I. Stephen Brown, DDS
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Oral Conditions Associated with COVID-19

Wednesday, December 30th, 2020

The general public associates COVID-19 with respiratory symptoms, such as difficulty breathing and a dry persistent cough. But the virus has been found in virtually every part of the body, including the mouth.

Recently, new data emerged from clinical practice showing that COVID-19 also has a deleterious effect on the oral cavity, causing a host of clinically significant symptoms. Dentists are noticing that patients with “long COVID-19” are experiencing tooth loss, greying gums, and tooth cracking alongside at a higher rate than usual.

For many, the question is why the disease appears to affect oral tissue so severely. So far, evidence suggests that it relates to the preponderance of ACE-2 receptors in the mouth targeted by the SARS-CoV-2 virus. The salivary glands, tonsils, and tongue carry more of the specific RNA-linked proteins that the coronavirus requires to infect cells, including specific enzymes that make it easier for it to penetrate the cell wall.

As a consequence, dentists are seeing more oral manifestations associated with COVID-19. Here’s a rundown.

Taste And Smell Loss

Loss of taste and smell were among the first identified symptoms of COVID-19. Doctors noticed that case-patients who tested positive would lose these senses early on, especially if their other symptoms were mild. Estimates suggest that the average prevalence of loss of taste among cases is around 38 percent.

The cause of loss of taste and smell in COVID-19 was originally thought to be the viral invasion of facial nerve cells. However, more recent studies cast doubt on that idea because of the absence of ACE-2 receptors in these tissues. Now the theory is that the virus infects susceptible cells surrounding the oral and nasal nervous system and this causes inflammation which then impacts patients’ sense capacities.

Cracked Teeth

Before the virus, the typical dentist might see one cracked tooth every other day. But with the onset of the pandemic, the number of patients with fractured teeth has risen significantly. Two visits per day are now the norm.

Dentists don’t believe that the virus is weakening teeth (although this remains a possibility). Instead, the current theory is that the stress of the pandemic is leading to more teeth grinding which, in turn, is leading to higher-than-usual levels of damage to dentition. COVID-19, looting, rioting, politics, and the general state of the nation has everyone on edge and unconscious bruxing is rising.

Gingival Tissue Breakdown And Oral Ulcerations

Evidence suggests that COVID-19 damages blood vessels across the body, including those that supply the mouth. And this could be leading to an increase in gingival breakdown and oral ulcerations.

The Angiogenesis Foundation – a group that works to uncover the mechanisms of cardiovascular disease – believes that the endothelial cells that line blood vessels are susceptible to SARS-CoV-2 because they carry the ACE-2 receptor. When the virus penetrates them, it damages them, depriving downstream areas of the body of oxygen. In the mouth, this process manifests as ulcerations and dying gum tissue. Generalized COVID-19-induced inflammation compounds the damage, worsening symptoms.

Dry Mouth

Pre-pandemic, dry mouth, or xerostomia, was a condition that dentists saw mainly in the elderly and smokers. Both age and tobacco use damage the salivary glands that keep the oral cavity moist. However, since the advent of the COVID-19 pandemic, more patients than usual are presenting with the condition.

Dry mouth is problematic because it causes bad breath and increases the rate of both cavities and oral infections. Saliva plays a vital role in the mouth, clearing away microbes and providing mild antiseptic action. When it is absent, the rate of oral health issues increases.

COVID-19 may be leading to an epidemic of dry mouth because of frequent mask use. Mouth breathing, evidence suggests, desiccates oral tissues, leading to halitosis and an increase in unhealthy bacteria.

Direct assault by the virus of salivary glands is a secondary mechanism. Data suggest that SARS-CoV-2 can enter salivary cells via the ACE-2 receptor, damage them, and cause them to produce less saliva than usual.

At present, the relationship between xerostomia and COVID-19 is poorly understood. Clinicians require more research to identify the causal mechanisms underlying the correlation. However, the rise in the prevalence of the condition is worrying for some, since in normal practice, dry mouth leads to an increase in both candida infection and caries.

Gingival Inflammation

Gingival inflammation typically occurs when bacteria in the oral cavity damage the gumline. Patients who fail to brush their teeth, for instance, often experience gum bleeding and damage to superficial tissues. And these problems get worse, the longer the oral hygiene hiatus lasts. However, many COVID-19 patients with excellent oral health practices are also experiencing gum problems.

Cytokines and interleukins – inflammatory signaling compounds – direct the immune system to target tissues afflicted by the SARS-CoV-2 virus, leading to redness and swelling. Since inflammation occurs across the whole body, it also adversely affects tissues in the mouth. And this, many researchers believe, is behind the rise of gingival inflammation.

Some patients experience severe inflammatory signaling dysregulation during COVID-19. Here, the body produces an abundance of cytokines and interleukins, inducing a “cytokine storm” as it attempts to direct the immune system to fight infection in multiple tissues. In small doses, inflammatory signaling compounds are helpful and marshal the body’s response to external threats. But in high quantities, they can be very damaging.

Regular periodontal disease causes elevated cytokine levels. Now evidence is emerging that the condition could also be contributing to cases where patients experience a cytokine storm, making the overall course of the disease worse.

Schedule An Appointment

The COVID-19 pandemic has been challenging for everyone. But it is also leading to a new raft of oral health problems.

If you’re concerned about your teeth and gums and would like a consultation, please schedule an appointment with Philadelphia Periodontist Dr. I. Stephen Brown. Solve any problems you may have and get peace of mind today!

Pathogens Contributing to Oral Cancer

Friday, October 30th, 2020


A new study posted in last month’s issue of PLOS Pathogens (1) by Yvonne Kapila of the University of California, San Francisco, has determined that pathogens surrounding the teeth are a leading contributor to a highly aggressive form of Oral Squamous cell Carcinoma (OSCC), commonly known as oral cancer. As a result, regular oral cancer screenings are advised to high-risk patients including tobacco smokers and regular alcohol consumers and should be incorporated as part of a good oral health routine.

Dr. I. Stephen Brown and The Perio Group team offer oral cancer screenings alongside a wide range of dental treatments to identify early signs of oral malignancies and select the right treatment for patients that are found to have the oral disease that can be closely linked to pathogens within the oral cavity.

What is oral cancer?

Oral cancer, also known as mouth cancer, is a term that describes any cancer that develops in the mouth or at the back of the throat. While several forms of oral cancer exist, over 90% of all oral cancers are defined as Oral Squamous Cell carcinoma (OSCC). This occurs when the fish-scale looking squamous cells found on the skin surface tissues are mutated. It can start out as any of the following, before spreading to other parts of the body;

  • Buccal mucosa cancer,
  • Floor of mouth cancer,
  • Gum cancer,
  • Hard palate cancer,
  • Lip cancer,
  • Tongue cancer.

Less common forms of mouth cancer include Oral Verrucous Carcinoma and Oral Melanoma, which can develop in the pigment-producing cells within any part of the oral cavity. When diagnosed early, the five-year survival rate of oral cancer is 84% (2). However, this rate does fall significantly if the cancer is allowed to spread. An oral cancer screening with Dr. Brown and his team will help you stay in control of the situation.

Pathogens causing oral cancer

Pathogens are any organism that can cause a disease. In relation to oral health, this may cover viruses, bacteria, and various other microorganisms. Unfortunately, this issue often goes unnoticed by patients due to a lack of pain while visible changes may be hard to spot due to their location too. This is one of the reasons that, in addition to the 9,750 annual deaths, oral cancer patients are up to 20 times (3) more likely to develop a secondary cancer.

While risk factors do extend to smoking, alcohol consumption, and human papilloma virus infection, Kapila’s study into the impact of periodontal pathogens in the development, progression and metastasis of OSCC tumors has been quite conclusive. It identified three oral pathogens as problematic for cell migration, invasion, and tumor growth. They are;

  • Porphyromonas gingivalis,
  • Treponema denticola,
  • Fusobacterium nucleatum.

The studies conducted on mice analyzed mediation through two pathways, integrin/FAK, and TLR/MyDD88, and determined that processes were inhibited by treatment with the nisin bacteriocin while also indicating its therapeutic potential as an antimicrobial and anticancer agent, which could subsequently inhibit the pathogen-mediated cancer formation.

It is suggested that the findings of Kapila’s study could alter the future of oral cancer treatment, with a greater focus on antimicrobial-based therapies. In turn, it may hold the key to finally unlocking an increased rate of five-year survival after decades of hovering around the 55% mark across patients of all oral cancers and stages. Crucially, an increased understanding of the role that pathogens play can further boost the impact of oral cancer screenings.

Diagnosing mouth cancer with oral screenings

The statistics are pretty clear regarding the importance of finding oral cancer at the earliest stage. It will boost survival rates from the initial cancer while simultaneously reducing the threat of developing secondary cancers. A professional screening with Dr. Brown can look for the presence of pathogens on the tissues surrounding the teeth, as well as other oral cancer symptoms, including lumps and various types of cell degeneration.

Comprehensive oral cancer screenings cover a wide range of factors to test all potential cancer sources.

Extraoral screenings

External examinations will include checking the entire face for a range of issues, such as;

  • Asymmetry,
  • Masses,
  • Swelling,
  • Discoloration,
  • Pigmented skin.

Further steps will include checking the eyes for swelling during movement, analyzing the nasal passages and the neck. The thyroid and lips will additionally undergo screenings.

Intraoral cavity examination

Internal examinations of oral cavities will include visual inspections in which Dr. Brown will use a gloved hand to move the tongue and gain visible access to the tongue, hard and soft palate, tonsils, floor of mouth, and buccal mucosa as well as the tissues surrounding the teeth.

Each part of the examination will look for different signs of oral cancer, which could include;

  • Swelling,
  • Discoloration,
  • Lumps,
  • Lesions,
  • Ulcerations,
  • Other abnormalities.

The examinations will be conducted using various dental appliances that allow for even greater visibility, including a gauze and added light. The examination should only take a few minutes to complete while Dr. Brown ensures a comfortable and safe setting for all patients.

In addition to examining your mouth for signs of cancer, the oral screening can look for additional oral health conditions while also checking your overall oral health. Following the examinations, then, you may be provided helpful advice on how to stay on top of your oral health and reduce the likelihood of getting oral cancer in the future (such as quitting smoking), which makes it a useful procedure even if it is found that no symptoms are present.

Contact Dr. Brown to arrange an oral cancer screening today

Have you noticed changes to your oral health, or wish to gain peace of mind by ruling out the development of oral cancer? If so, contact us to arrange your oral cancer screening today! The Perio Group proudly provides a safe dental practice that has been adapted to meet COVID-19 regulations to keep you protected while still providing the same high standards of dental care throughout every stage of your oral cancer screening. To find out more, including what steps we’ve taken, give us a call today!

The Different Types of Periodontal Disease in Children

Wednesday, April 17th, 2013

Hormonal changes related to puberty can put teens at greater risk for getting periodontal disease. During puberty, an increased level of hormones, such as progesterone and possibly estrogen, cause increased blood circulation to the gums. This may cause an increase in the gum’s sensitivity and lead to a greater reaction to any irritation, including food particles and plaque. During this time, the gums may become swollen, turn red and feel tender.

As a teen progresses through puberty, the tendency for the gums to swell in response to irritants will lessen. However, during puberty, it is very important to follow a good at-home dental hygiene regimen, including regular brushing and flossing, and regular dental care. In some cases, a dental professional may recommend periodontal therapy to help prevent damage to the tissues and bone surrounding the teeth.

3 Different Types of Periodontal Disease that Commonly Affect Children

Chronic gingivitis is common in children. It usually causes gum tissue to swell, turn red and bleed easily. Gingivitis is both preventable and treatable with a regular routine of brushing, flossing and professional dental care. However, left untreated, it can eventually advance to more serious forms of periodontal disease.

Aggressive periodontitis can affect young people who are otherwise healthy. Localized aggressive periodontitis is found in teenagers and young adults and mainly affects the first molars and incisors. It is characterized by the severe loss of alveolar bone, and ironically, patients generally form very little dental plaque or calculus.

Generalized aggressive periodontitis may begin around puberty and involve the entire mouth. It is marked by inflammation of the gums and heavy accumulations of plaque and calculus. Eventually it can cause the teeth to become loose.

To learn more about periodontal disease, or to set up an evaluation for your child today, please contact our Philadelphia dental office.

The Risk Factors of Gum Disease

Friday, April 12th, 2013

Gum disease is the leading cause of adult tooth loss. Fortunately, there are many factors that contribute to gum disease which we can control. In the ongoing fight against gum disease and for the protection of your overall health it is incredibly important to be aware of the following contributors to gum disease.

Clenching or Grinding Your Teeth

Clenching or grinding your teeth can put excess force on the supporting tissues of the teeth and could speed up the rate at which these periodontal tissues are destroyed.

Poor Nutrition and Obesity

A diet low in important nutrients can compromise the body’s immune system and make it harder for the body to fight off infection. Because periodontal disease begins as an infection, poor nutrition can worsen the condition of your gums. In addition, research has shown that obesity may increase the risk of periodontal disease.

Genetics

Research has indicated that some people may be genetically susceptible to gum disease. Despite aggressive oral care habits, these people may be more likely to develop periodontal disease. Identifying these people with a genetic test before they even show signs of the disease and getting them into early intervention treatment may help them keep their teeth for a lifetime.

Stress

Stress is linked to many serious conditions such as hypertension, cancer, and numerous other health problems. Stress also is a risk factor for periodontal disease. Research demonstrates that stress can make it more difficult for the body to fight off infection, including periodontal diseases.

Age

Studies indicate that older people have the highest rates of periodontal disease. Data from the Centers for Disease Control and Prevention indicates that over 70% of Americans 65 and older have periodontists.

Smoking/Tobacco Use

Tobacco use is linked with many serious illnesses such as cancer, lung disease and heart disease, as well as numerous other health problems. Tobacco users also are at increased risk for periodontal disease. Studies have shown that tobacco use may be one of the most significant risk factors in the development and progression of periodontal disease.

Medications

Some drugs, such as oral contraceptives, anti-depressants, and certain heart medicines, can affect your oral health. Just as you notify your pharmacist and other health care providers of all medicines you are taking and any changes in your overall health, you should also inform your dental care provider.

Other Systemic Diseases

Other systemic diseases that interfere with the body’s inflammatory system may worsen the condition of the gums. These include cardiovascular disease, diabetes, and rheumatoid arthritis.

 

Infection Control – Your Safety is Our Concern!

Wednesday, April 3rd, 2013

As you are probably aware, there is widespread news coverage involving the investigation of an Oklahoma oral surgeon for allegedly poor infection control practices.

I want you to assure you that in my periodontal and dental implant practice, we have in place significant infection control procedures.

– All staff are trained beyond state regulations, and undergo continuous infection control education and certification. We utilize hand washing, single use gloves, masks, eye ware, and gowns as necessary.

– We try to utilize disposable items, and after being used, they are placed in special containers for monitored disposal.

– Surgical instruments are cleaned and sterilized with a steam autoclave under heat and pressure. All items are bagged with chemical indicators and the autoclave is regularly spore tested to verify it is working correctly.

– We use sterile water and water that is distilled and treated on site. We also utilize water testing to check the water lines in the dental units.

– Before you enter the room and sit in the dental chair, all surfaces (dental chair, tray, dental light, handles, countertops care cleaned, disinfected, and plastic covers are placed as appropriate.

– Your well-being is the priority of my staff and me.

If you have any questions please call me at your earliest convenience so I can get you an answer.

Sincerely,

I. Stephen Brown, DDS, FACD, FICD

Identifying the Main Causes of Tooth Loss

Tuesday, March 12th, 2013

Tooth loss is a traumatic experience, regardless of how it occurs. Teeth are a major part of our lives, from chewing the food we need to digest, to enhancing a smile with a strong showing of self-confidence. While it can be a very hard time in your life, the exciting news is that modern day advanced dentistry allows you several options when considering the replacement of missing teeth.

 

Dental (Periodontal) Diseases

Periodontal diseases are regarded as the most common cause of tooth loss today. The word periodontal means around the tooth, signifying the typical location of the infection.

There are many key factors that contribute to periodontal disease, most specifically daily habits that would affect the teeth. To be more specific, the disease is caused by bacteria that, along with mucus and other particles, form plaque on our teeth. While daily cleaning of our teeth such as brushing or flossing helps remove plaque, it does not remove plaque that has hardened into tartar. While it’s true that a professional cleaning done by a dentist or hygienist can remove tartar, there is still a risk to your health if tartar is prevalent for too long.

Traditional treatment for periodontal disease requires blade surgery, extensive recovery time, and often leaves patients with scarring in the tissue affected. Dr. Brown is proud to offer the use of LANAP, a non-invasive laser gum treatment which serves as an alternative to traditional periodontal surgery.

To read more about periodontal disease, visit the section of our website dedicated to identifying and solving dental disease.

Trauma

Odds are high that you have experienced trauma to a tooth in your lifetime. Whether it’s from a sports incident when younger, or an accidental misplacement of your feet, any blunt force to the teeth often result in chipping or breaking off a tooth.

While trauma usually indicates a direct effect to the teeth itself, it can also mean as a result of outside influences affecting the jawbone, or other areas around the teeth. Individuals who have had defects of the jaw bone, such as following surgery or in an automobile accident, often require surgery to repair loss of jaw bone volume, which is often compounded with tooth replacement.

To learn more about how Dr. Brown helps individuals with tooth loss, visit the dental implants subsection of our website.

Congenital absence

The primary cause of congenital absence of teeth is widely debated, but is often agreed upon as being hereditary. How it comes to be is typically after a baby tooth falls out and there is no tooth to replace it. The teeth most often affected are the upper jaw lateral incisors and premolars.

You’ll often find that it is specific teeth affected by congenital absence, but in certain cases all permanent teeth are missing, making a full set of replacement teeth the solution.

 

Conclusion

There are many causes for missing teeth, but that doesn’t mean you have to live your life without them. It’s recommended to take steps to prevent teeth from falling out, but in the event of missing teeth, feel free to contact my Philadelphia office to discuss your options.

 

Dr. Brown Addresses Dental Anxiety

Monday, November 12th, 2012

Perhaps there is no other healthcare profession like dentistry that has the unfortunate (and false) reputation causing pain rather than preventing or eliminating it. For all the good that dentists do to improve our well-being, there are many patients with fears about sitting in the dentist’s chair. But whatever the reasons, there are countless people (young an old), who have dental anxiety.

For your teeth’s sake, there are ways to combat dental anxiety, a condition sure to cause cavities. If positive reinforcement, learning to control fear and other behavior management techniques don’t do the trick, dental sedation could ease your mind and allow you to get your teeth cleaned.

What would it be like to snooze through your dental appointment and not even remember that you were here?

It sounds like it comes from the dream book of every anxious dental patient and yet it is here. Today with just a few small pills it is possible to have safe, comfortable dental care while you snooze. Not awake, yet not asleep. No intravenous needles. No general anesthesia. No anxiety, No pain.

Sedation can occur through inhalation (nitrous oxide aka laughing gas), intravenously or orally through a pill or liquid. All of these are safe and can address most forms of dental anxiety by allowing you to get dental work done and simultaneously relieving the anxiety you feel inside.

Usually these forms of sedation are used in combination with a local anesthetic (Novocaine), to insure maximum comfort. These methods relieve stress and allow you to have a healthy smile without all of the worry.

Other dental and medical professionals, with whom I have discussed this approach, leave our office amazed that such a gentle and safe method could accomplish so much. They observe first hand, an extremely nervous patient go for a snooze and have all of their dentistry done painlessly. This method is especially suited for having most of your necessary dental procedures done in a minimum number of visits.

If you, or anyone who you care about, family of friends, would like to have any dental care done while snoozing, we would be glad to help. Our whole staff has been expertly trained to make your dental visits easy and comfortable.

Our team is unconditionally committed to providing your dental needs in a nurturing, caring and stress and anxiety free manner. Your comfort is our “Job Number One!”

A Confident Smile Can Change Your Day!

Thursday, October 25th, 2012

Give them a smile: a happy, friendly, and genuine smile. Go ahead, flash it; its contagious, it’s infectious, it’s the universal expression of happiness.  A simple smile can change someone’s day.

Some people are a little nervous about smiling. They don’t think their smile looks good, or they think that too much smiling might look unprofessional or signal vulnerability. No matter how professional, intelligent, or “together” you think a serious face appears; people almost always respond more favorably to a smile. A great smile can be your greatest personal asset.

We all know of someone who has an “infectious” smile.  Infectious smiles always start with confidence.  If you’re not 100% confident in your smile, we’re here to help. “Smile Makeovers” are our specialty at The Perio Group.

While our first concern is keeping your teeth and gums as healthy as possible, we have the tools and the training to provide you with an enhanced smile that gives you confidence and one you’re excited to share with others.

Would you like to make a dramatic improvement in your appearance without taking any extreme measures? A smile makeover can provide you with a straight, even and exceptionally bright smile that feels as great as it looks.

A smile makeover takes into consideration your facial appearance, skin tone, hair color, teeth (color, width, length, shape and tooth display), gum tissue and lips to develop your ideal smile. Smile makeovers are performed for many reasons and customized according to your unique considerations.

A beautiful smile is an asset beyond measure. White, well-shaped teeth will make you look fantastic, feel better about yourself, and show others the real you. Complete smile makeovers change patients’ appearances and lives!

We’re more than happy to discuss the many options available to help you achieve a smile worth sharing and a smile that will change someone’s day, including your own.

Can My Headaches Be Caused By My Teeth?

Monday, October 22nd, 2012

People who experience recurrent headaches are often diagnosed as having TMJ Dysfunction. TMJ is an umbrella term which refers to acute or chronic inflammation of the Temporomandibular Joint, which connects the mandible (lower jaw) to the skull. The disorder and altered function that often accompanies it can result in significant pain and impairment. These problems often include jaw joint pain, clicking, dislocation, chronic headaches, sinus problems and even loss of hearing.

What Causes TMD?

The cause of TMJ Dysfunction is not clear, but dentists believe that symptoms arise from problems with the muscles of the jaw or with the parts of the joint itself.

Injury to the jaw, temporomandibular joint, or muscles of the head and neck – such as from a heavy blow or whiplash – can cause TMD. Other possible causes include:

 

 

Some common symptoms of TMD include toothaches, headaches, neck aches, dizziness, earaches, hearing problems, upper shoulder pain, and ringing in the ears (tinnitis).

A study headed by a well-respected researcher from the University at Buffalo’s School of Dental Medicine, showed that examiners could reproduce tension-headaches in eighty- two percent of subjects, by performing a comprehensive clinical examination, including palpation of the temporalis muscle, one of the key chewing muscles involved in TMJ Disorder.

Diagnosis for TMJ requires an examination by a physician or dentist who has advanced training and expertise in the area of head and neck pain.

If you experience any of the symptoms such as those listed in this article, you may be just an appointment away from being headache and pain free. Call us for a comprehensive examination. We can assist you in finding relief from these vexing symptoms.

Some worthwhile links you may want to use:

http://www.nlm.nih.gov/medlineplus/ency/article/001227.htm

http://www.mayoclinic.com/health/tmj-disorders/DS00355/DSECTION=symptoms

Are There Links Between Gum Disease and Cardiovascular Disease?

Monday, October 15th, 2012

Researchers may be one step closer to establishing a link between periodontal disease and cardiovascular disease (CVD) – the number one cause of death worldwide.

These investigators report that older adults who have higher proportions of four periodontal-disease-causing bacteria inhabiting their mouths also tend to have thicker carotid arteries, a strong predictor of stroke and heart attack. The study, published in the journal Circulation, was supported by four agencies of the National Institutes of Health.

While current research does not yet provide evidence of a causal relationship between the two diseases, scientists have identified biologic factors, such as chronic inflammation, that independently link periodontal disease to the development or progression of cardiovascular disease.

According to the authors, these data mark the first report of a direct association between cardiovascular disease and bacteria involved in periodontal disease, inflammation of the gums that affects to varying degrees an estimated 200 million Americans.

Periodontal disease is characterized by bacterial growth and production of factors that gradually destroy the tissue surrounding and supporting the teeth. Some symptoms may include gums that are swollen or tender, receding gums or persistent bad breath.

According to a recent study in the New England Journal of Medicine, periodontal disease contributes to blood vessel dysfunction, which was improved by an intensive regimen of periodontal treatment.

Currently, more than one in three Americans over age 30 has some form of Periodontitis, according to the American Academy of Periodontology. Recent statistics have  estimated that the prevalence of moderate to advanced gum disease may be as high as 50% of adults in the US.

If you are concerned about the health of your gums and teeth, call today to schedule an appointment with a highly-trained periodontist. We can provide you with a thorough periodontal examination, from which we can make an assessment of your cardiovascular risk potential, associated with Periodontal Diseases.

 

Some worthwhile Links you may want to use:

http://www.perio.org/consumer/heart_disease

http://www.perio.org/consumer/AHA-statement