A Committed Battle to Save Teeth From Disease

Gum disease is a major cause of tooth loss in adults, and many people don’t realize they have it until their dentist tells them they need gum surgery, or worse, that a tooth must be pulled. Bacteria-laden plaque is the cause, and when the infection is advanced, the tissues and bone that hold the tooth in place are damaged. Once periodontal disease reaches this stage, it was thought to be irreversible.

Over the past several years, however, studies have found that mechanically removing plaque from around the roots of the affected tooth followed by antimicrobial treatment may save it.

Researchers at the University of Michigan School of Dentistry have been testing this nonsurgical approach for 20 years. What they didn’t know for certain was whether the technique provided temporary or lasting benefits. Their most recent study, published in the Journal of the American Dental Assn., found that the conservative treatment worked for many of those who were still available for evaluation five years later.

The researchers followed a group of patients who had initially been treated with debridement--removal of plaque and tartar from the roots of affected teeth--three times or less within three months. Twice, following the root-cleaning treatment, which is sometimes called “scaling and root planing,” they received a short course of oral antimicrobial therapy with metronidazole (Flagyl), doxycycline or a placebo. There was a 93% reduction in the need for periodontal surgery, and 66% of teeth that would have been extracted were saved. There was no difference between the two drugs.

Over the next several years, the patients were supposed to have scaling and root planing every three or four months. After the first and second year, they also were given a week’s supply of metronidazole or a placebo. One group received no drug. But the patients’ compliance was erratic. Some returned for treatment only 11 times. At best, patients were seen 29 times.

After five years, the researchers found the nonsurgical treatment benefits were sustained. Among the 44 people who were still available for evaluation, there was, on average, less than one tooth per person needing surgery or extraction. That compared to the initial recommendation of 8.7 teeth per person needing treatment. Those who had taken the follow-up treatments of metronidazole were significantly less likely to need surgery during the years of the study.

Sticking with a regular program of scaling and root planing might be the hardest part. After five years, about half of the original 90 people were available for evaluation.

“In any long-term study, it’s not surprising to lose about 10% of the study subjects each year,” says Walter J. Loesche of the University of Michigan School of Dentistry in Ann Arbor. It may be that those who stayed with the program had more incentive, he says. They had an average of nearly 10 teeth in danger.

Regular maintenance is a necessity if scaling and root planing alone are to succeed, says Michael Lynch, director of scientific information at the American Dental Assn. Another gem in the study, says Lynch, is the discovery that the benefits of the nonsurgical treatment were always tempered by smoking.

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Acupuncture’s Effect on Morning Sickness

At least half of pregnant women have morning sickness, and for many it can last all day. Nibbling on dry crackers and drinking herb tea may help, but waiting weeks or months for it to pass can be frustrating. For severe morning sickness, antinausea medications may be needed.

Now, an Australian study concludes that acupuncture, “especially the traditional Chinese type,” brings relief quickly. Researchers have tried to evaluate benefits of acupuncture before, but this is the largest study done in a scientific manner. It compared two acupuncture techniques to sham acupuncture--that is, needles placed in unrelated points--and no acupuncture.

Nearly 600 women less than 14 weeks along in a healthy pregnancy, except for the nausea, were divided into groups for the four-week study. Twice the first week and then weekly, one group received traditional acupuncture, according to their individual Chinese medicine diagnosis, with six needles or fewer. Another group received acupuncture to only one point on the forearm believed to relieve nausea. Those in the fake or sham group got needles in areas close to the traditional acupuncture points. The fourth group got no acupuncture but lots of advice on diet, using vitamin B6 and lifestyle.

At the end of the first week, those in the traditional acupuncture group had less frequent bouts of nausea and dry retching, report the researchers in the U.S. journal Birth. By the second week, those in the single needle group were starting to feel better. By the third week, some mothers-to-be in the sham group had less nausea than those who got no acupuncture, indicating that there may be a placebo benefit for some women. The researchers report that improvement continued over time, especially for those who received traditional acupuncture. Vomiting, however, was a persistent symptom in all the women who had it.

The researchers speculate that more frequent treatment might be needed in women whose nausea is accompanied by vomiting. Edna Bates, a spokeswoman for Women’s and Children’s Hospital in Adelaide, said the research “provides women with an additional option to manage their morning sickness without resorting to pharmacological agents.”

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Sound-Wave Therapy Shows Promise Against Heel Pain

The pain of plantar faciitis is unmistakable. It stabs at the bottom of the heel the minute your foot hits the floor in the morning. The tenderness usually improves as the tissue that supports the underside of the foot stretches, but any activity that creates an impact, like running to cross the street, may still be extremely painful.

Plantar faciitis is an inflammation of the thick connective tissue that extends beneath the foot, fanning out from the heel to the toes. Until recently, surgery was the last resort when stretching, heel cushions, foot taping and pain pills failed. Now, your foot doctor might suggest sound wave therapy.

One device, the Ossa Tron, was approved more than a year ago, and in January the Food and Drug Administration approved the Epos Ultra. The FDA says both of the approved devices are only for people who have had plantar faciitis that has persisted despite standard treatment for at least six months.

According to John A. Ogden, president of the International Society for Musculoskeletal Shock Wave Therapy, there are about six devices available in the Los Angeles area. A single treatment costs about $3,000 to $3,500, which is not yet covered by most insurance carriers.

The therapy works by bombarding the tough, dry, connective tissue under the foot with rapid-fire sound waves. The energy from the sound waves breaks up the tissue, creating little tunnels through which new blood vessels can grow, explains Ogden, who is also director of Orthopedics at the Atlanta Medical Center. After healing is complete, the tissue has a much improved blood supply and becomes more elastic. The therapy is easier on patients than surgery, which only works about half the time.

“You walk in, have the treatment, and walk out,” Ogden says. No crutches, no long healing period, no staying off the foot, except for avoiding vigorous pounding activity for about a month. Treatment is effective in about 60% of cases; about a third of those need two treatments, he says.

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Dianne Partie Lange can be reached by e-mail at DianneLange@cs.com.