WHAT IS MISSING IN YOUR COMPREHENSIVE DENTAL EXAM?

A truly professional comprehensive dental exam examination (D0150 or D0180) should include much more than what the CDT codes delineate.
What is essential?
Beyond the obvious FMX, the charting of existing and needed dental and periodontal conditions, and an oral cancer screening, there are many other useful evaluations which are directly related to our services and are within our range of authority and responsibility. 
The Comprehensive Exam should also include measurement of vitals such as blood pressure, a sleep dysfunction (Obstructive Sleep Apnea) screening such as the Epworth Sleepiness Scale, a nutritional analysis and a careful discussion of any notable items (alerts) in the patient’s med history. These things don’t need to be spelled out in the CDT code. They come with our desire to do what we know is right. .
11-27-11 APPLE A DAY
  TMJ exam, facial muscle palpation, Mallampati classification (of the airway entrance) and 
an oxygen saturation test will provide critical information.  Any dentist/hygienist will chose how extensive they wish their dental exams to be and what should be included.
Would we be “spending too much time” in a dental exam visit?

Not if we care about our patient’s total well being, about our conscience, and about our dental license.

And is this nearly always accepted by patients as hugely valuable and with appreciation?     YES, it is, where the dental team shows their patients how much passion, care and skill they have. I see it in many dental offices.    The really successful ones.

5-20-12 HUMAN PYR

A Hygienist is in a uniquely key position.
Here’s your opportunity to increase your service to your community, to create your “niche”, and  to stand out in your community as a complete care-giver.
It is reported that 34% of the population has Sleep Apnea symptoms. 
One of the next three patients that walk thru your doors is a Sleep Apnea victim. Are you able to help them?
Does your New Patient Exam include a screening for Sleep Apnea?
1-21-13 LOGO DENTAL PROS SHARING

Interested? Then check this out:   www.sleepgs.com

HOW TO BENEFIT FROM THE END OF DST


The days are getting shorter. Darkness arrives earlier.in the evening. Daylight Saving Time ends on November 2nd and we turn our clocks back one hour. When we wake up Sunday morning it will be a little darker than yesterday morning. We’ll have one extra hour for sleep.
10-29-13 fall-back 3
In order to fulfill the essential number of regenerating sleep cycles the average adult needs 7-8 hours. A five stage sleep cycle repeats consistently throughout the night. One complete sleep cycle lasts about 90 minutes. So during an average night’s sleep (8 hours), an adult will experience about four or five cycles of sleep.


A Little History of Daylight Saving Time
The concept of setting the clocks ahead in the spring in order to make better use of natural daylight was first introduced in the US by inventor Benjamin Franklin in 1784.

12-30-11 Benjamin_Franklin_1767During his time as an American envoy to France, Ben Franklin publisher of the old English proverb, “Early to bed, and early to rise, makes a man healthy, wealthy and wise” anonymously published a letter suggesting that Parisians economize on candles by rising earlier to use morning sunlight. This 1784 satire proposed taxing shutters, rationing candles, and waking the public by ringing church bells and firing cannons at sunrise.
US President Franklin D. Roosevelt instituted year-round DST in the United States, called “War Time” during World War II from February 9, 1942 to September 30, 1945. The change was implemented 40 days after the bombing of Pearl Harbor and during this time, the U.S. time zones were called “Eastern War Time”, “Central War Time”, and “Pacific War Time”. After the surrender of Japan in mid-August 1945, the time zones were relabeled “Peace Time”.
Congress decided to end the confusion and establish the Uniform Time Act of 1966 that stated DST would begin on the last Sunday of April and end on the last Sunday of October. However, states still had the ability to be exempt from DST by passing a local ordinance.
Healthy nights of sleep are essential to recharge our human organs and maintain good health and longevity. 

 This fall, dentists have the opportunity to spring forward with Dental Sleep Medicine and help the millions of their Sleep Apnea victims. 

Upcoming training seminars by DSM experts are available in the following cities:


Oklahoma City    Dr.Damian Blum
Atlanta                Dr. Marty Lipsey
Hollywood, FL     Dr. Dan Tache’
Boston               Dr Barry Freydberg
Indianapolis        Dr. George Jones
Orlando              Dr Anjoo Ely
LIP 8
You can view the dates and course outlines and register here:
http://sleepgroupsolutions.com/2.0/modules/piCal/index.php?smode=&op=&cid=2

 

BUFFALO- Are you able to help these patients?

Does your New Patient Exam include a screening for Sleep Apnea? 
It is reported that 34% of the population has SA symptoms. Of the next three patients 
that walk thru your doors, one is a Sleep Apnea victim.  Are you able to help them?
1-29-13  SNORING
In a 2 day seminar Dr. Marty Lipsey presents a Dental Sleep protocol A to Z, 
                                    including his unique systems on 
                  Medical Insurance billing- Codes, Fees and Procedures.

                     Friday and Saturday, July 25 and 26 in Buffalo, NY
7-18-14 BUFFALO NITE SKY Dentists are in the first line of discovery and defense of many systemic diseases. 
We are often the first ones to discover diabetes, oral cancer, SLEEP APNEA. 
The three serious conditions listed above are all too frequently under-diagnosed. 
New tools and techniques are now available for dental professionals to be able to 
do far more as comprehensive caregivers for their patients. 
Sleep Apnea Screening
--Patients are realizing how a blockage of oxygen to the brain, caused by 
nocturnal apnoeic events, can influence systemic damage. 
-Sleep Apnea is connected to strokes, cardiac arrest, diabetes, dementia and 
motor vehicle accidents. 
-The public asks their dentists for help and most dentists are unprepared. 
- Less than 1% of practicing dentists are trained and qualified to screen and treat 
the over 40 million victims of Sleep Apnea.
                                     -Are you prepared to help them? 

LIP 5In a 2 day seminar Dr. Lipsey will train you in Dental Sleep Medicine with 16 CE credits. 
                   Friday and Saturday, July 25 and 26 in Buffalo, NY


Review the course outline and register here:
http://sleepgroupsolutions.com/2.0/modules/piCal/index.php?smode=
Daily&action=View&event_id=0000004261&caldate=2014-7-18 Dr. Marty Lipsey Dr. Marty Lipsey, received his DDS degree from UCLA and a Master of Science 
from Northwestern University Dental School. Dr. Lipsey is the founder of 
Dental Sleep Med Systems, offering dental teams assistance in implementing and 
improving dental sleep medicine practices, including electronic medical billing 
and successful insurance coding and processing. Dr. Lipsey is also a 
Sleep Group Solutions Instructor, and teaches Dental Sleep Medicine regularly.
                  Are you providing a Comprehensive Exam?
11-26-13 DOS EQUOS

SIZE MATTERS- Sleep, Longevity and Telomere Length

Size matters. 
That old quip has been used, misused and abused. But when it comes to the size 
of your telomeres, nothing could be more important to you. The length of your 
telomeres can determine how long and how well you will live. 
Longevity and Quality of Life.

Telomeres are little protective caps at the ends of your chromosomes. They are 
likened to the aglets at the ends of your shoe laces, protecting your laces from 
fraying.
  5-1-14 TELOMERE 1In the journal Sleep, January issue, there are several studies relating sleep to 
telomere length (TL). 
One study shows the connection of sleep to longevity. The evidence is piling 
up that the aging process may be accelerated by not getting enough 
quality sleep.
"Telomeres are the DNA-protein structures located like caps at the ends of chromosomes. 
They shorten with aging and may also be a marker of biological, not chronological, aging. 
They are believed to be involved in protecting the chromosome  from inflammation and various 
stressors. In some studies, their diminishing length has been associated with 
diabetes and atherosclerosis."

The study demonstrated that poor sleepers, as defined by poor sleep quality or short duration 
(less than 7 hours per night), had significantly shorter telomere length. Even more interesting 
was the finding that in the older adults, adequate sleep was associated with telomere lengths 
comparable to middle-aged adults. The authors concluded that the study provides evidence that 
sleep is linked to cellular aging.
With Sleep Apnea, you are starving your body of oxygen and are being jarred closer to consciousness at least 6 times an hour. With normal regenerative sleep, you should
be enjoying a heightened anabolic (building up and restoring) state, with growth and rejuvenation of the immune, nervous, skeletal and muscular systems. The dozens of near-awakenings keep the Sleep Apnea sufferer in a vigilant and catabolic (breaking down and using up) state that should be reserved for the on-the-go, waking hours.
The telomere shortening mechanism normally limits cells to a fixed number of divisions, and animal studies suggest that this is responsible for aging on the cellular level and sets a limit on lifespans. 
We know that telomeres shorten with biological aging. We also know that they 
shorten in response to chronic inflammation and oxidative stress. In fact, even 
the telomeres of newborns exposed to physiological stressors in utero have 
been found to be shorter. We also have learned that the shortening of telomeres 
can result in increased susceptibility to tissue damage, including cancer.

 Telomeres protect chromosome ends from being mistaken for broken pieces of 
DNA that would otherwise be fixed by cellular repair .  When the telomeres get 
short enough, our cells no longer divide and our body stops making those cells. 
Over time, this leads to aging and death.
5-1-14 TELOMERE 2               Magnification of Chromosomes showing Telomeres
It is becoming increasingly obvious that not getting enough quality sleep will cause systemic destruction and may accelerate the aging process.
What is “enough quality sleep”? Stay tuned in.
References
  1. AtGoogleTalks, August 20, 2008 Molecular biologist Elizabeth Blackburn
  2. Passarge, Eberhard. Color atlas of genetics, 2007.
  3. Blackburn AM (March 1978). “A tandemly repeated sequence at the termini of the extrachromosomal ribosomal RNA genes in Tetrahymena”. J. Mol. Biol. 120 (1): 33–53. doi:10.1016/0022-2836(78)90294-2. PMID 642006.
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  21. BBC, World/Mundo. “Resuelven misterio sobre el origen del cáncer de mama”.
  22. Kannan, Nagarajan; Nazmul Huda, LiRen Tu, Radina Droumeva, Geraldine Aubert, Elizabeth Chavez, Ryan R. Brinkman, Peter Lansdorp, Joanne Emerman, Satoshi Abe, Connie Eaves, David Gilley (4 June 2013). “The Luminal Progenitor Compartment of the Normal Human Mammary Gland Constitutes a Unique Site of Telomere Dysfunction”. Stem Cell Reports 1 (1): 28–31. doi:10.1016/j.stemcr.2013.04.003. PMID 24052939.
  23. Richter T, von Zglinicki T (2007). A continuous correlation between oxidative stress and telomere shortening in fibroblasts. Exp Gerontol 42(11):1039-1042. PMID 17869047
  24. Shen J, Gammon MD, Terry MB, Wang Q, Bradshaw P, Teitelbaum SL, Neugut AI, Santella RM. Telomere length, oxidative damage, antioxidants and breast cancer risk. Int J Cancer. 2009 Apr 1; 124(7):1637-43/ijc.24105
  25. Cawthon RM, Smith KR, O’Brien E, Sivatchenko A, Kerber RA (2003). Association between telomere length in blood and mortality in people aged 60 years or older. Lancet 361:393-395
  26. Hayflick L, Moorhead PS (1961). “The serial cultivation of human diploid cell strains”. Exp Cell Res 25 (3): 585–621. doi:10.1016/0014-4827(61)90192-6. PMID 13905658.
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  28. Feng J, Funk WD, Wang SS, Weinrich SL, Avilion AA, Chiu CP, Adams RR, Chang E, Allsopp RC, Yu J (September 1995). “The RNA component of human telomerase”. Science 269 (5228): 1236–41. doi:10.1126/science.7544491. PMID 7544491.
  29. Bodnar, A.G., M. Ouellette, M. Frolkis, S.E. Holt, C.P. Chiu, G.B. Morin, C.B. Harley, J.W. Shay, S. Lichtsteiner, and W.E. Wright. 1998. Extension of life-span by introduction of telomerase into normal human cells” Science 279:349–352. doi:10.1126/science.279.5349.349
  30. Sample, Ian (November 28, 2010). “Harvard scientists reverse the ageing process in mice – now for humans”. The Guardian (London).
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  33. Nakagawa S, Gemmell NJ, Burke T (September 2004). “Measuring vertebrate telomeres: applications and limitations”. Mol. Ecol. 13 (9): 2523–33. doi:10.1111/j.1365-294X.2004.02291.x. PMID 15315667.
  34. Juola, Frans A; Haussmann, Mark F; Dearborn, Donald C; Vleck, Carol M (2006). “Telomere shortening in a long-lived marine bird: Cross-sectional analysis and test of an aging tool”. The Auk 123 (3): 775. doi:10.1642/0004-8038(2006)123[775:TSIALM]2.0.CO;2. ISSN 0004-8038.
  35. Gomes NM, Ryder OA, Houck ML, Charter SJ, Walker W, Forsyth NR, Austad SN, Venditti C, Pagel M, Shay JW, Wright WE (2011). Comparative biology of mammalian telomeres: hypotheses on ancestral states and the roles of telomeres in longevity determination. Aging Cell 10(5) 761-768. doi: 10.1111/j.1474-9726.2011.00718.x. PMID 21518243
  36. Harris SE, Martin-Ruiz C, von Zglinicki T, Starr JM, Deary IJ (2010). Telomere length and aging biomarkers in 70-year-olds: the Lothian Birth Cohort 1936. Neurobiol Aging 33(7) 1486.e3-8. PMID 21194798
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  38. Raynaud CM, Sabatier L, Philipot O, Olaussen KA, Soria JC (2008) Telomere length, telomeric proteins and genomic instability during the multistep carcinogenic process. Crit Rev Oncol Hematol 66: 99–117.
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  40. Artandi SE, Chang S, Lee SL, Alson S, Gottlieb GJ, et al. (2000) Telomere dysfunction promotes non-reciprocal translocations and epithelial cancers in mice. Nature 406: 641–645.
  41. Willeit Peter, Willeit Johann, Mayr Anita, Weger Siegfried, Oberhollenzer Friedrich, Brandstätter Anita, Kronenberg Florian, Kiechl Stefan (2010). “Telomere length and risk of incident cancer and cancer mortality”. JAMA 304 (1): 69–75. doi:10.1001/jama.2010.897. PMID 20606151.
  42. Ma H, Zhou Z, Wei S, et al. Shortened telomere length is associated with increased risk of cancer: a meta-analysis. PLoS One. 2011;6(6):e20466.
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  45. Paul L. Diet, nutrition and telomere length. J Nurt Biochem. 2011 Oct;22(10):895-901. doi: 10.1016/j.jnutbio.2010.12.001. Epub 2011 Mar 22.
  46. Epel ES, Lin J, Wilhelm FH, Wolkowitz OM, Cawthon R, Adler NE, Dolbier C, Mendes WB, Blackburn EH. Cell aging in relation to stress arousal and cardiovascular disease risk factors. Psychoneuroendocrinology. 2006 April; 31(3):277-87.
  47. Ornish D, Lin J, Chan JM, Epel E, Kemp C, Weidner G, Marlin R, Frenda SJ, Magbanua MJ, Daubenmier J, Estay I, Hills NK, Chainani-Wu N, Carroll PR, Blackburn EH. Effect of comprehensive lifestyle changes on telomerase activity and telomerelength in men with biopsy-proven low-risk prostate cancer: 5-year follow-up of a descriptive pilot study. Lancet Oncol. 2013 Oct;14(11):1112-20. doi: 10.1016/S1470-2045(13)70366-8. Epub 2013 Sep 17.
  48. Ornish D, Lin J, Daubenmier J, Weidner G, Epel E, Kemp C, Magbanua MJ, Marlin R, Yglecias L, Carroll PR, Blackburn EH. Increased telomerase activity and comprehensive lifestyle changes: a pilot study. Lancet Oncol. 2008 Nov;9(11):1048-57. doi: 10.1016/S1470-2045(08)70234-1. Epub 2008 Sep 15
  49. Henson JD, Neumann AA, Yeager TR, Reddel RR (2002). “Alternative lengthening of telomeres in mammalian cells”. Oncogene 21 (4): 598–610. doi:10.1038/sj.onc.1205058. PMID 11850785.
  50. Chris Molenaar, Karien Wiesmeijer, Nico P. Verwoerd, Shadi Khazen, Roland Eils, Hans J. Tanke, and Roeland W. Dirks (2003-12-15). “Visualizing telomere dynamics in living mammalian cells using PNA probes”. The EMBO Journal (The European Molecular Biology Organization) 22 (24): 6631–6641. doi:10.1093/emboj/cdg633. PMC 291828. PMID 14657034.
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  52. Chin L, Artandi SE, Shen Q, et al. (May 1999). “p53 deficiency rescues the adverse effects of telomere loss and cooperates with telomere dysfunction to accelerate carcinogenesis”. Cell 97 (4): 527–38. doi:10.1016/S0092-8674(00)80762-X. PMID 10338216.
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  64. “Elizabeth Blackburn calls time on ‘fountain of youth’ firm Telome Health”.



 

 

TWO SIGNIFICANT INDICATORS OF SLEEP APNEA- BMI and NECK CIRCUMFERENCE. Calculate them here:

The Body Mass Index (BMI) appraisal is one of the most widely used tools to measure healthy body weight. This ratio of height to weight will help assess whether you are underweight, normal weight or overweight.

 The higher the BMI, the greater the risk of some diseases, including:
Sleep Apnea, Stroke, High blood pressure, Coronary artery disease, Osteoarthritis, Some cancers,  Diabetes type 2
1-30-14 OBESE
Sleep Apnea awareness is “contagious”. As more and more people learn about SA, doctors are driven to get training and certification to be able to discover and treat this disease. Less than 1 % of doctors are trained in Sleep Medicine to help the 40 million people afflicted with SA.
1-21-13 LOGO DENTAL PROS SHARING
 Here is a BMI calculator, from the Mayo Clinic, that you can use to determine your (or a child’s) BMI. http://www.mayoclinic.com/health/bmi-calculator/NU00597
Take the assessment, then rate yourself (below).
Category BMI range – kg/m2 BMI Prime
Very severely underweight less than 15 less than 0.60
Severely underweight from 15.0 to 16.0 from 0.60 to 0.64
Underweight from 16.0 to 18.5 from 0.64 to 0.74
Normal (healthy weight) from 18.5 to 25 from 0.74 to 1.0
Overweight from 25 to 30 from 1.0 to 1.2
Obese Class I (Moderately obese) from 30 to 35 from 1.2 to 1.4
Obese Class II (Severely obese) from 35 to 40 from 1.4 to 1.6
Obese Class III (Very severely obese) over 40 over 1.6

Each unit increase in BMI is associated with a 14% increased risk of developing sleep apnea, and a 10% weight gain increases the odds of developing moderate or severe obstructive sleep apnea by six times. Compared to normal-weight adults, those who are obese have a sevenfold increased risk of developing obstructive sleep apnea.
NECK CIRCUMFERENCE
 Taking neck measurements is inexpensive, easy to obtain and could indicate health problems like sleep apnea, says one study.
BMI isn’t the sole marker of obesity that’s important. Men with a neck circumference above 16.5 inches (43 centimeters) and women with a neck circumference above 15 inches (38 centimeters) also have a significantly increased risk of developing obstructive sleep apnea.  That is because a thick neck may narrow the airway.
1-30-14 neck-circumference.jp g
MEN- What size shirt do you wear?

A VICIOUS CYCLE: Sleep Apnea, Sleepiness, Anxiety, Caffeine and Bruxism

We know there is a correlation between bruxism and sleep apnea, but how does the one contribute to the other?

It has been observed that a third of bruxism patients also suffer from sleep disorders like sleep apnea, restless legs syndrome, etc. Bruxism may be the effect or the cause of many types of sleep disorders including obstructive sleep apnea, snoring, daytime lethargy.

The effects of stress, anxiety and caffeine ingestion come into play here. Studies link high anxiety levels to bruxism, and the symptoms of sleep apnea itself may cause anxiety. Additionally, the daytime sleepiness caused by apnea may lead to high levels of caffeine consumption which, in turn, is linked to a high risk of bruxism. This is the vicious cycle.

12-18-13 HANDS ON HEADThe relationship between sleep bruxism and sleep apnea can be attributed to an arousal response. When an apnea event ends, various oral phenomena may occur: snoring, gasping, choking, grunting and teeth grinding. Immediately after the apnea episode, a physiological compensation occurs. The jaw will open and close, thus dilating the upper airway in order to facilitate normal breathing.  The patient then pushes the tongue forward to move away from the air tract and forces it against the teeth.
12-15-13 NOCT. BRUX man in bed

Research has shown that increase of teeth grinding is directly proportional to the increase of frequency of apnea episodes.The results of these studies suggest that when sleep bruxism is related to apnea/hypopneas, the successful treatment of these breathing abnormalities may eliminate bruxism during sleep.

WHAT IS MISSING IN YOUR COMPREHENSIVE DENTAL EXAM?

A truly professional comprehensive dental exam examination (D0150 or D0180) should include much more than what the CDT codes delineate.
What is essential?
Beyond the obvious FMX, charting of existing and needed dental and periodontal conditions, and an oral cancer screening,there are many other evaluations which are directly related to our services and are within our range of authority and responsibility. 
The Comprehensive Exam should also include measurement of vitals such as blood pressure, etc., sleep dysfunction screening such as the Epworth Sleepiness Scale, and a careful discussion of any notable items (alerts) in the patient’s med history. These things don’t need to be spelled out in the CDT code. They come with our desire to do what we know is right. If I were still practicing today I would certainly perform these and a nutritional analysis.

11-27-11 APPLE A DAY

  TMJ exam, facial muscle palpation,Mallampati classification  (correlates tongue size to pharyngeal size) and
an oxygen saturation test will provide critical information.  Any dentist/hygienist/team will chose how extensive they wish their dental exams to be and what should be included.
Would we be “spending too much time” in a dental exam visit?

Not if we care about our patient’s total well being, our conscience, and our dental license.

And is this “nearly always accepted by patients with huge value and appreciation”? YES, it is, where the dental team shows their patients how much passion, care and skill they have. I see it in many dental offices. The really successful ones.5-20-12 HUMAN PYR

Do you want to do more?
Here’s your opportunity to increase your service to your community, to create your “niche”, and  to stand out in your community as a complete care-giver.
It is reported that 34% of the population has SA symptoms.
One of the next three patients that walk thru your doors is a Sleep Apnea victim. Are you able to help them?
Does your New Patient Exam include a screening for Sleep Apnea?
1-21-13 LOGO DENTAL PROS SHARING

Interested? Then check this out: http://sleepgroupsolutions.com/2.0/

High Blood Pressure Linked to Sleep Apnea

3-24-14 SNORING

May is High Blood Pressure Awareness week.

Javier Nieto, MD, associate professor, Epidemiology, Johns Hopkins School of Public Health said, “The connection [to Sleep Apnea] is important because high blood pressure can lead to serious adverse health consequences, including heart attack, stroke, and kidney disease.”

In a study involving more than 6,000 adult men and women age 40 or older, he presence of sleep apnea was detected using polysomnography, which simultaneously records brain waves, heart waves, blood oxygen levels, and breathing rate while a person sleeps.

10-25-11 SUGAR

High Blood pressure? Salt is the killer.

http://www.jhsph.edu/news/news-releases/2000/apnea-hypertension.html

RECENT FINDINGS: Periodontal Spirochetes definitively linked to Alzheimer’s disease.

  Periodontal Spirochetes definitively linked to Alzheimer’s disease.

 

For several years dentists and hygienists have been making the public aware of the connection between Periodontal (gum) Disease and many other systemic diseases. It is well documented that the same bacteria (primarily spirochetes) that harbor in the gums and are directly related to heart disease, strokes, lung disease, kidney failure, and premature underweight births.

After all this time, insurance companies still have little regard for the treatment of periodontal disease, which we know is the main cause of tooth loss, a major contributor to the many systemic diseases, and recently connected to Altzheimer’s Disease. The inadquate coverage by most insurance companies discourages patients from accepting essential periodontal services.
 
Here is a technical report from The Journal of Neuroinflammation, August 2011, which is well documented: “Alzheimer’s disease – a neurospirochetosis.”
 
 
Spirochete under magnification by phase microscope.
 
 
The association of spirochetes with Alzheimer’s disease.
The frequency of spirochetes is significantly higher in the brains of
Alzheimer patients compared to controls. The statistical analysis is
based on the cumulative data of the literature entered in the table
The association is statistically significant in the four groups analyzed:
in the group where all types of spirochetes were detected using
neutral techniques (All spirochetes), in the group of oral periodontal
pathogen spirochetes (Oral spirochetes
), in the group where Borrelia
burgdorferi was detected alone (B. burgdorferi) and in the group
where all studies were considered (All studies).
 
FOR A QUICK SUMMARY CONCLUSION SEE : Periodontal pathogen spirochetes (pg 3)
The American Dental Association reports that over 85% of the adult population has some degree of Periodontal Disease. A complete “Perio Exam” can be performed by a Dentist or Hygienist.