Smoking is one of the biggest threats to public health, killing more than 8 million people yearly. Tobacco's nicotine is also a significant risk to oral health that makes it difficult to treat and detect serious gum diseases at their early stages.

All forms of tobacco are equally harmful to health, says Marja Juselius, an oral hygienist who has worked with young patients in Finland for many years. The No Tobacco Day, launched by the World Health Organisation (WHO) and celebrated annually on 31 May, is an important  reminder of this.

- Nicotine addiction is a key reason people continue using nicotine products. This also puts oral health on constant alert and increases the risks of gingivitis, mucosal changes, and decay.

Juselius points out that smoking and snus use, especially among young people, is linked to peer pressure: many people start smoking and using snus "because their friends do it also ."On the other hand, the motivation to quit can also come from friends who want to quit smoking.

It is widely known that nicotine products worsen oral and general diseases, but smokers rarely look into their mouths and notice the changes that occur there.

- Changes in the mouth happen gradually and do not necessarily "feel" like anything. That's why it's so important to have regular dental check-ups, Juselius encourages especially smokers.

Nicotine weakens the body's defenses

Tobacco, cigars, pipes, e-tobacco, and snuff weaken the body's defenses. This means that wounds - for example, after tooth extractions, tartar removal, and gum surgery – heal more slowly. Snuff also causes creases on the mucous membranes where oral bacteria easily accumulate, causing severe infections. All tobacco products increase the risk of oral cancer and reduce the effectiveness of cancer treatments.

Nicotine can also cause fungal infections and other changes in the oral mucosa, which can be precursors to oral cancer in the worst cases, says Juselius. 

Alcohol use increases the risk of mouth cancer even further. The combined effects of tobacco and alcohol account for around three-quarters of oral cancer cases. Heavy drinkers and smokers are 38 times more likely to develop the disease, studies have shown.

If nicotine products are used, and oral hygiene is not maintained, this can lead to the onset of periodontitis, even tooth loss. According to Juselius, this is why many smokers are missing teeth.

Gradually progressive periodontitis

The primary symptom of gingivitis is bleeding of the gums, but in smokers, this symptom can easily go unnoticed. The nicotine in tobacco impairs the blood supply to the gums, so gingivitis is not detected in time. This allows the gum disease to progress into periodontitis. Gum changes caused by periodontitis are permanent. Careful oral hygiene combined with professional treatment can help prevent the progression of the disease, but there is no real cure for it.

Juselius notes that gum disease can cause the gums to recede, exposing the neck of the tooth, which can become stained and easily decayed. If a smoker goes through dental implant surgery, the healing process is also slowed by nicotine-induced gingivitis, and the risk of complications increases.

All forms of tobacco are equally harmful, and there is no safe level of exposure to tobacco. Cigarette smoking is the most common form of tobacco use worldwide. 

- Using snus instead of smoking is not an alternative to quitting. Snus contains up to 20 times more nicotine, which is immediately absorbed through the mucous membranes into the bloodstream. 

Nicotine users often say that nicotine products are stimulating, but the feeling is that they relieve withdrawal symptoms. Athletes often use snus instead of smoking. 

- Studies have found, however, that snus users have about 20% lower sporting performance than those who do not use snus. This is due to the circulatory system's inability to transport oxygen to the muscles, which reduces the oxygen supply and impairs sports performance, says Juselius.

Marja Juselius admits that it can be challenging to quit using tobacco products. 

- However, you should not be discouraged by failures. It is essential to always try again. A variety of nicotine replacement therapies on the market may be suitable for you. It is important to read the instructions carefully to use the products correctly. 

- Health professionals will also help you to quit, if necessary, and will also encourage you to find ways to stop using nicotine products. Regular dental check-ups are essential so that even the slightest changes in the gums and teeth can be detected and addressed early.

Why quit smoking? Tips from an expert:

Tobacco products stain the surfaces of teeth, fillings, and dentures. The stains lead to discoloration of the enamel and cannot be removed by regular cleaning. Even if the stains can be cleaned, they will easily re-stain if the use of nicotine products continues. 

The sense of taste in the mouth may be impaired but will recover after quitting tobacco products. Many people consume lozenges or breath mints to freshen their breath, but these products often contain sugars that can cause tooth decay. 

Cigars and pipes are smoked for a long time, which means that toxic chemicals are inhaled for an extended period, and the effects of these substances last long in the mouth. Cigars also contain more nicotine, tar, and carbon monoxide than cigarettes. Pipe tobacco contains more nicotine than other forms of tobacco. Passive smoking also causes serious health problems like respiratory infections and asthma.

E-cigarettes contain nicotine, propylene oxide, and other chemicals that are cancer-causing carcinogens, among other things, and therefore should not be used for quitting tobacco.

The use of e-cigarettes contributes to and maintains nicotine dependence. E-tobacco also reduces saliva secretion, accumulating large amounts of bacterial plaque on teeth surfaces, causing gingivitis, tartar, and tooth decay. 

Oral hygienist Marja Juselius.

References:

Jiang X, Wu J, Wang J, Huang R. Tobacco and oral squamous cell carcinoma: A review of carcinogenic pathways. Tob Induc Dis. 2019 Apr 12;17:29. doi: 10.18332/tid/105844. PMID: 31582940; PMCID: PMC6752112.

Mu, G., Wang, J., Liu, Z. et al. Association between smokeless tobacco use and oral cavity cancer risk in women compared with men: a systematic review and meta-analysis. BMC Cancer 21, 960 (2021). https://doi.org/10.1186/s12885-021-08691-x

Finnish health technology company Koite Health Oy has signed a distribution agreement with a Danish distributor of specialized dentistry products in the tissue regenerative and surgical fields, such as dental implantology. Following the accord, Puredent ApS will also offer Lumoral® – the latest technology for improved oral health self-care – to consumers and oral health professionals in the Danish and Icelandic markets.

– Common to the solutions that we offer is that they can differentiate clinics from other clinics and help their patients reach better oral health, says Thomas Boas, Founder and CEO of Puremedical Group ApS.

Puredent is part of the Danish Puremedical Group – a company that operates in the dentistry, medical and veterinary fields. Thus far, the company's dentistry business has offered solutions mainly for the dental repair and restoration segments. Following the Lumoral agreement, Puredent will focus more marketing efforts on the continuously growing preventative oral care market in Denmark and Iceland. 

According to Boas, Lumoral is a unique product that helps prevent and treat common oral diseases such as gingivitis, periodontitis, and dental caries. 

Dental caries is the most common infectious disease in the world. According to the World Health Organisation (WHO), severe periodontal diseases are estimated to affect around 19% of the global adult population, representing over 1 billion cases worldwide. The main risk factors for periodontal disease are poor oral hygiene and tobacco use.

Boas notes that Lumoral fits well in the company's product line as more and more dentists and medical physicians are beginning to understand the close link between oral and general health. This also means that a growing number of dentists are starting to put increased emphasis on oral disease prevention.

Boas stresses that the current dental market situation differs from the pre-Covid-19 era five years ago. This is when Puredent first sought to enter the preventive oral health market with an innovative diagnostics test that reveals whether a person has periodontal disease or not in their mouth. The so-called Matrix metalloproteinase-8 immunological test (aMMP-8) developed by Dr. Timo Sorsa – Professor of Periodontology at Helsinki University and Karolinska University – helps detect whether there is a periodontal degradation process taking place in a person's gum pocket before it is even possible to see visually.

Professor Sorsa is one of the most respected periodontal researchers in the world. He has been developing and patenting many solutions for treating periodontitis, including the most validated clinical test for active periodontitis identification. 

– The market in Denmark was not ready then, but it is ready now. Increased knowledge of the link between oral diseases and general health encourages oral health professionals to provide early diagnosis and preventive care. This is where both the antibacterial Lumoral method and the aMMP-8 diagnostics test come in handy,  Boas notes.

According to Boas, even the Danish Association of Dentists is pushing the "Healthy Mouth, Healthy Body" theme today.

– Lumoral is a novel product category in preventative oral care. Minimal effort can have a significant effect. If you look at this from the dentists' point of view, Lumoral is a way to improve their patient's overall health as home care between the dental appointments.

According to Boas, the signed distribution deal helps to bridge Puremedical Group's dentistry and medical businesses closer together and create synergy benefits. 

Thomas Boas, Founder and CEO of Puremedical Group ApS.

Lumoral – a novel, cutting-edge technology 

The agreement between Koite Health and Puredent includes all activities necessary to launch a novel medical device and a new technology in the Danish and Icelandic markets. According to Boas, the agreement will initially mean focusing on B2C operations, making the Lumoral method available to the Danish consumer and Icelandic users through a local partner of Puredent.

Through extensive communication, the company seeks to ensure that dental professionals in the Danish B2B market are also introduced early to the benefits of Lumoral treatment so that they can start recommending the treatment to their patients.

Boas points out that good oral hygiene requires adequate motor and mental skills. For example, flossing or brushing can be difficult because of age or physical disability, leaving bacteria-filled dental plaque between teeth. On the other hand, even when brushing teeth perfectly, studies show that an effective electric toothbrush only removes about 65% of harmful oral bacteria.

– With Lumoral you can't go wrong. This is why the Lumoral method is so unique. With brushing and flossing, you must follow strict procedures (twice a day, 7 days a week, 2 minutes tooth brushing) to remove plaque efficiently from your mouth and reach optimal oral health. Still, the efforts might not be enough. With Lumoral you just swish the mouthwash in your mouth and then let the antibacterial effect of the mouthpiece do its work.

Boas says that it is crucial that scientific evidence of Lumoral's efficacy is communicated directly to dental professionals to help spread the message of Lumoral's scientifically proven effect on oral health. Several scientific studies that clearly show the clinical impact of Lumoral's antibacterial dual light therapy have already been released.

Lumoral is changing the future of dental care at home

Research shows that Lumoral's antibacterial aPDT phototherapy effectively eliminates harmful bacteria in the mouth while treating advanced gum disease. Similar light-activated antibacterial treatments have been used in dental clinics, for example. However, the problem has been the cost and frequency of these treatments to provide sufficient efficacy. 

Preventive health care, which includes the use of the antibacterial Lumoral method to improve oral hygiene, will quickly pay for itself. Preventive oral health care also brings significant savings to society. This applies not only to dental care but to the entire healthcare system. Lumoral supports regular mechanical dental hygiene, helps achieve gum health, and prevents inflammation when regular dental hygiene is insufficient.

Puredent aims at providing its customers with the best possible modern treatment for oral diseases.  

Boas sees multiple groups of people who can benefit most from using Lumoral. These include patients undergoing orthodontic treatment, patients into fitness sports and promoting healthy living habits, elderly patients with limited motor abilities, and competitive athletes as well as patient groups in cancer, diabetes and rheumatoid arthritis.

– The timing of this cooperation is likely to be very good. This cooperation is an exciting tool for expanding into the prevention business.

Sakari Nikinmaa, Koite Health's CEO, the partnership agreement's benefits are mutual. Partnership with Thomas Boas and his Puredent team are an important step for Lumoral to strengthen its reach in the Scandinavian market.

– Our strategy is to partner with industry leaders to raise awareness among professionals about the Lumoral product and its benefits and to build a global sales structure to secure product availability globally.

– By working together, we can take oral health to a new level and provide patients with the best possible treatment experience and outcomes. Koite Health's clinical results and Puredent's expertise and organization are perfectly combined with Lumoral's unique features and efficiency, says Nikinmaa.

Sakari Nikinmaa, Co-founder and CEO of Koite Health Oy.

A healthy mouth is linked to overall health and well-being. Especially for people with long-term illnesses, such as Inflammatory Bowel Disease (IBD), oral and dental health is essential for maintaining general health and managing the underlying chronic illness. For Laura Jalasto, an athlete from Finland diagnosed with IBD, good oral and dental hygiene is especially important.

The association between IBD and periodontal disease is starting to emerge in recent scientific literature. Due to the inflammatory nature of both disorders, it is hypothesized that underlying IBD can trigger a raised basal cytokine response that can induce periodontal disease (1). 

Several studies have been conducted to explore this relationship further. For instance, a German study has identified that twice as many patients with IBD had clinical attachment loss >5 mm compared to those without IBD (2). Other studies have shown that IBD patients have a higher prevalence of periodontal disease, deeper gum pockets, and more clinical attachment loss – a key symptom of periodontitis and peri-implantitis.

Laura Jalasto is one of the best triathletes in Finland today. She has won Ironman Tallinn 2020 and Ironman Mallorca 2021, among other major Triathlon competitions. 

- I have been a goal-oriented athlete all my life. In my childhood, I was a skier and later a horseback rider. Triathlon came into the picture four years ago. I did my first full-distance Ironman competition three years ago, says Jalasto. 

Last October, Jalasto competed in the full-distance Triathlon World Championships in Kona, Hawaii, bringing home a World Championship bronze medal in the W40-44 category. Her goal for this season was to win an award at the half-distance World Championships in Lahti, but a stress fracture put a damper on her plans for this summer.

What fascinates Jalasto about triathlon is the versatility of the sport. The training is varied, and there are always new areas to develop. 

- The sport is also surprisingly social, and the vibe in the community is lovely. Even though most competitions are individual, training and competitions are often done as a group, and people have found friends outside the sport, she adds. 

Making health a priority

Inflammatory bowel disease (IBD) mainly comprises two separate inflammatory conditions: Crohn's disease (CD) and ulcerative colitis (UC). Laura Jalasto was diagnosed with ulcerative colitis in October 2020. 

Ulcerative colitis is a chronic inflammatory bowel disease in which the lining of the large intestine becomes inflamed. The main symptoms of the disease are abdominal pain, bloody stools, and diarrhea. The condition may also be associated with extraintestinal complications such as joint and skin symptoms. The disease is characterized by both active and asymptomatic periods.

- My abdominal symptoms started unexpectedly in August 2020, initially just as a bout of unnecessary abdominal activity. After a couple of months, however, I also started having severe abdominal cramps. In October 2020, I was diagnosed with Ulcerative Colitis with an endoscopy, Jalasto says. 

Competitive sport is highly demanding. It requires intense training, a regular lifestyle, and a varied and healthy diet. If you suffer from a long-term illness, the list of demands becomes even longer. Taking care of your health becomes even more critical.

- The medications associated with IBD combined with intense training can predispose to vitamin and mineral deficiencies and create additional needs for certain nutrients, Jalasto reminds.

Studies show that malnutrition is, in fact, very prevalent within the IBD population. Literature has previously estimated this number to be almost one in four outpatients and nearly nine out of ten inpatients (3,4). This could be due to direct factors such as loss of normal resorptive mechanisms and higher nutritional requirements due to the inflammatory process. Particularly in CD, involvement of the small bowel can hinder the absorption of vital nutrients.

Jalasto admits that living with inflammatory bowel disease can pose both practical challenges to everyday life and additional demands on goal-oriented sport, depending on the stage of the disease. 

- However, if the disease can be balanced with medication. By listening to your body, and taking a holistic approach to your health, in most cases, you can live a nearly normal life with inflammatory bowel disease and even be active in sports with ambition. 

The gut starts from the mouth 

Teeth supporting tissue, or periodontal tissue, can become inflamed similarly to the tissue that lines intestines in IBD. Scientists have, in fact, proposed that treating periodontitis impacts the management of IBD positively. 

According to Tommi Pätilä, cardiac and transplant surgeon at the New Children's Hospital at HUS, bowel diseases, such as colitis and Crohn's disease, often appear together with severe gum diseases, such as periodontitis or peri-implantitis. 

- Not surprisingly, because the gut can be seen as a long, twisting tube that starts from the mouth and has bacteria present all along the way. In both diseases there is a strong overreaction of the immune system against a theoretically relatively mild bacterial trigger. Practically, the immune system attacks one's own body, Pätilä says. 

Laura Jalasto has acknowledged the importance of oral health to her IBD. She is also aware of the risks that intense training puts on her oral health. 

Active training requires sufficient energy to pass through the mouth. This in turn can be reflected in the number of times you eat. In addition, heavy breathing during hard training sessions reduces oral saliva secretion and dries out the athlete's mouth. Saliva naturally provides good protection for the teeth. When this is no longer present, bacteria can enter the mouth to form caries.

Jalasto’s oral care routine includes brushing her teeth every morning and evening and using Lumoral twice weekly to help achieve and maintain optimal oral health. 

The Lumoral teeth cleaning method improves dental self-care and oral health even when traditional methods fail. Lumoral is a new oral hygiene method developed by Finnish researchers that can remove 99.99% of plaque bacteria from the surface of teeth. Lumoral is a targeted treatment, which means that the normal, important bacterial flora of the mouth is preserved. At the same time, gingivitis is treated.

References:

1. Chandan, J., Thomas, T. Inflammatory bowel disease and oral health. BDJ Team 4, 17083 (2017). https://doi.org/10.1038/bdjteam.2017.83
2. Chandan, J., Thomas, T. Inflammatory bowel disease and oral health. BDJ Team 4, 17083 (2017). https://doi.org/10.1038/bdjteam.2017.83
3. Li S, Ney M, Eslamparast T, Vandermeer B, Ismond KP, Kroeker K, Halloran B, Raman M, Tandon P. Systematic review of nutrition screening and assessment in inflammatory bowel disease. World J Gastroenterol. 2019 Jul 28;25(28):3823-3837. doi: 10.3748/wjg.v25.i28.3823. 
4. Scaldaferri F, Pizzoferrato M, Lopetuso LR, Musca T, Ingravalle F, Sicignano LL, Mentella M, Miggiano G, Mele MC, Gaetani E, Graziani C, Petito V, Cammarota G, Marzetti E, Martone A, Landi F, Gasbarrini A. Nutrition and IBD: Malnutrition and/or Sarcopenia? A Practical Guide. Gastroenterol Res Pract. 2017;2017:8646495. doi: 10.1155/2017/8646495

World Digestive Health Day on 29 May

World Digestive Health Day is celebrated every year on 29 May. Each year World Digestive Health Day marks the start of a one-year-long campaign that focuses on raising public and professional awareness of a particular digestive disease or disorder.

The campaign for 2023 is entitled "A Healthy Gut from the Start.” From birth, the GI tract serves to provide nutrients to our bodies, enhance the immune response, house the intestinal microbiota, and serve as a "second brain" with the brain-gut axis.