Oral hygiene - myths and awareness

by Dr. Dheena Sadik

Oral hygiene has undoubtedly been a significant component of our individual wellness and progress as an evolving species.

According to Satish Goel who has 20 years' experience in the field and being responsible for areas of freshness in oral care, basic oral hygiene and essential Care, oral hygiene as "following a basic regime of brushing properly. At the very basic level, cavities are the first and biggest identifier of oral hygiene problems. So the absence of cavities means strong and healthy teeth".

Goel heads a team of professionals who spearheads new product development and critical changes in oral care products based in Mumbai, India. During his recent visit to Sri Lanka, the Oral Care expert was interviewed to share his diverse experiences and help create better awareness.

In regard to observations related to dental hygiene problems in South Asia, Dr. Goel admitted that Sri Lanka does not quite fall into the gross generalisation of South Asia; "This is my first visit to Sri Lanka. When I visited some consumers, they were quite aware of fluoride, vitamins and gum problems which come with general awareness. I observed an exceptional prevalence of 40 percent of people regularly brushing their teeth, which is huge. This habit alone removes many problems by a paradigm shift. As for the rest of South Asia, the biggest problems start with the lack of awareness of the importance of oral care. Majority doesn't brush their teeth and instead use tooth powder applied to their finger.

Children are born with healthy teeth, so the dental care problems start primarily with sugar which advance into cavity formation. Adults anywhere in the world have two causes, one is age-related problems and the other is habit-related."

As far as habits are concerned, Dr. Goel said, "There are two main contributors - sugars and acidic foods. Both are harmful in major ways.

More bacteria are present in our oral cavities which feed on sugars and convert to acids.

Acids in soft drinks are equally harmful. As for diet - what we eat, how frequently we eat and the lifestyle aspects matter, i.e. - whether or not one rinses the mouth after meals or practice advanced oral care regimes of brushing with mouth wash and flossing teeth.

As a parent, if I don't have the habit of practising good oral care and don't lead by example as a role model, my children are more likely not to follow good oral hygiene as well."

As for myths that surround dental hygiene, indeed they are specific to geographies. As far as the most common global oral hygiene myths, Dr. Goel said, "the biggest myth is the assumption that one should visit their dentist only when they have dental problems. Frequent visits to the dentist, can prevent many cavities. This also includes people who follow disciplined regimes in order to get professional cleaning.

The second common myth is regarding aging, that teeth are going to weaken and fall off anyway and this creates a resignation of oral care leading to neglect. With proper oral care, following an appropriate regime can maintain good quality teeth throughout life.

In reality, the process of age-related problems can be significantly slowed down by proper oral care. "

If there is one habit that can prevent most dental problems, Dr. Goel said "it is the right manner, right frequency and use of right dental products. Brushing too hard with excessive pressure, in a horizontal direction with non-fluoridated toothpaste are not recommended.

As long as one follows the basic regime religiously, majority of dental problems can be prevented.

The other important habit is to change the toothbrush every three months before excessive wastage which usually applies excessive pressure on gums. In addition to brushing, if one wants to go further, you should use a mouthwash and flossing.

As far as teeth sensitivity is concerned, Dr. Goel said, "the most common cause is unattended teeth. At the root it's all about bad oral hygiene; Not brushing leads to plaque attacks, prolonged acid attacks which weakens teeth and decays gums. Recession of gums exposes dentine making teeth sensitivity. Cavity lead roots can also cause sensitivity. Once sensitive, teeth are more temperature driven than pH driven."

Bad breath is a common oral complaint. Interestingly, Dr. Goel said that bad breath is accepted in certain cultures, while not in others.

The odour is basically caused by Sulphur compounds and is also the cause for various body odours. Prevention goes back to good oral care.

"You can never have a 100 percent germ free or suphur free environment, so it's back to good oral cleaning. Fragranced mouthwashes are helpful too."

When asked the effect of smoking on oral hygiene, Dr. Goel said "Tobacco, either chewed or smoked leads to oral Cancer. So does excessive betel chewing.

The simplest manifestation is extreme bad breathe."

As far as teeth discoloration, Dr. Goel explained , "there is a natural colour of his or her own natural colour which is the dentine showing through enamel. So aspire to your own colour than going for 100 percent white. What deteriorates the natural color is a lot related to food habits and poor oral hygiene - be it red wine, coffee or curries - i.e.: high staining foods.

" Dr. Goel said that in the past two decades the best thing that has happened in the world of oral care is the effect of Fluoride. He said research shows a clear decrease in oral diseases with uses of Fluoride and hence advise us to use a fluoridated toothepaste.

As for teeth whitening agents, Dr. Goel admitted "Bleaching of teeth have been done effectively by dentists for years.

There are a variety of ways and it's safe as long as done professionally. However, this is a much harsher treatment, therefore more prone to identify sensitivity, so I recommend taking your dentist's advice."

With regards to South Asian regions' recent progress in terms of dental care product development, Dr. Goel said "companies like Unilever, strive to do two things- one is to roll out the best global technologies developed - whether it is the basic regime or advanced regimes. Second, we always strive to understand our consumers - locally and regionally so we can adapt and cater to them.

That is part of the reason I have visited Sri Lanka, to understand the consumers and serve them better. "

Giving birth to large infants increases breast cancer risk

Delivering a high-birth-weight infant more than doubles a woman's breast cancer risk, according to research from the University of Texas Medical Branch at Galveston.

Researchers suggest that having a large infant is associated with a hormonal environment during pregnancy that favors future breast cancer development and progression.

Marking the first time that high birth weight was shown to be an independent risk factor, the finding may help improve prediction and prevention of breast cancer decades before its onset.

"We also found that women delivering large babies - those in the top quintile of this study, which included babies whose weight was 8.25 or more pounds - have increased levels of hormones that create a 'pro-carcinogenic environment.'

This means that they have high levels of estrogen, low levels of anti-estrogen and the presence of free insulin-like growth factors associated with breast cancer development and progression," said lead author Dr. Radek Bukowski, professor of obstetrics and gynecology in the Division of Maternal-Fetal Medicine.

"Women can't alter their pregnancy hormones, but can take steps to increase their general protection against breast cancer." Dr. Bukowski notes that breastfeeding, having more than one child, following a healthy diet and exercising have been shown to reduce breast cancer risk.

The study, published in *PLoS ONE*, builds on accumulating evidence that a woman's own birth weight and that of her children are linked to breast cancer. However, this is the first study to explore whether each is an independent risk factor. Dr. Bukowski's team examined two cohorts of women from distinct data sets:

- The Framingham Offspring Birth History Study, which has studied generations of women via medical examinations and laboratory assessments.

Dr. Bukowski's team studied 410 women from this study, observed between 1991-2008, and maternal birth weight, infant birth weight and results of later examinations (e.g., breast cancer diagnosis) to determine breast cancer risk.

The researchers also looked at data from the study on known breast cancer risk factors, such as age, race/ethnicity, body mass index, diabetes, use of hormone replacement therapy and maternal history of the disease, among others.

- The First and Second Trimester Evaluation of Risk for Aneuploidy (FASTER) trial, which examined pregnancy hormones in nearly 24,000 women at 15 U.S. clinical centers between 1999 and 2003.

The study included assessments of the hormones that affect infant birth weight and breast cancer risk - estriol (E3), anti-estrogen alpha-fetoprotein (AFP) and pregnancy-associated plasma protein-A (PAPP-A).

Approximately 7.6 percent of the women from the Framingham cohort in this study were later diagnosed with breast cancer.

The researchers found that the risk of breast cancer was two-and-a-half times higher in women whose infant's birth weight was in the top quintile compared with women whose infant weighed in the lower quintiles. Importantly, the risk was shown to be signficiant independent of the birth weight of the mother and traditional breast cancer risk factors.

Of the nearly 24,000 pregnancies studied in the FASTER trial, a strong positive relationship was observed between infant birth weight and E3, AFP and PAPP-A concentrations.

For women whose infant's birth weight was in the highest quintile, there was a 25 percent increased risk of having a high E3/AFP ratio and PAPP-A concentration.

"Recent animal studies have suggested that breast stem cells, which are involved in the origins of breast cancer, may increase or decrease their number in response to hormone exposures, including ones during pregnancy," added Dr. Bukowski. â

"They retain a 'memory' of prior hormone exposure, which could explain the increased risk of breast cancer seen following pregnancy, especially in women with a large birth weight infant.

The hormones create a long term effect that may lead to breast cancer later."

One limitation of this study is that the associations between large infants' birth weight and breast cancer risk and between infants' birth weight and hormonal environment during pregnancy were tested in different populations of women. Further research is needed to definitively demonstrate that the concentrations of pregnancy hormones mediates the relationship between large infant birth weight and breast cancer.

Subsequent studies will also focus on testing whether having an infant of high birth weight improves prediction of future breast cancer. - MNT

New therapeutic target for diabetes management

Scientists from Western University in London, Canada and the Children's Health Research Institute, an Institute within the Lawson Health Research Institute, have identified the critical role of a receptor called c-Kit in the development and function of insulin-producing beta cells, making it an exciting therapeutic target for the management of diabetes.

The research, led by Rennian Wang, demonstrated that over-expression of c-Kit not only leads to increased insulin production but also counteracts the early diabetic effects of a high-fat diet. The paper and an accompanying commentary, are published in the August issue of *Diabetologia*, and featured in the Research Highlights in *Nature Reviews Endocrinology*. Diabetes is one of the most common metabolic diseases affecting over 25 million Americans and 2 million Canadians.

It's associated with a multitude of complications leading to considerable morbidity and a major medical as well as financial burden on society.

One of the major defects in diabetes is the loss of beta cells in the pancreatic islet. Wang and colleagues, including Zhi Chao Feng, a PhD candidate and first author on the paper, developed a transgenic mouse model (c-Kit Wv) which overexpressed c-Kit, specifically in beta cells. "When c-Kit is overexpressed, we observed a significant improvement in beta cell function and survival," says Wang, a Professor in the Departments of Physiology and Pharmacology, and Medicine at Western's Schulich School of Medicine & Dentistry.

"You can even rescue c-Kit mutant mice from the early onset of diabetes, and protect against high-fat diet-induced beta cell defects.

This is a novel finding and is being reported for the first time."Wang believes ongoing research into c-Kit and its underlying mechanisms, will pave the way to develop strategies to preserve and restore function to beta cells as a cure for both type 1 and type 2 diabetes.

This study was funded by the Canadian Institutes of Health Research.

- diabetes.alltop

Liver cancer risk may be reduced by Vitamin E

High consumption of vitamin E either from diet or vitamin supplements may lower the risk of liver cancer, according to a study published in the Journal of the National Cancer Institute.

Liver cancer is the third most common cause of cancer mortality in the world, the fifth most common cancer found in men and the seventh most common in women.

Approximately 85 p.c. of liver cancers occur in developing nations, with 54 p.c. in China alone. Some epidemiological studies have been done to examine the relationship between vitamin E intake and liver cancer; however, the results have been inconsistent.

To determine the relationship between vitamin E intake and liver cancer risk, Wei Zhang, MD, MPH., of the Shanghai Cancer Institute, Renji Hospital, Shanghai Jiaotong University School of Medicine and colleagues analysed data from a 132,837 individuals in China who were enrolled in the Shanghai Women's Health Study (SWHS) from 1997-2000 or the Shanghai Men's Health Study (SMHS) from 2002-2006, two population-based cohort studies jointly conducted by the Shanghai Cancer Institute and Vanderbilt University.

Using validated food-frequency questionnaires, the researchers conducted in-person interviews to gather data on study participants' dietary habits.

They compared liver cancer risk among participants who had high intake of vitamin E with those with low intake. The analysis included 267 liver cancer patients (118 women and 149 men) who were diagnosed between two years after study enrollment and an average of 10.9 (SWHS) or 5.5 (SMHS) years of follow-up. Vitamin E intake from diet and vitamin E supplement use were both associated with a lower risk of liver cancer. This association was consistent among participants with and without self-reported liver disease or a family history of liver cancer.

"We found a clear, inverse dose-response relation between vitamin E intake and liver cancer risk," the authors write, noting a small difference between men and women in the risk estimate, which is likely attributable to fewer liver cancer cases having occurred among SMHS participants due to the shorter follow-up period. Overall, the take home message is that, "high intake of vitamin E either from diet or supplements was related to lower risk of liver cancer in middle-aged or older people from China.

- MNT

Why online self-diagnosis could be bad for health

Consumers who self-diagnose are more likely to believe they have a serious illness because they focus on their symptoms rather than the likelihood of a particular disease, according to a new study. This has significant implications for public health professionals as well as consumers.

"In today's wired world, self-diagnosis via internet search is very common. Such symptom- matching exercises may lead consumers to overestimate the likelihood of getting a serious disease because they focus on their symptoms while ignoring the very low likelihood that their symptoms are related to any serious illness," write Dengfeng Yan and Jaideep Sengupta (both Hong Kong University of Science and Technology).Consumers often fear the worst when it comes to their own health while maintaining a calm objectivity with regard to others. For example, when someone else suffers from indigestion, we tend to accurately perceive it as indigestion, but experiencing the same symptom might lead us to panic and worry that we're having a heart attack.

The authors asked consumers to imagine that they or someone else were suffering from common symptoms such as cough, fever, runny nose, and headache.They were then asked to assess the likelihood that they or the other person had contracted either H1N1 (swine flu) or regular flu .Consumers were much more accurate when assessing other people's symptoms. Since they are more likely to misdiagnose themselves, consumers may end up taking unnecessary medical action, which is bad for them, and also bad from a societal cost perspective.

- Healthnewszone