Dental Tribune United Kingdom Edition

T he culprit behind a failed hip or knee re- placements might be found in the mouth. DNA test- ing of bacteria from the fluid that lubricates hip and knee joints had bacteria with the same DNA as the plaque from patients with gum disease and in need of a joint replacement. This study is one of many coming from the Case West- ern Reserve University School of Dental Medicine that have linked oral bacteria to health problems when they escape from the mouth and enter the blood. Working with University Hospitals Case Medical Cent- er researchers, the dental, orthopaedic and arthritis re- searchers suggest it might be the reason why aseptic loos- ening or prosthetic wear of the artificial joints fail within 10 years when no infection appears to be present. The pilot study’s findings were reported in the April issue of the Journal of Clinical Rheu- matology. Dr Nabil Bissada, chair of the Department of Periodontics at the dental school, said the objective of the study, “Identifi- cation of Oral Bacterial DNA in Synovial Fluid of Patients with Arthritis with Native and Failed Prosthetic Joints” was to see if bacteria like Fusobacterium nucleatum and Serratia pro- teamaculans found in patients with gum disease were present in the fluid. The researchers recruited and studied 36 patients seeking care at the University Hospitals Case Medical Center for os- teoarthritis (the wearing of the joints) and rheumatoid arthritis (an autoimmune disease). These study participants had both natural and artificial joints. Researchers extracted samples of their synovial fluid, which is much like oil that keeps a door from squeaking. These patients also had signs of periodontitis or gum disease and undergone exams where dental plaque was obtained for the study. Plaque build-up from the bacteria, associated with gum disease, breaks down the walls of the pockets around the teeth. The inflammation process from the bacteria acts like a gate that gives bacteria access to the blood stream. Once in the blood, the oral bacteria have induced in- flammation in remote sites where the bacteria has been linked to heart, kidney and cancer dis- eases and premature births and fetal deaths. Because these bacteria can- not be found with routine lab tests, detection of bacteria in the plaque and fluid was done through a process called poly- merase chain reactions and DNA sequence analysis of specific genes (16S-23S rRNA). This is a sophisticated DNA track- ing procedure. Five of the 36 patients (14 per cent) showed direct DNA links between the bacteria in the fluid and plaque from the mouth. The breakdown in patients was: one from a rheumatoid arthritis (RA) patient with a failed natural joint and one RA patient with a failed replacement joint; two osteoar- thritis (OA) patients with failed artificial joints and one OA pa- tient with a failed natural joint. Bissada said researchers will continue exploring the oral health link in a larger study. DT CWRU researchers find joint failures potentially linked to oral bacteria 6 News United Kingdom Edition May 7-13, 2012 T he British Dental Asso- ciation (BDA) has wel- comed a reminder from the Welsh Government to Local Health Boards (LHBs) that fund- ing allocated for dentistry must not be diverted to fund any other type of healthcare. Minister for Health and So- cial Services Lesley Griffiths has written to LHB Chairs to remind them that budgets al- located for spending on general dental services contracts and the Designed to Smile programme should be used as intended, and that any underspends on these budgets should not be divert- ed to shore-up other services. The letter expresses concerns that some LHBs are not main- taining improvements to den- tal services and that access for patients remains problematic in some areas. The BDA has also applauded the letter’s confirmation that the dental budget will remain ringfenced until at least March 2014-15 and the renewal of a commitment to develop Com- munity Dental Services in Wales to help with the aim of ensuring vulnerable patients have access to appropriate care. The letter notes the lack of investment in CDS services in deprived areas and the responsibility LHBs hold providing or securing services for society’s most vulnerable groups. Stuart Geddes, BDA Direc- tor for Wales, said: “We welcome the Minister’s clear iteration that dental budgets designated for primary care are to be used solely for developing dental ser- vices in this area. The BDA has been concerned for some time that some health boards appear to be sitting on funds earmarked for dentistry, rather than com- missioning services where they are urgently needed. “In a country where some people are struggling to access dental care and we are fight- ing oral health inequalities, it is simply unthinkable that money intended to improve dental ser- vices should be diverted. Lo- cal health boards need to sit up and take notice of this letter and strive to deliver the care their populations require. “The Minister’s letter also provides a timely reminder to the Boards of the need to invest appropriately in Community Dental Services. As the BDA has consistently pointed out, vulner- able patients in Wales need to be afforded some political priority to ensure that they are getting the care they need. We are de- lighted to see that our message has been heard and that boards are being reminded of their duty to invest appropriately in the care of these patients.” DT BDA welcomes funding reminder in Wales An example of a failed knee replacement H ealth and care leaders have come together to drive improvements in dementia services and deliver on key ambitions set out in the Prime Minister’s dementia challenge. The Champion Group brings together representatives from the health sector, social care, lo- cal government and charities. They will be tasked with driving work on the ground to ensure that health and social care services get to grips with improving services for both people with dementia and their carers. Last month the Prime Minis- ter announced plans to make the UK a world leader on dementia. The programme aims to deliver major improvements in demen- tia care, dementia awareness and dementia research by 2015. Three ‘Champion Groups’ are being es- tablished to lead the work on each strand. Actions set out for improving dementia care include increasing diagnosis, rewarding best prac- tice, and ensuring memory ser- vices are both established across the country and accredited, giving people with dementia access to high quality services. TheDementiaHealthandCare Champion Group, co-chaired by Sarah Pickup, President of the As- sociation of Directors of Adult So- cial Services (ADASS) and Sir Ian Carruthers OBE, Chief Executive of NHS South of England, held its first meeting today. The group will take a broad approach to tackling the issue of dementia services, with a focus on how social care services, the NHS and local government or- ganisations can work together to effect real change. In addition to the specific ac- tions set out in the Prime Minis- ter’s challenge, the group’s ap- proach will also include: • Improving end of life care for people with dementia • Improving housing and social care accommodation – supporting innovative solutions to support people with dementia to continue to live at home • Promoting partnership working between primary and secondary health services and local govern- ment • Reducing the inappropriate use of antipsychotic medication for people with dementia. Care Services Minister Paul Burstow said: “We are deter- mined to go further and faster in bringing real improvements to the care and support people with dementia and their carers receive in all settings. “Early diagnosis is key as it allows people to plan for their future, preventing the need for crisis intervention, premature ad- mission to hospital care, and this delivers better outcomes for peo- ple with dementia, enabling them to live well. “But we must also ensure that, once they receive a diagnosis, people have access to the right information and high quality ser- vices wherever they live.” In England 670,000 people have dementia and the number of people developing the disease is increasing. One in three people will develop dementia and it costs society an estimated £19 billion a year. Sir Ian Carruthers OBE, Chief Executive of NHS South of Eng- land, said: “It is important that the pace of improvement is acceler- ated and progress made towards delivering top quality services for all who require care.” The three champion groups will report on progress to the Prime Minister, through Depart- ment of Health Ministers in Sep- tember 2012 and again in March 2013. DT Transforming care for people with dementia