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Rothfeld, M.D. Medical Director, WholeHealth New England Clinical Assistant Professor, Tufts University School of Medicine GRothfeld@WholeHealthNE.com WWW.WholeHealthNE.comComplementary Medicinein Clinical Dentistry: Complementary Medicine in Clinical Dentistry Glenn S. Rothfeld, M.D. Medical Director, WholeHealth New England Clinical Assistant Professor, Tufts University School of Medicine GRothfeld@WholeHealthNE.com WWW.WholeHealthNE.comWhy Am I Giving This Lecture?: Why Am I Giving This Lecture? Practice of Integrative Medicine (Complementary and Alternative Medicine, or CAM) for 29 years Acupuncture training 1983-1987 Board Certified in Medical Acupuncture Taught one of first courses in a medical school (Tufts), in Alternative Medicine 1988-1994 Set up Western Medicine curriculum at New England School of Acupuncture 9 books published on Integrative Medicine topics, including “Thyroid Balance”One Definition of CAIM:Complementary/Alternative/Integrative): One Definition of CAIM: Complementary/Alternative/Integrative) Conventional Medicine Functional Medicine Energy Medicine Manual Medicine Mind-Body Medicine Energy MedicineSlide5: Non-physical, Energetic, Functional, Immeasurable, Dynamic Physical, Material, Structural, Measurable, Static “Yin” --- Spiritual Healing --- Mind-Body Medicine --- Homeopathy --- Hands-on Healing --- Acupuncture* --- Functional/Nutritional Medicine --- Botanical Medicine --- Musculoskeletal Medicine --- Pharmaceutical Medicine --- Surgery “Yang””The art of medicine is to keep the patient entertained while nature cures the disease" -- Voltaire: ”The art of medicine is to keep the patient entertained while nature cures the disease" -- Voltaire Functional Medicine: Functional Medicine Nutrient Therapy Hormonal Therapy Detoxification Nutritional (Diet) Therapies Metabolic Therapies Botanical Medicine Oxygen Therapies (HBOT, ozone, etc)Energy Medicine: Energy Medicine Acupuncture Homeopathy Reiki QiGong Hands-on Healing Polarity (Yoga Therapy)Biomechanical (Manual) Medicine: Biomechanical (Manual) Medicine Chiropractic Osteopathic Manipulation Therapy (OMT) Massage and Muscular Therapy Movement Therapies (e.g. Feldenkreis) Physical Therapy Exercise TherapyMind-Body Medicine: Mind-Body Medicine Meditation Biofeedback Psychotherapies Hypnosis, EMDR, etc. (Yoga) Relaxation trainingConventional Medicine: Conventional Medicine Pharmaceuticals Surgery RadiotherapyAsk Your Patient What Else They’re Doing!! Ask Your Patient Who Else They’re Seeing!!: Ask Your Patient What Else They’re Doing!! Ask Your Patient Who Else They’re Seeing!! Medications Supplements Herbs Hormones Homeopathy Diet Therapy Acupuncture Chiropractor Bodywork Healer Hypnotist Yoga Etc.CAM and Dentistry: CAM and Dentistry “Biofeedback, acupuncture, herbal medication, massage, bioelectromagnetic therapy, meditation, and music therapy are examples of CAM treatments…. The dentist needs to be informed regarding the herbal and over-the-counter products that may impact the delivery of safe and effective dental treatment. ” Little JW. Complementary and alternative medicine: impact on dentistry. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2004 Aug; 98(2): 137-45.CAM and Dentistry: CAM and Dentistry “…only three patients had any written documentation of their herb use in their medical/dental health chart (p= .0001). Fifty-five herb users were also taking prescription drugs (69%) that could potentially lead to herb-drug interactions . ” Tam KK et al. Differences between herbal and nonherbal users in dental practice. J Dent Hyg. 2006 Winter;80(1):10. Epub 2006 Jan 1.CAM and Dentistry:Homeopathy: CAM and Dentistry: Homeopathy Many homeopathic remedies have been found to be effective for dental conditions, namely dental caries, dental abscess, oral lesions, post-extraction bleeding and even medications to treat the anxious and nervous child. ” Bhat SS et al. Dentistry and homeopathy: an overview. Dent Update. 2005 Oct;32(8):486-8, 491. Comment in: Dent Update. 2006 Jan-Feb;33(1):58; author reply 58. CAM and Dentistry:Herbal Medicine: CAM and Dentistry: Herbal Medicine “Herbs can substantially reduce gum bleeding and the depth of tissue pockets. Herbs can also reduce the mobility (or looseness) of teeth…help to avert abscesses, allowing patients to avoid root canals and extractions, and help to reduce caries. ” Abascal K and Yarnell E. Herbs for Treating Periodontal Disease. Alt Complem Ther. 2001 Aug; 216-220CAM and Dentistry:Acupuncture: CAM and Dentistry: Acupuncture “[Through a variety of effects] acupuncture can provide complimentary [sic] treatments to patients through implant rehabilitation . ” Vachiramon A et al. The use of acupuncture in implant dentistry. Implant Dent. 2004 Mar;13(1):58-64.CAM and Dentistry:Stress Reduction: CAM and Dentistry: Stress Reduction Dental anxiety is a widespread problem and has a significant impact on the provision of dental care for the general population. Anxiety leads to avoidance of dental treatment and increased stress for dental practitioners. This article reviews alternative treatment approaches, including psychological and complementary therapies which can be used in managing dental anxiety and facilitating dental treatment. Many of these approaches are currently being used within the dental profession. Others are gaining a wider acceptance as to their usage. Department of Restorative Dentistry, Birmingham Dental Hospital 2005 Mar;32(2):90-2, 94-6. CAM and Dentistry:Stress Reduction: CAM and Dentistry: Stress Reduction “Meditation and hypnosis, either alone or in combination with local anesthesia, were most effective in anxiety reduction as measured by questionnaire and/or salivary changes.” Morse DR et al. Stress, relaxation, and saliva: a pilot study involving endodontic patients. Oral Surg Oral Med Oral Pathol. 1981 Sep; 52(3):308-13. Case #1Recurrent Aphthous Ulcers: Case #1 Recurrent Aphthous Ulcers 57 year old man No medications or supplements Chronic Irritable Bowel Syndrome High-stress lifestyle Long-distance runner Severe recurrent aphthous ulcers Sodium Lauryl Sulfate and Oral Mucosal Disease: Sodium Lauryl Sulfate and Oral Mucosal Disease “Contact sensitivity-like reactions were also found in the oral mucosa after exposure to an irritant detergent, sodium lauryl sulfate (SLS). The oral mucosa reacted at smaller SLS doses than did skin.” Ahlfors EE and Lyberg T. Contact sensitivity reactions in the oral mucosa. Acta Odontol Scand. 2001 Aug;59(4):248-54. Sodium Lauryl Sulfate Toothpasteand Oral Mucosal Disease: Sodium Lauryl Sulfate Toothpaste and Oral Mucosal Disease “Both SLS-containing pastes had a similar, irritating effect on the mucosa as judged both by the appearance of the mucosa and the EI measurements. The dry mouth toothpaste (with betaine only) showed no significant irritation of the mucosa.” Rantanen I et al. The effects of two sodium lauryl sulphate-containing toothpastes with and without betaine on human oral mucosa in vivo. Swed Dent J. 2003;27(1):31-4.Sodium Lauryl Sulfate and Aphthous Ulcers: Sodium Lauryl Sulfate and Aphthous Ulcers “A statistically significant reduction in recurrent aphthous ulcers was observed during 2 months' use of SLS-free dentifrice compared to 2 months' use of the SLS-containing dentifrice.” Chahine L et al. The effect of sodium lauryl sulfate on recurrent aphthous ulcers: a clinical study. Compend Contin Educ Dent. 1997 Dec;18(12):1238-40. Sodium Lauryl Sulfate and Aphthous Ulcers: Sodium Lauryl Sulfate and Aphthous Ulcers “... same trend as the previous studies, that is, the SLS-free toothpaste usage resulted in fewer canker sores than usage of the SLS-containing toothpaste, this study could not claim a statistically significant effect.” Healy CM et al. The effect of a sodium lauryl sulfate-free dentifrice on patients with recurrent oral ulceration. Oral Dis. 1999 Jan; 5(1):39-43.Sodium Lauryl Sulfate and Aphthous Ulcers: Sodium Lauryl Sulfate and Aphthous Ulcers “The results showed a statistically significant decrease in the number of aphthous ulcers from 14.3 after using the SLS-containing dentifrice to 5.1 ulcers after brushing with the SLS-free dentifrice (p < 0.05) .” Herlofson BB and Barkvoll P. Sodium lauryl sulfate and recurrent aphthous ulcers. A preliminary study. Acta Odontol Scand. 1994 Oct;52(5):257-9. Sodium Lauryl Sulfate and Aphthous Ulcers: Sodium Lauryl Sulfate and Aphthous Ulcers “A significantly higher frequency of aphthous ulcers was demonstrated when the patients brushed with an SLS- than with a CAPB-containing or a detergent-free placebo paste.” Herlofson BB and Barkvoll P. The effect of two toothpaste detergents on the frequency of recurrent aphthous ulcers. Acta Odontol Scand. 1996 Jun;54(3):150-3Magnesium MPP and Sodium Lauryl Sulfate in Oral Mucosal Health: Magnesium MPP and Sodium Lauryl Sulfate in Oral Mucosal Health “Significant reduction in plaque was seen in subjects using an MMPP rinse and dentifrice compared with placebo subjects…Subjective reports of soreness, dryness or burning sensation, were recorded and observed more frequently in the experimental groups than in the placebos, especially in those also using SLS.” Scully C et al. The effects of mouth rinses and dentifrice-containing magnesium monoperoxyphthalate (mmpp) on oral microflora, plaque reduction, and mucosa. J Clin Periodontol. 1999 Apr;26(4):234-8.Sodium Lauryl Sulfate, Triclosanand Zinc in Oral Mucosa: Sodium Lauryl Sulfate, Triclosan and Zinc in Oral Mucosa “RESULTS: SLS treatment caused a significant increase in water permeability compared to control tissue P < 0.005. Treatment with a SLS/TCN/Zn mixture, however, had no effect on the permeability to water. Histological examination revealed that tissue exposed to SLS had a marked disruption of the epithelial surface whilst tissue treated with a SLS/TCN/Zn mixture was indistinguishable from controls. CONCLUSION: Although mucosa exposed to SLS alone showed an increase in permeability to water, the addition of TCN and Zn to SLS appeared to prevent this effect.” Healy CM. The effect of sodium lauryl sulphate, triclosan and zinc on the permeability of normal oral mucosa. Oral Dis. 2000 Mar;6(2):118-23. Zinc and Aphthous Ulcers: Zinc and Aphthous Ulcers “…Levels of serum zinc before treatment were under the normal value in the 42.5% percent of the patients with RAS.... After 1 month of zinc therapy the aphthae reduced and did not reappear for 3 months.” Orbak R et al. Effects of zinc treatment in patients with recurrent aphthous stomatitis. Dent Mater J. 2003 Mar;22(1):21-9. Zincand Aphthous Ulcers: Zinc and Aphthous Ulcers A topical recommendation for aphthous ulcers is an 8% solution of zinc chloride applied directly to the ulcers with a cotton applicator. The poor taste lasts for several minutes and then the pain is relieved. “Aphthous Ulcers: Zinc,” Rieber, William A., D.O., Cortlandt Forum, April 1991;101/38-47.B Vitamins B1, B2 and B6and Aphthous Ulcers: B Vitamins B1, B2 and B6 and Aphthous Ulcers “Seventeen patients (28.2%) were found to be deficient in one or more of these vitamins. Replacement therapy … for one month. At the end of therapy and after a follow-up period of 3 months, only those patients who had a B complex deficiency had a significant sustained clinical improvement in their mouth ulcers.” Nolan A et al. Recurrent aphthous ulceration: vitamin B1, B2 and B6 status and response to replacement therapy. J Oral Pathol Med. 1991 Sep;20(8):389-91Vitamin B12 and Aphthous Ulcers: Vitamin B12 and Aphthous Ulcers “We describe three patients in whom a clear relationship appeared to exist between recurrent aphthous ulcers and a deficiency of vitamin B12.” Weusten BL and van de Wiel A. Aphthous ulcers and vitamin B12 deficiency. Neth J Med. 1998 Oct;53(4):172-5. Vitamin B12 and Aphthous Ulcers: Vitamin B12 and Aphthous Ulcers “This physician had a difficult case of recurrent aphthous stomatitis which apparently has responded to monthly injections of vitamin B12. The physician noted that he discovered in The Lange Textbook of Dermatology, the 1991 edition that 15% of patients with recurrent aphthous stomatitis responded to B12…” “Should Vitamin B12 be Used for Aphthous Stomatitis,” Andrews, Chad, M.D., Consultant. Anti-Oxidant Vitamins and Aphthous Ulcers: Anti-Oxidant Vitamins and Aphthous Ulcers “In summary, this study demonstrated that enzymatic and nonenzymatic antioxidant defense systems are impaired in patients with RAS.” Cimen MY et al. Oxidant/antioxidant status in patients with recurrent aphthous stomatitis. Clin Exp Dermatol. 2003 Nov; 28(6):647-50. Anti-Oxidant Vitamins and Aphthous Ulcers: Anti-Oxidant Vitamins and Aphthous Ulcers “The present study demonstrates that the serum and saliva levels of selected antioxidant vitamins are lower, while the degree of lipid peroxidation, as judged by the MDA levels, is higher in patients with RAU than in the control subjects .” Saral Y et al. Assessment of salivary and serum antioxidant vitamins and lipid peroxidation inpatients with recurrent aphthous ulceration. Tohoku J Exp Med. 2005 Aug;206(4):305-12. D-Limonene (Citrus Oil)and Aphthous Ulcers: D-Limonene (Citrus Oil) and Aphthous Ulcers “Citrus oil had an antibacterial effect with a minimal inhibitory concentration (MIC) of 1 mg/ml, whereas MgCl2 at concentrations up to 10 mg/ml did not exhibit any antibacterial activity. However, a mixture of 10 mg/ml MgCl2 and 0.25 mg/ml citrus oil dramatically increased inhibition of bacterial growth.” Mizrahi B, et al. Citrus Oil and MgCl2 as antibacterial and anti-inflammatory agents. Journal of Periodontology 2006, Vol. 77, No. 6: 963-968 Deglycyrrhizinated Licorice (DGL)and Aphthous Ulcers: Deglycyrrhizinated Licorice (DGL) and Aphthous Ulcers Twenty patients with aphthous ulcers were advised deglycyrrhizinated licorice (DGL) mouth wash and were followed for two weeks. Fifteen patients experienced 50-75% improvement within one day followed by complete healing of the ulcers by the third day. Das SK et al. J Assoc Physicians India. 1989 Oct;37(10):647.Food Allergies (Gluten)and Aphthous Ulcers: Food Allergies (Gluten) and Aphthous Ulcers “Blood samples from 42 patients (with recurrent aphthous stomatitis) were evaluated and 2/42(4.7%) were IgA- and IgG-endomysial antibody-positive.... All symptoms related to aphthous stomatitis responded well to a gluten-free diet.” Olszewska M et al. Frequency and prognostic value of IgA and IgG endomysial antibodies in recurrent aphthous stomatitis. Acta Derm Venereol. 2006;86(4):332-4. Food Allergies (Gluten)and Aphthous Ulcers: Food Allergies (Gluten) and Aphthous Ulcers Out of a total of 5,280 students between 11 and 15 years of age celiac disease was diagnosed in 23 cases. Most of these cases were atypical or silent forms. The prevalence of undiagnosed celiac disease was 4.3 per 1,000 screened subjects and 5.03 per 1,000 in the general population. “High Prevalence of Undiagnosed Celiac Disease in 5,280 Italian Students Screened by Antigliadin Antibodies,” Catassi, C., etal, ACTA Pediatrica, 1995;84:672-676.Food Allergies (Gluten) and Aphthous Ulcers.: Food Allergies (Gluten) and Aphthous Ulcers. Fifty patients with a history of minor recurrent aphthous stomatitis were entered into a 6-month double-blind controlled trial of a gluten-free diet. One half of the group was given a gluten-free diet; the other half served as controls and received a gluten-free diet supplemented by gluten given blind (control diet). Twenty-three patients completed the trial, 11 patients on a gluten-free diet, 12 on the control diet. Four of the 11 on the gluten-free diet and 7 of the 12 on the control diet reported significant benefit in terms of minor recurrent aphthous stomatitis. Oral Surg, Oral Med, Oral Pathol. 1993 May;75(5):595-8.Stress Reductionand Aphthous Stomatitis: Stress Reduction and Aphthous Stomatitis Relaxation/imagery training was evaluated in two males and five females between 16 and 66 years of age. Results suggest that the relaxation/imagery treatment program was associated with a significant decrease in the frequency of ulcer recurrence for all subjects. “The Effects of Relaxation/Imagery Training on Recurrent Aphthous Stomatitis: Preliminary Study,” Andrews, Vivian H., MS and Hall, Howard R., Ph.D., Psychosomatic Medicine, Sept/Oct 1990;52(5):526-535.Stress Reductionand Aphthous Ulcers: Stress Reduction and Aphthous Ulcers 7 subjects, 2 males and 5 females 12 individual appointments for relaxation / imagery training 1 week apart Mean improvement in the seven treated patients was over 33%. The reduction in pain from individual ulcers, and in number of ulcers. “The Effects of Relaxation/Imagery Training on Recurrent Aphthous Stomatitis: A Preliminary Study,” Andrews, Vivian H,. MS and Hall, Howard R., Ph.D., Psychosomatic Medicine, Sept/Oct 1990; 52(5):526-535.Nicotineand Aphthous Ulcers: Nicotine and Aphthous Ulcers “The study was prompted by the observations that smokers are less likely to suffer from mouth ulcers, that some smokers on quitting develop them, and that patients on nicotine replacement therapy are less likely to develop ulcers than those having other types of smoking cessation therapy…each patient was given up to four 2 mg Nicorette chewing tablets per day. After one month of this regimen each patient was weaned off the tablets. In each case the ulcers healed and new ulcers did not appear during Nicorette therapy. Two of the patients relapsed when weaned off the tablet.” “Recurrent Aphthous Ulcers and Nicorette,” Bittoun, Renee, The Medical Journal of Australia, April 1, 1991;154:471-472.Recurrent Aphthous Ulcers:Suggested Therapeutic Approach: Recurrent Aphthous Ulcers: Suggested Therapeutic Approach SLS free toothpaste B Complex 50 mg Consider extra folic acid and B12 Chelated zinc 30 mg daily (or zinc liquid) Chew DGL (deglycyrrhizinated licorice) 4x/d Consider aloe vera juice – swish and swallow Consider gluten or other allergen elimination Stress Reduction Case #2Chronic Facial PainTreated by Acupuncture: Case #2 Chronic Facial Pain Treated by Acupuncture 63 year old man Dental pain treated with root canal Pain intensified after root canal x 2 Neurontin, tricyclics, analgesics, NSAIDs without improvement Proton knife without improvement Improvement after 8 acupuncture treatments N.I.H. Consensus Panelon Acupuncture 1997: N.I.H. Consensus Panel on Acupuncture 1997 “...the data supporting acupuncture are as strong as those for many accepted Western medical therapies.”Slide47: ESlide48: E m Slide49: E m Slide50: E =mc2Slide51: E m YANG YINSlide52: Acupuncture and Dental Pain: Acupuncture and Dental Pain “This article aims to introduce the combination of acupuncture and acupressure techniques for reducing orthodontic post-adjustment pain using a single acupuncture point, Hegu (LI-4). ” Vachiramon A and Wang WC. Acupuncture and acupressure techniques for reducing orthodontic post-adjustment pain. J Contemp Dent Pract. 2005 Feb 15;6(1):163-7. Acupuncture and Dental Pain: Acupuncture and Dental Pain DESIGN: Randomized, double-blind, placebo-controlled trial. Mean pain-free postoperative time significantly longer (P=.01) Time until moderate pain significantly longer (P=.008) . Mean number of minutes before requesting pain significantly longer (P=.01) Time until medication use significantly longer (P=.01) . Average pain medication consumption was significantly less (P=.05). Nearly half or more of all patients were uncertain of or incorrect about their group assignment. Outcomes were not associated with psychological factors in multivariate models. Lao L et al. Evaluation of acupuncture for pain control after oral surgery: a placebo-controlled trial. Arch Otolaryngol Head Neck Surg. 1999 May;125(5):567-72. Acupuncture and Dental Pain: Acupuncture and Dental Pain Cochrane Collaboration review 16 Studies reviewed “majority of these trials imply that acupuncture is effective in dental analgesia .” Ernst E and Pittler MH. The effectiveness of acupuncture in treating acute dental pain: a systematic review. Br Dent J. 1998 May 9; 184(9):443-7Acupuncture and TMJ Dysfunction: Acupuncture and TMJ Dysfunction Oral acupuncture in the therapy of cranicmandibular dysfunction syndrome-- a randomized controlled trial, Schmid-Schwap M, Simma-Kletschka l, et al, Wein Klin Wochenschr, 2006 ;118(1-2):36-42 Acupuncture as a Treatment for Temporomandibular Joint Dysfunction: A Systematic Review of Randomized Trials, Ernst E and White AR, Arch Otolaryngol Head Neck Surg, March,1999;125:269-272. The efficiency of acupuncture in the treatment of temporomandibular joint myofascial pain: A randomized controlled trial, Smith P, Mosscrop D, et al, Journal of Dentistry, 2006 Nov 7. Acupuncture and Dental Pain: Acupuncture and Dental Pain “There was a significant difference of pain scores between before treatment and after treatment (P < 0.0001). “ Goddard G. Short term pain reduction with acupuncture treatment for chronic orofacial pain patients. Med Sci Monit. 2005 Feb; 11(2):CR71-4Acupuncture and Dentistry: Acupuncture and Dentistry control of gagging reflex control of postoperative vomiting control of postoperative pain enhance anesthetic effects control of anxiety increase saliva production enhance immune responses management of temporomandibular dysfunction smoking cessation control diabetic mellitus stimulation of peripheral nerve regeneration Vachiramon A et al. The use of acupuncture in implant dentistry. Implant Dent. 2004 Mar;13(1):58-64. Case #3Periodontal Disease and Chronic Fatigue: Case #3 Periodontal Disease and Chronic Fatigue 47 year old woman No medications; Takes multi and Flax Oil Periodontal disease for 8 years Root planing, deep scaling Chronic Fatigue developed 5 years ago Lymphadenopathy, low-grade fevers Myalgias, sleep disturbance Case #3Periodontal Disease and Chronic Fatigue: Case #3 Periodontal Disease and Chronic Fatigue Normal CBC, standard testing Low antioxidant nutrient levels Low natural killer cells Low-normal lymphocyte counts Low RBC minerals Oral Infectionand Systemic Disease: Oral Infection and Systemic Disease “Periodontitis as a major oral infection may affect the host's susceptibility to systemic disease in three ways: by shared risk factors; subgingival biofilms acting as reservoirs of gram-negative bacteria; and the periodontium acting as a reservoir of inflammatory mediators.” Li X, et al. Systemic diseases caused by oral infection. Clin Microbiol Rev. 2000 Oct;13(4):547-58. Oral Infectionand Cardiovascular Disease: Oral Infection and Cardiovascular Disease “RESULTS: from these studies have shown positive associations between periodontal disease and CVD. CONCLUSIONS: Evidence continues to support an association among periodontal infections, atherosclerosis and vascular disease.” Demmer and Desvarieux. Periodontal infections and cardiovascular disease: The heart of the matter. J Am Dent Assoc. 2006 Oct;137 Suppl 2:14S-20S. Coenzyme Q 10 in Periodontal Disease: Coenzyme Q 10 in Periodontal Disease “Mean value of the specific (of Co Q 10) …on gingival biopsies increased (P<0.05) during treatment which could correlate with the extraordinarily healing.” Wilkinson et al. Adjunctive treatment with coenzyme Q in periodontal therapy. Res Commun Chem Pathol Pharmacol. 1975 Sep;12(1):111-23 Coenzyme Q 10 in Periodontal Disease: Coenzyme Q 10 in Periodontal Disease “These results suggest that topical application of CoQ10 improves adult periodontitis not only as a sole treatment but also in combination with traditional nonsurgical periodontal therapy.” Hanioka T, et al. Effect of topical application of coenzyme Q10 on adult periodontitis. Mol Aspects Med. 1994;15 Suppl:s241-8. Coenzyme Q 10 in Periodontal Disease: Coenzyme Q 10 in Periodontal Disease “. During gingivitis tissue displayed a large inflammatory infiltration … Vitamin E dramatically decreased and CoQ(10) remained unchanged despite the increased amount of cells present in the periodontally affected tissues, indicating that continuous oxidative stress which occurred in these structure affected the antioxidant pattern of the tissue.” Battino M, et al. Antioxidant status (CoQ10 and Vit. E levels) and immunohistochemical analysis of soft tissues in periodontal diseases. Biofactors. 2005;25(1-4):213-7.Vitaminsin Periodontal Disease: Vitamins in Periodontal Disease Sixty-three patients were randomly divided into two groups of 32 and 31 subjects and given either a vitamin tablet containing seven active ingredients (experimental treatment) or a placebo tablet. The clinical parameters assessed were the gingival index (GI), bleeding index (BI), periodontal pocket depth (PD), and attachment levels (AL)…. After 60 days, the data showed a clinical reduction in the GI, BI, and PD for the experimental group (P < .0001). Munoz CA et al. Effects of a nutritional supplement on periodontal status. Compend Contin Educ Dent. 2001 May;22(5):425-8, 430, 432 passim; quiz 440.Vitamin D3 in Periodontal Disease: Vitamin D3 in Periodontal Disease “…25-hydroxyvitamin D3 levels were significantly and inversely associated with periodontal attachment loss in men and women who were =50 years of age…bone mineral density of the total femoral region was not associated with attachment loss.” Dietrich T, et al. Association between serum concentrations of 25-hydroxyvitamin D and periodontal disease in the US population. Am J Clin Nutr. 2004; 80: 108-113 Vitamin D3 in Periodontal Disease: Vitamin D3 in Periodontal Disease “Conclusion: Low serum 25-hydroxyvitamin D3 levels may be associated with periodontal disease independently of bone mineral density.” Dietrich T, et al. Association between serum concentrations of 25-hydroxyvitamin D and periodontal disease in the US population. Am J Clin Nutr. 2004; 80: 108-113 Vitamin D3 in Periodontal Disease: Vitamin D3 in Periodontal Disease “CONCLUSIONS: Vitamin D may reduce susceptibility to gingival inflammation through its anti-inflammatory effects .” Dietrich T, et al. Association between serum concentrations of 25-hydroxyvitamin D and gingival inflammation. Am J Clin Nutr. 2005 Sep;82(3):575-80 Vitamin Cin Periodontal Disease: Vitamin C in Periodontal Disease “CONCLUSIONS: P. gingivalis infection is associated with low concentrations of Vitamin C in plasma, which may increase colonization of P. gingivalis or disturb the healing of the infected periodontium.” Pussinen PJ, et al. Periodontitis is associated with a low concentration of vitamin C in plasma. Clin Diagn Lab Immunol. 2003 Sep;10(5):897-902. Vitamin Cin Periodontal Disease: Vitamin C in Periodontal Disease “In evaluating 12,419 adults…relationship found between dietary vitamin C and increased risk for periodontal disease in the overall population…Vitamin C showed a weak, but statistically significant, correlation with periodontal disease in current and former smokers.” Nishida M, et al. Dietary Vitamin C and the Risk for Periodontal Disease. J Periodontol. 2000 Aug; 71 (8):1215-1223. Vitamin Cand Periodontal Disease: Vitamin C and Periodontal Disease 102 subjects given placebo, synthetic vitamin C plus citrus bioflavonoids, or natural vitamin C concentrate. 57% improvement in vitamin groups Greatest improvement with prophylaxis plus natural vitamin C plus bioflavonoids “Local and Systemic Influences in Periodontal Disease: II. Effect of Prophylaxis and Natural Versus Synthetic Vitamin C Upon Gingivitis,” El-Ashiry GM, et al, J Periodontal, 1964;35:250-259 Vitamin Cand Periodontal Disease: Vitamin C and Periodontal Disease Low Plasma ascorbic acid is associated with reduced periodontal health. “Periodontal Health Related to Plasma Ascorbic Acid,” Vaananen MK, et al, Proc Finn Dent Soc, 1993;89(1-2):51-59.Ascorbic Acidand TMJ repair: Ascorbic Acid and TMJ repair The temporomandibular joint (TMJ) disc is a specialized fibrocartilaginous tissue. When the disc becomes and obstacle and becomes damaged, surgeons have no choice but to perform a discectomy. Tissue engineering may provide a novel treatment modality for TMJ disorder patient who undergo discectomy. The objective of the current study was to examine the effects on biochemical and biomechanical properties of varying ascorbic acid concentrations (0,25,or 50microg/ml) on TMJ disc cells seeded on non-woven PGA scaffolds. The results of this study indicate that the use of 25microg/ml of ascorbic acid in culture media is effective for the tissue engineering of the TMJ disc, significantly outperforming media without or with 50microg/ml of ascorbic acid. Proc Inst Mech Eng [H]. 2006 April/220(3):439-47.B Vitaminsand Periodontal Disease: B Vitamins and Periodontal Disease Randomized double-blinded controlled study of 30 patients with moderate-severe chronic periodontitis One group given Vitamin B complex for 30 days after surgery “(Vitamin B complex supplemented group showed) statistically significant gains in clinical attachment levels (CAL) compared to placebo “Effects of vitamin-B complex supplementation on periodontal wound healing, ”Neiva RF, Al-Shammari K, et al, Journal of Periodontology, 2005; 76(7): 1084-1091. Folic Acidin Periodontal Disease: Folic Acid in Periodontal Disease “…after 4 weeks, the experimental group showed a significant decrease in mean number of colour change sites…and in bleeding sites…compared with control group…p<0.001. …Level of dietary folate did not correlate with changes in inflammation in experimental subjects,. …Folate MW appears to have an influence on gingival health through local rather than systemic influence..” Pack AR. Folate mouthwash: effects on established gingivitis in periodontal patients. . J Clin Periodontol. 1984 Oct;11(9):619-28. Vitamin Eand Periodontal Disease: Vitamin E and Periodontal Disease “Data suggest that prostaglandins are involved in periodontal inflammation and result in localized bone resorption. Vitamin E is an antioxidant which inhibits prostaglandin formation. …800 mg/day of vitamin E showed reduced inflammation…” “The Effect of a-Tocopherol on Sulcus Fluid Flow in Periodontal Disease,” Goodson JM and Bowles D, J Dent Res, 1973;52:217(#634).Calciumin Periodontal Disease: Calcium in Periodontal Disease 1,000 mg of calcium reduced or eliminated gingivitis in 10 patients studied. “…clear increase in alveolar bone…in patients on calcium supplements. Lutwalk L, et al “Calcium Deficiency and Human Periodontal Disease,”, Israel J Med Sci, 1971;7(3):504-505Calciumand Periodontal Disease: Calcium and Periodontal Disease In 10 cases of periodontal disease, 1,000mg of calcium per day reduced gingivitis in all patients and was completely absent in 1 patient after treatment. “Calcium Deficiency and Human Periodontal Disease. “ Lutwak L. et al, Israel J Med Sci, 1971;7(3):504-505.Zincin Periodontal Disease: Zinc in Periodontal Disease “…bacterial polysaccharides (stimulate) neutrophils and macrophages in the gingiva to produce interleukin 1 (which results in) redistribution by the liver of zinc and copper…resulting in increased permeability to bacteria and interleukin release.” The author suggests that zinc administration can disrupt this vicious cycle. Polenick, P.,“Zinc in Etiology of Periodontal Disease,” Polenick, P., Medical Hypotheses, 1993;40:182-185Magnesiumand Periodontal Disease: Magnesium and Periodontal Disease Epidemiological study 4,290 subjects In subjects >40 years old, “increased serum magnesium:calcium found to be significantly associated with reduced probing depth, less attachment loss, and higher number of remaining teeth.” Subjects taking magnesium drugs showed less attachment loss and more remaining teeth than matched counterparts “Magnesium deficiency is associated with periodontal disease,” Meisel P, Schwan C, et al, J Dent Res., 2005;84(10): 937-41. Probioticsand Periodontal Disease: Probiotics and Periodontal Disease Randomized double-blinded controlled study of 59 patients with moderate-severe chronic periodontitis Supplemented group given Lactobacillus reuteri “…found to significantly reduce gingivitis and plaque over a period of 2 weeks...significant drops in plaque index scores.” “Decreased gum bleeding and reduced gingivitis by the probiotic Lactobacillus reuteri,” Krasse P, Carlsson B, et al, Swed Dent J, 2006; 30(2): 55-60. Essential Fatty Acidsand Periodontal Disease: Essential Fatty Acids and Periodontal Disease “…after 12 weeks, there was an improvement observed in gingival inflammation in individuals treated with borage oil, with a trend apparent in subjects treated with fish oil….improvement in probing depth (with fish oil or borage oil alone).” “Pilot Study of Dietary Fatty Acid Supplementation in the Treatment of Adult Periodontitis,” Rosenstein ED, Kushner LJ, et al, Prostaglandins Leukot Essent Fatty Acids, 2003;68:213-218.Flavonoids and Reduction of Plaque Formation: Flavonoids and Reduction of Plaque Formation “Conclusions: The active flavonoid compound, quercetin-3-O-α-l-arabinopyranoside (guaijaverin) demonstrated high potential antiplaque agent by inhibiting the growth of the Strep. mutans.” Prabu GR et al. Guaijaverin – a plant flavonoid as potential antiplaque agent against Streptococcus mutans. Journal of Applied Microbiology 2006 Aug; 101: (2) 487 Green Tea and Periodontal Disease : Green Tea and Periodontal Disease Hydroxypropylcellulose (HPC) strips containing green tea catechin (Sunphenon®) as a slow release local delivery system were then prepared and inserted once a week for 8 weeks into the gingival pockets of 2 groups of subjects: 3 subjects who underwent tooth scaling and root planning and 3 subjects who did not undergo these procedures...The MIC of green tea catechin against P. gingivalis, P. intermedia, and P. nigrescens was 1.0 mg/mL Hirasawa M, Takada K, Makimura M, Otake S. Improvement of periodontal status by green tea catching using a local delivery system: A clinical pilot study. Journal of Periodontal Research 2002;37:433–438. Chewing Sticksand Oral Health: Chewing Sticks and Oral Health “It was found that there was antimicrobial effect on Streptococcus fecalis at 50% concntration of Kikar (Acacia arabica) rom Pakistan and Arak (Salvadora persica) from Saudi Arabia…inhibition zones up to 2 mm.” Almas K. The Antimicrobial Effects of Seven Different Types of Asian Chewing Sticks. Odonto-Stomatologie Tropicale 2001, N 96Nigerian Chewing Sticksand Oral Health: Nigerian Chewing Sticks and Oral Health “All the extracts demonstrated activity against Staphylococcal and Streptococcal isolates. Over half of the extracts were active against Enterobacteriaceae and obligate anaerobic isolates.” Ndukwe KC et al. Antibacterial activity of aqueous extracts of selected chewing sticks. J Contemp Dent Pract. 2005 Aug 15; 6(3):86-94. Gambian Woman with Chewing Stick: Gambian Woman with Chewing StickMiswak(Saudi Arabian Chewing Sticks)and Oral Health: Miswak (Saudi Arabian Chewing Sticks) and Oral Health “RESULTS: Compared to tooth brushing, the use of the miswak resulted in significant reductions in plaque (p < 0.001) and gingival (p < 0.01) indices. Image analysis of the plaque distribution showed a significant difference in reduction of plaque between the miswak and toothbrush periods (p < 0.05)..” Al-Otaibi M et al. Comparative effect of chewing sticks and tooth brushing on plaque removal and gingival health. Oral Health Prev Dent. 2003;1(4):301-7.Miswak(Saudi Arabian Chewing Sticks)and Oral Health: Miswak (Saudi Arabian Chewing Sticks) and Oral Health “A. actinomycetemcomitans was significantly reduced by miswak use (p < 0.05) but not by tooth brushing. These results were supported by the in vitro observations that extracts from S. persica interfered with growth and leukotoxicity of A. actinomycetemcomitans.” Al-Otaibi M et al. The miswak (chewing stick) and oral health. Studies on oral hygiene practices of urban Saudi Arabians. Swed Dent J Suppl. 2004;(167):2-75. Mastic Chewing Gumand Oral Health: Mastic Chewing Gum and Oral Health “RESULTS: The total number of bacterial colonies was significantly reduced during the 4 hours of chewing mastic gum compared to the placebo gum (P < 0.05). The mastic group showed a significantly reduced plaque index P =0.001) and gingival index (P= 0.021) compared to the placebo group. CONCLUSION: These results suggest that mastic chewing gum is a useful antiplaque agent in reducing the bacterial growth in saliva and plaque formation on teeth. .” Takahashi K et al. A pilot study on antiplaque effects of mastic chewing gum in the oral cavity. J Periodontol. 2003 Apr;74(4):501-5Xylitol and Dental Plaque: Xylitol and Dental Plaque “CONCLUSIONS: Commonly advocated xylitol-containing products gave elevated concentrations of xylitol in unstimulated whole saliva and dental plaque for at least 8 min after intake .” Lif Holgerson P, et al. Xylitol concentration in saliva and dental plaque after use of various xylitol-containing products. Caries Res. 2006; 40(5):393-7 Tongue Scraping and Oral Health: Tongue Scraping and Oral Health “The most effective treatment in reducing colony counts [of mutans streptococci] was seen within Group I "Tongue Scraping" which demonstrated the greatest change from baseline to each of the post treatment periods. The least effective was Group II "Listerine Strip" which showed a statistically insignificant increase in colony count .” White GE, , et al. Tongue scraping as a means of reducing oral mutans streptococci. J Clin Pediatr Dent. 2004 Winter;28(2):163-6 Tongue Scraping and Oral Health: Tongue Scraping and Oral Health “All patients were advised to use a tongue scraper twice daily for at least 2 minutes per day for 7 days. ….Salivary count of Mutans Streptococci and Lactobacilli had significant decrease (P = 0.000). It was concluded that tongue scraping twice daily for 7 days had significant effect on MS and Lb bacteria and also decreased oral malodour .” Almas K, et al. The effect of tongue scraper on mutans streptococci and lactobacilli in patients with caries and periodontal disease. Odontostomatol Trop. 2005 Mar;28(109):5-10. Melatonin in Periodontal Disease: Melatonin in Periodontal Disease “…When saliva volume was controlled for, a significant correlations (P<0.05) was found between lower salivary melatonin and a worse CPI.” Cutando Soriano A et al. Relationship Between Salivary Melatonin and Severity of Periodontal Disease. J Periodontol. 2006; 77 (9): 1533-1538. Melatonin in Periodontal Disease: Melatonin in Periodontal Disease “Conclusions: Salivary melatonin levels varied according to the degree of periodontal disease. As the degree of periodontal disease increased, the salivary melatonin level decreased, indicating that melatonin may act to protect the body from external bacterial insults.” Cutando Soriano A et al. Relationship Between Salivary Melatonin and Severity of Periodontal Disease. J Periodontol. 2006; 77 (9): 1533-1538. Melatonin in Periodontal Disease: Melatonin in Periodontal Disease “Diabetic patients had plasma and saliva melatonin levels…significantly lower (P<0.001) than those obtained in plasma and saliva of controls.” Cutando Soriano A et al. Relationship Between Salivary Melatonin Levels and Periodontal Status in Diabetic Patients. J Pineal Res. Nov 2003; 35 (4): 239-244. Melatonin in Periodontal Disease: Melatonin in Periodontal Disease “…plasma and salivary melatonin concentrations show a biphasic response in diabetic patients. Melatonin decreased in patients with a CPI index of 2, and then increased reaching highest levels in patients with a CPI index of 4. By contrast, IL-2 levels decreased from CPI index 1 to 4.” Cutando Soriano A et al. Relationship Between Salivary Melatonin Levels and Periodontal Status in Diabetic Patients. J Pineal Res. Nov 2003; 35 (4): 239-244. Melatonin in Periodontal Disease: Melatonin in Periodontal Disease “The results indicate that, in diabetic patients, the presence of a marked impairment of the oral status, as assessed by the CPI index, is accompanied by an increase in plasma and salivary melatonin. The increase in salivary melatonin excretion may have a periodontal protective role.” Cutando Soriano A et al. Relationship Between Salivary Melatonin Levels and Periodontal Status in Diabetic Patients. J Pineal Res. Nov 2003; 35 (4): 239-244. Acupuncture and Periodontal Disease: Acupuncture and Periodontal Disease “…a Korean acupuncturist had treated the patient (also Korean) …for ‘gum pain’…placed thin gold wires into the buccal and lip mucosae…The patient noted that the therapy was successful at the time.” Schoor RS et al. Acupuncture: A Unique Effort to Treat Periodontal Disease. JADA. 2001 Dec; 132:1705-1706. Stress Reductionand Periodontal Disease: Stress Reduction and Periodontal Disease 26 medical students participating in a major exam and the same number not participating in the exam “Severe deterioration (bleeding upon probing) in gingival health from baseline to the last exam day was observed more frequently in exam students than in controls.” “Increase in Gingival Inflammation Under Academic Stress,” Deinzer, R, et al, Journal of Clinical Periodontology, 1998;25:431-433.Periodontal Disease and Stress: Periodontal Disease and Stress We find that psychosocial measures of stress associated with financial strain and distress manifest as depression, are significant risk indicators for more severe periodontal disease in adults in an age-adjusted model in which gender (male), smoking, diabetes mellitus, B. forsythus, and P. gingivalis are also significant risk indicators. Of considerable interest is the fact that adequate coping behaviors as evidenced by high levels of problem-based coping, may reduce the stress-associated risk. Further studies also are needed to help establish the time course of stress, distress, and inadequate coping with respect to the onset and progression of periodontal disease, and the mechanisms that explain this association. R. Melzack, S. Guite and A. GonshorPeriodontal Disease and Stress: Periodontal Disease and Stress Stress may enhance nicotine effects on periodontal tissues. Recent studies have pointed to potentially periodontal risk indicators, which include stress. Stress significantly enhanced the effects of nicotine on the periodontal tissues. Benatti BB, et al. Journal of Periodontal Research Volume 38 Issue 3 Page 351 - June 2003 Seasonal Variationand Periodontal Disease: Seasonal Variation and Periodontal Disease Over 6 year period, 19,944 patients presented for periodontal treatment “The majority of acute necrotizing ulcerative gingivitis patients presented during the summer at 55.4%, during autumn at 27.7%, and during both winter and spring at 8.4%. “Seasonal Variation of Acute Necrotising Ulcerative Gingivitis in South Africans,” Arendorf TM, Bredekamp B, Cloete C-A, Joshipura K, Oral Dis, 2001;7:150-154.Periodontal Disease:Allopathic Approaches: Periodontal Disease: Allopathic Approaches Tetracycline and other antibiotics “Low dose” antibiotics MMP inhibition Anti-inflammatories (NSAIDs) Prostaglandin inhibitors Regular professional cleaningPeriodontal Disease:Holistic Approach: Periodontal Disease: Holistic Approach Topical herbal formulas Systemic herbal formula Stress reduction Dietary modification Regular professional cleaningPeriodontal Disease:Dietary Modification: Periodontal Disease: Dietary Modification Eliminate sugar Eliminate refined carbohydrates Increase complex carbohydrates Increase fiber content of food Increase fruits and vegetables Add green tea to dietPeriodontal Disease:Herbal Medicine: Periodontal Disease: Herbal Medicine “…herbs can substantially reduce gum bleeding and the depth of tissue pockets. “ Abascal K and Yarnell E. Herbs for Treating Periodontal Disease. Alt Complem Ther. 2001 Aug; 216-220Tea Tree Oil in Gingivitis and Plaque Formation: Tea Tree Oil in Gingivitis and Plaque Formation “The TTO group had significant reduction in PBI and GI scores…. CONCLUSIONS: …the anti-inflammatory properties of TTO-containing gel applied topically to inflamed gingival tissues may prove to be a useful non-toxic adjunct to chemotherapeutic periodontal therapy.” Soukoulis and Hirsch. The effects of a tea tree oil-containing gel on plaque and chronic gingivitis. Aust Dent J. 2004 Jun;49(2):78-83. Periodontal Disease:Topical Herbal Formula: Periodontal Disease: Topical Herbal Formula Applied with a water pick twice daily Mild-moderate stream lukewarm water ½ teaspoon (2-3 mL) of herbal formula added to the water Equal parts: Yerba mansa Skullcap Gotu KolaSkullcap in Periodontal Disease: Skullcap in Periodontal Disease “…an effect similar to prednisone on certain aspects of inflammation and worked as well as tetracycline to inhibit prostaglandins and collagen degradation while also strengthening collagen and protein in fibroblasts, which are ital for ensuring tooth attachment .” Chung CP, et al. Pharmacological effects of methanolic extract from he root of Scutellaria baicalensis and its flavonoids on human gingival fibtoblast. Planta Medica 1995;61(2):150-153 Skullcap in Periodontal Disease: Skullcap in Periodontal Disease “…was nearly as effective as tetracycline in reducing oral periodontopathogens.” Tsao TF, et al. Effect of Chinese and Western antimicrobial agents on selected oral bacteria. J Dent Res 1982;61(9):1103-1106 Gotu Kola in Wound Healing: Gotu Kola in Wound Healing “Gotu Kola and its flavonoids increased tensile strength, collagen content, and epithelialization in many types of wounds when used internally or topically.” Maquart, et al. Stimulation of collagen synthesis in fibroblast cultures by a triterpene extracted from Centella asiatica. Connect Tissue Res 1990;24(2):107-120 Periodontal Disease:Internal Herbal Formula: Periodontal Disease: Internal Herbal Formula Herbal Bitters Gentian Yellow Dock Dandelion Oregon Grape (berberis) Non Herbal Digestives: Ginger Wound Healing Herbs: Prunella Gotu Kola Calendula Relaxant Herbs Skullcap Avena Sativa (oat) Melissa American Ginseng Immune Support Herbs Echinacea Cat’s Claw Olive LeafPeriodontal Disease:Internal Herbal Formula: Periodontal Disease: Internal Herbal Formula 1 teaspoon twice daily 15 minutes before eating Swish in mouth for 15-30 seconds, then swallow Herbal contents: 20% Oregon grape 20% Skullcap 20% Gotu Kola 15% Healall (Prunella) 15% American ginseng Periodontal Disease:Suggested Therapeutic Approach: Periodontal Disease: Suggested Therapeutic Approach Dietary modification Regular professional cleaning Good quality antioxidant formula Coenzyme Q 10 100 mg or Ubiquinol 50 mg Tea Tree Oil applied to gums daily Vitamin C-based oral preparations Stress reduction Consider internal / external herbal formulaeCase #4Neck Pain after Dental Work: Case #4 Neck Pain after Dental Work 54 year old woman Mild generalized musculoskeletal pain Multiple dental procedures (2 root canals) Developed occipital pain radiating to head and intrascapular area MRI neg; x-ray shows mild cervical DJD without spinal cord impingement Soft collar helps temporarily Biomechanical Medicine and TMJ: Chiropractic: Biomechanical Medicine and TMJ: Chiropractic “CONCLUSION: The results of this prospective case series indicated that the TMD symptoms of these participants improved following a course of treatment using the Activator Methods, International protocol.“ Devocht JW et al. Chiropractic treatment of temporomandibular disorders using the activator adjusting instrument: a prospective case series. J Manipulative Physiol Ther. 2003 Sep;26(7):421-5 Biomechanical Medicine and TMJ: Chiropractic: Biomechanical Medicine and TMJ: Chiropractic “Overall, 20 months of chiropractic treatment along with 2 concurrent months of massage therapy yielded slow but continual progress that finally resulted in total resolution of all symptoms except some fullness of the right cheek.“ Devocht JW et al. Chiropractic treatment of temporomandibular disorders using the activator adjusting instrument and protocol. Altern Ther Health Med. 2005 Nov-Dec;11(6):70-3. Biomechanical Medicine and Dentistry: Chiropractic: Biomechanical Medicine and Dentistry: Chiropractic “. This co-treatment approach, which integrated dental orthopedic and cranio-chiropractic care, ameliorated the pain and improved head, jaw, neck and back function.“ Chinappi AS Jr and Getzoff H. Chiropractic/dental cotreatment of lumbosacral pain with temporomandibular joint involvement. J Manipulative Physiol Ther. 1996 Nov-Dec;19(9):607-12. Biomechanical Medicine and Dentistry: Chiropractic: Biomechanical Medicine and Dentistry: Chiropractic “…diagnosis of temporomandibular joint syndrome and had been treated unsuccessfully by a medical doctor and dentist….High-velocity, low-amplitude adjustments (ie, Gonstead technique) were applied to findings of atlas subluxation. The patient's symptoms improved and eventually resolved after 9 visits.“ Alcantara J et al. Chiropractic care of a patient with temporomandibular disorder and atlas subluxation. J Manipulative Physiol Ther. 2002 Jan;25(1):63-70. Osteopathic Manipulative Medicine and Temporomandibular Joint Dysfunction: Osteopathic Manipulative Medicine and Temporomandibular Joint Dysfunction Blinded controlled trial 18 subjects diagnosed with TMJ Randomized to OMT or control Conservative therapy continued in all Subjective data collected using Likert-type questionnaire Caprio et al. An Osteopathic Approach to Temporomandibular Joint Dysfunction Syndrome.How severe is the pain when you open your mouth? p=0.039: How severe is the pain when you open your mouth? p=0.039How often do you experience pain? p=0.02: How often do you experience pain? p=0.02How severe is your pain without jaw movement? p=0.029: How severe is your pain without jaw movement? p=0.029Does you jaw make noise while opening or closing? p=0.008: Does you jaw make noise while opening or closing? p=0.008Biomechanical Medicine and Head / Neck Pain: Biomechanical Medicine and Head / Neck Pain The manual therapy group showed a faster improvement than the physiotherapy group and the general practitioner care group up to 26 weeks…Manual therapy (spinal mobilisation) is more effective and less costly for treating neck pain than physiotherapy or care by a general practitioner.“ Korthals-de Bos IB et al. Cost effectiveness of physiotherapy, manual therapy, and general practitioner care for neck pain: economic evaluation alongside a randomised controlled trial. BMJ. 2003 Apr 26;326(7395):911 Full Slide Presentation and ReferencesWill be Downloadable on:: Full Slide Presentation and References Will be Downloadable on: www.WholeHealthNE.com Also please visit: www.ThyroidBalance.comSlide131: Controversial Issues in Alternative Medicine and Oral Health Mercury Filling Use and Removal Oral Infections, Cavitations and Systemic Pain and Disease Environmental Sensitivity and Amalgam ComponentsControversy #1: Controversy #1 Dental Amalgams as a Source of Mercury Toxicity Mercola J and Klinghardt D. Mercury toxicity and systemic elimination agents. J Nutr Environ Med 2001; 11:53-62Evidence for Dental Amalgams as a Source of Mercury Toxicity: Evidence for Dental Amalgams as a Source of Mercury Toxicity A single dental amalgam filling with a surface area of only 0.4 cm is estimated to release as much as 15 micrograms Hg daily primarily through mechanical wear and evaporation. Skare I and Engqvist A. Human exposure to mercury and silver released from dental amalgam restorations. Arch Environ Health 1994; 49:384-394Evidence for Dental Amalgams as a Source of Mercury Toxicity: Evidence for Dental Amalgams as a Source of Mercury Toxicity Reports of 60 micrograms Hg daily collected in human feces. Skare I and Engqvist A. Human exposure to mercury and silver released from dental amalgam restorations. Arch Environ Health 1994; 49:384-394Evidence for Dental Amalgams as a Source of Mercury Toxicity: Evidence for Dental Amalgams as a Source of Mercury Toxicity Amalgams are made up of 50% mercury. The amalgam also consists of 35% silver, 9% tin, 6% copper and a trace of zinc. Berry TC et al. Almost two centuries with amalgam. Where are we today? J Am Dent Ass 1994; 120:394-395Evidence for Dental Amalgams as a Source of Mercury Toxicity: Evidence for Dental Amalgams as a Source of Mercury Toxicity The mercury vapor from the amalgams is lipid soluble and passes readily through cell membranes and across the blood-brain barrier. The vapor serves as the primary route of mercury from amalgams into the body. Lorscheider F et al. Mercury exposure from “silver” tooth fillings: Emerging evidence questions a traditional dental paradigm. FASEB J 1995: 9:504-508Evidence for Dental Amalgams as a Source of Mercury Toxicity: Evidence for Dental Amalgams as a Source of Mercury Toxicity The mercury escapes continuously during the entire life of the filling primarily in the form of vapor, ions and abraded particles. Chewing, brushing, and the intake of hot fluids stimulate this release. Bjorkman L et al. Mercury in saliva and feces after removal of amalgam fillings. Toxicol Appl Pharmacol 1997; 144:156-162 Vimy MJ and Lorscheider F. Intra-oral air mercury released from dental amalgam. J Dent Res 1985; 64:1069-1071Evidence for Dental Amalgams as a Source of Mercury Toxicity: Evidence for Dental Amalgams as a Source of Mercury Toxicity Animal studies show that radioactively labeled mercury released from ideally placed amalgam fillings appears quickly in the kidneys, brain and wall of the intestines. Zalups RK. Molecular interactions with mercury in the kidney. Pharmacol Rev 2000 Mar; 52(1): 113-143Evidence for Dental Amalgams as a Source of Mercury Toxicity: Evidence for Dental Amalgams as a Source of Mercury Toxicity Gold placed in the vicinity of an amalgam restoration produces a 10-fold increase in the release of mercury. Zahnaerztl et al. Abgave von Quecksilberdamp f aus Dentalamalgame n unter Mundbedingungen. Welt/Reform 1985; 94:131-138Evidence for Dental Amalgams as a Source of Mercury Toxicity: Evidence for Dental Amalgams as a Source of Mercury Toxicity When dissimilar metal are placed in the oral cavity they exert a battery-like effect because of the electroconductivity of the saliva. The electrical current causes metal ions to go into solution at a much higher rate, thereby increasing the exposure to mercury vapor and mercury ions manyfold. Mercola J and Klinghardt D. Mercury toxicity and systemic elimination agents. J Nutr Environ Med 2001; 11:53-62Mercury Amalgam Fillings:Associations with Illnesses: Mercury Amalgam Fillings: Associations with Illnesses Alzheimer’s Disease Pendergrass 1997 Autoimmunity Hultman 1994; Biagazzi 1994 Kidney Dysfunction Nylander 1987 Infertility Rowlands 1994; Gerhard 1998 Mercury Amalgam Fillings:Associations with Illnesses: Mercury Amalgam Fillings: Associations with Illnesses Polycystic Ovary Syndrome Gerhard 1997 Neurotransmitter imbalances Duhr 1991 Food Allergies Hultman 1994 Multiple Sclerosis Siblered 1997 Mercury Amalgam Fillings:Associations with Illnesses: Mercury Amalgam Fillings: Associations with Illnesses Thyroid problems Barregard 1994 Impaired Immune System Moszczynski 1995 Prevalence of antibiotic resistant bacteria Summers 1993 Fatigue, poor memory, psychiatric disturbances Siblered 1989Mercury Elimination Agents: Mercury Elimination Agents DMPS IV monthly DMSA oral daily/cyclic IV Vit C IV 1-3 times weekly Glutathione IV 1-3 times weekly Chlorella oral daily Cilantro oral daily Garlic oral dailyProtection Protocol WhenHaving Mercury Amalgams Placed/Removed:orally starting 7 days before: Protection Protocol When Having Mercury Amalgams Placed/Removed: orally starting 7 days before Vitamin C 1-3 gm Vitamin E 400 iu Selenium 200 micrograms Garlitrin (garlic) 1 capsule twice daily N-Acetyl-Cysteine 500 mg twice daily Common Protection Protocol WhenHaving Mercury Amalgams Placed/Removed:within 24 hours after procedure: Common Protection Protocol WhenHaving Mercury Amalgams Placed/Removed: within 24 hours after procedure Vitamin C 25 grams intravenously Sometimes given before/after procedure Intravenous glutathione 400-1000 mg sometimes added Intravenous DMPS sometimes addedMercury Elimination –Potentiating Agents: Mercury Elimination – Potentiating Agents Sulfur Containing MSM Sulfur N-acetyl-Cysteine (NAC) Antioxidant Containing Vitamin E Selenium Alpha Lipoic Acid Vitamin C Hyaluronic AcidControversy #2: Controversy #2 Focal Oral Infections, Cavitations and Systemic Pain and Disease Theory of Focal Dental Infection as a Source of Systemic Illness: Theory of Focal Dental Infection as a Source of Systemic Illness 1911 English physician William Hunter wrote about root canal infections that had received insufficient therapy prior to restorative dental work, leading to “a mass of sepsis.” 1920s Numerous medical journals chronicles patients who were cured of medical illnesses after removal of septic oral foci. 1925 Dr. Weston Price, first research director of the National Dental Association (forerunner of the ADA) published research on focal dental infections and their association with circulatory, rheumatologic and neurological disorders.Theory of Focal Dental Infection as a Source of Systemic Illness: Theory of Focal Dental Infection as a Source of Systemic Illness 1930s A rash of tooth removals, along with lack of convincing scientific evidence, leads to discrediting of the FDI theory Infective Endocarditis remains an issue that embraces the FDI theory 1980s Finnish studies revive interest in FDI theory Slots J. Casual or Causal Relationship between Periodontal Infection and Non-oral Disease? J Dent Res 1998;77(10):1764-1765 Theory of Focal Dental Infection as a Source of Systemic Illness: Theory of Focal Dental Infection as a Source of Systemic Illness Association between poor oral care and: 1989 acute cerebral infarction (Syrjanen et al) 1989 coronary artery disease (Matilla et al) 1993 alveolar bone loss and CAD, stroke (DeStafano et al) 1996 periodontal disease and pre-term low birth weight (Offenbacher et al) 1998 periodontal disease and aspiration pneumonia (Loesche and Lopatin) Theory of Focal Dental Infection as a Source of Systemic Illness: Theory of Focal Dental Infection as a Source of Systemic Illness For the past 25 years, German toxicologist Dr. Max Daunderer has presented research from biopsies of jawbones and root tips, demonstrating the ability of these tissues to store toxins and to act as foci of chronic infections and inflammations.Toxicity and Accumulation Areas in the Jaw: Toxicity and Accumulation Areas in the Jaw Pesticides Solvents ( mostly lower jaw) Formaldehyde (mostly lower jaw) Amalgam ( mercury, tin, copper, silver) (jawbone and max.sinus) Palladium (from gold crowns) (mostly upper jaw) All other dental materials to a lesser degree Klinghardt D, Neural Therapy, The Dental Component 2004Theory of Focal Dental Infection as a Source of Systemic Illness: Theory of Focal Dental Infection as a Source of Systemic Illness Begins with trauma to the jawbone Most common initiating physical trauma seems to be tooth extraction as it is commonly performed. Often dentists do not take the time when extracting a tooth to make sure all of the ligament that holds the tooth to the bone is removed, nor do they routinely remove a portion of the bone (which may be infected) that lines the socket. The result is that remaining portions of the ligament form a barrier to healing by interfering with blood flow to the area www.dentalhelp.orgTheory of Focal Dental Infection as a Source of Systemic Illness: Theory of Focal Dental Infection as a Source of Systemic Illness Although the extraction site appears to heal properly, it is not uncommon for actual holes or pockets to form beneath the surface of the gum. When aerobic bacteria get trapped in such an anaerobic environment, they change form and give rise to the production of extremely potent toxins. The hidden hole in the jawbone, a cavitation, has thus become an invisible incubation chamber for microbes, whose toxic waste products weaken the entire body. www.dentalhelp.orgTheory of Focal Dental Infection as a Source of Systemic Illness: Theory of Focal Dental Infection as a Source of Systemic Illness When our bodies are young and vital, the immune system is likely strong enough to seal off the cavitation site from the general circulation As we age, however, and accumulate more stress to the body (in the form of injury and illness) immunity tends to decline, and the silent infection in the jawbone spreads via the blood and lymph systems. www.dentalhelp.orgTheory of Focal Dental Infection as a Source of Systemic Illness: Theory of Focal Dental Infection as a Source of Systemic Illness Bacterial toxins circulate in the same manner and tend to settle in organs of greatest weakness. Any disorder in the body can therefore originate in the jawbone, even though there may be no pain or discomfort there. www.dentalhelp.orgSlide158: Xiaojing Li et al, Clinical Microbiol Rev, 13(4); Oct 2000, 547–558Controversy #3: Controversy #3 Amalgam Components and Environmental SensitivityDental Materialsand Environmental Sensitivity: Dental Materials and Environmental Sensitivity 45 year old dentist who developed irritation and soreness of the throat in her work place in the spring of 1990. The symptoms disappeared during weekends and holidays. The dentist had an increasing exposure to acrylics in her practice …Patch tests were strongly positive, although the patient had no skin symptoms. The authors conclude that this was a type IV allergic reaction involving the upper respiratory system. “Occupational Pharyngitis with Allergic Patch Test Reactions From Acrylics,” Kanerva, L., et al, Allergy, 1992;47:571-573.Dental Sealant Toxicity: Dental Sealant Toxicity Ethyltoluene sulfonamide, common to all three sealants, is considered the primary cause of the NCS. Dr. Omar M. Amin, Ph.D. “Dental Sealant Toxicity: Neurocutaneous Syndrome(NCS), a dermatological and neurological disorder.”Holistic Dental Association Journal “The Communicator” volume 2004, number 1 pp.1-15. Dental Sealant Toxicity: Dental Sealant Toxicity Resolving the symptoms (effect) by removing the sealants (cause) in patients undergoing treatments, confirms this cause-effect relationship. Dr. Omar M. Amin, Ph.D. “Dental Sealant Toxicity: Neurocutaneous Syndrome(NCS), a dermatological and neurological disorder.”Holistic Dental Association Journal “The Communicator” volume 2004, number 1 pp.1-15. Dental Sealant toxicity: Dental Sealant toxicity Sealapex was shown to cause severe inflammatory infiltration and edema. Dr. Omar M. Amin, Ph.D. “Dental Sealant Toxicity: Neurocutaneous Syndrome(NCS), a dermatological and neurological disorder.”Holistic Dental Association Journal “The Communicator” volume 2004, number 1 pp.1-15. Dental Sealant Toxicity: Dental Sealant Toxicity The cytotoxicity and neurotoxicity of Sealapex was well demonstrated in various mammalian systems. Dr. Omar M. Amin, Ph.D. “Dental Sealant Toxicity: Neurocutaneous Syndrome(NCS), a dermatological and neurological disorder.”Holistic Dental Association Journal “The Communicator” volume 2004, number 1 pp.1-15. Dental Sealant Toxicity: Dental Sealant Toxicity Dycal was also shown to cause hemorrhage and acute to cinsistent inflammatory cell neurotxicity. Lifa has been the researched sealant. It, however, has the same toxic ingredients I.e.,ethyloleune sulfonamide and sinc oxide, as Sealapex and Dycal and had been associated with classical NCS symptoms in some of our patients. Dr. Omar M. Amin, Ph.D. “Dental Sealant Toxicity: Neurocutaneous Syndrome(NCS), a dermatological and neurological disorder.”Holistic Dental Association Journal “The Communicator” volume 2004, number 1 pp.1-15. Dental Sealant Toxicity: Dental Sealant Toxicity The neurological aspects of NCS are characterized by pin-prick and/or creeping, painful and irritating movement sensations,often interpreted as parasite movements subcutaneously or in various body tissue. Movement sensation are either unipolar or bipolar and may proceed horizontally or vertically. Dr. Omar M. Amin, Ph.D. “Dental Sealant Toxicity: Neurocutaneous Syndrome(NCS), a dermatological and neurological disorder.”Holistic Dental Association Journal “The Communicator” volume 2004, number 1 pp.1-15. Dental Sealant Toxicity: Dental Sealant Toxicity Neurological symptoms may also include loss of memory, brain fog, lack of concentration and control of voluntary movements. The cutaneous aspects include small itchy sores, inflamed often elevated pimples, amorphous mucoid lesions that often enlarge and coalese. Dr. Omar M. Amin, Ph.D. “Dental Sealant Toxicity: Neurocutaneous Syndrome(NCS), a dermatological and neurological disorder.”Holistic Dental Association Journal “The Communicator” volume 2004, number 1 pp.1-15. Dental Sealant Toxicity: Dental Sealant Toxicity Neurocutaneous syndrome (NCS), a newly discovered toxicity disorder, is described in light or our new understanding of its relationships with the causative agents included in the dental liners used in afflicted patients. Dr. Omar M. Amin, Ph.D. “Dental Sealant Toxicity: Neurocutaneous Syndrome(NCS), a dermatological and neurological disorder.”Holistic Dental Association Journal “The Communicator” volume 2004, number 1 pp.1-15. Dental Sealant Toxicity: Dental Sealant Toxicity NCS is characterized by neurological sensations, pain, depleted energy and memory loss as well as itchy cutaneous lesions that may invite various opportunistic infections. Dr. Omar M. Amin, Ph.D. “Dental Sealant Toxicity: Neurocutaneous Syndrome(NCS), a dermatological and neurological disorder.”Holistic Dental Association Journal “The Communicator” volume 2004, number 1 pp.1-15. Dental Materialsand Environmental Sensitivity: Dental Materials and Environmental Sensitivity Concept of “Biocompatibility”Dental Materialsand Environmental Sensitivity: Dental Materials and Environmental Sensitivity Types of “Biocompatibility” General Biocompatibility Immunologic Biocompatibility Bio-Energetic Biocompatibility www.tuberose.com/Biocompatible_Dental_Materials.htmlDental Materialsand Environmental Sensitivity: Dental Materials and Environmental Sensitivity General Biocompatibility Non-toxic to the body Environmentally friendly Mercury, e.g., is not considered generally biocompatibleDental Materialsand Environmental Sensitivity: Dental Materials and Environmental Sensitivity Immunological Biocompatibility Non-reactive to that patient, individualized Extensive immunological testing done by specialty laboratories: IgG, IgM “Muscle Testing” (Applied Kinesiology) also usedDental Materialsand Environmental Sensitivity: Dental Materials and Environmental Sensitivity Aluminum salts 91.4% Beryllium salts 74.3% Arsenic salts 86.4% Mercury salts 92.7% Chromium salts 82.7% Cadmium salts 63.0% Cobalt salts 78.4% Indium salts 77.5% Lead salts 68.0% Nickel salts 97.9% Polyethimine group 77.4% Toluenes group 81.0% Xylenes group 00.2% Polyvinyls group 11.7% Reactivity Percentages [database of 12,823 specimens]Dental Materialsand Environmental Sensitivity: Dental Materials and Environmental Sensitivity Bio-energetic Biocompatibility Energy flow, or electrical signaling Electrodermal testing (Voll Machine) frequently used Vascular Access Port (VAP) or acupuncture pulse-taking also usedDental Materialsand Environmental Sensitivity: Dental Materials and Environmental Sensitivity Assessing Biocompatibility in an Environmentally Sensitive Patient Start with materials that have low toxicity in general Eliminate those which show high antibody response (i.e. immunologic incompatibility) Select from the most compatible materials by using an electrodermal or bio-energetic methodYANKEE DENTAL CONFEENCE 2007: YANKEE DENTAL CONFEENCE 2007 Glenn S. Rothfeld, M.D. Medical Director, WholeHealth New England Clinical Assistant Professor, Tufts University School of Medicine GRothfeld@WholeHealthNE.com WWW.WholeHealthNE.com Thank You!!Full Slide Presentation and ReferencesWill be Downloadable on:: Full Slide Presentation and References Will be Downloadable on: www.WholeHealthNE.com Also please visit: www.ThyroidBalance.com You do not have the permission to view this presentation. In order to view it, please contact the author of the presentation.