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Obesity may influence orthodontic treatment in minors

15 February 2017

Obesity may influence orthodontic treatment in minors

In Western countries like the UK, it is estimated that almost every third child is now overweight or obese. At the same time, an increasing number of children are receiving fixed braces to correct malocclusions at an early age. A new study conducted by researchers at King’s College London Dental Institute and published in the Journal of Dental Research has now indicated that the response to this particular type of treatment can significantly vary depending on a child’s body weight.

In the cohort study, the researchers followed a number of adolescent patients, who were classified as normal weight or obese based upon their body mass index, from the start of their treatment to the completion of tooth alignment. During the examinations, it was found that those patients who were obese had a significantly increased rate of initial tooth movement and required less time to achieve tooth alignment compared with normal-weight patients.

The researchers also noticed increased levels of inflammatory biomarkers in the gingival tissue of obese patients prior to orthodontic treatment.

The first of its kind to study the relation between obesity and orthodontic tooth movement, it demonstrates that the condition in adolescent patients influences the supporting tissue around the tooth, the researchers said, and this could have important implications for orthodontic treatment outcome in obese patients over both the short and long term.

Levels of obesity have increased significantly throughout all age groups in Western societies in the last two decades, and it has been linked to multiple chronic diseases, including periodontal inflammation. In a 2015/2016 evaluation, Public Health England found that 14 per cent of one million schoolchildren in the UK were classified as overweight and almost 20 per cent as obese.

The King’s study, titled “Impact of obesity on orthodontic tooth movement in adolescents: A prospective clinical cohort study”, was published online on 23 January in the Journal of Dental Research.

The Irish Dental Association (IDA) has urged people to prioritise their oral health and not to ignore dental pain, gingival infection or oral trauma. The call follows the death of a 26-year-old man from the US, who recently passed away after a dental infection had spread to his lungs.

The President of the IDA, Dr P.J. Byrne, described the death of the father of two from California as a terrible tragedy. “While deaths from dental infection are thankfully rare, this tragedy underlines the fact that untreated tooth and gum infections can lead to other health complications and even fatal consequences. Prevention is key. Don’t ignore an abscess, gum infection, swelling or dental injury and be sure to visit your dentist promptly if you have a concern,” he said.

Byrne pointed to a study from 2015 that showed that there had been a 38 per cent increase in the number of patients admitted to Irish hospitals with severe dental infections.

“We have no doubt that the swingeing cuts which were made to the medical card and PRSI [Pay Related Social Insurance] dental schemes as well as the Public Dental Service are responsible for this massive increase. These cuts have removed preventive treatments, putting our patients at risk from dental disease with potential risks to their general health. At present antibiotics are often prescribed in the absence of the availability of effective treatment.”

In response to the 2015 study at the time, IDA CEO Fintan Hourihan described the rise in admissions in a so-called First World country as a disgrace. “If anything the situation is getting worse and people are being left with severe abscesses and potentially life-threatening infections,” Byrne concluded.

Football headers 'linked to brain damage'

Repeated headers during a footballer's professional career may be linked to long-term brain damage, according to tentative evidence from UK scientists.

The research follows anecdotal reports that players who head balls may be more prone to developing dementia later in life.

The Football Association says it will look at this area more closely.

Experts said recreational players were unlikely to incur problems.

Dawn Astle, the daughter of former England and West Brom striker Jeff Astle, who died aged 59 suffering from early onset dementia, said it was "obvious that it [his dementia] was linked to his footballing career".

The inquest into his death in 2002 found that repeatedly heading heavy leather footballs had contributed to trauma to his brain.

Ms Astle told BBC Radio 5 Live: "At the coroner's inquest, football tried to sweep his death under a carpet. They didn't want to know, they didn't want to think that football could be a killer and sadly, it is. It can be."

She said her father was 55 and physically very fit when he went to the doctor, who diagnosed him with the early onset of dementia.

By the end he "didn't even know he'd ever been a footballer", she said, before adding: "Everything football ever gave him, football had taken away."

Researchers from University College London and Cardiff University examined the brains of five people who had been professional footballers and one who had been a committed amateur throughout his life.

They had played football for an average of 26 years and all six went on to develop dementia in their 60s.

While performing post mortem examinations, scientists found signs of brain injury - called chronic traumatic encephalopathy (CTE) in four cases.

CTE has been linked to memory loss, depression and dementia and has been seen in other contact sports.

Prof Huw Morris, of University College London, told the BBC: "When we examined their brains at autopsy we saw the sorts of changes that are seen in ex-boxers, the changes that are often associated with repeated brain injury which are known as CTE.

"So really for the first time in a series of players we have shown that there is evidence that head injury has occurred earlier in their life which presumably has some impact on them developing dementia."

In the study, published in the journal Acta Neuropathologica, the report's authors make it clear they were not analysing the risks of heading by children.

But the science is far from clear-cut.

Each brain also showed signs of Alzheimer's disease and some had blood vessel changes that can also lead to dementia.

Researchers speculate that it was a combination of factors that contributed to dementia in these players.

But they acknowledge their research cannot definitively prove a link between football and dementia and are calling for larger studies to look at footballers' long-term brain health.

Dr David Reynolds, at the charity Alzheimer's Research UK, said: "The causes of dementia are complex and it is likely that the condition is caused by a combination of age, lifestyle and genetic factors.

"Further research is needed to shed light on how lifestyle factors such as playing sport may alter dementia risk, and how this sits in the context of the well-established benefits of being physically active."

He added that for people who are recreational footballers, football injuries are unlikely to cause long-term problems and he pointed to expert advice that the benefit of exercise is likely to outweigh the risks.

A number of previous cases involving boxers and American footballers have suggested that repetitive blows can cause long-lasting and progressive brain damage.

But until now there have only been a few case reports of individual footballers with CTE in the UK and the extent of the issue is still unknown.

The Football Association welcomed the study and said research was particularly needed to find out whether degenerative brain disease is more common in ex-footballers.

Dr Charlotte Cowie, of the FA, added: "The FA is determined to support this research and is also committed to ensuring that any research process is independent, robust and thorough, so that when the results emerge, everyone in the game can be confident in its findings."



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