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Perio Reports  Vol. 24, No. 4
Perio Reports provides easy-to-read research summaries on topics of specific interest to clinicians.
Perio Reports research summaries will be included in each issue to keep you on the cutting edge
of dental hygiene science.
Neck and Back Pain a Serious Problem for Dentists

Dentists and hygienists work long hours in seated, static positions. The work involves repetitive motions of the fingers and wrists and prolonged awkward postures. Neglecting proper posture and ergonomics leads to musculoskeletal pain. An occasional ache or pain is not a cause for alarm, but ignoring consistent pain and discomfort results in cumulative physiological damage leading to injury or worse, a career-ending disability.

Researchers in the Depar tment of Periodontics at Modern Dental College and Research Centre in Indore, India collected feedback from 500 randomly selected dentists in the state of Madhya Pradesh. Study subjects completed an 11-item questionnaire relating to their experience of work-related pain and also to their usual working positions.

Of these dentists, 91 percent suffered from pain in one or more areas of the body. Neck pain and back pain were each reported by 32 percent, shoulder pain by 21 percent and wrist pain by six percent. Only nine percent of the group reported no pain. Poor ergonomic positioning during clinical work was reported by a majority of subjects.

Periodontists and hygienists are prone to neck, shoulder and wrist pain due to prolonged static positions and forceful repetitive movements. General dentists seem to be more susceptible to lower back and neck injuries. Despite ergonomically designed chairs and equipment, clinicians find themselves consistently bending forward with the head, neck and torso and leaning to one side.

Clinical Implications: Clinicians should become aware of their body position during the day and attempt to counteract the static positions dictated by dentistry.

Kanteskwari, B., Sridhar, R., Mishra, A., Shirahatti, R., Maru, R., Bhusari, P.: Correlations of Awareness and Practice of Working Postures and Prevalence of Musculoskeletal Disorders Among Dental Professionals. Gen Dent Nov/Dec 476-483, 2011.
Head and Neck Problems for Hygienists

Hygienists experience high rates of neck and shoulder disorders, but specific risk factors haven’t been confirmed. Perhaps adding dental assisting experience to a dental hygiene career might be a risk factor. Combining selfreported findings and physician-diagnosed neck and shoulder problems might provide insights.

Researchers in the Department of Community Medicine and Ergonomic Technology Center at the University of Connecticut Health Center enrolled 94 dental hygiene clinicians with at least five years of experience and 66 dental hygiene students. Of the students, 39 had previous experience as dental assistants.

Subjects completed a questionnaire on perceived risk factors and pain and were also examined by a physician to determine the presence of a neck or shoulder disorder. Of those who reported no neck pain, 83 percent were found by the physician to be free of neck problems. More than half of the subjects who reported neck pain also had physical exam abnormalities identified by the physician. Concordance with shoulder pain was not as clear with just over half of those reporting no symptoms being found without abnormalities and 43 percent of those reporting pain being confirmed with a physical diagnosis.

Neck and shoulder disorders were higher in hygienists in clinical practice compared to students. Students with dental assisting background suffered more head and neck problems than other students. Neck disorders were more common than shoulder disorders in this group of hygienists and hygiene students.

Clinical Implications: Hygienists need to be aware of risk factors for neck and shoulder injury and practice ergonomically

Morse, T., Bruneau, H., Michalak-Turcotte, C., Sanders, M., Warren, N., Dussetschleger, J., Diva, U., Croteau, M., Cherniack, M.: Musculoskeletal Disorders of the Neck and Shoulder in Dental Hygienists and Dental Hygiene Students. J Dent Hyg 81; (1): 1-16, 2007.
Chocolate Reduces Risk of Cardiovascular Disease

Chocolate and cocoa contain flavan- 3-ols or flavanols. Not to be mistaken for flavonols which are another class of flavonoids, but the flavonols that contain a ketone group. Flavanols and other non-ketone containing falvonoids are often called bioflavonoids. Researchers in the Norwich Medical School in the University of East Anglia in Norwich, U.K. analyzed research articles dealing with the influence of chocolate and flavanol on risk factors for heart disease. A total of 42 papers were included in the review, with data from nearly 1,300 patients.

Serum insulin levels were found to be reduced with the addition of chocolate to the diet. Blood pressure was also reduced one to three points due to ingestion of chocolate. A small, but positive effect was evident in both HDL and LDL cholesterol levels. Both short-term and long-term eating of chocolate produced these results.

Flow-mediated dilation (FMD) is a measure of endothelial vasodilation and is used to evaluate cardiovascular risk. After a baseline measurement, a cuff is inflated for about five minutes to produce ischemia in the forearm. When the cuff is deflated, the endothelia cells release nitric oxide, a vasodilator. FMD is calculated as the percentage increase in blood vessel diameter due to vasodilation. FMD increased after both one-time and regular chocolate consumption.

Clinical Implications: Besides tasting good, chocolate and cocoa provide positive health benefits.

Hooper, L., Kay, C., Abdelhamid, A., Cohn, J., Rimm, E., Cassidy, A.: Effects of Chocolate, Cocoa, and Flavan-3-ols on Cardiovascular Health: A Systematic Review and Meta-Analysis of Randomized Trials. Am J Clin Nutr 95:(2) online, 2012.
Chocolate is a “Super Fruit”

Fruits are considered “super fruits” based on the their antioxidant capacity. Polyphenols are linked to health benefits and the more a food contains, the healthier it is considered. Chocolate and cocoa powder are made from the fruit of the cacao tree. More precisely, an extract is taken from seeds found in the cacao tree fruit. Although these seeds are called cacao beans, they are actually fruit.

Researchers at the Hershey Center for Health and Nutrition in Hershey, Pennsylvania, compared powders from both cocoa and dark chocolate and other fruit drinks to determine antioxidant levels for each. Fruit drinks included three commercially available brands for each: acai, blueberry, cranberry and pomegranate. No fruit drinks made of more than one fruit were tested. Polyphenol and flavanol content of the powders was measured in the laboratory using fluorescence techniques.

Dark chocolate had higher levels of antioxidants than the fruits and the cocoa powder. The highest antioxidant level among the fruit powders was pomegranate. Cocoa powders tested were comparable to pomegranate drinks for antioxidant levels.

Cocoa powder is often alkalized or “dutched” to mellow the flavor. Alkalizing will reduce the antioxidant value of the cocoa. Only natural, non-alkalized cocoa and chocolate were used in this study.

Clinical Implications: Dark chocolate and natural cocoa powder provide high levels of antioxidants and are therefore considered “super fruits.”

Crozier, S., Preston, A., Hurst, J., Payne, M., Mann, J., Hainly, L., Miller, D.: Cocao Seeds are a “Super Fruit”: A Comparative Analysis of Various Fruit Powders and Products. Chem Cent J 5: 5-10, 2011.
Green Tea Components Reduce Incidence of the Flu

Laboratory research shows promising outcomes for prevention of influenza with green tea catechins. Catechin binds to the virus preventing adsorption to host cells, thus preventing influenza. Theanine enhances systemic immunity. A small clinical trial showed gargling with green tea catechin extracts prevented flu infection in elderly nursing home patients.

Researchers in the School of Pharmaceutical Sciences at the University of Shizuoka in Japan measured the preventive benefits of an oral supplement containing green tea catechins and theanine. The 197 study subjects were health-care workers in a nursing home. Half the group was given capsules containing 378mg of green tea catechins and 210mg of theanine. The other half of the group was given placebo capsules. Subjects took their assigned supplements daily for five months between November and April.

The primary outcome measured was clinical influenza confirmed by a physician. Secondarily were the laboratory confirmation of influenza and the time from baseline to first symptoms. Laboratory confirmation was by measure of viral antigen.

The incidence of influenza was low overall for the entire group, but lowest in the green tea extract group with four cases compared to 13 in the placebo group. One case of influenza was confirmed through laboratory testing in the green tea extract group and five in the placebo group. Influenza in the test group occurred between day 40 and 75 while cases in the control group began at day 10 and continued throughout the study period.

Clinical Implications: Green tea consumption or green tea extract supplements might provide some protection from influenza.

Matsumoto, K., Yamada, H., Takuma, N., Niino, H., Sagesaka, Y.: Effects of Green Tea Catechins and Theanine on Preventing Influenza Infection among Healthcare Workers: A Randomized Controlled Trial. Complement Altern Med 21(11): 15-21, 2011.
Green Tea Linked to Less Depression in the Elderly

For centuries, green tea has been consumed in Asia with the belief it yields significant health benefits. Animal studies show that theanine, a major amino acid in green tea, has a tranquilizing effect on the brain. Other studies show antiinflammatory and stress-reduction effects associated with green tea.

Researchers in the Division of Biomedical Engineering for Health and Welfare at Tohoku University in Japan wanted to know if green tea consumption by the elderly would have a positive impact on controlling psychological depression. They designed a questionnaire for a group of 1,058 Japanese adults who were 70 years of age or older. None of them lived in nursing or group homes. The average age was 74 and 43 percent of the group were men.

Subjects completed a food diary covering 70 foods and beverages consumed over the past month. General health and physical activity questions were also included. They also completed a 30-item Geriatric Depression Scale.

Mild depressive symptoms were found in 34 percent of the group and severe depressive symptoms in 20 percent. Depressive symptoms were 44 percent less in those consuming four or more cups of green tea each day. The beneficial effects might be from the amino acid theanine or something else in the tea. Further studies are needed to determine exactly why green tea provides these beneficial effects.

Clinical Implications: Green tea consumption might have a potentially beneficial effect on the prevention of depressive symptoms.

Niu, K., Hozawa, A., Kuriyama, S., Ebihara, S., Guo, H., Nakaya, N., Ohmori- Matsuda, K., Takahashi, H., Masamune, Y., Asada, M., Sasaki, S., Arai, H., Awata, S., Nagatomi, R., Tsuji, I.: Green Tea Consumption is Associated with Depressive Symptoms in the Elderly. Am J Clin Nutr 90 (6):1615-1622, 2009.
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