Release Date: August 2, 2010

BUFFALO, N.Y. — Mark this one down as a parental nightmare.

First, your child gets her tongue pierced. Then, as if you needed something else, she starts “playing” with the tiny barbell-shaped stud, pushing it against her upper front teeth. And before you know it, she forces a gap between those teeth — a fraction-of-an-inch gap that may cost thousands of dollars in orthodontic bills to straighten.

“It is a basic tenet of orthodontic that force, over time, moves teeth,” explains the study’s primary investigator, Sawsan Tabbaa, DDS, MS, assistant professor of orthodontics at the UB School of Dental Medicine.

Tabbaa notes that a previous UB dental school survey study of Buffalo high school students revealed that the presence of a barbell implant/stud caused a damaging habit whereby subjects pushed the metal stud up against and between their upper front teeth, a habit commonly referred to among the students as “playing.”

“And it happened in very high percent of the cases,” said Tabbaa.

The example patient here was a 26- year-old female and complained that a large space had developed between her upper central incisors or upper front teeth. The patient also had a tongue piercing that held a barbell-shaped tongue stud.

The tongue was pierced seven years earlier and every day for seven years she had pushed the stud between her upper front teeth, creating the space between them and, subsequently, habitually placing it in the space. The patient did not have a space between her upper front teeth prior to the tongue piercing.

“The barbell is never removed because the tongue is so vascular that leaving the stud out can result in healing of the opening in the tongue, said Tabbaa, “so it makes perfect sense that constant pushing of the stud against the teeth — every day with no break — will move them or drive them apart.”

The patient provided the research team with photos that demonstrated she had no diastema, or space, prior to having her tongue pierced. For the purposes of treating this patient’s space, it was assumed that positioning of the tongue stud between the maxillary central incisors or “playing” caused the midline space.

Her treatment involved a fixed braces appliance to push the front teeth back together.

Tongue piercing can result in serious injury not just to teeth but has also been associated with hemorrhage, infection, chipped and fractured teeth, trauma to the gums and, in the worst cases, brain abscess, said Tabbaa.

“The best way to protect your health, your teeth and your money is to avoid tongue piercing.”

The University at Buffalo is a premier research-intensive public university, a flagship institution in the State University of New York system and its largest and most comprehensive campus. The School of Dental Medicine is one of five schools that constitute UB’s Academic Health Center. UB’s more than 28,000 students pursue their academic interests through more than 300 undergraduate, graduate and professional degree programs. Founded in 1846, the University at Buffalo is a member of the Association of American Universities.

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“Financial strain is a long-term, constant pressure,” said Dr. Robert Genco, chair of the Oral Biology Department at The State University of New York at Buffalo, who carried out the studies with the periodontal research group at Buffalo and behavioral scientist Dr. Lisa Tedesco of the University of Michigan. “Our studies indicate that this ever-present stress and a lack of adequate coping skills could lead to altered habits, such as reduced oral hygiene or teeth grinding, as well as salivary changes and a weakening of the body’s ability to fight infection.”

However, people who dealt with their financial strain in an active and practical way (problem-focused) rather than with avoidance techniques (emotion-focused) had no more risk of severe periodontal disease than those without money problems.

The good news is that many of the risk factors for periodontal disease, such as poor oral hygiene and infrequent professional care, can be controlled with minimal personal time and financial resources.  Eliminating periodontal disease also eliminates a risk factor for heart disease, respiratory disease, and diabetes complications, it is especially important for people to do what they can to protect their oral health.

Genco and his colleagues are following more than 1,400 people between the ages of 25 and 74 in the ongoing study, which is one of the first to examine the relationship of periodontal disease to stress, distress and coping in a large population.

Psychological tests were given to identify and weigh the causes of stress (children, spouse, financial strain, single life and work stress) in participants’ daily lives and to measure the ability to cope with stress. To measure financial strain, study participants answered nine questions, including:

• At the present time, are you able to afford a home that is large enough?
• Do you have difficulty in meeting monthly payments of your family bills?
• How often is it that you don’t have enough money to afford the kind of food, clothing, medical care, or leisure activities you and your family need or want?

Further studies are needed to help establish the time course of stress in respect to the onset and progression of periodontal disease and the mechanisms that explain the association. Intervention studies also are needed to determine the extent to which controlling stress will influence periodontal disease and its treatment.

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Osteoporosis may increase the severity of bone loss in periodontal disease. To assess your risk of gum disease, visit the American Academy of Periodontology.

Note, patients on medications to treat Osteoporosis may be at risk of bisphosphonate-associated osteonecrosis (BON) of the jaw (link).

Bisphosphonate Drugs, Osteoporosis, and Oral Osteonecrosis

Bisphosphonates are a family of drugs used to treat bone problems like osteoporosis, osteopenia, and bone cancer. If an Oral Bisphosphonate Drug (Fosamax (alendronate sodium), Boniva (ibandronate), and Actonel (risedronate), etc) has been taken for more than three years, there are certain precautions we need to take prior to treatment. We will obtain a special test, called a CTX Test, to determine the potential for risk of developing bisphosphonate-associated osteonecrosis (BON) of the jaw after treatment. As long as the test is in a safe range, the risk of this complication is low. If you have taken these oral drugs for less than three years, then no test is necessary and we can proceed with your needed treatment.

The Intravenous (IV) Form of the Bisphosphonate Drugs Zometa (zoledronic acid), Aredia (pamidronate disodium), and Reclast (pamidronate disodium), are very potent drugs to treat bone cancer (such as multiple myeloma) or osteoporosis. These drugs are more likely to result in BON and limit the type of dental treatments available. At the exam, we can determine what types of treatment can and cannot be utilized.

Other drugs are available to treat osteoporosis – estrogen or hormone replacement therapy, selective estrogen receptor modulators (like Evista), Calcitonin Hormones (like Forteo SubQ and Miacalcin Nasi), and Anabolic medications (like parathyroid hormone). Ask your doctor about switching to a non-bisphosphonate drug.

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