- Email: [email protected]
Myocardial infarction and oral infection
cytokines and creating persistent inflammation. This inflammation can facilitate the development of carcinogenesis by damaging cells and interfering with cell and tissue repair mechanisms.
Table 1.—Areas in Which Further Research Is Warranted to Clarify Links Between Oral/Dental Diseases and Cancer
Acetaldehyde is highly carcinogenic and metabolized from alcohol by oral microorganisms. This action of the oral bacteria could explain why poor oral hygiene and oral cancer are often observed in heavy drinkers and smokers. Under poor oral hygiene conditions, salivary acetaldehyde concentrations are significantly elevated. Although no clinical evidence is currently available in support, it has been suggested that antiseptic agents may indirectly reduce oral cancer development by inhibiting dental plaque bacteria and thereby reducing salivary acetaldehyde production. L-cysteine tablets have also been successful at removing acetaldehyde from saliva. However, such inhibition or reduction has not been shown to diminish the frequency of cancer.
Epidemiology
Because alcohol is used as a solvent in many commercial mouthwashes, there may be a higher risk of oral carcinogenesis when these products are used. No evidence shows that alcohol-containing mouthwashes increase cancer risk, but alcohol also offers no apparent benefit in these products. Alcohol-free mouthwash products are a recommended alternative. Saliva may contain mutagenic compounds, with polymicrobial supragingival plaque suggested as a possible cofactor in the development of oral carcinomas. In addition, oral bacteria may metabolize dietary components into carcinogenic substances. Nitrates and nitrites, for example, can be converted by intestinal microflora into carcinogenic nitrosamines, which are essential components and function in all tobacco-associated malignancies. Discussion.—Much further research is needed concerning the role of oral and dental diseases in carcinogenesis (Table 1). Inadequate evidence is currently available to make final conclusions regarding the role of oral infectious diseases as risk factors for malignancy.
Research area
Research topic
Oral infections and oral cancer Oral infections and malignancies in general Oral microbiota Role of specific micro-organisms (bacteria, yeasts, and viruses) in carcinogenesis Carcinogenic metabolites Direct effect on host cells and tissue reactions known to be associated with the development of cancer Saliva Innate mutagenicity Mechanisms affecting dietary and other external components with carcinogenic potential Defensive and protective factors in patients with and without cancer (Courtesy of Meurman JH, Bascones-Martinez A: Are oral and dental diseases linked to cancer? Oral Dis 17:779-784, 2011.)
Clinical Significance.—General inflammatory mechanisms linked to carcinogenesis also play a role in oral health. Poor oral hygiene is especially related to oral cancer and is a significant component found in other malignancies. Whether good oral hygiene and/or altering oral biofilm composition using specific chemical approaches can reduce the likelihood of cancer remains to be proved. Relationships between oral and dental disease and various forms of cancer should be investigated particularly in countries where there are reliable national cancer registries.
Meurman JH, Bascones-Martinez A: Are oral and dental diseases linked to cancer? Oral Dis 17:779-784, 2011 Reprints available from JH Meurman, Inst of Dentistry, PB 41, FI00014 Univ of Helsinki, Finland; fax: þ358 9 19127517; e-mail: [email protected]
Oral Surgery Myocardial infarction and oral infection Background.—Tooth extractions cause bacteremia that is modified by the person’s immune-inflammatory response and bacteriologic status. Generally, the bacteremia is transitory in otherwise healthy persons. For children, the bacteremia lasts less than 15 minutes. If three or
four teeth are extracted, the bacteremia may last at least 15 minutes. Studies of the relationship between bacteremia and tooth extraction have not previously investigated links between reason for extraction and myocardial infarction (MI).
Volume 57
Issue 5
2012
273
Methods.—The men who participated were studied in 1972/73 in Oslo, then took part in an investigation in 2000, when their age was between 48 and 77 years. Five hundred forty-eight men self-reported a history of MI, and 625 men served as randomly selected controls. The reasons for extraction were classified as infection (periodontal infections or apical infection of a single tooth) or noninfection (trauma, orthodontic treatment, etc.). Results.—A history of MI and extractions because of infection were significantly associated. No apparent association was noted between history of MI and extractions for noninfectious reasons. The relationship between MI and infection remained significant after adjusting for known risk factors for MI and for the upper quartile level of antibodies to periodontal pathogens. Discussion.—Tooth extraction performed to manage an infectious situation is linked to a history of MI, but extraction for other reasons is not. Limitations to the study include its focus on men only and not knowing whether the periodontal disease or the MI occurred first.
Clinical Significance.—The results in this study may reflect a common underlying trait of MI and oral infections. Both chronic marginal periodontitis and pulpal inflammation are associated with coronary heart disease. Diabetes and obesity and/or metabolic syndrome are also related to an increased risk for MI. In addition, oral health shares risk factors with MI, with both related to socioeconomic status. Overall, dentists should encourage the maintenance of oral health as a necessary element in preventing MI.
H aheim LL, Olsen I, Renningen KS: Association between tooth extraction due to infection and myocardial infarction. Community Dent Oral Epidemiol 39:393-397, 2011 Reprints available from LL H aheim, Inst of Oral Biology, Univ of Oslo, Pb 1052 Blindern, N-0316, Oslo, Norway; fax: þ47 22 84 03 05; email: [email protected]
Iatrogenic fracture of the mandible Background.—Several complications can occur in association with dental extractions. The most severe is mandibular fracture (Fig 1), with iatrogenic fracture of the mandible (IFM) occurring either immediately or later in
0.0034% to 0.0075% of cases. The available published information on IFM associated with tooth removal was collected and analyzed, seeking preventive measures to reduce the risk for this serious complication.
Fig 1.—Intraoperative fracture of the mandible associated with tooth removal. Preoperative (left) and postoperative (right) panoramic radiographs. (Courtesy of Bodner L, Brennan PA, McLeod NM: Characteristics of iatrogenic mandibular fractures associated with tooth removal: Review and analysis of 189 cases. Br J Oral Maxillofac Surg 49:567-572, 2011.)
274
Dental Abstracts
Table 1.—Areas in Which Further Research Is Warranted to Clarify Links Between Oral/Dental Diseases and Cancer
Acetaldehyde is highly carcinogenic and metabolized from alcohol by oral microorganisms. This action of the oral bacteria could explain why poor oral hygiene and oral cancer are often observed in heavy drinkers and smokers. Under poor oral hygiene conditions, salivary acetaldehyde concentrations are significantly elevated. Although no clinical evidence is currently available in support, it has been suggested that antiseptic agents may indirectly reduce oral cancer development by inhibiting dental plaque bacteria and thereby reducing salivary acetaldehyde production. L-cysteine tablets have also been successful at removing acetaldehyde from saliva. However, such inhibition or reduction has not been shown to diminish the frequency of cancer.
Epidemiology
Because alcohol is used as a solvent in many commercial mouthwashes, there may be a higher risk of oral carcinogenesis when these products are used. No evidence shows that alcohol-containing mouthwashes increase cancer risk, but alcohol also offers no apparent benefit in these products. Alcohol-free mouthwash products are a recommended alternative. Saliva may contain mutagenic compounds, with polymicrobial supragingival plaque suggested as a possible cofactor in the development of oral carcinomas. In addition, oral bacteria may metabolize dietary components into carcinogenic substances. Nitrates and nitrites, for example, can be converted by intestinal microflora into carcinogenic nitrosamines, which are essential components and function in all tobacco-associated malignancies. Discussion.—Much further research is needed concerning the role of oral and dental diseases in carcinogenesis (Table 1). Inadequate evidence is currently available to make final conclusions regarding the role of oral infectious diseases as risk factors for malignancy.
Research area
Research topic
Oral infections and oral cancer Oral infections and malignancies in general Oral microbiota Role of specific micro-organisms (bacteria, yeasts, and viruses) in carcinogenesis Carcinogenic metabolites Direct effect on host cells and tissue reactions known to be associated with the development of cancer Saliva Innate mutagenicity Mechanisms affecting dietary and other external components with carcinogenic potential Defensive and protective factors in patients with and without cancer (Courtesy of Meurman JH, Bascones-Martinez A: Are oral and dental diseases linked to cancer? Oral Dis 17:779-784, 2011.)
Clinical Significance.—General inflammatory mechanisms linked to carcinogenesis also play a role in oral health. Poor oral hygiene is especially related to oral cancer and is a significant component found in other malignancies. Whether good oral hygiene and/or altering oral biofilm composition using specific chemical approaches can reduce the likelihood of cancer remains to be proved. Relationships between oral and dental disease and various forms of cancer should be investigated particularly in countries where there are reliable national cancer registries.
Meurman JH, Bascones-Martinez A: Are oral and dental diseases linked to cancer? Oral Dis 17:779-784, 2011 Reprints available from JH Meurman, Inst of Dentistry, PB 41, FI00014 Univ of Helsinki, Finland; fax: þ358 9 19127517; e-mail: [email protected]
Oral Surgery Myocardial infarction and oral infection Background.—Tooth extractions cause bacteremia that is modified by the person’s immune-inflammatory response and bacteriologic status. Generally, the bacteremia is transitory in otherwise healthy persons. For children, the bacteremia lasts less than 15 minutes. If three or
four teeth are extracted, the bacteremia may last at least 15 minutes. Studies of the relationship between bacteremia and tooth extraction have not previously investigated links between reason for extraction and myocardial infarction (MI).
Volume 57
Issue 5
2012
273
Methods.—The men who participated were studied in 1972/73 in Oslo, then took part in an investigation in 2000, when their age was between 48 and 77 years. Five hundred forty-eight men self-reported a history of MI, and 625 men served as randomly selected controls. The reasons for extraction were classified as infection (periodontal infections or apical infection of a single tooth) or noninfection (trauma, orthodontic treatment, etc.). Results.—A history of MI and extractions because of infection were significantly associated. No apparent association was noted between history of MI and extractions for noninfectious reasons. The relationship between MI and infection remained significant after adjusting for known risk factors for MI and for the upper quartile level of antibodies to periodontal pathogens. Discussion.—Tooth extraction performed to manage an infectious situation is linked to a history of MI, but extraction for other reasons is not. Limitations to the study include its focus on men only and not knowing whether the periodontal disease or the MI occurred first.
Clinical Significance.—The results in this study may reflect a common underlying trait of MI and oral infections. Both chronic marginal periodontitis and pulpal inflammation are associated with coronary heart disease. Diabetes and obesity and/or metabolic syndrome are also related to an increased risk for MI. In addition, oral health shares risk factors with MI, with both related to socioeconomic status. Overall, dentists should encourage the maintenance of oral health as a necessary element in preventing MI.
H aheim LL, Olsen I, Renningen KS: Association between tooth extraction due to infection and myocardial infarction. Community Dent Oral Epidemiol 39:393-397, 2011 Reprints available from LL H aheim, Inst of Oral Biology, Univ of Oslo, Pb 1052 Blindern, N-0316, Oslo, Norway; fax: þ47 22 84 03 05; email: [email protected]
Iatrogenic fracture of the mandible Background.—Several complications can occur in association with dental extractions. The most severe is mandibular fracture (Fig 1), with iatrogenic fracture of the mandible (IFM) occurring either immediately or later in
0.0034% to 0.0075% of cases. The available published information on IFM associated with tooth removal was collected and analyzed, seeking preventive measures to reduce the risk for this serious complication.
Fig 1.—Intraoperative fracture of the mandible associated with tooth removal. Preoperative (left) and postoperative (right) panoramic radiographs. (Courtesy of Bodner L, Brennan PA, McLeod NM: Characteristics of iatrogenic mandibular fractures associated with tooth removal: Review and analysis of 189 cases. Br J Oral Maxillofac Surg 49:567-572, 2011.)
274
Dental Abstracts