A new study published in the Journal of Clinical Periodontology came up with an interesting fact that there is a strong association between periodontitis and the complications of COVID-19. After examining more than 500 COVID-19 patients the researchers could deduce that those who had gum disease were at a greater risk of getting admitted into ICU, or put on a ventilator support and even more likely to die.

Why Did The Researchers Suspect A Connection Between Gum Disease And COVID-19?

Though Coronavirus SARS-CoV-2, the virus responsible for COVID-19, produces mild symptoms in most of the cases and has a fatality rate as low as 2%, it has been reported that 14% of the patients develop severe conditions that need immediate hospitalization and oxygen support. Acute respiratory distress syndrome (ARDS), sepsis, septic shock and multi-organ failure are a few serious complications of COVID-19 and these symptoms are characteristics of cytokine storm syndrome, an exacerbated immune response in which the proinflammatory cytokine levels spike up and there is a lot of tissue damage. Moreover, the severity of COVID-19 has shown to be more in elderly or obese patients and patients with comorbidities (like hypertension and diabetes).

Periodontitis is one of the most common gum diseases and around half the adult population worldwide is affected by mild to moderate form of periodontitis. In a person with severe periodontitis, the attachment between and the supporting tissues is destroyed. This can lead to tooth loss when left unattended. Cases with periodontitis are characterized by chronic inflammation that progresses to cause systemic inflammation. Like COVID-19, severe periodontitis has shown a marked increase in the levels of cytokines like TNF (Tumour Necrosis Factor)-alpha, CRP (C-reactive protein), ferritin and interleukins. Periodontitis has reported to have a strong association with conditions like diabetes, cardiovascular diseases and even premature death.

These similarities between  periodontitis and COVID-19 urged the researchers to conduct a case-control study and assess the extent to which the two are connected with each other.

This Is How They Conducted Their Study

 With the help of the national electronic health records of the State of Qatar dated between February 2020 to July 2020, a case-control study was conducted. Those patients who suffered from the complications of COVID-19 like death, ICU admission or assisted ventilation were identified as cases whereas patients who were discharged from the hospital and did not have any of the major complications were identified as controls.

Periodontal status, including interdental bone loss of both the groups were assessed with the help of dental radiographs uploaded in the electronic health records. Information on the possible risk factors like diabetes, smoking habit and body mass index was taken into consideration. Blood parameters relevant for the disease like concentration of D-dimer, C-Reactive protein, vitamin D and WBC levels were also extracted from the electronic health records for the purpose of assessment. The association between COVID-19 and periodontitis was analysed with the help of logistic regression.

Here Is What They Found In Their Study

A total of 568 patients were analysed out of which  528 patients were discharged without any complications (controls) whereas 40 patients had severe COVID-19 complications (cases). These are the most prominent findings of the study-

As expected, patients with severe complications were older and had more comorbidities than those who had minor COVID-19 symptoms.Around 80% of the patients suffering from COVID-19 complications had periodontitis.In the deceased patients, the concentration of CRP, D-dimer and WBC were phenomenally high whereas the lymphocytes were significantly lower than the surviving patients.The concentration of D-dimer, CRP and WBC was also found higher in those admitted to the ICU and those patients who needed assisted ventilation.Around half of the examined patients had periodontitis.Periodontitis showed an association with a greater risk of developing COVID-19 complications, death, ICU admission and assisted ventilation.HBA1c, CRP and WBC blood levels were phenomenally higher in COVID-19 patients who had periodontitis than those who did not have periodontitis.It was also seen that the successful treatment of periodontitis brought a marked improvement in the serum markers of systemic inflammation and enhanced overall metabolic control.

nd They Concluded…

On the basis of the above-mentioned findings, the researchers concluded that patients suffering from COVID-19 were 3 times more likely to be admitted to ICU, 4.5 times more likely to be in need for assisted ventilation and 9 times more susceptible to die if they had gum disease along with COVID-19.

Though more research is needed to establish the connection between COVID-19 complications and periodontitis, one thing has become clear that gum disease can aggravate systemic inflammation thereby, worsening the condition of the COVID-19 patients. Hence, this is the right time to give due importance to gum health and ensure that you take good care of them!

The post How Deep Is The Connection Between Gum Disease And COVID-19 Complications? appeared first on Ask the Dentist.

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Wendell Curtis

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Retainers are appliances you should wear once you remove your braces. They are either permanent or removable. 

A permanent or fixed retainer is, basically, a piece of metal wire attached to the inner side of your teeth. The metal wire is glued to your teeth to hold them in place so that they don’t move back to their pre-braces position. 

Your orthodontist may advise you to use a removable retainer for the upper teeth and a fixed retainer for the lower. As fixed retainers are more convenient, they are becoming popular, especially among people with a busy lifestyle.

Are you wondering whether permanent retainers are the right choice for you? 

In this article, I discuss how permanent retainers work and describe their benefits and drawbacks.

How Do Permanent Retainers Work?

A permanent retainer is commonly referred to as a lingual wire because it is fixed to the back surfaces of the teeth. 

Since a glue known as bonding material is used to attach the retainer, it is often called a bonded retainer too.

To resolve the issue of crooked or misaligned teeth, orthodontists resort to braces. Braces help move your teeth into the right alignment and correct problems like crowding or spacing.

However, many people discover that once their braces are removed, their teeth begin to shift back to their previous position. To maintain the teeth in their new position, your orthodontist would want to restrict their movement. Otherwise, the entire treatment may end up failing due to relapse. 

This is where permanent retainers come into play. Permanent retainers secure the teeth effectively. You don’t need to take them out and place them back like removable retainers.

How Much Do Permanent Retainers Cost?

The charges of the first permanent retainer are typically covered within the overall charges of the braces. 

However, you can expect the cost to be anywhere between $150 to $500 if you need to get a replacement for a broken or lost permanent retainer. 

What Are The Benefits of Permanent Retainers?

Convenient– You won’t need to take your retainers on and off.Almost no speech interference– You won’t be uneasy while speaking in public.Unnoticeable– No one would notice that you have your retainers in place as the wires are placed on the inner and less visible surfaces of your teeth.No fear of loss or damage– As the retainers are attached to your teeth, there is less chance of losing a retainer.

What Are The Benefits of Removable Retainers?

Removable– You can remove them when you want to eat something.Easy to clean– Maintenance of removable retainers is easy as you can soak them in a cleaning liquid and wash them with water.Better for upper teeth– Fixed retainers on upper teeth are prone to damage as your lower teeth may bite on them.Easy to maintain oral hygiene– You can just take them off before brushing or flossing your teeth.

What Are The Drawbacks of Permanent Retainers? 

If the root cause of misaligned teeth is addressed accurately, there is no reason why the teeth will move to their previous positions, and therefore, there is no need for a permanent retainer.

So if your orthodontist prescribes a fixed retainer, it may mean that your orthodontic issue is still unresolved even after the removal of your braces.

Moreover, permanent retainers may pose some problems as well:

Diminished proprioception- Our teeth are meant to function as individual units while moving about independently within their respective sockets. Binding them together with a fixed retainer can decrease the proprioceptive property of our teeth.Early bone loss- Young and healthy individuals experience bone loss around the teeth that are bound by a permanent retainer. Our teeth move mildly during activities like chewing and clenching. Retainers restrict the normal tooth mobility leading to the decreased blood supply to the periodontal ligament and subsequent crestal bone loss.Potentially invasive procedure– The teeth need to be etched and a composite filling is applied to hold a metal wire or mesh chain. Applying, maintaining, and removing this material over time may lead to some damage to the enamel layer of your teeth. This is mostly dependent on the skills and temperament of your dentist.Difficult to maintain oral hygiene– Brushing and flossing with a piece of wire glued to the inner surfaces of teeth can be quite a challenge! You need extra patience, effort, and time to ensure that the area around your retainers is clean while using floss. You may need to use a floss threader to actually fish the floss through the gaps in between your teeth to accomplish this.Need for caution in your food choices– You will need to be more careful while biting on tough foods like bread crusts as you may bend the wire or cause a detachment between wire and tooth. It may take some time before you or your dentist is aware of this detachment potentially causing a need for additional orthodontic work. Make sure your dentist looks at your fixed retainer closely with dental loupes by pushing on each splinted tooth to see if there is a separation between wire and tooth. It’s easy to miss!Uncomfortable– Some individuals do not like the feel of a metal piece rubbing against their tongue at all times.Replacement expense– You should be prepared to pay an extra fee if your bonded retainer breaks off or gets detached. The detached end can even wear down your tongue.

What To Do If My Retainers Just Snap Off?

If your permanent retainers detach from your teeth or bend at some point, you should not try to fix the issue yourself. Neither should you leave the issue unattended. Here’s what you can do:

Call your dentist or orthodontist right away– A detached end of the retainer can be quite harmful as it may injure your mouth and damage your teeth. Hence, consider an emergency and meet your dentist right away to get it fixed. Also, the detached tooth can accelerate in the movement away from its ideal position (its position relative position to the other teeth).Book an appointment with your orthodontist– If your retainer ends are still at their place but the wire is detached from one or more teeth or bent in the mid-portion somewhere,  you have some grace time to get it fixed. Make an appointment with your orthodontist and get your retainer repaired or replaced before it causes any further damage.

How To Clean and Floss My Permanent Retainers?

Cleaning your teeth with your fixed retainers can be slightly tricky. Here are a few tips that you can incorporate into your oral hygiene regimen:

Brush your teeth just like you do regularly. Make sure that your bristles pass through the gaps between the teeth so that all the areas around the retainer are covered. A sonic toothbrush may be helpful in this area.Flossing in between the teeth can be tedious during those initial days when you are trying to get a hang of it. You will be an expert with a few days of genuine practice. While inserting the floss between the teeth, care should be taken not to jerk it in as that may harm your gums. Instead, maneuver the floss gently on the sides of the teeth so that the interdental surfaces are properly cleaned.

Final Note

Permanent retainers are a convenient option for holding the teeth in their new positions for the rest of your life.

It has a couple of significant drawbacks and is not meant for every case. Discuss your options with your dentist or orthodontist so that you can decide what is best for you.

My take: Short term (a few years maximum) is acceptable if this is an option you want. However, ultimately, use a removable retainer. Or better yet, address why the teeth are shifting if not held in place by any retainer, fixed or removable.

The post Are Permanent Retainers the Right Choice for You? appeared first on Ask the Dentist.

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Wendell Curtis

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Probiotics are microorganisms (mainly bacteria) that provide benefits to humans – from the prevention of bad breath and cavities to improved gum health. 

Probiotics in oral health are supported by years of research, although the number of human clinical trials is limited. 

Still, many patients are unaware of the potential benefits that dental probiotics can offer. 

What are dental/oral probiotics?

Oral probiotics (or dental probiotics) are specific strains of bacteria known to support a healthy mouth and improve oral health. They encourage the growth of good bacteria and stop the growth of bad (pathogenic) bacteria.

Like the gut, the mouth has its diverse bacterial community known as the oral microbiome. Dental probiotics are similar to gut probiotics in that they use good (commensal) bacteria to improve the health of the microbiome in the mouth. 

However, they’re not the same as gut probiotics — oral probiotics are most effective when delivered directly to the mouth via lozenges, chewable tablets, milk, or probiotic drinks. Oral probiotics in the form of swallowable tablets do not seem to be as effective. Some kinds of toothpaste contain oral probiotics.

Oral probiotic supplements deliver these bacterial strains directly to your mouth so that they can colonize the surfaces in your mouth and form biofilms.

The use of oral probiotics may offer health benefits because of the way they boost the immune system of the mouth. 

Do oral probiotics really work? Yes, oral probiotics work to improve oral health, especially for people who have existing dysbiosis (a disruption in the balance of bacterial communities) in their oral microbiome. 

One study concluded that dental probiotic supplements not only show promise for the prevention or treatment of oral disease but also cause little to no side effects. However, more research is needed to determine the right dosages and delivery for the best results.

Oral vs. Gut Probiotics

The major differences between gut probiotics and oral probiotics are the types of organisms included in each, as well as the method of delivery.

Gut probiotics contain bacterial strains native to the gut. 

They are delivered in capsules designed to resist the powerful gastric juices and acidic pH of your digestive system. 

Survivability is very important when it comes to gut probiotics. That’s why it’s important to choose a high-quality product with a large number of diverse strains and a high number of Colony Forming Units (or CFUs).On the other hand, oral probiotics, contain beneficial strains specific to the oral microbiome (though there may be some overlap with regular probiotics). 

What are the Best Probiotic Strains to Take?

Oral microbiome probiotic strains considered most beneficial to oral health include:

Lactobacillus reuteriLactobacillus salivariusStreptococcus salivarius K12Streptococcus salivarius M18Lactobacillus paracaseiLactobacillus sakei

Oral probiotics are usually given in the form of lozenges, drinks, mouth rinse, or chewable tablets. 

They are meant to sit in your mouth while they dissolve, thus allowing enough time to inoculate your oral microbiome.

However, the mouth is connected to the rest of the body — for instance, good gut bacteria established during birth and infancy may potentially reduce a child’s risk of cavities.

Benefits of Dental Probiotics

The benefits of dental probiotics are evident in every part of the mouth because a healthy oral microbiome is the key to oral health.

Oral/dental probiotics may prevent or address most oral diseases, such as:

CavitiesGingivitis/periodontitisOral thrush (Candidiasis)Bad breathRespiratory infectionsTonsillitisOral cancer

The good bacteria in oral probiotics can create biofilms to replace those created by undesirable bacteria. These new biofilms not only support the health of teeth and gums and reduce inflammation, but they can also block bad bacteria from reaching enamel or gum tissue to wreak havoc.

1. Oral Probiotics for Cavities

Cavities, or “dental caries”, develop when clusters of bacteria, called plaque, form on teeth and feed on sugar molecules, and excrete acids that break down enamel. 

If you address it early in the process, you can reverse some cavities with dietary and lifestyle changes. Left unchecked, this tooth decay can irreversibly damage the dentin and enamel and require a filling, root canal, or tooth extraction.

Oral probiotic supplements may prevent cavities and plaque buildup. 

The best dental probiotics for cavities include:

L. acidophilusL. paracaseiL. rhamnosusL. reuteriL. caseiL. salivariusBifidobacillusS. thermophilus

Research shows probiotics for teeth can prevent cavities by:

Improving the immunity of the mouth Producing antibacterial compounds to fight certain cavity-causing bacteriaPreventing bad bacteria from attaching to the teethAltering the pH of the mouth to stop cavity growthChanging the saliva quality to improve remineralization of enamel

One of the most problematic bacteria in the development of cavities is called Streptococcus mutans. However, an oral probiotic strain called Streptococcus A12can outcompete the harmful version and prevent plaque buildup.

As of mid-2020, 8 randomized, controlled trials on oral probiotics for dental caries have been completed. 75% of these studies found that the use of dental probiotics reduced cavities. 

However, the doses, strains, study methods, and lengths of study were inconsistent. 

It’s not possible to say for sure exactly what dose, probiotic strain, or length of treatment will effectively reverse or prevent cavities.

2. Oral Probiotics for Gingivitis & Periodontitis

Periodontitis (gum disease) is a chronic inflammatory condition that affects 42% of adults in the US. It is associated with higher rates of diabetes, Alzheimer’s, heart disease, and more. 

Once you develop gum recession, you can only halt gum disease, not reverse it. That’s why it’s so important to stop gum disease before it does lasting damage.

At least 11 clinical trials show that oral probiotics may improve gum disease symptoms. 

The best oral probiotics for gum disease are:

L. reuteriL. brevis

Improvements in gum disease from oral probiotics include:

Reduced plaque under the gum lineLess bleeding gumsLower gingival index (a marker of gingivitis)Smaller pocket depth (a measurement your dentist uses to spot periodontitis)

Using dental probiotics as part of your oral care routine may reduce inflammation, stop bleeding gums, and crowd out the bacteria that cause gingivitis. 

L. reuterican improve symptoms of gingivitis and gum bleeding, while L. brevis seems to reduce inflammation.

3. Oral Probiotics for Candidiasis/Oral Thrush

Oral thrush, or oral candidiasis, is a fungal condition in which candida fungus (usually C. albicans) overgrows and forms white spots on your tongue. Burning, redness, and dry mouth can result.

This fungal overgrowth is a common symptom of dysbiosis in the oral microbiome. 

The best way to combat this condition is to stop consuming the sugars and carbs that feed the candida yeast. Along with a dietary change, high-quality oral probiotics may help prevent or reverse oral thrush.

Changing your diet will stop candida growth, as it will no longer have an adequate food source. The influx of beneficial bacteria from the oral probiotic will crowd out any remaining candida microbes.

The best oral probiotics for oral thrush/candidiasis are:

Lactobacillus spp.S. salivarius K12

Lab research shows that dental probiotics including Lactobacillus species can stop candida from forming a biofilm in the mouth. 

A 2020 clinical trial found that 30 days of the oral probiotic S. salivarius K12 decreased oral thrush symptoms. It also improved inflammation of oral tissue caused by denture stomatitis, a bacterial overgrowth on dentures. 

4. Oral Probiotics for Halitosis/Bad Breath

3 studies on dental probiotics for halitosis found that good probiotics can reduce VSCs (volatile sulfur compounds) that cause bad breath. An additional study saw no VSC improvement although breath odor improved. 

Oral probiotics are a much better remedy for bad breath than mouthwash. Most mouthwash kills not only bad bacteria but good along with it.

Dental probiotics may stop bad breath by reducing the compounds that cause halitosis.

The best dental probiotics for bad breath include:

S. salivarius K12L. salivariusL. reuteriL. casei

5. Oral Probiotics for Respiratory Infections

Respiratory infections are infections of the respiratory tract caused by a variety of viruses or bacteria. Common examples include the common cold, sinusitis, strep throat, and bronchitis.

Oral probiotics may reduce the risk of respiratory infections, particularly in children.

The best oral probiotics for respiratory infections are:

S. salivarius K12S. salivarius M18L. reuteriL. sakeiL. paracaseiL. gasseri

A 2016 animal study found that L. gasseri was able to crowd out significant Group A Streptococcus bacteria responsible for infections like strep throat, scarlet fever, and sore throat. 

Animals who received the oral probiotics contracted Group A strep infections 4 times less frequently and were 15 times less likely to die from the infections than the control animals.

An oral probiotic supplement containing 5 strains of probiotics reduced the risk of children getting a respiratory tract infection by 76% in a 2018 clinical trial.

6. Oral Probiotics for Tonsillitis

Tonsillitis is inflammation of the tonsils, two oval-shaped pads of tissue at the back of the throat.

Oral probiotics may reduce symptoms of recurrent tonsillitis.

The best probiotic for tonsillitis is S. salivarius K12.

In a 2020 clinical trial, an oral probiotic given for 30 days provided “rapid relief” for symptoms of recurrent tonsillitis. It also resulted in a marked improvement in the microbiome of the upper respiratory tract.

7. Oral Probiotics for Oral Cancer

Oral cancer may develop, in part, due to harmful bacteria in the mouth. 

Correcting dysbiosis of the oral microbiome may decrease the risk of developing oral cancer, although no clinical trials with human patients have confirmed this theory.

According to two reviews published in 2020, oral probiotic strains that may stop oral cancer growth include:

L. rhamnosus GGL. plantarumAcetobacter syzigiiL. salivarius REN

More research is needed to draw serious conclusions.

There is no scientific evidence that oral probiotics can treat or reverse oral cancer in humans. 

How long do oral probiotics take to work?

Depending on the severity of your dysbiosis, oral probiotics may begin working in as little as 1 week.

Most studies on oral probiotics have been conducted for 2-4 weeks. Studies tracking cavity development have been longer, from 9-12 months.

When advising a patient to take oral probiotics, I generally recommend 2-3 months as a baseline treatment period.

How to Take Oral Probiotics

The most effective ways to take probiotics are via chewable tablets or lozenges. These allow the beneficial bacteria to be delivered directly to the surfaces of your mouth where biofilms are formed by bacteria.

For good bacteria to thrive, you must also eat plenty of prebiotics. Prebiotics are fibers that feed probiotic bacteria. 

Prebiotic foods include:

OnionsRaw dandelion greensGarlicArtichokesBananas (especially unripe)Chicory rootAsparagus LeeksRaw jicamaApplesCocoaFlaxseeds

Taking probiotics is unlikely to be effective without prebiotics present in the mouth. In other words, you must consume prebiotics every day for your probiotics to work.

Q

Should I take oral probiotics in the morning or at night?

A

The best time to take oral probiotics is in the morning after finishing your oral hygiene routine.

How to Choose the Best Oral Probiotic

When choosing an oral probiotic supplement, look for products with a high strain count, which is measured in colony-forming units (CFUs). Find a supplement with at least 3 billion CFUs.

Keep in mind, though, that oral probiotics will usually have a lower strain and CFU count than regular probiotics. 

Look for a probiotic with beneficial strains, such as S. salivarius K12S. salivarius M18L. rhamnosus, and L. reuteri.

Oral probiotics should not be swallowed but chewed or made to melt in the mouth.

You can buy dental probiotics on Amazon or directly from manufacturers. Most oral probiotics are not available at local drugstores or grocery stores.

Probiotic Foods

You may also try adding foods that contain probiotic bacteria to your diet to enhance the benefits of oral probiotic supplements. 

Common probiotic foods include:

KombuchaKimchiYogurtMisoNattoSauerkrautKefir

There are no published studies that prove these foods will act the same as targeted probiotic supplements for oral health. However, they may offer general benefits to your oral and overall health.

Side Effects of Dental Probiotics

Dental probiotics should not cause side effects. One of the benefits of dental probiotics is that they are “extremely safe” for human use.

Gut probiotic side effects include stomach upset and bloating. No symptoms have been identified for oral probiotic side effects.

If you have a condition that compromises immunity, such as HIV/AIDS, cancer, or inflammatory bowel disease, always talk to your doctor and/or dentist before starting a new probiotic regimen.

The Oral Microbiome

Your oral microbiome is made up of over 700 known species of bacteria that live in the biofilms of your mouth (on the teeth, lips, tongue, and upper/lower palates). 

It serves as your mouth’s immune system — a healthy oral microbiome can reduce rates of tooth decay, periodontal disease, oral thrush, and bad breath. Dysbiosis (imbalance) of the oral microbiome can result in inflammation and a higher risk for any oral disease.

There’s a lot of talk about the gut microbiome and how important it is to your whole body and digestive health, but your oral microbiome may be equally as important.

Balancing your oral microbiome has benefits beyond your mouth, too. Healthy microbial colonies in the mouth can reduce your risk of many systemic diseases. A dysbiotic oral microbiome is associated with problems like:

CancerDiabetesHeart diseaseAdverse pregnancy outcomes (APOs) like miscarriage, preeclampsia, and low birth weightObesityAlzheimer’s diseaseCOPDPneumoniaCognitive impairment

There are specific strains of oral microbes associated with each of these diseases. With predictive testing, your dentist can even test for the presence of these in your mouth and identify if you have an increased risk for these diseases.

Your oral microbiome is the gateway to the rest of your body. Everything that goes in through your nose and mouth passes through your oral cavities, which are home to millions of microbes that make up your oral microbiome.

In addition to the microbes that live in your mouth, you swallow over one trillion microbes every single day. These pass through your oral microbiome and travel down to your gut microbiome, in the process inoculating and reseeding both.

Depending on the health of your oral microbiome, certain microbes make it through this initial checkpoint and have a major say in your overall health. 

This just speaks to the importance of a healthy oral microbiome. 

I can’t state this enough: Whether your mouth maintains an ideal ratio of good-to-bad bacteria directly determines your oral and dental health, as well as the health of your entire body. 

re dental/oral probiotics right for you?

Using oral probiotics for dental health cannot replace oral hygiene, a healthy diet, or 6-month cleanings. However, used with other oral care strategies, dental probiotics can provide a significant benefit to your oral and overall health.

The health of your oral microbiome impacts the rest of the body in ways we are only just beginning to fully understand. Your body is a complex system of interactions, none of which are isolated from the rest of the body. 

As I always say, what happens in the mouth happens in the body.

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