"Here, use my toothbrush..."

1. Toothbrushes can be a source of repeated dental infections.
2. Toothbrushes can cause a bacteremia (bacteria entering the bloodstream) that may result in an endocarditis (a heart infection).
3. Toothbrushes can harbor and transmit viruses and bacteria.
4. Toothbrushes can retain 50% of the herpes simplex virus for one week.
5. Gingival inflammation can be reduced by changing toothbrushes biweekly.

Still think its sexy to share a toothbrush? How about sharing food? Kissing?

1. Certain bacteria can be transmitted from site-to-site in the mouth via dental instruments or from person-to-person sharing someone else's eating utensil.
2. In juvenile periodontitis, virulent bacteria can move from an infected site to an uninfected site in the same mouth.
3. Certain bacteria can be transmitted between spouses.
4. Certain bacteria can be transmitted between parents and children.
5. Certain bacteria can be transmitted from dogs to children.

So you see, bacteria once thought to be localized to specific sites in the mouth, can be migratory. We're not advocating that you stop tasting a scrumptious morsel or two at a four-star restaurant; we are advocating that everyone maintain good dental health not only for themselves but for the sake of those they love.

As far as ridding toothbrushes of bacteria, soaking them in a mouthrinse containing essential oils for 20 minutes kills 100% of the bacteria on the bristles. Ultraviolet light also sanitizes toothbrushes. But when researchers* tested the efficacy of using a toothpaste containing a common disinfectant compound - triclosan - they found little benefit when it came to eliminating the offending bacteria attached to the toothbrush bristles.

So what can you do about bacterial contamination from toothbrushes? Soak them in a suitable mouthwash, expose them to ultraviolet light, or from a practical stance, change them frequently. As for kissing someone, the benefits may still outweigh the risks …as long as you have an inkling as to their periodontal status!

*Warren DP, Goldshmidt MC, Thompson MB, Adler-Storhz K, and Keene HJ: The effects of toothpastes on residual microbial contamination of toothbrushes. JADA 132:1241-1245, 2001.

"Nylon is good, but polytetrafluoroethylene is better"

When it comes to removing dental plaque, using a toothbrush is not enough. The reason is clear: toothbrushing only removes bacterial plaque from the smooth surfaces on the front and back of teeth, and not from the contact areas where teeth touch each other. The latter is where most periodontal problems begin and are most harmful. Cleaning effectively between teeth is the reason dentists and hygienists recommend using dental floss.

There's waxed and unwaxed, minted and cinnamon flavored, dental tape and "gliding" flosses. Are any materially better than the others? One group wanted to find out.*

Study. Twenty-seven subjects (17 males and 10 females) between the ages of 23-31 tested five types of dental floss in a double-blind study. The flosses - Gore Glide®, Colgate Antiplaque®, Oral-B unwaxed®, Oral-B waxed®, and Oral-B waxed tape® - were used at all contact points between the premolars both in the maxilla and mandible, for a total of 14 test sites in each person. Each type of floss was fixed to a special holder equipped with a strain gauge to measure the force needed to pass through each contact point. The gliding capacity of each of the flosses was also measured.

The results. Flossing efficiency is not only technique sensitive, but it depends on many factors that comprise the manufacturing of dental floss. These include the type of filaments used to make the floss, how many strands comprise the floss, the number of twists in the floss, its width and strength, all of which contribute to its efficiencies, including how well it "glides" on the teeth.

The flip side to dental floss efficiencies is that patient compliance may correlate to its ease of use. Floss is more readily used when it doesn't impact or traumatize the gums, the lips, or the patient's fingers. It also matters how the floss distorts each time it is used.

In this study, ease of use was measured by the amount of force needed to get past the proximal contact of adjacent teeth. Waxed floss required more force than unwaxed to get past contact points. All flosses distorted during their first passages, making them "clot" during the second usages. The only floss that overcame this and had better frictional indices was the polytetrafluoroethylene (PTFE) sold as Gore Glide®. Gore Glide® proved superior passing through the contact points than all other flosses tested, except between the maxillary incisors where less pressure was needed.

Given its benefits, should everyone switch to using Gore Glide®? Not really. The reason has to do with compliance, not plaque removal. It turns out that there was no clinical difference in plaque-removing capacities among any of the flosses. So in the end, we suggest you use what is comfortable and what you like…as long as you floss.

**Dörfer CE, Wündrich D, Staehle HJ, and Pioch T: Gliding capacity of different dental flosses. J Perio 72:672-678, 2001.

"Gums and heart disease,
gums and stroke,
gums and diabetes,
...now gums and rheumatoid arthritis"

Articles appearing in many health-related publications have linked periodontal disease to a host of systemic diseases, including coronary disease, myocardial infarcts, pre-term low birth weights, and Type I diabetes mellitus. While rheumatoid arthritis (RA) has a similar pathobiology to periodontitis, few studies have directly linked the two...until now.*

Study. Sixty-five patients suffering from rheumatoid arthritis were compared to non-rheumatoid arthritis patients at the Royal Brisbane Hospital in Australia. Both groups were given a periodontal examination, while the RA group had their arthritis diagnoses reassessed.

Results. Both groups averaged similar ages: RA = 56.4 years while the Control Group = 53.9 years. Women outnumbered the men in both groups, 3:1. The RA group had nearly twice as many teeth missing as the control group, 11.6 as compared to 6.7.

Plaque and bleeding indices were similar in both groups.

Bone levels were distinctly different between the test and control groups. While 66.2% of the control group had zero to moderate periodontal bone loss, only 30.8 % of the RA group exhibited moderate bone loss. Advanced bone loss for the two groups was the reverse: 33.8% of the control group had moderate to severe bone loss while 69.2% of the RA group exhibited this problem.

Interestingly when bone loss and tender joints were examined together, those RA patients with minimal periodontitis had fewer tender joints compared to those with advanced periodontitis. Likewise, patients with more periodontitis also had more swollen joints. Morning stiffness was independent of periodontal severity, as was generalized pain.

Discussion. This study indicates that patients suffering from rheumatoid arthritis have a greater likelihood of having significant periodontal problems, including more tooth and bone loss when compared to patients without RA. While it is known that non-steroidal anti-inflammatory drugs (NSAIDs) limit periodontal bone loss, the patients in this study were suffering from an advanced form of RA and were beyond taking NSAIDs for disease control. The authors speculate that medications developed to treat the inflammatory response of RA may also modify periodontal conditions.

Mercado FB, Marshall RI, Klestov AC, and Bartold PM: Relationship between rheumatoid arthritis and periodontitis. J Perio 72:779-787, 2001.

"Calcium channel blockers:
good for hypertension, bad for gums!"

A host of factors cause the gums to enlarge or overgrow including: (1) Chronic inflammation, (2) Dilantin (for epileptics), (3) Cyclosporin A (for immunosupression - organ transplants), and (4) Calcium channel blockers (for hypertensives)

Since nifedipine is commonly used for hypertension and ischemia, researchers decided to learn more about the prevalence, severity, and risk factors of gingival enlargement in a group treated with nifedipine compared to a control group. Here's what they found.

Results. Sixty-five patients taking nifedipine were compared to 147 control patients not taking this drug. All clinical measurements - plaque index, gingival index, gingival enlargement index, and probing depths - were greater in the nifedipine group than in the controls.

Discussion. Thirty-four (34%) percent of the patients taking nifedipine had vertical gingival overgrowth and fifty-one (51%) percent had horizontal overgrowth compared to 6% and 11% respectively in the control group.

There was no correlation between the dose of nifedipine and the amount of gingival overgrowth.

Most gingival enlargements begin between the teeth. Common signs and symptoms of this condition include pain, bleeding on gentle touching, chronic food impaction, friable tissue, splaying of teeth/formation of diastemas, changes in the occlusion, and phonetic alterations.

Other parameters affecting gingival overgrowth were discussed but not measured in this study included: age, tobacco usage, and oral breathing patterns.

The authors suggest that nifedipine-induced gingival overgrowths may be reduced and even prevented by good oral hygiene measures aimed at reducing gingival inflammation. When the overgrowths cannot be controlled, the authors suggest changing medications. Surgery is often needed to reduce the overgrown tissues in severe cases.

Comment. Not only are physicians unaware of the causal relationship between calcium channel blockers and gingival enlargement, but patients rarely understand that medications affect gingival bleeding and swelling. It is our job to inform physicians about this calcium channel blocker/gingival enlargement link so that they may properly advise patients about the benefits of good oral hygiene and frequent dental care.

*Miranda J, Brunet L, Poset P, Berini L, Farré M, and Medieta C: Prevalence and risk of gingival enlargement in patients treated with nifedipine. J Perio 72:605-611, 2001.

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