LONDON, ENGLAND, UK – Persistent dental plaque may increase the risk of dying early from cancer, suggests an observational study published in the online journal British Medical Journal Open.

Dental plaque is made up of a film of bacteria, which covers the surfaces of the teeth, including the gaps between the teeth and gums. It leads to tooth decay and gum inflammation, with the potential for tooth loss.

Dental plaque has also been implicated in systemic health problems. And the authors wanted to find out if it might be a risk factor for early death from cancer as a result of infection and inflammation, both of which are thought to have a role in up to one in five cancers.

They tracked the health of almost 1,400 randomly selected Swedish adults from Stockholm for 24 years (1985 to 2009).

All participants were in their 30s and 40s at the start of the monitoring period, when they were all quizzed about factors likely to increase their cancer risk, such as smoking and levels of affluence.

Their mouth hygiene was also assessed to find out what levels of dental plaque, tartar, gum disease, and tooth loss they had. While they had no overt gum disease, they did have substantial levels of plaque on the tooth surface.

By 2009, 58 people had died of cancer, around a third of whom were women (35.6%). The average age of death was 61 for the women and 60 for the men. The women would have been expected to live around 13 years longer, and the men an additional 8.5 years, so their deaths could be considered premature, say the authors.

Deaths among the women were predominantly caused by breast cancer, while those among the men were attributed to a range of different cancers.

The dental plaque index in those who had died was higher than those who had survived, with values of 0.84 to 0.91, indicating that the gum area of the teeth had been covered with plaque.

The values among the survivors were consistently lower (0.66 to 0.67), indicating that the gum area was only partially covered with plaque.

When all the risk factors were considered, unsurprisingly, age almost doubled the risk of a cancer death. And male gender increased the odds by 90%.

After the other potential risk factors known to be associated with premature death, such as lower educational attainment, smoking, frequency of dental visits, and lower income were accounted for, the associations observed between age, male gender, the amount of dental plaque, and premature death remained strong.

Dental plaque was associated with a significantly (79%) increased risk of premature death, although the absolute risk of premature death was low, with only 58 out of 1,390 participants dying after 24 years.

The authors caution that their findings do not prove that dental plaque causes or definitely contributes to cancer.

“Our study hypothesis was confirmed by the finding that poor [mouth] hygiene, as reflected in the amount of dental plaque, was associated with increased cancer mortality,” they write. “Further studies are required to determine whether there is any causal element in the observed association.”

- MFP Wire Services
- 06-14-2012

LONDON, ENGLAND, UK – A simple and rapid test done near the patient that does not need laboratories, electricity, or highly trained staff (known as a point-of-care test) can effectively diagnose syphilis in pregnant women and has been adopted in six low- and middle-income countries thus preventing many stillbirths and deaths in newborn babies according to a report from international researchers published in Public Library of Sciences Medicine.

Syphilis in pregnancy causes more than half a million stillbirths or neonatal deaths every year but these deaths could be prevented if all pregnant women were screened for syphilis and treated with a single dose of penicillin before the third trimester (last three months) of their pregnancy.

In an international project in 6 countries, funded by the Bill & Melinda Gates Foundation and led by Rosanna Peeling from the London School of Hygiene and Tropical Medicine, researchers engaged policy makers in each country in the design of a prenatal syphilis screening project using point-of-care tests to ensure that the screening programme was appropriate to the local health care system: syphilis point-of-care tests were introduced in rural antenatal clinics in Tanzania, Uganda, and China; both rural and urban clinics in Peru and Zambia; and remote indigenous communities in Brazil.

In each country, health workers were trained in how to use the tests using training materials translated into the local language, and adapted according to the local cultural and social context. During the project, over 100,000 pregnant women were screened for syphilis—90% of women attending antenatal clinics and over 90% of these women were treated on the same day. Furthermore, the test was acceptable to women and increased the job satisfaction of health workers.

Importantly, as a result of this project, all six countries changed policy to adopt point-of-care syphilis testing into their prenatal screening programmes.

The authors say: “This project has shown that [point-of-care tests] for syphilis can be effectively introduced in a range of settings, from cities in China and Peru, to remote villages in East Africa, and even more remote indigenous populations in the Amazon rain forest. By working with the existing health care system to integrate testing, the introduction of [point-of-care tests] resulted in large numbers of women being tested and treated for syphilis, averting many stillbirths and reducing neonatal mortality.”

The authors conclude: “Our long-term vision is to facilitate the development and implementation of an essential [point-of-care test] package for prenatal care that could be broadened to include diagnostics for both infectious diseases and conditions such as anaemia and pre-eclampsia to ensure safe motherhood and healthy babies. Such an integrated approach could result in improved efficiency, a more robust health care system, and lives saved.”

- MFP Wire Services
- 06-13-2012

LONDON, ENGLAND, UK – A new risk prediction tool can identify patients at high risk of coronary artery disease who might need further diagnostic work, says a study published online with British Medical Journal. The tool is more accurate than existing models and could be easily integrated into electronic patient records or mobile applications.

Coronary artery disease is a major cause of death throughout the world. It occurs when the arteries supplying oxygen and nutrients to the heart become narrowed with fatty deposits.

Chest pain may be the first sign of the condition so current guidelines recommend using one of two prediction tools (the Diamond & Forrester model or the Duke Clinical Score) for patients with chest pain to help doctors estimate their risk and decide if further tests are needed.

However, questions about the accuracy of these tools have been raised.

So a team of European researchers decided to develop an improved prediction model using a range of variables with known links to coronary artery disease. They analysed data for 5,677 patients (3,283 men and 2,394 women) with chest pain but no previous history of heart disease from 18 hospitals across Europe and the USA.

Their basic model predicted coronary artery disease according to age, sex and symptoms. A clinical model included risk factors such as diabetes, high blood pressure, elevated lipid levels and smoking, while an extended model added the coronary calcium score (a measure of calcium in the coronary arteries that is associated with the presence of coronary artery disease and also determines the risk of a coronary event).

Their results suggest that the Duke Clinical Score (the tool that is currently recommended by the NICE guideline) significantly overestimates the probability of coronary artery disease.

Their clinical model improves these estimates, predicting probabilities between 2% for a 50 year old female with non-specific chest pain and no risk factors and 91% for an 80 year old male with typical chest pain and multiple risk factors.

Adding the coronary calcium score improved the prediction event further.

In addition, their model does not require resting heart (ECG) readings, making it better suited for use in primary practice, while an online calculator, also developed by the team, could be easily integrated into electronic patient records or mobile applications.

Because the implementation of the NICE guidelines requires an accurate estimate of the probability of coronary artery disease, the authors conclude that their model “allows doctors to make better decisions as to which diagnostic test is best in a particular patient and to decide on further management based on the results of such tests.”

- MFP Wire Services
- 06-12-2012