FitSugar

I Don't Buy It: Special Detergent For Your Fitness Clothes?

FitSugar — Thu, 19 Jun 2008 08:00:00 -0700

Of course, I think it is imperative to wash your fitness gear after every workout, but come on - do you expect me to believe that I need special soap to do it? This Sport-Wash ($10) says you should use this instead of regular detergent to "keep the high-tech in your high-tech fabrics so your workout wear will continue to look good and perform its best." This soap claims that it "leaves no residue to interfere with moisture control, breathability, water-repellency or insulation. It even restores factory-applied waterproofing." Is it me or do you agree that this is a total scam? Now I know workout gear can start to stink after a while, and detergent that gets the funk out is a necessity for some clothes, so that I'm down with. As for this Sport-Wash, I think it's a waste of money because if the fabric itself can't withstand washing in regular detergent, then chances are the gear isn't going to last very long anyhow. What do you think?

Source

Review: Get the Funk Out With Win Sport Detergent

FitSugar — Fri, 14 Mar 2008 08:45:00 -0700

Have you ever noticed that even after washing your workout gear in hot water, after a few sweaty workouts, a musty odor can inevitably develop. This odor is caused by bacteria attracted to sweat soaked fabric. A new sport detergent, Win ($13.99 for two 21 oz. bottles), which claims to take care of smelly gym clothes, works like this:

This powerful oxy cleaning technology eliminates the embedded sweat molecules and odors that overwhelm the fabric. Simultaneously, these same ingredients also react with soil and organic materials causing them to either decolorize or disintegrate. Once in a soluble form after oxidization, dirt and odors easily wash away.

Interesting, right? I tried it out recently so to see what I thought, just read more.

Win does have a nice fragrance and it left my not so fresh gym clothes feeling fresh, especially when I was wearing them the next day at the gym, which is when I usually start to think it's time to replace the old tank top. My only issue with it is that I typically wash my gym clothes with the rest of my laundry. To do a separate load on top of my whites, mediums and colors was a bit cumbersome and not something I realistically see happening all that frequently. However if you simply can't get the funk out of your old gym clothes, then it's definitely worth the extra load - I threw in some old rags and questionable socks to knock some more things out. If you're interested then buy it here.

Detergents

admin — Thu, 04 Sep 2008 19:00:09 -0700

Overview

Definition
Poisonous Ingredient
Where Found
Symptoms
Home Treatment
Before Calling Emergency
Poison Control, or a local emergency number
What to expect at the emergency room
Expectations (prognosis)

HEALTH GUIDE REFERENCE FROM A.D.A.M

Definition

Detergents are powerful cleaning products that may contain strong acids, alkalis, or phosphates. Cationic detergents are often used as germ-killing cleansers (antiseptics) in hospitals. Anionic detergents are sometimes used to clean carpeting. Detergent poisoning occurs when someone swallows cationic or anionic detergents.

Poisonous Ingredient

Damaging (corrosive) acids, including benzalkonium chloride
Simple soap

Where Found

Many different detergents and soaps

Symptoms

Blood
- Severe change in acid level of blood (pH balance), which leads to damage in all of the body organs
Eyes, ears, nose, and throat
- Loss of vision
- Severe pain in the throat
- Severe pain or burning in the nose, eyes, ears, lips, or tongue
Gastrointestinal
- Blood in the stool
- Burns and possible holes in the food pipe (esophagus)
- Severe abdominal pain
- Vomiting
- Vomiting blood
Heart and blood
- Collapse
- Low blood pressure that develops rapidly
Lungs and airways
- Breathing difficulty (from breathing in the detergent)
- Throat swelling (may also cause breathing difficulty)
Skin
- Burns
- Holes (necrosis) in the skin or tissues underneath
- Irritation

Home Treatment

Seek immediate medical help. DO NOT make a person throw up unless told to do so by Poison Control or a health care professional.

If the chemical was swallowed, immediately give the person water or milk, unless instructed otherwise by a health care provider. DO NOT give water or milk if the patient is having symptoms (such as vomiting, convulsions, or a decreased level of alertness) that make it hard to swallow.

Before Calling Emergency

Determine the following information:

Patient's age, weight, and condition
Name of the product (ingredients and strengths, if known)
Time it was swallowed
Amount swallowed

Poison Control, or a local emergency number

The National Poison Control Center (1-800-222-1222) can be called from anywhere in the United States. This national hotline number will let you talk to experts in poisoning. They will give you further instructions.

This is a free and confidential service. All local poison control centers in the U.S. use this national number. You should call if you have any questions about poisoning or poison prevention. It does NOT need to be an emergency. You can call for any reason, 24 hours a day, 7 days a week.

See: Poison control center - emergency number

What to expect at the emergency room

The health care provider will measure and monitor your vital signs, including temperature, pulse, breathing rate, and blood pressure. Symptoms will be treated as appropriate. You may receive:

Breathing tube
Bronchoscopy -- camera down the throat to see burns in the airways and lungs
Endoscopy -- camera down the throat to see burns in the esophagus and the stomach
Fluids by IV
Medicines to treat pain
Oxygen
Surgical removal of burned skin (skin debridement)
Washing of the skin (irrigation) -- perhaps every few hours for several days

Expectations (prognosis)

How well you do depends on the amount of poison swallowed and how quickly treatment is received. The faster you get medical help, the better the chance for recovery.

Swallowing such poisons can have severe effects on many parts of the body. The outcome depends on the extent of this damage. Damage continues to occur to the esophagus and stomach for several weeks after the poison was swallowed.

Review Date: 2/27/2008

Reviewed By: Stephen C. Acosta, MD, Department of Emergency Medicine, Portland VA Medical Center, Portland, OR. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org). URAC's accreditation program is an independent audit to verify that A.D.A.M. follows rigorous standards of quality and accountability. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.'s editorial policy, editorial process and privacy policy. A.D.A.M. is also a founding member of Hi-Ethics and subscribes to the principles of the Health on the Net Foundation (www.hon.ch).

A.D.A.M. Copyright

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997-2009 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.

adam.com

Source Doc: 1_002777

You Asked: Dealing With iPod Case Funk

FitSugar — Tue, 13 Oct 2009 09:00:14 -0700

Dear Fit,
I love my iPod Nano for running but I really hate the way the armband gets so smelly and sweaty! You can't wash your armband as frequently as your running gear because the thin plastic window gets destroyed. The best compromise I've found is to put some detergent in a bowl, let it soak in hot water, and then I rinse it out by hand and let it air dry overnight.

Do any of you have better ideas for keeping your iPod clean and non-smelly?
- spacekatgal

This question came to us from RunningSugar - FitSugar's online community dedicated to our readers who run. To hear my suggestion on getting rid of iPod funk, read more.

You're so right about iPod armbands getting sweaty and smelly. I spoke to all the runners I know and getting that nasty smell out seems to be a common problem.

Since your iPod armband has a plastic cover, handwashing is the best method to use. Like you pointed out, the plastic cover will end up coming off in your washing machine over time. You can also try washing your armband in the gentle cycle with cold water, but that might not get it clean enough. I'd suggest adding some vinegar to your soaking mix - since armbands trap bacteria, the vinegar will help kill the germs and the smell.

If you're open to a new product, I've been using the iStik for just over a year now and I love it. You put the iPod in a plastic face case, place that on your body wherever you like, and put the magnetic backing on the other side of your clothes in the same spot. I put mine on the waistband of my pants and it works like a charm.

I know it sounds a little iffy, but the magnets are extremely strong, your iPod is protected from sweat, and the case is so easy to clean. When I run, my iPod doesn't move around, and it's easy to change songs because I keep it on the belt area of my pants.

For more tips, advice, and support from fellow FitSugar runners, check out the RunningSugar group!

Eczema

FitSugar — Wed, 08 Oct 2008 17:34:55 -0700

HEALTH GUIDE REFERENCE FROM A.D.A.M

Eczema is a chronic, inflammatory skin disorder. Its main features are blisters that dry to become scaly, itchy rashes. The skin becomes dry and itchy because too much moisture is lost from its upper layer. This leaves the skin without protection, making it easy for bacteria and viruses to penetrate. The disease occurs episodically; in other words, there may be periods when symptoms are severe (flares) and times when there are no symptoms at all (remission). Although eczema is not contagious, it is very common -- estimates are that more than 15 million people in the United States have eczema. People with eczema often have a personal or family history of allergic conditions like asthma or hay fever. There is no cure, but treatments can reduce symptoms and help prevent outbreaks.

Signs and Symptoms

Symptoms of eczema occur repeatedly. The most common signs of eczema are:

Dry, extremely itchy skin
Blisters with oozing and crusting
Redness of the skin around the blisters
Raw areas of the skin from scratching which may even lead to bleeding
Dry, leathery areas with more or less pigment than their normal skin tone (called lichenification)

Eczema in children under 2 years old generally begins on the cheeks, elbows, or knees. In adults, it tends to be located on the inside surfaces of the knees and elbows.

Causes

The cause of eczema is thought to be a combination of hereditary (genetic) and environmental factors. This means that factors such as allergies can cause eczema in susceptible people. Exposure to certain irritants and allergens in the environment can worsen symptoms, as can dryness of the skin, exposure to water, temperature changes, and stress.

Risk Factors

Young age -- infants and young children are most affected by eczema (about 65% of cases occur before age one, and about 90% occur before age 5)
Skin exposure to harsh conditions
Living in a climate with low humidity
Personal or family history of allergies to plants, chemicals, or food
Deficiencies of certain vitamins and minerals (for example, zinc)
Stress can make eczema worse

Irritants that may worsen eczema include:

Wool or synthetic fibers
Certain soaps and detergents as well as perfumes and some cosmetics
Dust or sand
Cigarette smoke

Diagnosis

Your doctor will most likely base a diagnosis on both the appearance of the skin and on personal and family history. To find the cause of your rash, your doctor may ask about stress in your life, your diet, drugs you are taking, soaps and detergents you use, and chemicals or materials you may be exposed to at work. A skin lesion biopsy (removal of a small piece of skin for examination in a laboratory) may be performed, but is not always required to make the diagnosis.

Prevention

Control of stress, nervousness, anxiety, and depression may help prevent flares of eczema. Mind-body techniques that have shown some success include cognitive-behavioral therapy and autogenic training. These two techniques can also be combined with learning about eczema.

Dietary restrictions that may help avoid flare ups include eggs, fish, peanuts, and soy. This is very individual and should be discussed with your health care provider. A doctor, dietitian, or naturopath, for example, can help you make these dietary changes and determine if the lack of these foods in your diet is reducing the incidence and severity of your eczema.

Although somewhat controversial, some studies have shown that children who are exclusively breast-fed for at least 4 months are less likely to get eczema. This is particularly true when the nursing mother has avoided cow's milk in her own diet.

Similarly, recent studies suggest that babies whose mothers used probiotics during pregnancy and while breastfeeding were less likely to have eczema at up to 2 years of age.

Preliminary studies suggest that pretreatment of skin with creams containing omega fatty acids can reduce the severity of eczema or prevent eczema entirely.

Treatment

The goals when treating eczema are to heal the skin, reduce symptoms, prevent skin damage, and prevent flares. Treatment may vary depending on age, symptoms, and general health. Developing skin care routines, identifying factors that trigger flares, and avoiding these triggers are a large part of any treatment plan.

Lifestyle

Avoid anything that aggravates the symptoms, such as allergens (substances to which the immune system overreacts) and irritants to the skin. Common allergens include pollen, dust mites, and animal dander. Common skin irritants include wool, synthetic fibers, soaps and detergents, perfumes, cosmetics, lanolin, certain chemicals such as chlorine and solvents (including mineral oil), cigarette smoke, dust, and sand.
Avoid scratching or rubbing affected areas.
Protect skin from rough clothing and irritants.
Be aware of emotional stress, and try stress-reducing techniques.
Keep your environment cool, with stable temperature and humidity.

Dry skin often makes the condition worse. Remember to:

Avoid hot baths or showers; lukewarm water is best.
Wash or bathe as quickly as possible to lessen water contact.
Use a mild soap or a nonsoap cleanser, or less soap than usual.
Moisturize. After bathing, it is important to trap the moisture in the skin by applying lubricating cream on the skin while it is damp (within 3 minutes of bathing).

Parents can help their children by:

Providing distractions to prevent them from scratching.
Keeping fingernails short to reduce chances of infection from scratching.
Being aware that there may well be social and emotional stress associated with visible skin lesions; additional support and encouragement may be needed.

Medications

Mild anti-itch lotions (Caladryl or Calamine) or topical corticosteroids (hydrocortisone) may soothe less severe or healing areas, or dry scaly lesions.
Chronic thickened areas may be treated with ointments or creams that contain tar compounds (such as Psoriasin), corticosteroids (medium to very high potency), and ingredients that lubricate or soften the skin.
Systemic corticosteroids may be prescribed to reduce inflammation in some severe cases. Examples include prednisone (Deltasone) and methylprednisolone (Medrol). In very rare instances, medications that suppress the immune system (called immunosuppressants), such as cyclosporine, may be considered in adults with extremely severe eczema who do not respond to oral steroids.
Antihistamines, such as diphenhydramine (Benadryl), may be recommended for nighttime use to prevent scratching. These medications may cause drowsiness. Topical (on the skin) antihistamines preparations are also available.
New treatments -- the latest treatment for eczema is a new class of skin medications called topical immunomodulators (TIMs). These medications are steroid-free. The most common are tacrolimus (Protoptic) and pimecrolimus (Elidel). Clinical studies have reported as high as an 80% success rate using these new medications.

Surgery and Other Procedures

Phototherapy and Photochemotherapy

Treatment with ultraviolet light waves may effectively treat mild-to-moderate cases of eczema in children over age 12 and adults. If phototherapy is ineffective alone, it may be combined with a drug called psoralen. It is then called photochemotherapy.

Nutrition and Dietary Supplements

Nutritional deficiencies may be addressed with the following supplements:

Eliminate potential food allergens, including dairy, wheat (gluten), corn, preservatives, and food additives. Your health care provider may want to test for food sensitivities. Identifying and treating hidden food allergies along with stress management are often the cornerstones of effective complimentary medical treatment of eczema.
A multivitamin daily, containing the antioxidant vitamins A, C, E, the B-vitamins, and trace minerals, such as magnesium, calcium, zinc, and selenium.
Omega-3 fatty acids, such as fish oil (1 - 2 capsules or 1 tablespoonful oil 2 - 3 times daily), to help decrease inflammation and improve immunity. Cold-water fish, such as salmon or halibut, are good sources, but supplementation is recommended.
Probiotic supplement (containing Lactobacillus acidophilus), 5 - 10 billion CFUs (colony forming units) a day, for maintenance of gastrointestinal and immune health. Some probiotic supplements may need to be refrigerated for best results. Your child may also take probiotic supplements. Consult with your health care provider before giving your child any dietary supplements.
Alpha-lipoic acid, 25 - 50 mg twice daily, for antioxidant support.
Vitamin C, 500 - 1,000 mg 1 - 3 times daily, as an antioxidant and for immune support.
L-glutamine, 500 - 1,000 mg 3 times daily, for support of gastrointestinal health and immunity.
Grapefruit seed extract (Citrus paradisi), 100 mg capsule or 5 - 10 drops (in favorite beverage) 3 times daily when needed, for antibacterial, antifungal, and antiviral activity, and for immunity.
Resveratrol (from red wine), 50 - 200 mg daily, to help decrease inflammation and for antioxidant effects.

Herbs

Herbs are generally a safe way to strengthen and tone the body's systems. As with any therapy, you should work with your health care provider to get your problem diagnosed before starting any treatment. You may use herbs as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, you should make teas with 1 tsp. herb per cup of hot water. Steep covered 5 - 10 minutes for leaf or flowers, and 10 - 20 minutes for roots. Drink 2 - 4 cups per day. You may use tinctures alone or in combination as noted.

Green tea (Camellia sinensis) standardized extract, 250 - 500 mg daily, for antioxidant and anti-inflammatory effects. Use caffeine free products. You may also prepare teas from the leaf of this herb.
Cat's claw (Uncaria tomentosa) standardized extract, 20 mg 3 times a day, for inflammation and antibacterial, or antifungal activity.
Reishi mushroom (Ganoderma lucidum), 150 - 300 mg 2 - 3 times daily, for inflammation and for immunity. You may also take a tincture of this mushroom extract, 30 - 60 drops 2 - 3 times a day.
Olive leaf (Olea europaea) standardized extract, 250 - 500 mg 1 -3 times daily, for antibacterial or antifungal activity and immunity. You may also prepare teas from the leaf of this herb.
Evening primrose (Oenothera biennis) standardized oil extract (EPO), 500 mg - 8 grams daily in divided dosages, depending upon severity of symptoms. Ask a health care provider for more information on proper dosages of EPO.
Milk thistle (Silybum marianum) seed standardized extract, 80 - 160 mg 2 - 3 times daily, for detoxification support.

Homeopathy

Although very few studies have examined the effectiveness of specific homeopathic therapies, professional homeopaths may consider the following remedies for the treatment of eczema based on their knowledge and experience. Before prescribing a remedy, homeopaths take into account a person's constitutional -- your physical, emotional, and psychological makeup. An experienced homeopath assesses all of these factors when determining the most appropriate treatment for each individual. Any remedy that causes aggravation of symptoms should be discontinued right away.

Calendula -- applied to the skin, particularly if the affected area is inflamed; this remedy soothes but does not cure the skin condition.
Sulphur -- for redness, burning, itching, and hot skin that tends to worsen with washing and scratching.
Urtica urens -- for large, red rashes (particularly those related to allergies) that itch and burn intensely.
Rhus toxicodendron -- used as a remedy for inflamed skin resulting from direct contact with an irritating substance; some homeopaths use it to treat eczema.

Massage and Physical Therapy

One clinical study evaluating essential oils for treating children with eczema concluded that massage with and without essential oils was effective in improving the dry, scaly skin lesions. Children with this scaly, itchy skin problem seem to experience less redness, scaling, and other symptoms if receiving massage between flares. Massage should not be used when this skin condition is actively inflamed. The essential oils most often chosen by the mothers in the study included sweet marjoram, frankincense, German chamomile, myrrh, thyme, benzoin, spike lavender, and Litsea cubeba.

Exercise

In one clinical study it was found that regular group sporting activities improved symptoms in those who participated for 3 weeks. The therapeutic effect of exercise may be related to the positive impact it has on the emotions. Sports should be avoided during the worst stages of an outbreak.

Climatotherapy

Climatotherapy is the use of sunlight and water (such as the ocean) as therapy. The Dead Sea in Israel is known for its healing properties, and many people with eczema go there to sit in the sun and swim in the water. Clinical studies suggest that this is a successful treatment for eczema. One clinical study looked at the experience of more than 1,500 people with eczema and found that 95% of skin was cleared in people who had previous stays at the Dead Sea and stays longer than 4 weeks.

Mind-Body Medicine

Flares of eczema are associated with anxiety and stress. Several clinical studies have shown that relaxation techniques to reduce stress and anxiety can successfully decrease the number of occurrences and relieve symptoms of eczema. Biofeedback seems to be a particularly useful technique.

Other Considerations

Starting an infant on solid foods conservatively and gradually may help prevent the food sensitivities that can cause eczema. Those who are allergic to ragweed, chrysanthemums, asters, echinacea, or feverfew should avoid chamomile because it is in the same plant family.

Pregnancy

Avoid the use of burdock and sulfur during pregnancy.

Warnings and Precautions

Although Chinese herbal treatments for eczema have been gaining popularity in both the United States and the United Kingdom, caution must be exercised when considering such remedies for this skin condition. Many of the Chinese herbal creams available in these two countries have been tested, and high amounts of steroid medications have been discovered. This is worrisome and potentially dangerous because the amount of the medication in such creams is not standardized or regulated. In a few rare instances, the use of oral Chinese herbs (like a tea) for eczema has led to kidney damage.

Prognosis and Complications

Although there may be complications of eczema, such as bacterial infections of the skin and permanent scar formation, eczema is usually just an annoyance that is easily controlled with treatment and by avoiding irritants. Call for an appointment with your health care provider if it does not respond to treatment or if signs of infection (such as fever, redness, pain) occur. Children with eczema, after a certain period of time, often go into remission for the rest of their lives, although skin may remain sensitive and dry.

Supporting Research

Abrahamsson TR, Jakobsson T, Bottcher MF, et al., Probiotics in prevention of IgE-associated eczema: a double-blind, randomized, placebo-controlled trial. J Allergy Clin Immunol. 2007;119(5):1174-80.

Anderson C, Lis-Balchin M, Kifk-Smith M. Evaluation of massage with essential oils in childhood atopic eczema. Phyother Res. 2000;14(6):452-456.

Berger MM, Shenkin A. Vitamins and trace elements: Practical aspects of supplementation. Nutrition. 2006; 22(9):952-5.

Billmann-Eberwein C, Rippke F, Ruzicka T, Krutmann J. Modulation of atopy patch test reactions by topical treatment of human skin with a fatty acid-rich emollient. Skin Pharmacol Appl SkinPhysiol. 2002;15(2):100-104.

Borrek S, Hildebrandt A, Forster J. Gamma-linolenic-acid-rich borage seed oil capsules in children with atopic dermatitis. A placebo-controlled double-blind study [Article in German]. Klin Padiatr. 1997;209(3):100-104.

Bruno EJ Jr, Ziegenfuss TN, Landis J. Vitamin C: research update. Curr Sports Med Rep. 2006; 5(4):177-81.

Byremo G, Rod G, Carlsen KH. Effect of climatic change in children with atopic eczema. Allergy. 2006;61(12):1403-10.

Cabrera C, Artacho R, Gimenez R. Beneficial effects of green tea -- a review. J Am Coll Nutr. 2006;25(2):79-99.

Cooper R, Morre DJ, Morre DM. Medicinal benefits of green tea: Part I. Review of noncancer health benefits. J Altern Complement Med. 2005; 11(3):521-8.

Doron S, Gorbach SL. Probiotics: their role in the treatment and prevention of disease. Expert Rev Anti Infect Ther. 2006; 4(2):261-75.

Dryden GW Jr, Deaciuc I, Arteel G, McClain CJ. Clinical implications of oxidative stress and antioxidant therapy. Curr Gastroenterol Rep. 2005;7(4):308-16.

Ernst E, Huntley A. Tea tree oil: a systematic review of randomized clinical trials. ForschKomplementarmed Klass Naturheilkd. 2000; 7(1):17-20.

Ernst E. Adverse effects of herbal drugs in dermatology. Br J Dermatol. 2000;143(5):923-929.

Fleischer AB Jr, Abramovits W, Breneman D, Jaracz E; US/Canada tacrolimus ointment study group. Tacrolimus ointment is more effective than pimecrolimus cream in adult patients with moderate to very severe atopic dermatitis. J Dermatol Treat. 2007;18(3):151-7.

Harari M, Shani J, Seidl V, Hristakieva E. Climatotherapy of atopic dermatitis at the Dead Sea: demographic evaluation and cost-effectiveness. Int J Dermatol. 2000;39(1):59-69.

Hederos CA, Berg A. Epogam evening primrose oil treatment in atopic dermatitis and asthma. Arch Dis Child. 1996;75(6):494-497.

Horrobin DF. Essential fatty acid metabolism and its modification in atopic eczema. Am J Clin Nutr. 2000;71(1 Suppl):367S-72S.

Johnston CS. Recommendations for vitamin C intake. JAMA. 1999;282(22):2118-2119.

Kalliomaki M, Kirjavainen P, Eerola E, Kero P, Salminen S, Isolauri E. Distinct patterns of neonatal gut microflora in infants in whom atopy was and was not developing. J Allergy Clin Immunol. 2001;107(1):129-134.

Kalliomaki M, Salminen S, Arvilommi H, Kero P, Koskinen P, Isolauri E. Probiotics in primary prevention of atopic disease: a randomized placebo controlled trial. Lancet. 2001;357(9262):1076-1079.

Karamfilov T, Elsner P. Sports as a risk factor and therapeutic principle in dermatology [article in German]. Hautarzt. 2002;53(2):98-103.

Langan SM, Williams HC. What causes worsening of eczema? A systematic review. Br J Dermatol. 2006;155(3):504-14.

Levine M, Rumsey SC, Daruwala R, Park JB, Wang Y. Criteria and recommendations for vitamin C intake. JAMA. 1999;281(15):1415-1453.

Linde K, Hondras M, Vickers A, ter Riet G, Melchart D. Systematic reviews of complementary therapies - an annotated bibliography. Part 3: homeopathy. BMC Complement Altern Med. 2001; 1:4.

Magin PJ, Adams J, Heading GS, Pond DC, Smith W. Complementary and alternative medicine therapies in acne, psoriasis, and atopic eczema: results of a qualitative study of patients' experiences and perceptions. J Altern Complement Med. 2006;12(5):451-7.

McMenamy CJ, Katz RC, Gipson M. Treatment of eczema by EMG biofeedback and relaxation training: a multiple baseline analysis. J Behav Ther Exp Psychiatry. 1988;19(3):221-227.

Morse NL, Clough PM. A meta-analysis of randomized, placebo-controlled clinical trials of Efamol evening primrose oil in atopic eczema. Where do we go from here in light of more recent discoveries? Curr Pharm Biotechnol. 2006;7(6):503-24.

Osborn DA, Sinn J. Soy formula for prevention of allergy and food intolerance in infants. Cochrane Database Syst Rev. 2006;(4):CD003741.

Prescott SL, Bjorksten B. Probiotics for the prevention or treatment of allergic diseases. J Allergy Clin Immunol. 2007;120(2):255-62.

Rainone F. Milk thistle. Am Fam Physician. 2005 Oct 1; 72(7):1285-8.

Rautava S, Kalliomaki M, Isolauri E. Probiotics during pregnancy and breast-feeding might confer immunomodulatory protection against atopic disease in the infant. J Allergy Clin Immunol. 2002;109(1):119-121.

Schmitt J, Schakel K, Schmitt N, Meurer M. Systemic treatment of severe atopic eczema: a systematic review. Acta Derm Venereol. 2007;87(2):100-11.

Schulz P, Bunselmeyer B, Brautigam M, Luger TA. Pimecrolimus cream 1% is effective in asteatotic eczema: results of a randomized, double-blind, vehicle-controlled study in 40 patients. J Eur Acad Dermatol Venereol. 2007;21(1):90-4.

Sezer E, Etikan I. Local narrowband UVB phototherapy vs. local PUVA in the treatment of chronic hand eczema. Photodermatol PhotoimmunolPhotomed. 2007;23(1):10-4.

Siddiqui IA, Afaq F, Adhami VM, Ahmad N, Mukhtar H. Antioxidants of the beverage tea in promotion of human health. Antioxid Redox Signal. 2004; 6(3):571-82.

Simopoulos AP. Evolutionary aspects of diet, the omega-6/omega-3 ratio and genetic variation: nutritional implications for chronic diseases. Biomed Pharmacother. 2006;60(9):502-7.

Vlaski E, Stavric K, Isjanovska R, Seckova L, Kimovska M. Overweight hypothesis in asthma and eczema in young adolescents. Allergol Immunopathol (Madr). 2006;34(5):199-205.

Williams HC. Established corticosteroid creams should be applied only once daily in patients with atopic eczema. BMJ. 2007;334(7606):1272.

Worm M, Henz BM. Novel unconventional therapeutic approaches to atopic eczema. Dermatology. 2000;201(3):191-195.

Review Date:
8/23/2007
Reviewed By:
Ernest B. Hawkins, MS, BSPharm, RPh, Health Education Resources; and Steven D. Ehrlich, N.M.D., private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.

A.D.A.M. Copyright

adam.com

Periodontal disease

FitSugar — Wed, 08 Oct 2008 17:35:31 -0700

In This Report

Highlights
Introduction
Symptoms
Causes
Risk Factors
Complications
Prevention
Diagnosis
Treatment
Medications
Other Treatments
Resources
References

HEALTH GUIDE REFERENCE FROM A.D.A.M

Highlights

Symptoms of Periodontal Disease

Symptoms of periodontal disease include red and swollen gums, persistent bad breath, and gum recession and loose teeth. Smoking, certain types of illnesses (diabetes), older age, and other factors increase the risk for periodontal disease. If you have periodontal disease, your dentist may refer you to a periodontist, a dentist who specializes in treating this condition.

Practice Good Dental Hygiene

Consistent good dental hygiene can help prevent gingivitis and periodontitis. The American Dental Association recommends that everyone:

Brush twice daily with a fluoride toothpaste (be sure to replace toothbrushes every 3 - 4 months).
Clean between the teeth with floss or an interdental cleaner.
Eat a well-balanced diet and limit between meal snacks.
Have regular visits with a dentist for teeth cleaning and oral examinations.

Mouthwashes

In 2007, the American Dental Association stated that antimicrobial mouthwashes may provide additional oral health benefits for preventing and reducing gingivitis and plaque. However, they are not a substitute for daily brushing and flossing.

Research

Intensive treatment of periodontal disease may help reduce inflammation and improve blood flow throughout the body, according to a small study published in 2007 in the New England Journal of Medicine. In the study of patients with severe periodontitis, intensive treatment ultimately resulted in improved endothelial function. Poor endothelial function is associated with increased risk for atherosclerosis and heart disease. Researchers are investigating the connection between periodontal disease and heart disease, and whether treatment of periodontal disease can reduce heart disease risk.

Introduction

Periodontal disease refers to a group of problems that arise in the sulcus, the gap between the gum and the tooth.

The part of the mouth that consists of the gum and supporting structures is called the periodontium. It is made up of the following parts:

Gum (gingiva). When healthy, the gingiva is pale pink, firm, and does not move. It has a smooth or speckled texture. The gingival tissue between teeth is shaped like a wedge.
The space between the gum and tooth, called the sulcus
Root surface (the cementum)
Connective tissue
Bone. The crest of the supporting bone, which can be viewed on x-rays, is normally 2 mm below the point where the crown of the tooth meets the root (the cementoenamel junction).

The structure of the tooth includes dentin, pulp and other tissues, blood vessels, and nerves imbedded in the bony jaw. Above the gum line, the tooth is protected by the hard enamel covering.

Periodontal diseases are generally divided into two groups:

Gingivitis, which causes lesions (wounds) that affect the gums
Periodontitis, which damages the bone and connective tissue that supports the teeth

The process starts with bacteria. Even in healthy mouths, the sulcus is teeming with bacteria, but they tend to be harmless varieties. Periodontal disease develops usually because of two events in the oral cavity: an increase in bacteria quantity and a change in balance of bacterial types from harmless to disease-causing bacteria. These harmful bacteria increase in mass and thickness until they form a film called plaque.

Click the icon to see an image of plaque and damaged gum tissue.

In healthy mouths, plaque itself actually provides some barrier against outside bacterial invasion. When it accumulates to excessive levels, however, plaque sticks to the surfaces of the teeth and adjacent gums and causes cellular injury, with subsequent swelling, redness, and heat.

When plaque is allowed to remain in the periodontal area, it transforms into calculus (commonly known as tartar ). This material has a rock-like consistency and grabs onto the tooth surface. It is much more difficult to remove than plaque, which is a soft mass.

The most important component leading to the disease process, however, is the body's persistent immune response to the bacterial plaque. Specific immune factors are released that cause inflammation and damage that eventually destroys the support structures and bone and can lead to tooth loss.

Gingivitis is an inflammation of the gingiva, or gums. Is nearly always chronic, but an acute form infrequently occurs.

Chronic Gingivitis. Ordinary chronic gingivitis affects over 90% of the population. It is characterized by tender, red, swollen gums that bleed easily and may be responsible for bad breath (halitosis) in some cases. Treatment is very effective if initiated early in the course of gingivitis. Without good management, however, the problem can progress.

Periodontitis is characterized by the following:

Gum inflammation, with redness and bleeding.
Deep pockets (greater than 3 mm in depth) form between the gum and the tooth.
Loose teeth, caused by loss of connective tissue structures and bone.

Gingivitis precedes periodontitis, although it doesn't always lead to this more severe condition. In fact, some experts believe it is an entirely different disease. There are different categories of periodontal disease, including:

Chronic Periodontitis. Chronic periodontitis (also referred to as adult periodontitis) may begin in adolescence as a slowly progressing disease that becomes clinically significant in the mid-30s and continues throughout life. Some experts question whether it is a chronic, unrelenting condition and instead suggest that it waxes and wanes depending on the response of the immune system.

Aggressive Periodontitis. Aggressive periodontitis (also referred to as early onset periodontitis) often occurs in young people. It is subdivided according to whether it begins before or after puberty. Immune deficiencies and a genetic link have been shown to be possible factors for all types of aggressive periodontitis. If the condition is localized and treated, the outlook is positive. People with severe and widespread aggressive periodontitis are at high risk for tooth loss.

Periodontitis that occurs before puberty is very rare. It begins with the eruption of primary teeth in the first year and causes severe inflammation and bone and tooth loss.
Juvenile periodontitis begins at puberty and is defined by severe bone loss around the first molars and incisors. It is more common in girls than in boys. The clinical signs -- such as inflammation, bleeding, and heavy plaque accumulation -- are not present in this relatively rare disease. The treatment is the same as in chronic periodontitis.
Rapidly progressive periodontitis occurs in the early 20s to mid-30s. Severe inflammation and rapid bone and connective tissue loss occur, and tooth loss is possible within a year of onset.

Disease-Related Periodontitis. Periodontitis can also be associated with a number of systemic diseases, including type 1 diabetes, Down syndrome, AIDS, and several rare disorders of white blood cells.

Acute Necrotizing Periodontal Disease. Acute necrotizing periodontal disease is an acute infection in the gums. It is characterized by:

Black, dead tissue (necrosis)
Spontaneous bleeding
Rapid onset of pain
Bad odor
Blunted gum tissue (tissue is normally cone-shaped)

Stress, poor diet, smoking, and viral infections are predisposing factors for this acute necrotizing periodontal disease.

Symptoms

In general, symptoms progress over time and include:

Red and Swollen Gums
Gum Bleeding. Bleeding of the gums, even during brushing, is a sign of inflammation and the major marker of periodontal disease. One exception is juvenile periodontitis, in which symptoms are mild or even absent. It should be noted that the gums of smokers with periodontal disease tend to bleed less than nonsmokers.
Bad Breath. Debris and bacteria can cause a bad taste in the mouth and persistent bad breath.
Gum Recession and Loose Teeth. As the disease advances the gums recede, and supporting structure of bone is lost. Teeth loosen, sometimes causing a change in the way the upper and lower teeth fit together when biting down or a change in the fit of partial dentures.

Abnormally bulging, protruding, or swollen gums are a possible sign of disease.

Click the icon to see an image of recessed gums.

Abscesses. Deepening periodontal pockets between the gums and bone can become blocked by tartar or food particles. Infection-fighting white blood cells become trapped and die. Pus forms, and an abscess develops. Abscesses can destroy both gum and tooth tissue, cause nearby teeth to become loose and painful, and may cause fever and swollen lymph nodes.

Click the icon to see an image of a tooth abscess.

Pain is usually not a symptom, which partly explains why the disease may become advanced before treatment is sought and why some patients avoid treatment even after periodontitis is diagnosed.

Causes

Periodontal disease is marked by bacterial overgrowth. However, a persistent immune response to chronic infections in the mouth is believed to play a major role in gum destruction.

In the healthy mouth, more than 350 species of microorganisms have been found. Periodontal infections are linked to fewer than 5% of these species. Healthy and disease-causing bacteria can generally be grouped into two categories:

The harmless or helpful bacteria are usually known as gram positive aerobic bacteria.
In periodontal disease, the bacterial balance shifts over to gram negative anaerobic bacteria. Inflammatory disease and injury cannot develop without these bacteria.

Following are some of the bacteria most implicated in periodontal disease and bone loss:

Actinobacillus actinomycetemcomitans and Porphyromonas gingivalis. These two bacteria appear to be particularly likely to cause aggressive periodontal disease. Both P. gingivalis and A. actinomycetemcomitans, along with multiple deep pockets in the gum, are associated with resistance to standard treatments for gum disease. P. gingivalis may double the risk for serious gum disease. P. gingivalis produces enzymes, such as one called arginine-specific cysteine proteinase, which may be the specific destructive factors that disrupt the immune system and lead to subsequent periodontal connective tissue destruction.
Bacteroides forsythus is also strongly linked to periodontal disease.
Other bacteria associated with periodontal disease are Treponema denticola, T. socranskii, and P. intermedia. These bacteria, together with P. gingivalis, are frequently present at the same sites, and are associated with deep periodontal pockets.

Some bacteria are related to gingivitis, but not plaque development. They include various streptococcal species.

Evidence now suggests that periodontal disease is an autoimmune disorder, in which immune factors in the body attack the person's own cells and tissue -- in this case, those in the gum. It appears to work as follows:

The bacteria that form plaque and tartar release toxins that stimulate the immune system to overproduce powerful infection-fighting factors called cytokines.
Ordinarily, cytokines are important for healing. In excess, however, they can cause inflammation and severe damage. Cytokines of particular importance in periodontal disease are known as tumor necrosis factor-alpha (TNF-alpha) and interleukin-1beta, which are very active in the mouth, and are important in causing destructive inflammation.
In addition, white blood cells produced by the immune response to bacteria also release a family of enzymes called matrix metalloproteinases (MMPs), which break down connective tissue.

Studies suggest that this inflammatory response may have damaging effects not only in the gums but also in organs throughout the body, including the heart.

Certain herpes viruses (herpes simplex and varicella-zoster virus, the cause of chickenpox and shingles) are known causes of gingivitis. Other herpes viruses (cytomegalovirus and Epstein-Barr) may also play a role in the onset or progression of some types of periodontal disease, including aggressive and severe chronic periodontal disease. All herpes viruses go through an active phase followed by a latent phase and possibly reactivation.

Some experts theorize that these viruses may cause periodontal disease in different ways, including release of tissue-destructive cytokines, overgrowth of periodontal bacteria, suppressing immune factors, and initiation of other disease processes that lead to cell death.

Risk Factors

More than 75% of American adults have some form of gum disease, but according to a major survey, only 60% have any significant knowledge about the problem. Gum inflammation and ulcers are common, and not all people with these problems develop periodontal disease. Still, about 30% of people are genetically susceptible to periodontal disease. Other factors also put individuals at higher risk.

Lack of Oral Hygiene. Lack of oral hygiene encourages bacterial buildup and plaque formation.

Sugar and Acid. The bacteria that cause periodontal disease thrive in acidic environments. Therefore, eating sugars and other foods that increase the acidity in the mouth increase bacterial counts.

Poorly Contoured Restorations. Poorly contoured restorations (fillings or crowns) that provide traps for debris and plaque can also contribute to its formation.

Anatomical Tooth Abnormalities. Abnormal tooth structure can increase the risk.

Wisdom Teeth. Wisdom teeth, also called third molars, can be a major breeding ground for the bacteria that cause periodontal disease. In fact, for patients in their 20s, periodontal disease is most likely to occur around the wisdom teeth. Research suggests that periodontitis can occur in wisdom teeth that have broken through the gum as well as teeth that are impacted (buried). Periodontal disease can also be present even in patients with wisdom teeth who do not have any symptoms. Experts recommend that adolescents and young adults with wisdom teeth should have a dentist check for signs of periodontal disease

Children and Adolescents. Gingivitis, in varying degrees, is nearly a universal finding in children and adolescents. In rare genetic cases, children and adolescents are subject to destructive forms of the disease. Researchers have also observed some of the organisms seen in periodontal disease in young children without signs of gum problems. Healthy children, however, do not generally harbor two primary periodontal bacteria, P. gingivalis and T. denticola. The disease is also uncommon in teenagers.

Adults. One survey reported that 3.6% of adults between the ages of 18 - 34 had periodontal disease. As people age, the risk for periodontal disease increases. Over half of American adults have gingivitis surrounding 3 - 4 teeth, and 30% have significant periodontal disease surrounding 3 - 4 teeth. In a study of people over 70 years old, 86% had at least moderate periodontitis and over a quarter of them had lost their teeth.

About three-quarters of periodontal office visits are made by women, even though women tend to take better care of their teeth than men. Female hormones affect the gums, and women are particularly susceptible to periodontal problems. Hormone-influenced gingivitis appears in some adolescents, in some pregnant women, and is occasionally a side effect of birth control medication.

Before Menstruation. Gingivitis may flare up in some women a few days before they menstruate, when progesterone levels are high. Gum inflammation may also occur during ovulation. Progesterone dilates blood vessels causing inflammation, and blocks the repair of collagen, the structural protein that supports the gums.

Pregnancy. Hormonal changes during pregnancy can aggravate existing gingivitis, which typically worsens around the second month and reaches a peak in the eighth month. Pregnancy does not cause gum disease, and simple preventive oral hygiene can help maintain healthy gums. Any pregnancy-related gingivitis usually resolves within a few months of delivery. Because periodontal disease can increase the risk for low-weight infants and cause other complications, it is important for pregnant women to see a dentist.

Oral Contraceptives. Some studies report that oral contraceptives containing the synthetic progesterone desogestrel (but not dienogest, another common progesterone) increase the risk for periodontal disease.

Menopause. Estrogen deficiency after menopause reduces bone mineral density, which can lead to bone loss. Bone loss is associated with both periodontal disease and osteoporosis. Bone loss in the alveolar bone (which holds the tooth in place) may be a major predictor of tooth loss in postmenopausal women. Periodontal disease is the main cause of alveolar bone loss. During menopause, some women may also develop a rare condition called menopausal gingivostomatitis, in which the gums are dry, shiny, and bleed easily. Women may also experience abnormal tastes and sensations (such as salty, spicy, acidic, burning) in the mouth.

Periodontal disease often occurs in members of the same family. Genetics, intimacy, hygiene, or a mixture of factors may be responsible. Studies have found that children of parents with periodontitis are 12 times more likely to have the bacteria thought to be responsible for causing plaque and, eventually, periodontal disease.

Genetic Factors. Genetic factors may play the critical role in half the cases of periodontal disease. Up to 30% of the population may have some genetic susceptibility to periodontal disease. For example, some people with severe periodontal disease have genetic factors that affect the immune factor interleukin-1 (IL-1), a cytokine involved in the inflammatory response. Such individuals are up to 20 times more likely to develop advanced periodontitis than those without these genetic factors. Early onset and rapidly progressive periodontal disease also have strong genetic components.

Intimacy. Intimate partners and spouses of people with periodontal disease may also be at risk. Researchers have found that the bacteria P. gingivalis may be contagious after exposure to an infected person over a long period of time. There is no risk from short exposure such as after a fast kiss or when sharing an eating utensil.

Smoking is the single major preventable risk factor for periodontal disease. The habit can cause bone loss and gum recession even in the absence of periodontal disease. A number of studies indicate that smoking and nicotine increase inflammation by reducing oxygen in gum tissue and triggering an over-production of immune factors called cytokines (specifically ones called interleukins). In excess, cytokines are harmful to cells and tissue.

Furthermore, when nicotine combines with oral bacteria, such as P. gingivalis, the effect produces even greater levels of cytokines and eventually leads to periodontal connective tissue breakdown. Studies suggest that smokers are 11 times more likely than nonsmokers to harbor the bacteria that cause periodontal disease and four times more likely to have advanced periodontal disease. In one study more than 40% of smokers lost their teeth by the end of their lives.

The risk of periodontal disease increases with the number of cigarettes smoked per day. Smoking cigars and pipes carries the same risks as smoking cigarettes. Exposure to secondhand smoke is also associated with a 50 - 60% increased risk for developing periodontal disease, according to one study. Fortunately, when smokers quit, their periodontal health gradually recovers to a state comparable to that of nonsmokers.

Diabetes. Much evidence exists on the link between type 1 and 2 diabetes and periodontal disease. Diabetes causes changes in blood vessels, and high levels of specific inflammatory chemicals such as interleukins, that significantly increase the chances of periodontal disease. High levels of triglycerides (which are common in type 2 diabetes) also appear to impair periodontal health. Obesity, common in people with type 2 diabetes, may also predispose a person to gum disease. Controlling both type 1 and 2 diabetes may help reduce periodontal problems. For children with diabetes, good oral hygiene should begin at a young age. A 2006 study suggested that gum problems can start as early as 6 years of age in children with diabetes.

Osteoporosis and Osteonecrosis. Osteoporosis (loss of bone density) has been associated with periodontal disease in postmenopausal women. There have also been a few reports of osteonecrosis (bone decay) of the jaw in patients who take oral bisphosphonate drugs such as alendronate (Fosamax). Symptoms of osteonecrosis of the jaw include loose teeth, exposed jawbone, pain or swelling in the jaw, gum infections, and poor healing of the gums. As a precaution, the American Dental Association (ADA) recommends that patients who are prescribed bisphosphonate drugs get a thorough dental exam before beginning drug therapy, or as soon as possible after beginning therapy. The ADA also recommends that patients who take oral bisphosphonate drugs should discuss with their dentists any potential risks from dental procedures (such as extractions and implants) that involve the jawbone. In any case, be sure to inform your dentist if you are taking a bisphosphonate drug.

Osteoporosis is a condition marked by progressive loss of bone density, thinning of bone tissue, and increased risk of fractures. Osteoporosis may result from disease, dietary or hormonal deficiency, or advanced age. Regular exercise and vitamin and mineral supplements can reduce and may even reverse loss of bone density.

Giving intravenous bisphosphonates to patients being treated for bone cancer, or other cancers that have spread to the bone, increases their risk for developing osteonecrosis by 1 - 10%. Patients who take oral bisphosphonate drugs also have a slight risk, but 94% of osteonecrosis of the jaw cases involve patients who received bisphosphonates intravenously. If possible, see a dentist for a complete oral exam before beginning bisphosphonate therapy. In any case, be sure to inform your dentist if you are receiving intravenous bisphosphonates. Your dentist or oral surgeon may need to take special precautions when performing dental surgery

Herpes-Related Gingivitis. Herpes virus is a common cause of gingivitis in children and has become increasingly common in adults. It typically starts out with a purplish color and "boggy" sensation in the gums. Multiple blisters may form across the mucus membranes in the mouth and gums, followed by ulcers. They usually resolve in 7 - 14 days.

HIV-Associated Gingivitis. HIV-associated gingivitis has been reported in 15 - 50% of patients with HIV or AIDS. HIV-positive individuals harbor larger numbers of periodontal bacteria (candida albicans, P. gingivalis, black-pigmented anaerobic rods, and A. actinomycetemcomitans) than people without HIV. Severe pain is characteristic, along with odor, spontaneous bleeding, ulcers, and swollen, bright red gums. The inflammation never recedes, but halitosis and acute episodes can be managed by conventional cleaning treatments. Its severest form, known as necrotizing stomatitis, can be diagnostic for AIDS. In addition to bleeding, the gums in the front of the mouth are a yellowish-gray color, and bone thrusts out.

Autoimmune Diseases. Autoimmune conditions (Crohn's disease, multiple sclerosis, rheumatoid arthritis, lupus erythematosus, CREST syndrome) have been associated with a higher incidence of periodontal disease. Some research suggests that periodontal disease may even play some causal role. For example, one study suggested that P. gingivalis, one of the major bacteria in periodontal disease, was associated with destructive processes in the brain leading to multiple sclerosis. Still, more research is needed to determine a definitive association between these diseases.

Other Diseases. People with tuberculosis, syphilis, Wegener's granulomatosis, amyloidosis, and many genetic disorders are also at higher risk for periodontitis.

Vitamin C helps the body repair and maintain connective tissue, and its antioxidant effects are important in the presence of tissue-destroying oxidants in periodontal disease. Research indicates that vitamin C deficiency contributes to periodontal disease. A study of more than 12,000 adults found that people who consumed less than the recommended daily allowance of vitamin C, 60 mg (about one orange) were 1.5 times more likely to develop severe gingivitis than those who consumed more than 180 mg each day. Vitamin C levels are especially depleted in smokers. Eating citrus fruits high in vitamin C (such as grapefruit) may be helpful for patients with periodontitis.

Click the icon to see an image of the benefits of vitamin C.

Click the icon to see an image of the sources of vitamin C.

Dental disease is most likely to affect the poor. Children and the elderly suffer the worst oral care, and ethnic minorities follow. In the United States, the lack of access to dental insurance is a contributing factor. In a survey of residents of five states (Arizona, California, Hawaii, Oregon, and Wisconsin), the rate of total tooth loss was less than 20%. In three states (Kentucky, Louisiana, and West Virginia) it was greater than 40%.

Gingival overgrowth can be a side effect of nearly 20 different drugs, most commonly phenytoin (Dilantin), cyclosporine (Sandimmune), and a short-acting form of the calcium channel blocker nifedipine (Procardia).

Several other conditions can also cause gum inflammation, and some have been associated with periodontal disease. They include:

Mouth breathing
Psychologic stress. Stress can affect the immune system. Some studies suggest that stress can influence the development of chronic inflammatory diseases, like periodontitis.
Alcohol abuse. One study reported a higher incidence of periodontal disease, tooth decay, and possibly precancerous areas in patients who abuse alcohol.
Canker sores (aphthous ulcers)

Click the icon to see an image of a canker sore.

Self-injury in psychologically disturbed patients
Hereditary gingival fibromatosis. A rare genetic disease associated with both gum overgrowth and hairiness. It is often associated with gingivitis and periodontal disease.
Desquamative gingivitis. With this condition the outer layer of the gum tissue desquamates (peels away), exposing an acutely red surface. It usually occurs as a result of an allergic reaction or of skin diseases such as lichen planus, benign mucous membrane pemphigoid, bullous pemphigoid, and pemphigus vulgaris. (Bacteria may also play a role in this gum disease.) This condition generally resolves when the underlying problem is treated. It is fairly common in middle-aged women.

Complications

The ultimate outcome of uncontrolled periodontal disease is tooth loss. As the destructive factors cause the breakdown of bone and connective tissue, teeth lose their anchor.

A much less severe but nevertheless distressing problem caused by periodontal disease is bad breath, although coatings on the tongue may contribute more to bad breath than periodontal disease.

Studies have reported that people who have heart disease have a 1.5 - 4 times increased risk for periodontal disease. (The risk is highest for patients with extensive gum disease, bleeding from every tooth.) Acute coronary syndrome, high blood pressure (hypertension), and high cholesterol have also been associated with periodontal disease.

Periodontal disease has also been linked to stroke and coronary artery disease (CAD). The more severe the periodontitis, the greater the risk for heart problems. Many experts, however, are still not sure whether periodontal disease is a risk factor for stroke or a marker that reflects various risk factors common to both conditions.

A stroke is caused by a loss of blood circulation to areas of the brain. The blockage usually occurs when a clot or piece of atherosclerotic plaque breaks away from another area of the body and lodges within the blood vessels of the brain.

Recent evidence suggests that the inflammatory response may be the common element. This is an over-reaction of the immune system that causes injury to tissues in the body. A common link between patients with heart conditions and periodontal disease may be elevated levels of C-reactive protein (CRP), a marker for the inflammatory response. Some experts believe that immune factors causing this response are released into the bloodstream during periodontal disease and cause injury in the arteries supplying blood to the heart.

Other evidence suggests that the periodontal disease bacteria themselves -- particularly P. gingivalis, T. denticola, T. forsythia, and streptococci species -- may be the main culprit. In 2005, results from the NIH-sponsored Oral Infections and Vascular Disease Epidemiology Study (INVEST) determined an association between cardiovascular disease and the bacteria that cause periodontal disease. In this study, higher levels of periodontal bacteria were associated with thicker carotid arteries (a predictor of heart attack and stroke), regardless of C-reactive protein levels. While this study's findings are an important advance in understanding the relationship between periodontal and heart disease, it is still not clear if periodontal disease actually causes heart disease. Researchers hope that future results from INVEST will clarify this issue.

Experts are still not sure if treating gum disease can reduce the risks of heart disease and improve health outcomes for patients with periodontal disease and vascular heart problems. Studies have been mixed, but research is ongoing.

Diabetes is not only a risk factor for periodontal disease -- periodontal disease itself can worsen diabetes. Some evidence suggests that the bacteria that causes periodontal disease may enter the bloodstream and activate cytokines (damaging immune system factors), which then destroy cells in the pancreas where insulin is produced. Some studies indicate that treating periodontal disease can reduce the need for insulin and improve blood sugar control in some people with diabetes.

Bacteria that reproduce in the mouth can also be carried into the airways in the throat and lungs, increasing the risks for respiratory diseases and worsening chronic lung conditions, such as emphysema.

Click the icon to see an image of emphysema.

Many studies strongly indicate that bacterial infections that cause moderate-to-severe periodontal disease in pregnant women can increase the risk for premature delivery and low birth weight infants. The more severe the infection, the greater the risk to the baby. Research indicates that bacteria from gum disease and tooth decay may trigger the same factors in the immune system as genital and urinary tract infections. These biologic substances, called prostaglandins and tumor necrosis factor, produce inflammation in the cervix and uterus that can cause premature dilation and contractions. Research also suggests that periodontal disease increases the risk for preeclampsia, a life-threatening disorder that occurs in mid- to late pregnancy and is characterized by high blood pressure.

Experts recommend that women have a periodontal examination before becoming pregnant or as soon as possible thereafter. Because women with diabetes are at higher risk for periodontal disease, it is especially important that they see a dentist early in pregnancy. Experts are still not sure if treating periodontal disease can improve birth outcomes. A 2006 study in the New England Journal of Medicine indicated that the treatment does not affect pre-term birth or birth weight. However, the researchers reported that periodontal treatment is definitely safe for pregnant women.

Prevention

Healthy habits and good oral hygiene are critical in preventing gum disease. Regular and effective tooth brushing and mouth washing, however, are effective only above and slightly below the gum line. Once periodontal disease develops, more intensive treatments are needed.

It is important to reduce both the quantity and, in particular, the frequency of sugar intake. Avoid snacks and drinks with sugar (other than natural sugars found in fruits and vegetables). Eat sugar-containing foods with meals, ideally followed by brushing. Since fruit juices can also cause tooth erosion in children, parents should emphasize milk and water.

Smoking may play a significant role in over half the cases of chronic periodontal disease, according to research published in 2000. For smokers, quitting is one of the most important steps toward regaining periodontal health.

Fluoride treatment in children has helped to account for the decline in periodontal disease in adults. Because fluoride prevents decay, back molars, which keep the teeth in place, are spared, and are thus less vulnerable to bacteria. Even before teeth first erupt, babies' gums should be wiped clean with a bit of gauze bearing a dab of fluoride toothpaste. Supplementation with fluoride tablets or drops may be recommended for children 6 months or older who drink unfluoridated water or who are at risk for dental problems. A prescription from the child's pediatrician or dentist is required.

Some dentists recommend a fluoride gel for adult patients who are still at risk for tooth decay or sensitivity, but extra fluoride is generally not necessary for adults who use fluoride toothpaste.

Periodontitis is a silent disease. People with the disease rarely experience pain and may not be aware of the problem. A periodontal examination by a general dentist once or twice a year should reveal any incipient or progressive problems. A full mouth series of x-rays is advised every 2 - 3 years. This will alert the dentist to early bone loss and other disorders of the oral cavity.

Dentists now often perform Periodontal Screening and Recording (PSR) using a probe to measure gum pockets. Previously performed only by periodontists, this procedure is now encouraged as part of a regular dental examination. The dentist will identify any areas where deep pocketing has occurred, where the health of the gingiva appears compromised, and where there is undue mobility of teeth. It is the general dentist's responsibility to identify periodontal disease and inform the patient. If the condition is severe, the dentist may want to refer the patient to a periodontist.

Correct tooth brushing, mouth cleansing, and flossing should be everyone's defense against periodontal disease. (However, good hygiene is probably not sufficient to prevent periodontal disease in many people. Regular visits to a dentist are extremely important, especially for high-risk individuals.)

Brushing Guidelines. The following are some recommendations for brushing:

Use a dry brush. One study reported that when people brushed their teeth without toothpaste first, using a soft dry brush, their plaque deposits were reduced by 67%, and gum bleeding dropped by 50%.
No brush of any size, shape, or gimmick is effective if it is incorrectly positioned in the mouth. Place the brush where the gum meets the tooth, with bristles resting along each tooth at a 45-degree angle.
Begin by dry brushing the inside the bottom row of teeth, then the inner top teeth, and last the outer surfaces.
Wiggle the brush back and forth so the bristles extend under the gum line.
Scrub the broad, biting surfaces of the back teeth.
Dry brushing should take about a minute and a half.
A paste is then applied, and the teeth should again be brushed in the same way.
The tongue should be scrubbed for a total of about 30 seconds. A tongue scraper used with an anti-bacterial mouthwash (such as Listerine) is more effective than a toothbrush in removing bacteria.
Rinse the toothbrush thoroughly and then tap it on the edge of the sink at least five times to get rid of debris.
Flossing should finish the process. A mouthwash may also be used.

If brushing after each meal is not possible, rinsing the mouth with water after eating can reduce bacteria by 30%.

Toothbrushes. A vast assortment of brushes of varying sizes and shapes are available, and each manufacturer makes its claim for the benefits of a particular brush. Look for the American Dental Association (ADA) seal on both electric and regular brushes.

In spite of the wide variety of nonelectric toothbrushes, both in shape and bristle design, a study of eight brands found no significant differences in effectiveness among them.

Electric toothbrushes, particularly those with a stationary grip and revolving tufts of bristles, can be advantageous for some people with physical disabilities. Electric toothbrushes with heads that move back and forth up to 4,200 times a minute remove significantly more plaque than ordinary brushes. Even more high-tech brushes are now available that use sound waves to remove plaque.

In general, studies have reported no differences between electric and manual toothbrushes in their ability to remove plaque. (One study showed considerable improvement in groups using sonic toothbrushes, particularly in those with moderate periodontal disease.) Experts recommend, however, that if a regular toothbrush works, it isn't necessary to buy an expensive electric one.

For individuals with average dexterity, a four- or five-rowed, soft, nylon-bristled toothbrush is sufficient. The most important factor in buying any toothbrush, electric or manual, is to choose one with a soft head. Soft bristles get into crevices easier and do not irritate the gums, thereby reducing the risk of exposing teeth below the gum line compared to hard brushes.

Experts generally recommend replacing toothbrushes every 1 - 3 months. Not only do they become breeding grounds for bacteria, but the worn bristles are less effective at removing plaque.

Toothpaste. The object of a good toothpaste is to reduce the development of plaque and eliminate periodontal-causing microorganisms without destroying the organisms that are important for a healthy mouth. All brands should show ADA approval. Even a good toothpaste, however, cannot be delivered past 3 mm below the gum line, where periodontitis develops.

Toothpastes are a combination of abrasives, binders, colors, detergents, flavors, fluoride, humectants, preservatives, and artificial sweeteners. Avoid highly abrasive toothpastes, especially for individuals whose gums have receded.

Ingredients contained in toothpastes may include:

Fluoride. Most commercial toothpastes contain fluoride, which both strengthens tooth enamel against decay and enhances remineralization of the enamel. Fluoride also inhibits acid-loving bacteria, especially after eating, when the mouth is more acidic. This antibacterial activity may help control plaque.
Triclosan. Triclosan is an anti-bacterial substance that may help reduce mild gingivitis.
Metal salts. Metal salts, such as stannous and zinc, serve mostly as anti-bacterial substances in toothpastes. Stannous fluoride gel toothpastes do not reduce plaque, however, even though they have some effect against the bacteria that cause it, but slightly reduce gingivitis.
Peroxide and baking soda. Toothpastes with these ingredients claim to have a whitening action, but while they may help remove stains there is little evidence they whiten the actual color of the teeth. In addition, these substances appear to offer no benefits against gum disease.
Antibacterial sugar substitutes (xylitol), and detergents (delmopinol)

Mouthwashes. The American Dental Association recommends (in addition to daily brushing and flossing) antimicrobial mouthwash to help prevent and reduce plaque and gingivitis, and fluoride mouthwashes to help provide additional protection against tooth decay.

Chlorhexidine (Peridex or PerioGard) is an antimicrobial mouthwash available by prescription only. It reduces plaque by 55% and gingivitis by 30 - 45%. Patients should rinse for 1 minute twice daily. They should wait at least 30 minutes (and preferably 2 hours) between brushing and rinsing since chlorhexidine can be inactivated by certain compounds in toothpastes. It has a bitter taste. It also binds to tannins, which are in tea, coffee, and red wine, so it has tendency to stain teeth in people who drink these beverages. Studies are mixed as to its effectiveness for preventing or reducing periodontal disease.
Listerine is another antimicrobial mouthwash. It is composed of essential oils and is available over the counter. It reduces plaque and gingivitis, when used for 30 seconds twice a day. It leaves a burning sensation in the mouth that most people better tolerate after a few days of use. The usual regimen is to rinse twice a day. (Listerine PocketPaks, which are strips that dissolve on the tongue, have no proven effects on plague and gingivitis.)
Mouthwashes containing cetylpyridinium (Scope, Cepacol) have moderate antimicrobial effect on plaque, but only if they are used an hour after brushing. None are as effective as Listerine or chlorhexidine, but they may still have some value for people who cannot tolerate the other mouthwashes.
Mouthwashes containing stannous fluoride and amine fluoride (Meridol) are moderately effective, but are also not as effective as effective as Listerine or chlorhexidine.
Fluoride mouthwashes (Act) are helpful in preventing cavities.
Mouthwashes that contain alcohol are dangerous for children and should be kept away from them.

Flossing. The use of dental floss, either waxed or unwaxed, is critical in cleaning between the teeth where the toothbrush bristles cannot reach. In spite of this, nearly two-thirds of people do not floss.

To floss correctly, the following steps may be helpful:

Break off about 18 inches of floss and wind most of it around the middle finger of one hand and the rest around the other middle finger.
Hold the floss between the thumbs and forefingers and gently guide and rub it back and forth between the teeth.
When it reaches the gum line, the floss should be curved around each tooth and slid gently back and forth against the gum.
Finally, rub gently up and down against the tooth. Repeat with each tooth, including the outside of the back teeth.
If, on repeated flossing attempts, the floss becomes shredded or cannot be removed easily from between the teeth, a rough crown or overhanging filling may be the cause. In such cases, the restoration should be redone. Such areas create spaces for the collection of food debris, plaque, and calculus.

Here are some tips in choosing the right floss or flossing device:

Use a floss that does not shred or break.
Avoid a very thin floss, which can cut the gum if brought down with too much force or not guided along the side of the tooth.
A floss threader is an invaluable aid for the person who has bridgework. Made of plastic, it looks like a needle with a huge eye, or loop. A piece of floss is threaded into the loop, which can then be inserted between the bridge and the gum. The floss that is carried through with it can then be used to clean underneath the false tooth or teeth and along the sides of the abutting teeth.
Another handy device for cleaning under bridges is a Proxabrush, which is an interdental cleaner. This is a tiny narrow brush that can be worked in between the natural teeth and around the attached false tooth or teeth.
Special toothpicks such as Stim-U-Dent may be effective for wide spaces between teeth but should never replace flossing. Standard toothpicks should never be used for regular hygiene.
Electronic products, such as water piks, are also helpful. These devices are expensive but may improve flossing compliance.

Producing Saliva and Drinking Water. Saliva is important for diluting the toxins created by plaque. Drinking at least 7 glasses of water a day helps reduce inflammation in the mouth by producing more saliva. Increasing water intake is particularly important as one ages, when less saliva is produced.

Diagnosis

The dental practitioner typically performs a number of procedures to determine a diagnosis of periodontal disease.

The dentist will first take a medical history to reveal any past or present periodontal problems, any underlying diseases that might be contributing to the problem, and any medications the patient is taking. After noting the general state of oral hygiene, the dentist may ask about the quality of home dental care.

Inspection of the Gum Area. The dentist inspects the color and shape of gingival tissue on the cheek (buccal) side and the tongue (lingual) side of every tooth and compares these qualities to the healthy ideal. Redness, puffiness, and bleeding upon probing indicate inflammation. If the gum formation between teeth is blunt and not pointed, acute necrotizing periodontal disease may be indicated.

Periodontal Screening and Recording (PSR). PSR is a painless procedure used to measure and determine the severity of periodontal disease:

The dentist uses a mirror and a periodontal probe, a fine instrument calibrated in millimeters (mm), which is used to measure pocket depth. (A new automatic probing device may prove to be even more sensitive and accurate than the standard manual probe that most dentists use.)
The probe is held along the length of the tooth with the tip placed in the pocket. The tip of the probe will then touch the point where the connective tissue attaches to the tooth.
The dentist will "walk" the probe to six specified points on each tooth, three on the buccal (cheek) and three on the lingual (tongue) sides. The dentist measures the depth of the probe at each point.
Pocket depths greater than 3 mm indicate disease.

These measurements help determine the condition of the connective tissue and amount of gingival overgrowth or recession. PSR appears to be even more reliable than x-rays in diagnosing gum disease.

Testing Tooth Movement. Tooth mobility is determined by pushing each tooth between two instrument handles and observing any movement. Mobility is a strong indicator of bone support loss.

X-rays. X-rays are taken to show any loss of bone structure supporting the teeth. Eighteen x-rays make up the full mouth series necessary for diagnosis.

Treatment

Studies support the effectiveness of active treatment combined with a strict maintenance program for patients with periodontal disease. In one study, for example, people with periodontal disease who were inconsistent in caring for their gums after treatment had 5.6 times the risk for tooth loss as those who were very vigilant.

Some dentists have reported a success rate of 85% when professional treatment and good home maintenance are combined. Treatment helps nonsmokers more than smokers, particularly when pockets are deep and persistent. Some studies suggest that periodontal treatment in people with type 2 diabetes helps improve blood sugar levels. Whether treatment will help reduce other health risks, including heart attack and stroke, is unknown.

Treatment Goals. Once periodontal disease has been identified, the goals of treatment are:

To arrest and control the progress of the disease
To leave the periodontal tissues in an easily maintainable state
If possible, to restore the supporting structures, which include bone, gum tissue, and ligaments

Treatment Phases. To achieve these goals, there are various approaches:

Initial cleaning, scaling, and curettage
Surgery -- if needed for reducing deep pockets that remain underneath the gum after extensive cleaning sessions
Low-dose oral or topical antibiotics
Maintenance

After the active treatment is completed and the mouth is in a relative state of health, the patient should have regular cleanings lasting 45 minutes to 1 hour, approximately every 3 months. These may be done by the dental hygienist, the periodontist, or the general dentist. The patient may alternate between them. Home care, of course, must be continued.

Antibiotics Before Treatment. In cases where the individual has a mitral valve prolapse or history of rheumatic heart disease, pretreatment with an appropriate antibiotic is required before any dental work, including cleaning. This is necessary to prevent the possibility of bacterial endocarditis, which can be life threatening.

Scaling, polishing, and sometimes curettage are used to manage periodontal disease. They are usually accomplished in a series of three to four visits spaced about a week apart. (Patients might ask their dentist about the gas nitrous oxide, which is helpful for many patients and may reduce the visits to a single one.) The dental hygienist or practitioner generally uses both ultrasonic and manual instruments to remove calculus.

Calculus above the gum is easily seen. The dental professional usually detects calculus below the gum by careful probing with an instrument.
The hygienist or dentist may use an ultrasonic instrument for removal of the more accessible calculus. This probe-like device vibrates at a frequency range higher than is audible to the human ear. Some people with low tolerance for the ultrasonic probe may wish to request nitrous oxide.
A spray of water is used with ultrasound to prevent overheating and to flush out the debris that is dislodged.
The dental professional will scrape the plaque from above and below the gum line (called scaling). When the probe contacts the rock-like calculus, deposits fracture off the tooth fairly efficiently.
The hygienist or dentist will then smooth the rough spots on the tooth. Smoothing the surface helps remove bacteria that collect there (root planing) and also helps the gums reattach.
Polishing is the finishing procedure. It uses a rubber cup with an abrasive paste to remove plaque and stains on the crown portion of the tooth. It produces a smooth surface, making it temporarily harder for plaque to adhere.

After the cleaning procedure, the dentist will check the pocket depths around the teeth after the cleaning process has been completed. Further treatment needs are determined by the results of these initial sessions:

If the cleaning processes have reduced inflammation, observation only is needed.
If an abscess is present, surgery may be required.

Finally, the dental hygienist or practitioner should offer thorough instructions on home care to insure the removal of bacteria on a daily basis. This includes proper use of the toothbrush, paste, mouth rinses, floss, floss threaders, and proxabrushes. Home care can effectively eliminate the plaque above the gums and down to 2 mm below the gums.

Gingival curettage removes the soft tissue lining of the periodontal pockets in order to completely eliminate bacteria and diseased tissue. It may be used along with scaling and root planing, but achieves a deeper and more complete cleaning. Evidence indicates, however, that it does not contribute any additional benefits beyond simple scaling and planing.

Surgery allows access for deep cleaning of the root surface, removal of diseased tissue, and repositioning and shaping of the bones, gum, and tissues supporting the teeth. Surgical procedures vary depending on the individual diagnosis and needs of the patient. The basic procedure is known as open flap curettage. It involves:

The periodontal surgeon lifts, or flaps, the gums away from the tooth and surrounding bone.
The diseased root surfaces are cleaned and curetted (scraped) to remove deposits.
Gum tissue is replaced into positions to minimize pocket depth.
The periodontist may also contour the remaining bone and attempt to regenerate lost bone and gingival attachment through bone grafts and guided tissue regeneration or the use of enamel matrix protein derivatives.

There is some debate about whether this procedure is any more effective in preventing disease progression than non-surgical therapies, such as low-dose doxycycline, short-term antibiotics, or antibiotic gels. Some studies have reported that although surgical treatment reduced pocket depth more than non-surgical therapies for at least a year after the procedure, benefits from surgery do not persist beyond 5 years, except in very deep pockets.

Postsurgery Pain and Discomfort. Post-surgery discomfort is usually managed easily with over-the-counter medications such as ibuprofen. If discomfort is severe, stronger analgesics may be prescribed. Some patients experience sensitivity to hot or cold temperatures from exposed roots. These problems can be managed with topical fluoride treatments or, in severe cases, with dental restoration.

Guided Tissue Regeneration. A more advanced technique, called guided tissue regeneration, is used to stimulate bone and gum tissue growth:

First, the root surfaces and diseased bone are meticulously cleaned out. Preventing bacterial contamination is very important. The more residual bacteria, the greater the chance that the treatment will fail.
A specialized piece of fabric is sewn around the tooth to cover the crater in the bone left after the cleaning. It is either absorbable or nonabsorbable. (Some studies report highly beneficial results with new absorbable materials, including those coated with the antibiotic doxycycline.)
The gum is then sewn over the fabric. The fabric prevents the gum tissue from growing down into the bone defect and allows the bone and the attachment to the root to regenerate.
After 4 - 6 weeks, the nonabsorbable fabric must be removed using a minor surgical procedure. The absorbable membrane may be left in. In general, there is little difference in outcome between absorbable and nonabsorbable procedures. The absorbable fabric may not be as effective as standard grafts if gum tissue is thin, although newer materials may prove to produce better results.

Bone Grafting. In some cases of severe bone loss, the surgeon may attempt to encourage regrowth and restoration of bone tissue that has been lost through the disease process. This involves bone grafting:

The surgeon places bone graft material into the defect.
The material may be either bone from the same patient or a substance called decalcified freeze-dried bone allografts (DFDBA) which is obtained from a donor.
This material then stimulates new bone growth in the area.

Enamel Matrix Protein Derivative. Amelogenin is a derivative of a major protein in the structure (the matrix) of enamel that helps stimulate gum tissue growth. A gel containing amelogenin (Emdogain) is applied during surgery and forms a coat over the roots of the teeth. The gel itself dissolves after 2 days, leaving the active substance behind. Studies report that it is safe and may significantly reduce the effects of periodontal disease. One study suggested that the benefits, as indicated by bone attachment, can persist for at least 4 years. (Results were similar to guided tissue regeneration.)

Gum grafting techniques can also be very useful for improving the looks of the gum as well as adding support to the teeth. During this procedure, the periodontist takes gum tissue from the palate or another donor source to cover the exposed root in order to even the gum line and reduce sensitivity. Other procedures are available to improve the look of the gums and teeth. The gum line can be sculpted to improve uneven or excess gums and to cover exposed roots as gums recede.

Periodontists report that they are achieving great success with tooth implants in patients who have lost teeth due to periodontal disease. The average cost for a single implant is high, however, and one implant requires 5 - 7 months for completion.

Medications

Antibiotics are often used in combination with surgery, curettage, or alone to eliminate or prevent disease-causing bacteria after periodontal procedures. They are being investigated in oral forms as well as in topical forms that are applied directly to the gum. Increasingly, dental professionals are finding that local application of antibiotics is more effective than periodontal surgery alone. They may even prove to be an alternative to surgery.

Some experts are concerned, however, that long-term use of antibiotics increases the risk of bacterial resistance to these drugs, which is a growing health problem in general. Of some encouragement was a 2000 review, which indicated that low-dose antibiotics do not increase the risk of bacterial resistance. However, long-term studies are still needed

Antibiotics given orally and at standard doses have some limited applications for periodontal disease. They are typically given for an acute infection. Long-term use of antibiotics is advised for the control of juvenile periodontitis, refractory periodontitis, rapidly progressing periodontitis, and prepubertal periodontitis. Specific antibiotics used in periodontal disease include:

Tetracycline antibiotics -- which include tetracycline hydrochloride, doxycycline, and minocycline -- are the primary drugs used. They not only have anti-bacterial actions but also reduce inflammation and help block collagenase, the protein that destroys connective tissue and bone, even in low doses. In fact, these two actions seem to contribute most to periodontal protection, rather than their antibacterial properties. Short-term use of standard-dose doxycycline (a 10-day treatment) is used for treating acute periodontal infections and for eliminating inflammation. Topical application and long-term use of these antibiotics are showing particular promise.
Some macrolide antibiotics (roxithromycin) may have actions against inflammation and growth involved in periodontal disease.
Some quinolone antibiotics (moxifloxacin, ciprofloxacin) may specifically target A. actinomycetemcomitans, an important bacteria in periodontal disease.
Metronidazole (Flagyl) in combination with tetracycline or amoxicillin (a penicillin) may be used for severe and chronic periodontal disease.

There is growing bacterial resistance to many of these antibiotics, such as roxithromycin and metronidazole, therefore limiting their use in periodontal disease. One study indicated, however, that 3 months after antibiotic administration, the percentage of bacteria that could be eliminated with standard antibiotics returned to normal.

Topical application of antibiotics to the gum surface does not affect the entire body like oral antibiotics do, and they are preferred whenever possible. Studies suggest that, in combination with scaling and planing, any of these approaches are very effective for periodontal health.

Several different topical applications are showing promise, including:

Atridox is a doxycycline gel that conforms to the gum surface and then solidifies. Over the next few days, it releases the antibiotics.
Elyzol is a gel or strip applied to the gum that is composed of metronidazole. It has unique actions that are effective against parasites as well as bacteria. Studies suggest that Atridox, which contains doxycycline, may be more effective than Elyzol. (In one study, however, the doxycycline gel worked faster, but metronidazole achieved a greater bacterial reduction.)
PerioChip is a chip that is placed into the gum pocket after scaling. Over time, it slowly releases chlorhexidine, a powerful bacteria-killing antiseptic. Early studies report benefits in reducing pocket depths, but it is still not known whether these improvements are sustained.
Minocycline microspheres (Arestin) contain antibiotics in tiny capsules, which are applied to the gums after scaling and planing. Studies report that they are more effective in reducing pocket depth and bone loss than standard periodontal maintenance. Patients obtain these benefits regardless of their smoking status, age gender, or extent of the periodontal disease.
Actisite is a thin strip similar to dental floss, which is treated with tetracycline hydrochloride. The treated thread is temporarily inserted between the tooth and gum. (Using multiple strips may be more beneficial than using a single strip.) This was one of the first topical applications of antibiotics. Other topical approaches are being increasingly used.

Subantimicrobial Dose Doxycycline (Periostat). Subantimicrobial dose doxycycline (SDD) is a term used for a treatment that uses very low doses (20 mg) of doxycycline (Periostat). Although doxycycline is a tetracycline antibiotic, the doses used are too low to affect bacteria. However, at these dose levels, the drug blocks matrix metalloproteinases (MMPs) -- enzymes that destroy the connective tissues holding the teeth. Periostat is taken twice a day for months. There is some concern that such long-term use may pose a risk for the development of antibiotic-resistant bacteria or other, still unknown, adverse effects. The doses used in this treatment, however, are too low to have any effect on bacteria, so some experts believe this risk is very low. In fact, several 12-month studies report significant improvements in tooth attachment and pocket depth with no increased incidence of side effects. [Taking a common nonsteroidal anti-inflammatory drug, such as aspirin or ibuprofen (Advil) along with doxycycline, may enhance the effectiveness of this treatment.]

Chemically Modified Tetracyclines. Other tetracyclines are being developed that inhibit MMPs but have no antibiotic properties, which would, theoretically, avoid possible long-term problems with antibiotic resistance.

Other Treatments

Nonsteroidal Anti-inflammatory Drugs (NSAIDs). NSAIDs are drugs that block factors that cause inflammation and pain.

Over-the-counter NSAIDs include aspirin, ibuprofen (Motrin IB, Advil, Nuprin, Rufen), naproxen (Aleve), ketoprofen (Actron, Orudis KT).
Prescription NSAIDs include naproxen (Naprosyn, Anaprox), diclofenac (Voltaren), tolmetin (Tolectin), ketoprofen (Orudis, Oruvail), indomethacin (Indocin).

These drugs are used not only for relieving pain in periodontal disease but also for slowing the disease process. NSAIDs block inflammatory enzymes triggered by cytokines, which are important immune factors in periodontal disease. A number of NSAIDs have been investigated and have been shown to reduce gingivitis and slow progression of periodontal disease.

In one study, long-term use of oral flurbiprofen (Ansaid) resulted in significantly lower bone loss, although disease progression returned when the drug was stopped.

Investigators are also studying rinses, creams, and other topical forms of NSAIDs. For example, a cream containing ketoprofen appears to reduce bone loss. (Ketoprofen is of particular interest because it blocks not only COX-2 but also another pathway involved in the disease process.)

Warning about NSAIDs: Although NSAIDs work well, long-term use can cause stomach problems, such as ulcers and bleeding, and possible heart problems. In April 2005, the FDA asked drug manufacturers of NSAIDs to include a warning label on their product that alerts users of an increased risk for cardiovascular events and gastrointestinal bleeding.

Gels containing growth factors -- including substances called recombinant human (rh), platelet-derived growth factor-BB (PDGF-BB), and (rh) insulin-like growth factor-I (IGF-I) -- are showing promise for restoring bone.

Research is underway to find a vaccine against periodontal disease. To date, animal studies show promise, but an effective vaccine for people is years away.

Researchers are investigating the use of photodynamic therapy (PDT) as an alternative to antibiotic drugs. PDT destroys periodontal bacteria by applying photosensitive drugs to oral regions and exposing the drug-treated area to a light or laser. Research appears promising but is still in its preliminary stages.

Resources

www.nidcr.nih.gov -- National Institute of Dental and Craniofacial Research
www.perio.org -- American Academy of Periodontology
www.ada.org -- American Dental Association
www.aaoms.org -- American Association of Oral and Maxillofacial Surgeons

References

Amaliya , Timmerman MF, Abbas F, Loos BG, Van der Weijden GA, Van Winkelhoff AJ, et al. Java project on periodontal diseases: the relationship between vitamin C and the severity of periodontitis. J Clin Periodontol. 2007 Apr;34(4):299-304.

de Oliveira RR, Schwartz-Filho HO, Novaes AB Jr, Taba M Jr. Antimicrobial photodynamic therapy in the non-surgical treatment of aggressive periodontitis: a preliminary randomized controlled clinical study. J Periodontol. 2007 Jun;78(6):965-73.

Kolahi J, Soolari A. Rinsing with chlorhexidine gluconate solution after brushing and flossing teeth: a systematic review of effectiveness. Quintessence Int. 2006 Sep;37(:605-12.

Persson GR, Yeates J, Persson RE, Hirschi-Imfeld R, Weibel M, Kiyak HA. The impact of a low-frequency chlorhexidine rinsing schedule on the subgingival microbiota (the TEETH clinical trial). J Periodontol. 2007 Sep;78(9):1751-8.

Staudte H, Sigusch BW, Glockmann E. Grapefruit consumption improves vitamin C status in periodontitis patients. Br Dent J. 2005 Aug 27;199(4):213-7, discussion 210.

Review Date:
1/26/2008
Reviewed By:
Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

A.D.A.M. Copyright

adam.com

Dry hair

admin — Thu, 04 Sep 2008 19:07:47 -0700

Overview

Alternative Names
Considerations
Common Causes
Home Care
Call your health care provider if
What to expect at your health care provider's office

Illustrations

Skin layers

HEALTH GUIDE REFERENCE FROM A.D.A.M

Alternative Names

Hair - dry

Considerations

Dry hair is hair that does not have enough moisture and oil to maintain its normal sheen and texture.

Dry hair may result from too much washing, harsh detergents, a dry environment, inadequate diet, or underlying conditions, such as those due to malnutrition. (For example, kwashiorkor)

Dry, brittle hair may be a symptom of metabolic diseases such as hypothyroidism and Menkes kinky hair syndrome.

Common Causes

Excessive washing, harsh detergents or alcohols, excessive blow-drying
Environmental dryness
Anorexia nervosa
Malnutrition
Hypothyroidism
Hypoparathyroidism

Home Care

Shampoo less frequently -- perhaps only once or twice a week
Add conditioners
Avoid blow drying and harsh styling products

Call your health care provider if

Call your health care provider if:

Your hair does not improve with gentle treatment
You have hair loss
You have any other unexplained symptoms

What to expect at your health care provider's office

Your doctor will perform a physical examination and may ask the following questions:

Has your hair always been slightly dry?
When did the unusual hair dryness first start?
Is it always present, or is it off and on?
What are your eating habits?
What kind of shampoo is used?
How often do you wash your hair?
Do you use a conditioner? What type?
How do you normally style the hair?
Do you use a hair dryer? What type? How often?
What other symptoms are also present?

Diagnostic tests that may be performed include:

Examination of the hair under the microscope
Blood tests

Review Date: 10/13/2006

Reviewed By: Kevin Berman, MD, PhD, Associate, Atlanta Center for Dermatologic Disease, Atlanta, GA. Review provided by VeriMed Healthcare Network.

A.D.A.M. Copyright

adam.com

Source Doc: 1_003245

Rashes

admin — Thu, 04 Sep 2008 19:07:30 -0700

HEALTH GUIDE REFERENCE FROM A.D.A.M

Definition

Rashes involve changes in the color or texture of your skin.

Alternative Names

Skin redness or inflammation; Skin lesion; Rubor; Skin rash; Erythema

Considerations

Often, the cause of a rash can be determined from its visible characteristics and other symptoms.

Common Causes

A simple rash is called dermatitis, meaning inflammation of the skin. Contact dermatitis is caused by things your skin touches, such as:

Chemicals in elastic, latex, and rubber products
Cosmetics, soaps, and detergents
Dyes and other chemicals in clothing
Poison ivy, oak, or sumac

Seborrheic dermatitis is a rash that appears in patches of redness and scaling around the eyebrows, eyelids, mouth, nose, the trunk, and behind the ears. If it happens on your scalp, it is called dandruff in adults and cradle cap in infants.

Age, stress, fatigue, weather extremes, oily skin, infrequent shampooing, and alcohol-based lotions aggravate this harmless but bothersome condition.

Other common causes of a rash include:

Eczema (atopic dermatitis) -- tends to happen in people with allergies or asthma. The rash is generally red, itchy, and scaly.
Psoriasis -- tends to occur as red, scaly, itchy patches over joints and along the scalp. Fingernails may be affected.
Impetigo -- common in children, this infection is from bacteria that live in the top layers of the skin. Appears as red sores that turn into blisters, ooze, then crust over.
Shingles -- a painful blistered skin condition caused by the same virus as chickenpox. The virus can lie dormant in your body for many years and re-emerge as shingles.
Childhood illnesses such as chicken pox, measles, roseola, rubella, hand-foot-mouth disease, fifth disease, and scarlet fever.
Medications and insect bites or stings.

Many medical conditions can cause a rash as well. For example:

Lupus erythematosus
Rheumatoid arthritis, especially the juvenile type
Kawasaki disease

Home Care

Most simple rashes will improve with gentle skin care and avoiding irritating substances. Follow these general guidelines:

Avoid scrubbing your skin.
Use as little soap as possible. Use gentle cleansers instead.
Avoid applying cosmetic lotions or ointments directly on the rash.
Use warm (not hot) water for cleaning. Pat dry, don't rub.
Eliminate any newly added cosmetics or lotions.
Leave the affected area exposed to the air as much as possible.
Try calamine medicated lotion for poison ivy, oak, or sumac as well as other types of contact dermatitis.

Hydrocortisone cream (1%) is available without a prescription and may soothe many rashes. If you have eczema, apply moisturizers over your skin. Try oatmeal bath products, available at drugstores, to relieve symptoms of eczema, psoriasis, or shingles.

For psoriasis, you may need a prescription. You could also talk to your doctor about ultraviolet (UV) light therapy. It is safest to have such treatment under medical supervision. However, not all clinics or hospitals offer light therapy. Home units are available, but the cost is not always covered by insurance. If you do purchase a home unit, look for a device that delivers narrow band UVB light.

For seborrheic dermatitis, try applying small amounts of anti-dandruff shampoo to patches of this scaly rash on your skin, especially near hairy areas like your eyebrows. Leave on for 10 minutes and then carefully rinse off. If the shampoo feels irritating or your skin becomes redder, STOP use.

For impetigo, an antibacterial cream or oral antibiotic is generally prescribed.

See article on poison ivy, oak, and sumac to learn how to treat and prevent this type of contact dermatitis.

Call your health care provider if

Call 911 if:

You are short of breath, your throat is tight, or your face is swollen
Your child has a purple rash that looks like a bruise

Call your health care provider if:

You have joint pain, fever, or a sore throat
You have streaks of redness, swelling, or very tender areas as these may indicate an infection
You are taking a new medication -- DO NOT change or stop any of your medications without talking to your doctor
You may have a tick bite
Home treatment doesn't work, or your symptoms get worse

What to expect at your health care provider's office

Your doctor will perform a physical examination. He or she will ask questions about your medical conditions, medications, health problems that run in your family, and recent illnesses or exposures. Questions may include:

When did the rash begin?
What parts of your body are affected?
Does anything make the rash better? Worse?
Have you used any new soaps, detergents, lotions, or cosmetics recently?
Have you been in any wooded areas recently?
Have you had any change in your medications?
Have you noticed a tick or insect bite?
Have you eaten anything unusual of late?
Do you have any other symptoms like itching or scaling?
What are your underlying medical problems? Do you have, for example, asthma or allergies?

Tests may include:

Allergy testing
Blood tests
Skin biopsy
Skin scrapings

Depending on the cause of your rash, treatments may include medicated creams or lotions, medications taken by mouth, or skin surgery.

Many primary care doctors are comfortable dealing with common rashes, but for more complicated skin disorders, a referral to a dermatologist may be necessary.

Prevention

Identify and then stay away from products that irritate your skin. If allergies are suspected, your doctor may want to consider skin testing.
Receive appropriate vaccines for childhood illnesses, like the varicella vaccine for chicken pox and MMR immunization (a combination vaccine that protects against measles, mumps, and rubella).
Get strep throat treated right away to prevent scarlet fever.
Wash your hands frequently to prevent spreading viruses like roseola, hand-foot-mouth disease, and fifth disease.
Learn relaxation methods like yoga, meditation, or tai chi. Stress aggravates many rashes, including eczema, psoriasis, and seborrheic dermatitis.

References

Auerback PS, ed. Wilderness Medicine. St. Louis, Mo: Mosby; 2001.

Marx J. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 5th ed. St. Louis, Mo: Mosby; 2002.

Review Date: 7/18/2007

Reviewed By: Kevin Berman, MD, PhD, Associate, Atlanta Center for Dermatologic Disease, Atlanta, GA. Review provided by VeriMed Healthcare Network.

A.D.A.M. Copyright

adam.com

Source Doc: 1_003220

Vulvitis

admin — Thu, 04 Sep 2008 18:46:04 -0700

Overview

Definition
Causes, incidence, and risk factors
Symptoms
Signs and tests
Treatment
Expectations (prognosis)
Complications
Calling your health care provider
Prevention

HEALTH GUIDE REFERENCE FROM A.D.A.M

Definition

Vulvitis is inflammation of the external female genitalia (vulva).

Causes, incidence, and risk factors

Vulvitis can be caused by a number of conditions. These include chronic dermatitis, seborrhea or eczema, and allergies, particularly to soaps, colored toilet paper, vaginal sprays, laundry detergents, bubble bath, or fragrances. It can also be caused by infections such as fungal and bacterial infections, pediculosis, or scabies.

Vulvitis can affect women of all ages. In young girls and postmenopausal women, the condition may be caused by low estrogen levels.

Symptoms

Redness and swelling of the vulvar skin
Burning or itching of the vulvar skin
Thickening of the vulvar skin
Possible small cracks in the vulvar skin
Possible vaginal discharge

Signs and tests

A pelvic examination often reveals redness and thickening and may reveal cracks or skin lesions on the vulva.

If there is any vaginal discharge, a wet prep inspection may reveal vaginal infection such as vulvovaginitis or vaginitis as the source.

Treatment

Discontinue the use of any potential irritants. An over-the-counter cortisone cream may be used two or three times a day on the affected area for up to 1 week. If these measures do not relieve symptoms, see your health care provider.

If discharge from a vaginal infection is the cause of vulvitis, the source of the vaginal infection should be treated. Cortisone cream may be used to decrease vulvar itching.

If treatment of vulvitis does not work, further evaluation may include biopsy of the skin to rule out the potential of vulvar dystrophy (a chronic vulvar skin condition) or vulvar dysplasia, a precancerous condition. A biopsy may also be necessary if any skin lesions are present.

Expectations (prognosis)

Itching may be hard to control, but after the cause is identified and treated, it should go away in several weeks.

Complications

Itching of the vulva may be a sign of genital warts (HPV - human papilloma virus), vulvar dystrophy, or vulvar dysplasia (a precancerous condition).

Sexually transmitted diseases (STDs), which can cause vulvitis, may lead to other problems, such as infertily. STDs should be treated appropriately.

Calling your health care provider

Call for an appointment with your health care provider if symptoms occur and do not respond to self care measures, or if vaginal discharge accompanies the symptoms. Also call if skin lesions are noted on the vulva.

Prevention

Since one of the main causes of vulvitis is exposure of the vulva to chemicals (bubble bath, douches, detergents, fabric softeners, perfumes, etc.), or other irritating materials (wool, fibrous, or "itchy" materials), daily cleansing with mild soap, adequate rinsing, and thorough drying of the genital area is one of the best ways to avoid it. Also, avoid using feminine hygiene sprays, fragrances, or powders in the genital area.

Avoid wearing extremely tight-fitting pants or shorts, which may cause irritation by constantly rubbing against the skin and by holding in heat and restricting air circulation. Underwear made of silk or nylon is not very absorbant and also restricts air circulation. This can increase sweating in the genital area, which can cause irritation and may provide a more welcoming environment for infectious organisms.

Wearing cotton underwear or pantyhose that have a cotton crotch allow better air circulation and can decrease the amount of moisture in the area. For the above-mentioned reasons, you should also avoid wearing sweaty exercise clothing for prolonged periods. Not wearing underwear while sleeping will also allow more air circulation.

Those infections that may be spread by intimate or sexual contact may be prevented or minimized by practicing abstinence or using safer sexual behaviors, especially condom use.

Review Date: 11/8/2006

Reviewed By: Audra Robertson, MD, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA. Review provided by VeriMed Healthcare Network.

A.D.A.M. Copyright

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Contact dermatitis

admin — Wed, 03 Sep 2008 17:52:39 -0700

HEALTH GUIDE REFERENCE FROM A.D.A.M

Definition

Contact dermatitis is an inflammation of the skin caused by direct contact with an irritating substance.

Alternative Names

Dermatitis - contact; Allergic dermatitis; Dermatitis - allergic; Poison ivy; Poison oak; Poison sumac

Causes, incidence, and risk factors

Contact dermatitis is an inflammation of the skin caused by direct contact with an irritating or allergy-causing substance (irritant or allergen). Reactions may vary in the same person over time. A history of any type of allergies increases the risk for this condition.

Irritant dermatitis, the most common type of contact dermatitis, involves inflammation resulting from contact with acids, alkaline materials such as soaps and detergents, solvents, or other chemicals. The reaction usually resembles a burn.

Allergic contact dermatitis, the second most common type of contact dermatitis, is caused by exposure to a substance or material to which you have become extra sensitive or allergic. The allergic reaction is often delayed, with the rash appearning 24-48 hours after exposure. The skin inflammation varies from mild irritation and redness to open sores, depending on the type of irritant, the body part affected, and your sensitivity.

Overtreatment dermatitis is a form of contact dermatitis that occurs when treatment for another skin disorder causes irritation.

Common allergens associated with contact dermatitis include:

Poison ivy, poison oak, poison sumac
Other plants
Nickel or other metals
Medications
- Antibiotics, especially those applied to the surface of the skin (topical)
- Topical anesthetics
- Other medications
Rubber
Cosmetics
Fabrics and clothing
Detergents
Solvents
Adhesives
Fragrances, perfumes
Other chemicals and substances

Contact dermatitis may involve a reaction to a substance that you are exposed to, or use repeatedly. Although there may be no initial reaction, regular use (for example, nail polish remover, preservatives in contact lens solutions, or repeated contact with metals in earring posts and the metal backs of watches) can eventually cause cause sensitivity and reaction to the product.

Some products cause a reaction only when they contact the skin and are exposed to sunlight (photosensitivity). These include shaving lotions, sunscreens, sulfa ointments, some perfumes, coal tar products, and oil from the skin of a lime. A few airborne allergens, such as ragweed or insecticide spray, can cause contact dermatitis.

Symptoms

Itching (pruritus) of the skin in exposed areas
Skin redness or inflammation in the exposed area
Tenderness of the skin in the exposed area
Localized swelling of the skin
Warmth of the exposed area (may occur)
Skin lesion or rash at the site of exposure
- Lesions of any type: redness, rash, papules (pimple-like), vesicles, and bullae (blisters)
- May involve oozing, draining, or crusting
- May become scaly, raw, or thickened

Signs and tests

The diagnosis is primarily based on the skin appearance and a history of exposure to an irritant or an allergen.

According to the American Academy of Allergy, Asthma, and Immunology, "Patch testing is the gold standard for contact allergen identification." Allergy testing with skin patches may isolate the suspected allergen that is causing the reaction.

Patch testing is used for patients who have chronic, recurring contact dermatitis. It requires three office visits and must be done by a clinician with detailed experience in the procedures and interpretation of results. On the first visit, small patches of potential allergens are applied to the skin. These patches are removed 48 hours later to see if a reaction has occurred. A third visit approximately 2 days later is to evaluate for any delayed reaction. You should bring suspected materials with you, especially if you have already tested those materials on a small area of your skin and noticed a reaction.

Other tests may be used to rule out other possible causes, including skin lesion biopsy or culture of the skin lesion (see skin or mucosal biopsy culture).

Treatment

Initial treatment includes thorough washing with lots of water to remove any trace of the irritant that may remain on the skin. You should avoid further exposure to known irritants or allergens.

In some cases, the best treatment is to do nothing to the area.

Corticosteroid skin creams or ointments may reduce inflammation. Carefully follow the instructions when using these creams, because overuse, even of low-strength over-the-counter products, may cause a troublesome skin condition. In severe cases, systemic corticosteroids may be needed to reduce inflammation. These are usually tapered gradually over about 12 days to prevent recurrence of the rash. In addition to or instead of corticosteroid skin treatment, your doctor may prescribe tacrolimus ointment or pimecrolimus cream.

Wet dressings and soothing anti-itch (antipruritic) or drying lotions may be recommended to reduce other symptoms.

Expectations (prognosis)

Contact dermatitis usually clears up without complications within 2 or 3 weeks, but may return if the substance or material that caused it cannot be identified or avoided. A change of occupation or occupational habits may be necessary if the disorder is caused by occupational exposure.

Complications

Secondary bacterial skin infections may occur.

Calling your health care provider

Call your health care provider if symptoms indicate contact dermatitis and it is severe or there is no improvement after treatment.

Prevention

Avoid contact with known allergens. Use protective gloves or other barriers if contact with substances is likely or unavoidable. Wash skin surfaces thoroughly after contact with substances. Avoid overtreating skin disorders.

References

Noble J. Textbook of Primary Care Medicine. 3rd ed. St. Louis, Mo: Mosby; 2001:766-769.

Habif TP. Clinical Dermatology. 4th ed. St. Louis, Mo: Mosby, Inc. 2004:81.

Review Date: 2/5/2008

Reviewed By: Kevin Berman, MD, PhD, Associate, Atlanta Center for Dermatologic Disease, Atlanta, GA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

A.D.A.M. Copyright

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