Good oral health is essential in people with sickle cell anemia (SCA), according to a new study from Saudi Arabia that found that several disease-causing bacteria species — including Enterobacteriaceae — were significantly more abundant in a group of patients with poorer dental health than in those with better oral care.
“A healthy mouth has a balance of bacteria, but inadequate oral health narrows the range of bacteria, resulting in oral dysbiosis, a state in which beneficial bacteria decrease and potentially pathogenic [disease-causing] bacteria increase,” the researchers wrote.
The findings also indicated that patients with low levels of hemoglobin F — a type of hemoglobin normally produced during fetal development — had a significantly higher prevalence of harmful bacteria species than those who had higher levels of the protein.
“Our data further emphasise the importance of routine oral hygiene visits for patients with SCA,” the team wrote, adding, “This is especially important for patients with SCA and low [hemoglobin F], who have a higher probability of hospitalisation and clinical complications compared to patients with SCA and high [hemoglobin F].”
Sickle cell disease (SCD) is caused by mutations in the HBB gene that lead to the production of a faulty version of hemoglobin, the protein in red blood cells that is responsible for carrying oxygen through the body. This faulty version is called hemoglobin S.
People with sickle cell anemia or SCA, the most common and often the most severe form of SCD, have two faulty gene copies encoding hemoglobin S.
Complications of dental caries or tooth decay, including acute pain, are often observed in patients with SCA — and have been associated with poor quality of life.
In a healthy mouth, different bacteria species co-exist in a balanced ratio. However, in cases of inadequate oral health, the number of beneficial bacteria decreases, while that of potentially harmful ones increases. This can lead to dental caries, which often result in cavities and other oral health problems.
“Although ample evidence indicates a causative correlation between the disruption of the oral [bacteria] and dental caries, the effect in SCA has not been investigated,” the researchers wrote.
Now, a team from the Netherlands and Saudi Arabia conducted a study to examine oral bacteria composition in people with SCA. Their aim was to compare bacteria species in patients with a high decayed, missing, and filled permanent teeth (DMTF) index — a measure of dental health — compared with others who had a low index.
In addition, they evaluated the effect of hemoglobin F levels on bacterial composition by comparing the profiles of patients with low and high levels of the protein. Fetal hemoglobin or hemoglobin F is considered a major modulator of disease severity in SCA.
This type of hemoglobin normally is found in fetuses and newborn babies, but is typically replaced by another hemoglobin variant after birth. However, hemoglobin F is more effective at transporting oxygen than its adult counterpart, and may, therefore, help to counteract the harmful effects of hemoglobin S on blood flow and oxygen transport.
In some individuals, the levels of hemoglobin F remain relatively high during childhood, and only start to decline later on in life, rather than immediately after birth.
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High levels of Enterobacteriaceae bacteria found
This new study was conducted in the Eastern Province of Saudi Arabia, where the disease is highly prevalent. It included 100 patients, ages 5–12, from whom saliva was collected.
Among the patients, 27 had high dental caries — reflected by a high DMTF index of five points or more — and 73 had low dental caries, indicated by a low DMTF index of four points or fewer.
The research team identified 416 bacteria species in the patients’ samples. When analyzing their prevalence, seven were found to be significantly more abundant in patients with a high DMTF index than in those with a low index.
In addition, eight bacteria species were found to be significantly more prevalent in patients with low hemoglobin F levels compared with those with high levels of the protein.
In particular, the Enterobacteriaceae bacteria species, which have been associated with severe infections and high rates of antibiotic resistance, were found in great abundance in both patient groups, being the most significantly abundant bacteria species among those with low levels of hemoglobin F.
“It has been suggested that the presence of the Enterobacteriaceae species in the oral cavity is favoured when an individual’s immunity is compromised,” the researchers wrote, adding that “patients with SCA are immunocompromised.”
Overall, these findings indicate that Saudi SCA patients with poorer dental health and low levels of hemoglobin F have a higher predominance of harmful bacteria in their mouth.
Our data further emphasise the importance of routine oral hygiene visits for patients with SCA.
“Our results provide a valuable addition to the global microbiome reference data set in an underexamined community,” the researchers wrote, adding, “These efforts are essential and warranted given the scarcity of [bacteria composition] data in Middle Eastern populations.”
Nevertheless, a study with a large sample size evaluating how oral bacterial species can relate to dental caries in SCA patients is required, the team noted.
The researchers said their findings indicate the important of good dental health in people with sickle cell anemia, given that the bacteria species otherwise found “are thought to drive the development and progression of dental caries.”
New Brunswick‘s Liberal and Green parties are set to make announcements about health care on the campaign trail today as the provincial election race enters its second half.
Liberal leader Susan Holt is scheduled to hold her announcement this morning in Saint John, N.B., followed by lunch at the city’s market.
A spokesperson with the Progressive Conservative party shared few details about the event scheduled for leader Blaine Higgs in Fredericton this morning.
Green Party Leader David Coon will hold a news conference this morning about “local health-care decision-making” alongside deputy leader Megan Mitton in her Sackville, N.B. riding.
On Saturday, Coon said he was proud to put forward a gender-balanced slate among the party’s 46 candidates.
While the Liberals and Progressive Conservatives are running with full slates, the Greens are three candidates short and will not have full representation when the province’s residents go to the polls on Oct. 21.
This report by The Canadian Press was first published Oct. 7, 2024.
EDMONTON – The Health Quality Council of Alberta is investigating how some medical referrals weren’t properly processed, potentially affecting 14,000 patients over the last five years across the province.
The referrals were made to specialists outside of Alberta Health Services, such as physiotherapists and dietitians.
The health authority’s CEO, Athana Mentzelopoulos, says it does an average 100,000 referrals per year, but in some cases it can’t confirm if patients received referral services.
She says the problem was flagged in late September, and a preliminary estimate suggests 31 patients may have experienced a potential negative outcome due to the delays.
The provincial government requested the investigation, and the quality council is to find out how the snag occurred and how it can be prevented in the future.
The health authority says it has begun notifying patients who may have been affected by the disruption, and the cases could date back to 2019.
This report by The Canadian Press was first published Oct. 4, 2024.
WASHINGTON (AP) — If you have stained or chipped teeth, you might be considering veneers, customized teeth coverings that can restore a photogenic smile without more extensive dental work.
But dentists warn that these pricey cosmetic enhancements are at the center of a worrisome online trend: unlicensed practitioners without proper training or supervision offering low-cost veneers.
These self-described “veneer techs” often promote themselves on Instagram and TikTok, promising a full set of veneers for less than half of what dentists typically charge. Some also market their own training courses and certifications for people looking to get into the business.
It’s misleading, health professionals warn — and illegal. All states require dental work, including veneers, to be performed under the supervision of a licensed dentist.
On Thursday, Georgia law enforcement officials arrested Brandon Diller, who promoted himself to 158,000 Instagram followers as “Atlanta’s top veneer specialist and trainer.” Diller practiced dentistry without a license and sold “training and certificates, which were worthless” and “provided no legitimate or legal credentials,” according to an arrest warrant from Fulton County’s District Attorney’s office.
Here’s what to know about veneers and how to avoid bogus providers and services:
What are dental veneers?
Veneers are thin, custom-made dental coverings used to hide minor imperfections or to fill in gaps between teeth. Unlike crowns or more invasive dental implants, veneers are almost always considered cosmetic dentistry and generally aren’t covered by insurance.
Dentists usually charge between $1,000 and $2,000 per tooth for veneers, with higher prices for those made from porcelain compared with lower-grade materials.
Placing veneers involves stripping some of the natural enamel from the tooth and bonding the new covering into place. Because of that process, getting veneers is considered an irreversible procedure, according to the American Dental Association. They are not permanent, and can be expected to last between 5 to 15 years before they degrade and need to be replaced.
In recent months the ADA has been stepping up warnings about the risks of veneer procedures done by unlicensed individuals.
“Quality control is lost without the involvement of a licensed dentist,” said Dr. Ada Cooper, a New York-based dentist and ADA spokesperson. “We undergo years of education and training and need to be licensed by various regulatory bodies before we can practice.”
What are the risks of getting veneers from someone who isn’t licensed?
Improper veneer procedures can cause a range of health problems, including severe pain, nerve damage and tooth loss.
Patients need to be anesthetized before the enamel is removed from their teeth.
“It could be incredibly painful if they’re not anesthetized correctly,” said Dr. Zach Truman, who runs an orthodontics practice in Las Vegas. “You can also go too deep into the tooth and penetrate what’s called the pulp chamber, which contains blood vessels and nerves.”
One of the biggest problems Truman sees with unregulated veneer work is that customers aren’t getting screened for existing dental problems, such as gum disease and cavities.
“If you put a veneer on a tooth that has an active cavity, you’re just going to seal it in there and eventually it’s going to progress to tooth loss,” Truman said.
Dental veneers aren’t the only option for improving the appearance of teeth. Over-the-counter whitening kits can help with minor stains and discoloration. And dentists can sometimes use composite materials to reshape chipped or uneven teeth. But Truman says those fillings are prone to crack and won’t last as long as veneers.
How can I spot bogus veneer providers online?
One clue: Many individuals performing unlicensed dental work promote themselves on social media as “veneer technicians.”
Instead of working out of a dental office they often perform treatments at beauty salons, hotel rooms or private homes. Some advertise multi-city tours and encourage clients to message them to book an appointment in advance.
Much of the appeal of the services is in their pricing, with some offering a full set of veneers for a flat fee of $4,000 or $5,000. That’s less than half of what patients can generally expect to pay at a dental office.
Performing dental work without an appropriate license is illegal, the ADA notes.
Dentists and hygienists are licensed by state governments, who also define the work dental assistants can perform. But in all cases, veneers and other dental procedures must be supervised by a licensed dentist.
Earlier this year, Illinois law enforcement officials arrested a woman running a business called the Veneer Experts after she posted videos of herself fitting braces, veneers and other dental products without a license. She was previously arrested in Nevada on similar allegations of practicing dentistry without a license.
What are the best ways to find legitimate dental providers?
The ADA maintains a website detailing the training and licensing requirements for dentists across the U.S. Most states also maintain websites where you can lookup and verify licensure information and find any past disciplinary actions for dentists and other health professionals.
“It’s really critical to understand that dentistry is a regulated health care profession that requires formal educations and licensure,” Cooper said.
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The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.
