How Cavity-Causing Microbes Invade The Heart

More evidence of the links between oral & systemic diseases.

If you’re a dental professional why not:

  • Write a press release for your local newspaper? / Radio? /TV?
  • Add a link to your website?
  • Mention in your newsletters?
  • Write to your local GMPs?




How Cavity-Causing Microbes Invade The Heart

Scientists have discovered the tool that bacteria, normally found in our mouths, use to invade heart tissue, causing a dangerous and sometimes lethal infection of the heart known as endocarditis. The work raises the possibility of creating a screening tool – perhaps a swab of the cheek, or a spit test – to gauge a dental patient’s vulnerability to the condition.

The identification of the protein that allows Streptococcus mutans to gain a foothold in heart tissue is reported in the June issue of Infection and Immunity by microbiologists at the University of Rochester Medical Center.

S. mutans is a bacterium best known for causing cavities. The bacteria reside in dental plaque – an architecturally sophisticated goo composed of an elaborate molecular matrix created by S. mutans that allows the bacteria to inhabit and thrive in our oral cavity. There, they churn out acid that erodes our teeth.

Normally, S. mutans confines its mischief to the mouth, but sometimes, particularly after a dental procedure or even after a vigorous bout of flossing, the bacteria enter the bloodstream. There, the immune system usually destroys them, but occasionally – within just a few seconds – they travel to the heart and colonize its tissue, especially heart valves. The bacteria can cause endocarditis – inflammation of heart valves – which can be deadly. Infection by S. mutans is a leading cause of the condition.

“When I first learned that S. mutans sometimes can live in the heart, I asked myself: Why in the world are these bacteria, which normally live in the mouth, in the heart? I was intrigued. And I began investigating how they get there and survive there,” said Jacqueline Abranches, Ph.D., a microbiologist and the corresponding author of the study.

Abranches and her team at the University’s Center for Oral Biology discovered that a collagen-binding protein known as CNM gives S. mutans its ability to invade heart tissue. In laboratory experiments, scientists found that strains with CNM are able to invade heart cells, and strains without CNM are not.

When the team knocked out the gene for CNM in strains where it’s normally present, the bacteria were unable to invade heart tissue. Without CNM, the bacteria simply couldn’t gain a foothold; their ability to adhere was about one-tenth of what it was with CNM.

The team also studied the response of wax worms to the various strains of S. mutans. They found that strains without CNM were rarely lethal to the worms, while strains with the protein were lethal 90 percent of the time. Then, when Abranches’ team knocked out CNM in those strains, they were no longer lethal – those worms thrived.

The work may someday enable doctors to prevent S. mutans from invading heart tissue. Even sooner, though, since some strains of S. mutans have CNM and others do not, the research may enable doctors to gauge a patient’s vulnerability to a heart infection caused by the bacteria.

Abranches has identified five specific strains of S. mutans that carry the CNM protein, out of more than three dozen strains examined. CNM is not found in the most common type of S. mutans found in people, type C, but is present in rarer types of S. mutans, including types E and F.

“It may be that CNM can serve as a biomarker of the most virulent strains of S. mutans,” said Abranches, a research assistant professor in the Department of Microbiology and Immunology. “When patients with cardiac problems go to the dentist, perhaps those patients will be screened to see if they carry the protein. If they do, the dentist might treat them more aggressively with preventive antibiotics, for example.”

Until more research is done and a screening or preventive tool is in place, Abranches says the usual advice for good oral health still stands for everyone.

“No matter what types of bacteria a person has in his or her mouth, they should do the same things to maintain good oral health. They should brush and floss their teeth regularly – the smaller the number of S. mutans in your mouth, the healthier you’ll be. Use a fluoride rinse before you go to bed at night. And eat a healthy diet, keeping sugar to a minimum,” added Abranches.

Abranches presented the work at a recent conference on the “oral microbiome” hosted by the University’s Center for Oral Biology. The center is part of the Medical Center’s Eastman Institute for Oral Health, a world leader in research and post-doctoral education in general and pediatric dentistry, orthodontics, periodontics, prosthodontics, and oral surgery.

Additional authors of the study include laboratory technician James Miller; former technician Alaina Martinez; Patricia Simpson-Haidaris, Ph.D., associate professor of Medicine; Robert Burne, Ph.D., of the University of Florida; and Abranches’ husband, Jose Lemos, Ph.D., of the Center for Oral Biology, who is also assistant professor in the Department of Microbiology and Immunology. The work was funded by the American Heart Association.

Tom Rickey
University of Rochester Medical Center
Article URL:

Dental practice goodwill on the up in last quarter – NASDA Report

Dental Practice goodwill has risen in the last quarter but not across the board an update from Alan Suggett of UNW.

I’m curious how the transfer of CQC registration will affect the speed of future sales – the CQC don’t seem to have thought the practicalities through yet.




The Monday Morning Quote #122

“The optimist thinks this is the best of all possible worlds.

The pessimist fears it is true.”

J. Robert Oppenheimer



Clarence Clemons – RIP Big Man

Filmed just two months after the death of Danny Federici this features a superb sax solo from Clarence Clemons who departed this life a few days ago. Here’s Springsteen’s take on his old friend, a wonderful eulogy. And the band at Hammersmith in 1975…

“Tales from the Troubleshooter #4”

Firstly all congratulations to Dhru Shah & team at Dentinal Tubules as they reach their 5,000th subscriber.

Here’s the latest piece of mine they have published in which we reach the half way point of Jimmy’s story. You can find it on-line here

Tales from The Troubleshooter – Case 1. Jimmy’s story.

Part 4. Who are you really serving?

The Seven Pillars of Dental Practice Management© are:

  • Vision
  • Financial Controls
  • Sales
  • Marketing
  • People,
  • Environment
  • Systems

We’re halfway through the case study that is Jimmy’s rescue and it brings us to the vexed subject of marketing. At some point in their evolution most dental practices indulge in what I call “desperation marketing”. This frequently involves throwing sums of money at newspapers, magazines, radio, television or video displays in public areas. The result, because it is done without sufficient research and thought, is rarely worth the effort and certainly does not give a good return on the investment of time and money.

There are many definitions of marketing from the formal yet succinct used by the Chartered Institute of Marketing: “Marketing is the management process that identifies, anticipates and satisfies customer requirements”.

Adcock’s definition is even snappier: “The right product, in the right place, at the right time, at the right price.”

Not forgetting Chris Barrow’s take: “The process of eliminating those people you don’t want to treat”.

We looked at Jimmy’s customers whose requirements needed to be identified and satisfied.

Firstly the patients. They are the individuals that wanted / needed treatment in order for the business to survive. They came in two sub-groups:

A) The under 18’s – the majority of the practice. They were being treated under NHS contract mostly with standard straight-wire techniques.
B) Adults. 100% private contract, the majority referred by their GDPs many out of curiosity.

Second. The parents of group A. Their needs and expectations had to be assessed and managed.

Third. The referring dentists.

Last, but not least, the Primary Care Trust – they are the major source of income.

Patients Group A

The practice takes referrals from a large area including urban, suburban and rural areas with varying patterns of disease, motivations and views on health. The referring dentists were from wholly private and mixed practices with a sizeable proportion from “NHS corporates”.

Main concerns to everyone were:

  • The time wasted by non-attenders.
  • The large number of breakages that were having to be seen.
  • The number of treatments that were not completed.

The situation was turned round by changing one thing only – communication.

Steps were taken to ensure that the team listened to every patient. They sought to discover what the patients wanted and what they thought, sometimes it was apparent that the referring dentist had not told the patient why they were being referred. Frequently they (the patients) knew little of what might be involved and had no interest in interceptive treatment – especially if extractions were involved.

Before treatment was commenced it was made absolutely clear that the patient’s oral hygiene had to be and remain above average. Any patients with active lesions were returned to the referring dentist for treatment and disease control until the oral condition was stable.

Audits were undertaken of breakages, analysed by dentist, tooth, adhesive and cement used, appliance type and number per patient. We were able to say with confidence which patients were having most problems and advise accordingly.

A policy of zero toleration of time wasting was introduced.


The “rules” were laid down in a “what you can expect from us and what we expect from you” contract. This way we empowered the parent to ensure that the patient took good care of their appliances (fixed and removable), by cleaning properly as they were shown and keeping to the correct diet.

They were advised as to what to do in case of “emergency”, reassured as to the fact that a true orthodontic emergency is a rare event and how they should assess the situation if there were any concerns. The result was a reduction in urgent appointments and greater understanding of what the appliances were doing.

Patients Group B

At last what is understood as “conventional” marketing.

  • The website was completely refurbished and made more attractive to both adults and children.
  • The practice owner started writing a regular blog on matters orthodontic.
  • The practice introduced a social media policy utilising Facebook & Twitter.
  • Regular press releases to tie in with any current news items.
  • An online newsletter to current and past patients with details of new treatments, success stories and dentally related items.
  • The exterior of the building was given a “make over”.
  • Self referrals were encouraged.
  • Pricing became more transparent with several options made available.
  • Internal marketing techniques (aka asking for the business) led to increased interest from other potential patients.

Referring Dentists

All referring practices were contacted and asked whether they had any comments (positive or negative) on the service provided – and we listened and acted accordingly.

Open evenings were re-introduced so that new techniques could be explained and our approach reinforced:

  • The indications and limitations of some of the fashionable new techniques using removable aligners.
  • The difference between Damon, straight-wire and other fixed appliance techniques.
  • The use of twin-blocks and the importance of early referral in some cases.
  • The use of IOTN and the availability of alternatives to the NHS for those cases that fall outside the allowed limitations.
  • The use of orthodontics before, during and after restorative and periodontal cases.
  • The approximate costs of treatment.
  • The full range of adult treatments.

Primary Care Trust (PCT)

Since the imposition of the “new” contract in 2006 relations with the PCT had been lukewarm at best and hostile at worst. The need for clawback and the way it had been handled by the PCT representatives had done nothing to improve matters. So, much to the surprise of the PCT, pride was swallowed and we went on a charm offensive. Every letter was acknowledged and response was achieved within days rather than either weeks or not all. At every stage we went to great lengths to stay one step ahead of the bureaucrats with the result that cordial relations have been maintained. CQC compliance was attained.

So how did this benefit the practice?

There was an increase in

  • Private patients via self referral & GDPs
  • NHS referrals
  • Cash-flow
  • Gross turnover
  • Profitability
  • Staff satisfaction
  • Patient feedback
  • Patient compliance.

A reduction in:

  • Wasted time
  • Bad debts
  • Complaints

One year on the course is set fair, the work has been done and is constantly reviewed, new marketing techniques are introduced, evaluated and persevered, changed or rejected depending upon results.

Next month the People.

Nice video on Kolbe Wisdom

I like this video from Elizabeth Campbell PhD.

The Monday Morning Quote – #121

“You’ve got to get to the stage in life where going for it is more important than winning or losing.”
Arthur Ashe


The Monday Morning Quote – 120

“If you think education is expensive you should try ignorance”

Derek Bok


The Monday Morning Quote – 119

“People are delighted to accept pensions and gratuities, for which they hire out their labour or their support or their services.

But nobody works out the value of time: men use it lavishly as if it cost nothing.”

Seneca – on the shortness of life.

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