ORAL HEALTH COMPLICATIONS?

Transcription

1 ORAL HEALTH COMPLICATIONS? Your pathway to a better oral health

2 ORAL HEALTH AND PERIODONTAL (GUM) DISEASE Dental cavities are a multifactorial disease of bacterial origin that is characterized by acid demineralization of the tooth enamel. It appears following changes in the homeostasis of the oral ecosystem leading to proliferation of the bacterial biofilm 1. Periodontal disease is classified into two types 1 : Inflammation of the gums 1) Gingivitis, which refers to inflammation limited to the unattached gingiva Common risk factors for gingivitis are: Poor dental hygiene Uncontrolled diabetes Pregnancy General illness 2) Periodontitis, which is the progressive, destructive disease effecting all supporting tissues of the teeth, including the alveolar bone. It has a high prevalence in western countries, where it is the biggest single cause of loss of teeth. Serious health conditions are linked to periodontal disease 2 : Respiratory infections Osteoporosis Diabetes Rheumatoid arthritis Poor nutrition Low birth weight babies Cardiovascular disease 2

3 PREGNANCY AND GINGIVITIS Pregnancy causes hormonal changes that increase a woman s risk for developing gingivitis. The main cause of pregnancy gingivitis is the presence of the bacterium Porphyromonas gingivalis and the amount of bacterial plaque that accumulates. Thus, between 50-70% of women develop gingivitis during their pregnancy 4. DID YOU KNOW? Total expenditures by Canadians for dental services in 2013 was estimated to be $12.5 billion 3 An estimated 2.26 million school days and 4.15 million working days are lost annually due to dental visits or dental sick days 4 21% of adults have, or have had, a moderate or a severe periodontal (gum) problem 4 PROBIOTICS AND DENTAL HEALTH Probiotics are live micro-organisms which when administered in adequate amounts, confer a health benefit on the host. Probiotics have been proven effective for preventing caries. It has been stated that oral administration of probiotics may also benefit oral health by preventing the growth of harmful microbiota or by modulating mucosal immunity in the oral cavity 5. 3

4 MECHANISM OF ACTION TERRADENT is a patentprotected probiotic formula for oral health combining strains of Lactobacillus plantarum (CECT 7481) and Lactobacillus brevis (CECT 7480) with QPS status (Qualified Presumption of Safety). This probiotic has beneficial properties for maintaining a good oral health status by competing against bad bacteria and disrupting their adhesion to the different tissues in the oral cavity. L. plantarum (CECT 7481) and L. brevis (CECT 7840) are grampositive aero tolerant bacteria that display significant inhibitory activity against a broad number of pathogens of the oral cavity that are implicated in gingivitis, periodontitis, caries and halitosis, while displaying minimal antagonism against common commensal strains of the human oral flora. TERRADENT s bactericidal activity does not produce significant amounts of acid thereby preserving teeth, helping restore the protective oral flora by competing against bad bacteria and disrupting their adhesion to the different tissues in the oral cavity. NORMAL FLORA ALTERED FLORA 4

5 THE STRAINS IN THE FORMULA WERE SELECTED BECAUSE OF THE FOLLOWING PROPERTIES: High lysozyme survival/hydrogen peroxide survival rates Low acid production which protects and preserves dental integrity Aggregation capacity of the strains antagonizes undesirable microorganisms and facilitates the formation of probiotic films. Ability to adhere to hydroxyapatite beads mimics adherence to dentin Ability to adhere to caco-2 cells mimics adherence to the oral cavity epithelium Global Antimicrobial Activity Assessment demonstrated antagonistic activity against: Streptococcus salivarius (especially linked to tooth decay) Streptococcus sobrinus (especially linked to tooth decay) Fusobacterium nucleatum (the key microorganism in the initiation of dental plaque) Porphyromonas gingivalis (especially linked to gum disease) Treponema denticola (involved both in gum disease and bad breath) Prevotella denticola (involved both in gum disease and bad breath) Probiotic Bacteria Compete for adhesion sites Aggregate Compete for nutrients and growth factors Product antimicrobial compounds including acids Enhance the host immune responses e.g. Enhance the production of IgA and defensins Inhibit pathogen induced production of proinflammatory cytokines Decrease MMP production Inhibition of adhesion and enhanced clearance Inhibition of growth of pathogens and other effects on dental plaque ecology Influence on local and systemic immune responses Antagonism against pathogens Reduction of inflammation and tissue destruction 5

6 LOG CFU CLINICAL TRIAL Bosch et al (2011) 5 performed a screening of lactic acid bacteria, according to international guidelines for the evaluation of probiotics, in order to select candidate probiotic strains for preventing oral disorders. The strains were isolated from healthy children and were subjected to a variety of in vitro tests in order to show their functionality. The safety of the strains was assessed by determining antibiotic susceptibility and production of lactic acid. Results indicated that 46 of the 100 new isolates were assigned to lactic acid bacteria genera after a biochemical characterization. Most of the new isolated strains seem to be resistant to oral conditions, have great ability to form aggregates and have high antagonistic activity against oral pathogens. None of the strains produced unpleasant volatile compounds. The strains showed high ability to adhere to oral tissues and they do not present any antibiotic resistance TERRADENT Current Probiotic Approaches L. REUTERI + CHLORHEXIDINE TERRADENT + CHLORHEXIDINE L. REUTERI STREPTOCOCCUS SALIVARIUS STREPTOCOCCUS SALIVARIUS + CHLORHEXIDINE Figure 1: Resistance to bactericidal: Comparison between TERRADENT and other probiotic therapies for gingivitis and halitosis TERRADENT s probiotic strains have been specifically selected as the ones with the best performance in the prevention and treatment of oral complications, bad breath and tooth decay among others. When compared with current probiotic approaches, TERRADENT provided a greater resistance to bad bacteria for gingivitis and halitosis than other probiotic solutions. 6

7 Days Days CLINICAL TRIAL Riccia et al (2007) 8 analyzed the anti-inflammatory effects of L. brevis extracts on periodontitis patients and to investigate the involved mechanisms in vitro on activated macrophages. Eight healthy subjects and 21 patients with chronic periodontitis were enrolled to analyze the effect of L. brevis-containing lozenges on periodontitis-associated symptoms and signs. Saliva samples, collected before and after treatment, were analyzed for metalloproteinase and nitric oxide synthase (NOS) activity, immunoglobulin-a (IgA), prostaglandin E 2 (PGE 2 ) and c-interferon (IFN-y) levels. Effect of the treatment with L. brevis-containing lozenges on laboratory parameters Nitrate/ Nitrite Levels PGE2 IFN-Y Figure 2: Effect of L. brevis-containing lozenges on laboratory parameters Healthy Controls Periodontitis Patients Before Treatment Periodontitis Patients After Treatment The treatment led to the total disappearance or amelioration of all analyzed clinical parameters in all patients. This was paralleled to a significant decrease of nitrite/nitrate, PGE 2, matrix metalloproteinase, and IFN-y levels in saliva samples. Effect of L. Brevis Lozenges in the Treatment of Periodontitis Patients Gingival Inflammation Plaque Calculus Temperature Sensitivity Before After Bleeding Figure 3: Effect of the treatment with L. brevis-containing lozenges on gingival inflammation, plaque and calculus, temperature sensitivity and bleeding in periodontitis patients The treatment of chronic periodontitis patients with L. brevis with 4 lozenges/day for 4 days showed substantial improvement in all measured parameters. These results suggest that the antiinflammatory effects of L. brevis could be improve the conditions associated with periodontal disease. 7

8 SUPPLEMENT INFORMATION Supplement Information One box of TERRADENT contains 30 lozenges. Recommended Use: Source of probiotics. Medicinal Ingredients (per capsule): Lactobacillus plantarum.0.5 billion CFU Lactobacillus brevis billion CFU Directions for use: Take one lozenge daily. Let it dissolve in the mouth. For best results, avoid consuming food or liquid at least 30 minutes after taking TERRADENT. Caution: This product is intended for adults 18 years of age or older. Pregnant and breastfeeding women are advised to consult with their healthcare practitioner prior to using this product. Storage: Store at room temperature. TERRADENT has been registered with Health Canada; the Health Canada NPN number is: Safety & Drug Interactions: Keep out of reach of children. If you are on antibiotics, take at least 2-3 hours before or after your antibiotics. If you have fever, vomiting, bloody diarrhea or severe abdominal pain, consult a health care practitioner prior to use. If symptoms of digestive upset (e.g. diarrhea) occur, worsen, or persist beyond 3 days, discontinue use and consult a healthcare practitioner. If you have an immune-compromised condition (e.g. AIDS, lymphoma, patients undergoing long-term corticosteroid treatment), do not use this product. Food supplements should not be used as a substitute for a varied balanced diet and healthy lifestyle. Keep in a fresh dry place. 8

9 FAQs 1. How should TERRADENT be taken? Take one lozenge daily. Let it dissolve in the mouth. For best results, avoid consuming food or liquid at least 30 minutes after taking TERRADENT. 2. Who should take TERRADENT? Individuals who want to maintain a good oral health status or suffer from the following conditions: Gingivitis, bad breath, cavities, sensitive teeth, and/or periodontitis. 3. Are there any known side effects of taking TERRADENT? No, TERRADENT exerts no side effects on the individual. 4. Has TERRADENT been clinically tested? Yes, there are several trials that evaluated the efficacy of TERRADENT. 5. What benefits can my patient expect from TERRADENT? The components in TERRADENT help to maintain a good oral health status by competing against bad bacteria and disrupting their adhesion to the different tissues in the oral cavity. It also kills oral pathogens while producing minimal amounts of acid. 6. Where is TERRADENT available? TERRADENT is available in stores and online at or by calling ; customerservice@xediton.com CONTACT US For more information, please visit or call XEDITON PHARMACEUTICALS INC 2000 Argentia Road Mississauga, ON L5N 1W1 customerservice@xediton.com REFERENCES 1 Bonifait, L., et al. (2009). Professional ISSUES. 2 Oral Health More than Just Cavities. A Report by Ontario s Chief Medical Officer of Health Canadian Dental Association: Dental Car Expenditures in Canada in Canadian Health Measures Survey 5 Bosch M., et al. (2012). Isolation and characterization of probiotic strains for improving oral health. Archives of oral biology. 57(5): Waki, N. et al. Effects of probiotic Lactobacillus brevis KB290 on incidence of influenza infection among schoolchildren: an open-label pilot study. Letters in Applied Microbiology. doi: /lam Rushdy, AA. et al. Antimicrobial compounds produced by probiotic Lactobacillus brevis isolated from dairy products. Annals of Microbiology. DOI: /s Riccia DN, et al. Antiinflammatory effects of Lactobacillus brevis (CD2) on periodontal disease. Oral Dis Jul;13(4): Centers for Disease Control. Clostridium difficile Infection. Healthcare-associated Infections (HAIs). CDC. 10 MedlinePlus. Behcet s Syndrome. MedlinePlus. 9

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