CHICAGO–June 2, 2003–A case report published in this month’s Journal of Periodontology reported that minocycline, a commonly prescribed antibiotic in the treatment of acne and rheumatoid arthritis, can cause the teeth and bone to discolor, which may make gum tissue to appear blackish-blue in color. Patients who take this drug or healthcare professionals who prescribe it should be made aware of the possibility of oral discoloration. Case Report Abstract *

Mayo Clinic researchers were presented with a 29-year old white female patient referred to the periodontics department by her dermatologist for an evaluation of the dramatic blue appearance of the gum tissue and bone surrounding her teeth. A review of her medical history indicated that she had been taking 50 mg of minocycline four times a day for the past 17 months.

“We informed the patient that in addition to the bone discoloration, her permanent teeth could also become discolored with continued use of minocycline. And, unlike the periodontal bone, teeth discoloration from minocycline does not always resolve after discontinuation of the therapy,” said Phillip J. Sheridan, D.D.S., Mayo Clinic, Periodontics, Department of Dental Specialties. “In this patient’s case, the dermatologist elected to change antibiotics to treat her acne.”

“This case definitely ‘drives home’ the importance of collaboration between medical and dental professionals,” said Gordon Douglass, D.D.S. and president of the American Academy of Periodontology. “Periodontists have known for awhile that medical drugs can affect a person’s oral health, and this is a reminder for patients to inform their dental professionals of all medications they are taking.”

For example, over 400 medications produce dry mouth, which can be damaging to the gum tissue, including periodontal disease and tooth decay. Other drugs like calcium channel blockers, phenytoin (used for treating seizures) and cyclosporine (used following organ transplants) may also cause gingival overgrowth.

According to this case report, approximately three to six percent of long-term users of minocycline will develop dental staining. This discoloration does not harm the teeth, bone or gum tissue, but is the reason behind the blackish-blue appearance of the gums. The periodontal bone can become discolored from minocycline therapy and show through the gum tissue, causing it to appear discolored as well.

“Like acne, periodontal disease can take away a person’s confidence and smile,” said Douglass. “Also like acne, periodontal disease is a chronic bacterial infection. Whereas acne inflames the walls of the hair follicles causing the walls to inflame and break, periodontal disease destroys attachment fibers and supporting bone that hold the teeth into the mouth.”

A referral to a periodontist in your area and free brochure samples including one titled Periodontal Diseases: What You Need to Know are available by calling 800-FLOSS-EM or visiting the AAP’s Web site at www.perio.org.

The American Academy of Periodontology is an 8,000-member association of dental professionals specializing in the prevention, diagnosis and treatment of diseases affecting the gums and supporting structures of the teeth and in the placement and maintenance of dental implants. Periodontics is one of nine dental specialties recognized by the American Dental Association.

For more information, contact the AAP Public Affairs Department at 312/573-3243 or 312/573-3242.

CHICAGO – April 11, 2006 – The patient of a periodontist in private practice in New Orleans, LA, developed osteonecrosis of the jaw (ONJ), a condition that can cause severe, often irreversible and debilitating damage to the jaw, following periodontal surgical therapy. Two years prior to surgery, the patient had started receiving IV bisphosphonate therapy, or bone-sparing drugs commonly used in the treatment of osteoporosis and metastatic bone cancer to help decrease associated pain and fractures, following treatment for breast carcinoma. When the patient presented to the periodontist, no reports of ONJ had been reported in the literature. This case report is published in the April issue of the Journal of Periodontology (JOP). Study Abstract *

“It is counter-intuitive to believe that bone-sparing drugs such as IV bisphosphonates can have the opposite affect and actually necrotize the jaw bone,” said Kristi M. Soileau, DDS, case report author and member of the American Academy of Periodontology (AAP). “While we’re not sure exactly why this happens, one possibility is that the drug compromises the vascular supply, which contributes to non-healing or the development of a diseased wound once the bone is exposed such as with extractions or with oral surgery.”

“It is important that our colleagues in dentistry and medicine are aware of this potential complication in this large and growing population of patients for whom IV bisphosphonates are being prescribed,” explained Kenneth A. Krebs, DMD and AAP president.

“A complete dental examination, including a periodontal evaluation, should be performed before a patient begins IV bisphosphonate therapy to identify and address any oral conditions, as recommended with preradiation patients,” added Soileau.

The case report did not include information related to patients taking oral bisphosphonates, which are more relevant to osteoporotic concerns.

A referral to a periodontist in your area and free brochure samples including one titled Periodontal Diseases: What You Need to Know are available by calling 800-FLOSS-EM or visiting the AAP’s Web site at www.perio.org.

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The American Academy of Periodontology (AAP) is the professional organization for

CHICAGO – May 31, 2006 – Caregivers of people under psychological or physical stress, as well as those with the conditions themselves, should not overlook their oral health, according to a new study printed in the Journal of Periodontology. Study Abstract *

The results from the study suggest that being a caregiver to relatives with dementia, hypercortisolemia (overproduction of cortisol) or stress was associated with elevated plaque levels and increased gingival bleeding in adults aged 50 years and older.

“We found that short-term psychological stress was a risk indicator to elevated plaque levels and long-term physical stress was a risk indicator to gingivitis,” said Fernando N. Hugo, DDS and Faculty of Dentistry of Piracicaba, Brazil. “These findings support the health impact of psychosocial risk factors from chronic stress, which may lead to malfunction of some biological functions.”

The study indicates that the demanding task of caregiving, usually associated with increased stress, may also be a risk factor for poor oral hygiene. These findings point out that stress may contribute to a disinterest in performing oral hygiene.

“Flossing and brushing the teeth and gums had a protective effect against plaque and gingivitis,” said Kenneth A. Krebs, DMD and AAP president. “That said, future research is needed to explore the relationship between stress and oral hygiene negligence.”

In this study, 230 individuals were evaluated, and almost 52 percent were caregivers. Caregivers of patients with dementia were examined because they represent a well-known group suffering from the impacts of chronic stress on human health and immune functions. The results are among the first in literature to suggest that caregivers of relatives with dementia are at risk of having more plaque and gingivitis than non-caregivers.

A referral to a periodontist in your area and free brochure samples including one titled Periodontal Diseases: What You Need to Know are available by calling 800-FLOSS-EM or visiting the AAP’s Web site at www.perio.org.

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CHICAGO – July 5, 2006 – Researchers found that prolonged use of anabolic androgenic steroids (AAS) is closely associated with significant levels of gingival enlargement, according to a new study published in the Journal of Periodontology. Study Abstract *

Gingival overgrowth is a condition in which the gingival tissues become swollen and grow over the teeth. Overgrown gums make it easier for bacteria found in plaque to accumulate and attack supporting structures of the teeth, potentially leading to severe periodontal infection.

“It was found that AAS abusers had statistically significant levels of gingival enlargement compared to non-users, requiring a gingivectomy (removal of excess or diseased gum tissue) for many cases,” explains Onur Ozcelik, DDS, PhD, Faculty of Dentistry, Department of Periodontology, Cukurova University, Adana, Turkey. “Although it has been reported that many of the adverse effects of AAS abuse are fully reversible within several months after the cessation of the drug, it is not known if gingival enlargement would also regress after the withdrawal of AAS.”

Researchers also found that gingival inflammation was higher in the AAS user group compared to the non-AAS users. “Further studies are required to find out if increased gingival scores in the user group are a direct effect of AAS or if the inflammation is a result of compromised oral hygiene due to gingival enlargement,” said Ozcelik.

“It is not surprising that gingival tissue is a target for the actions of steroid hormones,” said Kenneth A. Krebs, DMD and AAP president. “Clinical changes in tissues of the periodontium have been identified during periods of hormonal fluctuations such as puberty, the menstrual cycle, pregnancy, menopause, contraceptives and ovulation induction drugs in women.”

People taking AAS without medical supervision, should be informed of the adverse effects and strongly encouraged to begin a cessation program. Since periodontal infection may be a risk factor for more serious conditions, such as cardiovascular disease, respiratory disease and pre-term, low birth weight babies it is important for patients to take care of their periodontal health.

Background Information

Researchers examined 24 athletes between the ages of 17 and 29 who had been using AAS for more than one year. All subjects were examined for plaque levels, gingival inflammation and gingival enlargement. The results were then compared with a control group of 20 bodybuilders who had never used AAS drugs and matched for age, educational level and oral habits according to the data obtained from the AAS user group.

A referral to a periodontist in your area and free brochure samples including one titled Periodontal Diseases: What You Need to Know are available by calling 800-FLOSS-EM or visiting the AAP’s Web site at www.perio.org.

About the AAP

The American Academy of Periodontology (AAP) is the professional organization for

CHICAGO – September 12, 2006 – Salivary melatonin may play an important role in maintaining periodontal health, according to a new study published in the Journal of Periodontology. This is one of the first attempts to examine the influence of salivary melatonin upon periodontal disease, an inflammation that destroys the tissues and bone that support the teeth. Study Abstract *

Researchers found that melatonin, a hormone created by the pineal gland, may be able to protect the oral cavity against free radicals produced by inflammatory diseases. Melatonin has strong antioxidant effects that can protect cells against inflammatory processes and oxidative damage. Melatonin supplements are commonly promoted to ease jet lag and hasten sleep.

“Patients with higher salivary and melatonin ratios had lower community periodontal index (CPI). CPI is the score used to assess periodontal status,” said Pablo Galindo, DDS, Department of Oral Surgery, School of Dentistry, University of Granada, Spain. “This finding suggests that the melatonin may fight against infection and inflammation possibly due to its antioxidant, anti-aging and immunoenhancing ability.”

It was also observed that older patients had lower saliva volumes and melatonin ratios and higher CPI scores compared to younger patients with increased salivary and melatonin levels and decreased CPI scores.

“Further research is required to fully explain the relationship between melatonin and its influence on periodontal health,” said

CHICAGO – November 14, 2006 – Researchers from the University of Connecticut Health Center report an interrelationship between periodontal and systemic inflammation in solid-organ-transplant recipients. This study appears in this month’s issue of the Journal of Periodontology. Study Abstract *

For a long time researchers have known that inflammation plays a pivotal role in organ transplant rejection and that levels of serum interleukin-6 (IL-6) can identify individuals who are at greater risk for transplant rejection. IL-6 is a protein that is secreted to stimulate the immune response to trauma, foreign antigens, or infections, such as periodontal infection. Once secreted, IL-6 can enter the bloodstream and circulate in an active form long enough to mediate distal effects in other tissues and organs.

“Our goal was to assess the periodontal status of solid organ transplant patients to quantify the IL-6 levels in bloodstream and gingival tissues and explore their possible association with chronic periodontitis,” explains Principal Investigator Anna Dongari-Bagtzoglou, DDS, MS, PhD, Associate Professor and Chair of the Division of Periodontology at University of Connecticut Health Center. “We found that in transplant patients with chronic periodontitis, bloodstream IL-6 levels were elevated compared to those with no periodontitis, and were positively association with locally synthesized levels of IL-6 within periodontal tissue. This suggests that periodontal infections have the potential to affect systemic levels of IL-6 in this population.”

In support of this, it was also found that clinical periodontal parameters such as probing depth and clinical attachment loss were independent predictors of the body’s IL-6 levels.

“With research and science advancing every day, the life expectancy after organ transplantation is on a steady rise,” said Preston D. Miller, DDS and AAP president. “Further studies monitoring periodontal disease, IL-6 and transplant tissues are needed to provide conclusive evidence that periodontal inflammation may have negative effects on long-term transplant survival.”

Background Information

Forty-seven kidney and cardiac transplant patients were recruited for this study. Patients had to be clinically stable, at least one-year post transplant, absent of additional systemic conditions that might elevate the systemic inflammatory status and no history of periodontal treatment within the last year. A group of 18 systemically healthy individuals that matched the age and sex were also recruited.

All individuals received a complete clinical periodontal examination, medical records of the transplant subjects were reviewed and a blood and gingival sample were taken to quantify levels of IL-6. This study was supported by the National Institute of Dental and Craniofacial Research (NIH).

A referral to a periodontist in your area and free brochure samples including one titled Periodontal Diseases: What You Need to Know are available by calling 800-FLOSS-EM or visiting the AAP’s Web site at www.perio.org.

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CHICAGO—June 12, 2007—Two new studies in the June issue of the Journal of Periodontology (JOP) suggest that periodontal diseases are a threat to women of all ages due to hormonal fluctuations that occur at various stages of their lives.

One study looked at 50 women who were between the ages of 20 to 35 with varying forms of periodontitis. The study found that women who currently were taking oral contraceptive pills had more gingival bleeding upon probing and deeper periodontal pockets (signs of periodontitis) than those who were not taking oral contraceptive pills. Study Abstract *

“Younger women often think that periodontal disease is a condition associated with old age,” explained study author Brian Mullally, PhD. “Our study shows that it is very possible for younger women to experience periodontal disease. It is important for women to alert their dental practitioners about any medications they are taking, such as oral contraceptive pills, because it is possible that their oral health may be affected. It might also be prudent where possible for young women to ensure that their periodontal health has been checked before commencing oral contraceptive therapy.”

Another study in this month’s issue of the JOP examined 1,256 postmenopausal women and looked for a potential association between periodontal bacteria and bone loss in the oral cavity. The study results showed that women with periodontal bacteria in their mouths were also more likely to have bone loss in the oral cavity, which can lead to tooth loss if not treated. Study Abstract *

“Our study’s findings are important for postmenopausal women because they suggest that good periodontal health is extremely important in the postmenopausal years,” said study author Renee Brennan, PhD. “We found that oral bone loss was associated with presence of oral bacteria. In fact, 62% of the women in our study had at least one species of subgingival bacteria present, and the women with these bacteria had more evidence of oral bone loss. Interestingly, women who had a Body Mass Index in the overweight range were much more likely to have oral bone loss associated with presence of oral bacteria. Oral bone loss has been associated with osteoporosis in this group as well. This association has been difficult to study because many risk factors for periodontal disease and osteoporosis—including smoking, age, medications, and overall general health—are similar. It should be noted that our study was limited in that it included a relatively healthy group of mostly Caucasian women and that future studies are needed to determine the effects of periodontal bacteria on bone loss in other groups of postmenopausal women.”

“Taking care of your teeth and gums is a lifelong commitment,” explained Preston D. Miller, DDS and AAP president. “Women should pay special attention to their oral health as they enter different stages of their lives because additional periodontal care may be needed during different points such as the reproductive years or menopause. Knowing your ‘pocket size’ depth can be a good way for women to keep track of their periodontal health; periodontal pockets of one to two millimeters with no bleeding are not a concern but pockets of three and four millimeters may need a more in depth cleaning called scaling and root planing.”

To find out if you are at risk for periodontal diseases take the Academy’s test to assess your gum disease risk. A referral to a periodontist in your area and free brochure samples including one titled Women and Periodontal Disease are available by calling 800-FLOSS-EM or visiting the AAP’s Web site at www.perio.org.

About the AAP

The American Academy of Periodontology (AAP) is the professional organization for

CHICAGO—August 8, 2007—A literature review published in the August issue of the Journal of Periodontology (JOP) saw a strong relationship between stress and periodontal diseases; 57% of the studies included in the review showed a positive relationship between periodontal diseases and psychological factors such as stress, distress, anxiety, depression and loneliness. Literature Review Abstract *

“More research is needed to determine the definitive relationship between stress and periodontal diseases” said study author Daiane Peruzzo, PhD. “However, patients who minimize stress may be at less risk for periodontal disease.”

Researchers speculate that the hormone cortisol may play a role in the possible connection between stress and periodontal diseases. A study in the July issue of the JOP found that increased levels of cortisol can lead to more destruction of the gums and bone due to periodontal diseases. It is well known that periodontal diseases left untreated can ultimately lead to bone loss or tooth loss.

“Individuals with high stress levels tend to increase their bad habits, which can be harmful to periodontal health. They are less attentive to their oral hygiene and may increase their use of nicotine, alcohol or drugs,” explained Preston D. Miller, DDS and AAP president. “Patients should seek healthy ways to relieve stress through exercise, balanced eating, plenty of sleep and maintaining a positive mental attitude.”

Patients should to also keep in mind their “pocket size guide” to periodontal health; periodontal probing depths of one to two millimeters with no bleeding are not a concern but probing depths of three and four millimeters may need a more in depth cleaning called scaling and root planing. Probing depths in excess of 5mm may require more advanced treatment and patients should talk to their dental specialist.

A referral to a periodontist in your area, additional information, and free brochure samples including one titled Periodontal Diseases: What You Need to Know are available by calling 800-FLOSS-EM or visiting the AAP’s Web site at www.perio.org.

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The American Academy of Periodontology (AAP) is the professional organization for

CHICAGO—June 4, 2008—Most people already know that maintaining oral health is a vital component of achieving overall health, but a recent study reveals why it is especially crucial that men pay close attention to their teeth and gums. Research published in the June issue of The Lancet Oncology found that men with a history of gum disease are 14 percent more likely to develop cancer than men with healthy gums. In fact, researchers uncovered that men with periodontal disease may be:

• 49 percent more likely to develop kidney cancer
• 54 percent more likely to develop pancreatic cancer
• 30 percent more likely to develop blood cancers

“Previous research has suggested a potential link between gum disease and other conditions such as heart disease, diabetes and rheumatoid arthritis,” says Dr. Susan Karabin, President of the AAP. “This study should prompt men to be particularly mindful of their teeth and gums now that gum disease may play a role in the onset of cancer.”

Gum disease can be managed with daily brushing and flossing, and routine visits to a dental health professional. Men who develop gum disease should consider consulting with a periodontist, the dentist specially trained in the prevention and treatment of periodontal disease. A periodontist can help develop an effective treatment plan to best manage the disease.

To learn more about gum disease, locate a periodontist, or to find out if you are at risk for periodontal diseases, visit perio.org or call (800) FLOSS-EM (800/356-7736).

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CHICAGO—June 5, 2008—Over 1.3 million Americans suffer from rheumatoid arthritis (RA), a chronic, inflammatory disease of the joints. RA is a disabling condition, and can lead to long-term joint damage resulting in persistent pain and loss of function in affected areas. A recent study published in the June issue of the Journal of Periodontology, the official publication of the American Academy of Periodontology (AAP), uncovered yet another potential side effect of RA. Researchers in Berlin, Germany discovered that patients with RA have a higher incidence of periodontal disease compared to healthy controls. Study Abstract *

For some patients, adverse RA symptoms may affect manual dexterity, which can make one’s daily routine quite difficult. One area that may be affected is oral hygiene which can ultimately lead to periodontal disease. However, these research findings indicate that poor oral hygiene alone did not account for the association between RA and gum disease, suggesting that other factors may play a role as well.

The study examined the oral health of 57 RA patients and 52 healthy controls. To determine oral hygiene status, each participant underwent a comprehensive oral examination including an assessment of plaque accumulation and gingival inflammation, both indicators of oral hygiene. Probing pocket depth and clinical attachment loss, two markers of periodontal disease, were also measured. Researchers used questionnaires to gauge the subjects’ risk factors for periodontal disease.

The study findings indicated that RA patients were nearly eight times more likely to have periodontal disease compared to the control subjects. These findings accounted for demographic and lifestyle characteristics such as age, gender, education and tobacco use. Researchers then examined the extent to which poor oral hygiene was connected to the increased occurrence of gum disease in RA patients. The results showed that while oral hygiene was markedly a factor, it did not fully explain the association between the two diseases, suggesting that there may be other parameters responsible for the increased prevalence of gum disease in RA sufferers.

“With results suggesting that rheumatoid arthritis is associated with periodontal disease, it is easy to assume that an RA sufferer is perhaps unable to properly care for his or her teeth and gums due to the debilitating nature of the disease,” says Dr. Kenneth Kornman, editor of the Journal of the Periodontology. “However, this study implies that there are other potential factors involved. For instance, both RA and gum disease are systemic inflammatory disorders which may explain the connection between the two. Inflammation is already thought to link periodontal disease with other conditions such as cardiovascular disease and diabetes. We look forward to future research that may reveal the biological mechanisms that link these two important diseases.”

In an effort to best maintain oral health, RA patients are encouraged to brush and floss on a regular basis and see a dental professional twice a year. If gum disease develops, consulting a periodontist is an effective way to determine the most appropriate course of treatment.

According to Dr. Susan Karabin, President of the AAP, maintaining the complete health of RA patients should be a collaborative effort. “It is critical that dental professionals and medical professionals work together when treating a patient living with rheumatoid arthritis. This partnership will assure that both the oral and overall health of these patients is paramount.”

To learn more about gum disease, locate a periodontist, or to find out if you are at risk for periodontal diseases, visit perio.org or call (800) FLOSS-EM (800/356-7736).

About the AAP

The American Academy of Periodontology (AAP) is the professional organization for