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April 5, 2012 — Previous studies have speculated that there may be an association between edentulism and worsening obstructive sleep apnea (OSA), but research presented at the recent American Association for Dental Research annual meeting did not find a link.

“We came across some papers stating that individuals who slept in their complete dentures had an improvement in their OSA,” study author Jeff Tanner, DDS, an oral and maxillofacial surgery resident at the University of California Los Angeles (UCLA), told “Their assumption was that tooth loss/edentulism contributes at least in part to the worsening of OSA.”

When people become edentulous, several physiological changes take place, Dr. Tanner noted. For example, the vertical dimension of occlusion reduces, the tongue grows larger because of the space that is no longer occupied by teeth, the position of the tongue changes, and the tongue rests in a different position.

Since no prior study has ever examined whether or not tooth loss per se was a predictor of OSA, the researchers decided to investigate this connection.

“When we became interested in this topic we found that there were several publications that had dealt with this issue, but not so directly,” he said during the session.

VA health system data

Dr. Tanner and his colleagues hypothesized that people with fewer teeth — especially those who are edentulous — have more serious OSA after controlling for age and body mass index (BMI), which are known predictors of OSA.

“This connection would be huge.”
— Jeff Tanner, DDS

They conducted a retrospective chart review of patients from the greater Los Angeles U.S. Department of Veterans Affairs (VA) health system who were referred to the dental service for treatment of OSA. The researchers looked at the electronic medical records of 210 male veterans who had already undergone a sleep study at the VA hospital and were able to collect the age and BMI of these patients. The researches also used an apnea-hypopnea index to classify the severity of the patients’ OSA.

They then used panoramic radiographs to quantify teeth using three different methods: total teeth lost, mandibular teeth lost, and posterior dental functional units lost.

Here are the key results:

  • Of the 210 subjects, 25.5% had not lost any teeth, 36.6% lost one to five teeth, 20.8% lost six to 16 teeth, and 17.1% lost more than 16 teeth.
  • 30% of the individuals had mild OSA, 36% moderate OSA, and 34% severe OSA.
  • The bivariate association between the number of dentition present and severity of OSA showed no significance.
  • In multivariate analysis, age and BMI were significant predictors of OSA severity, while total teeth loss was not significant

“The degree of tooth loss is not associated with OSA severity,” the authors concluded. “Tooth loss does not worsen OSA. ”

More research needed

OSA is difficult to understand because of the causative factors, Dr. Tanner

Age and obesity are proven predictors so the study controlled for those variables; however, the authors were still not able to prove that tooth loss predicted a worsening of OSA, he noted.

This line of research could be improved by obtaining a sleep study on the same individual prior to edentulism, after edentulism, and wearing complete dentures, Dr. Tanner added.

“Only by conducting this type of study will we be able to be certain to state whether or not tooth loss predicts OSA,” he said. “If in the future it could be stated that edentulism worsens OSA, it would be a strong case for dentists to attempt to restore patients back to a dentate state with implants which maintain alveolar ridge height unlike dentures.”

Given that OSA is an epidemic that is just now catching the public’s attention, “This connection would be huge, as that type of treatment would be medically driven dentistry, possibly covered by medical insurance,” he concluded.


Dr. Jeffrey Tanner

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Once in the bloodstream, it can evade the immune system
MONDAY, March 26 (HealthDay News) — A type of buy canadian topamax from the mouth can cause blood clots and lead to serious heart problems if it enters the bloodstream, a new study indicates.

The bacteria, called Streptococcus gordonii, contributes to plaque that forms on the surface of teeth. If the bacteria enters the bloodstream through bleeding gums, it can cause problems by masquerading as human proteins, the researchers found.

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The study authors, from the Royal College of Surgeons in Ireland and the University of Bristol in the United Kingdom, discovered that S. gordonii can produce a molecule on its surface that enables it to mimic the human protein fibrinogen, which is a blood-clotting factor.

This activates platelets (cells that are found in blood and involved in clotting) and causes them to clump inside blood vessels. The resulting blood clots encase the bacteria, protecting the invader from the immune system and from antibiotics used to treat infection.

Platelet clumping can result in growths on the heart valves (endocarditis) or blood vessel inflammation that can block blood supply to the heart or brain.

The findings, to be presented at a Society for General Microbiology meeting in Dublin this week, could help lead to new treatments for infective endocarditis, said study author Dr. Helen Petersen.

“In the development of infective endocarditis, a crucial step is the bacteria sticking to the heart valve and then activating platelets to form a clot,” Petersen said in a society news release. “We are now looking at the mechanism behind this sequence of events in the hope that we can develop new drugs which are needed to prevent blood clots and also infective endocarditis.”

The researchers stressed that it’s important to keep the gumswhere can you buy topamax and get regular dental care.

“We are also trying to determine how widespread this phenomenon is by studying other bacteria related to S. gordonii,” Petersen said. “What our work clearly shows is how important it is to keep your mouth healthy through regular brushing and flossing, to keep these bacteria in check.”

The U.S. National Heart, Lung, and Blood Institute has more about buy topamax canada.


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Poor brushing techniques, poor diet, and lack of tooth cleanings can result in tooth loss.

Patients commonly explain that “bad teeth run in the family.” The implied message is that they themselves are not to blame for the state of their mouths. While genetics obviously plays a role in determining the likelihood of developing all sorts of health problems, so do a person’s habitual patterns of behavior.

My grandmother wore two full dentures by the time she was middle age and both of my parents lost about half their teeth by the time they were senior citizens. I myself, although in my 50’s, have not lost a single tooth. Why?

Although I do not know for sure, I believe the choices they made and their lack of a good dental IQ are the reasons for their extensive tooth loss. All three were chain smokers for most of their adult lives and I do not believe any of them took good care of their teeth until it was too late. Poor brushing techniques, poor diet, lack of frequent tooth cleanings, and nicotine from cigarettes probably were responsible for their tooth loss. All eventually developed adult onset diabetes, which compounded their tooth problems.

Although I am far from perfect, I do not smoke, I brush regularly with an electric tooth brush, floss and get regular cleanings. These habits are most likely responsible for over coming any “genetic predisposition” that might lead to tooth loss.
— by Dr. L . Spindel DDS
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