Dr D’Aiuto explained that “evidence indicates that periodontal bacteria cause damage to the gums and also triggers inflammatory responses that can impact the development of systemic diseases including high blood pressure”.

The study analysed data from 250 adults with severe periodontitis and 250 adults without gum disease. All the participants were healthy otherwise. The findings were that participants with gum disease were twice as likely to have high systolic blood pressure (140 mm Hg or more), than those with healthy gums (14% and 7%, respectively). The results suggest that 50% of adults could have undetected high blood pressure due to gum disease and consequently many individuals may be unaware that they are at increased risk of heart-related problems.

The author of the present research explained that “Oral health strategies such as brushing teeth twice daily are proven to be very effective in managing and preventing the most common oral conditions, and our study’s results indicate they can also be a powerful and affordable tool to help prevent hypertension”.

Please contact the practice if you have any questions regarding your health condition.

According to the authors, COVID‐19 is associated with an exacerbated inflammatory response that can result in fatal outcomes. Since systemic inflammation is also a main characteristic of periodontitis, the association between periodontitis and COVID‐19 complications has been investigated.

COVID‐19 infection severity has been associated with patients suffering from hypertension, diabetes, cardiovascular disease, older age and obesity. However, the specific risk factors leading to severe clinical outcomes are still not clear.

The role of gum disease as exacerbated factor in severe Covid-19 outcomes has been investigated in this research.

Periodontitis is characterized by chronic non‐resolving gingival inflammation resulting in bone loss and teeth detachment, and it has been already linked by multiple studies as a risk factor in other medical conditions, like cardiovascular disease, hypertension, diabetes, renal disease, pneumonia and cancer.

The present study analysed the data of 568 Covid-19 patients. Among them, 40 experienced COVID-19 complications such as death, ICU admission and need for assisted ventilation, and 528 were discharged without any complications. The periodontal status was studied from these patients’ posterior bitewings and panoramic radiographs.

Out of the 568 patients included in the study, 258 presented periodontitis. Among the patients who presented periodontitis, 33 experienced Covid-19 complications, while only 7 of the 310 patients without periodontitis presented COVID‐19 complications

This study identified that the risk of COVID‐19 complications was significantly higher among patients with moderate‐to‐severe periodontitis compared to those with milder or no periodontitis.

Several hypothetical mechanisms may explain the strong associations observed between periodontitis and COVID‐19 severity. The oral cavity, and especially periodontal pockets could act as a viral reservoir and as a consequence the aspiration of periodontopathic bacteria might aggravate COVID‐19 virulence.

Gum disease is one of the most common chronic diseases in the world, although it being preventable and treatable. Multiple studies back the idea that by maintaining good oral health, specifically healthy gums, serious medical complications, from coronavirus included, can be reduced significantly.

Some of the signs of gum disease are bleeding when brushing or eating and bad breath. Since the symptoms are not painful, people tend to ignore them, leaving the disease untreated and increasing the risk of losing teeth and medical complications.

In order to prevent gum disease, it is very important to brush the teeth with a fluoride toothpaste at least twice a day, paying attention to clean along the gum line as well and flossing in between teeth.

Periodical visits to the dentist are important in assessing the teeth and gums condition and providing a professional clean.

For more information about gum disease, or if you are concerned about your oral health, please contact the practice.

Over time, after a crown is made, it is common to have black lines that form just at the base of the crown or visibly seen on the gums surrounding your crown. Typically, no pain is felt as this should only be a cosmetic problem.

If pain is present, it is recommended to see the dentist as soon as possible.

Whether it is an individual crown or a crown from a root canal treatment, the main causes of its unsightly appearance are:

• Having a porcelain-fused to metal (PFM) crown made by your dentist. When your gums recede as time goes, it reveals the top metal part of your crown
• Staining by the metal on your PFM crown where your gums touch the area with metal.
• Cavity formation between your crown and gums.

Dr Kaufman will assess the cause of the problem and recommend an appropriate solution, which can be:

• Replacing your old crown with a fully porcelain crown to get rid of the black lines and any stains that come along with it.
• In the case of a cavity, it  be treated as soon as possible to prevent further complications.
• Every treatment should be followed by proper dental hygiene at home and regular check up and  hygiene appointments at the dental practice.

Consumption of sugary drinks leads to overconsumption of calories, weight gain and obesity. In children it reduces milk consumption potentially leading to calcium deficiency with associated increased risk of osteoporosis and fractures. Sugary drinks contain high levels of sugar and may also have high levels of acid. They can significantly contribute to tooth decay and erosion in children and adults.

Facts

• There are 16 packs (teaspoons) of sugar in one 600ml bottle of regular soft drinks
• There are 9 packs of sugar in one 600ml bottle of sports drink
• 47% of children (2-6 years old)consume a sugary drink every day
• Consuming 340ml of sugary drink a day increase your risk of type 2 diabetes by 22% compared to drinking one ca a month or less.

Sugary drinks and your oral health

• Frequent consumption of sugary drinks has been linked to increased rates of tooth decay and erosion
• Even though diet soft drinks are sugar free, they have similar acidity to sugary carbonated drinks and can still cause erosion
• Sugary drinks frequently contain caffeine which can negatively affect fluid balance and lower pH and buffer capacity of saliva, adversely affecting your oral health
• Frequent, prolonged exposure of baby’s teeth to sugary drinks has been linked to early childhood caries.

Tips to help you cut back

For you

• If you are thirsty, have some water first
• Carry a water bottle instead of buying a drink
• If you order a fast food meal, see what other options are there for drinks apart from default sugary drink
• Be smart with the drinks you buy – they are made to sound healthier than they are, always check the nutrition panel for the sugar content
• For alcoholic sugary beverages, find out if there are lower sugar options
• Try and stay away from the soft drink aisle in the supermarket or specials at the checkout as they are often sweet
• Try to minimise the amount and number of times per day you drink sugary drinks:
• Only have it at meal times
• Use a straw where possible
•  Brush your teeth straight away
• Avoid swishing the drink around the mouth

For your children

• Give your child a water bottle to carry to school
• Avoid flavored milk if possible
• Check fruit juice packaging to ensure there is no added sugar
• If there are vending machines with sweet drinks at school, discuss the possibility of having them removed with the school

For your baby

• If your baby has teeth, don’t settle them to sleep with breasted milk, bottled milk, flavored milk, cordial, fruit juice or soft drink
• If your baby likes sucking on something before sleep, offer them a water bottle or a dummy

*By Dr Ksenia Fedorova, ADAVB Oral Health Committee

A study showing that tooth decay in Logan-Beaudesert children has dropped 19 per cent since the introduction of fluoridation has been backed by the Australian Dental Association of Queensland (ADAQ).

The University of Queensland (UQ) School of Dentistry study, led by Emeritus Professor Kim Seow and Professor Laurence Walsh, ran over three years and involved 457 children aged four to nine.

“Prior to the introduction of fluoridation in 2008, six-year-old children in the Logan-Beaudesert region had a tooth decay rate two-and-a-half times the national average,” Professor Walsh said.

“At that time, only five per cent of Queensland children had access to fluoridated water, but that figure is now 80 per cent.

“the consequent reduction in tooth decay certainly adds credence to the fluoridation initiative.”

Produced in conjunction with Queensland Health, the full findings are published in the journal of Caries Research.

The UQ study also showed the relative risk of decayed, missing or filled teeth reduced by 54 per cent overall. ADAQ President, Dr Ralph Kelsey said the molar tooth surface most at risk – outer facing surface of the primary molars – returned a significant reduction of 26 per cent of observed decay on dental X-rays.

“This positive scientific report confirms what dentists see every day,” Dr Kelsey said.

“I trust this latest research will be useful to those local councils in Queensland still having doubts about the benefits of fluoridation.”

Community water fluoridation is one of several interventions the UQ research group has evaluated.

Targeted telephone interventions around oral health, again in the Logan-Beaudesert region, have also been completed with encouraging results.

Not everyone’s teeth are suitable for whitening. If the teeth and gums are not in healthy condition before whitening, the procedure may cause more harm than good. Even if there is nothing wrong with the teeth there may be other reason why whitening will not work.

The safest way to work out if teeth are suitable for whitening is to see a dentist first. Dentists are the only people trained and qualified to make an accurate assessment of the teeth and gums before whitening.

What should a proper dental assessment include?

A dentist will check for things like enamel thickness, receding gums, existing restorations (e.g. fillings, crowns and veneers), and any other oral diseases or conditions. The cause of discoloration will be assessed, (e.g. diet, ageing, antibiotics etc.) and whether it is on the surface or inside the teeth. A tooth that has been discolored from root canal treatment may be whitened from inside the tooth; this is called non-vital bleaching. Only a qualified dentist is able to carry out these checks and then recommend a suitable whitening treatment.

How does teeth whitening work?

The process of teeth whitening involves oxidising agents such as hydrogen peroxide which alter the tooth surface to change the way it reflects light. When used repeatedly and in inappropriate dosages for long periods of time, it may cause irreparable damage to teeth.

There are usually two methods of application:

• A professionally made tray used at home to apply the whitening agent; this may involve applying the agent for a short period of time regularly over 1-2 weeks
• Application of the whitening agent by a dentist in the dental chair; this may involve one or two visits which can take up to over an hour and sometimes involves heat or light to accelerate the whitening process

A dentist will advise which method is most suitable. The agent used in the dental chair is usually of a higher concentration and may potentially cause more tooth sensitivity and other side effects.

What will be felt during and after the procedure?

Some people notice a ‘bubbly’ sensation on the surface of their teeth, or periods of sharp pain inside the tooth while the bleaching agent is in contact with their teeth. Others notice an achy feeling in their teeth for a few days following the treatment and temporarily heightened sensitivity when biting into certain foods and consuming cold beverages. Any painful; sensations should be reported to a dentist.

What can go wrong?

For many people teeth whitening poses no risk if done correctly. However, there are a number of potential side effects from teeth whitening. Some will be temporary but some can be permanent; if the teeth react badly to the treatment they may never be able to go back to the way they were. Some of the effects of teeth whitening can include:

• Heightened tooth sensitivity
• Alteration of the enamel surface (the effect of hydrogen peroxide on tooth enamel is irreversible)
• Reduced strength of resin-based filling materials
• Damaged and inflamed gums
• Chemical burns
• Blistering of mouth and gum tissues
• Uneven colored teeth (existing fillings, crowns and veneers will not change color)
• Severe irritation or burns if the bleaching agent is exposed to the skin or eyes
• Irritation to the esophagus and stomach if the bleaching agent is swallowed, which can result in bleeding

It is important to know how concentrated the whitening agent is before starting the procedure as the concentrations can range from 3% to 35%!

What results can be expected?

Depending on the cause of the discoloration results can range from impressive to disappointing so it’s important to understand what can reasonably be achieved before going ahead with any whitening procedure. The reality is that most people will achieve a one or two shades change but many will see no change at all. What works for one person will not work for another.  Again, a dentist’s advice is needed on this.

How to reduce staining:

Extrinsic stains are superficial stains found on the surface of the tooth, which are caused by dental plaque, tars (in tobacco), tannin, colored foods and frequent use of certain mouthwashes. Common foods and beverages that stain teeth include:

• Herbal and black tea
• Coffee
• Red wine
• Spicy foods like curries

Smoking cigarettes also causes stains on teeth, which can be extremely difficult to remove. Most extrinsic stains on the tooth’s surface can be removed by a dentist performing a professional scale and clean.

Teeth Whitening Checklist

• First try other ways to whiten teeth without using a chemical treatment, like having a professional scale and clean by a dentist and maintaining good oral hygiene and diet habits
• Consult a dentist to assess the suitability for teeth whitening
• Have a dentist recommend a course of action or specific treatment
• Make sure the treatment method, side effects and potential results are fully understood before applying any whitening agent at home or in the dental chair.

*By Dr James Fernando, ADAVB Oral Health Committee

Pregnancy can lead to dental problems, including gum disease and increased risk of tooth decay. Research has found a link between gum disease in pregnant women and premature birth with low birth weight. Common issues affecting dental health during pregnancy include:

• Gum problems
• Gingivitis (gum inflammation) – this is more likely to occur during the second trimester. Symptoms include swelling of the gums and bleeding, particularly during brushing and flossing between teeth
• Gum overgrowth also known as pregnancy epulis, which may or may not resolve after the birth of the baby
• Vomiting
• Cravings for sugary foods
• Retching while brushing teeth
• Mobile teeth which usually firm up after the birth of the baby

During pregnancy, the gum problems that occur are not due to increased plaque, but an increased response to plaque as a result of increased hormone levels. However, with proper hygiene at home and professional help from a dentist, good oral health can be maintained during pregnancy.

Pre-pregnancy and dental health

Women are less likely to have dental problems during pregnancy if they already have good oral hygiene habits. Steps for good oral hygiene include:

• Brushing teeth at least twice daily with fluoridated toothpaste
• Flossing between teeth
• Following a healthy diet
• Visiting the dentist regularly

It is important for women planning to become pregnant to visit the dentist and have a check-up. It is more convenient to have elective procedures done before conception.

Dental health during pregnancy

Women should not avoid the dentist during pregnancy. Routine dental treatment is safe during pregnancy. Women should advise their dentist if they are pregnant when scheduling their dental appointment.

Common dental health issues during pregnancy

Vomiting

Pregnancy hormones soften the ring of muscle that keeps food inside the stomach. Gastric reflux (regurgitating food or drink) or the vomiting associated with morning sickness can coat your teeth with strong stomach acids. Repeated reflux and vomiting can damage tooth enamel and increase the risk of decay. Suggestions for pregnant women experiencing vomiting include:

• Don’t brush your teeth immediately after vomiting. While the teeth are covered in stomach acids, the vigorous action of the toothbrush may scratch the tooth enamel. Wait at least an hour after vomiting before brushing teeth
• Rinse your mouth with water (preferably fluoridated tap water) after vomiting, which will assist in removing acids
• Follow up with a fluoridated mouthwash
• A dab of fluoridated toothpaste smeared over the teeth can replace a fluoridated mouth rinse. Rinse thoroughly with water
• A dentist can provide further information and individualised advice.

Retching while brushing teeth

Some pregnant women find that brushing their teeth, particularly molars, provokes retching. Suggestions for pregnant women experiencing retching include:

• Use a brush with a small head, such as a brush made for toddlers
• Take your time. Slow down your brushing action
• It may help to close the eyes and concentrate on breathing
• Try other distractions, such as listening to music
• Alternatively, brush teeth with water and follow up with a fluoridated mouthwash. Go back to brushing with fluoridated toothpaste as soon as possible

Food cravings

Some women experience unusual food cravings (and food avoidance) while they are pregnant. A regular desire for sugary snacks may increase the risk of tooth decay. Pregnant women should snack on low-sugar foods instead. Suggestions for pregnant women experiencing sweet food cravings include:

• Try to choose healthier sweet options such as fresh fruits
• Rinse your mouth with water or milk or brush your teeth after eating sugary snacks. This will help to remove decay causing sugars from your teeth

Dental health after pregnancy

If gum problems occur during pregnancy, it is important for women to have their gums checked by a dentist after they have given birth. While most types of gum problems caused by pregnancy hormones resolve after birth, a small number of women may have developed a deeper level of gum disease that will need treatment to resolve. Women should practice good oral hygiene after their baby is born. Whilst with a newborn, it can be difficult to find time alone, mothers should ensure they:

• Brush teeth twice a day with fluoridated toothpaste
• Clean between teeth daily with floss or interdental brushes
• Drink fluoridated tap water
• Limit intake of high sugar foods
• Have regular dental check ups

*By Kate Jameson, Policy and Research Officer, Australian Dental Association.

Based on extensive epidemiological and laboratory studies demonstrating the benefits of breastfeeding, the World Health Organisation (WHO) recommends exclusive breastfeeding for infants in the first six months of life. In addition, the guidelines recommend that breastfeeding should continue until two years and beyond supplemented with nutritionally adequate and safe complementary foods to meet evolving nutritional requirements. Importantly, current guidelines do not recommend a time to cease breastfeeding or provide any information about patterns of feeding or discuss the association between infant feeding and dental caries.

Breastfeeding has been shown to reduce the incidence and/or severity of infectious diseases and improve a range of other health outcomes, with benefits even extending into adulthood. Lower rates of otitis media (middle ear infections) and sudden infant death syndrome have been reported in children who are breastfed. Research from the United States reveals that post neonatal mortality is 21% lower among breastfed infants. A range of benefits have also been described for mothers who breastfeed. Finally, improved maternal and child health outcomes lead to a range of benefits for families and the wider community, such as reduced healthcare costs.

Early childhood caries (ECC) is the presence of one or more decayed, missing or filled tooth surfaces in a child under the age of six. It is associated with increased caries risk in the permanent dentition, increased number of hospitalisations and emergency visits, increased treatment costs, delayed growth and development, loss of school days, diminished ability to learn and reduced oral health related quality of life. ECC is a significant problem affecting Australian children, with severity increasing as socioeconomic statuses decreases. The role of infant feeding practices, including breastfeeding, bottle feeding and the use of infant formula in ECC is not fully understood but needs to be considered carefully when providing dietary advice to patients.

There is limited evidence for an association between dental caries and breastfeeding, mostly due to poor study design. However, there is moderate to weak evidence that prolonged, nocturnal and on-demand feeding is associated with ECC. In a recent Japanese study, the prevalence of ECC was significantly higher amongst children who were breastfed beyond 18 months of age, compared to those who stopped breastfeeding at six months. The authors suggest that a decline in maternal protective elements such as immunoglobulins and minerals such as calcium and phosphate in breast milk with prolonged breastfeeding may reduce its benefits and therefore increase potential for dental caries. In discussions with parents, clinicians should bear in mind the clear benefits of breastfeeding and the multi-factorial nature of dental caries. As such, recommendations against on-demand feeding after eruption of the first primary tooth should be complemented with broader dietary advice regarding reducing other sources of sugar-containing foods and drinks and appropriate oral hygiene practices.

There is evidence that prolonged bottle feeding with bovine milk and added sucrose results in pooling of milk on the tooth surface, which can lead to early establishment of Streptococcus mutans in the oral cavity. There is debate as to whether there is a clear link between prolonged bottle feeding and early childhood caries. However, what is clear is that feeding at night is a major risk factor. Parents should be counselled regarding the risks of nocturnal feeding, and bottles during the night (apart from those containing plain water) should be discouraged. It has been established that parents need significant amounts of support to change behaviours; they may need to be referred to an appropriate service to help with bedtime routines and to be provided with strategies other than nocturnal feeding to help placate their child.

Numerous in vivo and in vitro studies have demonstrated the ability of both bovine milk and soy-based infant formula to cause a significant decrease in pH and demineralisation of primary teeth, an effect that is further exacerbated with the addition of sucrose or fermentable carbohydrate. Infant formula has been reported to be more cariogenic than bovine and breast milk. Given the cariogenicity of infant formula, clinicians should recommend against night time and frequent feeding of infant formula, particularly in a nursing bottle. In the past, the use of infant formula has also been linked to increased fluorosis amongst young children, in both fluoridated and non-fluoridated communities. However reduction in the level of fluoride in formula powders by manufacturers in the early 1990s has allayed concerns regarding fluorosis. Recent evidence indicated that there is no difference in fluorosis among formula users in a fluoridated community but that the use of non-fluoridated water in mixing infant formula may be associated with increased caries risk. The National Health and Medical Research Council (NHMRC) recommends the use of cooled, boiled tap water to prepare infant formula.

When approaching discussions regarding possible dental implications of feeding practices it must be remembered the ways that parents choose to feed their infants can be a very personal choice. Families may have complex social and emotional reasons for the feeding practices they utilise in their home. While as oral health professionals we can counsel families regarding the implications of certain feeding practices, we must remember that decisions come down to the parents and families involved.

*By K Bach and MJ Silva

Paediatric Dentistry Program

Melbourne Dental School

University of Melbourne

On behalf of the Oral Health Committee, Australian Dental Association.

Charcoal has a long history of use, with its use intra-orally stemming from the capacity of roughly ground charcoal to abrade away stains and deposits on teeth and absorb noxious substances. These days, you will find charcoal in dental products, beauty products and even foods, such as bread and smoothies.

Information about charcoal dentifrices has been published in the British Dental Journal (BDJ) May 2019* paper which reviews the literature available, concluding that there is a lack of scientific data to support the use of these pastes and powders.

In summary, it concludes that:

• Most charcoal toothpastes do not contain fluoride and of the ones that do, consumers may still remain at increased risk of caries due to the absorptive capacity of activated charcoal; it has the capacity to remove fluoride and other active ions from toothpaste.
• Many of the charcoal-based dentifrices make claims of low abrasiveness; however, to date, these claims have not been independently verified. Particle size can influence the abrasiveness of the dentifrice.
• ‘Possible health risks exist’ considered to be related to the possible inclusion of human carcinogenic polyaromatic hydrocarbons in charcoal and the use of bentonite clay in some charcoal-based dentifrices. Bentonite clay is added due to its suggested ability to aid the binding properties of charcoal, ‘holding’ plaque, bacteria and stained material in the pores of the charcoal (and clay) which is brushed away leaving the surface of the tooth free of any deposits.
• Possible accumulation of charcoal particles in the periodontal pockets of patients with established periodontal disease can occur. This could result in grey/black discoloration of the tissues.
• Staining of the cavosurface margins and surface defects of composite restorations can occur. This can compromise aesthetics, particularly with anterior veneers or crowns with less than perfect supragingival margins.

The paper notes that there is a difference between whitening and bleaching teeth, and as with many over-the-counter-whitening products, these pastes and powders do not intrinsically affect tooth color but simply act by removing surface stain. It was reported that insufficient evidence was found to support claims of tooth whitening, let alone a bleaching effect.

In comparison to conventional oral hygiene product marketing, many charcoal dentifrices use marketing strategies that are attractive to consumers, by making use of wholesome words such as ‘natural’, ‘eco-friendly’, ‘organic’ and ‘herbal’. These terms were used in 88% of dentifrices examined, while 54% used at least two of these consumer-attracting terms.

With Australia’s Oral Health Tracker reporting only half of Australian adults (18+ years) brush their teeth twice per day, the marketing of charcoal dentifrices, which has led to an increase in people brushing their teeth once, if not twice per day, notes that the BDJ paper, be considered a positive.

It is hoped that through education, patients who choose to use non-fluoridated dentifrices transition to use evidence-based products containing fluoride.

*Based on the article by Mikaela Chinotti, ADA Oral Health Promoter, published at the ADA News Bulletin, August 2019.