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A collaboration led by a periodontal researcher from the University of Pennsylvania School of Dental Products Medicine has found a possible link between the success of gum-disease treatment and the likelihood of giving birth prematurely, according to a study published in the journal BJOG: An International Journal of Obstetrics and Gynaecology.

While a number of factors are associated with an increased rate of preterm birth, such as low body-mass index, alcohol consumption and smoking, the study adds to the body of research that suggests oral infection may also be associated with such an increase.

The study looked at 322 pregnant women, all with gum disease. Half the group was given oral-hygiene instruction and treated with scaling and root planning, which consists of cleaning above and below the gum line. The second half received only oral-hygiene instruction.

The incidence of preterm birth was high in both the treatment group and the untreated group: 52.4 percent of the women in the untreated control group had a preterm baby compared with 45.6 percent in the treatment group. These differences were not statistically significant.

However, researchers then looked at whether the success of periodontal treatment was associated with the rate of preterm birth. Participants were examined 20 weeks after the initial treatment, and success was characterized by reduced inflammation, no increase in probing depth and loosening of the teeth.

Within the treatment group of 160 women, 49 were classified as having successful gum treatment and only four, or 8 percent, had a preterm baby. In comparison, 111 women had unsuccessful treatment and 69, or 62 percent, had preterm babies.

The results show that pregnant women who were resistant to the effects of scaling and root planning were significantly more likely to deliver preterm babies than those for whom it was successful.

The mean age of the women in the study was 23.7 years; 87.5 percent were African-American, and 90 percent had not seen a dentist for tooth cleaning.

“First and foremost, this study shows that pregnant women can receive periodontal treatment safely in order to improve their oral health,” said Marjorie Jeffcoat, professor of periodontics at Penn Dental Medicine and lead author of the paper. “Second, in a high risk group of pregnant women, such as those patients who participated in this study, successful periodontal treatment when rendered as an adjunct to conventional obstetric care may reduce the incidence of preterm birth.”

Future papers will address the role of antimicrobial mouth rinses in reducing the incidence of preterm birth.

“Researchers have previously suggested that severe gum infections cause an increase in the production of prostaglandin and tumour necrosis factor, chemicals which are associated with preterm labor,” Philip Steer, editor-in-chief of BJOG, said. “This new study shows a strong link between unsuccessful gum-disease treatment and preterm birth; however, we need to bear in mind that 69 percent of women failed to respond to the dental treatment given. Therefore, more effective treatment will need to be devised before we can be sure that successful treatment improves outcome, rather than simply being a marker of pregnancies with a lower background level of inflammation that will go to term anyway.”

Notes:
The study was conducted by Jeffcoat, Mary Sammel, Bonnie Clothier and Annette Catlin of Penn Dental Medicine; Samuel Parry of the Department of Maternal and Fetal Medicine at Penn’s School of Medicine; and George Macones of Washington University in St. Louis.
The study was funded by the Commonwealth of Pennsylvania and an educational grant from the Procter and Gamble Company.

Using a moving 3D computer model based on the skull and teeth of a New Zealand reptile called tuatara, a BBSRC-funded team from the University of Hull, University College London and the Hull York Medical School has revealed how damage to dental products implants and jaw joints may be prevented by sophisticated interplay between our jaws, muscles and brain. This research will appear in a future edition of the Journal of Biomechanics.

The tuatara is a lizard-like reptile that has iconic status in its homeland of New Zealand because its ancestors were widespread at the time of the dinosaurs. Unlike mammals and crocodiles which have teeth held in sockets by a flexible ligament, tuatara have teeth that are fused to their jaw bone – they have no ligament, much like modern dental implants.

BBSRC postdoctoral fellow Dr Neil Curtis from the University of Hull said “Humans and many other animals prevent damage to their teeth and jaws when eating because the ligament that holds each tooth in place also feeds back to the brain to warn against biting too hard.”

Dr Marc Jones from UCL, also a BBSRC postdoctoral fellow, added “In the sugar-rich western world many people end up losing their teeth and have to live with dentures or dental implants instead. They’ve also lost the periodontal ligament that would attach their teeth so we wanted to know how their brains can tell what’s going on when they are eating.”

The team has created a 3-D computer model of the skull of the tuatara to investigate the feedback that occurs between the jaw joints and muscles in a creature that lacks periodontal ligaments.

“Tuataras live happily for over 60 years in the wild without replacing their teeth because they have the ability to unconsciously measure the forces in their jaw joint and adjust the strength of the jaw muscle contractions accordingly”, said Dr Curtis.

Although this explains why tuatara and people with false teeth manage not to break their teeth and don’t end up with jaw joint disorders, it is still clear that having a periodontal ligament is very useful, in particular for fine tuning chewing movements. This may explain why it has evolved independently in the ancestors of mammals, crocodiles, dinosaurs, and even some fish.

There is anecdotal evidence to suggest that people with implants and dentures may make food choices related to their lack of periodontal ligament. However, the tuatara pursues a broad diet on the islands where they live including beetles, spiders, snails, frogs and occasionally young seabirds.

Professor Douglas Kell, BBSRC Chief Executive said “To support the extension of health and wellbeing into old age, it is vital that we appreciate how we as human beings have developed our extraordinary ability to adapt to adverse situations. This work allows us to understand some of the complexities of the feedback and responses occurring in healthy human bodies and brains. It is impossible in evolution to predict future innovations such as dental implants and yet this research indicates a level of redundancy in our biology that opens opportunities to support long term health and wellbeing.”

Introduction

Imagine you’ve just been told that you have to have your wisdom teeth extracted or maybe you have already had them removed. If this applies to you and especially if you suffer from any ill health, please read on.

Wisdom teeth are the last of the adult or permanent dentition to develop. They are the third molars, or grinding teeth, and are situated at the back of the dental products arches.

They are often partially erupted with some of their surface covered by gum. This can lead to infection under the gum flap (pericoronitis) or decay in the crown of the wisdom tooth itself or in the posterior aspect of the tooth in front. Very occasionally they can be associated with other pathology in the jaw, such as cysts.

However the extraction of wisdom teeth for the most trivial reason has been a common phenomenon in dentistry. These teeth are often extracted to prevent the supposed overcrowding of lower anterior teeth later in life. Occasionally they are enucleated (removed) at age 14 before they have fully developed.

The National Institute for Clinical Excellence (NICE) in Great Britain issued the following guidelines to reduce the extraction of wisdom teeth.[1] The teeth could be extracted for the following exceptional reasons:
•    Cellulitis, abscess and osteomyelitis (severe bony infection);
•    Non-treatable pulpal and/or periapical pathology (nerve abscess);
•    Unrestorable caries (decay);
•    External internal resorption of the tooth or adjacent teeth;
•    Fracture of tooth;
•    Disease of follicle including cyst/ tumour;
•    Tooth within the field of tumour resection;
•    Tooth impeding reconstructive jaw surgery.

In all other cases the wisdom teeth are to be largely left in place, except for ‘recurrent pericoronitis’.

The above reasons for not extracting the teeth were circulated to dentists to save the British National Health Service around an additional £5m a year.

This directive is largely welcome but misses out on some real issues affecting patient health when the extraction of wisdom teeth is contemplated, either within or outside of any governmental contract.

A Disrupted Jaw and Ill Health

The relationship of the extraction of wisdom teeth or any other teeth and the effect this has on health is ill understood, and it is imperative that in the light of new knowledge the extraction of these teeth be severely curtailed.

It is both for the practitioner and the patient to note that our wisdom teeth provide essential support in the back of the mouth, support which is absolutely essential for the health of the Temporo mandibular joint (See figure this page).

This joint is located just in front of the ears where the jaw hinges with your skull. The word Temporo refers to the temporalis bone of your skull, which also houses the ear. The mandible is your lower jaw.

Occasionally on opening and closing you may feel and hear a click. The disc (Meniscus as above) housed between the skull and the lower jaw slipping in and out of its position causes this click. This click is often associated with the existence of other health problems.

Your mouth, jaws and indeed the entire head are served by the Trigeminal nerve, which provides 60% of the input to the brain. The slightest disturbance in this input, which comes from irregular teeth, jaw position or the space required by the jaw joint, results in a severe chain reaction throughout the body. It affects the ability to breathe, effectively giving rise to tiredness, breathing problems and often asthma. It also causes a distortion of the neck vertebrae resulting in neck pain. This distortion is compensated by an opposite distortion of the lower back, which results in a rotation of the pelvis on the affected side. Hip and lower back pains will not be uncommon. A clinical short leg on one side is also often a result, as you might have heard your chiropractor or osteopath mention.

Many patients have some or many of the above symptoms. Conventionally you could go to a whole range of medical consultants and have an exhaustive array of pathological tests and at the end of it you may be as perplexed about your condition as your medical practitioner. In the normal course of events you will be finally referred to the psychiatric community. You start challenging this and embark on a complete circle of alternative therapies.

Many in the dental and medical field will question what is hypothesized here. However in the light of my experience I feel it incumbent upon me to bring to their attention, as well as to that of the patient who is on the receiving end, some important issues. Extreme caution is better than blatant interference with no turning back.

The whole of the dental profession has to re-evaluate the necessity of extracting wisdom teeth. It is incumbent upon the profession to take the following points into consideration:

•    Where the patient already suffers from any of the related disease processes listed above, as it would often not only exacerbate those conditions but also potentially bring on additional symptoms;
•    Where a patient has had any extraction orthodontics, worn a headgear, elastics or any appliance to retract the upper jaw backwards;
•    Where a patient has genetically inherited small teeth or has some missing teeth;
•    Where a patient has jaw size discrepancies.

The extraction of these teeth must be avoided before the age of 22 even if all the above criteria are not applicable. Generally however the jaws are fully developed. Often the jaws do not fully develop and this will be evidenced by the concomitant existence of ill health. At this point orthodontic intervention becomes necessary.

Case History

Please note the changes in this patient’s profile. The patient led a healthy life until the extraction of her wisdom teeth. The first photograph below shows her appearance before the extraction of her wisdom teeth.

The next photograph shows the appearance after 18 months of the extraction event. Please note how the chin has receded and a flattening of the cheekbones has taken place resulting in an inadequate support for the eyes. At this stage the patient had been diagnosed as suffering from Chronic Fatigue Syndrome with a myriad of some 40 symptoms.

The pictorial evidence of a deterioration of her profile shows what a dramatic change in the appearance and health of the patient can take place.

In the next photograph the patient is shown in the recovery phase after intervention to correct the jaw abnormality. She has completely recovered from the symptoms from which she was suffering. The photographs are a testimony to what is being postulated here. Would you take the risk of having your wisdom teeth or any teeth extracted?

Conclusion

The role of Wisdom teeth is a very small aspect in the evolving field of Cranio-Mandibular and Skeletal Symmetry( and its relationship to health. This challenging field offers prospects beyond anyone’s imagination. Dentists are in a unique position to bring about a great deal of relief where medicine has been nothing more than palliative to the millions of sufferers with chronic ailments. It calls for them to rise up to the challenges that lie ahead. It gives you as the patient a hope and an answer that may have been elusive until now.

The interventions required to correct the jaw abnormalities requires a sea change in the dental philosophies, which have been put forth over decades. The concept of “too many teeth and not enough bone to house them” (Standard text book on orthodontics by Professor Leighton of Kings College hospital Dental School used in most universities) has to be passed to the history books where it belongs. The effects of pollution, the artificial ingredients in our diet, the lack of trace elements in our vegetables, radiation, dioxin poison, the oestrogen like chemicals in the plastic bottles that we drink from are all having a devastating effect on the development of the face, teeth, jaws and the cranium and subsequently or concomitantly the rest of the body. In fact, evolution is following a downward retrograde path. The incidence of abnormalities and illnesses like fatigue, asthma and autism are having an exponential leap in reported statistics in western society. This has been calculated after allowing for improvements in diagnosis. In these circumstances one can do very little without prolonged intervention. This is the subject of another article but suffice it to say that it is very important that we err towards caution and non-extraction rather than blatant and gross interference with what nature has provided for us.