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From the Townsend Letter
June 2016

Anti-Aging Medicine
An Anti-Aging Approach to Oral Health
by Ronald Klatz, MD, DO, and Robert Goldman, MD, PhD, DO, FAASP
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Having healthy teeth and gums is an important part of any healthful lifestyle. As part of an anti-aging regimen, it should be considered that oral wellness changes with age. Not only can the condition of teeth cause one to look older, by discoloration and/or tooth loss, but certain warning signs may be present in the mouth. One can tell a lot about a person's overall health by their dental health, which is often a reflection of the rest of the body. Dental issues can expose health problems that one may otherwise not have been aware of, and can also be a predictor of upcoming issues. For increased longevity, it is important to be alert to the oral health problems that often accompany aging and what they can signify. Below are recent studies which have determined health issues that may be predicted from oral wellness.

Tooth Loss Predicts Cardiovascular Disease
A chronic inflammatory disease affecting the teeth and oral tissues, periodontitis has been shown by previous studies to raise the risk of atherosclerotic vascular disease. J. M. Liljestrand and colleagues from the University of Helsinki (Finland) assessed the correlation between the number of missing teeth and incident cardiovascular diseases (CVDs), diabetes, and all-cause death. Analyzing data collected on 8446 participants, aged 25 to 75 years, in the National FINRISK 1997 Study with 13 years of follow-up, the team found that more than five missing teeth increased the risk for coronary heart disease events and myocardial infarctions by 140%. More than nine missing teeth indicated an increased risk for cardiovascular diseases (51%), diabetes (31%), and death (37%). Observing, "Even a few missing teeth may indicate an increased risk of [cardiovascular disease], diabetes, or all-cause mortality," the study authors submit: "When individual risk factors for chronic diseases are assessed, the number of missing teeth could be a useful additional indicator for general medical practitioners."

Liljestrand JM, Havulinna AS, Paju S, Männistö S, Salomaa V, Pussinen PJ. Missing teeth predict incident cardiovascular events, diabetes, and death. J Dent Res. 19 May 2015.

Poor Oral Health May Signal Prostate Issues
Prostatitis is a chronic inflammation of the prostate gland that can compromise a man's quality of life. Naif Alwithanani and colleagues from Case Western Reserve University (Ohio, US) studied 27 men, aged 21 years and older, all diagnosed with prostatitis within the past year (via biopsy and prostate specific antigen [PSA] test). The men were assessed for symptoms of prostate disease by answering questions on the International-Prostate Symptom Score (IPSS) test. Of the 27 participants, 21 had no or mild inflammation, but 15 had biopsy-confirmed malignancies, and 2 had both inflammation and a malignancy. Each of the subjects had at least 18 teeth, and all of them showed moderate to severe gum disease. They received treatment and were tested again for periodontal disease 4 to 8 weeks later and showed significant improvement. During the periodontal care, the men received no treatment for their prostate conditions. But even without prostate treatment, 21 of the 27 men showed decreased levels of PSA. Those with the highest levels of inflammation benefited the most from the periodontal treatment. Six participants showed no changes. Symptom scores on the IPSS test also showed improvement. The study authors write: "Periodontal treatment improved prostate symptom score and lowered PSA value in men afflicted with chronic periodontitis."

Alwithanani N, Bissada NF, Joshi N, Bodner D, Demko C, et al. Periodontal treatment improves prostate symptoms and lowers serum PSA in men with high PSA and chronic periodontitis. Dentistry. 5:284.

Teeth Tell of Toxins
Akin to the rings in a tree trunk, teeth provide a chronological record of exposure from their microchemical composition in relation to defined growth lines. Manish Arora and colleagues from the Mount Sinai School of Medicine (New York, US) analyzed iron deposits in teeth as a method for retrospective determination of exposure to the metal. In particular, the team sought to explore whether early iron exposure could be linked to late-life brain diseases such as Parkinson's and Alzheimer's, which are associated with the abnormal processing of iron. While not all formula-fed babies will experience neurodegeneration in adulthood, the combination of increased iron intake during infancy with a predisposition to impaired metal metabolism such as the inability of brain cells to remove excessive metals may damage those cells over time. Their study suggests that too much iron in infant formula may potentially increase risk for neurodegenerative diseases in adulthood; Writing, "We discuss the potential long-term implications of excessive iron intake in early life, propose the analysis of iron deposits in teeth as a method for retrospective determination of iron exposure during critical developmental windows," the study authors urge that a priority in pediatric research should be the rigorous determination of iron supplementation needs of infants according to their individual iron status.

Hare DJ, Arora M, Jenkins NL, Finkelstein DI, Doble PA, Bush AI. Is early-life iron exposure critical in neurodegeneration? Nat Rev Neurol. 23 June 2015.

Poor Dental Health Linked to Depression
Using data from a comprehensive health survey of more than 10,000 people, aged 20 to 75 years living in the US, researchers from the Deakin IMPACT Strategic Research Centre (Australia) found that poor dental health (as measured by the number of dental conditions that a person had) increases the likelihood of depression. Adrienne O'Neil and colleagues found that the more numerous the dental conditions, the greater the severity of depression. Even adjusting for other factors that could potentially play a role in the inflammatory process, the study authors write: "A positive association exists between poor dental health and depression that is independent of [C-reactive protein] and [body mass index]."

O'Neil A, Berk M, Venugopal K, Kim S-W, Williams LJ, Jacka FN. The association between poor dental health and depression: findings from a large-scale, population-based study (the NHANES study). Gen Hosp Psychiatry. May–June 2014;36(3):26–270.

Poor Heart Surgery Outcome Linked to Dental Extractions
Among candidates for heart surgery, abscessed or infected teeth often are removed prior to surgery, in an aim to reduce the risk of infections including endocarditis, an infection of the inner lining of the heart that can prove deadly. Prosthetic heart valve-related endocarditis accounts for up to one-fourth of infective endocarditis cases and proves fatal for up to 38 of patients who develop it. Kendra Grim and colleagues from Mayo Clinic (Minnesota, US) completed the largest review so far evaluating adverse outcomes after precardiac surgery dental extractions. The researchers studied outcomes in 205 adult Mayo patients who had teeth pulled before cardiovascular surgery. Eighty percent of the patients were men, the median age at the time of tooth extraction was 62 years, and the median time lapse between dental extraction and heart surgery was seven days. Six patients, or 3%, died in the period between their tooth extraction and the planned cardiac procedure. Another 6 died after heart surgery, all while still hospitalized. Ten patients, or roughly 5%, had other major adverse outcomes after heart surgery, such as bleeding, stroke, kidney failure requiring dialysis, acute coronary syndrome or strokelike transient ischemic attacks. The study authors warn: "Patients with planned dental extraction before cardiac operation are at risk for major adverse outcomes, including a 3% risk of death before cardiac operation and an 8% risk of a major adverse outcome."

Smith MM, Barbara DW, Mauermann WJ, Viozzi CF, Dearani JA, Grim KH. Morbidity and mortality associated with dental extraction before cardiac operation. Ann Thorac Surg. March 2014;97(3):838–844.


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