancy. J Turk Ger Gynecol Assoc. 2019;20(4):264-268. doi:10.4274/jtgga.galenos.2018.2018.0139

Ms. Jordan is a graduate of Westbrook College, UNE, dental hygiene, where she worked as adjunct clinical faculty for nearly 10 years and now serves on the advisory committee. She holds a master’s degree in organizational leadership and worked in private practice until 2001, when she became an employee of Procter & Gamble (Crest + Oral-B). She has held several positions for the company and currently holds the role of global professional & scientific relations. She has contributed to the Darby Walsh dental hygiene textbooks and has lectured locally to dental professionals, as well as students and faculty. She can be reached at jordan.ba.1@pg.com.

Dr. Gans graduated from the Ohio State University’s College of Dentistry in 2013 and completed a general practice residency at Saint Vincent Charity Hospital. She practiced dentistry in her hometown of Cleveland, Ohio, prior to joining Procter & Gamble in 2018. She is currently a P&G Professional and Scientific Relations Manager for Crest + Oral-B. Her goal is to teach dental professionals about the recent advances in paste and power brush technology to help improve oral health. In her free time, she enjoys spending time with her friends and family. She has five siblings including an identical twin who is also a dentist.

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As more research shows links between oral and systemic health, dentists and physicians are collaborating to improve care.

Awareness

Reputable medical and dental journals feature numerous studies peering into the awareness among dentists of the link between oral and systemic health. After peeling through many of them, there is no doubt that the knowledge is there.

One study in 2019 exploring dentists’ awareness about the link between oral and systemic health addresses common knowledge topics like the “associations between oral disease including periodontal disease and chronic systemic diseases such as diabetes, coronary artery disease, adverse pregnancy outcomes, and rheumatoid arthritis (RA).”¹

Although these topics are becoming common knowledge among medical and dental providers, there is still a need for medical professionals to step in with focused effort to continue updating their knowledge and educate patients about these oral-systemic tie-ins, regularly.

Patient Education

Creating this awareness for patients will no doubt open the door to greater motivation when it comes to home healthcare and seeking professional oral healthcare. Patients are severely limited in their ability to act without knowing that their periodontal health has systemic implications. In fact, it may still surprise some patients to learn that periodontal disease is a great example of an oral manifestation of systemic disease.

With the limiting belief that the mouth is separate from the body, patients are unaware of the impact that their oral health has on their overall quality of life, nor do they know just how “at risk” they might be for things like heart disease and diabetes related to poor oral health.

One of the ways in which medical professionals are collaborating to improve care is by doing the research so that information relayed to patients is evidence-based and consistent, but we have yet to fully integrate patient education into the plan.

Research

Through research, medical professionals have learned that many cross-referenced oral and systemic ailments are related through inflammation. Studies suggest that periodontal disease elicits regulatory molecules via the inflammatory cascade.

As the cascade progresses, these pro-inflammatory mediators as well as oral bacteria and lipopolysaccharides infiltrate other parts of the body, perpetuating the body’s inflammatory response (chronic inflammation) to disease and infection.

One study looked at the relationships between tooth loss, systemic inflammation, and periodontal pathogens in patients with cardiovascular disease and confirmed that periodontal disease could cause or worsen cardiovascular disease. The study suggests that Porphyromonas gingivalis, a known gram-negative, subgingival, and virulent periodontal bacteria “accelerated abdominal aortic aneurysm and arteriosclerosis in mice.”²

The Journal of Family Medicine & Primary Care offers a systematic review of the literature highlighting the fact that periodontal pathogens that protect the body against periodontal disease have been found in both crevicular fluid and in synovial joint fluid in the case of patients with RA, suggesting the role of periodontal bacteria in the etiology of RA.³

One of the most discussed bidirectional relationships is between diabetes and periodontal disease. “The two-way relationship between diabetes and periodontitis has established that diabetes increases the risk for periodontitis, and periodontal inflammation negatively affects glycemic control.”⁴ The good news is that stabilization of periodontal disease results in greater glycemic control on this two-way street.

Being Proactive

As medical professionals continue to dive into conducting research and versing themselves on these common oral and systemic health relationships, the next step is integrating holistic healthcare and the approach to patient education into graduate programs as well as educating patients in the dental office.

At Delta Dental of Arizona, for example, we have awarded grants to specifically tackle the integration of dental and medical care across the state. Among the programs we’ve supported through our Foundation:  

• The El Rio Community Health Center Pediatric Dental Integration Program provides direct screening, varnish treatments, and oral health education by embedding dental hygiene teams in five El Rio locations throughout southern Arizona. Additionally, the dental health outreach team engages in collaborative, community outreach events (some on hold or modified due to COVID-19) to connect with families who may not have a dental health home.
• The North Country Healthcare Medical-Dental Integration Program imbeds basic screening, fluoride applications, and dental education into existing pediatric and obstetric appointments across northern Arizona. The program also provides referral to dental care, as appropriate, with intent to provide dental homes for those who do not have an established relationship.
• The United Community Health Center (UCHC) Dental Program for Kids integrates oral health services and education into 500 low-income children’s medical well visits at UCHC pediatric clinics per year. The program aims to engage low-income and underserved pediatric patients in southern Arizona who receive medical care with dental services and educate patients about the importance of oral health.
• The Tohono O’Odham Nation Health Care Medical-Dental Collaboration Program, which is a medical-dental collaboration with the Tohono O’Odham Tribal Community, integrates a registered dental hygienist (RDH) into all acute and well pediatric medical visits providing dental education, screenings, fluoride applications, caries identification, and silver diamine fluoride (SDF) treatment in the medical clinic.
• The University of Arizona OHPEN (Oral Health Prevention and Education) Wide Program is a full-spectrum family medicine mobile clinic that provides free critical services to vulnerable populations in Tucson and Pima County. As a part of its care to low-income communities, the mobile unit provides dental screenings, fluoride varnish treatments, and oral health education to children and pregnant women.
• The Barrow Cleft and Cranial Facial Center Post-Surgery Education Program distributes jaw surgery kits and hosts a required oral health education workshop prior to surgery. Patients, parents, and all who will be part of the patient’s care are invited to the workshop to understand and prepare for what is to come following surgery. They also learn how each item in the kit needs to be used properly to care for the oral cavity for the critical two weeks following surgery to have a successful outcome.

As a final example, earlier this year Delta Dental of Arizona partnered with Neighborhood Outreach Access to Health (NOAH) and HonorHealth Foundation on Delta Dental of Arizona Dental Connect to support uninsured patients who visit an HonorHealth emergency room for dental issue across Greater-Phoenix.

It is my and Delta Dental of Arizona’s belief that we need to work together and continue innovating programs like these to improve both the smiles and lives of patients. We are all in this together, and there is much more to be done.

References

1. Nazir MA, Izhar F, Akhtar K, Almas K (n.d.). Dentists’ awareness about the link between oral and systemic health. Journal of Family & Community Medicine. doi:https://dx.doi.org/10.4103%2Fjfcm.JFCM_55_19
2. Aoyama N, Suzuki J, Kobayashi N, Hanatani T, Ashigaki N, Yoshida A, et al (2017). Associations among tooth LOSS, systemic inflammation and antibody TITERS To Periodontal pathogens in Japanese patients with cardiovascular disease. Journal of Periodontal Research, 53(1), 117-122. doi:10.1111/jre.12494
3. Arana P, Salazar D, Amaya S, Medina M, Moreno-Correa S, Moreno F, et al (2018). Periodontal microorganisms in synovial fluid of patients with rheumatoid Arthritis. systematic review of the literature – 2017. Revista Colombiana De Reumatología (English Edition), 25(4), 271-286. doi:10.1016/j.rcreue.2018.06.002
4. Lakshmanan R, Mahtani A, Jacob C (2020). Prevalence of diabetes among patients and the assessment of the awareness of the bidirectional relation between diabetes and periodontal disease. Journal of Family Medicine and Primary Care, 9(6), 2774. doi:10.4103/jfmpc.jfmpc_63_2
   

Dr. Schneider is the dental director at Delta Dental of Arizona. She has more than 19 years of experience in dental administration, dental education, and clinical dentistry.

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“Gum diseases are preventable” is the slogan for Gum Health Day 2021, a worldwide initiative on May 12 promoted by the European Federation of Periodontology (EFP). The event aims to educate the public about detecting and preventing gum diseases such as gingivitis, periodontitis, and peri-implantitis and explain why continuing to visit the dentist during the pandemic is important to overall health.

In addition to causing tooth loss and other oral problems, gum diseases are linked to major systemic health issues including diabetes, cardiovascular disease, chronic kidney disease, rheumatoid arthritis, Alzheimer’s disease, some cancers, pregnancy complications, and erectile dysfunction, the EFP said.

Recent research also has linked gum diseases COVID-19 transmission as well as severe COVID-19 complications and outcomes, suggesting that establishing and maintaining gum and oral health may become an important part of patient care, the EFP said.

“Gum Health Day 2021 aims to remind people that gum health is a key factor for health and well-bring even if, unfortunately, it’s still sometimes overlooked,” said Henrik Dommisch, coordinator of Gum Health Day 2021.

“Gum diseases that could be effectively prevented and treated still affect hundreds of millions of adults worldwide. It’s time to take decisive action against gum diseases. We can beat them just by keeping a good oral hygiene and going regularly to visit our dentist, periodontitis, or hygienist,” said Dommisch.

The awareness initiative will be celebrated in more than 40 countries in Europe, the Americas, Africa, Asia, the Middle East, and Australasia by EFP-affiliated societies of periodontology and by other scientific societies, dental organizations, hospitals, dental practices, universities, and companies.

Among the Gum Health Day 2021 materials that the EFP has produced are four short animated videos showing how among other factors bad breath, sensitive or loose teeth, and smoking can either trigger or be a sign of gum disease.

Most adults in developed countries are affected by gum disease at some point in their lives, the EFP said, even if they are not aware of it because gum diseases are usually painless and often go unnoticed for a time.

The EFP is inviting all members of the dental community to join this awareness day by disseminating Gum Health Day 2021 messages and materials, particularly on social media, and by signing the EFP Manifesto “Perio & General Health,” an international call to dentists and medical professionals to be more proactive in terms of the prevention, early detection, and treatment of gum disease and to acknowledge it as a major public health issue.

Besides activities organized at the national level, the EFP is holding a Gum Health Day 2021 Perio Talks live session at the EFP’s Instagram page, @perioeurope, on May 12 at 7 pm CET. It will be open to everyone and led by Dommisch with representatives from some EFP-affiliated societies.

The speakers will exchange ideas and experiences during the session and answer questions and suggestions from participants about how to educate the population to prevent and tackle the threat posed by gum diseases.

“Gum Health Day 2021 is a major EFP global initiative to get the public informed every year of the value of healthy gums as an integral part of a healthy life. Prevention of diseases is the best approach to a healthy life, and Gum Health Day 2021 will greatly get closer to our vision of periodontal health for a better life for everybody,” said Lior Shapira, EFP president.

“New associations between gum disease and COVID-19 are now being identified,” said Shapira.

“A new paper published in the Journal of Clinical Periodontology has found that the dental biofilm of symptomatic coronavirus patients can harbor ribonucleic acid (RNA) molecules of the SARS-CoV-2 virus and might act as a potential reservoir with an essential role in the transmission of COVID-19,” said Shapira.

“This reveals a previously unknown and unexplored human habitat of the viral RNA and could open a door to further research in developing COVID-19 containment strategies,” Shapira said.

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